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

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590SH ARM A AND CHANDOLAScvntarpnnn and Brimhnna, for patients with Vaiajn Framdiu.'1"*Santarpana refers to a highly nutritious, high-calorie dietintended to increase weight, and Brimhcma likewise refers toincreasing the body bulk or weight.Dietary managementAwiirvcda considers diet to be one of the primary pillars ofhealth. Food is an imperative internal factor that accounts forhealth as well as disease. As Hippocrates said 2000 yearsago, "Let rood be your medicine and medicine be yourfood."6 The proper diet imparts physical strength and help?diminish the morbidity of the Doshas, thereby maintainingequilibrium of the bodily tissues. Eating a proper diet is a keystep in preventing and controlling Apathyanimitlaia (acquired) Prtimeha. The role'of Ashta Aaham Vi'dhivibhcsluf andAnyatana Ankara Vidriwidharaf (dietetic regulations) has primary importance among the multiple preventive aspects ofPramehn. - @, '"What you eat." The prime aspect of the dietetic reûhtionscan be referred to as "what you oat." Patii-n^ \ ithPrnmeha must cat a diet that pacifies the disease.1 The bestfoods to eat are those that are not sweet, not too oily, luvethe ability to mitigate Kaphn and Mcda, and an? nourishing.Foods and drinks that arc sweet in taste, such as dairyproducts, Ikshu (sugar cane), sugar products, foods withGuru (heavy) quality and Shceta (cold) quality (such as icecream), Aâdya (alcoholic beverages and wines), and so onshould be avoided since they further provoke Kriphn andMeda.In the diet, first and foremost importance should be givento Yava (barley).3 A preparation called Apupa (a type of cake)made with barley can be eaten. Research, shows the.consumption of barley kernels and products made from baileyflour enriched with /J-glucan improves glucose tolerance,reduces insulin responses, and lowers inflammatory markers.7"10 Preparation of food from barley grain soaked' over-@ night in a decoction of Triphaln [an herbal mixture comprisedof Phyilanthus emblica Linn., Termirialia bellirica (Gaeitn.)Roxb., and Terminalia chebu'.a (Gaertn.) Retz.] helps mitigatePrameha. Research on Triphala and the herbs that comprise; ithas shown beneficial antidiabetic effects, In a study on-ratswith alloxan-induced diabetes, Triphalz reduced thi bloodglucose level significantly. It also scavenged hydibxy) andsuperoxide radicals in vitro and inhibited Upid' peroxideformation.11 Keeping lipid levels and their oxidation in checkis an important aspect in the management of obesity,, metabolic syndrome, and diabetes. Research on Arrfahiki. (Amla;Phyilanthus emblica; also known as Emblica oficimlis Cacrtn.)shows that it has antidiabetic, hypolipidemic, and antioxidantproperties.12 Amla reduced lipid peroxidatior; andstrongly inhibited production of advanced gly cosy kitedendproducts in rats with streptozotocin-induced d iabctes.1-1 Jnaging rats, Amla prevented dyslipidcmia and oxidativestress.14 Terminalia belcrka reduced alloxan-induced hyperglyceiniaby 50% in rats and significantly decreased oxidativestress.15 In a study on experimental myocardial injury inducedby isoproterenol, pretreatment with T. cliebula extract decreased lipid peroxide formation and ameliorated the effect oi:isoproteienol on myocardial marker enzymes, indicating areduction in myocardial necrosis.10In addition to bailey, preparing food from the seeds ofVenn (bamboo) and Godhooiim (wheat) soaked overnight in adecoction of Triphala may also be beneficial for Prameha.Studies conducted on extracts of bamboo (Bmnbusa denrfrocalaimts)have demonstrated hypoglycemic effects* ina 1! oxan-induced diabetes in rabbits1' and rats.18 With regardto wheat, foods with a low glycemic index and foods rich inwhole grain are associated with a reduced risk of metabolicsyndrome, type 2 diabetes, and cardiovascular disease.1 ~21A possible mechanism relates to the colonic metabolism ofindigestible carbohydrates, with a link between gut microbialmetabolism and key factors associated with insulin resistance.7-3An abundance of research has been conducted on theh'j.iltii-promoting properties of spices, including antidiabetic,a iiti1 ixidant, and lip id-lowering properties.""""25 Turmeric(Cifrcuina longa Linri.) and curcumin, the pigment that givestnum&ric its orange-yellow color, have been extensively ressr.V&hcdin relation to diabetes. More than 35 years ago, ity.'&k ::hown that curcumin can modulate blood glucose levelsiiVfcrftents with diabetes.26 Current research has shown mattutmeric extracts suppress blood glucose levels in mice withEypc*2 diabetes,27 prevent lipid pcroxidation and aortic fattystreak formation ui rabbits,28 and increase high-density lipo'profein(HDL) cholesterol.'1'1 Curcumin significantly decreases blood cholesterol and triglycerides in rats withstrepiozotocin-induced diabetes.""0 Tetrahydrocurcuinin, anactive metabolite ot curcumin, significantly reduces bloodglucose, increases plasma insulin, and reduces lipid peroxidation,cholesterol, and triglycerides in rats with diabetes.31Ciircumin is an effective irnnrunornodulator/'"" and it reducesthe1 impact of advanced glycosylated endproducts m diabetes.26 In Ayurocda, Haridrn (turmeric) and Amalaki are considered one of the best simple herbal combinations tomanage Prameha.3 They can be taken in powder form or aspart of the diet since Hiiridra is a spice commonly used in thepreparation of various dishes and Amalaki is a seasonal fruit.'. Additional spices with antidiabetic effects include cinnamon; Jeeniku (Cuminum cyminum Linn., cumin), Dhanyaka(Cori.wdnim sufivum Linn., coriander), Sliunthi (Zingiber ofjiciniile,Rose.,, ginger), Metljika (TrigomtUa foetium-graecumLinn., fenugieek), and Rnsona (Alliuni sntivum Linn., garlic).Cir.v-amon reduces serum glucose, @ triglycerides, and lowitensitylipoprotein (LDL) in patients with type 2 diabetes.33Curiiin reduces levels of blood glucose, glycosylated hemoglbl5ii"i,.plasma diolesterol, and. triglycerides in rats withsaUo>can-induced diabetes. It was more effective in treatingdiabetes than the idrug glibaiclamide.34 Coriander significantly decreased lipid peroxide, lev els and increased the activity, of antioxidant. enzymes in rats fed a high-fat diet.3r; Italso'significantly decreased levels of total cholesterol andtriglycerides, and increased levels of HDL cholesterol.30 Similar pharmacologic actions are seen with ginger. It reducesRpid levels, atherosclerotic lesions, and lipid peroxide levels:37 Fenugreek significantly reduces fasting blood glucose,trigiyecrides, and very
PRAMEHA IN AYURVEDA, PART 2 591and triglycerides.40 In rats with diabetes, it displayed immunomodulatbryand neuroprotective actions,41 reducedoxidative stress,42 and showed a significant effect on keycarbohydrate metabolic enzymes.4"1 Garlic lowered fastingblood glucose and serum triglyceride levels in a double-blindplacebo-controlled study on patients with type 2 diabetes.44In rats with streptozotocin-induced diabetes, it significantlydecreased serum glucose, total cholesterol, and triglycerides.The antidiabetic effect was greater than that of glibenclamide.'15Garlic significantly decreased total cholesteroland LDL, and significantly raised HDL, in a randomized,double-blind, placebo-controlled study on male patients withmild hypercholesterolemia.116 Similar results were seen in astudy.'on patients wittvcoronary artery disease, hi whichgarlic significantly reduced total serum cholesterol arid tri-'"glyceridiis, and significantly increased HDL/1'Vegetables'that mitigate Pramehn include Kiiraveflaki (Momoniiaicharantia Linn.; bitter gourd; bitter melon) and Paloh(Trichcsp.nthes artguina Linn.). M. dwrnntia administered orallyproduced a significant hvpoglyccmic effect in rabbits with alloxan-induceddiabetes.45 In rats with aHoxan-induced diabetessubjected to a chronic sucrose load, M. clmrantia maintainednormal glucose levels, reduced triglyceridc and LDL levels,and increased @ HDL levels. It also improved the antioxidantstatus, as evidenced by low levels of thiobarbituric acidreactivesubstances and normal levels of reduced glutathionc.Upon termination of the treatment, the rats were underoxidative stress and reverted back to diabetic conditions.49Feeding dried bitter gourd powder to rats with streptozotocininduceddiabetes decreased fasting blood glucose by nearly30%.5D An aqueous extract powder reduced fasting bloodglucose in rats with diabetes by 48%, an effect comparable tothat of glibenclarnide.''1 A methanol extract of bitter gourdnormalized blood glucose, reduced triglycerides and LDL, andincreased KDL in rats with diabetes. Discontinuation of theextract resulted in reversion to n diabetic stated2 Ai/uiivJa advocates using Tikia Shake?''' (green ieafy vegetables) as a maincomponent of the diet for patieiits with Pramelui. Judiciousadministration of legumes and grains such as Kodmva {kodomillet), Mudga (green gram, moong dal), Kulctha (Macrolylomauniflqrum Linn., horse gram), Adhaki Beeja (pigeon peas, tcor@dril), and so orr may be helpful. Oils such as Sarshapa Tail/i*4(mustard oil) and Ingiidi [Bnlanites asgyptinca (Linn.) Del.] can beused to prevent any further increase in lipicl levels.Ayurveda does not prohibit meat in .the diet of Pramclwpatients; however, frying of the meat is not recommended."Harlna (venison) and Shashakn (rabbit) are the recommendedmeats for Pramehn patients. The meat of domesticated animals is not recommended, and tliis correlates with currentresearch findings. Consumption of red meat and processedmeats are associated with an increased risk of diabetes inwomen.^5""57 Frequent consumption of processed meat hasbeen associated with an increased risk of diabetes in men.58A systematic review and meta-analysis oi studies on red andprocessed meats concluded that the consumption of processed meats is associated with a higher incidence of coronary heart disease and diabetes mellitus.59Ushnam Aiweeynt refers to eating a diet mat is warm. Thisis recommended since it will ease Krtpha, normalize Vain, andstimulate Pitta to intensify the power of digestion. However,food that is. extremely hot should n.o.t be. eaten. Leftovers orold food that is reheated should also not be eaten.Ayurveda recommends the use of Amtpana (an adjuvant)along with the dier and any herbs that are being utilized. Inaddition to the action of disease correction, the adjuvant actsas a carrier to transport the therapeutic phytochemicals intothe system, and may even act as a catalyst in the interactionof the various phylochemicals. Sarodaka and Kushodcka aredrinks that can be employed in this regard.3 Sarodaka is waterprepared from Khndira [Acticia catechu (Linn, f.) Willd.] thathas been boiled, then cooled down. Kushodnka is water prepared from Kusha [Destnostachyn bipiimata (Linn.) Stapfj thathas been boiled, then cooled. These drinks can be taken withmeals, with herbs, cr whenever the patient feels thirst. Theyare particularly helpful for obese individuals who are suffering from Prameha, since they weaken both Kapha andMeda. Another recommended drink is called Raga. It isusually prepared from, small- sour fruit." such as Ajn':;'aki,Knpuha5* {Fcrouia linonhi (Linn.) Swing1.;.1!, Jr.nibu {Syzygiv.nicumird '(Linn.) Skecls], ru\ so cL\>!o'.:j with a modestamount of sr.lt."How much you eat." Another consideration in tiis dietetic regulations is "how much you eat." The recommendation in this regard is Matnwat Asneeyr.t, which means tlvjfood should' be eaten in due measure:1 The quantity of foodthat is appropriate is not the same, for everyone. It variesaccording to the individual's psychophysiologic constitutionand Agni (digestive and metabolic process). The. idealamount of food is determined by the individual's level ofsatiety. Gum Aaluira (foods with a heavy quality) should beeaten to half of one's satiety level, whereas Laghit Aaham(foods with a light quality) can be eaten until the individualread^s Adi satiety.* With regard to optimal digestion of ameal, one can visualize the stomach as being divided intothree parts: One third should be filled with solid food, l -*third with 1 ^ id 1 r \ A n d rcn it t rjallow for tl ur j, \ \ r cF il rs n he d ^process.3 The prjtt incj.it off 1 o the udiv 1 inot produce undu p ro t tH torn ai v ill not le itin discomfort during activities such as waiting, standing,sleeping, talking, and so on; and will satisfy .the individual'shunger and thirst. .Eating-an excessive.amount of food,-mayprovoke all ihe.Dcrhas, and-.catiiig.,^.insufficient amountwill uiipairi the@ ";.:;'ijrrjijî of-i'.ifi.D.vsâ (trw fundamental ,principles th;.t enppoit the various bodily Cs5i".cs)."When you eat." @ For optimal digestion, it .is important toconsider,"when you eat.'.' Jeerne. Asneeyai refers to the recommendation that one should eat only after the previousmeal has been fully digested. Untimely ingestion and overeating leads to accumulation of.the Doshns and overwhelmsAgni (the digestive power), which contributes to the development of Apnthyan'mnttaja (acquired) Prameha. Digestion ofthe previous meal can b
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Prameha in terms of DiabetesMellitu
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Purvarupa (Premonitory Symptoms)of
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Metabolic syndrome• Central obesi
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Diabetes mellitus• Diabetes melli
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Diabetes as Prameha &MadhumehaSarva
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Diabetes as Prameha &MadhumehaMadhu
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Pathogenesis of Pittaja PramehaPidi
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Dosha-Dushya Samgraha• Ayurveda d
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Early diabetes (Kaphaja Prameha) co
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Chronic diabetes (Vataja Prameha)
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Investigations• Fasting Blood Sug
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Role of PsychosomaticConstitution (
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Physiological ExaminationPoint ofEx
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Ponderal Index and Body Surface Are
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Neurohumors in different psychosoma
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Neurohumors in different psychosoma
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Variations in Neurohumors in differ
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Dietary Management• The best food
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Sr.No.Pramehahara and Madhumehahara
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26. Ushira Vetiveria zizanoidis + +
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56. Kiratatikta Swertia chirayita +
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86. Mushkaka Schrebera swietenioide
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Recent advances• Shilajit (Asphal
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• Meshasringi (Gymmeme sylvestre
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C.tamala (Tejapatra)55
Page 57 and 58: Effect of C. tamala (Tejpatra) on F
Page 59 and 60: Immediate effect of C. tamala on fa
Page 61 and 62: Effect of Pterocarpus marsupium inm
Page 63 and 64: Effect of Pterocarpus marsupium alo
Page 65 and 66: Effect of Cassia auriculata (Avarta
Page 67 and 68: Effect of Azadirachta indica (Nimba
Page 69 and 70: Effect of Ficus glomerata (Udumbara
Page 71 and 72: Effect of Polyherbal Compound (Mame
Page 73 and 74: Student’s Paired ‘t’ Test** H
Page 75 and 76: Role of Constitution in treatment r
Page 77 and 78: Response of Chandraprabha vati inDi
Page 79 and 80: Response of treatment in Diabeticsw
Page 81 and 82: Response of treatment in Diabetics
Page 83 and 84: Psychic Symptoms observed in100 pat
Page 85 and 86: Effect of Sarasvata Formulation onp
Page 87 and 88: Dose: 1 gm thrice a day before meal
Page 89 and 90: Management of Complications of DMCe
Page 91 and 92: Diabetic EnteropathyBilvaKutajaHari
Page 93 and 94: Erectile DysfunctionKapikacchuAshva
Page 95 and 96: Diabetic CarbuncleMahamanjisthadi K
Page 97 and 98: Conclusion• Ayurvedic drugs shoul
Page 99 and 100: ConclusionContd..• Mental health
Page 101 and 102: THE JOURNAL OF ALTERNATIVE AND COMP
Page 103 and 104: PRAMEHA IN AYURVEDA, PART 1 4932. L
Page 105 and 106: PRAMEHA IN AYURVEDA, PART 1 495ity)
Page 107: THE JOURNAL OF ALTERNATIVE AND COMP
Page 111 and 112: PRAMEHA IN AYURVEDA, PART 2Box 1. R
Page 113 and 114: PRAMEHA IN AYURVEDA, PART 2595Ayurv
Page 115 and 116: PRAMEHA IN AYURVEDA, PART 259766. K
Page 117: PRAMEHA IN AYURVEDA, PART 2 599forc
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