Changes

Ashtauninditiya Adhyaya (view source)

Revision as of 12:32, 6 March 2023

494 bytes added , 12:32, 6 March 2023

no edit summary

Line 1: Line 1: +

{{#seo:

|title=Ashtauninditiya Adhyaya

Line 4: Line 5:

|keywords=Atisthaulya, Atikarshya, Morbid obesity, Hereditary and genetic Disorders, Endocrine Disorders, Sleep(Nidra), Insomnia(Anidra), sleep disorders,charak samhita, Ayurveda,Indian system of medicine.

|description=Sutra Sthana Chapter 21. Eight Undesirable Physical Constitutions

−

|image=http://www.carakasamhitaonline.com~~/mediawiki-1.32.1~~/resources/assets/ogimgs.jpg

+

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

|image_alt=carak samhita

|type=article

}}

−

<big>'''Sutra Sthana Chapter 21. Eight Undesirable Physical Constitutions '''</big>

{{Infobox

Line 38: Line 38:

}}

−

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

−

<~~div~~ style="text-align:justify;">This is the first chapter of tetrad on guidelines on management of diseases. After enlisting eight undesirable physical appearances based on the criteria like body height, body mass, complexion and presence of hair. The extreme presence or absence of these parameters leads to undesirable physical appearances. The most commonly observed conditions in the society like morbid obesity and extreme emaciation are described in details with their causative factors, signs and symptoms, and ways of effective management. In etio-pathogenesis of these disorders, sleep is the second most important cause after diet. Therefore a special emphasis is given on the merits of sleep, qualities or characteristics that define a “good sleep” and the demerits of sleep related disorders. </~~div~~>

+

<p style="text-align:justify;">This is the first chapter of tetrad on guidelines on management of diseases. After enlisting eight undesirable physical appearances based on the criteria like body height, body mass, complexion and presence of hair. The extreme presence or absence of these parameters leads to undesirable physical appearances. The most commonly observed conditions in the society like morbid obesity and extreme emaciation are described in details with their causative factors, signs and symptoms, and ways of effective management. In etio-pathogenesis of these disorders, sleep is the second most important cause after diet. Therefore a special emphasis is given on the merits of sleep, qualities or characteristics that define a “good sleep” and the demerits of sleep related disorders. </p>

−

'''Keywords''': ''Atisthaulya, Atikarshya,'' Morbid obesity, Hereditary and genetic Disorders, Endocrine Disorders, Sleep(''Nidra''), Insomnia(''Anidra'')

+

'''Keywords''': ''Atisthaulya, Atikarshya,'' Morbid obesity, Hereditary and genetic Disorders, Endocrine Disorders, Sleep([[Nidra]]), Insomnia(''Anidra'')

Line 49: Line 48:

== Introduction ==

−

Charak has laid down the foundation of genetic/hereditary and endocrinal disorders in relation to four pairs of opposing (and undesirable) physical characteristics- height (too tall, too short), body hair (too hairy, hairless), complexion (too dark, too light), and body mass (too obese, too lean). Among these, [[atisthula]] (morbid obesity) is the most undesirable characteristic because it is associated with several life-threatening complications including diabetes, hypertension, coronary artery diseases, joint disorders, skin disorders, anorectal problems, etc. This chapter focuses on the features of a healthy physical constitution of a person, definitions of sleep, as well as key concepts associated with disease management such as etiopathogenesis, clinical presentation, prognosis, and management of [[atisthula]]. Some key etiological factors of [[atisthula]] include dietary and lifestyle indicators (e.g., sedentary habit and high-calorie diet), and genetic and hereditary factors. This chapter also describes the pathogenesis of [[atisthula]] in detail, involving [[rasa dhatu]] (plasma) and [[meda dhatu]](adipose tissue) as important ''dushyas'' (affected tissues). Modern medicine has acknowledged the role of [[meda dhatu]] (adipose tissue) as a principal ''dushya'', with obesity and dyslipidemia regarded as the main components of the basic matrix of this disease and its related disorders.<ref name=ref1>Pandey A. K and Singh R. H.: “A Study of the Immune status in patients of diabetes mellitus and their Management with certain NaimittikaRasayana drugs”, JRAS. Vol. XXIV. No. 3-4, 2003; 48-61. </ref> <ref name=ref2>Pandey A.K and Singh R.H. (2012): A Clinical Study on Certain Diabetic Complications under the Influence of Naimittika Rasayana Therapy w.s.r. to Nishamalaki and Shilajatu), PhD. Thesis, Department of Kayachikitsa,, IMS, BHU, Varanasi. </ref> <ref name=ref3>Jaspreet Singh & A. K. Pandey: Clinical Evaluation of Pushkaramula (Inula racemosa) Capsule in the patients of Metabolic syndrome”, International Journal of Medicine and Pharmaceutical Sciences (IJMPS), ISSN(P): 2250-0049; ISSN(E): 2321-0095, Vol. 4, Issue 2, Apr 2014, 9-20. </ref> The recent concept of “metabolic syndrome” was already recognized in [[Ayurveda]]. Biomedical science points that overweight individuals experience greatly elevated morbidity and mortality from various ailments including cardiovascular diseases<ref>National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Bethesda, Md: National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases; 1998. </ref> <ref>Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci. 2001;321: 225–236.</ref>

+

Charak has laid down the foundation of genetic/hereditary and endocrinal disorders in relation to four pairs of opposing (and undesirable) physical characteristics- height (too tall, too short), body hair (too hairy, hairless), complexion (too dark, too light), and body mass (too obese, too lean). Among these, [[atisthula]] (morbid obesity) is the most undesirable characteristic because it is associated with several life-threatening complications including diabetes, hypertension, coronary artery diseases, joint disorders, skin disorders, anorectal problems, etc. This chapter focuses on the features of a healthy physical constitution of a person, definitions of sleep, as well as key concepts associated with disease management such as etiopathogenesis, clinical presentation, prognosis, and management of [[atisthula]]. Some key etiological factors of [[atisthula]] include dietary and lifestyle indicators (e.g., sedentary habit and high-calorie diet), and genetic and hereditary factors. This chapter also describes the pathogenesis of [[atisthula]] in detail, involving [[rasa dhatu]] (plasma) and [[meda dhatu]](adipose tissue) as important ''dushyas'' (affected tissues). Modern medicine has acknowledged the role of [[meda dhatu]] (adipose tissue) as a principal ''dushya'', with obesity and dyslipidemia regarded as the main components of the basic matrix of this disease and its related disorders.<ref name=ref1>Pandey A. K and Singh R. H.: “A Study of the Immune status in patients of diabetes mellitus and their Management with certain NaimittikaRasayana drugs”, JRAS. Vol. XXIV. No. 3-4, 2003; 48-61. </ref> <ref name=ref2>Pandey A.K and Singh R.H. (2012): A Clinical Study on Certain Diabetic Complications under the Influence of Naimittika Rasayana Therapy w.s.r. to Nishamalaki and Shilajatu), PhD. Thesis, Department of Kayachikitsa,, IMS, BHU, Varanasi. </ref><ref name=ref3>Jaspreet Singh & A. K. Pandey: Clinical Evaluation of Pushkaramula (Inula racemosa) Capsule in the patients of Metabolic syndrome”, International Journal of Medicine and Pharmaceutical Sciences (IJMPS), ISSN(P): 2250-0049; ISSN(E): 2321-0095, Vol. 4, Issue 2, Apr 2014, 9-20. </ref> The recent concept of “metabolic syndrome” was already recognized in [[Ayurveda]]. Biomedical science points that overweight individuals experience greatly elevated morbidity and mortality from various ailments including cardiovascular diseases.<ref>National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Bethesda, Md: National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases; 1998. </ref> <ref>Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci. 2001;321: 225–236.</ref>

−

Obesity research is focused on preventive measures and management of complications like prediabetes, diabetes, metabolic syndrome, hypertension, stroke, coronary artery disease, congestive heart failure, cardiomyopathy, and arrhythmia/sudden death<ref>Singh Jaspreet & Pandey A.K. (2012): Clinical Evaluation of Pushkarmula churna in the patients of metabolic syndrome w.s.r, to Ojas and Agni MD (Ay) Department of Kayachikitsa, IMS, BHU, Varanasi. </ref>. In the modern world, obesity has emerged as a serious health issue in both developed and developing nations and is recognized as one of the most serious public health problems of the 21st century. In 2008 the WHO estimated that globally, at least 500 million adults (or approximately 1 in 10 adults) are obese, with higher rates among women than men. Obesity is the reason for about 80% of type 2 diabetes, about 70% of cardiovascular diseases, and 42% of breast and colon cancers today. In the past two decades, the number of overweight children and adolescents has doubled<ref>Lau D.C. et al (April 2007). "2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]", CMAJ , 176 (8): S1–13. </ref>. The rate of obesity also increases with age at least up to 50 or 60 years old. Once considered a problem specific to only high-income countries, obesity has acquired pandemic proportions and is affecting people globally<ref>World Health Organization (WHO) (2000). Obesity: Preventing and Managing the Global Epidemic. Report on a WHO Consultation. Geneva. (WHO technical report series 894). </ref> <ref>P.J.English, M.A.Ghatei, I.A.Malik, S. R. Bloom and J. P. H. Wilding ( June-1, 2002): Food fails to suppress ghrelin levels in obese humans, The Journal of Clinical Endocrinology & Metabolism, 87(6):2984–2987. ~~</ref>, <ref>Pandey, A. K. (2015):~~ </ref>

+

Obesity research is focused on preventive measures and management of complications like prediabetes, diabetes, metabolic syndrome, hypertension, stroke, coronary artery disease, congestive heart failure, cardiomyopathy, and arrhythmia/sudden death.<ref>Singh Jaspreet & Pandey A.K. (2012): Clinical Evaluation of Pushkarmula churna in the patients of metabolic syndrome w.s.r, to Ojas and Agni MD (Ay) Department of Kayachikitsa, IMS, BHU, Varanasi. </ref>. In the modern world, obesity has emerged as a serious health issue in both developed and developing nations and is recognized as one of the most serious public health problems of the 21st century. In 2008 the WHO estimated that globally, at least 500 million adults (or approximately 1 in 10 adults) are obese, with higher rates among women than men. Obesity is the reason for about 80% of type 2 diabetes, about 70% of cardiovascular diseases, and 42% of breast and colon cancers today. In the past two decades, the number of overweight children and adolescents has doubled. <ref>Lau D.C. et al (April 2007). "2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]", CMAJ , 176 (8): S1–13. </ref> The rate of obesity also increases with age at least up to 50 or 60 years old. Once considered a problem specific to only high-income countries, obesity has acquired pandemic proportions and is affecting people globally.<ref>World Health Organization (WHO) (2000). Obesity: Preventing and Managing the Global Epidemic. Report on a WHO Consultation. Geneva. (WHO technical report series 894). </ref> <ref>P.J.English, M.A.Ghatei, I.A.Malik, S. R. Bloom and J. P. H. Wilding ( June-1, 2002): Food fails to suppress ghrelin levels in obese humans, The Journal of Clinical Endocrinology & Metabolism, 87(6):2984–2987.</ref>

−

Any course of treatment for obesity suggested by modern medical practitioners primarily includes dietary changes and physical exercise followed by anti-obesity drugs that help reduce appetite or inhibit fat absorption. In severe cases, various invasive and non-invasive surgical procedures could be prescribed - such as partial gastrectomy, gastric bypass, banding, gastric balloons, etc<ref>Puhl R, Brownell KD (December 2001): "Bias, discrimination, and obesity". Obes. Res.9 (12): 788–805. doi:10.1038/oby.2001.108. PMID 11743063. </ref>. However, [[Ayurveda]]’s approach to weight management is very different. Instead, [[Ayurveda]] advocates dietary restrictions according to the ''prakriti'' (~~predisposition or temperament of the patient~~), moderate exercise, practice of ''yogasanas'' and ''pranayama'', besides certain ayurvedic medications and bio-purificatory measures for its management<ref>Pandey A.K. (2013-2014): Conceptual background on obesity (sthaulya/medoroga) & an approach for its management through ayurveda, chapter published in a book ‘Integrative approach to metabolic syndrome’ published by Mahima research foundation and social welfare, Varanasi, UP, India, 2013-2014, p.no.-47-59. </ref>.

+

Any course of treatment for obesity suggested by modern medical practitioners primarily includes dietary changes and physical exercise followed by anti-obesity drugs that help reduce appetite or inhibit fat absorption. In severe cases, various invasive and non-invasive surgical procedures could be prescribed - such as partial gastrectomy, gastric bypass, banding, gastric balloons, etc.<ref>Puhl R, Brownell KD (December 2001): "Bias, discrimination, and obesity". Obes. Res.9 (12): 788–805. doi:10.1038/oby.2001.108. PMID 11743063. </ref> However, [[Ayurveda]]’s approach to weight management is very different. Instead, [[Ayurveda]] advocates dietary restrictions according to the [[prakriti]] (basic constitution), moderate exercise, practice of yoga postures (yogasanas) and breathing exercises( pranayama), besides certain ayurvedic medications and bio-purificatory measures for its management.<ref>Pandey A.K. (2013-2014): Conceptual background on obesity ([[sthaulya]]/[[medoroga]]) & an approach for its management through [[ayurveda]], chapter published in a book ‘Integrative approach to metabolic syndrome’ published by Mahima research foundation and social welfare, Varanasi, UP, India, 2013-2014, p.no.-47-59.</ref>

−

The etiology, pathogenesis, clinical features and consequences of extreme leanness (''atikrisha''), as an outcome of ~~''rasakshaya'' (~~decrease of ''rasa''), ~~''medokshaya'' (decrease of ''fat'')~~ and ~~''mamsakshaya'' (decrease of ''muscles'')~~ have also been described in this chapter. The two basic approaches for management of ''atikrisha'' and [[atisthula]] are augmentation (''brimhana'') and depletion (''karshana'') of body tissues respectively. Various drug and non-drug modalities have been suggested for the replenishment of ~~''dhatus''~~ and their nourishment to attain good health. In this regard, ''Rasayana'' drugs help balance hormones, promote essential nutrition and enhance immunity to [[atisthula]] and ''atikrisha'' respectively. As mentioned earlier, this chapter also emphasizes the role of good ''nidra'' (sleep) in maintaining a healthy life. In fact, as per [[Ayurveda]], after ''ahara'' (diet), ''nidra'' is one of the three sub-pillars of life (''trayopastambha'') and has a significant place in preventive medicine because normal sleep helps prevent diseases and unwholesome sleep may lead to fatal diseases. In [[Ayurveda]], ''nidra'' is considered a ''brimhana'' (nourishing) agent that promotes physical and mental health and enhances immunity. ~~<ref>H~~.~~S.Kushwaha, Charak~~. Sutra Sthana~~, Cha.~~11 ~~Tistraishaniya Adhyaya ver.~~35~~. In: H.S.Kushwaha, Editor. Charak Samhita.1st ed. Varanasi: Chaukhambha Orientalia;2009. </ref>.~~

+

The etiology, pathogenesis, clinical features and consequences of extreme leanness ([[atikrisha]]), as an outcome of decrease of [[rasa dhatu]]), [[meda dhatu]], and [[mamsa dhatu]] have also been described in this chapter. The two basic approaches for management of [[atikrisha]] and [[atisthula]] are augmentation ([[brimhana]]) and depletion ([[karshana]]) of body tissues respectively. Various drug and non-drug modalities have been suggested for the replenishment of [[dhatu]] and their nourishment to attain good health. In this regard, [[Rasayana]] drugs help balance hormones, promote essential nutrition and enhance immunity to [[atisthula]] and [[atikrisha]] respectively. As mentioned earlier, this chapter also emphasizes the role of good [[nidra]] (sleep) in maintaining a healthy life. In fact, as per [[Ayurveda]], after [[ahara]] (diet), [[nidra]] is one of the three sub-pillars of life (''trayopastambha'') and has a significant place in preventive medicine because normal sleep helps prevent diseases and unwholesome sleep may lead to fatal diseases. In [[Ayurveda]], [[nidra]] is considered a [[brimhana]] (nourishing) agent that promotes physical and mental health and enhances immunity. [Cha.Sa.[[Sutra Sthana]]11/35]

</div>

Line 110: Line 109:

−

Amongst these, the too obese and too lean physical appearances are considered the most undesirable ones. The excessively obese have eight inherent defects in them: reduced lifespan, constricted or limited movement (hampered due to loose, tender and heavy fats), reduced sexual activities or impotence (due to small quantity of semen produced and obstruction of the channel of semen by ~~''medas''~~), debility (due to ''dhatu'' imbalance), emit bad smell (due to the inherent nature of fatty tissues as well as excessive sweating), profuse sweating (since ~~''medas''~~ and ''kapha'' are vitiated), and excessive hunger and thirst (due to excessive digestive ''agni'' and ''vayu'' in the body). Excessive obesity is caused due to over-nourishment as a consequence of the intake of heavy, sweet, cold and fatty diet, lack of physical exercise, abstinence from sexual intercourse, sleeping during the day, uninterrupted cheerfulness, lack of mental activities and hereditary/genetic defects. These consequences may lead to an excess of fat (with further accumulation of only fat) and consequent depletion of ~~dhatus~~. [4]

+

Amongst these, the too obese and too lean physical appearances are considered the most undesirable ones. The excessively obese have eight inherent defects in them: reduced lifespan, constricted or limited movement (hampered due to loose, tender and heavy fats), reduced sexual activities or impotence (due to small quantity of semen produced and obstruction of the channel of semen by [[meda dhatu]]), debility (due to [[dhatu]] imbalance), emit bad smell (due to the inherent nature of fatty tissues as well as excessive sweating), profuse sweating (since [[meda dhatu]] and [[kapha]] are vitiated), and excessive hunger and thirst (due to excessive digestive ''agni'' and [[vayu]] in the body). Excessive obesity is caused due to over-nourishment as a consequence of the intake of a heavy, sweet, cold and fatty diet, lack of physical exercise, abstinence from sexual intercourse, sleeping during the day, uninterrupted cheerfulness, lack of mental activities, and hereditary/genetic defects. These consequences may lead to an excess of fat (with further accumulation of only fat) and consequent depletion of [[dhatu]]. [4]

</div>

Line 176: Line 175:

−

Due to the obstruction of body channels by ~~''medas''~~, the movement of ''vata'' is specially confined to ''koshtha'' (abdominal viscera) resulting in the stimulation of digestive power and absorption of food. Hence,the person digests food quickly and becomes a voracious eater. By not following rules of taking meals at specific times during the day, he is afflicted by dreadful diseases. ''Agni'' (''pitta'' component responsible for digestion) and ''vata'' are the two most troublesome factors from the standpoint of obesity. These factors blight an obese person as wildfire destroys a forest. As the body gains excessive fat, vitiated ~~''doshas''~~ suddenly cause severe diseases resulting in rapid deterioration of life. The person is considered too obese when there is an excessive increase in fat and muscle tissue in the regions of buttocks, abdomen, and breasts, which become pendulous and suffer from deficient metabolism and energy. These are the causes, signs, and symptoms of an obese person [5-10]

+

Due to the obstruction of body channels by [[meda dhatu]], the movement of [[vata]] is specially confined to ''koshtha'' (abdominal viscera) resulting in the stimulation of digestive power and absorption of food. Hence,the person digests food quickly and becomes a voracious eater. By not following rules of taking meals at specific times during the day, he is afflicted by dreadful diseases. ''Agni'' ([[pitta]] component responsible for digestion) and [[vata]] are the two most troublesome factors from the standpoint of obesity. These factors blight an obese person as wildfire destroys a forest. As the body gains excessive fat, vitiated [[dosha]] suddenly cause severe diseases resulting in rapid deterioration of life. The person is considered too obese when there is an excessive increase in fat and muscle tissue in the regions of buttocks, abdomen, and breasts, which become pendulous and suffer from deficient metabolism and energy. These are the causes, signs, and symptoms of an obese person [5-10]

</div>

+

==== Features of an excessively lean person ====

Line 384: Line 384:

−

Food and drinks that alleviate vata and reduce ''kapha'' and [[meda dhatu]] (fat), enema with sharp, ununctuous and hot drugs, therapeutic powder massage, use of ''guduchi'' (Tinospora cordifolia Miers), ''musta'' (Cyperus rotundus Linn), ''triphala'' (haritaki-Terminalia chebula Linn, ''bibhitaka''(Terminalia belerica Roxb) and ''amalaka'' (Emblica officinalis Gaertn), ''takrarishta'' (a fermented medicinal preparation of buttermilk) and honey are recommended for the management of obesity. A formulation prepared from ''vidanga'' (Embelia ribes Burm f.), ''nagara'' (Zingiber officinale Rose), ''yavakshara'' (alkali preparation of barley), ash powder of black iron along with honey, powder of ''yava'' (Hordeum vulgarae Linn) and ''amalaka'' (Emblica officinalis Gaertn) is also an excellent weight-loss drug. Similarly, ''Bilvadi panchamula'' (five major roots) mixed with honey and shilajatu along with the juice of ''agnimantha'' (Clerodendrum phlomidis Linn.f.) are also very effective preparations for weight-loss.

+

Food and drinks that alleviate [[vata]] and reduce [[kapha]] and [[meda dhatu]] (fat), enema with sharp, ununctuous and hot drugs, therapeutic powder massage, use of ''guduchi'' (Tinospora cordifolia Miers), ''musta'' (Cyperus rotundus Linn), ''triphala'' (haritaki-Terminalia chebula Linn, ''bibhitaka''(Terminalia belerica Roxb) and ''amalaka'' (Emblica officinalis Gaertn), ''takrarishta'' (a fermented medicinal preparation of buttermilk) and honey are recommended for the management of obesity. A formulation prepared from ''vidanga'' (Embelia ribes Burm f.), ''nagara'' (Zingiber officinale Rose), ''yavakshara'' (alkali preparation of barley), ash powder of black iron along with honey, powder of ''yava'' (Hordeum vulgarae Linn) and ''amalaka'' (Emblica officinalis Gaertn) is also an excellent weight-loss drug. Similarly, ''Bilvadi panchamula'' (five major roots) mixed with honey and shilajatu along with the juice of ''agnimantha'' (Clerodendrum phlomidis Linn.f.) are also very effective preparations for weight-loss.

−

A diet consisting of ''prashatika'' (Setaria italic Beauv.), ''priyangu'' (Aglaia roxburghiana Mig.), ''shyamaka'' (Echinochloa frumentaea Linn.), ''yavaka'' (small variety of Hordeum vulgarae Linn), ''yava'' (Hordeum vulgarae Linn), ''jurnahva'' (Sorghum vulgare Linn), ''kodrava'' (papalum scrobiculatum Linn.), ''mudga'' (Phaseolus mungo Linn.), ''kulattha'' (Dolichos biflorus Linn.), ''chakramudgaka'', ''adhaki'' (Cajanus cajan Millsp.) along with ''patola'' (Trichosanthes cucumerina Linn) and ''amalaka'' (Emblica officinalis Gaertn) is very effective in tackling obesity and maintaining good health. Honey water and alcoholic preparations may be taken as postprandial drinks that help in reducing excessive fat and muscle tissues, while also alleviating ''kapha dosha''.

+

A diet consisting of ''prashatika'' (Setaria italic Beauv.), ''priyangu'' (Aglaia roxburghiana Mig.), ''shyamaka'' (Echinochloa frumentaea Linn.), ''yavaka'' (small variety of Hordeum vulgarae Linn), ''yava'' (Hordeum vulgarae Linn), ''jurnahva'' (Sorghum vulgare Linn), ''kodrava'' (papalum scrobiculatum Linn.), ''mudga'' (Phaseolus mungo Linn.), ''kulattha'' (Dolichos biflorus Linn.), ''chakramudgaka'', ''adhaki'' (Cajanus cajan Millsp.) along with ''patola'' (Trichosanthes cucumerina Linn) and ''amalaka'' (Emblica officinalis Gaertn) is very effective in tackling obesity and maintaining good health. Honey water and alcoholic preparations may be taken as postprandial drinks that help in reducing excessive fat and muscle tissues, while also alleviating [[kapha]] [[dosha]].

</div>

One desirous of reducing obesity should indulge more and more in vigil, sexual activities, as well as physical and mental exercises [21-28]

Line 503: Line 503:

−

In human beings, happiness and misery, nourishment and emaciation, strength and weakness, fertility and infertility, knowledge and ignorance, and ~~life~~ and death depend upon proper (and improper sleep). Untimely, excessive sleep and sleep deprivation take away both happiness and longevity from a person. Similarly, proper sleep brings about happiness and longevity in human beings just as real knowledge brings about spiritual power in yogis [36-38]

+

In human beings, happiness and misery, nourishment and emaciation, strength and weakness, fertility and infertility, knowledge and ignorance, and longevity and death depend upon proper (and improper sleep). Untimely, excessive sleep and sleep deprivation take away both happiness and longevity from a person. Similarly, proper sleep brings about happiness and longevity in human beings just as real knowledge brings about spiritual power in yogis [36-38]

</div>

+

==== Indications of daytime sleep ====

Line 556: Line 557:

−

Sleeping during the day is advocated for those who are exhausted on account of singing, reading, alcoholic drinking, sexual intercourse, elimination therapy, carrying heavy weight, walking long distances, suffering from phthisis, wasting, thirst, diarrhea, colic pain, dyspnea, hiccup, insanity, or are too old, too young, weak and emaciated. It is also recommended for those who are injured by fall and assault or exhausted by travel-related stress, vigil, anger, grief, and fear. By this, equilibrium of ~~''dhatus''~~ and strength is maintained, and ''kapha'' nourishes the body parts and ensures longevity. In the summer season, nights become shorter, and ''vata'' gets provoked in the body in ~~''adanakala''~~ (seasons of low body strength, such as summer and rains) due to absorption of fluid. Therefore, during this period daytime sleeping is advocated for all [39-43]

+

Sleeping during the day is advocated for those who are exhausted on account of singing, reading, alcoholic drinking, sexual intercourse, elimination therapy, carrying heavy weight, walking long distances, suffering from phthisis, wasting, thirst, diarrhea, colic pain, dyspnea, hiccup, insanity, or are too old, too young, weak and emaciated. It is also recommended for those who are injured by fall and assault or exhausted by travel-related stress, vigil, anger, grief, and fear. By this, equilibrium of [[dhatu]] and strength is maintained, and [[kapha]] nourishes the body parts and ensures longevity. In the summer season, nights become shorter, and [[vata]] gets provoked in the body in [[adana kala]] (seasons of low body strength, such as summer and rains) due to absorption of fluid. Therefore, during this period daytime sleeping is advocated for all. [39-43]

</div>

+

==== Consequences of improper daytime sleep ====

Line 618: Line 620:

−

Sleeping during daytime is contraindicated in the seasons other than summer because it causes vitiation of ''kapha'' and ''pitta''. Persons having excessive fat, those who are addicted to fatty substances, having plenty of ''kapha'', suffering from vitiated ''kapha'' related disorders, and those afflicted by latent poisons should never sleep during daytime. If one violated the given advice of sleeping during the day, he would subject himself to ''halimaka'' (advance stage of jaundice), headache, cold, heaviness of body parts, malaise, loss of digestive power, ''hridyopalepa'' (a feeling as if phlegm adhered to the heart), edema, anorexia, nausea, rhinitis, hemicranias, urticarial patches, pustules, boils, itching, drowsiness, coughing, disorders of the throat, impairment of memory and intelligence, obstruction of the body channels, fever, incapability of sensory and motor systems and enhancement of the toxic effects of poisons. So, one should keep in view the merits and demerits of sleep in various seasons and situations to stay happy and live long [44-49]

+

Sleeping during daytime is contraindicated in the seasons other than summer because it causes vitiation of [[kapha]] and [[pitta]]. Persons having excessive fat, those who are addicted to fatty substances, having plenty of [[kapha]], suffering from vitiated [[kapha]] related disorders, and those afflicted by latent poisons should never sleep during daytime. If one violated the given advice of sleeping during the day, he would subject himself to ''halimaka'' (advance stage of jaundice), headache, cold, heaviness of body parts, malaise, loss of digestive power, ''hridyopalepa'' (a feeling as if phlegm adhered to the heart), edema, anorexia, nausea, rhinitis, hemicranias, urticarial patches, pustules, boils, itching, drowsiness, coughing, disorders of the throat, impairment of memory and intelligence, obstruction of the body channels, fever, incapability of sensory and motor systems and enhancement of the toxic effects of poisons. So, one should keep in view the merits and demerits of sleep in various seasons and situations to stay happy and live long [44-49]

</div>

+

==== Qualities of day and night sleep ====

Line 720: Line 723:

−

Elimination of ~~''doshas''~~ from the body and the head through purgation and emesis, predominance of ''sattva'' and suppression of ''tamas'', emotions such as fear, anxiety, and anger, habits and activities such as smoking, physical exercise, bloodletting, fasting, and environmental settings such as uncomfortable bed go a long way in overcoming excessive sleepiness/hypersomnolence.

+

Elimination of [[dosha]] from the body and the head through purgation and emesis, predominance of ''sattva'' and suppression of ''tamas'', emotions such as fear, anxiety, and anger, habits and activities such as smoking, physical exercise, bloodletting, fasting, and environmental settings such as uncomfortable bed go a long way in overcoming excessive sleepiness/hypersomnolence.

−

The above-mentioned factors, along with overwork, old age, ''vatika'' diseases, ''vatika'' constitution and aggravation of ''vata'' itself, are known to cause sleeplessness even in a normal individual. Some are insomniac even by nature. [55-57]

+

The above-mentioned factors, along with overwork, old age, ''vatika'' diseases, ''vatika'' constitution and aggravation of [[vata]] itself, are known to cause sleeplessness even in a normal individual. Some are insomniac even by nature. [55-57]

</div>

+

==== Origins and types of sleep ====

Line 737: Line 741:

</div></div>

−

Sleep is of seven types, categorized by its cause: ''Tamas'', vitiated ''kapha'', mental exertion, physical exertion, exogenous factors, diseases, and normal (nighttime). [58]

+

Sleep is of seven types, categorized by its cause: ''Tamas'', vitiated [[kapha]], mental exertion, physical exertion, exogenous factors, diseases, and normal (nighttime). [58]

Line 754: Line 758:

Natural sleep (sleeping at night) is the best form of sleep. This is also known as ''Bhutadhatri'', or “that which nurses all the living beings." The form of sleep that is caused by ''tamas'' is the cause of all sinful acts while the remaining types are observed in specific situations and ailments [59]

</div>

+

=== Summary ===

Line 807: Line 812:

*Excessive obesity has eight inherent defects viz. decrease in longevity, hampered mobility, difficulty in sexual intercourse, debility, bad body odor, profuse sweating, excessive hunger, and excessive thirst. [4]

*Excessive obesity is caused by over-nourishment due to the intake of heavy, sweet, cold and fatty diet, lack of physical exercise, abstinence from sexual intercourse, indulgence in the day sleeping, uninterrupted cheerfulness, lack of mental activities and hereditary/genetic defects. [4]

−

*Obesity is a result of obstruction of channels by excess accumulated ~~''medas''~~ (fat). This deranges the movement of ''vata'' is specially confined to ''koshtha'' (abdominal viscera) resulting in the stimulation and hastening of the digestive process through abnormally increased ''agni'' (''pitta''). This leads to excessive hunger and thirst and the person eats more food to gain weight. An excessive increase in adipose tissue and vitiation of ~~''tridosha''~~ causes severe diseases in obese people. [5-8]

+

*Obesity is a result of obstruction of channels by excess accumulated [[meda dhatu]] (fat). This deranges the movement of [[vata]] is specially confined to ''koshtha'' (abdominal viscera) resulting in the stimulation and hastening of the digestive process through abnormally increased ''agni'' ([[pitta]]). This leads to excessive hunger and thirst and the person eats more food to gain weight. An excessive increase in adipose tissue and vitiation of tri[[dosha]] causes severe diseases in obese people. [5-8]

*Disproportionate increase of fat occurs mainly around buttocks, abdomen, and breasts, which become pendulous and the person suffers from improper metabolism and energy. [9]

*Indulgence in dry (non-unctuous) diets and drinks, fasting, inadequate diet, overuse of therapeutic purificatory measures, grief, suppression of natural urges, sleep deprivation, dry powder massage, indulgence in baths, heredity, old age, continued illness and anger make a person too lean. [11-12]

*Too lean and too obese persons are prone to suffering from various diseases and need constant treatment. [16]

−

*Being lean is better than being obese because the lean person responds well to nourishing treatment and balancing of the causative ''dosha'' (''vata'' and ''pitta''). On the contrary, reducing therapy and drugs used in the treatment of obesity can cause an increase in ''agni'', which may cause increased appetite and thirst.Hence, the obese suffer more than the lean. [17]

+

*Being lean is better than being obese because the lean person responds well to nourishing treatment and balancing of the causative [[dosha]] ([[vata]] and [[pitta]]). On the contrary, reducing therapy and drugs used in the treatment of obesity can cause an increase in ''agni'', which may cause increased appetite and thirst.Hence, the obese suffer more than the lean. [17]

*A person possessing a balanced constitution of muscles and compactness of the body, and stable sense organs does not fall prey to diseases. He can tolerate hunger, thirst, heat and cold, and physical strain better. His digestion, assimilation of food and muscle metabolism are in a state of equilibrium. [18-19]

*The food that is heavy to digest but not having any fattening (such as high fiber diet) is prescribed for the obese. In lean persons, food that is light to digest and has high nourishing value is prescribed. [20]

−

*Food and drinks that alleviate ''vata'' and reduce ''kapha'' and ~~''medas''~~, as well as therapies such as enema (administered with drugs of sharply acting, dry and hot properties) and therapeutic powder massages are important treatments for obesity. [21-22]

+

*Food and drinks that alleviate [[vata]] and reduce [[kapha]] and [[meda dhatu]], as well as therapies such as enema (administered with drugs of sharply acting, dry and hot properties) and therapeutic powder massages are important treatments for obesity. [21-22]

−

*To enhance body mass of the excessively lean, an easy-to-digest and nourishing diet therapy, proper sleep, mind relaxing activities, ''rasayanas'' and aphrodisiacs, a diet with unctuous food and newly harvested food, and measures that eliminate vitiated ~~''doshas''~~ are prescribed. [29-34]

+

*To enhance body mass of the excessively lean, an easy-to-digest and nourishing diet therapy, proper sleep, mind relaxing activities, ''rasayanas'' and aphrodisiacs, a diet with unctuous food and newly harvested food, and measures that eliminate vitiated [[dosha]] are prescribed. [29-34]

*Tiredness, inactivity of mind, and detachment from sense organs are certain situations and conditions that help in falling asleep. [35]

*Normal sleep is necessary for the normal functioning of human body and excessive or inadequate sleep results in many diseases. Happiness and misery, nourishment and emaciation, strength and weakness, fertility and infertility, knowledge and ignorance and life and death depend on proper and improper sleep. [36]

−

*Sleeping during the day is indicated for restoring any damage to the physical constitution or depletion of body tissues. In a normal person, sleeping during the day is contraindicated in seasons other than summer because it causes vitiation of ''kapha'' and ''pitta''. Daytime sleep causes serious health problems. While insomnia causes roughness in the body, daytime sleep causes ''snigdhata'' (unctuousness) in the body. [39-50]

+

*Sleeping during the day is indicated for restoring any damage to the physical constitution or depletion of body tissues. In a normal person, sleeping during the day is contraindicated in seasons other than summer because it causes vitiation of [[kapha]] and [[pitta]]. Daytime sleep causes serious health problems. While insomnia causes roughness in the body, daytime sleep causes ''snigdhata'' (unctuousness) in the body. [39-50]

*Obesity and leanness are caused by improper diet and sleep. [51]

Line 827: Line 832:

=== Morbid obesity ===

−

In the context of ''atisthula'' and ''atikrisha'', Charak has explored these conditions from the standpoint of their diathesis, clinical presentation, and management, which is comparable to approaches taken today to the study of obesity and leanness. Suśruta has considered ''rasa dhatu'' as the main culprit for both obesity and emaciation (''rasa nimittameva sthaulyam karshyam ca'')<ref>Sushruta. Sutra Sthana, Cha.15 Doshadatumalkshayavriddivinjaniya Adhyaya verse 32. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. </ref>.

+

In the context of ''atisthula'' and ''atikrisha'', Charak has explored these conditions from the standpoint of their diathesis, clinical presentation, and management, which is comparable to approaches taken today to the study of obesity and leanness. Suśruta has considered [[rasa dhatu]] as the main culprit for both obesity and emaciation (''rasa nimittameva sthaulyam karshyam ca'')<ref>Sushruta. Sutra Sthana, Cha.15 Doshadatumalkshayavriddivinjaniya Adhyaya verse 32. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. </ref>.

−

Lipid precursors are acted upon by fat-specific energy (''medhodhatvagni'') for their conversion into adipose tissue (~~''medodhatu''~~)<ref>Mishra, L.C. (2003). Scientific Basis of Ayurvedic therapy, Chapter 9 Obesity (Medoroga) in [[Ayurveda]]; eBook, published by CRC press, Taylor & Francis Group. </ref>. Vitiation of ''kapha dosha'' and excessive accumulation of fat-specific energy and waste products of adipose tissues (''kleda'') lead to dysfunction of adipose tissues. Adipose channels have two origins - kidney, adrenal and fat around them and other are visceral and omental fat (''vapavahana'')<ref>Shastri, P.K (1983), (translater), Caraka samhita, Part I, 2nd ed., Chaukhambha Sanskrit Sansthan, Varanasi, India, p. 595. </ref>. These channels draw nutrition, including lipid from the antecedent flesh and transient lipid and then convert them into a stored form of lipid. As per biomedical science, obesity is associated with increased adipose stores in the subcutaneous tissues, skeletal muscles and internal organs such as kidney, heart, liver and omentum. Adipose tissues (~~''medodhatu''~~) form a crucial link to the concept of tissue metabolism. Low levels of fat-specific energy (''medodhatvagni''), despite a normal food intake, can lead to a steady accumulation of fat and the outcome is obesity<ref>Bleich S, Cutler D, Murray C, Adams A (2008). "Why is the developed world obese?". Annu Rev Public Health29: 273–95. doi:10.1146/annurev.publhealth.29.020907.090954. PMID 18173389. </ref> <ref>Drewnowski A, Specter SE (January 2004). "Poverty and obesity: the role of energy density and energy costs". Am. J. Clin. Nutr.79 (1): 6–16. </ref>. The conventional system of medicine has given due consideration to certain factors such as insufficient sleep, genetic predisposition, later age pregnancy, certain medications and other epigenetic factors in the etiopathogenesis of obesity and its related disorders<ref>Keith SW, Redden DT, Katzmarzyk PT et al. (2006). "Putative contributors to the secular increase in obesity: Exploring the roads less traveled". Int J Obes (Lond)30 (11): 1585–94. doi:10.1038/sj.ijo.0803326. PMID 16801930. </ref>.(Verse 3-4)

+

Lipid precursors are acted upon by fat-specific energy (''medhodhatvagni'') for their conversion into adipose tissue ([[meda dhatu]])<ref>Mishra, L.C. (2003). Scientific Basis of Ayurvedic therapy, Chapter 9 Obesity (Medoroga) in [[Ayurveda]]; eBook, published by CRC press, Taylor & Francis Group. </ref>. Vitiation of [[kapha dosha]] and excessive accumulation of fat-specific energy and waste products of adipose tissues (''kleda'') lead to dysfunction of adipose tissues. Adipose channels have two origins - kidney, adrenal and fat around them and other are visceral and omental fat (''vapavahana'')<ref>Shastri, P.K (1983), (translater), Caraka samhita, Part I, 2nd ed., Chaukhambha Sanskrit Sansthan, Varanasi, India, p. 595. </ref>. These channels draw nutrition, including lipid from the antecedent flesh and transient lipid and then convert them into a stored form of lipid. As per biomedical science, obesity is associated with increased adipose stores in the subcutaneous tissues, skeletal muscles and internal organs such as kidney, heart, liver and omentum. Adipose tissues ([[meda dhatu]]) form a crucial link to the concept of tissue metabolism. Low levels of fat-specific energy (''medodhatvagni''), despite a normal food intake, can lead to a steady accumulation of fat and the outcome is obesity<ref>Bleich S, Cutler D, Murray C, Adams A (2008). "Why is the developed world obese?". Annu Rev Public Health29: 273–95. doi:10.1146/annurev.publhealth.29.020907.090954. PMID 18173389. </ref> <ref>Drewnowski A, Specter SE (January 2004). "Poverty and obesity: the role of energy density and energy costs". Am. J. Clin. Nutr.79 (1): 6–16. </ref>. The conventional system of medicine has given due consideration to certain factors such as insufficient sleep, genetic predisposition, later age pregnancy, certain medications and other epigenetic factors in the etiopathogenesis of obesity and its related disorders<ref>Keith SW, Redden DT, Katzmarzyk PT et al. (2006). "Putative contributors to the secular increase in obesity: Exploring the roads less traveled". Int J Obes (Lond)30 (11): 1585–94. doi:10.1038/sj.ijo.0803326. PMID 16801930. </ref>.(Verse 3-4)

=== Increased desire to eat among the obese ===

−

Charak correlated an increased desire to eat with increased [[agni]] in the morbidly obese. Recent evidence suggests that leptin and ghrelin had shown their influence on appetite. In this context, ghrelin is produced from the stomach, and leptin is produced by the adipose tissue of fat storage reserves in the body, which is responsible for short-term and long-term appetite control respectively in the body.<ref>Hamann A, Matthaei S (1996). "Regulation of energy balance by leptin". Exp. Clin. Endocrinol. Diabetes104 (4): 293–300. doi:10.1055/s-0029-1211457. PMID 8886745. </ref> In the brain melanocortin pathway has drawn the attention of research scholars that this pathway has a specific role in stimulating appetite, which is located in the area of the lateral and ventromedial hypothalamus and arcuate nucleus. These areas are directly related to the feeding and satiety centers.<ref name="ref30"~~/>,<ref~~>Rao CR, Sen PK, Flier JS (2012). Handbook of Statistics: Bioinformatics in Human Health and Heredity; Published by North Holland; 1 edition, Kindle Edition, 1 edition.</ref>

+

Charak correlated an increased desire to eat with increased [[agni]] in the morbidly obese. Recent evidence suggests that leptin and ghrelin had shown their influence on appetite. In this context, ghrelin is produced from the stomach, and leptin is produced by the adipose tissue of fat storage reserves in the body, which is responsible for short-term and long-term appetite control respectively in the body.<ref>Hamann A, Matthaei S (1996). "Regulation of energy balance by leptin". Exp. Clin. Endocrinol. Diabetes104 (4): 293–300. doi:10.1055/s-0029-1211457. PMID 8886745. </ref> In the brain melanocortin pathway has drawn the attention of research scholars that this pathway has a specific role in stimulating appetite, which is located in the area of the lateral and ventromedial hypothalamus and arcuate nucleus. These areas are directly related to the feeding and satiety centers.<ref name="ref30">Rao CR, Sen PK, Flier JS (2012). Handbook of Statistics: Bioinformatics in Human Health and Heredity; Published by North Holland; 1 edition, Kindle Edition, 1 edition.</ref>

There are two distinct groups of neurons in the arcuate nucleus viz- The first group contains neuropeptide Y (NPY) and agouti-related peptide (AgRP) and the second group contains Pro-opiomelanocortin (POMC) and cocaine and amphetamine regulated transcript (CART). The first group of neuron i.e. NPY/AgRP exerts stimulatory inputs to the LH while inhibitory inputs to the VMH, which stimulate feeding and inhibit satiety respectively. Both groups of arcuate nucleus neurons are the under the regulation of leptin, which inhibits the NPY/AgRP group of neurons and stimulating the POMC/CART group of neurons. Hence, the leptin deficiency or leptin resistance leads to develop overfeeding tendency, which is caused by some genetic and acquired forms of obesity.<ref name="ref30"/>,<ref>Raina GS (2011).Obesity being the major health burden needed to be chased: A systemic review. J Appl Pharm Sci. 2011;1:238–45.</ref> These findings suggest the genetic inputs in overweight and obesity, which is quite comparable to the Ayurvedic lexicons.[verse 4]

Line 839: Line 844:

=== Consequences of obesity ===

−

Serious diseases ~~(''daruna vikara'')~~ are the outcome of excessive obesity due obstruction of body channels by the ~~''medas''~~. This indicates ancient wisdom of [[Ayurveda]] ~~''acharyas''~~, which is comparable to the impact of obesity on health perspectives of biomedical science<ref>Mishra, L.C. (2003). Scientific Basis of Ayurvedic therapy, Chapter 9 Obesity (Medoroga) in [[Ayurveda]]; eBook, published by CRC press, Taylor & Francis Group. </ref>. We have yet to understand what they had foreseen in reference to fat accumulation around the kidneys. Decreased life span ~~(''ayukshaya'')~~ is stated to be an important consequence of obesity in [[Ayurveda]]. According to contemporary science, metabolic and psychological pathologies are often present together and are associated with dysregulation of the hypothalamic-pituitary-adrenal axis<ref>Boulpaep, Emile L.; Boron, Walter F. (2003). Medical ~~physiologya~~: A cellular and molecular approach. Philadelphia: Saunders. p. 1227. ISBN 0-7216-3256-4 </ref>. Affect disorders are also reported among obese binge eaters. The National Institute of Health, USA has issued an alert labeling obesity a "Killer disease" due to its health-related consequences such as coronary disease, diabetes mellitus, hypertension, hyperlipidemia, kidney disorders, gallbladder disorders, cancer of colon, pancreas, breast, uterus, kidney and gallbladder, osteoarthritis, menstrual irregularities in females, cryptogenic cirrhosis of the liver and hepatocellular carcinoma, insulin resistance, and physiological hyperinsulinemia. Some of the social consequences of obesity could include divorces, due in part to reduce sexual activities between partners. Besides there, transitional physiological phases such as weight gain during adolescence in boys and girls, post-natal weight gain in women, and peri-post menopausal obesity are frequently noted in clinical settings that warrant special care and management<ref> Kuniko Takagi, Romain Legrand, Akihiro Asakawa, Haruka Amitani, Marie François, Naouel Tennoune, Moïse Coëffier, Sophie Claeyssens, Jean-Claude do Rego, Pierre Déchelotte, Akio Inui, Sergueï O. Fetissov. Anti-ghrelin immunoglobulins modulate ghrelin stability and its orexigenic effect in obese mice and humans. Nature Communications, 2013; 4 DOI: 10.1038/ncomms3685, site on 08/02/2014. </ref> <ref>Grundy SM (2004). "Obesity, metabolic syndrome, and cardiovascular disease". J. Clin. Endocrinol. Metab.89 (6): 2595–600. doi:10.1210/jc.2004-0372. PMID 15181029. </ref> <ref>Foster, W.R. and Burton, B.T.(1985). Health implication of obesity, Ann. Intern.Med., 103, 1024. </ref> <ref>Grunstein, R.R. and Widcox, I. (1994). Sleep-disordered breathing and obesity, Clin.Endocrinol.Metab. Baillier’s, 8, 601. </ref> <ref>Daugero, K.D. (2001). A new perspective on glucorticoid feedback: relation to stress, carbohydrate feeding and feeding behavior, J. Neuroendocrinol., 13, 1088. </ref> <ref>Larsson, B. et al (1984), Abdominal adipose distribution, obesity and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913, Br. Med. J., 288, 1401. </ref> <ref>Esposito K. et al (2004). "Effect of lifestyle changes on erectile dysfunction in obese men: A randomized controlled trial". JAMA, 291 (24): 2978–84. </ref>.(verse 5-8)

+

Serious diseases are the outcome of excessive obesity due obstruction of body channels by the [[meda dhatu]]. This indicates ancient wisdom of [[Ayurveda]] scientists, which is comparable to the impact of obesity on health perspectives of biomedical science<ref>Mishra, L.C. (2003). Scientific Basis of Ayurvedic therapy, Chapter 9 Obesity (Medoroga) in [[Ayurveda]]; eBook, published by CRC press, Taylor & Francis Group. </ref>. We have yet to understand what they had foreseen in reference to fat accumulation around the kidneys. Decreased life span is stated to be an important consequence of obesity in [[Ayurveda]]. According to contemporary science, metabolic and psychological pathologies are often present together and are associated with dysregulation of the hypothalamic-pituitary-adrenal axis<ref>Boulpaep, Emile L.; Boron, Walter F. (2003). Medical physiology: A cellular and molecular approach. Philadelphia: Saunders. p. 1227. ISBN 0-7216-3256-4 </ref>. Affect disorders are also reported among obese binge eaters. The National Institute of Health, USA has issued an alert labeling obesity a "Killer disease" due to its health-related consequences such as coronary disease, diabetes mellitus, hypertension, hyperlipidemia, kidney disorders, gallbladder disorders, cancer of colon, pancreas, breast, uterus, kidney and gallbladder, osteoarthritis, menstrual irregularities in females, cryptogenic cirrhosis of the liver and hepatocellular carcinoma, insulin resistance, and physiological hyperinsulinemia. Some of the social consequences of obesity could include divorces, due in part to reduce sexual activities between partners. Besides there, transitional physiological phases such as weight gain during adolescence in boys and girls, post-natal weight gain in women, and peri-post menopausal obesity are frequently noted in clinical settings that warrant special care and management<ref> Kuniko Takagi, Romain Legrand, Akihiro Asakawa, Haruka Amitani, Marie François, Naouel Tennoune, Moïse Coëffier, Sophie Claeyssens, Jean-Claude do Rego, Pierre Déchelotte, Akio Inui, Sergueï O. Fetissov. Anti-ghrelin immunoglobulins modulate ghrelin stability and its orexigenic effect in obese mice and humans. Nature Communications, 2013; 4 DOI: 10.1038/ncomms3685, site on 08/02/2014. </ref> <ref>Grundy SM (2004). "Obesity, metabolic syndrome, and cardiovascular disease". J. Clin. Endocrinol. Metab.89 (6): 2595–600. doi:10.1210/jc.2004-0372. PMID 15181029. </ref> <ref>Foster, W.R. and Burton, B.T.(1985). Health implication of obesity, Ann. Intern.Med., 103, 1024. </ref> <ref>Grunstein, R.R. and Widcox, I. (1994). Sleep-disordered breathing and obesity, Clin.Endocrinol.Metab. Baillier’s, 8, 601. </ref> <ref>Daugero, K.D. (2001). A new perspective on glucorticoid feedback: relation to stress, carbohydrate feeding and feeding behavior, J. Neuroendocrinol., 13, 1088. </ref> <ref>Larsson, B. et al (1984), Abdominal adipose distribution, obesity and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913, Br. Med. J., 288, 1401. </ref> <ref>Esposito K. et al (2004). "Effect of lifestyle changes on erectile dysfunction in obese men: A randomized controlled trial". JAMA, 291 (24): 2978–84. </ref>.[verse 5-8]

−

=== Etiology, features, and consequences of ''atikrisha'' (emaciation) ===

+

=== Etiology, features, and consequences of [[atikrisha]] (emaciation) ===

−

The etiological factors for ''atikrisha'' may be divided into two groups - excessive expenditure of calories and fewer intakes of calories. Either of these conditions leads to under-nutrition which ultimately results in ''atikrisha''. In the pathogenesis of ~~''krishata''~~, ~~''vayu''~~ plays an important role. Most of the etiological factors observed in the case ~~of ''krisha'' and ''atikrisha''~~ provoke ''vata'' vitiation. ~~Thus, vitiated ''vata'' may be considered the most important factor in the pathogenesis of ''krisha''.~~ In ''sthaulya'' there is excessive formation and under-utilization (due to sedentary habit) of the ''rasa dhatu''. On the other hand, in ''krishata'' there is less formation of ''rasa'' due to diseases or due to undernourishment. Further, Charak and Sushruta both have categorized ''krishata'' as a ''rasa pradoshaja vyadhi''. [Cha.Sa.[[Sutra Sthana]]28/10], [Su.Sa.Sutra Sthana 15/37]<ref name=Susruta>Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>,[Su.Sa.Sutra Sthana 24/8]<ref name=Susruta/> In this way, ''rasa dhatu dushti'' mainly in the form of ''kshaya'' is found in extremely lean or emaciated people. The other ''dhatu'' involved in the pathogenesis of obesity as well as ''atikrisha'' is [[meda dhatu]] since it is mentioned that ''medokshaya'' (or the deficiency of [[meda dhatu]]) cause ''krisanga''. [A.H.Sutra Sthana 11/18]<ref>Munshi, V.D. (translator) (1952). Ashtang Hridaya,Sastum Sahityavardhak Mudranalaya, Ahmedabad, India, p. 135, Sutrasthana-24/5, 11/18. </ref>

+

The etiological factors for [[atikrisha]] may be divided into two groups - excessive expenditure of calories and fewer intakes of calories. Either of these conditions leads to under-nutrition which ultimately results in [[atikrisha]]. In the pathogenesis of emaciation (karshya) , [[vata]] [[dosha]] plays an important role. Most of the etiological factors observed in the case provoke [[vata]] [[dosha]] vitiation.

+

In [[sthaulya]] there is excessive formation and under-utilization (due to sedentary habit) of the [[rasa dhatu]]. On the other hand, in [[krishata]] there is less formation of [[rasa dhatu]] due to diseases or due to undernourishment. Further, Charak and Sushruta both have categorized ''krishata'' as a ''rasa pradoshaja vyadhi''. [Cha.Sa.[[Sutra Sthana]]28/10], [Su.Sa.Sutra Sthana 15/37]<ref name=Susruta>Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>,[Su.Sa.Sutra Sthana 24/8]<ref name=Susruta/> In this way, ''rasa dhatu dushti'' mainly in the form of ''kshaya'' is found in extremely lean or emaciated people. The other [[dhatu]] involved in the pathogenesis of obesity as well as [[atikrisha]] is [[meda dhatu]] since it is mentioned that ''medokshaya'' (or the deficiency of [[meda dhatu]]) cause ''krisanga''. [A.H.Sutra Sthana 11/18]<ref>Munshi, V.D. (translator) (1952). Ashtang Hridaya,Sastum Sahityavardhak Mudranalaya, Ahmedabad, India, p. 135, Sutrasthana-24/5, 11/18. </ref>

In biomedical terms, emaciation is the outcome of loss of the fatty contents or loss of adipose tissue component of subcutaneous fat, which is lying beneath the outer covering of the body<ref>Gray D.S., Fujioka K. (1991). "Use of relative weight and Body Mass Index for the determination of adiposity". J Clin Epidemiol, 44 (6): 545–50. </ref>. It is also known as extreme weight loss, leanness, or thinness. In general term, it is also known as wasting, which is caused by hampered nutritional requirement at the tissue level and excessive starvation. Wasting or leanness is an important symptom of improper nourishment, which is commonly seen in various clinical conditions such as poverty, a variety of gastrointestinal disorders, various eating disorders, prolonged fever, malignant diseases, endocrine disorders, chronic infections, autoimmune disorders as well as parasitic infections. The malnourished person faced a lot of problems related to cardiovascular, integumentary and urogenital systems. Disturbances in blood circulation, serum electrolyte, and serum protein are commonly observed in emaciated person. Such type individuals are more to suffer from infections due to deranged immune power and swelling in general<ref>"Emaciation". Medical-Dictionary.TheFreeDictionary.com. Retrieved February 19, 2014. </ref>.

−

Obesity and leanness can manifest themselves in very severe and excessive forms than discussed here and those cases could make the management of such disorders - and any disease it could lead to – very challenging. While the principles of treatment remain unchanged, the therapeutic measures should be suitably intensified to counter the numerous disorders that arise because of excessive obesity and leanness (C.Su. 23/3-34). The patients of ''atikrisha'' and ''sthaulya'' perpetually suffer from diseases but the standpoint of treatment, the former is significantly more manageable because ''sthula'' (or the obese) suffers more in comparison to ''atikrisha'' (the emaciated) (Su.Su. 15:42). Further, it is mentioned that ''atikṛisha'' is a grave disease, but is considered better than ''atisthula'' from treatment aspect because there is no treatment for ''sthaulya''. For proper treatment of ~~''sthulya''~~ the drugs must have ''medohara, agnihara'' and ''vatahara'' action at the same time, which is neither possible from ''karshaṇa'' nor ''brimhana''. Recent evidence also suggests that Charak had associated extreme weight-loss/undernourishment with high rates of morbidity and mortality, although to a lesser extent than obesity<ref>Bose, Bholanoth (1877, 2009). A new system of medicine, entitled recognizant medicine; or, The state of the sick. London: J. & A. Churchill. pp. 192–199. Retrieved February 19, 2014. </ref> <ref>Lusky A, Barell V, Lubin F, Kaplan G, Layani V, Shohat Z, et al. Relationship between morbidity and extreme values of body mass index in adolescents. Int J Epidemiol 1996;25(4):829-834. </ref> <ref>Lake JK, Power C, Cole TJ. Women's reproductive health: the role of body mass index in early and adult life. Int J Obes Relat Metab Disord 1997;21(6):432-438. </ref> <ref> Kopp W, Blum WF, von Prittwitz S, Ziegler A, Lubbert H, Emons G, et al. Low leptin levels predict amenorrhea in underweight and eating disordered females. Mol Psychiatry 1997;2(4):335-340. </ref> <ref> He Q, Karlberg J. BMI in childhood and its association with height gain, timing of puberty, and final height. Pediatr Res 2001;49(2):244-251. </ref>.

+

Obesity and leanness can manifest themselves in very severe and excessive forms than discussed here and those cases could make the management of such disorders - and any disease it could lead to – very challenging. While the principles of treatment remain unchanged, the therapeutic measures should be suitably intensified to counter the numerous disorders that arise because of excessive obesity and leanness [Cha.Sa. [[Sutra Sthana]] 23/3-34]. The patients of [[atikrisha]] and [[sthaulya]] perpetually suffer from diseases but the standpoint of treatment, the former is significantly more manageable because [[sthula]] (or the obese) suffers more in comparison to [[atikrisha]] (the emaciated) [Su. Sa. [[Sutra Sthana]] 15/42].<ref name=Susruta/> Further, it is mentioned that [[atikṛisha]] is a grave disease, but is considered better than [[atisthula]] from treatment aspect because there is no treatment for [[sthaulya]]. For proper treatment of [[sthaulya]] the drugs must have ''medohara, agnihara'' and ''vatahara'' action at the same time, which is neither possible from [[karshaṇa]] nor [[brimhana]]. Recent evidence also suggests that Charak had associated extreme weight-loss/undernourishment with high rates of morbidity and mortality, although to a lesser extent than obesity. <ref>Bose, Bholanoth (1877, 2009). A new system of medicine, entitled recognizant medicine; or, The state of the sick. London: J. & A. Churchill. pp. 192–199. Retrieved February 19, 2014. </ref> <ref>Lusky A, Barell V, Lubin F, Kaplan G, Layani V, Shohat Z, et al. Relationship between morbidity and extreme values of body mass index in adolescents. Int J Epidemiol 1996;25(4):829-834. </ref> <ref>Lake JK, Power C, Cole TJ. Women's reproductive health: the role of body mass index in early and adult life. Int J Obes Relat Metab Disord 1997;21(6):432-438. </ref> <ref> Kopp W, Blum WF, von Prittwitz S, Ziegler A, Lubbert H, Emons G, et al. Low leptin levels predict amenorrhea in underweight and eating disordered females. Mol Psychiatry 1997;2(4):335-340. </ref> <ref> He Q, Karlberg J. BMI in childhood and its association with height gain, timing of puberty, and final height. Pediatr Res 2001;49(2):244-251. </ref>

=== Management of the Morbidly Obese ===

−

In the conventional system of medicine, the main treatment for obesity consists of diet and physical exercise for short-term weight control. Maintaining the weight by short-term dietary control is very difficult to an obese person, and it required guided exercise and low ~~calory~~ diet in their daily regimens. Because lack of physical exercise is the key factor and imparts a role in the diathesis of obesity. 61 The lack of physical activities also plays an important role in obesity-associated with the involvement of brain and abdominal. Regarding physical exercise, it not only reduces body weight but also counteract metabolic adaptation but regulating nutritional balance set point.64 It is presumed that physical inactivity contributes to both visceral adiposity and cerebellar brain changes because in the area of cerebellar cortex and hippocampal dentate gyrus of brain show enhanced synaptogenesis and neurogenesis in response to physical exercise training.<ref>Matthias Raschpichler et al (2013). Abdominal fat distribution and its relationship to brain changes: the differential effects of age on cerebellar structure and function: a cross-sectional, exploratory study. BMJ Open. 2013; 3(1): e001915.Published online 2013 Jan 24. doi: 10.1136/bmjopen-2012-001915 </ref> <ref>McCarthyHD, EllisSM, ColeTJ. (2003): Central overweight and obesity in British youth aged 11–16 years: cross sectional surveys of waist circumference. BMJ, 326:624. </ref> <ref>GollischKS, BrandauerJ, JessenN, et al. (2009):Effects of exercise training on subcutaneous and visceral adipose tissue in normal- and high-fat diet-fed rats, Am J Physiol Endocrinol Metab; 297:E495–504. </ref>

+

In the conventional system of medicine, the main treatment for obesity consists of diet and physical exercise for short-term weight control. Maintaining the weight by short-term dietary control is very difficult to an obese person, and it required guided exercise and low calorie diet in their daily regimens. Because lack of physical exercise is the key factor and imparts a role in the diathesis of obesity. The lack of physical activities also plays an important role in obesity-associated with the involvement of brain and abdominal. Regarding physical exercise, it not only reduces body weight but also counteract metabolic adaptation but regulating nutritional balance set point.64 It is presumed that physical inactivity contributes to both visceral adiposity and cerebellar brain changes because in the area of cerebellar cortex and hippocampal dentate gyrus of brain show enhanced synaptogenesis and neurogenesis in response to physical exercise training.<ref>Matthias Raschpichler et al (2013). Abdominal fat distribution and its relationship to brain changes: the differential effects of age on cerebellar structure and function: a cross-sectional, exploratory study. BMJ Open. 2013; 3(1): e001915.Published online 2013 Jan 24. doi: 10.1136/bmjopen-2012-001915 </ref> <ref>McCarthyHD, EllisSM, ColeTJ. (2003): Central overweight and obesity in British youth aged 11–16 years: cross sectional surveys of waist circumference. BMJ, 326:624. </ref> <ref>GollischKS, BrandauerJ, JessenN, et al. (2009):Effects of exercise training on subcutaneous and visceral adipose tissue in normal- and high-fat diet-fed rats, Am J Physiol Endocrinol Metab; 297:E495–504. </ref>

−

In this context, [[Ayurveda]] has laid down a strong emphasis on drugs, dietary and lifestyle interventions for the management of atisthaulya. Therefore, factors such as ''madhura, sheeta, snigdha, guru, picchila'' and lifestyle errors are to be avoided in such cases. ''Ruksha udvartanas'' are advocated obese patients as an external purificatory measure, while ''vamana, virechana,'' and ''asthapana basti'' as internal bio-purificatory measures. If an ''atisthula'' person possesses good stamina and strength, they should be treated with ''vamana'' and ''virechana ~~karma''~~. Non-unctuous, warm and strong enema are advocated such type of patients.<ref>Singh R.H.(1998). The holistic principles of Ayurvedic Medicine. Chaukhambha Publications, Varanasi. </ref> <ref>Singh R.H. (2002) . Panchakarma therapy (2nd Ed). Chaukhambha Sanskrit Sereis office, Varanasi. </ref> <ref>Paranjpe, P., Patki, P., and Patwardhan, P., (1990). Ayurvedic treatment of obesity: a randomized double blind, placebo-controlled clinical trial, J. Ethnopharmacol., 29, 1–11. </ref> <ref>Kasture, H.S. (translator) (1985). Ayurvediya Panchakarma Vignyana (3rd ed.). Shri Baidyanath Ayurved Bhavan Pvt. Ltd., Kolkata, India, p. 247. </ref>''Yogic'' practices have a significant impact on the physical, mental, emotional and spiritual health of the individual. It is reported that a significant improvement in the levels of BP, LDL cholesterol, and BMI can be noted after three months of residential therapy consisting of vegetarian diet and ''kriya yoga''. A randomized controlled study reveals that practicing ''yoga'' for a year brought about significant improvement in body weight and body density. Regular practice of ''yoga'' has shown to improve the serum lipid profile in patients (with known IHD) as well as in healthy subjects. A regular regimen of ''praṇayama'' reduces stress hormone and levels of endorphin and enkephalin, consequently increasing the level of HDL while decreasing the level of LDL, VLDL and TGs.<ref>Schmidt, T et al (1997): Changes in cardiovascular risk factors and hormones during a comprehensive residential three month kriyayoga training and vegetarian nutrition, Acta Physiol.Scand Suppl. 640:158:160. </ref> <ref>Bera, T.K., Rajapurkar, M.V. (1993): Body composition, cardiovascular edurance and anaerobic power of yogic practitioner, Indian J. Physiol. Pharmacol, 37:225-228. </ref> <ref>Mahajan, A.S., Reddy, K.S., Sachdeva, U. (1999): Lipid profiles of coronary risk subjects following yogic lifestyle intervention, Indian Heart J, 51:37040. </ref> <ref>Manachanda, S.C. et al.(2000): Retardation of coronary atherosclerosis with yoga lifestyle intervention, J Assoc.Physicians India, 48 (7): 687-694. </ref>

+

In this context, [[Ayurveda]] has laid down a strong emphasis on drugs, dietary and lifestyle interventions for the management of atisthaulya. Therefore, factors such as ''madhura, sheeta, snigdha, guru, picchila'' and lifestyle errors are to be avoided in such cases. ''Ruksha udvartanas'' are advocated obese patients as an external purificatory measure, while [[vamana]], [[virechana]], and [[asthapana basti]] as internal bio-purificatory measures. If an ''atisthula'' person possesses good stamina and strength, they should be treated with [[vamana]] and [[virechana]] therapies. Non-unctuous, warm and strong enema are advocated such type of patients.<ref>Singh R.H.(1998). The holistic principles of Ayurvedic Medicine. Chaukhambha Publications, Varanasi. </ref> <ref>Singh R.H. (2002) . Panchakarma therapy (2nd Ed). Chaukhambha Sanskrit Sereis office, Varanasi. </ref> <ref>Paranjpe, P., Patki, P., and Patwardhan, P., (1990). Ayurvedic treatment of obesity: a randomized double blind, placebo-controlled clinical trial, J. Ethnopharmacol., 29, 1–11. </ref> <ref>Kasture, H.S. (translator) (1985). Ayurvediya Panchakarma Vignyana (3rd ed.). Shri Baidyanath Ayurved Bhavan Pvt. Ltd., Kolkata, India, p. 247. </ref>''Yogic'' practices have a significant impact on the physical, mental, emotional and spiritual health of the individual. It is reported that a significant improvement in the levels of BP, LDL cholesterol, and BMI can be noted after three months of residential therapy consisting of vegetarian diet and ''kriya yoga''. A randomized controlled study reveals that practicing ''yoga'' for a year brought about significant improvement in body weight and body density. Regular practice of ''yoga'' has shown to improve the serum lipid profile in patients (with known IHD) as well as in healthy subjects. A regular regimen of ''praṇayama'' reduces stress hormone and levels of endorphin and enkephalin, consequently increasing the level of HDL while decreasing the level of LDL, VLDL and TGs.<ref>Schmidt, T et al (1997): Changes in cardiovascular risk factors and hormones during a comprehensive residential three month kriyayoga training and vegetarian nutrition, Acta Physiol.Scand Suppl. 640:158:160. </ref> <ref>Bera, T.K., Rajapurkar, M.V. (1993): Body composition, cardiovascular edurance and anaerobic power of yogic practitioner, Indian J. Physiol. Pharmacol, 37:225-228. </ref> <ref>Mahajan, A.S., Reddy, K.S., Sachdeva, U. (1999): Lipid profiles of coronary risk subjects following yogic lifestyle intervention, Indian Heart J, 51:37040. </ref> <ref>Manachanda, S.C. et al.(2000): Retardation of coronary atherosclerosis with yoga lifestyle intervention, J Assoc.Physicians India, 48 (7): 687-694. </ref>

−

Recent evidence suggests that some ''ayurvedic'' herbal drugs are found to be very effective in normalizing deranged lipid profiles, reducing BMI and slowing down the risk heart diseases. Ayurvedic drugs such as ''rasona'' (Allium cepa), ''guggulu'' (Commiphora mukul), ''puṣhkaramula'' (Inula racemosa), ''arjuna'' (Terminalia Arjuna), ''dhānyaka'' (Coriandrum sativum), ''nishamalaki churṇa'' (powder of Emblica officinalis and Curcuma longa),''haritaki'' (Terminalia chebula), ''haridra'' (Curcuma longa), ''bilva'' (Aegle marmelos), ''tejapatra'' (Cinnamomum tamala), ''vrikshamla'' (Garcinia cambogia) and Ayurvedic formulations such as- ''triphala guggulu'', ''medohara guggulu'', ''amṛitadi guggulu'', ''arogyavardhani vaṭi'' etc. are also found to be effective in weight reduction as well as relief in other signs and symptoms. <ref name=ref1/> <ref name=ref2/> <ref name=ref3/><ref>Banerjee, S.K., Maulik, S.K. (2002): Effect of garlic on cardiovascular disorders: a review, Nutr.J, 1:4.</ref> <ref>Satyavati, G.V., Dwarakanath, C., and Tripathi, S.N. (1950 & 1969). Experimental studies on the hypocholesterolemic effect of Commiphora mukul (Guggulu), Indian J. Med. Res., 57, 1950, 1969. </ref> <ref>Karthikeyan, K. et al. (2003): Cardioprotective effect of the alcoholic extract of Terminalia arjuna bark in an invitro model of myocardial ischemic reperfusion injury, Iife Scince, 10, 73 (21):2727:39. </ref> <ref>Verghese, J. (2001): Coriander, Indian Spices, 38 (1):8. </ref> <ref>Kannan, V et al. (2012): Anti-diabetic activity on ethanolic extracts of fruits of terminalia chebula in Alloxan induced diabetic rats, American J. of Drug Discovery and Development, 2:135-142. </ref> <ref>Despande, U.R. (1966): Effect of Turmeric extract on lipid profile (1-22), Int.Seminar on free radicals medicated disease, 2-4. </ref> <ref>Kesari, A.N. et al. (2006): Hypoglycemic and anti-hyperglycemic activity of Aegle mormelas seed extract in normal and diabetic rats, J. Ethnopharmacol, 103 (3): 374-79. </ref> <ref>Sharma, S.R., Dwivedi, S.K., Swarup, D (1996): Hypoglycemic and hypolipidaemic effects of Cinnamomum tamala Nees leaves, Indian J Exp Biol, 34 (2): 216-220. </ref> <ref>Kohsuke Hayamizu, MS, Yuri Ishii, et al.( SE P T EMB E R / O C T O B E R 2003):Effects of Garcinia cambogia (Hydroxycitric Acid) on Visceral Fat Accumulation: A Double-Blind, Randomized, Placebo-Controlled Trial, current therapeutic research,VO L UME 64, No. 8, 551-567. </ref> <ref>Bhagwat, B.K. (1995). Triphala-guggul in Sthoulya in [[Ayurveda]] Research Papers III, Kulkarni, P.H., Ed., Ayurved Rasashala, Pune, India, p. 215 </ref> <ref>Vaidya, A.B. et al. (1980). A double-blind clinical trial of Arogyawardhini — an Ayurvedic drug- in acute viral hepatitis, Ind. J. Med. Res., 72, 588. </ref>( verse 20-28)

+

Recent evidence suggests that some ''ayurvedic'' herbal drugs are found to be very effective in normalizing deranged lipid profiles, reducing BMI and slowing down the risk heart diseases. Ayurvedic drugs such as ''rasona'' (Allium cepa), ''guggulu'' (Commiphora mukul), ''puṣhkaramula'' (Inula racemosa), ''arjuna'' (Terminalia Arjuna), ''dhānyaka'' (Coriandrum sativum), ''nishamalaki churṇa'' (powder of Emblica officinalis and Curcuma longa),''haritaki'' (Terminalia chebula), ''haridra'' (Curcuma longa), ''bilva'' (Aegle marmelos), ''tejapatra'' (Cinnamomum tamala), ''vrikshamla'' (Garcinia cambogia) and Ayurvedic formulations such as- ''triphala guggulu'', ''medohara guggulu'', ''amṛitadi guggulu'', ''arogyavardhani vaṭi'' etc. are also found to be effective in weight reduction as well as relief in other signs and symptoms. <ref name=ref1/> <ref name=ref2/> <ref name=ref3/><ref>Banerjee, S.K., Maulik, S.K. (2002): Effect of garlic on cardiovascular disorders: a review, Nutr.J, 1:4.</ref> <ref>Satyavati, G.V., Dwarakanath, C., and Tripathi, S.N. (1950 & 1969). Experimental studies on the hypocholesterolemic effect of Commiphora mukul (Guggulu), Indian J. Med. Res., 57, 1950, 1969. </ref> <ref>Karthikeyan, K. et al. (2003): Cardioprotective effect of the alcoholic extract of Terminalia arjuna bark in an invitro model of myocardial ischemic reperfusion injury, Iife Scince, 10, 73 (21):2727:39. </ref> <ref>Verghese, J. (2001): Coriander, Indian Spices, 38 (1):8. </ref> <ref>Kannan, V et al. (2012): Anti-diabetic activity on ethanolic extracts of fruits of terminalia chebula in Alloxan induced diabetic rats, American J. of Drug Discovery and Development, 2:135-142. </ref> <ref>Despande, U.R. (1966): Effect of Turmeric extract on lipid profile (1-22), Int.Seminar on free radicals medicated disease, 2-4. </ref> <ref>Kesari, A.N. et al. (2006): Hypoglycemic and anti-hyperglycemic activity of Aegle mormelas seed extract in normal and diabetic rats, J. Ethnopharmacol, 103 (3): 374-79. </ref> <ref>Sharma, S.R., Dwivedi, S.K., Swarup, D (1996): Hypoglycemic and hypolipidaemic effects of Cinnamomum tamala Nees leaves, Indian J Exp Biol, 34 (2): 216-220. </ref> <ref>Kohsuke Hayamizu, MS, Yuri Ishii, et al.( SE P T EMB E R / O C T O B E R 2003):Effects of Garcinia cambogia (Hydroxycitric Acid) on Visceral Fat Accumulation: A Double-Blind, Randomized, Placebo-Controlled Trial, current therapeutic research,VO L UME 64, No. 8, 551-567. </ref> <ref>Bhagwat, B.K. (1995). Triphala-guggul in Sthoulya in [[Ayurveda]] Research Papers III, Kulkarni, P.H., Ed., Ayurved Rasashala, Pune, India, p. 215 </ref> <ref>Vaidya, A.B. et al. (1980). A double-blind clinical trial of Arogyawardhini — an Ayurvedic drug- in acute viral hepatitis, Ind. J. Med. Res., 72, 588. </ref>

+

The herbs listed in the treatment of obesity have multifarious pharmacological properties. Some research studies confirmed both hypolipidemic and hypoglycemic activities. The herbs that possess properties like pungent (katu), bitter (tikta), astringent (kashaya) tastes, hot potency (ushna virya), light to digest (laghu) and producing dryness (ruksha) are responsible for depletion of meda (medohara) and removing toxins (lekhaneeya)activities.<ref>Kumari H, Pushpan R, Nishteswar K. Medohara and Lekhaniya dravyas (anti-obesity and hypolipidemic drugs) in Ayurvedic classics: A critical review. Ayu. 2013;34(1):11-16. doi:10.4103/0974-8520.115437</ref>

+

[verse 20-28]

=== Management of the emaciated/too lean ===

−

Too lean patients are brought to good health through renourishment or reintroducing nourishing liquids and food to the body and check the process of catabolism. It starts with a glass of water followed by mixed with lemon and table salt and finally reach to juices, which is made up of vegetable, pulses, rice mixed with pepper, lemon juice and table salt. Later on, it is replaced with cow milk, soups of pulses and vegetable mixed with butter and salt. If the emaciated status is improved, try to introduced small amount of solid food in meals at the frequent interval and try to avoid a large amount of solid food at a time. The dietary regimen is to be focused on proteins, fats, carbohydrates, multi-vitamin and mineral for the management of the emaciated person. It is always kept in mind at the time of management of the too lean person, excessive fatty foods items and excess fiber dominated grains and vegetable are to be avoided because they are deficient in energy and consume too much time for digestion. Treatment of emaciation also includes prescribing a lot of sleep, rest, relaxation, and counseling. In the present context, ''rasa'' means body fluid which is responsible for the nourishment of entire body and mind. Impairment of circulation of body fluid results in diseases and decay. ''Rasa'' should be available in adequate quantity and quality for it to circulate through the cells of the body, providing the requisite nourishment they need for proper functioning.(verse 29-34)

+

Too lean patients are brought to good health through renourishment or reintroducing nourishing liquids and food to the body and check the process of catabolism. It starts with a glass of water followed by mixed with lemon and table salt and finally reach to juices, which is made up of vegetable, pulses, rice mixed with pepper, lemon juice and table salt. Later on, it is replaced with cow milk, soups of pulses and vegetable mixed with butter and salt. If the emaciated status is improved, try to introduced small amount of solid food in meals at the frequent interval and try to avoid a large amount of solid food at a time. The dietary regimen is to be focused on proteins, fats, carbohydrates, multi-vitamin and mineral for the management of the emaciated person. It is always kept in mind at the time of management of the too lean person, excessive fatty foods items and excess fiber dominated grains and vegetable are to be avoided because they are deficient in energy and consume too much time for digestion. Treatment of emaciation also includes prescribing a lot of sleep, rest, relaxation, and counseling. In the present context, [[rasa dhatu]] means body fluid which is responsible for the nourishment of entire body and mind. Impairment of circulation of body fluid results in diseases and decay. ''Rasa'' should be available in adequate quantity and quality for it to circulate through the cells of the body, providing the requisite nourishment they need for proper functioning.[verse 29-34]

=== Concept of Sleep ===

−

The age-old concepts of sleep (''nidra'') and its different stages such as ''jagrata'', ''swapana'' and ''sushupti'' are comparable to the current concept of sleep and its stages. The problems and pattern of sleep are assessed by observing the activity of brain through Electroencephalogram (EEG) pattern.<ref>Dement, William; Kleitman, Nathaniel (1 November 1957). "Cyclic variations in EEG during sleep and their relation to eye movements, body motility, and dreaming". Electroencephalography and Clinical Neurophysiology9 (4): 673–690. doi:10.1016/0013-4694(57)90088-3. PMID 13480240. </ref> It is pointed out that wakefulness and stages of sleep have a specific EEG pattern. The wakefulness is associated with Beta and Gama waves frequencies in EEG pattern, which depends on pleasurable or painful stressors of surrounding environment. Stage 1 non-rapid eye movement (NREM) sleep is characterized by slowing down of Beta and Gama wave frequencies, reached to slow down the Alpha wave, and finally reached to Theta wave frequencies in EEG pattern. At a higher stage of NREM and REM, these brain wave frequencies in EEG pattern gradually decreases, and the person falls into sleep. By observing overall brain activity in EEG pattern, we can say that frequencies of sleep waves are low in wakefulness and it is gradual increases in different stages of sleep. Sleep spindles and K-complexes appeared in EEG pattern in Stage 2 of sleep, while more sleep spindles are observed in Stage 3 of sleep. The slow wave sleep is also known as high amplitude Delta wave, which is commonly observed in Stages 3 and 4 of sleep in EEG pattern. Low amplitude, mixed frequency waves- a sawtooth wave in EEG pattern observed at REM stage of sleep.<ref> ~~71.~~ BARKER, W; BURGWIN, S (1948 Nov-Dec). "Brain wave patterns accompanying changes in sleep and wakefulness during hypnosis." Psychosomatic Medicine10 (6): 317–26. PMID 18106841. </ref> <ref>Jankel, WR; Niedermeyer, E (January 1985). "Sleep spindles.". Journal of clinical neurophysiology: official publication of the American Electroencephalographic Society2 (1): 1–35. PMID 3932462. </ref> <ref>Loomis, A. L.; Harvey, E. N.; Hobart, G. A (1938). "Distribution of disturbance-patterns in the human electroencephalogram with special reference to sleep". Journal of Neurophysiology1: 413–430. </ref>(verse 35)

+

The age-old concepts of sleep ([[nidra]]) and its different stages such as ''jagrata'', ''swapana'' and ''sushupti'' are comparable to the current concept of sleep and its stages. The problems and pattern of sleep are assessed by observing the activity of brain through Electroencephalogram (EEG) pattern.<ref>Dement, William; Kleitman, Nathaniel (1 November 1957). "Cyclic variations in EEG during sleep and their relation to eye movements, body motility, and dreaming". Electroencephalography and Clinical Neurophysiology9 (4): 673–690. doi:10.1016/0013-4694(57)90088-3. PMID 13480240. </ref> It is pointed out that wakefulness and stages of sleep have a specific EEG pattern. The wakefulness is associated with Beta and Gama waves frequencies in EEG pattern, which depends on pleasurable or painful stressors of surrounding environment. Stage 1 non-rapid eye movement (NREM) sleep is characterized by slowing down of Beta and Gama wave frequencies, reached to slow down the Alpha wave, and finally reached to Theta wave frequencies in EEG pattern. At a higher stage of NREM and REM, these brain wave frequencies in EEG pattern gradually decreases, and the person falls into sleep. By observing overall brain activity in EEG pattern, we can say that frequencies of sleep waves are low in wakefulness and it is gradual increases in different stages of sleep. Sleep spindles and K-complexes appeared in EEG pattern in Stage 2 of sleep, while more sleep spindles are observed in Stage 3 of sleep. The slow wave sleep is also known as high amplitude Delta wave, which is commonly observed in Stages 3 and 4 of sleep in EEG pattern. Low amplitude, mixed frequency waves- a sawtooth wave in EEG pattern observed at REM stage of sleep.<ref>BARKER, W; BURGWIN, S (1948 Nov-Dec). "Brain wave patterns accompanying changes in sleep and wakefulness during hypnosis." Psychosomatic Medicine10 (6): 317–26. PMID 18106841. </ref> <ref>Jankel, WR; Niedermeyer, E (January 1985). "Sleep spindles.". Journal of clinical neurophysiology: official publication of the American Electroencephalographic Society2 (1): 1–35. PMID 3932462. </ref> <ref>Loomis, A. L.; Harvey, E. N.; Hobart, G. A (1938). "Distribution of disturbance-patterns in the human electroencephalogram with special reference to sleep". Journal of Neurophysiology1: 413–430.</ref>[verse 35]

==== Sleep regulation ====

−

It is presumed that the sleep physiology is controlled by the hypothalamus and the suprachiasmatic nucleus (SCN) in the brain, which regulates mechanism of homeostatic and circadian rhythm respectively of the body. The actual mechanism of the physiology of sleep is still evolving in biomedical sciences. The sleep is initiated and begins by projections from the SCN to the brain stem. Borbely called projections as Process S (homeostatic) and Process C (Circadian) respectively, who first proposed these two process models in 1982. He pointed out that maximum sleep is the outcome of significant differences between homeostatic and circadian rhythm.<ref name=ref74>Saper, Clifford B.; Scammell, Thomas E.; Lu, (Jun (27 October 2005)): "Hypothalamic regulation of sleep and circadian rhythms". Nature437 (7063): 1257–1263. doi:10.1038/nature04284. PMID 16251950.</ref>(verse 39-43)

+

It is presumed that the sleep physiology is controlled by the hypothalamus and the suprachiasmatic nucleus (SCN) in the brain, which regulates mechanism of homeostatic and circadian rhythm respectively of the body. The actual mechanism of the physiology of sleep is still evolving in biomedical sciences. The sleep is initiated and begins by projections from the SCN to the brain stem. Borbely called projections as Process S (homeostatic) and Process C (Circadian) respectively, who first proposed these two process models in 1982. He pointed out that maximum sleep is the outcome of significant differences between homeostatic and circadian rhythm.<ref name=ref74>Saper, Clifford B.; Scammell, Thomas E.; Lu, (Jun (27 October 2005)): "Hypothalamic regulation of sleep and circadian rhythms". Nature437 (7063): 1257–1263. doi:10.1038/nature04284. PMID 16251950.</ref>[verse 39-43]

==== Effects of sleep ====

−

Recent conventional evidence suggests that seasonal variation can have an impact on sleep/wake cycle, which is quite interesting and proven the age-old concept of [[Ayurveda]]. Recent evidence shows that core temperature of body and secretion of melatonin hormone levels are slightly greater in the month of summer due to prolong the length of light exposure, which imparts significant role in daytime sleep in summer. This is the reason people go to bed early at night and wake up early in the morning in the month of summer. Sunlight exposure in the morning hours may affect internal biological clock, shifting the timing of the sleep window. The need and function of sleep are the most lacking areas of sleep research in biomedical sciences. Some of the important ones are- restoration and recovery of body systems, energy conservation, memory consolidation, protection from predation, brain development, and discharge of emotions.<ref name=ref74/> <ref>Krueger, James M.; Obál, Ferenc; Fang, Jidong. "Why we sleep: a theoretical view of sleep function". Sleep Medicine Reviews3 (2): 119–129. doi:10.1016/S1087-0792(99)90019-9. </ref> <ref>KRUEGER, JAMES M.; OBÄL, FERENC (1 June 1993). "A neuronal group theory of sleep function". Journal of Sleep Research2 (2): 63–69. doi:10.1111/j.1365-2869.1993.tb00064.x. </ref> <ref>Friborg, O., Bjorvatn, B., Amponsah, B., Pallesen, S. (2012). Associations between seasonal variations in day length (photoperiod), sleep timing, sleep quality and mood: a comparison between Ghana (5°) and Norway (69°). Journal of Sleep Research, 21(2), 176-184.) </ref>(verse 36-38 and 44-49)

+

Recent conventional evidence suggests that seasonal variation can have an impact on sleep/wake cycle, which is quite interesting and proven the age-old concept of [[Ayurveda]]. Recent evidence shows that core temperature of body and secretion of melatonin hormone levels are slightly greater in the month of summer due to prolong the length of light exposure, which imparts significant role in daytime sleep in summer. This is the reason people go to bed early at night and wake up early in the morning in the month of summer. Sunlight exposure in the morning hours may affect internal biological clock, shifting the timing of the sleep window. The need and function of sleep are the most lacking areas of sleep research in biomedical sciences. Some of the important ones are- restoration and recovery of body systems, energy conservation, memory consolidation, protection from predation, brain development, and discharge of emotions.<ref name=ref74/> <ref>Krueger, James M.; Obál, Ferenc; Fang, Jidong. "Why we sleep: a theoretical view of sleep function". Sleep Medicine Reviews3 (2): 119–129. doi:10.1016/S1087-0792(99)90019-9. </ref> <ref>KRUEGER, JAMES M.; OBÄL, FERENC (1 June 1993). "A neuronal group theory of sleep function". Journal of Sleep Research2 (2): 63–69. doi:10.1111/j.1365-2869.1993.tb00064.x. </ref> <ref>Friborg, O., Bjorvatn, B., Amponsah, B., Pallesen, S. (2012). Associations between seasonal variations in day length (photoperiod), sleep timing, sleep quality and mood: a comparison between Ghana (5°) and Norway (69°). Journal of Sleep Research, 21(2), 176-184.) </ref>[verse 36-38 and 44-49]

−

==== Sleep about ''atisthula'' and ''atikrisha'' ====

+

==== Sleep about [[atisthula]] and [[atikrisha]] ====

−

Recent evidence suggests that a good sleep plays an important role in the regulation of neuroendocrine, hormonal and metabolic function in the body. Since last few decades, the timing and quality of sleep is gradually hampered due to the affliction of modernization in many ways. At present, the adult and children progressively reduce bedtimes and increases times for other activities, which affect the metabolic functions in many ways. The ''atisthula'' and ''atikrisha'' are also the outcome of excessive sleep and lack of sleep and vice-versa. Evidence shows that sleep loss for prolong period may provoke the risk of weight gain and morbid obesity. Further, sleep reduction in young adults affects metabolic and endocrine functions in various ways such as- insulin resistance, hyperglycemia, elevated sympathovagal activity, an elevated level of serum glucocorticoid hormone, increased levels of ghrelin, and decreased the level of leptin. Due to improper and lack of good quality of sleep in adolescents may be important factors to consider in the prevention of childhood obesity.<ref>Neeraj K. Gupta,William H. Mueller,Wenyaw Chan, Janet C. Meininger (2002).: Is obesity associated with poor sleep quality in adolescents?. Am. J. Hum. Biol.; 14:762–768, 2002. </ref> Probably this is the reason that sleep is mentioned in ~~''ashṭoninditiya''~~ chapter by Charak about ''atisthula'' and ''atikrisha'' like other dietary and lifestyle intervention.(verse 51)

+

Recent evidence suggests that a good sleep plays an important role in the regulation of neuroendocrine, hormonal and metabolic function in the body. Since last few decades, the timing and quality of sleep is gradually hampered due to the affliction of modernization in many ways. At present, the adult and children progressively reduce bedtimes and increases times for other activities, which affect the metabolic functions in many ways. The [[atisthula]] and [[atikrisha]] are also the outcome of excessive sleep and lack of sleep and vice-versa. Evidence shows that sleep loss for prolong period may provoke the risk of weight gain and morbid obesity. Further, sleep reduction in young adults affects metabolic and endocrine functions in various ways such as- insulin resistance, hyperglycemia, elevated sympathovagal activity, an elevated level of serum glucocorticoid hormone, increased levels of ghrelin, and decreased the level of leptin. Due to improper and lack of good quality of sleep in adolescents may be important factors to consider in the prevention of childhood obesity.<ref>Neeraj K. Gupta,William H. Mueller,Wenyaw Chan, Janet C. Meininger (2002).: Is obesity associated with poor sleep quality in adolescents?. Am. J. Hum. Biol.; 14:762–768, 2002. </ref> Probably this is the reason that sleep is mentioned in the present chapter by Charak about [[atisthula]] and [[atikrisha]] like other dietary and lifestyle intervention.[verse 51]

==== Insomnia or sleeplessness ====

Line 882: Line 891:

Improper sleep has a harmful impact on carbohydrate metabolism and endocrine function. Besides, it also reduces the metabolic activity in the brain with prolonging lack of sleep. The effects are similar to those seen in normal aging and, therefore, sleep debt may increase the severity of age-related chronic disorders. <ref name=ref85>Van Dongen, HP; Maislin, G; Mullington, JM; Dinges, DF (2003-03-15). "The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation.". Sleep26 (2): 117–26.</ref> Lack of sleep for prolonged period has been shown to affect cognitive functions of people involved in versatile activities along with interfering in mood and emotion. This is one of reason to increased tendency to fear, depression, and rage in the people having a deficiency in sleep. The mechanism and effects of sleep deficit are still evolving in the pathophysiology of sleep deficit.<ref>Karine Spiegel, Rachel Leproult, BS, Eve Van Cauter.: Impact of sleep debt on metabolic and endocrine function. The lancet, Volume 354, Issue 9188, 23 October 1999, Pages 1435–1439. </ref> <ref name=ref85/> <ref>Chee, MW; Chuah, LY (August 2008). "Functional neuroimaging insights into how sleep and sleep deprivation affect memory and cognition.". Current Opinion in Neurology21 (4): 417–23. </ref>

−

The concept of ~~''Nidra''~~ in [[Ayurveda]] is quite comparable to the sleep of biomedical sciences. The ''nidra'' is so important for the maintenance of health and sustaining the life. This is true in the light of contemporary scientific knowledge too. According to [[Ayurveda]], ''kapha'' and ''tamas'' are responsible for ''nidra'' even as modern studies attribute the occurrence of sleep to many factors including stimulation of certain areas of the brain. [[Ayurveda]] classifies the ''nidra'' based on the mode of origin while modern classification of sleep based on physiological variations seen in association with the different types of sleep. Some factors like food, activities, external stimuli, etc. affect ''nidra'' or sleep. Any variation in the normal sleep pattern is not at all desirable, and they may cause serious health problems that demand proper medical attention.(verse 52-54)

+

The concept of [[nidra]] in [[Ayurveda]] is quite comparable to the sleep of biomedical sciences. The [[nidra]] is so important for the maintenance of health and sustaining the life. This is true in the light of contemporary scientific knowledge too. According to [[Ayurveda]], [[kapha]] and [[tamas]] are responsible for [[nidra]] even as modern studies attribute the occurrence of sleep to many factors including stimulation of certain areas of the brain. [[Ayurveda]] classifies the [[nidra]] based on the mode of origin while modern classification of sleep based on physiological variations seen in association with the different types of sleep. Some factors like food, activities, external stimuli, etc. affect [[nidra]] or sleep. Any variation in the normal sleep pattern is not at all desirable, and they may cause serious health problems that demand proper medical attention.[verse 52-54]

=== Conclusion ===

−

The present chapter reveals that the clinical entity, consequences, and management of too obese, too lean, insomnia, along with categorization of good built, information and mechanism of sleep and measures to induce good sleep was fairly well known even in the classical period of [[Ayurveda]], which is comparable to the latest development in this field. The Ayurvedic classics vividly describe the etiological factors, pathogenesis, clinical presentation, complications and its categories and treatment modalities of too obese, which has a striking resemblance to the latest development in this field. The ''samprapti'' (pathogenesis) of this disease is based on the specific ''dosha-dushya'' pattern. Besides, the special emphasis placed on vitiation of ~~''medas''~~. The age-old ideas are now getting strong scientific support for the emerging concept of prediabetes, insulin resistance, and metabolic syndrome, signifying the role of lipid disorders in the pathogenesis, hypometabolic state (''ama'' state) and immunodeficiency in these disorders. Numbers of complications have been described in this context including ''prameha'', GI problems, skin disorders, etc. It is presumed that in the diathesis of complications, impaired status of ''agni, ojas'' and ~~''medas''~~ play an important role6.

+

The present chapter reveals that the clinical entity, consequences, and management of too obese, too lean, insomnia, along with categorization of good built, information and mechanism of sleep and measures to induce good sleep was fairly well known even in the classical period of [[Ayurveda]], which is comparable to the latest development in this field. The Ayurvedic classics vividly describe the etiological factors, pathogenesis, clinical presentation, complications and its categories and treatment modalities of too obese, which has a striking resemblance to the latest development in this field. The ''samprapti'' (pathogenesis) of this disease is based on the specific [[dosha]]-dushya pattern. Besides, the special emphasis placed on vitiation of [[meda dhatu]]. The age-old ideas are now getting strong scientific support for the emerging concept of prediabetes, insulin resistance, and metabolic syndrome, signifying the role of lipid disorders in the pathogenesis, hypometabolic state (''ama'' state) and immunodeficiency in these disorders. Numbers of complications have been described in this context including ''prameha'', GI problems, skin disorders, etc. It is presumed that in the diathesis of complications, impaired status of agni, [[ojas]] and [[meda dhatu]] play an important role6.

On The overall assessment, the concept of overweight and obesity, emaciation, sleep and its type, indications, and contraindications of day sleep, the role of sleep in obesity, causes of insomnia and features of good and bad sleep along with features of good body built was a well-known entity since antiquity. The available descriptions appear very contemporary and scientific. Certain therapeutic modalities have close resemblance with several non-drug approaches of modern medicine. These modalities can be combined judiciously for individualized prevention and cure of too obese, too lean and insomnia. The current approaches and management of too obese and too lean along with insomnia are still not satisfactory in the conventional system of medicine; this chapter provides a new outlook to scholars and researchers of [[Ayurveda]], which is based on current publications and reports.

</div>

+

<big>'''[[Special:ContactMe|Send us your suggestions and feedback on this page.]]'''</big>

==References==

Agnivesha

Administrators, Editors, Bots, Bureaucrats, Charaksamhita, Moderators (CommentStreams), Interface administrators, Administrators

10,100

edits

Changes

Ashtauninditiya Adhyaya (view source)

Revision as of 12:32, 6 March 2023

Navigation menu

Search