OBESITY (STHAULYA)


Presenting Complaints with severity and episode duration

  • Over weight

Brief Relevant Medical History:

Patient, was apparently healthy before 5-6 years. Then he started gaining weight gradually. He was overweight. He underwent an accident 1 yr back and injured his ligament in Lt Knee. Later he was unable to do physical exercises and gained weight. Patient gained around 10kgs in one year andwants to reduce weight.

Current medication: Nil

Clinical Status
Allopathy Ayurveda
Vital Parameters

  1. BP - 120/70 mm of Hg.
  2. Pulse - 70 beats /min
  3. RR – 20/min
  4. Weight - 97kg
  5. BMI - 31.6/Obese
  6. WHR – 1.23
  7. Height - 5ft9inch
Asta Sthana Pariksha

  1. Nadi - Kaphaja
  2. Malam - Samyak
  3. Mutra - Samyak
  4. Jihva - Alipta
  5. Shabda - Samyak
  6. Sparsha - Sheeta
  7. Drik - Samyak
  8. Akruti - Uttama
Examinations

  1. GC - Fair, Afebrile.
  2. CVS - S1, S2 heard
  3. CNS - NAD
  4. RS - NVBSheard
  5. PA - Soft, No Organomegaly

O/E - Mild pain in Lt knee joint while flexion.

Dasa Vidha Pariksha

  1. Prakriti - Kaphavata
  2. Vikriti - Kaphavatadosha
  3. Sara - Mamsa, Meda
  4. Samhanana - Uttama
  5. Pramana - Uttama
  6. Satmya - Ushna, Katu
  7. Satva - Madhyama
  8. Aharashakti - Madhyana
  9. Vyayam Shakti-Avara
  10. Vaya-Madhya
  11. Desha-sadharana
  12. Kala- Adana
Rogi Bala - Madhyama
Roga Bala - Pravara
DSQ findings Rating
1. ADRS Med
2. ADSS High
NidanaPanchaka
  1. Nidana - Excessive intake of guru, madhura, sheeta, snigdha food along with absence of physical activities, not having Chinta or not being bothered about anything, genetic factors.
  2. Roopa - flaccidity in buttocks, Abdomen, breasts due to increased Medas and Mamsa, no interest in any activities.
  3. Updrava - Decreased ayu, loss of interest, difficulty in sexual activity, loss of strength, bad body odour, excessive sweating, excess hunger and thirst.
  4. Arishta Lakshana - Nil
  5. Samprapti
    1. Dosha - Vata, Kapha
    2. Dushya - meda, mamsa
    3. Agni - Jataragni, Dhatwagni
    4. Ama - Jataragni
    5. Srotas - Meda, Mamsavaha srotas
    6. Sroto Dushti Prakara - Sangha

Lab Tests- Not done

RogaSamprapti Flow Chart
Due to Nidanasevana, increase of Medodhatu

Increased medodhatu does Avarana of srotas

Vatadosha gets aggravated

Enhances agni and digests food quickly

Intake of more and more food

Sthoulya

Differential Diagnosis with reasoning


Obesity - a BMI greater than or equal to 30 is obesity.
http://www.who.int/mediacentre/factsheets/fs311/en

Differential Diagnosis with reasoning


Sthoulya-
Sphikstanaudaralambana, ayathopachaya
Utsaha = Atishoola (Ch Su 21)

Evidence Based Diagnosis with References
Obesity
Evidence Based Diagnosis with References
Sthoulya
ChikitsaVivechana:

Ahara-
INCLUDE:
  • Follow timely meal. Have freshly prepared warm homemade food.

  • Boiled- Warm jeera/ Coriander seed/ginger for Drinking water.

  • Ginger, hing , Jeera, Turmeric in cooking

  • Cooked vegetables


AVOID:
  • Refrigerated, deep oily fried, spicy, canned food items.

  • Fast foods
  • .
  • Avoid fermented food preparations
  • .
  • Curd, Pickles

  • Uncooked Salads.


Vihara-
  • Avoid exposure to cold.

  • Keep yourself warm and covered.

  • Exercise


Aushadha-
  • Varanadikashaya 3tsp + Triphala choorna 1tsp + with 8tsp warm water morning on empty stomach.

  • Ardhavilwadhikashayam(3tsp)+T Chandrapraprabha(1 tab)+10 tspwarm water evening on empty stomach.

  • T. Kanchanaragugulu (1 tab) + T Hyponid (1 tab) thrice daily after food.

  • Chinchadhi Tailamwarm it and apply ½ hour before bathing.


Details of Allopathy medicine if continued:b>
NIL

Kriya-

Type – OPT
Duration – 19 days
Primary Treatments - NIL
Main Treatments -
  • Udwartana
  • Virechana (Therapeutic Purgation)

Medications for Virechana-
  • Snehapana- Varanadighrita
  • Sarvangaabhyanga with Brihatsaindhava+Chinchaditaila
  • Virechana – Tab Icchabhediras

Post Treatments-NIL

Chikitsa Paddhati


Chikitsa and medicines selected, cures Medodushti, main cause for Sthoulya, which may also lead to Prameha, kushta etc rogas if not treated.

1. Udwartana - with Kolakulatthadi + Triphala + Kottamchukkadi churna

  1. Ruksha Udwartana is one of the treatments mentioned for sthaulya. It is kaphahara and liquefies excessive medodosha (Ch Su 21).
  2. Triphala churna is ruksha, kaphamedohara and lekhana (AH).
  3. Kolakulatthadi churna is indicated in sthaulya, since it is ruksha and ushna, medohara.
  4. Kottamchukkadi churna is indicated in Vatavyadhi, so controls Vata and also it is Ruksha and Teekshna.

2. Virechana -

  1. Virechana is done to remove the mobilised medodosha from the body.
  2. Sneha selected is Varanadighrita which is indicated in conditions with Kapha and vata involvement.
  3. Abhyanga with Brihatsaindhava, Chinchaditaila reduces kapha and prevents aggravation of Vata and to reduce pain in Lt knee joint.
  4. Virechana with Icchabhediras which contain Jayapala- Crtontiglium, a teekshnavirechaka, which does Lekhana and is Ruksha.

Internal mdeicines-

Varanadikashaya- kaphavata association, lekhana.

Triphalachoorna- indicated in meda, kaphavikara, prameha (AH)

Ardhabilwakashaya- indicated in mutravahasrotovikara, shopha- removes water retention in body, and is ruksha and teekshna.

Chandraprabhavati- Indicated in Prameha, a Kaphamedodushtijanyaroga.

Kanchanaraguggulu- indicated in Kaphamedojanyarogas, lekhana.

Hyponid- indicated in prameha, PCOS- kaphamedojanyarogas.

Referral Opinion Sought if any - No

    • Samyak Lakshanas achieved (Control Charts Summary Attached)
    • Sneha samyak lakshana achieved. Control Chart attached- No.1.
    • Snehana and swedana samyak lakshana achieved. Control Chart attached- No.2.
    • Virechana - 7 vegas – Avarashuddhi - No.3.
  1. Standardised Outcome Scales Used (Summary Table Attached) Attached - No.4
  2. Other outcomes as per following table -
  3. # Outcome Parameters R TSD T TED
    1 Sleep (Nidra) Good Good Good Good
    2 Appetite (Agni) Good Good Good Good
    3 Bowels (Mala) Regular Regular Regular Regular
    4 Urination (Mutra) Regular Regular Regular Regular
    5 Stress (Manas) Medium Medium Medium Medium
    6 Vitality (Ojus) Medium Medium Medium Medium
    7 Wellbeing (0-10) 5 6 7 7
    8 BP 120/80 120/80 120/80 120/80
    9 Pulse 68 68
    10 Weight, Kg 103 97 95 93
    11 Diet (Ahara) Poor Fair Fair Fair
    12 Exercise (Vyayama) Nil Nil Nil Nil
    13 Lifestyle (Vihara) Poor Poor Poor Poor
    14 Lt mid arm circumference in cm - 15 14.5 14.2
    15 Rt mid arm circumference in cm - 15.5 14.5 14
    16 Waist circumference in cm - 45 45 45
    17 Hip circumference in cm - 43 42.4 42
    18 Lt mid thigh circumference in cm - 24.5 23.5 22
    19 Rt mid thigh circumference in cm - 28 23 23

    Patient’s Outcome Scale


    # Presenting Complaint Weightage Status_TSD Status_TED Status_1Week Status_1 Month
    1 Obesity 80% Fair Good V good V good
    2 Lt knee joint pain 20% V good V good V good V good
    WEIGHTED AVERAGE SCORE-----> - - - - -
    IMPROVEMENT SCORE-----> - - 0.0 2.0 2.0
    IMPROVEMENT %-----> - - 0% 100% 100%


    Adverse Incident Report (Drug or Treatment): NIL

    obesity
    obesity
    obesity

At the end of treatments, patient felt better. Weight is decreased from 97 kgs to 90 kgs- Measurements also showed reduction in circumference of various parts. He is advised to continue all his internal and external medicines for 15 days and review thereafter.

Disclaimer: * Outcomes may vary from person to person