Diabetes is becoming a global problem
with 450 million people diagnosed worldwide.
In 2015, 23.4 million
people in the United States were diagnosed with diabetes, compared to only 1.6
million in 1958.
In
Adolescents, cases of type 2 diabetes in 1980 were ZERO and cases of type 2
diabetes in 2010 were 57,638. For decades, type II diabetes was
considered an adults-only condition. In fact, type II diabetes was once called
adult-onset diabetes. What was once a disease mainly faced by adults is
becoming more common in children. Among people under the age of 20, type I
diabetes rose 23 percent between 2001 and 2009, and among all ages its Quadrupled
Worldwide Since 1980.
Ayurveda defines health as an
optimal balance of the three doshas, with a healthy bio-fire, or enzymatic and digestive capacity (agni), balanced tissue metabolism and
waste disposal, combined with an enthusiastic nature, clarity of sense
perception and balanced mind and emotions. Thereby a healthy person is physically,
psychologically, socially and spiritually sound and Ayurveda is truly a
holistic medicine and way of life. (Doshic questionnaire).
To understand
Ayurveda, it is important to understand the tri-doshic
theory as the source of the universe and the key to elucidate the pharmacological,
pathological and therapeutic factors in the treatment of diseases. (click here and scroll down for article about the doshas).
Disease is
assessed based upon the person’s elemental constitution at birth or one’s
genetic combination, or their dosha,
as seen in their physical and psychosomatic make up, which plays a key role in
the disease or healing process.
The disease we
call Diabetes, can be found in Ayurvedic texts dating back over 1,000 years in
the Charaka and Susruta Samhitas, where it is called madhumeha and/or prameha,
which mean profuse urination, with all disorders that present with excessive
urination are a type of madhumeha, and include 20 major categories, with each
treated according to the doshas
involved.
Ayurveda sees
madhumeha not as one disease, but as
a multifaceted syndrome with various, complex metabolic disorders. It includes
diabetes mellitus types I and II, and calls these prameha and includes the systems involved, the complications
of the disease and the state of mind that assists in pain management. So its
definition is way more intricate than the modern medical definition of this disease which only
differentiates 2 main types: mellitus and insipidus.
Diabetes
Mellitus and its associated disorders, is a metabolic disorder of
the metabolic transformation or digestive capacity (agni). When there is a dysfunction of the agni, the carbohydrate metabolism, or the earth and water elements,
are disturbed, characterized by increased blood sugar, the passing of sugar in
the urine, and dysfunction and damage to the urinary system, which are the
water carrying channels and is especially due to a dysfunction of the agni of the pancreas and production of
insulin.
Diabetes is
classified as either insulin dependent (IDD)-type I or non-insulin dependent
(NIDD)-type II. Diabetes insipidus, at least in the beginning, is an imbalance
of the diuretic hormone vasopressin. It is rare and occurs most often in young
people.
(Ayurvedic Perspectives On Selected Pathologies, Vasant Lad, BAMS, MASc).
(Ayurvedic Perspectives On Selected Pathologies, Vasant Lad, BAMS, MASc).
Our tissues (dhatus) have a normal level of moisture
or liquid (kleda). One function of kleda is to maintain the body’s
water-electrolyte balance. It also nourishes and lubricates all the tissues. It
is associated with kledaka kapha in
the stomach and in the spreading stage of prameha,
kledaka kapha overflows from the GI
tract and enters the blood plasma (rakta
dhatu), and as it spreads, this kledaka
kapha disturbs the kleda present
in all the tissues (dhatus). The
function of urine is to remove excess liquids, so when kleda is increased, urination is also increased, called polyuria, hence
the profuse urination.
The first 3
stages of any disease are called accumulation (sanchaya), provocation (prakopa)
and spreading (prasara). High blood
sugar is described in Ayurveda as increased kapha
in the rasa and rakta dhatus (circulatory
and lymphatic systems). The increased kledaka
from the dhatus starts leaking via
the digestive system, through the kidneys and into the bladder, causing the
symptoms of diabetes that occur after the dosha
enters the third stage of the disease process.
During this
period, one may accumulate tarter on the teeth, sticky sweat even after a bath,
an increase in nasal crust, ear wax, sebaceous secretions and smegma. Excess
urination, nocturnal urination, and at the end of urination the anal sphincter
muscles constrict and create goose bumps. It’s common to have a sweet taste in
the mouth, the breath to smell like vinegar, and the pulse becomes slow and
sluggish with the stomach pulse showing a kapha
spike.
The general pathogenesis (samprapti) almost always begins with increased kapha, as seen in most of the signs and symptoms. Later, vata and pitta can enter the picture, because prameha is a complex syndrome that can involve all three doshas.
Prameha is most often due to
hyperglycemia or an increased blood sugar, caused by diminished insulin
production by the pancreas (kloma)
due to its faulty agni. It is a
chronic endocrine disorder that affects the metabolism of carbohydrates,
proteins and fats as well as the water–electrolyte balance. It can cause
functional and structural changes in the body’s cells, and create complications
of the eyes, kidneys, nervous system and other organs.
There can be
other causes of prameha, classified
as kapha types of which there are 10,
Pitta types 6, and vata types 4. Some are:
·Secondary condition to pancreatitis, a pitta disorder. Viral infections can create pancreatitis.
·Heredity plays a role in the destruction of beta cells in the pancreas, which can cause pancreatitis or neoplasm or tumor of the pancreas, leading to diabetes.
·A tumor of the pancreas-pitta/kapha
·Autoimmune dysfunctions-tejas (inflammation) burns ojas (immunity or antibodies) and affects the pancreas, pitta/kapha.
·Obesity, usually associated with non-insulin dependent diabetes; a metabolic disorder of kapha.
·Wrong diet, emotional overeating and excess consumption of heavy, damp and cold foods and sugar, kapha.
·Pregnancy, when there is an excessive demand for insulin that can lead to gestational diabetes. Also there is a natural increase in kapha, as kapha is responsible for the creation of the new baby and placenta. That kapha can inhibit the pancreatic function, which can also lead to gestational diabetes.
·Liver diseases, including hepatits and cirrhotic changes can lead to portal hypertension and affect the pancreatic function, resulting in diabetes, pitta/kapha.
·Corticosteroid therapy is a drug induced cause of diabetes. Steroidal hormones are kapha provoking and steroid toxicity may create underactive thyroid, water retention, hypertension and obesity. It also compromises kidney functions and causes “moon face”, which results in a swollen and fatty appearance of the face, kapha.
·Worry, anxiety, fear and anger are all connected to cerebral kloma (form of kapha or kleda) and these can affect glandular functions and lead to prameha, vata/pitta/kapha.
·Stress affects the nervous system, which governs all the functions of the body and mind. It affects blood flow, inhibits rejuvenation, increases stress hormones, affecting the endocrine system, hormones, triglycerides, cholesterol and blood sugar.
·Secondary condition to pancreatitis, a pitta disorder. Viral infections can create pancreatitis.
·Heredity plays a role in the destruction of beta cells in the pancreas, which can cause pancreatitis or neoplasm or tumor of the pancreas, leading to diabetes.
·A tumor of the pancreas-pitta/kapha
·Autoimmune dysfunctions-tejas (inflammation) burns ojas (immunity or antibodies) and affects the pancreas, pitta/kapha.
·Obesity, usually associated with non-insulin dependent diabetes; a metabolic disorder of kapha.
·Wrong diet, emotional overeating and excess consumption of heavy, damp and cold foods and sugar, kapha.
·Pregnancy, when there is an excessive demand for insulin that can lead to gestational diabetes. Also there is a natural increase in kapha, as kapha is responsible for the creation of the new baby and placenta. That kapha can inhibit the pancreatic function, which can also lead to gestational diabetes.
·Liver diseases, including hepatits and cirrhotic changes can lead to portal hypertension and affect the pancreatic function, resulting in diabetes, pitta/kapha.
·Corticosteroid therapy is a drug induced cause of diabetes. Steroidal hormones are kapha provoking and steroid toxicity may create underactive thyroid, water retention, hypertension and obesity. It also compromises kidney functions and causes “moon face”, which results in a swollen and fatty appearance of the face, kapha.
·Worry, anxiety, fear and anger are all connected to cerebral kloma (form of kapha or kleda) and these can affect glandular functions and lead to prameha, vata/pitta/kapha.
·Stress affects the nervous system, which governs all the functions of the body and mind. It affects blood flow, inhibits rejuvenation, increases stress hormones, affecting the endocrine system, hormones, triglycerides, cholesterol and blood sugar.
Primarily
aggravated kapha, are fatty tissue,
muscle tissue and body fluids.
Moderately affected pitta, are bone, blood, and plasma.
Chronic conditions deplete the body, especially lymph, muscle, vata, and ojas - the healthy and refined form of kapha that governs immunity and our ability to love and be loved.
Moderately affected pitta, are bone, blood, and plasma.
Chronic conditions deplete the body, especially lymph, muscle, vata, and ojas - the healthy and refined form of kapha that governs immunity and our ability to love and be loved.
(Charaka Samhita: 6/4) The
etiology or (Nidana):
·Sedentary lifestyle
·Excessive sleep or sleeping during the day
·Meat soup or meat made of domesticated, aquatic or animals from a swampy habitat
·Milk or dairy products
·Recently harvested grains or drinks
·Preparations made of unrefined cane sugar or jaggery
·That which aggravates kapha:
·Sedentary lifestyle
·Excessive sleep or sleeping during the day
·Meat soup or meat made of domesticated, aquatic or animals from a swampy habitat
·Milk or dairy products
·Recently harvested grains or drinks
·Preparations made of unrefined cane sugar or jaggery
·That which aggravates kapha:
(Ashtanga Hrdayam: Ni. 10/1-3)
·Food, drinks and activities that cause an increase
of fat (medas), urine (mutra) and kapha are the primary causes for prameha such as:·Food which is Sweet, Sour, Salty, Fatty, and
not easily digestible, slimy and cold,
·New grains
·New grains
·Beer
·Sugar
cane juice
·Molasses
·Milk
·Always
sitting in one place, sedentary lifestyle
·Sleeping
at inappropriate times or during the day
Purva Rupas – Premonitory Signs & Symptoms:
Sweating
Body odor
Flabbiness of the body
Desires constant rest and sleep, or sitting, has an easy life, laziness
Heaviness in the cardiac region
Exudation from eyes, tongue and ears
Overweight, excessive growth of hair and nails
Liking of cold comforts
Dryness of throat and palate
Sweet taste in the mouth
Burning sensation of the hands and legs
Swarming of ants especially near urine
Body odor
Flabbiness of the body
Desires constant rest and sleep, or sitting, has an easy life, laziness
Heaviness in the cardiac region
Exudation from eyes, tongue and ears
Overweight, excessive growth of hair and nails
Liking of cold comforts
Dryness of throat and palate
Sweet taste in the mouth
Burning sensation of the hands and legs
Swarming of ants especially near urine
Diagnosis
of Dosha involvement
An Ayurvedic consultation includes visual
observations, pulse, questioning and urine analysis to assess and classify in
order to choose the proper treatments.
For urine analysis, take some urine in a cup and put a drop of sesame
oil into the urine.
· If the urine takes a snake like image it is a Vata disease· If the urine takes an "umbrella" shape it is Pitta disease· If the urine takes a pearl shape it is Kapha disease
Oil Drop
· If the oil drop attains Mandala (circular
shape) Vata is predominant, · If the oil drop attains Budbuda(bubbles) shape Pitta is predominant· If the oil drop attains Bindu (globule or droplet) and sinks in the
urine Kapha is predominant.
Kaphaja
Prameha (10)
Urine resembling water, Hydruria
Urine resembling sugar cane juice, Glycosuria
Dense Urine, Chyluria
Dense urine at the bottom and clear at top, Belluria
Whitish urine
Urine containing seminal fluid, Spermaturia
Urine which is cold, Phosphaturia
Urine contain sand like substances, Graveluria
Urine passing slowly
Urine containing slimy material, Pyuria
Urine resembling water, Hydruria
Urine resembling sugar cane juice, Glycosuria
Dense Urine, Chyluria
Dense urine at the bottom and clear at top, Belluria
Whitish urine
Urine containing seminal fluid, Spermaturia
Urine which is cold, Phosphaturia
Urine contain sand like substances, Graveluria
Urine passing slowly
Urine containing slimy material, Pyuria
Pittaja Prameha (6)
Urine resembling the mixture of alkalis, Alkalinuria
Urine that has a blackish color, Melanuria
Urine having bluish color, Indigouria
Urine having blood in it, Hematuria
Reddish color urine, Hemoglobinuria
Bright yellow urine, Urobilinuria
Vataja Prameha (4)
Urine mixed with nervous tissue (majja), Myelouria
Urine mixed with muscle fat, Lipuria
Urine mixed with lasika or lymph, some consider this Diabetes Insipidus
Urine that is sweet like honey and mixed with ojas, Diabetes Mellitus
If kapha/pitta
type of prameha are left untreated,
then they may develop into Madhu meha
– indicating chronicity and hence also the involvement of vata.
If vata
type of prameha is the primary
manifestation, then it is considered incurable.
Types
of Premehi Patients
- Obese and strong–Sthoola Pramehi (kapha/pitta)
- Lean and weak–Krisha Pramehi (kapha/vata)
Kaphaja: Curable –due to compatibility
of treatment. Since bitter and pungent drugs (herbs and spices) are advised for
this condition, and they also alleviate kapha,
there is no contradiction in the line of treatment.
Pittaja: Palliable – due to mild contradiction of therapies.
Drugs (herbs and spices), which are pungent in taste, cannot be used in pittaja types as they would further
aggravate pitta, lymph (rasa) and blood (rakta).
Vataja: Incurable –due to incompatible
intervention, as a result of chronicity of the disease with complications, as
well as contradictory therapies. They tend to be severe and associated with
complications.
Treatment–Chikitsa
The prevailing strategy in conventional medicine for managing DPN focuses on stringent glycemic control by intensive maintenance of target blood sugar level to slow the progression. The symptomatic treatment in painful diabetic neuropathy includes tricyclic antidepressants, SSRI group drugs, antiepileptic drugs and opiods. Such medical intervention may not always produce effective results and are associated with known adverse effects.
The line of Ayurvedic treatment of prameha, however, is determined as per therapeutic classification.
Herbs or insulin, if necessary, can regulate blood sugar, and there also needs to be a holistic treatment program to treat this syndrome. That usually includes proper diet, daily exercise, yoga, hygienic measures, an appropriate lifestyle and panchakarma cleansing, all according to the individual’s constitution and the particular type of prameha.
Herbs or insulin, if necessary, can regulate blood sugar, and there also needs to be a holistic treatment program to treat this syndrome. That usually includes proper diet, daily exercise, yoga, hygienic measures, an appropriate lifestyle and panchakarma cleansing, all according to the individual’s constitution and the particular type of prameha.
For those who
are strong (Sthula pramehi) – Bio
Purifactory Panchakarma therapy (Shodhana) is a strong cleansing or
elimination of excess kledaka kapha
and includes therapeutic emesis and/or therapeutic purgation, as well as avoiding
the causes already listed, followed by palliative care after the panchakarma and the kleda kapha has been removed.
For those who
are lean and weak (Krisha Pramehi) – Palliative
management (Shamana) – Mild cleansing
followed by stronger rejuvenation and strengthening therapies with Ayurvedic
formulas and diet considering the individual’s constitution and condition and the
specific complications.
Peripheral
Neuropathy is a common and costly complication of both type I and type II
diabetes. Prevalence of neuropathy is estimated at about 8% of newly diagnosed
patients and greater than 50% in those with longstanding disease. In classical
Ayurvedic texts, the clinical features of peripheral neuropathy are described
in the context of prameha and its
various stages called burning palms and soles (khara pada daha).
Complications
in pitta types of prameha include urinary tract
infections, testicular hypo functioning, recurrent hypoglycemia, causing
dizziness and early neurological symptoms like paresthesia, especially burning,
GI symptoms including GERD, and diabetic diarrhea.
Complications
of vata type of prameha are emaciation, urine retention, and neurological symptoms
as various types of pain, palpitation, and vata
types of respiratory features characterized with dry cough and breathing
difficulties. Other classical texts mention sparsha
vatra and tvak shunyata,
characterized by severe pain, burning sensation and absolute loss of sensation.
Tvak shunyata presents as lack of
ability to differentiate hot and cold or soft and rough. (Ayurveda
Journal Of Health, vol 15 issue 4).
Localized vata/pitta clinical presentations may be
effectively managed with internal administration of kshira bala taila 101, and external
applications of shata dhouta ghrita
(100X medicated ghee) and a treatment of Takra Dhara: pouring medicated buttermilk over the entire body.
For other vata/pitta cases where vata is predominant or for lean or
emaciated diabetic individuals, medicated rice bolus poultice (shashtika pinda sveda) is commonly
practiced which improves muscle bulk and strength.
In autonomic
or peripheral neuropathy associated with insomnia or loss of balance and
coordination, shirodhara (medicated
oil poured on the forehead) is beneficial.
For Vata predominant cases, pour medicated oil, 4-5 liters over the entire body, followed by an abhynaga massage with the same medicated oil at home.
Ayurvedic
preventive diabetic foot care includes foot massage (pada abhynaga) with medicated oil.
In kapha/vata presentations, where kapha is predominant, as in diabetic
amyotrophy, a medicated powder massage (udvarttana)
is performed and a hot medicinal powder poultice (curna panda sveda) are beneficial.
In autonomic
neuropathy with gastrointestinal symptoms like constipation or GERD, judicious
use of mishraka sneha, shows to
improve gastrointestinal motility. It is useful in obstinate constipation,
colic, pain and inguino-scrotal swellings and various diseases due to vata manifesting in the GI tract. Maha dhanwantaram tablet may be used as
a palliative formula for GERD with symptoms like nausea, dysphagia, epigastric
discomfort, and gastroparesis.
In chronic
diabetic cases at the vata
predominant stage, dhanwantaram ghrita
is indicated for internal administration.
For erectile
dysfunctions seen in diabetic peripheral neuropathy patients, milk decoctions
of ashwagandha and bala yields promising results.
In diabetic
foot ulcers medicated ghee with
turmeric is effective for internal administration and external application.
For diabetes
retinopathy a therapy called tarpana
with patoladi ghrita applied to the
eyes has shown remarkable improvement in visual acuity.
Dietary
modifications are also very important in management of diabetes.
A beneficial
diet includes: Turmeric, cinnamon, feneugreek, barley, honey, roasted meat, corn
meal, green gram (mung dal), cooking foods with ghee and spices.
Consume one
meal per day of medicated gruel, with Mishraka Sneha, effective in maintaining
euglycemia and improving quality of life.
Dashamula
medicated gruel is successfully practiced in various stages of diabetes as a
diet therapy.
Avoid foods
and drinks that are cold, moist, heavy, fried, boiled, fermented or carbonated.
Lifestyle – Exercise!!
Body
Treatments–Several are already listed above. There are a variety of body
treatments, selected according to the person’s constitution, condition and
disease classification. Including Shirodhara or Takra Dhara, which are classically
recommended for many types and conditions of prameha. They are a stream of either warm herbalized oils or takra poured on the forehead. This is deeply relaxing, sooths and calms
the nervous system, synchronizes brain waves, calms the mind, and enhances
blood circulation to the brain. The affects of the deep relaxation are valuable
to the body, mind and energy.
We can use udvartana massage to dry and reduce a
heavy and moist person. This also increases lymphatic circulation and drainage,
so we want to reduce some of the kleda
first with diet and lifestyle rather than circulate it, then introduce this
treatment. If the person is not very damp we can provide
an abhyanga massage, which is the
signature massage of Ayurveda, that is a lymphatic drainage performed with warm
herbalized oils, preceded by garshana
silk glove and completed with a hot towel compress.
Nasya is often helpful,
which is a tri-fold treatment of neti pot,
nasya oil and gargle, cleansing and
nourishing of the sinuses, head and neck.
Medicine:
Ayurvedic Herbs: (Aushadha) to
include: Triphala, Shilajatu, Chardunika
(Gymnema Sylvestre), bilva leaf, guduchi, and Guggulu preparations. Gymnema Sylvestre showed similar glucose
lowering effects as the corticosteroid-inhibiting drug, ketoconazole. Experimental
and clinical studies revealed anti-diabetic and adaptogenic properties of the
aqueous extract of bitter gourd (momordica
charantia or karavellaka). The aqueous extract of the fruit was more
effective in diabetes than the powder of the dried fruit.
This article
is not meant for any diagnosis or treatment, but rather to provide Ayurvedic
education to get an idea of how an Ayurvedic professional will analyze a case
and organize a health plan according to the individual’s constitution and
condition. Please do not attempt to self treat. Always seek the consultation
and supervision of an experienced and properly educated Ayurvedic Practitioner
along with your doctor.
The earlier
we notice imbalances, especially within the first 3 stages, the easier it is to
correct them. The longer the imbalances are ignored, the harder it will be to
reverse them. Articles and mid level workshops are tools for people to become
aware of the Ayurvedic wisdom of life. It is advised to seek the analysis and
guidance of a properly educated and experienced Ayurvedic Practitioner to pinpoint
the root causes of imbalance and create a well rounded and appropriate health plan
and keep you on track to a life well lived.
Chaya has
been an Ayurvedic Practitioner, Ayurvedic Yoga Therapist and Massage Therapist
at some of the largest yoga and health centers in the country for 20 years. She
can be reached at her private practice in Gainesville, The ChayaVeda™
Integrative Healing Arts Studio, by visiting ChayaVeda.com
Ayurvedic Perspectives on
Selective Pathologies, Vasant Lad, BAMS, MASc
Referenced from DIABETES MELLITUS (MADHUMEHA) AND AYURVEDIC MANAGEMENT: AN
EVIDENCE BASED APPROACH; Article in WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES · August 2015
EVIDENCE BASED APPROACH; Article in WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES · August 2015
