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Concept of Ayurvedic Dietetics and Yoga therapy in the management of Diabetes Mellitus

KiranKumar V. mutnali, SanjeeV S. tonni, amrutha Kalyani

Health is a simple word with

a complex meaning. For few it is

a mere freedom from a disease,

a goal to be achieved, to some it is the normal functioning of body and to some it’s a business. But to be precise, Health is “Life”. In the present scenario, man is under the clutches of various challenging diseases due to his improper lifestyle and dietary regimen. Diseases like hypertension, diabetes, obesity are among such challenging diseases which not only need cure but complete elimination from the society. At present, due to the increasing incidence, Diabetes has throned itself as the “king of diseases”; and India is at the verge of being crowned as the “World Capital of Diabetes”. Every year 7th April is observed as World Health Day to commemorate the inception of WHO; with each year being assigned a health theme. The theme for the year 2016 stood as “Halt the Rise – Beat Diabetes”. The theme itself highlights the need of embracing prevention in managing Diabetes. From 2016, the Ministry of AYUSH, has decided to celebrate the DhanwantariJayanthi(Inceptor of Ayurveda) as the National Ayurveda Day and its theme in

Dr. Kirankumar V. Mutnali, Reader,

Dept. of PG Studies in

Dr. Sanjeev S. Tonni, Reader / HOD, Dept. of PG Studies in Swasthavritta, Dr. Amrutha Kalyani, PG Scholar, Dept. of PG Studies in Swasthavritta, KLE University’s Shri. B.M. Kankanawadi Ayurveda Mahavidyalaya, PG Studies and Medical Research Centre, Shahapur, Belagavi. Karnataka. India.

Kayachikitsa,

Specially Contributed to "The Antiseptic"

Vol. 114 No.

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2016 was “Prevention and Control of Diabetes”

ayurveda – the “Science of life”, firmly believes in the concept of prevention. Diabetes is mentioned in Ayurveda as Prameha, occurring due to the derangement of three basic psycho - physiological factors of the body (Vata, Pitta, Kapha) and bodily tissues like meda (Fat). Prameha is characterised by frequent urination, occurs due to various factors which affect all the entities framing health. It’s a disease occurring due to practise of unhealthy dietary regimen, lifestyle, genetic predisposition and disturbed psychosocial state. By this we infer that, Prameha is not a single organ targeted disease but is of multiorgan. The ancient texts describe each cause in detail and each of them stands valid till date.

causative factors:

1. Unhealthy dietary regimens:

Excess consumption of high calorific food and drinks, viz. those of oily, sweet, heavy for digestion, highly viscous, colder potency and more of soothing kind precipitate the risk of acquiring Prameha. Consuming incompatible foods, stale food, excess of food, untimely food intake serve as the welcoming causes for Prameha. 2. Unhealthy Lifestyle: Practice of sedentary lifestyle like excess of sleep, prolonged rest, inclination to have comfort in every action like sitting, sleeping instigate buildup of

kapha and meda (Fat) and serve as the prime causes of Prameha.

3. Genetic predisposition:

Ayurveda states that like other genetic diseases, Prameha too manifests due to the pathologies at the genetic level (Beejadosha). Derangement in the properties of sperm and ovum at the time of conception, adoption of unhealthy lifestyle and practices during pregnancy and lactation cause Prameha since the birth of a child.

4. Psychosocial factors: Mind, is both the cause and cure to a disease. Factors like constant grief, anger, anxiety and other such stress factors bring imbalance in the mind resulting in Prameha.

Pathogenesis of Prameha:

Though the disease develops by derangement in all thedosha; it is predominantly due to the vitiation of Kaphadosha and Medadhatu. These entities have properties similar to the properties of high calorific diet. Adoption of any form of above said causes, adds on to Kapha and meda leading to Obesityand Prameha.

types of Prameha:

Ayurvedic texts like Charaka Samhita and Sushruta Samhita, mention different types of Prameha, with basic types being SahajaPrameha or JatahPrameha (Juvenile/Hereditary) and Apa thyanimittajaPrameha(Maturity Onset Diabetes Mellitus/Acquired Variety). These can be correlated to Type I and Type II DM of

contemporary medical science respectively. Other classification is based on the physique of the patient like KrushaPramehi (asthenic/ thin type) and SthulaPramehi (over nourished/obese type) relating to SahajaPrameha and ApatyanimittajaPrameha respectively.

Sahaja Prameha:

It occurs either due to the union of defective sperm and ovum at the time of conception, improper diet and lifestyle practises opted by mother during pregnancy leading to the defective intrauterine environment or improper diet and lifestyle practises opted by mother during lactation which trigger genetic predisposition. Excess intake of high calorific diet may cause juvenile onset of Prameha in children who are genetically susceptible to it.

apatyanimittaja Prameha:

The unhealthy dietary, lifestyle and psychologic factors precipitate the manifestation of the disease. Prameha is also classified on the basis of doshic predominance as vataja, pittaja and kaphaja and further these having 4, 6 and 8 subtypes respectively.

Prodromal Symptoms of Prameha:

They are the symptoms observed prior to the complete manifestation of the disease. For Prameha they include excessive sweating, body odour, laziness, inclination towards rest, formation of excess wastes in eyes, ears, teeth, oral cavity, excess growth of hair and nails, matting of hair, burning sensation in feet and palms, sweet taste in mouth, attraction of insects towards body and urine. It presents many conditions of oral cavity especially on the gums and the periodontal tissues, like, gingivitis, cavities and oral candidiasis. Other symptoms like

the body odour occur due to the bacterial growth and thirst due to excess of disturbed metabolism. Few of these features represent Pre diabetic stage or noticed during impaired glucose levels.

diagnosis:

Prameha can be diagnosed on the basis of its symptoms viz., excess urination (polyuria), thrist (polydypsia), increased appetite (polyphagia), lethargy etc. Careful observation of the symptoms helps to diagnose the disease. Tests like fasting blood sugar, post prandial blood sugar, random blood sugar, Glycocylatedhemoglobin (HbA1c), Glucose Tolerance Test (GTT) help to confirm the condition more precisely and its prognosis.

Prognosis:

Madhumeha, variety ofvatajaprameha (Type I DM) is incurable, because the cause of the disease is lack of Insulin hormone from the pancreas or insensitivity towards insulin by the body tissues and the strength of the person being compromised. While KaphajaPrameha is easy to cure and PittajaPrameha is Yapya (controllable by diet and lifestyle modification). Both Kaphaja and Pittaja variety of Prameha can be correlated to Type II variety of Diabetes mellitus.

complications

(Upadravas)

of

Prameha:

Lack of control over the disease at the initial stage, progresses the disease to an irreversible state and also there occur emergence of other diseases. Few complications of Prameha are Kushtha (skin diseases), Pramehapidaka(diabetic carbuncles), abcess, sthoulya (obesity), shopha (generalised oedema), Mutrakricchra (urinary disorders), weakness, indigestion, diarrhoea.

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management of Prameha:

Ayurveda mentions avoidance

of

causative factors of the disease

as

the first line of treatment of

any disease. It stressess more on the preventive aspect of the disease than the curative. Samshodhana(biopurifaction)

therapy is adopted if the patient

is physically strong and suffers

from ApathyanimittajaPrameha,

on the contrary, to a weak patient

Samshamana(palliative therapy) is advisible. Management of Prameha mimics that of obesity wherein Apatarpanachikitsa (balanced diet with calorie restriction) is adopted to minimize the vitiation of kapha and meda.

dietary management:

Food is one of the three

basic pillars which govern life.

A text in Ayurveda quotes that

a disease gets cured by just

following appropriate Pathya (wholesome diet); but even 100

medicines fail to cure a disease

in the absence of pathya. A good

planned diet brings equilibrium among the body humours and tissues. The science mentions various food principles at the stage of preparation, processing and consumption, which are important both in prevention and cure of the disease.

SthulaPramehi should consume Apatarpakaahara(balanced diet with caloric restriction), avoid

food and drinks that are kapha and meda promoting. Yava (barley)

is quoted as the best diet to be

adopted by a pramehi. Many

researches have proven that use

of barley and preparations made

using barley flour improve glucose tolerance, reduce insulin responses and lowers the inflammmatory markers. Use of barley in the form

of Apupa (cake), foods prepared by soaking the barley seeds in the in Triphala decoction (herbal mixture

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of Teminaliachebuala, Terminalia bellerica and Phyllanthusemblica), because triphala is proved to be antidiabetic and antioxidant. Studies have proven Amalakim(Indian gooseberry) to be antidiabetic, hypolipidemic and antioxidant. Seeds of Venu (bamboo) and Godhuma (wheat) stand as substitutes to use of barley with triphaladecoction. Various spices and condiments like turmeric, jeera, dhaniya, ginger, methi, garlic and cinnamon are proven to be antidiabetic and thereby, use of these in routine, halts the progress and cures the disease. Ayurveda prescribes the use of tiktashaka (bitter vegetables) like bitter gourd, fenugreek, bottlegourd, snake gourd in managing Prameha. Grains like green gram, kodo-millet; mustard oil are helpful in resolving the disease. Use of meat is not restricted in Ayurveda; but the meat should be of preferably low calories (chicken meat). Most of the times liquids serve as medicines in many dieases. Sarodaka or kushodaka(liquids obtained after boiling and cooling water with heart wood of khadira (Acacia catechu) and leaves of kusha respectively) can be used as substitutes to normal drinking water in diabetic patients. One should always consume warm and fresh food as it helps

in relishing the food and aids digestion. Quantum of the food to be consumed should be decided on the basis of appetite. Foods heavy for digestion should be consumed to the half of the satiety level and those of light to be consumed to the full of individual’s satiety. Consumed quantum of food should not restrict an individual’s activities like standing, walking etc. Food should be consumed only on experiencing the urge of hunger. Prior and overeating leads to various gastrointestinal discomforts. Post meals one should practise walking for 100 steps and sleeping on left lateral position to aid digestion and prevent the build up of Ama (toxic metabolites).

lifestyle management:

This being a burning cause of the disease, should be checked at right time. Ayurvedic texts highlighting the importance of vyayama (physical activities) mention various activities like walking, running, jogging, horse riding and swimming. These should be practised by Sthulapramehi (Type II DM) as such activities reduce kapha and meda. Practice of Asanas (Yogic posture), Pranayama (breathing exercises) and meditation stabilize the mind and body and help in managing the disease. Asanas like Vakrasana, Mayurasana, Matsyasana, and Hamsasanarender excellent results in managing the

disease.

Psycho social management:

Practice of meditation, pranayama, deep and quick relaxation techniques would help to calm the mind; thereby curing the disease and its complications. Various brain tonics like Shankhapushpi (Convoluluspluricaulis), Brahmi (Bacopamonneirri), Vacha counter act the stress induced neuroendocerine changes and render good availability of insulin for metabolism. Herbs like Meshashrigi (Gymnemasylvestra), Guduchi(Tinosporacordifolia), Jambu, Asana (Pterocarpus marsupium Roxb.), Saptaparna, Amalaki have promising results in managing Prameha. Complications can be managed by the use of herbs like Arjuna (Terminalia arjuna), Pushkaramoola (Inularacemosa), Gokshura (Tribulusterrestris), Triphala, Dashamoola (roots of ten herbs) and Vacha (Acoruscalamus). Though Pramehais a complex disease, it can be managed (except the hereditary type) with Ayurvedic modalities. In its full fledged state, treatment is the only option, but preventing its progress to the stage of complications or its origin is needed. By adopting healthy dietary regimen, lifestyle and a good state of mind, we can definitely Halt the Rise and Beat Diabetes.

Filaggrin is a protein which is found in the skin, where it is involved in the formation of the corneal layer and contributes to protective functions. The gene coding for filaggrin is situated on the chromosome Iq21. It is the seat of several mutations which are significantly associated with an increased risk of atopic dermatitis. Among these mutations, R501 X and 2282del4 are the most significant in Europe and provoke a complete loss of expression of filaggrin. 14 to 56% of patients affected by atopic dermatitis and 10% of the European population in general have at least one allele of mutated filaggrin, which increases the risk of developing atopic dermatitis by 1.3 fold. Although it is more significant, filaggrin is not the only gene associated with atopic dermatitis. Other genes code for inflammatory factors such as some interleukins, proteases or their inhibitors.

- la medecine en France