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Prameha Chikitsa (view source)

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{{#seo:

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|title=Prameha Chikitsa

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|titlemode=append

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|keywords=Sthula Pramehi, Krisha Pramehi, Chikitsa, Diabetes Mellitus, obstinate urinary disorders

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|description=Chikitsa Sthana Chapter 6. Management of Prameha (Obstinate Urinary Disorders)

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}}

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<big>'''[[Chikitsa Sthana]] Chapter 6. Management of Prameha (Obstinate Urinary Disorders)'''</big>

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<big>'''Abstract'''</big>

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''Prameha'' is a set of complex clinical disorders characterized by frequent abnormal micturition, with the etiology involving genetic predisposition as well as improper diet and lifestyle. The clinical conditions described in ''prameha'' have much in common with diabetes mellitus. In the chapter dealing with the treatment for the alleviation of ''prameha'' following topics have been discussed: Etiology of the disease; ''doshas'' and ''dushyas'' involved in the pathogenesis of the disease; Curability and incurability of the disease; Signs and symptoms of the disease; Two types of ''prameha'' patients; Three categories of therapy; viz. ''samshodhana'' (elimination therapy), ''samshamana'' (alleviation therapy) and ''nidana parivarjana'' (avoiding causative factors); Disadvantages of over depletion; Eatables prepared of barley, ''mantha'' (thin gruel) and decoctions for the cure of ''prameha''.

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Treatment of ''prameha'' includes, medicated oil, medicated ghee, various recipes of linctus, food preparations; good quality ''asavas'' (fermented drinks) having known therapeutic utility; and different methods of exercise, baths, unctuous and fragrant applications. Though ''prameha'' is widely accepted as description of diabetes, it covers various types of urinary disorders.

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'''Keywords''': ''Sthula Pramehi, Krisha Pramehi, Chikitsa,'' Diabetes Mellitus, obstinate urinary disorders

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{{Infobox

|title = Prameha Chikitsa

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}}

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~~==([[Chikitsa Sthana]] Chapter 6, Chapter on the Management of Obstinate Urinary Disorders) ==~~

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~~=== Abstract ===~~

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''Prameha'' is a set of complex clinical disorders characterized by frequent abnormal micturition, with the etiology involving genetic predisposition as well as improper diet and lifestyle. The clinical conditions described in ''prameha'' have much in common with diabetes mellitus. In the chapter dealing with the treatment for the alleviation of ''prameha'' following topics have been discussed: Etiology of the disease; ''doshas'' and ''dushyas'' involved in the pathogenesis of the disease; Curability and incurability of the disease; Signs and symptoms of the disease; Two types of ''prameha'' patients; Three categories of therapy; viz. ''samshodhana'' (elimination therapy), ''samshamana'' (alleviation therapy) and ''nidana parivarjana'' (avoiding causative factors); Disadvantages of over depletion; Eatables prepared of barley, ''mantha'' (thin gruel) and decoctions for the cure of ''prameha''.

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Treatment of ''prameha'' includes, medicated oil, medicated ghee, various recipes of linctus, food preparations; good quality ''asavas'' (fermented drinks) having known therapeutic utility; and different methods of exercise, baths, unctuous and fragrant applications. Though ''prameha'' is widely accepted as description of diabetes, it covers various types of urinary disorders.

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~~'''Keywords''': ''Sthula Pramehi, Krisha Pramehi, Chikitsa,'' Diabetes Mellitus, obstinate urinary disorders~~

=== Introduction ===

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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.

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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.

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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.

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

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

===Sanskrit text, Transliteration and English Translation===

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अथातः प्रमेहचिकित्सितं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

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athātaḥ pramēhacikitsitaṁ vyākhyāsyāmaḥ||1||

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iti ha smAha bhagavAnAtreyaH||2||

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</div></div>

We shall now expound the chapter on the treatment of ''Prameha''. Thus, said Lord Atreya. [1-2]

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निर्मोहमानानुशयो निराशः पुनर्वसुर्ज्ञानतपोविशालः|

कालेऽग्निवेशाय सहेतुलिङ्गानुवाच मेहाञ्शमनं च तेषाम्||३||

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nirmōhamānānuśayō nirāśaḥ punarvasurjñānatapōviśālaḥ|

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kAle~agniveshAya sahetuli~ggAnuvAca Meha~jshamanaM ca teShAm||3||

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</div></div>

Punarvasu who is free from delusion, ego, hatred and attachment, and who has attained magnanimity because of his knowledge and penance, described the etiology, signs and symptoms, and treatment of ''meha'' (''prameha'') to Agnivesha at proper time (when query was asked).[3]

==== Etiology of ''prameha'' ====

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आस्यासुखं स्वप्नसुखं दधीनि ग्राम्यौदकानूपरसाः पयांसि|

नवान्नपानं गुडवैकृतं च प्रमेहहेतुः कफकृच्च सर्वम्||४||

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āsyāsukhaṁ svapnasukhaṁ dadhīni grāmyaudakānūparasāḥ payāṁsi|

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navAnnapAnaM guDavaikRutaM ca PramehahetuH kaphakRucca sarvam||4||

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</div></div>

Over-indulgence in the pleasure of sedentary habits, excess sleep, curds, soup of the meat of domesticated and 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''. [4]

==== ''Dushya'' (vitiated factors) and pathogeneis ====

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मेदश्च मांसं च शरीरजं च क्लेदं कफो बस्तिगतं प्रदूष्य|

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दोषो हि बस्तिं समुपेत्य मूत्रं सन्दूष्य मेहाञ्जनयेद्यथास्वम्||६||

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mēdaśca māṁsaṁ ca śarīrajaṁ ca klēdaṁ kaphō bastigataṁ pradūṣya|

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doSho hi bastiM samupetya mUtraM sandUShya Meha~jjanayedyathAsvam||6||

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</div></div>

Aggravated ''kapha'' vitiates ''medas, mamsa'' and ''kleda'' of the body located in ''basti'' (bladder and urinary system) and causes different types of ''kapha'' dominant ''meha''.

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==== Classification and Prognosis ====

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साध्याः कफोत्था दश, पित्तजाः षट् याप्या, न साध्यः पवनाच्चतुष्कः||

समक्रियत्वाद्विषमक्रियत्वान्महात्ययत्वाच्च यथाक्रमं ते||७||

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sādhyāḥ kaphōtthā daśa, pittajāḥ ṣaṭ yāpyā, na sādhyaḥ pavanāccatuṣkaḥ|

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samakriyatvAdviShamakriyatvAnmahAtyayatvAcca yathAkramaM te||7||

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</div></div>

''Kaphaja pramehas'' are of ten types and they are curable because of their compatibility of the therapies meant for their cure (''samakriyatvata'').

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==== Vitiating factors involved in pathogenesis ====

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कफः सपित्तः पवनश्च दोषा मेदोऽस्रशुक्राम्बुवसालसीकाः|

मज्जा रसौजः पिशितं च दूष्याः[१] प्रमेहिणां, विंशतिरेव मेहाः||८||

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kaphaḥ sapittaḥ pavanaśca dōṣā mēdō'sraśukrāmbuvasālasīkāḥ|

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majjA rasaujaH pishitaM ca dUShyAH pramehiNAM, viMshatireva MehaH||8||

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</div></div>

''Doshas'' like ''kapha, pitta'' and ''vata,'' and ''dushyas'' like ''medas, rakta, shukra, ambu'' (body fluid), ''vasa'' (muscle fat), ''lasika'' (lymph), ''majja, rasa, ojas'' and ''mamsa'' are responsible for the causation of ''prameha'' which is of twenty types. [8]

==== Twenty types of ''dosha'' dominant ''prameha'' ====

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जलोपमं चेक्षुरसोपमं वा घनं घनं चोपरि विप्रसन्नम्|

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चतुर्विधं मूत्रयतीह[१] वाताच्छेषेषु धातुष्वपकर्षितेषु||११||

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jalōpamaṁ cēkṣurasōpamaṁ vā ghanaṁ ghanaṁ cōpari viprasannam|

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caturvidhaM mUtrayatIha vAtAccheSheShu dhAtuShvapakarShiteShu||11||

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</div></div>

Ten varieties of ''kaphaja meha'' have the following characteristic features:

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==== Criteria for diagnosis ====

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वर्णं रसं स्पर्शमथापि गन्धं यथास्वदोषं भजते प्रमेहः|

श्यावारुणो वातकृतः सशूलो मज्जादिसाद्गुण्यमुपैत्यसाध्यः||१२||

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varṇaṁ rasaṁ sparśamathāpi gandhaṁ yathāsvadōṣaṁ bhajatē pramēhaḥ|

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shyAvAruNo vAtakRutaH sashUlo majjAdisAdguNyamupaityasAdhyaH||12||

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</div></div>

Different types of ''prameha'' are characterized by the color, taste, touch and smell of the respective ''dosha''. ''Vatika'' varieties of ''prameha'' are characterized by grayish or reddish coloration of the urine, pain and attributes of ''majja'', etc. These types of ''vatika prameha'' are incurable. [12]

==== Premonitory signs and symptoms ====

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स्वेदोऽङ्गगन्धः शिथिलाङ्गता च शय्यासनस्वप्नसुखे रतिश्च|

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भविष्यतो मेहगदस्य रूपं मूत्रेऽभिधावन्ति पिपीलिकाश्च||१४||

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svēdō'ṅgagandhaḥ śithilāṅgatā ca śayyāsanasvapnasukhē ratiśca|

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shItapriyatvaM galatAlushoSho mAdhuryamAsye karapAdadAhaH| bhaviShyato

Mehagadasya rUpaM mUtre~abhidhAvanti pipIlikAshca||14||

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</div></div>

Sweating, body odor, flabbiness of the body, liking for constantly lying on the bed, sitting, sleeping and leading an easy life, a feeling as if the cardiac region is covered with extraneous material, exudation of excreta from eyes, tongue and ears, corpulence of the body, excessive growth of hair and nails, liking for cold things, dryness of throat and palate, sweet taste in the mouth, burning sensation in hands and legs and swarming of ants on the urine- these are the premonitory signs and symptoms of ''prameha''. [13-14]

==== Principles of management ====

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स्थूलः प्रमेही बलवानिहैकः कृशस्तथैकः परिदुर्बलश्च|

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प्रमेहिणः स्युः, परितर्पणानि[२] कार्याणि तस्य[३] प्रसमीक्ष्य वह्निम्||१७||

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sthūlaḥ pramēhī balavānihaikaḥ kr̥śastathaikaḥ paridurbalaśca|

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pramehiNaH syuH, paritarpaNAni kAryANi tasya prasamIkShya vahnim||17||

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</div></div>

Patients suffering from ''prameha'' are classified into two categories, viz. (1) those who are obese and strong, and (2) those who are emaciated and weak.

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==== ''Samshamana'' ( pacification therapy) ====

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संशोधनं नार्हति यः प्रमेही तस्य क्रिया संशमनी प्रयोज्या|

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देयास्तथा वेणुयवा यवानां कल्पेन गोधूममयाश्च भक्ष्याः||२४||

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saṁśōdhanaṁ nārhati yaḥ pramēhī tasya kriyā saṁśamanī prayōjyā|

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kharAshvagohaMsapRuShadbhRutAnAM tathA yavAnAM vividhAshca bhakShyAH| deyAstathA veNuyavA yavAnAM kalpena godhUmamayAshca bhakShyAH||24||

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</div></div>

If the patient of ''prameha'' is not eligible for ''samshodhana'' or elimination therapy, ''samshamana'' or alleviation therapies should be given. [18]

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==== Specific Therapies ====

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संशोधनोल्लेखनलङ्घनानि काले प्रयुक्तानि कफप्रमेहान्|

जयन्ति पित्तप्रभवान् विरेकः सन्तर्पणः संशमनो विधिश्च||२५||

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saṁśōdhanōllēkhanalaṅghanāni kālē prayuktāni kaphapramēhān|

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jayanti pittaprabhavAn virekaH santarpaNaH saMshamano vidhishca||25||

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</div></div>

Purificatory therapies including specifically emesis and fasting therapies, administered at the appropriate time, cure ''kaphaja'' types of ''prameha''. Similarly, ''pittaja'' types of ''prameha'' are overcome by purgation, ''santarpana'' (refreshing therapy) and alleviation therapies. [25]

==== Various recipes ====

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दार्वीं सुराह्वां त्रिफलां समुस्तां कषायमुत्क्वाथ्य पिबेत् प्रमेही|

क्षौद्रेण युक्तामथवा हरिद्रां पिबेद्रसेनामलकीफलानाम्||२६||

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dārvīṁ surāhvāṁ triphalāṁ samustāṁ kaṣāyamutkvāthya pibēt pramēhī|

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kShaudreNa yuktAmathavA haridrAM pibedrasenAmalakIphalAnAm||26||

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</div></div>

The patient suffering from ''prameha'' should take the decoction of ''darvi, surahva, triphala'' and ''musta'' mixed with honey. He may also take ''haridra'' along with the juice of ''amalaki''. [26]

===== Decoctions for ''kaphaja prameha'' =====

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हरीतकीकट्फलमुस्तलोध्रं पाठाविडङ्गार्जुनधन्वनाश्च|

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पादैः कषायाः कफमेहिनां ते दशोपदिष्टा मधुसम्प्रयुक्ताः||२९||

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harītakīkaṭphalamustalōdhraṁ pāṭhāviḍaṅgārjunadhanvanāśca|

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pAdaiH kaShAyAH kaphamehinAM te dashopadiShTA madhusamprayuktAH||29||

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</div></div>

The following ten decoctions should be mixed with honey and given to patients suffering from ''kaphaja prameha'':

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===== Decoctions for ''pittaja prameha'' =====

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उशीरलोध्राञ्जनचन्दनानामुशीरमुस्ता मलकाभयानाम्|

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पैत्तेषु मेहेषु दश प्रदिष्टाः पादैः कषाया मधुसम्प्रयुक्ताः||३२||

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uśīralōdhrāñjanacandanānāmuśīramustāmalakābhayānām|

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paitteShu meheShu dasha pradiShTAH pAdaiH kaShAyA madhusamprayuktAH||32||

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</div></div>

The following ten decoctions should be mixed with honey and given to patients suffering from ''pittaja prameha'':

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===== Decoctions for all types of ''prameha'' =====

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सर्वेषु मेहेषु मतौ तु पूर्वौ कषाययोगौ विहितास्तु सर्वे|

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मेदः कफश्चैव कषाययोगैः स्नेहैश्च वायुः शममेति तेषाम्||३४||

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sarvēṣu mēhēṣu matau tu pūrvau kaṣāyayōgau vihitāstu sarvē|

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medaH kaphashcaiva kaShAyayogaiH snehaishca vAyuH shamameti teShAm||34||

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</div></div>

Two recipes of decoction are described for the treatment of all varieties of ''prameha''. These decoctions can be used for the preparation of ''mantha'' (a drink prepared of roasted corn flour mixed with water), for the impregnation of barley and for the preparation of different kinds of food and drinks.

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===== Formulations for ''kaphaja'' and ''pittaja prameha'' =====

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कम्पिल्लसप्तच्छदशालजानि बैभीतरौहीतककौटजानि|

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जीर्णे च भुञ्जीत पुराणमन्नं मेही रसैर्जाङ्गलजैर्मनोज्ञैः||३६||

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kampillasaptacchadaśālajāni baibhītarauhītakakauṭajāni|

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jIrNe ca bhu~jjIta purANamannaM mehI rasairjA~ggalajairmanoj~jaiH||36||

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</div></div>

Powder of ''kampillaka'', barks of ''saptachchada, bibhitaka, rohitaka'' and ''kutaja'' and flower of ''kapittha'' should be added with honey, made to a linctus and taken by patients suffering from ''kaphaja'' and ''pittaja prameha''. One ''aksha'' of the paste of above mentioned drugs should be mixed with the juice of ''amalaki'' and given at the appropriate time to patients suffering from ''kaphaja'' and ''pittaja'' types of ''prameha''. After the digestion of this potion, the patient should be given to eat old rice cooked and mixed with the delicious soup of the meat of animals living in arid land.[35-36]

===== Formulations for ''vata'' association in ''kaphaja'' and ''pittaja prameha'' =====

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दृष्ट्वाऽनुबन्धं पवनात् कफस्य पित्तस्य वा स्नेहविधिर्विकल्प्यः|

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पिबेत् कषायं मधुसम्प्रयुक्तं सर्वप्रमेहेषु समुद्धतेषु||४०||

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dr̥ṣṭvā'nubandhaṁ pavanāt kaphasya pittasya vā snēhavidhirvikalpyaḥ|

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pibet kaShAyaM madhusamprayuktaM sarvaprameheShu samuddhateShu||40||

+

</div></div>

If ''vayu'' is secondarily aggravated along with either ''kapha'' or ''pitta'', then the patient should be administered unctuous preparations. For the ''kapha'' aggravation, medicated oil should be processed with the decoction of ''kapha'' alleviating drugs. .For the pitta aggravation, medicated ghee should be processed with the decoction of ''pitta'' alleviating drugs. ''Trikantaka, ashmantaka, somavalka, bhallataka, ativisha, lodhra, vacha, patola, arjuna, nimbi, musta, haridra, padmaka, dipyaka, manjishtha, aguru'' and ''chandana''- all these drugs together should be used in the preparation of medicated oil for the treatment of ''kaphaja prameha'' which is associated with secondarily aggravated ''vayu''. In case of pitta dominance, ghee shall be processed with above mentioned drugs.

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==== ''Madhvasava'' ====

+

लोध्रं शटीं पुष्करमूलमेलां मूर्वां विडङ्गं त्रिफलां यमानीम्|

Line 667: Line 729:

इति मध्वासवः|

+

lōdhraṁ śaṭīṁ puṣkaramūlamēlāṁ mūrvāṁ viḍaṅgaṁ triphalāṁ yamānīm|

Line 703: Line 766:

iti madhvAsavaH|

+

</div></div>

''Lodhra, shati, pushkaramula, ela, murva, vidanga, triphala, yamani, chavya, priyangu, kramuka, vishala, kiratatikta, katurohini, bharngi, nata, chitraka, pippalimula, kushtha, ativisha, patha, kalingaka, keshara, indravaruni, nakha, patra, maricha'' and ''plava''- one ''karsha'' of each of these drugs should be boiled in one ''drona'' of water till one fourth remains. This decoction along with half its quantity of honey should be kept inside a ghee smeared jar for a fort night. This is called ''madhvasava''. It instantaneously cures ''kaphaja'' and ''paittika'' types of ''meha'' when administered in a dose of two ''palas''. It also cures ''pandu, arsha, aruchi, grahani dosha, kilasa'' and different types of ''kushtha''.[41-44]

==== ''Dantyasava'' and ''bhallatakasava'' ====

+

क्वाथः स एवाष्टपलं च दन्त्या भल्लातकानां च चतुष्पलं स्यात्|

सितोपला त्वष्टपला विशेषः क्षौद्रं च तावत् पृथगासवौ तौ||४५||

+

kvāthaḥ sa ēvāṣṭapalaṁ ca dantyā bhallātakānāṁ ca catuṣpalaṁ syāt|

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sitopalA tvaShTapalA visheShaH kShaudraM ca tAvat pRuthagAsavau tau||45||

+

</div></div>

In the above mentioned decoction, eight ''palas'' of ''danti'', eight ''palas'' of sugar and the same quantity of honey should be added and processed. Similarly, in the above mentioned decoction four ''palas'' of ''bhallataka'', eight ''palas'' of sugar and the same quantity of honey should be added and processed. These two ''asavas'' (namely ''dantyasava'' and ''bhallatokusava'') are useful in the treatment of ''prameha''. [45]

==== Beneficial diet and drinks ====

+

सारोदकं वाऽथ कुशोदकं वा मधूदकं वा त्रिफलारसं वा|

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श्वित्रं च कृच्छ्रं कफजं च कुष्ठं तथैव मुद्गामलकप्रयोगान्||४८||

+

sārōdakaṁ vā'tha kuśōdakaṁ vā madhūdakaṁ vā triphalārasaṁ vā|

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shvitraM ca kRucchraM kaphajaM ca kuShThaM tathaiva mudgAmalakaprayogAn||48||

+

</div></div>

The patient suffering from ''prameha'' should drink ''sarodaka'' (water boiled with the heart- wood of ''khadira'' etc.,), ''kushodaka'' (water boiled with ''kusha''), ''madhudaka'' (water mixed with honey), ''triphala rasa'' (juice or decoction of ''triphala'') or ''sidhu'' (a type of wine) which is properly fermented or ''madhvika'' (another type of wine) which is of superior quality and is prepared after fermenting for a long time.

Line 767: Line 837:

==== Indications of above treatment ====

+

सन्तर्पणोत्थेषु गदेषु योगा मेदस्विनां ये च मयोपदिष्टाः|

विरूक्षणार्थं कफपित्तजेषु सिद्धाः प्रमेहेष्वपि ते प्रयोज्याः||४९||

+

santarpaṇōtthēṣu gadēṣu yōgā mēdasvināṁ yē ca mayōpadiṣṭāḥ|

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virUkShaNArthaM kaphapittajeShu siddhAH prameheShvapi te prayojyAH||49||

+

</div></div>

Effective formulations for producing drying effect on obese patients while describing the management of diseases caused by over- nourishment are useful in the treatment of ''pramehas'' caused by ''kapha'' and ''pitta'' dominance. [49]

==== Various external applications ====

+

व्यायामयोगैर्विविधैः प्रगाढैरुद्वर्तनैः स्नानजलावसेकैः|

सेव्यत्वगेलागुरुचन्दनाद्यैर्विलेपनैश्चाशु[१] न सन्ति मेहाः||५०||

+

vyāyāmayōgairvividhaiḥ pragāḍhairudvartanaiḥ snānajalāvasēkaiḥ|

Line 795: Line 870:

sevyatvagelAgurucandanAdyairvilepanaishcAshu na santi MehaH||50||

+

</div></div>

''Pramehas'' get immediately cured by different types of exercises, unction, bath, sprinkling of water over the body and application of ointment made of ''sevya'' (''ushira''), ''tvak, ela, aguru, chandana'' etc. [50]

==== Indication of ''apatarpana'' treatment ====

+

क्लेदश्च मेदश्च कफश्च वृद्धः प्रमेहहेतुः प्रसमीक्ष्य तस्मात्|

वैद्येन पूर्वं कफपित्तजेषु मेहेषु कार्याण्यपतर्पणानि||५१||

+

klēdaśca mēdaśca kaphaśca vr̥ddhaḥ pramēhahētuḥ prasamīkṣya tasmāt|

Line 811: Line 889:

vaidyena pUrvaM kaphapittajeShu meheShu kAryANyapatarpaNAni||51||

+

</div></div>

Aggravated ''kleda'' (liquid element of the body), ''medas'' (adipose tissue) and ''kapha'' are responsible for the causation of ''prameha''. Keeping this in view, the physician, in the beginning, should administer depletion therapies to patients suffering with ''kapha'' and ''pitta'' dominant types of prameha. [51]

==== ''Vata'' dominant ''prameha'' ====

+

या वातमेहान् प्रति पूर्वमुक्ता वातोल्बणानां विहिता क्रिया सा|

वायुर्हि मेहेष्वतिकर्शितानां कुप्यत्यसाध्यान् प्रति नास्ति चिन्ता||५२||

+

yā vātamēhān prati pūrvamuktā vātōlbaṇānāṁ vihitā kriyā sā|

Line 827: Line 908:

vAyurhi meheShvatikarshitAnAM kupyatyasAdhyAn prati nAsti cintA||52||

+

</div></div>

Formulations described earlier for the ''vatika prameha'' are actually meant for ''vata'' dominant ''prameha'' where ''vayu'' is secondarily (subsequently) aggravated. If the ''vayu'' is primarily aggravated in ''prameha'' because of excessive depletion of tissue elements, then it is incurable and the physician need not make efforts to treat. [52]

==== Prevention of ''prameha'' ====

+

यैर्हेतुभिर्ये प्रभवन्ति मेहास्तेषु प्रमेहेषु न ते निषेव्याः|

हेतोरसेवा विहिता यथैव जातस्य रोगस्य भवेच्चिकित्सा||५३||

+

yairhētubhiryē prabhavanti mēhāstēṣu pramēhēṣu na tē niṣēvyāḥ|

Line 843: Line 927:

hetorasevA vihitA yathaiva jAtasya rogasya bhaveccikitsA||53||

+

</div></div>

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 ''raktapitta'' and ''prameha'' ====

+

हारिद्रवर्णं रुधिरं च मूत्रं विना प्रमेहस्य हि पूर्वरूपैः|

यो मूत्रयेत्तं न वदेत् प्रमेहं रक्तस्य पित्तस्य हि स प्रकोपः||५४||

+

hāridravarṇaṁ rudhiraṁ ca mūtraṁ vinā pramēhasya hi pūrvarūpaiḥ|

Line 859: Line 946:

yo mUtrayettaM na vadet pramehaM raktasya pittasya hi sa prakopaH||54||

+

</div></div>

If the color 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 ====

+

दृष्ट्वा प्रमेहं मधुरं सपिच्छं मधूपमं स्याद्द्विविधो विचारः|

क्षीणेषु दोषेष्वनिलात्मकः स्यात् सन्तर्पणाद्वा कफसम्भवः स्यात्||५५||

+

dr̥ṣṭvā pramēhaṁ madhuraṁ sapicchaṁ madhūpamaṁ syāddvividhō vicāraḥ|

Line 875: Line 965:

kShINeShu doSheShvanilAtmakaH syAt santarpaNAdvA kaphasambhavaH syAt||55||

+

</div></div>

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 ====

+

सपूर्वरूपाः कफपित्तमेहाः क्रमेण ये वातकृताश्च मेहाः|

साध्या न ते, पित्तकृतास्तु याप्याः, साध्यास्तु मेदो यदि न प्रदुष्टम्||५६||

+

sapūrvarūpāḥ kaphapittamēhāḥ kramēṇa yē vātakr̥tāśca mēhāḥ|

Line 891: Line 984:

sAdhyA na te, pittakRutAstu yApyAH, sAdhyAstu medo yadi na praduShTam||56||

+

</div></div>

''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'' dominant types of ''prameha'' are generally palliable. But they are curable if ''medas'' (adipose tissue) is not vitiated. [56]

==== In-curability of hereditary diseases ====

+

जातः प्रमेही मधुमेहिनो वा न साध्य उक्तः स हि बीजदोषात्|

+

ये चापि केचित् कुलजा विकारा भवन्ति तांश्च प्रवदन्त्यसाध्यान्||५७||

+

jātaḥ pramēhī madhumēhinō vā na sādhya uktaḥ sa hi bījadōṣāt|

+

yē cāpi kēcit kulajā vikārā bhavanti tāṁśca pravadantyasādhyān||57||

jAtaH pramehI madhumehino vA na sAdhya uktaH sa hi bIjadoShAt|

−

ye cApi

+

−

kecit kulajA vikArA bhavanti tAMshca pravadantyasAdhyAn||57||

+

ye cApi kecit kulajA vikArA bhavanti tAMshca pravadantyasAdhyAn||57||

+

</div></div>

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'' ====

+

प्रमेहिणां याः पिडका मयोक्ता रोगाधिकारे पृथगेव सप्त|

+

ताः शल्यविद्भिः कुशलैश्चिकित्स्याः शस्त्रेण संशोधनरोपणैश्च||५८||

+

pramēhiṇāṁ yāḥ piḍakā mayōktā rōgādhikārē pr̥thagēva sapta|

+

tāḥ śalyavidbhiḥ kuśalaiścikitsyāḥ śastrēṇa saṁśōdhanarōpaṇaiśca||58||

pramehiNAM yAH piDakA mayoktA rogAdhikAre pRuthageva sapta|

+

tAH shalyavidbhiH kushalaishcikitsyAH shastreNa saMshodhanaropaNaishca||58||

+

</div></div>

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 ====

+

तत्र श्लोकाः-

हेतुर्दोषो दूष्यं मेहानां साध्यतानुरूपश्च|

+

मेही द्विविधस्त्रिविधं[१] भिषग्जितमतिक्षपणदोषः||५९||

आद्या यवान्नविकृतिर्मन्था मेहापहाः कषायाश्च|

+

तैलघृतलेहयोगा भक्ष्याः प्रवरासवाः सिद्धाः||६०||

व्यायामविधिर्विविधः स्नानान्युद्वर्तनानि गन्धाश्च|

+

मेहानां प्रशमार्थं चिकित्सिते दिष्टमेतावत्||६१||

+

tatra ślōkāḥ-

hēturdōṣō dūṣyaṁ mēhānāṁ sādhyatānurūpaśca|

+

mēhī dvividhastrividhaṁ [18] bhiṣagjitamatikṣapaṇadōṣaḥ||59||

ādyā yavānnavikr̥tirmanthā mēhāpahāḥ kaṣāyāśca|

+

tailaghr̥talēhayōgā bhakṣyāḥ pravarāsavāḥ siddhāḥ||60||

vyāyāmavidhirvividhaḥ snānānyudvartanāni gandhāśca|

+

mēhānāṁ praśamārthaṁ cikitsitē diṣṭamētāvat||61||

Line 948: Line 1,061:

heturdoSho dUShyaM MehanAM sAdhyatAnurUpashca|

+

mehI dvividhastrividhaM bhiShagjitamatikShapaNadoShaH||59||

AdyA yavAnnavikRutirmanthA MehapahAH kaShAyAshca|

+

tailaghRutalehayogA bhakShyAH pravarAsavAH siddhAH||60||

vyAyAmavidhirvividhaH snAnAnyudvartanAni gandhAshca|

+

MehanAM prashamArthaM cikitsite diShTametAvat||61||

+

</div></div>

Here are the recapulatory verses:

Line 960: Line 1,077:

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 Sthana]] of Agnivesha’s work as redacted by ~~Charaka~~.[6]

+

Thus, ends the sixth chapter dealing with the treatment of ''prameha'' of [[Chikitsa Sthana]] of Agnivesha’s work as redacted by Charak.[6]

−

=== ''Tattva Vimarsha'' ===

+

=== ''Tattva Vimarsha'' / Fundamental Principles===

*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''.

Line 980: Line 1,097:

*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'' ===

+

=== ''Vidhi Vimarsha'' / Applied Inferences===

==== Role of ''kapha'' dominant diet ====

Line 1,080: Line 1,197:

**''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.

+

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 ====

Line 1,092: Line 1,209:

===== Importance of Barley in Diabetes =====

−

~~Charaka~~ gives much emphasis on the use of barley (''yava'') in ''prameha''. Barley has hypoglycemic effect along with its potent lipid reducing effect and it is best ''ruksha'' diet that helps in depleting excess of fat while providing essential energy required for maintaining daily life. Dutch researchers used a crossover study with 10 healthy men to compare the effects of cooked barley kernels and refined wheat bread on blood sugar control. The men ate one or the other of these grains at dinner, then were given a high glycemic index breakfast (50g of glucose) the next morning for breakfast. When they had eaten the barley dinner, the men had 30% better insulin sensitivity the next morning after breakfast<ref>American Journal of Clinical Nutrition. January 2010; 91(1):90-7. Epub 2009 Nov 4</ref>.

+

Charak gives much emphasis on the use of barley (''yava'') in ''prameha''. Barley has hypoglycemic effect along with its potent lipid reducing effect and it is best ''ruksha'' diet that helps in depleting excess of fat while providing essential energy required for maintaining daily life. Dutch researchers used a crossover study with 10 healthy men to compare the effects of cooked barley kernels and refined wheat bread on blood sugar control. The men ate one or the other of these grains at dinner, then were given a high glycemic index breakfast (50g of glucose) the next morning for breakfast. When they had eaten the barley dinner, the men had 30% better insulin sensitivity the next morning after breakfast<ref>American Journal of Clinical Nutrition. January 2010; 91(1):90-7. Epub 2009 Nov 4</ref>.

Scientists at the Functional Food Centre at Oxford Brookes University in England fed 8 healthy human subjects ''chapatis'' (unleavened Indian flatbreads) made with 0 g, 2g, 4g, 6g or 8g of barley beta-glucan fiber. They found that all amounts of barley beta-glucan lowered the glycemic index of the breads, with 4g or more making a significant difference<ref>Nutrition Research. July 2009; 29(7):4806 </ref>

Line 1,182: Line 1,299:

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<ref>Mahalakshmipuram PS, Ramachandran A, Nishteswar K, Chandola HM. A preface study on exploring the pharmacodynamics of Curcuma neilgherrensis Wight- A folklore medicine. Indian J of Traditional Knowl 2013; 12(2): 288-294</ref><ref>M Prasad Shyam, Chandola HM, Ravishankar. A clinico- experimental study to evaluate the therapeutic efficacy of Curcuma neilgherrensis Weight in the management of MadhuMeha (Type 2 Diabete Mellitus). PhD thesis. Institute of Post Graduate Teaching and Resaerch in Ayurveda, Gujarat Ayurveda University, Jamnagar, India, 2011</ref>

+

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<ref>Mahalakshmipuram PS, Ramachandran A, Nishteswar K, Chandola HM. A preface study on exploring the pharmacodynamics of Curcuma neilgherrensis Wight- A folklore medicine. Indian J of Traditional Knowl 2013; 12(2): 288-294</ref><ref>M Prasad Shyam, Chandola HM, Ravishankar. A clinico- experimental study to evaluate the therapeutic efficacy of Curcuma neilgherrensis Weight in the management of MadhuMeha (Type 2 Diabete Mellitus). PhD thesis. Institute of Post Graduate Teaching and Resaerch in [[Ayurveda]], Gujarat [[Ayurveda]] University, Jamnagar, India, 2011</ref>

===== ''Gymnema Sylvester'' =====

Line 1,196: Line 1,313:

''Mamejjaka'' (Enicostema littorale Blume) is used as a single herb and also as a part of an anti-diabetic mixture<ref>Shanmugasundaram ER, Gopinath KL, Radha Shanmugasundaram K, Rajendran VM. Possible regeneration of the islets of Langerhans in streptozocin- diabetic rats given Gymnema sylvestre leaf extracts. J Ethnnopharmacol 1990; 30: 265-279</ref>. In a clinical study on patients with type 2 diabetes, E. littorale reduced blood glucose and prevented the progression of diabetic complications. There was a significant improvement in the lipid profile, blood pressure, and kidney function<ref>Upadhyay UM, Goyal RK. Efficacy of Enicostemma littorale in type-2 diabetic patients. Phytother Res 2004; 18:233-235</ref>. It significantly reduced blood glucose and lipid peroxides in rats with alloxan- induced diabetes, and increased superoxide dismutase, catalase, and glutathione peroxidase<ref>Prince PS, Srinivasan M. Enicostemma littorale Blume aqueous extract improves the antioxidant status in alloxan induced diabetic rat tissues. Acta Pol Pharm 2005; 62: 363-367</ref>. In studies on rats with streptozotocin- induced type 1 diabetes, E. littorale significantly reduced glucose, cholesterol, and triglyceride levels<ref>Vishwakarma SL, Sonawane RD, Rajani M, Goyal RK. Evaluation of effect of aqueous extract of Enicostemma littorale in streptozotocin –induced type-1 diabetic rats. Indian J Exp Biol 2010; 48:26-30</ref>, and ameliorated diabetic nephropathy. Serum creatinine and urea were significantly decreased and glomerular function improved<ref>Sonawane RD, Vishwakarma SL, Lakshmi S, et al. Amelirotion of STZ-induced type 1 diabetic nephropathy by aqueous extract of Enicostemma littorale Blume and swertiamarin in rats. Mol Cell Biochem 2010; 340:1-6</ref>. In rats fed a hypercholesterolemic diet, E. littorale decreased serum cholesterol, triglycerides, LDL, VLDL, liver, and kidney cholesterol levels, and lipid peroxidation levels. There was an increase in HDL and an increase in reduced glutathione levels<ref>Vasu VT, Modi H, Thaikoottathil JV,Gupta S. Hypolipidaemic and antioxidant effect of Enicostemma littorale Blume aqueous extract in cholesterol fed rats. J Ethnnopharmacol 2005; 101: 277-282.</ref>.

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A pilot study on an herbal mixture containing ''tejapatra'' (Cinnamomum Tamala)<ref>Chandola HM, Tripathi S N. Hypoglycemic response of C.tamala in diabetes. In: Bajaj JS,ed. Diabetes Mellitus in developing Countries. New Delhi: Interprint, 1984: 383-386.</ref><ref>Chandola HM, Tripathi S N, Udupa KN. Effect of C.tamala on plasma insulin vis-à-vis blood sugar in patients of diabetes mellitus. J Res Ayurveda Siddha 1980;1:3455-357. </ref>, ''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<ref>Singh B, Singh G, Vyas SN, Chandola HM. The role of Virechana and herbal drugs in the management of MadhuMeha (diabetes mellitus). MD (Ayu) thesis. Institute of Post Graduate Teaching and Resaerch in Ayurveda, Gujarat Ayurveda University, Jamnagar, India, 1992</ref>. ''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 action33. 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<ref>Waheeda A, Miana GA, Ahmead SI. Clinical investigation of hypoglycemic effect of seeds of Azadirachata indica in type-2 (NIDDM) diabetes mellitus. Pak J Pharm Sci 2006; 19: 322-325</ref><ref>Khosla P, Bhanwra S,Singh J, et al. A study of hypoglycaemic effect of Azadirachata indica (Neem) in normal and alloxan diabetic rabbits. Indian J Physiol Pharmacol 2000:44:69-74</ref>.

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A pilot study on an herbal mixture containing ''tejapatra'' (Cinnamomum Tamala)<ref>Chandola HM, Tripathi S N. Hypoglycemic response of C.tamala in diabetes. In: Bajaj JS,ed. Diabetes Mellitus in developing Countries. New Delhi: Interprint, 1984: 383-386.</ref><ref>Chandola HM, Tripathi S N, Udupa KN. Effect of C.tamala on plasma insulin vis-à-vis blood sugar in patients of diabetes mellitus. J Res [[Ayurveda]] Siddha 1980;1:3455-357. </ref>, ''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<ref>Singh B, Singh G, Vyas SN, Chandola HM. The role of Virechana and herbal drugs in the management of MadhuMeha (diabetes mellitus). MD (Ayu) thesis. Institute of Post Graduate Teaching and Resaerch in [[Ayurveda]], Gujarat [[Ayurveda]] University, Jamnagar, India, 1992</ref>. ''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 action33. 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<ref>Waheeda A, Miana GA, Ahmead SI. Clinical investigation of hypoglycemic effect of seeds of Azadirachata indica in type-2 (NIDDM) diabetes mellitus. Pak J Pharm Sci 2006; 19: 322-325</ref><ref>Khosla P, Bhanwra S,Singh J, et al. A study of hypoglycaemic effect of Azadirachata indica (Neem) in normal and alloxan diabetic rabbits. Indian J Physiol Pharmacol 2000:44:69-74</ref>.

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The herb ''gokshura'' (Tribulus Terrestris Linn.)<ref>Amin A, Lotfy M, Shafiullah M, Adeghate E. The protective effect of Tribulus terreestris in diabetes. Ann NY Acad Sci 2006; 1084: 391-401</ref>, ''asana'' (Pterocarpus marsupium Roxb.)<ref>Anonymous. Sahasrayogam. 23rd ed. Alappuzha, Kerala, India: Vidyarambam Publisheres, 2000:93</ref>, ''kulatha'' (Vigna unguiculata (Linn.) Walp.), and saptaparna<ref>Dasa G. Bhaishajyaratnavali. Varanasi, India: Choukhamba Sanskrit Sansthan, 2000</ref> (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).

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The herb ''gokshura'' (Tribulus Terrestris Linn.)<ref>Amin A, Lotfy M, Shafiullah M, Adeghate E. The protective effect of Tribulus terreestris in diabetes. Ann NY Acad Sci 2006; 1084: 391-401</ref>, ''asana'' (Pterocarpus marsupium Roxb.)<ref>Anonymous. Sahasrayogam. 23rd ed. Alappuzha, Kerala, India: Vidyarambam Publisheres, 2000:93</ref>, ''kulatha'' (Vigna unguiculata (Linn.) Walp.), and saptaparna<ref>Dasa G. Bhaishajyaratnavali. Varanasi, India: Choukhamba Sanskrit Sansthan, 2000</ref> (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).

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''Prameha'' is described as a set of complex clinical disorders characterized by frequent abnormal micturition, with the etiology involving genetic predisposition as well as diet and life style. The role of stress and obesity in the pathogenesis is also elaborately described in ''prameha'' have much in common with those described for obesity, metabolic syndrome and diabetes mellitus. The management of ''prameha'' emphasizes dietary and life style recommendation and herbal preparations. Due to the richness and complexity of the compound in plants, herbal therapy has always been thought to act on multiple targets. Even one single compound can have multiple target which acts as a double edge sword in managing diabetes mellitus. ''Medhya'' or mental health promoting drugs, if added along with anti-diabetic therapy, will further potentiate anti-diabetic effect of the principal drug by counteracting stress. Ayurveda and modern medicine both are complimentary to each other. Simultaneous administration of Ayurvedic drug will not only potentiate therapeutic efficacy of modern drug rather it will also counteract or reduce the adverse effects of the modern drug, if any; to lead the patient a healthy and happy life. Moreover, organ specific ''rasayana'' may be added for prevention and cure of complications. Ayurvedic drugs should be use in its natural form without disturbing its natural combination/holistic principle of the drug. Single drug may have composite fractions and each fraction has its own medicinal value. Polyherbal combination potentiate therapeutic efficacy of a particular ingredient of the formulation and also counteract adverse effect if present in the combination. Instead of isolating a particular alkaloid it is suggested that the Ayurvedic drug should be use as a whole. All patients of diabetes are not similar, so a stepped care treatment is recommended. In early stage of disease and patients having ''kaphaja'' constitution, it is better to use Ayurvedic drugs alone. In acute stage and having ''pittaja'' constitution of patients wherever found necessary, oral insulin promoter may be added. In chronic stage and having ''vataja'' constitution, insulin therapy may also be added as these cases are insulin dependent.

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''Prameha'' is described as a set of complex clinical disorders characterized by frequent abnormal micturition, with the etiology involving genetic predisposition as well as diet and life style. The role of stress and obesity in the pathogenesis is also elaborately described in ''prameha'' have much in common with those described for obesity, metabolic syndrome and diabetes mellitus. The management of ''prameha'' emphasizes dietary and life style recommendation and herbal preparations. Due to the richness and complexity of the compound in plants, herbal therapy has always been thought to act on multiple targets. Even one single compound can have multiple target which acts as a double edge sword in managing diabetes mellitus. ''Medhya'' or mental health promoting drugs, if added along with anti-diabetic therapy, will further potentiate anti-diabetic effect of the principal drug by counteracting stress. [[Ayurveda]] and modern medicine both are complimentary to each other. Simultaneous administration of Ayurvedic drug will not only potentiate therapeutic efficacy of modern drug rather it will also counteract or reduce the adverse effects of the modern drug, if any; to lead the patient a healthy and happy life. Moreover, organ specific ''rasayana'' may be added for prevention and cure of complications. Ayurvedic drugs should be use in its natural form without disturbing its natural combination/holistic principle of the drug. Single drug may have composite fractions and each fraction has its own medicinal value. Polyherbal combination potentiate therapeutic efficacy of a particular ingredient of the formulation and also counteract adverse effect if present in the combination. Instead of isolating a particular alkaloid it is suggested that the Ayurvedic drug should be use as a whole. All patients of diabetes are not similar, so a stepped care treatment is recommended. In early stage of disease and patients having ''kaphaja'' constitution, it is better to use Ayurvedic drugs alone. In acute stage and having ''pittaja'' constitution of patients wherever found necessary, oral insulin promoter may be added. In chronic stage and having ''vataja'' constitution, insulin therapy may also be added as these cases are insulin dependent.

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Ayurveda has a vast array of herbs and herbal mixtures that are used in the treatment of ''prameha''. A large number of these herbs have demonstrated efficacy in research investigations. The herbs have various properties including hypoglycemic, antihyperglycemic, hypolipidemic, antihyperlipidemic, insulin promoting and antioxidant properties. Some of these herbs are capable of counteracting stress induced catecholamines, which are proven insulin antagonists. Hence, the choice of the herb or combination of herbs for the patient depends upon the stage of the disease, disturbances in the psychophysiologic constitution of the patient, and mode of action of the herbs. Further research is needed in the clinical setting to elucidate the Ayurvedic modalities that are effective in the management of obesity, metabolic syndrome and diabetes mellitus in light of their similarities with ''prameha''<ref>Sharma H, Chandola HM.Prameha in Ayurveda: Correlation with Obesity, Metabolic Syndrome, and Diabetes Mellitus.Part 2- Management of Prameha. The Journal of Alternative and Complementary Medicine.2011. 17(7):589-599</ref>.

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[[Ayurveda]] has a vast array of herbs and herbal mixtures that are used in the treatment of ''prameha''. A large number of these herbs have demonstrated efficacy in research investigations. The herbs have various properties including hypoglycemic, antihyperglycemic, hypolipidemic, antihyperlipidemic, insulin promoting and antioxidant properties. Some of these herbs are capable of counteracting stress induced catecholamines, which are proven insulin antagonists. Hence, the choice of the herb or combination of herbs for the patient depends upon the stage of the disease, disturbances in the psychophysiologic constitution of the patient, and mode of action of the herbs. Further research is needed in the clinical setting to elucidate the Ayurvedic modalities that are effective in the management of obesity, metabolic syndrome and diabetes mellitus in light of their similarities with ''prameha''<ref>Sharma H, Chandola HM.Prameha in [[Ayurveda]]: Correlation with Obesity, Metabolic Syndrome, and Diabetes Mellitus.Part 2- Management of Prameha. The Journal of Alternative and Complementary Medicine.2011. 17(7):589-599</ref>.

=== Future Scope for Research ===

Line 1,211: Line 1,328:

#Elaborating Urinalysis by adding new parameters like temperature for determining the abnormal physical characteristic of urine in different disease like assessing the presence of ketones in urine by low temperature of urine.

#Analysis of urine at different stages of diabetes for the assessment of its progression and prognosis.

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=== Related Chapter ===

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* [[Prameha Nidana]]

=== References ===

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