PRAMEHA – AN APPROACH BASED ON PATHOPHYSIOLOGICAL MECHANISMS
Dr K P Yadunandanan MD AyMedical OfficerGovt Ayurveda HospitalChelembra, Malappuram Dist
Our SpecialitiesFrozen ShoulderOA KneeTennis ElbowCTSLeg PainFeet NumbnessErectile Dysfunction
Ayurveda & DiabetesDiabetes = PramehaNisakathakadi or
KathakakhadiradiNirooryadiMehari powdersPaneeyams “Ayurvedic = Herbal Hypoglycemic
Drug”“Lack of a proper understanding of
disease & treatment approach”
Disease Approach based on Pathophysioloical mechanismsAnalysis of the disease
MechanismsNidana
Genetics, lifestyle, season, locality, occupation etc
Poorvaroopa & LakshanaSpecific to diseases
SamprapthiPathophysiological mechanisms
BedaStages
Patient ApproachSystematic Approach in Patient Examination & Evaluation
Evaluation of VayuPrana
◦JeevanaUdana
◦BalaVyana
◦Dhatu Parinama & DhatugatiSamana
◦Aharapaka Apana
◦Nishkramana
Evaluation of AgniJatara
◦Aharapaka & MalanirmanamRanjaka
◦Raktha NirmanamDhatwagni
◦Dhatuparinama & Kleda Nirmanam
Evaluation of Dhatu SaraTwakRakthaMamsa & MedasAsthi Majja & SandhiSukra
Evaluation of MalaPureesha
◦Consistency Moothra
◦Colour etcSwedaOther mala
Evaluation of ManasSatwaRajaTamas
Type 2 Diabetes Mellitus“A Vascular disease more than a
true metabolic disease”
Macroangiopathy◦Stroke, CAD, Leg Gangrene
Microangiopathy◦Retinopathy, Nephropathy,
Neuropathy
EpidemologyDiabetic epidemic
Between 2003 and 2025, the number of patients worldwide with diabetes is going to increase 72% to an estimated 333 million people
Epidemological profiles and trends loaded against India
Predisposing FactorsGenetic predispositionObesityLifestyleLack of exerciseEnvironmentalInflammation
DIABETES – PATHOPHYSIOLOGICAL MECHANISMS
Beta Cell DysfunctionBlunting of the beta-cell response
with loss of first phase insulin secretion
With time, there is overall loss of insulin secretion
A decrease in beta-cell mass and death of these beta cells
Insulin Resistance“Defect in ability of insulin to
stimulate glucose transport into the cell”
ObesityFree Fatty AcidsInflammation
Alterations in Lipid MetabolismEctopic deposition of Lipids –
lipotoxicity◦Pancreas, Liver, muscle, heart
muscleInsulin ResistanceReduced TG synthesisEnhanced lipolysisIncrease in Free fatty Acids
InflammationLow grade tissue InflammationInflammatory markers raised in
obese personsInflammation to endothelial
dysfunctionResults in Insulin ResistanceProgression of Disease
◦Death of fat cells & Beta cells
Diabetes MellitusMultifactorial complex
mechanisms◦Pancreatic Dysfunction◦Insulin Resistance◦Altered Lipid Metabolism◦Inflammation
Chronic HyperglycemiaHyperglycaemic pseudohypoxiaOxidative stressActivation of the coagulation
cascadeInflammation
“Endothelial Dysfunction of arteries”
Diabetic AngiopathyMacroangiopathy
◦Myocardial Infarction◦Stroke◦Leg gangrene
Microangiopathy◦Retinopathy◦End Stage Renal Failure◦Peripheral Neuropathy
PRAMEHA
BeejadushtiSahaja PramehaBeeja Avayava DushtiInherited Agni Vaigunya
Kapha Krit Cha SarvamNavannaDadhiAnoopa MamsaAvyayamaAsuchitwamKapha Medo Moothra Vridhi
Physical & Mental Inertia
AGNI & PRAMEHA
Panchabuta AkashaVayuAgniApPrithvi
Agnishomeeyam – Evolution of LifeLife – Dynamics
Of BhutasJala
◦ Dhatusara, OjasAgni
◦ Jatara, DhatwagniVayu
◦ Panchavayu
Vayu
JalaAgni
Panchabuta & PramehaJalarogaJala Buta
Prasada – MalaA disease of Jaladushti progressing
to Dhatukshaya
Agni & PramehaJataragni – Ahara Parinamam
◦Ahara to Rasa ◦Khara Mala - Pureesha
Dhatwagni – Dhatu Parinamam◦Annarasa to Dhatu Sara & Ojas ◦Drava Mala - Kleda – Moothra
Agni & PramehaAgnidourbalyamAma formationSrotorodhaMedovridhiDhatwagnivaikalyaMedodushtiExcess KledaExcess Moothra formationDisintegration of DhatusMadhumeha
Agnidourbalya & Ama – Beta cell Dysfunction & Insulin ResistanceAtyaharaAdhibojanaLack of proper exerciseAgnimandyamFormation of AmaMadhura Anna RasaSrotorodha
Medovridhi - SthoulyamIncrease in Medas
◦Deposition of medas in abdomen,thighs
Dhatwagni VaikalyaFurthur increase in formation of
MedasSrotorodhaDhatwagni Dourbalya
Medodushti - PrediabeticDhatwagnidourbalyaVridha Medas – Dushta MedasSthira Dhatu Sara – Shithila
DhatuDhatu Parinama VaikalyaProne to CAD, CVA
Prameha – Vasthi RogaActivation of PithaDissolution of MedasFormation of excess Kleda Elimination of excess Kleda As
MoothraExcess formation of Moothra
‘Athimoothratha’
Prameha – MadhumehaActivation Of Vyana & Apana
VayuWeakened Agni & Disintegration
Of Dhatu SaraDhatu & Ojas converted to KledaAvila Moothra - Increased
concentration of Urine‘Madhumeha – Asadhya’
CLINICAL SCENARIO
Agnimandya & Ama StageBeta cell stimulation & reducing
Insulin resistance Agnibalavardhana & Amahara
◦Panchakolam◦Indukantham
Eating Habit ModificationLife Style Modification
Medoroga & MedodushtiMedohara & Atisthoulya ChikitsaDhatwagni Deepana
◦ Varadi Kashayam, Ayaskriti, Lodhrasavam◦ Loha Prayoga
Navayasam◦ Mushta, Darvi, Thriphala, Devadaru◦ Vidangadi◦ Abyanga
Prabanjanam◦ Udwarthanam
Nalpamara, Eladi, Nisa◦ Vyayama◦ Ahara Vihara
Prameha - AtimehanaPitha SamanaKleda VishoshanaMoothra SthambanaMedo Doshahara & Agni DeepanaTiktha Rasa & Seetha Veerya
◦Ekanayakam◦Thettamparal◦Niroori◦Vanga & Abraka
Moothra SthambanaKashaya
Nisakathakadi, KathakakhadiradiGulika
Nirooryadi, Swethagunjadi, MehasamhariChoornam
◦AmritadiPaneeya
◦Ekanayaka Shadangam‘Combine Medohara & Deepana Chikitsa’
◦Chitrkathriphaladi, Navayasam
Madhumeha - AvilamoothrathaAggressive Treatment Prevent progression to Vatha stagePitha Vatha samanam & intensive
SthambanaMedodoshahara &
MoothravisodhanaBalyam & RasayanamAgnideepanamVathasamanam
AvilamoothramSilajathu Prayogam
◦RasayanamNisa & Amalaka in all stages
◦Nisa – Kledahara◦Amalaka – Rasayanam
Aveerabeejam◦Moothravisodhanam
Oushadham◦Akulyabdadi, Aakuyadi Gritam
Prameha - AvilamoothramIntensive Sthambana ChikitsaDhara
◦Takradhara◦Special Dhara – 28 days
SirolepamMoordha Thailam
◦Nisoseeradi, ArukaladiAbyangam
◦Lakshadi KuzhambuPizhichil
Krisha Meham Vata Pitha DoshaAgni VaishamyamStressSigns
◦Excess thirst & tiredness◦Karshyam
Sudden Progression to neuropathyVatha Pitha SamanamAgnideepanamMehahara & Balya
Krisha Meham - ChikitsaOushadham
◦Indukantham, Nisakathakadi◦Nirooryadi◦Amritadi◦Abrakam
Dhara & SirolepaPizhichilRasayanam
◦Amritha, Amalaka
PRAMEHA – COMPLICATIONS & ASSOCIATED SYMPTOMS
Prameha – Complications in Skeletomuscular System Microangiopathy & tissue
ischemiaChronic Inflammation Excess Kleda & SodhaDathushosha & Disintegration of
Structures
Approach – Management of Complications Aggressive Management of PramehaPrevent progressionEffective Management of ComplicationsKledahara & Sodha Hara
◦Kathakakadiradi with SilajathuVatha Samana
◦Rasnathamalakyadi, MaharasnadiBalyam
◦Bala, Amritha“Treat Prameha effectively & complications
will disappear”
Frozen Shoulder ACKledahara & Sodhahara
◦Kathakakadiradi with ChandrapraVatha Samanam
◦Maharasnadi with TrayodasangagugguluSnehana
◦Parinathakeree, PanchasnehamBalyam
◦Ksheerabala Prayogam◦Navara
Foot Abnormalities – Charcot footNeuropathic ArhtropathyManage PramehamVatha Samanam
◦Maharasnadi, GugguluBalyam
◦Navara
Vascular NeuropathyPeripheral – DSPMicroangiopathy & Nerve
IschemiaNerve Damage – Arhtopathy
◦Pain, Numbness, muscle atrophyAutonomic
◦Urination problems◦Erectile Dysfunction
Managemant - Vascular neuropathyAggressive Management of Prameha – Vatha
Pitha Meha◦ Nisakathakadi, Nirooryadi, Nisa & Amalaka◦ Amritadi
Dhara & SirolepaVatahara
◦ Rasnathamalakyadi, Ashtavargam,Balya & Rasayanam
◦ Bala – Ksheerabala◦ Amrita – Ksheeraguloochi◦ Abyangam & Pizhichil◦ Vasthi
Vascular neuropathyAutonomic – ED Vata Pitha Meha Samana
◦Nisakathakadi, AmrithadiVrishya
◦Silajathu, Abrakam, Vangam◦Jeevaneeyaganam◦Pizhichil◦Vasthi
Nephropathy - MadhimehamMadhumeha Chikitsa
◦Akulyabdadi Kashayam◦Silajathu
Rasayana – Saramabu Bavitha Silajathu◦Lajjalu
Sopha & Udara Chikitsa
PAD & PramehaChronic Leg Pain
◦Macroangiopathy – Atherosclerosis of Tibial artery
◦Guggulutikthakam◦Rasasindooram◦Amrita & Guggulu◦Mahamanjishtadi◦Madhusnuhi
PADLeg Gangrene
◦Guggulutikhakam◦Rasasindooram◦Mahamanjishtadi◦Amrita & Guggulu◦Madhusnuhi
Hyperglycemia as symptom
Stroke◦Ama◦Amahara Chikitsa◦Shaddharanam yogam
SummaryPrameha involves complicated
mechanisms which appear contradictory – Agnimandya, Ama, Medodushti, Dhatu Shaithilya & Ojakshaya.
Management requires understanding of different patho-physiology and treatment options should be adopted accordingly
THANK YOU