CHAPTER-6

PIOUS NECTOR OF AYURVEDA

AYURVEDIC VIEW OF PATHOGENESIS OF DIABETES

HOW DIABETES INVADES OUR BODY....

Integrating the theory and modalities of Ayurveda in the management of these disorders may prove to be beneficial. Even though Prameha is a Tridoshaja Vyadhi (a disease involving all three of the psychophysiological principles known as Doshas [i.e., Vata, Pitta, and Kapha]), it is basically a disease with Kapha predominance.

PRAMEHA IN AYURVEDA

According to classical Ayurveda, all Pramehas have the potential to become incurable (Madhumeha) if left untreated. DIABETES MELLITIS in Ayurveda is the chronic state of PRAMEHA when symptoms get worsened; the blockage in kidneys is believed to be the cause of frequent urination observed in Diabetes Mellitus. Pramehas left untreated may lead to deranged development of the bone marrow, body tissues, nutritional materials (fat, proteins, and carbohydrates), and hormones (ojas).

PRAMEHA starts with the derangement of kapha that spreads throughout the body and mixes with fat (Meda) that is similar in physical properties to kapha (mucus). Kapha mixed with fat passes into the urinary system, thereby interfering with normal urine excretion. Vitiated pitta, vata, and other body fluids (malas) may also be involved in this blockade which leads to insulin-dependent DIABETES MELLITIS.

DIABETES MELLITIS (it is called Madhumeha as Urine secreted is thick and sweet) may not be described precisely in Ayurveda, but it points in the direction of the current knowledge we have about the disease with respect to Neurological damage and insulin malfunctioning at the production (degeneration of islets of Langerhans in the pancreas) or at the utilization levels. The involvement of tissues (dushyas) leading to blood vessels, kidney, eye, and nerve damage is also described in Ayurveda as major complications. DM is described not only as a condition of madhumeha (sugar loss in urine), but also as a condition of ojameha (immunity and hormone loss) in Ayurveda for the purpose of treatment.

The kaphaja urinary disorders (pramehas) are curable because the causative dosha and the affected tissues (dushya) have the same properties, thus requiring the same type of therapy.

Although the pittaja urinary disorders are controllable (palliative), the resulting disorder may persist for life because the causative dosha is pitta, but the tissues and waste products (dushya) are different, requiring a different type of therapy.

AYURVEDIC VIEW – (IN CONTEXT WITH TRIDOSHA)

• INTRODUCTION
• CAUSES (NIDANA)
• SYMPTOMS (PURV ROOP, ROOP)
• PATHOGENESIS (SAMPRAPTI) PROGNOSIS (SADHYA / ASADHYATA)
• TREATMENT (UPCHHAR)

INTRODUCTION​

The disease Diabetes Mellitus can be compared with Prameha in Ayurveda. Ayurveda has given a deep insight about the disease Diabetes.

The words Prameha consist of two Words :

प्र + मेह => प्र = Increased intensity, मेह = to pass urine in excess.

प्रमेह = प्रकर्षेण मेहति क्षरति वीर्य्यादिरनेनेति [श.क.द्रु]

• मूत्रदोष, मेह : (Raja nighantu)
• बहुमूत्रता (Hemachandra)

Prameha can be the disease which indicates increased frequency or quantity of urine passed out from the body.

सामान्यं लक्षणं तेषां प्रभुताबिलमूत्रता I

दोषदूष्याविशेषेअपि तत्संयोगविशेषतः II​

मूत्रवर्णादिभेदन भेदो मेहेषु कल्प्यते I​

मूत्र की अधिकता और गंदलापन सभी प्रमेहों का सामान्य लक्षण है I सभी प्रमेहों में दोष और दूष्य के समान रहने पर भी उनके संयोग विशेष के कारण मूत्र के वर्ण गंध, स्पर्श, आदि भेद से प्रमेह के अनेक भेद हो जाते है I

PATHOGENESIS OF PRAMEHA IN AYURVEDA

As per Ayurvedic understanding of the disease, it is said to be a “Kleda pradhana vyadhi”, i.e., where there is a disturbance with the body fluid / water part of the body (Kleda). Then we get a question, what are the components of this kleda, how it gets disturbed ?

Here, Ayurveda says, at the very basic level (Mahabhoota level) Kleda is a material in which Ap(jala) Mahabhoota (water element) is predominant.So with respect to tridoshas, both Kapha & Pitta contribute & regulate kleda.

If Ap bhava of Kapha is disturbed, it may lead to increase of Kleda in the body; otherwise either increase in Ushna (heat) &Drava (jala) bhava, then Pitta is disturbed, henceforth it leads to disturbance of Kleda.

Let us see some of the causative factors for this Kapha & Pitta imbalance (which lead to Prameha).

Various dietary, lifestyle, and psychologic factors are involved in the etiology of Prameha, particularly in relation to disturbances in fat and carbohydrate metabolism. The ancient Ayurvedic knowledge regarding Prameha can be utilized to expand the current understanding of obesity, metabolic syndrome, and diabetes. Prameha is a syndrome described in the ancient Ayurvedic texts that includes clinical conditions involved in obesity, prediabetes, diabetes mellitus, and metabolic syndrome.

Recent rapid advancements in science & technology in every field has contributed immensely for pleasures & materialistic comforts for human race. Unfortunately it also has brought drastic change in the life style, which is a major contributor to the advent of numerous new & life threatening disorders. Globally large populations are prey to these lifestyle disorders such as Diabetes, Renal problems, Immunological problems, Cancer etc., regarded to be incurable.

Global community is looking towards Indian ancient system of life science Ayurveda as an effective alternative to tackle modern day maladies.

Diabetes is one such disease which is affecting mankind globally. As per the WHO (World Health Organization), 90% of diabetic people are Type 2. The common cause is diet as well as lifestyle changes hence its management has also posed several difficulties due to the diet & life style habits of individual thus proving a threat to health resulting in end organ damages and severe complications.

There are 20 subtypes of Prameha due to the interaction of the three Doshas and 10 Dushyas (disturbed functioning of the principles that support the various bodily tissues); several of these subtypes have sweet urine, whereas some of them have different coloration of the urine, highlighting the inflammatory conditions involved in the metabolic syndrome.

With regard to diabetes mellitus,

Sahaja Prameha and Jataj Prameh correlate with type 1 diabetes.

Apathyanimittaja Prameha correlates with type 2 diabetes. Madhumeha is a subtype of Vataja Prameha (Prameha with Vata predominance) that can occur as the terminal stage of type 2 diabetes (in which insulin is required), or as type 1 diabetes beginning in early childhood. The latter is defined as Jataj Pramehi Madhumeh in Charaka Samhita, one of the classical Ayurvedic texts.

NIDANA (REASONS)

आस्यासुखं स्वप्नसुखं दधीनि ग्राम्यौदकानूपरसाः पयांसि |

नवान्नपानं गुडवैकृतं च प्रमेहहेतुः कफकृच्च सर्वम् ||४||

Asyashuka – eating as per one’s will,

SwapnaSukha - Addiction to the pleasure of sedentary habits and sleep

Dadhi - excess intake of curds

Gramya udaka aanupa rasa – soup of meat of domesticated and aquatic animals and animals from marshy land,

Payas - excess intake of milk and its products preparations,

Navanna – freshly harvested grains

Nava pana - freshly prepared alcoholic drinks,

Guda vaikrtam - preparations of jaggery

All Kapha - aggravating factors

THE FACTORS WHICH AGGRAVATE KAPHA

Ahara – Madhura, snigda, picchila, sheetala dravya, nava dhanya, anoopa mamsa, guda,ksheera Medya & dravanna paana Oudaka mamsa, pishtanna, payasa, krushara, vilepi Dadhi, mamsa rasa.

Vihara - Swapna sukha (irregular sleeping habits) Divaswapna, avyayama, aalasya Who always indulge in thinking, which does not undergo regular vamana, virechana / any kind of shodhana

THE FACTORS WHICH AGGRAVATE PITTA

Ahara – Amla, lavana rasa pradhana ahaara, Sura ,Dadhi.

Vihara - Divaswapna

Here we can observe that few factors like dadhi sevana, divaswapna etc aggravate both Kapha & Pitta.

SAMPRAPTI (PATHOGENESIS) :

मेदश्च मांसं च शरीरजं च क्लेदं कफो बस्तिगतं प्रदूष्य |

करोति मेहान् समुदीर्णमुष्णैस्तानेव पित्तं परिदूष्य चापि ||५||

क्षीणेषु दोषेष्ववकृष्य बस्तौ धातून् प्रमेहाननिलः करोति |

दोषो हि बस्तिं समुपेत्य मूत्रं सन्दूष्य मेहाञ्जनयेद्यथास्वम् ||६||

Kapha vitiates Medas (fat tissue), Mamsa (muscle tissue) and Kleda (liquid elements) of the body located in Basti (urinary tract) and causes different types of meha. Similarly, Pitta aggravated by hot things, vitiates those elements and causes different types of Pittaja Prameha. When other 2 Doshas are in a relatively diminished state, the aggravated Vata draws tissue elements, viz, Ojas, Majja and Lasika into the urinary tract and vitiates them to cause the 3rd category of Prameha (Vataja Meha). Different doshas having entered the urinary tract in vitiated conditions give rise to the respective categories of Meha.

Lets us understand better :

(As many of the causative factors, divaswapa (day sleep), dadhi sevana (curds intake) etc. cause imbalance of both Kapha – Pitta simultaneously). As a result, there will be increase in the body fluid / KLEDA.

Ayurveda gives one more unique concept about SROTAS (स्रोतस् – internal channels) inside the body.

It also explains about the causes which creates imbalance in these channels. (स्रोतोदुष्टि निदान).

Signs & symptoms of these imbalance (स्रोतोदुष्टि लक्षण);

Management of these issues (स्रोतोदुष्टि चिकित्सा) etc.

Here the above mentioned causative factors which disturb Kapha & Pitta are also specific causes to disturb Medovaha srotas / internal channels of the fatty tissue. Hence the natural tendency of doshas is towards medo dhatu.

Doshas and tissues that get affected by Prameha :

कफः सपित्तः पवनश्च दोषा मेदोऽस्रशुक्राम्बुवसालसीकाः |

मज्जा रसौजः पिशितं च दूष्याः प्रमेहिणां, विंशतिरेव मेहाः ||८||

Doshas like Kapha, Pitta and Vayu and Dusyas like Medas, Raka, Shukra Ambu (body fluid), Vasa (fat), Lasika (Lymph) majja (Marrow), Rasa (end product of digestion), Ojas (Immunity factor) and Mamsa (muscle) are responsible for the causation of Prameha which is of 20 types.

So, here we can clearly understand that,

Because of indulgence in the causative factors, Kapha & Pitta get disturbed at first, lead to imbalance of Kleda,

These imbalanced doshas move towards Medo dhatu (fatty tissue), affect fat metabolism, lead to further imbalance of Kleda.

Usually our body has its own mechanism to manage Kleda,

Mootra (Urine)

Sweda (Sweat)

मूत्रस्य क्लेदवाहनम् , स्वेदस्य क्लेद विधृतिः ।

Elimination of excess fluid/moisture is through urine & retention is through sweat. But in diabetic patients due to their sedentary life style & wrong eating habits there will be no production of sweat. So, all kleda (fluid) moves towards urinary system & there will be increased production of urine leading to excess urination, gradually leading to Prameha.

At this level they show few signs & symptoms which are called as POORVA-ROOPA (premonitory symptoms).

स्वेदोऽङ्गगन्धः शिथिलाङ्गता च शय्यासन स्वप्नसुखे रतिश्च |

हृन्नेत्रजिह्वाश्रवणोपदेहो घनाङ्गता केशनखातिवृद्धिः ||१३||

शीतप्रियत्वं गलतालुशोषो माधुर्यमास्ये करपाददाहः |

भविष्यतो मेहगदस्य रूपं मूत्रेऽभिधावन्ति पिपीलिकाश्च ||१४||

Premonitory Signs and Symptoms :

Sweda – Sweating

Anga gandha – bad body odour

Shithilangata – flabbiness of body

Shayyasana – liking for constantly lying on the bed, feeling sedentary

Rati – sleeping and leading an easy life

Hrut Upadeha – a feeling as if the heart region is covered with some paste / coating

Netra, Jihva, Shravana Srava – exudation of excreta from eyes, tongue and ears

Ghana angata – bulkiness of the body

Kesha, kha, nakha ati vriddhi- excessive growth of hair and nails

Sheeta priyata – liking for cold things

Gala, talu shosha – dryness of the throat and palate

Madhura aasya – sweet taste in the mouth

Kara pada daha – burning sensation in hands and legs and

Mutre pipilika – swarming of ants on the urine

Like accumulation of impurities over the teeth (even after cleaning), burning palms & soles etc.If the condition is not treated properly at this stage, bahu, abaddha medas (fatty tissue with more quantity & which has lost its firmness) will be the result. Gradually this excess & improper Kleda spreads to deeper tissues, affects all the body tissues (mamsa, majja, ojus & lasika) except asthi dhatu & leads to Dhatu shaithilya (deterioration of body tissues) just like excess watering will not nourish but destroys paddy plant.

As per our analysis, at deep most level kleda may affect in either of these 2 ways,

1. If Kleda is affected by Pitta, its teekshatva (sharpness) will be more & will be having more penetrating action. So intra-cellular kleda (fluid level) will be more.

2. If Kleda is affected by Kapha, especially picchilata (sliminess) will be more & will be having more covering action. So inter-cellular kleda (fluid level) will be more.

If Kapha aggravating factors are more, it leads to Kaphaja Prameha, which is most common. Similarly Pitta & Vata aggravating factors lead to their respective type of Prameha.

PRAMEHA SIGNS AND SYMPTOMS :

जलोपमं चेक्षुरसोपमं वा घनं घनं चोपरि विप्रसन्नम् |

शुक्लं सशुक्रं शिशिरं शनैर्वा लालेव वा वालुकया युतं वा ||९||

विद्यात् प्रमेहान् कफजान् दशैतान् क्षारोपमं कालमथापि नीलम् |

हारिद्र माञ्जिष्ठमथापि रक्तमेतान् प्रमेहान् षडुशन्ति पित्तात् ||१०||

मज्जौजसा वा वसयाऽन्वितं वा लसीकया वा सततं विबद्धम् |

चतुर्विधं मूत्रयतीह वाताच्छेषेषु धातुष्वपकर्षितेषु ||११||

Generally Ayurvedic diagnosis of Prameha depends on the urine examination of the patient. Based on the nature of urine.

Kaphaja Prameha is of 10 types, Pittaja Prameha 6 types and Vataja Prameha 4 types.

Features of Kaphaja Prameha :

1. Udak meha : turbid (avila) and slimy (picchila).

2. Ikshu meha : The urine is very sweet and similar to sugar cane juice (ikshurasavat madhura). It is slimy and turbid in nature.

3. Sandra meha : The urine is dense (sandra) and it precipitates when allowed to settle down when kept overnight (paryushita sandra).

4. Sura meha : In this condition, the urine appears similar to arrack (sura). The supernatant part appears clear and the lower part will be dense and thick.

5. Pishta meha : In this condition, the person feels horripilation on urination and the urine is white (sita) like the paste of the fine grain flour (pishtavat).

6. Shukra meha : The urine appears like semen (shukrabha) or mixed with semen (shukramishra).

7. Sikatra meha : In this condition, the urinary gravels appearing like sand particles are expelled out.

8. Sheeta meha : Excess amount of urination which is sweet (madhura) and cold (sheeta) in nature is found in this condition.

9. Shanai meha : Little by little, repeated, slow urination is complained in this disease.

10. Lala meha : In lala meha, the urine appears similar to saliva (lalatantrayuta) and is slimy (picchila) in nature.

Features of Pittaja prameha :

1. Kshara meha : Here, the urine has the odor, color, taste and texture of alkaline solution (ksharatoyavat).

2. Kala meha : Large quantity of black colored urine, just like the burnt coal (masinibha) is found in Kalameha.

3. Neela meha : The urine which is blue in color similar to the feather if Blue jay bird (chashapakshanibha) is complained in this condition.

4. Rakta meha : Here, urine will have the color and smell of blood and is salty in taste.

5. Manjishta meha : Manjishta (Rubia cordifolia) is a drug which gives dark red colored decoction or fresh juice. Here, the urine will have bad smell (visra gandha) and the urine appears similar to the decoction of manjishta.

6. Haridra meha : In this particular kind of prameha, the urine will be pungent (katu), has dark yellow color similar to turmeric (haridranibha) and associated with burning sensation.

Features of Vatajaprameha :

1. Vasa meha : In vasa meha, the person passes the urine repeatedly which is mixed with fatty oil and often appears turbid and sticky similar to fat.

2. Majja meha : Here, urine will have the appearance similar to marrow and it is excreted frequently.

3. Hasti meha : In this condition of Hastimeha, urine is often excreted like an intoxicated elephant (mattahastiriva ajasrammutra) without force. In few of the cases lymph with clots are also found.

4. Madhu meha : Acharya Charaka explained that the roughness of aggravated vatadosha transforms the sweet taste (of ojas) into astringent taste and expels out along the urine. Thus, casuses Madhumeha. Urine with astringent mixed sweet taste, pale color and unctuousness are the features of this condition.

Acharya Vagbhata opines that all pramehas if neglected or not treated properly, ultimately they reach the terminal stage -madhumeha.

Signs & Symptoms

1. Thrishna (thirst).

2. Atisara (diarrhea)

3. Jwara (fever)

4. Daha (burning)

5. Dourbalya (debility)

6. Aruchi (anorexia).

7. Avipaka (indigestion).

8. Pootimamsa (bad odor).

9. Pramehapidaka (diabetic carbuncles).

10. Alaji (cellulitis).

11. Vidradhi (abscess).

12. Hrit shola (cardiac pain).

13. Makshikopasarpana (neuritis) etc.

Signs & Symptoms

• Polyuria – increased output of urine due to presence of high amounts of glucose in the urine.
• Polydypsia – increased urine output causes dehydration leading to thirst & hence increased water consumption.
• Polyphagia – excess eating due to increased appetite.
• Other symptoms – Weight loss, fatigue, non healing wounds etc.

Decrease of other Dhatus or Tissue elements is responsible for the causation of the above mentioned 4 varieties of Vataja Prameha.

वर्णं रसं स्पर्शमथापि गन्धं यथास्वदोषं भजते प्रमेहः |

श्यावारुणो वातकृतः सशूलो मज्जादिसाद्गुण्यमुपैत्यसाध्यः ||१२||

Vata types of Prameha are characterized by :

Shyava aruna varna mutra- greyish – red discoloration of urine.

Shoola – pain

Majjadi sadgunya – attributes of Majja etc.

These varieties are incurable.

These steps of samprapti (prognosis of DIABETES) can be summarized in the following steps,

Nidanas (causative factors) > Dosha dushti (aggravation of doshas) > Reaches medas (natural tendency) > Meda vilayana (liquification of fatty tissue) due to Pitta > Kleda vruddhi (increased fluid level in the body) > Kleda comes to basti (urinary system) – creates load > gradually involves all dhatus (Mamsa, Majja etc.) > leads to Dhatu shaithilya > Involvement of other doshas – leads to various types of Prameha.

Sometimes Rasashesha ajeerna (Due to indigestion also sugar levels are raised in blood, but it does not mean it will be DIABETES, as other symptoms are missing and it gets treated with the proper Digestion ) leads to increased blood sugar, but it cannot be considered as Prameha.

CLINICAL COURSE AND PROGNOSIS (SADHYATA)

साध्याः कफोत्था दश, पित्तजाः षट् याप्या, न साध्यः पवनाच्चतुष्कः |

समक्रियत्वाद्विषमक्रियत्वान्महात्ययत्वाच्च यथाक्रमं ते ||७||

Recent studies have observed a relationship between the body constitution and relative amounts of hyperglycemia and insulinemia consistent with the Ayurvedic prognosis.

Kapha constitution patients showed the highest level of insulinemia and the lowest levels of fasting blood sugar (FBS) and postprandial blood sugar (PPBS). Vata patients showed the lowest level of insulinemia and the highest levels of FBS and PPBS. Pitta patients were in the middle.

In Ayurveda the major complications of kaphaja urinary disorders are believed to be poor digestion, anorexia, vomiting, drowsiness, and coughing. Pittaja urinary disorder patients tend to exhibit a pricking pain in the urinary bladder, penis, and scrotum, as well as fever, burning sensations, thirst, sourness of the throat, fainting, and loose bowel movements. Vata urinary disorders (diabetes) patients often experience tremors, pain in the cardiac region, abdominal tenderness, insomnia, and dryness of the mouth. Vataja urinary disorders are considered incurable because tissues (dhatus) and hormones (ojas) undergo deterioration (DM) The major complications of vata DM most commonly include ulcers (eruptions) over joints, muscles, skin, blood vessels, as well as damage to the kidney and the retina.

सपूर्वरूपाः कफपित्तमेहाः क्रमेण ये वातकृताश्च मेहाः |

साध्या न ते, पित्तकृतास्तु याप्याः, साध्यास्तु मेदो यदि न प्रदुष्टम् ||५६||

Kaphaja and Paittika types of prameha, if preceded by their premonitory signs symptoms, are incurable. Similarly, Vatika Prameha,where Vayu is aggravated right from the beginning, is incurable. Paittika types of Prameha are generally, palliable. But they are curable if Medas (adipose tissue) is not vitiated.

COMPLICATIONS

If left untreated or improperly treated, gradually it leads to serious complications like

• Cardiac (heart) problems like – cardio-vascular disease (block etc.), ischemic heart disease, myocardial infarction (heart attack) etc.
• Nerve damage (neuropathy).
• Acute / chronic kidney disease (nephropathy).
• Eye damage (retinopathy).
• Keto-acidosis .
  
  • When anyone suffers from any type of metabolic disorder like Diabetes, Thyroid or any Neuropathic disorder, it leads to dryness in the body (According to Ayurveda vat Dosh increases in body).
  • The dryness of the body leads to the shrinkage and sagging of muscles of the body, affecting the nervous and blood supply to the extremities.
  • Feet are the weight bearing organ of the body and wear and tear is more important than any other part of body, muscles of the feet act as cushion and shield our bones from surface, when we have any problem muscles become weak and thin leading to pain during walking .Nerves and vessels of the feet also get affected leading to poor supply of blood and ceasing sensations in feet.
  • It causes numbness of the feet, so when there is small cut or wound or any sore and when it goes unnoticed it leads to gangrene formation.

LINE OF TREATMENT: PRAMEHA CHIKITSA SUTRA –

स्थूलः प्रमेही बलवानिहैकः कृशस्तथैकः परिदुर्बलश्च |

सम्बृंहणं तत्र कृशस्य कार्यं संशोधनं दोषबलाधिकस्य ||१५||

स्निग्धस्य योगा विविधाः प्रयोज्याः कल्पोपदिष्टा मलशोधनाय |

ऊर्ध्वं तथाऽधश्च मलेऽपनीते मेहेषु सन्तर्पणमेव कार्यम् ||१६||

गुल्मः क्षयो मेहनबस्तिशूलं मूत्रग्रहश्चाप्यपतर्पणेन |

प्रमेहिणः स्युः, परितर्पणानि कार्याणि तस्य प्रसमीक्ष्य वह्निम् ||१७||

Patients suffering from Prameha can be classified into 2 categories viz,

1) Sthula Pramehi – Those who are obese and strong. They are given Shodhana (cleansing, purification treatment).

2) Krusha Pramehi – Those that is emaciated and weak. They are given nourishing treatment – Brumhana therapy (Read more about Brumhana treatment).

In both the above cases, patient is administered Snehana – oleation treatment. Then, Vamana, Virechana recipes, described in KalpaSthana are administered. After Dosha is eliminated, the patient is given Santarpana or nourishing therapy because Apatarpana (fasting) therapy in this condition may produce.

If the patient of Prameha who needs Shodhana or elimination therapy is not eligible for it, he is given Shamana treatment (with oral medicines).

PATHYA FOR PRAMEHA :

संशोधनं नार्हति यः प्रमेही तस्य क्रिया संशमनी प्रयोज्या |

मन्थाः कषाया यवचूर्णलेहाः प्रमेहशान्त्यै लघवश्च भक्ष्याः ||१८||

ये विष्किरा ये प्रतुदा विहङ्गास्तेषां रसैर्जाङ्गलजैर्मनोज्ञैः |

यवौदनं रूक्षमथापि वाट्यमद्यात् ससक्तूनपि चाप्यपूपान् ||१९||

मुद्गादियूषैरथ तिक्तशाकैः पुराणशाल्योदनमाददीत |

दन्तीङ्गुदीतैलयुतं प्रमेही तथाऽतसीसर्षपतैलयुक्तम् ||२०||

सषष्टिकं स्यात्तृणधान्यमन्नं यवप्रधानस्तु भवेत् प्रमेही |

The patient suffering from Prameha is given the following food :

Mantha (flour of different types of corn mixed with water), Kashaya (herbal decoctions), barley powder, Avaleha prepared of barely and such other light-to-digest eatables.Mamsarasa prepared from Vishkira, Pratuda and Vihanga such Jangala animals.Yavagudana (cooked barley) without adding any dry articles, Vatya (barley porridge) Saktu (roasted corn flour) and Apupa (Pan- cakes) mixed with the meat- soup of gallinaceous (Vishkira) and pecker birds (Pratuda) and animals inhabiting arid land (Jangala);Purana Shali – old rice cooked and mixed with the soup of green gram etc. and preparations of bitter vegetables .Cooked Shashtika rice and Truna Dhanyas mixed with oil of Danti, Ingudi, Alasi and Sarshapa.

Importance of Barley :

Barley should constitute the principal ingredient of food of the patient suffering from Prameha.The patient suffering from Kaphaja Prameha should take eatables prepared of mixed with honey.Barley soaked in Triphala Kashaya (TRIPHALA CAPSULES) (TRIPHALA CHURAN) and is kept overnight. It is mixed with honey. It is a nourishing (Tarpana) diet.It is taken by the patient suffering from Prameha regularly to overcome the disease.

Barley is soaked separately with each of the decoctions prescribed for the treatment of Kaphaja Prameha and taken by the Patient in form of Saktu (Roasted flour), Apupa (pan-cake), Dhana (fried barely) and other types of eatables along with jaggery.

SPECIFIC THERAPIES

संशोधनोल्लेखनलङ्घनानि काले प्रयुक्तानि कफप्रमेहान् |

जयन्ति पित्तप्रभवान् विरेकः सन्तर्पणः संशमनो विधिश्च ||२५||

Purification therapies including Vamana and Langhana – fasting therapies, administered at appropriate time, cure Kaphaja types of Prameha. Similarly, Pittaja Pramehas are overcome by Virechana, Santarpana (nourishing therapy) and Shamana – alleviation therapies. Medicated oils and medicated ghee are prepared by cooking with these decoctions is administered to patients sufferings from Vatika Prameha and Kapha, and the aggravated Vata in these patients gets alleviated by the unctuous ingredients (viz, oil and ghee) included in these recipes (Immunorize Oil, Flax Seed Oil, Almomd Oil, Cow Ghrit, Brahmi Ghrit, Jatyadi Ghrit, Trifla Ghrit ).

If Vata is secondarily aggravated along with Kapha or Pitta, then the patient is administered medicated oil or medicated ghee.

If Vata is associated with Kapha, medicated oil is prepared by boiling oil with the decoction of herbs which alleviate Kapha. <,p>

For Vata, associated with Pitta, medicated ghee is prepared by cooking ghee with the decoction of herbs which alleviate Pitta.

EXERCISE AND OTHER REGIMENS :

व्यायामयोगैर्विविधैः प्रगाढैरुद्वर्तनैः स्नानजलावसेकैः |

सेव्यत्वगेलागुरुचन्दनाद्यैर्विलेपनैश्चाशु न सन्ति मेहाः ||५०||

Pramehas get immediately cured by different types of strenuous exercise, unction, bath, sprinkling of water over the body of Sevya (Usheera), Tvak (Cinnamon) , Ela (cardamom), Aguru, Chandana (Sandalwood) We have prepared everything for your ready use. (PURELEEN POWDER : made up from all these)

APATARPANA – DEPLETION THERAPY

Aggravated Kleda (Sticky or liquid elements in the body), Medas (fat tissue) and Kapha are responsible for the causation of Prameha.

Keeping this in view, the physician, in the beginning, should administer depletion therapies to patients suffering from Kaphaja and Patittika types of Prameha.

Prohibitions

यैर्हेतुभिर्ये प्रभवन्ति मेहास्तेषु प्रमेहेषु न ते निषेव्याः |

हेतोरसेवा विहिता यथैव जातस्य रोगस्य भवेच्चिकित्सा ||५३||

Factors responsible for the causation of different types of Prameha is avoided even after these Pramehas are manifested.

For the prevention of the occurrence of a disease different etiological factors are described to be avoided. These very causative factors are also required to be avoided during the treatment of that particular disease (even after its manifestation).

DIFFERENTIAL DIAGNOSIS

हारिद्रवर्णं रुधिरं च मूत्रं विना प्रमेहस्य हि पूर्वरूपैः |

यो मूत्रयेत्तं न वदेत् प्रमेहं रक्तस्य पित्तस्य हि स प्रकोपः ||५४||

If the color of the urine is yellow or if blood is excreted through the urine without the prior manifestation of premonitory signs and symptoms of Prameha, such a person should on the other hand be diagnosed as a case of Rakta- Pitta (a disease characterized by bleeding from different parts of the body.).

HEREDITARY DIABETES

जातः प्रमेही मधुमेहिनो वा न साध्य उक्तः स हि बीजदोषात् |

ये चापि केचित् कुलजा विकारा भवन्ति तांश्च प्रवदन्त्यसाध्यान् ||५७||

Patients who are diabetic right from the time of birth (congenital) and those who are born of diabetic parent’s genes.

Similarly, other hereditary (Kulaja= familial) ailments are to be considered as incurable. It is all about the DIABETES MELLITIS AS IN CHARAK SAMHITA.

You can also read the article MANAGEMENT OF DIABETES ACCORDING TO AYURVEDA.

Stay healthy stay happy

Dr. Inderjit Kaur

Astro Ayurveda

+91 - 92167 77272

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