Ayurveda Academy Bangalore

Guest lecture by Vd. V.B. Mahaiskar, Ayurveda parangat ex-principal superintendent, government ayurvedic college hospital, Baroda, Gujarat. State

Samprapti vighatan in Madhumeha

Hetus and dosha dushya sammuchya : -

Adhayatmika hetu: sahaja- mata- pitru beej doshaja or kulaj, appearing in progeny or heredity factor. This is comparable to Type 1 or juvenile type of the modern classification occurs before the age of 25 years. Basic cause is genetic susceptibility + virus infection destroying the insulin secreting cells in the pancreas.

Apathya nimityaja- Apacharaja diva swapna day time sleep avyasyama inactive life style alasya_prasakti, idle life style indulgence in sheeta, singhadha, madhura medya, drava, annapana sevna cold, oily, sweety fatty liquid foods and drinks respectively. Navadhanya, seva use of freshly cropped grains produce a proneness to prameha. This corresponds with type 2 or maturity onset variety of diabetes mellitus. Occurring after the age of 40 years family history is highly suggestive, obesity sedentary habits, over eating, lack of exercise and stress are the major causes. This has three subgroups, (l) where the damage is partial Avara sammurchana. (2) Where utilisation of insulin is not possible because of a receptor fault at the cell level dhatu agni dosha 3) when there is a presence of barrier substance- preventing the entrance of insulin in the cells. Something comparable to avarana in our terminology. Stulata or obesity; 4. Ashodhanam- non-cleaning of the body, 5) achinta / atichinta, stress, -some of these require special mention. Diva swapana causes mamsavaha srotodusti, avyayama inactivity, the pertness ; or sphutata of srotasas is thankful to three factors - Day time itself, vyayama and vihara as well as involvement of mind in the activity. This results in clogging of the srotasas. Kleda and the upakledana brought about it is a very important factor in madhumeha. Daytime sleep has been recorded as one of the eight mahadoshakara hetus, it is also first rated hetus for kapha- prakopa, atichinta results in rasayaha srotodushti. Madhumeha is kapha kara dhanani upalepakara, abhishanda kara, atimadhura medya snighdha atiguuru etc., result in-santarpanaja vikaras, prameha is the first and foremost of them. Other equally important effects of santarpana are indriya lepa, sroto lepa and buddhi moha, or blocking of sense organs-channels and delusion of intellect respectively. Medorogi is also prone to madhumeha because similar conditions prevail in its pathology-timely shodhana, or elimination of accumulated doshas can be helpful in easing the condition but non-cleaning helps to aggravate the situation, all the aforesaid causative factors provoke all three doshas. Mainly Kapha increase meda and give rise to the special features mentioned in madhumeha. The doshas in their turn also vitiate meda- mamsa - kleda-shukra--rakta- vasa majja lasika rasa and ojas.

The speciality of the main dosha is excessive fluidity of the kapha dosha. The specialty of the affected Dhatus is their excessive-ness and diminished viscousness or looseness or less compactness (bahu abbadhata)

As a result of accumulation of -large amounts of kleda and excessive fluidity of kapha, so also due to diminished

Viscousness of the involved dhatus there occurs an overall admixture of the kapha and the dhatus. Kleda is in excess and has to pass alongwith urine --- the clogging resultant dilatation and effects of heaviness are pronounce! In the mootra - vaha srotasas, there sanga followed by atipravriti results in bahu mutrata, excessive loss of fluids results in excessive thirst. The fluids alongwith them take away the kleda, and ojas. The srotorodha is not only restricted to the mulam of mutra-vaha srotas, but is spread all over the body in practically all srotasas connected with the dhatus or the dushyas involved in the samprapti, the effects of bahubadhatha meda are pronouncedly seen in all the; vessels, or rasayanis. They are in the form of upalepa resulting in the blocking or sanga. This is reflected in the form of weakness, harsha daha etc. Mamsa is another important dhatu that is affected the pratanns of all the siras, snayas and srotasas are situated in mamsa dhara kala. In the formation of kala, kleda is an important factor

This muscular weakness is experienced by the patient and is well recorded in the texts in a very typical manner. A persons suffering from madhumeha has a strong desire a) for standing still if he is walking, b)for sitting down if he is standing, c) for lying down if he is sitting, d) for sleeping if-he is lying down. And if not treated in time he may eventually develop sanyasa or coma.

The very occurrence of a disease, it is severity or mildness the number and strength of lakshanas, the manifestation upadravas and their severity or otherwise depends on the strength and severity of the causative factors, profoundness or mildness of the provoked doshas the nature and depths to which the dhatus and srotasas affected

Profound provocation of Doshas, severe sroto dushti affection of deeper dhatus and all pervading dosha gati result in a disease difficult to cure. This is true in most of the cases of madhumeha. madhumeha has been classified as one of the eight Maharoga very difficult to cure. This is true in most of the cases of Madhumeha.

Even so a person suffering from such ,a severe disorder is not likely to neglect himself. He takes care, avoids things that are definitely knew troublesome, observes certain does and donts. May even go for half hearted treatment a result of this or even by virtue of nature his signs and symptoms may ameliorate or excerabate, may become less or pronounced.

By the nature madhumeha has the following important features

1 Sarva shareera gatatva, all prevailing nature of the Samprapti

2. Mutra- Madhurya and Tanu madurya

3. Balavan srotorodha Sroto Lepa

4. Rasayani Daurbalya, dhamani prathichaya

5. abundence of kleda

6. Anushingitva relapsing nature

7.      Apatya sankramatva

8 the Jathragni is well functioning, but the Dhatuvagni mandya is pronunce

9. Tho krura koshtata, durvirechyata.

10.       Indriya upaleps and budhi moha (at an advanced Stage)

1.         The diseases may be resultant of ati santarpana or Aptarpana

2.         The person may be sthula as Krisha, Balavan or Durbala

3. In Sahaja variety the person is Krisha, ruksha less eating but has intense thirst and is parisarana sheela

4. In Ahitaharaja variety the person is obese, has voracious appetite. Is snigdha and. prefers idle inactive life.

Criteria for diagnosis

1. prabhuta avila mootrata, prameha

2. presence of prameha poorvaroopas along with even the slightest increase in the quantity of urine prameha.

3. Left to themselves all varieties-of -prameha- result- in madhumeha.

4. madhumeha along, with the features in no. l and 2 above have the following findings of importance

5.      Madhuram mehati

Madu iva mehati and madurya of tanu and shareera

Following varieties of Pram-ha may be given special attention:

Ikshu Meha aitairthy Madhura mutra

Shita Meha Subahuso maduram mutra.

Madhu meha. Madu samam mutram

Observation such as sharir and mutrabhi saranam by pipilikas may create strong doubts

Upadravas:

1) In the areas of primary affection ie. mutravahas srotas and it's mulam.

 2) as a result of rasayani daurbalya prameha pidakas. 3. The rasayanis arise from the Hridhaya and affection of rasayanis may affect the mula or Hridya, hrid upadeha

4 Sroto rodha- --and It's effects at various, places

5. Indriya Lepa- Ivianifestc by Tandra, Nidra, affections of the eyes Nasa, karna- upadeha affections of the skin like Kandu - Daha - Supti.

6. Extreme weakens and proneness to Jwara putimamsa pidaka, alaji and Vidradhis i.e. various infections

CHIKITSA

1. Sahaja beeja doshaja kulaja are asadya

Yet efforts may be made. Type one or Juvenile variety was having the same fate till the advent of insulin. They are insulin dependent and enjoy much longer life span these days.

2 apachara nimittaja is divided into two groups. Santarpana Nimittaja or stoolata may be Balavn or Durbala. Apatarpana nimittaja or Krisha he may be Balavan or durbala

3. Santarpanaja variety has kapha predominance, requires samshodhana

4. The Krisha doshaja or apatararpanaja has vata predominance and requires satarapana One should always keep in mind that the apatarpana or Shodhana is done very carefully. So that it does not bring about weakness, consumption etc. careof agni is very important while doing paritarpana or impletion. The Krusha or emaciated is to be constantly watched protected from not going weak. removal of the causes nidana parivarjana is the most important thing. This requires change in the life style. In eating and in activities, or in ahara and vihara. Kapha. kleda meda and mamsa are the most important factors in the Samprapti. They are in excess The excess is directly related to the type of food and the inactive life style.

Ahara yantranam controlled diet avoidance of madhura snighda and guru ahara. Intake of Yava, Godhuma, Bajara, ragai, Kodravas and such other course food grains. Using more patra shakha. Use of food grains that are pre treated with Medicine like triphala or the Kwatha's that are used in Kapha Meha are advised.

The second important causative factor connected with the life style is the inactivity  Taking into consideration the comparative strength of the person and his comparative strength, we may choose a particular set of Vyayama or exercise takeing into consideration the social and, financial status of persons alongwith other factor, Sushrutha prescribed various types of Vyayamas marathon walking (Yojonan Shatam)  wrestling, out door games, rides on various animals like Elephants, Camels, Horses, practicing of martial arts etc. Other rigorous exercises such as pulling of a sacred cart. Continuous farm works, Digging a well or participating, in digging projects etc. (In these days Jogging brisk or fast walking running continuously keeping engaged in projects- of Shrama Dana or joining a pada yatra may be useful type of exertions, avoidance of day time sleep is another important aspect.

The diet control and. daily exercise arc the factors which requires patient education. They are topics of daily practice or abhyasa, and therefore, education is required  In modern times much importance is given to patient- education.

            So far as diabetes mellitus is concerned, this includes points on diet exercise, self injecting techniques, punctual consumption of correct medicine in correct dosage, their ill effects and their immediate and easy treatments or diet adjustments etc. This was known to the poorva suris also, they have classified, the rogi population in two groups, pragnya rogi and. Ajnya rogi. The pragnya or the wise patient take timely care and does not allow the disease to grow. The ajnya or the ignorant one make no efforts for timely arrest of a disease and, repents, Their message in wide ranging We must apply it wherever we can, we must educate the public or the food and exercise aspects from our point of view Diva swpana is one such factor, prista Yana Gammana or riding or scooter or a motorbike is yet another factor. In a neighboring country some time ago the Government had officially advisee the officers to do some cycling or practice walking at least for some minutes daily to avoid the coming on of early diabetes, hypertension and coronary insufficiently followed by deaths in young age groups, diet control, regular exercise and oral medication of suitable type is sufficient in the management of the nilcer type or where the Samprapti is not much avagadha. They are persons from groups two with partial damage of the pancreas. (Group 2 category 1) control of the other two varities is not easy.  Kaphaghna, Kledaghna, Medhohara, Srotas shodhi, Ojo Vardhana and Balya group is of use. In my experience single and. Duel drugs of choice are as under

1. Dhatri Nisha, 2. Mammajaka, 3. Khadira kramuka Kashaya 4. Vasa Guduchi- Triphala Kashaya, &. Darvi, Surahva Triphala Musta Kasaha, 6. Shilajatu Prayoga, 7.Vasantkusumakara rasa 8. Jamboo Beeja Churna.

In selected cases udavarthana and Basti prayoga are also found useful. Here also diet control and. exercise play an important role. Upadravas are to be treated  as per the treatment in that particular roge.

In Modern Medical science also complete cure is a distant dream. They also discuss at length the complicate interaction of the various deemed causative factors involved in the pathogenesis. The limitations of various measures. Important of diet and exercise. They speak of the complex Nature of the disease in a language very similar to ours. The most obvious derangement is diabetes mellitus is that of carbohydrate metabolism but the fate of protein and facts of electrolytes and water all so intimately inter twined with that of carbohydrate that it is impossible to discuss any single factor of the abnormal metabolism without implies ting other areas it present, the biochemical and physiologic explanation of the mechanism of diabetes mellitus is undergoing intensive re-examination.