Prameha in terms of Diabetes Mellitus, Metabolic syndrome and ...

492 SHARMA AND CHANDOLA1. A certain defect in the sperm and ovum (referred to as BijaDoshaJ, which results in a genetic disorder or geneticpredisposition to disease.In regard to Prameha, Charaka Samhita mentions thatexcessive indulgence in Madhura Rasa (foods/drinkswith a sweet taste) by the parents is the chief cause ofthis chromosomal damage to the sperm and ovum. (InAyurveda, foods/drinks with a sweet taste include sugar, milk, butter, rice, and breads.).2. An intrauterine environment that negatively affects the development of the fetus due to the mother's diet, lifestyle,or adverse psychologic state during pregnancy. Thiscongenital aspect can trigger the disease process forwhich there is a genetic predisposition.Regarding Prameha, the overindulgence of MadhuraRasa by the mother during pregnancy is likely to triggerPrameha. Lifestyle factors include laziness or a sedentarylifestyle, and psychologic factors include depression.The diet, lifestyle, and adverse psychologic state of themother during lactation may also play a decisive role in precipitating Pramchn in the infants. In addition, excessive intakeof Madhura Rasa during childhood can contribute to the onsetof Pramelm in children who are genetically predisposed. Thus,hereditary predisposition and unwholesome dietary and lifestyle choices, especially the excessive intake of Mndhiira Rasa,can play a combined role to cause hereditary Prameha.The description of Sahaja Prameha in Sushruta Samhita andJatah Pramehi in Charaka Samhita are quite similar to that oftype 1 diabetes (also known as insulin-dependent diabetesmellirus or juvenile-onset diabetes). Jatah Pramehi Madlmrnehino,as defined in Charaka Samhita, correlates with type 1diabetes beginning in early childhood.Apathyanimittaja Prameha (Acquired)The acquired form of Prameha is referred to as Apathyanimittaja Prameha. The description of Apathyanimittaja Prameha inSitshruta Samhita is very similar to that of type 2 diabetes (alsoknown as non-insulin-dependent diabetes mellitus or adultonsetdiabetes). The types of food and drink likely to precipitatethis disease have been enumerated in all the classical Ayurvedictexts.1"4 These are briefly listed below, along with lifestylefactors and psychologic factors that lead to the onset of Prameha:and Vataja Prameha?'2-4 Ayurveda has identified a progressionof Prameha through several stages. In the initial stage, Kaphais in excess, which vitiates Meda (fat) and Kleda (body fluid),thereby precipitating Kaphaja Prameha. Further progressionresults in Kshaya (loss) of Kapha. Pitta then predominates,which vitiates the blood (Rakta), precipitating Pittaja Prameha.Further progression results in loss of Pitta. This leads to vitiation of Vata, which drags vital substances/vital essenceout of the body through the urine, precipitating Vataja Prameha.' Ayurveda also specifies that any of these three types ofPrameha can be precipitated directly, depending upon geneticpredisposition and improper diet and lifestyle.Correlating the Dosliic classification of Prameha with the etiological,Kaphaja and Pittaja Prameha are always ApathyanimittajaPrameha (acquired), while Vataja Prameha can be either hereditary or acquired. If Kaplwja and Pittaja Pramehn are not managedproperly, in due course of time they lead to Madhwnelia (asubtype of Vataja Prameha), which is a terminal stage of thedisease mat is said to be incurable.1'6 This disease can be equatedwith the terminal stage of type 2 diabetes, which has progressedinto insulin-dependent diabetes. It has been observed that in thePittaja stage of Prameha, mere is a tendency toward moderatehyperglycemia, which may be due to increased adrenal medullary and cortical activities. In Vaiaja Prameha, there may besevere hyperglycemia with hypoinsulinemia.7Correlating Prameha with obesity, metabolic syndrome,and diabetes mellitus, the early manifestation of the diseaseprocess in these conditions, with carbohydrate/ lipid, andprotein metabolism disturbances accompanied by glycosuria,proteinuria, etc., correlate with Kaphaja Prameha, which can beeasily controlled and cured. The inflarmnatory, hepatic, andgallbladder complications, and lipid and blood abnormalitiesare much more in line with the description of Pittaja Pramehn,which can be managed. The advanced stage of disease, withmetabolic disturbances associated with loss of immunity,correlates with type 2 diabetes that has progressed into insulin-dependent diabetes, and correlates with the hereditaryform of type 1 diabetes, which both correlate with VatajaPramelw. Both of these are incurable as described in Aywveda.Ayurveda describes 20 subtypes of Prameha on the basis ofgross urinary characteristics and clinical manifestations. Theseare divided into 10 subtypes of Kaphaja Prameha, six subtypes ofPittaja Prameha, and four subtypes of Vataja Prameha. Followingis a description of the etiological factors (dietary, lifestyle, and1. Dietary factors: Excessive intake of yogurt, meat of psychologic) for tb the three Doshic categories of Prameha, and aaquatic animals, milk, new (not aged) grains, foods/ description of the lurinary changes for the 20 subtypes.drinks containing sugar and jaggery (an unrefined formof cane sugar), cold foods, sweet foods, sour foods, Kaphaja Pramehaunctuous (oily) foods, liquid foods, foods that are heavyto digest, and slimy foods. *@ 1. Dietary factors2: Hm/nnaka (a type of millet grain), Yctvahi2.-Lifestyle factors: Sedentary lifestyle, excessive sitting, (a variety of barley), Avem saliva Linn, (a variety of oats),excessive sleeping, sleeping during the daytime, lack of Chnnaka Chanaka {Pan (Panicum miliaccum Linn., a type of millet grain),exercise, and laziness. Uddalaka llddalaka (Pa- (Paspahtm scrobicufatitm Linn., kodo millet),3. Psychologic factors: Disturbance in mental health caused Naishadha (a type of millet grain), Itkata (Sacchm'um speby extremes of psyche such as Vishada (depression) and cies)/ cies), M.ukundt b/lukitndaka (a type of rice), Mahavrihi (a type of rice),bipolar disorder. Prmnodaka^ (a type of rice), Sugandhakn (a type of- rice),Harenu (Pisum sativum Linn., green peas), Maslia (Vignamungo Linn., urad da! [a legume]), the meat of domestiDoshic Classification of Pramehacated, marshy, and aquatic animaPrameha has been classified according to the predominantDosIuj in the disease process. Ayutveda describes three groupsof basic clinical distinctiveness, which are Kaphnja, Pittajn,