Changes

Bedrest studies, though not sufficiently researched in humans, indicate that there is an increased sedentary behavior associated with a range of deleterious metabolic effects <ref> Kalupahana NS, Claycombe KJ, Newman SJ, Stewart T, Siriwardhana N, Mathhan N, Lichtenstein AH, Moustaid-Moussa N: Eicosapentaenoic acid prevents and reverses insulin resistance in high-fat diet-induced obese mice via modulation of adipose tissue inflammation.J Nutr 2010, 140:1915-1922 </ref>.   

Bedrest studies, though not sufficiently researched in humans, indicate that there is an increased sedentary behavior associated with a range of deleterious metabolic effects <ref> Kalupahana NS, Claycombe KJ, Newman SJ, Stewart T, Siriwardhana N, Mathhan N, Lichtenstein AH, Moustaid-Moussa N: Eicosapentaenoic acid prevents and reverses insulin resistance in high-fat diet-induced obese mice via modulation of adipose tissue inflammation.J Nutr 2010, 140:1915-1922 </ref>.   

It can be noted from the above enlisted disorders that ''kapha dosha, rasa, rakta, mamsa'' and ''meda dhatu'' are vitiated in ''santarpaniya'' diseases. Therefore, the treatment protocol shall be designed keeping these factors in mind.  

It can be noted from the above enlisted disorders that [[kapha]] [[dosha]], [[rasa]], [[rakta]], [[mamsa]] and [[meda dhatu]] are vitiated in ''santarpaniya'' diseases. Therefore, the treatment protocol shall be designed keeping these factors in mind.  

'''''Pramehapidaka''''': This can be compared with diabetic carbuncle which is a complication of uncontrolled diabetes mellitus. It is localized infective gangrene of the skin and subcutaneous tissues caused by infection. The predisposing factor is diabetes. In diabetic carbuncle, infection is at hair follicle with severe pain and there is involvement of fibrous strand along with sub-cutaneous tissues. A multi-locular lesion is seen which may give rise to ulcerating carbuncle. In this lesion, gangrenous process can occur which may be due to thrombosis of the lesion.

'''''Pramehapidaka''''': This can be compared with diabetic carbuncle which is a complication of uncontrolled diabetes mellitus. It is localized infective gangrene of the skin and subcutaneous tissues caused by infection. The predisposing factor is diabetes. In diabetic carbuncle, infection is at hair follicle with severe pain and there is involvement of fibrous strand along with sub-cutaneous tissues. A multi-locular lesion is seen which may give rise to ulcerating carbuncle. In this lesion, gangrenous process can occur which may be due to thrombosis of the lesion.

'''''Kotha''''', as explained, is a decay of tissues due to certain conditions. In the context of ''santarpanajanya vyadhi'', decay usually is seen in diabetic patients caused mostly due to microangiopathy. Involvement of the blood vessels by atherosclerosis leading to ischemia is a significant factor in diabetic foot. Lower extremity peripheral vascular disease (PVD) is the most common factor associated with limb ulceration, gangrene, impaired wound healing and ultimately amputation<ref> Gayle R, Benjamin AL, Gary NG. The burden of diabetic foot ulcers. The American Journal of Surgery 1998Aug 24; 176(Suppl 2A):65-105. </ref>. It mainly occurs due to blood flow changes, occlusive changes, micro angiopathy, and hematological changes. There is marked change in the flow of blood in peripheral vessels. The microcirculation is regulated by neural factors, local reflexes and vasoactive mediators. The initial haemodynamic changes will be increased flow and pressure of capillary blood<ref> Tooke JE. Microvascular hemodynamics in diabetes mellitus. Clin Sci 1986; 70:119-125 </ref> . As the disease progresses, autoregulation is lost and haemodynamic stress results. It could also be due to increased calcification of vessels or AV shunting or hyperosmolarity of blood. It is well documented by high ankle brachial ratio and also Doppler studies. Occlusive changes occur in more than 50% of diabetics having the disease for more than 10 – 15 years<ref> Pyorala K, Laasko M, Vusiitupa M. Diabetes and atherosclerosis, An epidemiologic view. Diabet Methob Rev 1987; 3:463-524 </ref>. It mainly affects arteries below profunda femoris and is characterized by multiple segment involvement. The tibial & peroneal arteries between the knee and the ankle are primarily affected. Dorsalis pedis artery and foot vessels are usually spared. Patients with diabetes have diminished ability to establish collateral circulation especially in arteries around knee.  This disease is more prevalent & accelerated with diabetes mellitus.   

'''''Kotha''''', as explained, is a decay of tissues due to certain conditions. In the context of ''santarpanajanya vyadhi'', decay usually is seen in diabetic patients caused mostly due to microangiopathy. Involvement of the blood vessels by atherosclerosis leading to ischemia is a significant factor in diabetic foot. Lower extremity peripheral vascular disease (PVD) is the most common factor associated with limb ulceration, gangrene, impaired wound healing and ultimately amputation<ref> Gayle R, Benjamin AL, Gary NG. The burden of diabetic foot ulcers. The American Journal of Surgery 1998Aug 24; 176(Suppl 2A):65-105. </ref>. It mainly occurs due to blood flow changes, occlusive changes, micro angiopathy, and hematological changes. There is marked change in the flow of blood in peripheral vessels. The microcirculation is regulated by neural factors, local reflexes and vasoactive mediators. The initial haemodynamic changes will be increased flow and pressure of capillary blood<ref> Tooke JE. Microvascular hemodynamics in diabetes mellitus. Clin Sci 1986; 70:119-125 </ref> . As the disease progresses, autoregulation is lost and haemodynamic stress results. It could also be due to increased calcification of vessels or AV shunting or hyperosmolarity of blood. It is well documented by high ankle brachial ratio and also Doppler studies. Occlusive changes occur in more than 50% of diabetics having the disease for more than 10 – 15 years<ref> Pyorala K, Laasko M, Vusiitupa M. Diabetes and atherosclerosis, An epidemiologic view. Diabet Methob Rev 1987; 3:463-524 </ref>. It mainly affects arteries below profunda femoris and is characterized by multiple segment involvement. The tibial & peroneal arteries between the knee and the ankle are primarily affected. Dorsalis pedis artery and foot vessels are usually spared. Patients with diabetes have diminished ability to establish collateral circulation especially in arteries around knee.  This disease is more prevalent & accelerated with diabetes mellitus.   

'''''Pandu''''' (anemia): It means pallor and is seen in metabolic disorders. Charak has explained it as a disease as well as complication of other disorders. ''Pandu'' that has been mentioned in ''santarpanajanya'' diseases chapter is ''kapha'' dominant where the causes are elaborated in verses 3 and 4. Two of the most common causes of anemia are due to abnormalities in iron homeostasis: iron-deficiency anemia and anemia of inflammation also known as anemia of chronic disease. The anemia caused due to inflammation is elaborated in this context. It is very interesting to know metabolic disorders like obesity and some complication of diabetes like diabetic nephropathy also lead to pallor and iron deficiency<ref> Karlee et al. Is Obesity Associated with Anaemia of Chronic Disease? A Population-based Study. 2008. Doi: 10.1038/oby.2008.353 </ref>. Along with anaemia, renal parameters also get deranged which may lead to abdominal symptoms like nausea and vomiting, so the word ''arochaka'' is used here adjoining to ''mutrakrichhra'' (urinary disorder)<ref> Mehdi et al. Anemia, Diabetes, and Chronic Kidney Disease. 2009. 32(7): 1320-1326 </ref>. In the latter stages of diabetic or hypertensive nephropathy urinary complaints like oligouria or anuria can occur. If it remains untreated due anaemia and congestion in heart, edema starts developing which has been called as ''shopha''.  

'''''Pandu''''' (anemia): It means pallor and is seen in metabolic disorders. Charak has explained it as a disease as well as complication of other disorders. ''Pandu'' that has been mentioned in ''santarpanajanya'' diseases chapter is [[kapha]] dominant where the causes are elaborated in verses 3 and 4. Two of the most common causes of anemia are due to abnormalities in iron homeostasis: iron-deficiency anemia and anemia of inflammation also known as anemia of chronic disease. The anemia caused due to inflammation is elaborated in this context. It is very interesting to know metabolic disorders like obesity and some complication of diabetes like diabetic nephropathy also lead to pallor and iron deficiency<ref> Karlee et al. Is Obesity Associated with Anaemia of Chronic Disease? A Population-based Study. 2008. Doi: 10.1038/oby.2008.353 </ref>. Along with anaemia, renal parameters also get deranged which may lead to abdominal symptoms like nausea and vomiting, so the word ''arochaka'' is used here adjoining to ''mutrakrichhra'' (urinary disorder)<ref> Mehdi et al. Anemia, Diabetes, and Chronic Kidney Disease. 2009. 32(7): 1320-1326 </ref>. In the latter stages of diabetic or hypertensive nephropathy urinary complaints like oligouria or anuria can occur. If it remains untreated due anaemia and congestion in heart, edema starts developing which has been called as ''shopha''.  

'''''Amaja vyadhi''''':  ''Ama'' is referred to an intermediate bio product of cellular metabolism leading to number of metabolic disorders. Generation of ''ama'' is thought to start with maldigestion or indigestion of food substances when taken in excess which begins in the stomach. It is a very important factor playing a pivotal role in the genesis of any disease. It is clearly stated that there is no disorder devoid of ''ama''. So all the anabolic disorders where ''ama'' is considered as cause are supposed to be under the category of ''ama vyadhis''.   

'''''Amaja vyadhi''''':  ''Ama'' is referred to an intermediate bio product of cellular metabolism leading to number of metabolic disorders. Generation of ''ama'' is thought to start with maldigestion or indigestion of food substances when taken in excess which begins in the stomach. It is a very important factor playing a pivotal role in the genesis of any disease. It is clearly stated that there is no disorder devoid of ''ama''. So all the anabolic disorders where ''ama'' is considered as cause are supposed to be under the category of ''ama vyadhis''.   

Ultimately, with all these symptoms and conditions, edema over the body develops and along with other complications lands the patient into severe difficulties.  

Ultimately, with all these symptoms and conditions, edema over the body develops and along with other complications lands the patient into severe difficulties.  

'''''Lekhana''''' is defined as the therapeutic action which (adequately) dries up body tissues and then literally scrapes the unwanted substances (generally solid, unctuous substances) out from the body tissues. Though this may be one meaning of ''lekhana'', all ''lekhana'' activites and ''lekhana dravya'' exert some pharmacological activates that reduce unwanted substances - unwanted ''dosha, dhatu'' or ''mala'' - from the body. The same properties of ''lekhana'' can be achieved by ''virechana, vamana'' or ''raktamokshana''.  

'''''Lekhana''''' is defined as the therapeutic action which (adequately) dries up body tissues and then literally scrapes the unwanted substances (generally solid, unctuous substances) out from the body tissues. Though this may be one meaning of ''lekhana'', all ''lekhana'' activites and ''lekhana dravya'' exert some pharmacological activates that reduce unwanted substances - unwanted [[dosha]], [[dhatu]] or [[mala]]- from the body. The same properties of ''lekhana'' can be achieved by [[virechana]], [[vamana]] or [[raktamokshana]].

 

Exercise and fasting has a very positive effect on anabolic disorders. Exercise results in reduction in fasting blood glucose, which replicates previous beneficial effects of exercise interventions in type II diabetes<ref> D. E. Kelley and B. H. Goodpaster, “Effects of exercise on glucose homeostasis in type 2 diabetes mellitus,” Medicine and Science in Sports and Exercise, vol. 33, no. 6, supplement, pp. S495–S501, 2001.</ref>.

=== Fasting ===

=== Fasting ===