Diabetes mellitus - Ayurvedic perspective

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The description of prameha (diabetes) and its treatment was delineated in Ayurvedic classics. A review of literature concerning prameha (diabetes) has been summarized in the following lines right from vedic period up to 20th*century.*

Etymon of word prameha/ diabetes:*According to various Sanskrit dictionaries and Koshas, it is apparent that the word Prameha (diabetes) is derived from the root "Miha Sechane" meaning by watering in reference to disease of human body. The prefix ‘Pra' means urine in excess both frequency and in quantity.*

Source material of Prameha (diabetes)
In Kaushika Sutra of Atharva Veda there is a reference about Prameha/ diabetes. (K.srt. 26/6-10). In Vedic literature two terms were denoted i.e. ‘Asrva' and ‘Prameha/ diabetes'. The term Asrva has been interpreted in various ways. This term formed a/sr meaning of flow, Whitney (1962) interpreted this as flux and Griffith (1262)(1262) as morbid flow, Sayana and Keshava, commentators of vedic works includes mutratisara (excessive urination) which through light on existence of references to a state akin to Prameha (diabetes) in the vedic period. Kautilya (321-396 B.C) mentions*in his book Arthashastra method to produce Prameha (diabetes) in the chapter dealing with means to injure the enemy. The soup obtained from chamellion (krukalsa) and household lizard (gruhlika) together with the intestine of a mother frog (chitraheka) and honey if administrated causes Prameha (diabetes). This obviously points to the knowledge of experimental technique about the production of the Prameha (diabetes) in ancient times.

In Ayurvedic texts prameha (diabetes) was defined as disease, which is to be characterized with excessive*urination and turbidity. Charaka has mentioned as one of the anusangi in Su.25. Chakrapani has commentated anusangi as Punarbhavi, which means it is very difficult to cure, or tendency of the disease to repeat number of times. Charaka has mentioned two types of prameha (diabetes) and included madhumeha/ diabetes mellitu in Vataja Prameha (diabetes). He has described the samprapti of madhumeha/ diabetes mellitu separately in 17th*chapter of sutrasthana. He has also described*the Prameha (diabetes) or Madhumeha/ diabetes mellitu of hereditary origin. He has delineted two types of Prameha (diabetes) patients i.e., sthula and Krushya and given two types of treatment for them. Sushruta also classified the prameha (diabetes) into 20 types and the etiology of the disease has been described as Sahaja and Apthyanimittaja. Sushruta has given specific drugs to each type of Prameha (diabetes), which can be considered as a new addition to therapeutics when compared to previous therapeutics.

Sushruta has indicated Shilajita and Tuvaraka for Madhumeha/ diabetes mellitu disease. One more interesting observation done by Sushruta is about Prameha (diabetes) nivritti lakshnas, which were not mentioned by predecessors. Dalhana commentating on roopa of prameha (diabetes) S..6/6 specifically mentioned that the increase in the quantity of urine is due to excretion of dushyas like medas, rakta, majja, sukra which are liquid in nature.
Sushruta has clearly mentioned that excessive urination accomained with full poorva roopa or half the number of poorva roopa of prameha (diabetes) can only be called as prameha (diabetes) and mere excessive*urination may not be prameha/ diabetes. Vagbhatta also has mentioned 20 types of prameha (diabetes) and clearly mentioned Amalaki and Nisha for prameha (diabetes) A.H.U40.

Bhelsamhita describes two types of prameha (diabetes) prikriija and svakritaja, which respectively mean the hereditary or genetic and acquired type. Kashapa did not mention the prameha (diabetes) separately but included it under the description of mutrakrichchha. Kashyapa compares prameha (diabetes) with mutrkrichchara and says that prameha (diabetes) is a chronic type of disease whereas mutrakrichchara is acute type. Mutrakrichcha is easy for treatment and can be cured but prameha (diabetes) is very difficult for treatment. Madhava has followed charaka and vagbhatta in the description of prameha (diabetes) poorvaroopa roopa and nidana, vijay raxit has commented avilatvam as gandham ma ni 33.

Many Ayurveda treatment like Sarngdhara Samhita (late 13th*A.D.), Chakradatta (11th*AD), Gadanigraham12th A.D), Vangsena (12thA.D), Bhavaprakasha (1550 A.D), Yogratnakaram(1676 A.D), and many other works also described this condition together with treatment.
The description of twenty types of prameha (diabetes) is based on the colour and the substances, which are passed in the urine. Vagbhatta says that the combination of dosha and sushya produces specific type of new compounds which gives he different types of color, odor etc., in urine by which prameha (diabetes) is classified in to various types. Sushruta has very clearly stated that the basic five colors like white, black, green, yellow and red combine*and form different colors like dark brown, reddish brown, dark green etc. similaraly dosha, dhatu, mala and products of diet from the different type. These observations indicate that the Acharyas were known to this fact that prameha (diabetes) is a metabolic disease and not merely the disease of urinary organs. Some scholars of recent times have attempted to interpret the 3 varieties of prameha (diabetes) i.e. Vataja, Pittaja and Kaphaja as different phases or stages of diabetes mellitus (S.N.Tripathi 1968) while some groups of scientists have interpreted madhumeha/ diabetes mellitu alone as diabetes.*

SUSHRTA'S OBSERVATION ABOUT DIABETES:*Sushruta has enumerated various diagnostic as well as therapeutic profiles of prameha (diabetes) under Nidana Sthana 6th*chapter and Chikitsa Sthaa 11th*,12th*and 13th*chapter. He has allocated a separate chapter Chikitsa 13th*for MADHUMEHA/ DIABETES MELLITU*and discussed various treatment modalities.*

Diabetic profile:*The person who indulges in day sleeping, abstains from physical exercise, is lazy and takes cold, sliy, sweet and fatty food or drinks should be known as who would develop prameha (diabetes) that is urinary abnormalities including diabetes. Pathogenesis:*In such a person, when the immature vata, pitta and kapha combine with meas and get unified they go downwards following the urine conducting channels and getting located at the neck of the bladder are excreted and ths produce urinary abnormalities.*

Prodromal features:*Their Prodromal features aaare - burning sensation in thepalms and sole; oiliness, sliminess and heaviness in the limbs; sweetness and whitisness in the urine; drowsiness; lethargy; thirst; bad smell in the breath; production of deposit in the palate, throat, tongue and teeth, matting together of hairs and increased growth of nails.*General features:*Turbidity and excessive urination are the symptoms present in all types of abnormalities.*
Definition of pramhea*In whomsoever the Prodromal features of urinary abnormalities are seen and even if there is a slight increase in urine, he should be considered to be a pramehi . In whomsoever present the Prodromal features are present fully or partially and who has an excessive urination should be considered to be a pramehi.*

Diagnostic criteria of Madhumha (Diabetes):*one who is suffering from boils and has severe complications is called madhumehi and that is considered incurable. And he prefers to stand rather than move from place to place, prefers sitting to standing, lying down to sitting and desires to sleep rather than lie down in bad. All types of urinary abnormalities if not treated in time develop madhumeha/ diabetes mellitus and then become incurable.*Hereditary origin of prameha/ diabetes:*There are two types of urinary abnormalities hereditary and that to indulgence in insalubrious. The hereditary one is caused by defect in the paternal or maternal germinal seeds; the insalubrious factors*are derived from the intake of non beneficial diets. One suffering from former is thin and dry skinned, eats less, has polydipsia and has active habits whereas*the person afflicted with the latter is obese, has polyphagia, is smooth skinned and prefers to sit idle, lie down and sleep.*Contra indicated diet:*the patients of both types of urinary abnormalities should give up sauviraka, tushodaka, sukta, maireya, sura, asava,water, milk, oil, ghrita, sugarcane preparations, yoghurts, grain cakes, sour substances, gruel and sweet drinks, swampy and acquatic animals.*Recommended diet:*Old shali, swastika, barley, wheat, kodraka and uddalaka or alternately grams, adhaki, kulattha, and mudga with bitter and astringent leafy vegetables cooked in the oils of nikumbha, ingudi, mustard and linseed or else fat free meats of wild animals having anti diuretic properties should be taken without ghritas and sour substances.

Eliminative procedure:*the patient suffering from urinary abnormalities should first be oleated by any one of the oil or any of ghrita processed with Priyangu group of drugs followed by strong emetic and purgative measures. After purgation medicated enema of the decoction surasadi group of drugs sunthi, bhadradaru and Musta added to it, should be given mixed with honey and rock*salt. In these patients who have a burning sensation a decoction of Nyagrodhadi group of drugs should be used without oil or ghrita.

General recipes:*Then after body has been purified Haridra should be taken with Amalaki juice and honey; or else the decoction of triphala, devdaru and musta should be taken with haridra and amalaki sweeten with honey; or else the paste of flowers of kutaja, kapiththa, rohitaka, bibhitaka and saptaparna, or else the decoction of the bark' leaves, roots, fruits, barks and flowers of the neem, argvadha, saptaparna, murva , kutaja, soma tree and palasha, these five recipes have been described which can cure all kinds of urinary abnormalities.

Role of exercise:*in advanced cases of urinary abnormalities exercise, wrestling, play, riding on hoarse, an elephant or on a chariot, walking on foot, touring and use of weapons or accessory weapons is indicted. The patients who are poor and are without relatives should walk hundre yojana or more without shoes and umbrella, living on alms, staying overnight only I each village and should be self - controlled like an ascetic. The rich patient should live amongst the deer and subsist on the grains of shymaka and nivara and the fruits of amalaki, kapiththa, unduka and asmantaka. He should constantly follow the cows and take their faeces and urine. A Brahmin patient should live on silavritti or unchavritti and recite the Vedas. The farmer should constantly be engaged in farming and digging of wells. The thin patient should always be protected. A poor patient who carefully follows the direction of the physicians gets cured of prameha (diabetes) within a year or less. The greatest merit of Sushruta's observation about the management of diseases is to focus the attention of the physician on the importance of diet and physical exercise.
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