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
• 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||