E-ISSN:2456-3110

Case Report

Obesity

Journal of Ayurveda and Integrated Medical Sciences

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

Lekhan Karma of Haridra w.s.r. to Obesity - Pilot Study

Sawant B.1, Mishra D.2*
DOI:

1 Balaji Sawant, Professor and H.O.D., Department of Dravya Guna, Smt. K.G.Mittal P. Ayurveda Mahavidyalaya, Mumbai, Maharashtra, India.

2* Darshana Mishra, Post Graduate Scholar, Department of Dravya Guna, Smt. K.G.Mittal P. Ayurveda Mahavidyalaya, Mumbai, Maharashtra, India.

A clinical study was conducted on patients of Sthaulya resembling conditions with obesity to evaluate the Lekhana Karma efficacy of Haridra mentioned in Charaka Samhita Lekhaniya Varga. The aim and objective of the study was to evaluate the efficacy of Haridraghanvati Lekhana Karma on Sthaulya. The preliminary study was done on 5 cases of Sthaulya w.s.r. to Obesity. Result obtained from study revealed that it shows good effect in relieving subjective criteria’s like Kshudrashwasa, Atiswedapravruti, Aniyamit Mala Pravrutti. Also shown result on objective criteria like lipid profile. The result of pilot trial provide preliminary support to continue work on larger sample size at OPD level.

Keywords: Haridra Kanda, Curcuma longa, Turmeric, Haridra Ghanvati, Sthaulya, Obesity

Corresponding Author How to Cite this Article To Browse
Darshana Mishra, Post Graduate Scholar, Department of Dravya Guna, Smt. K.G.Mittal P. Ayurveda Mahavidyalaya, Mumbai, Maharashtra, India.
Email: 		Balaji Sawant, Darshana Mishra, Lekhan Karma of Haridra w.s.r. to Obesity - Pilot Study. J Ayu Int Med Sci. 2022;7(1):359-366.
Available From
https://jaims.in/jaims/article/view/1676

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-01-18 2022-01-20 2022-01-27 2022-02-03 2022-02-10
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2022by Balaji Sawant, Darshana Mishraand 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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Sawant B. et al: Lekhan Karma of Haridra w.s.r. to Obesity - Pilot Study

Introduction

Obesity is an increasing, global public health issue. Patients with obesity are at major risk for developing a range of comorbid conditions, including cardiovascular disease (CVD), gastrointestinal disorders, type 2 diabetes, joint and muscular disorders, respiratory problems, and psychological issues, which may significantly affect their daily lives as well as increasing mortality risks. Obesity associated conditions are manifold; however, even modest weight reduction may enable patients to reduce their risk for CVD, diabetes, obstructive sleep apnea (OSA), and hypertension among many other comorbidities. A relatively small and simple reduction in weight, for example, of around 5%, can improve patient outcomes and may act as a catalyst for further change, with sustainable weight loss achieved through a series of incremental weight loss steps. 

The worldwide prevalence rate of obesity has risen dramatically in the developing countries over the past two decades. India, is the third most populous country of the world, has been severally affected by the obesity as a global epidemic recognized by WHO.

According to the World Health Organization (WHO), obesity is one of the most common, yet among the most neglected, public health problems in both developed and developing countries. According to the WHO World Health Statistics Report 2020, globally one in six adults is obese and nearly 2.8 million individuals die each year due to overweight or obesity. Due to the increased risk of morbidity and mortality, obesity is now being recognized as a disease in its own right. [ ICMR-Aug 2015][1]

As confronted with an abundance of easily available food which contributes toward obesity there is need to invest much more in research which confront with an easily available drugs in obesity and so Haridra is one among those Dravya. Haridra (Curcuma longa Linn.) is being easily, extensively available throughout India and as it is even economically less expensive, it will help to carry out research work smoothly on Sthaulya. As it has its reference as Lekhana Karma and Medohar property as per Charaka and Ashtang Hruday it has been selected. Its aim is to evaluate the efficacy of Haridra Ghan Vati (Curcuma longa linn.) Lekhana Karma in management of Sthaulya w.s.r. to obesity.

Review of Literature

Haridra is a Sanskrit word referring to Curcuma longa (turmeric) from the Scitaminacea family. Haridra (Curcuma longa Linn.) is one of the important plants having ritual and medicinal both usage. Haridra is very widely used in Ayurveda for the treatment of various disorders through its Rasapanchak.  The name Haridra signifies its colour.

Classically, Haridra is Varnya, Medaghna, Vrana Ropak, Visodhani, Stanya Sodhak etc. by its pharmacological activity. It is a well-known drug in Ayurveda which is auspicious and also has cosmetic and religious importance.

Vedic period

Atharva Veda[3]

In Switra and Palit, Haridra is used with Indravaruni and Nili. Even for external use it is being used as Udvartan for Kamala and Hrudrog. Kaushik Dharmasutra Sutra mentioned Haridra as an antidote of snake venom.

Samhita

Charak Samhita - Dashemani - Lekhaniya, Kushthaghana, Vishaghna.

In Chikitsa Sthan it is found in Prameh and Arsha Chikitsa.

Sushrut Samhita - Haridradi Gan, Mustadi Gana, Sleshma Samshaman

Ashtang Hruday - Haridradi, Mustadi, Tikta Skandha, Lekhaniya, Shirovirechanopag, Kusthaghna Dravya in Chikitsa Sthan.

Kashyap Samhita - It is mentioned as ingredients of Dhupa in Kalpsthan and Khila Sthan for Kasa, Shwas, Charmadala.

Nighantu - Almost Haridra is mentioned in various Nighantu[4-5]

SN Nighantu Varga
1. Bhavprakash Nighantu Haritkyadi Varga
2. Raja Nighantu Pippalyadi Varga
3. Kaiyadev Nighantu Aushadhi Varga
4. Madanpal Nighantu Abhyadi Varga
5. Shodhal Nighantu Guduchyadi Varga
6. Ashtang Nighantu Haridradi gana
7. Adarsha Nighantu Ardrakadi Varga
8. Dhanwantari Nighantu Guduchyadi Varga
9. Soushrut Nighantu Haridradi Varga

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Sawant B. et al: Lekhan Karma of Haridra w.s.r. to Obesity - Pilot Study

Adhunik Kala

In India Materia Medica by Nadakarni (1908),

Indian medicinal plants by Keerthikar and Basu (1918),

The Wealth of India, indigenous drug of India by R.N have identified the drug as Curcuma longa

In Dravyaguna Vigyan by Acharya Yadavji Trikamji, Haridra is mentioned in Haridradi Varga. In the Ayurvedic Pharmacopoeia of India, part 1 , vol viii detailed description of Haridra is found.[6]

In database of medicinal plant used in Ayurveda by PC Sharma, vol 1, Haridra morphology, pharmacognosy, cultivation, toxicity, substitutes are given in detail.[7]

Bhavprakash Nighantu[8]

Haridra Paryaya as per Bhavprakasha

Varvarnini, Hattvilasini, Nisha, Yoshitpriya.

Therapeutic uses in Kamala, Pandu, Kaph-Pittahara.


Charak Samhita Sushrut Samhita Ashtang Sangrah
Lekhaniya Haridradi Haridradi
Kushthaghna Mustadi Mustadi
Vishaghana Sleshma Sanshaman Shirovirechan
Aptarpan Aushadh Lakshadi Tikta Skandhas
Tikta Skandhas   Lekhaniya
    Vishaghana
    Vaman Dravyas
    Kushthaghana

Sthaulya: The Sthaulya is describe in details in classical text. There are few ref. in Mythological form but described in details in Brihattrayi Viz. Charak Samhita, Sushruta Samhita, Asthanga Sangraha, Asthanga Hridaya and Laghutrayees Viz. Sharangadhar Yogaratnakara, Bhavaprakasha.

The word “Sthoola” is derived from ‘Sthu’ with suffix ‘Ach’ which stands for thick or solid or strong or big or bulky.

Definition: The excessive deposition of Meda and Mamsa Dhatu in body especially at Sphika (buttocks), Udara (belly) and Stana (breast) resulting in their increased and abnormal movement along with their loss of enthusiasm (Utsaha). The person having this kind of personality is known as “Atisthula”.

A person having heaviness and bulkiness of the body due to extensive growth especially in Udaradi (Abdominal) region is termed as “Sthula” and the state (Bhava) of Sthula is called “Sthaulya”. As per Charaka Sutra 29th Adhyaya.

Pathophysiology of Sthaulya: Sthaulya is Rasa and Meda Dushya dominant Vyadhi, Meda plays a major role in pathogenesis of Sthaulya. Therefore, it is very important to know different aspects of Meda, which is describe as below. Literally, the word Meda is derived from root “Jhimida Snehana” Which stands for Sneha, Fat, Oil etc. It means the substance, which has Snigdhatva property, is called Meda. There are many oily substances in the body like Vasa, Majja etc.

Causes: Avyayam, Divaswap, Sleshmal Aharsevan, Madhur Rasa Sevan leads to Sneha Meda Vardhan as per Madhav Nidan, Medorog[10]

Samprapti Ghataka

Dosha

Kapha - Kledaka

Pitta - Pachaka

Vata - Samana, Vyana

Dushya - Rasa, Meda

Agni - Jatharagni, Dhatvagni (Medodhatvagni)

Srotas - Rasavaha, Mansavaha, Medovaha

Strotodushti - Sanga

Adhisthana - Whole body (Vapavahan and Medodhara Kala)

Udbhavasthana - Amashya

Prasara - Medadhatu

Rogamarga - Bahya

Ama - Jatharagni Vaigunyata and Dhatvagni Mandhya Janit

Vyaktisthana - Sarvanga, especially in Sphic, Udara and Stana, Gala.

Materials and Methods

Materials and Methods

Source of data: Botanically identified Curcuma longa Linn. Belonging to family scitaminae,


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Sawant B. et al: Lekhan Karma of Haridra w.s.r. to Obesity - Pilot Study

its rhizome was procured from Sangali and identified by Department of Dravyaguna, Smt. K.G. Mittal Ayurveda Mahavidyalya, Charni Road, Mumbai, India. Authenticated and standardized by Alarsin pharmaceuticals, Andheri, Mumbai, India in March 2020.

Source of the patients: Patients were selected after subjection them through clinical examination from OPD of Dravyaguna Department of Smt. K.G. Mittal Ayurveda Mahavidyalya, Charni Road, Mumbai, India.

Preparation of Medicine

Raw material procured from Sangali and as per Sharangdhar Samhita Ghanvati preparation was done. Haridra Kand was procured from three regions of Maharashtra, Sangali district. After standardization and authentication from authentic laboratory. Rhizomes were cleaned and kept at concerned department museum. Later It was crushed into Bharad Form and Kwath preparation was done in 16 times of water. It was kept to boil on low flam till the one eighth of water is left. Strain the content and keep it on flame again till Ghan is extracted. Vati preparation was done in tablet making device (10% of Haridra Churna is added as binding agent).

jaims_1676_01.JPGHaridra Kand

jaims_1676_02.JPGHaridra Kand Bharad

jaims_1676_03.JPGKand Kwath

jaims_1676_04.JPGPunah Paakam

jaims_1676_05.JPGHaridra Ghanavati

Place of work: Clinical trial was done at Dravyaguna department of Smt. K.G. Mittal Ayurvedic Mahavidyalaya, Mumbai, India.

Methods of collection of data

Written and informed consent was taken of the enrolled patients based on the classicals signs and symptoms of Sthaulya, the patients screening for inclusive criteria irrespective of sexes between the age group 18-50 years were selected from the OPD of Dravyaguna department of Smt. K.G. Mittal Ayurvedic Mahavidyalaya, Mumbai, India. Pilot study was carried out on 5 patients according to inclusion and exclusion criteria.


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Sawant B. et al: Lekhan Karma of Haridra w.s.r. to Obesity - Pilot Study

Drug administration details

1. Drug Haridra Kand
2. Kalpana Ghanvati
3. Dose 500mg for 3 months
4. Sevan Kaal Pragbhakta
5. Anupan Sukhoshna Jal
6. Mode of administration Oral

Inclusive criteria

  • Irrespective of gender (Male, female, Transgender)
  • Patient with BMI ranging between 25-40
  • Patient with classical symptoms of Sthaulya Roga mentioned in Ayurveda texts.
  • Age - 18-50years
  • Religion - no barrier
  • Economic status - no barrier

Patient who have signed written and informed consent.

Exclusive criteria

  • Patient having major cardiac disorders, diabetes mellitus, hormonal disorders, infectious disease or any other major illness
  • Pregnant and lactating mothers
  • Patient with BMI > 40
  • Medicolegal Cases.

Plan of study: In this pilot study 5 patients were selected as per inclusion and exclusion criteria. 500mg Haridra Ghanvati has been given to each patient twice before meal for 3 months.

Name of centre Concern institute OPD
Written consent Before starting treatment
Number of patients 5
Drug Haridra
Kalpana Ghanvati
Dose 500mg before meal twice a day
Sevan Kal Pragbhakta
Period of clinical study 3 months
Mode of administration Oral
Follow up follow up after every 15 days till completion of 3 months
Pathyapathya Will be explained to every patient individually as mentioned in Sthaulya.

Clinical Assessment   

Objective Criteria

  1. Weight
  2. Body Mass index (BMI): A key index for relating weight to height. BMI is a person’s weight in kilograms divided by his/her height in meters squared
< 18.5 Underweight
18.5 – 24.9 Normal weight
25.0 – 29.9 Overweight
30 – 39.9 Obese
> 40 Severely obese
  1. Waist and Hip Ratio (WHR) – Waist circumference/ Hip circumference (N.R. - <0.9 for men & <0.85 for women.)
  2. Mid arm circumference
  3. Lipid Profile (before treatment and after treatment)

Subjective criteria

Chala Sphik Stan Udar,

Kruchhavyavya,

Pipasadhiya,

Swedadhikya,

Angagandha,

Kshudraswas,

Kshudhadhikya,

Nidradhikya and as per severity of symptoms its gradation is given between 0-3.

Grades

0 Absent
1(+) Mild
2(+ +) Moderate
3(+ + +) Severe

Statistical analysis of data

The value of data were expressed as percentage of relief. The data was analyzed by standard mean deviation, mean deviation for comparing before and after treatment obtained scores.

Observation

In this all 5 patients completed the study. In this 4 patients were female and 1 was male.


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Sawant B. et al: Lekhan Karma of Haridra w.s.r. to Obesity - Pilot Study

All the above Subjective Parameters P value was <0.0001, which statistically differs and is significant.

Effect on objective criteria was also statistically significant. 

Demographic detail of patient selected in pilot study


SN Reg no. Age Sex Education Profession Economic Status Diet Addiction Family History Prakriti Agni
1. 202005973 49 F Literate Nurse Middle mixed No No KP Visham
2. 202128092 37 F Literate Housewife Middle Mixed No Yes PK Visham
3. 202006815 50 F Illetrate Housewife Low Mixed No Yes KP Visham
4. 202100502 39 M Illetrate Shopkeeper Low Veg No Yes PK Visham
5. 202100053 50 F Literate Housewife Middle Mixed Yes No KP Manda

Subjective criteria with gradation before and after treatment


SN Cala-Sphik-Udara -Stan Kruchhvyavyata Anga-Gandha Pipasadhikya Swedadhikya Kshudhadhikya Kshudraswas Nidradhikya
BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT
1. 2 1 1 0 1 0 2 1 1 1 0 0 2 1 2 1
2. 2 2 2 1 1 1 2 2 2 2 2 1 3 2 2 2
3. 3 1 2 1 1 0 2 1 3 1     2 1 3 2
4. 3 2 2 2 3 3 2 1 2 2 3 2 3 2 2 2
5. 3 1 2 1 2 1 3 1 3 1 2 1 3 1 2 1

Objective criteria of patient with grades before and after treatment


SN Height   Weight BMI WHR (waist hip ratio) WC (waist circumference) MC (mid arm circumference)
BT AT BT AT BT AT BT AT BT AT
1. 154 69 66 29.1 27.8 0.86 0.82 96 92 35 32
2. 150 70 70 31.1 31.1 0.88 0.87 97 96 33 33
3. 156 77 74 31.6 30.4 0.88 0.83 92 88 30 28
4. 170 87 86 30.1 30 0.89 0.88 108 107 34 34
5. 152 90 88 39 38.1 0.93 0.89 112 110 30 29

Laboratory parameters with grades before and after treatment

SN Lipid Profile
Sr. Cholesterol Sr. Triglyceride HDL LDL VLDL
BT AT BT AT BT AT BT AT BT AT
1. 242 236 168 160 55 60 123 120 68 60
2. 238 236 158 156 40 40.2 124 125 55 54
3. 236 228 160 154 50 54 110.2 104 38 36
4. 228 218 162 154 48 55 120 108 52 38
5. 243 220 149 136 48 54 136 128 58 49

Discussion

In this study 5 patients were selected for pilot study and following observation were found which has been recorded in before and after treatment chart as per the gradation. It has been seen that the HDL of the patients has been raised to normal value and even along with Lekhana Karma of Haridra in Medodushti also Malashodhan has been noticed in all 5 patients.

Probable mode of action of Lekhana Karma of Haridra in Sthaulya

In Sthaulya, Medodhatvagni Poshakansha stated at Jatharagni level is vitiated. Medodhatvagni does not function properly and leads to accumulation of fats in depots and Kshay of Utar Dhatu. Haridra possess properties like Kaph Vaathar and even Pittahar as per Bhavprakash Nighantu, by having Katu Vipak works on eliminating Medodhatvagni Mandya. As per Ashtang Hruday, Pachakansha present in each Dhatu is referred as Dhatvagni. Dhatvagnimandya of specific Dhatu causes Vriddhi of that Dhatu.

Dosha involved in Sthaulya is Kledak Kaph and Pachak Pitta.

Strotas involved is Rasavaha, Medovaha and Swedavaha, Haridra being Ruksha, Laghu Gunatmak works on Mala of Rasa Dhatu that is Kaph (Kleda).

Haridra being Katu-Tikta Rasatmak and has reference in Ajirna it leads to Karma mentioned in Tikta Rasa like Deepan, Pachan, Kledhara, Medohara. Due to Deepan Pachan Karma it corrects Jathargani and leads to Vatanuloman. Vibandha, Malabadhata (constipation) seen in Sthaulya Rogi has been found to be corrected by Ushna Veerya and Katu Vipak of Haridra which leads to Srotoshodhan. It possess property like Medaghna as per Ashtang Hruday. Considering above


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all properties it corrects the Medodhatvagni Mandya and also having Ruksha, Laghu and Lekhana property it tends to do Lekhana of accumulated Medodhatu and corrects pathogenesis of Sthaulya, hence it may be the probable mode of action Lekhana Karma of Haridra in Sthaulya.

Conclusion

On comparing the before and after treatment result it is observed that significant result has been found and study can be selected for further detailed study in larger sample size and for long duration than one month. As it corrects the Medodhatvagni Mandya and also having Ruksha, Laghu and Lekhana property it may tends to do Lekhana of accumulated Medodhatu and corrects pathogenesis of Sthaulya. Haridra Ghanvati along with its Lekhana Karma even Mala Shodhan Karma of Haridra is found to seen in all 5 patients selected in this study.

Reference

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  3. Atharva veda - https://vedicheritage.gov.in /samhitas/atharvaveda-samhitas/
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  5. Indradev Tripathi, Acharya Vishwanath Dwivedi, Raj Nighantu, Krshnadas Academy, Varanasi, edition-1982, Pipallyadi Varga, Haridra/199,pg no.175
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