Madhumeha

• The term Madhumeha is used interchangeably with Prameha, but it is one among the 4 Vataja Prameha.
• Prameha is one of the eight Maharoga described in Ayurveda.
• All types of Prameha, if not treated properly and on time, or if neglected, turn into Madhumeha (the advanced stage of Prameha).

Prameha

Literally, Pra = abundant, Meha = passing of a large quantity of urine.

• Although the main presenting symptom of the disease is excessive and sweet urine, it involves all three doshas and 10 dushyas, including Shukra and Oja.
• Ikshumeha and Sheetameha (types of Kaphaja Prameha) have mutra madhurya (glycosuria) as a presenting feature, which causes dhatukshaya and vitiation of Vata, resulting in Madhumeha in the long run.
• Similarly, Kapha-Pitta kshaya in a Kapha-Pitta pramehi, associated with chronicity and dhatukshaya, leads to aggravation of Vata, resulting in Madhumeha (Vataja Meha).

Etiology of Prameha

• Enjoying sedentary habits and the pleasure of sleep excessively
• Excessive use of yoghurt and its preparations
• Meat juice of domestic, aquatic and marshy animals
• Milk and its preparations
• Newly harvested cereals
• New / fresh wines and preparations of jaggery (cane sugar preparations)
• All other Kapha-aggravating factors

10 Dushyas in Prameha

Dosha

Kapha, Pitta and Vata (in sequential order)

Dushya

Meda, Rakta, Shukra, Ambu (sharirika kleda), Vasa, Lasika, Majja, Oja and Mamsa

Classification of Prameha according to dosha and prognosis

Kaphaja – 10 types

Sadhya (curable) due to samakriyatva and Meda dhatu not being totally dushita.

Pittaja – 6 types

Yapya (manageable) due to vishama kriyatva, moderate dushti of Medo dhatu and samsrita dosha in medosthana.

Vataja – 4 types

Asadhya (incurable) due to gambhira dhatu ashraya, severe dushti of dhatus and viparita kriyatva.

Classification of Prameha according to etiological causes

1. Sahaja / Jatapramehi (hereditary)

Due to beeja dosha; incurable. The patient is usually krisha (lean).

2. Apathyanimittaja (acquired)

• Avaranajanya and Dhatu-apakarshanajanya – due to avarana of Vata by Kapha and Pitta, and due to vitiation of Vata by dhatukshaya
• Santarpanajanya and Apatarpanajanya
• Anilatmaka and Kaphasambhava

Samprapti of Prameha

1. Nidana sevana
2. Dosha dushti
3. Dushta dosha enters Meda dhatu
4. Meda vilayana due to Pitta
5. Kleda vriddhi
6. Excess kleda shifts to Basti
7. Gradually involves other dhatus as well
8. Involvement of other doshas also
9. Prameha rogotpatti

Madhumeha

• One of the Vataja Prameha.
• Literally, Madhu = honey, Meha = urine.
• The disease in which the urine is similar to honey in colour, taste, smell and consistency.
• Synonyms: Kshaudrameha, Ojomeha.
• Chronic and incurable in nature.

Madhumeha – Nidana

• All Prameha, on being neglected or not treated properly, turn into Madhumeha.
• All things that produce excessive Kapha, Meda and Mutra are the etiological factors.
• All aahara-vihara having snigdha, sheeta, guru, picchila, madhura and slakshna properties vitiate the dushyas and cause Madhumeha.
• These factors mainly cause an excessive burden on metabolism at the cellular level, resulting in intermediate metabolites, which lead to excess production of meda, lasika, mutra and sweda, and deposition of meda at various sites.

Madhumeha – Purvarupa

• Burning sensation in the palms and soles
• Body (skin) becoming unctuous and slimy
• Heaviness in the body
• Urine is sweet, bad smelling and white in colour
• Stupor
• Debility
• Profound thirst
• Dyspnoea
• More accumulation of dirt on the palate, throat, tongue and teeth
• Hair of the head matting together, and excessive growth of hair and nails

Madhumeha – Rupa

• The general feature of the diabetes syndrome is the passage of profuse and/or turbid urine; the urine becomes like honey and the entire body becomes very sweet.
• Sushrutacharya also says that Sahajameha rogi are usually krisha (thin built), whereas Apathyanimittaja rogi are usually sthula (obese).

Samprapti of Madhumeha in the light of Kriyakala

Prameha – Chikitsa

Chikitsa sutra as per Charaka

• Sthula and balavan prameha rogi are subjected to samshodhana first, followed by santarpana, whereas krisha and durbala rogi are subjected to brimhana chikitsa.
• Samshodhana-ayogya pramehi should be treated by shamana.
• Mantha (sattu mixed in water), kashaya, powder of yava, avaleha and laghu food should be given to pacify the doshas.

Formulations

Classical formulations and their sources

• Baladi Churnam Kashaya – Harita Samhita
• Gokantakadyavaleha – Bhavaprakasha
• Kharpara Rasayanam – Rasa Ratna Samucchaya
• Manjishthadyam Ghritam – Gada Nigraha
• Simhamrita Ghritam – Chakradatta
• Khadiradi Kashaya – Gada Nigraha
• Pashanabheda Paka – Yoga Ratnakara
• Asanadi Yoga – Bhavaprakasha
• Indra Vati – Rasendrasara Sahasrayoga
• Vedavidya Vati – Bharata Bhaishajya Ratnakara, Vol. 4
• Bahumutrantaka Rasa – Sahasrayoga
• Mrigamriganka Rasa – Rasarajasundaram
• Meha Kesari Rasa – Brihat Yoga
• Pramadananda Rasa – Brihat Yoga Tarangini
• Sarveshwara Rasa – Bhaishajya Ratnavali
• Somashambhu Rasa – Rasa Ratna Samucchaya

Yogasanas

• Utthita Trikonasana
• Parivritta Trikonasana
• Prasarita Padottanasana
• Jathara Parivartanasana
• Pavanamuktasana
• Viparita Karani
• Bhujangasana
• Dhanurasana
• Mandukasana
• Paschimottanasana
• Ardha Ushtrasana

Pranayama

• Nadishodhana / Anuloma Viloma Pranayama
• Bhramari Pranayama

Kriyas

• Agnisara Kriya
• Kapalabhati
• Cyclic Meditation – Avartana Dhyana

Pathya Aahara (recommended diet)

Shooka Dhanya

Jeerna Shali, Shashtika, Kodrava, Yava, Godhuma, Uddalaka, Shyamaka

Shimbi Dhanya

Chanaka, Adhaki, Kulattha, Mudga

Shaka Varga

Leafy vegetables with a predominance of tikta-kashaya rasa; Patola, Karavellaka, Shigru

Phala Varga

Jambu, Dadima, Shringataka, Amalaki, Kapittha, Tinduka, Kharjura, Kalinga, Navina Mocha

Mamsa Varga

Vishkira mamsa, Pratuda, Jangala mamsa

Taila Varga

Danti, Ingudi, Sarshapa, Atasi

Kritanna Varga

Apupa, Saktu, Yavodana, Vatya, Yusha

Others

Madhu, Hingu, Saindhava, Maricha, Lasuna

Pathya Vihara (recommended lifestyle)

• Walking as much as possible
• Travelling on elephants and horses
• Different plays and games
• Practice of different forms of martial arts
• Roaming in different places other than temples, using an umbrella
• Following Sadvritta
• Dry massage (Udvartana)
• Bath (Snana)
• Yoga

Apathya Aahara (foods to avoid)

Shooka Dhanya (cereals)

White newly harvested rice (within one year) and its preparations, aromatic rice (Basmati), maida and its preparations – bread, noodles, pasta, maida biscuits, murukku, puri, jalebi

Shami Dhanya (pulses)

Black tila (sesame), Masha (urad / black gram) and its preparations, Rajamasha (cowpea), Matar (pea)

Mamsa Varga (non-veg)

Gramya-audaka-anupa rasa (meat soup of domestic, aquatic and marshy animals), meat soup of pork, buffalo, fish etc.

Phala Varga (fruits)

Banana, custard apple, jackfruit, grapes, dates, plum, pineapple, mango, papaya, watermelon, guava, sapota

Shaka Varga – Kanda (tubers)

Potato, sweet potato, beetroot, cabbage and their preparations

Madya Varga (drinks)

Nava madyapana (freshly brewed alcoholic drinks), sweet alcoholic drinks; better to avoid all kinds of alcohol

Pana (water / beverages)

Varsha ritu jala (rain-season water), soft drinks, soda, cold drinks, sweet fruit juice

Gorasa Varga (dairy products)

Dugdha (milk), Dadhi (curd), butter, cheese, Ghrita (ghee), milk preparations e.g. paneer, kheer, ice cream

Ikshuvikara

Jaggery, sugar and their preparations

Navanna

New / fresh grains and cereals less than one year old

Apathya Vihara (lifestyle to avoid)

• Atimatra sevana (excessive eating)
• Aasyasukham (enjoying comfortable sitting or luxury)
• Swapnasukham (enjoying the pleasure of excessive sleeping)
• Avyayama (lack of exercise and physical activity)