Santarpaniya Adhyaya

Sutra Sthana Chapter 23. Over-nutrition, under-nutrition and its disorders

Santarpaniya Adhyaya

Section/Chapter	Sutra Sthana Chapter 23
Tetrad/Sub-section	Yojana Chatushka
Preceding Chapter	Langhanabrimhaniya Adhyaya
Succeeding Chapter	Vidhishonitiya Adhyaya
Other Sections	Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Chikitsa Sthana, Kalpa Sthana, Siddhi Sthana
Translator and commentator	Sabnis M., Deole Y. S.
Reviewer	Byadgi P.S.
Editors	Dwivedi R.B., Deole Y.S., Basisht G.
Year of publication	2020
Publisher	Charak Samhita Research, Training and Skill Development Centre
DOI	10.47468/CSNE.2020.e01.s01.025

Abstract

Diseases are caused due to over nutrition and under nutrition. This chapter enlists the causative factors affecting nutritional status leading to two categories of diseases viz. Santarpana (over-nutrition) and apatarpana (under nutrition). The dietary and lifestyle management of these two disease categories is also elaborated. Nutraceutical preparations, weight reducing recipes, therapeutic procedures like panchakarma and other associated procedures are described with medicaments. The chapter also contains a comprehensive list of commonly available herbs used in treatment of these diseases.
Keywords: santarpana (over-nutrition), apatarpana (under-nutrition), management of over-nutrition induced disorders, nutrition deficiency disorders.

Introduction

In the series of chapters described for management principles, the present chapter describes two most commonly observed conditions in society viz. santarpana(over-nutrition) and apatarpana(undernutrition). It is sequenced after langhana and brimhana therapies. The present chapter enlists causes and diseases due to over-nutrition and under-nutrition and their management through diet and medicaments. It is a blend of nutraceutical food supplements with medicaments. Complications arising due to sedentary lifestyle and over-nutritive diet are also enlisted in the chapter with diseases caused due to undernutrition/ malnourishment and their management with simple dietary preparations. The pharmacological effect of herbs used in management are elaborated in detail as well.

Santarpana(overnutrition) leads to vitiation of kapha dosha and meda dhatu and various obstructive pathologies, whereas apatarpana(undernutrition) leads to vata-pitta dosha vitiation and various degenerative pathologies. This concept has been emphasized in this chapter.

Sanskrit text, Transliteration and English Translation

अथातः सन्तर्पणीयमध्यायं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

athātaḥ santarpaṇīyamadhyāyaṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

athAtaH santarpaNIyamadhyAyaM vyAkhyAsyAmaH||1||

iti ha smAha bhagavAnAtreyaH||2||

Now we shall expound the chapter "Santarpaniya" (Over-nutrition, under-nutrition and its disorders). Thus said Lord Atreya. [1-2]

Causes of santarpana induced diseases

सन्तर्पयति यः स्निग्धैर्मधुरैर्गुरुपिच्छिलैः|

नवान्नैर्नवमद्यैश्च मांसैश्चानूपवारिजैः||३||

गोरसैर्गौडिकैश्चान्नैः पैष्टिकैश्चातिमात्रशः|

चेष्टाद्वेषी दिवास्वप्नशय्यासनसुखे रतः||४||

रोगास्तस्योपजायन्ते सन्तर्पणनिमित्तजाः|५|

santarpayati yaḥ snigdhairmadhurairgurupicchilaiḥ|

navānnairnavamadyaiśca māṁsaiścānūpavārijaiḥ||3||

gōrasairgauḍikaiścānnaiḥ paiṣṭikaiścātimātraśaḥ|

cēṣṭādvēṣī divāsvapnaśayyāsanasukhē rataḥ||4||

rōgāstasyōpajāyantē santarpaṇanimittajāḥ|5|

santarpayati yaH snigdhairmadhurairgurupicchilaiH|

navAnnairnavamadyaishca mAMsaishcAnUpavArijaiH||3||

gorasairgauDikaishcAnnaiH paiShTikaishcAtimAtrashaH|

ceShTAdveShI divAsvapnashayyAsanasukhe rataH||4||

rogAstasyopajAyante santarpaNanimittajAH|5|

Excessive consumption of unctuous, sweet, heavy to digest and slimy food, new grains (especially new rice), new wine, flesh of animals living in marshy area or born in water, cow’s milk and its products, and those prepared with sugar or molasses, varieties of cakes lead to santarpana. Those who indulge in sedentary, inactive lifestyles and sleep during the day are prone to santarpaniya vyadhis (i.e. santarpana induced diseases). [3-4]

List of santarpana induced diseases

प्रमेहपिडकाकोठकण्डूपाण्ड्वामयज्वराः||५||

कुष्ठान्यामप्रदोषाश्च मूत्रकृच्छ्रमरोचकः|

तन्द्रा क्लैब्यमतिस्थौल्यमालस्यं गुरुगात्रता||६||

इन्द्रियस्रोतसां लेपो बुद्धेर्मोहः प्रमीलकः|

शोफाश्चैवंविधाश्चान्ये शीघ्रमप्रतिकुर्वतः||७||

pramēhapiḍakākōṭhakaṇḍūpāṇḍvāmayajvarāḥ||5||

kuṣṭhānyāmapradōṣāśca mūtrakr̥cchramarōcakaḥ|

tandrā klaibyamatisthaulyamālasyaṁ gurugātratā||6||

indriyasrōtasāṁ lēpō buddhērmōhaḥ pramīlakaḥ|

śōphāścaivaṁvidhāścānyē śīghramapratikurvataḥ||7||

pramehapiDakAkoThakaNDUpANDvAmayajvarAH||5||

kuShThAnyAmapradoShAshca mUtrakRucchramarocakaH|

tandrA klaibyamatisthaulyamAlasyaM gurugAtratA||6||

indriyasrotasAM lepo buddhermohaH pramIlakaH|

shophAshcaivaMvidhAshcAnye shIghramapratikurvataH||7||

Due to above mentioned causative factors, if the effects of santarpana are not treated properly, one suffers from various diseases such as obstinate urinary disorders including diabetes, carbuncles, urticaria, itching, pandu (anaemia), amaja diseases (i.e., due to formation of ama), jwara,obstinate skin diseases, diseases secondary to vitiation of ama, dysuria, anorexia or appetite related complaints, tandra (drowsiness/sleepiness), klaibya (erectile and sexual dysfunctions), obesity, laziness, heaviness of the body, adhesion or blockages in the channels as well as sense organs, delusion, various types of edema, and such of other diseases. [5-7]

Management of santarpana-induced diseases

शस्तमुल्लेखनं तत्र विरेको रक्तमोक्षणम्|

व्यायामश्चोपवासश्च धूमाश्च स्वेदनानि च||८||

śastamullēkhanaṁ tatra virēkō raktamōkṣaṇam|

vyāyāmaścōpavāsaśca dhūmāśca svēdanāni ca||8||

shastamullekhanaM tatra vireko raktamokShaNam|

vyAyAmashcopavAsashca dhUmAshca svedanAni ca||8||

Santarpaniya vyadhis and their complications should be managed by ullekhana(therapeutic emesis), virechana (therapeutic purgation), raktamokshana(blood-letting), specific exercises, therapeutic fasting, dhooma (hot fomentation with smoke of medicinal plants), and swedana(sudation). [8]

सक्षौद्रश्चाभयाप्राशः प्रायो रूक्षान्नसेवनम्|

चूर्णप्रदेहा ये चोक्ताः कण्डूकोठविनाशनाः||९||

sakṣaudraścābhayāprāśaḥ prāyō rūkṣānnasēvanam|

cūrṇapradēhā yē cōktāḥ kaṇḍūkōṭhavināśanāḥ||9||

sakShaudrashcAbhayAprAshaH prAyo rUkShAnnasevanam|

cUrNapradehA ye coktAH kaNDUkoThavinAshanAH||9||

Formulations made up of haritaki(Terminalia Chebula), such as agastyaharitaki mixed with honey, habituating with ruksha food (i.e., without using unctuous substances like oil, ghee etc.), those powders and poultice described in treatment of pruritus and urticaria (mentioned in the third chapter of this section) are advised. [9]

त्रिफलारग्वधं पाठां सप्तपर्णं सवत्सकम्|

मुस्तं समदनं निम्बं जलेनोत्क्वथितं पिबेत्||१०||

तेन मेहादयो यान्ति नाशमभ्यस्यतो ध्रुवम्|

मात्राकालप्रयुक्तेन सन्तर्पणसमुत्थिताः||११||

triphalāragvadhaṁ pāṭhāṁ saptaparṇaṁ savatsakam|

mustaṁ samadanaṁ nimbaṁ jalēnōtkvathitaṁ pibēt||10||

tēna mēhādayō yānti nāśamabhyasyatō dhruvam|

mātrākālaprayuktēna santarpaṇasamutthitāḥ||11||

triphalAragvadhaM pAThAM saptaparNaM savatsakam|

mustaM samadanaM nimbaM jalenotkvathitaM pibet||10||

tena mehAdayo yAnti nAshamabhyasyato dhruvam|

mAtrAkAlaprayuktena santarpaNasamutthitAH||11||

The decoction of triphala (amalaki (Emblica officinalis), bibhitaki (Terminalia bellirica), and haritaki (Terminalia chebula)), aragvadha (Cassia fistula), patha (Cissampelos pareira), saptaparna (Alstonia scholaris), vatsaka (Holarrhena antidysenterica), musta (Cyperus rotundus), madana (Randia dumetorum) and nimba (Azadirachta indica), mixed together and boiled in water, is advised for consumption regularly. By regular use of this decoction, in the right dose and at the right time, santarpaniya vyadhi like madhumeha and other diseases can be controlled properly. [10-11]

मुस्तमारग्वधः पाठा त्रिफला देवदारु च|

श्वदंष्ट्रा खदिरो निम्बो हरिद्रे त्वक्च वत्सकात्||१२||

रसमेषां यथादोषं प्रातः प्रातः पिबन्नरः|

सन्तर्पणकृतैः सर्वैर्व्याधिभिः सम्प्रमुच्यते||१३||

एभिश्चोद्वर्तनोद्धर्षस्नानयोगोपयोजितैः|

त्वग्दोषाः प्रशमं यान्ति तथा स्नेहोपसंहितैः||१४||

mustamāragvadhaḥ pāṭhā triphalā dēvadāru ca|

śvadaṁṣṭrā khadirō nimbō haridrē tvakca vatsakāt||12||

rasamēṣāṁ yathādōṣaṁ prātaḥ prātaḥ pibannaraḥ|

santarpaṇakr̥taiḥ sarvairvyādhibhiḥ sampramucyatē||13||

ēbhiścōdvartanōddharṣasnānayōgōpayōjitaiḥ|

tvagdōṣāḥ praśamaṁ yānti tathā snēhōpasaṁhitaiḥ||14||

mustamAragvadhaH pAThA triphalA devadAru ca|

shvadaMShTrA khadiro nimbo haridre tvakca vatsakAt||12||

rasameShAM yathAdoShaM prAtaH prAtaH pibannaraH|

santarpaNakRutaiH sarvairvyAdhibhiH sampramucyate||13||

ebhishcodvartanoddharShasnAnayogopayojitaiH|

tvagdoShAH prashamaM yAnti tathA snehopasaMhitaiH||14||

All santarpaniya diseases can be cured, if the juices (decoction) of musta, aaragvadha, paatha, triphala, devadaru (Cedrus deodara), shvadamshtra (Trinbulus terrestris), khadira (Acacia catechu Wild), nimba, haridra (Curcuma longa), daruharidra (Berberis aristata) and the bark of vatsaka (Holarrhena anti-dysenterica) are consumed every morning (depending upon the dominant dosha in the disease).

If the above herbs are used in a powdered form for udvartana with or without massage or the decoction of the above herbs are used for medicinal bath or if the oil made up of above drugs is used for body application it relieves all the skin disorders caused due to santarpaniya vyadhis.[12-14]

कुष्ठं गोमेदको हिङ्गु क्रौञ्चास्थि त्र्यूषणं वचा|

वृषकैले श्वदंष्ट्रा च खराह्वा चाश्मभेदकः||१५||

तक्रेण दधिमण्डेन बदराम्लरसेन वा|

मूत्रकृच्छ्रं प्रमेहं च पीतमेतद्व्यपोहति||१६||

kuṣṭhaṁ gōmēdakō hiṅgu krauñcāsthi tryūṣaṇaṁ vacā|

vr̥ṣakailē śvadaṁṣṭrā ca kharāhvā cāśmabhēdakaḥ||15||

takrēṇa dadhimaṇḍēna badarāmlarasēna vā|

mūtrakr̥cchraṁ pramēhaṁ ca pītamētadvyapōhati||16||

kuShThaM gomedako hi~ggu krau~jcAsthi tryUShaNaM vacA|

vRuShakaile shvadaMShTrA ca kharAhvA cAshmabhedakaH||15||

takreNa dadhimaNDena badarAmlarasena vA|

mUtrakRucchraM pramehaM ca pItametadvyapohati||16||

Kustha (Saussurea lappa), gomedaka (onyx), hingu (Ferula narthex), bones of the krauncha bird (Ardea Jaculator, demoiselle crane), sunthi (Zingiber officinalis), pippali (Piper longum), maricha (Piper nigrum), vacha (Acorus calamus), vasa (Adhatoda vasica Nees), ela (Elettaria cardamoum), gokshura (Tribulus terrestris), kharahva (Trachyspermum roxburghianum), and ashmabheda (Bergenia ligulata – crushed and mixed with buttermilk, whey and the juice of a sour variant of badara (Zizyphus jujuba) are used to treat mutrakruchchra (dysuria) and prameha (obstinate urinary disorders including diabetes mellitus characterized by excess frequency of micturition). [15-16]

तक्राभयाप्रयोगैश्च त्रिफलायास्तथैव च|

अरिष्टानां प्रयोगैश्च यान्ति मेहादयः शमम्||१७||

takrābhayāprayōgaiśca triphalāyāstathaiva ca|

ariṣṭānāṁ prayōgaiśca yānti mēhādayaḥ śamam||17||

takrAbhayAprayogaishca triphalAyAstathaiva ca|

ariShTAnAM prayogaishca yAnti mehAdayaH shamam||17||

Haritaki (Terminalia chebula) with butter milk, triphala (Terminalia chebula, Terminalia belerica Roxb. And Emblica officinalis Gaertn.) and arishta (different types of medicinal alcoholic preparations) are prescribed for the treatment of obstinate urinary disorders including diabetes mellitus and such other diseases. [17]

त्र्यूषणं त्रिफला क्षौद्रं क्रिमिघ्नमजमोदकः|

मन्थोऽयं सक्तवस्तैलं हितो लोहोदकाप्लुतः||१८||

tryūṣaṇaṁ triphalā kṣaudraṁ krimighnamajamōdakaḥ|

manthō'yaṁ saktavastailaṁ hitō lōhōdakāplutaḥ||18||

tryUShaNaM triphalA kShaudraM krimighnamajamodakaH|

mantho~ayaM saktavastailaM hito lohodakAplutaH||18||

Mantha (thin gruel) prepared of trikatu (Zingiber officinale, Piper longum, and Piper nigrum), triphala (Terminalia chebula, Terminalia belerica Roxb., and Emblica officinalis Gaertn.), honey, vidanga (Embelia ribes Burm f.), ajamoda (Trachy-spermum roxburghianum), roasted wheat flour or coarse ground meal, oil and the decoction of agaru (Aquilari agallocha Roxb.) help to cure the diseases due to over-nourishment. [18]

व्योषं विडङ्गं शिग्रूणि त्रिफलां कटुरोहिणीम्|

बृहत्यौ द्वे हरिद्रे द्वे पाठामतिविषां स्थिराम्||१९||

हिङ्गु केबुकमूलानि यवानीधान्यचित्रकान्|

सौवर्चलमजाजीं च हपुषां चेति चूर्णयेत्||२०||

चूर्णतैलघृतक्षौद्रभागाः स्युर्मानतः समाः|

सक्तूनां षोडशगुणो भागः सन्तर्पणं पिबेत्||२१||

vyōṣaṁ viḍaṅgaṁ śigrūṇi triphalāṁ kaṭurōhiṇīm|

br̥hatyau dvē haridrē dvē pāṭhāmativiṣāṁ sthirām||19||

hiṅgu kēbukamūlāni yavānīdhānyacitrakān|

sauvarcalamajājīṁ ca hapuṣāṁ cēti cūrṇayēt||20||

cūrṇatailaghr̥takṣaudrabhāgāḥ syurmānataḥ samāḥ|

saktūnāṁ ṣōḍaśaguṇō bhāgaḥ santarpaṇaṁ pibēt||21||

vyoShaM viDa~ggaM shigrUNi triphalAM kaTurohiNIm|

bRuhatyau dve haridre dve pAThAmativiShAM sthirAm||19||

hi~ggu kebukamUlAni yavAnIdhAnyacitrakAn|

sauvarcalamajAjIM ca hapuShAM ceti cUrNayet||20||

cUrNatailaghRutakShaudrabhAgAH syurmAnataH samAH|

saktUnAM ShoDashaguNo bhAgaH santarpaNaM pibet||21||

Trikatu (Zingiber officianel,Piper langum and Piper nigrum), vidanga (Embelia ribes), varieties of shigru (Moringa olefera), triphala, katurohini (Picrorhiza kurroa), brihati (Solanum indicum), kantakari (Solanum xanthocarpum), haridra (Curcuma longa), daaruharidra (Berberis aristata D.C.), two varieties of patha (Cissampelos pareira), ativisha (Aconitum heterophyllum), shalaparni (Desmodium gangeticum), hingu (Ferula narthex), root of kebuka (Costus speciosus), yavani (Trachyspermum ammi), dhanya (Coriandrum sativum), citraka (Plumbago Zeylanica), sonchal salt, ajaji (Cuminum cyminum), and hapusha (Juniperus communis) – all the above herbs powdered and mixed with equal quantities of oil, ghee and honey, added with sixteen times its volume of sattu (roasted corn flour) and water are used to prepare a formulation for indications (mentioned in the following verse.) [19-21]

Indications

प्रयोगादस्य शाम्यन्ति रोगाः सन्तर्पणोत्थिताः|

प्रमेहा मूढवाताश्च कुष्ठान्यर्शांसि कामलाः||२२||

प्लीहा पाण्ड्वामयः शोफो मूत्रकृच्छ्रमरोचकः|

हृद्रोगो राजयक्ष्मा च कासः श्वासो गलग्रहः||२३||

क्रिमयो ग्रहणीदोषाः श्वैत्र्यं स्थौल्यमतीव च|

नराणां दीप्यते चाग्निः स्मृतिर्बुद्धिश्च वर्धते||२४||

prayōgādasya śāmyanti rōgāḥ santarpaṇōtthitāḥ|

pramēhā mūḍhavātāśca kuṣṭhānyarśāṁsi kāmalāḥ||22||

plīhā pāṇḍvāmayaḥ śōphō mūtrakr̥cchramarōcakaḥ|

hr̥drōgō rājayakṣmā ca kāsaḥ śvāsō galagrahaḥ||23||

krimayō grahaṇīdōṣāḥ śvaitryaṁ sthaulyamatīva ca|

narāṇāṁ dīpyatē cāgniḥ smr̥tirbuddhiśca vardhatē||24||

prayogAdasya shAmyanti rogAH santarpaNotthitAH|

pramehA mUDhavAtAshca kuShThAnyarshAMsi kAmalAH||22||

plIhA pANDvAmayaH shopho mUtrakRucchramarocakaH|

hRudrogo rAjayakShmA ca kAsaH shvAso galagrahaH||23||

krimayo grahaNIdoShAH shvaitryaM sthaulyamatIva ca|

narANAM dIpyate cAgniH smRutirbuddhishca vardhate||24||

The above preparation is useful in the treatment of obstinate urinary disorders including diabetes mellitus, mudhavata (sluggishness of the bowels), obstinate skin diseases including leprosy, piles, jaundice-like hepatobiliary diseases, diseases of the spleen, anemia-like hematological disorders, edema, dysuria, anorexia, heart disease, tuberculosis-like immune-compromised conditions, cough, respiratory disorders, spasmodic obstruction of the throat, parasitic infestation, grahani (digestive disorders), vitiligo and morbid obesity caused by overnutrition. This also stimulates the power of digestion and enhances memory and intellect. [22-24]

व्यायामनित्यो जीर्णाशी यवगोधूमभोजनः|

सन्तर्पणकृतैर्दोषैः स्थौल्यं मुक्त्वा विमुच्यते||२५||

उक्तं सन्तर्पणोत्थानामपतर्पणमौषधम्|२६|

vyāyāmanityō jīrṇāśī yavagōdhūmabhōjanaḥ|

santarpaṇakr̥tairdōṣaiḥ sthaulyaṁ muktvā vimucyatē||25||

uktaṁ santarpaṇōtthānāmapatarpaṇamauṣadham|26|

vyAyAmanityo jIrNAshI yavagodhUmabhojanaH|

santarpaNakRutairdoShaiH sthaulyaM muktvA vimucyate||25||

uktaM santarpaNotthAnAmapatarpaNamauShadham|26|

Regular exercise, intake of food only after complete digestion of the previous meal, and regular consumption of barley and wheat are some of the ways for management of obesity and diseases due to overnutrition. In the next verses, formulations and regimen required for the management of malnourishment has been described. [25-26]

Diseases due to apatarpana(under-nutrition) and their treatment

वक्ष्यन्ते सौषधाश्चोर्ध्वमपतर्पणजा गदाः||२६||

देहाग्निबलवर्णौजःशुक्रमांसपरिक्षयः|

ज्वरः कासानुबन्धश्च पार्श्वशूलमरोचकः||२७||

श्रोत्रदौर्बल्यमुन्मादः प्रलापो हृदयव्यथा|

विण्मूत्रसङ्ग्रहः शूलं जङ्घोरुत्रिकसंश्रयम्||२८||

पर्वास्थिसन्धिभेदश्च ये चान्ये वातजा गदाः|

ऊर्ध्ववातादयः सर्वे जायन्ते तेऽपतर्पणात्||२९||

vakṣyantē sauṣadhāścōrdhvamapatarpaṇajā gadāḥ||26||

dēhāgnibalavarṇaujaḥśukramāṁsaparikṣayaḥ|

jvaraḥ kāsānubandhaśca pārśvaśūlamarōcakaḥ||27||

śrōtradaurbalyamunmādaḥ pralāpō hr̥dayavyathā|

viṇmūtrasaṅgrahaḥ śūlaṁ jaṅghōrutrikasaṁśrayam||28||

parvāsthisandhibhēdaśca yē cānyē vātajā gadāḥ|

ūrdhvavātādayaḥ sarvē jāyantē tē'patarpaṇāt||29||

vakShyante sauShadhAshcordhvamapatarpaNajA gadAH||26||

dehAgnibalavarNaujaHshukramAMsaparikShayaH|

jvaraH kAsAnubandhashca pArshvashUlamarocakaH||27||

shrotradaurbalyamunmAdaH pralApo hRudayavyathA|

viNmUtrasa~ggrahaH shUlaM ja~gghorutrikasaMshrayam||28||

parvAsthisandhibhedashca ye cAnye vAtajA gadAH|

UrdhvavAtAdayaH sarve jAyante te~apatarpaNAt||29||

Emaciation of the body, reduction in the power of digestion, strength, complexion, ojas (vital essence of body related with immunity and general strength), semen and muscle tissue, jwara (continuous fever and cough like condition), pain in chest and flanks, anorexia, weakness in the power of hearing sounds, psychosis, delirium, pain in cardiac region, accumulation of stool and urine, pain in calf, thigh and lumber regions, cracking pain in fingers, bones and joints, and such other diseases due to the vitiation of vata(such as urdhava vata upward movement of vata), etc. are caused due to improper nutrition and starvation. [27- 29]

Management of diseases due to undernutrition

तेषां सन्तर्पणं तज्ज्ञैः पुनराख्यातमौषधम्|

यत्तदात्वे समर्थं स्यादभ्यासे वा तदिष्यते ||३०||

tēṣāṁ santarpaṇaṁ tajjñaiḥ punarākhyātamauṣadham|

yattadātvē samarthaṁ syādabhyāsē vā tadiṣyatē ||30||

teShAM santarpaNaM tajj~jaiH punarAkhyAtamauShadham|

yattadAtve samarthaM syAdabhyAse vA tadiShyate ||30||

For the treatment of such ailments, therapies that nourish instantly need to be administered regularly and for a long period of time. [30]

सद्यःक्षीणो हि सद्यो वै तर्पणेनोपचीयते|

नर्ते सन्तर्पणाभ्यासाच्चिरक्षीणस्तु पुष्यति||३१||

sadyaḥkṣīṇō hi sadyō vai tarpaṇēnōpacīyatē|

nartē santarpaṇābhyāsāccirakṣīṇastu puṣyati||31||

sadyaHkShINo hi sadyo vai tarpaNenopacIyate|

narte santarpaNAbhyAsAccirakShINastu puShyati||31||

A person suffering from acute and drastic weight-loss should be treated with a regimen that nourishes instantly, but one suffering from a chronic type of emaciation requires long term consumption of nourishments. [31]

देहाग्निदोषभैषज्यमात्राकालानुवर्तिना|

कार्यमत्वरमाणेन भेषजं चिरदुर्बले||३२||

dēhāgnidōṣabhaiṣajyamātrākālānuvartinā|

kāryamatvaramāṇēna bhēṣajaṁ ciradurbalē||32||

dehAgnidoShabhaiShajyamAtrAkAlAnuvartinA|

kAryamatvaramANena bheShajaM ciradurbale||32||

Some of the critical factors for deciding a course of treatment of emaciation in chronic patients include: body constitution, power of digestion, predominant dosha, form of medicine, dose, and season and time of administration (of the therapy). [32]

हिता मांसरसास्तस्मै पयांसि च घृतानि च|

स्नानानि बस्तयोऽभ्यङ्गास्तर्पणास्तर्पणाश्च ये||३३||

hitā māṁsarasāstasmai payāṁsi ca ghr̥tāni ca|

snānāni bastayō'bhyaṅgāstarpaṇāstarpaṇāśca yē||33||

hitA mAMsarasAstasmai payAMsi ca ghRutAni ca|

snAnAni bastayo~abhya~ggAstarpaNAstarpaNAshca ye||33||

For this purpose, (of santarpana), soups made out of flesh, milk, various ghee preparations (clarified butter), along with activities such as bath, oil massage, and medicated enema (processed with santarpana medicines) are advocated for nourishment. [33]

ज्वरकासप्रसक्तानां कृशानां मूत्रकृच्छ्रिणाम्|

तृष्यतामूर्ध्ववातानां वक्ष्यन्ते तर्पणा हिताः||३४||

jvarakāsaprasaktānāṁ kr̥śānāṁ mūtrakr̥cchriṇām|

tr̥ṣyatāmūrdhvavātānāṁ vakṣyantē tarpaṇā hitāḥ||34||

jvarakAsaprasaktAnAM kRushAnAM mUtrakRucchriNAm|

tRuShyatAmUrdhvavAtAnAM vakShyante tarpaNA hitAH||34||

For these patients suffering from continuous jwara (fever like conditions), cough, emaciation, dysuria, thirst and upward movement of vata, the following nourishing drinks are prescribed. [34]

शर्करापिप्पलीतैलघृतक्षौद्रैः समांशकैः|

सक्तुद्विगुणितो वृष्यस्तेषां मन्थः प्रशस्यते||३५||

śarkarāpippalītailaghr̥takṣaudraiḥ samāṁśakaiḥ|

saktudviguṇitō vr̥ṣyastēṣāṁ manthaḥ praśasyatē||35||

sharkarApippalItailaghRutakShaudraiH samAMshakaiH|

saktudviguNito vRuShyasteShAM manthaH prashasyate||35||

Mantha (thin gruel) prepared from sugar, pippali (Pipper longum), oil, ghee, and honey - in equal quantities added with double the quantity of saktu (roasted corn flour) is considered an aphrodisiac and is useful in such conditions (as mentioned in above verse). [35]

सक्तवो मदिरा क्षौद्रं शर्करा चेति तर्पणम्|

पिबेन्मारुतविण्मूत्रकफपित्तानुलोमनम्||३६||

saktavō madirā kṣaudraṁ śarkarā cēti tarpaṇam|

pibēnmārutaviṇmūtrakaphapittānulōmanam||36||

saktavo madirA kShaudraM sharkarA ceti tarpaNam|

pibenmArutaviNmUtrakaphapittAnulomanam||36||

Saktu (roasted corn flour/ coarse ground meal) with madira (wine), honey and sugar are refreshing and shall be consumed for the elimination of flatus (obstructed vata), faeces, urine, kapha and pitta. [36]

फाणितं सक्तवः सर्पिर्दधिमण्डोऽम्लकाञ्जिकम्|

तर्पणं मूत्रकृच्छ्रघ्नमुदावर्तहरं पिबेत्||३७||

phāṇitaṁ saktavaḥ sarpirdadhimaṇḍō'mlakāñjikam|

tarpaṇaṁ mūtrakr̥cchraghnamudāvartaharaṁ pibēt||37||

phANitaM saktavaH sarpirdadhimaNDo~amlakA~jjikam|

tarpaNaM mUtrakRucchraghnamudAvartaharaM pibet||37||

A nourishing drink prepared of phanita (inspissated juice of the sugar cane and other plants), saktu (coarse ground meal/ roased corn flour), ghee, whey, and sour gruel nourishes and should be consumed for the treatment of dysuria and udavarta. [37]

मन्थः खर्जूरमृद्वीकावृक्षाम्लाम्लीकदाडिमैः|

परूषकैः सामलकैर्युक्तो मद्यविकारनुत्||३८||

manthaḥ kharjūramr̥dvīkāvr̥kṣāmlāmlīkadāḍimaiḥ|

parūṣakaiḥ sāmalakairyuktō madyavikāranut||38||

manthaH kharjUramRudvIkAvRukShAmlAmlIkadADimaiH|

parUShakaiH sAmalakairyukto madyavikAranut||38||

Mantha (thin guel) prepared from date-palm, dry grapes, vrikshamla (Garcinia indica Ehois), amlika (Tamarindus indica), dadima (Punica granatum), parushaka (Crewia asiatica), and amalaki (Emblica officinalis Gaertn.), are useful for management of disorders caused due to excess consumption of alcohol. [38]

स्वादुरम्लो जलकृतः सस्नेहो रूक्ष एव वा|

सद्यः सन्तर्पणो मन्थः स्थैर्यवर्णबलप्रदः||३९||

svāduramlō jalakr̥taḥ sasnēhō rūkṣa ēva vā|

sadyaḥ santarpaṇō manthaḥ sthairyavarṇabalapradaḥ||39||

svAduramlo jalakRutaH sasneho rUkSha eva vA|

sadyaH santarpaNo manthaH sthairyavarNabalapradaH||39||

Sweet and sour mantha prepared from water with or without unctuous substances refreshes instantly and gives stability, good complexion and strength. [39]

Summary

तत्र श्लोकः-

सन्तर्पणोत्था ये रोगा रोगा ये चापतर्पणात्|

सन्तर्पणीये तेऽध्याये सौषधाः परिकीर्तिताः||४०||

tatra ślōkaḥ-

santarpaṇōtthā yē rōgā rōgā yē cāpatarpaṇāt|

santarpaṇīyē tē'dhyāyē sauṣadhāḥ parikīrtitāḥ||40||

tatra shlokaH-

santarpaNotthA ye rogA rogA ye cApatarpaNAt|

santarpaNIye te~adhyAye sauShadhAH parikIrtitAH||40||

Diseases caused due to overnutrition and undernutrition, along with their treatment, have been described in this chapter. [40]

Tattva Vimarsha (Fundamental Principles)

1. Intake of calorie rich and excessive food and nutrition with little or no physical exercise, results in increased body tissues. This contributes to causing diseases such as metabolic syndrome. These conditions are managed by purification therapies leading to reduction (langhana), and prescribing a regimen of physical exercise, appropriate dietary changes, fomentation and reducing drugs.

2. Excessive physical and/or mental activities without adequate nutrition causes nutritional deficiency diseases like wasting and psychosis. Treatment is high calorie but less filling diet, rest, medicated oil enema and massage. In cases of acute weight loss, nutrition should be given immediately while in the case of chronic loss, the process should be gradual but prolonged.

Vidhi Vimarsha(Applied Inferences)

The word santarpana means the act of satiating, restoration or refreshing. In this context, the term is used for overeating or overnutrition. Dietary items that are prithvi and apa mahabhuta dominant lead to santarpana. Quality, quantity, and age of certain food items can cause alteration in the digestabilibty of the food. For example, aged food grains are light to digest than new food grains. Therefore, the new food grains tend to increase weight, and same quantity of aged food grains do not increase weight. What changes occur in aging of the grains and their mechanism of action needs to be studied.

I. Properties of Santarpanakarak food articles

Unctuous (snigdha), sweet (madhura), heavy to digest (guru), and slimy (pichhilla) foods predominantly have Prithvi and jala mahabhuta, leading to an increase in kapha and rasa dhatu.

The functional trait of such food articles is snigdha (oily) guna is sneha (unctuousness), mriduta (softness), and ardrata (malleability, fluidity) . Snigdha food articles include those derived from lipids and fat molecules. Similarly, madhura (sweetness) is a property of food substances that possess predominantly sweet taste - not just perceived at the tongue, but also in many parts/tissues along our digestive system. Guru is the primary property that indicates “heaviness” of a food item, and a guru food article is heavy to digest and increases bulkiness of the tissues. Guru is the opposite of agni and hence delays digestion and metabolism and is used, therefore, in therapies that require nourishment, enhancement of physical strength, etc (brimhana, agnimaandyakara, upalepa, bala, upachaya and tarpana). Finally, picchilla is sliminess and stickiness, and indicates food items that vitiate kapha and mamsa and meda dhatu particularly.

Today’s research is consistent with the above findings of Ayurveda. Researchers acknowledge that taste receptors exist in the upper gastrointestinal tract as well. These receptors are “primarily located in the intestinal brush and enteroendocrine cells, and recognize sugars, D-amino acids, sweet proteins, and artificial sweeteners”, per their research. Peptide YY (PYY) exerts its action through NPY receptors by inhibiting gastric motility and increasing water and electrolyte absorption in the colon. PYY may also suppress pancreatic secretion, as it is secreted by neuro-endocrine cells in the ileum and colon in response to a meal, and has been shown to reduce appetite. It works by slowing the gastric emptying, thereby increasing the efficiency of digestion and nutrient absorption after a meal. Considering the effects of sweet food substances, PYY, in certain quantities, helps induce satiety in a person and thus in excess, inhibits appetite. This study clearly suggests the impact of madhura rasa and snigdha food substances in creating santarpaniya vyadhi or increased anabolism. Like GLP -1, GIP is related to metabolism and inflammation.

Thus, it can be said that excess of madhura, guru, snigdha and pichchilla foods can have inflammatory effect at the molecular level. If the above properties elaborated by Charak are to be understood, it can be clearly stated that they increase body tissues in volume and delay the digestion of food. This seems to be acceptable and the effect may be mediated through peptide YY. As it delays digestion and increases the nutrient uptake, these food substances lead to santarpana.

II. Impact of age on grains and grain-based food products

The age of food grains helps determine the quality as well as digestibility of food. Shuka dhanya (monocotyledons) and shami dhanya (dicotyledons) that are old /aged are easy to digest and are dry in property as compared to new ones. [Cha.Sa.Sutra Sthana 27/309] Nava anna, or fresh, non-aged rice, millet, etc. increase kapha and are heavier than old grains. Charak notes that all new and fresh grains are heavy and induce santarpana, while aged grains are lighter to digest.

Sharangdhara in Purva Khanda also talks of new and old grains and recommends six to twelve month-old grains to be used. Biochemical changes that help in digestion may be occurring after certain aging of grains. Per researchers (Seguchi, 1993), aging of flour and grains does enhance their functionality as ingredients for cakes and batter. Cereals can be stored for long periods without microbial spoilage. However, biochemical changes also occur during aging. There is great possibility that certain amino acids and phyto chemicals get stabilized in the grain which make them safe for consumption. Eventually, the grain respires, dry matter is lost and functional and nutritional aspects of the grain are altered. Age related changes have great influence on the viscosity of any batter made out of wheat-flour and the water-binding ability of the wheat flour (Shelke et al, 1992). In addition, the starch granule surface protein is found to increase up to three to four times with aging. However, prolonged aging is not recommended (Pomeranz et al, 1968). The moisture content of grains, the storage temperature and relative humidity have been shown to exert dramatic changes in the acidity, pH, free amino nitrogen, crude protein, and protein quality. Significant changes in soluble sugars and amylase contents of the grains have also been reported during storage at elevated temperature.

It is to be noted from various studies that the protein content of wheat grains and flour do not change significantly over time (Kim et al 2003). While protein quantity may not change, protein quality does. In one of the studies it was noted that total content of starch gets reduced after certain time when the grains are kept within controlled temperature. In India, wheat gets harvested in the months of March and early April. The atmospheric temperature varies from 25℃ – 45℃ in summer in different parts of India. The total starch content of the flour got decreased by 50 % when stored at 50℃ in comparison to the freshly harvested wheat grains . This is a significant change that occurs due to aging of wheat. If the starch content of wheat is reduced with time, aged wheat will have lower calorific value and lower glycemic index. It will also be easier to digest. Similar changes have been observed in rice after aging. Post harvest storage has, it has been observed, significant effect on eight known textural properties that are important to the sensory characteristics of cooked rice: adhesion to lips, hardness, cohesiveness of mass, roughness of mass, toothpull, particle size, toothpack, and loose particles. A difference is observed between ageing of rice flour and rice starch. It is evident that pasting properties of fresh and aged rice are different. It is also reported that the cell wall structure is decomposed by endo –xylanase during storage which led to the changes in amylograms of rice fours.

These changes in physiochemical properties of grains exert their effect on digestibility of the food. It has been studied through experiments that the moisture content is higher in new grains indicating predominance of jala mahabhuta and prithvi mahabhuta which again tends towards santarpana. Aging of rice has an impact on its glycemic index and glycemic load. New grain may have higher glycemic index than the older grain. Due to the effect of time on these food stuffs there are greater possibilities that certain amino acids and phyto chemicals get stabilized in the grain that make them safe for consumption.

Navamadya/fresh wine: New or fresh wines should not be consumed because they cause heaviness and create imbalances in all the three dosha while old wines promote circulation in the body, increase digestion, lightness and enhance taste in food. The effect of aging on tannins and resveratrol has been studied and shows significant difference between old and fresh wine. Aging results in altered and reduced phenolic contents in red wine. Anthocyanin tannin complexes can be formed which can stabilize the colour of red wines resulting in wines that are tasteless, fruity and less astringent after aging. Oxidation reactions involving phenolics might also change the chemical and sensory profile of wines. Oxygen in the air is always ready to react with unprotected juice or wine and many of the substances present get adversely affected by oxidation, producing unpleasant, bitter, off-odours and off-tastes. However, it is recognized that some degree of oxygenation may be beneficial for the formation of red wine, but the quality of white wines is generally impaired by excessive air exposure. As tannins and anthocyanins interact with oxygen, which diffuses during barrel storage, these compounds further polymerize and become less astringent. Red wines become lighter in colour, and proanthocyanidins and other polyphenolics eventually aggregate in larger molecules which accumulate as sediment over time at the base of the bottle. In contrast, white wines often deepen in colour, turning darker honey colors as they oxidize and age .

The phenolic compound present in a bottle of wine slowly changes as it ages. The most important component of wine is tannin which binds with proteins. High tannin containing wine inhibits saliva’s ability to lubricate mouth and imparts astringent feeling in mouth. Aged wine undergoes polymerization of tannins. This makes tannin sediments settle to the bottom of the container and lose its property to bind with proteins. Aged wines are very aromatic and possess fruity flavors.

Ageing of wine solely depends on its storage and oxidation of the wine. Normally new wines contain about .02 - .03% acetic acid. This is reduced in aged wine if it is packed properly. This physico-chemical change in aged wine, change in taste and aroma modify its pharmacological effects. Increase in its antioxidant properties and change in Anthocyanin tannin complex makes wine more effective after age. There is also a possibility that chemical process in ageing of wine may also change the molecular size of tannins which might become more bio-available after consumption.

III. Categories of food leading to anabolism

Gorasa (milk and milk products): Over the years, there have been many conflicting views in scientific journals and from nutritionists regarding dairy products and it is often difficult to conclude about their health benefits. Charak has clearly mentioned in various texts, including this chapter and in Prameha Nidana, that excessive consumption of dairy products, meat, and carbohydrates may lead to many metabolic disorders. It may also create inflammation at a molecular level. Common allergens like casein and gluten create inflammation in the gut. Investigators have correlated higher levels of milk antibodies with rheumatoid arthritis (Arvikar, 2013). Studies suggest (Feskanich D. et al) that cow’s milk could be responsible for an irreversible inability to metabolize blood sugar, and could cause Type I and type II diabetes. This study also suggests that severe disorders such as rheumatoid arthritis, diabetes, heart attacks, multiple sclerosis, and osteoporosis could be attributed to diet rich in milk.

Thus, there has been much research concerning dairy products, besides meat and other forms of complex proteins, which shows their excessive consumption in a very unfavourable. These types of food have multifold impact on the health of a person. These can change the gut flora leading to disorders of absorption, adversely affecting auto-immunity and production of antibodies. It has been shown by certain researchers that excess of meat and dairy products leads to immune-activation . Excess of meat also has certain enzymatic toxicity which can lead to insulin resistance –a basic pathology of obesity, heart disease and type II diabetes.

All the above types of food mentioned herein could explain 57% of the total structural variation in gut microbiota whereas changes in genetics accounted for no more than 12% . This indicates that diet plays a dominant role in shaping gut microbiota and changing key populations may transform healthy gut microbiota into a disease-inducing entity. For example, the western diet, which is high in sugar and fat, causes dysbiosis affecting both host GI tract metabolism and immune homeostasis. Dysbiosis is a very important term that can be helpful in explaining many pathologies mentioned in Ayurvedic literature.

Thus, an excessive meat/dairy based diet that has been explained by Charak starts its dreadful effect from GI tract leading to metabolic disorders. This can be compared with the theory of agni elaborated by Ayurveda scholars and also explains how wrong food exerts its effect on immune system leading to inflammation at molecular level. Chronic inflammation changes the normal mechanism of body and leads to certain dreadful metabolic disorders. Thus, over and undernutrition both lead to certain metabolic diseases mediated through inflammation .

IV. Effect of lifestyle on anabolism

Charak not only explains the adverse effects of bad eating but also explains the ill effects of sedentary behaviour which are the leading cause of metabolic disorders. He explains that those averse to physical or mental activities (exercises), those who are habituated to sleeping during the day and always having the tendency to lying down will end up suffering from various metabolic disorders. Modern researchers have proved this too. Sedentary behaviour refers to low-energy activities that involve energy expenditure (at the level of 1.0–1.5 metabolic equivalent units (METs)), and include activities such as lying down, sitting, etc. Individuals could be spending a significant part of their waking hours in sedentary activities.

Per studies by Lee et al (2001), the association between sedentary behaviour and metabolic health could, to some extent, explain the association between sedentary time and metabolic syndrome .

Bedrest studies, though not sufficiently researched in humans, indicate that there is an increased sedentary behavior associated with a range of deleterious metabolic effects .

It can be noted from the above enlisted disorders that kapha dosha, rasa, rakta, mamsa and meda dhatu are vitiated in santarpaniya diseases. Therefore, the treatment protocol shall be designed keeping these factors in mind.

Pramehapidaka: This can be compared with diabetic carbuncle which is a complication of uncontrolled diabetes mellitus. It is localized infective gangrene of the skin and subcutaneous tissues caused by infection. The predisposing factor is diabetes. In diabetic carbuncle, infection is at hair follicle with severe pain and there is involvement of fibrous strand along with sub-cutaneous tissues. A multi-locular lesion is seen which may give rise to ulcerating carbuncle. In this lesion, gangrenous process can occur which may be due to thrombosis of the lesion.

It is interesting to note that pramehapidaka, skin disorders, pandu (anaemia), urinary problems (which can be referred to as renal problems) and arochaka (anorexia) are all complications of metabolic disorders. These diseases must not be taken as swatantra (independent) pathological entities but are to be seen in the light of metabolic disorders.

Kandu can be compared with urticaria, characterized by skin eruptions which are reddish and itchy in nature and are of mild intensity and increased by exposure to cold breeze. It is also manifested as a symptom of other diseases. In this context of santarpanajanya vyadhi, we have seen previously that certain foods have effect on immune system. Kandu is a peculiar indication of severe hyperglycemia as well. Due to dehydration, neuritis and micro angiopathy these types of symptoms can be developed. These are more seen in chronic uncontrolled diabetes patients.

Kotha, as explained, is a decay of tissues due to certain conditions. In the context of santarpanajanya vyadhi, decay usually is seen in diabetic patients caused mostly due to microangiopathy. Involvement of the blood vessels by atherosclerosis leading to ischemia is a significant factor in diabetic foot. Lower extremity peripheral vascular disease (PVD) is the most common factor associated with limb ulceration, gangrene, impaired wound healing and ultimately amputation. It mainly occurs due to blood flow changes, occlusive changes, micro angiopathy, and hematological changes. There is marked change in the flow of blood in peripheral vessels. The microcirculation is regulated by neural factors, local reflexes and vasoactive mediators. The initial haemodynamic changes will be increased flow and pressure of capillary blood . As the disease progresses, autoregulation is lost and haemodynamic stress results. It could also be due to increased calcification of vessels or AV shunting or hyperosmolarity of blood. It is well documented by high ankle brachial ratio and also Doppler studies. Occlusive changes occur in more than 50% of diabetics having the disease for more than 10 – 15 years. It mainly affects arteries below profunda femoris and is characterized by multiple segment involvement. The tibial & peroneal arteries between the knee and the ankle are primarily affected. Dorsalis pedis artery and foot vessels are usually spared. Patients with diabetes have diminished ability to establish collateral circulation especially in arteries around knee. This disease is more prevalent & accelerated with diabetes mellitus.

Pandu (anemia): It means pallor and is seen in metabolic disorders. Charak has explained it as a disease as well as complication of other disorders. Pandu that has been mentioned in santarpanajanya diseases chapter is kapha dominant where the causes are elaborated in verses 3 and 4. Two of the most common causes of anemia are due to abnormalities in iron homeostasis: iron-deficiency anemia and anemia of inflammation also known as anemia of chronic disease. The anemia caused due to inflammation is elaborated in this context. It is very interesting to know metabolic disorders like obesity and some complication of diabetes like diabetic nephropathy also lead to pallor and iron deficiency. Along with anaemia, renal parameters also get deranged which may lead to abdominal symptoms like nausea and vomiting, so the word arochaka is used here adjoining to mutrakrichhra (urinary disorder). In the latter stages of diabetic or hypertensive nephropathy urinary complaints like oligouria or anuria can occur. If it remains untreated due anaemia and congestion in heart, edema starts developing which has been called as shopha.

Amaja vyadhi: Ama is referred to an intermediate bio product of cellular metabolism leading to number of metabolic disorders. Generation of ama is thought to start with maldigestion or indigestion of food substances when taken in excess which begins in the stomach. It is a very important factor playing a pivotal role in the genesis of any disease. It is clearly stated that there is no disorder devoid of ama. So all the anabolic disorders where ama is considered as cause are supposed to be under the category of ama vyadhis.

When we think simply about the urinary complaints related with diabetes and obesity, urinary incontinence is prominent symptom, which is dominantly seen in obese women and men, which can be called as stress incontinence. So the word mutrakkrichra in this context of santarpanajanya vyadhis is to be taken as a complication of diabetic and hypertensive nepheropathy.

Kushtha: There are many skin diseases which are related to anabolism. Anabolism leads to discoloration and hyperpigmentation of skin. Majority of obese people show severe hyperpigmentation, which is called as acanthosis nigricans. Simple acne can also be the result of santarpanajanya vyadhis. Some of the studies had reported, how caloric restriction can change sebum composition. Another study linked acne to the consumption of milk.

Klaibya: A person who is unable to have proper sexual intercourse either due to erectile dysfunction or early ejaculation is termed as klaibya in Ayurveda.Klaibya is described in detail in Chikitsa Sthana [Cha.Sa.Chikitsa Sthana 30/155] and is mentioned as a complication of either obesity, diabetes or hypertension. While elaborating the properties of lashuna (garlic) Charak has explained that lashuna is important herb in cardiac disorders as well and is useful in klaibya. Looking at its properties on microvessels, garlic is proven to be a herb which regulates nitric oxide synthesis in the arteries and keeps the lumen of the arteries dilated. Per studies, in cases of hypertensive erectile dysfunction in rats, it has been observed that nitric oxide synthesis in penile artery is lowered. Garlic has positive impact on regulating nitric oxide synthesis.

The direct effect of obesity on increased risk of erectile dysfunction is well researched, and is often attributable to hormonal imbalance, endothelial dysfunction and insulin resistance.

Gurugatrata: Guru is heavy and gatra is body, and gurugatrata means a feeling of heaviness in the body. This condition can be due to excess fat deposition, or may be due peripheral odema developing due to certain cardiac and renal complications. In the initial stage tissues show inflammatory changes at molecular level and later develop symptoms of gurugatrata.

Aalasya(lethargy or lassitude), at the somatic as well as psychological level, signifies a feeling of lethargy along with hesitancy or weariness of body or mind from strain, oppressive climate, etc. It is mainly caused due to psychological factors that show through one’s sensory and motor organs. It is a primary stage of the major complications like tandra and moha. It could also be a condition symptomatic of diabetic and hypertensive cerebral encephelopathy. Uncontrolled hyperglycemia or hypertension in patients may lead to number of complications. These are all pre coma or coma conditions where all the sensory organs stop responding and a specific word, Lepa, is used to denote some form of “covering” that the sensory organs are covered with that makes them stop responding and lose orientation. Not only the sensory organs, but all the body channels from where not only the blood and sensation, but also the chemical signalling of the cells also gets disturbed and patients land into tandra, buddhi moha and prameelaka.

Tandra is an abnormal condition characterized by drowsiness.

Moha is an abnormal condition of the mind in which person cannot take correct decision and also is not able to scrutinize the subject referred by mind.

Prameelaka: An abnormal mental condition characterized by constant thoughts.

All the above mentioned conditions are due to severe hyperglycemia with hyperosmolality and dehydration, in the absence of significant ketosis. It occurs in patients with mild or occult diabetes, and most patients are middle-aged to elderly. Accurate figures are not available as to its true incidence, but from data on hospital discharges it is rarer than diabetic ketoacidosis even in older age groups.

Research shows that a partial or relative insulin deficiency may trigger a syndrome by reducing glucose utilization of muscle, fat, and liver while increasing hepatic glucose output.

Ultimately, with all these symptoms and conditions, edema over the body develops and along with other complications lands the patient into severe difficulties.

Lekhana is defined as the therapeutic action which (adequately) dries up body tissues and then literally scrapes the unwanted substances (generally solid, unctuous substances) out from the body tissues. Though this may be one meaning of lekhana, all lekhana activites and lekhana dravya exert some pharmacological activates that reduce unwanted substances - unwanted dosha, dhatu or mala- from the body. The same properties of lekhana can be achieved by virechana, vamana or raktamokshana.

Exercise and fasting has a very positive effect on anabolic disorders. Exercise results in reduction in fasting blood glucose, which replicates previous beneficial effects of exercise interventions in type II diabetes.

Fasting

That fasting and CR (calorie restriction) makes an organism’s metabolic process more efficient, enhancing the organism’s age, is a well-researched subject. Clive McCay at Cornell had published, in 1937, that a 33% caloric restriction resulted in a 50% increase in the maximum lifespan of a rat. Similar experiments were done on organisms such as yeasts, mosquitoes, flies, protozoa, roundworms, fish, etc. Many decades later, the National Institute of Aging (NIA) and the universities of Maryland and Wisconsin tried to study the impact of CR on aging using primates (squirrel and rhesus monkeys). The NIA Primate CR study indicated that CR monkeys “demonstrated an improved metabolic profile”, though they also concluded that the effects of CR in long-lived animals are complex and depend on a variety of factors besides caloric restriction.

Herbs used in management of santarpanajanya diseases

While treating santarpanajanya vyadhis like sthulata (obesity) and madhumeha (diabetes), consumption of dravyas that have guru and ruksha properties is advised. Along with medicines, the diet must also be ruksha. For skin ailments, applying powders of medicinal plants all over the body which can provide relief from kandu (itching) and kotha (pre-gangrenous condition) are advised. So the food must be guru and apatarpaka, i.e., it should induce catabolic activities. Applying these powders on the lesions may improve blood circulation which may consequently improve the increased hydroxylysine and glucose disaccharide content, decrease in proteoglycan and heparin sulfate and decrease in lysine content towards the lesion. The effects of honey, a food rich in antioxidants, on diseases such as cancer, coronary diseases, inflammatory disorders, and aging, has helped it gain lot of attention among nutritionists. Properties of honey are ruksha, guru, and kashaya. Food and medicine having these properties enhance akasha and vayu mahabhuta which tends the person towards apatarpana.

Since ruksha dravyas are akasha and vayu dominant, medicines and food articles of this property are advised. Of the three properties of honey, the most important one is guru. Since jatharagni is vitiated in obesity (since agni plays an important role in causing or aggravating anabolic disorders), guru and ruksha substances are used to pacify it, and thus honey is recommended for obesity. However, the use of honey in diabetes is controversial since honey is full of fructose and it imparts hyperglycaemic properties on diabetic patients. In diseases like obesity, lipid abnormality and diabetes mellitus, gut microbiota plays an important role in carbohydrate metabolism.

Pericarp of haritaki showed cardiotonic activities in frog hearts, increasing the force of contraction and cardiac output without altering the heart rate. Haritaki extracts administered before initiating any treatment showed signs of reduced myocardial damage caused by isoproterenol in rats. Haritaki reduced lipid peroxidation and significantly reduced cholesterolemia, aortic sudanophilia, and cholesterol content of the aorta and liver.

Local application by rubbing of certain herbal powders on the skin reduces kapha dosha and regulates vata dosha at that level and inhibits samprapti of kandu and kotha. Regular rubbing of the powders over the skin increases peripheral circulation of the capillaries supplying the skin and also reduced inflammation at dermal level. Rubbing of dry powders over the body is called udvartana. This softens the skin leaving it with a lustrous glow. The stimulating massage helps revitalize skin, removes fat deposits and improve circulation and digestion. Udvartana helps open the circulatory channels, facilitating metabolic activities, eliminating excessive perspiration and body odor and improving the complexion of the skin.

Triphala is one of the oldest used polyherbal preparations. It is comprised of Terminalia chebula, Terminalia bellerica and Emblica officinalis. Some of the positive qualities of triphala in-vivo and in-vitro are that it is an antioxidant, anti-hypercholesterolemic, anti-diabetic, anti-obesity, and possesses chemo-preventive potential and anti-mutagenic activities, anti-inflammatory, antimicrobial, radioprotective effect, immunomodulatory, improving wound healing, enteroprotective efficacies, anti-gastric ulcers and nitric oxide scavenging properties. This herbal combination can have profound healing benefits in multi-organ systems. It is rich in Mg, K, Ca, Fe, Se and Zn, which enhance their bioavailability. Low molecular weight tannins, gallic acid and other important phytochemicals are responsible for the above effects .

Aragwadha (Cassia fistula) possesses madhura rasa, madhura vipaka and has sheeta veerya. It possesses strong antioxidant properties. Aqueous extract of Aragwadha flowers administered in diabetic rats (streptozotocin induced diabetes) showed antioxidant effect. After investigating antioxidants marker enzymes in the brain, significant increase is observed, with decrease in thiobarbituric reactive substances and hydroperoxide formation comparable with glibenclamide.

Cassia auriculata L. seedlings, if irradiated with ultraviolet B (UV-B), it counteracted the induced oxidative stress with reduction in ascorbate, dehydroascorbate, glutathione/oxidized glutathione content at two doses assayed (7.5 and 15.0 kJ-2)

Ethanolic and methanolic extracts of the flowers showed antioxidant properties which may be due to presence of flavonoids and tannins . , Patha (cissampelos pareira): Certain controversies are there about patha. Two different herbs are used as patha in different part of India- Cyclea peltata and Cissampelos parietal. Properties of patha are elaborated as rasa-tikta virya-usna vipäka-katu guna.-laghu, tiksna karma-vata-kaphahara,visaghna ,grahi, balya. Patha is known to have potent diuretic properties. Certain flavonoids were found to exert their diuretic properties by binding with Adenosine A1 Receptor associated with the diuretic action. The diuretic properties of studied plant may be through any of these possible mechanisms since it is rich in alkaloids and flavonoids.

Saptaparna (Alstonia scholaris) possess tikta kashaya rasa, ushna veerya and katu vipaka. The bark is useful in malarial fevers, abdominal disorders, dyspepsia and in skin diseases. In Ayurveda, it is reported that the bark of the plant when soaked in water overnight, can reduce the blood glucose level after oral administration. However, not much characterization of this properties has been done on a scientific basis. The phytochemicals are indicative of its potential in the treatment of diabetes mellitus.

In one of the studies of saptaparna (Alstonia scholaris) showed decrease in glycogen content in streptozotocin-diabetic rats support the findings of Grover et al. The decrease in glycogen content may result due to disturbances in glycogen synthetase system. Improvement in liver glycogen of diabetic rats after chronic treatment with aqueous extract of Alstonia scholaris L. bark indicates that possible way of antidiabetic effect of the extract may be by improvement of glycogenesis and / or suppression of glycogenolysis. Thus, study showed that bark of Alstonia scholaris L. possesses antidiabetic and antihyperlipidemic effects in STZ diabetic rats. The antiatherogenic potential of the bark extract indicates its usefulness not only in diabetes mellitus but also in the long term complications associated with it.

Cyperus rotundus has antioxidant and anti-atherosclerotic effects due to the presence of flavanoids, polyphenols and terpenes which reduce absorption of total cholesterol and triglycerides. Cyperus rotundus, in the form of a fine powder or an aqueous solution, exhibits lipolytic properties and showed mobilization of fats from adipose tissues. Cyperus rotundus is supposed to have activators of beta adreno receptors.

Madanaphala (Randia dumentorum) has madhura, tikta rasa, katu vipaka and ushna veerya. It is a widely used herb for induction of vomiting used for vamana procedure. It has lekhana properties.

Clearly, the pharmacological action of the above dravyas all have been proven to have anti-diabetic and anti-hyperlipidimic properties. The interesting thing to note is that although these dravyas ultimately work for metabolic disorders, they have different modes of action. Anti-diabetic properties of triphala, neem, musta and saptaparna are different. The rasa of the above mentioned dravyas is tikta kasahaya or tikta katu which is akasha, teja and vayu mahabhuta dominant. As we have seen that santarpaniya vyadhis are due to excess consumption of Prithvi and jala mahabhuta those of opposing properties, i.e., akasha, teja and vayu are used in treating such ailments.

Devadaru (Cedrus deodara or Himalayan Cedar) is a herb that is very effective in improving the functions of liver and in maintaining cholesterol levels in healthy limits. Devadaru pacifies the kapha dosha by tikta, katu and ushna properties, and vata dosha by snigdha and ushna properties so it is useful in disorders induced by kapha and vata dosha.

Investigation demonstrate that extracts of C. deodara shows reduction in body weight in treated groups in a dose dependent manner. The major chemical constituents of C. deodara are sterols, poly-phenols, flavanoids such as taxifolin, quercetin and saponins. It is well established that saponins are useful in treatment of obesity. Phytosterols have beneficial effects on hyperlipidemia and poly-phenols and flavanoids have potential antioxidant properties. Therefore, it could be possible that presence of these compounds is responsible for observed glucose and lipid lowering properties.

Shwadanshtra or gokshura (Tribulus Terrestris) is madhura rasatmaka and has sheeta veerya with madhura vipaka. Gokshura is widely used to relieve certain anabolic disorders. It is helpful for the treatment of angina, high cholesterol 65, diabetes 65, and muscle spasms, and for the prevention of kidney stones.

It is very interesting to note that though gokshura or Tribulus terrestris is madhura and sheeta veerya dravya it has been included to treat santarpaniya vyadhis. Gokshura, by the virtue of its phytochemicals and its DHEAS (Dihydro epi andesterone sulphate) stimulating property and its potent diuretic qualities may have been in the group of medicines which are used to impart apatarpana. It has proved to be a very potent herb to cure erectile dysfunction and klaibyata in patients suffering from metabolic syndrome.

Khadira (Acacia Catechu): This herb is tikta, kashaya having sheeta veerya and katu vipaka. This herb is mostly used as kusthaghana to alleviate skin problems. In eastern traditional medicines, Acacia catechu Willd is extensively used in the management of diabetes in combinations with other medicinal plants. The most common chemical classes among these plants are flavonoid and other anti-oxidants. Hypoglycemic property of extract of Acacia catechu Willd is assumed to be due to the presence of flavonoids which also show inhibition of cyclo-oxygenase and regenerateβ cells. In vitro Acacia catechu Willd is reported to have broad spectrum anti-microbial and anti fungal properties. Phytochemical studies of Acacia catechu Willd leaves shows the presence of alkaloids, carbohydrates, flavones, glycosides, phenolic compounds, saponins, steroids and tannins which may be responsible for its anti-microbial properties.

Haridra (Curcuma longa) has tikta rasa, katu vipaka and ushna veerya. It is laghu ruksha in its qualities. Ingestion of 6 gm Curcuma longa increased postprandial serum insulin levels, but did not seem to affect plasma glucose levels or GI, in healthy subjects. The results indicate that Curcuma longa may have an effect on insulin secretion. The active principles in the rhizome of turmeric plant viz; curcuminoids lower lipid peroxidation by maintaining the activities of antioxidant enzymes like super oxide dismutase, catalase and glutathione per oxidase at higher levels. Antioxidant properties of curcuma longa is due to curcumin and its three derivatives (demethoxy curcumin, bisdemethoxy curcumin and diacetyl curcumin). A scientific and systemic exploration reveals antidiabetic, hypolipidemic and hepatoprotective effects of Curcuma longa freeze dried rhizome powder dissolved in milk which could be used as an effective and safe antidiabetic dietary supplement of high potential.

Curcuma longa is known to contain curcuminoids, glycosides, terpenoids, and flavonoids. Maximal inhibition of the enzyme Human Pancreatic Amylase (HPA) was obtained with Curcuma longa isopropanol extract and acetone extract. This inhibitory action on HPA causes reduction in starch hydrolysis leading to lowered glucose levels. The antioxidants in turmeric also prevent damage to cholesterol, thereby helping to protect against atherosclerosis. In fact, the ability of the antioxidants in turmeric to decrease free radicals is similar to that in vitamins C and E. Since the antioxidant activities of turmeric are not degraded by heat, even using the spice in cooking provides benefits. Animal studies show that curcumin lowers cholesterol and triglycerides, another fat that circulates in the blood stream and is a risk factor for cardiovascular disease. In a recent study of atherosclerosis, mice were fed a standard American diet, rich in refined carbohydrates and saturated fat, but low in fiber. Some of the mice, however, received this diet plus turmeric mixed in with their food. After four months on these diets, the mice that consumed the turmeric with their food had 20 percent less blockage of the arteries than the mice fed the diet without the turmeric. In another study, rabbits were fed turmeric plus a diet designed to cause atherosclerosis. Several risk factors for the disease were improved, including a decrease in cholesterol, triglycerides, and free-radical damage.

Antidermatophytic properties: Fresh juice of rhizome of haridra is used as an antiparasitic in many skin disorders. Its rhizome powder mixed with cow’s urine is taken internally in itching and dermatitis. Curcuma longa L. leaves have good promise as an antifungal agent that could be used as a therapeutic remedy against human pathogenic fungi on account of its various in vitro and in vivo antifungal properties, viz., strong fungicidal action, long shelf-life, its tolerability of heavy inoculum density, thermo stability, broad range of antidermatophytic properties and absence of any adverse effects. Curcumin obtained from the turmeric rhizome have shown to possess the ability to protect the skin from harmful UV-induced effects by displaying antimutagen, antioxidant, free radical scavenging, anti-inflammatory and anti-carcinogenic properties.

Neem (Azadirachta indica): It is a tikta rasa plant having sheeta veerya and katu vipaka. It imparts ruksha and laghu property. Hydroalcoholic extracts of this plant showed anti-hyperglycemic properties in streptozotocin treated rats and this effect is because of increase in glucose uptake and glycogen deposition in isolated rat hemidiaphragm. Apart from having anti-diabetic properties, this plant also has anti-bacterial, antimalarial, antifertility, hepatoprotective and antioxidant effects.

Twak (Cinnamomum Zelyanicum): It is katu-tikta rasatmaka having katu vipaka and ushna veerya. It has been shown that oral administration of cinnamaldehyde produces significant antihyperglycemic effect lowers both total cholesterol and triglyceride levels and, at the same time, increases HDL-cholesterol in STZ induced diabetic rats.

Matan et al. have reported antimicrobial properties of Cinnamon bark. The volatile gas phase of combinations of Cinnamon oil and clove oil showed good potential to inhibit growth of spoilage fungi, yeast and bacteria normally found on IMF (Intermediate Moisture Foods) when combined with a modified atmosphere comprising a high concentration of CO2 (40%) and low concentration of O2 (<0.05%). A. flavus, which is known to produce toxins, was found to be the most resistant microorganism.

Kushtha (Saussurea Lappa): has tikta katu madhur rasa, katu vipaka and ushna veerya. It is known to lower blood lipids and is also known to improve coronary circulation.

Barley: Barley contains greater amounts of soluble and non-soluble starches compared to other cereals, and approximately 17% of the carbohydrate in barley is not absorbed. Undigested carbohydrate produces short chain fatty acids, some which may reduce hepatic glucose production and affect postprandial glycemia. Barley also inhibits serum cholesterol and is also known to reduce blood pressure if given for long term use.

Hingu(Ferula asafoetida): is a resin having katu rasa, ushna veerya and katu vipaka. Ferula asafoetida exhibits anti-cholesterol anti-hypertensive and a potent anti-oxidant properties in experimental animals.

Vasa (Adhatoda vasica): has tikta rasa, sheeta veerya and sheeta vipaka and is strong anti diabetic and cardio protective.

Kharavha ajmoda (Trachyspermemum ammi): is a plant with katu, tikta rasa, katu vipaka and ushna veerya. T. ammi has been shown to possess antimicrobial, hypolipidaemic, digestive stimulant, antihypertensive, hepatoprotective, antispasmodic and broncho-dilating properties.

Pashanabheda (Berginia ligulata): has katu tikta rasa, katu vipaka and ushna veerya. It is a controversial herb and many other plants under the name pashanabheda are prescribed and used. Pashanabheda is enlisted in mootra virechaniya mahakashaya. Due to its diuretic property, it can be used in hypertension, congestive cardiac failure, renal complains etc.

Apart from its diuretic properties, pashanabheda exhibits good anti-diabetic properties. The 80% ethanolic extract of pashanabheda rhizome was fractionated to investigate for a-glucosidase or anti-diabetic properties. Sample solution were evaluated at dose levels of 5.0, 0.5, 0.05 mg/ml to obtain dose response. The ethyl acetate extract exhibited an inhibitory effect of a-glucosidase properties.

Takra (butter milk) is used to relieve santarpanajanya vyadhis. It has prime importance in diet and is supposed to be improve appetite. Its properties and medicinal qualities are described in Ashtanga Hridaya Sutra Sthana chapter 5.

Trikatu: is combination of equal parts of sunthi, maricha and pippali. Trikatu is regarded as an anti-obesity formulation and has been widely used in anabolic disorders. It is widely used to lower cholesterol and triglycerides and is known to increase HDL levels. In one of the studies it is found that trikatu, by virtue of its ability to reduce triglycerides and LDL cholesterol, increases HDL cholesterol to reduce the risk of hyperlipidaemia and atherosclerosis. Trikatu is also known to have immune modulatory properties and is known to be a good bioavailability enhancer.

Vidanga (Embelia ribes): The properties are rasa katu, kashaya rasa, ushna veerya and katu vipaka. It is one of the important plants used for relieving worm infestation. Vidanga exhibits a potent hypoglycaemic and lipid lowering properties.

Agaru (Aquilaria agallocha): Agaru is a tropical and sub-tropical, fragrant evergreen tree. The wood is very heavy, and sinks in water. The wood has tikta rasa, ushna veerya and katu vipaka. It exerts potent immunomodulator and anti inflammatory property.

Sunthi or ginger (Zinziber officinale): Ginger has katu rasa, madhura vipaka and ushna veerya. Ginger has been shown to exhibit antioxidant effects. (6)-gingerol appears to be the antioxidant constituent present in ginger, as it was shown to protect HL-60 cells from oxidative stress. Ginger oil has dominative protective effects on DNA damage induced by H2O2. Ginger oil might act as a scavenger of oxygen radical and might be used as an antioxidant. In vitro research indicates that gingerols and the related shogaols exhibit cardio depressant properties at low doses and cardiotonic properties at higher doses. Both (6)-shogaol and (6)-gingerol, and the gingerdiones, are reportedly potent enzymatic inhibitors of prostaglandin, thromboxane, and leukotriene biosynthesis. Spiced foods or herbal drinks, containing ginger, have the potential to produce significant effects on metabolic targets, such as satiety, thermogenesis, and fat oxidation thus, useful as anti-obesity agent. Thermogenic ingredients, such as ginger, may be considered as functional agent that could help restore a "positive energy balance" and prevent obesity.

Shigru (Moringa olifera): has properties of katu, kashaya rasa, ushna veerya and katu vipaka. It is widely used in santarpaniya vyadhis. Charak has also elaborated shigru to be used in obesity and heart diseases. It exhibits strong hypoglycaemic properties. The aqueous, ethanol and ether extracts of moringa oleifera leaves contain compounds that cause reduction in heart rate and relaxation of cardiac muscle and have medical use in management of cardiac conditions like hypertension.

Katukrohini or kutaki (Picrorrhiza kurroa): Kutaki has tikta rasa, katu vipaka and sheeta veerya. It possesses a strong hepatoprotective properties due to phytochemical picroliv and also have a potent antioxidant properties. It is found to be effective against CCl4 induced hepatic damage in rats, by reversal of increased serum level of SGOT, SGPT, ALP, Cholesterol, Bilirubin and decreases level of total protein which occurs during hepatotoxicit.

Brihati (Solanum indicum): Brihati has katu tikta rasa, katu vipaka and ushna veerya. Solanum indicum Linn. fruits have laxative and cardiotonic action.

Ativisha (Aconitum hetrophyllum): has tikta katu rasa, katu vipaka and ushna veerya. It is laghu and ruksha and hence is used in santarpaniya vyadhis. Research showed significant reduction in total cholesterol, TG, apolipoprotein B and increase HDL cholesterol and apolipoprotein A in serum samples and HMG CO A properties in liver samples. Properties of LCAT had increased and also there was increased fecal fat excretion. The mechanism explained for hypolipidemic properties was due to inhibition of HMG COA reductase properties and decrease fat absorption from intestine.

Sthiram (Shliparni desmodium gangeticum): It has madhura, tikta rasa, madhur vipaka and ushna veerya. It has alkaloids, pterocarpans, phospholipids, sterols, flavones and flavonoid glycosides. The plant shows many pharmacological activities like anti-inflammatory, anti-nociceptive, analgesic, anti-amnesic, anti-diabetic, anti-oxidant, anti-ulcer, and better CVS activites, CNS depressant, antibacterial, wound healing, antipyretic and several miscellaneous actions.

Kebukmool (Costus speciosus): It has tikta kashaya rasa, katu vipaka and sheeta veerya and has strong diuretic action. Increased excretion of Na+ and Cl is observed after its administration. It is known to relieve pulmonary edema.

Dhanayaka (Coriander sativum): Dhanayaka has katu, tikta and madhur rasa with katu vipaka and sheeta veerya. It possesses potent diuretic and antioxidant properties. Part of seeds shows a significant hypolipidemic action. There was significant increase in β-hydroxy, β-methyl glutaryl CoA reductase and plasma lecithin cholesterol acyl transferase properties (LCAT) were noted in the experimental group. The level of low density lipoprotein (LDL), very low density lipoprotein (VLDL) cholesterol decreased while that of high density lipoprotein (HDL) cholesterol increased in the experimental group. Besides diuretic properties it also exhibits a strong anti diabetic and anti convulsant action.

Chitraka (plumbago zeylanica): has katu rasa, katu vipaka and ushna veerya. It is one of the famous herbal medicine used for agnimandya. It also has antidiabetic and hypocholesterolemic action. Pharmacological studies carried out by researchers have indicated that plumbago zeylanica has antihyperglycemic effect on diabetes induced animals. The ethanol extract of Plumbago zeylanica root on key enzymes of glycolysis and muscle hexokinase, phosphofructokinase, pyruvate kinase, lactate dehydrogenase activities were diminished in diabetic rats.

Hypocholesterolemic Action: Pharmacological and Clinical studies carried out indicates that Plumbago zeylanica extract has hypolipidaemic and antiatherosclerotic activities. Plumbagin, an active principle isolated from plumbago zeylanica brings about a definite regression of atherosclerosis and prevents the accumulation of cholesterol and triglycerides in liver and aorta. Panchcole, an Ayurvedic formulation containing plumbago zeylanica as one of its chief ingredients has been advocated to produce hypolipidaemic effect.

Ajaji (Cumin seed (Cuminum cyminum L.)) has katu rasa, ushna veerya and katu vipaka. In studies conducted on rats with induced diabetes, cumin reduced blood glucose levels. One mechanism for this reduction suggests the inhibition of aldose reductase and alpha-glucosidase. In addition, reductions in plasma and tissue cholesterol, phospholipids, free fatty acids, and triglycerides (secondary to diabetes) were demonstrated in another animal study.

Hapusha (Juniperus Communis) has katu rasa, ushna veerya and katu vipaka. While there are not very many research papers written on the efficacy of Juniper berries and leaves as medicinal herbs, they are said to exhibit potent anti-inflammatory properties and are used to support healthy kidney and urinary tract function, besides promoting healthy blood pressure when taken in normal dosages .

Sattu is widely used in santarpaniya disorders. It is prepared by roasting gram flour but has now evolved to include other nutritious flours like barley, wheat etc. Sattu is a perfect blend of balanced nutrients and is prepared in one of the healthiest cooking methods – roasting. Sattu has high fibre and phytic acid content. Method of preparing sattu is such that it retains the nutrient value and increases the shelf life of the ingredients. Roasting can improve protein digestibility. The goal of roasting is to improve sensory qualities and achieve inactivation of destructive enzymes which improves the storage and nutritional quality of the product. Research reports reduced trypsin inhibitor properties when seed temperatures reached 90-100°C. Researchers reported lipoxygenase properties was lost at temperatures of 75-80°C. Some also reported that during roasting total phenols and tannins decrease. It has been observed that the reduction in mineral contents during roasting might be due to the loss of nutrients while heating at high temperature.

Elevated plasma cholesterol or elevated LDL-cholesterol concentrations have been shown to be one of the risk factors.It has been suggested that dietary fibre or more specifically phytate which is a component of fibre can influence the etiology of heart disease. Researchers showed that dietary phytate supplementation resulted in the lowering of serum cholesterol and triglyceride levels. This effect accompanied the decrease in serum Zn level and Zn-Cu ratio. This is because coronary heart disease appears to be caused by an imbalance of Zn-Cu metabolism.

Above are all the important reasons why sattu is recommended as one of the important food in santarpaniya vyadhi. Those individuals who consume these type of formulations can have normalization of agni, smriti (memory) and buddhi, that is the power of forming and retaining concepts and general notions, intelligence, reason, intellect, discernment, judgment which gets deranged in santarpaniya vyadhis in latter stages gets normalised.

Those individuals who exercise regularly, who do not eat until the previous meals are completely digested, who do not indulge in overeating, who regularly consume barley and wheat in diet get relief from all the diseases due to santarpana and obesity. This is how all the santarpanjanya vyadhis are treated with apatarpana medicines.

If we observe the herbs mentioned in the management of santarpaniya vyadhis it is evident from the following table that most of the herbs are tikta, katu, kashaya rasa dominant having katu vipaka and ushna veerya. These properties are attributed to akasha and vayu mahabhuta.

Table 1: Concise information about herbs used in management of santarpaniya diseases

Name	Latin name	Family	Rasa	Veerya	Vipaka
Amalaki	Emblica Officinalis	Euphorbiaceae	Pancharasa (lavanavarjit) amlapradhana	Madhura	Sheeta
Bibhitak	Terminalia bellerica	Combretaceae	Kashaya	Madhura	Ushna
Haritaki	Terminalia chebula	Combretaceae	Pancharasa (lavanavarjit) Kashaya pradhana	Madhura	Ushna
Patha	Cissampelous pareira	Meninspermiaceae	Tikta	Katu	Ushna
Saptparna	Alstonia scholaris	Apoyanaceae	Tikta-kashaya	Katu	Ushna
Vatsak	Cyprus rotundus	Apoyanaceae	Tikta-kashaya	Katu	Sheeta
Nagarmotha	Cissampelous	cyperaceae	Kashaya,tikta,Katu	Katu	Sheeta
Madanphala	Randia spinosa	Rubiaceae	Kashaya,madhura,tikta,Katu	Katu	Ushna
Nimb	Azardirecta indica	meliaceae	Tikta,katu	Katu	Sheeta
Aragvadh	Azardirecta indica	leguminaceae	Madhura	Madhura	Sheeta
Devdaru	Cedrus deodara	pinaceae	Tikta	Katu	Ushna
Gokhshur	Tribulis terreestis	Zygophyllaceae	Madhura	Madhura	Sheeta
Khadir	Acasia catechu	Leguminaceae	Tikta kashaya	Katu	Sheeta
Haridra	Curcuma longa	Zinziberaceae	Tikta katu	Katu	Ushna
Daru-haridra	Berberis aristata	Berberidaceae	Tikta kashaya	Katu	Ushna
Kushth	Saussurea lappa	Compositae	Tikta	Tikta katu madhura	Ushna
Hingu	Ferula narthex	Umbelliferae	Tikta-kashaya	Katu	Ushna
Sunthi	zinziber officinale	zinziberaceae	Tikta-kashaya	Katu	Ushna
Pimpli	Piper longum	Piperaceae	Katu	Madhura	Anu-ushna, Sheeta
Maricha	Piper nigrm	Piperaceae	Katu	Katu	Ushna
Ajmoda	Carum roxburghianum	Umbelliferae	Katu,tikta	Katu	Ushna
Pashanbhed	Bergenia ligulata	Saxifragaceae	Kashaya,tikta	Katu	Sheeta
Vacha	Acorus calamus	Araceae	Katu,tikta	Katu	Ushna
Ativisha	Aconiatum hetero phylum	Ranunculaceae	Tikta,katu	Katu	Ushna
Ajawayan	Trachyspermem um ammi	Umbelliferae	Katu,tikta	Katu	Ushna
Vidang	Emblic ribes	myrsinaceae	Katu,kashaya	Katu	Ushna
Shigru	Moringa olifera	Moringaceae	Katu ,tikta	Katu	Ushna
Kutki	Picrorhiza kurroa	Scrophulariaceae	Tikta	Madhura	Sheeta
Shalparni	Desmodium-Gangeticum	leguminosae	Madhura,tikta	Katu	Ushna
Kebhukmool	Costus speciosus	Zinziberaceae	Tikta,kashaya	Katu	Ushna
Dhanyaka	Coriandrum sativum	Umbelliferae	Tikta,kashaya,madhura,Katu	Katu	Ushna
Chitraka	Plumbago zeylanica	Plubaginanaceae	Katu	Katu	Ushna
Hapusha	Juniperus communis	Pinaceae	Katu ,tikta	Katu	Ushna
Twak	Cinnamomum zelyanicum	Lauraceae	Katu ,tikta,madhura	Madhura	Sheeta
Bruhati	Solanum indicum	Solaneaceae	Katu ,tikta	Katu	Ushna
Agnimantha	Premna mucronata	Verbenaceae	Katu,tikta,kashaya,madhura	Katu	Ushna
Khajura	Phoenix sylvestris	Palmae	Madhura	Madhura	Sheeta
Vrukshamal	Garcinia indica	Guttiferae	Amala(unripened) Madhuramala(ripened)	Amala	Ushna
Dadim	Punic a granatum	punicaceae	Madhur,kashaya,amala	Madhur/amala	Anu-Ushna
Ajaji (jeerak)	Cuminum cyminum	Umbelliferae	Katu	Katu	Ushna
Ela	Elettaria cardmomum	Zinziberceae	Katu , madhura	Katu	Sheeta
Musta	Cyprus rotendus	Cyperaceae	Tikta,katu, kashaya	Katu	Sheeta

Phanita (molasses) is a semisolid condensed sugarcane preparation, traditionally used to prepare arista, asava and other forms of alcoholic fermentation. Its heavy in nature, sweet in taste, nutritive and non - aphrodisiac and aggravates tridosha. Sattu, ghee, whey, sour fruits like Garcinia combojia, and kanji work as tarpana medicines in urinary ailments and udavarta (abnormal conditions characterized by retention of faeces, urine and flatus, associated with pain and leading to or caused by anti-peristaltic movements in the body).

Mantha is a formulation made by adding fourteen times of water and blending it thoroughly. Mantha of kharjura (dates), manuka (resins), gracinia, tamarind, pomegranate, falsa (Grewia asiatica) and amalaki is useful in alcoholics and alcohol induced disorders. Mantha prepared out of sweet and sour substances if mixed together and added with or without ghee proves to be santarpana and improves strength, lustre and power of body.

Kharjura (dates, Phoenix dactylifera) has madhura rasa, sheeta veerya and madhura vipaka. It is highly nutritious, and has therapeutic effect in the prevention of diseases through modulation of anti-inflammatory and antioxidant activities, besides other effects. It contains insignificant amounts of fat and has no cholesterol. It is rich in potassium and iron, besides having adequate levels of B-Complex group of vitamins. They contain health benefiting flavonoid polyphenolic antioxidants. Zea-xanthin is an important dietary carotenoid that selectively gets absorbed in the retinal macula lutea, where it is thought to provide antioxidant and protective light-filtering functions. It thus offers protection against age-related macular degeneration, especially in elderly populations.

Mrudvika are raisins made of dried grapes. They have madhura rasa, madhura vipaka and sheeta veerya and have potent nutritional properties. The most abundant are polyphenol, phenolic acid, tannin are the flavonols, quercetin, kaempferol, phenolic acids, caftaric and coutaric acid. On a wet weight basis, some polyphenol, phenolic acid, and tannin, such as protocatechuic and oxidized cinnamic acids, are present at a higher level in raisins compared to grapes. In human intervention studies, raisins can lower the postprandial insulin response, modulate sugar absorption (glycemic index), affect certain oxidative biomarkers, and promote satiety via leptin and ghrelin.

Dadima (Punica Granatum): It is madhura, kashaya and amla rasa with ushna veerya and madhura vipaka. Pomegranates have the potential to thin the blood, increase blood flow to the heart, reduce blood pressure, reduce plaque in the arteries, and reduce bad cholesterol while increasing good cholesterol. Pomegranate seed oil and fermented juice polyphenols tend to inhibit breastcancer cell proliferation, invasion, and promotes apoptosis of breast cancer cells.

Falasa (Grewia asiatica): has kashaya, amla, madhura rasa and laghu, veerya sheeta guna and madhura vipaka. It is useful in madatya, pittaprakopa, trishna, daha, hridroga, amavata, vatarakta, shoola, kshaya, rohini, yoniroga, vrana, jwara. It shows a potent antioxidant properties and shows radio protective properties.

If we observe the food substances, fruits and other edibles which are advised for the management of apatarpana have high glycemic index. Dates, raisins, and certain fruits mentioned are fast energy giving substances while formulation with sattu are slow energy giving substances.

It is very interesting to note that honey and sattu are used both in apatarpana and santarpaniya vyadhis. In santarpanajanya vyadhis, sattu is used along with certain herbs, which are tikta and katu rasa dominant. Apart from herbs oil, ghee and honey in prescribed portion is used. While in apatarpana diseases sattu has been used along with sugar, alcoholic beverages, honey, oil and ghee. This is the importance of samayoga (combination) of dravyas mentioned by Charak elsewhere. Sattu when advised with alcoholic beverages or with certain sour substance exerts different nutritional properties.

When sattu is given with acidic and fermented substances like alcohol, an enzymetic degradation of phytic acid of sattu is observed. Such a reduction in phytate may increase the amount of soluble iron, zinc and calcium several folds. This makes the combination of sattu more nutritious as compared to the formulation mentioned in the management of santarpanajanya diseases. Over-nutrition and disorders induced by it leads to immune activation or susceptibility to inflammatory diseases, such as diabetes while under nutrition results in immune suppression or susceptibility to infection. Over-nutrition (prolonged intake of high fat/sugar diets) and infection lead to chronic and acute inflammation through nutrient and pathogen sensing systems, respectively

List of research works done as post graduate and post doctoral level on obeisty, dyslipidemia, hyperlipidemia

About 42 research works are found on the subject of hyperlipidaemia with various aspects like aetiopathogenesis and management. Some important work on hyperlipidaemia and hypercholesterolaemia are as follows:

Faculty of Ayurveda, IMS, Banaras Hindu University,Varanasi:

1. Satyavati G.V. (1966): Effect of an indigenous drug on lipid metabolism w.s.r to obesity and atherosclerosis.
2. Shastri V. V. (1967): Effect of certain indigenous drugs on intraarterial thrombosis associated with hyperlipidaemia.
3. Tripathi S N (1973): Studies on the use of Oleoresin Guggulu an indigenous drug in the disorders of lipids.
4. Agarwal D.V. (1973): Clinical and experimental studies on Ayurvedic hypocholesterolaemic drugs.
5. Upadhayaya B.N. (1975): Clinical and experimental study on hypocholesterolaemic and hypolipidaemic action of Gum Guggulu.
6. Sharma Sudhakar (1975): Studies on effect of Terminalia tomentosa on hyperglycaemia and hypercholesterolaemia.
7. Gupta (Smt.) Mithilesh (1977): Effect of C. mukul and endocrinal and biochemical changes in hyperlipidaemia.
8. Gupta O.P. (1981): An assessment of intermittent use of C. mukul (Guggulu) in the treatment of hypercholesterolaemia and hyperlipidaemia in IHD.
9. Ranasingha S G (1990): A critical study on the concept of lipid group of drugs (Charka) in the management of lipidaemia and ischaemic heart disease.
10. Mamgain Pratibha (1991) :Study of lipid profile in individuals of IHD and evaluation of hypolipidaemic action of Lekhaneeya drugs Vacha and Ativisha.

State Ayurvedic College, Lucknow:

1. Mishra Ramanand (1975): The effect of Arogyavardhini in relation to obesity and blood cholesterol.
2. Shali Bala (1978): Role of Arogyavardhini on blood lipids and Medoroga with Anupan of Sharangdhar Mahamanjishthadi Kwath.
3. Nigam R. P. (1982): Clinical trial of Arogya-vardhini-herbal in cases of raised Raktagata Sneha (Hyperlipidaemia).

National Institute of Ayurveda, Jaipur:

1. Sood Rajiv (1999) : Clinical evaluation of Bala-Hareetaki on serum cholesterol.
2. Bhaskar Rao (2002) : Aetiopathologial study of hyperlipidaemia w.s.r. to Sthaulya : a clinical study.
3. Gupta Keshav Prasad (2005) : Aetiopathological studies of hyperlipidaemia (Medodushti) w.s.r to Diabetes mellitus and therapeutic trial of Ayurvedic formulation (Lipidocare).

Gopabandhu Ayurveda Mahavidyalaya, Puri :

1. Tripathy U.C. (1985): Concept of Medoroga vis-à-vis Hyperlipidaemia and its management with Navaka Guggulu.
2. Pande S (2002) : Biological effect of Lekhana Basti w.s.r. to lipid profile.

Smt. K G M Punarvasu Ayurveda College,Mumbai:

1. Majumadar Dattatraya B. (1990): Rasagata-Sneha (cholesterol) Ka Naidanika Chikitsatmaka Adhyayana.
2. Kadam Sandhya (1997): Hyperlipidaemia (Rasa-Raktagata Sneha Vriddhi) mein Amritadi Yoga Ka Prayoga Chikitsatmaka Adhyayana.
3. Ratnakaran Anuradha R. (1997): Clinical evaluation of the role of Navaka Guggulu on the Rasa-Raktagata-Sneha-Vriddhi.
4. More Manojkumar B. (1998): Methika-Beeja Ka hyperchole-sterolaemia (Rasa-Raktagata Sneha Vriddhi) mein Prayoga.
5. Virkar Dattu (1998): Mustadi Mahakashaya (Lekhaneeya Gana) Ka hyperlipidaemia (Rasagata-Sneha-Vriddhi) mein prayoga aur Chikitsatmaka Adhyayana.
6. Jagtap Reshma (1999): Hyperlipidaemia (Rasagata-Sneha-Vriddhi) evam Hypertension (Uchha-Rakta-Chapa) mein Krishnadi Choorna ka Prayoga aur Chikitsatmaka Adhyayana.
7. Jankar Nilambari (2002): Hyperlipidaemia (Rasa-Raktagata-Sneha) mein Lekhaneeya Mahakashaya (Gana) Kala Basti Ek Chikitsatmaka Adhyayana.
8. Paradkar Hemant S (2004): Rasa-Raktagata-Sneha-Vriddhi mein Trishila Guggulu (Triphala, Shilajit, Guggulu) yoga ka Chikitsatmaka Adhyayana.

Government Ayurvedic College, Trivandrum :

1. Ravindran C.A. (1986): A clinical evaluation of hyperchole-sterolaemia w.s.r. to Kalasaka.
2. Suresh Babu M.R. (1994): A clinical study to assess the efficacy of Lekhaneeya Gana in hypercholesterolaemia.
3. Ansari P.Y. (1994): An experimental study on effect of Musta (Cyperus rotundus) in hypercholesterolaemia.
4. Johny Joseph (1995) : A study to assess the hypolipidaemic properties of Dolichos biphlorus (Kulatha).
5. Sreelatha P.K.(1996):Management of hypercholesterolaemia with an Ayurvedic compound.
6. Suresh A.V. (1999): A study on Snehapana in hyperchole-sterolaemia conditions during treatment.
7. Razeena K. (2003): Pharmaceutical preparation and standardization of compound herbomineral preparation and its efficacy in hypercholesterolaemia.
8. Seemaja G. (2003): A clinical study to assess the efficacy of Ayurvedic compound in the management of hyperlipidaemia,
9. Pankajam P. K. (2003) : A study on the effect of selected modalities of Yoga and naturopathy in the control of hyperlipidaemia.

Tilak Ayurveda Mahavidyalaya, Pune:

1. Kad Vilas S (1997): Study of lipids/Prasadakaya Dhatu with reference toAyurvedic Swastha and Atura Pareekshana.

University of Pune:

1. Arora N. K. (2001): Effect of Hareetaki (Terminalia chebula ratha.) in hypercholesterolaemia.

B V College of Ayurveda, Pune:

1. Sankapal Milind Kumar (2005): Upashayatmak study of Ushnodaka on blood cholesterol and Sthaulaya lakshana.

Rajiv Gandhi Govt. PG Institute of Ayurveda, Paprola:

1. Gupta Madhu (2000): Effect of Ayurvedic formulation on Medoroga w.s.r. to Hyperlipidaemia.

Institute of Postgraduate Education and Research in Ayurveda,Kolkata:

1. Mishra D K (1991) : Role of Commiphora mukul and P. compound in Medoroga w.s.r. to obesity and cholesterol.

Govt. Ayurvedic Medical College, Mysore:

1. Suchitra S.S. (2002) : A study on Rookshna Chikitsa w.s.r. to the effect of Shuddha Guggulu and Shuddha Shilajatu on Sthaulya (hypercholesterolaemia) A comparative study.

SDGM Ayurveda Medical College, Gadag:

1. Mudigoudar Yoshadha S (2000) : The efficacy of Pippalyadi Guggulu in Medoroga (w.s.r. to its hypolipidaemic effect).

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