Treatment of pram®ham

¡yurv®dic approach
P.K.V.Anand
Vaidyaratnam Ayurveda College
Thaikkattussery, Thrissur

2-1-2014 VAF 1
 Objectives to be achieved
• Blood sugar control
• Urine sugar control
• Prevention of long term complications
• Prevention of damage to target organs
• Cure of symptoms like fatigue, polyurea,
polyphagia, polydipsia, albuminurea, etc.
• Limiting microvascular damages, H.T., etc.

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 Prevent pathogenesis
caused by DM
• Microvascular damages
• Atherogenic activities
• Neurological damages

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 Protect the target organs
• Heart
• Brain
• Kidneys
• Eyes
• Peripheral nerves
• Foot

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 Prevent the complications
• CAD / CVA
• Stroke
• Diabetic nephropathy
• Diabetic retinopathy
• Diabetic carbuncles
• Peripheral neuropathy

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 Current Attitudes
Vaidyas prefer to
• Continue using Allopathic drugs only
• Add on minor Ayurvedic tips
• Add on major medications
• Use Ayurvedic medication only

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 pram®ham takes leave
but never quits the job
• pram®ho anuÀa´g¢¸¡m ¿r®À¶ah
• - - - - - - iti sarva vik¡ra vigh¡ta bh¡v¡bh¡va
prativi¿®À¡bhinirv¤ttih®turbhavatyuktaÅ.
• Short term measures like attending hyperglycemia can keep
pram®ham abscent on the record.
• But the disease remains successful in serving its purpose
through its complications.

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 Very few studies only on effectiveness of
Precise glycemic control
• In people with longstanding type 2 diabetes who
are at high risk for heart attack and stroke,
– lowering blood sugar to near-normal levels did not
delay the combined risk of diabetic damage to kidneys,
eyes, or nerves,
– but did delay several other signs of diabetic damage
– The intensive glucose treatment was compared with
standard glucose control. ScienceDaily (June 30, 2010)
• Frequent fluctuations are more hazardous than
pesistant less fluctuant hyperglycemia

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 Common assumptions
• pram®ham is always santarpa¸ajanyam
– Lots of people get it despite being thin and undernourished
• DM is pram®ham
– All urinary disorders with an increase of quantity & quality are
pram®ham
– pram®ham needs a wide range of modern equallents
• pram®ham is specifically madhum®ham
– in this case madhum®ham is a vatika pram®ham and we
should go for b¤ha¸am

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 Diabetes mellitus
• Based carbohydrate metabolism
• Urine sugar is an obsolete symptom
• Hyper glycemia is the diagnostic feature
• Polyphagia is a feature mentioned
• Hyperglycemia makes hepatic complications
• Nowadays complications are neurological and vascular

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 pram®ham
• Based on fat metabolism
• Urine sugar is a Prodromal symptom and a symptom of 3-5
types of pram®hams
• Intensification of prodroms is the diagnostic feature
• Hyperglycemia may be interpreted to
– gurv¡tiv¤ddha saml¢na ¿l®Àmami¿rass°nnaj° rasaÅ of sthaulyam
• Polyphagia is not textually mentioned
• Complications are d°Àa related
• Neuro-vascular complications are due to Extreme kar¿anam

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 43 pram®ha p£rvar£p¡s
in Diabetes Mellitus

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 Blood is the degraded substance
• Glucose is madhuram & kaphakaram
– glucose is not the cause by itself
• It is a very essential energy supply for tissues
– Its presence in excess turns the quality of rasa-rakta dh¡tu to
madhuram & kaphakaram
• The ¡¿rayasth¡na is rasa-raktadh¡tu
РHence rasa-raktadu˦i is to be corrected and saved from
excess madhuram
• Both rasa & rakta are pitta domains
– presence of madhura dravyam in a pitta domain makes
kaphakopa but needs pittahara treatment.

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 Involvement of kapha

dravatva
m of
pittam

uÀ¸am bahudrava
of
pittam
¿l®Àama

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 Involvement of kapha

¿¢ta, snigdha, etc Foods kaphaprakopa

and
Activities
uÀ¸av¢ryam
which melts
kapha into fluid ¡mam
kapha accumulation
pr¡k¤tastu balam ¿l®Àm¡ vaik¤t° malamucyat®
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 Involvement of Pittha
• Offers dravaguna • takradh¡ra, tiktarasam, etc
• Many of the prevalant offers upa¿ayam - for
poorvaroopas are pittha related
hyperglycemia
• Polyphagia – not a part of
pram®halakshana in texts • Drugs used are also pittha
• Commonest age of onset of DM is in samana -
Pitthakala • dh¡tri, ni¿a, l°ha, gu½£ci,
• Sthambhana is the precise principle ¿at¡vari, m®thik¡, honey
of treatment in pram®ham
etc.

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 Involvement of v¡ta
• The destination of all pram®hams, is v¡ta dominance.
• Extreme damage is the situation (mahathyaya)

• Virudhopakramthwa

Asaadhya

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 Dooshyas in pram®ham

• Bahu-Abadha Medas • Vasa

• Mamsam • Majja
• Sareerajakleda • Laseeka
• Sukra • Rasa
• Sonitham • Ojah

The involvement of each of them determines

the complications to be manifested

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 The broader umbrella
• Pre-diabetic stage
– under kapha pramah¡
• Diabetis mellitus
– under pitta pram®h¡s
• Diabetis & complications
– under v¡tika pram®h¡s

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 Prevention is the cure
• Prevent the advancement to Vathikapram®ham
• Prevent the advancement to Paithikapram®ham
• Restrict the advancement from kaphajapram®ham

• Precautions against onset Vathika or Paithika mehas at first in predisposed ones

• Postpone the onset of pram®ham in predisposed individuals

• Protect & strengthen target organs

• Protective measures for complications and pathogenic damages
• If possible keep blood sugar in normal range

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 apatarpa¸am in pram®ham
is dangerous
• m£trakÀayam, ruj¡, gulmam, kÀayam, m®hana-
vasti¿£lam, m£tragraham
– Clear indication of diabetic nephropathy & v¡tavik¡ras

• Nutrition & dietetics differ from modern nutrition

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 Hyperglycemia in DM
70 % of Diabetes patients die of complications
related with diabetes because of

• Poor blood sugar control

• Inability to prevent these threats by change

in life style, Oral hypoglycemics or by Insulin

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 Poor blood sugar control
• Most of the diabetics are well aware and
concerned about the need to be in normal
range
• If not – health education is the remedy

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 Hyperglycemia out of control
• Find out the reasons for each patients individually
– foods can be identified for some like tapioca
– Lack of excercise for some
– Stress for some
• Categorize the d°Àa & dh¡tu involvement
• Name the clinical manifestation as far as possible
• Tailor made individual prescriptions

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 raktaja glucose & rasaja glucose
kapha
period of
digestion

v¡ta pitta
period of
digestion

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 raktaja glucose & rasaja glucose
kapha
period of
digestion

v¡ta pitta
period of
digestion

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 Treatment approach
• To block the glucose entry
from gut
– m®dhika etc
• To propel down the glucose
containing foods before
absorption -
– triphala
• Dries up / neutralize / mask
the glucose contents of food
– bitter gaurd
• To block the conversion &
release of glycogen to sugar
– Liver oriented medicines &
treatments like takradh¡ra
• To exhaust the blood sugar
by utelising
– excercises
– vai¿v¡nara c£r¸am for
breaking insulin resistance

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 Glycemic index

Maltose = 105 Sugar = 59

Glucose = 100 Suranakanda = 51
Boiled carrot = 92 Greengram = 48
Honey = 87 Maasha = 48
Iddali = 80 Sweet potato = 48
Rice (white) = 72 Kadala = 47
Uppumavu = 71 Soyabeen = 43
Ragi / bajra = 71 Carrot = 43
Bread = 70 Orange = 40
Potato = 70 Apple = 39
Wheat = 70 Curd = 36
Nenthrappazham = 69 Icecream = 36
Beetroot = 64 Milk = 33
Sprouted Mudga = 60 Fructose = 20

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 Glycemic index is altered when

Lowers the index Increases the index

• Complex carbohydrates • Sprouting etc., increases
make delayed digestion the index
- Sweet -
potato Mudga
• Fiber rich ones delays
glucose Absorption • Cooking increases the
- Medhika index
• High fat content delays - Carrot, laaja
absorption - Ice
creams / Milk

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 Glucose & Fructose content of
pram®hahara Oushadhas

Ayaskrithi = <1% Devadarvarishta= 14%

Chandanasava = <1% Dasamularishta= 20%
Duralabharishta= 40%
Madhookasava = <2%
Madusnuhirasayan = 40%
Useerasava = 3% Agasthyarasayana = 55%
Saribadyasava = 7% Sathavaree Gulam = 60%
Kumaryasava = 8%
Asokarishta = 12%

30ml Dasamoolarishta offers 7gms of glucose + fructose into the system

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 Hyperglycemia in pram®ham
• It is a Santharpanotha vyadhi and all are due to
Thrid°Àakopa
• kapha is the most dominant d°Àa even in Paithika
and Vathika mehas (Thadhavidhasarirasyaiva)
• Abundant availability of kapha is the reason for
kapha getting involved at first.
• Excessive fluidity is state of kapha (Bahudravah Sleshma
d°Àaviseshah)

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 We need model drugs
• Guloochyadi kashayam
• Gayathri darvi krimihrid vacha
• Dhathri
• Nisa
• Silajathu

Often insulin levels are increased

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 Ayush 82 - None are from
pram®hacikitsa
• Karrella - Bitter vegetable
• Jambu - Moothra sangrahana
• Amraasthi - Moothra sangrahana
• Gudmar (Gymnema sylvestris)

Good & Fair Control in 70% patients

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 Guloochyadi Kashayam

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 g¡yatri d¡rv¢ k¤mih¤t vac¡n¡m
kaph® traya kÀaudrayut¡Å kaÀ¡yaÅ

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 Santharpana is also Samana
Samana after sodhana -

Urdhwam thadhathascha malepaneethe

Meheshu santharpanameva karyam

Samana for those who are not fit for Sodhana -

Samsodhanam narhathi yah Pramehi

Thasya kriya samsamnee vidheya
Charaka

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 Samana Chikitsa
• kapha pram®hams – Foods modified with kashayas,
Yava, Laja, mandha, thrinadhanya, shashtika,
Mudga, Arishta / madya, Jangalamamsa etc.
• Sugar is OK but jaggary is bad being abhiÀyandi

Madhuram sleshmalam prayo

Jeernacchaliyavadruthe
Mudgad Godhoomathah kshoudrat
Sithayah jangalamishal

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 Special focus
• Laja
• Yava
• Thiktha rasa
• Kashaya bhavitha food

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 pram®ham as a complication
• kaphajarsas
• Grahani
• Sthoulya
• Stress

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 Which one for Santharpana
• Sapoorvaroopah kaphapittamehah
• Kramena ye v¡takrithascha mehah
Sadhya na the,
• pittakrithasthu yapyah
• Sadhyasthu medo yadi na pradushtam
• pram®h® tulya d£ÀyataÅ is a sughas¡dhya lakÀa¸am

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 Conclusion
• Prevent the advancement to Vathikapram®ham
• Prevent the advancement to Paithikapram®ham
• Restrict the advancement from kaphajapram®ham

• Precautions against onset Vathika or Paithika mehas at first in predisposed ones

• Postpone the onset of pram®ham in predisposed individuals

• Protect & strengthen target organs

• Protective measures for complications and pathogenic damages
• If possible keep blood sugar in normal range

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 T
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Y
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