Medohara and Lekhaniya dravyas (anti-obesity and hypolipidemic drugs) in Ayurvedic classics: A critical review.

Santarpanottha Vikaras (diseases due to excessive nutrition) are increasing during current times. Medodushti (disorders of fat metabolism) serves as one of the important etiological factor in most of these disorders including Ischemic Heart Disease (IHD). IHD is identified as one of the leading cause of morbidity and mortality worldwide in both developing and developed countries. Retention and deposition of serum lipids resulting in decreased flow of blood in coronary arteries being the underlying cause. Conventional and herbal drugs are being used to lower levels of serum cholesterol to prevent this menace. In this regard, an attempt has been made to critically review the Medohara and Lekhaniya (Anti-obesity and Hypolipidemic) drugs mentioned in Ganas (group of drugs) of Ayurvedic classical texts which may abet our understanding of prevention and management of conditions like Dyslipidemia and its complications. Administration of drugs possessing Tikta Rasa (bitter taste), Ushna Veerya (hot in potency), Laghu and Ruksha Guna (light and dry qualities), Katu Vipaka and Vata Kaphahara actions were noted during the analysis.

Introduction

Growing prevalence of obesity worldwide is an increasing concern surrounding the rising rates of Diabetes, Coronary and Cerebrovascular disease with the consequent health and financial implications for the population.[1] Obesity promotes a cascade of secondary pathologies including Diabetes, Insulin resistance, Dyslipidemia, Inflammation, Thrombosis, Hypertension, Metabolic syndrome, and Obstructive Sleep Apnea.[2] Increasing Body Mass Index (BMI) levels mediate a common pattern of Dyslipidemia characterized by higher triglycerides, lower High Density Lipoproteins (HDL), and increased small, dense Low Density Lipoproteins (LDL) particles, which are independent risk factors for coronary disease.[3] Atherosclerosis or hardening of the arteries results from buildup of cholesterol on the interior blood vessel walls.[4] Dyslipidemia associated with obesity predicts majority of the increased cardiovascular risks seen in obese patients.[5]

Atisthaulya (obesity) is considered as one of the eight despicable conditions as described by Acharya Charaka.[6] A person in whom there is excessive accumulation of Meda (fat/adipose tissue) and Mamsa (flesh/muscle tissue) leading to flabbiness of hips, abdomen, and breast has been categorized as Atisthula.[7] Medas is body tissue predominant in Prithvi and Ap Mahabhutas similar to Kapha Dosha.[8] It is characterized by Snighdha (unctuous), Guru (heavy), Sthula (space occupying), Picchila (slimy), Mridu (tender/soft) and Sandra (dense) Guna (qualities).[9] Sneha (oleation), Sweda (production of sweat), Drudhatva (compactness), and Asthipushti (nourishment of bones) are the main function of Medodhatu.[10] Consumption of Guru (heavy to digest), Sheeta (cold), Snigdha (unctuous), Madhuradi Kaphavardhaka (sweet and Kapha increasing) drugs along with lack of exercise and sedentary life style result in excessive nourishment of Medas while other bodily elements (Dhatus) are deprived of nourishment. Disproportionately increased Medas is accountable for several serious consequences reported in Charaka Samhita like Ayuhrasa (decrease of life span), Javoparodha (decrease in enthusiasm and activity), Krichravyavayata (difficulty in sexual act), Dourbalya (decrease of strength), Dourgandhya (bad odor), Swedabadha (excess perspiration) and Kshut Pipasadhikya (excessive hunger and thirst).[11] Mandotsaham (less activity referring to sedentary lifestyle), Atisnigdham (excessive intake of fatty substances), Atisthaulyam (gross obesity), and Mahashanam (excessive eating) constitute for causation of Prameha[12] (urinary diseases including Diabetes) and these etiological factors may also initiate Dyslipidemia.

Obesity and Hyperlipidemia being the most common problems in adolescents as well as older age groups, there is a necessity to combat them with drugs mentioned in classics which maybe useful to address the associated conditions of Medodushti. In this regard, an attempt has been made to critically review the Medohara drugs mentioned in the classical texts which may abet our understanding of prevention and management of the conditions like Obesity and Dyslipidemia.

Materials and Methods

Compilation and tabulation of Lekhaneeya (which scrapes excess Medas) and Medohara (which removes or dries up excess Medas) herbs were done from Ganas of Charaka Samhita,[13] Sushruta Samhita,[14] Astanga sangraha,[15] and Ashtanga Hrudaya.[16] Rasa (taste), Guna (quality), Veerya (potency), Vipaka (drug metabolism), Action on Doshas and useful part of the herbs were compiled from Dhanvantari Nighantu,[17] Bhavaprakasha Nighantu,[18] Nighantu Adarsha,[19] and Textbook of Dravyaguna[2021] which was tabulated. The tabulated data were then analyzed.

Results

Charaka has given single Gana of 10 drugs (Lekhaniya Gana), while Sushruta and Vagbhata have mentioned 8 and 10 Ganas respectively. A total of 160 different herbs have been enlisted from these various groups [Table 1]. Analysis of 100 drugs has been made, which are taken from different Ganas of classical texts after excluding the controversial drugs [Table 2]. Based on relevant references from classical texts and modern texts of Dravyaguna, useful part was recorded. The part used appears to be root, root bark, stem bark, and fruit in large number of drugs [Table 3]. Rasa and Anurasa of drugs have been enlisted. Tikta Rasa is seen in 59 herbs, Katu in 48, Kashaya in 41, Madhura in 33, and Amla in eight herbs [Table 4]. Herbs with proven lipid-lowering activity reported through different research models are tabulated [Table 5].

Table 1

List of Medohara Ganas mentioned in classical literature

Table 2

List of Medohara drugs

Table 3

Categorization of herbs on the basis of part used

Table 4

Number of drugs based on analysis of Rasa, Vipaka, Veerya, Guna and Doshaharatwa

Table 5

List of herbs proven by researches for hypolipidemic

Discussion

Kayagni or Pachakagni (digestive fire) contributes its moieties to the Dhatu or Dhatwagni dealing with tissue metabolism. Ama (undigested toxic substance) which results from hypofunctioning of Jatharagni (digestive fire) may clog to the Srotas (channels) leading to Srotorodha (obstruction of channels) which in turn increases Medodushti and decreases the nutrient supply to subsequent Dhatus namely Asthi (bone tissue), Majja (bone marrow), and Shukra (fertility promoting substance).[22]

Acharya Charaka has furnished six therapeutic measures (Shadupakrama), i.e., Langhana (lightening therapy), Brumhana (nourishing therapy), Rukshana (drying therapy), Snehana (oleation therapy), Swedana (fomentation therapy), and Stambhana (astringent therapy).[23] Langhaneeya Dravya (drugs causing lightness) can achieve the therapeutic effect by the dominance of Gunas like Laghu (light), Ushna (hot), Teekshna (strong), Vishada (non-slimy), Ruksha (dry), Sukshma (subtle), Khara (rough), Sara and Kathina (hard). Rukshaniya drugs (causing dryness) should possess Gunas like Ruksha, Laghu, Khara, Teekshna, Ushna, Sthira, Vishada, and Kathina.[24] The comparison of Gunas of both the Upakramas clearly indicate that a drug possessing the Gunas namely Laghu, Ruksha, Ushna, Teekshna, Vishada, Khara, and Kathina may significantly subdue Kapha and Medodhatu Dushti in the conditions like Obesity, Hyperlipidemia, and Diabetes mellitus.

Analysis of the herbs clearly indicate that Tikta Rasa Dravyas dominates the list (59) followed by Katu (48), Kashaya (41), Madhura (33), and Amla (8) Rasa drugs [Table 4]. Tikta being Laghu and Ruksha reduces vitiation of Kapha and Medodushti along with neutralization of Amavisha through its Deepaniya, Pachaniya, and Vishaghna[25] activities. Katu rasa exerts similar effect on Ama, Kapha, and Medodushti by its Laghu, Ushna, and Ruksha Gunas.[26] It can provide significant Rukshaneeya effect in comparison to Tikta, Kashaya Dravyas due to association with Ushna Guna. Kashaya Rasa being most Ruksha[27] may facilitate for Shoshana (absorption) of liquefied or detoxified Kapha and Medodhatu. The Dravya possessing Tikta Rasa and Katu Rasa are to be prescribed in the initial stages (Border line of hyperlipidemia) of treatment of Dyslipidemia and Kashaya dominant drugs can be incorporated in the subsequent phases (High and very high hyperlipidemia) which facilitates for Shoshana (absorption) of liquefied or detoxified Kapha and Medodhatus, a state produced by Tikta Rasa and Katu Rasa.

The application of Amla Rasa which is attributed with Deepana, Vatanulomana, and Hridya[28] properties may be preferred in the last phase which subdues Vataprakopa induced by Tikta, Katu, and Kashaya Rasa drugs. Agni Mahabhuta dominant Rasa like Katu and Amla should be judiciously applied by taking into consideration the involvement of Agni, Ama, and Srotorodha to establish normal lipidemic state in the body. Drugs like Priyala (Buchanania lanzan Spreng.), Shatavari (Asparagus racemosus willd.), Yashtimadhu (Glycyrrhiza glabra Linn.), etc., possessing Madhura Rasa and Snigdha Guna may help to soften and unction[29] the vessels hardened overtime by the deposited fat as in the case in Atherosclerosis.

Enumeration of Gunas of Medohara drugs [Table 4]clearly indicate the presence of Laghu and Ruksha (67 herbs and 59 herbs respectively) followed by Teekshna and Snigdha Guna (25 herbs and 23 herbs respectively) in majority of the drugs. It is also noted that some of the drugs possess Guru (20 herbs) and Sara (10 herbs) Guna. Among the analyzed drugs, Ushna Veerya drugs are more in number (59 herbs) in comparison to Sheeta Veerya (40 herbs) and only one drug is categorized under Anushna Veerya (Shireesha). Among Ashta Veerya,[30] Laghu, Ruksha, Ushna, and Teekshna contribute for Langhana and Rukshaniya effect. It is very explicit that Laghu and Ruksha Guna associated with Teekshna Guna and Ushna Veerya plays predominant role for eschewing vitiation of Kapha Dosha and Medodhatu.

Sushruta's classification of Vipaka reflects two dominant Gunas, i.e., Guru and Laghu further quoted as Katu and Madhura Vipaka.[31] Drugs with Katu Vipaka (82 herbs) are relatively more in number followed by Madhura (17 herbs) and Amla Vipakas (1 herbs)[Table 4]. The Vipaka of Langhana and Rukshaniya drug should be Laghu which is also interpreted as Katu Vipaka.

Majority of herbs possessing Kaphahara (89 herbs) and Vatahara (67 herbs) activity [Table 4] are also found to be Medohara in action. Antagonistic measures are usually employed to treat Doshavriddhi.[32] But in case of Medodushti, Sheeta Veerya dominant herbs are also suggested. Shalasaradi Gana,[33] Lodhradi,[34] and Nyagrodhadi[35] Ganas containing Kashaya, Tikta, and Sheeta Veerya drugs increases Ruksha Guna (dry) resulting in Medo Shoshana (absorption of vitiated fat).

The information with regards to part used has been compiled from Dravyaguna works of 20th century. Heartwood and bark forms the potent parts in majority of drugs in Shalasaradi Gana and Lodhradi Gana respectively. It is seen that the drug with root as useful part has been referred frequently (36 herbs)[Table 3]. Stem bark, fruit, leaf, and heartwood are also used along with less utilization of seed, flower, gum, rhizome etc.

Acharya Sushruta has given 8 Ganas, whereas Vagbhata included 10 Ganas to be Medohara [Table 1]. Surasadi Gana is not indicated for Medoroga by Sushruta,[36] while Vagbhata has included it.[37] The non-herbal drugs in Ushakadi Gana have also been excluded from the analysis. The drug groups Triphala, Trikatu, Brihatpanchamula and drugs like Vidanga, Nagara, Chitraka, Erandamula, and Haridra are useful in the management of Sthaulya.[38] They may have profound influence on reduction of bodyweight and dyslipidemia.

It is observed that drugs like Guggulu (Commiphora wightii (Arn.) Bhandari.), Vrukshamla (Garcinia indica Choisy., Garcinia cambogia Desr.), Atasi (Linum usitassimum Linn.), Lashuna (Allium sativum Linn.) etc., promoted for controlling Obesity and Dyslipidemia in market are not found in classical Ganas analyzed in the paper.

The relationship of Medodushti is well established in the pathogenesis of Santarpanottha Vikaras like Sthaulya and Prameha. Many of the herbs mentioned in Medohara Ganas possess hypolipidemic[394041] as well as hypoglycemic[424344454647] activities.

Conclusion

Drugs mentioned in each Gana of Ayurvedic classics have multifarious pharmacological properties. Some of the research studies carried out on these herbs confirmed both hypolipidemic and hypoglycemic activities. This observation is useful for designing new formulations to treat Medodushti and its complications. Drugs that are Katu, Tikta, Kashaya in Rasa, possessing Ushna Virya, and Laghu Ruksha Guna are largely responsible for Medohara and Lekhaneeya activities.