Sthaulya chikitsa other than oral administration

1. Dr M. Paramkussh Rau
M.D.(D.G),Ph.D.
P.G.Professor& H.O.D.
Department of Dravyaguna
S.V.Ayurvedic college,Tirupati,
Andhra pradesh
Review of Sthaulya chikitsa other than oral
administration
By-
Dr K.RAGHU RAMUDU,
1st year P.G Scholar
Department of Dravyaguna
S.V.Ayurvedic college,Tirupati,
Andhra pradesh

2. HEALTH IS WEALTH
It is a universally accepted fact
According to Ayurveda Swastha defined as the equilibrium state
of Dosha ,Agni ,Dhatu and Mala. And prasanna atma , indriya and
manas.
THE WORLD HEALTH ORGANIZATION defines
Good health as a state of complete physical mental and social well
being and not merely an absence of disease or infirmity. Which is
resembles the swastha definition.

3. Sthaulya Paribhasha:-
A person, having heaviness and bulkiness of the
body due to excessive collection of fat is
called obese (Sthula) and the condition is
called obesity (Sthaulya).

4. Acharya Charaka mentioned that a person in whom
Excessive and abnormal increase of fat tissue
(Medodhatu) along with Mamsadhatu is found
which results into pendulous appearance of
buttocks, belly and breasts and whose increase bulk
is not matched by a corresponding increase in
energy is called Sthula Purusha.
(Ch. Su. 21/8-9)

5. According to W.H.O definition
B.M.I greater then or equal to 25 is over
weight; B.M.I greater than or equal to 30 is
obesity.
Obesity is a major risk factor for non
communicable diseases i.e cardio vascular
diseases ; diabetes; musculo skeletal disorders
etc.

6. Obesity Class BMI (Kg/mt2)
Underweight < 18.5
Normal 18.5 – 24.9
Overweight 25.0 – 29.9
Obesity I 30.0 – 34.9
II 35.0 – 39.9
Extreme Obesity III > 40
CLASSIFICATION OF OVERWEIGHT AND OBESITY BY
BMI CHART

7. BODY MASS INDEX: -
The BMI which describes relative weight for
height.
The BMI used to assess overweight and obesity
and to monitor change in body weight.
BMI is calculated as weight in Kg divided by
height in metre square (mt²)
BMI = Weight in KG
Ht in Mt²

8. PHYSIOLOGY OF MEDA DHATU (FAT TISSUE):
Medo Dhatu is the 4th dhatu in the sequence of the 7
tissues explained in Ayurveda. Medo dhatu produced
from the mamsa dhatu. There is clear description in
Ayurveda regarding medo dhatu which can be compared
with depot fat tissue (adipose tissue) and rasa-rakta gata
sneha (fat present in blood) to the cholesterol,
triglyecerides, HDL, LDL, VLDL.

9. The total quantity of Meda is two Anjali (the
collected amount of liquid by both hands joined)
and the Vasa (Muscle’s fat) is three Anjali. Thus,
total Meda content of body is enumerated as 5
Anjali and total measurable body elements are
counted as 56.5 Anjali. From this proportion, it is
evident that total Meda content of body is 11 to
12% approximately. Modern physiology also
mentioned the same amount of fat. This quantity
may vary from person to person.

10. Medadhatu
Poshaka Poshya
(Mobile in nature) (Immobile in nature)
Which is circulated in whole body Which is stored in Medodharakala
Along with gatiyukta Rasa-rakta dhatu in its sites. i.e Udara,Sphik and
For nourishing the poshya meda dhatu Stana
According to modern science, it can be According to modern science, it
Correlated with Cholesterol and Lipids cen be correlated with Adipose
Which are present in cerculating blood. tissues/fat

11. तदततस्थौल्यमततसम्पूरणाद्गुरुमधुरीतत्स्ि
ग्धोपयोगादव्यायामादव्यवायाद्ददवास्व्िाद्ध
र्षतित्यत्वाद
चिन्तिाद्बतजस्वभावाच्िोपजायते
Cha.S.SU.21/4
Nidana of Sthaulya
Aharatmaka Nidana
Nidana of sthaulya Viharaja Nidana
Manasika Nidana
Bijadoshaja Nidana

12. •Aharatmaka Nidana
Atisampuram
Guru ahara sevana
Madhura ahara sevana
Sheeta ahara sevana
Snigdha ahara sevana

13. Role of aharatmaka nidana
Ahara plays a major role for increasing medo dhatu
in sthoulya.
Acharya Susrutha mentioned sthoulya and karshya
depend upon the quality and quantity of ahara
Su.S.Su15/32
On the basis of samanya vishesha siddhanta the
excessive food consumption of similar substance lead
to the over production of dhatu.

14. Role of Viharatmaka Nidana
All the viharatmaka Nidana indicates decreased
physical activity, which aggravates kapha and leads to
meda deposition
Divaswapna having abhishyandhi property leads
to blockage of the micro channels of the body
specifically in medovaha srotas
•Viharaja Nidana
Avyayama
Avyavaya
Diva swapna

15. •Manasika Nidana
Harshanityatvat
Achinthanat
Role of Manasika Nidana
Harshanitya and achintana are two psychological
factors mentioned by Acharya Charaka, these factors are
kapha aggravating and hence lead to meda sanchaya.

16. Role of Beejadosaja Nidana
Over nutrition particularly with madhura rasa during
pregnancy is mentioned as a causative factor for birth of
obese child (Cha.s.sha 8/21)
Beeja dosha Nidana

17. Samprapti
Nidana sevana
(Kapha medo vardhaka ahara)
Jatharagni mandya
Saama anna rasa utpatti
Predominance of Apa & Prithvi bhoota
Dhat vargni mandya
Medho vaha srotodushti (sanga) Vata prakopa
Sanchya of apachita meda in sphik stna, udara Sanchaya of vata in
kosta koshta
Sthoulya lakshana Athi ahara sevana

18. Samprapti Ghataka
Dosha: Kapha,Vata
Dusya: Meda , later other dhathus also
Agni : Jatharagni sandhukshana medo
dhatvagni mandya.
Srotas: Medovaha.
Srotodushti: Sanga.
Udbhava sthana: Amashaya.
Vyakta sthana: Sarvanga, specially in sphik,
udara, stana.
Roga marga: Bahya and abhyantara.
Swabhava: Chirakari.

19. Sthoulya lakshanas
According to Charaka cala sphik, cala udara, cala
stana, atimeda mamsa vrddhi are lakshanas of
sthaulya (Ca Su 21/8)
Beside these symptoms ashta dosha of
sthaulya viz. ayushohara, jaroparodha, kriche
vyavayata, daurbalya, daurgandhya, sveda badha,
ksudha atimatrata, pipasatiyoga are the most
prominent clinical features of sthaulya as narrated
by Charaka

20. Charaka has said that it is very dificult to treat
atisthoola people because,if Karshana therapy
is applied then it leads to further aggrivation of
already aggrivated Jathragni and vayu. And if
Brimhana therapy is applied it further increase
the meda
Management of Obesity

21. Management of Obesity other than oral
administration
वातघ्िान्यन्िपािाति श्लेष्ममेदोहराणण ि|
रूक्षोष्णा बस्तयस्ततक्ष्णारूक्षाण्युद्वतषिाति ि||२१||
गुडूितभद्रमुस्तािाां प्रयोगस्रैफलस्तथा|
तक्राररष्टप्रयोगश्ि प्रयोगो माक्षक्षकस्य ि||२२|| Ch.S.Su 21/21
•Diets and drinks that alleviate vata and kapha and which can
reduce fat.
• Enema with drugs that are sharp, unuctuous and hot.
•Unction with unuctuous drugs
•Intake of guduci(Tinospora Cordifolia), murta(cyperus rotundus),
haritaki(Terminalia chebula), bibhitaka((Terminalia blerica) and
amalaka(Emblica officinalia)
•Administration of takrarista.
Administration of honey

22. Ruksha Udvartana
Ruksha udvartana is the bahi parimarjana chikitsa
indicated for the management of sthoulya A.S.Su 24/33-34
Acharya charaka has also mentioned Ruksha
udvartana for sthoulya. Ch.S.Su 21/21
Vaghbhata has mentioned the benefits of Ruksha
udvartana in general as kapha hara, medasa pravilayana,
Sthirikaranam anganam etc (A.H.Su 2/15)

23. Basti
Ruksha, ushna & tikshna basti are suggested by
Acharya Charaka for sthoulya chikitsa
Eg; kshara basthi ,
lekhana basthi
Sharangdhara has given a clear description regarding
the properties of lekhana dravya and
characteristics of lekhana basti ( Sha.S.Pu 4/10)

24. Lekhana Basti
The reference of lekhana basti was taken
from Su.Ch.38/82 the ingredients are follows.
Triphala kwatha(Amlaki, harithaki, vibhitaki)
Gomutra
Madhu
Yavakshara
Ushakadi gana dravya
Ushakadi gana dravya contains ushaka,
saindhava ,shilajatu, kasisa, hingu & tutha.

25. Drug Rasa Guna Veerya Vipaka Doshagnatha
Harithaki
(Terminalia
chebula)
Pancha rasa
(lavana
varjitha)
Kashaya
pradhana
Laghu ruksha Ushna Madhura Tridosha hara
Vibhitaki
(Terminalia
bellerica)
Kasaya Laghu ruksha Ushna Madhura Kapha pitta
hara
Amlaki
(Emblica
officinalis)
Pancharasa
(Lavana
varjitha)
Amla pradana
Guru ruksha
seetha
Seetha Madhura Tridosha hara
Rasa panchaka of the lekhana basti dravya.

26. Shatapuspa
(Anethum
sowa)
Katu
Tikta
Laghu
Tiksna
Ushna Katu Kapha hara
Vata hara
Madhu Madhura
Kasaya
Ruksha,Laghu
sheeta
Ushna Madhura Kapha, Pitta,
Rakta samaka
Ushaka Tikta
Katu
Ruksha,Laghu Ushna Katu Kapha Vata
samaka

27. Kasisa Amla
Tikta
Ushna Ushna Katu Vata Kapha
samaka
Shilajitu Katu
Tikta ,
kasaya
Laghu
ruksha
Ushna
,teekshna
Ushna Katu Kapha vata
samaka
Hingu Katu Laghu,snigd
ha, Teekshna
Ushna Katu Kapha vata
hara
Saindhavam Lavana Snigdha,ruks
ha,sukshma
Sheeta Madhura Tridoshagna
Yavakshara Katu Laghu
Snigdha
Ushna Katu Kapha vata
samaka
Gomutra Katu, tikta
Kasaya
Ushna
Teekshna
,kshara
Ushna Katu Kapha vata
samaka

28. Name of
the drug
Rasa Guna Veerya Vipaka Doshagnata
Saindhava Lavana Laghu
Snigdha
sukshma
Seetha madhura Tridoshagna
Guda Madhura Guru
Snigdha
Ushna Madhura Vatagna
Naatipittash
amaka
Chincha Amla ,
Madhura
Guru
Ruksha
Ushna Amla Vata samaka
Kapha pitta
vardaka
Shatapuspa
(Anethum
sowa)
Katu
Tikta
Laghu
Tiksna
Ushna Katu Kapha hara
Vata hara
Gomutra Katu, tikta
Kasaya
Ushna
Teekshna
,kshara
Ushna Katu Kapha vata
samaka
Kshara basti :-
Kshara basti has been mentioned in Chakradatta niruha adhikarana
Rasapanchaka of kshara basti dravya

29. Nasya Karma :-
Susrutha has recommended
the use of Triphaladi Taila
nasya in The patients of
medovridhi
Su.S.Chi.37/33-35

30. Raktamokshana:-
Maharshi Kashyapa have
recommended raktamokshana for the treatment of
Medasvi Dhatri Chikitsa
Charaka has also mentioned
Raktamokshana for treatment of Santarpana janya
vyadhi including Atistoulya Cha.S.Su 23/6-9