Incidence in India compared to worldwide
The prevalence of diabetes in India is estimated to be 1-5%. Also, the number of diabetics is projected to rise from 15 million in 1995 to 57 million by the year 2025 making it the country with the highest number of diabetics in the world. The World Health Organization has estimated that a low income Indian family with a diabetic patient devotes 25% of the income to the care of that patient.
Ayurvedic Perspective of Diabetes mellitus
According to Ayurveda, the Indian system of medicine, mutrakrccha or dysuria, ashmari or renal calculus and prameha roga or polyuria are the major diseases mentioned under mutra vikara, described as diseases of the renal system.
The urine is filtered from the blood by the kidneys. Then the urine collects in the urinary bladder through the ureters and excreted out via the vital organs. In disease like mutrakrcca there is scarcity of urination where as in diseases like prameha or polyuria, there is increased urination or copious diuresis.
In the Ayurvedic system of medicine, meha roga defines the disease of the urinary system. Anything being excreted out in urine in abnormal fashion is indicator of meha roga.
When the normal functioning of the kidney is impaired, certain things are excreted out by the kidneys, which are normally required for physiological and nutritional aspects of the human body. Under the prevailing circumstances, urine acquires foul-smell and as a result there is increased frequency.
Following are the factors leading to prameha roga
- Sedentary- life style
- Hypersomnia or increased sleep
- Consumption of curd, flesh of goat and fish, milk, jaggery, fresh rain water and foods aggravating kapha, the biological water.
- Kapha prameha: Kapha, the biological water present in basti (urinary bladder) pollutes meda, mamsa and jala.
- Pitta prameha: Pitta (aggravated by consumption of hot foods) present in basti (urinary bladder) pollutes meda, mamsa and jala.
- Vata prameha: When kapha and pitta are scare, vata pollutes vasa, majja, ojasa and lasika and leads to vata prameha.
According to Ayurveda, like all diseases, the three biological humors viz; vata (the biological air), pitta (the biological air), and kapha (the biological water), are effected in prameha. In addition, there are ten dushya (body tissues) viz; meda (subcutaneous fat), rakat (blood), shukra (seminal fluid), jala (water), vasa (adipose tissue), lasika (lymphatic fluid), majja (bone-marrow), rasa (plasma), ojasa (immunity) and mamsa (flesh).
Purvarupa (Prodromal symptoms) of prameha
- Burning sensation in the extremities
- Coated tongue, palate, throat and teeth
- Sweet taste in the mouth
Common symptoms of prameha
- Contaminated urine
Signs and symptoms
Ayurvedic system of medicine considers twenty type of prameha roga. These are diagnosed on the basis of the color, taste, smell and organo-leptic resting of the urine.
It is of 10 types.
- Udakameha: Urine in this type is clear, comparatively increased, white, and cool, without any smell, picila and contaminated.
- Ikshumeha: Urine is sweet like sugarcane.
- Sandrameha: Urine when kept in a vessel becomes concentrated.
- Surameha: Urine like alcohol is clear at the top and concentrated at the bottom. This can be tested in a test tube.
- Pistameha: Urine is white and concentrated. There is sensation while voiding.
- Sukrameha: Here urine is mixed with seminal fluid.
- Siktameha: Urine is contaminated with sands particles.
- Sitameha: Urine is excessively sweet and cold.
- Lalameha: Urine is similar to saliva in appearance.
- Sarneyameha: Urination is slow.
Pitta prameha is of six types:
- Ksaramaeha: Here the colour, smell, taste is similar to lime water.
- Nilameha: The colour of the urine is blue.
- Kalameha: The colour of the urine is black or inky.
- Haridrameha: The colour of the urine is smile to turmeric.
- Manjistameha: The colour of the urine is yellow-red. It is smells foul.
- Rakatmeha: The urine is red coloured, foul-smelling and salt in taste.
Vata prameha is of four types:
- Vasameha: The urine contains fat globules.
- Majjameha: The urine contains marrow.
- Kaaudrameha: Urine is slightly astringent, sweet and ruksa.
- Hastimeha: There is involuntary passage of the urine.
All the types described above, if not cured properly, leads to madhumeha.
It was known to the Ayurvedic physicians for more than 2500 years ago as can be seen from medical tests such as Charaka and Sushruta Samhita. Caraka and Sushruta have mentioned madhumeha, a disease, in which a person passes urine resembling honey.
Charaka in Sutra Stahna 24 has indicated that madhumeha may be sometimes hereditary in nature. Apparently, the patient seems to be comfortable and as the time passes away, the disease tends to be chronic.
Ayurveda has mentioned two types of madhumeha:
- Caused by aggravated vata due to malnutrition.
- Caused by kapha and pitta in combination with vata.
As per Ayurvedic prognosis, the second one is difficult to cure.
Diabetes mellitus is a metabolic disorder characterized by two features:
- Elevated levels of glucose in the blood described as hyperglycemia,
- Detection of glucose in the urine described as glycosuria.
Pancreas is a glandular organ having dual function of exocrine as well as endocrine. The endocrinal part of the pancreas is constituted by group of cells (islet of Langerhans). The islets contain two types of cells, alpha and beta cells. alpha cells secrete glucagon, and beta cells secrete insulin.
Diabetes mellitus is observed in both obese as well as non-obese persons.
Glucose consumed in the food after the process of absorption reaches the liver. Insulin from the pancreas converts glucose into glycogen. If insulin is absent, glucose escapes in the blood circulation resulting in elevated levels (hyperglycemia).
- Fasting: Normal value of blood glucose on empty stomach is 80-120 mg/100 ml of blood (fasting) and
- Postprandial: After consuming meals 120-180 mg/100 ml of blood.
Diabetes mellitus is of two types:
- Insulin-dependent diabetes mellitus or juvenile or type-1
- Non-insulin dependent diabetes mellitus or maturity onset or type-2
Signs and symptoms:
A patient of diabetes mellitus may present with
- Excess of thirst (polydipsia),
- Excess of appetite (polyphagia),
- Excess of urination (polyuria),
- Weight gain or loss, and
- Ulcers refusing to heal (indolent ulcers).
- Antioxidants are gaining popularity in the treatment of diabetes mellitus. Shilajeet is the best drug for this purpose. One capsule, twice a day is highly recommended as a preventive therapy in the treatment of diabetes.
- Kino has been recently studied for anti-diabetic activity. 5 g of the powdered drug, twice a day is quiet efficacious in controlling symptoms of diabetes mellitus.
- Fenugreek is another effective remedy for reducing diabetic complications and elevated levels of blood lipids. One capsule thrice a day is recommended.
- Gumarbooti is described as best herb available for the treatment of diabetes mellitus. One teaspoonful of the powdered leaves is recommended for treating diabetes.
- Six teaspoonfuls (30 ml) of the juice of leaves of bitter-gourd have beneficial effect in diabetes.
Ayurvedic Research Studies
1. Nahi buti: A human study has reported efficacy of Enicostemma littorale in diabetes mellitus type-2 Pills prepared from Enicostemma littorale were administered to 84 patients with type 2-diabetes for 3 months. Estimation of various biochemical parameters showed that littorale reduced blood glucose as well as serum insulin levels and prevented the progression of complications in diabetic patients.
2. Vasant kusumakara rasa: A clinical evaluation of Vasant kusumakara rasa in complications of diabetes mellitus viz diabetic neuropathy and retinopathy has been done (Tamboli, 2001).
3. A study reported effect of Shilajit on glucose toelrance in rats (Gupta, 1966). Shilajit (50 & 100 mg/kg, p.o) had no discernible per se effect on blood glucose levels in normal rats but attenuated the hyperglycemic response of streptozotocin (Bhattacharya, 1995a).
Bhattacharya SK. Shilajit attenuates streptozotocin induced diabetes mellitus and decrease in pancreatic islet superoxide dismutase activity in rats. Phytotherapy Res 1995; 9: 41-4.
Chaturvedi B.N., Shastri, K.N. (1980). Charak Samhita. Commentary.
Gupta, K.R.L. (1997). Madhava Nidana: Ayurvedic System of Pathology. Eastern Book Corporation.
King, H., Aubert, R. E. and Herman, W. H., (1998). Global burden of diabetes (1995 -2025). Prevalence, numerical estimates and projections. Diabetes Care. 21: 1414 – 1431.
Lochan, K. (2003). Bhaisajya Ratnavali vol.1-3. Chaukhambha Orientalia, New Delhi.
Ryan, E. A., Pick, M. E. and Marceau, C. (2001). Use of alternative medicines in diabetes mellitus. Diabetes Medicine 18: 242 –245.
Tamboli S. A clinical evaluation of vasant kusumakara rasa in prameha upadrava with special reference to diabetic neuropathy and retinopathy. University of Mumbai, 2001.
Upadhay, U.M. et al., (2004), Efficacy of Enicostemma littorale in type 2 diabetic patients. Phytotherapy research: v. 18, no. 3 p. 233-235.
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