Changes

In the conventional system of medicine, the main treatment for obesity consists of diet and physical exercise for short-term weight control. Maintaining the weight by short-term dietary control is very difficult to an obese person, and it required guided exercise and low calory diet in their daily regimens. Because lack of physical exercise is the key factor and imparts a role in the diathesis of obesity. 61 The lack of physical activities also plays an important role in obesity-associated with the involvement of brain and abdominal. Regarding physical exercise, it not only reduces body weight but also counteract metabolic adaptation but regulating nutritional balance set point.64 It is presumed that physical inactivity contributes to both visceral adiposity and cerebellar brain changes because in the area of cerebellar cortex and hippocampal dentate gyrus  of brain show enhanced synaptogenesis and neurogenesis in response to physical exercise training. [48,49,50]   

In the conventional system of medicine, the main treatment for obesity consists of diet and physical exercise for short-term weight control. Maintaining the weight by short-term dietary control is very difficult to an obese person, and it required guided exercise and low calory diet in their daily regimens. Because lack of physical exercise is the key factor and imparts a role in the diathesis of obesity. 61 The lack of physical activities also plays an important role in obesity-associated with the involvement of brain and abdominal. Regarding physical exercise, it not only reduces body weight but also counteract metabolic adaptation but regulating nutritional balance set point.64 It is presumed that physical inactivity contributes to both visceral adiposity and cerebellar brain changes because in the area of cerebellar cortex and hippocampal dentate gyrus  of brain show enhanced synaptogenesis and neurogenesis in response to physical exercise training. [48,49,50]   

In this context, Ayurveda has laid down a strong emphasis on drugs, dietary and lifestyle interventions for the management of atisthaulya.  Therefore, factors such as madhura, sheeta, snigdha, guru, picchila and lifestyle errors are to be avoided in such cases. Ruksha udvartanas are advocated obese patients as an external purificatory measure, while vamana, virechana, and asthapana basti as internal bio-purificatory measures. If an atisthula person possesses good stamina and strength, they should be treated with vamana and virechana karma. Non-unctuous, warm and strong enema are advocated such type of patients. [51,52,53,54] Yogic practices have a significant impact on the physical, mental, emotional and spiritual health of the individual. It is reported that a significant improvement in the levels of BP, LDL cholesterol, and BMI can be noted after three months of residential therapy consisting of vegetarian diet and kriya yoga. A randomized controlled study reveals that practicing yoga for a year brought about significant improvement in body weight and body density. Regular practice of yoga has shown to improve the serum lipid profile in patients (with known IHD) as well as in healthy subjects. A regular regimen of Praṇayama reduces stress hormone and levels of endorphin and enkephalin, consequently increasing the level of HDL while decreasing the level of LDL, VLDL and TGs. [55,56,57,58]   

In this context, [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] has laid down a strong emphasis on drugs, dietary and lifestyle interventions for the management of atisthaulya.  Therefore, factors such as ''madhura, sheeta, snigdha, guru, picchila'' and lifestyle errors are to be avoided in such cases. ''Ruksha udvartanas'' are advocated obese patients as an external purificatory measure, while ''vamana, virechana,'' and ''asthapana basti'' as internal bio-purificatory measures. If an ''atisthula'' person possesses good stamina and strength, they should be treated with ''vamana'' and ''virechana karma''. Non-unctuous, warm and strong enema are advocated such type of patients. [51,52,53,54] ''Yogic'' practices have a significant impact on the physical, mental, emotional and spiritual health of the individual. It is reported that a significant improvement in the levels of BP, LDL cholesterol, and BMI can be noted after three months of residential therapy consisting of vegetarian diet and ''kriya yoga''. A randomized controlled study reveals that practicing ''yoga'' for a year brought about significant improvement in body weight and body density. Regular practice of ''yoga'' has shown to improve the serum lipid profile in patients (with known IHD) as well as in healthy subjects. A regular regimen of ''praṇayama'' reduces stress hormone and levels of endorphin and enkephalin, consequently increasing the level of HDL while decreasing the level of LDL, VLDL and TGs. [55,56,57,58]   

Recent evidence suggests that some ayurvedic herbal drugs are found to be very effective in normalizing deranged lipid profiles, reducing BMI and slowing down the risk heart diseases. Ayurvedic drugs such as Rasona (Allium cepa), Guggulu (Commiphora mukul),  Puṣhkaramula (Inula racemosa), Arjuna (Terminalia Arjuna), Dhānyaka (Coriandrum sativum), Nishamalaki churṇa (powder of Emblica officinalis and Curcuma longa),  Haritaki (Terminalia chebula), Haridra (Curcuma longa), Bilva (Aegle marmelos), Tejapatra (Cinnamomum tamala), Vrikshamla (Garcinia cambogia) and Ayurvedic formulations such as- triphala guggulu, medohara guggulu, amṛitadi guggulu, arogyavardhani vaṭi etc. are also found to be  effective in weight reduction as well as relief in other signs and symptoms. [1,2,3, 59.60,61,62, 63,64, 65, 66,67,68, 69]  

Recent evidence suggests that some ''ayurvedic'' herbal drugs are found to be very effective in normalizing deranged lipid profiles, reducing BMI and slowing down the risk heart diseases. Ayurvedic drugs such as ''rasona'' (Allium cepa), ''guggulu'' (Commiphora mukul),  ''puṣhkaramula'' (Inula racemosa), ''arjuna'' (Terminalia Arjuna), ''dhānyaka'' (Coriandrum sativum), Nishamalaki churṇa (powder of Emblica officinalis and Curcuma longa),  Haritaki (Terminalia chebula), Haridra (Curcuma longa), Bilva (Aegle marmelos), Tejapatra (Cinnamomum tamala), Vrikshamla (Garcinia cambogia) and Ayurvedic formulations such as- triphala guggulu, medohara guggulu, amṛitadi guggulu, arogyavardhani vaṭi etc. are also found to be  effective in weight reduction as well as relief in other signs and symptoms. [1,2,3, 59.60,61,62, 63,64, 65, 66,67,68, 69]

==== Management of the emaciated/too lean (verse 29-34) ====

==== Management of the emaciated/too lean (verse 29-34) ====