Santarpaniya Adhyaya: Difference between revisions

{{#seo:

|title=Santarpaniya Adhyaya

|type=article

}}

<big>'''Sutra Sthana Chapter 23. Over-nutrition, under-nutrition and its disorders '''</big>

{{Infobox

|data5 = [[Nidana Sthana]], [[Vimana Sthana]],  [[Sharira Sthana]],  [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

|label6 = Translator and commentator

|label7 = Reviewer  

|data7  = Byadgi P.S.

|label8 = Editors

|label9 = Year of publication  

|data9 =  2020

|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s01.025 10.47468/CSNE.2020.e01.s01.025]

}}

<big>'''Abstract'''</big>

'''Keywords''': ''santarpana'' (over-nutrition), ''apatarpana'' (under-nutrition), management of over-nutrition induced disorders, nutrition deficiency disorders.

Bedrest studies, though not sufficiently researched in humans, indicate that there is an increased sedentary behavior associated with a range of deleterious metabolic effects <ref> Kalupahana NS, Claycombe KJ, Newman SJ, Stewart T, Siriwardhana N, Mathhan N, Lichtenstein AH, Moustaid-Moussa N: Eicosapentaenoic acid prevents and reverses insulin resistance in high-fat diet-induced obese mice via modulation of adipose tissue inflammation.J Nutr 2010, 140:1915-1922 </ref>.   

'''''Pramehapidaka''''': This can be compared with diabetic carbuncle which is a complication of uncontrolled diabetes mellitus. It is localized infective gangrene of the skin and subcutaneous tissues caused by infection. The predisposing factor is diabetes. In diabetic carbuncle, infection is at hair follicle with severe pain and there is involvement of fibrous strand along with sub-cutaneous tissues. A multi-locular lesion is seen which may give rise to ulcerating carbuncle. In this lesion, gangrenous process can occur which may be due to thrombosis of the lesion.

'''''Kotha''''', as explained, is a decay of tissues due to certain conditions. In the context of ''santarpanajanya vyadhi'', decay usually is seen in diabetic patients caused mostly due to microangiopathy. Involvement of the blood vessels by atherosclerosis leading to ischemia is a significant factor in diabetic foot. Lower extremity peripheral vascular disease (PVD) is the most common factor associated with limb ulceration, gangrene, impaired wound healing and ultimately amputation<ref> Gayle R, Benjamin AL, Gary NG. The burden of diabetic foot ulcers. The American Journal of Surgery 1998Aug 24; 176(Suppl 2A):65-105. </ref>. It mainly occurs due to blood flow changes, occlusive changes, micro angiopathy, and hematological changes. There is marked change in the flow of blood in peripheral vessels. The microcirculation is regulated by neural factors, local reflexes and vasoactive mediators. The initial haemodynamic changes will be increased flow and pressure of capillary blood<ref> Tooke JE. Microvascular hemodynamics in diabetes mellitus. Clin Sci 1986; 70:119-125 </ref> . As the disease progresses, autoregulation is lost and haemodynamic stress results. It could also be due to increased calcification of vessels or AV shunting or hyperosmolarity of blood. It is well documented by high ankle brachial ratio and also Doppler studies. Occlusive changes occur in more than 50% of diabetics having the disease for more than 10 – 15 years<ref> Pyorala K, Laasko M, Vusiitupa M. Diabetes and atherosclerosis, An epidemiologic view. Diabet Methob Rev 1987; 3:463-524 </ref>. It mainly affects arteries below profunda femoris and is characterized by multiple segment involvement. The tibial & peroneal arteries between the knee and the ankle are primarily affected. Dorsalis pedis artery and foot vessels are usually spared. Patients with diabetes have diminished ability to establish collateral circulation especially in arteries around knee.  This disease is more prevalent & accelerated with diabetes mellitus.   

'''''Amaja vyadhi''''':  ''Ama'' is referred to an intermediate bio product of cellular metabolism leading to number of metabolic disorders. Generation of ''ama'' is thought to start with maldigestion or indigestion of food substances when taken in excess which begins in the stomach. It is a very important factor playing a pivotal role in the genesis of any disease. It is clearly stated that there is no disorder devoid of ''ama''. So all the anabolic disorders where ''ama'' is considered as cause are supposed to be under the category of ''ama vyadhis''.   

Ultimately, with all these symptoms and conditions, edema over the body develops and along with other complications lands the patient into severe difficulties.  

=== Fasting ===

While treating ''santarpanajanya vyadhis'' like ''sthulata'' (obesity) and ''madhumeha'' (diabetes), consumption of ''dravyas'' that have ''guru'' and ''ruksha'' properties is advised. Along with medicines, the diet must also be ''ruksha''. For skin ailments, applying powders of medicinal plants all over the body which can provide relief from ''kandu'' (itching) and ''kotha'' (pre-gangrenous condition) are advised. So the food must be ''guru'' and ''apatarpaka'', i.e., it should induce catabolic activities. Applying these powders on the lesions may improve blood circulation which may consequently improve the increased hydroxylysine and glucose disaccharide content, decrease in proteoglycan and heparin sulfate and decrease in lysine content towards the lesion. The effects of honey, a food rich in antioxidants, on diseases such as cancer, coronary diseases, inflammatory disorders, and aging, has helped it gain lot of attention among nutritionists<ref> Jaganathan et al. Antiproliferative Effects of Honey and of Its Polyphenols: A Review. 2009 Journal of Biomedicine and Biotechnology. Article ID 830616</ref>.  Properties of honey are ''ruksha, guru,'' and ''kashaya''. Food and medicine having these properties enhance ''akasha'' and ''vayu mahabhuta'' which tends the person towards ''apatarpana''.  

Pericarp of ''haritaki'' showed cardiotonic activities in frog hearts, increasing the force of contraction and cardiac output without altering the heart rate<ref> Reddy VRC, Kumari SVR, Reddy BM, Azeem MA, Prabhkar MC, Rao AVN (1990) Cardionic activity of the fruits of Terminalia chebula. Fitotera- pia 41, 517-52 </ref>. ''Haritaki'' extracts administered before initiating any treatment showed signs of reduced myocardial damage caused by isoproterenol in rats. ''Haritaki'' reduced lipid peroxidation and significantly reduced cholesterolemia, aortic sudanophilia, and cholesterol content of the aorta and liver<ref> The Ayurvedic medicines Haritaki, Amala and Bahira reduce cholesterol-induced atherosclerosis in rabbits. Int J Cardiol. 1988 Nov;21(2):167-75.Thakur CP, Thakur B, Singh S, Sinha PK, Sinha SK.Patna Medical College, India. </ref>.  

    

   

'''''Triphala''''' is one of the oldest used polyherbal preparations. It is comprised of Terminalia chebula, Terminalia bellerica and Emblica officinalis. Some of the positive qualities of ''triphala'' in-vivo and in-vitro are that it is an antioxidant, anti-hypercholesterolemic, anti-diabetic, anti-obesity, and possesses chemo-preventive potential and anti-mutagenic activities, anti-inflammatory, antimicrobial, radioprotective effect, immunomodulatory, improving wound healing, enteroprotective efficacies, anti-gastric ulcers and nitric oxide scavenging properties. This herbal combination can have profound healing benefits in multi-organ systems.  It is rich in Mg, K, Ca, Fe, Se and Zn, which enhance their bioavailability. Low molecular weight tannins, gallic acid and other important phytochemicals are responsible for the above effects <ref> A systematic review of the antioxidant, anti-diabetic, and anti-obesity effects and safety of triphala herbal formulation Kamali Seyed Hamid et al Journal of Medicinal Plants Research Vol. 7(14), pp. 831-844, 10 April, 2013  DOI: 10.5897/JMPR12.352  ISSN 1996-0875 ©2013 Academic Journals  http://www.academicjournals.org/JMPR  </ref>.   

Cyperus rotundus has antioxidant and anti-atherosclerotic effects due to the presence of flavanoids, polyphenols and terpenes which reduce absorption of total cholesterol and triglycerides. Cyperus rotundus, in the form of a fine powder or an aqueous solution, exhibits lipolytic properties and showed mobilization of fats from adipose tissues. Cyperus rotundus is supposed to have activators of beta adreno receptors<ref> Bhambhole V.d.et al Effect of some medicinal plant preparation on adipose tissue metabolism. Ancient Science of life 1998 117-124 </ref>.   

Investigation demonstrate that extracts of C. deodara shows reduction in body weight in treated groups in a dose dependent manner. The major chemical constituents of C. deodara are sterols, poly-phenols, flavanoids such as taxifolin, quercetin and saponins<ref> Agarwal PK, Agarwal SK, Rastogi RP. A new neolignan and other phenolic constituents from Cedrus deodara. Phytochemistry. 1980;19:1260–1.</ref>. It is well established that saponins are useful in treatment of obesity<ref> George Francis, Zohar Kerem, Harinder P.S. Makkar, Becker Klaus. The biological action of saponin in animal systems: A review. Brit J Nutr. 2002;88:587–605. [PubMed] </ref>. Phytosterols have beneficial effects on hyperlipidemia<ref> David JA, Cyril WC. Plant sterols, health claims and strategies to reduce cardiovascular disease risk.J Am Coll Nutr. 1999;18:559–62.  </ref> and poly-phenols and flavanoids have potential antioxidant properties. Therefore, it could be possible that presence of these compounds is responsible for observed glucose and lipid lowering properties.

Above are all the important reasons why ''sattu'' is recommended as one of the important food in ''santarpaniya vyadhi''.

Those individuals who exercise regularly, who do not eat until the previous meals are completely digested, who do not indulge in overeating, who regularly consume barley and wheat in diet get relief from all the diseases due to ''santarpana'' and obesity. This is how all the ''santarpanjanya vyadhis'' are treated with ''apatarpana'' medicines.  

</div>

#Mudigoudar Yoshadha S (2000) : The efficacy of Pippalyadi Guggulu in Medoroga (w.s.r. to its hypolipidaemic effect).

</div>

== References==