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Vatarakta - A challenge to Physician
In the day to day clinical practice physicians face many challenges in from of various diseases which are only palliative and not unable. Vatrakta stands conspicuously among such disorder. What adds to the trouble of both patient and physician is the severe pain associated with the disorder. Vatrakta is known to the humanity since ages and a very detailed description is available in ancient classic texts of Ayurveda like Charaka Samhita, Susrut Samhita and other Ayurvedic text.
The disorder has the prevalence of about 1% in general population with a high male predominance with a steep rise in 4th and 5th decade of life. It is more prevalent in people who consume protein rich diet.
Charaka considers various dietary factors and life style responsible for vatarakta e.g. excessive use of salt, alkalies, fats, excessive use of non vegetarian diet. Alcohol and pulses along with testa. Similar type of aetiological factors is mentioned in Susrut Samhita and Ashtang Hridya Modern medicine considers Hyperuricemia as the cause for manifestations of Gout. This Hyperuricemia may either be due to urate overproduction or under excretion of uric acid or a combinaton of both processes. Major factors responsible Hyperuricemia are certain enzyme deficiencies, Haemolytic processes, polycythemia vera, Proriasis, Exercise, alcohol, obesity, Purine rich diet, renal insuffiency, Polycystic kidney diseases, Diabetes inspidus, hypertension, Hyperparathyroidism, Hypothyroidism, Toxaemia of Pregnancy Drugs like salicylates, Diuretics, Alcohol levodope Ethembutol Pyrazinamide Nicotinic acid and cyclorporine.
STHAULYA (OBESITY)
Obesity is a chronic disease prevalent globally among the affluent and sedentary subjects and affects the young and old equally. In today’s world, where majority of the world’s population overeats regularly and physical activity is decreasing, fat storage leads to obesity related disorders. Obesity is recognized as a major health problem in both developing and developed countries. It has been considered as a key risk factor for many other chronic and non-communicable diseases.
Recent studies have shown that overweight and obesity affect over half the adult population in many countries. The prevalence of obesity in adults is 10 to 25% in most countries of Western Europe and 20% in some countries of Americans. Obesity is more common among women but its prevalence in children is also rising at a worrisome rate. Obesity is emerging as an important health problem in India. The Nutrition foundation of India (NFI) study showed that 32.3% of middle class males and 50% of middle class females in Delhi were obese.
Obesity is defined as state of excess adipose tissue mass or body Mass Index (BMI) more than 30. BMI > 25 is categorized as overweight. In terms of body weight it can be defined as body weight of 20% excess over ideal weight for age, sex and weight.
In Ayurved, obesity resembles with Sthaulya or Medo Roga. From the standpoint of physical constitution 8 types of undesirable person has been described in Charka Samhita. Out of these too corpulent or obese and too emaciated have more of unwanted distinctive features than other undesirable type of persons. Too corpulent or obese is again considered more harmful than too emaciated.
The etiology of Sthaulya is similar both in Ayurveda and Modern Science of Medicine i.e. Overeating specially of Madhur, Sheet and Snigdha food and lack of physical activity which are described in Ayurveda as vO;k;kekn~] vO;ok;kr~] fnokLoIukr~ etc. Hereditory causes i.e. chtLoHkkokr~ Some psychological factors which are mentioned only in Ayurveda like vfpUru g”kZ also contributes to obesity.
Pathogenesis of Sthaulya as mentioned in Charak Samhita is due to obstruction of the passage by fat, the movement of vata is specially confined to Koshtha resulting in stimulation of digestive power and absorption of food. So the patient digests food very quickly and become a voracious eater. That’s the reason why obese persons have more hunger.
Clinical features of Sthaulya mentioned in Ayurveda are pyfLQxqnjLru i.e. pendulous movements of buttocks, abdomen and breasts, impaired bodily movements, difficulty in sexual act, weakness excessive sweating and excessive sweating, excessive hunger and thirst.
Sthaulya Roga (Obesity) contributes too much morbidity in patients because major health consequences are associated with it. Mortality rate rises as obesity increases. Obesity is a major risk factor for type II Diabetes mellitus, as many as 80% of patients with type II Diabetes mellitus are obese. Weight loss, even of modest degree, is associated with increased insulin sensitivity and after improve glucose control in diabetes. There are increased risk cardiovascular diseases in men and women with obesity. Obesity is associated with atherogenic lipid profile. Disorders that affects reproductive axis are associated with obesity in both men and women. Male hypogonadism and in females menstrual irregularities are associated with obesity. 40% of women with PCOS (Poly cystic ovarian syndrome) are obese. A person 50% above ideal body weight has about six fold increased incidence of symptomatic gall stones. Obesity in males is associated with mortality from cancer of colon, rectum and prostate and in females from cancer of gall bladder, bile duct, breasts, endometriu, cervix and ovaries. Risk of osteoarthritis is more in obese persons. Venous stasis is also increased in obese.
Management of obesity with modern drugs is quite unsatisfactory. Many drugs like Amphetamine, Fenfluranine etc. are used but these drugs have serious side effects and rebound weight gain occurs after cessation of drugs. The basic principles of treatment of Sthaulya in Ayurveda is Nidana Parivarjana. The same is in modern texts of medicine in the form of low calorie diet and increase in exercise. Nidana Parivarjana plays an important role in the prevention of Sthaulya. In every text of Ayurveda Apatarpana Chikitsa is mentioned for Sthaulya whether it is sanshodhana or samshamana. Principle of treatment mentioned in chark Samhita is xq:pkiriZ.ka ps”Ba LFkwykuka d’kZua izfrA
Means xq: vkSj viriZ.k diet should be prescribed for obese persons like honey. By virtue of their heaviness such diets would minimize the force of aggravated power of digestion and due to their non-nourishing nature they would help to reduce fat.
Samshoudhan Chikitsa is again apatarpaka as mentioned in Charaka Samhita in ten types of Langhana. Ruksha Udvartana is also helpful in obesity because it causes mobilization and redistribution of fat deposits. Charaka has mentioned that Ruksha, Ushna, Tikshna tikshna lekhana Basti can be given in Sthaulya rogi.
In the context of Samshamana Chikitsa has been specially mentioned that lekhaniya Dashemani, which perform lekhana of excess and abnormal esn includes Mustaka, Vacha, Kustha, Haridra, Chitraka, Chirbilwa, Ativisha, Hemvati Daruharidra, Katurohini. Other drugs which are helpful in the management of obesity are honey. Amalaki, Vidanga, Shunthi, lauha bhasma, Shilajeet, Guggulu, Rasanjana, Triphala Churna Madhu udaka etc.
As life style changes due to urbanization involving major deviation in diet pattern, reduced physical activity contributed to obesity, weight reduction by life style modifications including dietary changes and regular physical activity reduces the riskof obesity. Implementation of preventive measures from early childhood will have far reaching benefits. Along with preventive measures Ayurvedic remedies can play a great role in management of obesity and may reduce its pathological consequences. Following drugs and combination has been successfully tried in our institution.
- A combination of Triphala Yava Kshar, Shuunthi and Lahsun
- Combination of Shunthi lahsun and Methi
- Amrit Bhallatak
- Guggulu and Lahsun
- Combination of Navak
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