Apart from many classifications - Susruta 7 fold classification has much importance to understand the disease Madhumeha.

1. In the Memory of VVS Sastry
20-11-1932 to 12-08-1999
Prof. Dr. K. Shiva Rama Prasad
Dept. of Kayachikitsa (PG)
PGARC, DGMAMC, Gadag
+91-9448746450
doctorksrprasad@gmail.com

2. A step towards healing
Sharing of the information of Madhumeha in
front of many intellectuals of Ayurveda is a
Herculean Task
Gnosis of Diabetes makes ones to attend it
either curative or prophylaxes forms.
Nosology of Madhumeha is necessary to
manage it full length.
Apart from many classifications - Susruta 7
fold classification has much importance to
understand the disease Madhumeha.
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3. 7 fold classification of Madhumeha
Adibala Pravrutta
Janmabala Pravrutta
Doshabala Pravrutta
Sanghatabala Pravrutta
Kalabala Pravrutta
Daivabala Pravrutta
Swabhavabala Pravrutta
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- ºÉÖ¸ÉÖiÉ ºÉÚjÉ 24/4
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4. Adibala Pravrutta
Matruja Madhumeha – probably developed because of
Matruja beeja avayava Medo vikruti – kostanga – kloma
(Pancreas-?)
Pitruja Madhumeha – Asthi beeja avayava – Acetylcholine –
citrus acid cycle disturbance – neo glycolysis - ketone bodies
Genetically influenced Madhumeha – where Beeja – Beeja
bhaaga avayava are influenced to give rise MM child
The genetics and involvement of Genes are even though not
new – medically to treat a patient of Shisava MM is not
possible.
But “Eugenics” – is provided by the Ayurveda to combat the
disease to eradicate or to avoid “predominance” of Beeja –
Pumsavana - sadvrutta etc.
Apart from this the colonial prophylaxis management as –
Atulya Grotriya is followed.
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EÖò¹`öɶÉÇ|ɦÉÞiɪÉ:, iÉä +Ê{É ÊuùÊ´ÉvÉÉ: ¨ÉÉiÉÞVÉÉ: Ê{ÉiÉÞVÉɶSÉ
-ºÉÖ¸ÉÖiÉ ºÉÚjÉ 24/5
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5. Janmabala Pravrutta
Rasakruta (Apatarpanajanaya MM) &
Douhrudapacharaja (Santarpanajanya MM)
Rasakruta MM is, where mother irregular food
habits or lack of food or incapacities of taking food
leaves an impression over the baby to develop
accumulation of food for future use habituated to
develop as Juvenile DM. – 2nd World war impression
over German population
Douhrudapacharaja literally mother’s deviated
habits influence the baby for deranged segregations
of Shareera Kleda (Blood Sugar) to develop JDM as
result of impaired metabolic functions
VÉx¨É¤É±É |É´ÉÞkÉÉ ªÉä ¨ÉÉiÉÖ®úÉ{ÉSÉÉ®úÉiÉ {ÉRÂóMÉÖVÉÉiɺlÉ
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VÉɪÉxiÉäiÉä +Ê{É ÊuùÊ´ÉvÉÉ: ®úºÉEÞòiÉÉ: nùÉè¾þnùÉ{ÉSÉÉ®úEÞòiÉɶSÉ
- ºÉÖ¸ÉÖiÉ ºÉÚjÉ 24/5
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6. Doshabala Pravrutta
Amashaya Samutha MM & Pakwashaya
Samutha MM
We always behind the Dosha and Dhatu, which
are altering all the time to target for any illness
in the body. Off course the Dosha are
dependent over the food and digestion.
The pre digestive manifested MM and post
digestive manifested MM has to be
differentiated before treatment
nùÉä¹É¤É±É |É´ÉÞkÉÉ ªÉä +ÉiÉÆEòºÉ¨ÉÖi{ÉzÉÉ Ê¨ÉvªÉɽþÉ®úÉSÉÉ®ú EÞòiÉɶSÉ iÉä +Ê{É ÊuùÊ´ÉvÉÉ,
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ÊuùÊ´ÉvÉÉ: ®úÉVɺÉÉ: iÉɨɺÉɶSÉ iÉ BiÉä +ÉvªÉÉÎi¨ÉEòÉ: - ºÉÖ¸ÉÖiÉ ºÉÚjÉ 24/5
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7. Sanghatabala Pravrutta
Shastra (armed fight) and Vyala
(animal) should be concerned to
exogenous causes of MM
Viral DM is said to be a new invention
in contemporary but the Krimija MM
even though not classified, its
existence is proved through usage of
Anti retroviral management in MM.
ºÉÆPÉÉiÉ¤É±É |É´ÉÞkÉÉ ªÉä +ÉMÉxiÉ´ÉÉä nÖù¤ÉDZɺªÉ ¤É±É´ÉÊuùOɽþÉiÉ iÉä +Ê{É ÊuùÊ´ÉvÉÉ: ¶ÉºjÉEÞòiÉÉ:
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8. Kalabala Pravrutta
Seasonal influences are common in
manifestation of disease. This cause Agni
disturbances. The MM of seasonal variations
dependent on food habits which are of external
causes implies influence on shareera kleda to
cause Amashaya samutha MM with apakwa rasa
kleda. In some seasons sugar levels alters to
high and low even – as we see in summer
hypoglycemia – so as the usage of madhura rasa
EòÉ±É¤É±É |É´ÉÞkÉÉ ªÉä ¶ÉÒiÉÉä¹hÉ´ÉÉiɴɹÉÉÇiÉ{É |ɦÉÞÊiÉ ÊxÉʨÉkÉÉ: iÉä +Ê{É ÊuùÊ´ÉvÉÉ:
´ªÉÉ{ÉzÉ @ñÊiÉEÞòiÉÉ: +´ªÉÉ{ÉzÉ @ñiÉÖEÞòiÉɶSÉ
- ºÉÖ¸ÉÖiÉ ºÉÚjÉ 24/7
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9. Daivabala Pravrutta
In it Vidud-ashanikruta – is said to be any
external shock referred to execute
electrical impulses that disturb the body
environment and cause Hyper or
Hypoglycemia
Pishacha once again fingers towards the
infectious origins - which could be
sudden or communicated viral or
Bacterial origins could occur either by
contact or epidemiological or transfusion
nèù´É¤É±É |É´ÉÞkÉÉ ªÉä näù´ÉpùÉä½þnùʦɶÉ{iÉEòÉ: +vÉ´ÉÇhÉEÞòiÉÉ ={ɺÉMÉÇVÉɶSÉ iÉä +Ê{É ÊuùÊ´ÉvÉÉ:
Ê´ÉtÖnù¶ÉÊxÉEÞòiÉÉ: Ê{ɶÉÉSÉÉÊnùEÞòiÉɶSÉ - {ÉÖxɶSÉ ÊuùÊ´ÉvÉÉ: - ºÉƺÉMÉÇVÉÉ: +ÉEòκ¨ÉEòɶSÉ
- ºÉÖ¸ÉÖiÉ ºÉÚjÉ 24/7
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10. Swabhavabala Pravrutta
In this the diseases manifested during the un
time/time schedule routine course pathological
conditions are discussed – like gestational DM
etc which may ultimately leads to precipitate
MM/DM permanently as marker
In the old age hypoglycemia (Vata) and
children with hyperglycemia (Kapha) are
common
º´É¦ÉÉ´É¤É±É |É´ÉÞkÉÉ ªÉä IÉÖÎi{É{ÉɺÉÉVÉ®úɨÉÞiªÉÖ ÊxÉpùÉ |ɦÉÞiɪÉ:, iÉä +Ê{É ÊuùÊ´ÉvÉÉ: - EòɱÉVÉÉ:
+EòɱÉVÉɶSÉ iÉjÉ {ÉÊ®ú®úIÉhÉ EÞòiÉÉ: EòɱÉVÉÉ: +{ÉÊ®ú®úIÉhÉEÞòiÉÉ: +EòɱÉVÉÉ:
- ºÉÖ¸ÉÖiÉ ºÉÚjÉ 24/7
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11. Sahaja MM
Sahaja MM is Krusha – Rooksha – Alpashi
– Always Parisarana sheela (hyperactive) -
is not indicated with any elimination but to
treat with “Samskruta Annpana” pathya –
transformed food regulations and
Samshamana chikitsa – palliative
management – along with diseases or
conditions associated to even treat is
indicated.
iÉjÉ ºÉ½þVÉÉä ¨ÉÉiÉÉÊ{ÉiÉÞ ¤ÉÒVÉnùÉä¹ÉEÞòiÉ: - - - iɪÉÉä {ÉÚ´ÉæhÉÉä{ÉoùiÉ: EÞò¶ÉÉä°üIÉÉä,+±{ÉɶÉÒ Ê{É{ÉɶÉɺÉÖ¦ÉÞǶÉÆ {ÉÊ®úºÉ®úhÉ ¶ÉұɶSÉ
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12. Apathyanimittaja MM
Apathya nimitta MM is Sthoola –
snigdha – wants comforts of food and
sleep – is to be treated with Apatarpana
Chikitsa – Samshodhana following the
“Samutha Vishesha” as either with
Vamana in case of Amashaya samutha
and Virechana fro Pakwashaya
samutha MM
+ʽþiÉɽþÉ®úVÉÉä%{ÉlªÉ ÊxÉʨÉkɶSÉ - =kÉ®äúhÉ ºlÉÚ±ÉÉä ¤É¼´ÉɶÉÒ ÎºxÉMvÉ: ¶ÉªªÉɺÉxÉ º´É{xɶÉұɶSÉ |ÉɪÉähÉäÊiÉ - - - -
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13. Vamana – Virechana – Vasti with Alpa sneha and
preferably with Ghruta (Medo- Kapha-Vata hara
Chikitsa)
Sneha pacifies Vata and Medohara Kaphahara Kashaya
are releave MM
In all MM methods of management are –
Baddhamootrani – Amedaskarani –Brumhana – Agni
deepana – Bala janana annapaana – Kleda prashamana
dravya– Medoprahsmana dravya -
´ÉɨɪÉäiÉ - |ÉMÉÉføÊ´É®äúSɪÉäSSÉ - Eò¡ò¨Éä½äþ ´ÉɨɪÉäiÉ - Ê{ÉkɨÉä½äþ Ê´É®äúSɪÉäiÉ - +ɨɶɪɺlÉä Eò¡òÊ{ÉkÉä ´ÉɨɪÉäiÉ - {ÉC´ÉɶɪɺlÉä
Ê´É®äúSɪÉäiÉ - - - +ɺlÉÉ{ɪÉäiÉ ÊxɺiÉè±ÉäxÉäÊiÉ ´ÉSÉxÉÉnù±{ÉPÉÞiÉɦªÉxÉÖYÉÉxɨÉ - +±{ɺxÉä½þÉlÉǨÉxªÉä - ºÉÖ¸ÉÖiÉ ÊSÉÊEòiºÉ 11/7
b÷±½þhÉ
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- ºÉ´ÉǺªÉSÉ ¤Érù¨ÉÚjÉÉhªÉɨÉänùºEò®úÉhªÉ ¤ÉÞƽþhÉÉxªÉÎMxÉnùÒ{ÉxÉÉÊxÉ ¤É±ÉVÉxÉxÉÉÊxÉ +zÉ{ÉÉxÉÉÊxÉ -+¹]õÉÆMÉ ºÉÆOɽþ ÊSÉÊEòiºÉ 14/2
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14. Murphy's Fourth Law states that - If there
is a possibility of several things going
wrong, the one that will cause the most
damage will be the one to go wrong.
“Management” rather than “treatment”, is
the appropriate term in MM/DM, and
involves diet, regulations, exercise,
insulin, oral hypoglycemic, patient
education and counseling.
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15. Points of observation @ MM
Sahaja meha (Beejadosha) - krusha MM
Apathyanimittaja - sthula MM
Amashaya Samutha MM indicated with Vamana
even (Kapha or Kapha Pitta MM)
Pakwashaya samutha MM indicated with Virechana
(Pitta MM)
Avruta Vata janaya MM
Dhatu kshaya Janya MM
Krimija MM
Garbhini MM
Chintajanya MM, etc.
nùÉè|ɨÉä½þÉè¦É´ÉiÉ: ºÉ½þVÉÉä%{ÉlªÉÊxÉʨÉkɶSÉ - - ºÉÖ¸ÉÖiÉ ÊSÉÊEòiºÉ - 11/3-4
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16. Prabhoota (more than 4 Anjali - Dushya
dravibhootata) – Avila (Samala) - Madhura
(Kleda- Ojas) Mootra as common symptoms are
developed due to – Shareera kleda (blood
sugar) added to urine as – glycosuria is
“Pratyatma Niyata Lakshana” requires
management
Usually the MM patient is with – impaired Agni
where in pathology has transformed meda as
mootra and the tejas of it augment Kleda with
Abhishyanna Deha – Drava Pradhana deha
|ÉɪÉähÉʽþ |ɨÉäʽþhÉÉä%ʦɹªÉhhÉnäù½þi´ÉÉnÖù{ɽþiÉÉMxÉä - ¨ÉÚjÉɪɨÉänùºÉäSÉ Ê´É{ÉÊ®úhɨÉiÉä - iɺ¨ÉnùºªÉ iÉäVÉÉävÉÉiÉÖ ´ÉÞqùªÉä
C±Éänù¨Éänù: |ɶɨÉxÉɪÉSÉ ¤ÉʱÉxÉ: ºÉƶÉÉävÉxÉÉÊxÉ |ɪÉÖÆVÉÒiÉ - +¹]õÉÆMÉ ºÉÆOɽþ ÊSÉÊEòiºÉ 14/2
+ʦɹªÉhhÉ: pù´É |ÉvÉÉxÉ ¶±É乨ÉÊ´ÉEòÉ®úÒ - SÉGò{ÉÉÊhÉ
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17. In a nut shell - Ahara consumed
Absorbed from Amashaya (Madhura rasa ahara) = Amashaya
samutha MM = Vamana indicated
Food absorbed and transformed at Pakwashaya (Madhura
vipaka ahara) = Pakwashaya samutha MM = Virechana
indicated
Rasa nimittaja or santarpana janya or Apathya nimittaja MM is
pathological state of excess rasa in shareera as (Dhatu
vruddhi) understood as intracellular glucose excess (many
times we are not considering this condition)
Excess is mala always – so the excess rasa from the dhatu is
brought in to system (interstitial glucose excess) to name as –
Shareera Kleda (Blood glucose)
Shareera kleda along with “Apdhatu” is filtered by Mootravaha
srotas to get Madhura Mootra where the re-absorption
capacities of “Vrukka” or Shareera is failed
Excess kleda (glucose) attracts 16 molecules of water so as
to get Prabhoota and Avila Mootra in MM – thus the
Baddhamootra drvaya along with Amedaskara as palliative
management
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18. Preparations Used In Prameha
Swarasa – Churna :
Amalaki Triphaladi
Haridra Mustadi
Gokshuradi
Nimbapatra Arkadi
Bilwapatra
Guduchi
Kwatha : Ghrita:
Vidangadi Dhanvantar ghrita
Phalatrikadi Trikantakadi ghrita
Sinhamrita ghrita
Mustadi
Dadimadi ghrita
Manjishthadi
Shalmali ghrita
Pathadi
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19. Avleha
kushavleha
Bangavleha
Gugglu
Gokshuradi Guggulu
Gutika : Modaka
Chandraprabha Kastur Modaka
Indravati Paka
Pramehantak Vati
Pugapaka
Ashwagandhadi paka
Draksha Paka. Asava Arishta:
Rasaushadhi: Lodhrasava
Vasant kusumakar Rasa Dantyasava
Mehamudgar Rasa Madhukasava
Brihat Vangeshwar Rasa
Devdarvyadiarishta
Prameha gajkesri Rasa
Trivanga Bhasma Lodhrarishta.
Vasant tilaka Rasa.
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20. Pathya in Madhumeha
(Low caloric diet)
Shook Dhanya: Jeerna Shali, Shashtika, Kodrava,
Yava, Godhuma, Uddalaka,Shyamaka
Shimbi Dhanya:Chanaka, Adhaki, Kulattha, Mudga
Shaka Varga: The leafy vegetables with a
predominance of tikta-kashaya rasa, Patola,
Karvellaka, Shigru
Phala Varga: Jambu, Dadima, Shringataka,
Amalaki, Kapittha, Tinduka, Kharjura, Kalinga,
Navina Mocha.
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21. Mamsa Varga:Vishkira mamsa,Pratuda,
Jangala mamsa
Taila Varga: Danti, Ingudi, Sarshapa , Atasi
Udaka Varga:
Sarodaka,Kushodaka,Madhudaka
Kritanna Varga:
Apupa,Saktu,Yavodana,Vatya,Yusha
Others: Madhu, Hingu, Saindhava, Maricha,
Lasuna
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22. Pathya Vihara
To have walk as much as possible
traveling on elephants, horses
different plays and games
different forms of marshal arts practice
roaming in different places other than
temples
using umbrella
Following “Sadvrutta”
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23. Apathya in Madhumeha
(High caloric diet)
Aahara: Jala, Milk, Ghee, Oils, Curd, Sugar,
Different types of rice preparations, anupa,
gramya and audaka mamsa, Ikshurasa,
Pishtanna, Navanna.
Vihara: Eksthana asana, Divaswapa,
Dhoompana, Sweda, Raktamoksha,
Mutravega dharana.
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24. Madhumeha Chikitsa
Baladi Churnam – Kshaya - Harita Samhita
Gokantkadyavaleha – Bhava Prakasha
Kharpara rasayanam – Rasa Ratna samucchyaya
Manjisthadyam Ghrutam – Gada Nigraha
Sinhamrut Ghrutam – Chakradutta
Khadirradi Kashaya – Gadanigraha
Pashanbhed Kashaya – Sahasra Yoga
Pashanbhed Pak – Yoga Ratnakara
Asanadi Yoga - Bhava Prakasha
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25. Indravati – Rasendrasara sangraha
Vedvidya vati – Bharata Bhaishajya Ratnakara Vol 4
Bahumootrantaka ras – Sahasrayoga
Maskmruganka ras – Rasaraja sundaram
Meha Kesari ras – Rasendra sara Sangraha
Pramadananda ras – Bruhat yoga Tarangini
Sarweshwar ras – Bhaishajya Ratnavali
Somanath ras – Rasendra Chintamani
Vangeshwara ras – Yoga Ratnakara
Taala Maranam – Bharata Bhaishajya Ratnavali vol-2
Umashambhu Ras – Rasa Ratna samucchya
283 Rasa yogas act on Prameha among 686
yogas
Exclusive Madhumeha hara yogas are 21
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26. Madhumeha
Shareerika Manasika Anya
•Douhruda
Sahaja Apathya Chinta dosha
Beeja Nimittja janya
Sthula
dosha •Krimija
Krusha Pakwashaya
Amashaya Samutha
Samutha
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27. Revalidation of Management
Two entities viz. Shareera Kleda Vruddhi
(Hyperglycemia) and Madhura Mutra
(Glycosuria) are specific w.s.r. to Madhumeha
management.
Increase in blood glucose depends upon the
tolerance and threshold of body and the action
counter depends upon the Vikara vighata bhava
in the body
Urine out put with sugar is lack of re absorption
capacity of kidney
The management is proposed - based upon the
level of pathology embedded in Amashaya
(Pancreatic) or Pakwashaya (Renal) influence
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28. In Amashaya Samutha MM –
Excess glucose absorption from Amashaya because of –
Navanna, Guda vikruti etc. makes initially temporary
increase of glucose levels there by the Santarpanotha
vikara MM develops.
The MM from Amashaya is combated from regulating
food – use of Pathya Ahara and medicines that inhibit the
absorption of glucose from stomach
Best example to block glucose absorption is “Indrayava”
and “Apamarga Tandula”
Here the importance of Vata regulation plays an important
role in terms of regulating the pancreas.
We should not only see that the shareera kleda is re
absorbed from Henley's loop but also re absorption from
gut – which could be controlled by controlling the
Vyanavata
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29. Pakwashaya Samutha MM is a condition which
is developed because of the post digestive
metabolism or protein/fat transformation or at the
interference of Citrus acid cycle which in turn
excreted through kidney
Mainly the action which regulate the fat
metabolism and additional glucose release in to
the blood as “Shareera Kleda” has to be
controlled by either burning it or eliminating it.
Here the management which is said is –
Virechana – Mootra virechana. Such as Asana –
Pashanabheda – Punarnava etc. along with
Anulomana – Virechana for Vata
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30. Krimija Madhumeha – a uncommon name –
practically observed should be treated by the
Krimihara – pramehahara – medohara –
Brumhana – Amedskara such as – (used in
Prameha & Madhumeha management)
Nisha – Amalaki – Akuli combination
The drugs such as – Vidanga etc.
The drugs acting on skin – Manjista etc
ºÉ´ÉǺªÉSÉ ¤Érù¨ÉÚjÉÉhªÉɨÉänùºEò®úÉhªÉ ¤ÉÞƽþhÉÉxªÉÎMxÉnùÒ{ÉxÉÉÊxÉ ¤É±ÉVÉxÉxÉÉÊxÉ +zÉ{ÉÉxÉÉÊxÉ
-+¹]õÉÆMÉ ºÉÆOɽþ ÊSÉÊEòiºÉ 14/2
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31. Dhatukshaya janya MM managed with the Dhatu
Pusti kara bhavas
Avaranajanya MM treated by controlling Vata
Chintajanya MM pacified by controlling Vata,
counseling and relieving from causative factors
Vastijanya MM (Hexosis) (defect of Hexose
transport or active Na+-glucose co-transporters
(SGLT) and the facilitative glucose transporters)
even though not new a condition, where the
glycosuria is observed with out rise of blood sugar –
shareera kleda because of filter disturbances in the
kidney
In the management of MM the role of Vanga and
Vatsaka are memorable
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32. Present trends of utilising hypoglycemic
agents to regulate the disease may give
temporary hypoglycemic conditions but the
understanding of the “Vikara Vighata Bhava”
and utilising them in right way offers the MM
management in full length.
Much to confer on Madhumeha and Diabetes
and to unveil – a never end saga
It is my privilege to speak on this topic at
“World Diabetic Capital” - Hyderabad
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