1. AETIOPATHOLOGY OF
MADHUMEHA
I sivarama prq!94 I(ETHAMAKI4
When the pathology of Prameha is discussed in
Madhava Nidana, Madhavakara, who followed a
specific pattern has kept this (metabolic) disorder
belore lfiedoroga (Obesity) and after the Ashmari
(Urinary caliculi). The chapter of prameha consists
of prameha pidika (boils). at the end as the
complications of prameha. There are twenty
pramehas explained, out of which 4 are vataia, 6
pittaja and 10 kaphaja
Because of Tulya dosha dooshyata normal and still the glucose levels are
(Homologous etiologic factors of high (hyperglycemia). lt suggests
vitiation of doshas and dooshyas) clearly, in insulin dependent patients,
kaphaja mehas are amenable to there are other causes other than that
treatment, where as vataja become of insulin. Madhumeha literally means
difficult for the same reason. The madhuryata of mootra (r:enal
medoroga is said to be the glycosuria).
nidanarthakara vyadhi for prameha SCAN:
pidika'other than that of prameha.
When we look in to the pathogenesis
Thus it is clgar, madhumeha -
of meha vis a vis prameha it gives
Diabetes mellitus, -is a disorder priority for medas (fat?) as dooshya
pertained to the lipid metabolism. along. with mamsa (muscle) and
Today when we observe the patients, shareera kleda (fluid contents"of the
many of them are non-insulin body). The seat of accumulation of
dependent and very few are insulin fluid is vasti (bladder). ln the category
dependent. ln fact many of the of shareera kleda, the other dooshyas
patients those who are having (vitiated tissues) are rakta (blood),
madhumeha, secrete more insulin sukra(semen), ambu (fluids), vasa
(hyper insulinemia) than that ot (adipose tissue), lasika (lymph?),
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2. Cover Etory
majja (bone marrow), rasa (plasma) molecules for one.glncose molecule
and ojas (essence of body tissues). and eicreted through, mootravaha
When we are analyzing the srotas (kidney, ureter, :bladder) and
pathogenesis, along witfr the dosha, ullirnately accumulates in vasti
the sequencei of dooshya involvement (bladder), where re-absorption
is to be followed.
mechanism fails (in Henley's loop)
It is explained in medoroga, how and sweet urine or glycosuria is
the medagni gets the ama samjna witnessed ultimately in all mehas.
and dustamedas is accumulated in Ama auto corrective mechanism :
the body. For the accurnulation of
ln the process of pathogenesis first
the medas in the body jatharagni dowrbalyata is seen with
medovahasrotas avritatva the above said etiology. lnitially
(encircling /covering), vata kaphavriddhi makes the Agni vitiation
vitiation, jathara$ni vriddi and with its seeta and guru gunas. The
kapha medovardhaka nidana is agni dusthi leads to varieties of
necessary. lt is a fact that, the obese Ajeerna according to the predominant
persons have the tendency of dosha associated. The Agni
developing prameha or madhumeha. disturbances follow with,Arna, in
ln both prameha and medoroga pachakagni and spreads to Rasa, the
kapha rnedodusti appears in the initial dhatu. lt further gets rooted in
body. the successive dhatui where first
Etiology: three make one set and rear three
make another. ln between of these
The etiology includes intake of two groups the Medas is not
navanna (newly harvested paddy)
accessible for treatment. Here the
which is rich of carbohydrates along
Auto corrective mechanism:of the
with the gudavikriti (items made of
body as protective mechanism act
jaggery and sugar), Payamsi, dadhini
(su.su.21l28) and makes the
(diary products) which have lactose
rectification of Ama in uttana dhatus
and less" number of carbohydrate (Rasa, Rakta and Mamsa). This can
chains and are easily metabolized,
be under the neural or secretary
gramyaanupa rasa (meat and flesh
control, or of'even both. But the
of the water and land animals) are Medas is not going to be get
righ in proteins and lipids/tats, The
corrected by auto rectification,
food which is ingested gets
assirnilated and'ulilized by jatharagni Ojas in pathogenesis :
and this gets impaired to begiri with. ln the nidana of pranieha, the cause
Thus free glucose increases in the which increases sleshma, mootra. and
blood which collects the seven water meda with a special reference to
11,

3. sleshma, which is abundantly watery Samprapti (Aetiopathology)
(Bahudrava sleshma), is discussed. The description of pathogenesis in
Specificalty Madhumeha appears Susruta Nidana 614 states
when ojodusti.is seen a.nd because "Pravrittasyapaiipakwa" for which
the sweetness in Ojas gets depleted Dalharra commenls as. Aparipakwa
by vata and reaches'the vasti, whicli Ama". lt refers both Amadosha and
is the cause of the cardinal symptom, Amadooshya. Further it is said as
sweet urine.: . 'Medascha Aparipakwam' pertaining
Browse the symptoms : to the dooshya alone. There by
Amatwa in dooshyas specifically
Among the lakshanas mentioned in
medas, isthe.meaning of "Medascha
Madhumeha the following are seen
Aparipakwamn.
as valuable for analysis.
.' Prabhootivila : mootrata
Gayadasa explains it as "medascha
aparinama mili asamyakparinatam",
(polyuria) : Sweda vaha sroto
in this the process of formation of
avarodhata causes increased
medas is not interrupted but impaired,
urinary output with turbidig
with the qualities of ama; " Ama
+ Madhuratwa ln mootra :
rasavadati snigdham" , snigdhatwa
Glycosuria (explained later in
will be in medas by virtue, but here it
Samprapti)
* Dantadinam mala sanchaya:
will become pichhilatwa with
atidravatwa. "Cha" usage indicates
Becayge of ,Arra. depositions are
not only medas but also other
seen in mouth.
.' dooshyas in the pathogenesis as
Pani pada daha: Abundance of
explained by Charaka. And Gayadasa
glucose ayailable in the blood is
in his commentary said il is in
not utilized by body tissue causes
stanasamshritavasta, in which
disturbance in the equillibrium of
amalakshana in medas and other
dhatus and doshas. lt gives rise to
dooshyas are visualized. lmpaired
pada pani daha (burning sensation
jatharagni and dhatwagnis causes
of feet and palm).
the atidravatwa of the dogshyas of
$ Chikkanata (stickiness):
prameha. These draveebhootha
(explained later in Samprapti)
dhatus get dragged and excreted
* Trishna (thirst - polydipsia): ln the
through mootra vaha srotas.
process of lypolysismore water is
utilized. lt results in to activation " lt/ootrasya kledavahanam", there by
of thirst center and Thirst. liquef ied waste/ non properly
s Swadasyata : Sweetness is metabolized or Ama/ Amadooshyas
experienced in the mouth due to dre excreted through mootravaha
increase in the sugar level. srotas and its seat"is vasti, a place
l3

4. Caver Story
Table - 1
Showing auto rectification of Agni giving rise increased Medas
Mithya ahara and vihara '
Kaphaja Ahara
Jatharagni dourbalya
Ama in Jatharagni
Ama in Rasa, Rakta, Non restricted
Mamsa and Meda Medo ama
/ Aulo
. rectilication Medoroga
, Samanavata
Nirama
Dhatu and Agni
Medo
deposition
Kindling
Jatharagni
Excessive
Metabollsm
'1
, Prabhoota mootrata 2. Avil mootrata
3. Madhura mootrata 4. Dantani mala sanchaya
5. Panipada daha 6. Chikkanata
7. Trishna 8. Abhishyanna deha

5. Cover Story
Table - 2 Sweet urine genesis - Polyglycosuria
Kapha kara Ahara-->
+
Kapha
Vatavriddhi
Vi
i
MedovilayaRa
Break down of the
l-ligher level of
molecules to.lower
level molecules
Table -3 lnterference of fat metabolism developing Diabetes mellitus
Reaction inside outside of Mitochondria
@1 in the presence of Carnitine (Lysine derivative)
Helps iJcrossing
Mitochondrial membrane
Oxidised.f Iavoprotein
stimulates in Mitochondria
i
Red,.rced f lavoprotein, Alpha,
Beta unsaturated fatty acid CoA
Carnitine deficiency Defective-.r
^ ..)l
Garnnrne rncreaseY With the interaction of
Hypoketonemia Liver and acelyl CoA
Hypoglycemia Hyperketonemia gives rise beta
Hyperglycemia hydroxy butyrate +
Adversity or active productionof Acetone along with
Beta oxidation of fatty acids .,----- Ketqne bodies
will produce Hyperglycemia /OtneefeS
(fatty aeid synthesis slops WIELLITUS/
when the chains in Aminoacids -----'z
are more then 16 Carbon atoms long)

6. Cover Story
for accumulalion of urine. Chakrapani kayagni amshas, which are
on Cha.Ni.4/6comments as dravatwa responsible lor catabolic activity in the
to kapha dosha. When kapha dosha tissues, are also diminished. The.
is in abundant liquefied form thenonly dFiatus are subjected to increase.
capable of generating the prameha, Here not only jatharagni vriddhi but
.by mixing with the medas which is also kayagni amshas of medodhatu
furiher liquefied and liquefy the ksheenata is expected. As a result of
medas in association with ama blockage of medovaha srotas,
lakshana. lmportance of drava ahara/ increased agni (jatharagni/
pana in liquefying kapha and medas pachakagni) and decreased medo
along with lhe other dooshyas are to amshagnis cause the medoroga.
be noticed. Kapha dosha is not Lastly, there is a similarity between
capable of causing the prameha roga prarneha and medoroga in etiology
without pitta or vata. The dooshyas with the factors capable ol causing
are said to be medas, rakta, sukra, kapha vriddhi like madhura rasa,
ambu (sareera kleda), vasa, lasika snigdha guna dravyas. The process
majja, rasa and ojas in chronological. of metabolism of fats in different
order. stages gives rise either medoroga or
prameha (santarpanothavikara).
lnmedoroga rasa, rakta and
Even in lakshanas of medoroga, we
mamsagni's are normal, where as
medagni is Vitiated orfat metabolism
see similarity with prameha
lakshanas.
is impaired: As medagni" is not
capable of assimilation of astayee Theflowcharts given will give clear
trnamsa, this agni is diverted. The insight about the discussed topics.
The author is Reader in Kayachikitsa,
Department of PG Sfudr'es, DGM Ayurvedic medical college,
Gadag, Karnatala
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