Sthaulya (also Medoroga) is a santarpana-janya vyadhi (disease of over-nourishment) described as excessive and pathological increase of Meda dhatu (fat tissue). Ayurveda classifies it among the Ashtauninditiya Purushas (eight undesirable constitutions). It is caused by improper ahara-vihara leading to dhatvagni mandya (impaired metabolism) and accumulation of meda. Manifestations include excess body bulk, loss of agility, dyspnea, and complications like Prameha.

"आयुः क्षयकरं पुंसां जरा व्याधिकरं तथा । स्थूलत्वं सर्वरोगाणां कारणं परिकीर्तितम् ॥"
(चरक संहिता, सूत्रस्थान २१/४)

Sthaulya is primarily a Kapha-Meda disorder. Charaka highlights it as one of the eight undesirable constitutions. Sushruta describes Medoroga under Nidana and Chikitsa sthana, noting obstruction of medovaha srotas and dhatvagni mandya. Ashtanga Hridaya elaborates lifestyle causes (day-sleep, avyayama) and chikitsa (Langhana, Udvartana, Lekhana Basti). Madhava Nidana details lakshana and upadrava. Yogaratnakara and Kashyapa Samhita add hereditary predisposition and psychosomatic contributors.

Dietary causes from all classical sources:

• Atisampurna (overeating)

  "अतिसम्पूर्णं हि अन्नं मेदोरोगस्य कारणम् ॥"
  (सुश्रुत संहिता, निदानस्थान ६/१५)

• Guru, Snigdha, Madhura Ahara

  "गुरूणि स्निग्धमधुरं भोजनं मेदवर्धनम् ॥"
  (अष्टाङ्गहृदय, सूत्रस्थान १३/२५)

• Dugdha, Ghrita, Madhura preparations

  "दुग्धं घृतं मधु चापि... मेदोरोगं प्रजनयेत् ॥"
  (माधवनिदान, मेदोरोगनिदान)

• Viruddha Ahara — incompatible food combinations (Charaka, Chikitsa).
• Beeja-dosha (hereditary) — predisposition noted in Yogaratnakara, Kashyapa.

Lifestyle causes:

• Avyayama (lack of exercise)

  "अव्यायामः श्लेष्मवर्धनः मेदवृद्धिकरः स्मृतः ॥"
  (चरक सूत्रस्थान २१)

• Divaswapna (day-sleep)

  "दिवास्वप्नः प्रियः स्थूलान् करोति मेदवर्धनम् ॥"
  (अष्टाङ्गहृदय, सूत्रस्थान ७/५३)

• Ati-adhyakshana — lying soon after meals (commentaries).
• Manasika hetu — ati-harsha, stress eating (Kashyapa Samhita, Yogaratnakara).

Pathogenesis: Excess santarpana with guru-snigdha-madhura ahara → Kapha and Meda vriddhi. Meda obstructs medovaha srotas → dhatvagni mandya → ama formation. Vyana Vata is obstructed → impaired circulation and metabolism. Sushruta describes srotorodha; Madhava Nidana explains Meda dushti as qualitative and quantitative abnormality.

"सन्तर्पणात् गुरु स्निग्धान् मधुरान् च पुनः पुनः । मेदोवृद्धिर्भवत्येव स्रोतोरोधं करोति च ॥"
(चरक सूत्रस्थान २१/५)

Diagnosis: Clinical assessment of body build, palpation of meda, nadi pariksha, agni assessment. Tongue shows kapha signs. Acharyas advise assessing dhatvagni and srotas-dushti for staging.

"नाडीपरिक्षणेन दोषप्रधानता ज्ञायते ॥"

• Gradual weight gain
• Heaviness (Guruta)
• Lethargy after meals
• Localized fat deposition
• Excessive sweating

• दीर्घासीनव्यायामजन्यं — Sedentary lifestyle (long sitting, lack of physical activity) related features.
• विकृतमेदाः — Abnormal deposition/distribution of Meda (fat) in various srotas (channels).
• स्निग्धत्वेन त्वचासमृद्धिः — Oily/greasy skin and soft subcutaneous tissue (snigdha guna prominent).
• अतिशयभोजनानि तथा असङ्गताहारात् जायमानम् — History of overeating or habitual heavy & unctuous diet.
• ह्रासितेन्द्रियविकाराः — Mild breathlessness on exertion, tendency to perspire easily.
• उदरवृद्धि तथा वृत्तिवृद्धि — Abdominal enlargement and disproportionate waist circumference.
• शरीरबलहानि तथा सुस्ती — Lethargy, decreased stamina and gradual reduction in agility.
• अतिपिपासां तथा अतिश्लेष्मता — Increased thirst and mucousiness / heaviness (Kapha features).
• कण्डुकमुद्रता — Localized fat pads (abdomen, thighs, chest) with soft, pliable feel.
• अतिकायत्वम् — Excessive body weight; generalized increase in adipose tissue leading to noticeable corpulence.

• Generalized flabbiness
• Increased abdomen, thighs, chest
• Dyspnea, fatigue
• Snigdha skin, intertrigo
• Heaviness, indigestion

"गुरुत्वं स्निग्धता चापि स्थौल्ये लक्षणलक्षणम् ॥"
(माधवनिदान)

• Santarpana-janya Sthaulya (Charaka)
• Dhatvagni-mandya type (Sushruta)
• Beeja-dosha type (Madhava, Yogaratnakara)

• Prameha (Diabetes)
• Shotha (Edema, HTN)
• Sandhigata Vata (joints)
• Infertility, menstrual irregularities
• Sleep apnea

Early-stage = Sadhya with Langhana-Lekhana. Chronic with complications = Krichrasadhya or Asadhya.

• सिद्धान्त (Principles): स्थौल्ये लङ्घन, लेखन, शोधन।

  "लङ्घनं लघुपानं च स्वेदनं लघुपाचनम् । लेखनं चोपयुक्तं च स्थौल्ये पथ्यं प्रकीर्तितम् ॥"
  (चरक संहिता, सूत्रस्थान २१/२०)

• पञ्चकर्म:
  • वमन: Kapha-predominant.

    "स्थौल्ये वमनमेव स्याद् गुरुत्वकफनाशनम् ॥"
    (चरक चिकित्सा ३/१५)

  • विरेचन: Pitta-associated cases.
  • लेखन बस्ती: मेदोहर basti.

    "बस्तिर्हि स्थूलदेहस्य मेदशोणितमर्धयेत् ॥"
    (सुश्रुत चिकित्सा ३३/९)

• बाह्य चिकित्सा: उद्वर्तन, अभ्यङ्ग, स्वेदन।

  "उद्वर्तनं च कुर्यात् स स्थौल्यं हरति शीघ्रतः ॥"
  (अष्टाङ्गहृदय सूत्रस्थान १४/१७)

• औषध योग: त्रिफला, त्रिकटु, चित्रक, मुस्ता, गुग्गुलु योग (त्रिफला गुग्गुलु, कांचनार गुग्गुलु), दरुहरिद्रा, लोध्र, शिलाजीत, आरोग्यवर्धिनी वटी, मेदोहर वटी।
• पथ्य: लघु-उष्ण-रुक्ष आहार (यव, कोद्रव, कुल्थ, शाक), व्यायाम, avoid day-sleep.
• अपथ्य: दुग्ध, घृत, मिष्ठान्न, fried foods, दिवास्वप्न, अव्यायाम।
• योग: त्रिकोणासन, भुजंगासन, शलभासन, पवनमुक्तासन; प्राणायाम — कपालभाति, भस्त्रिका, अनुलोम-विलोम।

• Laghu, ushna, ruksha ahara
• Barley, kulattha, leafy vegetables
• Daily vyayama, avoid diwaswapna

• Milk, ghee, sweets, fried foods
• Day-sleep
• Inactivity

Obesity = excess adiposity with systemic risk. Ayurveda = Meda-vriddhi from Santarpana & Dhatvagni mandya → Prameha, HTN, CAD. Management = diet, exercise, Panchakarma, Lekhaniya herbs.

• Nadi pariksha, agni/tongue exam
• BMI, waist circumference, lipid profile, HbA1c, TFT, LFT, ECG