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EVALUATION OF THE EFFICACY OF PIPPALYADI GUGGULU IN MEDOROGA, YASHODA. S. MUDIGOUDAR, Post Graduate Studies & Research Center, D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG

EVALUATION OF THE EFFICACY OF PIPPALYADI GUGGULU IN MEDOROGA, YASHODA. S. MUDIGOUDAR, Post Graduate Studies & Research Center, D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG

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    Sthoulya kc009 gdg Sthoulya kc009 gdg Document Transcript

    • 2000 EVALUATION OF THE EFFICACY OF PIPPALYADI GUGGULU IN MEDOROGA (WITH SPECIAL REFERENCE TO ITS HYPOLIPIDIMIC EFFECT) Thesis submitted to theRajiv Gandhi University of Health Sciences Karnataka,Bangalore In partial fulfillment of regulations for the Award of the degree of DOCTOR OF MEDICINE (AYURVEDA) By YASHODA. S. MUDIGOUDAR. Guide Dr. Ch. Ranga Rao. M.D. (Ayu) Professor and Head of the Department Post Graduate and Research Centre D.G.M.Ay. Medical College, Gadag. Co-Guide Dr. Siva Rama Prasad Ketamakka. M.D. (Ayu) Reader Post Graduate and Research Centre D.G.M.Ay. Medical College, Gadag. POST GRADUATE AND RESEARCH CENTRE DEPARTMENT OF KAYACHIKITSA D.G.M.AY. MEDICAL COLLEGE
    • Food is an entity with which we are associated from the first day ofour lives. We ignorantly consume many things in life, and probably foodis one out of them due to its own intimate association with us. In India, itseems that all functions, and social, spiritual, even corporate meetingseither begin or end with distribution of food. On all such occasions,including daily food ritual, major emphasis is on taste and only taste.Ignorant or otherwise, total neglect on the basic functions of food andbody needs, will allow our tongue to rule on entire body. These excess calories may “lengthen the waist line “ but shortensthe “life line” of the individual by imposing an extra burden. Thus obesityin humans is a health problem of appreciable magnitude, as it isassociated with an increased incidence of cardiovascular disease, gallbladder disease, diabetes and other conditions. And in which increasedmorbidity rate is witnessed 1 , survey shows 12-fold increase in the rate ofdeath form cardiovascular disease in men aged 25 – 34 with obesity. It is wisely told in Ayurveda, diet and drinks virtually constitute thevery life of all living beings. Those who take proper food and drinks willenjoy bliss without any disease during the present as well as future timesotherwise results into a premature death 2 . This properly utilised dietnourishes and supports the body like the pillars support the house 3Charaka has classified various articles of foods and drinks in the 1Introduction
    • following twelve groups VIZ; Shukadhanya, Shamidhanya, Mamsa, Shaka,Phala, Harita, Madya, Jala, Gorasa, Ikshuvikara, Kritanna, Aharayoga. It almost resembles the categorisation of food item done by Indiancouncil of medical research. It specifies the food requirement based onage, gender and physiological state, occupation or activity of a person.As a example, between 19 – 58 years of age group with sedentary typeof activity needs- Cereals 420g. Leafy vegetables 100g Other vegetables 100g Milk and Milk products 300g Sugars 25g Pulses 60g Roots and tubers 200g Fruits 100g Oil and fats 20gIf it is crossed gradually leads to obesity. In addition to the 2000 k cal / day necessary to meet basal needs,500 – 2500 or more k cal / day are required to meet the energy demandsof daily activities 4 . The caloric value of the dietary intake must equal the 2Introduction
    • energy expended as heat and work if body weight is to be maintained.When the intake is excessive, the obesity results. The word Medas is derived from “MID” dhatu that means snigdhadravya 5 . Thereby snigdha guna dravyas definitely increase Medodhatu.This excessive accumulation of Medas at udara, stana, sphik anddisproportionate growth (Ayatha upachaya) of the body is considered asMedoroga. Shleshmala and ama producing aharas induces madhurata toannarasa, which in turn causes increase of Medas by its snigdhaguna.This obstructs the nutrient channels of the remaining tissues deprivingthem of nutrition. Thus, only fat accumulates in large quantities in thebody. Because of obstruction only vayu comes to Kosta and begins to actfast inside the Kosta, increases the digestive activity, making forvoracious hunger and craving for large quantity of food. This excesshunger is the cause which make the treatment of the disease difficult. As it is virodhapakramaneeya for both Langhana and Brimhanatherapies, becomes kastasadhya. Along with Vata, kapha and Medohardravya, therapy needs strict diets and exercise. Treatment of obesity maysound like a strenuous program but it is really advantageous to come outof premature death. Increased mortality rate due to obesity andunsuccessful treatments for the disease attract the attention ofresearchers. 3Introduction
    • 6 The meaning of obesity is given as Medaswita and signs andsymptoms explained for obesity nearly resemble the sthoulya orMedoroga. Thus the comparison of Medoroga with obesity is justifiable. ITHIHAS Our ancient scripture Yajurveda quotes, “oh God! Give us a foodwhich will keep us away from diseases”. Charaka affirmed that in thebeginning of Kritayuga people were completely disease free and ojovanlike Devatas as they were getting foods rich in rasa, guna, veerya andvipaka. As days passed some become rich and habituated to eat more,which lead to increase in body weight. This increase in body weight leadthe disease free people of Kritayuga to the disease-full world. Thus,Medoroga is known since the times of Kritayuga and is one of the causesfor the disease to develop. Two thousand five hundred years ago Hippocratus, noted that fatmen “die suddenly 7. This suggests not only the disease but also he knewthe severity of the increased mortality rate due to obesity. 4Introduction
    • SAMHITA PERIODCharaka Samhita (Before1000 BC) 8 Incidence of disease may be high during that period, hence theywere able to study the disease clinically and mention the specific line oftreatment, and many single and compounds. Outstanding being theknowledge of genetic role in the etiopathogenesis.Sushruta Samhita (1000 – 1500 BC). 9 Increased incidences might have forced them to find the rootcause. So Sushruta clearly quotes Rasa is the cause for both obese andlean. 10Astanga Hridhaya (550C AD) Discussed sthoulya in dwividhopakramaneeya and included it underlanghan therapy. Treatment aspect of sthoulya is discussed but states asthere is no medicine for sthoulya. MEDIEVAL PERIODThis period of history of Indian medicine is known as a period ofcommentators. Hence most of the books of this period are collections ofthoughts of previous authors, commentaries of previous works. 5Introduction
    • Madhavakara (9C AD) 11 Madhavakara renamed sthoulya as Medoroga and compiled thedisease from the works of previous authors. But change of nomenclatureindicates, instead of considering anatomical change i.e. shareera sthulatahe wanted to consider physiological change in the disease condition.Chakrapani (11C AD) 12 The commentator of Charaka Samhita gives a critical commentaryover it but he has not emphasized much about the disease in his ownbook Chakradatta.Dalhana (12C AD) 13 A commentator of Sushruta Samhita, clarify important queries bygiving logical answers.Sharangadhara (13 C AD) 14 Even-though mentioned the disease in rogaganana prakarana, notconsidered in his explanations.Bhavamisra (16C AD) 15 He specifies profuse sweating due to excess Medas creates amedia for external germs on the skin. 6Introduction
    • Yoga Ratnakara (17C AD) 16 His views are almost similar to previous Acharyas.F ew rec ent w orks don e at d iffer en t re sear ch cen te rs ar e mentio ne d b elow 17 Effect of Turmeric extract on Lipid Profile by Deshapande U.R. and group, at Tata Memorial Hospital, Parel. Development of Hypolipidaemic agents from plants and Traditional remedies by Nityanand.S. at Central Drug Research institute, Lucknow. Hypolipidaemic effect of Fenugreek seeds, by Sharma.R.D. at P.G department S.N.Medical college, Agra Effect of purnus amygdalus seeds on lipid profile, by Sunita Teotia at Centre for Biomedical Engineering, IIT, Delhi. Hypolipidimic activity of Eleven different pectins, by Valsa.A.K.at Dept of Biochemestry,University of Kerala, Karivettam Hypocholesterolaemic action of three Guggulu preparations, by Nair R.B. RRI, Trivendrum. 7Introduction
    • Hypocholesterolaemic cffect of Terminalia Arjuna tree bark, by P. Gupta, at Dept of Pharmacology, SMS Medical college, Jaipur. Terminalia Arjuna : an ayurvedic cardiotonic, regualtes lipid metabolism in hyperlipaemic rates, by Kapoor N.K. at Div of Biochemistry, C.D.R.I Lacknow. Effect of boiled Barley rice feeding in hypercholesterolemic and Normolipidimic subjects, by Tomita, M at National Institute of Health and Nutrition. Tokyo. Preliminary screening of Hypocholesterolemic activity in solanium Indicum, by Badar, Y. at Pharmaceutical and Fine Chemical Research Centre, PCSIR Laboratories Complex, Karachi. Hypolipidemic effect of Coriander seeds, by Chitra, V at dept of Bio- Chemistry, University of Kerala, Kariavattom. Effect of agnimantha kwatha bhavita shilajita on Medoroga. By Murlikrishna.V at PG center Hydrabad. 8Introduction
    • REFERENCES1. Review of Medical Physiology – W. Ganong pp 2492. Charaka Sutrasthana 27 / 345,346,347 (chakrapani Commentary)3. Astanga Hridaya Sutrasthana 7 / 514. Review of Medical Physiology – W. Ganong pp 2945. Shabdha stoma maha nidi, vachaspathyam6. Dictionary English to Sanskrit by Sir Moniar Williams pp 647. your guide to health clifford .R.Anderson. pp 678. Ayurveda ka vigyanika ithihasa pp 189. Ibid pp 1910. Ibid pp 2111. Ibid pp 2312. Ibid pp 2513. Ibid pp 2614. Ibid pp 2715. Ibid pp 2916. Ibid pp 3017. Allied Ayurvedic Medical Research Abstracts (AAMRA) Research in ayurveda by Dr M.S.Baghel. 9Introduction
    • Basic knowledge about Anatomy and physiology concerned to thedisease is essential to study the pathophysiology of it. Some of theshareera aspects concerned to the Medoroga are explained here. AYURVEDIC VIEW It is essential to know the Medodhatu utpatti, transportation andalso about its place and function. The digestion of food commences as itenters into the mouth. Consumed food reaches the stomach with the helpof Pranavayu and Samanavayu stimulates the Jataragni to digest it.Even though the ingested food contains six Rasas, in Amashaya, aquiresfirst the Madhura paka at the influence of kapha. The partly digestedfood of Madhurabhavavastha moves into the Pachyamanashaya andenters into amlavasta. Pitta that is originally situated in this site, getsnourishment and support from this amlapakavasta. The partly digestedfood is then propelled from the Amashaya into pakvashaya 1 forcompletion of the digestion. The digested food after entering pakvashayabecomes dry due to the absorption of water and the waste material offood attains the form of solid mass with a little moisture. Thisavasthapaka is called katuavasthapaka and here Vata is increased 2. Eventhough the human body and the food are derived from thecombination of the five bhutas 3, the composition and the quality of their 9 Shareera
    • panchabhoutika constituents are different from each other there by it isknown as vijatiya. So transformation of vijatiya substances derived formthe food into the sajatiya nutrients which are to be incorporated in to thestructure of the dhatus is the function of bhutagnis, which follows afterthe completion of the action of jataragni. During this entire process the ahara gets divided into prasada andkittabhagas. The kitta bhagas of ahara excreted out as pureesh andmootra. The remaining prasada bhaga is again subjected to processingby dhatwagnis. Rasagni acts on it and forms rasa dhatu and does thenourishment of rakta dhatu. During this sthanya and arthava areproduced as upadhatus and malaroopi kapha as mala is formed.Similarly all the other dhatus can be explained. As Medoroga is mainlyconcerned with Medodhatu utpatti it can be explained as, mamsdhatwagniacts on mamsa and the nutrients of Medodhatu present in the mamsa-dhatu are transformed into Medodhatu getting an additional supply ofjalabhutamshas during paka, which make the dhatu snigdha and drawa 4.Probably vasa which is the sneha portion of mamsa is responsible for theproduction of Medas indirectly and partially. Medodhatu is 2 anjali in pramana and in its normal state does thesnehana, swedana, drudata and asthi pushti in the body. 10 Shareera
    • Srotas The internal transport system of the body is represented bysrotases and has been given a fundamental importance both in healthand disease. When the integrity of the srotases are impaired, both thesthanaga and margagha dhatus also become involved. The nutrients of aparticular dhatu pass through particular dhatuvaha srotas only. Vrikkaand vapavahana are considered as the moolas of Medovaha srotases 5.With regard to the Medodhatu it is necessary to look into the action of ahormone produced by the adrenal gland on the fat metabolism. Cortisol, aglucocorticosteroid produced by the cortex of the adrenal gland causes amoderate degree of fatty acid mobilization from the adipose tissue. Butpersons with excess cortisol secretion frequently develop a peculiar typeof obesity. This obesity result from excess stimulation of food intakemechanism so that fat is generated in some tissues of the body at a rateeven more rapidly than it is mobilised and oxidised. Glucocorticosteroidsstimulate the fat absorption from the intestines, mobilise fat from thedepot and disintegrate them to form ketone bodies in the liver and theexcess of cortisol redistributes the fat in the body. Chakrapani states that vapa is the snigdha varti located in theabdomen 6. Some authorities consider vapavahana as omentum where fatis accumulated. According to Sushruta, kati and vrikka are the moolas ofMedovaha srotases 7. Kati is the waist, where more accumulation of fat isseen in an obese person. 11 Shareera
    • Ama Derivation of ama is Aa + ma. “Aa” means near, towards and “ma”means poison. Therefore Ama should denote a substance or group ofsubstances which is “near to poison” or acts like a poison. Due tohypofunctioning of ushma, the food, which is not completely/properly,digested, yields immature rasa in Amashaya and due to the retentionundergoes fermentation and putrefaction. This state of rasa is spoken ofas “Ama” 8. Ama is also produced due to deficit functioning of dhatwagni 9therefore ushma may indicate either jataragni or Dhatwagni in respect ofthe genesis of ama, depending on the pathological processes exhibited. MODERN VIEW Obesity is included under “metabolic disorder”. Metabolism means“all the chemical processes in a living being producing energy andgrowth”. The changes that occur in the digested food stuffs from the timeof the ingestion until the elimination in the form of execration, the sum oftotal chemical changes which takes place within the body is to beconsidered as metabolism which yields energy and enriches growth. Asobesity is deposition of excess fat in the body, it is justified to be underthe heading of metabolic disorders. 12 Shareera
    • Origin of the body fat is from fats, carbohydrates and proteins inthe food. The carbohydrates and proteins consumed in excess areconverted into fats through the citric acid cycle. Hence study ofmetabolism of carbohydrate, fat and proteins are essential in this regard.Metabolism of carbohydrate 10 Metabolism of carbohydrate may be considered under threeheadings – supply, storage and utility. Supply is regulated by the diet,temporary storage in liver and utility by cells of the tissues and muscles.During the process of digestion, the carbohydrates are changed to simplesugars. Absorption of glucose takes place mainly into the capillaries ofthe small intestines. These capillaries pore their contents into portalvessels, which carries the blood rich with glucose to liver. The liver cellstake this glucose from the blood and convert it into glycogen that isstored in the liver cells. the sugar stored in the liver as glycogen isconverted as glucose, whenever needed it is released into the bloodstream, which will be taken up by the muscles and other tissues. Themaximum storage of glycogen in the body is about 400 gm. Theconversion of glycogen into glucose is under the control of variousenzymes contained in the liver cells and by hormones. The amount ofglucose required is proportionate to the utility of it in the body. 13 Shareera
    • Metabolism of fat After absorption of the nutrients from intestines, the grater portionof the fat passes into the central lymph channel of each villus. Fromthese small lacteal it finds its way through the larger lymphatic in themesentery to the thoracic duct and then through the thoracic duct to theblood. It seams probably some of the fatty acid and glycerol is absorbedby the capillaries in the villi it self, enters the portal vein and passesthrough the liver before reaching the general circulation. Much of the fatabsorbed form the intestine is deposited in fat storage cells, which arewidely distributed throughout the body. From these cells fat is constantlybeing withdrawn and is carried by the blood to all parts of the body. Thetissues slowly take it out, as they need it in their metabolic process.Some are oxidised to provide energy and remaining is used for synthesisof lipid for cellulose.Role of liver in fat metabolismLiver has many functions in relation to fat metabolism1. It synthesis fatty acids from carbohydrate intermediates.2. Rebuilds fatty acids through lengthening and shortening the chains, saturation and destruction to provide the lipids characteristic to the human. Oxidises fatty acids to acetyl coenzyme A, which may be used for synthesis of other substances such as cholesterol. The liver stores lipids chiefly as phospolipids, neutral fat and cholesterol. 14 Shareera
    • Metabolism of Protein: As a result of digestion, proteins are hydrolyzed in to amino acids,which are absorbed through the blood capillaries of the villi, pass into theportal vessel and are carried via the liver into the blood or the generalcirculation and distributed in to the tissues. The tissues select and storesome of these substances and in each organ they are either synthesizedinto new tissues or used to maintain and repair tissues. Amino acids notused in synthesis are broken down or deminised in the liver. Indemisation, the amino groups are removed from amino acid molecules.The non-nitrogenous portion of the amino acid molecules is oxidised toliberate energy or is synthesized in to glycogen or fat. Therefore thisportion of the amino acid molecule may be regarded as a source ofenergy.Citric Acid Cycle: The cells of the body do not use food directly for their energy, butuse A.T.P. as a source of energy. A.T.P. is stored in each cell and isconstantly being used and re-formed in the citric acid cycle. All metabolicintermediates from carbohydrates, fatty acids and amino acids enter thecitric cycle. After going through the above description of the metabolismof carbohydrate, fats and proteins, it is very clear that the body storesenergy source derived from excess amount of carbohydrate, fats andproteins in the form of fat or adipose tissue. 15 Shareera
    • Biochemistry of fat: Lipids are of four types1. Cholesterol Cholesterol is derived from the Greek word “chole” which meansBile and sterol means solid. That is solid material of the bile. Itparticipates in the formation of cell membrane and precursor of bile acid,and able to form the steroid hormones like estrogen, progesterone etc.2. Fatty acids Fatty acids are straight chain compounds of varying lengths. Theymay be of saturated or unsaturated. The main saturated fatty acids inplasma are palmitic and stearic acids. Fatty acids may be esterified withglycerol to form glycerides or they may be in free form as free fatty acids(FFA) or non-esterified fatty acids. In the blood FFA are bound toalbumin mainly. FFA is an immediately available energy source andprovides the significant proportion of the energy requirements of thebody.3. Phospolipids Phospolipids are complex lipids consists phosphate andnitrogenous products, which are water-soluble. The major Phospolipidsin plasma are lecithin and sphingomelin. As these are water soluble,plays an important role in lipid transport.4. Triglycerides Triglycerides consist of glycerol, each molecule of which is esterifiedwith three fatty acids. 16 Shareera
    • LIPOPROTEINS Lipids are relatively insoluble in water but are carried in the bodyfluids as soluble protein complexes known as lipoproteins. Thelipoproteins are macro molecular complexes of lipid and protein with amajor function of transporting lipids through the vascular and extravascular body fluids. These lipoproteins are classified on the basis oftheir densities as demonstrated by their ultra centrifugal separation.1) Chylo micrones (CM) These are comparatively large particles with density of about 0.95 gm per cm. The principle function is transport of exogenous triglyceride.2) Very low density lipoprotein. (VLDL) VLDL have a density of 0.96 – 1.006 gm / cm the principle function is transport of endogenous triglyceride.3) Intermediate density lipoprotein.(IDL) IDL have a density of 1.02 – 1.063 normally present in the blood stream in only small amounts but can accumulate in pathological disturbances of lipoprotein metabolism.4) low density lipoprotein (LDL) LDL have a density of 1.02 – 1.63, the principle function is the cholesterol transport.5) High-density lipoprotein (HDL) HDL is the heaviest and smallest of the lipoproteins with the density of 1.064 – 1.21 the principle function is the reverse cholesterol transport. 17 Shareera
    • Fat Cell 11 Fat cells when not too crowded they are spherical and denselypacked they seem to be polyhedral. These fat cells vary in diameter, onan average 50 µm. .Each cell consists of a peripheral rim of cytoplasm, inwhich the nucleus is embedded, surrounding the single large centralglobule of fat.Adipose Tissue 12 It is one of the connective tissue, which is specially meant for thestorage of fat. Adipose tissue occurs in great abundance and constitutesthe principal component. These tissue however seem to have a well-defined distribution within the body. They are distributed where itspresence as a store, will be least inconvenience but it also tend to laiddown where its thermal and mechanical insulation will be of greatestadvantage. Thus adipose tissue fills up such of the bone marrow that isnot needed for blood formation. It is also found around such importantorgans as the heart and kidney. As the omentum it protects theintestines. Superficial Nerves liable to injury are often protected by fat. Itoccurs in abundance in subcutaneous tissue and as localised pads insynovial membrane of major joints. In emaciation these deposits tend tobe spared until a late stage. Elsewhere they help to conserve the bodyheat as they are good nonconductors of heat and in some situations havemechanical functions such as in the soles of feet, palms of the hand andin synovial membranes. 18 Shareera
    • REFERENCES1. Arunadatta on Astanga Hridaya Shareerasthana 3 / 52. Charaka Chikitsasthana 15/43. Astanga Hridaya Sutrasthana 9/1 Sushruta. Sutrasthana 46/5264. Sharira kriya Vignanam by Dr M. Ramasundar Rao pp 2805. Chraka Vimanasthana 5/86. Chakrapani on Chraka Vimanasthana 5/87. Sushruta Shareerasthana 9/128. Astanga Hridaya Sutrasthana 13/289. Dalhana on Sushruta Sutrasthana 15/3210. Human Physiology by Dr.C.C.Chatterjee. pp 53411. Schafer’s essentials of Histology pp 10012. Gray’s Anatomy pp 1168 19 Shareera
    • For a crystal clear picture of a diseased condition, it is necessaryto be well versed with the cardinal factors causing the medoroga(Obesity), which are five in number. They are Hetu or Etiology, Purva-rupa or Prodromal signs and symptom, Rupa or actual signs andsymptoms of the disease, Dosha samprapti the actual disease process orpathology occurring in the body, and Upashaya, positive response withtreatment adopted for diagnosing a disease. HETU Among them Hetu, which literally means the causative factor has itsown place of significance. It is a fact highlighted by the assertion ofancient seers that Nidana parivarjana, removal of causative factors itselfis treatment 1. A disease treated symptomatically tends to recur, if thecausative factors are allowed to persist. Hence knowledge of nidana is amust. Comparative study of Nidana according to different texts is given.SN Nidanas Ch2 Su3 AS4 BP5 MN6 Y.R7 1 Shlesmala Ahara - a - - a a 2 Guru,Madhura,Sheeta,Snigdha Ahara a - a a - - 3 Adhika matra sevana a - - - - - 4 Adhyashana - a - - - - 5 Avyayama a a - a a a 6 Divashayana a a - a a a 7 Avyavaya a - - - - - 8 Na chinta and shoka a - - - - - 9 Harsha nityatwa a - - - - -10 Bija swabhava a - - - - - 19 Nidana
    • AHARAJA HETUShleshmala ahara, guru, madhura, and snigdha ahara, adhika matrasevana and adhyashana all these come under aharaja nidana.Panchabhoutika level of their study reveals 8 1. Guru- Prithvi and Jala 2. Snigdh- Jala 3. Sheeta- Jala 4. Madhura-Prithvi and Jala. 5. Meda - Prithvi and Jala 6. Kapha - Prithvi and Jala There by as a rule, similar qualities increases the quantity, theyincrease Kapha and Medas. Ayurveda is not only very particular about quality but also aboutquantity and mode of taking food. Annapana vidhi, Matrashiteeya 9, DravaDravya vijnaneeya 10 etc chapters are specifically meant for this.Quantities of the food and jataragni are interdependent. It means foodtaken in a proper quantity only maintains Agni 11 and this Matra dependson Agni bala 12. So adhika matra bhojana i.e. excess intake of foodcauses immediate aggravation of all the tridoshas 13. This leads to diseasemanifestation in the body. Adhyashana is intake of the food before the 20 Nidana
    • completion of digestion of previously consumed food. Dalhana has clearlytold, in the presence of deeptagni also adhyashana produces ama andleads to the formation of madhura anna rasa which in turn formsmedovriddhi 14 . The term “obesity” is derived from the Latin word “obsus” whichmeans having eaten 15. Its very name suggests the root cause of obesityis over eating. Body needs 2000k cal/day to meet basal needs, 500 –2500 k cal/day are required to meet the energy demands of dailyactivities 16, if consumed more than this (i.e. Adhika matra sevana) leadsto obesity. Especially fats and carbohydrates having more caloric value9.3 kcal/g and 4.1 kcal/g 17 respectively becomes the main cause forobesity.VIHARAJA HETU Avyayama, Avyavaya, Divashayana are categorised under ViharajNidana. References from the classics revels Vyayama is a must for aperson who take more fatty foods 18, since it reduces fat 19. Importance ofVyayama is exaggerated by saying “ one who does regular exercise neednot think of guruta and lughuta of the foods”. Contrary to this lack ofexercise or Avyayama along with guru aharas definitely lead tomadovriddhi. Vyavaya is also a kind of physical work where in morecalories is spent for one intercourse. If a person is not indulging in 21 Nidana
    • vyavaya dhatu kshaya will not take place instead it gives dathu pustiwhich leads to medovriddhi. It is strictly advised for an obese person notto sleep in the day and less sleep even in the night. Because waking inthe night causes rukshata and daytime sleep increases snigdhata 20 thatcauses kaphavriddhi and leads to sthoulya.MANASIKA HETU: Achinta and shoka can be included under this heading Ayurvedaconsiders Manasika karana also as an important entity for diseasemanifestation. Here in sthoulya also harsh nityatwa and Achinta andshoka that are Manasika karanas definitely influence the sthoulya.Mental disturbances cause vata vriddhi that indirectly causes dhatukshaya where as prasanna manas always increases kapha hencebecomes hetu of the sthoulya.BEEJA SWABHAVA Charaka samhita is the only text in Ayurveda that explains beejaswabhava as a causative factor. Commenting over the word beejaswabhava Gangadhara and Chakrapani have clearly told “ atisthula matapitra sonitha sukra swabhavat” 21 which means the character of sthoulya isinherited from obese parents. Study also revels there is 50% of chancefor children being obese when one of the parents is obese, thisproportion rising to 75% with both parents obese. Obesity runs in 22 Nidana
    • families. Further more, identical twins usually maintain weight levelswithin 2 pounds of each other through out life, if they live under similarcondition. Or within 5 pounds of each other if there condition of life differmarkedly, this might result from eating habits engendered duringchildhood but it is generally believed that this close similarity betweentwins is genetically controlled 22.HORMONAL CAUSE Ayurveda is silent about endogenous obesity Dr Jeffreys Flierexplains there is no established endocrine cause for most cases ofobesity. However endocrinologists frequently are consulted because ofconcern that the patient may have cushing syndrome or hypothyroidism.Endocrine syndromes that may be associated with obesity are cushingsyndrome, Hypothyroidism, Insulinoma, Craniopharyngioma, Turnersyndrome, Male hypogonadism.INFLUENCE OF DIETETICS IN PREGNANCY 23 Disorders such as obesity, diabetes, cancer, Heart disease etc arenot only the result of inheritance but also etiological factors. The newscience of fetal programming suggests that as pregnancy progresses,each month in the womb shapes our health for life. Under nutritionduring the fetus’s first trimester makes obesity more likely in adult hood,perhaps the appetite control center in the brain is programmed to over 23 Nidana
    • eat. One best evidence can be quoted here. In World War II Nazis triedto starve the population of western Holland from September 1944 untilthe following may. Men who were fetuses during all or part of the periodare studied. If their mothers were starving during the first trimester fromMarch to May 1945 but got adequate food later delivered heavier, longerand with larger head babies than in normal periods. As adults they weremore likely to be obese. If their mothers went hungry only in the finaltrimester (born in Nov 1944) they were lean. If the food is scarce during the first trimester, the fetus develops aso-called thrifty phenotype. Its metabolism is set so that every availablecalorie sticks and scarcity of food may affect the appetite centers in thefetal brain, and sets as “eat whatever is around, you never know whenfamine will hit”. 24 Nidana
    • REFERENCES1. Madhava Nidana 1 / 192. Charaka Sutrasthana 21 / 33. Sushruta Sutrasthana 15 / 324. Astanga Sangraha Sutrasthana 24 / 185. Bhava Prakasha Madhyamakhanda 39 / 16. Madhava Nidana 34 / 17. Yoga Ratnakara Medoroga nidana / 18. Dravya guna vignana by P.V.Sharma. pp 529. Astanga Sangraha Sutrasthana 1110. Astanga Sangraha Sutrasthana 611. Astanga Hridaya Sutrasthana 8 / 212. Charaka Sutrasthana 5 / 313. Charaka Vimanasthana 2 / 714. Dalhana on Sushruta. Sutrasthana 15 / 3215. Text Book of Medicine by R.J.Vakil pp 28716. Review of Medical Physiology by W.F.Ganong pp 24917. Review of Medical Physiology by W.F.Ganong pp 24918. Astanga Sangraha Sutrasthana 9 / 2119. Charaka Sutrasthana 7 / 3220. Astanga Sangraha Sutrasthana 9 / 2521. Gangadara on Charaka Sutrasthana 21 / 322. Text book of physology by Gyton pp 36723. The News week Sept 27 1999 25 Nidana
    • SAMPRAPTI The samprapti of the disease explains the method or process bywhich the vitiated doshas reach the dooshyas and produce the anatomicaland physiological changes in the target organs leading to expression as adisease. Usually this process follow a regular pattern according tosamanya siddhantas of Ayurveda that is why “ Samyak prapti of vyadhi isknown as samprapti” Exceptionally in diseases like Medoroga it differsfrom regular samprapti. Hence deep study and detailed analysis overpathogenesis of Medoroga carries importance. The samprapti ofMedoroga has been vividly described in almost all the textbooks ofAyurveda. Views of all the authors goes on a similar line, accept AstangaSangrahakara, where he deviates a little. Absence of physical activity, sleeping during day and Kaphakaraaharas induce Madhuryata to annarasa, which in turn increase the Medasby its Snigdhaguna. This obstructs the nutrient channels of theremaining tissues depriving them of nutrition. So only fat accumulates inlarge quantities in the body 24. Because of obstruction, Vayu in Kostabegins to act fast, increases the digestive activity rapidly, makingvoracious hunger and craving for large quantity of food, just as the forestfire destroy the forest, the Vata and Agni destroy the body 25 resulting intohypermetabolic activity. 25 Samprapti
    • This samprapti of Medoroga is confusing due to the Medoagnimandyata and formation of ama in presence of teekshnagni and where assuccessive dhatus are not nourished even though Medas is overnourished. Hence here “Rasat Raktam tato Mamsam” theory fails. Thusclarification at the level of process of pathogenesis is required. At thisjunction discussion about Agni, dhatuposhan and Ama concerned toMedoroga is essential.Jataragni In Medoroga both the extremes of vitiated Agni can be seen atdifferent levels. Mandagni, in the manifestation of the disease andteekshanagni, in aggravating the condition. In the beginning none of theauthors have specified about teekshagni, instead it is mentioned afterMedodhatu vriddhi. All the nidanas specified for Medoroga like excessive intake of,Guru, Sheeta aharas 26 and not indulging in sufficient physical exercise 27are the supportive factors for the production of Ama, which is formed dueto hypofunction of ushma 28. This ama or Madhura Annarasa 29 by itssnigdha guna increases Medas there by like other diseases here alsoMandagni is the root cause of the disease 30. After the accumulation of fat,teekshnagni play an important role. Vayu obstructed by Medas in kostaincreases Agni under kumbakar pawan nyaya 31, making for voracious 26 Samprapti
    • hunger and craving for large quantity of food. 32 This Agni will be so strongand harmful if proper food is not supplied to it, it destroys body as firedestroys the forest 33.Dhatwagni In Medoroga a link between Jataragni and Medodhatwagni isbroken and therefore even when the function of Jataragni is good thefunctions of Medogni is not so. This is because whatever the outcome ofthe Ahar i.e either pakwa rasa or ama rasa, it has to be supplied to alldhatus for their nourishment. In Medoroga rasa is rich in snigdha guna 34,and is similar to Medas. There by it is supplied to Medodhatwagni, whichincreases the Medodhatu. Agni and Ahara are interdependent. Ahara isthe fuel for agni 35 and agnibala depends on the material supplied to it fordigestion 36. In Medoroga excess quantity of ahara rasa is supplied toMedodhatwagni, which causes agnimandya and forms ama at Medodhatulevel.Dathu poshana in Medoroga Since ama represents the vitiated or deficiently formed ahararasaor rasadhatu with poor nutritional capacity, there is a disturbance indhatu poshana. In Medoroga, Medas is increased abundantly 37 Hencethere will be disparity between Medas and other dhatus 38 Charakaaccepts Atimedovriddhi 39 but not mentioned any cause for it. Sushruta 27 Samprapti
    • tried to clarify it and he tells remaining dhatus are not nourished becauseof Margavarodhata 40. Astanga Sangrahakara further gives theexplanation as, the remaining portion of rasa dhatu being very little inquantity is not enough to nourish the raktadi dhatus 41 and also quotes onesamanya siddhanta as “ that which has undergone increase first will onlyundergo increase further” and tells like vayuadi fat also follow it, there byonly Medo vriddhi is seen compared to other dhatus 42. Dalhana dividesdhatus as Poorvadhatu and Uttaradhatu and explains undernourishmentof uttaradhatu is due to Avruta marga and because of vishistaAharavashat, Adrastavashat and Medasavruta margata, overseadingRakta and mamsa directly Medas is increased 43.Hence poorvadhatuundernourishment is justified at present context. The specific nutrients of one dhatu are not channeled to any otherdhatu. The portion of Ahara rasa meant to provide nourishment to aparticular dhatu does not come in contact with other dhatus 44. Accordingto khalekapota nyaya, as their resting-places attract pigeons, the sthayidhatus attract their requisite nutrients from the Ahararasa through theirspecific dhatuvaha srotases and nourish themselves. Hence whenMadhura annarasa rich in snigdhaguna moves through channels, nourishonly Medas and as Ahararasa is having less quantity of requisitenutrients of other dhatus they are not properly nourished. 28 Samprapti
    • Ama As both jataragni and dhatwagni are impaired in Medoroga,production of jataragni or dhatwagnijanya ama is common. All the authorshave used the word madhura annarasa 45, Vagbhata specially tellskaphamishrita annarasa 46 acts as ama. Madhukosha commentry says- ifannavaha srotas is coated with madhura annarasa, that turns all the foodinto madhura 47. Sushruta tells, at the time of production of Pitta inannavaha srotas (ama vipaka), if food is consumed it turns into vidhahi 48.As Dalhana tells adhyashana sheelata is the cause for production of amain presence of teevragni, there by it can be said during the time ofproduction of kapha in annavaha srotas (madhura vipaka), food is againconsumed because of adhyashanasheela that leads to the production ofmadhura annarasa or kaphamishrita annarasa. This avipakwa rasa isknown as ama 49 Now it is more appropriate to say, because of jataragnijanya amadhatwagni is impaired and dhatwagnijanya ama is formed. Properconversion of poshakadhatu to poshya dhatus dose not takes place dueto medogni mandyata and more dusta Medas 50 is formed. This Medodhatubeing produced due to dhatwagni mandya is known as samadhatu.Thereby Medoroga is included under samamedodhatu janya vikaras 51. 29 Samprapti
    • REFERENCES24. Madhava Nidana 34 / 1,225. Charaka Sutrasthana 21 / 5, 6.26. Charaka Vimanasthana 2 / 7 Charaka Vimanasthana 15 / 42 Astanga Sangraha Sutrasthana 8 / 3127. Essentials of Basic Ayurveda concepts by V.V.S.Shastri. pp 9228. Astanga Hridaya Sutrasthana 13 / 2529. Madhava Nidana 34 / 130. Madhava Nidana 35 / 1131. Madhu kosha on Madhava Nidana 3432. Madhava Nidana 34 / 5,633. Madhava Nidana 34 / 7 Astanga Sangraha Sutrasthana 24 / 2234. Sushruta Sutrasthana 15 / 3235. Charaka Sutrasthana 5 /336. Astanga Hridaya Sutrasthana 8 / 237. Charaka Sutrasthana 21 / 438. Astanga Sangraha Sutrasthana 24 /24, Chakrapani on Charaka Sutrasthana 21 / 439. Charaka Sutrasthana 21 / 4 30 Samprapti
    • 40. Sushruta Sutrasthana 15 / 3241. Astanga Sangraha Sutrasthana 24 / 23,2442. Astanga Sangraha Sutrasthana 24 / 2443. Dalhana on Sushruta Sutrasthana 15 / 3244. Chakrapani on Charaka Sutrasthana 28 / 445. Sushruta Sutrasthana 15/32, Madhava Nidana 34/146. Astanga Sangraha Sutrasthana 24/1847. Madhukosha vyakya on Madhava Nidana 34/1-748. Sushruta Sutrasthana 46/49649. Bhava Prakasha Madhyama Khanda 1/1650. Chakrapani on Charaka Sutrasthana 21 / 3,4.51. Charaka Sutrasthana 28 / 25 Sushruta Sutrasthana 24 / 13 31 Samprapti
    • POORVA ROOPA The poorvaroopa of Medoroga are not specifically mentioned byany of the authors. The roopas mentioned for Medoroga are 52- Increase in Medodhatu- Pendulum movements of buttocks, abdomen and breast- Lack of enthusiasm in physical activities- Disproportion growth of the body. However the general principle about poorvaroopa states that, “roopaof the vyadhi when found in Avyakta or alpa avastha is considered aspoorvaroopa” 53. So, medovriddhi before to the pendulum movement ofSphik, Sthan, Udara can be considered as Poorvarupa. Before themanifestation of the disease, Agni is depraved and once the medas startaccumulating, it turns into teekshnagni. Similarly as kapha vriddhi isobserved, lakshanas told in kriyakalavastas of kapha are seen. 30 Poorva Roopa
    • REFERANCE52. Charaka Sutrasthana 21 / 8 Astanga Sangraha Sutrasthana 24 / 26 Madhava Nidana 34 / 953. Madhava Nidana 1/5,6 31 Poorva Roopa
    • ROOPA Roopa is the prominent diagnostic subjective parameter of adisease. At this stage, dosha dooshya sammurchana is completed andthe onset of the disease takes place, which gives the symptomology ofthe disease. These signs and symptoms may change from time to timeaccording to the progress of the disease. Certain symptoms may newlyappear while some may disappear. We can’t find all the symptoms inevery patient at once unless the disease becomes grave.Signs and symptoms mentioned in different texts are tabulated as below. Sl Laxanas Ch54 Su55 AS56 M.N B.P58 Y.R59 57 No 1 Chala Spik Udara & Stana a - a a - a 2 Kshudra Swasa - a - a a a 3 Ayasa - - a - - - 4 Aalpa bala a - a - a - 5 Ati kshudha a a a a a a 6 Ati pipasa a a a a a a 7 Ati Nidra - a a a a a 8 Ati sweda - a a a a a 9 Dourgandhya a a a a a a 10 Moha - - - a a a 11 Krathan - a - - a - 12 Utsahahani a - a a - a 13 Javoparodha a - - - - - 14 Jadya - - a - - - 15 Soukumaryatwa - - - - - - 16 Kricha vyavayata a - - a a a 17 Gadgadatwa - a a - - - 18 Alpa ayu a - a a - a 31 Roopa
    • It is very interesting to study how these lakshanas are manifested.1. Chala Spik, Udara, Sthana Though the medas is spread throughout the body, its seats of accumulation are Udara, Spik, and sthana. Thus increased medas accumulates more at these places and leads to pendulum movement of them.2. Kshudra Sw asa Excessive fat accumulation in the abdomen interferes with the mechanism of respiration. Respiration act depends on the movement of the diaphragm. Because of accumulated fat, diaphragm fails to move up and down to the expected extent, hence pressure created during contraction phase will not be sufficient to expel out air from the lungs 60. This excess carbondioxide present in the blood stimulate the respiratory centre which leads to kshudra swasa.3. Alpabala, Ayasa and Sukumarata The main function of medas is giving dridata 61 and bala 62 to the body. In sthoulya we find abundant medas but controversy to it we get symptoms like alpabala, ayasa, sukumarata. Chakarapani has commented over the word medodosha as dustamedas 63. Dustamedas can not be expected to do its normal function i.e. dridatwa to the 32 Roopa
    • body and at the same time poorva dhatus and uttardhatus of meda are undernourished. So all the sapta dhatu dourbhalya takes place which form the above said conditions.4. Atikshuda and Pipasa. The increased fat obstructs the channels of vata. Vata then begins to act within Amashaya, increases the digestive activity, making for voracious hunger and thirst 64, which are appetitive mechanisms.5. Kriccha Vyavaya Sthoulya rogi faces difficulty in intercourse because of two reasons. Foremost is undernourished shukra dhatu and on the other hand is the alpabala or inability to perform any act. Proper quantity of sukra rises the feeling of enjoyment (arousal) contrary in sukrakshaya condition. After prolonged intercourse in sukra kshaya condition, instead of secretion of sukra, sarakta veerya is being secreted 65. This is definitely a difficult intercourse or kriccha vyavaya. Whole of this act needs utsaha, bala or ability, which is absent in medorogi. So it is a common symptom we find in sthoulya rogi which disturb his mental state as well as sexual life. 33 Roopa
    • 6. Alpa Ayu. Life is very important factor and body is like a driver for chariot 66. Ayurveda is meant for maintenance and fulfilling the desire of long living. So leaving aside all other things body is to be protected. Since body is produced and maintained by food 67 person should take wholesome foods. Those who cultivate the habit of taking whole some food will not gives rise the victims premature death, loss of strength and enthusiasm. Where as Medorogi become a self-victim for his reduced longevity by adopting unwholesome food habits. Excess increase of medas causes the dhatu kshaya of all other dhatus and is associated with an increased incidence of cardiovascular, gall bladder diseases, diabetes, and other conditions, which are fatal important signs of increased mortality rate 68.7. Ati Nidra In obese patients excess sleep is commonly observed. Kapha, because of its increased quantity, which is not undergoing regularity, obstructs the srotas. This srotorodha causes heaviness of the body, from heaviness follows laziness, which in turn causes excess sleep 69 and lethargicness in the body. 34 Roopa
    • 8 Sw eda and Dourgandha All classics consider atisweda and dourgandha as lakshanas of sthoulya and further give explanation as – 1. By the presence of fat, at the origin of the channels of sweat increase in secretory activity and 2. Association of kapha makes profound increase of sweat 70. Contrary to this Charaka use the word swedabadha 71 and Chakrapani commenting over it as, “production of sweda is the function of meda where as in sthoulya due to shleshma samsarga this produced sweat is obstructed” 72. Gangadara have also clearly commented swedabadha means “sweda is not excreted” 73. So Charaka accepts the excess production of sweat but he is differing from others by saying as it is not excreted out properly. Meda is having amaghanda by nature, in the presence of dusta medas in sthoulya gives rise still more bad odour 74. Excess production of sweat, which is the mala of meda, gives daurgandha in the body.9. Gadgadhatwa Gadgadhatwa means the “Avyakta vachanam” 75 according Dalhana. Which means stammering or unclear pronouncetion of word or even horsness of the voice, which is the more appropriate word to be considered.9 Krathana. – Excess kapha obstructs pranavaha srotas resulting in krathana. 35 Roopa
    • In ayurveda, even though all the above said Lakshanas areexplained for sthoulya, a diagnostic key for considering a person asobese is given specifically. The person can be said as obese when hehas lack of enthusiasm in physical activities, disproportional to thegrowth of his body, intense increase in mamsa and meda, and hasmovement of the buttocks, abdomen and breasts 76 Parallel to this some more keynotes are available form modernconcepts. A number of different criteria have been suggested to identifythe obese person. Important among them are mentioned here1. Standard height and weight relation The most influential application of this approach has been through theuse of life insurance data that assesses mortality as a function of bodyweight per height, adjusted for frame size, with obesity defined on purelystatistical grounds as a weight that is above the average weight for givenheight 77. The charts are given below : 36 Roopa
    • Table No 1 Ideal weights for menHeight Small frame Medium frame Large frame (ft) (kg) (kg) (kg) 5.2 50.8 – 54.4 53.8 – 58.5 57.2 – 64.0 5.3 52.2 – 55.8 54.9 – 60.3 58.5 – 65.3 5.4 53.5 – 57.2 53.2 – 61.7 59.9 – 67.1 5.5 54.9 – 58.5 57.6 – 63.0 61.2 – 68.9 5.6 56.2 – 60.3 59.0 – 64.9 62.6 – 70.8 5.7 58.1 – 62.1 60.8 – 66.7 64.4 – 73.0 5.8 59.9 – 64.0 62.6 – 68.9 66.7 – 75.3 5.9 61.7 – 65.8 64.4 – 70.8 68.5 – 77.1 5.10 63.5 – 68.0 66.2 – 72.6 70.3 – 78.9 5.11 65.3 – 69.9 68.0 – 74.8 72.1 – 81.2 6.0 67.1 – 71.7 69.9 – 77.1 74.4 – 83.5 6.1 68.9 – 73.5 71.7 – 79.4 76.2 – 85.7 6.2 70.8 – 75.7 73.5 – 81.6 78.5 – 88.0 6.3 72.6 – 77.6 75.7 – 83.5 80.7 – 90.3 6.4 74.4 – 79.4 78.1 – 86.2 82.7 – 92.5 Table No 2 Ideal weights for womenHeight Small frame Medium frame Large frame (ft) (kg) (kg) (kg) 4.10 41.7 – 44.5 43.5 – 48.5 47.2 – 54.0 4.11 42.6 – 45.8 44.5 – 49.9 48.1 – 55.3 5.0 43.5 – 47.2 45.8 – 51.3 49.4 – 56.7 5.1 44.9 – 48.5 47.2 – 52.6 50.8 – 58.1 5.2 46.3 – 49.9 48.5 – 54.9 52.2 – 59.4 5.3 47.6 – 51.3 49.9 – 55.3 53.5 – 60.8 5.4 49.0 – 52.6 51.3 – 57.2 54.9 – 62.6 5.5 50.3 – 54.0 52.6 - 59.0 56.7 – 64.0 5.6 51.7 – 55.8 54.4 – 61.2 59.5 – 66.2 5.7 53.5 – 57.6 56.2 - 63.0 60.3 – 68.0 5.8 55.3 – 59.4 58.1 – 64.9 62.1 – 69.9 5.9 57.2 – 61.2 59.9 – 66.7 64.0 – 71.7 5.10 59.0 – 63.5 61.7 – 68.5 65.8 – 73.9 5.11 60.8 – 65.3 63.5 – 70.3 67.6 – 76.2 6.0 62.6 – 67.1 65.3 – 72.1 69.4 – 78.5 37 Roopa
    • 2. Body mass index A second approach for defining the obese state is body mass index(BMI). It can be calculated by using the formula- BMI = Weight in kg Height in meater 2 Table No 3 Optimal BMI values are given below. 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 With BMI 25 to 30 are defined as over weight and of those in excess of 30 are defined as obesity. 38 Roopa
    • 3. waist – to – hip ratio Recent evidence suggests that central obesity as judged by the waist to hip ratio is evident as many of the most important complications of obesity, including insulin resistance, diabetes, hypertension and hyperlipidemia are linked to the amount of intra abdominal fat, rather than to lower body fat (i.e. buttocks and leg) or subcutaneous abdominal fat. A waist – to – hip ratio for men is 0.9 while that for women if > 0.85 is ideal. Waist to hip ratio chart is given below. Table No 4Waist measurement in cmsHip 50 55 60 65 70 75 80 85 90 95 100 105 110 115 120 125 130cms50 1.00 1.10 1.20 1.30 1.40 1.50 1.60 1.70 1.80 1.90 2.00 2.10 2.20 2.30 2.40 2.50 2.6055 0.91 1.00 1.09 1.18 1.27 1.36 1.45 1.55 1.64 1.73 1.82 1.91 2.00 2.09 2.18 2.27 2.3660 0.83 0.92 1.00 1.08 1.17 1.25 1.33 1.42 1.50 1.58 1.67 1.75 1.83 1.92 2.00 2.06 2.1765 0.77 0.85 0.92 1.00 1.06 1.15 1.23 1.31 1.38 1.46 1.54 1.62 1.69 1.77 1.85 1.92 2.0070 0.71 0.79 0.86 0.93 1.00 1.04 1.14 1.21 1.29 1.36 1.48 1.50 1.57 1.67 1.78 1.70 1.8675 0.67 0.73 0.80 0.87 0.93 1.00 1.02 1.13 1.20 1.28 1.41 1.40 1.47 1.61 1.60 1.67 1.7380 0.63 0.69 0.75 0.81 0.88 0.94 1.00 1.06 1.13 1.19 1.25 1.31 1.38 1.44 1.50 1.56 1.6385 0.59 0.65 0.71 0.76 0.82 0.88 0.94 1.00 1.06 1.12 1.18 1.24 1.29 1.35 1.41 1.47 1.5390 0.56 0.61 0.68 0.72 0.78 0.83 0.89 0.94 1.00 1.06 1.11 1.18 1.22 1.28 1.33 1.39 1.4495 0.51 0.56 0.63 0.68 0.74 0.79 0.84 0.89 0.95 1.00 1.05 1.11 1.16 1.21 1.26 1.32 1.37100 0.50 0.55 0.60 0.65 0.70 0.75 0.80 0.85 0.90 0.95 1.00 1.05 1.10 1.15 1.20 1.25 1.30105 0.48 0.52 0.57 0.62 0.68 0.71 0.76 0.81 0.86 0.90 0.95 1.00 1.05 1.10 1.14 1.19 1.24110 0.45 0.50 0.55 0.59 0.64 0.68 0.73 0.77 0.82 0.86 0.91 0.95 1.00 1.05 1.09 1.14 1.18115 0.43 0.48 0.52 0.57 0.61 0.65 0.70 0.74 0.78 0.83 0.87 0.91 0.96 1.00 1.04 1.09 1.13120 0.47 0.46 0.50 0.54 0.58 0.63 0.68 0.71 0.76 0.79 0.83 0.88 0.88 0.98 1.00 1.04 1.08125 0.40 0.44 0.48 0.52 0.56 0.60 0.64 0.68 0.72 0.76 0.80 0.84 0.85 0.92 0.96 1.00 1.04130 0.38 0.42 0.46 0.50 0.54 0.58 0.62 0.65 0.69 0.73 0.77 0.81 0.81 0.86 0.92 0.96 1.00135 0.37 0.41 0.44 0.48 0.52 0.56 0.59 0.63 0.67 0.70 0.74 0.78 0.79 0.85 0.88 0.93 0.96140 0.36 0.39 0.43 0.46 0.50 0.54 0.57 0.61 0.64 0.68 0.71 0.75 0.76 0.82 0.86 0.84 0.91145 0.34 0.38 0.41 0.43 0.48 0.52 0.55 0.59 0.62 0.66 0.69 0.73 0.75 0.78 0.81 0.83 0.88150 0.33 0.37 0.40 0.41 0.46 0.50 0.54 0.57 0.60 0.64 0.67 0.70 0.74 0.77 0.80 0.81 0.84 39 Roopa
    • REFERENCES54. Charaka Sutrasthana 21 / 455. Sushruta Sutrasthana 15 / 3256. Astang Sangraha Sutrasthana 24 / 19, 2057. Madhava Nidana 34 / 3, 958. Bhava Prakasha madhyama khanda 3959. Yoga Ratnakara Medoroga nidana / 1,2 and 860. Nidana chikitsa hastamalaka pp 19761. Astang Sangraha Sutrasthana 19 / 2062. Bhava Prakasha Poorvakhanda 3 / 14963. Chakrapani on Charaka Sutrasthana 21 / 464. Astang Sangraha Sutrasthana 24 / 2165. Astang Sangraha Sutrasthana 9 / 5766. Astang Sangraha Sutrasthana 9 / 11067. Astang Sangraha Sutrasthana 9 / 11168. Joslin’s Diabetes mellitus pp 35569. Astang Sangraha Sutrasthana 9 / 3370. Astang Sangraha Sutrasthana 24 / 2271. Charaka Sutrasthana 21 / 372. Chakrapani on Charaka Sutrasthana 21 / 373. Gangadhara on Charaka Sutrasthana 21 / 374. Charaka Sutrasthana 21 / 475. Dalhana on Su Sutrasthana 15 / 3276. Astang Sangraha Sutrasthana 24/ 24 Madhava Nidana 34/9 Charaka Sutrasthana 21/877. Joslin’s Diabetes Mellitus pp 352 40 Roopa
    • CLASSIFICATION OF MEDOROGA Supporting references from the classics are not available to discussthe types of Medoroga. Astodareeya Adhyaya of Charaka, RogagananaPrakarana of Sharangadhara specially deal with types of disease. Charakahave not mentioned Medoroga in his Astodareeaya chapter where asSharangadhara clearly said Medoroga is of only one type. Though the description of Medoroga / sthoulya is mentioned in mostof the classical texts like Charaka samhita, Sushruta Samhita, AstangaSangraha, Bhavaprakash, Madhava nidana, Yoga Ratnakara, Chakradattaetc., but none of the author have classified Medoroga. Vitiation of doshasmay take place at the level of samprapti but ultimately meda dhatu is theonly one that has to be increased, to consider the condition as Medoroga.This may be the reason for not making any types in it. Hence it can besaid that according to ayurveda Medoroga is of only one type. But for the convenience of study it can be classified as following.Type Ii) Aharajanya – Consuming Snigdhadi Ahara, Adhyashana, Atimatra sevan etc,ii) Viharajanya – Diwaswapna etc, 40 Bheda
    • iii) Manasika Janya – harsha nityatwa etc.iv) Beeja swabhava – heredity.Type II i Sahaja - Beejaswabhava ii Janmottaraj – Ahara, vihara and Manasikakarana janya.Type III i Sadhya Medoroga – Navotpanna, Alpalakshanayukta.ii Asadhya Medoroga – Puratana Upadravayukta, Beejaswabhavaja etc. In modern text we find classification of obesity as Type I I) Exogenous - this is more common and due to excessive caloric intake. Here uniform distribution of fat with little execs under chin and abdomen is seen II) Endogenous – here endocrine factors are at fault and obesity occur inspite of small caloric intake. 41 Bheda
    • Type II Depending on the distribution of fat this classification is made.i) Generalised type – uniform distribution of fat.ii) Central or trunk – at trunk and neckiii) Superior or buffalo – at face, neck, arms and upper part of trunkiv) Inferior – at lower trunk and legsv) Girdle - at hips, buttocks, abdomen.vi) Breeches or trochentric – only buttocks.vii) Lipomatous - localised deposits of fat over body.Type IIIi) hypertrophic obesity - increase in amount of fat per fat cell.ii) Hyperplastic obesity – increase in number of fat cells. 42 Bheda
    • SADHYASADHYATA Before starting the treatment of any disease it is essential to knowwhether that particular state of the disease is curable or incurable.Almost all the texts consider sthoulya as kasta sadhya when comparedwith treatment of krishatwa. But Vagbhata goes to an extent of sayingthere is no treatment for sthoulya; neither Brimhana therapy norLanghana therapy are sufficient to control excessive fat accumulation andto decrease agni and Vata 78. Indu commenting over it states, Brimhanatherapy given to a obese person will decrease agni and Vata but not themedas, where as Langhana therapy will decrease medas but increasesagni and Vata. So treatment is very difficult 79. Modern texts say successful treatment of obesity means sustainedattainment of normal body weight and composition without producingunacceptable treatment induced morbidity, is rarely achievable in clinicalpractice 80 Medoroga can be considered as kasta sadhya, if it is novotpanna,having less intensity, and without complications. 43 Sadhyasadhyata
    • REFERENCES78. Astang Sangraha Sutrasthana 24 / 479. Indu on Astang Sangraha Sutrasthana 24/4580. Joshin’s diabetes mellitus PP 358 44 Sadhyasadhyata
    • UPADRAVA Complications appearing after the manifestation of the Primedisease and which are difficult to treat are termed as upadravas. Agniand Vata, in their aggravated state cause many of upadravas inMedoroga 81.Upadravas explained in different texts are tabulated below. Sl No Upadravas Ch82 Su A B M Y 83 S84 P85 N86 R87 1 Vata pitta Vikara a - - - a - 2 Prameha Pidika - a a - - - 3 Jwara - a a a - a 4 Bhagandara - a a a - a 5 Vidradhi - a a - - - 6 Vatavikara - a - - - - 7 Udar roga - - a - - - 8 Prameha - - a a - a 9 Urustambha - - a - - - 10 Kushta - - - a - - 11 Visarpa - - - a - a 12 Atisara - - - a - a 13 Arsha - - - a - a 14 Shleepada - - - a - a 15 Apachi - - - a - a 16 Kamala - - - a - a 17 Jantavo Anavaha - - - a - - Key : a = Present - = Absent 44 Upadrava
    • It is clearly mentioned, increased medas cause profuse sweatingand bad odour of the skin, which creates a media for production andsurvival of germs (anu jantus) 88. There by many of the skin diseases likekusta, visarpa etc are seen as upadravas and atisweda mentioned aspoorvarupa for Kusta 89. Impairment of Medovaha srotas in Medoroga maylead to the disease Prameha and Prameha pidika. Ama condition present in sthoulya may lead to urustamba, atisara,jwara etc. The etiological factors viz Avyavaya , Avyayama, diwaswapna 90are similar to both Medoroga and Arsha 91. These factors are increasedmore because of inactive nature of obese person, which probably leads toarsha. Obstruction of swedavaha and ambuvaha srotas leads to udara 92,as excess medas obstruct the srotases, this condition may arise asupadrava in obese person. Vata get aggravated because of obstructionand give rise many of the vatavyadhis as upadravas.Modern concept 93 Obesity has psychological, behavioral and medical consequences,the nature and severity of which are influenced by the degree of obesity.The common pathological consequences of obesity are discussed here.Non insulin dependent diabetes – Obesity is major risk factors for NIDDM and as many as 80% ofpatients with NIDDM are obese. 45 Upadrava
    • Cardiovascular Disease – Epidemiological studies reveal that obesity is associated with anincreased mortality and morbidity from cardiovascular disease. Increasedmass of tissue results in increased cardiac work. Blood volume, strokevolume and cardiac out put are all increased. Obesity is also associatedwith an atherogenic lipid profile.Pulmonary disease – The increased metabolic rate in obese subjects increases oxygenconsumption and CO 2 production, and these changes result in increasedminute ventilation. In subjects with marked obesity, compliance of thechest wall is reduced, the breathing is increased, and the respiratoryreserve volume and vital capacity are reduced, a resultant mismatchbetween ventilation and perfusion may result in hypoxemia. Severeobesity may cause hypoventilation, defined by the development of CO 2retention.Gall stones – Obesity is associated with enhanced billiary secretion ofcholesterol. This results in supersaturation of bile and a higher incidenceof gallstones.Endocrine consequences – Many changes in function of Thyroid, Gonadal, Adernal andPituitary functions can be seen in patients with established obesity. 46 Upadrava
    • REFERENCES81. Yoga Ratnakara Medoroga chikitsa / 782. Charaka sutrasthana 21 / 783. Sushruta sutrasthana 15 / 3284. Astanga sangraha sutrasthana 24 / 2585. Bhavaprakasha madhyamakhanda 39 / 1086. Madhava Nidana 34 / 887. Yoga Ratnakara Medoroga chikitsa / 1088. Bhavaprakasha Madhyama khanda 8 /1089. Charaka Chikitsa Sthana 7/1090. Sushruta sutrasthana 15/3291. Charaka Chikitsa Sthana 14/1092. Charaka Chikitsa Sthana 13/ 1993. Joslin’s Diabetes Mellitus pp355 47 Upadrava
    • It is important to emphasis that with optimal management andproper education about the disease to the patient only, reduces obesityalong with gaining confidence from the patient.Few facts acting over the disease are - General considerations in development and reduction of obesity. - Individual dietary requirements and meal planning. - The role of exercise. - Effects of medications. - Commonly associated conditions like Diabetes, Hypertension etc. - Importance of regular check-up. It is an established fact that the person who has acquired properunderstanding of the causes responsible for his obesity can lose hisexcess weight more easily and effectively, which is explained as chiefprinciple i.e. Nidana parivarjana.There are three ways of reducing over weight:a) Increase the output of workb) Reduce the food intake, andc) Plan for a suitable medication. In other words Ahara, Vihara and Aushadha are the three lines oftreatment 47 Chikitsa
    • AHARA Even-though the disease is santarpanajanya; langhan iscontraindicated 1 as it increases the Vata that is the prime cause forMedoroga. There by if the food is not supplied timely aggravates Agniand create many disturbances in the body 2. Keeping this in mind,dietetics has to be planned in such a way that Ahara should be guru foragni but at the same time it should cause apatarpana, kapha and vatashamana 3. Many of the Ahara dravyas are advised on this line, which arementioned in pathyapatha. Many experimental studies have been done onfasting and the inference is that during the period of fasting, the bloodpressure goes down, ketosis and hyperurecaemia occurs. Thus it isadvised to undertake prolonged fasting program under medicalsupervision 4. So instead of advising for Langhana it is better to follow theclassical treatment which explains to enhance Agni, which does notcause santarpana. It almost sounds similar to more quantity but lesscaloric diet. Diet for obese person should be planned that the body get about 50 –60 gm of protein per day, which is necessary for maintaining nitrogenbalance in the body, 100 gm of carbohydrate, 40 – 50 gm of fat. Thisproportion of protein, carbohydrate and fat has to be maintained whichotherwise disturbs the metabolism 5. The total calories allowed to anindividual will depend on the present weight, activity levels of the patient. 48 Chikitsa
    • Model diet plan supplying about 1,000 calories during the course of a dayis given below 1. Early morning - one glass of hot water with lemon or lime juice. 2. Morning breakfast – any one or two items from the list given below a) ¾ cup of milk without adding sugar or one cup of tea or coffee with a little milk. In tea or coffee saccharin, and not sugar, may be used b) An orange or a mosambi or any other fruit (except banana) of an ordinary size. c) One slice of bread or one small khakhara. Those who are heavily overweight should avoid them. d) One egg e) 2 to 3 small tomatoes or cucumbers 3. Mid–day meal a) take a cup of vegetable soup or any other soup before starting the meal or one glassful of water b) Before other courses are taken, take green–salad containing 4 to 5 tomatoes or 2 to 3 medium size cucumbers. Chew them well. These can be taken in a larger quantity also. c) One small bowl-full of a low-caloric cooked vegetable from the list given below; green leaf bhaji, carrots, cucumber, 49 Chikitsa
    • unripe tomatoes, brinjals, cabbage, beat, radish, white gourd, French-beans, bhindi, etc. d) One or two small chapaties or bread slices. e) One small cupful of moong soup or any other soup made from a common pulses or cereals. f) Some meat or fish. 4. Afternoon / Early evening – As per the morning breakfast, if patient feel restless 5. Dinner – same as the mid-day meal. But a small cupful rice or khichadi can be taken instead of bread or chapati.Caloric values of the uncooked and cooked food articles mentioned in theappendix ( Table No 5 and 6 ) are according to NIN (National institute ofnutrition), Hyderabad.VIHARA Vyayama, vyavaya, anidra, chinta, shoka, shrama, Gamana 6 are thevihara roopa treatment mentioned in the classics. Lacks of these factorsare mentioned as nidana for sthoulya. Hence, we can say this is one ofthe nidana parimarjana line of treatment. Regular exercise isrecommended as an important component of all obese managementregimens. Exercise help a person to spend energy and reduce his weight;and increases the basal metabolic rate of the body which in turn burns 50 Chikitsa
    • away the excess fat 7 and benefits in lipid abnormalities. Exercisesimprove the muscle tone and remove wrinkles and flabbiness of skin 8.Simple walking or exercise, when energy worth 3500 calories is spent,the weight is reduced by 1 pound. Table below show energy spent indifferent types of the physical activity. Table No 7 Sl No Type of the physical activity Energy spent per minute 1 Sitting, standing, reading, writing 1.5 2 Driving car, tailoring, 2.0 3 Household chores 2.2 4 Gardening 5.0 5 Walking 5 km / hr speed 3.0 6 Fast walking 9 km / hr speed 9.0 7 Light exercises of yoga 4.0 8 Cycling (depending upon speed) 3.5 – 8.0 9 Table tennis 5.5 10 Games like kho-kho etc. 8.0 11 Lawn tennis 6.0 12 Dancing 5.0 13 Swimming 3 km / hr speed 9.0 14 Skipping 7.0 15 Running (depending upon speed) 10-25 16 Heavy exercise 8.0 51 Chikitsa
    • AUSHADHI This can be discussed under two headings 1. Shodhana. 2. Shamana1. Shodhana Under the heading of Shodhana we can consider Rooksha Udwarthana, snana 9, Lekhana Basti 10 and Shodhana 11. The general term Shodhana is used by Vagbhata which indicate all the panchakarmas. But when we see the dos and don’ts of panchakarma it reveals – a. Snehana – As a general rule Snehana should not be administered in Medorogi 12 but tila taila prayoga is indicated in Medoroga. It may be because of its gunas like sukshma and vyavayi through which it opens the medovritha srotas and ushna guna of it reduces the kapha 13 b. Swedana – Swedana for obese patient is contra indicated 14 but if essential Mrudu sweda is advised 15. c. Vamana – not indicated in sthoulya 16 where as in conditions like amadoshayukta 17 and kapholbana vamana could be advised with yastimadhu 18. 52 Chikitsa
    • d. Virechana – not indicated 19 but with special precautions it can be used. e. Basti – Lekhana Basti is indicated f. Nasya and Raktamokshana - clear-cut indication is not available.2. Shamana Eventhough Meda, Vata and Kapha Nashana is said as chikitsa sutra 20, the drug planned should have deepana and pachana property to enhance Agni and digest ama. As obstruction of srotas is main factor in Medoroga, the drugs must have Rookshana and Chedan property 21 to Produce sroto vishodhan. Along with these Ati teekshna, ushna, rookshna guna dravyas are also advised 22 as they are opposite to manda, snigdha and sheeta gunas of kapha and Meda. There by they subside Meda and Kapha. Five types of fat reducing drugs are used in modern science. a. anti appetite b. drugs reducing the level of sugars in the c. Metabolic stimulants d. Laxative drugs e. Diuretics. And surgical treatment is also advised in the treatment of obesity as lipo suction. 53 Chikitsa
    • REFERENCES1. Astanga Sangraha Sutrasthana 24 / 452. Charaka Sutrasthana 21/53. Charaka Sutrasthana 21/204. Runcie,j and Itilditch, T.E (1974) – B.M.J, ii,2505. From fat to fit pp 616. Bhaishajya Ratnavali 39/17. From fat to fit pp 728. Bloom.w.l. (1968). To fat or to exercise (B M.J.clin. Nutr, 21,1475)9. Astanga Sangraha. Sutrasthana 24/26 Charaka Sutrasthana 21/1010. Sushruta Sutrasthana 15/3211. Astanga Sangraha Sutrasthana 24/2612. Charaka Sutrasthana 15/53 Sushruta Chikitsa 31/4613. Charaka Sutrasthana 13/44,4614. Charaka Sutrasthana 14 / 1715. Astanga Hridaya Sutrasthana 17 / 2416.Charaka Siddhisthana 2/8 Sushruta Chikitsa 33/1417. Astanga Sangraha Sutrasthana 27 / 3018. Sushruta Chikitsa 30 / 919. Charaka Siddhisthana 2/8,11 Sushruta Chikitsa 33/1820. Astanga Hridaya Sutrasthana 14 / 2121. Sushruta Sutrasthana 15 / 3222. Astanga Sangraha Sutrasthana 24 / 26 54 Chikitsa
    • PATHYA – APATHYA Pathya pathya is the part and parcel of the successful treatment.Especially in Medoroga it is most important. The aharas and viharasexplained by different acharyas, which help in curing a disease, arediscussed below. PathyasAHARACharak samhita prashatika, Priyangu, Shyamaka, Yavaka, Yava, Kodrava, Mudgha, Kulatha, Chakra mudgha, Patola, Amalaki, Modhoodaka, Arista.Sushruta samhita Madhu, Yava, Mudgha, Kodrava, Uddhalak.Astanga hridaya Kulatha, Yavaka, Yava, Shyamaka, Mudgha, Madhoodhaka, Aristaka, Mastu and Takra.Yoga ratnakara Purana shali, Mudgha, Kulatha, Uddhalaka, Kodrava, Yava, Shyamaka, Madhu.Sharagadhara samhita Shyamaka, Priyangu, Yava, Kulatha, Chanaka, Massora, Mudga, Madhu, Laja, Takra, Sura.
    • VIHARACharak Jagarana, Vyavaya, Vyayama, Chinta.Sushruta Causative factors should be avoided.Vagbhata Jagarana, Vyavaya, Vyayama, Chinta.Yoga ratnakara Jagarana, Vyavaya, Vyayama, Chinta, Margagamana.Sharagadhara Chinta, shrama, jagarana, Vyavaya, Langhana, Atapasevana, Hasti and ashwa Yana, bhramana. Apathyas Ahara - rasayana Dravyas, naveen shali, godhuma, ksheera vikruti, ikshu vikruti, masha, matsya, mamsa. Vihara - sheetala jala snana, diwaswapna, sugandha dravya sevana, drinking water immediately after consuming food.Apart form this, factors mentioned under causative factors are Apathyas.
    • Pippalyadi Guggulu, is a combination of Pippali, Triphala, Haritaki,Guggulu, Madhu and Gomutra.Criteria for selection Sthoulya or Medoroga is santarpanotha vikara 1, caused by atisnehadravya sevana 2. Accumulation of excess medas is chief sign ofMedoroga. Keeping all these points in view the present combination isselected. While explaining snehavyapat, Vagbhata affirms, excessivesnehana therapy give rise to all the diseases which might be caused byAtisneha sevana 3 it has to be treated with a combination of takrarista,uddala, Yava, Shyamaka, Kodrava, Pippali, Triphala, Honey, Pathya,Gomutra and Guggulu 4. As sthoulya is also santarpana vikara, thiscombination is found suitable for treatment. Among the above said,Pippali, Triphala, Honey, Pathya, Gomutra and Guggulu are onlyAushadhis, explained by Acharyas, thus the present yoga is selected astrial medicine. In addition to the above references except Pippali, all the otherherbs viz Triphala, Honey, Pathya, Gomutra and Guggulu are mentionedas treatment for sthoulya by Sushruta 5, while explaining the treatment forsantarpanotha vyadhi. Charaka offer a combination of Haritaki and Madhuwhile scheduling treatment of santarpanotha vikaras, especially for 54 Drug Review
    • sthoulya. This gives waitage to have Haritaki as separate part apart fromTriphala in the present combination. Individual drugs are also studied andeach of them are found to have Medohara effect. Pharmacologicalproperties of these drugs are also suitable for treating the selecteddisease. Medicine is prepared in tablet form, as Guggulu is Medohara andquickly absorbed in oral route. It can be taken for a long time withoutany ill effects 6. Herbs selected for formulating the medicine are verysimple, economical and abundantly available in all parts of India. Thereby present trial drug is an economical, suitable, long-term and convenientremedy for sthoulya. 55 Drug Review
    • DESCRIPTION OF INDIVIDUAL DRUG OF THE COMPOUND MEDICINE 1. HARITAKI Sanskrit - Haritaki Hindi - Harad Kannada - Anale kayi Latin - Terminalia chebula Family - Combretaceae.Synonyms - Pathya, Abhaya, Amruta, Vijaya.Distribution - Forests of Northern India, Common in Madras and Mysore 7Part used - Dried Phala Majja.Short description - Fruits are oval in shape and about 2 inch long and are of dull yellow in colour.Pharmacological properties –Guna – Laghu, Ruksha.Rasa - except lavana all the five.Vipaka – katu.Veerya – ushna.Doshaghnata – . Tridoshagna 56 Drug Review
    • Chemical composition – This contain astringent principles – Tannin, a brownish yellowcolouring matter, chebulinic acid- which when heated in water splits upinto tannic and gallic acids.Actions concerned to disease – It does Lekhan karma 8 and subsides all the Santarpanotha vyadhis 9Haritaki with Madhu is considered as best treatment for sthoulya 10 57 Drug Review
    • 2. BIBHITAKISanskrit - BIBHITAKIHindi - BahedaKannada - TarekayiLatin - Terminalia BelliricaFamily - Combtaceae.Synonyms - Karshaphala, Kali Druma.Distribution - Common in Indian forests and plains.Parts used – Dried phala majjaShort description - Fruits are 12 – 25 mm dia ovoid in shape grey incolour, suddenly narrowed into a very short stalk, Obscureles, 5 angled.Pharmacological properties –Guna – Laghu, Ruksha.Rasa - KashayaVipaka – Madhura.Veerya – Ushna.Doshaghnata – Tridoshagna. 58 Drug Review
    • Chemical composition – Gallotannic acid, colouring matters, resins and greenish yellow oil.Actions concerned to disease – Diseases due to Rasa, Rakta, Mamsa, Meda dushyas are subsided 11by Bibhitaki 59 Drug Review
    • 3. AMALAKI Sanskrit - AMALAKI Hindi - Avala Kannada - Nellikayi Latin - Emblica officinalis Family -. Euphorbiaceae.Synonyms - Dathri, Amraphala, Vayastha..Distribution - Deccan and sea coast Districts and Kashmir.Parts used - Dried phala majja.Short description - Fruit is 1.3 – 1.6 cm in diameter, fleshy with 6 obsure vertical furrows and pale yellow in colour.Pharmacological properties - Guna – Guru, Ruksha, Sheeta. Rasa - Except Lavan all the five Vipaka – Madhura. Veerya – Sheeta. Doshaghnata – Tridoshagna. 60 Drug Review
    • Chemical composition – Fruit contains Galic acid, Tannic acid, Sucrose, Albumin, Cellulose,Calcium and very rich with Vitamin C.Actions concerned to disease – It subsides Medas 12; and useful in the liver complaints, thirst, piles,etc. it is very good rasayana 13. 61 Drug Review
    • 4. PIPPALI Sanskrit - PIPPALI Hindi - Peepal Kannada - Hippali Latin - Piper longum Family -. Piperaceae.Synonyms - Magadhi, Kana, Krishna,Chapal, Ushana, Kola.Distribution- - Hotter provinces of India, Ceylon, Malasia etc.Parts used - Dry fruits.Short description- Fruits are very small, ovoid in shape, completely sunkin solid fleshy spike which is 2.5 to 3.8 cm. It is ovoid– oblong, erect,blunt and blackish green in colour.Pharmacological properties – Guna – Laghu, snigdha, Teekshna. Rasa - Katu Vipaka – Madhura. Veerya – Anushna Sheeta. Doshaghnata – Kapha vata hara. 62 Drug Review
    • Chemical composition – Resin, volatile oil, Starch, gum, fatty oil, inorganic matter and analkaloid, piperine.Actions concerned to disease – It is clearly told Pippali with Madhu subsides Meda and Kapha 14. Itsubsides kapha and vata because of its katu rasa and snigdha gunarespectively. It acts as yogavahi 15. 63 Drug Review
    • 5. GUGGULU Sanskrit - GUGGULU Hindi - Guggul Kannada - Guggulu Latin - Commiphora mukul Family -. Burseraceae.Synonyms - Devadhoopa, Mahishaksh, Jatayu etc.Distribution - Sindh, Rajastan and Mysore in India, Africa and also in Arab,Parts used - Niryas (old).Short description- It is dry, have good smell and natural colour (golden yellow) which will be lost on profound storage.Pharmocological properties – Guna – Laghu, Sookshma, Teekshna, Ushna, Vishada. Rasa - Katu Vipaka – Katu. Veerya – Ushna. Doshaghnata – Kapha vata hara. 64 Drug Review
    • Chemical composition – Gum 29.3%, resins, volatile oil and bitter principle.Actions concerned to disease – It is very good Madohara dravya 16. Many studies are done onGuggulu all over the world, one of them reveals Guggulu lipid decreasedthe total cholesterol level by 11.7%, the low density lipoproteincholesterol (LDL) by 12.5%, tirglycerides by 12.0%, and the totalcholesterol / high density lipoprotein (HDL) cholesterol ratio by 11.1%from the post diet levels, whereas the levels were unchanged in theplacebo group 17, others showed the changes in the body weight 18 andsignificant protection against atherosclerosis 19 and anti inflammatoryeffect 20. The aqueous suspension of Guggulu has been screened for itspotential to protect gastric mucous against the ulcers. It revealedincrease in nucleic acid and non-protein sulfhydryl concentration, whichappear as to be mediated through its free radical-scavenging, thyroid-stimulating and prostaglandin- inducing properties 21 65 Drug Review
    • 6. MADHUSanskrit - MADHUHindi - ShahadKannada - JenutuppaLatin - MelSynonyms - Makishaka, Kshoudra, Makshikavanta, Bringavanta, Pushpa rasodbhava..Distribution - Available throughout IndiaShort description - Honey is a sweet, thick liquid varying in colour from dark brown to light yellow. The sweetness and thickness also show variations depending upon the region, type of flowers bees feed on, season and verity of the bees.Pharmacological properties – Guna – Laghu, Sookshma, Ruksha, Sheeta. Rasa - Madhura, Kashaya. Karma - Lekhana Doshaghnata – Tridoshahara specially Kaphapittahara. 66 Drug Review
    • Chemical composition – It contains 20.06% of water, 71.41% of carbohydrate (in the form oftwo sugars – the dextrose and Lavulose ) 0.38% of protein, smallquantity of formic acid and Vitamin BActions concerned to disease – Madhu is well known for its Lekhana and Yogavahi action. Honeyis sukshma, Sroto shodhaka, and yogavahi 22, it does chedana and trishnanigrahana. Old honey reduces meda by Lekhana karma thus it is vividlyused in sthoulya treatment 23 67 Drug Review
    • 7. GOMUTRA Among eight types of mutra explained, Gomutra is considered asbest.Pharmacological properties – Guna – Laghu, Ruksha, Teekshna, Ushna. Rasa - Katu, Lavana. Veerya – Ushna Doshaghnata – Kapha vata hara.Actions concerned to disease – It subsides Kapha and vata, acts as medohara 24. deepana andpachana 25. 68 Drug Review
    • Table No 8 Properties of IngredientsN Name Rasa Guna Veerya Vipaka Karma Doshagnata1 Haritaki All except Lavana Laghu, Rooksha Ushna Madhura Lekhana Tridosha2 Bibhitaki Kashaya Laghu, Rooksha Ushna Madhura Medohara Tridosha3 Amalaki All except lavana Guru, Rooksha,Sheeta Sheeta Madhura Rasayana, Medohara Tridosha4 Pippali Katu Laghu, Snigdha,Tikshna Anushna Madhura Meda and kaphahara Kapha vata Sheeta Yogavahi5 Guggulu Katu Laghu,Sukshma, Tikshna, Ushna Katu Medohara, Lekhana Tridosha Ushna, Vishada6 Madhu Madhura, kashya Laghu, Rooksha, Sheeta, Madhura Lekhana, Yogavahi, Tridosha Sukshma -- Srotoshodhaka7 Gomutra Katu, lavana Laghu, Rooksha, Tikshna, Ushna Katu Medohara, Deepana and Kapha vata. Rooksha pachana. 69 Drug Review
    • Method of preparation of Medicine – Composition of Pippalyadi Guggulu Sl No Name of the drug Quantity 1 Pippali 1 part 2 Haritaki 1 part 3 Triphala 1 part 4 Madhu 1 part 5 Guggulu 4 parts 6 Gomutra Q.S Haritaki, Bibhitaki, Amalaki, Pippali are powdered separately.Equal quantity of fine powder of Triphala, Pippali and Haritaki are mixed.Gomutra bhavana is given to this mixture for 7 times. Purana Guggulu shodhana is done in Triphala kwata by using dolayantra. Gomutra bhavita churna is mixed with shodhita Guggulu in 1:1ratio. During mardhana process Madhu is added and the mixture is rolledinto pills each measuring 500 mg. Then they are dried in shade andpreserved in glass jar. 70 Drug Review
    • REFERENCES1. Charaka Sutrasthana 23 / 62. Sushruta Sutrasthana 15 / 323. Astanga Sangraha Sutrasthana 25 / 474. Astanga Sangraha Sutrasthana 25 / 495. Sushruta Sutrasthana 15 / 326. Indian Materia Medica pp 1687. Indian Materia Medica pp 12068. Dhanwantari Nighantu 19 / 2059. Dhanwantari Nighantu 19 / 20610. Charaka Sutrasthana 23 / 911. Charaka Sutrasthana 27 / 14812. Sushruta Sutrasthana 24 / 6913. Indian Medicinal Plants pp 222014. Bhava Prakasha 5715. Charaka Vimanasthana 1 / 1616. Charaka Sutrasthana 25 / 4017. by Niaz MA, at Heart Research Laboratory, Moradabad.18. Shah AH, Dept of Pharmacology, King saud university, Saudi Arabia19 Lata s at dept of Pharmacology, LLRM Medical college, Meerut20. Waterman PG at Dept of Physiology and Pharmacology, Royal college, University of Strathclyde, Scotland 71 Drug Review
    • 21. by Ahmed MM at Dept of pharmacology, college of pharmacy, King Saud University, Saudi Arabia.22. Bhava Prakasha Madhu varga / 2,323. Sushruta Sutrasthana 45 / 3624. Sushruta Sutrasthana 45 / 21725. Astanga Sangraha Sutrasthana 6 / 137 72 Drug Review
    • Table No xx Properties of IngredientsN Na me Ras a G una Ve er ya Vipak a Kar ma Dos hag nata1 Haritaki All e xcept La van a L agh u, Rooks ha Ushna Madhura L ekhana Tridosh a2 Bibhitak i Kas haya L agh u, Rooks ha Ushna Madhura Medohara Tridosh a3 Amalaki All e xcept la vana G uru , Ro oksh a,Shee ta Sh ee ta Madhura Ras ayana , Medohar a Tridosh a4 P i pp al i Ka tu L agh u, Sn ig dha ,T ikshn a An ushn a Madhura Meda an d kapha har a Kapha va ta Sh ee ta Y o g a va hi5 G uggulu Ka tu L agh u,Suks hma, Tiksh na , Ushna Katu Medohara , L ek ha na Tridosh a Ush na , Vish ada6 Mad hu M ad hura, kas h ya L agh u, Rooks ha , She eta , -- L ekhana, Yo gava hi, Tri dosh a S uk s hma -- S ro tosho dhak a7 Gomutra Ka tu, la vana L agh u, Rooks ha , Tiksh na , Ushna -- Medohara , De epa na K a p ha v a ta. Ro oks ha a nd p achan a.
    • Thirty patients are selected for the clinical study and grouped into group A and B each of fifteen. The data collected is as follows- DEMOGRAPHIC DATA. Master chart 1Sl. OPD Date of Name Age Sex Rl O ES Dt FH Ch Gr ResultNo. No. Initiation 1 03529 12/06/99 DRS 48 M M A 4 M P 3 A Relieved 2 11215 25/10/99 NPS 37 M O S 4 V P 1 A Not responded 3 11218 26/10/99 IDB 48 M H S 4 V P 1 A Relieved 4 11237 26/10/99 ARM 55 M M S 3 M M 2 A Not responded 5 11194 26/10/99 MKJ 48 M H S 3 M P 3 A Relieved 6 11416 29/10/99 PHG 40 M O S 3 V P 3 A Relieved 7 02438 25/05/99 SHH 21 F H S 2 V P 3 A Palliative 8 03606 14/06/99 GTH 58 F H S 2 V M 3 A Palliative 9 04587 02/07/99 SAP 43 F H A 3 M M 2 A Relieved10 08704 11/09/99 AGB 20 F H S 4 V P 1 A Not responded11 08769 14/09/99 SDS 53 F O S 4 M M 3 A Not responded12 11059 22/10/99 MFA 42 F H S 2 M P 2 A Relieved13 10667 25/10/99 VKP 36 F H S 3 V P 3 A Not responded14 11196 26/10/99 BRK 27 F H S 2 V P 3 A Relieved15 11405 29/10/99 BPG 35 F H S 3 V M 3 A Relieved16 06118 30/07/99 HSM 52 M O A 4 V N 3 B Relieved17 06645 09/08/99 APS 44 M O S 3 V N 2 B Relieved18 06659 09/08/99 TDN 60 M H S 2 V N 2 B Relieved19 02241 21/05/99 NMN 21 F O A 4 V M 3 B Palliative20 03482 11/06/99 MNK 26 F H S 2 V M 1 B Relieved21 03742 15/06/99 JSM 55 F H A 4 V N 3 B Palliative22 04878 07/07/99 LPO 41 F H S 4 V N 2 B Relieved23 06895 13/08/99 ZRC 36 F M S 2 V N 3 B Relieved24 07278 19/08/99 VFM 27 F H S 4 V P 3 B Palliative25 11090 20/12/99 ABC 60 F H S 3 V M 2 B Not responded26 11200 25/10/99 LVB 31 F H S 4 V M 2 B Relieved27 11241 26/10/99 NVR 42 F H S 3 V M 1 B Palliative28 11268 27/10/99 GHM 22 F H S 3 V P 2 B Relieved29 11522 30/10/99 SVD 36 F H S 3 V N 3 B Relieved30 11531 30/10/99 SBH 56 F H A 4 V M 3 B Relieved A: Age in Years; S: Sex (M: Male, F: Female); Rl: Religion (H:Hindu, M:Muslim, O:others); O: Occupation (S: Sedentary, A: Active, L: Labor); ES: Economical status (1: 0-1Lack,,2:1-2 Lack,3:2-3 Lack, 4:3 Lack & above); Dt: Diet (v: vegetarian, M: mixed); FH: Family history (P: Paternal, M: Maternal, N: Nil ); Ch: Chronicity(1: since 2 yrs, 2: since 3 yrs, 3: more than 3 yrs.); Gr: Group ( A: Hyperlipidimic & Obese, B: Hypolipidimic & Obese). 114 Observation, 79 Analysis & Interpretation
    • DATA RELATED TO PERSONAL HISTORY Master chart 2Sl Ahara Diva Adhyashan Vyayama Vyavaya Manasika NidraNo 1 2 3 4 shayanam 1 + + + + 3 + 1 1 1 1 2 + + + - 2 - 4 1 3 1 3 + + + + 3 - 2 2 3 1 4 + + + + 4 + 2 2 3 1 5 + + + + 2 - 2 2 3 1 6 + - + + 3 - 1 1 3 1 7 - + + + 3 - 2 0 1 2 8 + + - + 1 - 4 0 3 1 9 + + + + 2 - 3 2 3 110 + + + + 2 - 3 0 3 111 + + - + 3 + 0 1 3 112 + + + + 4 - 2 0 3 113 + + + - 3 - 1 2 3 114 + + - + 2 - 1 0 3 115 + + + + 3 - 2 2 3 116 + + + + 2 + 1 1 3 117 + + + + 3 - 2 2 1 118 - + + + 2 - 2 1 3 119 + + + - 2 - 3 0 3 120 - + + + 2 - 2 0 1 121 + + - + 3 - 0 2 2 222 - + + + 2 - 1 2 3 123 + + + - 3 - 2 2 3 124 + + + + 4 - 4 0 3 125 + + + + 4 - 3 0 1 126 + + + + 2 - 4 0 2 127 + + + + 3 - 3 2 3 128 + + + + 1 - 4 0 3 129 + - + + 4 - 2 2 1 130 + + - + 3 + 1 1 3 1Ahara (1- Guru, 2- Snigdha, 3- Sheeta, 4- Madhura), Adhyashana (1-15 min, 2-30 min, 3-1hr,4- 2 hrs),Vyayama ( +: yes, - : no), Diva shayanam (1: less than 1 hr, 2: 1 hr, 3: 2 hrs,4: morethan 2 hrs), Vyavaya (1: active, 2: Passive), Manasika ( 1: Chinta, 2: Shoka, 3: Harshnityatwa),Nidra (1: Sound, 2: Disturbed) 114 Observation, 80 Analysis & Interpretation
    • DATA RELATED TO DISEASE Master Chart 3Sl ComplaintsNo 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A1 - - - - - - + * + * + * - - + - + - + - - - + - + * - - + - - -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 + * + - + * + * - - + * + * + - + - - - + - + - - - + - + - - -27 - - - - + - + * + - + * - - + - + - - - + - + - - - + - + - - -28 + * + - + * + * - - + * + * + - + - - - - - - - + * + - + - - -29 - - + - + * + * - - + * - - + - + - + - - - - - + - - - + - - -30 + * + - + * + * + * + * - - + - - - - - - - - - - - - - + - - - 1-Spik chalatwa, 2- Spik guruta, 3- Spik vriddhi, 4- Udara lambana, 5- Udara chalatwa, 6- Stana vriddhi, 7- Stana chalatwa, 8- Shareera gowravata, 9- Alasya, 10- Kshudraswasa, 11- Kriya asamarthata, 12- Vyavaya asamarthata, 13- Snigdhangata, 14- Aruchi, 15-Talushosha, 16- Shopha, Symptoms (+: Present, -:absent, *:Reduced) 114 Observation, Analysis & Interpretation 81
    • Master chart 4 Sl. Associated Complaints No 1 2 3 4 5 6 7 B A B A B A B A B A B A B A 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 + - + + - - + - - - - - - - 27 + - + * + + + - + - + - + + 28 + - + * - - + - - - - - - - 29 + - + + + * + - - - + - - - 30 + - + * - - - - - - - - + +1-Adhika trishna, 2- Adhika kshudha, 3- Adhika sweda, 4- Adhika nidra, 5- Alpa bala,6- Shareera durgandhata, 7- Krathan. 114 83 Observation, Analysis & Interpretation
    • Master chart 5 UpadravaSl 1 2 3 4 5 6 7 8 9 10 11No B A B A B A B A B A B A B A B A B A B A B A 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 - - - - - - - - + + + + - - - - - - - - - -27 - - - - - - + * + + - - - - - - - - - - + -28 - - + - - - - - + + - - - - - - - - - - - -29 - - - - - - - - + + - - - - - - - - - - + -30 - - - - - - - - + + - - - - - - - - - - + *1-Jwara, 2- Atisara, 3- Kamala,4- Prameha, 5- Arsha, 6- Kusta, 7- Bhagandhara, 8- Visarpa, 9- Sleepada, 10- Apachi, 11- Vatavyadhi.B = Before treatment, A = After treatment, Symptoms (+: Present, -: Absent, *: Reduced) 114 Observation, Analysis & Interpretation 84
    • DATA RELATED TO OBJECTIVE PARAMETERS Master chart 6-A Sl Height Weight (in kg) Circumference of (in cms) Result N (In ft) SW B A Dif UB UA Dif SpB SpA Dif StB StA Dif 1 5.6 61 087 083 4 124 123 1 116 106 10 103 102 1 Cured 2 5.5 58 074 070 4 104 103 1 102 96 6 095 095 0 Not responded 3 5.5 58 095 093 2 114 112 2 112 108 4 111 108 3 Cured 4 5.5 63 085 080 5 116 113 3 118 109 9 109 108 1 Not responded 5 5.6 59 105 102 3 122 118 4 118 113 5 114 112 2 Cured 6 5.9 64 125 120 5 123 121 2 120 113 7 118 115 3 Cured 7 5.0 51 086 084 2 107 106 1 124 124 0 112 111 1 Palliative 8 5.4 51 088 085 3 107 107 0 119 116 3 108 104 4 Palliative 9 5.2 46 084 080 4 123 121 2 135 127 8 116 111 5 Cured 10 5.3 54 076 073 3 103 102 1 120 118 2 108 107 1 Not responded 11 5.3 48 064 062 2 084 084 0 105 104 1 083 082 1 Not responded 12 5.3 60 107 103 4 115 112 3 140 137 3 120 117 3 Cured 13 5.6 60 081 078 3 104 102 2 115 114 1 103 102 1 Not responded 14 5.1 58 104 099 5 125 122 3 140 134 6 119 117 2 Cured 15 5.2 46 067 065 2 107 105 2 122 120 2 101 101 0 CuredSW - Pre calculated Standard weight, UB – Udara before treatment, UA – Udara after treatment, SpB – Sphik before treatment,SpA – Sphik after treatment, StB – Sthana before treatment , StA – Sthana after treatment , Dif – Difference, B - Before treatment,A - After treatment , R- Result. Observation,114 Analysis & Interpretation 85
    • Master chart 6-B Sl OPD Height Weight (in kg) Circumference of (in cms) Result N No (In ft) SW B A Dif UB UA Dif SpB SpA Dif StB StA Dif 16 6118 5.7 61 85 81 4 93 90 3 87 79 8 86 82 4 Cured 17 6645 5.5 58 89 86 3 98 96 2 94 89 5 87 85 2 Cured 18 6659 5.1 48 84 80 4 114 110 4 118 111 7 103 100 3 Cured 19 2241 5.3 50 68 64 4 97 95 2 121 119 3 99 98 1 Palliative 20 3482 5.0 46 70 65 5 99 96 3 117 107 10 96 94 2 Cured 21 3742 5.3 50 67 63 4 108 107 1 120 116 4 100 99 1 Palliative 22 4878 5.1 45 65 60 5 88 85 3 106 97 9 109 107 2 Cured 23 6895 5.0 46 62 57 5 91 89 2 114 110 4 109 106 3 Cured 24 7278 5.2 46 73 69 4 89 87 2 109 107 2 108 107 1 Palliative 25 11092 4.10 42 67 65 2 94 94 0 118 117 1 98 97 1 Not responded 26 11200 5.4 52 91 84 7 102 99 3 98 85 13 90 85 5 Cured 27 11241 4.11 43 80 77 3 117 117 0 120 118 2 113 111 2 Palliative 28 11268 4.10 48 56 52 4 88 86 2 95 92 3 91 90 1 Cured 29 11522 4.10 45 72 69 3 100 97 3 120 116 4 100 98 2 Cured 30 11531 5.4 52 89 85 4 99 97 2 95 90 5 88 82 6 CuredSW - Pre calculated Standard weight, UB – Udara before treatment, UA – Udara after treatment, SpB – Sphik before treatment,SpA – Sphik after treatment, StB – Sthana before treatment , StA – Sthana after treatment , Dif – Difference, B- Before treatment,A- After treatment, R- Result. Observation,114 Analysis & Interpretation 86
    • Master chart 7- A Serum Triglyceride HDL LDL VLDL RandomSN Cholesterol Dif Dif Cholesterol Dif Cholesterol Dif Cholesterol Dif Blood sugar Dif Result B A B A B A B A B A B A 1 250 226 24 212 195 17 47 46 1 146 121 25 38 27 11 180 169 11 Cured 2 237 221 16 243 220 23 48 45 3 146 135 11 43 41 1 217 195 22 Not responded 3 223 231 -8 184 172 12 45 47 -2 137 116 21 37 34 3 160 91 69 Cured 4 249 217 32 307 296 11 43 41 2 142 139 3 61 52 9 110 116 -6 Not responded 5 187 160 27 172 157 15 33 32 1 114 105 9 34 33 1 185 178 7 Cured 6 225 239 14 208 193 15 48 47 1 135 140 -5 42 32 10 203 187 16 Cured 7 256 214 42 362 278 84 41 44 -3 133 111 22 72 56 16 142 131 11 Palliative 8 248 220 28 189 176 13 49 46 3 132 103 29 49 47 2 162 157 5 Palliative 9 211 186 25 176 150 26 37 39 -2 110 102 08 51 44 7 156 153 3 Cured10 247 231 16 258 250 8 49 48 1 123 98 25 46 34 12 109 113 -4 Not responded11 263 220 43 312 281 31 45 44 1 141 126 15 52 50 2 217 182 35 Not responded12 254 233 21 186 175 11 47 45 2 170 153 17 37 29 8 123 135 -12 Cured13 241 228 13 344 335 09 47 48 -1 125 113 12 69 64 5 149 142 7 Not responded14 214 178 36 226 228 -2 32 36 -4 122 107 15 45 41 4 103 98 5 Cured15 208 226 18 197 186 11 50 53 -3 119 103 16 39 36 3 110 108 2 Cured Observation,114 Analysis & Interpretation 87
    • Master chart 7– B Serum Triglyceride HDL LDL VLDL RandomSl. Cholesterol Di Dif Cholesterol Dif Cholesterol Di Cholesterol Dif Blood sugar Dif ResultNo. B A f B A B A B A f B A B A16 210 194 16 142 131 11 42 40 2 139 125 14 28 27 1 156 142 14 Cured17 202 183 19 126 118 8 36 36 0 167 151 16 26 24 2 123 121 2 Cured18 206 215 -9 138 129 9 40 44 -4 130 120 10 27 27 0 133 126 7 Cured19 201 186 15 158 139 19 35 37 -2 168 156 12 26 24 2 122 113 9 Palliative20 213 192 21 104 91 13 39 38 1 181 163 18 24 21 2 135 116 19 Cured21 208 201 7 134 124 10 40 40 0 155 146 9 27 26 1 119 120 -1 Palliative22 249 235 14 158 151 7 48 52 -4 169 156 13 30 26 4 133 117 16 Cured23 209 182 27 102 86 16 39 36 3 150 139 11 25 20 5 124 90 34 Cured24 219 203 16 138 126 12 41 40 1 192 187 5 32 31 1 227 201 26 Palliative25 233 196 37 131 116 15 36 39 -3 168 164 4 26 24 2 141 147 -6 Not responded26 199 173 26 70 50 20 40 38 2 183 167 16 29 26 3 126 120 6 Cured27 205 178 27 92 86 6 34 39 -5 188 162 26 33 30 3 204 185 19 Palliative28 198 180 18 65 63 2 37 37 0 192 177 15 31 29 2 122 109 13 Cured29 234 227 07 157 139 18 48 45 3 155 151 4 32 30 2 132 128 4 Cured30 210 183 27 74 77 -3 43 41 2 173 164 9 29 25 4 98 109 -11 Cured Observation,114 Analysis & Interpretation 88
    • 1. Distribution of patients by age Ag e No o f pa tien ts Perc en ta ge Res pon ded Perc en ta ge 21 – 30 7 24% 6 85% 31 – 40 7 24% 5 71% 41 – 50 9 30% 8 86% 51 – 60 7 24% 5 71% Largest incidences are found in the fourth decade. This showsmiddle aged people are more prone to get this condition, may be becauseof their physical inactiveness and continuing the younger age dietaryhabits.2. Distribution of patients by sex se x No o f pa tien ts Perc en ta ge Res pon ded Perc en ta ge M a le 9 30% 7 77 F em al e 21 70% 17 86 This data shows among 30 patients 21 (70%) are female and only 9(30%) are male. This indicates the incidence of sthoulya is more infemale and they responded well. Graphic representation of age and sex is shown in figure 1 114 Observation, 88 Analysis & Interpretation
    • Figure No 1 Showing the Age and sex incidence 8 7 6 5 Number of patients 4 3 2 1 0Age in years 21 - 30 31 - 40 41 - 50 51 - 60 Male 0 2 4 3 Female 7 5 5 4 114 Observation, 89 Analysis & Interpretation
    • 3. Distribution of patients by religion Religion No of patients Percentage Responded Percentage Hindu 21 70% 18 85% Muslim 3 10% 2 66% Others 6 20% 4 66% The data shows among 30 patients 21 ( 70% ) belongs to Hindu, 3 (10%) belongs to Muslim and 6 (20%) belongs to other religion. It dose not mean that Hindus are more prone for this disease. This may be due to the area from where sampling is being done. Figure No 2 Showing the Religion incidence Others 20% Muslim 10% Hindu 70% 114 Observation, 90 Analysis & Interpretation
    • 4. Distribution of patients by Occupation. Occupation No of patients Percentage Responded Percentage Sedantory 24 80% 18 75 Active 6 20% 6 100 Labour 0 0% 0 00 The data shows among 30 patients 24 (80%) belong to sedantaryoccupation group, 6 (20%) belong to active occupation group, noincidence vitnessed from labour group. This shows sedantary work orless labourious work might have more susceptibility. Figure No 3 Showing the Occupation incidence Labour Active 0% 20% Sedantory 80% 114 Observation, 91 Analysis & Interpretation
    • 5. Distribution of patients by Economical status Income @ No of patients % Responded Percentage under –1 lakh 0 0% 0 00 1 – 2 lakh 7 23% 7 100 2 – 3 lakh 11 37% 8 72 3 lakh and above 12 40% 9 75 This data shows out of 30 patients, 12 (40%) belong to 3 lakh andabove category, 11 (37%) belong to 2 – 3 lakh category. It clearlyindicate the incidence of the disease is more in higher economical classof people, because of high caloric diet in take and less utility of it. Figure No 4 Showing the incidence of economical status under –1 lakh 0% 1 – 2 lakh 23% 3 lakh and above 40% 2 – 3 lakh 37% 114 Observation, 92 Analysis & Interpretation
    • 6. Distribution of patients by Diet Diet No of patients Percentage Responded Percentage Veg 24 80% 20 85 mixed 6 20% 4 66 This data shows 24 (80%) of the patients are vegetarians and 6 (20%) are having mixed (both veg and nonveg) food habits. This may be because of more number of patients selected from Hindu and jain religion. But as vegetarians especially Rice eaters will consume more quantity of food and deep fried food will lead to deposit fats in the body. A German research proves that children who had nutritional deficiency in the first trimester in the womb after conception have had a specific tendency to accumulate more fat as reserves. In most of the vegetarians the needs of foetus is not fulfilled at 100%, there by susceptibility of getting obesity or tendency to accumulate fat is more in vegetarians. This is to be further evaluated. Figure No 5 Showing the incidence of Diet Mixed 20% Veg 80% 114 Observation, 93 Analysis & Interpretation
    • 7. Distribution of patients by Family history Family H No of patients Percentage Responded Percentage Paternal 12 40 9 75 Maternal 11 36 8 72 Nil 7 23 7 100 Maximum patients i.e. 23 (77%) had a family history. Among them 12 (40%) had paternal and 11 (37%) had maternal history. This signifies the hereditary or beeja swabhava mentioned by Charaka as one of the cause for sthoulya. Figure No 6 Showing the incidence of Family History without Family History 23% Paternal 40% Maternal 37% 114 Observation, 94 Analysis & Interpretation
    • 8. Distribution of patients by chronicity Chronicity No of patients Percentage Responded Percentage Since 2 yr 5 17 3 60 Since 3 yr 9 30 7 77 > than 3 yr 16 53 14 87 This clinical study reveled 53% of the patients had chronicity of more than 3 years. This study suggests that obesity is a chronic disease. The weight and fat accumulation takes slowly in the body with causative factors. Figure No 7 Showing the incidence of chorinicity since 2 Yrs 17% More than 3 Yrs 53% since 3 Yrs 30% 114 Observation, 95 Analysis & Interpretation
    • Data related to ResultTotal Result No of patients Percentage Relived 18 60% palliative 6 20% Not responded 6 20%Group A Result No of patients Percentage Relived 8 53% palliative 2 15% Not responded 5 35%Group B Result No of patients Percentage Relived 10 66% palliative 4 26% Not responded 1 6% By the above data we can observe the effect of the medicine issignificant, and is working better on group A patients than in Group B.Graphical representation of it is given in fig No 28. 114 Observation, 96 Analysis & Interpretation
    • DATA OF PERSONAL HISTORY To asses the nidanas of the disease, detailed personal history istaken with more concentration drawn towards ahara and vihara of thepatient.1. Ahara Ahara Number of patients Percentage Guru 26 86% Snidgha 28 93% Sheeta 25 83% Madhura 26 86%2. Adhyashana Time interval Number of patients Percentage 15 min 2 7% 30min 11 37% 1hr 12 40% 2hrs 5 16% 4 hrs 0 0% Data revels that more than 80% of the patients are habituated forGuru, sheeta, snigdha and madhura ahara, 100% of the patients havethe habbit of adhyashan. Detailed history of quantity in relation to timeof consumption of food was recorded, which indicated high caloric intakeof the food by patients, without proper utility of it. 114 Observation, 97 Analysis & Interpretation
    • 2. Vyayama. Vyayama Number of patients Percentage Present 5 16% Absent 25 84% Exercise will help in lowering the weight where as data shows 25(83%) of the patients under the category of Avyayama.3. Divashayana Divashayana (day sleep) No of patients Percentage No day sleep 2 7% Less than 1 hr 7 23% 1 hr 11 37% 2 hr 5 16% More than 2 hrs 5 16% Except 2 (7%) patients, remaining 28 (93%) patients have the habitof sleeping in the day. As it is one of the important Nidana of Medorogaaffirmed by Acharyas, these patients are victims of deposition ofMedodhatu in the body i.e. sthoulya,. 114 Observation, 98 Analysis & Interpretation
    • 5.Vyavaya. Vyavaya Number of patients Percentage Active 7 23% Passive 12 40% Widow / unmarried 11 37% This data shows 12 (40%) are passive and 7 (23%) are activeduring intercourse. Remaining 11 (37%) are unmarried or widows.9. Manasika Manasika Number of patients Percentage Harsha 22 73% Chinta 6 20% Shoka 2 7% 22 (73%) of the patients are leading happy life without any worries. With the above data it is clear “harsha nityatwa” is definitely one of the causative factor for sthoulya.10. Nidra Nidra Number of patients Percentage Sound 28 93% Disturbed 2 7% This data shows 28 (93%) patients are having sound sleep and 2 (7%) are having disturbed sleep. 114 Observation, 99 Analysis & Interpretation
    • Data related to disease.Subjectives Complaints complaints No of patients % Relived or % Reduced Spik chalatwa 17 56 16 94 Spik guruta 26 87 26 100 Spik vriddhi 28 94 28 100 Udara lambana 28 94 28 100 Udara chalatwa 19 63 19 100 Sthana vriddhi 27 90 27 100 Sthana chalatwa 16 53 16 100 Shareera gowravata 29 97 29 100 Alasya 25 83 25 100 Kshudraswasa 13 43 13 100 Kriya asamarthata 21 70 21 100 Vyavaya asamarthata 13 43 13 100 Snigdhangata 22 73 20 90 Aruchi 11 37 11 100 Talushosha 26 87 26 100 Sthula shopha 8 27 6 75 This data shows the symptomatic relief in the present trial. Exceptspik chalatwa, shopha and snigdhangata all the other symptoms arereduced or relived at the expectations. 114 Observation, 100 Analysis & Interpretation
    • Associated complaints Associated complaint No of patients % Relived or % Reduced Adhika trishna 27 90 27 100 Adhika kshudha 27 90 27 100 Adhika sweda 19 63 8 42 Adhika nidra 26 87 26 100 Alpa bala 19 63 19 100 Shareera durgandha 12 40 7 56 krathan 21 70 0 0 Adhika trishna, kshudha and nidra are found in majority of thepatients and these symptoms are relived in all patients. Krathana has notbeen effected in any of the patients.Upadravas Upadravas No of patients % Relived or % Reduced Jwara 2 7% 2 100 Atisara 7 23% 7 100 Kamala 2 7% 2 100 Prameha 7 23% 7 100 Arsha 25 83% 5 20 Kusta 7 23% 2 26 Bhagandara 0 0% 0 00 Visarpa 2 7% 2 100 Sleepada 0 0% 0 00 Apachi 0 0% 0 00 Vatavyadhi 19 64% 19 100 114 Observation, 101 Analysis & Interpretation
    • High incidence of Arsha as upadrava is found, 83% of the patientsare suffering from this upadrava. Sedentary life style, which is themain nidana for both Arsha and Sthoulya, might have increased theincidence of Arsha in this disease. As meda does margavarodha,patients are expected more prone for Vata vyadhi. Corresponding tothis data reveals 19 (64%) of incidence of Vata vyadhi. BothPrameha and Medoroga are medovaha srotodusti vikaras, there by30% of the patients are recorded as Prameha patients also. Incidenceof Atisara and Kusta is 7 (23%), Jwara, Kamala, Visarpa is 2 (7%).Bhagandara, Sleepada, Apachi are not found in any of the patients.Objectives Data related to height, weight and circumference is given in masterchart 6-A and 6-B. data related to lipid profile and random bloodsugar are given in master chart 7-A and 7-B and are graphicallyrepresented. Deviated t values, corresponding S.D , SE and P valuesare as under with significance. 114 Observation, 102 Analysis & Interpretation
    • Statistical Evaluation of the ResultsSl Objectives Group Total Mean S.D. S.E. ITI P – Value Remark1 Serum A 363 24.20 10.58 2.75 8.55 P< 0.001 Highly significant cholesterol B 286 19.06 08.52 2.20 8.66 P< 0.001 Highly significant2 Serum A 288 19.20 19.37 5.00 3.84 P< 0.001 Highly significant Triglyceride B 169 11.26 05.59 1.44 7.79 P< 0.001 Highly significant3 Serum HDL A 030 02.00 01.00 0.25 7.74 P< 0.001 Highly significant Cholesterol B 032 02.13 01.55 0.40 5.32 P< 0.001 Highly significant4 Serum LDL A 233 15.53 07.72 1.99 7.78 P< 0.001 Highly significant Cholesterol B 182 12.13 05.84 1.50 8.04 P< 0.001 Highly significant5 Serum VLDL A 094 06.26 04.58 1.18 5.28 P< 0.001 Highly significant Cholesterol B 034 02.26 01.33 0.34 6.57 P< 0.001 Highly significant6 Random blood A 215 14.33 17.40 4.49 3.18 P< 0.010 significant sugar B 187 12.46 09.21 2.37 5.24 P< 0.001 Highly significant7 Weight A 051 03.40 01.12 0.28 11.7 P< 0.001 Highly significant B 061 04.06 01.16 0.30 13.5 P< 0.001 Highly significant8 Circumference of A 027 01.80 01.14 0.29 6.08 P< 0.001 Highly significant Udara B 032 02.13 01.12 0.29 7.34 P< 0.001 Highly significant9 Circumference of A 067 04.46 03.11 0.80 5.55 P< 0.001 Highly significant sphik B 080 05.33 03.39 0.87 6.08 P< 0.001 Highly significant10 Circumference of A 028 01.86 01.45 0.37 4.96 P< 0.001 Highly significant sthana B 036 02.40 01.54 0.40 6.00 P< 0.001 Highly significant By observing the data above and the calculation of their significance we can conclude that the drug is having very good action and it is highly significant, except on blood sugar level. 114 Observation, 103 Analysis & Interpretation
    • Figure No 28 Showing the Results 20 Number of patients 15 10 5Result 0 Relived Palliative Not responded Total 18 6 6 Group A 8 2 5 Group B 10 4 1 Group B Not Group B responded Palliative 3% 13% Group A Relived 27% Group A Palliative Group B Relived 7% 33% Group A Not responded 17% 114 Observation, 104 Analysis & Interpretation
    • Thirty patients are selected for the clinical study and grouped into group A and B each of fifteen. The data collected is as follows- DEMOGRAPHIC DATA. Master chart 1Sl. OPD Date of Name Age Sex Rl O ES Dt FH Ch Gr ResultNo. No. Initiation 1 03529 12/06/99 DRS 48 M M A 4 M P 3 A Relieved 2 11215 25/10/99 NPS 37 M O S 4 V P 1 A Not responded 3 11218 26/10/99 IDB 48 M H S 4 V P 1 A Relieved 4 11237 26/10/99 ARM 55 M M S 3 M M 2 A Not responded 5 11194 26/10/99 MKJ 48 M H S 3 M P 3 A Relieved 6 11416 29/10/99 PHG 40 M O S 3 V P 3 A Relieved 7 02438 25/05/99 SHH 21 F H S 2 V P 3 A Palliative 8 03606 14/06/99 GTH 58 F H S 2 V M 3 A Palliative 9 04587 02/07/99 SAP 43 F H A 3 M M 2 A Relieved10 08704 11/09/99 AGB 20 F H S 4 V P 1 A Not responded11 08769 14/09/99 SDS 53 F O S 4 M M 3 A Not responded12 11059 22/10/99 MFA 42 F H S 2 M P 2 A Relieved13 10667 25/10/99 VKP 36 F H S 3 V P 3 A Not responded14 11196 26/10/99 BRK 27 F H S 2 V P 3 A Relieved15 11405 29/10/99 BPG 35 F H S 3 V M 3 A Relieved16 06118 30/07/99 HSM 52 M O A 4 V N 3 B Relieved17 06645 09/08/99 APS 44 M O S 3 V N 2 B Relieved18 06659 09/08/99 TDN 60 M H S 2 V N 2 B Relieved19 02241 21/05/99 NMN 21 F O A 4 V M 3 B Palliative20 03482 11/06/99 MNK 26 F H S 2 V M 1 B Relieved21 03742 15/06/99 JSM 55 F H A 4 V N 3 B Palliative22 04878 07/07/99 LPO 41 F H S 4 V N 2 B Relieved23 06895 13/08/99 ZRC 36 F M S 2 V N 3 B Relieved24 07278 19/08/99 VFM 27 F H S 4 V P 3 B Palliative25 11090 20/12/99 ABC 60 F H S 3 V M 2 B Not responded26 11200 25/10/99 LVB 31 F H S 4 V M 2 B Relieved27 11241 26/10/99 NVR 42 F H S 3 V M 1 B Palliative28 11268 27/10/99 GHM 22 F H S 3 V P 2 B Relieved29 11522 30/10/99 SVD 36 F H S 3 V N 3 B Relieved30 11531 30/10/99 SBH 56 F H A 4 V M 3 B Relieved A: Age in Years; S: Sex (M: Male, F: Female); Rl: Religion (H:Hindu, M:Muslim, O:others); O: Occupation (S: Sedentary, A: Active, L: Labor); ES: Economical status (1: 0-1Lack,,2:1-2 Lack,3:2-3 Lack,4:3 Lack & above); Dt: Diet (v: vegetarian, M: mixed); FH: Family history (P: Paternal, M: Maternal); Ch: Chronicity(1: since 2 yrs, 2: since 3 yrs, 3: more than 3 yrs.); Gr: Group ( A: Hyperlipidimic & Obese, B: Hypolipidimic & Obese).
    • DATA RELATED TO PERSONAL HISTORY Master chart 2 Sl Ahara Diva Adhyashan Vyayama Vyavaya Manasika Nidra No 1 2 3 4 shayanam 1 + + + + 3 + 1 1 1 1 2 + + + - 2 - 4 1 3 1 3 + + + + 3 - 2 2 3 1 4 + + + + 4 + 2 2 3 1 5 + + + + 2 - 2 2 3 1 6 + - + + 3 - 1 1 3 1 7 - + + + 3 - 2 0 1 2 8 + + - + 1 - 4 0 3 1 9 + + + + 2 - 3 2 3 1 10 + + + + 2 - 3 0 3 1 11 + + - + 3 + 0 1 3 1 12 + + + + 4 - 2 0 3 1 13 + + + - 3 - 1 2 3 1 14 + + - + 2 - 1 0 3 1 15 + + + + 3 - 2 2 3 1 16 + + + + 2 + 1 1 3 1 17 + + + + 3 - 2 2 1 1 18 - + + + 2 - 2 1 3 1 19 + + + - 2 - 3 0 3 1 20 - + + + 2 - 2 0 1 1 21 + + - + 3 - 0 2 2 2 22 - + + + 2 - 1 2 3 1 23 + + + - 3 - 2 2 3 1 24 + + + + 4 - 4 0 3 1 25 + + + + 4 - 3 0 1 1 26 + + + + 2 - 4 0 2 1 27 + + + + 3 - 3 2 3 1 28 + + + + 1 - 4 0 3 1 29 + - + + 4 - 2 2 1 1 30 + + - + 3 + 1 1 3 1Ahara (1- Guru, 2- Snigdha, 3- Sheeta, 4- Madhura), Adhyashana (1-15 min, 2-30 min, 3-1hr,4- 2 hrs),Vyayama ( +: yes, - : no), Diva shayanam (1: less than 1 hr, 2: 1 hr, 3: 2 hrs,4: morethan 2 hrs), Vyavaya (1: active, 2: Passive), Manasika ( 1: Chinta, 2: Shoka, 3: Harshnityatwa),Nidra (1: Sound, 2: Disturbed)
    • DATA RELATED TO SUBJECTIVE PARAMETERS Master Chart 3 Sl Complaints No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A 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 + * + - + * + * - - + * + * + - + - - - + - + - - - + - + - - - 27 - - - - + - + * + - + * - - + - + - - - + - + - - - + - + - - - 28 + * + - + * + * - - + * + * + - + - - - - - - - + * + - + - - - 29 - - + - + * + * - - + * - - + - + - + - - - - - + - - - + - - - 30 + * + - + * + * + * + * - - + - - - - - - - - - - - - - + - - - 1-Spik chalatwa, 2- Spik guruta, 3- Spik vriddhi, 4- Udara lambana, 5- Udara chalatwa, 6- Stana vriddhi, 7- Stana chalatwa, 8- Shareera gowravata, 9- Alasya, 10- Kshudraswasa, 11- Kriya asamarthata, 12- Vyavaya asamarthata, 13- Snigdhangata, 14- Aruchi, 15-Talushosha, 16- Shopha, Symptoms (+: Present, -:absent, *:Reduced)
    • Master chart 4 Sl. Associated Complaints No 1 2 3 4 5 6 7 B A B A B A B A B A B A B A 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 + - + + - - + - - - - - - - 27 + - + * + + + - + - + - + + 28 + - + * - - + - - - - - - - 29 + - + + + * + - - - + - - - 30 + - + * - - - - - - - - + +1-Adhika trishna, 2- Adhika kshudha, 3- Adhika sweda, 4- Adhika nidra, 5- Alpa bala,6- Shareera durgandhata, 7-Krathan.
    • Master chart 5 UpadravaSl 1 2 3 4 5 6 7 8 9 10 11No B A B A B A B A B A B A B A B A B A B A B A 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 - - - - - - - - + + + + - - - - - - - - - -27 - - - - - - + * + + - - - - - - - - - - + -28 - - + - - - - - + + - - - - - - - - - - - -29 - - - - - - - - + + - - - - - - - - - - + -30 - - - - - - - - + + - - - - - - - - - - + *1-Jwara, 2- Atisara, 3- Kamala,4- Prameha, 5- Arsha, 6- Kusta, 7- Bhagandhara, 8- Visarpa, 9- Sleepada, 10- Apachi, 11- Vatavyadhi.B = Before treatment, A = After treatment, Symptoms (+: Present, -: Absent, *: Reduced)
    • DATA RELATED TO OBJECTIVE PARAMETERS Master chart 6-A Sl Height Weight (in kg) Circumference of (in cms) Result N (In ft) SW B A Dif UB UA Dif SpB SpA Dif StB StA Dif 1 5.6 61 087 083 4 124 123 1 116 106 10 103 102 1 Cured 2 5.5 58 074 070 4 104 103 1 102 96 6 095 095 0 Not responded 3 5.5 58 095 093 2 114 112 2 112 108 4 111 108 3 Cured 4 5.5 63 085 080 5 116 113 3 118 109 9 109 108 1 Not responded 5 5.6 59 105 102 3 122 118 4 118 113 5 114 112 2 Cured 6 5.9 64 125 120 5 123 121 2 120 113 7 118 115 3 Cured 7 5.0 51 086 084 2 107 106 1 124 124 0 112 111 1 Palliative 8 5.4 51 088 085 3 107 107 0 119 116 3 108 104 4 Palliative 9 5.2 46 084 080 4 123 121 2 135 127 8 116 111 5 Cured 10 5.3 54 076 073 3 103 102 1 120 118 2 108 107 1 Not responded 11 5.3 48 064 062 2 084 084 0 105 104 1 083 082 1 Not responded 12 5.3 60 107 103 4 115 112 3 140 137 3 120 117 3 Cured 13 5.6 60 081 078 3 104 102 2 115 114 1 103 102 1 Not responded 14 5.1 58 104 099 5 125 122 3 140 134 6 119 117 2 Cured 15 5.2 46 067 065 2 107 105 2 122 120 2 101 101 0 CuredSW - Pre calculated Standard weight, UB – Udara before treatment, UA – Udara after treatment, SpB – Sphik before treatment,SpA – Sphik after treatment, StB – Sthana before treatment , StA – Sthana after treatment , Dif – Difference, B - Before treatment,A - After treatment , R- Result.
    • Master chart 6-B Sl OPD Height Weight (in kg) Circumference of (in cms) Result N No (In ft) SW B A Dif UB UA Dif SpB SpA Dif StB StA Dif 16 6118 5.7 61 85 81 4 93 90 3 87 79 8 86 82 4 Cured 17 6645 5.5 58 89 86 3 98 96 2 94 89 5 87 85 2 Cured 18 6659 5.1 48 84 80 4 114 110 4 118 111 7 103 100 3 Cured 19 2241 5.3 50 68 64 4 97 95 2 121 119 3 99 98 1 Palliative 20 3482 5.0 46 70 65 5 99 96 3 117 107 10 96 94 2 Cured 21 3742 5.3 50 67 63 4 108 107 1 120 116 4 100 99 1 Palliative 22 4878 5.1 45 65 60 5 88 85 3 106 97 9 109 107 2 Cured 23 6895 5.0 46 62 57 5 91 89 2 114 110 4 109 106 3 Cured 24 7278 5.2 46 73 69 4 89 87 2 109 107 2 108 107 1 Palliative 25 11092 4.10 42 67 65 2 94 94 0 118 117 1 98 97 1 Not responded 26 11200 5.4 52 91 84 7 102 99 3 98 85 13 90 85 5 Cured 27 11241 4.11 43 80 77 3 117 117 0 120 118 2 113 111 2 Palliative 28 11268 4.10 48 56 52 4 88 86 2 95 92 3 91 90 1 Cured 29 11522 4.10 45 72 69 3 100 97 3 120 116 4 100 98 2 Cured 30 11531 5.4 52 89 85 4 99 97 2 95 90 5 88 82 6 CuredSW - Pre calculated Standard weight, UB – Udara before treatment, UA – Udara after treatment, SpB – Sphik before treatment,SpA – Sphik after treatment, StB – Sthana before treatment , StA – Sthana after treatment , Dif – Difference, B- Before treatment,A- After treatment, R- Result.
    • Master chart 7- A Serum Triglyceride HDL LDL VLDL RandomSN Cholesterol Dif Dif Cholesterol Dif Cholesterol Dif Cholesterol Dif Blood sugar Dif Result B A B A B A B A B A B A 1 250 226 24 212 195 17 47 46 1 146 121 25 38 27 11 180 169 11 Cured 2 237 221 16 243 220 23 48 45 3 146 135 11 43 41 1 217 195 22 Not responded 3 223 231 -8 184 172 12 45 47 -2 137 116 21 37 34 3 160 91 69 Cured 4 249 217 32 307 296 11 43 41 2 142 139 3 61 52 9 110 116 -6 Not responded 5 187 160 27 172 157 15 33 32 1 114 105 9 34 33 1 185 178 7 Cured 6 225 239 14 208 193 15 48 47 1 135 140 -5 42 32 10 203 187 16 Cured 7 256 214 42 362 278 84 41 44 -3 133 111 22 72 56 16 142 131 11 Palliative 8 248 220 28 189 176 13 49 46 3 132 103 29 49 47 2 162 157 5 Palliative 9 211 186 25 176 150 26 37 39 -2 110 102 08 51 44 7 156 153 3 Cured10 247 231 16 258 250 8 49 48 1 123 98 25 46 34 12 109 113 -4 Not responded11 263 220 43 312 281 31 45 44 1 141 126 15 52 50 2 217 182 35 Not responded12 254 233 21 186 175 11 47 45 2 170 153 17 37 29 8 123 135 -12 Cured13 241 228 13 344 335 09 47 48 -1 125 113 12 69 64 5 149 142 7 Not responded14 214 178 36 226 228 -2 32 36 -4 122 107 15 45 41 4 103 98 5 Cured15 208 226 18 197 186 11 50 53 -3 119 103 16 39 36 3 110 108 2 Cured
    • Master chart 7– B Serum Triglyceride HDL LDL VLDL RandomSl. Cholesterol Dif Dif Cholesterol Dif Cholesterol Dif Cholesterol Dif Blood sugar Dif ResultNo. B A B A B A B A B A B A 16 210 194 16 142 131 11 42 40 2 139 125 14 28 27 1 156 142 14 Cured 17 202 183 19 126 118 8 36 36 0 167 151 16 26 24 2 123 121 2 Cured 18 206 215 -9 138 129 9 40 44 -4 130 120 10 27 27 0 133 126 7 Cured 19 201 186 15 158 139 19 35 37 -2 168 156 12 26 24 2 122 113 9 Palliative 20 213 192 21 104 91 13 39 38 1 181 163 18 24 21 2 135 116 19 Cured 21 208 201 7 134 124 10 40 40 0 155 146 9 27 26 1 119 120 -1 Palliative 22 249 235 14 158 151 7 48 52 -4 169 156 13 30 26 4 133 117 16 Cured 23 209 182 27 102 86 16 39 36 3 150 139 11 25 20 5 124 90 34 Cured 24 219 203 16 138 126 12 41 40 1 192 187 5 32 31 1 227 201 26 Palliative 25 233 196 37 131 116 15 36 39 -3 168 164 4 26 24 2 141 147 -6 Not responded 26 199 173 26 70 50 20 40 38 2 183 167 16 29 26 3 126 120 6 Cured 27 205 178 27 92 86 6 34 39 -5 188 162 26 33 30 3 204 185 19 Palliative 28 198 180 18 65 63 2 37 37 0 192 177 15 31 29 2 122 109 13 Cured 29 234 227 07 157 139 18 48 45 3 155 151 4 32 30 2 132 128 4 Cured 30 210 183 27 74 77 -3 43 41 2 173 164 9 29 25 4 98 109 -11 Cured
    • DEMOGRAPHIC DATA1. Distribution of patients by age Ag e No o f pa tien ts Perc en ta ge Res pon ded Perc en ta ge 21 – 30 7 24% 6 85% 31 – 40 7 24% 5 71% 41 – 50 9 30% 8 86% 51 – 60 7 24% 5 71% Largest incidences are found in the fourth decade. This showsmiddle aged people are more prone to get this condition, may be becauseof their physical inactiveness and continuing the younger age dietaryhabits.2. Distribution of patients by sex se x No o f pa tien ts Perc en ta ge Res pon ded Perc en ta ge M a le 9 30% 7 77 F em al e 21 70% 17 86 This data shows among 30 patients 21 (70%) are female and only 9(30%) are male. This indicates the incidence of sthoulya is more infemale and they responded well. Graphic representation of age and sex is shown in figure 1
    • Figure No 1 showing the Age and sex incidence 8 7 6 5 Number of patients 4 3 2 1 Age in years 0 21 - 30 31 - 40 41 - 50 51 - 60 Male 0 2 4 3 Female 7 5 5 43. Distribution of patients by religion
    • Re lig io n No o f pa tien ts Perc en ta ge Res pon ded Perc en ta ge H ind u 21 70% 18 85% M us li m 3 10% 2 66% O t hers 6 20% 4 66% The data shows among 30 patients 21 ( 70% ) belongs to Hindu, 3 (10%) belongs to Muslim and 6 (20%) belongs to other religion. It dose not mean that Hindus are more prone for this disease. This may be due to the area from where sampling is being done. Figure No 2 Showing the Religion incidence Others 20% Muslim 10% Hindu 70%4. Distribution of patients by Occupation Occ upa tio n No o f pa tien ts Perc en ta ge Res pon ded Perc en ta ge S e den t ar y 24 80% 18 75 A c ti v e 6 20% 6 1 00 L abo ur 0 0% 0 00
    • The data shows among 30 patients 24 (80%) belong to sedentaryoccupation group, 6 (20%) belong to active occupation group, noincidence witnessed from labour group. This shows sedentary work orless labourious work might have more susceptibility. 5. Distribution of patients by Economical status Inc ome @ No o f pa tien ts % Res pon ded Perc en ta ge u nde r –1 lak h 0 0% 0 00 1 – 2 lak h 7 23% 7 1 00 2 – 3 lak h 11 37% 8 72 3 lak h an d a bo ve 12 40% 9 75 This data shows out of 30 patients, 12 (40%) belong to 3 lakh andabove category, 11 (37%) belong to 2–3 lakh category. It clearlyindicates the incidence of the disease is more in higher economical classof people, because of high caloric diet in take and less utility of it. Diagrammatic representation of occupation and economical statusis shown in figure No 3
    • Figure No 3 showing the incidence of Economical status and occupation 12 10 8 Number of patients 6 4 2 Income per @ 0 3 Lacks and 0 - 1 Lack 1 - 2 Lacks 2 - 3 Lacks above Sedentary 0 7.01 10 7 Active 0 0 1 5 Labour 0 0 0 06. Distribution of patients by Diet D ie t No o f pa tien ts Perc en ta ge Res pon ded Perc en ta ge Veg 24 80% 20 85
    • m i x ed 6 20% 4 66 This data shows 24 (80%) of the patients are vegetarians and 6 (20%) are having mixed (both veg and non-veg) food habits. This may be because of more number of patients selected from Hindu and jain religion. But as vegetarians especially Rice eaters will consume more quantity of food and deep fried food will lead to deposit fats in the body. A German research proves that children who had nutritional deficiency in the first trimester in the womb after conception have had a specific tendency to accumulate more fat as reserves. In most of the vegetarians the needs of foetus is not fulfilled at 100%, there by susceptibility of getting obesity or tendency to accumulate fat is more in vegetarians. This is to be further evaluated. Figure No 4 Showing the incidence of Diet Mixed 20% Veg 80%7. Distribution of patients by Family history
    • F amily H No o f pa tien ts Perc en ta ge Res pon ded Perc en ta ge P a t er na l 12 40 9 75 M a ter na l 11 36 8 72 N il 7 23 7 1 00 Maximum patients i.e. 23 (77%) had a family history. Among them 12 (40%) had paternal and 11 (37%) had maternal history. This signifies the hereditary or beeja swabhava mentioned by Charaka as one of the cause for sthoulya. Figure No 5 Showing the incidence of Family History without Family History 23% Paternal 40% Maternal 37%7. Distribution of patients by chronicity Ch ron ic i ty No o f pa tien ts Perc en ta ge Res pon ded Perc en ta ge S i nce 2 yr 5 17 3 60 S i nce 3 yr 9 30 7 77
    • > th an 3 yr 16 53 14 87 This clinical study reveled 53% of the patients had chronicity of more than 3 years. This study suggests that obesity is a chronic disease. The weight and fat accumulation takes slowly in the body with causative factors and precipitation. Figure No 6 Showing the incidence of chorinicity since 2 Yrs 17% More than 3 Yrs 53% since 3 Yrs 30%DATA RELATED TO RESULTTotal Res ult No o f pa tien ts Perc en ta ge R e l i ved 18 60%
    • p al l ia t i ve 6 20% No t r esp ond ed 6 20%Group A Res ult No o f pa tien ts Perc en ta ge R e l i ved 8 53% p al l ia t i ve 2 15% No t r esp ond ed 5 35%Group B Res ult No o f pa tien ts Perc en ta ge R e l i ved 10 66% p al l ia t i ve 4 26% No t r esp ond ed 1 6% By the above data we can observe the effect of the medicine issignificant, and is working better on group A patients than in Group B.Graphical representation of it is given in fig. No. 7
    • Figure No 7 Showing the Results 20 18 16 14 12 Number of patients 10 8 6 4 2Result 0 Relived Palliative Not respondedTotal 18 6 6Group A 8 2 5Group B 10 4 1
    • DATA OF PERSONAL HISTORY To asses the nidanas of the disease, detailed personal history istaken with more concentration drawn towards ahara and vihara of thepatient.1. Ahara A h ara N u mb er o f p a ti en ts P er c en ta ge G ur u 26 86% S n id gha 28 93% S h i ta 25 83% M ad hura 26 86%2. Adhyashana T i me in te r va l N u mb er o f p a ti en ts P er c en ta ge 1 5 m in 2 7% 3 0 m in 11 37% 1 hr 12 40% 2 hrs 5 16% 4 hrs 0 0% Data revels that more than 80% of the patients are habituated forGuru, sheeta, snigdha and madhura ahara, 100% of the patients havethe habit of adhyashan. Detailed history of quantity in relation to time ofconsumption of food was recorded, which indicated high caloric intake ofthe food by patients, without proper utility of it.3. Vyayama V y a y ama N u mb er o f p a ti en ts P er c en ta ge
    • P r es en t 5 16% A bs en t 25 84% Exercise will help in lowering the weight where as data shows 25(83%) of the patients under the category of Avyayama.4. Divashayana D i vash a yan a (d a y slee p) No o f pa tien ts Perc en ta ge N o da y s lee p 2 7% L es s tha n 1 hr 7 23% 1 hr 11 37% 2 hr 5 16% M or e t han 2 hrs 5 16% Except 2 (7%) patients, remaining 28 (93%) patients have the habitof sleeping in the day. As it is one of the important Nidana of Medorogaaffirmed by Acharyas, these patients are victims of deposition ofmedodhatu in the body i.e. sthoulya,.5.Vyavaya. V y a v a ya N u mb er o f p a ti en ts P er c en ta ge A c ti v e 7 23% P as s i ve 12 40% W idow / unm arr ie d 11 37%This data shows 12 (40%) are passive and 7 (23%) are active duringintercourse. Remaining 11 (37%) are unmarried or widows.8. Manasika M an as ik a N u mb er o f p a ti en ts P er c en ta ge H a r s ha 22 73% C h in t a 6 20% S h oka 2 7%
    • 22 (73%) of the patients are leading happy life without any worries. With the above data it is clear “harsha nityatwa” is definitely one of the causative factor for sthoulya.9. Nidra N idr a N u mb er o f p a ti en ts P er c en ta ge S o und 28 93% D is tur bed 2 7% This data shows 28 (93%) patients are having sound sleep and 2 (7%) are having disturbed sleep. Harsha nityatwa and kapha vriddhi intensifies sound sleep, which is the major causative factor for Medoroga.
    • DATA RELATED TO DISEASE.Subjective Parameters Chief Complaints Re lived or Co mp la in ts No o f pa tien ts % % Re duce d S p ik c h al a tw a 17 56 16 94 S p ik g ur u ta 26 87 26 1 00 S p ik vr idd hi 28 94 28 1 00 U d ara la mb ana 28 94 28 1 00 U d ara c ha la tw a 19 63 19 1 00 S t h ana vr id dh i 27 90 27 1 00 S t h ana c hal a tw a 16 53 16 1 00 S h aree r a gow r a va t a 29 97 29 1 00 A l as ya 25 83 25 1 00 K s h udrasw as a 13 43 13 1 00 K r i ya as ama r t ha t a 21 70 21 1 00 V y a v a ya asa mar t ha ta 13 43 13 1 00 S n ig dha nga t a 22 73 20 90 A r uc hi 11 37 11 1 00 T a lus h osha 26 87 26 1 00 S t h ul a s hop ha 8 27 6 75 This data shows the symptomatic relief in the present tiral. Exceptspik chalatwa, shopha and snigdhangata all the other symptoms arereduced or relived at the expectations.
    • Associated complaints Re lived or Assoc ia ted co mp la in t No o f pa tien ts % % Re duce d A d hik a trish na 27 90 27 1 00 A d hik a k s hu dha 27 90 27 1 00 A d hik a s w ed a 19 63 8 42 A d hik a n idr a 26 87 26 1 00 A l pa ba la 19 63 19 1 00 S h aree r a du r ga ndh a 12 40 7 56 K r a t han 21 70 0 0 Adhika trishna, kshudha and nidra are found in majority of thepatients and these symptoms are relived in all patients. Krathana has notbeen effected in any of the patients.Upadravas Re lived or Up adr a vas No o f pa tien ts % % Re duce d Jwara 2 7% 2 1 00 A t is ara 7 23% 7 1 00 K a ma la 2 7% 2 1 00 P r a me ha 7 23% 7 1 00 Arsha 25 83% 5 20 K us t a 7 23% 2 26 Bh aga ndara 0 0% 0 00 V i s ar p a 2 7% 2 1 00 S l ee pad a 0 0% 0 00 A p ach i 0 0% 0 00 V a t a vyad hi 19 64% 19 1 00 High incidence of Arsha as upadrava is found, 83% of the patients are suffering from this upadrava. Sedentary life style, which is the main nidana for both Arsha and Sthoulya, might have increased the
    • incidence of Arsha in this disease. As meda does margavarodha,patients are expected more prone for Vata vyadhi. Corresponding tothis data reveals 19 (64%) of incidence of Vata vyadhi. BothPrameha and Medoroga are medovaha srotodusti vikaras, there by30% of the patients are recorded as Prameha patients also. Incidenceof Atisara and Kusta is 7 (23%), Jwara, Kamala, Visarpa is 2 (7%).Bhagandara, Sleepada, Apachi are not found in any of the patients.
    • Objective Parameters Data related to height, weight and circumference is given in master chart 6-A and 6-B. data related to lipid profile and random blood sugar are given in master chart 7-A and 7-B and are graphically represented. Deviated t values, corresponding S.D , SE and P values are as under with significance.Sl Objectives Group Total Mean S.D. S.E. ITI P – Value Remark1 Serum A 363 24.20 10.58 2.75 8.55 P< 0.001 Highly significant cholesterol B 286 19.06 08.52 2.20 8.66 P< 0.001 Highly significant2 Serum A 288 19.20 19.37 5.00 3.84 P< 0.001 Highly significant Triglyceride B 169 11.26 05.59 1.44 7.79 P< 0.001 Highly significant3 Serum HDL A 030 02.00 01.00 0.25 7.74 P< 0.001 Highly significant Cholesterol B 032 02.13 01.55 0.40 5.32 P< 0.001 Highly significant4 Serum LDL A 233 15.53 07.72 1.99 7.78 P< 0.001 Highly significant Cholesterol B 182 12.13 05.84 1.50 8.04 P< 0.001 Highly significant5 Serum VLDL A 094 06.26 04.58 1.18 5.28 P< 0.001 Highly significant Cholesterol B 034 02.26 01.33 0.34 6.57 P< 0.001 Highly significant6 Random A 215 14.33 17.40 4.49 3.18 P< 0.010 significant blood sugar B 187 12.46 09.21 2.37 5.24 P< 0.001 Highly significant7 Weight A 051 03.40 01.12 0.28 11.7 P< 0.001 Highly significant B 061 04.06 01.16 0.30 13.5 P< 0.001 Highly significant8 Circumferenc A 027 01.80 01.14 0.29 6.08 P< 0.001 Highly significant e of Udara B 032 02.13 01.12 0.29 7.34 P< 0.001 Highly significant9 Circumferenc A 067 04.46 03.11 0.80 5.55 P< 0.001 Highly significant e of sphik B 080 05.33 03.39 0.87 6.08 P< 0.001 Highly significant10 Circumferenc A 028 01.86 01.45 0.37 4.96 P< 0.001 Highly significant e of sthana B 036 02.40 01.54 0.40 6.00 P< 0.001 Highly significant By observing the data above and the calculation of their significance we can conclude that the drug is having very good action except on blood sugar level.
    • Figure No. 10 Circumference of Udara of Group A 140 120 100 Circumference in cms 80 60 40 20 0Patient Sl No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Before 124 104 114 116 122 123 107 107 123 103 84 115 104 125 107 After 123 103 112 113 118 121 106 107 121 102 84 112 102 122 105 Figure No. 11 Circumference of Udara of Group B 140 120 100 Circumference in cms 80 60 40 20 0Patient Sl No 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Before 93 98 114 97 99 108 88 91 89 94 102 117 88 100 99 After 90 96 110 95 96 107 85 89 87 94 99 117 86 97 97 104 Observation, Analysis & Interpretation
    • Figure No 26. Random Blood Sugar of Group A 250 200 RBS in mg / dl 150 100 50 0Patient Sl No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Before 180 217 160 110 185 203 142 162 156 109 217 123 149 103 110 After 169 195 91 116 178 187 131 157 153 113 182 135 142 98 108 Figure No. 27 Random Blood Sugar of Group B 250 200 RBS in mg / dl 150 100 50 0Patient Sl No 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Before 156 123 133 122 135 119 133 124 227 141 126 204 122 132 98 After 142 121 126 113 116 120 117 90 201 147 120 185 109 128 109 112 Observation, Analysis & Interpretation
    • Figure No 16. Serum Cholesterol of Group A 300 S. Cholesterol in mg/dl 250 200 150 100 50 0Patient Sl No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Before 250 237 223 249 187 225 256 248 211 247 263 254 241 214 208 After 226 221 231 217 160 239 214 220 186 231 220 233 228 178 226 Figure No 17 Serum Cholesterol of Group B 300 250 S.Cholesterol in mg/dl 200 150 100 50 0 Patient Sl No 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Before 210 202 206 201 213 208 249 209 219 233 199 205 198 234 210 After 194 183 215 186 192 201 235 182 203 196 173 178 180 227 183 107 Observation, Analysis & Interpretation
    • Figure No. 20 Serum HDL Cholesterol of Group A 60 50 S. HDL Cholesterol in mg / dl 40 30 20 10 0 Patient Sl No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Before 47 48 45 43 33 48 41 49 37 49 45 47 47 32 50 After 46 45 47 41 32 47 44 46 39 48 44 45 48 36 53 Figure No 21 Serum HDL Cholesterol of Group B 60 50 S HDL Cholesterol in mg / dl 40 30 20 10 0Patient Sl No 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Before 42 36 40 35 39 40 48 39 41 36 40 34 37 48 43 After 40 36 44 37 38 40 52 36 40 39 38 39 37 45 41 109 Observation, Analysis & Interpretation
    • Figure No. 22 Serum LDL Cholesterol of Group A 180 S. LDL Cholesterol in mg / dl 160 140 120 100 80 60 40 20 0 Patient Sl No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Before 146 146 137 142 114 135 133 132 110 123 141 170 125 122 119 After 121 135 116 139 105 140 111 103 102 98 126 153 113 107 103 Figure No. 23 Serum LDL Cholesterol of Group B 250 200 S. LDL Cholesterol in mg / dl 150 100 50 0Patient Sl No 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Before 139 167 130 168 181 155 169 150 192 168 183 188 192 155 173 After 125 151 120 156 163 146 156 139 187 164 167 162 177 151 164 110 Observation, Analysis & Interpretation
    • Figure No. 12 Circumference of Spik of Group A 160 140 120 Circumference in cms 100 80 60 40 20 0 Patient Sl No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Before 116 102 112 118 118 120 124 119 135 120 105 140 115 140 122 After 106 96 108 109 113 113 124 116 127 118 104 137 114 134 120 Figure No. 13 Circumference of Spik of Group B 140 120 100 Circumference in cms 80 60 40 20 0Patient Sl No 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Before 87 94 118 121 117 120 106 114 109 118 98 120 95 120 95 After 79 89 111 119 107 116 97 110 107 117 85 118 92 116 90 105 Observation, Analysis & Interpretation
    • Figure No. 14 Circumference of Sthana of Group A 140 120 100 Circumference in cms 80 60 40 20 0 Patient Sl No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Before 103 95 111 109 114 118 112 108 116 108 83 120 103 119 101 After 102 95 108 108 112 115 111 104 111 107 82 117 102 117 101 Figure No. 15 Circumference of Sthana of Group B 120 100 80 Circumference in cms 60 40 20 0Patient Sl No 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Before 86 87 103 99 96 100 109 109 108 98 90 113 91 100 88 After 82 85 100 98 94 99 107 106 107 97 85 111 90 98 82 106 Observation, Analysis & Interpretation
    • Figure No 18 Serum Triglyceride of Group A 400 350 300 S.Triglycride in mg/dl 250 200 150 100 50 0Patients Sl No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Before 212 243 184 307 172 208 362 189 176 258 312 186 344 226 197 After 195 220 172 296 157 193 278 176 150 250 281 175 335 228 186 Figure No. 19 Serum Triglyceride of Group B 180 160 140 S. Triglyceride in mg/dl 120 100 80 60 40 20 0Patient Sl No 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Before 142 126 138 158 104 134 158 102 138 131 70 92 65 157 74 After 131 118 129 139 91 124 151 86 126 116 50 86 63 139 77 108 Observation, Analysis & Interpretation
    • Figure No. 24 Serum VLDL Cholesterol of Group A 80 70 60 50 VLDL in mg / dl 40 30 20 10 0 Patient Sl No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Before 38 43 37 61 34 42 72 49 51 46 52 37 69 45 39 After 27 41 34 52 33 32 56 47 44 34 50 29 64 41 36 Figure No. 25 Serum VLDL Cholesterol of Group B 35 30 25 20 VLDL in mg / dl 15 10 5 0Patient Sl No 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Before 28 26 27 26 24 27 30 25 32 26 29 33 31 32 29 After 27 24 27 24 21 26 26 20 31 24 26 30 29 30 25 111 Observation, Analysis & Interpretation
    • Figure No. 8 Body weight of Group A 140 120 100 Weight in kg 80 60 40 20 0 Patient Sl No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Std weight 61 58 58 63 59 64 51 51 46 54 48 60 60 58 46 Before 87 74 95 85 105 125 86 88 84 76 64 107 81 104 67 After 83 70 93 80 102 120 84 85 80 73 62 103 78 99 65 Height (ft) 5.6 5.5 5.5 5.5 5.6 5.9 5.0 5.4 5.2 5.3 5.3 5.3 5.6 5.1 5.2 Sex M M M M M M F F F F F F F F F Figure No. 9 body weight of group B 100 90 80 70 Weight in kgs 60 50 40 30 20 10 0Patient Sl No 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Std Weight 61 58 48 50 46 50 45 46 46 42 52 43 48 45 52 Before 85 89 84 68 70 67 65 62 73 67 91 80 56 72 89 After 81 86 80 64 65 63 60 57 69 65 84 77 52 69 85 Height (ft) 5.7 5.5 5.1 5.3 5.0 5.3 5.1 5.0 5.2 4.10 5.4 4.11 4.104.105.4 Sex M M M F F F F F F F F F F F F Observation, Analysis & Interpretation
    • MATERIALSMATERIALS FOR LITERARY SEARCHLiterary search is done from Classical Ayurvedic texts Modern texts Medlar search Updated through journals.MATERIALS FOR CLINICAL STUDYPippalyadi Guggulu composed of Pippali Triphala Haritaki Guggulu Madhu GomutraIs taken for clinical trial. 71 Materials and Methods
    • METHOD Scientific method of research is a combination of observations,reasoning and experimentation. For gaining knowledge in research, oneproposes the problem, constructs suitable experimental model, makeshonest observation and arrives at logical conclusions. The clinical therapeutic trials are of importance due to the fact thatAyurvedic therapeutic measures and procedures have remained inpractice since long on the methodology prevalent in ancient times. It ishigh-time that the rationality of Ayurvedic therapeutic approach isexplained on scientific measures and attempts made to evolve. Somenew therapeutic combinations, the clinical trial which is carefully andethically designed by taking the serum lipid profile and other parametersbefore and after study achieve the above objects at present study“Evaluation of the efficacy of Pippalyadi Guggulu in Medoroga”(withspecial reference to its hypolipidimic effect).Research approach In the present study the objective is to determine the therapeuticeffect of “Pippalyadi Guggulu” which is a combination of Pippali, Triphala,Haritaki, Gomutra, Madhu and Guggulu in Medoroga. Efficacy can bedetermined by finding out the differences between the base line data andassessment data. 72 Materials and Methods
    • Research design For the present study, the patients are divided into two groups as,Group A – Hyperlipidimic and obeseGroup B – Normolipidimic and obeseBefore starting the study baseline data were collected. Then the testmedicine was administered for 60 days, then assessment data werecollected. No placebo was given to any patient, as it is prospectiveclinical trial.Availability Most of the cases were reported in medical camp held at D.G.M.Ayurvedic Medical College, Gadag. Some cases were reported to OPD ofpostgraduate and research center, Kayachikitsa department. D.G.M.Ayurvedic Medical college Hospital, Gadag.Selection criteria Fifteen cases of Hyperlipidimic and obese ( Group A ) and fifteencases of Normolipidimic and obese ( Group B ) are selected as per theinclusion criteria and were treated as out patients. Patients who areattending the Kayachikitsa OPD were selected for the present studystrictly on the basis of a detailed case sheet. Detailed case sheetscontaining data related to general history, physical and systemic 73 Materials and Methods
    • examinations are filled, to satisfy the inclusive criteria. Bio chemicalexamination (lipid profile and random blood sugar) of the blood was donein the laboratory under the supervision.Inclusive criteria♦ Patients between the age of 20 to 60♦ 10 % excess weight than the average weight in relation to height.♦ Irrespective of sexExclusive criteria♦ Patients having known organic lesion.♦ Any Hormonal disturbance.♦ Patients who are not regular for the treatment.Duration of study Duration of the study was 60 days from the day of initiation of“Pippalyadi Guggulu”Posology - 3 gm/24 hours in divided doses. Collection of data The data were collected according to the case sheet and are conveniently segregated under following headings. 74 Materials and Methods
    • 1. Demographic data It includes age, sex, religion, income, occupation, diet. family history, chronicity 2. Data related to habit and habitat of the patient It includes food , exercise, sleep pattern, habits, mental condition, pulse, blood pressure, temperature, respiration and height. 3. Data related to disease.( subjective parameters ) It includes chief complaints, associated complaints and upadravas. 4. Data related to disease ( objective parameters ) It includes weight, circumference of udara, sphik and sthana, lipid profile and random blood sugar.Assessment Considering the difference seen in the assessment data from the baseline data concerned to each of the parameters did the assessment. Theefficacy of treatment was assessed under three headings –Relieved, palliative (moderate response) and not responded. Objective assessment is done statistically. Allotting 2,1,0 pointsfor good response, moderate response and poor response respectivelythe subjective assessment is done. The percentage of total is taken ascriteria for assessment. 75 Materials and Methods
    • Pilot study Before the actual study to check the efficiency and Posology trialwas conducted on sample of three patients, where results are highlysignificant either of subjective or objective parameters.Treatment schedule The duration of the trial was fixed as 60 days. The dosage is 1gm( two Guggulu pellets of each 500 mg) administered orally at the 8 t h hourintervals (6 am, 2 pm and 8 pm). Patients ware advised to continue theirregular diet without any change for the treatment period and no furtherrestrictions were made.Plan for data analysis The statistical analysis of this study was planned to check thesignificance through, mean, standard deviation and standard error fordifferent parameters. The statistical significance of the differencebetween the means of various study parameters was derived usingdeviated ‘t’ test.ESTIMATION OF SERUM LIPIDSBlood sampling method The blood was taken from the patient randomly according to theadvice of pathologist. The venous blood was collected in sterilized test 76 Materials and Methods
    • tube that was not heparinized and allowed to settle in vertical position forone hour. Then centrifuged at 3000 rpm for 30 min. and the serumseparated. Modified Allain’s method Cholesterol kit and GPO-PAP methodtriglyceride kit is used for Lipid profile.For total cholesterol pipetting scheme Blank Standard Test Working enzyme reagent (ml) 1.0 1.0 1.0 Distilled water (ml) 0.01 - - Cholesterol Standard (ml) - 0.01 - Sample (ml) - - 0.01For HDL cholesterol pipetting scheme Blank Standard Test Working enzyme reagent (ml) 1.0 1.0 1.0 Distilled water (ml) 0.05 - - HDL Cholesterol Standard (ml) - 0.05 - Supernatant from step 1 - - 0.05For Triglyceride pipetting scheme Blank Standard Test Working enzyme reagent (ml) 1.0 1.0 1.0 Distilled water (ml) 0.01 - - Cholesterol Standard (ml) - 0.01 - Sample (ml) - - 0.01 77 Materials and Methods
    • Mixed well and allowed at room temperature for 10 min. measuredthe absorbance of Test and Standard against Blank on a photocolorimeterwith green filter. This procedure is followed separately for totalcholesterol, HDL and Triglyceride and readings are recorded.Calculations1. Total Cholesterol in mg% = A of (T) x 200 A of (S)2. HDL Cholesterol in mg% = A of (TH) x 50 A of (S)3. Triglyceride in mg% = A of (T) x 200 A of (S)4. VLDL Cholesterol = Triglyceride 55. HDL Ratio = HDL Total Cholesterol - HDL6. For Random blood sugar; It is done using Glucometer. 78 Materials and Methods
    • - Etiology and clinical features affirmed in the classics still stand true. Excess intake of food, nibbling habit, inactiveness and Hereditary factors which are mentioned as the etiological factors have not changed even after many scientific researches throughout the world. All the signs and symptoms mentioned in the classics namely Pendular movements of buttocks, abdomen and breast, Heaviness in the body, laziness, excess sweating, excess hunger and thirst and also the upadravas like arshas, vatavyadhi, kustha etc., are observed in the patients during present study.- The ingredients of the compound used for the trial are Pippali, Triphala, Haritaki, Guggulu, Madhu and Gomutra. And it is prepared in the Guggulu form for easy palatability.- Drug is very effective in relieving the symptoms, specially it induces activeness and lightness in the body. Within the span of eight days from the initiation of the treatment, patients reported that they were feeling lightness in the body and their activeness in the work was increased to a grate extent. This suggests that the lightness in the body is only due to Pippalyadi Guggulu. Diet and exercise were not induced to the patients very strictly. 115 Conclusion
    • - As all the ingredients in Pippalyadi Guggulu are having the property of rooksha, lagu, sookshma, which are of vayaveeya or akasheeya dravyas, bringing lightness in the body is the function of these dravyas. Because of this reason the patients might have felt the lightness in the body even without reduction in weight and this lightness naturally brings the activeness in the body.- Many of the patients were happy as they were relieved from joint pain (especially Knee and ankle joint), Which is due to the 50% of Guggulu added in Pippalyadi Guggulu. Guggulu is proved analgesic which have very good action over synovial fluids of joints.- Withdrawal of Pippalyadi Guggulu brought about laziness and heaviness in the body, so many of the patients returned and continued the treatment even after the completion of the trial. Surprisingly reduction of weight is more rapid after 8 weeks i.e after the completion of the trial period. There by the trials are still continued with the interest to know the mechanism and action of Pippalyadi Guggulu.- As all the ingredients of trial drug Pippalyadi Guggulu are either tridoshahara or Kaphavatahara, it subsides Kapha and Vata, which are the main doshas, involved. Pippali and Gomutra are having deepana and pachana effect, there by Ama pachana is being done by the drug. 116 Conclusion
    • Madhu is a very good srotoshodhaka and yogavhai, relieves the obstruction of srotas and reaches effectively and immediately into the site of action to disintegrate the Medodhatu with the help of other ingredients. Drugs used in the compound Pippalyadi Guggulu are having antagonistic properties to Kapha and Meda viz laghu, Rooksha, Teekshna guna and Ushna veerya. There by it subsides meda and kapha. At the same time Haritaki, Guggulu and Gomutra are known for their Lekhana Karma.- Drug helped in lowering the weight, circumference of sphik, stana, udara. Lab investigations reveled the reduction in Cholesterol, triglyceride, LDL Cholesterol and maintained ratio with HDL Cholesterol.- Two of the patients who were excluded because of hormonal imbalance were also treated with Pippalyadi Guggulu out of interest to know the action of the drug on them. It gave an encouraging result, which has to be elucidated further. 117 Conclusion
    • - Increased mortality rate due to obesity and unsuccessful treatments for the disease attract the attention of researchers.- Obesity runs in families.- Snigdha guna dravyas definitely increase medodhatu.- Origin of the body fat is from fats, carbohydrates and proteins in the food.- Liver has many functions in relation to fat metabolism. All metabolic intermediates from carbohydrates, fatty acids and amino acids enter the citric acid cycle and interfere with the fat metabolism.- Quantities of the food and jataragni levels are interdependent. In Medoroga excess quantity of ahara rasa is supplied to medodhatwagni, which causes agnimandya and forms the Ama at Medodhatu level.- Poorvaroopa is the stage where pendulus movements of buttocks, abdomen and breast are not well established.- Treatment of obesity is very difficult, Brimhana therapy given to a obese person by principle will decrease agni and Vata but not the 118 Summary
    • medas, where as Langhana therapy will decrease medas but increases the Agni and Vata which increases the medas once again.- Along with medicine, meal planning and regular exercises are necessary in reducing obesity.- The trial drug Pippalyadi Guggulu, composed of Pippali, Triphala, Haritaki, Guggulu, Madhu and Gomutra showed highly significance in Medoroga.- The clinical study of the entitled thesis “Evaluation of the effect of Pippalyadi Guggulu in Medoroga (with special reference to its hypolipidimic effect) have studied over 30 patients in tow groups viz. Group A Hyperlipidimic & obese, Group B Normolipidimic & obese.- Data related to the, subjective parameters and objective parameters are discussed thoroughly. Observation of the signs and symptoms, sex age, incidence, and results are explained in tabulation and graphic forms.- Results of the treatment were assessed on the bases of differences between the base line data and assessment data . The lab 119 Summary
    • investigation variables were subjected for statistical analysis by applying deviated mod ‘t’ test.- The subjective and objective parameters under statistical viability have shown high significance rate with respect to both groups. In Hyperlipidimic and obese group, 53% of the patient are relieved, 15% of palliative and remaining 35% are not responded well. Similarly in the group of Normolipidimic and obese, 66% of the patients are relieved, 26% are palliative group and 6% in not responded group. This data reveals the effect of Pippalyadi Guggulu is good in Group B (Normolipidimic and obese) when compared with group A (Hyperlipidimic and obese). Graphic representation of this is shown below. Group B Not responded Group B Palliative 3% 13% Group A Relived 27% Group A Palliative Group B Relived 7% 33% roup A Not responded 17% 120 Summary
    • 121 Summary
    • BMI chart Ht. Body weight in Kilogram(cm) 90 85 80 75 70 65 60 55 50 45135 49.4 46.6 43.9 41.2 38.4 35.7 32.9 30.2 27.4 24.7140 45.9 43.4 40.8 38.3 35.7 33.2 30.6 28.1 25.5 23.0145 42.8 40.4 38.0 35.7 33.3 30.9 28.5 26.2 23.6 21.4150 40.0 37.8 35.6 33.3 31.1 28.9 26.7 24.4 22.2 20.0155 37.5 35.4 33.3 31.2 29.1 27.1 25.0 22.9 20.2 18.7160 35.2 33.2 31.3 29.3 27.3 25.4 23.4 21.5 19.5 17.6165 33.1 31.2 29.4 27.5 25.7 23.9 22.0 20.2 18.4 16.5170 31.1 29.4 27.7 26.0 24.2 22.5 20.8 19.0 17.3 15.6175 29.4 27.8 26.1 24.5 22.9 21.2 19.6 18.0 16.3 14.7180 27.8 26.2 24.7 23.1 21.6 20.1 18.5 17.0 15.4 13.9185 26.3 24.8 23.4 21.9 20.5 19.0 17.5 16.1 14.6 13.1
    • Waist / Hip RatioHip 50 55 60 65 70 75 80 85 90 95 100 105 110 115 120 125 130 135 140(cm)50 1.00 1.10 1.20 1.30 1.40 1.50 1.60 1.70 1.80 1.90 2.00 2.10 2.20 2.30 2.40 2.50 2.60 2.70 2.8055 0.91 1.00 1.09 1.18 1.27 1.36 1.45 1.55 1.64 1.73 1.82 1.91 2.00 2.09 2.18 2.27 2.36 2.45 2.5460 0.83 0.92 1.00 1.08 1.17 1.25 1.33 1.42 1.50 1.58 1.67 1.75 1.83 1.92 2.00 2.06 2.17 2.25 2.3365 0.77 0.85 0.92 1.00 1.06 1.15 1.23 1.31 1.38 1.46 1.54 1.62 1.69 1.77 1.85 1.92 2.00 2.08 2.1570 0.71 0.79 0.86 0.93 1.00 1.04 1.14 1.21 1.29 1.36 1.48 1.50 1.57 1.67 1.78 1.70 1.86 1.81 2.0075 0.67 0.73 0.80 0.87 0.93 1.00 1.02 1.13 1.20 1.28 1.41 1.40 1.47 1.61 1.60 1.67 1.73 1.80 1.8780 0.63 0.69 0.75 0.81 0.88 0.94 1.00 1.06 1.13 1.19 1.25 1.31 1.38 1.44 1.50 1.56 1.63 1.69 1.7585 0.59 0.65 0.71 0.76 0.82 0.88 0.94 1.00 1.06 1.12 1.18 1.24 1.29 1.35 1.41 1.47 1.53 1.59 1.6590 0.56 0.61 0.68 0.72 0.78 0.83 0.89 0.94 1.00 1.06 1.11 1.18 1.22 1.28 1.33 1.39 1.44 1.50 1.5695 0.51 0.56 0.63 0.68 0.74 0.79 0.84 0.89 0.95 1.00 1.05 1.11 1.16 1.21 1.26 1.32 1.37 1.42 1.44100 0.50 0.55 0.60 0.65 0.70 0.75 0.80 0.85 0.90 0.95 1.00 1.05 1.10 1.15 1.20 1.25 1.30 1.35 1.40105 0.48 0.52 0.57 0.62 0.68 0.71 0.76 0.81 0.86 0.90 0.95 1.00 1.05 1.10 1.14 1.19 1.24 1.29 1.33110 0.45 0.50 0.55 0.59 0.64 0.68 0.73 0.77 0.82 0.86 0.91 0.95 1.00 1.05 1.09 1.14 1.18 1.23 1.27115 0.43 0.48 0.52 0.57 0.61 0.65 0.70 0.74 0.78 0.83 0.87 0.91 0.96 1.00 1.04 1.09 1.13 1.12 1.22120 0.47 0.46 0.50 0.54 0.58 0.63 0.68 0.71 0.76 0.79 0.83 0.88 0.88 0.98 1.00 1.04 1.08 1.11 1.14125 0.40 0.44 0.48 0.52 0.56 0.60 0.64 0.68 0.72 0.76 0.80 0.84 0.85 0.92 0.96 1.00 1.04 1.08 1.12130 0.38 0.42 0.46 0.50 0.54 0.58 0.62 0.65 0.69 0.73 0.77 0.81 0.81 0.86 0.92 0.96 1.00 1.04 1.08135 0.37 0.41 0.44 0.48 0.52 0.56 0.59 0.63 0.67 0.70 0.74 0.78 0.79 0.85 0.88 0.93 0.96 1.00 1.04140 0.36 0.39 0.43 0.46 0.50 0.54 0.57 0.61 0.64 0.68 0.71 0.75 0.76 0.82 0.86 0.84 0.91 0.96 1.00145 0.34 0.38 0.41 0.43 0.48 0.52 0.55 0.59 0.62 0.66 0.69 0.73 0.75 0.78 0.81 0.83 0.88 0.91 0.98150 0.33 0.37 0.40 0.41 0.46 0.50 0.54 0.57 0.60 0.64 0.67 0.70 0.74 0.77 0.80 0.81 0.84 0.90 0.95
    • Hip 50 55 60 65 70 75 80 85 90 95 100 105 110 115 120 125 130 135 140(cm)50 1.00 1.10 1.20 1.30 1.40 1.50 1.60 1.70 1.80 1.90 2.00 2.10 2.20 2.30 2.40 2.50 2.60 2.70 2.8055 0.91 1.00 1.09 1.18 1.27 1.36 1.45 1.55 1.64 1.73 1.82 1.91 2.00 2.09 2.18 2.27 2.36 2.45 2.5460 0.83 0.92 1.00 1.08 1.17 1.25 1.33 1.42 1.50 1.58 1.67 1.75 1.83 1.92 2.00 2.06 2.17 2.25 2.3365 0.77 0.85 0.92 1.00 1.06 1.15 1.23 1.31 1.38 1.46 1.54 1.62 1.69 1.77 1.85 1.92 2.00 2.08 2.1570 0.71 0.79 0.86 0.93 1.00 1.04 1.14 1.21 1.29 1.36 1.48 1.50 1.57 1.67 1.78 1.70 1.86 1.81 2.0075 0.67 0.73 0.80 0.87 0.93 1.00 1.02 1.13 1.20 1.28 1.41 1.40 1.47 1.61 1.60 1.67 1.73 1.80 1.8780 0.63 0.69 0.75 0.81 0.88 0.94 1.00 1.06 1.13 1.19 1.25 1.31 1.38 1.44 1.50 1.56 1.63 1.69 1.7585 0.59 0.65 0.71 0.76 0.82 0.88 0.94 1.00 1.06 1.12 1.18 1.24 1.29 1.35 1.41 1.47 1.53 1.59 1.6590 0.56 0.61 0.68 0.72 0.78 0.83 0.89 0.94 1.00 1.06 1.11 1.18 1.22 1.28 1.33 1.39 1.44 1.50 1.5695 0.51 0.56 0.63 0.68 0.74 0.79 0.84 0.89 0.95 1.00 1.05 1.11 1.16 1.21 1.26 1.32 1.37 1.42 1.44100 0.50 0.55 0.60 0.65 0.70 0.75 0.80 0.85 0.90 0.95 1.00 1.05 1.10 1.15 1.20 1.25 1.30 1.35 1.40105 0.48 0.52 0.57 0.62 0.68 0.71 0.76 0.81 0.86 0.90 0.95 1.00 1.05 1.10 1.14 1.19 1.24 1.29 1.33110 0.45 0.50 0.55 0.59 0.64 0.68 0.73 0.77 0.82 0.86 0.91 0.95 1.00 1.05 1.09 1.14 1.18 1.23 1.27115 0.43 0.48 0.52 0.57 0.61 0.65 0.70 0.74 0.78 0.83 0.87 0.91 0.96 1.00 1.04 1.09 1.13 1.12 1.22120 0.47 0.46 0.50 0.54 0.58 0.63 0.68 0.71 0.76 0.79 0.83 0.88 0.88 0.98 1.00 1.04 1.08 1.11 1.14125 0.40 0.44 0.48 0.52 0.56 0.60 0.64 0.68 0.72 0.76 0.80 0.84 0.85 0.92 0.96 1.00 1.04 1.08 1.12130 0.38 0.42 0.46 0.50 0.54 0.58 0.62 0.65 0.69 0.73 0.77 0.81 0.81 0.86 0.92 0.96 1.00 1.04 1.08135 0.37 0.41 0.44 0.48 0.52 0.56 0.59 0.63 0.67 0.70 0.74 0.78 0.79 0.85 0.88 0.93 0.96 1.00 1.04140 0.36 0.39 0.43 0.46 0.50 0.54 0.57 0.61 0.64 0.68 0.71 0.75 0.76 0.82 0.86 0.84 0.91 0.96 1.00145 0.34 0.38 0.41 0.43 0.48 0.52 0.55 0.59 0.62 0.66 0.69 0.73 0.75 0.78 0.81 0.83 0.88 0.91 0.98150 0.33 0.37 0.40 0.41 0.46 0.50 0.54 0.57 0.60 0.64 0.67 0.70 0.74 0.77 0.80 0.81 0.84 0.90 0.95
    • Master chart 1 Sl N OPD Date of Name A S Rl O E Dt F Ch Gr Result NO Initiation Yrs S H 1 03529 12/06/99 DRS 48 M 2 2 4 M P 3 A Cured 2 11215 25/10/99 NPS 37 M 3 1 4 V P 1 A Not responded 3 11218 26/10/99 IDB 48 M 1 1 4 V P 1 A Cured 4 11237 26/10/99 ARM 55 M 2 1 3 M M 2 A Not responded 5 11194 26/10/99 MKJ 48 M 1 1 3 M P 3 A Cured 6 11416 29/10/99 PHG 40 M 3 1 3 V P 3 A Cured 7 02438 25/05/99 SHH 21 F 1 1 2 V P 3 A Palliative 8 03606 14/06/99 GTH 58 F 1 1 2 V M 3 A Palliative 9 04587 02/07/99 SAP 43 F 1 2 3 M M 2 A Cured 10 08704 11/09/99 AGB 20 F 1 1 4 V P 1 A Not responded 11 08769 14/09/99 SDS 53 F 3 1 4 M M 3 A Not responded 12 11059 22/10/99 MFA 42 F 1 1 2 M P 2 A Cured 13 10667 25/10/99 VKP 36 F 1 1 3 V P 3 A Not responded 14 11196 26/10/99 BRK 27 F 1 1 2 V P 3 A Cured 15 11405 29/10/99 BPG 35 F 1 1 3 V M 3 A Cured 16 06118 30/07/99 HSM 52 M 3 2 4 V N 3 B Cured 17 06645 09/08/99 APS 44 M 3 1 3 V N 2 B Cured 18 06659 09/08/99 TDN 60 M 1 1 2 V N 2 B Cured 19 02241 21/05/99 NMN 21 F 3 2 4 V M 3 B Palliative 20 03482 11/06/99 MNK 26 F 1 1 2 V M 1 B Cured 21 03742 15/06/99 JSM 55 F 1 2 4 V N 3 B Palliative 22 04878 07/07/99 LPO 41 F 1 1 4 V N 2 B Cured 23 06895 13/08/99 ZRC 36 F 2 1 2 V N 3 B Cured 24 07278 19/08/99 VFM 27 F 1 1 4 V P 3 B Palliative 25 11090 20/12/99 ABC 60 F 1 1 3 V M 2 B Not responded 26 11200 25/10/99 LVB 31 F 1 1 4 V M 2 B Cured 27 11241 26/10/99 NVR 42 F 1 1 3 V M 1 B Palliative 28 11268 27/10/99 GHM 22 F 1 1 3 V P 2 B Cured 29 11522 30/10/99 SVD 36 F 1 1 3 V N 3 B Cured 30 11531 30/10/99 SBH 56 F 1 2 4 V M 3 B Cured Age & Sex Ratio Religion Group Occupation M F T20 – 30 0 7 7 Hindu 21 Group A 15 Sedentary 2431 - 40 2 5 7 Muslim 03 Group B 15 Active, 0641 – 50 4 5 9 Others 06 Labor 0051 – 60 3 4 7 Total 9 + 21 = 30 Total 30 Total 30 Total 30 Economical Status Diet Family history Chronicity Gr 1 00 Veg 24 Paternal 12 Since 2 yrs - 5 Gr 2 07 Mixed 06 Maternal 11 Since 3 yrs - 9 Gr 3 11 Total 30 Nil 07 More than 3 yrs - 16 Gr 4 12 Total 30 Total 30 Total 30A – Age in Yea rs, S – Sex (M – Male, F – Female), Rl - Religion (1- Hindu, 2 - Muslim, 3 - others),O - Occupation (1 - Sedentary, 2 - Active, 3 - Labor), ES - Economical status (1= 0-1Lack,2=1-2 L,3=2-3 L,4=3 L &above), Dt - Diet (v - vegetarian, M - mixed) FH – Family history (P- Paternal, M – Maternal), Chronicity – 1 – since 2yrs, 2 – since 3 yrs, 3 – more than 3 yrs. Gr – Group ( A – Hyperlipidimic & Obese, B – Hypolipidimic & Obese),Re – Result ( 1 – Cured, 2 – Palliative, 3 – Responded, 4 – Not responded, 5 – Discontinued.)
    • WEL COME
    • “Evaluation of the efficacy of Pippalyadi Guggulu in Medoroga”(with special reference to its hypolipidimic effect). By Y.S.MUDIGOUDAR.
    • NIDANASN Nidanas CH SU MN A BP YR S1 Shlesmala Ahara - a - - a a2 Guru,Madhura,Sheeta,Snigdha a - a a - - Ahara3 Adhika matra sevana a - - - - -4 Adhyashana - a - - - -5 Avyayama a a - a a a6 Divashayana a a - a a a7 Avyavaya a - - - - -8 Na chinta and shoka a - - - - -9 Harsha nityatwa a - - - - -10 Bija swabhava a - - - - -
    • SAMPRAPTINidana Medo vriddhi SrotorodhaMEDOROGA Only Medodhatu poshanaAdhika Agni Amashaya Vata vriddhibojana vriddhi pravesha
    • RUPASl Laxanas Ch Su AS M.N B.P Y.R 1 Chala Spik Udara & Stana a - a a - a2 Kshudra Swasa - a - a a a3 Ayasa - - a - - -4 Aalpa bala a - a - a -5 Ati kshudha a a a a a a6 Ati pipasa a a a a a a7 Ati Nidra - a a a a a8 Ati sweda - a a a a a9 Dourgandhya a a a a a a10 Moha - - - a a a11 Krathan - a - - a -12 Utsahahani a - a a - a13 Javoparodha a - - - - -14 Jadya - - a - - -15 Soukumaryatwa - - - - - -16 Kricha vyavayata a - - a a a17 Gadgadatwa - a a - - -18 Alpa ayu a - a a - a
    • UPADRAVASl No Upadravas Ch Su AS B P MN YR 1 Vata pitta Vikara a - - - a - 2 Prameha Pidika - a a - - - 3 Jwara - a a a - a 4 Bhagandara - a a a - a 5 Vidradhi - a a - - - 6 Vatavikara - a - - - - 7 Udar roga - - a - - - 8 Prameha - - a a - a 9 Urustambha - - a - - - 10 Kushta - - - a - - 11 Visarpa - - - a - a 12 Atisara - - - a - a 13 Arsha - - - a - a 14 Shleepada - - - a - a 15 Apachi - - - a - a 16 Kamala - - - a - a 17 Jantavo Anavaha - - - a - -
    • CHIKITSAThere are three ways of reducing over weight:1) Increase the output of work2) Reduce the food intake, and3) Plan for a suitable medication.In other wordsa) Aharab) Viharac) Aushadha
    • Properties of DrugsN Name Rasa Guna Veerya Vipaka Karma Doshagnata1 Haritaki All except Lavana Laghu, Rooksha Ushna Madhura Lekhana Tridosha2 Bibhitaki Kashaya Laghu, Rooksha Ushna Madhura Medohara Tridosha3 Amalaki All except lavana Guru, Rooksha,Sheeta Sheeta Madhura Rasayana, Medohara Tridosha4 Pippali Katu Laghu, Snigdha,Tikshna Anushna Madhura Meda and kaphahara Kapha vata Sheeta Yogavahi5 Guggulu Katu Laghu,Sukshma, Tikshna, Ushna Katu Medohara, Lekhana Tridosha Ushna, Vishada6 Madhu Madhura, kashya Laghu, Rooksha, Sheeta, -- Lekhana, Yogavahi, Tridosha Sukshma -- Srotoshodhaka7 Gomutra Katu, lavana Laghu, Rooksha, Tikshna, Ushna -- Medohara, Deepana Kapha vata. Rooksha and pachana.
    • PARAMETERSSigns & symptoms according to AyurvedLipid profileIdeal weight chartBMIHip to waist ratio
    • RESULTSSl Objectives Group Total Mean S.D. S.E. ITI P – Value Remark1 Serum cholesterol A 363 24.20 10.58 2.75 8.55 P< 0.001 Highly significant B 286 19.06 08.52 2.20 8.66 P< 0.001 Highly significant2 Serum Triglyceride A 288 19.20 19.37 5.00 3.84 P< 0.001 Highly significant B 169 11.26 05.59 1.44 7.79 P< 0.001 Highly significant3 Serum HDL A 030 02.00 01.00 0.25 7.74 P< 0.001 Highly significant Cholesterol B 032 02.13 01.55 0.40 5.32 P< 0.001 Highly significant4 Serum LDL A 233 15.53 07.72 1.99 7.78 P< 0.001 Highly significant Cholesterol B 182 12.13 05.84 1.50 8.04 P< 0.001 Highly significant5 Serum VLDL A 094 06.26 04.58 1.18 5.28 P< 0.001 Highly significant Cholesterol B 034 02.26 01.33 0.34 6.57 P< 0.001 Highly significant6 Random blood A 215 14.33 17.40 4.49 3.18 P< 0.010 significant sugar B 187 12.46 09.21 2.37 5.24 P< 0.001 Highly significant7 Weight A 051 03.40 01.12 0.28 11.7 P< 0.001 Highly significant B 061 04.06 01.16 0.30 13.5 P< 0.001 Highly significant8 Circumference of A 027 01.80 01.14 0.29 6.08 P< 0.001 Highly significant Udara B 032 02.13 01.12 0.29 7.34 P< 0.001 Highly significant9 Circumference of A 067 04.46 03.11 0.80 5.55 P< 0.001 Highly significant sphik B 080 05.33 03.39 0.87 6.08 P< 0.001 Highly significant10 Circumference of A 028 01.86 01.45 0.37 4.96 P< 0.001 Highly significant sthana B 036 02.40 01.54 0.40 6.00 P< 0.001 Highly significant
    • RESULT GRAPH Group B Not responded Group B Palliative 3% 13% Group A Relived 27% Group A PalliativeGroup B Relived 7% 33% Group A Not responded 17%
    • CONCLUSION- Drugs used in the compound Pippalyadi Guggulu are having antagonistic properties to Kapha and Meda viz laghu, Rooksha, Teekshna guna and Ushna veerya. There by it subsides meda and kapha. At the same time Haritaki, Guggulu and Gomutra are known for their Lekhana Karma.
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