Abstract:

Purpose:Obesity is a rapidly increasing metabolic disorder in India. A report states that almost 65% of adult urban Indians are-either overweight or obese or have abdominal obesity. Moreover Obesity is the leading cause for co-morbid diseases like Dyslipidemias, Diabetes, Cardio-vascular disorders including Hypertension, PCOD, Infertility, Osteoarthritis, etc. Atisthoulya is enlisted among the eight morbidity states [Ashta nindita purusha] in Ayurveda. Virechana is principal management procedure for all metabolic diseases including Ati-sthoulya. The present study is carried out to study effect of Virechana procedure in reduction of weight in obesity.

Methods: Total 110 patients between the age of 16 years to 70 years with Body Mass Index above 25 kg/m² attending OPD and IPD of SG Patel Ayurveda Hospital, Anand were studied under the present research. Classical Virechana Procedure including Deepana-Pachana followed by Abhyanatara Snehapana, Virechana and Samsarjana Krama was followed. Virechana schedule of average 15 days. Weight in Kg., Body Mass Index (kg/m²) were assessed before and after the Virechana Procedure.

Results: The observations show that   there is a steady weight loss pattern after deepana-pachana (average 3 days, 1.41 kg), the weight further reduces after Snehapana (after avg.5 days,1.24 kg) and it further continues to decrease after Virechana(after 4 days including Vishrama [rest period] of 3 days, 1.47 kg). Thus after the treatment of nearly 15 days of Virechana schedule, average 4.61 kg weight loss was observed.

Conclusion: Virechana was found to be an effective measure for weight reduction in obesity.

Keywords: Sthoulya, Obesity, Virechana

Introduction

India is slowly developing into a capital for metabolic diseases like Diabetes and Obesity. A survey report of 2012 states that almost 65% of adult urban Indians are-either overweight or obese or have abdominal Obesity. [1] Moreover, Obesity is the leading cause for co-morbid diseases like Dyslipidemias, Diabetes, Cardio-vascular disorders including Hypertension, PCOD, Infertility, Osteoarthritis and other such disorders. Many patients are being advised to reduce weight to get freed from their sufferings. Ayurveda enlists ‘Atisthoulya’ [morbid Obesity] among the eight morbid disease conditions [Ashta nindita dosha]. All the classical texts have given due importance to this disorder in reference to the Apatarpana [procedures that lead to depletion of tissue elements resulting in weight loss].

Ayurvedic texts like Charaka Samhita,[2,3] Ashtanga Hridaya[4] have prescribed Samshodhana Chikitsa [bio-purification measures] for the treatment of Santarpanajanya vyadhi [diseases due to over-nutrition] like Sthoulya [Obesity]. Vamana [therapeutic emesis], Virechana [therapeutic purgation], Lekhaniya Basti [therapeutic enemata forreducingcorpulence] are the most common procedures advised in the management of Obesity. Considering the co-morbidity of cardio-vascular diseases like Hypertension, convenience to the busy schedule patients, Virechana can be the safest procedure for elimination of Doshas in Obesity. The present clinical study has been conducted to study the effect of Virechana Procedure in overweight and obese patients.

Aims and Objectives

The present research was aimed to study the effect of Virechana on reducing weight and Body Mass Index [BMI] of the obese patients.

Material and Methods

Total 110 patients of Overweight and Obesity from the OPD and IPD of SG Patel Ayurveda Hospital were studied under the present research trial. All patients were administered Virechana procedure as per classical protocol.

Inclusion criteria:

1. Overweight and Obese patients with BMI above 25 were included for the study irrespective of their sex, religion, occupation.
2. Patients between the age of 16 years to 70 years are included.

Exclusion criteria:

1. Patients who had BMI below 25 were excluded.
2. Patients aged below 16 years and above 70 years were excluded.
3. Patients with serious systemic diseases like AIDS, Cancer, Coronary Artery Disease, Systemic Lupus Erythematosus etc. were excluded from the study.
4. Patients not suitable for Virechana as per the classics like those with Raktapitta, Ajeerna, Nava Jwara,Garbhini, weak etc. were also excluded from the study.

Methods:

Classical Virechana Procedure includes Deepana-Pachana [ promotion of digestion and metabolism], followed by Abhyanatara Snehapana [oleation] until symptoms of proper oleation [Samyak Snigdha Lakshana] are observed, actual administration of purgative medicine [Virechana] and post therapeutic dietetic schedule [Samsarjana Krama]. The patients were advised to follow a stipulated diet and lifestyle throughout the Virechana schedule for average 15 days. For Deepana-Pachana, Chitrakadi vati, Trikatu churna were administered. For snehapana, Tiktaka Ghrita, Mahatiktaka Ghrita or Panchatiktaka Ghrita [5] were prescribed. Total 36 patients with BMI between 25-30 kg/m²were prescribed Panchatikta ghrita; Total 26 patients with BMI between 31-35 kg/m² were prescribed Tiktaka ghrita; whreas total 26 patients with BMI above 35 kg/m² were prescribed Mahatikta ghrita.For purgation Triphala kashayam with Eranda taila and Avipattikara churna were prescribed .

Student’s ‘t’ test was applied in assessment markers of weight and BMI for statistical analysis. P

Assessment criteria:

Weight in Kg., Body Mass Index ( kg/m²) were assessed before and after Virechana Procedure.

       Observation and Results

Table 1: Data of 110 patients of Obesity

* Weight gain was observed in one patient.

Table 2: Effect of Virechana on weight and Body Mass Index

X –Axis: Weight in Kgs 1:Start day. 2:After Deepana Pachana. 3:After Snehapana 4:After Virechana 5:After Samsarjana krama

Y-Axis: Weight in Kg

Graph 1 : Weight loss pattern during Virechana

A total of 110 patients were enrolled in the present study, out of which 65 were female and 45 were male. The observations and results of the treatment are shown in the tables 1 and 2. The pattern of weight loss during the procedure is shown in graph 1.

The observations show that there is a steady weight loss pattern after deepana-pachana ( average 3 days, 1.41 kg), the weight further reduces after Snehapana ( after avg.5 days,1.24 kg) and it further continues to decrease after virechana( after 4 days including vishrama of 3 days, 1.47 kg). It decreases minimally after Samsarjana krama. Thus after the treatment of Nearly 15 days of Virechana schedule, average 4.60 kg weight loss was observed. Earlier, when the pilot study was conducted on 25 patients, average 5.08 Kg weight loss was observed.[6]  

Discussion

Graph 2: Mode of action of Virechana

The mode of action of Virechana in reducing weight needs to be discussed. Sthoulya is predominantly a Rasaja Vikara [diseases of nutrient fluid tissue] as per Sushruta.[7] Charaka states it as a Medoja vikara [diseases of fats and lipids].[8]

In the pathology of Sthoulya, the agni-vyapara [metabolism] has been emphasized. The Vata obstructed by morbid Medas stimulates the Koshthagni [digestive faculty] resulting in series of metabolic changes leading to Obesity. Agnimandya at the level of Rasa and Meda dhatu is needs to be corrected. Virechana is the Shodhana procedure which corrects the Agni at gross level as well as Dhatu level. As observed the Deepana Pachana drugs can remove the obstruction at the Dhatu level, followed by Snehapana which can dissolve the Meda dhatu dosha (mainly circulating fats). These wastes can further be eliminated by Virechana procedure. The dissolving of fat into fat is a topic of further study. Mobilization of these fats into mainstream by the procedures like Abhyanga [massage] and Swedana[fomentation] is important milestone for efficacy. Expulsion of these waste products through Purgation further improves the functions of Agni and cleanses body channels. Moreover Virechana can give additional benefits of feeling of well being in sense organs, elimination of doshas from body, Good sleep, correction of appetite and digestion. [9]

The benefits of Virechana as per current understanding may involve following mechanisms. [10]

• Detoxification of inflammatory products in serum
• Reducing inflammation, improving metabolic pathways
• Enhancement of digestion and metabolism
• Improving hepatic metabolism of carbohydrates and fats
• Improving blood and lymph circulation

Thus it can be summarized that Virechana therapy throws out accumulated toxic metabolites, ensures patency of micro and macro channels, optimizes absorption and assimilation of nutrients and pharmacological agents, permits the transport of ions and molecules through the cell membrane, and facilitates the desired pharmacokinetics of the curative remedies administered thereafter. The therapy ensures a disease free milieu interior, which turns receptive to anti aging, and longevity measures termed Rasayanas. [10]

Conclusion

From the present clinical study, it can be stated that Virechana procedure is moderately effective in reducing weight of the obese patients.

Acknowledgement

The author is thankful to the administration and management of Charutar Vidya Mandal’s S.G.Patel Ayurveda Hospital for providing support. The author acknowledges valuable inputs from Dr.Mukund Sabnis, Director, Jeevanrekha Ayurveda, Aurangabad and Dr.Somraj Kharche, Associate Professor, Department of Kayachikitsa, GJPIASR, New Vallabhvidya Nagar.

* Assistant Professor and Consultant, Department of Kayachikitsa,

References

1. http://www.diabetes2bfree.com/blog/rising-prevalence-of-overweight-and-obesity-in-india/ downloaded on 03/07/2012
2. Agnivesha ,’Charaka Samhita’, revised by Charaka and Dridhbala with ‘Ayurveda Dipika’ commentary,by Chakrapanidatta, edited by Vaidya Jadavaji Trikamaji Acharya, Krishnadas Academy, Gopal Mandir Lane,Varanasi -221 001, (India), reprint 2000. Sutra sthna 22/19, pg. 121
3. Agnivesha ,’Charaka Samhita’, revised by Charaka and Dridhbala with ‘Ayurveda Dipika’ commentary,by Chakrapanidatta, edited by Vaidya Jadavaji Trikamaji Acharya, Krishnadas Academy, Gopal Mandir Lane,Varanasi -221 001, (India), reprint 2000.Sutra sthana 23/8, pg. 122
4. Vagbhata, Ashtanga Hridayam, with the commentaries, ‘Sarvangasundara’ of Arunadatta and ‘Ayurvedarasayana’ of Hemadri collated by Dr.Anna Moreshvara Kunte, and Krishna Ramachandra Shastri Navre, edited by Pt. Harishastri Paradakar Vaidya, Krishanadas Academy, Gopal Mandir Lane,Varanasi -221 001, (India), reprint 2000, Sutra sthana 14/12, pg. 101
5. Chakradatta.Kushtha Chikitsa Prakaran.Meharchand Lachchmandas Publication.New Delhi.2000. third edition.pp.301-2
6. Deole YS.Murthy ARV. Effect of Virechana Karma on reduction of weight in management of obesity.Ayurvedamrutam.1[2],2012.pp.5-6.
7. Sushruta, ‘Sushruta Samhita’ with ‘Nibandha Sangrha ‘ commentary by Dallhanacharya, edited by Vaidya Jadavaji Trikamaji Acharya and Narayana Rama Aachrya, ,eigth edition, Chaukhamba Orientalia, post box. no. 1032, Gopal Mandir Lane, Varanasi -221 001, (India) Sutra sthana 15/32. Pp.73
8. Agnivesha ,’Charaka Samhita’, revised by Charaka and Dridhbala with ‘Ayurveda Dipika’ commentary,by Chakrapanidatta, edited by Vaidya Jadavaji Trikamaji Acharya, Krishnadas Academy, Gopal Mandir Lane,Varanasi -221 001, (India), reprint 2000. Sutra sthana 28/15 pp.179
9. Agnivesha ,’Charaka Samhita’, revised by Charaka and Dridhbala with ‘Ayurveda Dipika’ commentary,by Chakrapanidatta, edited by Vaidya Jadavaji Trikamaji Acharya, Krishnadas Academy, Gopal Mandir Lane,Varanasi -221 001, (India), reprint 2000. Siddhi sthana 1/17 pp.680
10.  Murthy ARV, Deole YS. Potentials of Ayurvedic Panchakarma procedures with a review on targeted actions of Virechana. Vishva Ayurveda Parishad Journal.May-June 2014.pp.31-37.