Obesity has reached epidemic proportions in India in the 21st century. Sedentary life style and unhealthy food habits being a major causative factors, resulting in many serious systemic complications like Diabetes, Heart disease etc. Udvartana is commonly practiced and this therapy explained to be Kaphahara and Meda Pravilayana property. Asana is the first step of Hatayoga. One should practice Asanas to obtain Sthairya, Arogya and Laghuthva. Sthoulya is one such disease where Asanas are useful in reducing the weight and their complications. A Comparative clinical Study of 40 patients suffering from Sthaulya were selected after thorough history taking, clinical assessment and laboratory investigations. Patients were subjected to Udvartana using in Shaileyadi Churna, Group A and Udvartana with Shaileyadi churna and Asanas in Group B for a period of 14 days where in the procedure was carried out daily for 45 min

Dr. Gururaja H.

Dr. Sarvjeet Singh

Mrs. Jyothsna Bhat

English

Journal of Ayurveda and Integrated Medical Sciences (JAIMS)

                                                      ORIGINAL ARTICLE Sept-Oct 2019  Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct  2019 | Vol. 4 | Issue 5 51  A comparative clinical study on Udvartana with Shaileyadi Churna and Yoga Asanas in Sthaulya Dr. Sarvjeet Singh1, Dr. Gururaja H.2, Mrs. Jyothsna Bhat3 1Post Graduate Scholar, 2Professor & HOD, Dept. of PG Studies in Panchakarma, 3Lecturer (M.sc. Yoga), Muniyal Institute of Ayurveda Medical Sciences, Manipal, Karnataka, INDIA.                   INTRODUCTION Obesity has reached epidemic proportions in India in the 21st century. Sedentary life style and unhealthy food habits being a major causative factors, resulting in many serious systemic complications like Diabetes, Heart disease etc.[1] However, it has been estimated to affect 20 to 40% of the adults and 10 to 20%of children and adolescents in developed countries.[3] WHO began sounding the alarm in the 1990s, guiding a series of expert and technical consultation. Public awareness  campaigns were also initiated to sensitize Address for correspondence:  Dr. Sarvjeet Singh Post Graduate Scholar, Dept. of PG Studies in Panchakarma,  Muniyal Institute of Ayurveda Medical Sciences, Manipal, Karnataka, INDIA. E-mail: drsarvjeets@gmail.com  Submission Date: 08/09/2019 Accepted Date: 15/10/2019 Access this article online Quick Response Code Website: www.jaims.in  DOI: 10.21760/jaims.4.5.10 policy makers, private sector partners, medical professionals and the public at large to aware that obesity is predominantly a “social and environmental disease.[2] In Ayurveda it is explained as Sthaulya and Medoroga in all Samhitas. It is a Rasa Nimittaja and more so a Santarpanajanya Vyadhi. Its Nidana, Samprapti, Lakshana, Upadravas are  mentioned in detail.[3] Elaborative description of Chikitsa is also done by the Acharyas. Mainly it includes Shodhana and Shamana type of treatments. Among them Udvartana Karma which is having Kaphahara and Medohara property, is used frequently with  Rookshana Dravyas. In this Karma powder of drugs is massaged against the hair follicles.[4] In this study Shaileyadi Churna having Rookshana, Laghu and Tridoshahara property is selected for Udvartana.[5] Ayurveda explained about Vyayama in the context of Dinacharya. Vyayama is defined as Visheshaayama of body that is attaining specific posture where in toughness and mobility of body parts are attained. Asana is the first step of Hatayoga. One should A B S T R A C T  Obesity has reached epidemic proportions in India in the 21st century. Sedentary life style and unhealthy food habits being a major causative factors, resulting in many serious systemic complications like Diabetes, Heart disease etc. Udvartana is commonly practiced and this therapy explained to be Kaphahara and Meda Pravilayana property. Asana is the first step of Hatayoga. One should practice Asanas to obtain Sthairya, Arogya and Laghuthva. Sthoulya is one such disease where Asanas are useful in reducing the weight and their complications. A Comparative clinical Study of 40 patients suffering from Sthaulya were selected after thorough history taking, clinical assessment and laboratory investigations. Patients were subjected to Udvartana using in Shaileyadi Churna, Group A and Udvartana with Shaileyadi churna and Asanas in Group B for a period of 14 days where in the procedure was carried out daily for 45 min. Key words: Asanas, Obesity, Sthaulya, Shaileyadi Churna, Udvartana. Dr. Sarvjeet Singh et al. A comparative clinical study on Sthaulya ISSN: 2456-3110                                                   ORIGINAL ARTICLE Sept-Oct 2019  Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct  2019 | Vol. 4 | Issue 5 52  practice Asana’s to obtain Sthairya, Arogya and Laghuthva.[6] Many Asanas have been explained in various books with successful practise all around the globe. They are effective and easily practised in most of the life style disorders. Sthoulya is one such disease where Asanas are useful in reducing the weight and their complications.[7] Hence a study is planned to evaluate the effect of Udvarthana with Shaileyadi Churna and Asana in Sthoulya. MATERIALS AND METHODS Source of Data 40 Patients suffering of Sthoulya were selected from Department of Panchakarma OPD and IPD of Muniyal Institute of Ayurveda Medical Sciences by preset inclusion and exclusion criteria. Method of collection of the data A special proforma was prepared incorporating all points of history taking, physical signs and symptoms of Sthaulya and lab investigations. Accordingly, the patients were selected and were subjected to a detailed clinical history and complete examination. Two group with 20 patients each will be randomly selected from above date. Study Design: This was a comparative clinical study.   Diagnostic criteria  Pratyatma Lakshana of Sthaulya presenting with symptoms like Chalasphik, Udara and Stana, lack of Utsaha, Svasa, Atinidra, Svedabadha, Daurgandhya, Atipipasa, Atiksudha, Alpavyavaya, Gatrasada.  Value of BMI. Inclusion Criteria  Patient  aged of above 18 and below 60.  Having BMI in between 27 to 33.  Patient presenting with “Pratyatmaka Lakshana” of Sthaulya as explained in classics. Exclusion Criteria  Patient having age of above 60 and below 18.  Patient having Eczema, Psoriasis, Cuts, Burns, wounds, Pregnant women.  Having BMI value above 33. Assessment Criteria 1. Chala Sphik Udara 2. Kshudra Svasa 3. Nidradhikya  4. Ati-Kshudha 5. Daurgandhya  Intervention  The simple procedure of massaging the whole body below neck with dry powder of Shaileyadi Churna in Group A  with it mixing of Dhatura Patra Swarasa and Lepa will be done on whole body. The Lepa is left to dry for few minutes . Massaging will be done opposite to the orientation of hair in the 7 postures of  body. The duration of the procedure is 45 minutes and carried out for 14 days. Soon after the procedure patient is asked to take rest for about 15 minutes and then allowed to take bath.  1. Sitting  - 5 min 2. Supine  - 10 min 3. Left lateral  - 5 min 4. Dorsal  - 5 min  5. Right lateral - 5 min 6. Supine  - 10 min 7. Sitting   - 5 min In group B Just after Udwartana Karma patient allow to take rest for 15 minutes then advised to do these Asanas.  Asanas Session of nine Asanas Yogic postures in sitting, standing, lying down, lying down on abdomen, forward bending will be conducted and all the Asanas will be done for five minutes for a total duration of 45 minutes. These are the Asanas. 1. Trikonasna Dr. Sarvjeet Singh et al. A comparative clinical study on Sthaulya ISSN: 2456-3110                                                   ORIGINAL ARTICLE Sept-Oct 2019  Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct  2019 | Vol. 4 | Issue 5 53  2. Parsvakonasana                       3. Paripoorna Navasana          4. Virabhadrasana 5. Padahastasana 6. Dhanurasana    7. Jathara Parivartasana 8. Urdhva Prasarita Padasana 9. Janu Sirsana RESULT Table 1: Objective parameters overall effect of Group A on 20 patients of Sthoulya. Total Effect Percentage No of Pts % Cured 100% 0 0 Markedly Improved 76-99% 0 0% Moderately Improved 51-75% 7 35% Improved 26-50% 9 45% Unchanged <25% 4 20% Table 2: Objective parameters overall effect of Group B on 20 patients of  Sthaulya. Total Effect  Percentage No of Pts % Cured 100% 0 0 Markedly Improved 76-99% 1 5% Moderately Improved 51-75% 6 30% Improved 26-50% 9 45% Unchanged <25% 4 20% DISCUSSION Sthaulya is considered as a burning problem of todays era caused due to sedentary life style, unwholesome food habits, lack of physical exercise, mental stress etc. factors. Its importance lies in the fact that it is the doorway to other major health complications. The Sthaulya was discussed with great importance since Vedic period itself, the references of Sthaulya could be seen in Ayurvedic classics like Bruhatrayees and Laghutrayees. It was considered as one among the Astamahagadas. The management of this condition also seeks great importance.As an aid to this,the present study had been selected. Obesity Sthaulya was refered to as Obesity in this context as the symptomatology, complications etc. of Obesity is very similar to Sthaulya. The final result was drawn based on assessment of individual patients on various parameters and then finally inferences were drawn considering relevant statistical methods  are presented here. Discussion on effect of Treatment The assessments of results were made by adopting the standard methods of scoring and the signs and symptoms of Sthaulya. Effect of treatment on Chala SphikUdara , Kshudra Svasa, Nidradhikya, Ati-Kshudha, Ksudrasvasa and Daurgandhya  Absolutely no much improvement was found in both the groups. As the total duration of the treatment is only 14 days. This treatment modality with longer duration with internal medicines may give much better results. Probable mode of  action Udvartana is having the Gunas of Kapha-Meda Vilayana property. Due to Ushna and Teekshna Guna of Dravya and forceful massage effect on Romakupa, the Veerya of drug enters into body through, there after it opens the Mukha of Siras, thereby making Paka of Kapha and Medas. Due to this, there will be Dravata Vriddhi of Kapha and Medas occurs, which is present in Abaddha form so it helps to proper formation of Medas. It also helps to remove the Avarodha which is an important factor to get rid of Sthaulya.  Dr. Sarvjeet Singh et al. A comparative clinical study on Sthaulya ISSN: 2456-3110                                                   ORIGINAL ARTICLE Sept-Oct 2019  Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct  2019 | Vol. 4 | Issue 5 54  Twak Prasadakara: By performing Udvartana, the amount of blood circulation beneath the skin increases due to friction. Due to this change the cells of the skin are supplied with more oxygen, there by changing the colour at least to some extent. In all 40 patients the investigator had observed no changes with respect to their skin colour, but if this procedure is conducted as a routine practices or in the form of Utsadana there are chances to prove above hypothesis. Anga Sthirikarana: By performing Udvarthana fat cells get lipolysed then the cells get shrunken causing compactness. Thus one can appreciate the above benefit. Gauravahara: Gaurava is feature due to increase in Kapha and Medas. Udvartana is having the Gunas of Kapha – Meda Vilayana property for Gauravahara. Tandrahara: Tandra is due to Tamo Guna, which is increased by Vikruta Kapha. Udvarthana will reduce Kapha, hence relieves Tandra. All the patients who received Udvarthana got this benefit. Kanduhara: One of the reasons for Kandu is obstruction in the Swedavaha Srotas. As Udvarthana clears the orifices of Swedavaha Srotas by its Sira Mukha Vishodhana Guna, it reduces itching. Vatahara: In Sthaulya, Medas and Kapha obstruct Vata. Udvarthana reduces Kapha and Medas and thereby normalizing the movement of Vata. Rubbing Rubbing helps in the absorption of effusions, relief of blood stasis and carrying away the morbid products in the system. Deep pressure massage helps the interchange of tissue fluids by increasing the circulation in the superficial veins and lymphatics. The pressure helps the contents of the vessels move towards the heart, if applied strongly and quickly, it has a stimulating effect. It increases nutrition in all tissues. It removes fatigue, carrying away the increased products of combustion. Also it assists the re-absorption of serous fluid. The rubbing may be said to act both by pressure and by suction. Massage diminishes the blood pressure without increasing the activity of the heart. But the blood vessels are relaxed, distended and stretched by this. After a course of this treatment blood has been found to contain more red blood corpuscles and haemoglobin. These are not manufactured by rubbing, but bring them into circulation instead of them remaining dormant in the system. It influences the general metabolism when applied on large areas. The rubbing helps to breakdown thickening and adhesions in sub acute and chronic conditions. Also helps in the re-absorption of inflammatory products and absorption of fat in fatty tissues. Effects of Asanas in Group B These Asanas is an isotonic type of exercise it does not increase the tension but increases the metabolic rate. Dynamic stretches in forword and backword direction and rhythmic positive and negative pressure changes in viscera stimulate various viceroceptors. That is why all the systems work at optimum level. This increases the stamina and cardiovascular endurance. It mobilizes the stored or accumulated fat by increasing the blood circulation. So the weight loss and other objective, subjective parameter had seen good result in Group B compare to Group A. CONCLUSION The conclusion drawn from the scientific discussion on present study are as follows; Sthoulya is a Santarpana Janya Vikara having unique Samprapti. Madhura Rasa Bhojana and Avayama are the prime causative factors along with Beeja Dosha. Guru and Apatarpana is the line of treatment to conquer Teekshnagani and Medovruddi respectively. Vataghna and Shleshma Medohara Ahara Aushadhi, Rukshoshna Udvaratana are the modalities of Sthoulya. Among those Shailayadi Churna having rukshana and medohara effect is the best remedy for Sthoulya. The present study establishes that 14 days regular practice of  these Nine Asanas with Udvartana helped obese person to reduce their weight. Treatment response of all objective parameters were highly significant in Dr. Sarvjeet Singh et al. A comparative clinical study on Sthaulya ISSN: 2456-3110                                                   ORIGINAL ARTICLE Sept-Oct 2019  Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct  2019 | Vol. 4 | Issue 5 55  both the groups but compared to group A, group B has shown better results. Hence further continuation of the treatment is justified or else this study will pave way for more clinical trials in this regard with more prolonged course. REFERENCES 1. http://en.wikipedia.org/wiki/Obesity.in.Indiadated-27|03|2017. 2. http://WHO.int>nutrition>topicics>obesitydated-30|03|2017. 3. Madhava Nidanam of Madhavakara by Prof. K. R. Srikantha Murthy published by Chaukhamba Orientalia, Varanasi 2016,pg.121. 4. Acharya Vridha Vagbhatta, Astanga Samgraha, edited with saroj Hindi commentry by Ravi Dutt Tripathi, publishedby Chaukhamba sanskrit Pratishthana, Varanasi,UP, Edition2003, Sutrasthana,chap.3:63,pg50. 5. Bhavamishra, Bhavaprakasha edited with Vidyotini hindi commentary by Bhisagratna. Brhamasankar Mishra’, published by Chaukhambha Sanskrit Sansthan, Varanasi, UP, 11th Edition-2012, MadhyamaKhanda, chap.39, Medorogadhikara Pg.407. 6. Swami Muktibodhananda Hatha yoga pradipika published 2011.pg 67,82. 7. BKS. Iyengar forwarded by yehudi Menuhin, Light on yoga 2000, PG 66to74,111 to 112,237to 242.      *******************************  How to cite this article: Dr. Sarvjeet Singh, Dr. Gururaja H., Mrs. Jyothsna Bhat. A comparative clinical study on Udvartana with Shaileyadi Churna and Yoga Asanas in Sthaulya. J Ayurveda Integr Med Sci 2019;5:51-55. http://dx.doi.org/10.21760/jaims.4.5.10  Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2019 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 

A comparative clinical study on Udvartana with Shaileyadi Churna and Yoga Asanas in Sthaulya

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A comparative clinical study on Udvartana with Shaileyadi Churna and Yoga Asanas in Sthaulya

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