Life style disorders are diseases which are
associated mainly with the way a person or group of people lives. These include
disorders such as diabetes mellitus, hypertension, heart disease, stroke,
obesity, tobacco and nutrition-induced
cancers, chronic bron-chitis etc. It is estimated that the total number of
people with diabetes will rise from 171 million in 2000 to 366 million by 2030.
As per WHO report, currently half a billion people (12% of the world’s
population) are considered obese. A healthy lifestyle promotes building and
maintaining healthy bones, muscles and joints as well as helps in controlling
weight
. It increases self esteem, reduces stress and promotes social well
being. Ayurveda has great potential in preventing life style disorders.
According to Ayurveda a healthy person is one who remains established in self
along with equilibrium of Tridosha. Dietetic factors, lifestyle as well as
environmental factors affect the Tridosha. Disease is the result of disturbance
in homeostasis of Tridosha. Inclusion of Prameha among the eight major
disorders in Caraka Nidana, shows the significance the disease was given by the
seer. It seems the disease was quite prevalent among the masses and was
considered important in as much as it was incurable besides imposing a ban on
dietary freedom of the patient.
Etymology
of Prameha
The word Prameha consists two words
i.e. Pra (Upsarga-Prefix) and Meha. Meha is derived from the root ‘Mih
Sechane’meaning to purfuse (watering), Excessive
quantity and frequency is indicated by
the prefix (pra).That is why the main characteristic features of prameha said
to be Prabhuta Mutrata and Avil Mutrata.
Etymology
of Madhumeha
The word Madhumeha consists two
words i.e.Madhu & Meha.The word Madhu is derived from the root ‘Manyante
Visheshena Janati Jana Yasmin’. The root “Manjane” is applied by Dha Adesha and
it shows the similarity of urine in taste,colour and appearance etc. The word
Meha was initially found in Rigveda as Mehanadthanam Karanallium (Rigveda
10/163.15). The commentator of Rigveda Sayanacharya, interpreted the word
Mehana as Medhra,which denotes Shishna (penis). In Sanskrit literature the mih
is used to denote To make water, To wet, to emit semen. Madhumeha is the
disease in which the excretion is having quality similar to madhu in its
colour,smell,taste &consistenc
DEFINITION
Prameha:
Acharya Vagbhatta describes Prameha
as frequent and copious urine with turbidity;i.e.Prabhutavil Mutrata.
Madhumeha:
Madhumeha is a clinical entity in
which patient passes large quantity of urine similar to Madhu having kashaya
& Madhura taste, Ruksha texture & Honey like colour and thus body
attains sweetness. (A.H.Ni.10/18, Cha.Ni.4/44) Acharya Sushruta has narrated
that untreated prameha in its initial stage, gets converted into Madhumeha
& becomes incurable. [Su.Ni.6/30]Acharya Sushruta narrated the term
Kshaudrameha, in place of Madhumeha .The Kshaudra is one of the varieties of
Madhu.So it is clear to us, that Kshaudrameha resembles madhumeha. On the other
hand, the word “Diabetes mellitus” consists of two words - Diabetes and
mellitus, diabetes word derived from Greek which means ‘excessive discharge of
urine’ and word mellitus derived from Latin word mellitus, meaning ‘mellite’
(i.e. sweetened with honey; honey-sweet). The Latin word comes from mell, which
comes from mel, meaning “honey”; sweetness; pleasant thing. So, above
descriptions shows that word Madhumeha and Diabetes mellitus have similar
literal meaning.
Importance
Of Madumeha treatment
Madhumeha has been classified under the
Vatika type of Prameha. The Vata may be provoked either directly by its
etiological factors, Avarana by Kapha and Pitta to its path or by continuous
depletion of Dhatus. Vagbhata has classified the Madhumeha into two categories
viz. Dhatukshayajanya Madhumeha and Avaranajanya Madhumeha. The factors which
provoke the Vata directly causes
Apatarpanajanya Madhumeha while the factors which provoke Kapha and
Pitta causes Santarpanajanya Madhumeha. The Apatarpanajanya Madhumeha patients
are usually Lean and are equivalent to
Type I Diabetes mellitus, while the Santarpanajanya Madhumeha patients are
Obese equivalent to Type II Diabetes mellitus. In Avaranajanya Madhumeha, Kapha
is the predominant Dosha while the important Dushyas are Meda and Kleda. Type 2
Diabetes mellitus is mainly associated with Avaranajanya Samprapti. In
Madhumeha, the main Avaraka are Kapha, Pitta, Rasa, Mamsa and Meda, and out of
these Meda is predominant. Principle of management of Avarana is Sramsana,
Rasayana treatment and the use of Shilajatu & Guggulu (Ch. Chi. 28/241).
Sushruta suggested common treatment for Kustha,Prameha, Sthaulya and Shotha
(Su. Chi. 10/3). In Madhumeha, the Dhatukshaya is predominant, so if in its
management the drugs against its main Dushya Meda i.e. Medoghna Dravyas are
used, they will increase Vata dosha, leading to increase in severity of the
disease. So at the same time we have to energize the starved tissues by giving
Santarpana treatment i.e. by Balya and Rasayana drugs. A lot of research work
has also been done by modern science also to study the antihyperglycemic action
of these drugs. So the above ingredients can take for the Samana treatment of
Madumeha. In Avaranajanya Madhumeha or the Sthula Madhumeha patients, the
Shodhana therapy has been recommended before the administration of the Shamana
drugs because the excessively vitiated Doshas can not be alleviated by Shamana
Chikitsa alone. In the patients of Madhumeha, the Kapha and Pitta are vitiated
excessively and they remain lying in the lower parts of the body owing to the
inefficiency of the Dhamanis (Su. Chi. 12/8). This is the rule that the Dosha
should be eliminated through the nearest passage (A. H. Su.13/29).So Sodhana is
also a good line of treatment in Mdhumeha.
OBJECTIVES
OF MADHUMEHA CHIKITSA
• The objectives of therapy for diabetes are to:
·
eliminate symptoms of hyperglycaemia
·
achieve optimum control
·
reduce or eliminate microvascular and macrovascular
·
complications of diabetes mellitus
·
treat associated disorders
·
allow the patient to achieve as normal a lifestyle as possible.
MADHUMEHA
CHIKITSA
During
treatment of Vataja Prameha following
points should be taken in account.
- Madhumeha type i.e.Dhatukshayajanya or Avaranjanya
- Bala of
patient with respect to Doshabala,
Agnibala.
- Beeja Dosha
Although
vatika mehas are incurable still Acharya Charaka explains to induce certain
treatment in kaphapittanubandhi Vatika meha. [Cha.Chi.6/52]Achrya Sushruta has
described that all types of prameha if not treated properly in time, gets
converted into madhumeha. [Su.Ni.6/30] So the treatment described for vatika
meha can be considered as treatment of madhumeha.
Samshodhan
Chikitsa
DOSHA KADACHIT KUPYANTHI JITHA LANGHANA PACAHNE
JITHA SAMSODHANEYIR THU NA THESHAM PUNARUTHBHAVA // CHA:SU:16/20//
Doshadushti nirharana
Doshadooshya sameekarana
Srothovishudhi
Doshakopa even after the langana & pachana(samana) because of
uncomplete eradication of vitiated doshas. So Samsodhana is a best line of
treatment.
Role Of
Vasti,Virechana and Vamana In MADHUMEHA
Considering
Sthula & krisha pramehi,Samshodhan Chikitsa should be administered only to
the sthula & Balvan Pramehi. Ghrita or Taila according to dosha
predominance should be used for Abhyantara Snehana.Here while explaining the
Samshodhan ,Charaka describes to use the Malashodhan yogas from Kalpasthana
Both Pitta & kapha are eliminated through shodhana. Either it may be vamana
or virechana, because of; Pittantam Vamanam, Kaphantam Virechanam.In Virechana
pitta is eliminated first, then Samyak
lakshana of virechana is kaphadarshan, so both pitta & kapha doshas which
are vitiated are eliminated. Then the described Anuvasana & Asthapana Basti
chikitsas are able enough to control the provocation of vata. Like this all the
doshas are normalized to keep the dosha samyata. Anuvasana with medicated oils
& ghritas are prescribed in madhumeha. After proper Shodhan Chikitsa,
Charakacharya details to give santarpan chikitsa to the patients.
Samshaman
Chikitsa
According
to condition of vitiated Dosha proper Shamana Chikitsa should be given.
Due to less strength (Bala) of patient, Acharyas mentioned various
Tarpana Upakarma in Vatika Prameha. Acharya Charaka &
Vagbhatta says that the kashaya yogas should be enriched with sneha and
given
to vatika mehas(madhumeha).
·
Dravya yoga – Salsaradi ,Nyagrodhadi
·
Swarasa –Bilavapatra , Guduchi ,Satavari,
Haridra , Amalaki
·
Choorna – Mammajak, Nimba, Jambu Beeja, Eladi
Nyagrodhadya, Amalaki,
·
Haridra.
·
Kwatha –Phalatrikadi ,Asanadi, Mustadi,
Triphaladi, Vidangadi (Y.R.)
·
Gutika –Chandraprabha, Gokshuradi guggulu.
·
Avaleha –Bangavaleha,
Salaradhi, Kushavaleha
·
Paka –Puga paka,Aswagandha pak (Y.R.)
·
Ghrita –Trikantakadhya, Mahadadi madya.
·
Asava-arishta – Lodhrasava, Dantyasava,
Jambvasa, Loharista,
·
Devadarvyarist.
·
Rasaaushadhi – Shilajit, Trivanga,
Swarnamakshika, Vasantkusumakar, Indra
·
vati, Bhrihatbangeshwarrasa, Chandrakalarasa,
Pramehagajakeshari,
·
Pramehantak.
SPECIFIC TREATMENT OF MADHUMEHA
Acharya Charaka has given detail
treatment of Prameha but he has not given specific treatment for Madhumeha.
Hence common treatment and line of treatment should be followed. Sushruta has
given specific treatment of Madhumeha explaining in separate chapter.(Su.Chi.
13).He has given specific medicines for Madhumeha like Shilajita,
Suvarnamakshika, Rajatmakshika and Tuvarak. Sushruta mentioned ‘Salsaradi Gana
Bhavit’ Shilajita in Madhumeha after Shodhana Chikitsa. (Su.Chi. 13/10/11)
Patient who takes one tula (100 pala) ShilajitAfter its digestion patient should
take Jangalamamsarasayukta Anna will be cured from Madhumeha. (Su.Chi.13/12).
PROBABLE MODE OF ACTION OF BASTI IN
MADHUMEHA
The drugs selected for the Asthapan having
Pramehaghna property and can act against the vitiation of Dosa and Dusya
because of their qualities. For Anuvasan purpose the oil is medicated with the
help of same drugs to enhance Pramehaghna action. It also normalizes the
functions of Vyana and Apana. Thus Basti can act as a purificative, curative
and preventive measure. Basti due to purification, eliminates the excess of
deranged metabolic waste and it inturn clears the Avarana of Vata and normalize
the functions of Vyana and Apana. Thus the normalized Vata in turn help to stop
the depletion of Vital Dhatus through urine. Once the proper purification is
done then the digestive power is going to become normal and the proper
metabolism starts which in turn's help to form the Samyak Dhatus. Again in the
Madhumeha when depletion of Dhatus is stopped the strength of the body is get
increase.
NIDAN
PARIVARJANA
This is primary principle to be
followed in every disease. Charaka described that etiological factors i.e.
Nidana Sevana of Prameha should be avoided. It is one of the treatments of
disease. (Ch.Chi.6/15) Chakrapani
quotes
that avoidance of etiological factors
in Prameha is very important to control further progress of disease. sufficient
but along with this proper diet management is necessary, various Acharyas
mentioned various types of diet. This diet is managed according to Sthula and
Krusha.
PATHYA
–APATHYA
Following are
Pathya and apathya for Madhumeha rogi according to Ayurvedic classics.
PATHYA
1. Ahara:
·
-Shookadhanya: Jeerna shali, Shastika, Kodrava, Yava, Godhuma, Uddalaka,
·
Shyamaka.
·
-Shimbi Dhanya: Chanaka, Adhaki, Kulattha, Mudga.
·
-Shaka Varga: Tikta Rasatmak Leafy Vegetables, Also Having Kashaya Rasa,
·
Patola, Karavella, Shigru.
·
-Phala Varga: Jambu, Dadima, Shrungataka, Amalki, Kapitta Induka,
·
Khajura, Kallinga.
·
-Mamsa Varga: Vishkira Mamsa, Pratuda, Jangal Mamsa
·
-Tail Varga: Danti Ingudi Sarshapa, Atasi
-
Udaka Varga: Sarodaka, Kushodaka, Madhudaka.
-
Krittanavarga: Apupa, Saktu, Yavodana, Yusha
·
Others – Madhu, Lasuna, Hingu, Saindhava, Maricha
2. Vihara:
To walk, different play, Vyayama, barefooted roaming at different places
without and umbrella,
Jitendriya Vrutti, Apatarpak kriya.
APATHYA:
1.Ahara: Excess consumtion of water, milk, ghee,
oil, curd, sugar, rice
preparations, Anupa Gramya, Audaka Mamsa Pishtanna,
Navanna.
2.Vihara: Eksthana Asana, Atinidra, Divaswapna,
Avyayam, Dhumapana,
Sweda, Mutravega Dharana.
CHALLENGES
IN THE PRESENT DAY AYU MANGEMENT OF
MADHUMEHA
§ No easy going approach
§ Ayurvedic Medicines
§ Quality & Supply Problems
§ Cost
§ Late results (Evaluation)
§ Patient’s Education
§ Not all diabetes can be treated by Ayurvedic drugs
alone
§ Success depends on chronicity of the disease &
regularity of drug intake, exercise & diet.
