Ayurvedic management of Sthoulya (Medoroga) W.S.R. to obesity

Obesity has been described as Sthoulya or Medoroga in Ayurvedic texts. It is described under Santarpanottha Vikar . Sthoulya is an abnormal state i.e., excessive accumulation of Medodhatu . Faulty lifestyle like over-eating, unhealthy diet, lack of exercise leads to various health problems. One of such lifestyle health problem is obesity which leads to various disease such as hypertension, hyperlipidemia, cardiovascular disease, joint disorders, diabetes and sometimes cancer also. Now a days, obesity is considered as a Global epidemic and a public health problem. One of the important aspects is mentioned in Ayurvedic text is Agni which plays an important role to maintain the normal state of health (equilibrium of Dosha, Agni, Dhatu and Mala ). Mandagni leads to production of Ama which may be at the level of Jatharagni, Bhutagni or Dhatvagni. Mandadhatvagni leads to improper Dhatu Vriddhi and vitiated Medodhatu is main cause of metabolic disturbance in an obese individual. Medodhatu also becomes increased due to excessive intake of Kaphavardhaka Aahar-vihar . The modern drugs like appetite suppressants and lipase inhibitor have their side effects but Ayurveda acts on the causative factors (aggravated Kapha Dosha, Mandagni and vitiated Medodhatu ) through Aoushadha, Aahar and Vihar which will be further described in full paper.


Introduction
Sthoulya is an abnormal state in which there is excessive accumulation of Medodhatu.As per modern medical science an individual is said to be obese when their BMI (Body Mass Index), a measurement obtained by dividing a person's weight by square of the person's height.The range of BMI between 25-30 kg/m 2 defined as overweight. [1]Faulty lifestyle like over-eating, unhealthy diet, lack of physical exercise or sleep at day time are generally responsible for Medoroga.It is precursor to various disease such as heart disease, diabetes mellitus type 2, certain type of cancer, osteoarthritis, high blood pressure and asthma [2] .In 2013 the American medical association classified obesity as a disease.In 2014, 600 million adults (13%) and 42million children under the age of 15years were obese.Obesity is more common in women than men.Authorities view it as one of the most serious public health problems of the 21 st century.Obesity is mostly preventable through a combination of social changes and personal choices.Changes to diet and exercising are main treatments.Medications may be taken along with a suitable diet to reduce appetite or decrease fat absorption.
The causative factors affect the Agni of the body which plays an important role in maintaining the normal state of health.Mandaagni leads to production of Ama which may be at the level of Jatharagni, Bhutagni or Dhatvagni that leads to production of Ama in concerned Dhatu and giving rise to improper Dhatu Vriddhi.Medodhatu is the site of metabolic disturbance in an obese person.The modern medicine acts on the symptoms only apart from that Ayurveda acts on pathogenesis.The Aahar, Vihar and Aushdha mentioned in Ayuverdic text, plays a significant role in managing the disease specially obesity.

Review of literature
The term Sthoulya derived from the root "Sthulya brimhane".The Sthoulya comes under Medoroga and it is described as increase in Meda and Mansa Dhatu resulting in pendulous appearance of Stana, Sphika and Udara.

Medoroga-Santarpanajanya Vyadhi
"Santarpana" means to nourish and satisfy the body.Also, "Brimhana" is a synonym of Santarpana which is also responsible for the nourishment of body.

Ayurvedic Management
In Ayurvedic text, Nidana Privarjana is the first line of choice for the management of any disease.As Aaharj and Viharaj Nidaan are the main culprit in Sthoulya Vyadhi as per Ayurveda.So, first of all correction of improper Aahar and Vihar is most important management of Sthoulya (Medoroga) apart from Aoushadha only.Therefore, there are three lines of choices of management/ treatment for the of Medoroga as:

Management through Vihar
When we are talking about Vihara, Aptarpana is basically Siddhanta which usually we should follow that includes Langhana, Rukhshna and Swedena.

Aptarpana
गु रु चािपा र्ां चे ष्ां स्र्थू लानाां कशा नां प्रति| [6] Guru Aptarpana Chikitsa of Sthoulya is mentioned in Ayurvedic Samhitas.Medoroga is a Santarpanojanya Vikar.So, Aptarpana must to be done which is one of the unique Ayurvedic principle.It includes Rukhshana, Langhana and Swedena.These induce lightness in the body and help in maintaining the health.Apatarpana helps in reducing the body fat found in body cells, tissues, organs and channels.Medoroga is amalgamation of Vata and Meda, so Guru Aptarpana plays a significant role in managing the disease at this level.Aptarpana is antagonistic to Meda and Guru Guna is antagonistic to Lagu Guna of Vata.

Udwartana
It also works on pathogenesis of the Medoroga through the massage of herbal powder all over the body in upward direction and helps in reducing the excess Kapha, Ama and Meda from the body and keeps healthy state of a person.

Panchkarma
Vamana is a therapeutic emesis that works on Kapha and Ama; and by expelling out these two; the accumulated fat expelled out which is a precursor of Kapha and Ama.Another modality in Panchkarma is Virechana that is a therapeutic purgation which eliminate excess Meda from the body.Some Medohara and Lekhaneeya Basti [10] are also mentioned in Ayurveda that will helpful in Medoavrita Vata mainly.

Discussion
In Ayurveda treatment, Siddhanta is based on the Viparit Guna.As Sthoulya is a Santarpanajanya Vyadhi, so we can cure Medoroga or Sthoulya by Viparit Guna Chikitsa i.e Aptarpan.That's why we need to follow Aptarpan Siddhanta in every type of treatment that can be Aahar, Vihaar, Auoshadha and Panchkarma.
Life style is also a major factor to cause Sthoulya.So, it become necessary to improve life style in every manner to cure this.According to Ayurveda, we treat the disease at the level of Dhatus and at this level Dhatwagni is responsible for further nourishment of the next Dhatu.Dhatwagni Mandya is main culprit behind all the disease.Like in Sthoulya Medodhatuagni Mandya is the reason.So, we need to correct the Medodhatuagni.By this we can treat Sthoulya.
Including all these things one more unique concept of Ayurveda is that two persons are not exactly alike, also they don't react alike.So Ahaar, Vihar and Auoshadha mentioned in Ayurveda not the same for every individual because of variation of Prakriti, Desh, Kaal and Agni of an obese person.In other words, there is need of more personalized approach is necessary while treating obesity.

Conclusion
 Santarpana act as Nidana for various Santarpanajanya Vyadhi.Medoroga comes under Santarpanajanya Vyadhi in Ayurveda.So basically, we need Aptarpnoth Chikitsa in Medoroga/Sthoulya.We can manage/treat Medoroga in so many ways i.e.Aahar, Vihar, Auoshadha and Panchkarma also. Drugs that are Katu, Tikta, Kashaya in Rasa, possessing Ushna Virya, and Laghu Ruksha Guna are largely responsible for Medohara and Lekhaneeya activities.Same concept we can follow about Aahar and Panchkarma also.By this approach we can manage Sthoulya. So, we can conclude that Medoroga/ Sthoulya is curable by the above Ayurvedic measures.

Compliance with ethical standards
Manage Kapha-The main cause of Medoroga Kapha plays an important role in causing of Medoroga.So, avoid Kapha aggravating factors that will help in reducing the fat from the body.Manage at the level of Srotodusti in MedodhatuThe factors which are responsible for Dusti of Medovaha Srotas are lack of exercise, sleeping during day time, eating luxurious, fat rich, fried, high caloric food in excess and excessive consumption of alcohol.So, avoid all these aggravating factors to keep the Medovaha Srotas healthy.Use of Deepana-Pachana ModalitiesManda Medodhatvagni is the principal cause of Medoroga which developed at the level of Dhatvagni.Agni works on the metabolism of fat.The Deepana drugs increase the weak metabolic process and Pachana drugs help in digestion of Ama which is an intermediate metabolic toxin.Sticky property of Ama may block the channels of the body which may lead to the improper nutrient supply to the organs or even the cell that in turn create disease.Most of the Deepana Pachana modalities works on the virtue of Katu, Tikta, Kshaya Rasa; Ushna Virya; Katu Vipaka and sometimes Prabhav.All these properties help in destroying the excess Kapha, Ama and Meda which are accumulated in body cells because of blockage of body channels.