CONCEPT OF STHOULYA IN AYURVEDA W.S.R TO MEDO DHATU

1. MDScholar, Department of Panchakarma, Government Ayurveda College, Trivandrum. 2. Professor, Department of Panchakarma, Government Ayurveda College, Trivandrum. 3. Assistant Professor, Department of Panchakarma, Government Ayurveda College, Trivandrum. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 05 June 2020 Final Accepted: 10 July 2020 Published: August 2020


Defnition Of Sthoulya:
A person with bulkiness of body especially around the udara region is considered to be sthoola. Charaka samhita says; the abnormal increase of medas and mamsa resulting in bulkiness of specific parts like sphik (buttocks), udara (abdomen) and stana (breast). Such type of people comes under the category of atisthoola. (25) Ayurvedic perspective of medas: Medo dhatu plays a prominent role in the pathogenesis of sthoulya. Infact the excessive formation of medas occurs and further dhatus remain unformed due to the dhatwagni mandhya of medas thereby resulting into sthoulya. Henceforth concept of medas has to be understood in detail before moving to the treatment aspects. Medas is derived from mother i.e. matrija bhava.
Based on the concept of panchamahabhoota, the formation of medodhatu is explained in grahani chikitsa of charaka samhita. Rakta dhatu combines with teja and jala gets solidified by the action of agni there by production of mamsa dhatu occurs. The mamsawill be digested by its own dhatwagni and combines with quality of jala and sneha (unctuous substance) results in the formation of medo dhatu. (26) Medodhara Kala (27) : Kala is a kleda bhava lying in between dhatu and ashaya covered with snayu, sleshma and jarayu. The third kala formed is medodhara kala; that is deposited in udara predominantly. In small asthi, it is mixed with rakta. In shiras it is termed as masthishkya and in sthoolasthi it is termed majja.

Organs developed from medas (28) :
The prasada bhaga of rakta and medas leads to the formation of vrikka. The prasada bhaga of mamsa, rakta, kapha and medas leads to the formation of vrishana.

Medovaha srotas:
The channels that carry nourishment to the medodhatu are considered as medovaha srotas. There are three different opinions for the origin of medo vaha srotas as follows; 1. Charaka samhitavrikka and vapavahana (29) 2. Susrutha samhitavrikka and kati (30) 3. Ashtanga sangrahavrikka and mamsa (31) Pramana of medodhatu -2 anjali (32) : Samprapti of sthoulya: Charaka samhita (33) : Due to the nidana sevana, the medo dhatu does avarana of koshta which hampers the normal gati (movement) of koshta vayu (samana). This vaigunya vayu moves inside koshta leading to the agni sandukshana and quick digestion of food thereby leading to excessive desire towards intake of food. Repeated consumption of food without burning the calories consumed might result in various vikaras. The similie explained to denote the potency of the disease is; in the event of excessive increase of medas, agni and vayu suddenly rises to severe disorders and destroy the life shortly like forest fire that spreads quickly and cause destruction.
187 Susrutha samhita (34) : Due to nidana sevana, there will be formation of aama in koshta (mahasrotas). This aama thereby gets deposited in srotas leading to srotosanga; depriving the formation of other dhatus. Only medas gets produced in excess leading to sthoulya.

Bhavaprakasha (35) :
Consequent to various causative factors, medas gets excessively deposited and obstructs the other dhatu vaha srotas creating obstacles to the nourishment of other dhatus. This makes the person unstable in all activities (asakta sarvakarmasu)

Role Of Shad Kriyakala In Sthoulya:
The six steps in development of roga is explained under the context vranaprashnam adhyaya of susrutha samhitha. These stages are explained in vrana; the same can be applicable to the samprapthi of other diseases also.

Sanchaya:
Due to the nidana sevana, the dosha gets commence to lodge in specific sthanas and give rise to specific symptoms.
Here, in sthoulya due to nidanasevana, the alteration of following doshas takes place. 1. Vatasamana , vyana 2. Pitta -pachaka 3. Kaphakledaka Symptoms are not clearly manifested as the progression had not taken place. Based on samanya vishesha sidhantha, we can understand that the involved dhatu will be medas. The sthana of medas is vrikka and vapavahana .Here, the samhati roopa vridhi would take place in these sites being the moola of medo vaha srotas. Kapha,meda vridhi occur due to aashraya aashrayi bhava of kapha dosha and medho dhatu.

Prakopa:
The second stage in the progression of roga is prakopa. The doshas apart had reached chaya avashtha, but not been intervened and further exposure to nidanas would give rise to vilayana roopi vridhi of the same that are explained under prakopa. Here, in sthoulya let us consider the prakopa of samana vayu in koshta since chaya of medas had already taken place in sanchaya stage and this leads to sroto sanga in mahasrotas, thereby normal anuloma of vayu doesnot occur. Since samana vayu stays near jataragni, this further kindles the agni. The formed annarasa does not undergo proper parinaama onto rasaadi dhatus since poshaka rasa is not the major part and aama rasa retains in koshta. Apart from jataragni mandhya, medodhatu agni also gets mandhya hence further parinaama gets hampered. Abnormal vridhi to kapha and medas occurs.

Prasara:
This is the stage where the lodged doshas are moved out of sanchitha sthana and deposited in various sites. The main role is played by vyana vayu which transports the aamaja annarasa, vridha kapha and medas to sarva shareera from maha srotas. 188

Sthana samsraya:
The Madura pradhana aama rasa combines with medo dhatu once it has been brought out of koshta by vyana vayu. This is the stage where dosha dooshyasamoorchana occurs. Apart from samana vayu, the circulating vyana vayu also gets obstructed in medo vaha srotas leading to kha vaigunya. This vyana again moves back to koshhta. Samana vayu and vyana vayu combined in koshta further kindles the agni and speeds up the digestion. The person gets increased appetite and craves for more food. Here medo dhatu gets excessive poshaka bhaga, hence the medo dhatu agni cannot digest further there by apakwa meda formation takes place repeatedly. Even if the agni is teekshna, the person undergoes adhyashana (bhuktasya upari bhojana) and kaala vyateeta ahara repeatedly, chance of aama formation gets increased due to medo dhatwagni mandhya.

Bheda:
Due to sroto rodha of various srotas, the nourishment of rest other dhatus are diminished. From the concept of aayu hrasa, we can understand that the person would obviously lack immunity, and since asthi, majja and sukra does not get poshaka amsha, diseases concerned to the same manifests as the complication of sthoulya roga.

Charaka samhita (37) :
These obese people are frequently prone for other diseases which indicate the incurability of sthoulya.

Ashtanga hridayam (39) :
In the context of sthoulya and karshya, he says karshya is considered better compared to sthoulya because there is no pin point treatment for obese people.

Sthoulya chikitsa:
Eventhough the disease is considered to be krichra sadhya, there are few treatment principles not only aim to subside the roopa of sthoulya, but it also helps in preventing the further vitiation of doshas in the body. The modalities of treatment can be; 1. Samshodanaantar and bahir 2. Samshamana

Shamana Chikitsa:
The implementation of shamana treatment in sthoulya is mainly aimed in subsiding the vitiated kapha and medas, regulate the movement of samana vayu and brings back the agni to normal stage. The medo dhatu agni mandhya has to be checked off. Generally pachana and deepana foods are to be administered for depletion therapy in general.

189
Here it is specifically adviced to administer guru and apatarpana ahara. Commentator chakrapani explains the role of guru and apatarpana ahara as; 1. Guru -vridham agnim yapayati 2. Apatarpanamedo hanti The example cited in this context is honey (40) .

Bahirparimarjana Chikitsa:
In sthoulya, the external procedure advised is mainly rooksha udwarthana (42). This procedure removes foetid odour, restricts the process of excess sweating and subsides the vitiated kapha and meda. It does twak prasadana, stireekarana of angas, gauravahara, dourbalyahara, tandra hara, kandu hara and mala hara. The procedure is patient friendly. By the tikshna guna of dravya and due to the friction created during the procedure by rubbing the herbal powder in a direction opposite to the hair follicles, virya of the drug enters the body.

Antarparimarjana chikitsa:
It is the other word given for shodana therapy. Sthoulya is said one among the lakshanas of bahudoshayukta by charaka samhita, wherein shodana is said to be the ultimate therapy for the same. The procedure by which the doshas in vitiated stage are eliminated through nearest route from the body is said to be shodana. This shodana therapy would be preceeded by the poorva karmas namely snehana and swedana.

Snehana:
The procedure of snehana is generally contra indicated for sthoola persons . Commentator Arunadutta in sarvanga sundara vyakhyana clarifies that, if a sthoola person is administered snehana, it would wind up in agni vridhi and medo vridhi. (43) Tila taila had been described to possess tikta, kashaya as anurasa by Susrutha samhita. It does lekhana, pachana and vata kapha hara in nature. Commentator Dalhana specifically says lekhana means medohara. (44). The intension of administering snehana prior to shodana is to bring up the utklesha of doshas that remains in leena avastha over the srotas. Hence in sthoola rogi, taila can be administered for snehana after a proper rookshana.

Swedana:
Swedana is also contra indicated in sthoola rogi. But with an intension of succeeding shodana therapy, swedana can be done in the form of niragni sweda. In medakaphaavrita vata, niragni sweda is adviced. (45) Vamana: Two different opinions regarding the administration of vamana in sthoulya can be seen in classics. In vimshati kaphaja nanatmaka vikaras, atisthoola had been mentioned and in the treatment principle vamana is pointed out as the pradhana upakrama among others. (46) On the contrary, in the contra indications of vamana in siddhi sthana atisthoulya is mentioned due to the inability of the patient to tolerate the oushada bala which may even lead to prana uparodha. (47) Susrutha samhita says persons with medo roga are generally indicated for vamana therapy. (48) Virechana: Generally virechana karma is contra indicated in sthoulya. But being the best upakrama of pitta dosha, it could be administered. This eliminates the vitiated pitta thereby the aamayukta anna rasa leading to removal of avarana and anulomana of vata dosha occurs.

Siro virechana:
Charaka samhita includes siro virechana as one among the treatment principle of 20 kaphaja nanatmaja vikaras eventhough it is not considered to be the pradhana treatment of sthoulya . (51) Under the context of avapeeda nasya, susrutha samhita mentions abhishyanna, which is justified as meda kapha abhivyaptha shiras by commentator Dalhana. (52) Discussion:-Thus Ayurveda clearly explains the concept of medas, its formation, role in metabolism, pramana, its vridhi & kshaya lakshana. The role of medas in the pathogenesis of sthoulya is also elicited elaborately in the classics. Role of both bahirparimarjana chikitsa and antarparimarjana chikitsa, the aim behind the administration of each of these chikitsa are also mentioned. Hence agni and medas do posses a vibrant role in sthoulya pathogenesis and correction of these through proper shodhana followed by shamana oushada and modification of patient's life style helps to maintain a healthy life.

Conclusion:-
Prevention of sthoulya with healthy life style has to be focussed. In cases where sthoulya is due to beeja dushti, intervention also may not help much. Sodhana as per ritucharya, vyayamaadi kriyas adviced in dinacharya and proper sodhana before conception by the parents may to an extent give a healthy progeny.