Changes

==== Various ''dushyas'' involved in the pathogenesis ====

==== Various ''dushyas'' involved in the pathogenesis ====

===== ''Medadhatu'' =====

==== ''Meda Dhatu'' ====

''Meda'' vitiation is common and dominant ''dushya'' in the pathogenesis of ''madhumeha''. ''Kapha'' and ''meda'' both have close resemblance in regard to functions as well as in regard to qualitative parameters. Both get vitiated more or less by same etiological factors. In ''madhumeha'' vitiation of ''meda'' results by two ways:   

''Meda'' vitiation is common and dominant ''dushya'' in the pathogenesis of ''madhumeha''. ''Kapha'' and ''meda'' both have close resemblance in regard to functions as well as in regard to qualitative parameters. Both get vitiated more or less by same etiological factors. In ''madhumeha'' vitiation of ''meda'' results by two ways:   

Excess of fat in the body get converted into FFA and is utilized in energy metabolism especially in the muscles causing retention of glucose in the blood. Increased appetite in ''medoroga'' is due to increased body demand, which is explained to be due to hyperinsulinism or increased secretion of growth hormone. Diabetes has been compared with the fasting state of the body, ketosis is nothing else but the advanced fasting stage of the body, so the deleterious effect of long fast specially in the patient of obesity is same as in diabetic stage.

Excess of fat in the body get converted into FFA and is utilized in energy metabolism especially in the muscles causing retention of glucose in the blood. Increased appetite in ''medoroga'' is due to increased body demand, which is explained to be due to hyperinsulinism or increased secretion of growth hormone. Diabetes has been compared with the fasting state of the body, ketosis is nothing else but the advanced fasting stage of the body, so the deleterious effect of long fast specially in the patient of obesity is same as in diabetic stage.

''Mamsadhatu'': It is one of the main ''dushyas'' (vitiating factors) described by Charaka in regards to ''prameha''. He narrated it especially in ''kaphaja prameha'' and ''avaranjanya madhumeha''. ''Mamsa'' and ''Kapha'' possess similar qualities and both give strength to the body. When vitiated, mamsa loses its normal consistency and develops ''shaithilya'' and provide space in between for the accumulation of morbid matter. That in turn results in ''putimamsa pidika'' (Ca.Ni. 4/8). ''Mamsa dushti'' can be compared to deranged protein metabolism which is an integral part of diabetes mellitus. Research studies have found that glucocorticoid activities and acidosis stimulates protein and amino acid catabolism . Amino acids breakdown in liver results in increased production of urea and these free amino acids can be compared with ''abaddha mamsa''. ''Putimamsa'' and ''pidaka'' are the morbid states of ''mamsa dhatu''. Two major changes take place in ''mamsa dhatu'' - protein degradation and reduction in its blood supply, both of which along with elevated blood sugar level form a favorable media for the growth and multiplication of microorganisms. The results are putrefaction and evolution of multiple septic foci in ''mamsa dhatu''. Diminished protein synthesis hampers the healing process and these complications adopt chronic course.

==== ''Mamsadhatu'' ====

''Majja'': ''Majja dhatu'' is not vitiated to maximum extent but ''vata'' causes its ''kshaya'' i.e. depletion. Thus vitiated majja produces symptoms like netragaurava (heaviness in eyes), angagaurava(heaviness in body) in patient of madhumeha. The ketone bodies production due to excessive utilization of fat may be referred to dushti of vasa and majja. Murchcha (temporary loss of consciousness) occurs due to dushti of majja in diabetes mellitus. The condition of hyperglycemic coma is characterized by the accumulation of ketone bodies.

It is one of the main ''dushyas'' (vitiating factors) described by Charaka in regards to ''prameha''. He narrated it especially in ''kaphaja prameha'' and ''avaranjanya madhumeha''. ''Mamsa'' and ''Kapha'' possess similar qualities and both give strength to the body. When vitiated, ''mamsa'' loses its normal consistency and develops ''shaithilya'' and provide space in between for the accumulation of morbid matter. That in turn results in ''putimamsa pidika'' (Ca.Ni. 4/8). ''Mamsa dushti'' can be compared to deranged protein metabolism which is an integral part of diabetes mellitus. Research studies have found that glucocorticoid activities and acidosis stimulates protein and amino acid catabolism . Amino acids breakdown in liver results in increased production of urea and these free amino acids can be compared with ''abaddha mamsa''. ''Putimamsa'' and ''pidaka'' are the morbid states of ''mamsa dhatu''. Two major changes take place in ''mamsa dhatu'' - protein degradation and reduction in its blood supply, both of which along with elevated blood sugar level form a favorable media for the growth and multiplication of microorganisms. The results are putrefaction and evolution of multiple septic foci in ''mamsa dhatu''. Diminished protein synthesis hampers the healing process and these complications adopt chronic course.  

Shukra: Shukra also get vitiated in the pathogenesis and produses symptoms like daurbalya (fatigue) and krichavyavayata (difficulty in sexual intercourse), because normal functions of sukra is to maintain dehabala. It also plays role in the precipitation of sahaja (genetic) prameha. Sexual impotency and testicular hypofuctions have been reported in diabetes mellitus.

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

''Majja dhatu'' is not vitiated to maximum extent but ''vata'' causes its ''kshaya'' i.e. depletion. Thus vitiated ''majja'' produces symptoms like ''netragaurava'' (heaviness in eyes), ''angagaurava''(heaviness in body) in patient of ''madhumeha''. The ketone bodies production due to excessive utilization of fat may be referred to ''dushti'' of ''vasa'' and ''majja''. ''Murchcha'' (temporary loss of consciousness) occurs due to dushti of ''majja'' in diabetes mellitus. The condition of hyperglycemic coma is characterized by the accumulation of ketone bodies.

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

Vasa: Charaka described it as a subtype of vatajaprameha i.e. vasameha. Vasa is the upadhatu of mamsa and the unctuousness present in the mamsa dhatu is called vasa.

 

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

 

 

 

 

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

 

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

 

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

Exclusion of asthi as a dushya:

Exclusion of asthi as a dushya: