Introduction

Ayurveda is ancient science of life. This branch of medicine has a 5000 years’ record of use in the Indian system of medicine. The concept and treatment of most of disease have been described in great depth relating with dosha ,dhatu ,mala of human body constituents .In Ayurvedic classics , Sthaulya (Obesity)  is referred as ‘Medoroga’ and is considered to be a disease of Medodhatu vriddhi . A variety of different types of treatment have been detailed in Ayurvedic classics. Obesity is a condition in which excess body fat gets accumulated in body to an extent that it may impair health .It is a global problem increasing progressively .It occurs as a result of lack of physical activity with increased intake of food. More than 1.4 billion adults are overweight and more than half a billion are obese worldwide. Overweight and obesity are linked to more deaths worldwide than underweight. An increased consumption of highly calorific foods without an equal increase in physical activity leads to an unhealthy increase in weight.

      Obesity is an important metabolic disorder associated with number of potential fatal disease such as onset of diabetics mellitus and heart diseases .Now a days ,treating obesity has become a problem since safe drugs are not available  for long term therapy .In previous days ,some modern drugs were used to treat obesity but these drugs have undesirable side effect like pulmonary hypertension and depression (Galloway et .al. ,1984) .Thyroid hormones were once used to treat obesity but now are contraindicated due to their untoward systemic effect (Kyle et.al. 1966) .    So the need for a safer drug for long term therapy is necessary for obesity. The use of a non-toxic compound with a capacity to hold the weight gain is needed. Sthaulya (Obesity) is a condition in which excessive consumption of fatty food without proper exercise routine   leads to the accumulation of excessive fat in body .This leads to an imbalance of Mamas and Meda Dhatu which results in obesity. Arogyavardhini Vati is described as “Medovinashini “ in Rasratnasamucchaya . It is an effective Ayurvedic preparation that helps to reduce weight by  its Deepan (appetizer) and Pachana (digestive) properties. It also helps to eliminate the waste product from the body because of its Shodhan (detoxification) nature.   Therefore, for this prospective single arm clinical study on Sthaulya  (obesity), Arogyavardhini vati was administered in patients of obesity , which is  well described in  Ayurvedic  classics as Medovinashini for this growing advance disease. Patients of Obesity were selected from OPD and IPD of Shri  Ayurved Mahavidalaya eyam Rugnalaya , Nagpur  .Results were assessed on the basis of fixed subjective and objective criteria and prove to be a good remedy for  Obesity .

Aim and objectives:

1.To review all literature regarding Sthaulya and its co- relation with Obesity

2. To study the disease Sthaulya  (obesity) and its management.

3.To evaluate the efficacy of Arogyavardhini vati in the management of sthaulya (Obesity)

Material and methods:

1. It was an open, single arm, randomized clinical study
2. The patience with clinical sign and symptoms of Sthaulya  (obesity) and supporting laboratory data were selected.

Inclusive criteria :

1. Patient aged between 20 to 60 years, irrespective of sex, occupation, socio economic status.
2. All patients presenting with clinical sign and symptoms of Sthaulya(obesity) as mentioned in Ayurveda texts.
3. BMI more than 25 were taken into consideration for the patient as obese. BMI can be measured by using formula.
4. Standard height and weight chart was took into consideration.

Exclusive criteria

1. Patients below age 20 and more than 60 years of age.
2. Patients suffering from hypothyroidism, C V disease, HTN, DM .
3. Patient with long term steroidal treatment.
4. Patient with other systemic illness.
5. Pregnant ladies and lactating mothers.

 6. Patient not willing for trial.

Content  of Arogyavardhini vati :

Name of the Ingredients( English Name) - Part /  Proportion

1.   Shuddha Parada       (Processed Mercury)      - 1Part

2. Shuddha. Gandhaka   (Processed Sulphur )      - 1Part

3. Lauha Bhasma           (Calcinated Iron )            - 1Part

4. Abharaka Bhasma      (Calcinated Mica )          - 1Part

5. Tamra Bhasma           (Calcinated Copper  )      - 1Part

6. Triphala Churna 

                      Haritaki  (Terminalia chebula)       -2 *3 parts 

                      Bibhitaka(TerminaliabelliricaRoxb)

                      Amalaki (Phyllanthusemblica )

7. Shuddha Shilajatu     ( Processed Black Bitumen)   - 3part

8 Shuddha Gugguluu (Processed Commiphora)         - 4part

9 Chitraka Moola       (Plumbago zeylanica linn)         - 4part

10 Katuki Moola      (Picrorhiza kurroa)                      -22part

11 NimbaPatra Swarasa -for 2days Mardana (Azadirachta indica) (for wet Lavigation)

Time and Duration of study :45 days  follow up for 15days.

Drug administration : 30 patients were given Arogyavardhini vati - 2 tab 500 mg each twice a day with Koshna jala (luke warm water) as anupan .

   Criteria for assessment : (subjective assessment)

1. Angachalatya
2. Atikshudha
3. Kshudraswasa
4. Daurgandhya
5. Swedadhikaya
6. Daurbalya
7. Alasya
8. Nidraadhikya
9. Body mass index –BMI

• Completely absent:0
• Mild presence:1
• Moderate presence:2
• Severe presence:3

Laboratory investigation (objective assessment) :

Following laboratory investigation was done at the time of screening and at the end of the study.

1.Hematological investigations - Hb%, TLC, DLC, ESR.

2.Urine analysis –Routine and Microscopic.

3.Biochemical examinations - PPBS, FBS.

4. Lipid profile - Sr. cholesterol, Sr. triglycerides,  HDL,  LDL.

5.Age specific weight for height table.

OBSERVATION & RESULTS:

The observations and results of the study ‘Clinical study on effect of Arogyavardhini vati in the management of Sthaulya w .r .t Obesity’ were as follows 45 days of administration of Arogyavardhini vati in the patients of Sthaulya. All the patients of this series were explored for investigations, which were carried out before the start of treatment. The status of all the symptoms & signs were also noted down after completion of treatment. Thus the change in the status of symptoms, sign & investigations were recorded.

     1. Showing status of 30 patients Of Sthaulya .

2. Age wise distribution of patients Of Sthaulya.

     3. Gender distribution of patients Of Sthaulya .

• 4. Religion distribution of patients of Sthaulya

Discussion

The data was statistically  assessed on each sign and symptoms of obesity and most of the symptoms were found to be relieved after treatment with intervention of Arogyavardhini Vati in the patients of obesity .Appropriate statistical test were applied on the data. 

Average BMI score before treatment was 33.38 which decreased to 32.52 after treatment of 45 days .Decrease in BMI by 0.55 statistically tested by paired ‘t’ test was 7.12 , p value <0.01 suggested that, Arogyavardhini vati is significant in decreasing BMI.

Sthaulya  is a predominant metabolic disorder, which is described by Charaka in Ashtaunindita Purusha. Excessive indulgence in oily and fatty food, sedentary life style, Divaswapana, Manasika factors like Harshanitya, Manasonivrita etc. along with genetic predisposition play a major role in aetiopathogenesis of Medo and mamans vriddhi. In condition of Mandagni and Medo-Dhatvagni Mandya which leads to excessive formation of improper Meda-Dhatu leading to Sthaulya . Obesity occurs more in female than male and specially increases after marriage mostly might be due to use of IUCD, contraceptive pills, after delivery and in menopausal period etc.  People of all age groups are equally affected by obesity, but the people belonging to age group of 30-40 years, are more prone to obesity. Most of the patients were married, as they were from middle age group and especially the females are more prone to obesity after marriage due to hormonal changes in the body. Occupation plays a major role as the causes of obesity. The people who are having sedentary work are more prone to obesity as compared to the people doing physical work. Socio economic conditions status greatly affect the prognosis of obesity.

Conclusion

From the study conducted, we can see the people belonging to middle class are highly affected whereas people of higher middle class were also affected. Kapha-pittaja Prakriti persons were found more prone to Medovriddhi, so they should be advised proper diet regimens and exercise. The obese people had dominant madhur ras in their diet and the dominant guna was guru.  By applying the non-parametric test Wilcoxon Signed Rank Test, in the Study group, it is proved that the drugs play  significant role in reduction of signs and symptoms of obesity. While considering effect of therapy on individual symptoms it is found that Arogyavardhini vati  is more effective on Aangachalatva, Abhayavaran Shakti, Daurbalya, Atipipasa, Aalsya and Nidraadhikya. Applying paired ”t” test, Sr.Cholesterol, HDL, LDL, Sr.Triglyceride, DL ratio, BMI were significant in the  groups.