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PRAMEHA – AN APPROACH Based On Pathophysiological Mechanisms
Dr K P Yadunandanan MD Ay Medical Officer Govt Ayurveda Hospital Chelembra, Malappuram Dist PRAMEHA – AN APPROACH Based On Pathophysiological Mechanisms
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Our Specialities Frozen Shoulder OA Knee Tennis Elbow CTS Leg Pain
Feet Numbness Erectile Dysfunction
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Ayurveda & Diabetes Diabetes = Prameha
Nisakathakadi or Kathakakhadiradi Nirooryadi Mehari powders Paneeyams “Ayurvedic = Herbal Hypoglycemic Drug” “Lack of a proper understanding of disease & treatment approach”
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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
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Systematic Approach in Patient Examination & Evaluation
Patient Approach Systematic Approach in Patient Examination & Evaluation
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Evaluation of Vayu Prana Udana Vyana Samana Apana Jeevana Bala
Dhatu Parinama & Dhatugati Samana Aharapaka Apana Nishkramana
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Evaluation of Agni Jatara Ranjaka Dhatwagni Aharapaka & Malanirmanam
Raktha Nirmanam Dhatwagni Dhatuparinama & Kleda Nirmanam
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Evaluation of Dhatu Sara
Twak Raktha Mamsa & Medas Asthi Majja & Sandhi Sukra
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Evaluation of Mala Pureesha Moothra Sweda Other mala Consistency
Colour etc Sweda Other mala
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Evaluation of Manas Satwa Raja Tamas
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Type 2 Diabetes Mellitus
“A Vascular disease more than a true metabolic disease” Macroangiopathy Stroke, CAD, Leg Gangrene Microangiopathy Retinopathy, Nephropathy, Neuropathy
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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
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Predisposing Factors Genetic predisposition Obesity Lifestyle
Lack of exercise Environmental Inflammation
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Diabetes – Pathophysiological mechanisms
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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
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Insulin Resistance “Defect in ability of insulin to stimulate glucose transport into the cell” Obesity Free Fatty Acids Inflammation
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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
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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
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Diabetes Mellitus Multifactorial complex mechanisms
Pancreatic Dysfunction Insulin Resistance Altered Lipid Metabolism Inflammation
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Chronic Hyperglycemia
Hyperglycaemic pseudohypoxia Oxidative stress Activation of the coagulation cascade Inflammation “Endothelial Dysfunction of arteries”
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Diabetic Angiopathy Macroangiopathy Microangiopathy
Myocardial Infarction Stroke Leg gangrene Microangiopathy Retinopathy End Stage Renal Failure Peripheral Neuropathy
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prameha
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Beejadushti Sahaja Prameha Beeja Avayava Dushti
Inherited Agni Vaigunya
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Kapha Krit Cha Sarvam Navanna Dadhi Anoopa Mamsa Avyayama Asuchitwam
Kapha Medo Moothra Vridhi Physical & Mental Inertia
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AGNI & PRAMEHA
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Panchabuta Akasha Vayu Agni Ap Prithvi
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Agnishomeeyam – Evolution of Life
Life – Dynamics Of Bhutas Jala Dhatusara, Ojas Agni Jatara, Dhatwagni Vayu Panchavayu Vayu Jala Agni
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Panchabuta & Prameha Jalaroga Jala Buta Prasada – Mala
A disease of Jaladushti progressing to Dhatukshaya
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Agni & Prameha Jataragni – Ahara Parinamam Dhatwagni – Dhatu Parinamam
Ahara to Rasa Khara Mala - Pureesha Dhatwagni – Dhatu Parinamam Annarasa to Dhatu Sara & Ojas Drava Mala - Kleda – Moothra
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Agni & Prameha Agnidourbalyam Ama formation Srotorodha Medovridhi
Dhatwagnivaikalya Medodushti Excess Kleda Excess Moothra formation Disintegration of Dhatus Madhumeha
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Agnidourbalya & Ama – Beta cell Dysfunction & Insulin Resistance
Atyahara Adhibojana Lack of proper exercise Agnimandyam Formation of Ama Madhura Anna Rasa Srotorodha
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Medovridhi - Sthoulyam
Increase in Medas Deposition of medas in abdomen,thighs Dhatwagni Vaikalya Furthur increase in formation of Medas Srotorodha Dhatwagni Dourbalya
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Medodushti - Prediabetic
Dhatwagnidourbalya Vridha Medas – Dushta Medas Sthira Dhatu Sara – Shithila Dhatu Dhatu Parinama Vaikalya Prone to CAD, CVA
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Prameha – Vasthi Roga Activation of Pitha Dissolution of Medas
Formation of excess Kleda Elimination of excess Kleda As Moothra Excess formation of Moothra ‘Athimoothratha’
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Prameha – Madhumeha Activation Of Vyana & Apana Vayu
Weakened Agni & Disintegration Of Dhatu Sara Dhatu & Ojas converted to Kleda Avila Moothra - Increased concentration of Urine ‘Madhumeha – Asadhya’
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Clinical Scenario
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Agnimandya & Ama Stage Beta cell stimulation & reducing Insulin resistance Agnibalavardhana & Amahara Panchakolam Indukantham Eating Habit Modification Life Style Modification
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Medoroga & Medodushti Medohara & Atisthoulya Chikitsa
Dhatwagni Deepana Varadi Kashayam, Ayaskriti, Lodhrasavam Loha Prayoga Navayasam Mushta, Darvi, Thriphala, Devadaru Vidangadi Abyanga Prabanjanam Udwarthanam Nalpamara, Eladi, Nisa Vyayama Ahara Vihara
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Prameha - Atimehana Pitha Samana Kleda Vishoshana Moothra Sthambana
Medo Doshahara & Agni Deepana Tiktha Rasa & Seetha Veerya Ekanayakam Thettamparal Niroori Vanga & Abraka
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Moothra Sthambana Choornam Paneeya
Kashaya Nisakathakadi, Kathakakhadiradi Gulika Nirooryadi, Swethagunjadi, Mehasamhari Choornam Amritadi Paneeya Ekanayaka Shadangam ‘Combine Medohara & Deepana Chikitsa’ Chitrkathriphaladi, Navayasam
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Madhumeha - Avilamoothratha
Aggressive Treatment Prevent progression to Vatha stage Pitha Vatha samanam & intensive Sthambana Medodoshahara & Moothravisodhana Balyam & Rasayanam Agnideepanam Vathasamanam
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Avilamoothram Silajathu Prayogam Nisa & Amalaka in all stages
Rasayanam Nisa & Amalaka in all stages Nisa – Kledahara Amalaka – Rasayanam Aveerabeejam Moothravisodhanam Oushadham Akulyabdadi, Aakuyadi Gritam
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Prameha - Avilamoothram
Intensive Sthambana Chikitsa Dhara Takradhara Special Dhara – 28 days Sirolepam Moordha Thailam Nisoseeradi, Arukaladi Abyangam Lakshadi Kuzhambu Pizhichil
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Krisha Meham Vata Pitha Dosha Agni Vaishamyam Stress Signs
Excess thirst & tiredness Karshyam Sudden Progression to neuropathy Vatha Pitha Samanam Agnideepanam Mehahara & Balya
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Krisha Meham - Chikitsa
Oushadham Indukantham, Nisakathakadi Nirooryadi Amritadi Abrakam Dhara & Sirolepa Pizhichil Rasayanam Amritha, Amalaka
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Prameha – complications & associated symptoms
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Prameha – Complications in Skeletomuscular System
Microangiopathy & tissue ischemia Chronic Inflammation Excess Kleda & Sodha Dathushosha & Disintegration of Structures
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Approach – Management of Complications
Aggressive Management of Prameha Prevent progression Effective Management of Complications Kledahara & Sodha Hara Kathakakadiradi with Silajathu Vatha Samana Rasnathamalakyadi, Maharasnadi Balyam Bala, Amritha “Treat Prameha effectively & complications will disappear”
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Frozen Shoulder AC Kledahara & Sodhahara Vatha Samanam Snehana Balyam
Kathakakadiradi with Chandrapra Vatha Samanam Maharasnadi with Trayodasangaguggulu Snehana Parinathakeree, Panchasneham Balyam Ksheerabala Prayogam Navara
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Foot Abnormalities – Charcot foot
Neuropathic Arhtropathy Manage Prameham Vatha Samanam Maharasnadi, Guggulu Balyam Navara
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Vascular Neuropathy Peripheral – DSP Microangiopathy & Nerve Ischemia
Nerve Damage – Arhtopathy Pain, Numbness, muscle atrophy Autonomic Urination problems Erectile Dysfunction
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Managemant - Vascular neuropathy
Aggressive Management of Prameha – Vatha Pitha Meha Nisakathakadi, Nirooryadi, Nisa & Amalaka Amritadi Dhara & Sirolepa Vatahara Rasnathamalakyadi, Ashtavargam, Balya & Rasayanam Bala – Ksheerabala Amrita – Ksheeraguloochi Abyangam & Pizhichil Vasthi
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Vascular neuropathy Autonomic – ED Vata Pitha Meha Samana Vrishya
Nisakathakadi, Amrithadi Vrishya Silajathu, Abrakam, Vangam Jeevaneeyaganam Pizhichil Vasthi
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Nephropathy - Madhimeham
Madhumeha Chikitsa Akulyabdadi Kashayam Silajathu Rasayana – Saramabu Bavitha Silajathu Lajjalu Sopha & Udara Chikitsa
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PAD & Prameha Chronic Leg Pain
Macroangiopathy – Atherosclerosis of Tibial artery Guggulutikthakam Rasasindooram Amrita & Guggulu Mahamanjishtadi Madhusnuhi
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PAD Leg Gangrene Guggulutikhakam Rasasindooram Mahamanjishtadi
Amrita & Guggulu Madhusnuhi
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Hyperglycemia as symptom
Stroke Ama Amahara Chikitsa Shaddharanam yogam
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Summary Prameha involves complicated mechanisms which appear contradictory – Agnimandya, Ama, Medodushti, Dhatu Shaithilya & Ojakshaya. Management requires understanding of different patho-physiology and treatment options should be adopted accordingly
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Thank You
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