The relation between Krucchra vyavaaya and Sthaulya detailed here

2. By
Dr. ABDUL SUKKUR M

3. • Obesity has increased at alarming rate in recent years
It is one of the major health hazards globally and
One of the serious health problems of 21st Century
• Obesity is significantly associated with erectile dysfunction
Studies shows obese males have 30% higher chance of
developing sexual dysfunction
• Ayurveda regards relationship between Obesity ( स्थौल्य ) and
sexual dysfunction ( कृ च्छ्रव्यवाय )

4. अतिदीर्घ: अतिह्रस्व:
अतिलोमा अलोमा
अतिकृ ष्ण: अतिगौर:
अतिस्थूल: अतिकृ श:
[ Ref. च. सं. सू. 21/3 ]

5. अतिस्थूलस्य
 आयुषो ह्रासो
 जवोपरोध:
 कृ च्छ्रव्यवायिा
 दौर्घल्यं
 दौगघन्ध्यं
 स्वेदार्ाध:
 क्षुदतिमात्रं
 पपपासातियोग:
- भवन्ध्यष्टौ दोषााः
[ Ref. च. सं. सू. 21/4 ]

6. मानस धािुक्षयज
शुक्रक्षयज अभभर्ािज
सहज खरशुक्रतनभमत्तज
षण्ढ – impotent persons
आसेक्य: सौगन्न्धधक
कु म्भीक: ईष्यघकं
षण्ढकं नरचेन्ष्टिा
[ Ref. सु. सं. चच. 26/ 9-15 ]
[ Ref. सु. सं. शा. 2/38-44 ]

7. • अतिसंपूरणाद्
• अतिगुरु मधुर शीि न्स्नग्धोपयोगाद्
• अव्यायामाद्
 अव्यवायाद्
• ददवास्वप्नाद्
• हषघतन्य्वाद्
• अचचन्धिनाद्
• र्ीजस्वभावाद्
[ Ref. च. सं. सू. 21/4 ]

8. मेदोमांसातिवृद्ध्वाच्छ्चलन्स्िगुदरस्िनाः ।
अयथोपचयो्साहो नरोऽतिस्थूल उच्छ्यिे
[ Ref. च. सं. सू. 21/9 ]

9.  Obesity has become the 6th common cause for disease burden worldwide.
 Increase in body weight of 10 – 20 % above the normal caused by excess
accumulation of fat is Obesity.
 Healthy young men & women have a total body fat below 20 % & 25 %
respectively.
 Measurement of skinfold thickness over the biceps, triceps, subscapular &
suprailiac regions is used in assessing Obesity.
 Skinfold thickness over triceps for normal Indians is < 20 mm , can be
measured by nomograms.
 In general, the ideal weight of an individual should be –
[ Height in cms minus 100 ] Kg
Eg:- Adult male with Height 175 cm , should have a weight of 75 kg ± 5%
[ Ref. Text Book of Medicine by Dr. K. V. Krishna Das ]

10. • Body Mass Index :-
BMI = Weight in Kg / Ht. in m2
• Body weight is only
a crude indicator of Obesity.
• Risk Factors :- BMI > 28 , higher incidence of Strokes, Ischemic Heart
Disease & Diabetes mellitus.
• Waist Hip Ratio above 1 in Men & above 0.9 in Women is an
independent risk factor for incidence of insulin resistance, Hypertension,
rise in LDL, lower levels of HDL, Hyperuricemia, Cardio vascular Disease,
Type 2 Diabetes & Stroke.
• Ideal Waist Hip Ratio is 0.85 in Men & 0.75 in Women.
• Waist circumference above 102 cm ( 403 ) is an independent risk factor.
Weight class Global Asians
Normal 18.5 – 24.5 18.5 – 22.9
Over Weight 25 – 29.9 23 – 24.9
Obese > 30 > 25
Severely obese > 40 -

11.  Etiology –
 Excessive consumption of Food
 Hormonal & Other factors ( Type 2 DM, Gigantism, Acromegaly, etc. )
 Genetic Factors – metabolic imbalance, role of Leptins, Ghrelin etc.
 Several Drugs lead to Weight gain – antipsychotics,
oral contraceptives, insulin, corticosteroids, antihistamins etc.
 Loss of Physical activity.
 Alcohol consumption.
 Clinical Features - Men : Women – 1 : 1.5
 Common Symptoms – Exertional dyspnoea, Sluggishness, Angina,
Arthalgias of Knees & Hips or any complications.
 Complications – ill effects of increased weight
abnormal skinfolds – fungal infection, moniliasis.
 CVS – Angina, IHD, HT; RS – exertional dyspnoea; Abdomen – Intra
Abdominal Pressure; Metabolic complications – DM, Gout; Psychological;
 Evidence of Cancer of Colon, Breast, Uterus, Ovaries & Prostate – more
common in Obese. Prognosis – gradually increase in Mortality Rate.

12. अतिमात्रमेदन्स्वनो मेद एवोपचीयिे
न िथेिर धािव:
Why कृ च्छ्रव्यवायिा ?
शुक्रार्हु्वान्धमेदसाऽऽवृिमागघ्वाच्छ्च
कृ च्छ्रव्यवायिा
किमेदोतनरुद्धमागघ्वाच्छ्चाल्पव्यवायो भवति
[ Ref. सु. सं. सू. 15/32 ]
[ Ref. च. सं. सू. 21/4 ]

13.  Persons with good built possess -
strong indriya , little ill health
 can stand hunger, thirst, heat of the sun, cold
and physical exercises
 Proper digestion & assimilation of food

14.  Sperm factor
 Obesity
 Declining sperm count
[ Ref. Male Reproductive Dysfunction – Dr. S.C.Basu, 2nd edition ]
 Temperature Factor
 Immunological Factor
 Female Factor
 Environmental factor

15.  Corresponding decrease in male
fertility may be attributed partly to obesity.
 Abnormal semen parameters like reduced
spermatogenesis , poor quality of sperm , reduced
percentage of normal sperm morphology
are seen among over weight men.
 Hence obesity can be considered as an etiology of male infertility.
 Estrogen is the positive regulator of adipodity; testosterone is the
negative regulator. High androgen levels inhibit adipogenesis.
 Elevated peripheral estradiol (E2 ) due to increased adipose tissue
mass, change in the adipose tissue distribution towards obesity.

16.  Adipose tissue represents rich source of peripheral
estrogens that regulate testicular function. There is
an increased risk for subfertility among couples in
which the male partner is obese.
 It is reported from various studies that a man’s
weight influences couple’s fertility. Every excess
of 10 Kgs. or 22 pounds may reduce man’s fertility
by 10%
( Dr. Markku Sallmen )
 Sperm concentration/ Total Sperm count likely to be negatively
associated with Body Mass Index ( BMI ); above 25 Kg/m2
body weight shows reduced normal sperm morphology & motility.
 Excess fat actually causes the male hormone Testosterone to be converted
into Estrogen and those decrease the stimulation of Testis.
( Dr. Peter N. Schlegel )

17.  The link between obesity & male infertility is serum Leptin.
Leptin is found in human sertoli cells, Leydig cells,
seminiferous tubules and Germ cells.
 Male Obesity is characterised by high serum estrogen,
leptin & insulin levels. Increasing evidence points
to the negative roles of leptin and insulin in the
HPT axis including testis functions.
 It is believed that high serum leptin is able to disturb testicular
steroidogenesis, spermocyte differentiation & development.
In morbidly obese men, high leptin level produces Hypogonadism,
reducing circulating gonadotropins & subsequently inducing
testicular apoptosis.
 Obese Oligozoospermic patients have significant increase in mean BMI,
Serum FSH, LH, Estradiol ( E2 ), Prolactin ( PRL ) and Leptin compared
with obese fertile control groups.

18.  A multidimensional scale, International Index of Erectile Function ( IIEF )
Questionnaire was used to assess sexual function of individuals. The
Scale was developed by Raymond et al.
 Observations & Results –
 Erectile Dysfunction in obese males varying from mild to severe was
statistically significant ( P < 0.02 )
 Orgasmic Dysfunction in obese males was statistically significant
( P < 0.02 )
 Sexual Desire Dysfunction in obese males varied from severe to mild
degrees was statisticallyinsignificant ( P < 0.08 )
 Intercourse satisfication in obese males was statistically insignificant
( P < 0.18 )
 Overall satisfaction in obese males had varying degree of dysfunction
was statistically significant ( P < 0.000 )
[ Ref. Study by Parampalli Geetha, B. S. Aravind, G. Pallavi,
V. Rajendra, Radhakrishna Rao, Naseema Akhtar –
Government Ayurveda Medical College, Mysore, India. ]

19.  Sexual dysfunction in Obesity can be considered as
the difficulty encountered in various stages of Vyavaaya
and there is a definite relationship between obesity
and sexual dysfunction.
 The difficulty in sexual act experienced in Obesity may be due to a
combination of psychological and physical causes . Erectile functions,
orgasmic function, sexual desire, intercourse satisfaction and
overall satisfaction are impaired in Obesity.
 Correlation studies suggest there was no relation between BMI and
Erectile functions. However, certain studies suggest that erectile
dysfunction increases proportionately with increase in waist-hip ratio.
 Ayurveda highlights that there could be structural and quantifiable
basis for the Sexual dysfunction and Obesity.
 More studies are needed to prove the sexual dysfunctions explained
in Ayurveda related with blockage of channels of Shukra by Medas as
the basis for Krucchra Vyavaaya and impotency in Obese individuals.

20. thank you