A Review Article on Various Ayuvedic Approaches in the Management of Sthaulya (Obesity)

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.

Introduction charya Charaka has included Atisthoola in eight varieties of impediment which are designed as Astha Nindita purusha. 1 Atisthaulya comprises one of them.
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. 2

Nidana (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.
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 Manas Vyaparain Sthaulya-Acharya
Charak mentioned some psychogenic causes of Sthaulya. ''Tatra Atisthoulya … Harshanityatvat Achintanat'' 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.
Role of Beejadosha in Sthaulya-Acharya Charaka has mentioned that Beejadosha plays a major role for Medovriddhi 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. 7 III.

Samprapti (pathogenesis) a) Role of Agni in Sthaulya According to Ayurveda
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.
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. 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.
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 Classification In Ashtanga Hridaya and Ashtanga Sangraha Vagbhata have been mentioned three types of Sthaulya i.e., Adhika, Madhyama and Hina with management point of view.
This classification can be correlated with modern as given below -
• Virechan (Therapeutic purgation).-Virechana is beneficial for Sthaulya. Virechana helps to initiate the weight loss mechanism in the body. Virechana being an appropriate Shodhan procedure is not only specific for the elimination of vitiated Pitta Dosha but also helps in the elimination of vitiated Kapha and Vata a where it is also indicated in Sthoulya.  V.

Discussion
Sthaulyais considered as one of the Santarpanjanya Vyadhi with the involvement of mainly Medodhatu and Kaphapradhanatridosh. Excessive accumulation of Kapha and Medawith other factors eventually leads to Sthaulya Roga. line of treatment for Sthulais Apatarpana and Langhana, which can be done by Shodhana and Shamana Yoga therapy, Vyayam proper dietary and lifestyle modification can play crucial role in prevention of Sthaulya. Acharya Charaka has illustrated that Krishata is better than Sthaulya because when Sthula Purusha affected by disease suffers more due to it as compared to Karshya. Kapha Prakriti persons are more prone to become obese (Sthula).