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ISSUE 5 (215) INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE eissn-2348-173 RESEARCH ARTICLE Impact Factor (214).815 by International Scientific Indexing (ISI) UAE STHOULYA (OBESITY) A MOST COMMON ETIOLOGY FOR SANDHIVATA- AN EPIDEMIOLOGICAL STUDY Das Jeuti Rani 1*, Das Hemanta Bikash 2, Mandal Sisir Kumar 3, Sharma Surendra Kumar 4 1. PG Scholar, Department of Roga Evam Vikriti Vijanana, National Institute of Ayurveda, Jaipur, Rajasthan, Contact No.- +91959192744, E-mail ID- djeutirani@yahoo.in 2. PG Scholar, Deptt of Prasuti and Stri roga, Govt. Ayurveda College, Guwahati, Assam, Contact No.- +91986448718, E-mail ID- dhemantabikash@gmail.com 3. Assistant prof. Department of RogaEvamVikritiVijanana,National Institute of Ayurveda, Jaipur, Rajasthan, Contact No.- +919982343576, E-mail ID- todrskmandal@gmail.com 4. Associate prof. Department of RogaEvamVikritiVijanana,National Institute of Ayurveda, Jaipur, Rajasthan, Contact No.- +919411436187, E-mail ID- drsksn31@rediffmail.com Article Received on - 22 nd June 215 Article Revised on - 2 th Sept 215 Article Accepted on - 25th Oct 215 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 Available @ www.ijaam.org) Page251 213 IJAAM This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3./deed.en_us), which permits unrestricted non commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Das Jeuti Rani et.al., Sthoulya (Obesity) A Most Common Etiology for Sandhivata- An Epidemiological Study, Int. J. Ayu. Alt. Med., 215;

ISSUE 5 (215) INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE eissn-2348-173 RESEARCH ARTICLE STHOULYA (OBESITY) A MOST COMMON ETIOLOGY FOR SANDHIVATA- AN EPIDEMIOLOGICAL STUDY *Corresponding Author Das Jeuti Rani PG Scholar, Department of Roga EvamVikritiVijanana, National Institute of Ayurveda, Jaipur, Rajasthan, Contact No.- +91959192744, E-mail ID- djeutirani@yahoo.in QR Code IJAAM ABSTRACT: Sandhivata is a Vatavyadhi and now days it is common health problem in the world. There are mainly three causes of Vatavyadhi which are Swanidana, Dhatukshayajanya and Margavarodha. Among which Dhatukshaya is also an important one. As a Vatavyadhi the Nidana of Sandhivata is same with this. In the Nidana of Vata Vyadhi, Sthoulya is not mention, but it leads Sandhivata due to Dhatukshaya. Here a survey study was done to analyze the prevalence of Sthoulya among patient having Sandhivata with classical sign and symptoms, Sthoulya (obesity) on the basis BMI in National institute of Ayurveda, Jaipur with a duly formed proforma. Among 11 patients, out of which 78 patient was Sthoulya. With the help of this it was also try to find out the pathogenesis of Sandhivata in perspective to Sthoulya (obesity). Key Words: Sandhivata, Sthoulya, Dhatukshaya, Obesity, Nidanarthakararoga www.ijaam.org INTRODUCTION In Ayurvedic text there are some diseases which is called Nidanarthakara Roga, where one diseases is the cause of other disease. [1] Here Sthoulya is the Nidanarthakara of Sandhivata. Sometime the Nidanarthakara Roga subside after producing the disease then it is called Ekarthikari Roga and sometime remain with the disease which is produced by this then it is called Ubhayarthakari. [2] Here Sthoulya is Ubhayarthakari for Sandhivata, because with Sandhivata, Sthoulya also present. From the Samhita period onwards, the disease Sandhigatavata has identified as a separate clinical entity. It is a Vatavyadhi, but it is not mentioned under 8 types of Nanatmaja Vyadhi, by any Acharyas. Acharya Charaka has described it by the name of Sandhigata Anila with the symptoms of Sotha, which is Vata Purna Driti Sparsha (palpable as air filled bag) and Akunchana Prasarane Vedana (Pain on flexion and extension of the joints) [3]. Except Acharya Caraka all Brihatrayee and Laghutrayee mentioned it as Sandhigatavata which is under Vatavyadhi. So, the Nidana of Sandhivata is same as Vatavyadhi. These Nidana can be categorized as Swanidana, Dhatukshayjanya and Margaavarodha. Swanidana [4] include all the Aharaja, Viharaja and Manashika Nidana which directly vitiates Vata & Dhatukshaya is that which increases Vata Dosha after Kshaya of any Dhatu and in Margaavarodha Vayu vitiate after obstruction [5]. In the Nidana of Vatavyadhi, it is not found that Sthoulya is a causative factor, but Uttara Dhatukshaya(asthi, majja) which occur after Sthoulya(obesity) leads the disease Sandhivata. Sthoulya is that where excessive fat and muscle is deposited in buttock, abdomen and breast for which the person has not proper body built and zeal. [6] In modern science Price said that obesity is a condition in which there is an excessive amount of fat. Sthoulya (obesity) is now a global problem, and it leads to Sandhivata. Here a survey study was done to analyze that Sthoulya is a causative factor of Sandhivata on the basis of sign and symptom of Sandhivata and Sthoulya. WHO (2)1 defines obesity as "abnormal or excessive fat accumulation in adipose tissue, to the extent that health is impaired" [7] AIM AND OBJECTIVE To study the etiopathology of Sandhivata in perspective of Sthoulya that may be considered as one of the most important causative factor in modern era. MATERIAL AND METHOD A survey study was conducted at I.P.D. and O.P.D. of N.I.A. Jaipur in a time period from Nov 13 to Dec 14 in 11 patients in a duly formed proforma in age Group 2-7, satisfying the inclusion criteria. Inclusion criteria: 1. Patients having classical sign and symptoms of Sandhivata 2. Not suffering from any systemic disease 3. Age between 2yrs-7yrs Page252 Das Jeuti Rani et.al., Sthoulya (Obesity) A Most Common Etiology for Sandhivata- An Epidemiological Study, Int. J. Ayu. Alt. Med., 215;

ISSUE 5 (215) INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE eissn-2348-173 4. Patients were taken irrespective of sex, religion, occupation. Exclusion criteria 1. suffering from any systemic disease 2. Age less than 2yrs and more than 7 yrs RESULT AND DISCUSSION The study was done on 11 patients of known case of Sandhivata, among them 78 patient were found with Sthoulya. The demographic data of 78 patients was like this-regarding age out of 78 cases maximum no. of cases i.e. 91 were found in the age group of 35-5. The next common age group was 51-7 years (8.97), followed by cases in age group of 21-35years (figure1). Which shows that among age group 35-5 yrs Sthoulya(obesity) was more. Among 78 patient weights from 68-7 kg was 8.97, from 71-75 kg was 48.71, 76-8 kg was 38.46 and 82-85 kg was 3.84 (figure2). Height among 78 patients was 29.48 from 1.54-1.6 meter and 7.52 from 1.61-1.7 meter (figure3). According to their height and weight BMI was like this from 28-29.99 kg/m 2 was 32.5 and from 3-32 kg/m 2 was 67.94(figure4), which shows that more BMI more is the prevalence rate of Sthoulya(obesity). Distribution of sex in 78 cases reveals that 7.51 of cases were female followed by 29.48 was male (figure5). Prevalency was more among the female. Out of 78 patients 97.43 were from urban habitat and 2.57 from rural habitat(figure6). Due to rising technology there is less physical activity so Sthoulya(obesity) is more in urban area. out of 78 surveyed patients different type of occupation was found among which maximum 62.82 were housewife, 2.56 were serviceman 3.76 businessman, 2.56 farmar, 1.28 teacher, (figure7). The disease is maximum in house wife because spending time in front of T.V., lack of physical activity leads to Sthoulya(obesity). Out of 78 patients 33.33 were Vatapitt Prakriti, 55.12 were Vatakapha Prakriti, 11.53 were Pittakapha Prakriti (figure8). It can be said that patients were more in Vatakapha dominancy(55.12) and as a whole Vata Prakriti patients was suffering from this Vatavyadhi (Sandhivata) is more. Out of 78 patients 87.17 were Rajasik Prakriti and 12.82 were Tamashik Prakriti (figure9). Vatavyadhi was more prevalent in Rajashik Prakriti because this Prakriti is Vata dominant. In this modern era people become more Rajashik Prakriti, because they forget about the rules of Sadvritta, which is also a cause of Vata Vyadhi. Out of 78 patient taking of cold substance (ice cream, cold drink, shield water) daily was 73.7, sometime 5.12 and never 21.79(figure1), Sita is a Guna of Kapha, if excessive amount is taken then it produced Amarasa and leads Srotorodha by Medodhatu Vridhi, which cause Asthidhatukshaya (because Uttaruttardhatu get nutrition) [8],as a result Vata is increased and produced Sandhivata. Out of 78 patients, ghee used in extra amount was 82.5 (figure11). This indicate that excessive amount of Sneha increase Meda and leads Sthoulya(obesity) [9]. Out of 78 patient 56.41 were taken MAL(Madhur, Amla, Lavana) Rasa daily, 2.56 were taken ML(Madhur Lavana), 31.17 were taken MALK(Madhur, Amla, Lavana, Katu), MAK(Madhur, Amla, Katu) 1.28, MKLT(Madhur, Katu, Lavana,Tikta) 2.56 (figure12), almost every patient had taken Madhur substance which increases Kapha, which is the causative factor of Sthoulya [1] among 78 patient day sleep was taken by 53.84 patient(figure13). Day sleep(divaswapna increases Snigdhata) [11] Assessment of Sthoulya(obesity): In Ayurvedic text Sthoulya (obesity) is that where Udara (abdomen), Nitamba (hip) and Stana (breast) size is increase in a person. To measure this there is description of Pramana(measure) of every part of body which is measured by one s own Anguliparva (digit). According to Caraka height of the individual is 84 Angula [12] and according to Susruta it is 12 Angula [13] by patients own Anguli, though the variation is mainly due to postural difference. Measurement of normal Udara its length is 12 Angula and breadth is 1 Angula, [14] distance between two Stana (breast) is 2 angula. [15] In case of Sthoulya (obesity) the measurement of Udara and distance between two breast is decreased. Again in case of Sthoulya(obesity)there is more sweating, cannot bear labour, lack of zeal, thirst and hunger is increased, lack of Vyavaya (sexual intercourse). [16] Again Sthoulya (obesity) can be best measured by BMI (the weight of a person in kilograms divided by the square of the height of that person in meters), between 25-29 is overweight and > 3 is clinically declared as obesity (Sthoulya). Pathophysiology: Sandhigata Vata is a Vatavyadhi so the pathogenesis is same as Vatavyadhi, either Nidana is Dhatukshayjanya or Margavarodhajanya. In case of Sthoulya (obesity) it is a Dhatukshayjanya Nidana, if we go through the pathogenesis of Sthoulya (obesity) then we see that the person who used to take Madhur Rasa, Sleshmala food and after that if enjoy the day sleep & does no physical exercise then the food substances get converted to Sneha Dravya and these Sneha increases Medodhatu [17], which results Sthoulya (obesity). In modern science it is Page253 Das Jeuti Rani et.al., Sthoulya (Obesity) A Most Common Etiology for Sandhivata- An Epidemiological Study, Int. J. Ayu. Alt. Med., 215;

ISSUE 5 (215) INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE eissn-2348-173 also said that consumption of refined and processed foods, causing nutrient bankruptcy in our body and the lack of adequate physical activity to burn calories and build health. Refined and processed foods are rich in fats, sugars, trans fats, and preservatives. They are also poor providers of nutrition. The lack of nutrients combined with the excess sugar and fats and lack of exercise lead to obesity and poor health [18] As a result other Dhatu get no nourishment due to obstruction of channels by Meda. The next Dhatu of Meda is Asthi, so Kshaya of Asthi Dhatu takes place slowly. Asthi makes Sandhi, [19] so due to Kshaya of Asthidhatu Vata is increased. As a result Vata is located in Sandhi and causes Sandhivata. Samprapti of Sandhivata due to Sthoulya Demographic Data 1 91 5 48.71 38.46 5 8.97 35-5 51-7 21-35 8.97 3.84 68-7 71-75 76-8 82-85 Fig1: Age wise prevalence of 78 patients Fig2: weight wise Prevalence of 78 Patients 1 5 7.25 29.48 1.54-1.6 1.61-1.7 1. 5.. 32.5 28-29.99 kg/m2 67.94 3-32 kg/m2 Page254 Fig3: Height wise prevalence of 78 patients Fig4: BMI wise Prevalence of 78 Patients Das Jeuti Rani et.al., Sthoulya (Obesity) A Most Common Etiology for Sandhivata- An Epidemiological Study, Int. J. Ayu. Alt. Med., 215;

VOL 3 ISSUE 5 (215) INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE eissn-2348-173 97.43 1 1 8 6 4 2 7.51 29.48 5 F Urban M Fig5: Sex wise prevalence of 78 patients 8 6 4 2 2.57 Rural Fig6: Habitat wise Prevalence of 78 Patients 55.12 62.82 33.33 2.56 1.28 6 4 2 33.33 11.53 Fig7:occupation wise prevalence of 78 pts 87.17 1 Fig8:Sharirik prakriti wise Prevalence of 78 Pts 1 73.7 5 5 12.82 5.12 21.79 Tamashik prakriti Fig9: Manashik prakriti wise prevalence of 78 patients 1 5 Fig1: weight wise Prevalence of 78 Patients 56.41 82.5 6 4 2 17.95 31.17 2.56 1.28 2.56 Page ghee used in not used extra amount was 255 Rajashik prakriti Fig11: using of ghee wise prevalence of 78 patients Fig12: weight wise Prevalence of 78 patients Das Jeuti Rani et.al., Sthoulya (Obesity) A Most Common Etiology for Sandhivata- An Epidemiological Study, Int. J. Ayu. Alt. Med., 215;

ISSUE 5 (215) INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE eissn-2348-173 55. 5. 45. 4. 53.84 yes 46.61 no Fig13: Day sleep wise prevalence of 78 patients CONCLUSION Sandhivata occurs in sthoulya person due to dhatukshayjanya vata. Its samprapti is same as vatavyadhi. Due to changing lifestyle as result of urbanization it is increase day by day. Low REFERENCES 1. Lakshmidhar Dwevedi, Dr. B.K. Dwevedi, et al editors, commentatory of Cakrapani on Caraka Samhita, 1 st ed. Varanasi: Chaukhambha Krishnadas Academy; 28.p.752. 2. Lakshmidhar Dwevedi, Dr. B.K. Dwevedi, et al editors, commentatory of Cakrapani on Caraka Samhita, 1 st ed. Varanasi: Chaukhambha Krishnadas Academy; 28.p.753. 3. Lakshmidhar Dwevedi, Dr. B.K. Dwevedi, et al editors, Caraka Samhita of Caraka, 1 st ed. Varanasi: Chaukhambha Krishnadas Academy; 213.p.913. 4. Lakshmidhar Dwevedi, Dr. B.K. Dwevedi, et al editors, Caraka Samhita of Baraka, 1 st ed. Varanasi: Chaukhambha Krishnadas Academy; 213.p.922 5. Lakshmidhar Dwevedi, Dr. B.K. Dwevedi, et al editors, commentatory of Cakrapani on Caraka Samhita, 1 st ed. Varanasi: Chaukhambha Krishnadas Academy; 213.p.922. 6. Lakshmidhar Dwevedi, Dr. B.K. Dwevedi, et al editors, Krishnadas Academy; 28.p.43 7. WHO. Obesity- Preventing and managing the Global Epidemic: understanding how overweight and obesity develop, Tech Rpt Ser, 2: 894, 8-9. 8. Ambikadutta Sashtri, editor, Susruta Samhita of Susruta, reprint Varanasi: Chaukhambha Sanskrita Samsthan; 212.p.81 nutritious and high calorie diet with day sleep is the most causative factor of sthoulya (obesity) and with other health problem it also causes sandhivata. 9. Yadavji Trikamji, editor,madhavnidana of Madhavkara, reprint, Varanasi: Chaukhambha orientalia; 21.p.226 1. Yadavji Trikamji, editor,madhavnidana of Madhavkara, reprint, Varanasi: Chaukhambha orientalia; 21.p.226 11. Lakshmidhar Dwevedi, Dr. B.K. Dwevedi, et al editors, Krishnadas Academy; 28.p.41 12. Lakshmidhar Dwevedi, Dr. B.K. Dwevedi, et al editors, Krishnadas Academy; 28.p.926 13. Ambikadutta Sashtri, editor, Susruta Samhita of Susruta, reprint Varanasi: Chaukhambha Sanskrita Samsthan; 212.p.169 14. Lakshmidhar Dwevedi, Dr. B.K. Dwevedi, et al editors, Krishnadas Academy; 28.p.926 15. Lakshmidhar Dwevedi, Dr. B.K. Dwevedi, et al editors, Krishnadas Academy; 28.p.926 16. Yadavji Trikamji, editor,madhavnidana of Madhavkara, reprint, Varanasi: Chaukhambha orientalia; 21.p.226 17. Yadavji Trikamji, editor, Madhavnidana of Madhavkara, reprint, Varanasi: Chaukhambha orientalia; 21.p.226 18. http://www.wallacebishop.com/types-of-obesity.html [Accessed on 2 Aug 215] 19. Brahmananda Tripathi, editor, hindi Commentary Dipika of Sarangadhar Samhita of Sarangadhar, Varanasi:Chowkhambha Surbharati Prakashan,212, p 62 CITE THIS ARTICLE AS Das Jeuti Rani et.al., Sthoulya (Obesity) A Most Common Etiology for Sandhivata- An Epidemiological Study, Int. J. Ayu. Alt. Med., 215; Source of Support Nil Conflict of Interest None Declared Page256 Das Jeuti Rani et.al., Sthoulya (Obesity) A Most Common Etiology for Sandhivata- An Epidemiological Study, Int. J. Ayu. Alt. Med., 215;

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