AyurvedGuru

AYURVEDIC MANAGEMENT OF DIABETES MELLITUS

Introduction

Madhu meha 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.
Diabetes Mellitus is also a maharoga (major disease) because it affects 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}.
All classical texts describes prameha. The word prameha derived from the root mih sechane meaning watering that means dilution of everything in the body not only urine).

Aetiology
The main causes of prameha (diabetes) are lack of exercise and improper food habits in excess food intake which falls in the category of ushna, snigdha and guru are the primal cause of this disease – fish, curd are good examples. Foods that increase kapha, medhas and moothra are the etiological factors for prameha.
Yashcha kinchith vidhiranyepi sleshma medho moothra
samjananam sa sarva: nidana vishesha:

Physical Classifications
For the management of this disease – prameha (diabetes) can be listed in two categories:
1) Apatharpana uthaja prameha describing the lean diabetic and
2) Santharpana uthaja prameha relating the obese diabetic.
Aetiological classification of diabetic patients
1) Sahaja prameha (congenital)
2) Apathyanimittaja prameha (due to over eating and poor habits)
The similar classification can be found in Bhela Samhitha
1) Prakruthi Prabhaavam
2) Narasya Swakrutham

Dosha classification

Though prameha is a tridoshaja vyadhi, the relative predominance of any one dosha and dooshya enables its classification in to Vathaja, Pithaja and Kaphaja pramehas.
These have further been classified in to twenty sub categories in all the three classics of Ayurveda. Kaphaja and Pittaja prameha have been sub classified in to ten types and six types
respectively. These sixteen types have the physical characteristics of urine that is colour, density
and volume depending up on the different gunas of Kapha and Pitta. Vataja prameha has been
sub classified in to four types depending up on dhathu being excreted through urine.
The above 20 types are classified on the basis of colour and physical characteristics of urine.
The above 20 types of prameha are the different types of prameha can also be correlated with a
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 sweetness of urine
is the common and important symptom. In our practice we could be classify prameha according
to dosha predominance. They are
1) kapahja,
2) pithaja,
3) vathaja,
4) kapha-pithaja,
5) kapha-vathaja,
6) pitha-vathaja, and
7) vatha-pitha-kaphaja.
In these types sannipatha, kevala vathaja and some stages of kapha-vthaja and pitha-vathaja
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 Brihathrayies
They are as follows
1. Sweda Profuced sweating
2. Angagandham Foul smell of the body
3. Anga shidhilathwam Looseness the body
4. Sayyasna swapnasukhabhishangithwam Feeling of lethargy
5. Hridayopadeham Feeling of some thing coated
or heaviness of Hridaya
6. Netropadeham Feeling of some thing coated on eyes
7. Jhwopadeham sensation of a coated
tongue
8. Shravanopadeham Feeling of coating on ears
9. Anga ghanathwam Heaviness of body parts
10. Keshathivridhi Excessive growth of hairs
11. Nakhathivridhi Excessive growth of Nails
12. Sheetha priyathwam Affinity towards cold
13. Gala shosham Dryness of throat
14. Thalu shosham Dryness of palate
15. Asya madhuryam Sweet taste in mouth
16. Karadaham Burning sensation of palms
17. Pada daham Burning sensation of soles
18. Moothra madhuryam Sweetness of urine

General Features
The characteristic features of all types of prameha are PRABHOOTHA and AAVILA
MOOTHRATHA & MEDO DUSHTI LAKSHANAS – { excessive urination & turbidity in urine
and symptoms of vitiated medodhatu
Prameha upadravas {Complications of prameha}
Doshas which are involved in pathogenesis of the disease. This may further complicate
the problem and must be considered in the management of the original disease, that is called
upadrava. 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 physician. Susrutha has described
prameha complications according to dosha pridominance. Briha Thrayees have described
prameha pidaka as a major complication of prameha. Sussrutha has mentioned
“Malabandhata” (constipation) as a commonly observed complication as the body of the
diseased person is loaded with meda hence they do not respond to common purgatives in usual
doses. Modern Physiological theories attribute this complication to the involvement of
autonomous nervous system.
The following symptoms under each category of kaphaja, pithaja and vathaja describes
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 upadrava. In most cases it is only after the complication have developed, individuals suffering form prameha seek a physician’s advise.
Sustrutha notes that Dosha predominance is a primary factor in prameha complication.
Susrutha documents that ‘malabandhata’(constipation) is a complication of this disease, because
the individual has a concentration of meda. The average doses of laxatives are not effective in
these cases.
Brihathrayees (Susrutha is one of the Brihathrayee 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
Vasthimehanyotoda – Pain in Bladder & urinary path
Mushkavatharanam – Pain in testes
Jwara – Fever
Daham – Burning sensation
Trishna – Thirst
Amlika – Acidity
Moorcha – Giddiness
Vitbhedanam – Loose Motion
Hridayashoola – Pain in heart region
Nidranasam – Loss of sleep
Vathaja
Udavartham Upward movement of vatha.
Kambam Tremor
Hridgraham Gripping pain in chest region
Lolatha Affinity
Soolam Pain
Anidratha Insomnia
Sosha Wasting
Kasam Cough
Swasam Difficulty to breath
Badhapureeshathwa Constipation

Prognosis

This classification has been given by Charaka. The three types of prameha.
1. Sadhya – curable
2. Yapya – Palliable
3. Asadhya – Incurable
Sadhya: Describes patients who have been diagnosed very early in the onset of prameha. In
this category of patients , there can be those who are sthoola[ obese] and the origin of their
disease is in apathyaja [poor living habbits]
Yapya: Patients under this catagory have Pittaja prameha & certain types of kaphaja
prameha.How ever Yapya {palliable} helps control the disease with treatment
Asadhya: Describes the incurable version of prameha & inherited diabetes.Sahaja patients
suffering from this veriety are Krisha {lean}
Involvement of ojus in Prameha
Ojus is the essence of life, an extract of the seven dhathus {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 component of the body which is reddish, white,
slightly yellowish in colour residing in heart and other vital organs of the body. If ojus is
distrubed, degeneration will be fast and result in decreased life span. In prameha the ojus (life
essence is expunged from the body through all navadwaras especially through urine & sweat.)
Ojus gets imbalanced in prameha in two ways:
1) Through obstruction in blood vessels {srothorodha}
2) 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 individuals
constitution. A special case sheet to analyse diabetes is developed as follows

1) The prakrithi of the patient
2) Dosha predominance of disease
3) Dooshya vitiation
4) Obstruction in srothus
5) Manasika Prakrithi
6) Ahara & Vihara
7) Hereditary factors etc…
This case sheet gives the profile of the patient & the pathology of the disease in accordance based with 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 {Vataj prameha}Patients are advised to have Bhrimhana medication & diet which increases dhathus in the body

Line of treatment
In Type 2 Diabetes, obese diabetic patient with optimal body strength having intense increase of doshas, Purification of the body is advocated This is dependent on dosha predominance {Kaphaja are adviced to have emetics, Pittaja are advised to have purgation.}
1) Snehanam { prescription of oils internally & externally
2) Sodhana {Purification therapy under three catagory}
a. Vamanam
b. Virechanam
c. Vasthi (This process is the application of medicine through the anal route.This is indicated only in specific condition
3) Samanam
4) Pathya – Apathyas
5) Vyayamam (exercises)
In strong prameha patients,but with increased doshas, sodhana chikitsa is prescribed.
The Purification Therapies are the foremost treatment in this condition. Snehana karma should be done before giving sodhana chikilsa. Generally swedana is contra indicated in Prameha as swethathi pravruthy (profuced sweating) is one of the main symptom 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 ghees and oils (dhanwantharam ghrutham, thrikandakathi ghrutham are some of them).
After snehana, one should undergo virchanam or vamana or both.This is determined on the predominant doshas. This can be done by classical shodhana oushadha. After shodhana,shamana is advised. The drug of choice must be both dosha shamana and roga shamana.

Type of Prameha Drug of choice (name of kashayam)
Kapha
Pitha
Vatha
Bhadrashree Kashyam
Chavyadi Kashayam
Chathusaram Kashayam
Thrijathakam Kashayam
Khadirathi Kashayam
Musthaabhayadi Kashayam
With the above shamana medications some more effective yogas also can be given for
better results. They are:
a) Diarid Powder
b) Diamel Powder
c) Melhar Powder
d) Meha Liquid
In hyper cholesteremic conditions Daru haridrathi choornam is found effective.
In neuropathy conditions Elagulgulu choornam and,.
In dhathukshaya condition, Silajathu kalpam is advised for better results
With this classical line of treatment, we are able to withdraw modern hypoglycemic
medicines gradualy.
Snehana and shodhana must be repeated in a definite intervals; depending upon the condition
of the disease.

The drastic disease diabetes can be controlled by giving comprehensive attention to 3 aspects
They are
1) Ahara (Diet)
2) Vihara ( Exercise)
3) Aushadha (medicine)
The role of ahara & Vihara are equally or even more important in diabetes to control
blood sugar level as well as to prevent complications of this disease .In all classics, ahara
dravyas are described in detail & they cover all the food groups are noted in the following table:

Ahara group Name of pathya ahara
Cereals
Pulses
Vegetables
Fruits
Seeds
Flesh
Yava -Barley{ Chenopodium Album}
Godhooma -Wheat
Shyamaka
Kodrava
Bajara
Mudga { Green gram}
Chanaka { Gram}
Thiktha shakas
Medhika
Nimba { Azadirachta Indica}
Karavella { Momordica charantia}
Patola {Trichosanthas Anguina
Rasona -Garlic
Udmbara {Ficus racemosa}
Jambu{Black berry}Syzygium cumini
Tala phala {Borassus flabellifer}
Kharjura { Phoenix sylvestris}
Kamala { Nelumbo nucifera}
Utpala {Nymphoea Stellata}
Harina –Deer flesh
Shashaka –Rabbit
Birds like Kapotha,Titira
Liquor
Oils
Old sura {Old wine}
Mustard
Ingudi {Balanitis aegypotiaca}
Ghritha may be used in pithaja prameha