Ayurvedic System of Medicine clearly defines this disease and its line of treatment. Diabetes Mellitus is known to Indians from the Vedic period as Asrava (Prameha). Diabetes is known as Madhumeha in Ayurveda.
According to Ayurveda, Prameha is classified into 4 major types, again subdivided into 21 divisions.
1. Kapha type (again divided into 10 types)
2. Pitta type (again divided into 6 types)
3. Vata type (divided into 4 types)
4. Juvenile diabetes for children (for unhealthy practices of parents and/or due to the sins of past-birth).
This study evaluates the efficacy of Classical and Traditional Ayurvedic line of treatment in the above different Diabetes types.
Madhumeha:-
Charak has included “Madhumeha” under vataja type of prameha.
Acharya Sushrut has used the term kshaudra to donate the same. In fact, Meha, Madhu & kshaudra are synonyms of Honey.
Ashtang Sangrah has defined “Madhumeha” as the disease where in the patient passes urine with sugar, which possesses of mainly madhura rasa along with kasaya rasa as Anurasa.
Vagbhatta has defined in different ways. “Madhumeha can be differentiated from Ikshu & Sheeta Meha on the basis of Hyperlipidaemia & Glucosuria”.
Madhumeha can be equated with modern Diabetes Mellitus, a combination of Greek & Latin term DIA- through + BAINEIN TO + MELLITUS- sweetened with Honey
Diabetes in the Greek word signified “Siphon”.
Ayurvedic Management of Diabetes Mellitus:-
Introduction:-
Madhumeha which has been correlated with Diabetes Mellitus has become a global problem in spite of advances in modern science. India has been projected by WHO as the country with the fastest-growing population of Diabetic patients. It is estimated that between 1995 – 2025 diabetic patients in India will increase by 195%. It is maharoga (major disease) because it affects the most part of the body and every cell of the human physiology. The ancient Indian physicians described not only the sweetness of urine as one of the major symptoms but also the relationship of the disease with disturbance of the 5 sheaths of the body – annamaya kosha{Food sheath}, pranamaya kosha{Energy sheath}, manomaya kosha{Mind Sheath}, vijnana maya kosha{Intalectual Sheath} and anandamaya kosha{Bliss Sheath}. Other classical texts also describes prameha. The word prameha derived from the root mih sechane meaning watering that means a dilution of everything in the body not only urine).
Prevailing Diabetes Mellitus:-
Aim of treatment,
Relief of “Hyperglycaemic symptoms”.
Correction of “Hyperglycaemic, ketonuria, & Hyperlipidemia ”.
Establishment & maintenance of desirable body weight.
Avoidness of acute complications.
To obtain the best possible control on DM & therefore prevent delay the onset of long-term complications.
Line of treatment:-
1) Diet
2) Exercise
3) Drug (a) Oral Hyperglycaemic agents,
(b) Insulin
Etiology:-
The main causes of Prameha (diabetes) are lack of exercise and improper food habits and food intake which imbalance of ushna, snigdha and guru properties of RP for example, fish, curd. Foods that increase kapha, medas and mootra are the etiological factors for prameha.
Classification:-
For the management of this disease – prameha can be listed in two categories:
1) Apatarpana utaja prameha describing the lean diabetic and
2) Santarpana utaja prameha relating the obese diabetic.
Etiological classification of diabetic patients:-
1) According to Acharya Sushrut:- (Shu. Chi. 11/3.)
a) Sahaja prameha (congenital) - Hereditary
b) Apatyanimittaja prameha (due to overeating and poor habits) – Acquired.
2) The similar classification can be found in Bhela Samhita:-
1) Prakriti Prabhaavam
2) Narasya Swakritam
Constitutional classification:-
1) According to Charaka:- (Cha. Chi. 6/15.)
a) Sthula – Balvan(Obese)
b) Krista – Durbala(Asthenic)
Prognostic classification:-
Prameha can be classified into three groups based on Prognosis. (Cha. Chi. 6/56 & Cha. Chi. 6/7.)
1. Sadhya - curable
2. Yapya - Palliable
3. Asadhya – Incurable
Sadhya:- Patients who have been diagnosed very early in the onset of prameha Those who are sthoola[ obese] and the origin of their disease is in apathyaja [poor living habbits]
Yapya: Patients are categorized as having Pittaja prameha & certain types of kaphaja prameha. It is controllable with particular treatment.
Asadhya: It is the incurable prameha & inherited diabetes. Sahaja patients suffering from this variety are Krisha {lean}.
Dosha classification:-
Though prameha is a tridoshaja vyadhi, the relative predominance of any one dosha and dooshya enables Vataja, Pitaja and Kaphaja pramehas. These have further been classified into twenty sub-categories in all the three classics of Ayurveda. Kaphaja and Pittaja prameha have been sub-classified into ten types and six types respectively. These sixteen types have the physical characteristics of urine that are color, density, and volume depending upon the different gunas of Kapha and Pitta. Vataja prameha has been sub-classified into four types depending upon dhatu being excreted through urine.
The above 20 types are classified on the basis of color and physical characteristics of urine. They can also be correlated with systemic urological and nephrological conditions. The above theory is well described by all acharyas by general prodromal symptoms for all types of pramehas in which the sweetness of urine is a common and important symptom. In our practice, they are classified prameha according to dosha predominance like-
Kapahja,
Pittaja,
Vataja,
Kapha-pittaja,
Kapha-vataja,
Pitta-vataja, and
Vata-pitta-kaphaja.
In these types sannipaata, kevala vataja, and some stages of Kapha-Vataja and Pitta-Pataja can be considered as IDDM, and others are considered as NIDDM.
Poorva Roopa:-
Prodromal Symptoms of prameha have been explained in detail by all the acharyas, especially in Brihatrayies.
They are as follows-
Sweda Produced sweating
Angagandham Foul smell of the body
Anga shidhilatwam Looseness the body
Sayyasna swapnasukhabhishangitwam Feeling of lethargy
Hridayopadeham Feeling of something coated or heaviness of Hridaya
Netropadeham Feeling of something coated on eyes
Jhwopadeham Sensation of a coated tongue
Shravanopadeham Feeling of coating on ears
Anga ghanatwam Heaviness of body parts
Keshathivridhi Excessive growth of hairs
Nakhathivridhi Excessive growth of Nails
Sheet priyatwam Affinity towards cold
Gala shosham Dryness of throat
Thalu shosham Dryness of palate
Asya madhuryam Sweet taste in the mouth
Karadaham Burning sensation of palms
Pada daham Burning sensation of soles
Mootra madhuryam Sweetness of urine
General Features:-
The characteristic features of all types of prameha are PRABHOOTA and AAVILA MOOTRATHA & MEDO DUSHTI LAKSHANAS - {excessive urination & turbidity in urine and symptoms of vitiated medodhatu.
Prameha upadravas {Complications of prameha}:-
Doshas are involved in pathogenesis of the disease. This may further complicate the problem and must be considered in the management of the original disease, which is called upadrava. An individual suffering from prameha usually seeks to doctor’s help when the complications have developed. Fatigue, excessive thirst, and excessive urination are some of the symptoms for which the diseased person approaches physicians. Acharya Sushruta has described prameha complications according to dosha predominance. Briha Thrayees have described prameha pidaka as a major complication of prameha. Acharya Sushruta has mentioned “Malabandhata” (constipation) as a commonly observed complication as the body of the diseased person is loaded with media hence they do not respond to common purgatives in usual doses. Modern Physiological theories attribute this complication to the involvement of the autonomous nervous system.
The following symptoms under each category of kaphaja, pittaja, and vataja describe the dominant element in each diabetic patient. Doshas which are involved in the pathogenesis of the disease may further complicate the problem and must be critically considered in the management of the original disease. This element in the treatment is called apadravya. In most cases, it is only after the complication have developed, individuals suffering from prameha seek physician's advise.
Acharya Sushruta noted that the Dosha predominance is a primary factor in prameha complication.
Acharya Sushruta documents that ‘malabandhata’(constipation) is a complication of this disease because the individual has a concentration of media. The average doses of laxatives are not effective in these cases.
Brihatrayees (Acharya Sushruta is one of the Brihatrayee writers) have described prameha as pidika (diabetic carbuncle) as a major complication of prameha.
Kaphaja-:
Avipakam – indigestion
Aruchi - Loss of appetite
Chardi - Vomiting tendency
Athinidra - Excessive sleep
Kasam - Cough
Peenasam - Cold with running nose
Pittaja-:
Vastimehanyotoda - Pain in Bladder & urinary path
Mushkavataranam - Pain in testes
Jwara - Fever
Daham - Burning sensation
Trishna - Thirst
Amlika - Acidity
Moorcha - Giddiness
Vitbhedanam - Loose Motion
Hridayashoola - Pain in the heart region, & Nidranasam - Loss of sleep
Vataja-:
Udavartam Upward movement of vata.
Kambam Tremor
Hridgraham Gripping pain in the chest region
Lolata Affinity
Soolam Pain
Anidratha Insomnia
Sosha Wasting
Kasam Cough
Swasam Difficulty to breath
Badhapureeshathwa Constipation
Involvement of the OJUS in Prameha:-
Ojus is the essence of life, an extract of the seven dhatus {Elements} represented as bala {strength} of the body. The ojus in a healthy person determines the physical, Psychic, sensory-motor functions of the body. The biochemical composition of the body which is reddish, white, slightly yellowish in color residing in the heart and other vital organs of the body. If ojus is disturbed, degeneration will be fast and result in a decreased life span. In prameha the ojus (life essence is expunged from the body through all navadwara especially through urine & sweat).
Imbalances of Ojus in Prameha:-
Through obstruction in blood vessels {srothorodha}
Degeneration of the body components is dhatu kshaya this can cause both cardiac & nervous system disorders.all this is ojakshaya meaning an imbalance in Ojus.
Management of Prameha:-
According to Ayurveda, the line of treatment of prameha is strictly on the individual's constitution. A special case sheet to analyze diabetes is developed as follows.
The Prakriti of the patient
Dosha predominance of disease
Dooshya vitiation
Obstruction in srotus
Manasika Prakriti
Ahara & Vihara
Hereditary factors etc...
This case sheet gives the profile of the patient & the pathology of the disease in accordance based on classical diagnostic skills in accordance with the classical way of diagnosis. After grouping the patient into different Prakriti, we were able to fix the line of treatment according to the types of the disease.
In general Type 1 Diabetes Mellitus {Vataja prameha} Patients are advised to have Bhrimhana medication & diet which increases dhatu in the body.
Line of treatment:-
In Type 2 Diabetes, an obese diabetic patient with optimal body strength having an intense increase of doshas, Purification of the body is advocated This is dependent on dosha predominance {Kaphaja are advised to have emetics, Pittaja is advised to have purgation}.
1) Snehanam { prescription of oils internally & externally
2) Sodhana {Purification therapy under three catagory}
a. Vamanam,
b. Virechanam,
c. Vasti (This process is the application of medicine through the anal route. This is indicated only in a specific condition.
3) Samanam
4) Pathya – Apathyas
5) Vyayamam (exercises)
In strong prameha patients, but with increased doshas, sodhana chikilsa is prescribed.
Purification therapies are the foremost treatment in this condition. Snehana karma should be done before giving sodhana chikilsa. Generally, swedana is contraindicated in Prameha as swetati pravrity (produced sweating) is one of the main symptoms of prameha. Moreover swedana induces kleda which is a causative factor for this disease. Different snehanas(oliations) are advised in different stages of prameha.
In our classical texts, there are prescriptions of medicated ghee and oils (dhanwantaram ghreetam, trikandakati ghreetam are some of them). For this process, Nagarjuna pharmacy has developed 3 special products that can be administered in different dosha conditions.
– Arjuna Sarshapa for Kaphaja types;
– Arjuna Ghreetam for pitta type and
– Arjuna Thailam for Vata type.
After snehana, one should undergo virchanam or Vamana or both. This is determined by the predominant doshas. This can be done by classical shodhana oushadh. After shodhana chikilsa, shamana chikitsa is advised. The drug of choice must be both dosha shamana and roga shamana. Nagarjuna has developed some effective combination of medicines for different doshas Type of Prameha Drug of choice (name of kashayam)
Kapha
Pitta
Vata
Bhadrashree Kashyam
Chavyadi Kashayam
Chathusaram Kashayam
Thrijathakam Kashayam
Khadirathi Kashayam
Musthaabhayadi Kashayam
In hypercholesterolemic conditions, Daruharidradi choornam is found effective. In neuropathy conditions Elagulgulu choornam and In dhatukshaya condition, Silajatu kalpam is advised for better results. With this classical line of treatment, we are able to withdraw modern hypoglycemic medicines gradually. Snehana and shodhana must be repeated in a definite interval; depending upon the condition of the disease. The drastic disease of diabetes can be controlled by giving comprehensive attention to 3 aspects. They are-
(1) Ahara (Diet)
(2) Vihara ( Exercise)
(3) Aushadha (medicine)
Ayurvedic Approach to diabetes:-
A protocol according to the classical line of treatments is as follows.
1. Snehana
2. Shodhana
3. Shamana with proper ahara & vihara
Diagnosis:-
When diabetes is suspected, single fasting blood glucose estimation(Venous blood) should be done. If the value is below 80mg/DL. the patient is called Hypoglycaemic. If an excess of 120mg/DL will confirm the diagnosis of Diabetes Mellitus, called Hyperglycaemic.
If the value is between 80-120mg/DL then an Oral Glucose Tolerance Test(OGTT) or, fasting & 2hrs post glucose estimation from blood 0should be done. Following the above test, If fasting blood glucose level in less than 100mg/DL and past glucose level is less than 20% mg/DL then Diabetes Mellitus is ruled out.
The respective value between 100-120mg/DL & that between 120-180mg/DL indicate Impaired Glucose Tolerance(IGT). If the value is more than 180mg/DL respectively then the Diagnosis of Diabetes Mellitus is conformed.
In normal individuals, glycated Hb is less than 80%, In the case of a person with impaired tolerance, It is less/equal to 80% & in the case of Diabetes, it is more than 80%.
Treatment schedule
First stage: All patients should be given, snehana for 5-10 days. The medicines should be used
– Arjuna Thaila
– Arjuna ghreeta &
– ArjunaSarshapa
The dose varies from 25 to 50 milliliters every day at bedtime.
Second stage: Virechana should be done in all cases with various virechana oushadh depending on the condition.
Third stage: Samana oushad like kashaya should prescribed for two weeks powders and liquids should be also given better results.
All medicines were specially made for these specific populations indicated in different Samhitas.
Formulation use in Diabetes: Under the proper guidance following suitable formulations can be taken to subside the disease:-
Chadraprabha vati,
Indravati,
Setu rasa,
Kasturi modak,
Meha keshari,
Yogeshwar rasa,
Aanand bhairav-rasa,
Ashtavarga,
Panchatikta varga,
Varunadi kwath,
Nimbadi churna,
Triphalaghreeta,
Bala chaturbhadrika churna
Disclaimer: All the above are compiled by Dr. Lovekush Singh (Ayurveda Specialist, Healthy lifestyle Advisor, Clinical Pharmaceutical Research Specialist, Clinical SAS Specialist, Hospital, Healthcare & Pharmaceutical Administration Specialist, Chief Pharmaceutical Consultant) on the basis of his study and practical performances. The information on this page is not intended to be a substitute for professional medical advice. We do not recommend any of the above medicines to directly intake or to do not use this information to diagnose or ayurvedic treatment of kids-health and/or colic pain without consulting the doctor. Consult your physician before beginning an exercise regime.
Ref classical textbooks:
1.Charak Samhita Ch. No. 6(Chikitsa-sthanam). 2.Sushruta Samhita Ch. No. 11. 3.Bhavaprakash. 4.Rasatarangini, 5.Rasendra sara sangrah second chapter-prameha chikitsa.