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\title{A Review Article on Various Ayuvedic Approaches in the Management of Sthaulya (Obesity)}
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\begin{document}

             \author[1]{Dr. O.P.  Vyas}

             \author[2]{Dr. Nikita  Mishra}

             \author[3]{Dr. Nimina Nanu  Manikkoth}

             \author[4]{Dr. Muraree  Girare}

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\date{\small \em Received: 6 April 2021 Accepted: 4 May 2021 Published: 15 May 2021}

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\begin{abstract}
        


A person having heaviness and bulkiness of the body due to extensive growth especially in Udaradi region is termed as "Sthula" and the state (Bhava) of Sthula is called "Sthaulya". Sthaulya or Medorog (obesity) is commonest metabolic disorders in affluent societies caused by irregular diet and sleep patterns, lack of physical activities, stress etc, and it is a direct result of modernization combined with lifestyle changes by exposing oneself to these factors. we unknowingly invited several diseases out of which Sthaulya is one which affects someone?s social, physical, and mental features. Acharya Charaka has mentioned Sthaulya under Santarpanajanya Vyadhi. The present study deals with all the details of Sthaulya according to ayurvedic classics and its preventive methods like Nidan Parivarjan, therapeutic management along with medicine, diet, Pathya and Apathya.

\end{abstract}


\keywords{sthaulya, santarpanjanita vyadhi, nidan parivarjan, pathya-apathya.}

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\let\tabcellsep& 	 	 		 
\section[{Introduction}]{Introduction}\par
charya Charaka has included Atisthoola in eight varieties of impediment which are designed as Astha Nindita purusha. \hyperref[b5]{1} Atisthaulya comprises one of them.\par
Acharya Charak mentioned that a person in whom excessive and abnormal increase of Medodhatu along with Mamsadhatu is found which results into pendulous appearance of buttocks, belly, breast and whose increased bulk is not matched by a corresponding increase in energy is called Sthulapurusha. \hyperref[b6]{2}   
\section[{II.}]{II.}\par
Nidana  {\ref (etiological factors)} The knowledge of Nidan not only aids the physician towards therapeutics but also in advising about Pathyaapathya. For easy management It is very important to know the Nidana of diseases.\par
Acharya Sushruta and Vagbhat have mentioned endogenous type of cause, Vagbhat has mentioned "Ama" as a causative factor. only Charaka has define "Beejadosha" as one of the causes besides other. In context with Sthula, exogenous causes are diet and whereas Dosha, Dhatu, Mala, Srotas etc. comes under the endogenous causes. Mainly four type of Nidana described in ayurvedic Samhitas- Role of Aharatmaka Nidana in Sthoulya-On the basis of "Samanya Vishesh Siddhant' 'that is ''Sarvada A Sarvabhavanam Samanyam Vruddhi Karanam'' \hyperref[b7]{3} The excessive food consumption of similar substance (Dravya Samanya), similar quality (Guna Samanya) or similar in action (Karma Samanya) help in the over production of dhatu. In the same manner increase intake of these Aharatmaka Nidana which are described above overproduction of medodhatu. Acharya Sushrut has mentioned Rasnimmitameva Sthoulya Karhyam Cha''  {\ref 4} means Sthaulya and Karshya depends upon the quantity and quality of Ahararasa. Ahararasa plays a major role for increasing Meda Dhatu in Sthaulya. 
\section[{Role of Viharatmaka Nidanin Sthaulya-All the}]{Role of Viharatmaka Nidanin Sthaulya-All the}\par
Aharatmaka Nidana ultimately decrease physical activity, which aggravates Kapha and leads to Meda deposition. Viharatmaka Nidan Avyayam, Sukhasana etc. which possesses the qualities same as Meda which increases Meda in the body, Divaswap having Snigdha property leads to blockage of the micro channels of the body. 
\section[{Role of Manas Vyaparain Sthaulya-Acharya Charak}]{Role of Manas Vyaparain Sthaulya-Acharya Charak}\par
mentioned some psychogenic causes of Sthaulya. ''Tatra Atisthoulya ? Harshanityatvat Achintanat'' \hyperref[b9]{5} Harshnitya and Achinta are two psychological factors mentioned by Acharya Charaka which are responsible for Meda Vriddhi. These factors are responsible for Meda Vriddhi. this type of psychological wellbeing and jolliness that person indulge more in worldly pleasure and excess energy stored in the form of Meda.Due to adaptation of modern lifestyles, a person has reduced his physical activity and instead of that the mental work is increased, as a result now a days the diseases caused by psychogenic factors are seen extensively more.\par
Role of Beejadosha in Sthaulya-Acharya Charaka has mentioned that Beejadosha plays a major role for Medovriddhi  {\ref 6.} defect of Beejabhagavayava that is the part of Beeja which resembles with genes may lead to defective development of that organ. also, Bhavamishra has mentioned that increased proportion of Meda and decreased development of Sthool but weak body. Moreover, overnutrition particularly with Madhura rasa during pregnancy is as a causative factor for birth of obese child which indicate role of hereditary factor in genesis of Sthaulya.  {\ref 7} III. 
\section[{Samprapti (pathogenesis) a) Role of Agni in Sthaulya According to Ayurveda}]{Samprapti (pathogenesis) a) Role of Agni in Sthaulya According to Ayurveda}\par
Jatharagni is main responsible factor for digestion of food. In Medoroga (Sthaulya) due to obstruction of Meda, Vata remains in Koshta and causes Tikshnagni. here the question arise, how Ama formation can occur in the presence of Tikshnagni. Chakrapani and Dalhana have clarify this by giving explanation thatin the stage of Tiksnagni, person goes for Adhyasana and Akal Bhojan Seven, which leads to disturbance in Agni and subsequently formation of Ama may take place. Moreover, Dalhana has explained that in the Sthaulya formation of ama is more due to decrease level of Medodhatavagni than Jathragni.\par
As per Vagbhata Pachakansa present in each Dhatu is refered to Dhatvagni. Usma present in Dhatu is part of Jatharagni and is controlled by it. Dhatavagnimandhya of specific Dhatavagni causes Vriddhi of that Dhatu and vis.a.vis. In the state of Hatavagnimandya Kshaya of Uttar Dhatu take place.  {\ref 8} In the case of Sthaulya Medodhatvagni Poshkansh started at Jathragni level is vitiated, this Poshak Ras which comes in large quantities to Meda Dhatu slow down the Medadhatavagni. Due to continuous excess of nutrient, the work of Medadhatvagni reaches almost to its lowest level, which leads to the increases of Meda dhatu in their depot. In addition due to decreased production of Sukshma and Sara part at Medadhatvagni level the further Asthi, Majja, Shukra dhatu get less Poshak Ras due to this Uttarottar Dhatu (Ashthi Majja Shukra) is not formed properly.\par
In another word, due to etiological factors, there is increase in the fatty tissue in the body. This increased fatty tissue produces obstruction in various system. Specifically, this causes obstruction to 'Vata'. This obstructed Vata starts wandering in abdominal cavity. It gives hyperstimulation to the digestive power (Jatharagni). This causes more and quick digestion and absorption of food. As a result of this appetite is increased to satisfy this increased hunger the person goes on eating more and more. This leads to increase in fatty tissue and vicious circle goes on. Even though the digestive power in the stomach (Jatharagni) is increased, there is reduced digestive power at the tissue level. The digestive power responsible for the production of fatty tissue (Medo Dhatwagni) from the muscle tissue into fatty tissue does not take place properly. This causes excess faulty deposition of fat in the body and Medorogais produced. 9 IV.\par
Lakshana of Sthaulya (sign and symptoms)\par
According to Charak, Chala Sphika, Chala Udara, Chala Stana, Ayathopcayotsaha, and Atimeda Mansavruddhi are obvious in all the patient of Sthaulya. hence these may be considered as cardinal symptoms or PratyatmLakshan. \hyperref[b13]{10} In Astang Sangrah Vagbhata also mention these Lakshan of Sthaulya   
\section[{''Guru Cha Aptarpan Chestham Shtaulanam Karsanam}]{''Guru Cha Aptarpan Chestham Shtaulanam Karsanam}\par
Prati'' \hyperref[b17]{14} Nidan parivarjan ''Sankshepta Kriyayoga Nidan Parivarjanam'' \hyperref[b18]{15} Nidan Parivarjan Chikitsa means avoiding all the Aharatmaka, Viharatmaka, Manasika and Anya Nidan responsible for the manifestation of diseases. Both Charaka and Sushrut have laid great emphasis on the principle of Nidan Parivarjana. Sushrut in particular has recommended Nidan Parivarjan as essential component in the management of any disorder. 
\section[{Samshodhana Chikitsa (Purificatory procedures)}]{Samshodhana Chikitsa (Purificatory procedures)}\par
? Vaman (Therapeutic emesis)-Vaman Karma is specifically indicated to cure Kapha related diseases and disorders like obesity.\par
? Virechan (Therapeutic purgation ? Ama Pachan (oral use of digestives to augment the fat metabolism). ? Ruksha Udwartan (Dry medicated powder massage).-Dry powder of herbs is used hence it is known as Ruksha Udvartana. Udvartana opens the circulatory channels, facilitates the metabolic activity and improves the complexion of skin.\par
Common classical preparations used in Sthaulya (obesity) \hyperref[b20]{17} \begin{figure}[htbp]
\noindent\textbf{1}\includegraphics[]{image-2.png}
\caption{\label{fig_0}1 .}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{11}\includegraphics[]{image-3.png}
\caption{\label{fig_1}11}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{113}\includegraphics[]{image-4.png}
\caption{\label{fig_2}1 . 1 .A 3 .}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.85\textwidth}}
Sthaulya as\\
1. Kapha Pradhanaja-predominantly caused due to\\
vitiated Kapha Dosha\\
2. Meda Pradoshaja-Meda is dhatu/tissue which is\\
predominantly affected\\
3. Bahudosa Avastha-Multi factorial conditions.\\
4. Santarpanjanya Vyadhi-Disease caused by due to\\
defected anabolism/overnutrition.\end{longtable} \par
  {\small\itshape [Note: a) Sthana and Swarupa of Meda Dhatu 1. Poshya (Immobile in nature)-which stored in Medodharakala ie; in its sites like., Udara, Sphika, Stana, Gala, etc and Vasa (Mamsagata) According to modern science, it can correlated with adipose tissue / fat. 2. Poshak (Mobile in nature)-which is circulated in whole body along with Gatiyukta Rasa-Rakta Dhatu for nourishing the Poshya Meda Dhatu/Sneha. According to modern science it can be correlated with cholesterol and lipids which are present in circulating blood.]} 
\caption{\label{tab_0}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.85\textwidth}}
Kustha 3. Haridra 4. Vaca 5. Ativisha 6. Katu Rohini 7.\\
Chitraka 8. Chirabilva 9. Daruharidra 10. Haimvati\\
(Karanj).\end{longtable} \par
  {\small\itshape [Note: Shamana Chikitsa (Palliative Treatment)? Langhan (Fasting).-Only in initial stageif Stha+ Ulya caused due to Adhyashan, then Langhan, Laghu Aahar, Alpa-Aahar should be taken]} 
\caption{\label{tab_1}}\end{figure}
 		 		\backmatter  			 
\subsection[{Yoga and exercise}]{Yoga and exercise}\par
Yoga Asana  {\ref 18}   
\subsection[{Yogic breathing or Pranayama 18}]{Yogic breathing or Pranayama 18}\par
It is said in the yogic text Hatha Yoga Pradeepika and others that practice of pranayama make the body slim and fit. Pranayama can help to burn excessive fat in the body. There are two pranayama practices that are good for weight reduction-Kapalabhati and Anulom Vilom Pranayama.\par
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\end{document}
