Apatarpana ss

176
“A STUDY ON APATARPAN WITH SPECIAL REFERENCE TO UDVARTANA IN STHOULYA”. BY Dr. AMIT A. MASULE DISSERTATION SUBMITTED TO THE RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE. IN THE PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF DOCTOR OF MEDICINE (Ayurveda) IN AYURVEDA SIDDHANTA UNDER THE GUIDANCE OF DR.M. B. KARAMBELKAR D.S.A.C ., A.V.P., Ph.D. PROFESSOR DEPARTMENT OF POST GRADUATE STUDIES IN SIDDHANTA, DR.BNMET’S SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH CENTRE, BIJAPUR NOVEMBER - 2009

description

STUDY ON APATARPAN WITH SPECIAL REFERENCE TO UDVARTANA IN STHOULYA" BY Dr. AMIT A. MASULE, DR.BNMET’S SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH CENTRE, BIJAPUR

Transcript of Apatarpana ss

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“A STUDY ON APATARPAN WITH SPECIAL REFERENCE TO

UDVARTANA IN STHOULYA”.

BY

Dr. AMIT A. MASULE

DISSERTATION SUBMITTED TO THE

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,

BANGALORE.

IN THE PARTIAL FULFILLMENT

OF THE REQUIREMENT FOR THE DEGREE OF

DOCTOR OF MEDICINE

(Ayurveda) IN

AYURVEDA SIDDHANTA UNDER THE GUIDANCE OF

DR.M. B. KARAMBELKAR D.S.A.C., A.V.P., Ph.D.

PROFESSOR

DEPARTMENT OF POST GRADUATE STUDIES IN SIDDHANTA,

DR.BNMET’S SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND

RESEARCH CENTRE, BIJAPUR

NOVEMBER - 2009

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE.

DECLARATION BY THE CANDIDATE

I, hereby declare that this dissertation entitled “A STUDY ON APATARPAN

WITH SPECIAL REFERENCE TO UDVARTANA IN STHOULYA” is a bonafide

and genuine research work carried out by me under the guidance of DR. M. B.

KARAMBELKAR D.S.A.C., A.V.P., Ph.D. Prof., Dept. of Siddhanta, Shri

Mallikarjuna Swamiji Post Graduate and Research Center, Bijapur.

Date: Signature of the Candidate Place: Bijapur. Dr. AMIT A. MASULE

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.

Dr. B. N. M. E. T’s SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH

CENTER, BIJAPUR.

DEPARTMENT OF POST GRADUATE STUDIES IN SIDDHANTA

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A STUDY ON APATARPAN

WITH SPECIAL REFERENCE TO UDVARTANA IN STHOULYA” is a bonafide

research work done by Dr. AMIT A.MASULE in partial fulfillment of the requirement

for the degree of DOCTOR OF MEDICINE (AYURVEDA).

Signature of the Guide.

Date: DR.M. B. KARAMBELKAR D.S.A.C.,A.V.P.,Ph.D Place: Professor and Guide

. Dept. of Siddhanta Shri Mallikarjuna Swamiji PostGraduate and Research centre,Bijapur

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

Dr. B. N. M. E. T’s SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH

CENTRE, BIJAPUR.

DEPARTMENT OF POST GRADUATE STUDIES IN SIDDHANTA

ENDORSEMENT BY THE H.O.D, PRINCIPAL/HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled “A STUDY ON APATARPAN

WITH SPECIAL REFERENCE TO UDVARTANA IN STHOULYA” is a bonafide

research work done by Dr. AMIT A. MASULE under the guidance of DR. M. B.

KARAMBELKAR D.S.A.C., A.V.P., Ph.D. Prof. DEPT. OF SIDDHANTA, Shri Mallikarjuna

Swamiji Post Graduate and Research Centre, Bijapur.

Seal & Signature of the HOD Seal & Signature of the Principal Dr. J. C. HUDDAR M.D (Ayu) Dr.R.N.GENNUR M.D (Ayu) Date : Date :

Place: Place:

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COPYRIGHT

DECLARATION BY THE CANDIDATE

I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka

shall have the rights to preserve, use and disseminate this dissertation / thesis in print or

electronic format for academic/research purpose.

Date: Signature of the Candidate Place: Bijapur. Dr. AMIT A. MASULE

© Rajiv Gandhi University of Health Sciences, Karnataka.

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ACKNOWLEDGEMENT

“Autsukya moha aratidhan jaghaana

Yo apurva vaidyaya namo astu tasmai”

On the eve of completion of this dissertation work, I bow my head to the great

almighty that always showers the blessings on me and without him I would not reach this

stage in my life.

I am very thankful of my grand father Sri. Annaso G. Masule and Late.Sou. Indira A.

Masule for their blessings which makes me helpful to achieve the goal.

This is an unforgettable moment of contentment on the successful fulfillment

of an ambition fostered for long. I offer my salutations to my parents

Prof.Appasaheb A.Masule and Sou. Rajani A.Masule for suffering great agony to

bring me up to this position. I am highly obliged for their blessing, support and

sacrifice which have always been the constant sources of inspiration in my life.

I am very thankful towards my brother Mr.Atul A. Masule,his wife Anuja

A. Masule and my sister Chi. Priyadarshani A. Masule for their kind support and

encouragement.

The smile of our sweet little kid Chi. Atharav A. Masule always encouraged me

for being ambitious and also helpful in gaining confidence.

I would like to offer my gratitude to the chairman Dr. K. B. Nagur, MD (Ayu), for

providing me all the requisites, including financial support. I am also grateful towards the

members of Dr. B.N.M. Education Trust for their support.

I extend my thanks to the principal Dr. R. N. Gennur, MD (Ayu), for providing

necessary facilities throughout my work.

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I express my gratitude towards my guide, Dr. M. B. Karambelkar, D.S.A.C., A.V.P.,

Ph.D., whose cooperation and encouragement made this dissertation a possible task.

My grateful thanks to our H.O.D., Dr. J. C. Huddar, MD (Ayu), whose guidelines

and support encouraged me in every step of this work.

Criticism by the teacher makes the student perfect; Dr. G.B.Bagali, MD (Ayu), such

a teacher is always remembered by me for his inspiration and genuine guidance.

‘Honesty gives success in life’ is always heard from Dr. Mahesh Patil MD (Ayu), to

whom I express my special gratitude for his loving kindness.

My hearty thanks to Dr. Gopu .S for his immense support in my work.

I express my thanks towards Dr. Shridhar B. Gouder MD (Ayu), for his guidance

during my dissertation work.

I express my special thanks to the member of scientific screening committee,

Dr. B. S. Tamagonda, MD(Ayu), for his patient observation and recommendations

throughout the dissertation.

I am thankful to Shri A. I. Tapashetty, M.Sc. (Stat) for his timely guidance and

suggestions in the statistical analysis of data.

I am very much thankful to Dr. Vijay Tungal, MD (Ayu), for his help.

My immense thanks to the seniors Dr, Shantibhushan S. Handur

Dr.Rajrajeshwari, Dr. Vinod S. Gurav, Dr. Deepa Bhairshetty,Dr.Sunil

Nair,Dr.Sudhir Koli, Dr.J.D.Khot and also to my colleagues Dr. Parashuramappa

Turabeen and Dr. Savita Padashetty and my juniors Dr.Kulgeri, Dr.Harron,

Dr.Sumangala and Dr.Ukumnal

My hearty thanks to Dr. Savita M. Sajjan MD(Ayu), for her immense support in my

work.

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The real friendship is proved by the love and affection rendered by the friend,

well wisher, my hostel room partner, Dr. Santosh D.Kodag and Pavan Lalsangi without

their cooperation, this work could not be completed.

I am thankful to Mr. R. G. Dolli, office superintendent and other non-teaching

staff of the college for their timely help.

I extend my thanks to the library staff for their kind cooperation during my work.

My humble thanks towards my patients without whose cooperation, this work

could not be completed at all.

Certain names might have been missed unintentionally, who helped directly or

indirectly. I thank all of them.

Bijapur.

Date: (Dr. Amit A. Masule.)

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LIST OF ABBREVIATIONS

1. A.H. - Astanga Hridaya

2. A. S. - Astanga Sangraha

3. A. T. - After Treatment

4. Bh.Ra. - Bhaishajya Ratnavali

5. Bh.S. - Bhela Samhita

6. B.P.N. - Bhava Prakasha Nighantu

7. B.T. - Before Treatment

8. C.R. - Complete Reduction

9. C.S. - Charaka Samhita

10. D.N. - Dhanvantari Nighantu

11. Ha.S. - Harita Samhita

12. H.S. - Highly Significant

13. Ka.S. - Kashyapa Samhita

14. K.D.N. - Kaiya Deva Nighantu

15. Lt - Left

16. MW - Monnier Williams

17. PTFU - Post Treatment Follow Up

18. Rt - Right

19. S - Significant

20. Sh.Ka.Dr. - Shabda Kalpa Druma

21. SR - Slight Reduction

22. S.S - Sushruta Samhita

23. Y.R. - Yoga Ratnakara

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ABSTRACT:

Apatarpana and Santarpana are the two folds of therapy explained in

samhitas.The six folds of therapies as Langhana, Brumhana, Rukshana, Sneehana,

Swedana and Sthambhana comes under these two folds. From which Langhana,

Rukshana and Swedana comes under Apatarpana while Brumhana, Snehana and

Sthambhana comes under Santarpana.So detail study on Apatarpana is taken as the basic

fundamental principle.

As Sthoulya itself is a Santarpanotta vyadhi so Apatarpana therapy is indicated in

the treatment of Sthoulya.It is achieved by Ruksha udvartana with Chanaka pishthi which

comes under Rukshana therapy.So this study has been taken to evaluate the effects of

Ruksha udvaratana with chanaka pishthi in the treatment of sthoulya under the basic

principle of Apatarpana.

Sthoulya is the most common disorder occurs in society. It is defined as a

condition in which there is an excessive amount of meda in sphik, sthana and udara

pradesha.

It correlates to obesity which is defined as a nutritional disorder and accumulation of

excessive amount of body fat.

Obesity is a chronic metabolic disease which requires persistant approach with

gradual improvement.

The prevalence of obesity is rising at an alarming rate. In the developing

countries it has been estimated that 115 million people suffer from obesity related

problem.

About every fourth person on earth is too fat around the globe, about 1.7 billion

people should lose weight according to international obesity task force.

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The existing obesity treatment options, in modern medicine includes drugs like

Fenfluramine, Dexfenfluramine and Sibutramine which acts as appetite inhibitors and

cannot be used for long periods and have got side effects.

The present study intends to know the effect of Ruksha udvartana with Chanak

pishthi in the treatment of sthoulya under the concept of basic principle,ie,Apatarpan.

Objective of study:-

The present study has following objectives,

1) Detail study on Apatarpana

2) Detail study of Sthoulya.

3) To study the effect of Ruksha udvartana with chanaka pishthi in Sthoulya.

Methods:-

Aim: The aim is” To assess the effect of Ruksha udvartana with Chanaka pishthi in

Sthoulya under the concept of Apatarpana.

Study design:- The patients of sthoulya within the age group of 20-50 yrs were

rselected.A group of 30 patients is selected for ruksha udvartana with chanaka pishthi.

Patients were assessed for BMI, vaksha, udara and sphika circumference along with the

symptoms adhika kshudha,adhika trishna ,kshudra shwasa and swedadhikata.Data was

collected as before treatment,after treatment and post treatment follow up. The data was

statistically analyzed.

Result:-

The result of the clinical study showed more significant with Chanaka pishthi udvartana

in treatment of sthoulya.

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Interpretation and conclusion:-

Apatarpana is a basic fundamental principle in dwividhopkrama.The ruksha

udvartana with chanaka pishthi is a rukshana upakrama under the concept of Apatarpana

in the treatment of sthoulya.Sthoulya is the most common disorder occurs in society. It is

defined as a condition in which there is an excessive amount of meda in sphik, sthana and

udara pradesh.

It correlates to obesity which is defined as a nutritional disorder and accumulation

of excessive amount of body fat.

Udvartana with chanak pishthi has shown non-significant results in the treatment

of sthoulya.

On the basis of this study, along with udvartana procedure, shamana aoushadhi,

pathyapathya, exercise and teekshana basti may be a better line of treatment in the

management of patients of sthoulya.

KEY WORDS:-

OBESITY, STHOULYA BMI, CHANAKA PISHTHI

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CONTENTS

PARTICULAR PAGE NO

1) Introduction 1-3

2) Objectives 4

3) Review of Literature 5-46

• Concept of Apatarpan 5-13

• Sthoulya Review 13-14

• Nidana Panchaka 14-19

• Chikitsa 20-25

• Modern Review 26-35

• Drug Review 36-37

• Udvartana Review 38-46

4) Materials and Methods 47-54

5) Observations and Results 55-88

6) Discussion 89-130

7) Conclusion 131

8) Recommendation for future study 132

9) Summary 133-134

10) Bibliography 135-145

11) Annexure

• Classical References 146-152

• Clinical Proforma 153-157

• Photographs

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LIST OF TABLES:-

TABLE PAGE NO

1. Paryayas of Sthaulya 14

2. Nidana for sthaulya according to different acharyas 15

3. Lakshanas of sthaulya according to different acharyas 16-17

4. Upadravas of sthaulya according to different acharyas 18-19

5. Different formulations in Sthaulya 23

6. Showing pathya vihara according to different Acharyas 24-25

7. Classification of overweight and obesity by BMI chart 29

8. Showing effects of Rookshana karma 38

9. Showing Samyak Rookshana Lakshana 39

10. Showing Rookshana atiyoga lakshana 40-41

11. Showing Rookshana Ayoga Lakshana 42

12. Showing benefits of Udvartana 43-44

13. Showing Therapeutic actions of Udvartana 45-46

14. .Classification of over weight and obesity by BMI chart 51

15. Subjective criteria 51

16. Circumferance of Vaksha, Udara and Sphik 53

17. Objective criteria 53

18. Distribution of patients according to age 55

19. Distribution of patients according to sex 56

20. Distribution of patients according to religion 56

21. Distribution of patients according to education 57

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22. Distribution of patients according to socio-economical status 57

23. Distribution of patients according to marital status 58

24. Distribution of patients according to habitat 58

25. Distribution of patients according to occupation 59

26. Distribution of patients according to diet 60

27. Distribution of patients according to vyasana 60

28. Distribution of patients according to prakruti 61

29. Distribution of patients according to agni 61

30. Distribution of patients according to kostha 62

31. Distribution of patients according to kula vruttanta 62

32. Distribution of patients according to BMI BT 63

33. Distribution of patients based on vaksha circumference BT 64

34. Distribution of patients based on udara circumference BT 64

35. Distribution of patients based on sphik circumference BT 65

36. Distribution of patients according to the adhika kshutha BT 66

37. Distribution of patients according to the adhika trishna BT 66

38. Distribution of patients according to the kshudra shwas BT 67

39. Distribution of patients according to the swedadikhata BT 68

40. Distribution of patients according to BMI AT 68

41. Distribution of patients based on vaksha circumference AT 69

42. Distribution of patients based on udara circumference AT 70

43. Distribution of patients based on sphik circumference AT 70

44. Distribution of patients according to the adhika kshutha AT 71

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45. Distribution of patients according to the adhika trishna AT 72

46. Distribution of patients according to the kshudra shwas AT 72

47. Distribution of patients according to the swedadikhata AT 73

48. Distribution of patients according to BMI AFU 74

49. Distribution of patients based on vaksha circumference AFU 74

50. Distribution of patients based on udara circumference AFU 75

51. Distribution of patients based on sphik circumference AFU 76

52. Distribution of patients according to the adhika kshutha AFU 76

53. Distribution of patients according to the adhika trishna AFU 77

54. Distribution of patients according to the kshudra shwas AFU 78

55. Distribution of patients according to the swedadikhata AFU 78

56. Result related responses of the patients AT 81

57. Result related responses of the patients AFU 84

58. Statistical analysis of BMI 87

59. Statistical analysis of Vaksha 87

60. Statistical analysis of Udara 87

61. Statistical analysis of Sphik 87

62. Statistical analysis of Adhika kshutha 88

63. Statistical analysis of Adhika trushna 88

64. Statistical analysis of kshudra shwas 88

65. Statistical analysis of swedadikhata 88

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LIST OF GRAPHS:-

GRAPH PAGE NO

1. Distribution of patients according to age 55

2. Distribution of patients according to sex 56

3. Distribution of patients according to religion 56

4. Distribution of patients according to education 57

5. Distribution of patients according to socio-economical status 57

6. Distribution of patients according to marital status 58

7. Distribution of patients according to habitat 58

8. Distribution of patients according to occupation 59

9. Distribution of patients according to diet 60

10. Distribution of patients according to vyasana 60

11. Distribution of patients according to prakruti 61

12. Distribution of patients according to agni 61

13. Distribution of patients according to kostha 62

14. Distribution of patients according to kula vruttanta 62

15. Distribution of patients according to BMI BT 63

16. Distribution of patients based on vaksha circumference BT 64

17. Distribution of patients based on udara circumference BT 65

18. Distribution of patients based on sphik circumference BT 65

19. Distribution of patients based on adhika kshudha BT 66

20. Distribution of patients based on adhikatrishna BT 67

21. Distribution of patients based on kshudra shwas BT 67

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22. Distribution of patients based on swedadikhata BT 68

23. Distribution of patients according to BMI AT 69

24. Distribution of patients based on vaksha circumference AT 69

25. Distribution of patients based on udara circumference AT 70

26. Distribution of patients based on sphik circumference AT 71

27. Distribution of patients based on adhika kshudha AT 71

28. Distribution of patients based on adhikatrishna AT 72

29. Distribution of patients based on kshudra shwas AT 73

30. Distribution of patients based on swedadikhata AT 73

31. Distribution of patients according to BMI AFU 74

32. Distribution of patients based on vaksha circumference AFU 75

33. Distribution of patients based on udara circumference AFU 75

34. Distribution of patients based on sphik circumference AFU 76

35. Distribution of patients based on adhika kshudha AFU 77

36. Distribution of patients based on adhikatrishna AFU 77

37. Distribution of patients based on kshudra shwas AFU 78

38. Distribution of patients based on swedadikhata AFU 79

39. Responses of the patients for BMI AT 81

40. Responses of the patients for Vaksha AT 81

41. Responses of the patients for udara AT 82

42. Responses of the patients for sphik AT 82

43. Responses of the patients for adhika kshudha AT 82

44. Responses of the patients for adhika trushna AT 83

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45. Responses of the patients for kshudra shwas AT 83

46. Responses of the patients for swedadhikata AT 83

47. Responses of the patients for BMI AFU 84

48. Responses of the patients for Vaksha AFU 84

49. Responses of the patients for udara AFU 85

50. Responses of the patients for sphik AFU 85

51. Responses of the patients for adhika kshudha AFU 85

52. Responses of the patients for adhika trushna AFU 86

53. Responses of the patients for kshudra shwas AFU 86

54. Responses of the patients for swedadhikata AFU 86

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Introduction ===============================================================

INTRODUCTION

Scientific and technological progress has made man highly sensitive and critical;

there by giving rise to different types of health problems. The advancement of

industrialization and communication is contributing towards sedentary life styles, in turn

causing chronic non- communicable diseases like obesity diabetes mellitus, hypertension,

cancer, ischemic heart disease, cerebro-vascular accidents, atherosclerosis, varicose veins

etc. Obesity being the risk factor for these diseases and hence prevention of obesity will

decrease the chances of such diseases. Excess of fat “shortens the life line” of the

individual by imposing an extra burden on all the systems of body.

Obesity is a major health problem in both developed and developing countries.

The exact estimation of prevalence is difficult as the standardized definition is lacking. In

countries like USA, approximately 55% of population in the age group of 20-70 years is

suffering from this problem. A study conducted in Delhi shown that approximately 25%

of populations are obese in urban areas. Another study conducted in United States,

showed increase in sudden death rate among men and women with at least 20%

overweight, which clearly shows the reduced life span due to its incidence.

Ayurveda, the science of life, had given much importance to primary and

secondary preventions of diseases. Acharya’s have explained at length the

dwividhopkram ie Santarpan and Apatarpan.As sthoulya itself is a Santarpanotta

vyadhi,so Apatarpana therapy is prescribed in sthoulya.Apatarpana is a basic fundamental

principle explained in samhitas so it comes under a branch moulika siddhanta which

explains basic fundamental principles.Apatarpan itself contains langhana,rukshana and

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Introduction ===============================================================

swedana upakrama.From which ruksha udvartana with chanaka pishthi comes under

rukshana upakram which is highlated in the treatment of sthoulya.

Sthoulya is the nearest clinical entity for obeisity in Ayurveda.So ruksha udvartan

with chanaka pishthi is a beter option for treatment of sthoulya under the concept of

Apatarpana. Considering the difficult nature of disease, obesity can be better prevented

rather than treated. In Ayurveda, obese persons are included under Asta Nindita purusha

(Athi Deerga, Athi Hraswa, Athi Stoola, Athi Krusha, Athi Goura, Athi Sweta, Athi

Roma and Aroma). The reason for difficult nature being the involvement of Tridosha and

meda mamsaadi dhatu. It is also mentioned that the preferred constitution for an

individual should be emaciated rather than obese.

The existing obesity treatment options, in modern medicine includes drugs like

Fenfluramine, Dexfenfluramine and Sibutramine which acts as appetite inhibitors have

with of adverse effects and cannot be used for long periods. Some devices like vibrators

are being used for local lipolytic action. Nutritional combinations (synthetic nutritional

compounds) are expensive and they too have untoward effects.

In the present context Ayurveda offers a ray of hope in treatments like Udvarthana

lekhana basti along with some internal medicines like Navaka guggulu, trayodashanga

guggulu etc. The internal administration of guggulu has certain limitations like gastric

irritation, constipation etc. On contrary, Udvarthana is a procedure which can be

undertaken daily with a preliminary training to the individual. Now it’s efficacy has been

proved in reduction of weight and associated lakshanas with no adverse effects.

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Introduction ===============================================================

To document and analyze this procedure for statistical interpretation, the study

entitled “A study on Apatarpan with special refference to udvarthana in Sthoulya” was

undertaken.

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Objectives Of Study

==============================================================

OBJECTIVES OF STUDY

1) Detail study on Apatarpana

2) Detail study of Sthoulya.

3) To study the effect of Ruksha udvartana with chanaka pishthi in Sthoulya.

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Review of literature ===============================================================

REVIEW OF LITERATURE

A STUDY ON APATARPANA WITH SPECIAL REFERENCE TO UDVARTAN

IN STHOULYA

CONCEPT OF APATARPAN: -

In Astanga Hridaya; Sutrasthana chapter no. 14; Dvividhopakramaniya adhyay

has been mentioned. In which there are two folds of therapies have been mentioned as 1)

Santarpana and 2) Apatarpana. The synonyms mentioned for Santarpana and Apatarpana

are Brahana and Langhana respectively.1Bramhan is for stoutening of the body while

Langhan is for making the body light i.e. thin2.

Functions such as snehana, Rukshana, Swedana and Stambhana are also of these

two kinds3. From which Snehana and Stambhana comes under bramhana i.e. Santarpana

and Rukshana and Swedana comes under Langhana i.e. Apatarpana. Langhana is of two

types : - 1) Shodhana and 2) Shamana4. Shodhana is that which expels the doshas out of

the body forcibly. It is of five kinds viz. Niruha, Vamana, Kayareka, Shiroreka and Asra-

visrut5.

Shamana is that treatment which is palliative in nature, it means which does not

expel the doshas and also does not increase the doshas but which makes the abnormal

doshas in normal state. It is of seven kinds as Pachana, Dipana, Kshut, Trushna,

Vyayama, Atapa and Maruta6. The dravyas which are of Agni, Vayu and Aakash

mahabhut predominant does the Apatarpana karma while Prithvi and Aap mahabhut

pradhana dravya does brahmana karma.

In Charaka samhita; Sutrasthana; chapter no. 22, Langhana-Brahmaniya adhyaya

it has been mentioned about six karmas as Langhana, Bramhana, Rukshana, Snehana,

--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 5

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Review of literature ===============================================================

Swedana and Stambhana7. Among them Langhana, Rukshana and Swedana karma comes

under Apatarpana therapy. While Bramhana, Snehana, Stambhana comes under

Santarpana therapy.

Langhana karma may be applied in various forms such as four types of evacuation

i.e. Vaman, Virechana, Niruha and Nasya; thirst, exposure to wind; exzposure to sun;

pachan, upavasa and vyayam8. These ten folds of Langhana therapy mentioned in Charak

Samhita. Those having big body and strength, abundant kapha, pitta, blood and excreta

and association of aggravated vayu should be subjected to reducing therapy by means of

evacuation i.e. Langhana9.

In Charak Samhita, Vimansthana chapter no. 3, Janapadodhwansaniya adhyaya it

has been mentioned that for the diseases therapy consists of that which contrary to the

etiology such as there is no allevation of the disease caused by apatarpana without puran

and of those caused by puran without apatarpana10. Apatarpana has been classified in

three types as Langhana, Langhana-pachana and Doshavirechana11.

Amongst them Langhana therapy is recommended for those having doshas with a

little strength. By Langhana therapy agni and vata are increased which dry up the little

dosha like the wind and sun dry up the little water. The Langhana-pachana therapy is

prescribed in case of doshas with medium strength. By this therapy the moderate doshas

are dried up in the same way as the moderate quantity of water is dried up by the sun heat

and wind and also by sprinkling dust and ashes. In case of abundant doshas, only letting

out of doshas is prescribed i.e. doshavirechana12.

In Astanga Sangraha; Sutrasthana; chapter no. 29, Dvividhopkramaniya adhyaya,

it has been mentioned that the treatments are of two folds as Santarpana and Apatarpana.

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The synonyms mentioned for Santarpana and Apatarpana are Bramhana and Langhana

respectively13. Bramhana is meant to make body stout and Langhana for making it light

(thin). Bramhana is caused by the predominancy of agi, vayu, akash bhutas14. The

treatments such as snehana, rukshana, swedan and stambhana are not separate from the

above two folds of therapies15. From which rukshana and swedana comes under the

Langhana therapy and snehana and stambhana comes under Bhamhana therapy.

Langhana is of two kinds 1) Shodhana and 2) Shamana.

Shodhana is that which expel the dosha out of body. It is of five kinds as

niruha,vaman kayavireka, shirovireka and asravisruti. Shamana is that which neither

expel dosha out, nor increases the doshas which are normal but only mitigates decrease to

normal the increased dosha. It is of seven kinds pachana, dipana, kshudha, trushna,

vyayama, atopa and maruta16.

In Sushruta Samhita; Chikitsasthana; chapter no. 1, Dvivraniya chikitsitam. It has

been mentioned about shashtiupakrama in which Apatarpana, is mentioned as first

upakrama which stands for briging effect of fasting17.

Langhana yogya : -

In Astanga Sangraha, Dvividhopkramaniya adhyaya, chapter no. 24, langhana

yogya has been mentioned. Langhana therapy should be done daily for person suffering

from diabetes, ama too much moisture in the body, fever stiffness of the thighs, leprosy

etc skin disorders, visarp abscess, splenic disease, diseases of the head, throat, eyes those

who are obese and even for others during shishira rutu18.

In Astanga Hrudaya, Sutrasthana,chapter no. 14, Dvividhopkramaniye adhyaya,

Langhaniya mentioned for those langhan should be done daily for person suffering from

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diabetes with amadosha disorders of poor digestive activity, more moistness, fever,

stiffness at the thighs, leprosy and other skin disorders, visarpa, abscess, disease of

spleen, head, throat, eyes, those who are obese and even to others during shishira19.

In Charaka Samhita; Sutrasthan, chapter no. 2, metioned the langhan yogya

persons are those having big body and strength, abundant kapha, pitta, blood and excreta

and association of aggravated vayu should be subjected to Apatarpana therapy by means

of evacuation. Those afflicted with disease of moderate severity and caused by kapha and

pitta like vomiting, diarrhea, heart disease cholera, alasaka, fever, constipation, heaviness

eructation, nausea, anorexia etc should mostly be treated with digestives in the beginning

by the learned physician. These vary diseases when with little severity, should be

overcome with control of thirst and fasting. The diseases of moderate and little severity in

strong persons should be treated with physical exercise and exposure to sun and wind.

The persons suffering from skin disorders, diabetes those using excess of unctuous,

channel blocking and promoting diet and also patients of vatika disorders should be

subjected to reducing therapy in shishira20.

As described above Apatarpana included three folds of treatments these are

Langhana, Rukshana and Swedana. As per Samhitas it is clear that langhan is synonym

for Apatarpana. Till though langhana itself contains a major documentation in Samhitas

so it is also concern as a type Apatarpana.

Langhana : -

In Charak Samhita Sutrasthana; chapter no. 22, Langhanbramhaniya adhyaya it is

stated that whatever produces lightness in the body is known as Langhana. The drugs

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producing laghu, ushna, teekshna, vishad, ruksha, suskhma, khara, sara guna and hard

properties has got mostly the langhana effect21.

In Langhana upakrama its utilization has been mentioned above i.e. Langhana

yogya. In Astanga Hridaya; Sutrasthana; chapter no. 14, Dvividhopkrimaniya adhyaya it

has been stated that those who are very obese, strong and having predominance of pitta

and kapha, those suffering from amadosha, fever, vomiting, diarrhea, heart disease,

constipation, feeling of heaviness, excess of belching, nausea, etc by the administration of

shodhana should be done. Those who are moderately obese first by administration of

digestives and hunger producing substances generally and later with other purifactory

therapies should be done. Those who are slightly obese by control of hunger and thirst

should be used. Those are troubled by increased doshas, who are of medium strength of

body and thirst and who are dridh for them by control of hunger and thirst should be

used. Those again of poor strength of body and disease by exposing them to breeze,

sunlight and exercise22.

It has been also stated that who are to be given Langhana should not be given

Bramhana, those who are to be given Bramhana, should be given mild Langhana, or both

Langhana and Bramhana together. Simultaneously may be given depending upon the

nature of habitat, season, strength etc23.

Chikitsaphala (Benefits of Langhana) : -

Keenness of the sense organs, expulsion of malas, feeling of lightness of body,

good taste perception, appearance of hunger and thirst together, purity of heart, belchings

and throat, softening of the diseases, increase of enthusiasm and loss of laziness occur

from Langhana therapy24.

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Atilanghana (Excess of Thinning therapy) : -

Profound emaciation, giddiness, cough, thirst, anorexia, loss of moistness and

digestive power, of sleep, vision, hearing, semen, ojas hunger and voice, pain in the

urinary bladder, heart, head, calves, thighs, upper shoulders and flanks, fever, delirium

(excess of talk), belching, exhaustion, vomiting, cutting pain, in joints and bones, non-

elimination of faeces, urine etc arise from excess of Langhana25.

In Astanga Sangraha; chapter no. 29, Dvividhopkramaniya adhyaya langhana

yogyah, langhana phalam has been highlighted as same in the Astanga Hridaya.

Rukshana : -

In Charaka Samhita; Sutrasthana; chapter no. 22, Langhanbramhaniya adhyaya,

Rukshana is that which produces roukshya, kharatwa, vaishadya. The drugs which are

ruksh, laghu, khara, teekshna, ushna, sthira, pichil and hard drug is mostly rukshana in

effect. Roughening therapy consists of the regular intake of Katu, Tikta, Kashaya articles

sexual acts and use of oil cakes, butter milk and honey etc. The roughening therapy is

indicated in diseases which are used by blocking of channels, strong doshas and are

located in vital parts and in urustambha etc26.

Samyak yoga lakshana : -

The roughening therapy should be regarded as properly administered when there

is proper elimination of wind, urine, faeces, lightness in body, cleansing of heart,

eructation, throat and mouth, disappearance of drowsiness and exhaustion, appearance of

sweat, relish and both hunger and thirst together and also feeling of well being27. Pain in

joints, bodyache, cough, dryness of mouth, loss of hunger, anorexia, weakness of hearing

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and vision, confusion of mind, feeling of darkness, loss of weight, digestive power and

strength these are symptoms of excessive reducing therapy28.

In Charak Sutrasthana; chapter no. 13, explains about the rukshana yogya, person

who have excess of kapha, meda, with mouth and anus having excessive secretions, have

slow digestion are afflicted with thirst and fainting, are pregnant have dry palate, aversion

to food, vomiting, one afflicted with abdominal enlargement, with ama and poison, are

weak in body and mind, depressed with unction, are under narcosis, should not be uncted

and also during administration of snuff and enema because by taking unction, they

become victim of severe disorders29.

Swedana : -

Swedan (sweating) produces sweat, it alleviates stiffness, heaviness and cold i.e.

stambha, gaurav, shitaghna in property. The drugs which are ushna, teekshna, sara,

snigdha, ruksha, sukshma, drav, sthira, and also guru gunatmak dravya can do swedan30.

Swedan yogya : -

In coryza, cough, dyspnoea, non-lightness,pain in ear, back, neck, head,

hoarseness of voice, choaked throat, paralysis of phase, one limb, whole or half body,

bending of body, hardness of bowels and constipation, suppression of urine, excessive

yawning, stiffness in sides, back waist and abdomen, sciatica, dysuria, enlargement of

scrotum, bodyache, pain and stiffness in feet, knees, thighs and shanks, swelling, khalli,

condition of ama, cold, shivering, vatakantak, contraction, extension pain, stiffness,

heaviness, numbness in organs, in these conditions swedana is beneficial31.

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Swedana ayogya : -

Swedan should not be applied to those who are habitual users of medicinal

extracts, wine, in pregnanat, ladies, those afflicted with internal haemorrhages and

bradhna having complication of poison and alcohol in fatigued uncouncious plumpy,

patients of pittaj meha, thirsty, hungry, angry and aggrieved ones, in those suffering from

the jaundice, abdominal enlargement, injury and aadhyaroga, in weak, emaciated and

those having diminished ojas and suffering from the timira etc32.

Types : -

According to Charaka Sutrasthana; chapter no. 14, there are 13 types of Swedana

1) Sankar 2) Prastar 3) Nadi 4) Parishek

5) Avgaha 6) Jentak 6) Ashmaghna 8) Karshu

9) Kuti 10) Bhu 11) Kumbhika 12) Kupa

13) Holak.

According to Sushruta Chikitsasthana; chapter no. 32, Swedanacharaniya chikitsa

adhyaya

1) Tap Sweda 2) Ushma 3) Upnaha 4) Drav.

According to Astanga Sangraha; chapter no. 26, Sweda vidhi adhyaya, mainly

classified into two types

1) Agni sweda 2) Anagni sweda.

Agni Sweda again classified into 4 kinds

1) Tap 2) Ushma 3) Upnaha 4) Drava

Ushma Sweda classified into 8 kinds

1) Pinda Sweda 2) Sankar Sweda 3) Nadi 4) Ghanashma

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5) Kumbhi 6) Kupa 7) Kuti 8) Jentak Sweda

Drava Sweda classified into 2 types

1) Avagah 2) Parishek Sweda

So these three folds of treatments i.e. Langhana,Rukshana and Swedana comes

under Apatarpana therapy. As sthoulya is santarpanotha vyadhi so ruksha udvartana with

chanak pishthi is indicated in sthoulya which comes under Apartana therapy.

STHOULYA REVIEW

Charaka has explained sthoulya under Ashtouninditiya Adhyaya of sutrasthana33

Sushruta under Dosha-dhatu – mala-kshaya vruddhi vijnaneeya Adhyaya34 and in

Dwividhopakramaneeya Adhyaya by Vagbhata35. While Madhava36 Yogartnakara37,

Bhavaprakasha 38 explained sthoulya under the heading of medo- roga.

HISTORICAL REVIEW:-

I) Vedic Period – In Rigveda, Yajurveda, Atharvaveda, Upanishad no references about

sthoulya were found.

II) Samhita Period – In Charaka samhita ,Sushruta samhita , Astanga sangraha we find

detail description regarding sthoulya.

III) Sangraha Kala – In Bhavamishra and in Yogratnakar we find the description about

sthoulya.

Nirukti :-

Sthoolasya bhavaha sthoolata lakshana and upachita shareeratwam39.

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Paribhasha:-

A person is said to be atisthoola when his sphik (buttock), sthana (breast) and udara

(abdomen) become pendulous due to accumulation of excess of mamsa and meda in

those places and his strength is rendered disproportionate with his physical growth40.

Paryaya:-

Sthoolata, Atishoulya, Atisthaulyata, Medaswi, Sthoola, Atisthoola.

TABLE NO 1:

Paryayas Ch.S41 Su.S42 A.S43

Sthoulya + + --

Atisthooala + + +

Atisthoulya + + +

Medaswi + -- --

NIDANA:-

Following are the nidanas for sthoulya. They are divided into sharirika, manasika and

beeja swabhavaja.

Sharirika nidana includes

Ahara Vihara

i) Atibhojana i) Avyayama

ii) Adhyashana ii) Avyavaya

iii) Ati gurusnigda and sheeta ahara iii) Diwaswapa

iv) Atishleshmala ahara

v) Santarpana ahara and mamsa sevana.

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Manasika nidana includes

a. Achintana

b. Harsha nityata

Beeja Swabhavaja: According to Charaka sthoulya is beeja swabhavaja vyadhi.

TABLE NO 2: NIDANA FOR STHOULYA ACCORDING TO DIFFERENT

ACHARYAS.

Nidana Ch.S44 Su.S45 A.S46 M.N47 Y.R48 B.P49

Atibhojana + - - - - -

Adhyashana - + - - - -

Atimadhura Ahara + - - - + +

Atishleshmala Ahara - + + + + +

Atiguru Ahara + - + - - -

Atisheeta Ahara + - - - - -

Atisnigda Ahara + - - - - -

Avyayama + + - + + +

Avyavaya + - - - - -

Diwaswapa + + - + + +

Achintata + - - - - -

Harshanityata + - - - - -

Atisneha Ahara - - + + -

Beeja Swabhavaja + - - - - -

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Purvarupa:-

Purva rupa for sthoulya is not available in classics.

Rupa:-

Rupa are the manifestations which develop during the course of disease. Below given

table shows lakshanas of sthoulya according to different Acharyas.

TABLE NO 3: LAKSHANAS OF STHOULYA ACCORDING TO DIFFERENT

ACHARYAS.

Lakshanas Ch.S50 Su.S51 A.S52 M.N53 Y.R54 B.P55

Chala udara + - + + + +

Chala stana + - + + + +

Chala spik + - + + + +

Javoparodha + - + + + +

Ayathopachaya + - + + + +

Ayuhrasa + + + + - -

Kruchra vyavaya + + - + + +

Durbalata + - + - + +

Dourgandhyata + + + + + +

Swedadhikya + - - - - -

Atikshudha + + + + + +

Atitrishna + + + + + +

Atinidra - + + + + +

Atisweda - + + + + +

Kshudrashwasa - + + + + +

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Shrama - + - - - -

Karyaakshamata - + + + - -

Jadyata - + + - - -

Gadagadatwa - + + - - -

Shwasavarodha - + - + + +

Moha - + - + + +

Sadana - + - + + +

Pratyatma Lakshanas of sthoulya are:- 56

a) Chala sphik b) Chala stana

c) Chala udara d) Ayathopa chayotsaha

SAMPRAPTI: 57

Due to nidana sevana srotorodha occurs by meda, vata moves to koshta

sandukshana of vayu in koshta takes place again by which jataragni become prajwala as a

result excess of kshuda and trushna occur.

Excessive of Agni and Vayu kills the sthoola person as the Agni and Vayu burn

up the tree which has a big cavity inside.

As meda dhatu is mula of sweda vaha srotas so excess of sweda occurs due to

Agni santapa Meda dhatu, which is assosciated with kapha all, makes profound increase

of sweda.

The meda getting digested in the kostha causing avarodha in the srotas of Rasa

hinders it from going from other dhatus and make for increase of only meda dhatu. The

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remaining portion of rasa dhatu being very little in quantity is not enough; to nourish the

rakta and other dhatu.

The increase in meda is similar to the increase of vata and others, that which has

under gone increase first will only undergo further increase. On this analogue there will

be disparity between medas and other dhatus, the increase medas will soon produce

shwasa, udara, bhagandra, prameha, urusthamba, jwara etc. other diseases may manifest

UPASHAYA AND ANUPASHAYA

In classics no references of upashaya and anupashaya are available for sthoulya

UPADRAVA

If the patient goes on indulging again in unsuitable ahara, vihara and without taking

treatment then the upadrava are seen due to the primary disease.

TABLE NO 4: UPADRAVAS OF STHOULYA ACCORDING TO DIFFERENT

ACHARYAS

Upadravas Su.S58 A.S59 M.N60 Y.R61 B.P62

Prameha + + - + -

Prameha pidika + + + - +

Jwara + + + + +

Vidradhi + + + - +

Bhagandara - + + + +

Udara roga - + - - -

Urushtamba - + - - -

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Vatavikara + - + - +

Shwasa - + - - -

Visarpa - - - + -

Atisara - - - + -

Arsha - - - + -

Shleepada - - - + -

Apachi - - + -

Kamala - - - + -

SADHYA SADHYATA

The two diseases karshya and sthoulya are always afflicted with disease and one

should be treated with constant nourishing and slimming remedies respectively.63

Karsha and sthoola are undesirable for treatment. Among these two sthoulya is

considered to be more undesirable64.

When compared to sthoulya krisha is better for treatment, as to bring back the

normlcy of vata, agni and meda is difficult in case of sthoulya65.

By the above quotations of different Acharyas sthoulya is said to be kashta sadhya

to treat .Beeja doshaja /Kulaja /sahaja is always asadhya.

ARISTHA LAKSHANAS

For sthoulya there are no references available as aristha lakshana.

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CHIKITSA

Chikitsa siddhanta includes

1) Nidana parivarjana – Avoidance of etiological factors constitute major course of

the management of sthoulya 66

2) Shodhana chikitsa – Lekhana basti is beneficial for sthoulya prepared of drugs

having ushna teekshna and rooksha gunas67

Powder of ushakadigana drugs are added with equal quantity of triphala

kwatha, gomutra madhu and yavakshara.

3) Guru Cha apatarpana - charak described for sthoola person, guru which is

apatarpaka ahara should be given68.

4) Shoolanam karshanam prati

For sthoulya karshana ahara should be preferred69.

5) Vata, kapha and medohara annapana

The oushada, ahara and pana for the sthoulya should be the alleviative of vata,

kapha and meda70.

6) Udvarthana - Udvarthana with rookshadravyas like musta, kulatha is beneficial as

it reduces kapha, meda and produces laghuta in the body71.

7) Udvartana with Chanak Pisthi is been utilised in Sthoulya.

8) Pana, abhyanga, gandusha, nasya, basti with triphaladi taila should be used.

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SHAMANAUSHADHI

Charaka 72

i) Guduchi, bhadramusta, triphala, takrarishta and madhu

ii) Vidanga, nagara, kshara, kala loha raja , yava, amlaki, churna

iii) Bhrahat panchamoola with madhu

iv) Agnimantha rasa and shilajitu

Sushruta73 – Shilajitu, shuddha guggulu, goumutra triphala churna, lobha bhasma,

Rasanjana madhu are used in sthoulya

Asthanga Hridaya74 –Trikatu, katukarohini triphala, shigru, vidanga, ativisha, sthira,

hingu, souvarchala jeeraka, yavani, dhanyaka, chitraka, haridra,

Daruharidra, hapusha, pata, etc. saktu, Vyoshadi guggulu.

Astanga sangraha75

i) Madhoodhaka ii) Triphala + Madhu

iii) Guduchi + Madhu iv) Brihat panchamoola + Agnimantha

rasa

v) Rasanjana + Agnimantha rasa vi)Yava + Amalaka churna

vii) Musta + Madhu

Chakradatta76

i) Madhoodaka ii) Vidangadya choorna

iii) Vidangadya loha iv) Vyosadya saktu

v) Badari patra siddapeya + shilajtu vi) Amurutadya guggulu

vi) Loha rasayana viii) Triphaladya taila

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For Durgandha

i) Teja patra, netrabala, abhaya and candana all churna should be applied over body.

ii) Vasa swarasa + shanka churna application

iii) Haridra choorna fried with chincha swarasa

For swedadhikya

Shiresha nagakeshara and lodhra should be applied.

Bhavaprakash77

i) Triphala +trikatu + taila + lavana ii) Triphala + madhoodaka

iii) Brahat panchamoola choorna + madhu iv)Erandapatra kshara+ hingu

v) Loha bhasma + guduchi + triphala qwatha vi) Loha bhasma + shilajitu + tripala

vii) Loha bhasma + guguulu + triphala viii)Amrutadi guggulu

ix) Dashanga guggulu x) Trushanadya guggulu

xi) Loharishta, loharasayana

Yoga – Ratnakara 78

i) Triphala kwatha + madhu ii) Phalatrikadi yoga

iii) Guduchyadi yoga iv) Trushanadya loha

v) Navaka guggulu vi) Mocha rasa + samudra phena

Bhaishajya Ratnavali 79

i) Chavyadi saktu ii) Vyosadya saktu

iii)Vidangadi choorna iv)Haritaki yoga

v) Vidangadi louha vi) Louha rasayana

vii)Navaka guggulu viii) Amrutadya guggulu

ix) Erandakshara prayoga x) Trushanadya loha

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TABLE NO 5: DIFFERENT FORMULATIONS IN STHOULYA

Formulation B.P Y.R B.R C.D

Amrutadhya guggulu + - + +

Agnimatha kwatha - - + -

Badavagniloha - - + -

Chavyadi sakta - - + -

Dashanga guggulu + - - -

Guduchyadi yoga - + - -

Loha rasayana + - + +

Loharshta + - + -

Mahasugandhi taila + - + -

Madhoodaka + + + +

Navaka guggulu - + + +

Phalatrikadi yoga - + - -

Trushanadi loha - + + -

Trushanadi guggulu + - - -

Triphaladya taila + - + +

Vyoshadya choorna - - - -

Vidangadya loha - - + +

Vyoshadi saktu + - + +

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PATHYAPATHYA:-

Charaka mentioned ahara, vihara which allivate vata and meda which is

prescribed for sthoola rogi.80

Pathya ahara – Guru and Apatarpaka

Yava Shyamaka Kodrava

Kulatha Adhaki beeja Patola

Amalaki Vartaka Masoora

Purana shali

Apathya ahara

Dugda Ikshu vikruti

Masha Matsya

Mamsa Snehana

Madhura dravyas

Pathya vihara

TABLE NO 6: SHOWING PATHYA VIHARA ACCORDING TO DIFFERENT

ACHARYAS

Name of Pathya

vihara

Ch.s81 Su.s82 A.S83 Y.R84 B.P85 B.R86 C.D87

Asukha Shayya - - - - + - -

Dhoomapana - - - - + - -

Krodha - - - - + - -

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Margakramana - - - + + + -

Parishrama - - - + + + +

Prajagara + - + + + + +

Upavasa - - - - + + -

Vyavaya + - + + + + +

Vyayama + + + + - + +

Chintana + - + + + + +

Apathya vihara: Diwaswpna

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MODERN REVIEW:-

OBESITY:-

DERIVATION – Obesity is word derived from O-bes- the Latin word obesus – the fat,

the adjective from ob-edo- meaning to eat away.

DEFINATION: Obesity described as a weight of 20% or above. Obesity is often

expressed in terms of body mass index (B.M.I.). A BMI of 30 or more in males and 28.6

or more in females indicates obesity88.

It is also defined as an abnormal growth of the adipose tissues due to enlargement

of fat cell size (hypertrophic obesity) or an increase in fat cell number (hyper plastic

obesity) or a combination of both89.

PREVALANCE: National Health and Nutrition Examination Surveys (NHANES)

shows that the prevalence of obesity is much higher in African-American and Mexican-

American women than in white women or in men.

The prevalence of overweight and obesity is generally higher for men and women

in racial – ethnic minority populations.

The third NHANES III estimated that 13.7% of children 11.5% adolesants are

overweight and obese. Between1960-1994, overweight was increased from 30.5 – 32%

among adult ages 20 – 74 and obesity increased from 12.8% - 22.5%.

BODY FAT DISTRIBUTION: Health care providers are concerned not only with how

much fat a person has, but also where the fat is located in the body. Women typically

collect fat in their hips and buttocks, giving them a "pear" shape.

Men usually build up fat around their bellies, giving them more of an "apple'

shape.

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TYPES:90 The distribution of fat induced by the weight gain affects the risk associated

with obesity and the kind of disease, that results. It is useful therefore, to be able to

distinguish between those at increased risk as a result of abdominal fat distribution or

"android obesity' from those with a serious "gynoid fat" distribution in which fat is more

evenly and peripherally distributed around the body.

AETIOLOGY (CAUSES OF OBESITY)91.

In scientific terms, obesity occurs when a person consumes more calories than he

or she burns. That causes this imbalance between calories in and calories out may differ

from one person to another person. Genetic, environmental, psychological and other

factors may all play a part in obesity.

GENETIC FACTORS: Obesity tends to run in families, suggesting a genetic cause.

Yet families also share diet and lifestyle habits that may contribute to obesity. Separating

these from genetic factors is often difficult. Even so, science shows that heredity is

linked to obesity.

ENVIRONMENTAL FACTORS: Genes do not destine people to a lifetime of obesity.

However, environment also strongly influences obesity. This includes lifestyle

behaviours such as what a person eats or drinks and his or her level of physical activity.

PSYCHOLOGICAL FACTORS: Psychological factors may also influence eating

habits. Many people eat in response to negative emotions, such as boredom, sadness or

anger.

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OTHER CAUSES OF OBESITY: Some illness can lead to obesity or a tendency to

gain weight. These include hypothyroidism, Cushing's syndrome, depression and certain

neurological problems that can lead to overeating.

Also drugs such as steroids and some antidepressants may cause weight gain

prevention of obesity in primary care settings is compatible with efforts to prevent their

health consequences, through control of high B.P, type 2 diabetes etc. Thus the quality

and quantity of life may be enhanced through preventive strategies.

CLINICAL FEATURES: Diagnoses will be apparent from the appearance but the

degree of obesity should also be assessed by measurement of BMI, skin fold thickness

over the triceps muscle can be measured using screw gauge and callipers. Obesity is

indicated by the reading above 20 mm in men and 28 mm in women.

ASSESSMENT OF WEIGHT AND BODY FAT92:

Two measures important for assessing overweight and total body fat content are

determining body mass index (BMI) and measuring waist circumference.

BODY MASS INDEX: - The BMI which describes relative weight for height is

significantly correlated with total body fat content. The BMI should be 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 Mts2

Weight classifications by BMI, selected for use in this report as shown in the table below.

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TABLE NO 7:-

CLASSIFICATION OF OVERWEIGHT AND OBESITY BY BMI CHART

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

WAIST CIRCUMFERENCE: The presence of excess fat in the abdomen out of

proportion to total body fat is an independent predictor of risk factors, and morbidity.

Waist circumference is positively correlated with abdominal fat content. It provides a

clinically accepted measurement for assessing a patient's abdominal fat content before

and during weight loss treatment. The waist circumstances at which there is an increased

relative risk is defined as follows:

High Risks:

Men > 102 cms (40 inch)

Women > 88 cm (> 35 inch)

DIAGNASTIC PROBLEMS: Simple obesity, which accounts for bulk of cases, has to

be distinguished from the following comparatively rare conditions:

1. Cushing's syndrome

2. Froehlich’s Syndrome

3. Hypothyroidism

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CUSHING'S SYNDROME

Causes adrenal hyperplasia more commonly in females

Truncal obesity and buffalow hump Hypertension

Glycosuria Hirsutism

Osteoporosis Centripetal fat distribution

Moon face

FROEHLICH'S SYNDORME:

Causes tumour of hypothalamic pituitary area Truncal obesity

Sexual infantilism – gonads underdeveloped. Mental retardation

Secondary sexual characters absent Impaired skeletal growth

Hairless skin, headache, vomiting Visual disturbances

Hands are small and flat with tapering fingers. Diabetes insipidus

HYPOTHYROIDISM: A clinical conditions resulting from decreased circulating

T4 and T3 by the thyroid gland irrespective of cause when the hypothyroidism is of

severe degree of long standing.

Clinical features:

Onset – Insidious with physical, mental and metabolic process below normal.

Tiredness Weight gain

Cold intolerance Goitre

Skin: Dry and subcutaneous tissues

Puffiness of face with flush Baggy eyelids

Swollen oedematous appearance of supraclavicular regions, neck backs of hand

and feet.

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Minimal sweating Alopecia

Neuro-Muscalor – Myalgia.

Stiffness, hoarseness of voice Deafness

Anaemia Infertility

Growth Retardation Mental retardation

Delayed puberty.

CONSEQUENCES OF OBESITY (HEALTH RISKS)93 Obesity is more than a

cosmetic problem, it is a health hazard. Approximately 2,80,000 adult deaths in U.S.

each year are related to obesity. Several serious medical conditions have been linked to

obesity, including Psychological, Mechanical, Metabolic disorders like type-2 diabetes,

cardiovascular disorders and stroke.

Obesity is also linked to higher rates of certain types of cancer. Obese men are

more likely than non-obese men to die from cancer of colon, rectum or prostrate. Obese

women are more likely than non-obese women to die from cancer of gall bladder, breast,

uterus, cervix or ovaries.

Other diseases and health problems linked to obesity include:

Gall bladder disease and gall stones.

Liver disease

Osteoarthritis, a disease in which the joints deteriorate. This is possibly the result

of excess weight on joints.

Gout, disease affecting the joints

Pulmonary (breathing) problems, including sleep apnoea in which a person can

stop breathing for a while during sleep due to arterial hypoxemia.

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Reproductive problems in women, including menstrual irregularities and

infertility.

PSYCHOLOGICAL AND SOCIAL EFFECTS: Emotional suffering may be one of

the most painful parts of obesity. American society emphasizes physical appearance and

often equates attractiveness with slimness, especially for women, such messages makes

overweight people feel unattractive.

Many people think that obese individuals are gluttonous, lazy, or both, even

though this is not true. As a result, obese people often face prejudice or discrimination

in the job market at school and in social situations. Feeling of rejection, shame or

depression is common.

TREATMENT94: The method of treatment depends on level of obesity Overall health

condition and motivation to lose weight. Treatment may include a combination of diet,

exercise, behaviour modification and sometimes weight loss drugs. In some severe

obesity gastrointestinal surgery may be recommended. But it should be kept in mind

weight control is a life long effort.

DIET: The most basic consideration is that the food energy in take should not be greater

than what is necessary for energy expenditure. It requires modification of patient's

behaviour and strong motivation to lose weight and maintain ideal weight.

The proportion of energy dense foods such as simple carbohydrates and fats

should be reduced the fibre content in diet should be increased. Adequate levels of

essential nutrients in low energy diets (most conventional diets for weight reduction are

based on 1000 k. cal daily model for an adult) should be ensured.

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EXERCISE: It is another positive part of the management of obesity. Strainuous

exercise is neither feasible nor advisable, but most obese people are capable of moderate

exercise such as walking, swimming, gardening etc, provided it should not exceed their

cardiovascular capacity.

Regular exercises improves the fitness and their feeling of well being some

consider it also gives people more control over their appetite.

An hour's walk 3 miles/hr will expend about 240 k cal above basal. Even though

it seems a small amount, 30 g of body fat, but if the daily walk becomes a habit it will

add up to a weight loss of 10 kg in a year.

DRUG95: The most useful group of drugs at present to support weight reducing regime

are serotoninergic compounds. The first of all there was dl-fenfluramine now largely

replaced by second generation drugs fenfluramine and fluoxetine.

Side effects are usually mild and include drowsiness, dry mouth, head ache. One

of these drugs is best used where there is medical need for short term weight reduction

like if obesity is associated with diabetes or hypertension.

Anorectic drugs such as amphetamines, fenfluramine are not advisable because of

the cerebral stimulating properties of amphetamine group and high incidence of valvular

heart disease and pulmonary hypertension with fenfluramine.

Sibutramine acts controls to inhibit serotonin and noradrenalin reuptake

prolonging the effects of both these appetite regularising neurotransmitters. It enhances

metabolic rate and energy expenditure via stimulation of peripheral Beta-adreno-

receptors.

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STARVATION: Fasting as a method of treatment offers advantage of dramatic drop in

weight within one week of treatment and this may be of psychological benefit.

FOODS TO BE AVOIDED: Bread and anything made with flour, cereals, potatoes and

other whole root vegetables, foods containing much sugar, all sweets and salt. Fatty

foods like cream butter, fat beans are avoided. Fluids not more than 2 pints a day.

SURGICAL PROCEDURES96: Jaw wiring to prevent eating has been used to treat who

have found it impossible to adhere to a low energy diet.

1. Jejuno-ileal bypass- indicated in vastly obese patients who have failed to lose

weight despite at least 5 years of medical treatment.

2. Gastricplication – An upper pouch of about 50 – 60 ml is made with aperture

outlet limited to a 12 mm ring.

3. Gastric bypass: - To reduce the size of the stomach, for example stapling

which can be done, small intestine bypass, aimed at inducing malabsorption has

been undertaken in some "morbid" obese patients.

4. Plastic surgery

5. Truncal vagotomy

PROGNOSIS: The published records of 7 obesity clinics in USA showed that

satisfactory results ranged only from 12 to 28% if the index of success was the loss of 12

kg or more.

It is difficult for patients to maintain their reduced weight since this required some

restriction of energy in take on a long term basis.

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PREVENTION OF OVERWEIGHT AND OBESITY:

Prevention of overweight and obesity is an important as treatment. Prevention

includes primary prevention of overweight or obesity itself, secondary prevention or

avoidance of weight regain following weight loss and prevention of further weight

increase in obese individuals unable to lose weight.

It has been suggested that primary prevention of obesity should include

environmentally based strategies that address major social contributors to over

consumption of calories and inadequate physical activity such as food marketing

practices and lack of opportunity for physical activity during the work day.

People at lower socio-economic levels living in urban areas also take excess of

physical activity sites. Such strategies will be essential for effective and long term

prevention of obesity.

Public health approaches for preventing obesity, that is approaches designed to

reduce the difficulty for any given individual of adopting healthful eating and activity

patterns will particularly benefit the socially disadvantaged, who compared to the more

advantaged may have less access to preventive health services.

Primary care practitioners are an important element in preventing and managing

obesity in United States.

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DRUG REVIEW:-

CHANAK97

Sanskrit name : Chanak

Latin name : Cicer arietinum

Botanical name : Cicer arietinum

Synonyms:

Chanak, Harimanth, Sakalpriya.

Vernacular names:

E – Bengal gram, Chickpea.

H – Chane, Cholla, Rahila, Bunta.

K – Kadale.

M – Harbara.

Kula : Shimbi kula

Family : Leguminasae.

Gana : Chanakadi gana (Chanak, Masura, Khandika, Saharenava)

Habitat : Throughout the greater part of India , Chanak is found as agricultural

product.

Botonical description: A small tree (kshupa) of about 1-1 ½ feet in height.

Leaf : Pakshawat, 6 mm in length and 4 mm in breadth.

Flower : Short , single and of different shapes and also colour.

Types : Shweta and of different colours.

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Properties

Rasa : Kashaya rasayukta.

Guna : Laghu , Rooksha

Veerya : Sheeta.

Vipaka : Katu.

Karma : Vatakarak, Pitta, Raktavikara nashak, Kapha and Jwara nashak.

Rogaghnata : Pitta and Kapha nashak, Jwara nashak, Vatajanak, Shukra

nashak98,

Raktavikar and Meha nashak.

Chemical Composition –

Protein 17.1, Sneha 5.3, Khanija 2.7, Fibres 3.9, Carbohydrates 61.2, Khatik,

Phosphorus and Vitamin A,B 1, Humidity 9.8.

Parts used: Chanak seeds.

Use : Used internally as food.

Properties of wet Chanak : -

Kashaya rasa, Soft, Tasty, Sheetal, Vatajanak, Grahi, Laghu, Pitta, Shukra and

Kapha-Pitta nashak.

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UDVARTANA:-

Nirukthi:-

The word Udvartana is derived from the root – ud + vrith + bhavae + karaneva

lyud, which means vilepana or Gharshana.

Paribhasha:-

It is described as the Rookshana karma, practiced by means of rubbing the body

with karshana karaka drugs.

“Udvartanam kashayadi choorna Gatra karshanam”

Giving friction to the body by kashayadi choorna is called as Udvarthana.

The concept of Udvartana is explained right from the oldest textbook Charaka

Samhita and most of the other authors under rookshana karma which is one among the

Shadvidhopakrama. The word meaning of Rookshana is making thin or inducing dryness.

The panchbhoutika composition of Rookshana dravyas is predominant of Vayu,

Agni and pruthvi mahabhutas99 and it is having kashaya pradhana, katu tikta rasa. The

best examples are yava and takra.

Rookshana is indicated in Vasantha Ruthu in which Udvarthana with Rooksha

dravya, which are having kaphagna property, is beneficial100.

The following tables describe the different aspects of udvartana as one of the

rookshana kriya.

TABLE NO. 8 SHOWING EFFECTS OF ROOKSHANA KARMA:-

Constituent Effects

Dosha Vata vardhaka, Kapha nashaka

Dhatu Vikruta Dhatu shoshana, Balya, Varnya

Mala Shoshana (dravamsha of mala)-performs sthambhana karma

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TABLE NO. 9 SHOWING SAMYAK ROOKSHANA LAKSHANA101:-

Lakshana Ch Su A.S & Hr

Samyak vata, mutra, mala Pravritti + + -

Hridaya Shuddhi + - +

Udgara Shuddhi + - +

Kantha Shuddhi + - +

Aasya Shuddhi + - -

Indriya Prasannata - + +

Tandra Nasha + - +

Klama Nasha + - -

Sweda + - -

Ruchi + - +

Kshuth Sahodaya + + +

Pipasa Sahodaya + + +

Vyadhi Mardava - - +

Utsaha - - +

Nirvyathe Antharatma + - -

Gatra Laghuta + + +

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TABLE NO.10 SHOWING ROOKSHANA ATHI YOGA LAKSHANA:-102

Lakshana Ch Su A.S & hr

Parva Bheda + - -

Anga Marda + - -

Kasa + + +

Mukha Shosha + + -

Kshuth Pranasha + - +

Aruchi + - -

Trishna + + +

Shrotra Netra Dourbalya + - +

Urdhva Vata + - +

Tamo Vrudhi + - -

Deha Bala Nasha + + -

Agni Bala Nasha + - +

Tandra - + -

Anidra - + +

Bhrama - + -

Klama - + -

Swara Kshaya - + -

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Chardi - + +

Hikka - + +

Shwasa - + +

Arochaka - - +

Sneha Kshaya - - +

Shukla Kshaya - - +

Oja Kshaya - - +

Swara Kshaya - - +

Basti Rukh - - +

Hridaya Rukh - - +

Murdha Rukh - - +

Jangha Rukh - - +

Uru Ruja - - +

Trika Ruja - - +

Parshva Ruja - - +

Jwara - - +

Pralapa - - +

Glani - - +

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Para Asthi Bhedana - - +

Varcho Mutra Graha - - +

Jrumbha - - +

TABLE NO. 11 SHOWING ROOKSHANA AYOGA LAKSHANA:-103

Lakshana

OUSHADANAM DHATUNAM ASHAMO

(No relief from the diseases treatable from upakrama)

ROGA VRIDDHI (Aggravation of diseases)

Shodhana Ayoga

Classification:- Udvartana can be classified as two types:

1) Udgharshana.

2) Utsadana.

1. Udgharshana (Reinforced friction):

This is the procedure where “body is rubbed with the powdered medicine without

mixing oil or other Drava dravya”.104

It has the properties of Vata Shamana, Kandu- Spota- Pidika nashaka, Sira shodhaka,

Twak gata Agni vardaka, stimulates Brajaka Pitta. Friction of body with karshana

dravya excites the heat of skin, destroys itching, rashes etc.

2. Utsadana (Rubbing):

This is the procedure where “body is rubbed with the sneha / drava yukta

medicine in the form of kalka”.105

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It is beneficial as it improves complexion in females, gives good appearance,

cleanses and beautifies.

Difference between Mardana and Udvarthana:-106

Mardana is a type of Abhyanga (abhyanga with pressure varience). Mardana is a

process of giving deep pressure from foot to waist, which is in prathiloma gathi

However, Udvartana is different from Abhyanga. In Udvartana, rubbing is done in

upward direction (prathiloma gathi) where as Abhyanga is done in downward direction

(anuloma gati). The intention of doing Udvartana is to bring Rookshana in the body

where as abhyanga pacifies rookashata.

TABLE NO. 12 Showing benefits of Udvartana:-

Sl. no Benefits Ch Su A.H Y.R

1 Dourgandya hara + - - -

2 Gourava hara + - - -

3 Tandra hara + - - -

4 Kandu hara + - - -

5 Mala hara + - - -

6 Aruchi hara + - - -

7 Vata hara - + - -

8 Kapha vilayana - + - -

9 Meda vilayana - + + -

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10 Anga sthirikarana - + + -

11 Twak prasadakara - + + +

12 Kapha hara - - + +

13 Meda hara - - - +

14 Shukrada - - - +

15 Balya - - - +

16 Kanthi - - - +

17 Twak mrudutwa - - - +

Mode of Action of Udvartana:- Important qualities of rubbing are –

• It gives a mechanical stimulation causing contraction followed by relaxation and thus

greatly influences the muscles.

• It increases the peripheral circulation and influence the venous drainage by its alternate

pressure and relaxation techniques.

• It improves the nutrition of the particular area by proper circulation.

• It raises temperature locally by continuous friction.

• It increases elimination of waste products especially in the form of sweating.

• It increases secretion and absorption capacities of skin.

• It conditions the nervous system by stimulating the cutaneous nerve endings.

• It influences the general metabolism when applied on large areas.

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Physiological effects:-

As the skin covers nearly the whole body its surface is affected by massage as

well as the structures, which lie beneath it. It increases the cutaneous circulation,

stimulates the sensory nerve ending and influences the vasoconstrictors and vasodilators

in the skin. The pressure of deep massage exerts a simultaneous influence on all the tissue

of the body. Further it accelerates the activity of the heart, helps the assimilation of food

and influences general metabolism of the body.

Influence of rubbing up on the circulation of fluid including lymphatic is also of

great importance. Rubbing stimulates both motor and sensory nerve endings. The

influence of rubbing on Motion of the molecules to participate in chemical activity results

in the anti-oxidant process.

TABLE NO. 13 SHOWING THERAPEUTIC ACTIONS OF UDVARTANA:-

Sl.No. Benefits Ch Su As.Hr. Y.R

1 Dourgandya hara + - - -

2 Gourava hara + - - -

3 Tandra hara + - - -

4 Kandu hara + - - -

5 Mala hara + - - -

6 Aruchi hara + - - -

7 Vata hara - + - -

8 Kapha vilayana - + - -

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9 Meda vilayana - + + -

10 Anga sthirikarana - + + -

11 Twak prasadakara - + + +

12 Kapha hara - - + +

13 Meda hara - - - +

14 Shukrada - - - +

15 Balya - - - +

16 Kanthi - - - +

17 Twak mrudutwa - - - +

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MATERIALS AND METHODS:

MATERIAL – The materials taken for the clinical trials were

A) Instruments

a. Weighing machine

b. Measuring tape

B) Drugs

a. Chanak Pisthi

C) 30 Patients of Sthoulya

COLLECTION OF MATERIALS

A) Instruments – Weighing machine of 0.5 kg gradation were taken for the study

from the O.P.D of Dr B.N.M.E Trust’s P.G and Research Centre, Bijapur The

measuring tape to measure the chest, abdomen, Hip for the study were taken from

Santosh Surgicals, Bijapur.

B) Drug – Chanak pisthi was prepared as per the classical reference

METHODOLOGY OF

1) Height

The patient was made to stand erect on ground level with bare foot, heels together

and arms hanging perpendicular to ground. The head should be so held that the eyes were

directed towards forward. The scale was held over the head and marked it.The

measurement from ground to the mark will be the height of the individual and it is

recorded in centimetres.

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2) Weight –

The patient was weighed with minimum garments on a lever balanced weighing

machine and the weight is recorded in kilograms

3) BMI: (Body Mass Index.)

BMI of the patient is calculated by using the formula

BMI = Weight in kg / Ht in mt2

5) Vaksha circumference:

Measurement at the nipple line in men, at the largest circumference above the

breasts in females

6) Udara circumference of udara was measured at the level of umbilicus.

7) Sphik circumference:

While standing erect horizontal measure taken at level of maximum

circumference of hips.

Normal readings of vaksha, udara and sphik were taken on the basis of pilot

study.

METHOD:-

Aim: The aim of study was to assess the effect of chanak pisthi udvartana in

sthoulya (obesity).

Study design-

The patients of sthoulya with in the age group of 18-60 yrs were selected

randomly from O.P.D and I.P.D of Dr. B.N.M.E Trust’s Shri Mallikarjun Swamiji Post

Graduate and research centre, Bijapur and camps conducted in the city (Bijapur) by the

institute, irrespective of sex, occupation and socio-economic status.

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The size of the sample is 30 excluding the drop outs. The present study is

comparative study where in patients were assigned into one group

SOURCE OF DATA:-

LITERARY DATA:-

The literary source of present study was obtained from Vedic scriptures, classical

texts of Ayurveda, modern texts, published articles in reputed journals and internet.

CLINICAL DATA

The clinical data was obtained from the patients enrolled for the clinical study.

INCLUSIVE CRITERIA

1. Sthoulya diagnosed according to signs and symptoms as in classical texts.

2. Sthoulya of both sex.

3. Between the age group of 20 – 50 years.

4. The patients with BMI above 30 and below 40 irrespective of sex.

EXCLUSIVE CRITERIA

1. Pregnant women.

2. Age group below 20 and above 50 years.

3. Obesity due to secondary causes.

4. Obesity observed since birth.

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SAMPLING METHODS

Randomly selected patients from O.P.D and I.P.D of Dr. B.N.M.E. Trust’s Shri

Mallikarjun Swamiji Post Graduate and Research Center, Bijapur were collected in single

group.

LAB INVESTIGATIONS

As the study was conducted only on the basis of subjective parameters hence no

investigations are carried out.

INTERVENTIONS:-

While making group simple random sampling procedure is adopted.

Sample size : 30 patients

Sample type : Sthoulya

Procedure : From 1st day to 30th day chanak pisthi udvartana is

carried out.

Duration : 30 days

Follow ups

Follow up before treatment : I follow up: 1st day

Follow up after treatment : II follow up: 30th day

Post treatment follow up : 15th day

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Materials and methods ===============================================================

ASSESSMENT OF SUBJECTIVE AND OBJECTIVE CRITIERA OF

STHOULYA: -

OBJECTIVE CRITERIA

1) B.M.I = Weight in Kg

Height in mt sq

CLASSIFICATION OF OVERWEIGHT AND OBESITY BY BMI CHART

TABLE No.14

Obesity Class BMI (mg/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

TABLE No.15

SUBJECTIVE CRITERIA:

Lakshanas BT ( 1st Day) AT (21st Day) AFU (30th Day)

Kshudra shwasa

Atikshuda

Atitrushna

Swedaadhikata

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Gradings for Subjective criteria are mentioned as,

Grade I Absent

Grade II Mild

Grade III Moderate

Grade IV Severe

OBJECTIVE CRITERIA:-

VAKSHA CIRCUMFERENCE

Grade I Overweight <80 cms

Grade II Mild obese 81-90 cms

Grade III Moderate obese 91-100 cms

Grade IV Grossly obese 101-110 cms

UDARA CIRCUMFERENCE

Grade I Overweight <80 cms

Grade II Mild obese 81-90 cms

Grade III Moderate obese 91-100 cms

Grade IV Grossly obese 101-110 cms

SPHIK CIRCUMFERENCE

Grade I Overweight <90 cms

Grade II Mild obese 91-100 cms

Grade III Moderate obese 101-110 cms

Grade IV Grossly obese 111-120 cms

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TABLE No.16

Circumference BT ( 1st Day) AT (21st Day) AFU (30th Day)

Vaksha

Udara

Sphik

TABLE No.17

OBJECTIVE CRITERIA:

Variable BT ( 1st Day) AT (21st Day) AFU (30th Day)

BMI

OBSERVATIONAL VARIABLES:-

1) Adhika Kshudha 3) Kshudra Shwasa

2) Adhika trishna 4) Swedaadhikata.

ASSIGNMENT OF CLINICAL IMPROVEMENT

Clinical improvement of the disease was based on improvement in the clinical

findings and reduction on the severity of the symptoms of the disease grading for the

clinical improvement for individual variables.

Grading for the clinical improvement for individual variables

1. CI-III: excellent i.e. 3 degree reduction in the severity score, against the initial

score, i.e. severe –normal.

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2. CI-II: Good i.e. 2 degree reduction in the severity score, against the score, i.e.

reduction from moderate –normal, severe-mild

3. CI-I: encouraging i.e. 1 degree reduction in the severity score, against initial

score, i.e. reduction from mild-normal, Moderate-Mild and Severe-moderate.

4. CS: Clinically stable, i.e. severity score remains as against the initial score.

5. CD: Clinically deteriorated i.e. increased in severity score against the initial

score.

STATISTICAL ANALYSIS:

The data was collected from both the groups before,and after treatment and at the

end of follow up and statistically analyzed by using student’s ‘t’ test.

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Observations and results ============================================================ 

OBSERVATIONS AND RESULTS:

OBSERVATIONS:-

Total 30 patients were taken for clinical study. The observation for present

study were done in three stage –

• Generalized observations.

• Specific observations.

• Result related observations.

GENERALIZED OBSERVATIONS:-

Table No – 18 Distribution of patients according to age. (n=30)

Sl. No Age in years No of patients %

1 18-30 13 43.33%

2 31-40 17 56.66%

Graph No 1: Distribution of patients according to age.

43.33

56.66

18-3031-40

In the present study it was observed that 13 patients (43.33%) were of 18-30

yrs,and 17 patients (56.66%) were of 31-40 yrs of age.

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Table No –19 Distribution of patients according to sex. (n=30)

Sl. No Sex No of patients %

1 Male 24 80%

2 Female 6 20%

Graph No 2: Distribution of patients according to sex.

80

20

0102030405060708090

malefemale

In the present study it was observed that 24 patients (80%) were male and 6

patients (20%) were females.

Table No – 20 Distribution of patients according to religion. (n=30)

Sl. No Religion No of patients %

1 Hindu 25 83.33%

2 Muslim 5 16.66%

Graph No 3: Distribution of patients according to religion.

83.33

16.66

0

20

40

60

80

100

Percentage

HinduMuslim

Majority of patients observed were Hindu 25 patients (83.33%) and Muslim

were 5 patients (16.66%).

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Table No – 21 Distribution of patients according to education. (n=30)

Sl. No Educational status No of patients %

1 Educated 26 86.66%

2 Uneducated 4 13.33%

Graph No 4: Distribution of patients according to education

020406080

100

Percentage

EducatedUneducated

In the present study 26 pts (86.66%) were educated and 4 (13.33%) pt was

uneducated.

Table No – 22 Distribution of patients according to socio-economical

status.(n=30)

Sl. No Socio economical status No of patients %

1 Lower class 0 0%

2 Middle class 24 80%

3 Upper class 6 20%

Graph No 5: Distribution of patients according to socio-economical status.

0%

80

20

0%

2000%

4000%

6000%

8000%

10000%

Percentage

Lower class Middle classUpper class

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In the present study maximum patients observed were of middle class i.e. 24

patients (80%),were patients observed of upper class is,6 patients (20%).

Table No – 23 Distribution of patients according to marital status. (n=30)

Sl. No Marital status No of patients %

1 Married 22 73.33%

2 Unmarried 8 26.66%

Graph No – 6 Distribution of patients according to marital status.

73.33

26.66

0

20

40

60

80

Percentage

Married

Unmarried

Maximum patients observed for the study were married 22 patients (73.33%)

and unmarried are only 8 patients (26.66%).

Table No – 24 Distribution of patients according to Habitat (n=30)

Sl. No Habitat No of patients %

1 Rural 4 13.33%

2 Urban 26 86.66 %

Graph No – 7 Distribution of patients according to Habitat.

13.33

86.66

0

20

40

60

80

100

Percentage

Rural Urban

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Majority of patients observed were from urban 26 (86.66%) and 4 patients

(13.33%) belong to rural area.

Table No – 25 Distribution of patients according to occupation (n=30)

Sl. No Occupation No of patients %

1 Student 8 26.66%

2 Farmer 6 20%

3 Business 9 30%

4 House wife 5 16.66%

5 Teacher 2 6.66%

Graph No –8 Distribution of patients according to occupation

26.66

20

30

16.66

6.66

05

101520253035

Percentage

StudentFarmerBusinessHouse wifeTeacher

The patients from various occupations were observed for the study. Among

them 8 patients (26.66%) were students,6 patients (20%)were farmer,9 patients

(30%)were business men,5 patients (16.66%) were house wife and , 2 patients

(6.66%) were teacher.

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Table No –26 Distribution of patients according to diet (n=30)

Sl. No Diet No of patients %

1 Veg 6 20%

2 Mixed 24 80%

Graph No – 9 Distribution of patients according to diet

Veg

Mixed

020406080

100

Percentage

VegMixed

Among the patients observed for study vegetarians were 6 patients (20%) and

those who took mixed diet were 24 patients (80%).

Table No – 27 Distribution of patients according to vyasana. (n=30)

Sl. No Vyasana No of patients %

1 Tea/Coffee 8 26.66%

2 Tobacco 5 16.66%

3 Alcohol 2 6.66%

4 Cigarette 3 10%

5 No habits 12 40%

Graph No – 10 Distribution of patients according to vyasana

26.66

16.6610

40

0

10

20

30

40

50

Percentage

Tea/CoffeeTobaccoAlcoholCigarette

No habits

In the present study it was observed that 8 patients (26.66%) have a habit of

Tea/ Coffee, tobacco chewers were 5 patients (16.66%) , alcohol habit were 2 patients

.66%) cigarette smokers were 3 patients (10%) and no habits were 12 patients (40%).

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Table No –28 Distribution of patients according to prakruti (n=30)

Sl. No Prakruti No of patients %

1 Kaphavata 8 26.66%

2 Kaphapitta 11 36.66%

3 Pittakapha 11 36.66%

Graph No – 11 Distribution of patients according to prakruti

26.66

36.66

05

10152025303540

Percentage

KaphavataKaphapittaPittakapha

In the present study it was observed that of kaphavata prakruti there were 8

patients (26.66%),kapha pitta prakruti11 patients (36.66%), and of pittakapha prakruti

11 patients (36.66%).

Table No – 29 Distribution of patients according to Agni (n=30)

Sl. No Agni No of patients %

1 Manda 0 0%

2 Teekshna 20 66.66%

3 Vishama 10 33.33%

Graph No – 12 Distribution of patients according to Agni

66.66

33.33

0

20

40

60

80

Percentage

MandaTeekshnaVishama

In the present study it was observed that most of the patients were having

Teekshnagni i.e. 20 patients (66.66%) and only 10 patients (33.33%) were having

vishamagni.

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Table No – 30 Distribution of patients according to Kostha. (n=30)

Sl. No Kostha No of patients %

1 Mrudu 3 10%

2 Madhyama 20 66.66%

3 Krura 7 23.33%

Graph No – 13 Distribution of patients according to Kostha

10.00

66.66

23.33

010203040506070

Percentage

MruduMadhyamKrura

Patients registered for study were assessed for mrudu, madhyama and kroora

kostha, majority of patients with madhyama koshta i.e. 20 (66.6%), 7 patients were

kroora kostha (23.33%) and 3 patients (10%) of mrudu kostha.

Table No – 31 Distribution of patients according to Kula Vruttanta. (n=30)

Sl. No Kula vruttanta No of patients %

1 Present 8 26.66%

2 Absent 22 73.33%

Graph No – 14 Distribution of patients according to Kula Vruttanta

26.66

73.33

0

20

40

60

80

Percentage

PresentAbsent

In the present study 8 patients (26.66%) patients had kula vruttanta of sthaulya

and 22 patients (73.33%) had no kula vruttanta of sthaulya.

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Table No – 32 Distribution of patients according to BMI (n=30) Before

treatment;

Grading BMI No of patients %

G1 30-34.9 27 90%

G2 35-39.9 3 10%

G3 >40 0 0%

Graph No – 15 Distribution of patients according to BMI

100

0

20

40

60

80

100

Percentage

30-34.935-35.9>40

Patients observed for study was assessed as G-1;B.M.I in between 30-34.9 were

27 patients (90%), G-2;B.M.I in between 35-35.9 were 3 patients (10%).

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Table No – 33 Distribution of patients based on Vaksha Circumference (n=30)

Before treatment;

Grading Vaksha circumferance No of patients %

G1 Overweight <80cms 0 0

G2 Mild obese 81-90 cms 18 60

G3 Moderate obese 91-100cms 10 33.33

G4 Grossly obese 101-110cms 2 6.66

Graph No – 16 Distribution of patients based on Vaksha Circumference

G2

G3, 33.33

G4

0

20

40

60

80

Percentage

G1G2G3G4

Vaksha circumference – patients observed for study were assessed grade 1 to

grade 4. Majority of patients were of grade 2 i.e., 18 patients (60%), grade 3 were 10

patients (33.33%) and grade 4 were of 2 patients (6.66%).

Table No – 34 Distribution of patients based on Udara Circumference (n=30)

Before treatment;

Grading Udara circumferance No of patients %

G1 Overweight <80cms 0 0

G2 Mild obese 81-90 cms 5 16.66

G3 Moderate obese 91-100cms 16 53.33

G4 Grossly obese 101-110cms 9 30

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Graph No – 17 Distribution of patients based on Udara Circumference

G3

G4

0

10

20

30

40

50

60

Percentage

G1

G2

G3

G4

Udara circumference – patients observed for study were assessed grade 1 to

grade 4. Majority of patients were of grade 3, 16 patients (53.33%), grade 2 were 5

patients (16.66%) andgrade 4 were 9 patients (30%).

Table No – 35 Distribution of patients based on Sphika Circumference (n=30)

Before treatment;

Grading Sphika circumferance No of

patients % G1 Overweight <90cms 0 0

G2 Mild obese 91-100 cms 6 20

G3 Moderate obese 101-110cms 17 56.66

G4 Grossly obese 111-120cms 7 23.33

Graph No – 18 Distribution of patients based on Sphik Circumference

G3

G4

0102030405060

Percentage

G1G2G3G4

Sphik circumference – Majority of patients were of grade 3 i.e. 17 patients

(56.66%), grade 2 were 6 patients (20%) and grade 4 were 7 patients (23.33%).

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Table No – 36 Distribution of patients according to adhika kshudha.(n=30)

Before treatment.

Grading adhika kshudha No of patients %

G1 Absent 0 0

G2 Mild 0 0

G3 Moderate 18 60

G4 Severe 12 40

Graph No – 19 Distribution of patients based on adhika kshudha.(n=30)

0 0

60

40

0

20

40

60

80

Total

G1G2G3G4

Majority of patients were of grade 3 ie,18 patients (60%) and of grade 4 were 12

patients (40%).

Table No –37 Distribution of patients according to adhika trishna.(n=30)

Before treatment;

Grading adhika trishna. No of patients %

G1 Absent 0 0

G2 Mild 2 6.66

G3 Moderate 22 73.33

G4 Severe 6 20

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Graph No – 20 Distribution of patients based on adhika trishna.(n=30)

0 6.66

73.33

20

0

20

40

60

80

Total

G1G2G3G4

Majority of patients were of grade 3 ie,22 patients (73.33%), grade 2 were 2 patients

(6.66%) and grade 4 were 6 patients (20%).

Table No –38 Distribution of patients according to Kshudra shwas.(n=30)

Before treatment;

Grading Kshudra shwas. No of patients %

G1 Absent 14 46.66

G2 Mild 12 40

G3 Moderate 4 13.33

G4 Severe 0 0

Graph No – 21 Distribution of patients based on Kshudra shwas.(n=30))

46.6640

13.33

00

1020304050

Total

G1G2G3G4

In present study it was observed that from grade 1 to grade4,14 patients (46.66%) were

of grade 1,12 patients (40%) were of grade 2,4 patients (13.33%) were of grade 3.

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Table No – 39 Distribution of patients according to swedadikhata.(n=30)

Before treatment;

Grading swedadikhata . No of patients %

G1 Absent 0 0

G2 Mild 2 6.66

G3 Moderate 14 46.66

G4 Severe 14 46.66

Graph No – 22 Distribution of patients based on swedadikhata.(n=30)

06.66

46.6646.66

01020304050

Total

G1G2G3G4

In present study it was observed that from grade 1 to grade4,2 patients (6.66%) were

of grade 2,14 patients (46.66%) were of grade 3,14 patients (46.66%) were of grade 4.

Table No – 40 Distribution of patients according to BMI (n=30)

After treatment;

Grading BMI No of patients %

G1 30-34.9 28 93.33%

G2 35-39.9 2 6.66%

G3 >40 0 0%

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Graph No – 23 Distribution of patients according to BMI

6.66 0%0

20406080

100

Percentage

<3030-31.531.6-33

Patients observed for study were assessed as G-1;B.M.I in between 30-34.9 were

28 patients (93.33%), G-2;B.M.I in between 35-35.9 were 2 patients (6.66%).

Table No – 41 Distribution of patients based on Vaksha Circumference (n=30)

After treatment;

Grading Vaksha circumferance No of patients % G1 Overweight <80cms 1 3.33

G2 Mild obese 81-90 cms 17 56.66

G3 Moderate obese 91-100cms 11 36.66

G4 Grossly obese 101-110cms 1 3.33

Graph No –24 Distribution of patients based on Vaksha Circumference

G2

G3, 36.66

G4

0

10

20

30

40

50

60

Percentage

G1

G2

G3

G4

Vaksha circumference – patients observed for study were assessed grade 1 to

grade 4. Majority of patients were of grade 2 i.e., 17 patients (56.66%), grade 3

were11 patients (36.66%) and grade 4 was 1 patient (3.33%) and grade 1 was 1

patient(3.33)’

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Table No – 42 Distribution of patients based on Udara Circumference (n=30)

After treatment;

Grading Udara circumferance No of patients %

G1 Overweight <80cms 0 0

G2 Mild obese 81-90 cms 7 23.33

G3 Moderate obese 91-100cms 16 53.33

G4 Grossly obese 101-110cms 7 23.33

Graph No – 25 Distribution of patients based on Udara Circumference

G3

G4

0

10

20

30

40

50

60

Percentage

G1

G2

G3

G4

Udara circumference – patients observed for study were assessed grade 1 to

grade 4. Majority of patients were of grade 3, 16 patients (53.33%), grade 2 were 7

patients (23.33%) and of grade 4 were 7 patients (23.33%).

Table No – 43 Distribution of patients based on Sphika Circumference (n=30)

After treatment;

Grading Sphika circumferance No of patients %

G1 Overweight <90cms 0 0

G2 Mild obese 91-100 cms 8 26.66

G3 Moderate obese 101-110cms 16 53.33

G4 Grossly obese 111-120cms 6 20

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Graph No – 26 Distribution of patients based on Sphik Circumference

G3

G4

0102030405060

Percentage

G1G2G3G4

Sphik circumference – Majority of patients were of grade 3 i.e. 16 patients

(53.33%), grade 2 were 8 patients (26.66%)and grade 4 were6 patients (20%).

Table No – 44 Distribution of patients according to adhika kshudha.(n=30)

After treatment.

Grading adhika kshudha No of patients %

G1 Absent 0 0

G2 Mild 0 0

G3 Moderate 19 63.33

G4 Severe 11 36.66

Graph No – 27 Distribution of patients according to the variables symptom

0 0

63.33

36.66

0

20

40

60

80

Total

Ati KshudaAti TrishnaKshudrashwasSwedaadhikata

Majority of patients were of grade 3 ie,19 patients (63.33%) and of grade 4 were

11 patients (36.66%).

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Table No –45 Distribution of patients according to adhika trishna.(n=30)

After treatment;

Grading adhika trishna. No of patients %

G1 Absent 0 0

G2 Mild 2 6.66

G3 Moderate 22 73.33

G4 Severe 6 20

Graph No – 28 Distribution of patients based on adhika trishna.(n=30)

0 6.66

73.33

20

0

20

40

60

80

Total

G1G2G3G4

Majority of patients were of grade 3 ie,22 patients (73.33%), grade 2 were 2 patients

(6.66%) and grade 4 were 6 patients (20%).

Table No – 46 Distribution of patients according to Kshudra shwas.(n=30)

After treatment;

Grading Kshudra shwas. No of patients %

G1 Absent 14 46.66

G2 Mild 12 40

G3 Moderate 4 13.33

G4 Severe 0 0

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Graph No –29 Distribution of patients based on Kshudra shwas.(n=30))

46.6640

13.33

00

1020304050

Total

G1G2G3G4

In present study it was observed that from grade 1 to grade4,14 patients (46.66%)

were of grade 1,12 patients (40%) were of grade 2,4 patients (13.33%) were of grade 3.

Table No – 47 Distribution of patients according to swedadikhata.(n=30)

After treatment;

Grading Swedadikhata . No of patients %

G1 Absent 1 3.33

G2 Mild 5 16.66

G3 Moderate 24 80

G4 Severe 0 0

Graph No – 30 Distribution of patients based on swedadikhata.(n=30)

3.3316.66

80

00

20406080

100

Total

G1G2G3G4

Majority of patients were of grade 3 i.e., 24 patients (80%), grade 2 were 5 patients

(16.66%) and grade 1 was 1 patients (3.33%).

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Table No – 48 Distribution of patients according to BMI (n=30) After Follow up

Grading BMI No of patients %

G1 30-34.9 27 90%

G2 35-39.9 3 10%

G3 >40 0 0%

Graph No – 32 Distribution of patients according to BMI

100

0

20

40

60

80

100

Percentage

30-34.935-35.9>40

Patients observed for study were assessed as G-1;B.M.I in between 30-34.9 were

27 patients (90%), G-2;B.M.I in between 35-39.9 were 3 patients (10%).

Table No – 49 Distribution of patients based on Vaksha Circumference (n=30)

After Follow up

Grading Vaksha circumferance No of patients %

G1 Overweight <80cms 0 0

G2 Mild obese 81-90 cms 18 60

G3 Moderate obese 91-100cms 10 33.33

G4 Grossly obese 101-110cms 2 6.66

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Graph No – 33 Distribution of patients based on Vaksha Circumference

G2

G3, 33.33

G4

0

20

40

60

80

Percentage

G1G2G3G4

Vaksha circumference – patients observed for study were assessed grade 1 to

grade 4. Majority of patients were of grade 2 i.e., 18 patients (60%), grade 3 were 10

patients (33.33%) and grade 4 were of 2 patients (6.66%).

Table No – 50 Distribution of patients based on Udara Circumference (n=30)

After Follow up

Grading Udara circumferance No of patients %

G1 Overweight <80cms 0 0

G2 Mild obese 81-90 cms 6 20

G3 Moderate obese 91-100cms 15 50

G4 Grossly obese 101-110cms 9 30

Graph No – 34 Distribution of patients based on Udara Circumference

G3

G4

0

10

20

30

40

50

60

Percentage

G1

G2

G3

G4

Udara circumference – patients observed for study were assessed grade 1 to

grade 4. Majority of patients were of grade 3, ie,15 patients (50%), grade 2 were 6

patients (20%) andgrade 4 were 9 patients (30%).

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Table No – 51 Distribution of patients based on Sphika Circumference (n=30)

After Follow up

Grading Sphika circumferance

No of

patients %

G1 Overweight <90cms 0 0

G2 Mild obese 91-100 cms 7 23.33

G3 Moderate obese 101-110cms 17 56.66

G4 Grossly obese 111-120cms 6 20

Graph No – 35 Distribution of patients based on Sphik Circumference

G3

G4

0102030405060

Percentage

G1G2G3G4

Sphik circumference – Majority of patients were of grade 3 i.e. 17 patients

(56.66%), grade 2 were7 patients (23.33%)and grade 4 were 6 patients (20%).

Table No – 52 Distribution of patients according to adhika kshudha.(n=30)

After Follow up

Grading adhika kshudha No of patients %

G1 Absent 0 0

G2 Mild 0 0

G3 Moderate 18 60

G4 Severe 12 40

------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 76

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Graph No – 36 Distribution of patients based on adhika kshudha.(n=30)

0 0

60

40

0

20

40

60

80

Total

G1G2G3G4

Majority of patients were of grade 3 ie,18 patients (60%) and of grade 4 were 12

patients (40%).

Table No – 53 Distribution of patients according to adhika trishna.(n=30)

After Follow up

Grading adhika trishna. No of patients %

G1 Absent 0 0

G2 Mild 2 6.66

G3 Moderate 22 73.33

G4 Severe 6 20

Graph No – 37 Distribution of patients based on adhika trishna.(n=30)

0 6.66

73.33

20

0

20

40

60

80

Total

G1G2G3G4

Majority of patients were of grade 3 ie, 22 patients (73.33%), grade 2 were 2

patients (6.66%) and grade 4 were 6 patients (20%).

------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 77

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Table No – 54 Distribution of patients according to Kshudra shwas.(n=30)

After Follow up

Grading Kshudra shwas. No of patients %

G1 Absent 14 46.66

G2 Mild 12 40

G3 Moderate 4 13.33

G4 Severe 0 0

Graph No – 38 Distribution of patients based on Kshudra shwas.(n=30))

46.6640

13.33

00

1020304050

Total

G1G2G3G4

In present study it was observed that from grade 1 to grade4,14 patients (46.66%)

were of grade 1,12 patients (40%) were of grade 2,4 patients (13.33%) were of grade 3.

Table No – 55 Distribution of patients according to swedadikhata.(n=30)

After Follow up

Grading Swedadikhata . No of patients %

G1 Absent 0 0

G2 Mild 2 6.66

G3 Moderate 14 46.66

G4 Severe 14 46.66

------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 78

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Graph No – 39 Distribution of patients based on swedadikhata.(n=30)

06.66

46.6646.66

01020304050

Total

G1G2G3G4

In present study it was observed that from grade 1 to grade4,2 patients (6.66%) were

of grade 2,14 patients (46.66%) were of grade 3,14 patients (46.66%) were of grade 4.

OBSERVATIONS FOR THE PATIENTS:-

1) All the patients were presenting with varied degree of laxanas

2) For all the patients of sthaulya udvartana with chanak pisti is done.

3) Patients were comfortable during and at the end of the treatment

4) The patients were observed while in undergoing udvartana procedure.

5) All the patients come regularly for the follow up after 15 days.

6) All the patients were asked not to sleep during day time

RESULT RELATED OBSERVATIONS OF PATIENTS AFTER TREATMENT

1) CI- III Excellent: None of patients showed excellent response at the end of the

treatment

2) CI- II Good: None of patients showed good response at the end of the

treatment

3) CI- I Encouraging: 3.33% (1 pt) for BMI, 6.66% (2pts) for vaksha, 13.33% (4

pt) for udara, and 10% (3 pt) for sphik, 3.33% (1 pt) for adhik khshudha,and

63.33%(19%) for sweda adhikata have showed encouraging response.

------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 79

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Observations and results ============================================================ 

4) C.S –96.66 % (29 pts) for BMI, 93.33 % (28 pts) for vaksha, 86.66% (26 pts)

for udara, 90% (27 pts) for sphik 96.66% (29 pts),for adhik kshudha 100% (30

pts) for adhika trushna,100% (30%) for kshudra shwas and 36.66% (11 pts)for

sweda adhikatha have showed no response i.e. stable.

5) C.D. – None of the patients showed deterioration in the conditions

RESULT RELATED OBSERVATIONS OF PATIENTS AFTER FOLLOW UP

1) CI- III Excellent: None of patients showed excellent response at the end of the

follow up.

2) CI- II Good: None of patients showed excellent response at the end of the

follow up.

3) CI- I Encouraging: 3.33% (1 pt) for Udara, 3.33% (1 pt ) for sphika, have

showed encouraging response.

4) C.S – 100% (30 pts) for BMI,100 % (30 pts) for vaksha, 96.66% (29 pts) for

udara, 96.66% 29 pts) for sphik,100 %(30 pts) for adhik kshudha,100%(30

pts) for adhik trushna,100%(30pts) for kshudra shwas,100% (30 pts) for sweda

adhikata have showed no response i.e. stable after follow up.

5) C.D. – None of the patients showed deterioration in the conditions after follow

up.

------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 80

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Observations and results ============================================================ 

TABLE NO 56:-RESULT RELATED RESPONSES OF THE PATIENTS

AFTER TREATMENT:

variables CI-3 CI-2 CI-1 CS CD

BMI 0% 0% 3.33%(1pt) 96.66%(29pts) 0%

VAKSHA 0% 0% 6.66%(2pts) 93.33%(28pts) 0%

UDARA 0% 0% 13.33%(4pts) 86.66%(26pts) 0%

SPHIKA 0% 0% 10%(3pts) 90%(27pts) 0%

ADHIKA KSHUDA 0% 0% 3.33%(1pt) 96.66%(29pts) 0%

ADIKA TRUSHNA 0% 0% 0% 100%(30pts) 0%

KSHUDRA SHWAS 0% 0% 0% 100%(30pts) 0%

SWEDA ADHIKATA 0% 0% 63.33%(19pts) 36.66%(11pts) 0%

GRAPH NO– 40 RESPONSES OF THE PATIENTS FOR BMI AFTER TREATMENT:-

020406080

100120

CI-3 CI -2 CI -1 CS CD

BMI

GRAPHNO–41 RESPONSES OF THE PATIENTS FOR VAKSHA AFTER TREATMENT:-

020406080

100

CI-3 CI -2 CI -1 CS CD

VAKSHA

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GRAPH NO– 42 RESPONSES OF THE PATIENTS FOR UDARA AFTER

TREATMENT:-

0

20

40

60

80

100

CI -3 CI -2 CI -1 CS CD

UDARA

GRAPH NO– 43 RESPONSES OF THE PATIENTS FOR SPHIK AFTER

TREATMENT:-

020406080

100

CI-3 CI -2 CI -1 CS CD

SPHIK

GRAPH NO– 44 RESPONSES OF THE PATIENTS FOR ADHIKA

KSHUDTHA AFTER TREATMENT:-

020406080

100120

CI-3 CI -2 CI -1 CS CD

SPHIK

------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 82

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Observations and results ============================================================ 

GRAPH NO– 45 RESPONSES OF THE PATIENTS FOR ADHIKA TRUSHNA

AFTER TREATMENT:-

020406080

100120

CI-3 CI -2 CI -1 CS CD

SPHIK

GRAPH NO– 46 RESPONSES OF THE PATIENTS FOR KSHUDRA SWAS

AFTER TREATMENT:-

020406080

100120

CI-3 CI -2 CI -1 CS CD

SPHIK

GRAPH NO– 47 RESPONSES OF THE PATIENTS FOR SWEDADHIKATA

AFTER TREATMENT:-

010203040506070

CI-3 CI -2 CI -1 CS CD

SPHIK

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TABLE NO 57:-RESULT RELATED RESPONSES OF THE PATIENTS

AFTER FOLLOW UP:

variables CI-3 CI-2 CI-1 CS CD

BMI 0% 0% 0% 100%(30pts) 0%

VAKSHA 0% 0% 0% 100%(30pts ) 0%

UDARA 0% 0% 3.33%(1pts) 96.66%(29pts) 0%

SPHIKA 0% 0% 3.33 %(1pts) 96.66%(29pts) 0%

ADHIKA KSHUDA 0% 0% 0% 100%(30pts) 0%

ADIKA TRUSHNA 0% 0% 0% 100%(30pts) 0%

KSHUDRA SHWAS 0% 0% 0% 100%(30pts) 0%

SWEDA ADHIKATA 0% 0% 0% 100%(30pts) 0%

GRAPH NO– 45 RESPONSES OF THE PATIENTS FOR BMI AFTER

FOLLOW UP:-

020406080

100120

CI-3 CI -2 CI -1 CS CD

BMI

GRAPHNO–46 RESPONSES OF THE PATIENTS FOR VAKSHA AFTER FOLLOW UP:-

020406080

100120

CI-3 CI -2 CI -1 CS CD

VAKSHA

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GRAPH NO– 47 RESPONSES OF THE PATIENTS FOR UDARA AFTER

FOLLOW UP:-

020406080

100120

CI-3 CI -2 CI -1 CS CD

UDARA

GRAPH NO– 48 RESPONSES OF THE PATIENTS FOR SPHIK AFTER

FOLLOW UP:-

020406080

100120

CI-3 CI -2 CI -1 CS CD

SPHIK

GRAPH NO– 49 RESPONSES OF THE PATIENTS FOR ADHIKA

KSHUDTHA AFTER FOLLOW UP:-

0204060

80100120

CI-3 CI -2 CI -1 CS CD

SPHIK

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GRAPH NO– 50 RESPONSES OF THE PATIENTS FOR ADHIKA TRUSHNA

AFTER FOLLOW UP:-

020406080

100120

CI-3 CI -2 CI -1 CS CD

SPHIK

GRAPH NO– 51 RESPONSES OF THE PATIENTS FOR KSHUDRA SWAS

AFTER FOLLOW UP:-

020406080

100120

CI-3 CI -2 CI -1 CS CD

SPHIK

GRAPH NO–52 RESPONSES OF THE PATIENTS FOR SWEDADHIKATA

AFTER FOLLOW UP:-

020406080

100120

CI-3 CI -2 CI -1 CS CD

SPHIK

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Observations and results ============================================================ 

STATISTICAL ANALYSIS :-

TABLE NO 58:- BMI Mean S.D t P Remarks

B .T

A. T

1.1000

1.0667

0.30513

0.25371

1.000 0.326 NS

B .T

A .F.U

1.1000

1.1000

0.30513

0.30513

0 1.000 NS

TABLE NO 59:- VAKSHA

Mean S.D t P Remarks

B.T.

A.T.

2.4667

2.4000

0.62881

0.62146 1.439 0.161 S

B.T.

F.U.

2.4667

2.4667

0.62881

0.62881 0 0.1.000 NS

TABLE NO 60: -UDARA

Mean S.D t P Remarks

B.T

AT.

3.133

3.000

0.68145

0.69481 2.112 0.043 S

B.T

F.U.

3.133

3.1000

0.68145

0.71197 1.000 0.326 NS

TABLE NO 61: -SPHIK

Mean S.D t P Remarks

B.T

AT.

3.0333

2.9333

0.66868

0.69149 1.795 0.083 S

B.T

F.U.

3.0333

2.9667

0.66868

0.66868 1.439 0.161 NS

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TABLE NO 62:- ADHIKA KSHUDHA

Mean S.D t P Remarks

B.T.

A.T.

3.4000

3.3667

0.49827

0.49013 1.0000 0.326 NS

B.T.

F.U.

3.4000

3.4000

0.49827

0.49827 0 1.000 NS

TABLE NO 63:- ADHIKA TRUSHNA

Mean S.D t P Remarks

B.T

AT.

3.1333

3.1333

0.50742

0.50742 0 1.000 NS

B.T

F.U.

3.1333

3.1333

0.50742

0.50742 0 1.000 NS

TABLE NO 64:- KSHUDRA SWAS

Mean S.D t P Remarks

B.T

AT.

1.6667

1.6667

0.71116

0.71116

0 1.000 NS

B.T

F.U.

1.6667

1.6667

0.71116

0.71116

0 1.000 NS

TABLE NO 65: - SWEDADHIKATA

Mean S.D t P Remarks

B.T

AT.

3.4000

2.7667

0.62146

0.50401 7.077 0.000 HS

B.T

F.U.

3.4000

3.4000

0.62146

0.62146 0 1.000 NS

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Discussion ===============================================================

DISCUSSION

TITLE ;

The dissertation entitled as ‘A STUDY ON APATARPAN WITH SPECIAL

REFERENCE TO UDVARTAN IN STHOULYA’ .

In astanga hrudaya,sutrasthan,chapter number 14,Dwividhopakramaniya adhyaya

has been mentioned.In which two folds of therapies has been mentioned as 1.santarpan

2.apatarpan.The synonyms mentioned for santarpan and apatarpan are Bruhmana amd

Langhana respectively,

It has been mentioned in asthanga-hrudaya that snehana and stambhana comes

under brumhana ie,santarpana and rukshan and swedan comes under langhana

ie,apatarpana respectively.Apatarpana contributes a major documentation as a part of

dwividhopakrama.

In charaka samhita,sutrasthana chapter number 22 Langhana-brumhaneeya

adhyaya six folds of therapies has been mentioned as langhana, brumhana,rukshana,

snehana,swedana and sthambhana,Among them langhana,rukshana and swedana comes

under Apatarpana.brumhana,snehana and sthambhana comes under Santarpana.So it is

clear that six folds of therapies comes under these two folds ie,Santarpana and

Apataarpana.

So in detailed study on apatarpana has been highlated as a basic fundamental

principle of dwividhopakrama along with three folds of therapies ie,langhana,rukshana

and swedana.

All the treatments comes under these two folds of therapies ie,Santarpana and

Apatarpana.as sthoulya itself is described as santarpanotha vyadhi so apatarpana therapy

-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 89

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Discussion ===============================================================

is essential for treating sthoulya.Acharya charaka described about sthoulya as

kastasadhya and asaadhya if it is beeja-swabhavaja.So as to treat sthoulya it is necessary

to assess basic fundamental principle ie,apatarpana and also its implementation in

sthoulya.

Acharya charaka has mentioned in treatment of sthoulya as consumption of food

and drinks so as to maintain equilibrium state of the aggrevated dosha ie,vata,kapha and

also meda dhatu.He has explained to give ruksha,ushna and teekshna basti.along with

acahrya charaka has explained to do the ruksha udvartana so as to treat the sthoulya.

So for treating the sthoulya which defined as kashtasadhya,ruksha udvarthan with

chanaka pishthi is taken.As rukshana is a part of apatarpan so ruksha udvartan in sthoulya

also comes under apatarpana therapy.In rukshana therapy,for redusing the bulk of the

obese,heavy and non saturated ie,apatarpana therapy is prescribed in sthoulya.Hence a

study on Apatarpan with special reference to udvartan in sthoulya is taken for study.

Sthoulya is most prevalent form of mal-nutrition in developing countries like

India.It has been estimated that 20-40% adults and 10-20% children are affected by

sthoulya.Sthoulya is root cause for many diseases like hypertension,diabetes

mellitus,cardio vascular disorders and respiratory disorders.Sthoulya is very nearer to the

clinical entity and is an importanat health problem of modern society.So a disease

sthoulya is taken for study to assess the effect of ruksha udvartana with chanaka pishthi

under the basic concept of apatarpana.

So The dissertation entitled as ‘A STUDY ON APATARPAN WITH SPECIAL

REFERENCE TO UDVARTAN IN STHOULYA’

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Discussion ===============================================================

DISCUSSION ON CONCEPT OF APATARPANA

In charaka samhita,astanga hrudaya,astanga sangraha two folds of therapies have

explained as santarpana and apatarpana.Brumhana and Langhana are synonyms of

santarpana and apatarpana respectively.From which six folds of therapies has been

mentioned as langhana,brumhana,rukshana,snehana,swedana and stambhana,Among

them langhana,rukshana and swedana comes under apatarpana.brumhana,snehana and

stambhana comes under santarpana.So these two folds of therapies are basic fundamental

principle in nidana aspect and also treatment aspects.In charaka samhita sutrasthana

chapter number 22,Langhana brumhaneeya adhyaya,in astanga

hrudaya,sutrasthana,chapter number 14 dwividhopakramaneeya adhyaya and in astanga

sangraha,sutrasthana,chapter number 29 dwividhopakramaneeya adhyaya the two folds of

therapies ie santarpana and apatarpana has been mentioned.

In astanga hrudaya,dwividhopakramaneeya adhyaya langhana is taken as

synonym for apatarpana and rukshana and swedana are described under

langhana.Langhana is of two types as 1.shodhana and 2.shamana.Shodhana is that which

expels the doshas out of the body forcibly.It is of five kinds viz.vamana,kayareka,

shirovirek,niruha and asravisruti.

Shamana is that treatment which is palliative in nature which does not expel the

doshas and also does not increase the doshas but which makes abnormal doshas in normal

state.It is of seven kinds as pachana,deepana,kshutha,trusha,vyayam,atapa and

maruta.The dravyas which are of agni,vayu and akasha mahabhuta predominant does the

apatarpana karma.

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Discussion ===============================================================

Langhana karma is applied in four types of evacuation ie,vaman,virechan,nirooh

and nasya along with thirst,exposure to wind,exposure to sun,pachana,upavas and

vyayama.Charak samhita mentioned these ten folds of therapies.In charaka samhita

vimanasthana,janapadodhwamsaneeya adhyaya apatarpana has been classified in three

types as langhana,langhana pachana and doshavirechana.Amongest them langhana

therapy is recommended for those having doshas with little strength,langhana pachana in

case of doshas with medium strength and in case of abundant doshas expelling out of

doshas is prescribed ie,doshavasechana

Astanga sangraha explained apatarpana in dwividhopakramneeya adhyaya same

as in astanga hrudaya.In susruta samhita chikitsa sthana,chapter 1,dwivraneeyam

chikitsitam adhyaya,shasti upakrama is mentioned in which apatarpana is first

upakrama.As described in samhita it is clear that langhana is synonym for apatarpana.Till

though langhana itself contains a major documentation as a part of apatarpana.So

apatarpana contains three folds of therapies ie,langhana,rukshana and swedana.

LANGHANA

In astanga- sangraha,Dvividopkramaniya adhyaya,chapter number 24,Langhana

yogya has been mentioned.In astanga-hrudaya,sutrasthan,chapter number 14

Dvividopkramaniya adhyaya,Langhaneeya is mentioned.In Charaka

samhita,sutrasthana,chapter number 22 Langhana yogya persons are mentioned.Chikitsa

phala (benefits of langhana),ati langhana (excess of thinning therapy) has been described

in Astanga- hrudayaa,sutrasthana chapter number 14 ie, Dvividopkramaniya

adhyaya.From above references it is clear that langhana is one of the six folds of

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Discussion ===============================================================

therapies.As per the references langhana is the part of Apatarpan and also plays important

role in nidan as well as in chikitsa aspect.

RUKSHANA

In charaka samhita,sutrasthana,chapter number 22 Langhana bramhaniya

adhyaya,rukshan and its properties has mentioned.Along with this samyaka yoga

lakshana and atiyoga lakshana has also mentioned.Rukshan is one of the upakram

amongst the six folds of therapies.Rukshan itself is a part of Apatarpan.So ruksha

udvartan with chanaka pishthi itself is a part of rukshana therapy.So udvartan with

chanak pishthi is taken as rukshan therapy in sthoulya under the concept of Apatarpan.

SWEDANA

In charaka samhita,sutrasthan,adhyay number 22 Langhana brumhaneeya

adhyay,swedana,its properties,swedana yogya,swedana ayogya and types of swedan are

mentioned clearly.So swedana is also part of six folds of therapies.It is also a type of

Apatarpan.

As per above references Langhana,Rukshana and swedana comes under

Apatarpan.As sthoulya itself is a Santarpanotha vyadhi,so ruksha udvartan with chanaka

pishthi is indicated in sthoulya which is a part of rukshana therapy which comes under

Apatarpan.

Sthaulya vis-à-vis medoroga:-

When we analyze the disease sthoulya reveals that in classics two words had

been used to describe sthoulya, when we observe these views we find some differences

that one supports sthaulya and medoroga are same, while other differs and suggest that

both are different.

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Discussion ===============================================================

Supporting views suggesting sthaulya as medoroga

1. Even though later acharayas in Laghutrayee have described about

medoroga, under that heading we still find that all literatures described in

Brihatrayas under sthaulya both are same especially with the nidana

panchaka.

2. Charaka used the term medasvi in context to sthoulya which indicates that

meda is mainly involved in the pathogenesis. Due to this reason might later

acharyas described it as a medoroga.

3. Chakrapani in his book chakradatta had followed the sequence of

madhavakara in “madhava nidana”, for description of chikista, for whom

madhava named it as medoroga. Hence by above description we may say

that medoroga and sthaulya are one and same.

Views supporting that sthaulya and medoroga are different.

1. None of the commentators have used the synonyms for sthaulya as medoroga

2. Sushruta and Vagbhata enlisted medoroga under vamana Arhvyadhi, while

sthaulya enlisted under vamana anarha vyadhi.

These views supports that medoroga and sthaulya are different.

According to charaka medoroga includes all the ashtanindita purushas as he

described them as medapradoshaja vyadhis.

Yet with the above information we can not conclude, and it’s a debatable

subject.

Nidana: Kapha, Meda & Vata are the main factors involved in the manifestation

of Sthoulya. Excessive brhumhana Karma of rasa is said to be the cause for Sthoulya.

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Discussion ===============================================================

The only cause responsible for obesity (excessive fat in body) is overeating. The

mechanism of human body is such that the food that is excess in quantity required for

generating energy gets converted into fat and then gets deposited in the body.

An average healthy person generally takes food just enough to meet the

requirements of his energy expenditure, and the weight remains stable. But when food

intake is more with less energy expenditure, this balance is lost, the weight no longer

remains stable and this imbalance between food intake and energy expenditure become a

cause for obesity.

Aharaja Nidana:- Excessive in take of madhura, guru, snigdha, picchila,

abhishyandi, sleshmala ahara leads to kapha vruddhi which in turn leads to meda vruddhi

which is the main dhatu involved in the manifestation of sthoulya.

In the present study it was observed that most of patients were having of habit of

consuming excess of sweets, bakery items routinely which vitiates kapha. They also take

in excess of fried items, chats, cold soft drinks, ice creams which are kapha prakopaka

nidanas.

Viharaja Nidana:- The viharaja nidanas which are responsible for vitiation of

kapha, vata and meda can be considered as the nidanas for sthoulya. During the nidanas

observed in the study patients have the nidana of diwaswapna and avyayama. Most of the

patients were having a history of sedentary life styles. These nidanas may be responsible

for sthaulya.

Diwaswapna makes the kapha prakopa which in turn vitiates meda and obstructs

the srotas. It has been noticed that when a fat person is sleeping or relaxing his metabolic

rate is reduced to almost nil.

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Discussion ===============================================================

Avyayama not exerting physically and spending more time infront of television is

one among the cause for obesity.

Manasika Nidana:- The etiological factors effect the mind. Tamoguna gets

increased due to lack of activity which results into obesity.

Kulaja nidana:-It is an undeniable fact that generally the parents or the children

of fat person are also fat.

A researcher Dr.Gurney after studying 75 fat woman noticed that either both or

one of the parents of 82 % women were obese. With the help of yet another study, he has

shown that;

i) If both parents are fat 73% of their children are also obese.

ii) If one of the parents is fat 45 % of their children are fat.

iii) If both the parents are of normal weight only 9% children appear to be fat.

All this happens because the fact that every individual inherits his physical

constitution. There after obesity develops depending upon factors like eating habits, way

of life & environment.

Evidently during the present study it is observed that ten patients (33.33%) were

having the kula vruttanta of sthoulya.

Other Causes of obesity:-Endocrinal factors rarely involved in gaining the

weight, which includes hypothyroidism, Cushing’s syndrome, Antidepressants and

steroids also cause gain in weight.

Poorva roopa of sthaulya: - Poorva roopa are set of signs and symptoms that

appear before the manifestation of the disease. Such signs and symptoms are not

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explained for all the vyadhis. For such vyadhis some of the lakshanas which are exhibited

in mild form before its manifestation can be considered as poorva roopa of sthaulya.

In context to sthoulya it may be said mild deposition of meda in vaksha, udara and

sphik can be considered as poorva roopa of sthoulya.

BMI above normal, i.e.24.5-29.9(over weight) can be considered as prodromal

sign of obesity.

Roopa: - Roopa are the lakshanas manifested, which develop during the course of

vyadhi. On the basis of different acharyas opinion regarding the sthoulya lakshanas it can

be arranged in to two groups;

a) Samnaya lakshanas & b) Vishesha lakshanas

a) Samanaya lakshana include Javoparodha, kruchra vyavaya, durbalata,

dourgandhyata, swedabadha, Atikshuda, Atitrishna and Ayuhrasa etc.

b) Vishesha lakshanas- the visehsa lakshana by which the vyadhi is diagnosed are

the pratyatma lakshans of that vyadhi.

Vishesha lakshana of sthoulya includes sthana lambana, udara lambana and sphik

lambana, Ayathopachaya i.e. malnourishment of all the dhatus and utshanasha.

In the present study these classical signs were present in all the patients.

In the conventional sciences also diagnoses will be apparent from the appearance

and only the level of obesity is assessed by measurements of Body mass index (B.M.I),

skin fold thickness (S.F.T), and waist circumference and waist hip ratio (W.H.R).

Astha dosha of sthaulya:-The 8 symptoms otherwise called Astha dosha of sthaulya are

1) Ayusha hrasa 2) Javoparodha 3) Kruchravyavayata 4) Daurbalya

5) Daurgandya 6) Swedabadha 7) Atikshuda 8) Atitrishna

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Ayusha hrasa

Due to excessive vruddhi of meda dhatu, person become sthoola, malnutrition of

Rasadi dhatus leads to Ayusha hrasa.

Though obesity not directly responsible for causing death certainly causes such

many complications which in turn cause premature death.

In a research, group of persons ranging from 40-70 in age. Among those who

were over weight by 30% the rate of mortality was higher by 42% in case of men and

36% in women.

Javoparodha:-

In sthoola person shithilata and sukumarata is observed as meda being guru in

nature. This makes the person lazy.

Kruchravyavayata:-

Due to avarodha of srotases and malnourishment of Rasadiparyanta shukra dhatus

are malnourished; alpa sukra is formed and causes kruchravyavayata.

Daurbalya:-

Even though akruti of the patient is sthoola due to improper nourishment of

Rasadi dhatus leads to Durbalata. In the present study maximum patients have

complained the symptom daurbalata.

Daurgandya, Swedabadha:-

Excessive of vikruta meda is formed and excess of kitta bhaga i.e. mala of meda,

sweda is formed.

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Due to layers of fat deposited on the body acts as sweaters and cause profuse

perspiration which emits a foul odour and this foul smelling sweat causes great

embarrassment to a person.

Atikshuda and Atitrishna:-

Due to margavarodha of vata by meda in kostha, sandhukshana of vata takes place

which causes excessive of kshudha. Excessive trishna is observed due to excessive

sweating in sthoola persons.

Along with this other lakshanas like atinidra, jadhyata, moha, kshudra shwasa, etc

lakshanas were seen in patients.

SAMPRAPTI GHATAKAS :-

Dosha : Kapha, vata, pitta

Dooshya : Meda, Mamsa

Srotas : Medovaha, Mamasavaha, Rasavaha.

Srotodusti prakara : Sanga

Agni : Jataragni - Teekshna

Ama : Medodhatwagnimadyata janya ama

Vyaktha sthana : Sphik, Sthana, Udara

Adhisthana : Sharira

Udbhava sthana : Amashaya

Rogmarga : Bahya

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Samprapti:-

Due to nidana sevana, ama sadrusha ahara rasa uttpatti takes place which affects

the medovaha srotas and impairs the medodhatwagni. By that dhatwagni mandya

formation of vikruta medadhatu will occur. This increased medadhatu due to sanga by

anulomagati affects asthi majja and shukra and by pratiloma gati mamsa rakta and rasa,

by which prakruta sthayi dhatu parinama impairs and all the dhatus become

malnourished.

The vruddha medadhatu make vata prakopa by margavarodha. Vayu then enters

the kostha and flares the jatharagni by which symptoms adhikshuda and atitrishna are

seen, hence person takes excess of food which directly increases meda (gets deposited in

sthana, udara and sphik pradesha), in analog with the madhuratara ahara rasa which is

having properties picchila, sleshmala, abhishyandi again increases meda.

Due to continuity in nidana sevana makes srotorodha leads again jatharagni,

teekshna and results in excessive intake, cycle continues and results in sthoulya.

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FLOW CHART OF STHAULYA:- Nidana sevan

Avyayam Madhura ahara sevana

Apachit Medo Dhatu vriddhi Medo dhatwagni mandya

Margavarodh of vata by Meda

Vayu vimarga gamana

Vata vridhi in kosth

Jatharagni sandhukshan

Kshudha vriddhi

Digestion and absorption increases Due to Srotorodha only Meda dhatu increases

Excessive intake of Ahara

Excess of Meda sanchaya in Sphik,Sthana and Udara

Sthoulya

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Types of sthoulya:-

Even though types of sthoola have not been mentioned directly, but description

regarding heena sthoola, madhyama sthoola and ati sthoola which is mentioned by

vagbhata during the apatarpana chikitsa, can be taken as types of sthoola.

Further these heena sthoola, madhyama sthoola and atisthoola can be taken as

mild obese, moderate obese and severely obese respectively.

In the present study, it was observed that patients of different grades of BMI were

registered for study.

Upashaya:-

There is no such direct explanation regarding the upashaya for sthoulya.

Oushadha, ahara and vihara which cares the vyadhi are upashaya for that particular

vyadhi. Hence all the therapies, ahara and vihar, that relieves symptoms of sthoulya can

be considered as upashaya.

Anupashaya:-

The ahara, vihar, oushadha that aggravates the symptoms of sthoulya are

anupashaya. Hence it can be said that the ahara which are kaphavardhaka and

medovardhaka and viharas like sleeping during day time, less physical activities are

anupashaya for sthoulya.

Sadhyaasadhyata:-

The Sadhyaasadhyata of the disease depends on dosha and dushyas. The disease

should not be of tulya dosha dooshya and prakruti if so then that vyadhi is said to be

kashta sadhya.

Sthaulya is a kaphananatmaja vyadhi and meda, mamsa are the dushyas involved.

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Sthoola had been considered as one among the asthanindita purusha by charaka.

Since the chikitsa is shareraapekshi before mentioning of chikista acharya charaka

described about sthoulya in sutrasthana itself, as kastasadhya and asadhya if it is beeja

swabhavaja.

“Satatam vyadhivetaiva Atisthoola, krushou Narah”.

i.e., Atisthoola and krusha persons are always afflicted by diseases, so sthoulya

can said to be kashta sadya for chikista.

Since obesity is associated with more than 30 medical conditions, hence the

prognosis of obesity is said to be poor.

It is a manageable disease, with strict diet plan, physical exercises, weight can be

maintained.

Upadravas:- The sthoola person if again goes on indulging in mithya ahara and vihara

and not adopted any appropriate chikitsa, then other symptoms like prameha, shwasa,

urusthamba, vatavikara udararoga etc. upadravas may be manifested.

As the nindanas of prameha and sthoola influence on the medovaha srotas in

sthoola, the prameha upadrava occurs. As many as 90% of individuals with type - 2

diabetes are reported to be over weight and obese.

Weight bearing joints like the ankles, hips and the spinal cord are also strained

constantly on account of heavy weight they have to carry. Consequently obese persons

are susceptible to degenerative diseases like osteoarthritis at a young age.

In the present study some patients have got the knee joint pain due to heavy

weight bearing.

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The act of breathing involves the movement of several parts of chest and stomach.

Mainly muscles of the chest and diaphragm. When the fat person breathes he has to lift

his heavy chest every time, besides this, person also finds it difficult to push the

diaphragm towards the fat belly and stomach. Because of this, a fat person gets tired and

breathlessness easily.

Pathya: - The ahara, viharas which are kapha and vata prakopaka and medodhatu

pradushaka are to be avoided.

Considering these factors following pathya can be advocated.

For example: kulatha, yava, vartaka, amalaki churna, shunti, patola, purana shali,

lashuna, mudga yusha, vegetable soups are pathya.

Kulattha is ushna, amlavipaka used in kaphavatajanya roga.

Yava is having ushna and rukshaguna.

Patola is having katu rasa, teekshna ushna guna, madhura and is

kaphavatanashaka.

Purana shali is madhura, laghwapaki and is tridosha shamaka.

Vartaka is katu, tikta rasa, ushna veerya, madhura, vatakaphanashaka and

ksharayukta.

Viharas like vyayama, physical activity, walking, manasika parisharma, prajagara

are pathya.

Vyayama is very important component in the management of obesity. Proper

vyayama is that which brings slight sweating at fore head. Regular exercises with the

above parameter will make the body light, ease in physicial activities improvement of

digestion and reduces the fat.

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Prajagara – obese people should be encouraged to keep awake for longer hours at

night. This directly helps in reduction of body weight as it causes rukshata.

Mental worries and stress also can lead to weight reduction.

Walking also helps to reduce the excess of calories inturn fat.

Apathya:-The food stuffs which are atimadhura snigdha, picchila abhishyandi

gunas are to be avoided Ghrita, mamsa rasa, taila, heavy food excessive sweet foods like

chats, puddings, bakery items like cakes, chocolates, ice creams, excess intake of tea,

coffee soft drinks are apathya.

Viharas like sleep during day, avyayama are apathya

As it is noticed that when obese persons are sleeping or relaxing their basal

metabolic rate is reduced to almost nil.

DISCUSSION OF CHIKITSA:-

“Karshgameva varam sthoulyat nahi sthoolasya Bheshajam”

Karsha is better for treatment when compared to sthaulya and sthoola is difficult

to treat. Mainly vata, meda and kapha are vitiated in sthoola if vata dosha is treated by

santarpana (brimhana) chikista then meda and kapha will get increase and if meda and

kapha are treated by Apatarapana(langhana) chikista then vata will increase and can

further cause other complications. Hence it is difficult to treat sthoola.

The treatment principle of obesity is to rectify medas, agni and sleshma that

means to give medicines which can disintegrate meda and also to influence the

metabolism of meda formation. The main aim is to improve the agni with the use of

appropriate herbs, combined with correct life styles.

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Nidana parivarjana:- Not indulging in nidanas which are sthoulyakara like

heavy meals excessive of fatty, oily food and excessive sweets and bakery items should

be withdrawn gradually. The energy generation and energy expenditure is properly

maintained and consequently weight remains steady. One of the most important remedial

measures in reducing the weight is dieting.

Shodhana chikitsa: - Therapies included under this heading aim at the radical

removal of causative morbid factors of sharirika doshas. For sthoulya as

antahparimarjana chikitsa, lekhana basti which consists of triphala quatha, gomutra,

madhu and ushakadi gana which makes the lekhana of meda and kapha and udvartana

and lepa as bahya parimarjana.

Udvartana: - Udvartana with ruksha drugs like chanak pisthi mitigates kapha

liquifies the meda makes the body parts firm and is best for the health of skin. Also for

daurgandya and swedadhikya drugs containing aromatic odours like chandana, tejapatra

are used as lepa.

The ahara which is guru, and is apatarpaka like yava should be given for

sthoola. The bulk of the food must be increased so that the time duration of digestion is

increased. The food more in quantity and less in calories can be given like Cucumber,

potato, raw tomatoes

Shamana chiktsa: - The Dravya which pacifies the aggravated doshas with out

expulsion from body as well as which does not provoke the equilibrated doshas is known

as shamana (dravya) chikitsa.

In context to sthaulya many such formulations have been described. They mainly

concentrate on kapha, vata, meda and agni.

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Sthaulya vis-à-vis obesity

There are many reasons available for comparing sthoulya with obesity the

predominant being the similarities in etiology and symtomatology, by this reason only

charaka samhita’s Hindi commentators in“vidyotini”Kashinath Panday and G.Chaturvedi

continued correlation of sthoulya with obesity and can be correlated as in table.

TABLE NO 48:

Particulars Sthoulya Obesity

Causes 1. Guru madhura, Sleshmala

ahara sevana

2. Avyayama

3. Bejaswabharaja

4. Rasaja Vyadhi

5. Ati Bhojana sevana

1. Excessive calorie intakes

than expenditure

2. Lack of physical activities,

sedentary lifestyles.

3. Genetic

4. Nutritional disorder

5. Overeating

Symptoms 1. Chala shana, chala udara and

chala sphik, kshudrashwasa

swedadikhya, ati kshuda and

atitrishna

1. Pendulous chest, abdomen

and hip. Dyspnoea, excessive

perspiration, excessive

hunger & thirst

Types 1.Heena sthaulya

2.madhyama sthaulya

3.Ati sthoola

1.Overweight

2. Obese

3. Morbid obese

Assessment Easily identified chala sphik, Easily identified at first sight

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stana and udara by darshana along with this BMI, SFT are

helpful.

Complications Prameha, vataroga, ayuhrasa Diabetes, osteoarthritis,

premature death

Treatment Gura cha apatarpana,

Vyayama

Bulk is increased with low

calories and physical activity

DISCUSSION ON UDVARTANA:-

UDVARTANA:-

Udvartana is extensively sited with the following attributions:-

--> According to Shabda kalpadruma it is vatahara, medavilayana, and kaphahara. As

per Acharya Vagbhata it is kaphahara medavilayana, angasthirikara, twakvarna

prasadakar.But Charakaacharya mentions certain special qualities other than the ones

above in his sutrasthana fifth chapter; viz, bhibhatsahara, dourghandyahara, kanduhara,

gauravahara, tandrahara, swedamalahara and in short it is said to do shariraparimarjana.

--> Even though in dinacharya adhyaya acharyaas have indicated abhynga prior to

udvartana it must be noted that it holds good more for swastha but in the present concept

of sthoulyas which is morbid state of meda along with rasagata ama srotorodha strongly

suggest contraindication of abhyanga as poorvakarma.Hence the above reference can not

be applied in case of sthoulya and udvartana in sthoulya does not have any poorvakarma

--> All acharyas have given prime importance to rooksha udvartana may be for

madhyama sthoulya as the local bahir parimarjana chikitsa for medopachaya.

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--> Considering the properties of udvartana dravya Indu (commentator of

Astangasangraha) has specifically underlined kashaya rasapradhana dravya but in

Astangahridaya we find kashayadi dravya being advocated that are tiktakara which

Arunadatta clarifies as katu tikta kashayarasa pradhana dravya.

--> Ruksha udvartana dravya alwayas have the agneya vayavya qualities which are

best to subside parthiva and aappya panchamahabhuta of meda and kapha.

-->Udvartana being a bahyaupakrama, is very analogous to abhyanga and should have

same timings .In (cha chi24/30) we find the clear specification of 700 maatrakala

(i.e. 3 min 48sec) for drug potency to reach the medodhatu. Which is approximately 4-5

minutes hence forth udvartana is done in seven different postures of 5 minutes duration

each, adding upto a total of 35 minutes. However, depending on severity of the disease

and severity of the patient adjustment in time is to be done.

-->Mode of action: - By the udvartana, the bhrajaka pitta seated in twacha absorbs

virya of chanak pishthi. Hence by rule paka vilinata of dosha that is kapha and meda

occurs.In udvartana chanak pishthi when applied externally being ruksha gunatmaka

absorbs prithakatwa mala through sweat pores as inferred by the varti formation of

sukshma chanak pishthi This validates the process of udvartana as an effective measure

to remove accumulated (medopachaya) at undesirable areas.(such as sphik udara etc)

locally.The above considerations lead us to the fact that chanak pishthi udvatana is the

best bahir parimarjana chikitsa for madhyama sthoulya. Besides which it has been

attributed to bhibhatsahara and dourghandyahara according to Charaka, which are the

commonest stigmas of sthoulya person.

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ABOUT DRUG:-

Udvartana procedure is mentioned with ruksha dravya ie ‘rukshanu udvartanani cha’in

charaka samhita,in treatment of sthoulya.

So chanaka pisti have been preffered for udvartana as it is laghu and ruksha in gunas.The

rasa properties of chanak is kashaya rasayukta which is antagonistic to the properties of

kapha.The physical qualities of chanak,laghu and ruksha are contrary to meda dhathu.In

charaka samhita chanak is mentioned as laghu,sheeta,madhura,kashaya and does the

rukshan by its prabhava.The properties of chanak is mentioned as vatakarak,pitta and

kapha nasaka,kapha pitta nashaka which is quiet conflicting to that of sthoulya.

The chanak pishti has been selected because of following factors.

1) To increase the fortified effect of sukshmata and to achieve laghuta.

2) Due to the principle of pharmacology “Smaller the particles greater the

penetration, and faster the action”

3) For synergizing and maximizing the pharmaco-therapeutic effect.

DISCUSSION ON ACTION OF UDVARTANA:-

As it is mentioned that ambu is present in Meda dhatu, to flush the excess of ambu

dhatu, which is present either in intercellular or intracellular places. This removes the

excess of water, which represents excess weight in the body. There are five basic

principles to bring dosha from shakha to kosta:

Vrudha – increasing the dosha

Vishyanda –liquification

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Pakat – due to the paka of dosha

Srotomukha vishodanat – due to Shodhana of sroto mukha

Vayu nigraha – due to control over Vata

Udvartana is having the gunas of Kapha:- Meda vilayana property. Due to ushna

and teekshna guna of dravya and forceful massage effect on romakupa, the Veerya of

drug enters into body through, there after it opens the mukha of siras, there by making

paka of Kapha and Medas. Due to this, there will be dravatha Vrudhi of Kapha and

Medas. Swedana, which is given after Udvarthana will further makes paka of the same. It

also makes sweda pravrathana and due to Sweda karma, which is given after Udvarthana,

acts as Sthambhana, Gouragna and Sheetagna. When the Doshas enters koshta, via above

methods, they should be flushed out of the body. By this the evacuation of these vikrutha

Dosha and Dushya occurs. By all of these nirharana of Vikruth Vata, Kapha, and aap

dhatu along with Medas will takes place ultimately resulting in Laghavata of Shareera.

Mode of action of Udvarthana on lipids:-

As it is seen that Udvarthana is having good efficacy over lipid levels. The probable

mode of action can be explained as follows:

Due to increased friction to all the parts of the body, the Triglycerides present in

the subcutaneous tissues will break down into fatty acids. These fatty acids are carried

out to the liver due to the effect of centripetal massage, which increase circulation to

internal organs for the conversation of these fatty acids into bile. As less caloric food is

supplied along with heavy exercises, the body needs more of energy to meet the same. In

the absence of carbohydrate, fats are utilized for the purpose of energy production. The

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bile that is formed in liver will be expelled out in excess. Hence the reabsorption of the

bile will be decreased, inturn further utilizing the lipid which is circulating in the blood.

Promotion of excretion of bile in the faeces is used as one of the treatment principle to

treat Hyperlipidemia eg. Colestipol.

Here is the explanation for the various benefits of Udvarthana:-

Twak prasadakara: This beneficial effect of Udvarthana is used to increase beauty.

Improvement in the complexion is the best criteria to assess the cosmetic property. The

colour of skin depends on level of melanocytes, blood circulating beneath the skin and

carotinoids. Colour given to skin by blood is mainly depends upon the quantity of

haemoglobin. By performing Udvarthana, the amount of blood circulation beneath the

skin increases due to friction. Due to this change the cells of the skin are supplied with

more oxygen, there by changing the colour at least to some extent.

Anga sthirikarana (stability of the body): There will be increase in the fat cells either

in number or in size or both in obese person. By performing Udvarthana these fat cells

get lipolysed then the cells get shrunken causing compactness. Thus one can appreciate

the above benefit.

Gourava hara (depletion of heaviness): Gourava is feature due to increase in Kapha

and Medas. Udvarthana enhances transport of Cholestrol from the periphery to the liver.

This cholesterol is utilized for formation of bile (bile salts). Hence due to decrease of fat

one feels lightness.

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Dourgandhya hara (removal of body odour): Dourgandhya is the resultant of Sweda,

which is mala of Medas. Due to Udvarthana there will be decrease in Mala of Medas,

hence formation of excess sweat is reduced, resulting in above benefit.

Tandra hara (removal of drowsiness): Tandra is due to tamo guna, which is increased

by vikrutha Kapha. Udvarthana will reduce Kapha, hence relieves Tandra. Some patients

got this benefit by above procedure.

Kandu hara (removal of itching): One of the reasons for Kandu is obstruction in the

Swedavaha srotas. As Udvarthana clears the orifices of Sweda vaha srotas by its Sira

mukha vishodhana guna, it reduces itching.

Mala hara (removal of excretory products): In general, mala includes Pureesha,

Mootra and Sweda. Here the term mala indicates only Sweda. Sweda is the mala, which

is excreted through orifices of the skin by Udvarthana.

Vata hara: In sthoulya, Medas and Kapha obstruct Vata. Udvarthana reduces Kapha and

Medas and there by normalizing the movement of Vata.

Shukrada: Due to mandata of Medodhatwagni, the uttarotara poshana of dhatu gets

hampered. Udvarthana corrects Medodhatwagni and hence formation of consecutive

dhatu takes place, there by increasing the level of last dhatu- Shukra. It is mentioned

in the modern literature “fat binds the testosterone”. i.e. high levels of lipids in blood will

decrease Testosterone. Udvarthana reduces the cholesterol there by hindering the

testosterone, binding thus making more availability of testosterone.

Twak mriduta (softness of skin): By performing the Udvarthana, expulsion of debris of

dermis and epidermis take place due to friction. It also increases blood circulation to

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layers of skin, there by supplying maximum oxygen to the dermal cells. Hence softness

of the skin is observed. Moreover massaging effect on sebaceous glands stimulates

sebum production and there by brings softness and texture to the skin.

DISCUSSION ON MATERIALS AND METHOD:-

Materials:-

• Chanak pisthi

• Weighing machine

• Measuring tape

Discussion of materials

ABOUT DRUG:-

Astangasangraha (Indu tika) suggests kashaya rasatmaka dravya to be used for

udvartana.

Astanga hridaya (Hemadri) specifies kashyaadi dravyas which can be interpreted

as Kashayatmaka dravyas to be used for udvartana. Acharya Charaka has given ten gunas

which are found as possibilities which induce rookshana in the body.But Aacharya

Vagbhata considered it under the heading of langhana which is again a paryaya of

apatarpana.

Criteria For Selection Of Chanak Pisthi:-

Udvartana procedure is mentioned with ruksha dravya ie ‘rukshanu udvartanani

cha’in charaka samhita,in treatment of sthoulya.

So chanaka pisti have been preffered for udvartana as it is laghu and ruksha in gunas.The

rasa properties of chanak is kashaya rasayukta which is antagonistic to the properties of

kapha.The physical qualities of chanak,laghu and ruksha are contrary to meda dhathu.The

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Discussion ===============================================================

chanak pisthi is kashaya rasayukta,laghu and ruksha in guna,veerya is sheet,vipaka is

katu and its karma is vatakarak,pitta,raktavikara nashaka,kapha and jwara nashak which

is quiet conflicting to that of sthoulya.And availability of drug is easy and economical.

The chanak pishti has been selected because of following factors.

4) To increase the fortified effect of sukshmata and to achieve laghuta.

5) Due to the principle of pharmacology “Smaller the particles greater the

penetration, and faster the action”

6) For synergizing and maximizing the pharmaco-therapeutic effect.

WEIGHING MACHINE

Dial type weighing machine with a reading 0-150 kgs was used and its horizontal

alignment was observe on a flat surface before reading each observation. The needle of

the dial was set at ‘0’ mark before taking the values and three readings are taken.

MEASURING TAPE

While using the tape maximum attention is given to the respiration, and

exhalation measure was recorded.

PROCEDURE OF UDVARTANA:-

Poorvakarma:-

The person has to pass his natural urges, have chittashuddhi and get undressed.

Patient has to be assessed for jeerna ahara lakshana.

Pradhana Karma:-

On the either side of supported patient two paricharakas, taking the sookshma

udvartana choorna on their palms should gently rub the angas (in pratilomagati) for the

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Discussion ===============================================================

stipulated time or until the samyak langhita lakshanas are observed. Then the patient is

tilted to the following positions in the same order and the procedure is repeated.

1 Sitting with stretched legs.

2 Left lateral

3 Right lateral

4 Back again to sitting position.

5 Prone

6 Supine

7 Prone again.

Paschat Karma:-

The acharyas have advocated the ushnodaka sinchana as the paschat karma. Hence

forth hot water bath or any of the dravya kashaya can also be used. The patient is thus

given a whole body wash either warm water or some medicated decoction. He is then

allowed to take light easily digestible food and asked to take complete bed rest for the

rest of the day.

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Discussion ===============================================================

METHODS:-

Aim: - ‘A STUDY ON APATARPAN WITH SPECIAL REFERENCE TO

UDVARTAN IN STHOULYA’.

The present study was taken to understand the concept of apatarpan and to see the effect

of chanak pisthi udvartan as a bahiparimarjan chikitsa in sthoulya.

Study design:-

The sample size is 30 patients of sthoulya.

Selection of patients:-

Selection of patients for the present study was done randomly. First thirty patients

fulfilling the diagnostic criteria and inclusion criteria were selected for the study; patients

were selected irrespective of sex caste, occupation and social economic status.

Inclusion criteria:-

1.Sthoulya diagnosed according to signs and symptoms as in classical texts.

2.Sthoulya of both the sex

3.Between the age group of 20-50 yrs

4.The patients with BMI in between 30-40.

Exclusion criteria:-

• Patients below 20 and above 50yrs of age.

• Pregnant women

• Patient associated with systemic disorders

Diagnostic criteria:-

a) In the present study the diagnosis was done based on the patients presenting with

classical signs like chala sthana chala udara and chala sphik and symptoms like

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Discussion ===============================================================

Atikshuda, Atiktrishna, kashtashwas, swedaadhikata, durbalata, dourgandya etc. were

selected.

b) Patients with BMI above 30 were selected

BMI – Advantages

• BMI provides a more accurate measure of total body fat and practical indicator of

a severity of obesity

• BMI provides an acceptable approximation of assessment of total body fat for the

majority of patients

• BMI is recommended as a practical approach for the clinical setting.

• Easily calculated directly based on height and weight regardless of gender.

Disadvantages

BMI overestimates body fat in person who are very muscular and can

underestimate body fat in persons who have lost muscle mass. Also overestimates the

diseases like Cushing’s syndrome, ascites etc.

General BMI is used to assess obesity and to determine efficacy of therapy.

The BMI which describes relative weight for height is significantly correlated be

used to assess obesity and to monitor changes in body weight. In addition to these

measurements of body weight alone can be used to determine efficacy of weight loss

therapy.

BMI is calculated as = Weight in Kg Ht in mt2

Normal range is 18.5 -24.9 and if it exceeds form 25 to 29.9 then the person is

said to be overweight. If the BMI is 30 and above, then that condition is said to be obesity

and if it is above or equal to 40, then those are included under extremely obese.

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Vaksha, Udara and Sphik Measurement:-

In addition to these above parameters measurements of vaksha, udara and sphik has been

taken for study.

Adhika kshutha,adhika trushna,kshudra shwas,swedadhikata :-

Signs and symptoms give an idea about the severity of disease.Grading are done

as,Grade 1,Grade 2,Grade3 and Grade4.Gradings for all the variables and mode of

grading are presented along with clinical proforma especially formatted for the present

study.

Data Collection:-

Data from 30 patients was collected as before treatment,after treatment and post

treatment follow up to analyse the effect of chanak pisthi udvartan in sthoulya.

Statistical analysis:-

The data collected were statistically analysed under the guidance of

statistician.The data was computed for mean,standard deviation,t values and p values.P

value was obtained using students t test.Significance of the results was based on the p

value.The results are obtained as significance of the treatment by using p values.

Interventions:-

• Sample size ; 30 pts

• Sample type ; sthoulya

• Procedure ; udvrtana with chanak pisthi for 30mins

• Duration ; 30 days

• Follow up ; 30th day

• Post treatment follow up ; after 15th day

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Discussion ===============================================================

DISCUSSION ON OBSERVATIONS:-

Following observations were made before clinical study

AGE ;

In the present study it was observed that 13 patients (43.33%) were of 18-30 yrs,and

17 patients (56.66%) were of 31-40 yrs of age.

So the age group 31-40 yrs contains more patients than the age group 18 -30 yrs of

sthoulya.

SEX ;

In the present study it was observed that 24 patients (80%) were male and 6

patients (20%) were females.

In the present study males are more in numer than females.

RELEGION ;

Majority of patients observed were Hindu 25 patients(83.33%) and Muslim were

5 patients (16.66%).

In the present study because of more population in Hindu community,so Hindu

patients are more.

SOCIO-ECONOMIC STATUS ;

In the present study maximum patients observed were of middle class i.e. 24

patients (80%),were patients observed of upper class is,6 patients (20%).

In the present study the patients observed from middle class are more than upper

class.

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Discussion ===============================================================

MARITAL STATUS ;

Maximum patients observed for the study were married 22 patients (73.33%) and

unmarried are only 8 patients (26.66%).

In the present study married patients are more than unmarried.

HABITAT ;

Majority of patients observed were from urban 26 (86.66%) and 4 patients

(13.33%) belong to rural area.

In the present study majority of patients are from urban area than of rural area.

OCCUPATION ;

The patients from various occupations were observed for the study. Among them

8 patients (26.66%) were students,6 patients (20%)were farmer,9 patients (30%)were

business men,5 patients (16.66%) were house wife and , 2 patients (6.66%) were teacher.

In the present study the more patients are business men than

students,teschers,farmers and housewives.

DIET ;

Among the patients observed for study vegetarians were 6 patients (20%) and

those who took mixed diet were 24 patients (80%).

In the present study majority of patients consumes mixed diet than vegetarians.

PRAKRUTI ;

In the present study it was observed that of kaphavata prakruti there were 8 patients

(26.66%),kapha pitta prakruti11 patients (36.66%), and of pittakapha prakruti 11 patients

(36.66%).

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Discussion ===============================================================

In the present study as per prakruti pareekshan,pitta kapha prakruti patients are more than

kapha vata prakruti.

AGNI ;

In the present study it was observed that most of the patients were having

Teekshnagni i.e. 20 patients (66.66%) and only 10 patients (33.33%) were having

vishamagni

Majority of patients were having teekshnagni than vishamaagni.

KULA VRUTTANT ;

In the present study 8 patients (26.66%) patients had kula vruttanta of sthaulya

and 22 patients (73.33%) had no kula vruttanta of sthaulya.

Vaksha Circumference ;

Vaksha circumference – patients observed for study were assessed grade 1 to

grade 4. Majority of patients were of grade 2 i.e., 18 patients (60%), grade 3 were 10

patients (33.33%) and grade 4 were of 2 patients (6.66%).

Udara Circumference ;

Udara circumference – patients observed for study were assessed grade 1 to grade

4. Majority of patients were of grade 3, 16 patients (53.33%), grade 2 were 5 patients

(16.66%) andgrade 4 were 9 patients (30%).

Sphik Circumference ;

Sphik circumference – Majority of patients were of grade 3 i.e. 17 patients (56.66%),

grade 2 were 6 patients (20%)and grade 4 were 7 patients (23.33%).

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Discussion ===============================================================

Adhika kshudha ;

Majority of patients were of grade 3 ie,18 patients (60%) and of grade 4 were 12

patients (40%).

Adhika trishna ;

Majority of patients were of grade 3 ie,22 patients (73.33%), grade 2 were 2 patients

(6.66%) and grade 4 were 6 patients (20%).

Kshudra shwas ;

In present study it was observed that from grade 1 to grade4,14 patients (46.66%) were of

grade 1,12 patients (40%) were of grade 2,4 patients (13.33%) were of grade 3.

Swedadikhata ;

In present study it was observed that from grade 1 to grade4,2 patients (6.66%) were of

grade 2,14 patients (46.66%) were of grade 3,14 patients (46.66%) were of grade 4.

Laboratory investigations-

As the study was conducted only on the basis of subjective and objective parameters

hence no investigations were carried out.

DISCUSSION ON RESULTS:-

BMI –The BMI of patients was assessed as before treatment,after treatment and post

treatment follow up by comparing the results.

The BMI after treatment shows 96.66% ie,29 patients with clinically stable and only one

patient 3.33% shows CI-1 ie,encouraging.

The t value for BMI after treatment is 1.000 and p value is 0.326.So the results for BMI

after treatment is non-significant.

The BMI after follow up shows 100% ie,total 30 patients with clinically stable.

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Discussion ===============================================================

The t value for BMI after follow up is 0 and p value is 1.000 which is non

significant,so only udvartana procedure with chanak pisthi can not prove beneficial in

case of BMI.

VAKSHA CIRCUMFERANCE ;

The VAKSHA CIRCUMFERANCE of patients was assessed as before treatment,after

treatment and post treatment follow up by comparing the results.

The VAKSHA CIRCUMFERANCE after treatment shows 93.33% ie,28

patients with clinically stable and only two patients ie, 6.66% shows CI-1 ie,encouraging.

The t value for VAKSHA CIRCUMFERANCE I after treatment is 1.439 and p value is

0.161 which is significant.

The VAKSHA CIRCUMFERANCE after follow up shows 100% ie,total 30

patients with clinically stable.

The t value for VAKSHA CIRCUMFERANCE after follow up is 0 and p value

is 1.000 which is non significant,so udvartana with chanak pisthi proves significant after

treatment and proves non-significant after follow up.

UDARA CIRCUMFERANCE ;

The UDARA CIRCUMFERANCE of patients was assessed as before

treatment,after treatment and post treatment follow up by comparing the results.

The UDARA CIRCUMFERANCE after treatment shows 86.66% ie,26 patients

with clinically stable and only 4 patients ie, 13.33% shows CI-1 ie,encouraging.

The t value for UDARA CIRCUMFERANCE after treatment is 2.112 and p value is

0.043 which is significant.

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Discussion ===============================================================

The UDARA CIRCUMFERANCE after follow up shows 96.66% ie,29% with

clinically stable and 3.33% ie one patient in CI-1 ie,encouraging..

The t value for UDARA CIRCUMFERANCE after follow up is 1.000 and p value is

0.326 which is non significant,so udvartana with chanak pisthi proves significant after

treatment and proves non-significant after follow up.

SPHIK CIRCUMFERANCE ;

The SPHIK CIRCUMFERANCE of patients was assessed as before treatment,after

treatment and post treatment follow up by comparing the results.

The SPHIK CIRCUMFERANCE after treatment shows 90% ie,27 patients with

clinically stable and only 3 patients ie, 10% shows CI-1 ie,encouraging.

The t value for SPHIK CIRCUMFERANCE after treatment is 1.795 and p value is 0.083

which is significant.

The SPHIK CIRCUMFERANCE after follow up shows 96.66% ie,29% with clinically

stable and 3.33% ie one patient in CI-1 ie,encouraging..

The t value for SPHIK CIRCUMFERANCE after follow up is 1.439 and p value is 0.161

which is non significant,so udvartana with chanak pisthi proves significant after treatment

and proves non-significant after follow up.

ADHIKA KSHUDHA ;

The symptom ADHIKA KSHUDHA of patients was assessed as before treatment,after

treatment and post treatment follow up by comparing the results.

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The symptom ADHIKA KSHUDHA after treatment shows 96.66% ie,29

patients with clinically stable and only one patient ie, 1.33% shows CI-1 ie,encouraging.

The t value for symptom ADHIKA KSHUDHA after treatment is 1.000 and p

value is 0.0326 which is non significant.

The symptom ADHIKA KSHUDHA after follow up shows 100% ie, total 30

patients with clinically stable.

The t value for symptom ADHIKA KSHUDHA after follow up is 0 and p value

is 1.000 which is non significant,so symptom ADHIKA KSHUDHA shows non

significant results after treatment and after follow up.

ADHIKA TRUSHNA ;

The symptom ADHIKA TRUSHNA of patients was assessed as before

treatment,after treatment and post treatment follow up by comparing the results.

The symptom ADHIKA TRUSHNA after treatment shows 100% ieTOTAL 30

patients with clinically stable.

The t value for symptom ADHIKA TRUSHNA after treatment is 0 and p value

is 1.000 which is non significant.

The symptom ADHIKA TRUSHNA after follow up shows 100% ie, total 30

patients with clinically stable.

The t value for symptom ADHIKA TRUSHNA after follow up is 0 and p value

is 1.000 which is non significant,so symptom ADHIKA TRUSHNA shows non

significant results after treatment and after follow up.

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Discussion ===============================================================

KSHUDRA SHWAS ;

The symptom KSHUDRA SHWAS of patients was assessed as before

treatment,after treatment and post treatment follow up by comparing the results.

The symptom KSHUDRA SHWAS after treatment shows 100% ieTOTAL 30

patients with clinically stable.

The t value for symptom KSHUDRA SHWAS after treatment is 0 and p value

is 1.000 which is non significant.

The symptom KSHUDRA SHWAS after follow up shows 100% ie, total 30

patients with clinically stable.

The t value for symptom KSHUDRA SHWAS after follow up is 0 and p value

is 1.000 which is non significant,so symptom KSHUDRA SHWAS shows non significant

results after treatment and after follow up.

SWEDA ADHIKATA ;

The symptom SWEDA ADHIKATA of patients was assessed as before

treatment,after treatment and post treatment follow up by comparing the results.

The symptom SWEDA ADHIKATA after treatment shows 36.66% ie,11

patients with clinically stable and 63.33% ie,19 patients with CI-1 ie,encouraging.

The t value for symptom SWEDA ADHIKATA after treatment is 7.077 and p

value is 0.000 which is highly significant.

The symptom SWEDA ADHIKATA after follow up shows 100% ie, total 30 patients

with clinically stable.

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Discussion ===============================================================

The t value for symptom SWEDA ADHIKATA after follow up is 0 and p value

is 1.000 which is non significant, so symptom SWEDA ADHIKATA shows highly

significant results after treatment and non-significant results after follow up.

So from above discussion of observations it is clear that,

1. In case of BMI udvartana with chanak pisthi can not prove beneficial

2. In case of vaksha circumference udvartana with chanaka pisthi proves significant

after treatment and proves non-significant after follow up.

3. In case of udara circumference udvartana with chanaka pisthi proves significant after

treatment and proves non-significant after follow up.

4. In case of sphik circumference udvartana with chanaka pisthi proves significant after

treatment and proves non-significant after follow up.

5. In case of symptom adhika kshutha udvartana with chanaka pisthi proves non-

significant for both after treatment and after follow up.

6. In case of symptom adhika trushna udvartana with chanaka pisthi proves non-

significant for both after treatment and after follow up.

7. In case of symptom kshudra shwas udvartana with chanaka pisthi proves non-

significant for both after treatment and after follow up.

8. In case of sweda adhikata udvartana with chanaka pisthi proves highly

significantafter treatment and proves non-significant after follow up.

From above results it is clear that in the treatment of sthoulya it is necessary to

give abhyanntara shamana aoushadhi,teekshana basti along with diet and exercise.As

sthoulya itself is kasta sadhya vyadhi so only udvartana with chanak pisthi can not

prove beneficial.

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Discussion ===============================================================

PROBABLE MODE OF ACTION ;

Chanaka pisti have been preffered for udvartana as it is laghu and ruksha in

gunas.The rasa properties of chanak is kashaya rasayukta which is antagonistic to the

properties of kapha.The physical qualities of chanak,laghu and ruksha are contrary to

meda dhathu.In charaka samhita chanak is mentioned as

laghu,sheeta,madhura,kashaya and does the rukshan by its prabhava.The properties of

chanak is mentioned as vatakarak,pitta and kapha nasaka,kapha pitta nashaka which

is quiet conflicting to that of sthoulya.

Due to ruksha and ushna guna it pacifies and meda shoshan.Especially the meda

dhathu with prithvi and jala mahabhuta pradhan which bears snigdha,sheeta and guru

gunas get pacified with opposite quality of the drug.

The sukshma chanaka pisthi has increased the fortified effect and achieved

laghuta contrary to guruta property oy sthoulya.

Udvartana is having the gunas of Kapha – Meda vilayana property. Due to

ushna and laghu ruksha guna of dravya and forceful massage effect on romakupa, the

Veerya of drug enters into body through, there after it opens the mukha of siras, there

by making paka of Kapha and Medas. Due to this, there will be dravatha Vrudhi of

Kapha and Medas. Swedana, which is given after Udvarthana will further makes paka

of the same. It also makes sweda pravarthana and due to Sweda karma, which is

given after Udvarthana, acts as Sthambhana, Gouragna and Sheetagna. When the

Doshas enter koshta, via above methods, they should be flushed out of the body. By

this the evacuation of these vikrutha Dosha and Dushya occur. By all of these

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Discussion ===============================================================

nirharana of Vikruth Kapha, aap dhatu along with Medas will takes place ultimately

resulting in Laghavata of Shareera.

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Conclusion ===============================================================

CONCLUSION

1. Apatarpana itself contributes a major documentation in samhitas and also proves

most important basic principle in Nidan as well as in Chikitsa aspect.

2. As sthoulya itself is a santarpanottha vyadhi and also kastasadhya so Apatarpana

chikitsa is prescribed for sthoulya.

3. As per results of statistical analysis after follow up it proves non significant in all

eight criterias as BMI,VAKSHA,UDARA,SPHIK CIRCUMFERANCE,ADHIK

KSHUTHA,ADHIK TRUSHNA,KSHUDRASWAS and SWEDAADHIKATA.

4. So only Udvartan procedure with Chanak pisthi not proved satisfactorily in

Sthoulya.

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Recommendations for future study ===============================================================

RECOMMENDATIONS FOR FUTURE STUDY:

The following recommendations are made on the basis of observations and

conclusions for the further studies as well as to over come the limitations.

1) Along with ruksha udvartana procedure shamana aoushadhi,teekshana

basti,pathyapathya and exercise are crucial factors in the treatment of sthoulya.

2) A large number of samples are necessary for the study.

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Summary ===============================================================

SUMMARY:-

Present study entitled “A study on Apatarpana with special reference to udvartana

in sthoulya’’comprises of

1) Review of literature

2) Materials and Methods

3) observation and Results

4) Discussion

5) Conclusion and

6) Recommendation for future study.

Review of literature is further divided into 1.Concept of Apatarpana 2. Ayurvedic

review of sthoulya 3. Modern review of sthoulya.4.Drug review.5.Udvartana

1.Concept of Apatarpana : Detailesd concept of Apatarpana along with

langhana,rukshana and swedana were reviewed.

Ayurvedicreview of sthoulya : Sthoulya nirukti, paribhasha, paryaya, nidana,

poorvarupa, rupa upashaya, samprapti, chikitsa, pathya, apathya were reviewed.

Modern review of sthoulya : In modern review obesity derivation, definition, types,

clinical features, classification diagnosis, treatment, surgical procedures, prevention, of

obesity were reviewed.

Drug review:-Synonemes properties, chem.composition etc have reviewed.

Udvartana review:-Nirukti, paribhasha, classification, benefits, mode of action,

physiological effects were reviewed.

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Summary ===============================================================

Observation and results: Here details of selection of patients along with methods are

described. There after various observation and results obtained and with statistical

analysis are reviewed in detail.

Discussion: On concept of Apatarpana, sthoulya, udvartana, materials and

methods,observations and results and discussin were done.

Result: The result of clinical study showed Udvartana with chanaka pishthi is non

significant in the treatment of sthoulya.

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Bibiliography

===============================================================

BIBILIOGRAPHY

1. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas

academy ; 1996 : 191

2. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas

academy ; 1996 : 191

3. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas

academy ; 1996 : 192

4. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas

academy ; 1996 : 192

5. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas

academy ; 1996 : 192

6. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas

academy ; 1996 : 192-193

7. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha

orientalia ;1996 : 150

8. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha

orientalia ;1996 : 151

9. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha

orientalia ;1996 : 151

10. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha

orientalia ;1996 : 323

11. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha

orientalia ;1996 : 323

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Bibiliography

===============================================================

12. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha

orientalia ;1996 : 323-324

13. Prof.K.R.Srikantha Murthy,Astanga samgraha (I),9th ed,varanasi,

Choukhambha orientalia ;2005 :421

14. Prof.K.R.Srikantha Murthy,Astanga samgraha (I),9th ed,varanasi,

Choukhambha orientalia ;2005 :421

15. Prof.K.R.Srikantha Murthy,Astanga samgraha (I),9th ed,varanasi,

Choukhambha orientalia ;2005 :421

16. Prof.K.R.Srikantha Murthy,Astanga samgraha (I),9th ed,varanasi,

Choukhambha orientalia ;2005 :421-422

17. Prof.K.R.Srikantha Murthy,Sushruta samhita(3rd),1st ed,varanasi,

Choukhambha orientalia ;2002 :6-7

18. Prof.K.R.Srikantha Murthy,Astanga samgraha (I),9th ed,varanasi,

Choukhambha orientalia ;2005 :422

19. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas

academy ; 1996 : 193-194

20. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha

orientalia ;1996 : 151

21. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha

orientalia ;1996 : 150

22. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas

academy ; 1996 : 194

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23. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas

academy ; 1996 : 194

24. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas

academy ; 1996 : 195

25. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas

academy ; 1996 : 197

26. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha

orientalia ;1996 : 150-152

27. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha

orientalia ;1996 : 152

28. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha

orientalia ;1996 : 152

29. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha

orientalia ;1996 : 90

30. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha

orientalia ;1996 : 150

31. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha

orientalia ;1996 : 96

32. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha

orientalia ;1996 : 96

33. Shastri K., Chaturvedi G., Charaka Samhita (1) 21st ed., Varanasi:

Chaukhambha Bharati academy, 1995 (1): 409

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34. Shastri A.D., Sushruta Samhita (1) 14th ed., Varanasi: Chaukhamba Sanskrit

Sansthan, 2003 : 62

35. Shastri L.C., Asthanga Samgraha (1) 3rd ed., Nagpur Baidyanath Ayurveda

Bhavan Pvt. Ltd. 1986 : 694

36. Upadhyaya Y. Madhavanidanam (II) 27th Varanasi; Chaukhambha Sanskrit

Sansthan, 1997 : 28

37. Shastri B. S. Yogaratnakara (II) Uttarardha 5th ed., Varanasi; Chaukhamba

Sanskrit Sansthan, 1993:97

38. Misra B.S. Bhavaprakasa (II) 7th ed., Varanasi; Chaukhamba Sanskrit

Sansthan 2000: 405

39. Shabda kalpadruma, Shabdakosha, Bahadhur R., 5th part Reprint, Delhi, Naga

Publishers 2002 :452

40. Shastri K., Chaturvedi G. Charaka Samhita (1) 21st ed., Varanasi;

Chaukhamba Bharati Academy, 1995: 411

41. Shastri K., Chaturvedi G. Charaka Samhita (1) 21st ed., Varanasi;

Chaukhamba Bharati Academy, 1995: 409

42. Shastri A.D., Sushruta Samhita (1) 14th ed., Varanasi, Chaukhamba Sanskrit

Sansthan 2003: 62

43. Shastri L.C. Asthanga Sangraha (1) 3rd ed., Nagpur Baidyanath Ayurveda

Bhavan Pvt. Ltd. 1986: 694, 695

44. Shastri K. Chaturvedi G., Charaka Samhita (1) 21st ed., Varanasi;

Chaukhamba Bharati academy 1995: 409, 411

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45. Shastri A.D., Sushruta Samhita (1) 14th ed., Varanasi Chaukhamba Sanskrit

Sansthan 2003: 62

46. Shastri L.C. Asthanga Samgraha (1) 3rd ed., Nagpur. Baidyanath Ayurveda

Bhavan Pvt. Ltd. 1986: 694

47. Upadhyaya Y. Madhavanidanam (II) Uttararda 5th ed., Varanasi; Chaukhamba

Sanskrit Sansthan

48. Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba

Sanskrit Sansthan 1993: 97

49. Mishra B.S. Bhavaprakasa (II) 7th ed., Varanasi Chaukhamba Sanskrit

Sansthan 2000: 405

50. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba

Bharati Academy 1995: 409, 411

51. Shastri A.D., Sushruta Samhita (I) 14th ed., Varanasi Chaukhamba Sanskrit

Samsthana 2003: 62

52. Shastri L.C. Asthanga Samgraha (1) 3rd ed., Nagpur. Baidyanath Ayurveda

Bhavan Pvt. Ltd. 1986: 694

53. Upadhyaya Y. Madhavanidanam (II) Uttararda 27th ed., Varanasi;

Chaukhamba Sanskrit Sansthan 1997: 28

54. Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba

Sanskrit Sansthan 1993: 97

55. Mishra B.S. Bhavaprakasa (II) 7th ed., Varanasi Chaukhamba Sanskrit

Sansthan 2000: 405

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56. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba

Bharati Academy 1995: , 411

57. Shrikantamurty K.R., Astanga Sangraha (1) 5th ed., Varanasi, Chaukhamba

Orientalia 2002 : 424- 426

58. Shastri A.D., Sushruta Samhita (I) 14th ed., Varanasi Chaukhamba Sanskrit

Samsthana 2003: 62

59. Shrikantamurty K.R., Astanga Sangraha (1) 5th ed., Varanasi, Chaukhamba

Orientalia 2002 : 424- 426

60. Upadhyaya Y. Madhavanidanam (II) Uttararda 27th ed., Varanasi;

Chaukhamba Sanskrit Sansthan 1997: 29

61. Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba

Sanskrit Sansthan 1993: 98

62. Mishra B.S. Bhavaprakasa (II) 7th ed., Varanasi Chaukhamba Sanskrit

Sansthan 2000: 405

63. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba

Bharati Academy 1995: , 412

64. Shastri A., Sushruta Samhita (II) Reprint ed., Varanasi, Chaukhamba Sanskrit

Sansthan 2004: 63

65. Upadhyaya Y. Asthanga hridaya 4th ed., Varanasi; Chaukhamba Sanskrit

Sansthan 2003: 103

66. Shastri A., Sushruta Samhita (II) Reprint ed., Varanasi, Chaukhamba Sanskrit

Sansthan 2004: 11

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67. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba

Bharati Academy 1995: , 415

68. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba

Bharati Academy 1995: , 414

69. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba

Bharati Academy 1995: , 414

70. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba

Bharati Academy 1995: , 414

71. Shastri L.C. Astanga Sangraha (1) 3rd ed. Nagpur Baidyanath Ayurveda

Bhavan Pvt. Ltd. 1986: 694

72. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba

Bharati Academy 1995: , 414

73. Shastri A.D., Sushruta Samhita (I) 14th ed., Varanasi Chaukhamba Sanskrit

Samsthana 2003: 62

74. Upadhyaya Y. Asthanga hridaya 4th ed., Varanasi; Chaukhamba Sanskrit

Sansthan 2003: 103

75. Shrikantamurty K.R., Astanga Sangraha (1) 5th ed., Varanasi, Chaukhamba

Orientalia 2002 : 695, 696

76. Dwivedi R. Chakradatta 4th ed. Varanasi Chaukhamba Sanskrit Sansthan,

2002: 221

77. Mishra B.S. Bhavaprakasa (II) 7th ed., Varanasi Chaukhamba Sanskrit

Sansthan 2000: 405

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78. Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba

Sanskrit Sansthan 1993: 98

79. Shastri R.D. Bhaishajja Ratnavali 11th ed. Varanasi Chaukhamba Sanskrit

Sansthan 1993: 525, 529.

80. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba

Bharati Academy 1995: 415

81. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba

Bharati Academy 1995: 415

82. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba

Bharati Academy 1995: 63

83. Shrikantamurty K.R., Astanga Sangraha (1) 5th ed., Varanasi, Chaukhamba

Orientalia 2002 : 502

84. Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba

Sanskrit Sansthan 1993: 98

85. Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba

Sanskrit Sansthan 1993: 98

86. Shastri R.D. Bhaishajja Ratnavali 11th ed. Varanasi Chaukhamba Sanskrit

Sansthan 1993: 529.

87. Dwivedi R. Chakradatta 4th ed. Varanasi Chaukhamba Sanskrit Sansthan,

2002: 221

88. Golwalla. Medicine for students, 12th ed. Mumbai: Dr. A.F.Golwall:

Churchgate: 2003: 397

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89. K. Park., Text book of preventive and social medicine, 17th ed. Jabalpur,

Banarsidar Bhanot: 2000: 298

90. http://WIN-publication-understandingAdultobesity.htm

91. C.R.W. Edwards, I.A.D. Boucher et. al., Davidson’s principles and practices

of medicine: Churchill living stone, Edinburg London, New York,

Philadelphia St. Louis Sydney, Toronto, 17th ed. 1995: 578, 579.

92. http://www.nhlbi.gov/guidelines/obesitytxtbk/4.11htm.

93. http://WIN-publication-understandingAdultobesity.htm

94. C.R.W. Edwards, I.A.D. Boucher et. al., Davidson’s principles and practices

of medicine: Churchill living stone, Edinburg London, New York,

Philadelphia St. Louis Sydney, Toronto, 17th ed. 1995: 582.

95. C.R.W. Edwards, I.A.D. Boucher et. al., Davidson’s principles and practices

of medicine: Churchill living stone, Edinburg London, New York,

Philadelphia St. Louis Sydney, Toronto, 17th ed. 1995: 583.

96. C.R.W. Edwards, I.A.D. Boucher et. al., Davidson’s principles and practices

of medicine: Churchill living stone, Edinburg London, New York,

Philadelphia St. Louis Sydney, Toronto, 17th ed. 1995: 583.

97. Pandey G.S., Bhavaprakasa Nighantu Reprint ed., Varanasi : Chaukhamba

Bharati Academy 1999 : 648

98. Pandey G.S., Bhavaprakasa Nighantu Reprint ed., Varanasi : Chaukhamba

Bharati Academy 1999 : 649

99. Shastri L.C., Asthanga Samgraha (1) 3rd ed., Nagpur Baidyanath Ayurveda

Bhavan Pvt. Ltd. 1986 : (As sa su 24/4 P434)

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100. 1)Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba

Sanskrit Sansthan 1993: (Y R Rutu charya adhyaya P 69.) 2) Upadhyaya Y.

Asthanga hridaya 4th ed., Varanasi; Chaukhamba Sanskrit Sansthan 2003: (A

hr su 3/19 P37)

101. 1) Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi

Chaukhamba Bharati Academy 1995: (Cha sa su22/34-35P P432). 2) Shastri

A.D., Sushruta Samhita (I) 14th ed.,Varanasi chaukamba Sanskrit

sansthan.2003(su ut39/104 p489) 3) Shastri L.C., Asthanga Samgraha (1) 3rd

ed., Nagpur Baidyanath Ayurveda Bhavan Pvt. Ltd. 1986 : (As sa su24/12

P136) 4) Upadhyaya Y. Asthanga hridaya 4th ed., Varanasi; Chaukhamba

Sanskrit Sansthan 2003: (A hr su 14/17 P 105)

102. 1) Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi

Chaukhamba Bharati Academy 1995: (Cha sa su 22/37 P436) 2) Shastri K.,

Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba Bharati

Academy 1995: (Cha sa su 21/13-14) 3) Shastri A.D., Sushruta Samhita (I)

14th ed., Varanasi Chaukhamba Sanskrit Samsthana 2003 (Su sa ut 39/ 105)

4) Upadhyaya Y. Asthanga hridaya 4th ed., Varanasi; Chaukhamba Sanskrit

Sansthan 2003 (As hr su 14/18) 5) Shastri L.C., Asthanga Samgraha (1) 3rd

ed., Nagpur Baidyanath Ayurveda Bhavan Pvt. Ltd. 1986 : (As sa su21/16).

103. 1) Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi

Chaukhamba Bharati Academy 1995: (Cha sa su 22/41 P153) 2) ) Shastri

K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba

Bharati Academy 1995: (Cha sa su 16/7-8 P111).

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104. 1) Shastri A.D., Sushruta Samhita (I) 14th ed., Varanasi Chaukhamba Sanskrit

Samsthana 2003 (Su chi24/54-56 P 489 Dalhana tika)

105. Shastri A.D., Sushruta Samhita (I) 14th ed., Varanasi Chaukhamba Sanskrit

Samsthana 2003 (Su chi24/54-56 P 489 Dalhana tika)

106. Shastri A.D., Sushruta Samhita (I) 14th ed., Varanasi Chaukhamba Sanskrit

Samsthana 2003 (Su chi24/54-56 P 489 Dalhana tika)

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Classical References

CLASSICAL REFERANCES

“उपबमःय ह वा धैवोपबमो मतः

एकः स तपणःतऽ तीय ापतपणः

बृंहणो ल घ ेित त पयावुदा तौ

बृंहणं य बहृ वाय ल घनं लाघवाय यत ्

देहःय भवतः ूायो भौमापिमतर च ते

ःनेहनं णं कम ःवेदनं ःत भमनं च यत ्

भूतानां तद प ै या तयं नाितवतते

शोधनं शमनं चेित धा तऽा प ल घनम”्

चतुंूकारा संशु ः पपासा मा तातपौ

पाचना युपवास यायाम ेित ल घनम ्

ूभूत ेंम प ाॐमंलाःसंसृ मा ताः

बहृ छर रा बिलने ल घनीया वशु िभः

(च.सू.२२/१८-१९)

A Study on Apatarpan with Special Reference to Udvartan in Sthoulya 146

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Classical References

एविमतरेषाम प याधीनां िनदान वपर तं भेषज ंबवित;

यथा- अपतपणिनिम ानां याधीनां ना तरेण पूरणम ःत शा तः,

तथापूरणिनिम ानां याधीनां ना तरेणापतपणम ्

अपतपणम प च ऽ वधं- ल घनं,ल घनपाचनं,दोषावसेचनं चेित

(च. व.३/४२-४३)

मेहामदोषाित ःन ध- वरो ःत भकु नः

वसप वििध लीहिशरःक ठा रोिगणः

ःथूलां ल घये न य ंिशिशरे वपरान प

(अ. .सू.१४/११)

यत ् क च लाघवकरं देहे त ल घनं ःमतृम ्

रौआयं खर वं वैश ं यत ्कुया णम ्

लघूंणतीआण वशदं ंसूआमं खरं सरं

क ठनं चैव य ि यं ूायःत ल घनं ःमतृम ्

(च.्सू.२२/९,१२)

न बहृये ल नीयान ्बृं ाःतु मदृ ुल घयेत ्

यु या वा देशकाला दबलतःतानुपाचरेत ्

(अ. .सू.१४/१५)

A Study on Apatarpan with Special Reference to Udvartan in Sthoulya 147

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Classical References

वमले ियतया सग मलानां लाघवं िचः

तुृ सहोदयः शु दयो ारक ठता

यािधमादवमु साहःत िानाश ल घते

(अ. .सू.१४/१७)

गु चातपणं चे ंःथूलानां कशनं ूित

कृशानां बॄहंणाथ च लघु संतपणं च यत ्

(च.सू.२१/२०)

अितकाँय ॅमःकास-ःतृं णािध यमरोचकः

ःनेहा निनिा क् ौोऽशुबौजः ु ःवर यः

ब ःत मूधज घो ऽकपा जा वरः

ूलापो वािनल लािनछ दपवा ःथभेदनम ्

वच मूऽमहा ा जाय तेित वल घनात ्

(अ. .सू.१४/२९-३०)

तऽाितःथूलकृशयोभूय एवापरे िन दत वशेषा भव त

अितःथूलःय तावदायुषॊ ॑ासो जवोपरोधःकृल यवायतां

दौब यं दौग यं ःवेदाबाधः दुितमाऽं पपासाितयोग ेित

भव ो दोषाः

A Study on Apatarpan with Special Reference to Udvartan in Sthoulya 148

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तदितःथौ यमितसंपूरणा मधुरशीत ःन धोपयोगाद यायामाद यवाया वाःवु

ना

हषिन य वादिच तना जीवःवभावा चोपजायते

तःय ितमाऽमेद ःवनो मेद एवोपचीयते न तथेतरे धातवः,

तःमादायुषो ॑ासः;शैिथ यात ्सौकुमाया वा चु मेदसो जवोपरोधः,

शुबाबह वा मेदसावतृमाग वा चु कृ ल यवायता,दौब यमसम वा ातूनां,

दौग यं मेदोदोषा मेदसः ःवभावात ्ःवेदन वा च,मेदसः

ेंमससंगा ं द वा -

बह वा वा यायामासह वा चु ु ःवेदाबाधः,तीआणा न वात ्

ूभूतको वायु वा च दुितमाऽं पपासाितयोग ेित

(च.्सू.२१/४)

मेदसावतृमाग वा ायुःको े वशेषतः

चरन ्संधु य य नमाहारं शोषय य प

तःमात ्स ्शीयं जरय याहारं चाितका ित

वकारां ा ौतेु घोरान ्कां काल यितबमात ्

एवादपिवकरौु वशेषद नमा तौ

एतौ ह दहतःःथूलं वनदावो वनं यथा

मेदःयतीव संवृ े सहसैवािनलादयः

A Study on Apatarpan with Special Reference to Udvartan in Sthoulya 149

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Classical References

वकारान दा णा कृ वा नाशय याशु जी वतम ्

मेदोमांसाितवृ वा चल ःफगदुरःतनः

अयथोपचयो साहो नरोितःथूल उ यते

इित मेद ःवनो दोषा हेतवो पमेव च िन द ं

(च.्सू.२१/५-९)

वात ना नपानािन ेंममेदोहरा ण च

ोंण बःतयःतीआण ा यु तनािन च

गडुचीभिमुःतानांु ूयोग ैफलःतथा

तबा र ूयोग ूयोगो मा क च

वडङग ंनागरं ारः काललोहरजो मधु

यवामलकचूण च ूयोगः ौे उ यते

ब वा दप चमूलःय ूयोगः ौिसंयुतः

िशलाजतुूयोग सा नम थरसः परः

(च.सू.२१/२१-१४)

उ तनं वातहरं कफमेदोअिनलापहम ्

ःथर करणमङगानां व ूसादकरं परम ्

(सु.िच.२४/५१)

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उ तनं कफहरं मेदसः ू वलायनम ्

ःथर करणम गानां व ूसादकरं परम ्

(अ.॑ु.सू.२/१५)

चणका मसुरा ख डकाः सहरेणवः

लघवःशीतमधुराः स कषाया व णाः

प ेंमणीशःय ते सुपेंवालेपनेषु च

तेषां मसुरःसंमाह कलायो वातलःपरम ्

(च.सू.२७/२८-२९)

चणको ह रम थः ःया सकल ूय इ य प

चणकः शीतलो ः प र कफापहः

लखःु कषायो व भी वातलो वरनाशनः

(भा.५३)

“ितय गाःसंूवआयािम कम चासां यथायथं

ितयगाणां तु चतसणृां धमनीनामेकैका शतधाः

सहॐधा चो रो रं वभ य ते,ताः वस येयाः,

तािभ रदं शर रं गवा तं वब माततं च,

तासां मुखािन रोमकूपूितब ािन,यैःःवेदमिभवह त

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Classical References

रसं चािभतपय य तब ह ,तैरेव चा य गप रषेकावगाह

आलेपनवीया य तःशर रमिभूितप ते विच वप वािन,

तैरेव च ःपश सुखमसुखं वा गृ ते,ताः वेता तॐो धम यः

सवा गगताः स वभागा या याताः”

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Case proforma

CASE PROFORMA

DEPARTMENT OF SIDDHANTA

Dr. B.N.M.E.Trust’s Shri Mallikarjuna Swamiji

Post Graduate and Research Centre, Bijapur.

Title: A STUDY ON APATARPANA W.S.R TO UDVARTANA IN STHOULYA

GUIDE - DR. M B. KARAMBELKAR. HOD - DR. HUDDAR. J C. D.S.A.C.A.V.P.Ph.D M.D. (Ayu) .

P.G.Scholar- Dr. AMIT A. MASULE

SR..No - Date - Name - OPD No - Age/ Sex - Caste - Marital Status- Occupation - Address - Socio-economical Status - Date of commencement of treatment - Date of completion of treatment -

LETTER OF CONSENT

I, ___________________________________, exercising my free power to choice, hereby Give my consent to be included as a subject in the clinical trial titled “A STUDY ON APATARPANA W.S.R TO UDVARTANA IN STHOULYA.” I have been informed in my vernacular language to my satisfaction by the attending investigator, the purpose of the clinical trial and the nature of medical intervention and follow-up, including the laboratory investigation to monitor me. I am agreeable to the data collected on me to be used by the investigators of the trial for scientific purposes. I am also aware of my right to opt myself out of the clinical trial without having to give reasons for doing so. Signature of the Patient Date:- Place:- Signature of the Witness Signature of the Investigator

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Case proforma

1) PRADHANA VEDANA:

2) ANUBANDHI VEDANA:

3) ADYATANA VYADHI VRITTANTA:

4) POORVA VYADHI VRITTANTA:

5) KULA VRITTANTA :

6) VAIYAKTIKA VRITTANTA : a) Ahara : b) Vihara : c) Nidra:

d) Vyasana: e) Raja pravritti:-

7) ASTHA STHANA PAREEKSHA :

1) Nadi - 5) Shabda - 2) Mala - 6) Sparsha - 3) Mutra - 7) Druk - 4) Jihwa - 8) Akruti -

8) DASHAVIDHA ATURABALA PAREEKSHA :

1) Prakrutitaha : 2) Vikrititaha : 3) Sarataha : Pravara / Madhyama / Avara 4) Samhanana : Pravara / Madhyama / Avara 5) Pramantaha : Pravara / Madhyama / Avara 6) Satmytaha : Pravara / Madhyama / Avara 7) Satwataha : Pravara / Madhyama / Avara 8) Ahar shaktitaha : Pravara / Madhyama / Avara 9) Vyayama shaktitaha : Pravara / Madhyama / Avara

10) Vayataha : Baala /Yuva / Vruddha

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Case proforma

9) PHYSICAL EXAMINATION:

A) GENERAL EXAMINATION: 1. Height - …….. 2. Weight - ……. kg 3. Pulse - ……. / min 4. Temperature - …… 5. Blood pressure - ………. mm of Hg 6. Respiratory rate - ……. /min B) SYSTEMIC EXAMINATION: 1. Cardio-Vascular System - 2. Respiratory System - 3. Locomotors System - 4. GIT System - C) SROTASA EXAMINATION:

10) AGNI PAREEKSHA : Manda / Teekshna / Vishama / Sama

11) KOSHTA PAREEKSHA : Mrudu / Madhyama / Krura

12) NIDAN PANCHAKA :

1) Hetu -

2) Purva rupa -

3) Rupa -

4) Upashaya -

Anupashaya -

5) Samprapti -

Samprapti Ghatakas:-

1) Dosha - 5) Rogamarga - 2) Dooshya - 6) Adhisthan - 3) Srotas - 7) Vyakta sthana - 4) Sroto Dusti prakara - 8) Vyadhi Avastha -

13) VYADHI VINISHCHAYA :

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Case proforma

14) CHIKITSA :

Kriya nama :- Udvartana procedure

Kala/Avadhi : - 30 min. for 30 days

1) Poorva karma:- Annapachana laxanas are observed 2) Pradhana karma:- Udhvartana with chanak pishthi for 30min. 3) Pashchata karma:- Parisheka with sukhoshna jala and snana 15) Pathya:- Apathya:- 16) SUBJECTIVE ASSESMENT:-

LAXANAS Before treatment(1st day)

After treatment (30th day)

Post treatment follow up (45th day)

Kshudrashwasa

Atikshudha

Atitrushna

Swedadhikya

Gradings:

Grade 1- Absent Grade 2- Mild Grade 3- Moderate

Grade 4- Severe A) ASSESSMENT OF MEDOPLEPA ON VAKSHA, UDAR AND SPHIK. 1) Vaksha circumference –

Grade 1- non obese(less than 80 cm) Grade 2- mild (81-90 cm) Grade 3- moderate (91-100 cm) Grade 4- severe (101-110cm)

2) Udara circumference – Grade 1- non obese(less than 80 cm)

Grade 2- mild (81-90 cm)

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Case proforma

Grade 3- moderate (91-100 cm) Grade 4- severe (101-110cm)

3) Sphik circumference –

Grade 1- non obese(less than 90 cm) Grade 2- mild (91-100 cm) Grade 3- moderate (101-110 cm)

Grade 4- severe (111-120cm)

Circumference Before treatment (1st day)

After treatment (30th day)

Post treatment follow up (45th day)

Vaksha Udar Sphik B) ASSESSMENT OF WEIGHT- Weight- kg Variable Before treatment (1st

day) After treatment (30th day)

Post treatment follow up (45th day)

Weight

C) ASSESSMENT OF BMI- BMI = weight (kg)/ height2 (m) BMI (body mass index)-

Grade 1- non obese (below 30) Grade 2- mild (30-31.5) Grade 3- moderate (31.6-33) Grade 4- severe (33.1-34.5)

Variable Before treatment (1st day)

After treatment (30th day)

Post treatment follow up (45th day)

BMI

Adverse effects (if any)-

Signature of Scholar Signature of HOD

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