Author Archives: Dr. Vaidya Karanvir Singh

In Ayurveda Diabetes can be compared to Madhumeha, one of the types of Vataj Prameh because of the similarities in etiopathogenesis, clinical features and prognosis. 

Main causes of Madhumeha are lack of exercise, improper food habits, eating food which has properties like snigdha and guru in large amounts which vitiates Kapha dosha, the primal cause of Madhumeha disease.

To prevent the complication of the disease it is mandatory to follow Ayurveda principles like Nidan parivarjan, Asht ahar vidhivishesh ayatana, Dincharya, Ritucharya, Sadavritta and practicing Yoga and pranayama.

Ayurveda describes about 20 types of Pramehas, If not treated on time they can convert into Madhumeha and become incurable.

CAUSES

• Inactivity or sedentary lifestyle
• Excessive sleep
• Excessive use of yoghurt
• Consumption of sweet food in large amounts
• Meat soup of domestic, aquatic, marshy animals
• Psychological factors like worry, grief, anger, anxiety etc.
• All kapha aggravating food items

CLASSIFICATION

1. Doshika  classification

• Kaphaj 10 : Prediabetes and early stage of Type 2 DM
• Pittaj 6 : Acute stage of type 2 DM
• Vataj 4 : Advanced stage of type 2 DM, genetic/hereditary DM

2. Aetiological classification

• Sahaj(Hereditary, Patients of Type 1 DM)
• Apathyanimmitaj(Acquired, Prediabetes and patients of Type 2 DM)

3. Constitutional 

• Sthula (Associated with obesity) : Prediabetes and  DM with or without insulin resistance
• Krisha pramehi (Associated with weight loss, malnutrition or type 1 DM)

4. Prognostic 

• Sadhya (Curable, Kaphaj type)
• Yapya (Palliative, Pittaj type)
• Asadhya (Incurable, Vataj type)

SYMPTOMS

• Increased frequency of urine
• Increased appetite
• Excessive thirst
• Turbid urine
• Tiredness
• Weight loss
• Visual disturbances
• In elderly patients symptoms like anorexia, loss of motivation,failure to thrive and urinary incontinence

Diabetes tends to affect all dhatus of the body causing different symptoms

Rasa dhatu (plasma): hyperglycaemia
Rakta Dhatu (blood):  Deteriorated quality of the blood cells with increased viscosity
Mamsa dhatu (muscles): muscle wasting, necrosis
Medhas dhatu (fat): hypertrophy of adipose tissue(Obesity)
Asthi Dhatu (bone): De-mineralization of bone tissue, reduced density
Majja Dhatu (nervous tissue): Degeneration of brain tissue
Shukra Dhatu  : (reproductive tissue): loss of libido, transmission to next generation
Sira Dhatu (arteries): atherosclerosis
Tvak  (skin): necrosis, ulcers, carbuncles
Snayu (nerves): neuropathies

COMPLICATIONS

• Boils and carbuncles
• General debility
• Gangrene
• Retinopathy
• Cardiovascular disease
• Renal damage

AYURVEDA  MANAGEMENT OF MADHUMEHA

• Abstinence from causative factors(Nidan parivarjan) 

Lifestyle modification can reverse Prediabetes and check in further progression of type 2 DM.

Nidana that should be avoided :

• Any type of fermented material
• Excessive water intake
• High calorie diet
• Milk, oil, ghee
• Sugarcane and its products
• Newly cultivated grains
• Rice, potato, maida, deep fried food, red meat
• Soups and meat of aquatic animals
• Sedentary lifestyle
• Lack of exercise or physical activity
• Excess sleeping

Diet and lifestyle (DO,S)

• Yava is considered as the best diet of Pramehi.  
• Shali and shashtik chawal(old rice)
• Pulses like Chana, Adhaki, Mudga, and kulatha are advised
• Diet should be taken keeping the agni(Digestive fire) in mind
• Fresh vegetables, fruits like methika, jamun, Apple, pear, orange
• Bitter and astringent food, bitter gourd
• Protein rich diet like, chickpeas, moong, masoor, lentils, soyabean
• Regular exercise : Brisk walking, swimming, biking, low impact aerobics

Mental  Relaxation :  Meditative asanas like Shavasana, sidhasana, Padasana, Vajrasana are good for mental relaxation. 

Pranayamas like Brahmri pranayama, alternate breathing helps cal down the mind, reduces stress and anxiety.

Yoga Asanas for madhumeha ; Asanas increase peripheral utilization of glucose by improving insulin sensitivity at target level. Some of the asanas are

• Mayr asana (Peacock pose)
• Bhujang asana (Cobra pose)
• Gomukhasana(Cow face pose)
• Halasana  (Plow pose)
• Pashchimottanasana ( Seated forward bend)

AUSHADHI

Pharmacological approach is only advised to those in which lifestyle modification fails or is not sustainable and great high risk of developing type 2 DM

A lot of bitter astringent, pungent property herbal and herbo mineral drugs are used in Prameh patients like Nisha, Amalaki, Nimba, pippali

1. Promotion of Agni Status( Metabolism promotion) : Drugs having deepan pachan properties such as Shunthi, pippali, marich, chitrak
2. Promotion of ojas status (Promoting immune system) : Drugs like Nisha, Amalaki, Guduchi, Shilajeet.

Few formulation and herbs used in Madhumeh are :

• Vasant kusumakar rasa
• Triphala churan
• Trivang bhasm
• Nimbpatra svaras
• Guduchi swaras
• Aloe vera and aloe barbadensis : Leaf extract of aloe vera

In Ayurveda cancer can be  co related with ARBUDA. Signs and symptoms of pre and post cancerous stages can be observed under different conditions like Gulma (Cystic growth), Apachi (Benign growth), Gandmala (Lymphatic growth) etc. Vitiated Doshas afflict Rakta, medo and mamsa dhatus and cause Arbuda. Pathogenesis in ayurveda is explained on the bases of tridoshas. Agni or pitta that resides in each and every cell of the body is responsible for digestion and metabolism on cellular level. Diminished or decreased Agni is inversely proportional to the related issue and therefore in Arbuda decreased state of Dhatwagni will cause excessive growth of the tissue.

ETIOLOGY OF ARBUDA

Ayurveda says there is no disease without imbalance of Doshas. Cancer develops due to metabolic crisis like aggravation of vata and suppression of kapha. Both the doshas interact with each other and and dhatus and causes the cells of our body to proliferate. All the doshas  and dhatu involved in Arbuda and their vitiating factors are as follows

• Vata :  Excess intake of Tikta(bitter), katu(pungent), kashaya(astringent), ruksha(dry and rough foods). Excess worrying or stress
• Pitta :  Excessive intake of Amla(Sour), katu(pungent), lavan(salty) diet, Vidahi(fried, spicy food), krodh(anger), Tobacco consumption or smoking, continuous contact with chemical or mechanical irritants(Sunlight, radiation)
• Kapha :   Excessive intake of sweet, sour, salty and oily diet, Sedentary lifestyle
• Rakta :  Excessive intake of fast food, sour and hot diet
• Mamsa :  Excessive intake of mamsa(red meat in perticular), irregular eating habits, injury to the body parts
• Meda :  Excessive intake of oily, sweet diet, Sedentary lifestyle, excessive Alcohol consumption. 

TYPES OF ARBUDA

1. Vataj arbuda
2. Pittaj arbuda
3. Kaphaj arbuda
4. Medo arbuda
5. Mamsaj Arbuda
6. Raktaj arbuda
7. Sthanarbuda(Agantuj sthan rog, eg.  breast cancer)
8. Karnarbud (Cauliflower ear)
9. Nasarbuda
10. Oshtharbuda
11. Jiwharbuda

TYPES ON THE BASIS OF PROGNOSIS

• SADHYA (curable or benign) :  It mostly consists of cysts, benign tumours, chronic inflammatory swellings. Though over a time period Sadhya arbuda may become asadhya i.e. it can spread from one place to other which can be called as metastatic stage.

• ASADHYA (incurable or malignant) :  Most Raktaj, mamsaj and tridoshaj Arbuda  occuring in ear, nose, throat. Adhyarbuda and Dvirarbuda are two stages of arbuda that can be corelated with metastatic stage.

Some features of Asadhya Arbuda explained in Ayurveda are :

• Raises or rolled edges
• Multiple firm, fleshy masses resembling cauliflower with various types of discharges.
• Some generalized symptoms like Anorexia, chronic cough, cachexia suggesting the spread to other places (Metastasis)

SIGN  AND  SYMPTOMS

GENERAL : Appearance of round, immobile, deep rooted, large and fast growing unripe swelling.

SPECIFIC :

• Vataj Arbuda : Black colour, rough, cutting, churning type sharp pain

• Pittaj Arbuda : Reddish yellow colour, hot and burning sensation, necrotic, pricking pain.

• Kaphaj Arbuda : Slow growing, stony hard and cold, less painful, severe  itching
• Medoj arbuda : Tumour increases and decreases with body weight, smooth, large, itchy and painless swelling.
• Raktaj Arbuda : Polyp  like appearance, spreads quickly and increases in size quickly and severe bleeding may be there.
• Mamsaj Arbuda : Skin coloured, immobile,painless, stony hard, glistening swelling.

GENERAL LINE OF TREATMENT

• Shodhan chickitsa (Panchkarma procedures) 
• Dhatwagni chikitsa (Correction of metabolic defects)
• Rasayana prayoga (Immunotherapy)
• Vyadhipratyanika chikitsa ( Anti cancerous drugs)
• Lakshanika chikitsa ( Symptomatic treatment)
• Shastra chikitsa and agnikarma (Surgical treatments and cauterisation)

TREATMENT OF VATAJ ARBUDA

1. 1. Mild sudation : Powder of Kushmanda(Benincasa hispida), narikela(Cocos nucifera), priyala (Buchnania lanzan), eranda(Ricinis communis) beej along with ghee or  milk is made into paste and applied over the Arbuda as Upnaha swed or poultice
   2. Application of swabs dipped in medicated oil that is treated with herbs having bitter property.

• Bloodletting with shringi.

TREATMENT OF PITTAJ ARBUDA

1. 1. Mild sudation (Dravya sweda)
   2. Upnaha swed(poultice) with the drugs of Kakolyadi gana
   3. Scraping with the leaves of Teak
   4. Application of medicated paste of Aragwadha(Cassia fistula), Gojiwha(Onosma bracteatum), Trivrit(Operculina turpatham)
   5. Mridu virechana (mild purgation)
   6. Udumbar and Shakhotak patra lepan

• Visravan 

TREATMENT OF KAPHAJ ARBUDA

1. Vaman(Emesis)
2. Virechana(Purgation)
3. Raktamokshana(Blood letting)
4. Kshar prayog(Application of alkali), Cautery, Surgery(if needed)

TREATMENT OF MEDOJ ARBUDA

1. Swedan followed by surgical excision.  Haridra, Lodhra, Manashila are made into powder and applied externally by mixing with honey. 
2. After surgical removal of tumour, doshas are removed from the body with emesis and purgation. For the postoperative care, oil cooked with Premna herbacea, Embelia ribes, Cissampelos pareira can also be applied.

SINGLE DRUGS IN CANCER  TREATMENT

1. AMLA(Emblics officinalis) : Its called Ayurveda superfood. It is one of the richest source of vitamin C. Also contains quercetin, gallic acid, tannins, flavonoids, pectins and various polyphenolic compounds, making it the best rejuvenating or Rasayana herb. It kills and prevents the growth  cancer cells without harming the healthy ones.
2. GARLIC :  It contains sulphur, flavonoids, argentine and selenium. It is known for its antibacterial  properties and ability to stop the formation and activation of cancer cells. One adult should consume 2-5grams or one bulb of garlic.
3. TURMERIC : It is anti oxidant, analgesic, anti inflammatory. Curcumin component of turmeric is potent anti oxidant scavenging free radicals and inhibiting the growth of cancer cells.
4. ASHWAGANDHA (Withania somnifera) : It helps the body deal with stress. Withaferin A is a crystalline steroidal compound present in it which has anti cancer properties. Its leaf extract possesses the same properties.
5. HOLY BASIL (Tulasi) : It is immunity booster, fights stress, anti inflammatory, analgesic. Phytochemicals present in Tulasi prevents chemically induced lung, liver, oral, and skin cancers by increasing anti oxidant activities, altering gene expressions and killing cancer cells and preventing the metastasis.

ROLE OF YOGA ASANAS AND PRANAYA IN CANCER TREATENT

• Lower fatigue
• Reduces stress :   Battling a life threatening disease is physically, emotionally and mentally exhausting so yoga and meditation can help with this aspect of cancer.  
• Better sleep
• Improves physical functioning

Few asanas are : 

• ARDH MATSYENDRASANA( seated spinal twist)  helps with digestion and nausea.
• VIPARIT KARANI MUDRA (Legs up the wall) helps with fatigue
• SUPT BADHA KONASANA(Reclined cobbler’s pose)  also helps with fatigue and relaxes and cals down the body and mind.
• SEATED  MEDITATION
• ALTERNATE  BREATHING or Pranayam in sukhasana. 

The features of Bronchial Asthma can be compared to Tamak shwasa  explaindes in Ayurveda.

Shwasa is a major clinical condition according to Ayurveda and it has classes and subclasses. There are five types of Shwasa roga, Maha svasa  Urdhava svasa  chinna shwasa Tamak shwasa  Kshudra  shwasa. Among these five first three are incurabe, Tamak shwasa is difficult to cure but is controllable(Yapya roga). Kshudra shwasa is curable.

ETIOPATHOGENESIS OF ASTHMA

It originates at the site of Pitta(in the stomach) with simultaneous aggravation of Kapha and vata. 

Kledak kapha accumulates and moves to the lungs. Kapha has properties like cold, slimy, unctuous, heavy and vata is cold dry rough and mobile in nature. These two intermix in lungs and and mucous present in the lungs becomes sticky, thick and it adheres to the walls of bronchi and narrows the bronchial tubes which leads to episodes of breathlessness or Asthma attack.

Charak Samhita says ” If vata predominantly associated with Kapha obstructs the circulation channels and moves in all directions in the body then this obstructed vata causes Shwasa.

Ashtang Hridyam has similar concept as Charaka. It says “Vata is obstructed in its movement by kapha and it spreads in all directions, vitiates the Pranavaha srotas(Channels of respiration), Udakvaha srotas(channels of water), Annavaha srotas(Channels of food), located in our chest and causes Shwasa, arising from stomach”

FACTORS AGGRAVATING  KAPHA AND VATA

Environmental factors are listed but most of the factors involved are due to lifestyle and dietary habits that aggravates vata and kapha.

• Exposure to dust, smoke, wind(airborne pollens)
• Residing in cold places
• Exercise or walk beyond one’s own capacity
• Stress that may be induced by exercise
• Improper food combining and habitual eating of unhealthy food leading to Vitiated metabolism(causing Agnimandya and Ama)
• Constipation associated with flatulence
• Intake of food in deficient or excessive quantity
• Excess fasting or excess eating and agitated digestion resulting from it.
• Dryness in Respiratory tract(particularly lower) and upper GIT due to non unctuous food.
• Trauma to throat, chest and vital organs

SYMPTOMS

PRODROMAL :

• Pain in the heart region and flanks
• Upward movement of Prana (Respiration)
• Flatulence
• Splitting pain in the temples

VATAJ  ASTHMA SYMPTOMS  PRESENTATION 

• • Dryness, cough and wheezing
  • Dry mouth and skin
  • Thirst
  • Constipation
  • Anxiety
  • Craving warm drinks

• Aggravation of the condition or episodes  occur at dawn and dusk (Vata times)

PITTAJ  ASTHMA  SYMPTOM PRESENTATION

• • Wheezing
  • Coughing with yellow Phlegm
  • Fever may be there
  • Sweating and need for cold air
  • Irritability

• Attacks occur during Pitta times, Noon and midnight

KAPHAJ  ASTHMA  SYMPTOMS  PRESENTATION

• • Wheezing and coughing with abundant white or clear phlegm(mucous)
  • Instead of wheezing there will be a Railing sound produced by fluid in the lungs

• Attacks occur during Kapha times of the day, Morning and Evenings.

LINE  OF TREATMENT  OF  ASTHAMA

Avoidance of triggering factors, improving quality of life with minimum medication is the aim of Astma management.

NIDAN  PARIVARJAN(Avoidance of triggering factors)  : Causative factor,  Exposure to allergen or factor causing recurrent exacerbation should be avoided.  For example

• Oily greasy fried food.
• Cold and refrigerated food and drinks
• Excessive physical exercise or other activities
• Smoking (Active and passive) 
• Heavy foods like milk, cheese, banana

SHODHAN CHIKITSA : It is purification process which eliminates vitiated doshas from the body. It includes  

• Snehan : Massaging body with Til oil mixed with saindhav lavan, specifically on chest and back region.
• Swedana
• Vaman
• Virechan(Purgation) : Ayurveda says “Tamke tu virechanam”. Virechana is best in Tamak shwasa(Bronchial Asthama).  Kutaki(picrorhiza kurroa ) 1-3gm with honey in Asthma and Bronchitis is given twice daily for virechana.
• Dhumpana : Chandan, Guggulu, Haridradi, Lehsunadi dhumpana

SHAMAN CHIKITSA : People who are too weak to be given Shodhan therapy are given Shaman chikitsa.  It includes internal medication that pacifies doshas, are Vatanuloak, ushna, have deepan pachan properties, Some ayurveda Shaman drugs and formulations are as follows 

CAC Cough Go Tablets : It is a herbo mineral preparation and helps in balancing Kapha dosha. It shows effective results in  all respiratory diseases along with seasonal allergies and bronchial asthma.

It has ingredients :

1. Sonth (Zingiber officinale)
2. Mulethi (Glycyrrhiza glabra)
3. Pippali(Piper longum)
4. Kali mirch(Piper nigrum)
5. Abhrak bhasm
6. Tankan bhasm
7. Lakshmivilas rasa

These ingredients are Anti inflammatory, Anti oxidant, immuno modulator, Bronchodialator, Expectorant.

Other than Bronchial asthma it is useful in Chronic cough, whooping cough, common cold, Bronchitis.

DOSAGE  : One tablet(650mg) twice a day with normal water.

SHWASKUTHAR RASA  :  It is an broncho dialator, expectorant, antioxidant.

 Useful in cough, breathlessness, restlessness, chronic bronchitis, Indigestion.

DOSE : 125-250mg, once or twice daily, with honey or water

Few other formulations used in Asthma are : Sitopaladi churan, Talisadi churana, Kantakari avleha, vasa haritaki leha, vyoshadi vati, Dashmool kwath.

SINGLE  DRUGS IN ASTHMA

• Powder of Talisa(Abies wabbiana) mixed with juice of leaves of VASA(Adhatoda vasica) should be used in cough caused by kapha and pitta
• Juice of Vasa leaves should be taken with honey in cough caused by Kapha and pitta and intrinsic haemorrhage
• In dry cough Vasa juice cooked Haridra (Curcuma longa) with fatty layer of milk
• Cold infusion(Phanta) of Vasa checks cough, fever and intrinsic haemorrhage
• Powder of Agaru(Aquilaria agalocha) mixed with honey is taken
• Shunthi(Zingiber officinale), Pippali(Piper longum), and Amalaki(Emblica officinalis) with honey
• Powdered seed of Timir(Eleusine aegyptiaca) and Karkatsringi(Pistacia integerria) mixed with ghee and honey
• Ghee cooked with double quantity of decoction of Sariva(Hemidesmus indicus)
• Decoction of Nirgundi, Guduchi, Haritaki, Marich in equal parts with salt

APATHYA

• Heavy foods like cheese, rice, sugar,lentils, curd, buttermilk, paneer
•  Masha, Tila, Sarshap(Brassica niagra), beans, Tubers like Potato
• Buffalo milk and ghee
• Fruits like Guava, Banana, Watermelon, Papaya 

PATHYA

• Garlic, Spinach, Brinjal, Grapes, Indian Gooseberry, Goat milk, Honey
• fruits like figs, dry grapes(raisins), pomegranate, fruits full of vitamin C such as oranges, strawberries, blueberries
• Maintain a gap of atleast  1hour between eating and sleeping.

YOGA  AND PRANAYAMA

These yoga asanas can relieve asthma symptoms by opening chest muscles

• Bridge pose
• Cobra pose
• Seated spinal twist

Breathing exercises relives stress and helps with the shortness of breath in asthma

• Alternate nostril breathing
• Victorious breathing or Ujjayi Pranayaa.