Madhumeha in Ayurveda
A medical condition in which body can’t produce enough insulin to process the glucose in the blood is known as diabetes. Diabetes has been known since the first century B.C.E., when a Greek physician, Aretus the Cappadocian, named it diabainein, meaning "a siphon, " referring to the excessive urination associated with the disease. The word diabetes was first recorded in 1425, and in 1675, the Greek word mellitus, meaning “like honey, ” was added, to reflect the sweet smell and taste of the patient’s urine. An unrelated and rare disorderSimilarly in Ayurveda a condition in which a person passes honey like (sweet) urine is called Madhumeha(Hyperglycemia) Reduced insulin production and decreased insulin sensitivity are the contributing factors for hyperglycemia. It is one among 20 types of Prameha (urological disorder) described in various Ayurvedic classics i.e. Charaka samhita, Sushruta samhita, Ashtanga sangraha, Madhava nidana, Yoga ratnakara etc.Ancient seers have narrated that excess use of guru (heavy to digest), snigdha (unctous), amla(Sour) and lavana(Salt) rasa, nav!nna (food prepared from newly harvested grains), new wine, Asya sukha (sedentary life style), atinidra (excess sleep), avyayama (lack of exercise), achinta (lack of mental exercise), obstaining from samshodhana (purification) therapy are the causes of Madhumeha.
Chronic hyperglycemia is associated with significant long term sequelae particularly damage or dysfunction of various organs especially the kidneys, eyes, nerves, heart and blood vessels. Diabetes is the seventh-leading cause of death, and is on the rise, both in developed and developing countries. It is the single most important metabolic disease that affects nearly every organ/ system in the body. Today diabetes affects more than 135 million people worldwide and that number is expected to increase to 300 million by 2025. India has the largest number of Diabetes patient in the world. As per the data published by the International Diabetes Federation in the year 2006, the number of people with type 2 diabetes in India is around 40.9 million and this is expected to rise to 69.9 million by 2025. In India, about 10% elderly people aged 65 or more are suffering from diabetes.
classification
Diabettes is classified on the basis of its etiology
1. Type-I DM - Due to 'Beta' cell destruction, usually leading to absolute insulin deficiency.
2. Type-II DM - Due to variable degree of
i. Insulin resistance
ii. Impaired Insulin secretion
iii. Glucose intolerance and insulin resistance which generally increases with advancement of age.
3. Other specific types of Diabetes due to
i. Impaired Beta cell function due to genetic defects
ii. Impaired Insulin action due to genetic defects
iii. Diseases of pancreas
iv. Endocrinopathies
v. Drugs (chemically induced)
vi. Infections-Like congenital rubella, cytomegalovirus etc.
Risk factors
1. Family history
2. Obesity (BMI > 27kg/ m2)
3. Age > 45 years
4. Hypertension (B.P. > 140/ 90 mm of Hg)
5. HDL < 35mg/ dl and/ or triglycerides levels > 250mg/ dl
6. Habitual physical inactivity
Clinical features
1. Increased frequency of urine(Polyuria)
2. Increased appetite (Polyphagia)
3. Excessive thirst (polydyspia)
4. Turbidity in urine
5. Debility/ tiredness
6. Weight loss
7. Non-healing ulcer
8. Visual disturbances
9. Inflammation of glans penis
The presentation of symptoms in elderly patients with diabetes may be significantly different from the classic triad of polyuria, polydypsia, polyphagia and weight loss. They may present
with fatigue, anorexia, failure to thrive, loss of motivation, difficulty in concentration and urinary incontinence.
Complications
In later stage of diabetes mellitus the following complications may appear
1. Burning sensation (neuropathy) over palmar and plantar region
2. Boils and carbuncles
3. Gangrene
4. General debility
5. Retinopathy
6. Renal tissue damage (nephropathy)
7. Cardiovascular diseases
Investigations
Disease Specific
i. Measurement of the plasma glucose level
a. Random blood sugar (RBS)
b. Fasting blood sugar (FBS)
c. Post prandial blood sugar (PPBS)
ii. Urine routine and microscopic
iii. Glycosylated haemoglobin (HbA1c)
iv. Lipid Profile
Other related Investigations
i. Blood urea and serum creatinine
ii. E.C.G.
iii. Fundus examination
iv. Serum electrolytes
Diagnosis
The diagnosis is made by corroborating symptoms and plasma glucose levels
1. Fasting plasma glucose > 126 mg/dl after an overnight fasting (or)
2. Random plasma glucose > 200 mg/dl (or)
3. Two hours prandial glucose > 200 mg/dl
Management approaches
a. Prevention
1. Use of various preparations made from yava (barley), mudga (green gram), old rice, bitter gourd, drum-stick, methi(fenugreek), patola (snake gourd), pumpkin, cucumber, bimbi, watermelon, buttermilk, triphala etc. are beneficial as preventive measures for borderline diabetic patients
2. Dinacharya (daily regimen) and ritucary! (seasonal regimen)
3. Regular exercise/ increase in calorie consuming activities (Brisk walking, swimming, etc.)
4. Regular use of rasayana drugs (Amalaki ras!yana etc.)
5. Restriction in intake of sugar/ sugar products, fried food and dairy products
6. Restriction in the use of different types of wine, excess use of oil, clarified butter, milk, sugarcane products, cakes and the meat of domestic and aquatic animals
7. Avoidance of day sleep and laziness
b. Medical management
Line of treatment (Charaka Samhita, Chikitsa Sthana.6/ 15)
1. Nidana parivarjana (avoidance of aetiological factors) – Avoidance of Tubers, sweets, dairy products, soft drinks, fried foods and sweet fruits like mango, banana, custard apple and date..
2. If patient is obese then Samshodhana chikitsa (bio-cleansing therapies) in the form of vamana, virechana, vasti are to be performed, however this need to be decided by the qualified physician of Ayurveda. If patient is lean and thin then only Shamana chikitsa (Palliative therapy) is recommended.
3. Drug therapy - In Ayurveda most of the drugs indicated in diabetes mellitus may act on beta cell of pancreas thus improve insulin production/ increase insulin sensitivity. The following drugs/ formulations are useful to control type II diabetes mellitus. In case of type I diabetes mellitus, these drugs/ formulations may be used as a supportive therapy in addition to conventional insulin therapy to prevent long term complications.
4. Smple medicinal Plants and their use
|
Plant name |
Dosage (per dose) |
Vehicle |
Duration |
|
AmalakI /Amla(Phyllanthusemblica Gartn.) Powder of dried seedless fruit |
3 - 6 gm |
Warm water |
90 days |
|
Haridra (Curcuma longaLinn.) Powder |
1 - 3 gm |
Luke warm water |
|
|
Jambu/jamun (Syzygium cumini(Linn.) Skeeds-Powder |
Water |
||
|
Meshsrigi/Gudmar (Gymnemasylvestre R.Br.)Powder of whole plant |
|||
|
Methika/Methi (Trigonellafoenum-graecum Linn.) Powder of seeds |
|||
|
Vijayasara /bijak(Pterocarpusmarsupium Roxb.)Powder of heart wood |
3 – 6 gm |
||
|
Karvalli/Karela(memorandia Charantia linn.)Juice |
10-20Ml |
Note-Take cooked rice with ghee in case of any untoward effrct of over dose |
|
|
Saptachakra(salacia chinancis Linn.)Decocction of root |
50-100ML |
30 days Note-Avoid during pregnancy |
|
|
Bimbi(Coccinia indica. W&A.)Juice of Leaf/Root/Fruit |
60days |
Formulations
|
Drug |
|||
|
Nishaamalakadi Churna |
Honey |
||
|
Triphaladi churna |
3 - 6 gm. |
Luke warm water/honey |
|
|
Chandraprabha vati |
250- 500 mg |
||
|
Suddha Shilajit |
500mg-1gm |
Luke warm water/Milk |
|
|
Nisha Katakadi kashaya |
20-40Ml |
Luke Warm water |
