E-ISSN:2456-3110

Research Article

Obesity

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 10 October
Publisherwww.maharshicharaka.in

Comparative study to evaluate the efficacy of Madhutailik Basti in comparison to Lekhana Basti in the management of Sthaulya (Obesity)

Dabas A1*, Gupta A2, Swati3, Mansi4
DOI:10.21760/jaims.8.10.8

1* Ankit Dabas, Post Graduate Scholar, Post Graduate Department Of Panchakarma, Ch Brahm Prakash Ayurved Charak Sansthan Khera Dabar, New Delhi, India.

2 Arun Gupta, Professor and Head, Post Graduate Department of Panchakarma, Ch Brahm Prakash Ayurved Charak Sansthan Khera Dabar, New Delhi, India.

3 Swati, Post Graduate Scholar, Post Graduate Department of Panchakarma, Ch Brahm Prakash Ayurved Charak Sansthan Khera Dabar, New Delhi, India.

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

Obesity is a chronic disease, increasing globally and is characterised by excess body fat. As a preventable cause of death, obesity is second only to smoking. Obesity is a potent co-morbid risk factor for mortality and morbidity, if it remains untreated. It emerges as an important health problem in India. It is estimated that 31.6 million Indians are obese, specially abdominally obese. Obesity is the primary driver of non-communicable diseases, like diabetes, cardiovascular diseases, disabilities like osteoarthritis and even cancer. In Ayurvedic texts, Sthaulya is categorized as Santarpanjanya Roga. Lekhana Basti is a well-known treatment for Sthaulya in Ayurveda and lot of research work has done in the past but it is not suitable for all Sthula Purusha because of its Tikshana nature. Many complications like abdominal pain or pricking pain in anal region, bleeding per rectum were observed practically. In the present study, Lekhana Basti and Madhutailik Basti were selected for Sthaulya. Sthaulya is Kapha-Meda Pradhana Vyadhi with Medavritta Vata. The drugs of Madhutailik Basti have Ushna Virya and Kapha Vatahara property. So, it regulates the Samana Vayu and restores the “Jatharagni” to normal, while also activating the Vyana Vayu to break the Srotosanga and synergize the activity of Madhutailik Basti at the cellular level. Thus, it helps to break the pathogenesis of the disease. Considering the above facts case study was planned to evaluate the comparative effectiveness of Madhutailik Basti with Lekhana Basti in the management of Sthaulya (obesity) in 60 clinically diagnosed and confirmed cases of Sthaulya from OPD of Ch. Brahm Prakash Ayurved Charak Sansthan, Khera Dabar, Delhi.

Keywords: Sthaulya, Obesity, Meda Dhatu, Madhutailik Basti, Lekhana Basti

Corresponding Author How to Cite this Article To Browse
Ankit Dabas, Post Graduate Scholar, Post Graduate Department Of Panchakarma, Ch Brahm Prakash Ayurved Charak Sansthan Khera Dabar, New Delhi, , India.
Email: 		Dabas A, Gupta A, Swati, Mansi, Comparative study to evaluate the efficacy of Madhutailik Basti in comparison to Lekhana Basti in the management of Sthaulya (Obesity). J Ayu Int Med Sci. 2023;8(10):53-60.
Available From
https://jaims.in/jaims/article/view/2700

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-08-15 2023-08-29 2023-09-11 2023-09-19 2023-09-27
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yea 19.96

© 2023by Dabas A, Gupta A, Swati, Mansiand 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

In a world where food supplies are intermittent, the ability to store energy in excess of what is required for immediate use is essential for survival. Fat cells, residing within widely distributed adipose tissue depots, are adapted to store excess energy as triglyceride and, when needed, to release stored energy as free fatty acids for use at other sites. This physiological system, orchestrated through endocrine and neural pathways, permits humans to survive starvation for as long as several months. However, in the presence of nutritional abundance and a sedentary lifestyle, and influenced importantly by genetic endowment, this system increases adipose energy stores and produces adverse health consequences.

Obesity is a state of excess adipose tissue mass.[1] Although often viewed as equivalent to increased body weight, this need not be the case- lean but very muscular individuals may be overweight by numerical standards without having increased adiposity. Obesity is therefore more effectively defined by assessing its linkage to morbidity or mortality. Based on data of substantial morbidity, a BMI of 30 is most commonly used as a threshold for obesity in both men and women. Large scale epidemiologic studies suggest that all-cause, metabolic, cancer, and cardiovascular morbidity began to rise when BMI are ≥ 25.

The distribution of adipose tissue in different anatomic depots also has substantial implications for morbidity. Specifically, intraabdominal and abdominal subcutaneous fat have more significance than subcutaneous fat present in the buttocks and lower extremities. Many of the most important complications of obesity such as insulin resistance, diabetes, hypertension, hyperlipidemia, and hyperandrogenism in women, are linked more strongly to intraabdominal and/or upper body fat than to overall adiposity.[2]

Data from the National Health and Nutrition Examination Surveys (NHANES) show that the percentage of the American adult population with obesity (BMI > 30) has increased from 14.5 % (between 1976 and 1980) to 33.9 % (between 2007 and 2008). According to ICMR-INDIAB study 2015, prevalence rate of obesity is 11.8%.[3]

In Sutra Sthana, Acharya Charaka described eight Asthoninditha

Purusha[4] among which Sthaulya has been most emphasis. A person having excess deposition of Meda and Mansa Dhatu at the site of Sphika, Udara and Stana is called Sthula Purusha.[5] Ati Sthaulya is mentioned among twenty Kaphaj Nanatmaja Vikara.[6] Impaired metabolism of Meda Dhatu (Adipose tissue) is the main cause of Sthaulya Roga, hence it is also known as Medo Roga. It is mentioned among Santarpana Janita Vyadhi[7] in Ayurvedic text. Though it is Santarpana Janita Vyadhi only Aptarpana Chikitsa is not sufficient for the management of Sthaulya. In Sthaulya etiological factors mainly vitiate Meda - Kapha, and Vata get Avarita by excessive Meda. Thus, if we used only Aptarpaka Dravya it increases the vitiated Vata. Therefore, treatment should be planned considering vitiated Vata, Meda and Kapha. Panchakarma can provide better solution to this problem.

Modern medical knowledge suggests that the best way to combat obesity is via a combination of dietary changes and physical activity. Though diet plans might help people shed pounds in the short term, keeping the weight off for good is often far more challenging and requires committing to regular exercise and eating less calories. Ayurveda is a system of medicine that emphasizes avoiding harmful side effects by adapting one's lifestyle to one's geographical location, seasonal changes, and daily routine (Ahara, Vihara, Nidra). This is the ideal treatment for obesity. Due to these reasons, the Ayurveda system of medicine must have the role in management of obesity without any side effects. So, the aim of this study is to manage the obesity by using cheap, easily available and safe Ayurveda Panchakarma procedures and Ayurveda medicines. Lekhana Basti and Madhutailik Basti[8] according to Ayurveda texts are used in this study. Primary aim of this thesis is to evaluate the comparative efficacy of Madhutailik Basti with Lekhana Basti in the management of Sthaulya.

Aim and Objectives

Aim

To evaluate the efficacy of Madhutailik Basti in comparison to Lekhana Basti in the management of Sthaulya.

Objectives

1. To evaluate the efficacy of Madhutailik Basti in the management of Sthaulya.


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2. To compare the efficacy of Madhutailik Basti in comparison to Lekhana Basti in the management of Sthaulya.

Materials and Methods

Research is essential for diagnosis of disease, development of new treatment and gives the latest information. It often led to effective treatment that helps people to improve quality of life. Keeping this in mind the present study was taken into consideration. A case study was planned “Comparative study to evaluate the efficacy of Madhutailik Basti in comparison to Lekhana Basti in the management of Sthaulya (Obesity)” in randomly selected 60 clinically diagnosed and confirmed cases of Sthaulya (Obesity) from OPD of Ch. Brahm Prakash Ayurved Charak Sansthan, Khera Dabar, New Delhi.

Plan of Study

Pre-Clinical screening: Complete medical history of patients with necessary physical examination was done.

Clinical screening: A detailed case history proforma was specially prepared for this purpose. All the following mentioned points were recorded in this proforma before the initiation of the trial. A total of 66 patients suffering from Sthaulya (Obesity) fulfilling the inclusion criteria were taken for the study and 60 patients completed the trial.

Eligibility Criteria

Inclusion Criteria

  • Patients which are willing to participate in the study.
  • Patients of age group 20-50 years irrespective of the gender.
  • Patients having clinical features of Sthaulya.
  • Patients with BMI 25-40 Kg/m2.

Exclusion Criteria

  • Patients which are not willing for participation in the study.
  • Patients of age less than 20 years and more than 50 years.
  • Patients which are suffering from Diabetes Mellitus, Uncontrolled Hypertension, Coronary Heart Disease, Chronic Kidney Disease.
  • Pregnant and lactating mothers.
  • Patients who are unfit for Basti Karma[9] as mentioned in the texts- Pandu, Unmada, Visuchika, Alasaka, Kushtha, Hikka, Swasa, Kasa, Bala, Vriddha, Chidrodara, Murchita, etc.

Withdrawal Criteria

  • If Patients willing to quit in between project, he/she will be allowed to quit and will be replaced.
  • If any serious illness develops during the procedure, he/she would be treated accordingly and would be replaced.

Procedure Protocol

Patients were randomly divided and studied under two groups viz. Group A and Group B irrespective of religion, sex, occupation, cast etc.

Group A - Kala Basti with Madhutailik Basti and Murchita Tila Taila[10] Anuvasana Basti.

Group B - Kala Basti with Lekhana Basti and Murchita Tila Taila Anuvasana Basti.

Kala Basti Schedule

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

A - Stands for Anuvasana Basti.

N - Stands for Niruh Basti/Asthapana Basti.

  • Time of administration of Madhutailik Basti/ Lekhana Basti - empty stomach in the morning.
  • Quantity of administration - 640 ml.
  • Time of administration of Murchita Tila Taila Anuvasana Basti - After taking lunch in the afternoon.
  • Quantity of administration - 120 ml
  • Frequency - once a day.

Duration of clinical trial and follow up study

Total duration of trial: 24 days for each patient.

Follow up screening: Initial assessment - 0 day, then on 16th day and follow-up on 24th day to evaluate their clinical status and to observe the effect or adverse effect of treatment.

Diet and Exercise

Patients of both the group


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have been advised to adhere to the Pathya Ahara and Vihara. Beside this patient is advised to do exercise and Yogasana and brisk walking for half an hour daily.

Assessment Criteria

Patient will be assessed on the basis of subjective and objective criteria.

Subjective Criteria[11]

Sign and symptoms of Sthaulya which are subjective in nature described in Ayurveda will be used for symptomatic evaluation for which scoring pattern will be adopted.

01. Chala Sphika Udara Stana

SNFeaturesGrading
1.Absence of Chalatva.0
2.Little visible movement after fast movement.1
3.Little visible movement after moderate movement.2
4.Movement after mild movement.3
5.Movement even after changing posture.4

02. Alasya/Utsahahani

SNFeaturesGrading
1.Doing work satisfactorily with proper vigour.0
2.Doing work satisfactorily with late initiation.1
3.Doing work satisfactorily under mental pressure and takes time.2
4.Not starting any work on his own responsibility and doing little work very slowly.3
5.Does not take initiation and does not want to work even after pressure.4

03. Kshudra Shwasa

SNFeaturesGrading
1.Dyspnoea after heavy work but relieved soon and up to tolerance.0
2.Dyspnoea after moderate work but relieved later and up to tolerance.1
3.Dyspnoea after little work but relieved later and up to tolerance.2
4.Dyspnoea after little work but not relieved later and beyond tolerance.3
5.Dyspnoea in resting condition.4

04. Daurbalya

SNFeaturesGrading
1.Feeling of well-being.0
2.Tired after doing strenuous physical activity.1
3.Tired after doing moderate physical activity but can perform daily chores.2
4.Perform daily chores with difficulty.3
5.Extreme tired to carry out daily routine work.4

05. Ati Nidra

SNFeaturesGrading
1.Sleep up to 6-8 hours/day.0
2.Sleep up to 8-10 hours/day.1
3.Sleep up to 10-12 hours/day.2
4.Sleep up to 12-14 hours/day.3
5.Sleep up to > 14 hours/day.4

06. Swedaadhikya

SNFeaturesGrading
1.Normal Perspiration.0
2.Mild perspiration after doing exertion.1
3.Increased perspiration after doing little exertion.2
4.Profuse perspiration after doing little exertion.3
5.Perspiration without exertion.4

07. Daurgandhya

SNFeaturesGrading
1.Absence of body odour.0
2.Occasional body odour removed after bathing.1
3.Persistent body odour limited to closed areas difficult to suppress with deodorants.2
4.Persistent body odour felt from long distance not suppress with deodorants.3
5.Persistent body odour felt from long distance not tolerated by patient himself.4

08. Ati Pipasa

SNFeaturesGrading
1.Drinks about 8-10 glass of water daily.0
2.Drinks about 10-15 glass of water daily.1
3.Drinks about 15-20 glass of water daily.2
4.Drinks about 20-25 glass of water daily.3
5.Unable to have a sound sleep for his thrust.4

Objective Criteria

Body Weight

The assessment was done before and after the treatment and during the follow-up period.

Statistical Analysis

The information gathered on the basis of observation made about various parameters was subjected to statistical analysis in term of Mean, Standard Deviation and Standard error.

For subjective parameters, within group p-value compared using ‘Friedman test’ and Between group p-value compared using ‘Mann – Whitney test’.

For Objective Parameter, within group p-value compared using Repeated Measure Anova, post hoc comparisons have been done using Bonferroni inequality and Between group p-value compared using independent sample t-test.

The results were calculated.

Not significant: P > 0.05

Significant: P < 0.05

Highly significant: P < 0.001



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Observations and Results

Overall effect of Therapy

Within group p-value compared using ‘Friedman test’.

SNParametersP value in Group ASignificanceP value in Group BSignificance
1.Chalsphikaudarstana<0.001HS<0.001HS
2.Alasya/Utsahahani0.368Insignificant0.135Insignificant
3.Kshudra Shwasa0.039Significant0.002Significant
4.Daurbalya<0.001HS<0.001HS
5.Atinidra<0.025Significant<0.025Significant
6.Daurgandhya<0.001HS<0.001HS
7.Swedadhikya0.135Insignificant0.050Insignificant
8.Atipipasa0.223Insignificant0.005Significant

In Group A, Value of P is less than 0.05 in Chala Sphika Udara Stana, Kshudra Shwasa Daurbalya, Atinidra and Daurgandhya Parameters, significant difference was observed between means of BT and AT score. Hence it is concluded that these 5 parameters are significantly decreased while value of P is more than 0.05 in Alasya/ Utsahahaani, Swedaadhikya and Atipipasa parameters means there was no statistically significant difference between mean of BT and AT score. Therefore, it is concluded that these 3 parameters are almost same before and after treatment.             

In Group B, Value of P is less than 0.05 in Chala Sphika Udara Stana, Kshudra Shwasa Daurbalya, Atinidra, Daurgandhya and Atipipasa Parameters, significant difference was observed between means of BT and AT score. Hence it is concluded that these 6 parameters are significantly decreased while value of P is more than 0.05 in Alasya/ Utsahahaani and Swedaadhikya parameters means there was no statistically significant difference between mean of BT and AT score. Therefore, it is concluded that these two parameters are almost same before and after treatment.

Mann Whitney’s Test: Subjective Parameters

Comparison in Group A and Group B

SNParametersComparison of P ValueResult
1.Chalsphikaudarstana0.153Insignificant (A ≈ B)
2.Alasya/Utsahahaani0.019Significant
3.Kshudra Shwasa0.622Insignificant (A ≈ B)
4.Daurbalya0.027Significant
5.Atinidra0.051Insignificant (A ≈ B)
6.Swedadhikya0.318Insignificant (A ≈ B)
7.Daurgandhya0.992Insignificant (A ≈ B)
8.Atipipasa0.537Insignificant (A ≈ B)

In between comparison of both the groups, P value is more than 0.05 in six Subjective Parameters viz.

Chalasphika Udara Stana, Kshudra Shwasa, Atinidra, Swedaadhikya, Daurgandhya and Atipipasa and it is less than 0.05 in two Subjective Parameters viz. Alasya/ Utsahahani and Daurbalya. Therefore, it is concluded that there is a significant difference in Madhutailik Basti and Lekhana Basti group in order to decrease these two symptoms of Sthaulya.

So, on comparison between Group A and Group B

  • Group A was found better than Group B in reducing Daurbalya
  • Group B was found better than Group A in reducing the Alasya/Utsahahaani

Jaims_2700_01.jpg
Graph 1: Showing % Relief in Subjective parameters.

Graph shows % relief in Madhutailik Basti Group on Chala Sphika Udara Stana symptom of obesity is 25.40% and Lekhana Basti group is 34.10%. Relief on Alasya/Utsaha Hani symptom in Madhutailik Basti group is 4.20% and in Lekhana Basti group is 5.5%. Better effect of Lekhana Basti was observed as compared to Madhutailik Basti on Kshudra Shwasa after treatment (22.9% v/s 11.5%). Better effect of Madhutailik Basti was observed as compared to Lekhana Basti on Daurbalya after treatment (38.6% v/s 23.7%). It was observed that effect of the treatment was slightly better in Lekhana Basti group as compared to Madhutailik Basti (9.5% compared to 6.4%) on Ati Nidra symptom. Effect of the treatment on Swedaadhikya was better in Lekhana Basti group as compared to Madhutailik Basti group (% change/relief was 26.8% as compared to 19.5%). Similarly, effect of the treatment on Daurgandhaya was slightly better in Lekhana Basti group as compared to Madhutailik Basti group (% relief was 10% as compared to 7%). Effect of the treatment on Ati Pipasa was better in


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Lekhana Basti group (% relief = 18.5%) as compared to Madhutailik Basti group (% relief = 5.66%).

Average % Relief in Subjective Parameters

In Group A, Average % Relief was 14.79% and in Group B, Average % Relief was 18.87%. Hence according to % relief in symptoms, Lekhana Basti is more effective than Madhutailik Basti in Sthaulya (Obesity).

Objective Parameter

SNParametersP value in Group ASignificanceP value in group BSignificance
1.Body weight<0.001HS<0.001HS

(Within group p-value compared using Repeated Measure Anova, post hoc comparisons have been done using Bonferroni inequality.)

In Group A as well as in Group B, Value of p is less than 0.001, significant difference was observed between mean of BT and AT score. Hence it is concluded that Body weight is significantly decreased in both the groups.

Independent T Test: Objective Parameter Comparison in Group A and Group B.

SNParametersComparison of P ValueResult
1.Body weight 0.004Significant

The P value is less than 0.05 in Objective Parameter, the mean difference between Group A and Group B was significant. Therefore, it is concluded that there is significant difference in Madhutailik Basti and Lekhana Basti group in order to decrease Body weight.

  • Group B was found better than Group A in reducing the Body Weight.

Jaims_2700_02.jpg
Graph 2: Showing % Relief in Objective parameter.

In the case of Objective parameter i.e., Body weight, Effect of Lekhana Basti was more as compared to Madhutailik Basti (% change was 1.71% v/s 1.48 %).

Discussion

After completion of clinical trial, all data was collected in Case Record Forms. Collected data was tabulated, classified and presented in the forms of tables and graphs. Data was then analysed statistically in order to draw interference. When compared, Average % Relief was 14.79% in group A and Average % Relief was 18.87% in Group B. Hence according to % relief in symptoms, Lekhana Basti is more effective than Madhutailik Basti in Sthaulya (Obesity) in reducing subjective parameters. Both treatments have decreased Body weight. Change in objective parameter is more in Group B than in Group A. Hence Lekhana Basti is more effective than Madhutailik Basti in Sthaulya in reducing body weight.

As the name suggests itself, Madhutailik Basti has Madhu and Tila Taila as the main contents. Main role of Madhu is to increase the retention time of Basti by counteract the irritative property of Saindhava. Honey contains natural sugars which are quickly absorbed by digestive system and converted into energy. In some research articles it is explained that obesity is accompanied by chronic inflammation mediated by oxidative stress[12] and Honey is very good antioxidant so it is obvious that honey is beneficial for obese patients. Madhu has Sukshma, Kaphashamak, Chedana, Lekhana and Srotoshodhana property which can help the medicated drugs to reach at micro level in all over body and clearing out all the aggravated Kapha Dosha and Vikriti Meda Dhatu from the channels of body, cleanses the Srotas and clearing the obstruction of Srotas. It’s Ruksha Guna counteract Snigdha Guna of the aggravated Kapha Dosha and Meda Dhatu. Madhu is also mentioned in Sthaulya Chikitsa.

Tila Taila is an oily compound so it increases the permeability of cell membrane and become helpful in the elimination of Dosha and Mala. Tila Taila has Sukhsma Guna through which it has the capability to reach all micro channels of the body. By its Lekhana Guna it can scrape out the viscid Kapha, by Vikasi Guna it pacifies the aggravated Dhatu and aggravated Kapha Dosha and Vyavayi Guna


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helps in fast spreading of drug throughout the body. It has Tikta Rasa and Kashaya Anurasa which counteract the aggravated Kapha Dosha. Because of it Vyavayi, Sukshma, Tikshna and Ushna property it helps in reducing the aggravated Meda Dhatu in Sthaulya.

Apart from Madhu and Taila, Erandamoola Kwatha is another main content in Madhutailik Basti. Eranda has Ushna property due to which it has Vatakaphahara Guna. It has aphrodisiac action also which helps in improving impotent condition in Sthaulya. These drugs, by virtue of their Ushna Virya acts on Kapha-Vata. In Medo Roga, excessive Meda Vridhi occurs along with production of Ama Rasa. Madhutailik Basti breaks the Srotosanga. So, the active principle reaches to the cellular level. Erandamoola Kashaya causes Shoshana, Lekhana, Amahara Karma due to Tikta, Katu and Kashaya Rasa.

Conclusion

Sthaulya (Obesity) is very prevalent disease in today’s world which is causing physical, mental, and social impact on the suffering individual. It is common in middle age, females, married woman, housewife and educated people. Administration of Lekhana Basti as well as Madhutailik Basti showed good results in the management of Sthaulya (obesity). Clinically, Lekhana Basti is found slightly better than Madhutailik Basti in reducing the parameters of Sthaulya. Average relief in parameters of Sthaulya (obesity) found more better in Lekhana Basti (18.87%) than Madhutailik Basti (14.79%). One interesting thing to note that Acharya Sharangdhara told Medonashaka as well as Brihana property of Madhutailik Basti so there is further scope for new researchers to conduct a study in both Sthula as well as Krisha patients.

References

1. Flier JS, Maratos-Flier E. Biology of obesity. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. Harrison’s Principles of Internal Medicine. 17th ed. New York: McGraw Hill; 2008. p. 462.

2. Flier JS, Maratos-Flier E. Biology of obesity. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. Harrison’s Principles of Internal Medicine. 17th ed. New York: McGraw Hill; 2008. p. 463.

3. Ahirwar R, Mondal PR. Prevalence of obesity in India: A systematic review. Diabetes Metab Syndr. 2019 Jan-Feb;13(1):318-321. DOI: 10.1016/j.dsx.2018.08.032. PMID: 30641719.

4. Pandey KS, Chaturvedi G. Charak Samhita; savimarsh vidiyotini hindi vyakhya (first part). Reprint 2020. Varanasi: Chaukhambha Bharati Academy; Sutra Sthana 21/3, p. 355.

5. Pandey KS, Chaturvedi G. Charak Samhita; savimarsh vidiyotini hindi vyakhya (first part). Reprint 2020. Varanasi: Chaukhambha Bharati Academy; Sutra Sthana 21/9, p. 357.

6. Pandey KS, Chaturvedi G. Charak Samhita; savimarsh vidiyotini hindi vyakhya (first part). Reprint 2020. Varanasi: Chaukhambha Bharati Academy; Sutra Sthana 20/17, p. 352.

7. Pandey KS, Chaturvedi G. Charak Samhita; savimarsh vidiyotini hindi vyakhya (first part). Reprint 2020. Varanasi: Chaukhambha Bharati Academy; Sutra Sthana 23/6, p. 379.

8. Srivastava S. Sharangadhar Samhita of Acharya Sharangdhar "Jiwanprada" hindi commentary. Reprint 2017. Varanasi: Chaukhambha Orientalia; Uttar Khanda ch.6, p.387/29-31.

9. Pandey KS, Chaturvedi G. Charak Samhita; savimarsh vidiyotini hindi vyakhya (second part). Reprint 2020. Varanasi: Chaukhambha Bharati Academy; Sidhi Sthana 2/14, p. 902.

10. Shastri KA. Jvararogadhikar 5/1286-1287. Bhaisjya Ratnavali. Varanasi: Chaukhambha Prakashana; 2018. p. 85-186.

11. Nagar S. Comparative study to evaluate the efficacy of Madhudaka and Manda in the management of Sthaulya (Obesity) [thesis]. New Delhi: CBPACS; 2020. p. 77.

12. Skalicky J, Muzakova V, Kandar R, et al. Evaluation of oxidative stress and inflammation in obese adults with metabolic syndrome. Clin Chem Lab Med. 2008;46:499–505.


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