E-ISSN:2456-3110

Review Article

Sthoulya

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 1 Jan-Feb
Publisherwww.maharshicharaka.in

Conceptual study on Sthoulya with its Chikitsa Sutra

Prarthana H.1*, Desai S.2
DOI:

1* HM Prarthana, 3rd Year Post Graduate Scholar, Department of Moulika Siddhanta, Ayurveda Mahavidhyalaya, Hubli, Karnataka, India.

2 Sandeep Desai, Assistant Professor, Department of Moulika Siddhanta, Ayurveda Mahavidhyalaya, Hubli, Karnataka, India.

Ayurveda is one of the most ancient medical science among the world. It describes the conceptual study of different disease with reference to its own principles and approaches. In Ayurveda ‘Sthoulya’ is described by different Acharya’s in their own way with its Nidana, Samprapti, Rupa, Upadrava, Chikitsa and Pathya Apathya as Sthoulya Roga, Medoroga, Santarpana Janya Vyadhi, Dhatvagni Mandhyajanya Vyadhi etc. and Acharya Charaka has described Sthoulya among the ‘Ashtaninditiya Purusha’. The sedentary lifestyles, stress and dietary habits etc., which are the gift of modern world, are primary predisposing factors for Sthoulya. Many theories have been put forward with many new hypothesis describing this disorder in Ayurveda as well as modern science, still there is an enough scope to work out on its aetiopathological and management aspect of Sthualya. So, looking upon the importance of this disorder an attempt is made to understand Nidana, Samprapti as well as Chikista Sutra of Sthoulya.

Keywords: Sthoulya, Obesity, Nidana Panchaka, Chikitsa, Pathya - Apathya

Corresponding Author How to Cite this Article To Browse
HM Prarthana, 3rd Year Post Graduate Scholar, Department of Moulika Siddhanta, Ayurveda Mahavidhyalaya, Hubli, Karnataka, India.
Email: 		HM Prarthana, Sandeep Desai, Conceptual study on Sthoulya with its Chikitsa Sutra. J Ayu Int Med Sci. 2022;7(1):135-141.
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https://jaims.in/jaims/article/view/1632

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-01-17 2022-01-19 2022-01-26 2022-02-02 2022-02-09
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2022by HM Prarthana, Sandeep Desaiand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Prarthana H. et al: Conceptual study on Sthoulya with its Chikitsa Sutra

Introduction

Ayurveda is a clinical science its concepts and principles are moulded in such a way that it becomes useful in clinical parlance. Sthoulya (Obesity) is one among major diseases of modern era with continuous changing lifestyles environment and dietary habits. A healthy body is the only one media to achieve ultimate goal among the Chaturvidha Purushartha. Acharya Sushruth also told that Madhyam sharira is the best.[1] Atisthula  and Atikrisha are always affected with some complaints.[2] Acharya Charaka has quoted Sthoulya under the eight varieties of reprehensible persons as Astauninditiya Purusha.[3] In this modern era and fast-moving life many drastic changes have taken place in dietary habits, modes of life style, various regimens of life style. Majority of individual are habituated to sophisticated and comfortable life style. This results in paving way for many metabolic disorders. These are popularly referred as life style disorders and obesity is one of them. In Ayurveda Obesity is described as ‘Medoroga’ or ‘Sthoulya Roga’. Continuous indulgence in high fatty food, fried items, etc., along with sedentary life-style leads to excess accumulation of body fat which gets deposited in the numerous body channels. According to ICMR-INDIAB study prevalence rate of obesity and central obesity are varies from 11.8% to 31.3% and 16.9% - 36.3% respectively. In India, abdominal obesity is one of the major risk factors for cardiovascular disease (CVD).[4] Obesity is such a disease, which provides platform for so many complications like HTN, DM, OA, infertility as well as psychological disturbances like stress, depression. Appropriate Ayurvedic internal medicines along with Shodhana procedures are used to achieve the best results, without any side effects. Vamana, Virechan, Basti, Udvartan according to vitiation of Doshas these Shodhana procedures gives effective results. Pathya - Apathya (Diet management) & Life style modifications play an important role in the management of Sthoulya. This article is an attempt to explore the Nidana (etiology), Samprati (pathogenesis), Rupa (symptoms) and Chikista Sutra (treatment) of Sthoulya with its Pathya – Apathya.

Sthoulya Nirukti: Sthula Paribrumhane[5]

As per Amarakosh, Sthula is condition as a result of excessive nourishment.

Paribhasha: Medo mamsa ati vrudhatvat chala sphik udara stanaayathopachayautsaho naro atisthula uchyate[6]

The increase of the Meda & Mamsa Dhatu causes flabbiness and pendulous appearance, thus movement of the abdomen, buttocks and breasts. This improperly formed Medodhatu causes Utsahahani in the individual; such person is called Atisthula.

Paryaya: Amarkosha has given synonyms of Sthula as Vipula, Pina, Pinvi, Pivara which indicates over nutritional condition of the person’s weight.[7]

Obesity: In modern Sthoulya is corelated with obesity. Obesity may be defined as an abnormal growth of the adipose tissue due to an enlargement of fat cell size or an increase in fat cell number or a combination of both8. The measurement of obesity is done by Body Mass Index (BMI).

Based on BMI, Obesity can be classified as follows

BMI = Weight is calculated in kilograms / height in meters square.

BMI Obesity
18.5 – 24. 9 Normal weight
25.0 – 29.9 Over weight
30.0 – 34.9 Class 1
35.0 – 39.9 Class 2
>_40 Class 3

Nidana: Nidana is the factor which cause the disease process. In our classics Nidana has been given utmost importance because the knowledge of Nidana is essential to understand the Samprapti, to know the Saadyasadhyata and plan for Chikitsa as the first step of treatment starts with Nidana Parivarjana.

In brief, all Nidana of Sthoulya described in Ayurveda can be classified into four groups as follows:[9]

Aharaja Viharaja Manasika Anya
Atisampoorna Guru Sheeta Snigdha Madhura Avyayama Avyavaya Divaswapna Achintata Harshita Beeja Dosha

Purvarupa: None of Ayurvedic texts has described the Purvarupa of Sthoulya. Acharya Charaka, in Nidana Sthana, has mentioned similar pathogenesis of Prameha and Medoroga, the reason being that in both of them there is vitiation of Kapha and Meda. Therefore, Purvarupa of Prameha[10] and Medovaha Strotodushti Lakshanas[11] can be considered as Purvarupa of Sthoulya. These are as follows.


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  • Atinidra
  • Tandra
  • Alasya
  • Visra Sharira Gandha
  • Anga Gaurava
  • Anga Shaithilya
  • Ati Sweda

Rupa: The Rupa manifest in fifth stage (Vyaktavastha) of Vyadhi Kriya Kala. The symptomatology of Sthoulya is asserted by Acharyas in broad manner.

Charaka Samhita mentions the cardinal symptoms of Sthoulya as

Pratyatma Lakshana: Medomamsa Ativruddhi, Chala Sphik, Chala Udara, Chala Stana, Ayathaopachaya, Anutsaha.[12]

Besides the Lakshanas, eight detrimental effects of Sthoulya have also been explained by

Acharya Charaka as

Ashta Mahadosha[13]

  1. Ayushohrasa (Diminution of lifespan)
  2. Javoparodha (Lack of interest in Physical activity)
  3. Kricchra Vyavaya (Difficulty in having coitus)
  4. Dourbalya (Debility)
  5. Dourgandhya (Unpleasent smell from the body)
  6. Swedaabadha (Excessive sweating)
  7. Kshudhatimatra (Excessive hunger)
  8. Pipasatiyoga (Excessive thirst)

Bheda: Vagbhata has explained three types of Sthoulya for better management [14]

  1. Hina Sthoulya
  2. Madyama Sthoulya
  3. Adhika Sthouly

Samprapti: According to Charaka, due to Avarana (obstruction) in the Strotas (channels) by the Meda, there is Vriddhi of Koshtasthit Samana Vayu, which in turn causes Ati Sandhukshana of Jatharagni. The increase in Jatharagni leads to rapid digestion of consumed food and leaves the person craving for more food. If at all due to some reason the person

doesn’t receive more food the increased Agni causes Dhatu Pachana which may lead to various complications. But because of the hunger the persons tend to eat more and the cycle continues. In this way it becomes a vicious circle creating excessive improperly formed Medo Dhatu with giving rise to various symptoms. Because of such condition of Strotorodha, the other Dhatus are not nourished properly causing Shaithilya (flabbiness) of Dhatus prior to Meda Dhatu and depletion of Dhatus next to Medo Dhatus.[15]

According to Sushruta, Kaphavardhaka Ahara, Adhyasana, Avyayama, Diwaswapna etc. leads to formation of a Ama Rasa i.e., Apachit Adya Rasa Dhatu. The Madhura Bhavayukta Ama Rasa moves within the body, the Snigdhamsha of this Ama Rasa causes Srotosanga which leads to Sthoulya.[16]

Samprapti Ghatakhas

Dosha Kapha, Kledaka Pitta, Pachaka Vata, Samana
Dushya Rasa, Meda
Agni Jatharagni, Medodhatvagni
Ama Jatharagni Vishamata Janita, Medo Dhatvagni Mandhya Janita
Srotas Medovaha
Sroto Dusti Sanga
Udbhava Amashaya
Prasara Sarva Deha (specially where ever Medodhara kala is present)
Adhishtana Vrukka and Vapavahana
Vyakta Sthana Sarvanga specially Sphik, Sthana, Udara, Gala
Roga Marga Bahya and Abhyantara
Vyadhi Prakara Chirakari
Sadhya Asadhyata Kruchrasadhya

Chikitsa: The general principle of treatment in Ayurveda is

  1. Nidana Parivarjana
  2. Samshodhana
  3. Samshamana

While describing the Chikitsa of Sthoulya, Acharya has said that it is very difficult to treat Atisthoola person because, if Karshana therapy is applied then it leads to further aggravation of already aggravated Jathra Agni and Vayu and if Brimhana therapy is applied it further increase the Meda. The management of Sthoulya is explained in detail as follows:


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Guru Cha Atarpanam Cheshtam Sthulanam Karshanam Prati[17]

  • Guru Ahara and Atarpana Chikitsa is the line of treatment for Sthoulya
  • Bahya Shodhana - Ruksha Udvartana[18]

Abhyantara Shodhana

  • Snehana - Medohara Taila like - Sarshapa Taila[19], Tuvaraka Taila[20]
  • Swedana - Mrudu Swedana[21], Niragni Sweda like Guru Pravarana, Bahupana, Kshudha Nigraha, Atap Sevan, Vyayama.
  • Pancha Karma - Vamana[22], Vireacana[23], Nasya[24], Ushna-Teekshna Basti[25], Lekhana Basti[26], Raktamokshana.[27]

Drugs

Eka Moolika Prayoga - Guduchi, Bhadramusta, Haritaki, Vibhitaki, Amalaki, Agnimantha, Guggulu. (C.S)

Churna Yogas - Trikatu Churna, Vidangadi Churna. (C.D)

Vati Yogas - Navaka Guggulu, Amritadya Guggulu, Taramandoora Guda (C.D)

Rasa Yogas - Trayushanadi Loha, Rasabhasma Yoga,Vadavagni Rasa, Trimurti Rasa, Mahalakshi Vilasa Rasa,Vidangadi Loha (Y.R)

Kashaya Yogas - Aragvadadi Kashaya, Varunadi Kashaya, Triphaladhya Kashaya, Brihatmanjistadi Kashaya (S.S)

Taila Yogas - Sarshapa Taila, Tuvaraka Taila,Yavatiktaka Taila, Triphaladhya Taila, Mahasugandhi Taila (Y.R)

Arista - Takra Arishta (C.S), Loharista (B.R)

Udvartana Yogas - Kolakulattadi Churna, Rasnadi Churna, Triphala Churna, Karpuradi Churna (C.D), Dhattura Patra Svarasa (Vangasena)

Lepa Kalpana - Medohara Lepa, Shareera Dourgandhyahara Lepa

Pathya – Apathya[28]

In case of treatment for Sthoulya diet i.e., Pathya is the most important which an individual should follow.

Acaharya Charaka advices Vata, Kapha, and Medahara Anna Pana for Sthoulya that are as follows:

Ahara

Ahara Varga Pathya Apathya
Shuka Dhanya Puran Shali, Kodrava, Shyamaka Yava, Priyangu, Laja, Nivara, Koradushaka, Prashatika, Godhuma, Naveena Shali
Shami Dhanya Mudga, Rajamasha, Kulatha, Chanaka, Masura, Adhaki, Makusthaka Masha
Shakha Varga Patola, Patrashaka, Shigru,Vruntaka, Katutikta, Rasatmaka, Vastuka, Trapusha Vartaka,Evaruka, Adraka, Mulaka, Surasa, Grajjana Kanda, Shaka Madhura Rasamtaka
Phala Varga Kapittha, Jambu, Amalki, Ela, Bibhitaki, Haritaki, Maricha, Pippali, Erand Karkati, Ankola, Narang, Bilvaphala. Madhura Phala
Drava Varga Honey, Takra, Ushnajala, Tila & Sarshapa Tail, Ashava Arista, Surasava, Jeerna Madhya Dugdha Varga, Ikshu Vikara
Mamsa Varga Rohita Matsya Aanupa, Audaka, Gramya Mamsa Sevana

Vihara

Pathya Apathya
Shrama Sheetala jala sevana
Jagarana Diwaswapna
Nitya bhramana Avyayama
Vyayama AVyavaya
Vyavaya Ati shayana

Manasika

Pathya Apathya
Chintana Achintana
Shoka Harshita
Krodha Manaso nivrutti

Discussion

In the Sthoulya, etiological factors mainly vitiate the Meda-Kapha. Due to continuous consumption of Kapha Vardhak Ahara, Vihara, Meda Dhatu is being increased by principle of Samanyam Vriddhi Karanam. This vitiated Meda obstructs the path of Vata, which results in to provocation of Vata, in turn it ignites the Agni. In the Samprapti two factors are of prime importance, Tikshna Jathara Agni and Medodhatu Agnimandya. Irrationality between two levels of Agni makes the disease Krichha Sadhya. In Medasvi Purusha only Meda Dhatu get Poshana and Uttaraottara Dhatu Poshana does not takes place and that leads to Asthi, Majja, Sukra Dhatu Kshaya, Shareera Spoorti Abhava, Sukumarata and Guru Guna of Meda makes Sthula Purusha


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to be inactive. Because of a Poshana of Uttara Dhatu, Dhatu Vishamata and Margavarodha by Meda, Sthula Purusha experience difficulty in Vyavaya, become Durbala. Meda Kapha Samsarga, Meda Adhika Vruddhi and Swabhavatah Sweda is Mala of Meda Dhatu, leads to excessive sweating and Dourgandha.

The obstructed Vata Dosha in Koshta stimulates the Agni hence, Sthula Purusha will feels Adhika Kshut and Pipasa. To break the Samprapti of Sthoulya administration of Guru and Atarpana Ahara which possess additional Vata, Shleshma and Medonashaka properties are considered as ideal. Chakrapani has explained that Guru Guna is required to alleviate vitiated Agni thereby suppressing the Atikshudha. Gangadhara has interpreted that Guru Guna is suitable to alleviate Tikshnagni and vitiated Vata especially Koshtagata Vata and there by Atikshudha, and Atarpana property is that which does not provide Tarpana and cause reduction of Meda. Hence Guru, Teekshna, Ushna, Rooksha, Guna Ahara Dravya are advised as they are opposite to Manda, Snigdha & Sheeta Guna of Vata, Kapha & Meda. As drugs used for Atarpana Chikista is Tikta Rasatmak, Katu Vipaki and having Laghu, Ruksha property.

It improves Meda Dhatwagni and it acts as Strotoshodhak there by helps in proper nourishment of Uttara Dhatu and also with the help of Tikta and Kashaya rasa it does Pittashamana. Acharya Sushruta and Vaghbhatta has mentioned the benefits of Rooksha Udavartan as Vatahara, Kapha hara, Meda Pravilayana, Anga Sthirakarana. Vamana helps to expel out the Utklista Kapha from the Shareera. Virechana is the choice of treatment for Pittaja Vikara and Pitta Sthanagata Vata Vikara, as its action is seen in Pakvashaya in the form of Vata Anulomana.

This can be adoptable in Sthoulya to counteract both the vitiated Agni and Vata. Lekhana Basti is one particular Basti which has been explained in Sthoulya as it is Kapha and Medohara in action.

Conclusion

Ayurveda is a rich source of therapeutic majors. ‘Sthoulya’ described in our Samhita from its Nidana to Chikitsa and Pathya - Apathya which is comparable with Obesity in modern medicine. Ayurveda uses various dosage forms

and treatment modalities in different disease conditions like Shodhana and Shamana therapies etc. with suitable dietary and lifestyle modifications, which have been found very effective in controlling obesity. It is suggested that there are significant results are obtained for Ayurveda management.

This shows that Anta Parimarjan Chikista (Basti, Virechana etc.) and Bahir Parimarjan Chikista (Udhvartana, Lepa etc.) are more effective in relieving signs & symptoms of Sthoulya.

In some case it may require longer duration to obtain the results. But Anta Parimarjana simultaneously Bahiparimarjan Chikista along with Pathya – Apathya will definitely give us hope in the management of Sthoulya i.e., Obesity.

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