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→Samprapti (pathogenesis) of prameha
==== ''Samprapti'' (pathogenesis) of ''prameha'' ====
==== ''Samprapti'' (pathogenesis) of ''prameha'' ====
The scientific utility of this chapter lies in the fact that in ''prameha'' the vitiated kapha first vitiates meda dhatu followed by mamsa and other dushya and then finally vitiates mutra to manifest as ''prameha''. This signifies that hyperglycemia is preceded by dyslipidiemias. One more interesting fact is that the main culprit of the disease i.e. kapha is inherently denatured, means it looses its natural properties due to hereditary defect what we know today as genetic susceptability. Furthermore, it is added that if a disease appeared due to genetic default, then it is incurable. A step ahead from the present contemporary knowledge, it is mentioned that as genetic modulation can cause disease similarly a chronic disease can cause gene modulation and vice-versa.
The scientific utility of this chapter lies in the fact that in ''prameha'' the vitiated ''kapha'' first vitiates ''meda dhatu'' followed by ''mamsa'' and other ''dushya'' and then finally vitiates ''mutra'' to manifest as ''prameha''. This signifies that hyperglycemia is preceded by dyslipidiemias. One more interesting fact is that the main culprit of the disease i.e. ''kapha'' is inherently denatured, means it loses its natural properties due to hereditary defect what we know today as genetic susceptability. Furthermore, it is added that if a disease appeared due to genetic default, then it is incurable. A step ahead from the present contemporary knowledge, it is mentioned that as genetic modulation can cause disease similarly a chronic disease can cause gene modulation and vice-versa.
Various dushyas involved in the pathogenesis:
==== Various ''dushyas'' involved in the pathogenesis ====
Medadhatu :
===== ''Medadhatu'' =====
''Meda'' vitiation is common and dominant ''dushya'' in the pathogenesis of ''madhumeha''. ''Kapha'' and ''meda'' both have close resemblance in regard to functions as well as in regard to qualitative parameters. Both get vitiated more or less by same etiological factors. In ''madhumeha'' vitiation of ''meda'' results by two ways:
Majja: Majja dhatu is not vitiated to maximum extent but vata causes its kshaya i.e. depletion. Thus vitiated majja produces symptoms like netragaurava (heaviness in eyes), angagaurava(heaviness in body) in patient of madhumeha. The ketone bodies production due to excessive utilization of fat may be referred to dushti of vasa and majja. Murchcha (temporary loss of consciousness) occurs due to dushti of majja in diabetes mellitus. The condition of hyperglycemic coma is characterized by the accumulation of ketone bodies.
#Qualitative: ''Abaddha'' (loose): The normal function of ''meda'' is to produce unctousness in the body along with ''drudhatva'' (compactness). This ''abadhatva'' (looseness) causes derangement in the structure of ''meda'' producing ''shaithilya'' (flabbiness) in the body this can be well correlated with FFA excess.
#Quantitative: ''Bahu''(excess): Here in the pathogenesis, ''meda'' is in excess quantity. This ''medadhatu'' is ''aparipakva'' (immature). It obstructs the path of ''vayu'' along with ''kapha''. This provoked ''vata'' increases the ''agni'', so patient eats more and more food causing excessive deposition of ''aparipakva meda''. This in turns causes severe depletion of the other ''dhatus'' and produces various sign and symptoms.
Excess of fat in the body get converted into FFA and is utilized in energy metabolism especially in the muscles causing retention of glucose in the blood. Increased appetite in ''medoroga'' is due to increased body demand, which is explained to be due to hyperinsulinism or increased secretion of growth hormone. Diabetes has been compared with the fasting state of the body, ketosis is nothing else but the advanced fasting stage of the body, so the deleterious effect of long fast specially in the patient of obesity is same as in diabetic stage.
''Mamsadhatu'': It is one of the main ''dushyas'' (vitiating factors) described by Charaka in regards to ''prameha''. He narrated it especially in ''kaphaja prameha'' and ''avaranjanya madhumeha''. ''Mamsa'' and ''Kapha'' possess similar qualities and both give strength to the body. When vitiated, mamsa loses its normal consistency and develops ''shaithilya'' and provide space in between for the accumulation of morbid matter. That in turn results in ''putimamsa pidika'' (Ca.Ni. 4/8). ''Mamsa dushti'' can be compared to deranged protein metabolism which is an integral part of diabetes mellitus. Research studies have found that glucocorticoid activities and acidosis stimulates protein and amino acid catabolism . Amino acids breakdown in liver results in increased production of urea and these free amino acids can be compared with ''abaddha mamsa''. ''Putimamsa'' and ''pidaka'' are the morbid states of ''mamsa dhatu''. Two major changes take place in ''mamsa dhatu'' - protein degradation and reduction in its blood supply, both of which along with elevated blood sugar level form a favorable media for the growth and multiplication of microorganisms. The results are putrefaction and evolution of multiple septic foci in ''mamsa dhatu''. Diminished protein synthesis hampers the healing process and these complications adopt chronic course.
''Majja'': ''Majja dhatu'' is not vitiated to maximum extent but ''vata'' causes its ''kshaya'' i.e. depletion. Thus vitiated majja produces symptoms like netragaurava (heaviness in eyes), angagaurava(heaviness in body) in patient of madhumeha. The ketone bodies production due to excessive utilization of fat may be referred to dushti of vasa and majja. Murchcha (temporary loss of consciousness) occurs due to dushti of majja in diabetes mellitus. The condition of hyperglycemic coma is characterized by the accumulation of ketone bodies.
Shukra: Shukra also get vitiated in the pathogenesis and produses symptoms like daurbalya (fatigue) and krichavyavayata (difficulty in sexual intercourse), because normal functions of sukra is to maintain dehabala. It also plays role in the precipitation of sahaja (genetic) prameha. Sexual impotency and testicular hypofuctions have been reported in diabetes mellitus.
Shukra: Shukra also get vitiated in the pathogenesis and produses symptoms like daurbalya (fatigue) and krichavyavayata (difficulty in sexual intercourse), because normal functions of sukra is to maintain dehabala. It also plays role in the precipitation of sahaja (genetic) prameha. Sexual impotency and testicular hypofuctions have been reported in diabetes mellitus.