Obesity (STHAULYA)

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Table of Contents
Casestudies of Contents

Brief Medical History

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 and wants to reduce weight.

Current medication: Nil

Integrated Summary

Clinical Status
Allopathy Ayurveda
Vital Parameters

- BP – 120/70 mm of Hg.
- Pulse – 70 beats /min
- RR – 20/min
- Weight - 97 kg
- BMI - 31.6/Obese
- WHR – 1.23
- Height - 5ft9inch
Astasthana 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 – NVBS heard
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
Samprapti
A. Dosha - Vata, Kapha
B. Dushya - meda, mamsa
C. Agni – Jataragni, Dhatwagni
D. Ama - Jataragni
E. Srotas - Meda, Mamsavaha srotas
F. 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
Chikitsa Vivechana:

Ahara-
INCLUDE:
1. Follow timely meal. Have freshly prepared warm homemade food.
2. Boiled – Warm jeera/ Coriander seed/ginger for Drinking water.
3. Ginger, hing , Jeera, Turmeric in cooking
4. Cooked vegetables

AVOID:
1. Refrigerated, deep oily fried, spicy, canned food items.
2. Fast foods .
3. Avoid fermented food preparations .
4. Curd, Pickles
5. Uncooked Salads.

Vihara-
1. Avoid exposure to cold.
2. Keep yourself warm and covered.
3. Exercise

Aushadha-
1. Varanadikashaya 3tsp + Triphala choorna 1tsp + with 8tsp warm water morning on empty stomach.
2. Ardhavilwadhikashayam(3tsp)+T Chandrapraprabha(1 tab)+10 tspwarm water evening on empty stomach.
3. T. Kanchanaragugulu (1 tab) + T Hyponid (1 tab) thrice daily after food.
4. 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 medicines-
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

Outcome

    • 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 –
# 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

Conclusion

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.

Patient's Stories

Patient’s testimonials

* Outcomes may vary from person to person

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