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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 3  |  Issue : 1  |  Page : 35-40

Efficacy of Vachadi vati in the management of childhood obesity


Department of Kaumarbhritya, I.P.G.T. and R.A., G.A.U., Jamnagar, Gujarat, India

Date of Submission07-Aug-2019
Date of Acceptance08-May-2020
Date of Web Publication14-Jul-2020

Correspondence Address:
Dr. Vishal Prajapati
Department of Kaumarbhritya, I.P.G.T and R.A., G.A.U., Jamnagar, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JACR.JACR_1_20

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  Abstract 


Childhood obesity is on the rise. Unaddressed situation may lead to various complications. It needs to be intervened at the appropriate level. Sthaulya (~obesity) and Medoroga (~disorder of fat metabolism) explained in the Ayurvedic texts are comparable with obesity. Acharya Charaka has described Sthaulya among the eight most Nindita purusha (~despicable personalities). A 10-year-old, school-going female child was brought to the outpatient department, I. P. G. T. and R. A. Hospital, Gujarat Ayurved University, Jamnagar, Gujarat, by her parents with complaints of excess weight gain for 2–3 years. On clinical examination, the child had 58 kg body weight with Body Mass Index (BMI) >30 kg/m2. Vachadi vati (an Ayurvedic formulation) was given in a dose of 3.5 g in three divided doses before meal with luke warm water for eight weeks along with diet and lifestyle modification. Anthropometric assessment and laboratory investigations were done before and after the treatment. After eight weeks of intervention, there was 10% reduction in body weight and BMI, reduction in chest circumference and waist-hip ratio. As per this case study, it can be said that Vachadi vati could be used in the management of childhood obesity along with some diet and lifestyle modification.

Keywords: Childhood obesity, Sthaulya, Vachadi vati


How to cite this article:
Prajapati V, Bhaskar CL, Kori V K, Patel K S. Efficacy of Vachadi vati in the management of childhood obesity. J Ayurveda Case Rep 2020;3:35-40

How to cite this URL:
Prajapati V, Bhaskar CL, Kori V K, Patel K S. Efficacy of Vachadi vati in the management of childhood obesity. J Ayurveda Case Rep [serial online] 2020 [cited 2020 Aug 6];3:35-40. Available from: http://www.ayucare.org/text.asp?2020/3/1/35/289371



[TAG:2]Introduction[/TAG:2]

Obesity is a leading preventable cause of death worldwide with the increasing prevalence in adults and children; authorities view, it as one of the most serious public health problems of the 21st century.[1] Due to the rising prevalence of obesity in children and its numerous adverse health effects, it is being recognized as a serious public health concern. The most frightening aspect of obesity is that it shortens the lifespan. According to the Centers for the Disease Control and Prevention (CDCP), childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years. Poor dietary intake, physical inactivity, and life style patterns are found to be the major reasons for obesity.[2]

Guidelines for obesity and overweight based on Body Mass Index (BMI) for Asian Indians were revised based on the consensus developed through discussions by a prevention and management of obesity and metabolic syndrome group.[3] The revised guidelines categorize overweight as a BMI of 23.0–24.9[4] and obesity as a BMI ≥25 using values lower than the ethnic specific BMI previously advocated for Asian Indians.[3] In the modern science, there are three main treatment modalities for obesity, namely lifestyle interventions, medications, and bariatric surgery. Except lifestyle interventions, other two have side effects. Lifestyle modification needs to be intensive (i.e., calorie restriction, individual and family counseling, and regular exercises) and continued to be effective, which is challenging to maintain in children and adolescents.[5]

In Ayurveda, Sthaulya has been described as Ashtanindita (~one of the eight disgraceful persons) in the context of the body.[6] The conventional concept of etiopathogenesis, prognosis, and management of obesity is very similar and equally advanced in Medoroga/Sthaulya in Ayurveda. Acharya Sushruta has elaborated the etiopathogenesis based on an endogenous entity due to Dhatvagnimandya.[7] Overweight or obesity is mostly found in people with predominantly Kapha (~phlegm) type constitutions. Ayurveda has holistic approach in the management of obesity as Ayurveda does not recommend any weight losing pills or fast weight loss programs such as modern science. Shodhana (~bio-purificatory) and Shamana (~pacificatory measures) are the important tools of Ayurvedic therapeutics. Beside this, it advocates dietary restrictions, moderate physical activities, practices of Yogasanas, Pranayama, and certain effective Ayurvedic formulations in the management. Ayurvedic formulations with Kapha vata hara (~reduce Kapha and Vata) and Medo hara (~anti-obesity) properties improve fat metabolism in an obese individual and thus helps in maintaining the weight. In the present case, Vachadi gana containing Vacha (Acorus calamus Linn.), Shunthi (Zingiber officinale Roxb), Musta (Cyperus rotundus Linn.), Devadaru (Cedrus deodara Roxb.), Ativisha (Aconitum heterophyllum Wall.), and Abhaya (Terminalia chebula Retz.) were administered in Vati form.[8]

[TAG:2]Case Report[/TAG:2]

A 10-year-old, female child was brought by her parents to Kaumarbhritya outpatient department (OPD), (Registration no. PG18052479), I. P. G. T. and R. A. Hospital, Gujarat Ayurved University, Jamnagar, Gujarat on July 04, 2018 with the main complaint of progressive weight gain for 2–3 years and associated complaints of hair fall for the last two months. There was no any past history of psychological or endocrinal illness or any history of long-term medication. She had a positive family history. Her mother and younger brother both were obese. She had a normal birth history, i.e., full-term normal vaginal delivery with birth weight of 2.75 kg and no any significant postnatal history. There was a complete immunization history, growth, and development of the child was also proper with age. She had a history of faulty dietary habits and sedentary life style. She used to take non-vegetarian diet one to two times per week, and also she used to take one to two extra meals to fulfil her satiety level. She had not taken any treatment for the above complaints. Her parents visited the OPD enquiring Ayurvedic solutions for her condition. The treatment was started from July 07, 2018 with parent's consent and child's assent.

Clinical findings

She had 58 kg of body weight, 137 cm height with 30.9 Kg/m2 of BMI (>95th percentile of CDC growth chart 2006), fat 34%, chest circumference 88 cm, waist/hip ratio 0.91, built-wise obese. She had complaint of Daurgandha (~offensive body odor), and acanthosis nigricans was present over the neck region. Pulse rate was 80/min, respiratory rate was 20/min, and blood pressure was 110/70 mmHg. No abnormality was noticed in the functioning of respiratory, circulatory, or digestive systems.

Dashavidha pareeksha(~Ten fold examination)

Child was having Sharirika prakriti (~physical constitution) as Pitta-kapha and Manasika prakriti (~ mental constitution) as Rajasika-tamasika; Vikriti (~morbidity) was Kapha dosha; Rasa, Rakta, Mamsa, Meda were Dooshya; Rasa-raktameda-sweda sarata (~essence of all Dhatus); Madhyama samhanana (~compactness); Pravara pramana (~anthropometry); Madhyama satmyata (~suitability or homologation); Madhyama satva (~psyche); Ahara shakti (~intake of food) with Pravara abhyavaharan shakti (~increased intake of food) and Pravara jarana shakti (~increased digestive fire); Agni was Tikshna (~overheated digestion); Avara Vyayama shakti (~ decreased capacity of exercise).

Ashtavidha pareeksha (~Eight fold examination)

Ashtavidha pareeksha showed that her Nadi (~pulse rate) was 80/Min, passing of hard stool occasionally; Mutra (~urine frequency) was regular, Jivha (~tongue) was Sama (~coated tongue), Shabda was Guru swara, Sparsh (~touch) was Snigdhnga; Drika (~eye) was Pandura (~pallor), Akriti (~built) was Sthoola (~obese).

Sroto pareeksha (~Examination of body channels)

Tandra, Ayathakala palita symptoms were associated with Rasavaha srotodushti, Vyanga (~acanthosis nigricans) with Raktavaha srotas, Pipasa, Alasya, Vishrasharirgandha, Sarvakala tandra-nidra with Medovaha srota and Atiswedanam with Swedavaha srotodushti.

Investigations

Hemoglobin percentage, total leukocyte count, red blood counts, fasting blood sugar, lipid profile, and apolipoprotein-B were done before and after the treatment. Thyroid stimulating hormone (TSH) and stool-urine routine were investigated before therapeutic intervention.

Differential diagnosis

  1. Exogenous (due to faulty diet and lifestyle): The patient had a history of frequent consumption of high calorie diet, day sleeping, and no/less physical activity.
  2. Endogenous (Endocrinal disorders such as Hypothyroidism) – TSH-1.6 mU/L (Normal).
  3. Psychological disorders: The child was a class five student and had normal Intelligence Quotient (IQ) level, No history of any psychological disorders.


Diagnosis

As per above history, BMI, anthropometric and laboratory parameters; child was diagnosed as grade 2 obesity due to exogenous causes, i.e., faulty diet and lifestyle.

[TAG:2]Treatment Protocol[/TAG:2]

Therapeutic intervention

The drugs from Vachadi gana were selected and given in Vati (~tablet) form to the patient. Vachadi vati was prepared by taking mentioned ingredients in proposed proportions in the Gujarat Ayurved University Pharmacy [Table 1].[8]
Table 1: Composition of Vachadi vati

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Posology of Vachadi vati

Seven vati (each of 500 mg) were given orally, Pragbhakta (~before meal) in three divided doses (3-2-2) with Usnodaka (~luke warm water) as Anupana (~vehicle) for eight weeks with weekly follow-up. Dose of Vachadi vati was calculated as per age on the basis of Sharangdhar's rule.[9] Physical assessments were done every week for eight weeks. During weekly follow-up, daily food pattern and physical activity were noted for 24 hr. by diet recall method. The patient was advised to follow the diet and lifestyle changes along with medication,[10],[11],[12] as shown in [Table 2].
Table 2: Diet and lifestyle modifications advised to the patient

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Assessment criteria

Improvement was assessed on the basis of percentage relief observed in the presenting complaints. Standard grading criterion[13] was adopted to assess the effectiveness of the therapy [Table 3].
Table 3: Grading criteria

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[TAG:2]Followup, Outcome and Discussion[/TAG:2]

Sthaulya is defined as a metabolic disorder stemming from lack of exercise, poor diet, stress, genetic predisposition, and ultimate increase in Kapha dosha (~bio-element) leading to the excessive accumulation of adipose tissue, associated with accumulation of Prithvi and Jala mahabhoota (~earth and water elements) in the body mind, poor digestive fire, and accumulation of toxins in the digestive tract.[14],[15],[16] Overeating and sedentary lifestyle contribute to the accumulation of Prithvi and Jala mahabhoota in the body, as does excess sleep, steroid medications, and psychoemotional conditions such as depression and anxiety.[17]Prithvi and Jala mahabhoota are associated with the heavy, dense, slow, and cold qualities and are antagonistic to Dhatvagni (~metabolic fire), which is sharp, light, and hot; thus contributing to slow metabolism and obesity.[17] The ingredients of Vachadi vati have Tikta–katu rasa (~bitter-pungent taste), Ruksha-laghu guna (~dry-light properties), Ushna veerya (~hot potency), Katu vipaka (~ catabolic bio-transformation); hence, they together have Kapha-medo hara (~removes and dries up excess Meda) properties along with Lekhaniya (~scrapes excess Meda) and Deepaniya (~increases the Dhatvagni) action.[8],[18],[19],[20],[21],[22],[23] They work by the principle of Guru cha apatarpana (~heavy and nonnourishing diet) which regulates the hunger and satiety center, thereby regulating the energy intake of a person. This aids in the proper utilization of stored fat to fulfill the energy needs. As drug is in Vati form; its intake is very easy and does not create any difficulty for its consumption.

After eight weeks of intervention of Vachadi vati, it was found that there was complete improvement (100%) in complaints such as Alasya/Utsahahani (~laziness) and Nidradhikya (~excess sleepiness), whereas marked improvement (50%) in complaints such as Swedhadhikya (~excess sweating) and Atikshudha (~excess appetite), 33% improvement in complaints such as Chala sphika udara stana (~pendulous movement of buttock, abdomen, and breasts)[Graph 1]. There was 10% reduction in body weight and BMI, 2% and 2.19% improvement in chest circumference and waist hip ratio, respectively [Table 4]. Other anthropometric measurements had also shown improvements. It was noted that there was significant improvement in laboratory parameters such as 6% improvement in hemoglobin%, 5% in red blood cell, 14% in white blood cell, 25% in fasting blood sugar, serum cholesterol and serum low-density lipoprotein (LDL), 47% improvement in serum triglycerides, 48% improvement in serum very low density lipoproteins, whereas 38% improvement in apolipoprotein B [Table 5]. Decrease in serum high-density lipoprotein was also observed but was within the normal limits. The follow-up study of the patient had shown that there was further decrease in anthropometric parameters by following just modified diet and lifestyle. Vachadi vati is effective possibly due to its Kapha-medo hara properties, helped in improving Dhatvagni thus improved the fat metabolism, thus there was marked improvement in anthropometric and laboratory parameters.
Table 4: Effect on anthropometric measurements

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Table 5: Effect on laboratory parameters

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[TAG:2]Conclusion[/TAG:2]

Ingredients of Vachadi vati are easily available and very cost-effective. This case study shows that Vachadi vati along with diet and lifestyle modification is effective regimen for weight loss in children. It can also be concluded that by following modified diet and lifestyle, healthy weight could be maintained. This case report can be useful in future studies related with childhood obesity.

Declaration of patient consent

Authors certify that they have obtained patient consent form, where the patient/caregiver has given his/her consent for reporting the case along with the images and other clinical information in the journal. The patient/caregiver understands that his/her name and initials will not be published and due efforts will be made to conceal his/her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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