Prameha and Diseases of Udakavaha Srotas
Prof. Muralidhar Sharma
based on the lecture available at–Prameha and Diseases of Udakavaha Srotas
Other common diabetic complications
The clonogenicity or diabetogenicity is not a new one, the Guru or Laghu words that are attributed to the substances are exactly the same. Vagbhat has stated that by consuming Guru food that is diabetogenic,high calory value then you should have only half of the satisfaction, when it is Laghu food then it should not be consumed to the full extent and some more space should be left over in the body.
मात्राशी सर्वकालं स्यान्मात्रा ह्यग्नेः प्रवर्तिका|
मात्रां द्रव्याण्यपेक्षन्ते गुरूण्यपि लघून्यपि||
गुरूणामर्धसौहित्यं लघूनां नातितृप्तता|
मात्राप्रमाणं निर्दिष्टं सुखं यावद्विजीर्यति|A.H 8/1,2
अन्नेन कुक्षेर्द्वावंशौ पानेनैकं प्रपूरयेत्|
आश्रयं पवनादीनां चतुर्थमवशेषयेत्| A.H 8/46
Our description from the text suggested half of the stomach volume should be filled by the food, one-fourth volume to be filled with liquids and the remaining one-fourth volume should be kept empty. I prefer any of these advice or in terms that the patient can understand all of these. Some of the patients can understand one of the said advice. It is also possible that some of the patients cannot understand anything. But my advice to the patient is don’t bother about what we eat but instead bother about how much we need when we eat. So all that advice would be never to eat repeatedly. Another very common piece of advice by a Diabetologist is to s eat more frequently, every two hours you have to take food. But my advice is not to have more than three foods. Every time try to eat lesser. In some cultures where one fistful of grain is collected every day for some charity. That kind of issue is possible depending on the culture and you may accept that. So that kind of advice could be more useful than going to the complex issue advised by a dietician.
The other parts is about the exercises. Again, best of the exercise advice is mentioned in Sushruta. The basic exercise mentioned by Sushruta is to pick up the food grains from the ground, prepare the food, and don’t keep that as a reserve. You have to move from one place to the other without staying in any place for more than a day. So that will not carry the food, you’ll be earning the food. Though it may not be practically possible, the theme behind it can be definitely useful. Sushruta’s advice would be like either you have to work in the field,plow the field, dig a well or follow the cows. All these physical activities are for Sthool Prameha patients while Krisha Prameh patient has to be protected from physical exertion. If the patient is physically fit and overweight then any form of suitable physical activity should be advised.
In present-day situation, it is not possible to perform many of exercises advised by Sushruta.
It is possible to perform some kind of physical activity. I always advise patients to do open field exercises though going to the gym is of course not harmful. But once you go the gym, there will be always a prescription of complex food that is focused on building the body. But here our target is not to build the body but to burn calories. Food advised in the gym is more harmful than the benefits of exercise. So my advice to the patient is don’t bother with complex issues and to do some work in the field. A simple version would be when you have to go to the gym, you have to pay for it,but if you dig some earth and then grow some plants you will gain something.
That’s exactly what I do and that would definitely be useful wherever possible. Whether this advice is taken by patients seriously or not is another issue. Many of the patients may not take that seriously. It is quite difficult to convince patients of diabetes about these issues. But those who are convinced will be definitely benefited. Our job is to give advice. WHO has recommended guidelines for making a healthy body is to do at least 30 minutes of regular moderate-intensity activity on most days and more activities are required for weight control. Eat a healthy diet, avoid sugar and saturated fats and avoid tobacco use. Virtually it is same as described in Samhitas, only with difference of language and words, otherwise ii is with the same theme
It is very commonly asked question whether to eat wheat or rice. Basically the wheat is comparatively Brihan Dravya than rice. So while advising low -calorie diet, rice is better than wheat. But in case of high calorie and nourishing diet, wheat is better than rice.
बद्धाल्पवर्चसः स्निग्धा बृंहणाः शुक्रमूत्रलाः||
रक्तशालिर्वरस्तेषां तृष्णाघ्नस्त्रिमलापहः | Ch Su 27/10,
सन्धानकृद्वातहरो गोधूमः स्वादुशीतलः|
जीवनो बृंहणो वृष्यः स्निग्धः स्थैर्यकरो गुरुः|| Ch Su 27/21
According Charak, wheat is Guru, Sandhankar and Vatahar. Rice is to be used when there is less Vataprakopa lakshna. If patient is having constipation then rice is better than wheat. Nutritional value of rice and wheat are depicted in the following images.
Calorie value of wheat is 7 times more than rice. All the components including magnesium and other minerals are more. So the ratio is 1:7 .
The protein content, carbohydrate content of the wheat is more than that rice comparatively. So necessarily wheat is more guru than the rice.
Whenever you have to prescribe a low calorie diet, it is always better to prescribe rice than the wheat. If a patient is a non-diabetic and emaciated then wheat will be better than rice. My advice is not to go on that whether you like wheat or rice, continue with Satmya is a more important issue which is not mentioned by any of the dieticians. Dietician they do not bother about that issue, conditioning which you are supposed to be.
I would advise continue whatever you need but with better regulation about its quantity and selection. And definitely if you have maintained that quantity, wheat or rice could be beneficial. One of the basic problems with wheat is Chapati or Parathas are usually deepened into ghee. Ghee in excess is definitely harmful, than one teaspoon of sugar added tea once in a day. My advice would be have a cup of tea with sugar once day rather than chapatti with ghee.
Lots of myths are there in society related with use of sugar and jiggery. Our texts described it very clearly that more clearer colour of product derived from sugarcane then it would become more Madhura, Guru and Sheet. White sugar is clearer in colour, so naturally compare to sweet products derived from sugar, it will be having more diabetogenic property. Once after consuming sugar, within two hours there will be rise in blood sugar levels. It doesnot last long duration. Tea spoon of sugar taken once a day will not be harmful but if taken continuously it will be definitely harmful. Puran Guda is considered to be Pathya.
Many of Prameha described in text are not seen practically in clinical condition. Here only practically seen certain conditions are mentioned.
- Udakameha – Diabetes insipidus
- Ikshumeha – Diabetes mellitus
- Sandrameha -Proteinuria
- Sura Meha – Aciduria
- Lalameha – Chronic prostatitis
- Shuklameha – Chyluria
- Shanaimeha – Bladder neck obstruction
- Sitameha – Atonic bladder
- Sukrameha – Speramaturia
- Sikatameha – Crystalluria
- Kshara Meha – Alkalosis
- Kala meha –Haemoglobinuria
- Nila meha – -do-
- Rakta meha Haematuria
- Manjishta Meha -do-
- Hardira meha – Bilirubinuria
- Vasa meha – Lipiduria
- Majja meha – -do-
- Hastimeha – Chronic renal failure
- Madhumeha – -do=
All those clinical conditions which are mentioned in the texts or identifiable, their correlation with modern terminologies is tabulated above, they can be seen practically. In the present context, they are totally different perspectives and they may not be under the same category of diabetes and clinically they are less frequent for not going into the details of managing those. So we have discussed the Kaphaja Prameha in genral and bit more of Madhumeha.
Sandra meha – Proteinuria
In this condition we can show a significant result and incidence is quite common. The patients presenting with the protein urea, they need to have evaluated thoroughly. Exact cause of protein urea has to be identified because it’s not that every patient is of the same category.
|Acute interstitial nephritis||Multiple Myeloma [Bence Jones protein)||Nephrotic syndrome|
|Immunosuppressive agents||Membranous glomerulonephritis|
|Cryoglobulinemia||Primary focal segmental glomerulosclerosis|
|Sjogren syndrome||Fibrillary glomerulonephritis|
An area where we can really manage would be Nephrotic syndrome. Other conditions with proteinuria like multiple myeloma, requires a separate line of treatment. It is one of the incurable condition. Tubular conditions like interstitial nephritis patients who are taking immunosuppressive drugs, they also have many of the other practical risk issues. So management of those issues is very complex.
I just keep the commonest variety of the we come across and which we can manage would be Nephrotic syndrome. It’s quite important to identify the patient properly and only the minimal damage category has to be identified.
Tapia C, Bashir K. Nephrotic Syndrome. 2019 Jan. [Medline].
You will have more of the diabetic type two patient’s complications or the neoplastic conditions in the later years. In younger ages there will be the focal pathologies either congenital nephrosis or glomerular sclerosis. Glomerular sclerosis patients can be managed better with our drugs. Whereas when it goes to the later complications, membranous conditions, it becomes difficult to be managed. The outcome will be relatively poor. Diabetic complications with its management has been already discussed in previous section.
The amyloidosis in the older age that responds to our treatment better. So whenever there is a minimal change, then only we will be prescribing our medicine. So when I take up Nerhrotic syndrome I will be always analysing the patient, selection of the right patient is a crucial and very complex issue. So full details may not be possible to explain. But the idea is to have a minimal damage patient and that the membranes have not yet damaged much. So that’s a very brief idea of how to select the patients.
My prescription would be
Salt restricted diet
Glucocorticoid dosage has to be tapered gradually
Saptaparna Kwatha is specifically mentioned as Sothahar in Sandrameha. You may have plenty of patients where the usual prescription of steroids can be avoided. Most important part is selection of right patient. So before we plan the management and predict the prognosis, detail workout is necessary and selection of the patient is crucial. Nephrotic syndrome can be effectively managed with this treatment. If the patient is on steroids then it has to be tapered gradually.