Best way to Manage Obesity/Sthaulya in Ayurveda

Obesity

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 into danger of a vicious circle of additional laziness and many other disorders like Hypertension, Osteoarthritis, Diabetes Mellitus, Cardio Vascular accident 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 that results in “Dhatvagni Mandya”.

Vruddha Vagbhat and Vagbhat also elaborated on the etiopathogenesis of Sthaulya based on 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 increase in energy “
  • Excess deposition of adipose tissue is obesity.
  • A body weight 20% or more above the desirable weight for age, sex, and height is regarded as obese.
  • A recent National Institute of Health consensus conference defined obesity as a Body Mass Index greater than 27 kg/m². Nowadays 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 Ahara Sevana (excessive intake of sweet food)
  • Sheeta Ahara Sevana (excessive intake of cold or non-fresh food)
  • Snigdha Ahara Sevana (excessive intake of oily/fatty or unctuous food)
  • Sleshmala Ahara Sevana (excessive intake of food that increases Kaph Dosha in the body)
  • Navannasevana (Using freshly collected grains)
  • Nava madya seven (Usage of recently manufactured or prepared alcoholic preparation)
  • Gramya Rasasevana (Usage of domestic animal meat & soups)
  • Mamsa sevana (Excessive intake of meat/flesh)
  • Dadhi Sevan (Excessive intake of curd)
  • Sarpi sevana (excessive intake of Ghee)
  • Ikshu Vikar seven (Intake of sugarcane Preparations like sugar or jaggery)
  • Shali seven (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 lifestyle)
  • Swapnaprasangat (Excessive sleep)
  • Gandhamalyanu Sevana (Using 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 (Uninterrupted cheerfulness)
  • Achintanat (Lack of anxiety)
  • Manasonivritti (Relaxation from tension)
  • Priyadarshana (Observations of beloved things)
  • Saukhyena

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 Systems 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 inguinal Erythema intertrigo

Miscellaneous:

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

CHIKITSA/TREATMENT

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

  1. Nidan Parivarjan
  2. Samshodhana
  3. 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 the following procedures

Bahya Samshodhana   Abhyantar Samshodhan  
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, and 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 overproduction of meda dhatu. Looking at this possibility it is advisable to give a 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 overproduction of Meda.
  • Trisha Nigraha – Excessive thirst is a symptom and also a cause of Sthaulya. Drinking 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 conclude that obese people should avoid sweet and soft drinks, nutritious fruit juice, and cold water.
  • Vyayam – Vyayam works as Nidana Parivarjan as well as melts the excessive fat, deposited in the fat depots. It is the definition 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 synonym of the Vata. By the Vata seven, 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 ideal for Samasaman therapy. For example, Madhu possesses Guru and Ruksh properties, hence it is ideal for the management of Sthaulya.
  • Some Samsamana yoga-like Guduchi – Bhadra Musta, Triphala, Takrarista, Makshika, Vidangadi Lauha, Bilvadi panchmula, and Silajatu. So, the etiological factors of Karsya are the line of treatment of Sthaulya Ruksh Annapana Prayoga, Langhana, Pramitasana, Kriya Atiyoga, Shoka, Nidra Vega Vinigraha, Ruksh Snana, Ruksh Udvartan, Abhyas, Krodha, etc. are practiced as a line of treatment for Sthaulya.

The treatment in modern science includes different six phases which are opted accordingly.

  1. Patient counseling
  2. Behavior therapy
  3. Dietary management
  4. Exercise therapy
  5. Drug Therapy
  6. Surgical treatment

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