Changes

''Ojas'' as ''dushya'' is mainly involved in ''vataja prameha'' i.e. ''ojomeha'' (''madhumeha''). The symptoms of ''ojakshaya'' manifests, like ''gurugatrata'' (heaviness in body), ''nidra'' (sleepiness), ''tandra'' (drowsiness) and ''daurbalya'' (fatigue) can be correlated with immunocompromised stage in diabetes mellitus due to deranged immunity.  

''Ojas'' as ''dushya'' is mainly involved in ''vataja prameha'' i.e. ''ojomeha'' (''madhumeha''). The symptoms of ''ojakshaya'' manifests, like ''gurugatrata'' (heaviness in body), ''nidra'' (sleepiness), ''tandra'' (drowsiness) and ''daurbalya'' (fatigue) can be correlated with immunocompromised stage in diabetes mellitus due to deranged immunity.  

''Kleda'': This is one of the body components mainly involved in the pathogenesis. The literary meanings of ''kleda'' are wetness, moisture and dumpness etc. The physiology of ''kleda'' is mainly related with ''mutra'' and ''sweda'' along with ''meda''. Thus, when ''kleda'' is involved then it directly affects the above factors. In normal physiology ''mutra'' and ''sweda'' maintain the balance of ''kleda''. Especially ''sweda'' holds it in the body and ''mutra'' gets excreted out of the body according to the body condition and requirement. If ''kleda'' gets vitiated it directly affects the physiology of ''mutra'' and ''sweda'' and disrupts the assemblage of bodily elements causing ''shaithilya''. Thus, the symptoms manifest due to ''kleda'' vitiation are ''prabhutamutrata'' (polyuria), ''swedavrddhi'' (increased sweating), ''shaithilya'' (weakness), ''daurgandhya'' (bad smell) and ''avilamutrata'' (polyuria).

==== ''Kleda'' ====

 

This is one of the body components mainly involved in the pathogenesis. The literary meanings of ''kleda'' are wetness, moisture and dumpness etc. The physiology of ''kleda'' is mainly related with ''mutra'' and ''sweda'' along with ''meda''. Thus, when ''kleda'' is involved then it directly affects the above factors. In normal physiology ''mutra'' and ''sweda'' maintain the balance of ''kleda''. Especially ''sweda'' holds it in the body and ''mutra'' gets excreted out of the body according to the body condition and requirement. If ''kleda'' gets vitiated it directly affects the physiology of ''mutra'' and ''sweda'' and disrupts the assemblage of bodily elements causing ''shaithilya''. Thus, the symptoms manifest due to ''kleda'' vitiation are ''prabhutamutrata'' (polyuria), ''swedavrddhi'' (increased sweating), ''shaithilya'' (weakness), ''daurgandhya'' (bad smell) and ''avilamutrata'' (polyuria).

The glycosuria raises the ''osmolar'' concentration of the urine and osmotic diuresis resulting in water and sodium loss along with potassium leads to generalized weakness in the patient of diabetes mellitus. The level of catecholamines is increased in DM causes excessive sweating that further leads to loss of electrolytes such as sodium and chlorides through the skin. The whole phenomenon described under ''kleda'' can be correlated with water and electrolyte imbalance.

The glycosuria raises the ''osmolar'' concentration of the urine and osmotic diuresis resulting in water and sodium loss along with potassium leads to generalized weakness in the patient of diabetes mellitus. The level of catecholamines is increased in DM causes excessive sweating that further leads to loss of electrolytes such as sodium and chlorides through the skin. The whole phenomenon described under ''kleda'' can be correlated with water and electrolyte imbalance.

''Vasa'': Charaka described it as a subtype of ''vatajaprameha'' i.e. ''vasameha''. ''Vasa'' is the ''upadhatu'' (minor tissue or sub-tissue) of ''mamsa'' and the unctuousness present in the ''mamsa dhatu'' is called ''vasa''.

==== ''Vasa'' ====

 

Charaka described it as a subtype of ''vatajaprameha'' i.e. ''vasameha''. ''Vasa'' is the ''upadhatu'' (minor tissue or sub-tissue) of ''mamsa'' and the unctuousness present in the ''mamsa dhatu'' is called ''vasa''.

 

 

 

''Lasika'': This is one of the liquid component present just beneath the skin. ''Lasika'' also get vitiated by ''vata'' resulting ''lasikameha''. There is no direct reference related to ''vasa'' and ''lasika dushti''.

Among the ten ''dushyas'' of ''prameha, asthi'' (bone) is not included. According to modern physiology, bone is a tissue that undergoes frequent remodeling and has a large capacity for regeneration. In the adult remodeling occurs so that the skeleton is replaced approximately every 10–11 yr. This physiological remodeling is initiated by osteoclasts that re-absorb bone and is followed by the formation of an equivalent amount of new bone by osteoblasts, bone loss is noted when the amount of bone resorption exceeds the amount of new bone formation.  

Exclusion of asthi as a dushya:

Diabetes has also been associated with a net loss of bone. A number of studies have reported that type 1 diabetes alters bone remodeling by reducing the formation of new bone, leading to osteopenia. This has been shown by a decrease in bone mineral density in humans and alterations in the formation of new bone in animal studies. In contrast, the presence of bone loss in type 2 diabetes is less clear, and current understanding suggests that this form of diabetes is not typically associated with osteopenia. The reasons for the lower bone mineral density in type 1 diabetes are not known.

Among the ten dushyas of prameha, asthi (bone) is not included. According to modern physiology, bone is a tissue that undergoes frequent remodeling and has a large capacity for regeneration. In the adult remodeling occurs so that the skeleton is replaced approximately every 10–11 yr. This physiologic remodeling is initiated by osteoclasts that resorb bone and is followed by the formation of an equivalent amount of new bone by osteoblasts. ,  Bone loss is noted when the amount of bone resorption exceeds the amount of new bone formation.

==== ''Vataja prameha'' as type 1 diabetes mellitus ====

Diabetes has also been associated with a net loss of bone. A number of studies have reported that type 1 diabetes alters bone remodeling by reducing the formation of new bone, leading to osteopenia. This has been shown by a decrease in bone mineral density in humans and alterations in the formation of new bone in animal studies. , , ,  In contrast, the presence of bone loss in type 2 diabetes is less clear, and current understanding suggests that this form of diabetes is not typically associated with osteopenia. , , ,  The reasons for the lower bone mineral density in type 1 diabetes are not known.

Vataja prameha as type 1 diabetes mellitus : The pathogenesis of vataja prameha is similar to that of type-1 diabetes mellitus. Vata is agitated due to various precipitating causes acts on the body in such a way that there is passage of vasa (fat), majja (bone marrow), lasika (lymph), and ojas (essence of the body /immune substances / vitality) through the urine. This condition indicates impaired renal function as a result of diabetes, leading to a dire prognosis. Due to dhatukshaya (loss of body tissues) the patient become very weak and emaciated.

The pathogenesis of ''vataja prameha'' is similar to that of type-1 diabetes mellitus. ''Vata'' is agitated due to various precipitating causes acts on the body in such a way that there is passage of ''vasa'' (fat), ''majja'' (bone marrow), ''lasika'' (lymph), and ''ojas'' (essence of the body /immune substances / vitality) through the urine. This condition indicates impaired renal function as a result of diabetes, leading to a dire prognosis. Due to ''dhatukshaya'' (loss of body tissues) the patient become very weak and emaciated.

Charaka Samhita deals with very specific pathogenesis for madhumeha, which is a subtype of vataja prameha. When an individual excessively consumes the foods that cause prameha, kapha and pitta become vitiated, then adipose tissues and muscle tissuses become disturbed and causes impaired functioning of vata. Subsequently vata gets vitiated and extends to urinary bladder along with ojas, resulting in ojas being expelled in the urine. In Ayurveda ojas is considered vital to the maintanence of health; its loss in prameha leads to many complications, including prameha pidika (boils and carbuncles). This advanced condition is comparable to non-insulin –dependent type -2 diabetes progressing into insulin dependent diabetes. It is the stage of diabetes in which there are complications, including nephropathy, which result in vital substances of the body being excreted through urine.

[[Charaka Samhita]] deals with very specific pathogenesis for ''madhumeha'', which is a subtype of ''vataja prameha''. When an individual excessively consumes the foods that cause ''prameha, kapha'' and ''pitta'' become vitiated, then adipose tissues and muscle tissuses become disturbed and causes impaired functioning of ''vata''. Subsequently ''vata'' gets vitiated and extends to urinary bladder along with ''ojas'', resulting in ''ojas'' being expelled in the urine. In Ayurveda ojas is considered vital to the maintanence of health; its loss in prameha leads to many complications, including prameha pidika (boils and carbuncles). This advanced condition is comparable to non-insulin –dependent type -2 diabetes progressing into insulin dependent diabetes. It is the stage of diabetes in which there are complications, including nephropathy, which result in vital substances of the body being excreted through urine.

Among patients with significant proteinuria, the degeneration of cells within epithelial casts may result in a characteristic "Maltese cross" appearance and a fatty cast. These droplets are composed of cholesterol esters and cholesterol, which may also be observed free in the urine. This may be correlated with vasameha (lipiduria). Majjameha can be correlated with appearance of waxy casts in urine in advanced renal failure.  Waxy cast are thought to be the last stage of the degeneration of a granular cast. Since this degenerative process is probably slow, it is most likely observed in nephrons with much diminished flow. Waxy casts are therefore most consistent with the presence of advanced renal failure.   

Among patients with significant proteinuria, the degeneration of cells within epithelial casts may result in a characteristic "Maltese cross" appearance and a fatty cast. These droplets are composed of cholesterol esters and cholesterol, which may also be observed free in the urine. This may be correlated with vasameha (lipiduria). Majjameha can be correlated with appearance of waxy casts in urine in advanced renal failure.  Waxy cast are thought to be the last stage of the degeneration of a granular cast. Since this degenerative process is probably slow, it is most likely observed in nephrons with much diminished flow. Waxy casts are therefore most consistent with the presence of advanced renal failure.