by Dr. Prasanna Venkatesh & Dr. Shilpa.S.N.

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 populaces 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.

Ayurveda being life science, global attention is looking towards Ayurveda for its effective management as recent times we often see patients with uncontrolled diabetes even with regular usage of tablets & / insulin. Insulin resistance is another major concern where patients approach Ayurveda.

We shall try to have a bird’s eye view about the modern & Ayurvedic concepts of this disease.

Contents

Modern view –       Introduction

(Diabetes)                  Causes

                                    Types

                                    Signs & symptoms

                                    Complications

Ayurvedic view – Introduction & Pathogenesis

(Prameha)                 Nidana / Causes

                                    Samprapti

                                    Management

Diabetes Mellitus

Introduction
Diabetes mellitus, commonly known as Diabetes (High blood sugar) is one among the metabolic diseases prevalent in recent times. Incidence is more in developed & developing countries. India topped the world with the highest number of people with diabetes mellitus in 2000. In the years to come the situation is going to further worsen. The changing dietary habits including the excessive usage of junk foods, over eating, etc, lack of exercise, stressful & sedentary life style are attributed as causative factors for the increasing incidence of diabetes mellitus.

What causes Diabetes?

Diabetes is result of either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced. It can be simplified under these 3 causes –

• Inefficient production of insulin – Either completely or lesser than the body needs
• Defective production of insulin – Rare / uncommon
• Inability of cells to use insulin properly & efficiently leads to increased sugar levels in the blood.

As a result, there will be impairment in the muscle & fat tissue metabolism, ultimately resulting in insulin resistance.

Types of Diabetes Mellitus

Type 1 DM – caused due to failure to produce enough insulin. It is also called as Insulin – dependent diabetes mellitus (IDDM) or Juvenile diabetes.
Type 2 DM – here cells fail to respond to the insulin properly, develops with insulin resistance. It is also called non – insulin dependent diabetes mellitus (NIDDM) or adult onset diabetes.

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.

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

Prameha in Ayurveda

Introduction
The disease Diabetes Mellitus can be compared with Prameha in Ayurveda. Traditional medical system of India, Ayurveda has given a deep insight about the disease Diabetes.

The word Prameha consist of two Words प्र+मिह

प्र = Increased intensity,

मिह = To pass urine  in excess ;  मिह  the word derived from the root “Mih secane” (profuse)

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.

Pathogenesis of prameha

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 w.r.t 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)  & / or 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).

Nidana

The factors which aggravate Kapha –
Ahara – Madhura, snigda, picchila, sheetala dravya, nava dhanya, anoopa mamsa, guda,
ksheera (A.H.Ni)
Medya & dravanna paana (Su.Ni)
Oudaka mamsa, pishtanna, payasa, krushara, vilepi (Ch.Ni)
Dadhi, mamsa rasa (Ch.Chi)

Vihara – Swapna sukha (irregular sleeping habits) (A.H.Ni)
Divaswapna, avyayama, aalasya (Su.Ni)
Who always indulge in thinking, who does not undergo regular vamana, virechana / any kind of shodhana (Ch.Ni)

The factors which aggravate Pitta
Ahara – Amla , lavana rasa pradhana ahaara, Sura (A.H.Ni)
Dadhi (Ch.Chi)
Vihara – Divaswapna

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

Samprapti

Indulgence in the above said nidanas (causitive factors) lead to disturbance in Kapha primarily, associated with Pitta. (As many of the causative factors, ex: 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.

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,

1. Mootra (Urine)
2. 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) 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, it’s 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.

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 & Vataja Prameha 4 types.

These steps of samprapti can be summarized in the following steps,

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

Note:

1. Sometimes Rasashesha ajeerna leads to increased blood sugar, but it cannot be considered as Prameha as we do not find actual samprapthi / pathogenesis of Prameha.
2. Generally the word Prameha & Madhumeha are used as synonyms but Madhumeha is a type of Vataja Prameha.

Management of Prameha in Ayurveda

The reversal of samprapti will be easy & quicker if diagnosed and treated at the earliest.
The primary importance in the chikitsa of prameha is the management of Kleda.

• As per Ayurvedic guidelines, Panchakarma / Shodana therapies (detox / purificatory procedures) are significant in the management of Prameha as it is a bahudoshaja vyadhi. Here bahudosha means quantitatively the dosha imbalance is high & qualitatively the combination of Kapha & Medas (Bahu abaddha medas) is very difficult to disintegrate due to their similar nature.
• Among Panchakarma, Vamana has been given more importance; it should / may be done twice when a patient comes in Kapha dominant stage. (As per Acharya Charaka).
• Later Virechana might be done as per the need, followed by oral medications.
• Generally Basti is contra – indicated in prameha but in exceptional cases special bastis may be indicated.
  Without panchakarma – symptomatic management is possible but root level correction is not possible as per Ayurveda.

Chikitsa of Prameha also depends on the physical strength of the patient.
Diabetic patients can be classified into two categories,
1) Those who are obese & strong ( sthoola pramehi & balavan)
2) Those who are emaciated & weak (krusha & durbala)
Patients belonging to 1st group are administered Panchakarma (detox procedures).
Patients belonging to 2nd group are given nourishing therapy (brumhana). – maintaining bala & correction of doshas.

As concern to curable or not,
Kaphaja Prameha is curable with difficulty,
Pittaja Prameha can be managed but can’t be cured completely (yapya) &
Vataja prameha is asadhya (incurable).

We in our treatment center Sriranga Ayurveda Chikitsa Mandira, Healthcare unit of Prakruthi Ayurveda Prathishtana, Mysore follow the traditional guidelines of Ayurveda in treating Diabetes mellitus (Prameha).

Authors:

     Dr. Prasanna Venkatesh is the Chief Physician of Sriranga Ayurveda Chikitsa Mandira, Prakruthi Ayurveda Pratistana ®, Mysore

 Dr. Shilpa. S.N. is the Senior Consultant in Sriranga Ayurveda Chikitsa Mandira, Prakruthi Ayurveda Pratistana ®,  Mysore