“A STUDY OF SAMANYA VISHESHA SIDDHANTA W. S. R. TO

“A STUDY OF SAMANYA VISHESHA SIDDHANTA

W. S. R. TO VISHESHA SIDDHANTA IN DIETARY &

THERAPEUTIC MANAGEMENT OF MADHUMEHA”

BY

Dr. SUMANGALA H.M.

Dissertation Submitted to the Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore.

In the partial fulfillment of the requirements for the degree of

DOCTOR OF MEDICINE (AYURVEDA)

[AYURVEDA VACHASPATI]

IN

AYURVEDA SIDDHANTA

Under the guidance of

DR. REVAPPA VEERAPPA YEDAVANNAVAR. M.D. (AYU)

Asst. Professor, Dept. P.G. Studies in Siddhanta

DR. B.N.M.E.T’S

SHRI MALLIKARJUNA SWAMIJI

POST GRADUATE AND RESEARCH CENTRE, BIJAPUR – 586 101

NOVEMBER - 2010

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE.

DECLARATION BY THE CANDIDATE

I, hereby declare that this dissertation thesis entitled “A

STUDY OF SAMANYA VISHESHA SIDDHANTA W.S.R TO VISHESHA

SIDDHANTA IN DIETARY & THERAPEUTIC MANAGEMENT OF

MADHUMEHA” is a bonafide and genuine research work

carried out by me under the guidance of DR. REVAPPA

VEERAPPA YEDAVANNAVAR. M.D.(Ayu) Asst. Prof., Dept. of Siddhanta, Dr.

B.N.M.E.T’S Shri Mallikarjuna Swamiji Post Graduate and Research

Centre, Bijapur.

Date:

Place : Bijapur Dr. SUMANGALA H.M. .

Dr. B. N. M. E. T’s

SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH CENTRE, BIJAPUR

Department of Post-Graduate Studies in Moulika Siddhanta

CERTIFICATE BY THE_GUIDE

This is to certify that the dissertation entitled “A STUDY

OF SAMANYA VISHESHA SIDDHANTA W.S.R TO VISHESHA SIDDHANTA IN

DIETARY & THERAPEUTIC MANAGEMENT OF MADHUMEHA” is a

bonafide research work carried out by Dr. SUMANGALA H.M. in the

partial fulfillment of the requirement for the degree of M.D.

(Ayurveda).

Date: Signature Place: Bijapur DR. REVAPPA VEERAPPA YEDAVANNAVAR. M.D (AYU)

Asst. Prof., Dept. of Siddhanta DR. B.N.M.E.T’S Shri Mallikarjuna Swamiji Post Graduate and Research Centre, Bijapur.

Dr. B. N. M. E. T’s SHRI MALLIKARJUNA SWAMIJI

POST GRADUATE AND RESEARCH CENTRE, BIJAPUR

Department of Post-Graduate Studies in Moulika

Siddhanta

ENDORSEMENT BY THE H.O.D. / PRINCIPAL / HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled “A STUDY

OF SAMANYA VISHESHA SIDDHANTA W.S.R TO VISHESHA SIDDHANTA IN

DIETARY & THERAPEUTIC MANAGEMENT OF MADHUMEHA” is a

bonafide research work done by Dr. SUMANGALA.H.M. under the

guidance of DR. REVAPPA VEERAPPA YEDAVANNAVAR. M.D (AYU),

Asst.Prof. Dept. of Siddhanta,, DR. B.N.M.E.T’S, Shri.

Mallikarjuna Swamiji Post Graduate and Research Centre, Bijapur.

Seal and Signature of H.O.D Seal and Signature of Principal Dr. J. C. HUDDAR M.D (Ayu) Dr. R. N. GENNUR. M.D (AYU) Date: Date: Place: Bijapur Place: Bijapur

COPYRIGHT

DECLARATION BY THE CANDIDATE

I, here by declare that the Rajiv Gandhi University of Health Sciences,

Karnataka shall have the rights to preserve, use and disseminate this

dissertation thesis in print or electronic format for academic/research purpose.

Date:

Place: Bijapur Dr. SUMANGALA.H.M.

© Rajiv Gandhi University of Health Sciences, Karnataka.

ACKNOWLEDGEMENT

At the very outset, I humbly seek this opportunity to bow down my head to the

holy feet of Lord Dhanvantari for showering sovereign graces upon me and enabling me

to complete my project work without any impediment.

It is an inexplicable pleasure, sincere and respectful regards to Dr. K.B. Nagur

(Babu), Hon’ble Chairman of Dr. Basavaraj Nagur Memorial Educational Trust

Bijapur.

I am thankful Dr. R. N. GENNUR MD (Ayu) Principal, for his momentary

support during my dissertation work.

I owe a debit of gratitude to my guide Dr. R.V.YEDAVANNAVAR MD (Ayu)

for his noble guidance, inspiration and construct to criticism during dissertation work.

My sincere thanks to Dr.J.C.HUDDAR MD (Ayu). HOD of Siddantha

department, for best cooperation, valuable suggestions, guidance, and motivational

inspiration, throughout the work.

I acknowledge with sincere thanks to, Dr.J.C.Huddar, Dr. Tamagond B. S, Dr.

G. B. Bagali, and Dr. R.V.Yedavannavar. for their kind cooperation.

I am thankful to my beloved husband Dr. VEDAMURTHY K. HIREMATH

MD (Ayu) and my dear daughter SUVEDA V.H.

My strength are my parents, Smt. H.M.Vishalakshi and Shri

H.M.Shanthamurthy, in whom I experience the blessings of god and it is because of

their pain taking efforts I have reached upto this position of life.

I am thankful to Shri. A. I. Tapashetti (M.Sc. Stat.) for his guidance and

suggestions for the statistical analysis.

I remain ever thankful to library which is the treasure houses of knowledge.

I express my immense thanks to Colleagues of My Department Dr. Haroon

Irshad, Dr. S.G.Ukamanal and Dr. S.S.Kulgeri.

I am thankful to my friends Dr. Shreedevi, Dr. Poornima, Dr. Haroon

I also express my gratitude to my bachamates, Dr. Prabhu, Dr. Bharthesh,

Dr. Bharath, Dr. Sunil P.V, Dr. Firoz for their needful help.

I thank Shri. Dolli for official work and other official staff of Dr. BNME

Ayurvedic Medical College Bijapur.

Certain names that have not been mentioned unintentionally who helped directly

or indirectly in this work, thanks to all of them.

Date :

Place : Bijapur. Dr. Sumangala.H.M.

Abstract

“A STUDY OF SAMANYA VISHESHA SIDDHANTA W S R TO VISHESHA SIDDHANTA IN DIETARY & THERAPEUTIC MANAGEMENT OF

i

ABSTRACT Background and Objectives:

Samanya vishesha plays amajor role in maintaing Dhatu samyata.hence Acharya

Charaka has given prime importance among the shat karanas as the main aim of

Ayurveda is maintaing Dhatusamyata.Madhumeha is a disease in which there will be

vruddhi of kaphavata dosha and vruddhi of medho dhatu which causes excessive

urination etc, symptoms and that can be managed by applying the Vishesha siddhanta

in the form of Diet and therapy. Arogyavardhini vati has got pramehagna,medogna

properties which helps in controlling madhumeha along with proper diet.

Methodology:

For the present study,30 patients filling the inclusion criteria of Madhumeha were

randomly selected from OPD and camp conducted by Dr. B.N.M.E.T’s Shri

Mallikarjuna Swamiji Post Graduate and Research Centre, Bijapur. They were

allocated to single group and were prescribed Arogyavardhini vati 2 tab twice daily

with ushnodaka with proper diet. Clinical signs and symptoms were given suitable

scores according to its severity and assessed based on pre and post data gathered

through pre-designed research proforma. The results having ‘p’ value less than <0.05

was considered to be statistically significant in this study.

Observation: all the patients were observed for general data and severity of the

symptoms.

MADHUMEHA”

Abstract


ii

Results:

Overall effect of Vishesha siddhanta in Madhumeha after 45 days of treatment was –

Moderate improvement was found in 14 patients (46.66%).

Marked improvement was found in 2 patients (6.66%).

Mild improvement was found in 11 patients (36.66%).

Unchanged was found in 3 patients (10%).

None of the patients was fond cured.

Discussion: Based on the important concepts, methods adopted for specific

observations and results, discussion was done.

Conclusion: By applying Vishesha Siddhanta, one can manage the disease

Madhumeha with proper diet and therapy.

Key Words:

Samanya

Vishesha

Madhumeha

Therapy

Diet

MADHUMEHA”

ABBREVIATION

• A.H. ASTANGA HRIDAYA • A.S. ASTANGA SANGRAHA • A.T. AFTER TRATMENT • B.P. BHAVAPRAKASH NIGHANTU • B.R. BHAISAJYARATNAVALI • B.T. BEFORE TREATMENT • CH CHARAKA • CHK CHAKRADATTA • CS CHARAKA SAMHITA • DH DRAVYA GUNA HASTAMALAKA • DN DHANVANTARI NIGHANTU • DS DRAVYAGUNA SANGRAHA • GN GADANIGRAHA • HS HIGHLY SIGNIFICANT • Hs HARITA SAMHITA • KS KASHYAPA SAMHITA • MN MADHAVA NIDANA • NA NIGHANTU ADARSHA • NS NON SIGNIFICANT • PN PRIYA NIGHANTU • PTFU POST TREATMENT FOLLOW UP • RRS RASARATNASAMUCCHAYA • S SIGNIFICANT • S.S. SUSHRUTA SAMHITA • SHS SHARANGDHARA SAMHITA • SN SIDDHANTA NIDANA • VAG VAGBHATA • VAI. DAR. VAISHESHIKA DARSHAN • YR YOGARATNAKARA

I N D E X

Sl. No Contents Page No. 1 Introduction 1-2

2 Objectives 3

3 Review of Literature 4-76

1. Samanya And Vishesha Siddhant

2. Madhumeha

4 Materials And Methods 77-83

5 Observations and Results 84-106

6 Discussion 107-121

7 Conclusion 122

8 Recommendation 123

9 Summary 124-126

10 Classical References 127-129

10 Bibliography 130-133

11 Annexure

A) Research Case Pro-forma

LIST OF TABLES

Sl. No LIST OF TABLES Page No.

1 Nidana and Guna Karma. 37

2 Poorvarupa According to Different Acharyas. 39

3 Pathya Ahara According to Different Acharyas. 56

4 Prameha Pidaka Mentioned In Brahatrayee. 57

5 Upadrva of Vataja Prameha. 58

6 Sign and Symptoms 65

7 Different Explanation of Madhumeha 67

8 Distribution of Patients According to Age. 84

9 Distribution of Patients According to Sex. 85

10 Distribution of Patients According to Religion. 86

11 Distribution of Patients Accordion to Occupation. 87

12 Distribution of Patients According to Socio-Economic

Condition. 88

13 Distribution of Patients According to Marital Status. 89

14 Distribution of Patients According to Ahara. 90

15 Distribution of Patients According to Agni. 91

16 Distribution of Patients According to Kostha. 92

17 Distribution of Patients According to Prakruti. 93

18 Distribution of Patients According to Bala. 94

19 Distribution of Patients According to Vysana. 95

20 Distribution of Patients According to Satva. 96

21 Different Degree of Assessment Criteria Before Treatment. 97

22 Different Degree of Assessment Criteria After Treatment. 98

23 Different Degree of Assessment Criteria After Follow Up. 99

24 Results After Treatment. 100

25 Results After Follow Up. 101

26 Statistical Analysis. 105

27 Final Results of Improvement in the Patients of

Madhumeha. 106

LIST OF GRAPHS

Sl. No LIST OF GRAPHS Page No.

1 Distribution of Patients According to Age. 84

2 Distribution of Patients According to Sex. 85

3 Distribution of Patients According to Religion. 86

4 Distribution of Patients Accordion to Occupation. 87

5 Distribution of Patients According to Socio-Economic Condition. 88

6 Distribution of Patients According to Marital Status. 89

7 Distribution of Patients According to Ahara. 90

8 Distribution of Patients According to Agni. 91

9 Distribution of Patients According to Kostha. 92

10 Distribution of Patients According to Prakruti. 93

11 Distribution of Patients According to Bala. 94

12 Distribution of Patients According to Vysana. 95

13 Distribution of Patients According to Satva. 96

14 Different Degree of Assessment Criteria Before Treatment. 97

15 Different Degree of Assessment Criteria After Treatment.

Different Degree of Assessment Criteria After Follow Up.

98

16 99

17 Comparison of Response of Individual Symptom at the End of

Treatment and Post Treatment Follow Up. 102

18 Final Results of Improvement In The Patients of Madhumeha. 106

Introduction

INTRODUCTION A healthy mind in a healthy body is the principle aim guiding all the prevailing

systems of medicine. To achieve longevity of life, several scholars have toiled for years.

The all time great, 'Science of Life' Ayurveda has also the same implicability.

Principles of Ayurveda have significant value even in the life of modern man. The reason

behind this is, life is the underlying theme over which the whole science of Ayurveda is

interwoven. Hence one cannot deny the implicability of these principles.

Acarya Caraka has introduced the concept of Sat Karana in the first chapter of

Sutrasthana. These Sat Karanas are described as Sat Padarthas by Maharsi Canada in

Vaisesika Darsana. But in Caraka Samhita the placement of these Sat Karanas by Acarya

Caraka is significant and it shows his vision as a physician rather than a philosopher. It

shows that Acarya Caraka aims at nothing but to provide relief to the persons suffering

from ailments. These Sata Karanas are meant to be utilized by physicians for the purpose

of Cikitsa i.e. to attain Dhatusamyata.

One can categorize all events occurring in the vast expanse of Universe into two

catagories one of Adana and other of Visarga. No one can remain isolated with respect to

the effect of the cosmos. The Adana reflects as Apacaya where as Visarga reflects as

Upacaya. In these conditions body tries to maintain the harmony, but when this harmony

disturbs due to increase or decrease in the body components i.e. Dhatus of the body, a

condition arises i.e. Dhatuvaisamya. This Dhatuvaisamya is of two types i.e. Vruddhi and

Ksaya, this Vruddhi type of Dhatuvaisamya can be redivided in three types i.e. Mild,

Moderate and Severe and according to these three types, a physician has to use three types

of Vishesha i.e. Karma, Guna and Dravya Vishesha respectively.

Let us consider a case of Madhumeha where Medodhatu is in a state of Vikrta

Vruddhi. It is one of the Santarpanottha Vikaras where a physician needs to apply the

“A STUDY OF SAMANYA VISHESHA SIDDHANTA W S R TO VISHESHA 1 SIDDHANTA IN DIETARY & THERAPEUTIC MANAGEMENT OF MADHUMEHA”

Introduction

principle of Vishesha, which can restore the unhealthy increase of components to the

previous undiseased form.

Faulty dietary habits and decreased awareness regarding exercise is the main cause

of the disease. Most of the people from the community are suffering from this disease as

well as with its complications. Previously it was said that Madhumeha is a disease of

affluent society but nowadays equations have changed and Madhumeha can be seen in

lower as well as middle class.

Since Samhitakala Madhumeha is well known asadhya Vyadhi. It can be better

managed by applying the concept of Vishesha, as described in the classics in terms of

Dravya, Guna and Karma Vishesha Siddhanta. Hence the study has been under taken to

see the effect of vishesha siddhanta in the management of Madhumeha.

“A STUDY OF SAMANYA VISHESHA SIDDHANTA W S R TO VISHESHA 2 SIDDHANTA IN DIETARY & THERAPEUTIC MANAGEMENT OF MADHUMEHA”

Objectives

OBJECTIVES

To study the Samanya Vishesha Siddhanta.

To assess the Vishesha Siddhanta with Diet and Therapy.

To apply Vishesha Siddhanta in Madhumeha.

“A STUDY OF SAMANYA VISHESHA SIDDHANTA W S R TO VISHESHA SIDDHANTA IN DIETARY & THERAPEUTIC MANAGEMENT OF MADHUMEHA”

3

Review of Literature


4

SIDDHANTHA1:

Siddhanta is the conclusion, which is established by scientists after testing

in several ways and on proving with reasoning.

It is of four types:

Sarvatantra siddhantha

Prathitantra siddhantha

Adhikarna siddhantha

Abhyupagama siddhantha

Sarvatantra siddhantha is that which is famous siddhantha in all the science

such as it accepts universally as there is a cause, there is a disease and there is a

treatment for the disease.

Prathitantra siddhantha is that which is not universal in nature and is held

by only one of the science, such as there are eight rasas in some shatras and in

other there six rasas,Some accepts five sense organs while the other texts accepts

six sense organs including mana etc.

Adhikarana siddhantha is that when there is discussion about the particular

vishayas, proving the others subject which is related to that particular subject such

as an ideal person will not be having any desires of loukika as he will be mukta

from all the desires and such person attains the muksha.

Abhyupagama siddhantha is that which is held up by physician temporarily

and hypothetically during the debate though the idea is unproved untested,

uninstructed and irrational such as will speak proposing that dravya is

predominant or guna is predominant or veerya is predominant etc. this is the four

fold theory.

MADHUMEHA”



5

Theory of Samanya and Vishesha:

The imbalance of body elements is the causes of disease. The imbalance

causes due to vruddhi or kshaya of dhatu. For bringing the equilibrium state of

these dhatus and doshas it is very essential that enrich the deficient elements and to

lession that the augmented elements of body (and in this method keeping the

balance of doshas, dhatus, and in malas and maintain equilibrium is the object and

science of life). Two, out of six categories (shad padarthas) samanya and vishesha

are considered to be important for this purpose. Generic concomitance (samanya)

is always the cause of the diminution of the elements. The medicine, regimens and

diet etc, are prescribed accordingly to the patient and healthy persons. So, this

theory has got an important role in the field of ayurvedic treatment.

PADARTHA:

The word padartha consist of two words ‘pada’ and ‘artha’. ‘Pada’ denotes

‘word’ and ‘artha’ denotes the substance or character denoted by ‘pada’.

A group of alphabets, which possesses the power to denote any meaning,

without the help of any other word is called pada.

Anything that is expressed by a word or a group is called padartha. Object of

learning is called padartha.

As per this definition anything in the universe can be called as padartha

whether it is a 1. Living or non living one, 2. A microstructure or a macrostructure,

3.A quality or an action. Hence, everything in the universe including the universe

comes under the heading padartha.

MADHUMEHA”



6

Padartha Laxana (characteristic of padartha):

As per the vaisheshika darshan, padartha has three characteristics,

1. Astitwam: it should have the characteristics of existence.

2. Abhideyatwam: it should be knowable.

3. Gneyatwam: it should be knowable.

Among the above three qualities abhidheyatwa i.e namability is the important

characterstic.Anything that exists namable and knowable is a padartha.

Shat Padarthas2:

With its scientific and applied background, the vaisheshika thoughts were

abundantly utilized in ayurveda in formulating its applied concept. Ayurveda is an

applied aspect of darshana and so same modifications are seen in the arrangement

of the counting of the padarthas. The two categories samanya and vishesha are

seen of two, the immense value in the applied aspect of treatment and also for

maintaining health. The object of ayurvada is to maintain dahtu samya that is to

maintain the homeostasis to the level of physiological equilibrium.samanya and

vishesha are the dynamic forces, which keeps the normal condition of the body.

Shat padarthas are accepted by vaisheshika as well as ayurvedic philosophies they

are recognized as same quality or properties to which they belong. The terms

Dharma here has been used for these properties, qualities, on the contrary same

difference are also available between. These padarthas, these peculiarities can be

named vaidharmya or disparallelism.

MADHUMEHA”



7

Padartha Sankhya, as per Different Darshanas:

Padarthas are six in numbers as per ayurveda (charaka)

1. Samanya. 4. Dravya.

2. Vishesha. 5. Karma.

3. Guna. 6. Samavaya.

Padartha According to Vaisheshika Darshana,

1. Dravya. 4. Samanya.

2. Guna. 5. Vishesha.

3. Karma. 6. Samavaya.

According to Nyaya Darshana there are Seven Padarthas as Follows,

1. Dravya 4. Samanya. 7. Abhava.

2. Guna. 5. Vishesha.

3. Karma. 6. Samavaya.

Padarthas are mainly divided into two types

1. Bhava padartha 2. Abhava padarthas.

Bhava padartha Abhava padartha

1. Dravya 1. Pragbhava

2. Guna 2 Pradhvamsabhava.

3. Karma 3.Atyantabhava

4. Samanya 4.Anyonyabhava

5. Vishesha

6. Samavaya.

MADHUMEHA”



8

Concept of samanya and vishesha siddhantha.

Meaning of each and every word is embedded in the word itself, for the

knowledge of evolution of that word one has to go through ‘vyakarna’ one has to

refer various koshas to understand the constitution of that word. Here an attempt is

made to compile the etymological origin of samanya and vishesha from various

kosas.

Samanya is one of the Sat Karanas described by Acarya Caraka in first

chapter of Sutrasthana i.e. Dirghanjivitiyam Adhyayam. Concept of Sat Karana is

introduced by Acarya Caraka. These Sat Karanas are the tools for a physician

whose aim is to set up harmony in the body. These Sat Karanas comprises

Samanya, Vishesha, Dravya, Guna, and Karma & Samavaya.

But these Sat Karanas are described as Sat Padarthas by Vaisheshika

Darshana. The sequence of these Sat Karanas in Vaisheshika Darshana is like that

Dravya, Guna, Karma, Samanya, and Vishesha & Samavaya. But Acarya Caraka

while accepting these Sat Padarthas as Sat Karanas changed the sequence in above

manner. Causativity behind this change is crystal clear & that is Ayurveda is a

practical science & aims at maintenance of health. Due to this reason Samanya &

Vishesha has got first & second place in this sequence. Because for the purpose of

cure & maintenance, a physician has to use different drugs & the selection of the

drugs totally depends on Samanya & Vishesha. As this study pertains to Samanya

& Vishesha only, different definitions of samanya and vishesha by Acarya Caraka

& the commentators are as follows.

MADHUMEHA”



9

SAMANYA3

Samanya: Samasu saadhuhu samaan + tatra sadhuhu samajaha.

Common in all, is samanya (shabdhakalpa)

Derivation: (Vyutpatti)

The samanya is made up of two words samana+ gyan pratyaya= samamya.

• Means connection of different objects by a common property, and it is also

known as common to, whole, entire, general, universal, insignificant, low,

totality, shared by others, joint.

Aneka samandhayo eka vastuhu /

• Similarity of many objects in many ways

• The thing which is very common in many objects is called Samanya.

Defination of Samanya4:

Sarvada sarva bhavanaam samanyam vruddhi karanam. (C.Su. 1/44)

Achary charaka has given quotation about samanya siddhantha. That is

similarity is the cause of the augmentation of all the beings.Samanya is one that

increases or aggravates doshas and dhatus etc.

Samanyam ekatvakaram (C.Su. 1/45)

One, which exists commonly in all the objects and brings them in to one

group with common name.Generic concomitance, brings the sense of ektwa or

oneness in any objects and causes the augmentations.

Tulyartham hi samanyam. (C. Su. 1/45)

Tulyarthata is called as samanya. Means the generic concomitance carries

the sense of similitude. Samanya is that which brings uniformity in many objects

and causes augmentation or (vruddi).

MADHUMEHA”



10

Classification (Bhedas)

According to karikavali the achary have explained two types of samanya,

1. Parasamanya.

2. Apara Samanya.

1. Parasamanya: A one which is very Vyapaka and which is present in many

persons that type of character is called as Parsamanya or it is wide or more

extensive ex.satta.Ex.Dravayatwa, Gunatwa and karmatwa in all these the

padartatva is same because in padartha only the dravya, guna, karma etc characters

are residing.

2. Apara samanya: It is one which is not spread so broadly. It is limited to one or

apara samanya is less extensive found in limited objects or the limited of which is

fixed may termed as Apara samanya for Ex.Akashatwa of dravyas, Ghatatwa is

limited only upto the ghata.The Samanya which is present in between para and

apara is called as parapara samamya.The above said two types of samanya have

been advocated by the commentators of vaisheshika (school of thoughts). Some

other commentator’s cancavas regarding a third types which is in between para and

apara labeling it is parapara samanya or Madhya samanya.

The above explained three definitions of the samanya according to charaka

were considered as three types of samanya by chakrapani i.e, dravya samanya,

guna samanya and karma samanya. So again these three are correlated with

sarvadesha samanya, Madhyama desha samanya and ekadesha samanya

respectively. According to ayurveda there are three categories of samanya.

1. Dravya Samanya

2. Guna Samanya.

MADHUMEHA”



11

3. Karma Samanya

1. Dravya Samanya:

Consuming the similar dravya (matter) causes the augmentation of same

objects or matter. For that Acharya charaka had given the equation about this i.e

Sarvada sarva bhavanaam samanyam vruddhi karanam.

Ex.by Consuming the meat or flesh it causes the augmentation of bodily

flesh. Dravya samanya is found in dravya of the same type of category.

Ex.Rakta (blood) of different human beings is similar, so blood transfusion is

advised to improve the rakta dhatu.

2. Guna samanya:

This samanya brings the uniformity or oneness, ‘Samanyam ekatvakaram’, it

means by consuming the dravya or objects having similar character it cause the

augmentation of same character.,or it exists in guna of same type.It indicates a

qualitative similarity between the two subjects, viz. by consuming milk or butter; it

causes the vruddhi or augementation of the . Because the semon consists of same

character that of the milk and ghee i.e, madhura, sheeta, snigddha. So these dravya

leads the augementation of shukra. In the same way, the dravya having the katu,

tikta, kashaya rasa increases the vata and lavana, amla, katu rasas makes dravya

toincreases pitta.Ex.Gunas of medhas and medhokara dravyas are similar. So,

medhokara dravyas are prescribed to improve intelligence.Since similar qualities

are present in rakta (blood) and loha bhasma, loha bhasma is indicated to increases

the blood count or haemoglobin of an anemic person.

3. Karma samanya: ‘Tulyartham hi samanyam.’ The action, which causes the

augementation or increases of dosha, called as karma samanya. This exists in

MADHUMEHA”



12

dravya with similar action. Ex:-Vayu or vata has the function, motion or moment,

returning and jumping are also movements or actions. Since they are similar,

running and jumping may aggravare vata.This sholka may be demarked by the

knowledge of functional similarity between the two concerned objects, just as the

increase in the gati karma of vayu by excessive running or walking or the increase

of sthiratva of kapha by being motionless. Acharya Bhattara Harichandra had

commented on these types and explained another three types.

1. Atyantya Samanya

2. Madhya Samanya,

3. Ekadeshi Samanya,

1. Atyantya samanya:-

Is a name given to that type of samanya whose characteristic reads as an

Alikeness of two substances in each and every aspect. Just as, the similarity

between the animal meat and the flesh of the human body. They resembles each

other in all aspects, viz ,dravyatha, rasatha, guntaha, veeryatah, and vipak.

Acharaya chakrapani says, ‘it is charters tics may be defined as “Sarvada

sarvabhavanam samanya vriddhi karanam”.

1. Madhaya samanya:-

May be understood as similarity, which is not found in each and every

aspect and both things, compared like the Atyantya samanya. But some of the

qualities may be similar where as, some may be different just as, the resemblance

of dugdha and shukra in rasa, guna,verrya etc.But as far as Dravyata is

concered,they differ from each other. This is the opinion of Acharaya

chakrapani;its charters tics may be depicted as ‘Samanyam ekatvakaram’.



13

3. Ekadasha Samanya:-

Is the name given to the samanya having the similarity between objects in

any one factor just as excessive walking provokes vata dosha. Hence there is only

similarity in functional aspects. Samanya has been further divided into two types

according to chakrapani.

1. Ubayavritti Samanya.

2. Ekavritti Samanya.

1. Ubayavritti Samanya:- The one that is related to the objects and subjects

,which performs both like posha and poshaka. Ex. The meat increase the flesh and

nourishes the meda dhatu, this is called as Ubayavritti samanya.

2. Ekavritti Samanya: - The one that is related to the one of the subjects or

objects, the subject are not similar but due prabhava or action it causes

Augmentation. Ex.Sitting in one place for long time cause increase of kapha or due

to excessive exercise increases the vata. Here both samanya and asamanya both are

the cause of augmentation or Where the posha and poshaka are totally different

but in spite of this, if the similarity is experienced , it may be termed as-Ekavritti

samanya just as the in case of deepana of agni by use of gritha.

Samanya – A philosophical Aspect5:

The characterstic of samanya according to the kanada muni,i.e vaishashika

reads as:

‘Nityamekamanekaanugatham samanyam’ (Taraka sangraha) which means that

property which is eternal, singular in itself but, found in multiple number is known

as samanya. The peculiar meaning of samanya referred here is ‘jati’ or type, which

MADHUMEHA”



14

is commonly found in many objects, but it is one in it self just as various cast in

human beings.

Vaisheshika Darashana has mainly explained about vishesha. So it is called

as vaisheshika darashana. This darashana is based on the vastu-vaada. They have

considered the saptha-padartha, i.e seven subjects as basic principles of nature.

They are dravya, guna, karma, samanya, vishesha and abhava. Their theory also

explained by Nyaya darshana.

Here the main topic of study is samanya vishesha. So, in this darshana there is a

wide explanation about the samanya vishesha siddhanth.

Samanya: -Which is nitya and present in many substances is called as samanya.

Every substance is having the particular identity. There is no any substance, which

is not having their own identity. Thus which is having particular identity is called

as samanya. It means the padartha or substance which is one and the same but

present in many objects is called as samanya.Ex. The cowness present in cow,

humanity present in human beings. Here cow and men are many in number but a

jati i.e Cowness and humanity is one and the same. Samanya is present in many

objects of its own subjects.The every cow is different from each other but the

cowness is same in all cows, it is non-separable. In the same way, the humans are

including in a group of human beings due to their similar jati,i.e humanity. .In

ancient days the samanya word is used as satta,jaati and dharma. This samanya

present equally in dravya, guna and karma. It has told that Dravyatwa is present in

dravya, Gunatwa is present in guna, and karmatwa is present in karma. This

differentiates the dravya from dravya, guna from guna, and karma from karma.



15

Siddhanta muktavali opines the samanya is that quality which is eternal, but

found in many objects just as, ‘this is a cow’, here the knowledge of a cow is

acquired by the cowness(gotva) which commonly prevails in all the cows in this

world. The death of a cow is obvious but the cow ness (Gotva) which commonly

prevails in all the cows in this world and never perishes. Thus, here also samanya

refers to jatti or type, there are mainly two qualities of jati or type viz 1) Nityatwa

[eternity] 2) Anekaasamavetatva [common content of multiple objects].

Saptha Padartha:-The specifications of samanya according to the

prashastthapada, maha bhashya may be listed as;

Swa vishaya sarvegata:- commonness (samanya) prevails in all its fundamental

subjects samanya spreads in all the individuals of one kind just as humanness

(manushyatva) is contained by each and every human beings.

Abhinnatmaka: -Human beings may be different but the humanness is common in

all of them, which means that samanya may be found in different objects but it is

ultimately one in itself

Aneka vritti:- The being of multiple objects is an undispensable requirement of

samanya because a type is only possible when it is carried by more than one

objects just as, the cow ness being a common factor of many cows, the cow type

(jati) is possible but as akasha is singular in number the akasha type (jati) is not

possible.

Anuvritti pratyaya karanam:-

Just as, the knowledge of cow ness is acquired by seeing one cow. Some

can be said after observing three or four cows also. As cow ness inseparably



16

prevails in all the cows at one and the same time. It is due to samanya that the

different individuals may be listed under one group.

Here they have said that, samanya is the cause for vruddhi but they did not

mention a particular siddhantha like samanya in the cause of vruddi, but in general,

we found the other examples. Ex. By grutha, the medha and Agni will get

increased, this condition has produced from prabhava.

Excessive thinking leads to vata vruddhi and by applying the paste of vrushya

padartha over the fingers causes the shukra vruddi. Though these all karya are not

causes due to samanya. These are obtained by its prabhava.

VISHESHA3 – AYURVEDIC VIEW

Derivation (uttapatti): Vi+sis+ghan prabedha prakar (shbdakalpa druma). Meaning:

Distinction, Difference, pecculiarness, special property.Vishesha padartha is just

opposite to samanya padartha which is the second padartha according to charaka.

Samanya shows the similarity in different things, where as vishesha shows the

difference between many objects. Samanya brings different objects into one group

where as vishesha differentiates one from other.

DEFINITIONS OF VISHESHA4:

Acharaya charaka gives three definitions for vishesha.

1. “Hrasahetur visheshascha”/

Vishesha is the entity which is the principle cause of Hrasa. After

application of this Vishesha in Cikitsa, it leads to diminution of provoked factors in

the body.

2. “Visheshastu pruthaktwakrt”



17

He has described prthaktva while explaining vishesha it means separation,

non combination distinctness and plurality by this one can say that Vishesha is the

entity which causes separation or distinctness. It is the entity which shows

difference between two objects and owing to that difference it separates the object

from one another.

3. “Visheshastu viparyaya”

Vishesha is the entity which gives the sense of dissimilitude. Due to this

sense of dissimilitude one can easily differentiate one object from another one.

These are the three statements of Aharya Caraka regarding Visesa.

• Chakrapani6:

Chakrapani explains vishesha as Vyavarta. Here dictionary meaning of Vyavarta

is to separate or distinct from something Cakrapani defines Vishesha as the entity

which causes distinction or separation. This definition of Vishesha by Cakrapani

shows the influence of Vaisesika Darsana on him. But this definition is not

sufficient to explain Vishesha in whole, as Ayurveda expects.

Yogindranath Sen- Carakopaskara This is just the interpretation of Caraka's main

verse, it interprets Vishesha as the cause for Apacaya i.e. Diminution. As Vishesha

causes differentration or separation, it is termed as Separator or Differentiator.

Gangadhara- Jalpakalpataru7

Gangadhara, one of the commentators of Caraka Samhita describes

vishesha, idea is that, which is used for the diminution of opposite or specific

qualities or matter does the same. Here one can understand that Vishesha should be

used for the purpose of diminution of provoked body constituents & it does the

same owing to its opposite or specific qualities.



18

Jyotishachandra Saraswati-Caraka Pradipika

One of the commentators of Caraka Samhita, Jyotishachandra Saraswati, in

his Caraka Pradipika Commentary mentions Vishesha as Hrasahetu. These are few

interpretations made by commentators.

Astanga Sangraha8:-

Indu, a commentator of Astanga Sangraha in his Sashilekha commentry

comments that this quotation has come under the caption of discussion to search

out the reasons of Vrddhi & Ksaya.

Astanga Hrdaya8:-

In Astanga Hrdaya there is no direct reference of Vishesha but one

quotation which has got similarity that is "Viparitaihi Viparyayaha"

Here the word "Viparitaihi Viparyayaha" gives the impression of Vishesha.

Further Arunadatta, one of the commentators of Astanga Hrdaya in his Sarvanga

Sundara commentary, comments which has the same meaning from Caraka

Samhita which is depicted in different words. According to this verse, Viparita i.e.

Vishesha is interpreted as the cause for Kshaya i.e. Hrasa.

Hemadri, one of the commentators of Astanga Hrdaya in his Ayurveda

Rasayana commentary comments, where one more word is used for Viparita & that

is Viruddha. It has also the same meaning ie. a substance which has got the power

of diminution.

According to Tarka sangraha vishesha is present in nitya dravya and itself

is nitya.

MADHUMEHA”



19

Vishesha is that which differs the one objects from another it can be

explained as the vishesha is that which causes separation from one person to other

or a factor which causes absolute different is called as vishesha.

NEED OF VISHESHA:-

1) Acarya Charaka has introduced the concept of Sat Karana and further he depicts

"Karyam Dhatusamyam". Here this Karya-Karana relation itself gives the

importance of Vishesha. These Sat Karanas are the basic needs for a physician to

achieve the goal of Dhatusamyata. A physician has to treat only two types of

conditions ie. Either Vrddhi or Kshaya. Out of which most of the condition are of

Vrddhi, so to treat these conditions one needs a substance which can reduce the

increased body constituents. A famous quotation "Necccessity is the mother of

invention." Here also the same thing happened & there was invention of such a

specific entity i.e. Vishesha.

2) Besides this other causes for invention of Vishesha are like, Sarir (Body) is the

main substratum for all types of treatments. To know this Sharira in detail is

difficult because it comprises various organs in it. Each organ is a complex

structure. So to differentiate one organ from another, there was need of an entity

which can differentiate them. Vishesha due to its differentiating nature fulfilled

this need.

3) In this Universe one can see millions of drugs (e.g. Herbs) & it is very much

difficult to differentiate those drugs. But due to the knowledge of Vishesha one can

easily differentiate them. Out of these needs the first need was most important one.



20

HRASA HETURVISHESHASCHA:-

While commenting on the quotation Cakrapani says that 'Sarvada means

both Nityaga (Everexisting) as well as Avasthika kala (Time), 'Sarvabhavanam'

includes Draya, Guna & Karma. This quotation suggests that whenever there will

be Hrasa ie. Apacaya (Diminution) of body constituents then the cause will be

Visesa.

But here Chakrapani himself raised a question & tried to clarify it.

According to Chakrapani, in conditions like when a person consumes improper

curd (Mandaka) or Nikucha (Artocarpus lakoocha, a fruit) then this curd or fruit

due to their opposite properties should alleviate Vata Dosa in the body. But

exactly opposite can be seen ie. These both provoke Tridosas in the body. So

according to Chakrapani, this condition contradicts the Vishesha Siddhanta. It will

cause a chaotic situation & such chaotic situations are not expected in Science. As

Ayurveda is a "Life Science", Chakrapani has clarified this confusion by saying

that Vishesha will be the cause of Hrasa but only in absence of inhibitory factors.

Here in the above example Chakrapani has given the cause that due to their innate

nature of unwholesomeness both of these provokes Tridosas.

VISHESHASTU PRITHAKTVAKRT AND VISHESHASTU VIPARYAYAH:

These are the interpretations of Hrasar heturvisheshascha. Here Vishesha

gives the sense of separation & dissimilitude. As Chakrapani comments in the

commentry & Hrasa Heturvishesascha that Antya Vishesha from Vaiseshika

Darshana is not expected in Ayurveda because it is not useful in the management

(Chikitsa) purpose. Here Ahcarya Charaka has given the characteristics of

Vishesha i.e. Prthaktvakrt & Atulyarthata. But these both the characteristics are

MADHUMEHA”



21

just supportive to the main definition of Vishesha i.e. Hrasa heturvisheshascha.

Further Chakrapani has tried to explain Vishesha on the basis of philosophical

aspect. The Vishesha brings about the relative sense of separation. So, even though

the quality of a cow posesses Samanya with all the other cows, still it brings about

the sense of separation in relation to the class of horses & as such it is the varient

factor in relation to the horses. It is according this principles that the quality of

flesh outside the body when taken in auguments flesh in the body. But the same

quality of flesh being varient factor in relation to Vata Dosa, alleviates Vata Dosa

in the body. Again being a non-inhibiting varient factor (Aviruddha Visesa) this

does not cause diminution in blood. Rather owing to the qualitative Samanya, it

auguments blood.Further Chakrapani says that Vishesha on the other hand brings

about distinction or separateness. Thus a cow & an elephant having dissimilar

connotation bring about a sense of separateness.

CONCEPT OF VIRUDDHA VISHESHA & AVIRUDDHA VISHESHA:

Chakrapani, the most authoritative commentator of Charaka Samhita has

introduced this concept of Viruddha Vishesha & Aviruddha Vishesha. According

to him Viruddha Vishesha is that substance which alleviates the body constituents

but Aviruddha Vishesha neither augments nor alleviates the body constituents.

Here Chakrapani comments that what Ayurveda expects is Viruddha Vishesha due

to its alleviating property. Whereas Aviruddha Vishesha is neutral in nature i.e.

But further Chakrapani himself has given an example & given the conclusion that

Aviruddha vishesha is also the indirect cause for Hrasa.Vishesha means inhibiting

varient factor. This application is to be kept in view whenever this term is used



22

subsequently. Even though non-inhibiting varient factor does not directly cause

augmentation or diminution, still its indirect effect on diminution can not be

questioned. For eg, the tactile quality of Prithvi which is neither hot nor cold does

not augment nor lessen the cooling property of Vata; still it can be indirectly taken

to be an inhibiting factor because of the absence of the productivity of the tissue

elements in it that are being normally consumed by enzymes ( in the process of

metabolism).

It is rather an established fact that the application of a dissimilar object

causes diminution in all the transient elements because of the absence of any other

factor to compensate the natural loss. For example, if a dam is constructed on a

river, the water in the downstream will get naturally lessened. In view of the fact

that diminution is effected even when an uninhibiting factor in general is present.

Therefore Agnivesa has made a general statement to the effect that the varient

factor is the cause of diminution of all beings.

While commenting on Chakrapani says that .Application of these both i.e.

Samanya & Vishehsa is needed for Dhatusamyavastha.

That is to say the Samanya & Vishesha when related to the body causes

augumentation & diminution respectively & neither of them can be effective

without having relationship with the body.

TYPES OF VISHESHA :-

Different commentators of Charaka have explained these two verses i.e. Ca, Su.

1/44 & 45 in different ways. Some hold the view that Samanya & Vishesha are

Further Cakrapani says



23

These 3 verses respectively suggest these 3 entities i.e. Dravya, Guna &

Karmavishesha. Chakrapani has given the examples for Dravya, Guna &

Karmasamanya only, he hasn't mentioned anything regarding Dravya, Guna &

Karmavishesha. But Yogindranath Sen in his Charakopaskar commentry given

examples for Draya, Guna & KarmaVishesha & tried to explain them :

1. Dravyavishehsa

Gavedhuka - Mamsa

(Vayu dominance) (Prthvi dominance)

Ksara - Kapha Dosha

(Teja dominance) (Aap dominance)

2. Gunavishesha

Arnal (Kanji) Kapha Dosa

(Laghu, Ruksa, (Guru, Snigdha, Sheeta,

Usna, Visada Guna) Pichchhila Guna)

(3) Karmavishesha

Asyasukha, Swapnasukham - Vata Dosha

Davana, Plavana, Langhana Karma Kapha Dosha

Supportive quotation is available in Sarvanga Sundara commentary in AH Su.

1/1/19.

Bhattara Haricandra has rejected this view, according to him all those types

of Samanya & Vishesha are included in the same verse. But then it might be

argued, if Samanya & Vishesha in their entirety are included in the previous verse

(Ca.Su. 1/44) then the present verse (Ca.Su. 1/45) becomes altogether irrelevant.

To remove this anomaly, some other commentators have brought forward another



24

set of clarification. According to them, three types of Samanya & Vishesha are

Atyanta, Madhya & Ekadesa Vishesha

Atyanta Vishesha (Radical) Saryada Sarva ......../

Madhya Vishesha (Medial) Visheshastu prithakatvakrit

Ekadesha Vishesha(Partial) Visheshastu Viparyayah

According to these Ahcaryas these three i.e. Atyanta, Madhya & Ekadesa

Vishesha are suggested by these respective verses. But Chakrapani himself

comments that this theory is also not tenable as this type of classification does not

serve any useful purpose.

How a same drug can cause Vrddhi as well as Kshaya ?

Meat is stated to be an augmenting factor for Vata. Now the question arises

as to how one & the same substance i.e. Meat, can simultaneously give rise to two

different factors. In actual life an individual e.g. Devadatta - does not manufacture

two different objects, say a pitcher and a bow at a time. But then this simile of

sentient beings does not hold good so far as insentient objects are concerned. By

nature sentient beings are not capable of doing two different thing at a time. But

this in not so with regard to insentient objects, e.g. one sound gives rise to many

other sounds at a time, fire produces light & heat both at a time. That is why

Caraka has also said that a medicine only taken in, simultaneously reconciles

deficient & excessive tissue elements of the body it reduces the excessive ones &

makes up the deficient ones. (Cha. Sa. 6/6)

VISHESHA - DARSHANIKA VIEW5

The word Visheha itself means particularity or distinguishing feature or

distinction and the word 'Vaisheshika' is derived from 'Vishesha' The Vaisheshika



25

Darshana, therefore, is a 'Pluralistic Realism' which emphasizes that diversity is the

soul of the Universe. The category of Vishesha or particularity is dealt with at

length in this system and is regarded as the essence of things.

The Vaisheshika Darsana is regarded as conducive to the study of all

systems. Its main business is to deal with the categories and to unfold its 'Atomistic

Pluralism'. The Vaisheshika Darshana is a Pluralistic Realism, a philosophy of

identity and difference, which emphasizes that the heart of reality consists in

difference.

As this Darshana has accepted the existence of Vishesha Padartha, it is

termed as Vaisheshika Darshana According to Vaisheshika darshana, each and

every object in this universe has its own existence. Each atom (paramanu) is

different from another one. As 'Vedanta' accepts 'Fundamental unity, Vaisheshika

Darshana believes in pluralism and difference e.g. consider an earthern pot, it has

got its own colour, structure and other different qualities. These qualities are

similar to that of other earthern pots. It means that these qualities are common. But

this earthern pot has got its own individuality which differs this earthem pot from

other pots. This is the entity which differs one object and from another one and is

termed as 'Vishesha' by Vaisheshika Darsana. After excluding all similar

characteristics between two paramanus (atoms), the remnant characteristic which

remains at last and which differentiates these two atoms is termed as Visheha.Each

and every atom has its own specific Vishesha. This Vishesha of each and every

fundamental reality can never be seen in others. As Kanada has accepted this

'Atomistic Pluralism', his Darsana is termed as 'Vaisheshika Darshana'.Vaisheshika

Darshana comprises a minute analysis of existing substances, which cannot be seen



26

in others. It has accepted the existence of different substances and this shows the

Analytical view of the same.

While defining 'Vaisheshika', Madhavacharya says that -

A Vaisheshika is one who can do the minute differentiation after

considering all the realistic differences.

AIM OF VAISHESHIKA DARSANA:

While describing the goal of Vaisheshika Darshana Kanada says that the

principle subject of this Vaisheshika Darshana is to describe 'Dharma' i.e. to

highlight Dharma. What is Dharma ? While answering this question Kanada

himself states in the second quotation that as Abhudaya which means 'Sukha' and

'Nishreyasa' means 'Moksa'.To achieve these two is the aim of Vaisheshika

Darshana.

Here Nisreyasa means permanent liberation from all the sorrows.Different

Acharyas has defined the 'Nishreyasa' in different ways; which depicts only one

thing that is permanent rescue from transmigration.While commenting on this

'Atyantiki', word 'Acharya' says that rescue from sorrows is of two types -

(1) Anatyantiki i.e.Temporary liberation from sorrows.

(2) Atyantiki i.e. Permanent rescue from all sorrows

It means permanent destruction of the basic causes of 'Dukha' i.e. Sadness.

After such destruction there will be no place for worldly sorrows. While

mentioning the path to achieve this goal Acharya Says -

that if one wants to achieve the goal of 'Nishreyasa' He/She has to get thorough

knowledge of these Dravya, Guna, Karma Samanya, Vishesha and Samavaya.As in

Nyaya Darsana Maharsi Gautama has quoted that only after the knowledge of 16



27

Padarthas one can achieve the goal of Moksha, in Vaisheshika Darshana, Maharsh

Kanada quotes for the detail knowledge of Dravya etc. 6 padarthas.,

In the second Ahnika of First chapter Maharsi Kanada says that -

Samanya and Vishesha both are the matter of intellect and one expects Buddhi

(Intellect) for the knowledge of these both entities. These both i.e.Samanya and

Vishesha depend upon Anuvrtti Buddhi and Vavrttibuddhi.

In the First Ahnik of Eighth chapter, Maharsi Kanada has narrated the definitions

of Samanya and Vishesha.

Maharsi Kanada in his 'Vaisheshika Sutra' has tried to classify all the

existing objects in six Padarthas. He has done it in such a way that each and every

object from this universe gets a place in one of these six padarthas and nothing

remains excluded.

Maharsi Kanada and the commentator Prashastapada have classified all all

objects in six Padarthas only. But their followers added one more Padartha i.e.

Abhava. In this way now Vaisheshika Darshana has seven padarthas included in it.

Visesa :

An entity which differentiates one object from another one in this unverse

is termed as Vishesha by Maharsi Kanada. Hence Vishesha means Vyavartak,

Vyavachedaka (differentiator). Samanya is also used for differentiation eg.

Ghatatva is the Jati which differentiates an Earthern pot (ghata) from a Pata (i.e.

cloth).

As Ghatatva is Samanya and here it is used for differentiation. But this

Samanya is not sufficient to differentiate one Ghata from another one. Here the

need comes of an entity which can differ one Ghata from another one, this need is



28

fulfilled by Vishesha. Hence it can be said that Samanya can be used for

differentiation but it is not sufficient for Absolute Differentiation. If two earthern

pots (Ghata) are similar in all external characteristics then also they differ in their

atoms because each and every atom has its own existence. This particularity is

known as Vishesha. One Vishesha can be seen in only one object not in another

one. Due to this reason, each and every fundamental reality has its own existence.

Hence, Vishesha is the only one which can cause absolute differentiation. Hence

Vishesha is termed as Absolute Differentiator (Antya Vyavartaka).

Karyadravyas are not everexisting realities hence they don't have any

specific Vishesha. But Karana dravyas possess those specific Visheshas and owing

to this it is said that Vishesha resides into only Nitya Parmanus i.e. Eternal Atoms.

Due to this, 'Annambhatta', in Tarkasangraha defines Vishesha as thatwhich

resides in only Nityadravyas i.e. Dik, Kala, Akasa, Atma and Paramanus of Prthvi,

Apa, Teja, Vayu and in Mana and this Vihesha causes Vyavartana i.e.

differentiation.

Shivaditya, in Sapta Padarthi, defines visesa as One vishesha resides in only one

object.

One of the chief commentators of Vaisheshika Sutra is Prasastapada.

Prasastapada in his 'Padartha-Dharmasangraha' commentry, has given detail

description of Vishesha. According to Prasastapada Vishesha can never be

destroyed because it resides in only eternal atoms i.e. Nitya Paramanus. Nitya

Dravyas are ever existing realities and Vishesha is the entity which inheres with

them. Hence, Vishesha also becomes ever existing. Neither it can be destroyed nor

generated. Ghatadi Dravyas can be generated and destroyed but the existence of



29

their atoms before the production and after their destruction remains the same.

These atoms may remain in whatsoever condition but their separate existence is

always with them. Owing to this Vishesha, each atom has got its own specificity.

Vishesha gives specific characters to its substratum i.e. Ashraya. Further

Prasastapada says that -

Vishesha is the Absolute Differentiator between eternal dravyas.

Knowledge of Vishesha:

Prasastapada has further mentioned about how one can get the knowledge

of Vishesha, while answering this question Prasastapada says that persons having

superhuman power, (Yogis) can easily see the vishesha between two parmanus as a

common man differentiates between two cows, horses etc.

DISEASE REVIEW

HISTORICAL REVIEW

Study of consecutive progression of an event is the chief step in any

research field. Study of history is incorporating the methodical development and

progress of a subject gains importance in evolving the future plans designing the

advanced research protocol. History of Medicine evolves from the very beginning,

the moment when the human being came into existence. An ancient literature of

Vedic as well as Samhita period having ample description of maladies and

remedies signifies the same. Contextually, the lingering disease Madhumeha

troubling the existence of the mankind since the daivika yuga till date. An account

of the same is elaborated in this historical review.



30

DAIVIKA YUGA

Ganesha is worshipped as the lord of beginnings and as the lord of

obstacles, the patron of arts and sciences, and the god of intellect and wisdom. He

is honored with affection at the start of any ritual or ceremony and invoked as the

"Patron of Letters" at the beginning of any writing. Ganesha has been represented

with the head of an elephant. About the adya devata lord Ganesha it is said that he

is crazy of eating sweets and likes in activity. He is also said to have the habit of

eating kapittha and jambu phala. It interesting to note that, the combination of

gluttonous eating as well as inactivity is the etiology of Madhumeha. Also the

kapittha and jambu are the best known medications of the Madhumeha.

Shivagutika10 is a popular medication of Madhumeha and the mythological origin

of Shivagutika is also related to the above story of lord Ganesha.

VEDIC KALA 11

In Atharvaveda indirect reference of Madhumeha is found as Mootratisara

(excessive urination), which point towards existence of a state akin to Prameha in

the Vedic period.

PURANA KALA

AGNI PURANA12 - In ‘Agni purana’ two types of meha’s are explained they are

Kshoudra Meha and Akshoudra Meha.

GARUDA PURANA - In Garuda purana it is said that Madhumeha is an illness

characterized by presence of sweetness in the whole body.

RAMAYANA12 - By intake of excessive sweet juices, some monkeys passed the

urine which is sweet in nature.

MADHUMEHA”



31

KOUTILYA ARTHASHASTRA13 - Arthashastra of Koutilya mentions

procedures to induce Prameha in the section dealing with the means to injure the

enemy. The spot obtained from burning Chameleon (Krukalaka) and house lizard

(Gruha Goulika) together with the intestines of mottled frog (Chitra Bheka) and

honey, if administered orally causes Prameha. This evidently points at the practice

of diabetogenic technique in the ancient times.

SAMHITA KALA

CHARAKA SAMHITA 14, 15, 16, 17

The salient feature of explanation of Madhumeha in Charaka Samhita is as

under- Charaka has mentioned Prameha as the best among Anushangis i.e. a

recurring disease (afflicts the patient continuously). He has also described Avarna

janya samprapti of Madhumeha and also he explained 2 types of Madhumeha i.e.

Avarana janya and Dhatukshaya janya. He narrates 20 types of Prameha and 2

types of patients viz ‘Sthula and Krisha’ and gave two types of treatment for them.

While explaining nidana, he added Beeja dusti also cause for this disease.

He had given synonym Oja meha for Madhumeha and considered Madhumeha is

one among the Asta Mahagada’s. He mentioned it as one of those diseases, which

started by the time of the epical disruption of Yajna organized by Daksha prajapati.

This is released with the over eating of Havish, a special type of food, made of

milk Sugar, Ghee, Rice etc., used for offering in Yajnas.

SUSRUTA SAMHITA 18, 19, 20

Susruta described the etiology of the disease as ‘Sahaja and Apathya

nimittaja’. He classified Prameha into 20 types and has given specific drugs to

each type of Prameha. One more interesting observation done by Susruta is about



32

Prameha nivritti lakshanas, which were not mentioned by his predecessors. He had

given synonym Kshoudra meha for Madhumeha and is one among the Asta

Mahagada’s.

ASHTANGA HRUDAYA 21 AND SHTANGA SANGRAHA 22

Author follows the description of Prameha as in Charaka as well as Susruta

Samhita - He enumerated 20 types of Prameha with symptoms & their general and

dosha vise treatment. While explaining the treatment, he added some new drugs

like Lodhrasava, Ayaskriti, and Shilajatu Rasayana etc. He also mentioned that all

the Pramehas if left untreated, in long course of time progress to vatika type.

BHELA SAMHITA 23

Bhela samhita describes 20 types of prameha under ‘Prakrutija’ and

‘Swakrutaja mehas’, which respectively mean hereditary and acquired types.

HARITA SAMHITA 24

He mentioned it as Papajanya and enumerated 13 types of Prameha with

nomenclature different from other Samhita’s and described Arista lakshnas and

Madhumeha in detail.

KASHYAPA SAMHITA25

He mentioned the symptoms of Prameha in children and noted that the

disease is Chirakari.

MEDIEVAL PERIOD 26 -30

SHARANGADHARA SAMHITA

Mentioned sankhya samprapthi of Prameha along with Prameha Pitikas.

CHAKRADATTA

Mentioned various prameha pidakas along with mukti lakshanas.

YOGA RATNAKARA



33

Explains madhumeha along with various choorna’s, vati’s, asava, Taila’s &

rasaushadhi’s in the treatment aspect. He mentioned Vanga Bhasma alone & along

with various yogas.

BHAVA PRAKASHA

He explained Prameha and Madhumeha along with Upadrava and Arista

Laxanas.

MADHAVA NIDANA

Explained madhumeha along with pidakas in uttarardha, his specialty lies

in describing the samprapti of Prameha by individual doshas, along with separate

description of madhumeha.

BHAISHAJYA RATNAVALI

Explained madhumeha with detail description regarding Pathyapathya,

Yogas. Prameha Pitikas and its chikitsa.



34

NIRUKTI AND PARIBHASHA NIRUKTI:

Madhumeha - Madhumeha is a compound word made up of Madhu + Meha

Madhu – Mana = Manavabhodane.

The word Madhu is derived from the root ‘mana’ and the meaning as ‘manaava

bhodane’ i.e. which brings gratification to the mind31.

Meha - Miha = Sinchana (to moisten); = Prasrava (to flow excessively); =

Ksharana (to flow). Meha is derived from the root ‘Miha’, which is employed in

the sense of Sinchana (to moisten), Ksharana (to flow) Prasrava (to flow

excessively) and as a Prameha roga bheda (Vachaspathyam).

PRAMEHA :

Prakarshana mehati ksharati iti

Pra + miha + Karane Ghang. Rogavishesha.

A disorder of urine characterized by excessive excretion of the same is

regarded as Prameha 32.

PARIBHASHA

Madhumeha can be defined as follows:

Madhumeha is a disease characterized by the excessive excretion of urine

which is similar to that of Madhu (Honey) either in its properties or in color. The

urine is Madhura and Kashaya in rasa and Rooksha in Guna.

PARYAYA

Meha: Is referred to as Prameha by Amara 33

Mootradosha: A urinary disorder.

Bahumootrata: A disease where there is excessive urination.

MADHUMEHA”



35

Madhumeha: A condition characterized by excess urination, resembling

honey either in color or taste. This word has been used synonymously with

Prameha.

Kshoudrameha: Kshoudra is a synonym of Madhu.

Khandameha: Khanda means sugar thus the illness characterized by passing

of urine which is identical to khanda sarkara is called as khandameha.

Madhuprabha: Urine is like Madhu and hence is known as Madhuprabha.

Ojomeha: Ojas is considered as sara or essence of all Dhatus, which is a

dushya in Madhumeha hence Ojomeha has been used by Charaka to describe

this disease.

Paushpameha: Narrated in Anjana Nidana. Paushparasa is again resembles

with Madhu 34.



36

NIDANA

APATHYANIMITTAJA NIDANA SAHAJA NIDANA

BEEJA UPATAPA

VISHESHA

Vataja Pittaja KaphajaAHARA VARGA

MANASIKA CHINTA TYAGA

Dhanya Mamsa Shaka Phala Harita Madya Ksheera Krutanna

SHAREERIKA Diwaswapna Avyayama Asyasukha Swapnasukha Alasya Mruja Varjana Samshodhana Varjana

VIHARA

SAMANYA

VYABHICHARI

HETU PRADHANIKA HETU

Prajnaparadha Asatmendriyartha Samyoga Parinama

Chart No: 1

MADHUMEHA”



37

Table 1 showing Nidana and Guna Karma 39, 40

TABLE NO: 1 Nidana and Guna Karma 39, 40

Nidana Predominant of

Rasa, Guna,

Veerya,

Vipaka

Vitiates

Guruguna ahara Prithvi,Ap Madhurarasa Kapha, Medas

Snigdhaguna ahara Prithvi, Ap Kleda

Dravaguna ahara Ap Kapha & Kleda

Picchilaguna ahara Prithvi, ap Kapha & Kleda

Sheetaguna ahara ap Udaka & vata

With dravaguna

Madhura rasa ahara

Snigdha,

Guru, Sheeta

veerya,

Madhura

vipaka

Kapha, Rasa, Rakta,

Mamsa, Medas, Majja,

Shukra and Ojas

Lavana rasa ahara Kleda, Kapha vilayana

Goksheera Kapha and Medas

Godadhi Kapha and Medas

Goghrita Kapha and Medas

Mahisha ghrita Kapha and Medas

Guda

Madhura in

rasa,

Snigdhaguna

, Sheeta and

in Veerya

Kapha & Medas

MADHUMEHA”



38

Trapusha Guru guna Kapha, Medas

Irvaruka

Madhura

rasa Sheeta

veerya

Kapha, Medas

Uddalaka Snigdha, Madhura rasa, Guruguna,

Kapha and Medas

Balya

Pishtanna Abhishyandi Kapha abhishyandi

Madhya Dravaguna and

Agni bhoota Dravaguna Increases Tamoguna

Nidra atisukha Shleshma vardhana

Asya atisukha Increases

Tamoguna Shleshma vardhana

Diwa swapna Increases

Tamoguna Shleshma vardhana

Tyakta chinta Kapha and Medas

Mruja varjana Inactiveness,

laziness Kapha and Medas

MADHUMEHA”



39

Tyakta vyayama

Increases

Agnimandya,shareera-

Kapha and Medas-

gourava Alasya

prasakta Kapha

Failure to perform

Samshodhana therapy Tridosha

POORVAROOPA Table 2 showing the poorvaroopa according to different Acharya’s 41

Table No: 2

Sl.

No. Poorvaroopa1, 2, 3 Charaka

Samhita

Sushruta

Samhita

Ashtanga

Hridaya

MADHUMEHA”



40

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

Sweda

Angagandha

Angashaithilya

Shayya sukherati

Swapna sukherati

Jihwopadeha

Taluni malotpatti

Danteshu malotpatti

Kesha ativruddhi

Kesha jatilibhava

Nakha ativruddhi

Talushosha

Asya madhurya

Kara daha

Pada daha

Mootrapipeelika abhisarana

Madhura mootrata

Guru gatrata

Pipasa

+

+

+

+

+

+

-

-

+

+

+

+

+

+

+

+

-

-

+

-

+

-

-

-

+

+

+

-

+

+

-

-

+

+

-

+

+

+

+

+

+

+

+

+

-

-

+

-

+

+

+

+

+

+

-

-

-

MADHUMEHA”



41

ROOPA VIVECHANA

“Karyayoni doshavaishamyam tasya lakshanam vikaragamah”- Charaka

Onset of Roopas marks the Agama of Vikara and they are usually

pronounced manifestations of Poorvaroopas. These are characteristic of Vyakta

avastha of a Vyadhi. The Pratyatma roopas are invariably encountered during this

stage. The Roopas can hence be studied under Mootrasambandhi roopas and

Sarvadaihika roopas.

MOOTRA SAMBANDHI ROOPAS 42:

Mootrasambadhi roopas can be grouped into Samanya Roopas and

Vishishta roopas.

A. SAMANYA ROOPAS:

1) Prabhoota Mootrata: It has been described as Atimatra mootrata and

Mootraprabhootatva. It is a result of Dravaihi ekikarana which means, there

is an increased frequency of micturition with increased quantity of urine.

2) Avila mootrata: Has been described as Samala mootra or Atyartha

kalushita mootra, which means, there is an abnormality in the density and

turbidity of urine.

B. VISHISHTA ROOPAS:

The classics describe the following Roopas as related to Mootra i.e.

Madhuryata, Rookshata, Panduta and Kashayata.

1. Madhurata: Refers to Rasa that is entirely due to Apakva ojas. The Rasa

of Ojas is Madhura and hence also of the Mootra as is evidenced by the

attraction of Shatpadapipeelika towards the Mootra.

2. Rooksha: Refers to the Guna and is due to vata vriddhi..

MADHUMEHA”



42

3. Pandu: Refers to the Varna of urine. The urine would have lost its normal

Varna as a result of abnormally increased Shareera kleda.

4. Kashaya: The term Kashaya denotes Varna of Mootra. The Kashaya

Varna can be an occurrence in conditions of Nephropathy as a sequel of

DM. Hence, this speculation can be clarified with an argument that does

not nullify the opinion of Bhavamishra and therefore the Kashaya varnata

could be understood as a terminal manifestation of DM.

Madhumehi madhusamam:

These words are also mentioned in the classics as Vishesha roopas of

Madhumeha, which means that the patient passes urine like that of Madhu. This

situation is similar to the previous one that can be analyzed on the basis of

Vagbhata’s statement, that the Samanya roopas of Prameha are Prabhoota and

Avila mootrata and the other Vishesha roopas are seen depending on the Dosha

and Dushya samyoga where, the urine assumes the respective character in terms of

Varna, Rasa, Sparsha and Gandha. When this is applied to Madhusamam, it can

mean that urine resembles honey in taste, color, touch and smell but clinically and

literally the disease favors more towards resemblance of urine with honey in its

taste rather than other qualities.

SARVADAIHIKA ROOPAS 43:

The Sarvadaihika roopas in Madhumeha can be grouped and studied under the

following headings:

a) Apathya nimittaja

b) Sahaja



43

a) Apathya nimittaja:

1) Sthoulya, 2) Bahvashee, 3) Snigdha, 4) Shayya Asana Swapna

Sheela

The Roopas mentioned above are in fact closely interlinked as is evident

that Bahvashee leads to Snigdhata due to Kaphamedo sanchaya and Sthoulya.

Excess Medas in Sthoulya leads to reduced capacity to work as well as

Alasya.Hence the patient always tends to be Shayya, Asana and Swapnasheela.

Bahuashitva may be due to Loulyata in the beginning, but later, when due

to excess Medosanchaya, the Kaphamedavrita Samana vayu which becomes

limited to Koshta causes Teekshnagni leading to Kshudati matram, the patient

develops Atikanksha for food again leading to Bahvashitva. Sthoulya may also be

due to Beeja dosha. Hence Bahvashitva may be a result of Sthoulya in a person

who wasn’t Bahvashee in the beginning but became so due to Sthoulya owing to

reasons as explained above. The Samana vayu is the Preraka for Agni, which is

now described as the internal cue.

b) Sahaja:

A Sahaja pramehi will present the following Sarvadaihika roopas

1) Krusha, 2) Alpashee, 3) Rooksha, 4) Paribhramanasheela

The Roopas here too are interlinked as Alpasheetva leads to Krushata &

Rookshata because of predominance of vayu as a result of Vapavahana dushti.

These Roopas may be a cause for Madhumeha and will continue to deteriorate later

as the disease progresses.

MADHUMEHA”



44

5) Tanu Madhuryata: Vagbhata has mentioned Tanu madhuryata as a Pratyatma

lakshana of Madhumeha. This is due to Aparipakva ojas in the Shareera as

evidenced by Makshikopasarpana towards Shareera.

Samprapti of Madhumeha

Madhumeha is considered as Mahagada and an Anushangi Vyadhi.This is

becasue in Madhumeha, Vyadhikshamatva is a major casualty. The

Charakacharya introduced the concept of Vikara Vighata Bhava Abhava Vishesha

in Prameha Nidana. Bala derived from Ojus Characterizes Vikara Vighata Bhava

and its deficiency characterizes Vikara Vighata Abhava. Hence the study of the

involvement of Ojas in the disease warrants a top priority.

Ojas: Ojas plays an active part as Dushya in the Samprapti of Madhumeha.

Sushruta has mentioned that Ojas is a supreme extract of all the Dhatus & strength

of the body. Charaka mentions that life depends on Ojas and therefore without

Ojas one cannot live. Such Ojas remains in the heart and called as Shareera Rasa

Sneha. In the commentary Chakrapani has described two varieties of Ojas i.e.,

Para and Apara Ojas. Para Ojas is supreme and remains in the heart, while its

Pramana is Ashta Bindu. Apara Ojas is of Ardha Anjali Pramana which is also

called as Shleshmika Ojas i.e. Shareera Bala.Further Chakrapani explained that, in

Madhumeha Apara Oja Kshaya occurs, which is Sleshmika in nature and not the

Para Ojas Kshaya.Pathological conditions regarding Ojas are of 3 types

Ojovisramsa – Sandhi Vishlesha, Gatra Sada, Dosha Chyavana,

Kriyaasannirodha.Ojovyapath –Sthabda Gurugatrata, Vatashopha, Varna Beda,

Glani, Tandra, Nidra.



45

1. Ojokshaya – Murcha, Mamsa Kshaya, Moha, Pralapa, Marana.

In Madhumeha Ojas is excreted through the Urine leading to Oja Kshaya,

so the symptoms of Oja Kshaya like Murcha, Mamsa Kshaya, Moha may

manifest.Vagbhata has mentioned some additional symptoms of Oja Kshaya like

Bibheti (excessive fear) Abhikshna Daurbalya (excessive weakness), Vyathita

Indriya, Rukshata etc. In Madhumeha though the pathology regarding Ojas is of

Kshaya nature, the other two pathological conditions may also be met with; if the

Samprapti remain unbroken for prolonged period with continuous Nidana Sevana

or due to improper treatment. Hence the pathological aspect of the Ojas is very

necessary to be observed to know the severity of the disease.

The extent of this Dosha Dushya Sammurchana is dependent on the Vikara

Vighata Bhava and its Abhava. Ojas is an important Vikara Vighatakara Bhava and

one of the main Dushya in Madhumeha, which is eliminated through Mutra leading

to Dhatu Kshaya. Hence Madhumeha is also called “Ojomeha”.

1) Vishishta Anilatmaka Madhumeha Samprapti :

“Sa prakupita tathavida shareere visarpan –

Ojaha punarmadhura swabhavam tad yada roukshyat vayuh kashayatvena

abhisamsrujya mutraashaye abhivahati tada madhumeham karothi.

tathavida shareere – bahudravasleshma, bahuabddha meda, bahu kleda yukta

shareera”

The patient who have the specific body tendency for Prameha onset which

means it may be due to genetic predisposition, Prakruti manifestation or sedentary

habit have the specific Meda Bahulyata preferably with Abaddhatva. If these

patients consume excessive Vata provocative Ahara, Vihara or Mano Abhighatkara

MADHUMEHA”



46

Bhava, then Vata gets provocated. This provocated Vata further gets implicated by

Meda. Now this provocated Meda complex leads to transfer of Vasa or Majja or

Lasika or Oja to Mutravaha Srotas. When Ojas due to the influence of Vata adopts

Kshaya and Ruksha Guna and excrete through urinary tract is termed as

Madhumeha.

2) Samprapti of Madhumeha due to Shudda Vata:

Charaka mentions the Samprapti of Madhumeha due to Shudda Vata.

“Ksheeneshu dosheshvavakrshya basthav dhatoon pramehaananila karothi

Ksheeneshu eti vriddavata apekshaya ksheeneshu”

Due to Vatakara Nidana, Vata Dosha provocated leading to Kshaya of

other two Doshas and Sarabhoota Dhatus like Vasa, Majja, Lasika and Oja. Due to

Kshaya of Dhatus Vata further gets provocated. This highly provocated Vata draws

Ojas towards Basti and leads to Madhumeha. This is Asadhya to treat due to its

Arambhaka Dosha Vata and resultant further provocation due to Dhatukshaya.

3) Aprathikaritha Vatanubanditha Madhumeha Samprapti:

This type of Madhumeha is actually not a separate entity but it is the further

stage of Kaphaja or Pittaja Prameha due to Deerga Kalanubandha or this may be

called as ignored stage of Prameha due to lack of proper treatment. Kaphaja and

Pittaja Pramehas which are present from quite longer period they do get

Anubandha of Vata to chronicity i.e., they get converted into Vataja Prameha.



47

4) Avarana Janya Madhumeha Samprapti:

The description of Avarana Janya Samprapti of Madhumeha is a unique

contribution of Charaka to the clinical medical knowledge. Here one can see that

Nidana is same as that of Kaphaja Prameha but still the resulting disease is

Madhumeha. Guru – Snigdhadi Ahara, Avyayamadi Vihara etc., leads to

provocation of Kapha and Pitta Dosha intern increases in the quantity of Meda and

Mamsa. All these increased factors obstruct the Gati of Vata leading to provocation

of Vata.This provocated Vata withdraws Ojas from the body and takes it towards

Basti and leads to Madhumeha, which is Krichhrasadya for treatment due to its

origin from Kapha and Pitta Doshas.

The process of Margavarana of Vata due to Kapha and Pitta occurs in two

kinds of people. First in those who are Sthula and secondly in those who are not

Sthula but indulged in Kapha Medokara Ahara and Vihara. If the Nidana for Pitta

are significant then it also gets Dushti. In Sthula people, the Sthaulya is the result

of two reasons. First it is due to excess indulgence in Kaphakara Ahara Vihara and

second is due to Beeja Dushti. In the former case, the Upachaya of Medas occurs

due to the Nidana Sevana. Whereas in the later case, the Medo Upachaya occurs

even in the absence of Kapha Medokara Ahara Vihara.

SAMPRAPTI GHATAKA OF MADHUMEHA

On the basis of various references the Samprapti Ghataka of Madhumeha

is described as follows:

MADHUMEHA”



48

Dosha : Kapha and vata.

DUSHYA : Rasa, Rakta, Mamsa, Meda, Majja, Vasa,

Shukra,Oja, Lasika, Kleda and Sveda.

SROTAS : Annavaha, Mutravaha, Udakavaha, Medovaha Srotas.

SROTODUSHTI : Atipravritti, Sanga, Vimarga Gamana.

AGNI : Vaishmya in all Agnis (or Dhatvaagni Mandya)

Udbhava STHANA : Amashaya.

Sanchara STHANA : Sarva Shareera.

ADHISTANA : Basti.

Vyaktha STHANA : Mootravaha Srotas and Sarva Shareera.

Vyadhi SWABHAVA: Chirakari.

Madhumeha is a Kapha Vata Dosha Pradhana Vyadhi in which the Vata Dushti

occurs in two different pathologic mechanisms.

SADHYA – ASADHYATA OF MADHUMEHA49 - 52

Madhumeha has been described as Anushangi which means it is

Punarbhavi, in other words once a Madhumehi, will be so always throughout his

life. Therefore one should make all efforts to prevent & control it.

MADHUMEHA”



49

Asadhyata of Vataja Prameha: The four Vataja Pramehas are considered Asadhya

due to the following reasons.

A) Mahatyayikatvat

B) Virudhopakramatvat

a) Mahatyayikatvat: The term Mahatyaya has following interpretations,

i) Mahata Gambhira Dhatunam Atyaya Nasho Yena Sa.

ii) Ashukaritva.

iii) Mahavyapattikatrukatva.

iv) Majja Prabruti Sarabhoota Dhatukshaya

v) Majjadi Gambhira Dhatu Apakarshakatvena.

vi) Uttarottara Saratara Dhatu Sravakatvat.

The above interpretations indicate the fatality of the disease, where all the

Dhatus including the Gambhira Dhatus undergo Nasha, Kshaya, Sravana &

Apakarshana. This process involves multiple Srotases producing Upadravas and is

hence Mahavyapathikara, which means that the disease is much too fatal to sustain

life. It is Ashukari and Sheegrakari which indicates the rapidity of the fatality in

the patient.



50

b) Virudhopakramatvat: The Chikitsa of Vataja Prameha involves Virudhopakrama

which means there is a mutual contradiction in the treatment modalities as use of

Snigdha etc are Pathya for Vata but Apatya for Medas. Hence the disease is

Asadhya.

OTHER SITUATIONS DETERMINING ASADHYATA OF MADHUMEHA

Madhumeha with all Poorva Roopa:

It has been said by Charaka that if a disease in Roopavastha has all the

Poorvaroopas manifested, and then the disease becomes Asadhya. The severity of

Asadhyata increases when associated with Poorvaroopas. Vataja Pramehas have

already been described as Asadhya but this term has to be analytically interpreted

in the two clinical types of Vataja Mehas, i.e., Dhatukshaya Janya & Margavarana

Janya.

Sahaja Madhumeha and Madhumeha with Dhatu Kshaya have Vata as

Anubandhya Dosha since the beginning, but in Margavarana Janya Madhumeha

Vata is only Anubandha to Pitta & Sleshma and therefore the Chikitsa for Vataja

Prameha have been designed keeping in mind the Anubandha Vata and not the

Anubandhya Vata because in the later case it has been categorically stated that

even thinking about managing this condition is a futile exercise.Where as in the

former case the status of Vata can be controlled through the treatment, as it is still

dependent on the status of Sleshma & Pitta. In this case the amenability of Vata to

the treatment becomes less & less depending on with what severity the

Poorvaroopas are associated.



51

Jatha Madhumeha is Asadhya due to Beeja Dosha as there is

irreversible. Madhumeharambaka Dosha Dusti since the birth itself.

Madhumeha with Pidakas is Asadhya.

Madhumehi who has Bala Mamsa Kshaya can be left untreated.

All Pramehas if left untreated terminate into Madhumeha, which is

Asadhya.

Prameha with Upadravas and Atiprasruta Mutra is Asadhya.

Madhumeha with Arista Lakshanas is Asadhya.

A patient who hates hygienic habits like Snana, Chankramana &

one who has

Manda Utsaha, who is Atisthula, Snigdha & Mahashana dies of

Madhumeha.

MADHUMEHA CHIKITSA

The principles of Chikitsa can be studied under a) Nidana Parivarjana, b)

Apakarshana, c) Prakriti Vighatana. These principles of treatment are to be studied

separately with respect to Dhatukshaya Janya Madhumeha & Margavarana Janya

Madhumeha.

MADHUMEHA”



52

SAMANYA CHIKITSA SIDDHANTA53

Nidanaparivarjana

In Margavarana Janya Madhumehi: An Apathyanimittaja Madhumehi is

usually Sthula, likes Abhyavaharana & hates Chankramana. Here, the patient

should be made to avoid all Kaphakara Ahara Vihara either to prevent the

occurrence or to cure the disease.

In Dhatu Kshaya Janya Madhumehi: It is studied with special reference to Sahaja

Madhumeha. It lies entirely on the Mata or Pita so as to how best they act to

prevent the occurrence of the disease in them. They should avoid the Beeja, Beeja

Bhaga or Beeja Bhaga Avayava Upatapa leading to Madhumeha Arambaka Dosha

Dusti.

Apakarshana & Prakriti Vighatana: The Apakarshana of Doshas is mainly done

through Samshodhana but only when Roga & Rogi Bala is in Pravaravastha and

when either one or both are Avara, then it is done through Langhana and Langhana

Pachana, which constitutes Samshamana Chikitsa, in other words Prakriti

Vighatana.

Apakarshana in Margavarana Janya Madhumeha: In Sthula Madhumehi

Samshodhana is indicated and before starting this therapy Snehana is advised. For

Snehana Karma when there is predominance of Kapha Dosha along with Vata then

Taila processed with Kaphagna drugs should be used. When there is Anubandha of

Pitta the Ghrita processed with Pittaghna drugs should be employed. Shodhana

MADHUMEHA”



53

especially Vamana should be preferred in a Madhumehi if the Dhatukshaya is

minimum & Kapha & Medodushti Lakshana are maximum. If there is Pittaja

Lakshana & Dhatu Kshaya but Virechana is not contraindicated then Virechana

can be performed. Similarly, if the Anubandha Vata Lakshana is more and the

patient is Samshodhana Arha then Basti can be performed.Madhumeha is a

Svedana Anarha Vyadhi but Niragni Sveda in the form of Vyayama is indicated.

The selection of Yoga for Samshodhana should be selected as per the recipes

prescribed in Kalpa Sthana. After Shodhana, Shamana Chikitsa can be done by

Kapha Medohara Dravya.

Prakruti Vighatana in Dhatu Kshaya Janya Madhumeha: Dhatu Kshaya

Avastha is the result of Beeja Dusti in Sahaja Madhumeha & due to a state of

Atikarshita Dhatus as a result of continued Dhatu Kshaya, which in fact is the

progressed stage of Margavarana Janya Madhumeha. Both the situations are

considered Samshodhana Anarha. In such cases, Samshamana Chikitsa is advised,

whereas Madhumeha in both these cases are Asadhya.

AVASTHA ANUSARA CHIKITSA OF MADHUMEHA:

Sushruta in the chapter of Prameha Pidaka Chikitsa has identified the stages

of Madhumeha & accordingly advised the treatment, which can be discussed as

follows:

Stage I: In the Poorvaroopa Avastha where the Dosha Dushya Sammurchana has

just begun, then the disease should be treated with Apatarpana, Vanaspathi

Kashaya and Chagamutra. If left untreated, Madhumeha proceeds to the II stage



54

Stage II: This is the Vyakta Avastha of Madhumeha where, due to continued

Madhura Ahara Sevana, the Sveda, Mutra and Shleshma attain Madhura Bhava &

hence should be treated with Ubhaya Samshodhana i. e. Vamana, Virechana &

Basti. If left untreated, the disease progresses to stage III.

Stage III: In this stage, the Mamsa & Shonita undergo Pravruddha Dusti causing

Shopha & other Upadravas and these should be appropriately treated as mentioned

accordingly, like Siramokshana in Shopha. If left untreated, the disease progresses

to stage IV.

Stage IV: In this stage, the Upadravas like Shopha would have attained Ativriddha

Avastha, manifesting symptoms like Ruja & Vidaha, where Shastra Chikitsa and

Vranakriya should be performed. If neglected, the disease proceeds into Asadhya

Avastha, which is the V & final stage.

Stage V: In the Asadhya Avastha, the Upadravas become Mahantha & makes the

disease Asadhya, like here when the Puya of Pidakas attains Abhyantaraprapti and

become Utsanga.

SANTARPANA APATARPANA CHIKITSA IN MADHUMEHA 54, 55

Madhumeha has been described as Santarpanotha Vyadhi as well as

Apatarpanotha Vyadhi. The former is Apathya Nimittaja Madhumeha & latter is

Sahaja Madhumeha or Madhumeha due to Dhatu Karshana due to long standing

Prameha. Accordingly, two forms of Madhumehis are encountered, one who is



55

Sthula & Balavan for whom Apatarpana is the best & the other who is Krusha &

Paridurbala for whom Santarpana is the best line of treatment.

Apatarpana chikitsa: is done in the form of langhana, langhana pachana &

doshavasechana. Langhana this is done in alpadoshavastha where only upavasa,

pipasa, maruta, atapa sevana, rooksha, udvartana, pragadha vyayama, nishi

jagarana & so on, which are kapha medohara, are helpful. Langhana pachana is

done in madhyama doshavastha where along with langhana; ama pachana is done

with tikshna, ushna dravyas. Doshavasechana is done in bahu doshavastha where

the shodhana of doshas is done from ubhaya margas.

Santarpana chikitsa: laghu santarpana chikitsa is prashastha for krusha and

durbala rogis. The following can be administered in madhumehi. A) mantha, b)

kashaya, c) yava, d) churna, e) lehya, f) laghu bhakshya. These formulations

should be prepared such that they cause santarpana without causing vriddhi of

kapha & medas. Among all these, yava is considered as best for madhumehi.

SHAMANA CHIKITSA 56

Sushruta as described to select drugs, which are having bitter pungent

Astringent taste, Katu Vipaka, Ushna Veerya and Shoshaka, Chedana properties in

the treatment of Madhumeha. Shilajatu, Guggulu & Loharaja are the best

medicines in Madhumeha, either in Krusha or Sthula, as they are Virukshana &

Chedaneeya, which is good for Kapha, as well as Rasayana, which is good for

Dhatukshaya & Vata Vriddhi.



56

a) Extracted juice of Amalaki mixed with Haridra powder and honey.

b) Decoction of roots, leaves, barks flowers and fruits of Nimba, Aragvadha,

Saptaparna, Murva, Kutaja, Somavriksha, and Palasha should be given to the

patients.

c) The decoction of Chitraka, Triphala, and Indrayava mixed with honey.

d) Extracted juice of Guduchi mixed with extracted juice of Amalaka fruit and

honey.

PATHYA APATHYA OF MADHUMEHA57

Pathya:

Nidana Parivarjana is the first and for most Pathya for Madhumeha. In

Sthula Madhumeha there is Margavarodha of Vata by Vriddha Kapha and Meda,

hence to rectify the imbalance of Doshas and to reduce to the Meda, usage of

Jangala Mamsa Rasa of Vishkira, Pratuda and Vihanga varieties, Shyamaka,

Uddalaka, Kodrava, Godhuma, Chanaka, Adhaki. Tikta Rasa Pradhana Shakas

grown in Jangala Desha, Yavanna, Madhu, Kulatta, Purana Dhanya Sevana,

Purana Shali, and Laja Sevana is beneficial.

Sushruta mentioned Vyayama and Ratri Jagarana are beneficial. Tikta Rasa

Dravyas are beneficial in Madhumeha because Tikta is Laghu and Ruksha where

as Kapha is Guru and Snigdha. Tikta Rasa helps in decreasing Kapha, Shareera

Kleda and Meda, which’s known as the important factors involved in Madhumeha.

MADHUMEHA”



57

It helps in reducing the Dravatva of Mutra in term decrease the Saratva hence the

frequency of Mutra will be reduced. Karavella, Bhumyamalaki etc are to be used

for this purpose. Yava is Ruksha and Laghu, helps in bringing Kapha Dosha to

normalcy.

Yava, Mantha, Vishkira Mamsa, Pratuda Mamsa are the Pathya beneficial for

Krusha Madhumehi.

Apathya: All the Nidanas which are mentioned for Madhumeha and Prameha are

Apathya.

PATHYA AHARA – VIVIDHA LEKHAKA NIRDESHA58

Table No: 3

Sl. No.

Ahara C.S. S.S. A.Hr B.P. Y.R. B. R.

1 Purana shashtika shali + + + + + -

2 Purana yava + + + + + +

3 Purana godhuma + + + + + +

4 Purana kodrava - + - + + +

5 Purana uddalaka - + - + + +

6 Kulatha - + + + + +

7 Mudga - + + + + +

8 Amalaki + + + - - +

9 Madhu + + + + + +

10 Nimba + + - - + -



58

Sl. No.

Ahara C.S. S.S. A.Hr B.P. Y.R. B. R.

11 Patha + + + + + +

12 Guduchi + + + + + +

13 Haridra - + - - - -

14 Jambu - + + - + +

UPADRAVA OF MADHUMEHA 59

Madhumeha Upadravas can be classified into two groups that is Samanya

Upadrava of Prameha as explained by Charaka and Vataja Prameha Upadrava as

Vishishta Upadrava of Madhumeha. The following list illustrates Samanya and

Vishishta Upadravas.

SAMANYA UAPDRAVA – Trishna, Atisara, Daha, Daurbalya, Arochaka,

Avipaka and Prameha Pidaka are the Upadravas of Madhumeha.

PRAMEHA PIDAKA MENTIONED IN BRAHATRAYEE

Table No: 4

Pidaka Nama Charaka Sushruta Astanga Hridaya

Sharavika + + +

Kachchapika + + +

Jalini + + +

Vinatha + + +

Alaji + + +

Vidradhi + + +

MADHUMEHA”



59


Sarshapika + + +

Masoorika - + +

Putrini - + +

Vidarika - + +

VISISTA UPADRAVA: Vataja prameha upadravas are considered as Visista

upadravas of Madhumeha. They are as follows.

UPADRAVA OF VATAJA PRAMEHA

Table No: 5


Udavartha - + +

Kampa + + +

Hridgraha + + +

Loulya + + +

Shoola + + +

Unnidrata + + +

Shosha - + +

Kasa - + +

Shwasa - + +

Sthambha + - -

Baddha Purishatvam + - -

MADHUMEHA”



60

MODERN ASPECT OF DIABETES MELLITEUS

INTRODUCTION 60

Diabetes Mellitus is defined as a syndrome characterized by chronic

hyperglycemia associated with disturbance of carbohydrate, fat and protein

metabolism due to the absolute or relative deficiency in insulin secretion and

action. The disease has a particular predisposition for micro vascular complications

and increased tendency for macro vascular complications.

HISTORY 61

1552 B.C. - Earliest known record of diabetes mentioned on 3rd Dynasty Egyptian

papyrus by physician Hesy-Ra; mentions polyuria (frequent urination) as a

symptom.

1st Century A.D. - Diabetes described by Arateus as 'the melting down of flesh and

limbs into urine.

C. 164 A.D. - Greek physician Galen of Pergamum mistakenly diagnoses diabetes

as an ailment of the kidneys.

Up to 11th Century -Diabetes commonly diagnosed by 'water tasters,' who drank

the urine of those suspected of having diabetes; the urine of people with diabetes

was thought to be sweet-tasting. The Latin word for honey (referring to its

sweetness), 'mellitus', is added to the term diabetes as a result.

16th Century - Paracelsus identifies diabetes as a serious general disorder.

Late 1850 - French physician, Priorry, advises diabetes patients to eat extra large

quantities of sugar as a treatment.

MADHUMEHA”



61

1869 - Paul Langerhans, a German medical student, announces in a dissertation

that the pancreas contains two systems of cells. One set secretes the normal

pancreatic juice; the function of the other was unknown. Several years later, these

cells are identified as the islets of Langerhans.

1870 - French physician, Bouchardat, notices the disappearance of glycosuria in

his diabetes patients during the rationing of food in Paris while under siege by

Germany during the Franco-Russian War; formulates idea of individualized diets

for his diabetes patients.

1889 - Oskar Minkowski and Joseph von Mering at the University of Strasbourg,

France, first remove the pancreas from a dog to determine the effect of an absent

pancreas on digestion.

Early 19th Century -First chemical tests developed to indicate and measure the

presence of sugar in the urine.

19th Century - French researcher, Claude Bernard, studies the workings of the

pancreas and the glycogen metabolism of the liver. Czech researcher, I.V. Pavlov,

discovers the links between the nervous system and gastric secretion, making an

important contribution to science's knowledge of the physiology of the digestive

system.

Late 19th Century - Italian diabetes specialist, Catoni, isolates his patients under

lock and key in order to get them to follow their diets.

1900-1915 - 'Fad' diabetes diets include: the 'oat-cure' (in which the majority of

diet was made up of oatmeal), the milk diet, the rice cure, 'potato therapy' and even

the use of opium.



62

1908 - German scientist, Georg Zuelzer develops the first injectable pancreatic

extract to suppress glycosuria; however, there are extreme side effects to the

treatment.

1910-1920 - Frederick Madison Allen and Elliot P. Joslin emerge as the two

leading diabetes specialists in the United States. Joslin believes diabetes to be 'the

best of the chronic diseases' because it was 'clean, seldom unsightly, not

contagious, often painless and susceptible to treatment.'

1913 - Allen, after three years of diabetes study, publishes Studies Concerning

Glycosuria and Diabetes, a book which is significant for the revolution in diabetes

therapy that developed from it.

1919 - Frederick Allen publishes Total Dietary Regulation in the Treatment of

Diabetes, citing exhaustive case records of 76 of the 100 diabetes patients he

observed, becomes the director of diabetes research at the Rockefeller Institute.

October 31, 1920 - Dr. Banting conceives of the idea of insulin after reading

Moses Barron's 'The Relation of the Islets of Langerhans to Diabetes with Special

Reference to Cases of Pancreatic Lithiasis' in the November issue of Surgery,

Gynecology and Obstetrics. For the next year, with the assistance of Best, Collip

and Macleod, Dr. Banting continues his research using a variety of different

extracts on de-pancreatized dogs.

Summer 1921 - Insulin is 'discovered'. A de-pancreatized dog is successfully

treated with insulin.

December 30, 1921 - Dr. Banting presents a paper entitled 'The Beneficial

Influences of Certain Pancreatic Extracts on Pancreatic Diabetes', summarizing his

work to this point at a session of the American Physiological Society at Yale



63

University. Among the attendees are Allen and Joslin. Little praise or

congratulation is received.

1940s - Link is made between diabetes and long-term complications (kidney and

eye disease).

1944 - Standard insulin syringe is developed, helping to make diabetes

management more uniform.

1955 - Oral drugs are introduced to help lower blood glucose levels.

1959 -Two major types of diabetes are recognized: type 1 (insulin-dependent)

diabetes and type II (Non-insulin-dependent) diabetes.

1960 - The purity of insulin is improved. Home testing for sugar levels in urine

increases level of control for people with diabetes.

1970 - Blood glucose meters and insulin pumps are developed. Laser therapy is

used to help slow or prevent blindness in some people with diabetes.

1983 - First biosynthetic human insulin is introduced.

1986 - Insulin pen delivery system is introduced.

1993 - Diabetes Control and Complications Trial (DCCT) report is published. The

DCCT results clearly demonstrate that intensive therapy (more frequent doses and

self-adjustment according to individual activity and eating patterns) delays the

onset and progression of long-term complications in individuals with type 1

diabetes.

1998 - The United Kingdom Prospective Diabetes Study (UKPDS) is published.

UKPDS results clearly identify the importance of good glucose control and good

blood pressure control in the delay and/or prevention of complications in type II

diabetes



64

. ETIOLOGY

PRIMARY

INHERENT DISPOSITION

GENETIC SUSCEPTIBILITY

AUTOIMMUNITY

HEREDITY

ENVIRONMENTAL

VIRAL INFECTIONS

BOVINE ALBUMIN

OBESITY

LIFE STYLE

MALNUTRITION

PANCREATIC DISEASES

RARE CAUSESCHEMICALLY

OTHER ENDOCRINEDISORDERS

Acromegaly

Cushings Syndrome

Phaeochromocytoma

Glucogonoma

Hyperthyrodism

Cons Syndrome

Carcinoid Syndrome

Congenital pancreatic aplasia Pancreatitis Pancreatic carcinoma Cystic fibrosis

Gestational Adrenal Pituitary Haemachromatos

Group-I

Alloxan Glycoxal etc. Diazoxide

cyproheptadyne etc.

Group-II

(eg: - Acanthosis nigricans Naunyn’s diabetes etc.)

SECONDARY

Chart No: 2

MADHUMEHA”



65

Pre-Diabetic States 66

Sometimes a patient with abnormal hyperglycemia may not have full

clinical symptoms of Diabetes mellitus and often pre-diabetic states are

asymptomatic. Mild symptoms if manifested go unrecognized but the identification

of such stages can go a long way in prevention of an overt disease. The British

Diabetic Association has suggested a classification that is accepted by W.H.O.

expert committee on Diabetes. They are as follows:

Potential Diabetes:

These are persons who have high probability of developing Diabetes. They

do not show any evidence of impaired glucose tolerance. They include,

a) Identical twin of a diabetic

b) Persons with both the parents diabetic

c) Persons with one parent diabetic, the other non-diabetic parent having a diabetic

parent or a diabetic sibling or their offspring having Diabetes.

Latent Diabetes:

a) Persons with a normal G.T.T. at present, but had an abnormal G.T.T. sometime

in the past viz. during pregnancy, infection when under stress or when obese.

b) Persons with a normal G.T.T. under standard conditions but an abnormal one

with provocative tests.

Asymptomatic Diabetes:

This stage is variously known as chemical, sub clinical or subliminal Diabetes.

They always show an abnormal G.T.T. but the fasting blood levels may be normal

in the early stage. Later on, even these levels may be raised.

MADHUMEHA”



66

CLINICAL SYMPTOMATOLOGY AND SIGNS67,68

Clinical manifestations of DM are variable and depend on the stage of

diabetes, its type, and mode of onset, age of patient and presence or absence of

complicating factors. DM before it becomes evident and symptomatic, passes

through various stages. Thus symptoms occur in a diabetic at a fairly advanced

stage of the disease.

The signs and symptoms have been summarized in the table as follows:

Table No: 6: Signs and Symptoms

Madhumeha Roopas Symptomatology of DM

Prabhoota Mootrata Polyuria

Bahvashee Polyphagia

Trushna Polydipsia

Alasya Lassitude

Sthoulya (Margavarana janya) Rapid wt. gain (especially in NIDDM)

Krusha (Sahaja) Rapid weight loss in IDDM

Mootra madhurya Glycosuria

Tanu madhurya Hyperglycaemia

PATHOGENESIS OF NIDDM 69, 70, 71

Patients with type II NIDDM have two physiologic defects viz. abnormal

insulin secretion and resistance to insulin action in target tissues, which of the

abnormalities is primary is not known. Descriptively, three phases can be

recognized in the usual clinical sequence. In the first phase, plasma glucose

MADHUMEHA”



67

remains normal despite demonstrable insulin resistance because insulin levels are

elevated.

In the second phase, insulin resistance tends to worsen so that postprandial

hyperglycemia develops despite elevated insulin concentrations. In the third phase,

insulin resistance does not change but declining insulin secretion causes fasting

hyperglycemia and overt DM. Most authorities believe that insulin resistance is

primary and that hyperinsulinaemia is secondary i.e. insulin secretion increases to

compensate for the resistance state.

However, hyper secretion of insulin may cause insulin resistance i.e. a

primary islet cell defect causes insulin hyper secretion and insulin hyper secretion

in turn leads to insulin resistance. Explanatory hypotheses increased fat synthesis

in the liver and enhanced fat transport (Via very low-density lipoprotein VLDL)

leading to secondary fat storage in the muscle.

Increased fat oxidation could impair glucose uptake and glycogen synthesis

most patients with NIDDM are obese and obesity per se causes insulin resistance,

but obesity is not the sole cause for insulin resistance. It is also true that a modest

reduction in weight often results in major improvement in the blood sugar control

in obese patients of NIDDM.

When we assess the pathophysiology of DM vis-à-vis Madhumeha

samprapti, the basic principles governing the mechanism of production of the

disease find striking similarities.



68

Table shows different explanation of madhumeha in ayurveda and modern

aspect

Table No 7: Different Explanation of Madhumeha

Madhumeha = Madhusamam Diabetes Mellitus = Honey urine

A disorder due to a Vikara Vighata Bhava Abhava witsh the involvement of all Drava Dhatus and Ojas.

Endocrinal metabolic disorder with a predominantly autoimmune pathology with wide spread complicational syndromes as a sequel sparing no cell of the body.

All the factors that are Kapha Medokara are unequivocally designated to be etiologically responsible whereby the Sneha and Kleda are abnormally increased in the body.

All the factors that lead to a lipid metabolic malfunction abnormally increasing the serum free fatty acids accompanied by increase in the VLDL and hypertriglyceridemia have been identified as invariable accompaniments of the etiology.

A condition where there is Medovaha Srotodushti including the Srotomoola Vapavahana & Vrukkau, these organs can be conveniently co-related with the two suprarenal? And pancreas based on highly suggestive evidences in the classics

A condition as a result of target specific destruction or malfunction of endocrine pancreas, as well as a condition due to hyper secretion of adrenaline (of course a secondary cause)

Madhumeha is a Sahaja as well as a Kulaja Vikara

Familial aggregation and genetic predisposition have been considered as prime etiologic factors.

Two kinds of Madhumehis- Sthula & Krusha have been identified clearly and Sthaulya is an important factor in Medodhatvagni Mandya

Obese people are more predisposed to develop the disease especially the Non Insullin Dependent Diabetes Mellitus though the non-obese people form a pretty good chunk of Diabetes Mellitus.

MADHUMEHA”



69

MANAGEMENT OF DM 72

Management, rather than treatment, is the appropriate term in DM, and

involves diet, exercise, insulin, oral hypoglycaemics, patient education and

counseling. Insulin and oral drugs are discussed here and the other aspects of

management in subsequent chapters.

INSULIN:

Insulin is required for treatment of all patients with IDDM & many patients

with NIDDM. No single standard exists for patterns of administration of insulin

and treatment plans vary from physician to physician. With a given physician for

different patients, three treatment regimes will be prescribed viz. Conventional,

Multiple subcutaneous injections (MSI) and Continuous subcutaneous insulin

infusion (CSII).

ORAL AGENTS:

Sulphonyl ureas:

NIDDM that cannot be controlled by diet & exercise often responds to

Sulphonyl ureas. Sulphonyl ureas, like Chlorpropamide & Tolbutamide act

primarily by stimulating release of insulin from β cell, but are useful only in

patients with relatively mild disease. Second generation drugs such as Glipizide &

Glyburide are effective in smaller doses and differ little from Sulphonyl ureas.

Hypoglycaemia occurs less often with oral agents than with insulin. But when it

occurs, it tends to be severe & prolonged.

Biguanides:

Metformin is useful in NIDDM patients who are not responsive to diet &

exercise. The primary action is thought to be inhibition of hepatic gluconeogenesis

MADHUMEHA”



70

& it also may enhance glucose disposal in muscle & adipose tissue. Metformin

does not cause hypoglycaemia unlike Sulphonyl ureas. Metformin can cause lactic

acidosis and so should not be given in patients with renal disease.

Thiazolidinedione derivatives:

Such as Troglitazone lower blood levels of glucose, free fatty acids &

triglycerides and appears to reduce insulin resistance. Troglitazone is approved for

use in obese patients with NIDDM who are poorly controlled on insulin.

Madhumeha DM

Margavarana janya madhumehi is

Sthoola & Balavan, so Apatarpana

chikitsa in the form of Langhana and

Nidana parivarjana.

Dhatu kshaya janya madhumehi is

Krusha & Durbala hence Santarpana

Chikitsa.

NIDDM patient is obese, so diet

exercise and oral hypoglycaemics

(sometimes insulin also)

IDDM patient is thin, so insulin

therapy.



71

DRUG REVIEW

The reference of Arogyavardhini is available in the texts Rasa Ratna

Samuchchaya of Vagbhata, Rasa Yoga Sagar of Pandit Hariprapanna Sharma and

Siddha Yoga Samgraha of Vaidya Yadavji Trikamji Acharya. It is also available

in Bheshaja Samhita, pharmacopia of government of Gujarat.

Among these available references, the oldest is Rasa Ratna Samuchchaya

written by Rasavagbhata. This is a text of 13th – 14th century AD. In this text Rasa

Vagbhata admits that the formulation of ‘Arogyavardhini’ was done by Nagarjuna

originally. The time of Nagarjuna has been assessed to be 7th – 8th cent AD. And

hence it can be said that the formulation of Arogyavardhini was done by Nagarjuna

during 7th – 8th cent AD. The ingredients, procedure, form and dosage of

administration, therapeutic uses is as follows.1

Ingredients –

1. Shuddha soota – 1 part 7. Triphala –

2. Shuddha Gandhaka – 1 part Haritaki - 2 parts

3. Loha Bhasma – 1 part Bibheetaki - 2 parts

4. Abhrak Bhasma – 1 part Amalaki - 2 parts

5. Tamra Bhasma – 1 part 8. Shuddha Pura i.e Guggulu

- 4 parts

6. Shuddha Shilajatu –3 parts 9. Chitraka moola - 4 parts

10. Tikta – i.e. Katuki - 22 parts

Bhavana Drava – Nimba-vriksha-dala-ambu.

1. Time for Bhavana – ‘Dwidinavadhi’

2. Procedure – The ingredients must be given bhavana of Nimba patra swarasa.

MADHUMEHA”



72

3. Form of administration – Vati. Vatis must be prepared as large as ‘Raja kola

phala’.

4. Dosage – ‘Raja kola phala pramana’

5. Duration of Therapy – One mandala for kushta, panchadina for Jwara etc.

6. Therapeutic uses – Kushta, Jwaras due to tridoshas, Paachani, deepani, Hridya,

Pathya, Medovinashak, ‘Malashuddhi kari’, ‘Durdharsha-kshut-pravartini’.

Further the author himself expresses his astonishment towards the action of

this Arogyavardhini indicating its multidimensional action in all diseases.

Other texts mentioned above are texts of 20th century AD. In these texts we

find slight modifications in the formulations, proportions, procedures, dosage and

indications.

Presently, it can also be noted that the formulation is called

‘Arogyavardhini’, but the original formulation calls it ‘Arogyavardhani’ which

means that it does ‘vardhana’ of ‘Arogya’. With the influence of time it has been

presently called as ‘Arogyavardhini’. The same formulation is also called

‘Arogyavardhini Rasa’ by some of the present day manufacturers.

Thus it can be seen, that ‘Arogyavardhini’ formulation originally

formulated by Nagarjuna in 7 – 8th cent AD has its record in a classical text Rasa

Ratna Samuchchaya of Rasa vagbhata of 13th – 14th cent AD. It can be seen in

other present-day texts with modifications in proportions, dosage, indications etc.

with retaining its original ingredients as it is.

Parad:

Rasa Panchaka of Parad.

Rasa – Shadrasa Veerya – Ushna



73

Guna – Snigdha, sara Vipaka – Madhura

Karma – Yogavahi, Rasayana, ativrishya, balya, vajkara, vayastambhakara,

dehasiddhakara, lohasiddhakara, khe-gatiprada, purushartha chatushtaya- prada,

Ayush-kara, Bhukti-mukti-prada, dristi-bala-prada, krimighna, Ropana, Shodhan,

Agni-vardhak, Pushtikara etc.

Doshaghnata – Tridoshahara,

Rogaghnata – Tapatrya janyaroga, papaja roga, krimi, vataroga, Akshiroga,

sarvarogahara especially ‘sarvakushta nut’.

Gandhaka-Sulphur:

Rasapanchaka –

Rasa – Katu Vipaka – Katu

Guna – Teekshna Veerya – Ushna

Karma of Gandhak –

Karma – Agni-deepak, Ama-pachaka, Kleda-shoshaka, Visha-nashak, soota-

veerya-prada, Ati-rasayan etc.

Doshaghnata – Vata and Kapha-hara, Pitta-vardhaka

Rogaghnata – Kushtaghna, Kandughna, visarpa-hara, Dadru-nashana, Krimi-hara

etc.

Loha Bhasma:

IRasa Panchaka – Veerya – Sheeta

Rasa – Tikta, Madhura, Kashaya Vipaka – Madhura

Guna – Rooksha, Sara, Guru Dosage – 1/4 - 2 Ratti = 31.25 - 250 mg.

Doshaghanata – Pitta and Kapha-hara.

MADHUMEHA”



74

Karma – Best Yogavahi, ‘Yogena Nanartinut’, Lekhana, Balya, Vrishya,

Ayushya, Kushtamaya dwamsak, Deepana, Shreshta Rasayan.

Abhrak bhasma:

Rasapanchaka of Abhrak bhasma –

Rasa – Madhura Veerya – Paramsheeta

Guna – Snigdha Vipaka-madura

Karma – ‘Agraganya in ayushya dravyas’ – Shreshta among ayur-vardhak dravyas.

Keshya, varnya, deepana, atibalya, chakshushya, medha-vardhak, stanya-vardhak,

Kshetra-sthairya – stabilization of shareera, Pushpaketodeepana – Kaamavardhak

etc.

Doshaghnata – tridosha-hara

Rogaghnata – ‘Maharogasanghata bheetim dalayati’ – it destroys the fear of

manifestation of maharogas, Kshayahara, ‘Tatatyogaihi sakala gadahari – destroys

all diseases in combination with different yogas.

Tamrabhasma:

Rasapanchaka of Tamrabhasma –

Rasa – Tikta, Kashaya Veerya – Ushna

Guna – Laghu (Sha. sam). Vipaka – Madhura

Doshaghnata – Pitta, Kapha

Karma – Lekhana, Vranaropana, Netrya, Amahara

Rogaghnata – Udara, Kushta, Yakrit pleeha roga, shoola, parinama shoola,

sthoulya, Krimi etc.

Triphala:

Rasa panchaka of Haritaki



75

Rasa – Kashaya pradhana lavanavarjita pancharasa

Guna – Laghu Ruksha Veerya - Ushna

Vipaka – Madhura Prabhava – Tridoshahara

Karma – Haritaki is Deepana, Paachana, Aayushya, Poushtika, best rasayana and

enhances buddhi, indriya, it is sarvadoshahara.

Rogaghnata – Kushta, Gulma, Udavarta, Shosha, pandu, arshas, grahanidosha,

purana jwara, vishamajwara, hridroga, shiroroga, kasa, prameha, pleena, udara,

krimi, kamala, vaivaswarya, kapha praseka, shwayahtu, chardi, cl

Rasa Panchaka of Bibheetaki –

Rasa – Kashaya Vipaka – Madhura

Guna – Ruksha, Laghu Veerya – Ushna

Doshaghnata – Tridoshas, predominantly kaphahara.

Karma – Best keshya, Bhedana, chakshushya, charaka has specified that

bibheetaki removes / destroys doshas of Rasa, Rakta, mamsa and meda dhatus and

also destroys kleda.

Rogaghnata – Kasa, Krimi, Vaisbarya, trishna, chardi etc.

ears srotorodhas.

Rasapanchaka of Amalaki

Rasa – Amlapradhana lavanavarjita pancharasa. Vipaka – Madhura

Guna - Guru, Ruksha Sheeta. Veerya – Sheeta

Doshaghnata – tridoshahara.

Karma – The karma, gunas of Amalaki are similar to that of Haritaki with

some more added qualities (vishesha). It is a Rasayana, Vrishya.

MADHUMEHA”



76

Rogaghnata – Raktapitta, Prameha, Vibandha, Adhmana, Vishtambha, parinama

shoola.

Shilajatu: Black bitumen, Asphaltum, Mineral Picth

Rasapanchaka of shilajatu–

Rasa – tikta, katu Vipaka – katu

Doshaghnata – Sleshmahara Veerya – Ushna

Guna – Laghu, sara shilajatu has all the qualities of maharasa, uparasa, parad,

Ratnas and lauhas, yogavahi.

Karma – Rasayana, amahara, very much helpful in dehasiddi and loha siddhi, jara

and mrityuhara

Rogaghnata – Jwara, Pandu, Shotha, Prameha, Mandagni, Medoroga – by

medachedan, Yakshma, Shoola, Gulma, Pleeha, all Jatharagnivikaras, sarvaroga

etc.

Guggulu: Commiphora mukul

Raa panchaka of guggulu

Rasa – Tikta, kashaya, katu, madhura. Veerya – Ushna

Guna – Vishad, sara, laghu, rooksha, sookshma. Vipaka – Katu

Karma – Agnideepaka, vatanulomana, sookshmasotogami, rasayana pidikahara.

Doshaghnata – Tridosha especially kapha, vata.

Rogaghnata - Medoroga, kushtahara, vatavyadhi etc.

Chiraka Mula:

Rasapanchaka–

Rasa – Katu Veerya – Ushna

Guna – Laghu, Rooksha Vipaka - Katu



77

Doshaghnata - Vata, Shleshma Karma – Agni-vardhak, Pachak, Graahi

Rogaghnata – Grahani, Kushta, Pandu, Guda Shotha, Arshas, krimi, kasa, etc.

According to Abhinava Navajeevanam there is no other drug like chitraka which

could cure all the diseases.

Katuki:

Rasa Panchaka –

Rasa – Tikta Veerya – Sheeta

Guna – Laghu, rooksha Vipaka – Katu

Dosha – Kapha, Pitta Karma – Bhedini, deepani, hridya

Rogaghnata – Prameha, shwasa, kasa, daha, kushta, krimi, etc.

Nimba:

Rasa Panchaka –

Rasa – Tikta, Kashaya, Vipaka – Katu

Guna – Laghu, snigdha Verya – Sheeta

Doshagnata – kapha-pitta-hara

Karma – Nimbapatra is chakshushya, Krimi-hara, pitta-hara, visha-hara, vata-kara

destroys all types of Arochaka, Kushta-hara.

MADHUMEHA”

Materials and methods

MATERIALS AND METHODS:

MATERIALS:

The present study was undertaken with following headings.

a) Literary study.

b) Clinical study.

a) Literary study:

Source of Literary study

The lierary sources regarding samanya vishesha siddhanta and Madhumeha

were compiled from classical texts, periodicals and electronic media. Thus the

collected matter was properly classified and presented as literary review.

b) Clinical stdy:

Materials

The following were the materials used for the clinical study,

1. Diagonised patients of Madhumeha

2. Arogya vardhini vati.

METHODS:

Aims of the study:

The aims of study was to evaluate the hypoglycemic effect of arogyavardhini vati

Selection of Yoga:

Arogya vardini vati

The ingredients of arogyavardini vati were shuddha paarada,shuddha

gandaka,loha bhasma, abraka bhasma,abraka bhasma,tamra bhasma,triphala

churna,shuddha shilajitu,shuddha guggulu,chitraka mula, katuki churna. For


77

Materials and methods purpose of clinical study these were purchased from Sri dhanvanthari pharmacy,

dhanvantari complex Malladi halli.

Preparation of Yoga:

Shudda parada and shudda gandaka were taken and made in to kajjali

form then the churna of drugs were mixed one by one after that nimba was added

and bhavana was given for three days.

Sources of Data:

The patients of either sex and between the age of 35-65yrs diagnosed as

Madhmeha selected incidentally for the study from the OPD of DR .BNMETrust

Shri Mallikarjuna swamiji post graduate and research centre.

1) Patients fulfilling the inclusive criteria.

Sampling Method:

In the present clinical study 34 patients were screened out of which there

were four dropouts during various stages of the clinical study. The patients were

treated as out patient of Dr.BNMETs,Ayurvedic hospital, Bijapur for present

study with the help of Performa prepared for the study .The patient included in the

study were explained in detail about the interventions of single group

Criteria for Selection of Patients:

1. Patients of either sex between type age group of 35-65yrs with the existence of

pratyatmaka laxana of madhumeha

2. patients fulfilling the criteria recommended by American Diabetes Association

i.e FBS >126mg/dl,PPBS>160mg/dl also were taken for the present study


78

Materials and methods Assessment of Response: The assessment of response of the patients were made on the basis of

improvements observed in the following subjective and objective parameters such

as

Subjective Parameters Includes:

Prabhootamootrata

Avilamootrata

Trishna

Karapada daha

Dourbalya

Alasya

Karapada suptata

Objective Parameters Include:

Blood sugar - fasting and postprandial

Urine sugar - fasting and postprandial

Investigation:

The investigations like FBS, PPBS and corresponding urine sugar were done on

mandatory basis for each patient before starting the treatment and were repeated

every fortnightly after starting the treatment to assess the efficacy of the therapys


79

0-Normal Range (80 – 126mg/dl)

0-Normal Range (120mg /dl -160mg /dl )

1-above 126mg /dl upto 150mg /dl




Fasting Blood Sugar

3-above 180mg /dl

Post Prandial Blood Sugar


Materials and methods

0-absence of glucose in urine ( No ppt )

1-presence of 0.5 % of glucose in urine ( green ppt )

2-presence of 1 % of glucose in urine ( yellow ppt )

3-presence of 1.5 % of glucose in urine ( orange ppt )

Urinesugar

4-presence of 2 % of glucose in urine ( brick red ppt )

Inclusive Criteria:

1. Diagonised patients of Madhumeha between 35 to 65 yrs of age group and

of either sex.

2. Patients of NIDDM with FBS raging from 126mg/dl-180mg/dland PPBS

ranging from 160mg/dl -250mg/dl.

Exclusive Criteria:

1) Patient with other systemic disorders.

2) Patients of IDDM.

Study Desing:

In the present study 30 patients were selected in a single group.

Observation:

All the patients irrespective of group were observed for age, sex, prakruti,

agni, kosta etc.

Gradation of Diseased Status:

The disease was assessed on subjective parameters.Seven variables were

included for subjective assessments and were assessed as:


80

Materials and methods Normal Grade-1

Mild Grade-2

Moderate Grade-3

Severe Grade-4

and were scored as 1-2-3-4 respectively based on fourth point scale gradation and

overall severeity of the disease was assessed on the sum of variable. The detailed

scheme of assessment of initial variables and overall assessment is provided with

clinical performa exclusively designed for the above study

Interventions:

After the completion of the treatment, follow up of 15 days was taken with

ideal diet. The data was collected from single group at the end of the treatment,

follow up of 15 days and statistically analysed

Pathya Apathya:

Patients were advised to take plenty of bitter gourd, cabbage, snake gourd,

drum stick, brinjal, onion, garlic, all leafy vegetables, unripe banana, yam, carrot in

form of different curries with less oil and coconut. Pulses like green gram, red

gram, Bengal gram, could be consumed in the form of different dishes. Rice and

wheat could also be consumed but the quantity was reduced. Fruits such as

pomegranate, papaya, dates, guava, fig can be taken. A minimum of 2km brisk

walk or exercise to his or her own strength was advised regularly.

Food Items to be avoided:

Patients were asked to avoid sweets, oily preparations, ghee, curds, butter,

cream, sugar, sweets, jam and. jellies deeply fried food stuffs, bakery foods like

cakes and pasteries, and fruit juices. Quantity of fish, mutton etc. non-vegetarian


81

Materials and methods diets were either reduced or were asked to avoid them. The vegetables like

pumpkin, potato, sweet potato beetroot, and bottle gourd should be avoided. The

black gram is avoided and new cereals.

OVER ALL ASSESSMENT OF SEVERITY:

1 CD: clinically deteriorated.

2 CS: clinically stable.

3 CI-1: Encouraging CI-2:Good CI-3: Excellent

ASSESSMENT OF CLINICAL IMPROVEMENT:

1. CD: clinically deteriorated, i.e increase in severity score against the initial

score.

2. CS: clinically stable, i.e severity score remains as against the initial score.

3.CI-1: Encouraging i.e 1 degree reduction in the severity score against the

initial score ,i.e reduction from mild to normal ,moderate to mild and sever to

moderate

4. CI-2: Good i.e 2 degree reduction in the severity score against the initial

score i.e reduction from moderate to normal, sever to mild.

5. CI-3: Excellent, 3 degree reduction in the severity score against the initial

score i.e reduction from sever to normal.

Data Collection:

The data from each group were collected before treatment, at the end of the

treatment and at the end of the followup.

The data thus collected was properly documented, tabulated and were

subjective for stastical analysis.


82

Materials and methods Satastical Analysis:

The data collected from individual group, were coputed for mean SD

(Standard Deviation) SE (Standard Error), t-value, p-value and obtained by

students‘t’ test and statistical values were compiled and analysed.


83

Observation and Results


84

OOBBSSEERRVVAATTIIOONNSS AANNDD RREESSUULLTTSS

Total 30 patients were taken for clinical study. The observations for

present study were done in the Following stages:

Section I – Demographic Data

Section II – Data related to Disease

Section III – Statistical Analysis

Section IV – Overall Results

SECTION I – DEMOGRAPHIC DATA

1. INCIDENCE OF AGE :

Table No 8: Distribution of patients According to Age. (n=30)

Sl. No Age in years No of patients %

1 35-45 17 56.6

2 46-55 11 36.6

3 56-65 2 6.6

Graph No 1 : Distribution of Patients According to Age

In the present study it was observed that 17 patients (56.6%) were of 35-45

yrs, and 11 patients (36.66%) were of 46-55 yrs and 2 patients (6.6%) were of 56-

65 age.


2. INCIDENCE OF SEX :

Table No 9: Distribution of Patients According to Sex. (n=30)

Sl. No Sex No of patients %

1 Male 17 56.6

2 Female 13 43.3

Graph No 2: Distribution of Patients According to Sex.

In the present study it was observed that 17 patients (56.6%) were

male and 13 patients (43.3%) were females.


85


3. INCIDENCE OF RELIGION :

Table No 10: Distribution of patients According to Religion. (n=30)

Sl. No Religion No of patients %

1 Hindu 28 93.33

2 Muslim 2 6.6

Graph No 3: Distribution of Patients According to Religion.

Majority of patients observed were Hindu 28 patients (93.3%) and Muslim

were 2 patients (6.6%).


86


4. INCIDENCE OF OCCUPATION :

Table No 11: Distribution of Patients According to Occupation (n=30)

Sl. No Occupation No of Patients %

1 House wife 10 33.3

2 Business 13 43.3

3 Employee 5 16.6

4 Nurse 2 6.6

Graph No 4: Distribution of Patients According to Occupation

The patients from various occupations were observed for the study. Among

them 10 patients (33.3%) were house wife, 13 patients (43.3%) were business, 5

patients (16.66%) were nurse and patients (6.6%) were employee.


87


5. INCIDENCE OF SOCIO-ECONOMIC STATUS :

Table No 12: Distribution of Patients According to Socio-Economical Status. (n=30)

Sl. No Socio economical status No of patients %

1 Upper Middle class 17 56.6

2 Middle class 11 36.6

3 Lower class 2 6.6

Graph No 5: Distribution of Patients According to Socio-Economical Status.

In the present study maximum patients observed were of upper middle class

i.e. 17 patients (56.6%),were patients observed of middle class is,11 patients

(36.6%) and were patients observed of lower class is 02 patients (6.6%) .


88


6. INCIDENCE OF MARITAL STATUS :

Table No 13: Distribution of Patients According to Marital Status. (N=30)

Sl. No Marital status No of patients %

1 Married 28 96.6

2 Unmarried 2 6.6

Graph No 6: Distribution of Patients According to Marital Status.

Maximum patients observed for the study were married 28 patients

(96.6%) and unmarried are only 02 patients (6.6%).


89


7. INCIDENCE OF AHARA :

Table No 14: Distribution of Patients According to Ahara (N=30)

Sl. No Ahara No of patients %

1 Veg 20 66.6

2 Mixed 10 33.3

66.6

33.3

Veg

Mixed

Graph No 7: Distribution of Patients According to Ahara

Among the patients observed for study vegetarians were 20 patients

(66.6%) and those who took mixed diet were 10 patients (33.3%).


90


8. INCIDENCE OF AGNI:

Table No 15: Distribution of Patients According to Agni (N=30)

Sl. No Agni No of patients %

1 Vishama 18 60

2 Teekshna 8 26.6

3 Manda 4 13.3

Graph No 8: Distribution of Patients According to Agni

In the present study it was observed that of vishama 18 patients (60%),

were the 8 teekshnagni patients (26.6%) and only4 patients (13.3%) were having

manda.


91


9. INCIDENCE OF KOSTHA:

Table No 16: Distribution of Patients According to Kostha. (n=30)

Sl. No Kostha No of patients %

1 Krura 18 60

2 Madhyama 4 13.3

3 Mrudu 8 26.6

Graph No 9: Distribution of Patients According to Kostha

Patients registered for study were assessed for mrudu, madhyama and krura

kostha, majority of patients with krura kostha i.e. 18 (60%), 4 patients were

madhyama kostha (13.3%) and 8 patients (26.66%) of mrudu kostha.


92


10. INCIDENCE OF PRAKRUTI :

Table No 17 – Distribution of Patients According to Prakruti (n=30)

Sl. No Prakruti No of patients %

1 Kaphavata 19 63.3

2 Kaphapitta 5 16.6

3 Vatakapha 6 20

Graph No –10 Distribution of Patients According to Prakruti

In the present study it was observed that of Kaphavata Prakruti there were 19

patients (63.3%), were 5 Kaphapitta Prakruti (16.6%), and of Vatakapha Prakruti 6

patients (20%).


93


11. INCIDENCE OF BALA:

Table No 18: Distribution of Patients According to Bala. (n=30)

Sl. No Bala No of patients %

1 Pravara 04 13.33

2 Madhyama 18 60

3 Avara 08 26.66

Graph No. 11: Distribution of Patients According to Bala.

In the present study it was observed that 4 patients (13.33%) were pravara,

18 patients (60%) were madhyama and 8 patients (26.66%) were of avara bala.


94


12. INCIDENCE OF SATWA:

Table No 19: Distribution of Patients According to Satwa. (n=30)

Sl. No Satwa No of patients %

1 Pravara 05 16.66

2 Madhyama 19 63.33

3 Avara 06 20

Graph No 12: Distribution of Patients according to Satwa.

In the present study it was observed that 5 patients (16.66%) were pravara,

19 patients (63.33%) were madhyama and 6 patients (20%) were of avara satwa.


95


13. INCIDENCE OF VYASANA:

Table No 20: Distribution of Patients According to Vyasana. (n=30)

Sl. No Vyasana No of patients %

1 Alcohol 08 26.66

2 Smoking 06 20

3 Tobacco 06 20

4 Tea/coffee 10 33.33

Graph No 13: Distribution of Patients according to Vyasana.

In the present study it was observed that 8 patients (26.66%) were

alcoholics, 06 patients (20%) were smokers, 6 patients (20%) had habit of tobacco

chewing and 10(33.33%) had the habit of tea/coffee.


96


SECTION II – DATA RELATED TO DISEASE

DISTRIBUTION OF PATIENTS ACCORDING TO SEVERITY

BEFORE TREATMENT Table No.21: Different Degree of Assessment Criteria before Treatment

Severity Sl.No. Assessment

Criteria NR

G1

% MLD

G2

% MDR

G3

% SVR

G4

%

1. Prabhootamutrata - - 4 13.33 23 76.66 3 10

2. Avilamutrata - - 14 46.66 16 53.33 - -

3. Thrushna - - 12 40 18 60 - -

4. Alasya - - - - 16 53.33 14 46.66

5. Dourbalya - - 1 3.33 17 56.66 12 40

6. Karapada Daha - - 2 6.66 22 73.33 6 20

7. Karapada Suptata - - 16 53.33 14 46.66 - -


97

Graph. No. 14: Different Degree of Assessment Criteria Before Treatment


DISTRIBUTION OF PATIENTS ACCORDING TO SEVERITY

AFTER TREATMENT

Table No.22 Different Degree of Assessment Criteria after Treatment


98

Severity No. Assessment

Criteria NR % MLD % MDR % SVR %

G1 G2 G3 G4

1. Prabhootamutrata - - 11 36.66 18 60 1 3.33

2. Avilamutrata 2 6.66 19 63.33 9 30 - -

3. Thrushna 2 6.66 18 60 10 33.33 - -

4. Alasya - - 3 10 20 66.66 7 23.33

5. Dourbalya - - 6 20 17 56.66 7 23.33

6. Karapada Daha - - 8 26.66 19 63.33 3 10

7. Karapada Suptata - - 24 80 6 20 - -

Graph No. 15: Different Degree of Assessment Criteria after Treatment

Observation and Results DISTRIBUTION OF PATIENTS ACCORDING TO SEVERITY

AFTER FOLLOW UP

Table No.23 Different Degree of Assessment Criteria after Follow up Treatment


99

Severity No. Assessment

Criteria NR % MLD % MDR % SVR %

G1 G2 G3 G4

1. Prabhootamutrata - - 11 36.66 17 56.66 2 6.66

2. Avilamutrata 2 6.66 19 63.33 9 30 - -

3. Thrushna - - 16 53.33 14 46.66 - -

4. Alasya - - 3 10 16 53.33 11 36.66

5. Dourbalya - - 6 20 17 56.66 7 23.33

6. Karapada Daha - - - - 28 93.33 2 6.66

7. Karapada Suptata - - 17 56.66 13 43.33 - -

Graph No. 16: Different Degree of Assessment Criteria After Follow up Treatment


RESPONSE OF THE THERAPIES {AFTER TREATMENT} Table No. 24: Results after Treatment (BT-AT)

Sl.

No.

Signs /

Symptoms

CI

-

III

% CI

–

II

% CI

– I

% CS % CD %

0 0 0 0 9 30.00 21 70 0 0 1. Prabhootamutrata

0 0 0 0 9 30.00 21 70 0 0 2. Avilamutrata


100

3. Thrushna 0 0 0 0 10 33.33 20 66.66 0 0

4. Alasya 0 0 0 0 10 33.33 20 66.66 0 0

0 0 0 0 10 33.33 20 66.66 0 0 5. Dourbalya

0 0 0 0 9 30.00 21 70 0 0 6. Karapada Daha

0 0 0 0 8 26.66 22 73.33 0 0 7. Karapada Suptata

Excellent Response - None of the patients showed excellent response after

treatment.

Good Response - None of the patients showed excellent response after treatment.

Encouraging Response – 9(30%) patients in Prabhootamutrata, Avilamutrata &

Karapada Daha, 10(33.33%) patients in Thrushna, Alasya and in Dourbalya,

8(26.66%) patients in Karapada Suptata showed encouraging response after

treatment.

Stable – 21 (70%) patients in Prabhootamutrata, Avilamutrata & Karapada Daha,

20(66.66%) patients in Thrushna, Alasya and in Dourbalya, 22(73.33% ) patients

in Karapada Suptata were stable after treatment.

Deteriorated - No patients had shown clinically deterioration in any symptom at the end of the treatment.


RESPONSE OF THE THERAPIES {AFTER FOLLOW UP} Table No. 25: Results after Follow Up Treatment (BT-AFU)

Sl.

No.

Signs /

Symptoms

CI

-

III

% CI

–

II

% CI

–

I

% CS % CD %


101

1. Prabhootamutrata 0 0 0 0 14 46.66 10 33.33 6 20

2. Avilamutrata 0 0 0 0 10 33.33 20 66.66 0 0

3. Thrushna 0 0 0 0 4 13.33 26 86.66 0 0

4. Alasya 0 0 0 0 9 30.00 18 60.00 3 10

5. Dourbalya 0 0 0 0 10 33.33 20 66.66 0 0

6. Karapada Daha 0 0 0 0 6 20.00 20 66.66 4 13.33

7. Karapada Suptata 0 0 0 0 2 6.66 27 90.00 1 3.33

Excellent Response - None of the patients showed excellent response after follow

up.

Good Response - None of the patients showed excellent response after follow up.

Encouraging Response – 14(46.66%) patients in Prabhootamutrata, 10(33.33)

Avilamutrata & Dourbalya, 4(13.33%) patients in Thrushna, 9(30%) patients in

Aiasya, 6(20%) patients in Karapada Daha, 2(6.66%) patients in Karapada Suptata

showed encouraging response after follow up.

Stable – 10 (33.33%) patients in Prabhootamutrata, 20(66.66%) patients in

Avilamutrata, Dourbalya & Karapada Daha, 26(86.66%) patients in Thrushna,

18(60%) patients in Alasya, 27(90% ) patients in Karapada Suptata were stable

after follow up.

Deteriorated – 6(20%) patients in Prabhootamutrata, 3(10%) patients in Alasya,

4(13.33%) patients in Karapada Daha, 1(3.33%) patient in Karapada Suptata had

shown clinically deterioration at the end of the treatment.


COMPARISION OF RESPONSE OF INDIVIDUAL SYMPTOM AT THE END OF TREATMENT AND POST TREATMENT

FOLLOW UP 1. PRABHOOTAMUTRATA:

Graph No- 14: End of Treatment Graph No- 15: Post Treatment F/U 2. AVILAMUTRATA:

Graph No-16: End of Treatment Graph No-17: Post Treatment F/U

3. THRUSHNA:


102

Graph No.18: End of Treatment Graph No. 19: Post Treatment F/U

Observation and Results 4. ALASYA


103

Graph No. 20: End of Treatment Graph No. 21: Post Treatment F/U

5. DOURBALYA:

Graph No- 22: End of Treatment Graph No. 23: Post Treatment F/U

6. KARAPADA DAHA:

Graph No- 24: End of Treatment Graph No- 25: Post Treatment F/U

Observation and Results 7. KARAPADA SUPTATA:


104

Graph No. 26: End of Treatment Graph No. 27: Post Treatment F/U


STATISTICAL ANALYSIS

RESULTS OF INDIVIDUAL CLINICAL SYMPTOMS BEFORE TREATMENT, AFTER TREATMENT AND AFTER FOLLOW

UP IN MADHUMEHA Table No.26: Statistcal Analysis

Variables Grading Mean SD SEM ‘t’ value

‘P’ value Remarks


105

BT 2.97 0.49 0.09 AT 2.67 0.55 0.10

2.2380 =0.0291 S

BT 2.97 0.49 0.09

Prabhoot Mutrata

AFU 2.70 0.60 0.11 1.8929 =0.0634 S

BT 2.53 0.51 0.09 AT 2.23 0.57 0.10

2.1567 =0.0352 S Avila Mutrata

BT 2.53 0.51 0.09 AFU 2.20 0.55 0.10

2.4377 =0.0179 S

BT 2.60 0.50 0.09 AT 2.27 0.58 0.11

2.3799 =0.0206 S Trishna

BT 2.60 0.50 0.09 AFU 2.47 0.51 0.09

1.0269 =0.3087 NS

BT 3.47 0.51 0.09 AT 3.13 0.57 0.10

2.3893 =0.0202 S Alasya

BT 3.47 0.51 0.09 AFU 3.20 0.61 0.11

1.8403 =0.0708 NS

BT 3.37 0.56 0.10 AT 3.03 0.67 0.12

2.0994 =0.0401 S Dourbalya

BT 3.37 0.56 0.10 AFU 3.03 0.67 0.12

2.0994 =0.0401 S

BT 3.13 0.51 0.09 AT 2.83 0.59 0.11

2.1072 =0.0394 S Karapada Daha

BT 3.13 0.51 0.09 AFU 3.07 0.25 0.05

0.6437 =0.5223 NS

BT 2.47 0.51 0.09 AT 2.20 0.41 0.07

2.2458 =0.0285 S

BT 2.47 0.51 0.09

Karapada Suptata

AFU 2.43 0.50 0.09 0.2553 =0.7994 NS


SECTION IV – OVERALL RESULTS

Table No.27: Final Results of Improvement In the patients of Madhumeha


106

Single Group No. Grading Improvement

No %

1. Cured - -

2. Marked Improvement 2 6.66%

3. Moderate Improvement 14 46.66%

4. Mild Improvement 11 36.66%

5. Unchanged 3 10%

Graph No- 42 Final Results of Improvement in the patients of Madhumeha

Discussion

DISCUSSION

Ayurveda has accepted the shatpadartha theory of vaisheshika darshna and

has enumareted padartha as samanya, vishesha, guna, dravya, karma, and

samavaaya..Acharya charaka has deliberately followed this padartha, hence

indicating the importance of samanya and vishesha samanya and vishesha has got

much importance and applicability than the other padarthas. Another reason for

this is even the other padarthas of dravya,guna and karma are being learnt from the

perceptive of samanya and vishesha as dravya samanya ,guna samanya, karma

samanya and dravya vishesha, guna vishesha, karma vishesha.This samanya and

vishesha padarthas have been accepted as samanya vishesha siddhanta in ayurveda

. Vishesha is one of the Sat Karanas described by Acarya Caraka in

Sutrasthana first chapter. These Sat Karanas help a physician to achieve the goal of

Dhatusamyavastha. This Dhatusamyavastha i.e. the equilibrium condition of

Dhatu's is disturbed by two conditions i.e. Vrddhi or Ksaya. Out of these both,

Vrddhi is important one because several Acaryas opine that Ksayavastha of Dosa's

does not lead to any type of Vyadhi. Therefore, the only condition remains is

Vrddhi which can be treated by Vishesha only as per the hypothesis. Because in

the condition of Vrddhi what is needed to do is Hrasa of the body constituents,

which are in increased levels. To get this effect of Hrasa one has to go for the use

of Vishesha principle.

In the conceptual study all the factors regarding Vishesha are explained

separately. Various definitions of Vishesha, by several Acaryas and commentators

are mentioned in detail. As per the conceptual study it can be said that vishesha is

the entity which gives a sense of dissimilitude (Atulyar thata) and owing to this


107

MADHUMEHA”

Discussion dissimilitude it causes differentiation (Prthaktva). But what Ayurveda expects is

not mere a differentiation but an effect of Hrasa also. If there are some factors

acting against Vishesha then it will not be the cause of Hrasa. Vishesha will be

cause of Hrasa only in absence of inhibiting factors.

As per the aims and objectives of the study, while going through

Vaisheshika Darshana it is found that Sat karanas are described as Sat Padarthus.

The detail description of various definitions of Vishesha by Kanada (Vaisheshika

Sutra) and commentators is explained in conceptual study. It is found that due to

the difference in the aims of Vaisesika Darshana and Ayurveda there lays a

difference between the definitions of Vishesha. Here, the word 'Darshana' itself

indicates knowledge, all the Darshanas are meant for the purpose of getting

knowledge. As aim of Vaisheshika Darshana is to achieve a state of Nisreyas and

for achieving this state it is necessary that one should get the detail knowledge of

all the objects in the Universe. The path which is shown by Vaisheshika Darshana

to achieve this goal is to get the detail knowledge of these Sat Padarthas.

Vaisheshika Darshana defines Vishesha as a cause of Absolute Differentiation.

Vishesha helps to differentiate two objects from one another. Due to this

differentiating property it has got some synonyms like Vyavartaka, Vyavachedaka

etc. Due to the same, Vishesha helps to fulfill the aim of Vaisheshika Darshana by

differentiating the different objects. In Vaisheshika Darshana a term used for

Vishesha is Anitya Vishesha which suggests that Vishesha resides into Nitya

Dravyas only. But in case of Ayurveda, 'Dhatusamyavastha' is the principle aim.

To achieve this aim it is not sufficient just to get the knowledge of Vishesha but it

requires the use of drugs which are having Vishesha property. Here lies a

difference between Ayurveda and Vaisheshika Darshana because Ayurveda


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MADHUMEHA”

Discussion considers a substance as Vishesha only if it is having the ability of Hrasa

(Diminution). It is not like that Ayurveda completely contradicts the definition of

Vishesha by Vaisheshika Darshana. But in Ayurveda one more important

characteristic is added to the definition of Vishesha and that is 'Hrasa Hetu'.

Ayurveda has accepted the definition of Vishesha by Vaisheshika Darshana as a

differentiator and termed it as 'Visheshastu Prthaktvakrta' and Visheshastu

Viparyayah (Atulyarthata). Ayurveda has not accepted the substance as Vishesha if

it is having only dissimilar characteristics and not having the ability of Hrasa

(Diminution).

Regarding the types of Vishesha.Cakrapani has taken some philosophical

view and classified it as Viruddha and Aviruddha Vishesha. Cakrapani gives the

classification that Viruddha Vishesha is the direct cause for Hrasa, whereas

Aviruddha Vishesha is the indirect cause for Hrasa. Further Cakrapani himself

quotes that Aviruddha Vishesha neither causes Vrddhi nor Hrasa. Such

contradictory statements create confusion. Actually there is no need to consider the

types like Viruddha Vishesha and Aviruddha Vishesha. As Acarya Caraka quoted

if a substance is doing Hrasa then it should be considered as Vishesha and if it is

not doing so then it should not be considered as Vishesha. Here there is no need to

go for Viruddha and Aviruddha Vishesha because definition by Acarya Caraka

itself solves the problem of Vishesha.

One more anonymous classification of Vishesha is available in Cakrapani

commentary i.e. Dravya, Guna and Karma Vishesha. It is said that Dravya, Guna

and Karma Vishesha should be inferred from those consecutive verses (i.e. Ca.Su.

1/44/45) but Cakrapani himself and Bhattara Harichandra have contradicted this

view. Cakrapani has tried to explain Dravya, Guna and Karma Samanya with


109

MADHUMEHA”

Discussion various examples but he didn't speak anything regarding Dravya, Guna and Karma

Vishesha. Here Cakrapani says that Dravya Guna and Karma Vishesha should be

understood by examples of Dravya, Guna and Karma Samanya. It is already

mentioned in the aims and objectives to explore the concept of Dravya, Guna and

Karma Vishesha. Though the examples like Raktam-Rakten, Mamsam-

Mamsena….. | are given in the classics for Dravya Samanya it can be understood

that the Mamsadhatu of the consumer and the external Mamsa which is to be

consumed both are not one and same. Here one can say that maximum

characteristics of both like external appearance and qualities are same. Owing to

this maximum similarity it will cause maximum increase of that substance into the

body. Here one can term this external appearance of that substance as the 'Jati' of

that substance. From this it can be said that while considering Dravya Vishesha

one should give importance to the Jati of that substance along with qualities. So

Dravya Vishesha can be defined as a substance which is having the different "Jati"

with opposite qualities e.g. Pitta-Vrddhi and Praval.

In case of Pittavrddhi, Pitta is in drava condition (liquid) with its Usna,

Tiksna properties, if one wants to pacify this Pitta with Dravya Vishesha then drug

of choice should be in Parthiva (solid form) with opposite qualities.

In case of Guna Vishesha, it is totally dependent on the opposite qualities

of drugs. Here not much importance should be given to the 'Jati' of that drug. Guna

Vishesha can be defined as a substance which is having opposite qualities. In case

of Dravya Vishesha there are two criterias i.e. 'Jati' and opposite qualities whereas

in case of Guna Visesa there is only one criteria i.e. opposite properties eg. In case

of Pittavrddhi if a drug like Amalaki is used which is having opposite qualities as

that of Pitta then it should be considered on Guna Vishesha.


110

MADHUMEHA”

Discussion Karmavishesha does not expect use of any dravya, the word 'Karmavisesa'

itself defines that a Karma which is having opposite action e.g. In case of Pitta

Vrddhi, living near water source as fountains, ponds and river can be termed as

Karma Visheshas.

After discussing Dravya, Guna and Karma Vishesha it is worth to say that

there are very less substances which are having the same Jati but opposite qualities.

Therefore, the less availability of Dravya Vishesha forces a physican to go for

Guna Vishesha and Karma Visesa only. It might be the reason that there is

abundant use of Guna Vishesha and Karma Visesa in classics for Cikitsa is

available.

Acarya Yogindranath Sen has tried to explain Vishesha on the basis of

examples considering Pancabhautik configuration of those Dravyas. It is difficult

to understand the difference between the examples of Dravya and Guna Vishesha

because both of them appear same. It is very much difficult to differentiate Dravya

Vishesha from Guna Vishesha because selection of a Dravya totally depends on

the Gunas of that Dravya.

In the same way one more classification is available i.e. Atyanta, Madhya

and Ekadesa Vishesha (Anonymous). Here also Cakrapani contradicted it, by

saying that these three Visheshas cannot be inferred from those two Verses i.e.

Ca.Su. 1/44-45 and there is no any rationality in doing so. Though Cakrapani has

contradicted this view but it is worth to consider these three Vishesha while

thinking of management of any disease. Here one can consider these three

Visheshas as the types of Guna Vishesha. Though there are no any clear cut

definitions of these three Visheshas mentioned in classics but on the basis of their

properties one can define them. If the number of opposite qualities is minimum


111

MADHUMEHA”

Discussion then the substance should be termed as Ekadesa Vishesha. If there are maximum

opposite qualities in that substance then it should be termed an Atyanta Vishesha.

But if the number of opposite qualities is between minimum and maximum then it

should be termed as Madhya Vishesha These Atyanta, Madhya and Ekadesa

Vishesha can be used in the management of diseases as per their severity.

DISCUSSION ON DISEASE:

Madhumeha is selected for the study to see effect by applying the vishesha

siddanta in the form of therapy and diet.

The term ‘Madhumeha’ itself indicates the excessive excretion of urine

which is similar to that of madhu..

Nidana of Madhumeha is divided in to 2 categories Apathyanimittaja and

sahaja Besides these Nidanas, nowadays it can be seen that due highly refined

found with maximum percentages of carbohydrates & high-tech machineries which

makes a person less active & prone to Madhumehaa Nowadays Nidanas of

Madhumeha are changing e.g. Previously aasya sukham and swapna sukham were

said to be the Nidanas of Madhumeha but these are now changing to increasing

stress which causes episodes of being eating leading to Madhumeha has become

prominent one.

Samprapti of Madhumeha has been clearly mentioned by A.Charaka as

madhumeha is caused by the deficiency of ojas which is vitiated from the vata

dosha and get localizes in basti and produces the laxanas.

Rupas of Madhumeha are compiled from various classics and all the

acharyas has explained prabhoota mootrata and avila mootrata are the cardinal

symtomps of madhumeha.


112

MADHUMEHA”

Discussion After the discussion of the available views of classics in the conceptual study,

now need is to discuss the practical observations and results to see the state of

hypothesis get proved

DISCUSSION ON DRUG:

It is the necessity of time to refurbish the principles of Ayurveda in today's

context. It is not sufficient to prove these principles conceptually but it should be

supported by some clinical data. These principles cannot be accepted if they are

not supported with clinical observations. Clinical study gives authenticity to such

principles. It is already said that the study was undertaken to manage the

madhumeha with therapy & diet clinically. The hypothesis decided for the study

was Visesa is a principle cause for Hrasa (Diminution). To prove this hypothesis a

clinical study was performed in the patients of Madhumeha. Here Madhumeha is

taken for the study because in Madhumeha there is vitiation of kapha vata dosha

along with the vikrutha vrddhi of Medodhatu in the body which affects the

mutravaha srotas causing excessive urination. So, it requires the drug which can

cause Hrasa (diminution) of Medodhatu for its management. As per the hypothesis

of this study, this is the unique condition to apply Vishesha. vishesha applied for

this study was in the form of pathya and arogyavardhini vati which are having

Kapha, vata Medoghna properties which helps in the management of madhumeha

So, it was thought at that time that being a Visesa for Madhumeha,in the form of

diet and therapy will cause Hrasa of increased kapha vata Meodhatu in

Madhumeha patients. Therefore, Arogyavardhini vati was used not to treat or cure

the patients of Madhumeha but to prove the hypothesis of this study clinically.


113

MADHUMEHA”

Discussion DISCUSSION ON MATERIALS AND METHODS:

The present study was conducted in to two parts i.e.,

1. Literary study

2. Clinical study

1. Lliterary study:

The effort was put to compile the scatterd matter regarding the samanya

vishesha siddhanta and madhumeha in the ayurvedic and other literary sources

On the outcome of the literary study, the clinical study was carried out to

assess the role of vishesha siddhanta in the management of madhumeha to

establish the concepts with statistical evidence.

Discussion on the objectives:

To fulfill the first objective, i.e. to study the samanya and vishesha siddhanta

in detail, most of the ayurvedic and other texts were referred. Favorable concepts

regarding the study were compiled and screened to understand the concepts in the

better way.

The second objective, i.e. to apply the vishesha siddhanta in the management

of madhumeha was made on the first objective along with other concepts of

ayurveda.with the help of these two objectives the clinical study was designed.

2. Clinical study:

The clinical study was designed to assess the role of vishesha siddhanta in the

management of mahdumeha .Following were the materials included for the study.

Selection of yoga:

Arogyavardhini vati has tridoshagna and pramehagna properties .Hence it

was selected for the trail.


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MADHUMEHA”

Discussion Preparation of yoga:

Arogya vardhini vati was prepared according to the classical method, and for

the purpose of clinical study it was purchased from the reputed pharmacy.

Patients:

The patients diagnosed as madhumeha based on the diagnostic criteria and

willing to participate in the trial, fitting in to the inclusive criteria, were selected

incidentally from OPD of Dr.BNMET`s ayurvedic medical college and research

center .

Selection criteria:

In the present study, the patients selected were between the age group of 35

to 65 yrs.i.e.madhyama vaya. This was done to maintain the uniformity in the

treatment. Patients suffering from madhumeha along with other systemic disorders

were excluded.they were explained in detail regarding study, interventions.Those

willing to participate in the study were taken with their written consent.

Diagnostic criteria:

1. Patient having cardinal symptoms of madhumeha were selected for the

present study

2. the patients following the criteria recommended by American Diabetes

Association i.e.FBS>126mg/dl,PPBS>160mg/dlwere taken for the study.

Inclusive criteria:

1. Diagnised patients of madhumeha.

2. Patients between age group of 35 to 65years of either sex.

3. Patients of NIDDM with FBS raging from 126mg/dl-180mg/dl,and PPBS

ranging from 160mg/dl-250mg/dl.


115

MADHUMEHA”

Discussion Exclusive criteria:

1. Patients of madhumeha below 35years and above 65years.

2. Patients of madhumeha along with other systemic disorders.

Study design:

In the present study, 30 patients were selected in a single group and treated

according to specific interventions. The efficacy of intervention was assessed for

the changes from pre treatment to post treatment and at the end of the follow up

with statistical values i.e. P & t values.

Generalized observations:

All the patients were observed for vital data, general examination, astasthana

pareeksha,dashavidha pareeksha ,vishessha pareeksha and their pathya apathya.

Intervention:

A pilot study was done, in order to grade the severity of the individual

symptom. All the patients were given arogya vardhini vati 3 tab,twce daily with

ushnodaka.

Duration- 30days

Post treatment follow up-15days

They were advised for regular follow up and to consult at any time, if they

develop any problem in a clinical study.

Interventions and observations:

All the patients followed the advice properly during the entire duration of the

study. There were 4 dropouts. 2 patients refused to take medicine, 2 were

discontinued the treatment.


116

MADHUMEHA”

Discussion Assessment of the clinical response:

The clinical response in a group were assessed with individual variables and

over all disease, which was assessed in comparison with before treatment status

and graded as encouraging, good, excellent response, clinically stable, clinically

deteriorated.

DISCUSSION ON THE OBSERVATION AND RESULTS:

Age- Most of the patients studied belonged to the age group of 35-45 yrs. This

finding shows a very similar about prevalence of Type II Diabetes or NIDDM in

middle age.

Sex- The disease was found more in males than females.

Religion- The disease incidence was quite more in Hindus. This may be due to the

demographic cause or distribution of the patients and most of them had history of

intake of more sweet diet.

Marital status- More of the married individuals showed the presence of disease.

Occupational status - The disease incidence was more in business man, followed

by House Wives when compared to other Occupational status.

Educational status- The disease incidence was more in Graduate when compared

to other educational status, which may be because of their fast food habits and

stress filled life.

Socio-economic status- The disease incidence was highest in upper middle class

followed by middle class and Lower class.

Family History – most of the patients had no family history.

Diet- Though incidence of mixed diet was more, it does to some extent highlight

that intake of excessive fatty substances can lead to manifestation of the disease.


117

MADHUMEHA”

Discussion Addictions- Majority of the patients were not addicted to anything but among

those who had addiction incidence was more in smokers.

Prakruti- The incidence of madhumeha was more in kaphavata prakruti followed

by Kaphapitta prakruti, followed by and Vatapitta prakruti. This reflects the risk of

developing madhumeha in kapha pradhana prakruti.

Satva- Majority of the patients of the present study were having madhyama satva.

Agni- vishamaagni was seen in majority of the patients. This indicates the

increased catabolism inside the body which results into excessive dhatu kshaya.

Bala- The majority of the patients had madhyama bala and few had avara bala.

This probably may be due to the involvement of the vyadhi. Ojo kshaya is also

present and it may lead to manifestation of bala kshaya.

ASSESSMENT OF THE RESULTS ON THE BASIS OF INDIVIDUAL

SYMPTOM.

Effect of therapies on the Prabhoota mootrata:

In the study 100% of the patients presented with mild to severe prabhoota

moothrata (an increase in both frequency as well as increase in quantity.) and 30%

of the patients showed encouraging,70% of the patients showed stable at the end of

the treatment. And 46% of the patients showed encouraging,33.33% showed

stable,20% showed deteriorated at the end of the follow up.

Effect of therapies on Avila mootrata:

Avilata was tried to understand by comparing it with turbidity which was

graded and studied and with specific gravity of urine.

In the study 30% of the patients showed encouraging,70% of the patients showed

stable at the end of the treatment. And 46.66% of the patients showed

encouraging,66.66% showed stable, at the end of the follow up.


118

MADHUMEHA”

Discussion Effect of therapies on Trushna:

Mild to severe Trushna was seen in 100% of the patient In the study 10%

of the patients showed encouraging,20% of the patients showed stable at the end of

the treatment. And 13.33% of the patients showed encouraging,86.66% showed

stable, at the end of the follow up.

Effect of therapies on Alasya:

In the study 10% of the patients showed encouraging,20% of the patients

showed stable at the end of the treatment. And 30% of the patients showed

encouraging,60% showed stable, 10% showed deteriorated at the end of the follow

up.

Effect of therapies on Dourbalya:

Mild to severe dourbalya was seen in 100% of the patients In the study

10% of the patients showed encouraging,20% of the patients showed stable at the

end of the treatment. And 27% of the patients showed encouraging,66.66% showed

stable, at the end of the follow up.

The drug acts on Madhumeha by rectifying the agni, which helps in the

normalisation of dhatuposhana kriya and subsides the dourbalya.

Effect of therapies on Karapada Daha:

In the study 100% of patients suffering with mild to moderate karapada

daha before treatment. In the study 30% of the patients showed encouraging, 70%

of the patients showed stable, at the end of the treatment. And 20% of the patients

showed encouraging, 66.66% showed stable, 13.33% showed deteriorated at the

end of the follow up.


119

MADHUMEHA”

Discussion The karapada daha is due to the vitiation of pitta in association of vata.

After administration of the drug and diet which are pitta hara, it helps to bring the

doshas towards equilibrium and thus controlling on karapada daha.

Effect of therapies on Karapada Suptata:

In the of both trial group and control group 100% of the patients presented

with karapada suptata In the study 26.66% of the patients showed

encouraging,73.33% of the patients showed stable, at the end of the treatment. And

6.66% of the patients showed encouraging,90% showed stable,3.33% showed

deteriorated at the end of the follow up.

Effect of the therapies on Serum Glucose levels:

The group showed 73.33% of relief in Fasting blood sugar levels at the end

of the treatment and was very statistically significant (P<0.0018) and 26.66%

showed relief at the end of the follow up with not quite statistically significant.

The group showed83.33% relief in the PPBS levels and was very

statistically significant (p<0.0018), 73.33 % of relief in PPBS sugar levels and was

not statistically significant (p<0.1177).

Effect of therapies on Urine Sugar:

On Urine Sample-

The group showed 73.33% of relief in urine sugar levels at the end of the

treatment and was statistically significant (p<0.0140) and 56.66% of relief in urine

sugar levels at the end pf the follow up and was statistically not significant

(p<0.2320).

Thus, there was mild difference in the results after the treatment but after

the follow up some of the symptoms showed increase in the severity thus it can be


120

MADHUMEHA”

Discussion concluded that madhumeha patients needs regular medicine and ideal diet from

which madhumeha can be managed

DISCUSSION ON THE STATISTICAL ANALYSIS:

After subjecting the data from the group for statistical analysis, using

student’s t test and based on the P value and t value, it comes to notice that the

patient of madhumeha should follow the ideal diet and should take the medicine

regularly because all the symptoms showed significance at the end of the treatment

but some symptoms showed non significant at the end of the follow up, When the t

value is analyzed for individual symptoms.

OVER ALL ASSESSMENT OF THE RESULTS:

Complete relief: None of the patients were assessed as completely cured.

Marked relief: In the study 6.66% of the patients were assessed as marked relief.

Moderate relief: In the study 46.66%of the patients were assessed as moderately

relief.

Mild relief: In the present study 36.66% of the patients were assessed as mildly

relief.

No improvement: in the present study 10% of the patients were assessed as no

any improvements.


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MADHUMEHA”

Conclusion

CONCLUSION

By an interactive literary review and based on clinical trials the following

conclusions can be drawn.

Ayurveda defines samanya and vishesha under shat karanas and they are

meant for the dhatusamyata.

The principles of vishesha are useful in preventive as well as curative

aspects.

Madhumeha is an anushangi disease which needs regular diet and therapy

for its control.

By applying vishesha siddhanta, one can manage the disease madhumeha

with proper diet and therapy.


122

Recommendations


123

RREECCOOMMMMEENNDDAATTIIOONNSS FFOORR FFUUTTUURREE SSTTUUDDYY

The study can be conducted in a large population with more number of patients

and with long duration.

Summary


124

SSUUMMMMAARRYY

Principles of Ayurveda have significant value in the life of modern man.

These principles are accepted by Ancient Acaryas after vast clinical experience.

Time has come to prove these principles once again in Today's context. Out of

such principles, Samanya Vishesha Siddhanta is the important one. Here the

principle of Vishesha is taken for the present study. To study the principle of

Vishesha conceptualy and practically, the work was entitled as "A study of

samanya vishesha siddhanta wsr to vishesha siddhanta in dietary and therapeutic

management of Madhumeha". Any concept cannot be considered as scientific

unless and until its applied aspect is proved. So Madhumeha is taken here for the

study of applied aspect of Vishesha. The present study is divided in seven main

sections viz. Introduction, Objectives, Review of literature, Methodology,Result,

Discussion and Conclusion and Summary.

1. Introduction: Importance of principles of Ayurveda, Importance of

Vishesha, and Increasing prevalence of Madhumeha is narrated in short.

2. Objectives: The main aim and objectives of the study has been mentioned

along with the hypothesis under this heading.

3. Review of literature: This chapter comprises description about Siddhanta,

Padartha, Samanya, concept of Vishesha with different references, disease

review according to classics and modern description along with drug

review.

4. Methodology: Clinical Study: Under this heading, the detailed description

of clinical study with specific reference to patients, selection, inclusion and

exclusion criteria, protocol, criteria for assessment of signs and symptoms,

dose, duration, distribution of patients etc of present study has been

discussed.

Summary 5. Results:

Total 30 patients were selected for the present study.

Result of clinical Study:

The result obtained after completion of 45 days of treatment and after

follow up is discussed under this heading. The scoring of important features of

Madhumeha before and after treatment is tabulated and percentage of improvement

is taken. The improvement grading is done and this is analyzed statistically with

student paired’t’ test. The total relief obtained after the treatment schedule was

recorded as-

i) Complete relief

ii) Marked relief

iii) Moderate relief

iv) Mild relief

v) No improvement.

In the present study no patients in the group got completely cured after 45

days of treatment.

In an observational group, 6.66% of patients showed marked relief, 46.66%

of patients showed moderately relief, 36.66% of patients showed mildly relief,

10% of patients showed no improvement.

6. Discussion: Under this heading, samanya vishesha siddhanta, and about

vishesha siddhanta, the Nidanatmaka study of Madhumeha and results obtained

from this study have been described.


125

Summary 7. Conclusion: In this chapter conclusion of the above study is done by

highlighting the outcome of the study along with limitations of the study and the

scope for further improvisation.

At the end of study an Appendix comprising Research proforma and

Bibliography is given.

Lacunae in the work are excused by the authorities. More work is needed

regarding the present subject. People should be made aware of Madhumeha and its

complications. All the honest efforts have made by the Scholar with valuable

suggestions and guidance from the guide.


126

References

CLASSICAL REFERENCES 1. C.S.Vi. 8th Chap.

2. C.S.Su..1st Chap

3. Shabdha Kalpa Druma

4. C.S.Su. 1st Chap

5. Vai.Dar.

6. CHK

7. GN

8. AS. 1st Chap

9. AH. 1st Chap

10. Indradeva deva Tripati et al 1991.

11. Prasanna B.V. 1980.

12. DM in Indian Medicine Page11.

13. Koutilya Arthashastra Page740.

14. C.S.Ni.4th Chap.

15. C.S.Chi.6th Chap.

16. C.S.Su.17th Chap.

17. C.S.In.9th Chap.

18. S.S.Su.4th Chap.

19. S.S.Ni.6th Chap.

20. S.S.Chi.11, 12, 13th Chap.

21. A.H.Ni.10 & Chi.12th Chap

22. A.S. Ni.10 & Chi.14th Chap.

23. B.H. Ni 6 &Chi. 7th Chap.

24. H.S. Dwithia Sthana 4/26.

25. K.S. Vedanadhyaya and Chi.10th chapter.

26. Sha.Sam.Prathama Khanda 7th chapter.

27. Y.R.Uttara ardha 9 chapter .

28. B.P. Madhyama Khanda. 38th Chapter.

29. Ma.Nid.33rd Chap.

30. Bhai.Rat37th & 38th chapter.

31. Raja Radhakantha Deva 1987.


127

References 32. Amara Kosha.Page.595.

33. Amara Kosha Page.284.

34. Raj.Nig Page.628.

35. C. S. Ni. 4/5, C. S. Ni. 4/6 and C. S. Ni. 6/4.

36. C. S. Su. 27th chap, C. S. Ni. 4/24-26 and C. S. Su. 17/80.

37. C. S. Chi. 6/55,C. S. Ni. 4/36 and S. S. Chi. 12/3.

38. C. S. Chi. 6/15. C. S. Su. 21/4 & Ck and S. S. Su. 15/32.

39. Anilkumar.G.2006.

40. S.G.Prasanna.A.2004.

41. C. S. Chi. 6/13 –14, S. S. Ni. 6/5 and A. H. Ni. 10/38- 39.

42. S. S. Ni. 6/6 (Dalhana), A. S. Ni. 10/7 (Indu) and C. S. Ni. 4/44.

43. H. Ni. 10/18, S. S. Chi 11/3 and A. H. Ni. 10/21.

44. S.S.Su. 17/13 (Dalhana), S.S.Su. 14/11., C.S.Su. 30/4 and C.S.Su. 30/37.

45. Chakrapani on C.S.Su. 30/5-7, S.S.Su.15/24, A.H.Su.11/40 and Chakrapani

on C.S.Ni. 4/37.

46. C.S.Chi. 6/6 and C.S.Chi. 6/34.

47. C.S.Ni.4/37, C.S.chi.28chapter and C.S.Ni.4/4.

48. A.H.Ni.10/4 and C.S.26/40.

49. C. S. Su 25/40,C. S. Su 25/40 (Chakrapani),C. S. Chi 6/7 and S. S. Ni 6/8.

50. C. S. Ni 4/37, B. P. Chi 387, C. S. Ni 4/37 and Y. R. U.

51. C. S. Ci 6/56 (Chakrapani), C. S. Ind 5/5, C. S. Ci 6/57 (Chakrapani) and S.

S. Ni 6/24.

52. C. S. Ind 9/8, S. S. Su 33/8 and C. S. Ni 4/50-52.

53. C.S.Vi.7/28-29, C.S.Chi. 6/53, C.S.Chi. 6/34,37 and S.S.Chi.12/7.

54. C.S.Chi 6/15-17, C.S.Chi.6/18, C.S.Chi.6/52 and S.S.Chi. 12/4.

55. C.S.Chi. 6/51, C.S.Vi. 4/43, C.S.Su.22/18 and C. S. Su 21/20.

56. C.S.Chi 6/18, S.S.Chi.13/8, S.S.Chi.11/8 and A.H.Chi.2/5,6.

57. C.S.Chi. 6/19, 20, 21, S.S.Chi.12 and S. S. Ni 6/6.

58. S. S. Ni 6/8 and S. S. Chi. 11/8-10.

59. C.Ni.6/48, S. S.ni6/15, A.H.Ni.10/24 and Ma.ni33.

60. Davidsons Medicine Page.472.

61. www.Chinese.com.


128

References 62. Anderson’s pathology.

63. Davidson’s Book of Medicine; chap. 7, Pg 474 18th Edition.

64. Harrison’s Principles of Internal Medicine Pg 2062 14th Edition.

65. BOYD’s Pathology.

66. Diabetes Mellitus for practitioners.

67. Harrisons14th edition pg 2062.

68. Diabetes Mellitus for practitioners.

69. Andersons pathology – Endocrine disorders.

70. Harrisons 2060 14th Edition.

71. Davidsons 17th Edition.

72. Harrisons Diabetes Mellitus page 2065.


129

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Varanasi, Chowkhamba Press , 1994; 630 pp







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133

Dr. B.N.M.E.Trust’s

Shri Mallikarjuna Swamiji Post Graduate and Research Centre, Bijapur.

DEPARTMENT OF SIDDANTA

CASE PROFORMA

Title: A STUDY OF SAMANYA VISHESHA SIDDANTA W.S.R TO VISHESHA SIDDANTA IN DIETARY AND THERAPEUTIC

MANAGAMENT OF MADHUMEHA

GUIDE -DR. R. V. YADAVANNAVAR. M.D. (Ayu) HOD - DR. J. C. HUDDAR. M.D.

(Ayu) P.G.Scholar - Dr. Sumangala H.M.

Sl. No ‐ Date ‐

Name ‐ Age/ Sex ‐ OPD No ‐ Caste ‐ Address ‐ Occupation ‐ Economical Status ‐ Date of commencement of treatment ‐ Date of completion of treatment ‐ =======================================================

LETTER OF CONSENT

Phone- No.

Consent :I am exercising my free power of choice hereby giving my consent to be included as a subject in this study. I have been informed to my satisfaction by the attending physician, the purpose of clinical trial and the nature of drug treatment and its follow up. I am also aware of my right to quit the trial at any time during the course of the study .for any reasons.

Signature of Patient


1) PRADHANA VEDANA :

2) ANUBANDHA VEDANA :

3) ADYATANA VYADHI VRITTANTA :

4) PURVA VYADHI VRITTANTA :

5) KULA VRITTANTA :

6) VAIYAKTIKA VRITTANTA :

a) Ahara : Vegetarian / Mixed

b) Vihara :

c) Nidra :

d) Mala Swarupa :

Mrudu, Madhya, Katina

Sankya

e) Mutra Swarupa

Sankya

f) Sweda Swarupa

g) Vyasana :


General Examination

Height:

Weight:

Blood Pressure:

ASTHA STHANA PARIKSHA :

1) Nadi - 5) Shabda -

2) Mala - 6) Sparsha -

3) Mutra - 7) Druk -

4) Jihwa - 8) Akruti -

DASHAVIDHA PARIKSHA :

1) Prakrutitaha : 6) Satmytaha :

2) Vikrititaha : 7) Satwataha :

3) Sarataha : 8) Ahar shaktitaha :

4) Samhanana : 9) Vyayama shaktitaha:

5) Pramantaha : 10) Vayataha :

Samprapati Ghatakas :

Dosha Dustiprakar

Dushya Adhistana

Srotas Vyakthastana

Utpatti sthana

AGNI PARIKSHA : Vishama / Tikshna / Manda

KOSHTA PARIKSHA : Krura / Mrudu / Madhyama


VISHESHA PAREEKSHA : Mutra

Frequency – Times/Day

Times / Night

Colour :

Density :

Amount : ______ml/24 hrs Since – days

(Approx Quant)

Others :

Thrushna : Adhika, Madyama, Alpa

Sweda : Adhika, madyama, alpa

Bala :

Nidana Panchakas :

Hetu

Purva roopa

Roopa

Upashaya

Anupashaya

Samprapti


Roopa (Vishesha) -

Sl.

No.

Laxanas B.T.

A.T AFU

1 Prabhoota mutrata

2 Avila mutrata

3 Trushna

4 Alasya

5 Dourbalya

6 Karapada Daha

7 Karapada Suptata

CLINICAL EVALUATION OF MADHUMEHA

Instructions

A. Scoring Pattern.

Sl. No. Symptoms Scores

1 No Symptoms 1

2 Mild Symptoms 2

3 Moderate Symptoms 3

4 Severe Symptoms 4

B. Following Symptoms to be observed for scoring

Prabhhota Mutrata Dourbalya

Avila mutrata Karapada Daha

Trishna Karapada Suptata

Alasya

INVESTIGATIONS :

Blood : FBS : PPBS :

Urine : Sugar :


c) Gradings for the Assessment of severity of Madhumeha

Scoring Sl. No Assessment for

Normal (1)

Mild (2) Moderate (3)

Severe (4)

1 Prabhoota Mutrata 6 – 8 times 8-12 times 12-16 times 16-20 times or more

2 Avila Mutrata Clear Milky Buffy Turbid

3 Trishna Based on quantity

Relived by 100-15 ml of water or personal best

Relives by 150-200 ml of water or > by 30% of personal best

Relieved by 200-250 ml of water > by 30-60% of personal best

Relieved by 250-300 ml of water or > 60% of personal best

4 Alasya Active in performing all sort of work

Disinterest in performing strenuous works

Disinterest in performing activities

Disinterest in performing daily activities

5 Dourbalya Able to perform normal activities

Feels weak on walking long distance

Feels weak on performing general activities

Unable to perform general activities

6 Karapada Daha No burning Sensation

Occasional burning sensation

Regular burning sensation

Persistent burning sensation

7 Karapada Suptata No numbness

Occasional numbness at finger tips

Numbness of palm, feet

Persistent numbness

Signature of PG Scholar Signature of HOD Signature of GUIDE


Documents

“A STUDY OF SAMANYA VISHESHA SIDDHANTA W. S. R. TO