“A STUDY ON APATARPAN WITH SPECIAL REFERENCE TO              UDVARTANA IN STHOULYA”.                             BY       ...
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,                       KARNATAKA, BANGALORE.                     DECLARATION BY...
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,                        KARNATAKA, BANGALORE.                               Dr....
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,                        KARNATAKA, BANGALORE                               Dr. ...
COPYRIGHT                   DECLARATION BY THE CANDIDATE        I here by declare that the Rajiv Gandhi University of Heal...
ACKNOWLEDGEMENT                             “Autsukya moha aratidhan jaghaana                             Yo apurva vaidya...
I express my gratitude towards my guide, Dr. M. B. Karambelkar,               D.S.A.C., A.V.P.,Ph.D.,   whose cooperation ...
The real friendship is proved by the love and affection rendered by the friend,well wisher, my hostel room partner, Dr. Sa...
LIST OF ABBREVIATIONS1.    A.H.     - Astanga Hridaya2.    A. S.    - Astanga Sangraha3.    A. T.    - After Treatment4.  ...
ABSTRACT:           Apatarpana and Santarpana are the two folds of therapy explained insamhitas.The six folds of therapies...
The existing obesity treatment options, in modern medicine includes drugs likeFenfluramine, Dexfenfluramine and Sibutramin...
Interpretation and conclusion:-       Apatarpana is a basic fundamental principle in dwividhopkrama.The rukshaudvartana wi...
CONTENTS           PARTICULAR                        PAGE NO1) Introduction                                 1-32) Objectiv...
LIST OF TABLES:-           TABLE                                              PAGE NO1.   Paryayas of Sthaulya            ...
22. Distribution of patients according to socio-economical status   5723. Distribution of patients according to marital st...
45. Distribution of patients according to the adhika trishna AT    7246. Distribution of patients according to the kshudra...
LIST OF GRAPHS:-               GRAPH                                               PAGE NO1. Distribution of patients acco...
22. Distribution of patients based on swedadikhata BT            6823. Distribution of patients according to BMI AT       ...
45. Responses of the patients for kshudra shwas AT     8346. Responses of the patients for swedadhikata AT      8347. Resp...
Introduction===============================================================                                       INTRODUC...
Introduction===============================================================swedana upakrama.From which ruksha udvartana wi...
Introduction===============================================================        To document and analyze this procedure ...
Objectives Of Study ==============================================================                                   OBJEC...
Review of literature===============================================================                                      R...
Review of literature===============================================================Swedana and Stambhana7. Among them Lang...
Review of literature===============================================================The synonyms mentioned for Santarpana a...
Review of literature===============================================================diabetes with amadosha disorders of poo...
Review of literature===============================================================producing laghu, ushna, teekshna, visha...
Review of literature===============================================================Atilanghana (Excess of Thinning therapy...
Review of literature===============================================================and vision, confusion of mind, feeling ...
Review of literature===============================================================Swedana ayogya : -          Swedan shou...
Review of literature===============================================================5) Kumbhi                       6) Kupa...
Review of literature===============================================================Paribhasha:-     A person is said to be...
Review of literature===============================================================Manasika nidana includes               ...
Review of literature===============================================================Purvarupa:-     Purva rupa for sthoulya...
Review of literature===============================================================                    Shrama             ...
Review of literature===============================================================remaining portion of rasa dhatu being v...
Review of literature===============================================================                         Vatavikara    ...
Review of literature===============================================================CHIKITSAChikitsa siddhanta includes    ...
Review of literature===============================================================SHAMANAUSHADHI               72Charaka ...
Review of literature===============================================================For Durgandha     i) Teja patra, netrab...
Review of literature===============================================================TABLE NO 5: DIFFERENT FORMULATIONS IN S...
Review of literature===============================================================PATHYAPATHYA:-          Charaka mention...
Review of literature===============================================================    Margakramana                      -...
Review of literature===============================================================                                       ...
Review of literature===============================================================TYPES:90 The distribution of fat induce...
Review of literature===============================================================OTHER CAUSES OF OBESITY: Some illness c...
Review of literature===============================================================TABLE NO 7:-CLASSIFICATION OF OVERWEIGH...
Review of literature===============================================================CUSHINGS SYNDROME          Causes adren...
Review of literature===============================================================          Minimal sweating             ...
Review of literature===============================================================          Reproductive problems in wome...
Review of literature===============================================================EXERCISE: It is another positive part o...
Review of literature===============================================================STARVATION: Fasting as a method of trea...
Review of literature===============================================================PREVENTION OF OVERWEIGHT AND OBESITY:  ...
Review of literature===============================================================                                       ...
Review of literature===============================================================Properties          Rasa               ...
Review of literature===============================================================UDVARTANA:-Nirukthi:-          The word...
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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
RESEARCH CENTRE, BIJAPUR

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Apatarpana ss

  1. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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

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