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EVALUATION OF EFFICACY OF BHADRADI ASTHAPANA VASTI IN STHOULYA (OBESITY) …

EVALUATION OF EFFICACY OF BHADRADI ASTHAPANA VASTI IN STHOULYA (OBESITY)
Vijaykumarswamy G. Hiremath
Department of Panchkarma,D.G.M.Ayurvedic Medical College, Hospital and P.G.Research Center, Gadag.

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  • 1. EVALUATION OF EFFICACY OF BHADRADI ASTHAPANA VASTI IN STHOULYA (OBESITY) By Vijaykumarswamy G. Hiremath DISSERTATION SUBMITTED TO THERAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA In partial fulfillments of the requirements for the degree of AYURVEDA VACHASPATI(M.D) In PANCHAKARMA Under the guidance of Dr.P. Shivaramudu M.D. (Ayu) Under the co-guidance of Dr.Shashidhar H. Doddamani M.D. (Ayu) J.S.V.V. SAMSTHE’S Shri.D.G.M. Ayurvedic Medical College, Hospital & P.G.Research Centre, GADAG - 582103 2004-2007
  • 2. Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation / thesis entitled Evaluation of Efficacyof Bhadradi Asthapana Vasti in Sthoulya (Obesity) is a bonafied and genuineresearch work carried out by me under the guidance of Dr. P. Shivaramudu, M.D(Ayu) Professor, Post - Graduate Department of Panchakarma and under the co-guidance of Dr. Shashidhar H. Doddamani M.D (Ayu) Asst Professor, Post – graduateDepartment of Panchakarma.Date: Signature of the CandidatePlace: (Vijaykumarswamy G. Hiremath)
  • 3. SHRI D.G. MELMALGI AYURVEDIC MEDICAL COLLEGE, GADAG. POST GRADUATE DEPARTMENT OF RASASHASTRA. I here by certify that this dissertation entitled Evaluation of Efficacy ofBhadradi Asthapana Vasti in Sthoulya (Obesity) is a bonafide and genuineresearch work done by Vijaykumarswamy G. Hiremath in partial fulfillment ofthe requirement for the degree of Ayurveda Vachaspati (M.D in Ayurveda) inPanchakarma of Rajiv Gandhi University of Health sciences, Bangalore,Karnataka under my Guidance. Guide Date: Dr.P.Shivaramudu M.D (Ayu) Place: Gadag Professor Department of Panchakarma, D.G.Melmalgi Ayurvedic Medical College, Hospital and P.G.Research Center, Gadag - 582103.
  • 4. CERTIFICATE BY THE CO-GUIDE This is to certify that the dissertation entitled “EVALUATION OFEFFICACY OF BHADRADI ASTHAPANA BASTI IN STHOULYA (OBESITY)”is a bonafide research work done by Vijaykumarswamy. G. Hiremath in partialfulfillment of the requirement for the degree of Ayurveda Vachaspati. M.D.(Panchakarma). Date: Dr. Shashidhar. H. Doddamanai M.D. (Ayu). Place: Assistant Professor, Post graduate Department of Panchakarma.
  • 5. ENDORSEMENT BY THE H.O.D. PRINCIPAL OF THE INSTITUTE This is to certify that the dissertation entitled “Evaluation of efficacy ofBhadradi Asthapana Basti in Sthoulya (Obesity)” is a bonafide researchwork done by Vijaykumarswamy G.Hiremath under the Guidance ofDr.P.ShivaramuduMD (Ayu) Professor, Post Graduate Department of Panchakarmaand under the Co-Guidance of Dr.shashidhar H. DoddamaniM.D(Ayu) AsstProfessor, Post Graduate Department of Panchakarma.Dr.Purushothamacharyulu, M.D (Ayu) Dr.G.B.Patil Professor & H.O.D Principal /C.M.O Department of Panchkarma,D.G.M.Ayurvedic Medical CollegeHospital and P.G.Research Center, Gadag.Date: Date:Place: Gadag Place: Gadag
  • 6. COPY RIGHT Declaration by the Candidate I here by declare that the Rajiv Gandhi University of Health Sciences, Bangalore,Karnataka shall have the rights to preserve, use and disseminate this dissertation in printor electronic format for academic/research purpose.Date: Vijaykumarswamy G. HiremathPlace: Gadag © Rajiv Gandhi University of Health Sciences, Bangalore.
  • 7. Acknowledgement Any research is never an individual effort. It is contributory effort of manyhearts, hands and heads. It gives me inexpressible pleasure to offer my sincere thanksto all those who have rendered their wholehearted support, guidance and Co-operationin completing my thesis work. My deep sense of gratification is due for my Parents who are the architects ofmy career, culture and discipline, which i could imbibe, are solely because of theirpainstaking, upbringing and strong moral support. I also cannot forget the love &affection of my younger sister sativa who constantly encouraged me. I express my obligation to my honorable H.O.D, Dr. G.Purushothamacharyulu M.D. (Ayu), H.O.D., P.G. Department of Panchakarma,P.G.S&R, D.G.M.A.M.C, Gadag for his critical suggestions and expert guidance forthe completion of this work. I am extremely happy to express my deepest sense of gratitude to my belovedGuide Dr.P.Shivaramudu.MD(ayu) Professor, P.G. Department of Panchakrma, P.G.S& R, D.G.M.A.M.C, Gadag whose sympathetic, scholarly suggestions and guidanceat every step have inspired me not only to accomplish this work but in all aspects. I express gratitude beyond words to my Co-Guide Dr.Shashidhar. H.Doddamani Asst. Professor, P.G.S & R, D.G.M.A.M.C, Gadag for his constantsupervision, guidance encouragement and wholehearted support during my researchstudy. I express my deep gratitude to Dr .G.B Patil, Principal, D.G.M.A.M.C, Gadag,for his encouragement as well as providing all necessary facilities for this researchwork. I express my sincere gratitude to Lecturer Dr. Santhosh. N. Belavadi MD(Ayu), Lecturer for their sincere advices and assistance. I take this opportunity to thank HOD’s of other departmentsDr.M.C.Patil MD (Ayu), Dr.Varadhacharyulu MD (Ayu), and Dr.G.V.Mulgund MD (Ayu) fortheir inspiration and valuable suggestions. I am grateful to all the PG teachers Dr.K.S.R.PrasadMD.(AYU), Dr.R.Y.ShetterMD(AYU), Dr.Girish Danappagouder MD(Ayu), , Dr.Jagadeesh. G. Mitti.MD.(AYU), i
  • 8. Dr.Kuber. SankMD.(AYU), Dr.Dilipkumar.B.MD(Ayu) Dr.Shashidhar NidagundiMD.(AYU)),and other PG Staff. for their valuable suggestions. I extend my immense gratitude to Dr.G.S.Hiremath, Dr.S.A.Patil,Dr.U.V.Purad, Dr.B.G.Swami, Dr.Paraddi, Dr.Sajjana, Dr.A.Samudri Dr.Yasmin, andDr.Shankaragouda, Dr. G. Yarageri, Dr. S.H.Radder, Dr. Mulkipatil and otherteaching staff who helped during my study. My sincere thanks are extended to Dr. Basavaraj SaraganachariMD.(AYU), andDr. P.V.Joshi for their inspiration and valuable suggestions. I cannot move further before thanking to my intimate friends Dr.C.B.Pattanashetty, Dr. S.B.Gouder, Dr. Jagadeesh and Dr. Madhushree who havebeen stood indefatigable with me in each and every circumstance and gave me indepth sense of friendship. I am greatly thankful to my friend cum brother in law, Gururaj and my sisterSuvarna for their ever co-operation and kind hearted support. I am highly under the debt of my beloved friends Dr. Sharnu,Dr. C.B.Pattanashetty, Dr. S.B.Gouder, Dr.V.B.Math Dr.Manjunath, Dr.Anand,Dr.Umesh, Dr.S.B.Patil Shivaprasad, Naveen, Manjunath shedagatagi who havehelped in all the moments during my Post Graduate studies. I would like to express my sincere thanks to LibrarianShri.V.M.Mundinamani, and Asst Librarian Shri.S.B.Sureban and Shri Shavi forproviding valuable books in time throughout the study. I take this moment to express my thanks to all my Departmental Friends Dr.Subin, Dr. Febin, Dr. Satheesh, Dr. Santosh, Dr.Varsha Dr. Shaila, Dr. Hugar, Dr.Chandramouli, Dr. Jayaraj, Dr. Kendadmath, Dr. Hakkandi, Dr. Ashwin,Dr.lingaraddy, Dr. Muttu, Dr. Sibu( Apple), Dr.Payappagouder, Dr.prasanna,Dr.Nataraj, Dr. udayaganesh, Dr adarsh, Dr,Mukta, Dr.Shailej. I take this moment to express my thanks to all my Post Graduate friendsDr.Channaverswami, Dr.Krishna, Dr.Gavi, Dr.Sarvi. Dr.Kalmath, Dr.Ashok,Dr.Kendadmath, Dr.Sajjanar, Dr. Basavaraj Ganti, Dr.Pradeep, Dr.Venkareddy, ,Dr.Sunita, Dr.Bingi, Dr.Ratan, Dr.Uday, Dr.Hugar, , Dr.Ashwini, , Dr.Shalini, Dr.Shivaleela, Dr. Sulochana, Dr.Jayashree Dr.Anita, and other post graduate scholar fortheir support. I am very much thankful to Smt. P. K. Belavadi, Mr. M. M. Joshi, Mr.Shankar, Mr. Biradar, Mr. Dasar and Smt. Sarangamath. ii
  • 9. Last but not least, I thank to the patients who are pillars of my research work,Khona pathology laboratory staff and Hospital staff and to all those names mymemory fails to recollect. I am very much thankful to M/s Pragati Xerox Center, Gadag for their timelyhelp bringing out this computer print. I express my thanks to all the persons who have helped me directly &indirectly with apologies for my ability to identify them individually. Dr.Vijaykumar.G.Hiremath. iii
  • 10. LIST OF ABBREVIATIONS USEDAH. - Ashtanga hridayaAS - Ashtanga sangrahaBMI - Body Mass IndexBP - BhavaprakashaCH - CharakaFFA - Free Fatty AcidsGR - Good ResponceHDL - High Density LipoproteinsKa - Kashyapa samhitaLDL - Low Density LipoproteinsLCD - Low Caloric DietMiR - Mild ResponceMN - Madhava nidanaMoR - Moderate ResponseNo. - NumberPt.’s - PatientsRW - Relative WeightSi - Serial numberSu. - SushrutaSD - SharangadharaVa - VagbhataYR - Yogaratnakara iv
  • 11. Abstract: In Ayurveda chikitsa is broadly classified into two parts shodhana andshamana. Here also shodhana occupies first place. Among five shodhana proceduresVasti is one among them and it has been called as Ardhachikhtsa. Sthoulya is considered under Ashtanidhita purushas. The persons life who issuffering from sthoulya roga becomes miserably pathetic because of the doshas likehampered physical activity, hampered sexual life, extreme lassitude, proneness todangerous diseases, above all decreases the span of life. Obesity is an upcomingburning problem and it is the mother of all the diseases. Hence the present study i.e.evaluation of efficacy of Bhadradi Asthapana vasti in sthoulya is under taken to assessthe effect of this vasti over sthoulya. The objectives of the study are to evaluate the efficacy of Vastikarma insthoulya and evaluation of efficacy of Bhadradi Asthapana Vasti in sthoulya. Thestudy is a prospective clinical trail in a single group of 30 patients where all thepatients received Bhadradi Asthapana Vasti for 8 days in yoga vasti krama and ascomponent of yoga vasti schedule Anuvasana vasti with Murchita tila taila is used.And a parihara kala (follow up) of 16 days is given. Subjective parameters are the chief and associated complaints of sthoulya.And objective parameters are weight, BMI and body circumference. Assessments aredone before and after the treatment. Among 30 patients 2 (6.66%) patients were shown good response i.e. above70% in signs and symptoms, 17 (56.66%) patients responded moderately i.e. 50-70%in signs and symptoms and 11 (36.66%) patients responded mildly i.e. 36.66% insigns and symptoms. all the subjective and objective parameters showed highlysignificant. v
  • 12. Sthoulya is a medo doshaja vyadhi and also one among the kaphaja nanatmajavyadhis. As kapha and meda are having ashrayashrayi bhava. Vata is considered asupadravakaraka in sthoulya. The vastidravyas are having the property of kaphavatashamaka, lekhaniya, etc. This vasti acts as karshana vasti too. So this Bhadradiasthapana vasti is an apt choice in sthoulya.Key words: Bhadradi asthapana vasti ; sthoulya ; BMI ; obesity ; meda doshja ;lekhaniya ; kaphaja nanatmaja vyadhi ; Ashtanidhita purusha ; yoga vasti ; good,moderate and mild response. vi
  • 13. TABLE OF CONTENTS Chapters Page No1. Introduction 01 - 032. Objectives 04 - 063. Review of Literature 07 - 1004. Methodology 101 - 1115. Results 115 - 1356. Discussion 136 - 1547. Conclusion 155 - 1578. Summary 158 - 1599. Bibliography 160 - 18010. Annexure vii
  • 14. List of TablesSI Tables PageNo No1 Showing the Classification of Vasti according to site of application 162 Showing the external Vasti procedures. 163 Showing the Classification of Vasti on sankya 174 Showing the Classification of Vasti on karma 175 Showing the measurements of Vasti Yantra 196 Showing the Netra Doshas and its effects 207 Showing the Putaka Doshas and its Effects 218 Showing contraindications for Anuvasana Vasti. 229 Showing the Dose schedule of Nirooha Vasti 2410 Showing the Patients contraindicated for Aasthapana 26- 2711 Showing the Patients indicated for Aasthapana 27- 2812 Showing the Proper, insufficient & excessive signs and symptoms of 30 Anuvasana Vasti13 Showing the Proper, insufficient & excessive signs and symptoms of 31 Niroha Vasti14 Showing the distribution of fat 4115 Showing plasma lipid values 4316 Showing classification of fatty acids 4717 Showing Aharaja Nidhana 5318 Showing the Viharaja Nidhana 5419 Showing Manasika Nidan 5420 Showing Anya Nidana 5421 Showing Rupas of Sthoulya 6422 Showing Pramana Pariksha 6623 Showing Normal Height & Weight 6724 Showing Grading Pattern as per BMI values 6825 Showing Optimal BMI values 6826 Showing updrava of stoulya 7827 Showing the Sadhyasadhyata of Sthoulya 8128 Showing samshodhana therapies of Sthoulya. 8229 Showing Pathya for Sthoulya 91- 9230 Showing Aharaja Pathyapathya 9331 Showing Viharaja Pathyapathya: 9332 Showing Manasika Pathyapathya 9333 Showing the Drugs of Bhadradi Asthapana VastiYoga 9434 Showing the textule Dose of Bhadradi Asthapana Vasti Yoga 9435 Showing Properties of Trial drugs 95- 9636 Showing Dosh & Roga prabhava, Chemical Comp and karma of Trial 96- drugs 9737 Showing the Materials used for Lipid Profile 107 viii
  • 15. 38 Showing data related to subjective parameters before and after treatment 11239 Showing data related to objective parameters before and after treatment 11340 Showing Demographical data related to evaluation of efficacy of Bhadradi 114 Asthapana Vasti in Sthoulya.41 Showing the incidence and overall response in age. 11542 Showing the incidence and overall response in sex. 11643 Showing the incidence of religion in the Sthoulya patients 11644 Showing the incidence and overall response in marital status 11745 Showing the incidence and overall response in occupational status 11746 Showing the incidence and overall response in socio-economic status 11847 Showing the incidence of Positive and negative family history in Sthoulya 11848 Showing the incidence of Chronicity of obesity 11949 Showing the incidence of Dietary habits 11950 Showing the incidence of Diet Pattern 12051 Showing the incidence of Aahara guna 12052 Showing the incidence and overall response of Agni of the patient 12153 Showing the incidence and overall response of Koshta of the patient 12154 Showing the incidence of Predominant Rasa 12255 Showing the incidence of Vyaayaama in Sthoulya patient 12356 Showing the incidence of Vyasana in Sthoulya patient 12357 Showing the incidence of Nidra of the sthoulya patient 12458 Showing the incidence and overall response of Prakruti of the patient 12459 Showing the incidence of Sara of the Sthoulya patient 12560 Showing the incidence of Samhanana of the Sthoulya patient 12561 Showing the incidence of Pramana of the Sthoulya patient 12662 Showing the incidence of Satmya of the Sthoulya patient 12663 Showing the incidence of Satva of the Sthoulya patient 12764 Showing the incidence of Abhyavaharana Shakti of the Sthoulya patient 12765 Showing the incidence of Jarana Shakti of the Sthoulya patient 12866 Showing the incidence of Vyayama of the Sthoulya patient 12867 Showing the incidence and overall response of weight 12968 Showing the incidence of height of the Sthoulya patient 12969 Showing the incidence and overall response of BMI in Sthoulya 13070 Showing the incidence and overall response of the nidanas of Sthoulya 13071 Showing the incidence of chief complaints of Sthoulya 13172 Showing retention time of Anuvasana and Nirooha vastii 13173 Showing incidence and result of Serum Cholesterol levels 13274 Showing incidence and result of Serum Triglycerides levels 13275 Showing incidence of Serum HDL levels 13276 Showing incidence of Serum LDL levels 13277 Showing incidence and result of Serum VLDL levels 13378 Statistical results of Lipid profile 13379 Showing the overall assessment 13480 Showing the Individual study of the parameters to show significance 134 effect before and after the treatment ix
  • 16. LIST OF GRAPHS, FLOW CHARTS, FIGURES AND PHOTOGRAPHS Si Page Title of Graphs No No1 Graph Showing the incidence and overall response in age. 1152 Graph Showing the incidence and overall response in sex. 1163 Graph Showing the incidence of religion in the sthoulya patients 1164 Graph Showing the incidence and overall response in marital status 1175 Graph Showing the incidence and overall response in occupational status 1176 Graph Showing the incidence and overall response in socio-economic 118 status7 Graph Showing the incidence of Positive and negative family history in 118 sthoulya8 Graph Showing the incidence of Chronicity of obesity 1199 Graph Showing the incidence of Dietary habits 11910 Graph Showing the incidence of Diet Pattern 12011 Graph Showing the incidence of Aahara guna 12012 Graph Showing the incidence and overall response of Agni of the patient 12113 Graph Showing the incidence and overall response of Koshta of the 121 patient14 Graph Showing the incidence of Predominant Rasa 12215 Graph Showing the incidence of Vyaayaama in sthoulya patient 12316 Graph Showing the incidence of Vyasana in sthoulya patient 12317 Graph Showing the incidence of in Nidra of the sthoulya patient 12418 Graph Showing the incidence and overall response of Prakruti of the 124 Sthoulya patient19 Graph Showing the incidence of Sara of the sthoulya patient 12520 Graph Showing the incidence of Samhanana of the sthoulya patient 12521 Graph Showing the incidence of Pramana of the sthoulya patient 12622 Graph Showing the incidence of Satmya of the sthoulya patient 12623 Graph Showing the incidence of Satva of the sthoulya patient 12724 Graph Showing the incidence of Abhyavaharana Shakti of the sthoulya 127 patient25 Graph Showing the incidence of Jarana Shakti of the sthoulya patient 12826 Graph Showing the incidence of Vyayama of the sthoulya patient 12827 Graph Showing the incidence and overall response of weight 12928 Graph Showing the incidence of height of the sthoulya patient 12929 Graph Showing the incidence and overall response of BMI in sthoulya 13030 Graph Showing the incidence and overall response of the nidanas of 130 sthoulya31 Graph Showing the overall assessment 134 x
  • 17. Sl Title of Flow Chart PageNo No1 Flowchart illustrating probable mode of action of vastikarma 372 Showing the schematic representation of samprapti of sthoulya 723 Schematic representation of Upadrava Sthoulya 79 Title of Figure1 Exogenous & Endogenous fat transport pathways are diagrammed 402 Showing classification of lipids 413 Showing causes of obesity 554 Showing etiology of obesity 76 Title of Photo1 Photography showing method of seeing the skin fold thikness2 Photography showing kwatha dravyas3 Photography showing kalka dravyas4 Photography showing prakshepaka dravyas and vasti procedure5 Photgraphy showing the Diagnostic instruments of Obesity xi
  • 18. IntroductionIntroduction: According to ancient Indians, the treatises that encompass the wholeknowledge of universe are the Vedas. They are four in number viz, Rigveda,Yajurveda, Samaveda, and Atharvaveda. Among these, since the Atharvaveda mainlydeals with different facts of health welfare, it is considered to be the predecessor ofAyurveda. The term Ayurveda is connected to this system because it gives theknowledge of the whole of the ayu (the life) to say in brief, the heralds of each andevery fact of life from birth to death; or, in other words the creations, sustenance anddestruction phenomena are elaborately explained. This was the reason for which theaffix Veda is added to ayurveda only even though a good number of other sciencestoo did exist in ancient India. Ayurveda is the science of life, its main objectives being to relive humansuffering and to import healthful longevity. The ayurveda envisages the means ofprevention and treatment of various ailments and preservation of health. This isachieved through appropriate regimes of ahara, vihara, and aushadhas. Systemicsamshodhana of the body has been conceived to be the prime pre requisite for allkinds of preventive and curative procedures. These purificatory procedures consist ofvariety of physico- physiological measures. Panchakarma therapy represents a similarintegrated procedure. It may be pointed out that besides being of preparatorysignificance, samshodhana karmas form a full therapy in themselves for a variety ofailments. Panchakarma therapy is designed to eradicate the vitiated doshas and tomaintain a state of normalcy and equilibrium, which is the fundamental basis ofhealth. The beauty and power of Ayurvedic purificatory therapy is its system forguiding the toxins to their sites for elimination. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 1
  • 19. Introduction The term Panchakarma consists of 2 words ‘Pancha’ and ‘Karma’. Panchameans five and also ‘visthara’ i.e. elaborate and karma means method of treatment i.e.five fold therapy ViZ., Vamana, Virechana, 2 types of vastis and Shirovirechana(Nasya). Vasti is further sub divided into two: Anuvasana and Nirooha vasti. Niroohavasti is also known as Asthapana vasti. Sushruta includes Raktamokshana also underthe Panchakarma. Among them acharyas have given prime importance to Vastikarmaand even termed as Ardhachikitsa.1 Vasti enjoys the same significance inpanchakarma therapy as the panchakarma therapy itself enjoys in chikitsa in general.It is praised as Aakeshagranakhagrebhyo vasti naran 2 by kashyapa. In the present days the man has to run with the time and he is trying to leadmechanical life. Though he knows the ill effects of such mechanical life, he madehimself victim to it by suffering with many disorders, among these sthoulya is aglobal problem and more common in modernized man and in present era. This sthoulya is considered as Santarpanajanya vyadhi and one among theAshta nidhita purushas and also as Kaphajananatmaja vyadhi. The obesity is the certainly the mother of dangerous diseases3 and mostburning problem in the present society. Obesity has become an epidemic in 21stcentury.4 It is a bitter truth to swallow about every 4th person on earth is too fat.Obesity is fast becoming one of the worlds leading reason why the people die.5According to WHO this obesity is considered as secondary in the list of dangerousdiseases in the world. And there are so many remedies are put forwarded till now likesurgical lipisection, treatments etc. but their are so many complications are observedwith those. Due to lack of knowledge about the diet & rules for taking the food this isgreatly observed in the developed countries like USA that showing approx one in sixor 39.8 million people and over 300 million adults 2 worldwide (WHO world health Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 2
  • 20. Introductionreport, 2003) were suffering from obesity6. They are searching for the solutions eitherby dietary things as well as keeping stress on need of exercise. So by observing thesefacts & statistics prevalence of over weight and obesity is also more in India. Solooking for a better management is needed. It is necessary to implement the chikitsa sutras mentioned by our acharyas inreducing the sthoulya / sthulata / medovriddi. So that one can lead a happy lifewithout misery. Vastikarma has doing wonders in the treatment of ayurveda. Though it is theprime treatment for vata, it acts on pitta, kapha, rakta and on sannipataj vyadhis. It hasits effect on shakhagata doshas also and it does its functions on the basis of differentdravya formulations like as Krisham Brimhayati, Sthulam Karshayati, Doshashodhana, Shamana etc. So it is forbidden moral responsible of Ayurvedic scholar to search anyeffective and curative procedure and drug from the Ayurvedic treasure oftherapeutics. In classics so many treatments are said for this sthoulya. There are somany types of vastis are explained for sthoulya like Teekshna vasti, Lekhana vasti etcamong these Bhadradhi Asthapana Vasti is one. So in the present study evaluation ofefficacy of Bhadradi Asthapana Vasti in sthoulya is taken for the study. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 3
  • 21. ObjectivesObjectives: • In today’s era the people want to leave a luxurious, sedentary life style with an improper dieting habits. Such as over eating, consuming high caloric, highly processed foodstuffs. This may lead to the over accumulation of fat in the body. • By seeing the pathology of Sthoulya i.e., accumulation of fat in different parts of the body it seems to be same as obesity of modern science. • The major risk related with Sthoulya is that, it favors complicated pathologies like Prameha, kushta, shwasa, kasa, vatavyadhi, etc. and it is well established fact that, obesity invites life threatening complications like cardiac diseases, HTN, DM, arterioscleroses, strokes, gallbladder diseases, cancers etc. obesity is a chronic disorder if unchecked will reduces the life expectancy and contributes to the increasing rate of morbidity and mortality. So it is widely said, “Longer is the size of the belt Shorter is the span of life”. • Though Sthoulya is considered as one among the ashtanindita purusha and stated as Sthoolasya Na hi bheshajam. But it is the demand of the time to treat him rationally with positive multidimensional approach, so that life expectancy can be hiked and he can be prevented from dreadful diseases. • In cotemporary medicine the treatment modalities like some appetite suppressants and other surgical modalities are explained among the drugs used in the management of obesity amphetamine has a limited scope because of its benefit for a short-term goal and being contraindicated in coronary heart diseases, HTN etc. secondly Fenfluramine has associated with adverse effects like nausea, diarrhea, lethargy, breathlessness etc.and some complications due to the surgery7.Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 4
  • 22. Objectives • By seeing the above said hazards because of the disease and the complications arising from the drugs used in contramprary medicine, it seems to be good to look at the ayurvedic remedies. Guru cha Apatarpana, Vaatagnha, Sleshmomedoharani, Vyaayama, Rukshana,and Shodhana are the principles of treatment for Sthoulya, Guru cha Apatarpana,Vaatagnha, Sleshma medohara in the form of annapana, form’s a major treatment ofsthoulya. Nidana parivarjana will helps in cessation of further accumulation of meda.Vyaayama that to aerobic exercise helps an individual to reduce weight, Rukshana inthe form of Udvarthana help in mobilization of Sthanika meda. Shodhana in the formof vamana virechana are less stressed upon in treatment of Sthoulya. But most ofVasti yoga’s are much emphasized that to ushna, tikshna, lekhana and karshana vasti,which helps in combating kapha, vata dosha & meda dhatu, considering this aspect inpresent study an attempt is made to find suitable remedy for sthoulya as mentionedspecially by the sushruta samhita i.e.Bhadradi Asthpana Vasti8 is taken andhypothetically the following objectives are evalued • Evaluation of efficacy of vastikarma in Sthoulya. • Evaluation of efficacy of Bhadradi asthapana vasti in Sthoulya1. Evaluation of efficacy of Vastikarma in Sthoulya: Sthoulya is a disease in which the vata gets prakopa by the margavarodha ofati upachita meda and does the agni sandhukshana, which leads to increased intake offood, and in further it produces more complications. So in the samprapti of Sthoulyavata dosha plays a major role. Due to the margavarodha by the meda the vata which is freely moving all overthe body is obstructed and that obstructed vata comes back to the koshta andaggravation of vata takes place when mixes with shamana vata then leads to the agni Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 5
  • 23. Objectivessandhukshana. So this derangement of the vata may be corrected by this vasti, as vastiis the prime and important treatment modality for vata. So it may helps to avoid thecomplications. Depending upon the different dravya formulations in vasti yoga, it carries outthe functions like dosha shodhana, brimhana in krisha and karshana in sthoola.Being an important chikitsa for vata this vasti will act on other doshas also like pittakapha rakta etc.as it does the karshana in sthoola it may help in reducing the lipidvalves. The action of vasti is also seen on asthivaha and majjavaha srotases, as saraktameda is considered as majjagata meda it may helps in reduction of meda and lipidvalues. This vasti is having the effect over shakhagata doshas, so it may relieve themargavarodha caused by ativruddha meda.2. Evaluation of efficacy of Bhadradi Asthapana Vasti in Sthoulya: As Sthoulya is formed by taking kaphakara ahara viharas. And Sthoulya ismedodoshaja vyaadhi. Kapha and meda are having ashrayashrayi bhava and in thesamprapti vata is also one of the pathological entity. So it is necessary to subside bothkapha and vata In this Bhadradi asthapana vasti most of the drugs are having the properties ofalleviating the kapha vata doshas. Which may helps to check the samprapti ofSthoulya. And some of the drugs like devadaru, vacha, madanaphala etc. are havingthe qualities of doing lekhana karma. Tailas used in this vasti i.e. tila taila andsarshapa taila are having the property of doing the karshana of meda the prakshepakadravyas like gomutra, kanji etc. will do karshana of meda and helps to reduce thedeposition of meda and in turn this vasti may check the pathology of Sthoulya. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 6
  • 24. Historical reviewHistorical Aspect of Vasti: All classical treatises of Ayurveda have emphasized the importance ofVastikarma as the most effective therapeutic measure than any other such methodsprescribed for various ailments especially in the diseases occurring due to vatadosha.Charaka Samhita9: Charaka has described Vasti elaborately and out of twelvechapters of Siddhi Sthana, 8 are contributed to Vasti and explained about Vastikarma,uses, complications, advantages of vasti. First two chapters of Siddhisthana deals withproperties of Vasti Samyakayoga, Ayoga Lakshanas, indications and 10contraindications of Vasti. Teekshna type of vasti is indicated for sthoulya . Thisdenotes the importance of Vasti in the field of panchakarma.Sushruta Samhita: He advised lekhana type of vasti in sthoulya11. In SushrutaSamhita, four chapters have been devoted completely for the description of the Vastiin Chikitsa sthana. In which he has elaborately described the Vastikarma procedures,about vastiyantra, types of vastis, classification, complications, management, etc12Ashtanga Sangraha13: 28th chapter of Sutra Sthana has been devoted to Vasti only.In addition four chapters of Kalpa Sthana also deal with Vasti.Ashtanga Hridaya14: In this text, 19th chapter of Sutrasthana-Vasti Vidhi and 4th and5th chapter of Kalpasthana named as Vasti Kalpa and Vasti Vyapada Siddhi explainthe every aspect of Vasti.Kashyapa Samhita15: In Kashyapa Samhita, Vasti has been explained in detail inSiddhisthana and in 8th chapter of Khilasthana. He equated the vastikarma as A«dm£d«dŠbecause of its wide applications even in both infants and old age.Sharngadhara samhitha16: He has given much importance to vastikarma with theprevious acharyas methods of explanations in 3 chapters, including uttaravasti. And the acharyas like Yogaratnakara, Bhavaparakasha and Vangasena17 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 7
  • 25. Historical reviewexplained about the vasti karma beautifully and mentioned newer combinations inthe Ayurvedic world for a better practice.Historical aspect of Sthoulya : “ The entire core of the universe is enlightened, in its true form, by the lampof history, the destroyer of veil of ignorance” - Mahabharata adiparva 1:27.Historyabout Sthoulya can be reviewed as following,Veda kala (1000-500 BC): Veda is called as Dean of science. And it is the firstsource of literature and knowledge that narrates the medical science logically.Though, detail description regarding sthoulya (obesity) is not available, somescattered references are available they are listed below, In Rigveda18 the words Meda and Vasa are mentioned. In Yajurveda19 Upachita a name of the disease has been mentioned. In Atharva veda the words like medina20, pivasi21, and medas22are available forSthoulya. It has been advised to strengthen and harden the body like a stone, i.e.expressed the hazards of flabbiness of the body and Sthoulya23.Samhita kala: (200B.C – 400 A.D)Charaka samhita (2 B.C): He is praised as father of medicine the sthoulya isconsidered as Sleshma Nanatmaja vikara.24 Santarpana Nimittaja vikara25 &Adhikadoshayukta Roga26. Beeja swabhavaja is considered as one of the cause forstoulya27. Detailed Anthropometry is described under the caption of PramanaPariksha28 As Samshodana yogya,29 Taila sevana yogya,30 It’s Nidana, Rupa,Samprapti, Chikitsa is been explained in 21st chapter of sutrastana.Sushruta Samhita (2 A.D.): The father of surgery. Nidana, Rupa, Samprapti,Chikitsa of Sthoulya are narrated.31 It is the resultant of vitiated Meda Dosha.32 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 8
  • 26. Historical reviewIt is described as a Rasa Nimittaja Vyadhi.33. And a new synonym Jatharya has beenused for Sthoulya34Ashtanga Samgraha (6 A.D), Ashtanga Hridhaya (6A.D.): Sthaulya is consideredas a disorder of Shleshmadosha seated in Medodhatu35. Classification of Sthoulya andtheir management36. Pathogenesis and symptoms of Sthoulya are highlighted37.Vitiation of Meda in pathogenesis of Arsa38. A new Paryaya Sthavima is explainedfor sthoulya.39Kashyapa Samhita: (6A.D):Rakta mokshana specially Siravyadha is indicated forthe medhasvidhatri.40Sthoulya is considered as one among the ashtanidhita pururshawhile explaining the anthropology41.Bhela Samhita (7 A.D.): In Bhela samhita Sthoulya is described as a disorder ofvitiated Meda 42Madhava Nidan (7 A.D): Madhavakar has elaborated the pathophysiology of thisdisease based on fat tissue and fat depot site.43 The clear symptomatology of sthoulyaincluding some additional symptom like moha, has been elaborated.44Sharangadhara Samhita (13th Century): He described Sthoulya by nameMedodosha and Medodosha is only one type and it is due to vitiation of Vata.45 He isthe pioneer to described the role of vrikka (renal & suprarenal glands) in thenourishment of Jatharastha meda (abdominal fat and omentum).46Samgraha kala and commentators:Chakrapani (11th Century):In line of treatment of Sthoulya he has commented thatguru and Apatarpana property helps to alleviate Kshudha and reduce Medarespectively.47 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 9
  • 27. Historical reviewDalhana (12th Century): Explains regarding Ama formation in tikshnagni,Regarding line of treatment he has interpreted virukshana as medoghna andchhedaniya as sroto vishodhana.48Indu (13th Century: He has given explanation of Saktu, Loha etc. words used in theline treatment of Sthoulya.49Arunadutta (13th Century): The word “sthavima” has been used for the sthoulya,explained on the basis of etymology in sarvanga sundari commentary in AstangaHridaya.50Hemadri: (13th Century): He had advised to take choorna of Yavani, Madukajalamas Madhu mishrita udaka Dandahata as Takra, Agnimantha as Tarkari, Kshara asYavakshara, while management of Sthoulya in his Ayurveda Rasayana commentaryon Astanga Hridaya.51Adamalla (14th century) & Kashiram (17th century): He explained definition ofSarakthameda is the one which is situated inner to the majja of the sthulasthi.52 Medodosha is of only one type and it is of vata pradhana is explained in kashirams gudarthadeepika.53Vangasena (12th century): Explains Karana, Samprapti, laxana, Chikista of Sthoulyain Medorogadhikara.54Bhava Prakasha (16th century): He explains about the nidana laxana andcomplications of Sthoulya in the chapter named as Sthoulyadhikara.55Yogaratnakara :(17th century): Explains Sthoulya under Medoroga nidanachikitsaadhyaya. Various herbo-mineral preparations been prescribed in the management ofSthoulya roga.56Review of previous work: Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 10
  • 28. Historical review Number of research works on the sthoulya under taking as various titles likesthoulya, obesity, Medoroga, Hypercholesteremia, Hyperlipidemia etc. Anti Cholesterolaemic effect of fenugreek (methi). – By Chakravarti. S. And Mitra .S. Dept of Home science, Calcutta submitted in national conference conducted on 2-4 April 1998. Effect of boiled Barley-rice-feeding in Hypercholesterimic and Normolipidaemic. -By Ikegami.S, Tomita. M., Honda.S, Yamaguchin, Muzukajya from National Institute of Health and Nutrition. Suinjuko, Tokio published in plant foods for human nutrition, volume – 49, p.no – 317-328, 1996. Medodhatvagni ka Sthoulya Roga ke Sandarbha mein Saindhantika Evam Prayogika Adhyayan, by Vasudeva, Department of Basic Principles, Jamnagar, 2001. 4) The role of certain Ayurvedic anorexiant drugs in the management of Sthoulya (obesity), by Pandya Amrish (Ph.D.), Department of Kayachikitsa, Jamnagar, 1999. A Clinical study on the management of Sthoulya by Panchtikta and Lekhana Vasti by. Rekha Savajani, Department of Kayachikitsa, Jamnagar, 2001. Aetiopathological study of sthoulya (obesity) and assessment of the effect of the Devadarvyadi vati and virechana karma, by Sarika Mehta, Department of Kayachikitsa, Jamnagar, 2003. A comprehensive study of “Chakramarda” with special reference to “Sthoulya”, by Zala Jyotsanaba, Department of Dravyaguna Jamnagar, 1998. A comprehensive study on Madhu & its role in the management of medoroga, by Charushila Giri, Department of Dravyaguna Jamnagar, 2000. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 11
  • 29. Historical review An assessment of activities of Ruksha guna with special reference to Sthoulya, by Anand Buchake, Department of Dravyaguna Jamnagar 2002. A comparative pharmaceutico-clinical study on Shilajeet (Triphala shodhita and Gomutra shodhita) and its effect on Medoroga, by Jagdev S.R., Department of Rasashastra and Bhaishajya, Jamnagar 2002. A Pharmaceutico - Pharmaco clinical study on guggulu w.s.r. to its medohara effect, by Rajput Anurag Singh, Department of Rasashastra and Bhaishajya, Jamnagar 2003. Conceptual and clinical study of “Sthoulya” Roga and its management with a selected indigenous compound, by Shah Hema A., Govt. Ayurveda College, Dept. of PGKC of Kayachikitsa , Ahmedabad, 1998. Comparative study of Lekhana therapies in the management of Sthoulya, by Ananda Prasad Nayak, Govt. Ayurveda College, Dept. of PGKC of Kayachikitsa , Ahmedabad, 2003. Study on inter-relationship between Medoroga and Prameha, by Priyadarshini, Banaras Hindu University Dept. of Kayachikitsa, Varanasi, 1999. A clinical study of Medoroga (obesity) with herbomineral compound, by Roy Krishna, Dept. of Kayachiktsa, Calcutta, 1999. Clinical evaluation of Bala Haritaki on serum cholesterol, by Sood Rajiv, Dept. of Kayachikitsa, Jaipur, 1999. Sthoulya vyadhi par Navayas loha ka parinam – Ek Adhyayan, by Pathan S. K., Dept. of Kayachikitsa, Nanded, 1998. Amrutadi Guggulu nirman Evam uske medovah karma ka aturalayin Adhyayan, by Kanholkar N.T., Dept. of Kaya Chikitsa, Nagpur, 2000.Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 12
  • 30. Historical review To study the efficacy of the Lekhan Vasti in Sthoulya, by Sabde M.S, Dept. of Panchkarma, Pune, 1999. The study of Lukewarm water (Koshna Jala) on obesity, by Velhal A.R., Dept. of Swasthvritta, Pune, 2000.Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 13
  • 31. VastikarmaVastikarma: Vasti is the major procedure among Panchakarma therapy. Vasti enjoysthe same significance in panchakarma therapy as the panchakarma therapy itselfenjoys in chikitsa in general. Vasti is mainly indicated in vata – predominantdiseases. The two types of abnormalities of vata namely, Avarana andDhatukshaya can be treated by vasti karma. Direct application of this kind oftreatment to pakwashaya (colon) helps not only in regulating and co-ordinatingvata dosha in its site, but also controls the other doshas involved in thepathogenesis of the disease. The term vasti means bladder it is used as a device forvastikarma. Hence, the term vasti has been used in Panchakarma therapy todesignate the process. It is also said that medicine administered through vastiyantra, first it reachs the lower abdominal area of the patient which contains theorgan vasti (urinary bladder). Due to these reasons the term vasti is used inPanchakarma. In modern medicine, enema is mainly given to remove the faces from thelarge intestine while in Ayurveda; Vasti is given as a route of administration ofthe drugs for multiple actions, which acts locally on large intestine as well assystematically on the body tissue.Etymology of vasti: According to Vachaspatyam, the word ‘Vasti’ has its origin from the root‘Vas’ with the suffix of Pratyaya ‘Tich’ to give raise the word ‘Vasti’ and it belongs to masculine gender. • ‘®d±dg e¦d®dd±dy’ 57 - Means residence. • ‘®d±dŠ-AdŸŸddQ¦dy’ - That which gives covering. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 13
  • 32. Vastikarma • ‘®d±dŠ ®dd±d¦dy ±dgTeªdI¶TPdî’ - That which gives fragrance. • ®de±£d ®d±£dy Ad®dm¦ddye£d «dgÎd«d - That which covers the urine. • ‘¦ddeªdTŠ A¥ddyªdd›dy «dgÎd¥ddTy’ - The position of vasti is just below nabhi (umbilicus) and is the collecting organ of urine in the body i.e. urinary bladder.Definition of Vasti: 1) ‘®de±£d¦dd QfSd£dy Be£d ®de±£d ’ 58 2) ‘®de±£deªdTŠ QfSd£dy Sd±«dd£dŠ £d±«dd£dŠ ®de±£dTŠ Be£d ±«d g£d:’ 59 3) ‘®de±£d¦dd QfSd£dy ®de±£de¦d ®dd §dg®d‰«d¦SddÏd®d±£ddy ®de±£d’ 60 As the apparatus used for introducing the medicine is made up of Vasti(animal urinary bladder), therefore it is known as Vasti. The medicine, which maybe, medicated decoctions, milk, oil, ghee, mamsarasa of prescribed quantities aretaken in the Vasti and administered through gudamarga by means of a deviceVastinetra after proper pre-treatment procedures. 4) Though in general the term vasti is applied for all kinds vastis such asnirooha vasti, anuvasana, uttara, shiro vasti etc.the charakas description of vasti,as interpreted by chakrapani and jejjata, appears specific for nirooha vasti.61 5) Charaka defines Vasti as the procedure in which the properly prepareddrug is administered through rectum, reaches up to the Nabhi Pradesha, Kati,Parshva and Kukshi, churns the accumulated Dosha and Purisha, spreads theunctuousness (potency of the drug) all over the body and easily comes out alongwith the churned Purisha and Doshas is called Vasti.62 According to modern medicine, enema is the procedure in which anyliquid preparation is introduced through rectum by means of adequate instruments(Ghosh) or injection as liquid or gas into the rectum. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 14
  • 33. VastikarmaImportance of Vastikarma: - Different acharyas appreciated this form oftreatment considering the efficacy it generates. No other elimination therapy isequal to vasti because of its quick action to produce the desired effects likeshodhana or tarpana without causing any adverse effects. It is evident that the oraladministration medicines for virechana therapy may produce the symptoms likeabdominal distress, nausea and distaste due to the katurasa, ushnaguna andteekhsna gunas the drugs used for this purpose.63 Moreover, virechana cannot beused as a method of shodhana in children and very elderly persons.64 In suchcondition vasti is the only treatment, which can produce the same effect as that ofvirechana.65 Among all the treatment modalities vasti is superior because it has gotmultidimensional therapeutic effect. By mixing with different drugs it willperform the actions like, samshodana, samshamana, krisham brimhayati, sthulamkarshayati etc.66 it is considered as one of the apt treatment for vata predominantdisease and designated as Ardhachikitsa .67 Vasti is not only best for Vata disorders it also equally effective incorrecting the morbid Pitta, Kapha and Rakta.68 While explaining the mode ofaction of nirooha vasti kashyapa explained as“AdIy¶¯dd›T¦dšdd›TyªSddy ©de±£d ©TŠ«UµSd£dy ¦dTd¦dŠ||” means it gives nourishment from the siras of kesha to the nakhagra i.e itnourishes whole body.69 It might be the reason why he equated the vastikarma as‘Amrutam’ because because of its wide application even in both infants and oldage.70Classification of vasti karma: In Ayurveda, wide scope of vasti therapy iscovered by many varieties of Vastis that can be applied in different states. Thefollowing classification of vasti may highlight this fact. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 15
  • 34. Vastikarma 711. Adhishtana bheda: According to the site of application, vasti is mainly classified into two: -A) Internal: Table no 1: showing the Classification of Vasti according to site of application The administration of medicine 1 Pakwasayagata vasti via ano-rectal route to pakwasaya The drug applied through 2 Garbhasayagata vasti vaginal route (Yonimarga) to the garbhashaya. The administration of medicine 3 Mutrasayagata vasti via urethral route to mootrasaya. The medicine administered 4 Vranagata vasti through the vranamukha by the process of vastikarma. Garbhasayagata & Mutrasayagata vastis are considered under Uttaravasti. B) External: In certain diseases, medicated oil is retained over the body part for a prescribed time and such method is also known as vasti in general. Table no 2: showing the external Vasti procedures. 1 Shiro vasti Allowing the oil to stay on the scalp for a stipulated time by using cap. 2 Kati vasti Allowing the oil to stay in the lumbo sacral region for a stipulated time by using flour paste. 3 Uro vasti Allowing the oil to stay in the chest region for a stipulated time by using flour paste.2) Sankhya bheda: It is stated that neither snehavasti nor niroohavasti can beapplied alone.72 So; Charaka has made this classification based on the number ofsnehavastis and niroohavastis in a treatment.73 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 16
  • 35. Vastikarma Table no 3: showing the Classification of Vasti on sankya bedaType of vasti No of Sequence of vasti Indication vastiKarma vasti 30 12 Niruha & 18 Anuvasna Uttama bala and Vata Vasti predominant (ka.khi.8/7)Kala vasti 16 6 Niruha & 10 Anuvasana Madhyama bala and vata Vasti Pitta predominant (ka.khi.8/8)Yoga vasti 8 3 Niruha & 5 Anuvasana Kapha predominant Vasti (ka.khi.8/9) 3) Karma bedha: Sushruta and Vagbhata have made the following classification according to their action.74, 75 Table no 4: showing the Classification of Vasti on karma beda 1 Shodhana vasti Contains shodhana dravyas and removes doshas and malas from the body. 2 Lekhana vasti Reduces medodhatu and produces lekhana in the body. 3 Sneha vasti Contains more of sneha and produces sneha in the body 4 Brimhana vasti Increases the rasadi dhathus and indirectly it helps in the growth of the body. 5 Utkleshana vasti Causes utklesha of malas and doshas by increasing its Pramana. 6 Doshahara vasti Purificatory or eliminating type 7 Shamana vasti Produces shamana of doshas. Sharangadhara added, shodhana vasti, lekhana, brimhana, deepana and pachana types of vastis.76Vataghna vasti, pittanashaka vasti, kaphanashaka vasti, balavarnakrita vasti, snehaneeya vasti, sukrakrit vasti, krimighna vasti, vrushatvakrit vasti has been explained by Charaka.77 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 17
  • 36. Vastikarma4) Matra bedha: The quantity may vary from person to person and it depends onrogi bala, roga bala and vaya of the patient. a) Dvadashaprasruta vasti – In nirooha, the maximum dose or quantityof vastidravya prescribed is dvadashaprasruta i.e. 24 palas.78 b) Prasritayogika vasti – Charaka has prescribed various types of niroohain different doses considering the strength of the patient and condition of thedisease.79 c) Padaheena vasti – matra of this vasti is 9 prasruthi.805) Anushangika bheda: - a) Yapana vasti – Enhances bala, shukra and mamsa. In treating the vyapats produced by excessive coitus. It can be practice daily.81 b) Siddha vasti – It increases the bala, varna, and prasanata.82 c) Yuktaratha vasti – Mainly indicated for travelers on vehicles etc.83 d) Vaitharana vasti –It is mainly concentrating on the elimination of doshas.84 e) Kshara vasti – Explained for shoolam, vitsangam, anaha, and mootrakrichra.85 f) Ardhamatrika nirooha vasti– snehana and swedana karmas are not required. Mainly it is indicated in rajayakhsma, shoola, and krimi and in vatarakta. It improves sukrha and ojus. 86 g) Picha vasti – It is given with pichhila dravyas like Shalmaliniryasa and lajjalu. It is indicated in pichhalasrava and jeevashonita. It acts as Sangrahi.87 h) Mutra vasti – It is Gomutra pradhana vasti it is mridu in nature, safe and pacifies the doshas.88 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 18
  • 37. Vastikarma i) Rakta vasti – It is indicated in adhika rakta srava.89Dravya bheda:90 Depending up on the nature of Vasti drugs i.e. Kashaya andSneha the Vasti is mainly sub-classified as • Anuvasana Vasti. • Niruha VastiVasti Yantra The device used for vasti karma is called as vastiyantra. Itcomprises by two parts – • Vastinetra • Vastiputaka Vastinetra The netra should be made of gold, silver, and copper or withother higher metals, alloys, long bones, bamboo, wood etc. Generally netra mustresemble like tail of cow with a tapering end and a wider base, or like pyramidshape with round ends and smooth surfaces.91 The dimensions are different fordifferent age group.Measurements of Vasti netra:92 93 Table no 5: showing the measurement of Vasti YantraAge Length Narrow end Base endBelow 1 year 5 angula Size of a wild green gram 1 angula1 - 6 years 6 angula Size of green gram 1 angula7 – 11 years 7 angula Size of black gram 1½ angula12 – 15 years 8 angula Size of kalayam 2 angula16 – 19 years 9 angula Size of soaked kalaya (chik pea) 2½ angula20 years and 12 angula Size of a karkandhu seed 3 angulaabove Uttaravasti yantra 12-14 Size of a sarshapa beejaAccording to susruta 94 1 6 Green gram Feather of kanku bird must pass through. 8 8 Black gram Feather of eagle must pass through. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 19
  • 38. Vastikarma 16 10 Kalayam Feather of peacock must through. >25 21 Kolasthi Feather of vulture must pass through.Pramana of vranavasti netra: The hole should be of a mudga pramana, with 8angulas of length.95Karnika: In order to prevent undue penetration of the vastinetra deep in to therectum, a karnika or rim has to be made. It is to be placed at a required pointabove the distal end. Two karnikas are provided on the netra at distance of 2angulas between one, another at proximal end to tie the vastiputaka properly.96Netra doshas and its effects. Acc.to Charaka 97Table no 6: showing the Netra Doshas and its effectsNo. Netradosha Features Effect1. Hraswata Too short Aprapti (Dravya will not reach pakwasaya)2. Deerghata Too long Atigati (Dravya go beyond the pakwasaya)3. Tanuta Too thin Kshoba (Produces irritation in the rectum)4. Sthoolata Too big Karshana (brussing the wall of the rectum)5. Jeernata Old dhatu used Kshanana (Injury to guda)6 Shithilabandhana Not fixed properly Srava (Dravya comes out) to the putaka7. Parshwachhidra Hole on side Guda pida (because of Leakage of dravya pain in the rectum will be observed)8. Vakrata Curved / irregular Jiwha gati (drava gati becomes irregular)Netra doshas and its effects. Acc. to sushruta, 98 1 Assannakarnika Karnika too near Karma becomes of no use 2 Prakrustakarnika Karnika too far Causes raktasrava by gudamarma peedana 3 Anusrotata Small hole Cannot perform properly 4 Mahasrotrata Broad hole Cannot perform properly Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 20
  • 39. VastikarmaVastiputaka: The container or bag used to carry the vastidravya, ready forapplication is known as vastiputaka. In ancient days the urinary bladder ofmatured animals like cow, buffalo, dear, pig, goat etc were used. It was thenprocessed to make soft and colorful by removing the blood vessels and otherimpurities. The container of the vastidravya is known as vastiputaka. And it should bemade suitable for well fitting with the vastinetra and should not have any badsmell. If good bladder is not available oter materials like skin of lower limb orneck of monkeys or other animals; thick cloth with sufficient strength and size arerecommended for the purpose.99 As the technology advances the development various types of materialsare available to make up of vastiputaka. The rubber bladder and polythene bagsare best choice these materials are disposable, safe and easy to perform. Vasti putaka doshas and its effects:100 Table no 7: showing the vasti Putaka Doshas and its EffectsNo. Putakadosha Features Effect1. Vishama Shape not in Gati vishamya (irregular flow of enema uniform fluid)2. Mamsala Muscular tissue Visratva (Produces offensive smell) present3. Chinnachidrayukta Presence of hole Srava (Dravya comes out)4. Sthoola Thick one Dourgrahya (difficulty in handling)5. Jalayukta Anastamosis Nisrava (exudation of enema fluid from present the receptacle)6. Vatala Excess air space Phenila (Frothy type of dravya)7. Ati Snigdha Unctuous Chyuti (Slip away form the hand)8. Klinnata Wet Adharyata (inability to hold the receptacle)A) Anuvasana vasti: -Definition:101“A¦dg®dd±d¦d Ae§d ¦dd Qg°Sd£Sd¦dgeQ®d±d«dŠ ®dd QfSd£dd B£Sdd¦dg®dd±d¦dd ||” Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 21
  • 40. Vastikarma It is Sneha pradhana vasti hence auvasana is named as sneha vasti. Thepeculiarity of this vasti is no adverse effects, it is safe, can be practice daily.Types:Based on the sneha matra it is of three types.102 1) Sneha Vasti: - 6 Pala (298ml) i.e.1/4th of the quantity of Nirooha. 2) Anuvasana Vasti: - 3 Pala (144ml) i.e. half of the Sneha Vasti. 3) Matra Vasti: - 1½ Pala (72ml) and this is the minimum quantity of Sneha Vasti.103Anuvasana yogya: 104,105,106 Anuvasana is indicated in patients who are indicated for asthapana, butspecial mention has been given to certain conditions like rooksha, kevala vatarogaand atyagni where anuvasana is more beneficial.Anuvasana ayogya: 107,108,109Table no 8: showing contraindications for Anuvasana Vasti.No. Contraindications Ch. Su. Va Complications1. Anasthapya + + +2. Abhuktabhakta + - + Sneha moves upwards3. Navajwara + - -4. Kamala + - + Leads to udara5. Prameha + - +6. Arshas + - - Leads to aadhmana7. Pratishyaya + - -8. Pandu + + +9. Arochaka + - - Leads to more annabhilasha10. Mandagni + - -11. Durbala + - - Increases the condition12. Pleehodara + + +13. Kaphodara + + + Leads to more dosha vardhana14. Oorustambha + - +15. Garapeeta + - +16. Kaphabhishyanda + - +17. Gurukoshta + - +18. Shleepada + - +19. Galaganda + - +20. Apachi + - +21. Krimikoshta + - +22. Prameha - + +23. Kushta - + +24. Sthoulya - + + Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 22
  • 41. Vastikarma25. Peenasa - - +26. Krushna - - +27. Varchobheda + - +28. Vishapeeta + - +B) Nirooha vasti:Definition: 110 ±dQdy°d e¦dTŠUµTPddŸJµTfTe¦dTdyUµPddÙd e¦déUµ || The Vasti, which eliminates the vitiated Dosha, thus provides strength tothe body, is called Niruha Vasti . ®dSd: ±¤dd§d¦ddQdSdg: ±¤dd§d¦dÙd Ad±¤dd§d¦d«dŠ || Its other important synonym is Asthapana. As it stabilizes the young age(Vaya Sthapana) and provided longevity (Ayu Sthapana), so it is called asAsthapana Vasti Nirooha vasti posseses varied therapeutic effects like shodhana;it makes the apakarshana of vit, sleshma, pitta and anila. It restores the dridata,bala Varna, shukra and it prevents the aging process.111Drugs used in Nirooha Vasti Karma: - Acharya susruta has mentioned numberof drugs used in the nirooha vasti. They are as follow, dugdha, amla, mautra,mamsasrasa, and lavana triphala, madhu, shatavha, sarshapa, vacha, ela, trikatu,rasna, devadaru, rajani, madhuka hingu, etc.112Contents of niroohavasti: 113,114,115The usual contents of nirooha vasti are: - 1.Makshika (honey) 2.Lavana (rock salt) 3.Sneha (oil/ghee/taila) 4.Kalka (medicines made as paste) 5.Kwatha (decoction) According to the condition of patient and disease other ingredients likemilk, mamsarasa, amla dravya, mutra and guda are also used.116Taila is selected Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 23
  • 42. Vastikarmaconsidering the disease and condition of patient. The paka of vasti taila should bestrictly mentioned as cikkanna paka.117 Drugs for kalka, if no drug is specificallymentioned shatapushpi choorna can be used.118Kwatha is the decoction made asper the ingredients selected rationally to suit the condition of the patient. madanaphala is the useful drug.Nirooha Vasti dravya yojana krama: Acharya vridda vagbhata has explainedthe mixing process of vasti dravya as in the order of makshika - lavana – sneha –kalka – kwatha – other prakshepaka dravyas. And this will be the procedure ofpreaping the solution of nirooha vasti.119Advantage of proper mixing: Honey, being auspicious, is first of all poured forauspiciousness. The salt disintegrates by its shrpness the sliminess, densenes andastringentness present in honey and thus a compound is formed, that is why afterhoney salt is added, then oil is poured. It brings uniformity (the content areproperly mixed together) and then put paste, it gets mingeled quickly and thedecoction brings homogeneity in this oligineous substance paste and decoctionmixed together then add urine it brings sharpness and increases its virya.120Dose schedule 121,122,123The adult dose of nirooha vasti is dvadasaprasrita i.e. 24 palas.Table no 9: showing the Dose schedule of Nirooha Vasti Sl Age in Dose No Years Ch Va Su 1. 1 ½ prasrita 1 pala 2 anjalis of patients hand i.e. 1 pala 2. 2 2 pala 2 pala 3. 3 3 pala 3 pala 4. 4 4 pala 4 pala 5. 5 5 pala 5 pala 6. 6 6 pala 6 pala 7. 7 7 pala 7 pala 8. 8 8 pala 8 pala 4 anjalis of patients hand 9. 9 9 pala 9 pala 10. 10 10 pala 10 pala 8 anjalis of patients hand Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 24
  • 43. Vastikarma 11. 11 11 pala 11 pala 12. 12 12 pala 12 pala 13. 13 14 pala 14 pala 14. 14 16 pala 16 pala 15. 15 18 pala 18 pala 16. 16 20 pala 20 pala To be fixed based on netra, 17. 17 22 pala 22 pala dravya pramana, age, bala 18. 18 – 70 24 pala 24 pala and saralaswabhava 19. Above 70 20 pala 20 pala 20. Above 25 12 prasthaContents and quantity of nirooha vasti: The quantity of nirooha is 12 prasrita,out of these 5-prasrita kwatha i.e. 10 palas. The sneha should be 1/6th, 1/4th and1/8th i.e. 4 pala, 6 pala, 8 pala in pitta, vata and kapha dosha respectively.124Innirooha. 24 palas of nirooha dose may be adjusted as follows: 1.Makshika – 4 palas. 2.Lavana – 1 karsha 3.Sneha – 4 palas. 4.Kalka – 2 palas. 5.Kwatha – 10 palas. 20 palas. The remaining portion should be made up by avapa dravyas (orprakshepaka dravyas) like gomutra, mamsarasa etc. i.e. 4 palas totals it to 24palas.According to Sushrutha 125 1.Makshika – 4 palas. 2.Lavana – 1 karsha. 3.Sneha – 6 palas. 4.kalka – 2 palas. 5.Kwatha – 8 palas. 6.Avapadravya – 4 palas Total quantity is 24 palas. This is the uttama matra of nirooha. It can be reduced upto 1prasrutaaccording to the need.126 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 25
  • 44. VastikarmaIndications and contraindications of Nirooha Vastikarma: As vasti is one ofthe prime treatment modality of Ayurveda, the knowledge of the indication andcontraindication will make the success in the treatment. A brief description hasbeen made here.Asthapana ayogya: 127,128,129Table no 10: Showing the Patients contraindicated for AasthapanaNo. Type of patient Cha. Su. Vag. Complication1. Ajeerna + + -2. Atisnigdha + - + Dooshyodara, Moorchha, Shotha.3. Peetasneha + - -4. Utklishtadosha + - - Teevra aruchi5. Alpagni + + +6. Yanaklanta + - -7. Atidurbala + + - Shaeerashosha, pranaparodha,8. Kshudhaarta + - - Kruchraswasa9. Trishnaarta + + -10. Sharmaarta + - -11. Atikrisha + + + More karshya, utklesha of dosha12. Bhuktabhakta + - + happens13. Pitodaka + - -14. Vamita + - + More rookshata happens15. Virikta + - +16. Krita nasyakarma + - + Manovibhrama, Srotonirodha17. Krudha + - - Vastidravya moves up18. Bheeta + - -19. Matha + + - Samnjanasha and20. Moorchita + + - Hrudayopaghata21. Prasaktachhardi + + +22. Prasaktanishteeva + - + Vastidravya moves up because of23. Swasaprasakta + + + the existing urdhwagati of vata24. Kasaprasakta + + +25. Hikkaprasakta + - +26. Baddhagudodara + - + Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 26
  • 45. Vastikarma27. Chhidrodara + - + Leads to death by causing severe28. Dakodara + - + distension of abdomen29. Adhmana + - +30. Alasaka + - -31. Visoochika + - - Causes teevra amavastha of the32. Asmadosha + - - body33. Amatisara + - +34. Madhumeha, + + + Vyadhi vardhakam Prameha35. Kushta + + +36. Arshas - + +37. Pandu - + -38. Bhrama - + -39. Arochaka - + -40. Unmad - + -41. Shokagrastha - + -42. Sthoulya - + -43. Kandhashosha - + -44. Kshathaksheena - + +45. Saptamasa - + + garbhini46. Bala, Vruddha - + -47. Alpavarcha - - +48. Gudashodha - - +49. Amaprajatha + - -50. Shopha - - -Asthapana yogya: 130,131,132 Table no 11 : Showing the Patients indicated for AasthapanaNo. Indication Ch. Su. Va No. Indication Ch. Su. Va1. Sarvangaroga + + - 37. Rajakshaya + + +2. Ekangaroga + + - 38. Vishamagni + - -3. Kukshiroga + - - 39. Spikshoola + - -4. Vatasanga + + + 40. Janushoola + - -5. Mutrasanga + + + 41. Janghashoola + - -6. Malasanga + + + 42. Urushoola + - -7. Shukrasanga + - + 43. Gulphashoola + - -8. Balakshaya + - - 44. Parshnishoola + - - Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 27
  • 46. Vastikarma9. Mamsakshaya + - - 45. Prapadashoola + - -10. Doshakshaya + - - 46. Yonishoola + + -11. Shukrakshaya + + - 47. Bahushoola + - -12. Aadhmana + + + 48. Angulishoola + - -13. Angasupti + - - 49. Sthanashoola + - -14. Krimikoshta + - - 50. Dantashoola + - -15. Udavarta + + - 51. Nakhashoola + - -16. Sudhatisara + + + 52. Parvasthishoola + - -17. Parvabheda + - - 53. Shopha + - -18. Abhitapa + - - 54. Sthmaba + - -19. Pleehadosha + - + 55. Aantrakoojana + - -20. Gulma + + + 56. Parikartika + - -21. Shoola + + + 57. Maharogoktavatavyadhi + - +22. Hridroga + - - 58. Jwara - + +23. Bhagandara + - - 59. Timira + + -24. Unmad + - - 60. Pratishaya - + -25. Jwara + - + 61. Adhimantha - + -26. Bradhna + + + 62. Ardita + + -27. Shirashoola + + + 63. Pakshaghata + + -28. Karnaroga + - - 64. Ashmari - + -29. Hritshoola + - - 65. Upadamsha - + -30. Parshwashoola + - - 66. Vatarakta - + -31. Prushtashoola + - - 67. Arshas - + -32. Katishoola + - - 68. Stanyakshaya - + -33. Vepana + - - 69. Manyagraha + + -34. Aakshepa + + - 70. Hanugraha + + -35. Angagaurava + - - 71. Ashmari - + +36. Atilaghava + - - 72. Moodhagarbha - + +Amlapitta, hridroga, asrugdhara133Amlapitta, hridroga, asrugdhara and Vishamanajwara 134Preparation and procedures of vastikarma: Generally, these procedures andpreparations are classified into three parts: - 1.Poorvakarma (pre-treatment) 2.Pradhanakarma (treatment) 3.Paschatkarma (post-treatment) Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 28
  • 47. Vastikarma The patients selected for vasti therapy has to undergo through clinicalexaminations to ascertain the physical as well as the mental conditions. Thefollowing ten factors are to be considered.1351.Dosha 2.Oushada 3.Desa 4.Kala 5.Satmya6.Agni 7.Satwa 8.Vaya 9.Bala The critical study of the above factors will enable the physician to decide,the type of vasti, number of vastis, vasti dravya, etc to be administered in theparticular patients.Procedure of Anuvasanavasti1.Poorvakarma (pre-treatment): The patient should pass is natural urges thenbody of the patient should be anointed with suitable sneha and mrudu sweda withhot water. He is advised to have his prescribed meal it is madyama matra andmade to take a short walk. Patient is asked to lie over vasti droni, which is notvery high, and the head must be at lower level. The patient should be on his leftside drawing up the right leg and straightening the left leg.136, 137,1382.Pradhanakarma (treatment): The prescribed amount of taila should be takenin the vastiputaka and tied well placing the vastinetra in position. Air is trappedfrom vastiyantra by gently pressing the vastiputaka. Then the anal region and thenetra should be smeared with oil to minimize the pain and irritation. Gently probethe anal orifice with the index finger of the left hand and introduce the vastinetrathrough it into the rectum up to the mark of first karnika. Keeping in the sameposition press the vastiputaka by putting the adequate force then withdraw fromthe sight, release carefully the vastinetra when a little quantity of snehare3maiuned inside the vastiputaka.1393.Paschatkarma (post-treatment): The patient is kept in same position as longas it would take to count up to hundred. The patient should be gently struck three Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 29
  • 48. Vastikarmatimes on each of the soles and over the buttocks. The distal part of the cot shouldbe raised thrice. Allow him to lie for sometime in the same position, if givensneha passed immediately; another anuvasanavasti should be adopted. Afterpassing the motion with sneha in proper time the patient is allowed to take lightfood if he feels hungry.140,141 9 hours is the maximum time for vastipratyagamana.Proper, Insufficient and excessive signs and symptoms of Anuvasana vasti.142 Table no 12: Showing the Proper, insufficient & excessive signs and symptoms of Anuvasana VastiProper Insufficient ExcessiveExpulsion of complete oil Low backache Palpitationwith faecesTissues, senses becomeclear and functioning Dry skin FaintingnormalSleep becomes usual Dry stool ConvulsionsBody becomes light and Parikartikastrengthens Obstruction of natural urges Cutting pain inProper flow of natural urges gudaComplications of Snehavasti 143Six types of complications may arise in snehavasti and are due to: - 1.Vata 4.Atibhukta 2.Pitta 5.Pureesha 3.Kapha 6.Abhukta Specific signs and symptoms with treatments are mentioned.Procedure of Niroohavasti:Purvakarma: Niroohavasti is indicated to be administered in noon, in a patientwho has an empty stomach. Abhyanga with suitable sneha and mild swedanashould be done prior to the process and the patient is advised to be on the cot asprescribed for anuvasanavasti. Vastidravya prepared as per the direction should be Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 30
  • 49. Vastikarmataken in vastiyantra and introduced into pakwasaya. The procedures followed foranuvasana during its applications are the same for nirooha. 144Paschatkarma: After giving the vasti the patient should use pillows and lie insupine position. Application of pressure on buttocks and other proceduresfollowed in anuvasana should not be done. When he gets up urges for defecationhe may do the same in squatting posture. After passing motion he may be advisedto take bath in hot water and have some solid food along with yusha, mamsarasaor milk in kapha, vata and pitta predominant diseases respectively. It is generallyseen that the adverse symptoms are produced if any, during the therapy willsubside after taking bath and their food. The maximum time allowed for passingout the motion after the administration of the nirooha vasti is one muhurtha (48minutes). If it did not pass out, giving vasti, which consists of sneha, kshara,mutra and amla dravyas, can bring it out. It should have snigdha, Ushna, andteekshna properties. Phalavarti may also be used for this purpose. If the nirooha ispassed out instantly and the patient is not showing desired symptoms and signsagain 2 or 3 vastis can be given. But if the patient shows excited symptoms ofvata, snehavasti should be given immediately. No particular regimen ofsamsarjanakarma is needed for vasti karma. 145Proper, Insufficient and excessive signs and symptoms of Nirooha vasti.146Table no13: Showing the Proper, insufficient & excessive signs andsymptoms of Niroha VastiProper Insufficient ExcessivePassing urine, stool, flatus Headache Passing stoolusually number of timesLightness in the body Pain in the heart, umbilicus, Dullness in the bladder, anus, penis or vagina bodyFeeling tasty Body acheIncreased digestive power Oedema Tiredness Coryza Tremors Cutting pain Sleep Anuria Weakness Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 31
  • 50. Vastikarma Dyspnoea Drowsiness Anorexia Insanity Heaviness HiccupComplications of niroohavastiDefects of physician147 1.Sa vata vastidana– Entry of an air into rectum leads to pain in abdomen and Colic, abdomen and colic. 2. Druta praneeta – Quick administration of vasti dravya leads to pain in hip, Anus, thigh, calves and retention of urine. 3. Tiryak praneeta – Horizontal introduction leads to blockage at the tip of vastinetra. Introduction of vastidravya by pressing vasti putaka more than once leads to chat pains, headache, and pain in thighs. 4.Ullipta – Introduction of vastidravya by pressing vastiputaka more than once leads to chat pains, headache, and pain in thighs. 5. Sakampa vastidana – Shivering while administration leads to erosion, burning and swelling at anal region. Not deeply introduced leads to burning pain in intestines. 6. Apraneeta – Not deeply introduced leads to burning pain in intestines. 7. Atimanda data – If done too slowly drug does not reach till intestines. 8. Ativega data– Forceful introduction leads to the dravya reaching up to koshta and sometimes may come out through upper orifices.Vasti vyapats 148 1.Ayoga – Due to the administration of less quantity of vasti dravya, rock salt, add oil leads to heaviness in abdomen, obstruction of flatus stool and urine, burning sensation, inflammation at anal region, itching, anorexia, dyspepsia. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 32
  • 51. Vastikarma2.Atiyoga – Administration of teekshna vasti to mridu koshta person leads to atiyoga and symptoms are similar to vamana-virechana atiyoga.3.Klama – Conduction of mridu vasti in ama state, pitta and kapha gets vitiated and block the channels, which leads to dyspepsia. There after vata also become vitiated and causes fatigue, syncope, burning sensation, colic, chest pain, heaviness.4.Adhmana – Due to administration of low potency drugs to strong person, dry bodies and costive bowel, the drugs not able to expel vitiated doshas and vata gets vitiated leads to adhmana causing pain in vasti and hridaya, severe burning sensation, pain in testicles and groin.5.Hikka – Hiccup results in administering teekshna vasti to weak person and mridu koshta with excessive expulsion of doshas.6.Hrit prapti – Vastidravya reaches the heart by entering into deeper levels due to complete squeezing or improper handling of vastiputaka and causes pain in chest and the surroundings.7.Urdhwagamana – Suppression of urges before or after vastikarma and squeezing vastiputaka with high pressure leads to the upward movement and may come out through mouth.8.Pravahika – Administration of less potent and insufficient quantity of vastidravya to the person suffering form intensive vitiated doshas leads to pravahika.9.Shiroarti – Includes symptoms of headache, earache, deafness, tinnitus and coryza, eye disorders due to administration of less potent sheetaveerya dravyas with insufficient quantity to weak persons.Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 33
  • 52. Vastikarma 10.Angarti – Administration of teekshna vasti without conducting pre-operative procedures like abhyanga and sweda leads to angarti with upward movement of vata and twisting and pricking pain in the body. 11.Parikartika – Administration of ruksha and teekshna vasti in excessive quantity to the person having mridukoshta and in conduction of less vitiated doshas leads to the excessive expulsion of doshas causing parikartika. 12.Parisrava – Administration of teekshna and ushna vastis to the person suffering from pitta roga / raktapitta leads to parisrava and causes burning sensation, erosion and cutting pain in anal region, severe bleeding and fainting.Drugs used in Vasti Karma: Number of drugs belonging to animal and plantorigin has been described in the classics, which are used in vastikarma. Forexample, herbs, milk, mutton juice, eggs, urine, alkalis, salts etc. The above listssuggest that almost all available drugs can be used for vastikarma. 1. Phalini drugs- Drugs useful for emesis can be used in asthapanavasti also. e.g:- phala, eemutaka, ikshwaku, dhamargava, kutaja, and kritavedhana.149 2. Sneha drugs - Ghrita, taila, vasa, majja.150 3. Mutravarga - Aja, avi, go, mahisha, hasti, ushtra, haya, etc.151 4. Asthapana & anuvasana gana - Dasamoola, bala, eranda, punarnava, yava, kola, kulatha, guduchi, madanaphala, palasa etc.152 5. Adjuants for asthapanavasti - Trivrit, bilwa, pippali, kushta, sarshapa, vacha, kutaja, satahwa, yashtimadhu, madanaphala. 6. Adjuants for anuvasanavasti - Rasna, devadaru, bilwa, madanaphala, satahwa, swetapunarnava, raktapunarnava, gokshura, agnimandha, syonaka.153 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 34
  • 53. VastikarmaVasti karmukata: Vastikarma having mulitidimentional therapeutic effects asearly mentioned for better understanding it can be studied under the followingheadings.The procedural effect: The rationality behind the left lateral position is the gudvalees becomes relaxed there by it helps in the administration of vasti.Pakwashaya resides in the given left side so the given vasti dravya reaches thepakwasaya, as it is the main seat of vata; hence the given drugs will counter actthe vatadosha. He also mentions that the grahani is situated in the left side.154Chakrapani states that Agni will be in the natural state in the posture whileGangadhara says; Agni, grahani and nabhi are present in the left side. Jejjatacomments Agni is present left side over the nabhi, guda has got a left sidedrelation with sthoolantra. So vastidravya can reach to the large intestine andgrahani, as they are present in the sequence.155Action based on drug effect: Action of vastidravya is due to itsAnupravanabhava, which contains sneha along with other dravyas like makshika,saidhavaSneha easily moves up to grahani by anupravanabhava guna similar tothat of dravya, which freely moves in the utensil. Charaka says vastidravya reachnabhi, katipradesha and kukshi.156The Shodhana effect: The action of vasti is mainly depends on its veerya. Thedrug used in the vasti karma will however spread in the body from pakwasaya dueto their veerya; through the appropriate channels and draws the vitiated doshas topakwashaya. It is like sun in the sky draws the water from earth. The veerya isdrawn into the body by vata dosha i.e. first by apana, then udana and throughoutthe body by vyana. In charaka siddi he gives a simily like water sprinkled at theroot of tree circulates all over the tree and nourishes the body by its own specific Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 35
  • 54. Vastikarmaproperty. In the same way vastikarma eliminates the morbid doshas and dooshyasfrom all the parts of the body.157Probable Mode of Action: Practically we can see that after appropriateadministration of vastikarma the signs and symptoms of vatavyadhi will bereduced. Vastidravya enters into the pakwasaya, where the water and minerals areabsorbed in proximal colon. Sodium and potassium which are essentialfundamental factors of the body, it is prove that bioavilability of a drug is more inrectal rout. The vasti dravyas gets absorbed by intestinal micro flora; there by itmaintains the electrolyte balance in the body. It enhances the biodegradability ofthe drugs and it increases the absorption of colon. The pakwashaya contains themaximum number of nerve plexuses originating from the hypo gastric plexus andlumbosacral plexus etc. and spreads all over the body. The given drug gets starabsorbing in intestinal flora, through heammoroidle vein potency of drug enters into the systemic circulation. Vastidravya prepared by madhu, lavana, sneha etchelps in formation of healthy bacteria in large intestine; it is essential for theabsorption and nourishment at cellular level. Another probable method is based on veerya. It is possible the veerya ofthe vastidravya pass through the autonomic nervous system and expels outvitiated dosha from the body, as we see in the pressure receptors. When vastinetrais introduced in the rectum the same phenomenon may take place, which results ininitiation of defecation reflex due to visceral distention and pressure response. Saindhava contains NaCl and it is integral part of the body. It is havingproperties like srotosravaka, srotoshodhaka, etc these are necessary in generatingthe action potential, it maintaince the osmotic pressure. The release of Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 36
  • 55. Vastikarmacatecholamines during visceral distention initiates the pressure response andultimately helping in defecation. When hypertonic solution is given in the form ofvastidravya, it circulates from blood vessels to the outer fluid. Absorption of vastidravya 60%-80% of water absorbed from the gut,Absorption in the proximal colon is better than the distal part as a result this routsubstitute’s oral rout.Regulating the Gut Brain.158 In 1981,Wood described the Enteric Nervous System (ENS) as ‘The Brainof the Gut’ that integrates information received and issues an appropriateresponse. ENS integrates sensory information from mucosal receptor andorganizes an appropriate motor response from a choice of predeterminedprogrammes. So enteric nervous system of gut brain is an integrative system withstructural and functional properties that are similar to those in CNS andphysiological and pharmacological properties of vasti chikitsa are said to be theoutcome of modification of gut brain up to certain extend.FLOW CHART NO 1: PROBEBLE MODE OF ACTION OF VASTIAbsorption of Vasti: First sodium ion in Saindhava actively absorb from colon High concentration of sodium ion facilitates sugar influx. Increase sodium ion in mucosal membrane generate osmotic gradient.Water follows this osmotic gradients thus passive absorption of water take place.Free fatty acid is easily absorbed by passive diffusion in the colon. From above description, it can be understood that how Saindhava, Madhu,Sneha and kwatha is absorb from the colon. And along with the Sneha (Lipids)and kwatha lipid and water-soluble portion is absorbed from the colon. Accordingto Modern pharmacokinetics, it is also proved that rectal drugs administration Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 37
  • 56. Vastikarmamight exceed the oral value due to partial avoidance of hepatic first passmetabolism. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 38
  • 57. Concept of MedaConcept of Meda:Introduction: Sthoulya being a Dooshya dominant disorder, in that, Meda plays amajor role in pathogenesis. Meda is one among the saptha dhatuNirukti: 159 Literally the word meda is derived from the root, e«dQŠ + ±d®d‰¥dd£dgªSddy Aae±«d¦dŠ || Which means “Jhimida snehane” stands for sneha, fat, oil etc.Definition:160 “«dyQSde£d e±¦dUµSde£d A¦dy¦d Be£d «dyQ: ||” i.e it produces smoothness in the bodySynonyms of Meda: Vapa, Vasa, Mamsa Sara, Mamsa sneha, Mamsasara bhutadhatu, Asthikrit (as it forms asthi), Majja (Asthi majjagata sneha), Gada(mastishkagata sneha) etc.Sthana and Swarupa of Meda dhatu:161There are 2 types of Medadhatu. One isposhaka and second is poshya. Among these two, poshaka meda dhatu is gatiyukta,which is circulated, in the whole body along the Rasa – Rakta dhatu, to give thenutrition to poshya meda dhatu. Second poshya meda dhatu is Gativivarjita, which isstored in medodharakala. The site of medodharakala is Udara and Anuasthi, Udara,Sphik, Sthana, Gala are also depots of poshya meda. It is also found in mamsa asVasa.Formation of meda dhatu: 162According to Caraka, when rakta dhatu gets solidifiedin the presence of vayu, jala & agni mahabhuta and digested by raktagni, it formsmamsa dhatu. This mamsa dhatu being digested by mamsa dhatvagni and mixed withits own agni and jala property, transformed into meda dhatu. 163Pramana of Meda dhatu: The total measurable elements in the body is 56 ½Anjalis out of which amount of meda dhatu is two Anjalis and vasa is three Anjalis. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 38
  • 58. Concept of MedaSo total amount of body fat is 5 Anjalis, which is 11 – 12% of total body elements.This equation may vary with person to person and exact measurement is not possibledue to unpredictable and ever-changing nature of the body (Su. Su. 15/44_). Insthoulya, this proportion may found to be raised.Medavaha srotas: The internal transportation system of the body is represented assrotas. Medovaha srotas are the channels that transport poshaka meda dhatu to the seatof poshya or sthayi meda dhatu.Moola of Medovaha Srotas: According to Ayurvedic classics every srotas has itsdefinite roots or place of orgin, same in case of Medovaha srotas. Different ancientAcharyas have drawn their opinions regarding root or moola of meda vaha srotas asfollows, • Charaka - Vrikka, Vapavahana164 • Sushrut - Vrikka, Kati 165Ashrayashrayeebhava of Meda: Kapha resides in Meda and Kapha is Ashrayee andMeda is Ashraya. (A.H.Su.11/26)Karma of Meda dhatu: 166 su.su15/7 • Sneha:- Sneha property helps to keep luster of skin, hairs and eyes etc. • Sweda: - During the stage of Meda dhatvagnipaka, sweda is produced as kitta bhaga167 (Cha.chi -15/18). Sharangadhar has considered sweda as the upadhatu of meda. • Drudhata: According to Caraka snayu and sandhis are upadhatus of Meda168which gives strength to the body • Asthipusthi: Nourishment of further dhatu i.e. asthi and its upadhatu is Snayu and Sandhi.169 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 39
  • 59. Concept of Meda • Further Vagbhata has mentioned, Netra and gatrasnigdhataare the symptoms of sthoulya may arise through increased Snehana function of Meda.170 Fig No 1: Exogenous & Endogenous fat transport pathways are diagrammedBasic Concept of Fat/Lipids: The basic difference between lipid and fat is lipids are oils which are liquid atroom temperature (taken to be 20ºC) where as fats are solid. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 40
  • 60. Concept of Meda Lipids (Greek: Lipos – Fat) are of great importance to the body as the chiefconcentrated storage forms of energy, besides their role in cellular structure andvarious other biochemical functions.Definition of lipid: Lipids are defined to be the esters of higher aliphatic acids with acharacteristic property of insolubility in water and solubility in fat solvents like,chloroform, ether, benzene, and carbon tetrachloride.171Classification of lipids: Lipids are classified into simple lipids, compound lipids,derived lipids and miscellaneous one.172 Classification of LipidsSimple lipids compound Lipids DerivedLipids Triglycerides Phospholipids Fattyacids Waxes Cerebrosides Steroid Others Lecithin Cephalins Plasmalogens Sphingomyelins Fig No 2: Showing classification of lipidsDepot fats: 173 About 12% of the body weight of a human being consists of fat, the major partof which remain stored in the fat depots called depot fats.Distribution: Table no 14: showing the distribution of fat Distribution % Subcutaneous tissue 50% Peripheral tissue 15% Mesentery 20% Omentum 10% Intra muscular connective tissue 5% Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 41
  • 61. Concept of Meda These are average percentages of depot fats remain inside the cells of adiposetissue or as intracellular fats.Composition: Depot fats are commonly composed of mixed triglycerides i.e. oneglycerol molecule is attached to three fatty acid molecules of either similar ordissimilar varieties. Trace of lecithin and cholesterol as well as a little amount ofpolyunsaturated fatty acid also present, but depot fat is not identical with food fat.Under customary diet the depot fat of each individual is a characteristic one. But ifdiet will be altered either in quality or quantity, specially after starvation the food fatsmay resemble the depot fat to some extent.Source of depot fats:Food fat – chief source.Carbohydrates - Carbohydrates may easily be converted into fats. During thisprocess an oxygen rich substance (Carbohydrates) being transformed into an oxygenpoor substance (fat) that result in, raised R.Q. (Respiratory quotient). Fats formedfrom Carbohydrates are more saturated and have a higher melting point.Proteins –Recent evidence shows that Carbohydrates derived from protein may beconverted in to fats. It is observed that pyridoxine in collaboration with thiaminecatalyses the formation of fat from proteins.Functions of depot fats:Mechanical - • It gives shape to limbs and body while remains under the surface. • It keeps the visceras in position and acts as a mechanical buffer against injury while remains around the visceras.Physical – Being a bad conductor of heat, the subcutaneous fat plays an importantpart in the regulation of body temperature. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 42
  • 62. Concept of MedaChemical – Storehouse of energy. Large amount of energy can be stored in theadipose tissue. 1gm. fat gives 9.3 calories of energy. As fat constitutes 12% of bodyweight, it represents stored energy up to the extend of 1,100 calories per kg bodyweight.PLASMA LIPIDS: Sources: -a) Endogenous: - • The lipids mobilized from the adipose tissue. • The lipids from the liver.b) Exogenous: - FoodComposition: -Values of plasma lipids in healthy adults depends on the pattern ofdiet. Thus persons following high quantities of animal fats (which contains saturatedfatty acids only) tend to have high plasma lipid values, particularly high values ofplasma cholesterol, on the other hand, persons taking rice, vegetables and highamount of Poly unsaturated fatty acid have low plasma lipid (particularly plasmacholesterol) values.Addition of lipids occurs through:174 • Absorption from intestine. • Synthesis of fat and its mobilization.Removal of Lipids occurs through: • Deposition of fat in the depots. • Oxidation of fat in the tissue. • Utilization for formation of tissue structure components.Table no 15: showing “plasma lipid values” Lipids Values (mg/100ml) Cholesterol (total) 140-250 Phospholipids 150-300 Triglycerides 30-150 FFA 10-30 Total lipid 350-800 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 43
  • 63. Concept of Meda * For routine clinical purposes ordinarily estimation of plasma (or serum)cholesterol and serum tryglycerides are usually considered sufficient.Cholesterol: 175 Cholesterol is present in the diet of all people and it can be absorbedslowly from gastrointestinal tract into the intestinal lymph. It is highly fat soluble butonly slightly soluble in water and is capable of forming esters with fatty acids. Indeeds, about 70% of the cholesterol in the lipoproteins of the plasma is in the form ofcholesterol ester.Factors that affects plasma cholesterol concentration: • An increase in the amount of cholesterol ingested each day increases the plasma concentration. • A highly saturated fat diet increases blood cholesterol concentration 15-25%. • Ingestion of fat containing highly unsaturated fatty acids usually depress the blood cholesterol concentration a slight to moderate amount. • Lack of insulin or thyroid hormone increases the blood cholesterol concentration, whereas excess thyroid hormone decrease.Specific use of Cholesterol: • Cholesterol, as much as 80 percent of the cholesterol is converted in to cholic acid, this is conjugated with other substance to form bile salts which promote digestion and absorption of fats. • A small quantity of cholesterol is used by. • The adrenal glands to form adrenocortical hormones. • The ovaries to form progesterone and estrogen and • The testes to form testosterone. • A large amount of cholesterol is precipitated in the corneum of skin. This along with other lipids make the skin highly resistant to the absorption of Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 44
  • 64. Concept of Meda water soluble substances and to the action of many chemical agents because cholesterol and other lipids are highly inert to acids and many solvents that might other wise easily penetrate the body. • Also, these lipid substances help to prevent water evaporations from the skin out this protection; the amount of evaporation (as occurs in burn patients who have lost their skin) can be 5 to 10 liters per day instead of the usual 300 to 400 milli liters. 176Lipoproteins: Lipoproteins are molecular complex that consist of lipids andproteins (conjugated proteins). They functions as transport vehicles for lipids in bloodplasma. Lipoproteins deliver the lipid components (Cholesterol, Triglycerides etc) tovarious tissues for utilization. Lipoproteins basically consists of a neutral lipid core (triglycerides and/ orcholesteryl ester) surrounded by a coat shell of phospholipids, apoproteins andcholesterol are exposed on the surface of lipoproteins so that lipoprotein is soluble inaqueous solution. The total concentration of lipoproteins in the plasma average about 700mg/dland this can be broken down into the following average concentrations of theindividual constituents. • Cholesterol - 180 • Phospholipids - 160 • Triglycerides - 160 • Protein - 200Classification Lipoproteins: Five major classes of lipoproteins are identified inhuman plasma: • Chylomicrons • Very Low density lipoproteins (VLDL) • Inter mediate density lipoproteins • Low-density lipoproteins (LDL) Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 45
  • 65. Concept of Meda • High-density lipoproteins. (HDL)Chylomicrons: They are synthesized in the intestine and transport exogenous(dietary) triglycerides to various tissues. They consist of highest (99%) quantity oflipid and lowest (1%) concentration of protein. The chylomicrons are the least indensity and the largest in size, among the lipoproteins.Very low density Lipoproteins (VLDL): Which contain high concentrations oftriglycerides and moderate concentrations of both cholesterol and phospholipids.Inter mediate density lipoproteins (LDL): Which are very low-density lipoproteinsfrom which a large share of triglycerides has been removed so that the concentrationsof cholesterol and phospholipids are increased.Low-density lipoproteins (LDL): Which are intermediate density lipoproteins fromwhich almost all the triglycerides have been removed leaving an especially highconcentration of phospholipids.High-density lipoproteins (HDL): Which contain a high concentration of protein,about 50%, but small concentration of cholesterol and phospholipids.Functions of Lipoproteins: • The primary function of the lipoproteins is to transport their lipid components in the blood. • The very low-density lipoproteins transport triglycerides synthesized in liver mainly to the adipose tissue. • Where as other lipoproteins are especially important in the different stages of phospholipids and cholesterol transport from the liver to the peripheral tissues or from the periphery back to the liver.Contribution of cholesterol and lipoproteins in Artherosclerosis: Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 46
  • 66. Concept of Meda A very common disease of advanced age, indicated as deposition ofcholesterol in the form of low-density lipoproteins in the damaged arterial wall.Eating highly highly saturated fat in the daily diet directly increases the plasmaconcentration of this high cholesterol low-density lipoprotein. To lesser extent, eating increased cholesterol in any form. Therefore, both,also increases it or either of these dietary indiscretions can contribute to thedevelopment of Artherosclerosis. This leads to cerebral thrombosis, my cordialinfarctions, etc.177Triglyceride: Triglycerides are esters of three fatty acids and glycerol. They aredivided into two types according to fatty acid contents. • Simple - in which all three fatty acids are same. • Mixed - in which all three fatty acids are different. They are transported primarily as chylomicrones and VLDL but in minoramounts as LDL and HDL also. They are main form of lipid storage in men.Fatty acids: Fatty acid esters may be formed with alcohols other than glycerol, suchas waxes. The commonest type of fatty acid occurring in natural fats usually containeven number of carbon atoms and are straight chain derivatives.Classification of fatty acids:Saturated: -Butyric acid, palmatic acid, and stearic acid.Unsaturated: - Oleic acid with one double bond, crotonic acid, linoleic acid with twodouble bonds, linolenic acid with three double bonds.Table no 16: showing classification of fatty acids FATTY ACIDSDepending upon no. Of Depending length Nature of HydroCarbon atoms carbon chaini) Even Chain ie. having 2- i) Short chain 2-6 carbon atoms i) Saturated fatty4.6 carbon atoms acidsii) Odd chain ie., having 3- ii) Medium chain 8-14 ii) Unsaturated5.7 Carbon atoms iii) Long chain 16 & above (24) a) Mono unsaturated b) Poly unsaturated Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 47
  • 67. Concept of Meda iii) Branched chain FA iv) Hydroxy FA v) Cyclin FA.Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 48
  • 68. Nirookti and vyutpattiVyutpatti and Nirukti Of Sthoulya:Vyutpatti: The word Sthoulya is derived from root “Sthu” with suffix “ Ach” whichstands probably for thick or solid or strong or big or bulky.178Nirukti: 179 According to Sabdakalpadruma the existence of Sthoolatva (bulkness) isknown as Sthoulya. • ±¤dg¬d±Sd ªdd®d«dŠ ±¤ddz¬S«dŠ | • ±¤dg¬d Be£d D§deŸd£d A®dSd®d || • Sthoola is a person who developed ©dma«UµPd£®d according to Kavikalpadruma. • Sthoola is Brumhanam vruddhi- Durgadas • Verbal meaning of Sthoola given in various dictionaries as large, great, bulky, huge, fat, corpulent etc.180Paribhasha:«dyQdy«dda±dde£d®dp¥QŠ£®ddŸŸd¬de±R¶›dgQT±£d¦d:|ASd¤ddy§dŸdSddy£±ddUµdy ¦dTdy e£d±¤dj¬d DŸŸd£dy|| A person having pendulous appearance of sphik, udara, and sthana due toexcess deposition of meda along with mamsa dhatu and also having unequal anabnormal distribution of meda with reduced zeal towards life is called Atisthula .181Paryaya: Pinam, Pivara, Pivaram, Sthoola, Pina, Piva, Pivam, Pivasa, Pivasa,Pivistha, Medana, Medini, Medasvina.182Etymology of word obesity: The word obesity is a noun form originated from Greek root word “Obesus”meaning “having eaten until fat”, Latin “Edo” meaning “eat” obese is used anadjective meaning “grossly fat” or “very fat”. 183Definition: Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 48
  • 69. Nirookti and vyutpatti Obesity defined as an increase in body weight beyond the limitation of skeletaland physical requirements, as the result of excessive accumulation of body fat.184 • An abnormal growth of adipose tissue due to an enlargement of fat cell size (Hypertrophic obesity) or an increase in fat cell number (Hyperplastic obesity) or a combination of both. (K. Park). • Obesity is defined as an excess of body fat that posses a health risk185 • Abnormal amount of fat in the body.186 • Obesity is defined as an excess of body fat that possess a health risk..187 Observing the above description and terminologies we can compare thedisease sthoulya with obesity.Synonyms: Adiposity, Corpulence, over weight, fatty, Turgidity, Hypertrophy,Stoutness, Enormity, Polysaraca, oily dropsy, Plumpness, Embonpoint. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 49
  • 70. Disease review – NidanaNidana of Sthoulya: - Aetiological factors provide vital information regarding diagnosis as well asinvolved pathological entities of a disease. More importantly, most of the times guidethe physician towards therapeutics & aid in advising pathyapathya. The components, which are responsible for vitiation of meda as well assleshma are said to be responsible for sthoulya. charaka has mentioned the exogenouscauses and susruta and vagbhata are mentioned the endogenous causes of sthoulya. Incontext with Sthoulya, exogenous causes are Medas potentiating diets and where asDosha, Dhatu, Mala, Srotas etc. come under the endogenous causes.Especially Acharya charaka mentioned Beejadosha as the cause for Sthoulya alongwith other causes.188Role of Aharaja nidana: - Ahara rasa plays a major role for increasing meda dhatuin sthoulya. acharya susruta has mentioned in Qdy°d¥dd£dg«d¬d´dSd®dmeÔe®d¡¦Sdd¦dfSd A¥SddSd as sthoulyand karshya depends upon the quality & quantity of ahara rasa.189In nutshell, it can be said that if ahara rasa posses,• Rasa – madhura• Guna – guru, sheeta, manda, snigdha, slakshna.• Virya – sheeta.• Vipaka –mdhura.• Mahabhuta – prithvi & aap. These qualities it will increase kapha & meda leads to sthoulya.Guru & snigdha ahara: - Guru and Snigdha are the properties of Meda or body fat.Acharya Caraka has mentioned that, Meda is the seat of sleshma190 more over Medaand Sleshma possess similar properties. So sleshmala ahara (Guru & Snigdha) canable to produce excess amount of fat in the body by virture of Ashryashryaee bhavaand samanya vriddhi karana concept Thus guru and snigdha ahara leads to sthoulya. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 50
  • 71. Disease review – NidanaMadhura Rasa Sevana: - All acharyas of Brihatrayis have considered Madhura rasaas a causative factor for Sthoulya.191 Excess intake of madhura rasa dravyas like Ikshu Vikaras (sugars),carbohydrates, sweet fruits, shali shastika dhanya as well as Godhuma will increasesthe meda as both are of Prithivi + Jala mahabhuta pradhana with the help of bhutagniAnd leads to sthoulya.Mamsa sevana: - On the basis of the version of charaka,±d®d‰Qd ±d®d‰ªdd®d¦dda ±d«dd¦Sda ®d a geQ I¶dTPd«dŠ|| Kashyapa has been mentioned mamsa as the best diet for growth of musclesand body fat.192 Especialy anoopa deshaja mamsa like Srumara (forest pig) Mahisha,Gavaya,Gaja, etc. (Cha.su.27/56-57) will have the qualities of kapha on the basis ofguna karma sadharmya these mamsa and meda are increased leads to sthoulya.Madya Sevana: - Nava Madya, as it is guru, and kaphavardhaka in nature it can beconsidered as a causative factor for Medovaha Shrota dushti there by medavriddioccurs. 193Gorasa, dadhi atisevana: - Gorasa includes all the secondary products of milk likedadhi navaneeta gritha etc., which are homogeneous to kapha & meda dhatu excessintake of these leads to sthoulya.Ahara krama: - The factors like Adhyashana and Atisampooranad are oftenmentioned in the nidana of Sthoulya by the acharyas.Bhojanottara Jalapana is also responsible for the production of ama, & becomecause for sthoulya.194 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 51
  • 72. Disease review – NidanaRole of viharaja Nidana: -Avyayama: - A person one who is not indulging in physical exercise, livesluxuriously with sedentary life style will always tend to accumulation of kapha &meda in the body & this leads to Sthoulya.Diwaswapna & atinidra: - All the acharyas have specially mentioned that day sleepis the one of the cause for aggravation of kapha and also a santarpaka hetu andincreases the abhishyandi guna which obstructs the srotases of the body, leads tosthoulya in due course of time.Role of manasika nidana: - Ayurveda considers Achintana, Harshanitya,Manasonivritti are the manasika nidanas for sthoulya .195Beejaswabhavaja: - Acharya Charaka has specifically mentioned Beejadosha as thenidana for sthoulya & chakrapani coments over it as “ati sthula mata pitru sonithasukra swabhavat”.These can be complied as below, Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 52
  • 73. Disease review – NidanaNidanas of sthoulya: 196,197,198,199,200,201202 Table no 17 : showing Aharaja Nidhana Sr Aharaja Nidana CH SU AS AH MN BP YR No 1. Atisampurana + - - - - - - 2. Santarpana + - + + - - - 3. Adhyasana - + - - - - - 4. Guru Ahara Sevana + - - - - - - 5. Madhura Ahara sevana + - - - - - - 6. Sheeta Ahara Sevana + - - - - - - 7. Snigdha Ahara Sevana + - + + + - + 8. SleshmalaAhara Sevana + + - - + + + 9. Navanna Sevana + - - - - - - 10. Navamadya Sevana + - - - - - - 11. Gramya Rasa Sevana + - - - - - - 12. Mamsa Sevana + - - - - - - 13. Paya Vikara Sevana + - + + - - - 14. Dadhi Sevana + - - - - - - 15. Sarpi Sevana + - - + - - - 16. Ikshu vikara sevana + - - + - - - 17. Guda vikara sevana + - - - - - - 18. Shali Sevana + - - - - - - 19. Godhuma Sevana + - - - - - - 20. Masha Sevana + - - - - - - 21. Rasayan Sevana + - - - - - - 22. Vrishya Sevana + - - - - - - 23. Bhojanottara Jala pana - - + - - + + Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 53
  • 74. Disease review – Nidana Table no 18 : showing the Viharaja Nidhana Sr Viharaja Nidana CH SU AS AH MN BP YR No 1. Avyayam + + + - + + + 2. Avyavaya + - + - - - - 3. Diva Swapna + + + - + + + 4. Asana Sukha + - + + - - - 5. Swapnaprasangat + - + + - - - 6. Gandhamalyanu Sevana + - - - - - - 7. Bhojanottara snana + - - - - - - 8. Bhojonottar Nidra - - - - - + + 9. BhojanottarAushadhi Sevana - - + - - - - Table no 19: showing Manasika Nidan SI.No Manasika Nidan CH Su AS AH MN BP YR 1. Harshanityatvat + - + + - - - 2. Achintanat + - + + - - - 3. Manasonivritti + - + + - - - 4. Priyadarshana + - - - - - - 5. Saukhyena - - - + - - - Table no 20: showing Anya Nidana SI.No Anya Nidana CH SU AS AH MN BP YR 1 Ama rasa - + - - - + - Snigdha Madhura 2. + - + + - - - Vasti Sevana 3. Tailabhyanga + - + + - - - 4. Snigdha Udvartana + - - - - - - 5. Beejadoshasvabhavat + - - - - - -Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 54
  • 75. Disease review – NidanaAetiology of obesity: Modern medical literatures classified the etiology ofobesity in three groups viz. CAUSESEXOGENOUS ENDOGENOUS MISCELLANEOUS Over eating Age Dieting habits Endocrine factors Sex Drinking habits Occupation Smoking SocioEconomic status Psychogenic factors Environmental factors Drugs Hypothalamic factors Physical activity Caloric Balance Heredity Fig No 3: Showing causes of obesity.Dietary Factors: 203 a modest but persistent excess intake of 50Kcal/day will resultover a 4year period in a slow but progressive rise in weight of 10kg. If intake of foodrises progressively and expenditure is reduced by decreasing the exercise, then weightrise will continue. An extra gain of 10kg of weight indicates an about 70,000 storedKcal. This storage potential explains why it takes so long to loose weight. Weightgain is due to imbalance in energy intake & energy expenditure. 204Endocrine factors: an endocrine influence on body fat is seen in normalphysiology as well as pathological condition. Obesity in women’s is commonlybegins at puberty, during pregnancy or at the menopause suggesting an endocrinefactor. Obesity frequently accompanies with Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 55
  • 76. Disease review – Nidana • Hypothalamic disorders – injury to the ventriomedial region of hypothalamus results in obesity. • Hypothyroidism: - this condition lowers the energy requirements by lowering the BMR & physical activity. • Cushing’s syndromes: - This can result from hyperplasia of the adrenal glands when excess ACTH from the pituitary stimulates them and in this condition there is accumulation of fat in the trunk, suprascapular fossa & dorsal cervical region will be seen. • Polycistic ovary syndrome: Here the ovary over produces androgens, because of this it is characterized by irregular menses or absence of menses, hirutism, obesity & infertility. • Hypogonadism: It is also associated with extra fat deposits, particularly in breasts, abdomen, hips & thighs & it seems possible that the obesity associated with mild degrees of hypopitutarism may be accounted for by the resulting combination of hypothyroidism & gonadism.Miscellaneous factors:Age & sex: - Obesity is more common in middle-aged persons. The body fatdistribution is affected by the gender & age. In both men and women body fatincreases with age. In lean young man, body fat is less than 20% & may rise in oldermen to more than 25%. In young women, body fat stores may be 30% & increasegradually to more than 35% in older women. At all ages after puberty women arefatter than men. 205Socio economic status: -All most all texts emphasize that obesity is more prevalentin upper socioeconomic groups. But obesity may occur in any class of society due toover eating & sedentary life style. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 56
  • 77. Disease review – NidanaSmoking: Giving up of smoking induces a fall in energy expenditure equal ant to9Kcal/cigerate & increase in food intake. The average weight gain is 2.8 kg in males& 3.8kg in females. Nevertheless, the risk of smoking is so substantial that a rise inweight of 1kg would be required to negate the benefit of giving up of smoking 20cigarettes /day.206Alcohol: -Alcohol promotes weight gain as it provides substantial energy & canstimulate appetite & loosens restraint. 207Urbanization: Urban people constantly consume dry foods made up of fat and sugarv.i.z. Biscuits etc. also reduce the need of strenuous physical exercise. These trendsincrease energy in take than energy output.Influence of Drugs: - 208,209In modern medicine, several drugs are found to becreating obesity, which are as follows, • Oral contraceptives • Glucocorticoids • Medroxy progesterone • Cyproheptadine • Tricyclic antidepressants • (Particularly amitrophlines) • Lithium • Pleothiazines • Antyepileptics-valporate, carbamezepine. • Antihypertensives- terazosin.etc.Genetic history: - Genetic determinants can either play a major role in thepathogenesis of obesity. The dimorphic forms of human obesity in which geneticsplay a major role include the conditions, such as Prodder willi syndrome Ahlstromessyndromes the Lourence-Moon-Bield syndrome coher’s syndrome & carpenter’ssyndrome.210 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 57
  • 78. Disease review – Nidana The leptin gene, which produces a syndrome complex, associated with obesityhave implicated over 20 genes on at least 12 chromosomes emphasizing the polygenicinfluence on the development of obesity. Overall, the genetic contribution to weight gain in susceptible families rangesfrom 25%-40%, with the genetic determination of selective intra-abdominal fatdeposition being greater at 30%-50%. 211Role of Psychologenic factors: -Role of Psychological factors in creating obesity isworldly recognized but specific type of mentality in association with it is yet to beachieved. According to Bruch obesity are of two types one is reactive, another isdevelopmental. Reactive obesity is a resultant of overeating as an emotional reaction to theenvironmental situation. The second is otherwise known as obese trait depression. Ingestion of food hasbeen frequently used to reduce the feelings of emotional deprivation present sincechild hood. The literature on the psychology related to obesity is diverse, inventive andechectic. Individual at risk for developing obesity appear to have a lower threshold forpsychological arousal than other people. Some studies show that acute hyperinsulinaemia can be produced in some people by looking at or thinking about food,lead to increased consumption and possibly weight gain. Lissual and Rensen (1994) reported that parental neglect could greatlyincrease the risk of obesity. Dirty and neglected children have a greater risk of obesityat an adult age than averagely growned children. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 58
  • 79. Disease review - ClassificationClassification of Sthoulya: For the purpose of diagnosis, prognosis and easy management disease shouldbe classified as per severity as well as chronicity. Hence, classification of Sthoulya isessential but there is no such clear classification is mentioned in our classics. Only some of the Ayurvedic classics like Astanga samraha, Astanga Hridayaand Sharangadhar samhita have enlighted regarding classification of the diseasesthoulya. While narrating the indications for langhana upakrama Ashtanga sangraha(A.S.Su. 24/13-16) and Ashtanga hridhaya 212have classified as, • Hina sthoulya • Madyama sthoulya • Adhika sthoulya And due to vitiation of meda and dominance of vata dosha Sharangadara hasmentioned as only one type of Sthoulya213 i.e. • Medo dosha. All other acharyas have mentioned only one type of sthoula.Classification of obesity: Obesity is classified on the different basis like onset, severity of the disease,histopathology and fat distribution etc. that are mentioned as below,According to the onset 1. Insidious 2. Gradual 3.RapidAccording to severity 1. Mild 2.Moderate 3.Severe Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 59
  • 80. Disease review - ClassificationOn the basis of BMI 214 • 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/m2According to Etiological factors: • Physiological: Observed temporarily during Puberty, Pregency and Lactation. • Pathological: It can be further divided into three – 1) Exogenous, 2. Endogenous, 3. Idiopathic.On the basis of Fat distribution: 215,216 • Generalized: Generalized obesity is usual seen in exogenous obesity. • Central or Trunk type: Involving only the trunk and neck, it is common in Cushing’s syndrome or hypothyroidism. • Superior or Buffalo type: Involving the face, neck, arm and upper part of trunk and is common in Cushing’s syndrome or hypothyroidism. • Inferior or lypodystrophy: Involving the lower part of the trunk and legs Accompanied by wasting of upper half of the body. • Girdle type or fatty apron: Involving the hips, buttocks and abdomen found in pituitary or hypothalamic lesions. • Breeches or trochanteric type: Involving only the buttocks, found in hypogonadal syndrome. • 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. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 60
  • 81. Disease review - Classification • Android or Abdominal or Male obesity: Accumulation of body fat in abdominal region commonly found in men and are high-risk form of obesity, they termed as Android obesity, • Gynoid or gluteofemoral or female obesity: Accumulation of body fat in gluteofemoral region commonly found in premenopausal women and they are termed, as Gynoid obesityOn the basis of histopathology: 217 • Hyper plastic obesity - Increase in adiposity’s number, life long history and bad prognosis. • Hypertrophic obesity - Increase in adipocyte size, history of adult onset and good prognosis Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 61
  • 82. Disease review - PoorvaroopaPurvarupa of Sthoulya : The Symptoms that appears before complete manifestitation of the disease isknown as Purvarupa. (Ch.Ni.1/8) Purvarupa of Sthoulya has not been described by any Ayurvedic texts.Acharya charaka mentioned similar pathogenesis of Prameha and Sthoulya.218 Kaphaand Meda also get vitiated in Sthoulya. Therefore purvarupa of Prameha andMedovaha Srotodushti Lakshanas can be considered as purvarupa of Sthoulya.These are as follows: • Atinidra • Tandra • Alashya • Visra sharira gandha • Anga gaurava • Anga shaithilya etc. In modern medical science there is no premonitory symptoms found in obesityor overweight. So, it is related mild symptoms can be consider as premonitorysymptoms. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 62
  • 83. Disease review – RupaRupa of sthoulya: Rupa is nothing but the feature of a completely manifested disease.(Ch.ni.1/9). Maharshi caraka has enlisted some cardinal features or pratyatmalakshanas of sthoulya v.i.z: • Medomamsa ativriddhi • Chala sphik • Chala udara • Chala Stana • Ayatha Upachaya • Anutsaha (Cha. Su. 21/9) Beside these Cardinal Symptoms, eight disabilities of Sthoulya are mentionedin which are as follows,219Ayushohrasa - Life expectancy is decreased because other Dhatus could not be nourished properly.Javoparodha - Shaithilya, Saukumarya and Guru Properties of Medadhatu, causes Javoparodha.Kricchavyavaya - Due to obstruction in genital passage by Medodhatu and less production of semen, the sex act becomes difficult.Daurbalya - This results because of the deranged metabolism owing to malnourishment of the Dhatus.Daurgandhya - Bad smelling is results due to excessive sweating, innate quality of Medodhatu 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 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 63
  • 84. Disease review – Rupathe symptoms of Sthoulya described in various Ayurvedic texts have beensummarized in the following table. Table No 21 : Showing Rupas of Sthoulya –220,221,222,223,224,225No. Rupa Cha Su AS AH MN BP 1 Chala Sphika + - + + + + 2 Chala Udara + - + + + + 3 Chala Stana + - + + + + 4 Ayatha Upachaya + - + - + + 5 Udara parshva Vriddhi - + - + + + 6 Anutsaha + - + - + + 7 Alasya (Jadyam) - - + - - - 8 Moha - - - - + + 9 Javoparodha - - + - - - 10 Alpa Vega - - + - - - 11 Shrama - - + - - - 12 Sarvakriyasu Asamrthata - + - - + + 13 Alpa Bala - - + - - - 14 Daurbalya + - + - - - 15 Alpa Prana - + + - + + 16 Ayushohrras + - + - - + 17 Krichh Vyavaya + - - - - - 18 Alpa Vyavaya - + - - + + 19 Daurgandhya + + + - + + 20 Swedabadha + - + - - + 21 Kshudhatimatra + + + - + + 22 Pipasatiyoga + + + - + + 23 Nidradhikya - + + - + + 24 Kshudra Swasa - + + + + + 25 Krathana - + - - + + 26 Gadgadvani - + + - - - 27 Gatrasada - + - - + + 28 Saukumarata + + - - - - Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 64
  • 85. Disease review – RupaClinical Features of Obesity -- The clinical manifestations of obesity as described in various textbooks ofModern Medicine are as under. • Obesity can be diagnosed from gain in weight. • Protuberant abdomen is a more common clinical feature of an obese person. Development skin fold 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 skin fold areas. • In fatty women menstrual disturbance and sterility is also observed.Diagnostic methods of Sthoulya: If the disease diagnosed in early stage we can stop its further stages.Diagnostic method describes in Ayurvedic text are subjective as well as objectivetype. Sushruta has mentioned as Chakshu Indriya Vijneya Bhava by following words, Ÿd´dgeT¦QŠTfSd e®d¡¦SdySd: ¯dTfTdy§dŸdSd§dŸdSd|| According to this over nutrition condition (Sthoulya) and under nutrition,condition (Karshya) both can be diagnosed by inspection only226. The measurementdescribed by Acharya Charaka and Acharya Sushruta for different Anga Pratyangaare summarised in table. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 65
  • 86. Disease review – RupaPramana Pariksha described in Ayurvedic texts. 227,228Table no 22 : Showing Pramana Pariksha Pramana inMeasurement Angula Inch Cm. Cha. Su.Ayama (Height) 84 120 63-90 157.50-225.00Vistar 84 - 63 157.50Sirah Parinah (Head circumference) 32 - 24 60.00Sirah Ayama (Height of head) 16 - 12 30.00Griva parinah (Neck circumference) 22 20 15-16.5 37.50-41.25Griva Ayama (Height of neck) 04 - 03 07.50Vaksha parinaha (Chest 48 - 36 96.00circumference) (Vajsa-24 + Pitha-16 +Kaksa-08)Bhuja Parinaha(Mid arm 16 16 12 30.00circumference)Bahu Parinaha (Fore arm circumferen 12 - 09 22.50ce)Udara Parinaha(Abdomen circumferen 40 - 30 75.00ce) (Kati-16 + Udara-12 + Parshva-12 =Kati-18 su)Sroni Parinaha(Hip circumference) 52 - 39 97.50(Kati-16 + Udara-12 + Parshva-12 + Trika-12 )Uru parinaha (Thigh circumference) 30 32 22-5-24 56.29-60.00Jangha Madhya Parinaha 16 18 12-23.5 30.33-75.00 229,230Diagnosis of obesity: Obesity can easily identified at first sight but a preciseassessment requires measurements and reference standards. . Although not a directmeasure of adiposity, the most widely used method to gauge obesity is body massindex, which is equal to weight/height2 (in Kg/m2) other approaches to quantifyingobesity includes. In modern methods of diagnosis, so many parameters are described as follows: • Direct methods of measuring body fat and under water weighing (Densitometry) • Estimation of fat cell mass by isotope dilution method. • Estimation of total body water. (Blood, lymph etc.) • Estimation of total body potassium. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 66
  • 87. Disease review – Rupa • The connective tissue (skin, bones, connective tissue) • Bioelectric impedance analysis – a harmless amount of electric current is sent • Through the body. The body has the ability to conduct an electric current reflects the total amount of water in the body. A higher % of body water indicates a larger amount of muscle and lean tissue. • Dual energy x-ray absorptiometry - to estimate born density, provides the best assessment of the body fat. • Both computed tomography (CT Scan) and nuclear magnetic resonance to • Distinguish between the fat and lean tissue of the body.Most widely used criteria diagnosis: 1) Specific weight for height: Table No 23 : Showing Normal Height & Weight: Height Female Male in cm. Normal wt Over wt (+20%) Normal Wt Over wt (+20%) (in Kgs) (in Kgs) (in Kgs) (in Kgs) 148 46.5 56.00 47.0 57.0 152 48.5 58.0 49.0 59.0 156 50.5 60.5 51.5 62.0 160 52.0 63.0 53.5 64.0 164 55.0 66.0 56.0 67.0 168 58.0 69.5 59.0 71.0 172 60.5 72.5 62.0 74.5 176 64.0 77.0 65.5 78.5 180 67.0 80.5 68.5 82.0 184 70.5 84.5 72.0 86.5 188 74.0 89.0 75.5 90.5 * L.I.C. Standard height /weight index2) Body Mass Index (BMI) / Quetlet’s Index: -231 Weight(kg) / Height2 (m) This index is more closely corresponds to measurement of body fat and betterdifferentiates “Over weight” due to an increase in muscle mass from true obesity. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 67
  • 88. Disease review – RupaThe international classification of BMI has been widely accepted based on thefollowing range of BMI values Table No 24: showing Grading Pattern as per BMI values Terminology BMI Underweight Below 20Kg/m2 Normal 20-25 Kg/m2 Over weight 25-30 Kg/m2 Obese 30-40 Kg/m2 Very obese Above 40 Kg/m2 Table No 25: showing Optimal BMI values: Height Body weight in kilogram (cms) 90 85 80 75 70 65 60 55 50 45 135 49.4 46.6 43.9 41.2 38.4 35.7 32.9 30.2 27.4 24.7 140 45.9 43.4 40.8 38.3 35.7 33.2 30.6 28.1 25.5 23.0 145 42.8 40.4 38.0 35.7 33.3 30.9 28.5 26.2 23.6 21.4 150 40.0 37.8 35.6 33.3 31.1 28.9 26.7 24.4 22.2 20.0 155 37.5 35.4 33.3 31.2 29.1 27.1 25.0 22.9 20.2 18.7 160 35.2 33.2 31.3 29.3 27.3 25.4 23.4 21.5 19.5 17.6 165 33.1 31.2 29.4 27.5 25.7 23.9 22.0 20.2 18.4 16.5 170 31.1 29.4 27.7 26.0 24.2 22.5 20.8 19.0 17.3 15.6 175 29.4 27.8 26.1 24.5 22.9 21.2 19.6 18.0 16.3 14.7 180 27.8 26.2 24.7 23.1 21.6 20.1 18.5 17.0 15.4 13.9 185 26.3 24.8 23.4 21.9 20.5 19.0 17.5 16.1 14.6 13.1 **Some therapeutic diets, national institute of nutrition, Indian Council of Medical Research, Hyderabad, India. 2323) Skin fold thickness: Several varieties ofcalipers (e.g. Harpenden’s skin calipers) areavailable for the purpose. Normally most of the adipose tissue is insub cutaneous layer, the thickness of which canestimate by measuring a skin fold thickness atdifferent sub cutaneous sites. source: Encyclopedia of Family Health Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 68
  • 89. Disease review – RupaSites for taking measurements: • Mid triceps • Mid biceps • Sub scapular • Supra iliac regions The sum of measurements should be less than 40 mm in males and 50mm infemales. Unfortunately standards for subcutaneous fat do not exist for comparison.Further, in extreme obese, measurement may be impossible.The main draw back of skin fold thickness measurement is their poor repeatability4) Relative Weight (RW): The RW is “actual weight” divided by “desirablesweight” (derived from acceptable weight table) • RW > 120% Obese • RW > 200% Morbid Obese 2335) Body girth measurements: WHR: The measurements of body circumferenceswith a tape measure provides the same advantages of portability and acceptability asheight weight measurements. In addition circumference measurement appears to bemore precise and less subject to inter observer errors than skin fold measurement evenin very obese persons. Although they have found their biggest use in the estimation ofbody fat distribution. Some studies have shown that, both men and women, who have a high ratio ofwaist to hip circumference have increased risk of ischemic heart disease, stroke anddeath. Studies have shown that a greater WHR ratio is associated with higher bloodpressure, glucose intolerance and higher serum lipid levels.To check for abdominal obesity one measures the waist hip ratio this is given by, Waist circumference (in cms) Hip circumference (in cms) Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 69
  • 90. Disease review – Rupa The waist circumference is usually measured half –way between the superioriliac crest and the rib cage in the mid axillary line, where as the hip circumference ismeasured one third of the distance between the superior iliac spine and the patella.The ratio of the former to the later provides an index of the proportion of intraabdominal fat. • The average value for men is about 0.93 with range 0.75 to 1.10 • For women 0.83 Range 0.70 to 1.0 The other may be called as abdominal gluteal ratio or android gynoid ratio(AGR). Patients with an elevated AGR i.g.greater than 0.9 for men and 0.8 for womenare said to have android or male pattern of obesity, while patients with low AGR aresaid to have gynoid or female pattern of obesity. The persons with abdominal obesityare a greater risk of cardio vascular complications than with gluteal obesity.Out of the several methods described, widely and practically used methods areweight, BMI and Skin fold thickness measurement. In ayurvedic classics the terms like sthula, sthoulya, medovridii, andmedoroga has been used by the acharyas in different contexts, some times often takenit as relative terms, but by observing the references and signs and symptoms slightchanges can be observed in the pattern of medovriddi, medodosha, sthoulya sthualata.As in modern medicine the international classification like BMI has been widelyaccepted as the basis for defining the terminologies like under weight, normal weight,over weight, obese and very obese. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 70
  • 91. Disease review – SampraptiSamprapti of sthoulya: - It is the term, which indicates the way in which a disease occurs beginningfrom dosha dushti to the manifestation of classical features. The knowledge ofSamprapti helps in the comprehension of the specific features of a disease like Dosha,Dushya, Srotodushti, Ama and Agni. Basically sthoulya has been narrated as a dushya 234dominant disorder i.e.medoja Vyadhi In some other places ati Sthoulya has beenconsidered as meda doshaja disorder 235Samanya samprapti: According to Charaka, Due to the avarana (obstruction) all srotases (channels)by the meda, vata vriddi occurs in the koshta leading to the ati sandhukshana ofjatharagni. By that, the consumed food will be digested rapidly and makes the personto crave for more food. If at all due to any reason the person does not receive food intime may lead to various complications. But repeated consumption of food in turnhelps in meda vriddi only leads to Sthoulya.236 According to Sushruta Ama Rasa is produced due to Kaphavardhakaahara,Adhysana, Avyayama, Divaswapana. The Madhura Bhava Ama Rasa moves withinthe body, Snigdhansha of this Anna Rasa cause sthoulya that produces excessivestoutness in turn Sthoulya.237 This may be illustrated as follows Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 71
  • 92. Disease review – Samprapti Nidhanasevana Bheeja Swabhava Koshtagni dushti Madhuratara annarasa utpatti Ama Medo Dhatwagni Mandhyata Atisneha utpatti Medo Dhatu Atiupachaya Ati meda avarana Ati vruddha Meda Dhatu Causes Anya Dhatu Margavarodha Vatavriddhi in koshta Jatharagni ati sandhukshana Anya Dhatu asamyak Upachaya Ati ahara sevana STHOULYA Flow Chart No 2: Schematic representation of samprapti of sthoulya.Vishesha smprapti: Samprapti of all the diseases are explained under someimportant components as below,Dosha: In the samprapti of Sthoulya all the 3 doshas are involved. Acharya charakahas considered Atisthoulya as one among the kaphajananatmaja vyadhi,238 which is Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 72
  • 93. Disease review – Samprapticlearly observed by the nidanas of Sthoulya like guru, snigdha, sheeta, madhura anddiwaswapna etc. which are also considered as kaphakara nidanas Basically in the samprapti of Sthoulya involvement of Paachaka and Brajakapitta can be observed by seeing the laxanas like atikshudha, atipipasa, atisweda etc. Due to the avarana of meda to the srotases the samanavata gets aggravated andagni sandhukshana will occur leeds to impaired digestion leeds to increased foodintake and because of vitiation of vyana vata there is impaired circulation anddistribution of meda can observed.Dushya: Acharya Sushruta has mentioned Sthoulya as a Dushya dominant disorder234Here, 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.239Srotas : In Sthoulya, the involvement of Medovaha srotas is the main factor alongwith the involvement of other Srotases like, Medavaha Rasavaha srotas andMamsavaha srotas are seen. Caraka considered avyayam, diva swapna, excessiveintake of medura dravyas and varuni or madya as causes of meda vaha srotasdusthi.240 And as the deposition of meda is seen inside the vasa (muscle) shows theinvolvement of Mamsavaha srotas.Agni: Involvement of agni is prime factor in the samprapti of Sthoulya. As“Rogosarveapi mandagnou,”But here due to the avarana by the meda, vata gets aggravatedin the koshta and causes jatharagni sandhkshana, at this stage the person goes forkalavyatheeta and adhyashana type of ahara sevana, and then further it leads toformation of ama. Vagbhata explained as, the agni which is present in the dhatu level isdhatwagni and it is the portion of the jatharagni because of its identical function i.e. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 73
  • 94. Disease review – Sampraptithe increase or decrease of particular dhatwagni leads to vriddi or kshaya of thatdhatu. In this state of Dhatavagnimandya Kshya of utter Dhatu takes place.241In the diseases sthoulya, meda dhatvagni poshakamsha is vitiated, for which medadhatvagni is unable to perform its function properly. Which causes formation of moremeda dhatu poshaka rasa and accumulates more sthula meda dhatu in their depots. Ama: Due to increased in sheeta, snigdha & madhura guna which is opposite to thatof Pitta the jataragni mandya take place leading to Jataragnijanitaama this furtheraccumulation of Ama in Medovaha srotas due to Medodhatwagni mandya thedhatwagni janitaama is resulted.242Samprapti Vighatana: -Dosha : Kapha : Kledaka Pitta : Pachaka Vata : Samana, VyanaDushya : Rasa,Mamsa & Meda dhatuAgni : Jatharagni : Rasa and Meda DhatvagniSrotas : Meda vaha Srotas : Rasa vaha Srotas : Sweda vaha Srotas : UdakavahaSrota Dushti : Sanga : Margavoradha (Cha. Su. – 21/3-4) : Amatah (Su. Su. 15/37)Adhisthan : Particularly Vapavahana & Meda dhara kala.Udbhava Sthala: AmashayaSanchara Sthana: RasayaniRoga marga : BahyaAgni : Jatharagni Vikriti Janita. Dhatvagni Mandya JanitaVyatktsthana : Sarvanga, Specifically Sphik, Udara, Stana & Gala. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 74
  • 95. Disease review – Samprapti 243PATHOGENESIS OF OBESITY: Obese persons having an increase in numberand/or size of adipose cells suggest hypertrophy and/or hyperplasia of adipositieseither due to functional demand in particular age or sex or due to genetic, endocrine,behavioral, psychological or iatrogenic factors. After reduction in weight the adiposecells shrink in size but hyperplasia remains fixed. Adult onset obesity ischaracterized predominantly by adipose cell hypertrophy with minimum hyperplasia.There are three main factors in the pathogenesis of obesity:Excessive lipid deposition: is due to either increased food intake, hypothalamic lesions.Adipose cell hyperplasia or hyperlipogenesis. Increased food intake in form ofcarbohydrates, proteins and fats by metabolic process lastly converts in fat and getstored at fat depots. Physiology of hunger and satiety is dependent upon hypothalamus. Lesionsmay damage these centre leads to voracious appetite (Ventro medial and lateralnuclear area of hypothalamus) and ultimately leads to obesity. Similarly adipose cell hyperplasia or hyperlipognesis due to genetic orendocrine pathology leads to obesity.Diminished lipid mobilization: Thyroxin, adrenaline and glucocorticoids stimulatemobilization of unsaturated fatty acids from adipose tissue, hypo secretion of thyroxinand hyper secretion of glucocorticoids causes diminished lipid mobilization andexcessive lipid deposition in certain areas such as abdomen, chest, face and buttocks,ultimately leads to obesity. Thyroxin generally increases the appetite and food intake.Diminished lipid utilization: is due to ageing, defective lipid oxidation, defectivetheromogenesis or inactivity. The BMR increases to as much as 60-100% above thenormal level, when large quantity of thyroxin is secreted. It falls by 20-40% below the Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 75
  • 96. Disease review – Sampraptinormal level when less quantity of thyroxin is secreted. It is the main pathology inmiddle age obesity. ETIOLOGY • Increased food • Decreased Lipolytic • Ageing intake. Hormones. • Defective lipid • Hypothalamic • Defective Adipose Oxidation Lesions Cells • Defective • Adipose cell • Abnormality in thermogenesis. hyperplacia autonomous • Hyperlipogenesis Innervation. Increased lipid deposition Diminished lipid Diminished Utilization mobilization OBESITY Fig No 4: Showing etiology of obesity.Metabolic changes related to obesity: 244Hyperinsulinaemia: Increased insulin secretion is a feature of obesity. Many obesepatients exhibit hyperglycemia or frank diabetes despite hyperinsulinaemia. This isdue to a state of insulin-resistance consequent to tissue insensitivity.NIDDM: There is strong association of NIDDM with obesity. Obesity oftenexacerbates the diabetic state and in many cases weight reduction often leads toamelioration of diabetes.Hypertension: Association of this with obesity is because of increased blood volumeweight reduction leads to significant reduction in systolic blood pressure. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 76
  • 97. Disease review – SampraptiHyperlipoproteinaemia: The plasma cholesterol circulates in the blood as low-density lipoprotein (LDL) containing most of the circulating triglycerides.obesity isstrongly associated with VLDL and mildly with LDL. Total blood cholesterol levelsare elevated in obesity.Atherosclerosis: In hypo secretion of thyroxin, the cholesterol level in plasmaincreases leading to atherosclerosis. Obesity predisposes to development ofahterosclerosis.Coronary artery disease and stroke: As a result of atherosclerosis and hypertension,there is increased risk of myocardial infarction and stroke in obese individuals.Cholelithiasis: There is six times higher incidence of gallstones in obese persons,may due to increased body cholesterol.Hypoventilation syndrome (pickwickian syndrome): This is characterized by hypersomnolence, both at night and during day in obese individuals along with carbondioxide retention, hypoxia, polycythaemia and eventually right-sided heart failure.Osteoarthritis: These individuals are more prone to develop degenerative jointdisease due to wear and tear following trauma to joints as a result of large bodyweight.Cancer: Certain cancers such as endometrium and breast seem to be related toobesity. Particularly implicated are the diets derived from animal fats and meats in thecausation of colon cancer. High fat intake increases the level of bile acids in the gut,which in turn modifies intestinal flora, favoring the growth of microaerophilicbacteria. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 77
  • 98. Disease review – UpadravaUpadrava of Sthoulya : The aliment, which is associated with a disease, and is manifested after themanifestation of the main disease, is called Upadrava. Describing the severity of Sthoulya, Carak has compared the aggravated vataand pitta with davanala, which destroys the whole forest.245Table no 26 : Showing updrava of stoulya: 246,247,248,249,250,251 Sl. Upadrava SU AS AH MN BP YR No 1 Ama Roga - - + - - - 2 Apachi - - + - + + 3 Arsa - + + - + + 4 Atisara - - - - + + 5 Bhagandara + + + + + + 6 Jwara + + + + + + 7 Jantavaha - - - - + + 8 Kaamala - - - - + + 9 Kasa - - + - - - 10 Kustha - - + - + - 11 Mutra Kriccra - - + - - - 12 Prameha - + + - + + 13 Pramehapidika + + - + - - 14 Shleepada - - - - + + 15 Sanyasa - - + - - - 16 Udararoga - + + - - - 17 Urusthambha - + - - - - 18 Vatavikara + - - + - - 19 Visarpa - - - - + + 20 Vruddhi + + - + - - Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 78
  • 99. Disease review – Upadrava Upadrava of SthoulyaDue to agnivikriti Medamamsavikriti Avaranam Swedabadha Ojadusti Atisara, Prameha, Urustambha, Kustha, Swasa, Ajirna, Pidaka, Apachi, Vatarakta, Jantvaha. Kasa, Udararoga Slipada, Granthi, Sandhivata, etc Sanyasa etc Vidradhi, Gridrasi, Visarpa, Arduda Damaniprath Arshas, etc -ichaya etc Flow Chart No 3: Schematic representation of Upadrava SthoulyaComplications of obesity: 252,253,254 Obesity is termed as the storehouse of diseases as well as leading cause ofmorbidity and mortality due to its manifold complications. Statistics on health showsthat a middle aged person who is 10kg over weight can expect to die roughly 4 yearsearlier then one with normal weight Obese women are more likely than non-obesewomen to die from cancer of the gall bladder, breast, uterus, cervix or ovaries. We can classify the complication related to obesity according to varioussystems as follows:Cardio Vascular System: Essential hypertension, coronary artery disease, leftventricular hypertrophy, corpulmonale, this obesity is mainly associated withcardiomyopathy, and pulmonary hypertension of obesity, cardiac arrythmias andatherosclerosis.Respiratory systems: Chronic bronchitis, Hypoxemia, Alveolar Hypoventilation,Hypoventilation syndrome (Pickwickian syndrome), Pulmonary Hypertension,Pulmonary embolism, Obstructive sleep apnea. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 79
  • 100. Disease review – UpadravaGastro intestinal system: Gall Stone, Hiatus Hernia, Cholecystitis, Pancreatitis,Hepatic Stenosis, Diverticulosis of colon, Reflux Oesophagitis, Dyspepsia.Central nervous system: Stroke, idiopathic intracranial hypertension, neralgiaparesthetica.Malignancies: Associated with endometria’s, prostate, gall bladder, breast, colon andpossibly lung cancer.Musculo skeletal: Osteo arthritis, Bach acheEndocrine and metabolic: Diabetes Mellitus, Hyper lipidaemia, Hypo metabolicState, Hyper Cholesteraemia. , Fatty liver, Gout, Polycystic Ovarian SyndroMiscellaneous: Reduced mobility, difficulty maintaining personal hygiene. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 80
  • 101. Disease review -SadhyasadhyataSadhyasdhata of Sthoulya : Charaka has mentioned bad prognosis for Sahaja (hereditary) disease.255Hence Sahaja Sthoulya can be considered as Asadhya. Therefore Sadhyasadhyata of Sthoulya can be constructed on the basis ofgeneral principles of Sadhyasadhyata depicted in Ayurvedic Texts (Ch. Ni. 8/33-35),which are as below. Table 27: Showing The Sadhyasadhyata of Sthoulya Sthoulya SUKHA SADHYA KRICHHA SADHYA ASADHYAJatotara Hina Sthoulya Jatotara Madhyama Sahaja Sahaja Sthoulya.Having duration of 1-5 Sthoulya Jatotara Adhika Sthoulyayears. Having duration of 5-10 Having more than 10 yearsWith out any complication years. of durationor secondary disease With least complications Associated with secondary but no secondary disease. complications.Prognosis: 256 The morbidity-associated obesity is not in doubt. For a person a BMI 25- 28Kg/m2, the relative risk for coronary heart disease. This risk progressively increasesan increasing BMI. Therefore, BMI greater than 33kg/m2 the relatively high risk forcoronary heart disease. Similar trends have been demonstrated in the relationshipbetween obesity and stroke or congestive heart failure. Overall obesity is estimated tobe associated a 4-fold increase cardio vascular mortality rate and a 2 fold increasedcancer related mortality rate. As a group, people who are severely obese have a 6 – 12fold increased all cause mortality rate. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 81
  • 102. Disease review - ChikitsaChikitsa of sthoulya : - Sddeªd: e¸¶Sddeªd¡dd‰Sd¦£dy ¯dTfTy ¥dd£d®d: ±d«dd | ±dd eŸdeI¶£±dd e®dI¶TdPdda I¶«d‰ £dQŠeªd°d¡dda àŠ«dg£d«dŠ || (Ch. Su. 16/34) Such actions, which bring the equilibrium of Dhatus, constitute the treatmentof diseases. Acharya Charaka has further amplified the scope of the term Chikitsa.According to him, “Chikitsa aims not only at the radical removal of the causativefactors of the disease, but also at the restoration of the Doshika equilibrium”. In Ayurveda, general principles of management of any disorder is ±da¯ddy¥dd¦da ±da¯d«d¦da e¦dQd¦d±Sd Ÿd ®d¡d‰¦d«dŠ|| (Ch. Vi. 7/30). Thus, in any disorder management is divided into 3 parts.Samshodhana Therapy:Table no 28: Showing methods of samshodhana therapy in Sthoulya. Bahir parimarjana Abhyantara chikitsa Samshodhana Udavartana Vamana Avagah Virechana Pariseka Nasya Lepana Niruha etc.Bahir parimarjana chikitsa: Many Acharyas have mentioned external purificationtherapy for management of Sthoulya. Acharyas narrated Ruksha Udavartana forSthoulya.257 The benefits of adverting also mentioned. i.e. Kaphahara, MedasaPravilayana, Sthirikaranam Angam etc (A.H.Su.2/15).Abhyantar Samshodhana: According to Vagbhata, Atisthoulya patients with AdhikaDosha and Adhik Bala should be treated by Samshodhana therapy including Vamana,Virechana, Ruksha Niruha, Raktamokshana etc.258 Charaka has mentioned Sthoulya under the caption of Santarpanajanita Vyadhiand for its management; Vamana, Virechana and Raktamokshana are recommended Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 82
  • 103. Disease review - Chikitsaas259 .He also suggested Ruksha, Tikshna and Ushna vasti for the managementpurpose of Sthoulya.Snehana: It is contraindicated for the patients of Sthoulya (Ch. Su. 13/53). However,Lekhaniya, Medohara properties260 and Sthulatvhara Karma (Su. Chi. 31/16, A.S. Su.6/100) of Taila are described in Ayurveda. So, on exigency usage of Taila isrecommended 261Swedana: Swedana is also contraindicated in Sthoulya rogi but Niragni sweda can beencouraged in Sthoulya in the form of Vyayama, Alpa Sevana and Upanaha areadvised.262 263Vamana :- Sushruta has recommended Vamana for the treatment of Medoroga .According to kashyapa by doing vamana the person is going to get laghuta in thebody and it irradicates the meda dourgandhya and kaphaja rogas.264Virechana: Virechana has been recommended for patients of Sthoulya265Vasti:-In classics Lekhan vasti is considered as a best therapy forSthoulya/medovriddhi266 The role of Ruksha, Ushna and Tikshna vasti in themanagement of Sthoulya is very well explained by Gangadhara (Jalpakapataru Tikacommentary on as it alleviates kapha and meda.267 Sharangahara has given a clear description regarding the properties of lekhandravyas and characteristics of lekhan vasti 268References of some vastis for Sthoulya: Vasti prepared with Taila, Gomutra, Kanji and Saindhava (Cha. Si. 10/13-14). Erandamuladi Niruha (Cha. Si. 3/41) Kapha nashak Vasti (Cha. Si 10/23-24) Lekhan Vasti (A.H.. Ka – 4/7-10) Madhutailika Vasti (Sha. U. –6/32-33, B.P. – 29/30) Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 83
  • 104. Disease review - ChikitsaRakata Mokshana: Maharshi Kashyapa has recommended Rakta mokshana with 269Urdhva and Adhah samshodhana for sthoulya, especially for medosvi dhatriSimilarly Bhavaprakash has considered Rakta mokshana as a therapy for sthoulya(Bha.Ma- 39/12). So we can adopt Raktamokshana for the treatment of Rakta gatameda.Shiro virechana: Kashyapa has considered karshana nasya as a treatment fordisorders of kapha270 and Sthoulya is enumerated as one of the twenty-kaphananatmaja vyadhis, so it can be applied to treat sthoulya. Triphaladya taila is indicatedfor nasya in the patients of medovriddhi271Samshamana: Charaka Samhita has been given treatment in following words. ›dgè Ÿdd£d§d‰Pda ŸdyÝa ±¤dg¬dd¦dda I¶¯d‰¦da §d e£d | i.e. Administration of Guru and Apatarpaka articles which possess additionalVata, Shleshman and Medonashaka properties are considered as an ideal forSamshaman therapy. Chakrapani has explained that Guru Guna is sufficient toalleviate vitiated Agni and Atikshudha. Apatarpana property provides lessnourishment and thus leads to depletion of Meda. For example Madhu possess Guruand Ruksha properties, hence it is ideal for management of Sthoulya. Gangadhara hasinterpreted that Guru property is suitable to alleviate Tikshnagni and vitiated vataespecially Kosthagata Vata which ultimately reduces Atikshudha and Apatarpanproperty causes reduction of Meda .272Nidana Parivarjana : Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 84
  • 105. Disease review - ChikitsaAharatmaka, Viharatamaka, Manasika and Anya Nidana, which are responsible forthe disease, should be avoided as a Nidanparivarjana chikitsa.Treatment of Obesity:Prevention: “Prevention is better is than cure” Prevention should begin in early childhood. Obesity is harder to treat in adultthan it is in children. This can be achieved by dietary changes, increased physicalactivity and a combination of both. The modern author have narrated the treatment of obesity in followingheadings, • Counseling of the Patient. • Diet Therapy • Behavioral Modification • Exercise Therapy • Drug Therapy • SurgicalCounseling of patient: Patient counseling has utmost importance in the managementof obesity. Detail knowledge of the disease including cause and treatment need to beexplained in front of an obese person. Emphasis should be laid upon fat reductionrather than weight loses. Patients must be made aware of the role of diet inaccelerating weight loss. At the same time, patients must be disposed with confident opinion concerningthe successful out come of the prescribed programs as well as importance of gradualweight loss instead of drastic. The weight loss will be very rapid in early period ofdieting and then gradual. This should be explained to the patients to avoiddisappointmentDiet Therapy: 273 Caloric restriction is the corner stone of weight reduction. If foodintake is less than energy expenditure, stored calories predominately in the form of fat Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 85
  • 106. Disease review - Chikitsawill be consumed. For any concidering a weight- reducing diet, the quantity of foodintake and the avoidance of settings in which excess quantities of high fat food areeaten are equally important. Controlling food intake is easier if the use of alcoholicbeverages is reduced or eliminated. People who eat breakfast have a lower risk ofdeveloping obesity than the individuals who do not. Ingestion of frequent small mealswith relatively high carbohydrate and high fiber content is a way of decreasing fatintake. While planning diet for an obese patient caloric intake should be reduced by500 to 1500 calories per day from the current level and perfect aim should be fixed.Middle aged obese house wife need 800 to 1000 kcal per day where as an obese manengaged in active physical work, need 1500 to 2000 kcal per day. Rigid dieting is besttreatment. (LCD) 800 to 900 calories/day is best to reduce the weight. But it mustcontain all the essential foodstuffs. Diet lower than 800 kcal/day (VLCD) have beenfound to be no more effective than low caloric diets in producing weight loss on along term basis. The diet should contain – protein 50gm, carbohydrate 100 gm, fat 40gm,vitamin A and C, minerals like iron and calcium, fluids and salts.Planned Diet Rules: • Eat when your are hungry • Diet should contain liberal amount of salad, fresh fruits and vegetables and dietary fibers. • Daily required calorie should not less than 500 kcal. • Reduce the amount of sugar and salt. • Calorie Requirement should be adjusted with type of physical activity • A chart of dietary calorie value is given below, which will be very helpful in planning diet schedule for an obese person. (All valves are as per 100gms.of edible portion) Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 86
  • 107. Disease review - ChikitsaContra Indications: There are several categories of subjects in whom VLCD andLCDs are contra indicated (absolutely or relatively), these include pregnant women,adolescents, growing children and patients with significant liver, kidney and cardiacdiseases. In addition there are some conditions while, it should only be used undermedical supervision e.g. gout, diabetic patients taking insulin or hypoglycemic agents,pre existing gall bladder disease and hyper tensive patients on antihypertensive drugs.Starvation: 274 Fasting as a method of treatment offers advantage of dramatic drop inweight within one week of treatment and this may be of psychological benefit totalstarvation for about 5-10 days prior to more conventional dietary therapy may bejustified in selected cases, like provided gout, renal insufficiency and ketosis pronediabetes are not present Probably the major usefulness of total fasting is asmotivational aid at the beginning of dietary programme or when weight loss hasstopped. The major problem in the treatment of obesity is not weight reduction butmaintenance of reduced weight. Obesity is an eating disorder, and limiting food intakedoes not reverse the underlying mechanisms. 275Behavioral modification: The principles of behavior modification provide theunderpinnings for many current programs of weight reduction. The basic principlesare those of operant conditioning and cognitive restructuring. Eating behavior isanalyzed into its antecedents, the act of eating, and the consequences of eating byasking the patient to monitor and record these activities. The setting in which eating occurs, the eating event itself and the use ofrewards designed to change maladaptive behaviors are all monitored. Attempt aremade to change thinking patterns from negative once such as “I have just eaten apiece of cake, I am bad person” into “I have just eaten a piece of cake and now I needto go exercise” or other positive ways of solving the problem. Features of behavior Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 87
  • 108. Disease review - Chikitsamodification of proven value in people who are successful in maintaining the weightloss over an extended period of time include: • Continued monitoring of food related behaviors, • Adoption of a low – fat diet, and • Increased levels of physical activity.Exercise therapy:276 Promotion of increased physical activity, which can bemaintained in the long term. Such exercises need not be over strenuous because healthgain is achieved at modest levels of exercise, as long as these are maintained. Walkingbriskly for 30mins each day can result in an additional weight loss of 1kg per month.Towards a possible vaccine against obesity:277 in what could become a new weaponin the battle of the bulge, scientists have had initial success with an experimentalvaccine for obesity. The reaserchers have found that when they gave rats a vaccine against ahunger hormones called ghrelin, the animals were able to live the dream of eatingwhat they wanted without packing on body fat. The finding, published online by the proceedings of the national academy ofsciences, suggests a whole new approach to weight loss. It is a long way however, from success in rats to similar results in people.more research in animals and more data on safety will be needed before an obesityvaccine is widely tested in humans, according to Dr. Kim Janda of the Scrippsresearch institute in lajolla California. One of the next step to see whether gherelin vaccination helps already obeserodents shed ponds, Dr. Janda said, if a vaccine were to become a reality for humans,it would be aimed at those obese individuals who continually “YO-YO” though diet& exercise, he noted. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 88
  • 109. Disease review - Chikitsa Secreted primariliy by the stomach, ghrelin is one of the harmone that help toregulate appetite, metabolism & weight – reuters.Drug therapy:278The goal of anti obesity drug is to include and maintain the state ofnegative energy balance until the desired weight loss is achieved. Appetitesuppressants drugs are useful in this condition. These are two groups of drugs areavailable: namely, those affecting the hypothalamic catecholaminergicpathway (e.g.amphetamine, diethylepropion, phentermine and mazindol) and those affecting thehypothalamic serotinergic system (fenfluramine, dexfenfluramine). Two new drugs are available. Orlistat (seeEBM panel) inhibit pancreatic andgastric lipases and thereby decreases the hydrolysis of ingested triglycerides. Thisproduces a 30% reduction in dietary fat absorption, which can contribute to a caloricdeficit of about 0.8 MJ (200) per 24hours. The second drug is sibutramine, which reduces food intake through beta -1 -adrenoceptor and 5-HT receptor agonist activity. Metabolic rate may also be enhancedvia stimulation of peripheral beta-3 adreno receptors. Weight loss achieved with thisagent is 3-5 kg better than placebo with 6 months’ therapy and is associated with animprovement in lipid profile. Thyroid replacement therapy should only be used in the obese person whenthere is definite biochemical evidence of hypothyroidism.Surgical management:279Surgical treatment is advised for the morbidly obesepersons with 100% weight above the weight for height standards and who are failed toloss their weight by other means. This treatment can be performed in 3 categories,they are, Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 89
  • 110. Disease review - Chikitsa • Excision effect: This not a very practical form of surgery and the obese individual is exposed to the risk of anesthesia, surgery and poor wound healing. • Surgery to cause malabsorption: This includes jejumo ileal bypass surgery. Where the upper jejunum is divided, the distal end is closed and the proximal end is anastomosed either end to side or end to end to the distal ileum. Decreased absorption of nutrients results in diarrhea and long term metabolic complication • Operation to restrict the food intake: Both gastric bypass and gastroplasty or gastric reduction operations, in which a new stomach is surgically constructed from the upper part of the normal stomach. This procedure produces a sense of fullness and helps the obese to stop eating. Obstruction to food intake can also be achieved by wiring the jaw together. Baratric surgery:280 These are 5 surgical methods of obesity, • An adjustable gastric band. • Vertical banded gastroplasty. • A biliopancreatic bypass. • A Rouse – en – y gastric bypass. • A sleeve gastroctomy with duodenal swith.Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 90
  • 111. Disease review - PathyapathyaPathyapathya of Sthoulya : Ancient ayurvedic classics have laid much more importance upon Pathya-pathya in the treatment of a disease. Without obeying the rules of Pathya-pathya, apatient will never get satisfactory result, rather a disease may aggravate with apathyasevan. “The things which is best for Srotases is called Pathyam, and one whichdeteriorates the condition is called Apathya”.Table no 29 : Showing Pathya for Sthoulya. 281,282,283,284,285,286 Sl No. Pathya Ch Su AH Bp YR BR 1 Puran Shali - - - + + + 2 Prashatika + - - - - - 3 Priyangu + - - - - + 4 Shyamaka + + + + - + 5 Yava + + + + + + 6 Yavaka + - + - - - 7 Jurna + - - - - - 8 Kodrava + + - + + + 9 Udalaka - + - + - - 10 Nivara - - - - - + 11 Laja - - + + + + 12 Mudga + + + + + + 13 Kulattha + - + + + + 14 Chakra Mudga + - - - - - 15 Makusthaka + - - - - - 16 Adhaki + - - - - - 17 Chanaka - - - - - + 18 Masura - - - - - + 19 Patola + - - - - - 20 Vartaka - - - - - + 21 Vruntaka - - - + + - 22 Patrasaka - - - - - + 23 Adraka - - - - + - 24 Bimbi - - - + + - 25 Amalaki + - - - - - 26 Tambula - - - - + - 27 Madhu - + - + - + 28 Madhudoka + - + - - - 29 Arishta + + - - - - Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 91
  • 112. Disease review - Pathyapathya Sl No. Pathya Ch Su AH Bp YR BR 30 Takra - - - - - + 31 Mastu - - + - - - 32 Sura - - - - - + 33 Sarshap Tail - - - - - + 34 Tila Tail - - - - - + 35 Ushnodaka - - - - - + 36 Kanji - - - + - - 37 Rohit Matsya + - - - - - 38 Chingat Matsya - - - - - + 39 Jangal Mamsa + + + + + - 40 Vyayama - + - - - - 41 Shrama - - - + - + 42 Jagarana - - + + - + 43 Vyavaya - - - + - + 44 Yana Bhramana - - - + - + 45 Chinta - - + + - + 46 Aguru Lepa - - - - - + 47 Udvartana - - - - - + 48 Atapa - - - - - + 49 Apatarpana - - - + - + 50 Vamana - - - - - + 51 Virechana - - - - - + 52 Lekhan Vasti - + - - + - 53 Shodhana - - + - - - 54 Langhana - - - - - + Prag Bhojane 55 - - - - - + Varipana Nishkale 56 - - - + + - Ushnodakapana Katu Tikta 57 - - - - - + Kashyaya Rasa 58 Ruksh anna - + - - - - 59 Saktu - - - + + - 60 Guggulu - - - - - + 61 Khshara + - - - - - 62 Ayash - - - - - + 63 Shilajit - - - - - + 64 Katurya - - - - - + 65 Phalatraya - - - - - + 66 Jirne Bhojana - - - + - -Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 92
  • 113. Disease review - PathyapathyaTable no 30 : Showing Aharaja Pathyapathya : Sl. Ahara Varga Pathya Apathya No. Puran Shali, Kodrava, Shyyamak, Suka Dhanya Yava, Priyangu, Laja, Nivara, Godhum, Naveen 1 (Cerel Grain) Koradushaka, Jurna, Prashatika, Dhanya(Shali) Kanguni. Shami Dhanya Mudga, Rajamasha, Kulattha, 2 Masha, Til (Pulses) Chanaka, Masur, Adhaki, Makusthaka. Patol, Patrashaka, Shigru, Vruntaka, Kanda Shaka, Shaka Varga Katutika, Rasatmak etc. Vastuka, 3 Madhura, (Vegetables) Trapusha Vartaka, Evaruka, Adraka, Rasatmak. Mulaka, Surasa, Grajjan. Kapittha, Jambu, Amaliki, Ela, Phala Varga Bibhitaki, Haritaki, Maricha, Pippali, 4 Madhura Phala (Fruits) Erand Karkati, Ankola, Naranga, Bilvaphala. Milk Honey, Takra, Ushnajala, Tila & Preparations, 5 Drava Varga Sarshapa Tail, Ashava Arista, (Dugdha, Dhadhi, Surasava, Jeerna Madya. Sarpi) Ikshuvikara Aanupa, Audaka, 6 Mamsa Varga Rohit Matsya. Gramya Mamsa SevanaPATHYA – APATHYA VIHARTable 31: Showing Viharaja Pathyapathya: Pathya Apathya Ushnodaka Sheetal Jala Sevan Sevana Diwaswapna Ratri Jagarana Avyavaya Bhraman Avyayam Rohan Ati Ashana Upavasa Sukha ShaiyaPATHYA – APATHYA VIHAR Table 32: Showing Manasika Pathyapathya: PATHYA APATHYA Shoka Nitya Harsha Chinta Achintana Bhaya Manaso NivruttiEvaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 93
  • 114. Disease review - PathyapathyaEvaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 94
  • 115. Drug reviewDrug review: Bhadradi Asthapana Vasti is mentioned only by the acharya sushruta innirooha basthyadhikara.287 . Vasti is the main treatment regimen for Vata Dosha.Drugs of this Vasti are Ushna Virya, Katu vipaka and Lekhana in nature; by virtue ofthese properties it reduces Kapha Dushti, kaphavata dushti as well as Meda Dushsti.The drugs used for this vasti are Table 33: showing the Drugs of Bhadradi Asthapana Vasti Yoga Saidhava lavana Vachadi kalka: Vacha, Madanaphala, Madhu Sarshapa Saindava lavana, Devadaru, Tila and Sarshapa taila kushta, Ela, Pippali, Bilwa, Shunti. Vachadi kalka Bhadradi kwatha: Bhadra(katphala), Bhadradi kwatha Nimba, Kulatha, Arka, Koshataki, Amruta, Yavakshara Devadharu, Sariva, Brihati, Pata, Murva, Gomutra Aragwada, Indrayava. Kanji The composition of vasti dravya as mentioned by the sushrta is as follows,Table 34: showing the textule Dose of Bhadradi Asthapana Vasti Yoga Ingredients Usual doses by Dalhana Saindhava lavana 1 aksha Madhu 6 pala Tila taila and Sarshapa taila 3 pala Vachadi kalka 3 pala Bhadradi kwatha 8 pala Yavakshara 1 pala Gomutra ½ pala Kanji ½ pala 24 pala Total Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 94
  • 116. Drug review Table No 35: showing Properties of Trial drugs: 288S Sans name Latin name Gana Kula Rasa Guna Virya VipakaN1 Katphala288 a Myrica Sukrashodana Katphala Kashay Laghu Ushna Katu esculenta sandhaniya (myricaceae) a tikta tikshna lodradi surasaadi katu2 Nimba 288 b Azadirachta Kandoogna, tikta Nimba Tikta Laghu Sheeta Katu indica skandha, aragwa (meliaceae) kashaya dadi, lakshadi3 Kulattha289 Dolichos - - Kashay Laghu Ushna Katu biflorus.4 Arka 288 c Calotropis Bhedaneeya Arka Katu, Laghu Ushna Katu procera swedopaga (asclepiadacea tikta ruksha arkadi e) tikshna5 Koshatak288 d Luffa Vamana, phalini Koshataki Tikta Laghu, Ushna Katu acutangula urdwabhagahara. ruksha, tikshna.6 Amruta 288 e Tinaspora Vayasthapana, Guduchi Tikta Guru, Ushna Madhur cordifolia Truptigna , Patol (menispermace kashaya snigdha a adi, Kakolyadi ae)7 Devadaru288 f Cedrus Sthanyashodana, Sarala Tikta Laghu Ushna Katu devodara vatasamshamana (pinaceae) snigdha8 Sariva288 g Hemidesmu Sthanyashodana, Arka Madhur Guru , Sheeta Madhur s indicus jwarahara (asclepiadacea a, tikta snigdha a sarivadi e)9 Brihati288 h Solanum Kanthya, Kantakari Katu Laghu Ushna Katu indicum shotahara, (solanaceae) tikta ruksha brihatyadi tikshna10 Pata 288 i Cissampelos Sthanyashodana, Guduchi Tikta Laghu Ushna Katu pareira sandhaneeya, Pat (menispermace tikshna oladi,aragwadadi ae)11 Murva 288 j Marsdenia Truptigna, Arka Tikta Guru, Ushna katu tenacissima tiktaskandhana, (asclepiadacea kashaya ruksha patoladi e)12 Aragvadha Cassia Kushtagna, Shimbi Madhur Guru, Sheeta Madhur 288 k fistula virechaneeya, (leguminosae) mridhu, a shyamadi, snigdha13 Vatsaka388 l Holarrhena Arshogna , kand Kutaja Tikta, Laghu, Sheeta Katu antidysentric oogna, aragwa (apocynaceae) kashaya ruksha. a dadi, pippalyadi.14 Madanaphal Randia Vamana,phalini, Manjishta Kashay, Laghu,r Ushma Katu 288 m spinosa mushakadi (rubiaceae) madhur, uksha prabhav tikt,katu a- vamana15 Sarshapa288 n Brassica - Rajeeka Katu Tikshna Ushna Katu campestris (cruciferae) tikta snigdha16 Kushta 288 o Saussurea Lekhaneeya,Aast Brigharaja Tikta, Laghu Ushna katu lappa hapanopaga,eladi (compositae) katu, ruksha madhur tikshna Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 95
  • 117. Drug review17 Ela 288 p Elettaria Shwasahara, Ardraka Katu Laghu Sheeta Madhur cardamon katukaskand (zingiberacea) madhur ruksha um a,eladi.18 Pippali288 q Piper Kasahara, Pippali Katu Laghu, Anushn Madhur longam Truptigna, (piperaceae) tikshn, asheeta pippalyadi shnigda19 Bilwa288 r Aegle Shothara Jambeera Kashay, Laghu, Ushna Katu marmelos arshogna (rutaceae ) tikta ruksha varunadi20 Shunti288 s Zingiber Triptigna , Ardraka Katu Laghu, Ushna Madhur officinale deepaneeya , snigdha. pippalyadi,21 Vacha288 t Acorus Lekhaneeya, Sarana Katu, Laghu Ushna Katu calamus Truptigna, (Araceae) tikta tikshna prabhav vachadi medhya Table No 36: showing Dosh & Roga prabhava, Chemical Comp and Action of Trial drugsSi Sans Dosha Roga prabhava Karma Chem. Compno name prabhava1 Katphala Kaphavata Prameha, Shotahara, kandugna, Bark contains tannin, (Bhadra28 shamaka shwasa,kasa,(B.P kaphanissaraka,vedana saccharin matter, 8a ) stapaka. &colouring principal galaganda,(C.D.) myricetin2 Nimb288 b Kaphapitt Kasa, kushta, Grahi, kandugna, Nimbin, nimbidin, a shamaka meha gulma, krimigna, nimbe sterol, volatile krimi (B.P.) oil, tannin, margosin and bitter substance.3 Kulatth290 Kaphavata Shwasa kasa Mutrala, medahara Protein –22%, fat - shamaka meda jwara 0.5%, nicotinic acid- krimi. 1.5mg, calcium-0.204 Arka288 c Kaphavata Kushata, kandu, Shotahara, kandugna, Uscherin, calptropin, shamaka gulma, krimi, kapha nissaraka, vedana calotoxin, amyrin, shwasa pleeha stapakadeepaka, giganteol (B.P.) rechana.5 Koshatak Kapha Kushta, pandu,, Vamaka, rechaka, A gelatinous bitter i 288 d pitta shota, kapha nissaraka. principle called Luffin, shodhaka prmeha,krimi fixed oil.6 Amrut288 e Tridosha Kushta, krimi, Deepaka ,pachaka, Berberine, bitter shamaka meha, kasa, vedana stapaka, substance, amavata (B.P.) kushtagna.. giloin.volatile oil.7 Devadaru Kaphavata Shota prameha Deepaka, pachaka, Wood yields alco resin 288 f shamaka, kasa kandu krimi anulomaka, amadosha kelanka-tel& dark lekhaniya. (B.P) pachaka. coloured oil tar i,e turpentine.8 Sariva288 g Tridosha Shwasa, Rochana, deepaka, Coumarin a volatile oil shamaka kasa,(B.P) kandu, pachaka, hemidesmine, sitoserol, kushta, anulomaka,shotahara,ra lupeole, tannin, meha.(D.N) ktashodaka.. essential oils & saponin. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 96
  • 118. Drug review9 Brihati Kaphavata Kushta, shwasa, Kandugna, uttejaka, Wax, fatty acids, 288 h shamaka kasa, (B.P) deepaka pachaka, alkaloids, solanin mutrala, &solanidine.10 Pata288 i Tridosha Shoola, kushta, Shotahara, kaphagna, Pelosine, serperine, shamaka kandu, visha, krimi, mutrala, deepaka, bebeerines, cyponin, jwara.(B.P) pachaka, grahi. Cissampeline11 Murv288 j Tridosha Prameha, kushta, Amapachaka, - shamaka hridroga. anulomaka, deepaka,.12 Aragvad Vatapitta Hridroga, udavarta, Mruduivirechaka, pulp contai ns sugar ha288 k shamaka shoola ,jwara. (B.P) anulomaka, gum astringent matter kaphanissaraka, gluten pectin, shotahara. alkaly,tannin etc..13 Vatsaka Kaphapitta Arsha atisara kushta Vamaka, deepaka, Non oxygenated alka 288 l shamaka visarpa shoola.(B.P) pachaka, amapachaka, loid-tanin, concessine raktashodaka. or kurchisine &holarrhenine.14 Madanap Kaphavata Kushta shota Shotahara, Saponin,valarianic hala288 m shamaka & gulma(B.P) kaphanissaraka, acids wax resin lekhaneeya swedajanaka, colouring matter & vatanulomaka. essential oils.15 Sarshapa Kaphavata Kandu, Deepaka, veedhahi, 35% of oil, sinalobin, 288 n shamaka kushta,krimi,(B.P) mutrajanaka, lekhana sinapin,. Lecithin, krimigna.. myrocin & ash contains potash16 Kushta Kaphavata Kushta, shwasa, kasa, Deepaka, pachaka, Resins alkaloids, salt of 288 o shamaka visarpa(B.P) anulomaka, amadosha voleric acids, pachaka, saussurine,innulin, kaphanissaraka. alkoloide, tereksesterol.17 Ela288 p Kaphavata Kapha, shwasa, kasa, Durghandhanashaka Fixed,Essential & Valo shamaka Arsha ,anulomaka, rochana, tile oil,Terpiny acetate, pachaka, Limonene,Cineole. kaphanissaraka..18 Pippali Kaphavata Kasa, kushta, meha Mutrala, vata Piplartin,sesamin,piplo 288 q shamaka gulma, krimi(B.P.) nulomaka, mrudu sterol, volatile oil, rechaka, deepaka. pepperine.19 Bilw288 r Kaphavata Grahi Grahi, deepajka Pulp contains mucilage shamaka mrudurechaka,kaphagn Pectine volatile oil, a shiotahara. Bitter principle, Marmelosin.aegelin.20 Shunt288 s Kaphavata Agnimandhya, Vatanulomana, Oleo resin i.e. shamaka kushta, pandu, rochana, pachgaka Ginggerin, shogaol, raktapitta. deepaka, kaphagna. zingerone.21 Vacha288 t Kaphavata Krimi, vibhanda Deepana, vamaka, Volatile, essential oil, shamaka admana (B.P) anulomaka, mutreala acorin bitter principle acoretin calamine starch mucilage tannin & palmatic acid.Saindhava lavana (rock salt) 290 a, b: This is the best in the lavanavarga. Rock salt is the common name for themineral Halite. Components - NaCl can have impurities of gypsum or transparent cubes. Ithas a pure saline taste. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 97
  • 119. Drug review Rasa - lavana Guna - laghu, snigdha, sukshma. Veerya - ushna. Vipaka - madhura. Properties - chakshushya, hridya, ruchikara, promotes appetite and assistsdigestion and assimilation. It posses a stronger purgative property also.Gomutra291:Proerties of Gomutra: Rasa: Katu, Tikta and kashaya. Guna: Tikshna, Kshara, Laghu Lekhan, Veerya: Ushna (Su. Y.R) Vipaka: Katu Dosha Prabhaba: Kapha-vatashamaka, Pittkaraka, Karma: Agni deepak, Medhya. Rodagnata : Shula, Gulma, Udara, , Anaha nashak.Madhu292: Paryaya: Madhu, Makshika, Madhvika, Kshoudra, Saragha, Makshikavanta, Varatavaanta, Bhringavaanta and Pushparasodbhava.Properties of Madhu:Rasa: Madhura, kashaya Guna: sheetala, laghu, ruksha, Karma: Grahi, vilekhana, srotoshodhaka, chakshushya, deepana, etc. Roga prabhava: kushta, Arsha, Kasa, Meha, Krimi, Meda, shwasa etcSarshapa taila293: Properties of Sarshapa taila: Rasa: katu Guna: Laghu, Tikshna Virya: ushna Vipaka: katu Dosha prabhava: kapha vata shamaka. Karma: Agnideepaka, lekhana, Roga prabhava: Meda, arsha, kushta, krimi, shwitra etc. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 98
  • 120. Drug reviewKanji294: Properties of Yavakshara: I¶de¦¡dI¶a ªdyQ£df´Pddy°Pda TdyŸd¦da §ddŸd¦da ¬dœdga | QdUµ¡®dTUµTa ±§d¯d‰|£dŠ §dd¦dd£dŠ Ùd£dI¶ñR¶dñ§dUµ«dŠ | ªdd.§T. 21/2 Varga – Madhyavarga Sanskrit – Kanji. Guna – Laghu, Teekshna. Dosha – Vata, Kapha shamaka. Uses – Deepaka, Pachaka, Trishna and Dahanashaka.Yavakshara295: Properties of Yavakshara: Rasa: Katu. Guna: Ushna, rooksha, teekshana, Sara. Veerya: Ushna Doshagnata: Kaphavata shamaka. Karma: Deepaka, pachaka, swedapravataka, mutrala. Rogagnata : Gulma, pleeha roga, etc.Tila taila296: Properties of Tila Taila: Rasa: Madhura. Anurasa: kashaya, tikta. Guna: guru, sukshma, snigdha sara vikasi, vishada. Virya: ushna Vipaka: madhura Doshagnata: vata kapha shamaka. Karma: Agnideepaka, lekhana, balakaraka, deepaka, medhya, brimhanakaraka, etc. Uses: Seeds are laxative, emollient and demulcent, diuretic, nourishing, lactagogue and emmenagogue. Composition: Palmitic acid (9.1%), stearic acid (4.3%), arachidic acid (0.8%), oleic acid (45.4%), linoleic acid (40.4%). Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 99
  • 121. Drug reviewImportance of murchana of tila taila: 297Crude oil contains Amadosha by morchanaprocess Amadosha are removed and also durgandhata & ugrata are removed. Afterdoing Moorchana Samskara Sneha gets good smell and colour. Apart from thesesSneha will gets the qualities of the drugs used for Murchana. While by Sneha pakaand Murchana the veerya of the Sneha is enhanced. The drugs used for Murchana of Tilataila are Haritaki, Vibitaki, Amalaki,Haridra, Mustha, Vatankura, Hrivera (Rasna), Ketaki pushpa, Manjistha, Lodra.With their lekhaneeya property and also removes the Amadosh of Taila. Beneficial effect of Moorchana sanskara reduces the degree of Saturation butenhances the degree of Unsaturation. It indicates the role of unsaturated fatty acids inreducing Serum Cholesterol, Serum Triglycerides and LDL levels, which are otherwise risk factor for the development of Atherosclerosis, Hyper tension, Coronaryheart diseases etc.List drugs for murchana process: - Manjistha - 1/16th part Haritaki - 1/64th part Vibhitaki - 1/64th part Amalaki - 1/64th part Mustha - 1/64th part Haridra - 1/64th part Lodra - 1/64th part Vatankura - 1/64th part Hrivera - 1/64th part Nalika - 1/64th part Ketakipushpa - 1/64th part Tila taila - 1 part Jala - 4 parts Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 100
  • 122. Clinical studyMaterials:The materials taken for the clinical study were 1) Bhadradi asthapana vasti yoga for nirooha vasti. 2) Murchita Tila taila for anuvasana vasti and abhyanaga.1) Bhadradi asthapana vasti yoga: The ingredients of Bhadradi asthapana vasti yoga like katphala, nimbakulattha etc were taken in equal quantity and sthula churna is preapared. And thekalka dravyas like vacha, madhanaphala, sarshapa, ela etc are also taken in equalquantity and powdered well. Filtered through cloth and made into fine powder. Theseare prepared in P.G. Department of Rasashastra D.G.M.A.M.C, Gadag.2) Murchita Tilataila: Tila taila was purchased from the local market and taila moorchana was donein P.G. Department of Rasa Shastra D.G.M.A.M.C, Gadag.Drugs for murchana of Tila taila areManjistha - 1/16th part Haritaki - 1/64th partHaridra - 1/64th part Vatankura - 1/64th partHrivera (Rasna)- 1/64th part Nalika - 1/64th part (Tamala patra)Ketakipushpa - 1/64th part Lodra - 1/64th partVibhitaki - 1/64th part Amalaki - 1/64th partMustha - 1/64th part Tilataila - 1 partJala - 4 parts Collections of drugs: All the raw drugs were purchased from the local market Gadag. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 101
  • 123. Clinical study Method of preparation: Tilataila is heated over mandagni till the foam and sound is subsided(phenashamana) then vessel is taken out from the fire. Above mentioned drugs aremade into coarse powder form, then made into kalka form by adding little amount ofwater, then this kalka and mentioned quantity of water is added to Tilataila and heatedfor making paka tillo attaining the Taila siddha laxanas. Then vessel is taken out fromthe fire and Taila is filtered. Such Murchita Tilataila does not possess any durgandhaand it is having its own specific colour and odor.Clinical study: Research is a scientific study through which one can establish new facts,discarding the old facts or modifying the present facts. Many times research is alsodone to validate the old principles with fresh proofs.The most significant milestone in the development of a drug or therapy is its firstadministration to a man.the efficacy of a drug or therapy can be proved only by well-conducted clinical trails. Ayurveda is an established fact, which have been approved by various ancientacharyas after rigorous experiments and examinations. But today its necessary toprove the Ayurvedic facts on the basis of systematic scientific research methodology,without altering its basic principles. Earlier sthoulya was seen more in developed countries. But this scene hasbeen dramatically changed due to sudden change in life style of people of even indeveloping countries because of urbanization, fast food and sedentary activitiesleading to morbid obesity with sudden spurt in disease like Hridroga, Prameha &Vatavyadhi etc. as its complication. Schematic representation of Upadrava Sthoulya 79 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 102
  • 124. Clinical study Vasti, especially ushna and tikshna vasti are explained in the treatment ofSthoulya. Possibly keeping in mind about the role of Kapha, Vaata and Meda, whichplay an active role in one, or the other stage of Sthoulya. So in the present study to achieve the objectives of study. The Sthoulya roga iscarefully and ethically designed by taking definite subjective, objective as well aslaboratory parameters before and after study conducted on scientific lines. To come toa satisfying conclusions.Research Approach: The objective is to “Evaluate the efficacy of BhadradiAsthapana Vasti in Stoulya (Obesity)”. The efficacy can be determined by finding outthe difference between the baseline data and after follow up data.Study Design: The study design set for the present study is ‘Prospective clinicaltrial’. The study was done in single group. Yoga Vasti krama is followed i.e. 3Nirooha + 5 Anuvasana.Selection Criteria: Patients suffering from Sthoulya were selected from the Post-graduation and Research Center OPD of D.G. Melmalagi Ayurvedic Medical CollegeHospital, Gadag. The criteria for inclusion and exclusion are as follows.Inclusion criteria: • The patients of Sthoulya diagnosed according to classical features • Patients of both sexes between the age group of 20 to 60 years. • Patients with BMI above 30 kg/m2. • The patients fit for Vastikarma.Exclusion criteria: • Sthoulya with later complications like Prameha Kustha etc • Obesity presented with secondary pathologies like Diabetic mellitus • Cardiac anomalies with secondary causes like endocrinal, CNS diseases etc. • Pregnant and lactating women Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 103
  • 125. Clinical study • The patients unfit for Vastikarma.Sample size: The sample size for the present study consists of 30 patients withSthoulya disease.Duration of Study: Vasti vidhi for 8 days, Anuvasana Vasti for 5 days, NiroohaVasti for 3 days. Pariharakala (Follow up) is for 15days.Data Collection: Patients selected were thoroughly examined by both subjective andobjective parameters. Detailed history and physical examination findings were noted.Laboratory investigations were done, to exclude and include in the study.Bhadradi Asthapana Vasti: This yoga was quoted by sushruta in 38th chapter ofchikitsa sthana. Dalhana acharya further elaborating over this fixes the dosage of eachingredient and indicated in all the kaphaja disorders. As it is a Teekshna vasti, it wasassumed after doing pilot study that the prescribed dosage schedule is difficult to beadopted in all the cases of Sthoulya because patient developed few untowardcomplications. So we have selected the matra i.e.48 tola and according to that thedosage of ingredients were fixed. They are as follows,Ingredients Selected dose for studySaindava lavana -------- 1 aksha (12 gms)Madhu ---------- 3 pala (144 gms)Tila taila and sarshapa taila --------- 1½ pala (72 ml )Vachadi kalka ---------- 1½ pala (72 gms)Bhadradi kwatha --------4 pala --(192 gms)Yavakshara -------- ½ pala (24 gms)Gomutra ------- ¼ pala(12ml)Kanji ------- ¼ pala (12ml)Total -------- 12 pala ( 48 tola ) (576ml) Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 104
  • 126. Clinical studyAnuvasana Vasti: As component of yoga vasti schedule anuvasana vasti wasselected. Vasti matra was selected as 6tola. Ingredient Matra Moorchita tila taila and saindhava 6 tola ( 72ml) TreatmentSchedule.Poorvakarma. All the patients were asked to be in the hospital at or after 9 o clock.Every patient was given mild abhyanga and sweda locally just prior to theintroduction of vasti. The abhyanga was done with plain tila taila to the whole bodyand sweda was done only on the area below the ribs to foot.Preparation of Bhadradi Asthapana Kwatha:Ingredients: Bhadradi Asthapana kwatha choorna-100grms Water -800mlEquipments: khalwa, vessel, measuring glass, stirrer, stove, matchbox, sieve etc.Materials or tools for therapeutic intervention • To administer Niruha Vasti- Plastic enema can fit with soft rubber tubes at the terminal end are used. • To administer Anuvasana Vasti- Plastic syringe fitted with soft rubber tube are used.Procedure: 100grms of Bhadradi Asthapana kwatha choorna added to 800ml ofwater in a vessel kept on stove and reduced to ¼ i.e. 200ml and used for the Vasti.Preparation of Vachadi Kalka: 72grms of Vachadi kalka choorna mixed. Q.S. wateris added and kept for a while and made it into bolus form and used for Vasti.Preparation of Bhadradi Asthapana Vasti: The different components of BhadradiAsthapana vasti are mixed in following way. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 105
  • 127. Clinical study Initially Madhu and Saindhava lavana taken and mixed thoroughly with a helpof wooden churner then Moorchita taila and Sarshapa taila was added slowly andmixed well. There should be no crystals of lavana found before adding taila. Vachadikalka is added little by little mixed well. Then Bhadradi Asthapana kwatha, which isprepared classically as well as freshly, added. All the ingredients are thoroughlymixed and a unique preparation is attained without sedimentation. This is madeSukhoshna by keeping it over ushna jala before administration.Pradhanakarma: Patient was asked to lie on the panchakarma droni in vamaparshwa (left lateral position with right leg flexed) and asked to take deep breath,sukoshna vasti dravya was administered slowly with the help of glycerin syringefitted with rubber tube( anuvasana vasti) or enema can fitted with soft rubber tube(nirooha vasti). Extreme care was taken to avoid all the vasti vyapat.then patient was asked toshift from right to left lateral and vice-versa repeatedly for a period of five minutes incase of anuvasana, mrudhu tadana was done over kati, prushta and uru pradesha. Thetime of administration, the time of retention and any complication present werenoticed at the spot.Paschat karma: Vasti pratyagamana kala was recorded and then thoroughexamination of the patient was repeated by noting all the vital data again. Patient wasadvised with all the pathyapathya to be maintained in the vasti pariharakala.Diet and exercise: Patients are advised to adhere to the Pathya Ahara and Viharaprepared according to the principals of Ayurveda and caloric value calculations andfood items and caloric demand of the individual. Beside this patients are advised to doexercise or yogasana and walking for half and hour daily. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 106
  • 128. Clinical study The body circumference measured at various parts like, upper mid arm (Rt &Lt), chest, abdomen, waist & hip the slandered measuring tape made of syntheticmaterial was used. To measure the body weight, a slandered weighing scale was used.The same machine was maintained exclusively for this current study. To measureheight a slandered measuring tape was used reading both in meters and feet.Materials for laboratory investigation: (used by Kuna laboratory Gadag) Table 37: Showing the Materials used for Lipid Profile Test Name of the reagent HDL Auto-span liquid Gold HDL cholesterol kit LDL Auto-Span Liquid Gold LDL Kit S. Triglycerides Auto-span Liquid Gold S. Triglycerides kit. S. Cholesterol Auto-span Liquid GoldMethod of Cholesterol kit Assessment oftreatment: Both subjective and objective assessments were done in all the patientsafter treatment. Separate grading has been given for subjective assessment parametersthat include the following.Chala Sphik Udara Stana: Grade • Absence of chalatva –0 • Little visible movement (in the areas) after fast movement –1 • Little visible movement (in the areas) even after moderate Movement -2 • Movement (in the areas) after mild movement –3 • Movement (in the areas) even after changing posture –4Alasya: • No Alasya (doing work satisfactory with proper vigor in time) –0 • Doing work satisfactory with late initiation –1 • Doing work unsatisfactory under mental pressure and takes time –2 • Not starting any work on his own responsibilities and doing Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 107
  • 129. Clinical study little work very Slowly –3 • Does not take any initiation and not want to work even after • Pressure –4Dourbalya: • Can do routine exercise –0 • Can do moderate exercise without difficulty –1 • Can do only mild exercise –2 • Can do mild exercise with very difficulty –3 • Cannot do even mild exercise –4Swedadikyata: • Sweating after heavy work and fast movement or in hot season –0 • Profuse sweating after moderate work and movement –1 • Sweating after little work and movement –2 • Profuse sweating after little work and movement –3Daurgandhyata: • Absence of bad smell –0 • Occasional bad smell from the body, which removed after bathing – 1 • Persistent bad smell limited to close areas difficulty to suppress with deodorants –2 • Persistent bad smell felt from long distance and is not suppressed by deodorant –3 • Persistent bad smell felt from long distance even intolerable to the atient himself -4Kshudraswasa: • Dyspnoea after heavy work but relieved soon and upto tolerance -0 • Dyspnoea after moderate work but relieved later and upto tolerance -1 • Dyspnoea after little work but relieved later and upto tolerance -2 • Dyspnoea after little work but relieved later and beyond tolerance -3 • Dyspnoea in resting condition -4Ati nidra: Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 108
  • 130. Clinical study • No day sleep can get up early, night sleep < 6 hrs. -0 • Can avoid day sleep easily bit drowsy, Night sleep < 7-8 hrs. -1 • Cannot avoid day sleep drowsy, day sleep 1-2 hrs and night sleep 8-9 hrs. –2 • Always drowsy, sleepy, day sleep 3-4 hrs and night sleep 9-10 hrs. - 3 • Sleep while sitting itself, day sleep 5-6 hrs and night sleep > 10 hrs. – 4Atikshudha: Atikshudha was decided on the basis of ruchi, abhyavaharana Shakti and jaranaShakti. Ruchi: • Totally unwilling for meal –0 • Unwilling for food, but could take the meal –1 • Willing towards only most liking food, and not to other –2 • Willing towards only one among Katu / Amla/ Madhura food stuffs –3 • Willing towards some specific aahara or rasa vishesha –4 • Equal willing towards all the Bhojya padartha –5Abhyavaharana Shakti: • The person not at all taking food –0 • Person taking food in less quantity once in a day –1 • Person taking food in less quantity twice in a day –2 • Person taking food in moderate quantity twice in a day –3 • Person taking food in normal quantity twice a day –4 • Taking food in excessive quantity twice or thrice –5Jarana Shakti: According to presence of Jirna aahara lakshana (M.N. 6/24), Utsahaha,Laghuta, Udagara shuddhi, Kshudha, Trushna Pravrutti, Yathochita malotsarga • Presence of one symptom after 6 hours –0 • Presence of two symptoms after 6 hours –1 • Presence of three symptoms after 5 hours –2 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 109
  • 131. Clinical study • Presence of four symptoms after 5 hours –3 • Presence of all symptoms after 4 hours –4 • Presence of all symptoms within 4 hours –5Ati Pipasa: • Normal thirst –0 • Up to 1-liter excess intake of water –1 • 1 to 2 liters excess intake of water –2 • 2 to 3 liters excess intake of water –3 • More than 3 liters excess intake of water –4OBJECTIVE CRITERIA: A. Weight : Grade –3 =〉 no change (Basic) Grade -2 =〉 1- 2kg. Grade-1 =〉 3-4kg. Grade-0 =〉 5kg and aboveB. BMI.: Grade –3 =〉 no change (Basic) Grade -2 =〉 0.01-1 kg/m2 Grade-1 =〉 1.01-2 kg/m2 Grade-0 =〉 2.01- and aboveC. In general body circumference for right arm, left arm, chest, abdomen, waist, hip, waist and hip ratio : Grade –3 =〉 no change (Basic) Grade -2 =〉 0.01-1.99 cms Grade-1 =〉 2-3.99 cm Grade-0 =〉 4 and aboveD. Total Body circumference: Grade –3 =〉 no change (Basic) Grade -2 =〉 upto33% Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 110
  • 132. Clinical study Grade-1 =〉 33.01-66% Grade-0 =〉 66.01-99%Overall assessment: Good respond - >70% in both subjective and objective parameters Moderate respond - 50-70% in both subjective and objective parameters Mild respond - 30-50% in both subjective and objective parameters No respond - < 30% in both subjective and objective parameters Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 111
  • 133. Results Table No.38 Showing data related to subjective parameters before and after treatment.Sl. OPD Sthana Udara Sphik Kshudras Dourbalya Nidradhiky Atikshudh Atipipasa Swedhadik Dourgadhy ResultsNo chalatwa chalatwa chalatwa whasa ata a yata ata BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT1 2326 3 2 3 1 4 3 4 2 3 2 3 2 3 2 2 1 3 2 2 1 MiR2 2427 2 1 2 1 3 2 3 2 2 0 3 2 2 1 1 0 2 1 2 1 MoR3 2668 2 2 2 1 2 2 3 2 2 1 2 1 1 0 - - 1 0 - - MiR4 2670 2 1 2 1 2 1 2 1 2 1 1 0 1 0 - - - - - - GR5 2673 2 1 3 2 2 2 2 0 3 2 2 1 1 1 - - 1 1 - - MiR6 2758 - - 2 1 1 0 2 0 1 0 2 1 2 1 1 0 2 1 1 1 MoR7 2767 2 1 2 1 2 1 3 1 2 1 3 1 2 0 2 0 1 0 1 1 MoR8 2770 2 1 2 1 2 2 3 2 2 1 - - 2 1 2 1 2 2 2 1 MiR9 2772 2 1 2 1 2 1 2 2 2 0 3 1 2 1 1 0 - - - - MoR10 2775 2 1 2 2 3 2 2 0 2 1 2 1 - - - - - - - - MoR11 2784 2 1 2 1 2 1 3 2 2 1 4 2 2 1 2 1 2 1 2 1 MoR12 2791 2 1 2 1 2 1 2 1 3 1 2 1 1 1 2 1 2 0 2 1 MoR13 2793 - - 3 1 2 1 1 0 - - - - - - - - - - - - MoR14 2946 2 0 2 1 2 1 1 0 2 1 2 1 - - 1 1 - - - - MoR15 3036 4 2 4 2 3 2 4 3 3 2 3 1 1 0 2 1 3 2 2 1 MiR16 3237 3 2 2 1 3 2 2 1 2 1 2 0 - - - - 2 1 1 1 MiR17 2649 2 1 2 1 2 1 2 0 2 0 3 2 1 0 - - 2 1 1 1 MoR18 3350 3 2 3 2 2 1 2 1 3 2 1 0 2 1 2 1 2 1 2 1 MoR19 4137 3 2 3 2 4 3 2 1 2 1 3 2 2 1 2 1 2 2 2 1 MiR20 4186 2 1 2 1 2 2 1 0 2 1 1 0 3 3 2 1 2 0 1 0 MoR21 4730 2 1 2 1 2 2 2 1 2 2 2 1 - - - - - - - - MiR22 4882 3 2 2 1 3 2 2 2 3 2 3 2 1 0 - - 1 0 2 1 MiR23 4919 2 1 2 1 2 1 2 0 2 1 3 2 2 0 1 1 - - - - MoR24 4924 2 1 2 1 2 1 2 0 2 0 - - 2 1 1 1 2 1 1 1 MiR25 66 2 0 2 1 2 1 1 0 2 0 2 1 2 1 1 1 - - - - MoR26 134 2 2 3 2 3 2 2 1 2 1 2 1 - - - - 2 1 2 1 MiR27 975 2 1 2 1 2 1 2 1 2 0 3 1 2 0 2 0 2 1 2 2 MoR28 1059 - - 1 0 1 0 1 0 - - 2 1 1 0 1 1 1 0 1 0 GR29 1120 3 2 3 1 3 2 3 2 3 1 3 2 3 1 2 1 3 2 2 2 MoR30 1251 3 1 2 0 2 1 3 1 2 1 2 0 2 1 2 1 2 1 2 1 MoR Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 112
  • 134. Results Table No.39 Showing data related to objective parameters before and after treatment. Upper mid armSi Opd Heig Weight in BMI Right in Left in Chest in Abdomen in Waist in Hip in Waist: Hip Ratio Resultsno No ht in Kg Wt / ht in m2 Cms Cms Cms Cms Cms Cms in . mts Cms BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT1 2326 1.61 100 96 38.61 37.06 35.5 33 35 33 101 99 112 109 121 119 122.5 120 121.5 119.5 MiR2 2427 1.54 85 81 35.86 34.17 33.5 30 33 30 104 101 106 101.5 114 112 112.5 110 113.25 111 MoR3 2668 1.50 72 72 32 32 32.5 32 32 32 94.5 94 100.5 99 102 102 114.5 114 108 108 MiR4 2670 1.52 75 70 32.46 30.30 33.5 30 33 30 93 90 95 92 103.5 100 106.5 103 105 101.5 GR5 2673 1.61 82 79 31.66 30.50 34.5 30 34 30 106 104 105 101 96 93 101 98 98.5 95.5 MiR6 2758 1.47 69 66 31.94 30.55 29 25 29.5 25.5 90 87 95 92 103 100 109 106 106 103 MoR7 2767 1.49 73 70 32.88 31.53 30 28 30 28 100.5 98 98.5 96 105 103 114 111 109.5 107 MoR8 2770 1.52 88 88 38.09 38.08 31 31 31 31 94 94 101 100 117 116 119.5 119 118.25 117.5 MiR9 2772 1.50 78 74 34.66 32.88 31 29 31 29 100.5 98 99.5 96 101.5 99 113 111.5 107.25 105.25 MoR10 2775 1.52 79 77 34.19 32.46 30.5 26.5 30 26 99 95 101 98 96 96 111.5 110 103.75 103 MoR11 2784 1.61 82 78 31.66 30.11 32 30 32 30 102 100 101 97 99.5 96 105.5 102 102.5 99 MoR12 2791 1.65 96 90 35.29 33.08 34.5 30.5 34 30 104.5 101 107 104 108 105 120.5 117 114.25 111 MoR13 2793 1.42 68 65 33.83 32.33 28.5 28 28 28 89.5 86 104 102 100 99 100.5 100 100.25 99.5 MoR14 2946 1.58 76 73 30.52 29.31 30.5 30 30 30 94.5 91 101 100 101 99 113.5 111 107.25 105 MoR15 3036 1.66 105 101 38.18 36.72 35.5 33 35 33 110 100 113.5 110 119 117 128.5 127 124 121.75 MiR16 3237 1.52 89 86 38.52 37.22 33 29 33.5 29 106.5 102 104.5 102 115 113 118 118 116.5 115.5 MiR17 2649 1.51 88 87 38.09 37.66 34.5 34 34 34 104 103 102 100 114.5 114 115 115 114.75 114.5 MoR18 3350 1.64 94 90 35.07 33.58 35 33 35.5 33 106 102 108.5 107.5 112 110 123 121 117.5 115.5 MoR19 4137 1.6 92 89 35.93 34.76 35.5 33 35 33 105 103 110 107 119.5 116.5 124 122 121.75 119.25 MiR20 4186 1.58 83 80 33.33 32.12 32.5 30 32 30 92.5 90 99.5 97 107.5 106 102.5 102 105 104 MoR21 4730 1.56 81 81 33.33 33.33 31 31 31 31 100.5 100 100 99 103.5 103 105.5 105 104.5 104 MiR22 4882 1.66 98 94 35.63 34.18 36 33 36 33 108 105 114.5 111.5 118 115.5 121.5 120 119.75 117.75 MiR23 4919 1.57 74 71 30.08 28.86 28.5 27 28 27 99 96 95.5 94 97.5 95 104.5 101 101 98 MoR24 4924 1.53 78 78 33.33 33.33 29 29 29.5 29 90.5 90 100.5 99 98 97 113 112 105.5 104.5 MiR25 66 1.48 70 68 31.96 31.05 28.5 25 28 25 90 87 98 96 100.5 98 105.5 103 103 100.5 MoR26 134 1.52 86 85 37.22 36.79 30 30 30 30 102 102 106.5 106 120 118 118 116 119 117 MiR27 975 1.50 80 77 35.55 34.22 31 31 31 31 100 99 102.5 100 99 98 102 101 100.5 99.5 MoR28 1059 1.45 68 65 32.38 30.95 27.5 24 27 24 90 87 92.5 89.5 94.5 91 100 99 97.25 95 GR29 1120 1.68 100 96 35.46 34.04 35.5 33 35 33 100.5 97 118.5 115 120 117 126 123 124 121 MoR30 1251 1.64 90 85 33.58 31.71 34 32 34 32 104 101 108.5 105 102.5 100 120.5 119 111.5 109.5 MoR Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 113
  • 135. Results Table No 40 Showing Demographical data related toevaluation of efficacy of Bhadradi Asthapana Vasti in Sthoulya..SI. OPD Age Sex Religion Marital Occ. Status Econ. Status Diet Chr. Agni Koshta Prakriti Family ResultNO NO status of. history Obesity 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 271 2326 - - - + + - + - - + - + - - - - - + - + >5 - + - - + - VP P MiR2 2427 - - + - - + - + - + - + - - - - + - - - - >5 - + - - + - KP A MoR3 2668 - - + - + - + - - + - - + - - - + - - + - 3-4 - - + - - + KV A MiR4 2670 - - + - + - + - - + - + - - - - + - - - + 3-4 - + - - - + KV A GR5 2673 - - - + - + + - - + - + - - - - + - - + - >5 - + - - + - KV P MiR6 2758 + - - - - + - + - + - + - - - - + - - - + 3-4 - - + - - + KP A MoR7 2767 - + - - - + + - - + - - + - - - - + - + - CHD - + - - + - VP P MoR8 2770 - + - - + - - + - + - + - - - + - - - + >5 - + - - - + KV A MiR9 2772 - - + - - + + - - + - + - - - - + - - + - >5 - - + - + - KV A MoR10 2775 + - - - - + + - - + - + - - - - + - - + 1 - + - - + - KV A MoR11 2784 - + - - - + + - - + - + - - - - + - - + - 2-3 - + - - + - KV A MoR12 2791 - - - + - + + - - + - + - - - - + - - + - >5 - - + - - + VP A MoR13 2793 + - - - + - + - - + - + - - - - - + - + CHD - - + - + - VP P MoR14 2946 - - + - - + + - - + - + - - - - + - - + - 3-4 - - + - - + KP A MoR15 3036 - - + - + - + - - + - + - - - - - - + - + CHD - - + - + - KV P MiR16 3237 - - + - - + + - - + - + - - - - - + - + - >5 - + - - - + KP A MiR17 2649 - - + - - + + - - + - - + - - - - + - + - >5 - + - - + - KV A MoR18 3350 + - - - - + - - - + + - - - - + - - + - CHD - + - - + - VP P MoR19 4137 - - - + - + + - - + - + - - - - + - - + - CHD - + - - + - KV P MiR20 4186 - - + - + - + - - + - - + - - - + - - + - 3-4 - + - - - + KP A MoR21 4730 - - + - - + + - - + - - + - - - + - - + - >5 - - + - - + KV A MiR22 4882 - - - + - + + - - + - + - - - - - - + - + >5 - - + - - + VP P MiR23 4919 - - - + - + + - - + - - + - - - + - - + - >5 - + - - + - KV A MoR24 4924 - - - + + - - + - + - - + - - - - + - - + >5 - - + - - + KP P MiR25 66 - - + - - + + - - + - + - - - - + - - + - 3-4 - + - - + - KP A MoR26 134 + - - - - + + - - + - + - - - - + - - + - 3-4 - - + - - + VP A MiR27 975 - - - + - + + - - + - - + - - - + - - + - 2-3 - + - - + - KV A MoR28 1059 - + - - - + - + - + - + - - - - + - - - + 3-4 - - + - - + KP A GR29 1120 - - + - + - + - + + - + + - - - - + - - + CHD - + - - + - KV P MoR30 1251 - - + - - + + - - + - + - - - - - - + + - >5 - + - - + - KP MoR P Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 114
  • 136. ResultsEvaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 115
  • 137. ResultsResults: The following observations were made during this study. Observations weremade before the treatment, during the treatment and after the treatment. In the presentstudy, 30 patients fulfilling the inclusion criteria of Sthoulya were studied. Followingpages contain the descriptive statistical analysis of the patients studied along with theobservation and results are as listed below. Table No. 41 Showing the incidence and overall response in age. Age No of % GR % MoR % MiR % in years patients 20-29 5 16.67 0 0 4 13.3 1 3.3 30-39 4 13.34 1 3.3 2 6.6 1 3.3 40-49 13 43.33 1 3.3 8 26.6 4 13.3 50-60 08 26.67 0 0 3 10 5 16.6 Showing the incidence and overall response in age 14 13 12 10 8 8 8 6 5 5 4 4 3 4 4 2 2 1 1 1 1 0 0 0 No of GR MoR MiR patients 20-29 30-39 40-49 50-60 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 115
  • 138. ResultsTable No.42 Showing the incidence and overall response in sex. Sex No of % GR % MoR % MiR % Patients Male 9 30 1 3.3 3 10 5 16.6 Female 21 70 1 3.3 14 46.6 6 20 Showing the incidence and overall response in sex 25 21 20 14 15 9 10 5 6 5 3 0 1 1 0 No of GR MoR MiR Male FemaleTable No.43 Showing the incidence of religion in the sthoulya patients. Religion No of patients % Hindu 24 80 Muslim 05 16.67 Christian 01 3.33 Showing the incidence of religion in the sthoulya patients. 5 1 24 Hindu Muslim Christian Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 116
  • 139. Results Table No. 44 Showing the incidence and overall response in marital status: Marital status No of % GR % MoR % MiR % Patients Married 26 86.7 2 6.66 14 46.6 10 30 Unmarried 4 13.3 0 0 3 10 1 3.3 Showing the incidence and overall response in marital status 30 26 20 14 10 10 4 2 3 1 0 0 No of GR MoR MiR Married Unmarried Table No.45 Showing the incidence and overall response in occupational status :Occupational No of % GR % MoR % MiR % Status Patients Sedentary 19 63.33 2 6.6 10 30 7 23.3 Active 11 36.67 0 0 8 26.6 4 13.3 Labour 0 0 - - - - - - Showing the incidence and overall response in occupational status 20 19 15 11 10 10 8 7 5 4 2 0 0 0 00 0 0 No of GR MoR MiR Status Sedentary Active Labour Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 117
  • 140. Results Table No.46 Showing the incidence and overall response in socio-economic status: Socio-economic No of % GR % MoR % MiR % Status Patients Poor 0 0 - - - - - - Middle class 18 60 2 6.6 11 36.6 6 20Upper middle class 6 20 0 0 4 13.3 2 6.6 Rich 6 20 0 0 2 6.6 3 10 Showing the incidence and overall response in socio-economic status 20 18 15 11 10 6 6 6 4 5 2 2 2 3 0 0 0 0 0 0 0 No of GR MoR MiR Patients Poor Middle class Upper middle class Rich Table No. 47 Showing the incidence of Positive and negative family history in sthoulya: +Ve & -Ve family history No of patients % Yes 11 36.66 No 19 63.33 Showing the incidence of Positive and negative family history in sthoulya 11 19 Yes No Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 118
  • 141. ResultsTable No. 48 Showing the incidence of Chronicity of obesity: Chronicity of obesity No of patients % Since childhood 6 20 1yr 1 3.33 1-2yrs - 0 2-3yrs 2 6.6 3-4yrs 8 26.6 >5yrs 13 43.3 Showing the incidence of Chronicity of obesity 50 43.3 40 26.6 30 20 20 13 6 6.6 8 10 3.33 1 00 2 0 od rs rs rs r s 1y yr 3y 4y 2y ho >5 1- 2- 3- ild ch e nc No of patients % SiTable No.49 Showing the incidence of Dietary habits : Dietary Habits No of patients % Vegetarians 18 60 Mixed 12 40 Showing the incidence of Dietary habits 12 Vegetarians 18 Mixed Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 119
  • 142. ResultsTable No.50 Showing the incidence of Diet Pattern: Diet Pattern No of pts % Samashana 0 0 Adhyashana 21 70 Anashana 0 0 Vishamashana 09 30 Showing the incidence of Diet Pattern 80 70 60 Samashana Adhyashana 40 30 21 Anashana 20 9 Vishamashana 0 0 0 0 0 No of pts %Table No. 51 Showing the incidence of Aahara guna: Ahara guna No of pts % Guru 26 86.6 Snigdha 23 76.6 Ushna 02 6.6 Sheeta 16 53.3 Showing the incidence of Aahara guna Sheeta Ushna % Snigdha No of pts Guru 0 20 40 60 80 100 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 120
  • 143. ResultsTable No. 52 Showing the incidence and overall response of Agni of the patient: Agni No of % GR % MoR % MiR % patients Manda 0 0 - - - - - - Teekshna 18 60 1 3.3 12 40 5 16.6 Vishama 12 40 1 3.3 5 16.6 6 20 Sama 0 0 - - - - - - Showing the incidence and overall response of Agni of the patient 20 18 15 12 12 Manda 10 5 56 Teekshna 5 0 0 01 10 0 0 0 0 Vishama 0 Sama No of GR MoR MiR patientsTable No. 53 Showing the incidence and overall response of Koshta of thepatient: Koshta No of % GR % MoR % MiR % patients Mrudhu 0 0 - - - - - - Madhyama 17 56.6 0 0 13 43.3 4 13.3 kroora 13 43.3 2 6.6 4 13.3 7 23.3 Showing the incidence and overall responseof Koshta of the patient 20 17 13 13 Mrudhu 15 10 7 Madhyama 4 4 5 0 0 0 2 0 0 kroora 0 No of GR MoR MiR patients Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 121
  • 144. ResultsTable No.54 Showing the incidence of Predominant Rasa: Rasa No of patients % Madhura 26 86.66 Amla 03 10 Lavana 0 0 Katu 01 3.33 Tikta 0 0 Kashaya 0 0 Showing the incidence of Predominant Rasa 100 86.66 80 60 No of patients 40 26 % 20 10 3 00 3.33 0 0 1 00 0 la u ra na a ta t ay Am Ka hu k va Ti sh ad La Ka MEvaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 122
  • 145. ResultsTable No.55 Showing the incidence of Vyaayaama in sthoulya patient: Vyaayama No of patients % No 25 83.33 Occasionally 05 16.66 Everyday 0 0 8 3 .3 3 1 6 .6 6 0 % 25 5 0 N o o f p a tie nts Occasionally Everyday NoTable No. 56 Showing the incidence of Vyasana in sthoulya patient: Vyasana No of pts % Alcohol 3 10 Smoking 8 26.6 Tobacco chewing 3 10 No habit 16 53.3 Showing the incidence of Vyasana in sthoulya patient 60 53.3 40 26.6 No of pts 16 20 10 8 10 % 3 3 0 Alcohol Smoking Tobacco No habit chewing Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 123
  • 146. ResultsTable No. 57 Showing the incidence of in Nidra of the sthoulya patient: Nidra No of patients % Sound 24 80 Disturbed 06 20 Showing the incidence of in Nidra of the sthoulya patient 6 Sound Disturbed 24Table No.58 Showing the incidence and overall response of Prakruti of thepatient:Prakruti No of patients % GR % MoR % MiR %Vaata-Pitta 7 23.3% 0 0 4 13.3 3 10Kapha- Vaata 14 46.6% 1 3.3 7 23.3 6 20Kapha -Pitta 9 30% 1 3.3 6 20 2 6.6 Showing the incidence and overall response of Prakruti of the patient 14 15 9 Vaata-Pitta 10 7 76 6 4 3 Kapha- Vaata 5 2 011 Kapha -Pitta 0 MiR MoR GR patients No of Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 124
  • 147. ResultsTable No. 59 Showing the incidence of Sara of the sthoulya patient: Sara No of pts % Pravara 9 30 Madhyama 19 63.3 Avara 2 6.67 Showing the incidence of Sara of the sthoulya patient 2 9 Pravara Madhyama Avara 19Table No. 60 Showing the incidence of Samhanana of the sthoulya patient: Samhanana No of pts % Pravara 5 16.67 Madhyama 21 70 Avara 4 13.33 Showing the incidence of Samhanana of the sthoulya patient 4 5 Pravara Madhyama Avara 21 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 125
  • 148. ResultsTable No. 61 Showing the incidence of Pramana of the sthoulya patient: Pramana No of pts % Pravara 8 26.67 Madhyama 18 60 Avara 4 13.33 Showing the incidence of Pramana of the sthoulya patient 4 8 Pravara Madhyama Avara 18Table No. 62 Showing the incidence of Satmya of the sthoulya patient: Satmya No of pts % Pravara 6 20 Madhyama 18 60 Avara 6 20 Showing the incidence of Satmya of the sthoulya patient 6 6 Pravara Madhyama Avara 18 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 126
  • 149. ResultsTable No. 63 Showing the incidence of Satva of the sthoulya patient: Satva No of pts % Pravara 4 13.3 Madhyama 13 43.3 Avara 13 43.3 Showing the incidence of Satva of the sthoulya patient 4 Pravara 13 Madhyama 13 AvaraTable No.64 Showing the incidence of Abhyavaharana Shakti of the sthoulyapatient: Abhyavaharana Shakti No of pts % Pravara 5 16.6 Madhyama 22 73.3 Avara 3 10 Showing the incidence of Abhyavaharana Shakti of the sthoulya patient Avara 10 3 % Madhyama 22 73.3 No of pts Pravara 16.6 5 0 20 40 60 80 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 127
  • 150. ResultsTable No. 65 Showing the incidence of Jarana Shakti of the sthoulya patient Jarana Shakti No of pts % Pravara 8 26.6 Madhyama 20 66.6 Avara 2 6.6 Showing the incidence of Jarana Shakti of the sthoulya patient 2 8 Pravara Madhyama Avara 20Table No. 66 Showing the incidence of Vyayama of the sthoulya patient Vyayama Shakti No of pts % Pravara 3 10 Madhyama 14 46.67 Avara 13 43.33 Showing the incidence of Vyayama of the sthoulya patient 3 Pravara 13 Madhyama 14 Avara Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 128
  • 151. ResultsTable No. 67 Table Showing the incidence and overall response of weight:Weight in No of % GR % MoR % MiR % Kg patients 65-74 7 23.3 1 3.3 4 13.3 2 6.6 75-84 10 33.3 1 3.3 6 20 3 10 85-94 8 26.6 0 0 5 16.6 3 10 95-105 5 16.6 0 0 1 3.3 4 13.3 Table Showing the incidence and overall response of weight 12 10 10 8 65-74 8 7 6 75-84 6 5 5 4 4 4 33 85-94 2 2 11 1 95-105 00 0 No of GR MoR MiR patientsTable No.68 Showing the incidence of height of the sthoulya patient: Height in meters No of patients % 1.40-1.49 5 16.6 1.50-1.59 15 50 1.60-1.69 10 33.3 Showing the incidence of height of the sthoulya patient 5 10 1.40-1.49 1.50-1.59 1.60-1.69 15 Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 129
  • 152. ResultsTable No. 69 Showing the incidence and overall response of BMI in sthoulya: BMI No of % GR % MoR % MiR % patients 30.05-32.04 7 23.3 0 0 5 16.6 2 6.6 32.05-34.04 8 26.6 2 6.6 4 13.3 2 6.6 34.05-36.04 9 30 0 0 6 20 3 10 36.05-38.10 6 20 0 0 1 3.3 5 16.6 Showing the incidence and overall response of BMI in sthoulya 10 9 8 8 7 30.05-32.04 6 6 6 5 5 32.05-34.04 4 4 3 2 22 34.05-36.04 2 1 0 00 36.05-38.10 0 No of GR MoR MiR patientsTable No.70 Showing the incidence and overall response of the nidanas ofsthoulya Nidana No of % GR % MoR % MiR % patients Aaharatmaka 30 100% 1 3.3 21 70 8 26.6 Viharatmaka 23 76.66 1 3.3 23 76.6 6 20 Manasika 16 53.33 0 0 11 36.6 5 16.6 Beejadoshaja 11 36.66 0 0 8 26.6 3 10 Incidence and overall response of the nidanas of sthoulya patient 40 30 Aaharatmaka 30 23 23 21 16 Viharatmaka 20 11 118 865 Manasika 10 1 1 00 3 Beejadoshaja 0 No of GR MoR MiR patients Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 130
  • 153. ResultsTable No.71 Showing the incidence of chief complaints of sthoulya: Symptoms No of patients % Swedadhikya 22 73.33% Atikshudha 24 80% Gatrasada 20 66.66% Atigauravata 20 66.66% Atipipasa 20 66.66% Javoparodha 18 60% Dourbalya 26 86.66% Utshahani 18 60% Nidradhikya 26 86.66% Snigdhanga 12 40% Dourgandhya 20 66.66% Sthana 27 90% Angachalatva Udara 30 100% Sphik 30 100%RETENTION TIME OF VASTI Table No.72 Showing retention time of Anuvasana and Nirooha vastiSi. Anuvasana vasti Nirooha vasti Si. Anuvasana vasti Nirooha vastiNo In hours In minutes No In hours In minutes 1 3.2 13.3 16 4.6 14.33 2 4.1 14.3 17 1.8 6 3 1.4 4.6 18 3.8 12.66 4 3.3 11.6 19 4 9.33 5 4.3 11 20 6.8 16.66 6 3.3 10 21 4.2 17.66 7 8.5 11.6 22 7.2 16.66 8 2.7 8.6 23 3.6 14.3 9 6.4 13.33 24 3.3 8.6610 7 11.66 25 4.2 9.3311 5.5 11 26 1.4 4.612 3.1 9.33 27 5.6 1013 7 10 28 5.8 23.3314 4.4 13.33 29 4.8 11.6615 8 25 30 5.4 21 Mean while, all the cases were investigated for lipid profile to know theefficacy of present therapy on lipid profile values. Among 30 patients most of them Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 131
  • 154. Resultsare normo lipidaemic and some of them were hyper lipidaemic, in all the cases afterresults are observed there was mild reduction in lipid values.Table No.73 Showing incidence and result of Serum Cholesterol levels (130-200mg/dl) Type No of Sex Increased Decreased patients values values Male Female Normal 17 2 15 - - lipidaemic Hyper 13 5 8 2 11 lipidaemicTable No.74 Showing incidence and result of Serum Triglycerides levels (25 –200 mg/dl) Type No of Sex Increased Decreased patients values values Male Female Normal 12 2 10 0 0 lipidaemic Hyper 18 7 11 2 16 lipidaemicTable No. 75 Showing incidence of Serum HDL levels (30 – 70 mg/dl) Type No of Sex patients Male Female Normal 30 9 21 lipidaemicTable No. 76 Showing incidence of Serum LDL levels (70 – 210 mg/dl) Type No of Sex patients Male Female Normal 30 10 20 lipidaemic Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 132
  • 155. ResultsTable No. 77 Showing incidence and result of Serum VLDL levels (20 – 40mg/dl) Type No of Sex Increased Decreased patients values values Male Female Normal 9 1 8 - - lipidaemic Hyper 21 8 13 1 20 lipidaemicTable No.78 Statistical results of Lipid profile: Si. Parameter Mean SD SE t value p value Rem No arks 1 Serum cholesterol 8.433 6.595 1.204 7.00 <0.001 HS 2 Serum 11.966 12.57 2.29 5.22 <0.001 HS Triglycerides 3 Serum HDL 1.3 0.952 0.173 7.514 <0.001 HS 4 Serum LDL 6.033 5.26 0.96 6.28 <0.001 HS 5 Serum VLDL 2.8 2.734 0.499 5.611 <0.001 HS Among the lipid profile serum HDL and serum cholesterol shows more highlysignificant but serum Triglyceride shows less significance. The net mean effect inTriglycerides is more with more variation but HDL having less net mean effect withless variation. Among serum Triglyceride and serum LDL, serum cholesterol shows more netmean effect with more variation and it is and it is more highly significant than LDL.(By comparing ‘t’ value, mean and SD) Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 133
  • 156. ResultsTable No. 79 Showing the overall assessment: Sl. No Response No of patients % 1 Good response 2 6.66 2 Moderate response 17 56.66 3 Mild response 11 3.66 4 No response 0 0 Showing the overall assessment Good response 0 2 11 Moderate response Mild response 17 No responseTable No. 80 Individual study of the parameters to show significance effectbefore and after the treatmentSi. No Parameter Mean SD SE t-value p- value Remarks1 Chala sthana 0.933 0.5208 0.095 9.821 <0.001 HS2 Chala udara 1.133 0.434 0.079 14.34 <0.001 HS3 Chala sphik 0.866 0.434 0.079 10.962 <0.001 HS4 Kshudrashwas 1.266 0.521 0.095 13.32 <0.001 HS5 Dourbalya 1.166 0.530 0.096 12.14 <0.001 HS6 Nidradhikyata 1.1 0.542 0.1 11.00 <0.001 HS7 Atikshudha 0.833 0.647 0.118 7.059 <0.001 HS8 Atipipasa 0.566 0.626 0.114 4.96 <0.001 HS9 Swedadhikyata 0.733 0.583 0.106 6.915 <0.001 HS10 Dourgandhya 0.4 0.498 0.0909 4.44 <0.001 HS11 Weight 3.00 1.462 0.266 11.27 <0.001 HS12 BMI 1.275 0.721 0.131 9.73 <0.001 HS13 Right mid arm 2.116 1.466 0.267 8.11 <0.001 HS14 Left mid arm 1.916 1.468 0.268 7.14 <0.001 HS15 Chest 2.316 1.309 0.239 9.69 <0.001 HS16 Abdomen 2.516 1.037 0.189 13.31 <0.001 HS17 Waist 2.033 1.016 0.185 10.981 <0.001 HS18 Hip 1.766 1.127 0.205 8.614 0.001 HS19 Waist and hip 2.125 1.625 0.296 7.179 <0.001 HS ratio Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 134
  • 157. ResultsConclusion of the statistical analysis:To know the effect of the drug the statistical analysis done by using paired t test byassuming that the drug is not responsible for the changes in the observation before andafter the treatment. From the analysis all the parameters shows highly significant (as p<0.001) thesubjective parameters Udarachalatwa , Kshudrashwasa, Dourbalya, and Nidradhikyatashows more highly significance than the other parameters.(By comparing ‘t’ values ). The parameter Udarachaltwa shows less variation where as the parameterAtikshudha shows more variation. The parameter Dourbhalya the net mean effect ismore than the other parameter. Among the parameter weight and BMI weight shows more highly significantthan the BMI with more net mean effect and variance. (By comparing mean, SD). Among the parameter circumference abdomen and waist shows more highlysignificance than the other but left mid arm shows less more significant In the parameter abdomen having net mean effect more but in parameter hip itis less mean effect. There is more variation in right mid arm circumference and theparameter waist has less variation. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 135
  • 158. DiscussionDiscussion: Discussion part is divided into five sections. • Discussion on Review of literature. • Discussion on Materials and Methods • Discussion on Clinical study. • Discussion on probable mode of action of Bhadradi Asthapana Vasti in sthoulya.Review of literature:Shodhana karma: Shodhana means Bio-purification. The therapy, which eliminatesthe vitiated doshas from the body, is known as Shodhana. The brimhana and langhana are the two types of treatment modalitiesmentioned in the classics and this langhana classified into shodhana and shamana,where shodhana can be considered as Panchakarma therapies. This purification may be either transmuscosal or transdermal. Panchakarmacan adopt as a part of Chikitsa, prior measures for Rasayana chikitsa and forSwasthavritta palana as well. It is a fact that shodhana strikes at the root of malaseradicates them and as such the disorders treated with samshodhana do not recurwhile those treated with samshamana may recur. Among these samshodhana therapies vasti is considered as best and praised itas Ardhachikitsa. Vasti has got multidimensional therapeutic effects. It can achievekarshanatwa, brimhanatwa, shodhana, shamana etc.and any desired therapeutic effect. Another notable advantage of vastikarma is quick action to produce thedesired effects like shodhana or tarpana without causing any adverse effects. Vamanaand virechana takes few hours to produce shodhana effect where as nirooha vasti takeonly few minutes which substantiates its shodhana effect. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 136
  • 159. DiscussionDigestion metabolism: Ahara paka kriya plays a major role in the pathogenesis ofSthoulya, because this disease is formed by the impairment of the digestive process.The ahra which is taken is enters the amashaya with the help of pranavayu and then itgets softened by the jaleeyanmsha, kledaka kapha, salivary secretions. Thepachakagni, which gets activated by the samana vata, will helps in the digestion ofahara. So in this way 5 factors are responsible for this process.1) pachakagni(enzymatic action) 2) samana vayu (nervous mechanism) 3) kledaka kapha (humoralmucin, function) 4) kala 5) ahara (proper combination and quantity of food). Kayagni is mainly concerned with chemical process involved in gastrointestinal digestion. Two types of kayagni can be categorized 1) general 2) special.Special type of kayagni is helpful in the process of digestion. This pachaka pitta issaid to be located in between the pakwashya and amashaya; in its constitution, it ispanchaboutica, it is drava or liquid in consistency, in spite of which it performs actionsimilar to anala, largely due to the ascension of its tejas component over the rest, itdigests the food and separates the srara and kitta bhaga. So formation of meda is discussed as when mamsagni acts upon mamsa dhatudue to mamsagni dhatu paka process, it is divided in three parts, A) sthula bhaga,responsible for the formation of sthula mamsa dhatu. B) sukshma bhaga, responsiblefor the formation of poshaka meda dhatu. C) kitta bhaga( excreta part). Again meda dhatwagni acts upon the poshaka meda dhatu and transforms itinto sthula or poshya meda dhatu as sthula bhaga. Asthi as sukshma bhaga and swedaas malabhaga.digestion of fat begins in the duodenum; pancreatic lipase is being mostinvolved enzyme. This process can be compared with medo dhatwagni paka. Afterdigestion 2 products are formed they are free fatty acids and 2-monoglycerides. Thedigestive mechanism is observed as following, Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 137
  • 160. DiscussionInjestion excretionDigestion basic nutrition internal transport metabolic synthesisEgestion storage The process of digestion and metabolism is depends on the agni. In livingorganisms this agni mentains its integrity and performs its vital activities, byconverting in pakadi karmas or biological and biochemical processes.Agni: Agni is of two kinds namely- 1) Jatharagni and 2) Dhatwagni. The former ischiefly concerned with the chemical processes taking place in the gastro-intestinaltract, while the latter is responsible for higher biochemical processes which takesplace in beyond the absorption of the digested food, which includes all relatedcatabolic and anabolic activities undergoing in tissue elements guided by a number ofenzymes and harmones.To be a little more broad Dhatwagni can be considered to be atype of heat present in all the tissues, which is responsible for proper functioning andtheir development, respective to the sapta Dhatu or the seven basic tissues of the bodythere are seven types of Dhatwagnis specific to each Dhatu or tissue viz., rasagni,raktagni, mamsagni, medoagni, asthyagni, and shukragni or artawagni. As a rulehypofuctioning of a particular Dhatwagni will cause increase of the respective dhatuor the tissue and likewise the hyper functioning of the dhatwagni would cause loos ordestruction of the related Dhatu. It is believed that all these Dhatwagnis are governedby the Jatharagni, which remaining in the koshta influences the agnis of the individualtissues and there by obliges the body as a whole. According to ayurveda the body is an outcome of nutrition. Likewise thediseases are the result of impaired nutrition as sthoulya. Charaka very clearly says thebody is the product of food and diseases occur as the result of faulty nutrition. But thisis in relation to the functions of agni. As principle all sort of agnis are governed by Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 138
  • 161. DiscussionJatharagni.An impaired Jatharagni causes hypo functioning of the Dhatwagnis, whichlead to faulty utilization of the nutritients in spite of the provision of the best possiblefood. As matter of fact this fault gives rise to diseases. The hypo functioning of agniresults into the production of ama of anna rasa in the gastrointestinal tract as well asama of Dhatu rasa in Dhatus, this leads to the diseased condition.Dietary factors Nidana and Samprapti : In ayurveda acharyas have given specialattention over the dietary regimen for a healthy and diseased person. Ayurveda doesnot prescribe a slandered diet for everyone. Charaka emphasized on this as the ahara,which gets digested in a proper time, and which should not produce any harm to theprakriti of an individual is considered as pramanitha ahara. (Ch.su.5/4). Different types of ahara are mentioned in ayurveda on the basis of theirqualitative and quantitative factors i.e. the laghu dravyas like shali, shashtika, mudghaetc which are explained in modern science as cerels grain products, pulses andlegumes while doing the food groups. And guru dravyas like mamsa of differentanimals, pishti, dugdha vikaras like guda, dhahi, malayi, etc. and tila, masha etc astold in modern science like milk, egg, flesh foods, fats etc. Dietic habits likeadhyashana, anashana, samashana, vishamashana are explained in ayurveda. Improperfollowing of these dietic habits will leads to many diseases. Especially adhyashanaand vishamashana are the causative factors of Sthoulya. In modern luxurious,sedentary life style with an improper dieting habits. Such as over eating, consuminghigh caloric, highly processed foodstuffs are considered as causative factors forobesity. This may lead to the over accumulation of fat in the body. In Sthoulya thisdietic impairement becomes one of the prime causative factor. Among the etiological factors of Sthoulya Bheejaswabhava is considered asone of the causative factor of Sthoulya by charaka. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 139
  • 162. Discussion This is probably due to genetically decrease in hormone sensitive lipase anddisturbed leptin level in serum or in fat cells results in a one way path that iscontinually fat being deposited but never released. This accumulation of fat due toabnormal in genetic factors leads to Sthoulya. The deficiency of hormone sensitive lipase might be the consideration ofDhatwagnimandhyata by ancient acharyas found even in Sthoulya resulted byimpaired jatharagni. In Sthoulya due to the avarana by meda the vata gets aggravated andjatharagni sandhukshsna will takes place. This leads to increased intake of food andthen meda atiupachaya will takes place finally Sthoulya is formed. In the same waythe dhatwagni i.e. medodhatwagni is vitiated and it is unable to perform the functionsproperly, causes formation of more meda dhatu poshaka rasa and accumulates moresthula meda dhatu in their depots and leads to Sthoulya.Materials and Methods: -The materials taken for the clinical study were 1) Bhadradi asthapana vasti yoga for nirooha vasti. 2) Murchita Tila taila for anuvasana vasti and abhyanaga.Bhadradhi Asthapana Vasti: Shodhana is a unique therapeutic procedure explained in ayurveda,categorized under apatarpanajanya variety of chikitsa. Sthoulya chikitsa alsocomprises of shodhana chikitsa, but there is very less scope for usual varieties likevamana, virechana, nasya, etc. procedures. Atisthoulya condition is being the majorcontraindication for these processes. In this connection, vasti especially lekhana, karshana, medahara type of vastiare explained for Sthoulya. Among these Bhadradi asthapana vasti is one. As the text Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 140
  • 163. Discussionsays due to wider scope and mode of action vasti comprehend the major portion ofwhole therapeutics explained. Sthoulya is arised by taking the kaphakara ahara viahara and this sthouly isconsidered as medodoshaja vyadhi. Kapha and meda are having ashrashrayibhava andvata, agni are considered as one of the upadravakarakas in Sthoulya rogi. So we haveto alleviate the vata and kapha doshas, In this Bhadradi asthapana vasti yoga most ofthe drugs are having the properties of alleviating the vata kapha doshas like nimbha,katphala vatsaka, pata, madanaphala etc. some of the drugs like devedaru,madhanaphala, vacha etc are having the property of lekhana karma. The tailas used inthis vasti yoga are tila taila and sarshapa taila. Which are having the property of doingthe karshana of meda and the prakshepaka dravyas like gomutra, kanji, yavaksharaetc will also do karshana of meda and helps to reduce the deposition of meda.Murchita tila taila: As component of yoga vasti schedule anuvasana vasti is givenwith murchita tila taila.Importance of murchana of tila taila: Crude oils contain Amadosha i.e, some enzyme lipase and racine (toxicproteins), by morchana process Amadosha are removed and also durgandhata &ugrata are removed. After doing Moorchana Samskara Sneha gets good smell andcolour. Apart from theses Sneha will gets the qualities of the drugs used forMurchana. While by Sneha paka and Murchana the veerya of the Sneha is enhanced. Before going to prepare any Aushadha siddha yogas, Taila Murchana isrequired. Murchana means to enhance, to spread over. This process removesamadosha. Usually Tailas are ushna veerya in nature. When treated with drugs likeAmalaki, Haritaki, etc., in the qualities of tailas changes takes place. i.e., Taila attains Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 141
  • 164. DiscussionSheeta veerya. If Gritha & Tailas are treated with Rooksha, Ushna, Sheeta Dravyas,snehatwa property will not be lost. The drugs used for Murchana of Tilataila are Haritaki, Vibitaki, Amalaki,Haridra, Mustha, Vatankura, Hrivera (Rasna), Ketaki pushpa, Manjistha, Lodra. Withtheir lekhaneeya property and also removes the Amadosh of Taila. Beneficial effect of Moorchana sanskara reduces the degree of Saturation butenhances the degree of Unsaturation. It indicates the essential role of unsaturatedfatty acids in reducing Serum Cholesterol, Serum Triglycerides and LDL levels whichare other wise risk factor for the development of Atherosclerosis, Hyper tension,Coronary heart diseases etc. (Sneha Murchana B. S. Hiremath)Clinical study: The patients were selected incidentally from exclusively conducted medicalcamps in the premise of Shri .D. G. Melamalagi Ayurvedic Medical College andHospital Gadag. Patients of both sexes were selected for the clinical study betweenthe age group 20 to 60 years for the purpose of administration of shodhana chikitsa. In total, 30 patients were selected for the study. All the patients were subjectedto thorough clinical and laboratory examinations. There is no drop out in the studyand all the 30 patients were appeared for the assessment of results. The laboratorytests like total blood count, differential count and ESR were carried out in general toexclude infectious diseases the RBS was carried out to rule out diabetes. But in thepresent study, among all the 30 patients, not a single patient has shown the aboveexclusion conditions. The BMI is a good objective parameter to diagnose the Sthoulya disease inwestern medicine. Some of the acharyas of Ayurveda mentioned that medomamsavriddi are the clinical feature of Sthoulya disease. This medomamsa vriddi symptom Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 142
  • 165. Discussioncan be attributed to BMI of modern medicine. The other objective parameters takenwere weight and body circumference of right and left mid arm, chest, abdomen, andhip. All the patients were administered Bhadradi asthapana vasti in yoga vastikrama, as component of yoga vasti schedule anuvasana vasti is given with murchitatila taila. The duration of treatment and follow up is 24days and details are as follows,Vasti vidhi for 8 days, Anuvasana Vasti for 5 days, Lekhaniya Vasti for 3 daysPariharakala (Follow up) is for 16 days.Observations and results:Age: During present study it was observed that 13(43.33%) patients belonged to theage group of 40-49 years in that 1 patient is showing GR, 8(26.6%) were showingMoR, and 4(13.3%) were showing MiR, 8(26.6%) patients were belonging to the age group of 50-60 years in that3(10%)were showing MoR and 5(16.6%) were showing MiR, 5(16.67?%) patientswere belonging to the age group of 20-29 years in that 4(13.33%) were showing MoR,1(3.3%) were showing MiR, 4(13.34%) patients belonged to the age group of 30-39 years in that 1 patientis showing GR, 2(6.6%) were showing MoR, and 1(3.3%) is showing MiR,According to Ayurveda, it is believed that Madhyama Vaya leading to Paripurnata ofShareera dhatu’s. In modern texts obesity is more prevalent in adolescent. But it’s notpossible to conclude the fact with our study because of age-restricted criteria.Sex: In present study 21(70%) patients were female among these 1(3.3%) is showingGR 14(46.6%) were showing MoR, and 6(20%) were showing MiR, Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 143
  • 166. Discussion 9(30%) were male, among these 1(3.3%) is showing GR 3(10%) wereshowing MoR, and 5(16.6%) were showing MiR. Sthoulya is more prevalent amongfemale than in male community.. Due to hormonal imbalance at their menopausalstage or the die tic habits the womens are more prone to this disease. But it’s notpossible to conclude the fact because of small sample size and type of populationattending the out patient departmentReligion: 24(80%) patients were Hindu, 5(16.6%) patients were Muslim and 1(3.3%)is Christian This may be the representation of the total community distribution in andaround Gadag city.Marital Status: The relation between marital life and obesity are not beenhighlighted in any of text as such. But it is common knowledge that people put onmore weight after marriage than before. It is very difficult to draw any conclusivescientific reasons for it. Some tentative reasons can be assumed like psychologicalfactors, sedentary life style etc. present study group includes more number of marriedpatients 26(86.7%) when compared to unmarried 4(13.3%).Occupational status: 19(63.3%) patients were belonging to sedentary life styleamong those 2(6.6%) were showing GR, 10(30%) were showing MoR and 7(23.3%)were showing MiR. 11(36.6%) were belonging to active among those, 8(26.6%) were showingMoR and 4(13.3%) were showing MiR. No patients were seen in lab our. Now daysdue to the luxurious life style (sedentary) will leads to sthoulya.Socio-economic status: 18(60%) were belonging to middle class among those2(6.6%) were showing GR, 11(36.6%) were showing MoR and 6(20%) were showingMiR.6 (20%) patients were belonging in upper middle class, among those 4(13.3%)were showing MoR and 2(6.6%) were showing MiR. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 144
  • 167. Discussion 6(20%) patients were belonging in rich class. among those 2(6.6%) wereshowing MoR and 3(10%) were showing MiR. No patients were found in poor class.Family history: As already mentioned, obesity runs in families, suggesting the role ofBeejaswabhava. In present study 19(63.3%) patients were having negative familyhistory when compared to positive family history i.e. 11(36.6%). This helps us toknow the role of genetic and chromosomal abnormalities in Sthoulya.Chronicity of Obesity: Sthoulya as well as obesity is considered as the diseasemanifest due to prolong accumulation of meda or fat in body. So probably, in presentstudy 13(43.3%) of patients giving history of sthoulya above 5 years and 8(26.6%)ofpatients giving history of sthoulya since 3-4 years. 6(20%)of patients giving history ofsthoulya since childhood.2 (6.6%) of patients giving history of sthoulya since2-3years. This suggests that obesity is a chronic disease.Dietary habits: Maximum number of patients i.e. 18(60%) were vegetarian and12(40%) were mixed. Most of the patients were taking Guru dravyas more in diet andfollowed by Snigdha and Sheeta dravyas more in diet, which are the predisposingfactors for Sthoulya.Dietary pattern: Maximum numbers of patients i.e. 21(70%) were of adhyashanatype and 9(30%) were of vishamashana type. Atisampooranad and improper dieticpattern as above mainly adhyashana will be the causative factor for Sthoulya.Agni, Aahara- Abhyavarana shakti, Jarana Shakti: Maximum number of patientsin present were observed to have Tikshnagni 18(60%) followed by Vishamagni12(40%). According to Ayurveda principles Agni can be assessed by observingAbhyavarana Shakti and Jarana Shakti in present study maximum number of patientshad Madhyama Abhyavarana shakti 22(73.3%) and Madhyama Jarana shakti20(66.6%) which followed by Pravara Abhyavarana Shakti 5(16.6%) and Pravara Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 145
  • 168. DiscussionJarana Shakti 8(26.6%) and 3(10%) of Avara Abhyavarana shakti and 2(6.6%) ofAvara Jarana Shakti. In all the classical texts have described Tikshnagni as root causefor most of the ill effects of Sthoulya. A number of neuro transmitters afferent and efferent signals plays vital role inenergy intake and metabolism. Decreased sympathetic activity increased level ofinsulin and disturbed serum leptin concentration causes excessive hunger in obesepatients. Ayurveda has explained this phenomenon in term of vitiation of vaata byobstruction of path by meda leads to Tikshnagni in Kosta.Kosta: In present series 17(56.6%) of patients were having Madhyama Kosta amongthose 13(43.3%) were showing MoR and 4(13.3%) were showing MiR. 13(43.3%) of patients were having kroora koshta, among those 2(6.6%) wereshowing GR, 4(13.3%) were showing MoR and 7(23.3%) were showing MiR. Innormal condition Madhyama Kosta found due to Kapha dominance, which play majorrole in predisposing Sthoulya.Intake of predominant rasa: In present study maximum numbers of patients26(86.6%) was taking madhura rasa dominant in diet. Madhura are Kaphaaggravating factors and Kapha is main Dosha in pathogenesis of Sthoulya. Acharyashad mentioned excessive use of madhura rasa as a predisposing factor of sthoulyaroga.Vyaayama: In present study 25(83.3%) of patients were showed No Vyaayama and5(16.6%) of were Occasional in their habit of Vyaayama. The diminished state ofphysical activity tends towards decreased in energy expenditure diminishedmetabolism leading to Sthoulya. The Avyaayama has been listed, as one of the nidanais causation of sthoulya. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 146
  • 169. DiscussionVyasana: In present study 8(26.6%) of patients were having the habit of smoking3(10%) of alcohol and 3(10%) of tobacco chewing. Giving up of smoking induces afall in energy expenditure equal ant to 9Kcal/cigerate & increase in food intake. theaverage weight gain is 2.8 kg in males & 3.8kg in females. Nevertheless, the risk ofsmoking is so substantial that a rise in weight of 1kg would be required to negate thebenefit of giving up of smoking 20 cigeates /dayNidra: In present study 24(80%) of patients were having sound sleep and 6(20%)were having disturbed sleep. As in Ayurveda Divaswpna is considered as one of thecausative factor for Sthoulya. This incidence may withhold the condition.Prakruti: In present study, 14 (46.6%) were of Kapha-Vaata Prakruti, among those1(3.3%) is showing GR, 7(23.3%) were showing MoR and 6(20%) were showingMiR. 9(30%) were of kapha- Pitta Prakruti among those 1(3.3%) is showing GR,6(20%) were showing MoR and 2(6.6%) were showing MiR. 7(23.3%) patients were of vata pitta Thus kapha predominant either associatedwith Vaata or Pitta, among those, 4(13.3%) were showing MoR and 3(10%) wereshowing MiR. This incidence is more in predisposing the disease Sthoulya.Sara, Satwa, and Samhanana: 19(63.3%) were of madhyama sara, 9(30%) were ofpravara sara and 2(6.67%) were of avara sara. Each 13(43.3%) were of madhyama,avara satwa and 4(13.3%) were of pravara satwa. And lastly 21(70%) were ofmadhyama samhahana, 5(16.67%) were of pravara samhahana and 4(13.3%) were ofavara samhahana. Acharyas opines that in sthoulya rogi will have Alpa bala due to theAsamatva in dhatus. The disproportion in height with weight ratio suggests vishamaSamhanana. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 147
  • 170. DiscussionSaatmya: In present study 18(60%)of patient were belonging to have madhyamaSaatmya, 6(20%) in each pravara and avara saatmya. This incidence may show thatsthoulya rogi consume more of madhura, mamsa and sneha dravyas as a routine diet.Pramana: In present study 18(60%)of patient, were belong to have MadhyamaPramana , 8(26.67%) in Pravara Pramana and 4(13.3%) in Avara Pramana.Weight and Height: 10(33.3%) of patient were noted in the weight group of 75-84kgamong those 1(3.3%) is showing GR, 6(20%) were showing MoR and 3(10%) wereshowing MiR. 8(26.6%) were between 85-94kgs among those 5(16.6%) were showing MoRand 3(10%) were showing MiR. 7(23.3%) were between 65-74kg among those 1(3.3%) is showing GR,4(13.3%) were showing MoR and 2(6.6%) were showing MiR. 5(16.6%) were between 95-105kg among those1 (3.3%) were showing MoRand 4(13.3%) were showing MiR. Height wise distribution showed that 15(50%) of patients were had heightbetween 1.50-1.59 meters, 10(33.3%) were between 1.60-1.69 meters and 5(16.6%)were between 1.40-1.49 meters. The above strategy revealed that all the patients areregistered were carrying 20% more weight i.e. more than the normal weight forheight. So all are considered to be sthoulya.BMI: 9(30%) of patients showing BMI between, 34.05-36.04, among those 6(20%)were showing MoR and 3(10%) were showing MiR, 8(26.6%) between 32.05-34.04 among those 2(6.6%) is showing GR,4(13.3%) were showing MoR and 2(6.6%) were showing MiR, 7(23.3%) between 30.05-32.04 among those, 5(16.6%) were showing MoRand 2(6.6%) were showing MiR Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 148
  • 171. Discussion 6(20%) between 36.05-38.10 among those, 1(3.3%) was showing MoR and5(16.6%) were showing MiR. The patients who are registered in present study are allconsidered as obese. Due to disproportionate body mass, studied through Quetelet’sindex.Nidana: Nidana wise distribution of 30 patients of Sthoulya revealed as 30(100%)were indulged in Aharatmaka nidana, 23(76.6%) were indulged in viharatmakanidana, 16(53.3%) were in manasika nidana and 11(36.6%) were had Beejadoshajanidana. The aharatmaka nidanas posses similar properties attributed to meda andaccording to Ayurvedic principles incidence of sthoulya by indulging in Ati snigdha,Ati madhura, Ati guru, Ati sheeta, Ati bhojana, Dadhi sevana, Ati sleshmala aahara,Mamsa sevana have been explained in detailed while description of nidana. Lack of physical activites is noted as one of major cause of obesity accordingto Ayurvedic principle incidence of sthoulya by indulging in Divaswapna, Ati Nidra,Avyaayama, and the detail description is given in nidana chapter. In Nidana of sthoulya many manasa karana’s are mentioned like harshanithyatwat, Achintanat. Even in present study it shows 36.6% of patients are exposedto manasika karana’s. Beeja dosha was noted in 36.6% of patients Beejaswabhava has beenmentioned as the causative factor of sthoulya in classics. Which was revealed bygiving family history were, and as rests of patients were not given the family history.Laxana: all most all the laxana of sthoulya stated in the texts can be observed inmany trial cases. But laxana like kshudra swasa, atikshudha, spik stana udarachalatwa atisweda, atinidrata, durbalya, swedadhikyata, dourgandhya etc. are seen asvery common features. Kruchra vyavaya was also observed in some cases, but due tothe limitations of the study and psychosocial problems, this particular laxana could Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 149
  • 172. Discussionnot be assessed in precise way, especially with female patient. More ever subjectiveparameters have been graded according to severity, so that assessment could bepossible as well as quantifiable. Here an effort has been made to grade the subjectiveparameters. Investigator felt, if the gradations are still standardized with the help ofdiscussions, can be utilized as slandered in all the different centers. All the objective parameters like weight, BMI, body circumference at differentareas were assessed body mass index is the common and easier parameter to assessthe severity of the obesity. Which is calculated as, BMI = weight / height 2 where weight in kg and height in meters. Skin fold thickness measurements also reveal considerable informationregarding peripheral fat deposition. But it has some limitations like, • Poor reproducibility of result. • Specific site of measurement varies each time.Response to the treatment: Increase in body weight in sthoulya is due to excess accumulation of fat only.Among 30 Patients the mean weight reduction was 3%. Which is statistically showshighly significant (t = 11.27, p <0.001). And the mean BMI reduction was 1.275 %,which is showing less reduction when compared to weight, but statistically it is alsoshowing highly significant.. And in Body circumference among 30 patients abdominal measurementshows well response i.e. mean of 2.516%, which is statistically showing highlysignificant (t = 13.31, p<0.001) when compared to others. This is followed by thechest circumference shows mean of 2.316% and it is also showing statistically highlysignificant (t = 9.69, p<0.001). Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 150
  • 173. Discussion The effect of this vasti on subjective parameters is also good. Among theparameters Sphik (t = 9.821), Udara (t = 14.34) and Sthana (t = 10.962) chalatwa,Udara chalatwa has shown about 50% relief. Which is statistically showing highlysignificant (t = 14.34, p<0.001). The parameter Kshudraswasa has shown 56.06% of relief and it is alsoshowing statistically highly significant (t = 13.32, p<0.001). This parameter is mainlyseen in sthoulya due to impedance exerted on respiratory system by excess fat aroundthorax and abdomen. In sever cases it may leads to severe respiratory complicationslike obesity hypoventilation syndrome. In Daurbalyata 56.45 % relief was observed at statistically significant level(t = 12.14, P<0.001). Here because of the increased body weight the person feels thissymptom. And also because of improper formation of other dhatus this dourbhalyatawill be seen. In the parameter Nidradhikyata it has shown 53.84% relief, which is alsoshowing statistically highly significant (t = 11.00, p<0.001). Due to the predominanceof kapha dosha, tama guna is increased and the laxanas like atinidra and tandra areobserved. Ati-kshudha is relived by 60.46% and statistically showing highly significant(t = 7.059, p<0.001). Due to the increased samana vata in the koshta, agni becomesteekshna and causes for ati-kshuda which makes the person to crave for more foodthis leads to sthoulya. Ati-pipasa is relived by 53.12% and statistically showing highly significant(t = 4.96, p<0.001). Because of excessive sweating and agniteevrata, ati-pipasa isseen. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 151
  • 174. Discussion Swedadhikya is relived by 50% and statistically showing highly significant(t = 6.915, p<0.001). As meda and kapha are inter related because both are havingashrayashrayi bhava and samanadhrmi and vishyandhi in nature. Excessive depositionof meda in Sthula person leads inability to do the vyayama, which predisposes theproduction of sweda by which the person feels tiredness. Sweda is mala of medadhatu. Dourgandhyata has shown 42.42% of relief, which is statistically highlysignificant (t = 4.44, p<0.001). Due to the vitiation of meda and swedaotpadakaswabhava of meda shareera dourgandhyata will be observed. Among the lipid profile serum HDL and serum cholesterol shows more highlysignificant but serum Triglyceride shows less significance. The net mean effect inTriglycerides is more with more variation but HDL having less net mean effect withless variation. Among serum Triglyceride and serum LDL, serum cholesterol shows more netmean effect with more variation and it is and it is more highly significant than LDL.(By comparing ‘t’ value, mean and SD) In the overall assessment, among 30 patients, 2 (6.66%) patients showed goodresponse i.e. above 70% relief in signs and symptoms, 17 (56.66%) patients showedmoderate response i.e. 50-70% relief in signs and symptoms and 11(36.66%) patientsshowed mild response i.e. below 30-50% relief in signs and symptoms. The statisticalevaluation showed all parameters, both subjective and objective has shown highlysignificance Here by, from the above-mentioned results it is obvious that BhadradhiAsthapana Vasti is efficient in the management of sthoulya. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 152
  • 175. DiscussionProbable mode of action of Bhadradi asthapana vasti: - As already stated regarding vasti karmukata that, action of vasti can beinferred at various levels of the body like dosha, dhatu, and malas etc. majoringredients of this particular bhadradi asthapana vasti yoga have the properties likekatu, kashaya, tikta rasa, ushna teekshna guna, ushna veerya, and katu vipaka. Inaddition to these kshara guna is also dominant because of the presence of the gomutra,yavakshara, and madhu. These dravya exhibit karma like lekhana, rookshana andkarshaana. This will helps in reducing the meda i.e. atiupachita meda which isdeposited in different parts of the body. Vasti has its action on shakaghata doshas, here probably the margavarodhacaused by the ati vrudda meda is relived by srotomargha vishodhana karma of thisvasti. Role of vasti is established on koshtagni. In case of Sthoulya, koshtagni dushtiresulted due to koshtagata vata vruddi. That vitiated vata is relived by vasti. And thereby sanga type of srotodushti is normalized and samprapti of Sthoulya is corrected, asvasti is a prime treatment for vata. The rectum has rich blood supply and drugs can cross the rectal mucosa likeother lipid membranes, thus unionized and lipid soluble substances are readilyabsorbed by the rectrum. There are two circulatory pathways by which the drugabsorption occurs and taken into site of action. First, the portion absorbed from rrectal mucosa is carried by the superior mesenteric vein into the portal circulation andenters into liver. Secondly, the portion absorbed from the lower rectum enters directlyinto systemic circulation via middle and inferior Haemorrhoidal veins. The vasti dravya given will reaches the liver through portal circulation willexert influence on the functioning on liver, especially concerned to its lipidmetabolism. The rookshana and lekhaniya dravyas present in this vasti will help to Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 153
  • 176. Discussionrelieve fatty liver conditions.lipid degradation also, by this lipid metabolism ismaintained, so that conditions like excess lipid accumulation (meda –vriddi/sanchaya/avarana). Vasti gets absorbed through sira, at guda/ pakwashaya level which isconsidered as shareera moola, is circulated throughout the body reaching all theminutest srotamsi, dhatu etc. Vasti absorbed into sira / rasayani which is commonly carrying rasa which isbeing circulated with rakta. Medamsha is also (sneha) circulated / transported todifferent parts as well as dhatu of the body through this circulating rasa, rakta only. Sothe vasti must have the effect over rakta leading to karshana / lekhana. Evenhyperlipidaemia is the condition, connected with blood (especially plasma) only. Bythis karshana / lekhaneeya property the sangha / avarodha is probably relieved.Tila taila which is used in this vasti yogais explained as “na anyaha snehasthathakwachitsamskaram anuvartate” i.e. when taila treated with other drugs it takes theproperty of that drugs after samskara. Vagbhata explained the importance of tila tailaas “krishanam Bhrimhanayalam Sthoolanam Karshanaya cha” it doesBrhimhanakarya for krisha person and does karshana for sthoola person. In sthoolapersons, by the sukshma, teekshna, ushna gunasit enters sukshma srotasesand doeskshapana of karya of meda. Due to kshapana of meda, the person becomes krisha.Even sarshapa taila also has the properties like ushna veerya, katu vipaka, lekhanakarya, kaphavata shamaka and meda karshana. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 154
  • 177. ConclusionConclusion: Vasti karma plays a major role among the shodhana karmas, as it is praised as Ardhachikitsa. Treatment modality like shodhana in the form of Bhadradi Asthapana Vasti shows better efficacy in reliving subjective features as well as objective features. karshana and lekhana property of this vasti probably responsible for the karshana of medadhatu, leading to srotoshodhana thus reliving the avarana. Most of the laxanas mentioned in the sthoulya in Ayurveda are subjective symptoms but some of the objective features mentioned in Ayurveda and allied sciences together can help to diagnose its severity. It is common misbbelief that all hyperlipidaemic (like hypercholesteraemia etc) are commonly associated with sthoulya. But factually it is not true only less proportion of obese may present with hyperlipidaemia. Sthoulya can be undoubtedly compared with that of obesity on its etiopathogenesis and symptom otology. And the samprapti and laxana can be understood with the help of modern pathophisiology of obesity. Objective parameters like weight, BMI, and body circumference in the trail cases have reduced conciderably. The vasti schedule tried was yoga vasti krama, if the same is tried with kala or karma vasti schedule results may be still encouraging. In the biochemical values also there was some mild reduction in lipid values were observed. This shows the action of this vasti over lipid values. In modern methods the procedure known as bar iatric surgery has been recently introduced but it has many complications like vomiting, diarrhea, abdominal hernia, infections, pneumonia etc.Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 155
  • 178. Conclusion Women’s are having higher incidence of obesity and they need more medical care than the man. By keeping above things ayurveda teaches us and safety less cost remedies in the management of sthoulya where the complications arises out of these treatments are minimal. By keeping the ideology of ayurveda in the diet principles and applying the shodhana therapies like vamana, virechana, and vasti etc the desire effect can be achieved in sthoulya rogi. By extensive literary research, it can be concluded that sthoulya chikitsa includes Satatha karshana, shodhana, and also shamana aushadhis. In addition to this following Pathyapathya are also plays an important role.Recommendations for further study: Study is better to be conducted on large sample. Some of the Bahirparimarjana measures like Udvartana can be adopted along with this type of vasti chikitsa. So that localized fat deposition can be reduced markedly. Some taila vastis, which are explained specially for sthoulya in the classics, are tried to assess the effect of plain taila vasti on sthoulya. Further specific studies on other types of lekhana vasti to know the mode of action of those vasti at tissue level, on biochemical and hormonal can be tried, so that understanding of vasti karmukata in a précised manner is possible. As there is a modern research done by Dr. Kim general director of the Scripps research institute in lajolla California, towards a possible vaccine called Ghrelin known as hunger hormone like that in the field of ayurveda alsoEvaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 156
  • 179. Conclusion further researches are needed that veerukshana chikitsa that help to reglet appetite, metabolism and weight.Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 157
  • 180. SummarySummary: The present study entitled ‘ evaluation of the efficacy of Bhadradi AsthapanaVasti in sthoulya (obesity)’ consists of 7 parts. 1) Introduction 2) Objectives 3) Review of literature 4) Methodology 5) Results 6) Discussion 7) ConclusionIntroduction: The part consists of the general description of Veda, Ayurveda,importance of Panchakarma, importance of vastikarma in Panchakarma and invatavyadhi and also on other doshas and importance of vasti in sthoulya. Disease ofsthoulya (obesity), Bhadradi asthapana vasti that is the trial drug of the study. Andincidence, need for study.Objectives of the study: The part consists of the purpose of the study and objectivesof the study.Review of literature: This part consists of the historical review, vyutpatti andnirukthi of both vastikarma and sthoulya. The pathophysiology of meda and lipid, Inthe disease review, nidana, samprapthi, poorvaroopa, roopa, etc are elaborated, In thekarma review, the procedure, indications and contraindications etc of nirooha,anuvasana and the drugs used and the probable mode of action of vasti are discussedand in drug review, drugs used in Bhadradi asthapana vasti and its properties arediscussed. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 158
  • 181. SummaryMethodology: This part deals with the preparation of Bhadradi asthapana vasti andmethod of administration of this vasti, the study design, subjective and objectiveparameters with their gradings and. diagnostic criteria, and criteria for assessment ofthe parameters are explained.Observations and Results: This part is dealt in the result section. The demographicdata, response to treatment and overall response are also dealt. Results are given in theform of tables along with demographical charts. The improvements in selectedparameters are statistically analyzed and presented in the form of tables and graphs.Discussion: This part is divided into five sections. First section entitled – discussionon review of literature – deals with the importance of shodhana karma andvastikarma, digestion process, formation of meda, importance and pathophysiology ofKayagni and Dhatwagni. Discussion on Causes samprapti of sthoulya and dietaryregimens. In the second section discussion on materials and methods – which dealswith the materials taken for the clinical study and a brief description of those, the thirdsection deals with the clinical study – observations and results. The fourth sectiondeals with the probable mode of action of Bhadradi asthapana vasti in sthoulya. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 159
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  • 195. Bibliography194.Vriddha Jivaka, Kashyapa Samhita, Khilasthana, Chapter No 23 3rd Edition, Varanasi, Chaukhambha Sanskrita Sansthan, , Page No358.195.Agnivesh, Charaka Samhita, Sutrasthana, Chapter No 21,Sloka No 4,Editor Dr Gangasahaya Pandeya, 5th Edition, Varanasi, Chaukhambha Sanskrita Sansthan, 1997. Page No 278.196.Ibid.197.Sushruta, Sushruta Samhita, Sutrasthana, Chapter No 15, Sloka No37, Editor Kaviraja Ambikadutta Shastri, 14th Edition, Varanasi, Chaukhambha Sanskrit Sansthan, 2003, Page No62.198.Vriddhavagbhata, Astangasamgraha, sutra sthana, Chapter No 24, Sloka No 11-33,Editor Dr.Ravi Dutt Tripathi, Delhi, Chaukhambha Sanskrita Pratishthan, 1996, Page No 435-439.199.Vagbhata, Astanga Hridayam, sutrasthana, Chapter No14, Sloka No 9-10Editor, Indradev Tripathi, 1st Edition, Varanasi, Krishnadas Academy, 1994, Page No 149.200.Shri Madhavakara, Madhavanidhana, Sansthana,2005.Part-2, Chapter No.34, Sloka No.1,Editor,Prof.Yadunandana Upadhyaya, Reprint,Varanasi,Choukambha Sanskrita , Page No.28.201.Bhavamishra, Bhavaprakasha,, Madhyamakhanda Chapter No39 , Sloka No1 , 5th Edition, Varanasi, Chaukhambha Sanskrita Sansthan,1998, Page No405202.Yogaratnakar, Yogaratnakar, Medhorog Nidhanchikitsa Adhikara,Sloka No. 1, Editor Brahmashankar Shastri, 2nd Edition, Varanasi, Chaukhambha Sanskrit Series, Page No 97.203. Davidson’s, Principle and Practice of Medicine, Chapter No.7 Editor, Christopher Hasleet and .Edwin .R.Chilvers, 18th Edition, Churchil livingtone, 1999, Page No.527.204. API, Text Book of Medicine, Section 4, Chapter No. 11 Editor, Gurumuk.S.Sainani, 6th Edition, Mumbai, Association of physicians of India,1999,Page No.209.205. Harrison’s, Principle of internal Medicine, Vol.-1, Part –5, Chapter No.75,Editor, Anthoni.S.Fauci and Joseph. B.Martin, 14th International Edition 1998. Page No.454.206. Davidson’s, Principle and Practice of Medicine, Chapter No.7 editor, Christopher Hasleet and Edwin .R.Chilvers, 18th Edition, Churchil livingtone, 1999., Page No.527-528.207. Ibid. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 173
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  • 197. Bibliography221.Sushruta, Sushruta Samhita, Sutrasthana, Chapter No15 ,Sloka No 37Editor Kaviraja Ambikadutta Shastri, 14th Edition, Varanasi, Chaukhambha Sanskrit Sansthan, 2003, Page No62.222.Vriddhavagbhata, Astangasamgraha, Sutrsthana, Chapter No24, Sloka No22-24 & 31,Editor Dr.Ravi Dutt Tripathi, Delhi, Chaukhambha Sanskrita Pratishthan, 1996, Page No 437 & 439.223.Vagbhata, Astanga Hridayam, Sutrsthana, Chapter No14, Sloka No20 Editor, Indradev Tripathi, 1st Edition, Varanasi, Krishnadas Academy, 1994, Page No150.224. Shri Madhavakara, Madhavanidhana,Part-2, Chapter No.34, Sloka No.9, Editor Prof.Yadunandana Upadhyaya, Reprint, Varanasi,Choukambha Sanskrita Sansthana,2005, Page No.29.225. Bhavamishra, Bhavaprakasha, Madhyamakhanda,Chapter No 39, Sloka No 3, 5th Edition, Varanasi, Chaukhambha Sanskrita Sansthan,1998, Page No405-406.226. Sushruta, Sushruta Samhita, Sutrsthana,Chapter No 10, Sloka No 5,Editor Kaviraja Ambikadutta Shastri, 14th Edition, Varanasi, Chaukhambha Sanskrit Sansthan, 2003, Page No 31.227. Agnivesh, Charaka Samhita, Vimanasthana, Chapter No 8, Sloka No 117, Editor Dr Gangasahaya Pandeya, 5th Edition, Varanasi, Chaukhambha Sanskrita Sansthan, 1997, Page No 668.228. Sushruta, Sushruta Samhita, Sutrsthana, Chapter No 35, Sloka No 12-14, Editor Kaviraja Ambikadutta Shastri, 14th Edition,Varanasi, Chaukhambha Sanskrit Sansthan, 2003, Page No 131.229. Harrison’s, Principle of internal Medicine, Vol.-1, Part –5, Chapter No.75, Editor, Anthoni.S.Fauci and Joseph.B.Martin, 14th Editon, international edition 1998. Page No.454230. Davidson’s, Principle and Practice of Medicine, Chapter No.7 editor, Christopher Hasleet and Edwin .R.Chilvers, 18th Edition, Churchil livingtone, 1999, Page No. 526.231.Hutchison’s, Clinical Methods, Chapter No.7 Editor, Michel Swash, 21st Edition,Saunders an imprint of Elsevier Limited, international Edition, 2004, Page No. 129.232. Ibid, Chapter No.7, Page No. 128.233. Davidson’s, Principle and Practice of Medicine, editor, Chapter No.7, Christopher Hasleet and Edwin .R.Chilvers, 18th Edition, Churchil livingtone, 1999, Page No. 526. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 175
  • 198. Bibliography234. Sushruta, Sushruta Samhita, Sutrasthana, Chapter No 24, Sloka No9 Editor Kaviraja Ambikadutta Shastri, 14th Edition, Varanasi, Chaukhambha Sanskrit Sansthan, 2003, Page No101 .235. Ibid, Chapter No 24, Sloka No13, Page No102.236. Agnivesh, Charaka Samhita, Sutrsthana, Chapter No21,Sloka No 5-6, Editor Dr Gangasahaya Pandeya, 5th Edition, Varanasi, Chaukhambha Sanskrita Sansthan, 1997. Page No 279.237.Sushruta, Sushruta Samhita, Sutrasthana, Chapter No 15, Sloka No37 Editor Kaviraja Ambikadutta Shastri, 14th Edition, Varanasi, Chaukhambha Sanskrit Sansthan, 2003, Page No62238. Agnivesh, Charaka Samhita, Sutrsthana, Chapter No20, Sloka No 17,Editor Dr Gangasahaya Pandeya, 5th Edition, Varanasi, Chaukhambha Sanskrita Sansthan, 1997. Page No 275.239. Vagbhata, Astanga Hridayam, Sutrasthana, Chapter No 11, Sloka No 26Editor, Indradev Tripathi, 1st Edition, Varanasi, Krishnadas Academy, 1994,Page No 119.240. Agnivesh, Charaka Samhita, Vimanasthana, Chapter No5, Sloka No 16,Editor Dr Gangasahaya Pandeya, 5th Edition, Varanasi, Chaukhambha Sanskrita Sansthan, 1997. Page No 595.241. Vagbhata, Astanga Hridayam, Sutrasthana, Chapter No 11, Sloka No 34-35, Editor, Indradev Tripathi, 1st Edition, Varanasi, Krishnadas Academy, 1994, Page No. 120-121.242. Shri Dalhanacharya, Sushruta Samhita, Sutrastana, Chapter No 15, Sloka No 32,Editor Vaidya Jadavji Trikamji Acharya, 7th Edition, Varanasi, Chaukhambha Orientalia, 2002, Page No 73.243. K.Sembulingam, Essentials of Medical Physiology, Chapter No.67 3rd Edition, New Delhi, Jaypee Brothers Medical Publishers (P) Ltd, 2005. & 70, Page No. 316-317 & 350.244. Harsh Mohan, Text Book of Pathology; Chapter 8. 4th Edition, New Delhi, Japee Brother’s Medical Publishers; 2002.p.334-342.245. Agnivesh, Charaka Samhita, Sutrsthana, Chapter No21, Sloka No 7, Editor Dr Gangasahaya Pandeya, 5th Edition, Varanasi, Chaukhambha Sanskrita Sansthan, 1997. Page No 279.246. Sushruta, Sushruta Samhita, Sutrasthana, Chapter No 15, Sloka No37, Editor Kaviraja Ambikadutta Shastri, 14th Edition, Varanasi, Chaukhambha Sanskrit Sansthan, 2003, Page No62. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 176
  • 199. Bibliography247. Vriddhavagbhata, Astangasamgraha, Sutrsthana, Chapter No24, Sloka No30, Editor Dr.Ravi Dutt Tripathi, Delhi, Chaukhambha Sanskrita Pratishthan, 1996, Page No 439.248. Vagbhata, Astanga Hridayam, Chapter No14, Sloka No 20, Editor, Indradev Tripathi, 1st Edition, Varanasi,Krishnadas Academy, 1994, Sutrsthana, Page No 150.249. Shri Madhavakara, Madhavanidhana, Part-2, Chapter No.34,Sloka No.1- 9,Editor,Prof.Yadunandana Upadhyaya, Reprint,Varanasi,Choukambha Sanskrita Sansthana,2005. Page No.28- 29.250. Bhavamishra, Bhavaprakasha, Madhyamakhanda, Chapter No39, Sloka No10, 5th Edition, Varanasi, Chaukhambha Sanskrita Sansthan,1998, Page No 406.251. Yogaratnakar, Yogaratnakar, Medhorog Nidhanchikitsa Adhikara, Sloka No.8 Editor Brahmashankar Shastri, 2nd Edition, Varanasi, Chaukhambha Sanskrit Series, Page No 98.252. Davidson’s, Principle and Practice of Medicine, Chapter No.7 editor, Christopher Hasleet and Edwin .R.Chilvers, 18th Edition, Churchil livingtone, 1999, Page No. 529.253. Golwalla, Medicine for Students, Chapter No 5,18th Edition, Mumbai, Dr.A.F.Gowalla Empress court Church gate, 1999, Page No 339-340.254. Harrison’s, Principle of internal Medicine, Vol.-1, Part –5, Chapter No.75, Editor, Anthoni.S.Fauci and Joseph.B.Martin, 14th Editon, international Edition 1998. Page No.459.255. Agnivesh, Charaka Samhita, Chikitsasthana, Chapter No 6, Sloka No 57, Editor Pt Rajeshwara Datta Shastri, Reprint Varanasi, Chaukhambha Bharati Academy, 1998, Page No 244.256. Davidson’s, Principle and Practice of Medicine, Chapter No.7 editor, Christopher Hasleet and Edwin .R.Chilvers, 18th Edition, Churchil livingtone, 1999, Page No. 528.257. Agnivesh, Charaka Samhita, Sutrsthana, Chapter No21, Sloka No 21Editor Dr Gangasahaya Pandeya, 5th Edition, Varanasi, Chaukhambha Sanskrita Sansthan, 1997, Page No 282.258. Vagbhata, Astanga Hridayam, Sutrasthana, Chapter No14, Sloka No 12, Editor, Indradev Tripathi, 1st Edition, Varanasi, Krishnadas Academy, 1994, Page No149.259. Agnivesh, Charaka Samhita, Sutrsthana, Chapter No23, Sloka No 6-9,Editor Dr Gangasahaya Pandeya, 5th Edition, Varanasi, Chaukhambha Sanskrita Sansthan, 1997. Page No 296. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 177
  • 200. Bibliography260. Sushruta, Sushruta Samhita, Sutrasthana, Chapter No 45,Sloka No112 Editor Kaviraja Ambikadutta Shastri, 14th Edition, Varanasi, Chaukhambha Sanskrit Sansthan, 2003, Page No178.261. Agnivesh, Charaka Samhita, Sutrsthana, Chapter No13,Sloka No 44-46Editor Dr Gangasahaya Pandeya, 5th Edition, Varanasi, Chaukhambha Sanskrita Sansthan, 1997, Page No 187.262. Sushruta, Sushruta Samhita, Chikitsasthana, Chapter No 32, Sloka No15 ,Editor Kaviraja Ambikadutta Shastri, 14th Edition, Varanasi, Chaukhambha Sanskrit Sansthan, 2003, Page No140.263. Ibid, Chapter No 33, Sloka No18, Page No143.264. Vriddha Jivaka, Kashyapa Samhita, Chapter No 2,3rd Edition, Varanasi, Chaukhambha Sanskrita Sansthan, Siddisthana, Page No 150.265. Vagbhata, Astanga Hridayam, Sutrasthana, Chapter No14, Sloka No 14, Editor, Indradev Tripathi, 1st Edition, Varanasi,Krishnadas Academy, 1994, Page No149.266. Sushruta, Sushruta Samhita, Chikitsasthana, Chapter No38, Sloka No82,Editor Kaviraja Ambikadutta Shastri, 14th Edition, Varanasi, Chaukhambha Sanskrit Sansthan, 2003, Page No174.267. Agnivesh, Charaka Samhita, Sutrsthana, Chapter No21,Sloka No 21, Editor Dr Gangasahaya Pandeya, 5th Edition, Varanasi, Chaukhambha Sanskrita Sansthan, 1997Page No 282.268. Sharangadhara, Sharangadhara Samhita, Prathamakhanda, Chapter No 4, Sloka No 10 4th Edition, Varanasi, Chaukhambha Orientalia, 2001, Page No 18.269. Vriddha Jivaka, Kashyapa Samhita, Chikitsasthana, MedhaswiDhatri Chikitsa,3rd Edition, Varanasi, Chaukhambha Sanskrita Sansthan, Page No140.270. Ibid, Siddisthana, Chapter No 2, Page No 150.271. Sushruta, Sushruta Samhita, Chikitsasthana, Chapter No37, Sloka No33-35, Editor Kaviraja Ambikadutta Shastri, 14th Edition, Varanasi, Chaukhambha Sanskrit Sansthan, 2003, Page No161.272. Agnivesh, Charaka Samhita, Sutrsthana, Chapter No21, Sloka No 20-21,Editor Dr Gangasahaya Pandeya, 5th Edition, Varanasi, Chaukhambha Sanskrita Sansthan, 1997. Page No 282.273.Harrison’s, Principle of internal Medicine, Vol.-1, Part –5,Chapter No.75,Editor, Anthoni.S.Fauci and Joseph.B.Martin, 14th Editon, international edition 1998. Page No.460. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 178
  • 201. Bibliography274. Golwalla, Medicine for Students, Chapter No 5,18th Edition, Mumbai, Dr.A.F.Gowalla Empress court Church gate, 1999, Page No 340.275. Harrison’s, Principle of internal Medicine, Vol.-1, Part –5, Chapter No.75, Editor, Anthoni.S.Fauci and joseph.B.Martin, 14th Editon, international edition 1998. Page No.460.276. Davidson’s, Principle and Practice of Medicine, Chapter No.10 editor, Christopher Hasleet and Edwin .R.Chilvers, 19th Edition, Churchil livingtone, 2002, Page No. 304.277. Towards a possible Vaccine against obesity;Hindu, 2nd August 2006, New scope, Page No.20.278. Davidson’s, Principle and Practice of Medicine, Chapter No.10 editor, Christopher Hasleet and Edwin .R.Chilvers, 19th Edition, Churchil livingtone, 2002, Page No. 305.279. API, Text Book of Medicine, Editor, Gurumuk.S.Sainani, Chapter No. 11, 6th Edition, Mumbai, Association of physicians of India,1999.Section 4, Page No.210.280. Rober Fear, Obesity Surgery Risks gets bigger; First Bariatric surgery; many methods: Deccan Chronicle July 27th , 2006, Health plus column.281. Agnivesh, Charaka Samhita, Sutrsthana, Chapter No21,Sloka No 25-27 Editor Dr Gangasahaya Pandeya, 5th Edition, Varanasi, Chaukhambha Sanskrita Sansthan, 1997, Page No 282.282. Sushruta, Sushruta Samhita, Sutrasthana, Chapter No 15, Sloka No38, Editor Kaviraja Ambikadutta Shastri, 14th Edition, Varanasi, Chaukhambha Sanskrit Sansthan, 2003, Page No62.283.Vagbhata, Astanga Hridayam, Sutrasthana, Chapter No14, Sloka No 21 Editor, Indradev Tripathi, 1st Edition, Varanasi, Krishnadas Academy, 1994, Page No150.284. Bhavamishra, Bhavaprakasha, , Madhyamakhanda, Chapter No 39, Sloka No 11 5th Edition, Varanasi, Chaukhambha Sanskrita Sansthan,1998, Page No 406.285. Yogaratnakar, Yogaratnakar, Medhorog Nidhanchikitsa Adhikara, Editor Brahmashankar Shastri, 2nd Edition, Varanasi, Chaukhambha Sanskrit Series, Page No 102.286. Bhavamishra, Bhavaprakasha, 5 Madhyamakhanda, Chapter No 39, Sloka No 66,th Edition, Varanasi, Chaukhambha Sanskrita Sansthan,1998, Page No 529.287. Sushruta, Sushruta Samhita, Chikitsasthana, Chapter No 38, Sloka No60-63 Editor Kaviraja Ambikadutta Shastri, 14th Edition, Varanasi, Chaukhambha Sanskrit Sansthan, 2003, Page No172. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 179
  • 202. Bibliography288. Prof. P.V. Sharma, Dravyaguna- vijnana, 14th Edition, Varanasi, Chaukambha Bharati Academy, 1993.Vol II , a) Page no 575-577, b) Page no 149-151, c) Page no 433-436, d) Page no 383-384, e) Page no 761-763, f) Page no 75-78, g) Page no 798-800, h) Page no 282-284, I) Page no 626-629, j) Page no 699-700, k) Page no 170-173, l) Page no 463- 466, m) Page no 376-378, n) Page no 152- 154, o) Page no 572- 575, p) Page no 719-721, q) Page no 275-279, r) Page no 455-458, s) Page no 331-335, t) Page no 28 -31.289. Shri Bhavamishra, Bhavaprakasha Nighantu, Shakavarga, Sloka no. 67-68, Editor Dr. G.S.Pandey, 6th Edition, Varanasi, Chaukhambha Bharati Academy,1982. Page no 685.290. a) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 540. b) Rubin.K.Dr, Chemical components of Rock salt. University of Hawaii.2003. Available from: www.geophysics.com/hawaii/HI96822. Accessed on 4th November 2004.291.Shri Bhavamishra, Bhavaprakasha Nighantu, Mutravarga, Sloka no. 1-6,Editor Dr. G.S.Pandey, 6th Edition, Varanasi, Chaukhambha Bharati Academy,1982. Page No 778.292. Ibid, Madhuvarga, Sloka no. 1-5, Page No 788.293. Ibid, Tailavarga, Sloka no. 13-15, Page No 780.294. Ibid, Sandhanavarga, Sloka no. 1-3, Page No 783.295. a) Davnvantari nighantu, Shatapushpadi varga, sloka No. 18-19, Editor, P.V.Sharma, 3rd Eition, Varanasi, Choukambha Bharati Academy, 2002. Page No. 73. b) Sadnand Sharma Rasatarangini, 14th Taranga, Sloka No.6-8, Editor, Kashinath Shastry, 11Edition, Varanasi, Motilal Banarasi Das, 1994, Page No. 307-308296.Shri Bhavamishra, Bhavaprakasha Nighantu, Tailavarga, Sloka No. 2-7, Editor Dr. G.S.Pandey, 6th Edition, Varanasi, Chaukhambha Bharati Academy,1982. Page No 779.297.Bhaishajya Kalpana Vijnanam, Chapter no. 5, 1st Edition, Varanasi, Chaukhambha Sanskrit Bhawana,1998. Page No 371. Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 180
  • 203. DEPT OF POST GRADUATE STUDIES IN PANCHAKARMA, D.G.M. Ayu. Medical college Gadag Clinical Trial “Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya” (Obesity)Guide: Dr. P. Shivaramudu PG scholar: Dr.V. G. Hiremath M.D. (Ayu)Co guide: Dr S. H. Doddamani MD (Ayu)1. Name of the patient : Sl. No.2. Father’s/Husband’s Name : OPD No.3. Age : ………... yrs IPD No.4. Sex : Male/Female Bed No.5. Religion : Hindu Muslim Christian Others6. Marital status : Married Unmarried6. Occupation : Sedentary Active Labor Others7. Economical Status : Poor Middle Upper middle Higher8. Diet : Veg Mixed9. Address : …………………………. Phone No. …………………………. E- Mail: …………………………. Pin code:10. Date of Schedule of Initiation:11. Date of Schedule of Completion:12. Result : Good Moderate Poor No Response Response Response Response13. Consent : I here by agree that, I have been fully educated with the disease and treatment. Here by satisfied whole-heartedly, and accept the medical trial over me.Investigator’s Signature. Patient’s Signature 1
  • 204. A) Pradhana Vedana: P/A Duration Medomamsa Ativriddi Stana Chala Udara Sphik Alasya Kshudra shwasa Dourbalya Nidradikyata Swedadikyata Dourgandyata Atipipasa Atikshuda Gatrasada AngagouravaB) Anubandi Vedana: P/A Duration Aruchi Kriya asamartata Vyayama asamartata Talu shosha Shopha Shareera gouravata Kratana Moha Alpa balaC) Poorvavyadi Vrittanta;D) Chikitsa Vrittanta: - 2
  • 205. E) Kula Vrittanta: Present Absent If present:F) Vayaktika Vrittanta: Ahara: Ahara: Veg NonVeg Dominant Rasa : Madhura Amla Lavana Katu Tikta Kashaya Dietic Habits : Samashana Adhyashana Anashana Vishamashana Agni Manda Theekshna Vishama Sama Guna : Guru Snigdha Ushna Sheeta Koshta: Mrudu Madhyama Kroora Vihara: Nature of work Manual Sedentary Labour Sleep: Nature of Sound Disturbed Day Night Total sleep sleep sleep hours Vyayama No Occasionally Everyday 3
  • 206. Rutusrava Vrittanta Manarche Menopause Menustrual Cycle Prasooti Vrittanta Issues Abortion Operation Vyasana: Alcohol Smoking Tabooco Any other Quantity Quantity Quantity Quantity Duration Duration Duration DurationG) Samanya pareeksha Asta sthāna Pareeksha : Vital examination1 Nadi /Min 1 Temp /F Mala2 2 Pulse /min pravritti 3 Resp.rate /min Mootra Frequency3 4 B.P __mm of Hg pravritti Day Night4 Jihwa5 Shabda6 Sparsha7 Druk8 Akruti 4
  • 207. H) Dashaveedha Pareeksha : Shareerika V P K VP PV KV Prakriti Mansika S R T SR ST TRSaratha Pravara Madhyama AvaraSamhana “ “ “Pramanatha “ “ “Satmyatha “ “ “Satvatha “ “ “Ahara Shakti “ “ “Vyayama Shakti “ “ “Vayatha Bala Madhyama VriddaVikrutithaI) Sroto Pareeksha : Srotus Observed Lakshanas 1. Udakavaha srotas 2. Rasavaha srotas 3. Mamsa vaha srotas 4. Medavaha srotas 5. Sweda vaha srotasJ) Systemic Examination :- Gastrointestinal system Respiratory system Cardio vascular system Nervous system 5
  • 208. K) Vikrutitha Pareeksha : Nidana Ahara Vihara Manasika Sleshmala Avyayama Chinta Madhura Chestadwesha Shoka Sneha Arati Bhaya Adhyashana Diwaswapna Krodha Guru Shayya, Asanasukha Picchila Harshata AtimatraharPoorva Roopa :Roopa: P/A Duration Medomamsa Ativriddi Chala Stana Udara Sphik Alasya Kshudra shwasa Dourbalya Nidradikyata Swedadikyata Dourgandyata Atipipasa Atikshuda Gatrasada Angagourava 6
  • 209. L) Treatment Protocol: Vasti chikitsa - Yoga vasti krama 1) Anuvasana Vasti - Murchita Tila Taila 2) Nirooha Vasti - Bhadradi Asthapana yoga AB NB AB NB AB NB AB ABDoseTime ofAdministrationTime of expulsionRetention timeNo. of times motionpassedAny other features Asthapana Samyakyoga Lakshana Prasrustavitkatha / Mutratha / Vathata / Ruch i/ Agnivriddhi / Laghutva Ashaya / RogaUpashamana / Prakrutisha / Bala. Ayoga Lakshana. Rugshiro / Hrudaya / Gudavedana / Basthivedana / Lingavedana / Sopha / Prathisaya / Hrlasa / Mutrasanga / Swasakruccha / Aruchi / Jadatwa. Athiyoga Lakshana. Supthi / Angamarda / Klama / Vapathu / Nidra / Dourbhalya / Tamapraresha / Unmada / Hikka / Murcha / Guda Bramsha / Sula/Medakandarvath srava / Trsna/Brama / Netra Praveshana / Raktakshaya / Kaphakshaya / Pittakshya / Vatakshaya / Kaphapitta rahita shweta udhaka nisarana / Kapha pitttaRahita lohitha udhaka nisarana / Mamsa dhavana udhaka srava / Adhmama / Srava / Mutragraha / Vibramsa / Parikarthika / Hrudhayagraha / Jivadhana / Sthamba / Klama. Pathyapathya: 7
  • 210. M) Assessment of results:Subjective parameters Complaints BB AB AT Stana Chala Udara Sphik Kshudra shwasa Dourbalya Nidradikyata Swedadikyata Dourgandyata Atipipasa AtikshudaObjective Parameters: Height: Parameters BB AB AT Weight BMI Wt/ht m2 BB AB AT Chest Abdomen Circum Waist ference Hip Waist to Hip ratio Rt mid arm Left mid arm 8
  • 211. M) Investigation: Special Investigation: Sr. Lipid profile Before treatment After treatment Sr. Cholesterol Triglyciredes HDL LDL VCDLOther investigations:N) Investigators Report:Signature of scholar Signature of Guide 9