Prameha, Prameha Purvarupa and Its Connection With Madhumeha or Diabetes Mellitus

With over 77 million diabetics, expected to grow to 98 million by 2030, diabetes is one of the most worrying & serious public health issues in India. Diabetes mellitus is a condition where there is insulin resistance as the body is unable to use the insulin effectively. Over the years as type II diabetes gets chronic, insulin production starts getting affected.

Ancient Ayurvedic texts such as Charak Samhita (approx. 400 BC), Sushrut Samhita (approx. 600 BC) and Vagabhatta provide detailed knowledge of diabetes mellitus as well as its causes and management. Ayurveda describes diabetes as Prameha . There are twenty types of Prameha – a Sanskrit term that defines increased frequency of urine.

Ayurveda believes that each individual is born with a specific Prakriti that is based on the interaction between the tridoshas in the body – vata, pitta and kapha. Healthy balance of the tridoshas and the digestive fire or agni is essential for smooth functioning of the digestive system. Any imbalance in their equilibrium causes diseases. Diabetes mellitus is a Vataja Prameha, or a disorder caused mainly due to vata dosha imbalance.

• Definition of Prameha

Ayurvedic manuscripts define Prameha as Pra meaning abundant and Meha meaning passing of large quantities of urine. Prameha is a tridoshas vyadhi (a condition that involves all the three doshas – vata, pitta and kapha) but with a kapha dominance. Prameha is a syndrome that includes clinical conditions concerning obesity, prediabetes, diabetes mellitus, and metabolic syndrome.

Prameha is a syndrome described in the ancient Ayurvedic texts that includes clinical conditions involved in obesity, prediabetes, diabetes mellitus, and metabolic syndrome.

Charak Samhita (Charak, Chikitsa 6/4) describes Prameha as

“Asyasukham swapnasukham dadhini gramyodakanuprasah payansi, Navannapanam gudvaikratam ch Pramehahetuh kaphakrichh sarvam”

It means that excessive sleeping, consumption of milk & curds, meats (of domestic, aquatic and wet-land animals), new grains, sweet food items made from jaggery (gur) are some of the things that aggravate the kapha dosha which causes Prameha.

• Purvarupa (Premonitory Symptoms) of Prameha

Purvarupa (Purva = past/prior and Rupa = features) of Prameha or initial symptoms of Prameha that arrive before the full manifestation of the disease and help in early diagnosis of the disease.

Purvarupa of Prameha are an opportunity to act early through timely detection. Any symptoms of Prameha are a warning sign of the possibility of diabetes development in the near future. Correct and timely identification of the risk factors of Prameha and effective ways to reduce those risk factors are the first practical measures to prevent diabetes mellitus.

Charak Samhita (Charak, Chikitsa 6/13-14) describes some of the known premonitory symptoms or Purvarupa of Prameha that include

“Swedoangagandhah shithilangata chshayyasanswapnasukhe ratishch,hrinetrajivhashravanopadeho ghanangata keshanakhativridhih sheetapriyatvam galatalushosho madhuryamasyekarpadadahah bhavishyato mehagadasyarupam mutre bhidhavanti pipilikashcha”

Excessive sweating with fetid smell, flabbiness, tendency for lying down, sedentary habits, excessive mucosal discharge, obesity, fast growth of nails & hairs, frequent thirst, sweetness of mouth, burning sensation in hands & feet etc.

• Categories of Prameha

There are 20 types of Prameha resulting from the interaction of the tridoshas. In addition there are 10 dushyas (Meda, Mamsa, Kleda, Shukra, Shonita, Vasa, Majja, Lasika, Rasa & Oja) or vitiated doshas that cause weak and susceptible bodily tissues. Many types of Prameha have sweet urine or Madhumeha, others have different coloring of urine that emphasizes the inflammatory conditions involved in the metabolic syndrome (including obesity, hypertriglyceridemia, impaired glucose tolerance, and insulin resistance).

They are classified as

• 10 types of Kaphaja Prameha (early diabetes) – overweight/obesity with mild hyperglycemia, Polyuria/Glycosuria
• 6 types of Pittaja Prameha (acute diabetes) – weight loss, Hyperglycemia and Glycosuria, Urinary Tract Infection
• 4 types of Vataja Prameha (Chronic diabetes) – Severe Hyperglycemia with Glycosuria, Cachexia, Nephropathy, Neuropathy, Retinopathy, Cardiorespiratory Complication, Gangrene

According to Acharya Charak, Prameha is also classified based on the body constitution namely

• Sthul Pramehi or obesity – this can be managed by regular exercise and diet control
• Krisha Pramehi or asthenic/weakened – this type cannot be managed only by diet control and requires Bruhana chikitsa or nutritive treatment

Prognostic classification of Prameha includes

• Sadhya or manageable – Apathyanimittaja Prameha (non-insulin-dependent diabetes or NIDDM), Kaphaja Prameha (arly Diabetes), Sthula Pramehi (Obese Diabetics)
• Yapya or palliative – Pittaja Prameha (acute diabetes)
• Asadhya or unmanageable – Sahaja Prameha (insulin dependent diabetes mellitus or IDDM), Vataja Prameha (Chronic Diabetes), Krisha Pramehi (Asthenic Diabetics)

• Concept of Prameha / Madhumeha (diabetes mellitus)

“Prakarsena Prabhutam Pracuram Varam Varam Va Mehati Mutratvagam Karoti Iti Pramehah”

Prameha is a condition that is characterized by increased quantities of urine. Diabetes mellitus is associated with hyperglycemia, with or without glycosuria, and/or insulin resistance.

Prameha means passing large quantities of urine whereas diabetes is derived from the Greek word ‘Diabainein’ which means continuous and free flow of fluid which is applicable to urine. So, in effect, Prameha and Diabetes have a similar meaning. Also, Madhumeha and diabetes mellitus are similar as in that madhu and mellitus both mean honey. Sahaja Prameha and Jatah Pramehi/hereditary (described as Jatah Pramehi Madhumehino in Charaka Samhita) correlate with diabetes mellitus.

Ayurveda states that the main cause that can result in diabetes mellitus is an aggravated Kapha dosha which is caused due to a sedentary lifestyle and incorrect dietary habits.

• Prameha chikitsa (treatment)

Prameha chikitsa involves

• Therapies (Samshamana/alleviation, samshodhana/elimination, santarpana/energizing, samshodhana/cleansing, ropana/healing)
• Diet – light eatables including barley, kashayas (decoctions), Manthas (flour of different types of mixed with water), saktu (roasted flour), preparations of bitter vegetables, cooked rice with moong soup, cooked shashtika rice and trina dhanyas, food recipes of yava with honey to reduce the kapha dosha, ghee preparations, fermented preparations like asava etc. are all useful in Prameha management. Especially, barley soaked in the decoction of triphala should be kept overnight and mixed with honey. It is a refreshing/tarpana diet and helps patient suffering from Prameha
• Herbs – darvi, surahva, triphala, musta, haridra, amalaki, kampillaka, saptachchada, bibhitaka, rohitaka, kutaja, kapittha, Trikantaka, ashmantaka, somavalka, bhallataka, ativisha, lodhra, vacha, patola, arjuna, nimbi, musta, padmaka, dipyaka, manjishtha, aguru, chandana are herbs that are useful in making formulations and decoctions to alleviate different types of Prameha. In fact, decoction of triphala, darunisha, vishala and musta should be mixed with the paste of haridra and honey is said to cure all types of Prameha
• External applications – different types of exercises, lotions, baths, sprinkling water over the body and application of ointment made of sevya (ushira), tvak, ela, aguru, Chandana, medicated oils, massages, fragrant applications are also useful in managing Prameha

• Ayurvedic concept and review of diabetes mellitus

Madhumeha or diabetes mellitus finds mention in ancient Ayurvedic medical texts with a detailed description of its features as well as management.

Ayurveda advises various methods to treat diabetes mellitus including

• Diet modifications
• Various therapies that reduce, cleanse, rejuvenate and heal Prameha
• Yoga & pranayama to alleviate stress and anxiety
• Usage of herbs such as shilajit, turmeric, neem, coccinea indica, amalaki, triphala, bitter gourd, rose apple, leaves of bilva, cinnamon, gymnema, fenugreek, bay leaf and aloe vera
• Herbal preparations (decoctions of triphala, fenugreek and Shilajit)
• Churnas or medicinal powders such as Amalaki Churna, Haldi powder (Turmeric) and Naag Bhasma
• Other ayurvedic medicinal preparations such as Vasanta Kusumakar Ras and Chandraprabhavati to lower sugar levels

As diabetes is an acquired disease caused due to incorrect lifestyle and diet, Ayurveda for diabetes management suggests healthy dietary changes, regular exercise, yoga & pranayama, herbal medicines etc. Make an appointment for an ayurvedic consultation with an experienced Ayurvedic Vaidya to help you successfully overcome diabetes.