Medoroga / Sthoulya: The terms (diseases) Sthoulya or Medoroga explained in Ayurveda can be simulated with the modern day disease Obesity (Weight Gain). There are other terms like Medo Vriddhi etc which fall into the category of Obesity. I shall discuss the meanings of all these terms in the forth-coming articles and also about how different are they or how similar are they to each other. In this context we shall discuss the term Medoroga or Sthoulya wrt Obesity.
Hridroga: Similarly I shall discuss the term Hridroga wrt Cardiovascular Diseases (CVD) though the term engulfs a wide array of diseases.
What is the relationship between Medoroga / Sthoulya (Obesity) and Hridroga (Cardiovascular Diseases)?
Obesity and Cardiac Disorders can very frequently be encountered in the modern era. They may be considered as 2 sides of the same coin because they are very often considered and practically evidenced as inter-related ailments.
Medoroga / Sthoulya (Obesity) is considered as one of the important modifiable risk factors of Coronary Artery Disease(CAD). A positive correlation has been established between obesity, plasma cholesterol concentration, familial hyperlipidemia and physical inactivity and prevalence of morbidity and death from coronary disease.
Similarly excessive obesity may increase the work load over the heart leading to excessive cardiac output which in-turn may event in Cardiac Hypertrophy, Cardiac Dilatation and Abnormal Ventricular Function.
The classical words Sthoulya and Medoroga as available in textual references of Ayurvedic literature may be considered to be related terminologies to the modern words of Obesity, Hypercholesterolemia and Hyperlipidemia etc.
Similarly a limited reference of cardiac related disorders is available in the explanation of Hridroga but the cardiac manifestations in systemic disorders have been given different terminologies like Hritshoola, Hritpeeda, Hridgraha, Hridayaashuddi, Hridishoonyata etc.
But the references indicating relationship of Sthoulya or Medoroga as a causative or risk factor of Hridaya Sambandhi Vikaras cannot be directly obtained from the classics. But the terminologies explained in Medoroga Prakarana of Madhava Nidana text and Ashtounindhita Adhyaya of Charaka Samhita viz Ayukshaya, Ashaktaha-sarvakarmasu, Alpaprana, Nashayatyashu-Jeevitham, Kshudra-Shwasa, Pushyanti Anye Na Dhatavaha etc will indirectly point towards the possible Cardiac Manifestations which could be understood only by Anumana(inference).
Comparative Analysis of the Ayurvedic and Modern concepts of Obesity (Medoroga/Sthoulya) – As a Risk Factor for Cardio-Vascular Diseases (Hridroga)
- The Meda or fat obstructing the margas or different srotas in the body i.e. Rasa-Raktadi Srotas, point towards the atherosclerosis and hyperlipidemia which in turn may lead into the formation of CAD’s
Pushyanti Anye Na Dhaatavaha (Under Nourishment of other Dhatus)
- The Medam (fat) which has gained an abnormal increase by consumption of meda vriddhikara aharas and viharas tend to cause avarodha in all the margas or Srotas’s which leads to deficient supply of nutrients and requirements to the other dhatus12 which in turn leads to their qualitative and quantitative depletion. At the same time there is excessive accumulation of only meda snatching away all the nutrients. This produces a functional overload over the heart which tries to compensate the requirements of other tissues. This chain of events may lead to many a cardiac manifestations like hypertrophy, dilatation of the heart, hypertension
- The Hridaya and its Dasha Dhamani’s being the Moola Sthana’s for Rasavaha Srotas and Rasa in turn is involved in Preenana Karma, the nutritional demands of other dhatus are met with only in the normal functioning of Hridaya and Rasavaha Srotas. The Medas poses to be a major obstacle in this process and leads to imbalanced nutrition.
Medastu Cheeyate (The fat accumulates)
- It indicates the impending atherosclerosis and plaques in the blood vessels which form a risk factor for the CVD’s.Atherosclerosis in coronary vessels may cause IHD (Ischemic Heart Disease)
Ashaktaha Sarva Karmasu (Inability to do any work), Dourbalya (Extreme weakness, Loss of strength) & Javoparodha(Breathlessness)
- The person suffering from Medoroga or Sthoulya will suffer from loss of strength and energy and will be unable to perform the daily routine activities. This mechanism probably points towards the exercise intolerance due to the functional overload produced by excess fat over the heart, which in turn functions to meet the metabolic needs of excessive adipose tissue, to metabolize and mobilize the excessive fat. This hyper-functioning of the heart may lead to hypertrophy and dilatation of the heart and abnormal ventricular function, pulmonary congestion, peripheral oedema and exercise intolerance.
Kshudra Shwasa (Dyspnoea, Difficulty in breathing)
- Dyspnoea (on mild exertion) may also be due to functional over load over the heart and lungs produced by excessive fat, as the hyper-functioning heart may cause pulmonary congestion.
Alpaprana (Decreased Life expectancy and Hypoxia)
- The person suffering from Sthoulya will have Alpapranae. decreased life expectancy and Hypoxia, which cannot be caused by the meagre increase of Medas. The abnormal increase in Medas producing hypercholesterolemia, hyperlipidemia, atherosclerosis etc. may in turn produce cardiac manifestation’s like cardiac dilatation, ventricular hypertrophy etc. leading to hypoxia, nutritional impairment, hypertension, renal insufficiency etc. This chain of events may cause a threat to the life and may be responsible for decreased life expectancy.
- Hridaya being a sthana (place) for ojus the sroto-avarodha caused by meda (fat) in medoroga may cause depletion of Dhatus (tissues) and hence ojokshaya (depletion of ojus) which may be a causative factor for Dourbalya, Ashaktata, Alpaprana and Javoparodha.
This explains that the meda (fat) is responsible for manifestation of life threatening disorders in the body.
- Obesity is generally responsible for hypertension, which in turn may cause hypertensive cardiac diseases. The patients of hypertensive heart disease have advanced coronary atherosclerosis and may develop progressive IHD. Weight reduction seems to reduce the systolic BP significantly. As a result of atherosclerosis and hypertension there is an increased risk of MI (Myocardial Infarction) and stroke in obese individuals, thus producing a threat to life.
- Atherosclerosis in coronary vessels may cause IHD. Myocardial ischaemia may event in MI, chronic IHD MI in turn may cause arrhythmias, Congestive Cardiac Failure (CCF), Cardiogenic shock, thrombo-embolism, cardiac aneurysm, pericarditis etc. all of which may be life threatening.
- Acute coronary syndromese. acute myocardial infarction, unstable angina and ischaemic death are often precipitated by fixed coronary atheromatous plaques
- Obesity causes hyperinsulinaemia and Non Insulin Dependent Diabetes Mellitus (NIDDM) or Type2 Diabetes which are responsible to produce hypertension which in turn is responsible for heart diseases.
- Obesity is related to hypo-ventilation syndrome which events in polycythaemia and eventually right sided heart failure
Ayurveda has accepted Medoroga or Sthoulya as a Santarpanottha Vyadhi, so as to the obesity being included in nutritional disorders in modern medical science. Though Hridroga has not been told to be caused by Santarpana, it has been included under the indications of Langhana which probably may indicate the relationship of Hridroga with Santarpana or Santarpanottha Sthoulya, which again is curable by Langhana or Apatarpana Chikitsa. Hridaya Shuddhi or feeling of comfort in the heart (chest) is one of the lakshanas of Samyak Langhana.
All the above said factors indicate the probable relation of obesity with CVD as a risk factor
Few Tips to keep the heart safe from fat (Preventive and Therapeutic):
- Keep away from over eating
- Get indulged in regular daily exercises (Physical and Mental activities) and avoid sedentary life style.
- Avoid calorie rich diets and the diets derived from carbohydrates and fats (Medhya-Fat rich and fat enhancing food, Shleshmala ahara-foods which cause vitiation of kapha in the body which in turn causes Obesity and CVD, Madhura anna rasa-Foods and drinks rich in sweet taste, Sneha-Oil rich foods etc)
- Therapeutic starvation – Only water, no caloric drink with vitamin mineral and protein supplements in very obese (Langhana, Apatarpana etc)
- Undergoing Panchakarma therapies (Ayurveda cleansing and detoxifying therapies), Yoga and Naturopathy will surely help
- Monitoring stress, dealing with conditions like Depression etc are essential