SWASTHA ARANA

According to WHO Statics DM (Diabetes Mellitus) is one of the leading Noncommunicable diseases (NCDs) in the world today. There are millions of peoples dyeing annually from DM.  DM has very old records. In Ayurveda it has unique classification and methodology for describe to DM.  “madumeha” is the term used in ayurvedic medicine to describe diabetes mellitus. In Ayurveda (2500 BC) of the vedic literature (the oldest literature in the world), diabetic mellitus is mentioned as “Aasttravam”, meaning excessive urination (polyuria).

The earliest documentation regarding the etiology, symptomatology, pathology, prognosis, and principles of treatment and management of madumeha is found in the Charaka Samhita written around 1200years BC and the Sushruta Samhita written around 10 BC by Sushruta, an Indian Ayurvedic physician and surgeon. In his treatise, Sushruta grouped the 20 different disease of urine referred to in the Dharaka as “Pramehas”(the term prameha refers to anomalies of urine excretion), based upon the color of urine and the dosha”s involved, into three main groups referred to as:

1. Vataja –  includes 4 pramehas
2. Pittaja – includes 6 pramehas
3. Kaphaja – includes 10 pramehas

  “Madumeha”(Sushruta also referred to it as Kshudrameha because urine in this condition resembles honey) is included in the vataja prameha group: the other pramehas included in this group are Vasameha, Majjameha(Sarpihmeha) and Hastimeha. Based on the content of Charaka and Sushruta Samhitas, Wagbhatta(Between the 2^nd and 3^rd century AD) compiled two other Samhita titled “Ashtanga Sangraha” and “Ashtanga Hridaya”. Details descriptions of Madumeha are found in the Ashtanga Hridaya. According to Wagbhatta, all pramehas when untreated get converted in to Madumeha.

Classification

In Ayurveda Samhitas diabetis mellitus has been classified according to:

• Etiology(causes)
• Body constitution(sthula or krisha)
• Predominance of doshas(vataja, pittaja or kaphaja)
• Sadhyasadhyatwa – curable or incurable(prognosis)

According to etiology, Sushruta has described two types of diabetes as follows:

1.       Sahaja prameha – congenital or inherited from parents. (Insulin dependent diabetes mellitus, according to the modern classification) Patients are characterized by emaciation and dryness of the body, diminished capacity of eating, excessive thirst and restlessness.

 2.       Apathyanimittaja prameha – Acquired diabetes mellitus. (Non insulin dependent or maturity onset diabetes mellitus, according to modern classification) Patients in this group are obese, pursue sedentary habits and gluttons. In his treatise, Sushruta states “it may be prognosticated that an idle man who indulges in day sleep or follows sedentary pursuits or is in the habit of taking sweet liquids or cold and fattening foods, will ere long fall an easy victim to this disease”.

Symptoms of diabetes mellitus according to Ayurveda

 Prodromal symptoms or purvarupa (signs and symptoms that appear earlier than the actual disease)

 According to the Charaka and Sushruta Samhita, the following prodromal symptoms may be observed in individuals at risk developing diabetes mellitus:

• Matting of hair
• Sweetness of mouth
• Numbness and burning sensation in hands and feet and other body parts
• Dryness in mouth, palate and throat
• Thirst
• Lassitude
• Heaviness of body
• Slimy mucous deposits on tongue, palate, pharynx and teeth
• Crawling of bees or ants on the body and urine
• Turbidity of urine
• Fleshy smell in body
• Frequent sleep or drowsiness
• Symptoms of Madumeha or Rupa(Lakshana)
• Increased quantity and sweetness of urine
• Madhviva meha (urine resembles honey)
• Madhuryascha tanorath (increased sweetness of whole body)
• Pipasadhikyata (thirst)
• Kshudhahaikyata (polyphagia)
• Alasyata (lassitude)
• Maladhikyata (accumulation of malas)

Complications of Madumeha

According to ancient Samhitas, uncontrolled diabetes may experience some or all of the following complications:

Diarrhea, Fever, Tiredness weakness due to excessive loss of body tissues (Shosha), Burning sensation in hands and feet, Anorexia, Indigestion, Boils, carbuncles, pustules, abscesses etc, Urine infections, Obesity, Looseness of limbs, Loss of appetite, Epileptic fits, Insomnia, Numbness of body, Constipation, Expectoration of mucous (cough), Vomiting, Labored breadth, Oppressive feeling at the heart (Hridagraha), Abdominal pain (Udara shoola), Mental apathy and confusion,

 Treatment

Two main principles of treatment followed in Ayurveda are:

1.  Sanshodana and apatarpana chikitsa (Purification and de-saturation therapy)
2. Sanshamana and santarpana chikitsa (pacification and saturation therapy)

 The former one is applied in Sthula and Balawan Madumeha (obese and strong patients) while the latter is applied in the case of Krisha and Durbal Maudmeha (lean and weak patients). Dietary control, exercise and yogasanam are recommended along with drug therapy. In insulin dependent diabetics, the primitive and pacificatory therapies recommended in ayurveda samhita, may benefit patients if administered along with modern hypoglycaemic remedies.

 The earlier known advice for the treatment of diabetes comes from the Ebers papyrus (16^th century BC) which recommends wheat grains and ochre- the original high fibre diet. Particular teas were favoured by the ancient Chinese while the Indian subcontinent used a variety of herbs, spices and other plant treatments believed to benefits the diabetes condition. Sushruta recommended several remedies including the intake of aqueous extracts of some medicinal plants for the control of non-insulin dependent diabetes. Wagbhatta, in his treatise recommended some new herbs and herbal compounds (rasa aushada) for the treatment of Madumeha. Culpepper mentions Myrrtis odarata (sweet cicely) and subsequent herbal treatise from Europe have described many purportedly antidiabetic plants. Although the use of plant based medicines has now almost completely disappeared in occidental societies, a dependence on these native forms of therapy continues in developing regions of the world.

 According to Ayurveda, when selecting medicinal drugs for the treatment of Madumeha, the following principles have to be taken into consideration.

• Rasa (taste) – the medicine should have tikta (bitter), katu (pungent) and kashaya (astringent) taste.
• Guna (attributes) – they should have attributes like rasa (mild laxative), shoshaka (bulk reducer) and chhedana (purifier).
• Virya (potency) – the ushna virya (active potency) against Madumeha.
•  Vipaka (the taste of the drug after digestion) against Madumeha.
• Prabhava (specific potency) – medicine should have specific potency against glycosuria (mutra madhuryata) and hyperglycaemia (sharir madhuryata).

Still DM has been threading the whole world. Unfortunately every answer today we have not the perfect answers for DM. The bitter truth is still it present as non Curable disease list. Only think we could is re think about our complex life style and arrange the proper and healthy precautionary behaviors to protect.