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          Thursday, October 19, 2017

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Prameha (Diabetes)
and Ayurveda

By  Dr Amit Kumar Yadav

The word Prameha is derived from the 'Miha sechane' which means watering. Pra means excess of urine in both frequency and volume. Prameha, thus, becomes self-explanatory and holds the twin meanings of "Prabhutha mutratha" or excessive urination and "Avilmutratha" or turbid urine.

HISTORICAL PERSPECTIVE

A chronological study of the Ayurvedic classics and the samgraha texts shows changing trends of emphasis on its study and practice. It is very interesting to note the prameha has been described eloquently and elaborately in Charak samhita chikistha sthana’s sixth chapter. In Shusurata samhita it is found in nidana sthana’s sixth chapter and in Chikitsha sthana’s 11th, 12th and 13th chapter. While Madava nidana describes it in its 33rd chapter, which is Prameha nidana.

GENETICAL PERSPECTIVE

Genetical view regarding prameha are clearly mentioned by Charaka and Shusurata samhita. They have given a specific word 'Beej dosha' i.e., which means a “defect in genes” if transliterated to English. Beej means seed and dosha means defect. Charaka has described anatomy of beej as below:

Beej = Semen or Shukra
Beej bhaga = Chromosome

Sushrutha has said that kshetra, ambu, beeja and ritu are the four factors involving genetic factor of any diseases, and these mean:

Kshetra > Woman’s reproductive organs
Beej > Sperm
Ambu > Watery contents that gives nutrition to fetus
Ritu > Environment around the fertilized ovum or fetus

Also the physical and mental stages including dietary habits of pregnant lady can cause changes in the body of the offspring.

OJAS AND PRAMEHA

Ojas is essence of life, extract of all the dhatus (body tissue), which manifests in the form of bala (strength). Normally all the physical, psychic, sensory and motor functions are determined by ojas. The appearance of ojas is supposed to be like ghee (in purity and luster), taste is supposed to be like honey, and smell like fried paddy. In diabetes mellitus normal quantity of ojas in the body hampered in two ways:

i) By obstruction in vessels (Srotorodha)
ii) By degeneration of the body contents (Dhatukshaya)

ETIOLOGICAL FACTORS OF PRAMEHA

"Aashyasukham swapnasukham dadhinigramyoodkanuprasaa pyaamsi Navaaanpaanam gudvayikritam ch prameha hetu kapahakrich swaramn.

-- Inactivity
-- Excessive sleep
-- Excessive use of curd
-- Meat soup of the domestic, aquatic and marshy animals, and
-- New cereals and drinks
-- Products of gud or jaggery
-- All other kapha-promoting regimens

PURVARUPA (PROMODAL) SYMPTOMS OF PRAMEHA

They are as follows:

1. Prabhutavilamootrata (polyuria): Swedawaha srotoavrodha causes increased urinary out put with turbidity

2. Madhuratava in mutra : Glycosuria

3.Dantadiham mala sanchaya: Due to ama, deposits are seen in mouth

4. Panipada daha : Abundance of unutilized glucose in the blood. This causes disturbance in the equilibrium of dhatus and doshas in the body exposing body to further complications. It gives rise to padapani daha, which means burning sensation of feet and palm.

5.Chikkanta - Stickiness.

6. Trishna (Thirst and Polydipsia) : In the process of lypolysis, more water is utilized which results into activation of thirst center in the brain.

7. Swadasyata : Sweetness is experienced in the mouth due to increase in the sugar level.

TYPES OF PRAMEHA

A) HETU BEDHAS (As per etiology)

1. Sahaja prameha : Juvenile or congenital diabetes
2. Kulaja : Familial
3. Apathyaja : Due to improper dietary habits

B) DEHA PRAKRITI BEDHAS (As per features of the body)

1. Sthula pramehi : Obese-related
2. Krisha pramehi : Leanness-related

C) MUTRA BIKARA BEDHAS (As per urinary abnormality)

1. Kaphaja : Kapha causes pramehas by affecting medhas thus altering lipid metabolism), muscles and body fluid situated in urinary bladder. They are of ten types as:

-- UDAKAMEHA (Chronic nephritis, Diabetes insipidus) > Watery urine
-- ISKHUMEHA (Alimentary glycosuria) > Like sugar cane
-- SAANDRAMEHA (Phosphaturia) > Viscous urine
-- SAANDRAPRASAADMEHA > Having solid precipitate
-- SUKLAMEHA (Chyleuria, albuminuria) > White
-- SUKRAMEHA (Spermaturia) > Urine with semen
-- SITAMEHA > Cold urine
-- SAINYAMEHA > Delayed and very slow impulse of urination
-- LALMEHA (Albuminaria) > Saliva-like urine
-- SIKTAMEHA (Lithuria) > Urine with gravels

2. Pittaja : Pitta aggravated by hot things causes the same by affecting medas, muscles and body fluid situated in urinary bladder. They are of six types as :

-- KCHARAMEHA (Alkanuria) > Urine like alkali
-- KAALAMEHA (Indikanuria) > Black urine
-- NILAMEHA (Indikanuria) > Blue urine
-- HARIDRAMEHA (Biluria) > Turmeric-like urine
-- MANJISTHAMEHA (Urobilinuria) > Urine is lighter
-- RAKTAMEHA (HAEMETURIA) > Urine is deep red

3. Vataja : Vayu, on relative diminution of other two doshas, draws on the dhatus in urinary bladder and thus causes Prameha. Prameha caused by vata and associated with pain has blackish or reddish urine. They are of four types as:

-- MAJJAMEHA (Albuminuria) > Urine with majja
-- OJOMEHA (Diabetes mellitus) > Urine with ojas
-- VASAMEHA (Lipuria) > Urine with vasa
-- HASTIMEHA (Prostatitis) > Urine with lasika

PREVENTION Proteins:

Intake of protein content should be normal i.e., 1gm/kg. In children it may be increased.

Fats:

Fats should be moderate; excessive intake of fats forbidden.

Carbohydrate:

Carbohydrate intake must be minimized in order to reduce blood sugar.
Calories:

Total calories should be adequate for the growing children and underweight persons. In obese patients it might be necessary to reduce calories.

Minerals:

Adequate amount should be supplied.

Vitamins:

Vitamin-B complex group should be taken to prevent and treat polyneuritis.

Drinks:

Sweet drinks and carbohydrate drinks should be avoided. Cakes, pastries, cream, dried and caned fruits, sweet pickles, and meats should be avoided.

Soups:

Thin vegetable soups supply fewer calories. So obese persons are encouraged to take large quantities which would fill up their stomach and give them a sense of satiety.

Green vegetables:

Diabetics should consume large amount of green vegetables, which are poor source of calories. Brinjals, spinach, and tomatoes can be consumed in plenty. Salads with lime or vinegar are useful.

Fruits:

Dried fruits and nuts should be avoided, and so should be bananas and mangoes. Orange and apples can be taken.

Desserts:

Sweets and ice cream or custard are not allowed.

Cooking media:

Ghee, oils, butter all are rich in calories so an obese diabetic is allowed only 1 teaspoonful per meal.

Tea and coffee:

Tea and coffee are permitted but milk and sugar should be regulated.

MANAGING PRAMEHA

Managing pramahea through Ayurveda is a comprehensive therapeutic modality that yields best outcome when treatment is individualized. It involves extensive dietary modifications, lifestyle changes and use of regimen derived from herbs/ food supplements like Momordica charantia, Phaseolus vulgaris, Allium sativum, Allium cepa, Trigonella foenum graeceum, Syzigium jambolana, Murraya koenigii, Tinospora cordifolia, Emblica offcinalis, Gymnema sylvestre, Eugenia jambolana, Azadirachta indica, and Shilajitu, apart from yoga asanas.

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