Anorexia nervosa is an eating disorder, which comprises of marked weight loss arising from food avoidance often in combination with bingeing, purging, excessive exercise or the use of diuretics and laxatives. Occasionally more extreme measures such as blood-letting are encountered. There is profound body image disturbance so that, despite their emaciation patients still feel overweight and are terrified of weight gain. These preoccupations are intense and pervasive, and the false beliefs at times with a conviction approaching the delusional. Anxiety and depressive symptoms are common accompaniments. Downy hair (lanugo) may develop on the back, forearm and cheeks. Extreme starvation is associated with a wide range of physiological and pathological body changes. All organ systems may be affected, although the most serious problems are cardiac and skeletal.
The cause or etiology of this disease is unknown but probably includes genetic and environmental factors including social pressure of women to be thin. The condition usually emerges in adolescence, with a marked female preponderance. The diagnosis is made on the presence of a pronounced fear of fatness despite being thin, and on the absence of alternative causes of weight loss.
Diagnostic Criteria
- Weight loss of at least 15% of total body weight or body mass index less than 17.5
- Avoidance of high calorie foods
- Distortion of body image so that patients regard themselves as fat even when grossly underweight
- Amenorrhea for at least three months
AYURVEDIC CONCEPT OF ANOREXIA: ARUCHI
Food is the life sustaining factor and such vital thing is disliked and even an aversion for food is developed in a clinical condition called Arochaka or anorexia. This condition is sometimes presented as an important symptom of other diseases like Kamala (Jaundice), Rajayakshma (Tuberculosis), Amavata (Rheumatoid arthritis) and as an independent disease entity. It is also known by synonyms like aruchi, bhaktadwesa (aversion to food) etc.
Arochaka is loss or deficiency of appetite for food, this may be either due to indigestion or psychological causes leading to atrophy of stomach. In this the patient does not like to eat and gets bad taste in the mouth, even he keeps food in the mouth forcefully, he does not feel any positive inclination to swallow the same inside.
CAUSES
- Manifested because of dosha vaishamya ie vitiation of vata dosha due to Nija (endogeneous) factors
- Manifested as a consequence of mano-vaishamya the vitiation of psychic factors like shoka (grief), bhaya (fear), lobha (greed), ershya (jealousy) and viewing the bhibhatsakara or frightening scenes etc. hence it can be termed as a psychosomatic disease.
- Somatic factors : vata, pitta, kapha, sannipatha (gastritis, gastric cancer, hypochlorhydria, anaemia, jaundice etc)
- Psychic factors: soka (grief),bhaya (fear), lobha (greed), krodha (anger), unpleasant or disliked and frightening things with bad odour or shape
SAMPRAPTI- ETIOPATHOGENESIS
Due to the aforesaid causative somatic factors, the annavaha and rasavaha srotas (channels of food and fluid circulation) are vitiated. The psychic factors affects the hrudaya (heart or conscious or mind) and causes arochaka. Arochaka – aversion to food is caused by the individual doshas and by all the doshas simultaneously vitiated. The site of the disease is tongue and stomach and the manifestation include sanga (obstruction). The vitiated doshas are located in the tongue and heart. The fifth type of arochaka is caused by the aversion for the object of gustatory sensation (taste). The taste of mouth becomes astringent, bitter and sweet in vataja, pittaja and kaphaja types of arochaka respectively. In the psychic type of arochaka , the patient finds fault with otherwise right type of food and drinks. Tridoshaja or sannipata type of arochaka is the result of homogeneous combination of doshas. In this, all the signs and symptoms of arochaka caused by individual doshas are manifested in combined form.
TYPES
Arochaka is a kapha dosha predominant disease but according to the involvement of the dosha, it is of five types
- Vataja
- Astringent taste in mouth
- Teeth sensitivity
- Pain in the heart region
- Tastelessness
- Pittaja
- Bitter , pungent, sour taste in mouth
- Foul smell from mouth
- Burning in heart region
- Fainting
- Thirst
- Kaphaja
- Sweet, salty taste in mouth
- Sticky mouth
- Itching
- Heaviness of body
- Oral secretions in excess
- Lethargy
- Sleepy
- Tridoshaja
- In this type of arochaka, mixed symptoms pertaining to all trisdoshas are manifested.
- Agantuja (Manasika)
- Normal taste sensation yet no desire for food or drinks etc
- Mental unrest
TREATMENT
- Internal purificatory measures
- Kaphaja arochaka : vamana (medicated emesis)
- Pittaja arochaka : virechana (medicated purgation)
- Vataja arochaka : vasti (medicated enema)
- External purificatory measures
- Kavala (gargles)
- Mukha shuddhi (mouth wash)
- Maintainence of oral hygiene
- Dhuma pana (medicated smoking)
- Assurance, keeping happy, pleasant food serving etc are also important in the management of arochaka , especially in manovaikalyakara arochaka (psychogenic anorexia)
MEDICINES
- Decoction of triphala , pata, dry draksha, mrudveeka, jatipallava for mukha dhavana (mouth wash)
- Kavala prayoga drugs
- Vataja arochaka: kushta, krushnalavana,jiraka, sugar, maricha and lavana
- Madiphala rasayana : 20 ml repeatedly
- Ardraka matulunga avaleha : 1 teaspoon thrice a day
- Talisadi churna : 3 to 5 grams with honey three times a day
- Ashtangalavana churna : 3 grams thrice a day
- Pittaja arochaka : amalaki, ela, padma kashta, usira, nilotpala, pippali and raktachandana
- Khandardraka yoga : 10 grams thrice a day
- Karpuradi churna : 5 grams thrice a day
- Drakshavaleha : 10 grams thrice a day
- Kaphaja arochaka : lodhra, tejbala, haritaki, trikatu, yavakshara etc
- Tridoshaja arochaka : ardraka, dadima(juice), jiraka and sugar
- Manovaikalya or Mano santapta arochaka : providing mental courage, keeping the patient in a pleasant environment
- All the above cited drugs powder for Vataja (kushta, krushnalavana,jiraka, sugar, maricha and lavana), Pittaja (amalaki, ela, padma kashta, usira, nilotpala, pippali and raktachandana) and Kaphaja arochaka (lodhra, tejbala, haritaki, trikatu, yavakshara ) should be made by taking in equal parts. This churna (powder) should be mixed in the required quantity of honey or sesame oil and should be applied inside as lepa (topical application) or used as kavala graham
- Draksha gandusha: 30 ml of drakshasava or draksharishta added with 30ml of lukewarm water should be taken for mouth gargling. It should be moved in mouth gently for 10 to 15 minutes and thrown out. This drakshadi gandusha should be undertaken three to four times in a day till normal appetite for food arises.
- Ardraka lavana prayoga: regular intake of lavana (rock salt) and ardraka (green ginger) before food is good in arochaka. It promotes taste, digestion and cleanses the oral cavity, tongue and entire digestive cavity and causes happiness of mind and heart.
- Green ginger juice mixed with honey regularly
- Repeated intake of black pepper powder with pure honey especially in kaphaja arochaka
- Pomegranate juice mixed with rock salt and honey should be kept in mouth for some time and slowly swallowed. It removes bad taste of mouth and corrects appetite
- Alubhukara ( dry fruits) should be kept in mouth and chewed slowly for appetite
- The mixture of coriander seeds, cardamom and black pepper powdered together taken with ghee and honey kept in mouth and swallowed slowly ill initiate appetite sensation
- Lemon to be cut into two halves, sprinkle 1 g. powdered Maricha (black pepper) and Lavaṇa (common salt) and to be sucked frequently.
- Take barks of Tvak/Dalachīnī (cinnamon), Daruharidra (berberis) and fruit of Yavanī (ptychotis) to be powdered in equal parts and to be placed on the tongue for chewing.
- Prepare decoction from the seed of Yava (barley). Add powdered fruit of Pippalī (long pepper) and honey and should be taken twice a day.
- Macerate fruit of Ciñcā (tamarind) in 100 ml. of water, strain, and add Guḍa (jaggery) and small quantity of powdered Tvak- Dālacīnī (cinnamon) and fruits of Elā (small cardamom) and Marica (black pepper). Take its Kavala (mouth wash) which is to be retained in the mouth for two minutes.
- Mix Draksha (Dried black grape fruit), seedless fruit rind of Harītakī /Haridra (chebulic myrobalan) and sharkara (raw sugar) in equal parts to be taken in the powder form in dose of 3 to 6 g. with 50 ml. of warm water twice a day.
