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=== Abstract ===

=== Abstract ===

 

The Ashtauninditiyam is the first chapter of the ''Yojana Chatushka'' (tetrad on management protocol) within the [[Sutra Sthana]]. It deals with the interrelationships of diseases and drugs that depend upon the physical constitution of an individual. This chapter talks about eight undesirable physical constitutions that require special attention during any course of treatment and then focuses on features that are extreme and undesirable - morbid obesity and extreme emaciation. The reader of this chapter would expect to learn about these two conditions, their causative factors, signs and symptoms, and ways of effective management. A special emphasis has also been given to the merits of sleep, qualities or characteristics that define a “good sleep” and the demerits of sleep related disorders.  

The Ashtauninditiyam is the first chapter of the ''Yojana Chatushka'' (tetrad on management protocol) within the [[Sutra Sthana]]. It deals with the interrelationships of diseases and drugs that depend upon the physical constitution of an individual. This chapter talks about eight undesirable physical constitutions that require special attention during any course of treatment and then focuses on features that are extreme and undesirable - morbid obesity and extreme emaciation. The reader of this chapter would expect to learn about these two conditions, their causative factors, signs and symptoms, and ways of effective management. A special emphasis has also been given to the merits of sleep, qualities or characteristics that define a “good sleep” and the demerits of sleep related disorders.  

 

'''Keywords''': ''Atisthaulya, Atikarshya,'' Genetic Disorders, Endocrine Disorders, Sleep(''Nidra''), Insomnia(''Anidra'')

'''Keywords''': ''Atisthaulya, Atikarshya,'' Genetic Disorders, Endocrine Disorders, Sleep(''Nidra''), Insomnia(''Anidra'')

=== Introduction ===

=== Introduction ===

 

Charaka has laid down the foundation of genetic/hereditary and endocrinal disorders in relation to four pairs of opposing (and undesirable) physical characteristics- height (too tall, too short), body hair (too hairy, hairless), complexion (too dark, too light), and body mass (too obese, too lean). Among these, ''atisthula'' (morbid obesity) is the most undesirable characteristic because it is associated with several life-threatening complications including diabetes, hypertension, coronary artery diseases, joint disorders, skin disorders, anorectal problems, etc. This chapter focuses on the features of a healthy physical constitution of a person, definitions of sleep, as well as key concepts associated with disease management such as etiopathogenesis, clinical presentation, prognosis, and management of ''atisthula''. Some key etiological factors of ''atisthula'' include dietary and lifestyle indicators (e.g., sedentary habit and high-calorie diet), and genetic and hereditary factors. This chapter also describes the pathogenesis of ''atisthula'' in detail, involving ''rasa'' (plasma) and ''meda'' (adipose tissue) as important ''dushyas'' (affected tissues). Modern medicine has acknowledged the role of ''meda'' (adipose tissue) as a principal ''dushya'', with  obesity and dyslipidemia regarded as the main components of the basic matrix of this disease and its related disorders. The recent concept of “metabolic syndrome” was already recognized in [https://en.wikipedia.org/wiki/Ayurveda Ayurveda]. Biomedical science points that overweight individuals experience greatly elevated morbidity and mortality from various ailments including cardiovascular diseases.   

Charaka has laid down the foundation of genetic/hereditary and endocrinal disorders in relation to four pairs of opposing (and undesirable) physical characteristics- height (too tall, too short), body hair (too hairy, hairless), complexion (too dark, too light), and body mass (too obese, too lean). Among these, ''atisthula'' (morbid obesity) is the most undesirable characteristic because it is associated with several life-threatening complications including diabetes, hypertension, coronary artery diseases, joint disorders, skin disorders, anorectal problems, etc. This chapter focuses on the features of a healthy physical constitution of a person, definitions of sleep, as well as key concepts associated with disease management such as etiopathogenesis, clinical presentation, prognosis, and management of ''atisthula''. Some key etiological factors of ''atisthula'' include dietary and lifestyle indicators (e.g., sedentary habit and high-calorie diet), and genetic and hereditary factors. This chapter also describes the pathogenesis of ''atisthula'' in detail, involving ''rasa'' (plasma) and ''meda'' (adipose tissue) as important ''dushyas'' (affected tissues). Modern medicine has acknowledged the role of ''meda'' (adipose tissue) as a principal ''dushya'', with  obesity and dyslipidemia regarded as the main components of the basic matrix of this disease and its related disorders. The recent concept of “metabolic syndrome” was already recognized in [https://en.wikipedia.org/wiki/Ayurveda Ayurveda]. Biomedical science points that overweight individuals experience greatly elevated morbidity and mortality from various ailments including cardiovascular diseases.   

    

    

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

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

 

===Sanskrit text, transliteration and english translation===

===Sanskrit text, transliteration and english translation===

tadatisthaulyamatisampUraNAdgurumadhurashItasnigdhopayogAdavyAyAmAdavyavAyAddivAsvapnAddharShanityatvAda- cintanAdbIjasvabhAvAccopajAyate|  

tadatisthaulyamatisampUraNAdgurumadhurashItasnigdhopayogAdavyAyAmAdavyavAyAddivAsvapnAddharShanityatvAda- cintanAdbIjasvabhAvAccopajAyate|  

tasya hyatimAtramedasvino meda evopacIyate na tathetare dhAtavaH, tasmAdasyAyuSho hrAsaH; shaithilyAt saukumAryAdgurutvAcca medaso javoparodhaH ,shukrAbahutvAnmedasA~a~avRutamArgatvAcca kRucchravyavAyatA, daurbalyamasamatvAddhAtUnAM, daurgandhyaM medodoShAnmedasaH svabhAvAtsvedanatvAcca, medasaH shleShmasaMsargAdviShyanditvAdbahutvAdgurutvAdvyAyAmAsahatvAcca svedAbAdhaH, tIkShNAgnitvAt prabhUtakoShThavAyutvAccakShudatimAtraM pipAsAtiyogashceti||4||

tasya hyatimAtramedasvino meda evopacIyate na tathetare dhAtavaH, tasmAdasyAyuSho hrAsaH; shaithilyAt saukumAryAdgurutvAcca medaso javoparodhaH ,shukrAbahutvAnmedasA~a~avRutamArgatvAcca kRucchravyavAyatA, daurbalyamasamatvAddhAtUnAM, daurgandhyaM medodoShAnmedasaH svabhAvAtsvedanatvAcca, medasaH shleShmasaMsargAdviShyanditvAdbahutvAdgurutvAdvyAyAmAsahatvAcca svedAbAdhaH, tIkShNAgnitvAt prabhUtakoShThavAyutvAccakShudatimAtraM pipAsAtiyogashceti||4||

 

Amongst these, the too obese and too lean physical appearances are considered the most undesirable ones. The excessively obese have eight inherent defects in them: reduced lifespan, constricted or limited movement (hampered due to loose, tender and heavy fats), reduced sexual activities or impotence (due to small quantity of semen produced and obstruction of the channel of semen by ''medas''), debility (due to ''dhatu'' imbalance), emit bad smell (due to the inherent nature of fatty tissues as well as excessive sweating), profuse sweating (since ''medas'' and ''kapha'' are vitiated), and excessive hunger and thirst (due to excessive digestive ''agni'' and ''vayu'' in the body). Excessive obesity is caused due to over-nourishment as a consequence of the intake of heavy, sweet, cold and fatty diet, lack of physical exercise, abstinence from sexual intercourse, sleeping during the day, uninterrupted cheerfulness, lack of mental activities and hereditary/genetic defects. These consequences may lead to an excess of fat (with further accumulation of only fat) and consequent depletion of dhatus. [4]  

Amongst these, the too obese and too lean physical appearances are considered the most undesirable ones. The excessively obese have eight inherent defects in them: reduced lifespan, constricted or limited movement (hampered due to loose, tender and heavy fats), reduced sexual activities or impotence (due to small quantity of semen produced and obstruction of the channel of semen by ''medas''), debility (due to ''dhatu'' imbalance), emit bad smell (due to the inherent nature of fatty tissues as well as excessive sweating), profuse sweating (since ''medas'' and ''kapha'' are vitiated), and excessive hunger and thirst (due to excessive digestive ''agni'' and ''vayu'' in the body). Excessive obesity is caused due to over-nourishment as a consequence of the intake of heavy, sweet, cold and fatty diet, lack of physical exercise, abstinence from sexual intercourse, sleeping during the day, uninterrupted cheerfulness, lack of mental activities and hereditary/genetic defects. These consequences may lead to an excess of fat (with further accumulation of only fat) and consequent depletion of dhatus. [4]  

==== Pathophysiology of Obesity ====

==== Pathophysiology of Obesity ====

iti medasvino doShA hetavo rUpameva ca|  

iti medasvino doShA hetavo rUpameva ca|  

nirdiShTaM, ....|10|

nirdiShTaM, ....|10|

 

Due to the obstruction of body channels by ''medas'', the movement of ''vata'' is specially confined to ''koshtha'' (abdominal viscera) resulting in the stimulation of digestive power and absorption of food. Hence,the person digests food quickly and becomes a voracious eater. By not following rules of taking meals at specific times during the day, he is afflicted by dreadful diseases. ''Agni'' (''pitta'' component responsible for digestion) and ''vata'' are the two most troublesome factors from the standpoint of obesity. These factors blight an obese person as wildfire destroys a forest. As the body gains excessive fat, vitiated ''doshas'' suddenly cause severe diseases resulting in rapid deterioration of life. The person is considered too obese when there is an excessive increase in fat and muscle tissue in the regions of buttocks, abdomen, and breasts, which become pendulous and suffer from deficient metabolism and energy. These are the causes, signs, and symptoms of an obese person [5-10]

Due to the obstruction of body channels by ''medas'', the movement of ''vata'' is specially confined to ''koshtha'' (abdominal viscera) resulting in the stimulation of digestive power and absorption of food. Hence,the person digests food quickly and becomes a voracious eater. By not following rules of taking meals at specific times during the day, he is afflicted by dreadful diseases. ''Agni'' (''pitta'' component responsible for digestion) and ''vata'' are the two most troublesome factors from the standpoint of obesity. These factors blight an obese person as wildfire destroys a forest. As the body gains excessive fat, vitiated ''doshas'' suddenly cause severe diseases resulting in rapid deterioration of life. The person is considered too obese when there is an excessive increase in fat and muscle tissue in the regions of buttocks, abdomen, and breasts, which become pendulous and suffer from deficient metabolism and energy. These are the causes, signs, and symptoms of an obese person [5-10]

 

==== Features of an excessively lean person ====

==== Features of an excessively lean person ====

shuShkasphigudaragrIvo dhamanIjAlasantataH|  

shuShkasphigudaragrIvo dhamanIjAlasantataH|  

tvagasthisheSho~atikRushaH sthUlaparvA naro mataH||15||  

tvagasthisheSho~atikRushaH sthUlaparvA naro mataH||15||  

 

Hereafter, the features of an excessively lean person will be explained by etiology, signs, symptoms and defects. Indulgence in the intake of dry (non-unctuous) diets and drinks, fasting, intake of food in inadequate quantity, overuse of therapeutic purificatory measures, grief, suppression of natural urges, inadequate sleep or sleep deprivation, dry powder massage, indulgence in baths, heredity, old age, continued illness and anger make a person too lean.   

Hereafter, the features of an excessively lean person will be explained by etiology, signs, symptoms and defects. Indulgence in the intake of dry (non-unctuous) diets and drinks, fasting, intake of food in inadequate quantity, overuse of therapeutic purificatory measures, grief, suppression of natural urges, inadequate sleep or sleep deprivation, dry powder massage, indulgence in baths, heredity, old age, continued illness and anger make a person too lean.   

The excessively lean person does not tolerate physical exercise, intake of food in large quantities, hunger, thirst, diseases, and drugs. They also cannot tolerate too much cold, heat and sexual intercourse. Such a person is often associated with splenic diseases, cough, wasting, dyspnoea, gulma (abdominal tumor), piles, abdominal disorders and disorders of grahanі. The excessively lean person has dried up buttocks, abdomen and neck, the prominent vascular network is mostly “skin and bones” with thickened nodes [10-15]

The excessively lean person does not tolerate physical exercise, intake of food in large quantities, hunger, thirst, diseases, and drugs. They also cannot tolerate too much cold, heat and sexual intercourse. Such a person is often associated with splenic diseases, cough, wasting, dyspnoea, gulma (abdominal tumor), piles, abdominal disorders and disorders of grahanі. The excessively lean person has dried up buttocks, abdomen and neck, the prominent vascular network is mostly “skin and bones” with thickened nodes [10-15]

 

सततं व्याधितावेतावतिस्थूलकृशौ नरौ|  

सततं व्याधितावेतावतिस्थूलकृशौ नरौ|  

सततं चोपचर्यौ हि कर्शनैर्बृंहणैरपि||१६||  

सततं चोपचर्यौ हि कर्शनैर्बृंहणैरपि||१६||  

sthaulyakArshye varaM kArshyaM samopakaraNau hi tau|  

sthaulyakArshye varaM kArshyaM samopakaraNau hi tau|  

yadyubhau vyAdhirAgacchet sthUlamevAtipIDayet||17||

yadyubhau vyAdhirAgacchet sthUlamevAtipIDayet||17||

 

Both these undesirable types of people (too obese and too lean) always suffer from some disease or the other and need to be constantly managed by bulk-reducing and bulk-promoting therapies respectively. Of the two, lean is less harmful than obese, and the physical and mental sufferings in the case of an obese person are far greater in comparison to a lean person [16-17]

Both these undesirable types of people (too obese and too lean) always suffer from some disease or the other and need to be constantly managed by bulk-reducing and bulk-promoting therapies respectively. Of the two, lean is less harmful than obese, and the physical and mental sufferings in the case of an obese person are far greater in comparison to a lean person [16-17]

 

==== The importance of ideal body proportion ====

==== The importance of ideal body proportion ====

   

   

kShutpipAsAtapasahaH shItavyAyAmasaMsahaH|  

kShutpipAsAtapasahaH shItavyAyAmasaMsahaH|  

samapaktA samajaraH samamAMsacayo mataH||19||

samapaktA samajaraH samamAMsacayo mataH||19||

 

A person with a balanced proportion of muscles and compactness of the body and firmness in sense organs is not overcome by the onslaught of disorders. Such people can tolerate hunger, thirst, the heat of the sun, cold and physical exercise. Their digestion, assimilation of food and muscle metabolism is in a state of equilibrium. [18-19]

A person with a balanced proportion of muscles and compactness of the body and firmness in sense organs is not overcome by the onslaught of disorders. Such people can tolerate hunger, thirst, the heat of the sun, cold and physical exercise. Their digestion, assimilation of food and muscle metabolism is in a state of equilibrium. [18-19]

 

==== The best diet for obese and lean persons ====

==== The best diet for obese and lean persons ====

prajAgaraM [2] vyavAyaM ca vyAyAmaM cintanAni ca|  

prajAgaraM [2] vyavAyaM ca vyAyAmaM cintanAni ca|  

sthaulyamicchan parityaktuM krameNAbhipravardhayet||28||

sthaulyamicchan parityaktuM krameNAbhipravardhayet||28||

 

Food and drinks that alleviate vata and reduce ''kapha'' and ''meda'' (fat), enema with sharp, ununctuous and hot drugs, therapeutic powder massage, use of ''guduchi'' (Tinospora cordifolia Miers), ''musta'' (Cyperus rotundus Linn), ''triphala'' (haritaki-Terminalia chebula Linn, ''bibhitaka''(Terminalia belerica Roxb) and ''amalaka'' (Emblica officinalis Gaertn), ''takrarishta'' (a fermented medicinal preparation of buttermilk) and honey are recommended for the management of obesity. A formulation prepared from ''vidanga'' (Embelia ribes Burm f.), ''nagara'' (Zingiber officinale Rose), ''yavakshara'' (alkali preparation of barley), ash powder of black iron along with honey, powder of ''yava'' (Hordeum vulgarae Linn) and ''amalaka'' (Emblica officinalis Gaertn) is also an excellent weight-loss drug. Similarly, ''Bilvadi panchamula'' (five major roots) mixed with honey and shilajatu along with the juice of ''agnimantha'' (Clerodendrum phlomidis Linn.f.) are also very effective preparations for weight-loss.

Food and drinks that alleviate vata and reduce ''kapha'' and ''meda'' (fat), enema with sharp, ununctuous and hot drugs, therapeutic powder massage, use of ''guduchi'' (Tinospora cordifolia Miers), ''musta'' (Cyperus rotundus Linn), ''triphala'' (haritaki-Terminalia chebula Linn, ''bibhitaka''(Terminalia belerica Roxb) and ''amalaka'' (Emblica officinalis Gaertn), ''takrarishta'' (a fermented medicinal preparation of buttermilk) and honey are recommended for the management of obesity. A formulation prepared from ''vidanga'' (Embelia ribes Burm f.), ''nagara'' (Zingiber officinale Rose), ''yavakshara'' (alkali preparation of barley), ash powder of black iron along with honey, powder of ''yava'' (Hordeum vulgarae Linn) and ''amalaka'' (Emblica officinalis Gaertn) is also an excellent weight-loss drug. Similarly, ''Bilvadi panchamula'' (five major roots) mixed with honey and shilajatu along with the juice of ''agnimantha'' (Clerodendrum phlomidis Linn.f.) are also very effective preparations for weight-loss.

A diet consisting of ''prashatika'' (Setaria italic Beauv.), ''priyangu'' (Aglaia roxburghiana Mig.), ''shyamaka'' (Echinochloa frumentaea Linn.), ''yavaka'' (small variety of Hordeum vulgarae Linn), ''yava'' (Hordeum vulgarae Linn), ''jurnahva'' (Sorghum vulgare Linn), ''kodrava'' (papalum scrobiculatum Linn.), ''mudga'' (Phaseolus mungo Linn.), ''kulattha'' (Dolichos biflorus Linn.), ''chakramudgaka'', ''adhaki'' (Cajanus cajan Millsp.) along with ''patola'' (Trichosanthes cucumerina Linn) and ''amalaka'' (Emblica officinalis Gaertn) is very effective in tackling obesity and maintaining good health. Honey water and alcoholic preparations may be taken as postprandial drinks that help in reducing excessive fat and muscle tissues, while also alleviating ''kapha dosha''.  

A diet consisting of ''prashatika'' (Setaria italic Beauv.), ''priyangu'' (Aglaia roxburghiana Mig.), ''shyamaka'' (Echinochloa frumentaea Linn.), ''yavaka'' (small variety of Hordeum vulgarae Linn), ''yava'' (Hordeum vulgarae Linn), ''jurnahva'' (Sorghum vulgare Linn), ''kodrava'' (papalum scrobiculatum Linn.), ''mudga'' (Phaseolus mungo Linn.), ''kulattha'' (Dolichos biflorus Linn.), ''chakramudgaka'', ''adhaki'' (Cajanus cajan Millsp.) along with ''patola'' (Trichosanthes cucumerina Linn) and ''amalaka'' (Emblica officinalis Gaertn) is very effective in tackling obesity and maintaining good health. Honey water and alcoholic preparations may be taken as postprandial drinks that help in reducing excessive fat and muscle tissues, while also alleviating ''kapha dosha''.  

 

One desirous of reducing obesity should indulge more and more in vigil, sexual activities, as well as physical and mental exercises [21-28]

One desirous of reducing obesity should indulge more and more in vigil, sexual activities, as well as physical and mental exercises [21-28]

acintanAcca kAryANAM dhruvaM santarpaNena ca|  

acintanAcca kAryANAM dhruvaM santarpaNena ca|  

svapnaprasa~ggAcca naro varAha iva puShyati||34||  

svapnaprasa~ggAcca naro varAha iva puShyati||34||  

 

Sleep, exhilaration, comfortable bed, contentment, relaxed mind, abstinence from anxiety, sexual act and physical exercise, cheerfulness, newly harvested cereals, fresh wine, meat soup of animals residing in domestic, marshy and aquatic areas, well-cooked and prepared meat, curd, ghee, milk, sugarcane, ''shali'' rice, ''masha'' (Phaseolus radiates Linn.), wheat and its products, jaggery and its products, enema consisting of unctuous and sweet drugs, regular oil massage, unctuous bath, use of fragrance and garlands, use of white dress, elimination of ''doshas'' in due time and regular use of rejuvenating and aphrodisiac formulations to reduce excessive leanness and nourish the body.   

Sleep, exhilaration, comfortable bed, contentment, relaxed mind, abstinence from anxiety, sexual act and physical exercise, cheerfulness, newly harvested cereals, fresh wine, meat soup of animals residing in domestic, marshy and aquatic areas, well-cooked and prepared meat, curd, ghee, milk, sugarcane, ''shali'' rice, ''masha'' (Phaseolus radiates Linn.), wheat and its products, jaggery and its products, enema consisting of unctuous and sweet drugs, regular oil massage, unctuous bath, use of fragrance and garlands, use of white dress, elimination of ''doshas'' in due time and regular use of rejuvenating and aphrodisiac formulations to reduce excessive leanness and nourish the body.   

Besides, freedom from anxiety about any work, intake of nourishing diet and adequate sleep makes the man too obese like a pig [29-34]

Besides, freedom from anxiety about any work, intake of nourishing diet and adequate sleep makes the man too obese like a pig [29-34]

 

==== Sleep physiology ====

==== Sleep physiology ====

saiva yuktA punaryu~gkte nidrA dehaM sukhAyuShA|  

saiva yuktA punaryu~gkte nidrA dehaM sukhAyuShA|  

puruShaM yoginaM siddhyA satyA buddhirivAgatA||38||

puruShaM yoginaM siddhyA satyA buddhirivAgatA||38||

 

In human beings, happiness and misery, nourishment and emaciation, strength and weakness, fertility and infertility, knowledge and ignorance, and life and death depend upon proper (and improper sleep). Untimely, excessive sleep and sleep deprivation take away both happiness and longevity from a person.  Similarly, proper sleep brings about happiness and longevity in human beings just as real knowledge brings about spiritual power in yogis [36-38]

In human beings, happiness and misery, nourishment and emaciation, strength and weakness, fertility and infertility, knowledge and ignorance, and life and death depend upon proper (and improper sleep). Untimely, excessive sleep and sleep deprivation take away both happiness and longevity from a person.  Similarly, proper sleep brings about happiness and longevity in human beings just as real knowledge brings about spiritual power in yogis [36-38]

 

==== Indications of daytime sleep ====

==== Indications of daytime sleep ====

grIShme tvAdAnarUkShANAM vardhamAne ca mArute|  

grIShme tvAdAnarUkShANAM vardhamAne ca mArute|  

rAtrINAM cAtisa~gkShepAddivAsvapnaH prashasyate||43||

rAtrINAM cAtisa~gkShepAddivAsvapnaH prashasyate||43||

 

Sleeping during the day is advocated for those who are exhausted on account of singing, reading, alcoholic drinking, sexual intercourse, elimination therapy, carrying heavy weight, walking long distances, suffering from phthisis, wasting, thirst, diarrhea, colic pain, dyspnea, hiccup, insanity, or are too old, too young, weak and emaciated. It is also recommended for those who are injured by fall and assault or exhausted by travel-related stress, vigil, anger, grief, and fear. By this, equilibrium of ''dhatus'' and strength is maintained, and ''kapha'' nourishes the body parts and ensures longevity. In the summer season, nights become shorter, and ''vata'' gets provoked in the body in ''adanakala'' (seasons of low body strength, such as summer and rains) due to absorption of fluid. Therefore, during this period daytime sleeping is advocated for all [39-43]

Sleeping during the day is advocated for those who are exhausted on account of singing, reading, alcoholic drinking, sexual intercourse, elimination therapy, carrying heavy weight, walking long distances, suffering from phthisis, wasting, thirst, diarrhea, colic pain, dyspnea, hiccup, insanity, or are too old, too young, weak and emaciated. It is also recommended for those who are injured by fall and assault or exhausted by travel-related stress, vigil, anger, grief, and fear. By this, equilibrium of ''dhatus'' and strength is maintained, and ''kapha'' nourishes the body parts and ensures longevity. In the summer season, nights become shorter, and ''vata'' gets provoked in the body in ''adanakala'' (seasons of low body strength, such as summer and rains) due to absorption of fluid. Therefore, during this period daytime sleeping is advocated for all [39-43]

 

==== Consequences of improper daytime sleep ====

==== Consequences of improper daytime sleep ====

bhavennRuNAM divAsvapnasyAhitasya niShevaNAt|  

bhavennRuNAM divAsvapnasyAhitasya niShevaNAt|  

tasmAddhitAhitaM svapnaM buddhvA svapyAt sukhaM budhaH||49||

tasmAddhitAhitaM svapnaM buddhvA svapyAt sukhaM budhaH||49||

 

Sleeping during daytime is contraindicated in the seasons other than summer because it causes vitiation of ''kapha'' and ''pitta''. Persons having excessive fat, those who are addicted to fatty substances, having plenty of ''kapha'', suffering from vitiated ''kapha'' related disorders, and those afflicted by latent poisons should never sleep during daytime. If one violated the given advice of sleeping during the day, he would subject himself to ''halimaka'' (advance stage of jaundice), headache, cold, heaviness of body parts, malaise, loss of digestive power, ''hridyopalepa'' (a feeling as if phlegm adhered to the heart), edema, anorexia, nausea, rhinitis, hemicranias, urticarial patches, pustules, boils, itching, drowsiness, coughing, disorders of the throat, impairment of memory and intelligence, obstruction of the body channels, fever, incapability of sensory and motor systems and enhancement of the toxic effects of poisons. So, one should keep in view the merits and demerits of sleep in various seasons and situations to stay happy and live long [44-49]

Sleeping during daytime is contraindicated in the seasons other than summer because it causes vitiation of ''kapha'' and ''pitta''. Persons having excessive fat, those who are addicted to fatty substances, having plenty of ''kapha'', suffering from vitiated ''kapha'' related disorders, and those afflicted by latent poisons should never sleep during daytime. If one violated the given advice of sleeping during the day, he would subject himself to ''halimaka'' (advance stage of jaundice), headache, cold, heaviness of body parts, malaise, loss of digestive power, ''hridyopalepa'' (a feeling as if phlegm adhered to the heart), edema, anorexia, nausea, rhinitis, hemicranias, urticarial patches, pustules, boils, itching, drowsiness, coughing, disorders of the throat, impairment of memory and intelligence, obstruction of the body channels, fever, incapability of sensory and motor systems and enhancement of the toxic effects of poisons. So, one should keep in view the merits and demerits of sleep in various seasons and situations to stay happy and live long [44-49]

 

==== Qualities of day and night sleep ====

==== Qualities of day and night sleep ====

svAstIrNaM shayanaM veshma sukhaM kAlastathocitaH|  

svAstIrNaM shayanaM veshma sukhaM kAlastathocitaH|  

AnayantyacirAnnidrAM pranaShTA yA nimittataH||54||  

AnayantyacirAnnidrAM pranaShTA yA nimittataH||54||  

 

If for some reason one suffers from sleeplessness, he can be cured by applying measures such as- body massages, unction, bath, (intake of) soup made up of meat of domestic, marshy and/or aquatic animals, ''shali'' rice with curd, milk, fat, wine, mental pleasure, pleasant smell and sound, application of soothing ointment to eyes, head and face, comfortable bed and home, and getting habituated to sleeping at a particular time.  [52-54]

If for some reason one suffers from sleeplessness, he can be cured by applying measures such as- body massages, unction, bath, (intake of) soup made up of meat of domestic, marshy and/or aquatic animals, ''shali'' rice with curd, milk, fat, wine, mental pleasure, pleasant smell and sound, application of soothing ointment to eyes, head and face, comfortable bed and home, and getting habituated to sleeping at a particular time.  [52-54]

 

==== Causes of sleeplessness ====

==== Causes of sleeplessness ====

eta eva ca vij~jeyA nidrAnAshasya [2] hetavaH|  

eta eva ca vij~jeyA nidrAnAshasya [2] hetavaH|  

kAryaM kAlo vikArashca prakRutirvAyureva ca||57||

kAryaM kAlo vikArashca prakRutirvAyureva ca||57||

 

Elimination of ''doshas'' from the body and the head through purgation and emesis, predominance of ''sattva'' and suppression of ''tamas'', emotions such as fear, anxiety, and anger, habits and activities such as smoking, physical exercise, bloodletting, fasting, and environmental settings such as uncomfortable bed go a long way in overcoming excessive sleepiness/hypersomnolence.  

Elimination of ''doshas'' from the body and the head through purgation and emesis, predominance of ''sattva'' and suppression of ''tamas'', emotions such as fear, anxiety, and anger, habits and activities such as smoking, physical exercise, bloodletting, fasting, and environmental settings such as uncomfortable bed go a long way in overcoming excessive sleepiness/hypersomnolence.  

The above-mentioned factors, along with overwork, old age, ''vatika'' diseases, ''vatika'' constitution and aggravation of ''vata'' itself, are known to cause sleeplessness even in a normal individual. Some are insomniac even by nature [55-57]

The above-mentioned factors, along with overwork, old age, ''vatika'' diseases, ''vatika'' constitution and aggravation of ''vata'' itself, are known to cause sleeplessness even in a normal individual. Some are insomniac even by nature [55-57]

 

==== Origins and types of sleep ====

==== Origins and types of sleep ====

rAtrisvabhAvaprabhavA matA yA tAM bhUtadhAtrIM pravadanti tajj~jAH|  

rAtrisvabhAvaprabhavA matA yA tAM bhUtadhAtrIM pravadanti tajj~jAH|  

tamobhavAmAhuraghasya mUlaM sheShAH punarvyAdhiShu nirdishanti||59||

tamobhavAmAhuraghasya mUlaM sheShAH punarvyAdhiShu nirdishanti||59||

 

Natural sleep (sleeping at night) is the best form of sleep. This is also known as ''Bhutadhatri'', or “that which nurses all the living beings." The form of sleep that is caused by ''tamas'' is the cause of all sinful acts while the remaining types are observed in specific situations and ailments [59]

Natural sleep (sleeping at night) is the best form of sleep. This is also known as ''Bhutadhatri'', or “that which nurses all the living beings." The form of sleep that is caused by ''tamas'' is the cause of all sinful acts while the remaining types are observed in specific situations and ailments [59]

 

==== Summary ====

==== Summary ====

=== ''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]

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

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

 

=== Glossary ===

=== Glossary ===