492 SHARMA AND CHANDOLA1. A certa<strong>in</strong> defect <strong>in</strong> the sperm <strong>and</strong> ovum (referred to as BijaDoshaJ, which results <strong>in</strong> a genetic disorder or geneticpredisposition to disease.In regard to <strong>Prameha</strong>, Charaka Samhita mentions thatexcessive <strong>in</strong>dulgence <strong>in</strong> Madhura Rasa (foods/dr<strong>in</strong>kswith a sweet taste) by the parents is the chief cause <strong>of</strong>this chromosomal damage to the sperm <strong>and</strong> ovum. (InAyurveda, foods/dr<strong>in</strong>ks with a sweet taste <strong>in</strong>clude sugar, milk, butter, rice, <strong>and</strong> breads.).2. An <strong>in</strong>trauter<strong>in</strong>e environment that negatively affects the development <strong>of</strong> the fetus due to the mother's diet, lifestyle,or adverse psychologic state dur<strong>in</strong>g pregnancy. Thiscongenital aspect can trigger the disease process forwhich there is a genetic predisposition.Regard<strong>in</strong>g <strong>Prameha</strong>, the over<strong>in</strong>dulgence <strong>of</strong> MadhuraRasa by the mother dur<strong>in</strong>g pregnancy is likely to trigger<strong>Prameha</strong>. Lifestyle factors <strong>in</strong>clude laz<strong>in</strong>ess or a sedentarylifestyle, <strong>and</strong> psychologic factors <strong>in</strong>clude depression.The diet, lifestyle, <strong>and</strong> adverse psychologic state <strong>of</strong> themother dur<strong>in</strong>g lactation may also play a decisive role <strong>in</strong> precipitat<strong>in</strong>g Pramchn <strong>in</strong> the <strong>in</strong>fants. In addition, excessive <strong>in</strong>take<strong>of</strong> Madhura Rasa dur<strong>in</strong>g childhood can contribute to the onset<strong>of</strong> Pramelm <strong>in</strong> children who are genetically predisposed. Thus,hereditary predisposition <strong>and</strong> unwholesome dietary <strong>and</strong> lifestyle choices, especially the excessive <strong>in</strong>take <strong>of</strong> Mndhiira Rasa,can play a comb<strong>in</strong>ed role to cause hereditary <strong>Prameha</strong>.The description <strong>of</strong> Sahaja <strong>Prameha</strong> <strong>in</strong> Sushruta Samhita <strong>and</strong>Jatah Pramehi <strong>in</strong> Charaka Samhita are quite similar to that <strong>of</strong>type 1 diabetes (also known as <strong>in</strong>sul<strong>in</strong>-dependent diabetesmellirus or juvenile-onset diabetes). Jatah Pramehi Madlmrneh<strong>in</strong>o,as def<strong>in</strong>ed <strong>in</strong> Charaka Samhita, correlates with type 1diabetes beg<strong>in</strong>n<strong>in</strong>g <strong>in</strong> early childhood.Apathyanimittaja <strong>Prameha</strong> (Acquired)The acquired form <strong>of</strong> <strong>Prameha</strong> is referred to as Apathyanimittaja <strong>Prameha</strong>. The description <strong>of</strong> Apathyanimittaja <strong>Prameha</strong> <strong>in</strong>Sitshruta Samhita is very similar to that <strong>of</strong> type 2 diabetes (alsoknown as non-<strong>in</strong>sul<strong>in</strong>-dependent diabetes mellitus or adultonsetdiabetes). The types <strong>of</strong> food <strong>and</strong> dr<strong>in</strong>k likely to precipitatethis disease have been enumerated <strong>in</strong> all the classical Ayurvedictexts.1"4 These are briefly listed below, along with lifestylefactors <strong>and</strong> psychologic factors that lead to the onset <strong>of</strong> <strong>Prameha</strong>:<strong>and</strong> Vataja <strong>Prameha</strong>?'2-4 Ayurveda has identified a progression<strong>of</strong> <strong>Prameha</strong> through several stages. In the <strong>in</strong>itial stage, Kaphais <strong>in</strong> excess, which vitiates Meda (fat) <strong>and</strong> Kleda (body fluid),thereby precipitat<strong>in</strong>g Kaphaja <strong>Prameha</strong>. Further progressionresults <strong>in</strong> Kshaya (loss) <strong>of</strong> Kapha. Pitta then predom<strong>in</strong>ates,which vitiates the blood (Rakta), precipitat<strong>in</strong>g Pittaja <strong>Prameha</strong>.Further progression results <strong>in</strong> loss <strong>of</strong> Pitta. This leads to vitiation <strong>of</strong> Vata, which drags vital substances/vital essenceout <strong>of</strong> the body through the ur<strong>in</strong>e, precipitat<strong>in</strong>g Vataja <strong>Prameha</strong>.' Ayurveda also specifies that any <strong>of</strong> these three types <strong>of</strong><strong>Prameha</strong> can be precipitated directly, depend<strong>in</strong>g upon geneticpredisposition <strong>and</strong> improper diet <strong>and</strong> lifestyle.Correlat<strong>in</strong>g the Dosliic classification <strong>of</strong> <strong>Prameha</strong> with the etiological,Kaphaja <strong>and</strong> Pittaja <strong>Prameha</strong> are always Apathyanimittaja<strong>Prameha</strong> (acquired), while Vataja <strong>Prameha</strong> can be either hereditary or acquired. If Kaplwja <strong>and</strong> Pittaja Pramehn are not managedproperly, <strong>in</strong> due course <strong>of</strong> time they lead to Madhwnelia (asubtype <strong>of</strong> Vataja <strong>Prameha</strong>), which is a term<strong>in</strong>al stage <strong>of</strong> thedisease mat is said to be <strong>in</strong>curable.1'6 This disease can be equatedwith the term<strong>in</strong>al stage <strong>of</strong> type 2 diabetes, which has progressed<strong>in</strong>to <strong>in</strong>sul<strong>in</strong>-dependent diabetes. It has been observed that <strong>in</strong> thePittaja stage <strong>of</strong> <strong>Prameha</strong>, mere is a tendency toward moderatehyperglycemia, which may be due to <strong>in</strong>creased adrenal medullary <strong>and</strong> cortical activities. In Vaiaja <strong>Prameha</strong>, there may besevere hyperglycemia with hypo<strong>in</strong>sul<strong>in</strong>emia.7Correlat<strong>in</strong>g <strong>Prameha</strong> with obesity, metabolic <strong>syndrome</strong>,<strong>and</strong> diabetes mellitus, the early manifestation <strong>of</strong> the diseaseprocess <strong>in</strong> these conditions, with carbohydrate/ lipid, <strong>and</strong>prote<strong>in</strong> metabolism disturbances accompanied by glycosuria,prote<strong>in</strong>uria, etc., correlate with Kaphaja <strong>Prameha</strong>, which can beeasily controlled <strong>and</strong> cured. The <strong>in</strong>flarmnatory, hepatic, <strong>and</strong>gallbladder complications, <strong>and</strong> lipid <strong>and</strong> blood abnormalitiesare much more <strong>in</strong> l<strong>in</strong>e with the description <strong>of</strong> Pittaja Pramehn,which can be managed. The advanced stage <strong>of</strong> disease, withmetabolic disturbances associated with loss <strong>of</strong> immunity,correlates with type 2 diabetes that has progressed <strong>in</strong>to <strong>in</strong>sul<strong>in</strong>-dependent diabetes, <strong>and</strong> correlates with the hereditaryform <strong>of</strong> type 1 diabetes, which both correlate with VatajaPramelw. Both <strong>of</strong> these are <strong>in</strong>curable as described <strong>in</strong> Aywveda.Ayurveda describes 20 subtypes <strong>of</strong> <strong>Prameha</strong> on the basis <strong>of</strong>gross ur<strong>in</strong>ary characteristics <strong>and</strong> cl<strong>in</strong>ical manifestations. Theseare divided <strong>in</strong>to 10 subtypes <strong>of</strong> Kaphaja <strong>Prameha</strong>, six subtypes <strong>of</strong>Pittaja <strong>Prameha</strong>, <strong>and</strong> four subtypes <strong>of</strong> Vataja <strong>Prameha</strong>. Follow<strong>in</strong>gis a description <strong>of</strong> the etiological factors (dietary, lifestyle, <strong>and</strong>1. Dietary factors: Excessive <strong>in</strong>take <strong>of</strong> yogurt, meat <strong>of</strong> psychologic) for tb the three Doshic categories <strong>of</strong> <strong>Prameha</strong>, <strong>and</strong> aaquatic animals, milk, new (not aged) gra<strong>in</strong>s, foods/ description <strong>of</strong> the lur<strong>in</strong>ary changes for the 20 subtypes.dr<strong>in</strong>ks conta<strong>in</strong><strong>in</strong>g sugar <strong>and</strong> jaggery (an unref<strong>in</strong>ed form<strong>of</strong> cane sugar), cold foods, sweet foods, sour foods, Kaphaja <strong>Prameha</strong>unctuous (oily) foods, liquid foods, foods that are heavyto digest, <strong>and</strong> slimy foods. *@ 1. Dietary factors2: Hm/nnaka (a type <strong>of</strong> millet gra<strong>in</strong>), Yctvahi2.-Lifestyle factors: Sedentary lifestyle, excessive sitt<strong>in</strong>g, (a variety <strong>of</strong> barley), Avem saliva L<strong>in</strong>n, (a variety <strong>of</strong> oats),excessive sleep<strong>in</strong>g, sleep<strong>in</strong>g dur<strong>in</strong>g the daytime, lack <strong>of</strong> Chnnaka Chanaka {Pan (Panicum miliaccum L<strong>in</strong>n., a type <strong>of</strong> millet gra<strong>in</strong>),exercise, <strong>and</strong> laz<strong>in</strong>ess. Uddalaka llddalaka (Pa- (Paspahtm scrobicufatitm L<strong>in</strong>n., kodo millet),3. Psychologic factors: Disturbance <strong>in</strong> mental health caused Naishadha (a type <strong>of</strong> millet gra<strong>in</strong>), Itkata (Sacchm'um speby extremes <strong>of</strong> psyche such as Vishada (depression) <strong>and</strong> cies)/ cies), M.ukundt b/lukitndaka (a type <strong>of</strong> rice), Mahavrihi (a type <strong>of</strong> rice),bipolar disorder. Prmnodaka^ (a type <strong>of</strong> rice), Sug<strong>and</strong>hakn (a type <strong>of</strong>- rice),Harenu (Pisum sativum L<strong>in</strong>n., green peas), Maslia (Vignamungo L<strong>in</strong>n., urad da! [a legume]), the meat <strong>of</strong> domestiDoshic Classification <strong>of</strong> <strong>Prameha</strong>cated, marshy, <strong>and</strong> aquatic anima<strong>Prameha</strong> has been classified accord<strong>in</strong>g to the predom<strong>in</strong>antDosIuj <strong>in</strong> the disease process. Ayutveda describes three groups<strong>of</strong> basic cl<strong>in</strong>ical dist<strong>in</strong>ctiveness, which are Kaphnja, Pittajn,
PRAMEHA IN AYURVEDA, PART 1 4932. Lifestyle factors'1: Lack <strong>of</strong> physical activity, excessive 2. Lifestyle factors: Excessive physical exercise, excessivesleep, too much ly<strong>in</strong>g down, too much sitt<strong>in</strong>g, seden- sexual <strong>in</strong>tercourse, excessive use <strong>of</strong> P<strong>and</strong>iakarmatary habits. (AyurveJic purification procedures), suppression <strong>of</strong>3. 1'sychologic factors: Depression. natural urges, fast<strong>in</strong>g, <strong>in</strong>jury, excessive exposure to the4. Subtypes <strong>and</strong> ur<strong>in</strong>ary cl<strong>in</strong>ical manifestations: sun, stay<strong>in</strong>g awake at night.2. -, ., , - @ , 3- 1'sychologic factors: Mental trauma, anxiety, <strong>and</strong> grief.2@ Udakamcha- Clear ur<strong>in</strong>e ,n larger quantity without d ^ ^ u ^.^ man,fatat,0J:odor; patient teels cold sensation while pass<strong>in</strong>g ur<strong>in</strong>e.@ iksiiiivalikaniL'lia2: Very sweet ur<strong>in</strong>e, cool, slightly @ Vasumcha? Ur<strong>in</strong>e conta<strong>in</strong>s Vasa (fat).viscid, turbid due to slimy substances, <strong>and</strong> resem- @ Mujjanu'l<strong>in</strong>-} Ur<strong>in</strong>e conta<strong>in</strong>s Majja (bone marrow). It isbl<strong>in</strong>g the juice <strong>of</strong> sugar cane. described as Sarpimeita <strong>in</strong> Sushntta Samhila 1@ Sti'idnuiwha2: If ur<strong>in</strong>e is kept overnight, precipitate is @ Hi^tiuwha-2 Lasika (lymph) is passed <strong>in</strong> the ur<strong>in</strong>e. Thepresent <strong>in</strong> the conta<strong>in</strong>er. flow <strong>and</strong> frequency <strong>of</strong> ur<strong>in</strong>e is almost cont<strong>in</strong>uous@ SaudrapmsailtmhiC: Literally, Saiidraprasadmeha means (<strong>in</strong>cont<strong>in</strong>ence).a portion <strong>of</strong> the ur<strong>in</strong>e is turbid <strong>and</strong> a portion is clean @ Madhuiiieliar Ur<strong>in</strong>e is astr<strong>in</strong>gent <strong>and</strong> sweet <strong>in</strong> taste,like Sara (undistilled alcohol). Described as Surawclm yellowish--white <strong>in</strong> color, <strong>and</strong> nonunctuous. Ojas2 (tbe<strong>in</strong> Susliruta Samtiita1 <strong>and</strong> Ashtauga llridaya* subtlest material substance <strong>in</strong> the body; tbe essence <strong>of</strong>@ Shuklnmcha : Ur<strong>in</strong>e is white <strong>and</strong> appears as if it is the body; Ojas ma<strong>in</strong>ta<strong>in</strong>s the body's immunity <strong>and</strong>mixed with flour (paste). While pass<strong>in</strong>g ur<strong>in</strong>e the vitality) is passed <strong>in</strong> the ur<strong>in</strong>e. This subtype is depatientfeels erection <strong>of</strong> body hairs. It is described as scribed as Ksliaudnuwha' {ur<strong>in</strong>e with color <strong>and</strong> tastePislilameha <strong>in</strong> Sitslirala Saiiihita.* like honey) <strong>in</strong> Sushruta Samhila.' Slmkrarm'ha2: Patient passes ur<strong>in</strong>e similar to quality <strong>of</strong>semen or semen itself may be mixed with ur<strong>in</strong>e. prakriti (Psychophysiologic constitution) <strong>and</strong> <strong>Prameha</strong>@ Shcctiimciia~: Ur<strong>in</strong>e is very sweet <strong>and</strong> abundant, withlow temperature. ' Praknti is tbe psychophysiologic constitution <strong>of</strong> an <strong>in</strong>-@ Siktamdia2: Patient passes small particles like s<strong>and</strong> <strong>in</strong> dividual <strong>and</strong> is determ<strong>in</strong>ed at the time <strong>of</strong> birth by thethe ur<strong>in</strong>e. <strong>in</strong>dividual's Dosha proportions, f-ach <strong>in</strong>dividual has a@ Shanairraclia2: Flow <strong>of</strong> ur<strong>in</strong>e becomes slow <strong>and</strong> patient certa<strong>in</strong> ratio <strong>of</strong> Vata, Pitta, <strong>and</strong> Kapha that is unique to him/feels difficulty <strong>in</strong> pass<strong>in</strong>g ur<strong>in</strong>e. hcr> as lonS as this 'atio is ma<strong>in</strong>ta<strong>in</strong>ed, the <strong>in</strong>dividual will@Ulamcha1: Ur<strong>in</strong>e is turbid <strong>and</strong> slimy; it is sticky <strong>and</strong> bl' Healthy. If an imbalance occurs <strong>in</strong> the Doshas due tothreads may be demonstrated like gum. improper diet <strong>and</strong> lifestyle or other factors, the beg<strong>in</strong>n<strong>in</strong>g<strong>of</strong> the disease process can occur. The Prakriti <strong>of</strong> an <strong>in</strong>di-Pittaja <strong>Prameha</strong> vidual plays an important role <strong>in</strong> the progression <strong>and</strong>prognosis <strong>of</strong> the disease <strong>and</strong> response to treatment. The1. Dietary factors: Intake <strong>of</strong> Llshmi (foods that are hot <strong>in</strong> prL,dom<strong>in</strong>ant Dosha(s) <strong>in</strong> the <strong>in</strong>dividual's Prakriti affectspotency), sour loods, excessively salty toods, alkal<strong>in</strong>e lho Doshlc mani(estation ,,f tht, d;M,asl, proa.ss. <strong>in</strong> a studvfoods, pungent toods, eat<strong>in</strong>g before the previous meal is l)n prilkrM <strong>and</strong> jiabL.,es mellitus, it was observed that thecompletely digested, eat<strong>in</strong>g mutually contradictory progr(,ssi(m <strong>of</strong> disi,,,se is sUm ,n d,abetic patients withfoods- (these are foods that should not be eaten to- Kaphaja prakril, {Pmfriti <strong>in</strong> which Kapha is the dom<strong>in</strong>antgether, e.g. milk <strong>and</strong> bananas, milk <strong>and</strong> salty loods, @@,,,,,,. ,hl,se pillienls had miW hypi.rg|ycl,mia wilh ra,yogurt <strong>and</strong> sour fruits, etc.). <strong>in</strong>su!m dl,ficicncy. ln contrast, progression is quick <strong>in</strong> di-2. Lifestyle factors: Exposure to very <strong>in</strong>tense heat ol the abL,tl^ hav<strong>in</strong>g Vata~a prakrili {pnknti <strong>in</strong> which Vata is thesun or lire, overexertion. ^ dom<strong>in</strong>ant Dosha); these patients had severe hyperglyeemia3. Psychologic factors: Anger. with hyp
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