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Introduction

Everything in the universe is made up of Panchamahabhoota or 5 basic elements of nature.(1) The body is formed of panchamahabhoota and so is food. (2) Shad-rasa (six types of tastes) and Panchamahabhoota (5 elements of nature) predominance: (3)

Table no.1 Rasa and its Physiological effect on dosha:

The Panchabhautik Shadrasatmak ahar nourishes Dhatu, varna, Bala, varna, etc. depending on Agni because Rasa, etc. can’t be produced from undigested food. (4)

In the process of digestion and metabolism, the food passes through three levels of action 13 types of agni. Agni represents Teja Mahabhoota in the body. At first, it is acted upon by jatharagni for gross digestion. At the second level, five types of Bhutagni namely, parthiva, apya, agneya, vayavya , and nabhasa one of each mahabhuta digest the respective fractions of the food and nourishes respective fraction in the body. e.g. The parthiva agni digests and transforms/metabolizes the Prithvi component of ingested food into parthiva components of the body. (5)

After the first 2 levels of digestion by Jatharagni and Bhutagni, the ingested food is divided into Saar bhag called Ahara-rasa (nutritive juices which are formed after the digestion of the food) and kitta or Mala bhag (excretory material). Ahara-rasa is further used for the formation of Rasadi Saptadhatu (seven tissue). According to “Khale-kapota nyaya” the nourishment of different dhatus takes place according to the rule of selectivity. Khale means treshing floor, kapota means pigeon. Like pigeon pecking the grains from the treshing floor and carring it back to their nests depend on the direction and the time required for them to travel, the nutrition required by the dharu is selected from the essence part of food which contains all the nutrients and the order of nutrition depends on the order of the dhatus. Here the field indicates the essence part of the food and the pigeons indicates the body tissue that is dhatus. i.e. the different dhatus, pick up the required nourishment from the common nutrient pool (Ahara-rasa). (6)

According to Acharya Vagbhata, there is derangement of Jatharagni due to Snigdh-Madhuradi atisevan of hetus, leads to the production of Ama (Apachita rasa dhatu-indigested food) which disturbs the Medo-dhatvagni (type of metabolic component situated at the level of Medodhatu get reduced)) and hampered the proper formation of further dhatus by blocking the srotasas. [7]

Aim:

To study the Concept of Sthaulya with special reference to Panchamahabhoota Siddhanta.

Materials:

• The Literary material related to Panchamahabhoota siddhanta and Sthaulya has been collected from Ayurvedic texts Charak Samhita, Sushrut Samhita, Ashtang hridaya etc. Various Research Publications, Journals, and internet resources.
• Previous research material related with the subject from articles published in various peer reviewed Journals, books, thesis.

Methodology:

• A thorough review of the literature regarding the concept of Sthaulya and Panchamahabhoota has been done from Bruhatrayi and their Commentary by various Acharyas.
• The references regarding Panchamahabhoota siddhanta given in sharirsthan of charaka Samhita chapter no.1,2,4,7. In Sushruta Samhita Sutrasthan chapter no.1, 46, Sharirsthan chapter no. 1,2,4,5.
• Acharya Charaka has mentioned Sthaulya in 21st and 23rd chapters of Sutrasthana.
• Sushruta has mentioned Sthaulya vyadhi in Sutrasthan’s 15th chapter.
• A detailed description of Sthaulya is given in Ashtang Sangraha Sutrasthan 24th Chapter and Ashtang Hridaya 14th chapter Dvividhopakramaniya.

Results:

Sthaulya:

Charakacharya has quoted Sthaulya under eight varieties of impediments which are referred as Nindita Purusha; Ati Sthaulya-Medoroga comprises one of them under the heading of Atisthool Purush. (8)

The person is considered as Atisthula when there is an excessive increase meda and mamsa dhatu in the regions of Sphik (buttocks), Udar (abdomen), and Stana (breasts), and suffer from deficient metabolism and energy. (9)

Meda and mamsa are predominant in Prithvi and Apa Mahabhutas similar to Kapha Dosha.

Table no.2 Hetu (Causative factors) of Sthaulya: (10)

Samprapti of Sthaulya:

Due to over consumption of diet with properties like Snigdha, madhur, Guru, Picchil and diet consists of Navanna, Nav Madya, Mansa especially Aanup as well as dugdha vikrutis (milk products) and Paishtik i.e more carbohydrates, etc. there is overload for digestion on Jatharagni results into formation of Ama-pradhan Ahara rasa. This guru, atimadhura and snigdha Ahara rasa nourishes Meda dhatu selectively according to “Khale-kapota nyay” and causes accumulation of medo dhatu which has similar properties of Prithvi and Apa mahabhoota. The accumulation of Medo dhatu causes srotorodha in the body leading to Vata prakopa in koshtha. The vitiated vayu in koshtha influenced jatharagni and causes Agni vaishamya. Thus, Tikshnagni in digests the food at a faster rate, further leading to kshudha vruddhi. (11) Consumption of Guru (heavy to digest), Sheeta (cold), Snigdha (unctuous), Madhuradi Kapha-vardhaka drugs along with lack of exercise and sedentary life style result in excessive nourishment of Meda. Medo-dhatvagni is responsible for the building of the Medo-dhatu. In Sthaulya, there is Medo-dhatvagnimandya which leads to formation of apachit meda dhatu with more guru, snigdha and madhura properties. This medovruddhi leads to avrodha (obstruction)of other strotasas in body and there is no formation of other dhatu rather than apachita meda dhatu. Hence there is more vruddhi of medodhatu leading to the disease Sthaulya. (12)

Sthaulya janita Dosh: (13)

Ayu-hrasa (decrease of life span).

Javoparodha (decrease in enthusiasm and activity),

Kruchhavyavayata (difficulty in sexual act)

Atiswedapravritti (Excessive sweating)

Daurgandhya (bad odour)

Daurbalya (Weakness)

Atikshudha (excessive hunger)

Atipipasa (excessive thirst)

Meda dhatu is characterized by Snighdha (unctuous), Guru (heavy), Sthula (space occupying), Picchila (slimy), Mridu (tender/soft) and Sandra (dense) Guna (qualities) (18) which are similar to Prithvi and Aap mahabhoota and are abnormally increased in Sthaulya due to Medovruddhi causes Javoparodha (decrease in enthusiasm and activity), Kruchhavyavayata (difficulty in sexual act) results into Ayuhrasa (decrease of life span).

The main function of Medodhatu are Sneha (oleation), Sweda (production of sweat), Drudhatva (compactness). (18) Medovruddhi in Sthaulya leads to the sweda function of meda dhatu in excess causes Atiswdapravritti results into Daurgandhya.

Hetu especially Madhura Rasatisevan, Mamsahara (meat), Avyayama (lack of exercise), Divaswapna (day sleep) causes increase of Medho Dhatu in our body, which result into Srotoavaroda and Vata is specially confined to Kosta and causes Jatharagni Vriddhi hence symptoms of Sthulata i.e, Atipipasa (excessive thirst) Atikshudha (excessive hunger), Alasya (lethargy) occurs.

Sthaulya Chikitsa:

The treatment of Sthaulya includes Guru and Apatarpan Chikitsa. (14) Since jatharagni represents Teja mahabhoota is vitiated in Sthaulya and Prithvi and jala mahabhuta are increased due to Madhuradi Kapha-vardhaka hetu causing Srotorodha leads to abnormal meda dhatu vruddhi in Sthaulya. Guru substances are used to pacify Tikshna Jatharagni and the herbs like Guduchi, Triphala, musta, shunthi having dominancy of the Vayu and Akash mahabhoota are administered in clearing the srotarodh which is the main part of Samprapti of Sthaulya.

Ruksha dravyas are Akasha and vayu dominant, which tends towards Apatarpan hence, Triphala, Agnimantha, Madhu (honey) are the medicines of Ruksh property are also advised for Sthaulya. Properties of honey are ruksha, guru, and kashaya. (15)

Table no.3  Drug used in Sthaulya:(16)

Discussion

The normal Jatharagni in the person taking proper food maintains the equilibrium of Dhatus by regular digestion but if Jatharagni gets irregular due to Abhojana (fasting), Atibhojana (overeating), Ajirnashan (eating during indegestion), Vishamashan (irregular eating), Guru-sheeta bhojana, causes disequilibrium in dhatus because of irregular digestion. (17) In Sthaulya, Jatharagni gets irregular due to excessive intake of Madhura rasatmaka, Snigdh, and pischila Aahara. Similar qualities cause an increase; dissimilar qualities cause a decrease. This concept is known as the Samanya Vishesha Siddhanta. (19)  Dosha or Dhatu gets increased by taking Saman dravya (similar to that of Dosh or dhatu) or saman gunabhuyistha ahar-vihar (similar properties of that dosh or dhatu). On contrary Dosha or Dhatu get decreased by taking Viparita dravya or Viparita-gunabhuyistha Ahara-vihara (opposite properties of that dosh or dhatu). (20) This Siddhanta is used to balance the disequilibrium of Panchamahabhoota in Sthaulya. In Sthaulya, Kapha dosh and Medo-dhatu are in increased state because of taking Saman dravya and saman gunabhuyistha ahar-vihar like Madhura, Snigdh, Mamsatisevan, Diwaswapa etc. So, to decrease them Viparita Guna and Viparita Gunabhuyistha dravyas should be used.

Kapha is constituted by Prithvi and Jala Mahabhoota. (21) Intake of substances and properties having Prithvi and Jala mahabhoota dominant will increase the same qualities in the body that is Kapha dosha and Medodhatu. Kaphadosh and Medodhatu are the main samprapti ghatak of Sthaulya vyadhi.  So, for Samprapti-Vighatana, substances dominant in Teja and Vayu mahabhoota are used which are having opposite properties to that of Prithvi and Aap Mahabhoota. Srotorodh is a key factor in Samprapti of the diseases where Avyahat Gati of Vata Dosha is obstructed by the vitiated Medodhatu and disease pathogenesis occurs. Triphala along with Guduchi, Nimba chal, Chirayata and Vasa are helpful in getting rid of metabolic waste which blocks the Srotasas. The Akash property of the Srotas which was blocked is cleared and regains normal functioning.

1. Apatarpan (Langhan)- Teja, Vayu and Akash Mahabhoota predominance.
2. Ruksha udvartana- Vayu Mahabhoota.
3. Guru and Ruksha dravya sevan- like Madhu (Honey).
4. Vyayam (Physical exercise)- Vayu mahabhoota.
5. Ruksha,Tikshna, Ushna Basti. (22)

Conclusion

Panchamahabhoota Siddhanta is applied in the diagnosis and management of diseases. Acharya Charaka has included Sthaulya in Santarpanajanya Vyadhi. (23) In the view of Panchamahabhoota siddhanta, Sthaulya is the result of abnormal and excessive Prithvi and Jala mahabhoota properties. According to “Pindi Te Brahmandi Nyaya”, the etiological factors vitiating Kapha and Meda are correlated to the properties of Prithvi and Aap Mahabhoot. The space is reduced and the movements of Vayu are obstructed. So, the first principle of treatment is to create space and stimulate the movements of Vayu and activation of Teja mahabhuta, to digest abnormal Parthiva and Apya properties.