Clinical evaluation of the Sthaulyahara effect of Haritaki and Amalaki based...

[Full title: Clinical evaluation of the Sthaulyahara effect of Haritaki and Amalaki based on the principle of Hrasa Hetur Visheshascha]

[Find the meaning and references behind the names: Man, Guna, June, Heart]

ISSN: 2456-3110 ORIGINAL ARTICLE May-June 2018 Journal of Ayurveda and Integrated Medical Sciences | May - June 2018 | Vol. 3 | Issue 3 54 Clinical evaluation of the Sthaulyahara effect of Haritaki and Amalaki based on the principle of Hrasa Hetur Visheshascha Dr. Shruti Hiremath, 1 Dr. Umapati Baragi, 2 Dr. M. R. Sajjanshetty 3 1 Post Graduate Scholar, 2 Associate Professor and Head, Dept. of Basic Principles, BLDEA’S AVS Ayurveda Mahavidyalaya Hospital and Research Centre, Vijayapur, Karnataka, 3 Professor and Head, Department of Basic Principles, S V M Ayurvedic Medical College, Ilkal, Karnataka, INDIA. I NTRODUCTION Today’s life style has completely changed by all the means our diet pattern, life styles and behavioral pattern which has made man the victim of many Address for correspondence: Dr. Shruti Hiremath Post Graduate Scholar, Dept. of Basic Principles, BLDEA’S AVS Ayurveda Mahavidyalaya Hospital and Research Centre, Vijayapur, Karnataka, INDIA. E-mail: sshiremath 2393@gmail.com Submission Date : 10/05/2018 Accepted Date: 14/06/2018 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.v 3 i 3.12876 diseases. Sthaulya (obesity) is one among them. Sthaulya is one of the most effective disease which affect someone social, physical and mental features. As per modern view, it is a precursor to coronary heart disease, high blood pressure, diabetes melitus and osteoarthritis which have been recognized as the leading killer diseases of the millennium [1] All these disorders are an indication of the failing systems, their inability to provide optimum performance to upkeep the physiological clock ticking. In Ayurveda, Sthaulya has been described by Acharya Charaka as one of the eight despicable persons ( Ashtaunindita ) in the context of the body [2] Principles of Ayurveda have significant value even in the life of modern man. The reason behind this is, life is the underlying theme over which the whole science of Ayurveda is interwoven. Hence one cannot deny A B S T R A C T Sthoulya is one of the most effective disease which affects someone social, physical and mental features. As per modern view, it is a precursor to coronary heart disease, high blood pressure, diabetic mellitis and osteoarthritis which have been recognised as the leading killer diseases of the millennium. Sthoulya is a state of increased Vikruta Vruddhi of Medodhatu . It is one of the Santarponottha Vikaras where a physician needs to apply the principle of Vishesha which can restore the unhealthy increase of components to the previous undiseased form. The drug Haritaki and Amalaki are having Laghu and Rooksha Guna which are opposite Gunas to that of the Sthoulya . Objectives - Practical evaluation of the Sthaulyahara effect of Haritaki and Amalkai based on the principle of Hrasa Hetur Visheshascha . Results - 60 patients (92%) had completed the trial, no adverse effect were reported. Both the groups had improved in the clinical trials, overall statistical significance was observed in the scores of both the groups. Discussion - By this statistical result we can concluded that Group A patients were more releived than Group B who were administered Haritaki Choorna . The hypothesis decided for the study was ‘ Vishesha’ is the prime cause for Hrasa . Here it was clear that Vishesha applied was Guna Vishesha . Here significant results itself shows that Vishesha has done its role in reducing the obesity ( Hrasa ) in better way in both the Groups. Key words: Vishesha, Sthoulya, Obesity, BMI, Haritaki, Amalaki.

Dr. Shruti Hiremath et.al. Clinical evaluation of the Sthaulyahara effect of Haritaki and Amalaki. ISSN: 2456-3110 ORIGINAL ARTICLE May-June 2018 Journal of Ayurveda and Integrated Medical Sciences | May - June 2018 | Vol. 3 | Issue 3 55 the implicability of these principles. The principles of Ayurveda are based on strict experimental studies of several years. These principles are the outcome of those studies. Several Acharyas have tested these principles for many years and then these principles have got a place in Ayurvedic Samhitas . Sthaulya is a state of increased Vikruta Vruddhi of Medodhatu . It is one of the Santarpanottha Vikaras [3] where a physician needs to apply the principle of ‘ Vishesha’ , which can restore the unhealthy increase of components to the previous undiseased form [4] Since Samhitakala Sthaulya is well a known Krcchrasadhya Vyadhi . It can be betterly managed by applying the concept of ‘ Hrasahetur Visheshacha’ , as described in the classics in terms of Dravya , Guna and Karma Vishesha Siddhanta [5] The drug Haritaki [6] has Laghu and Ruksha Guna and Amalaki [7] is having Kaphagna property which are opposite Gunas to that of the Sthaulya . Hence the present research work was planned to evaluate the concept of ‘ Hrasahetur Visheshascha’ and also compare the clinical effect of Haritaki and Amalaki in Sthaulya (Obesity) . O BJECTIVE OF THE STUDY Practical Evaluation of the Sthaulyahara effect of Haritaki and Amalaki based on the principle of Hrasahetur Visheshascha. M ATERIALS AND M ETHODS Drug Source The medicines required for the present study were procured from the Pharmacy of BLDEA’S AVS Ayurveda Mahavidyalaya, Vijayapur, Karnataka Clinical Source Patients of either sex diagnosed to be suffering from obesity were selected from OPD and IPD of BLDEA’s AVS Ayurveda Mahavidyalaya Hospital, Vijayapur Method of collection of data A special proforma was prepared with details of history, physical signs and symptoms mentioned for the Sthaulya . Patients were analyzed and selected accordingly. A viable and indigenously designed method was used to assess the parameters of signs and symptoms. Study Design: Randomised Single Blind Comparative Clinical Study Sample Size: Total number of patients taken for the study will be 60 including dropout Duration of treatment: 30 days Duration of follow-up: 15 days Study Duration Total study duration: 45 days Treatment duration: 30 days Follow up duration: 15 days Inclusion Criteria 1 Patients diagnosed as Sthaulya having classical signs and symptoms will be selected 2 Patients of either sex in between age group 20 - 60 years 3 Patients with BMI more than 25 Exclusion Criteria 1 Patients age less than 20 and more than 60 years 2 Patients having major systemic disorders or other illnesses which interfere with the present study 3 Patients of Sthaulya with its severe complications like Cerebral vascular diseases, Ischemic heart diseases will be excluded Diagnostic Criteria 1 Diagnosis will be made based on classical signs and symptoms like Spik , Sthana and Udara Lambana (increased fat deposition in chest, abdomen and gluteals) 2 Atisweda , Atikshudha and Atitrishna 3 Kshudra Shwasa (breathing difficulty) and Daurbalya (weakness) 4 Patients having BMI more than 25 Assessment Criteria Assessment will be done based on objective and subjective criteria before, during and after treatment. Subjective Criteria 1 Dourbalya (general weakness) 2 Swedabadha (excessive sweating)

[Find the meaning and references behind the names: Low]

Dr. Shruti Hiremath et.al. Clinical evaluation of the Sthaulyahara effect of Haritaki and Amalaki. ISSN: 2456-3110 ORIGINAL ARTICLE May-June 2018 Journal of Ayurveda and Integrated Medical Sciences | May - June 2018 | Vol. 3 | Issue 3 56 3 Kshudhatiyoga (excessive hunger) 4 Pipasaatimatram (excessive thirst) Objective Criteria 1 Calculation of BMI (Weight in kg divided by height in meter square) 2 Waist Hip circumference ratio 3 Circumference of chest, abdomen, mid arm and mid thigh. 4 Lipid profile (12 hours fasting) Laboratory Investigations 1 Urine routine (Albumin, Sugar and micro) 2 Blood routine (Hb, TC, DC) 3 Lipid profile (12 hours fasting) 4 Serum total cholesterol, Serum triglycerides, Low density lipoproteins, High density lipoproteins, VLDL and HDL: Cholesterol ratio. Drug and Posology Group A: Haritaki Churna Dosage: 6 g / b.i.d. Anupana: Ushna Jala Route: Oral Duration: 30 days Follow up: 15 days Group B: Amalaki Churna Dosage: 6 g / b.i.d. Anupana: Ushna Jala Route: Oral Duration: 30 days Follow Up : 15 days O BSERVATIONS AND R ESULTS Table 1: Age wise distribution of 65 patients of Sthaulya Age ‘A’ Group ‘B’ Group Total Percentage 20-30 12 13 25 41% 30-40 11 13 24 40% 40-50 5 3 8 13% 50-60 3 1 4 6% The maximum number of patients are from 20-30 yrs and 30-40 yrs. This shows middle age peoples are more prone to Sthaulya . Table 2: Medhavaha Srotas wise distribution of 65 patients of Sthaulya Symptoms ‘A’ Group ‘B’ Group Total Percentage Javoparodha 2 1 3 4% Daurbalya 25 28 53 81% Daurgandhya 14 11 25 38% Swedabhadha 15 12 27 41% Angashaithilya 21 21 42 64% Snigdhangata 17 12 29 44% Alasya 28 28 56 86% Pippasatimatra 22 16 38 58% Mutrasada 2 0 2 3% Talushosha 21 17 38 58% Kanthamukhash osha 8 9 17 26% Bahu Mutra 6 4 10 15% Spik Sthana Udara Chalatwa 28 21 49 75% Ati Slakshna 2 4 6 9% Among 65 patients Kanta Mukha Shosha 75%, Alasya 86%, Pipasatimatra and Talushosha 58%, Dourbalya 81%, Swedapravrutti 41%, Angashaithilya 64% symptoms patients were suffering from Sthaulya . Table 3: Nidanawise (Aharatmaka) distribution of 65 patients of Sthaulya Symptoms ‘A’ Group ‘B’ Group Total Percentage Athisampoorna 17 16 33 50% Adhyshana 6 5 11 16% Guruaharaseva na 28 22 50 76%

[Find the meaning and references behind the names: Main, Shakti]

Dr. Shruti Hiremath et.al. Clinical evaluation of the Sthaulyahara effect of Haritaki and Amalaki. ISSN: 2456-3110 ORIGINAL ARTICLE May-June 2018 Journal of Ayurveda and Integrated Medical Sciences | May - June 2018 | Vol. 3 | Issue 3 57 Madhuraahara Sevana 14 18 32 49% Sheeta Ahara Sevana 26 25 51 78% Snigdha Ahara Sevana 21 18 39 60% Gramybha Ahara Sevana 9 8 17 26% Phala Sevana 6 12 18 27% Navamadhya Sevana 3 4 7 10% Auduka Sevana 9 6 15 23% Ksheera Sevana 8 12 20 30% Shali Sevana 25 27 52 80% Bhojanotar Sheet Jala Pana 20 19 39 60% Among 65 patients, 80% are Shali Sevana , 78% are Sheeta Ahara Sevana , 76% are Guruaharasevana, Bhojana Nantara Sheeta Jala Sevana 60%, Atisampoorna 50%, Snigdha Ahara Sevana 60%, Snigdha Ahara Sevana 60% these are the main Nidana which are cause for the Sthaulya. Table 4: Nidanawise (Viharatmaka) distribution of 65 patients of Sthaulya. Symptoms ‘A’ Group ‘B’ Group Total Percentage Avyayama 27 25 52 80% Avyavaya 16 13 29 44% Diwaswapna 5 12 17 26% Asanasukha 13 18 31 47% Gandha Malayanu Sevana 6 11 17 26% Bhojanotar Snana 1 6 7 10% Bhojanotar Nidra 24 25 49 75% Among 65 patients, 80% are Avyayama , 75% are Bhojanotar Nidra , 47% are Asanasukha, 44% are Avyavaya, 26% are d iwaswapna and Gandha Malayanu Sevana , 10% are Bhojanotar Snana. Effect of therapy in Group A In this group total 62 patients were registered out of which 2 patients were dropped out while remaining 30 patients have completed the full course of treatment. Here the effect of drug Haritaki Churna on various parameters is presented in the following tables. Table 5: Effect on subjective and objective criteria ( Haritaki Choorna ) in Group ‘A’ Symptom Me an BT Me an AT Me an Diff % Rel ief SD SE t p Kshudra Shwasa 0.7 66 0.1 0.6 66 86 95 0.05 46 0.0 99 6.67 9 < 0.00 01 Chala Sphik Udara Stana 1.0 66 0.3 0.7 66 71 87 0.67 8 0.1 23 6.18 5 < 0.00 01 Dourbaly a 1.3 0.4 0.9 69 23 0.60 7 0.1 1 8.11 5 <0.0 001 Swedapr avrutti 0.7 0.1 66 0.5 33 76 19 0.62 8 0.1 14 4.64 5 <0.0 001 Dourgan dhya 0.3 66 0.1 66 0.2 54 54 0.40 6 0.0 74 2.69 2 0.01 17 Atikshud a (Ruchi) 3.8 3.7 66 0.0 33 0.8 7 0.71 8 0.1 31 0.25 4 0.80 13 Abhyavar a Shakti 4.2 66 4.1 66 0.1 2.3 4 0.54 7 0.1 1 0.32 56 Jarana Shakti 3.6 2.8 66 0.7 33 20 37 0.78 4 0.1 43 5.11 7 <0.0 001 Pipasa 1.8 33 1.2 66 0.5 6 30 90 0.77 3 0.1 41 4.01 0.00 04 Alpa Vyavaya 0.3 33 0.3 33 0 0 0 0 0 1.00 00

Dr. Shruti Hiremath et.al. Clinical evaluation of the Sthaulyahara effect of Haritaki and Amalaki. ISSN: 2456-3110 ORIGINAL ARTICLE May-June 2018 Journal of Ayurveda and Integrated Medical Sciences | May - June 2018 | Vol. 3 | Issue 3 58 Sexual Desire 2.9 61 2.9 61 0 0 0 0 0 1.00 00 Erection 3 2.6 66 0.0 66 2.2 2 0.36 5 0.0 66 1 0.32 56 Rigidity 1 0.6 66 0.6 66 6.6 6 0.25 3 0.0 46 1.43 9 0.16 09 Nidra 1.9 66 1.0 33 0.9 33 47 45 0.73 9 0.1 35 6.91 1 <0.0 001 Alasya 1.3 0.3 33 0.9 66 74 35 0.41 3 0.0 75 12.7 93 <0.0 001 Snigdhan gata 0.6 66 0.2 0.4 66 70 0.50 7 0.0 92 5.03 7 <0.0 001 Anga Gaurava 0.7 33 0.1 66 0.5 66 77 27 0.56 8 0.1 03 5.46 1 <0.0 001 Gatrasad a 0.7 66 0.1 0.6 66 86 95 0.75 8 0.1 38 4.81 6 <0.0 001 Angashai thilya 0.8 0.1 0.7 87 0.46 6 0.8 5 8.22 5 <0.0 001 In Kshudra Shwasa 86%, Angashitilya 87% and Gatrasada 86% relief was recoreded which is statistically significant (<0.0001), in Anga Gaurava 77%, Swedapravrutti 76%, Alasya 74 %, Chala Sphik Stana Udara 71%, Snigdhangata 70 %, Dourbalya 69%, relief were recorded and in Nidra 47%, Jarana Shakti 20% relief was recorded which is statistically significant (<0.0001), Pipasa 30% Daurgandhya 54%, Atikshudha 2.3% , Alpa Vyayaya 0% relief is recorded which is statistically insignificant. Table 6: Effect on Objective Criterias in Group ‘A’ Sympto ms Me an BT Me an AT Me an Diff % of Relief SD SE t p BMI 32 899 31 935 0.9 63 2.929 16 0.9 71 0.1 77 5.4 35 <0.0 001 Waiste circumfe rence 42 633 42 333 0.3 0.703 675 0.4 66 0.0 85 3.5 25 0.00 14 Hip circumfe rence 43 42 466 0.5 33 1.240 31 0.7 3 0.1 33 4 0.00 04 Abdome nal circumfe rence 42 566 42 1 0.4 66 1.096 319 0.6 28 0.1 14 4.0 64 0.00 03 Chest circumfe rence 39 533 39 066 0.4 66 1.180 438 0.5 07 0.0 92 5.0 37 <0.0 001 Waist Hip circumfe rence ratio 0.9 82 0.9 85 0.0 01 0.101 764 0.0 11 0.0 02 0.4 62 0.64 75 Mid arm circumfe rence 13 55 13 416 0.1 33 0.984 01 0.3 45 0.0 63 2.1 12 0.04 34 Mid Thigh circumfe rence 19 766 19 366 0.4 2.023 609 0.4 98 0.0 9 4.3 96 0.00 01 Weight 74 466 78 48 2.2 53 3.025 962 1.5 59 0.2 84 7.9 13 <0.0 001 Weight reduction 3.02% relief found which is statistically highly significant(p<0.0001) in BMI 2.929% relief found which is statistically highly significant. Relief was found which is highly significant (<0.0001), chest circumference 1.1804 relief found which is statistically highly significant (<0.0001), waist circumference 0.7036 relief found which is very statistically significant (0.0014) hip circumference 1.0963 relief found, abdominal circumference 1.096% relief were found which is consider as non significant (0.0004), (0.0003), in chest circumference 1.1804% relief were found which is highly statistically significant (<0.0001) mid arm 0.9 % and mid thigh circumference 2.02% relief were found which is not statistically significant. Table 7: Effect on laboratory investigestion in Group ‘A’ Symptoms M ea n BT Mean AT M ea n Dif f % of Relie f SD SE t p WBC Count 60 40 6436 - 39 6 6.567 3 13 26 3 24 2 2 - 1.6 38 0.11 22

[Find the meaning and references behind the names: Bin]

Dr. Shruti Hiremath et.al. Clinical evaluation of the Sthaulyahara effect of Haritaki and Amalaki. ISSN: 2456-3110 ORIGINAL ARTICLE May-June 2018 Journal of Ayurveda and Integrated Medical Sciences | May - June 2018 | Vol. 3 | Issue 3 59 Neotrophil s Count 58 36 6 55.13 3 3.2 33 5.539 69 7.8 72 1 43 7 2.2 49 0.03 23 Eosinophil s Count 4.2 66 3.133 1.1 33 26.56 25 1.3 32 0 24 3 4.6 59 <0.0 001 Lymphocit es Count 37 40.3 - 3.3 8.918 92 7.7 15 1 40 8 - 2.3 42 0.02 63 Monocytes Count 0.7 33 1.266 - 0.5 3 72.72 73 0.6 28 0 11 4 - 4.6 45 <0.0 001 Basinophil s Count 0 0 0 0 0 0 1 0 Haemoglo bin Count 11 25 12.01 3 - 0.7 5 6.721 94 0.7 83 0 14 - 528 7 <0.0 001 Serumchol estrol (HDL) 37 66 36.23 3 1.4 33 3.805 31 5.3 02 0 96 1.4 8 0.14 97 Serumchol estrol (LDL) 21 6.3 158.5 33 57 66 26.65 639 27 25 2 4 97 11 589 <0.0 001 Serumchol estrol (VLDL) 12 68 16.00 6 - 3.3 2 26.23 55 3.8 9 0 71 - 4.6 83 <0.0 001 Serum Triglycerid s 62 73 80 - 17 26 27.52 39 20 02 5 3 65 - 4.7 22 <0.0 001 Serum Total cholestrol 26 0.1 210.8 3 49 33 18.96 22 22 92 4 18 11 78 <0.0 001 Eosinophil count 26 %, Monocyte count 72.7 % , Haemoglobin count 6.72% , Serum cholesterol (LDL) 26.65 %, Serum cholesterol (VLDL) 26.23% , Serum Trigylcerides 20.02 %, Serum total cholesterol 18.96 % relief were recorded which is highly statistically significant(<0.0001). WBC count 6.56 % , Neutrophils Count 5.53 % , Serum Cholesterol (HDL) 3.80 % relief were found which is statistically insignificant. Effect of therapy in Group B In this group 63 patients were registered out of which 3 patients have dropped out and 30 patients have completed the full course of treatment. Here the effect of Amalaki Churna on various subjective and objective parameters is as follow . Table 8: Effect on subjective and objective criteria ( Amalaki Choorna ) in group ‘B’ Sympto ms Me an BT Me an AT Me an Diff % of Relief SD SE t p Kshudra Shwasa 0.5 33 0.1 0.4 33 81.25 0.5 68 0.1 03 4.1 76 0.00 02 Chala Sphik Udara Stana 1.6 66 0.4 33 0.6 33 59.37 5 0.6 68 0.1 22 5.1 87 <0.0 001 Dourbaly a 1.5 66 0.6 0.9 66 61.70 213 0.6 68 0.1 22 7.9 18 <0.0 001 Swedapr avrutti 0.6 66 0.2 0.4 66 70 0.5 07 0.0 92 5.0 37 <0.0 001 Dourgan dhya 0.4 33 0.0 66 0.3 66 84.61 538 0.5 56 0.1 01 3.6 11 0.00 11 Atikshud a (Ruchi) 3.8 66 3.8 33 0.0 33 0.862 069 1.0 98 0.2 0.1 66 0.86 93 Abhyavar a Shakti 4.5 4.3 33 0.1 66 3.703 704 0.4 61 0.0 84 1.9 79 0.05 74 Jarana Shakti 3.1 2.5 66 0.5 33 17.20 43 0.5 07 0.0 92 5.7 56 <0.0 001 Pipasa 1.6 0.9 0.7 43.75 0.8 3 0.1 52 4.5 82 <0.0 001 Alpa Vyavaya 0.4 48 0.3 79 0.6 66 14.87 17 0.2 53 0.0 46 1.4 39 <0.0 001 Sexual Desire 2.7 69 2.5 38 0.2 7.222 2 0.7 61 0.1 38 1.4 39 <0.0 001 Erection 2.5 2.5 0 0 0 0 0 1.00 0 Rigidity 0 0 0 0 0 0 0 1.00 0 Nidra 1.5 33 0.8 0.7 33 47.82 609 0.6 91 0.1 26 5.8 08 <0.0 001 Alasya 1.2 66 0.3 66 0.9 71.05 263 0.4 8 0.0 87 10 255 <0.0 001 Snigdhan gata 0.4 33 0.1 33 0.3 69.23 077 0.4 66 0.0 85 3.5 25 0.00 14 Anga Gaurava 0.7 66 0.2 33 0.5 33 69.56 522 0.5 07 0.0 92 5.7 56 <0.0 001 Gatrasad a 0.6 0.2 0.4 66.66 667 0.6 74 0.1 23 3.2 47 0.00 29 Angashai thilya 0.8 33 0.1 33 0.7 84 0.4 66 0.0 85 8.2 25 <0.0 001

Dr. Shruti Hiremath et.al. Clinical evaluation of the Sthaulyahara effect of Haritaki and Amalaki. ISSN: 2456-3110 ORIGINAL ARTICLE May-June 2018 Journal of Ayurveda and Integrated Medical Sciences | May - June 2018 | Vol. 3 | Issue 3 60 In Chala Sphik Stana Udara Lambana 59 %, Dourbalya 61.7%, Sweda Pravrutti 70%, Jarana Shakti 17 %, Pipasa 43 %, Alpa Vyava ya 14.4 % relief was found which is statistically highly significant. In Kshudra Shwasa 81%, Atikshudha 0.86%, Abhyavarana Shakti 3.7 % relief was found which is statistically insignificant. Table 9: Effect on subjective criteria in Group ‘B’ Sympto ms Me an BT Me an AT Me an Diff % of Relief SD SE t p BMI 31 113 29 982 1.1 31 3.635 09 1.0 91 0.1 99 5.6 76 <0.0 001 Waiste circumfe rence 42 883 42 816 0.0 66 0.155 461 0.2 53 0.0 46 1.4 39 0.16 09 Hip circumfe rence 43 433 43 333 0.1 0.230 238 0.3 05 0.6 55 1.7 95 0.08 31 Abdome nal circumfe rence 43 933 43 433 0.5 1.138 088 0.5 08 0.0 92 5.3 85 <0.0 001 Chest circumfe rence 39 133 38 666 0.4 66 1.192 504 0.6 81 0.1 24 3.7 5 0.00 08 Waist Hip circumfe rence ratio 0.9 36 0.9 36 0 0 0 0 0 1.00 0 Mid arm circumfe rence 14 05 13 783 0.2 66 1.897 983 0.4 49 0.0 82 3.2 47 0.00 29 Mid Thigh circumfe rence 19 366 19 1 0.2 66 1.376 936 0.4 49 0.0 82 3.2 47 0.00 29 Weight 74 766 72 016 2.7 5 3.678 11 1.8 13 0.3 31 8.3 05 <0.0 001 In weight reduction 3.67% relief was found which is extremly significant in BMI 3% were get relief which is extremely statistical significant, waist circumference 0.155461% got relief and which is statistically insignificant. Hip circumference 0.2302% relief was found which is statistically insignificant, chest circumference 1.192% releif was found which is statistically insignificant. Table 10: Effect on laboratory investigestion in Group ‘B’ Sympto ms Mea n BT Mea n AT M ea n Dif f % of Reli ef SD SE t p WBC Count 6123 .333 6906 .667 - 78 3.3 12 79 1486 .272 271 .35 6 - 2 88 6 0.0 073 Neotrop hils Count 58.8 52.8 33 5.9 6 10 14 9.11 4 1.6 64 3 58 5 0.0 012 Eosinop hils Cont 4.13 3 3.3 0.8 33 20 16 1.28 8 0.2 35 3 54 1 0.0 014 Lympho cites Count 36.7 66 42.9 33 - 6.1 6 16 77 9.43 9 1.7 23 - 3 57 8 0.0 012 Monocy tes Count 0.63 3 1.36 6 - 0.7 3 115 .78 0.69 1 0.1 26 - 5 80 8 0.0 284 Basinop hils Count 0 0 0 0 0 0 1 0 Haemog lobin Count 11.4 26 12.2 86 - 0.8 6 7.5 2 0.70 6 0.1 29 - 6 66 3 <0 000 1 Serumc holestro l (HDL) 39 38.6 66 0.3 33 0.8 5 4.29 3 0.7 83 0 42 5 0.6 74 Serumc holestro l (LDL) 192 766 146 6 46 16 23 94 30.0 78 5.4 91 8 40 6 <0 000 1 Serumc holestro l (VLDL) 12.5 16.9 66 - 4.4 6 35 73 4.11 6 0.7 51 - 5 94 <0 000 1 Serum Triglycer ids 62.1 66 84.5 - 22 3 35 924 9 20.2 02 3.6 88 - 6 05 4 <0 000 1 Serum Total 244 202 16 41 8 17 144 27.9 92 5.1 1 8 18 <0 000

Dr. Shruti Hiremath et.al. Clinical evaluation of the Sthaulyahara effect of Haritaki and Amalaki. ISSN: 2456-3110 ORIGINAL ARTICLE May-June 2018 Journal of Ayurveda and Integrated Medical Sciences | May - June 2018 | Vol. 3 | Issue 3 61 cholestr ol 1 Haemoglobin count 7.52% , Serum Cholesterol (LDL) 23.94 %, Serum Cholesterol (VLDL) 35.73%, Serum Triglycerides 35.92 % , Serum total Cholesterol 17.144% relief was found which is statistically highly significant . WBC count 12 % , Neutrophils count 10%, Eosinophil count 20 %, Lymphocyte count 16.7%, monocyte count 115 % , Serum cholesterol (HDL) 0.85% relief was found which is statistically insignificant. Table 11: Overall effect of treatment in Group A and B. Assessment ‘A’ Group ‘B’ Group Total Percentage Cured 3 4 7 10% Markedly. Imp 5 6 11 16% Moderately. Imp 12 12 24 26% Mild.Imp 8 5 13 20% Unchanged 2 3 5 7% DISCUSSION It is the necessity of time to refurbish the principles of Ayurveda in today's context. It is not sufficient to prove these principles conceptually but it should be supported by some clinical data. These principles cannot be accepted if they are not supported with clinical observations. Clinical study gives authenticity to such principles. It is already said that the study was undertaken to prove the principle 'Hrasa Hetur visesasca' clinically. The hypothesis decided for the study was Vishesha is a principle cause for Hrasa (Diminution). To prove this hypothesis a clinical study was performed in the patients of Sthaulya . Here Sthaulya is taken for the study because in Sthaulya there is abundant growth of Medodhatu in the body which is having Prthvi and Apa Mahabhuta dominance. It is a condition of Vrddha Medodhatu . So, it requires the drug which can cause Hrasa (diminution) of Medodhatu for its cure. As per the hypothesis of this study, this is the unique condition to apply Vishesha . Vishesha applied for this study was Haritaki and Amalaki . Both are having Kaphagna and Medoghna properties due to Agni and Vayu Mahabhuta dominance in them. So, it was thought at that time that being a Vishesha for Medhodhatu , Haritaki will cause Hrasa of increased Medodhatu in Sthula patients . In present study it was observed that most of the patients i.e. 41% were from the age group of 20 to 30 years, 40% were from age group of 30-40 yrs. Modern textbooks also supports the same observations i.e. Excess weight gain usually starts when individuals are aged between 20 and 40 years with maximum body weight being achieved in middle age [8] The reason behind this observations might be that as the age progresses person are not changing their dietic habits. As the age progress energy expenditure reduces but food intake providing energy remain the same. It leads to storage of excess energy in the form of fat, which leads to Sthaulya (Obesity). In this study almost 80% patients were females. In young women, body fat stores may be below 30 percent and increase gradually to more than 35 percent in older women whereas in men it increases upto 25 percent only. In every region the prevalence of Obesity is higher among women then among men (Oxford's textbook of Medicine). The reason behind this observation might be the feminine factors like puberty, menstrual disturbances, menopause, post operative and oral contraceptives. In this study maximum number of patients (73%) were married. This might be due to the middle age in which a person remains married. The reason behind this might be light nature of work, advancement of new techniques, tools (eg. Mixtures, washing machines) which reduces energy expenditure and besides these the most important cause is Diwaswapna . 78% patients were from middle class (S/E status). 18 % patients were from higher class. From this observation it cannot be said that Sthaulya has dominance in Middle class. In the present study 75 % patients were sedentary occupation, 23% patients

[Find the meaning and references behind the names: Tamas, Guru, Mala, Rasa, Good]

Dr. Shruti Hiremath et.al. Clinical evaluation of the Sthaulyahara effect of Haritaki and Amalaki. ISSN: 2456-3110 ORIGINAL ARTICLE May-June 2018 Journal of Ayurveda and Integrated Medical Sciences | May - June 2018 | Vol. 3 | Issue 3 62 were active occupation it shows sedentary occupation people more prone to Sthaulya . In the present study 95% patients get gradually increase of weight, 3% patients get insidious weight gain and 3% patients got rapid weight gain. It shows the time of onset of weight gain is gradually increased. In the present study 76% patients were of Kapha Pitta Prakriti and 23% patients were of Kapha Vata Prakrti . It shows the dominance of Kaphadosha in Prakriti , which is the most conductive one for Sthaulya . The study points out that involvement of Kapha Dosa playing very important role in Sthaulya . Most of the patients from the present study were having their weight between 60 to 80 kg. As the selection criteria of patients itself shows selection of overweight patients only. In this study maximum number of patients were found to have Mandagni . Obstructed Vatadosa due to Medodhatu leads to Tiksnagni , which is the major consequence of Sthaulya . Due to this Tiksnagni , whatever a person eats is digested in short time and patient demands for more food again and again. This might be due to Tiksnagni condition which manifests in the form of symptoms like increased Abhyavaharana and Jaranasakti . Maximum number of patients in the present study were i.e. 55% were Vegetarians, 38% patients were mixed. This observation reflects the predominant diet of this region which is vegetarian followed by local population. Vegetarian diet enriched with extra oil, butter, ghee, milk products causes production of extra fat which leads to conditions like Sthaulya . Observations from clinical study shows the Madhura 87%, Amla 13% and Lavana Rasa 1%, Katu 98% consuming tendency of the patients. All the patients possessing Katu Rasa Dravyas are not prone to Sthaulya , in this study patients of this region used to consume more Katu Dravyas . As well as over indulgence of the patients in the diet having Guru 89 %, Sheeta 26% and Snigdha Guna 58% dominance. This is evidenced in classics as well as in previous studies that these are Medovriddhikar factors which ultimately leads to Sthaulya . Maximum number of patients i.e. 25% were found to be doing moderate type of work followed by 75% who were doing sedentary type of work. In classics Acharyas have stated that causative factors like Avyayama, Cestadvesa, Asanasukha etc. Are the principles causes of Sthaulya . Maximum number of patients i.e. 72% were found to have sound sleep and 27% patients were having good sleeping hours as 6-8 hrs/day. Henceforth, sound sleep persons are more prone to Sthaulya . As it is stated in classics also that patients of Sthaulya are having Kapha dominant Sharira Prakrti and Tamas dominant Manasprakrti, so it is obvious that maximum number of patients should have sound sleep. This shows good prognosis of the disease. Aharatmaka Nidanas were found in maximum number of patients as evidenced in classics. All these Nidanas were having Kapha Medovriddhikar properties and owing to these properties they increase Kapha and Meda in the body. Viharatmaka Nidanas reported in the present study were also as per classics. The combine effect of all these Nidanas is reduction in energy expenditure and increase in energy gain which ultimately disturbs the balance and leads to Sthaulya . All the patients were selected for this study, after assessing the selection criteria for Sthaulya , so it is obvious that all the patients should have complaint of Bharvrddhi . 100% patients were found to be suffering from Angagauravata . The reason behind this is, Medodhatu is having Prthvi and Aap Mahabhuta dominance, so abundant growth of Medodhatu in Sarira leads to increase of Gunas like Guru, Seeta, Snigdha in the body, which ultimately leads to Angagauravata . It is also said in classics that Medodhatu produced in Sthaulya condition is in Amavastha which causes Angagauravata . In Sthaulya, Medodhatu obstructs the normal path of Vatadosa , this Vatadosa ( Samana Vayu ) stimulates the Pachaka Pitta in the Kostha which leads to symptom like Atiksudha . Sweda is said to be Mala of Medodhatu , increased production of Medodhatu increases Swedapravrtti of the body. This increased Swedapravartuna might be the reason behind Atipipasa .

[Find the meaning and references behind the names: Gupta, Rashmi, Gopal]

Dr. Shruti Hiremath et.al. Clinical evaluation of the Sthaulyahara effect of Haritaki and Amalaki. ISSN: 2456-3110 ORIGINAL ARTICLE May-June 2018 Journal of Ayurveda and Integrated Medical Sciences | May - June 2018 | Vol. 3 | Issue 3 63 Better results were found in symptoms like Atiksudha and Atinidra in both group A and group B. Due to this reason symptom like Atiksudha were found to have better results. This is also evidenced in classics that Haritaki with its own properties can do the function of Strotovibandhanasana . In Kshudra Shwasa 86% in group A and 81% patients were relieved in group B. in Chala Sphik Stana Udara 71% in group A and 59% in group B were relieved. In dourbalya 69% in group A and 61% in group B were relieved. In Sweda Pravrutti 76% in group A and 70% in group B were relieved. In Dourgandhya 54% in group A and 84% in group B were relieved. In Atikshudha both group 0.8% patients were relieved. In Abhyavarana Shakti 2.3% in group A and 3.7% in group B were relieved. In Jarana Shakti 20% in group A and 17% in group B were relieved . In Pipasa 30% in group A and 43% in group B were relieved. In Alpa Vyavaya 14% group B were relieved. In Nidra 47% in both group patients were relieved. In Alasya 74% patients of group A and 71% in group B were relieved. In Snigdhangata 70% in group A and 69% in group B were relieved. In Anga Gourava 77% in group A and 69% in group B patients were relieved. In Gatrasada 86% in group A and 66% in group B were relieved. In Angashaithilya 87% in group A and 84% in group B were relieved. In BMI 2.92% in group A , 3.63% in group B waist circumference 0.70% in group A and 0.155% in group B , Hip circumference 1.2 4% in group A and 0.23% in group B . In Abdominal circumference 1.09% in group A and 1.13% in group B. In chest circumference 1.18% in group A and 1.19% in group B . In Mid arm 0.98% in group A and 1.89% in group B. Mid thigh circumference 2.02% in group A and 1.37 in group B . weight 3.02% in group A and 3.67% in group B . By this statistical data we can depict or conclude that group A is highly significant in reducing the BMI in all circumference as compared to group B . In Medovaha Srotas the prominent symptoms are Alasya 86%, Dourbalya 81%, Sphik Stana Udara Chalatwa 75%, Snigdhangata 44% , Angashaithilya 64%, Pipasa Atimatra 58%, Talushosha 58%, Swedabadha 41%, Dourgandhya 38%, Kantashosha 26%, Bahumutrata 15%, Javoparodha 4%, Atishlakshna 9%, Mutrasada 3%. CONCLUSION By this statistical result we can conclude that Group A patients were more relieved than group B who were administered Haritaki Churna . Nidanas of Sthaulya mentioned in classics are now changing. Increasing stress, faulty dietary habits and decreased awareness regarding exercise are becoming the prominent causative factors for Sthaulya . The drug Haritaki and Amalaki shows better results on the objective parameters realted to obesity (i.e. body weight, BMI, body circumference) which shows depletory action. The hypothesis decided for the study was 'Vishesha' is the prime cause for Hrasa . Here it is clear that Vishesha applied were Guna Vishesha . Here significant result itself shows that Vishesha has done its role of Hrasa in betterway. REFERENCES 1 Gupta Gopal Das, Gupta Rashmi. Biochemical Study of Guggul In Case Of Adolescent Obesity, . Journal of Pharmacognosy and Phytochemistry, Vol. 4, Issue 2 (2015), 205-7 2 Vaidya Ravidatta Tripathi, Charak Samhita with vaidymanorama Hindi commentary. Chaukhamba Sanskrit pratishthan Delhi; 2013. Sutrasthana 21/3. 300 p. 3 Vaidya Ravidatta Tripathi, Charak Samhita with vaidymanorama Hindi commentary. Chaukhamba Sanskrit pratishthan; Delhi 2013. Sutrasthana 23/6. 317 p. 4 Vaidya Ravidatta Tripathi, Charak Samhita with vaidymanorama Hindi commentary. Chaukhamba Sanskrit pratishthan Delhi; 2013. Sutrasthana 1/44. 13 p. 5 Vaidya Ravidatta Tripathi, Charak Samhita with vaidymanorama Hindi commentary. Chaukhamba Sanskrit pratishthan Delhi; 2013. Sutrasthana 1/44. 13 p. 6 Planetayurveda.com. (2018). Haritaki, Harad (Terminalia chebula) - Properties, Benefits, Uses and Dosage . [online] Available at:

[Find the meaning and references behind the names: Nil, Med]

Dr. Shruti Hiremath et.al. Clinical evaluation of the Sthaulyahara effect of Haritaki and Amalaki. ISSN: 2456-3110 ORIGINAL ARTICLE May-June 2018 Journal of Ayurveda and Integrated Medical Sciences | May - June 2018 | Vol. 3 | Issue 3 64 http://www.planetayurveda.com/library/haritakiterminalia-chebula [Accessed 13 Jul. 2018]. 7 Planetayurveda.com. (2018). Amla (Emblica Officinalis) - Properties, Benefits and Dosage . [online] Available at: http://www.planetayurveda.com/library/amlaemblica-officinalis [Accessed 13 Jul. 2018]. 8 Davidson's Principles and Practice of Medicine, Nineteenth Edition, 2002 ******************************* How to cite this article: Dr. Shruti Hiremath, Dr. Umapati Baragi, Dr. M. R. Sajjanshetty. Clinical evaluation of the Sthaulyahara effect of Haritaki and Amalaki based on the principle of Hrasa Hetur Visheshascha . J Ayurveda Integr Med Sci 2018;3:54-64. http://dx.doi.org/10.21760/jaims.v 3 i 3.12876 Source of Support: Nil, Conflict of Interest: None declared.

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