PRAMEHA

By Dr Akhil.H.S

Dept of SHAREERA RACHANAALVAS AYURVEDIC COLLEGE.

PRAMEHA

• प्रकर्षे�ण मेहति� जनयति� मूतं्र इति� प्रमेहः ॥• �त्र आति�लप्रभू� मूत्र लक्षणः स�� ए� प्रमेहा ॥ सु. तिन

६/५• One of mahagada.

• प्रत्यात्म लक्षण - प्रभू�ाति�ल मूत्र�

DOSHAS AND DHAATUS• All the three doshas are vitiated. • मांस –मेद –शुक्र –मज्जा –रस –रक्त are vitiated.

• Other दूष्यास् are- ऒजस् - उदक - �सा – लसिसका.The doshas chiefly concerned is kapha and

among dhaatus मेद, उदक, मांस are principally involved. And रस –रक्त are moderately involved.

SROTAS

• स्रो�स् involved in prameha are- उदक�ह - मूत्र�ह – मेद�ह- स्�ेद�हस्रो�स्

मेद�हस्रो�स्

• मूल - �ृक्क �पा�हन

• लक्षण- प्रमेह पू��रूप् (मुख,�ालु,कण्ठ शोर्षे, तिपपास,आलस्य,मलसंचय,अंगसुप्ति=�,शरीर ति�स्रगंध,�न्द्र, तिनद्र ...

मूत्र�हस्रो�स्.

• Moola- basti and vankshana.

मूत्र�हस्रो�स् closely related to उदक�ह- रस�ह- स्�ेद�ह अन्न�हस्रो�स्.

मूत्र is on of the मल of body. Which depends on अग्निDन in अन्न�हस्रो�स् and धा�ुs. This स्रो�स्

determine the quantity and quality of urine to be excreted out.

उदक�हस्रो�स्

• उदक�हानां स्रो�सां �ालु मूलं क्लोमा च ॥ च.ति� ५• उदक - अप् धा�ु• Acc to charaka.sarira 7/15- • अप् धा�ु is 10 anjali.• It does sarira dhaarana.It forms part of

pureesha, mutra, sweda, lasika etc. and dhatus like rasa, rakta, mamsa etc.

• It helps in ahladana, kledana, bandhana , vishyandana.

स्�ेद�हस्रो�स्

• मूल - मेद and लोमकुप

• लक्षण- अति�स्�ेद, कण्डु, दौगGध्य

• वृक्क• Acc to susruta एको� �ामपार्श्व�स्थिK�ः तिL�ीय दक्षिक्षण पार्श्व� स्थिK�ः ।

सु.तिन • रक्त मेद प्रसादा�् �ृक्कौ ।• मेदो�हे Lे �योमू�लं कटिP �ृक्कौ च ।• From above reference we can almost consider

it as kidneys.

• क्लोम

• अ.हृ - कफाधिधष्ठान• सु.तिन- क्लोमो तिह आमाशयस्त्�धः। क्लोमो तिह शोक्षिण�जं क्लोमं

कालखण्डादधस्�ा�् स्थिK�ं दक्षिक्षणपार्श्व�Kं ति�लकं प्रसिसध्दं ॥• Udaka vaha sroto moola.• Varuna is considered as creator of kloma.• Acc to srikantadatta - �ृक्कादूध्�G तिपपासKानं ।• As a koshtanga it should come in thoracic/abdominal

cavity.• An organ Rt and Below liver is pancreas• Above kidney- Supra renal glands

• Basti

• अल्पमांसशोक्षिण�ो आभ्यन्�र�ः कट्या धनु��क्र एकLारो अधोमुखो बस्तिस्�ः ॥ अ.सं.शा ७/१९

• बस्तिस्� देशः अयं नक्षिभपृष्टकटिPमुष्कगुद�ङ्क्षणसेफसां मध्येऽलब्�ाकृति� सिसरास्नयुपरिरग्रहस्�नुत्�क्कौऽधोमुख एकLारश्च ॥ सु.तिन ३/२०

• Maana is 4 angula• A bag like structure that collect and store urine

before excretion, it can be Urinary Bladder.

LAKSHANA

• दन्�ादीनां मलाठ्यत्�ं• पाक्षिण पाद दाह• जटिPलीभा� केश• मधुरास्य�• करपाद सुप्ति=�• मुख �ालु शोर्षे• तिपपास• आलस्य• ति�सं्रशरीर गन्ध• तिनद्र• �न्दं्र

DIABETES MELLITUS• • What is DIABETES MELLITUS?• Acc to W.H.O –• It is heterogeneous metabolic disorder

characterized by common feature of chronic hyperglycemia with disturbance of carbohydrate, fat, and protein metabolism.

• Depending on the etiology, hyperglycaemia may result from

• a) reduced insulin secreation.• b) Decreased glucose use by the body.• c) increased glucose production.

INSULIN

• It’s a peptide hormone (a protien ) secreted by beta cells of islets of langerhans.

• It helps to transport glucose into the target cells of the body. And reduces the increased glucose level of blood.

PANCREAS

HISTOLOGY

ENDOCRINE PART

• MAJOR CELLS

MINOR CELLS

Beta cells 70% of islet cells INSULIN

Alpha cells 20% GLUCAGONE

Delta cells 5-10 % SOMATOSTATIN

Pancreatic Polypeptide cells

1-2 % PANCREATIC POLYPEPTIDE

D1 cells Vaso active Intestinal peptide

Entero chromaffin cells SEROTONIN

A- Alpha cell

B- Beta cell

D- Delta cell

F- PP cell

SOME MORPHOLOGICAL FEATURES IN PANCREATIC ISLETS

• Insulitis – Type 1 – In early stagethere is lymphatic infiltration of t-cells, macrophages

etc Type2 – Little fibrillous protien deposit.• Islet cell mass destruction – Type 1 – As DM become chronic there will be progressive Depletion of beta

cells, eventually result in total loss of pancreatic B-cell Type 2 –Mildly effected.• Amyloidosis. Type 1 –are absent. Type 2 - Amyloid deposit around capillaries of islet. Causing compression

and atrophy of islet tissue. Degranulation of B-cells.

FEATURES IN DM

• TYPE 1- Absence of insulin due to destruction of beta cell.

• TYPE 2- Insulin secreation is normal• a) Insulin resistance. b) failure of beta cells.

MECHANISM OF COMPLICATION

• The process of development of complications in D.M is explained by 2 mechanisms

1. Non – enzymatic protien glycosylation2. Polyol pathway mechanism

DIABETIC NEPHROPATHY

• Morphologically – 4 types of lesions1. Diabetic glomerulosclerosis2. Diabetic vascular lesion3. Diabetic polynephritis4. Tubular lesion

• Diabetic glomerulosclerosis

•Thickening of vessels•Increase matrix•Prolyferation of matrix

•1 or More .•Ovoid/spear• Surrounded by capillaries•Renal ischemia•Tubular atropy•Interstitial fibrosis•Small contracted kidney

DIFFUSE NODULAR

DIABETIC NEUROPATHY • Effects all nervous system.(peripheral neuropathy is more clear)

• Basic pathological changes – . . .

• Glucose deposit in micro capillaries.

• Demyelination Schwann cell injury Axonal damage

DIABETIC RETINOPATHY

BACKGROUND RETINOPATHY• Basement membrane

thickness increase.• Degeneration of pericytes

and loss of endothelial cells• Capillary micro-anurism• Waxy exudate accumilation near micro anurism.

(hyperlipidemia)• Dot and Blot – Retina• Soft Cotton-wool spot

PROLIFERATIVE RETINOPATHY• After long term• Neovascularisation of retina

at optic disc.• Friability of newly formed

B.V cause easy bleeding- haemorrhage of vitrous

• Also proliferation of fibrous tissue around B.V

• Contraction of fibro – vascular tissue = Retinal detachment

DISCUSSION• Prameha can not only be compared to D.M, but electrolyte

imbalance etc are also related to prameha.• The syndrome of D.M is largely covered under prameha. • Apathyanimitta prameha, sthula prameha in ayurvedic litrature has

similarities with D.M. Madhumeha can almost be Diabetes Mellitus. • But to understand remaining 19 types of prameha we need wide

discussion and proper reasoning.• In general destruction of B-cell mass and obesity are most important

cause of diabetes.• So approach in treating DM should be to control diet and good life

style. • Early diagnose and treatment can prevent complications due to

prameha.

THANK YOU