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How Under-Nutrition (Karshya) is Responded to Ayurvedic Treatment: A Case Study

Despite numerous global sensible corrective attempts to provide nutrition, undernutrition (Kaarshya) remains one of the most pressing issues. The bulk of the population in underdeveloped nations is undernourished. It is one of the main causes of death and morbidity in both children and adults. One of the eight components of primary health care in the worldwide campaign for health for all is the promotion of appropriate diet. A person who is malnourished is prone to a slew of problems. It is a condition in which the body's fat and muscles are depleted. This is why it is critical to treat it to restore the body's normalcy. With its unique approach to lifestyle management and medication therapy, Ayurveda, with its holistic perspective, can aid with this disease. Swasthavritta (Community Medicine) has a part in Kaarshya management. Ashwagandhadi avaleha acts as an excellent nutritional treatment to alleviate the symptoms of Kaarshya in youngsters. As a result, Ayurvedic therapy for Kaarshya was arranged. After one month of treatment, the patient gained 1.5 kg of weight, and the next month, i.e., the follow-up period, the patient exhibited substantial improvement in weight growth. Other anthropometric measures improved as a result of the therapy. The assessment was carried out over two months. Case Study Chauhan and Pani; JPRI, 33(40B): 7-12, 2021; Article no.JPRI.71623 8 Aim: To study the effect of Ashwagandhadi avaleha on BMI and weight in karshya. Materials and Methods: This is a single case study on underweight female. Ashwagandhadi avaleha was given for two months. Anthropometric parameters such as weight, body mass index (BMI), hip circumference (HC) and mid-arm circumference (MAC) and subjective parameters were assessed before and after 2 months. Result: Significantly increased in weight i.e. 2Kg was observed after two months. Conclusion: Regular intake of Ashwagandhadi avaleha significantly increases weight and body mass index in Karshya.


INTRODUCTION
According to contemporary research, Karshya is associated with being underweight. Body mass index (BMI) is a basic weight-for-height metric that is frequently used to categorize adults as underweight, overweight, or obese. It is estimated by measuring the in kg by the height in meters square (kg/m2). Underweight people have a BMI of less than 18.50 kg/m 2 and have a reduced risk of co-morbidities, but their risk of other clinical problems is higher. A typical person's BMI is from 18.50 to 24.99 kg/m2, and they have an average risk of co morbidities [1].
Diseases attack Atisthula and Atikarshya purushas at all times. Slimming and nourishing treatments are used to treat them. Karshyatwa is less harmful than Atisthula.
Ayurveda is known as the "science of life." The ultimate goal of Ayurveda is to help every human being in maintaining and promoting health, as well as preventing illnesses, which are the greatest inhibiting factor to achieving dharma. The medication Ashwagandhadi Avaleha is specifically used in the treatment of karshya, as described in Sahasrayogam [4].    Adopting chikitsa sootra explained by ayurveda in this disease context:

Advised Therapy and its Basis
The different areas of the body (for example, the abdomen and buttocks) are emaciated in Karshya Mansa and Meda dhatu. As an outcome, increased diet is required for the management of Karshya, Mansa, and Meda dhatus. In this example, the patient received only food control and no pharmaceutical therapy. Ashwagandhadi avaleha was used for nutritional management. For two months, this avaleha was taken on an empty stomach in the morning (between 6 and 8:00 a.m.) at the time of breakfast and in the evening (5-7:00 p.m.). The nutritional value of Ashwagandhadi avaleha is extremely high. It is rich in proteins, lipids, carbs, fibers, iron, calcium, and phosphorus. According to Ayurveda, it is bala and pushtivardhak [6]. That is why the Ashwagandhadi avaleha was selected for the research. Diet therapy was the only treatment used in this case. The normal range of BMI is 18.50 to 24.99Kg/m².

OBSERVATION AND RESULTS
Significantly increased in weight i.e. 2Kg was observed after two months of regular intake of Ashwagandhadi avaleha.

Effect of Ashwagandhadi avaleha on weight and
Changes in the anthropometric parameters before and after treatment are shown in table number 9. The results were assessed using weight, BMI and other subjective parameters.

DISCUSSION
The bulk of people in underdeveloped nations have apatarpana janya vikara ( rasapradoshaja vikara). This is due to a shortage of healthy food and a lack of understanding about its value. Poverty and a lack of personal cleanliness are two major contributing causes to the kaarshya's appearance. Adults may suffer from malnutrition owing to a lack of important nutrients such as proteins, carbs, vitamins, minerals, and other micronutrients. Because Kaarshya patients are prone to infections, therapy should focus on meeting their nutritional needs. The content Aswagandhadi avaleha is a nutritional medicine that has guru, snigdha guna, sheeta veerya, kaphavardhaka, vatashamaka, and brihmana qualities, is cheap, easy to administer, tasty, and may be used for a long time.

Chitrakadi vati [6]
Because of the use of the active component Chitraka, the formulation was given the name 'Chitrakadivati' (Plumbago zeylanica Linn). In Sanskrit literature, the word 'Chitrakadi' means 'fire or Agni,' since it boosts digestive fire or 'agni,' which aids in the removal of ama and the prevention of indigestion and other digestive problems caused by a lack of digestive fire (i.e., Mandagni). The major karmas are Deepana, Pachana, Rechana, Anulomana, Grahi, Shulahara, and Shothahara. The herbal components in the powerful composition assist to maintain the balance of Samanavata and Kapha and play an important role in efficiently cleansing ama from the body, leading to Agni Sandushanam (which improves the digestive power). This increases the rate of medication absorption while also enhancing Dhatwagni. As a result, we can see the role of karma in Chikitsa's growth.
Liv 52 -Improves poverty by increasing the liver function to secrete more bile, which aids in the digestion of ingested food and hence aids in weight gain. Liv -52 is a potent appetite stimulant, hemopoiesis booster, and anabolic agent.

CONCLUSION
As a result, in this situation, Ashwagandhadi Avleha operates on both agni and poshaka rasa. When administered as an anupana through the go-ksheera, it can nourish all the tissues of the body by raising the adya dhatu, ie, rasadhatu. Kaarshya is a chronic illness that requires long-term therapy to be effective. Other than focusing on the treatment elements of this condition, it is recommended that the socioeconomic situation and nutrition education awareness be improved.

CONSENT AND ETHICAL APPROVAL
As per international standard or university standard guideline parental consent and ethical approval has been collected and preserved by the authors.

ACKNOWLEDGEMENT
The authors are thankful to all the managing trustees of Parul University, Vadodara for availing the infrastructure required for the study. Also thankful to staff of Pharmacognosy laboratory, Pharmacology laboratory and Pharmacy of Parul Institute of Ayurved, Vadodara. Authors are also thankful to Vasu Research Laboratory, Vadodara.