DIABETES AND PRAMEHA POSTED BY MILAN BAROT

DIABETES AND PRAMEHA

          

Diabetes mellitus, or simply diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).    

 

What is Diabetes?

Diabetes is a chronic metabolic disorder in which the body cannot metabolize carbohydrates, fats, and proteins because of defects in insulin secretion and or action. The criteria for diagnosis is casual plasma glucose 200mg/dl or greater or fasting plasma glucose 126mg/dl or greater or a two-hour plasma glucose oral tolerance test of 200mg or greater.

Diabetes develops when the body cannot produce or use insulin, an essential hormone made in the pancreas. Insulin helps move glucose (a form of sugar) from the blood into the cells of your body.

When glucose builds up in the bloodstream, blood glucose (or blood sugar) rises, causing a condition known as hyperglycemia. When blood glucose goes too high, people experience a variety of symptoms.

The most common symptoms include:

·         Increased thirst

·         Frequent urination

·         Weight loss

·         Increased hunger

·         Blurred vision

Other symptoms include:

·         Irritability

·         Tingling or numbness in the hands or feet

·         Frequent skin, bladder or gum infections

·         Wounds that do not heal

·         Extreme fatigue

·         Very dry skin

BACKGROUND OF DIABETES MELLITUS

Diabetes, as a disease, is known from as early on as 1500 BCE, with its description found in an Egyptian manuscript. Indian physicians, named the disease as ‘Madhumeha’ (meaning Honey Urine) around the same time, with the term “diabetes” or “to pass through” first being used in 230 BCE by the Greek Appollonius of Memphis.

Various treatments for the disease have been put to practice since the time of antiquity, but its pathogenesis was not comprehended until 1900. It was in 1889 that Joseph von Mering and Oskar Minkowski learnt that pancreas had a pivotal role to play in Diabetes. They found that dogs, when made incapable of pancreatic function and the organ itself, developed diabetic symptoms, leading to their death.

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WHAT IS DIABETES?

                                                                                                                                  the first discovered cases of diabetes corresponded to Type 1 diabetes, today, both Type 1 and Type 2 diabetes are prominent among the respective age brackets.

Type 1, also called as insulin-dependent diabetes is rare and develops in adolescence or after, before the age of 40   while Type 2 commonly develops over the age of 40, it being the most common disease type. Both forms lead to surplus glucose levels in the blood, leaving body cells deficient of the same.

In Type 1 diabetes, lack of insulin in the body is the reason behind raised glucose levels because the insulin producing cells are damaged by the body’s own immune system.

Type 2 diabetes occurs due to the resistance the body cells form against insulin being produced. In both cases, the cells are deprived of the energy yielding glucose. This is the reason why the body gives out these symptoms, to manage and correct the imbalance created.

SYMPTOMS OF DIABETES

Both Type 1 and Type 2 diabetes are symptomatic, although symptoms of Type 1 diabetes are more prominent and severe. Symptoms for Type 2 diabetes can be easily overlooked, given their gradual onset and commonplace nature.

SYMPTOMS: TYPE 2 DIABETES

Excessive Urination and Thirst

Excessive blood glucose pushes the kidneys to filter and absorb the surplus sugar. In time, your kidneys fail to keep up with the rigorous overtime process, making you excrete the excess sugar through urinary discharge.

The excess urinary discharge leaves you dehydrated, generating periods of dry mouth and recurring thirst.

These two symptoms go hand in hand, relieving the body of excess sugar and managing the spike in blood glucose levels.

Increased Hunger

If you feel frequent, excessive pangs of hunger, it could be a sign of diabetes. The sharp, severe highs and lows created in blood sugar lead to bursts of hunger. With sugar levels taking a nosedive, the body is left feeling unfed for hours, triggering a need for glucose for cells to function.

Unexplained Weight Gain

Gradual weight gain can be the result of increased intake of food owing to a surge in hunger spasms.

Irritability and Fatigue

Of the many contributing factors to fatigue and crankiness, repetitive urge to urinate accompanied by hunger bursts is what leaves most diabetics irritated. Sleep disruption due to repeated bathroom rounds during the night can cause maximum grouchiness.

Body’s reduced ability to use sugar for energy leaves the body tired and fatigues more than usual.

Blurred Vision

If you notice a blurry vision, one of the reasons to it could be diabetes. Since excess blood sugar tweaks tissue fluids, inclusive of your eye tissues, it leaves your vision with an impaired focus.

If you observe occasional light flashes or a partial vision, it could be a result of high blood sugar.

Decelerated Healing

A classic symptom of Diabetes, decelerated healing of cuts and bruises usually occurs due to the continuous damage being done to the blood vessels by the increased blood glucose, which restricts the reach of blood to various body parts, an essential element to healing optimally.

Skin and Yeast Infections plus Frequent Gum and Bladder Infections

If you notice repetitive infections cropping up, it could be a significant sign of diabetes. Diabetes usually leaves the body vulnerable to a host of infections since fungi and bacteria easily prosper in sugar-rich conditions.

Other Symptoms

Sexual Dysfunction in Men

Vaginal Infections in Women

Numbness/Tingling in hands and feet

Itchy or Flaky Skin

SYMPTOMS: TYPE 1 DIABETES:

Frequent urination

Unusual thirst

Extreme hunger

Unusual weight loss

Extreme fatigue and Irritability

There is a reason why diabetes is termed the silent killer. The symptoms associated with this condition can escape one’s notice very easily but the disease itself is wrecking enough to leave some of the most vital body functions severely impaired.

 It is important to bear in mind that these symptoms may be mistaken for an ailment in themselves or for some other disease. 

 The best method to diagnose this condition is to have a blood test taken. And if you have already noticed this symptom, you should see a doctor at the earliest

There are three main types of diabetes mellitus (DM).

·         Type 1 DM results from the body's failure to produce insulin, and currently requires the person to inject insulin or wear an insulin pump. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes".

·         Type 2 DM results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. This form was previously referred to as non insulin-dependent diabetes mellitus (NIDDM) or "adult-onset diabetes".

·         The third main form, gestational diabetes occurs when pregnant women without a previous diagnosis of diabetes develop a high blood glucose level. It may precede development of type 2 DM.

 Other forms of diabetes mellitus include congenital diabetes, which is due to genetic defects of insulin secretion, cystic fibrosis-related diabetes, steroid diabetes induced by high doses of glucocorticoids, and several forms ofmonogenic diabetes.

Untreated, diabetes can cause many complications. Acute complications include diabetic ketoacidosis and nonketotic hyperosmolar coma. Serious long-term complications include cardiovascular disease, chronic renal failure, and diabetic retinopathy (retinal damage). Adequate treatment of diabetes is thus important, as well as blood pressure control and lifestyle factors such as stopping smoking and maintaining a healthy body weight.

All forms of diabetes have been treatable since insulin became available in 1921, and type 2 diabetes may be controlled with medications.

 Insulin and some oral medications can cause hypoglycemia (low blood sugars), which can be dangerous if severe. Both types 1 and 2 are chronic conditions that cannot be cured.

 Pancreas transplants have been tried with limited success in type 1 DM; gastric bypass surgery has been successful in many with morbid obesity and type 2 DM. Gestational diabetes usually resolves after delivery.

Diabetes mellitus is classified into four broad categories: type 1, type 2, gestational diabetes and "other specific types".
 The "other specific types" are a collection of a few dozen individual causes.
  The term "diabetes", without qualification, usually refers to diabetes mellitus. 
 The rare disease diabetes insipidushas similar symptoms as diabetes mellitus, but without disturbances in the sugar metabolism (insipidus means "without taste" in Latin) and does not involve the same disease mechanisms.


The term "type 1 diabetes" has replaced several former terms, including childhood-onset diabetes, juvenile diabetes, and insulin-dependent diabetes mellitus (IDDM).
  Likewise, the term "type 2 diabetes" has replaced several former terms, including adult-onset diabetes, obesity-related diabetes, and noninsulin-dependent diabetes mellitus (NIDDM). Beyond these two types, there is no agreed-upon standard nomenclature.

Type 1 diabetes

Main article: Diabetes mellitus type 1

Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas, leading to insulin deficiency. 
This type can be further classified as immune-mediated or idiopathic. 
The majority of type 1 diabetes is of the immune-mediated nature, in which beta cell loss is a T-cell-mediated autoimmune attack. There is no known preventive measure against type 1 diabetes, which causes approximately 10% of diabetes mellitus cases in North America and Europe. 
Most affected people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. Type 1 diabetes can affect children or adults, but was traditionally termed "juvenile diabetes" because a majority of these diabetes cases were in children.

"Brittle" diabetes, also known as unstable diabetes or labile diabetes, is a term that was traditionally used to describe to dramatic and recurrent swings in glucose levels, often occurring for no apparent reason in insulin-dependent diabetes. 
This term, however, has no biologic basis and should not be used. 
There are many reasons for type 1 diabetes to be accompanied by irregular and unpredictable hyperglycemias, frequently withketosis, and sometimes serious hypoglycemias, including an impaired counterregulatory response to hypoglycemia, occult infection, gastroparesis (which leads to erratic absorption of dietary carbohydrates), and endocrinopathies (e.g., Addison's disease).
 These phenomena are believed to occur no more frequently than in 1% to 2% of persons with type 1 diabetes.

Type 2 diabetes

Main article: Diabetes mellitus type 2

Type 2 diabetes mellitus is characterized by insulin resistance, which may be combined with relatively reduced insulin secretion. 
 The defective responsiveness of body tissues to insulin is believed to involve the insulin receptor. 
 However, the specific defects are not known. Diabetes mellitus cases due to a known defect are classified separately. 
 Type 2 diabetes is the most common type.
  In the early stage of type 2, the predominant abnormality is reduced insulin sensitivity. 

At this stage, hyperglycemia can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce glucose production by the liver.

Gestational diabetes

Main article: Gestational diabetes

Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness.

 It occurs in about 2%–5% of all pregnancies and may improve or disappear after delivery. 
   Gestational diabetes is fully treatable, but requires careful medical supervision throughout the pregnancy. About 20%–50% of affected women develop type 2 diabetes later in life.

Though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother.
    Risks to the baby include macrosomia (high birth weight), congenital cardiac and central nervous system anomalies, and skeletal muscle malformations. 
  Increased fetal insulin may inhibit fetal surfactant production and cause respiratory distress syndrome. Hyperbilirubinemia may result from red blood cell destruction. 
   In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. 
  Labor induction may be indicated with decreased placental function.
   A Caesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia.


A 2008 study completed in the U.S. found the number of American women entering pregnancy with pre-existing diabetes is increasing.
   In fact, the rate of diabetes in expectant mothers has more than doubled in the past six years. 
This is particularly problematic as diabetes raises the risk of complications during pregnancy, as well as increasing the potential for the children of diabetic mothers to become diabetic in the future.

Other types

Prediabetes indicates a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 DM. 
 Many people destined to develop type 2 DM spend many years in a state of prediabetes which has been termed "America's largest healthcare epidemic.
Latent autoimmune diabetes of adults (LADA) is a condition in which type 1 DM develops in adults.
  Adults with LADA are frequently initially misdiagnosed as having type 2 DM, based on age rather than etiology.
  Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function.

   Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreasmay lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). 

 Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). 

  Many drugs impair insulin secretion and some toxins damage pancreatic beta cells. The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization when the current taxonomy was introduced in 1999.

 Signs and symptoms

Overview of the most significant symptoms of diabetes

   
The classic symptoms of untreated diabetes are loss of weight, polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger). 

Symptoms may develop rapidly (weeks or months) in type 1 diabetes, while they usually develop much more slowly and may be subtle or absent in type 2 diabetes.

  Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes in its shape, resulting in vision changes. 
  Blurred vision is a common complaint leading to a diabetes diagnosis. A number of skin rashes that can occur in diabetes are collectively known as diabetic dermadromes.

Diabetic emergencies

People (usually with type 1 diabetes) may also present with diabetic ketoacidosis, a state of metabolic dysregulation characterized by the smell of acetone, a rapid, deep breathing known as Kussmaul breathing, nausea, vomiting and abdominal pain, and altered states of consciousness.

 A rare but equally severe possibility is hyperosmolar nonketotic state, which is more common in type 2 diabetes and is mainly the result of dehydration.

Complications

Main article: Complications of diabetes mellitus

All forms of diabetes increase the risk of long-term complications. 
  These typically develop after many years (10–20), but may be the first symptom in those who have otherwise not received a diagnosis before that time. 
  The major long-term complications relate to damage to blood vessels. Diabetes doubles the risk of cardiovascular disease. 
  The main "macrovascular" diseases (related to atherosclerosis of larger arteries) are ischemic heart disease (angina and myocardial infarction), stroke and peripheral vascular disease.

Diabetes also damages the capillaries (causes microangiopathy).Diabetic retinopathy, which affects blood vessel formation in the retina of the eye, can lead to visual symptoms including reduced vision and potentiallyblindness. 

  Diabetic nephropathy, the impact of diabetes on the kidneys, can lead to scarring changes in the kidney tissue, loss of small or progressively larger amounts of protein in the urine, and eventually chronic kidney disease requiring dialysis.

Another risk is diabetic neuropathy, the impact of diabetes on the nervous system — most commonly causing numbness, tingling and pain in the feet, and also increasing the risk of skin damage due to altered sensation. 
  
Together with vascular disease in the legs, neuropathy contributes to the risk of diabetes-related foot problems (such as diabetic foot ulcers) that can be difficult to treat and occasionally require amputation. As well, proximal diabetic neuropathy causes painful muscle wasting and weakness.
Several studies suggest a link between cognitive deficit and diabetes. Compared to those without diabetes, the research showed that those with the disease have a 1.2 to 1.5-fold greater rate of decline in cognitive function, and are at greater risk.

Causes

The cause of diabetes depends on the type.
Type 1 diabetes is partly inherited, and then triggered by certain infections, with some evidence pointing at Coxsackie B4 virus. 
    
A genetic element in individual susceptibility to some of these triggers has been traced to particular HLA genotypes (i.e., the genetic "self" identifiers relied upon by the immune system). However, even in those who have inherited the susceptibility, type 1 DM seems to require an environmental trigger. 
The onset of type 1 diabetes is unrelated to lifestyle.
Type 2 diabetes is due primarily to lifestyle factors and genetics.

PRAMEHA

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. 

o       Kaphaja Mehaa (10 types) are curable (Saadhya)

o       Pittaja Mehaa (6 types) are palliative (Yaapya)

o       Vaataja Mehaa (4 types) are incurable (Asaadhya) C.Chi.6/7

o       As per the combinations of Dosha, Dooshya Prameha gets manifested. These types of Prameha are Categorised on the basis of Colour (Varn`a), smell (Gandha), taste (Rasa), touch (SparS`ha) of urine. A.H.Ni.10/7, 8

Sampraapti 1 - Prameha (C.Chi.6/ 5, 6)

        Kapha aggravates due to its causative factors, like Aasyaa etc.

        Kapha vitiates Medas, Maamsa and Kleda (body fluid) which are located in Basti.

This is the basic cause of Meha. (Kaphaja Meha)

        Similarly, Pitta aggravated due to hot things vitiates Medas, Maamsa, Kleda situated in the Basti causes Meha. (Pittaja Meha)

        When other two Dosha (Pitta and Kapha) are relatively diminished, the aggravated Vaayu takes away the Dhaatu (Majja, Oja and Laseekaa Chakrapaan`iC.Chi.6/6) to Basti (urinary bladder) causing Meha. (Vaataja Meha)

Sampraapti 2 - Prameha (A.H.Ni.10/4)

        Vitiated Kapha Harbouring in bladder (Basti) and vitiating body fluid (Kleda), sweat (Sveda), Medas (Adipose tissue), Rasa and Maamsa, lead to Prameha.

        When Kapha and all other cold natured factors are diminished (Kaphaadau Ksheen`e sati) then Pitta and Rakta both Harbouring in urinary bladder give rise to Prameha.

        Vaayu takes the (Dhaatu) towards bladder. On the other way due to the depletion of Dhaatu, Vaayu lead to Prameha.

Saamaanya Sampraapti 3- Prameha

        In general, respective Dosha traverse through the body to Basti (urinary bladder) vitiating urine (Mootra) generate respective types of Meha. C.Chi.6/6

        Different types of Prameha as mentioned above are characterized by Varn`a (Colour), Rasa (Taste), Spars`ha (Touch) and Gandha (Smell) of urine. C.Chi.6/12

        It means that the type of Prameha should be diagnosed on the basis of urine examination looking at Varn`a, Rasa, SparS`ha, Gandha of urine.

        When urine turns to dark brown (S`hyaava) and reddish brown (Arun`a Varn`a), when urine resembles to the attributes of Majja etc., Dhaatu, also a person experiencing pain, then these are symptoms that Vaataja Prameha has turned to incurable status (Asaadhya) C.Chi.6/12

        If the Colour of urine is yellow or when Hematurea is there, without the Poorvaroopa (premonitory symptoms) of Prameha, this condition should be diagnosed as Raktapitta instead of Prameha. C.Chi.6/54.

         The patients who are Pramehee or Madhumehee (diabetic) right from the birth (Jaata Pramehee congenital) and those who are borne of Pramehee orMadhumehee (diabetic) parents (Kulaja - hereditary) are not curable (Asaadhya). Not only Prameha or Madhumeha but all other Kulaja (hereditary) diseases are also incurable. C.Chi.6/57

         Beeja Dosha (genetic cause) is the major factor in this aspect. Beeja (S`hukra or S`hon`ita) itself is affected by the factors that are responsible for manifestation of Prameha or Madhumeha.

         The word Meha is generally applied to all types of Prameha; on the other hand the word Madhumeha is applied to Madhumeha and also to all types ofPrameha.(Chakrapaan`i)

         Prameha is Anushangee Vikaara. C.Su.25 There is a possibility to happen Prameha in the progeny. Anushangee is Punarbhaavee as explained byChakrapaan`i.

        Aachaarya Charaka has explained pathogenesis in Sootrasthaanas 17^th chapter (Kiyantahshiraseeya) C.Su.17.78-89

        The pathogenesis happens in a person, who is eating heavy, unctuous, sour (Amla), salty (Lavan`a), in excess amount, newly arrived grains, who enjoys sleep (sedentary life) and remain at a place for longer time without moving here and there, who does not exercise, who does not have any stress and enjoys life completely, who never carry out cleansing processes (Panchakarma therapies); a person with these hobbits is more prone to have Prameha. This is a prerequisite for Prameha.

        In such person, S`hlshmaa, Pitta, Medas and Maamsa aggravate vigorously.

        The path of Vaayu gets obstructed (Aavrita Gati) and so Vaayu together with Ojas traverse to Basti (urinary bladder) causing the obstinate type of disease called Madhumeha.

        In this disease, the signs and symptoms of Madhumeha are seen according to the Dosha. Vaata, Pitta and Kapha manifest their signs and symptoms repeatedly. They vanish at times and reoccur again.

        If this disease is not treated properly or neglected, it causes more serious seven types of carbuncles. These carbuncles are named as Prameha Pid`akaa. These appear at Marma, joints (Sandhi) of the body, muscular areas, porous areas (AvakaaS`ha).

Sampraapti 4 – Prameha

        A person can be diseased who has sedentary habits, reluctant to exercise, lazy, consuming a food that is cold, unctuous, sweet, fatty, excess liquid. This is a prerequisite that in a person with such Habbits only a disease like Prameha will manifest.

        In above-mentioned person, Aakva Aama (Unripe (raw)) Dosha are the major factor.

        These all three Dosha, when combine with Medas, travel in the body in downward direction towards Mootravaha Storas.

        They Harbour in to Basti Mukha and are urinated. S.Ni.6/4

Prameha Pid`Kaa also are caused due to all the three Dosha. S.Ni.6/7

        

        Sushruta has classified Prameha in to S.Chi.11/3

1.    Sahaja (right from the birth) due to genetic reason

2.    Apathya Nimittaja (due to unwholesome practices)

        Vagbhat`a has classified Prameha in to A.H.Ni.10/18

1.    When Vaayu aggravates due to depletion of Dhaatu and generates Prameha

2.    When Vaayu becomes stagnant due to covering by Dosha

        When Vaayu gets covered by Dosha etc. the symptoms are suddenly manifested as Vaayu is of Chala (moving) attribute.

    Suddenly, urinary bladder gets filled by urine or remain empty. So when Prameha happens due to Aavaran`a of Vaayu by other entities it turns to Krichchhrasaadhya (difficultly curable) state, while when Prameha happens due to depletion of Dhaatu it remains Asaadhya (incurable). A.H.Ni.10/19

        When Prameha is Dhaatukshayaja (Kevala Vaataja), symptoms related to Vaayu only manifest. In this type there is no Aavaran`a.

Where as, Gadaadhara says that Madhumeha happens due to only Aavaran`a. He quotes reference of Charaka as C.Su.17/78-89

        All types of Prameha turns to Madhumeha when neglected or not treated. Generally, in all types of Prameha, urine turns to sweet taste and it resembles to honey (Madhu) by means of Colour, touch, taste, and smell. A.H.Ni.10/21 In other words, in a patient with Prameha, the body is completely enriched by sweetness. A.H.Ni.10/21 (Maadhuryaat Cha Tanoratah)