The Sanskrit term meha means to micturate. The verbal noun mehanam signifies urination as well as an act of passing any morbid urethral secretion. Hence the disease in which excessive sweet urination takes place is called Madhumeha.
In Madukosh the Nirukti of prameha is like that,
The state in which quantity, as well as the frequency of micturition, has increased is known as Prameha.
In Ayurvedic texts, the given characteristic features of Madhumeha show marked similarity with the syndrome of Type 2 diabetes. It is Tridoshaj in origin with the predominance of Kapha. According to Charaka major causative factors of Madhumeha are Madhura, Amla, and Lavana Rasa dominant diet mentioned as ‘ Gramya Udaka Anupa Rasa Payansi Dadhini, and lifestyles such as ‘Aasya Sukham Swana Sukham ‘ are similar to the causes quoted as, overeating, eating rich substances, dairy products, practicing sedentary lifestyle, overweight in modern medicine.
AcharyaSushruta has mentioned the Sahaj and ApathyaNimittaja varieties of Madumeha.
In Modern, Type 2 diabetes is a multifaceted disease, that is manifested by hyperglycemia that results from several dysregulated biological mechanisms. The excessive heavy diet, excessive use of sugar and jaggery and their products, and Lack of physical exercise are considered to be predisposing factors to the disease.
Diet and Dietary habits/Dadhi
Insulin insufficiency or resistance/Inheritance/IkshuVikar
Antibiotics and other medicines like statins/Advanced Glycation End-products/Asyasukham/Anuparasapayamsi
Acharya Sushruta explained typical symptomatology to evaluate prediabetes status. They are
GamanathSthanam(tends to stay while walking)
SthanathAasanam (tends to sit while walking)
AsanathSayanam(tends to lie down while sitting) and
SayanathSwapnam (tends to sleep while lying down)
Classicalsymptoms of diabetes mellitus are
3 “polys”-Polyuria, Polydipsia, Polyphagia
-Unexplained weight loss
The complications resulting from the disease are a significant cause of morbidity and mortality and are associated with the damage or failure of various organs such as the eyes, kidneys, and nerves. Individuals with type 2 diabetes are also at a significantly higher risk for coronary heart disease, peripheral vascular disease, and stroke, and they have a greater likelihood of having hypertension, dyslipidemia, and obesity.
1) Daily exercise at least 30 min a day.
2) Take a healthy control sugar diet
3) Oral medications
4) In severe cases – Insulin medications
In the Ayurvedic way, certain home remedies by consumption of
Prameha word consists of two words i.e., Pra (Upsarga-Prefix) and Meha. Meha is derived from the root ‘Mih Sechane’ meaning to perfuse (watering), Excessive quantity and frequency are indicated by the prefix (pra).
Acharya Vagbhatta described Prameha as frequent and copious urine with turbidity; i.e., Prabhut Avil Mutrata while Madhumeha is a clinical entity in which a patient passes a large quantity of urine similar to Madhu having kashaya & Madhura taste, Ruksha texture & Honey like color and thus body attains sweetness. (A.H.Ni.10/18, Cha. Ni.4/44)
Synonyms- Ojomeha, Kshaudrameha, Paushpameha.
Classification of Parmeha
Based on Dosha
Yapya (Continues on treatment)
Usually not much obese
Classification Of Madhumeha:
The clinicopathological status of the disease has an invariable relation with the physical constitution of the body in Madhumeha. [Cha.Chi.6/15] [Su.Chi.11/3]
Sthula or Krisha
Sahaja [Hereditary] or Apathyanimittaja [Acquired] [Su.Chi.11/3]
Sahaja: Due to Beejadosha i.e., genetic origin. [Su.Chi.11/3]
Apathyanimittaja: Occurs due to Ahitahara/ Dietary factor.
(B)According to etiological factors:
Santarpanjanya & Apatarpanjanya:
Santarpanjanya Madumeha is directly due to the intake of a nutritious diet, which are having kaphavardhaka properties. The excess intake of such substances will primarily lead to the vitiation of Kapha, pitta, Meda & Mansa, which in turn causes Madhumeha by doing Avarana of Vata. [Cha. Su.17/78-81] If the substances which deplete the dhatu & aggravate Vata are consumed then it leads to Apatarpanjanya Prameha. They act through the vitiation of Vata which in turn leads to the manifestation of madhumeha.
Abnormality in Stri & Pumbeeja (Ovum & Sperm) which is said to be Matrupitru Beejadoshakrita will cause Sahaja Prameha. Or in other words, it is being received from hereditary trends. Charaka stated that indulgence of Madhura rasa by parents is the chief cause of changes & damages in the sperm & ovum. Excessive intake of Madhura Rasa during pregnancy is depicted as a major cause.
Etiological Factors of General Prameha [Cha.Chi.6/4]
Excessive indulgence in Dadhini i.e., Various preparation of curd.
Gramya, Audaka, Anupa Mamsa i.e. Meat of domestic, aquatic, and wetland animals.
Payamsi i.e., excessive use of milk & its preparation
Navannapanam i.e., new grains & drinks
Guda vaikrutam i.e., various preparation of sugar & jaggery.
the substances which increase meda,mutra & Kapha may cause prameha.
Snigdha (unctuous), Medya (fatty) & Drava (liquid) types of food also
Kaphaja Prameha [Cha.Ni.4/5]:
Pittaja Prameha Nidana [Cha.Ni.4/24]
Vataja Prameha Nidana [Cha.Ni.4/36]
Frequent & Excessive intake of fresh corn like Hayanak, Yavaka, Chinaka, Uddalaka, Naishdha, Itkata,
Intake of Ushna, Amla Lavana, Kshara & Katura Dravyas.
Excessive intake of Dravyas having predominantly kashaya, katu,tikta rasa, Ruksha, Laghu & Sheeta very
Intake of pulses like fresh harenu & Masha with ghee
Intake of food before the digestion of the previous meal
Excessive indulgence in sex & physical exercise.
Intake of the meat of domestic, marshy & aquatic animals.
Exposure to excessively hot sun, the heat of the fire, physical exertion & anger
Excessive administration of emesis, purgations, asthapana & shirovirechana.
Intake of vegetables, tila, palala, pishtanna, payasa (a type of milk preparation), krishara, Vilepi & preparations of sugarcane.
Intake of mutually contradictory food articles.
Resorting to suppression of the manifested urges, fasting, assault, exposure to sun, anxiety, grief, Excessive bloodletting, Keeping awake at night & irregular posture of the body.
Intake of milk, fresh wine, immature curd & curd which are mostly liquid, Sheeta & immature.
Avoidance of unction & physical exercise
Indulgence in sleep, bed rest & sedentary habits
Restoring to even such regimens which produce more Kapha, fat & urine.
Specific Symptomatology of Madhumeha:
Madhumehi passes urine having Kashaya & Madhura taste, Pandu varna & Ruksha quality. According to Sushruta, the urine of Madhumehi resembles that of honey.
The special manifestation related to the behavioral pattern is depicted by Sushruta, Madhumehi prefers standing to walking, sitting then standing, lying down to sitting, & sleeping then lying down.
Prabhuta Mutrata (excess urine Quantity)
Avila Mutrata (Turbid urine):
Pichhila Mutrata (viscus in Consistency):
Akasmata Mutra Nirgama: The child excretes urine suddenly without any intention.
Makshika Akranta Mutra: Flies get attracted to urine.
Shveta & Ghana mutrata: Child passes urine having Shweta color & turbidity.
Prameha is a group of diseases that are established in the body due to Santarpana. Charka in Nidanasthana mentioned the disease in detail.
The Nidana, Dosha (Vatadi tridosha), and Dushya (Rasadi dushyas) are responsible for the occurrence and non-occurrence of disease. If these three factors are having less strength and are connected then the establishing disease will not have all the signs and symptoms. If they are complete & with full strength, and their connection is strong then the disease produced will be having all the signs and symptoms. Some important points in this concept are, that Natural Kapha is not having the quality of ‘Bahudravatva’. In the normal state, it is in bounded form. Here in Prameha samprapti, it loses its bounded form due to some specified causes and changes to the bahudravatva (liquid) form. Dravata(Liquid nature) is high in the acharya’s concept and it is stressed by the term ‘Bahu’. The dushyas included are, meda, mamsa, Sharir kleda, Shukra, Shonita, Vasa, Majja, Lasika, Rasa, and Oja. The special characteristic feature of the Dushyas is in the Bahuabadhha form.
Pathogenesis of Madhumeha:
When Sadhya Roga changes into Krichrasadhya or Asadhya it can be called as Vidhi Samprapti. It commonly occurs in untreated conditions. As far as Madhumeha is concerned, we can partly include it in Vidhi Samprapti. Acharya Sushruta explains as if all the Prameha are not treated first, they will gradually pass to the stage of Madhumeha.
Acharya Charaka has described Madhumeha vividly. Vagbhattacharya divides Madhumeha into two types, according to Samprapti. The Madhumeha is included in the Vataja type. If Vataprakopa occurs due to Sarvadhatukshya, it is called Dhatukshayajanya Madhumeha. And if Vataprakopa manifests as a result of Vatavarana, it is called Avaranjanya Madhumeha. Acharya Sushruta explains as if all the Pramehas are not treated initially, they will gradually pass the stage of Madhumeha.
Chikitsa-sutra (principles of treatments) and Chikitsa (Management Proper) are the two divisions of this major part. Both these are described very well in the classics. But the concepts & methods are different in different conditions, considering the Vyadhi Swabhava & Atura. The Samprapti should be considered deeply before stepping to manage.
Charaka Acharya considers two types of patients, one with stout body structure & strength and the other without strength & krisha.
Sushruta acharya also says that Sahaja Meha Rogi will be krisha & apathyanimittaja rogi will be sthula.
In the context of medoroga, the managements described are parallel to that of meha since the dosha & dushyas are the same to a major extent. After considering all the factors the two types of management emphasized are:
(1) Samshodhana Chikitsa [Elimination Therapy]
(2) Samshaman Chikitsa [Normalizing Therapy]
Like every disease, those factors which are responsible for the production of the diseases are eliminated and if further, causative factors are prevented Meha can also be treated. Madhumeha can be treated in this way although it is described as incurable. In Pratyakhyeya vyadhis, symptomatic relief can be given by proper management.
For Bastichikitsa- Surasadi gana kwatha.
Charaka- combinations of 10 drugs
Sushruta-Samshodhana with swarasa of Amalaki and Haridra powder with Madhu.
Vagbhatta- Three yogas
Lodhrad i- Lodhra, Abhaya, Musta, Katphala
Pathadi – Patha, Vidanga ,Arjuna,Dhanyaka
Gayatrayadi – Khadirsara, Darvi, Vidanga, Vacha
Importance of Apatarpana:
Different types of vyayama, kshut, udvartana, Dhara & snana with churns made of Chandana, Aguru, Ela, etc. are advised to use in kaphaja meha to reduce the increasing attitude of kleda, meda, and Kapha. [Cha. Chi. 6/50]
Asthapan Basti with Nyagrodhadi Gana kwatha
(ii) Samshaman Chikitsa:
Acharya Charaka -Combinations of 10 drugs
Sushrutacharya -6 specific kwatha yogas for the specific type of Pittaja prameha. [Su.Chi.11/9]
Acharya Vagbhatta -The three kwatha yogas
(i) Ushiradi: Ushira, Lodhra, Arjuna, Chandana.
(ii) Patoladi: Patola, Nimba, Amalaki, Amrita
(iii) Lodhradi: Lodhra, Ambu, Kaleyaka, Dhataki
Although Vatika mehas are incurable still Acharya Charaka explains induces certain treatments in kaphapittanubandhi Vatika Meha.
Acharya Sushruta has described that all types of Prameha if not treated properly in time, get converted into Madhumeha.
So, the treatment described for Vatika meha can be considered as the treatment of Madhumeha.
(i) Samshodhan Chikitsa:
Considering Sthula & krisha pramehi, Samshodhan Chikitsa should be administered only to the sthula & Balvan Pramehi. Sarshapa, Nimba, Danti, Bibhitak & Karanja Siddha Taila or Trikantakadya Sneha (Ghrita or Taila according to dosha predominance should be used for Abhyantara Snehana. Here while explaining the Samshodhan, Charaka describes using the Malashodhan yogas from Kalpasthana
Both Pitta & Kapha are eliminated through shodhana. Either it may be Vamana or virechana, because of; Pittantam Vamanam, Kaphantam Virechanam. In Virechana pitta is eliminated first, then Samyak Lakshana of virechana is kaphadarshan, so both pitta & Kapha doshas which are vitiated are eliminated. Then the described
Anuvasana & Asthapana Basti chikitsas are able enough to control the provocation of Vata. Like this, all the doshas are normalized to keep the dosha samyata.
Anuvasana with medicated oils & ghritas is prescribed in Madhumeha. After proper Shodhan Chikitsa, Charakacharya details to give santarpan chikitsa to the patients, to prevent the complications like Gulma, Bastishula, etc.
Samshaman Chikitsa includes mainly deepana (appetizers), Pachana, (enhancing digestion), Kshut (Hunger maintenance), Trit (Maintenance of thirst), Vyayama (Exercise), Atapa (Having exposure to sunlight) & Maruta (Exposing oneself to wind). According to the conditions of vitiated doshas & dushyas, the vaidya has to suggest proper Shaman Chikitsa to the patient.
Acharyas introduce different tarpana upakramas in Vatika mehas. It is due to the less strength of the patient. Acharya Charaka & Vagbhatta says that the kashaya yogas should be enriched with Sneha and given to Vatika Mehas.
Typical Madhumeha Chikitsa:
Acharya Sushruta explains that Shilajit should be taken after triturating with Salsaradi Gana kwatha. After its digestion patient should take Jangalamamsarasayukta Anna. He prescribes taking 1 Tula of shilajit.