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Year - 2023Volume - 1Issue - 1Pages - 19-28

Measures Of Ayurveda For Management Of Sthaulya- A Critical Review

 14 Jul 2023  359

About Author

Deshmane D1,Dachewar D2,
1 PG Scholar, Department of Kayachikitsa, Shree Ayurved Mahavidyalay, Nagpur
2 Professor and HOD, Department of Kayachikitsa, Shree Ayurved Mahavidyalay, Nagpur

Correspondence Address

Dr. Smita Gangaram Deshmane
PG Scholar, Department of Kayachikitsa,
Shree Ayurved Mahavidyalay, Nagpur

Contact No. : , Email :

Date of Acceptance : 14 Jun 2023

Date of Publication : 10 Aug 2023

Article ID : SD-IJAY_029

How to cite this article : Deshmane S.G., Dachewar A.S.Measures of Ayurveda for Management of Sthaulya- A Critical Review. Sanjivani Darshan National Journal of Ayurveda & Yoga 2023;1(1):21-30 http://doi.org/10.55552/SDNJAY.2023.1104

Abstract

Obesity is a significant burden on global healthcare , among non communicable diseases. It is major global issues and emerging health problem in developing countries such as India. Body as well as mind might get affected by Obesity. Keeping this mind W.H.O. coined new term to this global epidemic has ‘Globesity’1.In Ayurveda, Sthaulya belong to Santarpanjanya Vyadhi2 and described by many Acharyas. In Ayurvedic text many drugs , medicinal preparations, Pathya-Apathya, Yogasana, and Dincharyaare described which have significant result in prevention and cure of this global issue. An effort has been made to understand obesity through Ayurvedic prospective and to find out the likely solutions of obesity through Ayurveda. This paper is an effort to understand Nidan(aetiology), its sign and symptoms, preventive methods like NidanParivarjan, therapeutic management along with medicine, Pathya-Apathya, non-pharmacological methods like exercise and yogic kriyas

KEYWORDS: Sthaulya, Pathya-Apathya, Santarpanjanya, Dincharya, Yogasana,

Introduction

Ayurveda is one of the most ancient medical science in the world. Lifestyle disorder can be very well prevented and managed through Ayurveda . In recent years Sthaulya has become burning health issue. One in every five Indian men and women is suffering from either overweight or obesity3. In Ayurveda Sthaulya is included under Ashtaunindita4 (Eight undesirable conditions), the KaphaNanatmaja, SantarpanaNimittaja, Ati-Bruhmana Nimittaja and Bahu Dosha janitVikara5. Shushrut mentioned Dhatavagnimandya ( Metabolic disturbances) as a reason of Sthaulya. Obesity is a multifactorial disease and  it may gives rise to high Cholesterol level, high Blood Pressure, Coronary heart disease, Heart failure, Diabetes Mellitus, certain types of Cancer, Endocrine abnormalities, and Obstetrics complication as well as it hampers the cosmetic value of the victim.6 Obesity is a concerning epidemic worldwide. According to study of National Family Health Survey ( NFHS-4-2015-2016), prevalence of obesity in India was 18.6% and 20.7% of men and women respectively7. Worldwide obesity has tripled since 1975. In 2016 more than 1.9 billion adults were overweight, of these 650 million were obese8.Obesity often results from intake of high caloric diet that is resulting in deposition of excessive fats.9Sthaulya is among one of the 8 unwanted diseases mentioned by Acharya Charaka. To correct vitiated Doshas and Agni through Ayurvedic treatment , NidanParivarjana, Shodhana, Shamana, PathyaAahar - Vihar and ApatarpanaChikitsa should be done. 

NIRUKATI:  

A person having heaviness and bulkiness of the body due to extensive growth especially in Udaradi region is termed as “Sthula” and the State (Bhava) of Sthula is called ‘Sthaulya’10.

Obesity comes from Latin word ‘Obesus’ meaning fat.

DEFINITION: 

Sthaulya is the term used to describe the condition where an individual's buttocks, tummy, and breast become pendulous due to excessive growth of Meda and Mansa Dhatu (Fat and Flesh) and they lack energy.11 Modern science defines obesity as an accumulation of extra body fat (adipose tissue) that is significant enough to harm one's health.

CLASSIFICATION :

Acharya Vaghbhat Sthaulya classified three categories – Adhik,Madhyam and Hina Sthaulya.12Vaghbat Classification can be correlate with modern science as given below.

  1. Hina Sthaulya (Underweight (B.M.I. 25-30kg/m2))                                                            

Without any secondary disease and complication

  1. Madhyam Sthaulya ( Obesity Class 1&2 (B.M.I.  30-40kg/m2 obese)

Without  any secondary disese but with least complication.

  1. Adhika Sthaulya( Severe Obese – B.M.I.>40 kg/ m2 – Very Obese) 

With secondary disease and complication.    

TYPES OF OBESITY :

According to Body Fat Distribution, there are two categories of obesity.

a) Central obesity - Increased fat deposition in the abdomen and the trunk. It carries a higher risk of developing various diseases than does generalized obesity.

b) Generalized Obesity—Excessive fat is diffusely accumulated in the subcutaneous tissue. 

ETIOPATHOGENESIS :

According  to Ayurveda ,

Due to the imbalance between the energy consumption in the diet and energy expenditure through exercise and bodily functions.

Nidana of Sthaulya is basically classified in four groups13

  1. AharajaNidana
  2. ViharajNidana
  3. MansikaNidana
  4. Beejadusti

AharatmakNidana

ViharatmakaNidana

Manasa

Nidana

Other

  1. Adhyasana (Eating when previous meal is not digested) 
  2. Atisampurana(binge eating)
  3. AtiBrimhana ( eating food high in calories)
  4. Guru Ahara (Food heavy to digest)

  1. Madhura Ahara        ( Excessive use of food sweet in taste)
  2. SnighdhaAhara (oily food)
  3. Sheeta(cold food)
  4. Navanna( recently harvested grain)
  5. Atianavmadyapan( excessive use of freshly prepared alcohol)
  6. Paya Vikara (milk and its product)
  7. Iksuvikara(sugarcane and its product)
  8. Guda(jaggery)

1 Avyayam (lack of physical exercise)

2 Avyavaya (lack of sexual intercourse)

3 Divaswapana (sleeping during day time)

4 Asana Sukha(long time siting)

5 Bhojanottarasnana(after taking food idle sitting) 

6 Swapanaprasangat (Excessive sleep)

7 Harshanitya (always being cheerful)

8 Priyadarshana(constantly seeing those things which are liked)

1 Achintana(no worries)

2 Manasonivritti (relaxation of the mind)

3 Saukhya (happiness) 

1 Intake of sweet substances by mother during pregnancy

2 Beejadosha (Defective genes)

3 Amarasa (Indigestion)

4 Singhda, Madhura bastisevena (enema which contain oily and sweet drugs)

5 Tail Abhyanga (oil massage)

6 SnigdhaUdavartana (powder massage with oily drugs) 

SYMPTOMS : 

Subjective symptoms 14

  • Increased hunger (Atikshudha)
  • Increased thirst (Atipipasa)
  • Perspiration (Atisweda)
  • Breathlessness (Atishwas)
  • Sleepiness (Atinidra)
  • Difficulty to perform heavy work (AayasAshamata)
  • Sluggishness (Jadata)
  • Short lifespan (Alpayu)
  • Decreased body strength (Alpabala)
  • Bad body odour (Dourgandhya)
  • Unclear voice ( Gadgada)

THE CARDINAL SYMPTOMS AND EIGHT – FOLD DOSHAS 

Cardinal Symptoms of Sthaulya15

Eight – fold Dosha of Sthaulya16

  • Medomamsaativruddhi(excessive accumulation of Meda and Mamsa
  • Chalasphik, Udara, Stana (flabby buttocks, abdomen, breasts due to excessive fat deposition)
  • Ayathopachaya – anutsaha (improperly formed Medodhatu causes  Utsahahaniin the individual)
  • Ayushohrasa (Shortening of lifespan)
  • Javoparodha (lack of interest in physical activity/sluggish movement)
  • Krichvyavaya(difficulty in sexual intercourse)
  • Dourbalya (weakness)
  • Dourgandhya (Unpleasent odour from the body )
  • SwedaAtipravrithi ( over sweating)
  • Kshudhatimatra ( to much hunger)
  • Pipasatiyoga(excessive thirst)

SAMPRAPTI :

Samprapti Chakra of Sthaulya according to AcharyaCharaka17Nidana(Madhura rasa, Avyayma, Diwaswapa)                 

 

Medo Dhatu Vriddhi (Meda Dhatu gets increased)

 

StrotoAvarodha by meda (All Strotas get Avarodhaby the meda)

 

Vataspecially confined to Koshthaand causes JatharagniVriddhi

Sthaulya

DIAGNOSIS :

 Specific criteria to measure obesity –

  1. Body Mass Index – It is defined as a person’s weight in kilograms divided by the square of his/her height in meters (Kg/m2

               BMI=  body weight(kg)

                           Height (m2)

According to WHO,

The International Classification of adult underweight, overweight and obesity according to BMI18

            Classification

BMI (KG/M2)

  1. Underweight

<18.50

  1. Normal range 

18.50-24.99

  1. Overweight

>25

  1. Pre-obese

25.00-29.99

  1. Obese

Obese class 1

Obese class 2

Obese class 3

30.00-34.99

35.00-39.99

>40.00

  1.  Age specific weight for height table
  2. Skinfold Measurement
  3. Waist / Hip ratio (>0.55)
  4. Lab Investigation -

                            Lipid Profile

                            Blood glucose

                            Blood Pressure

 PRINCIPLES OF MANAGEMENT :

The occurrence of various diseases has increased in the modern period due to the way we live. One of the lifestyle disorders, obesity (Sthaulya), continues to be a problem for several medical systems. Medical science has conducted a lot of study on obesity (Sthaulya), but no treatment has yet been promoted as a comprehensive solution for the condition. Ayurvedic principles of nutrition, lifestyle, and morality (Ahara-Vihara, Dincharya, Ritucharya), which are useful in preventing many diseases. The following Ayurvedic management guidelines will help you control obesity (Sthaulya):

  1. NidanaParivarjana
  2. ShodhanChikitsa
  3. Shaman Chikitsa

1.Nidana Parivarjana :

Avoiding the hetu (causative factors ) which are responsile for causation of disease is NidanaParivarjana.

According to SamanyaVishesh Siddhant the excessive consumption of similar substance (DravyaSamanya), similar quality of food (GunaSamnya) , Similar on the action of food (Karma Samnya) cause the over production of Dhatu.19 Thus, Ahara and Vihara mentioned above that causes obesity should be avoided.  

2.Shodhana Chikitsa :

Sthaulya is Bahudoshavasta, here Shodhana plays as an important role. Vamana and Virechana Karma is the best treatment modality for Sthaulya. For Kaphaja Vikaras Vamana is the primary treatment. Virechana Karma acts on agni and stabilizes Dhatus. Both these Karma play important role in reduction of excessive weight, BMI, Triglyceride, Total Cholesterol, Total Triglyceride, LDL,VLDL, as well as increase HDL.

Lekhan Basti20 :

It is a type of enema(given through the ano-rectal route) which contains Ayurvedic drugs which cause the excoriation of the excessive fat from the body.  The drugs which are used in the preparationofLekhan Basti are Triphala decoction, Honey, Gomutra,Saindhavsalt, Hing , Yavakshar, Kasis, Shilajat which are all fat-reducing  virtu their properties. The drugs used in Lekhana  Basti possesses opposite quality of Meda and Kapha , which causes Lekhana of Medha and also Basti controls the Vayu and causes Kostasuddhi which starts proper metabolism by removing Vayu Avarana and provide nourishment to the later Dhatu.

Udvartana21 :

The most common Ayurvedic treatment used in for losing weight is the treatment of Udavartana.

The procedure of rubbing dry medicated powders over the body with  friction in a direction opposite to  the hair growth is termed as Udavartana. It is commonly practiced with TriphalaChurna, KolakulatthadiChurna. In Udavartana, due to increased friction to all parts of the body, the increased meda is depleted and increased heat generated during Udvartana helps in digesting the Ama thus correcting  the digestive metabolism in obese people. 

3.SHAMAN CHIKITSA :  

Shaman Chikitsa with the help of medication suppresses and eventually removed all vitiated doshas in the body.

Following are the commonly used Shaman Drug used in Sthaulya

Single Drug

1 Shilajatu

6 Guggulu

2 VidangaChurna

7 GuduchiChurna

3 VachaChurna

8 AmalakiChurna

4 shunthiChurna

9 HaritakiChurna

5 LodhraChurna

10 Madhu

                                                                                   

LekhaniyaMahakashaya

Acharya Charaka has mentioned 10 dravya that act as best Lekhaniyaand called it as LekhaniyaGana. These drug has Ushna, Tikshna properties that’s they act as Kaphahar and Medohar.

1 Musta

6 Ativisha

2 Kustha

7 Katuki

3 Haridra

8 Chitrak

4 Daru Haridra

9 Chirbilwa

5 Vacha

10 Hemavatya

Compound Formation :

1NavakaGugulu                                    4 AmritadiGugulu

2 DashangGugulu                                 5 MedoharGugulu

3 TryodashangGugulu                         6 TrihaladiGugulu

Apatarpana Chikitsa22

Sthaulya is SantarpanjanyaVikar That’s why AptarpanaChikitsa Should be Followed to get reduces of excess fat.

In Chikitsa sutra of Sthaulya  Acharya Charaka mentioned , heavy food which is hard to digest (less carbohydrate) and non- saturating (less fat) but lower down the appetite is suitable for obese person. 

Laghana23

Laghana is one of the ApatarpanaChikitsa explained in ayurveda texts. Nitya Langhana therapy is advised for obesity . Laghana therapy is further classified as Shodhan and Shamana therapy

Shodhana

Shamana

1 Vaman(Vomiting therapy)

Pipasa (controlling thirst)

2 Virechan ( Purgation therapy)

Atapa Sevan (exposure to sun rays

3 Nasya (cleansing nasal drops)

Vayu Sevana

4 Niruha Basti (Decoction enema)

Pachana (administration of foods and medicine that are hot in nature which help in digestion)

5                   -

Upawas (fasting)

6                   -

Vyayama (physical exercise)

UshnodakaPaanaBaishajyaratnavaliJwaradhikara :

The water which is simply boiled and reduced to 1/8 or ½ part is Ushnodaka. It is able to lower Kapha, Vayu and Medas.

Vyayama24(physical Exercise) :

It is advocated to be done every day. Acharya Vagbhat mentioned that one should exercise according to his individual strength. Vayama alleviates and expels excessive Kapha and helps in burning tissue belonging to specially Meda Dhatu. So that one who exercise regularly stay strong and trimmed. 

Yoga :

Surya Namaskar , Paschimottanasana , Uttanapadasana, Naukasana, such Yogasana and other physical exercise like bicycling, brisk walking, swimming are effective in prevention of Sthaulya.

Pathya – Apathya  :

PathyaAhara Vihara

Sr.no

PathyaAhara

Pathya Vihara

1

Millets like yava,Venuyava, barley, old rice, course wheat flour

Shrama(labour)

2

Mudga(green gram), Kulathi(horse gram), Chanak(Bengal gram)

Prajagara(Night awakening)

3

Amalaki(Amla),bitter gourd, carrot, Cucumber

Chintana (worry)

4

Madhu(Honey), buttermilk, Ginger water

Vyavaya(Intercourse)

5

Arishta(medicinal wine in adequate quantity)

Vyayama

6

Lukewarm water

ApathyaAhara Vihara

Sr No

ApathyaAhara

Apathya Vihara

1

Godhuma (especially fine and refined wheat flour like Maida) , Navanna(New grains)

Sheetala Jala Snana

2

Masha (black gram)

Excessive sleep

3

Dugdha, NavnitGhrita, Dadhi(dairy products)

Diwaswap (Day nap)

4

Anupa, Audakamamsa (sea animal’s meat)

Avyayama (No physical work)

5

Junk food

Nityaharsha(always happy)

6

Madhur Rasatmakaahara

Avyavaya (no intercourse)

7

Snigdha, SheetaAhara

Sukhashaiyya (comfortable bed resulting in sound sleep)

Discussion

Conclusion

Sthaulya is brought on by KaphaVardhakAhar and increased sedentary behavior, both of which cause the body to accumulate excess fat, or Meda Dhatu. Controlling calorie intake will help prevent the metabolic condition.Engaging in physical activity is the best and simplest strategy to lose weight.NidanaParivarjana, Shodhana, Shamana, ApatarpanaChikitsa, and Ushnodakpana are all components of the treatment protocol that incorporate physical activity and yoga into the daily schedule of an obese person.Since obesity is a disease that affects a lot of people, it is important to educate people about its causes, prevention, nutrition, and complications. Changes in lifestyle, such as altered eating patterns and regular physical activity, can greatly reduce the risk of obesity.

References

  1. WHO obesity preventing and managing global epidemic. Report of a WHO consulation on oesity 3-5 une 19,Geneva Switerland.WHO/NUT/NCD98.1
  2.   Vd. Pandey G. Agniveshpranita. Charak Samhita. Santarpaniyaadhaya verse 6 Chaukhamba Subharti publication re priny 2016. Page no 422.
  3. Dr. Karanjkar M. Ayurvedic Management of Sthaulya ISSN0975-833 an 2018. International Journal of current research.
  4.  Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutrasthana, AshtauninditiyaAdhyaya, 21/3, edited by Tripathi Brahmanand. Varanasi: ChaukhambhaPrakashan                                                                                                       
  5.  Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutrasthana, SantarpaniyamAdhyaya; 23/6, edited by Tripathi Brahmanand. Varanasi: ChaukhambhaPrakashan
  6. Bray GA. Complications of obesity. Ann Intern Med. 1985; 103(6_ part_2):1052_1062.
  7.  Dr. Shukla A.et.al.Life style related factors associated with Sthaulya (Obesity)- A cross sectional survey study.2018.International quarterly journal of research in Ayurveda 2.
  8. http://www.Who.int/news-room/fact.sheets/detail/obesity-and-overweight.
  9. Dr Shukla A.et al. Lifestyle related factors associated with sthaulya(obesity)- A cross sectional survey study.2018. International quarterly journal of research in Ayurveda.
  10. Mishra Bramhashankkar Bhavrakash Vidyotini Tika, Madhyam khanda 39,11 edition , Varanasi, Chaukhamha Sanskrit Sansthana.2004
  11. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutrasthana, AshtauninditiyaAdhyaya, 21/9, edited by Tripathi Brahmanand. Varanasi: ChaukhambhaPrakashan
  12. Sarvang Sundar on Vagbhat, Ashtang Hridayam with Sarvang Sundara and Ayurveda Rasayana Commentry.Ed.Kunte, AM Chaukhambha orientalia,Varanasi,9th Ed. 2002
  13. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutrasthana, AshtauninditiyaAdhyaya, 21/4, edited by Tripathi Brahmanand. Varanasi: ChaukhambhaPrakashan
  14. Shivprasad Sharma. Asthang Sangraha Shashilekha Teeka by Indu. Varanasi: Chaukhambha Sanskkrit Series ;1st edition,2006;184.
  15. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutrasthana, AshtauninditiyaAdhyaya, 21/9, edited by Tripathi Brahmanand. Varanasi: ChaukhambhaPrakashan
  16. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutrasthana, AshtauninditiyaAdhyaya, 21/4, edited by Tripathi Brahmanand. Varanasi: ChaukhambhaPrakashan2016;409.
  17. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutrasthana, AshtauninditiyaAdhyaya, 21/5-9, edited by Tripathi Brahmanand. Varanasi: ChaukhambhaPrakashan:2016;409
  18.  Source : Adopted from WHO 1995, WHO2000 & WHO 2004
  19. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutrasthana,Deerghaivitiya Adhyaya, 1/44, edited by Tripathi Brahmanand. Varanasi: ChaukhambhaPrakashan.
  20.  Vagbhat, AshtangHridaya with Sarvangasundar Tika, Sutrasthana, Dvividhopakramaniya Adhyaya, 2/15, edited by Prof K.R.SrikanthaMurthy, Varanasi, chowkhambaKrishnadas Academy.
  21. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutrasthana, AshtauninditiyaAdhyaya, 21/20, edited by Tripathi Brahmanand. Varanasi: ChaukhambhaPrakashan.
  22. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutrasthana, LanghanaBrihaniyaAdhyaya, 22/18, edited by Tripathi Brahmanand. Varanasi:ChaukhambhaPrakashan
  23.  Vagbhat, AshtangHridaya with SarvangasundariTika,Sutrasthana, DvividhopakramaniyaAdhyaya, 2/10, edited by Prof K.R.SrikanthaMurthy,Varanasi, ChowkhambaKrishnadas Academy


Source of Support: None declared
Conflict of interest: Nil

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