Changes

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.  

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<ref>Boden G, Chen X, Ruiz J, et al. Mechanisms of fatty acid-induced inhibition of glucose uptake. J Clin Invest.1994;93:2438–2446. </ref>Santomauro ATMG, Boden G, Silva M, et al. Overnight lowering of free fatty acids with acipimox improves insulin resistance and glucose tolerance in obese diabetic and nondiabetic subjects. Diabetes. 1999;48:1836–1841 </ref>. 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.  

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<ref>Boden G, Chen X, Ruiz J, et al. Mechanisms of fatty acid-induced inhibition of glucose uptake. J Clin Invest.1994;93:2438–2446. </ref><ref>Santomauro ATMG, Boden G, Silva M, et al. Overnight lowering of free fatty acids with acipimox improves insulin resistance and glucose tolerance in obese diabetic and nondiabetic subjects. Diabetes. 1999;48:1836–1841 </ref>. 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.