Changes

=== ''Tattva Vimarsha'' ===

=== ''Tattva Vimarsha'' ===

• Eight types of the undesirable appearance of humans are: too tall, too short, too hairy, hairless, too dark, too light (complexioned), too obese and too lean. Too obese and too lean are the most undesirable of human appearances that are also more prone to various diseases. [3]

*Eight types of the undesirable appearance of humans are: too tall, too short, too hairy, hairless, too dark, too light (complexioned), too obese and too lean. Too obese and too lean are the most undesirable of human appearances that are also more prone to various diseases. [3]

• Excessive obesity has eight inherent defects viz. decrease in longevity, hampered mobility, difficulty in sexual intercourse, debility, bad body odor, profuse sweating, excessive hunger, and excessive thirst. [4]

*Excessive obesity has eight inherent defects viz. decrease in longevity, hampered mobility, difficulty in sexual intercourse, debility, bad body odor, profuse sweating, excessive hunger, and excessive thirst. [4]

• Excessive obesity is caused by over-nourishment due to the intake of heavy, sweet, cold and fatty diet, lack of physical exercise, abstinence from sexual intercourse, indulgence in the day sleeping, uninterrupted cheerfulness, lack of mental activities and hereditary/genetic defects. [4]

*Excessive obesity is caused by over-nourishment due to the intake of heavy, sweet, cold and fatty diet, lack of physical exercise, abstinence from sexual intercourse, indulgence in the day sleeping, uninterrupted cheerfulness, lack of mental activities and hereditary/genetic defects. [4]

• Obesity is a result of obstruction of channels by excess accumulated Medas (fat). This deranges the movement of vata is specially confined to koshtha (abdominal viscera) resulting in the stimulation and hastening of the digestive process through abnormally increased Agni (pitta). This leads to excessive hunger and thirst and the person eats more food to gain weight.  An excessive increase in adipose tissue and vitiation of tridosha causes severe diseases in obese people. [5-8]

*Obesity is a result of obstruction of channels by excess accumulated Medas (fat). This deranges the movement of vata is specially confined to koshtha (abdominal viscera) resulting in the stimulation and hastening of the digestive process through abnormally increased Agni (pitta). This leads to excessive hunger and thirst and the person eats more food to gain weight.  An excessive increase in adipose tissue and vitiation of tridosha causes severe diseases in obese people. [5-8]

• Disproportionate increase of fat occurs mainly around buttocks, abdomen, and breasts, which become pendulous and the person suffers from improper metabolism and energy. [9]

*Disproportionate increase of fat occurs mainly around buttocks, abdomen, and breasts, which become pendulous and the person suffers from improper metabolism and energy. [9]

• Indulgence in dry [ non-unctuous] diets and drinks, fasting, inadequate diet, overuse of therapeutic purificatory measures, grief, suppression of natural urges, sleep deprivation, dry powder massage, indulgence in baths, heredity, old age, continued illness and anger make a person too lean.  [11-12]

*Indulgence in dry [ non-unctuous] diets and drinks, fasting, inadequate diet, overuse of therapeutic purificatory measures, grief, suppression of natural urges, sleep deprivation, dry powder massage, indulgence in baths, heredity, old age, continued illness and anger make a person too lean.  [11-12]

• Too lean and too obese persons are prone to suffering from various diseases and need constant treatment. [16]

*Too lean and too obese persons are prone to suffering from various diseases and need constant treatment. [16]

• Being lean is better than being obese because the lean person responds well to nourishing treatment and balancing of the causative dosha (vata and pitta). On the contrary, reducing therapy and drugs used in the treatment of obesity can cause an increase in agni, which may cause increased appetite and thirst. Hence, the obese suffer more than the lean. [17]  

*Being lean is better than being obese because the lean person responds well to nourishing treatment and balancing of the causative dosha (vata and pitta). On the contrary, reducing therapy and drugs used in the treatment of obesity can cause an increase in agni, which may cause increased appetite and thirst. Hence, the obese suffer more than the lean. [17]  

• A person possessing a balanced constitution of muscles and compactness of the body, and stable sense organs does not fall prey to diseases. He can tolerate hunger, thirst, heat and cold, and physical strain better. His digestion, assimilation of food and muscle metabolism are in a state of equilibrium. [18-19]

*A person possessing a balanced constitution of muscles and compactness of the body, and stable sense organs does not fall prey to diseases. He can tolerate hunger, thirst, heat and cold, and physical strain better. His digestion, assimilation of food and muscle metabolism are in a state of equilibrium. [18-19]

• The food that is heavy to digest but not having any fattening (such as high fiber diet) is prescribed for the obese. In lean persons, food that is light to digest and has high nourishing value is prescribed. [20]

*The food that is heavy to digest but not having any fattening (such as high fiber diet) is prescribed for the obese. In lean persons, food that is light to digest and has high nourishing value is prescribed. [20]

• Food and drinks that alleviate vata and reduce kapha and Medas, as well as therapies such as enema (administered with drugs of sharply acting, dry and hot properties) and therapeutic powder massages are important treatments for obesity. [21-22]  

*Food and drinks that alleviate vata and reduce kapha and Medas, as well as therapies such as enema (administered with drugs of sharply acting, dry and hot properties) and therapeutic powder massages are important treatments for obesity. [21-22]  

• To enhance body mass of the excessively lean, an easy-to-digest and nourishing diet therapy, proper sleep, mind relaxing activities, rasayanas and aphrodisiacs, a diet with unctuous food and newly harvested food, and measures that eliminate vitiated doshas are prescribed. [29-34]

*To enhance body mass of the excessively lean, an easy-to-digest and nourishing diet therapy, proper sleep, mind relaxing activities, rasayanas and aphrodisiacs, a diet with unctuous food and newly harvested food, and measures that eliminate vitiated doshas are prescribed. [29-34]

• Tiredness, inactivity of mind, and detachment from sense organs are certain situations and conditions that help in falling asleep. [35]

*Tiredness, inactivity of mind, and detachment from sense organs are certain situations and conditions that help in falling asleep. [35]

• Normal sleep is necessary for the normal functioning of human body and excessive or inadequate sleep results in many diseases. Happiness and misery, nourishment and emaciation, strength and weakness, fertility and infertility, knowledge and ignorance and life and death depend on proper and improper sleep. [36]

*Normal sleep is necessary for the normal functioning of human body and excessive or inadequate sleep results in many diseases. Happiness and misery, nourishment and emaciation, strength and weakness, fertility and infertility, knowledge and ignorance and life and death depend on proper and improper sleep. [36]

• Sleeping during the day is indicated for restoring any damage to the physical constitution or depletion of body tissues. In a normal person, sleeping during the day is contraindicated in seasons other than summer because it causes vitiation of kapha and pitta. Daytime sleep causes serious health problems. While insomnia causes roughness in the body, daytime sleep causes snigdhata (unctuousness) in the body. [39-50]

*Sleeping during the day is indicated for restoring any damage to the physical constitution or depletion of body tissues. In a normal person, sleeping during the day is contraindicated in seasons other than summer because it causes vitiation of kapha and pitta. Daytime sleep causes serious health problems. While insomnia causes roughness in the body, daytime sleep causes snigdhata (unctuousness) in the body. [39-50]

• Obesity and leanness are caused by improper diet and sleep. [51]

*Obesity and leanness are caused by improper diet and sleep. [51]

Vidhi vimarsha:  

=== Vidhi Vimarsha ===

In biomedical science, the above-described eight types of undesirable persons are comparable to a variety of genetic and neuroendocrine disorders. Out of these eight types, the last two (atisthula and atikrisha) need therapeutic interventions and deserve special attention. According to Chakrapanі, physical deformities such as kubja (hunchback) and pangu (limp gait) may also be taken as undesirable.   

   

In biomedical science, the above-described eight types of undesirable persons are comparable to a variety of genetic and neuroendocrine disorders. Out of these eight types, the last two (atisthula and atikrisha) need therapeutic interventions and deserve special attention. According to Chakrapanі, physical deformities such as kubja (hunchback) and pangu (limp gait) may also be taken as undesirable.   

Too Obese: (Verse 3-4)

Too Obese: (Verse 3-4)

1. In the context of atisthula and atikrisha, Charaka has explored these conditions from the standpoint of their diathesis, clinical presentation, and management, which is comparable to approaches taken today to the study of obesity and leanness. Suśruta has considered rasa dhatu as the main culprit for both obesity and emaciation (rasa nimittameva sthaulyam karshyam ca).  Lipid precursors are acted upon by fat-specific energy (medhodhatvagni) for their conversion into adipose tissue (medodhatu).  Vitiation of kapha dosha and excessive accumulation of fat-specific energy and waste products of adipose tissues (kleda) lead to dysfunction of adipose tissues. Adipose channels have two origins - kidney, adrenal and fat around them and other are visceral and omental fat (vapavahana).  These channels draw nutrition, including lipid from the antecedent flesh and transient lipid and then convert them into a stored form of lipid. As per biomedical science, obesity is associated with increased adipose stores in the subcutaneous tissues, skeletal muscles and internal organs such as kidney, heart, liver and omentum. Adipose tissues (medodhatu) form a crucial link to the concept of tissue metabolism. Low levels of fat-specific energy (medodhatvagni), despite a normal food intake, can lead to a steady accumulation of fat and the outcome is obesity.  The conventional system of medicine has given due consideration to certain factors such as insufficient sleep, genetic predisposition, later age pregnancy, certain medications and other epigenetic factors in the etiopathogenesis of obesity and its related disorders  .  

1. In the context of atisthula and atikrisha, Charaka has explored these conditions from the standpoint of their diathesis, clinical presentation, and management, which is comparable to approaches taken today to the study of obesity and leanness. Suśruta has considered rasa dhatu as the main culprit for both obesity and emaciation (rasa nimittameva sthaulyam karshyam ca).  Lipid precursors are acted upon by fat-specific energy (medhodhatvagni) for their conversion into adipose tissue (medodhatu).  Vitiation of kapha dosha and excessive accumulation of fat-specific energy and waste products of adipose tissues (kleda) lead to dysfunction of adipose tissues. Adipose channels have two origins - kidney, adrenal and fat around them and other are visceral and omental fat (vapavahana).  These channels draw nutrition, including lipid from the antecedent flesh and transient lipid and then convert them into a stored form of lipid. As per biomedical science, obesity is associated with increased adipose stores in the subcutaneous tissues, skeletal muscles and internal organs such as kidney, heart, liver and omentum. Adipose tissues (medodhatu) form a crucial link to the concept of tissue metabolism. Low levels of fat-specific energy (medodhatvagni), despite a normal food intake, can lead to a steady accumulation of fat and the outcome is obesity.  The conventional system of medicine has given due consideration to certain factors such as insufficient sleep, genetic predisposition, later age pregnancy, certain medications and other epigenetic factors in the etiopathogenesis of obesity and its related disorders  .  

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 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 doṣha-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.  

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 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 doṣha-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 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.  

Glossary of technical terms:

 

=== Glossary ===

 

1. अतिदीर्घ (atidirgha)- too tall

1. अतिदीर्घ (atidirgha)- too tall

2. अतिह्रस्व (atihrasva)- too short

2. अतिह्रस्व (atihrasva)- too short