Changes

==== Management of the Morbidly Obese (20-28) ====

==== Management of the Morbidly Obese (20-28) ====

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.<ref>Matthias Raschpichler et al (2013). Abdominal fat distribution and its relationship to brain changes: the differential effects of age on cerebellar structure and function: a cross-sectional, exploratory study. BMJ Open. 2013; 3(1): e001915.Published online 2013 Jan 24. doi:  10.1136/bmjopen-2012-001915 </ref> <ref>McCarthyHD, EllisSM, ColeTJ. (2003): Central overweight and obesity in British youth aged 11–16 years: cross sectional surveys of waist circumference. BMJ, 326:624. </ref> <ref>GollischKS, BrandauerJ, JessenN, et al. (2009):Effects of exercise training on subcutaneous and visceral adipose tissue in normal- and high-fat diet-fed rats, Am J Physiol Endocrinol Metab; 297:E495–504. </ref>

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]    

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.<ref>Singh R.H.(1998). The holistic principles of Ayurvedic Medicine. Chaukhambha Publications,  Varanasi. </ref> <ref>Singh R.H. (2002) . Panchakarma therapy (2nd Ed). Chaukhambha Sanskrit Sereis office, Varanasi. </ref> <ref>Paranjpe, P., Patki, P., and Patwardhan, P., (1990). Ayurvedic treatment of obesity: a randomized  double blind, placebo-controlled clinical trial, J. Ethnopharmacol., 29, 1–11. </ref> <ref>Kasture, H.S. (translator) (1985).  Ayurvediya Panchakarma Vignyana (3rd ed.). Shri Baidyanath Ayurved Bhavan Pvt. Ltd., Kolkata, India, p. 247. </ref>''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.<ref>Schmidt, T et al (1997): Changes in cardiovascular risk factors and hormones during a comprehensive residential three month kriyayoga training and vegetarian nutrition, Acta Physiol.Scand Suppl. 640:158:160. </ref> <ref>Bera, T.K., Rajapurkar, M.V. (1993): Body composition, cardiovascular edurance and anaerobic power of yogic practitioner, Indian J. Physiol. Pharmacol, 37:225-228.  </ref>  <ref>Mahajan, A.S., Reddy, K.S., Sachdeva, U. (1999): Lipid profiles of coronary risk subjects following yogic lifestyle intervention, Indian Heart J, 51:37040. </ref>  <ref>Manachanda, S.C. et al.(2000): Retardation of coronary atherosclerosis with yoga lifestyle intervention, J Assoc.Physicians India, 48 (7): 687-694. </ref>    

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. <ref>Banerjee, S.K., Maulik, S.K. (2002): Effect of garlic on cardiovascular disorders: a review, Nutr.J, 1:4. </ref> <ref>Satyavati, G.V., Dwarakanath, C., and Tripathi, S.N. (1950 & 1969). Experimental studies on the hypocholesterolemic effect of Commiphora mukul (Guggulu), Indian J. Med. Res., 57, 1950, 1969. </ref> <ref>Karthikeyan, K. et al. (2003): Cardioprotective effect of the alcoholic extract of Terminalia arjuna bark in an invitro model of myocardial ischemic reperfusion injury, Iife Scince, 10, 73 (21):2727:39. </ref> <ref>Verghese, J. (2001): Coriander, Indian Spices, 38 (1):8. </ref> <ref>Kannan, V et al. (2012): Anti-diabetic activity on ethanolic extracts of fruits of terminalia chebula in Alloxan induced diabetic rats, American J. of Drug Discovery and Development, 2:135-142. </ref> <ref>Despande, U.R. (1966): Effect of Turmeric extract on lipid profile (1-22), Int.Seminar on free radicals medicated disease, 2-4.  </ref> <ref>Kesari, A.N. et al. (2006): Hypoglycemic and anti-hyperglycemic activity of Aegle mormelas seed extract in normal and diabetic rats, J. Ethnopharmacol, 103 (3): 374-79. </ref> <ref>Sharma, S.R., Dwivedi, S.K., Swarup, D (1996): Hypoglycemic and hypolipidaemic effects of Cinnamomum tamala Nees leaves, Indian J Exp Biol, 34 (2): 216-220. </ref> <ref>Kohsuke Hayamizu, MS, Yuri Ishii, et al.( SE P T EMB E R / O C T O B E R 2003):Effects of Garcinia cambogia (Hydroxycitric Acid) on Visceral Fat Accumulation: A Double-Blind, Randomized, Placebo-Controlled Trial, current therapeutic research,VO L UME 64, No. 8, 551-567.  </ref> <ref>Bhagwat, B.K. (1995).  Triphala-guggul in Sthoulya in Ayurveda Research Papers III, Kulkarni, P.H., Ed., Ayurved Rasashala, Pune, India, p. 215 </ref> <ref>Vaidya, A.B. et al. (1980).  A double-blind clinical trial of Arogyawardhini — an Ayurvedic drug- in acute viral hepatitis, Ind. J. Med. Res., 72, 588. </ref>

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

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