Article by Dr Raghuram Y.S. MD (Ay) & Manasa S, B.A.M.S
Polyphagia or hyperphagia is a condition wherein a person experiences extreme and insatiable hunger which persists even after eating food. It often appears in the form of a symptom of underlying health conditions. It is a serious issue that requires medical attention as in diabetes mellitus or hypoglycaemia. It is one of the main symptoms of diabetes mellitus.
When one eats excessive food due to polyphagia, it may or may not cause weight gain. On the contrary, in some cases it can even lead to unexplained weight loss. It is very important to understand and address the underlying condition for effectively managing polyphagia.
Related Reading – Polyphagia
In this article we will try to understand polyphagia from an Ayurveda perspective.
Polyphagia: Ayurveda Understanding
Basic Considerations
Since there is extreme and insatiable hunger in polyphagia and these symptoms also define the mentioned condition, it can in simple words be correlated to conditions mentioned in Ayurveda such as –
Pitta vriddhi / prakopa – abnormal increase in pitta
Pitta is responsible for maintenance of heat and digestive activities in the body. When this pitta goes berserk on the upper side of the graph, it causes abnormal rise in heat, intensity of digestive fire and digestion of food in very quick time. This leads to feelings of frequent want of food, unsatiable hunger, food craving, raised appetite and frequent eating of food. This can end up in polyphagia.
Teekshnagni
When the digestive fire is influenced by high pitta, the fire becomes intense and all-consuming in nature. The impact will be as explained in pitta vriddhi which also will lead to manifestation of polyphagia.
Vishamagni
When the digestive fire is influenced and governed by high vata, the fire becomes erratic in nature. It sometimes is intense and sometimes weak. When intense it digests the food very quickly and produces quick and frequent hunger. When weak, its action will be opposite of this.
Bhasmaka
This is also a disease which is caused by very severe pitta. It is an advanced and more aggressive development over teekshnagni. Bhasma means ash. Here, the food is not digested, but is burnt into ash. So, the body is depleted of nutrition and there is an imbalance between demand and supply. The person feels severe and frequent hunger of a severe type in comparison to teekshnagni.
Anashana
Not eating food at all or overtly fasting may lead to malnutrition or inadequate nutrition. This leads to depletion of tissues which would result in imbalance between demand and supply. The body would demand more and frequent fuel in the form of food to compensate for the lost tissues. This manifests in the form of severe and frequent hunger – polyphagia.
Ati Langhana or Apatarpana
Excessive administration of langhana – measures and therapies which would cause excessive lightness in the body or apatarpana – depleting measures will cause similar impact as that of Anashana. Anashana or Upavasa is also included among the ten kinds of langhana.
Dhatu Kshaya
Massive destruction of tissues can be caused by vata increase or any disease like rajayakshma which can cause destruction of tissues. It can also happen due to severe increase in pitta or severe aggravation of both vata and pitta. Vata dries up the tissues while pitta causes burnouts. The combo of aggravated vata and pitta is deadlier, just like a strong breeze spreading a massive fire. Tissues are the support system of the body. Their balance defines endurance and immunity. The tissues are supported by the essence of food we consume, that food which is properly digested by the digestive fire. When tissues are destroyed, there is severe demand for compensation and replacement. This manifests in the form of severe and repeated hunger or crave for food. This is polyphagia.
Medo Roga
It is an extreme condition of fat metabolism gone berserk. This is a syndrome caused by errors of fat metabolism. In this condition, the increased fat causes blocks in almost all the channels of transportation in the body. This causes depletion of nutrition of all the tissues. Only fat tissue is nourished and enriched by the essence of food, at the cost of other tissues. This fat accumulates in the body, channels and tissues and causes medo roga.
Ashtau Nindita
The ‘Ati Sthula’ mentioned in the context of Ashta Nindita i.e. eight categories of despicable persons, which means ‘too fat or too stout’ may be a resultant of polyphagia. Polyphagia in this condition may be a cause or effect.
The concept of agni and its relation to hunger and polyphagia
Hunger, according to Ayurveda, is initiated when the agni i.e. the digestive fire in the stomach gets ignited indicating ‘want of food’ in the form of fuel, once the previously consumed food has been properly digested.
For the digestion of food to happen a perfect balance between the central agni i.e. jathara agni or pachaka agni – gut fire and the other peripheral agnis i.e. Bhuta agnis i.e. elemental fires and dhatu agnis – tissue fires are a must. This is the foundation of an intact and balanced metabolism.
If there is imbalance in the core or peripheral agnis, individually or relatively, the entire metabolism goes haywire and opens the gateways for many metabolic and systemic disorders to happen in future.
When the pachaka agni becomes intense and hyperactive, it also influences the other agnis through a feedback mechanism. With hyperactive central agni, there increases hunger and repeated urge for eating and only this intensifies with time. This is the basic core of understanding the concept of polyphagia.
Ayurveda has not mentioned direct relationship or cause and effect relation between Prameha under the umbrella of which Diabetes Mellitus falls and polyphagia, but has definitely given and accepted the concept of hyperactivity and hypoactivity of agni i.e. imbalances of agni on either side of the graph as being causal for many systemic and metabolic disorders.
A deeper understanding of the concept of prameha, medo roga, diseases occurring due to errors of fat metabolism – medo pradoshaja rogas and diseases caused due to contamination of rasavaha and medovaha srotas will give us a picture of agni imbalances in the backdrop. We also understand the same when we dive deep into the concept of agni and its subtle classification and the functions contributed to agni.
All diseases are said to be caused due to ‘mandagni’, a term which we can consider as imbalances of agni. So, an Ayurveda physician would first try to find out the gross and subtle imbalances in relation to agni in whichever ailment that is placed at his disposal for scrutiny, diagnosis and treatment. The entire foundation of Kaya Chikitsa, the first and elite branch of eightfold Ayurveda lays on the concept of agni and measures involved in balancing the agni firsthand so as to treat many diseases manifesting and troubling the mankind.
Imbalances of digestive fire
The imbalances of digestive fire are mainly of three types. They are –
Mandagni – Here, the digestive fire is influenced by increased kapha. The fire is almost put off and there is hypo-functioning of digestive fire. The digestive activities also slow down and the food is not properly digested or is incompletely digested. Here basically the patient is not eating much food. But on the other hand, if we are speaking about polyphagia associated with diabetes mellitus, which has been correlated with prameha, the concept which has not been explained by Ayurveda directly, all the pramehas have their roots in kapha aggravation, immaterial of the type of kapha.
Teekshnagni – Here the digestive fire is influenced by increased pitta. Here the digestive fire is so severe that it quickly digests the food and hence the person feels hungry often and in quick intervals. Polyphagia may not be present in all kinds or all stages of diabetes mellitus. But if polyphagia is predominant in diabetes mellitus in comparison to other symptoms, then the given condition may be pittaja prameha. Since the core fire – koshtagni or pachaka agni which is in the form of pachaka pitta is intense in this condition, its influence on the tissue fires too will be severe. Since there will be severe tissue burnouts, the body needs to compensate for the loss quickly. So, fuel in the form of food too is required in quick intervals. To indicate that the body gives signals in the form of frequent hunger bouts.
Vishamagni – Here the digestive fire is influenced by increased vata. The digestive fire in this condition is erratic. Sometimes the fire is intense and sometimes weak. Sometimes the digestion capacity is good and sometimes it is bad and so is the digestion of food. This fluctuant nature and behaviour of the agni is found in the polyphagia variants found in people of diabetes mellitus. If the digestion is erratic and the person is thin or is losing weight or tissues and his or her eating habits are also erratic in sync with the varying behaviour of the agni, the given condition may be vataja prameha or madhumeha. These people will have nutritional imbalances and will be trying various methods and degrees of compensating them. The tissues on the verge of damage would demand replacement and in this attempt the person may eat more food, more frequently but the graph is erratic.
The dosha axis and polyphagia
Timely and right type of hunger and proper digestion of food in the stomach is based on the synchronous functioning of pachaka pitta, samana vata and kledaka kapha in the stomach. When any one or more of these doshas are put out of balance, singly or relatively, the digestion activities go awry. Hyperactivity of pachaka pitta or samana vata or both and simultaneous deterioration of kledaka kapha will lead to excessive agni and its activity leading to polyphagia. This will be similar to teekshnagni when pachaka pitta dominates and vishamagni when samana vata dominates the picture.
The dhatu connection & diabetes link
As already discussed at the beginning, tissue loss or destruction can happen due to many causes. Immaterial of cause, tissue loss demands compensation and replacement of the lost tissues. This can be done only by consumption of food. Since there is too much tissue loss in some conditions like rajayakshma, there is severe and frequent demand for food which is presented in the form of severe and repeated hunger. The person craves for more and more food and hence can be correlated to polyphagia.
‘Mahashanam kshiyamanam’ – getting emaciated (loss of weight due to tissue loss) in a severe way in spite of eating large quantities of food, mentioned in the context of incurability of rajayakshma, probably denotes severe form of polyphagia. This is because in this dreadful disease it has been clearly mentioned ‘kshiyante dhatavaha sarve’ i.e. there is decrease or deterioration of all the tissues while they are not being compensated with. In the same context it has been mentioned ‘krichchrena bahu mehantam yakshma hantiha manavam’ i.e. excessive urination with difficulty. This may reflect the explanation of a complicated and incurable type of diabetes. The explanation also gives us a picture of polyphagia related to diabetes explained in some other context.
Ayurveda Management of Polyphagia
Nidana Parivarjana
Following the golden principles of management of any disease / diseases, the patient should be advised to keep away from the etiological factors responsible for aggravation of doshas or diseases responsible for polyphagia. They include foods and activities which increase vata, pitta and meda.
Treatment Principles
The main dosha or disease in the backdrop of polyphagia, as a cause or trigger, should be addressed.
The treatment principles include handling the below mentioned conditions in an effective way –
– Pitta vriddhi or prakopa
– Vata vriddhi or prakopa
– Teekshna agni
– Bhasmaka roga
– Vishama agni
– Dhatu kshaya
– Medo roga
Panchakarma Therapies
If there is high pitta in the gut which is causing polyphagia, virechana will be the best choice. It is also the best in treating medo roga.
When there is vata aggravation – in the colon, the entire body or tissues, Vasti is the ideal choice. Nourishing, tissue building and strengthening enemas should be given when severe aggravation of vata is causing tissue destruction.
External Therapies
Udwarthana or Udwarthana along with Virechana is ideal in sthoulya and medo roga to remove the excessive fat accumulation and also to cleanse the blocks caused by fat in the channels of the body.
Other principles
The below mentioned shall be included in the treatment protocol as and when needed –
– Brimhana – bulk enhancing / promoting
– Santarpana – nourishing
– Balya – strengthening
– Rasayana – medicines and foods which enhance the quality and balanced quantity of all the tissues, mediate and enhance immunity, acts as anti-ageing and rejuvenating agents and as preventive medicine
