Changes

|label7 = Reviewer  

|label7 = Reviewer  

|data7  = Byadgi P.S.

|data7  = Byadgi P.S.

|label8 = Editor

|label8 = Editors

|data8  = Dwivedi R.B.

|data8  = Dwivedi R.B.,Deole Y.S., Basisht G.  

|label9 = Date of publication  

|label9 = Year of publication  

|data9 = December 17, 2018

|data9 = 2020

|label10 = DOI  

|data10 = [https://doi.org/10.47468/CSNE.2020.e01.s01.023 10.47468/CSNE.2020.e01.s01.023]

|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

|label11 = DOI  

|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s01.023 10.47468/CSNE.2020.e01.s01.023]

}}

}}

== Introduction ==

== Introduction ==

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Charak 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<ref name=ref1>Pandey A. K and Singh R. H.:  “A Study of the Immune status in patients of diabetes mellitus and their Management with certain NaimittikaRasayana drugs”, JRAS. Vol. XXIV. No. 3-4, 2003; 48-61. </ref>  <ref name=ref2>Pandey A.K and Singh R.H. (2012): A Clinical Study on Certain Diabetic Complications under the Influence of Naimittika Rasayana Therapy w.s.r. to Nishamalaki and Shilajatu), PhD. Thesis, Department of Kayachikitsa,, IMS, BHU, Varanasi. </ref> <ref name=ref3>Jaspreet Singh & A. K. Pandey: Clinical Evaluation of Pushkaramula (Inula racemosa) Capsule in the patients of Metabolic syndrome”, International Journal of Medicine and Pharmaceutical Sciences (IJMPS), ISSN(P): 2250-0049; ISSN(E): 2321-0095, Vol. 4, Issue 2, Apr 2014, 9-20. </ref>. The recent concept of “metabolic syndrome” was already recognized in [[Ayurveda]]. Biomedical science points that overweight individuals experience greatly elevated morbidity and mortality from various ailments including cardiovascular diseases<ref>National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Bethesda, Md: National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases; 1998. </ref> <ref>Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci. 2001;321: 225–236.</ref>

Charak 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 dhatu]] (plasma) and [[meda dhatu]](adipose tissue) as important ''dushyas'' (affected tissues). Modern medicine has acknowledged the role of [[meda dhatu]] (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<ref name=ref1>Pandey A. K and Singh R. H.:  “A Study of the Immune status in patients of diabetes mellitus and their Management with certain NaimittikaRasayana drugs”, JRAS. Vol. XXIV. No. 3-4, 2003; 48-61. </ref>  <ref name=ref2>Pandey A.K and Singh R.H. (2012): A Clinical Study on Certain Diabetic Complications under the Influence of Naimittika Rasayana Therapy w.s.r. to Nishamalaki and Shilajatu), PhD. Thesis, Department of Kayachikitsa,, IMS, BHU, Varanasi. </ref> <ref name=ref3>Jaspreet Singh & A. K. Pandey: Clinical Evaluation of Pushkaramula (Inula racemosa) Capsule in the patients of Metabolic syndrome”, International Journal of Medicine and Pharmaceutical Sciences (IJMPS), ISSN(P): 2250-0049; ISSN(E): 2321-0095, Vol. 4, Issue 2, Apr 2014, 9-20. </ref>. The recent concept of “metabolic syndrome” was already recognized in [[Ayurveda]]. Biomedical science points that overweight individuals experience greatly elevated morbidity and mortality from various ailments including cardiovascular diseases<ref>National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Bethesda, Md: National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases; 1998. </ref> <ref>Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci. 2001;321: 225–236.</ref>

    

    

Obesity research is focused on preventive measures and management of complications like prediabetes, diabetes, metabolic syndrome, hypertension, stroke, coronary artery disease, congestive heart failure, cardiomyopathy, and arrhythmia/sudden death<ref>Singh Jaspreet & Pandey A.K. (2012): Clinical Evaluation of Pushkarmula churna in the patients of metabolic syndrome w.s.r, to Ojas and Agni MD (Ay) Department of Kayachikitsa, IMS, BHU, Varanasi. </ref>. In the modern world, obesity has emerged as a serious health issue in both developed and developing nations and is recognized as one of the most serious public health problems of the 21st century. In 2008 the WHO estimated that globally, at least 500 million adults (or approximately 1 in 10 adults) are obese, with higher rates among women than men. Obesity is the reason for about 80% of type 2 diabetes, about 70% of cardiovascular diseases, and 42% of breast and colon cancers today. In the past two decades, the number of overweight children and adolescents has doubled<ref>Lau D.C. et al (April 2007). "2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]", CMAJ , 176 (8): S1–13. </ref>. The rate of obesity also increases with age at least up to 50 or 60 years old. Once considered a problem specific to only high-income countries, obesity has acquired pandemic proportions and is affecting people globally<ref>World Health Organization (WHO) (2000). Obesity: Preventing and Managing the Global Epidemic. Report on a WHO Consultation. Geneva. (WHO technical report series 894). </ref> <ref>P.J.English, M.A.Ghatei, I.A.Malik, S. R. Bloom and J. P. H. Wilding ( June-1, 2002): Food fails to suppress ghrelin levels in obese humans, The Journal of Clinical Endocrinology & Metabolism, 87(6):2984–2987. </ref>, <ref>Pandey, A. K. (2015): </ref>

Obesity research is focused on preventive measures and management of complications like prediabetes, diabetes, metabolic syndrome, hypertension, stroke, coronary artery disease, congestive heart failure, cardiomyopathy, and arrhythmia/sudden death<ref>Singh Jaspreet & Pandey A.K. (2012): Clinical Evaluation of Pushkarmula churna in the patients of metabolic syndrome w.s.r, to Ojas and Agni MD (Ay) Department of Kayachikitsa, IMS, BHU, Varanasi. </ref>. In the modern world, obesity has emerged as a serious health issue in both developed and developing nations and is recognized as one of the most serious public health problems of the 21st century. In 2008 the WHO estimated that globally, at least 500 million adults (or approximately 1 in 10 adults) are obese, with higher rates among women than men. Obesity is the reason for about 80% of type 2 diabetes, about 70% of cardiovascular diseases, and 42% of breast and colon cancers today. In the past two decades, the number of overweight children and adolescents has doubled<ref>Lau D.C. et al (April 2007). "2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]", CMAJ , 176 (8): S1–13. </ref>. The rate of obesity also increases with age at least up to 50 or 60 years old. Once considered a problem specific to only high-income countries, obesity has acquired pandemic proportions and is affecting people globally<ref>World Health Organization (WHO) (2000). Obesity: Preventing and Managing the Global Epidemic. Report on a WHO Consultation. Geneva. (WHO technical report series 894). </ref> <ref>P.J.English, M.A.Ghatei, I.A.Malik, S. R. Bloom and J. P. H. Wilding ( June-1, 2002): Food fails to suppress ghrelin levels in obese humans, The Journal of Clinical Endocrinology & Metabolism, 87(6):2984–2987. </ref>, <ref>Pandey, A. K. (2015): </ref>

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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 dhatu]] (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''.  

=== Etiology, features, and consequences of ''atikrisha'' (emaciation) ===

=== Etiology, features, and consequences of ''atikrisha'' (emaciation) ===

The etiological factors for ''atikrisha'' may be divided into two groups - excessive expenditure of calories and fewer intakes of calories. Either of these conditions leads to under-nutrition which ultimately results in ''atikrisha''. In the pathogenesis of ''krishata'', ''vayu'' plays an important role. Most of the etiological factors observed in the case of ''krisha'' and ''atikrisha'' provoke ''vata'' vitiation. Thus, vitiated ''vata'' may be considered the most important factor in the pathogenesis of ''krisha''. In ''sthaulya'' there is excessive formation and under-utilization (due to sedentary habit) of the ''rasa dhatu''. On the other hand, in ''krishata'' there is less formation of ''rasa'' due to diseases or due to undernourishment. Further, Charak and Sushruta both have categorized ''krishata'' as a ''rasa pradoshaja vyadhi''. [Cha.Sa.[[Sutra Sthana]]28/10], [Su.Sa.Sutra Sthana 15/37]<ref name=Susruta>Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>,[Su.Sa.Sutra Sthana 24/8]<ref name=Susruta/> In this way, ''rasa dhatu dushti'' mainly in the form of ''kshaya'' is found in extremely lean or emaciated people. The other ''dhatu'' involved in the pathogenesis of obesity as well as ''atikrisha'' is ''meda'' since it is mentioned that ''medokshaya'' (or the deficiency of ''meda'') cause ''krisanga''. [A.H.Sutra Sthana 11/18]<ref>Munshi, V.D. (translator) (1952). Ashtang Hridaya,Sastum Sahityavardhak Mudranalaya, Ahmedabad, India, p. 135, Sutrasthana-24/5, 11/18. </ref>   

The etiological factors for ''atikrisha'' may be divided into two groups - excessive expenditure of calories and fewer intakes of calories. Either of these conditions leads to under-nutrition which ultimately results in ''atikrisha''. In the pathogenesis of ''krishata'', ''vayu'' plays an important role. Most of the etiological factors observed in the case of ''krisha'' and ''atikrisha'' provoke ''vata'' vitiation. Thus, vitiated ''vata'' may be considered the most important factor in the pathogenesis of ''krisha''. In ''sthaulya'' there is excessive formation and under-utilization (due to sedentary habit) of the ''rasa dhatu''. On the other hand, in ''krishata'' there is less formation of ''rasa'' due to diseases or due to undernourishment. Further, Charak and Sushruta both have categorized ''krishata'' as a ''rasa pradoshaja vyadhi''. [Cha.Sa.[[Sutra Sthana]]28/10], [Su.Sa.Sutra Sthana 15/37]<ref name=Susruta>Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>,[Su.Sa.Sutra Sthana 24/8]<ref name=Susruta/> In this way, ''rasa dhatu dushti'' mainly in the form of ''kshaya'' is found in extremely lean or emaciated people. The other ''dhatu'' involved in the pathogenesis of obesity as well as ''atikrisha'' is [[meda dhatu]] since it is mentioned that ''medokshaya'' (or the deficiency of [[meda dhatu]]) cause ''krisanga''. [A.H.Sutra Sthana 11/18]<ref>Munshi, V.D. (translator) (1952). Ashtang Hridaya,Sastum Sahityavardhak Mudranalaya, Ahmedabad, India, p. 135, Sutrasthana-24/5, 11/18. </ref>   

In biomedical terms, emaciation is the outcome of loss of the fatty contents or loss of adipose tissue component of subcutaneous fat, which is lying beneath the outer covering of the body<ref>Gray D.S., Fujioka K. (1991). "Use of relative weight and Body Mass Index for the determination of adiposity". J Clin Epidemiol, 44 (6): 545–50. </ref>. It is also known as extreme weight loss, leanness, or thinness. In general term, it is also known as wasting, which is caused by hampered nutritional requirement at the tissue level and excessive starvation. Wasting or leanness is an important symptom of improper nourishment, which is commonly seen in various clinical conditions such as poverty, a variety of gastrointestinal disorders, various eating disorders, prolonged fever, malignant diseases, endocrine disorders, chronic infections, autoimmune disorders as well as parasitic infections. The malnourished person faced a lot of problems related to cardiovascular, integumentary and urogenital systems. Disturbances in blood circulation, serum electrolyte, and serum protein are commonly observed in emaciated person. Such type individuals are more to suffer from infections due to deranged immune power and swelling in general<ref>"Emaciation". Medical-Dictionary.TheFreeDictionary.com. Retrieved February 19, 2014. </ref>.   

In biomedical terms, emaciation is the outcome of loss of the fatty contents or loss of adipose tissue component of subcutaneous fat, which is lying beneath the outer covering of the body<ref>Gray D.S., Fujioka K. (1991). "Use of relative weight and Body Mass Index for the determination of adiposity". J Clin Epidemiol, 44 (6): 545–50. </ref>. It is also known as extreme weight loss, leanness, or thinness. In general term, it is also known as wasting, which is caused by hampered nutritional requirement at the tissue level and excessive starvation. Wasting or leanness is an important symptom of improper nourishment, which is commonly seen in various clinical conditions such as poverty, a variety of gastrointestinal disorders, various eating disorders, prolonged fever, malignant diseases, endocrine disorders, chronic infections, autoimmune disorders as well as parasitic infections. The malnourished person faced a lot of problems related to cardiovascular, integumentary and urogenital systems. Disturbances in blood circulation, serum electrolyte, and serum protein are commonly observed in emaciated person. Such type individuals are more to suffer from infections due to deranged immune power and swelling in general<ref>"Emaciation". Medical-Dictionary.TheFreeDictionary.com. Retrieved February 19, 2014. </ref>.