What Constitutes a Healthy Person?

This chapter focuses on the features of a healthy physical constitution of a person, definitions of sleep, as well as key concepts associated with disease management such as etiopathogenesis, clinical presentation, prognosis, and management of atisthula. Some key etiological factors of atisthula include dietary & lifestyle indicators (e.g., sedentary habit and high-calorie diet), and genetic and hereditary factors. This chapter also describes the pathogenesis of atisthula in detail, involving rasa (plasma) and meda (adipose tissue) as important dushyas (affected tissues). The significance of meda (adipose tissue) as the principal dushya has been recently confirmed in modern medicine where the central obesity and dyslipidemia are being considered as the main components of the basic matrix of this disease and its related disorders. ^[1,2,3] The recent concept of "metabolic syndrome" was already recognized in Ayurveda. Biomedical science points that overweight individuals experience greatly elevated morbidity and mortality from various ailments including cardiovascular diseases. ^4,5

Obesity research is focused on preventive measures and management of complications like prediabetes, diabetes, metabolic syndrome, hypertension, stroke, coronary heart disease, congestive heart failure, cardiomyopathy, and arrhythmia/sudden death. ^[6] In the modern world, obesity has emerged as a serious health issue in both developed and developing nations and is recognized as one of the most serious public health problems of the 21st century. In 2008 the WHO estimated that globally, at least 500 million adults (or approximately 1 in 10 adults) are obese, with higher rates among women than men. Obesity is the reason for about 80% of type 2 diabetes, about 70% of cardiovascular diseases, and 42% of breast and colon cancers today. In the past two decades, the number of overweight children and adolescents has doubled. ^[7] The rate of obesity also increases with age at least up to 50 or 60 years old. Once considered a problem specific to only high-income countries, obesity has acquired pandemic proportions and is affecting people globally ^[8,9]

Most researchers agree that once it is established in the body, obesity mostly takes an incurable course and continues to develop many progressive complications - a fact that was already acknowledged in Ayurveda. ^[10] Any course of treatment for obesity suggested by modern medical practitioners primarily includes dietary changes and physical exercise followed by anti-obesity drugs that help reduce appetite or inhibit fat absorption. In severe cases, various invasive and non-invasive surgical procedures could be prescribed - such as partial gastrectomy, gastric bypass, banding, gastric balloons, etc.^[11]  However, Ayurveda's approach to weight management is very different in that it does not recommend pills or surgeries for inducing drastic weight-loss. Instead, Ayurveda advocates dietary restrictions according to the Prakriti (predisposition or temperament of the patient), moderate exercise, practice of yogāsanas and pranayama, besides certain ayurvedic medications and bio-purificatory measures for its management ^[12]

The etiology, pathogenesis, clinical features and consequences of extreme leanness (atikrisha), as an outcome of rasakshaya (decrease of rasa), medokshaya (decrease of meda) and mamsakshaya (decrease of mamsa) have also been described in this chapter. The two basic approaches for management of atikrisha and atisthula are augmentation (brimhana) and depletion (karshana) of body tissues respectively. Various drug and non-drug modalities have been suggested for the replenishment of dhatus and their nourishment to attain good health.  In this regard, Rasayana drugs of Ayurveda help balance hormones, promote essential nutrition and enhance immunity to atisthula and atikrisha respectively. As mentioned earlier, this chapter also emphasizes the role of good Nidra (sleep) in maintaining a healthy life. In fact, as per Ayurveda, after Ahara (diet), Nidra is one of the three sub-pillars of life (trayopastambha) and has a significant place in preventive medicine because normal sleep helps prevent diseases and unwholesome sleep may lead to fatal diseases. In Ayurveda, Nidra is considered a brimhana (nourishing) agent that promotes physical & mental health and enhances immunity.