Excessive urination which may be associated with excessive thirst and hunger, lethargy, numbness or burning sensation in the extremities, calf muscle cramps or sudden loss of weight with raised blood sugar levels
(BSL).
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Madhumeha
1. MADHUMEHA (DIABETES
MELLITUS)
Dr. Rajtilak Tiwari M.D. ( Kayachikitsa)
Assistant Professor in Kayachikitsa dept. in
Shivshakti lal sharma Ayurvedic College Ratlam
(M.P.)
2. INTRODUCTION
• Prameha is one among the eight Maharoga
(disorders needing serious concern) and
explained as most important among Anushangi
Roga (chronic disorders) manifested as polyuria
with turbidity in urine occurs due to vitiation of
Kapha Dosha and Meda Dhatu. Madhumeha the
commonest clinical presentation of Prameha can
be compared to Diabetes Mellitus. All such diet
and life style factors which increase Kapha, Meda
and Kleda, contribute in the pathogenesis of
Madhumeha
3. Prameha can be classified into two as Sthula Pramehi or
Apathya Nimittaja Pramehi with clinical features of
obesity along with excessive frequency of urination. In the
second variety, Vata may be dominantly involved, and
such patients are lean and termed as Krisha Pramehi.
Further Prameha can be further classified into Kapha
Prameha, Pitta Prameha and Vata Prameha according
Dosha involvement. Kapha Prameha is Sadhya (curable),
Pitta Parmeha is Yapya (manageable) and Vata Prameha
is Asadhya (incurable).
4. Case Definition:
Excessive urination which may be
associated with excessive thirst and
hunger, lethargy, numbness or burning
sensation in the extremities, calf muscle
cramps or sudden loss of weight with
raised blood sugar levels
(BSL).
5. General Diagnostic criteria
• Increased frequency of urine
• 2. Turbidity in urine
• 3. Excessive thirst & hunger
• 4. Lethargy
• 5. FBS >125 mg/dl and (or) PPBS >200 mg/dl1
• Along with, any 2 or more of the following symptoms:
• a. Like cool surroundings (Subjective)
• b. Sweetness in mouth (Subjective)
• c. Burning / Numbness in palms & soles (Subjective)
• d. Ants noted in the toilet (Subjective)
6. • Sthula Pramehi: General Diagnostic
criteria + BMI > 25
• Krisha Pramehi: General Diagnostic
criteria + BMI < 18
• Kapha Pramehi: General Diagnostic
criteria + BMI > 25 with some of the
following features
• • Recent onset of Diabetes (< 2 years)
• • Take excessive sweets and high calorie diet
• • Bulk eating habit
• • Indigestion, predominant upper GIT
symptoms and recurrent Upper Respiratory
Tract symptoms
7. Pitta Pramehi: General Diagnostic criteria + BMI
>18 and <25 with some of the following features
• Medium onset of Diabetes (2-6 years)
• Use of excessive spicy and salty diet
• Moderate eating habit
• Acidity predominant, upper GIT symptoms and
recurrent Urinary Tract Infections
Vata Pramehi: General Diagnostic criteria + BMI <
18 with some of the following features
• Chronic onset of Diabetes (> 6 years)
Use of dry low nutritional diet
• Less eating habit
9. LEVEL 1: AT SOLO AYURVEDA
PHYSICIAN CLINIC/PHC
• Clinical Diagnosis:
• On the basis of history and clinical
presentation patient can be diagnosed
provisionally as with subtypes as Sthula /
Krisha and Doshik variety Kapha/ Pitta/
Vata. Patients diagnosed as Sthula /
Kapha / Pitta and having at least
moderate physical strength and blood
sugar level as follows may be treated at
this level.
• • FBS >110 upto 180
• • PPBS > 200 upto 280
11. Treatment:
In the initial stage when the patient is
having mild raised blood sugar levels and
not associated with major complications,
along with diet restriction, two or more of
following drugs may be given
as in table 11.1:
12. Table 11.1: Medicines at level 1 for
Madhumeha
Drugs Dose
form
Dose Time of
administr
ation
Dosh
specificat
ion
Anupan
Vijayasara
di Kwatha
Decoction
10-15 ML
Before
meal /
twice a
day
Kapha /
Pitta
-
Phalatrikad
i
Kwatha1
Decoction 10-15 ml Before
meal /
twice daily
Kapha /
Pitta
-
Kathakakh
adiradi
Decoction 10-15 Ml Before
meal/twice
a days
Kapha -
13. Nisha
Katakadi
Kashaya
Decoction 10-15 ml Before
meal/twic
e a days
pitta -
Nisha-
Amalaki
powder 6 gm After meal
/twice a
days
Irrespectiv
e of Dosha
With water
Mamajjaka
Ghana Vati
Vati
2-3 Tab Before
meal
/thrice a
days
- With water
Sapta
Rgangyadi
Vati3
Vati 2-3 Tab Before
meal
/thrice
adays
- With water
With water
15. Chart Showing various diet Useful
in Prameha
Type of Diet
Name
Cereals Yava (Barley) (Hordeum vulgare), godh£ma (wheat),
kodrava (grain variety –Paspolum scrobiculatum) udd¡laka
(according to dhanvantari Nighantu forest variety of
k°drava), Kangu (Seteria italica), Madhulika (Elusine
coracana), Shyamaka (Echinochloea frumentacea),
Jurnahva (Sorghum vulgare), Vajranna (Pennisatum
typhoides), Purana shali (old rice),.
Pulses Adhaki (red gram-Cajamus cajan), kulattha (horse gram)
and mudga (green gram), Masura (Lentils), Makushtha
(Moth Bean/Acpnite bean), Chanaka (Cicer arietinum)
should be taken with bitter and astringent leafy
vegetables.
16. Pathya - Apathya (Diet and life
style education):
• Do’s-
• • Ahara: Use of Purana Dhanya
(grains harvested 1 year back),
Bharjit Dhanya (roasted grains), Yava
(Barley), Mudga (Green grams) and
Kulattha (Horse grams), Adhaki,
Masura (Lentils), Makushtha
• are recommended. Bitter leafy vegetables
like fenugreek, Atasi (Flaxseed), Sarshapa
(mustard) are recommended; roasted
meat of dry habitats animals
17. Don’ts –
• Ahara: Excessive use of sweets, fruit salad,
Sugarcane, fruits like Mango, Watermelon,
Chikoo, Dates, Jack fruits, Custard apple,
Banana, Grapes, Cashew nuts, and other fruits
with high glycemic index, use of cold drinks,
intake of oil, Hydrogenated Ghee, fried food,
over indulgence of meat especially of wet land
animals, to take food before complete
digestion of previous food, to take food in
improper time and in varied
quantity.
18. Vihara:
Day time sleep especially just after taking
heavy meal, irregular pattern of sleep i.e.
less than 5 hours or more than 10 hours
in a day or in improper way, no or less or
infrequent exercise.
19. Referral Criteria:
Patient not responding to above
mentioned management in terms of
symptomatology and reduction in blood
sugar levels and developing signs of
complication of Diabetes may be referred
to the next level.
20. LEVEL 2: AYURVEDIC HOSPITAL WITH
INDOOR FACILITIES:
All patients referred from level 1 and those
patients diagnosed as Krisha Parmehi / Vata
/ Durbala / Pitta with Medo Dushti may be
treated at this level
22. Treatment:
In addition to the management mentioned in
Level 1, few of the following drugs may be
added as per the requirement and status of the
patient (Table 11.3). Rasaushadhi (Herbo-
mineral drugs) or herbal drugs of potential
pharmaco-vigilance importance can be used at
this level. Patient may be kept under
observation while prescribing these kinds of
medicines.
23. Medicines at level 2 for Prameha
Name of
drugs
Dose form dose Time of
administr
etion
Special
indication
Anupana
Shiva
Gutika
Vati
1-2 vati Twice a
day/ before
meals
Diabetic
Impotence,
Neuropathy
Vanga
Bhasma7
powder 125-250
mg After meal
/ twice a
day
water
Trivanga
Bhasma
powder 125-250
mg
After meal
/twice a
day
- water
25. Referral Criteria:
Patients’ blood sugar not well under control and
having associated conditions like Macrovascular
complications like Ischemic heart disease,
microvascular complications like diabetic kidney
disease, retinopathy, neuropathy etc may be
referred to the next level.
26. LEVEL 3: HOSPITALS WITH INDOOR FACILITIES
LIKE
PANCHAKARMA, KSHARASUTRA ETC. AND HAVE
INTEGRATIVE FACILITIES
All patients referred from level 2 should be
treated at this level. All patients come
under Sthula Pramehi / Balavan / Kapha /
Pitta Pramehi and willing to undergo
Shodhana line
of management for better recovery should
be treated at this level. All patients of
Krisha Pramehi / Vata / Durbala should be
treated at this level. Patients having
HbA1c above 9 should be treated at this
level
27. Clinical Diagnosis:
Serum electrolytes
2. Blood urea and serum creatinine
3. Urine for Micro albumin
4. ECG
5. Fundus examination
28. Treatment:
In addition to the management of
Level 1 and Level -2, if needed
Panchakarma procedures can be
performed.
30. Oils
Condiments
Atasi (Linum usitatisimum),
Sarshapa (mustard).
Haridra (Turmeric), Maricha
(Pepper), Tvak (Cinnamon),
Lashuna (Garlic), Shunthi
(Ginger), Methika (Fenugreek),
Dhanyaka (Coriander), Jeeraka
(Cumin seeds)
Vihara: Ayurvedic texts suggest Long walks,
swimming, hard labor like pulling
carts, digging wells, serving animals
etc. All this involves muscular
activity, which will help in
maintaining muscle tone and
peripheral utilization of glucose.
Today, weight training exercises can
be done. Following norms should be
followed before or after exercise: