role of panchakarma therapies in the management of sthaulya

Centre for Innovation in Science and Social Action 1


ROLE OF PANCHAKARMA THERAPIES IN THE MANAGEMENT OF THE STHAULYA

PRESENTED BY GUIDED BYDr.Kaushal sinha Dr.Lohith BA 2nd year PG scholar Associate professor Department of Panchakarma SDM college of Ayurveda and Hospital Hassan


• Sthaulya is an burning problem in the world scenario and has acquired the status of an EPIDEMIC.

• Indiscriminate dietary habits, sedentary life styles, stress etc, which are the gifts of modern world, are predisposing factors for Stoulya (Obesity).

• Due to economical, industrial and astonishing progress in science & technology quality of life is deteriorating.

INTRODUCTION


• In Dec 1997; WHO declared Obesity as a global epidemic, giving rise to a new term ‘GLOBESITY’

• 5000 yrs back, Ayurveda had identified this state as Sthaulya and grouped it among the Santarpaṇotta vyādhi

• Obesity is basically a behavioral disorder.


NIDANA 1.AHARAJ

•Gunapradhana-Guru,Sheeta, Pichila, Snigdha

•Rasapradhana – Madhura

•Dravyapradhana- Navanna, Gorasa, Dadhi,

Goudika, Varuni, Anupa Varija Mamsa.

•Vidhipradhana-Adhyasana,Atisampoorna,Atimatra

Ahara.


2.VIHARAJ

• Shayyasana Sukha

• Diwaswapna

• Chesta Dwesha.

3.MANSIK

• Achinta

• Harshanityatwa


SAMPRAPTI GHATAK

Dosha : Kapha Pradhana Vata Pittanubandhi Udhbhava sthana: AmashayaDushya: Rasa, Mamsa, Meda vyakta sthana : sarvasharir Agni : Jataragni, Medodhatvagni Rogamarga : bahya abhyantraAma : Jataragnimandyajanita, Medo

dhatvagnimandyajanita Ama Srotodusti : Medovaha SrotasSrotodusti Prakara :SangaAdhisthana : Medoharakala,vapavahanRoga swabhava:chirakari


STHAULYA ROOPA

• Ayushohrasa (Diminution of life span)

• Javoparodha (Lack of enthusiasm)

• Kriccha Vyavaya

• Daurbalya (General debility)

• Daurgandhya (Foul smelling of body)

• Swedabadha (Distressful sweating)

• Kshudhatimatra (Excessive hunger)

• Pipasatiyoya (Excessive thirst)


TYPE OF STHAULYA

Acc to Charaka: Sthoola & Atisthoola

Acc to Sushruta: Sthoulya & Medoroga

Acc to Vagbhata: Adhika, Madhyama & Heena


BODY MASS INDEX •Body mass index (BMI) weight (kg)/ height squared (m2).

•BMI is significantly correlated with total body fat content.


Adhika Sthaulya : (BMI> 40 Kg/m2) - Very Obese Madhyama Sthaulya : (BMI 30-40 kg/m2) – Obese Hina Sthaulya : (BMI 25-30 kg/m2) - Over weight The international classification of BMI which is widely accepted is

as follows :• Below 20 kg m2 Under weight• 20-25 Kg/m2 Normal• 25-30 Kg/m2 Over weight• 30-40 kg/m2 Obese• Above 40 kg/m2 Very obese


COMPLICATIONS OF OBESITY• Metabolic disorders (DM, Gall stones, Gout, Hyperlipidaemia)

• Mechanical disabilities (OA, Hernia, Varicosity, Dysnoea, Accidents).

• Respiratory Complications (Dysnoea, Apnoea, Pickwickian syndrome, OHS, Resp. infections).

• Cardiovascular complications (Stroke, Venous stasis, CCF etc.).


STHAULYA CHIKITSA

NIDANAPARIVARJANA

GURU ATARPANA

LANGHANA CHIKITSA

SATATA KARSHANA CHIKITSA

PATHYAPATHYA


SHODHANA

• Charaka & Vagbhata both have very clearly mentioned Sthoulya in

Bahudoshavastha, hence Shodhana can be performed.

• Charaka considered Sthoulya as

Shlesma Nanatmaja Vyadhi in Cha.Su.20/17

Santarpana Nimitaja Vyadhi in Cha.Su.23/6• There are two main parts of Shodhana Bahya Samshodhana Abhyantara Samshodhana


BAHYA SHODHANA • Many Acharyas have mentioned external

purification therapy for management of Sthoulya.

• In all classical texts, Udvartana is mentioned as part of Dincharya and for Sthoulya ‘Udvartan’ is recommended.

• Because it is Kaphahara, Medasah Pravilayamanam, Sthirikaranam anganam.

• Charaka specifies ‘Teekshna Rooksha Udvartana’ for Sthoulya. (Ch.Su.21/21)


ABHYANTARA SHODHANA VAMANA

VIRECHANA

NIRUHASHIROVIRECHANA

RAKTAMOKHSANA

• Charak has recommended Vamana and Virechana Karmas for all Santarpanotta Vyadhis. (Ch.Chi.6/47).• As Sthoulya too comes under the same category; Vamana, Virechana therapies can be tried in Sthoulya.


SNEHANA

• Snehana Karma is always restricted for the patients of Sthoulya (Ch.Su. 13/53).• However on exigency usage of Taila is recommended (Ch.Su. 13/44-46).

• For Snehapana & Abhyanga following preparations can be used. Tila Taila (Su.Su45/112)

Sarshapa Taila (Bhai.Rat)

Triphaladi Taila (Bha.pra,Cha.dat,Yog.rat)

Panchatiktakaguggulughrita (Cha.dat,Bha.pra)


SWEDANA

• In Cha.Su.23/8 it is told Svedana as one of the Chikitsa for Santarpana

Janya Roga.

• In A.Sa.Su 24/15 for Sthoulya, Svedana is essential.

• Vagbhata has indicated the use of Pinda sweda on extreme

requirement (A.S.Su. 26/8).• Sagni sweda- Nadi Sveda, Parisheka Sveda, Drava Sveda, Ushna Jala Snana• Niragni sweda- Guru pravarana, Bahupana, Kushdha Nigraha, Atapa sevana, Vyayama, Ahava, Krodha, Bhaya and Upanaha (Ch.Su.14/64, SU.Chi.32/15)


VAMANA

• Sthoulya is Kaphaja Nanatmaja Vikara .Hence Vamana is the first line of measure.

• However Vamana is indicated for treatment of Medo Roga (SU.Chi. 33/18)

• Also similar line of treatment is advised for disorders of Shleshma and Meda (A.S. Su. 19/13, Y. R. 3)

• Vamana is considered as the best for Kapha dosha (Ch.Su.25/40).

• Hence, Vamana can be used for the treatment of Sthoulya, but only in uncomplicated patients.


VIRECHANA

• Clear indication of Virechana in Sthaulya is mentioned.

• Though Virechana has been forbidden for patients of Sthoulya (Ch.Si.2/11-12, SU.Chi.33/29, Ka.Si.7), as Virechana is indicated for Pittadhikya condition.

• In Sushruta Samhita, while describing Virechana Karma, Sthula Pramehi is considered as Durvirechya due to aggravation and dominance of Medas.

• However, Tikshna Sodhana (Virechana) is insisted (Su. Chi. 12/6) line of treatment for Sthaulya.

• It has been included for the management of Sthoulya by Bhava Mishra (B.P.Ma.39/11-26)


CONT...

Virechana Yogas like Triphala, Aragvadha, Katukarohini can be used.

• Pippalyadichoorna (Cha.Datt.Virechanadhikara)

• Hareetakyadichoorna (Cha.Datt.Virechanadhikara)

• Trivrutadigutika/ Leha (Cha.Datt.Virechanadhikara)


BASTI

As it is told by Sushruta and almost in all the classics we will get reference

regarding Lekhana Basti especially for Sthaulya.(Su .chi.38/82)

• Other Basti’s like:

– Bhadradi Asthapana Basti, Aragvadhadi Niruha Basti (Su.chi.38/60-63,79)

– Dvipanchamooladi Basti, Kaphamayaghna Niruha, Anuvasana (A.Sa.Kal.5)

– Erandamooladi Niruha (Ash.Hru.kal.4)

– Gomutra Basti (Cha.Datt)

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SHIROVIRECHANA• Ayurvedic texts have specified the benefits of Shirovirechana in Medo Roga,

Avapida Shirovirechana is mentioned as line of treatment for Abhishyanna Meda Vyaapta Sharira. (SU.Chi.40/44).

• Moreover Karshana Nasya is indicated in the disorders of Kapha Dosha (Ka. Si.2) and Sthoulya is enumerated as one of the twenty-kapha nanatmaja disorder.

• According to Bhavprakash Triphaladya taila has been indicated for Nasya Karma in patients of Sthoulya (BP.Ma.39/55-56, YR - Medoroga Chi.)

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DISCUSSION• Even though all the Panchakarmas are described in the

Chikitsa principle of Sthaulya, but during the indication of

each Karma, Sthoulya is Ayogya for each Panchakarma-why?

• In A.Sa.Su.24/15, Indu commentry & Cha.Su 23/8 mentioned

Rakta mokshana can be done in Sthaulya?

• In Yo.Ra, Cha.Datt, Bha.Pra (39/58-60) said that Triphaladi

Taila can be used for Nasya Karma in Sthaulya. How it will be

helpful?

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CONCLUSION • Based on the Avastha & Dosha Bahulyata suitable Shodhana can be adopted.• If necessary Mridu Vamana & Virechana can be performed so as to avoid

complications in Sthaulya.

• Among all these Shodhana modalities Basti Karma is more ideal and do not produce much complications compared to Vamana & Virechana Karma.

• Repeated & regular Shodhana followed by controlled diet, regular exercise along with Shamana medications should be carried to combat STHAULYA an Epidemic.

• Thus it can be concluded that Shodhana measures have very important role in management of Sthoulya.

role of panchakarma therapies in the management of sthaulya

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