E-ISSN:2456-3110

Review Article

Atisthaulya

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 8 August
Publisherwww.maharshicharaka.in

Ayurvedic and Modern Approach towards Ashta Dosha of Atisthaulya: A Review

Dewangan B1*, Shukla S2, Chandrakar R3
DOI: http://dx.doi.org/10.21760/jaims.8.8.15

1* Bhumika Dewangan, Post Graduate Scholar, Department of Roga Nidana Evam Vikriti Vigyana, Shri NPA Govt Ayurveda College, Raipur, Chhattisgarh, India

2 Sanjay Shukla, Reader Guide, Department of Roga Nidana Evam Vikriti Vigyana, Shri NPA Govt Ayurveda College, Raipur, Chhattisgarh, India

3 Rupendra Chandrakar, Reader Coguide, Department of Samhita Evum Siddhant, Shri NPA Govt Ayurveda College, Raipur, Chhattisgarh, India

Obesity is one of the major metabolic disorders now days due to sedentary lifestyle and diet habit along with stressful life. This affects the person physical, mental, and social well being. Atisthaulya is a disease that is described in almost all the Ayurveda text. Atisthaulya is describes under Ashtauninditya Purush by Acharya Charak which is correlated with obesity as there are similarities in their symptoms. Obesity is a major metabolic disorder which has high mortality and morbidity. This article aims to concentrate on elaboration of Ashta Dosha of Atisthaulya given by Acharya Charaka along with its modern pathophysiology and the Pathya Apathya (diet regime) that should be followed to manage Atisthaulya.

Keywords: Atisthaulya, Ashta Dosha, Obesity, Medo Dhatu

Corresponding Author How to Cite this Article To Browse
Bhumika Dewangan, Post Graduate Scholar, Department of Roga Nidana Evam Vikriti Vigyana, Shri NPA Govt Ayurveda College, Raipur, Chhattisgarh, India.
Email: 		Dewangan B, Shukla S, Chandrakar R, Ayurvedic and Modern Approach towards Ashta Dosha of Atisthaulya: A Review. J Ayu Int Med Sci. 2023;8(8):102-105.
Available From
https://jaims.in/jaims/article/view/2693

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-06-03 2023-06-14 2023-06-24 2023-07-01 2023-07-14
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2023by Dewangan B, Shukla S, Chandrakar Rand 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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Introduction

The word Atisthaulya is derived from two words Ati and Sthula. Ati means excessive and Sthu means bulky. “Sthaulyam Sthulasya Bhava” means state of heaviness of body parts.[1] It is a condition of the body that results from vitiated Meda Dhatu.[2] In Ayurveda, Acharya Charak has described Astaunindita Purusha in chapter 21 of Charaka Sutra Sthana which has a resemblance to metabolic disorder. Only Acharya Charak has described and elaborated the pathophysiology of Ashta Dosha of Atisthaulya. Sthaulya is also included under Shleshma Nanatmaja[3], Bahu Dosha Janita[4], Ati Brihana Nimittaja[5], Santarpana Nimittaja Vyadhi.[6] Sushruta has described Sthaulya as Dhatvaagni Mandyajan Vikara[7] (metabolic disease). Vaghbhatta has describe the pathogenesis of Sthaulya on the basis of formation of Ama. Madava Nidana has elaborated the pathophysiology of this disease on the basis of increase Meda.[8] Yogratnakar has also adopted the name Medo Roga to explain Sthaulya.[9] Various etiology of Sthaulya has been mentioned in Ayurveda text such as Atisampurna (overeating), Avyayama (lack of physical exercise), Avyavaya ( lack of sexual activity), Diwaswapna (day sleeping), Guru-Madhur-Sheeta-Snigdha Sewan (excessive consumption of heavy-sweet-cold-unctuous food, Harshnityaad (excessive joy), Achintanad (lack of worries), Beeja Dosha (hereditary).[10] The specific sign of Sthaulya are Medo-Mansa Ativriddhi, Chalsphik-Udara-Stana, Ayathopchaya-Utsaha.[11] The world obesity atlas 2022 published by the world obesity federation predicts that one billion people globally including 650 million adult, 340 million adolescent and 39 million children i.e. 1 in 5 women and 1 in 7 men will be living with obesity by 2030.

Materials and Methods

This article is based on literary review from Ayurveda Samhita and text available in the library of Govt. Ayurveda College, Raipur (C.G). Text book referred are Charak Samhita, Sushrut Samhita, Vagbhatt Samhita, Madhav Nidana, Bhaishjya Ratnavali along with commentaries, other Ayurvedic journals, articles and websites.

Aim and Objective

To study the detail description of Ashta Dosha in Atisthaulya

given by Acharya Charaka and its probable modern pathophysiology.

Samprapti (Pathogenesis)
Due to obstruction of Srotas by Meda, the Vata moving mainly in the stomach augments the Agni and absorbs the food. Thus, the obese person digests the food speedily and craves for food tremendously. Over eating produces excess production of Meda Dhatu, this leads to Sthaulya.[12] According to Acharya Sushruta, Ahara Rasa circulating in the body in a stage of partial metabolism remains Madhura and is converted into Medas and this process thus makes them obese.[13]

Due to etiology, Shleshma Vriddhi occurs that causes Jathar Agni Mandata this results in Madhur Rasa Pradhana Aam Nirman having excessive Anna Rasagat Sneha this results in Meda Vriddhi and Srotas Avarodha in the Koshta causes Vaata Vriddhi in the Koshta ultimately Agni Vriddhi then repeated absorption of Ahara Rasa causes increased hunger, therefore excessive consumption of food. Hence Meda Vriddhi results in Sthaulya.

Ashta Dosha of Atisthaulya[14]

1. Ayush Hrash (decreased life span)

2. Javoparodha ( diminished activity or deranged movement)

3. Kriccha Vyavaya (difficulty in intercourse)

4. Daurbalya (general debility)

5. Daurgandhya (foul smell from the body)

6. Swedabadh (excessive perspiration)

7. Kshuda Atimatra (excessive appetite)

8. Pipasa Atiyoga (excessive thrist).

Role of adipocytes in causing obesity[15]
Adipocytes secrets many hormones (adipokines) with effects on the brain, pancreatic beta-cells, the liver, skeletal muscle and the cardiovascular system. The major function of adipocytes is energy homeostasis, insulin resistance and inflammation. In obesity hypertropic adipocytes accelerate a chronic, proinflammatory profile with altered secretion of adipokines, thereby exacerbating cardiometabolic disease.

Important adipokines are leptin, resistin, adiponectin, adipsin, angiotensinogen,


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interlukin-6, fasting induced adipose factor, tumor necrosis factor-ἀ, plasminogen activator inhibitor-1(PAI-1), tissue factor.

In obesity leptin, PAI-1, Tissue Factor, TNF, IL-6 increases only adiponectin decreases.

Ayurvedic and scientific explanation of Ashta Dosha[16]

Ayush Hraash - among all the Dhatus only Meda Dhatu grow as a result of which longevity diminished.

Pathophysiology - accumulation of excessive morbid fat in the body passages leads to imbalanced supply of nutrients and building elements to the tissues. Deprivation of nutrition leads to cell damage consequentially leading to tissue depletion. This leads to manifestation of life threatening disorder which can ultimately end up in death.

Javoparodha - diminished activity, sluggishness and deranged body movements are due to looseness, tenderness and heaviness of Meda.

Pathophysiology - Increase in adipocytes, increases inflammatory cells. This heightened inflammatory cell can lead to a higher risk of developing depression. Depression may lack the energy or desire to exercise or take part in other activities. Also due to impaired adipokines there is decrease in fatty acid oxidation and glucose uptake in skeletal muscles which results in diminished activity.

Kriccha Vyavaya - difficulty in sexual intercourse is due to inadequate semen along with obstruction in its normal path by Meda.

Pathophysiology - fat cells convert a male hormone known as androstenedione into a female hormone called estrone. Estrone affects the metabolism of the part of the brain that regulates ovarian and testicular function.

Daurbalya - only Meda Dhatu Vriddhi and Kshaya of other Dhatus leads to deranged metabolism owing to malnourishment of the succeeding Dhatus (i.e., Asthi and Majja) leads to Daurbalya.

Pathophysiology - In obesity, FFA, TNF-ἀ, resistin increases and adiponectin decrease. This variation results in insulin resistance. Due to Insulin resistance, uptake of glucose inside

the cell gets inhibited, ultimately no production of energy which results in generalized body weakness.

Daurgandhya - foul smell from the body is due to inherent defect in Medas and general nature of Meda followed by excessive perspiration. Also, there is involvement of Swedavaha Srotas hence excessive Sweda occurs which is the Mala of Medo Dhatu and it’s a characteristic of Sweda.

Pathophysiology - obese person required additional exertion for doing task. Sweat may get stuck in thick skin layers which in turn gives bacteria a chance to thrive thus produces bad odour.

Swedabadh - when Meda is associated with Kapha, which is fluid, multitudinous and heavy then it cannot with stand physical exercise leading to excessive sweating.

Pathophysiology - it is probably due to the reduced heat loss caused by the thick subcutaneous adipose tissue layer, which may lead to a compensatory response characterized by the excessive production of sweat.

Kshudatimatrata - Avaran of Saman Vayu causes increase of Vata in Koshta that leads to increase in digestive fire thus result in excessive hunger.

Pipasaatiyoga - excessive appetite and thirst is due to enhanced digestive fire along with excess presence of Vata in Koshta.

Pathophysiology - in obesity, leptin concentration in the blood is elevated, promoting a central and peripheral leptin resistance that renders the elevated leptin futile in curbing appetite and obesity.

Pathya Apathya[17]

Pathya

Aharaj - Purana Shali Chawal, Munga Daal, Arhara Daal, Kulattha, Yava, Kodo, Shuddha Shilajit, Patrotta Shak, Ruksha Padartha, Chana, Masoor, Madhu, Dhaan Khali, Takra, Madya, Chingat Machali, Bangan, Triphala, Guggula, Lauka Bhasma, Trikatu, Sarso Tail, Til Taila, Ushna Jal, Prag Bhojana Varipana.

Viharaj - Lekhan Basti, Chinta, Shrama, Ratri Jagaran, Maithuna, Ubatana, Langhan, Dhoop Sevan, Bhraman, Virechan, Vaman, Aptarpana, Agru Lepa.



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Apathya

Aharaj - Sheetal Jalpaan, Rasayan Aushadh Sewan, Nava Shali Chawal, Godhum, Such Sheeltaam, Ksheer, Ikshu Vikar, Mash (Urad), Matsya Mansa, Madhur Sewan.

Viharaj - Snehan Kriya, Diwa Shayana, Sugandhit Dravya Dharan (e.g., garland / sandal / perfumes), excessive water intake after meal.

Conclusion

Ashta Dosha are the morbidity that can be found in Atisthaulya which leads to the study of the disease in detail. Atisthaulya not just changes the appearance of a person but also worsens the health of a person hence, assessment of Ashta Doshas in Atisthaulya is helpful for the management of the same. Acharya Charak has referred to Sthaulya under the caption of Santarpanotha Vikara and it should be treated with Aptarpana. Acharyas have described Sthaulya as hard to cure disease because its management is Chikitsaupkrama Virodhi. So, Nidana Parivarjana has always turned out to be an effective method to manage and treat the patient suffering from Sthaulya. Regulating the lifestyle of an individual will help in the Pachan of Vikrita Meda and consequently enhance the Poshan of other Dhatus to maintain the body equilibrium.

Reference

1. Raja Radha Kanta Deva, Shabda Kalpadrum, Bhag-5, Chaukhamba Sanskrita Series Office, Varanasi, 1967.

2. Madhavakara, Madhav Nidana With Madhukosha Commentary, Edited By Dr. Brahmananda Tripathi Volume 2 Medoroga Nidanam Adhyaya, Uttarardha Published By Chaukhambha Surabharati Prakashan, Varanasi. Reprint:2011. Pg. No. 34.

3. Pandit Kashinath Sashtri, Gorakhnath Chaturvedi, Charak Samhita, Part-1 Sutra Sthana Maharoga Adhyaya, Chaukhambha Bharti Academy, Varanasi, 2016 Pg-.404.

4. Pandit Kashinath Sashtri, Gorakhnath Chaturvedi, Charak Samhita, Part-1chikitsa Prabhritya Adhyaya, Chaukhambha Bharti Academy, Varanasi, 2016 Pg-320.


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6. Pandit Kashinath Sashtri, Gorakhnath Chaturvedi, Charak Samhita, Part-1santarpan Aptarpaniya Adhyaya, Chaukhambha Bharti Academy, Varanasi, 2016 Pg-436.

7. Ambikadutta Shastri, Sushrut Samhita, Part-1 Sutra Sthana chapter 15, Chaukhambha Sanskrit Sansthan, Varanasi 2018. Pg – 81.

8. Madhavakara, Madhav Nidana with Madhukosha Commentary, Edited by Dr. Brahmananda Tripathi Volume 2 Medoroga Nidanam Adhyaya, Uttarardha Published by Chaukhambha Surabharati Prakashan, Varanasi. Reprint: 2011. Pg. No. 34.

9. Indradev Tripathi, Yogaratnakar with Vaidyaprabha Hindi Commentary, Chaukhambha Krishnadas Academy, Varanasi 2011.

10. Pandit Kashinath Sashtri, Gorakhnath Chaturvedi, Charak Samhita, Part-1, Chaukhambha Bharti Academy, Varanasi, 2016 Pg-411.

11. Pandit Kashinath Sashtri, Gorakhnath Chaturvedi, Charak Samhita, Part-1, Chaukhambha Bharti Academy, Varanasi, 2016 Pg-409

12. Pandit Kashinath Sashtri, Gorakhnath Chaturvedi, Charak Samhita, Part-1, Chaukhambha Bharti Academy, Varanasi, 2016 Pg-411

13. Ambikadutta Shastri, Sushrut Samhita, Part-1 Sutra Sthana chapter 15, Chaukhambha Sanskrit Sansthan, Varanasi 2018. Pg – 81

14. Pandit Kashinath Sashtri, Gorakhnath Chaturvedi, Charak Samhita, Part-1, Chaukhambha Bharti Academy, Varanasi, 2016 Pg-409

15. Harsh Mohan, Text Book of Pathology- 8th Edition, Section 1 Chapter 9 Enviromental and Nutritional Disease, published By Saradi 2019. Pg No. 275.

16. Pandit Kashinath Sashtri, Gorakhnath Chaturvedi, Charak Samhita, Part-1, Chaukhambha Bharti Academy, Varanasi, 2016 Pg-410

17. Siddhinandan Mishra, Bhaishjya Ratnavali Chaukhamba Surbharati Prakashan, Varanasi, 2012 Pg. 595


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