Diabetes (Prameha) Management in Ayurveda

The disease currently affects more than 62 million Indians, which is more than 7.1% of India's adult Population. An estimate shows that nearly 1 million Indians die due to Diabetes every year. The average age of onset is 42.5 years.
Charaka Samhita Chikitsasthana Chapter 6 deals with Prameha its causes, symptoms, types, treatment and diet for various urinary disorders and diabetes (Madhumeha).
Diabetes is also known as Madhumeha. Diabetes is also called Maharoga (Major Disease) as almost all parts of the body and every cell of human physiology is affected.

CAUSES OF PRAMEHA

आस्यासुखं स्वप्नसुखं दधीनि ग्राम्यौदकानूपरसाः पयांसि|

नवान्नपानं गुडवैकृतं च प्रमेहहेतुः कफकृच्च सर्वम्||
The main cause of prameha (diabetes) are lack of exercise, indisciplined eating habits, sedentary life style, and day time sleep, excess intake of curd, heavy diet, excess intake of milk products, new grains, jaggery and consumption of excess food which is oily and heavy (snigdha andguru) in nature.
Even modern medicine considers obesity, living standards according to urban life style as main causes of Type II Diabetes.
This kind of diet and lifestyle aggravates kapha in the body.
In Diabetes all doshas like kapha, pitta and vata are involved.  It is a major disease (Maharog) as important body tissues (dhatus) are vitiated in this disease.

THESE VITIATED TISSUES (DUSHYAS) ARE

Nutrient plasma (Rasa), Blood (Rakta), Skin (Mansa), Adipose tissue (Medas) , Marrow (Majja), Semen (Shukra) Lasika (Lymph), Body fluid (Jal), Ojas (Immunity factor), Fat underneath skin (Vasa) are involved. These are 10 dushyas of prameha.

ORIGIN OF THE DISEASE (PRAMEHA SAMPRAPTI – PATHOGENESIS)

Due to the above said factors, Kapha dosha is dominantly aggravated (in association with other doshas) and it vitiates medas (fat), mamsa (muscles), udaka (lymphatic channel), liquid elements of the body and causes different types of  prameha.
Vata gets imbalanced in prameha in two ways:

1. Through obstruction in vessels due to Kapha (srothorodha)
2. Degeneration of the body components (dhatu kshaya)

When vata draws tissue elements like Ojas, Majja and Lasika into the urinary tract and vitiates them to cause Madhumeha (Vataja Meha). 

PRODROMAL SYMPTOMS (POORVARUPA)

Sweating, bad body odor, laziness, exudation of excreta from eyes, tongue and ears, bulkiness of the body, excessive growth of hair and nails, liking for cold things, dryness of the throat and palate ,sweet taste in the mouth, burning sensation in hands and feet and appearance of ants on the urine.
If these early symptoms are there one must be cautious about one's lifestyle.

THE MAIN SYMPTOMS MAY INCLUDE

• Constant hunger
• A lack of energy
• Fatigue
• Weight loss
• Excessive thirst
• Frequent urination
• Dry ness of mouth

CLASSIFICATION OF PRAMEHA (DIABETES)

1) Sthula Pramehi – Those who are obese and strong
Nidana parivarjana is very importantfor Madhumeha. In sthula Madhumeha there is obstruction (margavarodha) of vata by increased kapha and fat (meda).
2) Krusha Pramehi – Those who are emaciated and weak.
These are classified in Ayurveda on very similar grounds as Diabetics are classified as NIDDM and IDDM respectively.

OTHER NAMES FOR THIS CLASSIFICATION OF PRAMEHA (DIABETES) ARE

Apathaya nimmitaj (Due to overeating and wrong eating habits)- Type II Diabetes
Sahaj pramehi (Congenital)-Type 1 Diabetes

OTHER CLASSIFICATION OF PRAMEHA (DIABETES) ON BASIS OF TRIDOSHA

According to Ayurveda, Prameha (diabetes) is a tridoshaja vyadhi. However the predominance of any one dosha and dooshya enables its classification into Vataja, Pitaja & Kaphaja Pramehas.
They are further sub classified into 20 sub categories according to characteristics of urine, its volume, dhatu being excreted through urine.
Kaphaja Prameha are of 10 types and they are curable.
Pittaja Prameha are of 6 types and they are only palliable (Yapya)
Vatika prameha are of 4 types they are incurable because of their extremely serious nature.
Juvenile diabetes for children (for unhealthy dietary practices of parents)

ACCORDING TO CHARAKA : THREE TYPES OF PROGNOSIS OF PRAMEHA

1. Sadhya – Curable (Kapha type)
2. Yapya – Disease remains under control as long as proper medicine is taken.(Pitta type)
3. Asadhya – Incurable (vatatype) e.g. Madhumeha & inherited diabetes (Sahaja), Lean patients (krish)

INVOLVEMENT OF OJAS IN PRAMEHA (MADHUMEHA)

Ojas is the essence of life, an extract of the seven dhathus Rasa (Chyle), Rakta (Blood), Mamsa (Muscles), Meda (fat) Asthi (Bone), Majja (Marrow),  Sukra (Sperm & Ovum), Ojas represented as of the body. The ojas in a healthy person determines the physical and mental health of a person.
which is reddish, white, or yellowish in colour it is in heart and other vital organs of the body. If ojas is distrubed, degeneration will be fast and result in decreased life span.

MANAGEMENT OF PRAMEHA (MADHUMEHA)

According to Ayurveda the line of treatment for prameha is dependent on various factors:

1. The prakriti of the patient
2. Dosha dominance in disease
3. Dooshya vitiation
4. Obstruction in srotha
5. Manasika Prakrithi
6. Ahara & Vihara
7. Hereditary factors etc 

PLAN OF TREATMENT

Apatarpana Chikitsa: It is done as light diet plan (langhana) and purification (shodhan) for obese patient.
Santarpana Chikitsa: These formulations should be prepared such that they cause santarpana without causing vriddhi of kapha and medas. Vataja prameha patients are advised to have Bhrimhana medication & diet which increases dhathus in the body.

THE OTHER MANAGEMENT MODALITIES FOR DIABETES MELLITUS

• Vyaayam (Exercise),
• Pathya (dietary regulation),
• Panchakarma (Bio-purification procedures)
• The use of Ayurvedic medicines.

HERBS USEFUL IN TREATMENT OF DIABETES

The herbs used in the management of Prameha are bitter, astringent and pungent in taste. Some of the widely used herbs for the management of diabetes is as follows:

1. Eugenia jambolana (Jamun beej churna) 
2. Gymnema sylvestre (Gudmar patra churna) 
3. Pterocarpus marsupium (Vijaysar churna)  
4. Ficus bengalensis (Nyagrodha twaka churna) 
5. Shilajeet in case of generalized weakness.
6. Tejpatra
7. Fenugreek seeds powder (Methi seeds churna) 
8. Momordica chirantia (Karela juice) upto 10-20 ml
9. Emblica officinalis (Amla juice) upto 20 ml
10. Curcuma longa (Haridra) Haldi powder along with Amla juice is a very good combination in patients of Diabetes.
11. Kirat tikata (Chirayata) A decoction of this plant is to be taken daily every morning. 

HERBAL DECOCTION AS MENTIONED IN CHARAK SAMHITA

Decoction of Darvi ( Berberis aristata),Triphala and Musta (Cyperus rotundus) mixed with honey

AYURVEDIC COMBINATIONS/PREPARATIONS

• Chandraprabha vati: In a dose of 500 mg twice or thrice daily. This is specially used in patients having Diabetes with Urinary tract infection.
• Trivang Bhasma: This is a combination of three bhasmas namely Naga, Vanga and Yashaha Bhasma. It is to be taken in a dose of 125mg twice daily available in the form of powder..
• Dhatri Nisha: A combination of Haldi powder and Amla and has to be taken early morning and is especially useful in Diabetic Retinopathy.
• Vasant kusumakar rasa: A very useful tonic for diabetics especially useful in the stage of complications it has to be consumed in a dose of 125 mg twice daily.

RECOMMENDED FOOD ITEMS (PATHYA)

• Amalaki (goose berry), Yava (barley), Wheat, Jamun. Karela (bitter gourd), Blackpepper, Garlic are generally recommended.
• Vyayama (Exercise) is very important for management of Diabetes.

PROHIBITED DIET FOR DIABETICS (APATHYA)

• Sugar cane juice. Refined oil. Ghee, Jaggery, Alcohol. Carbohydrate rich foods. Curd and new grains.
• Day time sleep is responsible for bad prognosis of Diabetes.