1. Dr. Ananth Ram Sharma
MD Panchakarma, (Ph.D)
Panchakarma, (Ph.D)
Lecturer and Head

2. Prameha Statistics
Diabetes mellitus is one of the most common endocrine
disorders affecting almost 6% of the world population.
According to WHO “Diabetes is a major threat to global
public health that is rapidly getting worse, and the
biggest impact is on adults of working age in developing
countries”.
The total no. of recorded diabetes patients till year 2000
are 171 million and expecting to be increase by 366
million in year 2030.
Indian‘s stand at first in the whole world to have the
largest numbers of diabetic patient i.e. 31.7 million will
be increase up to 79.44 million by year 2030.
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3. Incidence
The epidemiology of diabetes in elderly people is not well
understood.
The estimated annual incidence of diabetes was 8.6 cases
per thousand for elderly Canadians.
Incidence decreased with age, from 9.5 for subjects 65–
74 years of age, to 7.9 for those 75–84 years of age and
then to 3.1 for those 85 years of age and older.
Diabetes was associated with death (relative risk 1.87,
95% confidence interval 1.59–2.19) and admission to an
institution (relative risk 1.58, 95% confidence interval
1.28–1.94).
Kenneth Rockwood. et.al.
Byadagi.S.P et.al
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4. Introduction
Terminology Prameha is used in a wide
angle.
Prakarshena adhikyena mehati iti
Prameha:
Almost 19 out of 20 Prameha may
converted in to Madhumeha.
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5. Prameha and Madhumeha
Prabhuta Mutrata
Another one is the Madhuryata of Mutra
Not only in Madhumeha, Ikshumeha and Sikatameha –
Madhuryata is there.
Because of Madhuryata Madhumeha is a Smanya samjna.
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6. Tridoshajatva of Prameha
Kaphaja, Pittaja and Vatajaare not Svatntra
Roga’s
They are anukrama avastha bheda’s
Tridoshatva is there for all the 3
Predominet Dosha decides the Avastha
Tatra vata pitta medobhiranvita shleshma
shleshma pramehan janayati, Vata kapha
shonita medobhiranvitam pittam pitta
pramehan, Kapha pitta vasa majja
medobhiranvito vayu: vatapramehan- Sushruta
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7. iÉåwÉÉqÉç rÉÎiMüÎgcÉiÉç AÉWûÉU eÉÉiÉÇ zsÉåwqÉ qÉåSÉå qÉ賈 eÉlÉlÉÇ xÉ WåûiÉÑÈ|
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iÉæÈ uÉxÉÉ sÉxÉÏMüÉ qÉ‹ÉæeÉÉãÍpÉ¶É uÉÉrÉÑÈ|| xÉÇaÉëWû
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8. Nidana’s
Food
Occupation
Vyayamadi Vihara’s
Kala Deshavastha’s
Kulaja – genetic
Vayah and Linga
ApatarpanaJanya
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9. Food and Drinks
Brumhana
Kapha medo mutrala Ahara
Madhuramla rasa pradhana
Shitavirya
Snigdha
Matra – Gurunam Ardha
sauhityam…….
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10. “pÉÔÌrɹ qÉkÉÑUÇ pÉÑ£Çü ÌuÉmÉÉMüÉiÉç qÉkÉÑUÉå¨ÉUÇ
pÉÔ
U£üqÉÉÍ´
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üiÉÉiÉç
mÉËUhÉÉqÉÇ lÉ sÉpÉiÉå xÉqrÉaÉç kÉÉiuÉÎalÉ uÉæM×üiÉÉiÉç
||”
qÉÉkÉÑrÉïÇ iÉålÉ U£üÉSå iÉiÉÉå qÉkÉÑU qÉÔ§ÉiÉÉ ||
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11. Occupation and Exercise
Sedentary Life style
Low activities high socio economical
status
Vyayma Guna
Adhana chatra Padatra rahito………
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12. Kala desha
When compaered to sheeta pradesha
More predominant in Ushna Pradesha
Adana kala – Balakshaya- Agni Kshaya-
saumya dhatu apachaya
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13. Genetic
MÑü¸ÉlÉliÉUÇ mÉëqÉåWûÉUÇpÉÈ AmÉirÉ xÉÇ¢üqrÉiuÉålÉ EpÉrÉÉåUmrÉmÉirÉaÉiÉiuÉÉiÉç||
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lÉ xÉÉkrÉ E£üÈ xÉ ÌWû oÉÏeÉ SÉãwÉÉiÉç||
Concidered as Asadhya
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14. Vayah and Linga
Approximately 13% of adults older than 70 years have diabetes
mellitus and 11% of adults between age 60 and 74 remain
undiagnosed.
Higher rates of premature death; functional disability; and
chronic illnesses, such as hypertension, cerebrovascular
accidents, and coronary artery disease, often affect elderly
diabetic patients. Brown AF et.al
UeÉmÉëxÉåMüÉiÉç lÉÉUÏhÉÉÇ qÉÉxÉÏ qÉÉxÉÏ ÌuÉzÉÑkrÉÌiÉ
xÉuÉïÇ zÉUÏUÇ SÉåwÉÉ¶É lÉ mÉëqÉåWûlirÉiÉ Îx§ÉrÉÈ ||
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pÉÉuÉmÉëMüÉzÉÉÌS
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LiɨÉÑ lÉ rÉÑ£üÉ xÉuÉïiÉl§ÉÉ mÉëÍxɬãÈ mÉëirÉ¤É ÌuÉUÉåkÉÉŠ| xÉÑ´ÉÑiÉ - lrÉÉrÉ cÉÎlSìMü
Él§ ÉÉŠ|
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15. Apatarpana Janya
eÉÉrÉiÉå xÉ ÌMüsÉ Ì²kÉÉ-̲kÉÉ-
¢Ñü®å kÉÉiÉѤÉrÉɲÉrÉÉæ SÉåwÉÉuÉ×iÉmÉjÉåÅjÉuÉÉ|
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pÉÉåÌaÉlÉÉÇ mÉëÉæRûuÉrÉÍxÉ mÉëqÉåWûÈ xrÉÉiÉç xÉÑSÒxiÉUÈ||
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16. Purva Rupa
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17. LAKSHANA PRAKARANAM
Kaphaja 10 Pittaja 6 Vataja 4
Udaka Meha
Nila meha
Ikshu meha Vasa meha
Sandra meha Kala meha
Sandra prasada meha Majja meha
Suklabha meha
Kshara meha
Sukla meham meha
Haridra meha
Shita meha Hasthi meha
Shanair meha Manjishta meha
Alala Meha
Madhu Meha
Sikata meha Lohita meha
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18. Exceptions
Kaphaja - Lavana Charaka’s Majjameha
meham, Phena meham and Madhumeha is
and Pittaja Amla termed by sushruta as
meham of sushruta is sarpi meha and
not in Charaka Kshaudra meha.
Charaka’s Alala Sushruta mentions
meham, Shitameham, anothr madhumeha
and Kala meham is not
So total 24
in sushruta
Their lakshana are also
not similar
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19. Samanya Lakshana
chronic pain, injurious falls,
polypharmacy, cognitive impairment,
urinary incontinence and depression.
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20. Elderly Signs and symptoms
Pain
Targeted history and physical examination for chronic pain and its
treatment
Injurious Falls
Falls are usually increased.
hypoglycemia, peripheral neuropathy, sensory deficits (poor
vision), polypharmacy, and overall decreased functional status.
Polypharmacy
Educate patients and caregivers regarding the indications,
expected risks, and expected benefits of the many medications.
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21. Cognitive Impairment
Education of caregivers is important because of increased
cognitive difficulties in the elderly diabetes.
Urinary Incontinence
Diabetes mellitus is associated with increased urinary
incontinence
Depression
Geriatric depression scale (GDS).
Treatment should be directed at stopping medications known
to cause depression and introducing, effective medications
with good safety profiles.
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22. Vishesha Lakshana
Sushruta Nidana
In elderly we can see more
dhatukshayajanya Madhumeha
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23. Vimshati meha Lakshana
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24. Courtesy Dr Krishnakumar
Mutra Pareeksha
24
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25. Courtesy Dr Krishnakumar
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26. CHIKITSA
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27. Apatrapana Chikitsa
Charaka
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28. Samshodhana Anarha
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29. Balavan – Vamana and rechana
Surasadi Ganam for Kapha and
Nyagrodadi for pitta then
Asthapana
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30. Shamana in General
Nishamalaki
Kramuka Khadira yogam
Amruta svarasam with Honey
Darvi, devadaru, triphala, Mustha
Chitraka, triphala, Darvi, Kalingaka
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31. Shamana for each Dosha
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32. Shamana for Vimshati meha
Kaphaja Meha Pittaja Meha
Meha Kashaya Meha Kashaya
Udaka meha Parijata Nila meha Asanadi Ganam
Ikshumeha Kashmarya Haridra meha Rajavruksha
Sura meha Nimba Amla meha Nyagrodadi gana
Sikata meha Chitraka Kshara meha Triphala
Sanair meha Khadira
Manjishta meha Manjishta, Chandana
Lavana Meha Patha, Agaru, Nisha
Rakta meha Amruta, tinduka bijam,
Pishta Meha Nisha, Darvi Kharjura
Sandra meha Sapta Parna or
Durvadi
Sukla meha Kakubha chandana
Phena meha Triphala aragvada,
Draksha
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33. Shiloncha vrutti
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34. Other Procedures
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35. HERBAL PREPARATIONS
1. Amalaki 1. Suvarchala Susrutacharya’s exclusive
2. Amrapushpam 2. Brahmi contribution:-
3. Gojihwa 1. Tuvaraka
3. Atibala
4. Haridra 2. Makshika
4. Bhurjapatra
5. Kakamachi 3. Shilajathu
5. Devadaru 6. Meshashringi
6. Guggulu 7. Pippali
7. Guduchi 8. Pashanabheda
8. Kampillaka 9. Sarjaka
9. Katuki 10. Varahi kanda
11. Tinduka phala
10. Katphala
12. Satavari swarasa
11. Karanjaphala
13. Palasapushpa with
12. Karanja Ksheeram
13. Moorva
14. Manjishta
15. Maha nimba Bhava Prakasha
16. Nimba
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36. Herbo Mineral Preparations
1) MUDGADI KANJIKA KASHAYA:-
“Atisthoulya pramehadi rogasya nivruttaye” (Sahasra yoga)
2) AVIPATTIKARA CHURNA:-
“Agnimandyodbhavan rogan nasayeth avikalpatah
Pramehan vimsatimchaiva nasanam” (BH.R)
3) NYAGRODHADI CHURNA:-
“Vimsathi mehan prasamam yanti” (Chakradatta)
“Pidakan na jayathe” (BH.R)
4) MUSTA, DEVADARU & TRIPHALA KASHAYA:-
“Prameha hrit” (Chikitsa kalika – Trisata acharya)
5) BHASKARA LAVANA CHURNA:-
“Viseshatah sharkaradeen rogan nanavidhan tadha -
Hridrogam hanti” (Gada Nigraha )
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37. 1) Vanga prayoga - “Madhumeha nut” (R.R.S)
2) Indra vati - “Madhumeha pra nasini” (Ra.Ch.)
3) Dhanwantari ghrita - “Jayeth Sarvan Pramehan pitakochitan” (S.Y)
4) Lodhradi kashaya - “Madhumeha jit” (Basava Rajeeyam)
5) Bahumutrantakaras - “Madhumeham Hanti Bhaswan yatha tamam”
(Parama durlabhaha) (Sahasra Yoga)
1) Sarveswara rasa - “Madhumehan su durjayam hanti” (Bh. Ra.)
2) Dadimadi ghritam - “Pramehan vimsati vividhan hanyath na samsayaha”(B.R)
3) Prameha mihira taila- “Pramehan vimsatischaiva nasayeth avikalpataha” (B.R)
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38. Minerals
1) Shilajathu
8. Swarnamakshika Bhasma
2) Abhraka Bhasma
9) Tamra yoga: “Vaktre
3) Vanga Bhasma sandharayeth Nisi –
Pramehaharam”
4) Naga Bhasma
10) Kaphari: “Madhumeha mapi
5) Jasada Bhasma
nihanti ashu” (R.R.S)
6) Tamra Bhasma
7) Rajatha Bhasma
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39. Other Kriya Krama’s
Takraara
Kayasseka
Udhdvartana
Abhyanga
Shirodhara
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40. PATHYA
AHARA
VIHARA
Yava
Chanaka Vyayama
Palandu “Padatra rahito munivartanah”
Tikta saka “Yojananam shatam yayat”
Purana dhanya “Khaneth va salilasayaha”
Purana kulutha “Gramaika ratram
Takra bhaikshwasee”
Bhojana madhye salila
Godhuma
Bhrumhana ahara (not
medokara)
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41. APATHYA
AHARA VIHARA
Dadhi – Mandaka Indiscriminate/excessive
Sura exposure to cold & chill.
Kshupaja maricha Exerting activity soon
(Chillies) after food.
Food substances
Excessive indulgence in
prepared out of wheat in
association with oil. This sex.
is more applicable Indulgence in sex
to patients suffering from immediately after food.
Diabetic Retinopathy. Intake of water at the end
of food.
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42. References
Charak Nidan sthana : Ch.4
Charak Chikitsa sthana : Ch.6
Sushruta Nidan sthana : Ch.6
Sushruta Chikitsa sthana : Ch.11
Ashtangahridaya Nidan sthana :
Ch.10
Ashtangahridaya Chikitsa sthana :
Ch.12
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43. To Summarize
Dhatu kshyaja Madhumeha
Concentrate over the Particular signs
and Symptoms
Shodhana Has limited Role
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44. “|| Na Matra Matramapyatra Kinchit Agama Varjitam||”
Varjitam||”
For your patient Hearing
Visit: http://panchakarma4all.blogspot.com
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