Obesity/Sthaulya: An Overview with Management in Ayurveda

Sthaulya (Obesity) is one of the major diseases due to faulty dietary habits, lifestyles, and environment of the Modern era received from the blessing of Machines and Materialism, is a result of a habitual and situational reduction in physical activity with increased intake of faulty food with the addition of stress. Obesity pushed humans in danger of a vicious circle of additional laziness and many other disorders like Hypertension, Osteoarthritis, Diabetes Mellitus, Cardio Vascular accidents impotence, and many other grave diseases.

In Ayurveda Sthaulya is described under “Ashath Nindit Purusha” (eight despicable personalities) by Acharya Charaka while Acharya Sushruta mentioned it as an endogenous entity which results in “Dhatvagni Mandya”.

Vruddha Vagbhat and Vagbhat had also elaborated on the etiopathogenesis of Sthaulya on the basis of the formation of Ama and the disturbance of the process of Dhatu Parinamana. i.e., intercellular metabolism and mechanism of respective of Agni, which later on understood as the process of metabolism in the modern era.

Different Definitions of Obesity/Sthaulya

Ati Sthula has been defined as a person, “who on account of the inordinate increase of fat and flesh, is disfigured with pendulous, buttocks, belly and breasts and whose increase bulk is not matched by a corresponding increas in energy “
Excess deposition of adipose tissue is obesity.
A body weight 20% or more above desirable weight for age, sex and height is regarded as obese.
A recent National Institute of Health consensus conference defined obesity as Body Mass Index greater than 27 kg/m². Now a days obesity is defined at or greater than 25 kg/m² BMI.
Parks has given obesity may be defined as an abnormal growth of the adipose tissue due to an enlargement of fat cell size (Hypertrophic obesity) or an increase in fat cell number (hyperplastic obesity) or a combination of both. Hence, the modern terminology obesity can be used satisfactorily for the disease Sthaulya.

Nidana/Causative factors of Obesity/Sthaulya

Aharatmaka Nidana (Dietary factors)

Ati-sampurana (Over/excessive eating)
Adhyasana (Frequent eating)
Guru Aharasevana (excessive intake of heavy food)
Madhura Aharasevana (excessive intake of sweet food)
Sheeta Aharasevana (excessive intake of cold or non-fresh food)
Snigdha Aharasevana (excessive intake of oily/fatty or unctuous food)
Sleshmala Aharasevana (excessive intake of food that increase Kapha Dosha in body)
Navannasevana (Using freshly collected grains)
Nava madya sevana (Usage of recently manufactured or prepared alcoholic preparation)
Gramya Rasasevana (Usage of domestic animal’s meat & soups)
Mamsa sevana (Excessive intake of meat/flesh)
Dadhi Sevan (Excessive intake of curd)
Sarpi sevana (excessive intake of Ghee)
Ikshu Vikara sevana (Intake of sugarcane’s Preparations like sugar or jaggery)
Shali sevana (Excessive intake of Rice)
Godhum sevana (Excessive use of wheat)
Bhojanotara Jal-pana (Intake of excessive water during feeding)

Viharatmaka Nidana (Behavioural causative factors)

Avyayam (Lack of physical exercise)
Avyavaya (Lack of sexual life)
Divaswapan (Day’s sleep)
Asana Sukha (Luxurious life style)
Swapnaprasangat (Excessive sleep)
Gandhamalyanu Sevana (Using of perfumes garlands)
Bhojanotar Snana (Bathing after taking the meals)
Nidra-Bhojanotar (Sleeping after meal)
Bhojanotar Aushadha sevana (Drugs after meal)

Manas Nidana (Mental causative factors)

Harshnityatvat (Uninterupted cheerfulness)
Achintanat (Lack of anxiety)
Manasonivritti (Relaxation from tension)
Priyadarshana (Observations of beloved things)
Saukhyena

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Anya Nidana (others)

Amarasa
Snigdha Madhura Basti Sevana (Administration of unctuous & Sweet enema)
Tailabhyanga (Massaging of oil)
Snigdha Udvartana (Unctuous unction)
Bijadoshasvabhavat (Heredity)

Complications of Obesity

Obesity causes many hazardous disorders that adversely affect the body. Some of them listed below in the table

Cardio Vascular system	Respiratory System	Gastro-Intestinal System	Endocrine and Metabolic System	Skin
Hypertension, Generalized Atherosclerosis, Coronary Heart disease, Peripheral Vascular Disease, Myocardial Infraction, Atheroma, Left ventricular Hypertrophy, Premature cardiovascular death	Chronic Bronchitis, Pulmonary hypertension, Hypoxaemia, Pulmonary embolism, Alveolar hypoventilation, Obstructive sleep, apnoea, Obesity hypoventilation syndrome	Gall Stone Dyspepsia Hiatus Hernia Diverticulosis of colon Cholecystitis, Reflux oesophagitis Pancreatitis	Diabetes mellitus, Fatty livery, Hyperlipidaemia, Gout, Hypometabolic stage, polycystic Ovarian Syndrome, Hypercholesterolaemia	Ulceration Acanthosis Nigricans Fungal infection Fragilitas cutis inguinalis Erythema intertrigo

Miscellaneous:

Varicose Veins
Delayed wound healing
Technical – difficulty in surgery.
Risk in general Anaesthesia.

CHIKITSA/TREATMENT

In Ayurveda, the principal treatment concept of any disease works as

Nidan Parivarjan
Samshodhana
Samsamana

(1) Nidan Parivarjan: Causative factors should be avoided mentioned above, in the forms of dietary, behavioral or mental factors

(2) Samshodhan Therapy: Extraction or elimination of toxins/excretory products of the digestive tract or Dosha.

It includes following procedures

Bahya Samshodhana	Abhyantar Samshodhana
Udavartana	Vamana
Avagah	Virechana
Parisheka	Nasya
Lepana	Niruha

3. Samshamana Therapy:

In Sadpakrama (Six types of therapies), Langhana and Rukshana may be considered for Samshaman purposes in Sthaulya. Saman Chikitsa is performed in seven different ways. Deepan, Pachana, Kshudha Nigraha, Trisha Nigraha, Vyayama, Atapasevan, these 7 entities are titled under a single heading i.e., “Samana Langhana Chikitsa”.

According to the general principle of management for Sthaulya alleviation of Vata, Pitta, and Kapha especially Samana Vayu, Pachaka Pitta, and Kledaka Kapha along with depletion of Medodhatu increasing Medo dhatvagni is the main aim of treatment in Sthaulya.

Deepan and Panchana – The Deepan dravyas are dominated by Agni and Vayu Mahabhutas which suppress Meda and Kapha i.e., Jala and Prithvi Mahabhuta. Deepan therapy is efficacious in Sthaulya because apart from digesting Ama and Apakva Meda, it has the additional property to potentiate Jatharagni, Bhutagni and Dhatvagni.
Kshudha Nigraha – Fasting is one type of “Nidana Parivarjan Chikitsa”, because the food is the main source of Nutrition for Meda dhatu fasting controls the over production of meda dhatu. Looking to this possibility it is advisable to give small quantity of Laghu and Ruksha Aahara in place of complete or severe starvation, so that the Tikshnagni gets fuel in the form of food and ultimately checks the over production of Meda.
Trisha Nigraha – Excessive thirst is a symptom and also a cause of Sthaulya. Drinking of cold water in large quantities depresses the Jatharagni by adding to the liquidity of Pitta. It also increases the metabolic by product, Kleda. So, a Sthula Purusha should take lukewarm water in small quantities. From the word control of thirst, we can arrive to the conclusion that obese person should avoid sweet and soft drinks, nutritious fruit juice and cold water.
Vyayam – Vyayam works as Nidana Parivarjan as well as it melts the excessive fat, deposited in the fat depots. It is the defination of Vyayam benefits of Vyayam was also mentioned i.e. Laghava, Karmasamrthya, Agnidipti, Medakshya, Vibhakta Ghangatratva
Atapa Sevan – Atapa sevan enhances Ushma in the body. This raised body heat reduces Meda by Vibhajana and Vilayan. It potentiates Kleda Vilayana.
Marut Sevan – The word Maruta is the synonyms of the Vata. By the Vata sevana, the Ruksha Guna of Vata reduces Kleda and Kapha by Shoshana and Stimulation Jatharagni. Administration of Guru and Apatarpan articles which possess additional Vata, Slesma and Meda Nasaka properties is considered as an ideal for Samasaman therapy. For example, Madhu possesses Guru and Ruksh properties, hence it is ideal for management for Sthaulya.
Some Samsamana yoga like Guduchi – Bhadra Musta, Triphala, Takrarista, Makshika, Vidangadi Lauha, Bilvadi panchmula and Silajatu with. So, etiological factors of Karsya are line of treatment of Sthaulya Ruksh Annapana Prayoga, Langhana, Pramitasana, Kriya Atiyoga, Shoka, Nidra Vega Vinigraha, Ruksh Snana, Ruksh Udvartan, Abhyas, Krodha etc. are practised as line of treatment for Sthaulya.