Obesity or loss of flesh (Karsha) should be ascribed to changes in the condition of the lymph chyle. The lymph chyle derived from the assimilated food of a person, who is habituated to a course of diet which tends to promote the quantity of the bodily Kapham or is in the habit of pampering his belly even when a previous meal has not been thoroughly digested, or who is addicted to a habit of sleeping in the day, or leading a sedentary life, or is averse to taking any sort of physical exercise, continues in an immature state and is transformed into a serum of sweet taste which moves about within the body, engendering the formation of fat which produces excessive stoutness. A person afflicted with obesity develops such symptoms as shortness of breath, thirst, ravenous appetite, excessive sleepiness, perspiration, fetid odours in the body, wheezing sound in the throat during sleep or sudden suspension of breath, inert feeling in the limbs, dulness or heaviness of the body, and indistinctness of speech. Owing to the softness of fat, a fatty person is unfitted for every kind of work. Capacity for sexual intercourse is diminished (in such a one), owing to the obstruction of the passage of semen by phlegm and fatty deposits; and the growth of the rest of the root-principles of the body such as, lymph chyle, albumen, semen, etc., is considerably arrested owing to the deposit of fatty matter within the channels of the internal passages of the body, thus seriously affecting his bodily strength. An obese or excessively corpulent person is likely to be afflicted with any of the following diseases such as, urethral discharges, eruptions, boils, carbuncles, fever, fistula in ano, or with any of the diseases which are caused by a deranged state of the bodily Vayu; and such attacks are invariably found to terminate in death. Any disease in such a person is apt to develop into one of a violent and dangerous type owing to the obstruction of the internal channels with deposits of fat.
Hence all things or conditions which foster the growth of abnormal fat should be carefully avoided.
Accordingly medicated compositions, consisting of such drugs and substances as Shilajatu, Guggulu, Go-Mutram, Triphala, Loharaja, Rasanjanam, Madhu, Yava, Mudga, Koradusha, Shyamaka and Uddalaka which are anti-fat in their properties, or of remedial agents possessing the efficacy of cleansing the internal channels, as well as enematas of liquefacient solutions technically known as Lekhana Vastis and physical exercise should be prescribed.
Loss of flesh or a gradual emaciation of the body should be ascribed to the partaking of food in the composition of which, matter which aggravates the bodily Vayu largely or excessively enters, to over-fatiguing physical exercise, sexual excesses, over study, fright, grief or anxiety, to the keeping up of late hours, to unsatisfied hunger, insufficient food, and to astringent food which tends to dry up the lymph chyle. The chyle, thus parched up, moves about in the organism, but fails to impart to it the necessary nutritive element owing to its being insufficiently charged with it, thus causing the body to grow extremely emaciated.
A patient suffering from extreme emaciation of the body fails to bear the inclemencies of weather and the variations of terrestrial heat, and becomes apathetic to all movements and does but imperfectly perform the 18 functions of vitality, and is also incapable of enduring thirst or hunger. The bodily strength suffers a gradual diminution, and diseases, incidental to a deranged state of the bodily Vayu, make their appearance, and the patient has to meet his doom from any of the following diseases as asthma, cough, Shosha (phthisis), enlarged spleen or liver, abdominal dropsy, dyspepsia, abdominal glands and haemoptysis. Any disease appearing in such a patient develops into one of a violent type owing to the loss or diminished condition of the bodily strength or protoplasm (Prana).
Contrarily, conditions or factors which produce obesity should be avoided. A case of patent obesity should be checked with a medicated compound, consisting of such drugs as, Payasya, Ashvagandha, Vidari, Vidarigandha, Shatavari, Vala, Ativala, Nagavala and such other drugs of sweet taste. Diets consisting of thickened milk, clarified butter, curd, meat, boiled Shali rice, Yasthika, wheat, barley, etc., should be prescribed in the case; and sleep in the day, sexual indulgence, physical exercise, etc., should be prohibited. Enematas of nutritive substances can be likewise given with advantage.
On the other hand, the lymph chyle of a man, who partakes of food belonging to both the abovesaid classes, courses through his organism and strengthens the root-principles of his body, thus giving a middling or healthful rotundity to his limbs owing to its properties being equipoised. A man possessed of such a body is capable of all kinds of work and movement. He can fairly stand the inclemencies of weather and the keenness of hunger and thirst, and will gain in strength and energy. Care should be always taken to have such a well equipped body of moderate size.
Excessively corpulent and excessively lean persons are alike condemnable. A body which is neither too stout nor too lean, but strikes the mean as regards plumpness, is the best. A lean frame should have the preference to a stout one. The enraged or aggravated bodily humours dry up the fundamental principles of the body, such as the lymph chyle etc., just in the same way as a well-kindled fire will evaporate the water contained in a basin placed over it. Since (the temperament, constitution, size and the fundamental principles of) the body vary in different individuals; (and since the body, in its turn, undergoes such gradual transformations as infancy, youth and old age), and changes its state each moment, it is absolutely impossible to lay down the exact quantity of the deranged humours, excrements and fundamental principles (of lymph chyle, blood, semen, albumen, etc.) that may be found in the human organism. Hence it is necessary for a physician to ascertain their state of equilibrium (their continuance in normal state and quantity) at any particular time; and which should be pronounced only in cases where signs of perfect health would be visible. An experienced physician would naturally draw a contrary inference from the improper functions of the organs in an individual. A person with an uniformly healthy digestion, and whose bodily humours are in a state of equilibrium, and in whom the fundamental vital fluids course in their normal state and quantity, accompanied by the normal processes of secretion, organic function, and intellection, is said to be a healthy person.
An intelligent physician should preserve the state of health in a healthy individual, while he should increase or decrease the quantity of the bodily humours, vital fluids, or excrements in a sick patient according to the exigencies of the case until his health is perfectly restored.