Ayurvedic Perspective of Dyslipidemia

Introduction

Although no disease can be directly correlated with dyslipidemia in Ayurveda, it can be understood under the concepts of Santarpanotta Vikara - Prameha and Sthoulya, Snehamsha Vruddi in Rasa, Rakta Dhatu, Ama Medo Dhatu, Abaddha Medas and Medo Roga.

Nidana Panchaka in Dyslipidemia vis-à-vis Abaddha Medas Nidana

The Nidanas (etiology) mentioned in the context of Prameha (Diabetes mellitus) and Sthoulya Nidanas (etiology of obesity) can be considered as Nidana for dyslipidemia vis-à-vis Abaddha Medas.

Prameha Nidana^1-5

Aasya Sukha, Swapna Sukha, Dadhi (excess intake of curds), Gramya-Ouduka- Anuparasa (meat of animals that are reared and available in rural region), Payamsi (milk based pudding), Navannapana (newly harvested grains), Guda Vaikruta (preparations of jaggery), frequent and excessive intake of newly harvested grains like Hayanaka (Oryza sativa linn), Yavaka (a variety of Hordeum vulgare Linn), Chinaka (Cucumis utilissiums), Uddalaka (Paspalum scrobiculatum) newly harvested pulses like Harenu (Pisum sativum Linn.) and Masha (Phaseolus radiates Linn.), consumed with ghee; the meat of domesticated, marshy and aquatic animals; vegetables, Tila (Sesamum indicum Linn.) oil, cakes of Tila, pastries, Payasa (milk-based pudding), Krisara (gruel prepared of tila, rice, and black gram), Vilepi (a type of thick gruel), and sugarcane-based food preparations; milk, new wine, immature curd (curd which is mostly liquid and sweet); various dietary regimen that produces excess Kapha and Meda. Lifestyle related activities, including avoidance of physical exercise; and excessive sleep, bed rest and sedentary habits.

Sthoulya Nidana^6-9

Ati-Guru Ahara Sevana (heavy food quality and quantity wise), Madhura Ati Sevana (food with more sweet and having more calories), Sheetahara Sevana (food having cold potency), Ati-Snigdha (food with more fat content), Shleshma Bahula and Pichhila Aahara (food articles which increase Kapha such as curd, pastries, cheese, etc), Adhyasana (over eating), Anupa Mamsa Sevana (intake of aquatic meat), Avyavaya (lack of sexual intercourse), Avyayama (lack of exercise), Diwaswapna (day sleep), Achinta (abstinence from anxiety), Nitya Harsha (continuous joy) and Beeja Swabhava (hereditary).

Medovaha Sroto Dushti Nidana¹⁰

Avyayama (lack of physical exercise), Divaswapna (day sleep), Medhyanam Cha Ati Sevana- excessive intake of fatty, fried caloric diet and consumption of Varuni – a type of alcohol are considered to be the Nidana of Medovaha Srotas Dushti (channels which carry nutritive material to Medo Dhatu).

The above mentioned Nidanas can be taken as Nidanas of dyslipidemia vis-à-vis Abaddha Medas and can be categorized as follows.

Nidana can be Sahaja/ Kulaja (hereditary) when dyslipidemia vis-à-vis Abaddha Medas is caused due to Beeja Dushti (genetic disorder). Population studies of genetic association identified more than one hundred genes that could have a direct impact on lipid levels.¹¹

Dosha Hetu (etiologies which vitiate Doshas) are those factors which are responsible for disequilibrium of Dosha inside the body. Under this criteria, the Aharatmaka Nidanas are Ati Bhojana - excessive eating, Adhyashana - eating before digestion of previous meal, Atimadhura Ahara Sevana – excessive sweet tasting dishes, Atiguru Ahara Sevana - which is heavy to digest, Atisnigdha Ahara Sevana - unctuous food, Atisleshmala Ahara Sevana - food stuffs which increase Kapha Dosha, Atisheeta Ahara Sevana - food stuffs which are cold in potency, Ati Navanna Sevana - freshly harvested rice, Ati Mamsahara Sevana - excessive intake of non-vegetarian, Ati Navamadhya Sevana - alcoholic beverages, Ati Gorasa Ahara Sevana like Dadhi - milk and its products, Ati Ikshuvikara Ahara Sevana - sugarcane and its products, Bhuktante Ambupana - drinking water after having food.

Either due to Madhura Rasa, Sheeta - Guru - Snigdha - Abhishyandi Guna or due to Guru- Madhura Vipaka, all the above mentioned Nidanas will increase Kapha Dosha which in turn vitiates Medo Dhatu.

Viharatmaka Nidanas are Avyayama - lack of exercise, Avyavaya – lack of sexual intercourse, Diwaswapna - day sleep, Sukhashayya - Cheshta Dwesha - sedentary life style. All these Nidanas increase the Kapha Dosha and affects the Meda Dhatu by obstructing the channels, which later on leads to the production Medoroga.

Manasika Nidanas mentioned are - Harsha Nitya - continuous joy and Achinta - abstinence from anxiety. This vitiates Tamo Guna which in turn vitiates Kapha Dosha, thereby affecting Medo Dhatu.

The above mentioned Hetus can act as Viprakrishta Hetu (distant etiologies) which leads to accumulation of Kapha Dosha which later act as a distant cause for production of dyslipidemia vis-à-vis Abaddha Medas. The above mentioned Nidanas exactly match with the causes mentioned for dyslipidemia, which can be classified as, Primary / Genetic - are the ones which are inherited, and Secondary - are the ones which are acquired due to sedentary lifestyle or improper diet, and from other diseases such as obesity or diabetes.

Samprapti Flow Chart

Note: Here Adrishtavashat means the Nidanas which cannot be perceived or assessed directly. Among which the Beeja Dushti (genetic/ hereditary cause) can be included. There will be Agnimandya even at Dhatu level as there is Jataragni Mandya, thus excess Abaddha Medas is formed.

Samprapti of Abaddha Medas can be understood by incorporating all the three Dhatu Poshana Nyayas, where due to the Nidana Sevana, there is Jataragni Mandya from which the Ahara Rasa rich in Kapha and Medo Dhatu Guna is taken up by Medo Dhatu (Khale Kapota Nyaya) and due to Dhatvagni Mandya of Rasadi Dhatu, there is formation of Poshaka Rasa which nourishes the upcoming Dhatus (Kedara Kulya Nyaya). This Poshaka Rasa is Snigdha, Guru Guna Yukta which in turn increases Medo Dhatu in terms of Baddha and Abaddha Medas (Ksheera Dadhi Nyaya).

Samprapti Ghatakas in Dyslipidemia vis-à-vis Abad-dha Medas

• Dosha: Kapha - Kledaka, Pitta - Pachaka, Vata - Samana, Vyana.

• Dushya: Rasa, Meda.

• Agni: Jataragni, Medo Dhatvagni

• Ama: Jataragni and Medo Dhatvagni Mandyajanya Ama.

• Srotas: Rasavaha Srotas and Medovaha Srotas

• Srotodushti Prakara: Atipravrutti (Parbramana of Abaddha Medas), Sanga (in cases of atherosclerotic plaque formation), Vimarga Gamana (in cases of fatty liver).

• Udbhavasthana: Amashaya

• Adhisthana: Medovaha Srotas

• Sanchara Sthana: Rasa, Rakta and Medovaha Srotas.

• Roga Marga: Abhyantara

• Swabhava: Chirakari

Purvaroopa in dyslipidemia vis-à-vis Abaddha Medas

There is no reference available for Purvaroopa of Bahu Abaddha Medas and Medoroga in the text.

Rupa in dyslipidemia vis-à-vis Abaddha Medas

In modern science, it is believed that dyslipidemia itself usually causes no symptoms but can lead to symptomatic vascular disease, including coronary artery disease (CAD), stroke, fatty liver and peripheral arterial disease, which can be understood under the terms of Ayushohrasa and Daruna Vikaras caused due to obstructed Vata and which may lead to death even as mentioned in context of Medo Roga.¹²

Thus, Avyakta Lakshana can be considered as Lakshana of Bahu Abaddha Medas.

However, the Lakshana of Medoroga 6 mentioned in classics are, Alasya (laziness), Ayusho Hrasa (decreased life span), Daurbalya (fatigue), Daurgandhya (bad body odour), Javoparodha (decreased enthusiasm), Gatrasada (debility), Krathana (sudden catching of breath), Moha (delusion), Sukumarata - Alpabala (reduced strength), Alpaprana (decreased life span), Alpavega (decreased physical activity), Alpavyavaya (poor sexual pleasure), Anga Shaithilya, Anutsaha (lack of enthusiasm to work), Ayatha Upachaya (disproportionate increase of body parts), Chala Sphik, Chala Sthana, Chala Udara (pendulous movement of buttocks, breast and abdomen), Gadgadavani (stammering), Kasa (cough), Kshudhaatimatra (excessive hunger), Kshudrashwasa (difficulty in breathing), Nidradhikyata (excessive sleep), Pipasatiyoga (excessive thirst), Sarvakriyasu Asamarthata (unfit for any sort of activities), Snigdhangata (oily, lustrous skin), Swedabadha (profuse sweating), Udaraparshwa Vruddhi (distension of abdomen due to fat).

Alasya (laziness), Daurbalya (fatigue), Gatrasada (debility), Krathana (sudden catching of breath, Sukumarata - Alpabala (reduced strength), Alpaprana (shortness of breath), Alpavega (decreased physical activity), Anga Shaithilya, Anutsaha (lack of enthusiasm to work), Ayatha Upachaya (disproportionate increase of body parts), Chala Sphik, Chala Sthana, Chala Udara (pendulous movement of buttocks, breast and abdomen), Gadgadavani (stammering), Kasa (cough), Kshudhaatimatra (excessive hunger), Kshudrashwasa (difficulty in breathing), Nidradhikyata (excessive sleep), Pipasatiyoga (excessive thirst), Sarvakriyasu Asamarthata (unfit for any sort of activities), Snigdhangata (oily, lustrous skin), Swedabadha (profuse sweating), Udaraparshwa Vruddhi (distension of abdomen due to fat) can be seen in obese dyslipidemic individuals. Ayusho Hrasa (decreased life span), Daurbalya (fatigue), Moha (delusion), Sukumarata - Alpabala (reduced strength), Alpaprana (shortness of breath), Sarvakriyasu Asamarthata (unfit for any sort of activities) features can be noted in case of Atherosclerosis condition.¹³

Bheda in dyslipidemia vis-à-vis Abaddha Medas

Adhamalla and Kasiram while commenting on Sharangadhara Samhita mentioned Medo Dosha as only one which is caused due to Meda Vruddhi, leading to Lakshans such as Kshudra Shwasa, Moha, Kratana, Angasadadi Lakshanas. Medodosha Eka Eva Cha.¹⁴

In modern science, dyslipidemia is categorized on specific components such as triglyceride, LDL, HDL like hyperlipoproteinemia, hypertriglyceridemia and hypercholesterolemia.¹⁵

Upadrava in dyslipidemia vis-à-vis Abaddha Medas

The Upadrava (complications) mentioned in context, Medoroga can be considered as Updravas even in case of Abaddha Medas.

According to Yogaratnakara, chronic nature of Medoroga gives rise to complications which occur mainly due to the involvement of Agni and Vata. ¹⁶  Sushruta Samhita, Madhavanidana, Yogaratnakara also enumerate Upadrava like Medasavruta Vata Lakshanas, such as Alpavyavaya (poor sexual pleasure), Alpa Prana, Prameha Pidaka (carbuncles), Jwara (fever), Bhagandhara (fistula), Vidradhi (abscess), Vata Vikaras which ultimately results in fatal end for the patient.^17,18

Vata Vikaras such as Pakshaghata can be seen in dyslipidemia.

Sadhya - Asadhyata vis-à-vis Abaddha Medas

The Sadhya - Asadhyata of Abaddha Medas is not mentioned in classics. However, the Sadhya- Asadhyata of Medoroga mentioned is as follows.

Medoroga is described as a Kricchra Sadhya Vyadhi. Charaka Samhita has mentioned the poor prognosis of Medoroga. ⁶

Chikitsa of Bahu Abaddha Medas

Chikitsa concepts to be employed in case of Bahu Abaddha Medas

Here the aim of the treatment should be to reduce Kapha Dosha and Medo Dhatu, either through Shodhana or through Shamana Chikitsa. ¹⁹ Thus Nidanas which increase Kapha Dosha and Medo Dhatu to be restricted in case of Bahu Abaddha Medas, i.e., the Ahara, Viharaja Nidanas which increase Kapha and Medo Dosha which in turn increase the production of Abaddha Medas to be avoided.^20,21

The treatment principles mentioned in the context of Ashta Nindita are to be employed in case of Abaddha Medas, which is a Medo Pradoshaja Vikara, where breaking down the Samprapti is more important.²² Thus the treatment principles of Abaddha Medas lie in Kapha-Medoharana, Agni Deepana, Ama Pachana, Prameha and Medo Roga/ Sthoulya line of treatment are to be employed.

As Bahu Abaddha Medas is a Santarpanotta Vyadhi, Atarpana Chikitsa (non-nourishing therapies) having the action of Medo Harana to be employed in Sthula and Balavan individuals, while lean and Alpa Balavan individuals having Abaddha Medas are to be treated with Laghu Santarpana Chikitsa. ²³ Aptarpana, a unique Ayurvedic principle includes Rukhshana, Langhana and Swedana. Atarpana helps to reduce the Medas and Kapha in the body. Medoroga is amalgamation of Vata and Meda, so Guru Aptarpana plays a significant role in managing the disease at this level. Atarpana is antagonistic to Meda and Guru Guna is antagonistic to Laghu Guna of Vata. If the individual is Sthula and Balavan, he is subjected for Shodhana, and if the person is not Balavan or if he is Krusha, then Brihmana line of treatment to be employed; however care must be exercised not to increase Abaddha Medas. ²⁴

Understanding Kriyakala of dyslipidemia vis-à-vis Abaddha Medas through Ayurveda

Shodhana Chikitsa

Role of Shodhana is to do Kapha Chedana, Dhatwagni Deepana and Sroto Shodhana. As the proper Shodhana brings about Dhatu Sthiratva and Agni Deepthi, it may be useful in dyslipidemia and here Ruksha Shodhana to be employed. Lekhana Basti is a Ruksha, Tikshna and Srotoshodhakai in nature and Ruksha Virechana, a type of Shodhana to be employed here as it has got direct impact, control and maintain the Agni, especially if Sthoulya is associated with Abaddha Medas. Vamana can be employed if Kapha Prakopavastha is seen, which reduces Kapha Dosha and thus acts as Medohara.

The main aim of Chikitsa is to restore the Jataragni, Medodhatvagni, and to bring back the equilibrium of Kapha and Vata Doshas. Dravyas, which are Kapha-Medohara, Deepana, Pachana are indicated. Also, the drugs which are Katu, Kashaya, Tikta Rasatmaka and Teekshna, Lekhana, Laghu, Ruksha Guna Yukta, Ushna Viryatmaka are indicated.

Charaka Samhita mentions the treatment principles of Medoroga as Guru Atarpana, Kapha and Medohara Dravyas, Ruksha Ushna Basti. Drugs like Triphala, Takrarishta, Makshika, Vidanga, Nagara, Shilajatu mixed with Agnimantha Swarasa, Bilwadi Panchamoola mixed with Madhu, Loha Bhasma, Kshara, and Yava to be used regularly to treat Medoroga. ²⁵ Sushrutha Samhita explains the Kriya Karmas like Nidana Parivarjana, Virukshana, Chedana and Lekhana Basti. Use of drugs like Shilajatu, Guggulu, Gomutra, Triphala, Loharaja, Rasanjana, Madhu and Yava are said to be beneficial in treating Sthoulya. ¹⁸

Astanga Hrudaya Sutrasthana, Medo Anila, Shleshmahara Shamanoushadha and Basti are mentioned as the Medoroga Nashaka Chikitsa. This text also shares the same opinion as that of Charaka Samhita and Sushrutha Samhita regarding the drugs to be used.²⁶ Bhavaprakasha mentions Raktamokshana and Dhoopana, along with Lekhana Basti, as some of the measures.²⁷

Shamana Chikitsa

As there is involvement of Ama, Amapachana and correction of Agni should be primary aim of treatment. Thus Pachana, Deepana and Rukshana should be done, as in this scenario, Sanchita Ama is present. The role of Pachana is first and foremost than Deepana. By Pachana and Deepana, Ama may be pacified and Agni Deepti is obtained which in turn corrects the Dhatu Parinama. Since most of the Pachana Dravyas possess Tikshna, Ushna Gunas, it easily pacifies the Ama condition by which Sroto Vibandhakaritva is removed. Here Ama is predominant in Ap and Prithvi Mahabhuta and Pachana is of Agneya. Use of Katu, Tikta Rasa that become Katu on Vipaka may be useful. They reduce Kapha and Medas. Katu Rasa is Deepana, Pachana and Sneha - Meda- Kleda Soshana. Drugs having Laghu, Ruksha and Ushna Veerya are also useful in this condition. Lekhaneeya Gana, Gomutra, Guggulu, etc are examples. They are Deepana, Pachana, and due to the Lekhana property, it removes the accumulated materials from the Srotas.

The drugs and Ahara Dravyas mentioned in context of Sthula Pramehi Chikitsa and Medo Roga Adhikara have their effect both on Baddha and Abaddha Meda, thus beneficial in dyslipidemia vis-à-vis Abaddha Medas.

In Ayurveda, it is mentioned that the treatment for any disease or any person is customized i.e., Purusham Purusham Vikshya^{. 28} Hence the line of treatment of dyslipidemia in Sthula and dyslipidemia in Krusha (non-Lean individuals) changes, and the line of treatment mentioned in Prameha Chikitsa for Sthula and Krusha, can be adopted in case of dyslipidemia vis-à-vis Abaddha Medas.²⁶

Chikitsa in Sthula Abaddha Medas person

Apatarpana line of treatment is advised for Sthula patients which can include Langhana, Vyayama, Shodhana using Tikta-Katu dravyas, such as Lekhana Basti, Ruksha Virechana, Vamana which acts as Kapha-Medohara, thus decreasing the Snehamsha or Abaddha Medas in the body and Kapha-Medo Nashaka Ruksha Aushadas can be prescribed internally. Here Vyayama in the form of active life style including physical activity to be incorporated along with treatment.

Chikitsa in Krusha (Non-obese individual) Abaddha Medas person

Krusha individuals should be treated with food and drinks which are Brimhana but not Medo-Mootrala. ²⁶ If a patient requires Samshodhana therapy but is not eligible for it, then he should be given Shamana Chikitsa. Some of the food preparations advised are Mantha, Kashaya Yava Churna Leha (powder and linctus of barley), Laghu Bhakshya Yavoudanam (which is Ruksha), Vatya (barley porridge), Saktu (roasted corn flour), Aapoopa (pancakes) mixed with meat soup of Vishkira Pratuta Vihanga Jangala Mriga, Mudgaadi Yusha, Tikta Shaka, Purana Shaliyodana. Yava soaked in the decoction of Triphala and kept overnight mixed with honey. This is a Laghu Tarpana/ Brihmana diet. It can be taken regularly. Correction of Agni at Jataragni and Dhatvagni levels is considered to be the main line of treatment in case of Krusha to ensure proper Poshana of each Dhatu with specific Poshakamsha delivered to each. If the patient is not Durbala, then Mrudu Shodhana can be done.²⁶

Rasayana Chikitsa in Medo Roga^29-37

Rasayana is one of the peculiar concepts of Ayurveda. Rasayana is a procedure where specific Dravyas are used to nourish Rasadi Dhatu which helps to attain Prashasta Avastha of Dhatu. Rasayana Dravyas have effect on both Agni and Srotas. In Sthoulya, excess Meda Dhatu will obstruct Rasadivaha Srotas, so Rasadi Dhatu will not get proper nourishment except Meda Dhatu; hence use of Dravyas having properties of Rasayana, Vataghna, Shleshmahara and Medohara will help boost immunity, removes obstruction of other Srotas for proper nourishment of Dhatu. Thus, a person can easily overcome Sthoulya and its other complications like Ashta Dosha and other diseases.

Some of the important Rasayana Dravyas mentioned in context of Medo Roga are Triphala, Guggulu, Loha Rasayana, Madhu, Shilajatu, Bhallataka Kshoudra, Guduchi, etc. Trushnadi Loha is considered Uttam Rasayana in the classic textbook. It contains Lohabhasma and other thirteen drugs. Its dose is one Masha along with Madhu and Ghrita. The actions mentioned are, if Lekhana of excess Medas is present, it increases Agni, Bala, Varna of person. The properties of Trayushandya Loha helps in Sthoulya person to reduce Dushta Meda Dhatu and normalizes Agni and is considered to be Balya and due to its Rasayana property, other Dhatus are nourished, which helps to combat other complications of Sthoulyata and other opportunistic diseases.

Discussion

Understanding dyslipidemia under single concept in Ayurveda is very difficult. It should be understood with the basic concepts of Dhatu Poshana, Agni Vaishamya, Kriya Kala and then in Vyadhi Avastas like Prameha, Sthoulya and Medo Roga. Vagbhata has described that ‘Jatharagni’ has its fractions known as ‘Dhatvagnis’ situated at the level of tissues. If these fractions become over active, there will be ‘Kshaya’ (catabolism) of Dhatu’ and if they become depressed, there will be abnormal ‘Vriddhi’ of the ‘Dhatu’. Several classical endocrine hormones determine the metabolic state of a tissue. For example, ‘Medodhatvagni’ may include glucocorticoids, insulin, glucagon etc. If glucagon levels are excess, lipolysis occurs which is equivalent to ‘Medokshaya’. Along with these hormones, all enzymes involved in lipid metabolism may also be regarded as ‘Medo Dhatvagnis’. In the pathogenesis of Prameha, there is mentioning of Paribhramana of Abaddha Medas in the initial stages which can be understood as ‘Hyperlipidemia’ and in the context of Ashta Nindita Purusha while explaining the pathogenesis of Ati-Sthula, it is mentioned as ‘Mede Dehavyapakatvena Labdha Vriddhi’ which can be understood in terms of hyperlipidemia. While explaining the Samprapti of Prameha Bahu Abaddha Medas, Mamsa, Kleda, Shukra, Shonita, Vasa, Majja, Lasika, Rasa and Ojas are considered as Dushyas. Abaddha Medas i.e., one which is not Samhata can be considered as freely floating lipids in blood. Kapha Dusti manifested in the form of Kleda, Upalepa causing Dhamani Upalepa formed due to Abaddha Medas can be compared with that of atherosclerosis condition caused due to increased cholesterol levels. Abaddhatva of Medo Dhatu and its Paribhramana in Rasa Dhatu can be understood as abnormal amounts of lipids and lipoproteins circulating in blood i.e., dyslipidemia. The proper functioning of Medo Dhatvagni will produce Prakruta Medo Dhatu (good cholesterol) which can be compared with that of HDL explained in contemporary science and Vikruta Sneha / Dushita Medas (bad cholesterol) produced due to Medo Dhatvagni Mandya can be compared to LDL, VLDL and raised total cholesterol.

Rasa Nimittameva Sthoulyam Karshyam Cha

During the explanation of Sthoulya Samprapthi, it is explained that due to Nidana Sevana there is Vriddhi of Medho Dhatu alone. This Vriddhi can be in two forms i.e., Vriddhi of Baddha Medas where the Lakshanas of Sthoulya can be appreciated in those patients, Vriddhi of Abaddha Medas which is compared to that of dyslipidemia in contemporary science. Asthi Poshana is the Karya of Medo Dhatu; thus when there is derangement in Medo Dhatvagni, Abaddha Medas is formed and there is lack of nourishment to Asthi Dhatu. This could be the reason for association of decreased bone mineral density (BMD) in dyslipidemia.

Mamsa has the Karma of Medo Pushti, this could be the main reason for non-veg restriction in dietary management in dyslipidemia. Scientists reported that severely obese people exhibit a fat-building enzyme called Stearoyl-CoA desaturase 1 (SCD-1) three times more in their muscle cells compared to lean people indicating that simple dietary management may not be sufficient in the treatment of obesity. Thus, a combination of diet and treatment is mentioned in the management of Sthoulya/ Medo Roga. There is an important relation between overweight and diabetes mellitus. There are only a few insulin receptors on the walls of cells in overweight individuals. Hence more insulin is required for cells to absorb glucose. This results in overworking beta cells to produce required insulin. Failure of production of insulin leads to diabetes mellitus. With weight reduction, the number of insulin receptor sites increase and this reduces the severity of hyperglycemia. Thus, maintaining ideal body weight becomes necessary to avoid the production of Bahu Abaddha Medas which can be seen in case of Prameha Poorvaroopa.

Conclusion

Although no disease can be directly correlated with dyslipidemia in Ayurveda, it can be understood under the concepts of Prameha Poorvaroopa where Bahu Abaddha Medas is mentioned and this is considered as a state of ‘Hyperlipidemia’. The Nidana Panchakas of dyslipidemia can be understood under the light of Sthoulya, Medo Roga and Prameha. The treatment principles mentioned in the context of Prameha, Sthoulya and Medo Roga are to be employed in case of dyslipidemia vis-a vis Abaddha Medas after assessing the Kriya Kala of the disease along with Bala and Prakruti of the person. The obese individuals with dyslipidemia are to be treated with Apatarpana line of treatment using Shodhana and Langhana as treatment modalities, whereas dyslipidemia in lean individuals can be treated in the lines of Laghu Santarpana. If Rogi is Balavan, Mrudu Shodhana can be adopted.

Conflict of Interest

None