SHAMANA VERSUS SHODHANA CHIKITSA IN THE MANAGEMENT OF MEDOROGA WITH SPECIAL REFERENCE TO OBESITY: A SYSTEMATIC REVIEW

Abstract

Background: According to Ayurveda, Medoroga & Sthoulya is a disorder of metabolism characterized by the accumulation of excess Meda Dhatu with impaired Agni and Srotorodha. Today's definition, it generally means obesity, dyslipidemia, and other metabolic risk conditions. Ayurveda describes two major therapeutic measures, namely Shamana Chikitsa and Shodhana Chikitsa. Clearly, the relative clinical efficacy of these tools in Medoroga not yet been thoroughly reviewed.

Objective: To systematically identify, critically appraise, and comparatively synthesize classical textual data and modern clinical evidence on Shamana and Shodhana Chikitsa in the management of Medoroga, following PRISMA 2020 guidelines.

Methods:Electronic databases, including PubMed/MEDLINE, AYUSH Research Portal, Google Scholar, and CCRAS repository, were searched from inception to June 2026. Manual searches of Ayurvedic classical compendia were also performed. Studies evaluating Ayurvedic Shamana, Shodhana, or combined protocols for Medoroga/Sthaulya/obesity were included. Data were synthesized narratively due to clinical heterogeneity.

Results: Of 312 records identified, 26 met inclusion criteria: 14 clinical studies (6 RCTs, 5 observational/open-label trials, 2 case series, 1 case report) and 12 classical textual references. Shamana-based regimens (n=6 studies) produced mean BMI reductions of 1.2–2.8 kg/m2 and weight reductions of 3–7 kg over 30–90 days. Shodhana-dominant protocols (n=5 studies) yielded greater and more sustained reductions: BMI 2.1–4.5 kg/m2, weight 5–12 kg, and significant improvements in lipid profiles over 30–60 days. Combined protocols (n=3 studies) showed the most comprehensive anthropometric and metabolic improvements. All modalities were generally well-tolerated.

Conclusion: Both Shamana and Shodhana Chikitsa demonstrate efficacy for Medoroga/Sthaulya, but Shodhana-based Panchakarma therapies, particularly Vamana and Virechana, appear to produce faster and more durable anthropometric and metabolic improvements. Combined integrative protocols may offer the best outcomes. Standardized large-scale RCTs are urgently needed.