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{{#seo:

{{#seo:

|title=Santarpaniya Adhyaya

|title=Santarpaniya Adhyaya

|keywords=santarpana (over-nutrition), apatarpana (under-nutrition), management of over-nutrition induced disorders, nutrition deficiency disorders, charak samhita, obesity, dislipidemia, hypercholesterolemia, Ayurveda, Indian system of medicine, charak samhita.  

|keywords=santarpana (over-nutrition), apatarpana (under-nutrition), management of over-nutrition induced disorders, nutrition deficiency disorders, charak samhita, obesity, dislipidemia, hypercholesterolemia, Ayurveda, Indian system of medicine, charak samhita.  

|description=Sutra Sthana Chapter 23. Over-nutrition, under-nutrition and its disorders

|description=Sutra Sthana Chapter 23. Over-nutrition, under-nutrition and its disorders

|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

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|type=article

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}}

}}

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

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

{{Infobox

{{Infobox

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

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

|label6 = Translator and commentator

|label6 = Translator and commentator

|data6 = Sabnis M., Deole Y. S.

|data6 = Sabnis M., [[Yogesh Deole|Deole Y. S.]]

|label7 = Reviewer  

|label7 = Reviewer  

|data7  = Byadgi P.S.

|data7  = Byadgi P.S.

|label8 = Editor

|label8 = Editors

|data8  = Dwivedi R.B.

|data8  = Dwivedi R.B., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]

|label9 = Date of publication  

|label9 = Year of publication  

|data9 = December 17, 2018

|data9 = 2020

|label10 = DOI

|label10 = Publisher

|data10  = [https://doi.org/10.47468/CSNE.2020.e01.s01.025 10.47468/CSNE.2020.e01.s01.025]

|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

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

}}

}}

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

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

 

<p style="text-align:justify;">Diseases are caused due to over nutrition and under nutrition. This chapter enlists the causative factors affecting nutritional status leading to two categories of diseases viz. Santarpana (over-nutrition) and apatarpana (under nutrition).  The dietary and lifestyle management of these two disease categories is also elaborated.  Nutraceutical preparations, weight reducing recipes, therapeutic procedures like panchakarma and other associated procedures are described with  medicaments. The chapter also contains a comprehensive list of commonly available herbs used in treatment of these diseases. </br>

<div style="text-align:justify;">Diseases are caused due to over nutrition and under nutrition. This chapter enlists the causative factors affecting nutritional status leading to two categories of diseases viz. Santarpana (over-nutrition) and apatarpana (under nutrition).  The dietary and lifestyle management of these two disease categories is also elaborated.  Nutraceutical preparations, weight reducing recipes, therapeutic procedures like panchakarma and other associated procedures are described with  medicaments. The chapter also contains a comprehensive list of commonly available herbs used in treatment of these diseases. </div>

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

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

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</p>

== Introduction ==

== Introduction ==

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In the series of chapters described for management principles, the present chapter describes two most commonly observed conditions in society viz. ''santarpana'' (over-nutrition) and ''apatarpana'' (undernutrition). It is sequenced after ''langhana'' and ''brimhana'' therapies. The present chapter enlists causes and diseases due to over-nutrition and under-nutrition and their management through diet and medicaments. It is a blend of nutraceutical food supplements with medicaments. Complications arising due to sedentary lifestyle and over-nutritive diet are also enlisted in the chapter with diseases caused due to undernutrition/ malnourishment and their management with simple dietary preparations. The pharmacological effect of herbs used in management are elaborated in detail as well.  

In the series of chapters described for management principles, the present chapter describes two most commonly observed conditions in society viz. santarpana(over-nutrition) and apatarpana(undernutrition). It is sequenced after [[langhana]] and [[brimhana]] therapies. The present chapter enlists causes and diseases due to over-nutrition and under-nutrition and their management through diet and medicaments. It is a blend of nutraceutical food supplements with medicaments. Complications arising due to sedentary lifestyle and over-nutritive diet are also enlisted in the chapter with diseases caused due to undernutrition/ malnourishment and their management with simple dietary preparations. The pharmacological effect of herbs used in management are elaborated in detail as well.  

''Santarpana'' (overnutrition) leads to vitiation of ''kapha dosha and meda dhatu'' and various obstructive pathologies, whereas ''apatarpana'' (undernutrition) leads to ''vata-pitta dosha'' vitiation and various degenerative pathologies. This concept has been emphasized in this chapter.

Santarpana(overnutrition) leads to vitiation of [[kapha]] [[dosha]] and [[meda dhatu]] and various obstructive pathologies, whereas apatarpana(undernutrition) leads to [[vata]]-[[pitta]] [[dosha]] vitiation and various degenerative pathologies. This concept has been emphasized in this chapter.

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==Sanskrit text, Transliteration and English Translation==

==Sanskrit text, Transliteration and English Translation==

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Due to above mentioned causative factors, if the effects of ''santarpana'' are not treated properly, one suffers from various diseases such as obstinate urinary disorders including diabetes, carbuncles, urticaria, itching, ''pandu'' (anaemia), ''amaja'' diseases (i.e., due to formation of ''ama''), ''jwara,'' obstinate skin diseases, diseases secondary to vitiation of ''ama'', dysuria, anorexia or appetite related complaints, ''tandra'' (drowsiness/sleepiness), ''klaibya'' (erectile and sexual dysfunctions), obesity, laziness, heaviness of the body, adhesion or blockages in  the channels as well as  sense organs, delusion, various types of edema, and such of other diseases. [5-7]

Due to above mentioned causative factors, if the effects of ''santarpana'' are not treated properly, one suffers from various diseases such as obstinate urinary disorders including diabetes, carbuncles, urticaria, itching, ''pandu'' (anaemia), ''amaja'' diseases (i.e., due to formation of ''ama''), [[jwara]],obstinate skin diseases, diseases secondary to vitiation of ''ama'', dysuria, anorexia or appetite related complaints, ''tandra'' (drowsiness/sleepiness), ''klaibya'' (erectile and sexual dysfunctions), obesity, laziness, heaviness of the body, adhesion or blockages in  the channels as well as  sense organs, delusion, various types of edema, and such of other diseases. [5-7]

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''Santarpaniya vyadhis'' and their complications should be managed by ''ullekhana'' (therapeutic emesis), ''virechana'' (therapeutic purgation), ''raktamokshana'' (blood-letting), specific exercises, therapeutic fasting, ''dhooma'' (hot fomentation with smoke of medicinal plants), and ''swedana'' (sudation). [8]

''Santarpaniya vyadhis'' and their complications should be managed by ullekhana(therapeutic emesis), [[virechana]] (therapeutic purgation), [[raktamokshana]](blood-letting), specific exercises, therapeutic fasting, ''dhooma'' (hot fomentation with smoke of medicinal plants), and [[swedana]](sudation). [8]

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Formulations made up of ''haritaki'' (Terminalia Chebula), such as ''agastyaharitaki'' mixed with honey, habituating with ''ruksha'' food (i.e., without using unctuous substances like oil, ghee etc.), those powders and poultice described in treatment of pruritus and urticaria (mentioned in the third chapter of this section) are advised. [9]

Formulations made up of haritaki(Terminalia Chebula), such as agastyaharitaki mixed with honey, habituating with ruksha food (i.e., without using unctuous substances like oil, ghee etc.), those powders and poultice described in treatment of pruritus and urticaria (mentioned in the third chapter of this section) are advised. [9]

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All ''santarpaniya'' diseases can be cured, if the juices (decoction) of ''musta, aaragvadha, paatha, triphala, devadaru'' (Cedrus deodara), ''shvadamshtra'' (Trinbulus terrestris), ''khadira'' (Acacia catechu Wild), ''nimba, haridra'' (Curcuma longa), ''daruharidra'' (Berberis aristata) and the bark of ''vatsaka'' (Holarrhena anti-dysenterica) are consumed every morning (depending upon the dominant ''dosha'' in the disease).  

All ''santarpaniya'' diseases can be cured, if the juices (decoction) of ''musta, aaragvadha, paatha, triphala, devadaru'' (Cedrus deodara), ''shvadamshtra'' (Trinbulus terrestris), ''khadira'' (Acacia catechu Wild), ''nimba, haridra'' (Curcuma longa), ''daruharidra'' (Berberis aristata) and the bark of ''vatsaka'' (Holarrhena anti-dysenterica) are consumed every morning (depending upon the dominant [[dosha]] in the disease).  

If the above herbs are used in a powdered form for ''udvartana'' with or without massage or the decoction of the above herbs are used for medicinal bath or if the oil made up of above drugs is used for body application it relieves all the skin disorders caused due to ''santarpaniya vyadhis''.[12-14]

If the above herbs are used in a powdered form for ''udvartana'' with or without massage or the decoction of the above herbs are used for medicinal bath or if the oil made up of above drugs is used for body application it relieves all the skin disorders caused due to ''santarpaniya vyadhis''.[12-14]

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Emaciation of the body, reduction in the power of digestion, strength, complexion, ''ojas'' (vital essence of body related with immunity and general strength), semen and muscle tissue, ''jwara'' (continuous fever and cough like condition), pain in chest and flanks, anorexia, weakness in the power of hearing sounds, psychosis, delirium, pain in cardiac region, accumulation of stool and urine, pain in calf, thigh and lumber regions, cracking pain in fingers, bones and joints, and such other diseases due to the vitiation of ''vata'' (such as ''urdhava'' ''vata'' upward movement of ''vata''), etc. are caused due to improper nutrition and starvation. [27- 29]

Emaciation of the body, reduction in the power of digestion, strength, complexion, [[ojas]] (vital essence of body related with immunity and general strength), semen and muscle tissue, [[jwara]] (continuous fever and cough like condition), pain in chest and flanks, anorexia, weakness in the power of hearing sounds, psychosis, delirium, pain in cardiac region, accumulation of stool and urine, pain in calf, thigh and lumber regions, cracking pain in fingers, bones and joints, and such other diseases due to the vitiation of [[vata]](such as ''urdhava'' [[vata]] upward movement of [[vata]]), etc. are caused due to improper nutrition and starvation. [27- 29]

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Some of the critical factors for deciding a course of treatment of emaciation in chronic patients include: body constitution, power of digestion, predominant ''doshas'', form of medicine, dose, and season and time of administration (of the therapy). [32]

Some of the critical factors for deciding a course of treatment of emaciation in chronic patients include: body constitution, power of digestion, predominant [[dosha]], form of medicine, dose, and season and time of administration (of the therapy). [32]

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For these patients suffering from continuous ''jwara'' (fever like conditions), cough, emaciation, dysuria, thirst and upward movement of ''vata'', the following nourishing drinks are prescribed. [34]

For these patients suffering from continuous [[jwara]] (fever like conditions), cough, emaciation, dysuria, thirst and upward movement of [[vata]], the following nourishing drinks are prescribed. [34]

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''Saktu'' (roasted corn flour/ coarse ground meal) with ''madira'' (wine), honey and sugar are refreshing and shall be consumed for the elimination of flatus (obstructed ''vata''), faeces, urine, ''kapha'' and ''pitta''. [36]

''Saktu'' (roasted corn flour/ coarse ground meal) with ''madira'' (wine), honey and sugar are refreshing and shall be consumed for the elimination of flatus (obstructed [[vata]]), faeces, urine, [[kapha]] and [[pitta]]. [36]

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== Tattva Vimarsha (Fundamental Principles) ==

== Tattva Vimarsha (Fundamental Principles) ==

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1. Intake of calorie rich and excessive food and nutrition with little or no physical exercise, results in increased body tissues. This contributes to causing diseases such as metabolic syndrome. These conditions are managed by purification therapies leading to reduction (''langhana''), and prescribing a regimen of physical exercise, appropriate dietary changes, fomentation and reducing drugs.  

1. Intake of calorie rich and excessive food and nutrition with little or no physical exercise, results in increased body tissues. This contributes to causing diseases such as metabolic syndrome. These conditions are managed by purification therapies leading to reduction ([[langhana]]), and prescribing a regimen of physical exercise, appropriate dietary changes, fomentation and reducing drugs.  

2. Excessive physical and/or mental activities without adequate nutrition causes nutritional deficiency diseases like wasting and psychosis. Treatment is high calorie but less filling diet, rest, medicated oil enema and massage. In cases of acute weight loss, nutrition should be given immediately while in the case of chronic loss, the process should be gradual but prolonged.

2. Excessive physical and/or mental activities without adequate nutrition causes nutritional deficiency diseases like wasting and psychosis. Treatment is high calorie but less filling diet, rest, medicated oil enema and massage. In cases of acute weight loss, nutrition should be given immediately while in the case of chronic loss, the process should be gradual but prolonged.

 

== Vidhi Vimarsha(Applied Inferences)==

== Vidhi Vimarsha(Applied Inferences)==

=== I. Properties of ''Santarpanakarak'' food articles ===

=== I. Properties of ''Santarpanakarak'' food articles ===

   

   

Unctuous (''snigdha''), sweet (''madhura''), heavy to digest (''guru''), and slimy (''pichhilla'') foods predominantly have ''prithvi'' and ''apa mahabhutas'', leading to an increase in ''kapha'' and ''rasa dhatu''.  

Unctuous (''snigdha''), sweet (''madhura''), heavy to digest (''guru''), and slimy (''pichhilla'') foods predominantly have [[Prithvi]] and [[jala mahabhuta]], leading to an increase in [[kapha]] and [[rasa dhatu]].  

The functional trait of such food articles is ''snigdha'' (oily) ''guna'' is ''sneha'' (unctuousness), ''mriduta'' (softness), and ''ardrata'' (malleability, fluidity)<ref> Gothecha Mohanlal., Dr., editor. Guna Parijnana. Jamnagar: Post Graduate Training Center in [[Ayurveda]]; 1958. pp. 19–20. </ref>  <ref> Sushruta. Sutra Sthana, Cha.41 Dravyavisheshavinjaniya Adhyaya verse 11. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. </ref>. ''Snigdha'' food articles include those derived from lipids and fat molecules. Similarly, ''madhura'' (sweetness) is a property of food substances that possess predominantly sweet taste - not just perceived at the tongue, but also in many parts/tissues along our digestive system. ''Guru'' is the primary property that indicates “heaviness” of a food item, and a ''guru'' food article is heavy to digest and increases bulkiness of the tissues. ''Guru'' is the opposite of ''agni'' and hence delays digestion and metabolism and is used, therefore, in therapies that require nourishment, enhancement of physical strength, etc (''brimhana, agnimaandyakara, upalepa, bala, upachaya'' and ''tarpana''). Finally, ''picchilla'' is sliminess and stickiness, and indicates food items that vitiate ''kapha'' and ''mamsa-meda dhatu'' particularly.  

The functional trait of such food articles is ''snigdha'' (oily) [[guna]] is ''sneha'' (unctuousness), ''mriduta'' (softness), and ''ardrata'' (malleability, fluidity)<ref> Gothecha Mohanlal., Dr., editor. Guna Parijnana. Jamnagar: Post Graduate Training Center in [[Ayurveda]]; 1958. pp. 19–20. </ref>  <ref> Sushruta. Sutra Sthana, Cha.41 Dravyavisheshavinjaniya Adhyaya verse 11. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. </ref>. ''Snigdha'' food articles include those derived from lipids and fat molecules. Similarly, ''madhura'' (sweetness) is a property of food substances that possess predominantly sweet taste - not just perceived at the tongue, but also in many parts/tissues along our digestive system. ''Guru'' is the primary property that indicates “heaviness” of a food item, and a ''guru'' food article is heavy to digest and increases bulkiness of the tissues. ''Guru'' is the opposite of [[agni]] and hence delays digestion and metabolism and is used, therefore, in therapies that require nourishment, enhancement of physical strength, etc ([[brimhana]], agnimaandyakara, upalepa, bala, upachaya'' and ''tarpana''). Finally, ''picchilla'' is sliminess and stickiness, and indicates food items that vitiate [[kapha]] and [[mamsa]] and [[meda dhatu]] particularly.  

Today’s research is consistent with the above findings of [[Ayurveda]]. Researchers acknowledge that taste receptors exist in the upper gastrointestinal tract as well. These receptors are “primarily located in the intestinal brush and enteroendocrine cells, and recognize sugars, D-amino acids, sweet proteins, and artificial sweeteners<ref>Greenfield Jerry R.,  Chisholm Donald J.  How Sweet It Is: Intestinal Sweet Taste Receptors in Type 2 Diabetes. Diabetes. 2013 Oct; 62(10): 3336–3337.</ref>”, per their research. Peptide YY (PYY) exerts its action through NPY receptors by inhibiting gastric motility and increasing water and electrolyte absorption in the colon<ref> Liu C, Aloia T, Adrian T, Newton T, Bilchik A, Zinner M, Ashley S, McFadden D (1996). "Peptide YY: a potential proabsorptive hormone for the treatment of malabsorptive disorders". Am Surg 62 (3): 232–6.Charak Samhita Sutra Sthana 27/309 </ref>.  PYY may also suppress pancreatic secretion, as it is secreted by neuro-endocrine cells in the ileum and colon in response to a meal, and has been shown to reduce appetite. It works by slowing the gastric emptying, thereby increasing the efficiency of digestion and nutrient absorption after a meal. Considering the effects of sweet food substances, PYY, in certain quantities, helps induce satiety in a person and thus in excess, inhibits appetite. This study clearly suggests the impact of ''madhura rasa'' and ''snigdha'' food substances in creating ''santarpaniya vyadhi'' or increased anabolism. Like GLP -1, GIP is related to metabolism and inflammation.  

Today’s research is consistent with the above findings of [[Ayurveda]]. Researchers acknowledge that taste receptors exist in the upper gastrointestinal tract as well. These receptors are “primarily located in the intestinal brush and enteroendocrine cells, and recognize sugars, D-amino acids, sweet proteins, and artificial sweeteners<ref>Greenfield Jerry R.,  Chisholm Donald J.  How Sweet It Is: Intestinal Sweet Taste Receptors in Type 2 Diabetes. Diabetes. 2013 Oct; 62(10): 3336–3337.</ref>”, per their research. Peptide YY (PYY) exerts its action through NPY receptors by inhibiting gastric motility and increasing water and electrolyte absorption in the colon<ref> Liu C, Aloia T, Adrian T, Newton T, Bilchik A, Zinner M, Ashley S, McFadden D (1996). "Peptide YY: a potential proabsorptive hormone for the treatment of malabsorptive disorders". Am Surg 62 (3): 232–6.Charak Samhita Sutra Sthana 27/309 </ref>.  PYY may also suppress pancreatic secretion, as it is secreted by neuro-endocrine cells in the ileum and colon in response to a meal, and has been shown to reduce appetite. It works by slowing the gastric emptying, thereby increasing the efficiency of digestion and nutrient absorption after a meal. Considering the effects of sweet food substances, PYY, in certain quantities, helps induce satiety in a person and thus in excess, inhibits appetite. This study clearly suggests the impact of ''madhura rasa'' and ''snigdha'' food substances in creating ''santarpaniya vyadhi'' or increased anabolism. Like GLP -1, GIP is related to metabolism and inflammation.  

=== II. Impact of age on grains and grain-based food products ===

=== II. Impact of age on grains and grain-based food products ===

The age of food grains helps determine the quality as well as digestibility of food. ''Shuka dhanya'' (monocotyledons) and ''shami dhanya'' (dicotyledons) that are old /aged are easy to digest and are dry in property as compared to new ones. [Cha.Sa.[[Sutra Sthana]] 27/309] ''Nava anna'', or fresh, non-aged rice, millet, etc. increase ''kapha'' and are heavier than old grains. Charak notes that all new and fresh grains are heavy and induce ''santarpana'', while aged grains are lighter to digest.

The age of food grains helps determine the quality as well as digestibility of food. ''Shuka dhanya'' (monocotyledons) and ''shami dhanya'' (dicotyledons) that are old /aged are easy to digest and are dry in property as compared to new ones. [Cha.Sa.[[Sutra Sthana]] 27/309] ''Nava anna'', or fresh, non-aged rice, millet, etc. increase [[kapha]] and are heavier than old grains. Charak notes that all new and fresh grains are heavy and induce ''santarpana'', while aged grains are lighter to digest.

Sharangdhara in Purva Khanda also talks of new and old grains and recommends six to twelve month-old grains to be used. Biochemical changes that help in digestion may be occurring after certain aging of grains. Per researchers (Seguchi, 1993), aging of flour and grains does enhance their functionality as ingredients for cakes and batter. Cereals can be stored for long periods without microbial spoilage. However, biochemical changes also occur during aging. There is great possibility that certain amino acids and phyto chemicals get stabilized in the grain which make them safe for consumption. Eventually, the grain respires, dry matter is lost and functional and nutritional aspects of the grain are altered. Age related changes have great influence on the viscosity of any batter made out of wheat-flour and the water-binding ability of the wheat flour (Shelke et al, 1992). In addition, the starch granule surface protein is found to increase up to three to four times with aging. However, prolonged aging is not recommended (Pomeranz et al, 1968). The moisture content of grains, the storage temperature and relative humidity have been shown to exert dramatic changes in the acidity, pH, free amino nitrogen, crude protein, and protein quality. Significant changes in soluble sugars and amylase contents of the grains have also been reported during storage at elevated temperature<ref> Zia-Ur Rehman, W.H. Shah. Biochemical changes in wheat during storage at three temperatures. Plant Foods for Human Nutrition 54: 109–117, 1999. </ref>.   

Sharangdhara in Purva Khanda also talks of new and old grains and recommends six to twelve month-old grains to be used. Biochemical changes that help in digestion may be occurring after certain aging of grains. Per researchers (Seguchi, 1993), aging of flour and grains does enhance their functionality as ingredients for cakes and batter. Cereals can be stored for long periods without microbial spoilage. However, biochemical changes also occur during aging. There is great possibility that certain amino acids and phyto chemicals get stabilized in the grain which make them safe for consumption. Eventually, the grain respires, dry matter is lost and functional and nutritional aspects of the grain are altered. Age related changes have great influence on the viscosity of any batter made out of wheat-flour and the water-binding ability of the wheat flour (Shelke et al, 1992). In addition, the starch granule surface protein is found to increase up to three to four times with aging. However, prolonged aging is not recommended (Pomeranz et al, 1968). The moisture content of grains, the storage temperature and relative humidity have been shown to exert dramatic changes in the acidity, pH, free amino nitrogen, crude protein, and protein quality. Significant changes in soluble sugars and amylase contents of the grains have also been reported during storage at elevated temperature<ref> Zia-Ur Rehman, W.H. Shah. Biochemical changes in wheat during storage at three temperatures. Plant Foods for Human Nutrition 54: 109–117, 1999. </ref>.   

It is to be noted from various studies that the protein content of wheat grains and flour do not change significantly over time (Kim et al 2003). While protein quantity may not change, protein quality does. In one of the studies it was noted that total content of starch gets reduced after certain time when the grains are kept within controlled temperature. In India, wheat gets harvested in the months of March and early April. The atmospheric temperature varies from 25℃ – 45℃ in summer in different parts of India. The total starch content of the flour got decreased by 50 % when stored at 50℃ in comparison to the freshly harvested wheat grains<ref>Seguchi, M. 1993. Effect of wheat flour aging on starch-granule surface proteins. J.Cereal Chem. Vol.70: 362-364.  </ref>  <ref> Shearer, G., Patey, A. L., and McWeeney, D. J. 1975. Wheat flour proteins: The selectivity of solvents and the stability of gliadin and glutenin fractions of stored flours. J. Sci. Food Agric. 26:337-344. </ref>. This is a significant change that occurs due to aging of wheat. If the starch content of wheat is reduced with time, aged wheat will have lower calorific value and lower glycemic index. It will also be easier to digest. Similar changes have been observed in rice after aging. Post harvest storage has, it has been observed, significant effect on eight known textural properties that are important to the sensory characteristics of cooked rice: adhesion to lips, hardness, cohesiveness of mass, roughness of mass, toothpull, particle size, toothpack, and loose particles<ref> sourced from : https://www.uark.edu/ua/uarpp/Publications/Sensory/Meullenet%20et%20al%202000%20Cereal%20Chem.pdf downloaded on 24/12/2016 </ref>. A difference is observed between ageing of rice flour and rice starch. It is evident that pasting properties of fresh and aged rice are different. It is also reported that the cell wall structure is decomposed by endo –xylanase during storage which led to the changes in amylograms of rice fours<ref> Shibuya, N. and Iwasaki, T. Eff ect of cell wall degradingenzymes on the cooking properties of milled rice and the texture of cooked rice. J Jpn Soc Food Sci Technol 31(1984) 656–660.  </ref>.  

It is to be noted from various studies that the protein content of wheat grains and flour do not change significantly over time (Kim et al 2003). While protein quantity may not change, protein quality does. In one of the studies it was noted that total content of starch gets reduced after certain time when the grains are kept within controlled temperature. In India, wheat gets harvested in the months of March and early April. The atmospheric temperature varies from 25℃ – 45℃ in summer in different parts of India. The total starch content of the flour got decreased by 50 % when stored at 50℃ in comparison to the freshly harvested wheat grains<ref>Seguchi, M. 1993. Effect of wheat flour aging on starch-granule surface proteins. J.Cereal Chem. Vol.70: 362-364.  </ref>  <ref> Shearer, G., Patey, A. L., and McWeeney, D. J. 1975. Wheat flour proteins: The selectivity of solvents and the stability of gliadin and glutenin fractions of stored flours. J. Sci. Food Agric. 26:337-344. </ref>. This is a significant change that occurs due to aging of wheat. If the starch content of wheat is reduced with time, aged wheat will have lower calorific value and lower glycemic index. It will also be easier to digest. Similar changes have been observed in rice after aging. Post harvest storage has, it has been observed, significant effect on eight known textural properties that are important to the sensory characteristics of cooked rice: adhesion to lips, hardness, cohesiveness of mass, roughness of mass, toothpull, particle size, toothpack, and loose particles<ref> sourced from : https://www.uark.edu/ua/uarpp/Publications/Sensory/Meullenet%20et%20al%202000%20Cereal%20Chem.pdf downloaded on 24/12/2016 </ref>. A difference is observed between ageing of rice flour and rice starch. It is evident that pasting properties of fresh and aged rice are different. It is also reported that the cell wall structure is decomposed by endo –xylanase during storage which led to the changes in amylograms of rice fours<ref> Shibuya, N. and Iwasaki, T. Eff ect of cell wall degradingenzymes on the cooking properties of milled rice and the texture of cooked rice. J Jpn Soc Food Sci Technol 31(1984) 656–660.  </ref>.  

These changes in physiochemical properties of grains exert their effect on digestibility of the food. It has been studied through experiments that the moisture content is higher in new grains indicating predominance of ''apa'' and ''prithvi mahabhuta'' which again tends towards ''santarpana''. Aging of rice has an impact on its glycemic index and glycemic load. New grain may have higher glycemic index than the older grain. Due to the effect of time on these food stuffs there are greater possibilities that certain amino acids and phyto chemicals get stabilized in the grain that make them safe for consumption.  

These changes in physiochemical properties of grains exert their effect on digestibility of the food. It has been studied through experiments that the moisture content is higher in new grains indicating predominance of [[jala mahabhuta]] and [[prithvi mahabhuta]] which again tends towards ''santarpana''. Aging of rice has an impact on its glycemic index and glycemic load. New grain may have higher glycemic index than the older grain. Due to the effect of time on these food stuffs there are greater possibilities that certain amino acids and phyto chemicals get stabilized in the grain that make them safe for consumption.  

''Navamadya''/fresh wine: New or fresh wines should not be consumed because they cause heaviness and create imbalances in all the three ''doshas'' while old wines promote circulation in the body, increase digestion, lightness and enhance taste in food. The effect of aging on tannins and resveratrol has been studied and shows significant difference between old and fresh wine. Aging results in altered and reduced phenolic contents in red wine. Anthocyanin tannin complexes can be formed which can stabilize the colour of red wines resulting in wines that are tasteless, fruity and less astringent after aging<ref> Scudamore-Smith PD, Hooper RL, McLaran ED (1990) Color and phenolic changes of Cabernet Sauvignon wine made by simultaneous yeast/bacterial fermentation and extended pomace contact. American Journal of Enology and Viticulture 41, 57-67 </ref>.  Oxidation reactions involving phenolics might also change the chemical and sensory profile of wines<ref> Bisson LF, Waterhouse AL, Ebeler SE, Walker MA, Lapsley JT (2002) The present and future of the international wine industry. Nature418, 696-699 </ref>.  Oxygen in the air is always ready to react with unprotected juice or wine and many of the substances present get adversely affected by oxidation, producing unpleasant, bitter, off-odours and off-tastes. However, it is recognized that some degree of oxygenation may be beneficial for the formation of red wine, but the quality of white wines is generally impaired by excessive air exposure. As tannins and anthocyanins interact with oxygen, which diffuses during barrel storage, these compounds further polymerize and become less astringent. Red wines become lighter in colour, and proanthocyanidins and other polyphenolics eventually aggregate in larger molecules which accumulate as sediment over time at the base of the bottle. In contrast, white wines often deepen in colour, turning darker honey colors as they oxidize and age <ref>sourcedfrom:http://www.academia.edu/8191054/Biochemical_Changes_throughout_Grape_Berry_Development_and_Fruit_and_Wine_Quality downloaded on 24/12/2016 </ref>.   

''Navamadya''/fresh wine: New or fresh wines should not be consumed because they cause heaviness and create imbalances in all the three [[dosha]] while old wines promote circulation in the body, increase digestion, lightness and enhance taste in food. The effect of aging on tannins and resveratrol has been studied and shows significant difference between old and fresh wine. Aging results in altered and reduced phenolic contents in red wine. Anthocyanin tannin complexes can be formed which can stabilize the colour of red wines resulting in wines that are tasteless, fruity and less astringent after aging<ref> Scudamore-Smith PD, Hooper RL, McLaran ED (1990) Color and phenolic changes of Cabernet Sauvignon wine made by simultaneous yeast/bacterial fermentation and extended pomace contact. American Journal of Enology and Viticulture 41, 57-67 </ref>.  Oxidation reactions involving phenolics might also change the chemical and sensory profile of wines<ref> Bisson LF, Waterhouse AL, Ebeler SE, Walker MA, Lapsley JT (2002) The present and future of the international wine industry. Nature418, 696-699 </ref>.  Oxygen in the air is always ready to react with unprotected juice or wine and many of the substances present get adversely affected by oxidation, producing unpleasant, bitter, off-odours and off-tastes. However, it is recognized that some degree of oxygenation may be beneficial for the formation of red wine, but the quality of white wines is generally impaired by excessive air exposure. As tannins and anthocyanins interact with oxygen, which diffuses during barrel storage, these compounds further polymerize and become less astringent. Red wines become lighter in colour, and proanthocyanidins and other polyphenolics eventually aggregate in larger molecules which accumulate as sediment over time at the base of the bottle. In contrast, white wines often deepen in colour, turning darker honey colors as they oxidize and age <ref>sourcedfrom:http://www.academia.edu/8191054/Biochemical_Changes_throughout_Grape_Berry_Development_and_Fruit_and_Wine_Quality downloaded on 24/12/2016 </ref>.   

The phenolic compound present in a bottle of wine slowly changes as it ages. The most important component of wine is tannin which binds with proteins. High tannin containing wine inhibits saliva’s ability to lubricate mouth and imparts astringent feeling in mouth. Aged wine undergoes polymerization of tannins. This makes tannin sediments settle to the bottom of the container and lose its property to bind with proteins. Aged wines are very aromatic and possess fruity flavors.  

The phenolic compound present in a bottle of wine slowly changes as it ages. The most important component of wine is tannin which binds with proteins. High tannin containing wine inhibits saliva’s ability to lubricate mouth and imparts astringent feeling in mouth. Aged wine undergoes polymerization of tannins. This makes tannin sediments settle to the bottom of the container and lose its property to bind with proteins. Aged wines are very aromatic and possess fruity flavors.  

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

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

It can be noted from the above enlisted disorders that ''kapha dosha, rasa, rakta, mamsa'' and ''meda dhatu'' are vitiated in ''santarpaniya'' diseases. Therefore, the treatment protocol shall be designed keeping these factors in mind.  

It can be noted from the above enlisted disorders that [[kapha]] [[dosha]], [[rasa]], [[rakta]], [[mamsa]] and [[meda dhatu]] are vitiated in ''santarpaniya'' diseases. Therefore, the treatment protocol shall be designed keeping these factors in mind.  

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

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

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

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

'''''Pandu''''' (anemia): It means pallor and is seen in metabolic disorders. Charak has explained it as a disease as well as complication of other disorders. ''Pandu'' that has been mentioned in ''santarpanajanya'' diseases chapter is ''kapha'' dominant where the causes are elaborated in verses 3 and 4. Two of the most common causes of anemia are due to abnormalities in iron homeostasis: iron-deficiency anemia and anemia of inflammation also known as anemia of chronic disease. The anemia caused due to inflammation is elaborated in this context. It is very interesting to know metabolic disorders like obesity and some complication of diabetes like diabetic nephropathy also lead to pallor and iron deficiency<ref> Karlee et al. Is Obesity Associated with Anaemia of Chronic Disease? A Population-based Study. 2008. Doi: 10.1038/oby.2008.353 </ref>. Along with anaemia, renal parameters also get deranged which may lead to abdominal symptoms like nausea and vomiting, so the word ''arochaka'' is used here adjoining to ''mutrakrichhra'' (urinary disorder)<ref> Mehdi et al. Anemia, Diabetes, and Chronic Kidney Disease. 2009. 32(7): 1320-1326 </ref>. In the latter stages of diabetic or hypertensive nephropathy urinary complaints like oligouria or anuria can occur. If it remains untreated due anaemia and congestion in heart, edema starts developing which has been called as ''shopha''.  

'''''Pandu''''' (anemia): It means pallor and is seen in metabolic disorders. Charak has explained it as a disease as well as complication of other disorders. ''Pandu'' that has been mentioned in ''santarpanajanya'' diseases chapter is [[kapha]] dominant where the causes are elaborated in verses 3 and 4. Two of the most common causes of anemia are due to abnormalities in iron homeostasis: iron-deficiency anemia and anemia of inflammation also known as anemia of chronic disease. The anemia caused due to inflammation is elaborated in this context. It is very interesting to know metabolic disorders like obesity and some complication of diabetes like diabetic nephropathy also lead to pallor and iron deficiency<ref> Karlee et al. Is Obesity Associated with Anaemia of Chronic Disease? A Population-based Study. 2008. Doi: 10.1038/oby.2008.353 </ref>. Along with anaemia, renal parameters also get deranged which may lead to abdominal symptoms like nausea and vomiting, so the word ''arochaka'' is used here adjoining to ''mutrakrichhra'' (urinary disorder)<ref> Mehdi et al. Anemia, Diabetes, and Chronic Kidney Disease. 2009. 32(7): 1320-1326 </ref>. In the latter stages of diabetic or hypertensive nephropathy urinary complaints like oligouria or anuria can occur. If it remains untreated due anaemia and congestion in heart, edema starts developing which has been called as ''shopha''.  

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

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

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

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

'''''Lekhana''''' is defined as the therapeutic action which (adequately) dries up body tissues and then literally scrapes the unwanted substances (generally solid, unctuous substances) out from the body tissues. Though this may be one meaning of ''lekhana'', all ''lekhana'' activites and ''lekhana dravya'' exert some pharmacological activates that reduce unwanted substances - unwanted ''dosha, dhatu'' or ''mala'' - from the body. The same properties of ''lekhana'' can be achieved by ''virechana, vamana'' or ''raktamokshana''.  

'''''Lekhana''''' is defined as the therapeutic action which (adequately) dries up body tissues and then literally scrapes the unwanted substances (generally solid, unctuous substances) out from the body tissues. Though this may be one meaning of ''lekhana'', all ''lekhana'' activites and ''lekhana dravya'' exert some pharmacological activates that reduce unwanted substances - unwanted [[dosha]], [[dhatu]] or [[mala]]- from the body. The same properties of ''lekhana'' can be achieved by [[virechana]], [[vamana]] or [[raktamokshana]].

 

Exercise and fasting has a very positive effect on anabolic disorders. Exercise results in reduction in fasting blood glucose, which replicates previous beneficial effects of exercise interventions in type II diabetes<ref> D. E. Kelley and B. H. Goodpaster, “Effects of exercise on glucose homeostasis in type 2 diabetes mellitus,” Medicine and Science in Sports and Exercise, vol. 33, no. 6, supplement, pp. S495–S501, 2001.</ref>.

=== Fasting ===

=== Fasting ===

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

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

Since ''ruksha dravyas'' are ''akasha'' and ''vayu'' dominant, medicines and food articles of this property are advised. Of the three properties of honey, the most important one is ''guru''. Since ''jatharagni'' is vitiated in obesity (since agni plays an important role in causing or aggravating anabolic disorders), ''guru'' and ''ruksha'' substances are used to pacify it, and thus honey is recommended for obesity. However, the use of honey in diabetes is controversial since honey is full of fructose and it imparts hyperglycaemic properties on diabetic patients. In diseases like obesity, lipid abnormality and diabetes mellitus, gut microbiota plays an important role in carbohydrate metabolism.  

Since ''ruksha dravyas'' are [[akasha]] and [[vayu]] dominant, medicines and food articles of this property are advised. Of the three properties of honey, the most important one is ''guru''. Since ''jatharagni'' is vitiated in obesity (since [[agni]] plays an important role in causing or aggravating anabolic disorders), ''guru'' and ''ruksha'' substances are used to pacify it, and thus honey is recommended for obesity. However, the use of honey in diabetes is controversial since honey is full of fructose and it imparts hyperglycaemic properties on diabetic patients. In diseases like obesity, lipid abnormality and diabetes mellitus, gut microbiota plays an important role in carbohydrate metabolism.  

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

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

    

    

Local application by rubbing of certain herbal powders on the skin reduces ''kapha dosha'' and regulates ''vata dosha'' at that level and inhibits samprapti of ''kandu'' and ''kotha''. Regular rubbing of the powders over the skin increases peripheral circulation of the capillaries supplying the skin and also reduced inflammation at dermal level. Rubbing of dry powders over the body is called ''udvartana''. This softens the skin leaving it with a lustrous glow. The stimulating massage helps revitalize skin, removes fat deposits and improve circulation and digestion. ''Udvartana'' helps open the circulatory channels, facilitating metabolic activities, eliminating excessive perspiration and body odor and improving the complexion of the skin.   

Local application by rubbing of certain herbal powders on the skin reduces [[kapha dosha]] and regulates [[vata dosha]] at that level and inhibits samprapti of ''kandu'' and ''kotha''. Regular rubbing of the powders over the skin increases peripheral circulation of the capillaries supplying the skin and also reduced inflammation at dermal level. Rubbing of dry powders over the body is called ''udvartana''. This softens the skin leaving it with a lustrous glow. The stimulating massage helps revitalize skin, removes fat deposits and improve circulation and digestion. ''Udvartana'' helps open the circulatory channels, facilitating metabolic activities, eliminating excessive perspiration and body odor and improving the complexion of the skin.   

   

   

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

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

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

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

'''''Madanaphala''''' (Randia dumentorum) has ''madhura, tikta rasa, katu vipaka'' and ''ushna veerya''. It is a widely used herb for induction of vomiting used for ''vamana'' procedure. It has ''lekhana'' properties.

'''''Madanaphala''''' (Randia dumentorum) has ''madhura, tikta rasa, katu vipaka'' and ''ushna veerya''. It is a widely used herb for induction of vomiting used for [[vamana]] procedure. It has ''lekhana'' properties.

Clearly, the pharmacological action of the above ''dravyas'' all have been proven to have anti-diabetic and anti-hyperlipidimic properties. The interesting thing to note is that although these ''dravyas'' ultimately work for metabolic disorders, they have different modes of action. Anti-diabetic properties of ''triphala, neem, musta'' and ''saptaparna'' are different. The ''rasa'' of the above mentioned ''dravyas'' is ''tikta kasahaya'' or ''tikta katu'' which is ''akasha, teja'' and ''vayu mahabhuta'' dominant. As we have seen that ''santarpaniya vyadhis'' are due to excess consumption of ''prithvi'' and ''apa mahabhuta,'' those of opposing properties, i.e., ''akasha, teja and vayu'' are used in treating such ailments.  

Clearly, the pharmacological action of the above ''dravyas'' all have been proven to have anti-diabetic and anti-hyperlipidimic properties. The interesting thing to note is that although these ''dravyas'' ultimately work for metabolic disorders, they have different modes of action. Anti-diabetic properties of ''triphala, neem, musta'' and ''saptaparna'' are different. The ''rasa'' of the above mentioned ''dravyas'' is ''tikta kasahaya'' or ''tikta katu'' which is [[akasha]], [[teja]] and [[vayu mahabhuta]] dominant. As we have seen that ''santarpaniya vyadhis'' are due to excess consumption of [[Prithvi]] and [[jala mahabhuta]] those of opposing properties, i.e., [[akasha]], [[teja]] and [[vayu]] are used in treating such ailments.  

'''''Devadaru''''' (Cedrus deodara or Himalayan Cedar) is a herb that is very effective in improving the functions of liver and in maintaining cholesterol levels in healthy limits. ''Devadaru'' pacifies the ''kapha dosha'' by ''tikta, katu'' and ''ushna'' properties, and ''vata dosha'' by ''snigdha'' and ''ushna'' properties so it is useful in disorders induced by ''kapha'' and ''vata doshas''.

'''''Devadaru''''' (Cedrus deodara or Himalayan Cedar) is a herb that is very effective in improving the functions of liver and in maintaining cholesterol levels in healthy limits. ''Devadaru'' pacifies the ''kapha dosha'' by ''tikta, katu'' and ''ushna'' properties, and [[vata]] [[dosha]] by ''snigdha'' and ''ushna'' properties so it is useful in disorders induced by [[kapha]] and [[vata]] [[dosha]].

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

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

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

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

Those individuals who consume these type of formulations can have normalization of ''agni, smriti'' (memory) and ''buddhi'', that is the power of forming and retaining concepts and general notions, intelligence, reason, intellect, discernment, judgment which gets deranged in ''santarpaniya vyadhis'' in latter stages gets normalised.

Those individuals who consume these type of formulations can have normalization of [[agni]], [[smriti]] (memory) and [[buddhi]], that is the power of forming and retaining concepts and general notions, intelligence, reason, intellect, discernment, judgment which gets deranged in ''santarpaniya vyadhis'' in latter stages gets normalised.

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

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

If we observe the herbs mentioned in the management of ''santarpaniya vyadhis'' it is evident from the following table that most of the herbs are ''tikta, katu, kashaya rasa'' dominant having ''katu vipaka'' and ''ushna veerya''. These properties are attributed to ''akash'' and ''vayu mahabhuta''.   

If we observe the herbs mentioned in the management of ''santarpaniya vyadhis'' it is evident from the following table that most of the herbs are ''tikta, katu, kashaya rasa'' dominant having ''katu vipaka'' and ''ushna veerya''. These properties are attributed to [[akasha]] and [[vayu]] [[mahabhuta]].   

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

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

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== References==

== References==