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2 REVIEW ARTICLE Global Impact Factor (GIF) (2013) ASSESSMENT OF MEDAVRIDDHI & STHAULYA WITH OBJECTIVE PARAMETERS A VISIONARY STUDY Waghulade Hemangini S., 1* Ohol Sarita V * Professor& HOD, Department of Kriya Sharir, Dr. D.Y. Patil College of Ayurved and Research Centre, Sector-7, Nerul, Navi Mumbai , E mailwaghuladehema@gmail.com, Mobile no Associate Professor, Department of Kriya Sharir, Dr. D.Y. Patil College of Ayurved and Research Centre, Sector-7, Nerul, Navi Mumbai , E mail- dr.saritav@gmail.com, Mobile no Article Received on - 17 th July 2014 Article Revised on - 25 th Aug 2014 Article Accepted on - 27 th Aug 2014 All articles published in IJAAM are peer-reviewed and can be downloaded, printed and distributed freely for non commercial purpose (see copyright notice below). (Full Text Page IJAAM This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestricted non commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

3 REVIEW ARTICLE ASSESSMENT OF MEDAVRIDDHI & STHAULYA WITH OBJECTIVE PARAMETERS A VISIONARY STUDY ABSTRACT: *Corresponding Author Waghulade Hemangini S. Professor& HOD, Department of Kriya Sharir, Dr. D.Y. Patil College of Ayurved and Research Centre, Sector-7, Nerul, Navi Mumbai , Mobile no E mailwaghuladehema@gmail.com QR Code IJAAM The nature has taught man how to be healthy before the science has discovered the laws of health. Obesity occurs as a result of lack of physical activity with increased intake of food and it can be diagnosed earlier i.e. overweight. Symptoms of medavriddhi & sthaulya are given in our Samhitas. Charaka has not stated medavriddhi but explained sthaulya whereas Vagbhata has explained medavriddhi & not sthaulya in detailed form of nidana panchaka. Most of these symptoms are overlapping; so a question arises whether medavriddhi & sthaulya are same or different and it is a difficult task to differentiate between the two. There is a need to develop a certain parameter which will help medico as well as non medico persons to get aware of this disease. This study has been done to develop objective parameters to diagnose medavriddhi & sthaulya. For this study, symptoms of medavriddhi & sthaulya have been reviewed and compared. As per Ayurvedic anthropometry, aayama & vistara of body parts have been graded. Possible modern parameters have been considered with their limitations. It is found that measurement of body fat percentage could be an effective modern parameter to diagnose and differentiate between medavriddhi & sthaulya. It is concluded that with the help of body fat monitor, range of body fat percentage could be determined to differentiate between medavriddhi & sthaulya. If sthaulya is diagnosed earlier at the stage of medavriddhi, hazards of sthaulya can be prevented. These sincere efforts will contribute in maintaining sound health. Key Words: Anguli pramana, Body fat percentage, Body Mass Index(BMI), Medavriddhi; Skin fold, Sthaulya INTRODUCTION The nature has taught man how to be healthy before the science has discovered the laws of health. But it is an irony of the fate that; on this earth on one hand, millions do not get enough food and roam in a skeletal appearance while on the other hand, there are many more who, besides over eating, lead a sedentary life to march towards an ultimate death. Overweight is a blessing of modern age of machines and materialism. It occurs as a result of lack of physical activity with increased intake of food, industrialization, stress during work, dietary habits, lack of exercise & various varieties in daily diet e.g. fast food, freezed fruits, increased amount of soft drinks and beverages, canned foods results into a clinical entity which is called as obesity. This condition of obesity can be diagnosed earlier & i.e. overweight. Many institutions and medical schools are making efforts to find a perfect remedy for the burning problem of obesity. Curiosity is one of the noblest instincts of man, the endless desire of man for his knowledge. Overweight or medavriddhi (aggravated adipose tissue) is the only one disease which is gaining more and more attention of scientists at global level. Overweight is the premonitory symptom of obesity. Symptoms of medavriddhi & sthaulya (obesity) are given in our samhitas. Charaka has not stated medavriddhi but explained sthaulya whereas Vagbhata has explained medavriddhi [1] but he has not stated sthaulya in form of nidana panchaka (five stages of pathogenesis),however treatment of sthoulya according to its types is mentioned in Ashtanga Hridaya. [2] Most of the symptoms of medavriddhi & sthaulya are overlapping. It is a difficult task to differentiate between the two. So a question arises if there is any objective parameter to differentiate between the two. The old adage, 'prevention is better than cure' holds true in case of obesity also. Though medavriddhi symptoms are given in detail in our samhitas, there is a need to develop a certain parameter which will help medico as well as non medico persons to get aware of this disease. Also this study will contribute in diagnosing & preventing hazards of obesity & its complications. These sincere efforts will contribute Page30

4 in maintaining global health. To get a way through the burning issue of overweight, present study is selected. AIMS & OBJECTIVES 1. To study and compare symptoms of medavriddhi & sthaulya quoted in Brihatrayi. 2. To study whether the symptoms of medavriddhi & sthaulya are same or different. 3. To develop objective parameters to diagnose medavriddhi & sthaulya. features), upadrava (complications), sadhyaasadhyata (prognosis) is reviewed. Among these, only purvarupa and rupa is briefly discussed to focus on present manuscript. Purvarupa of sthaulya-none of the textual authorities have described prodromal symptoms and signs of sthaulya. But, as manifestation of disease is preceded by premonitory signs as per nidana panchaka the weak manifestation of rupa should be considered as purvarupa. [6][7] MATERIALS & METHODS A] Literature searcha) Review of literature regarding medavriddhi & sthaulya is collected from Brihatrayi. b) Modern texts and relevant websites regarding body mass index, waist-hip ratio, skin fold, and body fat percentage are surfed. B] Type of study- Conceptual study CONCEPTUAL STUDY Etymology,quantity,functions,roots of medovaha srotas(channels carrying adipose tissue),formation of meda dhatu(adipose tissue),symptoms of meda kshaya(alleviated meda dhatu ), symptoms of meda vriddhi is reviewed regarding meda dhatu.among these,meda dhatu vriddhi is elaborated keeping in view the present study. Symptoms of meda vriddhi Aggravated meda dhatu produces unctuousness of body, enlargement of abdomen & flanks, cough, dysnoea, foetid odour etc. [3] Meda dhatu when increased produces the same symptoms as mamsa vriddhi (aggravated muscular tissue)& in addition, it causes fatigue, breathlessness even after little work, sagging of buttocks, breasts & abdomen. [4] Meda dhatu when increased produces enlargement of glands in the neck & scapula, malignant tumors, benign tumors, diseases of the palate, tongue & throat; increase in size & heaviness of buttocks, neck, lips arms, abdomen, chest & thighs; & other symptoms of increase of kapha (energy of cohesion) & rakta (blood tissue). [5] Hetu (aetiology), samprapti (pathogenesis), purvarupa (prodromal features), rupa (clinical Rupa of sthaulya -The symptoms of sthaulya are deficiency in longevity; the bodily movements are impaired due to looseness, tenderness and heaviness. This makes sexual act difficult because of small quantity of semen. Weakness prevails as the equilibrium of dhatu (tissue) is disturbed; foetid odour is caused by inherent defect & nature of fat tissue & also due to excessive sweating as the fat is associated with kapha and as it is fluid, multitudinous and heavy, as such it cannot withstand physical exercise and it brings about excessive sweating in the body; because of sharp digestive power and presence of vayu (energy of propulsion) in excessive quantity, there is excessive hunger and thirst. [8] Owing to excessive increase of fat and muscle tissue; buttocks, abdomen and breasts become pendulous, disproportionate growth of the body, lack of enthusiasm are the symptoms of sthaulya. [9] Dyspnoea on exertion, excessive thirst, excessive hunger, excessive sleep, perspiration, foetid body odour, snoring, prostration of the body, indistinctness of speech invade these persons quickly because of tenderness of fat, the person is unable to bear any physical exercise, because of obstruction of channel of shukra (semen)by kapha and fat, these persons are poor in sexual activities; because of obstruction of srotasas, the remaining dhatus do not get sufficient nourishment thereby makes the person poor of strength in all activities of life. [10] Excessive hunger and thirst, sweating, difficulty in breathing, excessive sleep, inability to withstand exertion, lassitude, decrease of life span, strength and vigor, bad smell of body, stammering are the symptoms of sthaulya. [11] Page31

5 Table No.1: showing features of medavriddhi No. Medavriddhi Symptoms Charaka Sushruta Ashtanga Ashtanga Sangraha Hridaya 1 Snighdhata(Unctuousness of body) Udar vriddhi (Increased abdominal circumference due to fat) Udarlambanam (Pendululous abdomen) Parshva vriddhi (Increased flank region due to fat) Uruvriddhi ( Increased thigh region due to fat) Sphik lambanam (Pendulous Buttocks) Stana lambanam (Pendulous breasts) Kasa (Cough) Shwas/alpepi Cheshtite shwasa (Breathlessness) Shrama(Fatigue) Daurgandhya (foetid body odor) Prameha purvarupa (premonitory symptoms of diabetes mellitus) Sthaulya upadrava(complications of obesity) Shleshma vikara(disorders of cohesive energy) Rakta vikara(blood tissue disorders) Mamsa vikara(muscular tissue disorders) Table No.2: showing rupa of sthaulya No. Rupa Charaka Sushruta Ashtanga Ashtanga Sangraha Hridaya 1 Chala Sphik (pendulous buttock) Chala Udara (pendulose abdomen) Chala Stana ( pendulous breast) Ayatha upachaya (abnormal growth of the body) Ayatha utsaha (lack of enthsiasm) Jadyam (dullness) Javoparodha (slugishness in movement) Alpa vega( low vitality) Shrama (fatigue) Sarvakriyasu asamarthata (unable to bear the any physical exercise) Alpa bala(less strength) Daurbalya (general weakness) Alpa prana (low vitality power) Ayushorrhas (shortening of the life spam) Krichhra vyavaya (Difficulty in Sexual activity) Alpa vyavaya (lack of Sexual activity) Daurgandhya (foetid body odour) Swedabadha (Excessive sweating) Kshudhatimatra (Excessive hunger) Pipasatiyoga (Excessive Thirst) Nidradhikya (Excessive Sleep) Kshudra Shwasa (Dyspnoea on exertion) Krathana (Snoring) Gadgadvani (Indistinctness of Speech) Gatrasada (Prostration of the Body) Sukumarya(tenderness) Page32

6 DISCUSSION According to definition of swastha purusha (healthy individual) by Charaka [12] and Sushruta [13] a healthy body is the only one media to achieve ultimate goal among the chaturvidha purushartha (four objectives of life). Acharya Sushruta also said that madhyama sharira (moderate physique) is the best but ati sthula (too obese) and ati krisha (too thin) are always affected with some complaints. [14] Acharya Charak has thrown light on the eight varieties of impediments which are designated as nindita purusha (undesirable constitution); ati sthula comprises one of them. [15] In our samhitas,medavriddhi & sthaulya symptoms are given in detail. Overweight or medavriddhi is such a physical state where hypertension, osteoarthritis, diabetes mellitus, cardio vascular accidents, impotency and many other grave complications are the vultures invited. The long term dangers of overweight are like a sword hanging over one's head tied in a weak thread which can strike at any time and create numerous difficulties and boundless miseries. Many theories have been put forward with many new hypotheses describing the exact aetiopathogenesis of sthaulya. Even though a question remains unexplained whether medavriddhi & sthaulya are same or different? With the help of three fold examination i.e. darshana (inspection), sparshana (palpation) & prashna (history taking), assessment of these two can be done. Among these, physiological symptoms i.e. daurbalya, daurgandhya etc. of medavriddhi & sthaulya can be judged by prashna pariksha. For anatomical symptoms of medavriddhi & sthaulya, knowledge of pramana pariksha (anthropometry) given in Ayurvedic Compendia can be used by which aayama (height) & vistar (breadth) is measured. [16] For e.g., one of the common symptoms of medavriddhi & sthaulya is enlargement of abdomen which can be measured by swaanguli pramana (individual finger unit)[ayama-10 anguli, Vistar -12 anguli ]. As per Ayurvedic textual protocol, aayama & vistara of body parts can be graded & validated as mentioned in table no. 3 Practically this method has certain limitations like human error; the reliability of anguli pramana can vary from tester to tester depending on their skill and experience. While doing anthropometry of body parts, some subjects may feel uncomfortable stripping down in front of the tester. For legal reasons, it is wise to have another person present, and to have female testers for female subjects & off course this method is time consuming. To overcome these limitations, modern parameters like waist hip ratio, body mass index, skin fold, body fat percentage etc. can be adopted. Table No.3: showing gradations for anguli pramana of body parts Particulars Std Udara (abdomen) Vistar(breadth) 12 <12 >14 >16 >18 Aayama (length) 10 <10 >12 >14 >16 Parshva (flanks) Aayama 12 <12 >14 >16 >18 Vistar 10 <10 >12 >14 >16 Uru (thigh) Aayama 12 <12 >14 >16 >18 Parinaha (circumference) 30 <30 >32 >34 >36 Sphik (hips) Utsedha(height) 12 <12 >14 >16 >18 Manya (neck) Utsedha 04 <04 >06 >08 >10 Parinaha 22 <22 >24 >26 >28 Waist hip ratio - Waist-to-hip ratio (WHR) is the ratio of the circumference of waist to that of the hips. According to World Health Organization s data gathering protocol, the waist circumference should be measured at the midpoint between the lower margin of last palpable rib and the top of the iliac crest, using a stretch resistant tape that provides a constant 100 g tension. Hip circumference should be measured around the widest portion of the buttocks, with the tape parallel to the floor. Waist hip ratio or waist-tohip ratio (WHR) is the ratio of the circumference of the waist to that of the hips. WHO STEPS states that abdominal obesity is defined as a waist hip ratio above 0.90 for males and above 0.85 for females. [17] By measuring merely Waist hip ratio, among the symptoms of medavriddhi & sthaulya,only the sphik region can be measured & other anatomical regions like stana,parshva,udara cannot be measured. Hence this method is not useful to differentiate between the two. Skin fold - Taking skin fold measurement is a common method for determining body fat composition. The skin fold caliper is a device which measures the thickness of a fold of your skin with its underlying layer of fat. Measurements are taken from 3 to 9 different standard anatomical Page33

7 sites around the body. The most common sites are triceps, biceps, subscapular, thigh, iliac crest, supraspinal, abdominal, calf, chest, axilla etc. [18] Up to some extent, skin fold measurement can be used to diagnose medavriddhi & sthaulya, but this technique is having its own limitations. This method only measures one type of fat: subcutaneous adipose tissue (fat under the skin). Two individuals might have nearly identical measurements at all of the skin fold sites, yet differ greatly in their body fat levels due to differences in other body fat deposits such as visceral adipose tissue, fat in the abdominal cavity. Therefore it may not be an ideal measurement for those who are having sthaulya. This method also has technical sources of error. [19] Body mass index -The body mass index (BMI) is a measure of relative weight based on an individual's mass and height. BMI = mass(kg)/[height(m)] 2. The WHO regards a BMI of less than 18.5 as underweight and may indicate malnutrition, an eating disorder, or other health problems, while a BMI greater than 25 is considered overweight and above 30 is considered obese. The medical establishment has acknowledged major shortcomings of BMI.Because BMI depends upon weight and the square of height, it ignores basic scaling laws whereby mass increases to the 3rd power of linear dimensions. Hence, larger individuals, even if they had exactly the same body shape and relative composition, always have a larger BMI. Also, its assumptions about the distribution between lean mass and adipose tissue are inexact. BMI generally overestimates adiposity on those with more lean body mass (e.g. athletes) and underestimates excess adiposity on those with less lean body mass. The widely used body mass index (BMI) provides a measure that allows comparison of adiposity of individuals of different heights and weights. There is no single ideal percentage of body fat for everyone. Levels of body fat are epidemiologically dependent on sex and age. Different authorities have developed different recommendations for ideal body fat percentages. While BMI largely increases as adiposity increases, due to differences in body composition it is not necessarily an accurate indicator of body fat; for example, individuals with greater muscle mass will have higher BMIs. The thresholds between "normal" and "overweight" and between "overweight" and "obese" are sometimes disputed for this reason. [20] The symptoms of medavriddhi & sthaulya are definitely not weight dependent but can be measured by aayama & vistar. Remaining physiological symptoms cannot be assessed by BMI. On the other hand; modern researchers also accepted the fact that BMI cannot be a diagnosing method for overweight & obese. Body fat percentage -The body fat percentage is the total mass of fat divided by total body mass; body fat includes essential body fat and storage body fat. Essential body fat is necessary to maintain life and reproductive functions. The percentage of essential body fat for women is greater than that for men, due to the demands of childbearing and other hormonal functions. The percentage of essential fat is 3% 5% in men, and 10-16% in women. Storage body fat consists of fat accumulation in adipose tissue, part of which protects internal organs in the chest and abdomen. A number of methods are available for determining body fat percentage, such as measurement with calipers or through the use of bioelectrical impedance analysis. [21] Though waist hip ratio measures ratio of circumference of waist & hip, skin fold determines body fat underneath the skin, BMI estimates adiposity; all these parameters are having their own limitations. Therefore these methods cannot be adequate modern parameters to diagnose medavriddhi & sthaulya. Whereas body fat percentage can be considered as a modern parameter to diagnose medavriddhi & sthaulya because the body fat percentage is the only body measurement which directly calculates a person's relative body composition without regard to height or weight. Being objective, it can bring uniformity in assessment. Also this method is time saving & easy as compared to anguli pramana pariksha. Along with these objective criteria, prashna pariksha is required for physiological symptoms of medavriddhi & sthaulya to diagnose the same more precisely. By determining the range of body fat percentage, medavridhhi & sthaulya can be differentiated to prevent complications of sthaulya. CONCLUSION It is concluded that measurement of body fat percentage could be an effective modern parameter to diagnose medavriddhi & sthaulya. With the help of body fat monitor, range of body fat percentage could be established to differentiate between medavriddhi & sthaulya. A true measure of body fat percentage will enable the user to evaluate weight loss progress by allowing the Page34

8 dieter to work out a plan to lose fat rather than weight. This visionary study will be helpful to bring healthy weight loss because it is easy to see if fat has been lost or not. This study will definitely prevent mortality & complications of sthaulya. REFERENCES 1. Ashtanga Hridaya of Vagbhata Annotated by Dr.Anna Kunte & Krishna Navre,edited by Pt.Hari Sadashiva Shastri Paradkar Chaukhamba Surbharati Prakashan Varanasi Reprinted 2002, Sutrasthana chapter 11,verse no.10,p Ashtanga Hridaya of Vagbhata Annotated by Dr.Anna Kunte & Krishna Navre,edited by Pt.Hari Sadashiva Shastri Paradkar Chaukhamba Surbharati Prakashan Varanasi Reprinted 2002,Sutrasthana chapter 14,verse no.10-14,p Sushruta Samhita of Sushruta with Nibandhasangraha Commentary of Shri Dakhanacharya &Nyayachandrika Panjika of Shri Gayadasacharya edited by Vaidya Jadavaji Trikamji Acharya & Narayana Ram Acharya, Choukhambha Krishanadas Academy Varanasi Reprinted 2004, Sutra sthana chapter 15,verse no.14,p Ashtanga Hridaya of Vagbhata Annotated by Dr.Anna Kunte & Krishna Navre,edited by Pt.Hari Sadashiva Shastri Paradkar Chaukhamba Surbharati Prakashan Varanasi Reprinted 2002, Sutrasthana chapter 11,verse no.10,p Ashtanga Sangraha of Vriddha Vagbhata with Shashilekha Commentary of Indu edited by Dr.Jyotirmitra Acharya, Chaukhamba Sanskrit Series Varanasi Reprinted 2012 Sutra sthana chapter 19,verse no.6,p Charaka Samhita of Agnivesha elaborated by Charaka Reprinted 2005, Chikitsa sthana chapter 28,verse no.19,p Charaka Samhita of Agnivesha elaborated by Charaka Reprinted 2005, Chikitsa sthana chapter 11,verse no.12,p Charaka Samhita of Agnivesha elaborated by Charaka Reprinted 2005, Sutra sthana chapter 21,verse no.9,p Charaka Samhita of Agnivesha elaborated by Charaka Reprinted 2005, Sutra sthana chapter 21,verse no.4,p Sushruta Samhita of Sushruta with Nibandhasangraha Commentary of Shri Dakhanacharya &Nyayachandrika Panjika of Shri Gayadasacharya edited by Vaidya JadavajiTrikamji Acharya & Narayana Ram Acharya, Choukhambha Krishanadas Academy Varanasi Reprinted 2004, Sutra sthana chapter 15,verse no.32,p Ashtanga Sangraha of Vriddha Vagbhata with Shashilekha Commentary of Indu edited by Dr.Jyotirmitra Acharya, Chaukhamba Sanskrit Series Varanasi Reprinted 2012, Sutra sthana chapter 24,verse no.14,p Charaka Samhita of Agnivesha elaborated by Charaka & Drudhabala with Ayurveda Dipika Commentary by Chakrapanidatta,edited by Vaidya JadavajiTrikamji Reprinted 2005, Sutra sthana chapter 30,verse no.26,p Sushruta Samhita of Sushruta with Nibandhasangraha Commentary of Shri Dakhanacharya &Nyayachandrika Panjika of Shri Gayadasacharya edited by Vaidya JadavajiTrikamji Acharya & Narayana Ram Acharya, Choukhambha Krishanadas Academy Varanasi Reprinted 2004, Sutra sthana chapter 15,verse no.41,p Sushruta Samhita of Sushruta with Nibandhasangraha Commentary of Shri Dakhanacharya &Nyayachandrika Panjika of Shri Gayadasacharya edited by Vaidya JadavajiTrikamji Acharya & Narayana Ram Acharya, Choukhambha Krishanadas Academy Varanasi Reprinted 2004, Sutra sthana chapter 35,verse no34,p Charaka Samhita of Agnivesha elaborated by Charaka Reprinted 2005, Sutra sthana chapter 21,verse no.4,p Charaka Samhita of Agnivesha elaborated by Charaka Reprinted 2005 Vimana sthana chapter 8,verse no.117, p ratio [Accessed date ] m [Accessed date ] Measurements%20.html [Accessed date ] [Accessed date ] [Accessed date ] CITE THIS ARTICLE AS Waghulade Hemangini S. et, al, Assessment of Medavriddhi & Sthaulya with Objective Parameters A Visionary Study, Int. J. Ayu. Alt. Source of Support Nil Conflict of Interest None Declared Page35

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