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Line 877: − + − − #Kaphaja prameha (progressive stage from pre-diabetic to diabetes mellitus type-2) − ##Udakameha – Osmotic diuresis (having characteristic similar to that of water) − ###Pre-diabetic stage - hyperglycemia causes decrease reabsorption of water and excessive loss of water through urine. − ##Ikshumeha – Alimentary glycosuria (having characteristic similar to sugarcane juice) − ###Pre-diabetic stage when liver is unable to metabolize excessive glucose due to hepatic insulin resistance and thus presence of − glucose in urine. − ##Sandra meha & Sandraprashada meha – (layered urine: 3 layers: a top layer of chylomicrons, a middle layer rich in protein, and a bottom layer containing fibrin clots and cellular debris). − ###Intermediary stage between pre-diabetic and diabetic mellitus start with the involvement of kidneys. − ##Lalameha – Albuminuria (heavy whitish foam in urine) − ###Progressive stage of diabetes mellitus type-2 which may show − the presence of albumin. − ##Shuklameha- (urine having white colour like that of pasted flour) − ###White & cloudy urine − ####Progressive stage of diabetes mellitus type-2 with the further derangement in the functioning of nephrons (proteinuria). − ##Shanaimeha – Reduced urinary flow (reduced urinary flow with increased frequency) − ###Stage of diabetes involving advanced nephropathy. Infective and reduced urinary flow. − ##Shitameha- (the patient gets frequent micturition which is exceedingly sweet and cold) − ###Stage of kidney failure due to diabetic nephropathy presence of excessive ammonical substance in urine. − ####Sukrameha – Spermaturia (patient passes semen like urine or urine mixed with semen) − ###Autonomic diabetic neuropathy leading to retrograde ejaculation of sperm. − #Pittaja prameha- (Stage of Infection & Inflammation in Diabetes) − ##Ksharameha- the patient passes urine having the smell, colour, taste and touch like those of alkalies. (pH of urine become alkaline) − ###Increased urinary pH due to UTI in diabetes. − ###Alkaline fermentation causes an ammoniacal smell, and patients with diabetic ketoacidosis produce urine that may have a sweet or fruity odour. − ##Kalameha- the patient passes black colour urine. − ###Highly concentrated urine due to dehydration. − ##Nilameha- the patient passes urine having sour taste and colour like that of the feather of casa bird. − ###Blue colour urine indicative of bacterial urinary tract infection − ##Raktameha - the patient passes urine having red colour, saline taste and smell like that of raw fish. − ###Microscopic hematuria. − ##Manjishthameha - the patient frequently passes urine having the smell like that of raw flesh and colour like that of the juice of manjistha (Rubia cordifolia Linn.) − ###Gross hematuria due to UTI. − ##Haridrameha - the patient passes urine having pungent taste and colour like that of the juice of haridra (Curcuma longa Linn.) − ###dark yellow colour urine due to dehydration. Highly concentrated urine due to UTI/ dark yellow colour due to jaundice. − #Vataja prameha- (Type-1Diabetes mellitus) − ##Vasameha - Lipiduria (prence of lipid in urine) in Nephrotic syndrome associated with type-1 diabetes mellitus (30-40%) known as Kimmelstiel –Wilsone Syndrome. − ##Majjameha – presence of bone marrow. − ##Lasikameha/ Hastimeha- Proteinuria/ diabetic ketoacidosis due to diabetes mellitus − ##Ojomeha/ Madhumeha- Type – 1 Diabetes mellitus − − Parameter of urinalysis used in above: − 1. Physical parameters: Colour − • Raktameha, haridrameha, majjisthameha, kalameha etc. − Appearance − • Cloudy: Shuklameha − • Layered: Sandrameha, Sandraprasadameha. − Foamy − • Lalameha − Temperature − • Shitameha − 2. Chemical parameters: pH − • Ksharameha − Sp.graity − • Udakameha − 3. Microscopic Examination − Hematuria − • Manjjisthameha − Red blood casts − • Raktameha − Crystalluria − • Siktameha − • Leukocytes – Shuklameha − • Nitrite – Shitameha − • Protein – Lalameha, Lasikameha − • Blood – Raktameha − • Glucose: Ikshumeha, Madhumeha − • Bilirubin : Haridrameha − − Vivid description of Manjjisthameha, Raktameha, Siktameha clearly indicate evolved observation skills of physicians. Analyzing the details of urine characteristics the scientific approach of Ayurveda is established. It is really appreciable that a disease can be classified and identified at every stage merely by urinalysis. − Importance of barley: − Barley should constitute the principal ingredient of food of the patient suffering from prameha. The patient suffering from kaphaja prameha should take eatable prepared of barley mixed with honey. − Barley soaked in the decoction of triphala and kept overnight should be mixed with honey. It is a refreshing (tarpana) diet. It should be taken by the patient suffering from prameha regularly to overcome the disease. Barley should be soaked separately with each of decoctions prescribed for the treatment of kaphaja prameha and taken by the patient in the form of saktu (roasted flour), apupa (pan-cake), dhana (fried barley) and other types of eatables along with jiggery. − Various eatables prepared from the barley or bamboo seed or wheat previously eaten by asses, horses, cows, swans and deer and collected from their dung should be given to the patient suffering from prameha. − Importance of Barley in Diabetes: Acharya Charaka gives much emphasis on the use of barley (Yava) in prameha. Barley has hypoglycemic effect along with its potent lipid reducing effect and it is best ruksha diet that helps in depleting excess of fat while providing essential energy required for maintaining daily life. Dutch researchers used a crossover study with 10 healthy men to compare the effects of cooked barley kernels and refined wheat bread on blood sugar control. The men ate one or the other of these grains at dinner, then were given a high glycemic index breakfast (50g of glucose) the next morning for breakfast. When they had eaten the barley dinner, the men had 30% better insulin sensitivity the next morning after breakfast . − Scientists at the Functional Food Centre at Oxfod Brookes University in England fed 8 healthy human subjects chapatis (unleavened Indian flatbreads) made with 0 g, 2g, 4g, 6g or 8g of barley beta-glucan fiber. They found that all amounts of barley beta-glucan lowered the glycemic index of the breads, with 4g or more making a significant difference . − In a crossover study involving 17 obese women at increased risk for insulin resistance, USDA scientists studied the effects of 5 different breakfast cereal test meals on subjects’ insulin response. They found that consumption of 10g of barley beta-glucan significantly reduced insulin response . − University of Connecticut researchers reviewed 8 studies evaluating the lipid-reducing effects of barley. They found that eating barley significantly lowered total cholesterol, LDL (“bad”) cholesterol, and triglycerides, but did not appear to significantly alter HDL (“good”) cholesterol . − Barley intake significantly reduced serum cholesterol and visceral fat, both accepted markers of cardiovascular risk . 25 adults with mildly high cholesterol were fed whole grain foods containing 0g, 3g or 6g of barley beta-glucan per day for five weeks, with blood samples taken twice weekly. Total cholesterol and LDL (“bad”) cholesterol significantly decreased with the addition of barley to the diet . Thus use of barley is very beneficial in diabetes. − Contemporary management of prameha: − Disease management: 1. Wholesome diet 2. Exercise 3. Pacification of dosha − Important medicines: 1. Shilajatu 2. Asana 3. Jambu 4. Yashada 5. Kumbha 6. Haridra 7. Aamalki 8. Tikta rasa − Pacification treatment: − Type Medicine Dose Time Vehicle − 1. Kapha − Dominant 1. Juice of Bilva leaves 10-20 ml Between two meals two times Milk − 2. Juice of nimba leaves 10-20 ml Between two meals two times Milk − 3.Shilajatu rasayana 250-500 mg Between two meals two times Milk − 4. Chandraprabha 250-500 mg Between two meals two times Milk − 5. Lodhrasava 10-20 ml Between two meals two times Milk − 6. Asanadi kwatha 10-20 ml Between two meals two times Milk − 2. Pitta dominant 1.Shatavryadi decoction 20 to 40 ml Between two meals two times -- − 2.Jambavasava 10-20 ml Between two meals two times -- − 3.Vasanta kusumakar rasa 60 -120 mg Between two meals two times -- − 3.Vata dominant 1. Trivanga bhasma 120-500 mg Between two meals two times milk − 3.Vasanta kusumakar rasa 60 -120 mg Between two meals two times Milk − Researches on effect of herbs on diabetes: − Research has shown that many of the herbs described have antioxidant properties, an anti-diabetic effect, and a beneficial effect on the lipid profile. Descriptions of few of them are as follows: − Curcuma neilgherrensis: − Curcuma neilgherrensis Wight, in the dose of 400mg/kg, showed a mild reduction in blood glucose level at 3rd and 5th hour in normoglycemic mice; however, the observed decrease in blood glucose level was found to be statistically insignificant. Even though the drug failed to cease the hypoglycemia in the first hour after the glucose overload, it attenuated the same in later hours, but not in a significant manner. − − The study reveals that C. neilgherrensis is having mild hypoglycemic potential and moderate antihyperglycemic effect. A clinical trial investigating the effects of combining C. neilgherrensis treatment with conventional therapy compared to the C. neilgherrensis alone showed that C. neilgherrensis significantly reduces the level of fasting blood sugar, postprandial blood glucose level, glycosylated hemoglobin, serum cholesterol, LDL and urine sugar. , − − Gymnema Sylvester: − Meshashringi (Gymnema Sylvester (Retz.) R.Br.; Gurmar) targets several of the etiological factors associated with diabetes, including chronic inflammation, obesity and pancreatic B-cell function. In a study on rats with streptozotocin – induced diabetes, G. sylvestre treatment resulted in 30% increase in total pancreatic weight and a significant increase in the number of islets and number of B-cells per islet. The regenerated pancreatic tissue resulted in complete control of fasting blood glucose levels within 20-60 days. Normal rats in this study did not experience an increase in insulin release when treated with G. Sylvestre extract, indicating that this herb has a normalizing effect on the blood glucose and may, therefore, be safer than conventional oral hypoglycemic agents such as sulphonylureas. Several clinical studies have demonstrated that G. Sylvestre effective in decreasing blood glucose levels in patients with type 1 and type 2 diabetes. Two (2) clinical trials investigated the effects of combining G. Sylvestre treatment with conventional therapy compared to the conventional therapy alone. In 22 patients with type 2 diabetes, treatment with G. Sylvestre extract significantly reduced blood glucose, glycosylated hemoglobin, and glycosylated plasma proteins, whereas, with conventional treatment alone (i.e. glibenclamide or tolbutamide), these values increased or remain the same. The patients receiving the herbal extract were able to decrease the dosage of their conventional drug, and five patients were able to discontinue the drug entirely and maintain their glucose level using only G. sylvestre. In 27 patients with type 1 diabetes, G. Sylvestre treatment reduced fasting blood glucose, glycosylated hemoglobin, and glycosylated plasma protein levels. − − Tinospora cordifolia: − Aqueous and alcoholic extracts of guduchi [Tinospora cordifolia (Willd.) Hook. f. & Thomson] reduced glucose levels in rats with alloxan- induced diabetes. The antihyperglycemic effect may be due to pancreatic islet free- radical- scavenging activity. This herb also lowers the levels of tissue and serum cholesterol, phospholipids, and free fatty acids. , − − Swertia chirata: − Kiratatikta [Swertia chirata (Roxb.) Buch.-Hum; also known as swertia chirayita (Roxb.) H. Karst.] is a potent anti-diabetic herb. In a pilot study, swertia chirata produced a significant decrease in fasting and postprandial blood glucose level in patients with diabetes. It contains swechirin, a xanthone found in the swertia species of plants. Xanthones are a unique class of biologically active compounds with antioxidant properties. Research has shown swerchirin produces a significant decrease in blood glucose levels in rat models. , , , A 60% decrease in blood glucose induced by swerchirin was accompanied by a marked depletion in B- granules and insulin in the pancreatic islets. Glucose uptake and glycogen synthesis in the diaphragm muscle was significantly enhanced in vitro by the serum of swerchirin- treated rats. It was therefore concluded that swerchirin lowers blood glucose levels by stimulating insulin release from the islets of Langerhans. − Enicostema littorale: − Mamejjaka (Enicostema littorale Blume) is used as a single herb and also as a part of an anti-diabetic mixture. In a clinical study on patients with type 2 diabetes, E. littorale reduced blood glucose and prevented the progression of diabetic complications. There was a significant improvement in the lipid profile, blood pressure, and kidney function. It significantly reduced blood glucose and lipid peroxides in rats with alloxan- induced diabetes, and increased superoxide dismutase, catalase, and glutathione peroxidase. In studies on rats with streptozotocin- induced type 1 diabetes, E. littorale significantly reduced glucose, cholesterol, and triglyceride levels, and ameliorated diabetic nephropathy. Serum creatinine and urea were significantly decreased and glomerular function improved. In rats fed a hypercholesterolemic diet, E. littorale decreased serum cholesterol, triglycerides, LDL, VLDL, liver, and kidney cholesterol levels, and lipid peroxidation levels. There was an increase in HDL and an increase in reduced glutathione levels. − A pilot study on an herbal mixture containing tejapatra (Cinnamomum Tamala) , pushkarmula (Inula racemosa), mamejjaka (E.littorale), meshashringi (Gymnema Sylvestre), and jambu (Syzygium cumini) seeds with karvellaka (bitter gourd; bitter melon; Momordica charantia) juice, administered at a dose of 5g twice a day before meals, decreased fasting and post- prandial blood glucose levels in patients with diabetes. Avartaki (Cassia auriculata Linn.) and methika (Trigonella foenum- graecum) as single herbs and decoction of nimba or neem (Azadirachta indica A.juss;) have also demonstrated blood glucose- lowering action. In a clinical study on patients with type 2 diabetes, neem showed significant hypoglycemic effect. The effect of neem was comparable to that of glibenclamide. , − The herb gokshura (Tribulus Terrestris Linn.), asana (Pterocarpus marsupium Roxb.), kulatha [ Vigna unguiculata (Linn.) Walp.], and saptaparna [Alstonia scholaris (Linn.) R.Br.] is also beneficial in treating prameha. These herbs can be used in different combinations, depending on the doshic involvement and severity of illness. An herbal mixture comprised of one part each of karvellaka (bitter gourd; bitter melon; Momordica charantia), jambu (Syzygium cumini), gurmar (Meshashringi G.sylvestre), and amra (Moringa indica Linn.), taken along with shilajit, was investigated in a clinical study on 805 patients with diabetes. The results showed a statistically significant reduction in fasting and postprandial blood glucose along with clinical improvement (website of India’s Central Council for Research in Ayurveda and Siddha).
→Diagnosis of prameha based on characteristics of urine
Excessive consumption of fats and sedentary life style causes obesity. Obesity causes derangement in lipid metabolism and storage which in turn leads to ''prameha'' as shown in the following chart:
Excessive consumption of fats and sedentary life style causes obesity. Obesity causes derangement in lipid metabolism and storage which in turn leads to ''prameha'' as shown in the following chart:
==== Diagnosis o''f prameha'' based on characteristics of urine ====
==== Diagnosis of ''prameha'' based on characteristics of urine ====
Different categories of ''prameha'' are described to possess the color, taste, touch, and smell of the respective ''doshas''. For example, in ''kaphaja prameha'', the urine is characterized by white color, sweet taste; cold touch and ''ama gandha'' (smell like that of flesh). In the same way, the characteristic features of ''pittaja prameha'' are to be determined. ''Vayu'' itself is colorless. Therefore, different varieties of ''vata'' dominant ''prameha'' are characterized by grayish or reddish color of urine as a result of the ''prabhava'' (specific action) of the ''vayu''.
Different categories of ''prameha'' are described to possess the color, taste, touch, and smell of the respective ''doshas''. For example, in ''kaphaja prameha'', the urine is characterized by white color, sweet taste; cold touch and ''ama gandha'' (smell like that of flesh). In the same way, the characteristic features of ''pittaja prameha'' are to be determined. ''Vayu'' itself is colorless. Therefore, different varieties of ''vata'' dominant ''prameha'' are characterized by grayish or reddish color of urine as a result of the ''prabhava'' (specific action) of the ''vayu''.
''Vata'' dominant ''prameha'' is already described to be incurable (''asadhya''). Again repeating the statement regarding its incurability implies that the presence of several symptoms including the grayish and reddish coloration of urine right from the origin of disease is incurable; and if these signs and symptoms appear at later stage, then the condition is incurable. In the latter type, attributes of ''majja'' etc., need not to be present. Alternatively, it can be explained that when at a later stage, any type of ''prameha'' gets associated with ''vayu'' and characterized by grayish and reddish coloration of urine, and then it also becomes incurable. In addition when ''kaphaja'' and ''pittaja'' types of ''prameha'' are associated with the passage of ''majja'' etc., in the urine, they become incurable. It is stated, “All types of ''prameha'', if not treated in time, leads to ''madhumeha'' and become incurable” (Sushruta : Nidana 6).
''Vata'' dominant ''prameha'' is already described to be incurable (''asadhya''). Again repeating the statement regarding its incurability implies that the presence of several symptoms including the grayish and reddish coloration of urine right from the origin of disease is incurable; and if these signs and symptoms appear at later stage, then the condition is incurable. In the latter type, attributes of ''majja'' etc., need not to be present. Alternatively, it can be explained that when at a later stage, any type of ''prameha'' gets associated with ''vayu'' and characterized by grayish and reddish coloration of urine, and then it also becomes incurable. In addition when ''kaphaja'' and ''pittaja'' types of ''prameha'' are associated with the passage of ''majja'' etc., in the urine, they become incurable. It is stated, “All types of ''prameha'', if not treated in time, leads to ''madhumeha'' and become incurable” (Sushruta : Nidana 6).
=== Future Scope for Research ===
=== Future Scope for Research ===