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*Unstable/flowing (sara): Sara property improves flow and proper channelization of body waste for excretion.
*Unstable/flowing (sara): Sara property improves flow and proper channelization of body waste for excretion.
*Hard (kathina): Substances without water or unctuousness are hard in consistency. These are applied in langhana therapy to reduce fat and moisture components.[Cha.Sa.[[Sutra Sthana]] 22/12-13]
*Hard (kathina): Substances without water or unctuousness are hard in consistency. These are applied in langhana therapy to reduce fat and moisture components.[Cha.Sa.[[Sutra Sthana]] 22/12-13]
=[[Panchamahabhuta]] composition=
The [[agni]], [[vayu]] and [[akasha]] [[mahabhuta]] play predominant and vital role in mechanism of langhana therapy. [A.S. Sutra Sthana 24/3]
=Methods of langhana therapy=
The methods of langhana therapy are broadly classified into:
I. '''Purifying (shodhana) procedures'''
II. '''Pacifying (shamana) procedures''' [A.Hr. Sutra Sthana 14/4]
==Purifying (shodhana) procedures==
This includes following procedures which are applied in patients having good strength (bala) and more severe conditions.
1.Enema with decoction (niruha [[basti]])
2.Therapeutic emesis ([[vamana]])
3.Therapeutic purgation ([[virechana]])
4.Intranasal drug administration (shirovirechana)
5.Bloodletting (asravisruti)[A.Hr. Sutra Sthana 14/5]
==Pacifying (shamana) procedures==
Following procedures are applied in weak patients and with mild to moderate disease conditions.
6.Carminatives ([[pachana]])
7.Appetizers ([[dipana]])
8.Withstanding hunger (kshut)/therapeutic fasting by restricting food
9.Withstanding thirst (trit)/restricted water or liquid intake
10.Exercise/physical activities ([[vyayama]])
11.Exposure to sunlight (atapa)
12.Exposure to wind/breathing exercises(maruta) [A.Hr. Sutra Sthana 14/6-7]
Bloodletting (asravisruti) and appetizers ([[dipana]]) are excluded from langhana therapy by Charaka.[Cha.Sa.[[Sutra Sthana]] 22/18]
=Indications=
Langhana therapy is indicated in following individuals and conditions:
*Persons who used to consume excess unctuous food
*Excess body discharges
*Those who had undergone nourishing therapies. [Cha.Sa.[[Sutra Sthana]] 22/24]
*In state of accumulation of undigested/toxic biological waste ([[ama]]) [Su.Sa.UttaraSthana 40/34]
*In state of nutritive fluid ([[rasa dhatu]]) associated with [[ama]] [Cha.Sa.[[Chikitsa Sthana]] 15/75]
*As a part of post therapeutic regimen after therapeutic emesis ([[vamana]]) and therapeutic purgation ([[virechana]]) where digestive power is weak.
*In diseases like [[jwara]], stiffness of thighs (urustambha), herpes (visarpa), abscess (vidradhi), splenic diseases(pleeha), obesity (sthaulya), diseases of head, throat and eyes [A.S.Sutra Sthana 24/10] skin disorders (kushtha), urinary disorders (prameha). [Cha.Sa.[[Sutra Sthana]] 22/24]
==Specific indications==
===Purifying procedures===
*In conditions of excessive accumulation of [[kapha]], [[pitta]], blood and waste products (mala).
*Obstruction of [[vata]] by morbidities
*Those who have good physical strength and bulky stature. [Cha.Sa.[[Sutra Sthana]] 22/19]
*Jwara, vomiting, diarrhea, cardiac complaints, constipation, heaviness, belching, nausea etc. [A.Hr. Sutra Sthana 14/12]
===Digestive measures ([[pachana]])===
*Diseases of moderate severity
*Diseases having [[kapha]] and [[pitta]] predominance
*Vomiting, diarrhea, heart disease, acute intestinal irritation, intestinal sluggishness, fever, constipation, heaviness of body, eructation, nausea and anorexia [Cha.Sa.[[Sutra Sthana]] 22/20-21]
===Restricted food and water consumption===
*Mild diseases [Cha.Sa.[[Sutra Sthana]] 22/22]
*Restricted intake of liquid or water results in pacification of [[kapha]] and [[pitta]] [[dosha]] due to depletion of their source i.e. [[jala mahabhuta]].
*By restriction of food, the [[agni]] (digestion and metabolism) is improved first and it hastens the process of normalizing [[dosha]] equilibrium. [A.Hr.Chikitsa Sthana 10/91]
Physical exercise (vyayama), exposure to sunlight (aatapa) and exposure to wind/breathing exercise (maruta)
*Mild to moderate intensity diseases for patients with good physical strength [Cha.Sa.[[Sutra Sthana]] 22/23]
=Contraindications=
In some diseases, langhana therapy can worsen the conditions due to degeneration of body components. Hence, it is contraindicated in following conditions:
*[[Vata]] predominant conditions
*Conditions of fear, anger, grief and physical exertion [Cha.Sa.[[Chikitsa Sthana]] 3/139]
*Jwara with excess dominance of [[pitta]] [[dosha]] [A.S.Chikitsa Sthana 1/13]
*Jwara due to exogenous causes (agantujaj wara) and chronic stage (jeerna jwara) [A.S.Chikitsa Sthana 1/17]
=Assessment of therapy=
Langhana therapy is always prescribed after assessment of strength of the individual and severity of disease. It is administered for specific duration and in specific dose as per the personified conditions. Assessment of effect is done by clinical observation of features. The therapy is stopped after attaining equilibrium of body components and observing following features.
==Features of optimal langhana==
*Proper evacuation of flatus, urine and feces
*Feeling of lightness in the body
*Feeling of clarity in heart, eructation, throat and mouth
*Disappearance of drowsiness and exhaustion
*Appearance of perspiration
*Reappearance of taste, hunger and thirst
*Feeling of wellbeing [Cha.Sa.[[Sutra Sthana]] 22/34-35]
*Intolerance to hunger and thirst [Su.Sa. Uttara Sthana 39/105]
*Clarity of sense organs [A.Hr. Sutra Sthana 14/17]
==Features of excessive administration of langhana==
Excess administration of langhana therapy leads to degeneration of body components and following clinical features are observed.
*Pain in the joints
*Body ache
*Cough
*Dryness of the mouth
*Complete loss of hunger
*Anorexia
*Thirst
*Diminished hearing and vision
*Confusion of mind
*Frequent eructation
*Fainting
*Frequent upward movement of [[vata]]
*Loss of body weight, digestive power and strength[Cha.Sa.[[Sutra Sthana]] 22/36-37]
*Excess emaciation
*Loss of sleep
*Delirium
*Depletion and non-elimination of feces and urine [A.Hr. Sutra Sthana 14/29-30]
*Occurrence of secondary disease like dyspnea [Su.Sa.Uttara Sthana. 39/106]
==Untoward effects of improper follow up of langhana therapy==
Improper fasting (langhana) may lead to untoward effects and etiopathogenesis of certain diseases/conditions like:
Emaciation of body [Cha.Sa.[[Sutra Sthana]] 21/11], wasting disorders due to over exertion (sahasaja rajayakshama) [Cha.Sa.[[Chikitsa Sthana]] 8/14], hemorrhoid [Cha.Sa.[[Chikitsa Sthana]] 14/13], excessive thirst (trishna) [Cha.Sa.[[Chikitsa Sthana]] 22/4], diseases of thigh (urustambha). [Cha.Sa.[[Chikitsa Sthana]] 27/9]
Therefore, langhana therapies should be performed to the extent that it does not hamper the vitality or strength of the individual. [Cha.Sa.[[Chikitsa Sthana]] 3/141]
==Benefits==
Langhana leads to pacification of [[dosha]], improves strength of digestive power ([[agni]]), lightness in body promotes healthy state, hunger, thirst, desire for food, strength and vigor. [A.S.Chikitsa Sthana 1/3]
=Importance in diagnosis=
Craving for fasting (langhana) is diagnostic feature in conditions of occlusion of [[vata]] by excess vitiated [[kapha]][[dosha]]. [Cha.Sa.[[Chikitsa Sthana]] 28/63]
=Importance in preservation of health and prevention=
Langhana therapy is more indicated in winter season (shishira and hemanta) to maintain equilibrium. [Cha.Sa.[[Sutra Sthana]] 22/24][A.Hr. Sutra Sthana 14/11] In case of accumulation of toxic biological waste ([[ama]]) and in obese persons, lightening therapy (langhana) should be done daily. [A.Hr. Sutra Sthana 14/10-11] The seasonal purification procedures play vital role in preservation of health and prevention of disease.
=Importance in management of disease=
Therapeutic fasting (upawasa) is indicated in mild vitiation of [[dosha]]. It stimulates digestive power ([[agni]]) and normal functions of [[vata]][[dosha]]. [Cha.Sa.[[Vimana Sthana]] 3/44]
Langhana therapies especially fasting is the first line of therapy in many disorders. It is advocated in the initial stage of following diseases.
*[[Jwara]] [Cha.Sa.[[Chikitsa Sthana]] 3/139] can be treated with only fasting (langhana) [Cha.Sa.[[Nidana Sthana]] 8/31] if it is associated with toxic metabolic waste ([[ama]]) or during the predominance of [[kapha]] or [[kapha]] and [[pitta]] [[dosha]]. [Cha.Sa.[[Chikitsa Sthana]] 3/284] The [[kapha]] predominant stage of chronic intermittent pattern of [[jwara]] can also be managed through reducing (langhana) therapies. [Cha.Sa.[[Chikitsa Sthana]] 3/295] The patients who are unsuitable for oleation and purificatory therapies are treated by langhana therapies. [Su.Sa.Uttara Sthana 39/99]
*Bleeding disorders (raktapitta) especially through the upper orifices (eyes, mouth and nose) as it is associated with [[pitta]] along with toxic biological waste (same [[pitta]]) and [[kapha]][[dosha]] [Cha.Sa.[[Chikitsa Sthana]] 4/30]
*Abdominal tumors (gulma) caused due to [[kapha]][[dosha]] [Cha.Sa.[[Chikitsa Sthana]] 5/49]
*Swelling associated with toxic biological waste ([[ama]]) [Cha.Sa.[[Chikitsa Sthana]] 12/17]
*Noninfectious gastroenteritis (visuchika) [Cha.Sa.[Vimana Sthana]] 2/13]
*Vomiting (chchardi) as it is considered to be originating from the agitations of the [[dosha]]s in the stomach (amashaya) [Cha.Sa.[[Chikitsa Sthana]] 20/20]
*All diseases which originates from the stomach (amashaya) can be treated through fasting (langhana) [Cha.Sa.[[Nidana Sthana]] 8/31]
*In all disorders of nutritive fluid ([[rasa]])[Cha.Sa.[[Sutra Sthana]] 28/25] and the conditions affecting mouth and oral cavity [Cha.Sa.[[Chikitsa Sthana]] 12/80]
*Bleeding hemorrhoids with [[kapha]] and [[pitta]] aggravation [Cha.Sa.[[Chikitsa Sthana]] 14/176], Diabetes mellitus (prameha) caused by [[kapha]] [Cha.Sa.[[Chikitsa Sthana]] 6/25], ulcers with [[kapha]] predominance [Cha.Sa.[[Chikitsa Sthana]] 25/16], rhinitis of [[kapha]] origin (kaphaja pinasa) associated with heaviness and anorexia [Cha.Sa.[[Chikitsa Sthana]] 26/149] Cardiac disorders [Cha.Sa.[[Chikitsa Sthana]] 26/100] and diseases caused by the suppression of urge of vomiting [Cha.Sa.[[Sutra Sthana]] 7/15]
*Mild aggravated [[dosha]] should be managed by fasting therapy (langhana) in case of diarrhea. [Cha.Sa.[[Chikitsa Sthana]] 19/19]
*In the prodormal stage of all varieties of erysipelas (visarpa). [A.S.Chikitsa Sthana 20/2] If erysipelas (visarpa) is caused with [[dosha]] in the state of incomplete transformation ([[ama]]) and is located in thorax and upper body parts ([[kapha]]sthana), fasting therapy (langhana) is beneficial. [Cha.Sa.[[Chikitsa Sthana]] 21/44]
*Fissure in ano if associated with [[ama]] [Cha.Sa.[[Siddhi Sthana]] 6/63]
*Indigestion caused due to [[ama]] (amajeerna) [Su.Sa.Sutra Sthana. 46/505]
*Bloating in upper abdomen (anaha) caused by improperly digested food/product of improper digestion ([[ama]]), associated with stiffness in cardiac region, diseases of head and heaviness, retention of belching, common cold should be treated with fasting therapy (langhana). [Cha.Sa.[[Chikitsa Sthana]] 26/26]
=Precaution=
The diseases treated by fasting etc. without purification therapies may recur due to incomplete elimination of morbid [[dosha]]. Hence, purification therapies are important to prevent recurrence of disease. [Cha.Sa.[[Sutra Sthana]] 16/20]
==Physiology of fasting==
The process of improvement in digestion and metabolic processes by fasting can be related to physiological mechanisms like glycogenolysis and lipolysis.
When a person follows fasting, the energy is derived by utilization of blood glucose. After that, glycogen stored in hepatocytes is utilized for energy. This also accelerates the breakdown of adipose tissue i.e. lipolysis. Thus, more fatty acids and glycerol are formed and released into blood. At the same time the other cells may produce ketones. The fatty acids are transported into hepatocytes, get metabolized and produce ketones beta-OHB and acetoacetate. This induces mitochondrial biogenesis.
The ketones thus produced are transported into cells with high metabolic activity such as neurons, muscles etc., becomes acetyl coenzyme A. It enters the tricarboxylic acid (TCA) cycle where ATP is generated. Thus, during fasting, primary energy source of the body shifts from glucose to fatty acids and ketones.<ref name=Antonsd>Anton SD, Moehl K, Donahoo WT, Marosi K, Lee SA, Mainous AG 3rd, Leeuwenburgh C, Mattson MP. Flipping the Metabolic Switch: Understanding and Applying the Health Benefits of Fasting. Obesity (Silver Spring). 2018 Feb;26(2):254-268. doi: 10.1002/oby.22065. Epub 2017 Oct 31. PMID: 29086496; PMCID: PMC5783752.</ref>
The ultimate beneficial effect of fasting is reduction in adipose tissue ([[meda dhatu]]) and [[kapha]][[dosha]].
=Current researches=
In a study conducted on 59 patients having poor digestive power, it is reported that the langhana therapies, fasting and digestive medicine, Zingiber officinale (shunthi), improves appetite, food intake and enthusiasm. It makes the body feel lighter and also aids in normal excretion of urine and feces. The digestive power influences the state of [[dosha]] in the absence of food. The body regains its normalcy once the vitiated [[dosha]] are in equilibrium state after digestion (paka).<ref>Rajani A, Vyas MK, Vyas HA. Comparative study of Upavasa and Upavasa with Pachana in the management of Agnisada. Ayu. 2010 Jul;31(3):351-4. doi: 10.4103/0974-8520.77166. PMID: 22131738; PMCID: PMC3221070.</ref>
Fasting therapy results in significant reduction in weight and body mass index (BMI). In a study conducted on 44 healthy individuals, short-term fasting therapy is compared with low calorie diet. Significant reduction in weight and Leptin levels were achieved through fasting than low calorie diet. Increased beta-oxidation is observed during fasting.<ref>Shetty P, Dinesh S, Halappa NG, Rajany T. Comparing the effects of short-term fasting therapy and low-calorie diet on anthropometric and leptin measures among obese or overweight persons: Randomized controlled trial. Ancient Sci Life 2018;37:133-40.</ref>
Average life span is increased by 30%, when the rats were maintained on alternate day fasting. Plasma glucose, insulin and leptin levels were low for the rats maintained on fasting. Ketone and adiponectin levels were more. Inflammatory markers were found to be reduced in liver of rats kept on time restricted feeding. The normal decline in muscle mass during ageing is found to be prevented by caloric restriction in mice. Fasting stimulates autophagy in muscles. Cardiovascular stress adaptations were noted in rats kept on alternate day fasting. It also increases brain derived neurotrophic factor which plays a major role in synaptic plasticity and neurogenesis.<ref name=Antonsd/>
==Relevance of fasting (upawasa) and autophagy==
Recently, the Noble prize for the year 2016 in physiology is awarded to Yoshinori Ohsumi for his research ‘autophagy’. Autophagy denotes “self-eating”. This concept emerged during the 1960’s, when researchers first observed that the cell could destroy its own contents by enclosing it in membranes, forming sack-like vesicles that were transported to a recycling compartment, called the lysosome, for degradation. The phenomenon was not well understood until a series of brilliant experiments were performed by the researcher in the early 1990’s. He used Baker’s yeast to identify genes essential for autophagy. He elucidated the underlying mechanisms for autophagy in yeast and showed that similar sophisticated machinery is used in human cells. He cultured mutated yeast lacking vacuolar degradation enzymes and simultaneously stimulated autophagy by starving the cells. Within hours, the vacuoles were filled with small vesicles that had not been degraded. These vesicles were nothing but autophagosomes and so the experiment proved that autophagy exists in yeast cells.<ref>Ohsumi Y. Yoshinori Ohsumi: autophagy from beginning to end. Interview by Caitlin Sedwick. J Cell Biol. 2012;197(2):164-165. doi:10.1083/jcb.1972pi</ref> Langhana therapy may work on the lines of autophagy, which may trigger the formation of autophagosomes to clear the unwanted accumulated substances. The vitiated [[dosha]] are responsible for mutation in body tissues. The abnormal states of [[dosha]] are transformed after langhana therapies. Further research on effect of langhana therapies on autophagy may provide valuable clues in prevention and management of diseases.
==Current strategies of fasting and langhana therapy==
In current times, a pattern of intermittent fasting is advised for health benefits and management of metabolic diseases. Intermittent fasting, or intermittent energy restriction, includes various meal timing schedules that cycle between voluntary fasting (or reduced calorie intake) and non-fasting over a given period.<ref>de Cabo, Rafael; Mattson, Mark P. (December 2019). "Effects of intermittent fasting on health, aging, and disease". New England Journal of Medicine. 381 (26): 2541–51. doi:10.1056/NEJMra1905136. PMID 31881139. Available from https://en.wikipedia.org/wiki/Intermittent_fasting accessed on 30/03/2021</ref> Methods of intermittent fasting include alternate-day fasting (ADF), periodic fasting, and daily time-restricted feeding. The other strategies of fasting include calory restricted diet, periodic fasting, fasting-mimicking diet, meal frequency and meal timing.
Ayurveda advised taking meals in proper quantity, at proper time and with proper methods (ahara vidhi) for preservation of health. A group of researchers observed kaalabhojana (optimal food at proper time) has additional health benefits over time restricted feeding. Kalabhojanam does not mean that food can be taken at will during the 24 hours. It must be in coherence with daily regimen (dinacharya) and sleep-wake timings as per day-night cycle. Consuming food just once a day is the best strategy [Cha.Sa. [[Sutra Sthana]] 25/40] and will automatically have a longer fasting period. The second meal shall be in accordance [[agni]] and sleep cycle. Thus, the feeding time must remain restricted during morning to evening (i.e., a maximum of 12-hour eating window during day and thus a minimum 12-hour gap during night), and not during the night. Thus, it extends the window between evening meal and morning meal. This may vary as per the digestion capacity and body constitution of individual.<ref>Prakash NP et.al.Prevention of metabolic risks by Kalabhojanam strategy of Ayurveda.Annals of Ayurvedic Medicine 2020; 9(2):116-129.</ref> The personified langhana therapies can be more beneficial as per the guidelines described above after consideration of body constitution, state of [[dosha]], strength of individual and digestion capacity. These guidelines, if followed while prescribing fasting strategies can yield more health benefits.
Fasting is beneficial in metabolic syndrome by decreasing fasting glucose, fasting insulin and insulin resistance. It also reduces the cardiovascular risk factors like total cholesterol, LDL, triglycerides etc. In diabetic patients improved insulin sensitivity and glucose tolerance was reported immediately after a fast.<ref name=Antonsd/>
=List of thesis done=
#Dharmi P Bhuva (2013): Fundamental and applied aspect of karma as karana in Ayurveda w.s.r. to langhana karma. Department of basic principles. IPGT&RA Jamnagar
=More information=
[[Langhanabrimhaniya Adhyaya]]
[[Janapadodhvansaniya Vimana]]
[[Jwara Chikitsa]]
=References=