1. This document discusses Prameha (diabetes) from an Ayurvedic perspective. It defines Prameha as a condition characterized by the excessive and frequent passing of urine that is sweet and sticky. 2. The causes of Prameha are described as vitiation of the three doshas (Vata, Pitta, Kapha) due to unhealthy lifestyle factors like excessive sleep, indulgence, and diet. The document outlines different types of Prameha classified by the color, smell, and characteristics of the urine. 3. Treatment principles focus on pacifying the aggravated doshas and eliminating toxic substances (ama) from the body. P

1. Prameh
Dr .Shital Patil .
Assistant Professor
M.D.(Ayu), M.A.(Sanskrit)
ADAMC, ASHTA

2. Present era -
• Full of stress & strain due to life style
modifications
• Change in dietary habits
• Urbanization
• Industrialization

3. Nidan
• तत्रेमे त्रयो निदािाददविशेषा: स्लेष्मनिममत्तािाां
प्रमेहाणाश्चामिनििृवत्तकरा ििन्तत; तद्यथा
हायिकयिकचीिकोद्दालकिैषधेत्कटमुकु तदमहाब्रीदहप्र
मोदकसुगतधकािाां ििािामनतिेलमनतप्रमाणेि
चोपयोग;तथा सवपिष्मताां ििहरेणुमाषसुप्यािाां,
ग्राम्यािूपौद्कािाां च
माांसािाांशाकनतलपललवपष्टातिपायसकृ शराविलेवप्ुविका
राणाां
्ीरििमद्यमतदकदधधद्रिमधुरतरूणप्रयाणाांचोपयोग;
मृजाव्यायामिजििां स्िप्िशयिासिप्रसांग॥ च.नि.

4. निदाि-
आस्यासुखां स्िप्िसुखां दधधनि ग्राम्यौदकािुपरसा: पयाांमस
ििातिांपािां गुड्िैकृ तां च प्रमेहहेतु: कफकृ च्च सििम॥ च.
धच.

6. प्रमेह
प्रकषेण प्रिूतां प्रचुरां िारांिारां िा मेहनत मुत्रत्याग
करोनत यन्स्मि रोगे स प्रमेह:॥

7. सांप्रान्प्त-
मेदश्च माांसां च शरीरजां च क्लेदां कफोबन्स्तगत:
प्रदुष्य:।
करोनत मेहाि समुदीर्णमुिष्णैस्तािेि वपत्तां परीदुष्य चावप
॥
्ीणेषु दोषेष्ििकृ ष्य धातुि सांदुष्य
प्रमेहािकु रूतेÅनिलश्च।
च.धच६/६
दुष्य-
कफ: सवपत्त: पििश्च दोषा मेदोÅस्रुशुक्राम्बुिसालमसका।
मज्जारसौज: वपमशतां च दुष्या: प्रमेदहणाां विांशनतरेिमेहा:॥
च.धच ६/८

10. िेद

13. Udakameha
Transparent
Abundant
White
Cold
Odourless
Waterlike.

14. Ikshuvalikarasameha
Excessively sweat,
Cold,
Slightly slimy,
Turbid,
Like the juice of
Ikshuvalika

15. Sandrameha
when urine kept for
the night precipitates
in the pot.

16. Shuklameha
Excretes urine
frequently as white and
flour like

17. Sikata meha
one who passes
small particles situated
morbidity
in urine.

18. Alal meha
Urine as bound with
threads. Saliva like, slimy

20. Ksharameha
Urine like alkali in
respect of smell, color,
taste & touch.

21. Raktameha
Urine has fleshy smell,
saline taste, hot & red
in colour.

22. Manjishtha meha
Urine resembles
the decoction of manjista
& having fleshy smell.

23. Haridrameha
Urine like decoction of
haridra has pungent
taste.

25. पुििरूप-
स्िेदोÅग्डगतध: मशधथलातडता च शय्यासि
स्िप्िसुखेरनतश्च।
ह्र्नतिेत्रन्जव्हाश्रिणोपदेहो घिातडता के शिखानतिृन्दद:॥
शीतवप्रयत्िां गलतालुशोषो माधुयिमास्ये करपाददाह:।
िविष्यतो मेहगदस्य रूपां मुत्रेÅमिधािन्तत वपपीमलकाश्च॥
च.धच.६/६

26. रूप-
सामातयां ल्णां तेषाां प्रिुताविलमूत्रता।
दोषदुष्यविशेषेÅवप तत्सांयोगविशेषत:॥
मुत्रिणािददिेदेि िेदो मेहेषु कल्पप्यते ।
मा. नि.३३/६

27. ्ौद्रमेह/मधुमेह-
सििएिप्रमेहास्तु कालेिाप्रनतकाररण:।
मधुमेहत्िमायान्तत तदाÅसादया ििनत दह॥
सुश्रुत
कालेिोपेक्ष्ता: सिे यद्यान्तत मधुमेहताम।
मधुरां यच्च मेहेषु प्रयोमन्दिि मेहनत॥
सिेÅवप मधुमेहाख्या माधुयािच्च तिोरत:॥
अ. ह्र्न.नि.३३/२६

28. सादयासादयता-
सादया:कफोत्था दश वपत्तजा:षडयाप्या ि सादय:
पििाचतुष्क:॥
समक्रक्रयत्िान्व्दषमक्रक्रयत्िातमहात्ययत्िाच्च यथाक्रमां
ते॥
च.धच.६/७

29. 1. In Kaphaja pramehas the vitiated dosa and dusyas have similar
attributes drugs prescribed in this condition allievate both dosa and
dusya,easily curable.
2. In Pittaja pramehas the vitiated dosa and dusyas have different
attributes ,so there is difficulty in managing the disease,it is said to
be Yapya{manageable} Pittajapramēhas are generally Yāpya, but, if
Mēdas is not affected much they become Sādhya.
3. In Vataja pramehas the vitiated dusya is deeper dhatus i.e majja,
ojas. many complications and serious in nature.so Asadhya.
Patient who suffers with Pramēha right from the time of birth and
those who are born of parents having Pramēha(hereditary) are not
curable because of the morbidity in their bīja.

31. DIABETES
 Diabetes is a common life-long health condition.
 Diabetes is a condition where the amount of glucose in your blood
is too high because the body cannot use it properly.
 This is because your pancreas doesn’t produce any insulin, or
not enough
insulin, to help glucose enter your body’s cells – or the insulin that is
produced does not work properly (known as insulin resistance).
 As of 2013, 382 million people have diabetes worldwide. Type 2
makes up
about 90% of the cases
 In 2014, the International Diabetes Federation (IDF) estimated
that diabetes resulted in 4.9 million deaths.
 TheWorld Health Organization (WHO) estimated that diabetes
resulted in 1.5 million deaths in 2012, making it the 8th leading cause
of death.

32. CLASSIFICATION
1. TYPE 1 DIABETES MELLITUS
2. TYPE 2 DIABETES MELLITUS
3. GESTATIONAL DIABETES
4. OTHER SPECIFIC TYPES
 MODY {MATURITY ONSET DIABETES OF THE
YOUNG}
 LADA {LATENT AUTOIMMUNE DIABETES OF
ADULT}
 NEONATAL DIABETES MELLITUS[NDM]
5 WOLFRAM SYNDROME
6 ALSTROM SYNDROME

33. Type I -{IDDM,JUVENILE DIABESTES}
It occurs when the individuals own immune
system acts against pancreatic β-cell and
destroys it.
Causes- beta cell loss, severe insulin
secretary deficiency, genetic,
immunogenic
c/f- age below 20 yrs,
osmotic symptoms i.e. wt loss
dehydration,

35. • Type II-{NIDDM}
It is a disorder of metabolism of carbohydrate ,
protein and fat due to absolute or relative
deficiency of insulin secretion and with varying
degree of insulin resistance.
• Age 35-65 yrs
• Often obese
• Slow insidious

37. What is Insulin?
• Insulin is a hormone secreted by pancreatic
beta cells. It works as a chemical messenger
that helps your body use the glucose in your
blood to give you energy.
• You can think of it as the key that unlocks
the door to the body’s cells. Once the door
is unlocked, glucose can enter the cells
where it is used as fuel.

39. GESTATIONAL DIABETES {GDM}
• Gestational diabetes is a type of diabetes
that affects pregnant women, usually
during the second or third trimester.

40. MODY –
• MODY is a rare form of diabetes which is
different from both Type 1 and Type 2
diabetes, and runs strongly in families.
• MODY is caused by a mutation (or change) in
a single gene. If a parent has this gene
mutation, any child they have, has a 50%
chance of inheriting it from them. If a child
does inherit the mutation they will generally go
on to develop
• MODY before they’re 25, whatever their
weight, lifestyle, ethnic group etc.

41. LADA
• Latent autoimmune diabetes of adults is a
form of type 1 diabetes that occurs in
adults, often with a slower course of onset.
Adults with LADA may initially be
diagnosed as type 2 based on their age.

42. NEONATAL DIABETES
MELLITUS
• Neonatal diabetes is a form of diabetes that
is diagnosed under the age of
6months.change in gene affects insulin
production.It is different type of diabetes than
the more common type 1 as its not an
autoimmune and type 1 doesn’t affect anyone
under 6months.
• a) Transient neonatal diabetes
mellitus(TNDM)
• b) Permanent neonatal diabetes
mellitus(PNDM)

43. WOLFRAM SYNDROME
• Wolfram Syndrome is a rare genetic
disorder which is also known as -
DIDMOAD syndrome after its four most
common features (Diabetes Insipidus,
Diabetes Mellitus, Optic Atrophy and
Deafness).

44. ALSTROM SYNDROME
• Alström Syndrome is a rare genetically
inherited syndrome which has a number
of features-Retinal degeneration,Type
2DM, Hearing loss, Cardiomyopathy,
Renal (kidney) failure, Orthopaedic and
rheumatology problems

45. Clinical features• Unexplained weight loss
• Polyuria(increased urination)
• Polydipsia (increased thirst)
• Polyphagia(increased hunger)
• Fatigue
• Slow healing of cuts
• Ketosis [Type 1]
• Prolonged high blood glucose can cause glucose absorption in the lens of the eye,
which
• leads to changes in its shape, resulting in vision changes.
• A number of skin rashes that can occur in diabetes are collectively known as
diabetic
• dermadromes.
• Symptoms may develop rapidly (weeks or months) in type 1 diabetes, while they
usually
• develop much more slowly and may be subtle or absent in type 2 diabetes

46. diabetes
Endocrine gland physiological
response
Hormone (1)
Target cell permeability,
lypolysis
ATP
adenyl cyclase(2)
Cyclic AMP enzyme

47. Causes-
1. Prereceptor defect
2. Receptor defect
3. Postreceptor defect
4. Effector defect

48. INSULIN SECRETION• Glucose from blood stream enters into beta
• cell by GLUT2(transporter) mechanism.
• 2. Glucose gets converted into pyruvic acid
• and then undergoes citric acid cycle
• &oxidative phosphorylation.
• 3. End product ATP is obtained.
• 4. Due to ATP formation ATP sensitive
• potassium channels gets closed.
• 5. Membrane depolarization occurs,by that
• voltage gated calcium channels are opened.
• 6. Influx of calcium takes place.
• 7. These calcium triggers the storage granules
• and by exocytosis insulin,c-peptide,amylin
• very little amount of proinsulin is released
• into the blood stream.

49. GLP-1,GIP
etc
secreted
Stimulate
Gstimulatory
protein in
βcell
Stimulate
Adenylyl
cyclase
Conversion
of ATP
into cAMP
cAMP
also leads to
release of
insulin
Intake of
food
Insulin

50. Management
• Lifestyle monitoring
• Oral hypoglycemics
• Insulin
• Surgery

51. Life style monitoring
Diet
 Physical activity
Stress management

52. ORAL HYPOGLYCEMIC
• Insulin secretogogues
SR NO. Category GENERIC NAME
1 SULFONYLUREALS GLYMEPIRIDE,GL
YBURIDE
2 MEGLITINIDE REPAGLINIDE

53. INSULIN
• Insulin is usually given subcutaneously, either by injections or by an
insulin pump.
• They are rapid acting insulins, intermediate acting insulins and long
acting insulins.
• Overdose of insulin causes insulin shock-low blood
sugar,weakness,convulsions,coma.
• Insulin shock therapy or insulin coma therapy[ICT] was a form of
psychiatric treatment in which patients were repeatedly injected large
doses to produce daily comas,each coma lasts upto an hour and
terminated by intravenous glucose.
• Inhalable insulin is available in 1mg and 3mg,should be given 10min before
meal faster than regular insulin. Contraindicated in smokers, pulmonary
disorders.

54. Surgery
• Bariatric surgery (weight loss surgery) includes a variety of
procedures performed on people who have obesity. Weight loss is
achieved by reducing the size of the stomach
• Long-term studies show the procedures cause significant long-term loss of
weight, recovery from diabetes, improvement in cardiovascular risk factors
• A pancreas transplant is occasionally considered for people with type 1
diabetes who have severe complications of their disease.
• Vertical banded gastroplasty,Sleeve gastrectomy,Gastric bypass
surgery are some of the techniques.
Surgery improves type 2 diabetes in nearly 90 percent of patients by:
• a) Lowering blood sugar
• b) Reducing the dosage and type of medication required
• c) Improving diabetes-related health problems
• Many are able to maintain normal blood sugar levels with little or no
medications
• following surgery.
• Islet cell transplantation will be soon available to persons having TYPE 1.

55. Diabetic 6.5%
Prediabetic 5.7-6.5%
Normal 5.7%

56. Diagnosis & Investigations
• Diagnosis of diabetes is determined through A1C levels, fasting blood
glucose levels, oral glucose tolerance tests
• Criteria for diagnosis of diabetes are:
• A1C levels greater than or equal to 6.5%.
• Fasting blood glucose levels greater than or equal to 126 mg/dL.
• Blood glucose levels greater than or equal to 200 mg/dL following an
oral glucose tolerance test[GTT]
• Random blood glucose levels greater than or equal to 200 mg/dL.
• Glycated hemoglobin (A1C) test: This blood test indicates your average
blood sugar level for the past two to three months. It measures the
percentage of blood sugar attached to haemoglobin. The higher your
blood sugar levels, the more hemoglobin you'll have with sugar attached.
Diabetic 6.5%
• Prediabetic 5.7-6.5%
• Normal 5.7%

57. • Random blood sugar test:
• Diabetic 200mg/dl {11.1 mmol/L}
• Fasting blood sugar test:
• A blood sample will be taken after an overnight fast
• Normal 100mg/dl {5.6mmol/L}
• Prediabetic 100-125mg/dl {5.6 to 6.9 mmol/L}
• Diabetic 126mg/dl {7mmol/L} on two separate tests.
• Oral glucose tolerance test:
• For this test,person fast overnight, and the fasting blood sugar
level is measured.
• Then glucose is given, and blood sugar levels are tested
periodically for the next two hours,
• Normal 140mg/dl
• Diabetes 200mg/dl
• Prediabetic 140 to 200mg/dl
• In type 1
• DM urine is tested for the presence of ketone [ketonuria].
• Presence of autoantibodies are tested.

58. Complications
• 1. Microangiopathy-
• Diabetic nephropathy,
neuropathy and
retinopathy comes under
this category
• 2.Macroangiopathy-
• Cerebrovascular disease,
Peripheral vascular
disease and
Coronary artery disease
comes under this
category.

59. Complications
• Life threatening complications of diabetes-
• 1DKA { Diabetic keto-acidosis
• HYPEROSMOLAR HYPERGLYCEMIC
NONKETOTIC SYNDROME {HHNS}
• HYPOGLYCEMIA

60. Chikitsa
स्थुल: प्रमेदह बलिानिहैक: कृ शस्थतैक:पररदुबिलश्च॥
सांबृहणां तत्र कृ शस्य कायि सांशोधिां दोषबलाधधकस्य॥
च.धच.६/१५
न्स्िग्धस्य योगा विविधा: प्रयोज्या: कल्पपोपददष्टा मलशोधिाय।
उदिि तथाÅधश्च मलेÅपिीते मेहेषु सततपिणमेि कायिम॥१६

61. गुल्पम: ्यो मेहिबन्स्त शुलां मुत्रग्रहश्चाप्यपतपिणेि।
प्रमेदहण: स्यु: पररतपिणानि कायािणण तस्य
प्रसमीक्ष्यिन्र्णहम॥१७
ततश्च जाांगलरसै: क्रमेण सांतपियेत। अत्यपतपििेि दह
प्रमेदहणो विशेषेण
मुत्रकृ च्छबन्स्तमेढ्र्शुलांगुल्पमानतकाश्यिभ्रमादमाददिाां सांम्िि:॥
अष्टाांग सांग्रह

62. अष्टाांग ह्रद्य-
मेदहिो बमलि: कु यािदादौ िमिविरेचिे:।
न्स्िग्धस्य सषिपाररष्टनिकु म्िा् करांजजै॥
तैलेत्रत्रकर्णटकाद्येि यथास्िां साधधतेि िा।
स्िेहेि मुस्तादेिाहुिागरप्रनतिापित॥
सुरसादद कषायेण दद्यादास्थापिां तत:॥
तयग्रोधादेस्तु वपत्ताति रसै शुददां च तपियेत॥
मुत्रग्रह रूजागुल्पम्याद्यास्त्िपतपिणात
ततोÅिुबतधर्ाथि शमिानि प्रयोजयेत॥१२/१-४

63. PATHYA-APATHYA• Patya- [Ca.ci.6:46-50]
• Āhāra
• Yavaudāna
• Sarodakam
• Kusodakam
• Triphala rasa
• Madhudakam
• Sidhu
• Barley soaked in the decoction of Triphala and kept overnight should be mixed
• with honey.
• Vihāra:
• Different types of Exercises, bath , Application of ointment made of uśīra,Tvak,
Ēla,
• Aguru, Candana etc.

64. Su.ci.
11/5
 Apatya
 Sauvīraka
 Tuṣōdaka
 Śukta
 Mairēya
 Surā
 Āsava
 Pānaka
 Ikṣuvikāra
 Piṣṭānna
 Āmlapadārta
 Anūpaudakamāṁsa

65. बन्स्त धचक्रकत्सा-
 मुस्तादद यापि बन्स्त (च.मस.१२)
 माधुतैमलक बन्स्त (अ.ह्र्न.क४)
 पांचनतक्त निरूह (च.मस.)
 प्रमेहहर आस्थापि बन्स्त(सु.धच.१२)

66. शमि योग-
कफज
 दारूहररद्रा+देिदारू+ त्रत्रफला+ मुस्ता= समप्रमाण
 आमलकी स्िरस+हररद्रा चुणि+मधु
 हररतक्रक+कटफल+मुस्ता+लोध्र
 पाठा+विडांग+अजुिि
 हररद्रा व्दय+तगर+विडांग+खददर सार
 पाठा+मुिाि+गो्ुर

67. वपत्तज-
 उशीर+लोध्र+चतदि
 उशीर+मुस्ता+आमलकी+हररतकी
 निम्ब+अजुिि+निशा+उत्पल(कमल)
फलत्रत्रकाददक्िाथ-
त्रत्रफला+दारूहररद्रा+विशाला(इतद्रायण)+मुस्ता+हररद्रा कल्पक

68. एलादद चुणि-
एला +पाषाणिेद + वपप्पली + मशलाजतु = १ तोला प्रमाण
मात्रा -१ माश
सुिणिमाक्ष्कयोग-
सुिणिमाक्ष्क िस्म + िाििा सालसारादद गण = मात्र १ रत्ती

69. पांचािि रस-
शु.पारद+शु.गतधक+लोहिस्म + अभ्रमादक िस्म+
(१तोला)+न्व्दगुण(८तोला) िांग िस्म+मधु= २० प्रमेह, १३
मुत्रघात,अश्मरी, मुत्रकृ च्र
प्रमेह धचततामनिरस:-
रसमसांधुर+ अभ्रमादकिस्म+ िांगिस्म+सुिणििस्म+लोहिस्म+मुक्ता िस्म+
प्रिाळिस्म+ स्िणिमा्ीक िस्म= २० प्रमेह, १३ मुत्रघात,अश्मरी,
मुत्रकृ च्र

70. योग-
िांगेश्िर रस, तारके श्िर रस
मेहकु लाांतक, चांद्रप्रिा, िसांतसुकु मार शुक्रमात्रुका िटी,
मशलाजत्िादद िदट, देिदारू अररष्ट लोध्रासि मदिासि,
िल्पलातकासि, दतत्यासि, त्रत्रकां टकाद्या घृत त्रत्रफला घृत

71. • Kaṣāya
• Pramēhī-niśā katakādi kaṣāya
• Palāśapuṣpa kaṣāya
• Ghr̥ tam
• Pancatiktaka guggulu ghr̥ tam
• Svadamstrādi ghr̥ tam
• Chūrṇas
• Pr̥ thu nimba pancaka cūrṇa
• Nimbādi cūrṇa
• Vyōṣādi cūrṇa
• Aśvagandhādi cūrṇa
• Kalyāṇa kṣāra cūrṇa

72. • Asava Arista
• • Daśamūlariṣṭa
• • Aśōkāriṣṭa
• • Dārvāriṣṭa
• • Uśīrāsava
• • Śatāvari guḍa
• Lehyam
• • Daśamūla harītakī lēhya
• • Daśamūlādi lēhya
• • Madhusnūhi rasāyana
• • Agastya rasāyana
• Vaṭi
• • Abhaya mōdaka
• • Kaiśōra guggulu
• • Nīlakanṭa ras
• • Bahumūtrāntaka ras

73. Vishesh yogas
• Udakamēha :Pārijāta
• Ikśuvālikamēha:Vaijayanti
• Sāndramēha :Saptaparna
• Surāmēha :Nimba
• Piṣṭamēha:Haridra, Dāruharidra
• Śukramēha :Dūrva, Śaivala,
• Plava, Haṭha, Karanja,
• Kaśēruka/Kākubha, Candana
• Phēnamēha :āragvadha,Mr̥Dvīk
• Śanairmēha :Khadira
• Lavaṇamēha:PāṭhaAguruHaridra
• Sikatamēha:Citraka
• Nīlamēha :SālasarādiGaṇa
• Hāridramēha :Rājavr̥ Kṣa
• Āmlamēha
:NyagrōdhādiGaṇa
• Kṣāramēha :Triphalā
• Manjiṣṭamēha:Manjiśṭa,Can
da
• na
• Śōnitamēha :Guḍūci, seeds
• of Tindūka, Kaśmarya,
• Kharjūra
• added with honey

74. Vishesha yogas
• Sarpimēha :Kalka of Kuṣṭa,Kuṭaja, Pāṭha,
Hingu,Kaṭukarōhini added withGuḍūci & Citraka
Kaṣāyās
• Vasāmēha:Agnimantha/Simśapa
• Kṣaudramēha:Kadara,Kramuka
• Hastimēha :Tindūka,Kapittha,Sirīṣa, Palāśa,Pāṭha,
Mūrva,Duhsparśa added with honeyand
sugar/jiggery and ash of bones of elephant, horse,
boar, donkey and camel

75. मशलाजतु रसायि-
सुिाविताां सारजलैस्तुलाां पीत्िा शीलोभ्दद्िात साराम्बुिैि िुांज्जाि: शालीि
जाांगलजै रसै:॥
सिाििमिमेहाि सुबहुपद्रिािवप।
गतडमालाÅबुिदग्रन्तथस्थौल्पय कु ष्ठिगांदराि।
कृ ममश्लीपद शोफाांश्च परां चैिाद्रसायिम॥
!

76. निधिि प्रमेदह धचक्रकत्सा-
अधिश्चत्रपादत्ररदहतो मुनिितिि:।
योजिािाां शतां यायात्खिेत्िा समललाशयाि॥
गोशकृ तमुत्रिृवत्तिाि गोमिरेि सह भ्रमादमेत॥