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→Prevention of prameha
Etiological factors responsible for the causation of different types of prameha should be avoided even after prameha are manifested. The causative factors described shall be avoided during the treatment of those particular diseases (even after its manifestation). [53]
Etiological factors responsible for the causation of different types of prameha should be avoided even after prameha are manifested. The causative factors described shall be avoided during the treatment of those particular diseases (even after its manifestation). [53]
Differentiation between rakta-pitta and prameha:
==== Differentiation between raktapitta and prameha ====
हारिद्रवर्णं रुधिरं च मूत्रं विना प्रमेहस्य हि पूर्वरूपैः|
हारिद्रवर्णं रुधिरं च मूत्रं विना प्रमेहस्य हि पूर्वरूपैः|
यो मूत्रयेत्तं न वदेत् प्रमेहं रक्तस्य पित्तस्य हि स प्रकोपः||५४||
यो मूत्रयेत्तं न वदेत् प्रमेहं रक्तस्य पित्तस्य हि स प्रकोपः||५४||
hAridravarNaM rudhiraM ca mUtraM vinA pramehasya hi pUrvarUpaiH|
hAridravarNaM rudhiraM ca mUtraM vinA pramehasya hi pUrvarUpaiH|
yo mUtrayettaM na vadet pramehaM raktasya pittasya hi sa prakopaH||54||
yo mUtrayettaM na vadet pramehaM raktasya pittasya hi sa prakopaH||54||
If the colour of the urine is yellow or if blood is excreted through the urine without the prior manifestation of premonitory signs and symptoms of prameha, such a person should not be diagnosed as a patient of prameha. He should be diagnosed as a case of rakta-pitta (a disease characterized by bleeding from different parts of body).[54]
If the colour of the urine is yellow or if blood is excreted through the urine without the prior manifestation of premonitory signs and symptoms of prameha, such a person should not be diagnosed as a patient of prameha. He should be diagnosed as a case of rakta-pitta (a disease characterized by bleeding from different parts of body).[54]
Two types of prameha patient:
==== Two types of prameha patient ====
दृष्ट्वा प्रमेहं मधुरं सपिच्छं मधूपमं स्याद्द्विविधो विचारः|
दृष्ट्वा प्रमेहं मधुरं सपिच्छं मधूपमं स्याद्द्विविधो विचारः|
क्षीणेषु दोषेष्वनिलात्मकः स्यात् सन्तर्पणाद्वा कफसम्भवः स्यात्||५५||
क्षीणेषु दोषेष्वनिलात्मकः स्यात् सन्तर्पणाद्वा कफसम्भवः स्यात्||५५||
syAt||55||
syAt||55||
If the patient suffering from prameha passes urine which is sweet, slimy and honey-like, then there are two possibilities. It is caused either by the diminution of doshas having vata dominant type or by over- nourishment having kapha dominant type. [55]
If the patient suffering from prameha passes urine which is sweet, slimy and honey-like, then there are two possibilities. It is caused either by the diminution of doshas having vata dominant type or by over- nourishment having kapha dominant type. [55]
Prognosis:
==== Prognosis ====
सपूर्वरूपाः कफपित्तमेहाः क्रमेण ये वातकृताश्च मेहाः|
सपूर्वरूपाः कफपित्तमेहाः क्रमेण ये वातकृताश्च मेहाः|
साध्या न ते, पित्तकृतास्तु याप्याः, साध्यास्तु मेदो यदि न प्रदुष्टम्||५६||
साध्या न ते, पित्तकृतास्तु याप्याः, साध्यास्तु मेदो यदि न प्रदुष्टम्||५६||
sAdhyA na te, pittakRutAstu yApyAH, sAdhyAstu medo yadi na praduShTam||56||
sAdhyA na te, pittakRutAstu yApyAH, sAdhyAstu medo yadi na praduShTam||56||
Kapha dominant and pitta dominant types of prameha, if preceded by their premonitory signs and symptoms, are incurable. Similarly, vatika prameha, where vayu is aggravated right from the beginning is incurable. Pitta dominanttypes of prameha are generally palliable. But they are curable if medas (adipose tissue) is not vitiated. [56]
Kapha dominant and pitta dominant types of prameha, if preceded by their premonitory signs and symptoms, are incurable. Similarly, vatika prameha, where vayu is aggravated right from the beginning is incurable. Pitta dominanttypes of prameha are generally palliable. But they are curable if medas (adipose tissue) is not vitiated. [56]
Incurability of hereditary diseases:
==== Incurability of hereditary diseases ====
जातः प्रमेही मधुमेहिनो वा न साध्य उक्तः स हि बीजदोषात्|
जातः प्रमेही मधुमेहिनो वा न साध्य उक्तः स हि बीजदोषात्|
ये चापि केचित् कुलजा विकारा भवन्ति तांश्च प्रवदन्त्यसाध्यान्||५७||
ये चापि केचित् कुलजा विकारा भवन्ति तांश्च प्रवदन्त्यसाध्यान्||५७||
kecit kulajA vikArA bhavanti tAMshca pravadantyasAdhyAn||57||
kecit kulajA vikArA bhavanti tAMshca pravadantyasAdhyAn||57||
Patients who suffer from prameha since birth (congenital) and those who are borne of prameha parents (hereditary) are not curable because of the morbidity in their bija (genes). Similarly, other hereditary (kulaja/familial) ailments are considered as incurable. [57]
Patients who suffer from prameha since birth (congenital) and those who are borne of prameha parents (hereditary) are not curable because of the morbidity in their bija (genes). Similarly, other hereditary (kulaja/familial) ailments are considered as incurable. [57]
Treatment of prameha pidaka:
==== Treatment of prameha pidaka ====
प्रमेहिणां याः पिडका मयोक्ता रोगाधिकारे पृथगेव सप्त|
प्रमेहिणां याः पिडका मयोक्ता रोगाधिकारे पृथगेव सप्त|
ताः शल्यविद्भिः कुशलैश्चिकित्स्याः शस्त्रेण संशोधनरोपणैश्च||५८||
ताः शल्यविद्भिः कुशलैश्चिकित्स्याः शस्त्रेण संशोधनरोपणैश्च||५८||
tAH shalyavidbhiH kushalaishcikitsyAH shastreNa saMshodhanaropaNaishca||58||
tAH shalyavidbhiH kushalaishcikitsyAH shastreNa saMshodhanaropaNaishca||58||
Seven types of prameha pidaka of patients suffering from prameha described in the quadrate on diseases (rogadhikara) are to be treated by expert surgeons with the help of shastras (surgical operations), samshodhana (cleansing) and ropana (healing therapies). [58]
Seven types of prameha pidaka of patients suffering from prameha described in the quadrate on diseases (rogadhikara) are to be treated by expert surgeons with the help of shastras (surgical operations), samshodhana (cleansing) and ropana (healing therapies). [58]
Summary:
==== Summary ====
तत्र श्लोकाः-
तत्र श्लोकाः-
हेतुर्दोषो दूष्यं मेहानां साध्यतानुरूपश्च|
हेतुर्दोषो दूष्यं मेहानां साध्यतानुरूपश्च|
vyāyāmavidhirvividhaḥ snānānyudvartanāni gandhāśca|
vyāyāmavidhirvividhaḥ snānānyudvartanāni gandhāśca|
mēhānāṁ praśamārthaṁ cikitsitē diṣṭamētāvat||61||
mēhānāṁ praśamārthaṁ cikitsitē diṣṭamētāvat||61||
Tatra shlokAH-
Tatra shlokAH-
heturdoSho dUShyaM MehanAM sAdhyatAnurUpashca|
heturdoSho dUShyaM MehanAM sAdhyatAnurUpashca|
vyAyAmavidhirvividhaH snAnAnyudvartanAni gandhAshca|
vyAyAmavidhirvividhaH snAnAnyudvartanAni gandhAshca|
MehanAM prashamArthaM cikitsite diShTametAvat||61||
MehanAM prashamArthaM cikitsite diShTametAvat||61||
Here are the recapulatory verses:
Here are the recapulatory verses:
The causes, dosha, dushya, curability, characteristics of urine in prameha, two types of patients, three modes of treatment, disadvantages of excess depletion therapy, various food items of yava, mantha, various decoctions used in treatment of prameha, medicated oils, ghee preparations, linctuses, diet articles, fermented preparations like asava, various exercises, baths, massage, fragrant applications all these are described in the management of prameha. [59-61]
The causes, dosha, dushya, curability, characteristics of urine in prameha, two types of patients, three modes of treatment, disadvantages of excess depletion therapy, various food items of yava, mantha, various decoctions used in treatment of prameha, medicated oils, ghee preparations, linctuses, diet articles, fermented preparations like asava, various exercises, baths, massage, fragrant applications all these are described in the management of prameha. [59-61]
Thus, ends the sixth chapter dealing with the treatment of prameha of chikitsa section of Agnivesa’s work as redacted by Charaka.[6]
Thus, ends the sixth chapter dealing with the treatment of prameha of chikitsa section of Agnivesa’s work as redacted by Charaka.[6]
Tattva vimarsha:
=== Tattva Vimarsha ===
• Excess intake of curds, soup of the meat of domesticated, aquatic animals and animals inhabiting marshy land, milk and its preparations, freshly harvested food articles, freshly prepared drinks, preparations of jaggery and all kapha- aggravating factors are responsible for the causation of prameha.
• Excess intake of curds, soup of the meat of domesticated, aquatic animals and animals inhabiting marshy land, milk and its preparations, freshly harvested food articles, freshly prepared drinks, preparations of jaggery and all kapha- aggravating factors are responsible for the causation of prameha.
• Over-indulgence in the pleasure of sedentary habits, excess sleep are lifestyle factors leading to prameha.
• Over-indulgence in the pleasure of sedentary habits, excess sleep are lifestyle factors leading to prameha.
• Patients who suffer from prameha since birth (congenital) and those who are borne of prameha parents (hereditary) are not curable because of the morbidity in their bija (genes). Similarly, other hereditary (kulaja/familial) ailments are considered as incurable.
• Patients who suffer from prameha since birth (congenital) and those who are borne of prameha parents (hereditary) are not curable because of the morbidity in their bija (genes). Similarly, other hereditary (kulaja/familial) ailments are considered as incurable.
=== Vidhi Vimarsha ===
Role of kapha dominant diet:
Role of kapha dominant diet:
In prameha, kapha is the main culprit both as dosha as well as dushya. Diet having high contents of bad fat and carbohydrates like curd (Fat= 3g/ 100g, carbohydrate= 7.8g/100g, Protein= 5.25g, calories= 63), meat soup (calories= 902), jaggery (Fat= 0g/ 100g, carbohydrate= 97.2 g/100g, Protein= 0.5g/100g, calories= 367), newly harvested grains that are having high calories than old one (If dry grains are held for only a few months, minimum nutritional changes will take place, but if the grains are held with a higher amount of moisture, the grain quality can deteriorate because of starch degradation by grain and microbial amylases) etc., causes prameha. All the causative factors are in diet that have high content of bad fat like saturated fats and no good fats like polyunsaturated or monounsaturated fats (which are mostly present in plant originated dietary products). It is advisable that maximum percentage of daily fat consumption should come from plant origin to lower the risk of dyslipidemia.
In prameha, kapha is the main culprit both as dosha as well as dushya. Diet having high contents of bad fat and carbohydrates like curd (Fat= 3g/ 100g, carbohydrate= 7.8g/100g, Protein= 5.25g, calories= 63), meat soup (calories= 902), jaggery (Fat= 0g/ 100g, carbohydrate= 97.2 g/100g, Protein= 0.5g/100g, calories= 367), newly harvested grains that are having high calories than old one (If dry grains are held for only a few months, minimum nutritional changes will take place, but if the grains are held with a higher amount of moisture, the grain quality can deteriorate because of starch degradation by grain and microbial amylases) etc., causes prameha. All the causative factors are in diet that have high content of bad fat like saturated fats and no good fats like polyunsaturated or monounsaturated fats (which are mostly present in plant originated dietary products). It is advisable that maximum percentage of daily fat consumption should come from plant origin to lower the risk of dyslipidemia.
Obesity consists of increased triglycerides (TG) and FFA, decreased HDL-C with HDL dysfunction and normal or slightly increased LDL-C with increased small dense LDL constitute to dyslipidemia.
An etiological factor first causes the provocation of kapha because of close resemblence to the related hetu. This provoked kapha spreads all over the body quickly because of the sharirashaithilya (weak assemblage in between tissues). While spreading it gets mixed with meda dhatu, which is excess in quantity and is abaddha (not mixed) and has concordent properties with kapha. This annexation of vitiated meda and kapha comes in contact with sharirakleda (moisture in body) and mamsa, which are already in excess quantity resulting putimamsapidaka (boil due to putrified muscle tissue). On the other hand the vitiated kleda gets converted into mutran(urine). The kapha along with meda and kleda covers the openings of mutravaha strotas resulting in prameha (Cha. ni.4/8).
An etiological factor first causes the provocation of kapha because of close resemblence to the related hetu. This provoked kapha spreads all over the body quickly because of the sharirashaithilya (weak assemblage in between tissues). While spreading it gets mixed with meda dhatu, which is excess in quantity and is abaddha (not mixed) and has concordent properties with kapha. This annexation of vitiated meda and kapha comes in contact with sharirakleda (moisture in body) and mamsa, which are already in excess quantity resulting putimamsapidaka (boil due to putrified muscle tissue). On the other hand the vitiated kleda gets converted into mutran(urine). The kapha along with meda and kleda covers the openings of mutravaha strotas resulting in prameha (Cha. ni.4/8).
Overweight in prediabetics has been observed to be associated with hyperinsulinism, whether the hyperinulinisim is cause or effect is questionable. To keep the glucose metabolism within normal limits there is more and more secretion of insulin, this causes overeating and its conversion into adipose tissue. The latter is possible due to excess of growth hormone. Thus excessive growth hormone and metabolism may be associated with diabetes especially kaphaja meha type.
Overweight in prediabetics has been observed to be associated with hyperinsulinism, whether the hyperinulinisim is cause or effect is questionable. To keep the glucose metabolism within normal limits there is more and more secretion of insulin, this causes overeating and its conversion into adipose tissue. The latter is possible due to excess of growth hormone. Thus excessive growth hormone and metabolism may be associated with diabetes especially kaphaja meha type.
Diagnosis of prameha based on characteristics of urine:
==== Diagnosis of prameha based on characteristics of urine ====
Different categories of prameha are described to possess the colour, taste, touch, and smell of the respective dohsas. For example, in kaphaja prameha, the urine is characterized by white colour, sweet taste; cold touch and ama gandha (smell like that of flesh). In the same way, the characteristic features of pittaja prameha are to be determined. Vayu itself is colourless. Therefore, different varieties of vata dominant prameha are characterized by grayish or reddish colour of urine as a result of the prabhava (specific action) of the vayu.
Different categories of prameha are described to possess the colour, taste, touch, and smell of the respective dohsas. For example, in kaphaja prameha, the urine is characterized by white colour, sweet taste; cold touch and ama gandha (smell like that of flesh). In the same way, the characteristic features of pittaja prameha are to be determined. Vayu itself is colourless. Therefore, different varieties of vata dominant prameha are characterized by grayish or reddish colour of urine as a result of the prabhava (specific action) of the vayu.
Vata dominant prameha is already described to be incurable (asadhya). Again repeating the statement regarding its incurability implies that the presence of several symptoms including the grayish and reddish colouration of urine right from the origin of disease is incurable; and if these signs and symptoms appear at later stage, then the condition is incurable. In the latter type, attributes of majja etc., need not to be present. Alternatively, it can be explained that when at a later stage, any type of prameha gets associated with vayu and characterized by grayish and reddish colouration of urine, and then it also becomes incurable. In addition when kaphaja and pittaja types of prameha are associated with the passage of Majja etc., in the urine, they become incurable. It is stated, “All types of prameha, if not treated in time, leads to madhumeha and become incurable” ( Susruta : Nidana 6).
Vata dominant prameha is already described to be incurable (asadhya). Again repeating the statement regarding its incurability implies that the presence of several symptoms including the grayish and reddish colouration of urine right from the origin of disease is incurable; and if these signs and symptoms appear at later stage, then the condition is incurable. In the latter type, attributes of majja etc., need not to be present. Alternatively, it can be explained that when at a later stage, any type of prameha gets associated with vayu and characterized by grayish and reddish colouration of urine, and then it also becomes incurable. In addition when kaphaja and pittaja types of prameha are associated with the passage of Majja etc., in the urine, they become incurable. It is stated, “All types of prameha, if not treated in time, leads to madhumeha and become incurable” ( Susruta : Nidana 6).
• Glucose: Ikshumeha, Madhumeha
• Glucose: Ikshumeha, Madhumeha
• Bilirubin : Haridrameha
• Bilirubin : Haridrameha
Vivid description of Manjjisthameha, Raktameha, Siktameha clearly indicate evolved observation skills of physicians. Analyzing the details of urine characteristics the scientific approach of Ayurveda is established. It is really appreciable that a disease can be classified and identified at every stage merely by urinalysis.
Importance of barley:
Importance of barley:
Barley should constitute the principal ingredient of food of the patient suffering from prameha. The patient suffering from kaphaja prameha should take eatable prepared of barley mixed with honey.
Barley should constitute the principal ingredient of food of the patient suffering from prameha. The patient suffering from kaphaja prameha should take eatable prepared of barley mixed with honey.
Curcuma neilgherrensis Wight, in the dose of 400mg/kg, showed a mild reduction in blood glucose level at 3rd and 5th hour in normoglycemic mice; however, the observed decrease in blood glucose level was found to be statistically insignificant. Even though the drug failed to cease the hypoglycemia in the first hour after the glucose overload, it attenuated the same in later hours, but not in a significant manner.
Curcuma neilgherrensis Wight, in the dose of 400mg/kg, showed a mild reduction in blood glucose level at 3rd and 5th hour in normoglycemic mice; however, the observed decrease in blood glucose level was found to be statistically insignificant. Even though the drug failed to cease the hypoglycemia in the first hour after the glucose overload, it attenuated the same in later hours, but not in a significant manner.
The study reveals that C. neilgherrensis is having mild hypoglycemic potential and moderate antihyperglycemic effect. A clinical trial investigating the effects of combining C. neilgherrensis treatment with conventional therapy compared to the C. neilgherrensis alone showed that C. neilgherrensis significantly reduces the level of fasting blood sugar, postprandial blood glucose level, glycosylated hemoglobin, serum cholesterol, LDL and urine sugar. ,
Gymnema Sylvester:
Gymnema Sylvester:
A pilot study on an herbal mixture containing tejapatra (Cinnamomum Tamala) , pushkarmula (Inula racemosa), mamejjaka (E.littorale), meshashringi (Gymnema Sylvestre), and jambu (Syzygium cumini) seeds with karvellaka (bitter gourd; bitter melon; Momordica charantia) juice, administered at a dose of 5g twice a day before meals, decreased fasting and post- prandial blood glucose levels in patients with diabetes. Avartaki (Cassia auriculata Linn.) and methika (Trigonella foenum- graecum) as single herbs and decoction of nimba or neem (Azadirachta indica A.juss;) have also demonstrated blood glucose- lowering action. In a clinical study on patients with type 2 diabetes, neem showed significant hypoglycemic effect. The effect of neem was comparable to that of glibenclamide. ,
A pilot study on an herbal mixture containing tejapatra (Cinnamomum Tamala) , pushkarmula (Inula racemosa), mamejjaka (E.littorale), meshashringi (Gymnema Sylvestre), and jambu (Syzygium cumini) seeds with karvellaka (bitter gourd; bitter melon; Momordica charantia) juice, administered at a dose of 5g twice a day before meals, decreased fasting and post- prandial blood glucose levels in patients with diabetes. Avartaki (Cassia auriculata Linn.) and methika (Trigonella foenum- graecum) as single herbs and decoction of nimba or neem (Azadirachta indica A.juss;) have also demonstrated blood glucose- lowering action. In a clinical study on patients with type 2 diabetes, neem showed significant hypoglycemic effect. The effect of neem was comparable to that of glibenclamide. ,
The herb gokshura (Tribulus Terrestris Linn.), asana (Pterocarpus marsupium Roxb.), kulatha [ Vigna unguiculata (Linn.) Walp.], and saptaparna [Alstonia scholaris (Linn.) R.Br.] is also beneficial in treating prameha. These herbs can be used in different combinations, depending on the doshic involvement and severity of illness. An herbal mixture comprised of one part each of karvellaka (bitter gourd; bitter melon; Momordica charantia), jambu (Syzygium cumini), gurmar (Meshashringi G.sylvestre), and amra (Moringa indica Linn.), taken along with shilajit, was investigated in a clinical study on 805 patients with diabetes. The results showed a statistically significant reduction in fasting and postprandial blood glucose along with clinical improvement (website of India’s Central Council for Research in Ayurveda and Siddha).
The herb gokshura (Tribulus Terrestris Linn.), asana (Pterocarpus marsupium Roxb.), kulatha [ Vigna unguiculata (Linn.) Walp.], and saptaparna [Alstonia scholaris (Linn.) R.Br.] is also beneficial in treating prameha. These herbs can be used in different combinations, depending on the doshic involvement and severity of illness. An herbal mixture comprised of one part each of karvellaka (bitter gourd; bitter melon; Momordica charantia), jambu (Syzygium cumini), gurmar (Meshashringi G.sylvestre), and amra (Moringa indica Linn.), taken along with shilajit, was investigated in a clinical study on 805 patients with diabetes. The results showed a statistically significant reduction in fasting and postprandial blood glucose along with clinical improvement (website of India’s Central Council for Research in Ayurveda and Siddha).
Future Scope for Research:
=== Future Scope for Research ===
1. Fundamental studies to observe link between meda (adipose tissue) and urinary disorders are needed.
1. Fundamental studies to observe link between meda (adipose tissue) and urinary disorders are needed.
2. Searching herbs describe in the chapter for their potential in reducing FFAs and blood glucose level.
2. Searching herbs describe in the chapter for their potential in reducing FFAs and blood glucose level.