Madhumeh w.s.r. to Type 2 Diabetes Mellitus-A Review.

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Review Article This work is licensed under a CC BY 4.0 License International Research Journal of Ayurveda & Yoga Vol. 6 (5),122-127, May,2023 ISSN: 2581-785 X : https://irjay.com/ DOI: 10.47223/IRJAY.2023.6519 Madhumeh w.s.r. to Type 2 Diabetes Mellitus-A Review. Vanita Nagar 1 Ajay Kumar Sahu 2 , Abhishek Upadhyay 3 Deepika Patidar 4 1,4-PG Scholar National Institute of Ayurveda, deemed to be university, Jaipur. 2-Associate Professor department of Kayachikitsa, National Institute of Ayurveda deemed to be university, Jaipur 3-Assistant professor department of Kayachikitsa, National Institute of Ayurveda, deemed to be university, Jaipur. INTRODUCTION Diabetes mellitus (DM) is probably one of the oldest diseases known to man. Type 2 DM (formerly known as non-insulin dependent DM) is the most common form of DM characterized by hyperglycemia, insulin resistance, and relative insulin deficiency 1,2 . Type 2 DM results from interaction between genetic, environmental and behavioral risk factors 3,4 People living with type 2 DM are more vulnerable to various forms of both shortand long-term complications, which often lead to their premature death. This tendency of increased morbidity and mortality is seen in patients with type 2 DM because of the commonness of this type of DM, its insidious onset and late recognition Based on symptoms, this metabolic condition is sub-classified as Vataja Prameha 5 in Ayurveda and might manifest depending on the predominance of one or more Doshas 6 The disease Madhumeha , its description, etiology, clinical manifestations, and several means of treatment are comparable to the disease diabetes mellitus, as explained in detail by Acharya Charaka . Madhumeha develops from two sources: the aggravation of vata brought on by dhatuksaya depletion /loss of tissues, and the doshas obstructing its path (movement). In the case of obstruction, the vata occasionally displays the symptoms of the dosha that covers it; as a result, the bladder is occasionally found to be empty and occasionally to be full, making the disease more challenging to treat. If left alone, all varieties of prameha will eventually turn into madhumeha. Dietary and lifestyle changes, anti-diabetic medications taken orally, and insulin injections are the Article Info Article history: Received on: 09-04-2023 Accepted on: 17-05-2023 Available online: 31-05-2023 Corresponding author- Vanita Nagar, PG Scholar National Institute of Ayurveda, deemed to be university, Jaipur, Email: vanitanagar 97@gmail.com ABSTRACT: A chronic metabolic condition with numerous etiologies, diabetes mellitus affects people all over the world. However, the prevalence of diabetes has increased recently, which is particularly troubling in developed countries. An estimated 537 million adults (20–79 years) were living with diabetes worldwide in 2021, of which 14% (74.2 million) were from India, the country with the second largest number of people with diabetes in the world. This number is projected to increase by 68% (124.9 million) over the next 25 years. More worryingly, slightly more than half (53.1%) of people with diabetes in India are unaware of their condition. The main causes of diabetes mellitus in the present period include an entirely sedentary lifestyle, eating a lot of junk food, and weight increase. Based on the symptoms, this metabolic condition is classified as Madhumeha in Ayurveda. It is a Vataja Prameha that develops as a result of different nidanas. As an outcome, Ayurveda should be considered for the treatment of diabetes mellitus. Keywords - Madhumeha , diabetes mellitus, nidana, Management, Vataja Prameha,

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Vanita et.al, “ Madhumeh w.s.r. to Type 2 Diabetes Mellitus-A Review . ” : 2023; 6 (5):122-127 123 mainstays of diabetes management 7 The main symptom predominantly which will be seen in patients as explained by Acharyas are prabhoota mootrata (polyuria), aavila mootrata (Turbidity of urine), atipipasa (polydipsia), kshudati pravruti (polyphagia), dourbalya (debility), karapada daha (burning sensation on palms and soles) 8 Searching for Ayurvedic treatment for diabetes is essential. The ideal standard protocol for treatment with effective medications remains elusive despite the fact that numerous studies have been undertaken in this area. This article will highlight, evaluate, elaborate and discuss about diabetes mellitus with special reference to Madhumeha . MATERIAL & METHODS Material related to is Madhumeha & type 2 diabetes mellitus collected from text book of Ayurveda, commentaries and modern medicine respectively. The index, non-index medical journals has also referred to collect information of relevant topic. Review Of Literature Etymology of madhumeha Madhu and Meha are the two words which make up the word Madhumeha. The source of the term Madhu is " Manyante Visheshena Janati Jana Yasmin ." The root " Manjane" is used by Dha Adesha and it demonstrates the likeness of urine in taste, colour, and appearance, among other things. The Rigveda's Mehanadtanam Karanallium is where the word "meha " first appears 9 Madhumeha is clinical condition in which the patient voids the urine which has similarity with Madhu i.e., Kashaya (astringent) and Madhura (sweet) Rasa (taste), Rukshatwa (dry) and Madhu (honey) like colour and body acquires sweetness is called Madhumeha. Aetiology The causes of the diabetic syndrome include sedentary lifestyles and the enjoyment of excessive sleep, milk and its preparation, freshly harvested grains, new/fresh wines, jaggery preparations (cane sugar preparations), and all other kapha-aggravating elements 10 Pathogenesis Pathogenesis of Madhumeha is best described by Acharya Vagbhatta. He said Madhumeha can originate in two ways- • By the aggravation of Vata caused by Dhatukshaya . • By the obstruction of Vata caused by Doshas covering it. Due to the loss of Oja, Madhumeha , which is brought on by Dhatukshaya, presents as a thin and asthenic person. The vitiated Kapha and Meda in Margavaranjanya Madhumeha hinder Vata's movement. Madhumeha is manifested when the blocked Vata becomes vitiated once more and carries Ojus to Basti. 11 According to Ayurveda, responses take the form of illnesses not manifesting or not manifesting at all depending on the potency of a particular characteristic of the aetiology, Dosha (innate pathogenic components), and Dushyas (substratum of pathology). The disorder will not exist, or it will manifest recently, in a mild form, or without all the mentioned symptoms if these three components do not combine, or if they do so after a long period or in a weaker state. Contrarily, the outcome will be the opposite. According to this, all ailments have a common cause that may or may not appear as a response 12 Classification After reviewing detail description of madhumeha in various ayurveda texts and commentaries , it can be classified as shown in table on the basis of aetiology, pathology, and prognosis. (Table 1) Classification of Diabetes Mellitus 15 • Type-1 Diabetes Mellitus- Juvenile diabetes, also known as type 1 diabetes, is typically discovered in children, teenagers, and young adults. Adults may develop type 1 diabetes. This autoimmune condition results in the particular destruction of pancreatic beta cells, which results in absolute insulinopaenia. • Type-2 Diabetes Mellitus - The most prevalent kind of diabetes, type 2, which used to be known as adultonset diabetes, has a sneaky beginning. Although it frequently affects adults, it can also affect children. Except in cases of extreme hyperglycaemia, weight loss is unusual, and ketosis is uncommon. The inheritance of genes occurs frequently. This kind of diabetes typically manifests as insulin resistance with initial counterregulatory hyperinsulinemia. Clinical diabetes emerges as the pancreas eventually loses its capacity to produce enough insulin in response to meals. • Gestational Diabetes- With an onset or initial recognition during pregnancy, gestational diabetes is a form of carbohydrate intolerance that causes hyperglycaemia of varying severity. Premonitory Symptoms Premonitory symptoms according to ayurveda texts include burning sensation in the palms and soles of the feet, heaviness in the body, sweet-smelling urine, stupor, debility, profound thirst, dyspnoea, increased accumulation of bacteria in the mouth, throat, tongue, and teeth, hairs that sticks together, and increased hair and nail growth 16

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Vanita et.al, “ Madhumeh w.s.r. to Type 2 Diabetes Mellitus-A Review . ” : 2023; 6 (5):122-127 124 Clinical Features The passing of copious amounts of turbid or cloudy urine, the transformation of the urine into honey like urine, and an overall increase in sweetness are the main symptoms of the diabetes 17 Additionally, Sahajameha Rogi are typically Krisha (thin build), while Apatyanimittaja Rogi are typically Sthula (obese), according to Sushrutacharya 18 Complications of diabetes mellitus - Table no 2. Complications of diabetes mellitus 19 Investigations 20 Disease-Specific 1 Measurement of the plasma glucose level 2 Random blood sugar (RBS) 3 Fasting blood sugar (FBS) 4 Postprandial blood sugar (PPBS) 5 Urine routine and microscopic 6 Glycosylated haemoglobin (HbA 1 c) 7 Lipid Profile 8 Serum insulin and c-peptide Other 1 Blood urea and serum creatinine 2 E.C.G. 3 Fundus examination 4 Serum electrolytes Management 1 Patients with Type 1 Diabetes Mellitus, also known as Krisha Pramehi , are typically advised to have Bringhan as well as a diet which increase Dhatus in the body. 2 In type 2 Diabetes, Obese diabetic patients ( Apatyanimittaja Rogi ) with optimal body strength having intense increase of Doshas, Samshodhan (purification) of the body advocated. 1 Snehana (preparation of oil internally &externally) 2 Shodhana (Purification therapy 3 Shamana with drugs. 4 Exercise and life style modification &following regular regimen of exercise, 5 yoga, pranayama and regular food& sleep 6 following Ritucharya & Dincharya . Diabetes can be controlled by giving comprehensive attention to three aspects 1 Ahara (Diet) 2 Vihara (Exercise) 3 Aushadha (Medicine) The role of ahara and vihara are equally or even more important than drugs in order to control blood sugar level as well as to prevent complication of this disease. • Some Herbal medications use in Madhumeha 1. Musta(Cyperus rotundus) 2. Daruharidra (Berberis aristata) 3. Arjuna (Terminalia arjuna] 4. Khadir (Acacia catechu) 5. Lodhra (Symplocos racemosa) 6. Guduchi(Tinosporacordifolia) 7. Patol (Trichosanthe dioica) 8. Vata (Ficus bengalensis), 9. \Udumbar(Ficusglomerata), 10. Gudmar (Gymnema sylvestre) 11. Asana (Pterocarpus marsupium), 12. Shilajit(Purified Bitumen) 13. Kumbha (Leucascephalotes) 14. Nimba (Azardicta indica). 21 • Some Aushadhi (Medicines) use in Madhumeha 1. Ghrita &Taila- Trikantakdya Sneha,Dadimadhya Ghrita, Shalmali Ghirta,Dhanvantar Ghirta, Triphala Ghirta, 2. Asava-Arista -LodhraAsava or Madhva Asava, Dantya Asava, Devdarvadi Arista. 3. Leha (Paste)- Salsaradi leha, Kusha Avleha, Vanga Avleha. 4. Udaka -Sarodaka, Kushodaka,Madhukodaka, Sidhu, Madhvika. 5. Vati (Tablet)- Trikatukadya Modaka,Shiva Gutika, Shilajatvadi Vati, Chandraprabha Vati, Indra Vati, Gokshuradi Vati, Aarogyavardhini Vati. 6. Churna(powders)- Nyagrodadi Churna, Eladi Churna, Karkatbijadi Churna, Triphala Churna. 7. Rasa/ Bhasam- Vasantakusumakar Rasa, Brihta Bangeshwar Rasa, Suvarnavanga, Apurvamalinivasant Rasa, Harishankar Rasa, Panchanana Rasa. 8. Kwatha (Decoction)- Phalatrikadi Kwath, Darvyadi Kwath, Vidangadi Kwath, Triphaladi Kwath 22 • Pathya and Apathya Shyama, Kodrava, Godhum and Kullatha which are old-are suitable to be used as foods by patients of Madhumeha (Diabetes). Vegetables of bitter taste ( Tikta ), meat of animals and eggs of birds of deserts like regions ( Jangala mamsa ),boiled Yava and its preparations, Mudaga, Shali , and Shastika are all suitable as foods. Sura (beer), Butter milk, oils, milk ghee, jaggery, foods processed with sours, sugarcane, juice, food prepared from flour, meat of animals of marshy regions should be avoided from use 23 Yoga Every type of metabolism in the body is improved by yoga. Because of this, people with diabetes should

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Vanita et.al, “ Madhumeh w.s.r. to Type 2 Diabetes Mellitus-A Review . ” : 2023; 6 (5):122-127 125 practise various forms of yoga. Yoga will undoubtedly benefit those with diabetes. In current era whole world is looking forward to ayurveda and showing interest in yoga. Padmasana, Shalabhasan, Mayurasan, Suryanamaskar, and Dhanurasan are common asanas that can be highly helpful for diabetes 24 DISCUSSION A metabolic disorder with numerous aetiologies, diabetes mellitus is referred to as Madhumeha in traditional Ayurvedic literature. Two types of clinical presentations are identified as Type-I and Type-II diabetes, respectively, in Krisha Pramehi and Sthula Pramehi . Ayurvedic treatment concepts can assist the patient in having better blood sugar control and a higher quality of life. Modern therapy has numerous limitations The specially prepared Ayurvedic diet and lifestyle plan in the present study have all the potential to maintain the glycemic index of Madhumeha (DM) patients. Cases of Diabetes Mellitus is increasing rap idly, because of increases in the prevalence of a sedentary lifestyle and obesity. Through appropriate use of Ayurvedic preventive measures such as Aharavidhi, Pathya, Apathya, Yoga, and therapeutic measures Madhumeha (Diabetes Mellitus) can be prevented. The appropriate approach of diet, daily regimen, exercise, and medication can be well managed by Ayurveda CONCLUSION Diabetes Mellitus can be conservatively managed by modification in a person's diet, exercise routine, medications, and way of life. Many herbal remedies and herbal medications have been shown to be effective in treating diabetes in recent Ayurvedic study. which, while being somewhat secure for long-term use, are only helpful in mild to moderate diabetics and lose their effectiveness with continued usage. Ayurvedic treatment concepts can assist the patient in having better blood sugar control and a higher quality of life. Modern therapy has numerous limitations. In addition, lifestyle changes such as adopting healthy eating practises, yoga, and exercise play a crucial role in the management of diabetes mellitus. Acknowledgment - Nil Conflicts Of Interest- Nil Source of finance & support – Nil ORCID Vanita Nagar , https://orcid.org/ 0009-0008-4194-4610 REFERENCES 1 International Diabetes Federation. IDF Diabetes Atlas, 10 th ed.; International Diabetes Federation: Brussels, Belgium, 2021 2 Maitra A, Abbas AK. Endocrine system. In: Kumar V, Fausto N, Abbas AK (eds). Robbins and Cotran Pathologic basis of disease (7 th ed) 2005. Philadelphia, Saunders; 1156-1226. [ Google Scholar ] 3 Chen L, Magliano DJ, Zimmet PZ. The worldwide epidemiology of type 2 diabetes mellitus: present and future perspectives. Nature reviews endocrinology. Available at: www.nature.com/uidfinder (Accessed 22 nd December 2011) [ PubMed 4 Genetic basis of type 1 and type 2 diabetes, obesity, and their complications. Advances and emerging opportunities in diabetes research: a Strategic Planning report of the DMICC. www 2.niddk.nih.gov/NR (Accessed 22 nd December 2011) 5 Acharya YT, Agnivesha; CharakaSamhita; redacted by Charaka and Dridabala with Ayurveda Dipika Commentary by Chakrapani Dutta;; 4 th Edition,; Nidhanasthana, chapter 4 published by Chaukhambha Surabharathi Prakashana Varanasi: 2001.pp.213 6 Acharya YT, Agnivesha; Charaka Samhita; redacted by Charaka and Dridabala with Ayurveda Dipika Commentary by Chakrapani Dutta; 4 th Edition,; nidhana sthana, chapter 4,verse 44 published by ChaukhambhaSurabharathiPrakashana Varanasi: 2001.pp.215 7 Boon NA, Colledge NR, Walker BR (2018) Davidson’s principles & practice of Medicine, Edition 20, Elsevier publication, Chapter 21 Diabetes mellitus, pp: 818 8 Acharya YT, Agnivesha; Charaka Samhita; redacted by Charaka and Dridabala with Ayurveda Dipika Commentary by Chakrapani Dutta; 4 th Edition,; nidhana sthana, chapter 4,verse 44 published by ChaukhambhaSurabharathiPrakashana Varanasi: 2001.pp.214 9 Lakhtakia R. The history of diabetes mellitus. Sultan Qaboos Univ Med J. 2013 Aug;13(3):368-70. doi: 10.12816/0003257. Epub 2013 Jun 25. PMID: 23984020; PMCID: PMC 3749019. 10 Singhal G.D. Madhava Nidana Madhavkara; Vol.- 2; (English translation); Chaukhamba Sanskrit pratisthan, Delhi; 2009.pp.565 11 Naresh K, Clinical Evaluation of Madhumehari Vati in the management of Madhumeha W.S.R. to Diabetes Mellitus-Type 2 2014, pp 36. 12 Sharma PV Charaka-Samhita Agnivesha; English translation; Vol. 1);Chaukhambha Orientalia Varanasi; Ninth edition 2005; pp.269

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Vanita et.al, “ Madhumeh w.s.r. to Type 2 Diabetes Mellitus-A Review . ” : 2023; 6 (5):122-127 126 13 Shastri A.D. Prameha chikitsa adhyaye, Ayurveda tatva sandeepika hindi vyakhya Chikitsa sthana 11:13, Chaukhamba Sanskrit Sansthan, 2010;pp. 3. 14 Tripathi B, Ashtanga Hridayam, Vagbhata with Sarvangsundara and Ayurvedarasayan commentary, chap. Ni.10:1 Chowkham-ba krishnadas Academy, Varanasi, 2006.pp. 502 15 API Text book of medicine Munjal YP et.al. (Vol.1) published by the association of physician of India 9 th edition 2012; pp. 321 16 Sharma P.V Charaka samhita (English Translation) Vol. 1; Chaukhamba Orientalia Varanasi; pp. 275. 17 India: Diabetes Capital of the world, Medirose, Monthly update of Clinical science,Vol.1 st Issue 1, June 2009 18 https://niimh.nic.in/ebooks/esushruta/?mod=read 19 Dennis l.Harrison’s principles of internal medicine , mc graw hill education , 19 th edition, part 16, chapter 419, pp. 2422-2423 20 Kumar R, Nandhini LP, Kamalanathan S, Sahoo J, Vivekanadan M. Evidence for current diagnostic criteria of diabetes mellitus. World J Diabetes. 2016 Sep 15;7(17):396-405. doi: 10.4239/wjd.v 7.i 17.396. PMID: 27660696; PMCID: PMC 502700 21 Murthy K.R. Bhavprakash of Bhavmishra, ,(vol.2) Krishnadas Academy, Varanasi, First edition 2000, pp. 491. 22 Sharma AK, Kayachikitsa, (vol.2), Chaukhambha Orientalia, Varanasi, Reprint edition 2009.pp.903. 23 Murthy K.R. Bhavprakash of Bhavmishra, ,(vol.2) Krishnadas Academy, Varanasi, First edition 2000.pp. 489. 24 Suresh B, The Principles and practice of Kayachikitsa; ; vol-3; Chaukhamba Orientalia, Varanasi ;Edition: 2009.pp.109. How to cite this article: Nagar V, Sahu A.K, Upadhyay A, Patidar D “ Madhumeh W.S.R. To Type 2 Diabetes Mellitus-A Review” IRJAY. [online] 2023;6(5); 122-127. Available from: https://irjay.com . DOI linkhttps://doi.org/ 10.47223/IRJAY.2023.6519

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Vanita et.al, “ Madhumeh w.s.r. to Type 2 Diabetes Mellitus-A Review . ” : 2023; 6 (5):122-127 127 Table 1 Shows Classification S. No. Classification Types 1 Etiological 13 a) Sahaja or Kulaja (Hereditary) b) Apathyanimittaja (Acquired) 2 Clinicopathological 14 a) Kaphaj - 10 types b) Pittaj - 6 subtypes c) Vataj - 4 subtypes 3 Constitutional a) Sthula or Balvana (Obese Type 2 DM) b) Krisha or Daurbalya (Asthenic Type 1 DM) 4 . Prognostic a) Sadhya (Curable) b) Yaapya (Pallable) c) Aasadhya (Incurable) Table no 2. Complications of diabetes mellitus 19 Microvascular Macrovascular Other 1 Retinopathy (Proliferative /Non- Proliferative) 2 Macular Oedema 3 Neuropathy (Sensory and Motor) 4 Nephropathy 1 Coronary Heart Disease 2 Peripheral Artery Disease 3 Cerebrovascular Disease 1 Gastro-Intestinal (Gastroparesis, Diarrhoea) 2 Genito-Urinary (Uropathy/Sexual Dysfunction) 3 Cataracts 4 Glaucoma 5 Dermatologic Related 6 Periodontal Disease 7 Hearing Loss

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