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MADHUMEHA (DIABETES
MELLITUS)
Dr. Rajtilak Tiwari M.D. ( Kayachikitsa)
Assistant Professor in Kayachikitsa dept. in
Shivshakti lal sharma Ayurvedic College Ratlam
(M.P.)
INTRODUCTION
• Prameha is one among the eight Maharoga
(disorders needing serious concern) and
explained as most important among Anushangi
Roga (chronic disorders) manifested as polyuria
with turbidity in urine occurs due to vitiation of
Kapha Dosha and Meda Dhatu. Madhumeha the
commonest clinical presentation of Prameha can
be compared to Diabetes Mellitus. All such diet
and life style factors which increase Kapha, Meda
and Kleda, contribute in the pathogenesis of
Madhumeha
Prameha can be classified into two as Sthula Pramehi or
Apathya Nimittaja Pramehi with clinical features of
obesity along with excessive frequency of urination. In the
second variety, Vata may be dominantly involved, and
such patients are lean and termed as Krisha Pramehi.
Further Prameha can be further classified into Kapha
Prameha, Pitta Prameha and Vata Prameha according
Dosha involvement. Kapha Prameha is Sadhya (curable),
Pitta Parmeha is Yapya (manageable) and Vata Prameha
is Asadhya (incurable).
Case Definition:
 Excessive urination which may be
associated with excessive thirst and
hunger, lethargy, numbness or burning
sensation in the extremities, calf muscle
cramps or sudden loss of weight with
raised blood sugar levels
(BSL).
General Diagnostic criteria
• Increased frequency of urine
• 2. Turbidity in urine
• 3. Excessive thirst & hunger
• 4. Lethargy
• 5. FBS >125 mg/dl and (or) PPBS >200 mg/dl1
• Along with, any 2 or more of the following symptoms:
• a. Like cool surroundings (Subjective)
• b. Sweetness in mouth (Subjective)
• c. Burning / Numbness in palms & soles (Subjective)
• d. Ants noted in the toilet (Subjective)
• Sthula Pramehi: General Diagnostic
criteria + BMI > 25
• Krisha Pramehi: General Diagnostic
criteria + BMI < 18
• Kapha Pramehi: General Diagnostic
criteria + BMI > 25 with some of the
following features
• • Recent onset of Diabetes (< 2 years)
• • Take excessive sweets and high calorie diet
• • Bulk eating habit
• • Indigestion, predominant upper GIT
symptoms and recurrent Upper Respiratory
Tract symptoms
Pitta Pramehi: General Diagnostic criteria + BMI
>18 and <25 with some of the following features
• Medium onset of Diabetes (2-6 years)
• Use of excessive spicy and salty diet
• Moderate eating habit
• Acidity predominant, upper GIT symptoms and
recurrent Urinary Tract Infections
Vata Pramehi: General Diagnostic criteria + BMI <
18 with some of the following features
• Chronic onset of Diabetes (> 6 years)
Use of dry low nutritional diet
• Less eating habit
Differential Diagnosis:
 Sthoulya
 • Mutratisara
LEVEL 1: AT SOLO AYURVEDA
PHYSICIAN CLINIC/PHC
• Clinical Diagnosis:
• On the basis of history and clinical
presentation patient can be diagnosed
provisionally as with subtypes as Sthula /
Krisha and Doshik variety Kapha/ Pitta/
Vata. Patients diagnosed as Sthula /
Kapha / Pitta and having at least
moderate physical strength and blood
sugar level as follows may be treated at
this level.
• • FBS >110 upto 180
• • PPBS > 200 upto 280
Investigation:
 Blood-sugar level
 • Urine- sugar
Treatment:
 In the initial stage when the patient is
having mild raised blood sugar levels and
not associated with major complications,
along with diet restriction, two or more of
following drugs may be given
 as in table 11.1:
Table 11.1: Medicines at level 1 for
Madhumeha
Drugs Dose
form
Dose Time of
administr
ation
Dosh
specificat
ion
Anupan
Vijayasara
di Kwatha
Decoction
10-15 ML
Before
meal /
twice a
day
Kapha /
Pitta
-
Phalatrikad
i
Kwatha1
Decoction 10-15 ml Before
meal /
twice daily
Kapha /
Pitta
-
Kathakakh
adiradi
Decoction 10-15 Ml Before
meal/twice
a days
Kapha -
Nisha
Katakadi
Kashaya
Decoction 10-15 ml Before
meal/twic
e a days
pitta -
Nisha-
Amalaki
powder 6 gm After meal
/twice a
days
Irrespectiv
e of Dosha
With water
Mamajjaka
Ghana Vati
Vati
2-3 Tab Before
meal
/thrice a
days
- With water
Sapta
Rgangyadi
Vati3
Vati 2-3 Tab Before
meal
/thrice
adays
- With water
With water
Triphala
5
Powder
/ Tab
3-6 gm /
2-3 Tab
Before
meal /
thrice a
day
-
With
warm
water
Chart Showing various diet Useful
in Prameha
Type of Diet
Name
Cereals Yava (Barley) (Hordeum vulgare), godh£ma (wheat),
kodrava (grain variety –Paspolum scrobiculatum) udd¡laka
(according to dhanvantari Nighantu forest variety of
k°drava), Kangu (Seteria italica), Madhulika (Elusine
coracana), Shyamaka (Echinochloea frumentacea),
Jurnahva (Sorghum vulgare), Vajranna (Pennisatum
typhoides), Purana shali (old rice),.
Pulses Adhaki (red gram-Cajamus cajan), kulattha (horse gram)
and mudga (green gram), Masura (Lentils), Makushtha
(Moth Bean/Acpnite bean), Chanaka (Cicer arietinum)
should be taken with bitter and astringent leafy
vegetables.
Pathya - Apathya (Diet and life
style education):
• Do’s-
• • Ahara: Use of Purana Dhanya
(grains harvested 1 year back),
Bharjit Dhanya (roasted grains), Yava
(Barley), Mudga (Green grams) and
Kulattha (Horse grams), Adhaki,
Masura (Lentils), Makushtha
• are recommended. Bitter leafy vegetables
like fenugreek, Atasi (Flaxseed), Sarshapa
(mustard) are recommended; roasted
meat of dry habitats animals
Don’ts –
 • Ahara: Excessive use of sweets, fruit salad,
Sugarcane, fruits like Mango, Watermelon,
Chikoo, Dates, Jack fruits, Custard apple,
Banana, Grapes, Cashew nuts, and other fruits
with high glycemic index, use of cold drinks,
intake of oil, Hydrogenated Ghee, fried food,
over indulgence of meat especially of wet land
animals, to take food before complete
digestion of previous food, to take food in
improper time and in varied
 quantity.
Vihara:
 Day time sleep especially just after taking
heavy meal, irregular pattern of sleep i.e.
less than 5 hours or more than 10 hours
in a day or in improper way, no or less or
infrequent exercise.
Referral Criteria:
 Patient not responding to above
mentioned management in terms of
symptomatology and reduction in blood
sugar levels and developing signs of
complication of Diabetes may be referred
to the next level.
LEVEL 2: AYURVEDIC HOSPITAL WITH
INDOOR FACILITIES:
 All patients referred from level 1 and those
patients diagnosed as Krisha Parmehi / Vata
/ Durbala / Pitta with Medo Dushti may be
treated at this level
Investigation:
 Hb A1C
 2. Lipid profile
Treatment:
 In addition to the management mentioned in
Level 1, few of the following drugs may be
added as per the requirement and status of the
patient (Table 11.3). Rasaushadhi (Herbo-
mineral drugs) or herbal drugs of potential
pharmaco-vigilance importance can be used at
this level. Patient may be kept under
observation while prescribing these kinds of
medicines.
Medicines at level 2 for Prameha
Name of
drugs
Dose form dose Time of
administr
etion
Special
indication
Anupana
Shiva
Gutika
Vati
1-2 vati Twice a
day/ before
meals
Diabetic
Impotence,
Neuropathy
Vanga
Bhasma7
powder 125-250
mg After meal
/ twice a
day
water
Trivanga
Bhasma
powder 125-250
mg
After meal
/twice a
day
- water
Vasanta
Kusumak
ara
Rasa9
powder 125-250
mg
Twice a
day/after
meal
Diabetic
periphera
l
neuropat
hy
water
Arogyavar
dhini
Vati10
vati 1-2 tab Before
meals/thri
ce a day
water
Chandrapr
abha
Vati11
vati
2-3 tablet
Before
meals/thri
ce a days
Diabetic
nephropat
hy
water
Referral Criteria:
 Patients’ blood sugar not well under control and
having associated conditions like Macrovascular
complications like Ischemic heart disease,
microvascular complications like diabetic kidney
disease, retinopathy, neuropathy etc may be
referred to the next level.
LEVEL 3: HOSPITALS WITH INDOOR FACILITIES
LIKE
PANCHAKARMA, KSHARASUTRA ETC. AND HAVE
INTEGRATIVE FACILITIES
 All patients referred from level 2 should be
treated at this level. All patients come
under Sthula Pramehi / Balavan / Kapha /
Pitta Pramehi and willing to undergo
Shodhana line
 of management for better recovery should
be treated at this level. All patients of
Krisha Pramehi / Vata / Durbala should be
treated at this level. Patients having
HbA1c above 9 should be treated at this
level
Clinical Diagnosis:
 Serum electrolytes
 2. Blood urea and serum creatinine
 3. Urine for Micro albumin
 4. ECG
 5. Fundus examination
Treatment:
 In addition to the management of
Level 1 and Level -2, if needed
Panchakarma procedures can be
performed.
Vegetables Navapatola (young Tricosanthus
dioica), young vegetables
variety of banana, tanduleyaka
(Amaranthus spinosus),
vastukam (bathuva), all bitter
vegetables (tiktasakam) like
methika (Fenugreek leaves),
Karavellaka (Bitter gourd),
Bimbi (Kovai), Shigru fruits and
leaves (Drum stick), Vrintaka
(Brinjal), Rakta vrintaka
(Tomato), Putiha (mint leaves),
Suran (amorhophellus), Curry
leaves, Mulaka (radish),
Kushmanda (Ash Gourd),
Kritavedhana (Ridge gourd),
Alabu (Bottle gourd),
Fruits Jambu (Syzigium cumini), Kapitha
(Feronia limonia), Amlaki
(Phyllanthus embilica), Bilva (Bael -
Aegle marmelos), Dadima
Oils
Condiments
Atasi (Linum usitatisimum),
Sarshapa (mustard).
Haridra (Turmeric), Maricha
(Pepper), Tvak (Cinnamon),
Lashuna (Garlic), Shunthi
(Ginger), Methika (Fenugreek),
Dhanyaka (Coriander), Jeeraka
(Cumin seeds)
Vihara: Ayurvedic texts suggest Long walks,
swimming, hard labor like pulling
carts, digging wells, serving animals
etc. All this involves muscular
activity, which will help in
maintaining muscle tone and
peripheral utilization of glucose.
Today, weight training exercises can
be done. Following norms should be
followed before or after exercise:
Madhumeha

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Madhumeha

  • 1. MADHUMEHA (DIABETES MELLITUS) Dr. Rajtilak Tiwari M.D. ( Kayachikitsa) Assistant Professor in Kayachikitsa dept. in Shivshakti lal sharma Ayurvedic College Ratlam (M.P.)
  • 2. INTRODUCTION • Prameha is one among the eight Maharoga (disorders needing serious concern) and explained as most important among Anushangi Roga (chronic disorders) manifested as polyuria with turbidity in urine occurs due to vitiation of Kapha Dosha and Meda Dhatu. Madhumeha the commonest clinical presentation of Prameha can be compared to Diabetes Mellitus. All such diet and life style factors which increase Kapha, Meda and Kleda, contribute in the pathogenesis of Madhumeha
  • 3. Prameha can be classified into two as Sthula Pramehi or Apathya Nimittaja Pramehi with clinical features of obesity along with excessive frequency of urination. In the second variety, Vata may be dominantly involved, and such patients are lean and termed as Krisha Pramehi. Further Prameha can be further classified into Kapha Prameha, Pitta Prameha and Vata Prameha according Dosha involvement. Kapha Prameha is Sadhya (curable), Pitta Parmeha is Yapya (manageable) and Vata Prameha is Asadhya (incurable).
  • 4. Case Definition:  Excessive urination which may be associated with excessive thirst and hunger, lethargy, numbness or burning sensation in the extremities, calf muscle cramps or sudden loss of weight with raised blood sugar levels (BSL).
  • 5. General Diagnostic criteria • Increased frequency of urine • 2. Turbidity in urine • 3. Excessive thirst & hunger • 4. Lethargy • 5. FBS >125 mg/dl and (or) PPBS >200 mg/dl1 • Along with, any 2 or more of the following symptoms: • a. Like cool surroundings (Subjective) • b. Sweetness in mouth (Subjective) • c. Burning / Numbness in palms & soles (Subjective) • d. Ants noted in the toilet (Subjective)
  • 6. • Sthula Pramehi: General Diagnostic criteria + BMI > 25 • Krisha Pramehi: General Diagnostic criteria + BMI < 18 • Kapha Pramehi: General Diagnostic criteria + BMI > 25 with some of the following features • • Recent onset of Diabetes (< 2 years) • • Take excessive sweets and high calorie diet • • Bulk eating habit • • Indigestion, predominant upper GIT symptoms and recurrent Upper Respiratory Tract symptoms
  • 7. Pitta Pramehi: General Diagnostic criteria + BMI >18 and <25 with some of the following features • Medium onset of Diabetes (2-6 years) • Use of excessive spicy and salty diet • Moderate eating habit • Acidity predominant, upper GIT symptoms and recurrent Urinary Tract Infections Vata Pramehi: General Diagnostic criteria + BMI < 18 with some of the following features • Chronic onset of Diabetes (> 6 years) Use of dry low nutritional diet • Less eating habit
  • 9. LEVEL 1: AT SOLO AYURVEDA PHYSICIAN CLINIC/PHC • Clinical Diagnosis: • On the basis of history and clinical presentation patient can be diagnosed provisionally as with subtypes as Sthula / Krisha and Doshik variety Kapha/ Pitta/ Vata. Patients diagnosed as Sthula / Kapha / Pitta and having at least moderate physical strength and blood sugar level as follows may be treated at this level. • • FBS >110 upto 180 • • PPBS > 200 upto 280
  • 11. Treatment:  In the initial stage when the patient is having mild raised blood sugar levels and not associated with major complications, along with diet restriction, two or more of following drugs may be given  as in table 11.1:
  • 12. Table 11.1: Medicines at level 1 for Madhumeha Drugs Dose form Dose Time of administr ation Dosh specificat ion Anupan Vijayasara di Kwatha Decoction 10-15 ML Before meal / twice a day Kapha / Pitta - Phalatrikad i Kwatha1 Decoction 10-15 ml Before meal / twice daily Kapha / Pitta - Kathakakh adiradi Decoction 10-15 Ml Before meal/twice a days Kapha -
  • 13. Nisha Katakadi Kashaya Decoction 10-15 ml Before meal/twic e a days pitta - Nisha- Amalaki powder 6 gm After meal /twice a days Irrespectiv e of Dosha With water Mamajjaka Ghana Vati Vati 2-3 Tab Before meal /thrice a days - With water Sapta Rgangyadi Vati3 Vati 2-3 Tab Before meal /thrice adays - With water With water
  • 14. Triphala 5 Powder / Tab 3-6 gm / 2-3 Tab Before meal / thrice a day - With warm water
  • 15. Chart Showing various diet Useful in Prameha Type of Diet Name Cereals Yava (Barley) (Hordeum vulgare), godh£ma (wheat), kodrava (grain variety –Paspolum scrobiculatum) udd¡laka (according to dhanvantari Nighantu forest variety of k°drava), Kangu (Seteria italica), Madhulika (Elusine coracana), Shyamaka (Echinochloea frumentacea), Jurnahva (Sorghum vulgare), Vajranna (Pennisatum typhoides), Purana shali (old rice),. Pulses Adhaki (red gram-Cajamus cajan), kulattha (horse gram) and mudga (green gram), Masura (Lentils), Makushtha (Moth Bean/Acpnite bean), Chanaka (Cicer arietinum) should be taken with bitter and astringent leafy vegetables.
  • 16. Pathya - Apathya (Diet and life style education): • Do’s- • • Ahara: Use of Purana Dhanya (grains harvested 1 year back), Bharjit Dhanya (roasted grains), Yava (Barley), Mudga (Green grams) and Kulattha (Horse grams), Adhaki, Masura (Lentils), Makushtha • are recommended. Bitter leafy vegetables like fenugreek, Atasi (Flaxseed), Sarshapa (mustard) are recommended; roasted meat of dry habitats animals
  • 17. Don’ts –  • Ahara: Excessive use of sweets, fruit salad, Sugarcane, fruits like Mango, Watermelon, Chikoo, Dates, Jack fruits, Custard apple, Banana, Grapes, Cashew nuts, and other fruits with high glycemic index, use of cold drinks, intake of oil, Hydrogenated Ghee, fried food, over indulgence of meat especially of wet land animals, to take food before complete digestion of previous food, to take food in improper time and in varied  quantity.
  • 18. Vihara:  Day time sleep especially just after taking heavy meal, irregular pattern of sleep i.e. less than 5 hours or more than 10 hours in a day or in improper way, no or less or infrequent exercise.
  • 19. Referral Criteria:  Patient not responding to above mentioned management in terms of symptomatology and reduction in blood sugar levels and developing signs of complication of Diabetes may be referred to the next level.
  • 20. LEVEL 2: AYURVEDIC HOSPITAL WITH INDOOR FACILITIES:  All patients referred from level 1 and those patients diagnosed as Krisha Parmehi / Vata / Durbala / Pitta with Medo Dushti may be treated at this level
  • 21. Investigation:  Hb A1C  2. Lipid profile
  • 22. Treatment:  In addition to the management mentioned in Level 1, few of the following drugs may be added as per the requirement and status of the patient (Table 11.3). Rasaushadhi (Herbo- mineral drugs) or herbal drugs of potential pharmaco-vigilance importance can be used at this level. Patient may be kept under observation while prescribing these kinds of medicines.
  • 23. Medicines at level 2 for Prameha Name of drugs Dose form dose Time of administr etion Special indication Anupana Shiva Gutika Vati 1-2 vati Twice a day/ before meals Diabetic Impotence, Neuropathy Vanga Bhasma7 powder 125-250 mg After meal / twice a day water Trivanga Bhasma powder 125-250 mg After meal /twice a day - water
  • 24. Vasanta Kusumak ara Rasa9 powder 125-250 mg Twice a day/after meal Diabetic periphera l neuropat hy water Arogyavar dhini Vati10 vati 1-2 tab Before meals/thri ce a day water Chandrapr abha Vati11 vati 2-3 tablet Before meals/thri ce a days Diabetic nephropat hy water
  • 25. Referral Criteria:  Patients’ blood sugar not well under control and having associated conditions like Macrovascular complications like Ischemic heart disease, microvascular complications like diabetic kidney disease, retinopathy, neuropathy etc may be referred to the next level.
  • 26. LEVEL 3: HOSPITALS WITH INDOOR FACILITIES LIKE PANCHAKARMA, KSHARASUTRA ETC. AND HAVE INTEGRATIVE FACILITIES  All patients referred from level 2 should be treated at this level. All patients come under Sthula Pramehi / Balavan / Kapha / Pitta Pramehi and willing to undergo Shodhana line  of management for better recovery should be treated at this level. All patients of Krisha Pramehi / Vata / Durbala should be treated at this level. Patients having HbA1c above 9 should be treated at this level
  • 27. Clinical Diagnosis:  Serum electrolytes  2. Blood urea and serum creatinine  3. Urine for Micro albumin  4. ECG  5. Fundus examination
  • 28. Treatment:  In addition to the management of Level 1 and Level -2, if needed Panchakarma procedures can be performed.
  • 29. Vegetables Navapatola (young Tricosanthus dioica), young vegetables variety of banana, tanduleyaka (Amaranthus spinosus), vastukam (bathuva), all bitter vegetables (tiktasakam) like methika (Fenugreek leaves), Karavellaka (Bitter gourd), Bimbi (Kovai), Shigru fruits and leaves (Drum stick), Vrintaka (Brinjal), Rakta vrintaka (Tomato), Putiha (mint leaves), Suran (amorhophellus), Curry leaves, Mulaka (radish), Kushmanda (Ash Gourd), Kritavedhana (Ridge gourd), Alabu (Bottle gourd), Fruits Jambu (Syzigium cumini), Kapitha (Feronia limonia), Amlaki (Phyllanthus embilica), Bilva (Bael - Aegle marmelos), Dadima
  • 30. Oils Condiments Atasi (Linum usitatisimum), Sarshapa (mustard). Haridra (Turmeric), Maricha (Pepper), Tvak (Cinnamon), Lashuna (Garlic), Shunthi (Ginger), Methika (Fenugreek), Dhanyaka (Coriander), Jeeraka (Cumin seeds) Vihara: Ayurvedic texts suggest Long walks, swimming, hard labor like pulling carts, digging wells, serving animals etc. All this involves muscular activity, which will help in maintaining muscle tone and peripheral utilization of glucose. Today, weight training exercises can be done. Following norms should be followed before or after exercise: