Almost all Ayurvedic text books have explained about the disease Madhumeha; some of the Acharyas (ancient authors) termed it as Kshudrameha as Kshoudra is the synonym of Madhu (honey). Diabetes mellitus is correlated with this disease. People are anxious to know regarding this disease elaborately. The response we got for our earlier articles have hinted us that many are anxious to know regarding this disease in detail.
Because, now in the whole world, nearly about 24% of the population are suffering from this disease. Its percentage may go as high as 40-45% in 2020- WHO says. So, there is an intense need to know the graveness of the disease and to understand the possible ways of preventive aspects of this disorder.
First of all it is very important to know that the diseases which are diagnosed now as Diabetes mellitus (madhumeha) are not originated suddenly. Its patho-physiology takes long term of as high as 3-5 years. Very rarely it may manifest in 1 – 6 months duration in exceptional cases like pregnancy, injury, operation, psychological conditions, infection etc.
Diet for diabetes
By Sharmishta Majumdar – [email protected]
1: Breakfast: 7:30- 8 Am
2. Midday Snack: 10:30 Am
3. Lunch: 12:30 – 1 Pm
4. Evening Snack (only if hungry and belch is clear of the taste from last meal): 4:30 Pm
5. Dinner: 6:30 -7 Pm
- Best Grains: Wheat, Barley, Corn, Millet (not in excess), Rye, Basmati Rice
- Best Vegetables: Bitter gourd, Drumstick, Leafy Greens, Garlic, Broccoli, Raw Papaya, Ginger, Asparagus, Cauliflower, Cabbage, Green Beans, Lettuce, Eggplant, Peppers, Peas, Spinach, Celery, Bok Choy, Asparagus, Mustard Greens, Artichoke, Bean (Mung) Sprouts, Bell Pepper, Carrots, Chilies/Hot Peppers, Cilantro (Coriander Leaf), Corn (Sweet), Kale, Radishes, Tomatoes (when occasionally eaten along with mustard/ cumin/ turmeric), Turnips And Rutabaga
- Best Legumes (Unpolished): Adzuki, Chick Pea, Flat Beans, Mung or Green Gram, Pigeon Pea (Toor), Masoor, LimaBeans
- Seeds (Roasted) : Pumpkin Seeds, Sunflower Seeds
- Dairy: Takra – Buttermilk (served with roasted mild spice powder of coriander, fennel, cumin, cardamom and a little bit of dry ginger), Ghee (little quantity)
- Best Animal Products: Chicken, Turkey, Fish ( fresh water varieties not more than 2 times a week), Eggs ( preferably organic, once a week in curry form)
- Best Fruits: Apples, Pomegranates, Cranberries, Grapefruit (small quantity), Guava, Lemon, Lime, Mango (small quantity during summer months), Oranges, Papaya, Pineapple, Raspberries/Blackberries/Blueberries, Strawberries (not in excess)
- Best Oils( choose only cold-pressed options): Mustard, Sunflower, Soy (controlled usage)
- Best Sweeteners: Honey (use raw), Jaggery (not in excess)
- Best Ama Deepana and Pachana Spices: Ginger, Black Cumin (Kalonji), Mustard, Wild Celery, Nutmeg, Mace, Allspice Cumin, Coriander, Fennel, Cardamom, Saffron, Bay leaf, Black Pepper, Cinnamon, Clove, Asafetida, Turmeric
Restrictions: Raw Salads; Fermented/ Refrigerated/ Stale Foods, Refined Sugar; Root Vegetables e.g. Potato, Beet, Tapioca, Yam, Tubers; Maida; Heavy Meats e.g. Pork, Buffalo, Beef; Oats; Sesame /Groundnut Oil; Lards/ Margarines; Ice Cream; Yogurt, Fried Sweets; Greasy Food or Fried Preparations; Mushroom
Avoid Overeating; Restrict To Four Meals A Day.
- Breakfast Recipes: Rava Upma; Vegetable Poha With Sweet Peas/Chick Peas Curry Cooked with Carminative Spices; Millet Vegetable Noodle; Methi-Palak / Cauliflower / Carrot / Radish/ Sweer Peas Chapati (served with ghee) and Green Vegetables Curry; Bean Soup; Quinoa Upma; Boiled Sweet Corn tossed with Onion, Ginger, Garlic, Bell Pepper and Carrots with Dry Roasted Poha; Thalipeeth/ Spiced Chapathi Made From Multigrain Flour + Sabji; Instant Ragi/Rava Idli, Mung Daal Sambaar & Curry Leaf Chutney; Very Light Millet Kanji Served with a tempering of Curry Leaves, Mustard and Cumin Seeds; Broken wheat gruel cooked with veggies
Replace Tea / Coffee with CCF Tea – Boil 1 Glass of Water with 1 tsp. of Cumin Seeds + 1 tsp. Coriander Seeds and 1 tsp. Fennel Seeds. When the quantity reduces to 1 cup, sip it slowly.
- Mid-day Snack: A whole small sized fruit or 3-4 slices of bigger fruits like Papaya; Roasted Seeds; One Cup of Takra
- Lunch: Aged Rice/ 2 Chapattis, Ghee, Boiled Bitter Gourd (1 Small), Sambaar Dal / Light Lentil Soup Spiced With Ginger, Cumin And Chillis/ Chicken Soup / Egg Curry (Runny Consistency)/ Fish Curry (2 Medium Pieces); One Dry Vegetable Recipe. Once a week enjoy light and easy to digest Rice and Moong Daal Khichdi/Pongal with Choice of Vegetables with a small serving of Tomato, Dates, Jaggery and Aam Papad Chutney.
- Snacks: Pan-Fried Poha Vegetable Cutlet; Vegetable Rice Paper Rolls; Upma; Besan Chilla; Rava Chilla; Moong Dal Cheela; Boiled Vegetable Stu; Half glass of non-pasteurized cow’s milk ( preferably A2 variety) boiled with cardamom, bayleaf and served with a pinch of turmeric.
Dinner: Chapati/ Basmati Rice with Boiled Veg Stu ; Khichdi; Veg Stu with Rice Noodles; Vegetable Chicken Stu with Chapati (though it is best to avoid non-veg food at night)
Madhumeha – Word derivation
Madhumeha is a compound word made up of two words, Madhu and Meha.
Madhu: – The word ‘Madhu’ is derived from the root ‘Mana’ and meaning ‘ manae bhodane: which gives Psychic contentment
Meha: – The word ‘Meha’ is derived form the root ‘Miha’ which is employed in the sense of sinchana to moisten, ksharana to flow, prasrava: – excessive excretion (vachaspathyam).
Ancient Ayurvedic scholars have grouped Madhumeha (Diabetes mellitus) under one among the 20 Prameha (urinary disorders); particularly one of the kind of vatic disorder. Also, any of the prameha (urinary disorder) if neglected ultimately ends up in madhumeha due to nature of the illness.
Who becomes a victim of T2DM?
Anyone may become a victim of T2DM and especially in the modern day lifestyle; none of us are spared from getting T2DM.
Highest risk group:
Above 45 years of age
Obese / overweight
Family history of T2DM
Do not exercise
Have low HDL or high triglycerides
Have high BP
Have had Gestational Diabetes
High fat and carbohydrate diet
High alcohol intake
Are older people
Women having PCOS
Madhumeha characteristic features
Characteristic feature of Madhumeha as per Ayurveda:
Madhumeha is a disease in which urine of the patient is sweet like honey and quantitatively increased as well as astringent, pale and rough in quality and the whole body of madhumehi becomes sweet. Other Acharyas also opines the same (As Sa ni 10/14 As. Hr ni 10/18, 21; ch. Ni 4/44, Su Ni 6/14, Ma Ni 33/26.
Causes of diabetes as per Ayurveda:
Physical and mental causes:
Asyasukham – Comfortable seating (luxury, sedentary lifestyle, lack of physical activities and exercise)
Svapnasukham – comforts of sleeping, excess sleeping
Kapha krut cha sarvam – All foods and lifestyle activities which increase Kapha
Sahaja (inherited factor)
Deergha roga (long standing illness)
Alasya (sedentary life)
Food and drinks that cause diabetes:
Dadheeni – Excessive consumption of curds and its preparations
Gramya-oudaka-anupa mamsa – flesh or meat soup of animals living in water and marshy regions
Payamsi – Excessive consumption of milk, its derivatives and preparations
Navaanna panam – Food, drinks and dishes prepared from new grains etc
Guda vaikruti – Jaggery, its derivatives and dishes made out of it
Ikshurasa (sugar cane)
Madhura Ahara (sweet substances)
Pishta Ahara (carbohydrate rich food)
Adyashana (repeated food intake)
Adhikashana (excess food intake)
Ahitashana (unwholesome diet)
Guru ahara (heavy food)
Samashana (improper diet)
Origin of diabetes
Acharya Vagbhata explained the Patho-physiology of Madhumeha as below-
Ojas – The essence of all dhatus (tissues) and the main entity of immunity is spread all over the body. (Read more to understand Ojus). It is frothy, clear, unctuous, sweet, thick, heavy, cold and slimy in nature.
Due to the relative causes of the disease Madhumeha, imbalanced Doshas (especially Kapha and Pitta in association with Vata) block the channels related to Meda (adipose tissue / fat tissue) and Mamsa (muscle).
Due to obstruction of Vata, it transforms sweet ojas into astringent mixed sweet taste like honey. Thus, it discharges in the urine. Thus, the condition Madhumeha is resulted.
Any of the prameha if neglected or treated improperly, leads to Madhumeha which is the terminal stage of urinary disorders.
Pathogenesis of diabetes
‘When the Meda (fat), Mamsa (flesh), Shareera kleda (fluids of the body) and Kapha on entering the Basti (urinary system) causes Prameha’
Stages of diabetes
Stages of the illness: a special reference
The text Vaidya sara sangraha quotes 10 stages for Diabetes in succeeding order:
1. Vasti bheda (pricking pain in bladder)
2. Mutra peedana (pain during micturition)
3. Vata prakopa (features of aggravated vata in urine)
4. Sannipata dosha prakopa (multiple dosha involvement / tissue damage)
5. Dhatu nasha (tissue necrosis / systemic effect)
6. Daha-moha (burning and hallucination)
7. Mootratisara (severe urination)
8. Mootra granthi / mootra sada (dysuria or controlled urine)
9. Ati trishna (severe thirst) and
10. Mrityu (death)
Prodromal symptoms of diabetes – Madhumeha Purvaroopa:
Sveda – excess sweating
Angagandha – excess body odour
Anga Shaitilya – lack of stability in body
Anga Sada – malaise
Sayya sukherati – feeling comfort in bed
Svapna Sukherati – feeling comfort in sleep
Asana Sukherati – feeling comfort in inactivity
Hrudayopadeha – feeling as if heart is heavy
Netropadeha – vision problems
Jihwopadeha – coated tongue
Shravanopadeha – hearing problems
Taluni Malotpathi – coated palate
Danteshu Malotpathi – coated teeth, caries
Ghana gatra – heaviness in the body
Kesha Ativruddhi – excessive hair growth
Nakha Ativruddhi – excess nail growth
Kesha Jathilee Bhava – brittle hair
Sheeta Priyatvam – person likes cold foods and season
Gala Talushosha- dryness of throat and palate
Asya Madhurya – sweetness in mouth
Kara Pada Daha – burning sensation in feet and palm
Mutra Pipeeliha Abhisarana – urine attracts ants
Madhura Mutrata – sweetness of urine
Shukla Mutrata – white discoloration of urine
Snigdha Gatra – excess oiliness of body
Picchila Gatrata – stickiness of body
Pipasa – excess thirst
Shvasa Dourgandhya – bad breath
Tandra – fatigue
Karapada Suptata – numbness of hand and feet
Anga Suptata – numbness
Alasya – lethargy
Mukha Shosha – dryness of mouth
Kaya Chitropadeham – heaviness of body
Sarvakala nidra – person wishes to sleep all the time
Shatpada Abhisarana on shareera – feeling as if ants are crawling on body
Pipeelika shareera Abhisarana – ants crawl on body
Clinical Features of Madhumeha
1. Atimutrata (excess urination)
2. Avila mutrata ( turbid urine)
3. Madhu tulya (urine similar to honey – sweetish astringent)
4. Panduta (pallor of the body)
5. Rukhsata (dryness of the body)
6. Dourbalya (debility)
7. Ratisu anasakti (loss of sexual urge)
8. Dourgandhya (bad body odour)
9. Dhatu kshaya (emaciation) etc
Complications of diabetes
1. Hridroga (cardiac disorder)
2. Loulya (urge to have food)
3. Anidra (loss of sleep)
4. Stambha (stiffness of the body)
5. Kampa (shivering)
6. Shoola (body ache)
7. Baddha purishata (constipation)
8. Udavarta (regurgitation)
9. Shosha (emaciation)
10. Kasa (cough)
11. Shwasa (dyspnea) etc.
Curability of Madhumeha
Madhumeha is a palliative disease. It cannot be completely cured; but, can be controlled by food and medicine. In rare cases, if it is originated due to any secondary cause or stress or medicine etc, on cure of the main illness or on withdrawal of the medicine, it will be subsided by its own.
Line of treatment
Ayurvedic treatment concept for diabetes:
Depending on the physical constitution or body type (prakriti), or the health status of an individual, ayurvedic classics advocate two different types of therapy schedules for diabetics. They are:
Apatarpana – de-nourishment treatment – useful in obese diabetic patients, usually in Kapha body type patients.
Santarpana – Nourishing treatment – useful in lean diabetic patients, usually in Vata or Pitta body type patients.
- Apatarpana (de-nourishment) and Samshodhana (cleansing): This treatment is prescribed if you are obese and heavily built. In this, along with anti-diabetic herbal medicines, importance is given on de-nourishment of fats and elimination of toxins by way of
- various exercises,
- fasting therapies – such as juice fasting, water fasting etc
- Cleansing therapies –called panchakarma (five fold therapies viz. emesis, purgation, oil enema, decoction enema and nasal drops instillation).
- Santarpana (replenishment) and Brumhana (body bulk promotion): This is prescribed if you are chronically ill, with low immunity and underweight due to the draining of essential nutrients. This therapy helps in providing the easily acceptable nutrients and micro-nutrients to rebuild body tissues and help strengthen the defence mechanism without increasing circulating blood sugar and fat tissue. This prevents further damage and ensures enhanced healing and repair. This is achieved by
- Oil enema therapies (Anuvasana Basti),
- nourishing massages such as Navarakizhi,
- oil massage
Administration of nourishing Ayurvedic herbs such as Ashwagandha (Withania somnifera), Vidari (Pueraria tuberosa), Shatavari (Asparagus racemosus), Aloe vera, pomegranate, nuts etc. Read more about nourishing treatments of Ayurveda
Classical and home remedies
1. Guduchi Kwatha: Decoction or juice of Tinospora cordifolia mixed with honey
2. Nisha kalka: Paste of Nisha (Curcuma longa) mixed with juice of Amalaki (Emblica officinalis).
3. 2 grams of turmeric powder (Curcuma longa) is added to the decoction of Jambu (Eugenia jambolana) / Asana (Pterocarpus marsupium) (40 ml) and taken routinely.
Nisha-triphala Yoga: The powders of the below said should be kept in water over night and should be strained through a sterile cloth or sieve in the morning. It should be consumed mixed with honey.
- Nisha – Curcuma longa
- Daruharidra – Berberis aristata
- Haritaki – Terminalia chebula
- Bibhitaki – Terminalia bellirica
- Amalaki – Emblica officinalis
Anti diabetic Herbs and Foods of Ayurveda
Jambhul (Eugenia jambolana): The jambul fruit is regarded as a specific medicine in traditional ayurvedic medicine because of its specific action on the pancreas. The fruit, the seeds, and the whole fruit juice are all useful in the treatment of diabetes. The seeds contain jamboline, which controls the excessive conversion of starch to sugar. For internal usage, dry the seeds, powder them, and take 3 grams, twice daily with water or butter milk.
Bitter Gourd / bitter melon (Momordica charantia): The fruit and seeds of this plant contain most active blood sugar -lowering components. This contains an active principle called charantin. For better therapeutic benefits, extract juice from four to five bitter gourds every morning and take on an empty stomach. You can take the seed powder either directly or in the form of a decoction.
Bel (Aegle marmelos): Though this plant is famous for its fruit, here we are interested in its leaves. They are scientifically proven to be anti-diabetic. Drink fresh juice of leaves daily along with pinch of black pepper. This will take care of your excess body sugar.
Fenugreek (Trigonella foenum graecum): The medicinal qualities or fenugreek seeds are described in ayurvedic literature. In recent studies, it has been reported that the decoction of fenugreek seeds suppressed the urinary excretion of sugar and relieved symptoms of diabetes. It contains trigonelline, and an alkaloid known to reduce blood sugar levels.
Turmeric: Ayurveda recommends turmeric as an exclusive remedy for diabetes. It is more effective if taken with an equal amount of amla powder.
Neem: Neem is an age-old remedy and does not require a trip to stores. It is easily available anywhere. Leaves made to juice or paste can be taken internally to lower blood sugar.
Wholesome diet for diabetes
Shigru (drum stick)
Amalaki (goose berry)
Shyamaka -Setaria italica (L.) Beau.
Kodrava – Paspalum scrobiculatum,Linn.
Mudga (green gram)
Kulattha (horse gram)
Patola (snake gourd)
Karavellaka (bitter gourd)
Maricha (black pepper)
Jambu (blue berry)
Vyayama (exercise) etc
Shyamaka – Setaria italic
Kodrava – Echinochloa frumentacea
Godhuma – wheat
Chanaka – Cicer arietinum
Aadhaki – Cajanus cajan (Pigeon pea, Red gram)
Mudga – green gram
Kulattha – horse gram
Tikta shaka – Vegetables which are bitter in taste
Patola – Snake gourd
Jangala rasa – Flesh / meat of animals living in dry lands
Saindhava lavana – rock salt
Unwholesome diet for diabetes
Ikshu (sugar cane juice)
Kanjika/shukta (sour beverages)
Pishtanna (carbohydrate rich food)
Navanna (new grains)
Divaswapna (day sleep etc)
Sadaasanam – Always sitting at one place (sedentary)
Diva swapna – Sleeping in the day time
Navanna – Dishes prepared from fresh rice
Mutravegam – Withholding the urge / reflex for urination
Dhoomapanam – smoking
Swedam – Excessive sweating / Sweating, Sudation therapy
Shonita mokshanam – Blood-letting treatment
Kshara – Alkalis
Guda – Jaggery
Suram – Alcohol / fermented drink
Ghritam – Ghee
Amla – sour foods
Ikshurasa – Sugarcane juice
Anupa mamsa – Flesh / meat of animals living in marshy areas etc
Herbs recommended in Madhumeha
Asana – Pterocarpus marsupium Linn
Nimba – Azadirachta indica A. Juss.
Bilva – Bael tree – Aegle marmelos Corr.
Haridra – Turmeric
Lodhra – Symplocos racemosa Roxb.
Jambu – Jamun seeds
Saptaparna – Alstonia scholaris R. Br.
Meshashringi – Gymnema sylvestre R. Br.
Kathaka – Strychnos potatorum Linn.
Khadira – Acacia catechu Willd.
Guggulu – Commiphora mukul (Hook. Ex. Stocks.) Engl.
Mamajjaka – Enicostemna littorale Linn
Shilajatu – Asphaltum punjabinum
Useful Ayurvedic medicines for diabetes:
Dhatri Nisha: A combination of Turmeric powder and Amla powder has to be taken early in the morning and is especially useful in Diabetic eye problems (diabetic retinopathy).
Triphala – A simple combination of three fruits – Terminalia chebula, Terminalia bellirica, Emblica officinalis. Apart from reducing blood sugar levels, it also relieves constipation, provides eye care. It is a very good source of anti oxidants.
Asanadi Kashayam – useful in diabetes associated with obesity, non healing wounds, diabetic carbuncles.
Chandraprabha vati – Useful in diabetes associated with recurrent urinary tract infection and diabetic nephropathy
Pathyakshadhatryadi Kashaya – rich in anti oxidants
Shilajatu vati – useful in diabetes associated with premature ejaculation, erectile dysfunction etc
Panchanimba churna – useful in diabetes associated with repeated skin infection disorders.
Other useful Anti diabetic medicines are –
Nimbamritadi panchatiktakam Kashayam
Mamajjaka Ghana vati
Vasanta kusumakara rasa
Nimbamritadi panchatiktakam Kashayam
Madhumeha is a burning problem all over the world. People are eagerly waiting for a quick and permanent cure. As the pathology takes long route of manifestation, finding an instant remedy will be very difficult. As there is an involvement of both body and mind, it will be very essential to undertake the measures which can bring under control our food and habits as well as undue stress.
Fear of disease is dangerous than the disease as such. So, here is the need of knowing the reasons and manifestations of the disease madhumeha and hence the role of relative food and habits which help in the control of the disease. Simple way to get control is –
‘Do not eat in hands, take food in fingers!’
‘Be aware of hurry, worry and curry and learn to say sorry…..!’
Along with the above medicines and remedies, Ayurveda also recommends
Regular Yoga, meditation and Pranayama to prevent or treat stress.
Regular exercise – to keep up good metabolism rates.
Regular oil massage – to treat muscle and joint aches and pains.
Regular eye exercises, eye checkup and Ayurvedic eye therapies such as Tarpana treatment to prevent and treat retinopathy.
Foot massage with neem based oils such as Nimbadi Tailam, to prevent and treat non healing wounds and ulcers.
Samprapti of Madhumeha – Pathogenesis
Ojas – essence part of all body tissues, plays an active part in the samprapti of Madhumeha. In Madhumeha, Ojas is excreted through the urine leading to oja kshaya (depletion), so the symptoms of ojakshaya like murcha, mamsa kshaya, moha may manifest (More about Ojas depletion symptoms and management).
Vishishta anilatmaka Madhumeha samprapti
“Sa prakupita thathavida shareera visarpan-
Ojaha punar madhura swabhavam tadyadaroukshyatvayuh kashayatvena abhisamsrujya mutrashaye abhivahati tada madhumeham karothi.
Thatha vida shareere – bahudrava sleshma, bahuabdh meda, bahu kleda yukta shareera( chakrapani on ch ni 4/37)
The patient who have the specific body tendency for premeha onset which means it may be due to genetic predisposition, prakruti manifestation or sedentary habit have the specific meda bahulyata preferably with abaddhatva. If these patients consume excessive vata provocative ahara, vihara or mano abhigatkara bhava, then vata gets provocated. This provocated vata further gets implicated by meda. Now this provocated meda complex leads to transfer of either vasa, majja, lasika, oja to mutravaha srotas. When oja due to influence for vata adopts kshaya and ruksha guna and excrete through urinary treat is termed as Madhumeha.
Samprapti of Madhumeha due to Shuddha Vata
Charaka mentions the samprapti of Madhumeha due to shuddavata
“ksheeneshu doshaeshvavakrshya basthav dhatoon pramehaananila karothi || (chi 6/6)
Due to vatakara nidana, provocated vatadosha leads to kshaya of other two doshas and sarabhoota dhatus like vasa, majja, lasika and oja. Due to kshaya of dhatus, vata gets further provocated. This highly provocated vata draws oja towards basti and leads to madhumeha. This is asadhya to treat due to its arambhaka dosha vata and resultant further provocation due to dhatukshaya (ch.chi 6/34)
3. Dhatukshaya janya Madhumeha samprapti:
Apakarshitheshwithi ksheeneshu, kshayasthesham prameha arambakena vatenaiva upaposhanadhibih karshanad va kriyate (chakrapani on ch chi 6/11)
The kshaya of gambhira and sarabhuta dhatus like majja, vasa, oja and lasika leads to vata prakopa vata dosha gets vitiated leading to ksharana of sarabhuta dhatus through mutra pravritti in such a quantity that this ksharana of sarabhuta dhatus itself acts as etiological factor again for vata prakopa hence this vicious circle goes on. But due to ashukaritva of vata all the stages of samprapti proceeds so fast that, it leads to asadhya stage of the disease very quickly
4. Aprathikaritha vatanu bandita Madhumeha samprapti:
This type of Madhumeha is actually not a separate entity but it is the further stage of kaphaja or pittaja prameha due to deerga kalanu bandha or this may be called as ignored stage of prameha due to lack of proper treatment. Kaphaja and pittaja prameha which are present from quite longer period they do get anubandha of vata to chronicity i.e. they get converted into vataja prameha (ch ni 4/37)
5. Avarana janya Madhumeha samprapti:
The description of avarana janya samprapti of madumeha is a unique contribution of Charaka to the clinical medical knowledge. Here one can see that nidana is same as that of kaphaja prameha but still the resulting disease in Madhumeha. Guru snigdhadi ahara, avyayamadi vihara etc. leads to provocation of kapha and pitta dosha inturn increases in quantity of meda and mamsa. All these increased factors obstruct the gati of vata leading to provocation of vata.
This provocated vata withdraws oja from the body and takes it towards basti and leads to Madhumeha, which is krichra sadhya for treatment due to its origin from kapha and pitta doshas.
Initially vata dosha remains innocent in the pathology. The vata, pitta and kapha doshas start manifesting their symptoms intermittently depending on their extent of dushti. Subsequently pitta and kapha attain kshayavastha compared to vata due to kshaya of dhatus. This process of margavarana of vata due to kapha and pitta occurs in two kinds of people. First in those who are sthula and secondly in those who are not sthula but have indulged in kapha medokara ahara and vihara. If the nidana for pitta are significant then it also gets dushti. In sthula people, the sthaulya is the result of two reasons. First it is due to excess indulgence in kaphakara ahara viha. If the nidana for pitta are significant then it also gets dushti. In sthula people, the sthulya is the result of two reasons. First it is due to excess indulgence in kaphakara ahara vihara and second is due to beeja dushti. In the former case, the upachaya of medas occurs due to the nidana sevana, where as in the later case, the medo upachaya occurs even in the absence of kapha medokara ahara vihara.
Obesity and diabetes relationship
Samprapti of sthaulya and its role in causing Madhumeha:
Sthaulya can be caused by tarpana (nourishing diet) as well as beeja dosha. The nidanas for sthaulya are same as those described for Madhumeha as “kapha krit cha sarvam” (all those which cause an abnormal increase in kapha dosha). A sthula rogi can be identified by an abnormal bulk especially to sphik, udara and stana and has the 8 doshas as characteristic features (ch su 21/4)
Samprapti based on Kriyakala
SAMPRAPTI OF MADHUMEHA IN THE LIGHT OF KRIYAKALA
1st Kriya kala – Sanchaya avastha
In this stage the samhathi roopa vriddhi of kapha occurs in svasthana i.e. amashaya, presenting the following symptoms
These are as a result of guru and manda guna of kapha. The occurrence of these symptoms have been inferred after studying the poorva roopa and roopas of Madhumeha
2nd Kriyakala – Prakopa avastha
In the event of the patient continuing with the nidana sevana, disease proceeds to prakopa avastha where the kapha undergoes vilayana roopa vriddhi and can be understood as presenting with the following symptoms
- hridayoklesha – due to amaroopi kapha
3rd Kriyakala – Prasara avastha
If unhindered the prakupitha doshas attain prasaravastha where the unmarga gamana kapha along with the other two doshas from the svasthana occurs. The doshas pervade the body and it can be inferred that the following symptoms are presented.
- Angasada – due to kapha along with vata and pitta
The importance of first 3 kriyakalas in preventing Madhumeha – any disorders in these 3 stages often goes unrecognized, as these symptoms are mild enough for the patient to ignore.
Moreover, the symptoms are so vague and varied that it becomes difficult to ascribe them as per to Madhumeha in these 3 stages. By suitable modification in the ahara and vihara in the form of laghu ahara sevana and vyayama etc, we can control as well as prevent the onset of Madhumeha.
4th Kriyakala – Sthana samshraya avastha
By repeated nidana sevana, prakupita doshas lodges in the srotas where khavigunya exists. The medhovaha sroto vaigunya in the vapavahana due to apathya sevana or beeja upatapa causes the dusti of kapha and vata & attains sthana samshraya initiating the process of dosha dushya sammurchana. The poorva roopas manifest in this kriyakala.
5th Kriyakala – Vyakta avastha
Dosha dushya sammurchana takes place actively during this kriyakala. The pratyatma lakshanas of Madhumeha i.e. prabhoota mutrata and avila mutrata along with sarvadaihika lakshanas manifest during this stage.
Prabhuta mutrata is a result of vriddhu svaroopa kleda dushti and avila mutrata is one of the symptoms of kleda dushti
6th Kriyakala – Bheda avastha
In this stage Madhumeha is no more new. It would have attained sub acute or chronic stage. This disease proceeds into more severe forms in the event of increasing dhatukshaya. It also starts manifesting the pittaja and vataja lakshanas rendering the disease yapya. The disease essentially attains asadhyatha in this stage. Hence forth, upadrava and arishta lakshas start appearing.
Arishta Lakshana of Madhumeha- lethal features –
A few references regarding the Arishta Lakshana of Madhumeha and Prameha can be found. If the Bala and Mamsa of Madhumeha Rogi is severely deteriorated then he should be considered as Achikitsya (not advisable for treatment) (ch. Ind. 9)
Svapna Vishayaka:- if a pramehi in his svapna sees himself drinking different varieties of snehas in the company of Chandala (people boycotted socially) he dies of prameha (sha.Ind.9/8)
If he dreams of drinking water, it is also Arishta (todaranda)
Dootha Vishayaka: – if the physician comes across a dootha carrying water or near a pond, then it is Arishta for a Madhumehi.
Anya: – A person who likes Abhyavaharana and hates snana and chankramana will fall victim to the disease Prameha just like eggs of a pakshi in its vasa Vruksha (needadruma) that fall prey to its predators, as it is unable to move and rescue itself due to the inherent inertia of the egg.
A manda uthsahi, Atisthula, Atisnigdha, Mahashani falls prey to the disease at the earliest (su.su.33). A snatha, Anulipta gatra Pramehi, attracting Makshikas is sure to die(Todarananda). If the Madhumehi is suffering from all upadravas with Pidaka, Atiprasrutha Mutra and if the disease is Gadha, then the patient will die. The knowledge of Arishta is very much essential to understand the prognosis of disease which denotes death definitely.
Curability of Madhumeha
Madhumeha or prameha has been described as anushangi which means it is punarbhavi in other words once a madhumehi will be so always throughout his life. Therefore one should make all efforts to prevent and control it. As described earlier Madhumeha passes through 3 stages of severity based on involvement of dhatus accordingly the sadhya asadhyata has been described.
Sadhyata of kaphaja pramehas
The ten-kaphaja pramehas are described as sadhya because of the following reasons.
- Atishaya medho na dustatvat
Yapyata of pittaja pramehas
The 6-pittaja pramehas are described as yapya because of the following reasons
- Vishama kriyatvat
- Atrapi atishayena medo na dustavat
- Samsrustha dosha medo sthanatvat
Asadhyatha of vataja pramehas
the four-vataja pramehas are considered asadhya due to the following reasons.
- Mahatyayikatvat: the term mahatyaya has following interpretations
- Mahata gambhira dhatunam atyaya nasko yena sa
- Mahavyapatti katrukatva
- Majja prabruti sarabhoota dhatukshaya
- Majjadi gambhira dhatu apakarshakatvena
- Uttarottara saratara dhatu sravakatvat
The above interpretations indicate the fatality of the disease, where all the dhatus including the gambhira dhatus undergo nasha, kshaya, sravana and apakarshana.
This process involves multiple srotases producing upadravas and is hence mahavyapathikara, which means that the disease is much too fatal to sustain life. Moreover it is ashukari and sheegrakari which indicates the rapidity of the fatality in the patient, which is why the authors advice the physician not to bother much in handling the patient as disease transcends all boundaries of management.
Virudhopakramatvat: the chikitsa of vataja prameha involves virudhopakrama which means there is a mutual contradiction in the treatement modalities as use of snigdha etc are pathya for vata but apatya for medas. Hence the disease is asadhya.
Other situations Determining Asadhyata of Madhumeha
Madhumeha with all poorvaroopa. It has been said by charaka that if a disease in Roopavastha has all the poorvaroopas manifested, and then the disease becomes asadhya. Based on this principle the inherent nature of Sadhya Asadhyata of kapha, pitta and Vataja Pramehas undergoes modification as follows
Sadhyata of kaphaja meha attains Asadhyata when associated with all poorvaroopa.
Yapyata of pittaja meha attains Pratyak hyeyata when associated with poorvaroopa.
Sometimes the pittaja meha can also be sadhya when dhatu kshaya is not Atishaya, which has been termed as Avastha Sadhya. In such situations the pittaja meha becomes Asadhya and in later stages when pittaja mehas are yapya, they attain pratyakeya Avastha when associated with poorvaroopas.
The severity of Asadhyata increases when associated with poorvaroopas Vataja pramehas have already been described as Asadhya but this term has to be analytically interpreted in the two clinical types of Vataja mehas i.e. Dhatu Kshaya Janya and Margavarana Janya.
The principles of chikitsa can be studied under
a) Nidana parivarjana
c) Prakriti Vighatana.
These principles of treatment are to be studied separately with respect to Dhatu Kshaya Janya Madhumeha and marga Varana Janya Madhumeha (ch. Vi 7/ 28-29)
Samanya Chikitsa Siddhanta
Nidana Parivarjana in Margvarana Janya Madhumehi:
An apathyanimittaja Madhumehi is usually sthula, likes Abhyavaharana and hates chankramana. Here the patient should be made to avoid all kaphakara ahara vihara to prevent the occurrence or to cure the disease.
Nidana Parivarjana in dhatukshaya janya madhumehi (ch.chi 6/53).
Nidana parivarjana in such madhumehis is studied with special referance to sahaja Madhumeha. It lies entirely on the vata or pitta so as to how best they act to prevent the occurrence of the disease in them. They should avoid the beeja, beeja bhaga or beeja bhaga avayava upatapa leading to Madhumeha arambaka dosha dushti.
Apakarshana and prakriti vighatana
The apakarshana of doshas are mainly done through samashodhana but only when roga and rogi bala are in pravaravastha and when either one or both are avara, then it is done through langhana and langhana pachana which constitutes samshamana chikitsa, in other words prakriti vighatana.
Apakarshana in margavarana janya Madhumeha: In sthula Madhumeha samshodhana is indicated and before starting this therapy snehana is advised. For snehana karma when there is predominance of kapha dosha along with vata then taila processed with kaphagna drugs should be used. When there is anubandha of pitta the ghrita processed with pittaghna drugs should be employed (ch.chi6/34,37). Shodhana especially vamana should be preferred in a madhumehi if the dhatukshaya is minimum and kapha and medodushti lakshana are maximum.
If there is pittaja lakshana and dhatukshaya but virechana is not contraindicated then virechana can be performed. Similarly, if the anubandha vata lakshana are more and the patient is samashodhana arha then basti can be performed.
Madhumeha is a svedana anarha vyadhi (su.chi 12/7) but niragni sveda in the form of vyayama is indicated. The selection of yoga for samshodhana should be selected as per the recipes prescribed in kalpa sthana. After shodhana, shamana chikitsa can be done by kapha medohara dravya.
Prakriti vighatana in dhatu kshaya Janya Madhumeha :-
Dhatu Kshaya avastha is the result of Beeja dushti in sahaja Madhumeha and due to a state of Atikarshita dhatus as a result of continued dhatu kshaya, which in fact is the progressed stage of Marga varana Janya Madhumeha. Both the situations are considered samsodhana Anarha (chi chi 6/18). In such cases, samshamana chikitsa is advised, whereas Madhumeha in both these cases are Asadhya (chi chi 6/52)
Not with standing this, the principles of chikitsa for vataja pramehas are for vata anubandha doshatva, which is still dependent on the Kapha and pitta doshas and not for Vata Anubandhya Dosha janya Madhumeha characterised by Atishaya karshana of dhatus. Hence samshamana chikitsa should be appropriately adopted in such patients.
Treatment based on stage of Madhumeha
AVASTHA ANUSARA CHIKITSA OF MADHUMEHA (SU CHI 12/4)
Sushrutha in the chapter of prameha pidaka chikitsa has identified the stages of Madhumeha and accordingly advised the treatment, which can be discussed as follows;
Stage I : chikitsa in poorvaroopavastha
Stage II: chikitsa in vyaktavastha.
Stage III : chikitsa in Upadrava Avastha
Stage IV : chikitsa in pravrudha Upadrava Avastha
Stage V chikitsa in asadhya Avastha.
Stage I: Is the poorvaroopa Avastha where the dosha dushya sammurchana has just begun, then the disease should be treated with Apatarpana, Vanaspathi Kashaya and chaga mutra. If left untreated, Madhumeha proceeds to the II stage.
StageII: this is the vyakta avastha of Madhumeha where, due to continued madhura ahara sevana, the sveda, Mutra and sleshma attain Madhura bhava and hence should be treated with ubhaya samshodhana i.e Vamana, virechana and Basti. If left untreated, the disease progresses to Stage III.
Stage III: in this stage, the Mamsa and Shonita undergoes pravruddha dushti causing shopha and other Upadravas and these should be appropriately treated as mentioned accordingly, like siramokshana in shopha. If left untreated, the disease progresses to stage IV.
Stage IV : in this stage, the upadravas like shopha would have attained Ativruddha Avastha manifesting symptoms like ruja and Vidaha, where shastra chikitsa and Vranakrija should be performed. If neglected the disease proceeds in to Asadhya Avastha which is the V and final stage.
Stage V : In the Asadhya Avastha, the Upadravas become Mahantha and makes the disease Asadhya, like here when the Puya of Pidakas attain Abhyantaraprapti and become utsanga.
Analysis: – Though explained as Prameha pidaka Avastha chikitsa, description of stage wise progression of the disease and the treatment has been done by Sushruta on the pretext of explaining prameha pidaka chikitsa.
This description seems to be chikitsa in case of Apathyanimittaja Madhumeha, the course of this illness has been discussed already under samprapti and accordingly in the poorvaroopavastha, sushrutha advices Apatarpana and other shamana dravyas, as there is alpa dosha and alpa dhatu dushti. Hence unless the need arises, samshodhana is not the treatment of choice and as the lakshana are predominantly due to kapha, kaphahara chikitsa should be done and this seems to be the logic behind prescribing Apatarpana and Tikshana dravyas like chaga mutra. Whereas in Vyakta avastha there is bahu dosha and relatively Alpa dusti of dhatu like medas and Rakta which wants shodhana, accordingly Vamana, Virechana and basti have been advised as the rogi is still Balavan and Stula so, shodanarha.
In the next stages, there is a progressive dhatu kshaya and production of upadravas. The patient is shodhana Anarha and there is Vata pradhanyata. Hence, only shamana chikitsa and respective upadrava chikitsa should be done. Sushruta has stressed the importance of timely intervention in Madhumeha because in case of negligence, the disease progresses involving gambhira dhatus and the upadravas pervade entire body making it Asadhya.
Santarpana Apatarpana Chikitsa
SANTARPANA APATARPANA CHIKITSA IN MADHUMEHA
Madhumeha has been described as santarpanodha vyadhi as well as Apatarpanodha vyadhi. The former is Apathya nimithya Madhumeha and later is sahaja Madhumeha i.e. Madhumeha due to dhatu karshna due to long lasting prameha. Acordingly, two forms of madhumehis are encountered one who is sthula and balavan for whom apatarpana is the best and other who is krusha and paridurbala for whom santarpana is the best line of treatment.
Apatarpana chikitsa (chi chi 6/51): – is done in the form of langhana, langhana pachana and doshavasechana (ch.vi 4/43). Langhana is done in Alpadoshavastha where only upavasa, pipasa, maruta, atapa, sevana (ch su 22/10). Rooksha udvartana, pragadha vyayama, nishijagarana & so on, which are kapha medohara, are helpful. Langhana pachana is done in madhyama doshavastha where along with langhana; amapachana is done with Tikshna, ushna dravyas.
Doshavasechana is done in bahu doshavastha where the shodhana of doshas is done from ubhaya margas.
Santarpana chikitsa: laghu santarpana chikitsa is prashastha for krusha and durbala rogis. The following can be administered in madhumehi. a) mantha b) kashaya c) yava d) churna e) lehya f) laghu bhakshya. These formulations should be prepared such that they cause santarpana without causing vriddhi of kapha and medas. Among all these yava is considered as best for madhumehi.
Sushruta has described to select drugs, which are having bitter, pungent, astringent taste, katuvipaka, ushna veerya and shoshaka, chedana properties in the treatment of Madhumeha (su chi 13/8). Shilajathu guggulu, loharaja are the best medicines in madhumeha, either in krusha or sthula, as they are virukshana and chedaneeya, which is good for kapha, as well as rasayana, which is good for dhatukshaya & vata vriddhi. Sushruta has described some medicinal remedies for all types of prameha and advised to use after purification therapy.
- Extracted juice of amalaka mixed with haridra powder and honey
- A decoction of triphala, vishala, devadaru and musta.
- Tola kalka of shala, kampillka, mustaka, sweetened with honey and extracted juice of amalaka should be taken together.
- Powders of the flower of kutaja, rohitha, kapittha and vibhitaka should be taken together with honey, haridra and extracted juice of amalaka.
- Decoction of roots, leaves, barks, flowers and fruits of nimba, aragvadha, saptaparna, murva, kutaja, somavriksha, palasha should be given to the patients (su chi 11/8)
The decoction of chitraka, triphala and indrayava mixed with honey.
Extracted juice of guduchi mixed with extracted juice of amalaka fruit and honey (as hr chi 2/5, 6). Few effective preparations for the management of Madhumeha have been recommended by sharngdhara are as follows
Amruta swarsa triphalachurna nyagrodhadikashaya
Dhatri swarasa tryushnadichurna lavangadi churna
Kalayanaka ghrita kumaryasava vidangarishta
Manduradi vatika Chandraprabhavati
Bhava Prakasha recommended – phalatrikadi kwatha, trikatukadhya, modaka, nygrodhadi churna, lodhradi churna, guduchi swarasa and trikatu gutika in the lohabhasma, shilajith, madhu, guduchi swarasa are the drugs of choice in all kinds of prameha. Madhumehasava, lavangasava, madvasava, chandanasava etc are useful for Madhumeha (bh ra 37/38)
PATHYA APATHYA OF MADHUMEHA
Pathya: Nidana parivarjana is the first and prime pathya for Madhumeha. In sthula Madhumeha there is margavarodha of vata by vridha kapha and meda hence to rectify the imbalance of doshas and to reduce to the meda, usage of jangala mamsa rasa of vishkira, pratuda and vihanga varieties, shyamaka, uddalaka, kodrava, godhuma, chanaka, adhaki tikta rasa pradhana shakas grown in jangala desha, yavanna, madhu, kulatta purana dhanya sevana, puranashali, laja sevana is also beneficial (ch chi 6/19,20,21)
Sushrutha mentioned vyayama and ratri jagarana are beneficial (su ch 12). Tikta rasa dravyas are beneficial in madhumeha because tikta is laghu and ruksha where as kapha is guru and snigdha. Tikta rasa helps in decreasing kapha, shareera kleda and meda, which are known as the important factors involved in Madhumeha. It helps in reducing the dravatva of mutra in term decrease the saratva hence the frequency of mutra will be reduced. Karavella, bhumyamalaki etc are to be used for this purpose. Yava is ruksha & laghu, helps in bringing kapha dosha to normalcy.
Yava, mantha, vishkira mamsa, pratuda mamsa are the pathya beneficial for krusha madhumehi.
Sahaja Madhumeha and Madhumeha with Dhatu Kshaya have Vata as anubandhya dosha. Since the beginning, but in margavarana Janya Madhumeha Vata is only Anubhandha to pitta by Sleshma and therefore the chikitsa for vataja prameha have been designed keeping in mind the Anubhandhavata and not the Anubandhyavata because in the later case it has been categorically stated that even thinking about managing this condition is a futile exercise. Whereas in the former case the status of Vata can be controlled through the treatment, as it is still dependent on the status of Sleshma and pitta. In this case the amenability of vata to the treatment becomes less and less depending on with what severity the poorvaroopas are associated.
In other words, in case of Anubandha vata if the prameha were have to been Avastha Sadhya, it would become Asadhya even if associated with Asamartha poorvroopas as vataja pramehas are Asadhya by svabhava. Hence the degree of Asadhyata in stages of vataja prameha worsens with the degree of association of poorvaroopas.
- Jatha Madhumeha is Asadhya due to Beeja dosha as there is irreversible madhumeharambaka dosha dusti since birth itself.
- Madhumeha with pidaka is Asadhya.
- Madhumehi who has Bala mamsa Kshaya can be left untreated.
- All pramehas if left untreated, terminate into Madhumeha which is Asadhya.
- Prameha with upadravas and Atiprasuta mutra is Asadhya.
- Pramehas with arista lakshanas is Asadhya.
- A patient who hates hygienic habits like snana, chankramana and one who has Manda Utsaha, who is Atisthula, Snigdha and Mahashana dies of prameha.
Targeting Pre-Diabetic Population – Effective way to prevent T2DM:
To do this we need to target the pre-diabetes group of people. If the diet, medication and lifestyle of the pre-diabetic population are monitored in an effective way, we can avoid this population heading towards T2DM and thus can limit the number of global cases of T2DM.
We need to intervene with pre-diabetic population before the disease progresses into fully developed T2DM. Thus we would have prevented many T2DM cases from getting manifested.
For this to happen, we need to identify pre-diabetic individuals, educate and provide suitable interventions to them. This gives a chance for the diabetes-prone people to avoid the diabetes and maintain a normal and healthy life.
Article by Dr MS Krishnamurthy and Dr Hebbar