ISBN ISSN Vol. 3 Issue: 3 rd July-September 2015

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1 Ayurvedic Management of Madhumeha (Diabetes mellitus) by Shodhan and Shaman Chikitsa A Brief Review Reshma Bhagwan Chavan* 1 Mangal S. Morbale 2 Veena G. Kanthi 3 1. (M.D. Third year scholar) 2. Guide and HOD and PG Director 3. Dean P.G. Dept.of Rasashastra and Bhaishajya, L.K.R Ayurved College, P. G. Training and Research centre, Gadhinglaj, Dist- Kolhapur, Maharashtra *Corresponding author: chavanrashmi19@gmail.com Abstract: Aacharya Charaka described the management of Madhumeha considering the body constitution and body strength of the patient. There are two types of patients, one is having stout body structure with strength and another is having thin body structure without strength. Acharya Sushruta also says that Sahajameha rogi (juvenile diabetes mellitus) is usually thin built while Apathyanimittaja rogi (acquired or dietetic reason diabetes mellitus) is usually observed in obese patients. Ayurvedic science, a boon in today s man life, in which maintenance of health is in the one hand and treatment of disease on the other. It has been described in Ayurveda that ther given treatment cures the disease without any complication and adverse effect. In this article an attempt has been made to highlight the general and specific management of Madhumeha (Diabetes mellitus) described in the classics of Ayurveda. Key words: Ayurveda, Diabetes mellitus, Madhumeha, Shodhan and Shaman Introduction: Diabetes mellitus is a major health problem for the world in the 21st century. In year 2000, the five countries with the largest numbers of persons with diabetes were in India, China, United States, Pakistan & Japan with 32.7 million, 22.6 million, 15.3 million, 8.8 million and 7.1 million diabetic patients respectively which indicates highest number of diabetic 84

2 patients as compare to other country. [1] Today in many ways people have greater opportunities of better life than ever before. Still it is clear that they need to evolve some new strategies or to follow the golden old rules, which are proved for millenniums, in each and every field of life. In spite of all sorts of advancements of science, in this world, man is not able to sail himself in the boat of happy and healthy life. Unnatural ways of life style, increased population and moreover world of machines has created unlimited desires in human mind while on the other hand, it has originated anxiety, anger, hostility and grief directly or indirectly. At least 50% of all people with diabetes are undiagnosed. In spite of advanced medical research, it is still a burning issue in globalization. Recent studies reveal that the prevalence rates are 10-18% in the urban Indian adult population and there is also evidence that the prevalence of type 2 diabetes is increasing in rural population too. [2] In the Samhita the etiological factors mentioned were diet and activity regimen. In developing countries the lifestyle is changed and there was not control on the diet and sedentary life. Acharya Sushruta also says that Sahajameha Rogi (juvenile diabetes mellitus) is usually thin built while apathyanimittaja rogi (acquired or dietetic reason diabetes mellitus) is usually observed in obese patients. [3-5] Nidana of Prameha and Madhumeha: Ayurvedic classics elaborately describes about the general etiological factors of prameha and according to Acharya Charaka, this disease is tridoshik in origin. He classified the etiological factors into two types like Sahaja (congenital) & Apathyanimittaja (acquired). [6] Sahaja type of madhumeha is due to certain defects in Stri & Pumbeeja (Ovum & Sperm) which is said to be matrupitru beejadoshakrita will result in sahajaprameha. Regarding beeja dosha (genetic disorder) it may have its origin from parents of both father and mother i.e.it may be inherited from generation to generation and hence it is an unique example of hereditary disease mentioned in Ayurveda. Apathyanimittaja madhumeha is due to Aptthakar ahar vihar sevana. Etiological Factors of Prameha and Madhumeha: The etiological factors described in Charaka samhita are Asyasukham (pleasure stay or living), Swapnasukham (pleasant and calm sleep in day and night time), Excessive indulgence in Dadhini 85

3 (various preparation of curd in excess quantity), Gramya, Audaka, Anupa Mamsa ( eating meat of domestic, aquatic, wet land animals), Payamsi (excessive use of milk and its different products or excess sweet products containing more glucose), Navannapanam (Newly harvested grains in daily diet and drinks), Gudavaikrutam (various preparation of sugar and jiggery) and other substances which increases Kapha dosha may cause Prameha. [7] The person indulging in food substances having Guru (heavy to digest), Snigdha (oily substances) qualities and excessive indulgence of Amla (sour) & Lavana (salty) rasa substances excessive sleep, sitting in a same place for longer duration, avoiding exercises and excess thinking or dipression. He also mentioned that the people who are not performing the Shodhana process (Panchakarma) in proper season and in a proper time lso suffers form madhumeha. [8] Acharya Sushruta added Snigdha (unctuous), Medya (fatty) and drava (liquid) type of food in causation of the Medhumeha in addition to Charaka.[9] According to Vagbhatta, the dietetic items consumed daily and activities which increase Meda, Mutra and Kapha are supposed to additional causes of Prameha. [10] Acharya Vagbhatta describes a slight difference in Prameha and Madhumeha in following ways. Acharya Vagbhatta describes Prameha as frequent and copious urination with turbidity in sanskrita it is Prabhutavil Mutrata which is cardinal symptom of Prameha. The Madhumeha is a clinical entity in which patient passes large quantity of urine similar which looks like Madhu (honey). The urine has Kashaya (Astringent ttaste) and Madhura (Sweet taste). The texture is Ruksha (Dry texture), Honey like colour and the body attains sweetness. [11-12]. Acharya Sushruta narrated the term Kshaudrameha, in place of Madhumeha. The Kshaudra is nothing but one of the varieties of Madhu. So it is clear evidence that Kshaudrameha is resembles to Madhumeha. Acharya Sushruta has also narrated that untreated Prameha in its initial stage gets converted into Madhumeha and becomes incurable. [13] In modern science on the basis of etiological factors mentioned as above by all ancients Acharyas Madhumeha can be correlated with Diabetes mellitus (DM). Diabetes mellitus is a group of metabolic disease characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action or both. The chronic hyperglycaemia of diabetes is associated 86

4 with long term damage, dysfunction and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels. [14] The chronic long term complications of the DM are kidney failure, neuritis or diabetic neuropathy, cardiomyopathy, diabetic retinopathy, and atherosclerosis. In DM early symptoms are not observed in the pre-diabetic patients so there is need to do the blood sugar of patients of age above 40 years or those who have the family history of diabetes. Chikitsa of Madhumeha as per classics: Chikitsasutra (principles of treatments) and Chikitsa (Management proper) are the two divisions of treating diseases. Both these parts are described very well in Ayurved classics and having their importance at their own place. But the concepts and methods are different in different conditions and may be changed considering the Vyadhi Swabhava (nature and condition of the disease) and Atura (nature condition and strength of the patient). In treatment of the disease the Samprapti (pathogenesis of the disease) must be understood to treat the patients and planning the treatments. Chikitsa sutra in Madhumeha: Sushrutacharya also says that Sahajameha Rogi are usually Krisha (Thin built) while Apathyanimittaja Rogi are usually Sthula (Obese). During Chikitsa Acharyays consider body constitution and strength of patient. Charakacharya considers two types of patients; one is that with stout body structure and with strength while others are without strength and Krisha. In the context of Medoroga, the managements described are parallel to that of Madhumeha since the Dosha and Dushyas are same to major extent. After considering all the factors the two types of management emphasized. 1. Samshaman Chikitsa [Normalizing Therapy] 2. Samshodhana Chikitsa [Elimination Therapy] Like every disease, those factors which are responsible for the production of the diseases are if eliminated and if further, causative factors are prevented Madhumeha can also be treated. Madhumeha can be treated in this way although it is described as incurable during ancient time. In Pratyakhyeya vyadhis (Diseases that are not complete curable) symptomatic relief can be given by proper management. 87

5 Samshaman Chikitsa (Conservative measures): Samshaman Chikitsa includes mainly Deepana (appetizers), Pachana, (enhancing digestion), Kshuta (Hunger maintenance), Trita (Maintenance of thirst), Vyayama (Physical exercise), Atapa (Having exposed to sunlight) and Maruta (Exposing oneself to wind). All these are the lifestyle modification in different way to control the Madhumeha. Vaidya has to decide for proper Shaman Chikitsa to the patient according to the aggravation of vitiated Doshas and Dushyas. Acharyas introduces different Tarpana upakramas (nutritional remedies) in Vatika Mehas. It is due to the less strength of the patient. Acharya Charaka and Vagbhatta says that the Kashaya Yogas should be enriched with Sneha should be given in Vatika Mehas. Acharya Sushruta explains that Shilajitu should be taken after triturating with Salsaradi gana kwatha. After its digestion patient should take Jangala Mamsarasa Yukta Ahar (diet with soup meat). He also prescribes to take 1 Tula of Shilajatu. The formulations used in the Madhumeha patients in different form are mentioned in the table no.1. Table-1: Different Herbal or herbo-mineral preparations used in Prameha and in Madhumeha. Sr. No. Forms of drugs Herbal or herbo-mineral preparations 1. Churna Triphaladi, mustadi, gokshuradi, arkadi 2. Swarasa Amalaki, haridra, nimbapatra, bilwapatra, guduchi 3. Kwatha Vidangadi, phalatrikadi, mustadi, manjishthadi, pathadi 4. Gutika Chandraprabha, indravati, pramehantak vati 5. Guggulu Gokshuradi guggulu 6. Modaka Kastur modaka 7. Avaleha Kushavleha, bangavleha 8. Paka Pugapaka, ashwagandhadi paka, draksha paka. 9. Asava arishta Lodhrasava, dantyasava, madhukasava, devdarvyadi arishta, lodhrarishta. 10. Ghrita Dhanvantar ghrita, trikantakadi ghrita, sinhamrita ghrita, dadimadi ghrita, Ghrita, shalmali ghrita. 11. Rasaushadhi Vasant kusumakar rasa, mehamudgar rasa, brihat bangeshwa rasa, Prameha gajkesri rasa, tribanga bhasma, vasant tilaka rasa. 88

6 Samshodhan Chikitsa: Considering Sthula and Krisha Pramehi patients Samshodhan Chikitsa should be administered only to the Sthula (obese or overweight patients) and Balvan (strong) Pramehi. Sarshapa, Nimba, Danti, Bibhitak and Karanja siddha Taila or Trikantakadya Sneha (Ghrita or Taila according to Dosha predominance should be used for Abhyantara Snehana. Here while explaining the Samshodhan, Charaka described to use the Malashodhan Yogas from Kalpasthana Both Pitta and Kapha Dosha are eliminated through Shodhana. Either it may be Vamana and Virechana, because of; Pittantam Vamanam, and Kaphantam Virechanam. In Virechana, Pitta is eliminated first, then Samyak Lakshana of Virechana is Kaphadarshan, so both vitiated Pitta and Kapha Doshas are eliminated in Virechana Karma. Then he described Anuvasana and Asthapana Basti Chikitsa are able enough to control the provocation of Vata Dosha. Like this all the Doshas are normalized to keep the Dosha Samyata and control the disease and prevent further complications. Anuvasana with medicated oils and Ghritas are prescribed in Madhumeha. After proper Shodhan Chikitsa, Charakacharya details to give Santarpan Chikitsa to the patients, to prevent the complications like Gulma, Bastishula, etc. Samshodhan procedure are carried out in three stages, Poorvakarma (Pre-panchkarma procedures): Snehana: Oral administration of sesame oil or cows s ghee for 3 to 7 days in specific manner. This helps to resolve the Doshas accumulated in the whole body. Swedana: Medicated steam bath after sesame oil application on the body for 3 to7 days. This helps to suppress the Vata Dosha and removes the Doshas from the various systems of the body and bring them to the alimentary track, so that it becomes easy to remove them through Vamana Karma (emesis process) or Virechana Karma (purgative process). Pradhankarma (Panchkarma /main procedure): First it should be planned that the procedures like either Vamana or Virechana or Basti or Raktamoshna or Nasya. Oral administration of oil or ghee is done prior to Vamana Karma (emesis process) or Virechana Karma (purgative 89

7 process), Raktamokhshana (bloodletting by different technique). The Snehana (external oleation) and Swedana (fomentation) prior to Basti (medicated enema) and Nasya (medicated inflation) should be done. Pachhatkarma (Post-Panchkarma procedures): Following measure should be done strictly for better effect of the panchakarma conducted on the patient. 1. Sansarjana Krama - Specific diet for a period of 3 to7 days. 2. Pathya Ahara (useful diet after Panchakarma) and Vihara 3. Dhumapana - (inhalation of medicated smoke) only after Vamana (emesis) 4. Rasayana treatment Conclusion: This review of Madhumeha showed that the disease can be well managed with the Pathya-Apathya (avoidance of the etiological factor), conservative treatment and Shodhan/Panchakarma treatment as per the Doshic involvement. Though the disease is Asadhya but can be controlled with regular Ayurved management and some lifestyle modifications. References: 1. Report of World Health Organization (WHO) on Diabetes on /EN_WHS2011_Full.pdf 2. James OH, brenda M.Socioecological Determinants of Prediabetes and Type 2 Diabetes. Scientific StatementDiabetes Care Publish Ahead of Print, published online June 20, Charaka Samhita, Dr. Brahmananda Tripathi, Chikitsa sthan.6/15 Chauukhamba Subhaarati Prakashan, Varanasi, Reprint ed Page Sushruta Samhita, Dalhan commentary Acharya Yadavji Trikamaji, Chikitsa sthan.12/6, Choukhamba Krishnadas academy, Varanasi, Reprint ed Page Astang Hruday, Dr Ganesh Krushna Garde, Chikitsa sthan. 12/1, Anmol Prakashan, Pune 2, Sushruta Samhita, Dalhan commentary Acharya Yadavji Trikamaji, Chikitsa sthan.11/3, Choukhamba Krishnadas academy, 90

8 Varanasi, Reprint ed Page Charaka Samhita, Dr. Brahmananda Tripathi, Chikitsa Sthan. 6/4 Chauukhamba Subhaarati Prakashan, Varanasi, Reprint ed Page Charaka Samhita, Acharya Ravidatta Tripathi, Sutra sthan. 17/78 Choukhamba Sanskrut Sansthan, Varanasi, Reprint Sushruta Samhita, Kaviraj Dr. Ambikadatta Shastri, Sutra Sthan.6/3, Choukhamba Sanskrut Sansthan, Varanasi, reprint Astang Hrudaya, Dr Ganesh Krushna Garde, Nidan Sthan. 10/1-3, Anmol Prakashan, Pune 2, Astang Hruday, Dr Ganesh Krushna Garde, Nidan Sthan. 10/18, Anmol Prakashan, Pune 2, Charaka Samhita, Acharya Ravidatta Tripathi, Nidan sthan. 4/44 Choukhamba Sanskrut Sansthan, Varanasi, Reprint Sushruta Samhita, Dalhan commentary Acharya Yadavji Trikamaji, Nidan sthan.6/27, Choukhamba Krishnadas academy, Varanasi, Reprint ed Page Acute or Chronic Complications of Diabetic Mellitus. downloaded on lications_of_diabetes_mellitus Cite this article: Ayurvedic Management of Madhumeha (Diabetes mellitus) by Shodhan and Shaman Chikitsa A Brief Review Reshma Bhagwan Chavan, Mangal S. Morbale, Veena G. Kanthi -2015; 3(3):