Download - Apatarpana ss
“A STUDY ON APATARPAN WITH SPECIAL REFERENCE TO
UDVARTANA IN STHOULYA”.
BY
Dr. AMIT A. MASULE
DISSERTATION SUBMITTED TO THE
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,
BANGALORE.
IN THE PARTIAL FULFILLMENT
OF THE REQUIREMENT FOR THE DEGREE OF
DOCTOR OF MEDICINE
(Ayurveda) IN
AYURVEDA SIDDHANTA UNDER THE GUIDANCE OF
DR.M. B. KARAMBELKAR D.S.A.C., A.V.P., Ph.D.
PROFESSOR
DEPARTMENT OF POST GRADUATE STUDIES IN SIDDHANTA,
DR.BNMET’S SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND
RESEARCH CENTRE, BIJAPUR
NOVEMBER - 2009
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE.
DECLARATION BY THE CANDIDATE
I, hereby declare that this dissertation entitled “A STUDY ON APATARPAN
WITH SPECIAL REFERENCE TO UDVARTANA IN STHOULYA” is a bonafide
and genuine research work carried out by me under the guidance of DR. M. B.
KARAMBELKAR D.S.A.C., A.V.P., Ph.D. Prof., Dept. of Siddhanta, Shri
Mallikarjuna Swamiji Post Graduate and Research Center, Bijapur.
Date: Signature of the Candidate Place: Bijapur. Dr. AMIT A. MASULE
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.
Dr. B. N. M. E. T’s SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH
CENTER, BIJAPUR.
DEPARTMENT OF POST GRADUATE STUDIES IN SIDDHANTA
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “A STUDY ON APATARPAN
WITH SPECIAL REFERENCE TO UDVARTANA IN STHOULYA” is a bonafide
research work done by Dr. AMIT A.MASULE in partial fulfillment of the requirement
for the degree of DOCTOR OF MEDICINE (AYURVEDA).
Signature of the Guide.
Date: DR.M. B. KARAMBELKAR D.S.A.C.,A.V.P.,Ph.D Place: Professor and Guide
. Dept. of Siddhanta Shri Mallikarjuna Swamiji PostGraduate and Research centre,Bijapur
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
Dr. B. N. M. E. T’s SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH
CENTRE, BIJAPUR.
DEPARTMENT OF POST GRADUATE STUDIES IN SIDDHANTA
ENDORSEMENT BY THE H.O.D, PRINCIPAL/HEAD OF THE INSTITUTION
This is to certify that the dissertation entitled “A STUDY ON APATARPAN
WITH SPECIAL REFERENCE TO UDVARTANA IN STHOULYA” is a bonafide
research work done by Dr. AMIT A. MASULE under the guidance of DR. M. B.
KARAMBELKAR D.S.A.C., A.V.P., Ph.D. Prof. DEPT. OF SIDDHANTA, Shri Mallikarjuna
Swamiji Post Graduate and Research Centre, Bijapur.
Seal & Signature of the HOD Seal & Signature of the Principal Dr. J. C. HUDDAR M.D (Ayu) Dr.R.N.GENNUR M.D (Ayu) Date : Date :
Place: Place:
COPYRIGHT
DECLARATION BY THE CANDIDATE
I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka
shall have the rights to preserve, use and disseminate this dissertation / thesis in print or
electronic format for academic/research purpose.
Date: Signature of the Candidate Place: Bijapur. Dr. AMIT A. MASULE
© Rajiv Gandhi University of Health Sciences, Karnataka.
i
ACKNOWLEDGEMENT
“Autsukya moha aratidhan jaghaana
Yo apurva vaidyaya namo astu tasmai”
On the eve of completion of this dissertation work, I bow my head to the great
almighty that always showers the blessings on me and without him I would not reach this
stage in my life.
I am very thankful of my grand father Sri. Annaso G. Masule and Late.Sou. Indira A.
Masule for their blessings which makes me helpful to achieve the goal.
This is an unforgettable moment of contentment on the successful fulfillment
of an ambition fostered for long. I offer my salutations to my parents
Prof.Appasaheb A.Masule and Sou. Rajani A.Masule for suffering great agony to
bring me up to this position. I am highly obliged for their blessing, support and
sacrifice which have always been the constant sources of inspiration in my life.
I am very thankful towards my brother Mr.Atul A. Masule,his wife Anuja
A. Masule and my sister Chi. Priyadarshani A. Masule for their kind support and
encouragement.
The smile of our sweet little kid Chi. Atharav A. Masule always encouraged me
for being ambitious and also helpful in gaining confidence.
I would like to offer my gratitude to the chairman Dr. K. B. Nagur, MD (Ayu), for
providing me all the requisites, including financial support. I am also grateful towards the
members of Dr. B.N.M. Education Trust for their support.
I extend my thanks to the principal Dr. R. N. Gennur, MD (Ayu), for providing
necessary facilities throughout my work.
ii
I express my gratitude towards my guide, Dr. M. B. Karambelkar, D.S.A.C., A.V.P.,
Ph.D., whose cooperation and encouragement made this dissertation a possible task.
My grateful thanks to our H.O.D., Dr. J. C. Huddar, MD (Ayu), whose guidelines
and support encouraged me in every step of this work.
Criticism by the teacher makes the student perfect; Dr. G.B.Bagali, MD (Ayu), such
a teacher is always remembered by me for his inspiration and genuine guidance.
‘Honesty gives success in life’ is always heard from Dr. Mahesh Patil MD (Ayu), to
whom I express my special gratitude for his loving kindness.
My hearty thanks to Dr. Gopu .S for his immense support in my work.
I express my thanks towards Dr. Shridhar B. Gouder MD (Ayu), for his guidance
during my dissertation work.
I express my special thanks to the member of scientific screening committee,
Dr. B. S. Tamagonda, MD(Ayu), for his patient observation and recommendations
throughout the dissertation.
I am thankful to Shri A. I. Tapashetty, M.Sc. (Stat) for his timely guidance and
suggestions in the statistical analysis of data.
I am very much thankful to Dr. Vijay Tungal, MD (Ayu), for his help.
My immense thanks to the seniors Dr, Shantibhushan S. Handur
Dr.Rajrajeshwari, Dr. Vinod S. Gurav, Dr. Deepa Bhairshetty,Dr.Sunil
Nair,Dr.Sudhir Koli, Dr.J.D.Khot and also to my colleagues Dr. Parashuramappa
Turabeen and Dr. Savita Padashetty and my juniors Dr.Kulgeri, Dr.Harron,
Dr.Sumangala and Dr.Ukumnal
My hearty thanks to Dr. Savita M. Sajjan MD(Ayu), for her immense support in my
work.
iii
The real friendship is proved by the love and affection rendered by the friend,
well wisher, my hostel room partner, Dr. Santosh D.Kodag and Pavan Lalsangi without
their cooperation, this work could not be completed.
I am thankful to Mr. R. G. Dolli, office superintendent and other non-teaching
staff of the college for their timely help.
I extend my thanks to the library staff for their kind cooperation during my work.
My humble thanks towards my patients without whose cooperation, this work
could not be completed at all.
Certain names might have been missed unintentionally, who helped directly or
indirectly. I thank all of them.
Bijapur.
Date: (Dr. Amit A. Masule.)
iv
LIST OF ABBREVIATIONS
1. A.H. - Astanga Hridaya
2. A. S. - Astanga Sangraha
3. A. T. - After Treatment
4. Bh.Ra. - Bhaishajya Ratnavali
5. Bh.S. - Bhela Samhita
6. B.P.N. - Bhava Prakasha Nighantu
7. B.T. - Before Treatment
8. C.R. - Complete Reduction
9. C.S. - Charaka Samhita
10. D.N. - Dhanvantari Nighantu
11. Ha.S. - Harita Samhita
12. H.S. - Highly Significant
13. Ka.S. - Kashyapa Samhita
14. K.D.N. - Kaiya Deva Nighantu
15. Lt - Left
16. MW - Monnier Williams
17. PTFU - Post Treatment Follow Up
18. Rt - Right
19. S - Significant
20. Sh.Ka.Dr. - Shabda Kalpa Druma
21. SR - Slight Reduction
22. S.S - Sushruta Samhita
23. Y.R. - Yoga Ratnakara
ABSTRACT:
Apatarpana and Santarpana are the two folds of therapy explained in
samhitas.The six folds of therapies as Langhana, Brumhana, Rukshana, Sneehana,
Swedana and Sthambhana comes under these two folds. From which Langhana,
Rukshana and Swedana comes under Apatarpana while Brumhana, Snehana and
Sthambhana comes under Santarpana.So detail study on Apatarpana is taken as the basic
fundamental principle.
As Sthoulya itself is a Santarpanotta vyadhi so Apatarpana therapy is indicated in
the treatment of Sthoulya.It is achieved by Ruksha udvartana with Chanaka pishthi which
comes under Rukshana therapy.So this study has been taken to evaluate the effects of
Ruksha udvaratana with chanaka pishthi in the treatment of sthoulya under the basic
principle of Apatarpana.
Sthoulya is the most common disorder occurs in society. It is defined as a
condition in which there is an excessive amount of meda in sphik, sthana and udara
pradesha.
It correlates to obesity which is defined as a nutritional disorder and accumulation of
excessive amount of body fat.
Obesity is a chronic metabolic disease which requires persistant approach with
gradual improvement.
The prevalence of obesity is rising at an alarming rate. In the developing
countries it has been estimated that 115 million people suffer from obesity related
problem.
About every fourth person on earth is too fat around the globe, about 1.7 billion
people should lose weight according to international obesity task force.
v
The existing obesity treatment options, in modern medicine includes drugs like
Fenfluramine, Dexfenfluramine and Sibutramine which acts as appetite inhibitors and
cannot be used for long periods and have got side effects.
The present study intends to know the effect of Ruksha udvartana with Chanak
pishthi in the treatment of sthoulya under the concept of basic principle,ie,Apatarpan.
Objective of study:-
The present study has following objectives,
1) Detail study on Apatarpana
2) Detail study of Sthoulya.
3) To study the effect of Ruksha udvartana with chanaka pishthi in Sthoulya.
Methods:-
Aim: The aim is” To assess the effect of Ruksha udvartana with Chanaka pishthi in
Sthoulya under the concept of Apatarpana.
Study design:- The patients of sthoulya within the age group of 20-50 yrs were
rselected.A group of 30 patients is selected for ruksha udvartana with chanaka pishthi.
Patients were assessed for BMI, vaksha, udara and sphika circumference along with the
symptoms adhika kshudha,adhika trishna ,kshudra shwasa and swedadhikata.Data was
collected as before treatment,after treatment and post treatment follow up. The data was
statistically analyzed.
Result:-
The result of the clinical study showed more significant with Chanaka pishthi udvartana
in treatment of sthoulya.
vi
Interpretation and conclusion:-
Apatarpana is a basic fundamental principle in dwividhopkrama.The ruksha
udvartana with chanaka pishthi is a rukshana upakrama under the concept of Apatarpana
in the treatment of sthoulya.Sthoulya is the most common disorder occurs in society. It is
defined as a condition in which there is an excessive amount of meda in sphik, sthana and
udara pradesh.
It correlates to obesity which is defined as a nutritional disorder and accumulation
of excessive amount of body fat.
Udvartana with chanak pishthi has shown non-significant results in the treatment
of sthoulya.
On the basis of this study, along with udvartana procedure, shamana aoushadhi,
pathyapathya, exercise and teekshana basti may be a better line of treatment in the
management of patients of sthoulya.
KEY WORDS:-
OBESITY, STHOULYA BMI, CHANAKA PISHTHI
vii
CONTENTS
PARTICULAR PAGE NO
1) Introduction 1-3
2) Objectives 4
3) Review of Literature 5-46
• Concept of Apatarpan 5-13
• Sthoulya Review 13-14
• Nidana Panchaka 14-19
• Chikitsa 20-25
• Modern Review 26-35
• Drug Review 36-37
• Udvartana Review 38-46
4) Materials and Methods 47-54
5) Observations and Results 55-88
6) Discussion 89-130
7) Conclusion 131
8) Recommendation for future study 132
9) Summary 133-134
10) Bibliography 135-145
11) Annexure
• Classical References 146-152
• Clinical Proforma 153-157
• Photographs
viii
LIST OF TABLES:-
TABLE PAGE NO
1. Paryayas of Sthaulya 14
2. Nidana for sthaulya according to different acharyas 15
3. Lakshanas of sthaulya according to different acharyas 16-17
4. Upadravas of sthaulya according to different acharyas 18-19
5. Different formulations in Sthaulya 23
6. Showing pathya vihara according to different Acharyas 24-25
7. Classification of overweight and obesity by BMI chart 29
8. Showing effects of Rookshana karma 38
9. Showing Samyak Rookshana Lakshana 39
10. Showing Rookshana atiyoga lakshana 40-41
11. Showing Rookshana Ayoga Lakshana 42
12. Showing benefits of Udvartana 43-44
13. Showing Therapeutic actions of Udvartana 45-46
14. .Classification of over weight and obesity by BMI chart 51
15. Subjective criteria 51
16. Circumferance of Vaksha, Udara and Sphik 53
17. Objective criteria 53
18. Distribution of patients according to age 55
19. Distribution of patients according to sex 56
20. Distribution of patients according to religion 56
21. Distribution of patients according to education 57
ix
22. Distribution of patients according to socio-economical status 57
23. Distribution of patients according to marital status 58
24. Distribution of patients according to habitat 58
25. Distribution of patients according to occupation 59
26. Distribution of patients according to diet 60
27. Distribution of patients according to vyasana 60
28. Distribution of patients according to prakruti 61
29. Distribution of patients according to agni 61
30. Distribution of patients according to kostha 62
31. Distribution of patients according to kula vruttanta 62
32. Distribution of patients according to BMI BT 63
33. Distribution of patients based on vaksha circumference BT 64
34. Distribution of patients based on udara circumference BT 64
35. Distribution of patients based on sphik circumference BT 65
36. Distribution of patients according to the adhika kshutha BT 66
37. Distribution of patients according to the adhika trishna BT 66
38. Distribution of patients according to the kshudra shwas BT 67
39. Distribution of patients according to the swedadikhata BT 68
40. Distribution of patients according to BMI AT 68
41. Distribution of patients based on vaksha circumference AT 69
42. Distribution of patients based on udara circumference AT 70
43. Distribution of patients based on sphik circumference AT 70
44. Distribution of patients according to the adhika kshutha AT 71
x
45. Distribution of patients according to the adhika trishna AT 72
46. Distribution of patients according to the kshudra shwas AT 72
47. Distribution of patients according to the swedadikhata AT 73
48. Distribution of patients according to BMI AFU 74
49. Distribution of patients based on vaksha circumference AFU 74
50. Distribution of patients based on udara circumference AFU 75
51. Distribution of patients based on sphik circumference AFU 76
52. Distribution of patients according to the adhika kshutha AFU 76
53. Distribution of patients according to the adhika trishna AFU 77
54. Distribution of patients according to the kshudra shwas AFU 78
55. Distribution of patients according to the swedadikhata AFU 78
56. Result related responses of the patients AT 81
57. Result related responses of the patients AFU 84
58. Statistical analysis of BMI 87
59. Statistical analysis of Vaksha 87
60. Statistical analysis of Udara 87
61. Statistical analysis of Sphik 87
62. Statistical analysis of Adhika kshutha 88
63. Statistical analysis of Adhika trushna 88
64. Statistical analysis of kshudra shwas 88
65. Statistical analysis of swedadikhata 88
xi
LIST OF GRAPHS:-
GRAPH PAGE NO
1. Distribution of patients according to age 55
2. Distribution of patients according to sex 56
3. Distribution of patients according to religion 56
4. Distribution of patients according to education 57
5. Distribution of patients according to socio-economical status 57
6. Distribution of patients according to marital status 58
7. Distribution of patients according to habitat 58
8. Distribution of patients according to occupation 59
9. Distribution of patients according to diet 60
10. Distribution of patients according to vyasana 60
11. Distribution of patients according to prakruti 61
12. Distribution of patients according to agni 61
13. Distribution of patients according to kostha 62
14. Distribution of patients according to kula vruttanta 62
15. Distribution of patients according to BMI BT 63
16. Distribution of patients based on vaksha circumference BT 64
17. Distribution of patients based on udara circumference BT 65
18. Distribution of patients based on sphik circumference BT 65
19. Distribution of patients based on adhika kshudha BT 66
20. Distribution of patients based on adhikatrishna BT 67
21. Distribution of patients based on kshudra shwas BT 67
xii
22. Distribution of patients based on swedadikhata BT 68
23. Distribution of patients according to BMI AT 69
24. Distribution of patients based on vaksha circumference AT 69
25. Distribution of patients based on udara circumference AT 70
26. Distribution of patients based on sphik circumference AT 71
27. Distribution of patients based on adhika kshudha AT 71
28. Distribution of patients based on adhikatrishna AT 72
29. Distribution of patients based on kshudra shwas AT 73
30. Distribution of patients based on swedadikhata AT 73
31. Distribution of patients according to BMI AFU 74
32. Distribution of patients based on vaksha circumference AFU 75
33. Distribution of patients based on udara circumference AFU 75
34. Distribution of patients based on sphik circumference AFU 76
35. Distribution of patients based on adhika kshudha AFU 77
36. Distribution of patients based on adhikatrishna AFU 77
37. Distribution of patients based on kshudra shwas AFU 78
38. Distribution of patients based on swedadikhata AFU 79
39. Responses of the patients for BMI AT 81
40. Responses of the patients for Vaksha AT 81
41. Responses of the patients for udara AT 82
42. Responses of the patients for sphik AT 82
43. Responses of the patients for adhika kshudha AT 82
44. Responses of the patients for adhika trushna AT 83
xiii
45. Responses of the patients for kshudra shwas AT 83
46. Responses of the patients for swedadhikata AT 83
47. Responses of the patients for BMI AFU 84
48. Responses of the patients for Vaksha AFU 84
49. Responses of the patients for udara AFU 85
50. Responses of the patients for sphik AFU 85
51. Responses of the patients for adhika kshudha AFU 85
52. Responses of the patients for adhika trushna AFU 86
53. Responses of the patients for kshudra shwas AFU 86
54. Responses of the patients for swedadhikata AFU 86
xiv
Introduction ===============================================================
INTRODUCTION
Scientific and technological progress has made man highly sensitive and critical;
there by giving rise to different types of health problems. The advancement of
industrialization and communication is contributing towards sedentary life styles, in turn
causing chronic non- communicable diseases like obesity diabetes mellitus, hypertension,
cancer, ischemic heart disease, cerebro-vascular accidents, atherosclerosis, varicose veins
etc. Obesity being the risk factor for these diseases and hence prevention of obesity will
decrease the chances of such diseases. Excess of fat “shortens the life line” of the
individual by imposing an extra burden on all the systems of body.
Obesity is a major health problem in both developed and developing countries.
The exact estimation of prevalence is difficult as the standardized definition is lacking. In
countries like USA, approximately 55% of population in the age group of 20-70 years is
suffering from this problem. A study conducted in Delhi shown that approximately 25%
of populations are obese in urban areas. Another study conducted in United States,
showed increase in sudden death rate among men and women with at least 20%
overweight, which clearly shows the reduced life span due to its incidence.
Ayurveda, the science of life, had given much importance to primary and
secondary preventions of diseases. Acharya’s have explained at length the
dwividhopkram ie Santarpan and Apatarpan.As sthoulya itself is a Santarpanotta
vyadhi,so Apatarpana therapy is prescribed in sthoulya.Apatarpana is a basic fundamental
principle explained in samhitas so it comes under a branch moulika siddhanta which
explains basic fundamental principles.Apatarpan itself contains langhana,rukshana and
----------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 1
Introduction ===============================================================
swedana upakrama.From which ruksha udvartana with chanaka pishthi comes under
rukshana upakram which is highlated in the treatment of sthoulya.
Sthoulya is the nearest clinical entity for obeisity in Ayurveda.So ruksha udvartan
with chanaka pishthi is a beter option for treatment of sthoulya under the concept of
Apatarpana. Considering the difficult nature of disease, obesity can be better prevented
rather than treated. In Ayurveda, obese persons are included under Asta Nindita purusha
(Athi Deerga, Athi Hraswa, Athi Stoola, Athi Krusha, Athi Goura, Athi Sweta, Athi
Roma and Aroma). The reason for difficult nature being the involvement of Tridosha and
meda mamsaadi dhatu. It is also mentioned that the preferred constitution for an
individual should be emaciated rather than obese.
The existing obesity treatment options, in modern medicine includes drugs like
Fenfluramine, Dexfenfluramine and Sibutramine which acts as appetite inhibitors have
with of adverse effects and cannot be used for long periods. Some devices like vibrators
are being used for local lipolytic action. Nutritional combinations (synthetic nutritional
compounds) are expensive and they too have untoward effects.
In the present context Ayurveda offers a ray of hope in treatments like Udvarthana
lekhana basti along with some internal medicines like Navaka guggulu, trayodashanga
guggulu etc. The internal administration of guggulu has certain limitations like gastric
irritation, constipation etc. On contrary, Udvarthana is a procedure which can be
undertaken daily with a preliminary training to the individual. Now it’s efficacy has been
proved in reduction of weight and associated lakshanas with no adverse effects.
----------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 2
Introduction ===============================================================
To document and analyze this procedure for statistical interpretation, the study
entitled “A study on Apatarpan with special refference to udvarthana in Sthoulya” was
undertaken.
----------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 3
Objectives Of Study
==============================================================
OBJECTIVES OF STUDY
1) Detail study on Apatarpana
2) Detail study of Sthoulya.
3) To study the effect of Ruksha udvartana with chanaka pishthi in Sthoulya.
----------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 4
Review of literature ===============================================================
REVIEW OF LITERATURE
A STUDY ON APATARPANA WITH SPECIAL REFERENCE TO UDVARTAN
IN STHOULYA
CONCEPT OF APATARPAN: -
In Astanga Hridaya; Sutrasthana chapter no. 14; Dvividhopakramaniya adhyay
has been mentioned. In which there are two folds of therapies have been mentioned as 1)
Santarpana and 2) Apatarpana. The synonyms mentioned for Santarpana and Apatarpana
are Brahana and Langhana respectively.1Bramhan is for stoutening of the body while
Langhan is for making the body light i.e. thin2.
Functions such as snehana, Rukshana, Swedana and Stambhana are also of these
two kinds3. From which Snehana and Stambhana comes under bramhana i.e. Santarpana
and Rukshana and Swedana comes under Langhana i.e. Apatarpana. Langhana is of two
types : - 1) Shodhana and 2) Shamana4. Shodhana is that which expels the doshas out of
the body forcibly. It is of five kinds viz. Niruha, Vamana, Kayareka, Shiroreka and Asra-
visrut5.
Shamana is that treatment which is palliative in nature, it means which does not
expel the doshas and also does not increase the doshas but which makes the abnormal
doshas in normal state. It is of seven kinds as Pachana, Dipana, Kshut, Trushna,
Vyayama, Atapa and Maruta6. The dravyas which are of Agni, Vayu and Aakash
mahabhut predominant does the Apatarpana karma while Prithvi and Aap mahabhut
pradhana dravya does brahmana karma.
In Charaka samhita; Sutrasthana; chapter no. 22, Langhana-Brahmaniya adhyaya
it has been mentioned about six karmas as Langhana, Bramhana, Rukshana, Snehana,
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 5
Review of literature ===============================================================
Swedana and Stambhana7. Among them Langhana, Rukshana and Swedana karma comes
under Apatarpana therapy. While Bramhana, Snehana, Stambhana comes under
Santarpana therapy.
Langhana karma may be applied in various forms such as four types of evacuation
i.e. Vaman, Virechana, Niruha and Nasya; thirst, exposure to wind; exzposure to sun;
pachan, upavasa and vyayam8. These ten folds of Langhana therapy mentioned in Charak
Samhita. Those having big body and strength, abundant kapha, pitta, blood and excreta
and association of aggravated vayu should be subjected to reducing therapy by means of
evacuation i.e. Langhana9.
In Charak Samhita, Vimansthana chapter no. 3, Janapadodhwansaniya adhyaya it
has been mentioned that for the diseases therapy consists of that which contrary to the
etiology such as there is no allevation of the disease caused by apatarpana without puran
and of those caused by puran without apatarpana10. Apatarpana has been classified in
three types as Langhana, Langhana-pachana and Doshavirechana11.
Amongst them Langhana therapy is recommended for those having doshas with a
little strength. By Langhana therapy agni and vata are increased which dry up the little
dosha like the wind and sun dry up the little water. The Langhana-pachana therapy is
prescribed in case of doshas with medium strength. By this therapy the moderate doshas
are dried up in the same way as the moderate quantity of water is dried up by the sun heat
and wind and also by sprinkling dust and ashes. In case of abundant doshas, only letting
out of doshas is prescribed i.e. doshavirechana12.
In Astanga Sangraha; Sutrasthana; chapter no. 29, Dvividhopkramaniya adhyaya,
it has been mentioned that the treatments are of two folds as Santarpana and Apatarpana.
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 6
Review of literature ===============================================================
The synonyms mentioned for Santarpana and Apatarpana are Bramhana and Langhana
respectively13. Bramhana is meant to make body stout and Langhana for making it light
(thin). Bramhana is caused by the predominancy of agi, vayu, akash bhutas14. The
treatments such as snehana, rukshana, swedan and stambhana are not separate from the
above two folds of therapies15. From which rukshana and swedana comes under the
Langhana therapy and snehana and stambhana comes under Bhamhana therapy.
Langhana is of two kinds 1) Shodhana and 2) Shamana.
Shodhana is that which expel the dosha out of body. It is of five kinds as
niruha,vaman kayavireka, shirovireka and asravisruti. Shamana is that which neither
expel dosha out, nor increases the doshas which are normal but only mitigates decrease to
normal the increased dosha. It is of seven kinds pachana, dipana, kshudha, trushna,
vyayama, atopa and maruta16.
In Sushruta Samhita; Chikitsasthana; chapter no. 1, Dvivraniya chikitsitam. It has
been mentioned about shashtiupakrama in which Apatarpana, is mentioned as first
upakrama which stands for briging effect of fasting17.
Langhana yogya : -
In Astanga Sangraha, Dvividhopkramaniya adhyaya, chapter no. 24, langhana
yogya has been mentioned. Langhana therapy should be done daily for person suffering
from diabetes, ama too much moisture in the body, fever stiffness of the thighs, leprosy
etc skin disorders, visarp abscess, splenic disease, diseases of the head, throat, eyes those
who are obese and even for others during shishira rutu18.
In Astanga Hrudaya, Sutrasthana,chapter no. 14, Dvividhopkramaniye adhyaya,
Langhaniya mentioned for those langhan should be done daily for person suffering from
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 7
Review of literature ===============================================================
diabetes with amadosha disorders of poor digestive activity, more moistness, fever,
stiffness at the thighs, leprosy and other skin disorders, visarpa, abscess, disease of
spleen, head, throat, eyes, those who are obese and even to others during shishira19.
In Charaka Samhita; Sutrasthan, chapter no. 2, metioned the langhan yogya
persons are those having big body and strength, abundant kapha, pitta, blood and excreta
and association of aggravated vayu should be subjected to Apatarpana therapy by means
of evacuation. Those afflicted with disease of moderate severity and caused by kapha and
pitta like vomiting, diarrhea, heart disease cholera, alasaka, fever, constipation, heaviness
eructation, nausea, anorexia etc should mostly be treated with digestives in the beginning
by the learned physician. These vary diseases when with little severity, should be
overcome with control of thirst and fasting. The diseases of moderate and little severity in
strong persons should be treated with physical exercise and exposure to sun and wind.
The persons suffering from skin disorders, diabetes those using excess of unctuous,
channel blocking and promoting diet and also patients of vatika disorders should be
subjected to reducing therapy in shishira20.
As described above Apatarpana included three folds of treatments these are
Langhana, Rukshana and Swedana. As per Samhitas it is clear that langhan is synonym
for Apatarpana. Till though langhana itself contains a major documentation in Samhitas
so it is also concern as a type Apatarpana.
Langhana : -
In Charak Samhita Sutrasthana; chapter no. 22, Langhanbramhaniya adhyaya it is
stated that whatever produces lightness in the body is known as Langhana. The drugs
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 8
Review of literature ===============================================================
producing laghu, ushna, teekshna, vishad, ruksha, suskhma, khara, sara guna and hard
properties has got mostly the langhana effect21.
In Langhana upakrama its utilization has been mentioned above i.e. Langhana
yogya. In Astanga Hridaya; Sutrasthana; chapter no. 14, Dvividhopkrimaniya adhyaya it
has been stated that those who are very obese, strong and having predominance of pitta
and kapha, those suffering from amadosha, fever, vomiting, diarrhea, heart disease,
constipation, feeling of heaviness, excess of belching, nausea, etc by the administration of
shodhana should be done. Those who are moderately obese first by administration of
digestives and hunger producing substances generally and later with other purifactory
therapies should be done. Those who are slightly obese by control of hunger and thirst
should be used. Those are troubled by increased doshas, who are of medium strength of
body and thirst and who are dridh for them by control of hunger and thirst should be
used. Those again of poor strength of body and disease by exposing them to breeze,
sunlight and exercise22.
It has been also stated that who are to be given Langhana should not be given
Bramhana, those who are to be given Bramhana, should be given mild Langhana, or both
Langhana and Bramhana together. Simultaneously may be given depending upon the
nature of habitat, season, strength etc23.
Chikitsaphala (Benefits of Langhana) : -
Keenness of the sense organs, expulsion of malas, feeling of lightness of body,
good taste perception, appearance of hunger and thirst together, purity of heart, belchings
and throat, softening of the diseases, increase of enthusiasm and loss of laziness occur
from Langhana therapy24.
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 9
Review of literature ===============================================================
Atilanghana (Excess of Thinning therapy) : -
Profound emaciation, giddiness, cough, thirst, anorexia, loss of moistness and
digestive power, of sleep, vision, hearing, semen, ojas hunger and voice, pain in the
urinary bladder, heart, head, calves, thighs, upper shoulders and flanks, fever, delirium
(excess of talk), belching, exhaustion, vomiting, cutting pain, in joints and bones, non-
elimination of faeces, urine etc arise from excess of Langhana25.
In Astanga Sangraha; chapter no. 29, Dvividhopkramaniya adhyaya langhana
yogyah, langhana phalam has been highlighted as same in the Astanga Hridaya.
Rukshana : -
In Charaka Samhita; Sutrasthana; chapter no. 22, Langhanbramhaniya adhyaya,
Rukshana is that which produces roukshya, kharatwa, vaishadya. The drugs which are
ruksh, laghu, khara, teekshna, ushna, sthira, pichil and hard drug is mostly rukshana in
effect. Roughening therapy consists of the regular intake of Katu, Tikta, Kashaya articles
sexual acts and use of oil cakes, butter milk and honey etc. The roughening therapy is
indicated in diseases which are used by blocking of channels, strong doshas and are
located in vital parts and in urustambha etc26.
Samyak yoga lakshana : -
The roughening therapy should be regarded as properly administered when there
is proper elimination of wind, urine, faeces, lightness in body, cleansing of heart,
eructation, throat and mouth, disappearance of drowsiness and exhaustion, appearance of
sweat, relish and both hunger and thirst together and also feeling of well being27. Pain in
joints, bodyache, cough, dryness of mouth, loss of hunger, anorexia, weakness of hearing
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 10
Review of literature ===============================================================
and vision, confusion of mind, feeling of darkness, loss of weight, digestive power and
strength these are symptoms of excessive reducing therapy28.
In Charak Sutrasthana; chapter no. 13, explains about the rukshana yogya, person
who have excess of kapha, meda, with mouth and anus having excessive secretions, have
slow digestion are afflicted with thirst and fainting, are pregnant have dry palate, aversion
to food, vomiting, one afflicted with abdominal enlargement, with ama and poison, are
weak in body and mind, depressed with unction, are under narcosis, should not be uncted
and also during administration of snuff and enema because by taking unction, they
become victim of severe disorders29.
Swedana : -
Swedan (sweating) produces sweat, it alleviates stiffness, heaviness and cold i.e.
stambha, gaurav, shitaghna in property. The drugs which are ushna, teekshna, sara,
snigdha, ruksha, sukshma, drav, sthira, and also guru gunatmak dravya can do swedan30.
Swedan yogya : -
In coryza, cough, dyspnoea, non-lightness,pain in ear, back, neck, head,
hoarseness of voice, choaked throat, paralysis of phase, one limb, whole or half body,
bending of body, hardness of bowels and constipation, suppression of urine, excessive
yawning, stiffness in sides, back waist and abdomen, sciatica, dysuria, enlargement of
scrotum, bodyache, pain and stiffness in feet, knees, thighs and shanks, swelling, khalli,
condition of ama, cold, shivering, vatakantak, contraction, extension pain, stiffness,
heaviness, numbness in organs, in these conditions swedana is beneficial31.
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 11
Review of literature ===============================================================
Swedana ayogya : -
Swedan should not be applied to those who are habitual users of medicinal
extracts, wine, in pregnanat, ladies, those afflicted with internal haemorrhages and
bradhna having complication of poison and alcohol in fatigued uncouncious plumpy,
patients of pittaj meha, thirsty, hungry, angry and aggrieved ones, in those suffering from
the jaundice, abdominal enlargement, injury and aadhyaroga, in weak, emaciated and
those having diminished ojas and suffering from the timira etc32.
Types : -
According to Charaka Sutrasthana; chapter no. 14, there are 13 types of Swedana
1) Sankar 2) Prastar 3) Nadi 4) Parishek
5) Avgaha 6) Jentak 6) Ashmaghna 8) Karshu
9) Kuti 10) Bhu 11) Kumbhika 12) Kupa
13) Holak.
According to Sushruta Chikitsasthana; chapter no. 32, Swedanacharaniya chikitsa
adhyaya
1) Tap Sweda 2) Ushma 3) Upnaha 4) Drav.
According to Astanga Sangraha; chapter no. 26, Sweda vidhi adhyaya, mainly
classified into two types
1) Agni sweda 2) Anagni sweda.
Agni Sweda again classified into 4 kinds
1) Tap 2) Ushma 3) Upnaha 4) Drava
Ushma Sweda classified into 8 kinds
1) Pinda Sweda 2) Sankar Sweda 3) Nadi 4) Ghanashma
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 12
Review of literature ===============================================================
5) Kumbhi 6) Kupa 7) Kuti 8) Jentak Sweda
Drava Sweda classified into 2 types
1) Avagah 2) Parishek Sweda
So these three folds of treatments i.e. Langhana,Rukshana and Swedana comes
under Apatarpana therapy. As sthoulya is santarpanotha vyadhi so ruksha udvartana with
chanak pishthi is indicated in sthoulya which comes under Apartana therapy.
STHOULYA REVIEW
Charaka has explained sthoulya under Ashtouninditiya Adhyaya of sutrasthana33
Sushruta under Dosha-dhatu – mala-kshaya vruddhi vijnaneeya Adhyaya34 and in
Dwividhopakramaneeya Adhyaya by Vagbhata35. While Madhava36 Yogartnakara37,
Bhavaprakasha 38 explained sthoulya under the heading of medo- roga.
HISTORICAL REVIEW:-
I) Vedic Period – In Rigveda, Yajurveda, Atharvaveda, Upanishad no references about
sthoulya were found.
II) Samhita Period – In Charaka samhita ,Sushruta samhita , Astanga sangraha we find
detail description regarding sthoulya.
III) Sangraha Kala – In Bhavamishra and in Yogratnakar we find the description about
sthoulya.
Nirukti :-
Sthoolasya bhavaha sthoolata lakshana and upachita shareeratwam39.
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 13
Review of literature ===============================================================
Paribhasha:-
A person is said to be atisthoola when his sphik (buttock), sthana (breast) and udara
(abdomen) become pendulous due to accumulation of excess of mamsa and meda in
those places and his strength is rendered disproportionate with his physical growth40.
Paryaya:-
Sthoolata, Atishoulya, Atisthaulyata, Medaswi, Sthoola, Atisthoola.
TABLE NO 1:
Paryayas Ch.S41 Su.S42 A.S43
Sthoulya + + --
Atisthooala + + +
Atisthoulya + + +
Medaswi + -- --
NIDANA:-
Following are the nidanas for sthoulya. They are divided into sharirika, manasika and
beeja swabhavaja.
Sharirika nidana includes
Ahara Vihara
i) Atibhojana i) Avyayama
ii) Adhyashana ii) Avyavaya
iii) Ati gurusnigda and sheeta ahara iii) Diwaswapa
iv) Atishleshmala ahara
v) Santarpana ahara and mamsa sevana.
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 14
Review of literature ===============================================================
Manasika nidana includes
a. Achintana
b. Harsha nityata
Beeja Swabhavaja: According to Charaka sthoulya is beeja swabhavaja vyadhi.
TABLE NO 2: NIDANA FOR STHOULYA ACCORDING TO DIFFERENT
ACHARYAS.
Nidana Ch.S44 Su.S45 A.S46 M.N47 Y.R48 B.P49
Atibhojana + - - - - -
Adhyashana - + - - - -
Atimadhura Ahara + - - - + +
Atishleshmala Ahara - + + + + +
Atiguru Ahara + - + - - -
Atisheeta Ahara + - - - - -
Atisnigda Ahara + - - - - -
Avyayama + + - + + +
Avyavaya + - - - - -
Diwaswapa + + - + + +
Achintata + - - - - -
Harshanityata + - - - - -
Atisneha Ahara - - + + -
Beeja Swabhavaja + - - - - -
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 15
Review of literature ===============================================================
Purvarupa:-
Purva rupa for sthoulya is not available in classics.
Rupa:-
Rupa are the manifestations which develop during the course of disease. Below given
table shows lakshanas of sthoulya according to different Acharyas.
TABLE NO 3: LAKSHANAS OF STHOULYA ACCORDING TO DIFFERENT
ACHARYAS.
Lakshanas Ch.S50 Su.S51 A.S52 M.N53 Y.R54 B.P55
Chala udara + - + + + +
Chala stana + - + + + +
Chala spik + - + + + +
Javoparodha + - + + + +
Ayathopachaya + - + + + +
Ayuhrasa + + + + - -
Kruchra vyavaya + + - + + +
Durbalata + - + - + +
Dourgandhyata + + + + + +
Swedadhikya + - - - - -
Atikshudha + + + + + +
Atitrishna + + + + + +
Atinidra - + + + + +
Atisweda - + + + + +
Kshudrashwasa - + + + + +
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 16
Review of literature ===============================================================
Shrama - + - - - -
Karyaakshamata - + + + - -
Jadyata - + + - - -
Gadagadatwa - + + - - -
Shwasavarodha - + - + + +
Moha - + - + + +
Sadana - + - + + +
Pratyatma Lakshanas of sthoulya are:- 56
a) Chala sphik b) Chala stana
c) Chala udara d) Ayathopa chayotsaha
SAMPRAPTI: 57
Due to nidana sevana srotorodha occurs by meda, vata moves to koshta
sandukshana of vayu in koshta takes place again by which jataragni become prajwala as a
result excess of kshuda and trushna occur.
Excessive of Agni and Vayu kills the sthoola person as the Agni and Vayu burn
up the tree which has a big cavity inside.
As meda dhatu is mula of sweda vaha srotas so excess of sweda occurs due to
Agni santapa Meda dhatu, which is assosciated with kapha all, makes profound increase
of sweda.
The meda getting digested in the kostha causing avarodha in the srotas of Rasa
hinders it from going from other dhatus and make for increase of only meda dhatu. The
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 17
Review of literature ===============================================================
remaining portion of rasa dhatu being very little in quantity is not enough; to nourish the
rakta and other dhatu.
The increase in meda is similar to the increase of vata and others, that which has
under gone increase first will only undergo further increase. On this analogue there will
be disparity between medas and other dhatus, the increase medas will soon produce
shwasa, udara, bhagandra, prameha, urusthamba, jwara etc. other diseases may manifest
UPASHAYA AND ANUPASHAYA
In classics no references of upashaya and anupashaya are available for sthoulya
UPADRAVA
If the patient goes on indulging again in unsuitable ahara, vihara and without taking
treatment then the upadrava are seen due to the primary disease.
TABLE NO 4: UPADRAVAS OF STHOULYA ACCORDING TO DIFFERENT
ACHARYAS
Upadravas Su.S58 A.S59 M.N60 Y.R61 B.P62
Prameha + + - + -
Prameha pidika + + + - +
Jwara + + + + +
Vidradhi + + + - +
Bhagandara - + + + +
Udara roga - + - - -
Urushtamba - + - - -
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 18
Review of literature ===============================================================
Vatavikara + - + - +
Shwasa - + - - -
Visarpa - - - + -
Atisara - - - + -
Arsha - - - + -
Shleepada - - - + -
Apachi - - + -
Kamala - - - + -
SADHYA SADHYATA
The two diseases karshya and sthoulya are always afflicted with disease and one
should be treated with constant nourishing and slimming remedies respectively.63
Karsha and sthoola are undesirable for treatment. Among these two sthoulya is
considered to be more undesirable64.
When compared to sthoulya krisha is better for treatment, as to bring back the
normlcy of vata, agni and meda is difficult in case of sthoulya65.
By the above quotations of different Acharyas sthoulya is said to be kashta sadhya
to treat .Beeja doshaja /Kulaja /sahaja is always asadhya.
ARISTHA LAKSHANAS
For sthoulya there are no references available as aristha lakshana.
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 19
Review of literature ===============================================================
CHIKITSA
Chikitsa siddhanta includes
1) Nidana parivarjana – Avoidance of etiological factors constitute major course of
the management of sthoulya 66
2) Shodhana chikitsa – Lekhana basti is beneficial for sthoulya prepared of drugs
having ushna teekshna and rooksha gunas67
Powder of ushakadigana drugs are added with equal quantity of triphala
kwatha, gomutra madhu and yavakshara.
3) Guru Cha apatarpana - charak described for sthoola person, guru which is
apatarpaka ahara should be given68.
4) Shoolanam karshanam prati
For sthoulya karshana ahara should be preferred69.
5) Vata, kapha and medohara annapana
The oushada, ahara and pana for the sthoulya should be the alleviative of vata,
kapha and meda70.
6) Udvarthana - Udvarthana with rookshadravyas like musta, kulatha is beneficial as
it reduces kapha, meda and produces laghuta in the body71.
7) Udvartana with Chanak Pisthi is been utilised in Sthoulya.
8) Pana, abhyanga, gandusha, nasya, basti with triphaladi taila should be used.
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 20
Review of literature ===============================================================
SHAMANAUSHADHI
Charaka 72
i) Guduchi, bhadramusta, triphala, takrarishta and madhu
ii) Vidanga, nagara, kshara, kala loha raja , yava, amlaki, churna
iii) Bhrahat panchamoola with madhu
iv) Agnimantha rasa and shilajitu
Sushruta73 – Shilajitu, shuddha guggulu, goumutra triphala churna, lobha bhasma,
Rasanjana madhu are used in sthoulya
Asthanga Hridaya74 –Trikatu, katukarohini triphala, shigru, vidanga, ativisha, sthira,
hingu, souvarchala jeeraka, yavani, dhanyaka, chitraka, haridra,
Daruharidra, hapusha, pata, etc. saktu, Vyoshadi guggulu.
Astanga sangraha75
i) Madhoodhaka ii) Triphala + Madhu
iii) Guduchi + Madhu iv) Brihat panchamoola + Agnimantha
rasa
v) Rasanjana + Agnimantha rasa vi)Yava + Amalaka churna
vii) Musta + Madhu
Chakradatta76
i) Madhoodaka ii) Vidangadya choorna
iii) Vidangadya loha iv) Vyosadya saktu
v) Badari patra siddapeya + shilajtu vi) Amurutadya guggulu
vi) Loha rasayana viii) Triphaladya taila
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 21
Review of literature ===============================================================
For Durgandha
i) Teja patra, netrabala, abhaya and candana all churna should be applied over body.
ii) Vasa swarasa + shanka churna application
iii) Haridra choorna fried with chincha swarasa
For swedadhikya
Shiresha nagakeshara and lodhra should be applied.
Bhavaprakash77
i) Triphala +trikatu + taila + lavana ii) Triphala + madhoodaka
iii) Brahat panchamoola choorna + madhu iv)Erandapatra kshara+ hingu
v) Loha bhasma + guduchi + triphala qwatha vi) Loha bhasma + shilajitu + tripala
vii) Loha bhasma + guguulu + triphala viii)Amrutadi guggulu
ix) Dashanga guggulu x) Trushanadya guggulu
xi) Loharishta, loharasayana
Yoga – Ratnakara 78
i) Triphala kwatha + madhu ii) Phalatrikadi yoga
iii) Guduchyadi yoga iv) Trushanadya loha
v) Navaka guggulu vi) Mocha rasa + samudra phena
Bhaishajya Ratnavali 79
i) Chavyadi saktu ii) Vyosadya saktu
iii)Vidangadi choorna iv)Haritaki yoga
v) Vidangadi louha vi) Louha rasayana
vii)Navaka guggulu viii) Amrutadya guggulu
ix) Erandakshara prayoga x) Trushanadya loha
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 22
Review of literature ===============================================================
TABLE NO 5: DIFFERENT FORMULATIONS IN STHOULYA
Formulation B.P Y.R B.R C.D
Amrutadhya guggulu + - + +
Agnimatha kwatha - - + -
Badavagniloha - - + -
Chavyadi sakta - - + -
Dashanga guggulu + - - -
Guduchyadi yoga - + - -
Loha rasayana + - + +
Loharshta + - + -
Mahasugandhi taila + - + -
Madhoodaka + + + +
Navaka guggulu - + + +
Phalatrikadi yoga - + - -
Trushanadi loha - + + -
Trushanadi guggulu + - - -
Triphaladya taila + - + +
Vyoshadya choorna - - - -
Vidangadya loha - - + +
Vyoshadi saktu + - + +
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 23
Review of literature ===============================================================
PATHYAPATHYA:-
Charaka mentioned ahara, vihara which allivate vata and meda which is
prescribed for sthoola rogi.80
Pathya ahara – Guru and Apatarpaka
Yava Shyamaka Kodrava
Kulatha Adhaki beeja Patola
Amalaki Vartaka Masoora
Purana shali
Apathya ahara
Dugda Ikshu vikruti
Masha Matsya
Mamsa Snehana
Madhura dravyas
Pathya vihara
TABLE NO 6: SHOWING PATHYA VIHARA ACCORDING TO DIFFERENT
ACHARYAS
Name of Pathya
vihara
Ch.s81 Su.s82 A.S83 Y.R84 B.P85 B.R86 C.D87
Asukha Shayya - - - - + - -
Dhoomapana - - - - + - -
Krodha - - - - + - -
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 24
Review of literature ===============================================================
Margakramana - - - + + + -
Parishrama - - - + + + +
Prajagara + - + + + + +
Upavasa - - - - + + -
Vyavaya + - + + + + +
Vyayama + + + + - + +
Chintana + - + + + + +
Apathya vihara: Diwaswpna
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 25
Review of literature ===============================================================
MODERN REVIEW:-
OBESITY:-
DERIVATION – Obesity is word derived from O-bes- the Latin word obesus – the fat,
the adjective from ob-edo- meaning to eat away.
DEFINATION: Obesity described as a weight of 20% or above. Obesity is often
expressed in terms of body mass index (B.M.I.). A BMI of 30 or more in males and 28.6
or more in females indicates obesity88.
It is also defined as an abnormal growth of the adipose tissues due to enlargement
of fat cell size (hypertrophic obesity) or an increase in fat cell number (hyper plastic
obesity) or a combination of both89.
PREVALANCE: National Health and Nutrition Examination Surveys (NHANES)
shows that the prevalence of obesity is much higher in African-American and Mexican-
American women than in white women or in men.
The prevalence of overweight and obesity is generally higher for men and women
in racial – ethnic minority populations.
The third NHANES III estimated that 13.7% of children 11.5% adolesants are
overweight and obese. Between1960-1994, overweight was increased from 30.5 – 32%
among adult ages 20 – 74 and obesity increased from 12.8% - 22.5%.
BODY FAT DISTRIBUTION: Health care providers are concerned not only with how
much fat a person has, but also where the fat is located in the body. Women typically
collect fat in their hips and buttocks, giving them a "pear" shape.
Men usually build up fat around their bellies, giving them more of an "apple'
shape.
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 26
Review of literature ===============================================================
TYPES:90 The distribution of fat induced by the weight gain affects the risk associated
with obesity and the kind of disease, that results. It is useful therefore, to be able to
distinguish between those at increased risk as a result of abdominal fat distribution or
"android obesity' from those with a serious "gynoid fat" distribution in which fat is more
evenly and peripherally distributed around the body.
AETIOLOGY (CAUSES OF OBESITY)91.
In scientific terms, obesity occurs when a person consumes more calories than he
or she burns. That causes this imbalance between calories in and calories out may differ
from one person to another person. Genetic, environmental, psychological and other
factors may all play a part in obesity.
GENETIC FACTORS: Obesity tends to run in families, suggesting a genetic cause.
Yet families also share diet and lifestyle habits that may contribute to obesity. Separating
these from genetic factors is often difficult. Even so, science shows that heredity is
linked to obesity.
ENVIRONMENTAL FACTORS: Genes do not destine people to a lifetime of obesity.
However, environment also strongly influences obesity. This includes lifestyle
behaviours such as what a person eats or drinks and his or her level of physical activity.
PSYCHOLOGICAL FACTORS: Psychological factors may also influence eating
habits. Many people eat in response to negative emotions, such as boredom, sadness or
anger.
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 27
Review of literature ===============================================================
OTHER CAUSES OF OBESITY: Some illness can lead to obesity or a tendency to
gain weight. These include hypothyroidism, Cushing's syndrome, depression and certain
neurological problems that can lead to overeating.
Also drugs such as steroids and some antidepressants may cause weight gain
prevention of obesity in primary care settings is compatible with efforts to prevent their
health consequences, through control of high B.P, type 2 diabetes etc. Thus the quality
and quantity of life may be enhanced through preventive strategies.
CLINICAL FEATURES: Diagnoses will be apparent from the appearance but the
degree of obesity should also be assessed by measurement of BMI, skin fold thickness
over the triceps muscle can be measured using screw gauge and callipers. Obesity is
indicated by the reading above 20 mm in men and 28 mm in women.
ASSESSMENT OF WEIGHT AND BODY FAT92:
Two measures important for assessing overweight and total body fat content are
determining body mass index (BMI) and measuring waist circumference.
BODY MASS INDEX: - The BMI which describes relative weight for height is
significantly correlated with total body fat content. The BMI should be used to assess
overweight and obesity and to monitor change in body weight.
BMI is calculated as weight in Kg divided by height in metre square (mt2)
BMI = Weight in KG
Ht in Mts2
Weight classifications by BMI, selected for use in this report as shown in the table below.
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 28
Review of literature ===============================================================
TABLE NO 7:-
CLASSIFICATION OF OVERWEIGHT AND OBESITY BY BMI CHART
Obesity Class BMI (Kg/mt2)
Underweight < 18.5
Normal 18.5 – 24.9
Overweight 25.0 – 29.9
Obesity I 30.0 – 34.9
II 35.0 – 39.9
Extreme Obesity. III > 40
WAIST CIRCUMFERENCE: The presence of excess fat in the abdomen out of
proportion to total body fat is an independent predictor of risk factors, and morbidity.
Waist circumference is positively correlated with abdominal fat content. It provides a
clinically accepted measurement for assessing a patient's abdominal fat content before
and during weight loss treatment. The waist circumstances at which there is an increased
relative risk is defined as follows:
High Risks:
Men > 102 cms (40 inch)
Women > 88 cm (> 35 inch)
DIAGNASTIC PROBLEMS: Simple obesity, which accounts for bulk of cases, has to
be distinguished from the following comparatively rare conditions:
1. Cushing's syndrome
2. Froehlich’s Syndrome
3. Hypothyroidism
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 29
Review of literature ===============================================================
CUSHING'S SYNDROME
Causes adrenal hyperplasia more commonly in females
Truncal obesity and buffalow hump Hypertension
Glycosuria Hirsutism
Osteoporosis Centripetal fat distribution
Moon face
FROEHLICH'S SYNDORME:
Causes tumour of hypothalamic pituitary area Truncal obesity
Sexual infantilism – gonads underdeveloped. Mental retardation
Secondary sexual characters absent Impaired skeletal growth
Hairless skin, headache, vomiting Visual disturbances
Hands are small and flat with tapering fingers. Diabetes insipidus
HYPOTHYROIDISM: A clinical conditions resulting from decreased circulating
T4 and T3 by the thyroid gland irrespective of cause when the hypothyroidism is of
severe degree of long standing.
Clinical features:
Onset – Insidious with physical, mental and metabolic process below normal.
Tiredness Weight gain
Cold intolerance Goitre
Skin: Dry and subcutaneous tissues
Puffiness of face with flush Baggy eyelids
Swollen oedematous appearance of supraclavicular regions, neck backs of hand
and feet.
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 30
Review of literature ===============================================================
Minimal sweating Alopecia
Neuro-Muscalor – Myalgia.
Stiffness, hoarseness of voice Deafness
Anaemia Infertility
Growth Retardation Mental retardation
Delayed puberty.
CONSEQUENCES OF OBESITY (HEALTH RISKS)93 Obesity is more than a
cosmetic problem, it is a health hazard. Approximately 2,80,000 adult deaths in U.S.
each year are related to obesity. Several serious medical conditions have been linked to
obesity, including Psychological, Mechanical, Metabolic disorders like type-2 diabetes,
cardiovascular disorders and stroke.
Obesity is also linked to higher rates of certain types of cancer. Obese men are
more likely than non-obese men to die from cancer of colon, rectum or prostrate. Obese
women are more likely than non-obese women to die from cancer of gall bladder, breast,
uterus, cervix or ovaries.
Other diseases and health problems linked to obesity include:
Gall bladder disease and gall stones.
Liver disease
Osteoarthritis, a disease in which the joints deteriorate. This is possibly the result
of excess weight on joints.
Gout, disease affecting the joints
Pulmonary (breathing) problems, including sleep apnoea in which a person can
stop breathing for a while during sleep due to arterial hypoxemia.
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 31
Review of literature ===============================================================
Reproductive problems in women, including menstrual irregularities and
infertility.
PSYCHOLOGICAL AND SOCIAL EFFECTS: Emotional suffering may be one of
the most painful parts of obesity. American society emphasizes physical appearance and
often equates attractiveness with slimness, especially for women, such messages makes
overweight people feel unattractive.
Many people think that obese individuals are gluttonous, lazy, or both, even
though this is not true. As a result, obese people often face prejudice or discrimination
in the job market at school and in social situations. Feeling of rejection, shame or
depression is common.
TREATMENT94: The method of treatment depends on level of obesity Overall health
condition and motivation to lose weight. Treatment may include a combination of diet,
exercise, behaviour modification and sometimes weight loss drugs. In some severe
obesity gastrointestinal surgery may be recommended. But it should be kept in mind
weight control is a life long effort.
DIET: The most basic consideration is that the food energy in take should not be greater
than what is necessary for energy expenditure. It requires modification of patient's
behaviour and strong motivation to lose weight and maintain ideal weight.
The proportion of energy dense foods such as simple carbohydrates and fats
should be reduced the fibre content in diet should be increased. Adequate levels of
essential nutrients in low energy diets (most conventional diets for weight reduction are
based on 1000 k. cal daily model for an adult) should be ensured.
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 32
Review of literature ===============================================================
EXERCISE: It is another positive part of the management of obesity. Strainuous
exercise is neither feasible nor advisable, but most obese people are capable of moderate
exercise such as walking, swimming, gardening etc, provided it should not exceed their
cardiovascular capacity.
Regular exercises improves the fitness and their feeling of well being some
consider it also gives people more control over their appetite.
An hour's walk 3 miles/hr will expend about 240 k cal above basal. Even though
it seems a small amount, 30 g of body fat, but if the daily walk becomes a habit it will
add up to a weight loss of 10 kg in a year.
DRUG95: The most useful group of drugs at present to support weight reducing regime
are serotoninergic compounds. The first of all there was dl-fenfluramine now largely
replaced by second generation drugs fenfluramine and fluoxetine.
Side effects are usually mild and include drowsiness, dry mouth, head ache. One
of these drugs is best used where there is medical need for short term weight reduction
like if obesity is associated with diabetes or hypertension.
Anorectic drugs such as amphetamines, fenfluramine are not advisable because of
the cerebral stimulating properties of amphetamine group and high incidence of valvular
heart disease and pulmonary hypertension with fenfluramine.
Sibutramine acts controls to inhibit serotonin and noradrenalin reuptake
prolonging the effects of both these appetite regularising neurotransmitters. It enhances
metabolic rate and energy expenditure via stimulation of peripheral Beta-adreno-
receptors.
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 33
Review of literature ===============================================================
STARVATION: Fasting as a method of treatment offers advantage of dramatic drop in
weight within one week of treatment and this may be of psychological benefit.
FOODS TO BE AVOIDED: Bread and anything made with flour, cereals, potatoes and
other whole root vegetables, foods containing much sugar, all sweets and salt. Fatty
foods like cream butter, fat beans are avoided. Fluids not more than 2 pints a day.
SURGICAL PROCEDURES96: Jaw wiring to prevent eating has been used to treat who
have found it impossible to adhere to a low energy diet.
1. Jejuno-ileal bypass- indicated in vastly obese patients who have failed to lose
weight despite at least 5 years of medical treatment.
2. Gastricplication – An upper pouch of about 50 – 60 ml is made with aperture
outlet limited to a 12 mm ring.
3. Gastric bypass: - To reduce the size of the stomach, for example stapling
which can be done, small intestine bypass, aimed at inducing malabsorption has
been undertaken in some "morbid" obese patients.
4. Plastic surgery
5. Truncal vagotomy
PROGNOSIS: The published records of 7 obesity clinics in USA showed that
satisfactory results ranged only from 12 to 28% if the index of success was the loss of 12
kg or more.
It is difficult for patients to maintain their reduced weight since this required some
restriction of energy in take on a long term basis.
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 34
Review of literature ===============================================================
PREVENTION OF OVERWEIGHT AND OBESITY:
Prevention of overweight and obesity is an important as treatment. Prevention
includes primary prevention of overweight or obesity itself, secondary prevention or
avoidance of weight regain following weight loss and prevention of further weight
increase in obese individuals unable to lose weight.
It has been suggested that primary prevention of obesity should include
environmentally based strategies that address major social contributors to over
consumption of calories and inadequate physical activity such as food marketing
practices and lack of opportunity for physical activity during the work day.
People at lower socio-economic levels living in urban areas also take excess of
physical activity sites. Such strategies will be essential for effective and long term
prevention of obesity.
Public health approaches for preventing obesity, that is approaches designed to
reduce the difficulty for any given individual of adopting healthful eating and activity
patterns will particularly benefit the socially disadvantaged, who compared to the more
advantaged may have less access to preventive health services.
Primary care practitioners are an important element in preventing and managing
obesity in United States.
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 35
Review of literature ===============================================================
DRUG REVIEW:-
CHANAK97
Sanskrit name : Chanak
Latin name : Cicer arietinum
Botanical name : Cicer arietinum
Synonyms:
Chanak, Harimanth, Sakalpriya.
Vernacular names:
E – Bengal gram, Chickpea.
H – Chane, Cholla, Rahila, Bunta.
K – Kadale.
M – Harbara.
Kula : Shimbi kula
Family : Leguminasae.
Gana : Chanakadi gana (Chanak, Masura, Khandika, Saharenava)
Habitat : Throughout the greater part of India , Chanak is found as agricultural
product.
Botonical description: A small tree (kshupa) of about 1-1 ½ feet in height.
Leaf : Pakshawat, 6 mm in length and 4 mm in breadth.
Flower : Short , single and of different shapes and also colour.
Types : Shweta and of different colours.
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 36
Review of literature ===============================================================
Properties
Rasa : Kashaya rasayukta.
Guna : Laghu , Rooksha
Veerya : Sheeta.
Vipaka : Katu.
Karma : Vatakarak, Pitta, Raktavikara nashak, Kapha and Jwara nashak.
Rogaghnata : Pitta and Kapha nashak, Jwara nashak, Vatajanak, Shukra
nashak98,
Raktavikar and Meha nashak.
Chemical Composition –
Protein 17.1, Sneha 5.3, Khanija 2.7, Fibres 3.9, Carbohydrates 61.2, Khatik,
Phosphorus and Vitamin A,B 1, Humidity 9.8.
Parts used: Chanak seeds.
Use : Used internally as food.
Properties of wet Chanak : -
Kashaya rasa, Soft, Tasty, Sheetal, Vatajanak, Grahi, Laghu, Pitta, Shukra and
Kapha-Pitta nashak.
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 37
Review of literature ===============================================================
UDVARTANA:-
Nirukthi:-
The word Udvartana is derived from the root – ud + vrith + bhavae + karaneva
lyud, which means vilepana or Gharshana.
Paribhasha:-
It is described as the Rookshana karma, practiced by means of rubbing the body
with karshana karaka drugs.
“Udvartanam kashayadi choorna Gatra karshanam”
Giving friction to the body by kashayadi choorna is called as Udvarthana.
The concept of Udvartana is explained right from the oldest textbook Charaka
Samhita and most of the other authors under rookshana karma which is one among the
Shadvidhopakrama. The word meaning of Rookshana is making thin or inducing dryness.
The panchbhoutika composition of Rookshana dravyas is predominant of Vayu,
Agni and pruthvi mahabhutas99 and it is having kashaya pradhana, katu tikta rasa. The
best examples are yava and takra.
Rookshana is indicated in Vasantha Ruthu in which Udvarthana with Rooksha
dravya, which are having kaphagna property, is beneficial100.
The following tables describe the different aspects of udvartana as one of the
rookshana kriya.
TABLE NO. 8 SHOWING EFFECTS OF ROOKSHANA KARMA:-
Constituent Effects
Dosha Vata vardhaka, Kapha nashaka
Dhatu Vikruta Dhatu shoshana, Balya, Varnya
Mala Shoshana (dravamsha of mala)-performs sthambhana karma
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 38
Review of literature ===============================================================
TABLE NO. 9 SHOWING SAMYAK ROOKSHANA LAKSHANA101:-
Lakshana Ch Su A.S & Hr
Samyak vata, mutra, mala Pravritti + + -
Hridaya Shuddhi + - +
Udgara Shuddhi + - +
Kantha Shuddhi + - +
Aasya Shuddhi + - -
Indriya Prasannata - + +
Tandra Nasha + - +
Klama Nasha + - -
Sweda + - -
Ruchi + - +
Kshuth Sahodaya + + +
Pipasa Sahodaya + + +
Vyadhi Mardava - - +
Utsaha - - +
Nirvyathe Antharatma + - -
Gatra Laghuta + + +
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 39
Review of literature ===============================================================
TABLE NO.10 SHOWING ROOKSHANA ATHI YOGA LAKSHANA:-102
Lakshana Ch Su A.S & hr
Parva Bheda + - -
Anga Marda + - -
Kasa + + +
Mukha Shosha + + -
Kshuth Pranasha + - +
Aruchi + - -
Trishna + + +
Shrotra Netra Dourbalya + - +
Urdhva Vata + - +
Tamo Vrudhi + - -
Deha Bala Nasha + + -
Agni Bala Nasha + - +
Tandra - + -
Anidra - + +
Bhrama - + -
Klama - + -
Swara Kshaya - + -
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 40
Review of literature ===============================================================
Chardi - + +
Hikka - + +
Shwasa - + +
Arochaka - - +
Sneha Kshaya - - +
Shukla Kshaya - - +
Oja Kshaya - - +
Swara Kshaya - - +
Basti Rukh - - +
Hridaya Rukh - - +
Murdha Rukh - - +
Jangha Rukh - - +
Uru Ruja - - +
Trika Ruja - - +
Parshva Ruja - - +
Jwara - - +
Pralapa - - +
Glani - - +
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 41
Review of literature ===============================================================
Para Asthi Bhedana - - +
Varcho Mutra Graha - - +
Jrumbha - - +
TABLE NO. 11 SHOWING ROOKSHANA AYOGA LAKSHANA:-103
Lakshana
OUSHADANAM DHATUNAM ASHAMO
(No relief from the diseases treatable from upakrama)
ROGA VRIDDHI (Aggravation of diseases)
Shodhana Ayoga
Classification:- Udvartana can be classified as two types:
1) Udgharshana.
2) Utsadana.
1. Udgharshana (Reinforced friction):
This is the procedure where “body is rubbed with the powdered medicine without
mixing oil or other Drava dravya”.104
It has the properties of Vata Shamana, Kandu- Spota- Pidika nashaka, Sira shodhaka,
Twak gata Agni vardaka, stimulates Brajaka Pitta. Friction of body with karshana
dravya excites the heat of skin, destroys itching, rashes etc.
2. Utsadana (Rubbing):
This is the procedure where “body is rubbed with the sneha / drava yukta
medicine in the form of kalka”.105
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 42
Review of literature ===============================================================
It is beneficial as it improves complexion in females, gives good appearance,
cleanses and beautifies.
Difference between Mardana and Udvarthana:-106
Mardana is a type of Abhyanga (abhyanga with pressure varience). Mardana is a
process of giving deep pressure from foot to waist, which is in prathiloma gathi
However, Udvartana is different from Abhyanga. In Udvartana, rubbing is done in
upward direction (prathiloma gathi) where as Abhyanga is done in downward direction
(anuloma gati). The intention of doing Udvartana is to bring Rookshana in the body
where as abhyanga pacifies rookashata.
TABLE NO. 12 Showing benefits of Udvartana:-
Sl. no Benefits Ch Su A.H Y.R
1 Dourgandya hara + - - -
2 Gourava hara + - - -
3 Tandra hara + - - -
4 Kandu hara + - - -
5 Mala hara + - - -
6 Aruchi hara + - - -
7 Vata hara - + - -
8 Kapha vilayana - + - -
9 Meda vilayana - + + -
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 43
Review of literature ===============================================================
10 Anga sthirikarana - + + -
11 Twak prasadakara - + + +
12 Kapha hara - - + +
13 Meda hara - - - +
14 Shukrada - - - +
15 Balya - - - +
16 Kanthi - - - +
17 Twak mrudutwa - - - +
Mode of Action of Udvartana:- Important qualities of rubbing are –
• It gives a mechanical stimulation causing contraction followed by relaxation and thus
greatly influences the muscles.
• It increases the peripheral circulation and influence the venous drainage by its alternate
pressure and relaxation techniques.
• It improves the nutrition of the particular area by proper circulation.
• It raises temperature locally by continuous friction.
• It increases elimination of waste products especially in the form of sweating.
• It increases secretion and absorption capacities of skin.
• It conditions the nervous system by stimulating the cutaneous nerve endings.
• It influences the general metabolism when applied on large areas.
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 44
Review of literature ===============================================================
Physiological effects:-
As the skin covers nearly the whole body its surface is affected by massage as
well as the structures, which lie beneath it. It increases the cutaneous circulation,
stimulates the sensory nerve ending and influences the vasoconstrictors and vasodilators
in the skin. The pressure of deep massage exerts a simultaneous influence on all the tissue
of the body. Further it accelerates the activity of the heart, helps the assimilation of food
and influences general metabolism of the body.
Influence of rubbing up on the circulation of fluid including lymphatic is also of
great importance. Rubbing stimulates both motor and sensory nerve endings. The
influence of rubbing on Motion of the molecules to participate in chemical activity results
in the anti-oxidant process.
TABLE NO. 13 SHOWING THERAPEUTIC ACTIONS OF UDVARTANA:-
Sl.No. Benefits Ch Su As.Hr. Y.R
1 Dourgandya hara + - - -
2 Gourava hara + - - -
3 Tandra hara + - - -
4 Kandu hara + - - -
5 Mala hara + - - -
6 Aruchi hara + - - -
7 Vata hara - + - -
8 Kapha vilayana - + - -
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 45
Review of literature ===============================================================
9 Meda vilayana - + + -
10 Anga sthirikarana - + + -
11 Twak prasadakara - + + +
12 Kapha hara - - + +
13 Meda hara - - - +
14 Shukrada - - - +
15 Balya - - - +
16 Kanthi - - - +
17 Twak mrudutwa - - - +
--------------------------------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 46
Materials and methods ===============================================================
MATERIALS AND METHODS:
MATERIAL – The materials taken for the clinical trials were
A) Instruments
a. Weighing machine
b. Measuring tape
B) Drugs
a. Chanak Pisthi
C) 30 Patients of Sthoulya
COLLECTION OF MATERIALS
A) Instruments – Weighing machine of 0.5 kg gradation were taken for the study
from the O.P.D of Dr B.N.M.E Trust’s P.G and Research Centre, Bijapur The
measuring tape to measure the chest, abdomen, Hip for the study were taken from
Santosh Surgicals, Bijapur.
B) Drug – Chanak pisthi was prepared as per the classical reference
METHODOLOGY OF
1) Height
The patient was made to stand erect on ground level with bare foot, heels together
and arms hanging perpendicular to ground. The head should be so held that the eyes were
directed towards forward. The scale was held over the head and marked it.The
measurement from ground to the mark will be the height of the individual and it is
recorded in centimetres.
------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 47
Materials and methods ===============================================================
2) Weight –
The patient was weighed with minimum garments on a lever balanced weighing
machine and the weight is recorded in kilograms
3) BMI: (Body Mass Index.)
BMI of the patient is calculated by using the formula
BMI = Weight in kg / Ht in mt2
5) Vaksha circumference:
Measurement at the nipple line in men, at the largest circumference above the
breasts in females
6) Udara circumference of udara was measured at the level of umbilicus.
7) Sphik circumference:
While standing erect horizontal measure taken at level of maximum
circumference of hips.
Normal readings of vaksha, udara and sphik were taken on the basis of pilot
study.
METHOD:-
Aim: The aim of study was to assess the effect of chanak pisthi udvartana in
sthoulya (obesity).
Study design-
The patients of sthoulya with in the age group of 18-60 yrs were selected
randomly from O.P.D and I.P.D of Dr. B.N.M.E Trust’s Shri Mallikarjun Swamiji Post
Graduate and research centre, Bijapur and camps conducted in the city (Bijapur) by the
institute, irrespective of sex, occupation and socio-economic status.
------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 48
Materials and methods ===============================================================
The size of the sample is 30 excluding the drop outs. The present study is
comparative study where in patients were assigned into one group
SOURCE OF DATA:-
LITERARY DATA:-
The literary source of present study was obtained from Vedic scriptures, classical
texts of Ayurveda, modern texts, published articles in reputed journals and internet.
CLINICAL DATA
The clinical data was obtained from the patients enrolled for the clinical study.
INCLUSIVE CRITERIA
1. Sthoulya diagnosed according to signs and symptoms as in classical texts.
2. Sthoulya of both sex.
3. Between the age group of 20 – 50 years.
4. The patients with BMI above 30 and below 40 irrespective of sex.
EXCLUSIVE CRITERIA
1. Pregnant women.
2. Age group below 20 and above 50 years.
3. Obesity due to secondary causes.
4. Obesity observed since birth.
------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 49
Materials and methods ===============================================================
SAMPLING METHODS
Randomly selected patients from O.P.D and I.P.D of Dr. B.N.M.E. Trust’s Shri
Mallikarjun Swamiji Post Graduate and Research Center, Bijapur were collected in single
group.
LAB INVESTIGATIONS
As the study was conducted only on the basis of subjective parameters hence no
investigations are carried out.
INTERVENTIONS:-
While making group simple random sampling procedure is adopted.
Sample size : 30 patients
Sample type : Sthoulya
Procedure : From 1st day to 30th day chanak pisthi udvartana is
carried out.
Duration : 30 days
Follow ups
Follow up before treatment : I follow up: 1st day
Follow up after treatment : II follow up: 30th day
Post treatment follow up : 15th day
------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 50
Materials and methods ===============================================================
ASSESSMENT OF SUBJECTIVE AND OBJECTIVE CRITIERA OF
STHOULYA: -
OBJECTIVE CRITERIA
1) B.M.I = Weight in Kg
Height in mt sq
CLASSIFICATION OF OVERWEIGHT AND OBESITY BY BMI CHART
TABLE No.14
Obesity Class BMI (mg/mt2)
Underweight < 18.5
Normal 18.5 – 24.9
Overweight 25.0 – 29.9
Obesity I 30.0 – 34.9
II 35.0 – 39.9
Extreme Obesity. III > 40
TABLE No.15
SUBJECTIVE CRITERIA:
Lakshanas BT ( 1st Day) AT (21st Day) AFU (30th Day)
Kshudra shwasa
Atikshuda
Atitrushna
Swedaadhikata
------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 51
Materials and methods ===============================================================
Gradings for Subjective criteria are mentioned as,
Grade I Absent
Grade II Mild
Grade III Moderate
Grade IV Severe
OBJECTIVE CRITERIA:-
VAKSHA CIRCUMFERENCE
Grade I Overweight <80 cms
Grade II Mild obese 81-90 cms
Grade III Moderate obese 91-100 cms
Grade IV Grossly obese 101-110 cms
UDARA CIRCUMFERENCE
Grade I Overweight <80 cms
Grade II Mild obese 81-90 cms
Grade III Moderate obese 91-100 cms
Grade IV Grossly obese 101-110 cms
SPHIK CIRCUMFERENCE
Grade I Overweight <90 cms
Grade II Mild obese 91-100 cms
Grade III Moderate obese 101-110 cms
Grade IV Grossly obese 111-120 cms
------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 52
Materials and methods ===============================================================
TABLE No.16
Circumference BT ( 1st Day) AT (21st Day) AFU (30th Day)
Vaksha
Udara
Sphik
TABLE No.17
OBJECTIVE CRITERIA:
Variable BT ( 1st Day) AT (21st Day) AFU (30th Day)
BMI
OBSERVATIONAL VARIABLES:-
1) Adhika Kshudha 3) Kshudra Shwasa
2) Adhika trishna 4) Swedaadhikata.
ASSIGNMENT OF CLINICAL IMPROVEMENT
Clinical improvement of the disease was based on improvement in the clinical
findings and reduction on the severity of the symptoms of the disease grading for the
clinical improvement for individual variables.
Grading for the clinical improvement for individual variables
1. CI-III: excellent i.e. 3 degree reduction in the severity score, against the initial
score, i.e. severe –normal.
------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 53
Materials and methods ===============================================================
2. CI-II: Good i.e. 2 degree reduction in the severity score, against the score, i.e.
reduction from moderate –normal, severe-mild
3. CI-I: encouraging i.e. 1 degree reduction in the severity score, against initial
score, i.e. reduction from mild-normal, Moderate-Mild and Severe-moderate.
4. CS: Clinically stable, i.e. severity score remains as against the initial score.
5. CD: Clinically deteriorated i.e. increased in severity score against the initial
score.
STATISTICAL ANALYSIS:
The data was collected from both the groups before,and after treatment and at the
end of follow up and statistically analyzed by using student’s ‘t’ test.
------------------------------------------------------------------------------------------------------- A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 54
Observations and results ============================================================
OBSERVATIONS AND RESULTS:
OBSERVATIONS:-
Total 30 patients were taken for clinical study. The observation for present
study were done in three stage –
• Generalized observations.
• Specific observations.
• Result related observations.
GENERALIZED OBSERVATIONS:-
Table No – 18 Distribution of patients according to age. (n=30)
Sl. No Age in years No of patients %
1 18-30 13 43.33%
2 31-40 17 56.66%
Graph No 1: Distribution of patients according to age.
43.33
56.66
18-3031-40
In the present study it was observed that 13 patients (43.33%) were of 18-30
yrs,and 17 patients (56.66%) were of 31-40 yrs of age.
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 55
Observations and results ============================================================
Table No –19 Distribution of patients according to sex. (n=30)
Sl. No Sex No of patients %
1 Male 24 80%
2 Female 6 20%
Graph No 2: Distribution of patients according to sex.
80
20
0102030405060708090
malefemale
In the present study it was observed that 24 patients (80%) were male and 6
patients (20%) were females.
Table No – 20 Distribution of patients according to religion. (n=30)
Sl. No Religion No of patients %
1 Hindu 25 83.33%
2 Muslim 5 16.66%
Graph No 3: Distribution of patients according to religion.
83.33
16.66
0
20
40
60
80
100
Percentage
HinduMuslim
Majority of patients observed were Hindu 25 patients (83.33%) and Muslim
were 5 patients (16.66%).
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 56
Observations and results ============================================================
Table No – 21 Distribution of patients according to education. (n=30)
Sl. No Educational status No of patients %
1 Educated 26 86.66%
2 Uneducated 4 13.33%
Graph No 4: Distribution of patients according to education
020406080
100
Percentage
EducatedUneducated
In the present study 26 pts (86.66%) were educated and 4 (13.33%) pt was
uneducated.
Table No – 22 Distribution of patients according to socio-economical
status.(n=30)
Sl. No Socio economical status No of patients %
1 Lower class 0 0%
2 Middle class 24 80%
3 Upper class 6 20%
Graph No 5: Distribution of patients according to socio-economical status.
0%
80
20
0%
2000%
4000%
6000%
8000%
10000%
Percentage
Lower class Middle classUpper class
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 57
Observations and results ============================================================
In the present study maximum patients observed were of middle class i.e. 24
patients (80%),were patients observed of upper class is,6 patients (20%).
Table No – 23 Distribution of patients according to marital status. (n=30)
Sl. No Marital status No of patients %
1 Married 22 73.33%
2 Unmarried 8 26.66%
Graph No – 6 Distribution of patients according to marital status.
73.33
26.66
0
20
40
60
80
Percentage
Married
Unmarried
Maximum patients observed for the study were married 22 patients (73.33%)
and unmarried are only 8 patients (26.66%).
Table No – 24 Distribution of patients according to Habitat (n=30)
Sl. No Habitat No of patients %
1 Rural 4 13.33%
2 Urban 26 86.66 %
Graph No – 7 Distribution of patients according to Habitat.
13.33
86.66
0
20
40
60
80
100
Percentage
Rural Urban
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 58
Observations and results ============================================================
Majority of patients observed were from urban 26 (86.66%) and 4 patients
(13.33%) belong to rural area.
Table No – 25 Distribution of patients according to occupation (n=30)
Sl. No Occupation No of patients %
1 Student 8 26.66%
2 Farmer 6 20%
3 Business 9 30%
4 House wife 5 16.66%
5 Teacher 2 6.66%
Graph No –8 Distribution of patients according to occupation
26.66
20
30
16.66
6.66
05
101520253035
Percentage
StudentFarmerBusinessHouse wifeTeacher
The patients from various occupations were observed for the study. Among
them 8 patients (26.66%) were students,6 patients (20%)were farmer,9 patients
(30%)were business men,5 patients (16.66%) were house wife and , 2 patients
(6.66%) were teacher.
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 59
Observations and results ============================================================
Table No –26 Distribution of patients according to diet (n=30)
Sl. No Diet No of patients %
1 Veg 6 20%
2 Mixed 24 80%
Graph No – 9 Distribution of patients according to diet
Veg
Mixed
020406080
100
Percentage
VegMixed
Among the patients observed for study vegetarians were 6 patients (20%) and
those who took mixed diet were 24 patients (80%).
Table No – 27 Distribution of patients according to vyasana. (n=30)
Sl. No Vyasana No of patients %
1 Tea/Coffee 8 26.66%
2 Tobacco 5 16.66%
3 Alcohol 2 6.66%
4 Cigarette 3 10%
5 No habits 12 40%
Graph No – 10 Distribution of patients according to vyasana
26.66
16.6610
40
0
10
20
30
40
50
Percentage
Tea/CoffeeTobaccoAlcoholCigarette
No habits
In the present study it was observed that 8 patients (26.66%) have a habit of
Tea/ Coffee, tobacco chewers were 5 patients (16.66%) , alcohol habit were 2 patients
.66%) cigarette smokers were 3 patients (10%) and no habits were 12 patients (40%).
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 60
Observations and results ============================================================
Table No –28 Distribution of patients according to prakruti (n=30)
Sl. No Prakruti No of patients %
1 Kaphavata 8 26.66%
2 Kaphapitta 11 36.66%
3 Pittakapha 11 36.66%
Graph No – 11 Distribution of patients according to prakruti
26.66
36.66
05
10152025303540
Percentage
KaphavataKaphapittaPittakapha
In the present study it was observed that of kaphavata prakruti there were 8
patients (26.66%),kapha pitta prakruti11 patients (36.66%), and of pittakapha prakruti
11 patients (36.66%).
Table No – 29 Distribution of patients according to Agni (n=30)
Sl. No Agni No of patients %
1 Manda 0 0%
2 Teekshna 20 66.66%
3 Vishama 10 33.33%
Graph No – 12 Distribution of patients according to Agni
66.66
33.33
0
20
40
60
80
Percentage
MandaTeekshnaVishama
In the present study it was observed that most of the patients were having
Teekshnagni i.e. 20 patients (66.66%) and only 10 patients (33.33%) were having
vishamagni.
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 61
Observations and results ============================================================
Table No – 30 Distribution of patients according to Kostha. (n=30)
Sl. No Kostha No of patients %
1 Mrudu 3 10%
2 Madhyama 20 66.66%
3 Krura 7 23.33%
Graph No – 13 Distribution of patients according to Kostha
10.00
66.66
23.33
010203040506070
Percentage
MruduMadhyamKrura
Patients registered for study were assessed for mrudu, madhyama and kroora
kostha, majority of patients with madhyama koshta i.e. 20 (66.6%), 7 patients were
kroora kostha (23.33%) and 3 patients (10%) of mrudu kostha.
Table No – 31 Distribution of patients according to Kula Vruttanta. (n=30)
Sl. No Kula vruttanta No of patients %
1 Present 8 26.66%
2 Absent 22 73.33%
Graph No – 14 Distribution of patients according to Kula Vruttanta
26.66
73.33
0
20
40
60
80
Percentage
PresentAbsent
In the present study 8 patients (26.66%) patients had kula vruttanta of sthaulya
and 22 patients (73.33%) had no kula vruttanta of sthaulya.
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 62
Observations and results ============================================================
Table No – 32 Distribution of patients according to BMI (n=30) Before
treatment;
Grading BMI No of patients %
G1 30-34.9 27 90%
G2 35-39.9 3 10%
G3 >40 0 0%
Graph No – 15 Distribution of patients according to BMI
100
0
20
40
60
80
100
Percentage
30-34.935-35.9>40
Patients observed for study was assessed as G-1;B.M.I in between 30-34.9 were
27 patients (90%), G-2;B.M.I in between 35-35.9 were 3 patients (10%).
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 63
Observations and results ============================================================
Table No – 33 Distribution of patients based on Vaksha Circumference (n=30)
Before treatment;
Grading Vaksha circumferance No of patients %
G1 Overweight <80cms 0 0
G2 Mild obese 81-90 cms 18 60
G3 Moderate obese 91-100cms 10 33.33
G4 Grossly obese 101-110cms 2 6.66
Graph No – 16 Distribution of patients based on Vaksha Circumference
G2
G3, 33.33
G4
0
20
40
60
80
Percentage
G1G2G3G4
Vaksha circumference – patients observed for study were assessed grade 1 to
grade 4. Majority of patients were of grade 2 i.e., 18 patients (60%), grade 3 were 10
patients (33.33%) and grade 4 were of 2 patients (6.66%).
Table No – 34 Distribution of patients based on Udara Circumference (n=30)
Before treatment;
Grading Udara circumferance No of patients %
G1 Overweight <80cms 0 0
G2 Mild obese 81-90 cms 5 16.66
G3 Moderate obese 91-100cms 16 53.33
G4 Grossly obese 101-110cms 9 30
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 64
Observations and results ============================================================
Graph No – 17 Distribution of patients based on Udara Circumference
G3
G4
0
10
20
30
40
50
60
Percentage
G1
G2
G3
G4
Udara circumference – patients observed for study were assessed grade 1 to
grade 4. Majority of patients were of grade 3, 16 patients (53.33%), grade 2 were 5
patients (16.66%) andgrade 4 were 9 patients (30%).
Table No – 35 Distribution of patients based on Sphika Circumference (n=30)
Before treatment;
Grading Sphika circumferance No of
patients % G1 Overweight <90cms 0 0
G2 Mild obese 91-100 cms 6 20
G3 Moderate obese 101-110cms 17 56.66
G4 Grossly obese 111-120cms 7 23.33
Graph No – 18 Distribution of patients based on Sphik Circumference
G3
G4
0102030405060
Percentage
G1G2G3G4
Sphik circumference – Majority of patients were of grade 3 i.e. 17 patients
(56.66%), grade 2 were 6 patients (20%) and grade 4 were 7 patients (23.33%).
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 65
Observations and results ============================================================
Table No – 36 Distribution of patients according to adhika kshudha.(n=30)
Before treatment.
Grading adhika kshudha No of patients %
G1 Absent 0 0
G2 Mild 0 0
G3 Moderate 18 60
G4 Severe 12 40
Graph No – 19 Distribution of patients based on adhika kshudha.(n=30)
0 0
60
40
0
20
40
60
80
Total
G1G2G3G4
Majority of patients were of grade 3 ie,18 patients (60%) and of grade 4 were 12
patients (40%).
Table No –37 Distribution of patients according to adhika trishna.(n=30)
Before treatment;
Grading adhika trishna. No of patients %
G1 Absent 0 0
G2 Mild 2 6.66
G3 Moderate 22 73.33
G4 Severe 6 20
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 66
Observations and results ============================================================
Graph No – 20 Distribution of patients based on adhika trishna.(n=30)
0 6.66
73.33
20
0
20
40
60
80
Total
G1G2G3G4
Majority of patients were of grade 3 ie,22 patients (73.33%), grade 2 were 2 patients
(6.66%) and grade 4 were 6 patients (20%).
Table No –38 Distribution of patients according to Kshudra shwas.(n=30)
Before treatment;
Grading Kshudra shwas. No of patients %
G1 Absent 14 46.66
G2 Mild 12 40
G3 Moderate 4 13.33
G4 Severe 0 0
Graph No – 21 Distribution of patients based on Kshudra shwas.(n=30))
46.6640
13.33
00
1020304050
Total
G1G2G3G4
In present study it was observed that from grade 1 to grade4,14 patients (46.66%) were
of grade 1,12 patients (40%) were of grade 2,4 patients (13.33%) were of grade 3.
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 67
Observations and results ============================================================
Table No – 39 Distribution of patients according to swedadikhata.(n=30)
Before treatment;
Grading swedadikhata . No of patients %
G1 Absent 0 0
G2 Mild 2 6.66
G3 Moderate 14 46.66
G4 Severe 14 46.66
Graph No – 22 Distribution of patients based on swedadikhata.(n=30)
06.66
46.6646.66
01020304050
Total
G1G2G3G4
In present study it was observed that from grade 1 to grade4,2 patients (6.66%) were
of grade 2,14 patients (46.66%) were of grade 3,14 patients (46.66%) were of grade 4.
Table No – 40 Distribution of patients according to BMI (n=30)
After treatment;
Grading BMI No of patients %
G1 30-34.9 28 93.33%
G2 35-39.9 2 6.66%
G3 >40 0 0%
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 68
Observations and results ============================================================
Graph No – 23 Distribution of patients according to BMI
6.66 0%0
20406080
100
Percentage
<3030-31.531.6-33
Patients observed for study were assessed as G-1;B.M.I in between 30-34.9 were
28 patients (93.33%), G-2;B.M.I in between 35-35.9 were 2 patients (6.66%).
Table No – 41 Distribution of patients based on Vaksha Circumference (n=30)
After treatment;
Grading Vaksha circumferance No of patients % G1 Overweight <80cms 1 3.33
G2 Mild obese 81-90 cms 17 56.66
G3 Moderate obese 91-100cms 11 36.66
G4 Grossly obese 101-110cms 1 3.33
Graph No –24 Distribution of patients based on Vaksha Circumference
G2
G3, 36.66
G4
0
10
20
30
40
50
60
Percentage
G1
G2
G3
G4
Vaksha circumference – patients observed for study were assessed grade 1 to
grade 4. Majority of patients were of grade 2 i.e., 17 patients (56.66%), grade 3
were11 patients (36.66%) and grade 4 was 1 patient (3.33%) and grade 1 was 1
patient(3.33)’
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 69
Observations and results ============================================================
Table No – 42 Distribution of patients based on Udara Circumference (n=30)
After treatment;
Grading Udara circumferance No of patients %
G1 Overweight <80cms 0 0
G2 Mild obese 81-90 cms 7 23.33
G3 Moderate obese 91-100cms 16 53.33
G4 Grossly obese 101-110cms 7 23.33
Graph No – 25 Distribution of patients based on Udara Circumference
G3
G4
0
10
20
30
40
50
60
Percentage
G1
G2
G3
G4
Udara circumference – patients observed for study were assessed grade 1 to
grade 4. Majority of patients were of grade 3, 16 patients (53.33%), grade 2 were 7
patients (23.33%) and of grade 4 were 7 patients (23.33%).
Table No – 43 Distribution of patients based on Sphika Circumference (n=30)
After treatment;
Grading Sphika circumferance No of patients %
G1 Overweight <90cms 0 0
G2 Mild obese 91-100 cms 8 26.66
G3 Moderate obese 101-110cms 16 53.33
G4 Grossly obese 111-120cms 6 20
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 70
Observations and results ============================================================
Graph No – 26 Distribution of patients based on Sphik Circumference
G3
G4
0102030405060
Percentage
G1G2G3G4
Sphik circumference – Majority of patients were of grade 3 i.e. 16 patients
(53.33%), grade 2 were 8 patients (26.66%)and grade 4 were6 patients (20%).
Table No – 44 Distribution of patients according to adhika kshudha.(n=30)
After treatment.
Grading adhika kshudha No of patients %
G1 Absent 0 0
G2 Mild 0 0
G3 Moderate 19 63.33
G4 Severe 11 36.66
Graph No – 27 Distribution of patients according to the variables symptom
0 0
63.33
36.66
0
20
40
60
80
Total
Ati KshudaAti TrishnaKshudrashwasSwedaadhikata
Majority of patients were of grade 3 ie,19 patients (63.33%) and of grade 4 were
11 patients (36.66%).
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 71
Observations and results ============================================================
Table No –45 Distribution of patients according to adhika trishna.(n=30)
After treatment;
Grading adhika trishna. No of patients %
G1 Absent 0 0
G2 Mild 2 6.66
G3 Moderate 22 73.33
G4 Severe 6 20
Graph No – 28 Distribution of patients based on adhika trishna.(n=30)
0 6.66
73.33
20
0
20
40
60
80
Total
G1G2G3G4
Majority of patients were of grade 3 ie,22 patients (73.33%), grade 2 were 2 patients
(6.66%) and grade 4 were 6 patients (20%).
Table No – 46 Distribution of patients according to Kshudra shwas.(n=30)
After treatment;
Grading Kshudra shwas. No of patients %
G1 Absent 14 46.66
G2 Mild 12 40
G3 Moderate 4 13.33
G4 Severe 0 0
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 72
Observations and results ============================================================
Graph No –29 Distribution of patients based on Kshudra shwas.(n=30))
46.6640
13.33
00
1020304050
Total
G1G2G3G4
In present study it was observed that from grade 1 to grade4,14 patients (46.66%)
were of grade 1,12 patients (40%) were of grade 2,4 patients (13.33%) were of grade 3.
Table No – 47 Distribution of patients according to swedadikhata.(n=30)
After treatment;
Grading Swedadikhata . No of patients %
G1 Absent 1 3.33
G2 Mild 5 16.66
G3 Moderate 24 80
G4 Severe 0 0
Graph No – 30 Distribution of patients based on swedadikhata.(n=30)
3.3316.66
80
00
20406080
100
Total
G1G2G3G4
Majority of patients were of grade 3 i.e., 24 patients (80%), grade 2 were 5 patients
(16.66%) and grade 1 was 1 patients (3.33%).
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 73
Observations and results ============================================================
Table No – 48 Distribution of patients according to BMI (n=30) After Follow up
Grading BMI No of patients %
G1 30-34.9 27 90%
G2 35-39.9 3 10%
G3 >40 0 0%
Graph No – 32 Distribution of patients according to BMI
100
0
20
40
60
80
100
Percentage
30-34.935-35.9>40
Patients observed for study were assessed as G-1;B.M.I in between 30-34.9 were
27 patients (90%), G-2;B.M.I in between 35-39.9 were 3 patients (10%).
Table No – 49 Distribution of patients based on Vaksha Circumference (n=30)
After Follow up
Grading Vaksha circumferance No of patients %
G1 Overweight <80cms 0 0
G2 Mild obese 81-90 cms 18 60
G3 Moderate obese 91-100cms 10 33.33
G4 Grossly obese 101-110cms 2 6.66
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 74
Observations and results ============================================================
Graph No – 33 Distribution of patients based on Vaksha Circumference
G2
G3, 33.33
G4
0
20
40
60
80
Percentage
G1G2G3G4
Vaksha circumference – patients observed for study were assessed grade 1 to
grade 4. Majority of patients were of grade 2 i.e., 18 patients (60%), grade 3 were 10
patients (33.33%) and grade 4 were of 2 patients (6.66%).
Table No – 50 Distribution of patients based on Udara Circumference (n=30)
After Follow up
Grading Udara circumferance No of patients %
G1 Overweight <80cms 0 0
G2 Mild obese 81-90 cms 6 20
G3 Moderate obese 91-100cms 15 50
G4 Grossly obese 101-110cms 9 30
Graph No – 34 Distribution of patients based on Udara Circumference
G3
G4
0
10
20
30
40
50
60
Percentage
G1
G2
G3
G4
Udara circumference – patients observed for study were assessed grade 1 to
grade 4. Majority of patients were of grade 3, ie,15 patients (50%), grade 2 were 6
patients (20%) andgrade 4 were 9 patients (30%).
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 75
Observations and results ============================================================
Table No – 51 Distribution of patients based on Sphika Circumference (n=30)
After Follow up
Grading Sphika circumferance
No of
patients %
G1 Overweight <90cms 0 0
G2 Mild obese 91-100 cms 7 23.33
G3 Moderate obese 101-110cms 17 56.66
G4 Grossly obese 111-120cms 6 20
Graph No – 35 Distribution of patients based on Sphik Circumference
G3
G4
0102030405060
Percentage
G1G2G3G4
Sphik circumference – Majority of patients were of grade 3 i.e. 17 patients
(56.66%), grade 2 were7 patients (23.33%)and grade 4 were 6 patients (20%).
Table No – 52 Distribution of patients according to adhika kshudha.(n=30)
After Follow up
Grading adhika kshudha No of patients %
G1 Absent 0 0
G2 Mild 0 0
G3 Moderate 18 60
G4 Severe 12 40
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 76
Observations and results ============================================================
Graph No – 36 Distribution of patients based on adhika kshudha.(n=30)
0 0
60
40
0
20
40
60
80
Total
G1G2G3G4
Majority of patients were of grade 3 ie,18 patients (60%) and of grade 4 were 12
patients (40%).
Table No – 53 Distribution of patients according to adhika trishna.(n=30)
After Follow up
Grading adhika trishna. No of patients %
G1 Absent 0 0
G2 Mild 2 6.66
G3 Moderate 22 73.33
G4 Severe 6 20
Graph No – 37 Distribution of patients based on adhika trishna.(n=30)
0 6.66
73.33
20
0
20
40
60
80
Total
G1G2G3G4
Majority of patients were of grade 3 ie, 22 patients (73.33%), grade 2 were 2
patients (6.66%) and grade 4 were 6 patients (20%).
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 77
Observations and results ============================================================
Table No – 54 Distribution of patients according to Kshudra shwas.(n=30)
After Follow up
Grading Kshudra shwas. No of patients %
G1 Absent 14 46.66
G2 Mild 12 40
G3 Moderate 4 13.33
G4 Severe 0 0
Graph No – 38 Distribution of patients based on Kshudra shwas.(n=30))
46.6640
13.33
00
1020304050
Total
G1G2G3G4
In present study it was observed that from grade 1 to grade4,14 patients (46.66%)
were of grade 1,12 patients (40%) were of grade 2,4 patients (13.33%) were of grade 3.
Table No – 55 Distribution of patients according to swedadikhata.(n=30)
After Follow up
Grading Swedadikhata . No of patients %
G1 Absent 0 0
G2 Mild 2 6.66
G3 Moderate 14 46.66
G4 Severe 14 46.66
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 78
Observations and results ============================================================
Graph No – 39 Distribution of patients based on swedadikhata.(n=30)
06.66
46.6646.66
01020304050
Total
G1G2G3G4
In present study it was observed that from grade 1 to grade4,2 patients (6.66%) were
of grade 2,14 patients (46.66%) were of grade 3,14 patients (46.66%) were of grade 4.
OBSERVATIONS FOR THE PATIENTS:-
1) All the patients were presenting with varied degree of laxanas
2) For all the patients of sthaulya udvartana with chanak pisti is done.
3) Patients were comfortable during and at the end of the treatment
4) The patients were observed while in undergoing udvartana procedure.
5) All the patients come regularly for the follow up after 15 days.
6) All the patients were asked not to sleep during day time
RESULT RELATED OBSERVATIONS OF PATIENTS AFTER TREATMENT
1) CI- III Excellent: None of patients showed excellent response at the end of the
treatment
2) CI- II Good: None of patients showed good response at the end of the
treatment
3) CI- I Encouraging: 3.33% (1 pt) for BMI, 6.66% (2pts) for vaksha, 13.33% (4
pt) for udara, and 10% (3 pt) for sphik, 3.33% (1 pt) for adhik khshudha,and
63.33%(19%) for sweda adhikata have showed encouraging response.
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 79
Observations and results ============================================================
4) C.S –96.66 % (29 pts) for BMI, 93.33 % (28 pts) for vaksha, 86.66% (26 pts)
for udara, 90% (27 pts) for sphik 96.66% (29 pts),for adhik kshudha 100% (30
pts) for adhika trushna,100% (30%) for kshudra shwas and 36.66% (11 pts)for
sweda adhikatha have showed no response i.e. stable.
5) C.D. – None of the patients showed deterioration in the conditions
RESULT RELATED OBSERVATIONS OF PATIENTS AFTER FOLLOW UP
1) CI- III Excellent: None of patients showed excellent response at the end of the
follow up.
2) CI- II Good: None of patients showed excellent response at the end of the
follow up.
3) CI- I Encouraging: 3.33% (1 pt) for Udara, 3.33% (1 pt ) for sphika, have
showed encouraging response.
4) C.S – 100% (30 pts) for BMI,100 % (30 pts) for vaksha, 96.66% (29 pts) for
udara, 96.66% 29 pts) for sphik,100 %(30 pts) for adhik kshudha,100%(30
pts) for adhik trushna,100%(30pts) for kshudra shwas,100% (30 pts) for sweda
adhikata have showed no response i.e. stable after follow up.
5) C.D. – None of the patients showed deterioration in the conditions after follow
up.
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 80
Observations and results ============================================================
TABLE NO 56:-RESULT RELATED RESPONSES OF THE PATIENTS
AFTER TREATMENT:
variables CI-3 CI-2 CI-1 CS CD
BMI 0% 0% 3.33%(1pt) 96.66%(29pts) 0%
VAKSHA 0% 0% 6.66%(2pts) 93.33%(28pts) 0%
UDARA 0% 0% 13.33%(4pts) 86.66%(26pts) 0%
SPHIKA 0% 0% 10%(3pts) 90%(27pts) 0%
ADHIKA KSHUDA 0% 0% 3.33%(1pt) 96.66%(29pts) 0%
ADIKA TRUSHNA 0% 0% 0% 100%(30pts) 0%
KSHUDRA SHWAS 0% 0% 0% 100%(30pts) 0%
SWEDA ADHIKATA 0% 0% 63.33%(19pts) 36.66%(11pts) 0%
GRAPH NO– 40 RESPONSES OF THE PATIENTS FOR BMI AFTER TREATMENT:-
020406080
100120
CI-3 CI -2 CI -1 CS CD
BMI
GRAPHNO–41 RESPONSES OF THE PATIENTS FOR VAKSHA AFTER TREATMENT:-
020406080
100
CI-3 CI -2 CI -1 CS CD
VAKSHA
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 81
Observations and results ============================================================
GRAPH NO– 42 RESPONSES OF THE PATIENTS FOR UDARA AFTER
TREATMENT:-
0
20
40
60
80
100
CI -3 CI -2 CI -1 CS CD
UDARA
GRAPH NO– 43 RESPONSES OF THE PATIENTS FOR SPHIK AFTER
TREATMENT:-
020406080
100
CI-3 CI -2 CI -1 CS CD
SPHIK
GRAPH NO– 44 RESPONSES OF THE PATIENTS FOR ADHIKA
KSHUDTHA AFTER TREATMENT:-
020406080
100120
CI-3 CI -2 CI -1 CS CD
SPHIK
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 82
Observations and results ============================================================
GRAPH NO– 45 RESPONSES OF THE PATIENTS FOR ADHIKA TRUSHNA
AFTER TREATMENT:-
020406080
100120
CI-3 CI -2 CI -1 CS CD
SPHIK
GRAPH NO– 46 RESPONSES OF THE PATIENTS FOR KSHUDRA SWAS
AFTER TREATMENT:-
020406080
100120
CI-3 CI -2 CI -1 CS CD
SPHIK
GRAPH NO– 47 RESPONSES OF THE PATIENTS FOR SWEDADHIKATA
AFTER TREATMENT:-
010203040506070
CI-3 CI -2 CI -1 CS CD
SPHIK
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 83
Observations and results ============================================================
TABLE NO 57:-RESULT RELATED RESPONSES OF THE PATIENTS
AFTER FOLLOW UP:
variables CI-3 CI-2 CI-1 CS CD
BMI 0% 0% 0% 100%(30pts) 0%
VAKSHA 0% 0% 0% 100%(30pts ) 0%
UDARA 0% 0% 3.33%(1pts) 96.66%(29pts) 0%
SPHIKA 0% 0% 3.33 %(1pts) 96.66%(29pts) 0%
ADHIKA KSHUDA 0% 0% 0% 100%(30pts) 0%
ADIKA TRUSHNA 0% 0% 0% 100%(30pts) 0%
KSHUDRA SHWAS 0% 0% 0% 100%(30pts) 0%
SWEDA ADHIKATA 0% 0% 0% 100%(30pts) 0%
GRAPH NO– 45 RESPONSES OF THE PATIENTS FOR BMI AFTER
FOLLOW UP:-
020406080
100120
CI-3 CI -2 CI -1 CS CD
BMI
GRAPHNO–46 RESPONSES OF THE PATIENTS FOR VAKSHA AFTER FOLLOW UP:-
020406080
100120
CI-3 CI -2 CI -1 CS CD
VAKSHA
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 84
Observations and results ============================================================
GRAPH NO– 47 RESPONSES OF THE PATIENTS FOR UDARA AFTER
FOLLOW UP:-
020406080
100120
CI-3 CI -2 CI -1 CS CD
UDARA
GRAPH NO– 48 RESPONSES OF THE PATIENTS FOR SPHIK AFTER
FOLLOW UP:-
020406080
100120
CI-3 CI -2 CI -1 CS CD
SPHIK
GRAPH NO– 49 RESPONSES OF THE PATIENTS FOR ADHIKA
KSHUDTHA AFTER FOLLOW UP:-
0204060
80100120
CI-3 CI -2 CI -1 CS CD
SPHIK
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 85
Observations and results ============================================================
GRAPH NO– 50 RESPONSES OF THE PATIENTS FOR ADHIKA TRUSHNA
AFTER FOLLOW UP:-
020406080
100120
CI-3 CI -2 CI -1 CS CD
SPHIK
GRAPH NO– 51 RESPONSES OF THE PATIENTS FOR KSHUDRA SWAS
AFTER FOLLOW UP:-
020406080
100120
CI-3 CI -2 CI -1 CS CD
SPHIK
GRAPH NO–52 RESPONSES OF THE PATIENTS FOR SWEDADHIKATA
AFTER FOLLOW UP:-
020406080
100120
CI-3 CI -2 CI -1 CS CD
SPHIK
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 86
Observations and results ============================================================
STATISTICAL ANALYSIS :-
TABLE NO 58:- BMI Mean S.D t P Remarks
B .T
A. T
1.1000
1.0667
0.30513
0.25371
1.000 0.326 NS
B .T
A .F.U
1.1000
1.1000
0.30513
0.30513
0 1.000 NS
TABLE NO 59:- VAKSHA
Mean S.D t P Remarks
B.T.
A.T.
2.4667
2.4000
0.62881
0.62146 1.439 0.161 S
B.T.
F.U.
2.4667
2.4667
0.62881
0.62881 0 0.1.000 NS
TABLE NO 60: -UDARA
Mean S.D t P Remarks
B.T
AT.
3.133
3.000
0.68145
0.69481 2.112 0.043 S
B.T
F.U.
3.133
3.1000
0.68145
0.71197 1.000 0.326 NS
TABLE NO 61: -SPHIK
Mean S.D t P Remarks
B.T
AT.
3.0333
2.9333
0.66868
0.69149 1.795 0.083 S
B.T
F.U.
3.0333
2.9667
0.66868
0.66868 1.439 0.161 NS
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 87
Observations and results ============================================================
TABLE NO 62:- ADHIKA KSHUDHA
Mean S.D t P Remarks
B.T.
A.T.
3.4000
3.3667
0.49827
0.49013 1.0000 0.326 NS
B.T.
F.U.
3.4000
3.4000
0.49827
0.49827 0 1.000 NS
TABLE NO 63:- ADHIKA TRUSHNA
Mean S.D t P Remarks
B.T
AT.
3.1333
3.1333
0.50742
0.50742 0 1.000 NS
B.T
F.U.
3.1333
3.1333
0.50742
0.50742 0 1.000 NS
TABLE NO 64:- KSHUDRA SWAS
Mean S.D t P Remarks
B.T
AT.
1.6667
1.6667
0.71116
0.71116
0 1.000 NS
B.T
F.U.
1.6667
1.6667
0.71116
0.71116
0 1.000 NS
TABLE NO 65: - SWEDADHIKATA
Mean S.D t P Remarks
B.T
AT.
3.4000
2.7667
0.62146
0.50401 7.077 0.000 HS
B.T
F.U.
3.4000
3.4000
0.62146
0.62146 0 1.000 NS
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartana In Sthoulya. 88
Discussion ===============================================================
DISCUSSION
TITLE ;
The dissertation entitled as ‘A STUDY ON APATARPAN WITH SPECIAL
REFERENCE TO UDVARTAN IN STHOULYA’ .
In astanga hrudaya,sutrasthan,chapter number 14,Dwividhopakramaniya adhyaya
has been mentioned.In which two folds of therapies has been mentioned as 1.santarpan
2.apatarpan.The synonyms mentioned for santarpan and apatarpan are Bruhmana amd
Langhana respectively,
It has been mentioned in asthanga-hrudaya that snehana and stambhana comes
under brumhana ie,santarpana and rukshan and swedan comes under langhana
ie,apatarpana respectively.Apatarpana contributes a major documentation as a part of
dwividhopakrama.
In charaka samhita,sutrasthana chapter number 22 Langhana-brumhaneeya
adhyaya six folds of therapies has been mentioned as langhana, brumhana,rukshana,
snehana,swedana and sthambhana,Among them langhana,rukshana and swedana comes
under Apatarpana.brumhana,snehana and sthambhana comes under Santarpana.So it is
clear that six folds of therapies comes under these two folds ie,Santarpana and
Apataarpana.
So in detailed study on apatarpana has been highlated as a basic fundamental
principle of dwividhopakrama along with three folds of therapies ie,langhana,rukshana
and swedana.
All the treatments comes under these two folds of therapies ie,Santarpana and
Apatarpana.as sthoulya itself is described as santarpanotha vyadhi so apatarpana therapy
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 89
Discussion ===============================================================
is essential for treating sthoulya.Acharya charaka described about sthoulya as
kastasadhya and asaadhya if it is beeja-swabhavaja.So as to treat sthoulya it is necessary
to assess basic fundamental principle ie,apatarpana and also its implementation in
sthoulya.
Acharya charaka has mentioned in treatment of sthoulya as consumption of food
and drinks so as to maintain equilibrium state of the aggrevated dosha ie,vata,kapha and
also meda dhatu.He has explained to give ruksha,ushna and teekshna basti.along with
acahrya charaka has explained to do the ruksha udvartana so as to treat the sthoulya.
So for treating the sthoulya which defined as kashtasadhya,ruksha udvarthan with
chanaka pishthi is taken.As rukshana is a part of apatarpan so ruksha udvartan in sthoulya
also comes under apatarpana therapy.In rukshana therapy,for redusing the bulk of the
obese,heavy and non saturated ie,apatarpana therapy is prescribed in sthoulya.Hence a
study on Apatarpan with special reference to udvartan in sthoulya is taken for study.
Sthoulya is most prevalent form of mal-nutrition in developing countries like
India.It has been estimated that 20-40% adults and 10-20% children are affected by
sthoulya.Sthoulya is root cause for many diseases like hypertension,diabetes
mellitus,cardio vascular disorders and respiratory disorders.Sthoulya is very nearer to the
clinical entity and is an importanat health problem of modern society.So a disease
sthoulya is taken for study to assess the effect of ruksha udvartana with chanaka pishthi
under the basic concept of apatarpana.
So The dissertation entitled as ‘A STUDY ON APATARPAN WITH SPECIAL
REFERENCE TO UDVARTAN IN STHOULYA’
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 90
Discussion ===============================================================
DISCUSSION ON CONCEPT OF APATARPANA
In charaka samhita,astanga hrudaya,astanga sangraha two folds of therapies have
explained as santarpana and apatarpana.Brumhana and Langhana are synonyms of
santarpana and apatarpana respectively.From which six folds of therapies has been
mentioned as langhana,brumhana,rukshana,snehana,swedana and stambhana,Among
them langhana,rukshana and swedana comes under apatarpana.brumhana,snehana and
stambhana comes under santarpana.So these two folds of therapies are basic fundamental
principle in nidana aspect and also treatment aspects.In charaka samhita sutrasthana
chapter number 22,Langhana brumhaneeya adhyaya,in astanga
hrudaya,sutrasthana,chapter number 14 dwividhopakramaneeya adhyaya and in astanga
sangraha,sutrasthana,chapter number 29 dwividhopakramaneeya adhyaya the two folds of
therapies ie santarpana and apatarpana has been mentioned.
In astanga hrudaya,dwividhopakramaneeya adhyaya langhana is taken as
synonym for apatarpana and rukshana and swedana are described under
langhana.Langhana is of two types as 1.shodhana and 2.shamana.Shodhana is that which
expels the doshas out of the body forcibly.It is of five kinds viz.vamana,kayareka,
shirovirek,niruha and asravisruti.
Shamana is that treatment which is palliative in nature which does not expel the
doshas and also does not increase the doshas but which makes abnormal doshas in normal
state.It is of seven kinds as pachana,deepana,kshutha,trusha,vyayam,atapa and
maruta.The dravyas which are of agni,vayu and akasha mahabhuta predominant does the
apatarpana karma.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 91
Discussion ===============================================================
Langhana karma is applied in four types of evacuation ie,vaman,virechan,nirooh
and nasya along with thirst,exposure to wind,exposure to sun,pachana,upavas and
vyayama.Charak samhita mentioned these ten folds of therapies.In charaka samhita
vimanasthana,janapadodhwamsaneeya adhyaya apatarpana has been classified in three
types as langhana,langhana pachana and doshavirechana.Amongest them langhana
therapy is recommended for those having doshas with little strength,langhana pachana in
case of doshas with medium strength and in case of abundant doshas expelling out of
doshas is prescribed ie,doshavasechana
Astanga sangraha explained apatarpana in dwividhopakramneeya adhyaya same
as in astanga hrudaya.In susruta samhita chikitsa sthana,chapter 1,dwivraneeyam
chikitsitam adhyaya,shasti upakrama is mentioned in which apatarpana is first
upakrama.As described in samhita it is clear that langhana is synonym for apatarpana.Till
though langhana itself contains a major documentation as a part of apatarpana.So
apatarpana contains three folds of therapies ie,langhana,rukshana and swedana.
LANGHANA
In astanga- sangraha,Dvividopkramaniya adhyaya,chapter number 24,Langhana
yogya has been mentioned.In astanga-hrudaya,sutrasthan,chapter number 14
Dvividopkramaniya adhyaya,Langhaneeya is mentioned.In Charaka
samhita,sutrasthana,chapter number 22 Langhana yogya persons are mentioned.Chikitsa
phala (benefits of langhana),ati langhana (excess of thinning therapy) has been described
in Astanga- hrudayaa,sutrasthana chapter number 14 ie, Dvividopkramaniya
adhyaya.From above references it is clear that langhana is one of the six folds of
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 92
Discussion ===============================================================
therapies.As per the references langhana is the part of Apatarpan and also plays important
role in nidan as well as in chikitsa aspect.
RUKSHANA
In charaka samhita,sutrasthana,chapter number 22 Langhana bramhaniya
adhyaya,rukshan and its properties has mentioned.Along with this samyaka yoga
lakshana and atiyoga lakshana has also mentioned.Rukshan is one of the upakram
amongst the six folds of therapies.Rukshan itself is a part of Apatarpan.So ruksha
udvartan with chanaka pishthi itself is a part of rukshana therapy.So udvartan with
chanak pishthi is taken as rukshan therapy in sthoulya under the concept of Apatarpan.
SWEDANA
In charaka samhita,sutrasthan,adhyay number 22 Langhana brumhaneeya
adhyay,swedana,its properties,swedana yogya,swedana ayogya and types of swedan are
mentioned clearly.So swedana is also part of six folds of therapies.It is also a type of
Apatarpan.
As per above references Langhana,Rukshana and swedana comes under
Apatarpan.As sthoulya itself is a Santarpanotha vyadhi,so ruksha udvartan with chanaka
pishthi is indicated in sthoulya which is a part of rukshana therapy which comes under
Apatarpan.
Sthaulya vis-à-vis medoroga:-
When we analyze the disease sthoulya reveals that in classics two words had
been used to describe sthoulya, when we observe these views we find some differences
that one supports sthaulya and medoroga are same, while other differs and suggest that
both are different.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 93
Discussion ===============================================================
Supporting views suggesting sthaulya as medoroga
1. Even though later acharayas in Laghutrayee have described about
medoroga, under that heading we still find that all literatures described in
Brihatrayas under sthaulya both are same especially with the nidana
panchaka.
2. Charaka used the term medasvi in context to sthoulya which indicates that
meda is mainly involved in the pathogenesis. Due to this reason might later
acharyas described it as a medoroga.
3. Chakrapani in his book chakradatta had followed the sequence of
madhavakara in “madhava nidana”, for description of chikista, for whom
madhava named it as medoroga. Hence by above description we may say
that medoroga and sthaulya are one and same.
Views supporting that sthaulya and medoroga are different.
1. None of the commentators have used the synonyms for sthaulya as medoroga
2. Sushruta and Vagbhata enlisted medoroga under vamana Arhvyadhi, while
sthaulya enlisted under vamana anarha vyadhi.
These views supports that medoroga and sthaulya are different.
According to charaka medoroga includes all the ashtanindita purushas as he
described them as medapradoshaja vyadhis.
Yet with the above information we can not conclude, and it’s a debatable
subject.
Nidana: Kapha, Meda & Vata are the main factors involved in the manifestation
of Sthoulya. Excessive brhumhana Karma of rasa is said to be the cause for Sthoulya.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 94
Discussion ===============================================================
The only cause responsible for obesity (excessive fat in body) is overeating. The
mechanism of human body is such that the food that is excess in quantity required for
generating energy gets converted into fat and then gets deposited in the body.
An average healthy person generally takes food just enough to meet the
requirements of his energy expenditure, and the weight remains stable. But when food
intake is more with less energy expenditure, this balance is lost, the weight no longer
remains stable and this imbalance between food intake and energy expenditure become a
cause for obesity.
Aharaja Nidana:- Excessive in take of madhura, guru, snigdha, picchila,
abhishyandi, sleshmala ahara leads to kapha vruddhi which in turn leads to meda vruddhi
which is the main dhatu involved in the manifestation of sthoulya.
In the present study it was observed that most of patients were having of habit of
consuming excess of sweets, bakery items routinely which vitiates kapha. They also take
in excess of fried items, chats, cold soft drinks, ice creams which are kapha prakopaka
nidanas.
Viharaja Nidana:- The viharaja nidanas which are responsible for vitiation of
kapha, vata and meda can be considered as the nidanas for sthoulya. During the nidanas
observed in the study patients have the nidana of diwaswapna and avyayama. Most of the
patients were having a history of sedentary life styles. These nidanas may be responsible
for sthaulya.
Diwaswapna makes the kapha prakopa which in turn vitiates meda and obstructs
the srotas. It has been noticed that when a fat person is sleeping or relaxing his metabolic
rate is reduced to almost nil.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 95
Discussion ===============================================================
Avyayama not exerting physically and spending more time infront of television is
one among the cause for obesity.
Manasika Nidana:- The etiological factors effect the mind. Tamoguna gets
increased due to lack of activity which results into obesity.
Kulaja nidana:-It is an undeniable fact that generally the parents or the children
of fat person are also fat.
A researcher Dr.Gurney after studying 75 fat woman noticed that either both or
one of the parents of 82 % women were obese. With the help of yet another study, he has
shown that;
i) If both parents are fat 73% of their children are also obese.
ii) If one of the parents is fat 45 % of their children are fat.
iii) If both the parents are of normal weight only 9% children appear to be fat.
All this happens because the fact that every individual inherits his physical
constitution. There after obesity develops depending upon factors like eating habits, way
of life & environment.
Evidently during the present study it is observed that ten patients (33.33%) were
having the kula vruttanta of sthoulya.
Other Causes of obesity:-Endocrinal factors rarely involved in gaining the
weight, which includes hypothyroidism, Cushing’s syndrome, Antidepressants and
steroids also cause gain in weight.
Poorva roopa of sthaulya: - Poorva roopa are set of signs and symptoms that
appear before the manifestation of the disease. Such signs and symptoms are not
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 96
Discussion ===============================================================
explained for all the vyadhis. For such vyadhis some of the lakshanas which are exhibited
in mild form before its manifestation can be considered as poorva roopa of sthaulya.
In context to sthoulya it may be said mild deposition of meda in vaksha, udara and
sphik can be considered as poorva roopa of sthoulya.
BMI above normal, i.e.24.5-29.9(over weight) can be considered as prodromal
sign of obesity.
Roopa: - Roopa are the lakshanas manifested, which develop during the course of
vyadhi. On the basis of different acharyas opinion regarding the sthoulya lakshanas it can
be arranged in to two groups;
a) Samnaya lakshanas & b) Vishesha lakshanas
a) Samanaya lakshana include Javoparodha, kruchra vyavaya, durbalata,
dourgandhyata, swedabadha, Atikshuda, Atitrishna and Ayuhrasa etc.
b) Vishesha lakshanas- the visehsa lakshana by which the vyadhi is diagnosed are
the pratyatma lakshans of that vyadhi.
Vishesha lakshana of sthoulya includes sthana lambana, udara lambana and sphik
lambana, Ayathopachaya i.e. malnourishment of all the dhatus and utshanasha.
In the present study these classical signs were present in all the patients.
In the conventional sciences also diagnoses will be apparent from the appearance
and only the level of obesity is assessed by measurements of Body mass index (B.M.I),
skin fold thickness (S.F.T), and waist circumference and waist hip ratio (W.H.R).
Astha dosha of sthaulya:-The 8 symptoms otherwise called Astha dosha of sthaulya are
1) Ayusha hrasa 2) Javoparodha 3) Kruchravyavayata 4) Daurbalya
5) Daurgandya 6) Swedabadha 7) Atikshuda 8) Atitrishna
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 97
Discussion ===============================================================
Ayusha hrasa
Due to excessive vruddhi of meda dhatu, person become sthoola, malnutrition of
Rasadi dhatus leads to Ayusha hrasa.
Though obesity not directly responsible for causing death certainly causes such
many complications which in turn cause premature death.
In a research, group of persons ranging from 40-70 in age. Among those who
were over weight by 30% the rate of mortality was higher by 42% in case of men and
36% in women.
Javoparodha:-
In sthoola person shithilata and sukumarata is observed as meda being guru in
nature. This makes the person lazy.
Kruchravyavayata:-
Due to avarodha of srotases and malnourishment of Rasadiparyanta shukra dhatus
are malnourished; alpa sukra is formed and causes kruchravyavayata.
Daurbalya:-
Even though akruti of the patient is sthoola due to improper nourishment of
Rasadi dhatus leads to Durbalata. In the present study maximum patients have
complained the symptom daurbalata.
Daurgandya, Swedabadha:-
Excessive of vikruta meda is formed and excess of kitta bhaga i.e. mala of meda,
sweda is formed.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 98
Discussion ===============================================================
Due to layers of fat deposited on the body acts as sweaters and cause profuse
perspiration which emits a foul odour and this foul smelling sweat causes great
embarrassment to a person.
Atikshuda and Atitrishna:-
Due to margavarodha of vata by meda in kostha, sandhukshana of vata takes place
which causes excessive of kshudha. Excessive trishna is observed due to excessive
sweating in sthoola persons.
Along with this other lakshanas like atinidra, jadhyata, moha, kshudra shwasa, etc
lakshanas were seen in patients.
SAMPRAPTI GHATAKAS :-
Dosha : Kapha, vata, pitta
Dooshya : Meda, Mamsa
Srotas : Medovaha, Mamasavaha, Rasavaha.
Srotodusti prakara : Sanga
Agni : Jataragni - Teekshna
Ama : Medodhatwagnimadyata janya ama
Vyaktha sthana : Sphik, Sthana, Udara
Adhisthana : Sharira
Udbhava sthana : Amashaya
Rogmarga : Bahya
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 99
Discussion ===============================================================
Samprapti:-
Due to nidana sevana, ama sadrusha ahara rasa uttpatti takes place which affects
the medovaha srotas and impairs the medodhatwagni. By that dhatwagni mandya
formation of vikruta medadhatu will occur. This increased medadhatu due to sanga by
anulomagati affects asthi majja and shukra and by pratiloma gati mamsa rakta and rasa,
by which prakruta sthayi dhatu parinama impairs and all the dhatus become
malnourished.
The vruddha medadhatu make vata prakopa by margavarodha. Vayu then enters
the kostha and flares the jatharagni by which symptoms adhikshuda and atitrishna are
seen, hence person takes excess of food which directly increases meda (gets deposited in
sthana, udara and sphik pradesha), in analog with the madhuratara ahara rasa which is
having properties picchila, sleshmala, abhishyandi again increases meda.
Due to continuity in nidana sevana makes srotorodha leads again jatharagni,
teekshna and results in excessive intake, cycle continues and results in sthoulya.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 100
Discussion ===============================================================
FLOW CHART OF STHAULYA:- Nidana sevan
Avyayam Madhura ahara sevana
Apachit Medo Dhatu vriddhi Medo dhatwagni mandya
Margavarodh of vata by Meda
Vayu vimarga gamana
Vata vridhi in kosth
Jatharagni sandhukshan
Kshudha vriddhi
Digestion and absorption increases Due to Srotorodha only Meda dhatu increases
Excessive intake of Ahara
Excess of Meda sanchaya in Sphik,Sthana and Udara
Sthoulya
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 101
Discussion ===============================================================
Types of sthoulya:-
Even though types of sthoola have not been mentioned directly, but description
regarding heena sthoola, madhyama sthoola and ati sthoola which is mentioned by
vagbhata during the apatarpana chikitsa, can be taken as types of sthoola.
Further these heena sthoola, madhyama sthoola and atisthoola can be taken as
mild obese, moderate obese and severely obese respectively.
In the present study, it was observed that patients of different grades of BMI were
registered for study.
Upashaya:-
There is no such direct explanation regarding the upashaya for sthoulya.
Oushadha, ahara and vihara which cares the vyadhi are upashaya for that particular
vyadhi. Hence all the therapies, ahara and vihar, that relieves symptoms of sthoulya can
be considered as upashaya.
Anupashaya:-
The ahara, vihar, oushadha that aggravates the symptoms of sthoulya are
anupashaya. Hence it can be said that the ahara which are kaphavardhaka and
medovardhaka and viharas like sleeping during day time, less physical activities are
anupashaya for sthoulya.
Sadhyaasadhyata:-
The Sadhyaasadhyata of the disease depends on dosha and dushyas. The disease
should not be of tulya dosha dooshya and prakruti if so then that vyadhi is said to be
kashta sadhya.
Sthaulya is a kaphananatmaja vyadhi and meda, mamsa are the dushyas involved.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 102
Discussion ===============================================================
Sthoola had been considered as one among the asthanindita purusha by charaka.
Since the chikitsa is shareraapekshi before mentioning of chikista acharya charaka
described about sthoulya in sutrasthana itself, as kastasadhya and asadhya if it is beeja
swabhavaja.
“Satatam vyadhivetaiva Atisthoola, krushou Narah”.
i.e., Atisthoola and krusha persons are always afflicted by diseases, so sthoulya
can said to be kashta sadya for chikista.
Since obesity is associated with more than 30 medical conditions, hence the
prognosis of obesity is said to be poor.
It is a manageable disease, with strict diet plan, physical exercises, weight can be
maintained.
Upadravas:- The sthoola person if again goes on indulging in mithya ahara and vihara
and not adopted any appropriate chikitsa, then other symptoms like prameha, shwasa,
urusthamba, vatavikara udararoga etc. upadravas may be manifested.
As the nindanas of prameha and sthoola influence on the medovaha srotas in
sthoola, the prameha upadrava occurs. As many as 90% of individuals with type - 2
diabetes are reported to be over weight and obese.
Weight bearing joints like the ankles, hips and the spinal cord are also strained
constantly on account of heavy weight they have to carry. Consequently obese persons
are susceptible to degenerative diseases like osteoarthritis at a young age.
In the present study some patients have got the knee joint pain due to heavy
weight bearing.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 103
Discussion ===============================================================
The act of breathing involves the movement of several parts of chest and stomach.
Mainly muscles of the chest and diaphragm. When the fat person breathes he has to lift
his heavy chest every time, besides this, person also finds it difficult to push the
diaphragm towards the fat belly and stomach. Because of this, a fat person gets tired and
breathlessness easily.
Pathya: - The ahara, viharas which are kapha and vata prakopaka and medodhatu
pradushaka are to be avoided.
Considering these factors following pathya can be advocated.
For example: kulatha, yava, vartaka, amalaki churna, shunti, patola, purana shali,
lashuna, mudga yusha, vegetable soups are pathya.
Kulattha is ushna, amlavipaka used in kaphavatajanya roga.
Yava is having ushna and rukshaguna.
Patola is having katu rasa, teekshna ushna guna, madhura and is
kaphavatanashaka.
Purana shali is madhura, laghwapaki and is tridosha shamaka.
Vartaka is katu, tikta rasa, ushna veerya, madhura, vatakaphanashaka and
ksharayukta.
Viharas like vyayama, physical activity, walking, manasika parisharma, prajagara
are pathya.
Vyayama is very important component in the management of obesity. Proper
vyayama is that which brings slight sweating at fore head. Regular exercises with the
above parameter will make the body light, ease in physicial activities improvement of
digestion and reduces the fat.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 104
Discussion ===============================================================
Prajagara – obese people should be encouraged to keep awake for longer hours at
night. This directly helps in reduction of body weight as it causes rukshata.
Mental worries and stress also can lead to weight reduction.
Walking also helps to reduce the excess of calories inturn fat.
Apathya:-The food stuffs which are atimadhura snigdha, picchila abhishyandi
gunas are to be avoided Ghrita, mamsa rasa, taila, heavy food excessive sweet foods like
chats, puddings, bakery items like cakes, chocolates, ice creams, excess intake of tea,
coffee soft drinks are apathya.
Viharas like sleep during day, avyayama are apathya
As it is noticed that when obese persons are sleeping or relaxing their basal
metabolic rate is reduced to almost nil.
DISCUSSION OF CHIKITSA:-
“Karshgameva varam sthoulyat nahi sthoolasya Bheshajam”
Karsha is better for treatment when compared to sthaulya and sthoola is difficult
to treat. Mainly vata, meda and kapha are vitiated in sthoola if vata dosha is treated by
santarpana (brimhana) chikista then meda and kapha will get increase and if meda and
kapha are treated by Apatarapana(langhana) chikista then vata will increase and can
further cause other complications. Hence it is difficult to treat sthoola.
The treatment principle of obesity is to rectify medas, agni and sleshma that
means to give medicines which can disintegrate meda and also to influence the
metabolism of meda formation. The main aim is to improve the agni with the use of
appropriate herbs, combined with correct life styles.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 105
Discussion ===============================================================
Nidana parivarjana:- Not indulging in nidanas which are sthoulyakara like
heavy meals excessive of fatty, oily food and excessive sweets and bakery items should
be withdrawn gradually. The energy generation and energy expenditure is properly
maintained and consequently weight remains steady. One of the most important remedial
measures in reducing the weight is dieting.
Shodhana chikitsa: - Therapies included under this heading aim at the radical
removal of causative morbid factors of sharirika doshas. For sthoulya as
antahparimarjana chikitsa, lekhana basti which consists of triphala quatha, gomutra,
madhu and ushakadi gana which makes the lekhana of meda and kapha and udvartana
and lepa as bahya parimarjana.
Udvartana: - Udvartana with ruksha drugs like chanak pisthi mitigates kapha
liquifies the meda makes the body parts firm and is best for the health of skin. Also for
daurgandya and swedadhikya drugs containing aromatic odours like chandana, tejapatra
are used as lepa.
The ahara which is guru, and is apatarpaka like yava should be given for
sthoola. The bulk of the food must be increased so that the time duration of digestion is
increased. The food more in quantity and less in calories can be given like Cucumber,
potato, raw tomatoes
Shamana chiktsa: - The Dravya which pacifies the aggravated doshas with out
expulsion from body as well as which does not provoke the equilibrated doshas is known
as shamana (dravya) chikitsa.
In context to sthaulya many such formulations have been described. They mainly
concentrate on kapha, vata, meda and agni.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 106
Discussion ===============================================================
Sthaulya vis-à-vis obesity
There are many reasons available for comparing sthoulya with obesity the
predominant being the similarities in etiology and symtomatology, by this reason only
charaka samhita’s Hindi commentators in“vidyotini”Kashinath Panday and G.Chaturvedi
continued correlation of sthoulya with obesity and can be correlated as in table.
TABLE NO 48:
Particulars Sthoulya Obesity
Causes 1. Guru madhura, Sleshmala
ahara sevana
2. Avyayama
3. Bejaswabharaja
4. Rasaja Vyadhi
5. Ati Bhojana sevana
1. Excessive calorie intakes
than expenditure
2. Lack of physical activities,
sedentary lifestyles.
3. Genetic
4. Nutritional disorder
5. Overeating
Symptoms 1. Chala shana, chala udara and
chala sphik, kshudrashwasa
swedadikhya, ati kshuda and
atitrishna
1. Pendulous chest, abdomen
and hip. Dyspnoea, excessive
perspiration, excessive
hunger & thirst
Types 1.Heena sthaulya
2.madhyama sthaulya
3.Ati sthoola
1.Overweight
2. Obese
3. Morbid obese
Assessment Easily identified chala sphik, Easily identified at first sight
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 107
Discussion ===============================================================
stana and udara by darshana along with this BMI, SFT are
helpful.
Complications Prameha, vataroga, ayuhrasa Diabetes, osteoarthritis,
premature death
Treatment Gura cha apatarpana,
Vyayama
Bulk is increased with low
calories and physical activity
DISCUSSION ON UDVARTANA:-
UDVARTANA:-
Udvartana is extensively sited with the following attributions:-
--> According to Shabda kalpadruma it is vatahara, medavilayana, and kaphahara. As
per Acharya Vagbhata it is kaphahara medavilayana, angasthirikara, twakvarna
prasadakar.But Charakaacharya mentions certain special qualities other than the ones
above in his sutrasthana fifth chapter; viz, bhibhatsahara, dourghandyahara, kanduhara,
gauravahara, tandrahara, swedamalahara and in short it is said to do shariraparimarjana.
--> Even though in dinacharya adhyaya acharyaas have indicated abhynga prior to
udvartana it must be noted that it holds good more for swastha but in the present concept
of sthoulyas which is morbid state of meda along with rasagata ama srotorodha strongly
suggest contraindication of abhyanga as poorvakarma.Hence the above reference can not
be applied in case of sthoulya and udvartana in sthoulya does not have any poorvakarma
--> All acharyas have given prime importance to rooksha udvartana may be for
madhyama sthoulya as the local bahir parimarjana chikitsa for medopachaya.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 108
Discussion ===============================================================
--> Considering the properties of udvartana dravya Indu (commentator of
Astangasangraha) has specifically underlined kashaya rasapradhana dravya but in
Astangahridaya we find kashayadi dravya being advocated that are tiktakara which
Arunadatta clarifies as katu tikta kashayarasa pradhana dravya.
--> Ruksha udvartana dravya alwayas have the agneya vayavya qualities which are
best to subside parthiva and aappya panchamahabhuta of meda and kapha.
-->Udvartana being a bahyaupakrama, is very analogous to abhyanga and should have
same timings .In (cha chi24/30) we find the clear specification of 700 maatrakala
(i.e. 3 min 48sec) for drug potency to reach the medodhatu. Which is approximately 4-5
minutes hence forth udvartana is done in seven different postures of 5 minutes duration
each, adding upto a total of 35 minutes. However, depending on severity of the disease
and severity of the patient adjustment in time is to be done.
-->Mode of action: - By the udvartana, the bhrajaka pitta seated in twacha absorbs
virya of chanak pishthi. Hence by rule paka vilinata of dosha that is kapha and meda
occurs.In udvartana chanak pishthi when applied externally being ruksha gunatmaka
absorbs prithakatwa mala through sweat pores as inferred by the varti formation of
sukshma chanak pishthi This validates the process of udvartana as an effective measure
to remove accumulated (medopachaya) at undesirable areas.(such as sphik udara etc)
locally.The above considerations lead us to the fact that chanak pishthi udvatana is the
best bahir parimarjana chikitsa for madhyama sthoulya. Besides which it has been
attributed to bhibhatsahara and dourghandyahara according to Charaka, which are the
commonest stigmas of sthoulya person.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 109
Discussion ===============================================================
ABOUT DRUG:-
Udvartana procedure is mentioned with ruksha dravya ie ‘rukshanu udvartanani cha’in
charaka samhita,in treatment of sthoulya.
So chanaka pisti have been preffered for udvartana as it is laghu and ruksha in gunas.The
rasa properties of chanak is kashaya rasayukta which is antagonistic to the properties of
kapha.The physical qualities of chanak,laghu and ruksha are contrary to meda dhathu.In
charaka samhita chanak is mentioned as laghu,sheeta,madhura,kashaya and does the
rukshan by its prabhava.The properties of chanak is mentioned as vatakarak,pitta and
kapha nasaka,kapha pitta nashaka which is quiet conflicting to that of sthoulya.
The chanak pishti has been selected because of following factors.
1) To increase the fortified effect of sukshmata and to achieve laghuta.
2) Due to the principle of pharmacology “Smaller the particles greater the
penetration, and faster the action”
3) For synergizing and maximizing the pharmaco-therapeutic effect.
DISCUSSION ON ACTION OF UDVARTANA:-
As it is mentioned that ambu is present in Meda dhatu, to flush the excess of ambu
dhatu, which is present either in intercellular or intracellular places. This removes the
excess of water, which represents excess weight in the body. There are five basic
principles to bring dosha from shakha to kosta:
Vrudha – increasing the dosha
Vishyanda –liquification
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 110
Discussion ===============================================================
Pakat – due to the paka of dosha
Srotomukha vishodanat – due to Shodhana of sroto mukha
Vayu nigraha – due to control over Vata
Udvartana is having the gunas of Kapha:- Meda vilayana property. Due to ushna
and teekshna guna of dravya and forceful massage effect on romakupa, the Veerya of
drug enters into body through, there after it opens the mukha of siras, there by making
paka of Kapha and Medas. Due to this, there will be dravatha Vrudhi of Kapha and
Medas. Swedana, which is given after Udvarthana will further makes paka of the same. It
also makes sweda pravrathana and due to Sweda karma, which is given after Udvarthana,
acts as Sthambhana, Gouragna and Sheetagna. When the Doshas enters koshta, via above
methods, they should be flushed out of the body. By this the evacuation of these vikrutha
Dosha and Dushya occurs. By all of these nirharana of Vikruth Vata, Kapha, and aap
dhatu along with Medas will takes place ultimately resulting in Laghavata of Shareera.
Mode of action of Udvarthana on lipids:-
As it is seen that Udvarthana is having good efficacy over lipid levels. The probable
mode of action can be explained as follows:
Due to increased friction to all the parts of the body, the Triglycerides present in
the subcutaneous tissues will break down into fatty acids. These fatty acids are carried
out to the liver due to the effect of centripetal massage, which increase circulation to
internal organs for the conversation of these fatty acids into bile. As less caloric food is
supplied along with heavy exercises, the body needs more of energy to meet the same. In
the absence of carbohydrate, fats are utilized for the purpose of energy production. The
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 111
Discussion ===============================================================
bile that is formed in liver will be expelled out in excess. Hence the reabsorption of the
bile will be decreased, inturn further utilizing the lipid which is circulating in the blood.
Promotion of excretion of bile in the faeces is used as one of the treatment principle to
treat Hyperlipidemia eg. Colestipol.
Here is the explanation for the various benefits of Udvarthana:-
Twak prasadakara: This beneficial effect of Udvarthana is used to increase beauty.
Improvement in the complexion is the best criteria to assess the cosmetic property. The
colour of skin depends on level of melanocytes, blood circulating beneath the skin and
carotinoids. Colour given to skin by blood is mainly depends upon the quantity of
haemoglobin. By performing Udvarthana, the amount of blood circulation beneath the
skin increases due to friction. Due to this change the cells of the skin are supplied with
more oxygen, there by changing the colour at least to some extent.
Anga sthirikarana (stability of the body): There will be increase in the fat cells either
in number or in size or both in obese person. By performing Udvarthana these fat cells
get lipolysed then the cells get shrunken causing compactness. Thus one can appreciate
the above benefit.
Gourava hara (depletion of heaviness): Gourava is feature due to increase in Kapha
and Medas. Udvarthana enhances transport of Cholestrol from the periphery to the liver.
This cholesterol is utilized for formation of bile (bile salts). Hence due to decrease of fat
one feels lightness.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 112
Discussion ===============================================================
Dourgandhya hara (removal of body odour): Dourgandhya is the resultant of Sweda,
which is mala of Medas. Due to Udvarthana there will be decrease in Mala of Medas,
hence formation of excess sweat is reduced, resulting in above benefit.
Tandra hara (removal of drowsiness): Tandra is due to tamo guna, which is increased
by vikrutha Kapha. Udvarthana will reduce Kapha, hence relieves Tandra. Some patients
got this benefit by above procedure.
Kandu hara (removal of itching): One of the reasons for Kandu is obstruction in the
Swedavaha srotas. As Udvarthana clears the orifices of Sweda vaha srotas by its Sira
mukha vishodhana guna, it reduces itching.
Mala hara (removal of excretory products): In general, mala includes Pureesha,
Mootra and Sweda. Here the term mala indicates only Sweda. Sweda is the mala, which
is excreted through orifices of the skin by Udvarthana.
Vata hara: In sthoulya, Medas and Kapha obstruct Vata. Udvarthana reduces Kapha and
Medas and there by normalizing the movement of Vata.
Shukrada: Due to mandata of Medodhatwagni, the uttarotara poshana of dhatu gets
hampered. Udvarthana corrects Medodhatwagni and hence formation of consecutive
dhatu takes place, there by increasing the level of last dhatu- Shukra. It is mentioned
in the modern literature “fat binds the testosterone”. i.e. high levels of lipids in blood will
decrease Testosterone. Udvarthana reduces the cholesterol there by hindering the
testosterone, binding thus making more availability of testosterone.
Twak mriduta (softness of skin): By performing the Udvarthana, expulsion of debris of
dermis and epidermis take place due to friction. It also increases blood circulation to
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 113
Discussion ===============================================================
layers of skin, there by supplying maximum oxygen to the dermal cells. Hence softness
of the skin is observed. Moreover massaging effect on sebaceous glands stimulates
sebum production and there by brings softness and texture to the skin.
DISCUSSION ON MATERIALS AND METHOD:-
Materials:-
• Chanak pisthi
• Weighing machine
• Measuring tape
Discussion of materials
ABOUT DRUG:-
Astangasangraha (Indu tika) suggests kashaya rasatmaka dravya to be used for
udvartana.
Astanga hridaya (Hemadri) specifies kashyaadi dravyas which can be interpreted
as Kashayatmaka dravyas to be used for udvartana. Acharya Charaka has given ten gunas
which are found as possibilities which induce rookshana in the body.But Aacharya
Vagbhata considered it under the heading of langhana which is again a paryaya of
apatarpana.
Criteria For Selection Of Chanak Pisthi:-
Udvartana procedure is mentioned with ruksha dravya ie ‘rukshanu udvartanani
cha’in charaka samhita,in treatment of sthoulya.
So chanaka pisti have been preffered for udvartana as it is laghu and ruksha in gunas.The
rasa properties of chanak is kashaya rasayukta which is antagonistic to the properties of
kapha.The physical qualities of chanak,laghu and ruksha are contrary to meda dhathu.The
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 114
Discussion ===============================================================
chanak pisthi is kashaya rasayukta,laghu and ruksha in guna,veerya is sheet,vipaka is
katu and its karma is vatakarak,pitta,raktavikara nashaka,kapha and jwara nashak which
is quiet conflicting to that of sthoulya.And availability of drug is easy and economical.
The chanak pishti has been selected because of following factors.
4) To increase the fortified effect of sukshmata and to achieve laghuta.
5) Due to the principle of pharmacology “Smaller the particles greater the
penetration, and faster the action”
6) For synergizing and maximizing the pharmaco-therapeutic effect.
WEIGHING MACHINE
Dial type weighing machine with a reading 0-150 kgs was used and its horizontal
alignment was observe on a flat surface before reading each observation. The needle of
the dial was set at ‘0’ mark before taking the values and three readings are taken.
MEASURING TAPE
While using the tape maximum attention is given to the respiration, and
exhalation measure was recorded.
PROCEDURE OF UDVARTANA:-
Poorvakarma:-
The person has to pass his natural urges, have chittashuddhi and get undressed.
Patient has to be assessed for jeerna ahara lakshana.
Pradhana Karma:-
On the either side of supported patient two paricharakas, taking the sookshma
udvartana choorna on their palms should gently rub the angas (in pratilomagati) for the
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 115
Discussion ===============================================================
stipulated time or until the samyak langhita lakshanas are observed. Then the patient is
tilted to the following positions in the same order and the procedure is repeated.
1 Sitting with stretched legs.
2 Left lateral
3 Right lateral
4 Back again to sitting position.
5 Prone
6 Supine
7 Prone again.
Paschat Karma:-
The acharyas have advocated the ushnodaka sinchana as the paschat karma. Hence
forth hot water bath or any of the dravya kashaya can also be used. The patient is thus
given a whole body wash either warm water or some medicated decoction. He is then
allowed to take light easily digestible food and asked to take complete bed rest for the
rest of the day.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 116
Discussion ===============================================================
METHODS:-
Aim: - ‘A STUDY ON APATARPAN WITH SPECIAL REFERENCE TO
UDVARTAN IN STHOULYA’.
The present study was taken to understand the concept of apatarpan and to see the effect
of chanak pisthi udvartan as a bahiparimarjan chikitsa in sthoulya.
Study design:-
The sample size is 30 patients of sthoulya.
Selection of patients:-
Selection of patients for the present study was done randomly. First thirty patients
fulfilling the diagnostic criteria and inclusion criteria were selected for the study; patients
were selected irrespective of sex caste, occupation and social economic status.
Inclusion criteria:-
1.Sthoulya diagnosed according to signs and symptoms as in classical texts.
2.Sthoulya of both the sex
3.Between the age group of 20-50 yrs
4.The patients with BMI in between 30-40.
Exclusion criteria:-
• Patients below 20 and above 50yrs of age.
• Pregnant women
• Patient associated with systemic disorders
Diagnostic criteria:-
a) In the present study the diagnosis was done based on the patients presenting with
classical signs like chala sthana chala udara and chala sphik and symptoms like
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 117
Discussion ===============================================================
Atikshuda, Atiktrishna, kashtashwas, swedaadhikata, durbalata, dourgandya etc. were
selected.
b) Patients with BMI above 30 were selected
BMI – Advantages
• BMI provides a more accurate measure of total body fat and practical indicator of
a severity of obesity
• BMI provides an acceptable approximation of assessment of total body fat for the
majority of patients
• BMI is recommended as a practical approach for the clinical setting.
• Easily calculated directly based on height and weight regardless of gender.
Disadvantages
BMI overestimates body fat in person who are very muscular and can
underestimate body fat in persons who have lost muscle mass. Also overestimates the
diseases like Cushing’s syndrome, ascites etc.
General BMI is used to assess obesity and to determine efficacy of therapy.
The BMI which describes relative weight for height is significantly correlated be
used to assess obesity and to monitor changes in body weight. In addition to these
measurements of body weight alone can be used to determine efficacy of weight loss
therapy.
BMI is calculated as = Weight in Kg Ht in mt2
Normal range is 18.5 -24.9 and if it exceeds form 25 to 29.9 then the person is
said to be overweight. If the BMI is 30 and above, then that condition is said to be obesity
and if it is above or equal to 40, then those are included under extremely obese.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 118
Discussion ===============================================================
Vaksha, Udara and Sphik Measurement:-
In addition to these above parameters measurements of vaksha, udara and sphik has been
taken for study.
Adhika kshutha,adhika trushna,kshudra shwas,swedadhikata :-
Signs and symptoms give an idea about the severity of disease.Grading are done
as,Grade 1,Grade 2,Grade3 and Grade4.Gradings for all the variables and mode of
grading are presented along with clinical proforma especially formatted for the present
study.
Data Collection:-
Data from 30 patients was collected as before treatment,after treatment and post
treatment follow up to analyse the effect of chanak pisthi udvartan in sthoulya.
Statistical analysis:-
The data collected were statistically analysed under the guidance of
statistician.The data was computed for mean,standard deviation,t values and p values.P
value was obtained using students t test.Significance of the results was based on the p
value.The results are obtained as significance of the treatment by using p values.
Interventions:-
• Sample size ; 30 pts
• Sample type ; sthoulya
• Procedure ; udvrtana with chanak pisthi for 30mins
• Duration ; 30 days
• Follow up ; 30th day
• Post treatment follow up ; after 15th day
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 119
Discussion ===============================================================
DISCUSSION ON OBSERVATIONS:-
Following observations were made before clinical study
AGE ;
In the present study it was observed that 13 patients (43.33%) were of 18-30 yrs,and
17 patients (56.66%) were of 31-40 yrs of age.
So the age group 31-40 yrs contains more patients than the age group 18 -30 yrs of
sthoulya.
SEX ;
In the present study it was observed that 24 patients (80%) were male and 6
patients (20%) were females.
In the present study males are more in numer than females.
RELEGION ;
Majority of patients observed were Hindu 25 patients(83.33%) and Muslim were
5 patients (16.66%).
In the present study because of more population in Hindu community,so Hindu
patients are more.
SOCIO-ECONOMIC STATUS ;
In the present study maximum patients observed were of middle class i.e. 24
patients (80%),were patients observed of upper class is,6 patients (20%).
In the present study the patients observed from middle class are more than upper
class.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 120
Discussion ===============================================================
MARITAL STATUS ;
Maximum patients observed for the study were married 22 patients (73.33%) and
unmarried are only 8 patients (26.66%).
In the present study married patients are more than unmarried.
HABITAT ;
Majority of patients observed were from urban 26 (86.66%) and 4 patients
(13.33%) belong to rural area.
In the present study majority of patients are from urban area than of rural area.
OCCUPATION ;
The patients from various occupations were observed for the study. Among them
8 patients (26.66%) were students,6 patients (20%)were farmer,9 patients (30%)were
business men,5 patients (16.66%) were house wife and , 2 patients (6.66%) were teacher.
In the present study the more patients are business men than
students,teschers,farmers and housewives.
DIET ;
Among the patients observed for study vegetarians were 6 patients (20%) and
those who took mixed diet were 24 patients (80%).
In the present study majority of patients consumes mixed diet than vegetarians.
PRAKRUTI ;
In the present study it was observed that of kaphavata prakruti there were 8 patients
(26.66%),kapha pitta prakruti11 patients (36.66%), and of pittakapha prakruti 11 patients
(36.66%).
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 121
Discussion ===============================================================
In the present study as per prakruti pareekshan,pitta kapha prakruti patients are more than
kapha vata prakruti.
AGNI ;
In the present study it was observed that most of the patients were having
Teekshnagni i.e. 20 patients (66.66%) and only 10 patients (33.33%) were having
vishamagni
Majority of patients were having teekshnagni than vishamaagni.
KULA VRUTTANT ;
In the present study 8 patients (26.66%) patients had kula vruttanta of sthaulya
and 22 patients (73.33%) had no kula vruttanta of sthaulya.
Vaksha Circumference ;
Vaksha circumference – patients observed for study were assessed grade 1 to
grade 4. Majority of patients were of grade 2 i.e., 18 patients (60%), grade 3 were 10
patients (33.33%) and grade 4 were of 2 patients (6.66%).
Udara Circumference ;
Udara circumference – patients observed for study were assessed grade 1 to grade
4. Majority of patients were of grade 3, 16 patients (53.33%), grade 2 were 5 patients
(16.66%) andgrade 4 were 9 patients (30%).
Sphik Circumference ;
Sphik circumference – Majority of patients were of grade 3 i.e. 17 patients (56.66%),
grade 2 were 6 patients (20%)and grade 4 were 7 patients (23.33%).
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 122
Discussion ===============================================================
Adhika kshudha ;
Majority of patients were of grade 3 ie,18 patients (60%) and of grade 4 were 12
patients (40%).
Adhika trishna ;
Majority of patients were of grade 3 ie,22 patients (73.33%), grade 2 were 2 patients
(6.66%) and grade 4 were 6 patients (20%).
Kshudra shwas ;
In present study it was observed that from grade 1 to grade4,14 patients (46.66%) were of
grade 1,12 patients (40%) were of grade 2,4 patients (13.33%) were of grade 3.
Swedadikhata ;
In present study it was observed that from grade 1 to grade4,2 patients (6.66%) were of
grade 2,14 patients (46.66%) were of grade 3,14 patients (46.66%) were of grade 4.
Laboratory investigations-
As the study was conducted only on the basis of subjective and objective parameters
hence no investigations were carried out.
DISCUSSION ON RESULTS:-
BMI –The BMI of patients was assessed as before treatment,after treatment and post
treatment follow up by comparing the results.
The BMI after treatment shows 96.66% ie,29 patients with clinically stable and only one
patient 3.33% shows CI-1 ie,encouraging.
The t value for BMI after treatment is 1.000 and p value is 0.326.So the results for BMI
after treatment is non-significant.
The BMI after follow up shows 100% ie,total 30 patients with clinically stable.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 123
Discussion ===============================================================
The t value for BMI after follow up is 0 and p value is 1.000 which is non
significant,so only udvartana procedure with chanak pisthi can not prove beneficial in
case of BMI.
VAKSHA CIRCUMFERANCE ;
The VAKSHA CIRCUMFERANCE of patients was assessed as before treatment,after
treatment and post treatment follow up by comparing the results.
The VAKSHA CIRCUMFERANCE after treatment shows 93.33% ie,28
patients with clinically stable and only two patients ie, 6.66% shows CI-1 ie,encouraging.
The t value for VAKSHA CIRCUMFERANCE I after treatment is 1.439 and p value is
0.161 which is significant.
The VAKSHA CIRCUMFERANCE after follow up shows 100% ie,total 30
patients with clinically stable.
The t value for VAKSHA CIRCUMFERANCE after follow up is 0 and p value
is 1.000 which is non significant,so udvartana with chanak pisthi proves significant after
treatment and proves non-significant after follow up.
UDARA CIRCUMFERANCE ;
The UDARA CIRCUMFERANCE of patients was assessed as before
treatment,after treatment and post treatment follow up by comparing the results.
The UDARA CIRCUMFERANCE after treatment shows 86.66% ie,26 patients
with clinically stable and only 4 patients ie, 13.33% shows CI-1 ie,encouraging.
The t value for UDARA CIRCUMFERANCE after treatment is 2.112 and p value is
0.043 which is significant.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 124
Discussion ===============================================================
The UDARA CIRCUMFERANCE after follow up shows 96.66% ie,29% with
clinically stable and 3.33% ie one patient in CI-1 ie,encouraging..
The t value for UDARA CIRCUMFERANCE after follow up is 1.000 and p value is
0.326 which is non significant,so udvartana with chanak pisthi proves significant after
treatment and proves non-significant after follow up.
SPHIK CIRCUMFERANCE ;
The SPHIK CIRCUMFERANCE of patients was assessed as before treatment,after
treatment and post treatment follow up by comparing the results.
The SPHIK CIRCUMFERANCE after treatment shows 90% ie,27 patients with
clinically stable and only 3 patients ie, 10% shows CI-1 ie,encouraging.
The t value for SPHIK CIRCUMFERANCE after treatment is 1.795 and p value is 0.083
which is significant.
The SPHIK CIRCUMFERANCE after follow up shows 96.66% ie,29% with clinically
stable and 3.33% ie one patient in CI-1 ie,encouraging..
The t value for SPHIK CIRCUMFERANCE after follow up is 1.439 and p value is 0.161
which is non significant,so udvartana with chanak pisthi proves significant after treatment
and proves non-significant after follow up.
ADHIKA KSHUDHA ;
The symptom ADHIKA KSHUDHA of patients was assessed as before treatment,after
treatment and post treatment follow up by comparing the results.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 125
Discussion ===============================================================
The symptom ADHIKA KSHUDHA after treatment shows 96.66% ie,29
patients with clinically stable and only one patient ie, 1.33% shows CI-1 ie,encouraging.
The t value for symptom ADHIKA KSHUDHA after treatment is 1.000 and p
value is 0.0326 which is non significant.
The symptom ADHIKA KSHUDHA after follow up shows 100% ie, total 30
patients with clinically stable.
The t value for symptom ADHIKA KSHUDHA after follow up is 0 and p value
is 1.000 which is non significant,so symptom ADHIKA KSHUDHA shows non
significant results after treatment and after follow up.
ADHIKA TRUSHNA ;
The symptom ADHIKA TRUSHNA of patients was assessed as before
treatment,after treatment and post treatment follow up by comparing the results.
The symptom ADHIKA TRUSHNA after treatment shows 100% ieTOTAL 30
patients with clinically stable.
The t value for symptom ADHIKA TRUSHNA after treatment is 0 and p value
is 1.000 which is non significant.
The symptom ADHIKA TRUSHNA after follow up shows 100% ie, total 30
patients with clinically stable.
The t value for symptom ADHIKA TRUSHNA after follow up is 0 and p value
is 1.000 which is non significant,so symptom ADHIKA TRUSHNA shows non
significant results after treatment and after follow up.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 126
Discussion ===============================================================
KSHUDRA SHWAS ;
The symptom KSHUDRA SHWAS of patients was assessed as before
treatment,after treatment and post treatment follow up by comparing the results.
The symptom KSHUDRA SHWAS after treatment shows 100% ieTOTAL 30
patients with clinically stable.
The t value for symptom KSHUDRA SHWAS after treatment is 0 and p value
is 1.000 which is non significant.
The symptom KSHUDRA SHWAS after follow up shows 100% ie, total 30
patients with clinically stable.
The t value for symptom KSHUDRA SHWAS after follow up is 0 and p value
is 1.000 which is non significant,so symptom KSHUDRA SHWAS shows non significant
results after treatment and after follow up.
SWEDA ADHIKATA ;
The symptom SWEDA ADHIKATA of patients was assessed as before
treatment,after treatment and post treatment follow up by comparing the results.
The symptom SWEDA ADHIKATA after treatment shows 36.66% ie,11
patients with clinically stable and 63.33% ie,19 patients with CI-1 ie,encouraging.
The t value for symptom SWEDA ADHIKATA after treatment is 7.077 and p
value is 0.000 which is highly significant.
The symptom SWEDA ADHIKATA after follow up shows 100% ie, total 30 patients
with clinically stable.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 127
Discussion ===============================================================
The t value for symptom SWEDA ADHIKATA after follow up is 0 and p value
is 1.000 which is non significant, so symptom SWEDA ADHIKATA shows highly
significant results after treatment and non-significant results after follow up.
So from above discussion of observations it is clear that,
1. In case of BMI udvartana with chanak pisthi can not prove beneficial
2. In case of vaksha circumference udvartana with chanaka pisthi proves significant
after treatment and proves non-significant after follow up.
3. In case of udara circumference udvartana with chanaka pisthi proves significant after
treatment and proves non-significant after follow up.
4. In case of sphik circumference udvartana with chanaka pisthi proves significant after
treatment and proves non-significant after follow up.
5. In case of symptom adhika kshutha udvartana with chanaka pisthi proves non-
significant for both after treatment and after follow up.
6. In case of symptom adhika trushna udvartana with chanaka pisthi proves non-
significant for both after treatment and after follow up.
7. In case of symptom kshudra shwas udvartana with chanaka pisthi proves non-
significant for both after treatment and after follow up.
8. In case of sweda adhikata udvartana with chanaka pisthi proves highly
significantafter treatment and proves non-significant after follow up.
From above results it is clear that in the treatment of sthoulya it is necessary to
give abhyanntara shamana aoushadhi,teekshana basti along with diet and exercise.As
sthoulya itself is kasta sadhya vyadhi so only udvartana with chanak pisthi can not
prove beneficial.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 128
Discussion ===============================================================
PROBABLE MODE OF ACTION ;
Chanaka pisti have been preffered for udvartana as it is laghu and ruksha in
gunas.The rasa properties of chanak is kashaya rasayukta which is antagonistic to the
properties of kapha.The physical qualities of chanak,laghu and ruksha are contrary to
meda dhathu.In charaka samhita chanak is mentioned as
laghu,sheeta,madhura,kashaya and does the rukshan by its prabhava.The properties of
chanak is mentioned as vatakarak,pitta and kapha nasaka,kapha pitta nashaka which
is quiet conflicting to that of sthoulya.
Due to ruksha and ushna guna it pacifies and meda shoshan.Especially the meda
dhathu with prithvi and jala mahabhuta pradhan which bears snigdha,sheeta and guru
gunas get pacified with opposite quality of the drug.
The sukshma chanaka pisthi has increased the fortified effect and achieved
laghuta contrary to guruta property oy sthoulya.
Udvartana is having the gunas of Kapha – Meda vilayana property. Due to
ushna and laghu ruksha guna of dravya and forceful massage effect on romakupa, the
Veerya of drug enters into body through, there after it opens the mukha of siras, there
by making paka of Kapha and Medas. Due to this, there will be dravatha Vrudhi of
Kapha and Medas. Swedana, which is given after Udvarthana will further makes paka
of the same. It also makes sweda pravarthana and due to Sweda karma, which is
given after Udvarthana, acts as Sthambhana, Gouragna and Sheetagna. When the
Doshas enter koshta, via above methods, they should be flushed out of the body. By
this the evacuation of these vikrutha Dosha and Dushya occur. By all of these
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 129
Discussion ===============================================================
nirharana of Vikruth Kapha, aap dhatu along with Medas will takes place ultimately
resulting in Laghavata of Shareera.
-------------------------------------------------------------------------------------------------------A Study on Apatarpan with Special Reference to Udvartan in Sthoulya. 130
Conclusion ===============================================================
CONCLUSION
1. Apatarpana itself contributes a major documentation in samhitas and also proves
most important basic principle in Nidan as well as in Chikitsa aspect.
2. As sthoulya itself is a santarpanottha vyadhi and also kastasadhya so Apatarpana
chikitsa is prescribed for sthoulya.
3. As per results of statistical analysis after follow up it proves non significant in all
eight criterias as BMI,VAKSHA,UDARA,SPHIK CIRCUMFERANCE,ADHIK
KSHUTHA,ADHIK TRUSHNA,KSHUDRASWAS and SWEDAADHIKATA.
4. So only Udvartan procedure with Chanak pisthi not proved satisfactorily in
Sthoulya.
-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 131
Recommendations for future study ===============================================================
RECOMMENDATIONS FOR FUTURE STUDY:
The following recommendations are made on the basis of observations and
conclusions for the further studies as well as to over come the limitations.
1) Along with ruksha udvartana procedure shamana aoushadhi,teekshana
basti,pathyapathya and exercise are crucial factors in the treatment of sthoulya.
2) A large number of samples are necessary for the study.
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 132
Summary ===============================================================
SUMMARY:-
Present study entitled “A study on Apatarpana with special reference to udvartana
in sthoulya’’comprises of
1) Review of literature
2) Materials and Methods
3) observation and Results
4) Discussion
5) Conclusion and
6) Recommendation for future study.
Review of literature is further divided into 1.Concept of Apatarpana 2. Ayurvedic
review of sthoulya 3. Modern review of sthoulya.4.Drug review.5.Udvartana
1.Concept of Apatarpana : Detailesd concept of Apatarpana along with
langhana,rukshana and swedana were reviewed.
Ayurvedicreview of sthoulya : Sthoulya nirukti, paribhasha, paryaya, nidana,
poorvarupa, rupa upashaya, samprapti, chikitsa, pathya, apathya were reviewed.
Modern review of sthoulya : In modern review obesity derivation, definition, types,
clinical features, classification diagnosis, treatment, surgical procedures, prevention, of
obesity were reviewed.
Drug review:-Synonemes properties, chem.composition etc have reviewed.
Udvartana review:-Nirukti, paribhasha, classification, benefits, mode of action,
physiological effects were reviewed.
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 133
Summary ===============================================================
Observation and results: Here details of selection of patients along with methods are
described. There after various observation and results obtained and with statistical
analysis are reviewed in detail.
Discussion: On concept of Apatarpana, sthoulya, udvartana, materials and
methods,observations and results and discussin were done.
Result: The result of clinical study showed Udvartana with chanaka pishthi is non
significant in the treatment of sthoulya.
------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 134
Bibiliography
===============================================================
BIBILIOGRAPHY
1. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas
academy ; 1996 : 191
2. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas
academy ; 1996 : 191
3. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas
academy ; 1996 : 192
4. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas
academy ; 1996 : 192
5. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas
academy ; 1996 : 192
6. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas
academy ; 1996 : 192-193
7. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha
orientalia ;1996 : 150
8. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha
orientalia ;1996 : 151
9. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha
orientalia ;1996 : 151
10. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha
orientalia ;1996 : 323
11. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha
orientalia ;1996 : 323
-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 135
Bibiliography
===============================================================
12. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha
orientalia ;1996 : 323-324
13. Prof.K.R.Srikantha Murthy,Astanga samgraha (I),9th ed,varanasi,
Choukhambha orientalia ;2005 :421
14. Prof.K.R.Srikantha Murthy,Astanga samgraha (I),9th ed,varanasi,
Choukhambha orientalia ;2005 :421
15. Prof.K.R.Srikantha Murthy,Astanga samgraha (I),9th ed,varanasi,
Choukhambha orientalia ;2005 :421
16. Prof.K.R.Srikantha Murthy,Astanga samgraha (I),9th ed,varanasi,
Choukhambha orientalia ;2005 :421-422
17. Prof.K.R.Srikantha Murthy,Sushruta samhita(3rd),1st ed,varanasi,
Choukhambha orientalia ;2002 :6-7
18. Prof.K.R.Srikantha Murthy,Astanga samgraha (I),9th ed,varanasi,
Choukhambha orientalia ;2005 :422
19. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas
academy ; 1996 : 193-194
20. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha
orientalia ;1996 : 151
21. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha
orientalia ;1996 : 150
22. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas
academy ; 1996 : 194
-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 136
Bibiliography
===============================================================
23. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas
academy ; 1996 : 194
24. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas
academy ; 1996 : 195
25. Prof.K.R.Srikantha Murthy,Astanga hridayam (I),3rd ed,varanasi,Krishnadas
academy ; 1996 : 197
26. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha
orientalia ;1996 : 150-152
27. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha
orientalia ;1996 : 152
28. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha
orientalia ;1996 : 152
29. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha
orientalia ;1996 : 90
30. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha
orientalia ;1996 : 150
31. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha
orientalia ;1996 : 96
32. Prof Priyavrat Sharma,Charaka samhita (Ist),4th ed,varanasi,Choukhambha
orientalia ;1996 : 96
33. Shastri K., Chaturvedi G., Charaka Samhita (1) 21st ed., Varanasi:
Chaukhambha Bharati academy, 1995 (1): 409
-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 137
Bibiliography
===============================================================
34. Shastri A.D., Sushruta Samhita (1) 14th ed., Varanasi: Chaukhamba Sanskrit
Sansthan, 2003 : 62
35. Shastri L.C., Asthanga Samgraha (1) 3rd ed., Nagpur Baidyanath Ayurveda
Bhavan Pvt. Ltd. 1986 : 694
36. Upadhyaya Y. Madhavanidanam (II) 27th Varanasi; Chaukhambha Sanskrit
Sansthan, 1997 : 28
37. Shastri B. S. Yogaratnakara (II) Uttarardha 5th ed., Varanasi; Chaukhamba
Sanskrit Sansthan, 1993:97
38. Misra B.S. Bhavaprakasa (II) 7th ed., Varanasi; Chaukhamba Sanskrit
Sansthan 2000: 405
39. Shabda kalpadruma, Shabdakosha, Bahadhur R., 5th part Reprint, Delhi, Naga
Publishers 2002 :452
40. Shastri K., Chaturvedi G. Charaka Samhita (1) 21st ed., Varanasi;
Chaukhamba Bharati Academy, 1995: 411
41. Shastri K., Chaturvedi G. Charaka Samhita (1) 21st ed., Varanasi;
Chaukhamba Bharati Academy, 1995: 409
42. Shastri A.D., Sushruta Samhita (1) 14th ed., Varanasi, Chaukhamba Sanskrit
Sansthan 2003: 62
43. Shastri L.C. Asthanga Sangraha (1) 3rd ed., Nagpur Baidyanath Ayurveda
Bhavan Pvt. Ltd. 1986: 694, 695
44. Shastri K. Chaturvedi G., Charaka Samhita (1) 21st ed., Varanasi;
Chaukhamba Bharati academy 1995: 409, 411
-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 138
Bibiliography
===============================================================
45. Shastri A.D., Sushruta Samhita (1) 14th ed., Varanasi Chaukhamba Sanskrit
Sansthan 2003: 62
46. Shastri L.C. Asthanga Samgraha (1) 3rd ed., Nagpur. Baidyanath Ayurveda
Bhavan Pvt. Ltd. 1986: 694
47. Upadhyaya Y. Madhavanidanam (II) Uttararda 5th ed., Varanasi; Chaukhamba
Sanskrit Sansthan
48. Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba
Sanskrit Sansthan 1993: 97
49. Mishra B.S. Bhavaprakasa (II) 7th ed., Varanasi Chaukhamba Sanskrit
Sansthan 2000: 405
50. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba
Bharati Academy 1995: 409, 411
51. Shastri A.D., Sushruta Samhita (I) 14th ed., Varanasi Chaukhamba Sanskrit
Samsthana 2003: 62
52. Shastri L.C. Asthanga Samgraha (1) 3rd ed., Nagpur. Baidyanath Ayurveda
Bhavan Pvt. Ltd. 1986: 694
53. Upadhyaya Y. Madhavanidanam (II) Uttararda 27th ed., Varanasi;
Chaukhamba Sanskrit Sansthan 1997: 28
54. Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba
Sanskrit Sansthan 1993: 97
55. Mishra B.S. Bhavaprakasa (II) 7th ed., Varanasi Chaukhamba Sanskrit
Sansthan 2000: 405
-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 139
Bibiliography
===============================================================
56. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba
Bharati Academy 1995: , 411
57. Shrikantamurty K.R., Astanga Sangraha (1) 5th ed., Varanasi, Chaukhamba
Orientalia 2002 : 424- 426
58. Shastri A.D., Sushruta Samhita (I) 14th ed., Varanasi Chaukhamba Sanskrit
Samsthana 2003: 62
59. Shrikantamurty K.R., Astanga Sangraha (1) 5th ed., Varanasi, Chaukhamba
Orientalia 2002 : 424- 426
60. Upadhyaya Y. Madhavanidanam (II) Uttararda 27th ed., Varanasi;
Chaukhamba Sanskrit Sansthan 1997: 29
61. Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba
Sanskrit Sansthan 1993: 98
62. Mishra B.S. Bhavaprakasa (II) 7th ed., Varanasi Chaukhamba Sanskrit
Sansthan 2000: 405
63. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba
Bharati Academy 1995: , 412
64. Shastri A., Sushruta Samhita (II) Reprint ed., Varanasi, Chaukhamba Sanskrit
Sansthan 2004: 63
65. Upadhyaya Y. Asthanga hridaya 4th ed., Varanasi; Chaukhamba Sanskrit
Sansthan 2003: 103
66. Shastri A., Sushruta Samhita (II) Reprint ed., Varanasi, Chaukhamba Sanskrit
Sansthan 2004: 11
-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 140
Bibiliography
===============================================================
67. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba
Bharati Academy 1995: , 415
68. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba
Bharati Academy 1995: , 414
69. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba
Bharati Academy 1995: , 414
70. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba
Bharati Academy 1995: , 414
71. Shastri L.C. Astanga Sangraha (1) 3rd ed. Nagpur Baidyanath Ayurveda
Bhavan Pvt. Ltd. 1986: 694
72. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba
Bharati Academy 1995: , 414
73. Shastri A.D., Sushruta Samhita (I) 14th ed., Varanasi Chaukhamba Sanskrit
Samsthana 2003: 62
74. Upadhyaya Y. Asthanga hridaya 4th ed., Varanasi; Chaukhamba Sanskrit
Sansthan 2003: 103
75. Shrikantamurty K.R., Astanga Sangraha (1) 5th ed., Varanasi, Chaukhamba
Orientalia 2002 : 695, 696
76. Dwivedi R. Chakradatta 4th ed. Varanasi Chaukhamba Sanskrit Sansthan,
2002: 221
77. Mishra B.S. Bhavaprakasa (II) 7th ed., Varanasi Chaukhamba Sanskrit
Sansthan 2000: 405
-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 141
Bibiliography
===============================================================
78. Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba
Sanskrit Sansthan 1993: 98
79. Shastri R.D. Bhaishajja Ratnavali 11th ed. Varanasi Chaukhamba Sanskrit
Sansthan 1993: 525, 529.
80. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba
Bharati Academy 1995: 415
81. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba
Bharati Academy 1995: 415
82. Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba
Bharati Academy 1995: 63
83. Shrikantamurty K.R., Astanga Sangraha (1) 5th ed., Varanasi, Chaukhamba
Orientalia 2002 : 502
84. Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba
Sanskrit Sansthan 1993: 98
85. Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba
Sanskrit Sansthan 1993: 98
86. Shastri R.D. Bhaishajja Ratnavali 11th ed. Varanasi Chaukhamba Sanskrit
Sansthan 1993: 529.
87. Dwivedi R. Chakradatta 4th ed. Varanasi Chaukhamba Sanskrit Sansthan,
2002: 221
88. Golwalla. Medicine for students, 12th ed. Mumbai: Dr. A.F.Golwall:
Churchgate: 2003: 397
-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 142
Bibiliography
===============================================================
89. K. Park., Text book of preventive and social medicine, 17th ed. Jabalpur,
Banarsidar Bhanot: 2000: 298
90. http://WIN-publication-understandingAdultobesity.htm
91. C.R.W. Edwards, I.A.D. Boucher et. al., Davidson’s principles and practices
of medicine: Churchill living stone, Edinburg London, New York,
Philadelphia St. Louis Sydney, Toronto, 17th ed. 1995: 578, 579.
92. http://www.nhlbi.gov/guidelines/obesitytxtbk/4.11htm.
93. http://WIN-publication-understandingAdultobesity.htm
94. C.R.W. Edwards, I.A.D. Boucher et. al., Davidson’s principles and practices
of medicine: Churchill living stone, Edinburg London, New York,
Philadelphia St. Louis Sydney, Toronto, 17th ed. 1995: 582.
95. C.R.W. Edwards, I.A.D. Boucher et. al., Davidson’s principles and practices
of medicine: Churchill living stone, Edinburg London, New York,
Philadelphia St. Louis Sydney, Toronto, 17th ed. 1995: 583.
96. C.R.W. Edwards, I.A.D. Boucher et. al., Davidson’s principles and practices
of medicine: Churchill living stone, Edinburg London, New York,
Philadelphia St. Louis Sydney, Toronto, 17th ed. 1995: 583.
97. Pandey G.S., Bhavaprakasa Nighantu Reprint ed., Varanasi : Chaukhamba
Bharati Academy 1999 : 648
98. Pandey G.S., Bhavaprakasa Nighantu Reprint ed., Varanasi : Chaukhamba
Bharati Academy 1999 : 649
99. Shastri L.C., Asthanga Samgraha (1) 3rd ed., Nagpur Baidyanath Ayurveda
Bhavan Pvt. Ltd. 1986 : (As sa su 24/4 P434)
-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 143
Bibiliography
===============================================================
100. 1)Shastri B.S. Yogaratnakara (II) Uttararda 5th ed., Varanasi ; Chaukhamba
Sanskrit Sansthan 1993: (Y R Rutu charya adhyaya P 69.) 2) Upadhyaya Y.
Asthanga hridaya 4th ed., Varanasi; Chaukhamba Sanskrit Sansthan 2003: (A
hr su 3/19 P37)
101. 1) Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi
Chaukhamba Bharati Academy 1995: (Cha sa su22/34-35P P432). 2) Shastri
A.D., Sushruta Samhita (I) 14th ed.,Varanasi chaukamba Sanskrit
sansthan.2003(su ut39/104 p489) 3) Shastri L.C., Asthanga Samgraha (1) 3rd
ed., Nagpur Baidyanath Ayurveda Bhavan Pvt. Ltd. 1986 : (As sa su24/12
P136) 4) Upadhyaya Y. Asthanga hridaya 4th ed., Varanasi; Chaukhamba
Sanskrit Sansthan 2003: (A hr su 14/17 P 105)
102. 1) Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi
Chaukhamba Bharati Academy 1995: (Cha sa su 22/37 P436) 2) Shastri K.,
Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba Bharati
Academy 1995: (Cha sa su 21/13-14) 3) Shastri A.D., Sushruta Samhita (I)
14th ed., Varanasi Chaukhamba Sanskrit Samsthana 2003 (Su sa ut 39/ 105)
4) Upadhyaya Y. Asthanga hridaya 4th ed., Varanasi; Chaukhamba Sanskrit
Sansthan 2003 (As hr su 14/18) 5) Shastri L.C., Asthanga Samgraha (1) 3rd
ed., Nagpur Baidyanath Ayurveda Bhavan Pvt. Ltd. 1986 : (As sa su21/16).
103. 1) Shastri K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi
Chaukhamba Bharati Academy 1995: (Cha sa su 22/41 P153) 2) ) Shastri
K., Chaturvedi G., Charaka Samhita (I) 21st ed., Varanasi Chaukhamba
Bharati Academy 1995: (Cha sa su 16/7-8 P111).
-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 144
Bibiliography
===============================================================
104. 1) Shastri A.D., Sushruta Samhita (I) 14th ed., Varanasi Chaukhamba Sanskrit
Samsthana 2003 (Su chi24/54-56 P 489 Dalhana tika)
105. Shastri A.D., Sushruta Samhita (I) 14th ed., Varanasi Chaukhamba Sanskrit
Samsthana 2003 (Su chi24/54-56 P 489 Dalhana tika)
106. Shastri A.D., Sushruta Samhita (I) 14th ed., Varanasi Chaukhamba Sanskrit
Samsthana 2003 (Su chi24/54-56 P 489 Dalhana tika)
-------------------------------------------------------------------------------------------------------A Study On Apatarpan With Special Reference To Udvartan In Sthoulya. 145
Classical References
CLASSICAL REFERANCES
“उपबमःय ह वा धैवोपबमो मतः
एकः स तपणःतऽ तीय ापतपणः
बृंहणो ल घ ेित त पयावुदा तौ
बृंहणं य बहृ वाय ल घनं लाघवाय यत ्
देहःय भवतः ूायो भौमापिमतर च ते
ःनेहनं णं कम ःवेदनं ःत भमनं च यत ्
भूतानां तद प ै या तयं नाितवतते
शोधनं शमनं चेित धा तऽा प ल घनम”्
चतुंूकारा संशु ः पपासा मा तातपौ
पाचना युपवास यायाम ेित ल घनम ्
ूभूत ेंम प ाॐमंलाःसंसृ मा ताः
बहृ छर रा बिलने ल घनीया वशु िभः
(च.सू.२२/१८-१९)
A Study on Apatarpan with Special Reference to Udvartan in Sthoulya 146
Classical References
एविमतरेषाम प याधीनां िनदान वपर तं भेषज ंबवित;
यथा- अपतपणिनिम ानां याधीनां ना तरेण पूरणम ःत शा तः,
तथापूरणिनिम ानां याधीनां ना तरेणापतपणम ्
अपतपणम प च ऽ वधं- ल घनं,ल घनपाचनं,दोषावसेचनं चेित
(च. व.३/४२-४३)
मेहामदोषाित ःन ध- वरो ःत भकु नः
वसप वििध लीहिशरःक ठा रोिगणः
ःथूलां ल घये न य ंिशिशरे वपरान प
(अ. .सू.१४/११)
यत ् क च लाघवकरं देहे त ल घनं ःमतृम ्
रौआयं खर वं वैश ं यत ्कुया णम ्
लघूंणतीआण वशदं ंसूआमं खरं सरं
क ठनं चैव य ि यं ूायःत ल घनं ःमतृम ्
(च.्सू.२२/९,१२)
न बहृये ल नीयान ्बृं ाःतु मदृ ुल घयेत ्
यु या वा देशकाला दबलतःतानुपाचरेत ्
(अ. .सू.१४/१५)
A Study on Apatarpan with Special Reference to Udvartan in Sthoulya 147
Classical References
वमले ियतया सग मलानां लाघवं िचः
तुृ सहोदयः शु दयो ारक ठता
यािधमादवमु साहःत िानाश ल घते
(अ. .सू.१४/१७)
गु चातपणं चे ंःथूलानां कशनं ूित
कृशानां बॄहंणाथ च लघु संतपणं च यत ्
(च.सू.२१/२०)
अितकाँय ॅमःकास-ःतृं णािध यमरोचकः
ःनेहा निनिा क् ौोऽशुबौजः ु ःवर यः
ब ःत मूधज घो ऽकपा जा वरः
ूलापो वािनल लािनछ दपवा ःथभेदनम ्
वच मूऽमहा ा जाय तेित वल घनात ्
(अ. .सू.१४/२९-३०)
तऽाितःथूलकृशयोभूय एवापरे िन दत वशेषा भव त
अितःथूलःय तावदायुषॊ ॑ासो जवोपरोधःकृल यवायतां
दौब यं दौग यं ःवेदाबाधः दुितमाऽं पपासाितयोग ेित
भव ो दोषाः
A Study on Apatarpan with Special Reference to Udvartan in Sthoulya 148
Classical References
तदितःथौ यमितसंपूरणा मधुरशीत ःन धोपयोगाद यायामाद यवाया वाःवु
ना
हषिन य वादिच तना जीवःवभावा चोपजायते
तःय ितमाऽमेद ःवनो मेद एवोपचीयते न तथेतरे धातवः,
तःमादायुषो ॑ासः;शैिथ यात ्सौकुमाया वा चु मेदसो जवोपरोधः,
शुबाबह वा मेदसावतृमाग वा चु कृ ल यवायता,दौब यमसम वा ातूनां,
दौग यं मेदोदोषा मेदसः ःवभावात ्ःवेदन वा च,मेदसः
ेंमससंगा ं द वा -
बह वा वा यायामासह वा चु ु ःवेदाबाधः,तीआणा न वात ्
ूभूतको वायु वा च दुितमाऽं पपासाितयोग ेित
(च.्सू.२१/४)
मेदसावतृमाग वा ायुःको े वशेषतः
चरन ्संधु य य नमाहारं शोषय य प
तःमात ्स ्शीयं जरय याहारं चाितका ित
वकारां ा ौतेु घोरान ्कां काल यितबमात ्
एवादपिवकरौु वशेषद नमा तौ
एतौ ह दहतःःथूलं वनदावो वनं यथा
मेदःयतीव संवृ े सहसैवािनलादयः
A Study on Apatarpan with Special Reference to Udvartan in Sthoulya 149
Classical References
वकारान दा णा कृ वा नाशय याशु जी वतम ्
मेदोमांसाितवृ वा चल ःफगदुरःतनः
अयथोपचयो साहो नरोितःथूल उ यते
इित मेद ःवनो दोषा हेतवो पमेव च िन द ं
(च.्सू.२१/५-९)
वात ना नपानािन ेंममेदोहरा ण च
ोंण बःतयःतीआण ा यु तनािन च
गडुचीभिमुःतानांु ूयोग ैफलःतथा
तबा र ूयोग ूयोगो मा क च
वडङग ंनागरं ारः काललोहरजो मधु
यवामलकचूण च ूयोगः ौे उ यते
ब वा दप चमूलःय ूयोगः ौिसंयुतः
िशलाजतुूयोग सा नम थरसः परः
(च.सू.२१/२१-१४)
उ तनं वातहरं कफमेदोअिनलापहम ्
ःथर करणमङगानां व ूसादकरं परम ्
(सु.िच.२४/५१)
A Study on Apatarpan with Special Reference to Udvartan in Sthoulya 150
Classical References
उ तनं कफहरं मेदसः ू वलायनम ्
ःथर करणम गानां व ूसादकरं परम ्
(अ.॑ु.सू.२/१५)
चणका मसुरा ख डकाः सहरेणवः
लघवःशीतमधुराः स कषाया व णाः
प ेंमणीशःय ते सुपेंवालेपनेषु च
तेषां मसुरःसंमाह कलायो वातलःपरम ्
(च.सू.२७/२८-२९)
चणको ह रम थः ःया सकल ूय इ य प
चणकः शीतलो ः प र कफापहः
लखःु कषायो व भी वातलो वरनाशनः
(भा.५३)
“ितय गाःसंूवआयािम कम चासां यथायथं
ितयगाणां तु चतसणृां धमनीनामेकैका शतधाः
सहॐधा चो रो रं वभ य ते,ताः वस येयाः,
तािभ रदं शर रं गवा तं वब माततं च,
तासां मुखािन रोमकूपूितब ािन,यैःःवेदमिभवह त
A Study on Apatarpan with Special Reference to Udvartan in Sthoulya 151
Classical References
रसं चािभतपय य तब ह ,तैरेव चा य गप रषेकावगाह
आलेपनवीया य तःशर रमिभूितप ते विच वप वािन,
तैरेव च ःपश सुखमसुखं वा गृ ते,ताः वेता तॐो धम यः
सवा गगताः स वभागा या याताः”
A Study on Apatarpan with Special Reference to Udvartan in Sthoulya 152
Case proforma
CASE PROFORMA
DEPARTMENT OF SIDDHANTA
Dr. B.N.M.E.Trust’s Shri Mallikarjuna Swamiji
Post Graduate and Research Centre, Bijapur.
Title: A STUDY ON APATARPANA W.S.R TO UDVARTANA IN STHOULYA
GUIDE - DR. M B. KARAMBELKAR. HOD - DR. HUDDAR. J C. D.S.A.C.A.V.P.Ph.D M.D. (Ayu) .
P.G.Scholar- Dr. AMIT A. MASULE
SR..No - Date - Name - OPD No - Age/ Sex - Caste - Marital Status- Occupation - Address - Socio-economical Status - Date of commencement of treatment - Date of completion of treatment -
LETTER OF CONSENT
I, ___________________________________, exercising my free power to choice, hereby Give my consent to be included as a subject in the clinical trial titled “A STUDY ON APATARPANA W.S.R TO UDVARTANA IN STHOULYA.” I have been informed in my vernacular language to my satisfaction by the attending investigator, the purpose of the clinical trial and the nature of medical intervention and follow-up, including the laboratory investigation to monitor me. I am agreeable to the data collected on me to be used by the investigators of the trial for scientific purposes. I am also aware of my right to opt myself out of the clinical trial without having to give reasons for doing so. Signature of the Patient Date:- Place:- Signature of the Witness Signature of the Investigator
A Study On Apatarpan With Special Reference To Udvartan In Sthoulya 153
Case proforma
1) PRADHANA VEDANA:
2) ANUBANDHI VEDANA:
3) ADYATANA VYADHI VRITTANTA:
4) POORVA VYADHI VRITTANTA:
5) KULA VRITTANTA :
6) VAIYAKTIKA VRITTANTA : a) Ahara : b) Vihara : c) Nidra:
d) Vyasana: e) Raja pravritti:-
7) ASTHA STHANA PAREEKSHA :
1) Nadi - 5) Shabda - 2) Mala - 6) Sparsha - 3) Mutra - 7) Druk - 4) Jihwa - 8) Akruti -
8) DASHAVIDHA ATURABALA PAREEKSHA :
1) Prakrutitaha : 2) Vikrititaha : 3) Sarataha : Pravara / Madhyama / Avara 4) Samhanana : Pravara / Madhyama / Avara 5) Pramantaha : Pravara / Madhyama / Avara 6) Satmytaha : Pravara / Madhyama / Avara 7) Satwataha : Pravara / Madhyama / Avara 8) Ahar shaktitaha : Pravara / Madhyama / Avara 9) Vyayama shaktitaha : Pravara / Madhyama / Avara
10) Vayataha : Baala /Yuva / Vruddha
A Study On Apatarpan With Special Reference To Udvartan In Sthoulya 154
Case proforma
9) PHYSICAL EXAMINATION:
A) GENERAL EXAMINATION: 1. Height - …….. 2. Weight - ……. kg 3. Pulse - ……. / min 4. Temperature - …… 5. Blood pressure - ………. mm of Hg 6. Respiratory rate - ……. /min B) SYSTEMIC EXAMINATION: 1. Cardio-Vascular System - 2. Respiratory System - 3. Locomotors System - 4. GIT System - C) SROTASA EXAMINATION:
10) AGNI PAREEKSHA : Manda / Teekshna / Vishama / Sama
11) KOSHTA PAREEKSHA : Mrudu / Madhyama / Krura
12) NIDAN PANCHAKA :
1) Hetu -
2) Purva rupa -
3) Rupa -
4) Upashaya -
Anupashaya -
5) Samprapti -
Samprapti Ghatakas:-
1) Dosha - 5) Rogamarga - 2) Dooshya - 6) Adhisthan - 3) Srotas - 7) Vyakta sthana - 4) Sroto Dusti prakara - 8) Vyadhi Avastha -
13) VYADHI VINISHCHAYA :
A Study On Apatarpan With Special Reference To Udvartan In Sthoulya 155
Case proforma
14) CHIKITSA :
Kriya nama :- Udvartana procedure
Kala/Avadhi : - 30 min. for 30 days
1) Poorva karma:- Annapachana laxanas are observed 2) Pradhana karma:- Udhvartana with chanak pishthi for 30min. 3) Pashchata karma:- Parisheka with sukhoshna jala and snana 15) Pathya:- Apathya:- 16) SUBJECTIVE ASSESMENT:-
LAXANAS Before treatment(1st day)
After treatment (30th day)
Post treatment follow up (45th day)
Kshudrashwasa
Atikshudha
Atitrushna
Swedadhikya
Gradings:
Grade 1- Absent Grade 2- Mild Grade 3- Moderate
Grade 4- Severe A) ASSESSMENT OF MEDOPLEPA ON VAKSHA, UDAR AND SPHIK. 1) Vaksha circumference –
Grade 1- non obese(less than 80 cm) Grade 2- mild (81-90 cm) Grade 3- moderate (91-100 cm) Grade 4- severe (101-110cm)
2) Udara circumference – Grade 1- non obese(less than 80 cm)
Grade 2- mild (81-90 cm)
A Study On Apatarpan With Special Reference To Udvartan In Sthoulya 156
Case proforma
Grade 3- moderate (91-100 cm) Grade 4- severe (101-110cm)
3) Sphik circumference –
Grade 1- non obese(less than 90 cm) Grade 2- mild (91-100 cm) Grade 3- moderate (101-110 cm)
Grade 4- severe (111-120cm)
Circumference Before treatment (1st day)
After treatment (30th day)
Post treatment follow up (45th day)
Vaksha Udar Sphik B) ASSESSMENT OF WEIGHT- Weight- kg Variable Before treatment (1st
day) After treatment (30th day)
Post treatment follow up (45th day)
Weight
C) ASSESSMENT OF BMI- BMI = weight (kg)/ height2 (m) BMI (body mass index)-
Grade 1- non obese (below 30) Grade 2- mild (30-31.5) Grade 3- moderate (31.6-33) Grade 4- severe (33.1-34.5)
Variable Before treatment (1st day)
After treatment (30th day)
Post treatment follow up (45th day)
BMI
Adverse effects (if any)-
Signature of Scholar Signature of HOD
A Study On Apatarpan With Special Reference To Udvartan In Sthoulya 157