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Evaluation of the effect of Bruhatpanchamooladi Yoga in Medoroga By VEENA S. JIGALUR, Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103

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Sthoulya kc047 gdg

  1. 1. “Evaluation of the effect ofBruhatpanchamooladi Yoga in Medoroga” By VEENA S. JIGALUR Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfillment of the degree of Ayurveda Vachaspati M.D. In Kayachikitsa Under the Guidance of Dr. Shiva Rama Prasad Kethamakka M.D. (Ayu) (Osm), C.O.P. (German) M.A., [Ph.D] (Jyotish) Department of KayachikitsaPost Graduate Studies & Research CenterD.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2006-2009
  2. 2. D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103 This is to certify that the dissertation “Evaluation of the effect of Bruhatpanchamooladi Yoga in Medoroga” is a bonafide research work done by Veena. S. Jigalur in partial fulfillment of the requirement for the post graduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health Sciences, Bangalore, Karnataka.Date: GuidePlace: Prof. Dr. Shiva Rama Prasad Kethamakka M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish) Professor in Kayachikitsa DGMAMC, PGS&RC, Gadag
  3. 3. J.S.V.V. SAMSTHE’S D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103 Endorsement by the H.O.D, principal/ head of the institution This is to certify that the dissertation entitled “Evaluation of the effect ofBruhatpanchamooladi Yoga in Medoroga” is a bonafide research work done byVeena. S. Jigalur under the guidance of Prof. Dr. Shiva Rama Prasad Kethamakka,M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish), Professor in Kayachikitsa in partialfulfillment of the requirement for the post graduation degree of “Ayurveda Vachaspati M.D.(Kayachikitsa)” Under Rajeev Gandhi University of Health Sciences, Bangalore,Karnataka.. Professor & HOD (Dr. G. B. Patil) Dept. of Kayachikitsa Principal, PGS&RC DGM Ayurvedic Medical College, Date: Gadag Place: Gadag Date: Place:
  4. 4. Declaration by the candidate I here by declare that this dissertation / thesis entitled “Evaluation of the effect ofBruhatpanchamooladi Yoga in Medoroga” is a bonafide and genuine research workcarried out by me under the guidance of Prof. Dr. Shiva Rama Prasad Kethamakka,M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)], Professor in Kayachikitsa, DGMAMC,PGS&RC, Gadag.DatePlace Veena S Jigalur
  5. 5. Copy right Declaration by the candidate I here by declare that the Rajiv Gandhi University of Health Sciences, Karnatakashall have the rights to preserve, use and disseminate this dissertation/ thesis in print orelectronic format for the academic / research purpose.DatePlace Veena S Jigalur© Rajiv Gandhi University of Health Sciences, Karnataka
  6. 6. Acknowledgement First and foremost, I salute almighty God who is omnipresent, omniscient andomnipotent. He is the possessor of the ocean of knowledge and wisdom-to which I wouldlike to contribute a drop in the form of my dissertation. As it is said, each and every dropgoes to make an ocean; this is my humble endeavor towards its goal of wisdom. It givesme in expressible pleasure to offer my sincere thanks to all who have rendered theirwholehearted support, guidance and co-operation in completing the thesis work. I am extremely happy to express my deepest sense of gratitude to my beloved andrespected guide Prof. Dr. K. Shiva Rama Prasad, M.D., C.O.P. (German), M.A., [Ph.D.](Jyotish), Department of Kayachikitsa (PG), for his guidance and timely help. I am sincerely gratefulness to Dr.G.B.Patil, Principal, for his encouragement andproviding all necessary facilities for this research work. I extend my gratitude to Dr. R.V.Shettar, Dr.Mulki Patil, Dr. Shankaragouda,Dr.V.Varadacharlu, Dr.P.Shivaramudu, Dr.G.Purushottamacharyulu, Dr.M.C.Patil, Dr.G.Danappagoudar, Dr.S.N.Belawadi, Dr.Nedugundi, Dr.Samudri, Dr,Kuber sankh.Dr.Mulgund, Dr.J.Mitti, Dr.Yasmin A.P. and all my U.G. Lecturers for time-to-time helpoffered by them. I express my immense gratitude to my statistician Nandakumar, librarian V.B.Mundinamani and assistant Shavi & Kerur for facilitating me in collection andproduction of my thesis. I would like to thank my family members who have given love and care duringmy studies. My deep sense of gratification is due for my Father Dr.S.B.Jigalur and mymother Smt.Bhagirathi S. Jigalur who are the architects of my career. The culture,discipline and perseverance, which I could imbibe, are solely because of theirpainstaking, upbringing and strong moral support. I express my deep gratitude toDr.Gachinmani N.G. for inspiring me to higher studies, and helped me in each and everystep of this course with his valuable suggestions. I express my heartfelt gratitude to my brother, Mr.Vivek Jigalur and my SisterSmt.Vidya Modi for constant help and encouragement to move ahead. My deepestgratitude to my husband for enormous love and moral support. EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA - ACKNOWLEDGEMENT
  7. 7. I feel proud in expressing my gratitude to final year UGS who helped me incarrying trial work. I take this moment to express my thanks to all my Post gratude colleagues, Dr.Ashok M.G., Dr.Kamalaxi, Dr.Sulochana, Dr.Shivaleela Kalyani, Dr.Prasann Joshi, Dr.Sanjeev Choudhari, Dr.Neeraj kumar, Dr. Vijayalakshmi B, Dr. Anupama Bijjal,Dr.Trupti Itagi, Dr.Ishwar Patil, Dr.Bodke, Dr.Kanthi, Dr.Praveen, Dr.Deepa T, Dr.AshaM. Finally I am thankful to all those who helped directly or indirectly for thecompletion of this work.(Veena S Jigalur.) EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA - ACKNOWLEDGEMENT
  8. 8. Contents of “Evaluation of the effect of Bruhatpanchamuladi Yoga in Medoroga” By Veena S. JigalurCHAPTER CONTENTS PAGES 1 Introduction 1 -3 2 Objectives 4 -5 3 Review of literature 6 - 78 4 Methods 79 - 87 5 Results 88 - 101 6 Discussion 102 - 113 7 Conclusion 114- 115 8 Summary 116- 117 9 Bibliographic References 1 to 9 10 Annex – data of clinical trial 1 to 12 11 Annex – Case sheet 1 to 6
  9. 9. Tables “Evaluation of the effect of Bruhatpanchamuladi yoga in Medoroga” By Veena S. Jigalur.S.N Title of Table Page 1 Showing the Manasika Nidana of Sthoulya 19 2 Showing the Vjharatmaka Nidana of Sthoulya 19 3 Showing the Aharaja Nidana of Sthoulya 20 4 Showing the Anya Nidana of Sthoulya 20 5 Showing Roopa of Sthoulya 29 6 Showing the Upadrava of Sthoulya 32 7 Showing Ahararoopi Pathya-Apathya for Sthoulya 38 8 Showing Vihararoopi Pathya-Apathya for Sthoulya 38 9 Showing Manasika Pathya-Apathya for Sthoulya 37 10 Showing Sadhyasadhyata of Sthoulya 39 11 Showing Methods of Estimating Body Fat and its Distribution 51 12 Showing Grading Pattern as per BMI Values 51 13 Showing Classification of Vasti According to Site of Application 63 14 Showing external Vasti Procedures 63 15 Showing Classification of Vasti On Sankhya Bheda 64 16 Showing Classification of Vasti On Karma Bheda 64 17 Showing Ingredients of Vasti 67 18 Showing ingredients of Internal medicine 67 19 Results by Age in Sthoulya with Bruhatpanchamuladi Yoga 89 20 Results by Gender in Sthoulya with Bruhatpanchamuladi Yoga 90 21 Results by Religion in Sthoulya with Bruhatpanchamuladi Yoga 91 22 Results by Occupation in Sthoulya with Bruhatpanchamuladi Yoga 92 23 Results by Economic Status in Sthoulya with Bruhatpanchamuladi 93 24 Results by Diet in Sthoulya with Bruhatpanchamuladi Yoga 94 25 Distribution of Patients by Presenting Complaints 95 26 Distribution of Patients by Associated Complaints 97 27 Ahara Nidana Observed in the Study 97 28 Vihara Nidana Observed in the Study 98 29 manasika Nidana Observed in the Study 98 30 Chronicity of sthoulya Observed in the Study 99 31 Data of Family History in the study 99 32 Results of Bruhatpanchamuladi Yoga in Sthoulya 100 33 Statistical analysis of Bruhatpanchamuladi Yoga 101
  10. 10. Figures and Photos “Evaluation of the effect of Bruhatpanchamuladi yoga in Medoroga” By Veena S. Jigalur.S.N Title of Figures and Photos Page1 Sthoulya samprapti 222 Upadrava of sthoulya 333 Sthoulya Chikitsa 374 Pathogenesis of Obesity 435 Body fat Distribution 496 Measuring Skin Fold Thickness 517 Risk Classification Algorithm 548 Composition of Bruhatpanchamuladi Yoga 679 Results by Age in Sthoulya with Bruhatpanchamuladi Yoga 8910 Results by Gender in Sthoulya with Bruhatpanchamuladi Yoga 9011 Results by Religion in Sthoulya with Bruhatpanchamuladi Yoga 9112 Results by Occupation in Sthoulya with Bruhatpanchamuladi Yoga 9213 Results by Economic Status in Sthoulya with Bruhatpanchamuladi 94 Yoga14 Results by Diet in Sthoulya with Bruhatpanchamuladi Yoga 9515 Distribution of Patients by Presenting Complaint 9616 Distribution of Patients by Associated Complaint 9717 Results of Sthoulya With Bruhatpanchamuladi Yoga 100
  11. 11. Abstract of “Evaluation of the effect of Bruhatpanchamuladi Yoga in Medoroga” Key words: Sthoulya, Chala udara, Bahudoshja vyadhi, Sedentary lifestyle, Waist hip ratio, Phenotype obesity, Bruhatpanchamuladi yoga A recent world health study reports that obesity is included among the top tenselected risks to health. Sedentary lifestyle and inclusion of increased intake of oily andfatty foods in the daily diet result in this disorder. 75% Indian women in the cities areapple-shaped, while 58% men are so. As Charka’s explanation of sthoulya matches withphenotype of obesity, W.H.Ratio and skin fold thickness can be taken as parameters toassess the sthoulya, as W.H.Ratio helps to check the abdominal fat (Chala udara) andgluteal fat (chala sphik) & Skin fold thickness helps to measure regional fat (chala sthana).Charaka has described sthoulya under 8 undesirable constitutions based on theirugly/awkward appearance, victims of public abuse, unmanageable health condition.Sthoulya is one among kapha predominant diseases (sleshma nanatmaja) involving kaphaand medas as main dosha and dushya in the pathogenesis. Charaka clearly mentioned thatsthoulya and prameha have a direct relation because both have kledaka kapha and medasdominance in their pathogenesis. It is also prescribed that sthoulya is a bahudoshaja vyadhiwhich further proves that it is the root cause of many killer diseases like diabetes, HTN,and heart diseases. Bruhatpanchamuladi yoga ingredients are kapha and medohara dravyas collectedform local area and prepared under GMP conditions, weighing about 500mg tablet form.Patients of Sthoulya fulfilling the criteria of diagnosis were selected in the present study.The female and male ratio in the study is approximately 3:2 patients and 76% patients wererecorded with sedentary life styles. In the present study 53.3% patients had family history.Apart from the symptoms which show high significance in the study the key parameters toassess “sthoulya”, W.H.Ratio has shown highly significance than any other with 8.04 % ofmean reduction, and Chala Udara with 68.25% of mean reduction. This is strong evidenceto state that the Bruhatpanchamuladi yoga is good combination of Ayurveda in reducingSthoulya / obesity. EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA - ABSTRACT
  12. 12. Chapter -1 Introduction “You are not good enough, is the message family and society send to Overweightand Obese people especially to women”. It’s nearly 60 years since a poet Simone deBeauvoir famously wrote, one is not born a woman but becomes one. Many of Obeselives are bedeviled by the three-letter word, ‘FAT’ along with “social anxiety, loss ofself-esteem, isolation and vulnerability in social and private lives”. In the present days the man has to run with the time and he is trying to leadmechanical life. Though he knows the ill effects of such mechanical life, he made himselfvictim to it by suffering with many disorders, among these sthoulya is a global problemand more common in modernized man and in present era. This sthoulya is considered as Santarpanajanya vyadhi and one among the Ashtanidhita purushas and also as Kaphaja nanatmaja vyadhi. The obesity is the certainly themother of dangerous diseases1 and most burning problem in the present society. Obesityhas become an epidemic in 21st century2. It is a bitter truth to swallow about every 4thperson on earth is too fat. Weighty women get six times more diseases3. Obesity is fastbecoming one of the worlds leading reason why the people die4. The ancient Indian science of health, Ayurveda is now being increasingly acceptedby the world at large for its facilities and adoptability even to the modern times. It is notsurprising that, the ancient science is accorded such importance in countries wheremodern medicine itself has made immense advances. The only reasonable explanationfor this phenomenon is the fact that Ayurveda remains the only system of medicine thatpossesses a natural form of treatment, one that prescribes remedies in accordance with 1 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-INTRODUCTION
  13. 13. nature itself. It approaches a patient holistically, taking in to account while treatingperson, not only the patient but also his general condition.Prevalence: According to WHO this obesity is considered as secondary in the list of dangerousdiseases in the world5 many remedies have been put forwarded till now like surgicallipisection, treatments etc. but there are so many complications observed with those. Dueto lack of knowledge about the diet & rules for taking the food this is greatly observed inthe developed countries like USA that showing approx one in six or 39.8 million peopleand over 300 million adults worldwide (WHO world health report, 2003) were sufferingfrom obesity6. 75% Indian women in the cities are apple shaped, while 58% of men areso7. They are searching for the solutions either by dietary things as well as keeping stresson need of exercise. So by observing these facts & statistics prevalence of over weightand obesity in India it is badly in need of a better remedy.Previous research literatures: 1) Clinical trial on obesity with lekhanvasti, Yoga and diet control. 2004 .AKDA, Amravati university Maharashtra. 2) Evaluation of efficacy of tryushanadhya loham in sthoulya w.s.r. to Hyperlipidaemia. 2004. Gadag Karnataka. 3) Effect of Guduchyadi yoga in Sthoulya. 2005, Pune. 4) Evaluation of Efficacy of Bhadradi Asthapana Vasti in Sthoulya 2007 Gadag, Karnataka.Research question: 2 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-INTRODUCTION
  14. 14. The transformation of India into an affluent nation has brought changes in lifestyle, and junk food diet that have led to an increase in Obesity8. Accumulated wealth andlower physical activity in the setting of deskwhite color jobs with more mental activityhas created a population who has a net increase in available energy stored as fat9,10. andto set a disease called as Obesity. Many research works have been carried out in relation to shamana treatment asmentioned in classics and their therapeutic values are proved. Present research work isintended to evaluate the effect of herbal combinations used as different line of treatments( Block box clinical trial). So looking for a better management needed.About concept: As Sthoulya being a morbid disease only Shamana can not give a better remedy,hence treatment can be better done if it is done after deha shodhana11, as shodhanaprevents the relapse of the condition. If treatment is given without shareera shudhi it isalmost like colouring a dirty cloth12. Hence here an attempt is made to treat Sthoulya withshodhana then with shamanoushadhi. In this study the selected drug Brihatpanchamoola are having laghu, rookshaguna, kashaya, tikta rasa, katu vipaka and ushna veerya. Due to these properties it acts asvatakaphahara and relives the medavrutavata.The study description: The study description consists of the headings according to the RGUHS protocolfollowed from 2nd chapter. 3 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-INTRODUCTION
  15. 15. Chapter -2 Objectives Ayurvedic science, a boon in today’s world, describes swastha parayanata,which means maintenance of health in the one hand and treatment of disease on the other.It has been described in Ayurveda that it is not rational treatment where the medicinemodifies one disease; on the other hand it provokes new complications. So here, we areputting our step forward to find safe and effective remedy for weight reduction. Thirty years ago13 overweight and obesity was defined as a nutritional disorder butit continues to be one of the most important yet preventable health hazards. Thetransformation of India in to an affluent nation has brought changes in lifestyle, and junkfood diet that have led to an increase in Obesity14 Accumulated wealth and lowerphysical activity in the setting ‘desk’ white collar jobs with more mental activity hascreated a population who has a net increase in available energy stored as fat15&16 and toset a disease called as obesity. Obesity i.e. sthoulya is a chronic disease that is increasing in prevalence and posesa serious risk for the development of many metabolic diseases such as diabetes mellitus,hypertension, heart diseases etc. To prevent such diseases it is very much required toattend the problem which is told as Sthoulya medoroga in Ayurveda. Till today many research works were taken up on the basis of Medohar andKaphahara therapy. The present study intended to focus on the disease evaluation i.e.Sthoulya and the management with Bruhatpanchamuladi yoga as a shamana as well asshodhana chikitsa. In this regard the objectives proposed in the study are - EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-OBJECTIVES 4
  16. 16. Objectives:1) Evaluation of the effect of Bruhatpanchamuladi yoga in medoroga w.s.r.t. weight.2) Evaluation of the effect of Bruhatpanchamuladi yoga in medoroga w.s.r.t. B.M.I.3) Evaluation of the effect of Bruhatpanchamuladi yoga in medoroga w.s.r.t. Waist Hip Ratio. The drugs which come under Brihatpanchamula (Bilwa, Agnimantha,Shyonaka, Gambhari and Patala) are having laghu and ruksha guna, kashaya and tiktarasa, katu vipaka, ushna veerya. Due to these properties it acts as vata kaphahara and atthe same time relieves the Medavruta vata inturn does samprapti vighatana, hence helpsto overcome Sthulata in terms of weight, B.M.I. and W.H.Ratio. In Indian population we observe many people with relatively lower B.M.I. butwith higher W.H.Ratio. It indicates presence of phenotype of obesity in Indians which isexactly explained as lakshanas of Sthoulya by Charaka as spik, udara, sthana chalatwa. Inthis study we have an aim to study the effect of the drug in Indian population byobserving effect on W.H.Ratio. EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-OBJECTIVES 5
  17. 17. Chapter -3 Review of literatureMedoroga – Sthoulya. Sthoulya and Medoroga are the two words used to describe the obese person inAyurvedic literature. There are two different views one supporting the thought that theSthoulya and Medoroga are one and same, and others opine that they are differententities.Supporting view for sthoulya as equivalent to medoroga:1) Chakrapani in his book Chakradutta has fallowed the sequence adopted byMadhvakara in Madhava Nidana for description of various Diseases. But Chakrapani haddescribed Sthoulya under the heading of Sthoulya chikitsa17. Where as in Madhavanidanathis is described under Medoroga described by Madhava18, treatment is advised byChakrapani under Sthoulya Chikitsa.2) Charaka had used the terms like Medasvi, Medovruddhi in context of Sthoulya todescribe a Sthula person19.3) Sharangadhara has specified Medoroga is of only one type20. Adhamalla commentsand made clear that medoroga is one in which Medomamsa ativrudhi is seen i.e.,Sthoulya21.Supporting view for sthoulya and medoroga as different entities: One who differs with the above opinion gives the reason as, Medoroga is enlistedamong “Vamana arha Vyadhi” by Sushruta22 and by Vagbhata Sthoulya is 6 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  18. 18. enlisted under “Vamana anarha Vyadhi”23 by the authors. But acharya Vagbhatahimself opines to adopt Samshodhana roopi, Langhana in case of Atisthoulya24. So the indication and contra-indication is general guidelines. It is up to thephysician to decide the proper line of treatment depending upon various factorslike Dosha, Dushya, Vyadhi, Bala etc. However by analyzing, one can speculate theSthoulya and Medoroga suggest the different stages of same disease process. 1) Medovrudhi is Pathogenesis 2) Medoroga and Medodosha are the Pathophysiology 3) Sthoulya is the resultant Diseases Depending upon Nidana, Lakshana, Upadrava and Chikitsa one can say thatSthoulya is nothing but Obesity told by cotemporary system. PHYSIOLOGICAL CONSIDERATION OF MEDODHATU Sthoulya being a Dooshya dominant disorder, in that, Meda plays a major role inpathogenesis. Meda is one among the saptha dhatu.Nirukti: Literally the word meda is derived from the root, This means “Jhimida snehane” stands for sneha, fat, oil etc25Definition: This produces smoothness in the bodySynonyms of Meda: Vapa, Vasa, Mamsa Sara, Mamsa sneha, Mamsasara bhuta dhatu,Asthikrit(as it forms asthi), Majja(Asthi majjagata sneha), Gada(mastishkagata sneha)etc.Sthana and Swarupa of Meda dhatu: There are 2 types of Medadhatu. One isPoshaka and second is Poshya. Among these two, poshaka meda dhatu is gatiyukta,this is circulated, in the whole body along the Rasa – Rakta dhatu, to give the nutrition 7 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  19. 19. to poshya meda dhatu. Second poshya meda dhatu is Gativivarjita, which is stored inMedodharakala. The site of medodharakala is Udara and Anuasthi, Udara, Sphik, Sthana,Gala are also depots of poshya meda. It is also found in mamsa as Vasa26.Utpatti of meda dhatu: According to Caraka, when rakta dhatu gets solidified in thepresence of vayu, jala & agni mahabhuta and digested by raktagni, it forms mamsa dhatu.This mamsa dhatu being digested by mamsa dhatvagni and mixed with its own agni andjala property, transformed into meda dhatu27.Pramana of Meda dhatu: Two anjali is said to be the quantity of Meda dhatu28.Meda Dhatu Mala: Sweda is the mala of Meda dhatu29.Meda Dhatu Upadhatu: Snayu and sandhis are the upadhatu of Medas30.Medavaha srotas: The internal transportation system of the body is represented as srotas.Medovaha srotas are the channels that transport poshaka meda dhatu to the seat of poshyaor sthayi meda dhatuMoola of Medovaha Srotas: According to Ayurvedic classics every srotas has itsdefinite roots or place of origin, same in case of Medovaha srotas. Different ancientAcharyas have drawn their opinions regarding root or moola of meda vaha srotas asfollows, Charaka - Vrikka, Vapavahana31 Sushrut - Vrikka, Kati32 Vagbhata -Vrikka, mamsa (Vasa) Sushruta and Vagbhata quotes anatomical preference than the physiological pointof view in considering kati and mamsa as mula of medovaha srotas. Where as Charaka’sconsideration of Vapavahana was physiological one. 8 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  20. 20. Medodhara Kala: It is the third Kala, present in Udara and Sukshma Asthi33.Ashrayashrayeebhava of Meda: Kapha resides in Meda and Kapha is Ashrayee andMeda is Ashraya34.Karma of Meda dhatu: 35 • Sneha: Sneha property helps to keep luster of skin, hairs and eyes etc. • Sweda: During the stage of Meda dhatvagnipaka, sweda is produced as kitta bhaga36. Sharangadhar has considered sweda as the upadhatu of meda. • Drudhata: According to Caraka snayu and sandhis are upadhatus of Meda37 which gives strength to the body • Asthipusthi: Nourishment of further dhatu i.e. asthi and its upadhatu is Snayu and Sandhi38. • Further Vagbhata has mentioned, Netra and gatrasnigdhata are the symptoms of sthoulya may arise through increased Snehana function of Meda39.Meda Dhatu Vridhi Lakshana: Snigdhata of Shareera, vrudhi of Udara and parshwa,kasa, swasa, hikka, dourgandha of shareera are seen as Meda vrudhi lakshana. It is alsomentioned that these persons will have Shrama and increase in size of Sphik, sthana andUdara40. NIRUKTI &VYUTPATTIVyutpatti: The word Sthoulya is derived from root “Sthu” with suffix “Ach” whichstands probably for thick or solid or strong or big or bulky41. • Shtulasya bhavam Sthoulyam – vachaspathyam (6/358) • Sthulayathi te cha athaha Sthoulyam - vachaspathyam (6/358) 9 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  21. 21. • Sthula paribhrane - Amarakosha (Nanartha varga 204)Nirukti: According to Sabdakalpadruma the existence of Sthoolatva (bulkiness) isknown as Sthoulya42.Paribhasha: A person having pendulous appearance of sphik, udara, and sthana due toexcess deposition of meda along with mamsa dhatu and also having unequal an abnormaldistribution of meda with reduced zeal towards life is called Atisthula43.Paryaya: Pinam, Pivara, Pivaram, Sthoola, Pina, Piva, Pivam, Pivasa, Pivasa, Pivistha,Medana, Medini, Medasvina44.HISTORICAL ELUCIDATIONVedic and Purana kala Sthoulya is not a new concept. It can be traced to Vedic and Purana kala as well.The first person to be described as Lambodara, Mahakaya etc. is lord Ganesha. According to Sanatana Dharma Shastra lord Ganesh is considered to be the lordof Jala Mahabuta. The lakshanas ascribed to Vinayaka are of Sthouly. Lord Ganesh is also namedmodaka priya. Modaka is a sweet dish prepared of red gram flour, ghee and sugar,possessing the properties of Madhura, Guru and Snigdha. These factors are likely tocause Sthoulya. The offerings of leaves made to the Lord are also specific and are 21 innumber. Durva, Bilwa, Karaveera, Arka , Kanchanara, Badar, Devadaru, Dhatura, Jati,Shami, Nirgundi, Dronapushpi, Dhataki, Kapitta, Shigru, Apamarga, Ashwatta,Machipatra, Brihati, Vishnukranta, Dadimapatra. All these are Kapha, Kandu, Kushta, 10 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  22. 22. Twagroganashakas, Pramehahara and some are Medohara, few are Atisaraharas. Theseare described as the Upadravas of Sthoulya roga. The later references of Sthoulya can be traced to the Rakshasa or Nishacharawho have been mentioned at the Deva-Danava struggle for Amritha at the sandhikala ofSatayuga and Tretayuga, later in the Ramayanakala and Dwaparayuga . The life style ofAsuras in almost all periods is similarly described. As nitya Mamsahara sevana,Madhyapana, Atinidra etc.. are all the Nidana for Sthoulya. This sect in itself is Sthoola,the Sthoolatva in Asuras is hereditary and natural which can be attributed to the beejaswabhava they are the Nindita as out cast of the community just as Charaka has describedAtisthoola as nindita purusha. BRUHATRAYICharaka samhita(Before 1000 BC) Incidence of disease may be high during that period; hence they were able tostudy the disease clinically. Charaka has considered sthoola as one of the Asta NinditaPurusha. He explains about stholya and its management in detail noting this as a graveproblem45.Sushruta samhita(1000-1500 BC) Increased incidences might have forced them to find the root cause. SoSushruta clearly quotes rasa is the cause for both sthoulya and krushata46.Astanga Hridaya(550C AD) Vagbhata discussed sthoulya in Dwividopakramaneeya chapter and included itunder ‘langhana’ therapy. Classification of Sthoulya and its management. Pathogenesis 11 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  23. 23. and symptoms of Sthoulya are highlighted. Treatment aspect of sthoulya is discussedvivid but further states that there is no specific medicine for Sthoulya47.LAGHUTRAYIMadhava nidana (9C AD) He is the first author to describe this disease under separate heading called “MedoRoga” in 34th chapter. He has mentioned Nidana, Lakshana and Samprapthi of thisdisease. Madhavakara renamed Sthoulya as medoroga and compiled the disease from theprevious authors. But change of nomenclature indicates instead of considering anatomicalchange i.e. shareera sthulata he wanted to consider physiological change in thecondition48.Sharangadhara Samhita(13C AD) This textbook is known for its many unique things like Nadi pareeksha, cleardefinition of pharmacological terms etc. He mentions about Sthoulya in rogagananaadhyaya, but has no details of it except about the management of medodosha asyogatraya49,50.Bhava Prakasha(16C AD) Author has stressed more on the treatment aspects compared to Brihatrayi.Acharya Bhava mishra has explained regarding a popular Dhupa called “Malayanila Dhupa” in 39th chapter of Chikitsa sthana. He has also explained regarding various Lepa and Udvartana to treat sthoulya. This author has explained sthoulya in separate chapter51. 12 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  24. 24. OTHER CLASSICAL TEXTSKashyapa Samhita: As this book gives more importance for “Koumarabruthya” and “Prasuthi tantra”,hence Acharya Kashyapa has described “Medasvi Dhatri Chikitsa”. Another specialty ofthis text is that Rakta mokshana(SIRAVYADHA) is explained as Chikitsa for Sthoulya52.Bhela Samhita: It is one of the popular texts of Ayurveda. In 11th Chapter of sutrasthana, variousaspects of Sthoulya have been explained. In Bhela samhita Sthoulya is described as adisorder of vitiated Meda 53.Yogaratnakara: Sthoulya is explained under a separate chapter. Many of the formulations to treatSthoola are explained. Explains Sthoulya under Medoroga nidanachikitsa adhyaya.Various herbo-mineral preparations been prescribed in the management of Sthoulya54.Chakradatta: Acharya Chakrapani datta has explained treatment of Sthoulya in 36th chapter55.Bhaishajyaratnavali: It is famous for various treatment and preparations of medicines. In 39th chapterSthoulya Chikitsa is explained56.Gada Nigraha: In 31st chapter, Sthoulya Roga and its Chikitsa is explained57. SANGRAHAKALA & COMMENTATORSChakrapani (11th Century): In line of treatment of Sthoulya he has commented that guru and Apatarpanaproperty helps to alleviate Kshudha and reduce Meda respectively58. 13 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  25. 25. Dalhana (12th Century): Explains regarding Ama formation in tikshnagni, Regarding line of treatment hehas interpreted virukshana as medoghna and chedaniya as sroto vishodhana.59Indu (13th Century): He has given explanation of Saktu, Loha etc. words used in the line treatment ofSthoulya.60Arunadutta (13th Century): The word “sthavima” has been used for the sthoulya, explained on the basis ofetymology in sarvanga sundari commentary in Astanga Hridaya.61Hemadri (13th Century): He has advised to take choorna of Yavani, Madukajalam as Madhu mishritaudaka Dandahata as Takra, Agnimantha as Tarkari, Kshara as Yavakshara, whilemanagement of Sthoulya in his Ayurveda Rasayana commentary on Astanga Hridaya.62Adhamalla(14thcentury) & Kashiram(17thcentury): Kashiram explained definition of Sarakthameda is the one which is situated innerto the majja of the sthulasthi.63 Medo dosha is of only one type and it is of vata pradhanais explained in Adhamalla gudartha deepika.64Vangasena (12thcentury): Explains Karana, Samprapti, laxana, Chikista of Sthoulya in Medorogadhikara.65 Nidana The low of nature states that without cause effect is not possible. As per thesequence of Pathogenesis of disease given by Madhavakara, Nidana is the first andforemost step for the manifestation of the disease and it gives the particular knowledge 14 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  26. 26. about the Pathogenesis of the disease, hence etiological factors provides vital informationregarding diagnosis as well as involved pathological entities of a disease. Moreimportantly, most of the times guide the physician towards therapeutics & aid in advisingpathyapathya. In the context of Sthoulya causes may be of two types,1. Exogenous causes are potentiating diet and regimen2. Endogenous causes are dosha, dhatu, mala, srotas etc. • Acharya Charaka has mentioned the nidana of Sthoulya analytically 66.Most of them are of exogenous type. Charaka has also defined Beejadosha as one of thecause besides the other. • Acharya Sushruta and Vagbhsta have made mention of the endogenous type. By telling that rasa is the prime cause for the sthoulya67. • Vagbhata has also mentioned ama as a causative factor68.Further all the causative factors described in the Ayurvedic classics can be classified intofour groups. 1) Aharathamaka nidana 2) Viharathamaka nidana 3) Manasika nidana 4) Beeja swabhavaja nidanaAharaja nidana: On the basis of the samanya and vishesha sidhanta69 the excessive consumption ofsimilar substance(dravya samanys), similar quality(guna samanya) or similar in action(karma samanya) help in the overproduction of dhatu. When one or two or all the threeproperties are similar, then such substances boost up the growth of the dhatus which 15 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  27. 27. result as dhatuvrudhi. In the same way, the growth of medodhatu is observed byexcessive consumption of: Dravyasamanya: Mamsa and meda (animal and plant fats) Gunasamanya: Food with snigdha,guru guna like - ghrita, vasa, taila, dugdha etc. Food and drugs with sheetaveerya Substance with madhura rasa and vipaka. Karmasamanya: Sedentary life, avyayama, diwaswapna etc. Aharaja nidana are wide spectrum of etiological factors, which is having variationin Ahara krama at one end, and Rasadi factors at another end. The following are theAharaja Hetu70: 1. Adhyashana 2. Athi matra ahara 3. Athi sampurana 4. Guru, sheeta, pichila, snigdha guna ahara 5. Madhura Rasapradhana ahara 6. Specific dravya pradhana ahara • Adhyashana: Food that is consumed before the digestion of previous meal is called asAdhyashana. Here the patient will be not following the ahara ashta vidha visheshayatana. • Ati matra Ahara: Excess consumption of food is called as Athi matra Ahara sevana. Here theconsumption of food is related not only for quantity of intake but also the frequency ofintake. As the formation of Rasa is more, it over- nourishes the Dhatu of the body; thereby leading to Brihath Shareera. 16 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  28. 28. • Ati sampurana: Intake of food up to ones full belly is called as Athi sampurana. To assessthe quantity of food in take the parameters had been explained in the classics. • Guru, sheeta, pichila, snigdha guna ahara: All these guna have an affinity towards the Kapha and the Medas there byleading to increase in their quality and quantity. More over due to Picchila and Snigdhaguna, it causes the obstruction of the Vata in the srotas, in turn leads to sandukshana ofAgni. Guru and Snigdha are the properties of Meda or body fat. Acharya Caraka hasmentioned that, Meda is the seat of sleshma190 more over Meda and Sleshma possesssimilar properties. So sleshmala ahara ( guru & snigdha) can able to produce excessamount of fat in the body by virture of Ashryashryaee bhava and samanya vriddhi karanaconcept Thus guru and snigdha ahara leads to sthoulya) • Madhura Rasapradana ahara: Madhura Rasa is having the Kapha prakopaka property because of whichthere will be increase of Kapha and Medas. When the Madhura Rasa is added to Snigdhaguna then there will be more vitiation of Dosha.Viharaja nidana: Following life style factors play an important role in Sthoulya71:1. Avyayama2. Avyavaya3. Divaswapna 17 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  29. 29. 4. Asanasukha5. Swapnasukha • Avyayama & Avyavaya: A person one who is not indulging in physical exercise, lives luxuriously withsedentary life style will always tend to accumulation of kapha & meda in the body & thisleads to Sthoulya. • Diwaswapna & atinidra: All the acharyas have specially mentioned that day sleep is the one of the causefor aggravation of kapha and also a santarpaka hetu and increases the abhishyandi gunawhich obstructs the srotases of the body, leads to sthoulya in due course of time.Manasika nidana: Manasika bhavas have an important role in Sthoulya72,viz. 1. Harshanityatwa 2. Achintana 3. Soukhya. Mental disterbances (chinta) cause vata vrudhi, which indirectly cause dhatukshaya, where as prasanna manas always increases kapha and does tarpana hencebecomes hetu for the Sthoulya.Beejaswabhavaja: • Acharya Charaka has specifically mentioned Beejadosha as the nidana forSthoulya. Chakrapani and Gangadhara comments over this statement as “Ati sthula matapitru shonita shukra swabhavat”, which means the character of Sthoulya is inherited from 18 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  30. 30. Obese parents73. • In Bhavaprakasha it has been mentioned that decreased proportion of ‘shonita’and increased proportion of ‘shukra’ in beeja at the time of conception, results indevelopment of lean but potent body, while increased proportion of ‘shonita’ anddecreased proportion of ‘shukra’ predisposes towards the development of stout but weakbody74. These genetic disorders are said to be incurable. • Apart from that overnutrition during pregnancy, particularly with madhurarasa ismentioned as a predisposing factor for the birth of an obese child i.e, childhoodobesity, which indicates role of environmental and hereditary cultural factors in thegenesis of Sthoulya75.Tables showing different nidanas of Sthoulya76, 77, 78, 79,80,81,82.Table no.01. Showing manasika Nidana of Sthoulya: Sl. Nidana Ch. Su. As Ma Bh Yo No Sam Sam Hru Ni. Pr Ra. 1 Harsha Nitya + - + - - - 2 Achintana + - + - - - 3 Priyadarshana + - - - - -Table no.02. Showing viharatmaka Nidana of Sthoulya: Sl. Ch. Su. As Ma Bh Yo No Nidana Sam Sam Hru Ni. Pr Ra. 1 Avyayama + + - + + + 2 Avyavaya + - - - - - 3 Divaswapna + + - + + + 4 Sukha shayya + - + - - - 5 Gandhamala dharana + - - - - - 19 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  31. 31. Table no.03. Showing Aharaja NidhanaSNo Aharaja Nidana CH SU AS AH MN BP YR1. Atisampurana + - - - - - -2. Santarpana + - + + - - -3. Adhyasana - + - - - - -4. Guru Ahara Sevana + - - - - - -5. Madhura Ahara sevana + - - - - - -6. Sheeta Ahara Sevana + - - - - - -7. Snigdha Ahara Sevana + - + + + - +8. SleshmalaAhara Sevana + + - - + + +9. Navanna Sevana + - - - - - -10. Navamadya Sevana + - - - - - -11. Gramya Rasa Sevana + - - - - - -12. Mamsa Sevana + - - - - - -13. Paya Vikara Sevana + - + + - - -14. Dadhi Sevana + - - - - - -15. Sarpi Sevana + - - + - - -16. Ikshu vikara sevana + - - + - - -17. Guda vikara sevana + - - - - - -18. Shali Sevana + - - - - - -19. Godhuma Sevana + - - - - - -20. Masha Sevana + - - - - - -21. Rasayan Sevana + - - - - - -22. Vrishya Sevana + - - - - - -23. Bhojanottara Jala pana - - + - - + +Table no.04. Showing anya Nidana of Sthoulya: Sl Nidana Ch. Su. As Ma Bh Yo No Sam Sam Hru Ni. Pr Ra. 1 Ama Rasa - - - - + - 2 Snigdha Madhura basti + - - - - - 3 Tailabhyanga + - + - - - 20 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  32. 32. Samprapti It is defined as “the description of the evolution of the disease in sequentialorder, commencing with Dosha-Dushya vaishyamya till the disease manifestscompletely. For the manifestation of a disease various deranged structural and functionalelements of the body are responsible and all such things are studied under Samprapti. Theknowledge of Samprapti (also called as jathi and agathi) is very helpful to the physicianboth for accurate diagnosis and also for planning appropriate treatment. It is essential toknow about “Ghataka” of the Samprapti because Samprapti vighatana itself is Chikitsa.Samanya Samprapti of sthoulya: • According to Charaka, Due to the avarana (obstruction) all srotases (channels) themeda, vata vriddi occurs in the koshta leading to the ati sandhukshana of jatharagni. Bythat, the consumed food will be digested rapidly and makes the person to crave for morefood. If at all due to any reason the person does not receive food in time may lead tovarious complications. But repeated consumption of food in turn helps in meda vriddionly leads to Sthoulya83. • According to Sushruta Ama Rasa is produced due to Kaphavardhakaahara,Adhysana, Avyayama, Divaswapana. The Madhura Bhava Ama Rasa moves within thebody, Snigdhansha of this Anna Rasa cause sthoulya that produces excessive stoutness inturn Sthoulya84. • According to Vagbhata, due to the nidana sevana medovrudhi takes place.Thisvrudha meda does srotorodha(Obstructs the srotus) because of which Koshthachara vayucannot move out of the koshtha resulting into agni prajwalana. This prajwalita agni in thekoshtha does kshudha vrudhi hence person consumes more and more food (repeatedly). 21 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  33. 33. Hence repeated intake of food will result into the ama utpatti, this ama being produced bymadhura rasa pradhana ahara, gets mixed up with dhatugata samleena sleshma and doesdhatu shlatheekarana leading to Sthoulya85.Figure no.01.showing illustration of samprapti of sthoulya. Nidhanasevana Bheeja Swabhava Koshtagni dushti Madhuratara annarasa utpatti Ama Medo Dhatwagni Mandhyata Atisneha utpatti Medo Dhatu Atiupachaya Ati meda avarana Ati vruddha Meda Dhatu Causes Anya Dhatu Margavarodha Vatavriddhi in koshta Jatharagni ati sandhukshana Anya Dhatu asamyak Upachaya Ati ahara sevana STHOULYA 22 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  34. 34. Vishesha Samprapti of Sthoulya: For the manifestation of any disease, vitiation of few basic components of thebody required aredosha, dushya, srotas, agni and ama.Dosha:1) Kapha: In the samprapti of Sthoulya all the 3 doshas are involved. Acharya charakahas considered Atisthoulya as one among the kaphajananatmaja vyadhi 86 which is clearlyobserved by the nidanas of Sthoulya like guru, snigdha, sheeta, madhura and diwaswapnaetc. which are also considered as kaphakara nidanas. Hence inspite of involvement oftridosha Kapha is the main dosha involved in pathogenesis of the Sthoulya.2) Pitta: In obese persons, pitta also remains in a higher sight because the symptoms ofthe Sthoulya like atikshudha, atipipasa, swedadhikyata, dourgandhya have also beenmentioned in the pittavrudhi. Mainly the pachaka pitta is involved in the etiopathogenesisof the Sthoulya.3) Vata:The process of circulation, digestion and proper distribution of dhatus includingmedas is controlled by Samana and Vyana vayu. Involvement of samanavayu can be clearly postulated with the evidence of Agnisandhukshana. Improper distribution of fat in the body proves the involvement of vyanavayu. Vata has been mentioned in the state of Avruta in koshtha,which makes the agnivaishamya,ultimately increases the the abhyavarana shakti or demand of food. 23 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  35. 35. Dushya: Acharya Sushruta has mentioned Sthoulya as a Dushya dominant disorder87 .Here,Rasa, Mamsa, Meda, majja and shukra Dhatus are taken as Dushyas, as Kapha is seatedin all these Dhatus on the basis of Ashrayashrayeebhava. So, vitiation of Kapha also leadsto vitiation of dhatus in which kapha is seated88.Srotas: Involvement of medovahasrotas is the main factor along with the involvement ofother srotas in Sthoulya. Charaka specifies Avyayama, Diwaswapna, Madhuradravyas and varuni(madya) as nidanas of Sthoulya.It indicates clear involvement of rasavahasrotas. Atisweda and dourgandhya indicate the involvement of swedavahasrotas. Presence of Atipipasa indicates the involvement of udakavahasrotas. An increased fat deposit inside the muscle indicates the involvement of mamsavahasrotas. Harshanityata, Achinta, Soukhya indicate the involvement of manovahasrotas.Agni & Ama: According to Vagbhata, mandagni, jatharagni and dhatwagni level are consideredroot cause of all diseases “Rogo sarveapi mandagnou”89. In Sthoulya, due to vitiation ofvata by obstruction of medas, teekshnagni is a prominent feature. Here a question ariseshow ama formation can take place instead of teekshnagni. Commentators Chakrapani andDalhana have tried to clarify this controversy by giving explanation, that in the state ofteekshnagni, person go for adhyashana, kalavyateeta ahara sevana again and again, whichleads to disturbance in agni which subsequently leads to the formation of ama. It has been 24 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  36. 36. further explained by Dalhana that in the Sthoulya, formation of ama is due to the decreaseof medodhatwagni than jatharagni. Due to increased in sheeta, snigdha & madhura gunawhich is opposite to that of Pitta the jataragni mandya take place leading toJataragnijanitaama. This further accumulation of Ama in Medovaha srotas due toMedodhatwagni mandya the dhatwagni janita ama is resulted90.Samprapti ghataka:Dosha : Kapha : Kledaka Pitta : Pachaka Vata : Samana, VyanaDushya : Rasa,Mamsa & Meda dhatuAgni : Jatharagni : Rasa and Meda DhatvagniSrotas : Meda vaha Srotas : Rasa vaha Srotas : Sweda vaha Srotas : UdakavahaSrota Dushti : Sanga : Margavoradha91 : Amatah 92Adhisthan : Whole body (Particularly Vapavahana & Meda dhara kala.)Udbhava Sthala: AmashayaSanchara Sthana: RasayaniRoga marga : BahyaAma : Jatharagni Vikriti Janita. Dhatvagni Mandya JanitaVyatktsthana : Sarvanga, Specifically Sphik, Udara, Stana & Gala. 25 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  37. 37. Poorvaroopa: It refers to the features, which indicates the forth-coming disease. It usuallyhappens during (this corresponds with) fourth kriya kala called “Sthana samsraya”.Clinically, this is important for early diagnosis, treatment and prognosis. Mild exhibitionof actual features of disease itself can be considered as Poorvaroopa.Poorvaroopa is of two types: 1)Samanya poorvaroopa 2) Vishesha poorvaroopSamanya poorva rupa gives the knowledge about forthcoming disease, but not regardingthe exact disease, where as Vishesha Poorvaroopa gives the knowledge regarding Doshaas well as the disease. In the context of present disease, none of the Acharayas have stressed upon thepoorva rupa, but it doesn’t mean that they are absent; Acharya charaka mentioned similarpathogenesis of Prameha and Sthoulya93. Kapha and Meda also get vitiated in Sthoulya.Therefore purvarupa of Prameha and Medovaha Srotodushti Lakshanas can be consideredas purvarupa of Sthoulya. These are as follows: • Atinidra • Tandra • Alasya • Visra sharira gandha • Anga gaurava • Anga shaithilya etc. 26 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  38. 38. Roopa: When the Vyadhi kriya kala is in fifth stage(Vyakthavastha), the disease will produces the features called as “Rupa”. These rupa will indicate the manifestation of disease. Rupa is having synonyms like Samsthana, Vyanjaka, Linga, Lakshana, Chinna, and Akruthi. Rupa includes both subjective symptoms as well as objective signs. This is the stage when Dosha -Dushya Sammurchana is completed. All the lakshanas can be broadly classified as: 1) Sthoulya Pratyatmaka Lakshana 2) Sthoulya Samanya Lakshana1. Sthoulya Pratyamtaka Lakshana: The following are the diagnostic features of Sthoulya94: • Medomamsa ativriddhi • Chala sphik • Chala udara • Chala Stana • Ayatha Upachaya • Anutsaha2. Sthoulya Samanya Lakshana: Beside these Cardinal Symptoms, eight disabilities of Sthoulya are mentioned in which can be considered as Sthoulya samanya lakshana are as follows95 Ayushohrasa - Life expectancy is decreased because other Dhatus could not be nourished properly 27 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  39. 39. Javoparodha - Shaithilya, Saukumarya and Guru poperties, causes JavoparodhaKricchavyavaya - Due to obstruction in genital passage by Medodhatu and lesspoduction of semen, the sex act becomes difficultDaurbalya - This results because of the deranged metabolism owing tomlnourishment of the DhatusDaurgandhya - Bad smelling results due to excessive sweating, innate quality ofMedodhatu and morbid nature of vitiated MedaSwedabadha - It occurs due to sang in Swedavaha Srotas by amaKshudhatimatrata and Pipasatiyoga - Because of increased Agni in Koshtha andvitiation of Vata by obstruction of Meda it results in excessive appetite and thirst.All the symptoms of Sthoulya described in various Ayurvedic texts have beensummarized in the following table. 28 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  40. 40. Table no.05. Showing Rupas of Sthoulya 96,97,98,99,100,101.No. Rupa Cha Su AS AH MN BP1 Chala Sphika + - + + + +2 Chala Udara + - + + + +3 Chala Stana + - + + + +4 Ayatha Upachaya + - + - + +5 Udara parshva Vriddhi - + - + + +6 Anutsaha + - + - + +7 Alasya (Jadyam) - - + - - -8 Moha - - - - + +9 Javoparodha - - + - - -10 Alpa Vega - - + - - -11 Shrama - - + - - -12 Sarvakriyasu Asamrthata - + - - + +13 Alpa Bala - - + - - -14 Daurbalya + - + - - -15 Alpa Prana - + + - + +16 Ayushohrras + - + - - +17 Krichh Vyavaya + - - - - -18 Alpa Vyavaya - + - - + +19 Daurgandhya + + + - + +20 Swedabadha + - + - - +21 Kshudhatimatra + + + - + +22 Pipasatiyoga + + + - + +23 Nidradhikya - + + - + +24 Kshudra Swasa - + + + + +25 Krathana - + - - + +26 Gadgadvani - + + - - -27 Gatrasada - + - - + +28 Saukumarata + + - - - - 29 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  41. 41. Classification of Sthoulya: For the purpose of diagnosis, prognosis and easy management disease should beclassified as per severity, as well as chronic. Hence classification of Sthoulya is essential,but there is no such classification found in Ayurvedic texts. Astanga sangraha102,Asthanga hrudaya103 and Sharangadhar samhita104 have thrown little light regardingclassification of Sthoulya as mentioned below. In Astanga sangraha and hrudaya, three types of sthoulya i.e., adika, madhyamaand heena have been mentioned for better management while narrating the indications oflanghana upakrama. From the above references Sthoulya may be classified as; Charaka: Sthula, Atisthula Sushruta: Sthoulya, medoroga Vagbhata: Adhika, madhyama, heena. Sharangadhara: Medodosha. Though Vagbhata has classified sthoulya as of three types, he has not given anyexplanation or parameters to consider so. Hence it is not clear that the classificationAdhika, Madhyama, Heena has been made by considering deha pramana or deha bala.Upadrava: The aliment, which is associated with a disease, and is manifested after themanifestation of the main disease, is called Upadrava. Describing the severity of Sthoulya, Charak has compared the aggravated vataand Pitta with davanala, which destroys the whole forest.105 Though Charak has notmentioned any specific Upadrava of Sthoulya, he describes that as Medas blocks the 30 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  42. 42. Vayu in koshta it stimulates Agni which in turn digest the food quickly and wants moreand more food if not given enough food it causes severe Upadravas and kill the personand also that Sthoola rogi always suffers from one or other disease106. As Sthoulya is an Asadhya Vyadhi, it will always have the tendency to exhibitupadrava. The concept of Sthoulya Ashta Maha Dosha can be considered as upadravaitself. Here Agni and Vayu are important factors for upadrava. Prakupita Vata due to itsobstruction by Medas will make the Sandukshana of Agni. This Pradeepta Agni digeststhe food as quick as fire burning the forest. Hence there will be Athi kshudha in theSthoola. If the proper quality and quantity of food is not supplied to this Teekshnagni, itwill produce hazardous effect, which may cause even death. Bhava mishra and Yogaratnakara have used the word “Sudustara” in the placeof upadrava shabda. 31 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  43. 43. Table no.06. Showing updrava of stoulya: 107,108,109,110,111,112. Sl. Upadrava AHR No SU AS MN BP YR 1 Ama Roga - - + - - - 2 Apachi - - + - + + 3 Arsa - + + - + + 4 Atisara - - - - + + 5 Bhagandara + + + + + + 6 Jwara + + + + + + 7 Jantavaha - - - - + + 8 Kaamala - - - - + + 9 Kustha - - + - + - 10 Mutra Kriccra - - + - - - 11 Prameha - + + - + + 12 Pramehapidika + + - + - - 13 Shleepada - - - - + + 14 Sanyasa - - + - - - 15 Udararoga - + + - - - 16 Urusthambha - + - - - - 17 Vatavikara + - - + - - 18 Visarpa - - - - + + 19 Vruddhi + + - + - - 20 kasa - - + - - -Causes of the upadrava in Sthoulya are; Agnivikruti, Medovikruti, Avarana of vata, Swedabadhata, Vikruti of pranavaha srotas, Dusti of Oja. 32 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  44. 44. Figure no.02.showing upadravas of sthoulya. Upadrava of SthoulyaDue to agnivikriti Medamamsavikriti Avaranam Swedabadha Ojadusti Atisara, Prameha, Pidaka, Urustambha, Kustha, Swasa, Ajirna, Apachi, Slipada, Vatarakta, Jantvaha Kasa, Udararoga Granthi, Vidradhi, Sandhivata, .etc Sanyasa etc Visarpa, Arduda Gridrasi, Arshas, etc Damaniprath- ichaya etcChikitsa: Ayurvedic treatment aims not only at the radical removal of the causative factorsof the diseases,but also at the restoration of the Doshik equilibrium113. In Ayurveda, general principles of management of any disorder is of three types 1) idanaparivarjana 2) amshodhana 3) amshamana114 Further samshodhana is of two types:A) Bahiparimarjana – a) Udwartana B) Abhyantara Samshodhana – a) Vamana b) vagaha b) Virechana c) Parisheka c) Nasya d) epana d) Niruha 33 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  45. 45. Aims of treatment in Sthoulya: Alleviation of Vata and Kapha along with depleted Medodhatu by increasing medodhatwagni is the main aim of treatment of Sthoulya.(Gada nigraha) Guru cha Apatarpanam – Administration of the drugs which are guru and karshana that results in thealleviation of medas, sleshma anvata115 Administration of virukshana and chedaniya dravyas116Nidana Parivarjana: Aharatmaka, Viharatamaka, Manasika and Anya Nidana, which are responsiblefor the disease (apathya), should be avoided as a Nidanparivarjana chikitsa.Samshodhana:Bahir parimarjana chikitsa: Acharyas have mentioned external purification therapy for management ofSthoulya. Acharyas narrated Ruksha Udavartana for Sthoulya117. The benefits ofUdwartana also mentioned. I.e. Kaphahara, Medasa Pravilayana, SthirikaranamAngam118 etc.Abhyantar Samshodhana: According to Vagbhata, Atisthoulya patients with Adhika Dosha and Adhik Balashould be treated by Samshodhana therapy including Vamana, Virechana, RukshaNiruha, Raktamokshana119 etc. Charaka has mentioned Sthoulya under the caption of Santarpanajanita Vyadhiand for its management; Vamana, Virechana and Raktamokshana are recommended120.He also suggested Ruksha, Tikshna and Ushna vasti for the management purpose ofSthoulya. 34 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  46. 46. Snehana: It is contraindicated for the patients of Sthoulya121. However, Lekhaniya,Medohara properties122 and Sthulatvahara Karma123,124of Taila are described inAyurveda. So, on exigency usage of Taila is recommended125Swedana: Swedana is also contraindicated in Sthoulya rogi but Niragni sweda can beencouraged in Sthoulya in the form of Vyayama, Alpa Sevana and Upanaha areadvised.126Vamana : Sushruta has recommended Vamana for the treatment of Medoroga127.According to kashyapa by doing vamana the person is going to get laghuta in the bodyand it irradicates the meda dourgandhya and kaphaja rogas128Virechana: Virechana has been recommended for patients of Sthoulya129Vasti: In classics Lekhan vasti is considered as a best therapy for Sthoulya /medovriddhi130 The role of Ruksha, Ushna and Tikshna vasti in the management ofSthoulya is very well explained by Gangadhara (Jalpakapataru Tika commentary on as italleviates kapha and meda131.Sharangahara has given a clear description regarding theproperties of lekhan dravyas and characteristics of lekhan vasti132Practices in Sthoulya with vasti: Vasti prepared with Taila, Gomutra, Kanji and Saindhava 133 Erandamuladi Niruha134 Kapha nashak Vasti135 Lekhan Vasti 136 Madhutailika Vasti 137,138Rakata Mokshana: Maharshi Kashyapa has recommended Rakta mokshana with Urdhvaand Adhah samshodhana for sthoulya, especially for medosvi dhatri139 Similarly 35 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  47. 47. 140Bhavaprakash has considered Rakta mokshana as a therapy for sthoulya . So we canadopt Raktamokshana for the treatment of Rakta gata meda.Shiro virechana: Kashyapa has considered karshana nasya as a treatment for disorders ofkapha141 and Sthoulya is enumerated as one of the twenty-kapha nanatmaja vyadhis, so itcan be applied to treat sthoulya. Triphaladya taila is indicated for nasya in the patients ofmedovriddhi142.Samshamana: • Among Sad upakramas,langhana and rukshana can be administrated forsamshamana purpose in Sthoulya143. Samshamana chikitsa can be implemented throughseven different ways. All the seven ways of langhana can be applied to the patient ofSthoulya according to rogi-roga bala. • Charaka Samhita has been given treatment in following words.I.e. Administration of Guru and Apatarpaka articles which possess additional Vata,Shleshmala and Medonashaka properties are considered as an ideal for Samshamantherapy. Chakrapani has explained that Guru Guna is sufficient to alleviate vitiated Agniand Atikshudha. Apatarpana property provides less nourishment and thus leads todepletion of Meda. For example Madhu possess Guru and Ruksha properties, hence it isideal for management of Sthoulya. Gangadhara has interpreted that Guru Property issuitable to alleviate Tikshnagni and vitiated vata especially Kosthagata Vata whichultimately reduces Atikshudha and Apatarpan property causes reduction of Meda144. 36 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  48. 48. Figure no.03. Showing schematic representation of Sthoulya chikitsa.Sthoulya Pathyapathya:145,146 This is the unique contribution of Ayurveda and explained for almost all diseases.It plays an important role as much as of medicine and it is rightly mentioned that “if onefollow Pathya, than there is no need of medicine and if not than also there is no use oftherapeutic measures”. “The things which are best for Srotases is called Pathyam, and one whichdeteriorates the condition is called Apathya”.Table no.09. Showing Manasika Pathya - Apathya for Sthoulya: Pathya Apathya Shoka Nitya harsha Chinta Achintata Bhaya Manaso nivrutti 37 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  49. 49. Table no. 07. Showing Ahararupi Pathya - Apathya for Sthoulya: Ahara varga Pathya Apathya Shuka dhanya Yava, Kodrava Godhuma, Navanna, shali Shami dhanya Mudga, Rajamasha, Kulatha, Chanaka Masha, Tila Shakha varga Patola, vrunthaka Madhura phala Dravya Takra, Madhu, ushnodhaka, Sarshapa Dugda, draksha, Taila, Arista, Asava, Jeerna Madya navaneeta, grutha, dadhi Mamsa Rohita matsya Anupa, gramyaTable no. 08. Showing Vihararupi Pathya - Apathya for Sthoulya: Pathya Apathya Srama Jagarana Divaswapna Avyayama Vyayama Chintana Avyavaya Sukha shayya Shoka Krodha Nitya harsha Achintana Nitya bramana Sheetala jalapanaSadhyasadhyata: Ancient scholars keeping in view of success rate of treatment have explainedthe concept of Sadhyasadhyata.Charaka has mentioned bad prognosis for Sahaja(hereditary) disease147. Hence Sahaja Sthoulya can be considered as Asadhya. ThereforeSadhyasadhyata of Sthoulya can be constructed on the basis of general principles ofSadhyasadhyata depicted in Ayurvedic Texts 148, which are as below. 38 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  50. 50. Table no.10. Showing the Sadhyasadhyata of SthoulyaSthoulyaSUKHA SADHYA KRICHHA SADHYA ASADHYAJatotara Hina Sthoulya Jatotara Madhyama Sahaja Sahaja Sthoulya.Having duration of 1-5 Sthoulya Jatotara Adhika Sthoulyayears. Having duration of 5-10 Having more than 10 yearsWith out any complication years. of durationor secondary disease With least complications Associated with secondary but no secondary disease. complications. Disease reviewEtymology: The word obesity is a noun form originated from Greek root word “Obesus”meaning “having eaten until fat”, Latin “Edo” meaning “eat”, obese is used as anadjective meaning “grossly fat” or “very fat”. 149Definition: “Obesity is defined as an excess of adipose tissue that imparts health risk; a bodyweight of 20% excess over ideal weight for age, sex and height is considered a healthrisk.”150 The modern science considers the Obesity as a Nutritional disorder and itsetiology is explained as; Excess fat accumulates because there is imbalance betweenenergy intake and expenditure. Obesity can be understood in the following way:1. Excess of adipose tissue deposition that imparts as obesity.2. A body weight 20% or more than desirable/normal weight according to age, sex and 39 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  51. 51. height is regarded as obese.3. Nowadays obesity is defined as BMI > 25kg/m2.4. Obesity may be defined as an abnormal growth of adipose tissue which is in three Ways as; i. Enlargement of fat cells in size (hypertrophy obesity) ii. Increase in the number of fat cells (hyperplasic obesity) iii. Combination of the above two.Etiology:1511. Overeating: The overeating may be in terms of quantity (multiple meals and snaking)as well as in terms of quality (high calorie diet). It has been shown that obese patientstend to overeat which eventually results in the accumulation of fat. For example, 10.5kcal excess energy would lead to a 10 kg weight gain over 20 years.2. Age: Obesity is most prevalent in middle-age, but can occur at any stage of life.Obesity n childhood and adolescence is likely to be followed by obesity in adult life.3. Socio-economic: In affluent countries obesity is more common in the lower socio-economic groups. In developing countries like India it can occur only in prosperous elite.Some occupations predispose to obesity, e.g. cooks and barmen, IT experts, clerks,managers etc.4. Addictions: Frequent uses of alcohol will cause deposition of adipose as one gram ofalcohol gives 7 kcal of energy.5.Smoking: Offspring’s of mother smoked during pregnancy have a significantlyincreased risk of overweight later in life. While additional weight gain can be seen aftercessation of smoking in adults. 40 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  52. 52. 6. Heredity: A familial tendency exists in many cases, but it is difficult to disentangleenvironmental and genetic components. Pattern of eating and activity are influenced bysocial, cultural and economic factors, which may be passed on from one generation toanother. However studies involving twins and adopted children indicate the importanceof genetic factor in both total body fat and its distribution. Genes in the individual decidethe number of Adiposities and set point of weight.7. Environmental factors: This factor is divided into, i. Physical environment – this includes air, water and food. In obesity only the foodfactor is applicable which is already discussed. ii. Psycho-social environment - it covers a complex of psychosocial factors which aredefined as those factors affecting personal health, health care and community well being.The latest studies have proved that even stress ups weight.152 Nowadays this factor isseen more in the society.8. Endocrine factors: An endocrine influence on body fat is seen both in normalphysiological situations and in pathological states. Obesity in women commonly beginsat puberty, during pregnancy or at menopause, obesity frequently but not invariablyaccompanies hypothyroidism, hypogonadism, hypopitutarism etc. However, the overwhelming majority of the obese patients show no clinical evidence of endocrinaldisorder. The plasma concentration of Insulin and Cortisol is commonly raised and that ofgrowth hormone is reduced.9. Drugs: The use of steroids, oral contraceptives, phenothiazines and insulin iscommonly followed by weight gain, mainly because appetite is stimulated. 41 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  53. 53. 10. Lack of sexual drive: ‘Losing interest’ is a refrain that revolves around the husbandin many a 35-plus woman’s life. The AIMS cardiology unit along with the Indian councilof medical research (ICMR) verified that in an obesity survey in 2004, a large number ofrespondents blamed the lack of sexual drive in career-obsessed as the prime cause behindtheir apathy towards their own self.153Pathogenesis:154 Obese persons having an increase in number and/or size of adipose cells suggesthypertrophy and/or hyperplasia of adiposities either due to functional demand inparticular age or sex or due to genetic, endocrine, behavioral, psychological or iatrogenicfactors. After reduction in weight the adipose cells shrink in size but hyperplasia remainsfixed. Adult onset obesity is characterized predominantly by adipose cell hypertrophywith minimum hyperplasia. There are three main factors in the pathogenesis of obesity:Excessive lipid deposition: Excessive lipid deposition is due to either increased food intake, hypothalamiclesions. Adipose cell hyperplasia or hyperlipogenesis. Increased food intake in form ofcarbohydrates, proteins and fats by metabolic process lastly converts in fat and get storedat fat depots. Physiology of hunger and satiety is dependent upon hypothalamus. Lesions maydamage these centre leads to voracious appetite (Ventro medial and lateral nuclear area ofhypothalamus) and ultimately leads to obesity. Similarly adipose cell hyperplasia or hyperlipognesis due to genetic orendocrine pathology leads to obesity. 42 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  54. 54. Diminished lipid mobilization: Thyroxin, adrenaline and glucocorticoids stimulate mobilization of unsaturatedfatty acids from adipose tissue, hypo secretion of thyroxin and hyper secretion ofglucocorticoids causes diminished lipid mobilization and excessive lipid deposition incertain areas such as abdomen, chest, face and buttocks, ultimately leads to obesity.Thyroxin generally increases the appetite and food intake.Diminished lipid utilization: Diminished lipid utilization is due to ageing, defective lipid oxidation,defective theromogenesis or inactivity. The BMR increases to as much as 60-100% abovethe normal level, when large quantity of thyroxin is secreted. It falls by 20-40% belowthe normal level when less quantity of thyroxin is secreted. It is the main pathology inmiddle age obesity.Figure no.04. Showing Schematic representation of pathogenesis of Obesity. ETIOLOGY • Increased food • Decreased Lipolytic • Ageing intake. Hormones. • Defective lipid • Hypothalamic • Defective Adipose Oxidation Lesions Cells • Defective • Adipose cell • Abnormality in thermogenesis. hyperplasia autonomous • Hyperlipogenesis Innervation. Increased lipid deposition Diminished lipid Diminished Utilization mobilization OBESITY 43 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  55. 55. Lipid / Fat Metabolism, Transport, Storage:155 • Biomedical importance: Fat absorbed from the diet and lipids synthesized by the liver and adipose tissuemust be transported between the various tissue and organs for utilization and storage.Since lipids are insoluble in water, the problem of how to transport them in the aqueousblood plasma is solved by associating nonpolar lipids (triacylglycerol and cholesteryleasters) with amphipathic lipids (phospholipids and cholesterol) and proteins to makewater miscible lipoproteins. In a meal-eating omnivore such as the human, excess calories are ingested in theanabolic phase of the feeding cycle, followed by a period of negative caloric balancewhen the organism drows upon its carbohydrate and fat stores. Lipoproteins mediate thiscycle by transporting the lipids from the intestines as chylomicrons- and from the liver asvery low density lipoproteins (VLDL) – to most tissue for oxidation and to adipose tissuefor storage. Lipids are mobilized from adipose tissue as free fatty acids (FFA) attached toserum albumin. • Lipids are transported in the plasma as lipoproteins: Four major lipid classes are present in Lipoproteins – Plasma lipids consists ofTriacylglycerol - 16 %Phospholipids - 30 %Cholesterol - 14 %Cholesteryleasters–36% 44 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  56. 56. and a much smaller fraction of uneasterified long-chain fatty acids (free fatty acids) – 4%this latter fraction, the free fatty acids (FFA), is metabolically the most active of theplasma lipids. Four major groups of plasma lipoproteins have been identified – Because fat isless dense than water, the density of lipoprotein decreases as the proportion of lipid toprotein increases. In addition to FFA, four major groups of lipoproteins have beenidentified that are identified physiologically and in clinical diagnosis. These are:i. Chylomicrons, derived from intestinal absorption of triacylglycerol and other lipidsii. Very low density lipoproteins (VLDL),derived from the liver for export of triglyceroliii. Low density lipoprotein (LDL), representing a final stage in the catabolism of VLDLiiii. High density lipoprotein (HDL), involved in VLDL and Chylomicron metabolism and also in cholesterol transport. • Triacylglycerol is transported from the intestine in chylomicrons and from the liver in VLDL: By definition, chylomicrons are found in chyle formed only by the lymphaticsystem draining the intestine. They are responsible for the transport of all dietary lipidsinto the circulation. Small quantities of the VLDL are also to be found in chyle; however,most of the plasma VLDL are of hepatic origin. They are the vehicle for transport oftriacylglycerol from the liver to the extra hepatic tissues. • The Liver plays a central role in lipid Transport & Metabolism: The Liver carries out the following major functions in lipid metabolism: 45 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  57. 57. 1) It facilitates the digestion and absorption of lipids by the production of bile, whichcontains cholesterol and bile salts synthesized within the liver de novo or from uptake oflipoprotein cholesterol.2) The liver has active enzyme systems for synthesizing and oxidizing fatty acids, and forsynthesizing triacylglycerol and phospholipids.3) It converts fatty acids to ketone bodies (ketogenesis).4) It plays an integral part in the synthesis and metabolism of plasma lipoproteins. • Adipose tissue is the main store of triacylglycerol in the body: The triacylglycerol stores in adipose tissue are continually undergoing lipolysis(hydrolysis) and reesterification. These two processes are entirely different pathwaysinvolving different reactants and enzymes. This allows the process of esterification orlipolysis to be regulated separately by many nutritional, metabolic and hormonal factors.The resultant of these two processes determines the magnitude of the free fatty acid poolin adipose tissue, which in turn determines the level of free fatty acids circulating in theplasma. Since the latter has most profound effect on the metabolism of other tissues,particularly liver and muscle, the factors operating in adipose tissue that regulate the outflow of free fatty acids exert an influence far beyond the tissue itself. And there is acontinuous cycle of lipolysis and reesterification within the tissue. However, when therate of reesterification is not sufficient to match the rate of lipolysis, free fatty acidsaccumulate and diffuse into the plasma, where they bind to albumin and raise theconcentration of plasma free fatty acids. • Hormones regulate fat mobilization:1) Insulin reduces the output of free fatty acids: 46 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  58. 58. Insulin inhibits the release of free fatty acids from adipose tissue, which is followed by afall in circulating plasma free fatty acids. It enhances lipogenesis and the synthesis ofacylglycerol and increases the oxidation of glucose to CO2 via the pentose phosphatepathway.2) Several hormones promote lipolysis: Other hormones accelerate the release of freefatty acids from adipose tissue and raise the plasma free fatty acid concentration byincreasing the rate of lipolysis of the triacylglycerol stores. These include epinephrine,nor epinephrine, glucagon, adrenocorticotropic hormone (ACTH), thyroid stimulatinghormone (TSH), growth hormone (GH), and vasopressin. Many of these activate thehormone-sensitive lipase. For an optimal effect, most of these lipolytic processes requirethe presence of ‘glucocorticoids’ and ‘thyroid hormones’. Totally the whole process can be summarized as triacylglycerol is the mainstorage lipid in adipose tissue. Upon mobilization, free fatty acids and glycerol arereleased. Free fatty acids are an important fuel source. ‘Even stress ups obesity’. Nature magazine reported last year how the bodyreleases a molecule, NPY (neuropeptide Y) when stressed. It unlocks the body’s fat cellsand makes them grow in both size and number. Cortisol, a hormone, released during thestress response, has also been implicated in developing belly fat. Also, bodies that are notrested produce increased amounts of ghrelin, a hormone that triggers the sensation ofhunger, and reduces production of leptin-a hormone that regulates appetite.Intra abdominal (central) fat accumulation and increased Risk. Compared with subcutaneous adipose tissue, intra abdominal adipose tissue hasmore cells per unit mass. Intra-abdominal adipocytes are located upstream from liver in 47 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW
  59. 59. the portal circulation. This means that there is a marked increase in the flux ofnonesterified fatty acid to the liver via the portal blood in patients with abdominalobesity.Classification:156 The most common cause of obesity is excess calorie intake coupled with physicalinactivity.I. Anatomical characteristic of adipose tissue. 1. Hyper trophic obesity: (Increase in enalargement of fat cells) correlates with android or truncal fat distribution and is more often associated with metabolic disorders such as DM, HTN etc. 2. Hyperplastic obesity: Increase in no of fat cells.II. Age at onset of obesity: Obesity which starts in early childhood tends to be more severe and generalizedand obese children have a higher chance of being obese in adulthood. Over nutrition ismore often responsible for this condition.III Etiological factors: 1. Neuro-endocrine disorders: a) Hypothalamic disorders b) Hypothyroidism c) Cushings syndrome d) Hyperinsulinism etc. 2. Genetic syndromes: a) L.M.B 48 EVALUATION OF THE EFFECT OF BRUHATPANCHAMULADI YOGA IN MEDOROGA-LITERARY REVIEW

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