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| CASE REPORT |
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| Year : 2022 | Volume
: 1
| Issue : 1 | Page : 39-43 |
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Management of Medoroga w.s.r. to obesity: A leading role of Ayurveda
Ritu Wadhwa
Department of Panchakarma, D.Y. Patil School of Ayurveda, Navi Mumbai, Maharashtra, India
| Date of Submission | 06-Jan-2022 |
| Date of Acceptance | 30-Apr-2022 |
| Date of Web Publication | 12-Aug-2022 |
Correspondence Address:
Dr. Ritu Wadhwa
Department of Panchakarma, D.Y. Patil School of Ayurveda, D-29, Ellora, Anushakti Nagar, BARC Colony, Trombay, Navi Mumbai 400094, Maharashtra
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jahas.jahas_1_22
To combat the COVID-19 pandemic, governments have imposed various interventions such as lockdowns, that was need of the hour but this situation has changed daily regimen which includes less physical activities and may lead to overweight and obesity. It occurs when calorie intake exceeds the metabolic expenditure. So, the aim is to decrease calorie intake and increase the expenditure through Ayurveda Principles, that is, NidanParivarjan (preventive therapy) and Samshodha (purification therapy). A Female visited to D.Y. Patil Ayurvedic Hospital, Nerul, Navi Mumbai for weight reduction as during lockdown period she has gained 12 kg weight, having aalasya, atikshudha, breathing difficulty while climbing, fatigue and knee joint pain. Her weight was 84 kg and BMI was 34.5kg/m2. On the basis of BMI and her symptoms it was diagnosed as Medoroga (sthaulya). To manage her weight yoga Asanas and diet chart are explained and two sittings of nine PippalyadiBastiwas given. It was found that PippalyadiBastias samshodhan and yog aasanas, diet chart as nidanparivarjanare effective in the management of Medoroga. Patient lost 12kg weight. Keywords: NidanParivarjan, Niruhabasti, AnuvasanBasti, PippalyadiBasti, Samshodhan
How to cite this article:
Wadhwa R. Management of Medoroga w.s.r. to obesity: A leading role of Ayurveda. J Ayurveda Homeopath Allied Health Sci 2022;1:39-43 |
How to cite this URL:
Wadhwa R. Management of Medoroga w.s.r. to obesity: A leading role of Ayurveda. J Ayurveda Homeopath Allied Health Sci [serial online] 2022 [cited 2023 Dec 10];1:39-43. Available from: http://www.dpujahas.org/text.asp?2022/1/1/39/353694 |
| Introduction | |  |
During lockdown period fitness centers were closed and outdoor games were stopped in combination with the need for physical distancing because of that excess energy may result in sustained negative effects on physical, mental and metabolic health. This change in life style, environment and dietary habits make person victim of metabolic disorder such as obesity.
Medoroga (Obesity) is the only life style disorder which is gaining more attention after pandemic –COVID-19 at global level. Basically medoroga (obesity) comes under the category of santarpanottha vyadhies.[1] Acharya Charak had explained in sutra sthanAshtanindateeyaadhyaya, eight undesirable constitution, out of these Atisthula (obese) person is considered as most despicable constitution. It is not only for appearance wise but also its associated complications such as hypertension, dyslipidaemia, cardiac problems and their management. Diet such as guru (heavy to digest), abhishyandi (obstruct the channel) and shleshmakar (produces kapha) and sedentary life style such as avyayam (no exercise) divaswapna (day time sleeping) plays a vital role in the nidaan (cause) of medoroga.[2]
Acharya Charak had described ruksha (dry), tikshana (pungent) basti which is beneficial for Shleshmavikar,[2]PippalyadiBasti is one such type of Basti which is advised to the patient as Samshodhanchikitsa (biopurification of the body). Pippalyadi Basti is quite effective in weight reduction as it does strotas shodhan and found to be effective in Pilot study done in 2020,on 30 obese patients in DY Patil School of Ayurveda, Nerul, Navi Mumbai. Acharya Charak advocated Avyayam as Nidan of Atisthul (CH.SU.21/4) and chikitsa Sutra of Atisthul (CH.SU.21/20) is Chestam. Therefore yoga asan is considered as Nidan Parivarjan To maintain that reduced weight Yoga asana was explained as NidanParivarjan (preventive therapy).
| Case History | | |
A 35-year-old woman visited D.Y. Patil Ayurvedic Hospital, Navi Mumbai on 01/02/2021 for her increased weight, during lockdown period she has gained 12 kg weight her physical activities get reduced and diet pattern has changed. At home she was having ready to eat food products which contain various preservatives in it. Intake of excess quantity of food articles such as chocolates, pudding, cheese pasta, bakery products and sweets were increased. madhur rasa and meda, share the same mahabhuta composition, that is, Prithvi+Jala. Having predominance of Pruthvi and Jala Mahabhuta, which is similar to the qualities of Kapha and Meda, has become an important Nidan for Medoroga(Obesity).
Her abdominal girth was increased and was feeling lethargic and heaviness in the body. She had symptoms like knee joint pain. fatigue, dyspnea and profuse sweating. No past history of hypothyroid, hypertension and diabetes was noted.
| Clinical Findings | | |
On general examination her vitals were stable, that is, B.P. 120/80, P/R-72/MIN.R/R-18 breath/min. was normal. Her weight was 84 kg and height was 156 C.M. On the basis of Weight and Height, BMI was 34.5kg/m2,waist and hip circumstances was taken. Waist Hip Ratio(W.H.R.)was calculated as (45/43)and it was1.046.
| Dashavidhapariksha (Ten Foldcheckup) | | |
Prakriti (~body temperament) was Kapha, Pittaja; Vikriti was Kaphapradhanatridoshaja; Sarata of Maans dhatu (~excellence of tissues)and Satmya (~suitability) were Madhyama (~moderate). Aaharashakti (~power of food intake), Samhanana (~compactness of organs), and Pramana (~measurement of body organs) were Avar. VyayamaShakti (~power of performing physical activity) was Avar(gets tired easily). Vaya was Madhyam (35 Yr.).
| Ashtavidhapareeksha (Eightfold check Up) | | |
Nadi (pulse) was Kaphaj; Mala (stool) was Vibandha (constipated) and irregular; Mutra(urine) was Alpa (lessinamount); Shabda (voice) was Sadharana (normal);Jihva(tongue) was Svachha(clean); Akriti (body built) was Madhyama (moderate); Drik(vision) was Heena (diminished).
| Diagnostic Assessment | | |
Assessment was done on following subjective and objective parameters-
Subjective parameters –
Based on CharakSamhita Sutrasthan 21, which includes[2] ∙UtsahaHani (Lethargy) ∙Atikshudha (Polyphagia) ∙Atipipasa (Polydipsia) ∙Atisweda (Profuse sweating) ∙Dourbalya (Weakness) ∙Dourgandhya (Bad Odor).
| Objective Parameters | | |
Body weight∙ Waist – Hip ratio (WHR)∙BMI (Weight in kg / Height in m2)
classification of obesity[3] on the basis of BMI is as follows-
Quantifying Obesity with BMI
- If BMI is 25–29.9 kg/m2 it is consider as Overweight.
- If BMI is30-34.9 kg/m2 it comes under Class I Obesity.
- If BMI 35–39.9 kg/m2 it is known as Class II Obesity.
- If BMI >40 kg/m2 then it is considered as Class III or morbid obesity.
Laboratory Investigations
CBC and ESR, SERUM T3 and T4 and TSH, BSL, LIPID PROFILE.
Her lipid profile was deranged and other lab. reports were found Normal.
| Treatment Protocol | | |
Nine days course of Basti was given in the First sitting, after gap of 18 days second sitting of Pippalyadi Basti for nine days was repeated. Pippalyadibasti comes under NiruhaBasti which was followed by Triphaladi tail Basti and it is prepared as per standard operative procedure. First Anuwasan Basti with Triphaladi tail (100 ml) was given then three Pippalyadi Basti (560ml) administered, fifth day Anuwasan Basti with Triphaladi tail was given again three PippalyadiBasti(NiruhaBasti) andlast, that is, ninth day Anuwasan Basti with Triphaladi tail was administered. In the same way, after a gap of 18 days second sitting was administered. Last follow up was taken after18 days of second sitting.
| Material of Pippalyadibasti | | |
[Table 1]
Preparation of pippalyadi Basti (NiruhBasti)
NiruhaBasti is a decoction based basti. Decoction of Niruha Basti was prepared as per sharangdharsamhita. One part of raw drug(40 grams each of coarse powder of Chitrak and Pippali) was boiled with sixteen parts (1280 ml) of water and reduced to one fourth (320 ml). Apart from kwath, other ingredients of Basti were taken and mixed properly in specific manner as mentioned in Charak Samhita.
Niruhabasti was administered in the form of an emulsion containing (Ch / Si/3/23–24) honey (makshik), rock salt (lavana), oil (sneha), fine paste of herbs (kalka), decoction (kwatha), other liquid additives (avaap/ prakshepdravya) mixed in sequential manner, that is, in the beginning, makshik and lavana were pounded together, followed by sneha, kalka, kwatha and avaap dravya. It was ensured that proper stirring was done before adding each of the subsequent material. This homogenous mixture was thereafter be placed in the
Basti putak (enema receptacle). The Bastinetra (Enema nozzle) and Bastiputaka of the Basti apparatus should be assembled and tied properly.
Method of Administration of Basti:
PipplyadiBasti was administered after ensuring that the patient had properly digested previous food. Patient was asked to pass her natural urges before administration of Basti. Patient was asked to lie down in the left lateral position on the Bastitable, Sthaniksnehan (local massage) was done at the lumbar and lower abdominal region including thighs with Triphaldi tail and sthanik Nadi Swedan (local fomentation) was given. After Sthanik Snehan and Swedan patient was asked to keep her left hand below the head as a pillow, to extend the left leg completely and to flex the right leg at the Knee Joint keeping on the left leg by flexing the hip Joint. Basti Putak was filled with prepared emulsion. Warm oil was applied in the anal region and on the Bastinetra. Basti netra upto 1/4th of its length was gradually introduced parallel to direction of the vertebral column. Basti Putaka was held in the left hand and patient was asked to breathe in to allow the basti into the rectum. A little quantity of Basti was kept as a residue to prevent air entering into the rectum. The nozzle was gradually removed and the patient was asked to lie down in the supine position for 30 Matra (15–30 sec). She was instructed to pass urge on its manifestation.
Anuvasana Basti
Anuvasan should be given after meal and in the same position.
Following Yoga asana was included as routine exercise - 1. parivartitchakrasana (adopted wheel pose) 1. vakrasana (spinal twist pose) 2. paschimottanasana (posterior stretch pose) 3. Naukasana (boat pose) 4. Pavanmuktasana (gas releasing pose) 5. SuryaNamaskar.
| Time Line of Bastichikitsa | | |
[Table 2]
Follow-up and outcome
It was noticed that Patient has reduced 5 kg weight in first sitting with the help of Yoga asanas and Bastichikitsa and after second sitting finally she has reduced total 12 kg weight. Her knee joint pain, fatigue, dyspnea had reduced significantly.
Clinical evaluation: [[Table 3] and [Table 4]]
| Discussion | | |
The present case report demonstrated a successful recovery in obesity and allied symptoms by following Ayurvedic Basti formulations administration and Yoga therapy. In this case report, the treatment protocol was based on involvement of Vata-Kapha dosha and meda mansa dushya and disturbances in Mansa-medovaha strotas for occurrence of Medoroga.
Considering patient’s age, prakriti, specific symptoms, and involvement of Kapha dosha along with abnormal functions of Mamsa-Meda dhatu,Kapha-vatahar and stroto rodhahar [Samshodhan] treatment was selected. Basti application is considered as the best treatment therapy for Kapha-Vata dominant disorders; therefore, in this study for correction of all those abnormal entities Samshodhan with Pippalyadi Basti for nine days were chosen. Along with Basti administration Yoga therapy has been advised to maintain the normal functioning of disturbed dhatu. By following above said treatment Patient got 100% relief in Lethargy, Polyphagia and profuse sweating where as 80% relief in polydipsia and weakness, this percentage was calculated before and after treatment on the bases of grading scale given in the table. Patient had reduced 12 kg weight in two months.
Pippalyadi Basti was advocated by Acharya Charak in siddhi sthan chapter ten as Ardha shlokokta Basti, for Shleshma vikar and Santarpanotha Vyadhi. Probable mode of action of Pippalyadi Basti is depends on gun,karma and veerya of the ingradients such as Basti kadha(decoction) contains Pippali and Chitrak, both have UshnaVeerya(hot potency) and KatuVipaka,[4] thus plays vital role on kapha dosha and by their UshnaVeerya (hot potency) they possess vatahar karma, in that way prime cause of disease, that is, kaphaandvata are managed. Apart from this By the virtue of Deepana, Pachana Karma, it works at the level of Agni, its Deepana property mainly corrects the Medodhatu Agnimandya and Pippalyadi Basti comprises mainly gomutra, shatpushpa, lavan, honey, Yavakshar possess Ruksha, tikshnaGuna (dry, pungent property),UshnaVeerya (hot potency) the combination corrects the Sanga in Medovaha Srotas, by which Uttarotar Dhatu are nourished and the process of Meda Vriddhi stops. Use of Triphaladi taila, Anuvasan Basti is mentioned by Chakradatta in Sthoulyadhikara.[5] Classification of Obesity based on BMI is taken from the contemporary science.[6]
Patient’s counseling regarding diet and yogaasan was done. Regular practice of yoga and correct dietary habit helps the patient to maintain her reduced weight for that purpose patient was advised to practice a few important techniques regularly. These asanas helps to reduce fat deposition on the side of waist and abdominal wall.[7]
| Conclusion | | |
It is concluded that change in the lifestyle which includes regular practice of Yoga, sensible eating habits and Pippalyadi Basti as Samshodhan chikitsa plays significant role in the management of Medoroga (obesity).
Acknowledgement
Thanks to Rasshastra Department of D.Y. Patil School of Ayurveda for helping in the formulation of TriphaladiTail, which was used in Basti chikitsa. I express my sincere thanks to whole Panchakarma department of D.Y. Patil School of Ayurveda, NaviMumbai for providing substantial help in preparing Pippalyadi basti packets.
Financial support and sponsorship
Not applicable.
Conflicts of interest
There are no conflicts of interest.
| What This Study Is Added | | |
Panchakarma plays vital role in the management of Medoroga (obesity). Virechan karma is also useful in weight reduction, but after samsarjankram patient regain weight quickly. It is observed in this case that even after one year of Basti karma, patient did not regain weight. Ingredients of PippalyadiBasti are simple, easily available and very effective that we came to know by conducting this study. Role of LekhanBasti is well proven in medoroga however Kalk drugs (OshakaadiGana, that is, Kasis, Tutha, Shilajit, Hingu etc.) of LekhanBasti sometimes create complications that may be avoided by opting PippalyadiBasti for sthoulyachikitsa.
| References | | |
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| 2. | Chakrapani on CharakSamhita, Sutrasthan, Ashtaunindatiyadhyaya 21/4. Available from: http://niimh.nic.in/ebooks/echarak. [Last accessed on 2021 Oct 17]. |
| 3. | Boon NA, Colledge NR Walker BR, Hunter JAA Davidson’s Principles & Practice of Medicine. 20th ed. Edinburgh: Churchill Livingstone; 2006. |
| 4. | Pandey G Dravyagunavijana (English-Sanskrit), Part-1(A-Z). 3rd ed. Varanasi: Chowkhamba Krishna Das Academy; 2005, KaiyadevaNighantu, Oshadhi varga,1179-1180, p. 517. pg. no.113. |
| 5. | TripatiIndradeva, Chakradatta, Sthaulyachikitsaprakaranam Chapter 36, Verse 31-32. Varanasi: Chaukhambha Sanskrit Bhawan; 2014. p. 223. |
| 6. | Dwivedi RN, ed. Harrison’s Principal of Internal Medicine Part-1. McGraw Hill; 2001. p. 1442, pg no – 47. |
| 7. | Nimbalkar SP In: Kasper D, Fauci A, Hauser S, Longo D, Jameson JL, Loscalzo J. Text Book of Yoga For Health & Peace. Mumbai: Yoga Vidya Niketan Publication; 2003. |
[Table 1], [Table 2], [Table 3], [Table 4]
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