a successful management of case of sthoulya or obesity with raised lipid profile

1. CASE PRESENTATION
By
Dr LAL RAVI SAHU
2ND YEAR PG SCHOLAR ,
DEPARTMENTR OF PG STUDIES IN PANCHAKARMA,
SDMCAH HASSAN

2. CONTENTS
 OBJECTIVES
 CASE PRESENTATION

3. OBJECTIVES
Understand the pathophysiology, signs, symptoms
& treatments of the disease.
 Improve diagnosis skills of disease.

4. Name : xyz
Age : 30 Yrs
Date of Admission : 1/08/2016
Ward : SW
Bed No : 323
Address : Hassan
Occupation : KSRTC employee
Religion : Hindu

5. Main complaint with duration:
Weight gain since 2 years.
Other complaints:
Heaviness of the body

6. HISTORY OF PRESENT ILLNESS
Patient was healthy and having normal weight before 2 years then
gradually he started gaining weight. Although general health was
good and other major illness like DM, HTN or Asthma were not
present. Both physical examination and laboratory examination
like blood tests (routine test) were within normal limits except
marked raise in lipid profile.

7. FAMILY HISTORY
No relevant history

8. PERSONAL HISTORY
Appetite- Good
Bowel- Twice a day
Micturition - Regular
Sleep- Sound sleep
Diet- Mixed
Tea-3-4 times a day

9. WEIGHT AND BMI
on day of admission
Height 157 CM
Weight 85.45 kg
BMI 34.73 kg/m2

10. ASHTAVIDH PARIKSHA
 Nadi : Gati - 74/ min
 Mutra : D/ N – 4 / 2 times
 Mala : Twice in a Day,
 Jivha : Alipta
 Shabda : Prakrita
 Druk : Prakrita
 Akriti : Madhyama

11. DASHVIDH PAREEKSHA
 Prakriti : Vata kapha
 Vikriti : Samana Vayu, meda
 Sara : Mamsa sara
 Samhanana : Madhyama
 Pramana : Madhyama
 Satva : Prawara Sattva
 Satmya : Shad Rasa Satmya
 Ahara shakti:
Abyavarana shakti : Pravara
Jarana shakti : Prawara
 Vyayama shakti : Prawara
 Vayah : yuva

12. SAMPRAPTI GHATAKA
 Dosha : Tridosha / Kapha Praghana
 Dushya : Meda
 Adishtana : Sarva Sharira,
 Srotas : Medovaha Srotas
 Agni : Dhatu agni mandya
 Ama : Sama
 Srotodushti : Sanga
 Udbhawastana : Amashaya
 Sadhya Asadhyata : Kruccha sadhya

13. INVESTIGATIONS
Serum
Cholesterol
Serum
Triglyceride
HDL LDL VLDL
B.T 248.0 192.0 52.0 123.0 56.0

14. DIFFERENTIAL DIAGNOSIS AND
DIAGNOSIS
 Depression
 Type 2 diabetes mellitus / Prameha
 Malnutrition / Kuposhana
 Gastroesophageal reflux disease (GERD)
 Polycystic ovarian disease (Stein-Leventhal syndrome)
 Ascites
 HTN / Ucha Rakta Chaap
DIAGNOSED AS case of Sthoulya/ Obesity

15. TREATMENT
The patient was administered classical Virechana
(Purgation therapy) after proper Deepana pachana
followed by Snehapana .

16. PURVA KARMA
 Patient was administered with Panchakola Phanta 50ml twice a day daily before
food for three consecutive days as Deepana Pachana.
 In mean time patient was administered with Sarwanga Udwaratana with Triphaladi
churna for three consecutive days..
 Samyaka rukshana lakshana patient was posted for Arohana Shodhana Purava
Snehapana with Murchita taila for 4 consecutive days with initial dosage of 30 ml
then raised to 60ml,100ml,140ml,on second, third and fourth day respectively.
 Patient advised Sarvanga Abhyanga with Murchita taila and Svedana by Sarwanga
baspa Sweda for next 3 days. Three days Vishrama kala was given during which
patient was administered with Pitta Utkleshakara Ahara like Laghu Bhojana, Amla
phala Rasa,UshnaUdaka to alliveate pitta dosha.

17. PRADHANA KARMA
Before administration of Virechana, Abhyanga by Murchita taila
and Baspa Svedana was done in the morning of Virechana day.
Pulse, blood pressure and temperature were recorded.
Virechana Yoga was Trivrut Lehya 70gm and Triphala kashaya
100 ml.
Patient had 21 Vegas.

18. PASHCHAT KARMA
Patient had 21Vega with Kaphanata and attained Pravara
Vegiki Shuddhi.
No untoward complications were observed.
Later patient was advised to follow Samsarjana karma ie
Peyadi samsarjana for 7 days.

19. RESULTS
Before
Treatment
After
Snehapana
After Virechana After Samsarjana Krama
Height 157 CM 157CM 157CM 157 CM
Weight 85.45 kg 80 kg 79 kg 78.23 kg
BMI 34.73 kg/m2 32.46 kg/m2 32.11kg/m2 31.80 kg

20. ANTHROPOM-
-ETRY
Before Treatment After Snehapana After Virechana After Samsarjana
Chest 112cm 102 cm 102 cm 101 cm
Waist 102 cm 98 cm 97 cm 94 cm
Hip 106 cm 100 cm 99 cm 97.1 cm
Abdomen 111 cm 99 cm 96 cm 96 cm
Thigh
Right- 56 cm
Left – 57 cm
Right- 49 cm
Left – 50 cm
Right- 49 cm
Left -49 cm
Right-49
Left -48
Mid arm Right- 31 cm
Left -30 cm
Right- 28 cm
Left – 29 cm
Right- 28 cm
Left – 28 cm
Right-28
Left -28

21. LIPID PROFILE
Serum
Cholesterol
Serum
Triglyceride
HDL LDL VLDL
B.T 248.0 192.0 52.0 123.0 56.0
A.T 180.0 158.0 40.0 99.2 40.8

22. DISCUSSION
The normal status of Agni is important before the administration
of Snehapana. Deepana and Pachana does kindling of Agni and
Digestion of Ama respectively. If Agni is not in normal condition
Sneha will not undergo digestion properly in turn leading to
complication.
Rookshana is the Vishishta Purvakarma before the administration
of Shodhananga Snehapana in specific conditions like: Mamsala
(Upachita Mamsa),Medura (Medasvina),Bhurishleshma(excess of
kapha),Vishamagni (altered state of digestive strength).

23. Shodhananga Snehapana is the most important Purvakarma
for Vamana and Virechana. The Properties of Sneha
Dravya’s are like Sukshma, Sara, Snigdha, Drava, Picchila,
Guru, Shita, Manda and Mrdu.
Swedana is done to liquefy the vitiated Dosha which are
spread throughout the body. As a result of application of
Swedana,the vitiated Dosha are made easily expelled out
with the help of Pradhana karma such as Virechana etc.

24. Drugs capable of inducing Virechana, possesses Ushna, Tikshna,
Sukshma, Vyavayi and Vikasi properties. The Ushna property may
help in increasing the quantum of Agni. It can cause Vishyandana i.e.
oozing of the Dosha in the Koshtha from where they can be readily
expelled out. Due to Tikshna property, drug is able to disintegrate
the Sanghata of the Dosha. Due to Vyavayi property such a medicine
is able to spread in the whole body prior to its digestion.

25. CONCLUSION
Ayurvedic line of management gives satisfactory answer as
well equally beneficial for the promotion and preservation of
health in a obese person by removing toxic wastes, by
balancing morbid humours and by correction of Agni
(digestive fire) which results in marked relief for a Patient of
sthoulya leading to the healthy and peaceful life.

26.  Thank you