IJAMS I International Journal of Ayurveda & Medical ...ijams.org.in/wp-content/uploads/2015/05/comparative-clinical-study... · classics have mentioned Lekhana Basti, [4, 5] and Vamana

IJAMS I International Journal of Ayurveda & Medical Sciences ISSN: 2455-6246

ABSTRACT

A Comparative Clinical Study of Shamana and Shodhana Purvaka Shamana in the Management of Sthaulya (Obesity)

Ranjip Kumar Dass, Pradip Kumar Panda 1

Department of Panchakarma, Government Ayurved College, Raipur, Chattisgarh, 1 Department of Roganidan, Government Ayurved College, Balangir, Odisha, India

INTRODUCTION

Twenty first century, marked by continuously changing life

styles, environment and dietary habits, has made man the victim of

many diseases. Sthaulya is one of them, which is mentioned among

Santarpanajanita Vyadhi, [1] (diseases due to over nutrition) as well

as Shlesmaja Vikara, [2]

(diseases due to Kapha Dosha) in Ayurvedic

text. Sthaulya is one of the most effective disease which affect

someone social, physical and mental features. Lack of physical

activity along with increased intake of food, industrialization, stress

during the work, various varieties of the junk food e.g. fast food,

frozen food, bakery items, increased amount of soft drinks results in

Sthaulya. Sthaulya is not only physical problem but it is also having

social and psychological impact. Due to increasing awareness

towards the physical fitness, every layman wants to be slim and

trim, when he or she doesn’t achieve this goal they develop

inferiority complex and it creates social and psychological problem

for them. So obesity is the disease, which is attracting scientists at

global level.

Panchakarma is the heart of Ayurvedic treatment. Its mainly

consider as Shodhana (bio-purification) therapy. Acharya Charaka

quoted that there is a chance of recurrence in disease treated by

Shamana therapy but Shodhana therapy cures the disease from its

root and there is no chance of recurrence. [3]

It has been discussed

above that it is a difficult task to reduce Meda (fat) and to pacify the

Samana Vata (a subtype of bio–humor Vata) at same time.

Panchkarma can provide better solution to this problem. Ayurvedic

classics have mentioned Lekhana Basti, [4, 5]

and Vamana Karma

among the Shodhana Chikitsa for Sthaulya.

Kutki root contains lots of powerful glucosides such as

cucurbatacin, pictrohizin, benetic acid, vanillic acid, D-mannitol,

and Kutkisterol, [6] etc many of which help to lower cholesterol (In a

study of over 100 subjects with high cholesterol there was a

significant drop in cholesterol by almost 30% with no side

effects).[7]

Again, Kutki root powder contains the phytochemical

Kutkoside as well as antioxidant flavonoids, which shields the liver

from toxins. Kutki also contain Kutkin & Picrorhizin, which shows

hepatoprotective properties and protects liver against toxins. As liver

synthesizes cholesterol & fatty acids and helps in cholesterol

degradation in our body, so it is used to lower the high cholesterol

level. Kutki also improves the gall bladder secretions, which helps in

digestion and metabolism of fats. For all above properties, Kutki has

been selected as a drug of choice for Shamana therapy in the

management of obesity.

Aims and Objectives of this study

1. To study the disease Sthaulya.

ORIGINAL RESEARCH ARTICLE (CLINICAL)

Nowadays Sthaulya (Obesity) is one among the most burning problem of our society because of this modern age of machine and

materialism. Western lifestyle has made the man to forget the laws of nature. So, no one is bothered about their balanced diet as well as

style of living. Panchakarma is the heart of Ayurvedic treatment and can provide better solution to this problem. Ayurvedic classics

have mentioned Lekhana Basti (medicated enema containing Ayurvedic drugs for reducing weight) and Vamana Karma (a process of

emesis) among the Shodhana Chikitsa for Sthaulya, whereas Kutki Churna acts by its Medohara property on the basis of Tikta (bitter)

Rasa, Laghu (light)- Ruksha (dry) Guna, Katu Vipaka and actions like Lekhana (depletive), Medo-Vasa-Sleshma Upashoshana

(desiccant of fat) etc. In this research work, 102 patients were registered and randomly divided into 3 groups- Group A: Kutki Churna

(powder of Picrorhiza kurrooa) [As Shamana (palliative) therapy], Group B: Vamana Karma + Kutki Churna, Group C: Lekhana

Basti + Kutki Churna. The result of the study shows that Group C provided better relief compared to Group A and B in the

management of Sthaulya.

Key words: Basti, Kutki, Sthaulya, Lekhana, Obesity, Shodhana, Shamana, Vamana

Corresponding author: Dr. Ranjip Kumar Dass,

Associate Professor, Department of Panchakarma,

Govt. Ayurved College, Raipur, Chattisgarh, India.

Email: [email protected]

mailto:Email:%20drranjipayu

Dass and Panda: Comparative Clinical Study of Shamana and Shodhana Purvaka Shamana in Management of Sthaulya (Obesity)

International Journal of Ayurveda & Medical Sciences I April - June 2017 I Vol 2 I Issue 2 31

2. To evaluate the efficacy of Vamana Karma in the management of

Sthaulya.

3. To evaluate the efficacy of Lekhana Basti in the management of

Sthaulya.

4. To evaluate the efficacy of Kutki Churna in the management of

Sthaulya.

5. To compare the efficacy of Vamana and Lekhana Basti along

with Kutki Churna in the management of Sthaulya.

MATERIALS AND METHODS

Study participants

In the present study total 102 obese patients were registered for

the treatment of Sthaulya irrespective of sex, religion, occupation

etc. from O.P.D. and I.P.D. of Panchakarma Hospital, M.S.M.

Institute of Ayurveda, Khanpur Kalan (Haryana) and Govt. Ayurved

College, Raipur (Chattisgarh), out of which total 90 Patients

completed the full course while 12 patients left the treatment at

different stages (LAMA).

Inclusion criteria

1. Age between 15 - 60 years.

2. The patients having clinical signs and symptoms of Sthaulya.

3 Standard height – weight chart was also taken into

consideration.

4. B.M.I. (Actual body weight divided by the height squared)

criteria was followed for selection of patients.

Exclusion criteria

1. Age < 15 years or > 60 years.

2. Patients with hypothyroidism.

3. Patients with long term steroid treatment.

4. Patients with severe hypertension.

5. Patients with evidence of renal, hepatic and cardiac

involvement.

6. Patients with diabetes mellitus.

Ethical clearance

Informed consent of the participants was obtained and the study

was approved by the Institutional Ethics Committee (IEC) vide

registration no. 20/2015N/Ayurveda.

Design of Groups

All the registered cases were divided randomly into following

three therapeutic groups -

Group A (n=36): Patients were given Kutki Churna 3 gms twice a

day, ½ hour before meal in the duration of 1½ months

Group B (n=32): First Vamana Karma was performed as per

classical method according to Charaka, [8]

and Sushruta, [9]

followed

by Kutki Churna (as in Gp. A) given as a Shamana therapy

Group C (n=34): Patients were administered Lekhana Basti daily

for 15 days as per the classical method, [10]

followed by Kutki

Churna (as in Gp A) given as a Shamana therapy.

Table 1: Status of 102 Patients of Sthaulya

No. of Patients Total %

Group A Group B Group C

Completed 30 30 30 90 88.24

LAMA* 6 2 4 12 11.76

Total 36 32 34 102 100

*LAMA - Leaving Against Medical Advice

Drug Review

In Vamana Group, Til Tail (oil of Sesamum indicum) was used

as Abhayantara Snehapana (internal oleation) because of its Kapha-

Vatahara and Medohara property. Madanphala Pippali (Randia

dumetorum), Vacha (Acorus calamus), Saindhava Lavana (Rock

Salt) and Yastimadhu Phanta (Glycyrrhiza glabra) were used as a

Vamaka (emetics)/Vamanaopaga Dravya (emesis helping drugs).

Drugs of Lekhana Basti were Triphala, Tuttha Bhasma (Copper

Sulphate), Kasisa Bhasma (Ferrous Sulphate), Shilajita (Black

asphaltum), Hingu (Asafoetida), Yavakshara (Potash/Hordeum

vulgare), Saindhava, Madhu (Honey), Til Tail, and Gomutra (Cow’s

Urine). Most of the drugs were having Kattu-Tikta-Kashaya Rasa,

Laghu-Tikshna-Sukshma Guna, Ushna Virya, Katu Vipaka and

Kapha-Vatahara property.

Kutki Churna was used as Shamana drug in both the groups. It

was prepared as per the method described in ‘Sharangadhara

Samhita’.

Assessment criteria

Total assessment of the therapy was done on the basis of ‘subjective

parameters’ such as relief in the sign and symptoms mentioned in

classics as well as ‘objective parameters’ like Weight, BMI, Skin

fold Thickness, Body Circumference and Biochemical parameters.

1. Angachalatva (body movement) :

- Absence of Chalatva - 0

- Little visible movement after fast movement -1

- Little visible movement after moderate movement – 2

- Movement after mild movement - 3

- Movement even after changing posture - 4

2. Atikshudha (Excessive hunger):

Atikshudha was decided on the basis of Abhyavaharana Shakti

and Jarana Shakti.

a. Abhyavaharana Shakti (appetite):

- Person taking food in less quantity once a day - 0

- Person taking food in less quantity twice in a day - 1

- Person taking food in moderate quantity twice in a day - 2

- Person taking food in normal quantity twice in a day - 3

- Person taking food in excessive quantity twice or thrice – 4

b. Jarana Shakti (digestive capacity):

- According to presents of Jirna Ahara Lakshana (M.N. 6/24)

Utsaha, Laghuta, Udgara Shuddhi, Kshudha-Trisha Pravritti,

Yathochita, Malotsarga.



- Presence of two symptoms after 6 hours - 0

- Presence of three symptoms after 5 hours - 1

- Presence of four symptoms after 5 hours - 2

- Presence of all symptoms after 4 hours - 3

- Presence of all symptoms within 4 hours - 4

3. Kshudraswasa (Dyspnoea after heavy works):

- Dyspnoea after heavy works but relieved soon and upto tolerance -

0

- Dyspnoea after moderate works but relieved later and uptotolerance

- 1

- Dyspnoea after little works but relieved later and upto tolerance - 2

- Dyspnoea after little works but relieved later and beyond tolerance-

3

- Dyspnoea in resting condition - 4

4. Gatrasada (fatigue):

- No fatigue - 0

- Little fatigue in doing hard work - 1

- Moderate fatigue in doing routine work - 2

- Excessive fatigue in doing routine work - 3

- Excessive fatigue even in doing little work - 4

5. Daurgandhya (bad smell):

- Absence of bad smell - 0

- Occasional bad smell in the body removed after bathing - 1

- Persistent bad smell limited to close areas difficult to suppress

with deodarants -2

- Persistent bad smell felt from long distance is not suppressed by

deodarants - 3

- Persistent bad smell felt from long distance even intolerable to

the patient himself -4

6. Swedadhikya: (at normal temperature in normal condition):

- Sweating after heavy work and fast movement or in hot season -

0

- Profuse sweating after moderate work and movement - 1

- Sweating after little work and movement - 2

- Profuse sweating after little work and movement - 3

- Sweating even at rest or in cold season - 4

7. Atipipasa (excessive thirst):

- Normal thirst - 0

- Upto 1 litre excess intake of water - 1

- 1 to 2 litre excess intake of water - 2

- 2 to 3 litre excess intake of water - 3

- More than 3 litre of water - 4

8. Snigdhangata (Oily luster of body):

- Normal Snigdhata - 0

- Oily luster of body in summer season - 1

- Oily luster of body in dry season - 2

- Excessive oily luster of body in dry season which can be

removed with difficulty - 3

- Persistence and profuse stickiness all over body – 4

9. Daurbalya (weakness):

- Can do routine exercise – 0

- Can do moderate exercise without difficulty – 1

- Can do only mild exercise – 2

- Can do mild exercise with very difficulty - 3

- Cannot do even mild exercise – 4

10. Alasya (laziness):

- No Alasya (doing work satisfactory with proper vigour in time) –

0

- Doing work satisfactory with initiation late in time – 1

- Doing work unsatisfactory with lot of mental pressure and late in

time – 2

- No starting any work in his own responsibility doing little work

very slowly - 3

- Does not have any initiation and not wants to work even after

pressure – 4

11. Nidradhikya (Excessive sleep):

- Normal sleeps 6-7 hrs/ day – 0

- Sleep upto 8 hrs /day with Angagaurava – 1

- Sleep upto 8 hrs /day with Angagaurava and Jrimbha – 2

- Sleep upto 10 hrs/day with Tandra – 3

- Sleep more than 10 hrs /day with Tandra and Klama – 4

Overall Assessment of Therapy

<25 % Relief – Unchanged.

25 - 50 % Relief – Minor Improvement.

50- 75 % Relief – Moderate Improvement.

>75 % Relief – Marked Improvement.

100% Relief – Complete Remission.

Laboratory Investigations

1. Routine Hematological, Urine and Stool examinations were done

to know the present status of patient, as well as to exclude other

pathological conditions.

2. Biochemical test like Serum Cholesterol, Serum Triglyceride,

Serum HDL (High-Density Lipoproteins), Serum LDL (Low-

Density Lipoproteins), Serum VLDL (Very-Low-Density

Lipoproteins), and Serum Creatinine were carried out before

starting, and after completion of treatment.

Procedure

1) In Group A- Kutki Churna was given 3 gms twice a day, ½ hour

before meal in the duration of 1½ months

2) Group-B - Vamana Karma along with Kutki Churna.

Vamana Karma was performed as per classical method according

to Charaka and Sushruta

Snehapana (Internal Oleation) : By Til Tail

Sarvanga Abhyanga (Whole Body Massage): By Bala Tail

Sarvanga Swedana (Whole Body Fomentation): By Baspa Sweda

(Steam Bath)

Yastimadhu Kwatha (Decoction of Glycyrrhiza glabra):

Approximately 3 liters

Madanphala Pippali (Randia dumetorum): Antarnakha Musti

Pramana



Saindhava Lavana (Rock Salt): Quantity Sufficient

Madhu (Honey): Quantity Sufficient

3) Group-B - Lekhana Basti along with Kutki Churna.

Lekhana Basti was given daily in the duration of 15 days as per

the classical method.

Triphala Kwatha : 200 – 300 Ml.

Madhu (Honey) : 80 gms.

Saindhava Lavana : 5 gms.

Til Tail : 90 Ml.

Kalka (Paste) of Shilajit, Tuttha Bhasma,

Kasis Bhasma, Hingu, Yavakshara : (2gms each) 10 gms.

Gomutra (Cow’s Urine) : 100 ml

In both the groups, Kutki Churna was given as a

Shamana therapy after Sansarjan Krama and In Basti group next

day after the completion of the Basti.

-Dose: 3gms. Twice a day - Duration: for 1½ months.

- Anupana: warm water. - Time: half hour before meal.

Follow up Period

After completion of treatment, follow up was maintained for one

month.

Total Duration of Therapy

3 months (including follow up period).

Data analysis

For statistical analysis of observations and results, percentage

change was calculated and the paired ‘T’-test and independent ‘T’-

tests were used.

OBSERVATIONS AND RESULTS

Table 2: Sex Wise Distribution of 102 Patients of Sthaulya

Sex No. of Patients Total %

Group–A Group–B Group–C

Male 11 8 6 25 24.50

Female 25 24 28 77 75.49

Table 3: Religion Wise Distribution of 102 Patients of Sthaulya

Religion No. of Patients Total %


Muslim 15 5 4 24 23.52

Hindu 21 27 30 78 76.47

Table 4: Marital Distribution of 102 Patients of Sthaulya

Marital No. of Patients Total %


Married 24 17 23 64 62.74

Unmarried 10 14 7 31 30.39

Widow 2 1 4 7 6.86

In the above study, majority of 75.49% patients were

female, 76.47% patients were hindus, 62.74% patients were married,

45.09% patients were housewife, maximum 85.28% were having

Kapha predominant Prakriti either related with Vata or Pitta,

maximum 57.84% patients were having dietetic habit of

Adhyashana (excess eating), 62.74% were having Pravara

(superior) Abhyavahrana Shakti and 65.68% patients were having

positive family history. Among the female patients, 42.85% were

reported history of irregular menses followed by 24.67%

menopausal history. Maximum 53.92% patients were consuming

excess 300-600 Kcal /day.

Table 5: Pramana (Measurement) Wise Distribution of 102

Patients of Sthaulya Weight in Kg. No. of Patients Total %


65-75 11 9 10 30 29.41

76-85 16 14 8 38 37.25

86-95 5 3 9 17 16.67

96-105 2 2 2 6 5.88

106-115 2 2 3 7 6.86

116-126 0 2 2 4 3.92

Atibhojana (excessive eating) 64.70%, Guru Ahara

(heavy diet) 74.50%, Snigdhahara (oily diet) and Ati Madhura

Ahara (sweet diet) 66.67% were reported as Aharatmaka Nidana

(dietary pathology). Maximum 66.67% patients reported

Harshanityatvata (joyfulness) as Manashika Nidana (mental

pathology) while 66.67 % patients were reported Divaswapna (day

sleep) as Viharatmaka Nidana (habitat pathology).

100 % patients reported Bharavriddhi (weight gain), 74.50%

patients reported Angachalatva and 72.54% reported Atikshudha as

chief complain. 80.39% patients were reported Alasya and 64.70%

were reported Gatrasada as associated complain.

100 % patients reported Kapha Dushti as well as Medovaha

and Rasavaha Srotodushti. Majority 81.25% patients required 4- 5

days for Snehapana, maximum 43.75% patients reported Pravara

Vamana Vega (vomiting) and 70.58% patients showed Basti

Retention time between 10 -15 minutes.

Effects of trial drugs

Effect of Kutki Churna Group (Group A)

In this group, total 36 patients were registered and 6 patients had left

the treatment (LAMA). Effect of Kutki Churna on 30 patients is

being presented here.

Table 6:Effect on Signs and Symptoms of 30 Patients of GroupA

Symptoms Mean Score %

Relief Mean S.D. ± S.E. ±

t P

B.T. A.T.

Daurbalyata

(Weakness)

1.4 0.7 50 0.7 0.82 0.26 2.69 <0.05

Kshudraswasa

( Dyspnoea)

0.8 0.5 37.5 0.3 0.48 0.15 1.96 >0.05

Swedadhikya

(Profuse Sweating)

2.1 1.4 33.33 0.7 0.48 0.15 4.58 <0.01

Daurgandhya

(Bad Smell)

1.5 1.0 33.33 0.5 0.53 0.17 3.00 <0.05

Atipipasa

(Excess Thirst)

1.1 0.8 27.27 0.3 0.48 0.15 1.96 >0.05

Atikshudha

(Excess Appetite)

0.3 0.1 66.66 0.2 0.42 0.13 1.50 >0.05

Gatrasada

(Fatigue)

1.3 0.5 61.00 0.8 0.42 0.13 6.00 <0.001

Angachalatva

(Movements)

2.2 1.8 18.18 0.4 0.52 0.16 2.45 <0.05

Snigdhangata

(Oilyluster of body)

1.3 0.8 38.46 0.5 0.71 0.22 2.24 >0.05

Alasya (Lazyness) 1.4 0.8 42.86 0.6 0.52 0.16 3.67 <0.01

Nidradhikya

(Excess Sleep)

1.0 0.7 30.00 0.3 0.48 0.15 1.96 >0.05



In this Group, 18.18% relief was observed in Angachalatva which

was significant (P<0.05). Relief in Daurbalyata was 50% which was

also significant (P<0.05). Relief in Alpavyavaya was 66.66%, in

Kshudraswasa 37.5%, in Atipipasa 27.27%, in Snigdhangata

38.48% and in Nidradhikya 30.00% was observed. All these relief

were statistically insignificant (P>0.05). Relief in Swedadhikya was

3.33% and in Alasya 42.86%, both being statistically significant

(P<0.01). Relief in Daurgandhya was observed 33.33%, which was

statistically significant. Relief in Gatrasada was 61%, which was

statistically highly significant (P<0.001).

Table 7: Effect on Weight and B.M.I. of 30 Patients of Group A

In this Group, 2.48% reduction in body weight and 2.34%

reduction in B.M.I. was observed. Both these results were

statistically highly significant.

Table 8: Effect on Circumference and Skin fold Thickness of 30

Patients of Group A

Decrease in various body circumferences i.e. in chest circumference

0.65%, in abdominal circumference 2.49%, in hip circumference

1.48%, in mid thigh circumference 1.54%, in mid calf circumference

1.73% and in mid arm circumference 3.37% were observed in

Group-A. Except chest and mid arm circumference, all the results

were statistically highly significant (P<0.01).

Decrease in various skin fold thickness i.e. in

biceps thickness 3.39%, in triceps thickness 8.28%, in scapular

thickness 2.04%, in abdominal skin fold thickness 11.05% and in

thigh skin fold thickness 5.8% were observed. Except abdominal

skin fold thickness, all the results were statistically insignificant

(P<0.05). While highly significant result was observed in abdominal

skin fold thickness.

Table 9: Effect on Dosha Dushti of 30 Patients of Group A

54% effect on Vata Doshadushti, 49.86% on Pitta

Doshadushti and 52.26% on Kapha Doshadushti were observed in

Group A, which were statistically highly significant (P<0.001).

Table 10: Effect on Srotodushti of 30 Patients of Group A

53.04% relief in Rasavaha Srotodushti Lakshana, 48.90% in

Medovaha Srotodushti Lakshana, 52.47% in Swedavaha and

54.23% relief in Udakavaha Srotodushti Lakshana were observed in

Group A, which were statistically highly significant (P<0.001).

Table 11: Effect on Biochemical Parameters of 30 Patients of

Group A Biochemical

Parameter

Mean Score %

Relief Mean

S.D.

±

S.E.

±

t P

B.T. A.T.

S. Cholesterol 173.12 162.88 5.91 10.23 16.57 5.52 1.85 >0.05

S.Triglyceride 114.9 106.9 6.96 8.00 60.91 18.45 0.43 >0.05

S. HDL 36.97 43.50 17.66 +6.53 8.24 2.75 +2.38 <0.05

S. VLDL 20.70 19.59 5.36 1.11 15.41 4.28 0.25 >0.05

S. LDL 86.98 83.37 4.15 3.61 24.02 7.11 0.50 >0.05

5.91% decrease in S.Cholesterol, 24.70% decrease in

S.Triglyceride, 5.36% decrease in S.VLDL and 4.15% decrease in

S.LDL were observed in Group-A. These all are statistically

insignificant (P>0.05). 17.66% increased in HDL cholesterol was

noted, which was statistically significant (P<0.05).

Effect of Vamana Karma + Kutki Churna Group (Group B)

Table 12: Effect on Sign and Symptoms of 30 Patients of Group

B

Symptoms

Mean Score %

Relief

Mea

n

S.D.

±

S.E.

± t

P

B.T. A.T.

Weight

(Kg)

76.88 74.97 2.48 1.91 1.46 0.46 4.12 <0.001

B.M.I.

(Kg/m2)

30.29 29.58 2.34 0.71 0.58 0.18 3.86 <0.001

Circumference

(in Inches)

Mean Score %

Relief Mean S.D. ± S.E. ±

t P

B.T. A.T.

Chest 38.40 38.15 0.65 0.25 0.37 0.12 2.11 >0.05

Abdomen 36.90 35.98 2.49 0.92 0.61 0.19 4.74 <0.01

Hip 42.50 41.87 1.48 0.63 0.42 0.13 4.75 <0.01

Mid thigh 21.37 21.04 1.54 0.23 0.16 0.049 4.64 <0.01

Mid calf 14.44 14.19 1.73 0.25 0.18 0.058 4.29 <0.01

Mid arm 11.85 11.45 3.37 0.40 0.41 0.13 3.05 <0.02

Skin fold thickness

Biceps 1.18 1.14 3.39 0.04 0.084 0.027 1.5 >0.05

Triceps 1.57 1.44 8.28 0.23 0.45 0.14 1.6 >0.05

Scapular 1.47 1.44 2.04 0.03 0..67 0.021 1.4 >0.05

Thigh 2.07 1.95 5.80 0.12 0.17 0.055 2.17 >0.05

Dosha

Mean Score

%

Relief

Mean S.D.

± S.E. ±

T P

B.T. A.T.

Vata

3.00 1.38 54.00 1.62 0.77 0.21 7.58 <0.001

Pitta 3.67 1.84 49.86 1.83 0.58 0.17 11.00 <0.001

Kapha 3.54 1.69 52.26 1.85 0.55 0.15 12.00 <0.001

Srotas

Mean Score

%

Relief Mean

S.D.

±

S.E.

±

T P

B.T. A.T.

Medovaha 3.62 1.85 48.90 1.77 0.73 0.20 8.80 <0.001

Rasavaha

3.62 1.70 53.04 1.92 0.64 0.18 10.83 <0.001

Swedavaha 3.64 1.73 52.47 1.91 1.14 0.34 5.57 <0.001

Udakavaha 3.43 1.57 54.23 1.86 0.69 0.26 7.12 <0.001

Symptoms Mean Score %

Relief Mean S.D.

±

S.E.

±

t P

B.T. A.T.

Daurbalyata

(Weakness)

1.33 0.58 56.34 0.75 0.86 0.22 3.40 <0.01

Kshudraswasa

( Dyspnoea)

1.33 0.33 75.80 1.00 0.85 0.25 4.00 <0.01

Swedadhikya

(Profuse Sweating)

1.41 0.50 64.53 0.91 0.79 0.23 3.95 <0.01

Daurgandhya

(Bad Smell)

0.91 0.50 45.05 0.41 0.66 0.18 2.27 <0.05

Atipipasa

(Excess Thirst)

2.08 0.83 60.09 1.25 0.75 0.22 5.68 <0.001

Atikshudha

(Excess Appetite)

1.50 0.67 55.33 0.83 0.57 0.16 5.18 <0.001

Gatrasada

(Fatigue)

1.46 0.63 56.84 0.83 1.02 0.30 2.76 <0.05

Angachalatva

(Movements)

2.36 1.79 24.15 0.57 0.53 0.20 2.83 <0.05

Snigdhaangata

(Oily Luster of

Body)

1.00 0.59 41.00 0.41 0.51 0.15 2.73 <0.05

Alasya (Lazyness) 2.32 0.82 64.65 1.50 0.79 0.23 6.52 <0.001

Nidradhikya

(Excess Sleep)

1.65 0.65 60.60 1.00 0.73 0.21 4.76 <0.001



In this Group, relief in Alasya was 64.65%, Nidradhikya 60.60%,

Atipipasa 60.09%, Atiksudha 55.33% and all these result were

statistically highly significant (P <0.001). Effect on Kshudrashwasa

was 75.80%, Swedadhikya was 64.53%, Daurbalyata was 56.34%

and all this result were statistically significant (P <0.01). Relief

observed in Gatrasada, Daurgandhya, Snigdhaangta, Angachaltva

was 56.84%, 45.05%, 41.00%, 24.15% respectively and all these

result were also statistically significant (P <0.05).

Table 13: Effect on Weight and B.M.I of 30 Patients of Group B

Criteria Mean Score %

Relief Mean S.D.

±

S.E.

±

t P

B.T. A.T.

Weight (In Kg) 80.58 77.83 3.41 2.75 1.81 0.53 5.18 <0.001

B.M.I (Kg/m2) 36.80 35.39 3.83 1.41 1.04 0.30 4.70 <0.001

In this Group, 3.41% reduction was observed in body

weight and 3.83 % reduction in B.M.I. Both these results were

statistically highly significant (P <0.001).

Table 14: Effect on Circumference of 30 Patients of Group B

Decrease in various body circumference i.e. chest, abdomen,

hip and mid thigh, mid calf and mid arm circumference was 2.60%,

3.81%, 2.48%, 4.59%, 3.09%, 3.78% respectively in Group B. All

the results were statistically highly significant (P <0.001), except

mid calf (P <0.01), and an average 3.39% reduction was observed in

the measurement of different body circumference.

Table 15: Effect on Skin Fold Thickness of 30 Patients of Group

B

Skin fold

Thickness

(in cm.)

Mean

Score

%

Relief Mean

S.D.

±

S.E.

±

t P

B.T. A.T.

Biceps 2.50 2.40 3.96 0.10 0.026 0.008 11.22 <0.001

Triceps 2.66 2.54 4.51 0.12 0.05 0.015 7.50 <0.001

Scapular 3.58 3.45 3.76 0.13 0.043 0.013 9.92 <0.001

Thigh 3.88 3.73 3.86 0.15 0.032 0.010 10.92 <0.001

3.96%, 4.51%, 3.76%, 3.86% reduction was found in

biceps, triceps, scapular and thigh skin fold respectively in Group B.

All the results were highly significant (p<0.001). Average 4.02%

reduction was observed.

Table 16: Effect on Dosha Dushti (Vitiation of Dosha) of 30

Patients of Group B

Dosha Mean Score %

Relief Mean

S.D.

±

S.E.

±

t P

B.T. A.T.

Vata 1.41 0.58 58.86 0.83 0.83 0.24 3.45 <0.01

Pitta 1.50 0.50 66.66 1.00 0.60 0.17 5.88 <0.001

Kapha 1.83 1.08 59.00 0.75 0.66 0.19 5.68 <0.001

Relief in Pitta Dushti lakshana (signs and symptoms) was

66.66% and Kapha Dushti lakshana was 59%, which were

statistically highly significant at the level P<0.001 in Group-B.

Improvement in Vata Dushti Lakshna was 58.86%, which was

statistically significant at the level P<0.01.

Table 17: Effect on Srotodushti (Vitiation of Srotasa) of 30

Patients of Group B

Srotas Mean Score %

Relief Mean S.D.

±

S.E.

±

t P

B.T. A.T.

Medovaha 2.08 0.92 55.70 1.16 0.57 0.16 7.25 <0.001

Rasavaha 1.66 0.58 65.60 1.08 0.66 0.19 5.68 <0.001

Swedavaha 1.37 0.46 67.00 0.91 0.79 0.23 3.95 <0.01

Udakavaha 1.36 0.44 67.00 0.92 0.64 0.17 5.41 <0.001

Relief in Medovaha Srotodushti, Rasavaha Srotodushti and

Udakvaha Srotodushti were 55.70%, 65.60%, 67% respectively in

Group B. All these result were statistically highly significant (P

<0.001). Improvement in Swedavaha Srotodushti was 67%, which

was statistically significant (P<0.01).


Group B

4.95%, 3.93%, 16.13% and 17.62% reduction was

observed in S.cholesterol, S.Triglyceride, S.VLDL and S.HDL level

respectively in Group B. All these results were statistically

insignificant (P>0.05). The S.LDL level was decreased by 23.91%,

which was statistically significant (P<0.001).

Effect of Lekhana Basti + Kutki Churna Group (Group C)

In this group, a total of 34 patients were registered and 4

patients had left the treatment. Effect of Lekhana Basti + Kutki

Churna on 30 patients is presented here.

Circumference

(in Inches)

Mean Score %

Relief Mean S.D.

±

S.E.

±

t P

B.T. A.T.

Chest 40.00 38.96 2.60 1.04 0.68 0.20 5.20 <0.001

Abdomen 44.58 42.88 3.81 1.70 1.09 0.32 5.31 <0.001

Hip 48.25 47.05 2.48 1.20 0.65 0.19 6.31 <0.001

Mid Thigh 21.78 20.78 4.59 1.00 0.76 0.22 4.64 <0.001

Mid Calf 14.54 14.09 3.09 0.45 0.39 0.11 4.09 <0.01

Mid Arm 13.20 12.75 3.78 0.50 0.36 0.10 5.00 <0.001

Biochemical

Parameters

Mean Score %

Relief Mean S.D.

±

S.E.

±

t P

B.T. A.T.

S.Cholesterol 181.58 172.0 4.95 9.00 22.44 6.6 1.36 >0.05

S.Triglyceride 99.19 95.29 3.93 3.90 37.63 11.06 0.35 >0.05

S.HDL 41.47 34.16 17.62 7.31 11.94 3.51 2.08 >0.05

S.VLDL 19.83 16.63 16.13 3.2 9.02 2.65 1.20 >0.05

S.LDL 115.00 87.5 23.91 27.5 9.56 3.90 7.04 <0.00

1



Table19: Effect on Signs & Symptoms of 30 Patients of Group C

Symptoms

Mean Score %

Relief Mean

S.D.

±

S.E.

±

t P

B.T. A.T.

Daurbalyata

(Weakness)

1.23 0.38 68.29 0.84 0.80 0.22 3.81 <0.01

Kshudraswasa

( Dyspnoea)

1.61 0.23 85.71 1.38 0.96 0.26 5.30 <0.001

Swedadhikya

(Profuse Sweating)

1.38 0.38 72.46 0.1 0.81 0.22 4.54 <0.001

Daurgandhya

(Bad Smell)

0.53 0.20 56.60 0.30 0.48 0.13 2.30 <0.05

Atipipasa

(Excess Thirst)

1.38 0.69 50.00 0.69 0.75 0.20 3.45 <0.01

Atikshudha

(Excess Appetite)

1.69 0.61 63.90 1.08 0.51 0.15 7.20 <0.001

Gatrasada

(Fatigue)

1.61 0.31 80.74 1.30 0.85 0.23 5.65 <0.001

Angachalatva

(Movements)

2.38 1.71 28.15 0.67 0.78 0.22 2.96 <0.05

Snigdhangata

(Oily Luster of

Body)

0.84 0.15 82.14 0.69 0.75 0.20 3.45 <0.01

Alasya (Lazyness) 2.38 0.38 84.03 2.00 0.81 0.22 9.09 <0.001

Nidradhikya

(Excess Sleep)

1.76 0.23 86.93 1.53 1.20 0.31 4.93 <0.001

[Table 19] reveals that 86.93% relief in Nidradhikya, 85.71% in

Kshudraswasa, 84.03% in Alasya, 80.74% in Gatrasada, 63.90% in

Atikshudha and 72.46% in Swedadhikya was observed which was

statistically highly significant (P<0.001). Improvement in Atipipasa,

Snigdhangta and Daurbalyta was 50%, 82.14%, 68.29%

respectively at statistically significant level (P <0.01). The

significant result was observed were 56.60% in Daurgandhya and

28.15% in Angachalatva (P< 0.05).

Table 20: Effect on Weight and B.M.I of 30 Patients of Group C

Criteria

Mean Score %

Relief Mean

S.D.

±

S.E.

±

t P

B.T. A.T.

Weight (In Kg) 80.38 75.31 6.30 5.07 2.81 0.78 6.5 <0.001

B.M.I(Kg/M2) 31.88 29.95 6.02 1.92 1.25 0.34 5.64 <0.001

6.30% reduction in body weight and 6.02% reduction in B.M.I

were observed in Group C. The result was statistically highly

significant (P < 0.001).

Table 21: Effect on Circumference of 30 Patients of Group C

Circumference

(in Inches)

Mean Score %

Relief Mean

S.D.

±

S.E.

±

T P

B.T. A.T.

Chest 40.26 39.26 2.48 1.00 0.67 0.18 5.50 <0.001

Abdomen 45.45 42.49 6.51 2.96 1.60 0.44 6.72 <0.001

Hip 48.03 46.30 3.66 1.73 0.85 0.23 7.52 <0.001

Mid Thigh 23.84 22.69 4.82 1.15 0.71 0.19 6.05 <0.001

Mid Calf 15.04 14.51 3.52 0.53 0.47 0.13 4.07 <0.01

Mid Arm 13.50 12.89 4.51 0.61 0.36 0.10 6.01 <0.001

2.48%, 6.51%, 3.66%, 4.82%, 3.52%, 4.51% reduction was

observed in chest, abdomen, hip, mid thigh, mid calf and mid arm

circumference respectively in Group C. All the results were

statistically highly significant (P <0.001) except mid calf

circumference (P < 0.01), where average 4.25% reduction was

observed.

Table 22: Effect on Skinfold Thickness of 30 Patients of GroupC

Skin fold

Thickness

(in cm.)

Mean Score %

Relief Mean S.D.

±

S.E.

±

t P

B.T. A.T.

Biceps 2.53 2.41 4.34 0.11 0.030 0.008 13.48 <0.001

Triceps 2.68 2.55 4.85 0.13 0.041 0.012 11.03 <0.001

Scapular 3.52 3.36 4.54 0.16 0.036 0.010 15.21 <0.001

Thigh 3.90 3.69 5.38 0.21 0.044 0.012 16.60 <0.001

Reduction in skin fold thickness showed highly

significant result as 4.34%, 4.85%, 4.54%, and 5.38% in biceps,

triceps, scapular, and thigh skin fold respectively in Group C.

Average 4.77% result was reported. All the results were statistically

highly significant (P <0.001).

Table 23: Effect on Dosha Dushti of 30 Patients of Group C

Dosha Mean Score %

Relief Mean

S.D.

±

S.E.

±

t P

B.T. A.T.

Vata 1.76 0.61 65.34 1.15 0.55 0.15 7.66 <0.001

Pitta 1.15 0.46 60.00 0.69 0.75 0.20 3.45 <0.01

Kapha 2.38 0.62 73.94 1.76 0.83 0.23 7.65 <0.001

Improvement in Kapha Dushti lakshana 73.94% and in Vata

Dushti lakshna 65.34% was observed in Group C. Both the results

were statistically highly significant (P<0.001). Improvement in Pitta

Dushti lakshana was 58.26% and the result was statistically

significant (P < 0.01).

Table 24: Effect on Srotodushti of 30 Patients of Group C

Srotas Mean Score %

Relief Mean

S.D.

±

S.E.

±

t P

B.T. A.T.

Medovaha 2.76 0.84 69.56 1.92 0.75 0.20 9.20 <0.001

Rasavaha 1.53 0.53 65.35 1.00 0.70 0.19 5.26 <0.001

Swedavaha 1.28 0.28 78.12 1.00 0.81 0.22 4.54 <0.001

Udakavaha 1.21 0.52 50.00 0.69 0.75 0.20 3.45 <0.01

Improvement observed in Medovaha Sroto Dushti was

69.56%, Rasavaha Sroto Dushti was 65.35% and Swedavaha Sroto

Dushti was 72.46% at statistically highly significant level (P<0.001)

in Group C. 50% relief was observed in Udakavaha Sroto Dushti at

statistically significant level (P<0.01).


Group C

Biochemical

Parameters

Mean Score %

Relief Mean S.D.

±

S.E.

±

t P

B.T. A.T.

S.Cholesterol 186.08 168.20 9.17 17.08 33.87 9.96 1.71 >0.05

S.Triglyceride 135.72 102.19 24.70 33.53 53.13 17.71 1.89 >0.05

S.HDL 39.35 71.94 82.92 +32.63 45.78 13.23 2.46 <0.05

S.VLDL 35.44 31.66 10.68 3.78 1.64 0.55 6.90 <0.01

S.LDL 118.28 75.27 36.36 43.01 50.49 14.02 3.06 <0.01



9.17%, 6.96%, 10.68% and 36.36% reduction was observed

in S.Cholesterol, S.Triglyceride, S.VLDL and S.LDL level

respectively in Group-C. Reduction in S.LDL and S. VLDL level

was statistically significant (P < 0.01), while significant increase in

S.HDL level by 82.92% was observed (P<0.05).

Overall Effect of Therapies

In the present study, total assessment of the therapy was done

based on relief in the signs and symptoms as well as objective

criteria Weight, B.M.I, Skin fold thickness, Body circumference and

Biochemical parameters.

Table 26: Overall Effect of Therapy Observed in GroupA (Kutki

Churna)

Assessment No. of Patients %

Complete Remission 0 0

Marked Improvement 0 0

Moderate Improvement 12 40.00

Minor Improvement 14 46.67

Unchanged 4 13.33

In this group 46.67% showed minor improvement, 40 %

patients were moderately improved while 13.33% patients were

remained unchanged.

Table 27: Overall Effect of Therapy Observed in Group B

(Vamana Karma + Kutki Churna)

In this Group, 40 % patients were moderately improved as

well as showed minor improvement whereas 13.33% patients were

markedly improved and 6.67% were remaining unchanged.

Table 28: Overall Effect of Therapy Observed in Group C

(Lekhana Basti + Kutki Churna)



Marked Improvement 7 23.33



Unchanged 1 3.33

In this Group, 23.33% patients were markedly

improved, 46.67% patients were moderately improved while

26.67% patients showed minor improvement and rest 3.33% patients

remain unchanged.

DISCUSSION

Group C provided better result in improvement of sign and

symptoms, Dosha Dushti lakshana, Sroto Dushti lakshana and in

objective parameters i.e. Weight, B.M.I, Circumference and Skin

fold thickness as compared to Group B and Group A. Moreover

Lekhana Basti Group showed better result in overall effect of

therapy than Vamana Group and Kutki Churna Group.

The probable reasons for better result of the Lekhana Basti

1. It may be due to change in route of administration: To make this

point more clear, Acharya Sushruta has said that the similarly of

spreading water poured at root of the plant reaches up to the

leaves.[11]

This fact is supported by the modern findings that

administration of medicaments in the liquid form or lipid soluble

from into rectum, stimulated the rectum by distension or it may

act systemically after getting absorbed by passive or active

diffusion in mucous membrane of rectum, large intestine and

small intestine.

2. Basti not only eliminates Dosha from the body, but through the

colon (Pakvashaya) the drug is absorbed and reaches up to the

micro channels of the body, which performs the action of

Samprapti Vighatana (breaking of pathogenesis) at cellular

level. It is also supported by our classics.[11]

The important points related to these results are summarised as

follows:

1. Kutki helps in cholesterol degradation in our body and also

improves the gall bladder secretions, which helps in digestion and

metabolism of fats. So it is used to lower the high cholesterol

level.

2. Vamana is the most important measure among Shodhana

therapies. Sthaulya being Medo and Kapha dominant disorder,

Vamana Karma eliminates those excessive Kapha and Meda.

3. In Vamana and Basti Group, Madhu and Til Tail were used. Both

the Dravyas are strong Cholesterol lowering agents, as well as

they decrease LDL. Moreover Madhu increases HDL.

4. In Vamana Group, Til Tail was given in increasing dose for few

days while in Lekhana Basti it was given in steady dose for 15

days.

5. Moreover Basti Dravya was more effective in reducing Meda

Dhatu which in turn may have reduced Rasa-Raktagata Meda

(cholesterol).

CONCLUSION

Sthaulya is a Dushya dominant Vyadhi (disease).

There is an involvement of all the three Doshas in Sthaulya but

the vitiation of Kapha-Vata and Meda of prime importance.

Etiological factor mainly vitiate Kapha-Meda. This vitiated Meda

obstruct the path of Vata and causes its Avarana which results in

to provocation of Vata.



Marked Improvement 4 13.33



Unchanged 2 06.67



Thus remaining in the Kostha Vata causes Atikshudha, this

increases gravity of the disease and makes the Sthualya

Krichhrasadhya (very difficult to treat).

Due to obstruction by Meda (Fat), Vyana Vayu cannot transport

nutrients to other Dhatus (tissues). So Medadhatu (fat tissue) is

increased and Uttaradhatus (Further Tissues) are decreased.

So, treatment modality should be planned considering vitiated

Meda, Kapha and Vata. Lekhana Basti and Vamana Karma are

amongst them.

Sedentary life, lack of exercise, faulty food habits and

urbanization precipitate the disease.

Genetic predisposition, Kapha predominant Prakriti increases the

prevalence of Sthaulya.

Females are more prone to Obesity due to feminine factor like

menopause and aggravating factors like delivery, I.U.C.D., oral

contraceptive pills and miscarriage.

Lekhana Basti provided better result in almost all the parameters

than Vamana Karma and Kutki Churna because it eliminates

Meda, Kapha and Vata Doshas from the body and the

simultaneously absorbed drug perform their action of Samprapti

Vighatana at cellular level too. Moreover, Kutki Churna can also

be given in a larger dose for reducing weight, and Vamana

Karma can also be advised for elimination of Kapha-Meda

Dosha in the disease Sthaulya.

REFERENCES

1. Tripathi Brahmanand, Editor, (5th

Ed.). Hindi Commentary,

‘Charaka Chandrika’ on Charaka Samhita of Charaka,

Sutrasthana; Santarpaneeyam: Chapter 23, Verse 06, Varanasi:

Chaukhambha Surbharati Prakashan, 1997; p.422.

2. Ibidem (1). Charaka Samhita, Sutrasthan; Maharogadhyaya:

Chapter 20, Verse 17; p.395.

3. Ibidem (1). Charaka Samhita, Sutrasthana; Chikitsaprabhrutiya:

Chapter 16, Verse 20; p.323.

4. Shastri Ambikadatta, Editor, (11th

Ed.). Sushruta Samhita of

Sushruta, Chikitsasthana; Niruhakramachikitsitam: Chapter 38,

Verse 82,Varanasi: Chaukhambha Sanskrit Sansthan, 1997;

p.174.

5. Tripathi Brahmanand, Editor, Hindi Commentary, ‘Dipika’ on

Sharangadhara Samhita of Sharangdhara, Uttarkhanda;

Niruhabasti: Chapter 6, Verse 21-22, Varanasi, Chaukhambha

Surbharati Prakashan, 2001; p.364.

6. Sharma P. V., Dravya Guna - Vijnana, Deepanadi Varga;

Chapter 05, Verse 15, PittaVirechana (Katuka), Varanasi:

Chaukhambha Bharti Academy, 1998, p.441-443.

7. https://paulhaider.wordpress.com/2013/06/07/kutki-root-a-

powerful-liver-healing-agent-from-asia/

8. Tripathi Brahmanand, Editor, (6th

Ed.). Hindi Commentary,

‘Charaka Chandrika’ on Charaka Samhita of Charaka,

Kalpasthan; Madankalpa: Chapter 01, Verse 14, Varanasi:

Chaukhambha Surbharati Prakashan, 1999; p.1080.

9. Ibidem (5). Sushruta Samhita, Sutrasthana;

Vamanadravyavikalpavijnaniyam: Chapter 43, Verse 05; p.160.

10. Kasture H.S., (8th

Ed.). Ayurvediya Panchakarma Vijnan,

Bastivijnan: Chapter 6, Verse 2, Allahabad, Shri Vaidyanath

Ayurved Bhawan Limited, 2004, p.417-420.

11. Ibidem (5). Sushruta Samhita, Chikitsasthana;

Netrabastipramanpravibhagachikitsitam: Chapter 35, Verse 25-

26; p.155.

How to cite this article: Dass RK, Panda PK. A Comparative

Clinical Study of Shamana and Shodhana Purvaka Shamana in

The Management of Sthaulya (Obesity). Int J Ayurveda & Med

Sc 2017; 2(2): 30-38.

Source of Support: Nil Conflict of Interest: None

Documents

IJAMS I International Journal of Ayurveda & Medical ...ijams.org.in/wp-content/uploads/2015/05/comparative-clinical-study... · classics have mentioned Lekhana Basti, [4, 5] and Vamana