A Comparative Clinical Study On Udvartana Virechana Followed By Vrikshamla Swarasa And Udvartana Virechana Followed By Guduchi Bhadraadi Kashaya In Sthoulya Wsr To Obesity

Obesity is a disease of caloric imbalance that results from an excess intake of calories that exceeds their consumption of various food items by the body. Lifestyle diseases depends upon day-to-day habits and sedentary routine that causes many health problems.

About 16% of adults aged 18 years and older worldwide were obese in 2022.1According to WHO, a BMI greater than or equal to 25 is considered as overweight and a BMI greater than or equal to 30 as Obesity.2 Apart from this, hormonal imbalance also contributes to the accumulation of fat stores.3

Sthoulya is a Santarpanajanya Vyadhi.4Meda is increased in the body due to intake of shleshmala and medovruddhikara ahara and due to lack of physical exercises, divaswapna, achintha. Due to more kaphakara and medovruddhikara ahara vihara there is undigested food left in the stomach that leads to ati snigdhatha and lead to the formation of ama.The atimatra upachaya of medas due to medodhatwagnimandhya causes margavarana by medas.Vata will get confined to koshta which leads to ahara shoshana and sheegra ahara jarana.Athikanksha of ahara will ultimately lead to atisthoulya.4It is the abnormal and excessive accumulation of Medodhatu in the body and is one of the Medodoshaja Vikaras.5Acharya Charaka considered Atisthula as one among Ashtonindita Purusha.6A person having pendulous appearance of sphik, udara and sthana due to excess deposition of meda along with mamsa dhatu having unequal and abnormal distribution of meda with reduced enthusiasm towards life is called atisthula7 .

Acharya Charaka has mentioned Sleshma- medohara Ahara ,ruksha Udvartana along with Guru Ahara and Atarpana Chikitsa as the line of treatment for Sthoulya⬚8. Sneha purva rukshana is indicated in Mamsala, medhura, bhurisleshma, vishamagnyaha.9

Udvartana is having the Gunas of Kapha-MedaVilayana property. The Virya of the medicine enters the body due to Ushna and Tikshna Guna of Dravya and its powerful influence on Romakupa. It then opens the Mukha of Sira, resulting in Paka of Kapha and Medas. There will be Dravata Vriddhi of the Kapha and Medas as a result of this,Swedana, which comes after Udvartana, gives to the Paka of the same. As a result, Nirharana of Vikrita Kapha Dosha, Dushya along with Medo Dhatu (Alleviation of vitiated Kapha and Meda) and removes avarana and srotorodha will take place ultimately resulting in laghutva of Sharira.10

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Virechana karma does the Sroto-avarodha and normalizes the Agni.11According to Charaka Samhitha, Sthoulya is a Bahudoshaja Vyadhi hence Shodhana is advocated.12Virechana karma is one of the treatment modalities for treating Santarpanajanya

Vikaras.13⬚ The principal action of Virechana Karma is elimination of vitiated Pitta Dosha which

is the important factor in the regulation of Agni. Drugs of Virechanaa Karma have maximum ingredient of Katu Rasa, Laghu, Ruksha Guna, Ushna Virya and Katu Vipaka, Vatakapha Shamaka, Karshana, Lekhaniya, Medorogahara, Amapachana, Dhatu-Shoshana properties, which normalize the state of Agni. After Virechana Karma, followed by Samsarjana Karma, it leads to Agnivridhi and Amahara. By Virechana Karma all Srotas especially Medovaha andRasavaha Srotas gets purified.14

Vrikshamla fruits has Amla, Katu and Madhura Rasa. It has Laghu and Ushna Guna. It has deepana, rochana and kapha-medohara properties.15,38 Due to its Laghu and Ushana Guna it digests the Amasanchaya and clears the Srotorodha.Vrikshamla has inherent tendency of agnisamdhukshana. Many studies have shown that intake of HCA present in Vrikshamla reduces appetite, inhibits lipogenesis and reduces body weight.16 The active components of Garcinia indica is hydroxycitricacid (HCA),garcinol,cyanidine-3-sambubioside,cyanidin-3- glucoside has anti-obesity effect.17

Guduchi contains guru, snigdha guna ,ushna virya, tikta kashaya rasa, medohara property and it is indicated in medoroga.18,19Triphala contains laghu, ruksha guna,it has tridoshahara, lekhana property.20,21Musta contains katu, tiktha, kashaya rasa, deepana, pachana, grahi, kapha pittahara properties.36Guduchi Bhadraadi kashaya is indicated insthoulya.37These drugs have potent antihyperlipidemic activity and does kaphamedohara activity with life style modification, daily practice of exercise is needed.

In this view of thinking the present study is taken to compare the effect of Udvartana,Virechana followed by oral administration of Vrikshamla rasa and Guduchi Bhadraadi kashaya in the management of Sthoulya w.s.r to obesity.

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