K.L. RAMESH KUMAR, A CONCEPTUAL STUDY ON PATHYA IN MADHUMEHA W.S.R. TO TYPE-2 DIABETES MELLITUS, DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA, GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE. 2010
“A CONCEPTUAL STUDY ON PATHYA IN MADHUMEHA W.S.R.TO TYPE-2 DIABETES MELLITUS.”ByDr. K.L. RAMESH KUMAR B.A.M.S.,Dissertation submitted to theRajiv Gandhi University of Health Sciences,Karnataka, Bangalore.In partial fulfillment of the requirements for the degree ofDOCTOR OF MEDICINE (AYURVEDA)InAYURVEDA SIDDHANTAUnder The Guidance ofDr. K. NASEEMA AKHTAR M.D. (Ayu)Professor & HOD,Department of Post-Graduate Studies in Ayurveda Siddhanta,G.A.M.C., Mysore.Co-GuideDR. K.S.SHANTHARAM M.D. (Ayu)Asst.professor & HOD,Department of Basic Principles for UG,Govt Ayurveda Medical College,Mysore - 570021DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA,GOVERNMENT AYURVEDA MEDICAL COLLEGE,MYSORE.2010
viiACKNOWLEDGEMENTI bow to the sacred feet of Almighty, without the blessings of whom this study wouldnot have been completed. He is the possessor of the ocean of knowledge and wisdom –to which I would like to contribute a drop in the form of my dissertation.I am highly thankful to my beloved, Former. Professor and HOD, Department of PGStudies in Ayurveda Siddhanta, Government Ayurveda Medical College, Mysore,Dr.N.Anjaneya Murthy.Joint Director, Department of Ayush, Karnataka. For hisconstant guidance, continuous supervision and help to take up this study. Also, for histhoughtful provoking concepts and constructive criticism, which have catalysed my work.Without his guidance with regards to publication via media sources it would not havebeen possible to reach out to the society and attract the patients to volunteer for thisstudy. I owe my heartfelt gratitude for the same.I sincerely express my indebtedness and profound gratitude to my Guide Dr. NaseemaAkhtar, Professor, Department of PG Studies in Ayurveda Siddhanta, GovernmentAyurveda Medical College, Mysore for her valuable guidance & encouragementthroughout my PG studiesFirst of all it was my privilege that i had the chance to work under the one whom, iadmired since 2002, the year when i started my under graduation. I sincerelyacknowledge my reverend teacher and Co- guide Dr.K.S.Shantharam sir,Assistant.professor, Department of Kayachikitsa, Government Ayurveda MedicalCollege, Mysore. He is the one, who has made a great influence on me as a teacher, as awell wisher and as a source of vibrant energy. Without his encouragement and supportthis work could not have become possible. I am very much greatful for his valuableguidance and support throughout my student life.I owe my deep sense of gratitude and my heartfelt thanks to my respected teacher andmy well wisher Late.Dr.G.N.Shakunthala, Former.Professor& HOD, Department of
viiiPG Studies in Ayurveda Siddhantha, Government Ayurveda Medical College, Mysore.She was the one who supported and encouraged me in all aspects since my undergraduation.I am grateful to Principal Dr.Ashok D.Satpute, Professor and Head, Department ofRasashastra and Bhaishajya Kalpana, Government Ayurveda Medical College, Mysorefor his support and encouragement.I owe my deep sense of gratitude and my heartfelt thanks to my respected teachersDr.T.D.Ksheera sagar, Dr.V.Rajendra and Dr.Shreevathsa, for their patientobservations, valuable suggestions and corrections throughout my study without whichmy dissertation would not have taken this shape. Also, I owe my deep sense of gratitudeto all my teachers Dr.V.A.Chate, Dr. Anand Katti and all other teachers for theirsupport in this study.I sincerely express my indebtedness and profound gratitude toMr.M.C.Narasimhamurthy, Scientist, Defense food Research laboratories (DFRL),Mysore. For providing me the valuable text books and scientific journals from theLibrary, DFRL, Mysore.I express enormous amount of thanks to my colleague’s Dr. Kalyani Ashok Bhusane,Dr.Ranjit kumar shetty and Dr.Geetha, and my seniors Dr.Yogesh MukundJirankalgikar, Dr.Savitha shenoy, Dr.Soubhagya, Dr.Abdul khader patel,Dr.Annapoorani, Dr.Aparna, Dr.Pankaj pathak and Dr.Rajesh Bhat for their helpand overall support and for making my stay in the college very joyful and educative.I express my heartfelt gratitude to Mr.Sampath, senior research scholar and Lecturer,Department of Bio-technology, Maharani’s college, Mysore. and Ms.Girijamba.R.Senior Research scholar, department of Bio-Technology, University of mysore, mysore.For guided me in clarifying and identifying the taxonomical features of thePathyaaharas.
ixI express my heartfelt gratitude to my friend Mohan Kumar. A.P for his strong supportand encouragement throughout my student life.I wish to convey my thanks to U.G. and PG Librarian Varalakshmi and Somasundarfor providing library facilities and also thank the Lab Technicians, Hospital Staff,Physicians and other staff for their timely help.My doctoral study could not have been possible without the co-operation of myPatients and I would fail in my duties if I do not express deep sense of gratitude to eachand every one of them.I am thankful to Dr. Lancy D’Souza for helping in statistical analysis andinterpretation.I could not be able to come up in my life up to this level without the blessings of myParents, Lingaiah and Gayathri, friends and well wishers. I convey my gratitude to allof them who supported me in all ways.Last but not the least, I express my thanks to all persons who helped me directly orindirectly in my studies with apologies for my inability to identify and thank themindividually.Date: Dr. K.L.Ramesh KumarPlace: Mysore
xABSTRACTBackground of the StudyDiabetes was considered to have prevalence in the developed world and higherclasses. Recent studies reveal that it is an increasing problem even in the developingcountries and in lower economical strata.Diabetes mellitus is a leading cause of morbidity and mortality world over. It isestimated that approximately 1% of population suffers from DM. The incidence is risingin the developed countries of the world at the rate of about 10% per year, especially oftype 2 DM, due to rising incidence of obesity and reduced activity levels.The present study is intended to evaluate the anti-diabetic efficacy of the pathyaaharas in the management of type-2 diabetes. In Sthoulya. Thus, this study is intended todevice a convenient, cost effective and specific treatment for SthoulyaObjectives of the Study To compile the available literature on pathya in madhumeha. To develop a module of pathya for madhumeha. To evaluate the efficacy of the developed module of pathya in the management ofmadhumeha w.s.r.to Type-2 diabetes mellitus.MethodA Single group Observational Study with pre and post design.InterventionAs it is a Observational study, the patients are assigned in to single group of 30patients.The Module of Pathya ahara & vihara was advised to the patients for duration of 30days. Followed by a follow-up period of 30 days.
xiStatistical Analysis to assess Individual and comparative effects of the groups wasdone using Chi- Square test, One Sample t- test, and Repeated Measures ANOVA.ResultsAll the patients with newly detected diabetes, considered for the study showedmild improvement during the first two visits of the study, which is statisticallysignificant. But there was no overall improvements interms of the normal glucose level ofall the patients, statistically there is no significance in the overall improvement.Interpretation and Conclusion:Statistically it shows no significance result in the overall results. The declining values inFBS & PPBS in the beginning of the dietic advice shows the definite effect action of thediet on the hyperglycemia, but the consistency in following the diet is not maintained bythe patients regularly, It results in the failure of the overall result.Keywords Pathya. Madhumeha Diabetes mellitus Hyperglycemia Anti-diabetic efficacy
xiiiPathya aharas in Madhumeha Dhanya varga Shakha varga Harita varga Phala varga Taila varga57607888109117Pictures of Pathya aharasReview of Previous works 122Methodology 123Observation 128Results 138Discussion 154General observations 182Recommendations 183Conclusion 184Summary 185Bibliography 187Master ChartAnnexure i-xviii
xivNo. LIST OF TABLES P .no1. Classification of Ahara according to Charaka 162. List of Pathyatama and Apathyatama aharas 213. Classification of vataja prameha 294. Classification on the basis of prognosis 305. Specific Madhumeha Nidana 326. List of Poorva roopas in Brihatrayees 327. Prameha pidakas 418. ADA recommended diagnostic criteria of Diabetes mellitus 529. List of Pathya aharas in Madhumeha 5710. List of foods used in Diabetes mellitus 12611. The assessment criteria’s 12712. Distribution of sex 12813. Distribution of Age group 12814. Distribution of Religion 12915. Distribution of Location 12916. Distribution of Family History 12917. Distribution of Occupation 13018. Distribution of Exercising Practice 13019. Distribution of Socio Economic Status 13120. Distribution of Education 13121. Distribution of Nature of Work 13222. Distribution of Diet 13223. Distribution of Hours of Day Sleep 13324. Distribution of Hours of Night Sleep 13325. Distribution of Habits 13426. Distribution of Prakruti 13427. Distribution of Saara 13528. Distribution of Samhanana 13529. Distribution of Satmya 13530. Distribution of Sattva 13631. Distribution of Abhyavaharana Shakti 13632. Distribution of Jarana Shakti 13733. Distribution of Vyayama Shakti 13734. Results showing Mean PU values on 0th,14th, 30th&60thdays 13835. Results showing Mean PP values on 0th,14th, 30thand 60thdays 13836. Results showing Mean PD values on 0th,14th, 30thand 60thdays 13937. Results showing Mean BFP values on 0th,14th, 30thand 60thdays 13938. Results showing Mean FBS values on 0th,14th, 30thand 60thdays 140
xv39. Showing the results of repeated measure ANOVA for mean FBS 14040. Results showing Mean PPBS values on 0th,14th, 30thand 60thdays 14141. Showing the results of repeated measure ANOVA for mean PPBS 14142. Shows the distribution of overall results 14243. Showing the results of repeated measure ANOVA for overallresults142No. LIST OF ILLUSTRATIONS P. no1 Showing Distribution Of Age 1432 Showing Distribution Of Sex 1433 Showing Distribution Of Religion 1444 Showing Distribution Of Occupation 1445 Showing Distribution Of Education 1456 Showing Distribution Of Socio-Economic Status 1457 Showing Distribution Of Location 1468 Showing Distribution Of Family History 1469 Showing Distribution Of Diet 14710 Showing Distribution Of Nature Of Work 14711 Showing Distribution Of Exercising Habit 14812 Showing Distribution Of Hours Of Day Sleep 14813 Showing Distribution Of Hours Of Night Sleep 14914 Showing Distribution Of Habits 14915 Showing the Distribution of Mean values of Polyurea 15016 Showing the Distribution of Mean values of Polyphagia 15017 Showing the Distribution of Mean values of Polydypsia 15118 Showing the Distribution of Mean values of BFP 15119 Showing the Distribution of Mean values of FBS 15220 Showing the Distribution of Mean values of PPBS 15221 Showing the Distribution of Overall improvements 153No. LIST OF FLOW CHARTS P.no1 Synthesis and releas e of Insulin 542 Schematic representation of pathogenesis of Type-2 dm: 553 Pathophysiological basis of common signs and symptoms 564 Prameha nidanasNo. LIST OF PICTURE P.no1 Pthya aharas of Madhumeha 121.a2 Annexure i-
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 1INTRODUCTIONDiabetes is a disease known from the dawn of civilization. Sedentary life style,lack of exercise, faulty food habits and improper medication and urbanizationprecipitate the disease. Diabetes mellitus is a common chronic metabolic disorderprevalent all over the world. Although diabetes has been a known morbidity sincetime immemorial, its incidence has been growing notably in recent years. It has turnedout to be the biggest “silent killer” today in the world. The mortality rate due toDiabetes mellitus is very high and is ranked fifth amongst the ten major causes ofdeath in southern part of India.The rising prevalence of diabetes is closely associated with industrializationand socio-economic development. It will soon become the first incommunicabledisease whose severity will be endorsed by the United Nation. Forecasts of soaringrates of diabetes in the next two decades may be wildly underestimated, a new studysuggests. Evidence from Canada indicates that the diabetes "time-bomb" may be a farworse global health threat than anyone imagined. The World Health Organization(WHO) predicts that the prevalence of diabetes among adults will reach 6.4% by 2030- a 60% increase since 1995.In spite of tremendous advancement of modern system of medicine i. e. oralhypoglycemic agent and insulin till date, an ideal drug which can cure diabetes is notyet available and still scientists are struggling to search an effective and harmlesstherapy.The ancient Ayurvedic classical texts, namely the Samhitas of Charaka,Sushruta, Vagbhata and the subsequent treatises have invariably given detaileddescription of the disease diabetes, its causes, types, pathology and the line ofmanagement and treatment both preventive and curative.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 2Madhumeha is mainly caused due to Apathya ahara and vihara sevana, whiledescribing the chikitsa for Madhumeha all scholars have focussed on Pathya aharas inthe management of madhumeha with a greater importance.Well known Cikitsa Grantha of medieval period “Vaidhya Jivanam” by Lolimbarajahas stated the importance of Pathya-Apathya in Cikitsa as ,mÉjrÉãxÉÌiÉ aÉSÉiÉïxrÉ ÌMüqÉÉæwÉkÉ ÌlÉwÉãuÉhÉæ: ?mÉjrÉå AxÉÌiÉ aÉSÉiÉïxrÉ ÌMüqÉÉæwÉkÉ ÌlÉwÉãuÉhÉæ: ?If a person follows the dietary rules for particular disease there is very littlesignificance of drug treatment and when a person is exposed to Apathya the drugtreatment has not value because taken drug can’t cure the disease1.Ahara is said to be Mahabhaisajya by Kasyapacarya, hence no any othermedicament just like diet is not available. In other words, one is capable to make mandisease free only with the cereals (congenial diet).One is not able to sustain lifewithout diet even of endowed with medicine that is why the diet is said to be the greatmedicament by physician2.Madhumeha is basically a disease of metabolic derangement of carbohydraytemetabolism. The fualty food itself is being a cause of the disease, it can be managedby the administration of the suitable food which is wholesome to the body channels. Itis not yet become possible to frame an ideal diabetic diet for the effectivemanagement of the disease. In ayurveda, pool of information is available in scatteredform. In the present day scenario there is need to collect the scattered matter and it isto be reproduced with a scientific data base in front of the ultra modern world. Hencethis work was undertaken to find a better dietic management for the management ofType-2 diabetes mellitus.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 3This study is a single observational Study with Pre and Post‐test design. The patients are assigned in to single group. Diet and Regimen proforma was given to all patients. This dissertation comprises of two parts, Part I and II. The First Part deals with the Review of the literature on the concept of Pathya, Madhumeha and Pathya aharas in madhumeha, which are carried out, by thoroughly reviewing Ayurvedic Literature and also modern literature regarding Madhumeha and Pathya. The Second Part deals with Materials and methods, Observation, Results, Discussion, Conclusion and Summary. This part is based on a Observational trial organized on 30 patients of newly detected diabetes selected from OPD, IPD of Government Ayurveda Medical College and Hospital, Mysore and special camps conducted in and around Mysore. OBJECTIVES OF THE STUDY To compile the available literature on Pathya in madhumeha. To develop a module of pathya for madhumeha. To evaluate the efficacy of the developed module of pathya in the management of madhumeha w.s.r.to Type‐2 diabetes mellitus.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 4
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 5CONTENTS1. Introduction 2. Derivation 3. Definition 4. Historical Review 5. Synonym 6. Classification 7. Classification of individual food articles: 8. Ashtavidha ahara vidhi visheshayatana 9. Ahara vidhi vidhana 10. Dwadasha ashana vichara 11. Sada Pathyas 12. Pathyatama & Apathyatama aharas 13. Importance of Pathya
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 6REVIEW ON PATHYAINTRODUCTIONPathya is one which is very much wholesome to the srotases (channels ofbody) and it is very specific according to the different conditions of the body.Wholesome diet is the prime cause for the growth and development of the body, onthe contrary, unwholesome diet causes several diseases. Caraka samhita emphasizesthat, the ideal diet is that which maintains the equilibrium of the body constituents.Irrational diet acts otherwise, producing disease3.In Ayurvedic classics for the regular usage, some of the Pathyas have beentold. They are called as Sadaa Pathyas and the specific foods which are designed forthe specific diseases are avastika pathyas. In the management of disease Pathya ishaving equal and even more importance than that of Beshaja or Treatment. Hence toadvice the suitable Pathya for the diseased as well as healthy individual, it is veryimportant to understand the concept of Pathya in detail.DERIVATION:The word pathya is a streelinga shabdha, it is derived from the root of pathin i.e.,“mÉÍjÉlÉç+kÉiqÉmÉjrÉjÉïlrÉÉrÉÉSlÉmÉãiÉã |ÍcÉÌMüixÉÉSÉæ ÌWûiÉMüÉUMüqÉç iÉimÉrÉÉïrÉ: MüÉUlÉqÉç ÌWûiÉqÉç || (zÉ.Mü.SìÓ) – means hitakara in the chikista4.The word Pathya is made up of two words, mÉjÉç+AcÉç mÉëirÉrÉ.ã çmÉjrÉÇ ÍcÉÌMüixÉÉlÉÑxÉÉËU qÉÉaÉÉïrÉÌWûiÉqÉç|Means which is hitakaraka to the srotomargas according to the chikista”5.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 7DEFINITIONS:mÉjrÉÇ mÉjÉÉãlÉmÉãiÉÇ rÉkrÉŠÉã£üqÉç qÉlÉxÉ: ÌmÉërÉqÉç |rÉŠÉÌmÉërÉqÉmÉjrÉÇ cÉ ÌlÉrÉiÉã iÉ³É sÉYzÉrÉãiÉç ||In Caraka samhita, Pathya is defined as, the wholesome Àhàra, which do notadversely affect the body channels i.e Patha, and which is very pleasant to the mind 6.ÍcÉÌMüixÉÉSÉæ ÌWûiÉMüÉUMüqÉç iÉimÉrÉÉïrÉ: MüÉUlÉqÉç ÌWûiÉqÉç ||That which is good for chikitsa is called Pathya 7qÉÉaÉïxÉÉkÉÉæ mÉjÉÉãlÉmÉãiÉ: rÉiÉç |ÌWûiÉã ÍcÉÌMüixÉÉSÉ, æ ÌWûiÉ MüÉUMü pÉÉãerÉSìurÉpÉãSãWhich is, good for the sroto margas and does not harm the sroto margas, Hitakarakaahara is one among the Bhojya dravya bheda.8mÉjÉÉãlÉmÉãiÉç rÉiÉç |EÌ¨É¹qÉÉlÉxiÉÑ mÉUÉã lÉÉãmÉ¤ÉrÉ : mÉjrÉÍqÉŠiÉ |Which does not makes harm to the sroto margas is called as Pathya & that which ishaving the compatibility, wholesomeness & comfortness with marga, is called Pathya.9ÌWûiÉã ÍcÉÌMüixÉÉSÉæ ÌWûiÉMüÉUMãü ||LãiÉ²Éã qÉlÉuÉ; mÉjrÉÇ ÎxlÉakÉÇ AsmÉÇcÉ pÉÉãeÉlÉÇ.ÌuÉlÉÉÌmÉpÉãwÉeÉæurÉïÍkÉ: mÉjrÉÉSãuÉÌlÉuÉiÉïiÉã |That which is good for chikitsa is called Pathya, one should eat Snigdha and alpaahara. And the disease can be cured only by following Pathya even withoutmedicines.10
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 8ÌuÉ,mÉjÉÉãlÉmÉãiÉqÉç, xuÉxjÉxrÉ xuÉÉxjrÉ U¤ÉhÉqÉÉiÉÑU urÉÉÍkÉ urÉÍkÉmÉËUqÉÉã¤É¶ÉãÌiÉ mÉljÉÉxiÉxqÉSè AlÉmÉãiÉqÉç | qÉlÉ: ÌmÉërÉqÉç|That which is very wholesome to the body channels, maintains the health and curesthe disease & which is very pleasant to the mind is called Pathya.11mÉjÉÇ ÍcÉÌMüixÉÉlÉÑxÉÉËU qÉÉaÉÉïrÉ ÌWûiÉqÉç |ÍcÉÌMüixÉÉãmÉrÉÉãÌaÉÌlÉ UÉãÌaÉxÉãurÉ uÉxiÉÑÌlÉ | ÌWûiÉMüUMãü cÉ |That which is good to the channels of chikitsa , and it is very good for the diseasedperson to get cured from his Vyadhis.12Meaning of the word Pathya:Path., pathati, to go, move, to flyPatha: away, path, road, course, reach.Pathin: in a way, Path, road, course.Pathya: Belonging to the way, suitable, fit proper, wholesome, salutary, andespecially said of diet in a medical science.Pathyaasin: Eating or an eater of wholesome diet 13Modern Dictionary meaning of word Ahara:Collins dictionary defined the word food as “Any substance that can be ingested by aliving organism and metabolized into energy and body tissue is known as food”.According to TABER’s dictionary food is defined as “any material that provides thenutritive requirements of an organism to maintain growth and physical well being.Major B. N. Khan – Nutrition: “Food is a substance which, when taken in the body,is able to build up or repair tissue, protect against ill health (disease) and supplyMaterial for the production of health and energy”.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 9HISTORICAL REVIEWVeda kalaIn Yajurveda, Ahara has been praised as “oh! God, Give us food which does notcause any diseases and also gives us strength. And also, Lord Agnideva is calledannaswami. Upanishad kala:Chandogyaopanishad Bhashyartha: 7thchapter, Anna is called as Brahma. Andalso it is described that, the food that we consume gets separated in to three parts. Thesthula or exterior gets converted into pureesha, Madhyama or the middle one isconverted into mamsa and Sukshma or intrinsic part is converted into mind or mana.Taittiryopanishad: while explaining the Importance of Ahara, it is told that,All human beings are made of anna, all living creatures which are living on the earthare made up of anna, and anna is the very basic need of all living creatures on theearth. So it is called as Sarvaushada.Purana kalaIn Vishnu purana: An important rule has been told for Ahara sevana, One shouldtake half part of stomach with solid foods; one fourth part of liquids and remainingpart should be kept empty for vata.In Brihadhyajnavalkya Smriti: The food which we consume should be consideredas amrita. If we took the food through ‘Prana agnihotra vidhana’, then it destroys allthe diseases.In Ramayana: Diet has been classified into two groups by Valmeeki viz, SatvikaAhara & Tamasika Ahara.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 10In Mahabharata: The one who wants to be healthy should take food such as easilypalatable, well digestible and will be helpful for the body after digestion. And it alsotold that, the one who takes food on proper quantity lives long life without anydiseases, get strength and alertness of mind. And also he will get healthy progenies.In Bhagavat geeta: All living beings are made out of food, the purpose of food is toincrease the duration of life, purify the mind and to aid bodily strength. Thedescription of three different types of food has been told viz, Satvika, Rajasika&tamasika.In Chanakyasutra: mÉjrÉqÉmrÉmÉjrÉÉeÉÏhÉãï lÉÉÎzlÉrÉÉiÉç | (cÉÉhÉYrÉ xÉÑ§É)If somebody is suffering from indigestion due to unwholesome food and over diet, heshould not take any kind of food.In Buddhist literature: it has told that, the food should be consumed with duerespect and mercy along with the sanga bikkhus. Buddhagosha says that, the one whotakes one meal in a day will not be suffered by any illness.14SAMHITA KALA:In Charaka Samhita: The concept of Pathya is scattered everywhere in charakasamhita. In Sutrasthana only we can get many references regarding the concept ofPathya. In the first chapter Dirganjeevitiya adhyaya, the concept of hita ahita has beentold. In 5thchapter Matrashitiya, sada Pathya is told. In 6thch tasyashitiya. In CharakaSutrasthana 22, 23, 25, 27, 28, 29 and 30thchapters we can get various referencesrelated to the concept of pathya. In Ca.Vi 5thchapter the importance of Pathya hasbeen told. In Ca.Ci 1stchapter Pathya has been told as synonym for beshaja. InCa.Ci.30thchapter importances of Pathya have been told.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 11In Sushruta Samhita: The Concept of Pathya is also found scattered throughout theSusruta Samhita, In Sutra sthana 1stch Vedotpatti adhyaya, the importance of Ahara& Aushada is told. In 20thch Hitahitiya adhyaya the concept of Hita ahara and Ahitaahara is explained in 35thch, the concept of satmya and asatmya has been explained.In Uttara tantra 64thchapter, dwadasha ashana vichara has been told according to thedifferent conditions of body.SANGRAHA KALA:In Ashtanga Samgraha: The concept of Pathya is found in various chapters &Sthanas of Ashtanga samgraha, in sutra sthana 3,4,10 and 11thchapters the scatteredinformation related to pathya is available. And also the description of pathya is foundscattered in various sthanas.In Ashtanga Hridaya:In Sutra sthana 3rdch Ritu charya, Seasonal dietic regimen hasbeen told. In 8thch Matrashitiya adhyaya, Sada Pathyas, Ahara matra and diseasescaused due to atimatra and amatra, has been told. And the related concepts are alsofound in other sthanas of Ashtanga hridaya.SYNONYMS:Atmaneena, Ayushya and Hita (D.N.Mishraka varga.77)Chikitsitam, Vyadhiharam, Pathyam, Sadhanam, Oushadham, Prayaschitam,Prashamanam, Prakruti Sthapanam, Hitam, these are synonyms for the bheshaja.(ch.chi.1/3)TERMS RELATED WITH PATHYAIn the Ayurvedic classics, the terms Hita, Satmya, Pathya, Upashaya are usedto impart the perception of wholesomeness. Even though these technical terms ofAyurveda imparts similar meaning, these terms along with there antagonisms must be
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 12studied to get a proper understanding of the concepts of wholesome and unwholesomefood/diet, dietary regimens.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 13Satamya- Asatamya:A substance conductive to an individual is called Satmya and the use of suchsubstances results in the well being of that individual. This is of three types, viz.superior, inferior and mediocre. According to another mode of classification, it is ofseven types, depending upon the administration of individual Rasas (six types) andthe use of Rasas jointly (seventh type). Use of all the Rasas is of the superior type ofSatmya; use of only one Rasa is of an inferior type and in between the superior andthe inferior types is the mediocre type of Satmya. The inferior and mediocre typesshould be slowly changed over to the superior types of Satmya. 15Chakrapani opines that, the term Satmya is used to convey the idea of OkaSatmya (i.e. to make a substance conducive to the body by its habitual intake.) (Ca.Vi.1/20 Ck.) Satmya or homologation stands for such factors which are wholesome to theindividual even when continuously used. 16In Susruta samhita: Satmya (habituation, a customization) is the use of suchthings which do not cause harm to the body even though they are opposite of /different from ones own constitution, habitat, time, caste(family) season, disease,exercise (physical activities) water, day sleep, taste and such others.The taste (substance of such tastes) which consumed makes for happiness(health) only, apart from that (health) produced by exercises and others (season,habitat etc.) should be considered as Satmya .17Upasaya and AnupasayaUpasaya is also one of the synonyms of satmya. Upasaya means that which giveshappiness eventually. Though upasaya is a synonym of satmya it helps mainly in
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 14diagnosis of hidden diseases. Chakrapani comments, Upashaya is that which helps todiagnose the invisible diseases. 18Upasaya is the suitable use of drug, diet, and behavior which are contrary to the causeof diseases or the disease itself or which produce effects contrary tothem(A.S.Ni.1/6).19Such medicines, diets, regimens bring about happiness either byacting directly against the cause of the disease and or the disease itself or byproducing such effects indirectly are called upasaya.Upashaya is the explanatory theory that provides diagnostic aid for disease which isotherwise difficult for diagnosis. Most of the commentators called upasaya asvyadhisatmya.20Upasaya is divided into the following two broad groups:1. Drugs, diet, and regimens which are actually antagonistic to the cause of thedisease or disease itself. (Hetu vyadhi vipareeta )2. Drugs, diets, and regimens which are actually not antagonistic either to the cause ofthe disease or to the disease itself but when employed, they actually alleviate thecondition by counteracting either the disease or the cause of the disease.( Hetu vyadhivipareetharthakari) 20Hita and ahitaThe food articles, which maintain the equilibrium of bodily Dhàtus and help ineliminating the disturbance of their equilibrium, are to be regarded as Hitakara Àhàraotherwise they are Ahitakara to body. In Caraka, it is stated that Hitakara diet is theonly cause of growth and development of body and Ahitakara diet is the only cause ofdisease.21Wholesome and unwholesome food articles bring out opposite effects,depending upon the variations in dose, time, method of preparation, habitat, and
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 15constitution of the body, disease and the age of the individual. The bodies as well asdiseases are caused by food; wholesome and unwholesome food is responsible forhappiness and misery respectively.22Chakrapani comments on the following factors to be considered,Matra: By the Improper dosage the pathya becomes Apathya and vice versa. Ex. Pathyaahara Raktha shali, if given atimatra or heena matra it becomes apathya.Kala: Raktashali is laghu ahara, if it is given in hemanta kala where agni is very muchpredominant then it will become Ahita.Samskara: By the proper methods of processings like swinna, prasrutva etc, the odana or ricewill become Hita. And in relation with Bhumi, it becomes Apathya in Anupa desa.Avastha: The tikta rasa is Pathya in balyavasta, because of the predominance of kapha inbalyavastha, where in vriddhavasta it becomes Apathya because the vata will be moredominant in this age.23The body is constituted of food, hence one should take wholesome (Hita) Ahara onlyafter careful examination and should not indulge in unwholesome (Ahita) ones out ofgreed or ignorance.24As Susruta stated in Sutra 20, there are 3 types of dravya.1] Ekanta Hita(always/totally wholesome): Those which do not harm the body eventhough used always (routinely) are called as Ekanta Hitakara e.g. given in classics aswater, milk, ghee and audana (boiled rice), which are always suitable and accustomedto man by birth2] Ekanta Ahita: (Absolutely unsuitable): It means those which harm the bodyquickly and so can not be used even for short period, which are always unsuitable andperform actions like Dahana, Pacana and Marana such as Agni, Ksara and Visa etc.3] Hitahita Ahara: (conditional wholesome /Suitable- conditional /unsuitable): thosewhich do not harm in certain conditions (proper quantity, time, season, admixture,
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 16processing etc.) but cause harm in certain other conditions (improper quantity, time,season, admixture, processing etc.) are said to be Hitahita Ahara. Due to their natureand result of combination they become absolutely suitable, absolutely unsuitable orsuitable –unsuitable. Thus substances are of three kinds.Therefore, conditional unwholesome is called Apathya e.g. Milk is alwaysHitakari in healthy state of body but when one individual is suffering fromNavajwara, milk is not Hitakari in this condition. So milk is called Apathya inNavajwara. Another point is that Hitakari term is used mostly in healthy state ofindividuals while Pathya term is used mostly in ill conditions.25According to Sushruta, the meal processed by the special methods appropriateto the patha and desired taste etc and which is pleasant to manas, clean, not too hot,and is fresh, is considerd as hita.26PATHYA AND APATHYA:The drugs and regimen which do not adversely affect the body channels andwhich are pleasant to mind are regarded as Pathya or wholesome; those whichadversely affect them are considered to be Apathya or unwholesome27,but this cannotbe accepted as a general rule in absolute terms. The drugs and regimen in fact changetheir qualities, depending on the dosage, season, and method of preparation, habitatand combination with other useful and harmful substance.28So the natural qualities ofregimen and drugs as well as the conditions like dosage etc. are required to be wellascertained before the administration of the requisite therapy in order to achieve thedesired effect.29Chakrapani opines that, The Patha here is to be considered as shareera margasi.e. srotas, the food which do not harm the body and mind is regarded as Pathya andclarifies with an Ex. Ghee is generally regarded to be Pathya ahara but intake of ghee
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 17in excessive quantity or its intake during spring or when it is prepared with drugs ofopposite qualities or its intake by an individual of marshy land or by an individualhaving corpulent body or the one in whom Kapha is aggravated is considered to beApathya.30Conversely even an unwholesome drug like poison becomes wholesome, iftaken in proper quantity. For the purpose of rejuvenation poison is said to be given inthe quantity of a sesame seed.31generally, wholesome nature of a drug may howeverbe defined. But the definition of wholesomeness relates only to its natural form & alsoabout unwholesomeness. For example red variety of Sali rice is wholesome by natureand Yavaka etc are unwholesome. 31Gańgàdhara in Jalpakalpataru Tika of Caraka Samhita has given a very clear cutexplanation. A drug and diet not causing harmful effects to any channel of body andwhich is comfortable to Mana is granted as ‘Pathya’. Although pungent and bittercause discomfort at a time to mind but, it is ultimately comfortable for body, so it istaken as ‘Pathya’. Thus anything producing discomfort to mind initially or later on isgranted as ‘Apathya’ otherwise taken under ‘Pathya’.32From the above descriptions it is clear that hita, satmya, upasaya, and pathya, arealmost conveying the same meaning. The hita when applied for diagnostic purpose iscalled as upasaya and for therapeautic purposes as pathya, and for the conducivepurpose it is known as satmya.CLASSIFICATION OF PATHYA (Ahara):
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 18For the proper understanding of any subject a systematic classification is necessary.Pathya is also considered as hitakara bhojya dravya, hence the classification of aharacan be considered for Pathya.Table.No.1 Classification of Ahara according to Charaka 33Sr no Classified By Type Name1 Aharatva(Edible) 1 Ahara2 Yoni(Origin) 2 Sthavaram(Vegetable products)Jangama (Animal products)3 Prabhava 2 Hitam (wholesome)Ahitamn (unwholesome)4 Virya 2 SitaUsna5 Upayogat (Natureof intake)4 Pana (Beverages), Ashana (Eatables),Bhakshya (Masticable food), Lidhyam(Linctuses)6 Mahabhuta 5 Parthiva, Apya, Tejasiya,Vayaviya,Akasiya7 Rasa 6 Madhura, Amla, Lavana,Katu, Tikta, Kasaya8 Virya 8 Guru, Laghu, Sita, Usna,Snigdha,Ruksha, Manda, Tiksnab. Considering the effect of Ahara on mental faculties Srimad Bagavat Geetaclassifies ahara in to three groups.1. Satvika, 2. Rajasika and 3. Tamasika:c. According to effect of Ahara Susruta Acarya has classified it in to threegroups34Ekanta Hitakara, Ekanta-Ahitkara and Hita –Ahitkarad. Classification of Ahara according to various Acaryas:Bhavamishra, Yogaratnakar, Kasyapa, Sarangdhar has classified Ahara in sixcategories by the nature of intake.1. Chusya (which are sucked)
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 192. Peya (liquids which are drinkable)3. Lehya (which are licked)4. Bhojya (solid food)5. Bhaksya (eatable food)6. Carvya (which require mastication)Except the above classification Kashyapacarya has mentioned twelve types of Aharaas Ahara Pravicarana and 24 types of Ahara as per Kaladinam. 35Factors responsible for the Pathya DravyasThe Wholesomeness (Pathya) and unwholesomeness (Apathya) of Ahara dravyasdepends upon these following factors like, Matra, Kala, Kriya, Bhoomi, Deha, Dosha,guna. All these factors are to be taken into consideration before advising Pathya.36Ashtavidha ahara vidhi viseshayatanaIn Charaka Sutrasthana it is explained that, there are eight factors37to be consideredin dietetics. They are responsible for causing happiness or misery. These factors areto be examined before taking any food.38Definition:Ahara Vidhi Viseshayatanani consists of three different words. Here, Visesha relatesto both word - Ahara and Vidhi as, Ahara Visesha, Vidhi Visesha and Ayatana.Ahara Visesa: means – Speciality, special property, distinguished effect (of Ahara).Vidhi Visesa: means – Special system, Special method, Special manner, Special way,Special arrangement, Special rule, Special command or Special statement for dietintake.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 20Ayatana: Cause, support, Hetu etc. Thus Ahara Vidhi Vishesayatanani means thecausative factors which are responsible for the wholesome and unwholesome effect ofthe food or the method for the diet intake.The eight factors which determine the utility or otherwise of various types of food are:1) Prakrti - Nature of substances2) Karana - Processing of substances3) Samyoga - Combination of different substances4) Rasi - Quantum of substances to be taken5) Desa - Habitat of substances6) Kala - Time as age, seasons and conditions7) Upayoga Samstha - Dietetic rules8) Upayoktra - The individualAHARAVIDHI VIDHANA:These are the dietetic rules which are to be followed while taking the food.39One should consume only that in proper quantity which are, Ushna Snigdha Matravat is consumed after the digestion of previously ingested food Virya Aviruddha Ahara Is to be taken in Ishte desha, where it is provided with Ista Sarvopakarana Not to be taken speedily Not to be taken too slowly Taken without talking with others Taken without laughing
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 21 Taken with the concentration of the mind Taken after paying due regard to oneself or own self. This description given by the Caraka is mainly for the healthy and unhealthy personsand Sushruta has described it for Unhealthy persons and called it as DwadasaAsanavicara.DWADASHA ASHANA VICHARA: 401. Shita Anna: Persons afflicted with thirst, heat, alcoholism, burning sensation,Rakta-Pitta, poisoning and epileptic fits as well as those suffering from the effects ofsexual excess should be treated with cold food.2. Ushna Anna: Persons afflicted with the aggravation of bodily Kapha and Vayu aswell as those already treated with purgatives of Sneha and those whose bodies are fullof Kleda (physical moisture) should be treated with warm food.3. Snigdha Anna:Persons suffering from the aggravation of bodily Vayu and from aparched (Ruksa) condition of the body as well as those suffering from the effects ofsexual excess and those accustomed to physical exercise should be treated withSnigdha food.4. Ruksha Anna: Persons with an excess of bodily Medas and Kapha as well as thosesuffering from Meha and those previously treated with a Sneha should be treated withRuksa food.5. Drava Anna: Weak, parched and thirsty persons should be given Drava food.6. Shushka Anna: Those suffering from Meha and ulcers as well as those whosebodies are full of Kleda should be given dry food.7. Eka-Kala Anna: Persons with impaired digestion should be given only one mealevery day, so that the digestive fire may have opportunities to be rekindled.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 228. Dwi-Kala Anna: Persons with the proper amount of digestion should be given twomeals a day.9. Matra Hina: Food and drink in smaller quantity would be beneficial to personssuffering from impaired digestion or any other disease.10. Aushadha Yukta: Medicine should be given with food and drink to a person,having aversion to it.11. Dosha Prasamana: Foods consumed appropriate- suitable to season is DoshaPrasamana12. Vrityartha:All foods consumed by the healthy person is meant to maintain healthand life. Considering these twelve aspects ingestion of food should be planned. Inorder to prevent the unmanifested diseases and to cure the manifested ones, anindividual desirous of happiness, should follow the prescribed regimen.Daily indicated pathya aharaShasthika shali,Mudga, Saindhava, Amalaki,Rain water collected before falling on theground, Ghrita, Meat of animals dwelling in arid climate (jangala) and Madhu. Allthese foods to be practiced for the regular usage, but in the proper dosage andmanagement.41By the usage of these food articles, it maintains the health and itprevents the person from getting sick.In Ashtanga hridaya it is told, Shali, Godhuma, Yava, Shashtika, Jangala mamsa,Jivanti shaka, mulaka, Vastuka, Amalaka, Mridvika, Mudga, Sharkara, Ghrita,Vyodaka, Ksheera, Kshoudra, Dadima and Saindhavas are to be use habitually.42
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 23Table.No.2 THE LIST OF PATHYATAM AND APATHYATAMA AHARAS INVARIOUS CATEGORIES.43Sl.no. Ahara Dravya HitamAhara Dravya AhitamAhara Dravya1 Shukadhanya Shali Yavaka2 Shamidhanya Mudga Masha3 Udaka Toya ambu Nadi jala4 Lavana Saindhava Ushara5 Saka Jivanti Sarshapa6 Mriga mamsa Ena Gomamsa7 Pakshi mamsa Lava Kana kapota Mamsa8 Vilesaya Godha Bheka9 Matsya Rohita Cilcima10 Sarpi Goghrita Avi sarpi11 Milk Godugdha Avi dugdha12 Sthawara Sneha Tila taila Kusumbha oil13 Anupa mriga vasa Varaha vasa Mahisha vasa14 Matsya vasa Chuluki vasa Kumbhira vasa15 Jalcara Vihanga vasa Pakahamsa vasa Kakamadgu vasa16 Vishkira Sakuni vasa Kukkuta vasa Chataka vasa17 Sakhada Medsam Aja medas Medas of hasti/ Gaja18 Kanda shaka Shringavera Nikucha19 Phala Mridvika Aluka20 Iksu Vikara Sharkara PhanitaIMPORTANCE OF PATHYA:The main aim of Àyurveda is to preserve the health of a healthy person and totreat the disease of diseased one. Àhàra, Swapna (Nidra) and Brahmacarya play animportant role in the maintenance of “Swasthya” of an individual. That is why these
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 24are called as Trayopastambha of life. Àhàra plays an important role in healthy and indiseased. It is more important than the medicine itself. The body can be nourished andmaintained in good health status, by adopting suitable diet and full benefits of life canalso be reaped by adherence to proper mental hygiene. 44Wholesome diet is the prime causes for the growth and development of thebody, on the contrary, unwholesome diet causes several diseases. Caraka emphasizesthat the ideal diet rebuilds the worn out systems, nourishes the Dhàtus and maintainsthe equilibrium of the body constituents. Irrational diet acts otherwise, producingdisease.45Food sustains the life of living beings. All living beings in the universe requirefood. Complexion, clarity, good voice, longevity, geniuses’ happiness, satisfaction,nourishment, strength and intellect are all conditioned by food. Professional activitiesleading to happiness in the world, Vedic rituals leading to abode in heaven andobservance of truth, Brahmacarya leading to salvation are all based on food.Only the individual having a healthy body can afford to perform all activitiesleading to happiness, heaven and salvation, and for the preservation of health intakeof food is essential. Hence food is the basic factor for the attainment of all of them.In Chakrapani commentary of Ca.Vi.5/4, he has said that which causes doshaprakopa is Apathya, in contrary to this that causes dosha prashamana is Pathya.46Pathya is being considered as the ideal Ahara (dietic regimen) which suits for thedifferent conditions of the body, to maintain the normal state of Dosha-Dhatus & tobring back the imbalanced Dosha-Dhatus of body.Well known Cikitsa Grantha of medieval period “Vaidhya Jivanam” by Lolimbarajahas stated the importance of Pathya-Apathya in Cikitsa as ,
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 25mÉjrÉãxÉÌiÉ aÉSÉiÉïxrÉ ÌMüqÉÉæwÉkÉ ÌlÉwÉãuÉhÉæ: ?mÉjrÉå AxÉÌiÉ aÉSÉiÉïxrÉ ÌMüqÉÉæwÉkÉ ÌlÉwÉãuÉhÉæ: ?If a person follows the dietary rules for particular disease there is very littlesignificance of drug treatment and when a person is exposed to Apathya the drugtreatment has no value because the drug taken can’t cure the disease. 47In Charaka Sutrasthana 27thchapter, the importance of Pathya has been quotedas , Paying the due consideration to the quantity and time, a self controlled manshould regularly intake such useful food & drinks as are conducive to the internalpower of digestion including metabolism. Like a man who performs ‘yajna’. Theproper consumption of Pathya is compared to the ‘Yajna’ or ‘Homa’. Fuel like woodor coal is required to keep the fire continuously or enlighten. Similarly the Àhàra actsas the Indhana (fuel) for the Jatharagni and other Agnis in the body. 48Who takes the diet conducive to the power of digestion being aware of thewholesomeness of food and drinks, who resort to meditation of ‘Brahma’ and charity,enjoys the bless without any disease during the present as well as future lives.49Chakrapani: During the present life, man becomes free from diseases due to theintake of Pathya ahara. And in the future life due to the influence of the invisibleeffect occurred as a result of the righteous acts of the present life. Sinful acts andapathya ahara , these two are the important factors for the causation of diseases. Inthe absence of these factors, the individual becomes free from all the diseases.50A self controlled man, blessed by noble man lives for 100 years free from diseases bythe intake of Hita ahara (Pathya). 51
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 26The Relation of food with Body and diseases.Diseases are a result of the food taken in four fold manner via eating, drinking,licking and masticating. Intake of wholesome and unwholesome food is responsiblefor the maintenance of health and production of diseases respectively. 52The body is constituted of food; hence one should take wholesome food onlyafter careful examination and should not take unwholesome ones out of greed orignorance.Chakrapani: Out of greed some individuals indulge in unwholesome food eventhough they are fully aware of its harmful effects. Some others out of ignorance treatunwholesome food as useful one and take it. Both of them are subjected to misery. 53Need for the consideration of Pathya.The wise who always avoid the intake of Apathya food are held in high esteem bysaints. It means the one who is habitually taking Pathya aharas will be praised by thesaints. The Shareera as well as the diseases is caused by food. Wholesome andunwholesome foods are responsible for Sukha and Dukha. 54Chakrapani: The compactness of doshas (caused by chaya prakopa) which areaggrevated internally (Anta: kupita) become soft (mridu) and the non-compact doshaswhich take gross form (mahan kupita) become reduced in quantity by theadministration of Pathya aharas.Pathya can be modified according to the Palatability:Because of the regular intake of the same Pathya, if the Pathya is disliked & it is notpalatable to the eater, then it should be modified to the form of palatable one.55Due to the favorableness of the sense object (taste of food) one attains satisfaction,energy, relish, strength, happiness and consequent loss of severity of diseases.56
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 27The relish which appears due to greediness, diminution of dosha, disorder orcontrariness should be managed with Pathya ahara processed with drugs if necessary.57Diet is the greatest medicament.The food is said to be cause of stability for all living beings. There is nothing elseexcept diet for sustaining the life of living beings. Ahara is said to be Mahabhaisajyaby Kasyapacarya, hence no any other medicament just like diet is not available. Inother words, one is capable to make man disease free only with the cereals (congenialdiet).One is not able to sustain life without diet even of endowed with medicine, thatis why the diet is said to be the great medicament by physician.58and Pathya has beenconsidered as one of the Ashtavidha chikitsa in hareetha samhita. 59Pathya can be ultimately understood as the food which suits any condition of thebody. It may be in the form of satmya, hita, upashaya, that which ultimately provideshealth to the individual. To have a healthy life one should have the awarenessregarding proper diet, its dose, time, place, and wholesomeness, .etc. the food havingall these qualities, which becomes hita to the mind, body through its srotases and thusproduces health.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 28CONTENTS1. Introduction 2. Derivation 3. Definition 4. Synonyms 5. Classification 6. Nidana 7. Poorva Roopa 8. Roopa 9. Samprapti 10. Roga nirnaya 11. Sadhyasaadhyata 12. Upadrava 13. Chikitsa 14. Diabetes mellitus
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 29
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 30INTRODUCTION:Madhumeha is one of the varieties of vataja meha. It is the last variety of vataja meha.Much importance is being given to the management of the disease. The disease is tobe managed with very much caution. If it is neglected it may lead to life threateningcomplications. So there are many advancements happening regarding, understandingthe pathology and management of the disease. In spite of tremendous advancement ofmodern system of medicine i. e. oral hypoglycemic agent and human insulin till date,an ideal drug which can cure diabetes is not yet available and still scientists arestruggling to search an effective and harmless therapy. Along with the currentknowledge, it is very much important to redefine the available ancient knowledge ofthe disease for the benefit of diabetic community.AYURVEDIC REVIEWIn Ayurveda, Madhumeha has been described as one among the 20 types of Prameha& is a sub-type of Vatik Prameha in which patient passes excessive amounts of urinethat tastes & looks like honey. To understand the iatrogenecity, pathophysiology,complications and management first it is merely necessary to emphasize the diseasePrameha as whole.Derivation of the word madhumeha:The word ‘Prameha’ is pullinga shabdha, it consist of two sub-words. i.e. ‘Pra’ and‘Meha’. The word Meha is derived from the root “Mih Secane” by adding ‘Lue’Pratyaya to it "Mehati, Sinchati Mutraretansi" which means to excrete(Halayudhakosha).64In Sanskrita literature, The Mih is used to denote, to make water, to wet, to emitsemen. So this root Mih is added to prefix Pra the word becomes Prameha.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 31mÉëqÉãWû: = mÉë+ÍqÉWèû= qÉãWûÌiÉ qÉÔ§ÉrÉÌiÉ CìiÉ AjÉï:|60The word Madhumeha consists of two words:Madhu and MehaThe word ‘Madhu’is also pullinga shabdha, it is derived from the root “qÉÉlrÉiÉã ÌuÉzÉãwÉãhÉeÉÉlÉÉÌlÉ eÉlÉÉ rÉÎxqÉlÉç “(Manyante Viseshena Jananti Jana Yasmin.) In Sanskrit literature,Madhu word is used in various contexts like PushpaRasa, Makarandah, Makshikam,Madhy, Ama, Kshiram, Jalam, Madhura Rasa61etc. It is termed as Mutra roga andMutraatisaara.62qÉkÉÑUÇ rÉŠ qÉãWãûwÉÑ mÉëÉrÉ qÉÎkuÉuÉ qÉãWûÌiÉ | xÉuÉãïÌmÉ qÉkqÉãWûÉZrÉÉ qÉÉkÉÑrÉÉïŠ iÉlÉÉãUiÉ: ||mÉëMüwÉãïhÉ qÉãWûÌiÉ ¤ÉUÌiÉ uÉãrÉÉïÌSUlÉãlÉãÌiÉ | qÉÉkÉÑrÉïÇ rÉŠ xÉuÉãïwÉÑ qÉkÉÑÌuÉuÉ qÉåWãûÌiÉ || 63So’ it can be defined, that the disease in which the excretion is having qualityconcordant with Madhu (honey) in its colour, taste, smell, and consistency calledMadhumeha.63Definition of madhumeha:MüwÉÉrÉ qÉkÉÑUÇ mÉÉhQÒû Ã¤ÉÇ qÉãWûÌiÉ rÉÉã lÉU:| uÉÉiÉMüÉãmÉÉSxÉÉkrÉÇ iÉÇ mÉëÌiÉrÉÉlqÉkÉÑqÉãÌWûlÉÉÇ ||64qÉkÉÑqÉãWûÏ qÉkÉÑxÉqÉÇ 65qÉkÉÑqÉãWûÏ qÉkÉÑxÉqÉÇ mÉëqÉãÌWû 66The clinical entity in which patient voids the urine having concordance with Madhui.e. of Kashaya and Madhura taste, Ruksha (dry) texture and honey like colour andbody acquires sweetness called Madhumeha.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 32¤ÉÉæSìqÉãWûÉã qÉkÉÑqÉãWûÉ:67uÉÉiÉÉixÉÌmÉïuÉïxÉÉ¤ÉÉæSìqÉãWûÉxcÉiuÉÉUÉã AxÉÉkrÉiÉqÉÉ: qÉWûirÉÉÌrÉMüiuÉÉiÉç ||68Sushruta has term narrated the term Kshaudra Meha in place of Madhumeha.Kshaudra is nothing but variety of Madhu (honey), which is Kapila (tawny) in colour.So it is clear that Kshaudrameha resembles with Madhumeha. Further, he asserted thatwhen all the Pramehas are ill-treated or neglected, it is converted into Madhumehaand especially he emphasized that the disease Prameha along with Pidaka shouldtermed as Madhumeha.SYNONYMS:These are the few synonyms mentioned in the ancient treatise, which are as follows: Paushpa Meha:69 Ojo Meha: 70 Kshaudra Meha.71CLASSIFICATION OF PRAMEHA:Three important Ayurvedic ancient treatises elaboratively classified the diseasePrameha on the basis of dosha dominance, as shown below in tabular form:-A.CLASSIFICATION ON THE BASIS OF DOSHATable.No.3 VATAJA MEHA:Charaka samhita Sushruta VagbhataVasameha Vasameha VasamehaMajjameha Sarpimeha MajjamehaHastimeha Hastimeha HastimehaMadhumeha Kshaudrameha Madhumeha
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 33B.Table.No.4 CLASSIFICATION ON THE BASIS OF PROGNOSIS:SADHYA YAAPYA ASAADHYAKaphaja Pittaja VatajaObese Usually not much obese AsthenicAcquired Acquired HereditaryEarly stage Acute stage Advance stageWithout complications With complications With complicationsC.CLASSIFICATION ON THE BASIS OF BODY CONSTITUTION. 72Sthula and Krisha:D. CLASSIFICATION ON THE BASIS OF THE ETIOLOGICAL FACTORS.73Sahaja (Hereditary) and Apathyanimittaja (Acquired)E. CLASSIFICATION ON THE BASIS OF SAMPRAPTI.74 Avaranajanya and Dhatuapakarsanjanya:Vagbhata has clearly mentioned the two types of Madhumeha. (A.H.NI. 10/18-19) Dhatukshyajanya Madhumeha and Avaranajanya Madhumeha NIDANA (ETIOLOGY)All ancient treaties mentioned the common etiological factors of Prameha butCharaka samhita mainly narrated the specific etiological factors according to dosha,and also mentioned the specific etiological factors of Madhumeha. This is the uniquecontribution of Charaka samhita. Etiological factor can be classified according to thetype ie. Sahaja and Apathyanimittaja.751) Sahaja (Hereditary)Charaka samhita has clearly narrated that Madhumeha is a Kulaja Vikara whichresults due to the defect in the Beeja. As per Chakrapani it can be caused by father,
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 34mother or grand parents, which means that, disease may be inherited from generationto generation.76Charaka samhita narrated that Sahaja type of diseases can occur dueto defect in Beeja, Beejabhaga or Beejabhagavayava.77Chakrapani explained that thisdefect may be caused due to the indulgence of faulty foods at the time of pregnancy.Charaka samhita narrated that indulgence in excessive use of Madhura Rasa bymother at the time of pregnancy causes Madhumeha and Sthaulya.78Thus, genetic predisposition and the over indulgence of etiological factors at the timeof pregnancy by mother helps to precipitate the disease Madhumeha.2) Apathyanimittaja: (Acquired)Charaka samhita has narrated etiological factors according to Dosha predominance inNidana Sthana and common etiological factors in Chikitsa Sthana.SPECIFIC ETIOLOGY OF MADHUMEHA:On the basis of causative theory, Madhumeha have been subdivided into twoetiological types by Vagbhata. The specific factors which lead to excessive tissuedepletion (Dhatukshaya) cause Dhatukshayajanya Madhumeha.The specific factors which increase Kapha, Pitta, Meda and Mamsa in turn lead toobstruction (Avarana) of Vata causing Avaranajanya Madhumeha.Specific etiology of Madhumeha79Ahara: Kashaya, Katu, Tikta, Sheeta, and Laghu, Ruksha guna ahara sevana.Vihara: Vyavaya,Vyayama,Vishama ashana, Vamana, Virechana Atiyoga,Atapasevana,Shirovirechana Atiyoga, Vega Sandharana, Anashana, Abhighata andAsthapana Atiyoga.Manasika: Chinta, Shoka and Bhaya.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 35Table.No.5. Specific Madhumeha nidana AHARA VIHARAExcessive intake of Excessive indulgence in Guru Snigdha Amla Lavana Navannapana Nidra Asyasukha Tyakta Vyayama Chinta Sanshodhana Akurvatam PURVARUPAIn Ayurvedic treatises common premonitory symptoms of Prameha are mentioned indetail, but special premonitory symptoms of Madhumeha are not mentioned.Table.No.6. List of Poorva roopas in Brihatrayees.8o, 81, 82Purvarupa C.S S.S A.S A.H M.NKesheshu Jatilabhava + + + - -Asya Madhurya + - + + +Karapada Daha + + + + +Karapada Suptata + - - - -Mukha Talu Kantha Shosha + - + + -Pipasa + + + - +Alasya + - + - -Kaye Malam + - + - -Kaya Chhidreshu Upadeha + - + - -Paridaha Angesu + - + - -ShatpadaPipilakabhi Mutrabhisaranam + - + + -Mutra Cha Mutra Doshan + - - - -Visra Sharira Gandha + + + + -Nidra Sarva Kalam + - + - -Tandra Sarva Kalam + + + - -Sweda + - + + -Shithilangata + - - + -Shaiyya Asana Swapneshu Sukhe Ratischa + - - + -Hridaya-Netra-Jihva-shravana- Upadeha + - - + -Ghanangata + - - + -
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 36Kesha Nakha Ativriddhi + + - + -Sheeta Priyata + - + + -Shatpada Pipilika Sharirabhisaranam + - + + -Snigdha Gatrata - + + - -Picchila Gatrata - + - - -Guru Gatrata - + - - -Madhura Mutrata - + - - -Shukla Mutrata - + + - -Sada - + - - -Shwasa - + + - -Deha Chikkannata - - - - +Dantadinam Maladhyatvam - - - - +Gala Talu Shosha - - + + -RUPAAll acharya have focused specifically on character of Urine in Rupa, Madhumehapatient excretes urine having Kashaya and Madhura taste, Panduta in colour and ofRuksa quality. Sushruta has clearly mentioned that the diagnosis of Prameha shouldbe made when complete or partial prodromal symptoms of Prameha accompanied byPolyuria get manifested.83In this regard Gayadasa opined that, in this disease all prodromal symptoms getconverted into Rupa due to specific nature of the disease i.e. Vyadhi Prabhava. TheRupa as described in Ayurveda includes both, signs and symptoms of the disease.GENERAL SYMPTOMATOLOGY: URINE CHARACTERISTICS:xÉÉqÉÉlrÉsÉ¤ÉhÉÇ iÉãwÉÉÇ mÉëpÉÔiÉÉÌuÉsÉqÉÔ§ÉiÉÉ | SÉãwÉSÕwrÉÌuÉzÉãwÉãÌmÉ iÉixÉqrÉÉãaÉÌuÉzÉãwÉiÉ: ||qÉÔ§ÉuÉhÉÉïÌSpÉãSãlÉ pÉãSÉã qÉãWãûwÉÑ MüsmrÉiÉã |84iÉ§ÉÉÌuÉsÉ mÉëpÉÔiÉqÉÔ§ÉsÉ¤ÉhÉ: xÉuÉïÇ LãuÉ mÉëqÉãWûÉã pÉuÉÎliÉ || 85(1) Prabhutamutrata:
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 37This is the main cardinal sign described by all acharayas. Vagbhata mentionedPrameha as the disease of Mutraatipravrtija.86Patient voids urine more in quantity.Gayadasa, opined that this excess urine quantity is because of liquification of thedusyas and their amalgamation.87(2) Avilamutrata:Patient voids urine having hazy consistency or having turbidity. Gayadasa andDalhana both opined that, this characteristic feature of urine is because of the nexusbetween mutra, dusya and dosha.88Vagbhata also emphasized that this turbidity ofthe urine is because of its annexation with the dhatus.89(3) Picchila mutrata :Charaka samhita has mentioned this character of urine especially at the time ofdiagnosis of the Prameha.Kashaypa mentioned following symptoms of Prameha to be observed in pediatricpatients90 Akasmat Mutra Nirgama: Child excretes urine suddenly with no intention. Makshika Akrant: Flies get attracted towards the urine. Shweta and Ghana Mutra : Child excretes urine having Shweta colour And solid consistency i.e. turbidity.Associated signs and symptoms:In ChikitsaSthana, Sushruta before profounding the treatment of Prameha, assertedtwo types of Prameha along with their features as follows:Sahaja Pramehi: Krisha (Asthenic) 91 Ruksha (dry body) Alpashi (consumes less food) Bhrisha Pipasa (Excessive thirst)
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 38 Parisaranshila (restless always want to wonder)
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 39Apathyanimittaja: Sthula (obese) 92 Bahuashi (consumes excessive food) Snigdha (unctuous body texture) Shayyasanswapnasheela (like to sit down and sleep always) Psychophysiological feature (Characteristic) or manifestation:xÉ cÉÌmÉ aÉqÉlÉiÉç xjÉÉlÉÇ xjÉÉlÉÉSxÉÍqÉdcÉÎliÉ || AéxÉlÉÉSèSìÓhÉÑiÉã zÉrrÉÉÇ zÉrÉlÉÉiÉç xuÉmlÉÍqÉdcÉÌiÉ ||QûsWûhÉ: cÉiÉÑÌuÉïkÉ Ì¢ürÉÉ´ÉrÉÇ ÍsÉÇaÉÇ SzÉïrÉ³ÉÉ: xÉ cÉÉÌmÉ aÉqÉlÉÌSirÉÉÌS:|93This special manifestation related to behavioural pattern is enumerated bySushruta that, Madhumehi prefer to stand still than walking, sitting than standing,lying down than sitting and sleeping than lying down. This manifestation mainlybecause of the Alasya (indolence).93this feature mentioned as Pancavidhakriya-Srayalinga by Dalhana in contenxt to above quotation.SAMPRAPTI:The process of manifestation of disease is called Samprapti or pathogenesis. Itincludes various stages as disease progresses.According to Sushruta, the excessive indulgence of the etiological factors related toPrameha results into Aparipakva Vata, Pitta, Kapha and Meda, which further proceeddownward through the Mutravaha Srotasa to get localized at Basti Mukha and thusleading to disease Prameha.94Dalhana interprets the term Aparipakva as Ama. Again he asserts that alongwith Aparipakva Vata, Rasa, Mamsa etc. should also be considered.95Sushruta alsoasserted that, if all the Pramehas are treated improperly or ignored they get terminatedinto Madhumeha. 96
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 40Vataja Prameha:Vata gets provoked due to its own etiological factors and draws out Vasa-adi Dhatusfrom the body towards Basti resulting into four types of Vataja Prameha. When Oja isdrawn towards Basti due to vitiation of Vata, the natural Madhura Swabhava of Ojadue to the Ruksha Guna of Vata gets transformed into Kashaya Rasa leading to themanifestation of Madhumeha.97Sushruta narrated the typical Dushya Sangrahaaccording to Dosha. He explained that, in Vataja Prameha, Kapha, Pitta, Meda, Vasaand Majja take part in pathogenesis.98SAMPRAPTI OF MADHUMEHAAccording to Vagbhata two types of pathogenesis get precipitated.99(a) Dhatukshayata(b) AvritapathataThe different types of Samprapti which are mentioned by various Acharyas are beingdescribed below.Sampraptivishishta Anilatmaka Madhumeha:This type of Samprapti of Vataja Prameha occur in the persons who have the specificbody tendency for Prameha onset i.e. Tathavidha Sharire. These persons have thespecific Abadhdhatva Meda Bahulyata. It may be due to genetic predisposition,Prakriti manifestation or sedentary habits. Due to excessive indulgence of Aharaja andviharaja nidana vata gets vitiated in these person. This vitiated Vata further getsimplicated by Meda. Now this provoked Vata – Meda complex spreads through outthe body and leads to transfer of either of Vasa, Majja, Lasika, or Oja in to basti.When Oja due to influence of Vata changes to Kashaya and Ruksha Guna and isexcreted through urinary tract then this disorder is called Madhumeha.100
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 41Tathavidha Sharire (Genetic predisposition) can also be correlated to SahajaPrameha. Sushruta narrated that Sahaja Prameha precipitates because of defect inBeeja.101Charaka samhita says that Sahaja Madhumeha is a Kulaja Vikara, because ofthe defect in Beeja (sperm/ovum)/ beeja bhaga avayava.102Madhumeha due to Shuddha Vata: 103Due to kshaya (depletion) of Kapha and Pitta, Vata gets provoked and causes theexcretion of Dhatus (like Vasa, Majja, Oja and Lasika) through urinary tract resultinginto Madhumeha.104in this category of Madhumeha is Asadhya due to Vata asArambhaka Dosha and its further consequential provocation due to Dhatukshaya.Dhatukshayajanya Madhumeha: 105The Kshaya of Gambhira and Sarabhuta Dhatus like Vasa, Majja, Oja and Lasika leadto Vata provocation. The expulsion of Sarabhuta Dhatus through urine occurs in suchexcess amount that this Kshaya itself again acts as nidana for Vata Prakopa. Hencethis vicious cycle goes on and on, but due to Ashukaritva property of Vata all thestages of Samprapti proceed so fast that it leads to Asadhya stage of disease veryquickly.Avritapathata (Avaranjanya) Madhumeha:The etiological factors of Avaranjanya Madhumeha have been described by Vagbhatabut he has not explained the pathogenesis of this type of Madhumeha. 106Charaka samhita has fully illustrated this type of Samprapti in detail.107Due toexcessive indulgence in the etiological factors mentioned above, Kapha and Pitta getprovoked and vitiates Meda and Mamsa. All are in excess quantity. They in turn causeobstruction to the normal pathway of Vata. This obstructed Vata get provoked anddraws out the Apara Oja from all over the body and carries it towards Basti causing
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 42Madhumeha.108The Kricchrasadhyata of this Avaranajanya Madhumeha is due toprovocation of Vata by Kapha-Pittakara etiological factors.Kala Prabhavaja Madhumeha:This type of Madhumeha is described by Sushruta & Vagbhata.109Though directpathogenesis is not mentioned but it is said that when all types of Prameha are ignoredor not treated properly, they get transformed into Madhumeha. We can say that this isthe last stage or further progression of Kaphaja and Pittaja Prameha110or complicatedstage of the diseases.SAMPRAPTI GHATAKA OF MADHUMEHA:On the basis of various references the Samprapti Ghataka of Madhumeha areillustrated below:-Dosha: Disease is Tridoshakopanimittaja.111Dushya: Rasa, Rakta, Mamsa, Meda, Majja, Shukra, Vasa, Oja, Lasika, Kleda112and Sweda.113Srotodushti: Sanga & Ati PravrittiSrotas:- Medovaha, Mutravaha,Udakavaha and MamsavahaAgni: Vaishamya of all Agnis (or Dhatvagnimandya)Ama: Medogata Ama produced due to Jatharagnimandya and Dhatvagnimandya.Adhishtana: BastiUdbhavaSthana: AmashayaBhedavastha: Occurrence of Upadravas such as Puti Mamsa and Prameha Pidika etc.Nature: Chirakari114
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 43ROGA NIRNAYA (Differential diagnosis of madhumeha)It has been mentioned in Charaka samhita Chikitsa Sthana regarding diagnosis ofPrameha that:In Charaka samhita Samhita –Chikitsa 6/54 it is told,Until and unless Haridra and Rudhira coloured Mutrapravritti is not associatedwith the premonitory symptoms of Prameha, the disease cannot be diagnosed asPrameha, but it goes more in favour of RaktaPitta. Here more importance is given toPurvarupa of Prameha and not only to Mutra Pravritti. Regarding Madhumeha, it is tobe specially emphasized that instead of only Mutra Madhurya, ‘Shareera Madhurya’is also found which is not present in other types of Pramehas. Apart fromMutramadhurya, other characters of urine are also helpful in differential diagnosisamong various Doshika varieties of Prameha.115In Charaka samhita chikitsa 6/12, the description has been given to describeVarna, Rasa, Sparsha and Gandha of whole body, so it may be applied to MutraPravritti also viz. in IkshuMeha, Mutra Pravritti is Atimadhura in Rasa, Sheeta-Picchila by Sparsha, Turbid and like sugarcane juice in Varna. In SheetaMeha,Mutrapravritti is Atimadhura, Bhrusha and Sheeta. While in Madhumeha, theMutrapravritti is116i.e. Rasataha Mutrapravritti is not only Madhura but it is Kashaya– Madhura due to Vata dominance, Ruksha by Sparsha instead of Picchila and alsoPandu in Varna.117SADHYA ASADHYATVA (Prognostic criteria for madhumeha):Krichhrasadhya (Difficult to treat)Madhumeha resulted because of Avaranjanya pathogenesis is difficult to treat i.e.Krichhrasadhya. Here the provocation of Vata results, but the etiological factors
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 44mainly related to the Kapha and Meda. So it should have been considered for both ofthem. There are very few therapeutic measures, which act against the Vata and Kaphacombinely.118Asadhya (Incurable):Vataja Prameha is incurable because there is involvement of vital Dhatus like Majja,Oja in the pathogenesis and the treatment modalities quite opposite to Dosha andDushya.119Sushruta mentioned that if Kaphaja and Pittaja Prameha or If all types ofPramehas are not treated properly or ill treated they become asadhya.120Charaka samhita mentioned that Madhumeha because of the BeejaDosha i.e.genetic predisposition is incurable.121Sushruta mentioned that Madhumeha inassociation with complication i.e. Pidaka is incurable.122UPADRAVA (COMPLICATIONS)Charaka samhita enumerated the general complications while Sushruta and Vagbhatadescribed according to the Dosha predominance.General Complications: These are Trishna, Atisara, Jwara, Daha, Daurbalya,Arochaka, Avipaka, Putimamsapidaka, Alaji and Vidradhi.123Chakrapani opined thatthese complications manifest because of the long term Anubandha of Pramehadisease.Specific Complications:Vataja Meha Janmanam:Hridagraha, Laulyam, Anidra, Stambha, Kampa, Shula, Badhapurishatvam, Shosha,Kasha and Shwasa. 124Complications specifically related to Madhumeha:Charaka samhita mentioned the Sapta Pidaka as complication, because of thenegligence of the Madhumeha125while Sushruta mentioned that Madhumeha along
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 45with Pidaka is Asadhya. He quoted that these Pidaka are caused by the tridosha andbecause of the vitiated Meda and Vasa. 126Sushruta and Vagbhata mentioned 10 Pidaka while Charaka samhitamentioned only 7 Pidaka. These are also follows:Table.No.7. Prameha pidakasSl No Pidaka Charaka Sushruta Vagbhata1 Saravika + + +2 Kacchapika + + +3 Jalini + + +4 Vinitha + + +5 Jalaji + + +6 Masoorika - + +7 Sarshapika + + +8 Putrini - + +9 Vidharika - + +10 Vidhradhika + + +CHIKITSA (TREATMENT)Following are the treatment modalities we can apply in the Madhumeha to alleviatethe disease. Nidana parivarjana. Treatment according to Dosha & Dushya. Treatment according to Complications. This is the prime treatment principle narrated by every Acharya before describing thetreatment of every disease. Charaka samhita enumerated that we should avoid theseetiological factors which are causing the disease Prameha. Avoidance of theetiological factors is the prime treatment.127Chakrapani opined that this avoidance of etiological factors in Prameha isprime concern because; this disease is Chirakari having long impact on the body.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 46Treatment According to Body ConstitutionKrishapramehi:In Krisha patient, such foods should be used which are going to increase the strengthof patient without increasing the vitiation and after proper strength gaining, mildpurificative measures can be used along with herbal medicine.128For the krishapramehi patient the Brimhana therapy is to be done with aushadha and ahara.129Sthulapramehi: 130In Sthula patient we have to apply apatarpana Chikitsa along with powerfulpurificative measures to be done. Again the treatment modalities described for MedoRoga can be applied here too.TREATMENT ACCORDING TO DOSHA PREDOMINANCE:Though the disease is of Tridosha predominant, but individual Doshika considerationfor the treatment is important for good prognosis.KAPHAJAPRAMEHA:I) Vamana and Virechana: Dalhana further commented that after Vamana Karma,Virechana is essential to alleviate the Prameha and also to reduce the Kledavitiation.131, 132ii) Basti: After vamana and virechana, Basti can be administered specially Asthapana.Arundatta especially commented133that after completion of Vamana and Virechana, ifpatient has strength then Asthapana Basti can be administered.iii.Udavartana: This procedure helps to reduce the excess of Kapha and Meda byperforming Shoshana.134
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 47Iv.Snana and Jalavaseka: This will help to eliminate the waste products byabsorption from skin and also effective in excessive sweating and bad smell, it willalso help to regain strength. 135v.Vilepana: Various herbs can be used for the external application all over thebody.136Vi.Lekhana and Apatarpana Chikitsa: Charaka samhita mentioned that thetreatment principle of Lekhana can be applied by means of purification.Charaka samhita also mentioned that we can apply the treatment principleswhich are described for Santarpanajanya Vyadhi like in MedoRoga.137, 138vii.ShamanaThere are lot of herbs and decoctions described by eminent Acharya. Sushrutaspecifically mentioned the decoctions according to the type.Pittaja prameha:Pitta is one of the prominent Dosha in the pathogenesis. Acharya mentioned followingmeasures to alleviate its vitiation.Shodhana: Vamana and Virechana along with Para-procedures like, Snana,Jalavaseka and Vilepana with the help of described herbs.Shamana: By the use of decoctions and Ghrita mentioned by Acharyas.Vataja prameha:Before treating the patient of Vataja Prameha following points should be carefullyobserved.(1) Type of Madhumeha i.e. either Kevala Vataja or Avaranjanya.(2) Strength of the patient according to Doshabala, Agnibala and Vyadhibala.(3) Involvement of genetic predisposition.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 48After observing the patient carefully we can profound the following treatmentmodalities.Shodhana: Vamana and Virechana can be performed if possible according to strengthof patient. In Madhumeha, Vata Dosha is dominant so Basti therapy is ideal treatmentfor it.Shamana: Various decoctions and some Arishta for vataja meha were described forthe treatment.Special food regimen is required for Krisha Pramehi.139
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 49CONTENTS:1. DEFINITION AND EPIDEMIOLOGY2. CLASSIFICATION AND ETIOLOGY3. PATHOGENESIS4. CLINICAL FEATURES5. COMPLICATIONS6. DIAGNOSIS7. MANAGEMENT
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 50DIABETES MELLITUS 2251. Definition and Epidemiology:As per WHO, diabetes mellitus (DM) is defined as heterogeneous metabolic disordercharecterised by common feature of chronic hyperglycemia with disturbance ofcarbohydrate, fat and protein metabolism.DM is a leading cause of morbidity and mortality world over. It is estimatedthat approximately 1% of population suffers from DM. The incidence is rising in thedevoloped countries of the world at the rate of about 10% per year, especially of type2 DM, due to rising incidence of obesity and reduced activity levels. DM is expectedto continue as a major health problem owing to serious complications, especially endstage renal disease, IHD, gangrene of the lower extremities, and blindness in theadults. It is anticipated that the number of diabets will exceed 250million by the year2010.2. Classification and Etiology:Etiologic classification of Diabetes Mellitus as per American DiabetesAssociation-2007I. TYPE-1 DIABETES MELLITUS (10%)(Earlier called insulin –dependent or juvenile onset diabetes )Type-1ADM: Immune mediatedType-1B DM: IdiopathicII. TYPE-2 DIABETES MELLITUS (80%)(Earlier called non-insulin dependent or maturity onset diabetes.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 51III.OTHER SPECIFIC TYPES OF DIABETES (10%)A.Genetic defect of beta-cell function due to mutations in various enzymes ( earliercalled maturity onset diabetes of young or MODY).(eg.hepatocyte nuc;leartranscription factor HNF, Glucokinase)B.Genetic defect in insulin action (eg.Type A insulin resistance)C. Diseases of exocrine pancreas (Eg.chronic pancreatitis, pancreatic tumours, postpancreatectomy)D.Endocrinopathies (Eg. Acromegaly, Cushing’s syndrome, pheochromacytoma)E.Drug or chemical induced (Eg.steroids, thyroid hormone, thiazides, beta-blockeretc.)F.Infections (Eg. Congenital rubella, cytomegalo virus.)G.Un common forms of immune mediated DM (stiffman’s sundrome, anti-insulinreceptor antibodies).H.Other genetic syndrome (Eg. Down’s syndrome, klinfelter’s syndrome, Turner’ssyndrome)IV. GESTATIONAL DIABETES MELLITUSAmerican Diabetic Association -2007 has identified major risk factors for type-2diabetes mellitus.1. Family history of type-2 DM2. Obesity3. Habitual physical inactivity4. Race and Ethnicity (Blacks, Asians, Pacific islanders)5. Previous identification of impaired fasting glucose or impaired glucose tolerance6. History of gestational DM or delivery of baby heavier than 4kgms.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 527. Hypertension.8. Dyslipedaemia ( HDL level <35mg/dl or Triglycerides > 250mg/dl)9. Poly cystic ovary diseases and acanthesis nigricans.10. History of vascular diseases.3. PATHOGENESIS:Depending upon Etiology of DM hyperglycemia may result from the following. Reduced insulin secretion. Decreased glucose use by the body. Increased glucose production. PATHOGENESIS OF TYPE-2 DIABETES MELLITUS:The basic metabolic defect in type-2 DM is either a delayed insulin secretion relativeto glucose load( Impaired insulin secretion), or the peripheral tissues are unable torespond to insulin (Insulin resistance).INSULIN RESISTANCE:One of the most prominant metaboplic features of type-2 DM is the lack ofresponsiveness of pheripheral tissues to insulin, especially of the skeletal muscle andliver. Obesity, in particular is strongly associated with insulin resistance and hencetype-2 DM. Mechanism of hypergycemia in these cases is explained as under.I.Resistance to action of insulin impairs glucose utilisation and hance hyperglycemia.ii. There is increased hepatic synthesis of glucose.iii. Hyperglycemia in obesity is related to high level of free fatty acid and cytokines(eg.TNF-alpha and adeponectin) affect peripheral tissue sensitivity to respond toinsulin.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 53IMPAIRED INSULIN SECRETION:In type-2 DM, insulin resistance and insulin secretion are interlinked.i).Early in course of disease, In response to insulin resistance there is compemnsatoryincreased secretion of insulin (hyoer insulinaemia) in an attempt to maintain normalblood glucose level.ii) Eventually, however , there is failure of beta cell function to secrete adequateinsulin, although there is some secretion of insulin i.e. cases of type-2 DM have mildto moderate deficiency of insulin (which is much less severe than that in type-1 DM )but not its total absence.INCREASED HEPATIC GLUCOSE SYNTHESIS:One of the normal roles played by insulin is to promote hepatic storage of glucose asglycogen and suppress gluconeo genesis. In type-2DM as a part of insulin resistanceby pheripheral tissues , the liver also shows insulin resistance i.e. inspite of hyperinsulinaemia in the early stages of disease, gluconeogenesis in the liver is notsuppressed. This results in increased hepatic synthesis of glucode which contributes tohyperglycemia In these cases.CLINICAL FEATURES:It can be appreciated that hyperglycemia in DM does not causes single disease but itis associated with numerous diseases and symptoms, especially due to complications.Two main type of DM can be distinguished clinically. However overlapping ofclinical features occurs as regards the age of onset, duration of symptoms and familyhistory. Pathophysiology in evolution of clinical feature is schematically shoen in thefollowing figure.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 54CLINICAL FEATURES OF TYPE-2 DM:I.This form of diabetes generally manifests in middle life or beyond, usually abovethe age of 40yers.ii. The onset of symptoms in type-2 Dm is slow and insidious.iii. Generally the patient is asymptomatic when the diagnosis is made on the basis ofglucosuria or hyperglycemia during physical examination, or may present withpolyuria and polydipsia.iv. The patients frequently obese and have unexplained weakness and loss of wait.v. Metabolic complications such as ketoacidocis are infrequent.COMPLICATIONS OF DIABETES MELIITUS:As a consequence of hyperglycemia of diabetes, every tissue and organ of the bodyundergoes biochemical and structural alterations which account for the majorcomplication in diabetics which may be acute matabolic or chronic systemic. Bothtype of diabetes mellitus may develop complications which are broadly divided intotwo major groups:A.ACUTE METABOLIC COMPLICATIONS: Diabetic ketoacidocis Hyperosmolar non ketotic coma and Hypogycemia. B.LATE SYSTEMIC COMPLICATIONS: Artherosclerosis, Diabetic microangiopathy,
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 55 Diabetic nephropathy, Diabetic neuropathy, Diabetic retenopathy and Infections - Skin infections - Pulmonary tuberculosis- Urinary tract infections- Vaginal monoliasis etc. DIAGNOSIS OF DIABETES:Hyperglycaemia remains the fundamental basis for the diagnosis of diabetes mellitus.In symptomatic cases, the diagnosis is not a problem one can be confirm by findingglycosuria and a random plasma glucose concentration above 200mg/dl. The severity of clinical symptoms of polyuria and polydipsia is direcly related to the degree of hyperglycaemia. In a symptomatic cases, when there is persistantly eleveted fasting plasma glucose level, diagnosis again posses no difficulty. The problem aeises in asymptomatic patients who have normal fasting glucose level in the plasma but are suspected to have diabetes on other grounds and are thus subjected to oral GTT. If abnormal GTT values are found, these subjects are said to have “chemical diabetes”.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 56 Table.No.8. the American Diabetes Association (2007) has recommended definite diagnostic drieteria for early diagnosis of diabetes mellitus. Revised Criteria for Diagnosis of Diabetes by oral GTT(American DiabetesAssociation (2007)PLASMA GLUCOSE VALUE DIAGNOSISFASTING ( for > 8 hours) VALUE Below 100mg/dl Normal fasting value 100‐125mg/dl Impaired fasting glucose (IFG) 126mg/dl or more Diabetes mellitusTWO-HOUR AFTER 75GM ORAL GLUCOSE LOAD Less than 140mg/dl Normal post prandial GTT 140‐199mg/dl Impaired post prandial glucosetolerance(IGT) 200mg/dl or more Diabetes mellitusRANDOM VALUE 200mg/dl or more in asymptomatic patient Diabetes mellitusTHE FOLLOWING INVESTIGATIONS ARE HELPFUL IN ESTABLISHINGTHE DIAGNOSIS OF DIABETES MELLITUS.1. Urine testing: Glucosuria and Ketonuria2. Single Blood Sugar estimation3. Screening by fasting glucose test4. Oral glucose tolerance test.5. Glycosylated haemoglobin (HbA1c) test.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 576. Glycated albumin7. Extended GTT8. Intravenous GTT9. Cortisone primed GTT10. Insulin Assay11. C-Peptide assay12. Islet Auto antibodies13. Screening for diabetes associated complications7. MANAGEMENT:Diabetes mellitus requires ongoing medical care as well as patient and familyeducation both to prevent acute illness and to reduce the risk of long termcomplications. The therapeutic objective is to restore known metabolicderangements towards normal in order to prevent and delay progression ofdiabetic complications.The goals of therapy for type 1 or type 2 DM are to:(1) Eliminate symptoms related to hyperglycemia,(2) Reduce or eliminate the long-term microvascular and macrovascularcomplications of DM, and(3) Allow the patient to achieve as normal a life-style as possible.(4)Education of the patient about DM, Nutrition, and ExerciseOral Drugs for Treating Hyperglycemia: Oral drugs are used to lower Bloodglucose level by achieving following goals.1. Drugs that primarily stimulate insulin secretion2. Drugs that alter insulin action.
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 583. Drugs that principally affect absorption of glucose.A. Pathway of normal insulin synthesis and release in beta cells of pancreatic islets. B. Chain of events in action of insulin on target cell. A.SYNTHESIS AND RELEAS E OF INSULIN Altered ion channel Activity Betacell Outflow of K+ Influx of Ca+ ATP A&B chains with C‐peptide Pro‐insulin GLU‐6 Ph Nucls GLUTPre‐pro‐insulin Release of insulin Hypoglycaemia(<70mg/dl) Insulin receptor TARGET CELLIrs1
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 59B.ACTIONS OF INSULINSCHEMATIC REPRESENTATION OF PATHOGENESIS OF TYPE-2 DM:Irs2NUCLEUS Concordance in identical twins Both parents Diabetic, 50% risk to the child Obesity Hypertension Low physical activity DECREASED INSULIN INSULIN RESISTANCE Amylin ? Glucose Toxicity of islets ? Receptor and post receptor defects INCREASED HEPATICGLUCOSE SYNTHESISHYPERGLYCAEMIAGENETIC FACTORS CONSTITUTIONAL
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 60PATHOPHYSIOLOGICAL BASIS OF COMMON SIGNS AND SYMPTOMSDUE TO UNCONTROLLED HYPERGLYCEMIA IN DIABETES MELLITUS:TYPE-2 DMHYPERGLYCAEMIAGLYCOSURIAFatigueVulvitis, BalanitisHungerPolyphagiaWeight lossWastingIncreased catabolismLipolysis (in adipose)Free fatty acids (in plasma)& Oxidation (liver)Decreased anabolismOsmotic diuresisDehydration &Loss of ElecrolytesPoluuria,polydipsiaTachycardiaHypotensionDIABETIC COMAKETOACIDOCISINSULIN DEFICIENCY
“A Conceptual study on Pathya in Madhumeha with special reference to Type-2 DM”. Dr.Ramesh Kumar.K.L 61CHAPTER-3PATHYA AHARAS IN MADHUMEHA:The description of pathyaaharas for madhumeha is found in many classical text booksunder the chapter Prameha. As madhumeha is one of the varieties of prameha, thepathyas mentioned in prameha should be considered for the management ofmadhumeha too (Su.Ci.13/3). For the convenience of understanding, the pathyas arecategorised in to Dhanya varga, Shimbhi varga, Shaaka varga, Hareeta varga, Phalavarga and Taila varga.Table.No.9. List of Pathya aharas in MadhumehaA.Dhanyavarga(Cereals&Millets ) B.Shimbhi varga(Pulses)1. Yava 1. Chanaka2. Godhuma 2. Adaki3. Shastika Shali 3. Kulattha4. Kangu 4. Mudga5. Shyamaka 5. Masura6. Kodrava7. Joorna8. MadhulikaC. Shaka varga (Vegetables) D. Harita varga (Leafy vegetables)1.Kushmanda 1. Katillaka2. Karavellaka 2. Shigru patra