PRAMEHA – AN APPROACH Based On Pathophysiological Mechanisms

1. Dr K P Yadunandanan MD Ay Medical Officer GovtAyurveda Hospital Chelembra, Malappuram Dist PRAMEHA – AN APPROACH Based On Pathophysiological Mechanisms

2. Our Specialities • Frozen Shoulder • OA Knee • Tennis Elbow • CTS • Leg Pain • Feet Numbness • Erectile Dysfunction

3. Ayurveda & Diabetes • Diabetes = Prameha • Nisakathakadi or Kathakakhadiradi • Nirooryadi • Mehari powders • Paneeyams “Ayurvedic = Herbal Hypoglycemic Drug” “Lack of a proper understanding of disease & treatment approach”

4. Disease Approach based on Pathophysioloical mechanisms • Analysis of the disease Mechanisms • Nidana • Genetics, lifestyle, season, locality, occupation etc • Poorvaroopa & Lakshana • Specific to diseases • Samprapthi • Pathophysiological mechanisms • Beda • Stages

5. Patient Approach Systematic Approach in Patient Examination & Evaluation

6. Evaluation of Vayu • Prana • Jeevana • Udana • Bala • Vyana • DhatuParinama & Dhatugati • Samana • Aharapaka • Apana • Nishkramana

7. Evaluation of Agni • Jatara • Aharapaka & Malanirmanam • Ranjaka • RakthaNirmanam • Dhatwagni • Dhatuparinama & KledaNirmanam

8. Evaluation of Dhatu Sara • Twak • Raktha • Mamsa & Medas • AsthiMajja & Sandhi • Sukra

9. Evaluation of Mala • Pureesha • Consistency • Moothra • Colour etc • Sweda • Other mala

10. Evaluation of Manas • Satwa • Raja • Tamas

11. Type 2 Diabetes Mellitus “A Vascular disease more than a true metabolic disease” • Macroangiopathy • Stroke, CAD, Leg Gangrene • Microangiopathy • Retinopathy, Nephropathy, Neuropathy

12. Epidemology • Diabetic epidemic • Between 2003 and 2025, the number of patients worldwide with diabetes is going to increase 72% to an estimated 333 million people • Epidemological profiles and trends loaded against India

13. Predisposing Factors • Genetic predisposition • Obesity • Lifestyle • Lack of exercise • Environmental • Inflammation

14. Diabetes – Pathophysiological mechanisms

15. Beta Cell Dysfunction • Blunting of the beta-cell response with loss of first phase insulin secretion • With time, there is overall loss of insulin secretion • A decrease in beta-cell mass and death of these beta cells

16. Insulin Resistance “Defect in ability of insulin to stimulate glucose transport into the cell” • Obesity • Free Fatty Acids • Inflammation

17. Alterations in Lipid Metabolism Ectopic deposition of Lipids – lipotoxicity • Pancreas, Liver, muscle, heart muscle • Insulin Resistance • Reduced TG synthesis • Enhanced lipolysis • Increase in Free fatty Acids

18. Inflammation • Low grade tissue Inflammation • Inflammatory markers raised in obese persons • Inflammation to endothelial dysfunction • Results in Insulin Resistance • Progression of Disease • Death of fat cells & Beta cells

19. Diabetes Mellitus • Multifactorial complex mechanisms • Pancreatic Dysfunction • Insulin Resistance • Altered Lipid Metabolism • Inflammation

20. Chronic Hyperglycemia • Hyperglycaemicpseudohypoxia • Oxidative stress • Activation of the coagulation cascade • Inflammation “Endothelial Dysfunction of arteries”

21. Diabetic Angiopathy • Macroangiopathy • Myocardial Infarction • Stroke • Leg gangrene • Microangiopathy • Retinopathy • End Stage Renal Failure • Peripheral Neuropathy

22. prameha

23. Beejadushti • SahajaPrameha • BeejaAvayavaDushti • Inherited Agni Vaigunya

24. KaphaKrit Cha Sarvam • Navanna • Dadhi • AnoopaMamsa • Avyayama • Asuchitwam • KaphaMedoMoothraVridhi Physical & Mental Inertia

25. AGNI & PRAMEHA

26. Panchabuta • Akasha • Vayu • Agni • Ap • Prithvi

27. Agnishomeeyam – Evolution of Life • Life – Dynamics Of Bhutas • Jala • Dhatusara, Ojas • Agni • Jatara, Dhatwagni • Vayu • Panchavayu

28. Panchabuta & Prameha • Jalaroga • JalaButa Prasada – Mala A disease of Jaladushti progressing to Dhatukshaya

29. Agni & Prameha • Jataragni – AharaParinamam • Ahara to Rasa • Khara Mala - Pureesha • Dhatwagni – DhatuParinamam • Annarasa to Dhatu Sara & Ojas • Drava Mala - Kleda – Moothra

30. Agni & Prameha • Agnidourbalyam • Ama formation • Srotorodha • Medovridhi • Dhatwagnivaikalya • Medodushti • Excess Kleda • Excess Moothra formation • Disintegration of Dhatus • Madhumeha

31. Agnidourbalya & Ama – Beta cell Dysfunction & Insulin Resistance • Atyahara • Adhibojana • Lack of proper exercise • Agnimandyam • Formation of Ama • Madhura Anna Rasa • Srotorodha

32. Medovridhi - Sthoulyam • Increase in Medas • Deposition of medas in abdomen,thighs • DhatwagniVaikalya • Furthur increase in formation of Medas • Srotorodha • DhatwagniDourbalya

33. Medodushti - Prediabetic • Dhatwagnidourbalya • VridhaMedas – DushtaMedas • SthiraDhatu Sara – ShithilaDhatu • DhatuParinamaVaikalya • Prone to CAD, CVA

34. Prameha – VasthiRoga • Activation of Pitha • Dissolution of Medas • Formation of excess Kleda • Elimination of excess Kleda As Moothra • Excess formation of Moothra ‘Athimoothratha’

35. Prameha – Madhumeha • Activation Of Vyana & ApanaVayu • Weakened Agni & Disintegration Of Dhatu Sara • Dhatu & Ojas converted to Kleda • Avila Moothra - Increased concentration of Urine ‘Madhumeha – Asadhya’

36. Clinical Scenario

37. Agnimandya & Ama Stage • Beta cell stimulation & reducing Insulin resistance • Agnibalavardhana & Amahara • Panchakolam • Indukantham • Eating Habit Modification • Life Style Modification

38. Medoroga & Medodushti • Medohara & AtisthoulyaChikitsa • DhatwagniDeepana • VaradiKashayam, Ayaskriti, Lodhrasavam • LohaPrayoga • Navayasam • Mushta, Darvi, Thriphala, Devadaru • Vidangadi • Abyanga • Prabanjanam • Udwarthanam • Nalpamara, Eladi, Nisa • Vyayama • AharaVihara

39. Prameha - Atimehana • PithaSamana • KledaVishoshana • MoothraSthambana • MedoDoshahara & Agni Deepana • Tiktha Rasa & SeethaVeerya • Ekanayakam • Thettamparal • Niroori • Vanga & Abraka

40. MoothraSthambana • Kashaya • Nisakathakadi, Kathakakhadiradi • Gulika • Nirooryadi, Swethagunjadi, Mehasamhari • Choornam • Amritadi • Paneeya • EkanayakaShadangam ‘Combine Medohara & DeepanaChikitsa’ • Chitrkathriphaladi, Navayasam

41. Madhumeha - Avilamoothratha • Aggressive Treatment • Prevent progression to Vatha stage • PithaVathasamanam & intensive Sthambana • Medodoshahara & Moothravisodhana • Balyam & Rasayanam • Agnideepanam • Vathasamanam

42. Avilamoothram • SilajathuPrayogam • Rasayanam • Nisa & Amalaka in all stages • Nisa – Kledahara • Amalaka – Rasayanam • Aveerabeejam • Moothravisodhanam • Oushadham • Akulyabdadi, AakuyadiGritam

43. Prameha - Avilamoothram • Intensive SthambanaChikitsa • Dhara • Takradhara • Special Dhara – 28 days • Sirolepam • MoordhaThailam • Nisoseeradi, Arukaladi • Abyangam • LakshadiKuzhambu • Pizhichil

44. KrishaMeham • VataPithaDosha • Agni Vaishamyam • Stress • Signs • Excess thirst & tiredness • Karshyam • Sudden Progression to neuropathy • VathaPithaSamanam • Agnideepanam • Mehahara & Balya

45. KrishaMeham - Chikitsa • Oushadham • Indukantham, Nisakathakadi • Nirooryadi • Amritadi • Abrakam • Dhara & Sirolepa • Pizhichil • Rasayanam • Amritha, Amalaka

46. Prameha – complications & associated symptoms

47. Prameha – Complications in Skeletomuscular System • Microangiopathy & tissue ischemia • Chronic Inflammation • Excess Kleda & Sodha • Dathushosha & Disintegration of Structures

48. Approach – Management of Complications • Aggressive Management of Prameha • Prevent progression • Effective Management of Complications • Kledahara & Sodha Hara • Kathakakadiradi with Silajathu • VathaSamana • Rasnathamalakyadi, Maharasnadi • Balyam • Bala, Amritha “Treat Prameha effectively & complications will disappear”

49. Frozen Shoulder AC • Kledahara & Sodhahara • Kathakakadiradi with Chandrapra • VathaSamanam • Maharasnadi with Trayodasangaguggulu • Snehana • Parinathakeree, Panchasneham • Balyam • KsheerabalaPrayogam • Navara

50. Foot Abnormalities – Charcot foot • Neuropathic Arhtropathy • Manage Prameham • VathaSamanam • Maharasnadi, Guggulu • Balyam • Navara