A Review on the Concept of Sthoulya (Obesity) and Its Management

Abstract

Modern Civilization has paved way to a number of diseases notably lifestyle diseases and Communicable diseases.As the technologies have progressed so far,man has become more inactive. Sedentary lifestyle alongwith junk foods and fermented bevarages turns more people Obese. Ayurveda is a life science which focuses not only in disease management but also in its prevention .Thus lifestyle diseases can be managed effectively through the principles of Ayurveda. Acharya Charaka has included sthula as one among the ‘Ashtaninditeeya purusha’.Acharya Vagbhata has pointed it out to be a condition arising due to excess brimhana while Madhavanidana,Yogaratnakara and Bhavaprakasa explains it under medoroga. Acharya Susruta considers sthoulya and karshya as the derangement in the circulation of rasadhatu.Thus sthoulya is covered in all its angles

Introduction

I. INTRODUCTION

‘STHOULYA’ refers to the sthulata of sharira due to the accumulation of medodhatu in excess. Overweight and Obesity constitute the basic pathology of most of the disease conditions in the present era. Cardiovascular, musculoskeletal, neurological, metabolic, endocrine and mental health gets affected due to these. Ayurvedic classics elaborate this under the concept of medoroga. Basically agni is the prime moiety involved in its pathogenesis. Obesity and overweight has to be managed in a  judicious manner to prevent its complications.  Worldwide obesity has nearly tripled since 1975. Most of the world's population live in countries where overweight and obesity kills more people than underweight. 39 million children under the age of 5 were overweight or obese in 2020. Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016. In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese.

39% of adults aged 18 years and over were overweight in 2016, and 13% were obese. Obesity is preventable.

II. OVERWEIGHT AND OBESITY

Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health.

Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person's weight in kilograms divided by the square of his height in meters (kg/m2).

III. NIDANA

1. Atisampurana or excess nourishment is the prime nidana for sthoulya.Atiguru,madhura,sheetha and snigdha upayoga increases gurutva and snigdhatva of body.
2. Avyayama,avyavaya,divaswapna,harsha nitya and achintana –ie a sedentary lifestyle accelerates the condition.
3. Beejaswabhava ie heredity and inheritance play a major role.Familial tendancy towards Obesity increases its incidence among the family members.

The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Globally, there has been:

An increased intake of energy-dense foods that are high in fat and sugars; and an increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization.

Changes in dietary and physical activity patterns are often the result of environmental and societal changes associated with development and lack of supportive policies in sectors such as health, agriculture, transport, urban planning, environment, food processing, distribution, marketing, and education

A. Factors Predisposing To Primary Obesity

1. Genetic_familial tendency
2. Sex_more in females
3. Activity_lack of physical activity
4. Psychogenic_emotional deprivation and depression.
5. Social class_poor classes .
6. Alcohol_problem drinking.
7. Smoking _Cessation of smoking .
8. Prescribed drugs_tricyclic antidepressants .

B. Secondary Obesity

1. Genetic disorders_prader_willi Alstrom syndrome.
2. Systemic diseases

• Hypothalamic diseases
• Hypothyroidism
• Cushings syndrome
• Polycystic Ovarian syndrome
• Hyperprolactenemia.
• Primary Hypogonadism
• Insulin secreting tumors
• Drugs_Steroids, estrogen,Sodium valproate, OCP, beta blockers etc.

IV. CHARACTERSTICS OF A STHULA

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Medasthatha sremam,alpeapi cheshtithe swasam,sphiksthanodara lambanam

Due to ativriddhi of medo-mamsa dhatu,sphik,udara and stana will be hanging or. lamba and chala and the person lacks utsaha and will have a disproportionate body.Madhavakara has pointed out that excess medas is situated in udarasthi.This clearly points out abdominal obesity associated with metabolic syndrome.Those with medoroga will have kshudra swasa or dyspnoea.

A. Samprapti

                DUE TO MEDOAVARANA IN KOSHTA                   MARGAVARANA OF VAYU                VAYU

                    CAUSES  IMPROPER AGNI SANDHUKSHANA              CONSUMED AHARA DIGESTS QUICKLY                                             

                                                                                                                                       VORACIOUS APPETITE

Agni in a sthula will be in a ‘sandhukshita’ avastha and this increases the tendancy to consume more food.Excessively accumulated medodhatu creates an avarana in various pathways of body; especially in koshta and obstructs the path of vata.

This Vata augments agni in an abnormal manner such that the appetite will be voracious since the consumed food gets digested at a faster rate.Thus the major factors contributing to the pathogenesis of sthoulya is agni and vata.

“LEPTIN” is a hormone produced by the adipose tissue in the body.It regulates longterm energy balance and influence appetite,satiety and motivated behaviours oriented towards the maintenance of energy reserves.As adipose tissue increases;the level of leptin also increase and finally a state called ‘leptin resistance’arise.Thus,in Obese persons,body is not sensitive to leptin and so appetite is increased and irregular.

B. Longterm Complications Of Sthoulya

As per Charakacharya there are eight doshas in a sthula.

1. As the medodhatu accumulates disproportionately,the other dhatus are not nourished properly leading to dhatu asatmya and thus ayu declines.
2. Due to the looseness and heaviness of fats and its avarana;sukra  marga is obstructed and the sexual activity becomes difficult.
3. Due to asamatva of dhatus,dourbalya occurs.
4. Medodhatu mala is sweda and so excess medodhatu causes excess swedana and due to vyayama asahatva dourgandhya occurs.
5. Due to teekshnagni and prabhuta vayu in koshta excessive appetite and thirst occurs.

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  Excess accumulation of triglycerides, LDL, VLDL etc. Results in ischemic events in brain,heart and other vasculature and causes life threatening complications. Diabtes mellitus, Hypertension and dyslipidemia leads to metabolic syndrome in obese.

V. MANAGEMENT PRINCIPLES

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1. .Agni and vayu are the basic elements involved in the pathogenesis of sthoulya.Agni or appetite is voracious and so enough fuel has to be provided else it will result in dhatu soshana.

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Therefore ahara which are guru but which causes depletion should be employed.Fasting all of a sudden to reduce weight will result in unforeseen complications.

2. ANTHAPARIMARJANA AND BAHIPARIMARJANA CHIKITSA

• External  therapies like udwartana helps to reduce excess medas.
• Consuming medohara oushadha in the form of kashaya,lehya,arishta,kshara etc can manage sthoulya.
• Kapha upakrama

Vyayama, ratrijagarana, teekshna sodha,r uksha alpa teeksha ushna anna,dirghakala sthitha madya,visheshat vamanam, yusha, kshoudra and medogha oushadha.

VI. MEDICINES

Those which are medo-anila ,sleshma nashana can be used both internally and externally.

A. Ahara Dravya

Kulatha,shyamaka,yava,mudga,madhu,takra

B. Oushadha Dravya

1. Triphala,guduchi,abhaya and Ghana with madhu.
2. Decoction of mahatpanchamula.
3. Decoction of Agnimantha and rasanjana.
4. Guggulu,Silajathu
5. Vidanga, nagara, kshara, kalaloha raja,yava-amalaka churna
6. ‘Ushnam bhaktasya manda’

C. Formulations

1. Varaasanadi kwatha
2. Krimighnadi kwatha
3. Lodhrasava
4. Ayaskriti
5. Takrarishta
6. Triphala guggulu
7. Vyoshadi guggulu.
8. Navaka guggulu
9. Dasamoola hareetaki
10. Gomutra hareetaki
11. Navayasa churna

VII. FOR UDWARTANA

1. Kolakulathadi churna
2. Yava churna

VIII. LEPANA AND ABHYANGA

1. Mocharasa-samudraphena churna lepana to remove durgandha of body.
2. Mahasugandhi taila abhyanga.

IX. PATHYAPATHYA

PATHYAYAPATHYA AHARA

PATHYA-APATHYA  VIHARA(SHAREERIKA)

PAHYA-APATHYA VIHARA(MANASIKA)

Conclusion

IMPORTANCE OF A GOOD BUILT ???????????????? ???????? ???| ???????????? ????????? [?] ? ????????????||??|| ????????????????? ???????????????| ??????? ????? ????????? ???| A person who is neither too sthula nor too krisha will be healthy enough to withstand adverse and extreme climates and situations and will be able to bear extreme thirst and appetite. Digestion will be proper and dhatus will be healthy and sama. Thus,a good built should be maintained to attain the purushardhas and stay healthy.

References

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Copyright

Copyright © 2023 Ancy Emmanuel. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.