Madhumeha in Elderly

Dr. Ananth Ram Sharma MD Panchakarma, (Ph.D) Panchakarma, (Ph.D)Lecturer and Head

Prameha Statistics Diabetes mellitus is one of the most common endocrine disorders affecting almost 6% of the world population. According to WHO “Diabetes is a major threat to global public health that is rapidly getting worse, and the biggest impact is on adults of working age in developing countries”. The total no. of recorded diabetes patients till year 2000 are 171 million and expecting to be increase by 366 million in year 2030. Indian‘s stand at first in the whole world to have the largest numbers of diabetic patient i.e. 31.7 million will be increase up to 79.44 million by year 2030.17/05/2011 Dr Sharmas Panchakarma 2 Concepts

Incidence The epidemiology of diabetes in elderly people is not well understood. The estimated annual incidence of diabetes was 8.6 cases per thousand for elderly Canadians. Incidence decreased with age, from 9.5 for subjects 65– 74 years of age, to 7.9 for those 75–84 years of age and then to 3.1 for those 85 years of age and older. Diabetes was associated with death (relative risk 1.87, 95% confidence interval 1.59–2.19) and admission to an institution (relative risk 1.58, 95% confidence interval 1.28–1.94). Kenneth Rockwood. et.al. Byadagi.S.P et.al17/05/2011 Dr Sharmas Panchakarma 3 Concepts

Introduction Terminology Prameha is used in a wide angle. Prakarshena adhikyena mehati iti Prameha: Almost 19 out of 20 Prameha may converted in to Madhumeha.17/05/2011 Dr Sharmas Panchakarma 4 Concepts

Prameha and Madhumeha Prabhuta Mutrata Another one is the Madhuryata of Mutra Not only in Madhumeha, Ikshumeha and Sikatameha – Madhuryata is there. Because of Madhuryata Madhumeha is a Smanya samjna.17/05/2011 Dr Sharmas Panchakarma 5 Concepts

Tridoshajatva of Prameha Kaphaja, Pittaja and Vatajaare not Svatntra Roga’s They are anukrama avastha bheda’s Tridoshatva is there for all the 3 Predominet Dosha decides the Avastha Tatra vata pitta medobhiranvita shleshma shleshma pramehan janayati, Vata kapha shonita medobhiranvitam pittam pitta pramehan, Kapha pitta vasa majja medobhiranvito vayu: vatapramehan- Sushruta17/05/2011 Dr Sharmas Panchakarma 6 Concepts

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Nidana’s Food Occupation Vyayamadi Vihara’s Kala Deshavastha’s Kulaja – genetic Vayah and Linga ApatarpanaJanya17/05/2011 Others Dr Sharmas Panchakarma 8 Concepts

Food and Drinks Brumhana Kapha medo mutrala Ahara Madhuramla rasa pradhana Shitavirya Snigdha Matra – Gurunam Ardha sauhityam…….17/05/2011 Dr Sharmas Panchakarma 9 Concepts

“pÉÔÌrÉ¹ qÉkÉÑUÇ pÉÑ£Çü ÌuÉmÉÉMüÉiÉç qÉkÉÑUÉå¨ÉUÇ pÉÔ U£üqÉÉÍ´ UxÉÇ xÉÇeÉlÉrÉåiÉç xÉÉãÅxÉÉæ U£üqÉÉÍ´ÉirÉ xÉgcÉUlÉç || üiÉÉiÉç mÉËUhÉÉqÉÇ lÉ sÉpÉiÉå xÉqrÉaÉç kÉÉiuÉÎalÉ uÉæM×üiÉÉiÉç ||” qÉÉkÉÑrÉïÇ iÉålÉ U£üÉSå iÉiÉÉå qÉkÉÑU qÉÔ§ÉiÉÉ ||17/05/2011 Dr Sharmas Panchakarma 10 Concepts

Occupation and Exercise Sedentary Life style Low activities high socio economical status Vyayma Guna Adhana chatra Padatra rahito………17/05/2011 Dr Sharmas Panchakarma 11 Concepts

Kala desha When compaered to sheeta pradesha More predominant in Ushna Pradesha Adana kala – Balakshaya- Agni Kshaya- saumya dhatu apachaya17/05/2011 Dr Sharmas Panchakarma 12 Concepts

Genetic MÑü¸ÉlÉliÉUÇ mÉëqÉåWûÉUÇpÉÈ AmÉirÉ xÉÇ¢üqrÉiuÉålÉ EpÉrÉÉåUmrÉmÉirÉaÉiÉiuÉÉiÉç|| QûsWûhÉ eÉÉiÉ mÉëqÉåWûÏ qÉkÉÑqÉåÌWûlÉÉã uÉÉ | lÉ xÉÉkrÉ E£üÈ xÉ ÌWû oÉÏeÉ SÉãwÉÉiÉç|| Concidered as Asadhya17/05/2011 Dr Sharmas Panchakarma 13 Concepts

Vayah and Linga Approximately 13% of adults older than 70 years have diabetes mellitus and 11% of adults between age 60 and 74 remain undiagnosed. Higher rates of premature death; functional disability; and chronic illnesses, such as hypertension, cerebrovascular accidents, and coronary artery disease, often affect elderly diabetic patients. Brown AF et.al UeÉmÉëxÉåMüÉiÉç lÉÉUÏhÉÉÇ qÉÉxÉÏ qÉÉxÉÏ ÌuÉzÉÑkrÉÌiÉ xÉuÉïÇ zÉUÏUÇ SÉåwÉÉ¶É lÉ mÉëqÉåWûlirÉiÉ Îx§ÉrÉÈ || Îx§ pÉÉuÉmÉëMüÉzÉÉÌS LiÉ¨ LiÉ¨ÉÑ lÉ rÉÑ£üÉ xÉuÉïiÉl§ÉÉ mÉëÍxÉ¬ãÈ mÉëirÉ¤É ÌuÉUÉåkÉÉŠ| xÉÑ´ÉÑiÉ - lrÉÉrÉ cÉÎlSìMü Él§ ÉÉŠ|17/05/2011 Dr Sharmas Panchakarma 14 Concepts

Apatarpana Janya eÉÉrÉiÉå xÉ ÌMüsÉ Ì²kÉÉ-Ì²kÉÉ- ¢Ñü®å kÉÉiÉÑ¤ÉrÉÉ²ÉrÉÉæ SÉåwÉÉuÉ×iÉmÉjÉåÅjÉuÉÉ| ÉÉuÉ×iÉmÉjÉå AÍcÉliÉlÉÉ²É MüÉrÉÉïhÉÉÇ ÍcÉliÉlÉÉ²É ÌuÉzÉåwÉiÉÈ pÉrÉzÉÉåMüÉÌS WåûiÉÉåuÉÉï qÉkÉÑqÉåWûÈ mÉëeÉÉrÉiÉå| pÉÉåÌaÉlÉÉÇ mÉëÉæRûuÉrÉÍxÉ mÉëqÉåWûÈ xrÉÉiÉç xÉÑSÒxiÉUÈ||17/05/2011 Dr Sharmas Panchakarma 15 Concepts

Purva Rupa17/05/2011 Dr Sharmas Panchakarma 16 Concepts

LAKSHANA PRAKARANAM Kaphaja 10 Pittaja 6 Vataja 4 Udaka Meha Nila meha Ikshu meha Vasa meha Sandra meha Kala meha Sandra prasada meha Majja meha Suklabha meha Kshara meha Sukla meham meha Haridra meha Shita meha Hasthi meha Shanair meha Manjishta meha Alala Meha Madhu Meha Sikata meha Lohita meha17/05/2011 Dr Sharmas Panchakarma 17 Concepts

Exceptions Kaphaja - Lavana Charaka’s Majjameha meham, Phena meham and Madhumeha is and Pittaja Amla termed by sushruta as meham of sushruta is sarpi meha and not in Charaka Kshaudra meha. Charaka’s Alala Sushruta mentions meham, Shitameham, anothr madhumeha and Kala meham is not So total 24 in sushruta Their lakshana are also not similar17/05/2011 Dr Sharmas Panchakarma 18 Concepts

Samanya Lakshana chronic pain, injurious falls, polypharmacy, cognitive impairment, urinary incontinence and depression.17/05/2011 Dr Sharmas Panchakarma 19 Concepts

Elderly Signs and symptoms Pain Targeted history and physical examination for chronic pain and its treatment Injurious Falls Falls are usually increased. hypoglycemia, peripheral neuropathy, sensory deficits (poor vision), polypharmacy, and overall decreased functional status. Polypharmacy Educate patients and caregivers regarding the indications, expected risks, and expected benefits of the many medications.17/05/2011 Dr Sharmas Panchakarma 20 Concepts

Cognitive Impairment Education of caregivers is important because of increased cognitive difficulties in the elderly diabetes. Urinary Incontinence Diabetes mellitus is associated with increased urinary incontinence Depression Geriatric depression scale (GDS). Treatment should be directed at stopping medications known to cause depression and introducing, effective medications with good safety profiles.17/05/2011 Dr Sharmas Panchakarma 21 Concepts

Vishesha Lakshana Sushruta Nidana In elderly we can see more dhatukshayajanya Madhumeha17/05/2011 Dr Sharmas Panchakarma 22 Concepts

Vimshati meha Lakshana17/05/2011 Dr Sharmas Panchakarma 23 Concepts

Courtesy Dr Krishnakumar Mutra Pareeksha 2417/05/2011 Dr Sharmas Panchakarma Concepts

Courtesy Dr Krishnakumar17/05/2011 Dr Sharmas Panchakarma Concepts 25

CHIKITSA17/05/2011 Dr Sharmas Panchakarma Concepts 26

Apatrapana Chikitsa Charaka17/05/2011 Dr Sharmas Panchakarma 27 Concepts

Samshodhana Anarha17/05/2011 Dr Sharmas Panchakarma 28 Concepts

Balavan – Vamana and rechana Surasadi Ganam for Kapha and Nyagrodadi for pitta then Asthapana17/05/2011 Dr Sharmas Panchakarma 29 Concepts

Shamana in General Nishamalaki Kramuka Khadira yogam Amruta svarasam with Honey Darvi, devadaru, triphala, Mustha Chitraka, triphala, Darvi, Kalingaka17/05/2011 Dr Sharmas Panchakarma 30 Concepts

Shamana for each Dosha17/05/2011 Dr Sharmas Panchakarma 31 Concepts

Shamana for Vimshati meha Kaphaja Meha Pittaja Meha Meha Kashaya Meha Kashaya Udaka meha Parijata Nila meha Asanadi Ganam Ikshumeha Kashmarya Haridra meha Rajavruksha Sura meha Nimba Amla meha Nyagrodadi gana Sikata meha Chitraka Kshara meha Triphala Sanair meha Khadira Manjishta meha Manjishta, Chandana Lavana Meha Patha, Agaru, Nisha Rakta meha Amruta, tinduka bijam, Pishta Meha Nisha, Darvi Kharjura Sandra meha Sapta Parna or Durvadi Sukla meha Kakubha chandana Phena meha Triphala aragvada, Draksha17/05/2011 Dr Sharmas Panchakarma 32 Concepts

Shiloncha vrutti17/05/2011 Dr Sharmas Panchakarma 33 Concepts

Other Procedures17/05/2011 Dr Sharmas Panchakarma 34 Concepts

HERBAL PREPARATIONS 1. Amalaki 1. Suvarchala Susrutacharya’s exclusive 2. Amrapushpam 2. Brahmi contribution:- 3. Gojihwa 1. Tuvaraka 3. Atibala 4. Haridra 2. Makshika 4. Bhurjapatra 5. Kakamachi 3. Shilajathu 5. Devadaru 6. Meshashringi 6. Guggulu 7. Pippali 7. Guduchi 8. Pashanabheda 8. Kampillaka 9. Sarjaka 9. Katuki 10. Varahi kanda 11. Tinduka phala 10. Katphala 12. Satavari swarasa 11. Karanjaphala 13. Palasapushpa with 12. Karanja Ksheeram 13. Moorva 14. Manjishta 15. Maha nimba Bhava Prakasha 16. Nimba17/05/2011 Dr Sharmas Panchakarma 35 Concepts

Herbo Mineral Preparations 1) MUDGADI KANJIKA KASHAYA:- “Atisthoulya pramehadi rogasya nivruttaye” (Sahasra yoga) 2) AVIPATTIKARA CHURNA:- “Agnimandyodbhavan rogan nasayeth avikalpatah Pramehan vimsatimchaiva nasanam” (BH.R) 3) NYAGRODHADI CHURNA:- “Vimsathi mehan prasamam yanti” (Chakradatta) “Pidakan na jayathe” (BH.R) 4) MUSTA, DEVADARU & TRIPHALA KASHAYA:- “Prameha hrit” (Chikitsa kalika – Trisata acharya) 5) BHASKARA LAVANA CHURNA:- “Viseshatah sharkaradeen rogan nanavidhan tadha - Hridrogam hanti” (Gada Nigraha )17/05/2011 Dr Sharmas Panchakarma 36 Concepts

1) Vanga prayoga - “Madhumeha nut” (R.R.S) 2) Indra vati - “Madhumeha pra nasini” (Ra.Ch.) 3) Dhanwantari ghrita - “Jayeth Sarvan Pramehan pitakochitan” (S.Y) 4) Lodhradi kashaya - “Madhumeha jit” (Basava Rajeeyam) 5) Bahumutrantakaras - “Madhumeham Hanti Bhaswan yatha tamam” (Parama durlabhaha) (Sahasra Yoga) 1) Sarveswara rasa - “Madhumehan su durjayam hanti” (Bh. Ra.) 2) Dadimadi ghritam - “Pramehan vimsati vividhan hanyath na samsayaha”(B.R) 3) Prameha mihira taila- “Pramehan vimsatischaiva nasayeth avikalpataha” (B.R)17/05/2011 Dr Sharmas Panchakarma 37 Concepts

Minerals 1) Shilajathu 8. Swarnamakshika Bhasma 2) Abhraka Bhasma 9) Tamra yoga: “Vaktre 3) Vanga Bhasma sandharayeth Nisi – Pramehaharam” 4) Naga Bhasma 10) Kaphari: “Madhumeha mapi 5) Jasada Bhasma nihanti ashu” (R.R.S) 6) Tamra Bhasma 7) Rajatha Bhasma17/05/2011 Dr Sharmas Panchakarma 38 Concepts

Other Kriya Krama’s Takraara Kayasseka Udhdvartana Abhyanga Shirodhara17/05/2011 Dr Sharmas Panchakarma 39 Concepts

PATHYA AHARA VIHARA Yava Chanaka Vyayama Palandu “Padatra rahito munivartanah” Tikta saka “Yojananam shatam yayat” Purana dhanya “Khaneth va salilasayaha” Purana kulutha “Gramaika ratram Takra bhaikshwasee” Bhojana madhye salila Godhuma Bhrumhana ahara (not medokara)17/05/2011 Dr Sharmas Panchakarma 40 Concepts

APATHYA AHARA VIHARA Dadhi – Mandaka Indiscriminate/excessive Sura exposure to cold & chill. Kshupaja maricha Exerting activity soon (Chillies) after food. Food substances Excessive indulgence in prepared out of wheat in association with oil. This sex. is more applicable Indulgence in sex to patients suffering from immediately after food. Diabetic Retinopathy. Intake of water at the end of food.17/05/2011 Dr Sharmas Panchakarma 41 Concepts

References Charak Nidan sthana : Ch.4 Charak Chikitsa sthana : Ch.6 Sushruta Nidan sthana : Ch.6 Sushruta Chikitsa sthana : Ch.11 Ashtangahridaya Nidan sthana : Ch.10 Ashtangahridaya Chikitsa sthana : Ch.1217/05/2011 Dr Sharmas Panchakarma 42 Concepts

To Summarize Dhatu kshyaja Madhumeha Concentrate over the Particular signs and Symptoms Shodhana Has limited Role17/05/2011 Dr Sharmas Panchakarma 43 Concepts

“|| Na Matra Matramapyatra Kinchit Agama Varjitam||” Varjitam||” For your patient Hearing Visit: http://panchakarma4all.blogspot.com17/05/2011 Dr Sharmas Panchakarma Concepts 44

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Madhumeha in Elderly

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Madhumeha in Elderly — Presentation Transcript