Changes

=== Introduction ===

=== Introduction ===

The word ‘Prameha’ literally means urinary disorders with increased quantity of urine with turbidity in it. In the last chapter of nidana section, prameha is referred to be originated from excess consumption of ghee. The present chapter prameha deals with detail etio-pathogenesis, clinical features, classification and management of prameha. It is widely considered as diabetes mellitus. However, prameha covers various types of obstinate urinary disorders under its umbrella. The key to management of prameha roga is to attempt to stop its pathogenesis for which the etiological factors responsible for the origin of the disease are identified. These etiological factors include both faulty dietary habits and life style that cause imbalance between energy consumption and energy expenditure and ultimately cause obesity. Indulgence in high calory diet including refined carbohydrate and bad fat associated with sedentary life style causes excessive storage of fatty tissue in body to disturb the body mass index. The disturbed body mass index reflects as obesity causing disturbed lipid metabolism and assimilation (FFAs, TG, HDL and VLDL) that in turn causes insulin resistance and produces type-2 DM. This is very intresting that the ancient Acharyas were aware of the fact that insulin resistance is secondary to the dyslipidemia. Therefore, the patients of prameha are classified as sthoola pramehi and krisha pramehi which can be identified based on body mass index. All those factors, that cause vitiation of kapha will produce prameha. In the end of the chapter, it is mentioned that jatah/ kulaja (hereditary) prameha and madhumeha are incurable. Prameha is also classified as (1) jatah pramehi (hereditary) and (2) sthula pramehi (acquired). Further justification  that acquired type of prameha (apathyanimmitaja) occurs only in obese persons i.e. obesity is the root cause for insulin resistance. But in addition to that it is stated that genetic predisposition is also required for the development of disease. There is difference of opinion among Ayurvedic personnel for accepting prameha as diabetes mellitus. Though it is not always justified to have neck to neck correlation of Ayurvedic terms with modern terms but sometime beams from this ancient science prove helpful in probing the right path for management of some dreaded diseases that puzzle the modern scientists today. One of the good examples for this is diabetes. Years of research and inexplicable expenditure are unable to have any successful management for this disease and to prevent its horrible complications, while the key for its successful management is very well decribed in this most authentic tretise of Ayurveda. Now modern science belives that it is raised FFAs that causes insulin resistance and produces diabetes mellitus along with hypertension and atherogenic dislipidemias.[ , ] Now it is assumed that targeting FFA will help in improving insulin resistance more than using only hypoglycemic drugs. The chapter clearly depicts that Ayurvedic approach for the management of prameha by apatarpana chikitsa (depleting therapy), drugs as well as diet that are helpful in lowering both fat as well as glucose such as yava (barley), triphala etc.   

The word ''Prameha'' literally means urinary disorders with increased quantity of urine with turbidity in it. In the last chapter of [[Nidana Sthana]], ''prameha'' is said to have originated from excess consumption of ghee. This chapter deals with the detail etio-pathogenesis, clinical features, classification and management of ''prameha''. It is widely considered as diabetes mellitus. However, ''prameha'' covers various types of obstinate urinary disorders under its umbrella. The key to management of ''prameha roga'' is to attempt to stop its pathogenesis for which the etiological factors responsible for the origin of the disease are identified. These etiological factors include both faulty dietary habits and life style that cause imbalance between energy consumption and energy expenditure and ultimately cause obesity. Indulgence in high calorie diet including refined carbohydrate and bad fat associated with sedentary life style causes excessive storage of fatty tissue in body to disturb the body mass index. The disturbed body mass index reflects as obesity causing disturbed lipid metabolism and assimilation (FFAs, TG, HDL and VLDL) that in turn causes insulin resistance and produces type-2 DM.  

 

It is interesting to note that the ancient acharyas (preceptors, teachers) were aware of the fact that insulin resistance is secondary to the dyslipidemia. Therefore, the patients of ''prameha'' are classified as ''sthula pramehi'' and ''krisha pramehi'' which can be identified based on body mass index. All those factors, that cause vitiation of ''kapha'' will cause ''prameha''. At the end of the chapter, it is mentioned that ''jatah/ kulaja'' (hereditary) ''prameha'' and ''madhumeha'' are incurable. ''Prameha'' is also classified as (1) ''jatah pramehi'' (hereditary) and (2) ''sthula pramehi'' (acquired). Further justification  that acquired type of ''prameha'' (''apathyanimmitaja'') occurs only in obese persons i.e. obesity is the root cause for insulin resistance. But in addition to that it is stated that genetic predisposition is also required for the development of disease. There is difference of opinion within the Ayurvedic community on equating ''prameha'' with diabetes mellitus. Though it is not always feasible to accurately/exactly correlate or map Ayurvedic terms with modern medical concepts (e.g., there are no accurate medical terms to explain the concepts of gulma or prameha) , Ayurveda provides insights that can prove to be invaluable in exploring effective ways of the management of various chronic diseases, including diabetes. The medical community of today believes that raised FFAs cause insulin resistance leading to diabetes mellitus along with hypertension and atherogenic dislipidemias. It is assumed that targeting FFA will help in mitigating insulin resistance more than using only hypoglycemic drugs. This chapter clearly depicts that the Ayurvedic approach for the management of ''prameha'' by ''apatarpana chikitsa'' (depleting therapy), drugs as well as diet that are helpful in lowering both fat as well as glucose such as ''yava'' (barley), ''triphala'' etc.  

   

The chapter also gives the detailed description of urinalysis for the diagnosis, classification and assessment of prognosis of the disease. Distinctive description of raktameha and siktameha correlates with current method of microscopic examination of urine.

The chapter also gives the detailed description of urinalysis for the diagnosis, classification and assessment of prognosis of the disease. Distinctive description of raktameha and siktameha correlates with current method of microscopic examination of urine.

Description of Sahaja prameha and role of genetic predisposition in the development of disease clears all the dout about the scientific validity of Ayurveda.

Description of Sahaja prameha and role of genetic predisposition in the development of disease clears all the dout about the scientific validity of Ayurveda.