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

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

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

<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'')

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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]  

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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]

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

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

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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]].  

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

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

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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]

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

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

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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]

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

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

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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]

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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]

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]

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=== Summary ===

=== Summary ===

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*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 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]

*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]

*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]

*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]

*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]

*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]

*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]

*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]

*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]

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

=== Morbid obesity ===

=== 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  ===

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

=== Conclusion ===

=== 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.

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.

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==References==

==References==