1. 1. Dr M. Paramkussh Rau M.D.(D.G),Ph.D. P.G.Professor& H.O.D. Department of Dravyaguna S.V.Ayurvedic college,Tirupati, Andhra pradesh Review of Sthaulya chikitsa other than oral administration By- Dr K.RAGHU RAMUDU, 1st year P.G Scholar Department of Dravyaguna S.V.Ayurvedic college,Tirupati, Andhra pradesh
2. 2. HEALTH IS WEALTH It is a universally accepted fact According to Ayurveda Swastha defined as the equilibrium state of Dosha ,Agni ,Dhatu and Mala. And prasanna atma , indriya and manas. THE WORLD HEALTH ORGANIZATION defines Good health as a state of complete physical mental and social well being and not merely an absence of disease or infirmity. Which is resembles the swastha definition.
3. 3. Sthaulya Paribhasha:- A person, having heaviness and bulkiness of the body due to excessive collection of fat is called obese (Sthula) and the condition is called obesity (Sthaulya).
4. 4. Acharya Charaka mentioned that a person in whom Excessive and abnormal increase of fat tissue (Medodhatu) along with Mamsadhatu is found which results into pendulous appearance of buttocks, belly and breasts and whose increase bulk is not matched by a corresponding increase in energy is called Sthula Purusha. (Ch. Su. 21/8-9)
5. 5. According to W.H.O definition B.M.I greater then or equal to 25 is over weight; B.M.I greater than or equal to 30 is obesity. Obesity is a major risk factor for non communicable diseases i.e cardio vascular diseases ; diabetes; musculo skeletal disorders etc.
6. 6. Obesity Class BMI (Kg/mt2) Underweight < 18.5 Normal 18.5 24.9 Overweight 25.0 29.9 Obesity I 30.0 34.9 II 35.0 39.9 Extreme Obesity III > 40 CLASSIFICATION OF OVERWEIGHT AND OBESITY BY BMI CHART
7. 7. BODY MASS INDEX: - The BMI which describes relative weight for height. The BMI used to assess overweight and obesity and to monitor change in body weight. BMI is calculated as weight in Kg divided by height in metre square (mt) BMI = Weight in KG Ht in Mt
8. 8. PHYSIOLOGY OF MEDA DHATU (FAT TISSUE): Medo Dhatu is the 4th dhatu in the sequence of the 7 tissues explained in Ayurveda. Medo dhatu produced from the mamsa dhatu. There is clear description in Ayurveda regarding medo dhatu which can be compared with depot fat tissue (adipose tissue) and rasa-rakta gata sneha (fat present in blood) to the cholesterol, triglyecerides, HDL, LDL, VLDL.
9. 9. The total quantity of Meda is two Anjali (the collected amount of liquid by both hands joined) and the Vasa (Muscles fat) is three Anjali. Thus, total Meda content of body is enumerated as 5 Anjali and total measurable body elements are counted as 56.5 Anjali. From this proportion, it is evident that total Meda content of body is 11 to 12% approximately. Modern physiology also mentioned the same amount of fat. This quantity may vary from person to person.
10. 10. Medadhatu Poshaka Poshya (Mobile in nature) (Immobile in nature) Which is circulated in whole body Which is stored in Medodharakala Along with gatiyukta Rasa-rakta dhatu in its sites. i.e Udara,Sphik and For nourishing the poshya meda dhatu Stana According to modern science, it can be According to modern science, it Correlated with Cholesterol and Lipids cen be correlated with Adipose Which are present in cerculating blood. tissues/fat
11. 11. Cha.S.SU.21/4 Nidana of Sthaulya Aharatmaka Nidana Nidana of sthaulya Viharaja Nidana Manasika Nidana Bijadoshaja Nidana
12. 12. Aharatmaka Nidana Atisampuram Guru ahara sevana Madhura ahara sevana Sheeta ahara sevana Snigdha ahara sevana
13. 13. Role of aharatmaka nidana Ahara plays a major role for increasing medo dhatu in sthoulya. Acharya Susrutha mentioned sthoulya and karshya depend upon the quality and quantity of ahara Su.S.Su15/32 On the basis of samanya vishesha siddhanta the excessive food consumption of similar substance lead to the over production of dhatu.
14. 14. Role of Viharatmaka Nidana All the viharatmaka Nidana indicates decreased physical activity, which aggravates kapha and leads to meda deposition Divaswapna having abhishyandhi property leads to blockage of the micro channels of the body specifically in medovaha srotas Viharaja Nidana Avyayama Avyavaya Diva swapna
15. 15. Manasika Nidana Harshanityatvat Achinthanat Role of Manasika Nidana Harshanitya and achintana are two psychological factors mentioned by Acharya Charaka, these factors are kapha aggravating and hence lead to meda sanchaya.
16. 16. Role of Beejadosaja Nidana Over nutrition particularly with madhura rasa during pregnancy is mentioned as a causative factor for birth of obese child (Cha.s.sha 8/21) Beeja dosha Nidana
17. 17. Samprapti Nidana sevana (Kapha medo vardhaka ahara) Jatharagni mandya Saama anna rasa utpatti Predominance of Apa & Prithvi bhoota Dhat vargni mandya Medho vaha srotodushti (sanga) Vata prakopa Sanchya of apachita meda in sphik stna, udara Sanchaya of vata in kosta koshta Sthoulya lakshana Athi ahara sevana
18. 18. Samprapti Ghataka Dosha: Kapha,Vata Dusya: Meda , later other dhathus also Agni : Jatharagni sandhukshana medo dhatvagni mandya. Srotas: Medovaha. Srotodushti: Sanga. Udbhava sthana: Amashaya. Vyakta sthana: Sarvanga, specially in sphik, udara, stana. Roga marga: Bahya and abhyantara. Swabhava: Chirakari.
19. 19. Sthoulya lakshanas According to Charaka cala sphik, cala udara, cala stana, atimeda mamsa vrddhi are lakshanas of sthaulya (Ca Su 21/8) Beside these symptoms ashta dosha of sthaulya viz. ayushohara, jaroparodha, kriche vyavayata, daurbalya, daurgandhya, sveda badha, ksudha atimatrata, pipasatiyoga are the most prominent clinical features of sthaulya as narrated by Charaka
20. 20. Charaka has said that it is very dificult to treat atisthoola people because,if Karshana therapy is applied then it leads to further aggrivation of already aggrivated Jathragni and vayu. And if Brimhana therapy is applied it further increase the meda Management of Obesity
21. 21. Management of Obesity other than oral administration | |||| | |||| Ch.S.Su 21/21 Diets and drinks that alleviate vata and kapha and which can reduce fat. Enema with drugs that are sharp, unuctuous and hot. Unction with unuctuous drugs Intake of guduci(Tinospora Cordifolia), murta(cyperus rotundus), haritaki(Terminalia chebula), bibhitaka((Terminalia blerica) and amalaka(Emblica officinalia) Administration of takrarista. Administration of honey
22. 22. Ruksha Udvartana Ruksha udvartana is the bahi parimarjana chikitsa indicated for the management of sthoulya A.S.Su 24/33-34 Acharya charaka has also mentioned Ruksha udvartana for sthoulya. Ch.S.Su 21/21 Vaghbhata has mentioned the benefits of Ruksha udvartana in general as kapha hara, medasa pravilayana, Sthirikaranam anganam etc (A.H.Su 2/15)
23. 23. Basti Ruksha, ushna & tikshna basti are suggested by Acharya Charaka for sthoulya chikitsa Eg; kshara basthi , lekhana basthi Sharangdhara has given a clear description regarding the properties of lekhana dravya and characteristics of lekhana basti ( Sha.S.Pu 4/10)
24. 24. Lekhana Basti The reference of lekhana basti was taken from Su.Ch.38/82 the ingredients are follows. Triphala kwatha(Amlaki, harithaki, vibhitaki) Gomutra Madhu Yavakshara Ushakadi gana dravya Ushakadi gana dravya contains ushaka, saindhava ,shilajatu, kasisa, hingu & tutha.
25. 25. Drug Rasa Guna Veerya Vipaka Doshagnatha Harithaki (Terminalia chebula) Pancha rasa (lavana varjitha) Kashaya pradhana Laghu ruksha Ushna Madhura Tridosha hara Vibhitaki (Terminalia bellerica) Kasaya Laghu ruksha Ushna Madhura Kapha pitta hara Amlaki (Emblica officinalis) Pancharasa (Lavana varjitha) Amla pradana Guru ruksha seetha Seetha Madhura Tridosha hara Rasa panchaka of the lekhana basti dravya.
26. 26. Shatapuspa (Anethum sowa) Katu Tikta Laghu Tiksna Ushna Katu Kapha hara Vata hara Madhu Madhura Kasaya Ruksha,Laghu sheeta Ushna Madhura Kapha, Pitta, Rakta samaka Ushaka Tikta Katu Ruksha,Laghu Ushna Katu Kapha Vata samaka
27. 27. Kasisa Amla Tikta Ushna Ushna Katu Vata Kapha samaka Shilajitu Katu Tikta , kasaya Laghu ruksha Ushna ,teekshna Ushna Katu Kapha vata samaka Hingu Katu Laghu,snigd ha, Teekshna Ushna Katu Kapha vata hara Saindhavam Lavana Snigdha,ruks ha,sukshma Sheeta Madhura Tridoshagna Yavakshara Katu Laghu Snigdha Ushna Katu Kapha vata samaka Gomutra Katu, tikta Kasaya Ushna Teekshna ,kshara Ushna Katu Kapha vata samaka
28. 28. Name of the drug Rasa Guna Veerya Vipaka Doshagnata Saindhava Lavana Laghu Snigdha sukshma Seetha madhura Tridoshagna Guda Madhura Guru Snigdha Ushna Madhura Vatagna Naatipittash amaka Chincha Amla , Madhura Guru Ruksha Ushna Amla Vata samaka Kapha pitta vardaka Shatapuspa (Anethum sowa) Katu Tikta Laghu Tiksna Ushna Katu Kapha hara Vata hara Gomutra Katu, tikta Kasaya Ushna Teekshna ,kshara Ushna Katu Kapha vata samaka Kshara basti :- Kshara basti has been mentioned in Chakradatta niruha adhikarana Rasapanchaka of kshara basti dravya
29. 29. Nasya Karma :- Susrutha has recommended the use of Triphaladi Taila nasya in The patients of medovridhi Su.S.Chi.37/33-35
30. 30. Raktamokshana:- Maharshi Kashyapa have recommended raktamokshana for the treatment of Medasvi Dhatri Chikitsa Charaka has also mentioned Raktamokshana for treatment of Santarpana janya vyadhi including Atistoulya Cha.S.Su 23/6-9