Diabetes Mellitus in Ayurveda

"Diabetes mellitus (DM) comprise a group of common metabolic disorders that share the phenotype of hyperglycemia. Several distinct types of DM exist and are caused by a complex interaction of genetics, environment factors and lifestyle choices, depending on the etiology of the DM, factors contributing to hyperglycemia may include reduced insulin secretion, decreased glucose utilization, and increased glucose production. The metabolic deregulation associated with DM causes secondary path physiologic changes in multiple organ systems that impose a tremendous burden on the individual with diabetes and on the health case system. In the United States DM is the leading cause of end stage renal disease (ESRD), non traumatic lower extremity amputations and adult blindness. With an increasing incidence worldwide. DM will be a leading cause of morbidity and mortality for the foreseeable future"

------Chapter no. 323 on DM 13 y Dr. Alvin C. Powers.

From Harrison’s principles of Internal Medicine 16th edition.

According to Western Medicine the DM is classified on the basis of the disease process that leads to hyperglycemia-

Type 1: Insulin deficiency present

Type 2: Insulin resistance, impaired insulin secretion and increases glucose production

What does Ayurveda say about DM?

DM has been described under the heading PRAMEHA in Ayuevedic texts like Charaka Samhita, Sushruta Samhita, Astanga Sangraha & Hrudaya, Hareeta Samhita.

In Charaka Samhita, it is described that Prameha (DM) is of 2 types:

Sahaja: due to genetic factors – can be compared to Type 1 – seen mostly in lean individuals.

Apathya Nimittaja: due to unwholesome lifestyle and diet seen mostly in obese individuals.

Prameha has been classified into 20 types depending on the various signs and symptoms manifested with urine. According to Sushruta Samhita, they are:

Kapha type 10

Udaka

Ikshuvalika

Puy

Sikata

Shanairh

Lavana

Pista

Sandra

Shukra

Phena

Pitta type 6

Neela

Haridra

Amla

Kshara

Manjista

Shonitha

Vata type 4

Sarpi

Vasa

Hasti

Kshoudra

In charaka Samhita the causes of Prameha have been described as follows:

Asyasukham -Svapnasukham dadhini Gramyaudakanooparsah payamsi

Navannapanam gudavaikrutamcha pramehahetuh kaphakruccha sarvam

----- 4th shloka/6th chapter Chikitsa sthana

Asyasukha

Asyasukha means happiness of tongue, eating food which is sweet, salt, sour in taste. According to Ayurveda one has to eat when he is hungry and the food should contain all the six tastes viz: sweet (madhura), sour (amla), salty (lavana), bitter (tikta), pungent (katu) and astringent (kashaya), but if only one taste like sweet is predominant (i.e., fruits), it can increase kapha & medas (fat) and cause prameha.

Swapnasukha

Sleeping in the day for more than 30 min and sleeping more at night. It also means not living an active life with good amount of exercise & sports. The following should be avoided:

Curd (Yoghurt)

Meat of pig, buffalo

Excess use of milk from buffalo and cow.

Grains like rice, wheat from fresh crop. According to Ayurveda the fresh grains should not be used till they are one year old.

Jaggery and its preparation like white sugar, molasses etc.

Treatment of the 2 types of pramehas in Ayurveda

Krusha Pramehi (Type1): samshamana means palliative treatment and Santarpana (antivata) treatment.

Sthula Pramehi: A Samshodana ( Panchakarma like vamana (emesis), virechana (purging) and later medicines & diet to normalize the condition (antikapha) treatment.

Exercise: Sports, walking, physical exercise under the sun

Medicine: the medicines having katu, tikta, kashaya taste are generally considered good in prameha.

The herbs mentioned in Ayurveda for increased blood sugar include:

Amla: Phyllanthus emblica

Triphala: Fruits of haritaki, vibhitaki, amalaki

Asana: Pterocarpus marsupium

Guduchi: Tinospora cardifolia

Arjuna: Terminalia arjuna

Methika: Trigonaella foenugraecum

Haridra: Curcuma Longa

Khadira: Acacia catechu

Musta: Cyperus rotendus

Aristaka: Azadirachta indica

Gokshura: Tribulus terrestris

Saptarangi: Casearia esculenta

Karela: Momardica charantia

Bhunimba: Andrographis paniculata

Meshashrungi: Gymnema sylvestrae

Jambu: Syzygum cumini

Daruharidra: Berberis aristata

Shatavari: Asparagus racemosus

Mamajjaka: Enicostemma littorale

Shilajith

Guggul

The importance of exercise is highlighted in Ayurveda treatment

In Sushruta samhita, it is written that a type 2 DM patient should walk barefoot for 800 miles in a year (average of 3.5 km/day) or do heavy work like digging a well etc.. Physical exercise results in lightness in the body, stability of the organs, increased pain endurance, balances the doshas by normalizing the metabolism. Yogic postures and Pranayama (breathing exercise) are also important part of this treatment.