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Madhumeha niyantrana By

Ayurveda
Dr Jayalaxmi.M.Nagur MD(Ayu) ( PhD ) ,
Asst. Professor
Dept. of RS and BK, SSAMC,Naubad, Bidar,
Karnataka.
Content

• Introduction .
• Correlation .
• Nidana , Purva rupa, Rupa.
• Samprapti.
• Chikitsa.
• Research findings.
• Acknowledgement .
Reference :

Madhumeha –Prameha nidana


and
chikitsa adhyaya- Brahatrayi.

Correlation -DM
Introduction

• Madhumeaha –madhuvat-i.e. kashaya madhura


ruksha bhava of mutra.

• Madhurata---- presence of glucose in urine.

• Pratyatma lakshana -Prabhuta avila mutrata-


increased frequency and turbidity of urine.
Correlation

• Diabetes mellitus is a clinical syndrome characterized


by hyperglycemia.

• Where there is combination of resistance to the


actions of insulin in the liver and muscle together
with impaired functions of pancreatic beta cell
leading to absolute or relative deficiency of insulin .
Nidana
Aharaja:
Vidhi vipareeta sevana
• Guru, snigdha, pichila,sheetala dravya .
• Madhura amla lavana rasa padartha.
• Nava dhanya,ikshu,guda,gorasa.
• Sura ,anupa desha –mamsa ahara.

Kapha krut cha sarvam.


( Cha. Sam & AH).
Contd…

Viharaja:
Asyasukha, swaapnasukha.
cha.sam.
Eka sthana asana, vidhi rahita shayana.
A.H.
Manasika - kshobha, dukha .
Purva rupa

Frequently observed:
Pipasa, Mutra dosha, Madhuryam asyasya.
Others:
• Kara pada daha.
• Mukha talu kantha shosha.
• Tandra ,saada ,nidra sarvakalam.
• Mutre pipalika abhidavanti.
• Kesha nakha vridhi/jatilata.
Samanya lakshana
Prabhuta -avila mutrata.
Excessive and turbid/dirty urine-polyuria .
Upadrava:
Trushna, atisara, jwara , daha,daurbalya, avipaka,
pidaka, alaji, vidradi etc.
Contd…

In modern science: Triad recognized with


increased frequency.

• Neuropathy.
• Retinopathy.
• Nephropathy.
Contd……
Others include-
Samprapti

Nidana
Ama Tridosha

Ama+Tridosha+Medas
Vitiates other dushyas Mutra marga anusarana

PRAMEHA
Contd…

ओज: पुनर्मधुरस्वभावं तद् यदा रौक्षाद्वायु : |


कषायत्वेनाभभसंसृज्य र्ूत्रशये अभभवहभत ||
Cha.sam.
Rukshata of vata
Madhura
Dushita vata Imparts kashaya
swabhavaja oja dharma in ojus

Mutramarga
Madhumeha
anusarana
Contd…

Nidana panchaka helps in prevention - before


manifestation of disease or avoids further progression
after onset of disease.
Contd…

• As explained earlier, ahara vihara, manasika nidana


leads to madhumeha.
• Everything is due to disturbance in the agnivyapara/
metabolism abnormality.
• Concept –insulin – remains untouched ,but concept
of agni –includes –all enzymes/harmones responsible
for metabolism.
Contd…

Therefore the verse which explains

“Hitahitam sukham dukham……..”


cha.su.1.

Should be understood properly.


Eg:
Guru, snigdha, madhura ahara
and drava annapana.
i.e. Rich or heavy diet/ rich protein
diet decreases fat use and dietinduced
thermogenesis.
Rich diet aided with sweetened
drinks(coco and north dish) further
decreases fat use and diet induced
thermogenesis.
Sura/alchohol:
Decreases body fat burning
ability by 73%.

Excess alchohol-forms
acetaldehyde .

Metabolism works hard to


detoxify it rather burning
calories.
Contd…

Diwaswpa /swapna sukha /


Alasya/Ekasthanasana.

Decreased metabolic activity.

Elevated fat store and glucose


level.
.
Contd….

Present trend of food habits.


Refined foods:
The Metabolism becomes
more active and work hard for
breaking down the nutrients and
ends up in excess sugar and fat
store.
Contd…

Yoghurt-
Less protein in body ends up in
breaking down muscles to
access the nutrients .

less muscle mass and disturbs


the metabolism.
Contd…

Restorant fried food: Gives guilty pleasure


Fried in trans fats/partial hydrogenated oil
Leads to abdominal obesity and weight
gain.

Frozen meals:
Loaded with sodium , hydrogenated oil
etc and packed tray with BPA ends up in
weight gain ,disturbed metabolism.
Contd…

Farmed Beef:

Alters the bacterial flora


of gut leads to disturbed
digestion.
Stress
Acute:

feeding suppression.

HPA AXIS .

CRH release anorexigenic effects.


Contd…

Chronic stress over consumption

Increased visceral adiposity and weight gain.

It may be due to chronic release of Glucocorticoids


and neuropeptides.
Contd…

Due to indulgence in nidana –whenever patient


approaches :

Differentiate with raktapitta .


Diagnose- madhumeha.
And categories it.
Contd…

1)According to vyadhi bheda.

• Adibala Pravrutta--genetically influenced :


Pumsavana and sadvritta palana.

• Janmabala Pravrutta-rasakruta –pregnant ladies


habits-juvenile diabetes : Pathya ahara,vihara.
Contd…

• Doshabala Pravrutta- amsahaya and pakwashaya


samutha.
Agni vyaishamya - normalize the agni .

• Sanghatabala Pravrutta-external – injury instrumental


/ animal—viral DM—krimija?.
Contd…

• Kalabala Pravrutha-seasonal variations –agni


vaishamya.

• Daivabala Pravrutta - external factors - sudden /


communicated bacterial/ infectious origin—treat
accordingly.

• Swabhavabala Pravrutta -untime schedule—


gestational - samskrita ahara vihara.
Contd…

2)Sahaja:
• Mata pitru beeja doshakrit.
Generally such patient will be krusha, alpa ahara
ashini, bhramana sheela : samskrita ahara vihara.
• Apathya nimittaja:
Due to ahita ahara vihara , just opposite to sahaja
madhumeha : pathya ahara sevana.
Contd…

3) If a person passes excess and turbid urine:


• Dhatu kshayaja-vata.
• Over nourishment –kapha.

4)Sthoola –balavan—samshodhana- after samshodhana


santarpna/rasayana.
• Krusha-paridurbala-sa bruhmanam.
According to Gender?

Streenam prameha na bhavanti iti,


tatha |
Rajah prasekam narinam masi masi
vishudhyati…
sarva shareera doshascha||
Dalhana ||(esrogen-
protein anabolism)..
Contd…

• Research findings suggest that girls with youth-onset


diabetes may need the additional intervention above
and beyond their diabetes treatment to improve their
menstrual health.( medical press endocrine society-
2018).
• Long periods-type 2 diabetes.
(ncbi.nlm.nih.gov/pmc/articles)
Contd ….

• Among women with oligomenorrhea before diagnosis


of diabetes, the frequency of type 2 diabetes was
significantly higher in obese subjects than in their
non-obese counterparts.
• Several studies have reported an increased prevalence
of amenorrhea and other menstrual irregularities in
diabetic women.
Contd…

• Insulin resistance and hyperinsulinemia are also


associated with having an irregular menstrual cycle.
• The mechanism of insulin action on the ovaries leads
to hyperinsulinemia resulting in excessive androgen
production, leading to menstrual cycle disturbances
and decreased fertility rates(DMJ journal).
Contd…

• Patient may visit first ayush centre without any aid of


modern drugs or with treatment of modern medicine
like oral hypoglycemic drugs, insulin etc.
• Concept of treatment should encircle around to
achieve near normal metabolism and closer glucose
control kept normal.
Contd…

Through some modifications in


Diet and life style:
Ahara : Morning after yoga, prarthana and snana
according to agni bala.
Eg;
Java, godhuma, shastikashali, kulatha, mudga, chanaka,
adhaki-tuvar, sarshapa taila, atasi taila, jangala mamsa,
meda rahita mamsa.
Contd…

Shaka:
Patola, methi, karavella etc aided with maricha,
saindhava, hingu etc.

Fruits :
Jambu, dadima, kapittha, amlaki etc.
Contd..

Ratri– after food :


• Padagamana,
• Light dhyana –yoga.
• Once a week apatarpana-12 hrs
with light diet at night.
.
Contd…

Mantra/nada:
• Biswal Raga –morning.
• Vrindavani saranga—
noon.
• Raga bhimpalase on
sitar- evening.
Chikitsa

• Mantha/kashaya prepared of yava and other light


veggies.
• Yavodana-cooked barley without unctuousness.
• Saktu –corn floor apupa (pan cake) –mixed with meat
soups of jangala mamsa, truna dhanya along with
guda.
Herbs

• Kashaya—Daru haridra,
triphala ,musta, kusta, guduchi
with honey.
• Amalaki rasa with haridra.
• Khadira and kramuka kashaya.
• Medicated oil/ghee-with above
drugs---corrects aggravated
medas, kapha, aggravated vata.
Minerals

• Shilajatu
• Swarna makshika, Abhraka bhasma with tulasi
churna/ haridra churna/ trikatu churna.
• Trivanga bhasma, Swarna vanga, Vangasindoora,
Vangeshwara rasa.
• Vasanta kusumakara rasa,chandraprbha vati etc.
Preparations
• Khadira ,puga kwatha.
• Asava-Madhvasava, dantyasava, bhallataka asava.
• Arista -Devadarvyarista etc.
• Leha-kushavaleha , vangavaleha, shaalasaradi leha.
• Ghrita-Dadimadya, shalmali, dhanwantaram etc.
Discussion

Differentiate hita ahita in all aspect.

Follow :
Ruksha udwartana gaadham vyayama nishi jagara |
Yaschanya shleshmapittaghnam bahirantanscha
taddhitam||
Bhai.ra.
.
Contd….

Vyayam jata akhilam ….padatra chatra rahita


yojannan shatam gachhet..
Vane vaapi nivaara amalakashana …||
Bhai.Ra.
Contd..

One can adopt


• Diet containing onion,
garlic, bilva, biitter
guard, methi etc.
• Practise yoga dhyana as
possible.
• Vajrasana after food.
• Listen to classical music.
• Be optimistic in nature
Researches in Ayurveda w.s.r. Madhumeha

Swarna makshika bhasma , Abhraka bhasma, trivanga,


Vanga bhasma with madhu in experimental studies-15
days shown marked decrease in glucose level (Ayu
Journal).
Contd…

Diabetic neuropathy:
Vasanta kusumakara rasa – BF - twice - 12 weeks –
reduced pain, burning sensation, numbness, tingling
sensation.
Contd…

Diabetic retinopathy:
• Deepana,pachana,mrudu virechana, takra dhara,
rasayana yoga and pratimarsha nasya with durvadi
ghrita -3 months.
• Improvement in near vision and visual acuity in both
eyes.
• Opthalmoscopy revealed reduction in exudates and
haemorraghe,reduction in HbA1C 10.3-7.4.
Contd….

Diabetic nephropathy:
Shiljitwadi gutika, punarnava mandoora,
triphala gugulu, pippali mooladi paneeya-clinical
study-48 days, proved-significant improvement
in microalbuminuria and GFR.
Contd…

Nephro toxicity:
Vanga sindoora –experimental study in gentamicin
induced nephrotoxity-10days.
Fig showing comparative average values of urea .
Fig showing comparative average values of
Creatinine .
Control group Standard group

Histo Pathological studies


Test1 and Test 2 groups

Histo Pathological studies


Conclusion :

As its said :
Shleshma mutra sanjanah sarva sa nidana
visheshah|
Bahu drava shleshma dosha visheshah||
Bahu baddha medo mamsa cha shareeraja kledah
shukram shonitam cha vasa majja lasika rasaschojah
sankhyatah iti dushya vishesha||
Su sam.
Contd…

Its all due to agni vaishamya. Therefore its explained as

Etavaupadravkarau visheshad agni marutau, medaya


ateeva samvrudhhe sahaseva aniladayah|
Vikaran darunan krutva nashayanti ashu jeevitam||
. cha.sam
Contd…

Management of madhumeha encircles around the


Concept:

Guru cha atarpanam shreshtam sthulanam


karshanam prati|
Krushanam bruhmnrtha cha laghu santarpanam
cha yat||
Cha.sam.
Contd…

That’s why it said :

Shama prakopau doshanam sarvesham agni


samshritau|
Tasmat agni sada rakshayet nidanani cha varjayet||
cha.sam.
Acknowledgement

• Principal and Staff of Sri Sidharmeshara


Ayurveda Medical College and hospital,
Naubad ,Bidar.
• District Ayush centre,Bidar.