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AYURVEDA and DIABETES MELLITUS

By- Pranava Kerala Ayurveda Clinic London Team

Introduction

 

Recent rapid advancements in science & technology in every field has contributed immensely for pleasures & materialistic comforts for human race. Unfortunately it also has brought drastic change in the life style, which is a major contributor to the advent of numerous new & life threatening disorders. Globally large populaces are prey to these lifestyle disorders such as Diabetes, Renal problems, Immunological problems, Cancer etc., regarded to be incurable.

 

Global community is looking towards Indian ancient system of life science Ayurveda as an effective alternative to tackle modern day maladies.

 

Diabetes is one such disease which is affecting mankind globally. As per the WHO (World Health Organization), 90% of diabetic people are Type 2. The common cause is diet as well as lifestyle changes hence its management has also posed several difficulties due to the diet & life style habits of individual thus proving a threat to health resulting in end organ damages and severe complications.

 

Ayurveda being life science, global attention is looking towards Ayurveda for its effective management as recent times we often see patients with uncontrolled diabetes even with regular usage of tablets & / insulin. Insulin resistance is another major concern where patients approach Ayurveda.

 

We shall try to have a bird’s eye view about the modern & Ayurvedic concepts of this disease.

 

DIABETES MELLITUS

 

Introduction
Diabetes mellitus, commonly known as Diabetes (High blood sugar) is one among the metabolic diseases prevalent in recent times. Incidence is more in developed & developing countries. India topped the world with the highest number of people with diabetes mellitus in 2000. In the years to come the situation is going to further worsen. The changing dietary habits including the excessive usage of junk foods, over eating, etc, lack of exercise, stressful & sedentary life style are attributed as causative factors for the increasing incidence of diabetes mellitus.

 

What causes Diabetes?

Diabetes is result of either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced. It can be simplified under these 3 causes –

  • Inefficient production of insulin – Either completely or lesser than the body needs
  • Defective production of insulin – Rare / uncommon
  • Inability of cells to use insulin properly & efficiently leads to increased sugar levels in the blood.

 

As a result, there will be impairment in the muscle & fat tissue metabolism, ultimately resulting in insulin resistance.

 

Types of Diabetes Mellitus

Type 1 DM – caused due to failure to produce enough insulin. It is also called as Insulin – dependent diabetes mellitus (IDDM) or Juvenile diabetes.
Type 2 DM – here cells fail to respond to the insulin properly, develops with insulin resistance. It is also called non – insulin dependent diabetes mellitus (NIDDM) or adult onset diabetes.

Signs & symptoms

  • Polyuria – increased output of urine due to presence of high amounts of glucose in the urine.
  • Polydypsia – increased urine output causes dehydration leading to thirst & hence increased water consumption.
  • Polyphagia – excess eating due to increased appetite
  • Other symptoms – Weight loss, fatigue, non healing wounds etc.

Complications
If left untreated or improperly treated, gradually it leads to serious complications like

  • cardiac (heart) problems like – cardio-vascular disease (block etc.), ischemic heart disease, myocardial infarction (heart attack) etc.
  • nerve damage (neuropathy),
  • acute / chronic kidney disease (nephropathy),
  • eye damage (retinopathy)
  • keto-acidosis

 

PRAMEHA IN AYURVEDA

Introduction
The disease Diabetes Mellitus can be compared with Prameha in Ayurveda. Traditional medical system of India, Ayurveda has given a deep insight about the disease Diabetes.

The word Prameha consist of two Words प्र+मिह

प्र = Increased intensity,

मिह = To pass urine  in excess ;  मिह  the word derived from the root “Mih secane” (profuse)

प्रमेह = प्रकर्षेण मेहति क्षरति वीर्य्यादिरनेनेति      [..द्रु]

  • मूत्रदोष , मेह :(Raja nighantu)
  • बहुमूत्रता (Hemachandra)

 

Prameha can be the disease which indicates increased frequency or quantity of urine passed out from the body.

 

Pathogenesis of prameha

As per Ayurvedic understanding of the disease, it is said to be a “Kleda pradhana vyadhi”, i.e, where there is a disturbance with the body fluid  / water part of the body (Kleda).

Then we get a question, what are the components of this kleda, how it gets disturbed ?

Here, Ayurveda says, at the very basic level (@ mahabhoota level) Kleda is a material in which Ap (jala) Mahabhoota (water element) is predominant. So w.r.t tridoshas, both Kapha & Pitta contribute & regulate kleda.

If Ap bhava of Kapha is disturbed, it may lead to increase of Kleda in the body; otherwise either increase in Ushna (heat)  & / or Drava (jala) bhava, then Pitta is disturbed, henceforth  it leads to disturbance of Kleda.

Let us see some of the causative factors for this Kapha & Pitta imbalance (which lead to Prameha).

 

Nidana

The factors which aggravate Kapha –
Ahara – Madhura, snigda, picchila, sheetala dravya, nava dhanya, anoopa mamsa, guda,
ksheera (A.H.Ni)
Medya & dravanna paana (Su.Ni)
Oudaka mamsa, pishtanna, payasa, krushara, vilepi (Ch.Ni)
Dadhi, mamsa rasa (Ch.Chi)

Vihara – Swapna sukha (irregular sleeping habits) (A.H.Ni)
Divaswapna, avyayama, aalasya (Su.Ni)
Who always indulge in thinking, who does not undergo regular vamana, virechana / any kind of shodhana (Ch.Ni)

The factors which aggravate Pitta
Ahara – Amla , lavana rasa pradhana ahaara, Sura (A.H.Ni)
Dadhi (Ch.Chi)
Vihara – Divaswapna

Here we can observe that few factors like dadhi sevana, divaswapna etc aggravate both Kapha & Pitta.

 

Samprapti

 

Indulgence in the above said nidanas (causitive factors) lead to disturbance in Kapha primarily, associated with Pitta. (As many of the causative factors, ex: divaswapa (day sleep), dadhi sevana (curds intake) etc. cause imbalance of both Kapha – Pitta simultaneously). As a result, there will be increase in the body fluid / KLEDA.

 

Ayurveda gives one more unique concept about SROTAS (स्रोतस् – internal channels) inside the body. It also explains about the causes which creates imbalance in these channels (स्रोतोदुष्टि निदान); signs & symptoms of these imbalance (स्रोतोदुष्टि लक्षण); management of these issues (स्रोतोदुष्टि चिकित्सा) etc. Here the above mentioned causative factors which disturb Kapha & Pitta are also specific causes to disturb Medovaha srotas / internal channels of the fatty tissue. Hence the natural tendency of doshas is towards medo dhatu.

 

So, here we can clearly understand that,

  • Because of indulgence in the causative factors, Kapha & Pitta get disturbed at first, lead to imbalance of Kleda,
  • These imbalanced doshas move towards Medo dhatu (fatty tissue), affect fat metabolism, lead to further imbalance of Kleda.

 

Usually our body has its own mechanism to manage Kleda,

  1. Mootra (Urine)
  2. Sweda (Sweat)

मूत्रस्य क्लेदवाहनम् , स्वेदस्य क्लेद विधृतिः  ।

Elimination of excess fluid / moisture is through urine & retention is through sweat. But in diabetic patients due to their sedentary life style & wrong eating habits there will be less production of sweat. So, all kleda (fluid) moves towards urinary system & there will be increased production of urine leading to excess urination, gradually leading to Prameha.

At this level they show few signs & symptoms which are called as Poorva-roopa (premonitory symptoms) like accumulation of impurities over the teeth (even after cleaning), burning palms & soles etc.

If the condition is not treated properly at this stage, bahu, abaddha medas (fatty tissue with more quantity & which has lost its firmness) will be the result.

Gradually this excess & improper Kleda spreads to deeper tissues, affects all the body tissues (mamsa, majja, ojus & lasika) except asthi dhatu & leads to Dhatu shaithilya (deterioration of body tissues) just like excess watering will not nourish but destroys paddy plant.

As per our analysis, at deep most level kleda may affect in either of these 2 ways:

  1. If Kleda is affected by Pitta, it’s teekshatva (sharpness) will be more & will be having more penetrating action. So intra-cellular kleda (fluid level) will be more.
  2. If Kleda is affected by Kapha, especially picchilata (sliminess) will be more & will be having more covering action. So inter-cellular kleda (fluid level) will be more.

If Kapha aggravating factors are more, it leads to Kaphaja Prameha, which is most common. Similarly Pitta & Vata aggravating factors lead to their respective type of Prameha.

Generally Ayurvedic diagnosis of Prameha depends on the urine examination of the patient. Based on the nature of urine Kaphaja Prameha is of 10 types, Pittaja Prameha 6 types & Vataja Prameha 4 types.

These steps of samprapti (pathogenesis) can be summarized in the following steps:

  1. Nidanas (causative factors)
  2. Dosha dushti (aggravation of doshas)
  3. Reaches medas (natural tendency)
  4. Meda vilayana (liquification of fatty tissue) due to Pitta
  5. Kleda vruddhi (increased fluid level in the body)
  6. Kleda comes to basti (urinary system) – creates load
  7. Gradually involves all dhatus (Mamsa, Majja etc.) – leads to Dhatu shaithilya
  8. Involvement of other doshas – leads to various types of Prameha

 

Note:

  1. Sometimes Rasashesha ajeerna leads to increased blood sugar, but it cannot be considered as Prameha as we do not find actual samprapthi / pathogenesis of Prameha.
  2. Generally the word Prameha & Madhumeha are used as synonyms but Madhumeha is a type of Vataja Prameha.

 

Management of Prameha in Ayurveda

The reversal of samprapti (Pathogenesis) will be easy & quicker if diagnosed and treated at the earliest.
The primary importance in the chikitsa (treatment) of prameha is the management of Kleda.

  • As per Ayurvedic guidelines, Panchakarma / Shodhana therapies (detox / purificatory procedures) are significant in the management of Prameha as it is a bahudoshaja vyadhi. Here bahudosha means quantitatively the dosha imbalance is high & qualitatively the combination of Kapha & Medas (Bahu abaddha medas) is very difficult to disintegrate due to their similar nature.
  • Among Panchakarma, Vamana has been given more importance; it should / may be done twice when a patient comes in Kapha dominant stage. (As per Acharya Charaka).
  • Later Virechana might be done as per the need, followed by oral medications.
  • Generally Basti is contra – indicated in prameha but in exceptional cases special bastis may be indicated.
     

Without panchakarma – symptomatic management is possible but root level correction is not possible as per Ayurveda.

 

Chikitsa of Prameha also depends on the physical strength of the patient.
 

Diabetic patients can be classified into two categories,
1) Those who are obese & strong ( sthoola pramehi & balavan)
2) Those who are emaciated & weak (krusha & durbala)
 

Patients belonging to 1st group are administered Panchakarma (detox procedures).
Patients belonging to 2nd group are given nourishing therapy (brumhana) – maintaining bala (power) & correction of doshas.

 

Prognosis

In terms of prognosis of Prameha-
Kaphaja Prameha is curable but with difficulty,
Pittaja Prameha can be managed but can’t be cured completely (yapya) &
Vataja prameha is asadhya (incurable).

 

 

 
 

 

 

 

We at our Pranava Kerala Ayurveda Clinic in London have consulted and managed many patients with diabetes and its complications which were treated with medicines and therapies deeply rooted in Ayurveda principles.

 

 

 
 

 

 

Author-

Dr Suja Vinod, BAMS, MBRCP

Senior Ayurveda Consultant,

Pranava Kerala Ayurveda Clinic,

197 Kenton Road, Harrow, London, HA3 0HD

 

HYPERTENSION and Ayurveda: Causes and treatment

by Pranava Kerala Ayurveda Clinic Team

 

Introduction

Hypertension, most commonly known as ‘Blood Pressure’ is deemed to be a Silent killer, which is widely prevalent among the people due to various factors owing to the modern life style.

Today most of the people have some information about the ‘B P’, like it’s ill effects,  upper and lower limits (Systolic & Diastolic), how to maintain within limits etc. This information itself makes one overanxious and stressful instead of being useful, from the moment one is diagnosed as having Hypertension. First thing that comes to one’s mind when he has a headache or when he is under constant stress is the hypertension. Hyperlipdemia / Dyslipedemia or in other words high blood cholesterol mostly found associated with hypertension.

Is it really as dreadful as it is made out to be?

 

Ayurvedic practitioners are often confronted with patients already diagnosed as having hypertension with reference to the recommended safe limits of Systolic & Diastolic pressures. How reliable/important are these readings to assess whether one is healthy or not?

We often come across patients with high systolic / diastolic pressures, and yet are so comfortable. And on the contrary, we hear patients complain of unease, discomfort, pain etc., despite the controlled BP values etc. This signifies that, keeping a check on one’s BP / cholesterol levels alone does not make one healthy and is not an absolute indicator of health.

In view of the above factors, Ayurvedic doctors are faced with situations, when it becomes difficult to decide whether to focus on bringing down the BP levels through Ayurvedic drugs, compromising on the classics or to follow the classical line of treatment, paying less attention to the BP values initially. (Which is bound to come to limits after the treatment).

How Ayurveda can help in Hypertension / Dyslipedemia ?

Before going in to this, first it is important to understand hypertension in the light of Ayurvedic principles.

Hypertension is of two types  viz Primary or  the essential hypertension and  secondary hypertension. Clinically both of these may be benign or malignant. Haemodynamic factors regulating hypertension are cardiac output and the total peripheral vascular resistance.

 

Essential hypertension

Pathogenetic mechanism:

  • Increase in blood volume (volume hypertension), arteriolar constriction (vasoconstrictor hypertension)
  • Increased cardiac output

 

Secondary Hypertension

 

  • Renal vascular hypertension
  • Renal parenchymal hypertension

 

 

 

 

Ayurvedic Interpretation of Hypertension

 

Coming to the Ayurvedic interpretations for hypertension, we need to first understand what are the existing conditions in Ayurveda and how they can be related or compared with hypertension. Uccha rakta chapaShonita dushtiraktagata vata and so on are compared or correlated to hypertension. Is it the case always? And is sufficient to understand and manage hypertension in Ayurveda?

 

Measuring BP and treating a patient just for his High BP is not a classical way of treatment as per Ayurveda. The possible sampraptis that might occur in the body in a hypertensive state is explained clearly in the classics and these in any way cannot be directly correlated to hypertension, but can be used to understand such new conditions.

 

It only is a pointer to understand a new disease condition in Ayurvedic way.  This article is mainly aimed to clarify that-

  • Hypertension is not always fatal; Ayurvedic doctors need not treat a patient for his High BP i.e just because the patient is panicking. He need not be prescribed “AYURVEDIC anti-hypertensives” as it is not the classical line of treatment.

 

Once his dosha dushyas are brought to prakruta awastha (प्राकृत अवस्था), BP values automatically come under control. And most importantly knowledge about the samprapti that is happening helps the doctors to get an idea as to the stage from where the treatment can begin and also helps in approximating the required time span, to bring the BP values under control, which is important from the point of view of the patient and the doctor too. Ultimately that which is important to doctor as well as the patient is “when can I expect my BP to come under control”? If the samprapti is understood, doctors can approximate the time span required for the BP to come under control. But the treatment always should be towards prakruthi sthapana (प्रकृतिस्थापनand not a TREATMENT that lower BP like sarpagandha so on.

In reality we need not understand or frame a pathogenesis / samprapti (सम्प्राप्ति) in Ayurveda for hypertension, because hypertension only is a presentation in different other sampraptis. This effort of interpretation of hypertension in Ayurveda is made to simplify the concept and only is a pointer as to how a new condition could be interpreted based on Ayurvedic principles. Even after not having measured the BP, we can treat a condition based on our lines if the patient is ill when looked at, in Ayurvedic perspective.

In hypertension there is

  • Increased pressure exerted by the heart during the phase of relaxation on the arterial walls.
  • Increased cardiac output.
  • Raised peripheral resistance.

 

Hypertension in Ayurveda can be understood keeping these two factors in mind:

a) Increased cardiac output and

b) Raised peripheral resistance.

 

Initially, there is increased cardiac output, resulting in peripheral resistance after some time.

What actually happens in hypertension?

 

To know this, physiology has to be first understood to the core. If Prakruti (प्रकृति) is understood well, vikruti (विकृति) could be known.

आहार सम्भवं वस्तु रोगश्चाहार सम्भवः (Ch. Su 28)

Creatures are formed out of ahara (food / आहार) and so are the diseases. Therefore any change, be it a positive or a negative, is a result of ahara and this shows the importance of the food.

The Food Metabolism Pathway in Ayurveda

The Metabolism process or Prakruta  Ahara  Parinamana (प्राकृत आहार परिणमन) – the Ayurvedic physiology as below:

 

http://ayurvedamysore.org/wp-content/uploads/2016/03/image1.png

So derangement in any stage of this cycle itself is the cause for all diseases and is true for hypertension as well.

Components of the body involved in hypertension are:

  • Heart              –   Hrudaya (हृदय)
  • Blood vessels –   Dhamani (धमनि)
  • Blood               –  Drava (द्रव)

 

So, it could be inferred that hypertension is the Derangement of   

  1.   Drava
  2.   Hrudaya/vyana prana vata (functional components)
  3.   Dhamani

 

Any or all of these can lead to high blood pressure once impaired and any one of the impaired component will invariably affect the other as they are interlinked.

  1. Role of deranged DRAVA in causation of hypertension

Firstly it should be understood what exactly is this entity called drava (द्रव). It is commonly known that the circulating fluid is the blood and its pressure we measure. Is it the case when it comes to Ayurveda? Is it the blood / the rakta dhatu (रक्त धातु) which is circulation?

No, the drava, that is to be considered is the AHARA rasa, the end product of jatharagni paka  (जाठराग्निपाक)and not the RASA or RAKTA. Because according to chakrapani, AHARARASA – the resultant of jatharagani paka, is the one in circulation. So, the circulating fluid / drava is predominantly is AHARA RASA. It might contain a portion of rasa and rakta but is mostly ahara rasa.

 

How does it get deranged?

 

http://ayurvedamysore.org/wp-content/uploads/2016/03/image2.png

स्रोतोरोध बलभ्रंश गौरवानिलमूढताः

आलस्यापक्तिनिष्ठीव मलसंङ्गारुचिक्लमाः॥

 

These are the samanya ama lakshanas. As per — drava guru aneka varna, hetu sarva rogananam durgandhi hariita etc are the ama lakshanas. Based on this, the formed AMA may be of two consistencies, i.e

AAMA (आम) can be of two types,

 

A) Drava guna pradhana (increased ap mahabhoota- based on nidana sevana)

 

http://ayurvedamysore.org/wp-content/uploads/2016/03/image3.png

B) Guru guna pradhana (incraesed pruthwi mahabhoota – based on nidana sevana)

 

image4

Any of these or both these sampraptis can happen when the drava or circulating fluid gets disturbed.

Not only this, drava can also get deranged by pre-existing pathologies like Grahani, Pandu, Shotha and Shonita dushti ultimatelty affecting the blood pressure.

Here, in derangement of drava, based on the nidana sevana (consumption of causative agents), type of ahara rasa dushti is to be found out and treated accordingly. In-case of grahani, pandu so on, and treatment should aim at vighatana (destruction) of respective sampraptis.

  1. Role of Deranged Vyana Vata (Hrudaya) in causation of hypertension-

 

image5

Stress is another important factor in causing High BP. It is a common knowledge that, when a person is under pressure /tension, body gives out natural reactions like increased heart rate /increased respiration and so on. If this is the state once in a while as mechanism (fight or flight) of survival, it does not cause any harm to the body but, if continued for a prolonged period of time, body suffers the changes like increased HR etc, throughout, resulting in vyana vata dushti. When vyana is affected, normal functioning of hrudaya is affected. In case of HYPERTENSION, longstanding stress vitiates vyana vata – leading to increased vyana karma i.e increased pumping. This increased pumping further vitiates vyana vata.So this becomes a vicious cycle.

Stress, apart from doing vyana vata dushti, also impairs agni to a very great extent, leading to ama ahara rasa utpatti and when this happens – samprapti of deranged drava sets in.

Here in such cases, only after nidana parivarjana, (i.e, tackling stress) first, the vyana vata should be taken care of. Treating vyana without reducing stress or using anti hypertensives like sarpagandha  / manasamitra vati etc., is  not the classical approach. After having tackled stress, vyana vata has to be corrected and then the agni, because agni suffers greatly by stress.

  1. Role of Deranged Vessels (dhamani) in causation of hypertension-

 

The vessels here are the dhamanis, because the ahara rasa, the circulating fluid remains in circulation in the dhamanis, as they are sthana of Ahara rasa.  This only means, that 365 days 24/7, this ahara rasa keeps circulating without stop and this is the entity which gets replenished every day. So every meal contributes to raised or lowered BP. Therefore, a sphygnomanometer measures the “ahararasa stimulated by vyana vata in dhamani”.

Initial sampraptis happen at the level of dhamani i.e., mainly in the form of avarodha. Changes in the arteriolar walls result in raised peripheral resistance (only after some time).

Phenomenon – 01

image6

In longstanding HYPERTENSION case, doshas are usually uttana dhatugata, they bring in some structural change in the arteriolar walls. They pose obstruction to the normal flow. When the hrudaya (हृदय) has to pump against this avarodha (अवरोध / obstruction), it needs to work really hard, then vyana vata dushti happens. Unless this dhatugata doshas are cleared, vyana dushti will not stop. So in such cases of established HYPERTENSION with dhatugata dosha, it may take months to years for the BP to come under control. Here too the treatment should be targeting the dosha dushya and not BP. After having cleared the dhatugata dosha, vyana vata which has undergone dushti, secondarily has to be looked after. Anulomana has to be done.

Phenomenon – 02

image7

This is easier to treat when compared to the first condition. Because, the doshas here are not dhatugata. So clearance of srotorodha and then the vyana vata correction should be the line of treatment.

In such cases, controlling BP needs lesser span of time compared to first one.

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To sum up:

  • The circulating material is predominantly AHARA rasa.
  • The force that is pumping is the Vyana vata  & / or Prana vata
  • The channels through  which it is moving is predominantly  Dhamanis

 

Factors involved are:

  • Jatharagni
  • Ahara rasa
  • Rasa / rakta dhatus (dushti / impaired agni)
  • Vyana vata
  • Dhamanis

 

So whenever a patient  comes with the presentation of hypertension, all the above factors have to be considered which are the real causes for the symptom, rather than HIGH blood pressure which is just a manifestation or a presentation of underlying cause.

 

 

 

We at our Pranava Kerala Ayurveda Clinic in London have consulted and managed many patients with hypertension and its complications which were treated with medicines and therapies deeply rooted in Ayurveda principles.

 

 

 
 

 

Author-

Dr Suja Vinod, BAMS, MBRCP

Senior Ayurveda Consultant,

Pranava Kerala Ayurveda Clinic,

197 Kenton Road, Harrow, London, HA3 0HD

 

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