Talekar Manisha et al / Int. J. Res. Ayurveda Pharm.

8 (5), 2017

Research Article
www.ijrap.net

AN EPIDEMIOLOGICAL STUDY TO FIND OUT SANTARPANOTTHA HETU IN PATIENTS OF

MADHUMEHA (DIABETES MELLITUS) AT JAIPUR AND ITS PERIPHERY
Talekar Manisha *1, B. K. Sevatkar 2, Deshmukh Prashant Nareshrao 3, R. Govind Reddy 4
1
Ph.D. Scholar, P.G. department of Roga Evam Vikriti Vijanana, National Institute of Ayurveda, Jaipur, India
2
Assistant Professor, P.G. department of Roga Evam Vikriti Vijanana, National Institute of Ayurveda, Jaipur, India
3
Assistant Professor, Vaidya Yagya Dutt Sharma Ayurved Mahavidyalaya, Khurja, Uttar Pradesh, India
4
Research Officer (Scientist-III) & In-charge, R.R.A. Podar Central Ayurveda Research Institute for Cancer, Worli,
Mumbai, India

Received on: 30/06/17 Accepted on: 12/08/17

*Corresponding author
E-mail: [email protected]

DOI: 10.7897/2277-4343.085272

ABSTRACT

Madhumeha (Diabetes mellitus) is classical metabolic disorder of tissue and cellular level. Unhealthy diet and physical inactivity are the leading causes
of the major non communicable diseases (NCDs) which are similar to Santarpaṇa Hetu as mentioned by Acharya Charaka in Nidana of Prameha. A
survey study was carried out to study the prevalence of Madhumeha patients and associated risk factors in terms of Santarpa ṇa Hetu on randomly
selected 240 diabetic patients from OPD of NIA hospital & diabetes camps at Jaipur region. A survey proforma was prepared and detailed history of
each patient fulfilling the diagnostic criteria of ADA 2016 was taken. On considering data of Santarpana Hetu, maximum patients were taking potato
(100%); dairy products (100%); Basmati rice (88.75%); jaggery and its preparations (73.33%); junk food (81.66%); bakery products (72.08%) in
excessive quantity and 55.41% patient were found to be with increased BMI. Factors observed related to life style are Avyayam (70.41%); Divasvap
(62.08%) & Aasyasukham (58.75%). Chinta (stress) were found in 62.91% patients. This study revealed that prevalence of high glycemic index diet;
dairy products; junk food and increased BMI are found dominant in diabetes patients in Jaipur and its periphery. If people avoid these faulty dietary
habits and sedentary lifestyle (Nidana Parivarjana Chikitsa) then development of diabetes will be controlled upto some extent.

Keywords: Diabetes mellitus; Santarpana Hetu; Madhumeha; Dhatvagnimandya

INTRODUCTION disease considered as one of the arch enemy of the mankind

caused by improper diet and lifestyle. It is often referred to as a
In the 21st century, because of invention of newer technology, “Silent Killer”. Unhealthy diet and physical inactivity are the
man’s life becomes more mechanical and having less effort to do leading causes of the major non communicable diseases (NCDs).
anything. There is increasing stress and strain which leads to
various physical and psychological disorders and various diseases According to Ayurveda, Madhumeha is a classical metabolic
like hypertension, arthritic disorders, cardiac diseases and most disorder of tissue and cellular level. In Ayurveda, this condition
harmful Diabetes Mellitus. Among all Diabetes Mellitus is may correlate with Dhatvagnimandya. Since Vedic period
remarkable and very challenging disease. In spite of constant and Madhumeha is a disease known to mankind and it is mentioned
meticulous efforts of medical science to cure Diabetes Mellitus, among the twenty types of Prameha. It is a disease in which
it is still in top ten lists of diseases causing death. With an patient passes the urine having similar with Madhu i.e. "Kashaya
estimated 40 million people in 2007, suffering from Diabetes and Madhura taste, Pandu colour and Ruksha Guna" 6 or when
Mellitus, now India is having the largest number of diabetics in the urine of the patient become sweet and resembles with honey
the world and get the name ‘Diabetic capital’. 1 Recent in any type of Prameha and the whole body becomes sweet, it is
epidemiological studies from India; point to the great burden due to be named as Madhumeha. It is documented as one among the
to Diabetes and its micro and macrovascular complication on the twenty obstinate urinary disorders i.e. Prameha. It is also
society. This is because the status of diabetes control in India is explained that, when the other Prameha are left untreated, this
far from the ideal status.2 lead to the condition called Madhumeha. 7 So Madhumeha can
also be considered as an advanced condition or stage of Prameha.
Based on available data, the mean GHb level is around 9% which
is at least 2% higher than the goal currently. It is estimated by In modern science, over eating, sedentary habits, Obesity, genetic
International Diabetic Federation (IDF) that by 2025 every fifth and hereditary factors are considered as a predisposing factor for
diabetic subject in world will be an Indian. 3 Genetic D.M., which is similar to Santarpaṇa Hetu (nourishing, enriching
predisposition with life-style changes, increased urbanization and causes) as mentioned by Acharya Charaka in Prameha Nidana. 8
globalization contribute to this rapid rise of Diabetes Mellitus in These Santarpana Hetu are dominant etiological factor for
India. More over Type 2 Diabetes Mellitus in Indian population Agnimandya which leads to formation of Vidagdha Kapha which
appears to occur at least a decade earlier than Europeans. 4 This is Kledakara. Again this Agnimandya is responsible for the
mean that in the next 10-20 yrs productivity of the youth of our Dhatvagnimandya of each Dhatu. Due to this, Apachit/Apakva
country could be seriously affected as >56% population of India Dhatu are formed, which leads to Dhatushaithilya and
is in between 15-54 years.5Amongst many dreadful conditions Kledavriddhi. Simultaneously these Nidana causes Kha-
arising because of modern day living, Diabetes mellitus is a giant Vaigunya in Medovaha Srotasa and vitiates Medo Dhatu which is

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Bahu and Abaddha in nature which makes body flaccid. As a OBSERVATIONS

result, this increased Kledavridhhi manifest as
Prabhutavilmutrata (polyuria). In Survey study out of 240 patients, maximum patients (66.66%)
were found in the age group of 41-60 years. 60.41% patients were
Today, the era of urbanisation has produced increased number of male. Maximum patients (64.16%) were taking vegetarian diet.
fast food and restaurants. The food habit and lifestyle has also Regarding family history, 50.41% patients had positive family
been modified according to the profession /carrier of an history of type 2 diabetes mellitus. After the observation of
individual. Hence much importance for taste is given but not for chronicity of disease, it was observed that 52.50% patients were
health benefits. Acharya Sushruta mentioned that avoidance of with maximum chronicity of disease i.e. 3-6 years. (Graph 1)
Nidana or causative factors is treatment.9 Today, in this present
era, people are neglecting the causative factors for the diseases On considering the data of Sharirika Prakriti (body constitution),
and rushing in the direction of treatment methodologies. It’s the maximum i.e. 59.58% patients had Vata-Kapha Prakriti. 55.41%
need of the hour to concentrate on the concept of Nidana patients were having BMI 25-30 kg/m2 which indicate obesity.
Parivarjana Chikitsa i.e. towards causative factors. In every On analyzing the Agni (digestive power) of the patients it was
disease, this is prime theory to be followed. Acharya Charaka found that, 62.08% patients were having Vishamagni
described that etiological factors i.e. Nidana Sevana of Prameha (Agnidushti). 56.25% patients had Madhyama Koshtha. Out of
should be avoided. It is one of the treatments of disease. On this, total 240 patients, 68.75% were having sedentary nature of work.
Chakrapaṇi commented that avoidance of etiological factors in 65.83% patients had habit of Adhyashana. Maximum patients
Prameha is very important to control further progress of disease. (79.58%) were consuming more amount of Madhura Rasa (sweet
Only Nidana Parivarjana is not enough but along with this proper food items) followed by Lavana and Amla Rasa. (Graph 2)
diet management is essential10 Hence to find out cause and effect
relationship between dietary & life style related causes and On considering the data of Santarpana Hetu, it was found that all
Madhumeha (DM) and also put awareness in current population i.e. 100% patients were taking potato and its preparations e.g. aloo
regarding excessive use of Santarpana Hetu, this survey study has sabji (cooked potato vegetable), French fries (batonnet or
been selected. allumette-cut deep fried potatoes), chips, aloo tikki (fried spicy
potato) & Maida (refined wheat flour) preparations like bread,
Aim and objective noodles, pasta, maida biscuits, maida murukku, maida chapati,
maida barfi (dessert made with condensed milk), puri
To conduct a Nidanatmaka observational study of Madhumeha (unleavened deep-fried Indian bread), jalebi (sugar crystallized
(Diabetes Mellitus) with special reference to Santarpana Hetu and flavoured funnel cake). 59.16% patients were consuming Masha
also put awareness in current population regarding excessive use and its preparation e.g. Idli, Dosa, Dhokla, Meduvada. Patients
of Santarpana Hetu. having indulgence with Basmati rice were 88.75%. Patient taking
Soft drinks, Cold drinks, Sweet fruit juices were 52.91%. All
MATERIALS AND METHODS patients (100%) were taking dairy products like Dugdha (milk),
Dadhi (curd), butter, cheese, Ghrita (ghee) and milk preparations
A cross-sectional survey study was carried out to study the e.g. paneer, kheer (An Indian dessert consisting of rice and sugar
prevalence of Madhumeha patients and associated risk factors in boiled in milk), icecreams, shrikhand (sweet dish made of
terms of Santarpaṇa Hetu. Total 240 patients of Madhumeha strained yogurt), rabdi (sweet condensed milk based dish) in
(Diabetes Mellitus) fulfilling the diagnostic criteria of American excessive quantity. 73.33% patients were taking ikshuvikara
Diabetes Association (ADA.) 2016, were randomly selected (Jaggery and its preparations). Maximum patient (81.66%) were
irrespective of age, sex, occupation and socio-economic consuming junk food like samosa chaat (samosa is an Indian food
conditions from OPD of Satellite hospital, Jawahar Nagar- consisting of vegetables, spices wrapped in pastry and fried;
resident area of Jaipur. Survey was based on a specially prepared samosas are often served in chaat, alongwith the traditional
questionnaire which included both Ayurvedic and Allopathic accompaniments of yogurt, chutney, chopped onions, coriander,
parameters such as Anthropometric measurement, laboratory and chaat masala), dabheli (spicy snack made by mixing boiled
parameters and Nidanatmaka criteria of Ayurveda. This is an potatoes with a dabheli masala), dahi puri (delicious savory chaat
epidemiological study and study was in accordance with with mixed flavors and curd), sheva puri (a spicy, sweet and tangy
STROBE guidelines. The informed consent from each patient street snack), ragada pattice (combination snack made with thick
was taken. The reference number of institutional ethical ragda (dried yellow pea stew) and pattice, a fried potato cutlet),
committee is IEC/ACA/2016/27. pizza/burger/snacks Oily, spicy food etc. 72.08% patient were
taking bakery products like cake, pestris, biscuit, cookies etc.
The diagnostic criteria of American Diabetes Association (ADA) (Table 1)
2016 for Diabetes Mellitus is given below: 11
• FPG ≥126 mg/dL (7.0 mmol/L), Factors observed related to life style are: Aasyasukham-58.75%
• 2-h PG ≥200 mg/dL (11.1 mmol/L) (enjoying the pleasure of continuous sitting); Svapnasukham-
• HbA1c ≥6.5% (48 mmol/mol) 66.25% (enjoying the pleasure of excessive sleeping); Avyayam-
70.41% (lack of exercise and physical activity); Divasvap-
62.08% (sleeping in the daytime/afternoon) (Table 2) Out of 240
patients, 62.91% patients were having Chinta as Manasa Nidana
and 17.50% patients were indulged with Shoka. (Table 3)

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Graph 1: Prevalence of Age Group, Gender, Diet Pattern, Family History, Socio-economic status & Chronicity of Total Study Patients
(N=240)

Graph 2: Prevalence of BMI, Prakriti, Agni, Koshtha, nature of work, dietary habits & dominant Rasa Sevana of Total Study Patients
(N=240)

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Table 1: Prevalence of Aharaja Nidana (Dietary Factors)

Availability of Aharaja Nidana No. of patients (n=240) %

Shuka Dhanya (Cereals)
Basmati Rice & its preparations (Pishthanna) 213 88.75
Maida & its preparations 240 100
Bread, Noodles, Pasta, Maida biscuits, Maida Murukku, Maida Chapati,
Maida Barfi, Puri, Jalebi
Shami Dhanya (Pulses) 142 59.16
Masha (Udad/ black gram & its preparation e.g.
Idli, Dosa, Dhokla, Meduvada
Mamsa Varga (Non-veg)
Gramyaudakanuparasa 86 35.83
(meat soup of the domestic, aquatic and mashy animals)
Meat soup of pork, buffalo, fish etc.
Phala Varga (Fruits juices)
Custard apple, Grapes, Dates, Pineapple, Watermelon, Guava, Sapota 102 42.50
Shaka Varga: Kanda (tubers)
Potato, sweet potato and its preparations e.g. Alu sabji, French fries, Chips, 240 100
Alu tikki etc.
Madya Varga (Drink)
Navamadyapana (fresh alcoholic drinks) which is not having premium 76 31.66
quality and not fermented since long time. Sweet alcoholic drinks
Pana (Water) 127 52.91
Soft drinks, Cold drinks, Sweet fruit juices
Gorasa Varga (Dairy products)
Dugdha(Milk), Dadhi (Curd), Butter, Cheese, Ghrita (ghee) 240 100
Milk preparations e.g. Paneer, Kheer, Icecreams, Shrikhand, Rabdi
Ikshuvikara (Jaggery and its preparations) 176 73.33
Jaggery, Sugar
Navanna (new/not aged grains, cereals)
Cereals and grains that are less than one year old 102 42.50
Bakery products 173 72.08
e.g. cake, pestris, biscuit, cookies etc.
Junk food 196 81.66
e.g. samosa chaat, dabheli, dahi puri, sheva puri, ragada pattice,
pizza/burger/snacks Oily, spicy food etc.

Table 2: Prevalence of Viharaja Nidana (Life Style Factors)

Availability of Viharaja Nidana No. of patients (n=240) %

Aasyasukham (enjoying the pleasure of continuous sitting) 141 58.75
Svapnasukham (enjoying the pleasure of excessive sleeping) 159 66.25
Avyayam (lack of exercise and physical activity) 169 70.41
Divasvap (sleeping in the daytime/afternoon) 149 62.08
Tyaktachinta (abstinence from mental work/ worry) 89 37.08

Table 3: Prevalence of Manasika Nidana (Psychological Factors)

Availability of Manasika Nidana No. of patients (n=240) %

Chinta (stress) 151 62.91
Shoka (grief) 42 17.50

DISCUSSION positive history of type 2 diabetes in family. It indicates that,

Madhumeha have relation with Bijadosha & described as
For type 2 diabetes, Age is a significant risk factor. It is “Anushangi Vyadhi” 12 i.e. it runs in the families. But that
principally a disease of the middle-aged or an elderly. In this condition afflicts the Srotasa (body channels) & for the further
survey study, Maximum patients belong to the age group of 40- progress of disease it needs particular Nidanas (causes). Equal no.
60 years, this reveals that maximum prevalence of the disease at of patients showed negative family history, it may be due to
Madhyama Avastha (middle age). Maximum patients were males irregular, improper, irrelevant diet habits, and regular intake of
followed by female. Modern studies show that male & female junk food and faulty lifestyle.
suffers from the disease equally. It is also mentioned in Ayurvedic
Classics. Dalhana in his commentary remarks that females also Regarding BMI, maximum patients had BMI 25-30 kg/m2, and
suffer from Madhumeha. Observation of socio-economic status likely therefore being most contributing risk factor for diabetes.
shows that maximum patients belong from middle class and upper According to international classification of BMI as per WHO
middle class. Now a day, in modern civilization, peoples consume Expert Consultation for Asian population, this BMI range
unhealthy dietary articles like junk food and sedentary lifestyle indicates obesity 13, 14 which is one important cause of insulin
frequently. Most of patients had chronicity between 3-6 yr. which resistance. High BMI is a strong risk factor for Diabetes. Acharya
indicates Chirakari (chronic) nature of Madhumeha. One other Charaka has used term “Abadhha Meda” 15 (circulating fat) and
reason may be that most patients came for ayurvedic medication also emphasized on Medovruddhi and Medodhatvagnimandya.
because they were not getting relief from other therapies since Majority of patient were belonging to Vata-Kapha Prakriti
long time. Regarding family history, equal no. of patients had followed by Pitta-Kapha Prakriti So it can be said that person

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having Kapha dominant Prakriti are more prone to be diabetic. well reduces insulin utilization in the body, 18 which are the main
Maximum patients were having Madhyama Koshtha. It suggests reasons in type 2 Diabetes mellitus of rise the blood sugar level.
dominance of Kapha Dosha in their body. On analyzing the Agni
(digestive fire), Majority of patient were having From the above discussion, we can say that the correction of
Vishamagni (imbalanced appetite) or Agnidushti which signifies various Agni in Prameha/Madhumeha may be a part of treatment.
the imbalanced state of Agni. Adhyashana (over eating) is found In Prameha, carbohydrate and fat metabolism is impaired and
to be common in present survey, which is proved as a risk factor therefore intermediary acids are produced. Again due to lack of
for Diabetes Mellitus.16 Adhyashana leading to excessive insulin or due to defect in function of liver glucose is not
accumulation of Kapha & Meda in the body, a main Dosha and converted in glycogen and it retains in the body. All these
Dushya of Prameha. They may lead to Agnidushti and increased unmetabolised products can be called as Ama. Insulin which is
Ama production in the body. secreted by beta cells of pancreas, works as key factor for the
entry of glucose at the cellular level. Thus the function of insulin
On considering data of Aharaja Nidana (Dietary Factors), Most is similar to the function of Dhatvagni. So, absolute or relative
of patients were having indulgence with rice, Masha, sweet fruit insulin deficiency can be correlated to Dhatvagnimandya.
juices, potato, milk and its preparation, Dadhi (curd), Ikshuvikara
(jaggery and its preparations), Madhura Rasa (sweet taste) & CONCLUSION
Lavana Rasa (salty taste), Dravannapana (liquid diet), Guru and
Snigdha Ahara (heavy and unctuous diet), bakery products, junk This cross-sectional study revealed that prevalence of high
food etc in excessive quantity. Madhura Rasa is dominant glycaemic index diet, dairy products, junk food and increased
etiological factor for generation of Agnimandya (weak digestive BMI are found dominant in diabetes patient. Excessive
fire) because its excessive use leads to vitiation of Agni, which is consumption of these faulty dietary habits, faulty lifestyle and
root cause of every disease. Because Agni is responsible for bio- Chronic Stress play a significant role in causation of the disease
transformation of different materials. So vitiation of Jatharagni with disturbance in blood glucose & lipid profile. If people avoid
(digestive fire) leads to vitiation of Dhatvagni and Bhutagni. these faulty dietary habits and sedentary lifestyle then
Lavana Rasa is responsible for Kaphaprakopa and Kedakara. development of diabetes will be controlled up to some extent.
Buffalo milk is having Madhura Rasa, Madhura Vipaka (post Because Up to 80% of type 2 Diabetes is preventable by adopting
digestive effect) & Guru Guna raises "bad" (LDL) cholesterol and a healthy diet and increasing physical activity. So, by exploring
promoting inflammation throughout the body. Studies have Nidana, it will be contribution to society making them aware
shown that high (saturated) fat intake seems to be associated with about risk factor of diabetes and its association with disease.
insulin resistance, obesity and increased risk of NIDDM.
Excessive use of Dadhi causes Srotorodha (blockage of channels) REFERENCES
due to its Abhishyandi nature. Ikshuvikara when consumed,
raises blood glucose levels. 1. Saikat Neogi, Hindustan times, New delhi,Sept.03,2007-
www.hindustantimes.com
In survey study, prevalence of high glycaemic index diet like 2. Dr. V. Mohan, Health Administrator vol:XXII no.1&2-
white rice, excessive intake of fruits viz. pine-apple, watermelon, 2009;1-18pg.-http://medind.nic.in
white wheat flour bread. These diets having high glycaemic index 3. Scree R. et. al. Diabetic atlas Gan D Ed. IDF, belgium pp 15-
for e.g. White flour bread with glycaemic index 71, white rice 130, 2006 .
with glycaemic index 89, fruits like pine-apple, water-melon 4. Mohan V et al, International textbook of Diabetes Mellitus
having glycaemic index 72. Glycaemic load of diet is one of the 1997;171-187
biggest factor affecting hormones. Prevalence of junk food user 5. Census of India, 2000 – http://censusindia.gov.in
like samosa chaat, dabheli, dahi puri, sheva puri, ragada pattice, 6. Agnivesha, Charaka, Charaka Samhita revised by
pizza/burger/snacks, fried foods, oily & spicy foods was more. Dridhabala, Nidanasthana Pramehanidanadhyaya 4/44,
Junk food is a classic example of unbalanced diet usually edited by pt. Kashinath Sastri and Dr. Gorakhanath
characterized by high proportion of carbohydrates, refined sugar, Chaturvedi, 1st edi., Chaukhambha Sanskrit Sansthana,
salt, fats & low nutritional value, which can raise various health Varanasi. 2005; 639.
concerns. Anything that is processed (frozen, canned, packaged 7. Vagbhatta, Ashtanga Hridaya, Nidanasthana
or wrapped) could be considered junk food like: Fried foods, Pramehanidanadhyaya 10/20, edited by vaidya Yadunandana
Boxed/Packaged foods, Foods with dyes, Microwavable foods, Upadhyaya , 1st edi., Chaukhamba Sanskrit Sansthan,
Restaurant foods, canned foods, processed foods. Junk food is Varanasi. Reprint 2005;255.
unhealthy for digestive system as they slow down the digestion 8. Agnivesha, Charaka, Charaka Samhita revised by
process making the stomach bloated. In Viharaja Nidana, Dridhabala, Chikitsasthana Pramehachikitsadhyaya 6/4,
maximum patients were having habit of Aasyasukha, edited by Acharya Vidyadhara Shukla and Prof. Ravi Dutt
Svapnasukham, Divasvap and Avyayama Again all these lifestyle Tripathi, 1st edi., Chaukhambha Sanskrit Sansthana,
factors increase quantity of Kapha and Abaddha Meda in the Varanasi. 2007;167.
body. Regarding Manasa Nidana, Chinta (stress) were dominant 9. Sushruta. Sushruta Samhita, Part II. Uttaratantra,
in many patient along with Shoka (grief), Mano-Aghata (mental Aaupadravikadhyaya 1/25, edited by Ambikadutta Shastri,
disturbance) is the cause in the production of vitiation of Agni 9th ed. Varanasi: Chaukhamba Sanskrit Sansthana; 1995; 14.
which is also given by Acarya Charaka in Vimana Sthana chapter 10. Agnivesha, Charaka, Charaka Samhita with Ayurvedadipika
2 as the wholesome food taken even in proper quantity do not get commentary by shri chakrapanidatta, Part III, Chikitsasthana
properly digested when the individual is afflicted with grief, fear, Pramehachikitsadhyaya 6/53, edited by Dr. B. K. Dwivedi, 1st
anger, sorrow, excessive sleep and excessive vigil. 17 It is clear edi., Chaukhambha krishnadas academy, Varanasi; reprint
that psychological factors like stress, anger, anxiety etc. may play 2013; 272.
a major role in the etiology of Apathya Nimittaja Prameha (type 11. American Diabetes Association. Standards of medical care in
2 DM). The high prevalence of diabetes observed in urbanized diabetes-2016. Diabetes Care. 2016;39(suppl 1):S1-S106.
societies of metro city, has been attributed to psychological stress. 12. Agnivesha, Charaka, Charaka Samhita revised by
Disturbed psychological factors affect the blood sugar many ways Dridhabala, Sutrasthana Yajjyapurushiyadhyaya 25/40,
like it increases glucagon secretion, inhibits insulin secretion as edited by pt. Kashinath Sastri and Dr. Gorakhanath

189
 Talekar Manisha et al / Int. J. Res. Ayurveda Pharm. 8 (5), 2017

Chaturvedi, 1st edi., Chaukhambha Sanskrit Sansthana, 17. Agnivesha, Charaka, Charaka Samhita revised by
Varanasi. 2005; 469. Dridhabala, Vimanasthana Trividhakukshiyavimanadhyaya
13. WHO/IASO/IOTF. The Asia-Pacific perspective: redefining 2/9, edited by pt. Kashinath Sastri and Dr. Gorakhanath
obesity and its treatment. Health communications Australia: Chaturvedi, 1st edi., Chaukhambha Sanskrit Sansthana,
Melbourne, 2000. Varanasi. 2005; p.688.
14. WHO expert consultation. Appropriate body-mass index for 18. Principles of Anatomy and Physiology by Ferard J. Tortora,
Asian population and its implications for policy and 8th Edi. P:530-594 and Harrison : Principles of Internal
intervention strategies. The Lancet , 2004;157-163. Medicines, edited by Eugene Braunwald, Anthony S. Fanci,
15. Agnivesha, Charaka, Charaka Samhita revised by Stephen L. Hauser, Dennis L. Kasper, Dan L. Longo, J. Larry.
Dridhabala, Nidanasthana Pramehanidanadhyaya 4/7-8, 16th edi, page no. 2156-67.
edited by pt. Kashinath Sastri and Dr. Gorakhanath
Chaturvedi, 1st edi., Chaukhambha Sanskrit Sansthana, Cite this article as:
Varanasi. 2005; 632-633.
16. Colledge NR, Walker BR, Ralston SH. 21st ed. Ch. 21. Talekar Manisha et al. An epidemiological study to find out
Edinburgh: Churchill Livingstone Elsevier; 2010. Davidson's Santarpanottha hetu in patients of Madhumeha (Diabetes
Principles and Practice of Medicine; pp. 802–3. mellitus) at Jaipur and its periphery. Int. J. Res. Ayurveda Pharm.
2017;8(5):185-190 http://dx.doi.org/10.7897/2277-4343.085272

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