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→Samprapti (pathogenesis) of prameha
Various dushyas involved in the pathogenesis:
Various dushyas involved in the pathogenesis:
Medadhatu :
Medadhatu :
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:
(1) Qualitative: Abaddha (loose): The normal function of meda is to produce unctousness in the body along with drudhatva (compactness). This abadhatva causes derangement in the structure of meda producing shaithilya (flabbiness) in the body this can be well correlated with FFA excess.
(1) Qualitative: Abaddha (loose): The normal function of meda is to produce unctousness in the body along with drudhatva (compactness). This abadhatva causes derangement in the structure of meda producing shaithilya (flabbiness) in the body this can be well correlated with FFA excess.
(2) Quantitative: Bahu(excess):
(2) Quantitative: Bahu(excess):
Here in the pathogenesis, meda is in excess quantity. This medodhatu is aparipakva (immature). It obstructs the path of vayu along with kapha. This provoked vata increases the agni, so patient eats more and more food causing excessive deposition of aparipakva meda. This in turns causes severe depletion of the other dhatus and produces various sign and symptoms.
Here in the pathogenesis, meda is in excess quantity. This medodhatu is aparipakva (immature). It obstructs the path of vayu along with kapha. This provoked vata increases the agni, so patient eats more and more food causing excessive deposition of aparipakva meda. This in turns causes severe depletion of the other dhatus and produces various sign and symptoms.
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.
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.
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.
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.
Ojas: Ojas as dushya is mainly involved in vataja prameha i.e. ojomeha (madhumeha). The symptoms of ojakshaya manifests, like gurugatrata (heaviness in body), nidra (sleepiness), tandra (drowsiness) and daurbalya (fatigue) can be correlated with immunocompromised stage in diabetes mellitus due to deranged immunity.
Ojas: Ojas as dushya is mainly involved in vataja prameha i.e. ojomeha (madhumeha). The symptoms of ojakshaya manifests, like gurugatrata (heaviness in body), nidra (sleepiness), tandra (drowsiness) and daurbalya (fatigue) can be correlated with immunocompromised stage in diabetes mellitus due to deranged immunity.
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
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).
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).
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.
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.
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.
Exclusion of asthi as a dushya:
Exclusion of asthi as a dushya:
Among the ten dushyas of prameha, asthi (bone) is not included. According to modern physiology, bone is a tissue that undergoes frequent remodeling and has a large capacity for regeneration. In the adult remodeling occurs so that the skeleton is replaced approximately every 10–11 yr. This physiologic remodeling is initiated by osteoclasts that resorb bone and is followed by the formation of an equivalent amount of new bone by osteoblasts. , Bone loss is noted when the amount of bone resorption exceeds the amount of new bone formation.
Among the ten dushyas of prameha, asthi (bone) is not included. According to modern physiology, bone is a tissue that undergoes frequent remodeling and has a large capacity for regeneration. In the adult remodeling occurs so that the skeleton is replaced approximately every 10–11 yr. This physiologic remodeling is initiated by osteoclasts that resorb bone and is followed by the formation of an equivalent amount of new bone by osteoblasts. , Bone loss is noted when the amount of bone resorption exceeds the amount of new bone formation.
Diabetes has also been associated with a net loss of bone. A number of studies have reported that type 1 diabetes alters bone remodeling by reducing the formation of new bone, leading to osteopenia. This has been shown by a decrease in bone mineral density in humans and alterations in the formation of new bone in animal studies. , , , In contrast, the presence of bone loss in type 2 diabetes is less clear, and current understanding suggests that this form of diabetes is not typically associated with osteopenia. , , , The reasons for the lower bone mineral density in type 1 diabetes are not known.
Diabetes has also been associated with a net loss of bone. A number of studies have reported that type 1 diabetes alters bone remodeling by reducing the formation of new bone, leading to osteopenia. This has been shown by a decrease in bone mineral density in humans and alterations in the formation of new bone in animal studies. , , , In contrast, the presence of bone loss in type 2 diabetes is less clear, and current understanding suggests that this form of diabetes is not typically associated with osteopenia. , , , The reasons for the lower bone mineral density in type 1 diabetes are not known.
Vataja prameha as type 1 diabetes mellitus : The pathogenesis of vataja prameha is similar to that of type-1 diabetes mellitus. Vata is agitated due to various precipitating causes acts on the body in such a way that there is passage of vasa (fat), majja (bone marrow), lasika (lymph), and ojas (essence of the body /immune substances / vitality) through the urine. This condition indicates impaired renal function as a result of diabetes, leading to a dire prognosis. Due to dhatukshaya (loss of body tissues) the patient become very weak and emaciated.
Vataja prameha as type 1 diabetes mellitus : The pathogenesis of vataja prameha is similar to that of type-1 diabetes mellitus. Vata is agitated due to various precipitating causes acts on the body in such a way that there is passage of vasa (fat), majja (bone marrow), lasika (lymph), and ojas (essence of the body /immune substances / vitality) through the urine. This condition indicates impaired renal function as a result of diabetes, leading to a dire prognosis. Due to dhatukshaya (loss of body tissues) the patient become very weak and emaciated.
Charaka Samhita deals with very specific pathogenesis for madhumeha, which is a subtype of vataja prameha. When an individual excessively consumes the foods that cause prameha, kapha and pitta become vitiated, then adipose tissues and muscle tissuses become disturbed and causes impaired functioning of vata. Subsequently vata gets vitiated and extends to urinary bladder along with ojas, resulting in ojas being expelled in the urine. In Ayurveda ojas is considered vital to the maintanence of health; its loss in prameha leads to many complications, including prameha pidika (boils and carbuncles). This advanced condition is comparable to non-insulin –dependent type -2 diabetes progressing into insulin dependent diabetes. It is the stage of diabetes in which there are complications, including nephropathy, which result in vital substances of the body being excreted through urine.
Charaka Samhita deals with very specific pathogenesis for madhumeha, which is a subtype of vataja prameha. When an individual excessively consumes the foods that cause prameha, kapha and pitta become vitiated, then adipose tissues and muscle tissuses become disturbed and causes impaired functioning of vata. Subsequently vata gets vitiated and extends to urinary bladder along with ojas, resulting in ojas being expelled in the urine. In Ayurveda ojas is considered vital to the maintanence of health; its loss in prameha leads to many complications, including prameha pidika (boils and carbuncles). This advanced condition is comparable to non-insulin –dependent type -2 diabetes progressing into insulin dependent diabetes. It is the stage of diabetes in which there are complications, including nephropathy, which result in vital substances of the body being excreted through urine.