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=== Introduction ===

=== Introduction ===

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Charaka has laid down the foundation of genetic/hereditary and endocrinal disorders in relation to four pairs of opposing (and undesirable) physical characteristics- height (too tall, too short), body hair (too hairy, hairless), complexion (too dark, too light), and body mass (too obese, too lean). Among these, ''atisthula'' (morbid obesity) is the most undesirable characteristic because it is associated with several life-threatening complications including diabetes, hypertension, coronary artery diseases, joint disorders, skin disorders, anorectal problems, etc. This chapter focuses on the features of a healthy physical constitution of a person, definitions of sleep, as well as key concepts associated with disease management such as etiopathogenesis, clinical presentation, prognosis, and management of ''atisthula''. Some key etiological factors of ''atisthula'' include dietary and lifestyle indicators (e.g., sedentary habit and high-calorie diet), and genetic and hereditary factors. This chapter also describes the pathogenesis of ''atisthula'' in detail, involving ''rasa'' (plasma) and ''meda'' (adipose tissue) as important ''dushyas'' (affected tissues). Modern medicine has acknowledged the role of ''meda'' (adipose tissue) as a principal ''dushya'', with  obesity and dyslipidemia regarded as the main components of the basic matrix of this disease and its related disorders<ref name=ref1>Pandey A. K and Singh R. H.:  “A Study of the Immune status in patients of diabetes mellitus and their Management with certain NaimittikaRasayana drugs”, JRAS. Vol. XXIV. No. 3-4, 2003; 48-61. </ref>  <ref name=ref2>Pandey A.K and Singh R.H. (2012): A Clinical Study on Certain Diabetic Complications under the Influence of Naimittika Rasāyana Therapy w.s.r. to Niśāmalakī and Śilājatu), PhD. Thesis, Department of Kayachikitsa,, IMS, BHU, Varanasi. </ref> <ref name=ref3>Jaspreet Singh & A. K. Pandey: Clinical Evaluation of Puskaramula (Inula racemosa) Capsule in the patients of Metabolic syndrome”, International Journal of Medicine and Pharmaceutical Sciences (IJMPS), ISSN(P): 2250-0049; ISSN(E): 2321-0095, Vol. 4, Issue 2, Apr 2014, 9-20. </ref>. The recent concept of “metabolic syndrome” was already recognized in [https://en.wikipedia.org/wiki/Ayurveda Ayurveda]. Biomedical science points that overweight individuals experience greatly elevated morbidity and mortality from various ailments including cardiovascular diseases<ref>National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Bethesda, Md: National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases; 1998. </ref> <ref>Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci. 2001;321: 225–236. </ref>

Charaka has laid down the foundation of genetic/hereditary and endocrinal disorders in relation to four pairs of opposing (and undesirable) physical characteristics- height (too tall, too short), body hair (too hairy, hairless), complexion (too dark, too light), and body mass (too obese, too lean). Among these, ''atisthula'' (morbid obesity) is the most undesirable characteristic because it is associated with several life-threatening complications including diabetes, hypertension, coronary artery diseases, joint disorders, skin disorders, anorectal problems, etc. This chapter focuses on the features of a healthy physical constitution of a person, definitions of sleep, as well as key concepts associated with disease management such as etiopathogenesis, clinical presentation, prognosis, and management of ''atisthula''. Some key etiological factors of ''atisthula'' include dietary and lifestyle indicators (e.g., sedentary habit and high-calorie diet), and genetic and hereditary factors. This chapter also describes the pathogenesis of ''atisthula'' in detail, involving ''rasa'' (plasma) and ''meda'' (adipose tissue) as important ''dushyas'' (affected tissues). Modern medicine has acknowledged the role of ''meda'' (adipose tissue) as a principal ''dushya'', with  obesity and dyslipidemia regarded as the main components of the basic matrix of this disease and its related disorders<ref name=ref1>Pandey A. K and Singh R. H.:  “A Study of the Immune status in patients of diabetes mellitus and their Management with certain NaimittikaRasayana drugs”, JRAS. Vol. XXIV. No. 3-4, 2003; 48-61. </ref>  <ref name=ref2>Pandey A.K and Singh R.H. (2012): A Clinical Study on Certain Diabetic Complications under the Influence of Naimittika Rasāyana Therapy w.s.r. to Niśāmalakī and Śilājatu), PhD. Thesis, Department of Kayachikitsa,, IMS, BHU, Varanasi. </ref> <ref name=ref3>Jaspreet Singh & A. K. Pandey: Clinical Evaluation of Puskaramula (Inula racemosa) Capsule in the patients of Metabolic syndrome”, International Journal of Medicine and Pharmaceutical Sciences (IJMPS), ISSN(P): 2250-0049; ISSN(E): 2321-0095, Vol. 4, Issue 2, Apr 2014, 9-20. </ref>. The recent concept of “metabolic syndrome” was already recognized in Ayurveda. Biomedical science points that overweight individuals experience greatly elevated morbidity and mortality from various ailments including cardiovascular diseases<ref>National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Bethesda, Md: National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases; 1998. </ref> <ref>Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci. 2001;321: 225–236. </ref>

    

    

Obesity research is focused on preventive measures and management of complications like prediabetes, diabetes, metabolic syndrome, hypertension, stroke, coronary heart disease, congestive heart failure, cardiomyopathy, and arrhythmia/sudden death<ref>Singh Jaspreet & Pandey A.K. (2012): Clinical Evaluation of Pushkarmula churna in the patients of metabolic syndrome w.s.r, to Ojas and Agni MD (Ay) Department of Kayachikitsa, IMS, BHU, Varanasi. </ref>. In the modern world, obesity has emerged as a serious health issue in both developed and developing nations and is recognized as one of the most serious public health problems of the 21st century. In 2008 the WHO estimated that globally, at least 500 million adults (or approximately 1 in 10 adults) are obese, with higher rates among women than men. Obesity is the reason for about 80% of type 2 diabetes, about 70% of cardiovascular diseases, and 42% of breast and colon cancers today. In the past two decades, the number of overweight children and adolescents has doubled<ref>Lau D.C. et al (April 2007). "2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]", CMAJ , 176 (8): S1–13. </ref>. The rate of obesity also increases with age at least up to 50 or 60 years old. Once considered a problem specific to only high-income countries, obesity has acquired pandemic proportions and is affecting people globally<ref>World Health Organization (WHO) (2000). Obesity: Preventing and Managing the Global Epidemic. Report on a WHO Consultation. Geneva. (WHO technical report series 894). </ref> <ref>P.J.English, M.A.Ghatei, I.A.Malik, S. R. Bloom and J. P. H. Wilding ( June-1, 2002): Food fails to suppress ghrelin levels in obese humans, The Journal of Clinical Endocrinology & Metabolism, 87(6):2984–2987. </ref>.

Obesity research is focused on preventive measures and management of complications like prediabetes, diabetes, metabolic syndrome, hypertension, stroke, coronary heart disease, congestive heart failure, cardiomyopathy, and arrhythmia/sudden death<ref>Singh Jaspreet & Pandey A.K. (2012): Clinical Evaluation of Pushkarmula churna in the patients of metabolic syndrome w.s.r, to Ojas and Agni MD (Ay) Department of Kayachikitsa, IMS, BHU, Varanasi. </ref>. In the modern world, obesity has emerged as a serious health issue in both developed and developing nations and is recognized as one of the most serious public health problems of the 21st century. In 2008 the WHO estimated that globally, at least 500 million adults (or approximately 1 in 10 adults) are obese, with higher rates among women than men. Obesity is the reason for about 80% of type 2 diabetes, about 70% of cardiovascular diseases, and 42% of breast and colon cancers today. In the past two decades, the number of overweight children and adolescents has doubled<ref>Lau D.C. et al (April 2007). "2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]", CMAJ , 176 (8): S1–13. </ref>. The rate of obesity also increases with age at least up to 50 or 60 years old. Once considered a problem specific to only high-income countries, obesity has acquired pandemic proportions and is affecting people globally<ref>World Health Organization (WHO) (2000). Obesity: Preventing and Managing the Global Epidemic. Report on a WHO Consultation. Geneva. (WHO technical report series 894). </ref> <ref>P.J.English, M.A.Ghatei, I.A.Malik, S. R. Bloom and J. P. H. Wilding ( June-1, 2002): Food fails to suppress ghrelin levels in obese humans, The Journal of Clinical Endocrinology & Metabolism, 87(6):2984–2987. </ref>.

      

      

<ref>Pandey, A. K. (2015):  </ref>Any course of treatment for obesity suggested by modern medical practitioners primarily includes dietary changes and physical exercise followed by anti-obesity drugs that help reduce appetite or inhibit fat absorption. In severe cases, various invasive and non-invasive surgical procedures could be prescribed - such as partial gastrectomy, gastric bypass, banding, gastric balloons, etc<ref>Puhl R, Brownell KD (December 2001): "Bias, discrimination, and obesity". Obes. Res.9 (12): 788–805. doi:10.1038/oby.2001.108. PMID 11743063. </ref>. However, [https://en.wikipedia.org/wiki/Ayurveda Ayurveda]’s approach to weight management is very different in that it does not recommend pills or surgeries for inducing drastic weight-loss. Instead, [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] advocates dietary restrictions according to the ''prakriti'' (predisposition or temperament of the patient), moderate exercise, practice of ''yogasanas'' and ''pranayama'', besides certain ayurvedic medications and bio-purificatory measures for its management<ref>Pandey A.K. (2013-2014): Conceptual background on obesity (sthaulya/medoroga) & an approach for its management through ayurveda, chapter published in a book ‘Integrative approach to metabolic syndrome’ published by Mahima research foundation and social welfare, Varanasi, UP, India, 2013-2014, p.no.-47-59. </ref>.

<ref>Pandey, A. K. (2015):  </ref>Any course of treatment for obesity suggested by modern medical practitioners primarily includes dietary changes and physical exercise followed by anti-obesity drugs that help reduce appetite or inhibit fat absorption. In severe cases, various invasive and non-invasive surgical procedures could be prescribed - such as partial gastrectomy, gastric bypass, banding, gastric balloons, etc<ref>Puhl R, Brownell KD (December 2001): "Bias, discrimination, and obesity". Obes. Res.9 (12): 788–805. doi:10.1038/oby.2001.108. PMID 11743063. </ref>. However, Ayurveda’s approach to weight management is very different in that it does not recommend pills or surgeries for inducing drastic weight-loss. Instead, Ayurveda advocates dietary restrictions according to the ''prakriti'' (predisposition or temperament of the patient), moderate exercise, practice of ''yogasanas'' and ''pranayama'', besides certain ayurvedic medications and bio-purificatory measures for its management<ref>Pandey A.K. (2013-2014): Conceptual background on obesity (sthaulya/medoroga) & an approach for its management through ayurveda, chapter published in a book ‘Integrative approach to metabolic syndrome’ published by Mahima research foundation and social welfare, Varanasi, UP, India, 2013-2014, p.no.-47-59. </ref>.

The etiology, pathogenesis, clinical features and consequences of extreme leanness (''atikrisha''), as an outcome of ''rasakshaya'' (decrease of ''rasa''), ''medokshaya'' (decrease of ''meda'') and ''mamsakshaya'' (decrease of ''mamsa'') have also been described in this chapter. The two basic approaches for management of ''atikrisha'' and ''atisthula'' are augmentation (''brimhana'') and depletion (''karshana'') of body tissues respectively. Various drug and non-drug modalities have been suggested for the replenishment of ''dhatus'' and their nourishment to attain good health. In this regard, ''Rasayana'' drugs of [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] help balance hormones, promote essential nutrition and enhance immunity to ''atisthula'' and ''atikrisha'' respectively. As mentioned earlier, this chapter also emphasizes the role of good ''nidra'' (sleep) in maintaining a healthy life. In fact, as per [https://en.wikipedia.org/wiki/Ayurveda Ayurveda], after ''ahara'' (diet), ''nidra'' is one of the three sub-pillars of life (''trayopastambha'') and has a significant place in preventive medicine because normal sleep helps prevent diseases and unwholesome sleep may lead to fatal diseases. In [https://en.wikipedia.org/wiki/Ayurveda Ayurveda], ''nidra'' is considered a ''brimhana'' (nourishing) agent that promotes physical and mental health and enhances immunity<ref>Vd. H.S.KHushvaha (2009). Agniveshakrita Charaka Samhita, Sutrasthana-11, Varanasi, Chaukhambha Orientalia, 2009.  </ref>.

The etiology, pathogenesis, clinical features and consequences of extreme leanness (''atikrisha''), as an outcome of ''rasakshaya'' (decrease of ''rasa''), ''medokshaya'' (decrease of ''meda'') and ''mamsakshaya'' (decrease of ''mamsa'') have also been described in this chapter. The two basic approaches for management of ''atikrisha'' and ''atisthula'' are augmentation (''brimhana'') and depletion (''karshana'') of body tissues respectively. Various drug and non-drug modalities have been suggested for the replenishment of ''dhatus'' and their nourishment to attain good health. In this regard, ''Rasayana'' drugs of Ayurveda help balance hormones, promote essential nutrition and enhance immunity to ''atisthula'' and ''atikrisha'' respectively. As mentioned earlier, this chapter also emphasizes the role of good ''nidra'' (sleep) in maintaining a healthy life. In fact, as per Ayurveda, after ''ahara'' (diet), ''nidra'' is one of the three sub-pillars of life (''trayopastambha'') and has a significant place in preventive medicine because normal sleep helps prevent diseases and unwholesome sleep may lead to fatal diseases. In Ayurveda, ''nidra'' is considered a ''brimhana'' (nourishing) agent that promotes physical and mental health and enhances immunity<ref>Vd. H.S.KHushvaha (2009). Agniveshakrita Charaka Samhita, Sutrasthana-11, Varanasi, Chaukhambha Orientalia, 2009.  </ref>.

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==== Consequences of obesity (verse 5-8) ====

==== Consequences of obesity (verse 5-8) ====

Serious diseases (''daruna vikara'') are the outcome of excessive obesity due obstruction of body channels by the ''medas''. This indicates ancient wisdom of [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] ''acharyas'', which is comparable to the impact of obesity on health perspectives of biomedical science<ref>Mishra, L.C. (2003). Scientific Basis of Ayurvedic therapy, Chapter 9 Obesity (Medoroga) in Ayurveda; eBook, published by CRC press, Taylor & Francis Group.  </ref>. We have yet to understand what they had foreseen in reference to fat accumulation around the kidneys. Decreased life span (''ayukshaya'') is stated to be an important consequence of obesity in [https://en.wikipedia.org/wiki/Ayurveda Ayurveda]. According to contemporary science, metabolic and psychological pathologies are often present together and are associated with dysregulation of the hypothalamic-pituitary-adrenal axis<ref>Boulpaep, Emile L.; Boron, Walter F. (2003). Medical physiologya: A cellular and molecular approach. Philadelphia: Saunders. p. 1227. ISBN 0-7216-3256-4 </ref>. Affect disorders are also reported among obese binge eaters. The National Institute of Health, USA has issued an alert labeling obesity a "Killer disease" due to its health-related consequences such as coronary disease, diabetes mellitus, hypertension, hyperlipidemia, kidney disorders, gallbladder disorders, cancer of colon, pancreas, breast, uterus, kidney and gallbladder, osteoarthritis, menstrual irregularities in females, cryptogenic cirrhosis of the liver and hepatocellular carcinoma, insulin resistance, and physiological hyperinsulinemia. Some of the social consequences of obesity could include divorces, due in part to reduce sexual activities between partners. Besides there, transitional physiological phases such as weight gain during adolescence in boys and girls, post-natal weight gain in women, and peri-post menopausal obesity are frequently noted in clinical settings that warrant special care and management<ref> Kuniko Takagi, Romain Legrand, Akihiro Asakawa, Haruka Amitani, Marie François, Naouel Tennoune, Moïse Coëffier, Sophie Claeyssens, Jean-Claude do Rego, Pierre Déchelotte, Akio Inui, Sergueï O. Fetissov. Anti-ghrelin immunoglobulins modulate ghrelin stability and its orexigenic effect in obese mice and humans. Nature Communications, 2013; 4 DOI: 10.1038/ncomms3685, site on 08/02/2014. </ref>  <ref>Grundy SM (2004). "Obesity, metabolic syndrome, and cardiovascular disease". J. Clin. Endocrinol. Metab.89 (6): 2595–600. doi:10.1210/jc.2004-0372. PMID 15181029. </ref> <ref>Foster, W.R. and Burton, B.T.(1985). Health implication of obesity, Ann. Intern.Med., 103, 1024.  </ref> <ref>Grunstein, R.R. and Widcox, I. (1994). Sleep-disordered breathing and obesity, Clin.Endocrinol.Metab. Baillier’s, 8, 601.  </ref> <ref>Daugero, K.D. (2001). A new perspective on glucorticoid feedback: relation to stress, carbohydrate feeding and feeding behavior, J. Neuroendocrinol., 13, 1088.  </ref> <ref>Larsson, B. et al (1984), Abdominal adipose distribution, obesity and risk of cardiovascular disease  and death: 13 year follow up of participants in the study of men born in 1913, Br. Med. J., 288, 1401. </ref> <ref>Esposito K. et al (2004). "Effect of lifestyle changes on erectile dysfunction in obese men: A randomized controlled trial". JAMA, 291 (24): 2978–84.  </ref>.

Serious diseases (''daruna vikara'') are the outcome of excessive obesity due obstruction of body channels by the ''medas''. This indicates ancient wisdom of Ayurveda ''acharyas'', which is comparable to the impact of obesity on health perspectives of biomedical science<ref>Mishra, L.C. (2003). Scientific Basis of Ayurvedic therapy, Chapter 9 Obesity (Medoroga) in Ayurveda; eBook, published by CRC press, Taylor & Francis Group.  </ref>. We have yet to understand what they had foreseen in reference to fat accumulation around the kidneys. Decreased life span (''ayukshaya'') is stated to be an important consequence of obesity in Ayurveda. According to contemporary science, metabolic and psychological pathologies are often present together and are associated with dysregulation of the hypothalamic-pituitary-adrenal axis<ref>Boulpaep, Emile L.; Boron, Walter F. (2003). Medical physiologya: A cellular and molecular approach. Philadelphia: Saunders. p. 1227. ISBN 0-7216-3256-4 </ref>. Affect disorders are also reported among obese binge eaters. The National Institute of Health, USA has issued an alert labeling obesity a "Killer disease" due to its health-related consequences such as coronary disease, diabetes mellitus, hypertension, hyperlipidemia, kidney disorders, gallbladder disorders, cancer of colon, pancreas, breast, uterus, kidney and gallbladder, osteoarthritis, menstrual irregularities in females, cryptogenic cirrhosis of the liver and hepatocellular carcinoma, insulin resistance, and physiological hyperinsulinemia. Some of the social consequences of obesity could include divorces, due in part to reduce sexual activities between partners. Besides there, transitional physiological phases such as weight gain during adolescence in boys and girls, post-natal weight gain in women, and peri-post menopausal obesity are frequently noted in clinical settings that warrant special care and management<ref> Kuniko Takagi, Romain Legrand, Akihiro Asakawa, Haruka Amitani, Marie François, Naouel Tennoune, Moïse Coëffier, Sophie Claeyssens, Jean-Claude do Rego, Pierre Déchelotte, Akio Inui, Sergueï O. Fetissov. Anti-ghrelin immunoglobulins modulate ghrelin stability and its orexigenic effect in obese mice and humans. Nature Communications, 2013; 4 DOI: 10.1038/ncomms3685, site on 08/02/2014. </ref>  <ref>Grundy SM (2004). "Obesity, metabolic syndrome, and cardiovascular disease". J. Clin. Endocrinol. Metab.89 (6): 2595–600. doi:10.1210/jc.2004-0372. PMID 15181029. </ref> <ref>Foster, W.R. and Burton, B.T.(1985). Health implication of obesity, Ann. Intern.Med., 103, 1024.  </ref> <ref>Grunstein, R.R. and Widcox, I. (1994). Sleep-disordered breathing and obesity, Clin.Endocrinol.Metab. Baillier’s, 8, 601.  </ref> <ref>Daugero, K.D. (2001). A new perspective on glucorticoid feedback: relation to stress, carbohydrate feeding and feeding behavior, J. Neuroendocrinol., 13, 1088.  </ref> <ref>Larsson, B. et al (1984), Abdominal adipose distribution, obesity and risk of cardiovascular disease  and death: 13 year follow up of participants in the study of men born in 1913, Br. Med. J., 288, 1401. </ref> <ref>Esposito K. et al (2004). "Effect of lifestyle changes on erectile dysfunction in obese men: A randomized controlled trial". JAMA, 291 (24): 2978–84.  </ref>.

==== Etiology, features, and consequences of ''atikrisha'' (emaciation) ====

==== Etiology, features, and consequences of ''atikrisha'' (emaciation) ====

In the conventional system of medicine, the main treatment for obesity consists of diet and physical exercise for short-term weight control. Maintaining the weight by short-term dietary control is very difficult to an obese person, and it required guided exercise and low calory diet in their daily regimens. Because lack of physical exercise is the key factor and imparts a role in the diathesis of obesity. 61 The lack of physical activities also plays an important role in obesity-associated with the involvement of brain and abdominal. Regarding physical exercise, it not only reduces body weight but also counteract metabolic adaptation but regulating nutritional balance set point.64 It is presumed that physical inactivity contributes to both visceral adiposity and cerebellar brain changes because in the area of cerebellar cortex and hippocampal dentate gyrus  of brain show enhanced synaptogenesis and neurogenesis in response to physical exercise training.<ref>Matthias Raschpichler et al (2013). Abdominal fat distribution and its relationship to brain changes: the differential effects of age on cerebellar structure and function: a cross-sectional, exploratory study. BMJ Open. 2013; 3(1): e001915.Published online 2013 Jan 24. doi:  10.1136/bmjopen-2012-001915 </ref> <ref>McCarthyHD, EllisSM, ColeTJ. (2003): Central overweight and obesity in British youth aged 11–16 years: cross sectional surveys of waist circumference. BMJ, 326:624. </ref> <ref>GollischKS, BrandauerJ, JessenN, et al. (2009):Effects of exercise training on subcutaneous and visceral adipose tissue in normal- and high-fat diet-fed rats, Am J Physiol Endocrinol Metab; 297:E495–504. </ref>  

In the conventional system of medicine, the main treatment for obesity consists of diet and physical exercise for short-term weight control. Maintaining the weight by short-term dietary control is very difficult to an obese person, and it required guided exercise and low calory diet in their daily regimens. Because lack of physical exercise is the key factor and imparts a role in the diathesis of obesity. 61 The lack of physical activities also plays an important role in obesity-associated with the involvement of brain and abdominal. Regarding physical exercise, it not only reduces body weight but also counteract metabolic adaptation but regulating nutritional balance set point.64 It is presumed that physical inactivity contributes to both visceral adiposity and cerebellar brain changes because in the area of cerebellar cortex and hippocampal dentate gyrus  of brain show enhanced synaptogenesis and neurogenesis in response to physical exercise training.<ref>Matthias Raschpichler et al (2013). Abdominal fat distribution and its relationship to brain changes: the differential effects of age on cerebellar structure and function: a cross-sectional, exploratory study. BMJ Open. 2013; 3(1): e001915.Published online 2013 Jan 24. doi:  10.1136/bmjopen-2012-001915 </ref> <ref>McCarthyHD, EllisSM, ColeTJ. (2003): Central overweight and obesity in British youth aged 11–16 years: cross sectional surveys of waist circumference. BMJ, 326:624. </ref> <ref>GollischKS, BrandauerJ, JessenN, et al. (2009):Effects of exercise training on subcutaneous and visceral adipose tissue in normal- and high-fat diet-fed rats, Am J Physiol Endocrinol Metab; 297:E495–504. </ref>  

In this context, [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] has laid down a strong emphasis on drugs, dietary and lifestyle interventions for the management of atisthaulya.  Therefore, factors such as ''madhura, sheeta, snigdha, guru, picchila'' and lifestyle errors are to be avoided in such cases. ''Ruksha udvartanas'' are advocated obese patients as an external purificatory measure, while ''vamana, virechana,'' and ''asthapana basti'' as internal bio-purificatory measures. If an ''atisthula'' person possesses good stamina and strength, they should be treated with ''vamana'' and ''virechana karma''. Non-unctuous, warm and strong enema are advocated such type of patients.<ref>Singh R.H.(1998). The holistic principles of Ayurvedic Medicine. Chaukhambha Publications,  Varanasi. </ref> <ref>Singh R.H. (2002) . Panchakarma therapy (2nd Ed). Chaukhambha Sanskrit Sereis office, Varanasi. </ref> <ref>Paranjpe, P., Patki, P., and Patwardhan, P., (1990). Ayurvedic treatment of obesity: a randomized  double blind, placebo-controlled clinical trial, J. Ethnopharmacol., 29, 1–11. </ref> <ref>Kasture, H.S. (translator) (1985).  Ayurvediya Panchakarma Vignyana (3rd ed.). Shri Baidyanath Ayurved Bhavan Pvt. Ltd., Kolkata, India, p. 247. </ref>''Yogic'' practices have a significant impact on the physical, mental, emotional and spiritual health of the individual. It is reported that a significant improvement in the levels of BP, LDL cholesterol, and BMI can be noted after three months of residential therapy consisting of vegetarian diet and ''kriya yoga''. A randomized controlled study reveals that practicing ''yoga'' for a year brought about significant improvement in body weight and body density. Regular practice of ''yoga'' has shown to improve the serum lipid profile in patients (with known IHD) as well as in healthy subjects. A regular regimen of ''praṇayama'' reduces stress hormone and levels of endorphin and enkephalin, consequently increasing the level of HDL while decreasing the level of LDL, VLDL and TGs.<ref>Schmidt, T et al (1997): Changes in cardiovascular risk factors and hormones during a comprehensive residential three month kriyayoga training and vegetarian nutrition, Acta Physiol.Scand Suppl. 640:158:160. </ref> <ref>Bera, T.K., Rajapurkar, M.V. (1993): Body composition, cardiovascular edurance and anaerobic power of yogic practitioner, Indian J. Physiol. Pharmacol, 37:225-228.  </ref>  <ref>Mahajan, A.S., Reddy, K.S., Sachdeva, U. (1999): Lipid profiles of coronary risk subjects following yogic lifestyle intervention, Indian Heart J, 51:37040. </ref>  <ref>Manachanda, S.C. et al.(2000): Retardation of coronary atherosclerosis with yoga lifestyle intervention, J Assoc.Physicians India, 48 (7): 687-694. </ref>   

In this context, Ayurveda has laid down a strong emphasis on drugs, dietary and lifestyle interventions for the management of atisthaulya.  Therefore, factors such as ''madhura, sheeta, snigdha, guru, picchila'' and lifestyle errors are to be avoided in such cases. ''Ruksha udvartanas'' are advocated obese patients as an external purificatory measure, while ''vamana, virechana,'' and ''asthapana basti'' as internal bio-purificatory measures. If an ''atisthula'' person possesses good stamina and strength, they should be treated with ''vamana'' and ''virechana karma''. Non-unctuous, warm and strong enema are advocated such type of patients.<ref>Singh R.H.(1998). The holistic principles of Ayurvedic Medicine. Chaukhambha Publications,  Varanasi. </ref> <ref>Singh R.H. (2002) . Panchakarma therapy (2nd Ed). Chaukhambha Sanskrit Sereis office, Varanasi. </ref> <ref>Paranjpe, P., Patki, P., and Patwardhan, P., (1990). Ayurvedic treatment of obesity: a randomized  double blind, placebo-controlled clinical trial, J. Ethnopharmacol., 29, 1–11. </ref> <ref>Kasture, H.S. (translator) (1985).  Ayurvediya Panchakarma Vignyana (3rd ed.). Shri Baidyanath Ayurved Bhavan Pvt. Ltd., Kolkata, India, p. 247. </ref>''Yogic'' practices have a significant impact on the physical, mental, emotional and spiritual health of the individual. It is reported that a significant improvement in the levels of BP, LDL cholesterol, and BMI can be noted after three months of residential therapy consisting of vegetarian diet and ''kriya yoga''. A randomized controlled study reveals that practicing ''yoga'' for a year brought about significant improvement in body weight and body density. Regular practice of ''yoga'' has shown to improve the serum lipid profile in patients (with known IHD) as well as in healthy subjects. A regular regimen of ''praṇayama'' reduces stress hormone and levels of endorphin and enkephalin, consequently increasing the level of HDL while decreasing the level of LDL, VLDL and TGs.<ref>Schmidt, T et al (1997): Changes in cardiovascular risk factors and hormones during a comprehensive residential three month kriyayoga training and vegetarian nutrition, Acta Physiol.Scand Suppl. 640:158:160. </ref> <ref>Bera, T.K., Rajapurkar, M.V. (1993): Body composition, cardiovascular edurance and anaerobic power of yogic practitioner, Indian J. Physiol. Pharmacol, 37:225-228.  </ref>  <ref>Mahajan, A.S., Reddy, K.S., Sachdeva, U. (1999): Lipid profiles of coronary risk subjects following yogic lifestyle intervention, Indian Heart J, 51:37040. </ref>  <ref>Manachanda, S.C. et al.(2000): Retardation of coronary atherosclerosis with yoga lifestyle intervention, J Assoc.Physicians India, 48 (7): 687-694. </ref>   

Recent evidence suggests that some ''ayurvedic'' herbal drugs are found to be very effective in normalizing deranged lipid profiles, reducing BMI and slowing down the risk heart diseases. Ayurvedic drugs such as ''rasona'' (Allium cepa), ''guggulu'' (Commiphora mukul),  ''puṣhkaramula'' (Inula racemosa), ''arjuna'' (Terminalia Arjuna), ''dhānyaka'' (Coriandrum sativum), ''nishamalaki churṇa'' (powder of Emblica officinalis and Curcuma longa),''haritaki'' (Terminalia chebula), ''haridra'' (Curcuma longa), ''bilva'' (Aegle marmelos), ''tejapatra'' (Cinnamomum tamala), ''vrikshamla'' (Garcinia cambogia) and Ayurvedic formulations such as- ''triphala guggulu'', ''medohara guggulu'', ''amṛitadi guggulu'', ''arogyavardhani vaṭi'' etc. are also found to be  effective in weight reduction as well as relief in other signs and symptoms. <ref name=ref1/> <ref name=ref2/> <ref name=ref3/><ref>Banerjee, S.K., Maulik, S.K. (2002): Effect of garlic on cardiovascular disorders: a review, Nutr.J, 1:4.</ref> <ref>Satyavati, G.V., Dwarakanath, C., and Tripathi, S.N. (1950 & 1969). Experimental studies on the hypocholesterolemic effect of Commiphora mukul (Guggulu), Indian J. Med. Res., 57, 1950, 1969. </ref> <ref>Karthikeyan, K. et al. (2003): Cardioprotective effect of the alcoholic extract of Terminalia arjuna bark in an invitro model of myocardial ischemic reperfusion injury, Iife Scince, 10, 73 (21):2727:39. </ref> <ref>Verghese, J. (2001): Coriander, Indian Spices, 38 (1):8. </ref> <ref>Kannan, V et al. (2012): Anti-diabetic activity on ethanolic extracts of fruits of terminalia chebula in Alloxan induced diabetic rats, American J. of Drug Discovery and Development, 2:135-142. </ref> <ref>Despande, U.R. (1966): Effect of Turmeric extract on lipid profile (1-22), Int.Seminar on free radicals medicated disease, 2-4.  </ref> <ref>Kesari, A.N. et al. (2006): Hypoglycemic and anti-hyperglycemic activity of Aegle mormelas seed extract in normal and diabetic rats, J. Ethnopharmacol, 103 (3): 374-79. </ref> <ref>Sharma, S.R., Dwivedi, S.K., Swarup, D (1996): Hypoglycemic and hypolipidaemic effects of Cinnamomum tamala Nees leaves, Indian J Exp Biol, 34 (2): 216-220. </ref> <ref>Kohsuke Hayamizu, MS, Yuri Ishii, et al.( SE P T EMB E R / O C T O B E R 2003):Effects of Garcinia cambogia (Hydroxycitric Acid) on Visceral Fat Accumulation: A Double-Blind, Randomized, Placebo-Controlled Trial, current therapeutic research,VO L UME 64, No. 8, 551-567.  </ref> <ref>Bhagwat, B.K. (1995).  Triphala-guggul in Sthoulya in Ayurveda Research Papers III, Kulkarni, P.H., Ed., Ayurved Rasashala, Pune, India, p. 215 </ref> <ref>Vaidya, A.B. et al. (1980).  A double-blind clinical trial of Arogyawardhini — an Ayurvedic drug- in acute viral hepatitis, Ind. J. Med. Res., 72, 588. </ref>

Recent evidence suggests that some ''ayurvedic'' herbal drugs are found to be very effective in normalizing deranged lipid profiles, reducing BMI and slowing down the risk heart diseases. Ayurvedic drugs such as ''rasona'' (Allium cepa), ''guggulu'' (Commiphora mukul),  ''puṣhkaramula'' (Inula racemosa), ''arjuna'' (Terminalia Arjuna), ''dhānyaka'' (Coriandrum sativum), ''nishamalaki churṇa'' (powder of Emblica officinalis and Curcuma longa),''haritaki'' (Terminalia chebula), ''haridra'' (Curcuma longa), ''bilva'' (Aegle marmelos), ''tejapatra'' (Cinnamomum tamala), ''vrikshamla'' (Garcinia cambogia) and Ayurvedic formulations such as- ''triphala guggulu'', ''medohara guggulu'', ''amṛitadi guggulu'', ''arogyavardhani vaṭi'' etc. are also found to be  effective in weight reduction as well as relief in other signs and symptoms. <ref name=ref1/> <ref name=ref2/> <ref name=ref3/><ref>Banerjee, S.K., Maulik, S.K. (2002): Effect of garlic on cardiovascular disorders: a review, Nutr.J, 1:4.</ref> <ref>Satyavati, G.V., Dwarakanath, C., and Tripathi, S.N. (1950 & 1969). Experimental studies on the hypocholesterolemic effect of Commiphora mukul (Guggulu), Indian J. Med. Res., 57, 1950, 1969. </ref> <ref>Karthikeyan, K. et al. (2003): Cardioprotective effect of the alcoholic extract of Terminalia arjuna bark in an invitro model of myocardial ischemic reperfusion injury, Iife Scince, 10, 73 (21):2727:39. </ref> <ref>Verghese, J. (2001): Coriander, Indian Spices, 38 (1):8. </ref> <ref>Kannan, V et al. (2012): Anti-diabetic activity on ethanolic extracts of fruits of terminalia chebula in Alloxan induced diabetic rats, American J. of Drug Discovery and Development, 2:135-142. </ref> <ref>Despande, U.R. (1966): Effect of Turmeric extract on lipid profile (1-22), Int.Seminar on free radicals medicated disease, 2-4.  </ref> <ref>Kesari, A.N. et al. (2006): Hypoglycemic and anti-hyperglycemic activity of Aegle mormelas seed extract in normal and diabetic rats, J. Ethnopharmacol, 103 (3): 374-79. </ref> <ref>Sharma, S.R., Dwivedi, S.K., Swarup, D (1996): Hypoglycemic and hypolipidaemic effects of Cinnamomum tamala Nees leaves, Indian J Exp Biol, 34 (2): 216-220. </ref> <ref>Kohsuke Hayamizu, MS, Yuri Ishii, et al.( SE P T EMB E R / O C T O B E R 2003):Effects of Garcinia cambogia (Hydroxycitric Acid) on Visceral Fat Accumulation: A Double-Blind, Randomized, Placebo-Controlled Trial, current therapeutic research,VO L UME 64, No. 8, 551-567.  </ref> <ref>Bhagwat, B.K. (1995).  Triphala-guggul in Sthoulya in Ayurveda Research Papers III, Kulkarni, P.H., Ed., Ayurved Rasashala, Pune, India, p. 215 </ref> <ref>Vaidya, A.B. et al. (1980).  A double-blind clinical trial of Arogyawardhini — an Ayurvedic drug- in acute viral hepatitis, Ind. J. Med. Res., 72, 588. </ref>

==== Effects of sleep (verse 36-38 and 44-49) ====

==== Effects of sleep (verse 36-38 and 44-49) ====

Recent conventional evidence suggests that seasonal variation can have an impact on sleep/wake cycle, which is quite interesting and proven the age-old concept of [https://en.wikipedia.org/wiki/Ayurveda Ayurveda]. Recent evidence shows that core temperature of body and secretion of melatonin hormone levels are slightly greater in the month of summer due to prolong the length of light exposure, which imparts significant role in daytime sleep in summer. This is the reason people go to bed early at night and wake up early in the morning in the month of summer.  Sunlight exposure in the morning hours may affect internal biological clock, shifting the timing of the sleep window. The need and function of sleep are the most lacking areas of sleep research in biomedical sciences. Some of the important ones are- restoration and recovery of body systems, energy conservation, memory consolidation, protection from predation, brain development, and discharge of emotions.<ref name=ref74/> <ref>Krueger, James M.; Obál, Ferenc; Fang, Jidong. "Why we sleep: a theoretical view of sleep function". Sleep Medicine Reviews3 (2): 119–129. doi:10.1016/S1087-0792(99)90019-9. </ref> <ref>KRUEGER, JAMES M.; OBÄL, FERENC (1 June 1993). "A neuronal group theory of sleep function". Journal of Sleep Research2 (2): 63–69. doi:10.1111/j.1365-2869.1993.tb00064.x. </ref> <ref>Friborg, O., Bjorvatn, B., Amponsah, B., Pallesen, S. (2012). Associations between seasonal variations in day length (photoperiod), sleep timing, sleep quality and mood: a comparison between Ghana (5°) and Norway (69°). Journal of Sleep Research, 21(2), 176-184.) </ref>

Recent conventional evidence suggests that seasonal variation can have an impact on sleep/wake cycle, which is quite interesting and proven the age-old concept of Ayurveda. Recent evidence shows that core temperature of body and secretion of melatonin hormone levels are slightly greater in the month of summer due to prolong the length of light exposure, which imparts significant role in daytime sleep in summer. This is the reason people go to bed early at night and wake up early in the morning in the month of summer.  Sunlight exposure in the morning hours may affect internal biological clock, shifting the timing of the sleep window. The need and function of sleep are the most lacking areas of sleep research in biomedical sciences. Some of the important ones are- restoration and recovery of body systems, energy conservation, memory consolidation, protection from predation, brain development, and discharge of emotions.<ref name=ref74/> <ref>Krueger, James M.; Obál, Ferenc; Fang, Jidong. "Why we sleep: a theoretical view of sleep function". Sleep Medicine Reviews3 (2): 119–129. doi:10.1016/S1087-0792(99)90019-9. </ref> <ref>KRUEGER, JAMES M.; OBÄL, FERENC (1 June 1993). "A neuronal group theory of sleep function". Journal of Sleep Research2 (2): 63–69. doi:10.1111/j.1365-2869.1993.tb00064.x. </ref> <ref>Friborg, O., Bjorvatn, B., Amponsah, B., Pallesen, S. (2012). Associations between seasonal variations in day length (photoperiod), sleep timing, sleep quality and mood: a comparison between Ghana (5°) and Norway (69°). Journal of Sleep Research, 21(2), 176-184.) </ref>

==== Sleep about ''atisthula'' and ''atikrisha'' (verse 51) ====

==== Sleep about ''atisthula'' and ''atikrisha'' (verse 51) ====

==== Insomnia or sleeplessness (verse 52-54) ====

==== Insomnia or sleeplessness (verse 52-54) ====

''Anidra'' of [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] is closely related to Insomnia, or sleeplessness of biomedical sciences. It is a disorder of sleep in which a person is unable to fall in sleep. Nowadays, insomnia is an important area of clinical practice to seek the attention of the physician because a large number of patients come to the hospital suffering from insomnia as secondary conditions.  It is sometimes a functional impairment during awake, which may occur at any age, but it is particularly common in the elderly. Insomnia is either short-term lasting up to 3 hours, or it may be long term lasting for > 3 hours. It may lead to developing dementia, lack of concentration, depression, mental irritation and increases the risk of cardio-vascular accidents along with increases the chances of a roadside accident. <ref>Roth, T. (2007). "Insomnia: Definition, prevalence, etiology, and consequences". Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine3 (5 Suppl): S7–10.  </ref>  <ref>Wilson, Jennifer F. (2008). "Insomnia". Annals of Internal Medicine148: ITC1. doi:10.7326/0003-4819-148-1-200801010-01001 </ref> Regarding its management some drug such as valerian extract has undergone multiple studies and appears to be moderately effective. Similarly, L-Arginine L-aspartate, S-adenosyl-L-homocysteine, and delta sleep inducing peptide (DSIP) appear to be significantly effective in the cases of insomnias.<ref>Morin, C. M.; Koetter, U.; Bastien, C.; Ware, J. C.; Wooten, V. (2005). "Valerian-hops combination and diphenhydramine for treating insomnia: A randomized placebo-controlled clinical trial". Sleep28 (11): 1465–1471.  </ref>  <ref>Meolie, A. L.; Rosen, C. et al.: Clinical Practice Review Committee; American Academy of Sleep Medicine (2005). "Oral nonprescription treatment for insomnia: An evaluation of products with limited evidence". Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine1 (2): 173–187. PMID 17561634. </ref>

''Anidra'' of Ayurveda is closely related to Insomnia, or sleeplessness of biomedical sciences. It is a disorder of sleep in which a person is unable to fall in sleep. Nowadays, insomnia is an important area of clinical practice to seek the attention of the physician because a large number of patients come to the hospital suffering from insomnia as secondary conditions.  It is sometimes a functional impairment during awake, which may occur at any age, but it is particularly common in the elderly. Insomnia is either short-term lasting up to 3 hours, or it may be long term lasting for > 3 hours. It may lead to developing dementia, lack of concentration, depression, mental irritation and increases the risk of cardio-vascular accidents along with increases the chances of a roadside accident. <ref>Roth, T. (2007). "Insomnia: Definition, prevalence, etiology, and consequences". Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine3 (5 Suppl): S7–10.  </ref>  <ref>Wilson, Jennifer F. (2008). "Insomnia". Annals of Internal Medicine148: ITC1. doi:10.7326/0003-4819-148-1-200801010-01001 </ref> Regarding its management some drug such as valerian extract has undergone multiple studies and appears to be moderately effective. Similarly, L-Arginine L-aspartate, S-adenosyl-L-homocysteine, and delta sleep inducing peptide (DSIP) appear to be significantly effective in the cases of insomnias.<ref>Morin, C. M.; Koetter, U.; Bastien, C.; Ware, J. C.; Wooten, V. (2005). "Valerian-hops combination and diphenhydramine for treating insomnia: A randomized placebo-controlled clinical trial". Sleep28 (11): 1465–1471.  </ref>  <ref>Meolie, A. L.; Rosen, C. et al.: Clinical Practice Review Committee; American Academy of Sleep Medicine (2005). "Oral nonprescription treatment for insomnia: An evaluation of products with limited evidence". Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine1 (2): 173–187. PMID 17561634. </ref>

Improper sleep has a harmful impact on carbohydrate metabolism and endocrine function. Besides, it also reduces the metabolic activity in the brain with prolonging lack of sleep. The effects are similar to those seen in normal aging and, therefore, sleep debt may increase the severity of age-related chronic disorders. <ref name=ref85>Van Dongen, HP; Maislin, G; Mullington, JM; Dinges, DF (2003-03-15). "The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation.". Sleep26 (2): 117–26.</ref> Lack of sleep for prolonged period has been shown to affect cognitive functions of people involved in versatile activities along with interfering in mood and emotion. This is one of reason to increased tendency to fear, depression, and rage in the people having a deficiency in sleep. The mechanism and effects of sleep deficit are still evolving in the pathophysiology of sleep deficit.<ref>Karine Spiegel, Rachel Leproult, BS, Eve Van Cauter.: Impact of sleep debt on metabolic and endocrine function. The lancet, Volume 354, Issue 9188, 23 October 1999, Pages 1435–1439. </ref>  <ref name=ref85/> <ref>Chee, MW; Chuah, LY (August 2008). "Functional neuroimaging insights into how sleep and sleep deprivation affect memory and cognition.". Current Opinion in Neurology21 (4): 417–23.  </ref>

Improper sleep has a harmful impact on carbohydrate metabolism and endocrine function. Besides, it also reduces the metabolic activity in the brain with prolonging lack of sleep. The effects are similar to those seen in normal aging and, therefore, sleep debt may increase the severity of age-related chronic disorders. <ref name=ref85>Van Dongen, HP; Maislin, G; Mullington, JM; Dinges, DF (2003-03-15). "The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation.". Sleep26 (2): 117–26.</ref> Lack of sleep for prolonged period has been shown to affect cognitive functions of people involved in versatile activities along with interfering in mood and emotion. This is one of reason to increased tendency to fear, depression, and rage in the people having a deficiency in sleep. The mechanism and effects of sleep deficit are still evolving in the pathophysiology of sleep deficit.<ref>Karine Spiegel, Rachel Leproult, BS, Eve Van Cauter.: Impact of sleep debt on metabolic and endocrine function. The lancet, Volume 354, Issue 9188, 23 October 1999, Pages 1435–1439. </ref>  <ref name=ref85/> <ref>Chee, MW; Chuah, LY (August 2008). "Functional neuroimaging insights into how sleep and sleep deprivation affect memory and cognition.". Current Opinion in Neurology21 (4): 417–23.  </ref>

The concept of ''Nidra'' in [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] is quite comparable to the sleep of biomedical sciences. The ''nidra'' is so important for the maintenance of health and sustaining the life. This is true in the light of contemporary scientific knowledge too. According to [https://en.wikipedia.org/wiki/Ayurveda Ayurveda], ''kapha'' and ''tamas'' are responsible for ''nidra'' even as modern studies attribute the occurrence of sleep to many factors including stimulation of certain areas of the brain. [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] classifies the ''nidra'' based on the mode of origin while modern classification of sleep based on physiological variations seen in association with the different types of sleep. Some factors like food, activities, external stimuli, etc. affect ''nidra'' or sleep. Any variation in the normal sleep pattern is not at all desirable, and they may cause serious health problems that demand proper medical attention.

The concept of ''Nidra'' in Ayurveda is quite comparable to the sleep of biomedical sciences. The ''nidra'' is so important for the maintenance of health and sustaining the life. This is true in the light of contemporary scientific knowledge too. According to Ayurveda, ''kapha'' and ''tamas'' are responsible for ''nidra'' even as modern studies attribute the occurrence of sleep to many factors including stimulation of certain areas of the brain. Ayurveda classifies the ''nidra'' based on the mode of origin while modern classification of sleep based on physiological variations seen in association with the different types of sleep. Some factors like food, activities, external stimuli, etc. affect ''nidra'' or sleep. Any variation in the normal sleep pattern is not at all desirable, and they may cause serious health problems that demand proper medical attention.

==== Conclusion ====

==== Conclusion ====

The present chapter reveals that the clinical entity, consequences, and management of too obese, too lean, insomnia, along with categorization of good built, information and mechanism of sleep and measures to induce good sleep was fairly well known even in the classical period of [https://en.wikipedia.org/wiki/Ayurveda Ayurveda], which is comparable to the latest development in this field. The Ayurvedic classics vividly describe the etiological factors, pathogenesis, clinical presentation, complications and its categories and treatment modalities of too obese, which has a striking resemblance to the latest development in this field. The ''samprapti'' (pathogenesis) of this disease is based on the specific ''dosha-dushya'' pattern. Besides, the special emphasis placed on vitiation of ''medas''. The age-old ideas are now getting strong scientific support for the emerging concept of prediabetes, insulin resistance, and metabolic syndrome, signifying the role of lipid disorders in the pathogenesis, hypometabolic state (''ama'' state) and immunodeficiency in these disorders. Numbers of complications have been described in this context including ''prameha'', GI problems, skin disorders, etc. It is presumed that in the diathesis of complications, impaired status of ''agni, ojas'' and ''medas'' play an important role6.  

The present chapter reveals that the clinical entity, consequences, and management of too obese, too lean, insomnia, along with categorization of good built, information and mechanism of sleep and measures to induce good sleep was fairly well known even in the classical period of Ayurveda, which is comparable to the latest development in this field. The Ayurvedic classics vividly describe the etiological factors, pathogenesis, clinical presentation, complications and its categories and treatment modalities of too obese, which has a striking resemblance to the latest development in this field. The ''samprapti'' (pathogenesis) of this disease is based on the specific ''dosha-dushya'' pattern. Besides, the special emphasis placed on vitiation of ''medas''. The age-old ideas are now getting strong scientific support for the emerging concept of prediabetes, insulin resistance, and metabolic syndrome, signifying the role of lipid disorders in the pathogenesis, hypometabolic state (''ama'' state) and immunodeficiency in these disorders. Numbers of complications have been described in this context including ''prameha'', GI problems, skin disorders, etc. It is presumed that in the diathesis of complications, impaired status of ''agni, ojas'' and ''medas'' play an important role6.  

On The overall assessment, the concept of overweight and obesity, emaciation, sleep and its type, indications, and contraindications of day sleep, the role of sleep in obesity, causes of insomnia and features of good and bad sleep along with features of good body built was a well-known entity since antiquity. The available descriptions appear very contemporary and scientific. Certain therapeutic modalities have close resemblance with several non-drug approaches of modern medicine. These modalities can be combined judiciously for individualized prevention and cure of too obese, too lean and insomnia. The current approaches and management of too obese and too lean along with insomnia are still not satisfactory in the conventional system of medicine; this chapter provides a new outlook to scholars and researchers of [https://en.wikipedia.org/wiki/Ayurveda Ayurveda], which is based on current publications and reports.

On The overall assessment, the concept of overweight and obesity, emaciation, sleep and its type, indications, and contraindications of day sleep, the role of sleep in obesity, causes of insomnia and features of good and bad sleep along with features of good body built was a well-known entity since antiquity. The available descriptions appear very contemporary and scientific. Certain therapeutic modalities have close resemblance with several non-drug approaches of modern medicine. These modalities can be combined judiciously for individualized prevention and cure of too obese, too lean and insomnia. The current approaches and management of too obese and too lean along with insomnia are still not satisfactory in the conventional system of medicine; this chapter provides a new outlook to scholars and researchers of Ayurveda, which is based on current publications and reports.

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===references===

===references===