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PRAMEHA – AN APPROACH Based On Pathophysiological Mechanisms

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Presentation on theme: "PRAMEHA – AN APPROACH Based On Pathophysiological Mechanisms"— Presentation transcript:

1 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

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 Systematic Approach in Patient Examination & Evaluation
Patient Approach Systematic Approach in Patient Examination & Evaluation

6 Evaluation of Vayu Prana Udana Vyana Samana Apana Jeevana Bala
Dhatu Parinama & Dhatugati Samana Aharapaka Apana Nishkramana

7 Evaluation of Agni Jatara Ranjaka Dhatwagni Aharapaka & Malanirmanam
Raktha Nirmanam Dhatwagni Dhatuparinama & Kleda Nirmanam

8 Evaluation of Dhatu Sara
Twak Raktha Mamsa & Medas Asthi Majja & Sandhi Sukra

9 Evaluation of Mala Pureesha Moothra Sweda Other mala Consistency
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
Hyperglycaemic pseudohypoxia Oxidative stress Activation of the coagulation cascade Inflammation “Endothelial Dysfunction of arteries”

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

22 prameha

23 Beejadushti Sahaja Prameha Beeja Avayava Dushti
Inherited Agni Vaigunya

24 Kapha Krit Cha Sarvam Navanna Dadhi Anoopa Mamsa Avyayama Asuchitwam
Kapha Medo Moothra Vridhi 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 Vayu Jala Agni

28 Panchabuta & Prameha Jalaroga Jala Buta Prasada – Mala
A disease of Jaladushti progressing to Dhatukshaya

29 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

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 Dhatwagni Vaikalya Furthur increase in formation of Medas Srotorodha Dhatwagni Dourbalya

33 Medodushti - Prediabetic
Dhatwagnidourbalya Vridha Medas – Dushta Medas Sthira Dhatu Sara – Shithila Dhatu Dhatu Parinama Vaikalya Prone to CAD, CVA

34 Prameha – Vasthi Roga 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 & Apana Vayu
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 & 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

39 Prameha - Atimehana Pitha Samana Kleda Vishoshana Moothra Sthambana
Medo Doshahara & Agni Deepana Tiktha Rasa & Seetha Veerya Ekanayakam Thettamparal Niroori Vanga & Abraka

40 Moothra Sthambana Choornam Paneeya
Kashaya Nisakathakadi, Kathakakhadiradi Gulika Nirooryadi, Swethagunjadi, Mehasamhari Choornam Amritadi Paneeya Ekanayaka Shadangam ‘Combine Medohara & Deepana Chikitsa’ Chitrkathriphaladi, Navayasam

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

42 Avilamoothram Silajathu Prayogam Nisa & Amalaka in all stages
Rasayanam Nisa & Amalaka in all stages Nisa – Kledahara Amalaka – Rasayanam Aveerabeejam Moothravisodhanam Oushadham Akulyabdadi, Aakuyadi Gritam

43 Prameha - Avilamoothram
Intensive Sthambana Chikitsa Dhara Takradhara Special Dhara – 28 days Sirolepam Moordha Thailam Nisoseeradi, Arukaladi Abyangam Lakshadi Kuzhambu Pizhichil

44 Krisha Meham Vata Pitha Dosha Agni Vaishamyam Stress Signs
Excess thirst & tiredness Karshyam Sudden Progression to neuropathy Vatha Pitha Samanam Agnideepanam Mehahara & Balya

45 Krisha Meham - 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 Vatha Samana Rasnathamalakyadi, Maharasnadi Balyam Bala, Amritha “Treat Prameha effectively & complications will disappear”

49 Frozen Shoulder AC Kledahara & Sodhahara Vatha Samanam Snehana Balyam
Kathakakadiradi with Chandrapra Vatha Samanam Maharasnadi with Trayodasangaguggulu Snehana Parinathakeree, Panchasneham Balyam Ksheerabala Prayogam Navara

50 Foot Abnormalities – Charcot foot
Neuropathic Arhtropathy Manage Prameham Vatha Samanam Maharasnadi, Guggulu Balyam Navara

51 Vascular Neuropathy Peripheral – DSP Microangiopathy & Nerve Ischemia
Nerve Damage – Arhtopathy Pain, Numbness, muscle atrophy Autonomic Urination problems Erectile Dysfunction

52 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

53 Vascular neuropathy Autonomic – ED Vata Pitha Meha Samana Vrishya
Nisakathakadi, Amrithadi Vrishya Silajathu, Abrakam, Vangam Jeevaneeyaganam Pizhichil Vasthi

54 Nephropathy - Madhimeham
Madhumeha Chikitsa Akulyabdadi Kashayam Silajathu Rasayana – Saramabu Bavitha Silajathu Lajjalu Sopha & Udara Chikitsa

55 PAD & Prameha Chronic Leg Pain
Macroangiopathy – Atherosclerosis of Tibial artery Guggulutikthakam Rasasindooram Amrita & Guggulu Mahamanjishtadi Madhusnuhi

56 PAD Leg Gangrene Guggulutikhakam Rasasindooram Mahamanjishtadi
Amrita & Guggulu Madhusnuhi

57 Hyperglycemia as symptom
Stroke Ama Amahara Chikitsa Shaddharanam yogam

58 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

59 Thank You

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