E-ISSN:2456-3110

Review Article

Obesity

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 10 OCTOBER
Publisherwww.maharshicharaka.in

Overview of Sthaulya (Obesity) management In Ayurveda

Kumar Y1*, Joshi PK2, Patel H3, Sahu KV4, Rathour G5
DOI:10.21760/jaims.9.10.8

1* Yashvant Kumar, Post Graduate Scholar, Department of Dravyaguna Vigyan, Shri Npa Govt Ayurved College, Raipur, Chhattisgarh, India.

2 Pravin Kumar Joshi, Professor and HOD, Department of Dravyaguna Vigyan, Shri Npa Govt Ayurved College, Raipur, Chhattisgarh, India.

3 Harsha Patel, Post Graduate Scholar, Department of Dravyaguna Vigyan, Shri Npa Govt Ayurved College, Raipur, Chhattisgarh, India.

4 Kumar Vikram Sahu, Post Graduate Scholar, Department of Dravyaguna Vigyan, Shri Npa Govt Ayurved College, Raipur, Chhattisgarh, India.

5 Geetu Rathour, Post Graduate Scholar, Department of Kriya Sharir, Shri Npa Govt Ayurved College, Raipur, Chhattisgarh, India.

Globally, there is a greater correlation between overweight and obesity and mortality than underweight. An epidemic-like chronic health issue that affects people all around the world is obesity. Over 135 million people in India suffered from obesity. In Sthaulya, a Dushya dominant condition, there is an excess of Medodhatu production due to Medodhatvagni Mandya, which leads to obesity. One of the main diseases of the modern period is obesity. According to the World Health Organisation, obesity is one of the most ignored public health issues that impact people of all ages worldwide. The primary causes of obesity include sedentary lifestyles, increased fast food consumption, and decreased physical activity. In Ayurveda, numerous Acharyas have described Sthaulya (Obesity), which is attributed to Santarpanajanya Vyadhi.[1] Numerous medicinal preparations, medications, including Pathya-Apathya, Dinacharya, Yogasana, and are detailed in Ayurvedic texts and have been shown to significantly reduce and prevent this worldwide problem. An attempt has been made to examine obesity from both an Ayurvedic and a modern perspective, as well as to determine whether Ayurveda offers any plausible remedies for obesity. This article sheds light on the classification, etiopathology of Sthaulya, including its signs and symptoms, therapeutic care using medication, and preventive measures like Nidan Parivarjan, Pathya-Apathya, and Dinacharya, Apatarpan Chikitsa etc. should be done.

Keywords: Sthaulya, Obesity, Medodhatvagni Mandya, Santarpanajanya Vyadhi, Apatarpan Chiktsa, Pathyaapathya

Corresponding Author How to Cite this Article To Browse
Yashvant Kumar, Post Graduate Scholar, Department of Dravyaguna Vigyan, Shri Npa Govt Ayurved College, Raipur, Chhattisgarh, India.
Email: 		Kumar Y, Joshi PK, Patel H, Sahu KV, Rathour G, Overview of Sthaulya (Obesity) management In Ayurveda. J Ayu Int Med Sci. 2024;9(10):53-58.
Available From
https://jaims.in/jaims/article/view/3934

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-09-13 2024-09-23 2024-10-03 2024-10-12 2024-10-24
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 13.58

© 2024by Kumar Y, Joshi PK, Patel H, Sahu KV, Rathour Gand 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

Now a days, Obesity is a major global issue. because of the rise in popularity of fast food and changes in lifestyle. Previously considered a lifestyle disorder, the World Health Organisation has now categorised it as a disease. Any person whose body mass index (BMI) is 30 kg/m² or higher is considered obese by the World Health Organisation. In 1997, the World Health Organization's press stated that obesity has so many different and severe effects that it should be considered one of the most significant but underappreciated health issues of our day, maybe having an even greater negative influence on health than smoking. In both industrialised and emerging nations, the prevalence of obesity is rising.[3]

Obesity is associated with Sthaulya or Medoroga in Ayurveda. According to Acharya Charaka, it is regarded as one of the eight disgusting situations (Ashta Nindit Purush). He considered it as Kapha Nanatmaja Vikar and Santarpanjanya Vyadhi.[4]

According to Acharya Sushruta, it is as Rasa Nimittaja Vyadhi and result of disrupt Medovaha Srotas.[5] Obesity is a condition where Medodhatvagani Mandya causes an abnormal increase in Vikruti of Medodhatu. Excessive Mamsa and Meda buildup resulting in breast, abdominal, and hip flabbiness. It is classified as Sthaulya.An abnormal and excessive build-up of fat in adipose tissue is called obesity. It results from consuming more calories than the body needs each day, with the extra calories being turned into fat and stored in the body.

Materials and Methods

Information about obesity has been compiled from several Ayurvedic text books. Like Charaka Samhita, Sushrut Samhita, Asthang Hridayam, Asthang Sangraham, etc.

Additionally gathered using a number of search engines, including PubMed, Scopus, Medline, and Google Scholar. These references underwent thorough comparison and analysis.

Classification[6]

Disease classification should be based on several factors, such as onset, severity, chronicity, histology, and distribution of fat,

in order to facilitate diagnosis, prognosis, and straightforward care. which are listed below.

1) On the basis of onset

1. Insidious
2. Gradual
3. Rapid

2) On the basis of BMI

1. Below 18.5: Underweight
2. 18.5-24.9: Normal weight
3. 25.0-29.9: Pre obesity or Overweight
4. 30.0-34.9: Obesity class 1
5. 35.0-39.9: Obesity class 2
6. Above 40: Obesity class 3

3) On the basis of severity

1. Mild
2. Moderate
3. Severess

4) On the basis of etiological factors

1. Physiological: Observed temporarily during puberty and pregnancy.
2. Pathological: It can be further divided into 3 viz:

  • Exogenous
  • Endogenous
  • Idiopathic

5) On the basis of Fat distribution

1. Generalized : Generalized obesity is usually seen in exogenous Obesity.
2. Central type : Involving only the neck and trunk.
3. Superior (Buffalo type) : Involving the face, neck arms and upper part of trunk.
4. Inferior type : Involving lower part of trunk and legs.
5. Girdle type (Gynoid Obesity) : Involving hips, buttock, abdomen and with a fatty apron.
6. Breachers of trochanteric type : Involving the buttocks.
7. Lipomatous type : Multiple lypomatosis with localized deposits of fat over the

6) Histopathological classification

1. Hypertrophic Obesity : Involves enlargement of fat cells, hypertrophic obesity tends to correlate with an android fat distribution and this is more often associated with metabolic disorder such as diabetes ellitus,


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Hypertension, Coronary artery diseases and Hyperlipidemia.

2. Hyperplastic Obesity : The total no. of fat cells is increased in Hyperplastic Obesity.

7) According to Etiology:

1. Physiological : Observed temporarily during pregnancy delivery and lactation.
2. Idiopathic : Obesity is labelled idiopathic after all possible cause of weight gain have been investigated and ruled out.
3. Water salt retention : Characterized by sudden increase of body weight which responds promptly to diuretics therapy.
4. Dermis disease : Obesity associated with symmetrical tender and painful lumps over the body.
5. Hyper insulinism : Obesity observed in cases of pancreatic tumor associated with attacks of spontaneous hypoglycemia or in diabetic children over treated with insulin.

Etiology (Nidana)[7,8]

Aharaj Nidana

  • Adhyashan (eating while the preceding meal is still being digested)
  • Atibruhana (consuming calorie-dense meals)
  • Madhura Ahara (overuse of sweet flavours in food).
  • Sheeta (meals that are cold).
  • Snigdha Ahara (fatty food)
  • Navanna (grain just harvested).

Viharaj Nidana

  • Avyayam (insufficient physical activity)
  • Avyavaya (absence of sex)
  • Diwaswapna (Daytime sleep)
  • Asana sukha (extended periods of sitting)
  • Swapnaprasangat (oversleeping)
  • Harshnitya (the state of constant joy).

Manasika Nidana

  • Achintana (stress-free)
  • Mansonivritti (mind relaxation)
  • Saukhya (Happiness).

Others

  • Beejdosha (faulty genes)
  • Consumption of excessive sweets by the pregnant mother.

Purvarupa (Prodromal symptoms)

Symptoms that develop prior to the illness's full presentation.

Among these are:

1. Excessive sleep
2. Fatigue
3. Lethargic behaviour
4. A strong bodily odour
5. body heaviness
6. The bodily part's laxity.

Rupa (Symptoms)[9]

When a person accumulates excessive fat in the breast, belly, or buttocks, it is said that they have Sthaulya.

According to the classics, Atisthool person have following symptoms-

1. Javoparodha (restricted or impeded mobility (affected by excessive fat accumulation).
2. Krichhvyavaya (difficulty in sexual activity or impotence (caused by Medas blocking the semen route).
3. Dourrbalya (debility as a result of Dhatus imbalance).
4. Swedadhikya (excessive perspiration due to vitiated Medas and Kapha Dosha).
5. Dourgandhya (an offensive bodily odour)
6. Pipasa and Khudha Adhikya (Severe thirst and hunger).
7. Ayushohrasa (reduction in lifespan).

Samprapti (Pathogenesis)[10]

Nidana Sevana
↓
The Kaphadi Doshas' vitiation
↓
Enhanced Meda dhatu blocks the abdomen's Vata Dosha pathways.
↓
Vata Dosha stimulates Agni in Koshta, which leads to the urge for excessive food intake and rapid food digestion.
↓


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Consumption of a larger amount of food
↓
Sthaulya

Chikitsa (Treatment)

1. Nidana Parivarjana: Aharatmak, Viharatmak, and Mansik Nidana should all be avoided.

2. Aptarpana Chikitsa[11] : Sthaulya is Santarpanjanya Vikar since Aptarpana Chikitsa is considered, it is advisable to practice it in order to lose excess fat. Obese people should eat heavy, difficult-to-digest foods (lower in carbohydrates and fat), as this will suppress their hunger.

Three steps of the Shat Upkrama are included in Aptarpana Chikitsa:

1. Langhan
2. Rukshana
3. Swedana

3. Sanshodhana

  • Vaman
  • Virechan
  • Shiro Virechana (Karshan Nasya)
  • Niruh Basti.

Vamana (Medicated Emesis) and Virechana (Medicated Purgation) are two aspects of Samshodhana therapy that should be administered to all obese patients with excess Dosha and excess Bala (More strength). Acharya Charaka also suggests Ruksha, Ushna, and Tikta Basti (Enema including hot, bitter, and dry medications). One type of external therapy recommended by Bahya Shodhana (traditional medicine) for managing obesity is Ruksha Udvartana, or dry powder massage.

4. Sanshamana

  • Upavasa
  • Pachana Aushadhi
  • Vyayam
  • Maruta sevana
  • Atapa sevana
  • Udvartana

5. Single drug

  • Gugglu  
  • Vacha
  • Patla
  • Amlaki Churna
  • Arjuna Churna
  • Gambhari
  • Musta
  • Vidanga
  • Bilva
  • Shunthi
  • Shilajatu
  • Gomutra
  • Kshara
  • Madhu
  • Rasanjana

6. Formulation

  • Navaka Gugglu
  • Dasang Guggulu
  • Arogyavardhini Vati
  • Medohara Guggulu
  • Amritadi Guggulu
  • Triphla Churna
  • Brihata Panchamula
  • Loha Arista
  • Phaltikadi Kwath
  • Chavyadi Sattu
  • Triphaladi Tailam
  • Shilajatu Rasayan

7. Lekhaniya Mahakashaya

  • Vacha
  • Chitrak
  • Kustha
  • Mustaka
  • Chitrak
  • Katuki
  • Daru haridra
  • Haridra
  • Chirbilva

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    • Hemvatya

    Pathya-Apathya[12]

    Pathya Aahar (Do's)Pathya Vihar (Do's)
    Mudga, Masura, Yava, Rajmasha, Kulattha, Patola, Takra, Madhu, UshnodakaNitya Langhana (Reducing therapy used regularly)
    Chintana (Critical Thinking)
    Shrama (Working Hard)
    Krodha (Anger)
    Shoka(Despairing)
    Vyavaya (Sexual activity)
    Jagarana (Late nights)
    Apathya Aahar (Dont's)Apathya Vihar (Dont's)
    Navanna,
    Shali,
    Masha,
    Godhuma,
    Taila, Madhuraphala
    Navnita,
    Ikshu,
    Ghrita,
    Dadhi
    Anupa Mamsa
    Audaka Mamsa.    		Avyayama (Lessactivity)
    Avyavaya (Less pleasure)
    Swapna Prasanga (Oversleeping)
    Sukha Shaiyya
    Nitya Harsha (Happiness)
    Achintana,
    Manaso Nivritti
    Sheetala Jala Snan (Taking a bath with cold water)
    Divaswapa (Day-slumbering).

    Conclusion

    Sthaulya (Obesity) has been referenced by Charaka in the Santarpanottha Vikara, and Apatarpan Chiktsa (reducing therapy) is the recommended treatment. The main treatment for obesity is increasing physical activity and decreasing daily calorie intake. The classical Nidanas of Sthaulya are currently undergoing a transformation. Stress levels rising, unhealthy eating patterns, and a decline in exercise awareness are increasingly being identified as the main contributing reasons. The percentage of people in society who suffer from Sthaulya is rising daily, thus people need to be made aware of the illness and its serious side effects before it spreads to an epidemic proportion. Ayurvedic treatment is based on the Trisutra of Ayurveda, which consists of Aahar, Vihar, and Aushadhi. Only until the aetiology, symptomatology, aggravating and relieving variables, and pathophysiology of the disease are understood can the diagnosis and treatment be made.

    References

    1. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutrasthana, Ashtauninditiya

    2. Adhyaya, 21/8-9, edited by Brahmanand Tripathi. Varanasi: Chaukhambha Surbharati Prakashan, 2016; 401.
    3. Mishra Bramhashankar. Bhavaprakasha Vidyotini Tika, Madhya Khanda 39, 11 edition. Varanasi, Chaukhambha Sanskrit Sansthana, 2004.
    4. https://www.who.int/health-topics/obesity.
    5. Charak Samhita, Sutra Sthana, Ashtauninditiya Adhyaya, 21/3 and 20/17, P.V. Sharma, vol 1, Chaukhambha Orientalia, Varanasi, 7th edition, 2005.
    6. Susrutha Samhita, Sutra Sthan, Doshdhatumalakshyavriddhi Vigyaniya Adhyaya 15/4 Vaidya Yadvji Trikamji Acharya (Reprint ed) Varanasi Chaukhambha Sanskrit Sansthan, 2009.
    7. Rajesh K Srivastav, A Clinical Study on Aetiopathogenesis of Sthoulya.
    8. Charaka Samhita, Sutrasthana, chapter 21, Astounindita adhyaya. by Agnivesa, Vaidya Yadvji Trikamji Acharya (5th ed) Varanasi Chaukhambha Sanskrit Sansthan 2001.
    9. Medorognidanam Adhyaya 34/1 with The Sanskrit Commentary Madhukosa by Vijayarakșita & Srikanthadatta, Hindi Commentary by Dr. Brahmananda Tripathi (Vol.2) Chaukhamba Surbharati Prakashan Varanasi 2016, 34
    10. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutrasthana, Ashtauninditiya Adhyaya, 21/4, edited by Brahmanand Tripathi. Varanasi: Chaukhambha Surbharati Prakashan, 2016; 409.
    11. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutrasthana, Ashtauninditiya Adhyaya, 21/5-9, edited by Brahmanand Tripathi. Varanasi: Chaukhambha Surbharati Prakashan. 2016; 411.
    12. Charaka Samhita Sutrasthana, Ashtauninditiya Adhyaya, 21/20 of Agnivesa, elaborated by Charaka & Dridhabala edited with Charaka Chandrika Hindi Commentary by Dr. Brahmanand Tripathi, Chaukhambha Surbharati Prakashan Varanasi, 2001; 404.
    13. Bhaisajyaratnavali Medorogadhikar Adhyaya 39/63-70 of Kaviraj Govind Das Sen hindi commentary by Prof. Siddhi Nandan Mishra, Varanasi: Chaukhambha Surbharati Prakashan. 2012,729.


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