Difference between revisions of "Meda dhatu"

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Meda dhatu is a body component indicate fat in general and adipose tissue in particular.<ref>Available from https://ayurvedanetworkbhu.com/physiological-issues-related-to-medo-dhatu-with-special-reference-to-obesity/ cited on 18/05/2020 </ref>  Its important function is snehana (to oleate or lubricate).  (SAT-B.435)<ref>Available from http://namstp.ayush.gov.in/#/sat</ref> The baddha or bounded form of meda can be understtod by stored fats. The abadhha or free form can included circulating lipids like those in the form of lipoproteins or those in the form of free fatty acids.<ref>Kishor Patwardhan, ‘Human Physiology in Ayurveda’, Published by Chaukhambha Orientalia, Varanasi (2005) Page No.19</ref>
 
  
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== References ==
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Meda dhatu is the body component which indicates fat in general and adipose tissue in particular. Its important function is to oleate or lubricate (snehana). (SAT-B.435)
 +
 
 +
It is present in two forms:
 +
 
 +
1. Fixed or bounded form is observed as stored fats in adipocytes.
 +
 
 +
2. The free form is observed as circulating lipids like lipoproteins or free fatty acids.
 +
 
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{{Infobox
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|title = Contributors
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|label1 = Section/Chapter/topic
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|data1 = [[Sharira]] / [[Dhatu]] / Mamsa Dhatu
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|label2 = Authors
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|data2 = Deole Y.S.<sup>1</sup>,Anagha S.<sup>1</sup>, 
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|label3 = Reviewed by
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|data3 = Basisht G.<sup>1</sup>
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|label4 = Affiliations
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|data4 = <sup>1</sup>[[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar
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|label5 = Correspondence email:
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|data5 = carakasamhita@gmail.com
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|label6 = Date of first publication:
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|data6 = June 4, 2020
 +
}}
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==Etymology, derivation and meanings:==
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The word Meda is derived from Sanskrit root medas[meda-asun].  It means to lubricate or oleate or to provide unctuousness.
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The literary meanings of word meda are as follows:
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1. Marrow; applicable not merely to the marrow of the bones, but more properly, to the serous or adipose secretion that spreads amongst the muscular fibres, and which is considered as performing the same functions to the flesh that the marrow of the bones performs to them. in physiology its proper seat is said to be the abdomen.
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2. Morbid or unnatural obesity.
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3. In general, obesity or fat in the body are denoted by the word Meda.
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==Panchabhautika constitution and properties: ==
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Medadhatu has dominance of prithvi, jala and agnimahabhuta. It possesses properties like unctuousness (snigdha) and heaviness(guru).
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==Formation and metabolism ==
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Meda dhatu is formed from the unctuous portion of mamsa dhatu by action of factors responsible for metabolism of meda(medadhatvagni). [Cha. Sa ChikitsaSthana 15/29-30]
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There are two forms of meda dhatu in body:
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1. Structural component (poshyameda dhatu): It is the form,that is stored in thelayer of meda(medodhara kala). It is also called fixed or stored fat (baddhamedas). This portion is located mainly in the omentum.This form is responsible for nutrition of meda dhatu itself in case of starvation.
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2. Circulating component (poshakameda dhatu): This form is circulated with nutrient fluid or plasma (rasa dhatu) and blood(rakta).  It is free and unbound (abaddhameda). This provides lubrication and unctuousness wherever needed. This form is vitiated in the pathogenesis of obstinate urinary disorders including diabetes (prameha) [Cha.Sa.NidanaSthana 4/7]
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Metabolic byproducts and waste products (Upadhatu and mala):
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During the process of metabolism and formation of meda dhatu, ligaments (snayu) are formed as the metabolic byproducts (upadhatu). [Cha. Sa. ChikitsaSthana 15/17].  Sweat and sebum is formed during this process as waste products (mala). [Cha.Sa. ChikitsaSthana 15/18].
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Quantity:
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The total quantity of medadhatu is two anjali (personified measurement unit). The quantity of vasa is three anjali (personified measurement unit). One Anjali is equal to the quantity that can be filled in a space formed from joining one’s palms together. [Cha. Sa. ShariraSthana 7/15]
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Time span:
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The meda dhatu is formed on 4th day from nutrient fluid (ahara rasa). [Cha.Sa. ChikitsaSthana 15/20-21] However, Sushruta opines that the meda dhatu is formed in fifteen days (a time span of 9045 kala). [Su. Sa. Sutra Sthana 14/14]
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Characteristics of best quality of adipose tissue (medasara ):
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The person endowed with best quality of meda dhatu have significant unctuousness specifically in complexion, voice, eyes, hair, skin hair, nails, teeth, lips, urine and feces. This indicates wealth, power, happiness, enjoyment, charity, simplicity and delicacy in dealings.[Cha.Sa.VimanaSthana 8/106]
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==Physiological aspects: ==
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Channels of transportation and transformation of meda dhatu (medovahasrotas):
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The channels of transportation and transformation of meda dhatu originate from the kidneys(vrikka) and omentum (vapavahana), [Cha. Sa. Vimana Sthana 5/8]Sushruta opines that they originated from pelvic region(kati) and kidneys(vrikka).[Su. Sa. ShariraSthana 9/12]Vagbhata added mamsa dhatu to the origin with kidneys (vrikka).[Ashtanga SangrahaShariraSthana 6/26]
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Considering above opinions, the origin of meda dhatu can be considered in pelvic region, omentum and kidneys. The sites of origin are important for knowing the source of nourishment in diagnosis and treatment. 
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Following structures can be considered as components of transportation and transformation system of meda dhatu.
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Layer of meda dhatu (medodharakala):
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It is the layer of fat present in abdominal cavity, small bones and long bones. In abdominal cavity it is present in the form of visceral fats. 
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Meda dhatu presentin the long and big bones is known as marrow (majja).That presentinside the small bones is termed as red marrow (saraktameda). The unctuous portion of mamsa dhatu transforms into fat and is known as muscle fat (vasa). [Su. Sa. ShariraSthana 4/13]
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Role of meda dhatu in embryonic development:
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During embryogenesis, veins (sira) and ligaments (snayu) are formed from the unctuous portion of meda dhatu. The veins are formed after mild action of factors responsible for metabolism(agni)that makes them elastic and smooth. Ligaments(snayu) are formed after strong action of factors responsible for metabolism(agni) that makes them hard. [Su. Sa. ShariraSthana 4/29-30]
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The kidneys (vrikka) are formed from unification of essence of blood tissue(rakta dhatu)and adipose tissue (meda dhatu).The testis(vrishana) are formed from unification of essence of adipose tissue (meda dhatu),muscle tissue (mamsa dhatu), blood tissue (rakta dhatu) and kaphadosha. [Su. Sa. ShariraSthana 4/31]
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• Functions:
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Meda dhatu is responsible for functions of lubrication(sneha),sweating (sweda), stability (dridhatwam) and nourishment of bone tissue(asthipushti). [Su. Sa. Sutra Sthana 15/5]
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==Importance in diagnosis: ==
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===Causes of vitiation===
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The channels of transportation and transformation of meda dhatu (medovahasrotas) are affected by sedentary lifestyle including lack of physical exercise, daytime sleep, excessive consumption of fatty food and alcoholic drinks. [Cha. Sa. Vimana Sthana 5/16]
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===Abnormal states===
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The increase or decrease in quality and/or quantity of meda dhatu can lead to various abnormal conditions. The states can be assessed by following clinical features.
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Decrease of meda dhatu:
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Symptoms of decrease of meda dhatu are cracking sound in the joints, lassitude in eyes, exhaustion, decreased abdominal girth or thinning, splenomegaly, feeling of emptiness in joints. dryness and craving for fatty food and meat. [Cha. Sa. Sutra Sthana 17/66], [Su. Sa. Sutra Sthana 15/9]
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Increase of meda dhatu:
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The increase in meda dhatu can be observed by unctuousness of body,increased abdominal girth (abdominal obesity), increased size of flanks,cough, dyspnoeaand bad body odour. [Su. Sa. Sutra Sthana 15/14]
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Clinical features of vitiation:
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• Premonitory symptoms of obstinate urinary disorders including diabetes mellitus (prameha)and signs of eight undesirable types of physical constitutions are observed due to vitiation of channels of transportation and transformation of meda dhatu. [Cha. Sa. Sutra Sthana 28/15]
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• The premonitory symptoms of obstinate urinary disorders including diabetes mellitus (prameha) include excess sweating, body odor, flabbiness of the body, desire for constantly lying on the bed, sitting, sleeping and leading an easy life, a feeling as if the cardiac region is covered with extraneous material, exudation of excreta from eyes, tongue and ears, corpulence of the body, excessive growth of hair and nails, liking for cold things, dryness of throat and palate, sweet taste in the mouth, burning sensation in hands and legs and swarming of ants on the urine. [Cha.Sa.ChikitsaSthana 6/13-14]
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• The signs of eight undesirable physical constitutions include too tall, too short, too hairy, hairless, too dark, too light (complexion), too obese and too lean body statures. [Cha, Sa.Sutra Sthana 21/3]
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• When there is injury to channels of transportation and transformation of meda dhatu(medovahasrotas), the symptoms like excessive sweating, unctuousness of body, dryness of the palate, thick or hard swelling and severe thirst are observed. [Su. Sa.ShariraSthana 9/12]
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Role of meda dhatu as vitiated factor in diseases:
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Meda dhatu is involved in the pathogenesis of following diseases:
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• Obstinate urinary diseases including diabetes (Prameha)() [Cha. Sa. NidanaSthana 4/8],
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• vitiligo (Shwitra) [Cha. Sa. ChikitsaSthana 7/174]
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• swelling (Shotha) [Cha. Sa. ChikitsaSthana 12/94],
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• Anaemia(Pandu)[Cha.Sa. ChikitsaSthana 16/6],
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• Disorders of thigh and hip (Urusthambha) [Cha. Sa. ChikitsaSthana 27/14].
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• Obesity (Sthaulya)[Cha. Sa. Sutra Sthana 21/5-8].
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• Vitiated dosha located in the channels of transport of medadhatu or medovahasrotascause quaternary fever (chaturthakajwara).[Cha. Sa. ChikitsaSthana 3/66]
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• The clinical features of fever due to vitiation of meda dhatu by pitta dosha (medadhatugatajwara) are excessive sweating, thirst, incoherent speech, frequent emesis, inability to tolerate own body odor, wet feeling in the body and anorexia. [Cha. Sa. ChikitsaSthana 3/79].
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• When vitiated vata is located in mamsa and meda dhatu, it manifestsproduces symptoms like heaviness of body, pricking pain and as if beaten by a strong rod or fist cuff and painful severe fatigue. [Cha. Sa. ChikitsaSthana 28/32].
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• When the vata is occluded in the meda dhatu, it causes movable, smooth, soft, cold swellings in the body, and anorexia. This condition is known as ‘adhyavata’ and is difficult to cure. [Cha. Sa. ChikitsaSthana 28/66].
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• Obesity (Sthaulya) is defined as excessive increase of meda and mamsa dhatu in the regions of buttocks, abdomen, and breasts. This leads to flabby or pendulous appearance the person suffers from deficient metabolism and energy. The pathogenesis of obesity begins with the obstruction of body channels by medas leading to excess deposition of fats. It causes severe diseases resulting in rapid deterioration of life. [Cha. Sa. Sutra Sthana 21/5-9].
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==Importance of concept in preservation of health and prevention: ==
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Meda dhatu provides unctuousness to all body components. Unctuousness is essential property of essence of all seven dhatu (oja). It is related to vitality and immunity of body. [Cha.Sa. ChikitsaSthana 24/31] The unctuous portion (sneha) carries functions like lubrication, providing moisture, smoothening, unction, fluidity, and ooziness. [Cha.Sa.Sutra Sthana 22/11] These are importantin various physiological processes and functions of body.
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==Management: ==
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• Nourishing therapy (brimhana) and oleation therapy (snehana) are indicated in conditions of decrease of meda dhatu. Drying therapy (rukshana)and scraping therapy (lekhana) are indicated in conditions of increase in meda dhatu. [Cha.Sa.Sutra Sthana22]
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• The management of diseases due to vitiation of medadhatu includes following measures: [Cha. Sa. Sutra Sthana 21/21-22]
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• Food and drinks that alleviate vatadoshaand reduce kaphadosha and meda dhatu (fat),
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• Therapeutic enema processed with drugs of sharply acting, dryand hot properties,
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• Drypowder massage (udwartana),
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• Use of guduchi (TinosporacordifoliaMiers), musta (CyperusrotundusLinn), triphala (combination of Haritaki (Terminalia chebula Linn), bibhitaki(Terminalia belericaRoxb) and amalaki (Emblica officinalis Gaertn)), takrarishta (a fermented medicinal preparation of buttermilk) and honey .
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• The condition of fever due to pitta dosha in mamsa dhatu and meda dhatu is managed by therapeutic purgation (virechana) and fasting (upavasa). [Cha. Sa. Chikitsa Sthana3/316].
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• The treatment measures for vata located in meda dhatu are therapeutic purgation (virechana), evacuative enema(basti) and palliative measures(shamana). [Cha. Sa. ChikitsaSthana 28/93].
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==Contemporary approach: ==
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• In conventional physiology, concept of meda dhatu is perceived in view of adipose tissue, fats and lipids. Fat is found primarily as a continuous layer or as a deposition on membranes such as mesenteries or greater omentum. It is usually found around kidneys helping to hold them in place around the intestine and furrows of the heart. Fat is found in marrows of long bones also.
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• Origin and formation:
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Adipose tissue is a loose connective tissue including adipocytes, fibroblasts, vascular endothelial cells, and some immune cells.
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Adipocytes, or lipocytes or  fat cells, primarily compose adipose tissue and store fat as energy.  Adipocytes are derived from mesenchymal stem cells  through adipogenesis.
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There are two types of adipose tissue, white adipose tissue (WAT) and brown adipose tissue (BAT), which are also known as white and brown fat, respectively, and comprise two types of fat cells.
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The WAT carries out functions of storage of fat, whereas BAT is involved in thermogenesis.
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The third but poorly understood Marrow fat cells (unilocular cells) are also derived from mesenchymal stem cells.  These cellsexpand in states of low bone density but additionally expands in the setting of obesity.
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• Embryonic development:
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Mesenchymal stem cells can differentiate into adipocytes, connective tissue, muscle or bone. The fibroblast are pre adipocytes that can differentiate to form adipocytes.  Connective tissues are originated from mesoderm during embryogenesis. The development of adipose tissue starts in 14th week of gestation in buccal pad.6
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• Quantity and measurement:
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The total weight of fat in an average human adult measuresabout 13.5 kg. There are 30 billion fat cells. In case of excess weight gain, the fat cells show fourfold increase in size before dividing and increasing the absolute number of fat cells present.
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• Functions:
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Storage of fat:
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The fat is stored in body for energy in case of starvation. The white fat cells store fat in a semi-liquid state. It is composed primarily of triglycerides and cholesteryl ester. White fat cells secrete many proteins acting as adipokines such as resistin, adiponectin, leptin and apelin.
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Generation of heat:
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The brown color in the brown fat cells comes from the large quantity of mitochondria. Therefore, the brown fat, also known as "baby fat," is used to generate heat.11
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Adaptation:
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The fat cells tend to increase in size to store more fat in case needed.This expansion of fat mass leads to obesity.
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Investigations:
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The levels of meda dhatu can be investigated through various assessment parameters like:
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1. Body mass index
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2. Waist: hip ratio
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3. Distribution of fat like measurement of visceral fat, muscle fats through body fat monitor
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4. Estimation of total Cholesterol, triglyceride, HDL (high density lipoprotein), LDL (low density lipoprotein) and VLDL Cholesterol (very low-density lipoprotein)
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5. Serum insulin
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Role of adipocytes in causing obesity and diabetes:
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From the above description, it is clear that meda dhatu is responsible for obesity (sthaulya)due to excess nourishment. The vitiation of channels of transportation and transformation ofmeda dhatu(medavahasrotasa) leads to  obstinate urinary disorders including diabetes(prameha).
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Thispathophysiology can be linked as follows:
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Excess nutrition leads to expansion of fat mass and increase in size of adipocytes (hypertrophy).  This leads to obesity. In the fat cells of obese individuals, there is increased production of metabolism modulators, such as glycerol, hormones, macrophage stimulating chemokines, and pro-inflammatory cytokines, leading to the development of insulin resistance. Insulin plays major role in fat production in adipocytes, synthesis of unsaturated fatty acids and stimulating lipogenesis. It also play role in uptake of glucose by muscles.  The malfunctioning of insulin in turn leads to diabetes.
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==Current researches: ==
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• An observational study assessing the qualities of excellence of medadhatu(sarata) in 60 individualsshowedsignificantlypositive relationshipwith values of lipids. The data showed that persons showing excellent qualities of meda dhatu have normal to high values of HDL (high density lipoproteins), comparatively low values of LDL (low density lipoproteins) and serum cholesterol.
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===List of theses ===
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Very few research workshave been carried out on fundamental approach towards concept of meda dhatu.
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Prameha (obstinate urinary disorders including diabetes) and sthaulya (obesity) are two most prevalent disorders observed in society. Hence the clinical research in relation to meda dhatu is mostly focused on these two disorders and effect of Ayurveda therapies in management.  Hyperlipidaemia and dyslipidaemia are two other disorders related to meda dhatu.
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1.Upadhyay Vashudev J (2001) : Medo-Dhatvagni ka SthaulyaRogakeSandharbhameinSaidhantikaevamPrayogikaAdhyayana, Department of Basic Principles, IPGT&RA,Jamnagar
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2.Savjani Rekha T (2001) :A clinical study on the management of Sthaulya by Pancha-Tikta and Lekhana-Basti, Department of Kayachikitsa, IPGT &RA, Jamnagar
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3.BuchakeAnand(2002) :An assessment of the activities of RookshaGunaw.s.r. to Sthaulya, Department of Dravyaguna, IPGT &RA, Jamnagar
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4. Parmar Sheetal (2002): The role of Virechana and Triphaladi Ghana-Vati in the management of Madhumeha (Diabetes mellitus), Department of Kayachikitsa, IPGT &RA, Jamnagar
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5. GujarathiRitesh A ( 2004) : Conceptual and applied aspects of HrasaHetur-Visheshascha in the context of Sthaulya, Department of Basic Principles, IPGT&RA,Jamnagar.
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6. Talathi Sameer (2005) : A study of Saptaparna (Alstoniascholaris) w.s.r. to Sthaulyahara Karma, Department of Dravyaguna, IPGT &RA, Jamnagar
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7.Dyuti Dave (2006) : Further Clinical Studies In The Management Of Madhumeha With MedoghnaRasayanaVati, Department of Kayachikitsa, IPGT &RA, Jamnagar
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8.Umesh Kumar Sapra (2007) : A Clinical Study Of Hyperlipidaemia And The Effct Of Panchatikta Ghana In Its Management-A Double Blind Study, Department of Kayachikitsa, IPGT &RA, Jamnagar
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9.Jyoti Kumari (2007) :A Comparative Clinical Study Of NyagrodhadiGhanavati And Virechana Karma In The Management Of Madhumeha (Diabetes mellitus), Department of Kayachikitsa, IPGT &RA, Jamnagar
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10.Amit Kumar Singh (2007): A comparative study of Vidangadichurna and some indigenous drug in the management of sthaulya (obesity), Department of Kayachikitsa, IPGT &RA, Jamnagar
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11. Shweta M Khanapurkar (2008) :Comparative Study of the Efficacy of TriphaladiVati and ShilajitwadiVati in the Management of Prameha (DM), Department of Kayachikitsa, Akhandanand Ayurveda College, Ahmedabad
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12.Anoop K (2010) :Pharmaco-Therapeutical Evaluation of Anti-Hyperlipidaemic Activity of Vacha (Acorus calamus Linn.) W.S.R. to Sthaulya,Department of Dravyaguna, IPGT &RA, Jamnagar
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13. Yogesh K Patil (2010) : A Comparative Study of NyagrodhadiVati and GokshuradiGuggulu in the Management of Madhumeha W.S.R. to Diabetes Mellitus, Department of Kayachikitsa, IPGT &RA, Jamnagar
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14Falguni S Patel (2010) :A Clinical Study of TryushnadhyaLauhaVati in the Management of Sthaulyaw.s.r. to Obesity, Department of Kayachikitsa, IPGT &RA, Jamnagar
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15.Manjiri S Ghorpade (2011) : A Comparative Study of Vatsakadi Ghana Vati and Mamajjaka Ghana Vati in the management of Madhumehaw.s.r. to Diabetes Mellitus, Department of Kayachikitsa, IPGT &RA, Jamnagar
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16.Kanwar S Singh(2011) : Study on ApathyanimittajaPrameha (Type 2 Diabetes) and its Management with SaptarangyadiGhanvati (A Clinico-Experimental study), Department of Kayachikitsa, IPGT &RA, Jamnagar
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17.Shivam Joshi (2013) :A Comparative clinical study of AsanadiGhanavati and GomutraHaritakiVati in KaphaMedoMargavaranaw.s.r. to Dyslipidemia, Department of Kayachikitsa, IPGT &RA, Jamnagar
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18.Ankush Gunjal (2013) : A Clinico-experimental Study on Triphaladi Granules in ApathyaNimittajaPrameha (Type 2 Diabetes mellitus), Department of Kayachikitsa, IPGT &RA, Jamnagar
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19.Chitra Devi Sharma (2013) : Comparative Study of AsanadiyogaVati and ShilajitwadiVati in the management of Madhumehaw.s.r. to Diabetes mellitus, Department of Kayachikitsa, IPGT &RA, Jamnagar
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20.MalivadShila (2014) : A Comparative Study of VidangadiLauh and TriphaladiVati in the Management of Madhumeha with special reference to Diabetes Mellitus (Type II), Department of Kayachikitsa, IPGT &RA, Jamnagar
 +
21.Jatin M Vyas (2014) : A Comparative Study of BilvadiPanchmoolGhanvati and NavakGuggulu in the Management of Sthaulya with special reference to Obesity, Department of Kayachikitsa ,IPGT &RA, Jamnagar
 +
22. PadharBharatkumarChhaganbhai(2014) :A Comparative Clinical Study of Tryoshnadiguggulu and Lasuna in Management of Dyslipidemia, Department of Kayachikitsa, IPGT &RA, Jamnagar
 +
23. Bhushan Bhav Ram Prakash Niranjan(2014) : Management of ApathyanimittajaPrameha (Type 2 Diabetes mellitus) with Mayaphala (Quercus infectoria Olivier) A Clinio-experimental Study, Department of Kayachikitsa, IPGT &RA, Jamnagar
 +
 
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==Related Chapters ==
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[[ VividhashitapitiyaAdhyaya]] [[Snehadhyaya]] [[LanghanabrimhaniyaAdhyaya]] [[AshtauninditiyaAdhyaya]] [[SantarpaniyaAdhyaya]]
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[[ GrahaniChikitsa]]
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[[ AshtauninditiyaAdhyaya]]
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[[PramehaNidana]]
 +
[[ PramehaChikitsa]]
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== More information ==
 +
[[Adipocyte]] [[fat cells]]
 +
References:

Revision as of 09:45, 4 June 2020

Meda dhatu is the body component which indicates fat in general and adipose tissue in particular. Its important function is to oleate or lubricate (snehana). (SAT-B.435)

It is present in two forms:

1. Fixed or bounded form is observed as stored fats in adipocytes.

2. The free form is observed as circulating lipids like lipoproteins or free fatty acids.

Contributors
Section/Chapter/topic Sharira / Dhatu / Mamsa Dhatu
Authors Deole Y.S.1,Anagha S.1,
Reviewed by Basisht G.1
Affiliations 1Charak Samhita Research, Training and Development Centre, I.P.G.T.& R.A., Jamnagar
Correspondence email: carakasamhita@gmail.com
Date of first publication: June 4, 2020

Etymology, derivation and meanings:

The word Meda is derived from Sanskrit root medas[meda-asun]. It means to lubricate or oleate or to provide unctuousness. The literary meanings of word meda are as follows: 1. Marrow; applicable not merely to the marrow of the bones, but more properly, to the serous or adipose secretion that spreads amongst the muscular fibres, and which is considered as performing the same functions to the flesh that the marrow of the bones performs to them. in physiology its proper seat is said to be the abdomen. 2. Morbid or unnatural obesity. 3. In general, obesity or fat in the body are denoted by the word Meda.

Panchabhautika constitution and properties:

Medadhatu has dominance of prithvi, jala and agnimahabhuta. It possesses properties like unctuousness (snigdha) and heaviness(guru).

Formation and metabolism

Meda dhatu is formed from the unctuous portion of mamsa dhatu by action of factors responsible for metabolism of meda(medadhatvagni). [Cha. Sa ChikitsaSthana 15/29-30] There are two forms of meda dhatu in body: 1. Structural component (poshyameda dhatu): It is the form,that is stored in thelayer of meda(medodhara kala). It is also called fixed or stored fat (baddhamedas). This portion is located mainly in the omentum.This form is responsible for nutrition of meda dhatu itself in case of starvation. 2. Circulating component (poshakameda dhatu): This form is circulated with nutrient fluid or plasma (rasa dhatu) and blood(rakta). It is free and unbound (abaddhameda). This provides lubrication and unctuousness wherever needed. This form is vitiated in the pathogenesis of obstinate urinary disorders including diabetes (prameha) [Cha.Sa.NidanaSthana 4/7] Metabolic byproducts and waste products (Upadhatu and mala): During the process of metabolism and formation of meda dhatu, ligaments (snayu) are formed as the metabolic byproducts (upadhatu). [Cha. Sa. ChikitsaSthana 15/17]. Sweat and sebum is formed during this process as waste products (mala). [Cha.Sa. ChikitsaSthana 15/18]. Quantity: The total quantity of medadhatu is two anjali (personified measurement unit). The quantity of vasa is three anjali (personified measurement unit). One Anjali is equal to the quantity that can be filled in a space formed from joining one’s palms together. [Cha. Sa. ShariraSthana 7/15] Time span: The meda dhatu is formed on 4th day from nutrient fluid (ahara rasa). [Cha.Sa. ChikitsaSthana 15/20-21] However, Sushruta opines that the meda dhatu is formed in fifteen days (a time span of 9045 kala). [Su. Sa. Sutra Sthana 14/14] Characteristics of best quality of adipose tissue (medasara ): The person endowed with best quality of meda dhatu have significant unctuousness specifically in complexion, voice, eyes, hair, skin hair, nails, teeth, lips, urine and feces. This indicates wealth, power, happiness, enjoyment, charity, simplicity and delicacy in dealings.[Cha.Sa.VimanaSthana 8/106]

Physiological aspects:

Channels of transportation and transformation of meda dhatu (medovahasrotas): The channels of transportation and transformation of meda dhatu originate from the kidneys(vrikka) and omentum (vapavahana), [Cha. Sa. Vimana Sthana 5/8]Sushruta opines that they originated from pelvic region(kati) and kidneys(vrikka).[Su. Sa. ShariraSthana 9/12]Vagbhata added mamsa dhatu to the origin with kidneys (vrikka).[Ashtanga SangrahaShariraSthana 6/26] Considering above opinions, the origin of meda dhatu can be considered in pelvic region, omentum and kidneys. The sites of origin are important for knowing the source of nourishment in diagnosis and treatment. Following structures can be considered as components of transportation and transformation system of meda dhatu. Layer of meda dhatu (medodharakala): It is the layer of fat present in abdominal cavity, small bones and long bones. In abdominal cavity it is present in the form of visceral fats. Meda dhatu presentin the long and big bones is known as marrow (majja).That presentinside the small bones is termed as red marrow (saraktameda). The unctuous portion of mamsa dhatu transforms into fat and is known as muscle fat (vasa). [Su. Sa. ShariraSthana 4/13] Role of meda dhatu in embryonic development: During embryogenesis, veins (sira) and ligaments (snayu) are formed from the unctuous portion of meda dhatu. The veins are formed after mild action of factors responsible for metabolism(agni)that makes them elastic and smooth. Ligaments(snayu) are formed after strong action of factors responsible for metabolism(agni) that makes them hard. [Su. Sa. ShariraSthana 4/29-30] The kidneys (vrikka) are formed from unification of essence of blood tissue(rakta dhatu)and adipose tissue (meda dhatu).The testis(vrishana) are formed from unification of essence of adipose tissue (meda dhatu),muscle tissue (mamsa dhatu), blood tissue (rakta dhatu) and kaphadosha. [Su. Sa. ShariraSthana 4/31] • Functions: Meda dhatu is responsible for functions of lubrication(sneha),sweating (sweda), stability (dridhatwam) and nourishment of bone tissue(asthipushti). [Su. Sa. Sutra Sthana 15/5]

Importance in diagnosis:

Causes of vitiation

The channels of transportation and transformation of meda dhatu (medovahasrotas) are affected by sedentary lifestyle including lack of physical exercise, daytime sleep, excessive consumption of fatty food and alcoholic drinks. [Cha. Sa. Vimana Sthana 5/16]

Abnormal states

The increase or decrease in quality and/or quantity of meda dhatu can lead to various abnormal conditions. The states can be assessed by following clinical features. Decrease of meda dhatu: Symptoms of decrease of meda dhatu are cracking sound in the joints, lassitude in eyes, exhaustion, decreased abdominal girth or thinning, splenomegaly, feeling of emptiness in joints. dryness and craving for fatty food and meat. [Cha. Sa. Sutra Sthana 17/66], [Su. Sa. Sutra Sthana 15/9] Increase of meda dhatu: The increase in meda dhatu can be observed by unctuousness of body,increased abdominal girth (abdominal obesity), increased size of flanks,cough, dyspnoeaand bad body odour. [Su. Sa. Sutra Sthana 15/14] Clinical features of vitiation: • Premonitory symptoms of obstinate urinary disorders including diabetes mellitus (prameha)and signs of eight undesirable types of physical constitutions are observed due to vitiation of channels of transportation and transformation of meda dhatu. [Cha. Sa. Sutra Sthana 28/15] • The premonitory symptoms of obstinate urinary disorders including diabetes mellitus (prameha) include excess sweating, body odor, flabbiness of the body, desire for constantly lying on the bed, sitting, sleeping and leading an easy life, a feeling as if the cardiac region is covered with extraneous material, exudation of excreta from eyes, tongue and ears, corpulence of the body, excessive growth of hair and nails, liking for cold things, dryness of throat and palate, sweet taste in the mouth, burning sensation in hands and legs and swarming of ants on the urine. [Cha.Sa.ChikitsaSthana 6/13-14] • The signs of eight undesirable physical constitutions include too tall, too short, too hairy, hairless, too dark, too light (complexion), too obese and too lean body statures. [Cha, Sa.Sutra Sthana 21/3] • When there is injury to channels of transportation and transformation of meda dhatu(medovahasrotas), the symptoms like excessive sweating, unctuousness of body, dryness of the palate, thick or hard swelling and severe thirst are observed. [Su. Sa.ShariraSthana 9/12] Role of meda dhatu as vitiated factor in diseases: Meda dhatu is involved in the pathogenesis of following diseases: • Obstinate urinary diseases including diabetes (Prameha)() [Cha. Sa. NidanaSthana 4/8], • vitiligo (Shwitra) [Cha. Sa. ChikitsaSthana 7/174] • swelling (Shotha) [Cha. Sa. ChikitsaSthana 12/94], • Anaemia(Pandu)[Cha.Sa. ChikitsaSthana 16/6], • Disorders of thigh and hip (Urusthambha) [Cha. Sa. ChikitsaSthana 27/14]. • Obesity (Sthaulya)[Cha. Sa. Sutra Sthana 21/5-8]. • Vitiated dosha located in the channels of transport of medadhatu or medovahasrotascause quaternary fever (chaturthakajwara).[Cha. Sa. ChikitsaSthana 3/66] • The clinical features of fever due to vitiation of meda dhatu by pitta dosha (medadhatugatajwara) are excessive sweating, thirst, incoherent speech, frequent emesis, inability to tolerate own body odor, wet feeling in the body and anorexia. [Cha. Sa. ChikitsaSthana 3/79]. • When vitiated vata is located in mamsa and meda dhatu, it manifestsproduces symptoms like heaviness of body, pricking pain and as if beaten by a strong rod or fist cuff and painful severe fatigue. [Cha. Sa. ChikitsaSthana 28/32]. • When the vata is occluded in the meda dhatu, it causes movable, smooth, soft, cold swellings in the body, and anorexia. This condition is known as ‘adhyavata’ and is difficult to cure. [Cha. Sa. ChikitsaSthana 28/66]. • Obesity (Sthaulya) is defined as excessive increase of meda and mamsa dhatu in the regions of buttocks, abdomen, and breasts. This leads to flabby or pendulous appearance the person suffers from deficient metabolism and energy. The pathogenesis of obesity begins with the obstruction of body channels by medas leading to excess deposition of fats. It causes severe diseases resulting in rapid deterioration of life. [Cha. Sa. Sutra Sthana 21/5-9].

Importance of concept in preservation of health and prevention:

Meda dhatu provides unctuousness to all body components. Unctuousness is essential property of essence of all seven dhatu (oja). It is related to vitality and immunity of body. [Cha.Sa. ChikitsaSthana 24/31] The unctuous portion (sneha) carries functions like lubrication, providing moisture, smoothening, unction, fluidity, and ooziness. [Cha.Sa.Sutra Sthana 22/11] These are importantin various physiological processes and functions of body.

Management:

• Nourishing therapy (brimhana) and oleation therapy (snehana) are indicated in conditions of decrease of meda dhatu. Drying therapy (rukshana)and scraping therapy (lekhana) are indicated in conditions of increase in meda dhatu. [Cha.Sa.Sutra Sthana22] • The management of diseases due to vitiation of medadhatu includes following measures: [Cha. Sa. Sutra Sthana 21/21-22] • Food and drinks that alleviate vatadoshaand reduce kaphadosha and meda dhatu (fat), • Therapeutic enema processed with drugs of sharply acting, dryand hot properties, • Drypowder massage (udwartana), • Use of guduchi (TinosporacordifoliaMiers), musta (CyperusrotundusLinn), triphala (combination of Haritaki (Terminalia chebula Linn), bibhitaki(Terminalia belericaRoxb) and amalaki (Emblica officinalis Gaertn)), takrarishta (a fermented medicinal preparation of buttermilk) and honey . • The condition of fever due to pitta dosha in mamsa dhatu and meda dhatu is managed by therapeutic purgation (virechana) and fasting (upavasa). [Cha. Sa. Chikitsa Sthana3/316]. • The treatment measures for vata located in meda dhatu are therapeutic purgation (virechana), evacuative enema(basti) and palliative measures(shamana). [Cha. Sa. ChikitsaSthana 28/93].

Contemporary approach:

• In conventional physiology, concept of meda dhatu is perceived in view of adipose tissue, fats and lipids. Fat is found primarily as a continuous layer or as a deposition on membranes such as mesenteries or greater omentum. It is usually found around kidneys helping to hold them in place around the intestine and furrows of the heart. Fat is found in marrows of long bones also. • Origin and formation: Adipose tissue is a loose connective tissue including adipocytes, fibroblasts, vascular endothelial cells, and some immune cells. Adipocytes, or lipocytes or fat cells, primarily compose adipose tissue and store fat as energy. Adipocytes are derived from mesenchymal stem cells through adipogenesis. There are two types of adipose tissue, white adipose tissue (WAT) and brown adipose tissue (BAT), which are also known as white and brown fat, respectively, and comprise two types of fat cells. The WAT carries out functions of storage of fat, whereas BAT is involved in thermogenesis. The third but poorly understood Marrow fat cells (unilocular cells) are also derived from mesenchymal stem cells. These cellsexpand in states of low bone density but additionally expands in the setting of obesity. • Embryonic development: Mesenchymal stem cells can differentiate into adipocytes, connective tissue, muscle or bone. The fibroblast are pre adipocytes that can differentiate to form adipocytes. Connective tissues are originated from mesoderm during embryogenesis. The development of adipose tissue starts in 14th week of gestation in buccal pad.6 • Quantity and measurement: The total weight of fat in an average human adult measuresabout 13.5 kg. There are 30 billion fat cells. In case of excess weight gain, the fat cells show fourfold increase in size before dividing and increasing the absolute number of fat cells present. • Functions: Storage of fat: The fat is stored in body for energy in case of starvation. The white fat cells store fat in a semi-liquid state. It is composed primarily of triglycerides and cholesteryl ester. White fat cells secrete many proteins acting as adipokines such as resistin, adiponectin, leptin and apelin. Generation of heat: The brown color in the brown fat cells comes from the large quantity of mitochondria. Therefore, the brown fat, also known as "baby fat," is used to generate heat.11 Adaptation: The fat cells tend to increase in size to store more fat in case needed.This expansion of fat mass leads to obesity. Investigations: The levels of meda dhatu can be investigated through various assessment parameters like: 1. Body mass index 2. Waist: hip ratio 3. Distribution of fat like measurement of visceral fat, muscle fats through body fat monitor 4. Estimation of total Cholesterol, triglyceride, HDL (high density lipoprotein), LDL (low density lipoprotein) and VLDL Cholesterol (very low-density lipoprotein) 5. Serum insulin Role of adipocytes in causing obesity and diabetes: From the above description, it is clear that meda dhatu is responsible for obesity (sthaulya)due to excess nourishment. The vitiation of channels of transportation and transformation ofmeda dhatu(medavahasrotasa) leads to obstinate urinary disorders including diabetes(prameha). Thispathophysiology can be linked as follows: Excess nutrition leads to expansion of fat mass and increase in size of adipocytes (hypertrophy). This leads to obesity. In the fat cells of obese individuals, there is increased production of metabolism modulators, such as glycerol, hormones, macrophage stimulating chemokines, and pro-inflammatory cytokines, leading to the development of insulin resistance. Insulin plays major role in fat production in adipocytes, synthesis of unsaturated fatty acids and stimulating lipogenesis. It also play role in uptake of glucose by muscles. The malfunctioning of insulin in turn leads to diabetes.

Current researches:

• An observational study assessing the qualities of excellence of medadhatu(sarata) in 60 individualsshowedsignificantlypositive relationshipwith values of lipids. The data showed that persons showing excellent qualities of meda dhatu have normal to high values of HDL (high density lipoproteins), comparatively low values of LDL (low density lipoproteins) and serum cholesterol.

List of theses

Very few research workshave been carried out on fundamental approach towards concept of meda dhatu. Prameha (obstinate urinary disorders including diabetes) and sthaulya (obesity) are two most prevalent disorders observed in society. Hence the clinical research in relation to meda dhatu is mostly focused on these two disorders and effect of Ayurveda therapies in management. Hyperlipidaemia and dyslipidaemia are two other disorders related to meda dhatu. 1.Upadhyay Vashudev J (2001) : Medo-Dhatvagni ka SthaulyaRogakeSandharbhameinSaidhantikaevamPrayogikaAdhyayana, Department of Basic Principles, IPGT&RA,Jamnagar 2.Savjani Rekha T (2001) :A clinical study on the management of Sthaulya by Pancha-Tikta and Lekhana-Basti, Department of Kayachikitsa, IPGT &RA, Jamnagar 3.BuchakeAnand(2002) :An assessment of the activities of RookshaGunaw.s.r. to Sthaulya, Department of Dravyaguna, IPGT &RA, Jamnagar 4. Parmar Sheetal (2002): The role of Virechana and Triphaladi Ghana-Vati in the management of Madhumeha (Diabetes mellitus), Department of Kayachikitsa, IPGT &RA, Jamnagar 5. GujarathiRitesh A ( 2004) : Conceptual and applied aspects of HrasaHetur-Visheshascha in the context of Sthaulya, Department of Basic Principles, IPGT&RA,Jamnagar. 6. Talathi Sameer (2005) : A study of Saptaparna (Alstoniascholaris) w.s.r. to Sthaulyahara Karma, Department of Dravyaguna, IPGT &RA, Jamnagar 7.Dyuti Dave (2006) : Further Clinical Studies In The Management Of Madhumeha With MedoghnaRasayanaVati, Department of Kayachikitsa, IPGT &RA, Jamnagar 8.Umesh Kumar Sapra (2007) : A Clinical Study Of Hyperlipidaemia And The Effct Of Panchatikta Ghana In Its Management-A Double Blind Study, Department of Kayachikitsa, IPGT &RA, Jamnagar 9.Jyoti Kumari (2007) :A Comparative Clinical Study Of NyagrodhadiGhanavati And Virechana Karma In The Management Of Madhumeha (Diabetes mellitus), Department of Kayachikitsa, IPGT &RA, Jamnagar 10.Amit Kumar Singh (2007): A comparative study of Vidangadichurna and some indigenous drug in the management of sthaulya (obesity), Department of Kayachikitsa, IPGT &RA, Jamnagar 11. Shweta M Khanapurkar (2008) :Comparative Study of the Efficacy of TriphaladiVati and ShilajitwadiVati in the Management of Prameha (DM), Department of Kayachikitsa, Akhandanand Ayurveda College, Ahmedabad 12.Anoop K (2010) :Pharmaco-Therapeutical Evaluation of Anti-Hyperlipidaemic Activity of Vacha (Acorus calamus Linn.) W.S.R. to Sthaulya,Department of Dravyaguna, IPGT &RA, Jamnagar 13. Yogesh K Patil (2010) : A Comparative Study of NyagrodhadiVati and GokshuradiGuggulu in the Management of Madhumeha W.S.R. to Diabetes Mellitus, Department of Kayachikitsa, IPGT &RA, Jamnagar 14Falguni S Patel (2010) :A Clinical Study of TryushnadhyaLauhaVati in the Management of Sthaulyaw.s.r. to Obesity, Department of Kayachikitsa, IPGT &RA, Jamnagar 15.Manjiri S Ghorpade (2011) : A Comparative Study of Vatsakadi Ghana Vati and Mamajjaka Ghana Vati in the management of Madhumehaw.s.r. to Diabetes Mellitus, Department of Kayachikitsa, IPGT &RA, Jamnagar 16.Kanwar S Singh(2011) : Study on ApathyanimittajaPrameha (Type 2 Diabetes) and its Management with SaptarangyadiGhanvati (A Clinico-Experimental study), Department of Kayachikitsa, IPGT &RA, Jamnagar 17.Shivam Joshi (2013) :A Comparative clinical study of AsanadiGhanavati and GomutraHaritakiVati in KaphaMedoMargavaranaw.s.r. to Dyslipidemia, Department of Kayachikitsa, IPGT &RA, Jamnagar 18.Ankush Gunjal (2013) : A Clinico-experimental Study on Triphaladi Granules in ApathyaNimittajaPrameha (Type 2 Diabetes mellitus), Department of Kayachikitsa, IPGT &RA, Jamnagar 19.Chitra Devi Sharma (2013) : Comparative Study of AsanadiyogaVati and ShilajitwadiVati in the management of Madhumehaw.s.r. to Diabetes mellitus, Department of Kayachikitsa, IPGT &RA, Jamnagar 20.MalivadShila (2014) : A Comparative Study of VidangadiLauh and TriphaladiVati in the Management of Madhumeha with special reference to Diabetes Mellitus (Type II), Department of Kayachikitsa, IPGT &RA, Jamnagar 21.Jatin M Vyas (2014) : A Comparative Study of BilvadiPanchmoolGhanvati and NavakGuggulu in the Management of Sthaulya with special reference to Obesity, Department of Kayachikitsa ,IPGT &RA, Jamnagar 22. PadharBharatkumarChhaganbhai(2014) :A Comparative Clinical Study of Tryoshnadiguggulu and Lasuna in Management of Dyslipidemia, Department of Kayachikitsa, IPGT &RA, Jamnagar 23. Bhushan Bhav Ram Prakash Niranjan(2014) : Management of ApathyanimittajaPrameha (Type 2 Diabetes mellitus) with Mayaphala (Quercus infectoria Olivier) A Clinio-experimental Study, Department of Kayachikitsa, IPGT &RA, Jamnagar

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