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== Introduction ==

== Introduction ==

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The fourth chapter in the [[Nidana Sthana]], dealing with the diagnosis of ''prameha'', follows the diagnosis of ''gulma'' disease associated with the ''mamsa dhatu''. Twenty known types of ''prameha'', including diabetes mellitus (''madhumeha''), have been described here. However, there could be innumerable variations of a disease based on the presence or absence of disease (provoking or mitigating) factors in the body. The manifestation of the disease depends upon the interaction between causative factors, ''dosha, dushya'' and the defense mechanism of the body. Some of these factors can also help determine if there could be a delayed or an early onset of the disease, the severity of the disease, etc. Various etiological factors of ''prameha'' are described here that lead to vitiation of ''kapha, meda,'' and ''mutra''. A vitiated ''kapha'' affects ten fluid-predominant body tissues, resulting in the production of excessive ''kleda'' (moisture/excess discharge of body fluids) that, when intermixed with ''meda'' (lipid)and ''mamsa'' (muscle protein), further vitiates ''mutra'' (urine) and results in ''prameha''. A patient afflicted with diabetes mellitus, on an initial visit to the physician, may complain of numbness, tingling, burning sensation in feet, fatigue, dryness of mouth, drowsiness, etc. It is highlighted these signs and symptoms for an early diagnosis and management of ''prameha''. Ten types of curable ''kaphaja prameha'', six variants of ''yaapya'' (palliative) and four variants of incurable ''vataja prameha'', totaling twenty types of ''prameha'' have been described here in this text. Prodromal symptoms, complications, treatment procedures (enumerated briefly), and some rules (do’s and don’ts) have been included in the course of this chapter.

The fourth chapter in the [[Nidana Sthana]], dealing with the diagnosis of ''prameha'', follows the diagnosis of ''gulma'' disease associated with the [[mamsa dhatu]]. Twenty known types of ''prameha'', including diabetes mellitus (''madhumeha''), have been described here. However, there could be innumerable variations of a disease based on the presence or absence of disease (provoking or mitigating) factors in the body. The manifestation of the disease depends upon the interaction between causative factors, [[dosha]], dushya'' and the defense mechanism of the body. Some of these factors can also help determine if there could be a delayed or an early onset of the disease, the severity of the disease, etc. Various etiological factors of ''prameha'' are described here that lead to vitiation of [[kapha]] [[dosha]], [[meda dhatu]], and [[mutra]]. A vitiated [[kapha]] affects ten fluid-predominant body tissues, resulting in the production of excessive [[kleda]] (moisture/excess discharge of body fluids) that, when intermixed with [[meda]] (lipid)and [[mamsa]] (muscle protein), further vitiates [[mutra]] (urine) and results in ''prameha''. A patient afflicted with diabetes mellitus, on an initial visit to the physician, may complain of numbness, tingling, burning sensation in feet, fatigue, dryness of mouth, drowsiness, etc. It is highlighted these signs and symptoms for an early diagnosis and management of ''prameha''. Ten types of curable ''kaphaja prameha'', six variants of ''yaapya'' (palliative) and four variants of incurable ''vataja prameha'', totaling twenty types of ''prameha'' have been described here in this text. Prodromal symptoms, complications, treatment procedures (enumerated briefly), and some rules (do’s and don’ts) have been included in the course of this chapter.

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==Sanskrit Text, Transliteration and English Translation==

==Sanskrit Text, Transliteration and English Translation==

Now we shall expound the chapter "Prameha Nidana" (Diagnosis and etiopatheogenesis of Obstinate Urinary Disorders including diabetes). Thus said Lord Atreya. [1-2]

Now we shall expound the chapter "Prameha Nidana" (Diagnosis and etiopatheogenesis of Obstinate Urinary Disorders including diabetes). Thus said Lord Atreya. [1-2]

=== Types of ''Prameha'' ===

=== Types of Prameha ===

 

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Due to vitiation of three ''doshas'', (any of) twenty types of ''prameha'' could occur. However, there may be innumerable other variations of the disease. We shall now explain the ways in which vitiation of the three ''doshas'' leads to the manifestation of the various types of ''prameha''. [3]

Due to vitiation of three [[dosha]], (any of) twenty types of ''prameha'' could occur. However, there may be innumerable other variations of the disease. We shall now explain the ways in which vitiation of the three [[dosha]] leads to the manifestation of the various types of ''prameha''. [3]

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=== Process of Onset of Disease ===

=== Process of Onset of Disease ===

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इहखलुनिदानदोषदूष्यविशेषेभ्योविकारविघातभावाभावप्रतिविशेषाभवन्ति|

इह खलु निदानदोषदूष्यविशेषेभ्यो विकारविघातभावाभाव प्रतिविशेषा भवन्ति|

यदाह्येतेत्रयोनिदानादिविशेषाःपरस्परंनानुबध्नन्त्यथवा[१]

यदाह्येतेत्रयोनिदानादिविशेषाःपरस्परंनानुबध्नन्त्यथवा[१]

कालप्रकर्षादबलीयांसोऽथवाऽनुबध्नन्तिनतदाविकाराभिनिर्वृत्तिः,  

कालप्रकर्षादबलीयांसोऽथवाऽनुबध्नन्तिनतदाविकाराभिनिर्वृत्तिः,  

Thus, the presence or absence of specific factors determine the ability or otherwise of the body to resist all types of diseases. [4]

Thus, the presence or absence of specific factors determine the ability or otherwise of the body to resist all types of diseases. [4]

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=== Etiology of ''Kaphaja Prameha'' ===

=== Etiology of ''Kaphaja Prameha'' ===

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बहुद्रवःश्लेष्मादोषविशेषः||६||

बहुद्रवःश्लेष्मादोषविशेषः||६||

बह्वबद्धं[१]मेदोमांसंशरीरजक्लेदःशुक्रंशोणितंवसामज्जालसीका

बह्वबद्धं मेदोमांसंशरीरजक्लेदःशुक्रंशोणितंवसामज्जालसीका रसश्चौजःसङ्ख्यातइतिदूष्यविशेषाः||७||

रसश्चौजःसङ्ख्यातइतिदूष्यविशेषाः||७||

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*Frequent and excessive intake of:

*Frequent and excessive intake of:

**Newly harvested grains like ''hayanaka, yavaka'' (a variety of Hordeum vulgare Linn), ''cinaka, uddalaka,naishadha,itkata, mukundaka,'' ''mahavrihi, promodaka,'' and ''sugandhaka'';

**Newly harvested grains like ''hayanaka, yavaka'' (a variety of Hordeum vulgare Linn), ''chinaka, uddalaka,naishadha,itkata, mukundaka,'' ''mahavrihi, promodaka,'' and ''sugandhaka'';

**Newly harvested pulses like ''harenu'' (Pisum sativum Linn.) and ''masha'' (Phaseolus radiates Linn.), consumed with ghee;  

**Newly harvested pulses like ''harenu'' (Pisum sativum Linn.) and ''masha'' (Phaseolus radiates Linn.), consumed with ghee;  

**The meat of domesticated, marshy and aquatic animals;

**The meat of domesticated, marshy and aquatic animals;

The ''kapha'' with excessive fluid component is specific vitiation in ''prameha''.

The ''kapha'' with excessive fluid component is specific vitiation in ''prameha''.

Specific ''dushyas'' of ''prameha'' include excess ''abaddha meda'' (loose fat), ''mamsa'' (muscle tissues), ''vasa'' (muscle fat), ''majja'' (marrow), ''kleda''(body fluids), ''shukra'' (semen and reproductive tissues), ''rakta'' (blood), ''lasika'' (lymph) and ''rasa'' (plasma) and ''ojas'' (the purest of all ''dhatus'').  [5-7]

Specific ''dushyas'' of ''prameha'' include excess abaddha [[meda]] (loose fat), [[mamsa]] (muscle tissues), [[vasa]] (muscle fat), [[majja]] (marrow), [[kleda]](body fluids), [[shukra]] (semen and reproductive tissues), [[rakta]] (blood), [[lasika]] (lymph) and [[rasa]] (plasma) and [[ojas]] (the purest of all [[dhatu]]).  [5-7]

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=== Pathogenesis ===

=== Pathogenesis ===

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Etiological factors (especially ''kapha''-dominant ones), ''doshas'', and ''dushyas'' mentioned in the preceding verses can trigger the manifestation of ''kaphaja prameha''. The aggravated ''kapha'' spreads all over the body quickly because of flaccid muscles and fatty tissues. The ''kapha'' blends quickly with the ''medas'' (fat) – primarily because the fats typically are excessive in quantity and viscous and soft in "favorable" body conditions but also because ''kapha'' and ''medas'' share identical qualities. As ''kapha'' itself is vitiated, it vitiates ''medas'' in the process. The vitiated ''kapha - meda'' then mixes with ''mamsa'' (muscle tissues) and ''kleda'' (moisture/body fluid), in as much as these two are supposed to have already exceeded their quantity. Vitiation of the muscle tissues provides a congenial atmosphere for the manifestation of putrified carbuncles (''pidika'') like ''sharavika'' and ''kacchapika'' in the muscle. The liquid ''dhatus'' in the body get further vitiated and transformed into ''mutra'' (urine). ''Vrikka'' (kidney) and ''basti'' (urinary bladder) are at the two ends of the channels carrying urine; the openings of these channels get affected by ''meda'' (fat) and ''kleda''. The vitiated ''kapha'' obstructs the openings of these channels. This results in the manifestation of ''prameha'' which becomes chronic or incurable due to the affection of all qualities of ''kapha'' and simultaneous vitiation of homogenous and heterogenous ''dhatus''. [8]

Etiological factors (especially ''kapha''-dominant ones), ''doshas'', and ''dushyas'' mentioned in the preceding verses can trigger the manifestation of ''kaphaja prameha''. The aggravated ''kapha'' spreads all over the body quickly because of flaccid muscles and fatty tissues. The ''kapha'' blends quickly with the ''medas'' (fat) – primarily because the fats typically are excessive in quantity and viscous and soft in "favorable" body conditions but also because ''kapha'' and ''medas'' share identical qualities. As ''kapha'' itself is vitiated, it vitiates ''medas'' in the process. The vitiated ''kapha - meda'' then mixes with ''mamsa'' (muscle tissues) and ''kleda'' (moisture/body fluid), in as much as these two are supposed to have already exceeded their quantity. Vitiation of the muscle tissues provides a congenial atmosphere for the manifestation of putrified carbuncles (''pidika'') like ''sharavika'' and ''kacchapika'' in the muscle. The liquid ''dhatus'' in the body get further vitiated and transformed into ''mutra'' (urine). ''Vrikka'' (kidney) and ''basti'' (urinary bladder) are at the two ends of the channels carrying urine; the openings of these channels get affected by ''meda'' (fat) and ''kleda''. The vitiated ''kapha'' obstructs the openings of these channels. This results in the manifestation of ''prameha'' which becomes chronic or incurable due to the affection of all qualities of ''kapha'' and simultaneous vitiation of homogenous and heterogenous ''dhatus''. [8]

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=== Signs, Types, and Prognosis of ''Kaphaja Prameha'' ===

=== Signs, Types, and Prognosis of ''Kaphaja Prameha'' ===

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=== Specific Features of Types of ''Kaphaja Prameha'' ===

=== Specific Features of Types of ''Kaphaja Prameha'' ===

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=== Etiology and Types of ''Pittaja Prameha'' ===

=== Etiology and Types of ''Pittaja Prameha'' ===

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''Ojas'' is, by nature, of sweet taste. However, its roughness causes ''vata'' to convert it into an astringent tasting element. This ''vata''-afflicted ''ojas'', when gets into the urinary bladder, causes ''madhumeha''. [36-37]

''Ojas'' is, by nature, of sweet taste. However, its roughness causes ''vata'' to convert it into an astringent tasting element. This ''vata''-afflicted ''ojas'', when gets into the urinary bladder, causes ''madhumeha''. [36-37]

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=== Incurability of ''Vataja Prameha'' and its Other Characteristics ===

=== Incurability of ''Vataja Prameha'' and its Other Characteristics ===

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=== General Prodromal Features of ''Prameha'' ===

=== General Prodromal Features of ''Prameha'' ===

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=== Various ''dushyas'' involved in the pathogenesis ===

=== Various ''dushyas'' involved in the pathogenesis ===

==== ''Medadhatu'' ====

==== [[Meda dhatu]] ====

''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:<ref> sourced from http://www.slideshare.net/ayurmitra/madhumeha-kc041-gdg </ref>  

''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:<ref> sourced from http://www.slideshare.net/ayurmitra/madhumeha-kc041-gdg </ref>  

It is one of the main ''dushyas'' (vitiating factors) described by Charak 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''. [Cha.Sa.[[Nidana Sthana]] 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 <ref> May, RC et al. 1996. Glucocorticoids and acidosis stimulate protein and amino acid catabolism in vivo. Kidney Int. 1996 Mar;49(3):679-83. </ref>. Amino acids breakdown in liver results in increased production of urea<ref> Vaudevan et al. 2011. Textbook of biochemistry for medical students, Sixth Edition, JP Medical Publishers </ref> 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.

It is one of the main ''dushyas'' (vitiating factors) described by Charak 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''. [Cha.Sa.[[Nidana Sthana]] 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 <ref> May, RC et al. 1996. Glucocorticoids and acidosis stimulate protein and amino acid catabolism in vivo. Kidney Int. 1996 Mar;49(3):679-83. </ref>. Amino acids breakdown in liver results in increased production of urea<ref> Vaudevan et al. 2011. Textbook of biochemistry for medical students, Sixth Edition, JP Medical Publishers </ref> 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 dhatu'' ====

==== [[Majja dhatu]] ====

''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.

''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]] ====

''Shukra'' also get vitiated in the pathogenesis and produces symptoms like ''daurbalya'' (fatigue) and ''krichavyavayata'' (difficulty in sexual intercourse), because normal functions of ''shukra'' 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'' also get vitiated in the pathogenesis and produces symptoms like ''daurbalya'' (fatigue) and ''krichavyavayata'' (difficulty in sexual intercourse), because normal functions of ''shukra'' 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.

==== ''Ojas'' ====

==== [[Ojas]] ====

''Ojas'' as ''dushya'' is mainly involved in ''vataja prameha'' i.e. ''ojomeha'' (''madhumeha''). The symptoms of ''ojakshaya'' manifests, like ''gurugatrata'' (heaviness in body), ''nidra'' (sleepiness), ''tandra'' (drowsiness) and ''daurbalya'' (fatigue) can be correlated with immunocompromised stage in diabetes mellitus due to deranged immunity.

[[Ojas]] as ''dushya'' is mainly involved in ''vataja prameha'' i.e. ''ojomeha'' (''madhumeha''). The symptoms of ''ojakshaya'' manifests, like ''gurugatrata'' (heaviness in body), ''nidra'' (sleepiness), ''tandra'' (drowsiness) and ''daurbalya'' (fatigue) can be correlated with immunocompromised stage in diabetes mellitus due to deranged immunity.

==== ''Kleda'' ====

==== [[Kleda]] ====

This is one of the body components mainly involved in the pathogenesis. The literary meanings of ''kleda'' are wetness, moisture and dumpness etc. The physiology of ''kleda'' is mainly related with ''mutra'' and ''sweda'' along with ''meda''. Thus, when ''kleda'' is involved then it directly affects the above factors. In normal physiology ''mutra'' and ''sweda'' maintain the balance of ''kleda''. Especially ''sweda'' holds it in the body and ''mutra'' gets excreted out of the body according to the body condition and requirement. If ''kleda'' gets vitiated it directly affects the physiology of ''mutra'' and ''sweda'' and disrupts the assemblage of bodily elements causing ''shaithilya''. Thus, the symptoms manifest due to ''kleda'' vitiation are ''prabhutamutrata'' (polyuria), ''swedavrddhi'' (increased sweating), ''shaithilya'' (weakness), ''daurgandhya'' (bad smell) and ''avilamutrata'' (polyuria).

This is one of the body components mainly involved in the pathogenesis. The literary meanings of ''kleda'' are wetness, moisture and dumpness etc. The physiology of ''kleda'' is mainly related with ''mutra'' and ''sweda'' along with ''meda''. Thus, when ''kleda'' is involved then it directly affects the above factors. In normal physiology ''mutra'' and ''sweda'' maintain the balance of ''kleda''. Especially ''sweda'' holds it in the body and ''mutra'' gets excreted out of the body according to the body condition and requirement. If ''kleda'' gets vitiated it directly affects the physiology of ''mutra'' and ''sweda'' and disrupts the assemblage of bodily elements causing ''shaithilya''. Thus, the symptoms manifest due to ''kleda'' vitiation are ''prabhutamutrata'' (polyuria), ''swedavrddhi'' (increased sweating), ''shaithilya'' (weakness), ''daurgandhya'' (bad smell) and ''avilamutrata'' (polyuria).

The glycosuria raises the ''osmolar'' concentration of the urine and osmotic diuresis resulting in water and sodium loss along with potassium leads to generalized weakness in the patient of diabetes mellitus. The level of catecholamines is increased in DM causes excessive sweating that further leads to loss of electrolytes such as sodium and chlorides through the skin. The whole phenomenon described under ''kleda'' can be correlated with water and electrolyte imbalance.

The glycosuria raises the ''osmolar'' concentration of the urine and osmotic diuresis resulting in water and sodium loss along with potassium leads to generalized weakness in the patient of diabetes mellitus. The level of catecholamines is increased in DM causes excessive sweating that further leads to loss of electrolytes such as sodium and chlorides through the skin. The whole phenomenon described under ''kleda'' can be correlated with water and electrolyte imbalance.

==== ''Vasa'' ====

==== [[Vasa]] ====

Charak described it as a subtype of ''vatajaprameha'' i.e. ''vasameha''. ''Vasa'' is the ''upadhatu'' (minor tissue or sub-tissue) of ''mamsa'' and the unctuousness present in the ''mamsa dhatu'' is called ''vasa''.

Charak described it as a subtype of ''vatajaprameha'' i.e. ''vasameha''. ''Vasa'' is the ''upadhatu'' (minor tissue or sub-tissue) of ''mamsa'' and the unctuousness present in the ''mamsa dhatu'' is called ''vasa''.

==== ''Lasika'' ====

==== [[Lasika]] ====

This is one of the liquid component present just beneath the skin. ''Lasika'' also get vitiated by ''vata'' resulting ''lasikameha''. There is no direct reference related to ''vasa'' and ''lasika dushti''.

This is one of the liquid component present just beneath the skin. ''Lasika'' also get vitiated by ''vata'' resulting ''lasikameha''. There is no direct reference related to ''vasa'' and ''lasika dushti''.

==== Exclusion of ''asthi'' as a ''dushya'' ====

==== Exclusion of [[asthi]] as a [[dushya]] ====

Among the ten ''dushyas'' of ''prameha, asthi'' (bone) is not included. According to modern physiology, bone is a tissue that undergoes frequent remodeling and has a large capacity for regeneration. In the adult remodeling occurs so that the skeleton is replaced approximately every 10–11 yr. This physiological remodeling is initiated by osteoclasts that re-absorb bone and is followed by the formation of an equivalent amount of new bone by osteoblasts,<ref> Parfitt A. 1982 The coupling of bone formation to bone resorption: a critical analysis of the concept and of its relevance to the pathogenesis of osteoporosis. Metab Bone Dis Relat Res 4:1–6. </ref>  <ref> Mundy G 1989 Local factors in bone remodeling. Rec Prog Horm Res 45:507–531. </ref> bone loss is noted when the amount of bone resorption exceeds the amount of new bone formation.  

Among the ten ''dushyas'' of ''prameha, asthi'' (bone) is not included. According to modern physiology, bone is a tissue that undergoes frequent remodeling and has a large capacity for regeneration. In the adult remodeling occurs so that the skeleton is replaced approximately every 10–11 yr. This physiological remodeling is initiated by osteoclasts that re-absorb bone and is followed by the formation of an equivalent amount of new bone by osteoblasts,<ref> Parfitt A. 1982 The coupling of bone formation to bone resorption: a critical analysis of the concept and of its relevance to the pathogenesis of osteoporosis. Metab Bone Dis Relat Res 4:1–6. </ref>  <ref> Mundy G 1989 Local factors in bone remodeling. Rec Prog Horm Res 45:507–531. </ref> bone loss is noted when the amount of bone resorption exceeds the amount of new bone formation.  

Diabetes has also been associated with a net loss of bone. A number of studies have reported that type 1 diabetes alters bone remodeling by reducing the formation of new bone, leading to osteopenia. This has been shown by a decrease in bone mineral density in humans and alterations in the formation of new bone in animal studies<ref> Hayward M, Fiedler-Nagy C 1987 Mechanisms of bone loss: rheumatoid arthritis, periodontal disease and osteoporosis. 22:251–254. </ref>  <ref> Tuominen J, Impivaara O, Puukka P, Ronnenmaa T 1999 Bone mineral density in patients with type 1 and type 2 diabetes. Diabetes Care 22:1196–1200. </ref>  <ref> Krakauer J, McKenna M, Burderer N, Rao D, Whitehouse F, Parfitt A 1995 Bone loss and bone turnover in diabetes. Diabetes 44:775–782. </ref>  <ref> Macey L, Kana SM, Jingushi S, Terek RM, Borretos J, Bolander ME 1989 Defects of early fracture-healing in experimental diabetes. J Bone Joint Surg Am 71:722–733. </ref>. In contrast, the presence of bone loss in type 2 diabetes is less clear, and current understanding suggests that this form of diabetes is not typically associated with osteopenia<ref> Gebauer G, Lin S, Beam H, Vieira P, Parsons J 2002 Low-intensity pulsed ultrasound increases the fracture callus strength in diabetic BB Wistar rats but does not affect cellular proliferation. J Orthop Res 20:587–592. </ref>  <ref> Barrett-Conner E, Holbrook T 1992 Sex differences in osteoporosis in older adults with non-insulin-dependent diabetes mellitus. JAMA 268:3333–3337. </ref>  <ref> Loe H 1993 Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care 16:329–334. </ref>  <ref> Nelson R, Shlossman M, Budding L, Pettitt DJ, Saad MF, Genco RJ, Knowler WC1990 Periodontal disease and NIDDM in Pima Indians. Diabetes Care 13:836–840. </ref>. The reasons for the lower bone mineral density in type 1 diabetes are not known.

Diabetes has also been associated with a net loss of bone. A number of studies have reported that type 1 diabetes alters bone remodeling by reducing the formation of new bone, leading to osteopenia. This has been shown by a decrease in bone mineral density in humans and alterations in the formation of new bone in animal studies<ref> Hayward M, Fiedler-Nagy C 1987 Mechanisms of bone loss: rheumatoid arthritis, periodontal disease and osteoporosis. 22:251–254. </ref>  <ref> Tuominen J, Impivaara O, Puukka P, Ronnenmaa T 1999 Bone mineral density in patients with type 1 and type 2 diabetes. Diabetes Care 22:1196–1200. </ref>  <ref> Krakauer J, McKenna M, Burderer N, Rao D, Whitehouse F, Parfitt A 1995 Bone loss and bone turnover in diabetes. Diabetes 44:775–782. </ref>  <ref> Macey L, Kana SM, Jingushi S, Terek RM, Borretos J, Bolander ME 1989 Defects of early fracture-healing in experimental diabetes. J Bone Joint Surg Am 71:722–733. </ref>. In contrast, the presence of bone loss in type 2 diabetes is less clear, and current understanding suggests that this form of diabetes is not typically associated with osteopenia<ref> Gebauer G, Lin S, Beam H, Vieira P, Parsons J 2002 Low-intensity pulsed ultrasound increases the fracture callus strength in diabetic BB Wistar rats but does not affect cellular proliferation. J Orthop Res 20:587–592. </ref>  <ref> Barrett-Conner E, Holbrook T 1992 Sex differences in osteoporosis in older adults with non-insulin-dependent diabetes mellitus. JAMA 268:3333–3337. </ref>  <ref> Loe H 1993 Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care 16:329–334. </ref>  <ref> Nelson R, Shlossman M, Budding L, Pettitt DJ, Saad MF, Genco RJ, Knowler WC1990 Periodontal disease and NIDDM in Pima Indians. Diabetes Care 13:836–840. </ref>. The reasons for the lower bone mineral density in type 1 diabetes are not known.

=== ''Vataja prameha'' as type 1 diabetes mellitus ===

=== ''Vataja prameha'' vis a vis type 1 diabetes mellitus ===

The pathogenesis of ''vataja prameha'' is similar to that of type-1 diabetes mellitus. ''Vata'' is agitated due to various precipitating causes acts on the body in such a way that there is passage of ''vasa'' (fat), ''majja'' (bone marrow), ''lasika'' (lymph), and ''ojas'' (essence of the body /immune substances / vitality) through the urine. This condition indicates impaired renal function as a result of diabetes, leading to a dire prognosis. Due to ''dhatukshaya'' (loss of body tissues) the patient become very weak and emaciated.

The pathogenesis of ''vataja prameha'' is similar to that of type-1 diabetes mellitus. ''Vata'' is agitated due to various precipitating causes acts on the body in such a way that there is passage of ''vasa'' (fat), ''majja'' (bone marrow), ''lasika'' (lymph), and ''ojas'' (essence of the body /immune substances / vitality) through the urine. This condition indicates impaired renal function as a result of diabetes, leading to a dire prognosis. Due to ''dhatukshaya'' (loss of body tissues) the patient become very weak and emaciated.