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Introduction

A person is considered obese when there is excess accumulation of fat in subcutaneous tissue & other parts of body. This excess accumulation of Fat can be estimated with BMI. A person is considered as Obese if his body mass index (BMI) is greater than or equal to 301. As per modern science, increased intake of energy dense foods & less physical activity causes obesity. More than 1 billion people worldwide are obese. An obese person is more prone to noncommunicable diseases like cardiovascular disease (leading cause of death in 2012), Diabetes, Osteoarthritis, some cancers2. In ayurvedic literature Atisthaulya Vyadhi is described which we can correlate with Obesity. Charaka Acharya has described Atisthaulya vyadhi in Ashtauninditiya adhyaya. The person is considered Atisthoola if there is excessive increased production & accumulation of Fat & Mansa over buttocks, abdomen & breasts also there is visible movement of these parts while movement. Also, this person lacks enthusiasm3. Charak Acharya has mentioned relationship between Vyadhi & Hetus. Single Hetu can give rise to many diseases also many hetus can give rise to Single disease4. Hence a clinician must understand & study Nidan Panchak of disease before starting treatment5. Ayurveda has enlightened on various etiological factors (Aharaj, Viharaj, Manasik & Anya hetus) responsible for obesity.

AIM: - To Study Literature on Aharaj, Viharaj, Manasik & Anya Hetus of Obesity (Atisthaulya)

OBJECTIVE: -

1) To review Literature on Aharaj, Viharaj, Manasik & Anya Hetus of Obesity (Atisthaulya) in Brihatrayi

2) To review Literature on Aharaj, Viharaj, Manasik & Anya Hetus of Obesity (Atisthaulya) in Laghutrati

STUDY TYPE: - Literature Study

MATERIALS & METHODS: -

MATERIALS: -

1. To fulfil the moto of conceptual study, materials have been collected from samhitas, brihatrayis, laghutrayis & all available commentaries & other texts of ayurveda,
2. Research papers, articles, textbooks
3. Concerned subject related information available on internet has been used.

METHODS: -Data collected from above said texts is compiled, critically analyzed & presented in scientific manner.

LITERATURE REVIEW: -

Atisthaulya: The person is considered Atisthoola if there is excessive increased production & accumulation of Fat & Mansa over buttocks, abdomen & breasts also there is visible movement of these parts while movement. Also, this person lacks enthusiasm3.

Samprapti of Atisthaulya: Continuous & Excessive intake of Guru gunatmak and Madhur Rasa pradhan ahar & Vihar causes Agnimandya & aggravate Kapha Dosha. Due to agnimandya Ama rasa production take place so apachit Meda Dhatu is produced. This increased & apachit Meda obstruct the various Strotas. Due to agnimandya & apachit Meda Dhatu other Dhatus are not nourished properly. This apachit Meda Dhatu gets deposited in Udar, Sphik & stan of person. Due to this obstruction Vata moving in the Kostha becomes hyperactive and stimulates Agni. This Agni digests food rapidly and vitiated or hyperactive Vata absorbs it rapidly. So, a person requires frequent and heavy food resulting in Atisthaulya.

Symptoms of Atisthaulya5

1. Ayushohrasa (Diminution of life span)

2. Javoparodha (Lack of enthusiasm)

3. Kriccha Vyavaya (Difficulty in sexual act)

4. Daurbalya (General debility)

5. Daurgandhya (Foul smelling of body)

6. Swedabadha (Distressful sweating)

7. Kshudhatimatra (Excessive hunger)

8. Pipasatiyoya (Excessive thirst)

Obesity: A person is considered obese when there is excess accumulation of fat in subcutaneous tissue & other parts of body. This excess accumulation of Fat can be estimated with BMI. A person is considered as Obese if his body mass index (BMI) is greater than or equal to 301.

Body Mass Index1: The formula is BMI = kg/m2 where kg is a person’s weight in kilograms and m2 is their height in meters squared

Causes of Obesity: The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Globally, there has been:

•An increased intake of energy-dense foods that are high in fat and sugars; and

•An increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization.

Secondary causes are:

1. Genetic cause
2. Hormonal diseases like Hypothyroid, Polycystic Ovarian Disorder, Cushing`s syndrome
3. Drugs like Glucocorticoids, Tricyclic antidepressants, Oral contraceptive pills.  

1. ATI SAMPURAN: - Ati sampuran is defined as regular ingestion of food in excess quantity (Overeating). Regular Ati sampuran may cause Dhatwagni mandya, Kapha vruddhi, medo vruddhi.
2. ATI GURU AHAR SEVAN: - Food that is Guru gunatmak get delayed digested. Regular consumption of Guru ahar sevan again causes Agnimandya causing vitiated Kapha vriddhi, apachit medo dhatu vriddhi. Also, Guru gunatmak food contains Pruthvi & Aapa Mahabhutansha, which is heavy to digest.
3. ATI MADHURA AHAR SEVAN: - Ati Madhur rasatmak ahar sevan may cause vitiation of meda dhatu, which may lead to Kaphaja disorders like Atisthaulya Obesity, Agnisada, Sanyas, Prameha, Ganda, Arbuda etc.
4. ATI SHEETA AHAR SEVAN: - Kapha & Vata dosha, Jala mahabhuta possess Sheeta guna. Sheeta guna has Stambhan property. Regular ingestion of Food that is cold in nature also living in Cold environment may cause vitiation of Kapha dosha causing inhibition of Motion ultimately Srotorodha as Srotodushti.
5. ATI SNIGDHA AHAR SEVAN: - Snigdha ahar is Vatahar & Kapha vriddhikar. Excessive regular consumption of Snigdha gunatmak ahar thus leads to Dhatwagnimandya, vitiation of Kapha dosha, apachita Medo dhatu production, which leads to Srotorodha as khavaigunya.
6. ATI DADHI SEVAN: - Excessive consumption of Dadhi (Curd) may cause Srotorodha in medovaha srotas as it is Abhishyandi.
7. GRAMYA AUDAK MANSA RASA SEVAN: - Gramya audak mansa rasa has Prithwi & Aap mahabhutadhikya. Also, it is heavy to digest. It has more content of Meda. So due to excessive & regular intake of these Meat it casuses Agnimandya, Medovriddhi & Vitiation of Kapha dosha which leads to Atisthaulya. Also, it causes accumulation of meda in various sites like vessels, Udar, sfik & stan etc.
8. ATI PAY VAIKRUTI SEVAN: - Various Milk & milk products like Milk, Curd, Buttermilk, Ghee, Paneer, Cheese, & Shreekhanda etc. Most of these products are Heavy to digest. Also, they cause Madhur Vipak after digestion. Curd, Buttermilk, Ghee, Paneer, Cheese are Abhishyandi in nature so causes Srotorodha. So, it leads to Atisthaulya due to Vitiation of Kapha dosha, Medovriddhi & srotorodha when taken in excess quantity & improper manner.
9. ATI NAVANNA SEVAN: - It is Guru in nature, Madhur Vipaki also it may cause Abhishyand. So, if consumed in excess quantity, it may cause Jatharagni- Dhatwagnimandya- apachit medovriddhi – srotorodha- Vitiation of Kapha dosha causing Atisthaulya.
10. ATI NAVA MADYA SEVAN: - Nava madya is heavy to digest. It may cause Vitiation of Kapha dosha & srotodushti. If consumed in excess quantity it may lead to Atisthaulya.
11. GUDA VAIKRUTI: - Sugarcane, Sugar, Guda (Jagery) & Khanda are Sweet in taste & Vipaki. Also, these are Snigdha, Brinhan & Abhishyandi in nature. So, when consumed in excess quantity it causes vitiation of Kapha dosha, srotorodha & apachit Medo dhatu vriddhi.
12. SANTARPAN: - Ati Santarpan causes vitiation of Kapha dosha, srotorodha & apachit Medo dhatu vriddhi which is responsible for Atisthaulya.
13. ADHYASHAN: -Sushruta Acharya has stated Adhyashan as a hetu of Atisthaulya. It causes Jatharagni-Dhatwagni Dushti leads to apachit dhatu production causing disease progression.

VIHARAJ HETU

1. AVYAYAM (LACK OF EXERCISE): It leads to excess production of to medo dhatu casuing obstruction of vessels & srotasa which leads to Atisthaulya.
2. AVYAVAYA (LACK OF SEXUAL INTERCOURSE): It leads to accumulation of Shukra dhatu which is unctuous form of Majja & Meda Dhatus. So, with other hetus it may lead to srotorodha, medovriddhi causing Atisthaulya. Also, it increases Tamo dosha which intensifies Atisthaulya pathogenesis.
3. DIWASWAP, ASANA SUKH, BHOJANOTTAR AUSHADH- NIDRA-SNANA SEVAN, SWAPNA PRASANGAT: It casues Agnimandya- vitiation of Kapha dosha- apachit meda production which leads to Atisthaulya.

MANASIK HETU

1. HARSHANITYATVAT: It leads to increased Kapha dosha production, over nourishment, srotodushti causing Atisthaulya.
2. ACHINTANAT, MANASO NIVRUTTI, PRIYA DARSHANAT, SAUKHYENA: Achintanat means lack of stress or worries which increases Kapha dosha production, over nourishment, srotodushti causing Atisthaulya. It leads to increase in Tamo dosha which leads to Avaran pathogenesis.

ANYA HETU

1. BIJA DOSHA SWABHAVAT: Charaka Acharya have stated BIJA DOSHA SWABHAVAT as a major hetu of Atisthaulya. Sthoola Mother & father carry same pathological properties in their respective ovum & sperm. So Sthoola Mother & father may carry their disease to their children through bija. Also diet of mother during pregnancy may also cause dosha in fetus.

1. SNIGDHA MADHUR BASTI SEVAN, SNIGDHA UDVARTAN, TAILA ABHYANGA: These hetus vitiates Kapha doshas, increases Medovriddhi causing Atisthaulya Vyadhi.

Discussion

• In Aharaj hetu Ati Sampuran, Ati Guru, Madhur, Sheeta, Snigdha, Dadhi, pay vikar, Gramya Audak Mansa rasa Sevan, Navanna, Nava madya Sevan, Guda Vikruti is described by Acharya Charak and Ashtang Hrudaya. But Santarpan is described by Ashtang Hrudaya and Adhyashan by Sushruta acharya.
• Avyayam, Avyavaya, Diwaswap, Asanasukh, Swapna Prasangat these Viharaj Hetus are described by Acharya Charak and Ashtang Hrudaya. Bhojanottar Aushadh Sevan described by Ashtang Hrudaya. Bhojanottar Nidra described by Yogratnakara and Bhavaprakash. Bhojanottar Snana, Gandhamalyanu Sevan described by Acharya Charak.
• Harshanityatvat, Achintanat, Manaso Nivrutti these Manasik Hetus are described by Acharya Charak and Ashtang Hrudaya. Priya Darshanat is described by Acharya Charak.

• Snigdha Madhur Basti Sevan, Taila Abhyanga these hetus are described by Acharya Charak and Ashtang Hrudaya. Ama Rasa is specific hetu described by Acharya Sushruta and Bhavaprakash.
• Bija Dosha Swabhavat and Snigdha Udvartan these specific hetus are described by Acharya Charak.

Conclusion

Ayurvedic literatures not just thinks about energy imbalance for hetu of obesity. It has described Aharaj, Viharaj, Manasik & Anya hetus responsible for obesity (atisthaulya). Aharaj hetus are more focussed on diet intake in quantity, quality (guna), time & agni status. Ahar vidhi visheshayatan guides us for proper dietary rules which can avoid causative factors for Disease. Viharaj hetus are focussed on physical inactivities. Lack of exercise, lack of physical activity gives rise to disease. Manasik hetus have also been described accordingly.

These manasik hetus increases Tamo Guna which again leads to disease progression. In anya hetus   Bija dosha has been described which we can correlate to genetics in today`s modern era. Ayurveda has covered all hetus like energy imbalance, genetics, and hormonal causes as etiological factors. Ayurveda thinks every person individually, his Agni status, dietary habits, mental status, genetic cause deeply.