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A CLINICAL STUDY TO EVALUATE THE EFFICACY OF VIRECHANA KARMA IN STHAULYA W.S.R. TO OVERWEIGHT” BY Dr. MAGDUM RAHUL RAVINDRA, Department of Panchakarma in P.G. studies. S.D.M. COLLEGE OF AYURVEDA, ...

A CLINICAL STUDY TO EVALUATE THE EFFICACY OF VIRECHANA KARMA IN STHAULYA W.S.R. TO OVERWEIGHT” BY Dr. MAGDUM RAHUL RAVINDRA, Department of Panchakarma in P.G. studies. S.D.M. COLLEGE OF AYURVEDA, KUTHPADY, UDUPI

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    • “A CLINICAL STUDY TO EVALUATE THE EFFICACY OFVIRECHANA KARMA IN STHAULYA W.S.R. TO OVERWEIGHT” BY Dr. MAGDUM RAHUL RAVINDRA B.A.M.S Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfillment of the requirements for the degree of AYURVEDA VACHASPATI DOCTOR OF MEDICINE (Ayu) In PANCHAKARMA Under the guidance of Dr. SHREEKANTH U. M.D. (Ayu) Former Dean, Professor & H O D Department of Panchakarma in P.G. Studies Co-guide Dr. NIRANJAN RAO M.D. (Ayu) Professor Department of Panchakarma in PG Studies Department of Panchakarma in P.G. studies. S.D.M. COLLEGE OF AYURVEDA, KUTHPADY, UDUPI 2010-11 I
    • RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation entitled“A Clinical Study To Evaluate TheEfficacy Of Virechana karma in Sthaulya wsr to Overweight” is a bonafide andgenuine research work carried out by me under the guidance of Dr.Shrikanth U,M.D.(Ayu.), former Dean H.O.D & Professor, P.G. Department of Panchakarma, and co-guidance of Dr.Niranjan Rao, M.D.(Ayu.), Professor SDM College of Ayurveda, Udupi. Signature of CandidateDate: Dr.Magdum Rahul Ravindra,Place: Udupi Department of Panchakarma in P.G. studies, SDM College of Ayurveda, Udupi. II
    • RAJIIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE. CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “A Clinical Study To Evaluate TheEfficacy Of Virechana karma in Sthaulya wsr to Overweight” is a bonafide researchwork done by Dr. Magdum Rahul Ravindra, in partial fulfillment of the requirementfor the degree of in Ayurveda, under my guidance. Date Signature of Guide Place : Udupi Dr. Shrikanth U, M.D. (Ayu.), Former Dean, Professor and H. O. D. Department of Post Graduate, Studies in, Panchakarma SDM College of Ayurveda, Udupi. III
    • RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE. ENDORSEMENT BY THE H.O.D, PRINICIPAL/HEAD OF THE INSTITUTION This is to certify that the dissertation entitled “A Clinical Study To EvaluateThe Efficacy Of Virechana karma in Sthaulya wsr to Overweight” is a bonafideresearch done by Dr. Magdum Rahul Ravindra, under the guidance of Dr.ShrikanthU, M.D.(Ayu.), Former Dean, H.O.D & Propfessor, P.G. Department of Panchakarma , andco-guidance Dr. Niranjan Rao, M.D.(Ayu), Professor, S.D.M.College of Ayurveda,Kuthpady, Udupi.Signature of H.O.D Signature of PrincipalDr. Shrikanth U, M.D. (Ayu.), Dr.U.N.Prasad, M.D. (Ayu),Former Dean, Professor and H O D, Principal,Post Graduate studies in panchakarma, SDM College of Ayurveda,SDM College of Ayurveda, Udupi. Udupi.Date: Date:Place: Udupi Place: Udupi. IV
    • COPYRIGHT DECLARATION BY THE CANDIDATE I hereby declare that The Rajiv Gandhi University of Health Sciences,Karnataka, Banglore shall have the rights to preserve, use and disseminate thisdissertation/ thesis in print or electronic format for academic/ research purpose. Date: Signature of the Candidate Place: Udupi Dr. Magdum Rahul Ravindra © Rajiv Gandhi University of Health Sciences. V
    •    ACKNOWLEDGEMENTI offer my salutation to the almighty for his blessings that made me accomplish thisdissertation work and to my beloved parents and family for their everlasting support.It is a matter of utmost pride, privilege and honors for me to say that Dr. Shreekanth U.sir former Dean, Professor & HOD of Dept of Panchakarma has guided me for thisdissertation work and I am sincerely grateful to him for his expert guidance and constantencouragement.I avail this opportunity to express my deepest sense of indebtness to my co guide Dr.Niranjan Rao Sir Professor who has been my inspiration for following the path oflearning, discipline and hard work right from the day, I have entered this institution.I am thankful to Dr. Rajlaxmi and Dr Padmakiran for their help, encouragement, andsuggestions during the study.I am ever grateful to Dr.U.N Prasad, Principal for his encouragement and support.I thank Dr. Murali and Dr. Mohan Sir for helping me with the preparation of drug.I also take this opportunity to thank my collegues Dr. Prakash, Dr. Riyas, Dr. Greeshma,Dr. Girija for their help and useful insights. I am thankful to my seniors Dr. Mayur, Dr.Paresh,Dr Harshavardhan, Dr. Subhash, Dr. Praveen, Dr. Prajwal, Dr. Avinash,Dr.Prashant Kumar, Dr. Sandeep, Dr. Vinaykumar for their guidance, and my juniors Dr.Shankar, Dr. Varun, Dr. Vishwanath, Dr. Vighnesh, Dr. Raksha who have always beenthere to help. I wish to thank my my roommates Dr. Vivek, Dr. Yagyik, Dr. Kartikeya foralways being with me. I would like to acknowledge the support and encouragement of  VI  
    •   my friends Dr. Tejo Lakshman, Dr. Vineet, Dr. Sushant, Dr. Gauhar, Dr. Ravikant,Dr. Nikhil. My sincere gratitude also goes to all those who instructed and taught methrough the years.I thank Mr. Harish Bhat Librarian SDMCA and Mr. Reynold for their timely help.I am very thankful to Sampark Xerox and all my volunteers for their brand teamwork,which was very much requisite for the booming sleeve up of this work.Last but not the least I thank all the hospital staff, Panchakarma masseurs & my patientswithout whom this study was not possible.After all this I would like to say that I thank and seek forgiveness if I have not mentionedany names which have directly or indirectly been a part of this study.Dr. Rahul Magdum VII  
    • ABBREVIATIONS1. Cha. : Charaka Samhita2. Sus. : Sushruta Samhita3. A.S. : Ashtanga Sangraha4. A.Hr. : Ashtanga Hridaya5. B.P. : Bhava Prakasha6. M.N. : Madava nidana7. Sha. : Sharangadhara Samhita.8. B.S : Bhela Samhita9. H.S. : Harita Samhita10. Ka. : Kashyapa Samhita11. Van. : Vangasena12. Y.R. : Yogaratnakara13. G.D. : GadaNigraha14. Bhai.Rat : Bhaishajya Ratnavali15. Nig.A. : Nighantu Adarsha16. Su. : Sutra Sthana17. Ni. : Nidana Sthana18. Vi. : Vimana Sthana19. Chi. : Chikitsa Sthana20. K : Kalpa Sthana21. Si. : Siddhi Stana22. Pu. : PurvaKhanda23. M : Madyama Khanda24. U : UttarKhanda25. Nig. : Nighantu26. AT : After tretment27. BT : Before treatment28. No. : Number29. SD : Standard Deviation30. SE : Standard Error VIII
    • ABSTRACTObesity has been described by the term Sthaulya Roga in various Ayurvedic classics.According to Ayurveda, Obesity is the excess amount of body fat. In this way excessweight of muscles, bone, fat and water in the body can be labelled as Obesity, is alsoknown as “Overweight”. Obesity is a condition in which the natural energy reserve,stored in the fatty tissues of the body, is increased to a point where it is associatedwith certain health conditions or increased mortality. Obesity is both an individualclinical condition and is increasingly viewed as a serious public healthproblem. Obesity contributes too much morbidities in the population and it is knownas causative or precipitating factor for various killer ailments like diabetes,hypertension, joint disorders, Breast, Prostrate and Colon Cancers, Respiratoryproblems, Stroke, Heart diseases like IHD / CAD etc.OBJECTIVES OF THE STUDY To evaluate the efficacy of Virechana Karma in Sthaulya w.s.r to Overweight.METHODOLOGYThis was a single blind clinical study with pre-test & post- test design where in 20patients diagnosed as sthaulya of either sex & the patients fulfilling the criteria ofundergoing the process of Virechana karma were selected. Patients were subjected todipana pachana with shunthi kwatha before food thrice daily till amapachana. Afterwhich snehapana with Murchita ghrita was administered until samyak snigdhalakshana (3-7days). Then from next day of samyak snigdha lakshana, SarvangaAbhangya with murchita taila followed by bashpa sweda was performed for 4 daysand during this period patient advised to avoid consumption of Kaphakar Ahara andVihara. On 4th day depending upon the rogi & roga bala Virechana Karma wasinduced with Pippali, Nagar, Kshar(yavakshar), (each 5grams) and Shyamatrivrutta12grams mixed with Madhu (Q.S)1 along ushnodaka as Anupana. Finally based onshuddhi lakshanas samsarjana karma was prescribed. IX
    • RESULTS Statistically significant results were obtained in Weight and BMI recordings. The values of skin fold thickness showed negligible improvement. Statistically significant results were obtained in  the values of abdominal circumference but these results did not bring satisfaction to the patients as they expected more. Statistically significant results were obtained on Bio chemical parameter of Lipids.Keywords :- Virechana karma, Sthaulya, Overweight.  X
    • Table of contents   TABLE OF CONTENTS SERIAL CONTENTS PAGE NO. NO. 01 Introduction 01 - 02 02 Objectives of the study 03 03 Review of Literature 3.1 Concept of Virechana 04 - 39 40 - 70 3.2 Disease Review 04 Drug Review 71 - 82 05 Methodology 83 - 87 06 Observations 88 - 100 07 Results 101 - 118 08 Discussion 119 - 127 09 Conclusion 128 10 Summary 129 - 130 11 Bibliography 131 - 146 12 Annexure 147 - 161        
    • List of Tables    LIST OF TABLESSR. NO. NAME OF THE TABLE PAGE NO 01 Detail description regarding Virechana in Ayurveda 05 – 06 02 Indications of Virechana 08 – 09 03 Contra-indications of Virechana karma 10 – 12 04 Classification of virechana drug 13 – 15 05 Poorva, Pradhana & Pashchata karma of Virechana 15 – 18 06 Dose of Virechana drug in its different form 21 - 22 07 Assessment of Virechana 35 08 Peyadi Samsarjana krama 36 09 Rasa samsarjana 37 10 Samyaka yoga, ayoga & atiyoga lakshanas of Virechana 37 – 38 karma 11 Aharatmaka nidana 43 12 Viharatmaka nidana 44 13 Manasa nidana 44 14 Anya nidana 44 15 Rupa 47 – 48 16 Upadrava 53 17 Pathya-apathya ahara 55 18 Pathya-apathya vihara 55 19 Drug used for Koshtha pareeksha 71 20 Drug used for pachana-deepana 71 21 Drug used for Snehapana 72 22 Drugs used for Swedana 72 23 Drugs used for virechana 72 - 73 24 Laingiki features 85 25 Age 88  
    • List of Tables    26 Sex 89 27 Religion 89 28 Educational status 90 29 Marital status 90 30 Socioeconomic status 91 31 Occupation 91 32 Desha 92 33 Nature of work 92 34 Diet 93 35 Nidra 93 36 Addiction 94 37 Prakruti 94 38 Satwa 95 39 Samhanana 95 40 Satmya 96 41 Ahara shakti & Jarana shakti 96 42 Koshtha 97 43 Nidana 98 44 Strotus 98 45 Symptoms 99 46 BMI 100 47 Days of appearance of samyaka snigdha lakshana 101 48 Average amount of Ghrita required to attain Samyak 101 Snigdha Lakshanas 49 Daily mean dose of Snehapaana 102 50 Total amount of abhyantara sneha during the whole course 102 of snehapaana 51 Analysis of samyak snigdha Lakshana 103 52 Analysis of latency period 104  
    • List of Tables    53 Analysis of Vaigiki Shuddhi 104 54 Analysis of Anthiki of Virechana 105 55 Analysis of Laingiki Lakshana of Virechana 105 56 Effect of treatment on Swedadhikya 106 57 Effect of treatment on Daurgandhya 107 58 Effect of treatment on Atitrisha 108 59 Effect of treatment on Atikshudha 108 60 Effect of treatment on Bhaaravruddhi / Weight 109 61 Effect of treatment on BMI 110 62 Effect of treatment on Udara lambana / Waist circumference 110 63 Effect of treatment on Chest circumference 111 64 Effect of treatment on Waist / Hip Ratio 112 65 Effect of treatment on total cholesterol 113 66 Effect of treatment onTriglyceride 113 67 Effect of treatment on HDL 114 68 Effect of treatment on LDL 114 69 Effect of treatment on VLDL 115 70 Effect of treatment on mid arm circumference 115 71 Effect of treatment on biceps 116 72 Effect of treatment on triceps 117 73 Effect of treatment on suprailiac 117 74 Effect of treatment on subscapular 118 75 Overall results of statistics on parameters 127  
    • List of graph   LIST OF GRAPH Sr. No. Content Page no 01 AGE 88 02 Sex 89 03 Religion 89 04 Educational status 90 05 Marital status 90 06 Socioeconomic status 91 07 Occupation 91 08 Desha 92 09 Nature of work 92 10 Diet 93 11 Nidra 93 12 Addiction 94 13 Prakruti 94 14 Satwa 95 15 Samhanana 95 16 Satmya 96 17 Abhyavaran shakti 96 18 Jarana shakti 97 19 Koshtha 97 20 Nidana 98 21 Stratus 98 22 Symptoms 99 23 BMI 100 24 Days of appearance of samyaka snigdha lakshana 101 25 Daily mean dose of Snehapaana 102 26 Total amount of abhyantara sneha during the whole course of 102 snehapaana 27 Analysis of samyak snigdha Lakshana 103 28 Analysis of latency period 104 29 Analysis of Vaigiki Shuddhi 104 30 Analysis of Anthiki of Virechana 105  
    • List of graph   31 Analysis of Laingiki Lakṣana of Virechana 106 32 Effect of treatment on Swedadhikya 106 33 Effect of treatment on Daurgandhya 107 34 Effect of treatment on Atitrisha 108 35 Effect of treatment on Atikshudha 109 36 Effect of treatment on Bhaaravruddhi / Weight 109 37 Effect of treatment on BMI 110 38 Effect of treatment on Udara lambana / Waist circumference 111 39 Effect of treatment on Chest circumference 111 40 Effect of treatment on Waist / Hip Ratio 112 41 Effect of treatment on total cholesterol 113 42 Effect of treatment onTriglyceride 113 43 Effect of treatment on HDL 114 44 Effect of treatment on LDL 114 45 Effect of treatment on VLDL 115 46 Effect of treatment on mid arm circumference 116 47 Effect of treatment on biceps 116 48 Effect of treatment on triceps 117 49 Effect of treatment on suprailiac 118 50 Effect of treatment on subscapular 118  
    • List of Charts   LIST OF CHARTS Sr. No Contents Page No 01 Samsarjana Krama 35 02 Drug Review 71  
    • Introduction   INTRODUCTIONThe Nature has taught the man how to be healthy before the science hasdiscovered the laws of health. But, it is an irony of the fate that on thisearth on one hand Millions do not get enough food and roam in a skeletalappearance while on the other hand, there are many more who, besidesover eating lead a sedentary life to march towards an untimely death.Sthaulya (Overweight and Obesity) is one among the major diseases of Modern era.In Modern era with continuous changing life styles and environment,changed diet habits, man has become the victim of many disease caused byunwholesome dietary habits and Obesity is one of them.Obesity is a gift of the Modern age of Machines and Materialism. It occursas a result of lack of physical activity with increased intake of food. Theindustrialization, stress during the work, dietary habits, lack of exerciseand various varieties among the daily diet e.g. fast food, frozen fruits,increased amount of soft drinks and beverages, canned foods results intothe clinical entity which we can call as Obesity.Obesity is the only one disease which is gaining more and more attentionof scientists at global level. Many institutions and Medical schools aremaking efforts to find a perfect remedy for this burning problem.Curiosity is one of the noblest instincts of man, the endless desire of manfor his knowledge. By this time, many countries are making an effort intothis field of research. Many theories have been put forward with manynew hypothesis describing the exact aetiopathogenesis of Sthaulya.As it is said that " wherever is the carcass there will be vultures gatheredtogether" in the similar fashion, the Obesity (Sthaulya) is such a physical state whereHypertension, Osteoarthritis, Diabetes Mellitus, Cardio Vascular accidents,impotency and many other grave complications are the Vultures invited.The long term dangers of Obesity are like a sword hanging over ones headtied in a weak thread which can strike at any time and create numerousdifficulties and boundless miseries. “A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 1                      
    • Introduction  According to W.H.O., Ayurveda is a system of natural medicine having a detailedscientific literature, a comprehensive materia medica & a wide breadth of clinicalprocedures relevant to prevention & treatment of acute and chronic diseases. AcharyaCharaka rightly says that Ayurveda is shashvat (traditionally eternal) as it is anadi.Acharya Sushruta even goes further and states that Ayurveda was revealed by thecreator even before the creation. In Ayurveda, Panchakarma is a specific unique,natural, holistic health giving series of therapeutic treatments that cleanse the body’sdeep tissue toxins, open the subtle channels, bring life by enhancing energy therebyincreasing vitality, inner peace, confidence & well being. As Ayurveda is based onTridoshas and Panchamahabhutas, Panchakarma highlights itself by normalising thesedoshas after being eliminated from their mulasthanas. Hence proves whole and sole oftreatment in Ayurveda, by rejuvinating tissues & by enhancing the life span. In Ayurveda, Sthula purusha is considered as one of the nindita purusha2. Acharya Charaka has explained the swastha purusha3 as sama mamsa, sama pramana, sama samhanana and having Dridha Indriyas, but sthula person is not having such qualities. Regarding this explaination is available in ayurvedic classics4,5. Overweight and obesity has reached epidemic proportions in India in the 21st century affecting 5% of countries population. Approximately 1.6 billion adults of age above 15 years are overweight, at least 400 million adults are obese and by 2015 approximately 2.3 billion adults will be overweight and more than 700 million will be obese7. Overweight and obesity can be compared with sthaulya. Which is one of the Santarpanottha vyadhi and line of treatment for it is apatarpana8 and langhana, which can be done by shodhana and shamana. Virechana is one of the shodhana procedures, which expels morbid doshas and helps to maintain health of an individual, which can be done by virechana yoga using drugs like pippali, nagar, kshara (yavakshara) and shyama trivritta with madhu in the form of leha9. Thus considering above facts this study “A clinical study to evaluate the efficacy of Virechana karma in Sthaulya wsr to Overweight” is being planned.  “A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 2                      
    • Objectives    OBJECTIVES OF THE STUDYTo evaluate the efficacy of Virechana karma w.s.r. to Overweight.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 3                      
    • Concept of Virechana  THE CONCEPT OF VIRECHANAVEDAS:They are the oldest, authentic, reliable first manuscripts of the world. These are thefoundation stone of the world’s literature known till date. The origin & developmentof medical science is closely associated with the origin & evolution of man on thisearth. Indian culture starts from vedic time is a general belief. Some mantras of Vedasdenote the presence of Ayurveda in them. Although it is very difficult to say thatprocedures of Panchakarma therapy were in practice in vedic period. Few mantras ofRigveda indirectly refer towards the karmas which are included under Panchakarmameasures. For the purpose of virechana, no specific reference has been found. But thedrugs like Eranda was mentioned which might be used for bowel evacuation. Some ofthe mantras which suggest the principal of evacuation like “yatasannam vinirharet”meaning to excrete from the nearest orifice. From this one can infer that virechanamight have been carried out at that time.KASIKA10 :It was explained that Panchakarma was common method of treatment whichprescribed with Poorvakarma such as Snehana, Swedana and Paschatkarma ,Samsarjana krama.AGNIPURANA11 : Virechana karma is highlighted as treatment of various diseases and Trivrut isconsider as best virechana drug. But detail description of Virechana was not found.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 4                      
    • Concept of Virechana   Detail description regarding Virechana in Ayurveda:- Table No:- 01 Drugs Book Virechana Drug Virechana Kalpa/ Procedure, Complication Sthana (Chapter/Shloka) Yoga Benifits & Treatment (Chapter/Shloka) (chapter/shloka (Chapter/Shloka) ) 1/77,75 ; 2/9,10; Sutrasthana 4/13 15/7; 15/ 17,18,16, 15/ 13 ; 25/40 - 22; 16/ 5-10, 22-26 16/ 17-19 Vimanasthana 8/136 - - -Charaksamhita Kalpasthana 1/6 7-12 chapters 1/3,4,5. ; 12 chapter 12 Siddhisthana - - 1; 2/11,12,13. 6 chapter Sutrastana 38/30 ; 44 chapter - -Sushrut 39/ 4samhita Chikitsasthana - - 33/19-47 34 chapter Sutrastana 15/2 - 18 chapter 18 chapterAstanga Kalpasthana - 2 chapter - 3 chapterhridaya Sutrasthana 13/2;14/3-4;15/6 - 27 chapter 27 chapterAstanga Kalpasthana - 2 Chapter - 3 Chaptersangraha Sutrasthana - - 4;21; - 23;25chapters Kalpasthana - 7 ; 8 ; 9. Chapters - -Bhelasamhita Siddhisthana - - - 1 ; 4 ChaptersSharanga purvakhanda 4 Chapter - - -dhara Uttarakhandasamhita Detail about virechana karmaVangasena samhita Virechanadhik Detail about virechana karma araBhavapra Nighantu Part - 5 Chapter 5 Chapter 5 Chapterkasha “A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to   overweight.”    Page 5                       
    • Concept of Virechana  Chakra - - 71Chapter 71 Chapter 71 Chapterdutta Sutrasthana - - 24 Chapter -Kashyapa Siddhisthana - - 2 ; 3 ; 7Chapters -samhita Khilasthana - - 7 Chapter 7 Chapter Etymology:- (1) Virechana12 :V+Rich+ Nich , lyut-malade: nissernam ......Vachaspathyam. (2)Virechanaha13:V+Rich+Nich, lyut-Visheshena rechathete ...... Shabdakalpadruma The Vircehana word is derived from the ‘Rich’ dhatu ,‘Nich’ &’Lyut’ pratyaya &with ‘Vi’ upasarga. It also means Maladehe nissaranam i.e. expelling out the malas. "Ricir" - evacuation "Ric" - Viyojana (separation) Virechana word is derived from the ‘Rich’ dhatu, ‘Rich’ meaning – To empty , evacuate, leave, give up. (M.Monier Williams). DEFINITION: Tatra doshaharanamoordhwabhagam vamana samdyakam, adhobhagam virechana samdyakam...14 (Cha.Ka.1/4) Virechana is defined as the act of of expelling Doshas through Adhobhaga (Cha.Ka.1/4). Here Chakrapani commented that ‘Adhobhaga’ means ‘Guda’. Vipakwam yadapakwam va malady dravatam nayet. Rechatyapi tadyeyam rechanam trivruta yatha..15.(Sha.Pu.4/6) The procedure of expelling of the morbid doshas out of the body in the form of Drava either pakva or apkva state. Vireko mukhapeetam gudamargenantah sthitasya doshasya nihsaranam...16 ( A.Hr.Su.1/25) Virechana is the procedure in which the drug is administered through oral route which acts on morbid do as, specifically on Pitta and expels them out through anal route. Pitte tu virekam shleshmasamsrushte va tatsthanagate va shleshmaneeti17. (A.Sa.Su.27/4) “A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to   overweight.”    Page 6                       
    • Concept of Virechana  Vyakulan sannipatothana paittikana kapha paittikana. Samsrushtan kapahamoolamshcha sramsanenabhyupakrameta18. (Ka.Si.7)Virecana is the best line of treatment modality for pitta dosha19, (Cha.Su.25/40) also itcan act on kaphasamsrusta pitta or pittasthanagat kapha. And moreover in case ofVatasyopakrama mridu shodhana indicated which refers to mridu virechanakarma20(A.Hr.Su.13/1). Hence Virechana is the major line of treatment for morbidpitta dosha & also it acts on morbid kapha &Vata Dosha. Thus the action of Virecanacan be observed on all the tridoshas.Synonyms of Virechana:The following terms were used different texts in different contexts for the virecana,these are all may be considered as synonyms for the virecana.• Vireka, Recana, Adhobhagahara, Prasramsana.• Anulomana21 (cha.Su.16/16)• Adhaparisrava22 (Sus.Chi.34/21)Karyakshetra of Virechana:This can be explained on the basis of its effect on dosha, dushya, srotas, agni& ama.Dosha: Virechana is said to be beneficial for Pitta dosha, since it eliminates vitiatedPitta from its root. According to Vagbhata, Virechana is helpful even in Pittacombined with Kapha or Kapha in Pitta sthana23 (A.S.Su.27). But Bhela mentionsVirechana in Sannipata conditions also.Dushya: Virechana is mentioned as Shodhana procedure in dushti of Rasa, Rakta,Mamsa, Asthi, Majja & Shukra dhatus. Hence in majority of the dhatupradoshajavikaras Virechana is the better option24 (Ch.Su.28/25-28).Srotas: Since on the above mentioned dushyas Virechana is helpful, we can say thatit is beneficial in Rasavaha, Raktavaha, Mamsavaha, Asthivaha, Majjavaha &Shukravaha srotodushti also.Agni: In the Samyak virikta lakshana, deeptagni is mentioned. Hence Virechanaimproves the mandagni state also.Ama: Since langhana is done for amapachana, Virechana is mentioned underShodhana langhana, hence it is even beneficial in ama state25 (Ch.Su.22).“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 7                      
    • Concept of Virechana Indications and Contraindications of Virechana KarmaINDICATIONSTable No:- 02 Virechana Ch.Si26 Sus.Chi27 A.S.28 A.Hr.29 K.Si.730 Sha.S.U31 Yogya 2/13 33/32 27 /8 18/8-9 4/8-11 Pranavaha srotoduhti vikara Shwasa + - - - - - Kasa + - - - - - Parshvaruja + - - - - - Annavaha srotoduhti vikara Aruchi + + + - - + Avipaka + - + - - - Visuchika + + + - - + Alasaka + + + - - - Chardi + + + + - + Udakavaha srotoduhti vikara Udara + + + + - + Rasa pradoshaja vikara Pandu + + - - + + Jwara + + + + - + Aruchi + + - - - + Avipaka + - + - - - Hridroga + + - - + + Kamala + - - + + - Vidradhi - + + + - + Netradaha + + - - - + Aasyadaha + + - - - + Vatarakta + + + + - + Kustha + + - + + +“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 8                      
    • Concept of Virechana  Paittika + + + - - - vyadhi Visarpa + + - - + - Pliha + + + + - + Vyanga + - + + - - Nilika + - - + - - Urdva + + + + + - Raktapitta Mamsa pradoshaja vikara Arbuda + + - - - - Galaganda + - - - - - Meda pradoshaja vikara Prameha + + - + + + Yoni Dosha + + + + - + Retodosha + - + + - - Mootravaha srotoduhti vikara Mutraghata + + + + - + Purishavaha srotoduhti vikara Arsha + + + + + + Bhagandara + + + - - + Udavarta + - + + + Vibhandha - + + + + - Pakvashaya + + + + - - shoola Other Visphota - - - - + + B.SU.21/3 Vatavyadhi - - - - + + B.SU.21/3 Garavisha - + + + + +“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 9                      
    • Concept of Virechana Reason for indication:1. Pitta pradhana vyadhi’s are indicated since virechana is best in those diseases32 (Ch.Su.25/40) Eg: Pandu, Kamala.2. Rakta pradoshaja vyadhi: Since there is clearcut indication of Virechana in those diseases. Eg: Kustha, visarpa, Raktapitta, Gudapaka (Ch.Su.24/18).3. Diseases wherein there is extreme need to eliminate doshas like in gara visha, krimi kostha & udavarta.4. Diseases having viparita gati like Urdhwaga Raktapitta & Chardi etc, Virechana is indicated to reverse the gati of the disease.5. Diseases in which there will be excessive vitiation of doshas & also having tridosha prakopa & also those diseases requiring Ubhaya bhaga shodhana like Kustha, virechana is indicated.6. Those diseases wherein Pitta has its location: Eg: Hridroga- Sadhaka pitta, Jwara- Pachaka pitta, Kamala- Ranjaka pitta.CONTRA-INDICTIONSTable No:- 03 Ch. Sus. A.S36 A. Sha.S. 34 35 37 38 Virechana Ayogya Si 2/13 Chi. 27/9 Hr . K.Si .7 U39 33/29-30 18/ 10 4/ 6-7Physiological conditionLangitha + - + - - -Upavasita + - - - - -Durbalendriya + - - - - -Durbala + - - - + -Alpagni + + + + - +Shranta + + - - - +Pipasita + + - - - +Karmabharadhvahata + + - - - -Daruna koshtha + - + + - -Kshama + - - - - -Kamadivyagra + + - - - -Bhakta + + - - - -“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 10                      
    • Concept of Virechana Sukumara - - - - + -Navaprasuta - + - - - +Rathri Jagarana - - + - - -Atiruksha + - + - - +Bhayoptapta - + - - - +Chinta prasaktha + - - - - -Maithuna prasaktha + - - - - -Adhyayana + - - - - -prasakthavyayama prasaktha + + - + - -Garbhini + + - - - -Age related conditionVriddha + + - - - +Bala + + - - - +Pathological conditionKshatkshina + + - - - +Atikrisha + - - - + -Atisthula + + - - + +Muktanala + - + - - -Atisara - - + + - -Adhoga Raktapitta + + + + - -Shosha - - - - - -Rajayakshma - - + - - -Urustambha - - - - + -Madatyaya + + + - - +Talushosha - - - - + -Hridroga - - - - + -Abhighata + - - - - -Subhaga + - - - - -Kshataguda + + + - - -Shalyardita + + + + - +Saama condition“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 11                      
    • Concept of Virechana Nava Jwara + + + + - +Nava Pratishyaya - + - - - -Some vaataroga conditionKevala Vataroga - - - - + -Hanugraha - - - - + -Ardita - - - - + - poorva karma related condition Nirudha + - + - - -Atisnigdha + + + + - +Anupasnigdha - - - - + -Pakshahata - - - - + -Reason for contra-indication: 1. Patient who is incapable of tolerating the stress produced during Virechana like langhita, durbalendriya. 2. Ashukari roga: Hridroga, kshata ksheena which may collapse the patient. 3. Sama avasthas, wherein snehapana itself is contra indicated. 4. Local problem: To guda pradesha like in kshata guda. 5. Altered or disturbed mental conditions of the patients like in bhaya bheeta, kamadi vyaghra wherein there may be the risk of mithya yoga. 6. Certain altered physiques like atisthula, atikrisha & in weak physical conditions like bala, vriddha conditions. 7. Pathology involving the elimination of doshas through adhomarga like in atisara, adhoga raktapitta.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 12                      
    • Concept of Virechana  CLASSIFICATION OF VIRECHANA DRUGTable No:- 04SL.NO DRUG Animal Milk,Takra,Mastu, Urine40(A.S.Su.14/3) origin Hastidanti,Vaca,Shymatrivrit,Adhoguda, Saptala,Shveta,,Gavakshi,jyotishmati, Pratyagshreni,Danti,Bimbi,Shanapushpi, Mo Vishanika,Ajagandha,Dravanti, ola Kshirini41(cha.su 1/77-78). Citraka,Kinihi,Kusha,Kasha,Tilvaka,1 Based on Shankhini42 (Sus.Su.39/4) origin and Vruchhiva,Hrusvapanchamoola,Punarna parts used Plant origin va,Palnkasha,Vaastuka,Shaka40 (A.S.Su.14/3) Shankhini, Vidanga, AnupMadhuyasti, Sthalaja Madhuyasti , karanjadvaya , Abhaya, Anthakotarapushpi, Kampillaka Aragvadha43 (cha.su 1/80-82) Pha Puga,Saptachada,Arka,Triphala,Nilini, la Eranda42 (Sus.Su.39/4) Pilu,Priyal,Kaval,Badar, Karkandhu, Kashmarya, Parushaka, Draksha.40 (A.S.Su.14/3) Ksh Saptachada,jyotishmati,Mahavruksha. eera Arka42 (Sus.Su.39/4) Sva Karavellaka44 (Sus.Su. 44/4) rasa Tva Tilvaka,Patala,Ramyaka,Kampillka42. k (Sus.Su.39/4) Tail Eranda tail44 (Sus.Su. 44/4)“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 13                      
    • Concept of Virechana  a Patr Pootik,Aragvadha42 (Sus.Su.39/4) a Pha Kampillka42.(Sus.Su.39/4) lara ja Anulomana Krutwa paka malanam yat bhitwa bandhamdho nayet. Tacchanulomanam dyeyam prokta haritaki2 Based on Bhedana Maladikam baddham vaa pinditam malaih. 45 Action Bhitwadh paatayati, tad bhedanam katuki (Sha.Pu.4/4 yatha. ) Samsrana Paktavyam yadpaktavyam shlishtam koshthe maladikam. Nayatyadhahsramsanam tad yatha syad kritmalakam. Rechana Vipakwam yadpakwam vaa malady dravatam nayet. Rechtyapi tadyeyam rechanam trivrutta yatha.3 Based on Mridu Draksha,Ksheera,Ushnambu,Eranda tail intensity Virechaka of action46 Madhyama Trivrut,Katuki, Aragvadha (Sha.U.4/1 Virechaka 4 )-314 Tikshna Snuhi,Danti,Svarnaksheri Virechaka4 In relation With Sneha Ruksha Virechana Eg-Eranda tail +Triphala with fat Kvatha media47 Without Snigdha VirechanaEg - Triphala Kvatha Cha.Si.6/9- Sneha 7045 Fermented Madhya,Dhanyamla40 (A.S.Su.14/3)“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 14                      
    • Concept of Virechana  Virechana Souveerak,Tushodaka48 (Cha.Su.27/191) drug 1. 1).The Virechana drugs can be classified under plant & animal origin depending on their source of drug. Based on presence of adhobhagahara property in different parts, these can be further subdivided as moolini,Phalini etc.Eg.Trivrut moola twak has Virechak property, Jayapaala fruits are having Virechak property etc. 2. 2) Depending on pharmaodynamic action of drug on Dosha, Mala these drugs can be classified as Anulomana, Bhedana, Samsrana, Rechana. 3. 3) Among all virechana drugs some are drastic purgative while some are mild & moderate in nature. So depending on nature of intensity of drugs, these are classified as Mridu Virechaka, Madhyama Virechaka & Tikshna Virechaka. 4. 4) Addminstration of virechana karma through virechaka drug with Sneha and /or without Sneha depends on preoperative procedure especially Snehana i.e in Atisnigdha person select Without sneha (Ruksha)Virechana and for Anatisnigdha select with Sneha (snigdha)Virechana.Procedure of Virechana:Any procedure should be understand under three headings, these are 1. Purva Karma 2. Pradhana Karma 3. Paschat Karma49 (Su. Su.5/3)Table No:- 05 Poorva,Pradhan, Paschat Karma of Virechana Shali.Mudga,Maasha,Yava,Tila, Ahara Dugdha,GrithaUshana jala, Mamsa etc. Deepananeeya,Paachaneeya, Dravya Auosha Upashamaneeya,Vatahara,Sneh dh a,Swedana ,Virechana, drugs like draksha, triphala,Sura, Sambhara Suoveerak. etc.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 15                      
    • Concept of Virechana  Samgraha50 Achamani,Udaka koshta , Sharava,Darvi, ghata,etc.utennsils .Bed,Chair etc.for Equipm-ents patient to rest. Kartari etc.Cutting instrument. Tula,Manabhanda,Dhumanetra,Sutra,Karp asa etc. Atura Before performing Virechana karma it is necessity to Pariksha51 know patient fitness in terms of his/fer Dosha, Dushya, Atura Bala kala, desha, agni, koshta ,Sharir &Ahara Satma, Satva etc.for proper adminstration of Verchana karma. Poorva Vamana karma & Basti Chikitsa chikitsa Ama is considered as one among the etiological factor of most of disease, & Deepana and Shodhana in ama state is Said to be Pachana52 contraindication. So it is necessary to administration of deepan & pachana drugs before the virechana to attainI POOR nirama state. VAKA Shodhananga snehana in terms of RMA Atura Snehapana53 sehapan Should performed before Siddhata proper verchana karma whieh helps to liquefaction & to bring dosha from shakha to koshata. Snehana follwed by Sewdana in terms of Sarvanga sweda is helpful to extract Swedana54 the morbid dosha from Sookshma srotas,it controls vata dosha. Thus it helps to bring morbid dosha from shakha to koshata. After Samyak snigdh lakshana 3 days gap should be their“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 16                      
    • Concept of Virechana  Diet55 & during this period patient must consume laghu,Drava,Ushna.Anabhishandhi, Natisnigdha, Asankara food. But Kapha vardhaka Ahara is to be strictly avoided. Dose of virechana drug varies according to different Matra author. It depends upon patients Koshta, Desha ,Vaya Vinischaya etc. & form(Kalpana) of medicine selected to induce virechana. Assessment On the day of virechana patient should & assess in terms of his stable mind, good & preparatio undisturbed sleep, proper digestion of n patient previous night consumed food,then perform svastivachana,Homa,Bali,Mangala etc karya. Administra tion of Virechana yoga51II Pradha na“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 17                      
    • Concept of Virechana  Karma Administra Once shlema kala over & Pitta kala tion Drug begins43,(A.Hr.Su.18/33) about 9.30-10 AM Select uttama, mooharta, Tithi, Nakshatra then advice patient to consume selected virechana drug51.(Cha.su.15/7) Aushadha Vatanulomana, Svasthya, Kshudha, Jirna Trishna, Sumanaska ,Indriya Laghuta and Lakshana Udgara Shuddhi.57 (Chakradatta.javra / 57) Ajirna Klama, Daha, Angasadana, Bhrama, Aushadha Murcha, Siroruja, Arati,Balahani.57 Lakshana (Chakradatta.javra / 57) Hritadosha Sequential expulsion of Vit, Pitta.Kapha Lakshana58 through rectal route & association of (Cha.Si. Dourbalya, Laghutha, and Karshya are 6/20)-705 indicative of Hrithadosha lakshana . Shuddhi Prava Madh Avara Observatio ra yama n and manageme Laingiki Samyak virechana lakshna nt during Antiki 30 20 10 Vegas Shuddhi Vegas Vegas Virechana 59 Lakshana Vega Vaigiki 4 3 2 Prasth Prasth Prasth Maniki Kapha Kapha Kaphanta nta nta Virechana Any improper function of Bheshaja Vyapat58 chatushpada leads to virechana vyapat. Immediate Paschat Washing the hands, feet and face51. (Cha.Su.15/17)“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 18                      
    • Concept of Virechana  karma Peyadi Samsarjana60 (Cha.Si.1/11)3 Paschat Remote Samsarjana Tarpanadi krama58 (Cha.Si.6/25) karma Paschat Karma Rasa Samsarjana krama61 karma (Cha.Si.12/6-8)1. Before initiating any Panchakarma procedure Physician should collect all the required things like Mudga, Masha etc.food articles ; Draksha, Triphala , Deepananeeya etc. Medicines and measuring, cutting etc. equipments. By all these things one can carryout proper procedure & can able to handle any sort of complications arises during & after the procedure.62 (Cha.su.15/7)2. To get success in Shoshana karma physician must examine the patient properly. Because factors like selection of particular procedure & medicine, Dose of medicine etc. mainly depends on patient.63 (cha.Si.3/6)3. In Patient whom Virechana is nessessity but in such patient if dominance of kapha or Vata dosha,Krura Koshta is their, then one should plan first to expel kapha dosha through Vaman karma and administration of Basti Chikitsa to mitigateVata dosha. Otherwise these may pave for manifestation of complication during & after the Virechana Karma in terms of Pravaheeka, Gourava and Ayoga respectively64 (Cha.ka.12/79-80)4. Shodhana karma differs from Shaman karma in term of expulsion morbid doshas out of body where as shaman karma mitigation of such doshas in side the body only without expel it out of body.65(A.Hr.Su.14/6)So it is necessity of presence of morbid doshas in koshta to expel out i.e. if suchdoshas are their in Shakha these should be bring to koshta which can be achievedthrough Snehana & Swedan karma66. (Cha.Su.28/ 33).Before admintrataion of Shodhanaaga Snehana it is need to assess the patients statusof Agni & Saama ,Niraama condition. Based on it one should plan for Deepana –Pachana prescription and then it is followed by Snehapaana. Depending upon morbiddosha involved in disease one should select the any Sarvanga sweda Eg. In Kapha“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 19                      
    • Concept of Virechana dosha select ushma Sweda, in Pitta Samsrashta condition select Drava Sweda likePareesheka & Avagaha67 (Sus.Chi.33/14).Diet & regimen: During snehapana, drava, ushna, anabhishyandi ahara should beconsumed. Ushonodaka is mandatory, one should follow brahmacharya & avoidvyayama, krodha, shoka, hima & atapa, pravata, yana, adhwa bhashya, atyasana sthiti,dhuma & raja also should be avoided68 (A.H.Su.16/25-27).Diet before Virechana: Diet containing jangala mamsa rasa, yusha & diet withsnigdha, laghu, ushna quality & kapha avriddhikara aharas are necessary69(Ch.Si.1/9), since manda kapha state is required during Virechana.According to Sushruta, on the previous day of Virechana laghu ahara, phalamla,ushnodaka should be given70 (Su.Chi.33/19). Dalhana commenting on it says that forPitta vardhanartha, these diets are mentioned.If during snehapana itself, dosha paka occurs in durbala & bahudosha patients &swayam pravritti of doshas starts then one should give bhedaneeya bhojana with 71Yavakshara (Hemadri on A.H.Su.18/48). Manasopachara is necessary to get someconfidence while performing procedure72 (Ch.Su.15/17).Reason for 3 days of gap prior to Virechana karma is mentioned below:Since snehapana increases kapha in the body, there will be aggravation of kaphadosha. To attain manda kapha avastha, 3 days of gap is adviced. Snehapana should becarried out after the shleshma in the body decreases73 (Ch.Chi.3/164-165). If soonafter snehapana, virechana is performed, then there may be occurance of grahani,pravahika, gourava, since kapha masks the grahani & it may even cause Vamanainstead of causing Virechana since there is Kaphotkleshavastha. Hence Virechanaaushadhi is administered after passing of Kapha kara kala43 (A.H.Su.18/33).Even the virechanoushadhi requires pachana unlike that of Vamanoushadhi, which issaid in (A.H.Su.18/47) as suggests the occurance of virechana in Pachyamanavastha.Main precautions during Virechana includes: Kaphakara diets should be avoided.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 20                      
    • Concept of Virechana  If kapha becomes more than normal, then virechana drug may produce vamana69(Ch.Si.1/9). During Virechana karma amashaya should be empty in contrast to vamana. In natisnigdha shareera, snigdha virechana is indicated & for snehotklishta shareeraruksha virechana is indicated.In certain cases like mandagni, krura kostha, snehapana is performed after addingkshara, lavana to it to obtain deeptagni & vatakapha hara state & later virechanashould be administered74 (A.H.Su.18/52).Matra vinischaya:The medicine which results in removal of vaikarika doshas, without causing ati ,ayoga or any other complications is said to be the proper matra for shodhana. Thedrug selected should have the following properties. They are: The potency of the drugshould be such that in alpa matra it should act to produce maha vega, should have thecapacity to eliminate bahudosha, laghu paka, good taste, preenana, vyadhinashanaproperty, natiglanikara, having proper gandha varna rasa75 (Ch.Si.6/15-16)One should consider the following 5 points just before the administration ofVirechana aushadhi. They are: 1. Whether atura is durbala or not. 2. Previously shodhana is carried out or not. 3. State of alpa dosha vikriti. 4. If constitution is Krisha. 5. Aparijnata kostha.76 (A.H.Su.18/50,51).In above conditions alpa & mridu medicines should be given.To decide the exact matra, one should have the knowledge of agni & kostha of thepatient. DOSE OF VIRECHANA DRUG IN ITS DIFFERENT FORM Table No:-06 FORM OF MEDICINE KOSHTA DOSE Sus77,78 Sha79 Van80“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 21                      
    • Concept of Virechana  1 Any form Krura Uttama Tikshana Tikshana 1 pala Madhyam Madhyam Madhya Madhya ½ pala Mrudu Heena Mrudu Mrudu 1 Karsha 2 Kwatha Krura Uttama 8 Karsha Madhyam Madhyam 1 Anjali 4 Karsha 2 pala (4 pala) Mrudu Heena 2 Karsha 3 Churna Krura Uttama - 2 Karsha Madhyam Madhyam 1 Karsha 1 Karsha 1 Karsha Mrudu Heena - ½Karsha 4 Svarasa Krura Uttama - 8 Karsha Madhyam Madhyam - 4 Karsha 1 pala Mrudu Heena - 2 Karsha 5 Kalka Krura Uttama - - Madhyam Madhyam 1 Karsha 1 Karsha - Mrudu Heena - - 6 Modaka Krura Uttama - - - Madhyam Madhyam - 1 Karsha - Mrudu Kaneeya - - - 7 Hima& Krura Uttama 8 Karsha - phanta 1 Anjali Madhyam Madhyam (4 pala) 4 Karsha - Mrudu Heena 2 Karsha - 8 Sneha - - - - 2 Karsha - - - - or 1 pala - - - - 9 Ushna jala as Mrudu - - - 2 pala s Anupaan Madhyam - - - 4 pala Krura - - - 8 pala  Conditions Matra 1. Young age, afflicted with visha, having Good strength, in skin diseases Uttama 2. Madhyama balayukta vyadhi with Madhyama bala Madhyama“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 22                      
    • Concept of Virechana  3. Alpa dosha with alpa bala Laghu81 (Bh.Si.1/5-12).Vyapad & its management:Vyapads are complications which are produced due to ayoga, atiyoga & also due tomismanagement of upacharaka, improper medicine, mistakes of vaidya & atura(Chatuspadas are involved).Charaka explains 10 vyapads: 1. Adhmana 2. Parikartika 3. Srava 4. Hritgraha 5. Gatra graha 6. Jivadana 7. Savibhramsha 8. Stambha 9. Upadrava 10. Klama 81- Ch.Si.6/29,30.Chakrapani divides these vyapad’s intoAyoga AtiyogaAdhmana, Parikartika, Srava, Jivadana, Hritgraha, Vibhramsha, Gatragraha,Gudabhramsha, Kandwadi Sanjna bhramsha, vibhramsha, Upadrava, KlamaSushruta has mentioned 15 complications, out of which adhmana, jivadana,parikartika, parisrava, anga graha, vibandha, hridayopasarana are common,savasheshoushadhatwa, jirnaoushadhatwa, hina doshapahritatwa, vamanasya adhogati& virechanasya urdhwa gati are different in Sushruta which are included in causes ofcomplication by Charaka82 (Su.Chi.34/3).Causes of complication:1. Adhmana: caused when manda veerya aushadhi’s are given to ruksha patient or in bahu dosha conditions or in agnimandhya condition. Signs and symptoms are adhmana, kati shula, shira shula, shwasa, mala mutra and adhovata avarodha.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 23                      
    • Concept of Virechana  Treatment: Abhyanga,swedana, phala varti, niruha & anuvasana basti (Ch.), deepana and langhana according to Sushruta.2. Parikartika: Causes: a) a.In snigdha atura having guru kostha & in samavastha, tikshna medicine is given. b) b.Durbala atura with mridu kostha if medicines are given in alpadoshavastha. c) c. In durbala shareera, mridu kosthi, mandagni patient when ati ushna lavana or ruksha medicines are given. Signs and symptoms: Kartanavat peeda in guda, piccha and rakta yukta mala pravritti, daha in guda,medhra, nabhi, basti. Chikitsa: Langhana, Pachana, Rukshana, Ushna drugs, Brimhana in weak patients, sheeta basti, piccha or anuvasana basti.3. Srava: Causes: Mridu veerya oushadhi to bahudosha & krura kosthi patient, unable to remove doshas causes vitiation leads to parisrava. Signs & symptoms: Kandu, shotha, kustha, gourava, agnimandhya, sthaimitya, aruchi, pandu, dourbalya. Chikitsa: Shamana, vamana, virechana, asthapana, churna, asava & aristapana told in grahani and arsha chikitsa.4. Hritgraha: Causes: If vegavarodha is done to retain the vega induced by karma, vata dosha gets vitiated which reaches hridaya & causes hridgraha. Signs and symptoms: Hikka, shwasa, kasa, parshwashula, lalasrava, dinata, sanjna nasha. Treatment: Vamana, pachana medicine, abhyanga, swedana with dhanya & tikshna nasya, anuvsana basti, snigdha, lavana. In murchita, tikshna prashamana nasya.5. Anga graha: Caused due to vegadharana & due to atiyoga of virechana, vata gets vitiated and gatra graha occurs.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 24                      
    • Concept of Virechana  Signs & symptoms: Angagraha, kampa, toda, pindikodwestana. Treatment: Vatahara snehana & swedana.6. Jeevadana: Causes: When atitikshna drug is given in mridukostha & alpa doshayukta patient, leads to irritation & discharge of blood. Sushruta says due to atiyoga, along with chandrika varna rakta in later stage udaka discharges, mamsadhavanatulya udaka srava, guda bhramsha also results. Chikitsa: Pittahara treatment. Fresh blood of mriga, go & mahisha or goat is given, rakta basti, piccha basti, ghrita manda, anuvasana basti is also beneficial.7. Vibhramsha: 3 types. 1.Guda bhramsha 2.Sanjna bhramsha 3. Kandwadi laxana yukta vibhramsha. Guda bhramsha: it is replaced by kashaya dravyas, sourashtri churna, udumbara sara, lodhra churna along with jatyadi & padmakadi taila & also mushaka taila is beneficial. Sanjna nasha: Sama veda patana & gandharva gana are the treatments. Treatment of kandu is also advocated.8. Stambha : If snigdha atura is given with sneha virechana then causes doshavrita & stambha. Signs & symptoms: Guda stambha, shula, alpa malapravritti with pain. Treatment: Langhana, pachana, tikshna basti & virechana.9. Upadrava: When ruksha virechana drug is given to ruksha patient, it vitiates vata & leads to upardravas like stambha, shula, gatragraha & murcha. Treatment : Snehana, swedana, vatahara drugs.10. Klama: When snigdha & mridu kostha patient is given mridu drug, then vitiation of kapha and pitta occurs & due to retention of vata causes following symptoms.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 25                      
    • Concept of Virechana  Signs & symptoms: Tandra, gourava, klama, weakness & pain in the body. Treatment: Langhana, pachana, snehana, tikshna shodhana drug.Savashesha oushadhi :When drug is given in small dose, it is unable to eliminate dosha & may lead tosavashesha oushadha.Signs & symptoms: Trishna, parshwa peeda, chardi, murcha, sandhi ruja, hrillasaTreatment: Vamana.Jeerna oushadhi vyapat: When drug of low potency given in small doses in patientwith krura kostha & tikshnagni, it may be digested without causing purgation. It leadsto bala & vyadhi vibhramsha.Treatment: Tikshna drug in sufficient quantity is given after snehana.Vibandha: When patient is exposed to sheetala jala or vayu, then doshas retained &causes retention of vayu, mutra & purisha occurs.Signs & symptoms: Atopa, daha, jwara, teevra ruja.Treatment: Vamana, virechana, asthapana & anuvasana basti.Pratiloma gati: When drug is given before digestion of previous meal or the kapha isaggravated or the drug is having durgandha then vamana & pratiloma gati occurs.Treatment: Snehana, swedana & virechana should be given.Probable mode of action: 1. Deepana & pachana: Due to ushna, laghu guna it enhances the agni & ama pachana occurs and facilitates the easy digestion of sneha during snehapana. 2. Snehapana:Sneha is the sarabhaga of purusha & even the life is dependant on it. Also thequalities of snehana dravyas like guru, sheeta, sara, snigdha, manda, sukshma, mridu& drava83 (A.H.Su.16/1) will perform the function of snehana, vishyandana, mardava& kledakaraka84 (Ch.Su.22/11). Snehana dravyas are having the properties of keepingthe particles together & also to bring about adhesion. Human body is made up ofinfinitesimal & innumerable units known as paramanus & they are held in properposition by sneha dravyas.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 26                      
    • Concept of Virechana Snehana dravyas will produce the following properties in the body: 1. Vatashamana ensues. 2. It makes the body smooth, soft & dissolves & disintegrates the vitiated doshas. 3. Mala sanga in the body is removed85 - Ch.Si.1/7. 4. Enhances digestive fire in the body. 5. Purifies the kostha. 6. Nourishment to the body. 7. Helps to maintain proper functioning of Indriyas 8. Vyadhi kshamatwa is enhanced.The kledakaraka action enhances the doshas by liquifying morbid doshas. Here thedrava quality helps in liquifying concentrated doshas.The vishyandana quality of sneha causes liquifaction by snigdha, mridu, drava, sara &sukshma guna & helps in liquid doshas like kapha, pitta & liquid dhatus like rasa,rakta are brought from shakha to kostha, thereby for easy elimination during shodhanaprocess.Mridu guna helps to soften & loosen the dosha. Liquidity of dosha increases & alsocauses shaithilya in various organs. Sara guna causes anulomana of the doshas.Vivarana karma i.e. dilating the srotas, thereby entering into anusrotas is done bysukshma guna.Administration of snehapana in arohana krama helps in bringing the doshas fromshakha to kostha by vriddhi, vishyandana, paka, srotomukha vishodhana and bynigraha of vata86 (Ch.Su.28/34). Vriddhikarma is done by drava guna of sneha, whichhelps even for vilodana of doshas (A.H.Su.1/18 - Hemadri). Vishyandana is vilayanawhich is due to snigdha guna, Srotomukha vishodhana karma is achieved by sukshmaguna of sneha dravyas87 (A.H.Su.1/18- Hemadri). The mode of action is compared tojust like a vessel smeared with oil, water slips down from it, without any applicationof force, so also in the body, the application of oleation therapy the moistened &vitiated doshas will be alleviated easily88 (Ch.Si.6/11).Importance of Snehapana: Deeptagni, parishuddha kostha, pratyagradhatu,balavarna, dridha indriyata, mandajara & shatayu are the benefits of snehapana89“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 27                      
    • Concept of Virechana (A.H.Su.13/46). Snehana is beneficial in durbalagni state to enhance it. Hence prior tosnehapana shodhana is contraindicated. If we try to remove the doshas from rukshashareera, then there may be possibility of lodging the dosha due to rukshata in srotas.In our body, each & every cell has got cell membrane which is made of lipidsubstances & is permeable to lipids & impermeable to water soluble molecules. Thepermeablity permits the snehana dravyas inside the cytoplasm through cell membrane& this process takes place by simple or lipid diffusion. Saturation kinetics: When thenumber of molecules inside the cell increase so much that all the carrier proteins areoccupied, the saturation point is reached, i.e. further increase of the molecules will notcause any further rise in the rate of transport. The above concept adds to the point tothe action of malodeerana which is not possible when the administered sneha reachesmore than the saturation point.Swedana:The qualities of Swedana drugs are Ushna, tikshna, sara, snigdha, ruksha, sukshma,drava, sthira & guru90 (Ch.Su.22/16).The actions obtained by these gunas includes:The action of swedana is performed by ushna guna & tikshna guna does shodhana ofdoshas, sara guna doshashamana, ruksha guna does shoshana, vivarana by sukshmaguna, stambha is relived by ushna guna, vilodhana by drava guna, dharana karma bysthira guna91,92 (A.H.Su.1/18 -Hemadri). Addition of liquification of doshas occursdue to swedana, by the virtue of its drava guna & shodhana by tikshna guna whichenters into minute srotas by its sukshma guna. The agneya property of tikshna &ushna gunas produce paka & srava.Due to snehana, kledana of doshas takes place & swedana does liquifaction therebythey are brought to kostha. The function of sweda is to produce kleda in the body.Kleda is the product of jala in the body & it should be removed out. The final productof jala dhatu is ap dhatu & kitta is kleda. The mula of swedavaha srotas is medas &romakupa. Sthoola medas produces the function of snehana & its mala causesswedana. Swedana pacifies vata & enhances agni.Mode of action of Swedana94:“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 28                      
    • Concept of Virechana Klinna doshas which are present either in kostha, dhatu, srotas & shakhas & asthi(includes madhyama roga marga) are liquified by swedana & brought to kostha,thereby eliminated through shodhana karma.In short, snehana softens doshas & localizes them. Swedana liquifies those doshas dueto its ushna & tikshna properties. The fluid is defined as dravata, prakledana, alodanadrava i.e. the fluied properties will make things to move & causes klinnata of thebody. Then only the doshas will reach to the kostha & they will be removed either byvamana or by virechana.Importance of snehana & swedana:This suggests the administration of snehana & swedana before shodhana therapy. Ifpurvakarma is not performed, then just like the destruction of shushka daru, the bodywill be destroyed94.Swedana is administered after snehana, ultimately brings vata under control & therebyhelps for facilitating the easy elimination of purisha, mutra & retas95(Cha.Su14/4).Snehana & swedana enhance the doshas & helps them to come from Shakha to kostha& then they can be removed very easily.As the dirty cloth will be separated from dirt after it is washed with water, so also inthe body after snehana & swedana, vitiated doshas will be thrown out of the body oftheir entirety96(Cha.Si.6/13).Mode of action of Swedana:Heat has thermal effect on blood vessels, nerves. There will be increased metabolismacting on the walls of the capillaries & arterioles causing dilatation of these vessels.Sun light has a direct effect on blood vessels, causing vasodilatation in superficialtissues where there is more heating. Due to vasodilatation there is an increased flowof blood through the area, so that the necessary oxygen & nutritive materials aresupplied & waste products are removed.Heat reaches to subcutaneous region & through the blood conveys the heat to theentire body. The capillaries will be dilated, the sweat glands will be stimulated &local temperature rises. The resultant action is appearance of perspiration. The sweat“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 29                      
    • Concept of Virechana produced from the skin (through roma kupas), will enhance the colouration of skin &softness. Sweat regulates heat & water balance of the body. The muscles are suppliedwith parasympathetic nerves. Since the centre is situated in anterior hypothalamus, byits stimulation sweat is formed. The skin is stimulated by hot rays of sun & therebyperspiration results. Excessive exposure may lead to oedema or sun burns in sensitiveskin which is a local effect. The general effects are produced in proportion to intensity& duration of exposure to sun rays. During this process, there will be increasedelimination of heat, excess perspiration & signs of ordinary fever.Mode of action of drugs used for virechana:The drugs that are having ushna, tikshna, sukshma, vyavayi, vikasi properties reachesthe hridaya through swaveerya (swaprabhava - Chakrapani) & circulates through large& small blood vessels of the body98(Cha.Ka1/5).Action of ushna guna: Ushna guna has agneya property & hence vishyandana occursi.e. ‘vilininam kurvanti’ (Chakrapani). Hence it facilitates movement of morbiddoshas towards kostha.Tikshna guna : ‘taikshnyat vicchindanti’ - vicchindanti cchinnam kurvanti(Chakrapani), i.e. they breaks up the doshas, from larger to smaller molecules.Dalhana says that this helps in quick excretion.Sukshma : Sukshma guna due to its anupravanabhava, i.e It will open micro channels& makes the doshas to move towards kostha.Vyavayi: Due to this, drugs spreads quickly throughout the body & starts their actionbefore its digestion.Vikasi : Vikasi drugs loosens the dhatu bandhana (Sh.Sam.Pu.Kh.4). It creats thedhatu shaithilyata (Dalhana). Hence drugs initiates their action without beingdigested. From all these properties doshas are driven to kostha. The presence ofprithvi & ap bhuta in virechana drug & the adhobhaga prabhava, the doshas areeliminated out through guda.It can be summarised that the above mentioned properties of drug reaches hridaya byswaveerya & then with the help of the large & small dhamanis it pervades the whole“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 30                      
    • Concept of Virechana body. Due to agneya property, it causes vishyandana i.e.oozing of doshas & bytikshna property causes vicchandana (disintegration) of doshas.Mode of action:Systemic action: Doshas are brought to kostha from snehana & swedana, from therethey are eliminated by virechana, which suggests action throughout the body.Local action: Locally mild inflammation occurs which is transient due to ushna &tikshna properties of drugs which irritates the intestinal mucosa. Hence hyperaemiaresults due to arteriolar & capillary dilatation & also exudation of protein substanceswhich helps in dilution of toxins.LAXATIVES:These are the drugs that promote the evacuation of bowels. Depending on theintensity of action, they are classified into: 1. Laxative or aperient: which has milder action, & eliminates soft but formed stools. 2. Purgative or cathartic: It has stronger action resulting in more fluid evacuation. Many of the drugs in low doses acts as laxatives & in larger doses as purgatives.Classification:1. Bulk forming125 : Dietary fibre – bran. Dietary fibre consists of unabsorbable cellwall & other constituents of vegetable food- cellulose, pectins, glycoproteins & otherpolysaccharides. Bran consists of 40% dietary fibre. It absorbs water in the intestines,swells, increases water content of the faeces, softens it & facilitates colonic transit.Dietary fibre supports bacterial growth in colon which contribute to the faecal mass.Certain dietary fibres like gums, lignins, pectins bind bile acids & promote theirexcretion in faeces, leads to degradation of cholesterol in liver & then lowering ofplasma LDL cholesterol.Psyllium (plantago) & Ispaghula: They contain natural colloidal mucilage whichforms a gelatinous mass by absorbing water.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 31                      
    • Concept of Virechana Methyl cellulose & carboxymethyl cellulose: These are semi-synthetic, colloidal,hydrophilic derivaties of cellulose.Generous amounts of water must be taken with all bulk forming agents.2. Stool softener126 :Docusates: (Dicotyl sodium sulfosuccinate):Is an anionic detergent softens the stools by net water accumulation in the intestinallumen by action on the intestinal mucosa. It emulsifies the colonic contents. By adetergent action, it can disrupt the mucosal barrier & enhance the absorption of manynon absorbable drugs. Eg: liquid paraffin should not be combined with it.Lubricant: Liquid paraffin – is a viscous liquid, a mixture of petroleum hydrocarbons.Taken for 2-3 days, it softens stools & is said to lubricate hard scybali by coatingthem. 3. Stimulant purgatives127 :They are powerful purgatives & often produce griping. They may irritate the intestinalmucosa & thus stimulate motor activity. The more important mechanism of action isaccumulation of water & electrolytes in the lumen by altering absorptive & secretoryactivity of the mucosal cell. They inhibit Na + K+ ATpase at the basolateralmembrane of villous cells- transport of Na+ & accompanying water into theinterstitium is reduced. Secretion is enhanced by activation of CAMP in crypt cells &by increased PG synthesis. Larger doses of stimulant purgatives can cause excesspurgation, leads to fluid & electrolyte imbalance.Anthraquinones: Senna obtained from leaves & pod of certain cassia species. Theycontain an anthraquinone glycoside called emodins. Glycosides not active as such.Unabsorbed in the small intestine, they are passed to the colon where bacteria liberatethe active anthrol form, which either acts locally or is absorbed into circulation.Excreted in bile to act on small intestine. They take 6-7 hours to produce action.The active principle is believed to act on the myenteric plexus to increase peristalsis& decrease segmentation. They also inhibit salt & water absorption in the colon.Senna anthraquinone has been found to stimulate PGE2 production in rat intestine.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 32                      
    • Concept of Virechana Castor oil: Is one of the oldest purgatives. It is a bland vegetable oil obtained from theseeds of Ricinum communis, has been used on skin as emollient. It mainly containstriglyceride of ricinoleic acid, which was believed to irritate the mucosa & stimulateintestinal contracations. The primary action has shown to be decreased intestinalabsorption of water & electrolytes & enhanced secretion by a detergent like action onthe mucosa.4. Osmotic purgatives128 : Solutes that are not absorbed in the intestine retain waterosmotically & distend the bowel increasing peristalsis indirectly. Magnesium ionsrelease cholecystokinin which may aid purgative action of magnesium salts. Allinorganic salts are used as osmotic (saline) purgatives have similar action.Eg: Magnesium sulfate, Magnesium hydroxide, Sodium sulfate, Sodium phosphate,Sodium potassium tartrate, Lactulose.Mechanism of action:All the purgatives increase the water content of faeces by:A hydrophilic or osmotic action, retaining water & electrolytes in the intestinal lumen– increase volume of colonic content & make it easily propelled.Acting on intestinal mucosa to decrease net absorption of water & electrolyte,intestinal transit is enhanced indirectly by the fluid bulk.Increasing propulsive activity as primary action- allowing less time for absorption ofsalt & water as a secondary effect.Certain purgatives do increase motility through an action on the myenteric plexus.Laxatives modify the fluid dynamics of the mucosal cell & may cause fluidaccumulation in gut lumen by one or more of following mechanisms. 1. Inhibiting Na+ K+ Atpase of villous cells – impairing electrolyte & water absorption. 2. Stimulating adenylyl cyclase in crypt cells – increasing water & electrolyte secretion.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 33                      
    • Concept of Virechana  3. Enhancing PG synthesis in which increases secretion. 4. 4.Structural injury to the absorbing intestinal mucosal cells. The irritant action of the drugs causes inflammation in the small & large intestine & since the mucosa is extensively irritated, secretion rate is enhanced & motility of the intestinal wall usually increases. As a result, large quantities of fluid are propelled by propulsive movements & results in formation of loose stools. The influence of virechana drugs are even appreciated on nerves, hormones, liver & crypts of lieberkuhn.Action on nerves: Here the defaecation centre is irritated in Medulla oblongata. Thevagus nerve stimulates pancreas, liver to produce secretions. Bile is secreted due tocontraction of G.B.,& also due to irritant & vagal stimulation, Brunner’s glands arestimulated which secretes mucus. Due to increased peristalisis, sacral & lumbarplexus are irritated, ileo caecal & anal sphincters are relaxed & these secretions areexcreted out & is said to be purgation. Hormonal action causes irritation of liver &pancreas, secretions are increased which adds to further irritation of mucosa. Someother hormones also increase small intestinal secretions like secretin &cholecystokinin. Whenever a segment of large intestine becomes irritated, thenmucosa secretes large quantities of water & electrolytes in addition to alkaline mucus.This acts to dilute irritating factors & to cause rapid movement of the faeces towardsanus. The mechanism by which marked secretion of watery fluid by crypts ofLieberkuhn is unknown. However, 2 active secretory processes occurs. Activesecretion of chloride ions into the crypts & bicarbonate ions. The secretion of chlorideions causes electrical drag of sodium ions through the membrane. Finally all thesecause osmotic movement of water & hence fluidity in the purgation occurs. Indiarrhoea, both sodium & potassium are excreted out of the body.The crypts oflieberkuhn are located at jejunal region of small intestine, causes extreme rate of fluidsecretion.The process of virechana is regulated & controlled by a special centre situated nearMedulla oblongata in the brain. This centre is close to respiratory & vomiting centre.When the virechana drugs stimulate the purgation centre, indirectly vomiting centre isrelaxed. Sacral plexus of the spinal cord also helps in controlling & regulating the actof purgation, & it is also controlled & regulated by local reflex actions. Hence during“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 34                      
    • Concept of Virechana the act of defaecation, the respiration is arrested momentarily, diaphragm is activated& presses transverse colon. Simultaneously, the accessory muscles of the abdomenare also activated & helps in propelling the faecal matter towards anus along with thediaphragm. Faecal matter, when it reaches the intestine, stimulates local nerveplexuses & then enforced peristalisis further helps in expelling contents of intestinestowards rectum & finally to anal canal. When these voluntary or involuntary act ofdefaecation starts, finally results in evacuation of bowels. Elimination of Pitta: Potentstimulus for causing the G.B. contracation is from cholecystokinin hormone. Thiscauses increased secretion of digestive enzymes from pancreas. The stimulation forthis hormone is the presence of fatty food in duodenum & G.B.is also stimulated byAcetylcholine secreting nerve fibres from both vagi & intestinal enteric nervoussystem. Due to the relaxant action of sphincter of oddi, bile enters into duodenum.This bile contains bile acids, bile pigments, cholesterol, lecithin, water, sodium,potassium, bicarbonate ions which are eliminated out can be called as pitta.Assessment of Virechana:Four types of Shuddhi Vizard Antiki, Vaigiki, Mnikia and Laingiki should beobserved. (Ch. Si. 1/14-16). However, the important should be given to LangikiShuddhi all the Shuddhi are described below in a tabular form.Table No:- 07 Shuddhi Pravara Madhyama Avara Vaigiki 3 2 1 Maniki 3Prastha 2 Prastha 1 Prastha Antiki Kaphanta Kaphanta Kaphanta Once it is confirmed that Virechana Vegas are stop, then advise patient to wash hands, feet and face51. (Cha.Su.15/17). And advise to avoid ashta mahadosha bhavas i.e.1.Ucchabhashana, 2.Rathakshobha, 3.Atichankramana, 4.Atiasana, 5.Adhyashana, 6.Ahita bhojana, 7.Diwaswapna, 8.Maithuna98. (Cha.Si.12/11-12). Based on shuddui lakshana especially Vaigiki advise patient to follow Samsarjana karma.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 35                      
    • Concept of Virechana  Chart No. 01 Samsarjana Krama Samsarjana Krama Anna Smsarjana [chakrapani99 (Cha.Chi.2/75) Rasa Samarjana Peyadi100 Tarpanadi58 Madhuradi Shadrasa (Cha.si.1/11) (Cha.Si.6/25) (Cha.Si.12/ 7-8) Physician should plan for Samsarjana karma depending on Shodhana. If in case of Samyak Shodhana occurs but complete Dosha are not expelled then advise patient to consume Yavagu etc. food along with Antarpana (Kashaya pana ) so that their will be mitigation of Koshtaupalepak Dosha i.e. remaining dosha102. (Cha.Ka.12/66). Similarly when proper Virechana does not occur at that time instead of Peyadi Krama, Tarpana should indicated since Peyadi by virtue of their Abhishandhi property causes Srotas obstruction. It is also recommended that the persons addicted to alcohol, having Vata Pitta Prakrti and if Kapha and Pitta are dominant even after Virechana Karma. And Cakrapani mentioned that in place of Peya and Vilepi, Svaccha and Ghana Tarpana should be given respectively58. (Cha.Si.6/25) While Arunadatta described as Laaja Saktu & Mamsarasodana in Prathama & Dviteeya Annakala respectively103. (A.Hr.Su.18/46) Table No:08 Peyadi Samsarjana Krama104(Cha.si.1/11) Dina Kala Annakala Pradhana Madhyama Hina shuddhi shuddhi shuddhi Prathama Pratah - - - sayam 1 Peya Peya Peya Dwitiya Pratah 2 Peya Peya Vilepi sayam 3 Peya Vilepi Kritaakrita yusha Trutiya Pratah 4 Vilepi Vilepi Kritaakrita sayam 5 Vilepi akrita yusha mamsarasa Samanya bhojana“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 36                      
    • Concept of Virechana  Chaturtha Pratah 6 Vilepi Krita yusha - sayam 7 Akrita yusha Akrita - mamsarasa Panchama Pratah 8 Krita yusha Krita - sayam 9 Krita yusha mamsarasa - Samanya bhojana Shashta Pratah 10 Akrita - - sayam 11 mamsarasa - - Krita mamsarasa Saptama Pratah 12 Krita - - sayam 13 mamsarasa - - Samanya bhojana To maintain the normal status of Dosha especially in Amaashaya & Pakvashya, rasasamsarjana krama is identified in classics. Here particular Rasaatmaka food articles are given to patient with proper order & this can be consumed along with Peyadi Samsarjana karma or after it. Table no : 09 Rasa Samsarjana Author Rasa Effect on Dosha Snigdha, amla, Pakwashyasthita vata shamanartha swaduCharaka105 Amla, lavana Urdhwasthita agnisandhukshanartha Swadu, tikta Pittashamanartha Kashaya, katu Pittordhwasthita kaphashamanartha Swadu, tikta Pravruttiragnihetuh vatapittasthavajayartham agnesameekaranarthaSushruta106 Snigdha, amla, Vatakaphavajayartha agnesandhukshanartha lavana, katu Swadu, tikta Pittavatavajayartha Thus after the Virechna karma patient should follow ashta mahadosha bhavas and diet properly still Prakritagata Lakshana seen. These are when patient able to consume and digest all Rasatmaka food, proper functioning of all sense organ,“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 37                      
    • Concept of Virechana  normalise of bowel habits & micturation, regaining of strength ,Satvavaan107 (Cha.Si.12/9)Samyak yoga, Ayoga & Atiyoga lakshnas of virechana karma Table No: 10 Sl. Lakshana Ch.108 Sus.109 A.Hr.110 no (Si.1/17-19) (Chi.33/24-26) (Su.18/38-40) Samyak yoga lakshana of virechana 1. Sroto Vishuddhi + - - 2. Indriya Prasada + + - 3 Laghuta + + - 4 Agnivrddhi + - - 5 Anamayatva + + - 6 Kramat Vit Pitta + + - Kaphagamana 7 Vatanulomana - + - 8 Absence of Ayoga - - + Lakshanas Ayoga lakshanas of virechana karma 1 Kapha Prakopa + + + 2 Pitta Prakopa + + + 3 Vata Prakopa + - - 4 Agnimandya + + - 5 Gaurava + + - 6 Pratishyaya + - + 7 Tandra + - - 8 Chardi + - - 9 Aruci + + + 10 Vata Pratilomana + - Vatagraha 11 Daha - + + 12 Hrdaya Ashuddhi - + + 13 Kukshi Ashuddhi - + + 14 Kandu - + + Atiyoga lakshnas of virechana karma 1 Kapha Kshaya Vikara + + - 2 Pitta Kshaya Vikara + - - 3 Rakta Kshaya Vikara + - -“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 38                      
    • Concept of Virechana  4 Supti + - - 5 Angamarda + - - 6 Klama + - - 7 Vepathu + - - 8 Nidra + - - 9 Balabhava + - - 10 Tamah Pravesha + - - 11 Unmada + - - 12 Hikka + - - 13 Murcha - + - 14 Guda Bhramsa - - - 15 Kapha,Pitta,Rahita - - + ShvetaUdaka Nihssarana 16 Kapha,Pitta,Rahita - - + LohitaUdaka Nihssarana 17 MamsaDhavanavat - - + udaka srava 18 Medokhandavat Srava - - + 19 Trishna - - + 20 Bhrama - - + 21 Netrapraveshanam - - + 1. Chakrapani explains though Ayoga, Atiyog and Mithyayoga are described everywhere accordingly in the text, but in case of vamana & virechana there is no need to consider Mithyayoga as a separate entity. In these procedures, expulsion occur in 4 different ways Atipravrutti – Excessive expulsion. (Elimination) Asamyak pravrutti – Expulsion by improper way. Apravrutti – Cessation of process of expulsion or improper elimination. Alpapravrutti – Expulsion in lesser quantity. Here apravrutti & alpa pravrutti are included in ayoga. As asamyak Pravrutti means expulsion through opposite route, it indicates that expulsion of vitiated“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 39                      
    • Concept of Virechana  Dosha is not in a quantity, which is expected, so it must be considered under the term of ayoga and not mithyayoga111. (Cha.Si.6/29-30)“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 40                      
    • Disease review   HISTORICAL REVIEWVedic Kala : (10000 to 500 B.C.)Vedas are known as dawn of the sciences and considered as the oldest authenticmanuscripts ever found. Veda narrated medical science very lucidly.Though a detaildescription regarding Sthaulya (Obesity) is not available. But,some scatteredreferences like Medas, Medini, Pivasi are available in Atharvaveda 112 with the detaildescription of anthropology and anthropometry (10/2). The word Medini and Pivasiare used as synonyms of herbs (1/11/14, and 8/7/7), which probably stands forlargeness having substance like Meda. In Rigveda and Yajurveda (25th chap.) Medaand Vapa are mentioned114. Moreover, in Yajurveda (12/97) a disease named"Upachita" has also been described in this reference. Veda appreciated exercise andhard work and slashed upon laxity, in context of health (Aiytraya Brahma 33, Rigveda8/12/18). Atharvaveda has advised to strengthen and hardened the body like a stone,in other words indicated hazards of flabbiness of the body and obesity (1/2/2).Samhita Kala : (200 B.C. - 400 A.D.)Charaka Samhita115 : (2 B.C.)Coming to post vedic era, in samhita kala, Charaka Samhita has described scientificstudy on Sthaulya. Sthaulya has been classified under "Ashta Nindit Purusha"Charaka has narrated its causative factors mainly exogenous and hereditary type alongwith its pathology, sign and symptoms, prognosis and management. Definition ofSthaulya, its etiopathogenesis (Su. 21/3-4), pathophysiology of excessive hunger andthirst, cardinal symptoms, Ashta dosha of Sthaulya, complication of Sthaulya due toits ignorance are described in detail (Su. 21/18-19). Besides that, other aspect ofSthaulya and line of treatment have been described on various places in CharakaSamhita i.e. Taila Sevana Yogya (Su13/44), Swedana Ayogya (Su.14/17), AdhikaDoshayukta Rogi (Su, 16/13-16). It is also mentioned as disorder of SleshmaNanatmaja (Su. 20/17), Samtarpana Nimitaja (Su. 23/6), Ati Brimhana Nimitaja (Su.22/24) and Samsodhana yogya (Su, 16/16). Detailed Anthropometry is described inVimana Sthana (8/117), under the caption of Pramana Pariksha. Gramya Ahara andGramya Vasa are mentioned as root cause of all illness due to flabbiness of body andexcessive accumulation of Meda (Chi 1/2-3).“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 40                     
    • Disease review  Sushruta Samhita116 : (2 A.D.)In Sushruta Samhita (Su. su. 15), he has narrated the etiopathogenesis of SthaulyaRoga on the basis of an endogenous entity being caused due to "Dhatvagni Mandya"and Sthaulya is considered as the physical condition of the body (Su.35/40), result ofvitiated Meda (Su. 24/13), as symptom of disrupt (Viddha) Medovaha Srotasa (Sha.9/12) and Rasa Nimitaja disorder (Su. 15/37). A new synonym Jatharya has been usedin chi 12/11. Further, elaboration of line of treatment has been done by Sushruta andso many remedies described for the management of Sthaulya at different places (Chi.24/40&79).Kashyapa Samhita117 : (6 A.D.);Kashyapa has given some new aspects of management while narrating MedasviDhatri Chikitsa and suggested Raktamokshana (blood letting) as one of the besttreatment for Medasvi Dhatri i.e. Obese foster mother. Sthula and Atisthula word arefrequently used at different places especially in description of Anthropology in SutraSthana. Sthaulya is one of the disorders where Snehana Karma is contraindicated, as itincreases severity of disease. Despite of that in some condition it can be used withTriphala, Lavana, and Vyosha (Su. 22/55)Ashtanga Samgraha (6 A.D.) and Hridaya118,119 (7 A.D.) :Vriddha Vagbhata and Vagbhata have elaborated etiopathogenesis of Sthaulya on thebasis of formation of Ama and disturbance of the process of Dhatu Parinamana.In Ashtanga Hridaya Su. 14 and in Ashtanga Samgraha Su. 24, they have mentionedvarious therapeutic and prophylactic measures to cure and to prevent this disease andconsidered Rasanjana as a drug of choice for Sthaulya. But after observing relapseand challenging nature of the disease, they concluded that there is no treatment ofexcessive obesity (AH. Su. 14/31).Sthaulya is counted as a disorder of Sleshma Dosha seated in Medodhatu (AS. Su.19/26). Jathara Unnati i.e. abdominal adiposity is stated as the result of placement ofshlesma in Koshtha (AS. Su. 19/28). Flabbiness of Dhatu caused by Ama is mainpathogenesis of Sthaulya as highlighted (Su.24/23). Vagbhata has first timementioned types of Sthaulya and their management (Su. 24/14-16).“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 41                     
    • Disease review  Madhava Nidana120 (7 A.D.) :Madhavakara has elaborated the symptomatology and pathophysiology of this diseaseon the basis of fat tissue & fat depot site and mentioned natural tendency towardsandroid obesity (Ni. 34/4).Sharangadhara Samhita121 (13th Century) :In this text, Sthaulya was described by the name of Medo Dosha (Pu.7/65) and ischaracteristic of Sleshma Prakriti (Pu.6/21).Other Literature During Medieval Period :Sthaulya is also highlighted by various Acharyas like Bhava Mishra and by somecommentators like Chakrapani, Dalhana, Indu, Arundatta, Vijayarakshitaja etc.ETIMOLOGY VYUTPATTI OF STHAULYA:The word Sthaulya is derived from Mula Dhatu “Sthu” with suffix “Ach” pratyaya,which stands probably for bulky or big, or thick.Definition of Sthaulya:Acharya Charaka mentioned that a person in whom excessive and abnormal increaseof Medodhatu along with Mamsadhatu is found which results into pendulousappearance of buttocks, belly and breasts and whose increase bulk is not matched by acorresponding increase in energy is called Sthula Purusha122.For the purpose of diagnosis, prognosis and easy management disease should beclassified as per severity as well as chronicity. Hence, classification of Sthaulya isessential but there is no such clear classification is found in our classics. AstangSamgraha, Astanga Hridaya and Sharangadhara have thrown little light regardingclassification of Sthaulya as mentioned below.A.S.Su. 24/13-16 and A.H.Su.14/14 mentioned three types of Sthaulya123,124 i.e.Adhika, Madhya and Hina for better management while narrating the indication ofLanghana Upakrama.From the above references, Sthaulya may be classified as:Charaka : 1. Sthula 2. AtisthulaSushruta : 1. Sthaulya 2. MedorogaVagbhat : 1. Adhik 2. Madhya 3. HinaSharangadhara : 1. Medodosha“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 42                     
    • Disease review    NIDANA129,130,131,132 (CAUSATIVE FACTORS):- In Ayurvedic literature, various acharyas have mentioned so many aetiological factors of Sthaulya Roga. The heredity component (Bijadosha) besides Aharatmaka, Viharatmaka and Manasa factors in causation of Sthaulya have been described by Acharya Charaka (Ch. su. 21/3). They are mostly exogenous types, but endogenous type of cause has been mentioned by Acharya Sushruta and Acharya Vagbhata. Vagbhata has also mentioned ‘Ama’ as a causative factor, besides other components. In brief, all causative factors described in Ayurveda can be classified into four groups. 1) Aharatmaka 2) Viharatmaka 3) Manasa Nidana 4) Anya Nidana For better understanding these causes are being tabulated as follow : AAHARATMAKA NIDANA: Table No:-11Sl. Nidana Ca Su Va Ma Ni. Bha. Yo. Rano Pra1 Ati bhojana + + + - - -2 Guru aahara sevana + - - - - -3 Madhura aahara sevana + - - + + +4 Snigdha aahara sevana + - + - + -5 Adhyashana - + - - - -6 Navanna sevana + - - - - -7 Navamadya sevana + - - - - -8 Gramya rasa sevana + - - - - -9 Paya vikara sevana + - + - - -10 Dadhi sevana + - - - - -11 Shlemala aahara sevana + - + - - +12 Ikshu vikara sevana + - + - - -13 Guda vikara sevana + - - - - - “A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to   overweight.”    Page 43                     
    • Disease review  VIHARATMAKA NIDANA :Table No:-12 Sr. Nidana Ca Su Va Ma. Bha. Yo. no Ni Pra. Ra. 1 Avyaayama + + + + + + 2 Avyavaya + - - - - - 3 Divaaswapna + + - + + + 4 Sukha shayya + - + - - -MANASA NIDANA :Table No:-13 Sr. Nidana Ca Su Va Ma. Ni. Bha. Yo. Ra no Pra. 1 Achinta + - + - - - 2 Harsha nitya + - + - - - 3 Priya darshana + - - - - - 4 Saukhyena - - + - - -ANYA NIDANA:Table No:- 14 Sr. Nidana Ca Su Va Ma. Bha. Yo. no Ni. Pra Ra. 1 Ama rasa - - - - + - 2 Snigdha madhura basti + - - - - - sevana 3 Snigha udwartana + - - - - - 4 Bijadosha swabhavat + - - - - -Role of Aharatmaka Nidana in Sthulya :Ahararasa plays a major role for increasing Meda dhatu in Sthaulya. So, AcharyaSushruta has mentioned.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 44                     
    • Disease review  Rasanimittameva Sthaulya evam karshyamch. (Sus.Su15/32)Means, Sthaulya and Karshya depends upon the quality and quantity of Ahararasa.On the basis of Samanya Vishesh Siddhanta (Ch. Su. 1/44), the excessive foodconsumption of similar substance (Dravya Samanya), similar quality (Guna Samanya)or similar in action (Karma Samanya) helps in the over production of Dhatu. In thesame manner increase intake of Aharatmaka Nidanawhich are described above causesover production of Medodhatu.Role of Viharatmaka Nidana in Sthaulya:All the Aharatmaka Nidana ultimately decreases physical activity, which aggravatesKapha and leads to Meda depostion. Viharatmaka Nindana like Divaswap havingAbhishyandi property leads to blockage of the micro channels of the body,specifically in Medovaha srotas133 (Ch. Vi. 5/16). Moreover, reduced metabolic rateduring sleep is an important factor for genesis of excess fat.Role of Manas Vyapara in Sthaulya :Due to adoptation of modern lifestyle, a person has reduced his physical activity andinstead of that, the mental work is increased. As a result now a days the diseasescaused by psychogenic factors are seen extensively more. Acharyas also mentionedsome psychogenic causes of Sthaulya in Ayurvedic texts, because Sthaulya is alsoconsidered under the group of psychosomatic diseases.Harshanitya and Achintana are two psychological factors mentioned by AcharyaCharaka, which are responsible for Meda vriddhi. These factors are Kaphaaggravating factors lead to Meda deposition. With this type of psychological wellbeing and jolliness that person indulge more in worldly pleasure and excess energystored in the form of Meda.Role of Beejadosha :Acharya Charaka has mentioned that Beejadosha plays a major role forMedovriddhi134 (Ch. Su. 21/04). Defect of Beejabhagavayava i.e. part of Beeja, whichresembles with Genes, may lead to defective development of that organ. Also,Bhavamishra has mentioned that increased proportionate of Meda and decreasedproportion of Shukra in Beeja at the time of conception predisposes towards“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 45                     
    • Disease review  development of stout but weak body (B. P. Ma. 40/4-6). Moreover, overnutritionparticularly with Madhura Rasa during pregnancy is mentioned as a causative factorfor birth of obese child, which indicate role of hereditary factor in genesis ofSthaulya135. (Ch. Sa. 8/29).PURVARUPA136:The Symptoms that appears before complete manifestitation of the disease is knownas Purvarupa137 (Ch.Ni.1/8). Purvarupa of Sthaulya is not described by any Ayurvedictexts. According to Charaka, the Medovahasrotodushti Lakshanas, which are alsomentioned as Purvarupa of Prameha138 (Ch.Su. 28/18), can be considered aspurvarupa of Sthaulya. Again, there is similarity in pathogenesis of Prameha andSthaulya. Bahudrava Shleshma and Abaddha Meda are the two morbid componentsinvolved in pathogenesis of Prameha (Ch. Ni. 4/8) Kapha and Meda also gets vitiatedin Sthaulya .Therefore purvarupa of Prameha and Medovaha Srotodushti Lakshanascan be considered as purvarupa of Sthaulya. The symptoms related with Meda Dushtilike Atinidra, Tandra, Alasya, Visra Shariragandha, Angagaurav, Shaithilya etc. canbe considered as Purvarupa of Sthaulya. In modern medical science there is nopremonitory symptoms found in obesity or overweight. So, its related mild symptomscan be considered as premonitory symptoms.RUPA136 :Charaka has narrated Pratyamlakshana122 (Rupa) of Sthaulya as MedomamsAtivriddhi, Chala Sphika, Chala Udara, Chala Stana, Ayatha Upachya, Anutshaha i.e.Beside these Cardinal Symptoms, eight disabilities of Sthaulya are 1) Ayusohrasa (Diminution of lifespana) 2) Javoparodha (Lack of enthusiasm) 3) Kriccha Vyavaya (Difficulty in sexual act) 4) Daurbalya (Debility) 5) Daurgandhya (Foul smelling of body) 6) Swedabadha (Distressful sweating) 7) Kshudhatimatrata (Excessive hunger) 8) Pipasatatiyoga (Excessive thirst)Elaborated pathogenesis of occurrence of Asta Dosha of Sthaulya has been“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 46                     
    • Disease review  mentioned in Ch.Su. 21/04 which are as follow :Ayushohrasa - Life expectancy is decreased because other Dhatus could not benourished properly.Javoparodha - Shaithilya, Saukumarya and Guru Properties of Medadhatu, causesJavoparodha.Kricchavyavaya - Due to obstruction in genital passage by Medodhatu and lessproduction of semen, the sex act becomes difficult.Daurbalya - This results because of the deranged metabolism owing tomalnourishment of the Dhatus.Daurgandhya - Bed smelling is results due to excessive sweating, innate quality ofMedodhatu and morbid nature of vitiated Meda.Swedabadha - It’s occurs due to sang in Swedavaha Srotasa by amaKshudhatimatrata and Pipasatiyoga - Because of increased Agni in Koshtha andvitiation of Vata by obstruction of Meda it results in excessive appetite and thirst.All the symptoms of Sthaulya described in various Ayurvedic texts have beensummarized in the following table.Rupa:-Table No:-15 Sr. Rupa Cha. Su. A.S A.H MN Bp no 1 Chala sphika (pendulous + - + + + + buttock) 2 Chala udara (pendulous + - + + + + abdomen) 3 Chala stana (pendulous breast) + - + + + + 4 Ayatha upachaya (abnormal + - + - + + growth of the body) 5 Udara parshwa vruddhi - + - + + + (enlargement of abdomen) 6 Anutsaha (lack of entusiasm) + - + - + + 7 Aalasya / jadyam (dullness) - - + - - - 8 Moha - - - - + +“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 47                     
    • Disease review   9 Javoparodha (sluggishness in - - + - - - movement) 10 Alpa vega - - + - - - 11 Shrama - - + - - - 12 Sarvakriyasu asamarthata - + - - + + (unable to bear any physical exercise) 13 Alpa bala - - + - - - 14 Daurbalya + - + - - - 15 Alpa prana (low vitality - + + - + + power) 16 Aayushorhas (shortening of + - + - - + life span) 17 Krichra vyavaaya (difficulty in + - - - - - coitus) 18 Alpavyavaaya (lack of sexual - + - - + + life) 19 Daurgandhya (bad smell of + + + - + + body) 20 Swedabadha (excess sweating) + - + - - + 21 Kshudhatimaatra (excess + + + - + + hunger) 22 Pipaasaatiyoga (excess thrist) + + + - + + 23 Nidraadhikya (exces sleep) - + + - + + 24 Kshudra swapa (dyspnoea on - + + + + + exertion) 25 Krathana - + - - + + 26 Gadgadvani (indistinctness of - + + - - - speech) 27 Gatrasada (prostration of body) - + - - + + 28 Saukamarata (delicacy) + + - - - -“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 48                     
    • Disease review  SAMPRAPTI136 :The term Samprapti is applied to express the course of the disease, from NidanaSevana to Vyadhi Utpatti. The knowledge of Samprapti helps in the comprehension ofthe specific features of a disease like Dosha, Dushya, Srotodushti, Ama and Agni.Sthaulya has been narrated as Dushya dominant disorder i.e. Medaja Vyadhi139 infollowing words.Granthivruddhigalagandarbudamedojaushthaprakopmahumehatisthaulyatiswedaprabhrutayo medodoshajah..... (Sus.Su.25/9)Acharya Charaka has accepted “Ahara” as most common pathogenic factor forMedovriddhi in Sthaulya. Whereas Sushruta has accepted Amadosha.Due to obstruction of Srotas by Meda, the Vata moving mainly into stomach, whipsup the Agni and absorbs the food. The carpulent man digests food speedily and cravesfor food inordinatary. Over eating produces more upadanarasa which causesovergrowth of Meda Dhatu leads to Sthaulya.According to Sushruta Ama Rasa is produced due to Kaphavardhakaahara, Adhysana,Avyayama, Divaswapana. The Madhura Bhava Ama Rasa moves within the body,Snigdhansha of this Anna Rasa causes Medovruddhi which produces excessivestoutness140 (Sus.Su15/32).In the manifestation of any disease vitiation of certain basic components like doshadushya stratus and agni takes place which are described as followsDoshaSthaulya is a kapha predominant vyadhi but involvement of vata and pitta cannot beneglected. These three Doshas collectively participates in the process of pathogenesisin Sthaulya.KaphaMost of the Ayurvedic scholars have considered Sthaulya as Kaphaja Vyadhi.Moreover, Acharya Charaka has mentioned Sthaulya under Shleshma NanatmajaVyadhi141 (Ch.Su. 20/17). Due to excessive intake of Guru, Snigdha, Madhura,Sheeta, Picchila and Abhishyandi Ahara and Vihara like Diwaswapna, Achintana etcleads to vitiation of Kapha. Most of the symptoms of Sthaulya comes under thecategory of Kaphavriddhi i.e. Alasya, Gatrasada, Angagaurava, Nidradhikya etc.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 49                     
    • Disease review  Usually the Sthaulya rogi belongs to Kapha Prakriti. So, they are slow and lethargic inphysical activity.PittaIn obese person, Pittaja Lakshanas are very less but most of obese persons haveTikshnagni. Which is also increased by Pitta Dosa Moreover symptoms like-Atipipasa, Swedadhikya, Dauragandhya have also been mentioned in the Pitta VriddhiLakshanas.VataVata creates two situations in Sthaulya. First is the state of Avrita Vata whichprovocates the Agni and ultimately increases the demand for the food (AbhyavaharanShakti) and absorbs the nutrients.Second is inactiveness of Vyana Vayu. Vyanvayu is responsible for proper circulationand distribution of Dhatus.Due to, Sanga in Medovaha srotas the nutrients cannot be carried by Vyanavayu totheir respective Dhatus. Hence, involvement of Saman vayu can be clearly postulatedwith the evidence of Agnisandhukshana and improper distribution of fat in the bodyproves the involvement of Vyanavayu 142(Cha.Chi.15/36).DushyaWithout Doshadushya sammurchchhana disease process is not possible. AcharyaSushruta has mentioned Sthaulya as a Dushya dominant disorder139 (Su.Su.25/9) andin this disease, the excessive production of abnormal Meda dhatu is clearly visualized.Here, Rasa, Mamsa, Meda, Majja and Shukra Dhatus are Dushyas as Kapha is seatedin all these Dhatus on the basis of Ashrayashrayeebhava. So, vitiation of Kapha alsoleads to vitiation of above Dushyas. Poshakansha in excessive quantity and qualityincreased the particular Dhatu. In Sthaulya, excessive intake of Guru, Snigdha,Madhuradi Guna dominant diet increase accumulation of Medodhatu.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 50                     
    • Disease review  Srotas :In Sthaulya, the involvement of Medovaha srotas is the main factor along with theinvolvement of other Srotasa. Avyayam, Diwasvapna, excessive intake of MeduraDravya and Varuni are vitiating factors for Medovaha Srotodusti as mentioned inCharaka Samhita.Rasadraktam tatomamsam mamsanmedatatosthicha.Asthno majja tatah shukradgarbhah prasadajah. (Cha.Chi15/16)It indicates the clear involvement of Medovaha srotas along with Rasavaha srotas.Atisweda and Daurgandhya indicates the involvement of swedavaha srotas. Presenceof Atipipasa indicates the involvement of Udakavaha srotasa. In the pathogenesis ofSthaulya, increased fat deposition inside the muscle (vasa) indicates the involvementof Mamsavaha Srotasa.Agni :Jatharagni :In Sthaulya due to obstruction of Meda Vata remains in the Koshtha and causesTikshnagni. Here in such condition, how Ama formation can occur in the presence ofTikshnagni. Chakrapani and Dalhana have tried to clarify this controversy by givingexplanation that in the stage of Tikshnagni, person goes for Adhyasana andKalavyatita Ahara Sevana, which leads to disturbance in Agni, and subsequentlyformation of Ama may take place. Moreover, Dalhana has explained that in theSthaulya formation of Ama is more due to decrease level of Medodhatvagni thanJatharagni143 (Sus.Su. 15/38)Dhatvagni :As per Vagbhata Pachakamsha present in each Dhatu is refered to Dhatvagni144(A.Hr.Su.11/34) i.e. Ushma presents in Dhatu is part of Jatharagni and is controlledby it, Dhatvagnimandya of specific Dhatvagni causes Vriddhi of that Dhatu andVis.a.vis. In the state of dhatavagnimandya Kshya of utter Dhatu takes place.In case of Sthaulya Medodhatvagni Poshakamsh stated at Jatharagni level is vitiated.So, Medodhatvagni may not do its work properly and also due to good JatharagniMeda Dhatu poshaka Rasa is formed in more quantity so overload on Medodhatvagnicauses accumulation of more Meda Dhatu in their depots. In addition, due to decrease“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 51                     
    • Disease review  production of Sukshma part and Sara part at Medodhatvagni level the further Asthi,Majja and Shukra Dhatu get less poshaka Rasa.The aetiological factors described by Acharyas, can be categorized under four groupsi.e. 1. Dosha Dushtikara : Guru, Madhura, Sheeta guna dominant diet. 2. Dhatu Daurbalyakar / Khavaigunyakar - Avyayam, Avyavaya, Achintana, Nityaharsh etc. 3. Agnimandyakara - Ati Bhojana, Madhura, Snigdha pradhan Bhojan. 4. Beejadosha - It impairs Medodhatvagni poshakansha and ultimately provides the base to Sanchaya of Ama in Medodhatu, which leads to Sthaulya. The persons having genetic predisposition may develop both type of obesity - Hypertrophic and Hyperplastic obesity.The whole process of manifestation of Sthaulya can be described as below:Samprapti Ghatakas :Dosha - Tridosha,Samanavayu, vyanvayu, Pachaka Pitta, Kledaka Kapha,Dushya – Rasa, Mamsa and MedaAgnimandya - Medodhatvagnimandya, JatharagnimandyaAma - Medodhatvagnimandyajanit, JatharagnimandyajanitSrotasa - Annavaha, Rasavaha, Mamsavaha, MedovahaSrotodushti - Sanga, Avarana, AmathaUdabhavasthana – AmashayaSanchar - RasayaniAdhisthana - Whole body specifically udara, sphika, stanaVyaktasthana - Whole bodyUPADRAVA :According to Charaka, in the letter phase of pathogenesis due to ignorance andmismanagement of the disease, some new symptoms appear beside the symptoms ofmain disease which are known as a Updrava or complications of the disease145(Cha.Su.21/6). Acharya said that due to, chronic consistence of Sthaulyacomplications occurs like havoc due to the two complicating elements Agni and Vata.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 52                     
    • Disease review  Acharya Charaka has not mentioned another specific Upadravas, but other Acharyashave listed a few. These upadravas have been presented in the table.Upadrava :-Table No:-16Sr.no. Upadrava Su A.S A.H M.N B.P 1 Amaroga - - + - - 2 Apachi - - + - + 3 Arsha - + + - + 4 Atisara - - - - + 5 Bhagandara + + + + + 6 Jwara + + + + + 7 Vaatavikaara + - - + - 8 Kamala - - - - + 9 Kasa - - + - - 10 Kshudha - - + - + 11 Mutrakrichra - - + - - -12 Prameha - + + - + 13 Pramehapidaka + + - + - 14 Shleepada - - - - +SADHYASADHYATA :It is a Kricchasadhya Vyadhi. Acharya Charaka has explained te prognosis ofSthaulya is bad146 (Cha.Su21/8). If a sthaulya purush is not duely managed, he isprone to death.Hina Sthaulya with duration of 1 to 5 years, without any complicationsor secondary disease, can be considered as Sukhasadhya. Madhyama Sthaulya withduration of 5 to 10 years with least complications but without secondary diseases canbe considered as Kriccha Sadhya.Sahaja Sthaulya is Asadhya. Adhika Sthaulya with duration of more than 10 years, inwith complication and secondary diseases can be considered as Asadhya.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 53                     
    • Disease review  CHIKITSA147 :In Ayurveda, general principles of management of any disorder is 1. Samshodhana 2. Samshamana 3. Nidaana parivarjanaSamshodhana : Sthaulya can be by treated langhana measures which causeapatarpana & one among them is Samshodhana. The measures for Samshodhana;vamana, virechana, basti, raktamokshana have been explained. Even udvaratana, lepaetc. external measures also explained.The samshodhana measures act directly on the root cause of sthaulya and help to curethe disease. Samshamana : There are various references for the samshamana measures like useof shiilajatu, Triphala, guggulu prayoga, madhvaambu prayoga etc.Nidana parivarjana : Nidana is the main cause of any disease. Avoiding thesecauses will surely prevent the further prognosis of disease so nidana parivarjana isfirst line of management.Administration of Guru and Apatarpaka articles which possess additional Vataghna,Shleshmahar and Medohar properties is considered as an ideal for Samshaman 148therapy (Cha.Su.21/20-21). Chakrapani has explained that Guru Guna is sufficientto alleviate vitiated Agni and Atikshudha. Apatarpana property provides lessnourishment and thus leads to depletion of Meda.Gangadhara has explained that Guru guna is suitable to alleviate Tikshnagni andvitiated vata especially Kosthagata Vata which ultimately reduces Atikshudha andApatarpan property causes reduction of Meda .“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 54                     
    • Disease review  Pathya-apathya aahara:Table No:-17 Ahar varga Pathya ApathyaShuka dhanya Yava, venuyava, kodrava, Godhuma, navanna, shaliShami dhanya Mudga, rajamamsa, Masha, tila kulatha, chanaka, masura, adhakiShaka varga Vrintaka. Patrashaka, Madhuraphala patolaDravya Takra, madhu, ushnodaka, Dugdha, ikshu, navaneeta, tilataila, sarshapa taila, ghrita, dadhi. arishta, asava, jirnamadyaMamsa Rohita matsya Aanupa, audaka, gramyaPathya-apathya vihara :Table No:-18 Pathya Apathya Shrama Sheetal jala snaana Jagarana Divaswapna Vyavaaya Avyavaya Vyaayama Avyayama Nitya bhramana Swapna prasanga chintana Sukha shayya Shoka Nitya harsha Krodha Achintana, manaso nivrutti“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 55                     
    • Disease review  DISEASE REVIEW MODERN ASPECTOVERWEIGHT / OBESITY149, 150, 151 :-Introduction:Obesity is the metabolic disorder. Metabolism is a chemical processes in living beingswhich produces energy and growth. The changes which occur in the digested foodmaterial,from the time of ingestion till the elimination in the form of excretion, thesum of total chemical changes which occurs within the body is to be considered asmetabolism which yields energy and enriches growth. As obesity is deposition of fatin the body, it is justified to be under the heading of metabolic disorders.Defination:Excess deposition of adipose tissue in the body is known as obesity.Obesity exists when body weight is 20% above ideal body weight.Park defined obesity152 as an abnormal growth of adipose tissue due to anenlargement of fat cell or an increase in number of fat cell or a combination of both.EPIDEMIOLOGY (PREVALENCE OF OBESITY) :An escalating epidemiology of over weight and obesity is affecting many countries inthe world and if action is not taken to stem the pandemic, millions of people willdevelop non communicable diseases. Obesity is now well recognized as a diseasewhich is largely preventable through changes in life style especially, diet. Recentstudies have shown that over weight and obesity affect over half the adult populationin many countries. The prevalence of obesity in adults is 10 to 25% in most countriesof Western Europe and 20% in some countries in the Americans.Etymology of the word obesity:The word Obesity is derived from Latin term ― obesus which means: Ob → by reason ofEdo → I eatObesus → having eaten or having eaten until fat Obesity → grossly fat“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 56                     
    • Disease review  Synonyms of Obesity:Overweight, corpulence, adiposity, fattiness, turgidity, stoutness, enormity, plumpness,embonpoint.CLASSIFICATION OF OBESITY:Obesity is classified on the basis of onset, severity of the disease, histopathology andfat distribution etc.1. On the basis of onset Insidious Gradual Rapid2. On the basis of severity Mild Moderate Severe3. On the basis of clinical condition Enviable Regal Pitiable4. On the basis of BMI Overweight – 25 – 29.9 Kg/m2 Obesity (class-I) 30 – 34.9 Kg/m2 Obesity (class-II) 35 – 39.9 Kg/m2 Severe or morbid obesity (class-III) > 40kg/m25. On the basis of etiological factorsa. Physiological- Observed temporarily during puberty & pregnancy.b. Pathological - It can be further divided into three viz. Exogenous Endogenous Idiopathic“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 57                     
    • Disease review  Exogenous: It is caused by over eating and sedentary habits.Endogenous : Due to endocrine disorders Hypothalamic Cushing’s syndrome Hypothyroidism Polycystic ovarian syndrome Dercum’s disease HyperinsulinismIdiopathic : Obesity is labeled as idiopathic when every possible causes of weight gain has beeninvestigated and ruled out.6. On the basis of Fat distribution: a) Generalized: Generalized obesity is usual seen in exogenous obesity. b) Central or Trunk type: Involving only the trunk and neck, it is common in Cushing’s syndrome or hypothyroidism. c) Superior or Buffalo type: Involving the face, neck, arm and upper part of trunk and is common in Cushing’s syndrome or hypothyroidism. d) Inferior or lypodystrophy : Involving the lower part of the trunk and legs accompanied by wasting of upper half of the body. e) Girdle type or fatty apron: Involving the hips, buttocks and abdomen found in pituitary or hypothalamic lesions. f) Breeches or trochanteric type: Involving only the buttocks, found in hypogonadal syndrome. g) Lipomatous or multiple lipomatous : With localized deposits of fat over the body called Dercum’s disease or adiposis dolorosa when associated with tenderness and pain over the fatty lamps.7. On the basis of Histopathology: a. Hyperplastic obesity: Increase in adipocyte’s number, life long history and bad prognosis.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 58                     
    • Disease review   b. Hypertrophic obesity: Increase in adipocyte sites, history of adult onset and good prognosis.ETIOLOGY OF OBESITY:The causes of obesity are distributed in main three groups according to modernscience.Exogenous : Where the main cause are excessive appetite or overeating.Endogenous : Where endocrine factors are responsible.Miscellaneous: A number of factors responsible for development of obesity, whichare described under this heading.Causes of Obesity:|ExogenousEndogenousMiscellaneousOver eating,Dietary habits,Drinking habits,SmokingEndocrine factors AgeSexOccupationSocioeconomic factorsPsychogenic factorsEnvironmental factorsConstitutionDrugsCaloric imbalanceHeredityHypothalamic traumaSome Factors Which Are Responsible for Obesity:1. Diet Pattern And Physical Activity:“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 59                     
    • Disease review  The balance body weight chiefly depends on Caloric intake and energy expenditure.In our routine diet, proportion of fat is increased and fiber and carbohydrates isdecreased.Due to the advanced technology physical activity is also decreased. Fathas caloric value twice than that of carbohydrate and proteins. So high fat diet andredused physical activity increases the risk of Obesity and its complications.Conversation of dietary fat into stored fat (TG)Fat Digestion Tg Cholesterol Chylomicrons Pass through the Capillaries of adiposetissue and liver Phospholipida Diffuse into the fat Cell and Liver cell Fatty acidsGycerol Lipoprotein Lipase Stored in the from of Tg Excess Carbohydrate GlycogenTg Storage in Adipose tissue Protein Amino Acids Acetyl Co-A Tg StorageAdipoetissue From above description it can be well understood that how excess fat isstored in the form of Tg and increases the risk of Obesity.2. Childhood Over Nutrition:The rate of formation of new fat cells is rapid in the first few years of life. Therefore,when excessive fat is consumed by child it also increases the number of fat cells.Therefore it has been suggested that over nutrition of children especially in infancyand to lesser extent during the starting few years of childhood can lead to lifetimeobesity.3. Drugs:Some drugs when taken over a long period can result in unwanted weight gain. This isespecially true of some of the hormonal preparations taken by women. Such as theoral contraceptive pills and hormone replacement therapy, weight gain is a commonside effect of oral contraceptive pills. In a recent study, it has reported that womenhad noticeably lower level of cholecystokinin when they were using oralcontraceptive pills. Cholecystokinin is a hormone, which suppress the desire for food.If levels were low in the body this would naturally lead women to feel hunger andthey take more food than the requirement, which results overweight. The long-termuse of steroid in the treatment of Asthma can also lead to weight problems in somepatients.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 60                     
    • Disease review  4. Genetic factors:Genetic determinants can either play a major role in the pathogenesis of obesity orenhance susceptibility to its development. It has been recognized for a long time thatobesity is not a single disorder but rather, a heterogeneous group of disorders.It is possible for an individuals genetic makeup to directly cause obesity; disorderssuch as Prader-Willi syndrome and Bardet-Biedl syndrome are examples. However,most cases of morbid obesity are not based solely on such a genetic cause. The term"genetic factors" might be more easily understood as "heredity." It has been observedthat obesity often runs in families, with obesity being more common in some familiesthan others. This would suggest genetic causes of obesity. However, a given familywould also probably share a similar lifestyle and similar diet, which would contributeto the incidence (or absence) of obesity.There does appear to be at least an association between heredity and obesity. In awell-known study regarding this issue, adults who were adopted as children werefound to have body weights closer to those of their biological parents than theiradoptive parents, suggesting that their genetic makeup had more influence on theirbody weight (and the incidence of obesity) compared to the environment in theiradoptive familys home.In another frequently cited study, it was noted that identical twins, even when raisedapart from one another, had similar weights much more frequently than did fraternaltwins. In other words, the identical twins (who shared DNA and genes) showed muchmore similar weight patterns than their non-DNA-sharing counterparts.5. Endocrine Aspect of Obesity :Some times obesity is diagnosed as a consequence of hormonal imbalance. Thesepatients are grouped under endogenous obesity. So, obesity frequently accompanieshypothyrodism, hypogonadism, hypopituitarism and Cushing’s syndrome. But it isnot an essential feature of these conditions. Some diseases associated with obesityare-“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 61                     
    • Disease review  (a) Cushing’s syndrome :This can result from hyperplasia of the adrenal glands when they are stimulated byexcess ACTH from the pituitary. In this syndrome, fat is accumulated on the trunk, inthe supraclavicular fossa and over the dorsal posterior cervical region. The arms andlegs usually are spared.(b) Thyroid Disease :Obesity is often ascribed to ‘hypometabolism’ caused by underactivity of the thyroidgland, severe hypothyrodism can lead to some increased fat, but most of the excessweight is actually edema, which is lost with the institution of thyroid hormonereplacement.(c) Polycystic ovarian syndrome :Mild hirutism, irregular menses or amenorrhoea and obesity have been linked in the“polycystic ovarian syndrome”. The ovaries overproduce androgens. Althoughhirsutism is common, virilization is not. The relation of obesity to the polycysticovarian syndrome is not clear but the two conditions often coexist.Psychogenic obesityPsychological factors in the development of obesity are widely recognized, butattempts to define a specific personality type in association with obesity have beenunsuccessful.Psychological factors in obesity can have a big impact on the prevalence of obesity inour society. There are a number of factors that can come into play, including:-Depression-Low self-esteem and/or body image and-Eating disorders.By creating an understanding of these factors in obesity, we are hopeful that thosefighting them can also fight obesity. When considering these factors in obesity, let’sfirst consider how depression can lead to obesity. Many people who are depressedturn to food for comfort. They may have various associations with food that makethem feel better.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 62                     
    • Disease review  ASSESSMENT OF OBESITYObesity can be assessed by following tools : 1. Body Mass Index 2. Waist circumference 3. Waist / Hip ratio 4. Skinfold thicknessBody Mass Index :The B.M.I. is the actual body weight divided by the height squared (kg/m2). Thisindex provides a satisfactory measure of obesity in people who are not hypertrophiedathletes. The classification of obesity as per B.M.I..Under weight - <18.5 kg/m2Normal weight - 18.5 - 24.9 kg/m2Over weight - 25 - 29.9 kg/m2Obesity (Class-I) - 30 - 34.9 kg/m2Obesity (Class-II) - 35 - 39.9 kg/m2Morbid Obesity (Class-III) - > 40 kg/m2Waist circumference :Waist circumference mesutement becomes helpful to assess the risks associated withobesity. Men who have waist circumference greater than 35 inches (88 cms) are athigher risk of D.M., hypertension and cardiovascular disease because of excessabdominal and visceral fat.Waist / Hip ratio :From studies it is evident that men and women, who have a high ratio of waist / Hipcircumference have increased risk of death, blood pressure and serum lipid levels.Average value is as follow :WHR in men is about 0.93 with a range of 0.75 to 1.10In women is about 0.83 with a range of 0.70 to 1.00Waist circumference is the minimum circumference between the costal margin andiliac crest, measured in the horizontal plane, with the subject standing. Hipcircumference is the maximum circumference in the horizontal plane, measured over“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 63                     
    • Disease review  the buttocks. The ratio of the former to the latter provides an index of the proportionof intraabdominal fat.Skinfold Thickness :The thickness of the adipose tissiue which is lying in subcutaneous layer is measuredby skinfold thickness.The four most commonly site used for skinfold measurementare Biceps, Triceps, subscapular and suprailiac. The method is inexpensive, butrequires a skilled observer and is not applicable to very obese people whose skinfoldswould not fit between the jaws of the measuring caliper. This is not a reliable methodfor estimating intra-abdominal fat.Clinical features of obesityThe clinical manifestation of obesity as described in various text books of ModernMedicine are as under . Obesity can be diagnosed from gain in weight Protuberant abdomen is a more common clinical feature of an obese person. Development skinfold around the axilla below the breast, peritoneal region. Dyspnoea on exertion and general lassitude. Varicose veins and oedema of the ankles are most troublesome features of obese person. Fatty liver may be palpable in few cases. In obese person possibility of fungal infection is greater in the skinfold areas. In fatty women menstrual disturbance and sterility is also observed.Pathogenesis of obesity :Obese persons having an increase in number and/or size of adipose cells suggesthypertrophy and/or hyperplasia of adipocytes either due to functional demand inparticular age or sex or due to genetic, endocrine, behavioural, psychological oriatrogenic factors. After reduction in weight the adipose cells shrink in size buthyperplasia remains fixed.Adult onset obesity is characterized predominantly by adipose cell hypertrophywith minimum hyperplasia.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 64                     
    • Disease review  There are three main factors in the pathogenesis of obesity : 1. Excessive lipid deposition 2. Diminished lipid mobilization and 3. Diminished lipid utilization. • Excessive lipid deposition is due to either increased food intake, hypothalamic lesions. Adipose cell hyperplasia or hyperlipogenesis. Increased food intake in form of carbohydrates, proteins and fats by metabolic process lastly converts in fat and get stored at fat depots. • Diminished lipid mobilization is due to either decrease lypolytic hormones or defective cells or abnormality of autonomous innervation. Thyroxin and adrenaline stimulate mobilization of unsaturated fatty acids from adipose tissue, abnormality of these two causes diminished lipid mobilization and excessive lipid deposition ultimately leads to obesity. • Diminished lipid utilization is due to either ageing, defective lipid oxidation, defective theromogenesis or inactivity. It is the main pathology in middle age obesity. With advancing age, newer scientific methods and continuous research works regarding the subject obesity, day by day multiple factors and hypothesis have been formulated concerning the pathogenesis of obesity.Obesity associated health issue:-1. Obesity and Diabetes Mellitus :The growing prevalence of NIDDM in the United States is undoubtedly associatedwith the increasing prevalence of obesity. Approximately 70 to 80% of patients withNIDDM are over weight.The risk for the development of NIDDM also increases with a greater waist / hip ratio.Clinically manifest diabetes develops only with the appropriate genetic legacy, butobesity, by enhancing insulin resistance, increases the demand on the pancreatic isletsand tends to unmask and exacerbate an underlying genetic propensity.2. Obesity and Hypertension :The prevalence of hypertension is approximately three times higher for the obese thanfor the nonobese. In the Framingham study, high blood pressure developed 10 timesmore often in persons who were 20% or more overweight than in those of normal“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 65                     
    • Disease review  weight. The mechanism by which obesity contributes to high blood pressure is notclear. Hyperinsulinemia leading to increased tabular reabsorption of sodium may be afactor increased sympathetic tone may be another. Whatever the mechanism, weightloss from dieting leads to a fall in arterial pressure even when salt intake is notrestricted.3. Obesity and Cancer :Obese men have a higher mortality rate due to collateral & prostrate cancer.Menoposal women with excess adiposity have an increased risk of developing Breastcancer. Morbid obese women have significantly higher mortality rates from cancer ofBreast, Cervix, Endomatrium uterus unspecified & ovary.4. Obesity and Gall blander Diseas :Obese women of age 20-30 years are more prone to develop Gall Blodder disease(GED), compared to normal weight women. By at the age 60, nearly 1/3 of obesewomen can be expected to have prosper GED. For each kg of fat approx 20 mg/dl ofCholesterol is synthesized. In obese person, the bile is therefore more saturated withcholesterol.5. Obesity and Arthritis :The exact cause is obscure but an excess weight gain, causes trauma to weight bearingjoints and in middle aged women, excess body weight is a major predictor ofosteoarthritis of the knee. Thus it is a mechanical problem. Weight reduction willdecrease the chance of prospering osteoarthritis.6. Obesity and Artherosclerosis :Obesity is a risk factor for the development coronary artery disease and stroke. Mostof the risk is mediated through the associated hyper tension, hyper lipoproteinemiaand diabetes.7. Obesity and Respiratory Disease :Sleep apnoea occur in severely obese patients and possess a potentially seriousproblem. Obstructive sleep apnoes is belived to occur because of local fat“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 66                     
    • Disease review  accumulation in the tracheopharyngeal area. The obstructive epidodes of sleep apneaproduce interrupted sleep associated with hypoxia and hypercapnia.8. Obesity and Endocrine Abnormalities :Obese women commonly shows irregularity in menstrual cycles as well as greaterfrequency of other menstrual abnormalities then normal weight women. In obesegirls, the onset of menarchy occurs at a younger age then in normal weight girls.9. Obesity and Lipid Levels:In obese individual the triglyceride and serum cholesterol are at higher level on bothsides. Unquestionably, the thicker the fat fold, or the broader the fat shadow, thehigher the triglyceride levels.BASIC CONCEPT OF FAT / LIPID :Origin of the body fat is from fats, carbohydrates and proteins in the food. Thecarbohydrates and proteins consumed in excess are converted into fats through thecitric acid cycle. Hence study of metabolism of carbohydrate, protein and lipid areessential in this regard.CarbohydratesCarbohydrate metabolism takes place under three headings- Supply, Storage & utility.Supply is regulated through the diet temporary storage in liver and utility by the cell& tissue & muscles. Glucose absorption takes place mainly into the capillaries of thesmall intestine, which then take the contains into the portal circulation to the liver.The liver cells take the glucose from the blood and convert into the glycogen whichstored in the liver cells. The sugar stored in the liver as a glycogen is converted as aglucose whenever needed it is released into the blood stream which will be taken upby the muscles and the other tissues. The maximum storage of the glycogen in thebody is about 400 gms.ProtienProteins are hydrolised into the amino acids after digestion and absorbed by the villiand through the portal circulation enter the liver. The tissues select some of these“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 67                     
    • Disease review  substances and in each organ either synthesized into new tissues or used to maintainand repair tissues. Amino acids not used in synthesis are broken down or diminishedin the liver. In demisation, the amino groups are removed from amino acidsmolecules. The non-nitrogenous portion of the amino acid molecules is oxidized toliberate energy or is synthesised in to glycogen or fat. Therefore this portion of theamino acid molecule may be regarded as a source of energy.LipidsLipids may be defined as compounds, which are relatively insoluble in water, butfreely soluble in organic solvents like benzene, ether, chloroform, etc. Lipidsconstituted a heterogeneous group of compounds of biochemical importance. Theyare found in the membranes, which maintain the integrity of cells & allows thecompartmentalization of cytoplasm in to specific organelles. Lipids function as amajor form of stored nutrients (TGs), as a precursor for adrenal & gonadal steroids &bile acids (cholesterol) & as an extra cellular & intra cellular messenger(prostaglandins). Lipoproteins provide a vehicle for transporting the complex lipids inthe blood as water – soluble complexes & deliver lipids to cells through out the body.Classification of LipidsLipids are classified into simple lipids, compound lipids, derived lipids &miscellaneous one.Simple Lipids : Esters of fatty acids with various alcoholsNeutral fatsWaxesCompound LipidsEsters of fatty acids containing groups other than & in addition to an alcohol & fattyacids. i) Phospolipids ii) Glycolipids iii) Sulpholipids iv) Aminolipids v) Lipoproteins“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 68                     
    • Disease review  Derived LipidsDerived lipids obtained by hydrolysis of those given in those group A & B which stillpossesses the general characteristics of lipids.Fatty acidsMonoglyceriodsAlcoholsMiscellaneousAliphatic hydrocarbons including iso-octa-decomeCarotenoidsSqualenceVit. E & K.Fatty AcidsFatty acids may be defined as an organic acid that occurs in a neutral TG & aremonocarboxylic acid ranging in chain length from 6-24 carbon atoms. In human bodyfree fatty acids are formed only during metabolism due to hydrolysis of fat.Fatty acidsvi) Depending upon no. Of Carbon atoms A. Even Chain i.e., having 2-4-6 carbon atoms B. Odd chain i.e., having 3-5-7 carbon atomsvii) Depending length A. Short chain 2-6 carbon atoms B. Medium chain 8-14 C. Long chain 16 & above (24)viii) Nature of hydrocarbon chain A. Saturated fatty acids B. Unsaturated fatty acids i) Mono unsaturated ii) Polyunsaturated C. Branched chain FA D. Hydroxy FA E. Cyclin FA“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 69                     
    • Disease review  The lipids in the body physiologically exist in two forms – a) Element constant or structural lipids. b) Element variable – stored lipids.Elements constant is a part of the essential structure of the cells. The organelles arecomposed of macromolecules of lipids & protein, the lipid is mainly phospholipid.The amount in the body between 0.5 to 1 kg & is independent of the state of nutrition.Cholesterol is another lipid present in cell membranes; it has also an important role inthe blood.Element variable lipid, which is stored in the body, is in excess. The amountfluctuates & it is composed mainly of TG also called as neutral fats. Thus fat ischiefly composed of glyceriods of various fatty acids & usually contains 75 % of oleicacid, 20 % palmitic acid 5 % stearic acid. Traces of lacithic & cholesterol as well aslittle amount of PUFA are also present. The deposition of fat takes place adiposetissue. “A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 70                     
    • Drug review    Chart No:- 02 Drug Review                                                                                      I II III IV V Koshtha Pachana Swedana Virechana   Snehana pariksha Dipana     Triphala   Shunthi Murchita Murchita Pippali, nagar, Kwatha Kwatha Ghrita Tila Taila kshara, shyama trivrutta, madhu Drug used for koshtha pariksha:- Table No:- 19 Drug Rasa Guna Veerya Vipaka KarmaHaritaki LavanaVarjitha Laghu Ushna Madhura Tridoshahara,(Terminalia Pancharasa.Kashay Ruksha SrotoshodanaChebula) a Rasa PradhanaAmlaki Lavana Varjitha Guru, Sheeta Madhura Tridoshahara(Emblica Pancharasa,Amla Rukshaofficinalis) Rasa Pradhana SheetaVibhitaki Kashaya Laghu Ushna Madhura Tridoshahara, Kapha(Terminalia Ruksha Vikara & Medo VikaraBellirica)   I. Drug used for Paachana Dipana:- Shunthi kwatha:- Table No:-20 Dravya Rasa Guṇa Vīrya Vipāka Karma Kaphavata Shunthi Guru shamaka (Zingeber Katu Ushna Madhura Ruksha Dipana, Pacana Officinalis) truptighna “A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to   overweight.”    Page 71                     
    • Drug review    III. Drug used for Snehapaana: Murchita Ghrita:- Ama is such a thing that can be seen in sharira as well as Dravya, so drug should be free from Ama. Ghrita murchana is a process through which present Ama can be removed. The esters present in the raw ghee hinders the Absorption as well as it won’t allow other active principles to mingle with the lipid molecule. Murchana process removes these unwanted esters. Table No:-21drug used for Snehapana Drug Rasa Guna Veerya Vipaka KarmaGhrita Madhura SnigdhaSheeta Sheeta Madhura Vata pittaharaTri phala - - - - -Haridra Tikta Ruksha Laghu Ushna Katu Kaphavata shamakaCurcumalonga KatuMatulunga Amla Laghu Ushna Amla Kapha vata hara,Citrus medica Snigdha Dipana hrudya Ruchya Tikshna IV. Drug used for Swedana: Murchita tila taila abhyanga followed by bashpa sweda with Balamula kwatha was administered. Table No:-22 Drug Rasa Guna Veerya Vipaka Karma Bala Madhura Snigdha ,Sita. Ushna Madhura Kapha Vata Hara (Sida acuta) Manda. ,Vata vyadhi V. Drug used for Virechana: Table No:-23 Drug Rasa Guna Veerya Vipaka Karma Pippali Katu Laghu, Ushna Katu Vatakapha Shamaka (Pipper uRuksha Deepana longum) Nagar Katu Guru Ushna Madhura KaphavataShamaka “A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to   overweight.”    Page 72                     
    • Drug review   (Zingeber Ruksha eDeepana, pachana,Officinalis) triptighnaKshara katu Laghu, Ushna Katu Kaphavatashamaka,(potassium Snigdha Deepana, pachana,carbonate) AmadoshaharaShyama Kashaya, Ruksha Ushana Katu Kapha-Pitta shamakatrivrutta Mahura VirechanaMadhu Madhur, Guru, Ruksha Sheeta Katu Lekhana, Deepana, Kashaya Tridoshashamaka, Medohara, Hrudya PIPPALI 153:- Common Name: Long pepper(Eng.)- Here pepper stands for spirit or the energy Sanskrit Names: Pippali Magadhi- A plant that generally grows in Magadha constituancy(Region covering the area of Bihar and West Bangal in India) Vaidehi- Means this plant grows successfully in Videha region (Southern Nepal) Krishna- As it is normally with Krishna (black) color Kana- As its fruits are embedded in the surface of a flower spike in the form of minute projections Chapala- Means it is very sharp in character Teekshna tandula Ushna- As it is having Ushna / Katu(Pungent taste) Some special notes about Pippali : • Pippali is the best medication among the plants those are appetizer, digestive stimulant, and anti flatulant. • Pippali powder should be taken with honey to get rid of unwanted fat and maintain normal body weight. • In chronic fever pippali powder should be taken with jaggery. • Taking Pippali powder with castor oil and cow urine is very effective in management of neurralgic conditions specially the Sciatica. “A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to   overweight.”    Page 73                     
    • Drug review  NAGAR 154:-Name: GingerBiological Name: Zingiber officinaleOther Names:Ginger; Ardrakam; Shunthi; Adrak; Sunth; black ginger; race ginger; African ginger;sheng jiang;Active Compounds:The dried rhizome of ginger contains approximately 1-4% volatile oils. These are themedically active constituents of ginger; they are also responsible for gingerscharacteristic odor and taste. The aromatic principles include zingiberene andbisabolene, while the pungent principles are known as gingerols and shogaols.Volatile Oil:Components can vary greatly, depending on the country of origin. The maincomponents of the volatile oil are:( -)-zingiberene and arcurcumeneBeta-bisabolene and arcurcumeneneral and geranialD-camphorbeta-phellandrenegeranialneral and linalool(E)-alpha-farnesene, important as aroma carrier zingiberol (mixture of cis- and trans-beta-eudesmol)Arylalkane - Pungent SubstancesGingerols: chief components [6]-gingerol, [8]-gingerol, [10]- gingerolShogaols:chief components [6]-shogaol, [8]- shogaol, [10]- shogaolGingerdiols Diarylheptanoids: including, among others, gingerenone A and BAction: Aromatic, carminative, stimulant to the gastro- intestinal tract, diaphoretic,expectorant, antiemetic, and stomachic, also sialagogue and digestive; Externally, alocal stimulant and rubefacient.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 74                     
    • Drug review  Ginger is used for:Atherosclerosis, heart diseaseChemotherapy supportMigraine headachesMorning sicknessMotion sicknessNausea and vomiting following surgeryRheumatoid arthritisBelchingLaryngitisVomitingConstipationDigestive System Actions:Ginger is a classic tonic for the digestive tract. Classified as an aromatic bitter, itstimulates digestion. It also keeps the intestinal muscles toned. This action eases thetransport of substances through the digestive tract, lessening irritation to theintestinal walls. Ginger may protect the stomach from the damaging effect of alcoholand non steroidal anti-inflammatory drugs (such as ibuprofen) and may help preventulcers.Action and Uses in Ayurveda and SiddhaGinger is an important herb used in Ayurveda. Ayurveda takes advantage of thefollowing medicinal properties for ginger:Analgesic, anti-emetic, aromatic, aphrodisiac, carminative, diaphorelic, digestive,expectorant, nervine, sialagogue, stimulant.Ayurvedic practitioners consider ginger to be a truly a wonder drug, having so manyhealing properties. It was called the universal medicine. Taken with rock salt itreduces vayu; with rock candy it reduces Pitta; with honey it reduces Kapha. Thus itcan be used to influence all tridoshas.Ginger is used in the following ayurvedic remedies: katu rasam, ushna veeryam, vata-kapha-haram, katu- vipaka, lagu, snigdam, pachanam, ruchyam, vrishyam, swaryam,vibhanda haram, in grahani agnimanthyam. amavatham, chardhi, swasam, soolam,“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 75                     
    • Drug review  arsas, anaham, hrith-rogam, udhara rogam. It is used externally in kapha, swellings,headache.KSHARA (YAVAKSHARA)155:Sanskrit Name : YavaksharaLatin name : Potassium CarbonateArabic Name : NatroonEnglish Name : Pearl AshFrench Name : Carbonate de potassiumGerman Name : KaliumkarbonatHindi Name : Jawakhar, KharUrdu Name : JawakharDescription: It is alterative, antacid, diuretic, laxative, resolvent and stomachic.Useful in urinary diseases, uric acid diathesis leading to gout and rheumatism, uterineirritability, piles, colic, cardialgia and dyspepsia. It is also useful in oedema.Contraindication: This mineral is contraindicated in hyperkalaemia, acute andchronic renal failure, impaired renal function disorder and transitory neonatalhyperkalaemia.Chemical composition167:Potassium chloride – 50.8%Potassium sulphate – 20.2%Potassium bicarbonate – 12.6%Potassium carbonate – 6.8%“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 76                     
    • Drug review  TRIVRUUTA156:-It is a sukha virechaka drug among all Virechana drugs160. (Cha.Su.25/40) Trivut root is Considered as Shreshta161 (Cha.Si.7/3)Botanical classification156Kingdom PlantaeDivision MagnoliophytaClass MagnoliopsidaOrder solamaceaeFamily convolvulacaceaeGenus OperculinaSpecies TurpethumSynonyms:-English name- turpethHindi name – nishothSanskrit name – trivrittGujarati name – nasotarThe root bark contains glycosidium resin which is 10 %. It also contains a glycosidenamed turoethin that provides it the purgative action. Besides these it contains twoglycosides, volatile oils and yellow coloured substance.It is vata and pitta moderator. It helps in improving the peristaltic movements in thebody ther fore are used as laxative. It is anti-inflammatory in action because of its hotpotency. It also helps in managing the normal body temperature.Toxicology:-It is a strong purgative so it is to be given in proper dosage other wise it may causeextremes harms to the body.Plant part used:- Bark of the rootIndication:-Constipation, Piles, Jaundice, Abdominal disorders, Gout, Rheumatoid arthritis,Cough, Asthma, Inflammation, Fever, Obesity.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 77                     
    • Drug review  History157:-Ipomoea Turpethum (operculina Turpethum (L.) Peter) (Fam. Convolvulaceae) is aconvolvulaceous plant which is found throughout India, China, Ceylon, Australia, andis occasionally cultivated in botanical gardens as an ornamental plant.Ipomoea means worm-like, referring to the peculiar, twisted nature of the root system.Jalap is a centuries-old purgative and vermifuge used by the Mexicans, who thentaught the Spanish colonizers how to use the herb. It was introduced into Europe in1565 and used for all types of illnesses until the 19th century. Because it is considereda good remedy for kidney problems, the plant is also widely-known as riñona from theSpanish word for kidneys, riñones.The Spanish name of Michoacán was given because that was the place where it wasfirst found in the "New World" by Spanish invaders. Also known as Jalapa, the plantwas named for the city in the state of Vera Cruz. In the 16th century book, Joyfulle Newes Out of the Newe Founde Worlde, thephysician-author, tells of a friar who fell gravely ill shortly after the conquest of theAztecs. The local Aztec lord, who had befriended the friar, brought his personalphysician to see the friar who, thinking he had nothing left to lose, decided to try theAztec doctors remedy. The friar purged so much that he started to get better, and thegood news passed up the grapevine to counterparts in Spain. This "miracle cure" wassoon embraced, and the root was renamed Rhubarb of the India, replacing the Rhubarbof Barbary as the favoured purging agent of the day. The root eventually became sopopular that it was exported to Europe in great quantities and sold at such premiumprices that fortunes were made in the purging business.The root was also used as an emergency food by the Pawnee, Cheyenne, Arapaho, andKiowa.US Pharmaccopoeia from 1820 to 1864 as a catharti165.Chemical composition: The chief constituent is about 10 per cent. of a grey resin, insoluble in ether, called turpethin, which resembles jalapin (convolvulin)158. The active principle of the leaves is a cardiotonic substance named oleandrin. It has anti-inflammatory and stimulant properties.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 78                     
    • Drug review   The roots bark and seeds contain cardio-active glycosides, formerly designated as neriodorin, neriodorein and karabin, which are anti-inflammatory and stimulant, good pain relievers159.The root bark contains glycosidium resin which is 10%. It also contains a glycosidenamed turoethin that provides it the purgative action160.Discription about root163:-According to Merat and De Lens, the root itself formerly came into commerce, but atpresent turpeth consists of the root and stem of the plant cut into short lengths, usuallyfrom 1.5 to 5 cm. in diameter; the central woody portion is often removed by splittingthe bark on one side. The pieces are cylindrical, somewhat twisted and externally of adull gray color. A transverse section shows a porous central wood surrounded by abroad cortical portion, containing yellowish-brown resin cells, lactiferous vessels andcrystals of calcium oxalate. The fracture is short in the cortex and fibrous in the centralportion. The drug has a faint odor and a nauseous taste, which is perceptible only afterit has been some time in the mouth. "In cylindrical pieces of varying length, from oneto five centimetres wide, often split on one side and deprived of the central portion;longitudinally furrowed; dull grey or brown. Fracture of the bark short, of the woodfibrous; internally usually pale grey. In transverse section, a porous wood surroundedby a thick bark in which abnormal wood-bundles are frequently present. Slight odor;taste nauseous, slowly developed." Boutron-Chalard found in turpeth root, resin, a fatty substance, volatile oil, albumen, starch, a yellow coloring matter, lignin, salts, and ferric oxide. (J. P. C., viii, 121.) The root contains 10 per cent. of resin. (Andouard, Ann. Ther., 1866, 118.) According to Spirgatis this resin is a glucoside, turpethin, C76H128O36 like that of other Convolvulaceae, insoluble in ether, but soluble in alcohol, to which it imparts a brown color not removable by animal charcoal.The roots are long, branchy, somewhat fleshy, and when fresh contain a milky juicewhich quickly hardens into a resinous substance, altogether soluble in spirits of wine.The milk has a taste at first sweetish, afterwards slightly acid; the dried root hasscarcely any perceptible taste or smell. It abounds in woody fibers, which, however,separate from the more resinous substance in pounding, and ought to be removed“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 79                     
    • Drug review  before the triturating is completed. It is, in fact, in the bark of the root that all thepurgative matter exists. The older the plant the more woody is the bark of the root; andif attention be not paid in triturating to the removal of the woody fibers, the quality ofthe powder obtained must vary in strength accordingly. It is probably from thiscircumstance that its character for uncertainty of operation has arisen, which hasoccasioned its disuse in Europe164.Resin163:-To obtain it pure, the alcoholic solution is concentrated; the resin precipitated by, and"afterwards boiled with, water, then dried, reduced to powder, digested with ether, andfinally redissolved by absolute alcohol and thrown down by ether. After being treatedseveral times in this way, it is obtained in the state of a brownish resin, yielding onpulverization a gray powder.It strongly irritates the mucous membrane of the nostrils and mouth, and is fusible at182.2° C. (360° F.).It is inflammable, burning with a smoky flame and emitting irritant vapours.With strong bases it acts like jalapin, takes up water, and is transformed into a solubleacid, turpethic acid, C34H60O18, while with dilute acids it is decomposed intoturpetholic acid, C16H32O4, and glucose. Uses164:- The resin is a powerful purgative and used to facilitate bowel evacuation in the most dramatic cases of constipation. It is so strong that it must be combined with such other herbs as ginger, licorice, or some other digestive stimulant. It is occasionally used for constipation, colic and pain in the intestinal region, dysentery, colitis, and rheumatism. Homeopathic remedies are used for night restlessness in children and in cases of diarrhoea. Another Ipomoea species, I. turpethum, is native to Asia and Australia and is also a drastic purgative. Other related species have interesting uses. A paste of the root is used as an external application in haemorrhoids, chancres and ulcerations.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 80                     
    • Drug review   Oil extracted from the root bark is used in skin diseases of a scaly nature. The fresh juice of leaves is dropped into the eyes for inducing lachrymation in ophthalmic disease. HONEY165:-Composition Food value : per 100 gm Calories - 294 Water-20gm Protein -0.3 gm Ash -0.2gm Total carbohydrate-79.5gm Calcium- 5mg Phosphorus-16mg Iron -0.9 mg Sodium- 7mg Potassium-10mg Vitamin-B1—Traces Vitamin-B2-0.04mg Nicotinic acid-0.2 mg Vitamin –C- 4mg PROPERTIES:Honey is essentially a highly concentrated water solution of two sugars, dextrose andlevulose, with small amounts of at least 22 other more complex sugars. Many othersubstances also occur in honey, but the sugars are by far the major components. Themost important physical characteristics and behavior of honey are due to its sugars,but the minor constituents - such as flavoring materials, pigments, acids, and minerals- are largely responsible for the differences among individual honey types.HONEY, a most assimilable carbohydrate compound, is a singularly acceptable,practical and most effective aliment to generate heat, create and replace energy, andfurthermore, to form certain tissues. Honey, besides, supplies the organism withsubstances for the formation of enzymes and other biological ferments to promoteoxidation. It has distinct germicidal properties and in this respect greatly differs from“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 81                     
    • Drug review  milk which is an exceptionally good breeding-ground for bacteria. Honey is a mostvaluable food, which today is not sufficiently appreciated. Its frequent if not daily useis vitally important.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 82                     
    • Methodology  SUBJECTS:Twenty patients diagnosed as Sthaulya and fit for Virechana were taken for the studyfrom the OPD and IPD of S.D.M. Ayurveda Hospital, Udupi.METHODS:Objectives of the study:To evaluate the efficacy of Virechana Karma in Sthaulya wsr to Overweight.Method of collection of data:This is a single blind clinical study to evaluate the effect of Virechana karma inSthaulya w.s.r to Overweight.Subjects of either sex are based on the inclusion criteria were selected. & a detailProforma was prepared based on the Ayurvedic books, allied sciences & the patientswere evaluated accordingly.Inclusion criteria-Subjects who are fit for Virechana karma.Patients diagnosed as sthaulya.Age: 16 – 60yr.BMI (kg/m2)>=25-29.9Exclusion criteria-Subjects who were not fit for Virechana karma.Subjects with other primary systemic diseases.Study design:This is a single blind clinical study with pre-test & post- test design where in 20patients diagnosed as sthaulya of either sex are selected. All the patients falling in theinclusion criteria are subjected to Virechana karma.Total duration of study:Total duration of study: 13 – 25 days.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 83                     
    • Methodology  POORVAKARMADipana-pachana: Dipana - Pacana cikitsa was carried out with Shunṭhi kwatha for a period of 3-7 days. After attaining, the Nirama lakshaṇa.Snehana: The Murchit Gritha was given to all the 25 patients. The initial dose was 25ml (Hrisiyasi matra) with Luke warm water in early morning, after the digestion of the last night meal. During this period the patients were advised to consume little quantity of hot water in between and to follow all the restriction of Snehapaana in terms of diet (Time of food intake, Nature of food) , Sleep (Avoid Divasvapna & Rathrijagaran) etc. Then patient was continuously observed for appearance of Sneha Jeeryaman, Sneha Jeerna features. Based on the time of Snehajeerna lakshana the dose of Sneha for next day was decided. Thus Arohankarma Snehapaana was administered still samyak snigdha lakshana arises in all the patients.Swedana: Once samyak snigdha lakshana appears then, from next day Sarvanga Abhangya with Murchit Taila followed by Bashpa Sweda was performed. Thus Bhaya Snehan and Swedan was performed for 4 days and during this period patient advised to avoid consumption of Kaphakar Ahara and Vihara.     PRADHANA KARMA: On 4th day depending upon the rogi & roga bala Virechana Yoga of Pippali, Nagar, Kshara,(each 4gm) Shyama Trivritta (10gm) & Madhu(Q.S) combination dose was decided. After the Bashpa procedure, ascertain the patient proper digestion of previous night consumed meal. Then above mentioned Virechana yoga with sufficient quantity of Madhu was administered to patient on empty stomach in the morning hours at 9.30 AM. Before & after virechana karma, vitals like Temperature, Pulse, Respiratory rate, B.P were recorded & careful monitor of the patients during virechana process was done.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 84                     
    • Methodology   Then Patient was advised to follow all the restrictions and regulations on the day of Virechana karma. Finally Shuddhi lakshana in terms of Laingiki, Vaigiki, Antiki, and Maniki were assessed.PASCHATA KARMA: The Virechana was executed successfully in all the patients for deciding the Shuddhi, Laingiki, Vaigiki and Antiki parameters were considered. After the successful completion of Virechana, the patients were asked to follow all the precautions related to Virechana. Then Samsarjana Karma was decided on the basis of Shuddhi lakshana and it was started from the same day evening still for 3/5/7 days.Assessment criteria:Sign and Symptoms of Samyak and Asamyak Virechana.Patients will be evaluated for severity of illness during and after the intervention.Subjective: Lakshanas of sthaulya.Laingiki featuresAll the Lainiki features were identified as immediate and remote features on the basisof their time of appearance during and after the Virechana karma. Table No : 24 Sl. Immediate features Remote features 1 Kale vega pravartanam Samyaka shuddhi 2 Daurbalya Indriya prasada 3 Kshuta Agnivrudhi 4 Vatanulomana Anamayatva 5 Vit,Pitta, kapha, vata Srotoshuddhi kramashanissaranaAntaki featureAntaki feature was identified at the end of Virechana karma based on the colour,consistence etc. parameters of Stool and finally depending on observation it wasdocumented as Pittant / Kaphant/ Aoushadhanta/ Malanta.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 85                     
    • Methodology  Objective: Maniki features & vegiki features of Virechana karma. BMI (Kg/m2) Anthropometrics features (Measuring skin fold thickness by using slide calipers.) Triceps, Biceps, Intra scapular, Sub Scapular, Abdomen & Thigh. Measurements will be taken before treatment, after treatment and during follow up i.e. after one month of samsarjana karma. .Signs of Samyak and Asamyak Virechana Laxanas i.e.vaigaki and Maanaki. 1. Vaigaki feature It is nothing but total number of motion passed by patient after administration of Virechana medicine still the cessation of Vega. In the all cases first one Vega was negotiated and from second Vega the actual counting of Vega done still the end of (stoppage) of Vega. Thus finally total number of Vega was documented as Vaigiki feature of present study.2. Maanaki feature In present study during the each time of motion the stool and urine was collected and then it was measured and documented separately. Thus it was performed after each Vega. Then finally the value of total quantity of stool and urine added to obtain total amount of output. Apart from this total amount of water consumed by patient after passing each Vega was documented and it was consider as total amount of input. Afterwards difference between total amount of output and input was calculated and documented as Manaki feature in terms of millilitresPrevious works done:1. Bhat.S.K – Assessment of efficacy of lekhana basti and Navaka Guggulu in cases of obesity (sthaulya). Govt. Akhandanand Ayurvedic college, Ahmedabad, GAU Jamnagar, 1991.2. Kaushik M.K- Concept of Langhana Upakrama & its effect on Sthoulya I.P.G.T. & R. Gujrat Ayurveda University, Jamnagar, 1992.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 86                     
    • Methodology  3. Vora Bindu V– Lekhana Basti evam varunadi Ghana vati ka sthaulya roga mein tulanatmaka adhyayana, . Govt. Akhandanand Ayurvedic college, Ahmedabad, GAU Jamnagar, 1996.4. Nayak Anand Prasad – Comparative study of lekhana therapies in the management of sthaulya (Obesity), Govt. Akhandand and Ayurvedic college, Ahmedabad GAU, Jamnagar, 2003.5. Sajjan Shetty M.R.-A study on Medovaha Srotos wsr to Sthaulya & its management with Musta churna & Udvartana. Dr.B.N.M. Rural Ayurved medical College, Bijapur. R.G.U.H.S. Bangalore, 2004.6. Khunt Tejal – Comparative study on virechana karma and lekhana basti in the management of sthaulya. I.P.G.T. and R. GAU, Jamnagar, 2005.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 87                     
    •                             Observation   OBSERVATIONThe following observations were made during this study. Observations were madebefore the start of the treatment, immediately after completion of the treatment and 30days after the Samsarjana krama. In the present study, 20 patients fulfilling theinclusion criteria of Sthaulya were studied.INCIDENCE OBSERVATION: AGE: Table No:25 Graph No:- 01Age (in years) No of patients % 16-30 6 30% 31-45 6 30% 41-60 8 40%In this study it was found that the incidence was highest in the age group of 51-60years constituting 52% of total number of patients. 12% patients were in the agegroup of 20-30 and 31-40 years each. The incidences of other age groups are shown inthe table above.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 88                      
    •                             Observation  SEX:Table No:- 26 Graph No:- 02Sex No of patients % Male 10 50%Female 10 50% In the sample taken for the study, 50% patients were females in comparison to 50%of male patients.RELIGION:Table No:- 27 Graph No:- 03 Religion No of % patients Hindu 16 80% Muslim 1 05% Christian 3 15%“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 89                      
    •                             Observation  In this study incidence of hindus were 80% followed by Christian were 15% andmuslim were 5%.EDUCATIONAL STATUS Table No:- 28 Graph No:- 04  Education Number % of Patients High 05 25 Graduates 12 60 Post graduate 03 15     The study shows that majority of pts have taken education upto graduates60%followed by highschool were 25% & Post graduate were 15%.MARITAL STATUSTable No:- 29 Graph No:- 05 Marital Numbe % Status r of Patient s Married 16 80Unmarried 04 2016 patients belonged to married group and 3 patients belonged to Unmarried group.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 90                      
    •                             Observation  SOCIOECONOMIC STATUSTable No:- 30 Graph No:- 06 Socioeconomic Number % Status of Patients Lower middle 03 15 Middle 11 55 Upper middle 06 30Most of the patients were from middle class 55% followed by 30%,patients belongingto upper middle class and 15% patient belonged to lower middle class.OCCUPATIONTable No:- 31 Graph No:- 07OCCUPATION NUMBER % OF PATIEN TS Student 04 20 House wife 07 35 Business 06 30“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 91                      
    •                             Observation   Service 03 1507 patients were house wife (35%), 6 were from business class(30%), 03 fromservice (15%) and 04 were students (20%).DESHATable No:- 32 Graph No:- 08 Desha Number of % Patients Anupa 17 85Sadharana 03 15 In the present study that 85 % patients hailed from Anupa desha and 15 % fromsadharana desha.Nature of work:Table No:- 33 Graph No:- 09“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 92                      
    •                             Observation   Nature of work Number of % Patients Sedentary 12 60 Moderate stress 07 35 Stressful 01 05 A maximum of 60 % of patients had sedentary work; where as 35 % of patients hadmoderate type of work. Rest of incidence is as shown in the table.DIETTable No:- 34 Graph No:- 10 Diet Number of % PatientsVegetarian 06 30 Mixed 14 70The present study shows that maximum No. of Patients in the study had mixed diethabit 70% where as 30% of them had Vegetarian diet.NIDRATable No:- 35 Graph No:- 11“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 93                      
    •                             Observation   Nidra Number of % Patients Sound 17 85 Disturbed & 3 15 delayedThe study shows that 15% of Pts suffered from disturbed & delayed sleep and 85% ofthem had un-disturbed sleep.ADDICTIONTable No:- 36 Graph No:- 12 Addiction Number % of Patients Tea coffee 20 100 beverages Alcohol 04 20 Smoking 02 10PRAKRUTITable No:- 37 Graph No:- 13“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 94                      
    •                             Observation   Prakruti Number % of Patients Vata-pitta 03 15 kapha Pitta 05 25Kapha-vaata 12 60The study shows that majority of the patients belonged to Kapha-Vata Prakruti(60%),Patients belonged to Pitta-kapha (25%), 3 patients belonged to Vata-pitta prakruti (15%).SATWATable No:- 38 Graph No:- 14 Satwa Number % of Patients Pravara 01 05Madhyama 18 90 Avara 01 05The study shows that most of patients in the study had Madhyama satwa (90%), while5% of them had Avara satwa, and 5% were having pravara satva .SAMHANANA“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 95                      
    •                             Observation  Table No:- 39 Graph no:- 15 Samhanana Number of % Patients Pravara 00 00 Madhyama 16 80Avara 04 20Most of the patients had madhyama samhanana and remaining were found to behaving avara samhanana.SATMYATable No:- 40 Graph No:- 16 Satmya Number % of Patients Pravara 00 00 Madhyama 13 65 Avara 07 35The study shows that 13 patients had madhyama satmya . and 7 patients had avarasatmya , whereas no patient was reported in the category of pravara satmya.AHARA SHAKTI & JARANA SHAKTI: Table No:- 41“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 96                      
    •                             Observation   Abhyavaran Number % Jarana Shakti Number of % Patients shakti of Patients Pravara 15 75 Pravara 15 75 Madhyama 05 25 Madhyama 05 25 Avara 00 00 Avara 00 00Abhyavaran shakti: Graph No:- 17 Jarana Shakti: Graph No:- 18Maximum patients were having pravara Abhyavarana and Jarana shakti(75%).followed by madhyama Abhyavarana and Jarana shakti 25%.KOSHTA:Table No:- 42 Graph No:- 19“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 97                      
    •                             Observation   Koshta Number of % Patients Mrudu 02 10Madhyama 12 60 Krura 06 30 In the present study 60% of patients had Madhyama koshta, where as 30% had krurakoshta, and remaining 10% of patients had Mrudu koshta.Nidana:Table no:- 43 Graph No:- 20 No of Percentage Nidana patients % Guru and Snigdha 20 100 % Ahara Madhura Rasa 14 70 % Pradhana Ahara Samishahara sevan 14 70 % Avyayama 15 75 % Divasvapna / 12 60 % Atinidra Bija dosha 05 25 %“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 98                      
    •                             Observation  100 % of the patients had indulged in guru snigdha ahara, 70% had indulged inmadhura rasa pradhana & samishahara, 75 % of avyayama, 60 % had indulged indivaswapna /atinidra.Strotas:Table no: 44 Graph no:- 21 No of Percentage Strotas patients % Meda 20 100 % Mamsa 20 100 % Sweda 11 55 % Rasa 06 30 % Anna 04 20 %In all patients involvement of Medavaha and Mamsavaha srotas was observed, theinvolvement of other srotas has been tabulated in the above table.Symptoms:Table no: 45 Symptoms No of patients Percentage % Sthulata 20 100% Udara lambana 20 100 % Stana lambana 07 35 % Sphik lambana 07 35 % Trusha 10 50 % Moha 00 00% Swapna kruthana 08 40 % Sweda daurgandhya 04 20 %“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 99                      
    •                             Observation   Snigdhangata 08 40 % Talu shosha 00 00 % Alpa maithuna 04 20 % Kshudra shwasa 02 10 %Graph no:- 22All patients complained of sthulata, udara laṃbana the other complaints and itsincidence has been shown in the table above.BMI:Table no: 46 Graph no:- 23 No of Percentage BMI Patients % 25.0 – 25.9 1 05 26.0 – 26.9 3 15 27.0 – 27.9 4 20 28.0 – 28.9 6 30“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 100                      
    •                             Observation   29.0 – 29.9 6 30It is observed that 6 patients each were in BMI between 28.0-28.9 and 29.0-29.9,remaining BMI and its incidence is shown in the above table.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 101                      
    • Results   RESULTSEffect of Virechana karma on different parameters: The analysis was done statistically by using SPSS Statistics 17.0 software. Paired t- test was used for comparing the results.BT – Before treatment.AT1 – Aafter snehapaana.AT2 – after virechana.AT3 - One month after samsarjana karma.Effect of therapy:-Days of appearance of samyaka snigdha lakshana:-Table No:- 47 Graph No:- 24No. of days No of % patients 3 7 35% 4 11 65% 5 2 10% 6 1 05%Out of 20 patients of Sthaulya studied in this work about 35 % of the patientsdeveloped samyak snigdhaLakṣana on third day, 65 % of patients developed it on the4th day, 10 % of patients developed it on fifth day and only 5% required six days ofsnehapaana to attain the samyak snigdha Lakshanas.Average amount of Ghrita required to attain Samyak Snigdha Lakshanas‐ Table No:- 48 Total number of Mean of total Ghrita required to attain samyak patients snigdhata 20 290 ml“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 101                     
    • Results  In this study, mean of total amount of ghrita required was 290 ml, however aminimum of 175 ml and a maximum of 775 ml were administered in differentpatients.Daily mean dose of Snehapaana-Table No:- 49 Graph No:- 25Day No of patients Mean dose Total 1 20 25 ml 2 20 51.25 ml 176.25 ml 3 20 100 ml 4 13 140.38 ml 323.07 ml 5 2 200 ml 525 ml 6 1 250 ml 775 mlIn the present study, the first day dose of ghee was fixed as 25 ml wheras the thesubsequent dose was fixed only after assessing the sneha jirna lakshana. Themaximum second day dose was 75ml, the maximum third day dose was 125 ml, themaximum dose on the fourth day was 150 ml, the maximum dose on fifth day was200 ml and maximum dose of sixth day was 250 ml.Total amount of abhyantara sneha during the whole course of snehapaana:Table No:- 50 Graph No:- 26Dose in ml No of % patients 0-200 ml 8 40%201-400 ml 10 50%401-600 ml 1 05%601-800 ml 1 05%“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 102                     
    • Results  Out of 20 patients of Sthaulya studied in this work maximum of 50 % of the patientstook anything between 201-400ml and the number of patients who took in between000-200ml was 40 5 and 05 % each of the patients required anything between 401-601ml and 601-800 ml of total snehapaana.Analysis of samyak snigdha Lakshana:Table No:- 51 Symptoms No of patients Percentage % Adhastat sneha darshana 20 100 Twak snigdhata 20 100 Gatra mardavata 11 55 Snehodwega 18 90 Klama 15 75 Vaatanulomana 20 100 Angalaghava 13 65 Shaitilya 04 20Graph No:- 27“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 103                     
    • Results  Among the 20 no of patients all the patients developed adhastat sneha darshana,twaksnigdhata,vaatanulomana features. And about 20 % of the patients developed shaitilyafeature and the other lakshanas are shown in the above table.Analysis of latency period:Table No:- 52 Graph No:- 28 Time in No of % minutes patients l-30 00 00% 31-60 02 10% 61-90 15 75% 91-120 03 15%The time required for the manifestation of the first Virechana Vega after theadministration of Virechana drug may be called as Latency period. In the presentstudy, Out of 20 patients, maximum number of patients i.e. 75% the latency periodwas between 61-90 minutes, where as in minimum of 10% of patient’s latency periodwas between 31-60 minutes.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 104                     
    • Results  Analysis of Vaigiki Shuddhi :-Table No:- 53 Graph No:- 29 Vaigiki No of % Shuddhi patients Pravara 2 10%Madhyama 15 75% Avara 3 15%Out of 20 patients maximum of 70% of the patients had madhyama shuddhi and 10%had pravara and 15% had avara shuddhi.Analysis of Anthiki of Virechana:-Table No:- 54 Graph No:- 30 Antiki No of % Shuddhi patients Kaphanta 07 35% Pittanta 02 10% Drava 08 40% malaantaAushadhanta 03 15%In maximum number of patient i.e. 40% exhibited drava malaanta virechana , about35% of the patients had kaphanta Virechana and 15% had aushadhanta and 10% hadpittanta virechana.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 105                     
    • Results  Analysis of Laingiki Lakshana of Virechana:-Table No :- 55 Symptoms No of patients Percentage % Laghuta 20 100 Agnivruddhi 15 75 Vatanulomana 19 95 Kramat 07 35 VitPittakaphagamana Daurbalya 19 95 Karshyata 17 85 Kshut 10 50 Trishna 06 30 Graph No:- 31Laghuta, daurbalya and karshyata are the laingiki features observed in maximumnumber of patients.Effect of treatment on Swedadhikya:Table No:- 56“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 106                     
    • Results  Graph No:- 32  Statistical analysis revealed that Swedadhikya showed an improvement of 2.04%soon after the snehapaana and it was increased to 30.61% after virechana and44.89% at follow up . This change is statistically significant (P=<0.001)Effect of treatment on Daurgandhya:Table No:- 57n BT Follow up Mean Diff % Paired ‘t’ test Mean “d” SD SE ‘t’ Pn BT Follow up Mean Diff % Paired ‘t’ test Mean “d” SD SE ‘t’ P AT1 2.40 0.05 2.04 0.680 0.153 0.438 0.66620 2.45 AT2 1.70 0.75 30.61 0.470 0.105 6.097 0.001 AT3 1.35 1.10 44.89 0.489 0.109 7.678 0.001 AT1 2.40 0 0 0.753 0.16820 2.40 AT2 1.75 0.65 27.08 0.550 0.123 5.940 0.001 AT3 1.45 0.95 39.58 0.510 0.114 6.190 0.001Graph No:- 33“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 107                     
    • Results     Statistical analysis revealed that there was 27.08% improvement in daurgandhyascore after the virechana and after follow up it was increased to 39.58% . Thischange is statistically significant (P=<0.001).“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 108                     
    • Results  Effect of treatment on Atitrisha:-Table No:- 58n BT Follow up Mean Diff % Paired ‘t’ test Mean “d” SD SE ‘t’ P AT1 2.50 0.05 1.96 0.512 0.114 1.000 0.33020 2.55 AT2 1.65 0.90 35.29 0.498 0.109 13.077 0.001 AT3 1.50 1.05 41.17 0.512 0.114 11.917 0.001 Graph no:- 34  Statistical analysis revealed that there was 35.29 % improvement in Atitrisha scoreduring AT2 and was further increased to 41.17% during follow up. This change isstatistically significant (P=<0.001)Effect of treatment on Atikshudha:Table No:- 59n BT Follow up Mean Diff % Paired ‘t’ test Mean “d” SD SE ‘t’ P AT1 2.45 0.10 3.92 0.510 0.114 1.453 0.16320 2.55 AT2 1.65 0.90 35.29 0.498 0.109 13.077 0.001 AT3 1.45 1.1 43.13 0.510 0.114 8.904 0.001“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 109                     
    • Results   Graph No:- 35  Statistical analysis revealed that there was 35.29 % improvement in Atikshudha scoreduring AT2 and was further increased to 41.13% during follow up. This change isstatistically significant (P=<0.001)Effect of treatment on Bhaaravruddhi / Weight:Table No:- 60 n BT Follow up Mean Diff % Paired ‘t’ test Mean “d” SD SE ‘t’ P AT1 75.27 3.13 3.99 11.18 2.50 13.643 0.00020 78.40 AT2 74.37 4.03 5.14 11.15 2.49 13.610 0.000 AT3 74.87 3.53 4.50 11.469 2.56 15.667 0.000  Graph No:- 36  “A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 110                     
    • Results  Statistical analysis revealed that there was 3.99 % improvement in Bhaaravriddhi /Weight score after snehapaana and was further increased to 5.14% after virechanaand 4.50 % at follow up. This change is statistically significant (P=<0.001).Effect of treatment on BMI:Table No:- 61n BT Follow up Mean Diff % Paired ‘t’ test Mean “d” SD SE ‘t’ P AT1 27.04 1.11 3.94 1.088 0.243 17.619 0.00020 28.15 AT2 26.67 1.48 5.25 1.138 0.254 20.242 0.000 AT3 26.84 1.31 4.65 1.147 0.256 21.099 0.000 Graph No:- 37   Statistical analysis revealed that there was 3.94 % improvement in BMI score aftersnehapaana and was further increased to 5.25% after virechana and 4.65 % atfollow up. This change is statistically significant (P=<0.001).Effect of treatment on Udara lambana / Waist circumference:Table No:- 62 n BT Follow up Mean Diff % Paired ‘t’ test Mean “d” SD SE ‘t’ P AT1 100.10 0.9 0.89 10.259 2.278 4.414 0.00020 101“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 111                     
    • Results   AT2 99.200 1.8 1.78 10.195 2.279 9.658 0.000 AT3 99.40 1.6 1.58 10.200 2.280 9.491 0.000  Graph No:- 38   Statistical analysis revealed that there was 0.89 % improvement in Udara lambana /waist circumference score after snehapaana and was further increased to 1.78% aftervirechana and 1.58 % at follow up. This change is statistically significant (P=<0.001).Effect of treatment on Chest circumference:Table No:- 63 n BT Follow up Mean Diff % Paired ‘t’ test Mean “d” SD SE ‘t’ P AT1 100.05 0.45 0.44 10.190 2.278 2.015 0.5820 100.50 AT2 99.400 1.1 1.09 10.399 2.325 2.728 0.13 AT3 99.60 0.9 0.89 10.348 2.31 2.714 0.014 Graph No:- 39“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 112                     
    • Results    Statistical analysis revealed that there was 0.44% improvement in chest circumferencescore after snehapaana and was further increased to 1.09% after virechana and 0.89% at follow up. This change is statistically insignificant (P=<0.014).Effect of treatment on Waist / Hip Ratio:Table No:- 64n BT Follow up Mean Diff % Paired ‘t’ test Mean “d” SD SE ‘t’ P AT1 0.988 0.003 0.30 0.039 0.008 8.847 0.00020 0.991 AT2 0.987 0.004 0.40 0.0399 0.0089 1.859 0.79 AT3 0.986 0.005 0.50 0.043 0.0097 2.114 0.48  Graph No:- 40  “A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 113                     
    • Results  Statistical analysis revealed that there was 0.30 % improvement in Waist / hip ratioscore after snehapaana and was 0.40% after virechana and 0.50 % at follow up. Thischange is statistically insignificant.Effect of treatment on total cholesterol:Table No:- 65n BT Follow up Diff % Paired ‘t’ test Mean Mean “d” SD SE ‘t’ P20 181.50 157.50 24 13.22 27.81 6.22 5.466 0.001 Graph No:- 41  The change that occurred with the treatment is greater than would be expected bychance; there is a statistically highly significant change (P = <0.001)  Effect of treatment onTriglyceride:Table No:- 66n BT Follow up Diff % Paired ‘t’ test Mean Mean “d” SD SE ‘t’ P20 100.60 82.80 17.8 17.69 18.89 4.22 -2.356 0.29“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 114                     
    • Results   Graph No:- 42  The change that occurred with the treatment is not great enough to exclude thepossibility that the difference is statistically insignificant (P =<0.29).Effect of treatment on HDL:Table No:- 67  n BT Follow up Diff % Paired ‘t’ test Mean Mean “d” SD SE ‘t’ P20 45.90 48.20 2.3 5.01 5.28 1.18 2.464 0.23 Graph No:- 43  The change that occurred with the treatment is less than would be expected by chance;there is a statistically insignificant change (P= < 0.23). Effect of treatment on LDL:Table No:- 68n BT Follow up Diff % Paired ‘t’ test Mean Mean “d” SD SE ‘t’ P“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 115                     
    • Results  20 115.35 104.85 10.5 9.01 26.31 5.88 1.945 0.67 Graph No:- 44  The change that occurred with the treatment is not greater than would be expected bychance; there is a statistically insignificant change (P= < 0.67).Effect of treatment on VLDL:Table No:- 69n BT Follow up Diff % Paired ‘t’ test Mean Mean “d” SD SE ‘t’ P20 20.10 16.70 3.4 16.91 5.27 1.17 1.413 0.174 Graph No:- 45  The change that occurred with the treatment is not greater than would be expected bychance; there is a statistically insignificant change (P = <0.174).Effect of treatment on mid arm circumference:Table No:- 70“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 116                     
    • Results  n BT Follow up Mean Diff % Paired ‘t’ test Mean “d” SD SE ‘t’ P20 31.25 AT1 31.11 0.14 0.44 3.41 0.763 2.358 0.29 AT2 30.98 0.27 0.86 3.46 0.77 2.418 0.26 AT3 31.25 0.00 - 3.53 0.79 -0.84 0.934 Graph No:- 46The change that occurred with the treatment is not great enough to exclude thepossibility that the difference is insignificant (P = 0.934).Effect of treatment on biceps:Table No:- 71n BT Follow up Mean Diff % Paired ‘t’ test Mean “d” SD SE ‘t’ P20 1.77 AT1 1.69 0.08 4.51 0.42 0.094 1.00 0.29 AT2 1.69 0.08 4.51 0.401 0.089 1.29 0.211 AT3 1.69 0.08 4.51 0.40 0.089 1.29 0.211 Graph No:- 47“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 117                     
    • Results  The change that occurred with the treatment is not great enough to exclude thepossibility that the difference is insignificant (P = 0.211).Effect of treatment on triceps:Table No:- 72n BT Follow up Mean Diff % Paired ‘t’ test Mean “d” SD SE ‘t’ P20 1.94 AT1 1.94 0 - 0.50 0.11 AT2 1.94 0 - 0.50 0.11 AT3 1.94 0 - 0.50 0.11 Graph No:- 48The change was same before and after the treatment and so could not exclude anypossibility as the difference is insignificant.Effect of treatment on suprailiac:Table No:-73“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 118                     
    • Results  n BT Follow up Mean Diff % Paired ‘t’ test Mean “d” SD SE ‘t’ P20 3.48 AT1 3.27 0.21 6.03 1.15 0.25 5.92 0.000 AT2 3.15 0.33 9.48 1.089 0.24 7.56 0.000 AT3 3.22 0.26 7.47 1.07 0.24 5.42 0.000 Graph No:- 49The change that occurred with the treatment great enough to exclude the possibilitythat the difference is (P =< 0.001).Effect of treatment on subscapular:Table No:- 74n BT Follow up Mean Diff % Paired ‘t’ test Mean “d” SD SE ‘t’ P20 2.84 AT1 2.76 0.08 2.81 0.94 0.21 2.138 0.046 AT2 2.72 0.12 4.22 0.93 0.20 3.26 0.004 AT3 2.77 0.07 2.46 0.95 0.21 2.15 0.44 Graph No:- 50“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 119                     
    • Results  The change that occurred with the treatment is not great enough to exclude thepossibility that the difference is due to chance (P = 0.44).“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 120                     
    • Discussion    DISCUSSION ON OBSERVATIONA total of 20 patients fulfilling the inclusion criteria were studied. The observationand the result as well as statistical analysis of these are elaborated below.Number of Individuals registered for the Study – 20Number of Individuals completed the Study – 20Number of Dropouts – NilAge-In this study it was found that the incidence was highest in the age group of 41-60years constituting 40 % of total number of patients. 30 % patients were in the agegroup of 16-30 and 31-45 years each. This is in concurrence with the increasedincidence of Overweight in the middle age groups. But a conclusion cannot be drawnas the sample size is small.Sex –In the sample taken for the study, 50% patients were females in comparison to 50 %of male patients. Though overweight is more prevalent among females than in malesbut it is not possible to conclude the fact because of a small sample size. Religion-In the study sample, the incidence of Hindus was 80 % , Christians was 15 % and thatof Muslims was 05%. As the sample size is small it doesnot represent thegeographical as a hole.Educational status-Majority of the patients were graduates constituting 60% where as 25% had theirsecondary education, 15% were post graduates.Marital status-Most of the patients were married comprising of 80 % and the remaining 20 % wereunmarried. This is in concurrence with a study that associated marriage to Overweightand obesity.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 119                      
    • Discussion   Socio Economic status:Majority of patients belonged to the middle class 55%, 30% were in upper middleclass and 15 % were in lower middle class. This is in concurrence that overweight isubiquitous regardless of economic status.Occupation-Maximum number of patients were house wife (35%), 30% were businessman, 20%were students, 15% were in service.Nature of work-In this study, maximum of 60 % of patients had sedentary work; where as 35 % ofpatients had moderate type of work and 5% had a stressful work.Desha-In this study, 85 % of the patients belonged to Anupa deṣha and 15 % belonged toSadharana desha. This represents that most of the patients in the sample belonged tothe same geographical area, but the role of Anupa desha in causing Sthaulya canot beruled out as it is Kapha pradhana desha.Diet-70% of the patients were using mixed diet while 30 % were to a vegetarian diet; butall the 100 % indulged in guru snigdha ahara which is the predisposing factor forOverweight and Obesity.Nidra-Of the total 20 patients, 85% had normal and sound sleep whereas remaining15% haddisturbed sleep. Excessive nidra is one of the nidana predisposing to Sthoulya roga.Addiction-In this study it was found that 100 % of the patients had addiction of tea, coffee orbeverages. 20 % were addicted to alcohol and 10% were addicted to cigarette. It isdifficult to draw any conclusions as the sample size is small.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 120                      
    • Discussion   Prakruti-A majority of patients (60%) belonged to Kapha-Vāta Prakruti, 25 % belonged toKapha- Pitta Prakruti and remaining 15% belonged to Vata-Pitta. Thus kaphapredominant either associated with Vata or Pitta, is more in predisposing the diseaseSthaulya.Satwa-The analysis of Satva revealed 90% of patients had madhyama satva while 5 % hadavara satwa and 5% had pravara satva.Samhanana-20% of patients were found having avara samhanana, 80% had madhyamasamhanana. Acharyas opines that an obese will have alpa bala due to the asamatva indhatus.Satmya-Analysis of satmya revealed that 65 % of patients had madhyama satmya, while 35 %of patients had avara satmya. This might be because sthool person consumes more ofmadhura, mamsa and sneha dravyas as a routine diet.Ahara shakti and Jarana shakti:In this study it was found that 75 % of patients had pravara abhyavaran shakti andjarana shakti where as 25 % had madhyama abhyavaran shakti and jarana.Koshtha-In the present study, 60 % had madhyama koshtha, 30 % of the patients had krurakoshtha and 10% had mrudu koshtha.Nidana-Among the Aharatmaka nidana, all 20 patients were found indulging in Guru, SnigdhaPradhana Ahara sevana and 70% indulged in Madhura Rasa Pradhana Ahara sevana.70% of patients were found indulging in Samishahara sevana. 25 % of patients hadbija doshaja sthaulya. Divasvapna and atinidra was noted in 60% of the patients andavyayama was noted in 75 % of the patients. Both aharatmaka and viharatmakanidana’s support the causation of overweight and obesity.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 121                      
    • Discussion   Bijasvabhava has been mentioned as one of the causative factor of Sthaulya inclassics, which was revealed by taking family history.Srotas involved-In the present study all the patients had Medo and mamsa dushti lakshana (100%).55% of patient had involvement of Svedavaha srotas and 30% rasavaha. Vitiation ofMedovaha srotas is mentioned by acaryas, in pathogenesis of sthaulya.Symptoms-The symptom sthulata, udara laṃbana was observed in all 100% patients,snigdhangata and swapna kruthana was found in 40 % of patients respectively. 35%of patients had sphik lambana. 10% of patients had trisha while 20% of patients hadsymptom of sweda daurgandhyata.Vata presents with symptoms like swapna kruthana, kapha Dosha presents withpramana vruddhi, Snigdhangata, Pitta like daurgandhya. Vitiation of Tridosha inpathogenesis of sthaulya is mentioned by acharyas and the same is reflected in thisstudy.BMI-As the study carried out in over weight, 30 % patiets each had BMI in between 28.0 –28.9 and 29.0-29.9, 20% were in 27.0 – 27.9, 15% were in 26.0 – 26.9 and remaining5% were in 25.0 – 25.9.OBSERVATION OF PROCEDURE:Snehapana-Snehapana was started with the Murcita ghrita and the dose was 25ml (Hrisiyasimatra). On the basis of the time taken to digest first day of Sneha, the subsequent doseof ghrita was planned. The sneha was given in arohana matra till patients developedsamyak snigdha lakshana or upto a maximum of seven days, whichever is earlier. Theaverage days of samyak snigdha lakshaṇa was observed in patients were three days.However a maximum of six days also noted. Mean of the total amount of the ghrita toattain the samyak snigdha lakshanas were 290 ml. On the first day average amount ofghrita was 25 ml, 2nd day 51.25 ml, on 3rd day 100 ml, on 4th day 140.38ml, on 5th day“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 122                      
    • Discussion   200ml and on 6th day 250 ml was observed. All the patients showed features of thesamyak snigdhata. None of the patients had any complications of snehapana. Duringthe snehapana with Murcita ghrita, there was marked reduction in the weight andtherefore BMI. There was improvement in the agni. Maximum samyak snigdhalakshana was seen on the 4th day. Out of 20 patients of Sthaulya studied in this workmaximum of 50 % of the patients took anything between 201-400ml and the numberof patients who took in between 000-200ml was 40 5 and 05 % each of the patientsrequired anything between 401-601ml and 601-800 ml of total snehapaana.Latency period:-The time required for the manifestation of the first Virechana Vega after theadministration of Virechana drug may be called as Latency period. In the presentstudy, Out of 20 patients, maximum number of patients i.e. 75% the latency periodwas between 61-90 minutes, where as in minimum of 10% of patient’s latency periodwas between 31-60 minutes.Vaigiki Shuddhi:-Out of 20 patients 70% i.e 15 patients had madhyama shuddhi, 15% of patients hadavara shuddhi whereas 10% of patients ended with pravara shuddhi.Anthiki of Virechana:-Out of 20 patients In maximum number of patient i.e. 40% exhibited drava malaantavirechana , about 35% of the patients had kaphanta Virechana and 15% hadaushadhanta and 10% had pittanta virechana.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 123                      
    • Discussion    DISCUSSION ON PARAMETERS:Disscussion on Swedadhikya:-Swedadhikya showed an improvement of 2.04% soon after the snehapaana and itwas increased to 30.61% after virechana and 44.89% at follow up . This change isstatistically significant (P=<0.001)Daurgandhya:There was 27.08% improvement in daurgandhya score after the virechana and afterfollow up it was increased to 39.58% . This change is statistically significant(P=<0.001).Atitrisha:-35.29 % improvement in Atitrisha score during AT2 and was further increased to41.17% during follow up. This change is statistically significant (P=<0.001)Atikshudha:There was 35.29 % improvement in Atikshudha score during AT2 and was furtherincreased to 41.13% during follow up. This change is statistically significant(P=<0.001)Bhaaravruddhi / Weight:Statistical analysis revealed that there was 3.99 % improvement in Bhaaravriddhi /Weight score after snehapaana and was further increased to 5.14% after virechanaand 4.50 % at follow up. This change is statistically significant (P=<0.001).BMI:There was 3.94 % improvement in BMI score after snehapaana and was furtherincreased to 5.25% after virechana and 4.65 % at follow up. This change isstatistically significant (P=<0.001).Udara lambana / Waist circumference:“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 124                      
    • Discussion   Statistical analysis revealed that there was 0.89 % improvement in Udara lambana /waist circumference score after snehapaana and was further increased to 1.78% aftervirechana and 1.58 % at follow up. This change is statistically significant (P=<0.001).Chest circumference:there was 0.44% improvement in chest circumference score after snehapaana and wasfurther increased to 1.09% after virechana and 0.89 % at follow up. This change isstatistically insignificant (P=<0.014).Waist / Hip Ratio:There was 0.30 % improvement in Waist / hip ratio score after snehapaana and was0.40% after virechana and 0.50 % at follow up. This change is statisticallyinsignificant.Total cholesterol:The change that occurred with the treatment is greater than would be expected bychance; there is a statistically highly significant change (P = <0.001). Triglyceride:The change that occurred with the treatment is not great enough to exclude thepossibility that the difference is statistically insignificant (P =<0.29).HDL:The change that occurred with the treatment is less than would be expected by chance;there is a statistically insignificant change (P= < 0.23). LDL: The change that occurred with the treatment is not greater than would be expected bychance; there is a statistically insignificant change (P= < 0.67).VLDL:The change that occurred with the treatment is not greater than would be expected bychance; there is a statistically insignificant change (P = <0.174).Mid arm circumference:The change that occurred with the treatment is not great enough to exclude thepossibility that the difference is insignificant (P = 0.934).“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 125                      
    • Discussion   Biceps:The change that occurred with the treatment is not great enough to exclude thepossibility that the difference is insignificant (P = 0.211).Triceps:The change was same before and after the treatment and so could not exclude anypossibility as the difference is insignificant.Suprailiac:The change that occurred with the treatment great enough to exclude the possibilitythat the difference is (P =< 0.001).Subscapular:The change that occurred with the treatment is not great enough to exclude thepossibility that the difference is due to chance (P = 0.44). In this study whatever the statistical changes were observed are shown in the table below“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 126                      
    • Discussion   Overall results of statistics on parameters: Table No:- 75 Parameters Significant InsignificantSwedadhikya + -Daurgandhya + -Atitrisha + -Bharavruddhi / weight + -BMI + -Udara lambana / Waist + -circumferenceChest circumference - +Waist / Hip Ratio - +Totsl cholesterol + -triglyceride - +HDL - +LDL - +VLDL - +Mid arm circumference - +Biceps - +Triceps - +suprailiac + -Subscapular - +“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 127                      
    • Conclusion    CONCLUSION Sthaulya is a Dushya Dominant Vyadhi. There is an involvement of all the three Doshas in Sthaulya but the vitiation of Kapha- Vata and Meda of prime importance. Etiological factor mainly Vitiate Kapha-Meda. This vitiated Meda obstruct the path of Vata and causes its Avarana which results in to provocation of Vata. Thus remaining in the Kostha Vata causes Atikshudha, which increases gravity of the disease and make the Sthualya Kritchhsadhaya. Due to obstruction by Meda, Vyana Vayu could not transport nutrient to other Dhatu so Medadhatu is increased and Uttardhatu decreased. Sedentary life, lack of exercise, faulty food habits, and urbanization precipitate the disease. Genetic predisposition, Kapha predominant Prakriti increases the prevalence of Sthaulya. So treatment modality should be planed considering vitiated Meda,Kapha and Vata. and Virechana Karma are amongst them. Indication of Virechana in Sthaulya are indirect references. Virechana is beneficial for Sthaulya w.s.r. to overweight. Virechana helps to initiate the weight loss mechanism in the body.  Virechana helps to check the future complications in the healthy obese as well as in the obese. The plus point observed in case of Ayurvedic management is absence of any hazardous effect, which is really a great benefit to the patients and is of vital importance in view of the global acceptance of Ayurveda. Results of this study are very encouraging and trial should be conducted on large sample with better parameters. “A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 128                      
    • Summary  SUMMARYThis thesis entitled “A Clinical study to evaluate the efficacy of Virechana karma inSthaulya w.s.r. to overweight” comprises of 6 parts.1. Conceptual study of Virechana karma, Sthaulya, Overweight2. Drug review3. Methodology4. Observations and results5. Discussion6. conclusionChapter 1.It deals with the historical aspect of Virechana karma, etymology, definition,indications and contraindications of Virechana karma, method of administration ofvirechana, mode of action of Virechana. Conceptual study on Sthaulya its nidana,lakshana, samprapti, chikitsa, pathyapathya and conceptual study on Overweight itscause, symptoms, diagnosis, examination, complications, treatments.Chapter 2.Explains regarding properties of drugs used for dipana pacana, snehapana, swedanadravya, Virechana yoga.Chapter3. Subjects and methods adopted for the study Protocol of the of the study Inclusion and Exclusion criteria Intervention and assessment of Vamana karma Review on previous work doneChapter4.The observation made on 20 patients regarding demographic incidence of age, sex,habits etc and is presented in the form of charts. The results of the therapy on Obesityare presented with statistical analysis in the form of tables and charts.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 129                      
    • Summary Chapter5. It deals on the entire part of conceptual part of Virechana, clinical observations arediscussed in detail. The results obtained in clinical study are discussed with relevantargument.Chapter6.It deals with conclusion of the present clinical study.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.”    Page 130                      
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    •                              Annexure   S.D.M COLLEGE OF AYURVEDA DEPARTMENT OF PANCHAKARMA KUTHPADY, UDUPI. A CLINICAL STUDY TO EVALUATE THE EFFICACY OF VIRECHANA KARMA IN STHAULYA w.s.r TO OVERWEIGHT. RESEARCH PROFORMA Guide: Dr. Shreekanth U. Co Guide: Dr. Niranjan Rao Researcher: Dr. RAHUL R. MAGDUMName :Age : Serial No :Sex :M/F OPD No :Religion :H/M/C/O IPD No :Education : UE / P / S / HS / GR / PG DOA :Marital Status : UM / M / D / W DOD :Social Status : VP / P / LM / M / UM / RVR Occupation :Postal Address : Date of commencement: / / Date of completion: / /Desha : Anupa / Jangala / SadharanaResult : Change/Marked change/ Unchanged“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 147  
    •                              Annexure  Complaints:1. Main Complaints :Medovriddhi/ bhaaravriddhiJavoparodhaKrucchra vyavayaSwedadhikyaDaurgandhyaDourbalyaAtikshutaAtitrishnaAngachalatwa2. Associated Complaints:NidradhikyaAngashaithilyaAalasyaSukumarataSnigdhangataSheetapriya3. Vedana samutpatti karmaWeight increased at the age of _____yrsTime of onset: childhood/adult : Gradual/ rapid“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 148  
    •                              Annexure  4.poorva vyadhi chikitsa vruttanta5.kautumbika vruttantaRelative Dead/ Alive Health status Treatment history6. Vyaktigata vruttanta1.Aahar sambadhi vruttanta: veg / mixed More likeness for particular food 1. Staple: Rice /Wheat/Ragi/Ready products [Bengalgram (toor dal)/Blackgram (urad dal)/Green gram (moong dal)/Horsegram/Chanaka/Others] 2. Vegetables: Green leafy/Stem/Rootstubers/Rhizomes/Others______________________________. 3. Fruits: Banana/Grape/Apple/Chikku/Pineapple/Mango/Others______________________4. Milk & Dairy products:Milk/Curds/Butter/Ghee/Butter milk/others_______________________.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 149  
    •                              Annexure   5. Sugar & its products: Sugar/Jaggery/Chocolate(A) FOOD Time Dominant rasa Time taken for consumption Morning: Afternoon: Evening: Night:(B) Approx. amount of intake per meal: 6. Desserts: Milk or Cream preparations /Ghee butter preparations/Dalda or Vanaspathi preparation/Curd preparation/Ice cream / Fruit salads/Pastries/Wafers/Cakes 7. Deep fried food stuffs: Vada/Bonda/Pakoda/Bajji/Other fried snacks__________________________. 8. Oils: Sunflower/Coconut/Ground nut /Dalda/Vanaspathi/Ghee/Mustard/Others 9. Meat: Chicken/Mutton/Pork/Beef/Seafood/Egg/Others________________________________. 10. Beverages:“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 150  
    •                              Annexure   Tea/Coffee/Soft Drinks/Alcohol_________________________________.Vihara sambadhi vruttanta:1. Nidra: Sound/Disturbed/Good Day_____hours / Night______hours If disturbed reason: Mental strain: Y/N If yes, since_______ Jagarana: Y/N If yes, since_______ 2. Exercise: Type of excersise: for ____ mins 3. Mental activity: Type of stress Reliving factors Aggravating factors Day/years of exposure 4. Type of profession: Sedentary/Involves physical strain/Involves mental strain Since_______day/years Hours of work: _______ /day 5. Recreation entertainment: Television/ Indoorgames/ outdoorgames/Outing/ others 6. Sex : Duration _______mins. Frequency __________time/day/week. 7. Bowels: Reg/irreg/formed/unformed/constipated frequency______ time/day Consistency_______Colour_________Pramana_________ 8. Micturation: Usual/Dysuria/polyuria/Oliguria frequency_________time/day Consistency_______Pramana______ Colour_________“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 151  
    •                              Annexure   9. Addictions: Beedi/Cigarattes/Alcohol/Tobacco chewing/Tobaccosnuff Since______time/day 10.Others:Gynecological History:Menstrual cycle: …… Regular / Irregular / Menarche …… yearsBleeding ….. days Menorrhagia / Metrorrhagia / Dysmenorrhoea / LeucorrhoeaMenopause since……yearsObstetric History:No. of delivery ……. Normal…… Surgical Intervention……Abortions …… Miscarriages …… Last Delivery …… Years Back……History of contraception: Temporary: Mechanical/Chemical/Oral/Local/I.U.C.D Permanent: Tubectomy/ Vasectomy/ HysterectomyVital signs: Pulse : / min B.P : / mm of Hg Temperature : °F Heart rate : / min Respiratory rate: / min“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 152  
    •                              Annexure  General Physical examination. 1. Built and nourishment: well/ 5. Pallor: P/A moderate/ poor. 6. Cyanosis: P/A 2. Height: meter 7. Edema: P/A 3. Weight: kg 8. Ictrus: P/A 9. Lymphadenopathy: P/A 4. BMI: kg/m2 10. Neck: Thyroid: Normal/abnormal.Dashavidha Pariksha: Prakrithi V/ P/ K/ VP/ PK/ KV/ Sama Satva P / M/ A Sara Twak/ Rasa/Rakta/ Mamsa/ Meda/ Asthi/ Majja/Shukra/Satwa. Samhanana P/ M/ A Rasa Satmya Madhura/ Amla/ Lavana/ Tikta/ Katu/ Kashaya Ahara shakthi Purvakalina P/ M/A Adyatana P/M/A Abhyavarna shakthi Purvakalina P/ M/ A Adyatana P/ M/ A Jarana Shakthi Purvakalina P/ M/ A Adyatana P/ M/ A Vaya Bala/ Vridhi/ Yauvana/ Sampurana/ Parihani /Vriddha Koshta Mridu/ Madhyama/ Krura Sroto Pariksha Pranavaha srotas Udakavaha srotas Annavaha srotas Rasavaha srotas Raktavaha srotas“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 153  
    •                              Annexure   Asthivaha srotas Majjavaha srotas Shukravaha srotas Mootravaha srotas Swedhovaha srotasMamsavaha srotasDarshana parikshaGanda/Arbuda/Granthi/Uraudaravriddhi/Adhimamsa/Mamsaarbuda/Mamsakela/Galashaluka/Gal-asundika/Puthimamsa/Alaji/Galaganda/Upajihwaka.Sparshana parikshaGanda/Arbuda/Granthi/ Ura udara vriddi/Adhimamsa/Alaji/Galaganda.Mamsa sara parikshaSthira/Guru/Subha/Mamsaupachitha inShanka/Lalahata/Krukatika/Akshi/Ganda/Hanu/Griva/Skanda/Udara/Kaksha/Vaksha/Pani/Pada/Sandhi.Medhavaha srotasDharsana parikshaJavoparodha/ Dourbalya/ Dourgandhya/ Swedhabada/ Angashaithilya/ Saukumarata/Snigdagata/ Jatilabhavakesha/ Alasya/ Malakayachidraupadeha/ Mutradosha/ Talusosha/Kanthamukhasosha/ Shad--padhapipillikaabhisarana/ Bahumutra/ Avilamutra.Sparshana parikshaSwedabhadha/ Saukumarata/ Sphik/ Sthana/U darachalatwa/ Jatilabhavakesha/Atislakshana.Prashana parikshaJavoparodha/ Kurcchavyavayatha/ Dourbhalya/ Dourgandhya/ Swedhabada/Kshudhatimatra/ Pipasatimatra/ Gurutwa/ Talusosha/ Madhuraasya/“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 148  
    •                              Annexure  Karapadadahasuptatha/ Mukhatalukanthasosha/ Shadadhapipillika/ Nidraati/ Tandra/Seetapriya.Rasavaha SrotasDarshana :Shosha/ Akroshana/ Vinamana/ Moha/ Vepana.Annavaha SrotasShoola/ Annadwesha/ Chardhi/ Pipasa/ Annanabhilasha/ Aruchi/ Avipaka/ Murcha.Sweda vaha ParikshaDarshana pariksha : Asweda/ Atisweda/ Roma HarshaSparshana pariksha: Asweda / Atisweda /Parushata /Atishlakshnata.Prashna pariksha: Asweda /Atisweda / ParidahaMedo sara parikshaSnigdha Varna/Netra/Kasha/Koma/Naka/Ostha/Mutra purisha.Systemic Examination :CNS :RS :CVS :PA :GUS :“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 149  
    •                              Annexure  Indriya pariksha:ChakshuShrotraGhraanaTwakRasanaNidana:Aharatmaka : Atibhojana/Guruahara/Madhura/Sheeta/Snigdha/Navannasevana/Dadhi- sarpi -payasa-ikshu- gudavikarasevana/Mamsarasasevana/Godhuma/Shali/Masha/OthersViharatmaka : Avyayama/Avyavaya/Divaswapna/Sukhashaiyasevana/Bhojanotharasnananidrasevana/others Manasa: Harsa nitya/Achinta/Manasanivriti/Priya darshana/Others2Purvarupa:Atinidra/aalasya/shaithilya/others.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 150  
    •                              Annexure  Rupa Rupa B.T A.T1 A.T2 Angachalwata Udara Sphika Stana Dourbalya Swedadhikya Daurgandhya Atikshudha Atitrishna Alpavyavaya Nidradhikya Snigdhanga Angagauravata Gatrasaada Sandhishoola Aalsya/utsaha hani Kshudrashwasa/ aayasenshwasaPramana: B.T A.T.1 A.T.2 Height Weight kg kg Kg BMI Waist-Hip ratio“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 151  
    •                              Annexure   Body parts measurement in centimeter: B.T A.T 1 A.T 2 AT3 Urah(Chest) Udara(Waist) Sphik(Hip) Uru(Midthigh) Jangha(Leg) Bahu(Midarm) Anthropometry Measurement B.T A.T 1 A.T 2 AT3 Waist Biceps Triceps Scapular Hip ThighBT- Before treatment; AT1-After Snehapana, AT2- after virechana, AT3-one month after samsarjana krama. Investigations Routine Hematological Investigations: Hb% T.C. D .C E.S.R B.T A.T “A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to   overweight.” Page 152  
    •                              Annexure  Lipid profile: Serum Serum HDL LDL VLDL cholesterol Triglyceride B.T A.TECG: ECG within normal levels are selected.Koshta:Administration of Triphala quatha for identificationof Koshta. Observation Time of Quantity Date administration Onset of No. of Consistency defecation defecationKoshta-“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 153  
    •                              Annexure  Treatment Schedule:Purvakarma:1. Dipana- Pachana with Shunthi quatha 20 ml BD, from……/……/…… to…../……/……2. Snehapana with Moorchita gritha from ……/……/…… to …../……/…… Observation Date Time No. of Days Matra Jiryamana Jirna Samyak Lakshana Lakshana Lakshana“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 154  
    •                              Annexure  Sneha JiryamanaLakshana: Day 1 2 3 4 5 6 7 Siroruja Lalasrava SnehaUdgara Angasada Arathi Klama Trishna Daha Brama MurchaSneha Jirna Lakshana : In Hours 2 4 6 8 10 12 Jiryamana Lakshana prshamana Udgara Shuddhi Vata Anulomana Ksuda Pravruthi Trishna Pravruthi Sharira Laghutha“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 155  
    •                              Annexure  Samyak Snigdha Lakshana: Features of Gritha 1 2 3 4 5 6 7 Samyak Snigdha pana lakshana day’s Quantity Vata Anulomana Agni Dipti Sneha Udvega Asamhatha Varchas Anga Laghava Gatra SnigdhataPurisha Snigdhata Klama Adastad sneha darshanaGatra mardavatha Shaitilya3. Vishrama Kala: Moorchita Tila Taila abhyanga & Bashpa sweda followed by usnajala snana for 4 days.“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 156  
    •                              Annexure  Samyak Sweda Lakshana: LAKSHNAS DAY1 DAY 2 DAY 3 DAY4 Sheeta uparama Shoola uparama Stambha nigraha Gaurava nigraha Mardavata Sweda virathi/sheetaartitva Vyadi haani LaghutavaOBSERVATION OF VITAL DATA & WEIGHT DURING PROCEDURE Time Pulse Blood Pressure Resp.Rate Weight“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 157  
    •                              Annexure  PRADHANA KARMA:Administration of virechana yogaPippali, nagar, kshara, shyama trivrutta with madhuTime of administration ofVirechana Dravys-….......1] MANIKI No. of Time Colour Consistency Virikta Water Urine Vega Dravys Consumed 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 158  
    •                              Annexure   21 22 23 24 25 26 27 28 29 30In put = ml Total Virikta dravya = mlOutput = ml Total out put = ml“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 159  
    •                              Annexure  Shuddhi lakshanas:Samyak Yoga Ati Yoga AyogaSrotoshuddi Supti AgnimandyaIndriya prasada Angamarda PratishyayaLaguta Klama TandraAgnivrudhi Bhrama ChardiAnamayatva Balaabhava AruchiVitpittakapha vata Nidraabhava Vata PratilomatakramashanissaranaVatanulomana Tama Pravesha DahaDaurbalya Netra pravesha Hritkukshi ashudhiHritvarna shuddhi Moorcha KanduKshut Unmada VitsangaTrishna Hikka MootrasangaGlani Trishna PidikaBuddhi indriya mana shuddhi Parshwa Shoola KukshishoolaKale vega pravartanam Guda Shoola GauravaRuchi Parikartika Sthivan Angamarda Aadhmana Gudabhramsha Daurbalya Yadraktamedomamsodakopamam Alaaghavataa strava Nishleshma pittam udakam shonit krishnameva kaphatiyoga Na vitpittakaphavaata kramatah nissaran“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 160  
    •                              Annexure  PASCHAT KARMADiet Regimen No. of Annakalas Pravara Shuddhi Madhyama Shuddhi Avara ShuddhiPeyaVeelepiAkrita YushaKrita YushaCONDITION OF THE PATIENT AFTER TREATMENT Cured Worse Marked Improvement No Improvement Moderate Improvement DropoutSignature of Scholar: Signature of Guide:“A clinical study to evaluate the efficacy of  Virechana Karma in Sthoulya w.s.r to  overweight.” Page 161  
    •                                                                                                                                                   Master chart   Sr. Ipd Name Subjective criteria acc to graded scaleNo No. Swedadhikya Daurgandhya Atitrisha Atikshudha B A A A B A A A B A A A B A A A T T T T T T T T T T T T T T T T 1 2 3 1 2 3 1 2 3 1 2 31 58619 Girija 2 2 2 2 2 2 2 2 3 3 2 2 3 3 2 22 58695 Gauhar 2 2 2 1 3 3 2 2 3 3 2 2 3 3 2 23 59727 Vijayalaxmi 2 2 2 1 2 2 2 1 2 2 2 1 2 2 2 14 58812 Vijaynath 3 3 2 1 3 3 2 1 3 3 2 2 3 3 2 25 62966 C.G.Naik 3 3 2 2 3 3 2 2 3 3 2 2 3 3 2 26 62543 Sukesh 3 3 2 2 3 3 3 2 3 3 2 2 3 3 2 17 62771 Mary 2 2 2 1 2 2 2 1 2 2 2 1 2 2 2 1 D’souza8 62789 Mohd. Salih 3 3 2 2 3 3 2 2 3 3 2 1 3 3 2 19 62685 Roopa 2 2 1 1 2 2 1 2 2 2 1 1 2 2 1 210 62976 Stephen 3 3 2 1 3 3 2 1 3 3 2 1 3 2 2 1 Lewis11 62829 Latha 3 1 1 1 1 1 1 1 2 2 1 2 2 2 1 212 62828 Ravindra 1 2 1 1 2 2 1 1 2 2 1 1 2 2 1 113 62960 Chintaman 3 3 2 1 3 3 2 1 3 3 2 2 3 3 2 1 Naik14 62876 Sudheer 3 3 2 2 3 3 2 2 3 3 2 2 3 3 2 215 62877 Nandini 3 3 2 1 3 3 2 1 2 2 1 1 2 2 1 116 62925 Yasharee 3 3 2 2 3 3 2 2 3 2 2 2 3 2 2 217 62654 Bharati 1 1 1 1 1 1 1 1 2 2 1 1 2 2 1 118 62387 Shobhadevi 3 3 2 2 3 3 2 2 3 3 2 2 3 3 2 219 62729 Jacqulene 2 2 1 1 1 1 1 1 2 2 1 1 2 2 1 120 58224 Shankar 2 2 1 1 2 2 1 1 2 2 1 1 2 2 1 1 Poojari        Dept. Of pg studies in Panchakarma S.D.M.C.A. Udupi  Page 1 “A clinical study to evaluate the efficacy of Virechana karma in Sthaulya wsr to overweight”.     
    •                                                                                                                                                   Master chart   Sr. Ipd Name Objective criteriaNo No. Weight BMI Abdominal Chest. circumfere circumference nce B A A A B A A A B A A A B A A A T T T T T T T T T T T T T T T T 1 2 3 1 2 3 1 2 3 1 2 31 58619 Girija 7 6 6 6 2 2 2 2 9 9 9 9 1 9 9 9 2 9 7 9 6. 5. 5 5. 9 8 7 7 0 6 2 4 8 7 7 0 6 4 42 58695 Gauhar 8 8 8 8 2 2 2 2 9 9 9 9 9 9 9 9 6 2 1 3 6. 5. 5. 5. 5 4 3 4 2 2 1 2 8 6 3 9 7 2 1 33 59727 Vijayalaxmi 7 7 7 7 2 2 2 2 9 9 9 9 9 9 9 9 3 1 1 0. 8. 7. 7. 7. 9 8 7 7 6 5 4 4 5 1 4 4 2 8 1 1 24 58812 Vijaynath 9 9 9 9 2 2 2 2 9 9 9 9 9 9 9 9 9 5 3 4 9. 8. 8. 8. 9 8 7 7 6 5 4 4 8 6 0 3 1 1 1 15 62966 C.G.Naik 7 7 7 7 2 2 2 2 1 1 1 1 1 1 1 1 8 5 4 5 8. 6. 6. 6. 1 1 1 1 2 2 2 2 0 9 6 9 2 2 1 1 1 1 1 1 5 7 1 76 62543 Sukesh 1 9 9 1 2 2 2 2 1 1 1 1 1 1 1 1 0 9 8 0 9. 8. 7. 8. 2 2 2 2 1 1 1 1 5 0 7 0 7 3 4 1 0 1 7 7 6 7 4 4 6 27 62771 Mary 6 6 6 6 2 2 2 2 9 9 9 9 9 9 9 9 D’souza 8 5 4 4 7. 6. 5. 5. 8 7 6 6 9 9 8 7 3 1 7 7 0 0 0 08 62789 Mohd. Salih 8 7 7 7 2 2 2 2 1 1 1 1 1 1 1 1 2 8 7 7 8. 6. 6. 6. 0 0 0 0 0 0 0 0 3 9 6 6 2 2 1 1 0 0 0 0 7 8 4 49 62685 Roopa 7 6 6 6 2 2 2 2 9 9 9 9 9 9 9 9 0 8. 7 7 7. 6. 5. 5. 2 2 0 1 4 4 4 4 5 0 4 8 8 2 4 6 610 62976 Stephen 9 8 8 8 2 2 2 2 1 1 1 1 1 1 1 1 Lewis 0 7 6 6. 9. 8. 8. 8. 0 0 0 0 0 0 0 0 5 4 4 1 2 6 6 5 5 2 2 2 2 1 3 0 6Dept. Of pg studies in Panchakarma S.D.M.C.A. Udupi  Page 2 “A clinical study to evaluate the efficacy of Virechana karma in Sthaulya wsr to overweight”.     
    •                                                                                                                                                   Master chart  11 62829 Latha 6 6 5 5 2 2 2 2 8 8 8 8 8 8 8 2 0 9 9 5. 5. 4. 4. 5 5 5 5 5 5 5 8 0 5 5 3 0 8 812 62828 Ravindra 6 6 6 6 2 2 2 2 8 8 8 8 8 8 8 8 8 6 7 7 6. 5. 5. 5. 1 0 0 0 5 5 5 5 2 4 0 0 5 8 9 913 62960 Chintaman 7 7 7 7 2 2 2 2 1 1 1 1 1 1 1 1 Naik 8 5 4 4 8. 6. 6. 6. 1 1 1 1 1 1 1 1 0 9 6 6 2 2 1 1 6 6 6 6 5 7 1 114 62876 Sudheer 9 9 9 9 2 2 2 2 1 1 1 1 1 1 1 1 7 3 3 3 9. 8. 8. 8. 2 2 2 2 1 1 1 1 3 0 0 0 3 0 0 0 6 6 6 6 0 9 9 915 62877 Nandini 7 7 7 7 2 2 2 2 1 1 1 1 1 1 1 1 5 1 0 0 8. 7. 7. 7. 0 0 0 0 0 0 0 0 9 4 0 0 4 4 2 2 4 4 4 4 5 1 9 916 62925 Yasharee 6 6 6 6 2 2 2 2 9 9 9 9 1 9 9 9 9 6 5 6 9. 8. 8. 8. 9 8 7 7 0 8 8 8 8 5 1 5 0 7 7 3 717 62654 Bharati 7 7 7 7 2 2 2 2 9 9 9 9 1 1 9 9 4 2 1 1 7. 6. 6. 6. 9 8 7 7 0 0 9 9 6 8 4 4 0 0 1 6 9 918 62387 Shobhadevi 6 6 6 6 2 2 2 2 9 9 9 9 9 9 9 9 6 3 2 2 9. 8. 7. 7. 8 6 6 6 5 5 4 4 7 3 9 9 2 7 2 219 62729 Jacqulene 7 6 6 6 2 2 2 2 9 9 9 9 1 9 9 9 0 7 6 6. 8. 6. 6. 6. 8 7 6 6 0 9 8 8 5 1 9 5 7 0 1 0 0 020 58224 Shankar 8 8 8 8 2 2 2 2 9 9 9 9 9 9 9 9 Poojari 6 3 2. 3 7. 6. 6. 6. 5 4 3 4 2 2 1 2 5 8 8 6 8 3 6 9 6     Dept. Of pg studies in Panchakarma S.D.M.C.A. Udupi  Page 3 “A clinical study to evaluate the efficacy of Virechana karma in Sthaulya wsr to overweight”.     
    •                                                                                                                                                   Master chart    Dept. Of pg studies in Panchakarma S.D.M.C.A. Udupi  Page 4 “A clinical study to evaluate the efficacy of Virechana karma in Sthaulya wsr to overweight”.     
    •                                                                                                                                                   Master chart  Sr. Ipd Name Objective criteriaNo No. Total Triglyceride HDL LDL cholesterol BT AT BT AT BT AT BT ATSr. Ipd Name Objective criteria1No 58619 No. Girija 157 178 Waist / hip88 ratio 80 44 Mid 47arm 110 892 58695 Gauhar 170 142 63 55 circumference77 39 42 70 BT AT 1 AT2 AT3 BT AT AT AT3 59727 Vijayalaxmi 160 157 86 85 56 1 52 2 87 3 881 58619 Girija 0.9 0.907 0.90 0.89 30 30 28 304 58812 Vijaynath 176 148 6 85 70 42 53 118 7825 58695 62966 Gauhar C.G.Naik 1.03 1.021 1.03 1.032 33 45 32. 51 207 151 113 57 32. 33 139 98 2 3.. 7 536 59727 62543 Vijayalaxmi 0.97 0.97 Sukesh 230 210 0.97 0.94 168 119 28 53 28 48 28 28 143 14947 58812 62771 Vijaynath Mary 1.04 169 1.042 151 1.04 119 1.043 37 39 36. 42 107 36. 37 106 98 D’souza 2 3 5 55 62966 C.G.Naik 0.92 0.925 0.91 0.917 31 31 31 31 5 786 62789 62543 SukeshSalih 1.03 Mohd. 238 204 1.008 77 1.00 69 1.016 38 39 38 41 38 170 38 149 3 89 62685 Roopa 150 118 101 93 43 48 87 897 62771 Mary 0.92 0.915 0.91 0.914 28 28 28 2810 62976 D’souza Stephen 4 160 147 4 86 79 52 56 87 88 Lewis8 62789 Mohd. Salih 1.02 1.02 1.01 1.01 34 33 33 35911 62685 62829 Roopa Latha 0.97 138 0.989 104 0.96 0.978 28 39 27. 41 67 59 27. 27. 107 105 8 7 7 7 71210 62828 62976 Ravindra Stephen 125 1.02 110 1.039 1.03 1.039 33 44 33 40 107 88 33 152 33 161 Lewis 9 913 62960 Chintaman 203 186 137 115 47 43 112 12011 62829 Naik Latha 1 1 1 1 25 25 25 2512 62828 Ravindra 1.01 1.01 1.01 1.01 27 27 27 2714 62876 Sudheer 199 180 86 74 41 47 141 13713 62960 Chintaman 0.98 0.98 0.99 0.99 31 31 30. 3115 62877 Naik Nandini 186 181 91 80 44 8 47 124 1101614 62925 62876 Yasharee Sudheer 198 1.05 167 1.025 1.02 1.025 36 50 36 52 131 108 36 87 36 79 1 51715 62654 62877 Bharati Nandini 207 0.99 168 0.99 119 82 34 51 34 57 0.99 0.99 34 130 34 1121816 62387 62925 Shobhadevi Yasharee 203 0.99 171 0.98 115 98 0.97 0.979 30 57 30 53 30 102 30 110 91917 62729 62654 Jacqulene Bharati 170 0.97 142 0.96 76 68 0.97 0.97 31 45 31 51 31 87 31 892018 58224 62387 Shankar Shobhadevi 163 0.98 148 0.97 97 0.97 70 0.97 33 48 32. 53 32. 141 32. 78 Poojari 7 5 519 62729 Jacqulene 0.98 0.989 0.98 0.989 22 27. 27. 27. 9 7 7 920 58224 Shankar 1.03 1.032 1.02 1.032 30 30 30 30 Poojari 2 1Dept. Of pg studies in Panchakarma S.D.M.C.A. Udupi  Page 5 “A clinical study to evaluate the efficacy of Virechana karma in Sthaulya wsr to overweight”.     
    •                                                                                                                                                   Master chart   Sr. Ipd Name Objective criteria  Dept. Of pg studies in Panchakarma S.D.M.C.A. Udupi  Page 6 “A clinical study to evaluate the efficacy of Virechana karma in Sthaulya wsr to overweight”.     
    •                                                                                                                                                   Master chart  No No. VLDL Triglyceride HDL LDL. BT AT BT AT BT AT BT AT1Sr. 58619 Ipd Girija Name 13 13 Subjective criteria acc to graded scaleNo No2 58695 Gauhar 10 83 59727 Vijayalaxmi 17 174 58812 Vijaynath 16 175 62966 C.G.Naik 23 126 62543 Sukesh 34 317 62771 Mary 51 19 D’souza8 62789 Mohd. Salih 19 149 62685 Roopa 19 2110 62976 Stephen 17 17 Lewis11 62829 Latha 11 1312 62828 Ravindra 21 2413 62960 Chintaman 23 23 Naik14 62876 Sudheer 17 1215 62877 Nandini 18 2016 62925 Yasharee 21 1717 62654 Bharati 18 1318 62387 Shobhadevi 13 1319 62729 Jacqulene 17 1720 58224 Shankar 24 13 Poojari    Dept. Of pg studies in Panchakarma S.D.M.C.A. Udupi  Page 7 “A clinical study to evaluate the efficacy of Virechana karma in Sthaulya wsr to overweight”.     
    •                                                                                                                                                   Master chart   Biceps Triceps Suprailliac Subscapular B A A A B A A A B A A A B A A A T T T T T T T T T T T T T T T T 1 2 3 1 2 3 1 2 3 1 2 31 58619 Girija 2. 2. 2. 2. 3 3 3 3 3 3. 3. 3 3. 3. 3. 3. 5 5 5 5 . 5 5 . 5 5 5 5 5 52 58695 Gauhar 1. 1. 1. 1. 1. 1. 1. 1. 2 2. 2. 2 3. 3. 3. 3. 3 3 3 3 7 7 7 7 . 5 3 . 5 5 4 5 5 43 59727 Vijayalaxmi 2 2 2 2 2. 2. 2. 2. 4 4. 4. 4 1. 1. 1. 1. 1 1 1 1 . 7 7 . 2 2 2 2 8 84 58812 Vijaynath 1. 1. 1. 1. 2 2 2 2 4 3. 3. 3 4. 4. 4. 4. 8 8 7 7 5 2 . 5 2 2 3 25 62966 C.G.Naik 2. 2. 2. 2. 3 3 3 3 5 5. 5 5 3. 3. 3. 3. 4 4 4 4 . 2 6 6 6 6 46 62543 Sukesh 1. 1. 1. 1. 2. 2. 2. 2. 5 5 4. 4 4. 4. 4. 4. 8 8 8 8 2 2 2 2 . 5 . 5 3 3 5 2 57 62771 Mary 1. 1. 1. 1. 1. 1. 1. 1. 2 2. 2. 2 3. 3. 3. 3. D’souza 2 2 2 2 8 8 8 8 . 3 3 . 6 0 0 0 2. 5 3 58 62789 Mohd. Salih 1. 1. 1. 1. 1. 1. 1. 1. 3 2. 2. 3 2 2 1. 2. 5 5 5 5 5 5 5 5 . 8 8 . 8 0 2 09 62685 Roopa 1. 1. 1. 1. 1. 1. 1. 1. 3 3 3 3 3. 2. 2. 3 8 8 8 8 8 8 8 8 . . 1 7 7 1 110 62976 Stephen 1. 1. 1. 1. 1. 1. 1. 1. 2 2 2 2 2 2 2 2 Lewis 5 5 5 5 5 5 5 5 . 511 62829 Latha 1. 1. 1. 1. 1. 1. 1. 1. 2 2. 2. 2 1. 1. 1. 1. 2 2 2 2 3 3 3 3 . 3 3 . 7 7 7 7 8 712 62828 Ravindra 1. 1. 1. 1. 1. 1. 1. 1. 2 2. 2. 2 1. 1. 1. 1. 3 3 3 3 3 3 3 3 . 1 0 . 6 6 6 6 4 113 62960 Chintaman 2. 2. 2. 2. 2. 2. 2. 2. 5 4. 4. 4 3. 3. 3. 3. Naik 2 2 2 2 4 4 4 4 . 8 6 . 8 8 6 6 0 614 62876 Sudheer 2. 2. 2. 2. 2. 2. 2. 2. 5 5. 5. 5 3. 3. 3. 3. 2 2 2 2 4 4 4 4 . 4 2 . 8 8 6 6 6 3Dept. Of pg studies in Panchakarma S.D.M.C.A. Udupi  Page 8 “A clinical study to evaluate the efficacy of Virechana karma in Sthaulya wsr to overweight”.     
    •                                                                                                                                                   Master chart  15 62877 Nandini 1. 1. 1. 1. 2. 2. 2. 2. 3 3. 3. 3 3. 3. 3. 3. 8 8 8 8 0 0 0 0 . 4 3 . 1 0 0 1 6 416 62925 Yasharee 1. 1. 1. 1. 1. 1. 1. 1. 3 3. 3. 3 3. 3. 3. 3. 8 8 7 7 9 9 9 9 . 4 2 . 2 2 1 1 6 217 62654 Bharati 1. 1. 1. 1. 1. 1. 1. 1. 2 2. 2. 2 2. 2. 2. 2. 4 4 4 4 5 5 5 5 . 1 0 . 0 0 0 0 2 018 62387 Shobhadevi 1. 1. 1. 1. 1. 1. 1. 1. 2 2. 2. 2 2. 2. 2. 2. 3 3 3 3 5 5 5 5 . 5 3 . 2 2 2 2 5 319 62729 Jacqulene 1. 1. 1. 1. 2. 2. 2. 2. 3 3. 2. 3 2. 2. 2. 2. 8 8 8 8 4 4 4 4 . 0 8 . 4 4 4 4 1 020 58224 Shankar 1. 1. 1. 1. 1. 1. 1. 1. 2 2. 2. 2 1. 1. 1. 1. Poojari 3 3 3 3 6 6 6 6 . 0 0 . 6 6 6 6 2 0         Dept. Of pg studies in Panchakarma S.D.M.C.A. Udupi  Page 9 “A clinical study to evaluate the efficacy of Virechana karma in Sthaulya wsr to overweight”.     
    •   MADHU PIPPALI NAGAR (SHUNTHI) YAVAKSHARA YAVAKSHARA TRIVRUTTA MADHU