Prameha and Diseases of Udakavaha Srotas (Part-1)
Prof. Muralidhar Sharma
based on the lecture available at–Prameha and Diseases of Udakavaha Srotas
I am trying to limit the theory part to the least possible extent, but of course, some part of the theory has to be there. I am trying to make up as much as possible, certain of the practical issues which we are facing and certain crucial issues related to practice. There is a lot of confusion about the description of Udakavaha Srotas. Virtually there is no confusion. Every compartment of the fluid in the body in the form of the extracellular or intracellular compartment is described as Udaka.
द्रवास्तु यत्तदतियोगेन च्यवमानं पुरीषमनुबध्नाति|
तथा मूत्रं रुधिरमन्यांश्च शरीरे धातून्|
यच्च सर्वशरीरगतंबाह्या त्वग्विभर्ति|
यच्च त्वगन्तरे व्रणगतं लसीकाशब्दवाच्यम्|
तासामुदकधरा चा द्या||
In the above shloka, Vagbhat described different forms of Udaka present in various regions of the body. Fluid present in whole body, skin, urine, sweat including Lasika i.e fluid present below skin all can be considered as Udaka.
Here, I am considering Prameha as Udakavaha Srotas disorder although it is a controversial issue whether to consider Prameha under Udakvaha or Medovaha Srotas disorder.
यद्द्रवसरमन्दस्निग्धमृदुपिच्छिलं रसरुधिरवसाकफपित्तमूत्रस्वेदादि तदाप्यं रसो रसनं चl Ch.Sha7/16
उदकवहानां स्रोतसां तालुमूलं क्लोम च l Ch.Sha 5/8
इन्द्रियप्राणवहानि च स्रोतांसि सूर्यमिव गभस्तयः संश्रितानि, बस्तिस्तु स्थूलगुदमुष्कसेवनीशुक्रमूत्रवाहिनीनां नाडी(ली)नां मध्ये मूत्रधारोऽम्बुवहानां l Ch.Si 9/5
As per Charak Basti is the area where all the Udakvaha Srotas confluences together and the analogy of sea and rivers has been used to describe it. Talu and Kloma are considered the root of Udakvaha Srotas. Many anatomists of Ayurveda consider Kloma as the pancreas. Prameha is one of the diseases related to Basti. Basti could be the urinary bladder or another set of organs, but I consider it as whole of urinary tract and not only urinary bladder. Mootrakriccha, Mootraghata, and Prameha are disorders of the urinary tract. I consider Prameha as a nephrological problem and the Mootraghat and Mootrakriccha are urological problems. The Mootraghat and Mootrakriccha are also related to Basti. Basti is not only about the urinary bladder but it is about the whole urinary tract.
बस्तिमाश्रित्य कुरुते प्रमेहान् दूषितः कफः|
दूषयित्वा वपुःक्लेदस्वेदमेदोरसामिषम्|| ||
धातून् बस्तिमुपानीय तत्क्षयेऽपि च मारुतः|| A.H.Ni 10/4
बह्वबद्धं मेदो मांसं शरीरजक्लेदः शुक्रं शोणितं वसा मज्जा लसीका रसश्चौजःसङ्ख्यात इति दूष्यविशेषाः|| l Ch.Ni 4/7
Among the Basti Gata Vyadhis Prameha is the most important one. It involves multiple Dhatus like Kleda Medas, Vasa, Mamasa even Shukra and Shona. In the case of Prameha, it is not only the Udaka but almost every component of the body that is involved in the pathogenesis of Prameha. It is a broad spectrum of diseases that involves many diseases.
एकस्थानासनरतिः शयनं विधिवर्जितम्||३||A.H.Ni10/1,2,3
स चापि गमनात् स्थानं स्थानादासनमिच्छति |
आसनादृणुते शय्यां शयनात् स्वप्नमिच्छति| Su. Ni 6/25
दिवास्वप्नाव्यायामालस्यप्रसक्तं शीतस्निग्धमधुरमेद्यद्रवान्नपानसेविनं पुरुषं जानियात् प्रमेही भविष्यतीति | Su.Ni 6/3
There are twenty varieties of Prameha. The basic reason for Prameha is anything that adversely affects Medas, Mutra, or Kapha. Any of the reasons could be either in the form of food or activities. Therefore it is primarily a lifestyle disorder. The major etiological factors are mentioned in the above shloka. eg. Consumption of Nava Dhanya, ingestion of Sura, prolonged sitting, etc. A sedentary lifestyle and a tendency to sleep more are the major causes behind the development of Prameha. Features of Prameha patients are described uniquely in Sushruta Samhita. “A walking person preferring to sit; sitting one opting to lie down; lying one desires to sleep; sleeping one dislikes awakening are the signs of Prameha,” I think there cannot bean any better description of a diabetic personality than this.
Madhumeha and Diabetes
सर्व एव प्रमेहास्तु कालेनाप्रतिकारिणः| मधुमेहत्वमायान्ति तदाऽसाध्या भवन्ति हि | Su. Ni 6/12
पिडकापीडितं गाढमुपसृष्टमुपद्रवैः |
मधुमेहिनमाचष्टे स चासाध्यः प्रकीर्तितः || Su. Ni 6/24
Madhumeha and Diabetes are fundamentally disputed issues. Diabetes Mellitus is popularly understood as Madhumeha. I differ from this established convention for the following reasons. Madhumeha is a Vataja Prameha and Diabetes mellitus; to a great extent presents with Kaphaja Prameha Lakshana. The end stage of any type of Prameha, when they are not managed properly leads to the Madhumeha stage or any of type Prameha, present along with complications then only it would be called Madhumeha.
Type 1 and Type 2diabetes Mellitus
द्वौ प्रमेहौ भवतः- सहजोऽपथ्यनिमित्तश्च |
तत्र सहजो मातृपितृबीजदोषकृतः, अहिताहारजोऽपथ्यनिमित्तः |
तयोः पूर्वेणोपद्रुतः कृशो रूक्षोऽल्पाशी पिपासुर्भृशं परिसरणशीलश्च भवति; उत्तरेण स्थूलो बह्वाशी स्निग्धः शय्यासनस्वप्नशीलः प्रायेणेति ||Su.Chi 11/3
Sushruta has been described as two classical subtypes of Prameha. Sushruta has been described as a type of Prameha primarily as Sahaja and Apathya Nimittaja. Sahaja Prameha is a genetic deformity while Apathya Nimittaja is a lifestyle acquired disorder. Charak described two categories Sthool Pramehi and Krisha Pramehi. In the case of Sthool Pramehi, the approach for treatment and prognosis could be different from that of Krisha Pramehi. It is well known that diabetes mellitus is classified as Type 1 and 2. Earlier we used to study insulin-dependent and noninsulin-dependent diabetes mellitus. Charaka Samhita described this as Sthoola Pramehi and Krisha Pramehi with exact clinical presentation of Type 2 and type 1 diabetes mellitus. It is also described by Charaka that the majority of the diseases are produced due to Santarpana than Apatarpana.
India has the dubious prestige of being crowned as diabetic capital in near future. It is predicted that by 2024 more than half of the Diabetic patients would be from India. The global incidence of type 1 Diabetes in India is comparatively low whereas American subcontinents have a maximum incidence. Incidence of type 2 Diabetes in India and South Asia is maximum.
World health organization of Diabetes country profile 2016 in India
World health organization of Diabetes country profile 2016 in India suggests a significant mortality rate due to diabetes mellitus. In 2016 more than 1.2 lakh people died due to diabetes in the age group of 36-69. Another nearly lakh have succumbed in the age group of above 70. Almost 3 times the above figures have died as a complication of hypertension. The majority of the hypertensive patients were suffering from diabetes even. The majority of mortality incidences are associated with Type 2 Diabetes. Type 2 Diabetes is supposed to have a better prognosis and be better managed than type 1 Diabetes.
Diabetes prevalence, by region of birth and BMI category: National Health Interview Survey
In my opinion, the incidence of type 2 diabetes is always related to obesity and weight gain, lifestyle, and BMI (body mass index). BMI is supposed to be one of the predictive factors for Diabetes risk. A comparative study based on the BMI among different races indicates that despite having a lesser BMI than the average BMI, the incidence of diabetes is more in Indian and African races than in Americans. The same lifestyle produces a higher risk of Diabetes in Indians and Africans played lots of theorization and study.
Another factor that has drawn attention to research about genetics and related issues is body weight. The body weight of the Indian population is lesser than the western population. The underweight population in India is higher and comparatively among the underweight category diabetic patients are higher in India than elsewhere. Overweight or obesity is considered as the primary cause of diabetes throughout the globe, and every textbook also supports the fact that obesity is responsible for diabetes. A Universal BMI index of more than 28 is supposed to be cut off level for the development of Diabetes or metabolic disorders, compare to that BMI Indians who even have a lesser BMI are prone to develop Diabetes. This is an important issue derived from statistical facts.