Effect of Virechana Karma and Basti in the management of Sthaulya - A Case Study

Neha Yadav; Arun Gupta; Megha Nautiyal; Chinky

Effect of Virechana Karma and Basti in the management of Sthaulya - A Case Study

Yadav N.^1*, Gupta A.², Nautiyal M.³, Chinky.⁴

DOI:

^1* Neha Yadav, Post Graduate Scholar, Department of Panchkarma, Ch. Brahm Prakash Ayurved Charak Sansthan Khera Dabar, New Delhi, India.

² Arun Gupta, Professor & HOD, Department of Panchkarma, Ch. Brahm Prakash Ayurved Charak Sansthan Khera Dabar, New Delhi, India.

³ Megha Nautiyal, Post Graduate Scholar, Department of Panchkarma, Ch. Brahm Prakash Ayurved Charak Sansthan Khera Dabar, New Delhi, India.

⁴ Chinky, Post Graduate Scholar, Department of Panchkarma, Ch. Brahm Prakash Ayurved Charak Sansthan Khera Dabar, New Delhi, India.

Sthaulya (obesity) is a predominant metabolic disorder, which is described by Charaka in Ashtaunindita Purusha. Sedentary life, lack of exercise, faulty food habits, urbanization, psychological factors along with genetic predisposition play a major role in the aetiopathogenesis of Sthaulya. Females are more prone to obesity due to feminine factors like menopause and aggravating factors like delivery, I.U.C.D., O.C.P, and miscarriage. Being overweight and Obesity contributes to Diseases like Heart attacks, stroke, arteriosclerosis, Diabetes, Mental Retardation/affection like Mood swings, and even depression. According to the Ayurvedic text, Sthaulya is caused due to Medovriddhi which includes an abnormal and excessive accumulation of Medodhatu in the body. In the Sthaulya etiological factors mainly vitiate the Meda-Kapha. This vitiated Meda obstructs the path of Vata, which results in the provocation of Vata. In the Samprapti of Sthaulya, two factors are of prime importance, Tikshna Jatharagni, and Medodhatvagnimandya. Irrationality between two levels of Agni makes the disease Krichha Shadhya, but Panchkarma therapy can give a better solution for this problem. So, treatment modality should be planned considering vitiated Meda, Kapha, and Vata. Lekhana Basti and Virechana Karma are selected for the management of Sthaulya.

Keywords: Sthaulya, Medovridhi, Lekhana Basti, Virechana

Corresponding Author	How to Cite this Article	To Browse
Neha Yadav, Post Graduate Scholar, Department of Panchkarma, Ch. Brahm Prakash Ayurved Charak Sansthan Khera Dabar, New Delhi, , India. Email:	Neha Yadav, Arun Gupta, Megha Nautiyal, Chinky, Effect of Virechana Karma and Basti in the management of Sthaulya - A Case Study. J Ayu Int Med Sci. 2022;7(10):236-240. Available From https://www.jaims.in/jaims/article/view/2051

Introduction

Everybody in the present era is quite busy with their daily activities. Nobody has the time to consider living a healthy life. Despite knowing the significance of it, none of us follow Dinacharya and Ritucharya. Due to this artificial living life-style, person is suffering from various life style disorders. Sthaulya is one of them. Sthaulya is a condition in which vitiation & aggravation of Meda Dhatu occurs due to which Srotasa get obstructed causing improper nourishment of other Dhatu and only Meda gets increased.^[1] Acharya Charaka mentioned it in Santarpanajanta Vyadhi^[2] and Ashtonindita Purusha^[3] which is characterised by heaviness and bulkiness in the body, due to accumulation of fat especially in abdominal and hip region.^[4] In modern science, its sign and symptoms are similar to obesity. According to the World Health Organization (WHO), obesity is one of the most common, yet among the most neglected, non-communicable health problems in both developed and developing countries.^[5] Obesity is a condition in which an individual's body weight increases due to the accumulation of excess adipose tissue. It is normally caused by a sedentary lifestyle, irregular diet, lack of physical activity, sleep pattern and stress etc. Obesity not only reduces the life span of an individual but also leads to life threatening complications, like stroke and Ischemic heart diseases, diabetes mellitus, HTN as well as psychological disorders like depression, mental retardation etc. Most widely used method to quantify obesity is BMI (body mass index) which is equal to weight/height²(kg/m²). BMI^[6] of 25 or more indicates obesity that leads to rise in morbidities steadily. In modern science, there is no particular treatment for obesity. They mainly focused on dietary habit and exercise for weight loss. Guru & Aptarpana Chikitsa^[7] & Shodhana^[8] is mentioned as line of treatment for Sthaulya in Ayurveda alongside varied formulations like Udwartana, Basti etc. Here Virechana and Lekhana Basti was selected for the management of Sthaulya. Lekhana Basti^[9] was chosen for the management of Sthaulya because it has the Lekhana property, which lowers Meda and also pacifies the Vata by affecting its seat, Pakvasaya. Virechana is also mentioned in the treatment of Santarpana Janita Vyadhi.^[10] So, here attempt was done to evaluate the effect of Virechana as well as Lekhana Basti in the management of Sthaulya.

Aim

To study the effect of Virechan Karma and Lekhana Basti in the management of Sthaulya.

Case Report

Patient information: A 23yrs old female patient in the OPD of Panchakarma comes with complaint of increased body weight since 5 years. Associated symptoms are excessive sweating, excessive thrist and excessive hunger since 3 years.

Past history: No history of diabetes mellitus, hypertension, thyroid dysfunction or any major illness.

General examination

Pulse - 74/min

Temp - 98.1°F

Blood Pressure - 130/72 mm/Hg.

Respiration rate - 16/min.

Height - 162.5 cm

Weight - 77kg

Astavidha Pariksha

Nadi (pulse) - Vatakaphaj

Mala (stool) - Samyak Pravritti

Mutra (urine) - 4-5 times in a day

Jeevha (tounge) - Niraam

Shabda (speech) - Prakrit

Sparsh - Anushna Sheeta

Drik - Prakrit

Akriti - Sthula

Dashavidha Pariksha

1. Prakriti - Vatkaphj

2. Vikriti - Medodhatu Dushti

3. Sara - Madhya

4. Samhanana - Pravara

5. Pramana - Adhik

6. Satmya - Madhyama

7. Satva - Madhyama

8. Aharashakti - Madhyama

9. Vyayamashaki - Madhyama

10. Vaya - Madhyama

Patient was conscious and well oriented about the place, time, and person. The respiratory and cardiovascular systems were normal.

Criteria of Assessment
Subjective parameters^[11]

Atikshudha
Atitrishna
Swedadhikya
Daurbalya

Objective parameters

Body weight (kg)
BMI (Body mass index)
Waist Circumference (cm)
Chest Circumference (cm)

Materials and Methods

Centre of study: O.P.D of Panchkarma Department of CBPACS, Khera Dabar, Najafgarh, New Delhi.

Study design: Simple Clinical Single Case Study

Materials: Virechana and Lekhana Basti treatment given to the patients

Ingredients for Virechana Karma
Abhayantara Snehapana - Mahatriphala Ghrit

Drugs for Deepana - Pachana - Chitrakadi Vati

Virechana - Triphala, Amaltasa Kwath (150ml) with Trivrit Avleha (60gm)

Ingredients of Lekhana Basti

Table 1: Ingredients of Lekhana Basti

SN	Drugs	Dose
1.	Triphala Kwath (Amalaki, Haritaki, Vibhitaki)	400ml
2	Saindhava	10-12gm
3	Gomutra	100ml
4	Madhu	50gm
5	Katu Taila	50ml
6	Yavakshaar	2gm
7	Shilajeet	5gm
8	Tuttha	5gm
9	Kasisa	5gm
10.	Hingu	2gm

Method: Virechana Karma followed by Lekhana Basti

1. Virechana

Purvakarma

Deepana - Paachana - For 3 days by Chitrakadi Vati

Table 2: Abhyantra Snehpana

Mahatriphala Ghrita	1st day	2nd day	3rd day	4th day	5th day	6th day
Quantity	40ml	60ml	90ml	120ml	150ml	180ml

Bahya Snehana and Swedana for 4 days

Sarvang Abhayang - Tila Taila for 30 min.

Sarvang Swedana - Vashapa Sweda for 10 min.

Pradhana Karma: Administration of Virechaka drugs - Triphala + Aaragvadha Kwath with Trivrit Avaleha

Paschata Karma

Sansarjan Karma - According to Shuddhi of patient.

2. Lekhana Basti Schedule

Given in the form of Kala Basti^[12] for 16 days with Murchita Tila Tail Anuvasana Basti

Table 3: Kala Basti Schedule

Day 1	Day 2	Day 3	Day 4	Day 5	Day 6	Day 7	Day 8	Day 9	Day 10	Day 11	Day 12	Day 13	Day 14	Day 15	Day 16
A	A	N	A	N	A	N	A	N	A	N	A	N	A	A	A

A - Stands for Anuvasana Basti

N - Stands for Niruh / Asthapana Basti

Time of administration of Lekhana Basti - Empty stomach in the morning

Quantity of administration - 450ml

Time of administration of Murchit Tila Tail^[13] Anuvasana Basti - After taking light diet in the afternoon

Frequency - Once in a day

Observations and Results

Table 4: Subjective criteria

Lakshanas	Before Treatment	After Virechana	After Basti
1) Atikshudha	++	+	-
2) Atitrishna	++	+	-
3) Swedadhikya	++	+	-
4) Daurbalya	++	++	-

Table 5: Objective Criteria

Parameters	Before Treatment	After Virechana	After Basti
1) Body Weight	77kg	71.2kg	70kg
2) Body Mass Index	29.2Kg/m2	27 Kg/ m2	26.5 Kg/ m2
3) Waist circumference	87cm	82cm	82cm
4) Chest circumference	86cm	81cm	81cm

Discussion

In Ayurvedic texts different Shodhana procedure i.e., Vamana, Virechana, Lekhana Basti, Raktamokshana are mentioned for the treatment of Sthaulya. In present study, Lekhana Basti and Virechana Karma were selected for the management of Sthaulya. As we know, Charaka has prescribed Ruksha, Ushna and Tikshna Basti for Sthaulya patients and Sushruta has mentioned Lekhana Basti for Shodhana or Lekhana Karma.

Usually, Virechana is to be administered when Pitta has undergone increase alone or in association with Kapha or when Kapha has got localised in the seat of Pitta and Sthaulya is Kapha Pradhana Tridoshaj Vyadhi so Virechana is very helpful for reducing Meda and Kapha from the body. In Virechan Karma maximum ingredients have Katu Rasa, Laghu, Ruksha Guna, Ushna Virya and Katu vipaka, VataKaphahara, Karshana, Lekhaniya, Amapachana, Dhatu-Shoshana properties, which normalize the state of Agni. Thus, regulated Jathargani, checks the excessive growth and accumulation of Medo-Dhatu^[14] and thereby causing Lakshana Upashamana of disease Sthaulya. By Virechankarama, all Dosha Vata, Pitta & Kapha are alleviating so the weight of the body automatically decrease which leads to Sthoulyanasha. Meda and Kleda are the chief culprits in Sthaulya. Tikta & Katu Rasa performs Medokledopashoshana action. Ushna Virya also helps in Kleda and Meda-Vilayana action. After Virechana Karma, followed by Samsarjana Karma, it leads to Agnivridhi and Amanasha. By Virechana Karma all Srotas especially Medovaha and Rasavaha Srotas gets purified.

Lekhana Basti prepared with Triphala Kwatha, Gomutra, Madhu, Kshara etc. Triphala Kwath having Tikshana, Ushana properties, and consists of Katu, Tikta, Kashaya Rasa. These drugs, by virtue of their Ushna Virya acts on Kapha-Vata. In Sthaulya, Meda and Mamsa Vridhi occurs along with production of Ama Rasa. The Lekhan Basti breaks the Srotosanga. So the active principle reaches to the cellular level.

The drugs of Triphala Kashaya causes Shoshana, Lekhana, Amahara Karma due to Tikta, Katu and Kashaya Rasa. Most of these drugs having Deepana and Pachana properties, and by these properties mainly corrects Medodhatvagnimandya and checks the further progression of Meda Sanchaya by stopping the formulation of Meda.

Conclusion

Sthaulya is a Dushya Dominant Vyadhi. There is an involvement of all the three Doshas in Sthaulya but the vitiation of Kapha-Vata and Meda of prime importance. The management of Sthaulya done by reducing the alleviated Vatadosha and Kaphadosha. The Dravyas used in both procedures possessing Katu, Tikta and Kashayarasa and also with Lekhana Karma facilitates for Shoshana and removal of liquefied or detoxified Kapha and Meda. Majority of drugs possessing Kaphahara, Vatahara and activity which is Medohara in action. These all drugs help in maintaining digestion and inhibit Ama production. Due to Laghu, Ushna and Teekshana properties of Basti, when absorbed through intestinal mucosa, obstruction of channels broken down. Thus, morbid material from all over the body will expelled out and it breaks the pathogenesis of obesity. Virechana Karma followed by Lekhana Basti can be considered as a good modality for management of Sthaulya. And on the basis of modern parameters, we can conclude that by overall comparison of all the parameters before and after treatment, showed that effect of Virechana with Lekhana Basti is significant in Sthaulya.

Reference

1. Shastri K.N. Ashtoninditiya Sutra 21/4. In: Charaka Samhita of Agnivesha. Varanasi: Chaukhambha Bharti Academy; 2013. p.no.408.

2. Shastri K.N. Santarpaniya Sutra 23/6. In: Charaka Samhita of Agnivesha. Varanasi: Chaukhambha Bharti Academy; 2013. p.no.436.

3 Shastri K.N. Ashtoninditiya Sutra 21/3. In: Charaka Samhita of Agnivesha. Varanasi: Chaukhambha Bharti Academy; 2013. p.no.407.

4. Shastri K.N. Ashtoninditiya Sutra 21/9. In: Charaka Samhita of Agnivesha. Varanasi: Chaukhambha Bharti Academy; 2013. p.no.411.

5. World Health Organization (WHO). Obesity: preventing and managing the global epidemic. Report of a WHO consultation. (1-253). World Health Organ Tech Rep Ser. 2000;p.894:i–xii. [PubMed]

6. BMI classification”. Global Database on Body Mass Index. WHO. 2006.

7. Shastri K.N. Ashtoninditiya Sutra 21/20. In: Charaka Samhita of Agnivesha. Varanasi: Chaukhambha Bharti Academy; 2013. p.no.414.

8. Gupt K.A. Dvividhaupkarmaniya Sutra 14/12. In: Ashtanga Hridyayam of Vaghbhata. Varanasi: Chaukhambha Prakashana; 2018. p.no.136.

9. Shastri KA. Niruhakrama Chikitsa 38/82. In: Sushruta Samhita of Maharshi Sushruta Dalhana. Varanasi: Chaukhambha Sanskrit Sansthan; 2014. p.no.214.

10. Shastri K.N. Santarpaniya Sutra 23/8. In: Charaka Samhita of Agnivesha. Varanasi: Chaukhambha Bharti Academy; 2013. p.no.437.

11. Shastri K.N. Ashtoninditiya Sutra 21/4. In: Charaka Samhita of Agnivesha. Varanasi: Chaukhambha Bharti Academy; 2013. p.no.408.

12. Shastri K.N. Kalpana Siddhi Adhyaya 1/47-48 In: Charaka Samhita of Agnivesha. Varanasi: Chaukhambha Bharti Academy; 2013. p.no.973.

13. Gupt K.A. Dravadravyavijaniya Sutra 5/56. In: Ashtanga Hridyayam of Vaghbhata. Varanasi: Chaukhambha Prakashana; 2018. p.no.59.

14. Shastri K.A. Doshadhatumalakshyavridhi Sutra 15/7. In: Sushruta Samhita of Maharshi Sushruta. Varanasi: Chaukhambha Sanskrit Sansthan; 2014. p.no.75

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-09-24	2022-09-26	2022-10-03	2022-10-10	2022-10-17
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	16%

Case Report

Sthaulya

Journal of Ayurveda and Integrated Medical Sciences