Abstract:

Ayurved is based on three principles and that's why it is called Tri (Three) sutra Ayurved. These principles are as follows:

1. Hetu – Causes (cause of health and disease)
2. Linga – Symtoms (Symtoms of health & disease)
3. Aushadh – Medicines (In both roles as preventive & curative).

Pra means excess of urine in both frequency and volume. Prameha, thus, becomes self-explanatory and holds the twin meanings of "Prabhutha-mutratha" or excessive urination and "Avil-mutratha" or turbid urine. Any of the prameha (urinary disorder) if neglected ultimately it ends up in Madhumeha due to nature of the illness. A diabetic person passes urine in large quantities and urinates frequently during day and night; thirst levels are increased; and there may be weight loss or weight gain, fatigue, urinary tract infections, and blurred vision. The Ayurvedic treatment for this disease is based on an entire change in the lifestyle of the person. Along with medication and diet, the patient is also advised to lead a healthy lifestyle and live an active life. Dietary and lifestyle changes rejuvenate the body’s cells and tissues, allowing them to produce insulin properlyNow in the whole world, nearly about 24% of the population are suffering from this disease. Its percentage may go as high as 40-45% in 2020- WHO says. So, there is intense need to know the graveness of the disease and to understand the possible ways of preventive aspects of this disorder. So it is the demand of time to know about Madhumeha according to Tri-Sutra Siddhant by which a common man get healthy life without having any disease.

Keywords: Prameha,Madhumeha,Trisutra Siddhant, Brihattrayi Samhita Granthas.

Introduction: Ayurveda, the term is made of two words- “Ayu” and “Veda” which literally means the knowledge of long life.It is the oldest existing medical system of India which dates back to Vedic period. Ayurveda has a holistic preventive and curative approach where the aim is not only to curb the disease of ill but also to maintain the Physical , mental and spiritual health of a healthy person.

Ayurved is based on three principles and that's why it is called Tri (Three) sutra Ayurved. These principles are as follows:1.Hetu – Causes (cause of health and disease) 2. Linga–Symtoms (Symtoms of health & disease)3. Aushadh–Medicines (In both roles as preventive & curative).

The word Prameha is derived from the 'Miha-sechane' which means watering. Pra means excess of urine in both frequency and volume. Prameha, thus, becomes self-explanatory and holds the twin meanings of "Prabhuth-amutratha" or excessive urination and "Avil-mutratha" or turbid urine. Any of the prameha (urinary disorder) if neglected ultimately it ends up in Madhumeha due to nature of the illness. Madhumeha (Diabetes Mellitus) is a chronic metabolic disorder in which the body is unable to make proper use of glucose, resulting in the condition of hyperglycemia (high blood sugar). Excess glucose in the blood ultimately results in high levels of glucose being present in the urine (glycosuria). This increases the urine output, which leads to dehydration and increased thirst.Glucose comes from the food we eat and is also made in liver and muscles. The blood carries glucose to all the cells in our body. Insulin, a chemical (or hormone) produced in the pancreas, is responsible for the uptake of glucose into cells for energy. Decreased levels of insulin affects this mechanism leading to increased glucose in the blood stream.

In Madhumeha (DiabetesMellitus) Synthetic drugs like Sulphonylureas, biguanidine, acarbose and Insulin are widely used in Allopathic treatment of Diabetes. Ayurveda has classified Diabetes (madhumeha) into 20 Types. Description of two types of Prameha from management point of view strikingly is the same Krisha Pramehi (Lean Diabetic) and Sthula pramehi (Obese Diabetic) are classified in Ayurveda on very similar grounds as Diabetics are classified in IDDM and NIDDM respectively.

1. Causes:

1. Excessive intake of foods that are difficult to digest, such as fried foods, creams,etc.
2. Lack of exercise
3. Mental stress and strain 4. Excessive sleep4.Overeating and consequent obesity.
4. Excessive intake of sugar and refined carbohydrates.
5. Overloading of proteins and fats.6.Hereditary factors.

2. Symptoms:

A diabetic person passes urine in large quantities and urinates frequently during day and night; thirst levels are increased; and there may be weight loss or weight gain, fatigue, urinary tract infections, and blurred vision. Wound healing is delayed. If left untreated, Diabetes can lead to blindness, loss of limbs (particularly feet or legs), heart disease, and kidney failure.

3. Treatment:

It is based on an entire change in the lifestyle of the person. Along with medication and diet, the patient is also advised to lead a healthy lifestyle and live an active life. Dietary and lifestyle changes rejuvenate the body’s cells and tissues, allowing them to produce insulin properlyBecause, now in the whole world, nearly about 24% of the population are suffering from this disease. Its percentage may go as high as 40-45% in 2020- WHO says. So, there is intense need to know the graveness of the disease and to understand the possible ways of preventive aspects of this disorder.

So it is the demand of time to know about Madhumeha according to Tri-Sutra Siddhant by which a common man get healthy life without having any disease. So I have selected this topic to study in detailed about Madhumeha.

Review of Literatures:

The information about the concept of Madhumeha according to Tri-Sutra Siddhant and its importance is mentioned in Ayurvedic Samhita Granthas. The detailed study of Madhumeha according to Tri-Sutra Siddhant had been reviewed for collection of study material.

Aims & Objectives:

1. To study about the concept of Madhumeha according to Tri-Sutra Siddhant.
2. To Study about the concept of Madhumeha according to Tri-Sutra Siddhant from Brihattrayi.

Materials:

1. Charak Samhita, Sushrut Samhita, Astang Hridaya & other Samhitas.
2. Modern Medicine Books & Articles on Madhumeha according to Tri-Sutra Siddhant.

Methods: Ayurveda has flourished over 5000 years because of its own unique and original fundamental principles which seem to be even more relevant in the context of modern life style. There is an increasing eagerness to know about all aspects of Ayurveda in the present era all over the globe. However Diabetes is termed as Silent Killer and recently evidence of cases of “Insulin resistance” and the occurrence of side effects from prolonged administration of conventional drugs have triggered the search for safe and effective alternatives. Diabetes is also known as Madhumeha. Diabetes is also called Maharoga (Major Disease) as almost all parts of the body and every cell of human physiology are effected. According to Ayurveda, Prameha is divided in 4 major types (and total 20 types) Kapha type (again divided into 10 types) Pitta type (again divided into 6 types) Vata type (divided into 4 types). The main cause of prameha (diabetes) are lack of exercise and consumption of excess food having ushna, snigdha and guru nature. Foods that increase kapha, medhas and mootra are the major factors for prameha.

Classification of Prameha(Diabetes):

According to Ayurveda, Prameha (Diabetes) can be classified in two categories:

(1) Apatharpanauthaja-prameha describing the lean diabetic and
(2) Santharpanauthaja-prameha relating the obese diabetic.

Classification according to Causes of diabetes:

(1) Sahajaprameha (congenital)
(2) Apathya nimittaj-aprameha (due to over eating and poor habits)

Classification of Diabetes according to Dosha:

According to Ayurveda, Prameha (diabetes) is a tridoshajavyadhi. However the predominance of anyone dosha and dooshya enables its classification into Vataja, Pitaja & Kaphaja Pramehas. They are further sub classified into 20 sub categories according to characteristics of urine, its volume, dhatu being excreted through urine.

Normally, Prameha (Diabetes-Madhumeha) is classified by Ayurvedic Practitioners according to dosha predominance viz.

(1) Kapahja,
(2) Pittaja,
(3) Vathaja,
(4) Kapha-pithaja,
(5) Kapha -vathaja,
(6) Pitta-vathaja, and
(7) Vatha-pitha-kaphaja.

Sannipatha, kevala vathaja and kapha-vthaja (to some extent)and pitta-vathaja can be considered as IDDM. And others are considered as NIDDM.

According to Sushruta, Dosha predominance is the primary factor in Diabetes Complication According to him Malabandha (Constipation) is a complication of this disease as the patient has a concentration of Meda. In such cases laxatives of average doses are not effective.

According to Brihattrayees, pidika (diabetic carbuncle) is a major complication of prameha (Madhumeha).(Su.Ni.6),(Su.Chi.11/12),

Acharya Vagbhata explained the Patho-physiology of Madhumeha as below-Ojus - The essence of all dhatus (tissues) and the main entity of immunity is spread all over the body.).It is frothy, clear, unctuous, sweet, thick, heavy, cold and slimy in nature. Due to the relative causes of the disease Madhumeha, imbalanced Doshas (especially Kapha and Pitta in association with Vata) block the channels related to Meda (adipose tissue / fat tissue) and Mamsa (muscle).Due to obstruction of Vata, it transforms sweet ojas into astringent mixed sweet taste like honey. Thus, it discharges in the urine. Thus, the condition Madhumeha is resulted. Any of the prameha if neglected or treated improperly, it leads to Madhumeha which is the terminal stage of urinary disorders.(As.Hri.Ni.10),(As.Hri.Chi.14)

According to Acharya Charaka there are three types of prameha. :-Sadhya –curable Yapya–Palliable Asadhya – Incurable

 1. Sadhya: Describes patients who have been diagnosed very early in the onset of prameha (Madhumeha). In this category of patients , there can be those who are sthoola ( obese) and the origin of their disease is in apathyaja (poor living habbits) 2.Yapya: Patients under this catagory have Pittajaprameha & certain types of kaphaja prameha .However Yapya (palliable) helps control the disease with treatment 3. Asadhya: Describes the incurable version of prameha (Madhumeha) & inherited diabetes. Sahaja patients suffering from this veriety are Krisha (lean).(Cha.Ni.4),(Cha.Chi.6)

Tri Sutra Siddhant: (1.)Hetu Sutra Siddhant : (Causes for Diabetes):

1. Sahaja (inherited factor) 2.Guda (jaggery) 3. Ikshurasa (sugarcane) 4. Madhura Ahara (sweet substances) 5. Pishta Ahara (carbohydrate rich food) 6. Adyashana (repeated food intake) 7. Adhikashana (excess food intake) 8. Ahitashana (unwholesome diet) 9. Chinta (stress) 10. Shoka (grief) 11. Bhaya (fear) 12. Deergharoga (long standing illness) 13. Alasya (sedentary life) 14. Avyayama (lack of body exercise) 15. Guru ahara (heavy food) 16. Samashana (improper diet) etc

(2). Linga Sutra Siddhant: (Symptoms of Prameha) Types of Prameha: (A) Hetu Bheda (As per Etiology

1. Sahajaprameha: Juvenile or congenital diabetes 2. Kulaja: Familial 3. Apathyaja: Due to improper dietary habits (B) Deha Prakriti Bheda (As per features of the body)1. Sthulapramehi : Obese-related 2. Krishapramehi : Leanness-related (C) Mutra Vikaar Bheda (As per urinary Abnormality) (1). Kaphaja :Kapha causes pramehas by affecting medhas thus altering lipid metabolism), muscles and body fluid situated in urinary bladder. They are of ten types as: Udakmeha (Chronic nephritis, Diabetes insipidus) Watery urine, Ikshumeha (Alimentary glycosuria) Like sugar cane, Saandrameha (Phosphaturia) Viscous urine, Saandra Prasad meha Having solid precipitate, Suklameha (Chyleuria, albuminuria) White, Sukrameha (Spermaturia)= Urine with semen, Sitameha Cold urine, Sainyameha Delayed and very slow impulse of urination, Lalameha (Albuminaria)Saliva-like urine, Sikatameha (Lithuria)= Urine with gravels

(2). Pittaja: Pitta aggravated by hot things causes the same by affecting medas, muscles and body fluid situated in urinary bladder. They are of six types as: Ksharmeha (Alkanuria) Urine like alkali, Kaalameha (Indikanuria) Black urine, Nilameha (Indikanuria)Blue urine, Haridrameha (Biluria) Turmeric-like urine, Manjisthameha (Urobilinuria Urine is lighter, Raktameha (Haematuria) Urine is deep red.

(3).Vataja: Vayu, on relative diminution of other two doshas, draws on the dhatus in urinary bladder and thus causes Prameha. Prameha caused by vata and associated with pain has blackish or reddish urine.They are of four types as: Majaameha (Albuminuria) Urine with majja, Ojomeha (Diabetes mellitus) Urine with ojas, Vasaameha (Lipuria) Urine with vasa, Hastimeha (Prostatitis) Urine with lasika.

(3). Aushadha Sutra Siddhant:- (Treatment of Prameha): Treatment for this disease is based on an entire change in the lifestyle of the person. Along with medication and diet, the patient is also advised to lead a healthy lifestyle and live an active life. Dietary and lifestyle changes rejuvenate the body’s cells and tissues, allowing them to produce insulin properly. Even mental aspects of the disease are stressed upon in Ayurveda. The medicines that are administered are therefore meant to keep the brain in its right manner of functioning.The herbal drugs used in the management of Prameha are bitter, astringent and pungent in taste.

1. Eugenia jambolana: (Jamunbeejchurna) Dry seed powder of Jamun fruits have to be used in a dose of one-teaspoon twice/thrice daily with lukewarm water. 2. Gymnemasylvestre: (Gudmarpatrachurna) Dry leaves of this plant have to be used one teaspoon daily with lukewarm water. The leaves when chewed render the mouth tasteless to sweet for 45 min to one hour. 3. Pterocarpusmarsupium (Vijaysarchurna) Bark of this plant is available in the form of powder. Cubes or Vijaysaarglasses are also very popular & Effective. The piece of Vijaysaar is kept in water overnight or water is kept in the glass is consumed early morning on empty stomach.

CONCLUSION: As a civic is cautious in the duties of the city and the charioteer in those of the chariot, a wise person should be cautious in duties relating to his own body. (Cha.su.5/103).

References:
(1) AstangHridaya, By Kaviraj AtriDev Gupta, Chaukhambha Prakashan,Varanasi, 2007.
(2) SusrutaSamhita, By Kaviraj Ambika Dutta Shastri, Chaukhambha Sanskrit Sansthan, Varanasi, 2009.
(3) CharakSamhita, By DrBrahmaNandTripathi, Chaukhambha Surbharati Prakashan,Varanasi, 2004.