Obesity: Pathology, Signs And Symptoms As Per Ayurveda

By Dr Rangaprasad Bhat and Dr Raghuram.
Ayurveda explains obesity as the effect of increase of fat tissue (Medo Dhatu). Ayurveda explains obesity with below symptoms.
avyAyAmadivAsvapnashleShmalAhArasevinaH | madhuro.annarasaH prAyaH snehAnmedaH pravardhayet ||1||Madhava Nidana 34th chapter.

Cause for build up of fat in the body are –
Avyayama (lack of exercise),
Divasvapna (sleeping at day time),
Shleshmala Ahara Sevana – intake of foods which increase Kapha Dosha

Due to above factors the annarasa (the end product of digestion) becomes sweet by not getting properly digested and there by results in accumulation of sneha (oiliness) and fat.

Pathology of obesity: 
medasA.a.avRRitamArgatvAt puShyantyanye na dhAvataH |
medastu cIyate tasmAdashaktaH sarvakarmasu ||2||Madhava Nidana 34

Due to the blocking of tissue channels by the fat tissue, the successive Dhatus (bone, marrow and Shukra) do not get nourishment and they fail to develop properly.
It leads to more accumulation of Medas – fat, resulting in the person facing difficulty in executing his daily tasks.

Sthoulya (Ati sthula), Obesity or overweight –
Medo maamsaa ati vruddhatvaat chala spik udara stanaha
Ayathaa upachaya utsaaho naro ati sthoola uchyate (Ref – Yoga Ratnakara Medoroga Chikitsa 7)

A person who due to excessive accumulation of muscles and fat in the body presents with sagging butts, abdomen and breasts, the muscles and fat tissue are nourished and formed normally (they are abnormally deposited) and the energy levels also are not normal (below normal) is called ati sthula or obese.
obesity complicationsClinical features of obesity:
kShudrashvAsatRRiShAmohasvapnakrathanasAdanaiH |
yuktaH kShutsvedadurgandhairalpaprANo.alpamaithunaH ||3||Madhava Nidan 34

Kshudra shwasa (gasping for air),
Trusha – excessive thirst,
Moha – delusion, inprecisive work,
Svapna Krathana – snoring
Saada – exhausion.
Kshut – excess hunger,
Sveda – excess perspiration,
Durgandha – foul body odor,
Alpa pran – short breaths
Alpa maithuna- less sexual strength occur due to depletion of Shukra dhatu.

Reason for fat deposition around abdomen area: 
medastu sarvabhUtAnAmudareShvasthiShu sthitam | ata evodare vRRiddhiH prAyo medasvino bhavet ||4||Ma. Ni.

In human beings, fat gets accumulated in abdominal region.
The root for medovaha srotas – fat channels are – Vrukka (kidney) and Vapvahana (greater omentum) as per the statement of Charaka –
That probably is the cause for the pendulant abdomen in sthoulya people.

Relationship between excess fat tissue and Agni:
medasA.a.avRRitamArgatvAdvAyuH koShThe visheShataH |
charan sandhukShayatyagnimAhAraM shoShayatyapi ||5||
tasmAt sa shIghraM jarayatyAhAramabhikA~NkShati |
vikArAMshcApnute ghorAn kAMshcit kAlavyatikramAt ||6||

Due to blocking of fat tissues, Vata Dosha is increase within Koshta – (alimentary canal). Vata influences the Agni and leads to increase of Agni (digestive fire). This leads to parching of food.
This leads to quicker digestion of food, forcing the person to long for food and indulge in binge eating.
This binge eating habit leads to severe health complications in due course of time.

Complications due to involvement of ?ma in sthaulya,
prameha  pidaka (carbuncles),
jvara (fever),
bhagandara (fistula in ano),
vidradhi (abscess),
Vata roga

According to Vijaya Rakshita, Madhukosha vyakhya,
clarification regarding contrasting terms agni Sandukshana & ama.
He himself raises a query like –
“how is it possible when in an obese person, the agni is tikshna (strong) to beget ?ma?”

He clarifies the doubt  –
“The complications mentioned in aforesaid stanza occurs only when one indulges in binge eating. Though the agni may be sharp, when one indulges in contionuous Kapha increasing foods, the agni gets weakened and the resultant ahara paka becomes madhura (sweet), there by resulting in Ama.

The thus formed madhura anna rasa (post digestion product, which is sweet in taste) gets adhered to the inner coatings of the anna vaha srotas – food channels.
Hence, though the annavaha srotas is supposed to be predominant with the activities of pitta, it starts experiencing vidaha (burning) within its channels and thus starts exhibiting the pathological features of Ama –

etAvupadravakarau visheShAdagnimArutau | etau tu dahataH sthUlaM vanadAvo vanaM yathA ||7|| medasyatIva saMvRRiddhe sahasaivAnilAdayaH | vikArAn dAruNAn kRRitvA nAshayantyAshu jIvitam ||8|| Ma. Ni.

The complications in sthUla is caused by the aggravated vAyu and agni, the accumulation of fat is directly proportional to the increase of vata which results in difficult to cure complications which affects the quality of life.

medomAMsAtivRRiddhatvAchchalasphigudarastanaH | ayathopachayotsAho naro.atisthUla uchyate ||9||  (cha. sU. a. 21) |

The excessive vrddhi of the m?das and mamsa with in the regions of the spik (gluteals – hip region), udara (abdomen) and stana (breast tissues) is so humongous that it causes pendulance of those structures. The unrestrained (ayatha) accumulation of medas in human being is known by the name sth?la or sthoulya.

Sthoulya means obese or looking obese (bulky / busty). This is an anatomical description of the disease. This also is another term which reflects Medo Vriddhi. Symptoms to differentiate Medo Vriddhi and Sthoulya have not been given. But these different terms have been used in different contexts. By description, it looks like Medo vriddhi is the physiological part of disturbance (imbalance) which takes place on the backdrop of sthoulya. Sthoulya is the anatomical presentation of Medo Vriddhi. They are 2 sides of the same coin.

Sthoulya may or may not have progressed to the level of causing severe damages in the body, enough to be called as a disease but may be a warning sign that the body tissues and organs are under danger. The body dimensions in this condition will be blown out of proportions. This seems to be a predisposing stage earlier to Medo Roga
Read related: Effective Obesity Treatment, Remedies And Ayurveda Tips

Ati sthula (over obese) –
Ayurveda has mentioned ‘ati sthula’ – a person who is too obese (fat / over weight) under the category of Ashtau Nindita’s – 8 categories of people who are socially unfit.

Many symptoms explained when the term ‘ati sthula’ is used points towards diseases caused due to pathology of fat metabolism. In this context, Ati sthula or ati sthoulya doesn’t look anything different from MedoRoga. These terms are used interchangeably.
Click to Consult Dr Raghuram Y.S. MD (Ayu) 


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