Review of Metabolic Syndrome (Santarpana Janya Vyadhi) and its Management by Virechana Karma and Vyoshadi Saktu

Introduction

Metabolic syndrome is a multi-factorial disease, frequently associated with a cluster of pathologies including obesity, hypertriglyceridemia, impaired glucose tolerance, and insulin resistance, collectively referred to as the metabolic syndrome (formerly known as syndrome X and insulin resistance syndrome). Ayurveda, being a life science and not merely a medical science, is the appropriate choice for treating metabolic disorders. Metabolic syndrome, resulting from improper metabolism, is described in Ayurveda as Agnivaishamya (Disturbed Agni) indicating issues in digestion and absorption. According to Ayurveda, this condition arises from the vitiation of digestive fire, often caused by an imbalance in Doshas. Blockages in the individual channels of metabolism lead to excess or improper digestion and absorption, giving rise to diseases. Metabolic syndrome encompasses a combination of interconnected physiological, biochemical, clinical, and metabolic factors that significantly elevate the risk of cardiovascular diseases, type 2 diabetes mellitus (DM), and all-cause mortality. It includes abdominal obesity, insulin resistance, hypertension, and hyperlipidemia [1]. Various diagnostic criteria exist for quantifying MetS, with the International Diabetic Federation (IDF) and the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) [2] being widely used. Metabolic syndrome poses a complex metabolic disorder and emerges as a clinical challenge in today’s society, affecting 11% - 41% of Indians and approximately 1 in 4 adults worldwide [3]. Ayurvedic treatment encompasses addressing the root cause (Nidan Parivarjan) and utilizing medications for treating diseases resulting from excessive nourishment (Santarpana Janya Vyadhi), similar to modern medicine. However, the fundamental difference lies in the approach of eliminating Doshas and clearing congested Srotasa (channels) to eliminate harmful chemical by-products from the body. This approach not only serves to prevent the ailment but also eradicates the underlying cause, averting the potential development of more intricate conditions and hindering the recurrence of the current ailment.

Ayurvedic Review

In Ayurvedic literature, Acharya Charaka has mentioned group of diseases which arises due to over intake of heavy meals and sedentary life style collectively called as Santarpana Janya Vyadhi [4] which can be symptomatically co-related with metabolic syndrome, especially Medaavrit Vata [5] described in Charaka Samhita. In Ayurveda, the consideration of obesity and lipid disorders revolves around the concepts of Medo Roga and Prameha. Ayurvedic terminology describes Santarpana Janya Vyadhi as diseases resulting from over-sustenance and diseases arising from a lack of sustenance. The premise is that improper dietary habits and disrupted functions of various Agni [6] sets contribute to the formation of Ama [6] (a reactive antigenic factor). When Meda Dhatu interacts with the formed Ama, it undergoes changes, affecting the quality of fatty tissues, including cholesterol. The convergence of Ama and fatty tissues leads to the formation of poorly structured Meda Dhatu, known as Sama Meda Dhatu. As this ill-formed Meda Dhatu circulates throughout the body, it may cause the obstruction of micro-channels, swift antigenic reactions, and trigger a series of inflammatory events in the body. Interaction between such categories of Ama and Meda Dhatu can result in various metabolic disorders, with metabolic syndrome being one of them. In essence, metabolic syndrome is a Dushya dominant disorder, and Meda plays a major role in the pathogenesis of Santarpana Janya Vyadhi.

Modern Review

The first formal definition of the MetS was put forth in 1998 by the World Health Organization (WHO). This definition focused primarily on the presence of insulin resistance, identified by hyperinsulinemia, impaired glucose tolerance (IGT), or the diagnosis of T2D, which had to be present to make the diagnosis. In addition, two of the following also had to be present: dyslipidemia (reduced HDL-C and increased triglycerides), hypertension, and microalbuminuria. Metabolic syndrome defines the clustering in an individual of multiple metabolic abnormalities. World Health Organization and programs including the National Cholesterol Education Program (NCEP) and Adult Treatment Program III (ATP III) have now agreed to consider metabolic syndrome as a disease and defined it as A subject has metabolic syndrome if he or she has three or more of the following criteria [2]:

• Abdominal obesity: WC ≥102 cm in men and ≥88 cm in women.
• Hyper triglyceridemia: ≥150 mg/dl (1.695 mmol/L).
• Low HDL-C: <40 mg/dl in men and <50mg/dl in women.
• High blood pressure (BP): ≥130/85 mmHg.
• High fasting glucose: ≥100 mg/dl.

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I took the National Cholesterol Education Program (NCEP) and Adult Treatment Program III (ATP III) criteria for my research on metabolic syndrome (Santarpana Janya Vyadhi). I will select patients who meet three or more of these criteria.

Management of Metabolic Syndrome with Ayurveda

Metabolic Syndrome can be managed effectively by following Ayurvedic principles of treatment enumerated below

• Nidana Parivarjana (avoidance of cause)
• Langhana (Fasting)
• Vyayama & Pranayama (physical & breathing exercise)
• Kapha Medo nashaka Chikitsa/ Deepan Pachana Chikitsa (hypolipidaemic and digestive)
• Shodhana Chikitsa (bio-purification)
• Samshamana Chikitsa (drug therapy) Recognizing the significance of the cleansing process in treating metabolic syndrome, we have opted for one important detoxification procedure, “Virechana Karma [4] and “Vyoshadi Saktu [7] as Sanshaman Chikitsa as described in Ayurvedic texts for the treatment.

Conclusion

The study concludes that excessive intake of high-calorie fatty foods, sedentary lifestyle, Divaswapna, and mental factors like stress play a major role in the etiopathogenesis of Santarpana Janya Vyadhi. Nidan Parivarjana and regular physical exercise are essential in managing Metabolic Syndrome. Amapachaka, Agnideepaka, and Srotosodhaka drugs that specifically work at the level of Jathragni and Medodhatwagni are the preferred choices in the management of Metabolic Syndrome. The claim of absence of hazardous effects in Ayurvedic management is a significant benefit for patients.