DIABETES (MADHUMEHA) AND ITS AYURVEDIC MANAGEMENT

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