Changes

In biomedical science, the above-described eight types of undesirable persons are comparable to a variety of genetic and neuroendocrine disorders. Out of these eight types, the last two (''atisthula'' and ''atikrisha'') need therapeutic interventions and deserve special attention. According to Chakrapanі, physical deformities such as ''kubja'' (hunchback) and ''pangu'' (limp gait) may also be taken as undesirable.   

In biomedical science, the above-described eight types of undesirable persons are comparable to a variety of genetic and neuroendocrine disorders. Out of these eight types, the last two (''atisthula'' and ''atikrisha'') need therapeutic interventions and deserve special attention. According to Chakrapanі, physical deformities such as ''kubja'' (hunchback) and ''pangu'' (limp gait) may also be taken as undesirable.   

=== Too Obese  ===

=== Morbid obesity ===

In the context of ''atisthula'' and ''atikrisha'', Charak has explored these conditions from the standpoint of their diathesis, clinical presentation, and management, which is comparable to approaches taken today to the study of obesity and leanness. Suśruta has considered ''rasa dhatu'' as the main culprit for both obesity and emaciation (''rasa nimittameva sthaulyam karshyam ca'')<ref>Acharya, J.T. (translator) (1915).  Sushrut Sanhita of Sushrut, Nirnay Sagar Press, Mumbai, India, p. 65, Su.Su-15/39. </ref>.  

In the context of ''atisthula'' and ''atikrisha'', Charak has explored these conditions from the standpoint of their diathesis, clinical presentation, and management, which is comparable to approaches taken today to the study of obesity and leanness. Suśruta has considered ''rasa dhatu'' as the main culprit for both obesity and emaciation (''rasa nimittameva sthaulyam karshyam ca'')<ref>Acharya, J.T. (translator) (1915).  Sushrut Sanhita of Sushrut, Nirnay Sagar Press, Mumbai, India, p. 65, Su.Su-15/39. </ref>.  

There are two distinct groups of neurons in the arcuate nucleus viz- The first group contains neuropeptide Y (NPY) and agouti-related peptide (AgRP) and the second group contains Pro-opiomelanocortin (POMC) and cocaine and amphetamine regulated transcript (CART). The first group of neuron i.e. NPY/AgRP exerts stimulatory inputs to the LH while inhibitory inputs to the VMH, which stimulate feeding and inhibit satiety respectively. Both groups of arcuate nucleus neurons are the under the regulation of leptin, which inhibits the NPY/AgRP group of neurons and stimulating the POMC/CART group of neurons. Hence, the leptin deficiency or leptin resistance leads to develop overfeeding tendency, which is caused by some genetic and acquired forms of obesity<ref name=ref30/>Rao CR, Sen PK, Flier JS (2012). Handbook of Statistics: Bioinformatics in Human Health and Heredity; Published by North Holland; 1 edition, Kindle Edition, 1 edition.  </ref>  <ref>Raina GS (2011). Obesity being the major health burden needed to be chased: A systemic review. J Appl Pharm Sci. 2011;1:238–45.  </ref>. These findings suggest the genetic inputs in overweight and obesity, which is quite comparable to the Ayurvedic lexicons.(verse 4)

There are two distinct groups of neurons in the arcuate nucleus viz- The first group contains neuropeptide Y (NPY) and agouti-related peptide (AgRP) and the second group contains Pro-opiomelanocortin (POMC) and cocaine and amphetamine regulated transcript (CART). The first group of neuron i.e. NPY/AgRP exerts stimulatory inputs to the LH while inhibitory inputs to the VMH, which stimulate feeding and inhibit satiety respectively. Both groups of arcuate nucleus neurons are the under the regulation of leptin, which inhibits the NPY/AgRP group of neurons and stimulating the POMC/CART group of neurons. Hence, the leptin deficiency or leptin resistance leads to develop overfeeding tendency, which is caused by some genetic and acquired forms of obesity<ref name=ref30/>Rao CR, Sen PK, Flier JS (2012). Handbook of Statistics: Bioinformatics in Human Health and Heredity; Published by North Holland; 1 edition, Kindle Edition, 1 edition.  </ref>  <ref>Raina GS (2011). Obesity being the major health burden needed to be chased: A systemic review. J Appl Pharm Sci. 2011;1:238–45.  </ref>. These findings suggest the genetic inputs in overweight and obesity, which is quite comparable to the Ayurvedic lexicons.(verse 4)

=== Consequences of obesity (verse 5-8) ===

=== Consequences of obesity ===

Serious diseases (''daruna vikara'') are the outcome of excessive obesity due obstruction of body channels by the ''medas''. This indicates ancient wisdom of [[Ayurveda]] ''acharyas'', which is comparable to the impact of obesity on health perspectives of biomedical science<ref>Mishra, L.C. (2003). Scientific Basis of Ayurvedic therapy, Chapter 9 Obesity (Medoroga) in [[Ayurveda]]; eBook, published by CRC press, Taylor & Francis Group.  </ref>. We have yet to understand what they had foreseen in reference to fat accumulation around the kidneys. Decreased life span (''ayukshaya'') is stated to be an important consequence of obesity in [[Ayurveda]]. According to contemporary science, metabolic and psychological pathologies are often present together and are associated with dysregulation of the hypothalamic-pituitary-adrenal axis<ref>Boulpaep, Emile L.; Boron, Walter F. (2003). Medical physiologya: A cellular and molecular approach. Philadelphia: Saunders. p. 1227. ISBN 0-7216-3256-4 </ref>. Affect disorders are also reported among obese binge eaters. The National Institute of Health, USA has issued an alert labeling obesity a "Killer disease" due to its health-related consequences such as coronary disease, diabetes mellitus, hypertension, hyperlipidemia, kidney disorders, gallbladder disorders, cancer of colon, pancreas, breast, uterus, kidney and gallbladder, osteoarthritis, menstrual irregularities in females, cryptogenic cirrhosis of the liver and hepatocellular carcinoma, insulin resistance, and physiological hyperinsulinemia. Some of the social consequences of obesity could include divorces, due in part to reduce sexual activities between partners. Besides there, transitional physiological phases such as weight gain during adolescence in boys and girls, post-natal weight gain in women, and peri-post menopausal obesity are frequently noted in clinical settings that warrant special care and management<ref> Kuniko Takagi, Romain Legrand, Akihiro Asakawa, Haruka Amitani, Marie François, Naouel Tennoune, Moïse Coëffier, Sophie Claeyssens, Jean-Claude do Rego, Pierre Déchelotte, Akio Inui, Sergueï O. Fetissov. Anti-ghrelin immunoglobulins modulate ghrelin stability and its orexigenic effect in obese mice and humans. Nature Communications, 2013; 4 DOI: 10.1038/ncomms3685, site on 08/02/2014. </ref>  <ref>Grundy SM (2004). "Obesity, metabolic syndrome, and cardiovascular disease". J. Clin. Endocrinol. Metab.89 (6): 2595–600. doi:10.1210/jc.2004-0372. PMID 15181029. </ref> <ref>Foster, W.R. and Burton, B.T.(1985). Health implication of obesity, Ann. Intern.Med., 103, 1024.  </ref> <ref>Grunstein, R.R. and Widcox, I. (1994). Sleep-disordered breathing and obesity, Clin.Endocrinol.Metab. Baillier’s, 8, 601.  </ref> <ref>Daugero, K.D. (2001). A new perspective on glucorticoid feedback: relation to stress, carbohydrate feeding and feeding behavior, J. Neuroendocrinol., 13, 1088.  </ref> <ref>Larsson, B. et al (1984), Abdominal adipose distribution, obesity and risk of cardiovascular disease  and death: 13 year follow up of participants in the study of men born in 1913, Br. Med. J., 288, 1401. </ref> <ref>Esposito K. et al (2004). "Effect of lifestyle changes on erectile dysfunction in obese men: A randomized controlled trial". JAMA, 291 (24): 2978–84.  </ref>.

Serious diseases (''daruna vikara'') are the outcome of excessive obesity due obstruction of body channels by the ''medas''. This indicates ancient wisdom of [[Ayurveda]] ''acharyas'', which is comparable to the impact of obesity on health perspectives of biomedical science<ref>Mishra, L.C. (2003). Scientific Basis of Ayurvedic therapy, Chapter 9 Obesity (Medoroga) in [[Ayurveda]]; eBook, published by CRC press, Taylor & Francis Group.  </ref>. We have yet to understand what they had foreseen in reference to fat accumulation around the kidneys. Decreased life span (''ayukshaya'') is stated to be an important consequence of obesity in [[Ayurveda]]. According to contemporary science, metabolic and psychological pathologies are often present together and are associated with dysregulation of the hypothalamic-pituitary-adrenal axis<ref>Boulpaep, Emile L.; Boron, Walter F. (2003). Medical physiologya: A cellular and molecular approach. Philadelphia: Saunders. p. 1227. ISBN 0-7216-3256-4 </ref>. Affect disorders are also reported among obese binge eaters. The National Institute of Health, USA has issued an alert labeling obesity a "Killer disease" due to its health-related consequences such as coronary disease, diabetes mellitus, hypertension, hyperlipidemia, kidney disorders, gallbladder disorders, cancer of colon, pancreas, breast, uterus, kidney and gallbladder, osteoarthritis, menstrual irregularities in females, cryptogenic cirrhosis of the liver and hepatocellular carcinoma, insulin resistance, and physiological hyperinsulinemia. Some of the social consequences of obesity could include divorces, due in part to reduce sexual activities between partners. Besides there, transitional physiological phases such as weight gain during adolescence in boys and girls, post-natal weight gain in women, and peri-post menopausal obesity are frequently noted in clinical settings that warrant special care and management<ref> Kuniko Takagi, Romain Legrand, Akihiro Asakawa, Haruka Amitani, Marie François, Naouel Tennoune, Moïse Coëffier, Sophie Claeyssens, Jean-Claude do Rego, Pierre Déchelotte, Akio Inui, Sergueï O. Fetissov. Anti-ghrelin immunoglobulins modulate ghrelin stability and its orexigenic effect in obese mice and humans. Nature Communications, 2013; 4 DOI: 10.1038/ncomms3685, site on 08/02/2014. </ref>  <ref>Grundy SM (2004). "Obesity, metabolic syndrome, and cardiovascular disease". J. Clin. Endocrinol. Metab.89 (6): 2595–600. doi:10.1210/jc.2004-0372. PMID 15181029. </ref> <ref>Foster, W.R. and Burton, B.T.(1985). Health implication of obesity, Ann. Intern.Med., 103, 1024.  </ref> <ref>Grunstein, R.R. and Widcox, I. (1994). Sleep-disordered breathing and obesity, Clin.Endocrinol.Metab. Baillier’s, 8, 601.  </ref> <ref>Daugero, K.D. (2001). A new perspective on glucorticoid feedback: relation to stress, carbohydrate feeding and feeding behavior, J. Neuroendocrinol., 13, 1088.  </ref> <ref>Larsson, B. et al (1984), Abdominal adipose distribution, obesity and risk of cardiovascular disease  and death: 13 year follow up of participants in the study of men born in 1913, Br. Med. J., 288, 1401. </ref> <ref>Esposito K. et al (2004). "Effect of lifestyle changes on erectile dysfunction in obese men: A randomized controlled trial". JAMA, 291 (24): 2978–84.  </ref>.(verse 5-8)

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

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

Obesity and leanness can manifest themselves in very severe and excessive forms than discussed here and those cases could make the management of such disorders - and any disease it could lead to – very challenging. While the principles of treatment remain unchanged, the therapeutic measures should be suitably intensified to counter the numerous disorders that arise because of excessive obesity and leanness (C.Su. 23/3-34). The patients of ''atikrisha'' and ''sthaulya'' perpetually suffer from diseases but the standpoint of treatment, the former is significantly more manageable because ''sthula'' (or the obese) suffers more in comparison to ''atikrisha'' (the emaciated) (Su.Su. 15:42). Further, it is mentioned that ''atikṛisha'' is a grave disease, but is considered better than ''atisthula'' from treatment aspect because there is no treatment for ''sthaulya''. For proper treatment of ''sthulya'' the drugs must have ''medohara, agnihara'' and ''vatahara'' action at the same time, which is neither possible from ''karshaṇa'' nor ''brimhana''. Recent evidence also suggests that Charak had associated extreme weight-loss/undernourishment with high rates of morbidity and mortality, although to a lesser extent than obesity<ref>Bose, Bholanoth (1877, 2009). A new system of medicine, entitled recognizant medicine; or, The state of the sick. London: J. & A. Churchill. pp. 192–199. Retrieved February 19, 2014. </ref> <ref>Lusky A, Barell V, Lubin F, Kaplan G, Layani V, Shohat Z, et al. Relationship between morbidity and extreme values of body mass index in adolescents. Int J Epidemiol 1996;25(4):829-834. </ref> <ref>Lake JK, Power C, Cole TJ. Women's reproductive health: the role of body mass index in early and adult life. Int J Obes Relat Metab Disord 1997;21(6):432-438. </ref> <ref> Kopp W, Blum WF, von Prittwitz S, Ziegler A, Lubbert H, Emons G, et al. Low leptin levels predict amenorrhea in underweight and eating disordered females. Mol Psychiatry 1997;2(4):335-340. </ref> <ref> He Q, Karlberg J. BMI in childhood and its association with height gain, timing of puberty, and final height. Pediatr Res 2001;49(2):244-251. </ref>.

Obesity and leanness can manifest themselves in very severe and excessive forms than discussed here and those cases could make the management of such disorders - and any disease it could lead to – very challenging. While the principles of treatment remain unchanged, the therapeutic measures should be suitably intensified to counter the numerous disorders that arise because of excessive obesity and leanness (C.Su. 23/3-34). The patients of ''atikrisha'' and ''sthaulya'' perpetually suffer from diseases but the standpoint of treatment, the former is significantly more manageable because ''sthula'' (or the obese) suffers more in comparison to ''atikrisha'' (the emaciated) (Su.Su. 15:42). Further, it is mentioned that ''atikṛisha'' is a grave disease, but is considered better than ''atisthula'' from treatment aspect because there is no treatment for ''sthaulya''. For proper treatment of ''sthulya'' the drugs must have ''medohara, agnihara'' and ''vatahara'' action at the same time, which is neither possible from ''karshaṇa'' nor ''brimhana''. Recent evidence also suggests that Charak had associated extreme weight-loss/undernourishment with high rates of morbidity and mortality, although to a lesser extent than obesity<ref>Bose, Bholanoth (1877, 2009). A new system of medicine, entitled recognizant medicine; or, The state of the sick. London: J. & A. Churchill. pp. 192–199. Retrieved February 19, 2014. </ref> <ref>Lusky A, Barell V, Lubin F, Kaplan G, Layani V, Shohat Z, et al. Relationship between morbidity and extreme values of body mass index in adolescents. Int J Epidemiol 1996;25(4):829-834. </ref> <ref>Lake JK, Power C, Cole TJ. Women's reproductive health: the role of body mass index in early and adult life. Int J Obes Relat Metab Disord 1997;21(6):432-438. </ref> <ref> Kopp W, Blum WF, von Prittwitz S, Ziegler A, Lubbert H, Emons G, et al. Low leptin levels predict amenorrhea in underweight and eating disordered females. Mol Psychiatry 1997;2(4):335-340. </ref> <ref> He Q, Karlberg J. BMI in childhood and its association with height gain, timing of puberty, and final height. Pediatr Res 2001;49(2):244-251. </ref>.

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

=== Management of the Morbidly Obese ===

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 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, [[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>   

In this context, [[Ayurveda]] has laid down a strong emphasis on drugs, dietary and lifestyle interventions for the management of atisthaulya.  Therefore, factors such as ''madhura, sheeta, snigdha, guru, picchila'' and lifestyle errors are to be avoided in such cases. ''Ruksha udvartanas'' are advocated obese patients as an external purificatory measure, while ''vamana, virechana,'' and ''asthapana basti'' as internal bio-purificatory measures. If an ''atisthula'' person possesses good stamina and strength, they should be treated with ''vamana'' and ''virechana karma''. Non-unctuous, warm and strong enema are advocated such type of patients.<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. <ref name=ref1/> <ref name=ref2/> <ref name=ref3/><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>

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 name=ref1/> <ref name=ref2/> <ref name=ref3/><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>( verse 20-28)

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

=== Management of the emaciated/too lean ===

Too lean patients are brought to good health through renourishment or reintroducing nourishing liquids and food to the body and check the process of catabolism. It starts with a glass of water followed by mixed with lemon and table salt and finally reach to juices, which is made up of vegetable, pulses, rice mixed with pepper, lemon juice and table salt. Later on, it is replaced with cow milk, soups of pulses and vegetable mixed with butter and salt.  If the emaciated status is improved, try to introduced small amount of solid food in meals at the frequent interval and try to avoid a large amount of solid food at a time. The dietary regimen is to be focused on proteins, fats, carbohydrates, multi-vitamin and mineral for the management of the emaciated person. It is always kept in mind at the time of management of the too lean person, excessive fatty foods items and excess fiber dominated grains and vegetable are to be avoided because they are deficient in energy and consume too much time for digestion. Treatment of emaciation also includes prescribing a lot of sleep, rest, relaxation, and counseling. In the present context, ''rasa'' means body fluid which is responsible for the nourishment of entire body and mind. Impairment of circulation of body fluid results in diseases and decay. ''Rasa'' should be available in adequate quantity and quality for it to circulate through the cells of the body, providing the requisite nourishment they need for proper functioning.

Too lean patients are brought to good health through renourishment or reintroducing nourishing liquids and food to the body and check the process of catabolism. It starts with a glass of water followed by mixed with lemon and table salt and finally reach to juices, which is made up of vegetable, pulses, rice mixed with pepper, lemon juice and table salt. Later on, it is replaced with cow milk, soups of pulses and vegetable mixed with butter and salt.  If the emaciated status is improved, try to introduced small amount of solid food in meals at the frequent interval and try to avoid a large amount of solid food at a time. The dietary regimen is to be focused on proteins, fats, carbohydrates, multi-vitamin and mineral for the management of the emaciated person. It is always kept in mind at the time of management of the too lean person, excessive fatty foods items and excess fiber dominated grains and vegetable are to be avoided because they are deficient in energy and consume too much time for digestion. Treatment of emaciation also includes prescribing a lot of sleep, rest, relaxation, and counseling. In the present context, ''rasa'' means body fluid which is responsible for the nourishment of entire body and mind. Impairment of circulation of body fluid results in diseases and decay. ''Rasa'' should be available in adequate quantity and quality for it to circulate through the cells of the body, providing the requisite nourishment they need for proper functioning.(verse 29-34)

=== Sleep in general (verse 35) ===

=== Concept of Sleep ===

The age-old concepts of sleep (''nidra'') and its different stages such as ''jagrata'', ''swapana'' and ''sushupti'' are comparable to the current concept of sleep and its stages. The problems and pattern of sleep are assessed by observing the activity of brain through Electroencephalogram (EEG) pattern.<ref>Dement, William; Kleitman, Nathaniel (1 November 1957). "Cyclic variations in EEG during sleep and their relation to eye movements, body motility, and dreaming". Electroencephalography and Clinical Neurophysiology9 (4): 673–690. doi:10.1016/0013-4694(57)90088-3. PMID 13480240. </ref> It is pointed out that wakefulness and stages of sleep have a specific EEG pattern. The wakefulness is associated with Beta and Gama waves frequencies in EEG pattern, which depends on pleasurable or painful stressors of surrounding environment. Stage 1 non-rapid eye movement (NREM) sleep is characterized by slowing down of Beta and Gama wave frequencies, reached to slow down the Alpha wave, and finally reached to Theta wave frequencies in EEG pattern.  At a higher stage of NREM and REM, these brain wave frequencies in EEG pattern gradually decreases, and the person falls into sleep. By observing overall brain activity in EEG pattern, we can say that frequencies of sleep waves are low in wakefulness and it is gradual increases in different stages of sleep. Sleep spindles and K-complexes appeared in EEG pattern in Stage 2 of sleep, while more sleep spindles are observed in Stage 3 of sleep.  The slow wave sleep is also known as high amplitude Delta wave, which is commonly observed in Stages 3 and 4 of sleep in EEG pattern. Low amplitude, mixed frequency waves- a sawtooth wave in EEG pattern observed at REM stage of sleep.<ref> 71. BARKER, W; BURGWIN, S (1948 Nov-Dec). "Brain wave patterns accompanying changes in sleep and wakefulness during hypnosis." Psychosomatic Medicine10 (6): 317–26. PMID 18106841. </ref> <ref>Jankel, WR; Niedermeyer, E (January 1985). "Sleep spindles.". Journal of clinical neurophysiology: official publication of the American Electroencephalographic Society2 (1): 1–35. PMID 3932462. </ref> <ref>Loomis, A. L.; Harvey, E. N.; Hobart, G. A (1938). "Distribution of disturbance-patterns in the human electroencephalogram with special reference to sleep". Journal of Neurophysiology1: 413–430.  </ref>

The age-old concepts of sleep (''nidra'') and its different stages such as ''jagrata'', ''swapana'' and ''sushupti'' are comparable to the current concept of sleep and its stages. The problems and pattern of sleep are assessed by observing the activity of brain through Electroencephalogram (EEG) pattern.<ref>Dement, William; Kleitman, Nathaniel (1 November 1957). "Cyclic variations in EEG during sleep and their relation to eye movements, body motility, and dreaming". Electroencephalography and Clinical Neurophysiology9 (4): 673–690. doi:10.1016/0013-4694(57)90088-3. PMID 13480240. </ref> It is pointed out that wakefulness and stages of sleep have a specific EEG pattern. The wakefulness is associated with Beta and Gama waves frequencies in EEG pattern, which depends on pleasurable or painful stressors of surrounding environment. Stage 1 non-rapid eye movement (NREM) sleep is characterized by slowing down of Beta and Gama wave frequencies, reached to slow down the Alpha wave, and finally reached to Theta wave frequencies in EEG pattern.  At a higher stage of NREM and REM, these brain wave frequencies in EEG pattern gradually decreases, and the person falls into sleep. By observing overall brain activity in EEG pattern, we can say that frequencies of sleep waves are low in wakefulness and it is gradual increases in different stages of sleep. Sleep spindles and K-complexes appeared in EEG pattern in Stage 2 of sleep, while more sleep spindles are observed in Stage 3 of sleep.  The slow wave sleep is also known as high amplitude Delta wave, which is commonly observed in Stages 3 and 4 of sleep in EEG pattern. Low amplitude, mixed frequency waves- a sawtooth wave in EEG pattern observed at REM stage of sleep.<ref> 71. BARKER, W; BURGWIN, S (1948 Nov-Dec). "Brain wave patterns accompanying changes in sleep and wakefulness during hypnosis." Psychosomatic Medicine10 (6): 317–26. PMID 18106841. </ref> <ref>Jankel, WR; Niedermeyer, E (January 1985). "Sleep spindles.". Journal of clinical neurophysiology: official publication of the American Electroencephalographic Society2 (1): 1–35. PMID 3932462. </ref> <ref>Loomis, A. L.; Harvey, E. N.; Hobart, G. A (1938). "Distribution of disturbance-patterns in the human electroencephalogram with special reference to sleep". Journal of Neurophysiology1: 413–430.  </ref>(verse 35)

=== Sleep regulation (verse 39-43) ===

==== Sleep regulation ====

It is presumed that the sleep physiology is controlled by the hypothalamus and the suprachiasmatic nucleus (SCN) in the brain, which regulates mechanism of homeostatic and circadian rhythm respectively of the body. The actual mechanism of the physiology of sleep is still evolving in biomedical sciences. The sleep is initiated and begins by projections from the SCN to the brain stem. Borbely called projections as Process S (homeostatic) and Process C (Circadian) respectively, who first proposed these two process models in 1982. He pointed out that maximum sleep is the outcome of significant differences between homeostatic and circadian rhythm.<ref name=ref74>Saper, Clifford B.; Scammell, Thomas E.; Lu, (Jun (27 October 2005)): "Hypothalamic regulation of sleep and circadian rhythms". Nature437 (7063): 1257–1263. doi:10.1038/nature04284. PMID 16251950.</ref>

It is presumed that the sleep physiology is controlled by the hypothalamus and the suprachiasmatic nucleus (SCN) in the brain, which regulates mechanism of homeostatic and circadian rhythm respectively of the body. The actual mechanism of the physiology of sleep is still evolving in biomedical sciences. The sleep is initiated and begins by projections from the SCN to the brain stem. Borbely called projections as Process S (homeostatic) and Process C (Circadian) respectively, who first proposed these two process models in 1982. He pointed out that maximum sleep is the outcome of significant differences between homeostatic and circadian rhythm.<ref name=ref74>Saper, Clifford B.; Scammell, Thomas E.; Lu, (Jun (27 October 2005)): "Hypothalamic regulation of sleep and circadian rhythms". Nature437 (7063): 1257–1263. doi:10.1038/nature04284. PMID 16251950.</ref>(verse 39-43)

=== Effects of sleep (verse 36-38 and 44-49) ===

==== Effects of sleep ====

Recent conventional evidence suggests that seasonal variation can have an impact on sleep/wake cycle, which is quite interesting and proven the age-old concept of [[Ayurveda]]. Recent evidence shows that core temperature of body and secretion of melatonin hormone levels are slightly greater in the month of summer due to prolong the length of light exposure, which imparts significant role in daytime sleep in summer. This is the reason people go to bed early at night and wake up early in the morning in the month of summer.  Sunlight exposure in the morning hours may affect internal biological clock, shifting the timing of the sleep window. The need and function of sleep are the most lacking areas of sleep research in biomedical sciences. Some of the important ones are- restoration and recovery of body systems, energy conservation, memory consolidation, protection from predation, brain development, and discharge of emotions.<ref name=ref74/> <ref>Krueger, James M.; Obál, Ferenc; Fang, Jidong. "Why we sleep: a theoretical view of sleep function". Sleep Medicine Reviews3 (2): 119–129. doi:10.1016/S1087-0792(99)90019-9. </ref> <ref>KRUEGER, JAMES M.; OBÄL, FERENC (1 June 1993). "A neuronal group theory of sleep function". Journal of Sleep Research2 (2): 63–69. doi:10.1111/j.1365-2869.1993.tb00064.x. </ref> <ref>Friborg, O., Bjorvatn, B., Amponsah, B., Pallesen, S. (2012). Associations between seasonal variations in day length (photoperiod), sleep timing, sleep quality and mood: a comparison between Ghana (5°) and Norway (69°). Journal of Sleep Research, 21(2), 176-184.) </ref>

Recent conventional evidence suggests that seasonal variation can have an impact on sleep/wake cycle, which is quite interesting and proven the age-old concept of [[Ayurveda]]. Recent evidence shows that core temperature of body and secretion of melatonin hormone levels are slightly greater in the month of summer due to prolong the length of light exposure, which imparts significant role in daytime sleep in summer. This is the reason people go to bed early at night and wake up early in the morning in the month of summer.  Sunlight exposure in the morning hours may affect internal biological clock, shifting the timing of the sleep window. The need and function of sleep are the most lacking areas of sleep research in biomedical sciences. Some of the important ones are- restoration and recovery of body systems, energy conservation, memory consolidation, protection from predation, brain development, and discharge of emotions.<ref name=ref74/> <ref>Krueger, James M.; Obál, Ferenc; Fang, Jidong. "Why we sleep: a theoretical view of sleep function". Sleep Medicine Reviews3 (2): 119–129. doi:10.1016/S1087-0792(99)90019-9. </ref> <ref>KRUEGER, JAMES M.; OBÄL, FERENC (1 June 1993). "A neuronal group theory of sleep function". Journal of Sleep Research2 (2): 63–69. doi:10.1111/j.1365-2869.1993.tb00064.x. </ref> <ref>Friborg, O., Bjorvatn, B., Amponsah, B., Pallesen, S. (2012). Associations between seasonal variations in day length (photoperiod), sleep timing, sleep quality and mood: a comparison between Ghana (5°) and Norway (69°). Journal of Sleep Research, 21(2), 176-184.) </ref>(verse 36-38 and 44-49)

=== Sleep about ''atisthula'' and ''atikrisha'' (verse 51) ===

==== Sleep about ''atisthula'' and ''atikrisha'' ====

Recent evidence suggests that a good sleep plays an important role in the regulation of neuroendocrine, hormonal and metabolic function in the body. Since last few decades, the timing and quality of sleep is gradually hampered due to the affliction of modernization in many ways. At present, the adult and children progressively reduce bedtimes and increases times for other activities, which affect the metabolic functions in many ways. The ''atisthula'' and ''atikrisha'' are also the outcome of excessive sleep and lack of sleep and vice-versa. Evidence shows that sleep loss for prolong period may provoke the risk of weight gain and morbid obesity. Further, sleep reduction in young adults affects metabolic and endocrine functions in various ways such as- insulin resistance, hyperglycemia, elevated sympathovagal activity, an elevated level of serum glucocorticoid hormone, increased levels of ghrelin, and decreased the level of leptin. Due to improper and lack of good quality of sleep in adolescents may be important factors to consider in the prevention of childhood obesity.<ref>Neeraj K. Gupta,William H. Mueller,Wenyaw Chan, Janet C. Meininger (2002).: Is obesity associated with poor sleep quality in adolescents?. Am. J. Hum. Biol.; 14:762–768, 2002.  </ref> Probably this is the reason that sleep is mentioned in ''ashṭoninditiya'' chapter by Charak about ''atisthula'' and ''atikrisha'' like other dietary and lifestyle intervention.

Recent evidence suggests that a good sleep plays an important role in the regulation of neuroendocrine, hormonal and metabolic function in the body. Since last few decades, the timing and quality of sleep is gradually hampered due to the affliction of modernization in many ways. At present, the adult and children progressively reduce bedtimes and increases times for other activities, which affect the metabolic functions in many ways. The ''atisthula'' and ''atikrisha'' are also the outcome of excessive sleep and lack of sleep and vice-versa. Evidence shows that sleep loss for prolong period may provoke the risk of weight gain and morbid obesity. Further, sleep reduction in young adults affects metabolic and endocrine functions in various ways such as- insulin resistance, hyperglycemia, elevated sympathovagal activity, an elevated level of serum glucocorticoid hormone, increased levels of ghrelin, and decreased the level of leptin. Due to improper and lack of good quality of sleep in adolescents may be important factors to consider in the prevention of childhood obesity.<ref>Neeraj K. Gupta,William H. Mueller,Wenyaw Chan, Janet C. Meininger (2002).: Is obesity associated with poor sleep quality in adolescents?. Am. J. Hum. Biol.; 14:762–768, 2002.  </ref> Probably this is the reason that sleep is mentioned in ''ashṭoninditiya'' chapter by Charak about ''atisthula'' and ''atikrisha'' like other dietary and lifestyle intervention.(verse 51)

=== Insomnia or sleeplessness (verse 52-54) ===

==== Insomnia or sleeplessness ====

''Anidra'' of [[Ayurveda]] is closely related to Insomnia, or sleeplessness of biomedical sciences. It is a disorder of sleep in which a person is unable to fall in sleep. Nowadays, insomnia is an important area of clinical practice to seek the attention of the physician because a large number of patients come to the hospital suffering from insomnia as secondary conditions.  It is sometimes a functional impairment during awake, which may occur at any age, but it is particularly common in the elderly. Insomnia is either short-term lasting up to 3 hours, or it may be long term lasting for > 3 hours. It may lead to developing dementia, lack of concentration, depression, mental irritation and increases the risk of cardio-vascular accidents along with increases the chances of a roadside accident. <ref>Roth, T. (2007). "Insomnia: Definition, prevalence, etiology, and consequences". Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine3 (5 Suppl): S7–10.  </ref>  <ref>Wilson, Jennifer F. (2008). "Insomnia". Annals of Internal Medicine148: ITC1. doi:10.7326/0003-4819-148-1-200801010-01001 </ref> Regarding its management some drug such as valerian extract has undergone multiple studies and appears to be moderately effective. Similarly, L-Arginine L-aspartate, S-adenosyl-L-homocysteine, and delta sleep inducing peptide (DSIP) appear to be significantly effective in the cases of insomnias.<ref>Morin, C. M.; Koetter, U.; Bastien, C.; Ware, J. C.; Wooten, V. (2005). "Valerian-hops combination and diphenhydramine for treating insomnia: A randomized placebo-controlled clinical trial". Sleep28 (11): 1465–1471.  </ref>  <ref>Meolie, A. L.; Rosen, C. et al.: Clinical Practice Review Committee; American Academy of Sleep Medicine (2005). "Oral nonprescription treatment for insomnia: An evaluation of products with limited evidence". Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine1 (2): 173–187. PMID 17561634. </ref>

''Anidra'' of [[Ayurveda]] is closely related to Insomnia, or sleeplessness of biomedical sciences. It is a disorder of sleep in which a person is unable to fall in sleep. Nowadays, insomnia is an important area of clinical practice to seek the attention of the physician because a large number of patients come to the hospital suffering from insomnia as secondary conditions.  It is sometimes a functional impairment during awake, which may occur at any age, but it is particularly common in the elderly. Insomnia is either short-term lasting up to 3 hours, or it may be long term lasting for > 3 hours. It may lead to developing dementia, lack of concentration, depression, mental irritation and increases the risk of cardio-vascular accidents along with increases the chances of a roadside accident. <ref>Roth, T. (2007). "Insomnia: Definition, prevalence, etiology, and consequences". Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine3 (5 Suppl): S7–10.  </ref>  <ref>Wilson, Jennifer F. (2008). "Insomnia". Annals of Internal Medicine148: ITC1. doi:10.7326/0003-4819-148-1-200801010-01001 </ref> Regarding its management some drug such as valerian extract has undergone multiple studies and appears to be moderately effective. Similarly, L-Arginine L-aspartate, S-adenosyl-L-homocysteine, and delta sleep inducing peptide (DSIP) appear to be significantly effective in the cases of insomnias.<ref>Morin, C. M.; Koetter, U.; Bastien, C.; Ware, J. C.; Wooten, V. (2005). "Valerian-hops combination and diphenhydramine for treating insomnia: A randomized placebo-controlled clinical trial". Sleep28 (11): 1465–1471.  </ref>  <ref>Meolie, A. L.; Rosen, C. et al.: Clinical Practice Review Committee; American Academy of Sleep Medicine (2005). "Oral nonprescription treatment for insomnia: An evaluation of products with limited evidence". Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine1 (2): 173–187. PMID 17561634. </ref>

Improper sleep has a harmful impact on carbohydrate metabolism and endocrine function. Besides, it also reduces the metabolic activity in the brain with prolonging lack of sleep. The effects are similar to those seen in normal aging and, therefore, sleep debt may increase the severity of age-related chronic disorders. <ref name=ref85>Van Dongen, HP; Maislin, G; Mullington, JM; Dinges, DF (2003-03-15). "The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation.". Sleep26 (2): 117–26.</ref> Lack of sleep for prolonged period has been shown to affect cognitive functions of people involved in versatile activities along with interfering in mood and emotion. This is one of reason to increased tendency to fear, depression, and rage in the people having a deficiency in sleep. The mechanism and effects of sleep deficit are still evolving in the pathophysiology of sleep deficit.<ref>Karine Spiegel, Rachel Leproult, BS, Eve Van Cauter.: Impact of sleep debt on metabolic and endocrine function. The lancet, Volume 354, Issue 9188, 23 October 1999, Pages 1435–1439. </ref>  <ref name=ref85/> <ref>Chee, MW; Chuah, LY (August 2008). "Functional neuroimaging insights into how sleep and sleep deprivation affect memory and cognition.". Current Opinion in Neurology21 (4): 417–23.  </ref>

Improper sleep has a harmful impact on carbohydrate metabolism and endocrine function. Besides, it also reduces the metabolic activity in the brain with prolonging lack of sleep. The effects are similar to those seen in normal aging and, therefore, sleep debt may increase the severity of age-related chronic disorders. <ref name=ref85>Van Dongen, HP; Maislin, G; Mullington, JM; Dinges, DF (2003-03-15). "The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation.". Sleep26 (2): 117–26.</ref> Lack of sleep for prolonged period has been shown to affect cognitive functions of people involved in versatile activities along with interfering in mood and emotion. This is one of reason to increased tendency to fear, depression, and rage in the people having a deficiency in sleep. The mechanism and effects of sleep deficit are still evolving in the pathophysiology of sleep deficit.<ref>Karine Spiegel, Rachel Leproult, BS, Eve Van Cauter.: Impact of sleep debt on metabolic and endocrine function. The lancet, Volume 354, Issue 9188, 23 October 1999, Pages 1435–1439. </ref>  <ref name=ref85/> <ref>Chee, MW; Chuah, LY (August 2008). "Functional neuroimaging insights into how sleep and sleep deprivation affect memory and cognition.". Current Opinion in Neurology21 (4): 417–23.  </ref>

The concept of ''Nidra'' in  [[Ayurveda]] is quite comparable to the sleep of biomedical sciences. The ''nidra'' is so important for the maintenance of health and sustaining the life. This is true in the light of contemporary scientific knowledge too. According to  [[Ayurveda]], ''kapha'' and ''tamas'' are responsible for ''nidra'' even as modern studies attribute the occurrence of sleep to many factors including stimulation of certain areas of the brain. [[Ayurveda]] classifies the ''nidra'' based on the mode of origin while modern classification of sleep based on physiological variations seen in association with the different types of sleep. Some factors like food, activities, external stimuli, etc. affect ''nidra'' or sleep. Any variation in the normal sleep pattern is not at all desirable, and they may cause serious health problems that demand proper medical attention.

The concept of ''Nidra'' in  [[Ayurveda]] is quite comparable to the sleep of biomedical sciences. The ''nidra'' is so important for the maintenance of health and sustaining the life. This is true in the light of contemporary scientific knowledge too. According to  [[Ayurveda]], ''kapha'' and ''tamas'' are responsible for ''nidra'' even as modern studies attribute the occurrence of sleep to many factors including stimulation of certain areas of the brain. [[Ayurveda]] classifies the ''nidra'' based on the mode of origin while modern classification of sleep based on physiological variations seen in association with the different types of sleep. Some factors like food, activities, external stimuli, etc. affect ''nidra'' or sleep. Any variation in the normal sleep pattern is not at all desirable, and they may cause serious health problems that demand proper medical attention.(verse 52-54)

=== Conclusion ===

=== Conclusion ===