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STUDY ON APATARPAN WITH SPECIAL REFERENCE TO UDVARTANA IN STHOULYA" BY Dr. AMIT A. MASULE, DR.BNMET’S SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND …

STUDY ON APATARPAN WITH SPECIAL REFERENCE TO UDVARTANA IN STHOULYA" BY Dr. AMIT A. MASULE, DR.BNMET’S SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND
RESEARCH CENTRE, BIJAPUR

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  • 1. “A STUDY ON APATARPAN WITH SPECIAL REFERENCE TO UDVARTANA IN STHOULYA”. BY Dr. AMIT A. MASULE DISSERTATION SUBMITTED TO THE RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE. IN THE PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF DOCTOR OF MEDICINE (Ayurveda) IN AYURVEDA SIDDHANTA UNDER THE GUIDANCE OF DR.M. B. KARAMBELKAR D.S.A.C., A.V.P., Ph.D. PROFESSOR DEPARTMENT OF POST GRADUATE STUDIES IN SIDDHANTA, DR.BNMET’S SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH CENTRE, BIJAPUR NOVEMBER - 2009
  • 2. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE. DECLARATION BY THE CANDIDATE I, hereby declare that this dissertation entitled “A STUDY ON APATARPANWITH SPECIAL REFERENCE TO UDVARTANA IN STHOULYA” is a bonafideand genuine research work carried out by me under the guidance of DR. M. B.KARAMBELKAR D.S.A.C., A.V.P., Ph.D. Prof., Dept. of Siddhanta, ShriMallikarjuna Swamiji Post Graduate and Research Center, Bijapur.Date: Signature of the CandidatePlace: Bijapur. Dr. AMIT A. MASULE
  • 3. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE. Dr. B. N. M. E. T’s SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH CENTER, BIJAPUR. DEPARTMENT OF POST GRADUATE STUDIES IN SIDDHANTA CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “A STUDY ON APATARPANWITH SPECIAL REFERENCE TO UDVARTANA IN STHOULYA” is a bonafideresearch work done by Dr. AMIT A.MASULE in partial fulfillment of the requirementfor the degree of DOCTOR OF MEDICINE (AYURVEDA). Signature of the Guide.Date: DR.M. B. KARAMBELKAR D.S.A.C.,A.V.P.,Ph.DPlace: Professor and Guide . Dept. of Siddhanta Shri Mallikarjuna Swamiji PostGraduate and Research centre,Bijapur
  • 4. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE Dr. B. N. M. E. T’s SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH CENTRE, BIJAPUR. DEPARTMENT OF POST GRADUATE STUDIES IN SIDDHANTA ENDORSEMENT BY THE H.O.D, PRINCIPAL/HEAD OF THE INSTITUTION This is to certify that the dissertation entitled “A STUDY ON APATARPANWITH SPECIAL REFERENCE TO UDVARTANA IN STHOULYA” is a bonafideresearch work done by Dr. AMIT A. MASULE under the guidance of DR. M. B.KARAMBELKAR D.S.A.C., A.V.P., Ph.D. Prof. DEPT. OF SIDDHANTA, Shri MallikarjunaSwamiji Post Graduate and Research Centre, Bijapur.Seal & Signature of the HOD Seal & Signature of the PrincipalDr. J. C. HUDDAR M.D (Ayu) Dr.R.N.GENNUR M.D (Ayu)Date : Date :Place: Place:
  • 5. COPYRIGHT DECLARATION BY THE CANDIDATE I here by declare that the Rajiv Gandhi University of Health Sciences, Karnatakashall have the rights to preserve, use and disseminate this dissertation / thesis in print orelectronic format for academic/research purpose.Date: Signature of the CandidatePlace: Bijapur. Dr. AMIT A. MASULE© Rajiv Gandhi University of Health Sciences, Karnataka.
  • 6. ACKNOWLEDGEMENT “Autsukya moha aratidhan jaghaana Yo apurva vaidyaya namo astu tasmai” On the eve of completion of this dissertation work, I bow my head to the greatalmighty that always showers the blessings on me and without him I would not reach thisstage in my life.I am very thankful of my grand father Sri. Annaso G. Masule and Late.Sou. Indira A.Masule for their blessings which makes me helpful to achieve the goal. This is an unforgettable moment of contentment on the successful fulfillmentof an ambition fostered for long. I offer my salutations to my parentsProf.Appasaheb A.Masule and Sou. Rajani A.Masule for suffering great agony tobring me up to this position. I am highly obliged for their blessing, support andsacrifice which have always been the constant sources of inspiration in my life. I am very thankful towards my brother Mr.Atul A. Masule,his wife AnujaA. Masule and my sister Chi. Priyadarshani A. Masule for their kind support andencouragement. The smile of our sweet little kid Chi. Atharav A. Masule always encouraged mefor being ambitious and also helpful in gaining confidence. I would like to offer my gratitude to the chairman Dr. K. B. Nagur, MD (Ayu), forproviding me all the requisites, including financial support. I am also grateful towards themembers of Dr. B.N.M. Education Trust for their support. I extend my thanks to the principal Dr. R. N. Gennur, MD (Ayu), for providingnecessary facilities throughout my work. i
  • 7. I express my gratitude towards my guide, Dr. M. B. Karambelkar, D.S.A.C., A.V.P.,Ph.D., whose cooperation and encouragement made this dissertation a possible task. My grateful thanks to our H.O.D., Dr. J. C. Huddar, MD (Ayu), whose guidelinesand support encouraged me in every step of this work. Criticism by the teacher makes the student perfect; Dr. G.B.Bagali, MD (Ayu), sucha teacher is always remembered by me for his inspiration and genuine guidance. ‘Honesty gives success in life’ is always heard from Dr. Mahesh Patil MD (Ayu), towhom I express my special gratitude for his loving kindness. My hearty thanks to Dr. Gopu .S for his immense support in my work. I express my thanks towards Dr. Shridhar B. Gouder MD (Ayu), for his guidanceduring my dissertation work. I express my special thanks to the member of scientific screening committee,Dr. B. S. Tamagonda, MD(Ayu), for his patient observation and recommendationsthroughout the dissertation. I am thankful to Shri A. I. Tapashetty, M.Sc. (Stat) for his timely guidance andsuggestions in the statistical analysis of data. I am very much thankful to Dr. Vijay Tungal, MD (Ayu), for his help. My immense thanks to the seniors Dr, Shantibhushan S. HandurDr.Rajrajeshwari, Dr. Vinod S. Gurav, Dr. Deepa Bhairshetty,Dr.SunilNair,Dr.Sudhir Koli, Dr.J.D.Khot and also to my colleagues Dr. ParashuramappaTurabeen and Dr. Savita Padashetty and my juniors Dr.Kulgeri, Dr.Harron,Dr.Sumangala and Dr.Ukumnal My hearty thanks to Dr. Savita M. Sajjan MD(Ayu), for her immense support in mywork. ii
  • 8. The real friendship is proved by the love and affection rendered by the friend,well wisher, my hostel room partner, Dr. Santosh D.Kodag and Pavan Lalsangi withouttheir cooperation, this work could not be completed. I am thankful to Mr. R. G. Dolli, office superintendent and other non-teachingstaff of the college for their timely help. I extend my thanks to the library staff for their kind cooperation during my work. My humble thanks towards my patients without whose cooperation, this workcould not be completed at all. Certain names might have been missed unintentionally, who helped directly orindirectly. I thank all of them.Bijapur.Date: (Dr. Amit A. Masule.) iii
  • 9. LIST OF ABBREVIATIONS1. A.H. - Astanga Hridaya2. A. S. - Astanga Sangraha3. A. T. - After Treatment4. Bh.Ra. - Bhaishajya Ratnavali5. Bh.S. - Bhela Samhita6. B.P.N. - Bhava Prakasha Nighantu7. B.T. - Before Treatment8. C.R. - Complete Reduction9. C.S. - Charaka Samhita10. D.N. - Dhanvantari Nighantu11. Ha.S. - Harita Samhita12. H.S. - Highly Significant13. Ka.S. - Kashyapa Samhita14. K.D.N. - Kaiya Deva Nighantu15. Lt - Left16. MW - Monnier Williams17. PTFU - Post Treatment Follow Up18. Rt - Right19. S - Significant20. Sh.Ka.Dr. - Shabda Kalpa Druma21. SR - Slight Reduction22. S.S - Sushruta Samhita23. Y.R. - Yoga Ratnakara iv
  • 10. ABSTRACT: Apatarpana and Santarpana are the two folds of therapy explained insamhitas.The six folds of therapies as Langhana, Brumhana, Rukshana, Sneehana,Swedana and Sthambhana comes under these two folds. From which Langhana,Rukshana and Swedana comes under Apatarpana while Brumhana, Snehana andSthambhana comes under Santarpana.So detail study on Apatarpana is taken as the basicfundamental principle. As Sthoulya itself is a Santarpanotta vyadhi so Apatarpana therapy is indicated inthe treatment of Sthoulya.It is achieved by Ruksha udvartana with Chanaka pishthi whichcomes under Rukshana therapy.So this study has been taken to evaluate the effects ofRuksha udvaratana with chanaka pishthi in the treatment of sthoulya under the basicprinciple of Apatarpana. Sthoulya is the most common disorder occurs in society. It is defined as acondition in which there is an excessive amount of meda in sphik, sthana and udarapradesha. It correlates to obesity which is defined as a nutritional disorder and accumulation ofexcessive amount of body fat. Obesity is a chronic metabolic disease which requires persistant approach withgradual improvement. The prevalence of obesity is rising at an alarming rate. In the developingcountries it has been estimated that 115 million people suffer from obesity relatedproblem. About every fourth person on earth is too fat around the globe, about 1.7 billionpeople should lose weight according to international obesity task force. v
  • 11. The existing obesity treatment options, in modern medicine includes drugs likeFenfluramine, Dexfenfluramine and Sibutramine which acts as appetite inhibitors andcannot be used for long periods and have got side effects. The present study intends to know the effect of Ruksha udvartana with Chanakpishthi in the treatment of sthoulya under the concept of basic principle,ie,Apatarpan.Objective of study:-The present study has following objectives,1) Detail study on Apatarpana2) Detail study of Sthoulya.3) To study the effect of Ruksha udvartana with chanaka pishthi in Sthoulya.Methods:-Aim: The aim is” To assess the effect of Ruksha udvartana with Chanaka pishthi inSthoulya under the concept of Apatarpana.Study design:- The patients of sthoulya within the age group of 20-50 yrs wererselected.A group of 30 patients is selected for ruksha udvartana with chanaka pishthi.Patients were assessed for BMI, vaksha, udara and sphika circumference along with thesymptoms adhika kshudha,adhika trishna ,kshudra shwasa and swedadhikata.Data wascollected as before treatment,after treatment and post treatment follow up. The data wasstatistically analyzed.Result:-The result of the clinical study showed more significant with Chanaka pishthi udvartanain treatment of sthoulya. vi
  • 12. Interpretation and conclusion:- Apatarpana is a basic fundamental principle in dwividhopkrama.The rukshaudvartana with chanaka pishthi is a rukshana upakrama under the concept of Apatarpanain the treatment of sthoulya.Sthoulya is the most common disorder occurs in society. It isdefined as a condition in which there is an excessive amount of meda in sphik, sthana andudara pradesh. It correlates to obesity which is defined as a nutritional disorder and accumulationof excessive amount of body fat. Udvartana with chanak pishthi has shown non-significant results in the treatmentof sthoulya. On the basis of this study, along with udvartana procedure, shamana aoushadhi,pathyapathya, exercise and teekshana basti may be a better line of treatment in themanagement of patients of sthoulya.KEY WORDS:-OBESITY, STHOULYA BMI, CHANAKA PISHTHI vii
  • 13. CONTENTS PARTICULAR PAGE NO1) Introduction 1-32) Objectives 43) Review of Literature 5-46 • Concept of Apatarpan 5-13 • Sthoulya Review 13-14 • Nidana Panchaka 14-19 • Chikitsa 20-25 • Modern Review 26-35 • Drug Review 36-37 • Udvartana Review 38-464) Materials and Methods 47-545) Observations and Results 55-886) Discussion 89-1307) Conclusion 1318) Recommendation for future study 1329) Summary 133-13410) Bibliography 135-14511) Annexure • Classical References 146-152 • Clinical Proforma 153-157 • Photographs viii
  • 14. LIST OF TABLES:- TABLE PAGE NO1. Paryayas of Sthaulya 142. Nidana for sthaulya according to different acharyas 153. Lakshanas of sthaulya according to different acharyas 16-174. Upadravas of sthaulya according to different acharyas 18-195. Different formulations in Sthaulya 236. Showing pathya vihara according to different Acharyas 24-257. Classification of overweight and obesity by BMI chart 298. Showing effects of Rookshana karma 389. Showing Samyak Rookshana Lakshana 3910. Showing Rookshana atiyoga lakshana 40-4111. Showing Rookshana Ayoga Lakshana 4212. Showing benefits of Udvartana 43-4413. Showing Therapeutic actions of Udvartana 45-4614. .Classification of over weight and obesity by BMI chart 5115. Subjective criteria 5116. Circumferance of Vaksha, Udara and Sphik 5317. Objective criteria 5318. Distribution of patients according to age 5519. Distribution of patients according to sex 5620. Distribution of patients according to religion 5621. Distribution of patients according to education 57 ix
  • 15. 22. Distribution of patients according to socio-economical status 5723. Distribution of patients according to marital status 5824. Distribution of patients according to habitat 5825. Distribution of patients according to occupation 5926. Distribution of patients according to diet 6027. Distribution of patients according to vyasana 6028. Distribution of patients according to prakruti 6129. Distribution of patients according to agni 6130. Distribution of patients according to kostha 6231. Distribution of patients according to kula vruttanta 6232. Distribution of patients according to BMI BT 6333. Distribution of patients based on vaksha circumference BT 6434. Distribution of patients based on udara circumference BT 6435. Distribution of patients based on sphik circumference BT 6536. Distribution of patients according to the adhika kshutha BT 6637. Distribution of patients according to the adhika trishna BT 6638. Distribution of patients according to the kshudra shwas BT 6739. Distribution of patients according to the swedadikhata BT 6840. Distribution of patients according to BMI AT 6841. Distribution of patients based on vaksha circumference AT 6942. Distribution of patients based on udara circumference AT 7043. Distribution of patients based on sphik circumference AT 7044. Distribution of patients according to the adhika kshutha AT 71 x
  • 16. 45. Distribution of patients according to the adhika trishna AT 7246. Distribution of patients according to the kshudra shwas AT 7247. Distribution of patients according to the swedadikhata AT 7348. Distribution of patients according to BMI AFU 7449. Distribution of patients based on vaksha circumference AFU 7450. Distribution of patients based on udara circumference AFU 7551. Distribution of patients based on sphik circumference AFU 7652. Distribution of patients according to the adhika kshutha AFU 7653. Distribution of patients according to the adhika trishna AFU 7754. Distribution of patients according to the kshudra shwas AFU 7855. Distribution of patients according to the swedadikhata AFU 7856. Result related responses of the patients AT 8157. Result related responses of the patients AFU 8458. Statistical analysis of BMI 8759. Statistical analysis of Vaksha 8760. Statistical analysis of Udara 8761. Statistical analysis of Sphik 8762. Statistical analysis of Adhika kshutha 8863. Statistical analysis of Adhika trushna 8864. Statistical analysis of kshudra shwas 8865. Statistical analysis of swedadikhata 88 xi
  • 17. LIST OF GRAPHS:- GRAPH PAGE NO1. Distribution of patients according to age 552. Distribution of patients according to sex 563. Distribution of patients according to religion 564. Distribution of patients according to education 575. Distribution of patients according to socio-economical status 576. Distribution of patients according to marital status 587. Distribution of patients according to habitat 588. Distribution of patients according to occupation 599. Distribution of patients according to diet 6010. Distribution of patients according to vyasana 6011. Distribution of patients according to prakruti 6112. Distribution of patients according to agni 6113. Distribution of patients according to kostha 6214. Distribution of patients according to kula vruttanta 6215. Distribution of patients according to BMI BT 6316. Distribution of patients based on vaksha circumference BT 6417. Distribution of patients based on udara circumference BT 6518. Distribution of patients based on sphik circumference BT 6519. Distribution of patients based on adhika kshudha BT 6620. Distribution of patients based on adhikatrishna BT 6721. Distribution of patients based on kshudra shwas BT 67 xii
  • 18. 22. Distribution of patients based on swedadikhata BT 6823. Distribution of patients according to BMI AT 6924. Distribution of patients based on vaksha circumference AT 6925. Distribution of patients based on udara circumference AT 7026. Distribution of patients based on sphik circumference AT 7127. Distribution of patients based on adhika kshudha AT 7128. Distribution of patients based on adhikatrishna AT 7229. Distribution of patients based on kshudra shwas AT 7330. Distribution of patients based on swedadikhata AT 7331. Distribution of patients according to BMI AFU 7432. Distribution of patients based on vaksha circumference AFU 7533. Distribution of patients based on udara circumference AFU 7534. Distribution of patients based on sphik circumference AFU 7635. Distribution of patients based on adhika kshudha AFU 7736. Distribution of patients based on adhikatrishna AFU 7737. Distribution of patients based on kshudra shwas AFU 7838. Distribution of patients based on swedadikhata AFU 7939. Responses of the patients for BMI AT 8140. Responses of the patients for Vaksha AT 8141. Responses of the patients for udara AT 8242. Responses of the patients for sphik AT 8243. Responses of the patients for adhika kshudha AT 8244. Responses of the patients for adhika trushna AT 83 xiii
  • 19. 45. Responses of the patients for kshudra shwas AT 8346. Responses of the patients for swedadhikata AT 8347. Responses of the patients for BMI AFU 8448. Responses of the patients for Vaksha AFU 8449. Responses of the patients for udara AFU 8550. Responses of the patients for sphik AFU 8551. Responses of the patients for adhika kshudha AFU 8552. Responses of the patients for adhika trushna AFU 8653. Responses of the patients for kshudra shwas AFU 8654. Responses of the patients for swedadhikata AFU 86 xiv
  • 20. Introduction=============================================================== INTRODUCTION Scientific and technological progress has made man highly sensitive and critical;there by giving rise to different types of health problems. The advancement ofindustrialization and communication is contributing towards sedentary life styles, in turncausing chronic non- communicable diseases like obesity diabetes mellitus, hypertension,cancer, ischemic heart disease, cerebro-vascular accidents, atherosclerosis, varicose veinsetc. Obesity being the risk factor for these diseases and hence prevention of obesity willdecrease the chances of such diseases. Excess of fat “shortens the life line” of theindividual by imposing an extra burden on all the systems of body. Obesity is a major health problem in both developed and developing countries.The exact estimation of prevalence is difficult as the standardized definition is lacking. Incountries like USA, approximately 55% of population in the age group of 20-70 years issuffering from this problem. A study conducted in Delhi shown that approximately 25%of populations are obese in urban areas. Another study conducted in United States,showed increase in sudden death rate among men and women with at least 20%overweight, which clearly shows the reduced life span due to its incidence. Ayurveda, the science of life, had given much importance to primary andsecondary preventions of diseases. Acharya’s have explained at length thedwividhopkram ie Santarpan and Apatarpan.As sthoulya itself is a Santarpanottavyadhi,so Apatarpana therapy is prescribed in sthoulya.Apatarpana is a basic fundamentalprinciple explained in samhitas so it comes under a branch moulika siddhanta whichexplains basic fundamental principles.Apatarpan itself contains langhana,rukshana and----------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 1
  • 21. Introduction===============================================================swedana upakrama.From which ruksha udvartana with chanaka pishthi comes underrukshana upakram which is highlated in the treatment of sthoulya. Sthoulya is the nearest clinical entity for obeisity in Ayurveda.So ruksha udvartanwith chanaka pishthi is a beter option for treatment of sthoulya under the concept ofApatarpana. Considering the difficult nature of disease, obesity can be better preventedrather than treated. In Ayurveda, obese persons are included under Asta Nindita purusha(Athi Deerga, Athi Hraswa, Athi Stoola, Athi Krusha, Athi Goura, Athi Sweta, AthiRoma and Aroma). The reason for difficult nature being the involvement of Tridosha andmeda mamsaadi dhatu. It is also mentioned that the preferred constitution for anindividual should be emaciated rather than obese. The existing obesity treatment options, in modern medicine includes drugs likeFenfluramine, Dexfenfluramine and Sibutramine which acts as appetite inhibitors havewith of adverse effects and cannot be used for long periods. Some devices like vibratorsare being used for local lipolytic action. Nutritional combinations (synthetic nutritionalcompounds) are expensive and they too have untoward effects. In the present context Ayurveda offers a ray of hope in treatments like Udvarthanalekhana basti along with some internal medicines like Navaka guggulu, trayodashangaguggulu etc. The internal administration of guggulu has certain limitations like gastricirritation, constipation etc. On contrary, Udvarthana is a procedure which can beundertaken daily with a preliminary training to the individual. Now it’s efficacy has beenproved in reduction of weight and associated lakshanas with no adverse effects.----------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 2
  • 22. Introduction=============================================================== To document and analyze this procedure for statistical interpretation, the studyentitled “A study on Apatarpan with special refference to udvarthana in Sthoulya” wasundertaken.----------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 3
  • 23. Objectives Of Study ============================================================== OBJECTIVES OF STUDY1) Detail study on Apatarpana2) Detail study of Sthoulya.3) To study the effect of Ruksha udvartana with chanaka pishthi in Sthoulya.---------------------------------------------------------------------------------------------------------- A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 4
  • 24. Review of literature=============================================================== REVIEW OF LITERATURE A STUDY ON APATARPANA WITH SPECIAL REFERENCE TO UDVARTAN IN STHOULYACONCEPT OF APATARPAN: - In Astanga Hridaya; Sutrasthana chapter no. 14; Dvividhopakramaniya adhyayhas been mentioned. In which there are two folds of therapies have been mentioned as 1)Santarpana and 2) Apatarpana. The synonyms mentioned for Santarpana and Apatarpanaare Brahana and Langhana respectively.1Bramhan is for stoutening of the body whileLanghan is for making the body light i.e. thin2. Functions such as snehana, Rukshana, Swedana and Stambhana are also of thesetwo kinds3. From which Snehana and Stambhana comes under bramhana i.e. Santarpanaand Rukshana and Swedana comes under Langhana i.e. Apatarpana. Langhana is of twotypes : - 1) Shodhana and 2) Shamana4. Shodhana is that which expels the doshas out ofthe body forcibly. It is of five kinds viz. Niruha, Vamana, Kayareka, Shiroreka and Asra-visrut5. Shamana is that treatment which is palliative in nature, it means which does notexpel the doshas and also does not increase the doshas but which makes the abnormaldoshas in normal state. It is of seven kinds as Pachana, Dipana, Kshut, Trushna,Vyayama, Atapa and Maruta6. The dravyas which are of Agni, Vayu and Aakashmahabhut predominant does the Apatarpana karma while Prithvi and Aap mahabhutpradhana dravya does brahmana karma. In Charaka samhita; Sutrasthana; chapter no. 22, Langhana-Brahmaniya adhyayait has been mentioned about six karmas as Langhana, Bramhana, Rukshana, Snehana,--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 5
  • 25. Review of literature===============================================================Swedana and Stambhana7. Among them Langhana, Rukshana and Swedana karma comesunder Apatarpana therapy. While Bramhana, Snehana, Stambhana comes underSantarpana therapy. Langhana karma may be applied in various forms such as four types of evacuationi.e. Vaman, Virechana, Niruha and Nasya; thirst, exposure to wind; exzposure to sun;pachan, upavasa and vyayam8. These ten folds of Langhana therapy mentioned in CharakSamhita. Those having big body and strength, abundant kapha, pitta, blood and excretaand association of aggravated vayu should be subjected to reducing therapy by means ofevacuation i.e. Langhana9. In Charak Samhita, Vimansthana chapter no. 3, Janapadodhwansaniya adhyaya ithas been mentioned that for the diseases therapy consists of that which contrary to theetiology such as there is no allevation of the disease caused by apatarpana without puranand of those caused by puran without apatarpana10. Apatarpana has been classified inthree types as Langhana, Langhana-pachana and Doshavirechana11. Amongst them Langhana therapy is recommended for those having doshas with alittle strength. By Langhana therapy agni and vata are increased which dry up the littledosha like the wind and sun dry up the little water. The Langhana-pachana therapy isprescribed in case of doshas with medium strength. By this therapy the moderate doshasare dried up in the same way as the moderate quantity of water is dried up by the sun heatand wind and also by sprinkling dust and ashes. In case of abundant doshas, only lettingout of doshas is prescribed i.e. doshavirechana12. In Astanga Sangraha; Sutrasthana; chapter no. 29, Dvividhopkramaniya adhyaya,it has been mentioned that the treatments are of two folds as Santarpana and Apatarpana.--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 6
  • 26. Review of literature===============================================================The synonyms mentioned for Santarpana and Apatarpana are Bramhana and Langhanarespectively13. Bramhana is meant to make body stout and Langhana for making it light(thin). Bramhana is caused by the predominancy of agi, vayu, akash bhutas14. Thetreatments such as snehana, rukshana, swedan and stambhana are not separate from theabove two folds of therapies15. From which rukshana and swedana comes under theLanghana therapy and snehana and stambhana comes under Bhamhana therapy. Langhana is of two kinds 1) Shodhana and 2) Shamana. Shodhana is that which expel the dosha out of body. It is of five kinds asniruha,vaman kayavireka, shirovireka and asravisruti. Shamana is that which neitherexpel dosha out, nor increases the doshas which are normal but only mitigates decrease tonormal the increased dosha. It is of seven kinds pachana, dipana, kshudha, trushna,vyayama, atopa and maruta16. In Sushruta Samhita; Chikitsasthana; chapter no. 1, Dvivraniya chikitsitam. It hasbeen mentioned about shashtiupakrama in which Apatarpana, is mentioned as firstupakrama which stands for briging effect of fasting17.Langhana yogya : - In Astanga Sangraha, Dvividhopkramaniya adhyaya, chapter no. 24, langhanayogya has been mentioned. Langhana therapy should be done daily for person sufferingfrom diabetes, ama too much moisture in the body, fever stiffness of the thighs, leprosyetc skin disorders, visarp abscess, splenic disease, diseases of the head, throat, eyes thosewho are obese and even for others during shishira rutu18. In Astanga Hrudaya, Sutrasthana,chapter no. 14, Dvividhopkramaniye adhyaya,Langhaniya mentioned for those langhan should be done daily for person suffering from--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 7
  • 27. Review of literature===============================================================diabetes with amadosha disorders of poor digestive activity, more moistness, fever,stiffness at the thighs, leprosy and other skin disorders, visarpa, abscess, disease ofspleen, head, throat, eyes, those who are obese and even to others during shishira19. In Charaka Samhita; Sutrasthan, chapter no. 2, metioned the langhan yogyapersons are those having big body and strength, abundant kapha, pitta, blood and excretaand association of aggravated vayu should be subjected to Apatarpana therapy by meansof evacuation. Those afflicted with disease of moderate severity and caused by kapha andpitta like vomiting, diarrhea, heart disease cholera, alasaka, fever, constipation, heavinesseructation, nausea, anorexia etc should mostly be treated with digestives in the beginningby the learned physician. These vary diseases when with little severity, should beovercome with control of thirst and fasting. The diseases of moderate and little severity instrong persons should be treated with physical exercise and exposure to sun and wind.The persons suffering from skin disorders, diabetes those using excess of unctuous,channel blocking and promoting diet and also patients of vatika disorders should besubjected to reducing therapy in shishira20. As described above Apatarpana included three folds of treatments these areLanghana, Rukshana and Swedana. As per Samhitas it is clear that langhan is synonymfor Apatarpana. Till though langhana itself contains a major documentation in Samhitasso it is also concern as a type Apatarpana.Langhana : - In Charak Samhita Sutrasthana; chapter no. 22, Langhanbramhaniya adhyaya it isstated that whatever produces lightness in the body is known as Langhana. The drugs--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 8
  • 28. Review of literature===============================================================producing laghu, ushna, teekshna, vishad, ruksha, suskhma, khara, sara guna and hardproperties has got mostly the langhana effect21. In Langhana upakrama its utilization has been mentioned above i.e. Langhanayogya. In Astanga Hridaya; Sutrasthana; chapter no. 14, Dvividhopkrimaniya adhyaya ithas been stated that those who are very obese, strong and having predominance of pittaand kapha, those suffering from amadosha, fever, vomiting, diarrhea, heart disease,constipation, feeling of heaviness, excess of belching, nausea, etc by the administration ofshodhana should be done. Those who are moderately obese first by administration ofdigestives and hunger producing substances generally and later with other purifactorytherapies should be done. Those who are slightly obese by control of hunger and thirstshould be used. Those are troubled by increased doshas, who are of medium strength ofbody and thirst and who are dridh for them by control of hunger and thirst should beused. Those again of poor strength of body and disease by exposing them to breeze,sunlight and exercise22. It has been also stated that who are to be given Langhana should not be givenBramhana, those who are to be given Bramhana, should be given mild Langhana, or bothLanghana and Bramhana together. Simultaneously may be given depending upon thenature of habitat, season, strength etc23.Chikitsaphala (Benefits of Langhana) : - Keenness of the sense organs, expulsion of malas, feeling of lightness of body,good taste perception, appearance of hunger and thirst together, purity of heart, belchingsand throat, softening of the diseases, increase of enthusiasm and loss of laziness occurfrom Langhana therapy24.--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 9
  • 29. Review of literature===============================================================Atilanghana (Excess of Thinning therapy) : - Profound emaciation, giddiness, cough, thirst, anorexia, loss of moistness anddigestive power, of sleep, vision, hearing, semen, ojas hunger and voice, pain in theurinary bladder, heart, head, calves, thighs, upper shoulders and flanks, fever, delirium(excess of talk), belching, exhaustion, vomiting, cutting pain, in joints and bones, non-elimination of faeces, urine etc arise from excess of Langhana25. In Astanga Sangraha; chapter no. 29, Dvividhopkramaniya adhyaya langhanayogyah, langhana phalam has been highlighted as same in the Astanga Hridaya.Rukshana : - In Charaka Samhita; Sutrasthana; chapter no. 22, Langhanbramhaniya adhyaya,Rukshana is that which produces roukshya, kharatwa, vaishadya. The drugs which areruksh, laghu, khara, teekshna, ushna, sthira, pichil and hard drug is mostly rukshana ineffect. Roughening therapy consists of the regular intake of Katu, Tikta, Kashaya articlessexual acts and use of oil cakes, butter milk and honey etc. The roughening therapy isindicated in diseases which are used by blocking of channels, strong doshas and arelocated in vital parts and in urustambha etc26.Samyak yoga lakshana : - The roughening therapy should be regarded as properly administered when thereis proper elimination of wind, urine, faeces, lightness in body, cleansing of heart,eructation, throat and mouth, disappearance of drowsiness and exhaustion, appearance ofsweat, relish and both hunger and thirst together and also feeling of well being27. Pain injoints, bodyache, cough, dryness of mouth, loss of hunger, anorexia, weakness of hearing--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 10
  • 30. Review of literature===============================================================and vision, confusion of mind, feeling of darkness, loss of weight, digestive power andstrength these are symptoms of excessive reducing therapy28. In Charak Sutrasthana; chapter no. 13, explains about the rukshana yogya, personwho have excess of kapha, meda, with mouth and anus having excessive secretions, haveslow digestion are afflicted with thirst and fainting, are pregnant have dry palate, aversionto food, vomiting, one afflicted with abdominal enlargement, with ama and poison, areweak in body and mind, depressed with unction, are under narcosis, should not be unctedand also during administration of snuff and enema because by taking unction, theybecome victim of severe disorders29.Swedana : - Swedan (sweating) produces sweat, it alleviates stiffness, heaviness and cold i.e.stambha, gaurav, shitaghna in property. The drugs which are ushna, teekshna, sara,snigdha, ruksha, sukshma, drav, sthira, and also guru gunatmak dravya can do swedan30.Swedan yogya : - In coryza, cough, dyspnoea, non-lightness,pain in ear, back, neck, head,hoarseness of voice, choaked throat, paralysis of phase, one limb, whole or half body,bending of body, hardness of bowels and constipation, suppression of urine, excessiveyawning, stiffness in sides, back waist and abdomen, sciatica, dysuria, enlargement ofscrotum, bodyache, pain and stiffness in feet, knees, thighs and shanks, swelling, khalli,condition of ama, cold, shivering, vatakantak, contraction, extension pain, stiffness,heaviness, numbness in organs, in these conditions swedana is beneficial31.--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 11
  • 31. Review of literature===============================================================Swedana ayogya : - Swedan should not be applied to those who are habitual users of medicinalextracts, wine, in pregnanat, ladies, those afflicted with internal haemorrhages andbradhna having complication of poison and alcohol in fatigued uncouncious plumpy,patients of pittaj meha, thirsty, hungry, angry and aggrieved ones, in those suffering fromthe jaundice, abdominal enlargement, injury and aadhyaroga, in weak, emaciated andthose having diminished ojas and suffering from the timira etc32.Types : - According to Charaka Sutrasthana; chapter no. 14, there are 13 types of Swedana1) Sankar 2) Prastar 3) Nadi 4) Parishek5) Avgaha 6) Jentak 6) Ashmaghna 8) Karshu9) Kuti 10) Bhu 11) Kumbhika 12) Kupa13) Holak. According to Sushruta Chikitsasthana; chapter no. 32, Swedanacharaniya chikitsaadhyaya1) Tap Sweda 2) Ushma 3) Upnaha 4) Drav. According to Astanga Sangraha; chapter no. 26, Sweda vidhi adhyaya, mainlyclassified into two types1) Agni sweda 2) Anagni sweda. Agni Sweda again classified into 4 kinds1) Tap 2) Ushma 3) Upnaha 4) Drava Ushma Sweda classified into 8 kinds1) Pinda Sweda 2) Sankar Sweda 3) Nadi 4) Ghanashma--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 12
  • 32. Review of literature===============================================================5) Kumbhi 6) Kupa 7) Kuti 8) Jentak Sweda Drava Sweda classified into 2 types1) Avagah 2) Parishek Sweda So these three folds of treatments i.e. Langhana,Rukshana and Swedana comesunder Apatarpana therapy. As sthoulya is santarpanotha vyadhi so ruksha udvartana withchanak pishthi is indicated in sthoulya which comes under Apartana therapy.STHOULYA REVIEW Charaka has explained sthoulya under Ashtouninditiya Adhyaya of sutrasthana33Sushruta under Dosha-dhatu – mala-kshaya vruddhi vijnaneeya Adhyaya34 and inDwividhopakramaneeya Adhyaya by Vagbhata35. While Madhava36 Yogartnakara37,Bhavaprakasha 38 explained sthoulya under the heading of medo- roga.HISTORICAL REVIEW:-I) Vedic Period – In Rigveda, Yajurveda, Atharvaveda, Upanishad no references aboutsthoulya were found.II) Samhita Period – In Charaka samhita ,Sushruta samhita , Astanga sangraha we finddetail description regarding sthoulya.III) Sangraha Kala – In Bhavamishra and in Yogratnakar we find the description aboutsthoulya.Nirukti :- Sthoolasya bhavaha sthoolata lakshana and upachita shareeratwam39.--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 13
  • 33. Review of literature===============================================================Paribhasha:- A person is said to be atisthoola when his sphik (buttock), sthana (breast) and udara(abdomen) become pendulous due to accumulation of excess of mamsa and meda inthose places and his strength is rendered disproportionate with his physical growth40.Paryaya:-Sthoolata, Atishoulya, Atisthaulyata, Medaswi, Sthoola, Atisthoola.TABLE NO 1: Paryayas Ch.S41 Su.S42 A.S43 Sthoulya + + -- Atisthooala + + + Atisthoulya + + + Medaswi + -- --NIDANA:- Following are the nidanas for sthoulya. They are divided into sharirika, manasika andbeeja swabhavaja.Sharirika nidana includes Ahara Viharai) Atibhojana i) Avyayamaii) Adhyashana ii) Avyavayaiii) Ati gurusnigda and sheeta ahara iii) Diwaswapaiv) Atishleshmala aharav) Santarpana ahara and mamsa sevana.--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 14
  • 34. Review of literature===============================================================Manasika nidana includes a. Achintana b. Harsha nityataBeeja Swabhavaja: According to Charaka sthoulya is beeja swabhavaja vyadhi.TABLE NO 2: NIDANA FOR STHOULYA ACCORDING TO DIFFERENTACHARYAS. Nidana Ch.S44 Su.S45 A.S46 M.N47 Y.R48 B.P49 Atibhojana + - - - - - Adhyashana - + - - - - Atimadhura Ahara + - - - + + Atishleshmala Ahara - + + + + + Atiguru Ahara + - + - - - Atisheeta Ahara + - - - - - Atisnigda Ahara + - - - - - Avyayama + + - + + + Avyavaya + - - - - - Diwaswapa + + - + + + Achintata + - - - - - Harshanityata + - - - - - Atisneha Ahara - - + + - Beeja Swabhavaja + - - - - ---------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 15
  • 35. Review of literature===============================================================Purvarupa:- Purva rupa for sthoulya is not available in classics.Rupa:- Rupa are the manifestations which develop during the course of disease. Below giventable shows lakshanas of sthoulya according to different Acharyas.TABLE NO 3: LAKSHANAS OF STHOULYA ACCORDING TO DIFFERENTACHARYAS. Lakshanas Ch.S50 Su.S51 A.S52 M.N53 Y.R54 B.P55 Chala udara + - + + + + Chala stana + - + + + + Chala spik + - + + + + Javoparodha + - + + + + Ayathopachaya + - + + + + Ayuhrasa + + + + - - Kruchra vyavaya + + - + + + Durbalata + - + - + + Dourgandhyata + + + + + + Swedadhikya + - - - - - Atikshudha + + + + + + Atitrishna + + + + + + Atinidra - + + + + + Atisweda - + + + + + Kshudrashwasa - + + + + +--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 16
  • 36. Review of literature=============================================================== Shrama - + - - - - Karyaakshamata - + + + - - Jadyata - + + - - - Gadagadatwa - + + - - - Shwasavarodha - + - + + + Moha - + - + + + Sadana - + - + + +Pratyatma Lakshanas of sthoulya are:- 56 a) Chala sphik b) Chala stana c) Chala udara d) Ayathopa chayotsahaSAMPRAPTI: 57 Due to nidana sevana srotorodha occurs by meda, vata moves to koshtasandukshana of vayu in koshta takes place again by which jataragni become prajwala as aresult excess of kshuda and trushna occur. Excessive of Agni and Vayu kills the sthoola person as the Agni and Vayu burnup the tree which has a big cavity inside. As meda dhatu is mula of sweda vaha srotas so excess of sweda occurs due toAgni santapa Meda dhatu, which is assosciated with kapha all, makes profound increaseof sweda. The meda getting digested in the kostha causing avarodha in the srotas of Rasahinders it from going from other dhatus and make for increase of only meda dhatu. The--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 17
  • 37. Review of literature===============================================================remaining portion of rasa dhatu being very little in quantity is not enough; to nourish therakta and other dhatu. The increase in meda is similar to the increase of vata and others, that which hasunder gone increase first will only undergo further increase. On this analogue there willbe disparity between medas and other dhatus, the increase medas will soon produceshwasa, udara, bhagandra, prameha, urusthamba, jwara etc. other diseases may manifestUPASHAYA AND ANUPASHAYA In classics no references of upashaya and anupashaya are available for sthoulyaUPADRAVA If the patient goes on indulging again in unsuitable ahara, vihara and without takingtreatment then the upadrava are seen due to the primary disease.TABLE NO 4: UPADRAVAS OF STHOULYA ACCORDING TO DIFFERENTACHARYAS Upadravas Su.S58 A.S59 M.N60 Y.R61 B.P62 Prameha + + - + - Prameha pidika + + + - + Jwara + + + + + Vidradhi + + + - + Bhagandara - + + + + Udara roga - + - - - Urushtamba - + - - ---------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 18
  • 38. Review of literature=============================================================== Vatavikara + - + - + Shwasa - + - - - Visarpa - - - + - Atisara - - - + - Arsha - - - + - Shleepada - - - + - Apachi - - + - Kamala - - - + -SADHYA SADHYATA The two diseases karshya and sthoulya are always afflicted with disease and oneshould be treated with constant nourishing and slimming remedies respectively.63 Karsha and sthoola are undesirable for treatment. Among these two sthoulya isconsidered to be more undesirable64. When compared to sthoulya krisha is better for treatment, as to bring back thenormlcy of vata, agni and meda is difficult in case of sthoulya65. By the above quotations of different Acharyas sthoulya is said to be kashta sadhyato treat .Beeja doshaja /Kulaja /sahaja is always asadhya.ARISTHA LAKSHANAS For sthoulya there are no references available as aristha lakshana.--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 19
  • 39. Review of literature===============================================================CHIKITSAChikitsa siddhanta includes 1) Nidana parivarjana – Avoidance of etiological factors constitute major course of the management of sthoulya 66 2) Shodhana chikitsa – Lekhana basti is beneficial for sthoulya prepared of drugs having ushna teekshna and rooksha gunas67 Powder of ushakadigana drugs are added with equal quantity of triphala kwatha, gomutra madhu and yavakshara. 3) Guru Cha apatarpana - charak described for sthoola person, guru which is apatarpaka ahara should be given68. 4) Shoolanam karshanam prati For sthoulya karshana ahara should be preferred69. 5) Vata, kapha and medohara annapana The oushada, ahara and pana for the sthoulya should be the alleviative of vata, kapha and meda70. 6) Udvarthana - Udvarthana with rookshadravyas like musta, kulatha is beneficial as it reduces kapha, meda and produces laghuta in the body71. 7) Udvartana with Chanak Pisthi is been utilised in Sthoulya. 8) Pana, abhyanga, gandusha, nasya, basti with triphaladi taila should be used.--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 20
  • 40. Review of literature===============================================================SHAMANAUSHADHI 72Charaka i) Guduchi, bhadramusta, triphala, takrarishta and madhu ii) Vidanga, nagara, kshara, kala loha raja , yava, amlaki, churna iii) Bhrahat panchamoola with madhu iv) Agnimantha rasa and shilajituSushruta73 – Shilajitu, shuddha guggulu, goumutra triphala churna, lobha bhasma, Rasanjana madhu are used in sthoulyaAsthanga Hridaya74 –Trikatu, katukarohini triphala, shigru, vidanga, ativisha, sthira, hingu, souvarchala jeeraka, yavani, dhanyaka, chitraka, haridra, Daruharidra, hapusha, pata, etc. saktu, Vyoshadi guggulu.Astanga sangraha75i) Madhoodhaka ii) Triphala + Madhuiii) Guduchi + Madhu iv) Brihat panchamoola + Agnimantharasav) Rasanjana + Agnimantha rasa vi)Yava + Amalaka churnavii) Musta + MadhuChakradatta76i) Madhoodaka ii) Vidangadya choornaiii) Vidangadya loha iv) Vyosadya saktuv) Badari patra siddapeya + shilajtu vi) Amurutadya gugguluvi) Loha rasayana viii) Triphaladya taila--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 21
  • 41. Review of literature===============================================================For Durgandha i) Teja patra, netrabala, abhaya and candana all churna should be applied over body. ii) Vasa swarasa + shanka churna application iii) Haridra choorna fried with chincha swarasaFor swedadhikya Shiresha nagakeshara and lodhra should be applied.Bhavaprakash77i) Triphala +trikatu + taila + lavana ii) Triphala + madhoodakaiii) Brahat panchamoola choorna + madhu iv)Erandapatra kshara+ hinguv) Loha bhasma + guduchi + triphala qwatha vi) Loha bhasma + shilajitu + tripalavii) Loha bhasma + guguulu + triphala viii)Amrutadi gugguluix) Dashanga guggulu x) Trushanadya gugguluxi) Loharishta, loharasayanaYoga – Ratnakara 78i) Triphala kwatha + madhu ii) Phalatrikadi yogaiii) Guduchyadi yoga iv) Trushanadya lohav) Navaka guggulu vi) Mocha rasa + samudra phenaBhaishajya Ratnavali 79i) Chavyadi saktu ii) Vyosadya saktuiii)Vidangadi choorna iv)Haritaki yogav) Vidangadi louha vi) Louha rasayanavii)Navaka guggulu viii) Amrutadya gugguluix) Erandakshara prayoga x) Trushanadya loha--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 22
  • 42. Review of literature===============================================================TABLE NO 5: DIFFERENT FORMULATIONS IN STHOULYA Formulation B.P Y.R B.R C.D Amrutadhya guggulu + - + + Agnimatha kwatha - - + - Badavagniloha - - + - Chavyadi sakta - - + - Dashanga guggulu + - - - Guduchyadi yoga - + - - Loha rasayana + - + + Loharshta + - + - Mahasugandhi taila + - + - Madhoodaka + + + + Navaka guggulu - + + + Phalatrikadi yoga - + - - Trushanadi loha - + + - Trushanadi guggulu + - - - Triphaladya taila + - + + Vyoshadya choorna - - - - Vidangadya loha - - + + Vyoshadi saktu + - + +--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 23
  • 43. Review of literature===============================================================PATHYAPATHYA:- Charaka mentioned ahara, vihara which allivate vata and meda which isprescribed for sthoola rogi.80Pathya ahara – Guru and ApatarpakaYava Shyamaka KodravaKulatha Adhaki beeja PatolaAmalaki Vartaka MasooraPurana shaliApathya aharaDugda Ikshu vikrutiMasha MatsyaMamsa SnehanaMadhura dravyasPathya viharaTABLE NO 6: SHOWING PATHYA VIHARA ACCORDING TO DIFFERENTACHARYAS Name of Pathya Ch.s81 Su.s82 A.S83 Y.R84 B.P85 B.R86 C.D87 vihara Asukha Shayya - - - - + - - Dhoomapana - - - - + - - Krodha - - - - + - ---------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 24
  • 44. Review of literature=============================================================== Margakramana - - - + + + - Parishrama - - - + + + + Prajagara + - + + + + + Upavasa - - - - + + - Vyavaya + - + + + + + Vyayama + + + + - + + Chintana + - + + + + +Apathya vihara: Diwaswpna--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 25
  • 45. Review of literature=============================================================== MODERN REVIEW:-OBESITY:-DERIVATION – Obesity is word derived from O-bes- the Latin word obesus – the fat,the adjective from ob-edo- meaning to eat away.DEFINATION: Obesity described as a weight of 20% or above. Obesity is oftenexpressed in terms of body mass index (B.M.I.). A BMI of 30 or more in males and 28.6or more in females indicates obesity88. It is also defined as an abnormal growth of the adipose tissues due to enlargementof fat cell size (hypertrophic obesity) or an increase in fat cell number (hyper plasticobesity) or a combination of both89.PREVALANCE: National Health and Nutrition Examination Surveys (NHANES)shows that the prevalence of obesity is much higher in African-American and Mexican-American women than in white women or in men. The prevalence of overweight and obesity is generally higher for men and womenin racial – ethnic minority populations. The third NHANES III estimated that 13.7% of children 11.5% adolesants areoverweight and obese. Between1960-1994, overweight was increased from 30.5 – 32%among adult ages 20 – 74 and obesity increased from 12.8% - 22.5%.BODY FAT DISTRIBUTION: Health care providers are concerned not only with howmuch fat a person has, but also where the fat is located in the body. Women typicallycollect fat in their hips and buttocks, giving them a "pear" shape. Men usually build up fat around their bellies, giving them more of an "appleshape.--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 26
  • 46. Review of literature===============================================================TYPES:90 The distribution of fat induced by the weight gain affects the risk associatedwith obesity and the kind of disease, that results. It is useful therefore, to be able todistinguish between those at increased risk as a result of abdominal fat distribution or"android obesity from those with a serious "gynoid fat" distribution in which fat is moreevenly and peripherally distributed around the body.AETIOLOGY (CAUSES OF OBESITY)91. In scientific terms, obesity occurs when a person consumes more calories than heor she burns. That causes this imbalance between calories in and calories out may differfrom one person to another person. Genetic, environmental, psychological and otherfactors may all play a part in obesity.GENETIC FACTORS: Obesity tends to run in families, suggesting a genetic cause.Yet families also share diet and lifestyle habits that may contribute to obesity. Separatingthese from genetic factors is often difficult. Even so, science shows that heredity islinked to obesity.ENVIRONMENTAL FACTORS: Genes do not destine people to a lifetime of obesity.However, environment also strongly influences obesity. This includes lifestylebehaviours such as what a person eats or drinks and his or her level of physical activity.PSYCHOLOGICAL FACTORS: Psychological factors may also influence eatinghabits. Many people eat in response to negative emotions, such as boredom, sadness oranger.--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 27
  • 47. Review of literature===============================================================OTHER CAUSES OF OBESITY: Some illness can lead to obesity or a tendency togain weight. These include hypothyroidism, Cushings syndrome, depression and certainneurological problems that can lead to overeating. Also drugs such as steroids and some antidepressants may cause weight gainprevention of obesity in primary care settings is compatible with efforts to prevent theirhealth consequences, through control of high B.P, type 2 diabetes etc. Thus the qualityand quantity of life may be enhanced through preventive strategies.CLINICAL FEATURES: Diagnoses will be apparent from the appearance but thedegree of obesity should also be assessed by measurement of BMI, skin fold thicknessover the triceps muscle can be measured using screw gauge and callipers. Obesity isindicated by the reading above 20 mm in men and 28 mm in women.ASSESSMENT OF WEIGHT AND BODY FAT92: Two measures important for assessing overweight and total body fat content aredetermining body mass index (BMI) and measuring waist circumference.BODY MASS INDEX: - The BMI which describes relative weight for height issignificantly correlated with total body fat content. The BMI should be used to assessoverweight and obesity and to monitor change in body weight. BMI is calculated as weight in Kg divided by height in metre square (mt2) BMI = Weight in KG Ht in Mts2Weight classifications by BMI, selected for use in this report as shown in the table below.--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 28
  • 48. Review of literature===============================================================TABLE NO 7:-CLASSIFICATION OF OVERWEIGHT AND OBESITY BY BMI CHART 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 > 40WAIST CIRCUMFERENCE: The presence of excess fat in the abdomen out ofproportion to total body fat is an independent predictor of risk factors, and morbidity.Waist circumference is positively correlated with abdominal fat content. It provides aclinically accepted measurement for assessing a patients abdominal fat content beforeand during weight loss treatment. The waist circumstances at which there is an increasedrelative risk is defined as follows:High Risks:Men > 102 cms (40 inch)Women > 88 cm (> 35 inch)DIAGNASTIC PROBLEMS: Simple obesity, which accounts for bulk of cases, has tobe distinguished from the following comparatively rare conditions: 1. Cushings syndrome 2. Froehlich’s Syndrome 3. Hypothyroidism--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 29
  • 49. Review of literature===============================================================CUSHINGS SYNDROME Causes adrenal hyperplasia more commonly in females Truncal obesity and buffalow hump Hypertension Glycosuria Hirsutism Osteoporosis Centripetal fat distribution Moon faceFROEHLICHS SYNDORME: Causes tumour of hypothalamic pituitary area Truncal obesity Sexual infantilism – gonads underdeveloped. Mental retardation Secondary sexual characters absent Impaired skeletal growth Hairless skin, headache, vomiting Visual disturbances Hands are small and flat with tapering fingers. Diabetes insipidusHYPOTHYROIDISM: A clinical conditions resulting from decreased circulatingT4 and T3 by the thyroid gland irrespective of cause when the hypothyroidism is ofsevere degree of long standing.Clinical features:Onset – Insidious with physical, mental and metabolic process below normal. Tiredness Weight gain Cold intolerance GoitreSkin: Dry and subcutaneous tissues Puffiness of face with flush Baggy eyelids Swollen oedematous appearance of supraclavicular regions, neck backs of hand and feet.--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 30
  • 50. Review of literature=============================================================== Minimal sweating Alopecia Neuro-Muscalor – Myalgia. Stiffness, hoarseness of voice Deafness Anaemia Infertility Growth Retardation Mental retardation Delayed puberty.CONSEQUENCES OF OBESITY (HEALTH RISKS)93 Obesity is more than acosmetic problem, it is a health hazard. Approximately 2,80,000 adult deaths in U.S.each year are related to obesity. Several serious medical conditions have been linked toobesity, including Psychological, Mechanical, Metabolic disorders like type-2 diabetes,cardiovascular disorders and stroke. Obesity is also linked to higher rates of certain types of cancer. Obese men aremore likely than non-obese men to die from cancer of colon, rectum or prostrate. Obesewomen are more likely than non-obese women to die from cancer of gall bladder, breast,uterus, cervix or ovaries. Other diseases and health problems linked to obesity include: Gall bladder disease and gall stones. Liver disease Osteoarthritis, a disease in which the joints deteriorate. This is possibly the resultof excess weight on joints. Gout, disease affecting the joints Pulmonary (breathing) problems, including sleep apnoea in which a person canstop breathing for a while during sleep due to arterial hypoxemia.--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 31
  • 51. Review of literature=============================================================== Reproductive problems in women, including menstrual irregularities andinfertility.PSYCHOLOGICAL AND SOCIAL EFFECTS: Emotional suffering may be one ofthe most painful parts of obesity. American society emphasizes physical appearance andoften equates attractiveness with slimness, especially for women, such messages makesoverweight people feel unattractive. Many people think that obese individuals are gluttonous, lazy, or both, eventhough this is not true. As a result, obese people often face prejudice or discriminationin the job market at school and in social situations. Feeling of rejection, shame ordepression is common.TREATMENT94: The method of treatment depends on level of obesity Overall healthcondition and motivation to lose weight. Treatment may include a combination of diet,exercise, behaviour modification and sometimes weight loss drugs. In some severeobesity gastrointestinal surgery may be recommended. But it should be kept in mindweight control is a life long effort.DIET: The most basic consideration is that the food energy in take should not be greaterthan what is necessary for energy expenditure. It requires modification of patientsbehaviour and strong motivation to lose weight and maintain ideal weight. The proportion of energy dense foods such as simple carbohydrates and fatsshould be reduced the fibre content in diet should be increased. Adequate levels ofessential nutrients in low energy diets (most conventional diets for weight reduction arebased on 1000 k. cal daily model for an adult) should be ensured.--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 32
  • 52. Review of literature===============================================================EXERCISE: It is another positive part of the management of obesity. Strainuousexercise is neither feasible nor advisable, but most obese people are capable of moderateexercise such as walking, swimming, gardening etc, provided it should not exceed theircardiovascular capacity. Regular exercises improves the fitness and their feeling of well being someconsider it also gives people more control over their appetite. An hours walk 3 miles/hr will expend about 240 k cal above basal. Even thoughit seems a small amount, 30 g of body fat, but if the daily walk becomes a habit it willadd up to a weight loss of 10 kg in a year.DRUG95: The most useful group of drugs at present to support weight reducing regimeare serotoninergic compounds. The first of all there was dl-fenfluramine now largelyreplaced by second generation drugs fenfluramine and fluoxetine. Side effects are usually mild and include drowsiness, dry mouth, head ache. Oneof these drugs is best used where there is medical need for short term weight reductionlike if obesity is associated with diabetes or hypertension. Anorectic drugs such as amphetamines, fenfluramine are not advisable because ofthe cerebral stimulating properties of amphetamine group and high incidence of valvularheart disease and pulmonary hypertension with fenfluramine. Sibutramine acts controls to inhibit serotonin and noradrenalin reuptakeprolonging the effects of both these appetite regularising neurotransmitters. It enhancesmetabolic rate and energy expenditure via stimulation of peripheral Beta-adreno-receptors.--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 33
  • 53. Review of literature===============================================================STARVATION: Fasting as a method of treatment offers advantage of dramatic drop inweight within one week of treatment and this may be of psychological benefit.FOODS TO BE AVOIDED: Bread and anything made with flour, cereals, potatoes andother whole root vegetables, foods containing much sugar, all sweets and salt. Fattyfoods like cream butter, fat beans are avoided. Fluids not more than 2 pints a day.SURGICAL PROCEDURES96: Jaw wiring to prevent eating has been used to treat whohave found it impossible to adhere to a low energy diet. 1. Jejuno-ileal bypass- indicated in vastly obese patients who have failed to lose weight despite at least 5 years of medical treatment. 2. Gastricplication – An upper pouch of about 50 – 60 ml is made with aperture outlet limited to a 12 mm ring. 3. Gastric bypass: - To reduce the size of the stomach, for example stapling which can be done, small intestine bypass, aimed at inducing malabsorption has been undertaken in some "morbid" obese patients. 4. Plastic surgery 5. Truncal vagotomyPROGNOSIS: The published records of 7 obesity clinics in USA showed thatsatisfactory results ranged only from 12 to 28% if the index of success was the loss of 12kg or more.It is difficult for patients to maintain their reduced weight since this required somerestriction of energy in take on a long term basis.--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 34
  • 54. Review of literature===============================================================PREVENTION OF OVERWEIGHT AND OBESITY: Prevention of overweight and obesity is an important as treatment. Preventionincludes primary prevention of overweight or obesity itself, secondary prevention oravoidance of weight regain following weight loss and prevention of further weightincrease in obese individuals unable to lose weight. It has been suggested that primary prevention of obesity should includeenvironmentally based strategies that address major social contributors to overconsumption of calories and inadequate physical activity such as food marketingpractices and lack of opportunity for physical activity during the work day. People at lower socio-economic levels living in urban areas also take excess ofphysical activity sites. Such strategies will be essential for effective and long termprevention of obesity. Public health approaches for preventing obesity, that is approaches designed toreduce the difficulty for any given individual of adopting healthful eating and activitypatterns will particularly benefit the socially disadvantaged, who compared to the moreadvantaged may have less access to preventive health services. Primary care practitioners are an important element in preventing and managingobesity in United States.--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 35
  • 55. Review of literature=============================================================== DRUG REVIEW:-CHANAK97Sanskrit name : ChanakLatin name : Cicer arietinumBotanical name : Cicer arietinumSynonyms: Chanak, Harimanth, Sakalpriya.Vernacular names: E – Bengal gram, Chickpea. H – Chane, Cholla, Rahila, Bunta. K – Kadale. M – Harbara.Kula : Shimbi kulaFamily : Leguminasae.Gana : Chanakadi gana (Chanak, Masura, Khandika, Saharenava)Habitat : Throughout the greater part of India , Chanak is found as agriculturalproduct.Botonical description: A small tree (kshupa) of about 1-1 ½ feet in height.Leaf : Pakshawat, 6 mm in length and 4 mm in breadth.Flower : Short , single and of different shapes and also colour.Types : Shweta and of different colours.--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 36
  • 56. Review of literature===============================================================Properties Rasa : Kashaya rasayukta. Guna : Laghu , Rooksha Veerya : Sheeta. Vipaka : Katu. Karma : Vatakarak, Pitta, Raktavikara nashak, Kapha and Jwara nashak. Rogaghnata : Pitta and Kapha nashak, Jwara nashak, Vatajanak, Shukranashak98, Raktavikar and Meha nashak.Chemical Composition – Protein 17.1, Sneha 5.3, Khanija 2.7, Fibres 3.9, Carbohydrates 61.2, Khatik,Phosphorus and Vitamin A,B 1, Humidity 9.8.Parts used: Chanak seeds.Use : Used internally as food.Properties of wet Chanak : - Kashaya rasa, Soft, Tasty, Sheetal, Vatajanak, Grahi, Laghu, Pitta, Shukra andKapha-Pitta nashak.--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 37
  • 57. Review of literature===============================================================UDVARTANA:-Nirukthi:- The word Udvartana is derived from the root – ud + vrith + bhavae + karanevalyud, which means vilepana or Gharshana.Paribhasha:- It is described as the Rookshana karma, practiced by means of rubbing the bodywith karshana karaka drugs.“Udvartanam kashayadi choorna Gatra karshanam”Giving friction to the body by kashayadi choorna is called as Udvarthana. The concept of Udvartana is explained right from the oldest textbook CharakaSamhita and most of the other authors under rookshana karma which is one among theShadvidhopakrama. The word meaning of Rookshana is making thin or inducing dryness. The panchbhoutika composition of Rookshana dravyas is predominant of Vayu,Agni and pruthvi mahabhutas99 and it is having kashaya pradhana, katu tikta rasa. Thebest examples are yava and takra. Rookshana is indicated in Vasantha Ruthu in which Udvarthana with Rookshadravya, which are having kaphagna property, is beneficial100. The following tables describe the different aspects of udvartana as one of therookshana kriya. TABLE NO. 8 SHOWING EFFECTS OF ROOKSHANA KARMA:- Constituent Effects Dosha Vata vardhaka, Kapha nashaka Dhatu Vikruta Dhatu shoshana, Balya, Varnya Mala Shoshana (dravamsha of mala)-performs sthambhana karma--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 38
  • 58. Review of literature=============================================================== TABLE NO. 9 SHOWING SAMYAK ROOKSHANA LAKSHANA101:- Lakshana Ch Su A.S & Hr Samyak vata, mutra, mala Pravritti + + - Hridaya Shuddhi + - + Udgara Shuddhi + - + Kantha Shuddhi + - + Aasya Shuddhi + - - Indriya Prasannata - + + Tandra Nasha + - + Klama Nasha + - - Sweda + - - Ruchi + - + Kshuth Sahodaya + + + Pipasa Sahodaya + + + Vyadhi Mardava - - + Utsaha - - + Nirvyathe Antharatma + - - Gatra Laghuta + + +--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 39
  • 59. Review of literature=============================================================== TABLE NO.10 SHOWING ROOKSHANA ATHI YOGA LAKSHANA:-102 Lakshana Ch Su A.S & hr Parva Bheda + - - Anga Marda + - - Kasa + + + Mukha Shosha + + - Kshuth Pranasha + - + Aruchi + - - Trishna + + + Shrotra Netra Dourbalya + - + Urdhva Vata + - + Tamo Vrudhi + - - Deha Bala Nasha + + - Agni Bala Nasha + - + Tandra - + - Anidra - + + Bhrama - + - Klama - + - Swara Kshaya - + ---------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 40
  • 60. Review of literature=============================================================== Chardi - + + Hikka - + + Shwasa - + + Arochaka - - + Sneha Kshaya - - + Shukla Kshaya - - + Oja Kshaya - - + Swara Kshaya - - + Basti Rukh - - + Hridaya Rukh - - + Murdha Rukh - - + Jangha Rukh - - + Uru Ruja - - + Trika Ruja - - + Parshva Ruja - - + Jwara - - + Pralapa - - + Glani - - +--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 41
  • 61. Review of literature=============================================================== Para Asthi Bhedana - - + Varcho Mutra Graha - - + Jrumbha - - +TABLE NO. 11 SHOWING ROOKSHANA AYOGA LAKSHANA:-103 Lakshana OUSHADANAM DHATUNAM ASHAMO (No relief from the diseases treatable from upakrama) ROGA VRIDDHI (Aggravation of diseases) Shodhana AyogaClassification:- Udvartana can be classified as two types: 1) Udgharshana. 2) Utsadana.1. Udgharshana (Reinforced friction): This is the procedure where “body is rubbed with the powdered medicine withoutmixing oil or other Drava dravya”.104It has the properties of Vata Shamana, Kandu- Spota- Pidika nashaka, Sira shodhaka,Twak gata Agni vardaka, stimulates Brajaka Pitta. Friction of body with karshanadravya excites the heat of skin, destroys itching, rashes etc.2. Utsadana (Rubbing): This is the procedure where “body is rubbed with the sneha / drava yuktamedicine in the form of kalka”.105--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 42
  • 62. Review of literature=============================================================== It is beneficial as it improves complexion in females, gives good appearance,cleanses and beautifies.Difference between Mardana and Udvarthana:-106 Mardana is a type of Abhyanga (abhyanga with pressure varience). Mardana is aprocess of giving deep pressure from foot to waist, which is in prathiloma gathi However, Udvartana is different from Abhyanga. In Udvartana, rubbing is done inupward direction (prathiloma gathi) where as Abhyanga is done in downward direction(anuloma gati). The intention of doing Udvartana is to bring Rookshana in the bodywhere as abhyanga pacifies rookashata.TABLE NO. 12 Showing benefits of Udvartana:- Sl. no Benefits Ch Su A.H Y.R 1 Dourgandya hara + - - - 2 Gourava hara + - - - 3 Tandra hara + - - - 4 Kandu hara + - - - 5 Mala hara + - - - 6 Aruchi hara + - - - 7 Vata hara - + - - 8 Kapha vilayana - + - - 9 Meda vilayana - + + ---------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 43
  • 63. Review of literature =============================================================== 10 Anga sthirikarana - + + - 11 Twak prasadakara - + + + 12 Kapha hara - - + + 13 Meda hara - - - + 14 Shukrada - - - + 15 Balya - - - + 16 Kanthi - - - + 17 Twak mrudutwa - - - + Mode of Action of Udvartana:- Important qualities of rubbing are –• It gives a mechanical stimulation causing contraction followed by relaxation and thus greatly influences the muscles.• It increases the peripheral circulation and influence the venous drainage by its alternate pressure and relaxation techniques.• It improves the nutrition of the particular area by proper circulation.• It raises temperature locally by continuous friction.• It increases elimination of waste products especially in the form of sweating.• It increases secretion and absorption capacities of skin.• It conditions the nervous system by stimulating the cutaneous nerve endings.• It influences the general metabolism when applied on large areas. -------------------------------------------------------------------------------------------------------------------------------- A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 44
  • 64. Review of literature ===============================================================Physiological effects:- As the skin covers nearly the whole body its surface is affected by massage as well as the structures, which lie beneath it. It increases the cutaneous circulation, stimulates the sensory nerve ending and influences the vasoconstrictors and vasodilators in the skin. The pressure of deep massage exerts a simultaneous influence on all the tissue of the body. Further it accelerates the activity of the heart, helps the assimilation of food and influences general metabolism of the body. Influence of rubbing up on the circulation of fluid including lymphatic is also of great importance. Rubbing stimulates both motor and sensory nerve endings. The influence of rubbing on Motion of the molecules to participate in chemical activity results in the anti-oxidant process. TABLE NO. 13 SHOWING THERAPEUTIC ACTIONS OF UDVARTANA:- Sl.No. Benefits Ch Su As.Hr. Y.R 1 Dourgandya hara + - - - 2 Gourava hara + - - - 3 Tandra hara + - - - 4 Kandu hara + - - - 5 Mala hara + - - - 6 Aruchi hara + - - - 7 Vata hara - + - - 8 Kapha vilayana - + - - -------------------------------------------------------------------------------------------------------------------------------- A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 45
  • 65. Review of literature=============================================================== 9 Meda vilayana - + + - 10 Anga sthirikarana - + + - 11 Twak prasadakara - + + + 12 Kapha hara - - + + 13 Meda hara - - - + 14 Shukrada - - - + 15 Balya - - - + 16 Kanthi - - - + 17 Twak mrudutwa - - - +--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 46
  • 66. Materials and methods=============================================================== MATERIALS AND METHODS:MATERIAL – The materials taken for the clinical trials were A) Instruments a. Weighing machine b. Measuring tape B) Drugs a. Chanak Pisthi C) 30 Patients of SthoulyaCOLLECTION OF MATERIALS A) Instruments – Weighing machine of 0.5 kg gradation were taken for the study from the O.P.D of Dr B.N.M.E Trust’s P.G and Research Centre, Bijapur The measuring tape to measure the chest, abdomen, Hip for the study were taken from Santosh Surgicals, Bijapur. B) Drug – Chanak pisthi was prepared as per the classical referenceMETHODOLOGY OF1) Height The patient was made to stand erect on ground level with bare foot, heels togetherand arms hanging perpendicular to ground. The head should be so held that the eyes weredirected towards forward. The scale was held over the head and marked it.Themeasurement from ground to the mark will be the height of the individual and it isrecorded in centimetres.-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 47
  • 67. Materials and methods===============================================================2) Weight – The patient was weighed with minimum garments on a lever balanced weighingmachine and the weight is recorded in kilograms3) BMI: (Body Mass Index.) BMI of the patient is calculated by using the formula BMI = Weight in kg / Ht in mt25) Vaksha circumference: Measurement at the nipple line in men, at the largest circumference above thebreasts in females6) Udara circumference of udara was measured at the level of umbilicus.7) Sphik circumference: While standing erect horizontal measure taken at level of maximumcircumference of hips. Normal readings of vaksha, udara and sphik were taken on the basis of pilotstudy.METHOD:- Aim: The aim of study was to assess the effect of chanak pisthi udvartana insthoulya (obesity). Study design- The patients of sthoulya with in the age group of 18-60 yrs were selectedrandomly from O.P.D and I.P.D of Dr. B.N.M.E Trust’s Shri Mallikarjun Swamiji PostGraduate and research centre, Bijapur and camps conducted in the city (Bijapur) by theinstitute, irrespective of sex, occupation and socio-economic status.-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 48
  • 68. Materials and methods=============================================================== The size of the sample is 30 excluding the drop outs. The present study iscomparative study where in patients were assigned into one groupSOURCE OF DATA:-LITERARY DATA:- The literary source of present study was obtained from Vedic scriptures, classicaltexts of Ayurveda, modern texts, published articles in reputed journals and internet.CLINICAL DATA The clinical data was obtained from the patients enrolled for the clinical study.INCLUSIVE CRITERIA 1. Sthoulya diagnosed according to signs and symptoms as in classical texts. 2. Sthoulya of both sex. 3. Between the age group of 20 – 50 years. 4. The patients with BMI above 30 and below 40 irrespective of sex.EXCLUSIVE CRITERIA 1. Pregnant women. 2. Age group below 20 and above 50 years. 3. Obesity due to secondary causes. 4. Obesity observed since birth.-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 49
  • 69. Materials and methods===============================================================SAMPLING METHODS Randomly selected patients from O.P.D and I.P.D of Dr. B.N.M.E. Trust’s ShriMallikarjun Swamiji Post Graduate and Research Center, Bijapur were collected in singlegroup.LAB INVESTIGATIONS As the study was conducted only on the basis of subjective parameters hence noinvestigations are carried out.INTERVENTIONS:- While making group simple random sampling procedure is adopted. Sample size : 30 patients Sample type : Sthoulya Procedure : From 1st day to 30th day chanak pisthi udvartana is carried out. Duration : 30 days Follow ups Follow up before treatment : I follow up: 1st day Follow up after treatment : II follow up: 30th day Post treatment follow up : 15th day-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 50
  • 70. Materials and methods=============================================================== ASSESSMENT OF SUBJECTIVE AND OBJECTIVE CRITIERA OF STHOULYA: -OBJECTIVE CRITERIA1) B.M.I = Weight in Kg Height in mt sqCLASSIFICATION OF OVERWEIGHT AND OBESITY BY BMI CHARTTABLE No.14 Obesity Class BMI (mg/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 > 40TABLE No.15 SUBJECTIVE CRITERIA: Lakshanas BT ( 1st Day) AT (21st Day) AFU (30th Day) Kshudra shwasa Atikshuda Atitrushna Swedaadhikata-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 51
  • 71. Materials and methods===============================================================Gradings for Subjective criteria are mentioned as, Grade I Absent Grade II Mild Grade III Moderate Grade IV SevereOBJECTIVE CRITERIA:-VAKSHA CIRCUMFERENCE Grade I Overweight <80 cms Grade II Mild obese 81-90 cms Grade III Moderate obese 91-100 cms Grade IV Grossly obese 101-110 cmsUDARA CIRCUMFERENCE Grade I Overweight <80 cms Grade II Mild obese 81-90 cms Grade III Moderate obese 91-100 cms Grade IV Grossly obese 101-110 cmsSPHIK CIRCUMFERENCE Grade I Overweight <90 cms Grade II Mild obese 91-100 cms Grade III Moderate obese 101-110 cms Grade IV Grossly obese 111-120 cms-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 52
  • 72. Materials and methods===============================================================TABLE No.16 Circumference BT ( 1st Day) AT (21st Day) AFU (30th Day) Vaksha Udara SphikTABLE No.17OBJECTIVE CRITERIA: Variable BT ( 1st Day) AT (21st Day) AFU (30th Day) BMIOBSERVATIONAL VARIABLES:- 1) Adhika Kshudha 3) Kshudra Shwasa 2) Adhika trishna 4) Swedaadhikata.ASSIGNMENT OF CLINICAL IMPROVEMENT Clinical improvement of the disease was based on improvement in the clinicalfindings and reduction on the severity of the symptoms of the disease grading for theclinical improvement for individual variables. Grading for the clinical improvement for individual variables 1. CI-III: excellent i.e. 3 degree reduction in the severity score, against the initial score, i.e. severe –normal.-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 53
  • 73. Materials and methods=============================================================== 2. CI-II: Good i.e. 2 degree reduction in the severity score, against the score, i.e. reduction from moderate –normal, severe-mild 3. CI-I: encouraging i.e. 1 degree reduction in the severity score, against initial score, i.e. reduction from mild-normal, Moderate-Mild and Severe-moderate. 4. CS: Clinically stable, i.e. severity score remains as against the initial score. 5. CD: Clinically deteriorated i.e. increased in severity score against the initial score.STATISTICAL ANALYSIS: The data was collected from both the groups before,and after treatment and at the end of follow up and statistically analyzed by using student’s ‘t’ test.-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 54
  • 74. Observations and results ============================================================  OBSERVATIONS AND RESULTS:OBSERVATIONS:- Total 30 patients were taken for clinical study. The observation for presentstudy were done in three stage – • Generalized observations. • Specific observations. • Result related observations.GENERALIZED OBSERVATIONS:-Table No – 18 Distribution of patients according to age. (n=30) Sl. No Age in years No of patients % 1 18-30 13 43.33% 2 31-40 17 56.66% Graph No 1: Distribution of patients according to age. 43.33 18-30 31-40 56.66 In the present study it was observed that 13 patients (43.33%) were of 18-30yrs,and 17 patients (56.66%) were of 31-40 yrs of age.------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 55
  • 75. Observations and results ============================================================ Table No –19 Distribution of patients according to sex. (n=30) Sl. No Sex No of patients % 1 Male 24 80% 2 Female 6 20% Graph No 2: Distribution of patients according to sex. 90 80 80 70 60 50 male 40 female 30 20 20 10 0 In the present study it was observed that 24 patients (80%) were male and 6patients (20%) were females.Table No – 20 Distribution of patients according to religion. (n=30) Sl. No Religion No of patients % 1 Hindu 25 83.33% 2 Muslim 5 16.66% Graph No 3: Distribution of patients according to religion. 100 83.33 80 60 Hindu 40 Muslim 16.66 20 0 Percentage Majority of patients observed were Hindu 25 patients (83.33%) and Muslimwere 5 patients (16.66%).------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 56
  • 76. Observations and results ============================================================  Table No – 21 Distribution of patients according to education. (n=30) Sl. No Educational status No of patients % 1 Educated 26 86.66% 2 Uneducated 4 13.33% Graph No 4: Distribution of patients according to education 100 80 60 Educated 40 Uneducated 20 0 PercentageIn the present study 26 pts (86.66%) were educated and 4 (13.33%) pt wasuneducated.Table No – 22 Distribution of patients according to socio-economicalstatus.(n=30) Sl. No Socio economical status No of patients % 1 Lower class 0 0% 2 Middle class 24 80% 3 Upper class 6 20% Graph No 5: Distribution of patients according to socio-economical status. 10000% 80 8000% Lower class 6000% Middle class 4000% 20 Upper class 2000% 0% 0% Percentage------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 57
  • 77. Observations and results ============================================================  In the present study maximum patients observed were of middle class i.e. 24patients (80%),were patients observed of upper class is,6 patients (20%).Table No – 23 Distribution of patients according to marital status. (n=30) Sl. No Marital status No of patients % 1 Married 22 73.33% 2 Unmarried 8 26.66% Graph No – 6 Distribution of patients according to marital status. 73.33 80 60 Married 40 26.66 Unmarried 20 0 Percentage Maximum patients observed for the study were married 22 patients (73.33%)and unmarried are only 8 patients (26.66%).Table No – 24 Distribution of patients according to Habitat (n=30) Sl. No Habitat No of patients % 1 Rural 4 13.33% 2 Urban 26 86.66 % Graph No – 7 Distribution of patients according to Habitat. 100 86.66 80 60 Rural 40 Urban 20 13.33 0 Percentage------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 58
  • 78. Observations and results ============================================================  Majority of patients observed were from urban 26 (86.66%) and 4 patients(13.33%) belong to rural area.Table No – 25 Distribution of patients according to occupation (n=30) Sl. No Occupation No of patients % 1 Student 8 26.66% 2 Farmer 6 20% 3 Business 9 30% 4 House wife 5 16.66% 5 Teacher 2 6.66% Graph No –8 Distribution of patients according to occupation 35 30 30 26.66 Student 25 20 Farmer 20 16.66 Business 15 House wife 10 6.66 Teacher 5 0 Percentage The patients from various occupations were observed for the study. Amongthem 8 patients (26.66%) were students,6 patients (20%)were farmer,9 patients(30%)were business men,5 patients (16.66%) were house wife and , 2 patients(6.66%) were teacher.------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 59
  • 79. Observations and results ============================================================ Table No –26 Distribution of patients according to diet (n=30) Sl. No Diet No of patients % 1 Veg 6 20% 2 Mixed 24 80% Graph No – 9 Distribution of patients according to diet 100 Mixed 80 60 Veg 40 Mixed Veg 20 0 Percentage Among the patients observed for study vegetarians were 6 patients (20%) andthose who took mixed diet were 24 patients (80%).Table No – 27 Distribution of patients according to vyasana. (n=30) Sl. No Vyasana No of patients % 1 Tea/Coffee 8 26.66% 2 Tobacco 5 16.66% 3 Alcohol 2 6.66% 4 Cigarette 3 10% 5 No habits 12 40% Graph No – 10 Distribution of patients according to vyasana 50 40 40 Tea/Coffee 26.66 Tobacco 30 Alcohol 16.66 20 10 Cigarette 10 No habits 0 Percentage In the present study it was observed that 8 patients (26.66%) have a habit ofTea/ Coffee, tobacco chewers were 5 patients (16.66%) , alcohol habit were 2 patients.66%) cigarette smokers were 3 patients (10%) and no habits were 12 patients (40%).------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 60
  • 80. Observations and results ============================================================ Table No –28 Distribution of patients according to prakruti (n=30) Sl. No Prakruti No of patients % 1 Kaphavata 8 26.66% 2 Kaphapitta 11 36.66% 3 Pittakapha 11 36.66% Graph No – 11 Distribution of patients according to prakruti 40 36.66 35 30 26.66 25 Kaphavata 20 Kaphapitta 15 Pittakapha 10 5 0 Percentage In the present study it was observed that of kaphavata prakruti there were 8patients (26.66%),kapha pitta prakruti11 patients (36.66%), and of pittakapha prakruti11 patients (36.66%).Table No – 29 Distribution of patients according to Agni (n=30) Sl. No Agni No of patients % 1 Manda 0 0% 2 Teekshna 20 66.66% 3 Vishama 10 33.33% Graph No – 12 Distribution of patients according to Agni 80 66.66 60 Manda 33.33 40 Teekshna 20 Visham a 0 Percentage In the present study it was observed that most of the patients were havingTeekshnagni i.e. 20 patients (66.66%) and only 10 patients (33.33%) were havingvishamagni.------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 61
  • 81. Observations and results ============================================================  Table No – 30 Distribution of patients according to Kostha. (n=30) Sl. No Kostha No of patients % 1 Mrudu 3 10% 2 Madhyama 20 66.66% 3 Krura 7 23.33% Graph No – 13 Distribution of patients according to Kostha 66.66 70 60 50 Mrudu 40 23.33 Madhyam 30 20 10.00 Krura 10 0 Percentage Patients registered for study were assessed for mrudu, madhyama and kroorakostha, majority of patients with madhyama koshta i.e. 20 (66.6%), 7 patients werekroora kostha (23.33%) and 3 patients (10%) of mrudu kostha.Table No – 31 Distribution of patients according to Kula Vruttanta. (n=30) Sl. No Kula vruttanta No of patients % 1 Present 8 26.66% 2 Absent 22 73.33% Graph No – 14 Distribution of patients according to Kula Vruttanta 80 73.33 60 Present 40 26.66 Absent 20 0 Percentage In the present study 8 patients (26.66%) patients had kula vruttanta of sthaulyaand 22 patients (73.33%) had no kula vruttanta of sthaulya.------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 62
  • 82. Observations and results ============================================================ Table No – 32 Distribution of patients according to BMI (n=30) Beforetreatment; Grading BMI No of patients % G1 30-34.9 27 90% G2 35-39.9 3 10% G3 >40 0 0% Graph No – 15 Distribution of patients according to BMI 100 80 60 30-34.9 35-35.9 40 >40 20 10 0 0 Percentage Patients observed for study was assessed as G-1;B.M.I in between 30-34.9 were27 patients (90%), G-2;B.M.I in between 35-35.9 were 3 patients (10%).------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 63
  • 83. Observations and results ============================================================ Table No – 33 Distribution of patients based on Vaksha Circumference (n=30)Before treatment; Grading Vaksha circumferance No of patients % G1 Overweight <80cms 0 0 G2 Mild obese 81-90 cms 18 60 G3 Moderate obese 91-100cms 10 33.33 G4 Grossly obese 101-110cms 2 6.66 Graph No – 16 Distribution of patients based on Vaksha Circumference 80 G2 60 G1 G3, 33.33 G2 40 G3 20 G4 G4 0 Percentage Vaksha circumference – patients observed for study were assessed grade 1 tograde 4. Majority of patients were of grade 2 i.e., 18 patients (60%), grade 3 were 10patients (33.33%) and grade 4 were of 2 patients (6.66%).Table No – 34 Distribution of patients based on Udara Circumference (n=30)Before treatment; Grading Udara circumferance No of patients % G1 Overweight <80cms 0 0 G2 Mild obese 81-90 cms 5 16.66 G3 Moderate obese 91-100cms 16 53.33 G4 Grossly obese 101-110cms 9 30------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 64
  • 84. Observations and results ============================================================  Graph No – 17 Distribution of patients based on Udara Circumference 60 G3 50 G1 40 G4 G2 30 G3 20 G4 10 0 Percentage Udara circumference – patients observed for study were assessed grade 1 tograde 4. Majority of patients were of grade 3, 16 patients (53.33%), grade 2 were 5patients (16.66%) andgrade 4 were 9 patients (30%).Table No – 35 Distribution of patients based on Sphika Circumference (n=30)Before treatment; No of Grading Sphika circumferance patients % G1 Overweight <90cms 0 0 G2 Mild obese 91-100 cms 6 20 G3 Moderate obese 101-110cms 17 56.66 G4 Grossly obese 111-120cms 7 23.33 Graph No – 18 Distribution of patients based on Sphik Circumference G3 60 50 G1 40 G2 30 G4 20 G3 10 G4 0 Percentage Sphik circumference – Majority of patients were of grade 3 i.e. 17 patients(56.66%), grade 2 were 6 patients (20%) and grade 4 were 7 patients (23.33%).------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 65
  • 85. Observations and results ============================================================ Table No – 36 Distribution of patients according to adhika kshudha.(n=30) Before treatment. Grading adhika kshudha No of patients % G1 Absent 0 0 G2 Mild 0 0 G3 Moderate 18 60 G4 Severe 12 40 Graph No – 19 Distribution of patients based on adhika kshudha.(n=30) 80 60 60 G1 40 G2 40 G3 20 G4 0 0 0 Total Majority of patients were of grade 3 ie,18 patients (60%) and of grade 4 were 12patients (40%). Table No –37 Distribution of patients according to adhika trishna.(n=30) Before treatment; Grading adhika trishna. No of patients % G1 Absent 0 0 G2 Mild 2 6.66 G3 Moderate 22 73.33 G4 Severe 6 20------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 66
  • 86. Observations and results ============================================================  Graph No – 20 Distribution of patients based on adhika trishna.(n=30) 80 73.33 60 G1 G2 40 20 G3 20 6.66 G4 0 0 TotalMajority of patients were of grade 3 ie,22 patients (73.33%), grade 2 were 2 patients(6.66%) and grade 4 were 6 patients (20%). Table No –38 Distribution of patients according to Kshudra shwas.(n=30) Before treatment; Grading Kshudra shwas. No of patients % G1 Absent 14 46.66 G2 Mild 12 40 G3 Moderate 4 13.33 G4 Severe 0 0 Graph No – 21 Distribution of patients based on Kshudra shwas.(n=30)) 46.66 50 40 40 G1 30 G2 20 13.33 G3 10 G4 0 0 TotalIn present study it was observed that from grade 1 to grade4,14 patients (46.66%) wereof grade 1,12 patients (40%) were of grade 2,4 patients (13.33%) were of grade 3.------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 67
  • 87. Observations and results ============================================================ Table No – 39 Distribution of patients according to swedadikhata.(n=30) Before treatment; Grading swedadikhata . No of patients % G1 Absent 0 0 G2 Mild 2 6.66 G3 Moderate 14 46.66 G4 Severe 14 46.66 Graph No – 22 Distribution of patients based on swedadikhata.(n=30) 46.66 46.66 50 40 G1 30 G2 20 G3 6.66 10 G4 0 0 Total In present study it was observed that from grade 1 to grade4,2 patients (6.66%) wereof grade 2,14 patients (46.66%) were of grade 3,14 patients (46.66%) were of grade 4.Table No – 40 Distribution of patients according to BMI (n=30)After treatment; Grading BMI No of patients % G1 30-34.9 28 93.33% G2 35-39.9 2 6.66% G3 >40 0 0%------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 68
  • 88. Observations and results ============================================================  Graph No – 23 Distribution of patients according to BMI 100 80 <30 60 30-31.5 40 31.6-33 20 6.66 0% 0 Percentage Patients observed for study were assessed as G-1;B.M.I in between 30-34.9 were28 patients (93.33%), G-2;B.M.I in between 35-35.9 were 2 patients (6.66%).Table No – 41 Distribution of patients based on Vaksha Circumference (n=30)After treatment; Grading Vaksha circumferance No of patients % G1 Overweight <80cms 1 3.33 G2 Mild obese 81-90 cms 17 56.66 G3 Moderate obese 91-100cms 11 36.66 G4 Grossly obese 101-110cms 1 3.33 Graph No –24 Distribution of patients based on Vaksha Circumference G2 60 50 G3, 36.66 G1 40 G2 30 G3 20 G4 10 G4 0 Percentage Vaksha circumference – patients observed for study were assessed grade 1 tograde 4. Majority of patients were of grade 2 i.e., 17 patients (56.66%), grade 3were11 patients (36.66%) and grade 4 was 1 patient (3.33%) and grade 1 was 1patient(3.33)’------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 69
  • 89. Observations and results ============================================================ Table No – 42 Distribution of patients based on Udara Circumference (n=30)After treatment; Grading Udara circumferance No of patients % G1 Overweight <80cms 0 0 G2 Mild obese 81-90 cms 7 23.33 G3 Moderate obese 91-100cms 16 53.33 G4 Grossly obese 101-110cms 7 23.33 Graph No – 25 Distribution of patients based on Udara Circumference 60 G3 50 G1 40 G2 30 G4 G3 20 G4 10 0 Percentage Udara circumference – patients observed for study were assessed grade 1 tograde 4. Majority of patients were of grade 3, 16 patients (53.33%), grade 2 were 7patients (23.33%) and of grade 4 were 7 patients (23.33%).Table No – 43 Distribution of patients based on Sphika Circumference (n=30)After treatment; Grading Sphika circumferance No of patients % G1 Overweight <90cms 0 0 G2 Mild obese 91-100 cms 8 26.66 G3 Moderate obese 101-110cms 16 53.33 G4 Grossly obese 111-120cms 6 20------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 70
  • 90. Observations and results ============================================================  Graph No – 26 Distribution of patients based on Sphik Circumference 60 G3 50 G1 40 G2 30 G4 20 G3 10 G4 0 Percentage Sphik circumference – Majority of patients were of grade 3 i.e. 16 patients(53.33%), grade 2 were 8 patients (26.66%)and grade 4 were6 patients (20%).Table No – 44 Distribution of patients according to adhika kshudha.(n=30) After treatment. Grading adhika kshudha No of patients % G1 Absent 0 0 G2 Mild 0 0 G3 Moderate 19 63.33 G4 Severe 11 36.66 Graph No – 27 Distribution of patients according to the variables symptom 80 63.33 60 Ati Kshuda 36.66 Ati Trishna 40 Kshudrashwas 20 Swedaadhikata 0 0 0 Total Majority of patients were of grade 3 ie,19 patients (63.33%) and of grade 4 were11 patients (36.66%).------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 71
  • 91. Observations and results ============================================================ Table No –45 Distribution of patients according to adhika trishna.(n=30) After treatment; Grading adhika trishna. No of patients % G1 Absent 0 0 G2 Mild 2 6.66 G3 Moderate 22 73.33 G4 Severe 6 20 Graph No – 28 Distribution of patients based on adhika trishna.(n=30) 80 73.33 60 G1 G2 40 20 G3 20 6.66 G4 0 0 TotalMajority of patients were of grade 3 ie,22 patients (73.33%), grade 2 were 2 patients(6.66%) and grade 4 were 6 patients (20%).Table No – 46 Distribution of patients according to Kshudra shwas.(n=30)After treatment; Grading Kshudra shwas. No of patients % G1 Absent 14 46.66 G2 Mild 12 40 G3 Moderate 4 13.33 G4 Severe 0 0------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 72
  • 92. Observations and results ============================================================  Graph No –29 Distribution of patients based on Kshudra shwas.(n=30)) 46.66 50 40 40 G1 30 G2 20 13.33 G3 10 G4 0 0 Total In present study it was observed that from grade 1 to grade4,14 patients (46.66%)were of grade 1,12 patients (40%) were of grade 2,4 patients (13.33%) were of grade 3.Table No – 47 Distribution of patients according to swedadikhata.(n=30)After treatment; Grading Swedadikhata . No of patients % G1 Absent 1 3.33 G2 Mild 5 16.66 G3 Moderate 24 80 G4 Severe 0 0 Graph No – 30 Distribution of patients based on swedadikhata.(n=30) 100 80 80 G1 60 G2 40 G3 16.66 20 3.33 G4 0 0 TotalMajority of patients were of grade 3 i.e., 24 patients (80%), grade 2 were 5 patients(16.66%) and grade 1 was 1 patients (3.33%).------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 73
  • 93. Observations and results ============================================================ Table No – 48 Distribution of patients according to BMI (n=30) After Follow up Grading BMI No of patients % G1 30-34.9 27 90% G2 35-39.9 3 10% G3 >40 0 0% Graph No – 32 Distribution of patients according to BMI 100 80 30-34.9 60 35-35.9 40 >40 20 10 0 0 Percentage Patients observed for study were assessed as G-1;B.M.I in between 30-34.9 were27 patients (90%), G-2;B.M.I in between 35-39.9 were 3 patients (10%).Table No – 49 Distribution of patients based on Vaksha Circumference (n=30) After Follow up Grading Vaksha circumferance No of patients % G1 Overweight <80cms 0 0 G2 Mild obese 81-90 cms 18 60 G3 Moderate obese 91-100cms 10 33.33 G4 Grossly obese 101-110cms 2 6.66------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 74
  • 94. Observations and results ============================================================  Graph No – 33 Distribution of patients based on Vaksha Circumference 80 G2 60 G1 G3, 33.33 G2 40 G3 20 G4 G4 0 Percentage Vaksha circumference – patients observed for study were assessed grade 1 tograde 4. Majority of patients were of grade 2 i.e., 18 patients (60%), grade 3 were 10patients (33.33%) and grade 4 were of 2 patients (6.66%).Table No – 50 Distribution of patients based on Udara Circumference (n=30)After Follow up Grading Udara circumferance No of patients % G1 Overweight <80cms 0 0 G2 Mild obese 81-90 cms 6 20 G3 Moderate obese 91-100cms 15 50 G4 Grossly obese 101-110cms 9 30 Graph No – 34 Distribution of patients based on Udara Circumference 60 G3 50 G1 40 G4 G2 30 G3 20 G4 10 0 Percentage Udara circumference – patients observed for study were assessed grade 1 tograde 4. Majority of patients were of grade 3, ie,15 patients (50%), grade 2 were 6patients (20%) andgrade 4 were 9 patients (30%).------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 75
  • 95. Observations and results ============================================================ Table No – 51 Distribution of patients based on Sphika Circumference (n=30)After Follow up No of Grading Sphika circumferance patients % G1 Overweight <90cms 0 0 G2 Mild obese 91-100 cms 7 23.33 G3 Moderate obese 101-110cms 17 56.66 G4 Grossly obese 111-120cms 6 20 Graph No – 35 Distribution of patients based on Sphik Circumference G3 60 50 G1 40 G2 30 G4 20 G3 10 G4 0 Percentage Sphik circumference – Majority of patients were of grade 3 i.e. 17 patients(56.66%), grade 2 were7 patients (23.33%)and grade 4 were 6 patients (20%).Table No – 52 Distribution of patients according to adhika kshudha.(n=30)After Follow up Grading adhika kshudha No of patients % G1 Absent 0 0 G2 Mild 0 0 G3 Moderate 18 60 G4 Severe 12 40------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 76
  • 96. Observations and results ============================================================  Graph No – 36 Distribution of patients based on adhika kshudha.(n=30) 80 60 60 G1 40 G2 40 G3 20 G4 0 0 0 Total Majority of patients were of grade 3 ie,18 patients (60%) and of grade 4 were 12patients (40%).Table No – 53 Distribution of patients according to adhika trishna.(n=30) After Follow up Grading adhika trishna. No of patients % G1 Absent 0 0 G2 Mild 2 6.66 G3 Moderate 22 73.33 G4 Severe 6 20 Graph No – 37 Distribution of patients based on adhika trishna.(n=30) 80 73.33 60 G1 G2 40 20 G3 20 6.66 G4 0 0 Total Majority of patients were of grade 3 ie, 22 patients (73.33%), grade 2 were 2patients (6.66%) and grade 4 were 6 patients (20%).------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 77
  • 97. Observations and results ============================================================ Table No – 54 Distribution of patients according to Kshudra shwas.(n=30) After Follow up Grading Kshudra shwas. No of patients % G1 Absent 14 46.66 G2 Mild 12 40 G3 Moderate 4 13.33 G4 Severe 0 0 Graph No – 38 Distribution of patients based on Kshudra shwas.(n=30)) 46.66 50 40 40 G1 30 G2 20 13.33 G3 10 G4 0 0 Total In present study it was observed that from grade 1 to grade4,14 patients (46.66%)were of grade 1,12 patients (40%) were of grade 2,4 patients (13.33%) were of grade 3.Table No – 55 Distribution of patients according to swedadikhata.(n=30) After Follow up Grading Swedadikhata . No of patients % G1 Absent 0 0 G2 Mild 2 6.66 G3 Moderate 14 46.66 G4 Severe 14 46.66------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 78
  • 98. Observations and results ============================================================  Graph No – 39 Distribution of patients based on swedadikhata.(n=30) 46.66 46.66 50 40 G1 30 G2 20 G3 6.66 10 G4 0 0 Total In present study it was observed that from grade 1 to grade4,2 patients (6.66%) wereof grade 2,14 patients (46.66%) were of grade 3,14 patients (46.66%) were of grade 4.OBSERVATIONS FOR THE PATIENTS:- 1) All the patients were presenting with varied degree of laxanas 2) For all the patients of sthaulya udvartana with chanak pisti is done. 3) Patients were comfortable during and at the end of the treatment 4) The patients were observed while in undergoing udvartana procedure. 5) All the patients come regularly for the follow up after 15 days. 6) All the patients were asked not to sleep during day timeRESULT RELATED OBSERVATIONS OF PATIENTS AFTER TREATMENT 1) CI- III Excellent: None of patients showed excellent response at the end of the treatment 2) CI- II Good: None of patients showed good response at the end of the treatment 3) CI- I Encouraging: 3.33% (1 pt) for BMI, 6.66% (2pts) for vaksha, 13.33% (4 pt) for udara, and 10% (3 pt) for sphik, 3.33% (1 pt) for adhik khshudha,and 63.33%(19%) for sweda adhikata have showed encouraging response.------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 79
  • 99. Observations and results ============================================================  4) C.S –96.66 % (29 pts) for BMI, 93.33 % (28 pts) for vaksha, 86.66% (26 pts) for udara, 90% (27 pts) for sphik 96.66% (29 pts),for adhik kshudha 100% (30 pts) for adhika trushna,100% (30%) for kshudra shwas and 36.66% (11 pts)for sweda adhikatha have showed no response i.e. stable. 5) C.D. – None of the patients showed deterioration in the conditionsRESULT RELATED OBSERVATIONS OF PATIENTS AFTER FOLLOW UP 1) CI- III Excellent: None of patients showed excellent response at the end of the follow up. 2) CI- II Good: None of patients showed excellent response at the end of the follow up. 3) CI- I Encouraging: 3.33% (1 pt) for Udara, 3.33% (1 pt ) for sphika, have showed encouraging response. 4) C.S – 100% (30 pts) for BMI,100 % (30 pts) for vaksha, 96.66% (29 pts) for udara, 96.66% 29 pts) for sphik,100 %(30 pts) for adhik kshudha,100%(30 pts) for adhik trushna,100%(30pts) for kshudra shwas,100% (30 pts) for sweda adhikata have showed no response i.e. stable after follow up. 5) C.D. – None of the patients showed deterioration in the conditions after follow up.------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 80
  • 100. Observations and results ============================================================ TABLE NO 56:-RESULT RELATED RESPONSES OF THE PATIENTSAFTER TREATMENT: variables CI-3 CI-2 CI-1 CS CD BMI 0% 0% 3.33%(1pt) 96.66%(29pts) 0% VAKSHA 0% 0% 6.66%(2pts) 93.33%(28pts) 0% UDARA 0% 0% 13.33%(4pts) 86.66%(26pts) 0% SPHIKA 0% 0% 10%(3pts) 90%(27pts) 0% ADHIKA KSHUDA 0% 0% 3.33%(1pt) 96.66%(29pts) 0% ADIKA TRUSHNA 0% 0% 0% 100%(30pts) 0% KSHUDRA SHWAS 0% 0% 0% 100%(30pts) 0% SWEDA ADHIKATA 0% 0% 63.33%(19pts) 36.66%(11pts) 0% GRAPH NO– 40 RESPONSES OF THE PATIENTS FOR BMI AFTER TREATMENT:- 120 100 80 60 BMI 40 20 0 CI-3 CI -2 CI -1 CS CD GRAPHNO–41 RESPONSES OF THE PATIENTS FOR VAKSHA AFTER TREATMENT:- 100 80 60 VAKSHA 40 20 0 CI-3 CI -2 CI -1 CS CD------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 81
  • 101. Observations and results ============================================================  GRAPH NO– 42 RESPONSES OF THE PATIENTS FOR UDARA AFTER TREATMENT:- 100 80 60 UDARA 40 20 0 CI -3 CI -2 CI -1 CS CD GRAPH NO– 43 RESPONSES OF THE PATIENTS FOR SPHIK AFTER TREATMENT:- 100 80 60 SPHIK 40 20 0 CI-3 CI -2 CI -1 CS CD GRAPH NO– 44 RESPONSES OF THE PATIENTS FOR ADHIKA KSHUDTHA AFTER TREATMENT:- 120 100 80 60 SPHIK 40 20 0 CI-3 CI -2 CI -1 CS CD------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 82
  • 102. Observations and results ============================================================ GRAPH NO– 45 RESPONSES OF THE PATIENTS FOR ADHIKA TRUSHNA AFTER TREATMENT:- 120 100 80 60 SPHIK 40 20 0 CI-3 CI -2 CI -1 CS CD GRAPH NO– 46 RESPONSES OF THE PATIENTS FOR KSHUDRA SWAS AFTER TREATMENT:- 120 100 80 60 SPHIK 40 20 0 CI-3 CI -2 CI -1 CS CD GRAPH NO– 47 RESPONSES OF THE PATIENTS FOR SWEDADHIKATA AFTER TREATMENT:- 70 60 50 40 SPHIK 30 20 10 0 CI-3 CI -2 CI -1 CS CD------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 83
  • 103. Observations and results ============================================================  TABLE NO 57:-RESULT RELATED RESPONSES OF THE PATIENTS AFTER FOLLOW UP: variables CI-3 CI-2 CI-1 CS CD BMI 0% 0% 0% 100%(30pts) 0% VAKSHA 0% 0% 0% 100%(30pts ) 0% UDARA 0% 0% 3.33%(1pts) 96.66%(29pts) 0% SPHIKA 0% 0% 3.33 %(1pts) 96.66%(29pts) 0% ADHIKA KSHUDA 0% 0% 0% 100%(30pts) 0% ADIKA TRUSHNA 0% 0% 0% 100%(30pts) 0% KSHUDRA SHWAS 0% 0% 0% 100%(30pts) 0% SWEDA ADHIKATA 0% 0% 0% 100%(30pts) 0% GRAPH NO– 45 RESPONSES OF THE PATIENTS FOR BMI AFTER FOLLOW UP:- 120 100 80 60 BMI 40 20 0 CI-3 CI -2 CI -1 CS CD GRAPHNO–46 RESPONSES OF THE PATIENTS FOR VAKSHA AFTER FOLLOW UP:- 120 100 80 60 VAKSHA 40 20 0 CI-3 CI -2 CI -1 CS CD------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 84
  • 104. Observations and results ============================================================  GRAPH NO– 47 RESPONSES OF THE PATIENTS FOR UDARA AFTER FOLLOW UP:- 120 100 80 60 UDARA 40 20 0 CI-3 CI -2 CI -1 CS CD GRAPH NO– 48 RESPONSES OF THE PATIENTS FOR SPHIK AFTER FOLLOW UP:- 120 100 80 60 SPHIK 40 20 0 CI-3 CI -2 CI -1 CS CD GRAPH NO– 49 RESPONSES OF THE PATIENTS FOR ADHIKA KSHUDTHA AFTER FOLLOW UP:- 120 100 80 60 SPHIK 40 20 0 CI-3 CI -2 CI -1 CS CD------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 85
  • 105. Observations and results ============================================================ GRAPH NO– 50 RESPONSES OF THE PATIENTS FOR ADHIKA TRUSHNA AFTER FOLLOW UP:- 120 100 80 60 SPHIK 40 20 0 CI-3 CI -2 CI -1 CS CD GRAPH NO– 51 RESPONSES OF THE PATIENTS FOR KSHUDRA SWAS AFTER FOLLOW UP:- 120 100 80 60 SPHIK 40 20 0 CI-3 CI -2 CI -1 CS CD GRAPH NO–52 RESPONSES OF THE PATIENTS FOR SWEDADHIKATA AFTER FOLLOW UP:- 120 100 80 60 SPHIK 40 20 0 CI-3 CI -2 CI -1 CS CD------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 86
  • 106. Observations and results ============================================================  STATISTICAL ANALYSIS :-TABLE NO 58:- BMI Mean S.D t P Remarks B .T 1.1000 0.30513 1.000 0.326 NS A. T 1.0667 0.25371 B .T 1.1000 0.30513 0 1.000 NS A .F.U 1.1000 0.30513TABLE NO 59:- VAKSHA Mean S.D t P Remarks B.T. 2.4667 0.62881 1.439 0.161 S A.T. 2.4000 0.62146 B.T. 2.4667 0.62881 0 0.1.000 NS F.U. 2.4667 0.62881TABLE NO 60: -UDARA Mean S.D t P Remarks B.T 3.133 0.68145 2.112 0.043 S AT. 3.000 0.69481 B.T 3.133 0.68145 1.000 0.326 NS F.U. 3.1000 0.71197TABLE NO 61: -SPHIK Mean S.D t P Remarks B.T 3.0333 0.66868 1.795 0.083 S AT. 2.9333 0.69149 B.T 3.0333 0.66868 1.439 0.161 NS F.U. 2.9667 0.66868------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 87
  • 107. Observations and results ============================================================ TABLE NO 62:- ADHIKA KSHUDHA Mean S.D t P Remarks B.T. 3.4000 0.49827 1.0000 0.326 NS A.T. 3.3667 0.49013 B.T. 3.4000 0.49827 0 1.000 NS F.U. 3.4000 0.49827TABLE NO 63:- ADHIKA TRUSHNA Mean S.D t P Remarks B.T 3.1333 0.50742 0 1.000 NS AT. 3.1333 0.50742 B.T 3.1333 0.50742 0 1.000 NS F.U. 3.1333 0.50742TABLE NO 64:- KSHUDRA SWAS Mean S.D t P Remarks B.T 1.6667 0.71116 0 1.000 NS AT. 1.6667 0.71116 B.T 1.6667 0.71116 0 1.000 NS F.U. 1.6667 0.71116TABLE NO 65: - SWEDADHIKATA Mean S.D t P Remarks B.T 3.4000 0.62146 7.077 0.000 HS AT. 2.7667 0.50401 B.T 3.4000 0.62146 0 1.000 NS F.U. 3.4000 0.62146------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 88
  • 108. Discussion =============================================================== DISCUSSIONTITLE ; The dissertation entitled as ‘A STUDY ON APATARPAN WITH SPECIALREFERENCE TO UDVARTAN IN STHOULYA’ . In astanga hrudaya,sutrasthan,chapter number 14,Dwividhopakramaniya adhyayahas been mentioned.In which two folds of therapies has been mentioned as 1.santarpan2.apatarpan.The synonyms mentioned for santarpan and apatarpan are Bruhmana amdLanghana respectively, It has been mentioned in asthanga-hrudaya that snehana and stambhana comesunder brumhana ie,santarpana and rukshan and swedan comes under langhanaie,apatarpana respectively.Apatarpana contributes a major documentation as a part ofdwividhopakrama. In charaka samhita,sutrasthana chapter number 22 Langhana-brumhaneeyaadhyaya six folds of therapies has been mentioned as langhana, brumhana,rukshana,snehana,swedana and sthambhana,Among them langhana,rukshana and swedana comesunder Apatarpana.brumhana,snehana and sthambhana comes under Santarpana.So it isclear that six folds of therapies comes under these two folds ie,Santarpana andApataarpana. So in detailed study on apatarpana has been highlated as a basic fundamentalprinciple of dwividhopakrama along with three folds of therapies ie,langhana,rukshanaand swedana.All the treatments comes under these two folds of therapies ie,Santarpana andApatarpana.as sthoulya itself is described as santarpanotha vyadhi so apatarpana therapy------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 89
  • 109. Discussion ===============================================================is essential for treating sthoulya.Acharya charaka described about sthoulya askastasadhya and asaadhya if it is beeja-swabhavaja.So as to treat sthoulya it is necessaryto assess basic fundamental principle ie,apatarpana and also its implementation insthoulya. Acharya charaka has mentioned in treatment of sthoulya as consumption of foodand drinks so as to maintain equilibrium state of the aggrevated dosha ie,vata,kapha andalso meda dhatu.He has explained to give ruksha,ushna and teekshna basti.along withacahrya charaka has explained to do the ruksha udvartana so as to treat the sthoulya. So for treating the sthoulya which defined as kashtasadhya,ruksha udvarthan withchanaka pishthi is taken.As rukshana is a part of apatarpan so ruksha udvartan in sthoulyaalso comes under apatarpana therapy.In rukshana therapy,for redusing the bulk of theobese,heavy and non saturated ie,apatarpana therapy is prescribed in sthoulya.Hence astudy on Apatarpan with special reference to udvartan in sthoulya is taken for study. Sthoulya is most prevalent form of mal-nutrition in developing countries likeIndia.It has been estimated that 20-40% adults and 10-20% children are affected bysthoulya.Sthoulya is root cause for many diseases like hypertension,diabetesmellitus,cardio vascular disorders and respiratory disorders.Sthoulya is very nearer to theclinical entity and is an importanat health problem of modern society.So a diseasesthoulya is taken for study to assess the effect of ruksha udvartana with chanaka pishthiunder the basic concept of apatarpana. So The dissertation entitled as ‘A STUDY ON APATARPAN WITH SPECIALREFERENCE TO UDVARTAN IN STHOULYA’------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 90
  • 110. Discussion ===============================================================DISCUSSION ON CONCEPT OF APATARPANA In charaka samhita,astanga hrudaya,astanga sangraha two folds of therapies haveexplained as santarpana and apatarpana.Brumhana and Langhana are synonyms ofsantarpana and apatarpana respectively.From which six folds of therapies has beenmentioned as langhana,brumhana,rukshana,snehana,swedana and stambhana,Amongthem langhana,rukshana and swedana comes under apatarpana.brumhana,snehana andstambhana comes under santarpana.So these two folds of therapies are basic fundamentalprinciple in nidana aspect and also treatment aspects.In charaka samhita sutrasthanachapter number 22,Langhana brumhaneeya adhyaya,in astangahrudaya,sutrasthana,chapter number 14 dwividhopakramaneeya adhyaya and in astangasangraha,sutrasthana,chapter number 29 dwividhopakramaneeya adhyaya the two folds oftherapies ie santarpana and apatarpana has been mentioned. In astanga hrudaya,dwividhopakramaneeya adhyaya langhana is taken assynonym for apatarpana and rukshana and swedana are described underlanghana.Langhana is of two types as 1.shodhana and 2.shamana.Shodhana is that whichexpels the doshas out of the body forcibly.It is of five kinds viz.vamana,kayareka,shirovirek,niruha and asravisruti. Shamana is that treatment which is palliative in nature which does not expel thedoshas and also does not increase the doshas but which makes abnormal doshas in normalstate.It is of seven kinds as pachana,deepana,kshutha,trusha,vyayam,atapa andmaruta.The dravyas which are of agni,vayu and akasha mahabhuta predominant does theapatarpana karma.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 91
  • 111. Discussion =============================================================== Langhana karma is applied in four types of evacuation ie,vaman,virechan,niroohand nasya along with thirst,exposure to wind,exposure to sun,pachana,upavas andvyayama.Charak samhita mentioned these ten folds of therapies.In charaka samhitavimanasthana,janapadodhwamsaneeya adhyaya apatarpana has been classified in threetypes as langhana,langhana pachana and doshavirechana.Amongest them langhanatherapy is recommended for those having doshas with little strength,langhana pachana incase of doshas with medium strength and in case of abundant doshas expelling out ofdoshas is prescribed ie,doshavasechana Astanga sangraha explained apatarpana in dwividhopakramneeya adhyaya sameas in astanga hrudaya.In susruta samhita chikitsa sthana,chapter 1,dwivraneeyamchikitsitam adhyaya,shasti upakrama is mentioned in which apatarpana is firstupakrama.As described in samhita it is clear that langhana is synonym for apatarpana.Tillthough langhana itself contains a major documentation as a part of apatarpana.Soapatarpana contains three folds of therapies ie,langhana,rukshana and swedana.LANGHANA In astanga- sangraha,Dvividopkramaniya adhyaya,chapter number 24,Langhanayogya has been mentioned.In astanga-hrudaya,sutrasthan,chapter number 14Dvividopkramaniya adhyaya,Langhaneeya is mentioned.In Charakasamhita,sutrasthana,chapter number 22 Langhana yogya persons are mentioned.Chikitsaphala (benefits of langhana),ati langhana (excess of thinning therapy) has been describedin Astanga- hrudayaa,sutrasthana chapter number 14 ie, Dvividopkramaniyaadhyaya.From above references it is clear that langhana is one of the six folds of------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 92
  • 112. Discussion ===============================================================therapies.As per the references langhana is the part of Apatarpan and also plays importantrole in nidan as well as in chikitsa aspect.RUKSHANA In charaka samhita,sutrasthana,chapter number 22 Langhana bramhaniyaadhyaya,rukshan and its properties has mentioned.Along with this samyaka yogalakshana and atiyoga lakshana has also mentioned.Rukshan is one of the upakramamongst the six folds of therapies.Rukshan itself is a part of Apatarpan.So rukshaudvartan with chanaka pishthi itself is a part of rukshana therapy.So udvartan withchanak pishthi is taken as rukshan therapy in sthoulya under the concept of Apatarpan.SWEDANA In charaka samhita,sutrasthan,adhyay number 22 Langhana brumhaneeyaadhyay,swedana,its properties,swedana yogya,swedana ayogya and types of swedan arementioned clearly.So swedana is also part of six folds of therapies.It is also a type ofApatarpan. As per above references Langhana,Rukshana and swedana comes underApatarpan.As sthoulya itself is a Santarpanotha vyadhi,so ruksha udvartan with chanakapishthi is indicated in sthoulya which is a part of rukshana therapy which comes underApatarpan.Sthaulya vis-à-vis medoroga:- When we analyze the disease sthoulya reveals that in classics two words hadbeen used to describe sthoulya, when we observe these views we find some differencesthat one supports sthaulya and medoroga are same, while other differs and suggest thatboth are different.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 93
  • 113. Discussion ===============================================================Supporting views suggesting sthaulya as medoroga 1. Even though later acharayas in Laghutrayee have described about medoroga, under that heading we still find that all literatures described in Brihatrayas under sthaulya both are same especially with the nidana panchaka. 2. Charaka used the term medasvi in context to sthoulya which indicates that meda is mainly involved in the pathogenesis. Due to this reason might later acharyas described it as a medoroga. 3. Chakrapani in his book chakradatta had followed the sequence of madhavakara in “madhava nidana”, for description of chikista, for whom madhava named it as medoroga. Hence by above description we may say that medoroga and sthaulya are one and same.Views supporting that sthaulya and medoroga are different. 1. None of the commentators have used the synonyms for sthaulya as medoroga 2. Sushruta and Vagbhata enlisted medoroga under vamana Arhvyadhi, while sthaulya enlisted under vamana anarha vyadhi. These views supports that medoroga and sthaulya are different. According to charaka medoroga includes all the ashtanindita purushas as hedescribed them as medapradoshaja vyadhis. Yet with the above information we can not conclude, and it’s a debatablesubject. Nidana: Kapha, Meda & Vata are the main factors involved in the manifestationof Sthoulya. Excessive brhumhana Karma of rasa is said to be the cause for Sthoulya.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 94
  • 114. Discussion =============================================================== The only cause responsible for obesity (excessive fat in body) is overeating. Themechanism of human body is such that the food that is excess in quantity required forgenerating energy gets converted into fat and then gets deposited in the body. An average healthy person generally takes food just enough to meet therequirements of his energy expenditure, and the weight remains stable. But when foodintake is more with less energy expenditure, this balance is lost, the weight no longerremains stable and this imbalance between food intake and energy expenditure become acause for obesity. Aharaja Nidana:- Excessive in take of madhura, guru, snigdha, picchila,abhishyandi, sleshmala ahara leads to kapha vruddhi which in turn leads to meda vruddhiwhich is the main dhatu involved in the manifestation of sthoulya. In the present study it was observed that most of patients were having of habit ofconsuming excess of sweets, bakery items routinely which vitiates kapha. They also takein excess of fried items, chats, cold soft drinks, ice creams which are kapha prakopakanidanas. Viharaja Nidana:- The viharaja nidanas which are responsible for vitiation ofkapha, vata and meda can be considered as the nidanas for sthoulya. During the nidanasobserved in the study patients have the nidana of diwaswapna and avyayama. Most of thepatients were having a history of sedentary life styles. These nidanas may be responsiblefor sthaulya. Diwaswapna makes the kapha prakopa which in turn vitiates meda and obstructsthe srotas. It has been noticed that when a fat person is sleeping or relaxing his metabolicrate is reduced to almost nil.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 95
  • 115. Discussion =============================================================== Avyayama not exerting physically and spending more time infront of television isone among the cause for obesity. Manasika Nidana:- The etiological factors effect the mind. Tamoguna getsincreased due to lack of activity which results into obesity. Kulaja nidana:-It is an undeniable fact that generally the parents or the childrenof fat person are also fat. A researcher Dr.Gurney after studying 75 fat woman noticed that either both orone of the parents of 82 % women were obese. With the help of yet another study, he hasshown that; i) If both parents are fat 73% of their children are also obese. ii) If one of the parents is fat 45 % of their children are fat. iii) If both the parents are of normal weight only 9% children appear to be fat. All this happens because the fact that every individual inherits his physicalconstitution. There after obesity develops depending upon factors like eating habits, wayof life & environment. Evidently during the present study it is observed that ten patients (33.33%) werehaving the kula vruttanta of sthoulya. Other Causes of obesity:-Endocrinal factors rarely involved in gaining theweight, which includes hypothyroidism, Cushing’s syndrome, Antidepressants andsteroids also cause gain in weight. Poorva roopa of sthaulya: - Poorva roopa are set of signs and symptoms thatappear before the manifestation of the disease. Such signs and symptoms are not------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 96
  • 116. Discussion ===============================================================explained for all the vyadhis. For such vyadhis some of the lakshanas which are exhibitedin mild form before its manifestation can be considered as poorva roopa of sthaulya. In context to sthoulya it may be said mild deposition of meda in vaksha, udara andsphik can be considered as poorva roopa of sthoulya. BMI above normal, i.e.24.5-29.9(over weight) can be considered as prodromalsign of obesity.Roopa: - Roopa are the lakshanas manifested, which develop during the course ofvyadhi. On the basis of different acharyas opinion regarding the sthoulya lakshanas it canbe arranged in to two groups; a) Samnaya lakshanas & b) Vishesha lakshanas a) Samanaya lakshana include Javoparodha, kruchra vyavaya, durbalata, dourgandhyata, swedabadha, Atikshuda, Atitrishna and Ayuhrasa etc. b) Vishesha lakshanas- the visehsa lakshana by which the vyadhi is diagnosed are the pratyatma lakshans of that vyadhi. Vishesha lakshana of sthoulya includes sthana lambana, udara lambana and sphiklambana, Ayathopachaya i.e. malnourishment of all the dhatus and utshanasha. In the present study these classical signs were present in all the patients. In the conventional sciences also diagnoses will be apparent from the appearanceand only the level of obesity is assessed by measurements of Body mass index (B.M.I),skin fold thickness (S.F.T), and waist circumference and waist hip ratio (W.H.R).Astha dosha of sthaulya:-The 8 symptoms otherwise called Astha dosha of sthaulya are1) Ayusha hrasa 2) Javoparodha 3) Kruchravyavayata 4) Daurbalya5) Daurgandya 6) Swedabadha 7) Atikshuda 8) Atitrishna------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 97
  • 117. Discussion ===============================================================Ayusha hrasa Due to excessive vruddhi of meda dhatu, person become sthoola, malnutrition ofRasadi dhatus leads to Ayusha hrasa. Though obesity not directly responsible for causing death certainly causes suchmany complications which in turn cause premature death. In a research, group of persons ranging from 40-70 in age. Among those whowere over weight by 30% the rate of mortality was higher by 42% in case of men and36% in women.Javoparodha:- In sthoola person shithilata and sukumarata is observed as meda being guru innature. This makes the person lazy.Kruchravyavayata:- Due to avarodha of srotases and malnourishment of Rasadiparyanta shukra dhatusare malnourished; alpa sukra is formed and causes kruchravyavayata.Daurbalya:- Even though akruti of the patient is sthoola due to improper nourishment ofRasadi dhatus leads to Durbalata. In the present study maximum patients havecomplained the symptom daurbalata.Daurgandya, Swedabadha:- Excessive of vikruta meda is formed and excess of kitta bhaga i.e. mala of meda,sweda is formed.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 98
  • 118. Discussion =============================================================== Due to layers of fat deposited on the body acts as sweaters and cause profuseperspiration which emits a foul odour and this foul smelling sweat causes greatembarrassment to a person.Atikshuda and Atitrishna:- Due to margavarodha of vata by meda in kostha, sandhukshana of vata takes placewhich causes excessive of kshudha. Excessive trishna is observed due to excessivesweating in sthoola persons. Along with this other lakshanas like atinidra, jadhyata, moha, kshudra shwasa, etclakshanas were seen in patients.SAMPRAPTI GHATAKAS :- Dosha : Kapha, vata, pitta Dooshya : Meda, Mamsa Srotas : Medovaha, Mamasavaha, Rasavaha. Srotodusti prakara : Sanga Agni : Jataragni - Teekshna Ama : Medodhatwagnimadyata janya ama Vyaktha sthana : Sphik, Sthana, Udara Adhisthana : Sharira Udbhava sthana : Amashaya Rogmarga : Bahya------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 99
  • 119. Discussion ===============================================================Samprapti:- Due to nidana sevana, ama sadrusha ahara rasa uttpatti takes place which affectsthe medovaha srotas and impairs the medodhatwagni. By that dhatwagni mandyaformation of vikruta medadhatu will occur. This increased medadhatu due to sanga byanulomagati affects asthi majja and shukra and by pratiloma gati mamsa rakta and rasa,by which prakruta sthayi dhatu parinama impairs and all the dhatus becomemalnourished. The vruddha medadhatu make vata prakopa by margavarodha. Vayu then entersthe kostha and flares the jatharagni by which symptoms adhikshuda and atitrishna areseen, hence person takes excess of food which directly increases meda (gets deposited insthana, udara and sphik pradesha), in analog with the madhuratara ahara rasa which ishaving properties picchila, sleshmala, abhishyandi again increases meda. Due to continuity in nidana sevana makes srotorodha leads again jatharagni,teekshna and results in excessive intake, cycle continues and results in sthoulya.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 100
  • 120. Discussion =============================================================== FLOW CHART OF STHAULYA:- Nidana sevanAvyayam Madhura ahara sevanaApachit Medo Dhatu vriddhi Medo dhatwagni mandyaMargavarodh of vata by MedaVayu vimarga gamanaVata vridhi in kosthJatharagni sandhukshanKshudha vriddhiDigestion and absorption increases Due to Srotorodha only Meda dhatu increasesExcessive intake of AharaExcess of Meda sanchaya in Sphik,Sthana and UdaraSthoulya------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 101
  • 121. Discussion ===============================================================Types of sthoulya:- Even though types of sthoola have not been mentioned directly, but descriptionregarding heena sthoola, madhyama sthoola and ati sthoola which is mentioned byvagbhata during the apatarpana chikitsa, can be taken as types of sthoola. Further these heena sthoola, madhyama sthoola and atisthoola can be taken asmild obese, moderate obese and severely obese respectively. In the present study, it was observed that patients of different grades of BMI wereregistered for study.Upashaya:- There is no such direct explanation regarding the upashaya for sthoulya.Oushadha, ahara and vihara which cares the vyadhi are upashaya for that particularvyadhi. Hence all the therapies, ahara and vihar, that relieves symptoms of sthoulya canbe considered as upashaya.Anupashaya:- The ahara, vihar, oushadha that aggravates the symptoms of sthoulya areanupashaya. Hence it can be said that the ahara which are kaphavardhaka andmedovardhaka and viharas like sleeping during day time, less physical activities areanupashaya for sthoulya.Sadhyaasadhyata:- The Sadhyaasadhyata of the disease depends on dosha and dushyas. The diseaseshould not be of tulya dosha dooshya and prakruti if so then that vyadhi is said to bekashta sadhya. Sthaulya is a kaphananatmaja vyadhi and meda, mamsa are the dushyas involved.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 102
  • 122. Discussion =============================================================== Sthoola had been considered as one among the asthanindita purusha by charaka.Since the chikitsa is shareraapekshi before mentioning of chikista acharya charakadescribed about sthoulya in sutrasthana itself, as kastasadhya and asadhya if it is beejaswabhavaja. “Satatam vyadhivetaiva Atisthoola, krushou Narah”. i.e., Atisthoola and krusha persons are always afflicted by diseases, so sthoulyacan said to be kashta sadya for chikista. Since obesity is associated with more than 30 medical conditions, hence theprognosis of obesity is said to be poor. It is a manageable disease, with strict diet plan, physical exercises, weight can bemaintained.Upadravas:- The sthoola person if again goes on indulging in mithya ahara and viharaand not adopted any appropriate chikitsa, then other symptoms like prameha, shwasa,urusthamba, vatavikara udararoga etc. upadravas may be manifested. As the nindanas of prameha and sthoola influence on the medovaha srotas insthoola, the prameha upadrava occurs. As many as 90% of individuals with type - 2diabetes are reported to be over weight and obese. Weight bearing joints like the ankles, hips and the spinal cord are also strainedconstantly on account of heavy weight they have to carry. Consequently obese personsare susceptible to degenerative diseases like osteoarthritis at a young age. In the present study some patients have got the knee joint pain due to heavyweight bearing.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 103
  • 123. Discussion =============================================================== The act of breathing involves the movement of several parts of chest and stomach.Mainly muscles of the chest and diaphragm. When the fat person breathes he has to lifthis heavy chest every time, besides this, person also finds it difficult to push thediaphragm towards the fat belly and stomach. Because of this, a fat person gets tired andbreathlessness easily. Pathya: - The ahara, viharas which are kapha and vata prakopaka and medodhatupradushaka are to be avoided. Considering these factors following pathya can be advocated. For example: kulatha, yava, vartaka, amalaki churna, shunti, patola, purana shali,lashuna, mudga yusha, vegetable soups are pathya. Kulattha is ushna, amlavipaka used in kaphavatajanya roga. Yava is having ushna and rukshaguna. Patola is having katu rasa, teekshna ushna guna, madhura and iskaphavatanashaka. Purana shali is madhura, laghwapaki and is tridosha shamaka. Vartaka is katu, tikta rasa, ushna veerya, madhura, vatakaphanashaka andksharayukta. Viharas like vyayama, physical activity, walking, manasika parisharma, prajagaraare pathya. Vyayama is very important component in the management of obesity. Propervyayama is that which brings slight sweating at fore head. Regular exercises with theabove parameter will make the body light, ease in physicial activities improvement ofdigestion and reduces the fat.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 104
  • 124. Discussion =============================================================== Prajagara – obese people should be encouraged to keep awake for longer hours atnight. This directly helps in reduction of body weight as it causes rukshata. Mental worries and stress also can lead to weight reduction. Walking also helps to reduce the excess of calories inturn fat. Apathya:-The food stuffs which are atimadhura snigdha, picchila abhishyandigunas are to be avoided Ghrita, mamsa rasa, taila, heavy food excessive sweet foods likechats, puddings, bakery items like cakes, chocolates, ice creams, excess intake of tea,coffee soft drinks are apathya. Viharas like sleep during day, avyayama are apathya As it is noticed that when obese persons are sleeping or relaxing their basalmetabolic rate is reduced to almost nil.DISCUSSION OF CHIKITSA:- “Karshgameva varam sthoulyat nahi sthoolasya Bheshajam” Karsha is better for treatment when compared to sthaulya and sthoola is difficultto treat. Mainly vata, meda and kapha are vitiated in sthoola if vata dosha is treated bysantarpana (brimhana) chikista then meda and kapha will get increase and if meda andkapha are treated by Apatarapana(langhana) chikista then vata will increase and canfurther cause other complications. Hence it is difficult to treat sthoola. The treatment principle of obesity is to rectify medas, agni and sleshma thatmeans to give medicines which can disintegrate meda and also to influence themetabolism of meda formation. The main aim is to improve the agni with the use ofappropriate herbs, combined with correct life styles.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 105
  • 125. Discussion =============================================================== Nidana parivarjana:- Not indulging in nidanas which are sthoulyakara likeheavy meals excessive of fatty, oily food and excessive sweets and bakery items shouldbe withdrawn gradually. The energy generation and energy expenditure is properlymaintained and consequently weight remains steady. One of the most important remedialmeasures in reducing the weight is dieting. Shodhana chikitsa: - Therapies included under this heading aim at the radicalremoval of causative morbid factors of sharirika doshas. For sthoulya asantahparimarjana chikitsa, lekhana basti which consists of triphala quatha, gomutra,madhu and ushakadi gana which makes the lekhana of meda and kapha and udvartanaand lepa as bahya parimarjana. Udvartana: - Udvartana with ruksha drugs like chanak pisthi mitigates kaphaliquifies the meda makes the body parts firm and is best for the health of skin. Also fordaurgandya and swedadhikya drugs containing aromatic odours like chandana, tejapatraare used as lepa. The ahara which is guru, and is apatarpaka like yava should be given forsthoola. The bulk of the food must be increased so that the time duration of digestion isincreased. The food more in quantity and less in calories can be given like Cucumber,potato, raw tomatoes Shamana chiktsa: - The Dravya which pacifies the aggravated doshas with outexpulsion from body as well as which does not provoke the equilibrated doshas is knownas shamana (dravya) chikitsa. In context to sthaulya many such formulations have been described. They mainlyconcentrate on kapha, vata, meda and agni.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 106
  • 126. Discussion ===============================================================Sthaulya vis-à-vis obesity There are many reasons available for comparing sthoulya with obesity thepredominant being the similarities in etiology and symtomatology, by this reason onlycharaka samhita’s Hindi commentators in“vidyotini”Kashinath Panday and G.Chaturvedicontinued correlation of sthoulya with obesity and can be correlated as in table.TABLE NO 48:Particulars Sthoulya ObesityCauses 1. Guru madhura, Sleshmala 1. Excessive calorie intakes ahara sevana than expenditure 2. Avyayama 2. Lack of physical activities, 3. Bejaswabharaja sedentary lifestyles. 4. Rasaja Vyadhi 3. Genetic 5. Ati Bhojana sevana 4. Nutritional disorder 5. OvereatingSymptoms 1. Chala shana, chala udara and 1. Pendulous chest, abdomen chala sphik, kshudrashwasa and hip. Dyspnoea, excessive swedadikhya, ati kshuda and perspiration, excessive atitrishna hunger & thirstTypes 1.Heena sthaulya 1.Overweight 2.madhyama sthaulya 2. Obese 3.Ati sthoola 3. Morbid obeseAssessment Easily identified chala sphik, Easily identified at first sight------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 107
  • 127. Discussion =============================================================== stana and udara by darshana along with this BMI, SFT are helpful.Complications Prameha, vataroga, ayuhrasa Diabetes, osteoarthritis, premature deathTreatment Gura cha apatarpana, Bulk is increased with low Vyayama calories and physical activityDISCUSSION ON UDVARTANA:-UDVARTANA:-Udvartana is extensively sited with the following attributions:- --> According to Shabda kalpadruma it is vatahara, medavilayana, and kaphahara. Asper Acharya Vagbhata it is kaphahara medavilayana, angasthirikara, twakvarnaprasadakar.But Charakaacharya mentions certain special qualities other than the onesabove in his sutrasthana fifth chapter; viz, bhibhatsahara, dourghandyahara, kanduhara,gauravahara, tandrahara, swedamalahara and in short it is said to do shariraparimarjana. --> Even though in dinacharya adhyaya acharyaas have indicated abhynga prior toudvartana it must be noted that it holds good more for swastha but in the present conceptof sthoulyas which is morbid state of meda along with rasagata ama srotorodha stronglysuggest contraindication of abhyanga as poorvakarma.Hence the above reference can notbe applied in case of sthoulya and udvartana in sthoulya does not have any poorvakarma --> All acharyas have given prime importance to rooksha udvartana may be formadhyama sthoulya as the local bahir parimarjana chikitsa for medopachaya.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 108
  • 128. Discussion =============================================================== --> Considering the properties of udvartana dravya Indu (commentator ofAstangasangraha) has specifically underlined kashaya rasapradhana dravya but inAstangahridaya we find kashayadi dravya being advocated that are tiktakara whichArunadatta clarifies as katu tikta kashayarasa pradhana dravya. --> Ruksha udvartana dravya alwayas have the agneya vayavya qualities which arebest to subside parthiva and aappya panchamahabhuta of meda and kapha. -->Udvartana being a bahyaupakrama, is very analogous to abhyanga and should havesame timings .In (cha chi24/30) we find the clear specification of 700 maatrakala(i.e. 3 min 48sec) for drug potency to reach the medodhatu. Which is approximately 4-5minutes hence forth udvartana is done in seven different postures of 5 minutes durationeach, adding upto a total of 35 minutes. However, depending on severity of the diseaseand severity of the patient adjustment in time is to be done. -->Mode of action: - By the udvartana, the bhrajaka pitta seated in twacha absorbsvirya of chanak pishthi. Hence by rule paka vilinata of dosha that is kapha and medaoccurs.In udvartana chanak pishthi when applied externally being ruksha gunatmakaabsorbs prithakatwa mala through sweat pores as inferred by the varti formation ofsukshma chanak pishthi This validates the process of udvartana as an effective measureto remove accumulated (medopachaya) at undesirable areas.(such as sphik udara etc)locally.The above considerations lead us to the fact that chanak pishthi udvatana is thebest bahir parimarjana chikitsa for madhyama sthoulya. Besides which it has beenattributed to bhibhatsahara and dourghandyahara according to Charaka, which are thecommonest stigmas of sthoulya person.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 109
  • 129. Discussion ===============================================================ABOUT DRUG:-Udvartana procedure is mentioned with ruksha dravya ie ‘rukshanu udvartanani cha’incharaka samhita,in treatment of sthoulya.So chanaka pisti have been preffered for udvartana as it is laghu and ruksha in gunas.Therasa properties of chanak is kashaya rasayukta which is antagonistic to the properties ofkapha.The physical qualities of chanak,laghu and ruksha are contrary to meda dhathu.Incharaka samhita chanak is mentioned as laghu,sheeta,madhura,kashaya and does therukshan by its prabhava.The properties of chanak is mentioned as vatakarak,pitta andkapha nasaka,kapha pitta nashaka which is quiet conflicting to that of sthoulya.The chanak pishti has been selected because of following factors. 1) To increase the fortified effect of sukshmata and to achieve laghuta. 2) Due to the principle of pharmacology “Smaller the particles greater the penetration, and faster the action” 3) For synergizing and maximizing the pharmaco-therapeutic effect.DISCUSSION ON ACTION OF UDVARTANA:- As it is mentioned that ambu is present in Meda dhatu, to flush the excess of ambudhatu, which is present either in intercellular or intracellular places. This removes theexcess of water, which represents excess weight in the body. There are five basicprinciples to bring dosha from shakha to kosta:Vrudha – increasing the doshaVishyanda –liquification------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 110
  • 130. Discussion ===============================================================Pakat – due to the paka of doshaSrotomukha vishodanat – due to Shodhana of sroto mukhaVayu nigraha – due to control over Vata Udvartana is having the gunas of Kapha:- Meda vilayana property. Due to ushnaand teekshna guna of dravya and forceful massage effect on romakupa, the Veerya ofdrug enters into body through, there after it opens the mukha of siras, there by makingpaka of Kapha and Medas. Due to this, there will be dravatha Vrudhi of Kapha andMedas. Swedana, which is given after Udvarthana will further makes paka of the same. Italso makes sweda pravrathana and due to Sweda karma, which is given after Udvarthana,acts as Sthambhana, Gouragna and Sheetagna. When the Doshas enters koshta, via abovemethods, they should be flushed out of the body. By this the evacuation of these vikruthaDosha and Dushya occurs. By all of these nirharana of Vikruth Vata, Kapha, and aapdhatu along with Medas will takes place ultimately resulting in Laghavata of Shareera.Mode of action of Udvarthana on lipids:- As it is seen that Udvarthana is having good efficacy over lipid levels. The probablemode of action can be explained as follows: Due to increased friction to all the parts of the body, the Triglycerides present inthe subcutaneous tissues will break down into fatty acids. These fatty acids are carriedout to the liver due to the effect of centripetal massage, which increase circulation tointernal organs for the conversation of these fatty acids into bile. As less caloric food issupplied along with heavy exercises, the body needs more of energy to meet the same. Inthe absence of carbohydrate, fats are utilized for the purpose of energy production. The------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 111
  • 131. Discussion ===============================================================bile that is formed in liver will be expelled out in excess. Hence the reabsorption of thebile will be decreased, inturn further utilizing the lipid which is circulating in the blood.Promotion of excretion of bile in the faeces is used as one of the treatment principle totreat Hyperlipidemia eg. Colestipol.Here is the explanation for the various benefits of Udvarthana:-Twak prasadakara: This beneficial effect of Udvarthana is used to increase beauty.Improvement in the complexion is the best criteria to assess the cosmetic property. Thecolour of skin depends on level of melanocytes, blood circulating beneath the skin andcarotinoids. Colour given to skin by blood is mainly depends upon the quantity ofhaemoglobin. By performing Udvarthana, the amount of blood circulation beneath theskin increases due to friction. Due to this change the cells of the skin are supplied withmore oxygen, there by changing the colour at least to some extent.Anga sthirikarana (stability of the body): There will be increase in the fat cells eitherin number or in size or both in obese person. By performing Udvarthana these fat cellsget lipolysed then the cells get shrunken causing compactness. Thus one can appreciatethe above benefit.Gourava hara (depletion of heaviness): Gourava is feature due to increase in Kaphaand Medas. Udvarthana enhances transport of Cholestrol from the periphery to the liver.This cholesterol is utilized for formation of bile (bile salts). Hence due to decrease of fatone feels lightness.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 112
  • 132. Discussion ===============================================================Dourgandhya hara (removal of body odour): Dourgandhya is the resultant of Sweda,which is mala of Medas. Due to Udvarthana there will be decrease in Mala of Medas,hence formation of excess sweat is reduced, resulting in above benefit.Tandra hara (removal of drowsiness): Tandra is due to tamo guna, which is increasedby vikrutha Kapha. Udvarthana will reduce Kapha, hence relieves Tandra. Some patientsgot this benefit by above procedure.Kandu hara (removal of itching): One of the reasons for Kandu is obstruction in theSwedavaha srotas. As Udvarthana clears the orifices of Sweda vaha srotas by its Siramukha vishodhana guna, it reduces itching.Mala hara (removal of excretory products): In general, mala includes Pureesha,Mootra and Sweda. Here the term mala indicates only Sweda. Sweda is the mala, whichis excreted through orifices of the skin by Udvarthana.Vata hara: In sthoulya, Medas and Kapha obstruct Vata. Udvarthana reduces Kapha andMedas and there by normalizing the movement of Vata.Shukrada: Due to mandata of Medodhatwagni, the uttarotara poshana of dhatu getshampered. Udvarthana corrects Medodhatwagni and hence formation of consecutivedhatu takes place, there by increasing the level of last dhatu- Shukra. It is mentionedin the modern literature “fat binds the testosterone”. i.e. high levels of lipids in blood willdecrease Testosterone. Udvarthana reduces the cholesterol there by hindering thetestosterone, binding thus making more availability of testosterone.Twak mriduta (softness of skin): By performing the Udvarthana, expulsion of debris ofdermis and epidermis take place due to friction. It also increases blood circulation to------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 113
  • 133. Discussion ===============================================================layers of skin, there by supplying maximum oxygen to the dermal cells. Hence softnessof the skin is observed. Moreover massaging effect on sebaceous glands stimulatessebum production and there by brings softness and texture to the skin.DISCUSSION ON MATERIALS AND METHOD:-Materials:-• Chanak pisthi• Weighing machine• Measuring tapeDiscussion of materialsABOUT DRUG:- Astangasangraha (Indu tika) suggests kashaya rasatmaka dravya to be used forudvartana. Astanga hridaya (Hemadri) specifies kashyaadi dravyas which can be interpretedas Kashayatmaka dravyas to be used for udvartana. Acharya Charaka has given ten gunaswhich are found as possibilities which induce rookshana in the body.But AacharyaVagbhata considered it under the heading of langhana which is again a paryaya ofapatarpana.Criteria For Selection Of Chanak Pisthi:- Udvartana procedure is mentioned with ruksha dravya ie ‘rukshanu udvartananicha’in charaka samhita,in treatment of sthoulya.So chanaka pisti have been preffered for udvartana as it is laghu and ruksha in gunas.Therasa properties of chanak is kashaya rasayukta which is antagonistic to the properties ofkapha.The physical qualities of chanak,laghu and ruksha are contrary to meda dhathu.The------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 114
  • 134. Discussion ===============================================================chanak pisthi is kashaya rasayukta,laghu and ruksha in guna,veerya is sheet,vipaka iskatu and its karma is vatakarak,pitta,raktavikara nashaka,kapha and jwara nashak whichis quiet conflicting to that of sthoulya.And availability of drug is easy and economical.The chanak pishti has been selected because of following factors. 4) To increase the fortified effect of sukshmata and to achieve laghuta. 5) Due to the principle of pharmacology “Smaller the particles greater the penetration, and faster the action” 6) For synergizing and maximizing the pharmaco-therapeutic effect.WEIGHING MACHINE Dial type weighing machine with a reading 0-150 kgs was used and its horizontalalignment was observe on a flat surface before reading each observation. The needle ofthe dial was set at ‘0’ mark before taking the values and three readings are taken.MEASURING TAPE While using the tape maximum attention is given to the respiration, andexhalation measure was recorded.PROCEDURE OF UDVARTANA:-Poorvakarma:- The person has to pass his natural urges, have chittashuddhi and get undressed.Patient has to be assessed for jeerna ahara lakshana.Pradhana Karma:- On the either side of supported patient two paricharakas, taking the sookshmaudvartana choorna on their palms should gently rub the angas (in pratilomagati) for the------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 115
  • 135. Discussion ===============================================================stipulated time or until the samyak langhita lakshanas are observed. Then the patient istilted to the following positions in the same order and the procedure is repeated.1 Sitting with stretched legs.2 Left lateral3 Right lateral4 Back again to sitting position.5 Prone6 Supine7 Prone again.Paschat Karma:- The acharyas have advocated the ushnodaka sinchana as the paschat karma. Henceforth hot water bath or any of the dravya kashaya can also be used. The patient is thusgiven a whole body wash either warm water or some medicated decoction. He is thenallowed to take light easily digestible food and asked to take complete bed rest for therest of the day.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 116
  • 136. Discussion ===============================================================METHODS:-Aim: - ‘A STUDY ON APATARPAN WITH SPECIAL REFERENCE TOUDVARTAN IN STHOULYA’.The present study was taken to understand the concept of apatarpan and to see the effectof chanak pisthi udvartan as a bahiparimarjan chikitsa in sthoulya.Study design:- The sample size is 30 patients of sthoulya.Selection of patients:- Selection of patients for the present study was done randomly. First thirty patientsfulfilling the diagnostic criteria and inclusion criteria were selected for the study; patientswere selected irrespective of sex caste, occupation and social economic status.Inclusion criteria:-1.Sthoulya diagnosed according to signs and symptoms as in classical texts.2.Sthoulya of both the sex3.Between the age group of 20-50 yrs4.The patients with BMI in between 30-40.Exclusion criteria:- • Patients below 20 and above 50yrs of age. • Pregnant women • Patient associated with systemic disordersDiagnostic criteria:-a) In the present study the diagnosis was done based on the patients presenting with classical signs like chala sthana chala udara and chala sphik and symptoms like------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 117
  • 137. Discussion =============================================================== Atikshuda, Atiktrishna, kashtashwas, swedaadhikata, durbalata, dourgandya etc. were selected.b) Patients with BMI above 30 were selectedBMI – Advantages • BMI provides a more accurate measure of total body fat and practical indicator of a severity of obesity • BMI provides an acceptable approximation of assessment of total body fat for the majority of patients • BMI is recommended as a practical approach for the clinical setting. • Easily calculated directly based on height and weight regardless of gender.Disadvantages BMI overestimates body fat in person who are very muscular and canunderestimate body fat in persons who have lost muscle mass. Also overestimates thediseases like Cushing’s syndrome, ascites etc. General BMI is used to assess obesity and to determine efficacy of therapy. The BMI which describes relative weight for height is significantly correlated beused to assess obesity and to monitor changes in body weight. In addition to thesemeasurements of body weight alone can be used to determine efficacy of weight losstherapy. BMI is calculated as = Weight in Kg Ht in mt2 Normal range is 18.5 -24.9 and if it exceeds form 25 to 29.9 then the person issaid to be overweight. If the BMI is 30 and above, then that condition is said to be obesityand if it is above or equal to 40, then those are included under extremely obese.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 118
  • 138. Discussion ===============================================================Vaksha, Udara and Sphik Measurement:-In addition to these above parameters measurements of vaksha, udara and sphik has beentaken for study.Adhika kshutha,adhika trushna,kshudra shwas,swedadhikata :-Signs and symptoms give an idea about the severity of disease.Grading are doneas,Grade 1,Grade 2,Grade3 and Grade4.Gradings for all the variables and mode ofgrading are presented along with clinical proforma especially formatted for the presentstudy.Data Collection:- Data from 30 patients was collected as before treatment,after treatment and posttreatment follow up to analyse the effect of chanak pisthi udvartan in sthoulya.Statistical analysis:- The data collected were statistically analysed under the guidance ofstatistician.The data was computed for mean,standard deviation,t values and p values.Pvalue was obtained using students t test.Significance of the results was based on the pvalue.The results are obtained as significance of the treatment by using p values.Interventions:- • Sample size ; 30 pts • Sample type ; sthoulya • Procedure ; udvrtana with chanak pisthi for 30mins • Duration ; 30 days • Follow up ; 30th day • Post treatment follow up ; after 15th day------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 119
  • 139. Discussion ===============================================================DISCUSSION ON OBSERVATIONS:- Following observations were made before clinical studyAGE ; In the present study it was observed that 13 patients (43.33%) were of 18-30 yrs,and 17 patients (56.66%) were of 31-40 yrs of age. So the age group 31-40 yrs contains more patients than the age group 18 -30 yrs of sthoulya.SEX ; In the present study it was observed that 24 patients (80%) were male and 6patients (20%) were females.In the present study males are more in numer than females.RELEGION ; Majority of patients observed were Hindu 25 patients(83.33%) and Muslim were5 patients (16.66%). In the present study because of more population in Hindu community,so Hindupatients are more.SOCIO-ECONOMIC STATUS ; In the present study maximum patients observed were of middle class i.e. 24patients (80%),were patients observed of upper class is,6 patients (20%). In the present study the patients observed from middle class are more than upperclass.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 120
  • 140. Discussion ===============================================================MARITAL STATUS ; Maximum patients observed for the study were married 22 patients (73.33%) andunmarried are only 8 patients (26.66%). In the present study married patients are more than unmarried.HABITAT ; Majority of patients observed were from urban 26 (86.66%) and 4 patients(13.33%) belong to rural area. In the present study majority of patients are from urban area than of rural area.OCCUPATION ; The patients from various occupations were observed for the study. Among them8 patients (26.66%) were students,6 patients (20%)were farmer,9 patients (30%)werebusiness men,5 patients (16.66%) were house wife and , 2 patients (6.66%) were teacher. In the present study the more patients are business men thanstudents,teschers,farmers and housewives.DIET ; Among the patients observed for study vegetarians were 6 patients (20%) andthose who took mixed diet were 24 patients (80%). In the present study majority of patients consumes mixed diet than vegetarians.PRAKRUTI ;In the present study it was observed that of kaphavata prakruti there were 8 patients(26.66%),kapha pitta prakruti11 patients (36.66%), and of pittakapha prakruti 11 patients(36.66%).------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 121
  • 141. Discussion ===============================================================In the present study as per prakruti pareekshan,pitta kapha prakruti patients are more thankapha vata prakruti.AGNI ; In the present study it was observed that most of the patients were havingTeekshnagni i.e. 20 patients (66.66%) and only 10 patients (33.33%) were havingvishamagni Majority of patients were having teekshnagni than vishamaagni.KULA VRUTTANT ; In the present study 8 patients (26.66%) patients had kula vruttanta of sthaulyaand 22 patients (73.33%) had no kula vruttanta of sthaulya.Vaksha Circumference ; Vaksha circumference – patients observed for study were assessed grade 1 tograde 4. Majority of patients were of grade 2 i.e., 18 patients (60%), grade 3 were 10patients (33.33%) and grade 4 were of 2 patients (6.66%).Udara Circumference ; Udara circumference – patients observed for study were assessed grade 1 to grade4. Majority of patients were of grade 3, 16 patients (53.33%), grade 2 were 5 patients(16.66%) andgrade 4 were 9 patients (30%).Sphik Circumference ;Sphik circumference – Majority of patients were of grade 3 i.e. 17 patients (56.66%),grade 2 were 6 patients (20%)and grade 4 were 7 patients (23.33%).------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 122
  • 142. Discussion ===============================================================Adhika kshudha ; Majority of patients were of grade 3 ie,18 patients (60%) and of grade 4 were 12patients (40%).Adhika trishna ;Majority of patients were of grade 3 ie,22 patients (73.33%), grade 2 were 2 patients(6.66%) and grade 4 were 6 patients (20%).Kshudra shwas ;In present study it was observed that from grade 1 to grade4,14 patients (46.66%) were ofgrade 1,12 patients (40%) were of grade 2,4 patients (13.33%) were of grade 3.Swedadikhata ;In present study it was observed that from grade 1 to grade4,2 patients (6.66%) were ofgrade 2,14 patients (46.66%) were of grade 3,14 patients (46.66%) were of grade 4.Laboratory investigations- As the study was conducted only on the basis of subjective and objective parametershence no investigations were carried out.DISCUSSION ON RESULTS:-BMI –The BMI of patients was assessed as before treatment,after treatment and posttreatment follow up by comparing the results.The BMI after treatment shows 96.66% ie,29 patients with clinically stable and only onepatient 3.33% shows CI-1 ie,encouraging.The t value for BMI after treatment is 1.000 and p value is 0.326.So the results for BMIafter treatment is non-significant.The BMI after follow up shows 100% ie,total 30 patients with clinically stable.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 123
  • 143. Discussion =============================================================== The t value for BMI after follow up is 0 and p value is 1.000 which is nonsignificant,so only udvartana procedure with chanak pisthi can not prove beneficial incase of BMI.VAKSHA CIRCUMFERANCE ;The VAKSHA CIRCUMFERANCE of patients was assessed as before treatment,aftertreatment and post treatment follow up by comparing the results. The VAKSHA CIRCUMFERANCE after treatment shows 93.33% ie,28patients with clinically stable and only two patients ie, 6.66% shows CI-1 ie,encouraging.The t value for VAKSHA CIRCUMFERANCE I after treatment is 1.439 and p value is0.161 which is significant. The VAKSHA CIRCUMFERANCE after follow up shows 100% ie,total 30patients with clinically stable. The t value for VAKSHA CIRCUMFERANCE after follow up is 0 and p valueis 1.000 which is non significant,so udvartana with chanak pisthi proves significant aftertreatment and proves non-significant after follow up.UDARA CIRCUMFERANCE ; The UDARA CIRCUMFERANCE of patients was assessed as beforetreatment,after treatment and post treatment follow up by comparing the results. The UDARA CIRCUMFERANCE after treatment shows 86.66% ie,26 patientswith clinically stable and only 4 patients ie, 13.33% shows CI-1 ie,encouraging.The t value for UDARA CIRCUMFERANCE after treatment is 2.112 and p value is0.043 which is significant.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 124
  • 144. Discussion =============================================================== The UDARA CIRCUMFERANCE after follow up shows 96.66% ie,29% withclinically stable and 3.33% ie one patient in CI-1 ie,encouraging..The t value for UDARA CIRCUMFERANCE after follow up is 1.000 and p value is0.326 which is non significant,so udvartana with chanak pisthi proves significant aftertreatment and proves non-significant after follow up.SPHIK CIRCUMFERANCE ;The SPHIK CIRCUMFERANCE of patients was assessed as before treatment,aftertreatment and post treatment follow up by comparing the results.The SPHIK CIRCUMFERANCE after treatment shows 90% ie,27 patients withclinically stable and only 3 patients ie, 10% shows CI-1 ie,encouraging.The t value for SPHIK CIRCUMFERANCE after treatment is 1.795 and p value is 0.083which is significant.The SPHIK CIRCUMFERANCE after follow up shows 96.66% ie,29% with clinicallystable and 3.33% ie one patient in CI-1 ie,encouraging..The t value for SPHIK CIRCUMFERANCE after follow up is 1.439 and p value is 0.161which is non significant,so udvartana with chanak pisthi proves significant after treatmentand proves non-significant after follow up.ADHIKA KSHUDHA ;The symptom ADHIKA KSHUDHA of patients was assessed as before treatment,aftertreatment and post treatment follow up by comparing the results.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 125
  • 145. Discussion =============================================================== The symptom ADHIKA KSHUDHA after treatment shows 96.66% ie,29patients with clinically stable and only one patient ie, 1.33% shows CI-1 ie,encouraging. The t value for symptom ADHIKA KSHUDHA after treatment is 1.000 and pvalue is 0.0326 which is non significant. The symptom ADHIKA KSHUDHA after follow up shows 100% ie, total 30patients with clinically stable. The t value for symptom ADHIKA KSHUDHA after follow up is 0 and p valueis 1.000 which is non significant,so symptom ADHIKA KSHUDHA shows nonsignificant results after treatment and after follow up.ADHIKA TRUSHNA ; The symptom ADHIKA TRUSHNA of patients was assessed as beforetreatment,after treatment and post treatment follow up by comparing the results. The symptom ADHIKA TRUSHNA after treatment shows 100% ieTOTAL 30patients with clinically stable. The t value for symptom ADHIKA TRUSHNA after treatment is 0 and p valueis 1.000 which is non significant. The symptom ADHIKA TRUSHNA after follow up shows 100% ie, total 30patients with clinically stable. The t value for symptom ADHIKA TRUSHNA after follow up is 0 and p valueis 1.000 which is non significant,so symptom ADHIKA TRUSHNA shows nonsignificant results after treatment and after follow up.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 126
  • 146. Discussion ===============================================================KSHUDRA SHWAS ; The symptom KSHUDRA SHWAS of patients was assessed as beforetreatment,after treatment and post treatment follow up by comparing the results. The symptom KSHUDRA SHWAS after treatment shows 100% ieTOTAL 30patients with clinically stable. The t value for symptom KSHUDRA SHWAS after treatment is 0 and p valueis 1.000 which is non significant. The symptom KSHUDRA SHWAS after follow up shows 100% ie, total 30patients with clinically stable. The t value for symptom KSHUDRA SHWAS after follow up is 0 and p valueis 1.000 which is non significant,so symptom KSHUDRA SHWAS shows non significantresults after treatment and after follow up.SWEDA ADHIKATA ; The symptom SWEDA ADHIKATA of patients was assessed as beforetreatment,after treatment and post treatment follow up by comparing the results. The symptom SWEDA ADHIKATA after treatment shows 36.66% ie,11patients with clinically stable and 63.33% ie,19 patients with CI-1 ie,encouraging. The t value for symptom SWEDA ADHIKATA after treatment is 7.077 and pvalue is 0.000 which is highly significant.The symptom SWEDA ADHIKATA after follow up shows 100% ie, total 30 patientswith clinically stable.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 127
  • 147. Discussion =============================================================== The t value for symptom SWEDA ADHIKATA after follow up is 0 and p valueis 1.000 which is non significant, so symptom SWEDA ADHIKATA shows highlysignificant results after treatment and non-significant results after follow up.So from above discussion of observations it is clear that,1. In case of BMI udvartana with chanak pisthi can not prove beneficial2. In case of vaksha circumference udvartana with chanaka pisthi proves significant after treatment and proves non-significant after follow up.3. In case of udara circumference udvartana with chanaka pisthi proves significant after treatment and proves non-significant after follow up.4. In case of sphik circumference udvartana with chanaka pisthi proves significant after treatment and proves non-significant after follow up.5. In case of symptom adhika kshutha udvartana with chanaka pisthi proves non- significant for both after treatment and after follow up.6. In case of symptom adhika trushna udvartana with chanaka pisthi proves non- significant for both after treatment and after follow up.7. In case of symptom kshudra shwas udvartana with chanaka pisthi proves non- significant for both after treatment and after follow up.8. In case of sweda adhikata udvartana with chanaka pisthi proves highly significantafter treatment and proves non-significant after follow up. From above results it is clear that in the treatment of sthoulya it is necessary to give abhyanntara shamana aoushadhi,teekshana basti along with diet and exercise.As sthoulya itself is kasta sadhya vyadhi so only udvartana with chanak pisthi can not prove beneficial.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 128
  • 148. Discussion =============================================================== PROBABLE MODE OF ACTION ; Chanaka pisti have been preffered for udvartana as it is laghu and ruksha in gunas.The rasa properties of chanak is kashaya rasayukta which is antagonistic to the properties of kapha.The physical qualities of chanak,laghu and ruksha are contrary to meda dhathu.In charaka samhita chanak is mentioned as laghu,sheeta,madhura,kashaya and does the rukshan by its prabhava.The properties of chanak is mentioned as vatakarak,pitta and kapha nasaka,kapha pitta nashaka which is quiet conflicting to that of sthoulya. Due to ruksha and ushna guna it pacifies and meda shoshan.Especially the meda dhathu with prithvi and jala mahabhuta pradhan which bears snigdha,sheeta and guru gunas get pacified with opposite quality of the drug. The sukshma chanaka pisthi has increased the fortified effect and achieved laghuta contrary to guruta property oy sthoulya. Udvartana is having the gunas of Kapha – Meda vilayana property. Due to ushna and laghu ruksha guna of dravya and forceful massage effect on romakupa, the Veerya of drug enters into body through, there after it opens the mukha of siras, there by making paka of Kapha and Medas. Due to this, there will be dravatha Vrudhi of Kapha and Medas. Swedana, which is given after Udvarthana will further makes paka of the same. It also makes sweda pravarthana and due to Sweda karma, which is given after Udvarthana, acts as Sthambhana, Gouragna and Sheetagna. When the Doshas enter koshta, via above methods, they should be flushed out of the body. By this the evacuation of these vikrutha Dosha and Dushya occur. By all of these------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 129
  • 149. Discussion =============================================================== nirharana of Vikruth Kapha, aap dhatu along with Medas will takes place ultimately resulting in Laghavata of Shareera.------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 130
  • 150. Conclusion=============================================================== CONCLUSION 1. Apatarpana itself contributes a major documentation in samhitas and also proves most important basic principle in Nidan as well as in Chikitsa aspect. 2. As sthoulya itself is a santarpanottha vyadhi and also kastasadhya so Apatarpana chikitsa is prescribed for sthoulya. 3. As per results of statistical analysis after follow up it proves non significant in all eight criterias as BMI,VAKSHA,UDARA,SPHIK CIRCUMFERANCE,ADHIK KSHUTHA,ADHIK TRUSHNA,KSHUDRASWAS and SWEDAADHIKATA. 4. So only Udvartan procedure with Chanak pisthi not proved satisfactorily in Sthoulya.-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 131
  • 151. Recommendations for future study=============================================================== RECOMMENDATIONS FOR FUTURE STUDY: The following recommendations are made on the basis of observations andconclusions for the further studies as well as to over come the limitations. 1) Along with ruksha udvartana procedure shamana aoushadhi,teekshana basti,pathyapathya and exercise are crucial factors in the treatment of sthoulya. 2) A large number of samples are necessary for the study.------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 132
  • 152. Summary=============================================================== SUMMARY:- Present study entitled “A study on Apatarpana with special reference to udvartanain sthoulya’’comprises of1) Review of literature2) Materials and Methods3) observation and Results4) Discussion5) Conclusion and6) Recommendation for future study.Review of literature is further divided into 1.Concept of Apatarpana 2. Ayurvedicreview of sthoulya 3. Modern review of sthoulya.4.Drug review.5.Udvartana1.Concept of Apatarpana : Detailesd concept of Apatarpana along withlanghana,rukshana and swedana were reviewed.Ayurvedicreview of sthoulya : Sthoulya nirukti, paribhasha, paryaya, nidana,poorvarupa, rupa upashaya, samprapti, chikitsa, pathya, apathya were reviewed.Modern review of sthoulya : In modern review obesity derivation, definition, types,clinical features, classification diagnosis, treatment, surgical procedures, prevention, ofobesity were reviewed.Drug review:-Synonemes properties, chem.composition etc have reviewed.Udvartana review:-Nirukti, paribhasha, classification, benefits, mode of action,physiological effects were reviewed.------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 133
  • 153. Summary===============================================================Observation and results: Here details of selection of patients along with methods aredescribed. There after various observation and results obtained and with statisticalanalysis are reviewed in detail.Discussion: On concept of Apatarpana, sthoulya, udvartana, materials andmethods,observations and results and discussin were done.Result: The result of clinical study showed Udvartana with chanaka pishthi is nonsignificant in the treatment of sthoulya.------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 134
  • 154. Bibiliography=============================================================== BIBILIOGRAPHY 1. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas academy ; 1996 : 191 2. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas academy ; 1996 : 191 3. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas academy ; 1996 : 192 4. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas academy ; 1996 : 192 5. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas academy ; 1996 : 192 6. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas academy ; 1996 : 192-193 7. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha orientalia ;1996 : 150 8. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha orientalia ;1996 : 151 9. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha orientalia ;1996 : 151 10. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha orientalia ;1996 : 323 11. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha orientalia ;1996 : 323-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 135
  • 155. Bibiliography=============================================================== 12. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha orientalia ;1996 : 323-324 13. Prof.K.R.Srikantha Murthy,Astanga samgraha (I),9th ed,varanasi, Choukhambha orientalia ;2005 :421 14. Prof.K.R.Srikantha Murthy,Astanga samgraha (I),9th ed,varanasi, Choukhambha orientalia ;2005 :421 15. Prof.K.R.Srikantha Murthy,Astanga samgraha (I),9th ed,varanasi, Choukhambha orientalia ;2005 :421 16. Prof.K.R.Srikantha Murthy,Astanga samgraha (I),9th ed,varanasi, Choukhambha orientalia ;2005 :421-422 17. Prof.K.R.Srikantha Murthy,Sushruta samhita(3rd),1st ed,varanasi, Choukhambha orientalia ;2002 :6-7 18. Prof.K.R.Srikantha Murthy,Astanga samgraha (I),9th ed,varanasi, Choukhambha orientalia ;2005 :422 19. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas academy ; 1996 : 193-194 20. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha orientalia ;1996 : 151 21. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha orientalia ;1996 : 150 22. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas academy ; 1996 : 194-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 136
  • 156. Bibiliography=============================================================== 23. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas academy ; 1996 : 194 24. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas academy ; 1996 : 195 25. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas academy ; 1996 : 197 26. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha orientalia ;1996 : 150-152 27. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha orientalia ;1996 : 152 28. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha orientalia ;1996 : 152 29. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha orientalia ;1996 : 90 30. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha orientalia ;1996 : 150 31. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha orientalia ;1996 : 96 32. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha orientalia ;1996 : 96 33. Shastri K., Chaturvedi G., Charaka Samhita (1) 21st ed., Varanasi: Chaukhambha Bharati academy, 1995 (1): 409-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 137
  • 157. Bibiliography=============================================================== 34. Shastri A.D., Sushruta Samhita (1) 14th ed., Varanasi: Chaukhamba Sanskrit Sansthan, 2003 : 62 35. Shastri L.C., Asthanga Samgraha (1) 3rd ed., Nagpur Baidyanath Ayurveda Bhavan Pvt. Ltd. 1986 : 694 36. Upadhyaya Y. Madhavanidanam (II) 27th Varanasi; Chaukhambha Sanskrit Sansthan, 1997 : 28 37. Shastri B. S. Yogaratnakara (II) Uttarardha 5th ed., Varanasi; Chaukhamba Sanskrit Sansthan, 1993:97 38. Misra B.S. Bhavaprakasa (II) 7th ed., Varanasi; Chaukhamba Sanskrit Sansthan 2000: 405 39. Shabda kalpadruma, Shabdakosha, Bahadhur R., 5th part Reprint, Delhi, Naga Publishers 2002 :452 40. Shastri K., Chaturvedi G. Charaka Samhita (1) 21st ed., Varanasi; Chaukhamba Bharati Academy, 1995: 411 41. Shastri K., Chaturvedi G. Charaka Samhita (1) 21st ed., Varanasi; Chaukhamba Bharati Academy, 1995: 409 42. Shastri A.D., Sushruta Samhita (1) 14th ed., Varanasi, Chaukhamba Sanskrit Sansthan 2003: 62 43. Shastri L.C. Asthanga Sangraha (1) 3rd ed., Nagpur Baidyanath Ayurveda Bhavan Pvt. Ltd. 1986: 694, 695 44. Shastri K. Chaturvedi G., Charaka Samhita (1) 21st ed., Varanasi; Chaukhamba Bharati academy 1995: 409, 411-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 138
  • 158. Bibiliography=============================================================== 45. Shastri A.D., Sushruta Samhita (1) 14th ed., Varanasi Chaukhamba Sanskrit Sansthan 2003: 62 46. Shastri L.C. Asthanga Samgraha (1) 3rd ed., Nagpur. Baidyanath Ayurveda Bhavan Pvt. Ltd. 1986: 694 47. Upadhyaya Y. Madhavanidanam (II) Uttararda 5th ed., Varanasi; Chaukhamba Sanskrit Sansthan 48. Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba Sanskrit Sansthan 1993: 97 49. Mishra B.S. Bhavaprakasa (II) 7th ed., Varanasi Chaukhamba Sanskrit Sansthan 2000: 405 50. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba Bharati Academy 1995: 409, 411 51. Shastri A.D., Sushruta Samhita (I) 14th ed., Varanasi Chaukhamba Sanskrit Samsthana 2003: 62 52. Shastri L.C. Asthanga Samgraha (1) 3rd ed., Nagpur. Baidyanath Ayurveda Bhavan Pvt. Ltd. 1986: 694 53. Upadhyaya Y. Madhavanidanam (II) Uttararda 27th ed., Varanasi; Chaukhamba Sanskrit Sansthan 1997: 28 54. Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba Sanskrit Sansthan 1993: 97 55. Mishra B.S. Bhavaprakasa (II) 7th ed., Varanasi Chaukhamba Sanskrit Sansthan 2000: 405-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 139
  • 159. Bibiliography=============================================================== 56. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba Bharati Academy 1995: , 411 57. Shrikantamurty K.R., Astanga Sangraha (1) 5th ed., Varanasi, Chaukhamba Orientalia 2002 : 424- 426 58. Shastri A.D., Sushruta Samhita (I) 14th ed., Varanasi Chaukhamba Sanskrit Samsthana 2003: 62 59. Shrikantamurty K.R., Astanga Sangraha (1) 5th ed., Varanasi, Chaukhamba Orientalia 2002 : 424- 426 60. Upadhyaya Y. Madhavanidanam (II) Uttararda 27th ed., Varanasi; Chaukhamba Sanskrit Sansthan 1997: 29 61. Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba Sanskrit Sansthan 1993: 98 62. Mishra B.S. Bhavaprakasa (II) 7th ed., Varanasi Chaukhamba Sanskrit Sansthan 2000: 405 63. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba Bharati Academy 1995: , 412 64. Shastri A., Sushruta Samhita (II) Reprint ed., Varanasi, Chaukhamba Sanskrit Sansthan 2004: 63 65. Upadhyaya Y. Asthanga hridaya 4th ed., Varanasi; Chaukhamba Sanskrit Sansthan 2003: 103 66. Shastri A., Sushruta Samhita (II) Reprint ed., Varanasi, Chaukhamba Sanskrit Sansthan 2004: 11-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 140
  • 160. Bibiliography=============================================================== 67. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba Bharati Academy 1995: , 415 68. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba Bharati Academy 1995: , 414 69. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba Bharati Academy 1995: , 414 70. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba Bharati Academy 1995: , 414 71. Shastri L.C. Astanga Sangraha (1) 3rd ed. Nagpur Baidyanath Ayurveda Bhavan Pvt. Ltd. 1986: 694 72. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba Bharati Academy 1995: , 414 73. Shastri A.D., Sushruta Samhita (I) 14th ed., Varanasi Chaukhamba Sanskrit Samsthana 2003: 62 74. Upadhyaya Y. Asthanga hridaya 4th ed., Varanasi; Chaukhamba Sanskrit Sansthan 2003: 103 75. Shrikantamurty K.R., Astanga Sangraha (1) 5th ed., Varanasi, Chaukhamba Orientalia 2002 : 695, 696 76. Dwivedi R. Chakradatta 4th ed. Varanasi Chaukhamba Sanskrit Sansthan, 2002: 221 77. Mishra B.S. Bhavaprakasa (II) 7th ed., Varanasi Chaukhamba Sanskrit Sansthan 2000: 405-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 141
  • 161. Bibiliography=============================================================== 78. Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba Sanskrit Sansthan 1993: 98 79. Shastri R.D. Bhaishajja Ratnavali 11th ed. Varanasi Chaukhamba Sanskrit Sansthan 1993: 525, 529. 80. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba Bharati Academy 1995: 415 81. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba Bharati Academy 1995: 415 82. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba Bharati Academy 1995: 63 83. Shrikantamurty K.R., Astanga Sangraha (1) 5th ed., Varanasi, Chaukhamba Orientalia 2002 : 502 84. Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba Sanskrit Sansthan 1993: 98 85. Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba Sanskrit Sansthan 1993: 98 86. Shastri R.D. Bhaishajja Ratnavali 11th ed. Varanasi Chaukhamba Sanskrit Sansthan 1993: 529. 87. Dwivedi R. Chakradatta 4th ed. Varanasi Chaukhamba Sanskrit Sansthan, 2002: 221 88. Golwalla. Medicine for students, 12th ed. Mumbai: Dr. A.F.Golwall: Churchgate: 2003: 397-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 142
  • 162. Bibiliography=============================================================== 89. K. Park., Text book of preventive and social medicine, 17th ed. Jabalpur, Banarsidar Bhanot: 2000: 298 90. http://WIN-publication-understandingAdultobesity.htm 91. C.R.W. Edwards, I.A.D. Boucher et. al., Davidson’s principles and practices of medicine: Churchill living stone, Edinburg London, New York, Philadelphia St. Louis Sydney, Toronto, 17th ed. 1995: 578, 579. 92. http://www.nhlbi.gov/guidelines/obesitytxtbk/4.11htm. 93. http://WIN-publication-understandingAdultobesity.htm 94. C.R.W. Edwards, I.A.D. Boucher et. al., Davidson’s principles and practices of medicine: Churchill living stone, Edinburg London, New York, Philadelphia St. Louis Sydney, Toronto, 17th ed. 1995: 582. 95. C.R.W. Edwards, I.A.D. Boucher et. al., Davidson’s principles and practices of medicine: Churchill living stone, Edinburg London, New York, Philadelphia St. Louis Sydney, Toronto, 17th ed. 1995: 583. 96. C.R.W. Edwards, I.A.D. Boucher et. al., Davidson’s principles and practices of medicine: Churchill living stone, Edinburg London, New York, Philadelphia St. Louis Sydney, Toronto, 17th ed. 1995: 583. 97. Pandey G.S., Bhavaprakasa Nighantu Reprint ed., Varanasi : Chaukhamba Bharati Academy 1999 : 648 98. Pandey G.S., Bhavaprakasa Nighantu Reprint ed., Varanasi : Chaukhamba Bharati Academy 1999 : 649 99. Shastri L.C., Asthanga Samgraha (1) 3rd ed., Nagpur Baidyanath Ayurveda Bhavan Pvt. Ltd. 1986 : (As sa su 24/4 P434)-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 143
  • 163. Bibiliography=============================================================== 100. 1)Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba Sanskrit Sansthan 1993: (Y R Rutu charya adhyaya P 69.) 2) Upadhyaya Y. Asthanga hridaya 4th ed., Varanasi; Chaukhamba Sanskrit Sansthan 2003: (A hr su 3/19 P37) 101. 1) Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba Bharati Academy 1995: (Cha sa su22/34-35P P432). 2) Shastri A.D., Sushruta Samhita (I) 14th ed.,Varanasi chaukamba Sanskrit sansthan.2003(su ut39/104 p489) 3) Shastri L.C., Asthanga Samgraha (1) 3rd ed., Nagpur Baidyanath Ayurveda Bhavan Pvt. Ltd. 1986 : (As sa su24/12 P136) 4) Upadhyaya Y. Asthanga hridaya 4th ed., Varanasi; Chaukhamba Sanskrit Sansthan 2003: (A hr su 14/17 P 105) 102. 1) Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba Bharati Academy 1995: (Cha sa su 22/37 P436) 2) Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba Bharati Academy 1995: (Cha sa su 21/13-14) 3) Shastri A.D., Sushruta Samhita (I) 14th ed., Varanasi Chaukhamba Sanskrit Samsthana 2003 (Su sa ut 39/ 105) 4) Upadhyaya Y. Asthanga hridaya 4th ed., Varanasi; Chaukhamba Sanskrit Sansthan 2003 (As hr su 14/18) 5) Shastri L.C., Asthanga Samgraha (1) 3rd ed., Nagpur Baidyanath Ayurveda Bhavan Pvt. Ltd. 1986 : (As sa su21/16). 103. 1) Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba Bharati Academy 1995: (Cha sa su 22/41 P153) 2) ) Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba Bharati Academy 1995: (Cha sa su 16/7-8 P111).-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 144
  • 164. Bibiliography=============================================================== 104. 1) Shastri A.D., Sushruta Samhita (I) 14th ed., Varanasi Chaukhamba Sanskrit Samsthana 2003 (Su chi24/54-56 P 489 Dalhana tika) 105. Shastri A.D., Sushruta Samhita (I) 14th ed., Varanasi Chaukhamba Sanskrit Samsthana 2003 (Su chi24/54-56 P 489 Dalhana tika) 106. Shastri A.D., Sushruta Samhita (I) 14th ed., Varanasi Chaukhamba Sanskrit Samsthana 2003 (Su chi24/54-56 P 489 Dalhana tika)-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 145
  • 165. Classical References CLASSICAL REFERANCES“उपबमःय ह वा धैवोपबमो मतःएकः स तपणःतऽ तीय ापतपणःबृंहणो ल घ ेित त पयावुदा तौबृंहणं य बृह वाय ल घनं लाघवाय यत ्दे हःय भवतः ूायो भौमापिमतर च तेःनेहनं णं कम ःवेदनं ःत भमनं च यत ्भूतानां तद प ै या तयं नाितवततेशोधनं शमनं चेित धा तऽा प ल घनम ्”चतुंूकारा संशु ः पपासा मा तातपौपाचना युपवास यायाम ेित ल घनम ्ूभूत ेंम प ाॐमंलाःसंस ृ मा ताःबृह छर रा बिलने ल घनीया वशु िभः (च.सू.२२/१८-१९) A Study on Apatarpan with Special Reference to Udvartan in Sthoulya 146
  • 166. Classical Referencesएविमतरे षाम प याधीनां िनदान वपर तं भेषजं बवित;यथा- अपतपणिनिम ानां याधीनां ना तरे ण पूरणम ःत शा तः,तथापूरणिनिम ानां याधीनां ना तरे णापतपणम ्अपतपणम प च ऽ वधं- ल घनं,ल घनपाचनं,दोषावसेचनं चेित (च. व.३/४२-४३)मेहामदोषाित ःन ध- वरो ःत भक नः ुवसप वििध लीहिशरःक ठा रोिगणःःथूलां ल घये न यं िशिशरे वपरान प (अ. .सू.१४/११)यत ् क च लाघवकरं दे हे त ल घनं ःमृतम ्रौआयं खर वं वैश ं यत ् कया ु णम ्लघूंणतीआण वशदं ं सूआमं खरं सरंक ठनं चैव य ि यं ूायःत ल घनं ःमृतम ् (च ्.सू.२२/९,१२)न बृहये ल नीयान ् बृं ाःतु मृद ु ल घयेत ्यु या वा दे शकाला दबलतःतानुपाचरे त ् (अ. .सू.१४/१५) A Study on Apatarpan with Special Reference to Udvartan in Sthoulya 147
  • 167. Classical Referencesवमले ियतया सग मलानां लाघवं िचः त ृ सहोदयः शु ु दयो ारक ठता यािधमादवमु साहःत िानाश ल घते (अ. .सू.१४/१७)गु चातपणं चे ं ःथूलानां कशनं ूितकृ शानां बॄहणाथ च लघु संतपणं च यत ् ं (च.सू.२१/२०)अितकाँय ॅमःकास-ःतृंणािध यमरोचकःःनेहा निनिा क् ौोऽशुबौजः ु ःवर यःब ःत मूधज घो ऽकपा जा वरःूलापो वािनल लािनछ दपवा ःथभेदनम ्वच मूऽमहा ा जाय तेित वल घनात ् (अ. .सू.१४/२९-३०)तऽाितःथूलकृ शयोभूय एवापरे िन दत वशेषा भव तअितःथूलःय तावदायुषॊ ॑ासो जवोपरोधःकृ ल यवायतांदौब यं दौग यं ःवेदाबाधः दितमाऽं पपासाितयोग ेित ुभव ो दोषाः A Study on Apatarpan with Special Reference to Udvartan in Sthoulya 148
  • 168. Classical Referencesतदितःथौ यमितसंपूरणा ु मधुरशीत ःन धोपयोगाद यायामाद यवाया वाःव नाहषिन य वादिच तना जीवःवभावा चोपजायतेतःय ितमाऽमेद ःवनो मेद एवोपचीयते न तथेतरे धातवः,तःमादायुषो ॑ासः;शैिथ यात ् सौकमाया ु ु वा च मेदसो जवोपरोधः,शुबाबहु वा मेदसावृतमाग वा च कृ ल यवायता,दौब यमसम वा ातूनां,दौग यं मेदोदोषा मेदसः ःवभावात ् ःवेदन वा च,मेदसः ेंमसंसगा ं द वा -बहु वा ु वा यायामासह वा च ःवेदाबाधः,तीआणा न वात ्ूभूतको वायु वा च दितमाऽं पपासाितयोग ेित ु (च ्.सू.२१/४)मेदसावृतमाग वा ायुःको े वशेषतःचरन ् संधु य य नमाहारं शोषय य पतःमात ् स ् शीयं जरय याहारं चाितका ितवकारां ा ौुते घोरान ् कां काल यितबमात ्एवादपिवकरौ वशेषद नमा तौ ुएतौ ह दहतःःथूलं वनदावो वनं यथामेदःयतीव संव ृ े सहसैवािनलादयः A Study on Apatarpan with Special Reference to Udvartan in Sthoulya 149
  • 169. Classical Referencesवकारान दा णा कृ वा नाशय याशु जी वतम ्मेदोमांसाितवृ वा चल ःफगुदरःतनःअयथोपचयो साहो नरोितःथूल उ यतेइित मेद ःवनो दोषा हे तवो पमेव च िन द ं (च ्.सू.२१/५-९)वात ना नपानािन ेंममेदोहरा ण च ोंण बःतयःतीआण ा यु तनािन चगुडु चीभिमुःतानां ूयोग ैफलःतथातबा र ूयोग ूयोगो मा क चवडङगं नागरं ारः काललोहरजो मधुयवामलकचूण च ूयोगः ौे उ यतेब वा दप चमूलःय ूयोगः ौिसंयुतःिशलाजतुूयोग सा नम थरसः परः (च.सू.२१/२१-१४)उ तनं वातहरं कफमेदोअिनलापहम ्ःथर करणमङगानां व ूसादकरं परम ् (सु.िच.२४/५१) A Study on Apatarpan with Special Reference to Udvartan in Sthoulya 150
  • 170. Classical Referencesउ तनं कफहरं मेदसः ू वलायनम ्ःथर करणम गानां व ूसादकरं परम ् (अ.॑ु .सू.२/१५)चणका मसुरा ख डकाः सहरे णवःलघवःशीतमधुराः स कषाया व णाःप ेंमणीशःय ते सुपेंवालेपनेषु चतेषां मसुरःसंमाह कलायो वातलःपरम ् (च.सू.२७/२८-२९)चणको ह रम थः ःया सकल ूय इ य पचणकः शीतलो ः प र कफापहःलखुः कषायो व भी वातलो वरनाशनः (भा.५३)“ितय गाःसंूवआयािम कम चासां यथायथंितयगाणां तु चतसृणां धमनीनामेकका शतधाः ैसहॐधा चो रो रं वभ य ते,ताः वस येयाः,तािभ रदं शर रं गवा तं वब माततं च,तासां मुखािन रोमकपूितब ािन,यैःःवेदमिभवह त ू A Study on Apatarpan with Special Reference to Udvartan in Sthoulya 151
  • 171. Classical Referencesरसं चािभतपय य तब ह ,तैरेव चा य गप रषेकावगाहआलेपनवीया य तःशर रमिभूितप ते विच वप वािन,तैरेव च ःपश सुखमसुखं वा गृ ते,ताः वेता तॐो धम यःसवा गगताः स वभागा या याताः” A Study on Apatarpan with Special Reference to Udvartan in Sthoulya 152
  • 172. Case proforma CASE PROFORMA DEPARTMENT OF SIDDHANTA Dr. B.N.M.E.Trust’s Shri Mallikarjuna Swamiji Post Graduate and Research Centre, Bijapur. Title: A STUDY ON APATARPANA W.S.R TO UDVARTANA IN STHOULYA GUIDE - DR. M B. KARAMBELKAR. HOD - DR. HUDDAR. J C. D.S.A.C.A.V.P.Ph.D M.D. (Ayu) . P.G.Scholar- Dr. AMIT A. MASULESR..No - Date -Name - OPD No -Age/ Sex -Caste -Marital Status-Occupation -Address -Socio-economical Status -Date of commencement of treatment -Date of completion of treatment - LETTER OF CONSENTI, ___________________________________, exercising my free power to choice, herebyGive my consent to be included as a subject in the clinical trial titled “A STUDY ONAPATARPANA W.S.R TO UDVARTANA IN STHOULYA.” I have been informed inmy vernacular language to my satisfaction by the attending investigator, the purpose of theclinical trial and the nature of medical intervention and follow-up, including the laboratoryinvestigation to monitor me. I am agreeable to the data collected on me to be used by theinvestigators of the trial for scientific purposes. I am also aware of my right to opt myselfout of the clinical trial without having to give reasons for doing so.Signature of the PatientDate:-Place:-Signature of the Witness Signature of the Investigator A Study On Apatarpan With Special Reference To Udvartan In Sthoulya 153
  • 173. Case proforma1) PRADHANA VEDANA:2) ANUBANDHI VEDANA:3) ADYATANA VYADHI VRITTANTA:4) POORVA VYADHI VRITTANTA:5) KULA VRITTANTA :6) VAIYAKTIKA VRITTANTA : a) Ahara : b) Vihara : c) Nidra: d) Vyasana: e) Raja pravritti:-7) ASTHA STHANA PAREEKSHA : 1) Nadi - 5) Shabda - 2) Mala - 6) Sparsha - 3) Mutra - 7) Druk - 4) Jihwa - 8) Akruti -8) DASHAVIDHA ATURABALA PAREEKSHA : 1) Prakrutitaha : 2) Vikrititaha : 3) Sarataha : Pravara / Madhyama / Avara 4) Samhanana : Pravara / Madhyama / Avara 5) Pramantaha : Pravara / Madhyama / Avara 6) Satmytaha : Pravara / Madhyama / Avara 7) Satwataha : Pravara / Madhyama / Avara 8) Ahar shaktitaha : Pravara / Madhyama / Avara 9) Vyayama shaktitaha : Pravara / Madhyama / Avara 10) Vayataha : Baala /Yuva / Vruddha A Study On Apatarpan With Special Reference To Udvartan In Sthoulya 154
  • 174. Case proforma9) PHYSICAL EXAMINATION: A) GENERAL EXAMINATION: 1. Height - …….. 2. Weight - ……. kg 3. Pulse - ……. / min 4. Temperature - …… 5. Blood pressure - ………. mm of Hg 6. Respiratory rate - ……. /min B) SYSTEMIC EXAMINATION: 1. Cardio-Vascular System - 2. Respiratory System - 3. Locomotors System - 4. GIT System - C) SROTASA EXAMINATION:10) AGNI PAREEKSHA : Manda / Teekshna / Vishama / Sama11) KOSHTA PAREEKSHA : Mrudu / Madhyama / Krura12) NIDAN PANCHAKA :1) Hetu -2) Purva rupa -3) Rupa -4) Upashaya - Anupashaya -5) Samprapti - Samprapti Ghatakas:- 1) Dosha - 5) Rogamarga - 2) Dooshya - 6) Adhisthan - 3) Srotas - 7) Vyakta sthana - 4) Sroto Dusti prakara - 8) Vyadhi Avastha -13) VYADHI VINISHCHAYA : A Study On Apatarpan With Special Reference To Udvartan In Sthoulya 155
  • 175. Case proforma14) CHIKITSA : Kriya nama :- Udvartana procedure Kala/Avadhi : - 30 min. for 30 days1) Poorva karma:- Annapachana laxanas are observed2) Pradhana karma:- Udhvartana with chanak pishthi for 30min.3) Pashchata karma:- Parisheka with sukhoshna jala and snana15) Pathya:- Apathya:-16) SUBJECTIVE ASSESMENT:-LAXANAS Before treatment(1st After treatment (30th Post treatment follow up day) day) (45th day)KshudrashwasaAtikshudhaAtitrushnaSwedadhikyaGradings: Grade 1- Absent Grade 2- Mild Grade 3- Moderate Grade 4- SevereA) ASSESSMENT OF MEDOPLEPA ON VAKSHA, UDAR AND SPHIK.1) Vaksha circumference – Grade 1- non obese(less than 80 cm) Grade 2- mild (81-90 cm) Grade 3- moderate (91-100 cm) Grade 4- severe (101-110cm)2) Udara circumference – Grade 1- non obese(less than 80 cm) Grade 2- mild (81-90 cm) A Study On Apatarpan With Special Reference To Udvartan In Sthoulya 156
  • 176. Case proforma Grade 3- moderate (91-100 cm) Grade 4- severe (101-110cm)3) Sphik circumference – Grade 1- non obese(less than 90 cm) Grade 2- mild (91-100 cm) Grade 3- moderate (101-110 cm) Grade 4- severe (111-120cm)Circumference Before treatment (1st After treatment (30th Post treatment day) day) follow up (45th day)VakshaUdarSphikB) ASSESSMENT OF WEIGHT-Weight- kgVariable Before treatment (1st After treatment (30th Post treatment day) day) follow up (45th day)WeightC) ASSESSMENT OF BMI- BMI = weight (kg)/ height2 (m)BMI (body mass index)- Grade 1- non obese (below 30) Grade 2- mild (30-31.5) Grade 3- moderate (31.6-33) Grade 4- severe (33.1-34.5)Variable Before treatment (1st After treatment (30th Post treatment day) day) follow up (45th day)BMIAdverse effects (if any)-Signature of Scholar Signature of HOD A Study On Apatarpan With Special Reference To Udvartan In Sthoulya 157

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