Prameha Chikitsa: A Comprehensive Review w.s.r. to Charaka Samhita

Vol.01, Issue-02, August 2024

Author: Dr. Manish Singh Tomar, MD, PhD Ayurveda

Abstract

Prameha, a group of metabolic disorders described in the ancient Ayurvedic text Charaka Samhita, bears remarkable resemblance to modern-day diabetes mellitus and other urinary anomalies. Acharya Charaka provides an extensive exposition on the etiology, classification, pathogenesis, clinical features, prognosis, and therapeutic approaches for Prameha. This article delves into the Ayurvedic understanding of Prameha as presented by Charaka, correlating it with contemporary medical knowledge. By integrating traditional insights with modern science, we aim to enhance the understanding of metabolic and urinary disorders and explore holistic management strategies.

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Introduction

Metabolic disorders, particularly diabetes mellitus, pose significant health challenges globally. The increasing prevalence of such conditions necessitates a comprehensive understanding and innovative management approaches. Ayurveda, the ancient Indian system of medicine, offers valuable perspectives on these disorders under the term Prameha.

Derived from the Sanskrit roots “pra” (excessive) and “meha” (urination), Prameha encompasses a spectrum of urinary disorders characterized by frequent and excessive urination with various qualitative changes in urine. Acharya Charaka, one of the principal exponents of Ayurveda, provides a detailed account of Prameha in the Chikitsa Sthana (treatment section) of the Charaka Samhita.

This article aims to present a detailed analysis of Prameha as described by Charaka, correlating it with modern medical concepts, particularly diabetes mellitus and metabolic syndrome. By examining the etiopathogenesis, classification, clinical features, and treatment modalities, we seek to bridge the ancient wisdom of Ayurveda with contemporary medical science.

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Etiology (Nidana) of Prameha

Ayurvedic Perspective

Acharya Charaka emphasizes that Prameha arises due to the vitiation of all three doshas—Kapha, Pitta, and Vata—with a predominant involvement of Kapha. The etiological factors primarily include improper diet and lifestyle practices that increase Kapha and Medas (adipose tissue).

Dietary Factors

1. Excessive Intake of Sweet and Unctuous Foods:
   • Milk and Dairy Products: Overconsumption of milk (Payāṁsi), curd (Dadhīni), and their derivatives.
   • New Grains and Drinks: Consumption of freshly harvested grains (Navānnapāna).
   • Sugarcane Products: Excess intake of jaggery and its preparations (Guḍavaikṛtaṁ).
2. Heavy and Oily Foods:
   • Foods that are heavy (Guru) and oily (Snigdha) increase Kapha and lead to obesity.
3. Incompatible Foods (Viruddha Ahara):
   • Consumption of foods that are incompatible in combination or preparation.

Lifestyle Factors

1. Sedentary Lifestyle:
   • Lack of physical activity (Āsyāsukhaṁ), excessive sleep (Svapnasukhaṁ).
2. Daytime Sleep (Divasvapna):
   • Sleeping during the day increases Kapha and leads to metabolic sluggishness.
3. Lack of Mental and Physical Discipline:
   • Indulgence in pleasures without restraint contributes to dosha imbalance.

Shloka Reference:

• “Āsyāsukhaṁ svapnasukhaṁ dadhīni grāmyaudakānūparasāḥ payāṁsi| Navānnapānaṁ guḍavaikṛtaṁ ca pramehahētuḥ kaphakṛcca sarvam||” (Verse 4)

Pathogenesis (Samprapti)

• The etiological factors lead to the vitiation of Kapha, which in turn vitiates Medas (fat tissue) and other body tissues.
• The vitiated Kapha and Medas accumulate in the urinary bladder (Basti), causing obstruction and contamination of urine.
• Pitta and Vata doshas may also become involved, leading to various types of Prameha.

Shloka References:

• “Medaśca māṁsaṁ ca śarīrajaṁ ca kledaṁ kapho bastigataṁ pradūṣya| Karoti mehān samudīrṇamuṣṇais tāneva pittaṁ paridūṣya cāpi||” (Verse 5)
• “Kṣīṇeṣu doṣeṣvavakṛṣya bastau dhātūn pramehānanilaḥ karoti||” (Verse 6)

Modern Correlation

The etiological factors of Prameha closely align with the risk factors for diabetes mellitus and metabolic syndrome:

1. Dietary Habits:
   • High intake of carbohydrates and sugars.
   • Consumption of high-fat and calorie-dense foods.
2. Lifestyle Factors:
   • Sedentary lifestyle leading to obesity.
   • Lack of physical exercise contributing to insulin resistance.
3. Genetic Predisposition:
   • Family history of diabetes increases susceptibility.
4. Obesity and Adiposity:
   • Excessive fat accumulation, particularly visceral fat, is linked to type 2 diabetes.

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Classification of Prameha

Ayurvedic Perspective

Charaka classifies Prameha into twenty types based on the predominant dosha and the nature of the urine:

1. Kaphaja Prameha (Ten Types): Arising from Kapha dosha.
2. Pittaja Prameha (Six Types): Arising from Pitta dosha.
3. Vataja Prameha (Four Types): Arising from Vata dosha.

Shloka Reference:

• “Sādhyāḥ kaphotthā daśa, pittajāḥ ṣaṭ yāpyā, na sādhyaḥ pavanāccatuṣkaḥ| Samakriyatvād viṣamakriyatvān mahātyayatvācca yathākramaṁ te||” (Verse 7)

Characteristics of Urine in Prameha

1. Kaphaja Prameha:
   • Urine is turbid, oily, and resembles sugarcane juice or curd water.
   • It may be sweet, sticky, cold, and unctuous.
2. Pittaja Prameha:
   • Urine is yellowish, reddish, or has colors like saffron or lac.
   • It is hot, acidic, and may have a foul smell.
3. Vataja Prameha:
   • Urine is scanty, frothy, and resembles the color of bone marrow or honey.
   • It is thin, dry, and may cause burning sensation.

Shloka References:

• “Jalopamaṁ cekṣurasopamaṁ vā ghanaṁ ghanaṁ copari viprasannam| Śuklaṁ saśukraṁ śiśiraṁ śanair vā lāleva vā vālukayā yutaṁ vā||” (Verse 9)
• “Vidāt pramehān kaphajān daśaitān kṣāropamaṁ kālamathāpi nīlam| Hāridramāñjiṣṭhamathāpi raktam etān pramehān ṣaḍuśanti pittāt||” (Verse 10)

Modern Correlation

The classification of Prameha aligns with various types of diabetes and urinary disorders:

1. Type 2 Diabetes Mellitus:
   • Corresponds to Kaphaja Prameha with features like obesity and insulin resistance.
2. Type 1 Diabetes Mellitus:
   • May correlate with Pittaja and Vataja Prameha, involving autoimmune destruction and insulin deficiency.
3. Other Urinary Disorders:
   • Includes polyuria, glycosuria, and other anomalies in urine composition.

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Clinical Features (Purvarupa and Lakshana) of Prameha

Ayurvedic Perspective

Prodromal Symptoms (Purvarupa)

• Excessive sweetness in the mouth (Mādhuryamāsyē).
• Dryness of palate and throat (Gala tālu śōṣaḥ).
• Burning sensation in hands and feet (Karapāda dāhaḥ).
• Ants attracted to urine due to its sweetness.

Shloka Reference:

• “Śītapriyatvaṁ galatāluśōṣō mādhuryamāsyē karapādadāhaḥ| Bhaviṣyatō mēhagadasya rūpaṁ mūtrē’bhidhāvanti pipīlikāśca||” (Verse 14)

General Symptoms

• Excessive urination (Prabhūta mūtratā).
• Turbid and sweet urine.
• Obesity (Sthūlatā) or emaciation (Karśyatā).
• Lethargy and heaviness in the body.
• Itching and skin disorders.

Specific Symptoms Based on Dosha

1. Kaphaja Prameha:
   • Excessive sleep, heaviness, and unctuousness.
   • Pale complexion and coldness.
2. Pittaja Prameha:
   • Burning sensation, thirst, and irritability.
   • Yellowish discoloration of urine and skin.
3. Vataja Prameha:
   • Dryness, emaciation, and weakness.
   • Urine is scanty and causes burning.

Shloka References:

• “Svēdō’ṅgagandhaḥ śithilāṅgatā ca śayyāsanasvapnasukhē ratiśca| Hr̥nnētrajihvāśravaṇōpadēhō ghanāṅgatā kēśanakhātivr̥ddhiḥ||” (Verse 13)
• “Varṇaṁ rasaṁ sparśamathāpi gandhaṁ yathāsvadōṣaṁ bhajatē pramēhaḥ||” (Verse 12)

Modern Correlation

The clinical features of Prameha correspond closely with diabetes mellitus:

1. Polyuria:
   • Increased frequency and volume of urination.
2. Polydipsia:
   • Excessive thirst.
3. Polyphagia:
   • Increased appetite.
4. Weight Changes:
   • Weight gain in type 2 diabetes.
   • Weight loss in type 1 diabetes.
5. Fatigue and Weakness:
   • Due to impaired glucose utilization.
6. Blurred Vision:
   • Resulting from osmotic changes in the lens.
7. Recurrent Infections:
   • Skin infections, urinary tract infections.
8. Glycosuria:
   • Presence of glucose in urine attracting ants.

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Pathogenesis (Samprapti) of Prameha

Ayurvedic Perspective

• The vitiated Kapha dosha leads to the vitiation of Medas (fat), Mamsa (muscle), and Kleda (body fluids).
• These vitiated tissues contaminate the urine, leading to Prameha.
• In Vataja Prameha, the vitiated Vata draws from the depleted tissues, causing emaciation.

Shloka References:

• “Kaphaḥ sapittaḥ pavanaśca dōṣā mēdō’sraśukrāmbuvasālasīkāḥ| Majjā rasaujaḥ piśitaṁ ca dūṣyāḥ pramēhiṇāṁ, viṁśatirēva mēhāḥ||” (Verse 8)
• “Kṣīṇēṣu dōṣēṣvavakṛṣya bastau dhātūn pramehānanilaḥ karoti||” (Verse 6)

Modern Correlation

• Insulin Resistance:
  • Excess adipose tissue leads to decreased insulin sensitivity.
• Beta-cell Dysfunction:
  • Inadequate insulin production in the pancreas.
• Autoimmune Destruction:
  • In type 1 diabetes, autoimmune attack on beta cells.
• Metabolic Dysregulation:
  • Altered metabolism of carbohydrates, fats, and proteins.

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Prognosis (Sadhya-Asadhya) of Prameha

Ayurvedic Perspective

• Kaphaja Prameha:
  • Considered curable (Sadhya) with appropriate treatment.
• Pittaja Prameha:
  • Manageable but may require prolonged treatment.
• Vataja Prameha:
  • Generally considered incurable (Asadhya), especially when associated with emaciation and depletion of tissues.

Shloka References:

• “Sādhyāḥ kaphotthā daśa, pittajāḥ ṣaṭ yāpyā, na sādhyaḥ pavanāccatuṣkaḥ||” (Verse 7)
• “Jātaḥ pramehī madhumehinō vā na sādhya uktaḥ sa hi bījadōṣāt||” (Verse 57)

Modern Correlation

• Type 2 Diabetes Mellitus:
  • Can be managed effectively with lifestyle modifications and medication.
  • Potential for remission with significant weight loss and lifestyle changes.
• Type 1 Diabetes Mellitus:
  • Requires lifelong insulin therapy.
  • Focus on management rather than cure.
• Complications:
  • Poorly managed diabetes leads to complications like nephropathy, neuropathy, retinopathy, and cardiovascular diseases.

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Treatment Principles (Chikitsa Sutra)

Ayurvedic Perspective

General Approach

1. Nidana Parivarjana (Avoidance of Causative Factors):
   • Eliminate dietary and lifestyle factors contributing to Prameha.
2. Purification Therapies (Shodhana Chikitsa):
   • Emesis (Vamana): For Kapha-dominant Prameha.
   • Purgation (Virechana): For Pitta-dominant Prameha.
3. Pacification Therapies (Shamana Chikitsa):
   • Use of herbal decoctions, powders, and medicated oils.
4. Nourishing Therapies (Brimhana Chikitsa):
   • For emaciated patients with Vataja Prameha.
5. Dietary Management (Ahara Chikitsa):
   • Emphasis on barley preparations and other Kapha-reducing foods.
6. Lifestyle Modifications (Vihara Chikitsa):
   • Regular exercise, massage, and adherence to daily routines.

Specific Treatments Based on Patient Type

1. Obese and Strong Patients (Sthula Pramehi):
   • Purification Therapies: Emphasis on detoxification and reduction of Kapha and Medas.
   • Shloka Reference:
     • “Sthūlaḥ pramehī balavān ihaikaḥ kr̥śas tathaikaḥ paridurbalaśca| Sambr̥ṁhaṇaṁ tatra kr̥śasya kāryaṁ saṁśōdhanaṁ dōṣabalādhikasya||” (Verse 15)
2. Emaciated and Weak Patients (Krisha Pramehi):
   • Nourishing Therapies: Focus on strengthening and nourishing depleted tissues.
   • Shloka Reference:
     • “Sambr̥ṁhaṇaṁ tatra kr̥śasya kāryaṁ saṁśōdhanaṁ dōṣabalādhikasya||” (Verse 15)

Modern Correlation

• Lifestyle Modifications:
  • Diet control and increased physical activity for overweight patients.
  • Nutritional support for underweight or malnourished patients.
• Medications:
  • Use of insulin sensitizers and secretagogues.
  • Insulin therapy for type 1 diabetes.
• Monitoring and Management:
  • Regular monitoring of blood glucose levels.
  • Management of complications.

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Dietary Management (Ahara Chikitsa)

Ayurvedic Perspective

Recommended Foods

1. Barley (Yava) Preparations:
   • Barley is considered the best grain for Prameha patients due to its Kapha-reducing and diuretic properties.
   • Forms include barley gruel, bread, and roasted flour.
2. Old Rice (Purana Shali):
   • Aged rice is lighter and reduces Kapha.
3. Green Gram (Mudga):
   • Easily digestible and reduces Kapha.
4. Bitter Vegetables (Tikta Shaka):
   • Bitter gourd, neem leaves, and other bitter substances help in Kapha reduction.
5. Honey (Madhu):
   • Natural Kapha-reducer and enhances the properties of other herbs.

Shloka References:

• “Manthāḥ kaṣāyā yavacūrṇalēhāḥ pramehaśāntyai laghavaśca bhakṣyāḥ||” (Verse 18)
• “Yavaudanaṁ rūkṣamathāpi vāṭyam adyāt sasaktūn api cāpyapūpān||” (Verse 19)
• “Mudgādiyūṣairatha tiktaśākaiḥ purāṇaśālyōdanam ādadīta||” (Verse 20)

Foods to Avoid

• New grains, sugarcane products, dairy in excess, oily and heavy foods.

Modern Correlation

• Low Glycemic Index Foods:
  • Whole grains like barley and old rice have a lower glycemic index, aiding in better glucose control.
• High Fiber Diet:
  • Increases satiety and reduces glucose absorption.
• Avoidance of Simple Sugars and Refined Carbohydrates:
  • Reduces postprandial glucose spikes.
• Inclusion of Functional Foods:
  • Bitter gourd and other bitter substances have hypoglycemic effects.

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Discussion

The detailed description of Prameha by Acharya Charaka highlights a profound understanding of metabolic disorders and their systemic implications. The emphasis on holistic management—encompassing diet, lifestyle, medications, and purification therapies—aligns with modern approaches to managing diabetes and metabolic syndrome.

Relevance of Ayurvedic Concepts

• Dosha Imbalance and Metabolic Dysfunction:
  • The concept of dosha imbalance mirrors the pathophysiological mechanisms in diabetes, such as insulin resistance and beta-cell dysfunction.
• Dietary Guidelines:
  • Recommendations of low-glycemic and high-fiber foods resonate with modern dietary advice for diabetic patients.
• Lifestyle Modifications:
  • The importance of physical activity and stress management is universally acknowledged in both systems.

Integration with Modern Medicine

• Herbal Medicines:
  • Potential for incorporating herbal formulations with proven efficacy into integrative treatment plans.
• Personalized Medicine:
  • Ayurveda’s individualized approach based on patient constitution (Prakriti) complements the modern trend towards personalized medicine.
• Preventive Strategies:
  • Early identification of risk factors and intervention can prevent or delay the onset of diabetes.

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Treatments for Prameha Mentioned in the Charaka Samhita

Prameha, as described in the ancient Ayurvedic text Charaka Samhita, refers to a group of urinary disorders characterized by excessive urination and turbidity of urine. The given shlokas from the Prameha Chikitsa chapter provide detailed insights into the treatment modalities for Prameha, focusing on purification therapies, dietary management, herbal formulations, lifestyle modifications, and specific interventions based on the dosha predominance and patient condition.

Below is a comprehensive summary of the treatments for Prameha mentioned in the Prameha Chikitsa Adhyaya, organized for clarity and ease of understanding.

1. Treatment Principles Based on Patient Condition

A. Classification of Patients

1. Obese and Strong Patients (Sthula):
   • Characteristics:
     • Excess body weight and strength.
     • Predominant Kapha dosha.
   • Treatment Approach:
     • Purification Therapies (Shodhana): To eliminate excess doshas and reduce body weight.
2. Emaciated and Weak Patients (Krisha):
   • Characteristics:
     • Thin body frame and debility.
     • Predominant Vata dosha.
   • Treatment Approach:
     • Nourishing Therapies (Brimhana): To strengthen and nourish the body tissues.

Shloka References:

• Verse 15:
  • “sthūlaḥ pramēhī balavānihaikaḥ kr̥śastathaikaḥ paridurbalaśca| sambr̥ṁhaṇaṁ tatra kr̥śasya kāryaṁ saṁśōdhanaṁ dōṣabalādhikasya||”
  • “One type of Pramehi is obese and strong, and the other is thin and weak. Nourishment should be given to the thin one, and purification should be done for the one with excess doshas and strength.”

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2. Purification Therapies (Shodhana Chikitsa)

A. Emesis (Vamana) and Purgation (Virechana)

• Purpose: To eliminate vitiated doshas from the body.
• Indications:
  • Vamana: For Kapha-dominant Prameha.
  • Virechana: For Pitta-dominant Prameha.

Shloka References:

• Verse 25:
  • “saṁśōdhanōllēkhanalaṅghanāni kālē prayuktāni kaphapramēhān| jayanti pittaprabhavān virēkaḥ santarpaṇaḥ saṁśamanō vidhiśca||”
  • “Purification, scraping, and fasting, when administered timely, cure Kapha Prameha; Purgation cures Pitta Prameha; Nourishing and pacifying therapies are prescribed.”

B. Enema (Basti)

• Purpose: To balance Vata dosha and support elimination.
• Indications: For Vata-dominant Prameha in emaciated patients.

Note: While Basti is not explicitly mentioned in the given shlokas, it is a standard practice in Ayurveda for Vata disorders.

C. Avoidance in Certain Patients

• Contraindications: Emaciated and weak patients should not undergo strong purification therapies.

Shloka References:

• Verse 17:
  • “gulmaḥ kṣayō mēhanabastiśūlaṁ mūtragrahaścāpyapatarpaṇēna| pramēhiṇaḥ syuḥ, paritarpaṇāni kāryāṇi tasya prasamīkṣya vahnim||”
  • “Due to excessive depletion, Pramehi may suffer from abdominal tumors, emaciation, pain in the bladder, and urinary retention. Therefore, nourishing therapies should be done after assessing the digestive fire.”

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3. Dietary Management

A. Recommended Foods

1. Barley (Yava) Preparations:
   • Forms:
     • Barley gruel (Yavanna), thin gruel (Vāṭya), roasted barley flour (Saktu), barley cakes (Apūpa).
   • Benefits:
     • Reduces Kapha and Medas (fat).
     • Light and easy to digest.
2. Old Rice (Purāṇa Śāli):
   • Cooked with green gram (Mudga) and bitter vegetables (Tikta Śāka).
3. Meat Soups:
   • From animals and birds of arid regions (Jāṅgala Mamsa).
4. Bitter Vegetables:
   • Supports digestion and reduces Kapha.
5. Honey (Madhu):
   • Used as a sweetener and therapeutic agent.
   • Mixed with barley preparations and decoctions.

Shloka References:

• Verses 18-21:
  • “manthāḥ kaṣāyā yavacūrṇalēhāḥ pramēhaśāntyai laghavaśca bhakṣyāḥ||”
  • “Yavaudanaṁ rūkṣamathāpi vāṭyamadyāt sasaktūnapi cāpyapūpān||”
  • “Mudgādiyūṣairatha tiktaśākaiḥ purāṇaśālyōdanamādadīta||”
  • “Yavapradhānastu bhavēt pramēhī yavasya bhakṣyān vividhāṁstathā’dyāt kaphapramēhī madhusamprayuktān||”

B. Specific Preparations

1. Barley Soaked in Triphala Decoction:
   • Preparation:
     • Barley soaked overnight in Triphala decoction mixed with honey.
   • Usage:
     • Consumed as a drink for therapeutic purposes.
2. Barley Processed with Decoctions:
   • Decoctions of Herbs:
     • Used for Kaphaja Prameha.
     • Herbs include Daruharidra, Devadaru, Triphala, Musta, etc.

Shloka References:

• Verses 22-24:
  • “niśisthitānāṁ triphalākaṣāyē syustarpaṇāḥ kṣaudrayutā yavānām||”
  • “tān sīdhuyuktān prapibēt pramēhī prāyōgikānmēhavadhārthamēva||”
  • “saktūnapūpān saguḍān sadhānān bhakṣyāṁstathā’nyān vividhāṁśca khādēt||”

C. Foods to Avoid

• Kapha-Aggravating Foods:
  • New grains.
  • Heavy, oily, and sweet substances.
  • Dairy products in excess.

Note: While not explicitly mentioned in the given shlokas, Ayurveda generally advises avoiding Kapha-increasing foods in Prameha.

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4. Herbal Formulations

A. Decoctions (Kaṣāya)

1. For Kaphaja Prameha:
   • Ingredients:
     • Daruharidra (Berberis aristata)
     • Devadaru (Cedrus deodara)
     • Triphala (Three myrobalans)
     • Musta (Cyperus rotundus)
     • Haridra (Turmeric)
     • Amalaki (Emblica officinalis)
   • Preparation and Usage:
     • Decoction prepared and consumed with honey.
     • Helps in reducing Kapha and purifying the urinary system.

Shloka References:

• Verses 26-27:
  • “dārvīṁ surāhvāṁ triphalāṁ samustāṁ kaṣāyamutkvāthya pibēt pramēhī| kṣaudrēṇa yuktāmathavā haridrāṁ pibēdrasēnāmalakīphalānām||”

2. Ten Decoctions for Kaphaja Prameha:
   • Herbs Include:
     • Haritaki, Katphala, Musta, Lodhra, Patha, Vidanga, Arjuna, Nimba, etc.
   • Usage:
     • Decoctions prepared from these herbs, taken with honey.

Shloka References:

• Verse 29:
  • “pādaiḥ kaṣāyāḥ kaphamēhināṁ tē daśōpadiṣṭā madhusamprayuktāḥ||”

3. For Pittaja Prameha:
   • Herbs Include:
     • Ushira, Lodhra, Anjana, Chandana, Musta, Amalaki, Padmaka, Vrikshaka, etc.
   • Usage:
     • Decoctions prepared and consumed with honey.

Shloka References:

• Verses 30-32:
  • “paittēṣu mēhēṣu daśa pradiṣṭāḥ pādaiḥ kaṣāyā madhusamprayuktāḥ||”

4. General Use in All Prameha Types:
   • First Two Groups of Decoctions:
     • Considered effective in all types of Prameha.
   • Usage:
     • Employed in drinking, processing barley preparations, and during meals.

Shloka References:

• Verse 33:
  • “sarvēṣu mēhēṣu matau tu pūrvau kaṣāyayōgau vihitāstu sarvē||”

B. Medicated Oils and Ghee

1. For Vataja Prameha:
   • Medicated Oils (Taila) and Ghee (Ghrita):
     • Prepared with herbs that pacify Vata and nourish tissues.
   • Herbs Include:
     • Trikantaka, Ashmantaka, Somavalka, Bhallataka, Ativisha, Lodhra, Vaccha, Patola, Arjuna, Nimba, Musta, Haridra, Padmaka, Dipyaka, Manjishtha, Aguru, Chandana.

Shloka References:

• Verses 37-39:
  • “dr̥ṣṭvā’nubandhaṁ pavanāt kaphasya pittasya vā snēhavidhirvikalpyaḥ| tailaṁ kaphē syāt svakaṣāyasiddhaṁ pittē ghr̥taṁ pittaharaiḥ kaṣāyaiḥ||”

C. Herbal Powders and Linctus

1. Powders Mixed with Honey:
   • Ingredients:
     • Kampilla, Saptacchada, Shalaja, Baibhita, Rauhitaka, Kutaja flowers.
   • Usage:
     • Consumed by Kapha and Pitta Pramehi patients to alleviate symptoms.

Shloka References:

• Verse 35:
  • “kampillasaptacchadaśālajāni baibhītarauhītakakauṭajāni| kapitthapuṣpāṇi ca cūrṇitāni kṣaudrēṇa lihyāt kaphapittamēhī||”

2. Madhvasava (Fermented Preparation):
   • Ingredients:
     • Decoction of various herbs like Lodhra, Shati, Pushkaramula, Murdva, Vidanga, Triphala, etc.
     • Honey added and fermented.
   • Benefits:
     • Alleviates Kapha and Pitta Prameha, anemia, hemorrhoids, loss of appetite, and skin diseases.

Shloka References:

• Verses 41-44:
  • “drōṇē’mbhasaḥ karṣasamāni paktvā pūtē caturbhāgajalāvaśēṣē| rasē’rdhabhāgaṁ madhunaḥ pradāya pakṣaṁ nidhēyō ghr̥tabhājanasthaḥ||”

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5. Lifestyle Modifications

A. Physical Activities

1. Vigorous Exercise (Vyāyāma):
   • Purpose:
     • Reduces excess Kapha and Medas.
     • Enhances metabolism.
2. Powder Massage (Udvartana):
   • With Herbal Powders:
     • Helps in reducing body fat.
     • Stimulates circulation.
3. Bathing and Water Pouring (Snāna, Jalāvasēka):
   • Benefits:
     • Refreshes the body.
     • Removes toxins through sweating.

Shloka References:

• Verses 49-50:
  • “vyāyāmavidhirvividhaḥ snānānyudvartanāni gandhāśca| mēhānāṁ praśamārthaṁ cikitsitē diṣṭamētāvat||”

B. Use of Fragrant Substances

• Applications of Pastes and Oils:
  • Ingredients:
    • Sevyatwak, Ela, Aguru, Chandana, and other aromatic herbs.
  • Purpose:
    • Pacifies the mind and body.
    • Reduces symptoms of Prameha.

Shloka References:

• Verse 50:
  • “sēvyatvagēlāgurucandanādyairvilēpanaiścāśu na santi mēhāḥ||”

C. Avoidance of Causative Factors

• Diet and Lifestyle:
  • Avoid:
    • Foods and behaviors that increase Kapha and Medas.
    • Sedentary lifestyle.

Shloka References:

• Verse 53:
  • “yairhētubhiryē prabhavanti mēhāstēṣu pramēhēṣu na tē niṣēvyāḥ| hētōrasēvā vihitā yathaiva jātasya rōgasya bhavēccikitsā||”

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6. Specific Treatments Based on Dosha Predominance

A. Kaphaja Prameha

1. Purification Therapies:
   • Emphasis on:
     • Emesis, purgation, and fasting.
2. Herbal Decoctions:
   • Ten Specific Decoctions:
     • Prepared with herbs that reduce Kapha.
3. Diet and Lifestyle:
   • Use of:
     • Barley preparations.
     • Bitter vegetables.
     • Honey.

Shloka References:

• Verses 25, 29, 51:
  • “saṁśōdhanōllēkhanalaṅghanāni kālē prayuktāni kaphapramēhān||”
  • “pādaiḥ kaṣāyāḥ kaphamēhināṁ tē daśōpadiṣṭā madhusamprayuktāḥ||”
  • “vaidyēna pūrvaṁ kaphapittajēṣu mēhēṣu kāryāṇyapatarpaṇāni||”

B. Pittaja Prameha

1. Purgation (Virechana):
   • Purpose:
     • To eliminate excess Pitta.
2. Herbal Decoctions:
   • Ten Specific Decoctions:
     • Prepared with cooling and Pitta-pacifying herbs.
3. Diet and Lifestyle:
   • Avoid:
     • Spicy, sour, and heating foods.

Shloka References:

• Verses 25, 32:
  • “jayanti pittaprabhavān virēkaḥ||”
  • “paittēṣu mēhēṣu daśa pradiṣṭāḥ pādaiḥ kaṣāyā madhusamprayuktāḥ||”

C. Vataja Prameha

1. Nourishing Therapies (Brimhana):
   • Use of Oils and Ghees:
     • Medicated with herbs that pacify Vata.
2. Diet and Lifestyle:
   • Emphasis on:
     • Warm, unctuous foods.
     • Gentle exercises.

Shloka References:

• Verses 34, 52:
  • “siddhāni tailāni ghr̥tāni caiva dēyāni mēhēṣvanilātmakēṣu||”
  • “yā vātamēhān prati pūrvamuktā vātōlbaṇānāṁ vihitā kriyā sā||”

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7. Management of Complications

A. Treatment of Ulcers (Pidakas)

• Surgical Intervention:
  • Performed by:
    • Skilled surgeons.
  • Procedures:
    • Surgical removal, purification, and healing techniques.

Shloka References:

• Verse 58:
  • “pramēhiṇāṁ yāḥ piḍakā mayōktā rōgādhikārē pr̥thagēva sapta| tāḥ śalyavidbhiḥ kuśalaiścikitsyāḥ śastrēṇa saṁśōdhanarōpaṇaiśca||”

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8. Considerations for Incurable Cases

A. Madhumeha (Diabetes Mellitus)

• Prognosis:
  • Incurable (Asadhya):
    • Due to genetic factors (Beeja Dosha).

Shloka References:

• Verse 57:
  • “jātaḥ pramēhī madhumēhinō vā na sādhya uktaḥ sa hi bījadōṣāt||”

B. Hereditary Diseases

• Prognosis:
  • Considered Incurable:
    • Diseases that are familial or genetic in nature.

Shloka References:

• Verse 57:
  • “yē cāpi kēcit kulajā vikārā bhavanti tāṁśca pravadantyasādhyān||”

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Treatment Conclusion

The treatments for Prameha mentioned in the given shlokas emphasize a holistic and individualized approach, integrating:

• Purification Therapies: Employed based on dosha predominance and patient strength.
• Dietary Management: Use of barley, old rice, green gram, bitter vegetables, and avoidance of Kapha-increasing foods.
• Herbal Formulations: Decoctions, medicated oils, ghees, and fermented preparations tailored to specific types of Prameha.
• Lifestyle Modifications: Regular exercise, powder massages, bathing, and use of fragrant substances to reduce Kapha and Medas.
• Avoidance of Causative Factors: Eliminating dietary and lifestyle habits that contribute to the development of Prameha.
• Treatment of Complications: Surgical management of ulcers and other complications by skilled practitioners.
• Consideration of Prognosis: Recognizing incurable cases due to genetic factors and focusing on management strategies.

Conclusion

Acharya Charaka’s exposition on Prameha offers valuable insights into the understanding and management of metabolic disorders. The parallels between Prameha and modern diabetes mellitus underscore the timeless relevance of Ayurvedic principles. Integrating Ayurvedic wisdom with contemporary medical practices can enhance patient care by providing holistic, personalized, and effective management strategies.

Continued research and collaboration between traditional and modern medical systems are essential to harness the full potential of this ancient knowledge in addressing today’s health challenges.

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References

1. Charaka Samhita, Chikitsa Sthana, Prameha Chikitsa Adhyaya.
2. Sharma, P. V. (1981). Charaka Samhita: Text with English Translation. Chaukhambha Orientalia.
3. Lad, V. (2002). Textbook of Ayurveda. Ayurvedic Press.
4. Dash, B., & Kashyap, L. (2001). Diagnosis and Treatment of Diseases in Ayurveda. Concept Publishing Company.
5. Murthy, K. R. S. (2012). Astanga Hridaya (English Translation). Krishnadas Academy.
6. Kumar, V., Abbas, A. K., & Aster, J. C. (2015). Robbins and Cotran Pathologic Basis of Disease. Elsevier.
7. Wild, S., et al. (2004). Global prevalence of diabetes. Diabetes Care, 27(5), 1047-1053.
8. Singh, R. H. (1998). Essentials of Ayurveda. Motilal Banarsidass Publishers.
9. Fauci, A. S., et al. (2015). Harrison’s Principles of Internal Medicine. McGraw-Hill Education.
10. Bolognia, J. L., Schaffer, J. V., & Cerroni, L. (2018). Dermatology. Elsevier.