Kedar, Joshi, and Prabhudesai: Efficacy of Abhaya (Terminalia chebula) and exercise in management of obesity (Sthaulya) — A case report


Introduction

Sthaulya (obesity) is a state of the increased medodhatu (fatty tissue).1 India is currently witnessing rising number of people who are obese. Many among the Indian population have started relying on processed food that contain a huge percentage of trans-fat, sugar and other unhealthy and artificial ingredients. Sthaulya is one such lifestyle disorder. Sedentary lifestyles are leading people to silent self-destruction, making one in every five Indian men and women obese. It has reached epidemic properties globally. 39% of adults in the world are overweight. One-in-five children and adolescents, globally, are overweight. In Ayurveda, obesity has been described as Sthoulya or Medoroga in Santarpanottha Vikara. i.e the disease caused by over nourishment.2 Kapha which is heavy and dense in nature abnormally accumulates in weaker channels of the body, causing their blockage.3 Metabolic disturbances in an obese individual is Medodhatu caused mainly due to excess intake of Madhura and Snigdha Ahara.4 Nidana (causative factors) of Sthoulya can be classified as Aharatmaka Nidana, Viharatmaka Nidana, Manasika Nidana and Anya Nidana.5 Acharya Charaka has mentioned Guru (heavy to digest) and Apatarpana (with no or less nutrition value) diet as treatment for Medoroga.6

Case History

Research methodology- This case report is the part of clinical study conducted for post graduate study. Approval for clinical trial was obtained from the scientific committee and Institutional Ethics committee (No: DPU/455-21/2019) and was also registered for CTRI in Feb 2021. There is no conflict of interest with respect to present work.

Table 1

Classification of overweight and obesity by BMI, waist circumference, and associated disease risk. 7

Terminology

BMI Kg/m2

Disease Risk* (Relative to Normal Weight and Waist Circumference)

Under Weight

<18.5

Men ≤40 inches (≤ 102 cm) Women ≤ 35 inches (≤ 88 cm)

> 40 in (> 102 cm)> 35 in (> 88 cm)

Normal Weight

18.5-24.9

-

-

Over Weight

25-29.9

-

-

Obesity (class l)

30-34.9

Increased

Increased

Obesity (Class ll)

35-39.9

High Very High

Very HighVery High

Morbid Obesity (Class lll)

>40

Extremely High

Extremely High

Table 2

Personal history general examination of patient before starting the treatment.8

Sr. No.

Parameter

Observed Values

1

B. P

120/80 mm of hg

2

Pulse

78 /min

3

Ht. (Height)

143 cm

4

Wt. (Weight)

84 kg

5

BMI (Body Mass Index)

41.08 kg/m2

6

C.C (Chest Circumference)

110 cms

7

A.C (Arm Circumference)

112 cms

8

M.A.C (Mid Arm Circumference)

Rt hand – 33 cm, Lt hand – 34 cm

9

M.T.C (Maximum Thigh Circumference)

Rt leg – 60 cm, Lt leg – 58 cm

10

W.C (Waist Circumference)

110 cm

11

H.C (Hip Circumference)

132 cm

12

Ahara

Mixed diet, Bakery products

13

Vihara

Avyayam, Diwaswap, Sedentary lifestyle

14

Appetite

Less

15

Bowels

Regular, Normal consistency, twice per day

16

Micturition

Normal, 5-6 times in a day,

17

Sleep

Good sound sleep

18

Habits

Fond of bakery items, junk food and curried items

[i] (Ht- Height, Wt- Weight, BMI- Body mass index, C.C- Chest circumference, A.C- Arm circumference, M.A.C -Mid arm circumference, M.T.C- Maximum thigh circumference, W.C- Waist circumference, H.C-Hip circumference)

Table 3

Historyof biochemical laboratory investigation

Sr. No.

Parameter

Observed Values

1

HB

13.2 gm%

2

W.B.C

9000 cells/cu mm

3

E.S.R

20 mm/hr

4

Neutrophils

59%

5

Lymphocytes

42%

6

Monocytes

38%

7

Eosinophils

01%

8

Platelets

2.84 lakh cells/cu mm

9

Total RBC Count

4.50 millions/cu mm

10

Blood urea

15.3 mg/dl

11

Serum Creatinine

0.8 mg/dl

Table 4

Lipid profile

Sr. No.

Parameter

Observed Values

1.

Total Cholesterol

168.0 mg/dl

2.

H.D.L Cholesterol

48 mg/dl

3.

L.D.L Cholesterol

85.0 mg/dl

4.

Triglycerides

145 mg/dl

5.

V.L.D.L Cholesterol

24.8 mg/dl

Table 5

Scheduled diet and daily routine during treatment

Aahar and Vihara

Do’s

Don’t’s

Ahara

1. Chapatti prepared with Yava (barley),

2. MoongaDaal (green gram) with or without husk or sprouted or TuvarDaal in food.

3. Use of fruits like papaya, orange, sweet lemon, co­conut water etc.

Heavy fried food, Refined foods such as white flour, Potatoes, Curd, milk Fermented and bakery items.

Vihara

1.Waking up early morning, Regular 2.exercise- 30 min. Walking

1.excess sleep 2.sedentary life style

Table 6

Assessment of anthropometry changes before and aftertreatment

Observation

Before Treatment

After Treatment

WT. (Weight)

84 kg

78 kg

BMI (Body Mass Index)

41.08 kg/m2

38.14 kg/m2

A.C (Arm Circumference)

122 cm

115 cm

M.A.C (Mid Arm Circumference)

Rt hand – 33 cm Lt hand – 34 cm

Rt hand – 30 cm Lt hand -32 cm

M.T.C (Maximum Thigh Circumference)

Rt leg – 58 cms Lt leg – 56 cms

Rt leg – 55 cm Lt leg – 57 cm

W.C (Waist Circumference)

123cms

116 cms

H.C (Hip Circumference)

132 cms

128 cms

W/H (Waist Hip Ratio)

0.93

0.91

[i] (Wt- Weight, BMI- Body mass index, A.C- Arm Circumference, M.A.C -Mid arm circumference, M.T.C - Maximum thigh circumference, W.C- Waist circumference, H.C- Hip circumference, W/H-Waist Hip ratio)

A 29-year-old female patient attended the OPD of the hospital with complaint of Infertilityalong with Bharavruddhi (increase in weight) in the last 5 years and symptoms of Kshudrashwasa (difficulty in breathing while doing normal day to day chores), Daurbalya (general weakness), kshudhaalpata (loss of appetite) but cravings for fast food, bakery items etc. Also, she had complaints about the menstrual cycle like- regular but with scanty menstrual flow since last 1.5 years. Patient had no history of hypertension, diabetes mellitus, bronchial asthma, hypothyroidism or PCOS. But she had a family history of increased weight and obesity from her maternal side.

Assessment

Ashtavidh Pariksha, Dashvidha Pariksha (Ayurvedic methods for patient examination), Systemic and general physical examinations with anthropometry of the patient was done. Biochemical investigations showed normal Haematological report. Considering the Clinical examination, BMI and body girth measurements at defined parts, patient was diagnosed as obese class lll.

The assessment was planned on weekly basis for three weeks.

Goal settings

  1. Medicine — Abhayachoorna 3gm dose given two times before meal with anupana of Honey

  2. Behavioral modification — as walking exercise for 30 minutes daily; as a part of treatment

  3. Dietary modification -as minor changes in diet explained in table no 5

  4. The patient was followed every week, up to 21 days. The goals set for assessment were specific, measurable, and achievable.

Result

  1. Bharavruddhi (increase in weight)-On the very first day, 11-02-2021 when the treatment started the weight of the patient was 84kg, which got reduced to 78 kg. That means there was a reduction of weight by 6 kg (7.15%) after 21 days. Considerable reduction in BMI from 41.08 kg/m2 to 38.14 kg/m2 was noted. M.A.C. and M.T.C. showed average reduction by 2-3 cm. There was considerable reduction of 7 cmin waist circumference.

  2. Kshudrashwas (breathlessness due to exertion)- There was a considerable reduction in Kshudrashwas from difficulty in breathing while doing normal day to day chores to only while doing strenuous work.

  3. Daurbalya (general weakness)- This complaint also reduced within 21 days. Gradually patient started feeling fresh and energetic.

  4. Kshudhaalpata (loss of appetite)-appetite increased along with decreased cravings for fast food and bakery items.

  5. Menstrual problems- patient had her menstrual period during the course of treatment. This month’s menstrual flow was improved as compared to her last 1.5 years menstrual cycles, and she was feeling relaxed and fresh after her periods.

All the parameters showed appreciable reduction after following the treatment protocol, which underlines the efficacy of ayurvedic management of Obesity.

Discussion

In this case, patient was consuming diet predominant in sweet taste, oily, junk food and bakery items. Sedentary lifestyle along with day-sleep was major factors in her daily routine. All these Aaharaj (guru, snigdha and abhishyandi), Viharaja (external causes) and Manasa (mental) factors are associated with kaphadoshavriddhi which ultimately resulted in srotorodha and medodhatvagnimandya and thereby into excessive increase in medadhatu. Srotorodh results in confinement of vaat dosh to koshta and causes jatharagnivriddhi. This again contributes to medovruddhi.9 Initially there was angagaurav as purvaroop (prodromal symptom), but then there was gradual enlargement of sphik (gluteal region) and udar(abdomen) started, along with alasya (lethargy) atikshudha (excess of hunger), ati-pipasa (excess of thirst) etc. These symptoms increased gradually due to continuous consumption of santarpanjanya (over nourishing) aahar and vihar.

In this case Samprapti (pathogenesis) of the disease was found to be as follows- Udbhavasthana of sthaulyaroga was aamashaya while vyaktasthana was sarvasharir and adhishthana was Medodhatu. This disease is Bahya- rogamargagata. Here condition of jatharagni was tikshna while that of dhatwagniwasmanda. predominance was there and rasa, mamsa, meda wereinvolvedas dushyas. Rasavaha and medovahasrotas are in volved in this case and sanga type of srotodushti is noted. Considering all these points Acharyas have enlisted this disease in krucchrasadhya (difficult to treat) type.

After conducting trial and studying results it can be concluded that administration of Abhayachoorna in 3 gms dose, two times before meal with anupana (adjuvant) of honey and vyayam as a daily walking exercise minimum 30 minutes as a part of treatment gave expected outcome of weight reduction.p.10 The drug abhayachoorna has laghu and rukshaproperties which are opposite to the gunas of Sthaulya and Vyayam brings about lightness in the body and alleviation of kapha dominant doshas. Regular walking exercise, Abhayachoorna as medicine along with counselling for diet restrictions made her lose 6 kg of her body weight with BMI reduction from41.08 kg/m2 to 38.14 kg/m2. Appropriate adequate physical exercise and proper adherence to Ayurved guidelines for Dinacharya (daily regimen) can reduce rising problem of obesity in society.

Source of Funding

None.

Conflict of Interest

None.

References

1 

J T Achrya Ashtauninditiya95th 2001117

2 

R B Das Varanasi: Chaukamba Sanskrit series61st 2009395

3 

Pr Mishra Role of Ayurveda in the Management of Obesity (Sthoulya) International Ayurvedic medicalInt Ayurvedic Med J2017512447

4 

Role of Ayurveda In The Management of Obesity (Sthoulya)Int Ayurvedic Med J2017512447http://www.iamj.in/posts/2017/images/upload/244_247.pdf

5 

R B Das Varanasi: Chaukamba Sanskrit series32009395

6 

R B Das Chaukamba Sanskrit Series212009375

7 

R B Das Chaukamba Sanskrit Series202009378

8 

Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Bethesda (MD): National Heart, Lung, and Blood Institute199851209

9 

Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence ReportObes Res199866464

10 

R B Das Astuninditiya Adhyaya171st 2004377



jats-html.xsl

© This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


  • Article highlights
  • Article tables
  • Article images

Article History

Received : 07-07-2021

Accepted : 11-08-2021

Available online : 01-12-2021


View Article

PDF File   Full Text Article


Copyright permission

Get article permission for commercial use

Downlaod

PDF File   XML File   ePub File


Digital Object Identifier (DOI)

Article DOI

https://doi.org/10.18231/j.jpmhh.2021.025


Article Metrics






Article Access statistics

Viewed: 192

PDF Downloaded: 55



Open Abstract (Increase article citation) Wiki in hindi