E-ISSN:2456-3110

Review Article

Ayurveda

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 1 January
Publisherwww.maharshicharaka.in

Concept of Sthoulya in Ayurveda and its management with Pathya Apathya

Chauhan S1*, Ram M2, Jaiswal RT3, Dubey RK4
DOI:10.21760/jaims.9.1.10

1* Simran Chauhan, Post Graduate Scholar, Dept of Samhita evam Siddhant, Government PG Ayurvedic College and Hospital, Varanasi, Uttar Pradesh, India.

2 Manohar Ram, Reader and HOD, Dept of Samhita evam Siddhant, Government PG Ayurvedic College and Hospital, Varanasi, Uttar Pradesh, India.

3 Ramnihor Tapsi Jaiswal, Reader, Dept of Samhita evam Siddhant, Government PG Ayurvedic College and Hospital, Varanasi, Uttar Pradesh, India.

4 Ramesh Kant Dubey, Reader, Dept of Swasthavrutta, Government PG Ayurvedic College and Hospital, Varanasi, Uttar Pradesh, India.

According to WHO - 39% of adults aged 18 year and over were overweight in 2016 and 13% were obese. Over 340 million Children and adolescent aged 5-19 were overweight or obese in 2016. 39 million children under the age of 5-19 were overweight or obese in 2020.[1] The prevalence of Sthoulya (obesity) is increasing worldwide in all age groups. Sthoulya is a burgeoning global problem due to change in life style, Faulty diet pattern and decrease interest in the Exercise which lead to Hypertension, Diabetes mellites, Atherosclerosis and other non-communicable disease. Ayurveda is the science of life according to Ayurveda Samhitas Sthoulya is a Santarpanjanya Vyadhi which is described in Astonindatiya Adhyaya in Sutrasthana of Charak Samhita in detail. In Sthoulya disease mainly Medo Vaha Srotas is affected due to which their overgrowth of Medodhatu and this process eventually manifests as Sthoulya. In Ayurveda several measures are given by which we can reduce the risk of Sthoulya by the help Ahaar Vihaar and Aushadha. A study has shown that how Triphala Tail and Triphala Churna act on Samprapti of Sthoulya and breaks it to reduce the Meda which is the main cause of Sthoulya.

Keywords: Sthoulya, Santarpanjanya Vyadhi, Astonindatiya Adhyaya, Medovaha Srotas, Medodhatu, Triphala Churna, Triphala Tail.

Corresponding Author How to Cite this Article To Browse
Simran Chauhan, Post Graduate Scholar, Dept of Samhita evam Siddhant, Government PG Ayurvedic College and Hospital, Varanasi, Uttar Pradesh, India.
Email: 		Chauhan S, Ram M, Jaiswal RT, Dubey RK, Concept of Sthoulya in Ayurveda and its management with Pathya Apathya. J Ayu Int Med Sci. 2024;9(1):84-89.
Available From
https://jaims.in/jaims/article/view/2908

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-11-15 2023-11-20 2023-11-25 2023-11-30 2023-12-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 21.98%

© 2024by Chauhan S, Ram M, Jaiswal RT, Dubey RKand 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 prevalence of Sthoulya (obesity) is increasing worldwide in all age groups. According to Ayurvedic Samhitas Sthoulya is a Santarpanjanya Vyadhi which is described in Astonindatiya Adhyaya in Sutrasthana of Charaka Samhita in detail. In Sthoulya disease mainly Medovaha Srotas is affected due to which there is overgrowth of Medodhatu and this process eventually manifests as Obesity disease. The prevalence of Sthoulya (obesity) is increasing worldwide in all age groups. According to Ayurvedic Samhitas, Sthoulya is a Santarpanjanya Vyadhi which is described in Astonindatiya Adhyaya in Sutrasthana of Charaka Samhita in detail. In Sthoulya disease mainly Medovaha srotas is affected due to which there is overgrowth of Medodhatu and this process eventually manifests as Obesity disease.

The over obese has eight defects[3]

आयुषो ह्रासो (Shorting of life span)

जवोपरोधः (Deranged movement)

कृच्छव्यवायता (Difficulty in sexual inter course)

दौर्बल्यं (General debility)

दौर्गन्ध्यं (Foul smell from the body)

स्वेदाबाधः (Excessive sweating)

क्षुदतिमात्रं (Excessive hunger)

पिपासातियोगश्चेति (Excessive thirst)

Causes[3,4]

गुरुमधुरशीतस्निग्धोपयोगादव्यायामादव्यवायाद्दिवास्वप्नाद्धर्पनित्यत्वाद- चिन्तनाद्वीर्जस्वभावाच्चोपजायते I (Ch. Su.21/4)

अव्यायामदिवास्वप्नश्लेष्मलाहारसेविनः । मधुरोऽन्नरसः प्रायः स्नेहान्मेहो विवर्द्धयेत् I (Yogratnakar 40/1 , Bh.39/1)

Acc. to Brihatrayi and Laghutrayi

  • Intake of heavy, sweet, cold and fatty diet
  • Lack of physical exercise
  • Abstinence from sexual intercourse
  • Indulgence in day sleeping
  • Exhalation or excessive cheerfulness
  • Lack of mental work
  • Genetic defect or hereditary one

Pathophysiology of obesity (Sthoulya)

मेदसाऽऽवृतमार्गत्वाद्वायुः कोष्ठे विशेषतः । चरन् संधुक्षयत्यग्निमाहारं शोषयत्यपि ॥५॥

तस्मात् स शीघ्रं जरयत्याहारं चातिकाङ्क्षति । विकारांश्चाश्नुतेघोरान् कांश्चित्कालव्यतिक्रमात् ॥६॥

एतावुपद्भवकरौ विशेषादग्निमारुतौ । एतौ हि दहतः स्थूलं वनदावो वनं यथा ॥७॥

मेदस्यतीव संवृद्धे सहसैंवानिलादयः । विकारान्दारुणान् कृत्वा नाशयन्त्याशु जीवितम् ॥८॥ (Ch.Su.21/5,6,7,8)

Due to excessive accumulation of Meda in the body Vata gets obstruction to its normal movement as a result Vata is specially confined to Kostha leading to stimulation of digestive power and absorption of the food. Digestion of consumed food become very fast due to enhanced Agni that’s person eats more and more amount of food. In case of delay in taking food, he is afflicted with some serious disorders because it digest the Dhatus. The Agni and Vata are the two most troublesome and complicating and burns the obese individual like the forest fire burning forest. In the event of excessive increase of fat, Vata etc which may lead to development of severe disorders and destroy the life of an individual instantaneously.

Complication

According to Yogratnakar

Prameha

Hridroga (can be correlated with Kaphaj Hridroga)

Atisar

Arsha

Shleepada

Apachi

Kamala

Symptoms

मेदोमांसातिवृद्धत्वाच्चलस्फिगुदरस्तनः । अयथोपचयोत्साहो नरोऽतिस्थूल उच्यते ॥९॥ (Ch.Su.21/9, Yogratnakar 40/9)

Due to increase in fat and flesh, the person buttocks, abdomen and breasts keep on shaking. The body does not grow properly. He does not have proper enthusiasm and should be considered as a symptom of obesity.


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Chikitsa Siddhant

  • Nidan parivarjan
  • गुरु चातर्पणं चेष्टं स्थूलानां कर्शनं प्रति । (Ch.Su.21/20)
  • Very obese people should be given Guru & Aptarpan diet to make them
  • क्षौद्रेण त्रिफलाक्वाथः पीतो मेदोहरः स्मृतः । शीतीभूतं तथोष्णाम्बु मेदोहृत्क्षौद्रसंयुतम् (Yogratnakar 40/12)[9]
  • Food and drinks alleviating Vata and reducing Kapha and Fat, Hot and sharp Enema, use of Guduchi, Devdaru, Musta, Triphala, Takrarishta, Honey is recommended for removing the over Obesity.
  • Use of Vidanga, Shunthi, Yavakshara, and Ash powder of black Iron mixed with Honey, Powder of Barley, Amla juice mixed with Honey.
  • Use of Bilvadi Panchmula mixed with honey and Shilajatu along with the juice of Agnimantha is recommended.
  • Physical and mental exercise.
  • Use of urinary laxatives.
  • Abhyanga and Udvartana with Triphaladi Tail and Triphala

Chikitsa[5]

1. Sansodhana Chiktsa
2. Samshaman Chikitsa

Sansodhan Chikitsa

1. Vaman
2. Virachan
3. Niruha Basti
4. Karshan Nasya

Sanshaman Chikitsa

Rasa/Bhasma/Pisti

  • Parad Bhasma - 125-250 mg (Anupan - Madhu)
  • Trimurti Rasa - 125-250 mg ( Anupan - Madhu)

Vati

  • Arogyavardhini Vati - 250-500 mg (Anupan Madhu/hot water)

Churna

  • Triphala Churna - 3-6 gm (Anupan - Madhu/hot water)
  • Vacha Churna - 3-6 gm
  • Vidangadi Churna - 3-6 gm
  • Phaltrikaadi Churna – 3-6 gm

Kwatha/Aasav-Arista

  • Musthaadi Kwath - 10-20 ml (Anupan - water)
  • Phalatrikadi Kwath
  • Agnimanthaadi Kwath
  • Lohasava

Guggulu Yoga

  • Medohar Gugglu
  • Trayodashanga Gugglu

Ekal drugs

Gugglu, Vacha, Haritki, Gomutra, Aamlaki, Shunthi, Patola, Guduchi,

Kshara Yoga - Yava Kshara, Apamarga Kshara, Eranda Kshara

Sattu Yoga - Vyosahdhya Sattu, Trayushadhya Sattu

Vihar (Yoga Asana)

Halasana, Mayurasan, Shirshasana, Naukasana, Pranayama, and Meditation, Suryanamaskar, Pawanmuktasana.

Exercise

It is very useful to treat Obesity. Extra calories should be burnt with exercise.

Mode of action of Triphaldi Tail Abhyanga in Sthoulya[7]

Acharya Dalhana has explained in detail about the absorption of Sneha used in Abhyanga procedure. According to that the oil used in Abhyanga reaches the different Dhatus one by one like Ksheera Dhadhi Naya and Kadar Kulya Naya if it applied for the sufficient time.

Triphala Tail Abhyanga
↓
Guna - Due to Ushna and Teekshna Guna of Dravya
↓
Kapha Meda Vilayana
↓
Abhyanga effect
↓
Due to Veerya of Dravya - Enters in to Romakupa
↓
Open the Mukha of Siras
↓
Paka


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of Kapha and Meda Dhatu
↓
Evacuation of Vikrutha Dosha and Dushya
↓
Nirharana of Vikrutha Vata, Kapha and Aapya Dhatu along with Meda
↓
Shareera Laghavata

Mode of action of Triphala Churna Udhvartana in Sthoulya

Udvartana with Triphala Churna
↓
Bhrajaka Pitta in Twacha Absorbs Triphala
↓
Paka Vilinata of Kapha Dosha and Meda occur
↓
Triphala because of Ruksha Gunatmaka
↓
Absorbs Prithakatwa Mala through sweat

By Udvartana - Remove Undesirable Meda from Sphik, Udara, Vaksha.

  • Udvartana is the best Bahir Parimarjana Chikitsa for Madhyama Sthoulya.
  • According to Charaka it has been attributed to Bhibhatsahara and
  • Dourghandyahara, which are the commonest stigmas of Sthoulya person.

Pathya Ahara in Sthoulya[8]

  • Anna Varga - Purana Shali, Rakta Shali, Shasthika Shali, Yava, Chanaka.
  • Jalavarga - Shruta Sheeta Jal, Panchkola Shruta Jal, Sunthi Siddha Jal.
  • Madyavarga - Purana Sidhu.
  • Mutravarga - Gomutra.
  • Kandavarga - Lasuna, Sunthi, Ardraka.
  • Ksheeravarga - Takra
  • Shakavarga - Patola, Karavellaka, Shigru, Nimbpatra.
  • Mamsavarga - Jangalmamsa.

Apathya Ahara in Sthoulya[8]

  • Anna Varga - Navanna, Masha.
  • Jalavarga - Dusita Jala, Sheet Jala.
  • Madyavarga - Nutana Madya.
  • Ksheeravarga - Dadhi, Ksheera.
  • Mamsavarga - Anupamamsa

Modern Aspects

What Is Obesity or Overweight

Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health BMI is a simple index of weight for height that is commonly used to classify overweight and obese in adults. It is defined as a person’s weight in kilogram divided by the square of his hight in meters (kg/m).

Adults

  • Overweight is a BMI greater than equal to 25
  • Obesity is a BMI greater than or equal to 30

Children Aged Between 5-19 Year

  • Overweight is BMI for age greater than 1 standard deviation above the WHO growth reference.
  • Obesity is greater than 2 standard deviations above the WHO growth reference.

Body Mass Index (BMI)[1]

Acc.to WHO

jaims_2908_02.jpg

What Cause Obesity and Over Weight

The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expanded Globally, there has been;

  • An increased intake of energy dense foods that are high in fat and sugar
  • An increase in physical inactivity due to increasingly sedentary nature of many forms of work, and increasing urbanization

Changing in dietary and physical activity pattern are often the result of environmental and societal changes associated with development and lack of supportive policies in sectors such as health, agriculture, urban planning, environment, food processing, education.

What are the symptoms of Obesity?[2]

  • Excess body fat, particularly around the waist.
  • Shortness of breath.
  • Sweating more than usual.

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  • Skin problems from moisture accumulating in the folds.
  • Inability to perform simple physical tasks you could easily perform before weight gain.

Complications

  • Type 2 diabetes mellitus
  • Hypertension
  • Coronary heart disease
  • Breathlessness
  • Hirsutism
  • Infertility
  • Psychological depression
  • Varicose veins

How can Overweight and Obesity be reduced

  • Limit energy intake from total fats and sugars.
  • Increase consumption of fruit and vegetable, as well as legumes, whole grains and nuts.
  • Engage in regular physical activity.
  • The food industry can play a significant role in promoting healthy diets by;
  • Reduced the fat, sugar and salt content of processed food.
  • Ensuring that healthy and nutritious choices are available and affordable to all consumers.
  • Restricting marketing of foods high in sugar, salt and fat, especially those foods aimed at children and teenagers

Some Useful Tips

  • Maintain a regular daily routine. Wake up before 6.00am
  • Exercise at morning at least 40min/day
  • Eat light nourishing breakfast - cooked apple, toast, cooked barley,
  • Boil water with fresh ginger and drink frequently throughout the day
  • Do not sleep during day
  • Avoid eating late at night
  • Eat only after digestion of previous food
  • Eat only when you are hungry. Find out correct quantity for you
  • Take a walk after meal

Conclusion

At the end it can be concluded that Sthoulya is Santarpanjanya Vyadhi and is a Kashtasadhya Vyadhi which can be correlated with Obesity in present era and caused by improper lifestyle and food habbits. Ayurveda is the Science of Life which explains how longevity and health can be maintained by Ahaar and Vihaar. In Ayurveda several measures are given by which we can reduce the risk of Sthoulya or Obesity by the help of Ahaar, Vihaar and Aushadha. A study has shown that how Triphaladi Tail and Triphaladi Churna act on Samprapti of Sthoulya and breaks it to reduce the Meda which is the main cause of obesity. Nidan Parivarjan is the main treatment firstly we should apply. Kapha Pradhana Prakriti persons are more prone to Sthoulya. Kapha, Meda and Vata Dosha are the main Dosha and Dushya responsible for Sthoulya manifestation. Sansodhan and Sanshaman Chikitsa should be given in patients of Sthoulya.

References

1. WHO. Obesity and Overweight [Internet]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and weight.

2. Patley S, Kande A, Diwan R. A Review Article in World Journal of Pharmaceutical Research. World J Pharm Res. 2018;7(16):133-142.

3. Sharma PV. Charaka Samhita Part 1. Chaukhambha Orientalia, Varanasi; 2004. 9th ed. Sutra Sthana 21/3:144.

4. Sharma PV. Charaka Samhita Part 1. Chaukhambha Orientalia, Varanasi; 2004. 9th ed. Sutra Sthana 28/1:229.

5. Sharma AK. Kaya Chikitsa, Part 3rd. Chaukhambha Orientalia, Delhi; 2011. P. 174-177, 180.

6. Dhanya KV. A Birds Eye View on Metabolic Syndrome with Special Reference to Obesity (Sthoulya). IAMJ. 2017 Jun; ISSN 2320-5091:1972.

7. Tabassum, Patil UA. A review Article of A comparative Clinical study of Triphaladi Taila Abhyanga and Triphaladi Choorna Udhvartana in Management of Sthoulya. J
Ayurveda Integr Med Sci (JAIMS).

8. Humanabad S, Katti BH,


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Kannolli GN, Sajjanshetty MR. Ahara as Pathya and Apathya in Sthoulya (Obesity). JAIMS.

9. Yogratnakar. Siddhinandan Mishra, Acharya. Siddhiprada Vyakhaya Yukta. Chaukhambha Orientalia. Chapter 40/9.


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