Scientific Basis for
Ayurvedic Therapies
edited by
Brahmasree Lakshmi Chandra Mishra
Obesity (Medoroga) in Ayurveda
9.1 Introduction
Several centuries ago before foreign rule, India was one
of the world’s most affluent nations,
and the affluence and sedentary habits at that time were
known to be the leading cause of
obesity.
1,2
This was due to a deadly imbalance of high energy input
through rich foods and
low energy expenditure due to lack of physical exercise.
Daily and seasonal health regimens
Ashok D.B. Vaidya, Rama A. Vaidya, Bharati A. Joshi, and
Nutan S. Nabar
(
swasthavritta
and
ritucharya
) and other modalities, such as detailed instructions on
a proper
balanced diet and appropriate levels of exercise as per
the constitution (
prakriti
) of the person,
have been laid out clearly in Ayurvedic texts.
3
It is interesting to note that the world is now
again focusing on a healthy lifestyle as key to avoiding
risk factors like obesity.
4
The pioneers of Ayurveda, 2 millennia ago, have described
the unhealthy consequences
of obesity. Charaka, who may be called as the Indian
Hippocrates, described obesity as a
disease of the fat tissue (
medoroga
) leading to hugeness (
sthoulyam
).
5
The Sanskrit word
sthoulya
is derived from
sthool
, meaning gross or material.
6
Nondrug and drug modalities
to prevent and reduce obesity were elaborated and
regularly utilized. Even now there are
millions of Indians who do avail themselves of some of
these interventions in their daily
lives. The prevalence of obesity is higher in urban areas
than in rural populations of India,
due to a steady erosion of the Ayurveda way of life in
the cities as well as the sedentary
and overeating habit factor.
Being a holistic system of health care, Ayurveda has
emphasized the psychospiritual
dimensions in its philosophy; mere drugging without
holistic healing is not advocated.
The hierarchy of the spiritual, psychological, and
physical levels of human health and
disease is given due importance.
The disease management approaches in Ayurveda have two
basic principles: repletion
of the body tissues (
brimhan)
or the depletion (
karshan
) of them, as required. For this
process, the groups of modalities used are spiritual and
the karmic interventions (
daivavyapashraya
), astral and psychological measures (
satwavajaya
), and nondrug and drug modalities
(
yuktivyapashraya
). The holistic base of Ayurveda provides a different
kind of evidence
than the current reliance on randomized controlled
trials.
7
The clinical effects are evident
in the field.
This chapter may embolden the open-minded physicians of
the world to learn from
Ayurveda — a live and growing system of health that is
more than 5000 years old.
8
There are leads which can be followed-up proactively for
research, too.
9
The current
understanding of adipose tissue as an endocrine organ
coupled with the successful leads
from Ayurveda may form a scientific basis for the
management of obesity.
10
Already,
Commiphora wightii
(g
uggulu
) is emerging as a drug of global potential for obesity
and
hyperlipidemia.
11
9.2
Agni
and
Srotas
with Reference to Obesity
As per Ayurveda,
agni
is the cosmic fire — the principle of transformations of
materials.
It is the energy or capacity of the body to convert
complex food materials to their constitutents
and then to build the body tissues (
dhatus
).
12
The first and foremost level of
Agni
is digestive fire (
jatharagni
).
13
It digests all types of food in the stomach and the small
intestine. The digested and absorbed essence of the food
material is called
ahar rasa
, which
circulates, providing the substrates for tissues. For
each of the seven tissues, there is a
special energy or digestive power (
dhatwagni
)
14
assimilating the digested substrates. The
lipid precursors are acted upon by fat-specific energy (
medodhatwagni)
for its conversion
into adipose tissue (
medadhatu
). The channels and the loci where these conversions take
place are called
srotas
or
dhatuvahasrotas
. The quality of all the specific energies depends
on the quality of the digestive fire, which is protected
and maintained carefully. The
impairement of the digestive fire and the specific tissue
energies lead to poor availability
of the constitutents and depletion of tissues (
dhatukshaya
).
With the substrates and energies in balance, all the
metabolic activities occur properly
in the channels. Defects in the sources with undigested
matter block tissue channels. A
healthy person is one in whom the activites of humor (
dosa
), tissue (
dhatu
), wastes (
mala
),
fire, mind (
manas
), soul
(atma
), and senses are harmonious and in balance.
15
9.3 Adipose Tissue (
Medodhatu
) and Dynamics
Any disequilibrium in
kapha
humor, fat-specific energy, and waste products of adipose
tissues (
kleda
) leads to a dysfunction of adipose tissue — obesity.
Adipose channels have
two origins: the kidneys, adrenals, and fat around them
(vrukkas)
and the visceral and
omental fat (
vapavahan
).
16
These channels draw the nutritive parts (
medoposhakansh
), including
lipid, from the antedecent flesh (
mansa dhatwagni
) and the transient lipids (
asthayi
) and
then they are converted into a stored form (
sthayi
) of lipid.
Adipose-tissue dynamics is a crucial link for the tissue
metabolism. Low adipose energy,
despite a normal food intake, could lead to a steady
accumulation of fat (
apachith
) and
obesity. Excessive consumption of fat and oils, lack of
exercise, and overindulgence of
wine and sleeping during daytime can disturb the fat
channels, as mentioned in Charaka.
17
9.4 Measurement of Obesity
To determine the normal physique of a person, Charaka
gave a standard termed as
proportionate body (
samasanhanan nara
), with appropriate measurements and compactness.
18
Gangadhar, a later author, has given the measurements of
various parts of body
for a normal physic. According to Charaka, fat gets
deposited mainly in the abdomen
(
udara
), so the measurement of the abdomen size was considered
to determine obesity.
19
The exact dimensions given in the text are not relevant
today.
9.5 Obesity, Health Risks, and Life Span
Recent importance of obesity control and its adverse
impact on health was presaged 1000
years ago by Bhavamishra and Madhavakar. Today, with a
better understanding of the
reference to the importance of the visceral and abdominal
obesity as a cardiovascular risk
factor, the reference in ancient texts seems a valuable
insight of the seers.
19
We have yet
to understand what they have foreseen in the reference
about fat accumulation around
the kidneys. The management of morbid obesity was
considered difficult and the prognosis
grave if other risk factors were also present. Decreased
life span (
ayu-kshaya
) is stated
to be an important consequence of obesity. Even today, early
diagnosis and timely management
of obesity is mostly neglected because few people realize
that obesity is associated
with increased mortality.
20
Charaka emphasized that serious diseases (
darun vikar
) arise
when fat blocks channels. Sushruta describes several
complications of obesity such as
tumors and space-occupying lesions like tumorous growth,
diabetes mellitus (DM), and
excessive perspiration. Thirty to fifty percent
postmenopausal women in the U.S.
are said
to be overweight.
21
9.6 Symptoms and Signs
The three major and three minor Ayurvedic treatises
(i.e., Charak, Sushruta, and Vagbhat
and Madhavnidhan, Bhavaprakasha, and Sharangdhar,
respectively) give detailed
descriptions of obese individuals and their afflications.
Table 9.1 summarizes these descriptions
as given by the first five treatises.
15,19,22–24
Bhavamishra describes additional features
of obesity such as difficulty in breathing and the
emergence of a snoring sound from the
throat while breathing. Snoring and daytime sleepiness are
important markers of obesity
that were well recognized in Ayurveda.
19
In extreme forms of obesity, obesity-hypoventilation
(OHV), or Pickwickian syndrome, and obstructive sleep
apnea (OSA) are severe as
reported in conventional medical literature.
25
They lead to pulmonary hypertension and
often to a degree of cardiac failure. There is a spectrum
of sleep-related disordered breathing
in obesity that varies from simple snoring to OHV.
Recognition of the association of
OSA, obesity, and daytime sleepiness in conventional
medicine is quite recent. Daytime
sleeping contributes to obesity. OSA is associated with
increased rates of hypertension,
stroke, ischemic heart disease, and mortality.
26
9.7 Obesity and Affect Disorders
Obese people are depressed and often experience sadness
as per one of the Ayurvedic texts
(
Bhavamishra
).
19
As physicians, we must recognize that obesity, a
heterogenous disorder, does
have psychopathology as a cause in an individual with a
possible familial, environmental,
TABLE 9.1
Features of Obesity
Symptom Charak Sushrut Vagbhat Bhavmishra Madhavkar
Visceral obesity (
udarvrudhi
) + + + + +
Flaccidity (
angashaithilya
) + _ _ + +
Pendulous abdomen (
chalodara
) + _ + + +
Pendulous breasts (
chala-stana
) + _ + - +
Pendulous buttocks
(chala-sphik)
+ _ + + +
Heaviness in body
(gourav)
+ _ _ _ _
Weakness
(dourbalya)
+ _ _ _ _
Poor self-care
(swakriya-asamarthata)
+ + _ _ _
Less coitus
(krichha-vyavaya)
+ + _ + +
Oversleeping
(nidradhikya)
+ + + + +
Lethargy
(utsaha-nash)
+ + + _ _
Breathlessness (
kshudra-shwasa)
+ + _ + +
Oversweating
(swedati-pravruti)
+ + + + +
Bad body odor
(dourgandhya
) + + + + +
Excessive thirst
(trishnadhikya)
+ + + + +
Polyphagia (
kshudhadikya)
+ + + + +
Delicate and tender
(sukumarata)
+ + _ _ _
Short life (
ayushyarrhasa)
+ + _ + +
or hereditary basis. According to modern medicine,
specific organic causes may rarely be
present. Metabolic and psychological (e.g., depression)
pathologies often present together
and are associated with dysregulation of the hypothalamo-pituitary
adrenal axis.
27
Affect
disorders are also reported among obese binge eaters
(OBEs). Sixty percent of OBE had one
or more psychiatric disorders. Some of the OBEs also had
a lifetime prevalence of affective
disorders as well as more frequent mood fluctuations and
panic attacks.
9.8 Obesity and Diabetes Type 2-NIDDM (
Madhumeha
)
Sushruta, though classifying disorders according to their
causes, has stated obesity and
DM as the disorders of adipose tissue.
28
Charaka attributes the voracious appetite of obese
people to increase in humor (
vata
) and digestive fire, which together rapidly consume
ingested food. This leads to increased frequency and
amount of food intake. This further
increases the fat accumulation, particularly in the
abdomen, breasts, and buttocks. The
extent of fat accumulation, in these parts is so great
that they become pendulous. Clogged
fat channels in Ayurveda, as described earlier, then
cause preclinical symptoms of urinary
disorders (
prameha
) such as perspiration, bad body odor, flaccidity of the
body, a desire
sleep or sit, thickening of layers on teeth, accumulation
of waste in eyes, nose, ears, mouth,
etc., sweet taste in mouth, burning sensation of palms
and soles, and dryness of the throat
and palate.
29
9.9 Etiological Factors for Obesity (
Karana
-
Hetu
)
“The central causes of all disease are the vitiated
Malas
, induced by harmful diet and
lifestyles.”
30
According to Ayurveda, the central cause of almost all
diseases is the vitiation
of wastes (
malas
— the end products of
dhatus
) and vitation of humor (
dosa
provocation).
This is due to harmful regimens of foods and beverages,
rest and exercise, restraint and
indulgence, etc. (see Table. 9.2). Both Ayurveda and
conventional medicine have considered
obesity as multifactorial.
TABLE 9.2
Etiology of Obesity as per Ayurveda
Ayurvedic Factors Allopathic Correlates
No exercise (avyayama)
Dense food (sleshmal
ahara)
Daytime sleeping (diva
swapna)
No sexual intercourse (avyavaya)
No anxiety (achinta)
Genetic (beeja-dosa)
Prodromal signs (prameha-poorvarupa)
Loss of appetite (agnimandya)
Lipotoxicity (medavrittavayu)
Lack of restraint (ahara-asamyama)
Tissue indigestion (apathya-dhatwagni)
Lack of exercise
Fattening diet and foods
Obesity sleep apnea
Difficulty in intercourse
Affect disorders
Genetic basis
Hyperinsulinemia
Low energy expenditure
Defective satiety cascade
Environmental food clues
Stress and hormones
9.10 Diagnosis and Markers of Overweight and Obesity
Differences in overweight (pushta), obesity, and morbid obesity (ati sthoulya) were
recognized
in Ayurveda. The measures of normality of the body
structure have been described
as follows. Charaka described the assessment of obesity
by the patient’s own fingers
(angulapramana), breadth, and length (midcarpal–middle finger level) to
be borders defined
on the abdomen. This may be investigated through the
waist–hip ratio (WHR), waist
circumference (WC), and body–fat ratio analysis.
According to conventional medicine, the body mass index
(BMI) is a simple method of
estimating adiposity. It is calculated as weight in
kilograms divided by the square of the
height in meters (kg/m2). The World Health Organization
(WHO) has classified individuals
as per BMI (Table 9.3). Class 3 obese is considered
morbidly obese.
It is now well recognized that central or visceral
obesity is more important as a risk
factor for cardiovascular diseases (CVDs) and
noninsulin-dependent DM (NIDDM), independent
of general obesity.31 Accurate assessment for the central
and visceral obesity is
paramount in evaluation of obesity. WHR and WC correlate
better with degree of CVD
risks. High accumulation of the upper body fat
(abdominal) is associated with high plasma
triglyceride levels. A high WHR is shown to be associated
with dyslipidemia.
For clinical services and epidemiological studies, the
measurements of height, weight,
BMI, WHR, or WC are important and suffice. For research
purposes, more sophisticated
methods like electrical impedence, dual absorptiometry
(DEXA), and other imaging techniques
such as computered-aided tomography scan (CAT-scan) and
magnetic resonance
imaging (MRI) may be required. Other markers of obesity
are hypertension, hyperpigmentation
(Acanthosis nigricans), skin tags, hirsuitism, menstrual dysfunctions, and
female
infertility. Hyperinsulinemia, hyperglycemia (type II
DM), and hyperlipidemia are given
associated biochemical features.
In a series of 90 cases of polycystic ovarian syndrome
(PCOS) with hirsutism at our
clinic, only 23% had normal weight. The rest were either
overweight or obese. Sixty
percent of these women were in their teens.32 Infertility
and menstrual dysfunctions due
to anovulation, abortions, and increased fetal wastage,
and gestational diabetes are common
among women with PCOS.
9.11 Clinical Course and Prognosis of Obesity
The long-term adverse impact on health has been well
described in Ayurveda, including
diminished life span (vide supra). Obesity-related increase in
complications like NIDDM
TABLE 9.3
Body Mass Index (BMI) and Obesity
Classification BMI (kg/m2)
Normal
Overweight or pre-obese
Obese Class 1
Obese Class 2
Obese Class 3
18.5–24.9
25.0–29.9
30.0–34.9
35.0–39.9
>40
and CVDs (including hypertension and arthritis) are well
known. However, obesityrelated
cryptogenic cirrhosis of the liver and hepatocellular
carcinoma has recently been
recognized. In spite of the rising incidence of obesity
and NIDDM, obese individuals are
often not screened for nonalcoholic fatty infiltration of
the liver and nonalcoholic steatohepatitis
(NASH). Early diagnosis and treatment of NASH in
overweight and obese
patients may prevent hepatocellular carcinoma in
cryptogenic cirrhosis of the liver. The
incidence of the hepatocellular carcinoma among these
patients is reported to be 27%.
This rate is similar to that found among hepatitis C
virus-related cirrhosis (21%). Early
and persistent long-term interventions can certainly
alter the progressive course and
complications of obesity. Even a 5 to 10% loss in body
weight can reduce the risk caused
by obesity. Diet, exercise, and stress management can
also reduce insulin resistance (IR)
in a patient. Ayurvedic way of life is the need for
altering the course of obesity.
Weight gains during adolescence in boys and girls,
enormous weight gains during and
after pregnancy, and peri-post menopausal obesity are
noted frequently in clinics that are
dedicated to management of obesity. These transitional
physiological phases are known to
be associated with changes in insulin resistance (IR) and
physiological hyperinsulinemia.
An antiobesity preventive measure for such physiological
phases for smooth transitions may
save many individuals, particularly women, a lifetime
burden of obesity and its health
consequences.
9.12 Prevention of Obesity
The knowledge of the etiological factors and their
lifelong avoidance, besides the countermeasures,
constitute the foundation of prevention of obesity in
Ayurveda and other systems
of medicine.33
Ayurveda has much to offer for prevention in terms of
daily and seasonal regimens,
healthy foods, yoga exercise, panchakarma, and
medicines. The daily routine in Ayurveda
involves the following:
1. Going to bed early and waking up early
2. Proper eliminations, tongue cleaning, washing, etc.
3. Meditation
4. Massage
5. Sun-yoga-asana (surya-namaskar)
6. Proper clothing
7. Suitable, balanced, and measured dietary intake
8. Adequate fluid intake
9. Family, friends, and community relationships
10. Avoidance of undue stress or exertion
11. Pleasant, healthy, and socially permissible sex life
12. Continuing self-education etc.3
Similarly, as per the seasons and climate and age of the
person, certain regimens are to
be followed to maintain health and prevent diseases. Chyavanprash in the
winter, gulkand
© 2004 by CRC Press LLC
156 Scientific Basis for
Ayurvedic Therapies
in the summer, and ginger candy in the monsoon are taken
still by millions of Indians as
seasonal foods. Bitter and astringent items are also
included in the diet.
Education in daily healthy lifestyle should begin very
early. Functional information on
health, diet, proper exercise, and stress management,
given in an incremental manner at
the school level, would prove beneficial for prevention
of adult obesity. The predictors of
weight gain — genetic, metabolic, and demographic — can
be identified early and appropriate
steps can be taken. Overweight parents have overweight
children. In twin studies,
heritability estimates are 30 to 50%. Early genetic
diagnosis would help identify need for
prevention strategies with the advances in genomics. This
would assist early Ayurvedic
and modern preventive interventions in highly
obesity-prone persons.
Breathing yoga practices (pranayama) under guidance of a proper expert are
advisable
for all persons prone to obesity, besides other measures.
Meditation and yoga physical
and breathing practices (asanas and pranayama) diminish the sympathetic overdrive, which
has a role in inducing IR and obesity. Only massive
public health education and values
of restraint despite affluence can help prevent the
rising prevalence of obesity globally.
Ayurveda and modern medical measures have to be
individualized for their synergy by
practicing doctors and health educators.
9.13 Management of Obesity (Chikitsa)
9.13.1 Purification Modalities
The five modes of eliminating Nature’s waste by panchakarma to
reestablish the harmony
of dosas is a unique gift of Ayurveda.34 These modes are often
preceded by the preparatory
indicated for those who do not exercise or are very obese
or very thin.35 It is also not given
to those who have voracious appetites or anorexia. Before
oil therapy is carried out in the
obese, the vitiated digestive fire will have to undergo
drying through controlled dieting
and then careful oleation will produce benefit. The oil
dose frequency can be individualized
as necessary.
Induced sweating usually after oil therapy is indicated
to transport the vitiated dosas to
the trunk (koshtha). As per Ayurveda, dry heat, hot poultice, slow hot
shower and saunabath,
and hot-water bottles are used to induce sweating.36
Sweating can be induced for
patients with kapha diseases without preceding oil therapy. The parts of the
body to be
warmed have been described and are followed carefully by
the experts. Very obese people
are contraindicated for sweating therapy before reducing
their weight to a reasonable level
with other measures like diet, exercise, and medicine.
Induced therapeutic vomiting is indicated in kapha-dominant diseases. The
procedures,
contraindications, and cautions of this procedure are
well described elsewhere in this
textbook.37 Besides preparations for panchakarma,
follow-up (paschatkarma)
is equally vital.
Only qualified and experienced vaidyas should engage in
panchakarma therapy.
Of the five purification procedures, the enema (basti) is the
major component, as it
controls the vata, which is responsible for the disease. In addition,
enemas also cause
cleaning of bowels (malashooddhi), which reestablish proper balanced metabolism within
the tissue elements. Enema decoction of roots of ten
medicinal plants (dashasmool) and
fruits of three medicinal plants (triphala) are
indicated for their vataghna and tridoshhar
properties frequently used in obesity.39 To prevent
aggravation of vata, an oil enema
oil-therapy (snehan)
and induced sweating (swedana) (see
Chapter 4). Oil
therapy is not
(anuwasan basti) is then given in succession initially. The decoction
and oil enemas are
given alternately until 8 or 15 days, depending upon
symptomatic response. Shirobasti of
oil is also advisable to counter stress element.
9.13.2 Palliative Therapy
For obese patients, according to the symptoms of ama, digestive (dhatwagni deepan) and
carminative (pachan) medications are given. Ayurvedic formulation of a guggulu kalpa
decoction (e.g., triphala
guggulu, medohara guggulu, arogyavardhini, chandraprabhavati, shilajitvati,
loharasayan vati, dashamoolarishta, manjisthadi) are also advised with appropriate
doses (as per age, sex, severity of obesity) with water
or decoction of triphala.
Gentle oil massage is followed by massage with powders of
medicinal plants (turmeric,
sandalwood, rosepowder, manjistha powder, chickpea flour) along
the antidirection of the
lanugo hairs, reducing perspiration and its smell.
A diet known as sansarjankrama
is advised as per the quality results
obtained after
elimination therapy and the state of digestive fire.40 It
includes rice preparations (manda,
peya, vilepi) and
soups of meat in successive days. Some of the preparations are mentioned
in Table 9.4.
The current common treatment of obesity in Ayurveda
involves the following:
1. Nondrug modalities of reasonable fasting with dieting,
exercise, and yoga and
lifestyle changes and counseling to stress, sleep, sex,
etc.
2. Diverse formulations and sometimes single plants with
appropriate individualized
dosage needs
The weight loss is expected to be gradual, long term, and
lasting due to integral care
rather than drastic weight loss advocated by crash
dieting.38 Individual prakruti, aptitude,
tastes, profession, peer support, motivation,
relationships, and stage of obesity are carefully
looked into for a successful outcome of the therapeutic
program.
9.13.3 Baseline Acceptance of the Patient’s State
Hidden within every obese person, a thin person with a
proportionate body is struggling
to emerge. Similarly, in every adult there is a hidden
child who may regress to oral phase
of development under stress.
A physician’s nonjudgmental attitude about the patient’s
body image earns the
patient’s trust and builds the foundation for a
long-term, warm, and effective
patient–physician relationship; it is also essential for
a sustained motivation, continued
long-term compliance management. The repressed sexuality
has to be rekindled by
subtle and persistent professional counseling, as lack of
sexual intercourse is one of the
TABLE 9.4
Preparations To Be Taken after Panchakarma Therapy
Preparation Frequency of Intake after Elimination Therapy
Gruel (peya) 3 times/day
Rice gruel (vilepi) 3 times/day
Incomplete soup (akruta
yusha) 3 times/day
Complete soup (kruta
yusha) 3 times/day
Incomplete meat soup (akruta mansarasa) 3 times/day
Complete meat soup (kruta
mansarasa) 3 times/day
© 2004 by CRC Press LLC
158 Scientific Basis for
Ayurvedic Therapies
causative factors in obesity in Ayurveda. The aforesaid
have to be complemented by
lifestyle changes in exercise, sleep, and stress
management. The patient’s friend, spouse,
or family member, as well as the team, has to be firm and
supportive for long-term care
and compliance (chatushpada).
9.13.4 Dietary and Nutrient Diet
The diet for treating obesity has to be individualized as
per the level of the caloric needs,
energy expenditure, tastes, lifestyle, weight-loss goals,
medicines, and other measures
used. No formula diets or regimens are usually followed
in Ayurveda. In reducing the
bulk of a person, food that is heavy but falls in the
category of a low-fat diet (apatarpan)
is beneficial. Roasted pulses (bharjit dhanya) such as
green beans (mudga),
dolichos (kulatha),
and barley (yava) are beneficial.
9.13.5 Energy Expenditure and Hormonal Stress
As per Charaka, occasional staying awake at night, sexual
intercourse, physical exercise,
and mental exertion should also be gradually indulged in
to reduce fat. The patients are
advised to walk at least 1 h in the morning or evening
with regularity and consistency.
Adolescent and young adults are advised to engage in
vigorous sports and exercise.
Movements of shoulder girdle and pelvic girdle are
advised to prevent sarcopenia (mansadaurbalya).
Yoga, particularly physical asanas (hathayoga) with
mind control (rajayoga),
is to be integrated in daily routine. Yoga in everyday
life (i.e., sun salutations [suryanamaskar])
is an excellent dawn practice that has been and continues
to be an integral part of
Indian life.
9.14 Scientific Basis: Clinical Studies
At hundreds of Ayurvedic hospitals and clinics in India, obesity
is being treated with
diverse modes. It is desirable to analyze carefully
maintained records of many obese
patients by pharmacoepidemiological methods. At our
Bhavan’s Swami Prakashananda
and Ayurveda Research Centre (SPARC), we have ambulant
care of patients with obesity
and the drug treatment given in female patients with
their usual unmodified diet and
exercise.
In one study at our clinic, patients were given standard
doses of the formulations. It is
interesting to note that only two women showed no change,
despite the fact that one was
given the formulations for 4 months. A weight loss of 1
to 3 kg was observed in four
patients within 1 to 2.5 months. There were seven
patients who showed a 4- to 6.5-kg
weight loss and received the formulations for 3.5 to 6
months. Significant weight loss (4
to 5 kg) occurred in two patients within a month and
surprisingly within 1 week in a
single subject. Besides arogyawardhini there is a widespread use of medohar-guggulu (MHG),
a formulation based on Commiphora wightii, in India. The
experiential data suggest the
need to increase the dose, as per the individual needs of
the patient, and concurrently
by Ayurvedic and modern experts. Table 9.5 shows in brief
the basal and final body weights
advise essential diet and exercise measures. Then the
magnitude and the rate of weight
loss is expected to be more. Our studies with guggulu preparations
in arthritis have
highlighted the need to use larger doses than usually,
and hesitantly, prescribed.41 Panchakarma,
too, should be judiciously combined for integral therapy.
However, some
patients who are given higher doses of guggulu may
complain of gastrointestinal irritation
and burning.
At Bhavan’s SPARC, the experiential data on the larger
doses of different guggulu
preparations and with a compliance for moderate diet and
exercise, as well as steam and
massage, showed interesting confirmation of the aforesaid
statement of titrating the dose.
Thirty-two of 36 patients with an average weight of 81 kg
had lost an average of 3.6 kg
in 4 weeks with a weight-loss range of 2 to 20 kg; 7 of
them had lost more than 10 kg.
Guggulu has been
considered lipolytic (medohara) since ancient times. Hypolipidemic
effects have been well demonstrated both experimentally
and clinically.
In a placebo-controlled trial of 70 obese subjects,
Patwardhan et al.42 showed significant
weight loss, decrease in body measurements, and a decline
in serum cholesterol and
triglycerides with Ayurvedic formulations (i.e., guggulu preparations
used were triphala
guggul, gokshuradhi guggul, and sinhnad guggul). The
placebo group did not show any
change in body weight or other variables mentioned above.
9.15 Ayurvedic Drugs and Medicinal Plants for Obesity
For obesity, many plants and formulations have been
described in the Ayurvedic texts
and are also currently used by Ayurvedic physicians. The
herbs are chosen based on
Ayurvedic pharmacology, which relies on taste and other
physical-chemical properties for
its action. Medicinal plants having bitter (tikta), pungent (katu), astringent (kashay) tastes,
TABLE 9.5
Response in Ambulant Obese Patients to Ayurvedic Therapy
Initials Sex
Age
(Years)
Body Weight (kg)
Treatment
Givena
Duration
(Months)
Change
Initial During End (D kg)
AJ
AS
AG
SS
MB
AS
JP
PM
LD
EJ
BS
SM
MT
F
F
F
F
F
F
F
F
F
F
F
F
F
40
34
52
38
39
33
44
45
43
35
32
54
53
79
64
75
95
75
90
60
98
64
63
64
91
79
76
63
72
93
—
—
55.5
—
63
62
64
91
78
75
59
70
90
71
86
53.5
95
62
63
64
90
77
MHG, AW, SV
AV, TG
MHG, AW, SV
MHG, AW
MHG, AW, SV
MHG, AW, SV
MHG, AW
MHG, AW, SV
MHG, AW, SV
MHG, AW, SV
MHG, AW, SV
AW, SV
MHG, AW, TG
6
1
3.5
8
1
1
4.5
2
2
4
1.5
1.5
2.5
–4
–5
–5
–5
–4
–4
–6.5
–3
–2
0
0
–1
–2
Source: Bhavan’s Swami Prakashananda
Ayurveda Research Centre (SPARC).
aMHG = Medoharaguggulu; AW = Arogyawardhini; SV =
Shankhvati; TG = Triphalaguggulu.
and light (laghu), dry (ruksha), rough (khara), subtle (sukshma), sharp (tikshna
guna), hot
(ushna veerya), and pungent (katu
vipak) properties are used to treat obesity. Substances
having sweet (madhur), sour (amla), and salty (lavan) tastes increase fat, whereas bitter,
pungent, and astringent tastes have a reverse effect.
Bitter tastes are dry, cold, and light (ruksha, sheeta, and laghu); they stabilize skin and
flesh in the body and absorb subtle liquid waste products
(kleda),
excessive fat, excessive
mucus, pus, sweat, urine, stool, and humor (agni and apa)43 (e.g., neem [Azadirachta indica
Linn.] and kutaki [Picrorrhiza kurroa]).
Pungent tastes have similar properties like bitter,
light, and dry tastes but are unlike hot
tastes. They act on the fat tissue through scraping (lekhan) and channels its excretion
through sweat, urine, stool, etc. They also destroy
coughing (e.g., ginger [Zingiber officinalis
Roscoe] and pipali [Piper longum]). Astringent tastes are dry, cool, and heavy; they
basically
suppress pitta but also act on kapha.
The property of a substance, called guna, is equally important when
selecting it as a
medicine. In obesity, substances having light, dry, and
rough properties are used. It also
should have minute and sharp properties. Substances that
are light and easy to digest
relieve kapha and increase vata and digestive power (agni). They also cause depletion of
tissues in the body, scrape out (lekhan) excessive fat, and clear the
channels of the body
for waste. Together, this brings lightness in the body.44
Dry substances absorb water and create hardness and
dryness. They aggravate vata and
reduce kapha.45 The rough property of substances increases vata, depletes the constitutents
of the body, and absorbs water. Substances having these
three gunas will
reduce kapha and
increase vatta in obese patients; combined action of these properties on
fat will be through
scraping (lekhan), drying, and depleting through various
channels in the form of waste.
Sharp (tikshna)
substances act as sharp-edged weapons and
cause depletion of tissues and
thereby emaciation of the body — this process is called lekhana.46 The
hot quality and bitter
taste of a substance has light, dry, and sharp and subtle
(sukshma)
properties that act on
obesity as described above.
9.16 Formulations Used and Cited (Aushadhi-Yogas)
Various formulations containing three to eight medicinal
plants in the form of a decoction
(quath), powder (churna), and tablet (vati) are widely used based on its description in the
47–55
9.16.1 Single Plants Used for Obesity
Although Ayurveda commonly uses multiple plants in the
formulations, with varying
ingredients and concentrations, single plants have also
been mentioned in the text.
or with a follow-through vehicle (anupan). Many of these tikta/katu in rasa are light,
dry, and rapidly acting (tikshna) in guna, hot in veerya, and usually pungent in vipaka.
Most of these are antiobesity (medohara) and
pacifying vata and kapha dosas. The
groups
of scraping, digestive (pachaniya), and appetite stimulating (deepaniya)
dominate.
ancient text and are given in Table 9.6.
Table 9.7 lists many plants and their parts used either
individually or in combination
9.17 The Future of Ayurvedic Modalities for Obesity
Certain Ayurvedic modalities bear close resemblance to
several nondrug approaches of
modern medicines. These modalities can be judiciously
combined for individualizing
prevention and therapy of obesity and are listed below:
1. Ayurvedic modes of fasting and dietary regulations
over long-term period56
2. Yoga, suryanamaskara, and exercise integrated in daily activities57
3. Shodhana complementary to obesity programs by vaidya experts
for induced vomiting,
laxation, etc., as per Ayurvedic fundamental principles58
4. Advocating frequent sexual intercourse, keeping awake,
experiencing anxiety and
concern for dear ones and social issues59
5. Adopting an inner mind-set change for a new body image
Commonly used drugs and herbs can be adopted by
non-Ayurvedic family doctors and
obesity specialists who are willing to learn from
transcultural healing traditions. These
would include the following:
TABLE 9.6
Formulations Used for Obesity
Formulations Plants Botanical Name Parts Used
Triphaladiquath
Bilvadhiquath
Trayushanadya-churna
Vidangadi-churna
Amrutadiguggulu
Haritaki
Bibhitaki
Amla
Bilva
Adulsa/Vasa
Kashmiri
Patala
Pippali
Shunthhi
Marich
Vidanga
Shunthhi
Yavamal/Yavakshar
Kantloh Bhasma
Amla
Guduchi
Chota Eliachi
Vidanga
Indrajav
Harali
Behada
Amala
Guggulu
Terminalia chebula Retz.
Terminalia belerica Roxb.
Emblica officinalis Gaertn.
Aegle marmelos Corr.
Adhatoda vasica Nees.
Gmelina arboria Linn.
Stereospermum suaveolens
Piper longum Linn.
Zingiber officinale Roscoe
Piper nigram Linn.
Embelia ribesburm Brum. F.
Zingiber officinale Roscoe
Alhaji mourorum
Iron formulation
Emblica officinalis Gaertn.
Tinospora cordifolia
Elettaria cardmomum
Embelia ribes Burm.
Holarrhena antidysentrica
Terminalia belerica
Emblica officinalis Gaertn.
Commiphora wightii
Fruits
Fruits
Fruits
Roots
Roots
Roots
Roots
Fruits
Rhizome
Seeds
Seeds
Rhizome
Om Tat Sat
(Continued...)
(My
humble salutations to H H Maharshi ji, Brahmasri
Sreeman Lakshmi Chandra Mishra ji and other eminent medical scholars and
doctors for the collection)
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