A CLINICAL EVALUATION OF STHAULYAHAR YOG IN THE MANAGEMENT OF STHAULYA (OBESITY)

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1 WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Parashar et al. SJIF Impact Factor Volume 6, Issue 03, Research Article ISSN A CLINICAL EVALUATION OF STHAULYAHAR YOG IN THE MANAGEMENT OF STHAULYA (OBESITY) Dr. Rakesh Parashar* Reader Department of Kriyasharir, Government Ayurved College, Pancheshwar Road, Junagadh (Gujarat). Article Received on 26 Dec. 2016, Revised on 26 Jan. 2017, Accepted on 06 Feb DOI: /wjpps *Corresponding Author Dr. Rakesh Parashar Reader Department of Kriyasharir, Government Ayurved College, Pancheshwar Road, Junagadh (Gujarat). ABSTRACT The aim of ayurveda is not only to cure the disease but also to maintain healthy Status of a healthy individual so the Ayurveda is not only a medical science but also a science of life. To remain a person healthy Ayurveda also descrived Dincharya, Ratricharya, Ritucharya, Dietetic Rules and Regulations that are complete the side of life science of Ayurveda. Sthoulya (obesity) is a common growing health problem. It is a disease which is the result of an unorganized way of living, taking food, stress, lack of physical work and much common among the people of middle- higher socioeconomic status. Sthaulya is global problem in both developing and developed countries. There are around 475 million obese adults with over twice that number overweight - that means around 1.5 billion adults are too fat. Over 200 million school-age children are overweight, making this generation the first predicted to have a shorter lifespan than their parents and affecting adult as well as children. Sthaulya Roga strikingly resembles with disease entity termed as obesity in modern system of medicine. In Ayurveda the treatment of Sthaulya Roga is Apatarpana chikitsa including Ahara, Vihara & drugs. The management of obesity with modern medicine is quite unsatisfactory and associated with serious side effect. So it was decided to do a trial on Herbomineral medicines in form of Sthaulyahar yog. The study was conducted in thirty clinically diagnosed patient of Sthaulya (Obesity). It was observed that the patient of Sthaulya Roga treated with Sthaulyahar yog showed good results on reducing their body weight. KEYWORDS: Ahar, Dhatu poshan, Dhatu, Sthaulya, Ayurvedic drug, weight loss, Sthaulyahar yog, Vol 6, Issue 03,

2 INTRODUCTION In the present era of civilization a person is not aware towards his ideal health. A person will be completely healthy if he follows the dictums of Tripods of Life i.e. Āhāra, Nidrā and Brahamcarya [1] Āhāra is important among the others because nourishes and maintain the equilibrium state of Dosha, Dhātu and Mala. Aharrasa which is produced from Ahara after digestion is circulated all over the body. It reaches in minute channels and supply nutrition to all the dhatus. [2] Sthaulyatā is a disorder of Medo-dhātu. Sthoulya is described as a kapha predominant disease involving kapha and medas as main dosha and Dushya. [3] Sthoulya is one among the Santharpanajanya vyadhi mentioned inayurveda, which can be correlated with obesity explained in contemporary science. The problem of Sthaulya (obesity) is not new; it has its existence right from Vedic period. Charaka samhita the pioneer text of Ayurveda has mentioned about Sthaulya. In the description of Physical constitution under astha ninditiya purusha; Ati-Sthula is one among eight undesirable physical constitutions. [4] According to Acharya charaka chal-sphik udara, Stana are the main clinical features of Sthaulya. [5] The prevalence of overweight and obesity is increasing at an alarming rate in developed and developing countries throughout the world. [6] So we can say that sthaulya is the most vulnerable disease in the present era and there is no safe and satisfactory management of Sthaulya available in modern system of medicine. According to the World Health Organization in 2014 more than 1.9 billion adults, eighteen years and older were overweight and that over 600 million of these are obese. In 2014, 39% of adults aged 18 years and over (38% of men and 40% of women) were overweight. The worldwide prevalence of obesity more than doubled between 1980 and [7] India has a bio-diversity in herbal medicine and these play an important role in human life. Herbal medicine satisfies both the aims of Ayurveda, by maintaining the health of healthy individual and cures the disease of the diseased one. Therefore, it was decided to evaluate Herbo-minaral drugs in the management of Sthaulya as per the principle of Ahara, Vihara and drugs. Vol 6, Issue 03,

3 AIMS AND OBJECT To reduce the symptoms of sthaulya such as, lethargy, Adephagia, Dyspnea, Anadipsia, phantasm, Hypersomnia. To evaluate the efficacy of Sthaulyahar yog in the management of sthaulya (obesity). MATERIALS AND METHODS The study comprises of two parts literary review and clinical study. Literary review includes disease review and drugs review. In disease review section the etiopathogenesis and symptoms of disease Sthaulya is reviewed critically by referring various classical texts and modern references. Drugs review section studied the contents of formula Sthaulyahar yog having property deepan, pachan, rookshan, meda kshapan in detail. In clinical study the effects of Sthaulyahar yog are assessed by specially prepared assessment criteria and the significance of the effect is measured by statistical test. DISEASE REVIEW According to Dhatu poshana theory all dhatus nourishes from ahar rasa but in Staulya Medo dhatu get over nourished as compare to other dhatu, because of over nourishment deposition of medo dhatu take place in various body parts. [8] Obesity is very well said in Ayurveda by the name of sthoulya and atisthoulya. Acharya Charaka, who may be called as the Indian Hippocrates, described obesity as a disease of the fat tissues (medoroga) leading to hugeness (sthoulyam). [9] As per Acharya charak Sthaulaya is defined as movable body parts of an individual like buttock, chest and abdomen due to excessive accumulation of medo and mansa, known sthaulaya. [10] Obesity can be defined as an excessive accumulation of fat in the adipose tissue of the body. The Framingham study demonstrated that a 20% excess over desirable weight clearly imparted a health risk. The basic cause of obesity is over nutrition. A diet containing more energy than needed may lead to prolonged prodigal post hyperlipidemia and to deposition of triglycerides in adipose tissue resulting in obesity. [11] Obesity is a disorder of energy imbalance. The two sides of the energy equation, intake and expenditure are finally regulated by neural and hormonal mechanism. This fine balance is Vol 6, Issue 03,

4 maintained by an internal 'set point' or liposat. The concept of a 'set point' of body weight suggests that each person has a control system that 'sets' how much weight or alternatively how much fat he or she should have. [12] DRUGS REVIEW Kantloh Bhasm, Yavakshar(A crude potassium carbonate obtained from barley ash), Haritaki (Terminalia Chibula), Vibheethaki (Terminalia Belerica), Amalaki (Amblica Officinalis), Sunthi (Gingiber officinale), Maricha (piper nigrum), Pippali (piper longum), Chitrak (plumbago zeylanica), Nagarmotha (Cyperus Rotundus), Vidang (Emblica Ribes). CLINICAL STUDY Selection of Patients Inclusion criteria 1. Patients were randomly selected, Irrespective of Age, Sex, Prakriti, Sara, Religion, Satmya, Satva etc. 2. Patients with classical sign & symptoms of Sthaulya were selected. 3. Patients having the BMI more than 25 were selected. 4. All the patients were examined and assessed by taking detailed case history through clinical examination to establish final diagnosis of Sthaulya. Exclusion Criteria 1. Patients suffering from Infectious disease were excluded. 2. Patients suffering from hypothyroidism were excluded. 3. Associated with Coronary heart disease, Hypertension, etc. 4. Pregnant & lactating woman 5. BMI > 45 Intervention 30 Patients were administered orally with Sthaulyahar yog for a period of 90 days. Patients were assessed before treatment on -1st day and after completion of medication on 90 th day. Doses Sthaulyahar yog Two capsules of 500 mg in adults patient twice a day with in unequal quantity of Honey & ghee. Vol 6, Issue 03,

5 Exercise All the patients were instructed to morning walk, cycling and other exercise that they can do. Diet All Patients were given a chart comprising diet restrictions and exercises. MODE OF ACTION OF THE DRUG Drugs of Sthaulyahar Yog have Tikta, Katu and Kashaya Rasa, Deepana Pachana Lekhan propertya, Laghu, Ruksha, tikshna, Ushana guna. Because of these they cause srothoshodhana, Shoshana, Lekhana, Amahara, Mutrala, medososhana karma. They facilitate the depletion of the baddha medas which is accumulated in the body. It corrects the Agni mainly Medodhathwagni mandy and checks the further progression of Meda Sanchaya by preventing the accumulation of Medas. It Removes the Avarodha in Medavaha Srotas. So the Uttarottara dhatu are get nourished and the process of Medavriddhi is thus get culminated and the poshana of other dhathus also takes place. Hence Dhatu Poshakamsa can easily reach to respective Dhatu enhancing the proper nutrition to all Dhatu. ASSESSMENT For assessing the changes, patients were examined at two week intervals. Suitable scoring method for the symptoms and signs was adopted. The efficacy of the therapy was assessed on the basis of subjective as well as objective criteria. Statistical test was performed on the data obtained on 0 day and on 90 th day. Subjective criteria Most of the signs and symptoms of Sthaulya described in Ayurveda are subjective in nature. Symptomatic Assessment Patient were assessed on the criteria of symptomatic relief such as presence of Sthaulya symptoms like Unctuousness, coughing, foul smelling, abdomen enlargement, enlargement of flanks, Dyspnea, Anadipsia, [13] lethargy, [14] Adephagia, desudation, snoring, Hypersomnia, phantasm, lack sex power. [15] Alapprana. [16] Objective criteria It was assessed on body weight, measurement of circumference and BMI before and after the treatment. Vol 6, Issue 03,

6 Weight Loss Percentage of reduction in weight is calculated by the ratio of change in weight and excess weight beyond normal BMI. Reduction in Organ circumference Detail table of organ circumference before and after treatment like neck, arm, chest, abdomen, buttock, thigh of all patients. Table-1 Organs name Mean BT AT SD SE t p Neck <0.001 Arm <0.001 Chest <0.001 Abdomen <0.001 Buttock <0.001 Thigh <0.001 Detail table of weight loss and Symptomatic relief before and after seeking treatment of all patients. Table: 2 Mean Criteria SD SE t p BT AT Weight Loss <0.001 Symptomatic relief <0.001 DISCUSSION In all patients Unctuousness, Dyspnea, Hypersomnia, Lethargy will be because of the deposition of excess amount of kapha dosha & meda dhatu. Because of the deposition of meda in excess quantity in various body parts the various symptoms like abdomen enlargement, enlargement of flanks, movement and extra enlargement in the areas of Shirk (Buttock) Udara (abdomen) Stana (chest) Vitiated Vata dosh can cause Trushadhikya and kshudhadhikya. [17] Excessive sweating is because of infected swedmala and medadhatu. We get the percentage of symptomatic relief 61.81% in Sthaulya patients. We get maximum symptoms like Unctuousness, abdomen enlargement, enlargement of flanks, Dyspnea, Anadipsia, phantasm, Hypersomnia, snoring, lethargy, Adephagia, desudation, etc. Vol 6, Issue 03,

7 CONCLUSION An ideal Sthoulyahara dravya which helps in the Samprapthi Vighattana of Sthoulya should possess Tikta, Katu Rasa, Ruksha, Theekshna Guna, Ushna virya and Chhedana, Lekhana, Medo-sleshmahara Karmas. Sthaulyahar yog possess these ideal qualities thus helpful in the breaking of the pathogenesis of the sthoulya roga. As per the criteria of symptomatic relief we got the average percentage relief in all patient is 53.75%. As per the weight loss assessment criteria we got the average of percentage weight loss in all patient is 40.88%. As per the organ circumference we got average less circumference in neck-1.73cm, arm- 1.73cm, chest-4.13cm, abdomen-5.14cm, buttock-3.9cm and thigh-2.4- of all patients. After observing all the results we can say that Sthaulyahar yog is beneficial in sthaulya disease. REFERENCES 1. Smriti Pandey, G.P.Tewari, Ramji Kanaujia. A Study of Medo-dhatu and its Effect on the Clinical Cases of Sthaulyata (Obesity). Adv BIORESEARCH, 2010 Dec; 1(2): Kour A, Vikas G, Danisha S. Int J Ayu Pharm Chem. [cited 2017 Jan 23]; Available from: 3. Parvathy Ravindran M. THRAYOOSHANAADYA LOHA IN T STH. [cited 2017 Jan 20]; Available from: 4. Charak samhita of Agnivesha revised by Charak and Dradhabala with introduced by sri satya narayan shastri with vidyotini hindi comentary by Pt.kashi nath shastri and Gorakh nath chaturvedi published by Chaukhambha bharati acadamy varanasi, edited in 2003, sutra sthan chapter -21, paze no-409,viceversa Charak samhita of Agnivesha revised by Charak and Dradhabala with introduced by sri satya narayan shastri with vidyotini hindi comentary by Pt.kashi nath shastri and Gorakh nath chaturvedi published by Chaukhambha bharati acadamy varanasi, edited in 2003, sutra sthan chapter -21,paze no-411,viceversa-9. Vol 6, Issue 03,

8 6. Kelly T, Yang W, Chen C-S, Reynolds K, He J. Global burden of obesity in 2005 and projections to Int J Obes, 2008 Jul 8; 32(9): WHO Obesity and overweight [Internet]. WHO. [cited 2015 Aug 3]. Available from: 8. Shusrut samhita with ayurved tattva sandeepika hindi commenttary by kaviraj Dr. Ambika datta shastri published by chaukhamba sanskrit sansthan varanasi edition-8, sutra sthan chapter- 15/37, paze no Shekhar C. STHOULYA (OBESITY), ETIOLOGY AND ITS MANAGEMENT IN AYURVEDA. Glob J Res Anal [Internet], 2016; Jun 17 [cited 2017 Jan 20]; 4(9). Available from: Charak samhita of Agnivesha revised by Charak and Dradhabala with introduced by sri satya narayan shastri with vidyotini hindi comentary by Pt.kashi nath shastri and Gorakh nath chaturvedi published by Chaukhambha bharati acadamy varanasi, edited in 2003, sutra sthan chapter -21, paze no-411,viceversa Price text book of the practice of medicine edited by sir Ronald bodley scoeet, published by english language book society and oxford university press, edition-12, page no Environmental and nutritional pathology, Robin s pathologic basic of disease, edition-6, Shusrut samhita with ayurved tattva sandeepika hindi commenttary by kaviraj Dr. Ambika datta shastri published by chaukhamba sanskrit sansthan varanasi edition-8, sutra sthan, chapter-15/19, Astang sangrah of vagbhata hindi commenttary byvaidya shree Goverdhan sharma chhangani published by chaukhambha sanskrit sansthan varanasi, edition-5, sutra sthan Bhavprakash of shree bhavmishra edited with the Vidyotini hindi commentary by bhisagratna Pt. brahma Shankar Mishra part -2 published by Chaukhamba sanskrit bhawan varanasi, edition -11,madhya khanda-39/03, Shusrut samhita with ayurved tattva sandeepika hindi commenttary by kaviraj Dr. Ambika datta shastri published by chaukhamba sanskrit sansthan varanasi edition-8, sutra sthan chapter-15/37, Shusrut samhita with ayurved tattva sandeepika hindi commenttary by kaviraj Dr. Ambika datta shastri published by chaukhamba sanskrit sansthan varanasi edition-8, sharir sthan chapter-9/18, Vol 6, Issue 03,

9 18. Vol 6, Issue 03,