AETIO-PATHOGENESIS

&
MANAGEMENT OF MADHUMEHA
Dr. V.V.S.RAMA SASTRY
M.D(Ay)
PROFESSOR & HEAD
Post Graduate Dept. of Kaya Chikitsa
Dr.B.R.K.R.Govt.Ayu. College/Hospital,Hyderabad, A.P.

1. Graduate from GAC, Hyd and stood State First - Awarded STATE GOLD MEDAL
2. M.D. (Ay) from Osmania University 1983
3. Worked as Asst. Research Officer, CCRAS, Govt. of India.
4. Worked in Post Doctoral Dept. of Inorganic Chemistry at Nagarjuna University
5. Recipient of DHANWATARI AWARD for the year 2002
6. Founder member Faculty of Scientists of Ayurveda
7. Guided 75 Post graduate M.D.(Ay) Scholars
8. Associated with Research on Medical Palmistry
9. Visited many countries Viz. BELGIUM,HOLLAND,GERMANY,SWEDEN,DENMARK,
BRITAIN, LUXEMBURGE, FRANCE, SWITZERLAND, SPAIN,U.K. ITALY etc.,
and had interaction with many EUROPEAN MEDICAL ASSOCIATION MEMBERS.
 I. INTRODUCTION

1) Madhumeha, a disease seems to be as old as humanity.

2) The present day life style is the commonest cause.

3) 10% of the people in the World are suffering from this.

3) WHO reveals India is the Diabetic capital of the world

&
- Hyderabad is the Diabetic capital of India.

5) This is generally identified in routine investigations.

 II. DEFINITION OF PRAMEHA:-

Prakarshena
Prabhutam
Prachuram
Varam varam va Mehati / mutratyagam Karothi iti
pramehaha

i. Altered and excessive urine is secreted from the body

ii. The pathological changes in the body are severe.

iii. The above quotation enlights the depth of the

knowledge of our Acharyas about the disease.
 III. DEFINITION OF MADHUMEHA:-

Madhwiwa mehati madhumehaha

Madhumehi madhusamam jayate

i. Madhura rasa dominates as a component of urine

ii. The urine starts resembling Madhu.

iii. When unchecked at this stage, patient starts

yielding sweet smell and taste.
 IV. HISTORICAL IMPORTANCE:-

i. In Vedas, we find two terms i.e., Asrava & Prameha

ii. Asrava vyadhis include Nasa srava & Atimootra.

iii. Garuda purana described 20 types of Pramehas.

iv. References of Prameha are seen in all Samhitas

v. Bhela described 2 types of Pramehas

1) Prakruta prabhava
2) Swakruta prabhava
 V. INTERESTING INFORMATION:-

i. Alloxan An Uric aicd derivative used to induce

Diabetes in animals for experimentation.

ii. Koutilyas Arthasastra Ref. of - PARABALA VIGHATA

ADHIKARA (Diabetogenic technique observed)

Technique Soot (Carbon particles after burning)

obtained from household lizard with the intestines of a
mottled frog with honey, induces Prameha.
 VI. NIDANA :-

i. Ahara

ii. Vihara

iii. Abhighata

iv. Sahaja

v. Vitiation of Medodhatu
leads to Madhumeha (Su.Su.)
 i. AHARA :-
AHARA

1. ASYA SUKHAM 2. DADHI (MANDAKAM)

VIRUDDHA AHARA
(Incompatible foods)

Ratrou dadhi na bhunjeeta

Na kadalyah takrena / dadhna va
Sarvamcha amlam payasa saha virudham
Chakshusyopi godhumaha taila pakwasthu drushtiha
Pakwannam, vyanjanam, tailam, ghrutam,
punaha, ushneekrutam tyajeth
Sarvam phalam, patrasakam, akalajam, varjaneeyam

Incompatible foods concept of toxicity

 ii. VIHARA

1) Swapna sukham
2) Madya sevana
3) Over anxiety & over work
4) Bakthasya adou jalam peetam sthulatwam,
kaphakaram
5) Ingestion of food with inadequate intervals.
6) Indulging in sex / sleep with full belly etc.

Basavaraja 14th century Physician of Andhra Pradesh

observed the ill affect of alcohol in producing
Madhumeha.
 iii. ABHIGHATA

1. Direct trauma:- Siras, Kukshi, Vasti etc.

2. Indirect trauma:- Stress and other diseases etc.

iv.SAHAJA

1. Charaka, Susrutha and Bhela observed the

hereditary cause of Madhumeha.

All the pramehas not treated / improperly treated

lead to Madhumeha.
VII. SAMPRAPTHI
 VIII. POORVA ROOPA

i. The Pathological process in Prameha

is slow but continuous.
ii. Dhatus take a variable length of time,
to establish the clinical features of the disease.
iii. Clinical features vary in intensity from pt. to pt.
Some important are -
i. Ghanaanghata
ii. Sayyasana swapna sukham & Seeta priyatwam
iii. Aasya sosha
iv. Anga gandha, durgandha swasa
v. Jatilee bhavam keseshu
 IX. ROOPA

Important: Vagbhata paid much attention in

diagnosing the disease in his treatise (R.R.S) viz.,

1) Aswasthyam sarva gatreshu

2) Sosha
3) Taapo angah
4) Bahumootrata
5) Karshyam.
 Aswasthyam sarva Gatreshu (R.R.S. Vagbhata)

This is more supported by SUSRUTHA as follows-

a) Gamanath sthanam
b) Sthanath asanam
c) Asanath sayanam
d) Sayanath swapnam

THE ABOVE CONDITIONS PROMPT US TO UNDERSTAND

THEIR OBSERVATIONAL SUPREMACY.
However :-

a) Prabhuta mootrata
b) Avila mootrata
c) Madhviva mehati
d) Madhuryacha tanorataha,

These symptoms are seen, after

well establishment of the disease.
 X. BHEDAS
Pramehas are enumerated as 20.
Madhumeha was also included in them.
The Nomenclature used by our Acharyas appears to be
different based on the physical properties of urine.
Apart from the above, Dwandwaja Pramehas
are also seen in the text YOGARATNAKARA.

MADHUMEHA CLINICAL PRESENTATION

1) a) Sahaja (Beeja doshaja) - Hereditary

b) Doshaja (Apathya nimittaja) - Acquired
2) a) Sthula (Margavarodhaja) - Stout and hefty
b) Krisha (Dhatukshayaja) - Emaciated
SAHAJA - KRISHA APATHYA NIMITTAJA- STHULA

1. Krisha Sthula
2. Rukshatwa Snigdhatwa
3. Alpasi Bahwasi
4. Pipasabhisam Shayanaseela sukhi
5. Parisarana seelatha Swapnaseelatha
 XI. DIAGNOSIS

1) Subjective parameters:-
Symptomatology explained in the texts.

2) Objective parameters-
Investigational procedures:-
a) Taila bindu pariksha
b) Conventional modern investigations

Susrutacharya gave a direction:-

Swasastre kusalaha
Anyeshu sastraardheshu, Abahishkrutah
 XII. CHIKITSA
1) Shodhana
2) Shamana
3) Rasayana

1) Shodhana: Indicated in Sthula prameha only.

A conventional Virechana appears
to have more applicable value,
besides other shodhana therapies.
2) Shamana:
i) Herbal preparations
ii) Mineral preparations
iii) Herbo mineral preparations
1) Herbal preparations: Bhava prakasha Nighantu is screened
for Pramehahara drugs. Interestingly around 30 drugs are found:
1) Amalaki 2) Amrapushpam
3) Atibala 4) Bhurjapatra
5) Devadaru 6) Guggulu
7) Guduchi 8) Kampillaka
9) Katuki 10) Katphala
11) Karanjaphala 12) Karanja
13) Moorva 14) Manjishta
15) Maha nimba 16) Nimba
17) Suvarchala 18) Brahmi
19) Gojihwa 20) Haridra
21) Kakamachi 22) Meshashringi
23) Pippali 24) Pashanabheda
25) Sarjaka 26) Varahi kanda
27) Tinduka phala 28) Satavari swarasa
29) Palasapushpa with Ksheeram

Susrutacharyas exclusive contribution:-

1) Tuvaraka 2) Makshika 3) Shilajathu
2. Compound preparations: Important are:-

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 )
 3. Mineral Preparations

1) Shilajathu 2) Abhraka Bhasma

3) Vanga Bhasma 4) Naga Bhasma
5) Jasada Bhasma 6) Tamra Bhasma
7) Rajatha Bhasma 8) Swarnamakshika Bhasma
9) Tamra yoga: Vaktre sandharayeth Nisi Pramehaharam

10) Kaphari: Madhumeha mapi nihanti ashu (R.R.S)

 iii. HERBO MINERAL PREPARATIONS
Some important are :-
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)
6) Sarveswara rasa - Madhumehan su durjayam hanti (Bh. Ra.)
7) Dadimadi ghritam - Pramehan vimsati vividhan hanyath
na samsayaha (B.R)
8) Prameha mihira taila- Pramehan vimsatischaiva nasayeth
avikalpataha (B.R)
9) HARISHANKARA RAS - Pramehan vimsatim hanti
(Brihat) Satyam satyam na samsayah (RTSSPS)
 APPROACH UNIQUE PREPARATION UNIQUE

UMASHAMBHAVA RAS (Rasaratna Samuchaya)

Vagbhata gave much emphasis:-

1) on the age of the patients
&
2) Chronicity of the diseases

- Sisu age
- Upto 20 years Suggested in different doses
- 20 to 25 years with
- 25 to 30 years different Anupanas
- 30 & above

NOTE: THIS SHOWS THEIR MONUMENTAL APPROACH.

 MANAGEMENT OF PRAMEHA

We find different nomenclature in different texts with

special reference to its management in different modalities.
They are
INDEPENDENT INDICATIONS:- COLLECTIVE INDICATIONS:-

1)Prameha HARAM Sarvan pramehan -

2)Prameha NASHAM Vividhan pramehan
3)Prameha NUTH Nanavidhan pramehe-
4)Prameha JITH
5)Prameha HANTI JAYETH
6)Prameha NIVARTAYE Nasamsayah
7)Prameha KSHAYAM HANTI
 MANAGEMENT OF MADHUMEHA
(Different nomenclature with different modalities)

1. Madhumeha prasantha Kruth.

2. Madhumeham su durjayam hanti.
3. Madhumehamapi nihanti ashu.
4. Madhumeha nuth.
5. Madhumeha pranasini.
6. Madhumeha jit.
 3) RASAYANA
1) The Disturbance in formation and functioning of all dhatus
including OJUS is found.
2) Therefore Rasayana chikitsa is more required / advocated.
INTERESTING DEFINITION:
Dehasya indriya danthanam drudhikarana mevacha
Ya kriya tath Rasayanam ucchyate
(Haritha Samhita)
IMPORTANT RASAYANA PREPARATIONS:-
1. Triphala mastu
samyuktam kantam - Sarva Rasayanam (R.M)
2. Sapta vimsati guggulu - Rasayanam uttamam (G.N)
3. Loha Bhasma - Rasayana varam (R.R.S)
4. Lakshminarayana rasam - Rasayananam uttamam (Y.R)
5. Shalmali ghritam - Hanti dhatu kshayam (B.R)
6. Kaishora guggulu - Nityam upayukto Rasayanam (S.S)
7. Bahusala gudam - Rasayana varaschaiva Pramehan jayeth (G.N)
8. Kakamachi - Sadyah Rasayanam (B.P)
9. Babbularishta - Kshayam hanti (B.R.)
 XIII. PATHYA
AHARA
1) Yava 6) Chanaka
2) Palandu 7) Tikta saka
3) Purana dhanya 8) Purana kulutha
4) Takra 9) Bhojana madhye salila
5) Godhuma 10) Bhrumhana ahara (not medokara)

VIHARA
1) Vyayama
2) Padatra rahito munivartanah
3) Yojananam shatam yayat
4) Khaneth va salilasayaha
5) Gramaika ratram bhaikshwasee
Note: All the above indicates, the equal importance to diet & exercise besides medication.
 XIV. APATHYA

AHARA VIHARA

1. Dadhi Mandaka 1. Indiscriminate/excessive

2. Sura
3. Kshupaja maricha (Chillies)
4. Food substances prepared
out of wheat in association
with oil. This is more applicable
to patients suffering from
Diabetic Retinopathy.
exposure to cold & chill.
2. Exerting activity soon
after food.
3. Excessive indulgence in sex.
4. Indulgence in sex immediately
after food.
5. Intake of water at the end of
food.
 XV. SADHYA - ASADHYATA
i. Generally all the 20 types of Pramehas are said to be grave in nature.
ii. Sadhya asdhyata is made based on involvement of doshas.
iii. Madhumeha is Asadhya by nature.
iv. This can be only well managed.
v. Pidaka peeditam Gaadham pramehan hanti manavam (Su.Su.)
vi. INTERESTING:- When the urine of the patient is boiled and
evaporated, if the residue is
1/5th of the volume of the urine taken in Vataja,
1/7th of the volume of the urine taken in Pittaja,
1/9th of the volume of the urine taken in Kaphaja,
PRAMEHAS ARE INCURABLE. (BASAVA RAJEEYAM)
 XVI. UPADRAVAS

1) Trishna 2) Atisara
3) Jwara 4) Daha
5) Dourbalya 6) Arochaka
7) Pootimamsa (Gangrene) 8) Pidaka
9) Hruthshoola 10) Hrudgraha etc. (Su.Ni.)
 CONCLUSION

The disease Madhumeha (Diabetes Mellitus) though often stated to

be well studied and managed in Allopathy ..
In fact seems to be well studied and thoroughly understood
by Ayurveda.
Hopefully in near future it would become well managed in
Ayurveda by following Health education and awareness in the
patients.
The management of Madhumeha with useful remedies is the need
of the hour and indeed essential.

CENTURIES OLD / HOLD AYURVEDA, WOULD SOON APPEAR CENTURIES AHEAD

Thank you