STHOULYA (OBESITY)  Treatment Protocol by Ayush

INTRODUCTION

Sthaulya is excessive body weight due to vitiated status of Kapha, Rasa and Meda. Certain genetic characteristics may increase an individual’s susceptibility to excess body weight. Atisthaulya has been discussed under Ashtanindita Purusha (eight undesirable conditions).

Case Definition

Increased body mass i.e. BMI more than >25 (kg/m2) associated with pendulous abdomen-buttocks-breasts, dyspnea on exertion, weakness, excessive perspiration and hunger, is termed as Sthaulya.

Differential Diagnosis:

• Metabolic syndrome,
• Hypothyroidism,
• Cushing syndrome
• PCOD

LEVEL 1: AT SOLO AYUVEDIC PHYSICIAN’S CLINIC/PHC

Clinical Diagnosis: Clinical presentation i.e. overweight/obese, BMI more than 25 (kg/m2), waist circumference value more than 80 cm in female and 102 cm in male, patient can be diagnosed as case of Sthaulya.

Investigations: Nothing specific

Examination:

• BMI which includes weight measurements
• Waist circumference values
• Anthropometry measurements

Treatment: Obesity being life style disorder, diet restriction, physical exercise with life style modification is the most important part of management.

• If the patient presents with features of Ama and impaired digestion, for the beginning few days Trikatu powder or a mixture of Haritaki, Guduchi and Shunthi powder in the dose of 3-6 gm, before meal twice daily shall be given for 2-3 weeks with lukewarm water.
• Similarly, patient complaining of constipation and low appetite shall be treated first with laxatives like Triphala powder or Haritaki powder 5-6 gm twice daily empty stomach with lukewarm water.
• In addition, patient may be encouraged to drink medicated warm water like Musta Siddha Jala, Triphala Siddha Jala instead of taking normal water

Table 12.1: Medicines at level 1 for Sthaulya

Note: selection of above drugs depends upon the status of obesity, e.g.

Patients having overweight i.e. BMI between 25 and 30 and have no other associated conditions like hypothyroidism or positive family history of obesity, may be given drugs like Triphala powder, Haritaki

powder or Triphala Guggulu Vati or Gomutra Haritaki Vati along with strict diet and life style modification.

• Patients having BMI between 30 and 35, may be given above mentioned drugs with Anupana of Phalatrikadi

Kwatha or drugs like Kanchanara Guggulu, Medohara Guggulu or Vidangadi Lauha may be added. Patients having Udavarta like pathogenesis i.e. chronic history of severe constipation and having Kapha dominant Prakriti may be better treated with Arogyvardhini, Abhyarishta, Katuki powder or Gomutra Haritaki Vati.

• Patients having BMI more than 35 and having genetic predisposition may be given long term manage­ment and if needed, may be re­ferred to higher centers for better management.

Pathya–Apathya (Diet and life style):

Do’s –

• Ahara: Chapatti prepared with Yava (barley), maize, millet like Jowara, Ragi; regular use of Laja (puffed rice/ grains), Moonga Daal (green gram) with or without husk or sprouted or Tuvar Daal in food. Use of fruits like papaya, orange, sweet lemon, co­conut water, salads prepared with cucumber, carrot, radish, spinach etc. Vegetables soups prepared of Patola (Trichosanthes dioica), gourd etc. Luke warm water and seasoned honey.
• Vihara: Waking up early morning, regular exercises, brisk walking, swimming, playing outdoor games, Yoga.

Don’ts–

• Ahara: Heavy fried food, black gram, refined foods such as white

flour, peas, chick peas, potatoes, curd, milk, fermented and bakery items, day sleep,

• Vihra: excess sleep and sedentary life style

Referral criteria: Patients not responding to above mentioned management, BMI more than 35, having genetic or hormonal involvement or uncontrolled hypertension, diabetes, hypothyroidism or IHD

LEVEL 2: CHC’S OR SMALL HOSPITALS WITH BASIC FACILITIES

Clinical diagnosis: Same as Level 1: For a fresh case reporting directly.

Sthaulya due to hormonal imbalance should be treated depending upon the underlying pathogenesis.

Investigation: Same as level 1: In addition

• Thyroid function test

Treatment:

• Patient suffering from Hypothy­roidism may be given additional treatment like Kanchanara Guggulu, Chincha Bhalltaka Vati, Varuna Shigru Kwatha, Amrutadi Guggulu, Vardha­mana Pippali Rasayana. In addition, external treatment in the form of Udvartana with Triphala Churna, barley powder or Bashpa Swedana may also be done.
• Patients suffering from Diabetes Mellitus may be given Phalatrikadi Kwatha, Guduchyadi Kwatha, Shilajatu.

Table 12.2: Medicines at level 2 for Sthaulya

In addition to it,

Mridu Virechana: As per the status of the patient, Mridu Virechana/Koshtha Shuddhi with Haritaki powder 5-10 gm with warm water 3-5 days before treatment. Similarly patient may be kept on fasting for early few days.

Pathya–Apathya (Diet and life style): Same as level 1

Referral criteria: Cases not respond­ing to above therapy and needs further management in the form of Panchakarma procedures.

LEVEL 3: AYURVEDA HOSPITALS AT INSTITUTIONAL LEVEL OR DISTRICT

HOSPITAL / INTEGRATED AYURVEDIC HOSPITALS

Clinical Diagnosis: Same as Level 1 for a fresh case reporting directly

Investigation: Hormonal assessment for endocrinal disorders

Treatment: In addition to the management of Level 1 and Level 2, Panchakarma procedures as follows:

Vamana:

• Vamana Karma but for Snehana should be either avoided or oil should be used instead of Ghrita1.

Virechana:

• Virechana Karma with Triphala Kwatha 100 ml along with Eranda (castor) oil 40 ml or any other suitable Virechana Kalpa

Tikshna Basti: Kshara Basti, Lekhana Basti

Rasayana:

1. Shilajatu Rasayana Kalpa
2. Amalaki Rasayana Kalpa
3. Vardhamana Pippali Rasayana Kalpa
4. Vidangadi Rasayana Kalpa
5. Haritakyadi Rasayana Kalpa

Pathya–Apathya (Diet and life style): Same as Level 1

REFERENCES

1.Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part I, vol. III (59)

2 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part I, vol. I (31)

3 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part I, vol. II (40)

4 Anonymous, The Ayurvedic Pharmacopoe­ia of India, Ministry of Health and Family Welfare, Govt. of India, Part I, vol. I (77),2000

5 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (7/8), 2000

6 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part II (4/16), 2000

7 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (5/1), 2000

8 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (5/5), 2000

9 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (21/10), 2000

10 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (1/1), 2000

11 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (20/4), 2000

12 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (1/32), 2000

13 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (8/21), 2000