UNDERSTANDING PRAMEHA THROUGH TRISUTRA SIDDHANTA
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1 Impact factor: 3.958/ICV: 4.10 ISSN: Pharma Science Monitor 8(2), Apr-Jun 2017 PHARMA SCIENCE MONITOR AN INTERNATIONAL JOURNAL OF PHARMACEUTICAL SCIENCES Journal home page: UNDERSTANDING PRAMEHA THROUGH TRISUTRA SIDDHANTA Bharat L. Bhadiyadra 1*, Hitesh A.Vyas 2, Mahesh Vyas 3, Kamal Kumar 4, Devang Patel 5, Chandani Goswami 6 1 PhD Scholar, Basic Principles Department, IPGT & RA, Jamnagar, Gujarat, India. 2 Associate Professor, Basic Principles Department, IPGT & RA, Jamnagar, Gujarat, India. 3 Professor & Head, Basic Principles Department, IPGT & RA,Gujarat Ayurved University Jamnagar, Gujarat, India. 4 PhD Scholar, Basic Principles Department, IPGT & RA, Jamnagar, Gujarat, India. 5 PhD Scholar, Basic Principles Department, IPGT & RA, Jamnagar, Gujarat, India. 6 PhD Scholar, Basic Principles Department, IPGT & RA, Jamnagar, Gujarat, India. ABSTRACT Ayurveda the science of life is based on Trisutra i.e. Hetu, Linga and Aushadha. It is explained for both Swastha and Atura. The understanding of Trisutra is the best way to fulfill the objectives of Ayurveda. There is need to put emphasis on Trisutra-Siddhanta for Prameha. Pra means excess of urine in both frequency and volume. Thus Prameha become self-explanatory and having two meanings of "Prabhuta-Mutrata" and "Avil-Mutrata" (turbid urine). Any of the Prameha if neglected at last it leads to Madhumeha due to nature of the illness. To explain the importance of Trisutra in the pathogenesis and management of Prameha; support of the scholarly articles, information on internet and available literature of Trisutra Siddhanta and Prameha described in classics has been referred thoroughly. Prameha Nidana like sedentary lifestyle, excessive sleep, excessive intake of sweets, milk products etc comes under Hetu Sutra. While symptoms like urine in large quantities and urinates frequently throughout day and night; excessive thirst and hunger, polypapsia, polydypsia etc. comes under Lingasutra. Prameha Chikitsa is considered in Aushadhasutra. So, there is strong need to know the severity of the disease and to understand the possible ways of preventive aspects of this disorder. So it is the demand of time to know about Prameha according to Tri-Sutra Siddhanta by which a common man get healthy life without having any disease. KEYWORDS: Trisutra Siddhanta, Prameha, Hetu, Linga, Aushadha. INTRODUCTION Ayurveda have a holistic, preventive, promotive and curative approach where the aim is not only to cure the disease of ill person but also to maintain health of a healthy person [1]. Ayurveda is mainly based on three principles which are described for Swastha (healthy) as well as Atura (unhealthy), and it is named as Trisutra Ayurveda. These principles are as follows: 1)Hetu Causes 2. Linga Symtoms (Symtoms of health & disease) 3. Aushadha Medicines (In both roles as preventive and curative) [2]. Mainly whole Charaka Samhita is described in context to Trisutra [3].
2 Impact factor: 3.958/ICV: 4.10 ISSN: In this regards here an effort made to understand the Prameha through Trisutra Siddhanta. The word Prameha is derived from the 'Miha-Sechane' which means watering [4]. Pra means excess of urine in both frequency and volume. Thus Prameha having two meanings of "Prabhuthamutratha" (Increase in Quantity and frequency) and "Avil-mutrata" (turbid urine) [5]. Any of the Prameha if neglected ultimately it leads to Madhumeha [6]. In modern perspective Madhumeha (Diabetes Mellitus) is a chronic metabolic disorder in which the body is unable to make proper use of glucose, resulting in the condition of hyperglycemia. Aims & Objectives: To explains the importance of Trisutra in the pathogenesis and Management of Prameha. MATERIALS AND METHODS The information about the concept of Prameha according to Tri-Sutra Siddhanta and its importance is mentioned in Ayurvedic classics. The thorough study of Prameha according to Tri- Sutra Siddhanta had been reviewed for compilation of study material. Conceptual: Prameha is a Tridoshajavyadhi as per all Ayurvedic texts [7,8]. Prameha is a list of urinary disorders, especially characterized by profuse urination with several abnormal qualities due to Doshik imbalances. The major causes of Prameha are improper lifestyle, lack of exercise and faulty diet habits. Food intake which comes under the category of Ushna, Snigdha and Guru are the leading cause of this disease Fish and curd are excellent example. Foods that increase or vitiated Kapha, Meda and Mutra are the main etiological factors for Prameha [9]. Main causes [10] Asya Sukhama (sedentary lifestyle) Swapna Sukham- Excessive Sleep Excess consumption of Various Curd Preparation Consumption of Gramya, Aanup, Audaka Mamsa Excess intake of Milk & It s Various Preparation Consumption of new Grains, Jaggery and Sugar preparation Classification of Prameha: As per aetiologically, Prameha can be classified in two categories [11] : (1) Apatharpanautha- Prameha relating the lean diabetic (2) Santharpanautha- Prameha relating the obese diabetic.
3 Impact factor: 3.958/ICV: 4.10 ISSN: Classification according to causes [12] : (1)SahajaPrameha(congenital) (2) Apathyanimittaja - Prameha (due to faulty and poor eating habits) Classification of Prameha according to Dosha: Prameha are divided into 20 sub categories according to characteristics of urine, its volume, Dhatu being excreted through urine [13]. (1)Kaphaja-10 (2)Pittaja-6 (3)Vataja-4 Samprapthighatakas [14] : Dosha Vata,Pitta,Kapha Dushya Meda,Mamsa,Kleda,Rakta,Vasa,Majja,Lasika,Rasa and Ojas Srotas (channel) Mootravaha, Medovaha, Mamsavaha and Udakavaha Srotas Srotodusti Atipravrutti Agni Dhatvagni Udhbhavasthana Kostha Vyaktasthana Mootravaha Srotas Samprapthi (Pathogenesis) [15] Acharya Charaka enumerated the general Samprapti in Chikitsasthana. He narrated that due to over indulgence of etiological factors, Kapha along with Meda, Mamsa and Kleda get vitiated and results into formation of metabolic waste which carried towards Basti resulting Prameha. In same manner Pitta get vitiated resulting Pittaja Prameha. While Vata due to deplition of other two Dosha get provocated inturns causes deplition of Dhatus by excrete them through urine resulting Vataja Prameha. Purvarupa (Premonitory symptoms) [16] Ayurveda described early symptoms of the disease. They are accumulation of dirt on the teeth (mouth, eyes, nose, and ears), a feeling of burning sensation in the palms and soles, stickiness of the skin all over the body, thirst and a sweet taste in the mouth etc., and Mutra Madhuryata (sweetness of urine).
4 Impact factor: 3.958/ICV: 4.10 ISSN: As per the prognosis [17] According to prognosis of Prameha it is described of three types i.e. Sadhya (curable), Yapya(Palliable), Asadhya (Incurable) Sadhya: Describes patients who have been diagnosed very earlier in the onset of Prameha (diabetes). These types of patients, those who are Sthula (obese) and the root of their disease are in Apathyaja (due to faulty diet and lifestyle) 2.Yapya: Patients under this category have Pittaja Prameha & certain types of Kaphaja Prameha. However Yapya (palliable) helps to control the disease with treatment 3. Asadhya: Describes the incurable version of Prameha (diabetes) & inherited diabetes. Sahaja patients suffering from this variety are Krusha (lean). Complications Prameha, on chronicity, give rise to these complications like Trishna (Thirst), Atisara (Diarrhoea), Jvara (Fever), Daha(Burning sensation), Daurbalya (General debility), Aruchi(Anorexia), Avipaka (Indigestion),Various boils (Pidika, Alaji, Vidradhi) etc [18,19]. DISCUSSION From the above description, the Prameha is divided in three division in light to understanding this disease through Trisutra Sidhhanta. Tri Sutra Siddhanta: (1.) Hetu Sutra Siddhanta: (Causes for Prameha): 1. Sahaja (inherited factor) 2.Guda (jaggery) 3. Ikshurasa (sugarcane) 4. Madhura Ahara (sweet substances) 5. Pishta Ahara (carbohydrate rich food) 6. Adyashana (repeated food intake) 7. Adhikashana (excess food intake) 8. Ahitashana (unwholesome diet) 9. Chinta (stress) 10. Shoka (grief) 11. Bhaya (fear) 12. Dirgharoga (long standing illness) 13. Alasya (sedentary life) 14. Avyayama (lack of body exercise) 15. Guru Ahara (heavy food) 16. Samashana (improper diet) etc [20]. All the Nidanas are comes under the heading of Hetusutra Siddhanta. (2). Linga Sutra Siddhant: (Symptoms of Prameha) Types of Prameha: (A) Hetu Bheda (As per Etiology) [21] 1. SahajaPrameha: Juvenile or congenital diabetes 2. Kulaja: Familial 3. Apathyaja: Due to faulty dietary habits (B) Deha Prakriti Bheda [22] (As per features of the body) 1. Sthulapramehi : Obese-related 2. Krishapramehi : Leanness (C) Mutra Vikara Bheda (As per urinary Abnormality) [23] (1). Kaphaja [24] : Kapha causes Prameha by vitiation of Meda, due to this changing lipid metabolism), muscles and body fluid located in urinary bladder. They are ten subtypes as: Udakmeha (Diabetes insipidus, Chronic
5 Impact factor: 3.958/ICV: 4.10 ISSN: nephritis) Watery urine, Ikshumeha (Alimentary glycosuria) Like sugar cane, Sandrameha (Phosphaturia) Viscous urine, Sandra Prasadmeha Having solid precipitate, Suklameha (Chyleuria, albuminuria) White, Sukrameha (Spermaturia) Urine with semen, Sitameha Cold urine, Sainyameha Delayed and very slow impulse of urination, Lalameha (Albuminaria)Salivalike urine, Siktameha (Lithuria) Urine with gravels. (2) Pittaja [25] : Pitta aggravated by hot stuffs causes the same by affecting Medas, muscles and body fluid located in urinary bladder. They are of six types as: Ksharmeha (Alkanuria) Urine like alkali, Kalameha (Indikanuria) Black urine, Nilameha (Indikanuria) Blue urine, Haridrameha (Biluria) Turmeric-like urine, Manjisthameha (Urobilinuria Urine is lighter; Raktameha (Haematuria) Urine is deep red. (3) Vataja [26] : Vayu, on relative reduction of other two Doshas, draws on the Dhatus in urinary bladder it leads to causes Prameha. Prameha caused by Vata and associated with pain has blackish or reddish urine. They are of four types as: Majameha (Albuminuria) Urine with Majja, Ojomeha (Diabetes mellitus) Urine with Ojas, Vasameha (Lipuria) Urine with Vasa, Hastimeha (Prostatitis) Urine with Lasika. In context to Trisutra Sidhhanta, Purvrupa, Rupa of Prameha including its 20 types and their specific Lakshnas(symptoms), Upadrva (complications) are included in Linga Sutra Sidhhanta. (3). Aushadha Sutra Siddhanta:- (Treatment of Prameha): Treatment for this disease is mainly based on an entire change in the lifestyle of the person. Along with medication and diet, the patient is also advised to lead a healthy lifestyle and active life. The medicines that are administered are therefore meant to keep the brain in its right manner of functioning. The drugs having properties like bitter, astringent and pungent in taste are beneficial in the management of Prameha. The principles of treatment in a diabetic patient may be classified as under There are two types of diabetics: 1. Sthulya (Obese) 2. Krusha (Asthenic) 1. In Sthulya The treatment is based on proper utilization of excess fat i.e. he should be give: a). Shodhana (purification process), b) Apatarpana - reduction in body weight by way of diet control or drugs, Vyayama (exercise) etc [27]. Fasting Diet control Cleansing therapies Vamana, Virechana, Basti
6 Impact factor: 3.958/ICV: 4.10 ISSN: Physical exercise 2. In Krusha (For Lean patient) Treatment should be mainly based on the line of increasing stamina and vitality by way of tonics (Bruhana) diet, drugs etc [28]. Pathya [29] : Table: Pathya Ahara as described in Samhitas PULSES Chanaka (Gram), Adhaki(pigeon pea), Mudga (Green Gram) VEGETABLE Tikta Shakas Nimba(margosa leaves). Sarshapa(Mustard), Methika (fenu geek), Karavellak (bitter gaurad), Kulaka (Patola-wild snake guard), Sobhanjana (drum sticks), Karkotaka(spiny guard), Udumbara (country fig), Rasona(Garlic) FRUITS Jambu(rose apple), Talaphala(palm fruit), Tinduka(Indian persimmon) SEEDS Kamala(lotus), Utpala stelleta(species of lotus) FLESH Harina (Deer Flesh), Shashaka (Rabit), Birds likes Kapota(pegion), Titira(patridge), Lavaka(quail sommon). LIQUIDS Old Sura (Old Wine) OILS Sarshapa (Mustard), Ingudi(desert date), best for Vatic & Kaphaj Prameha. Ghrita (Ghee) may be used in Pittaja Prameha Ghritta,& Taila(oil) in Sannipatika Premeha Exercises Paribhraman, Exposure to sun, wrestling, In the context of Aushdha Sutra Sidhhanta of Prameha, from Chikitsa Sutra of Prameha, all the Aushdha yoga including Pathyapathya comes under the umbrella of this Sidhhanta. CONCLUSION The whole Ayurveda is described in relation to Trisutra Sidhhanta. This is the prime principles of Ayurveda which is described for Swastha and Atura. By applying this Trisutra Sidhanta one can easily understand the disease Samprapti and their management. Prameha is understood very well in context to Trisutra Sidhhanta and its management. REFERENCES 1. Agnivesha, Charaka Samhitha, Edited by Vaidya Acharya Yadavji Trikamji, Chaukhambha Prakashan, Varanasi, Reprint 2007, sutrasthan 30/26, pg-187.
7 Impact factor: 3.958/ICV: 4.10 ISSN: Agnivesha, Charaka Samhitha, Edited by Vaidya Acharya Yadavji Trikamji, Chaukhambha Prakashan, Varanasi, Reprint 2007, sutrasthan 1/24, pg Agnivesha, Charaka Samhitha, Edited by Vaidya Acharya Yadavji Trikamji, Chaukhambha Prakashan, Varanasi, Reprint 2007, sutrasthan 1/25, pg-7 4. Shabdakalpadruma second part pg-787 third column. 5. Sushruta, Sushruta Samhita, Edited by Vaidya Acharya Yadavji Trikamji and Kavyatita chapter 6/ 6, pg Sushruta, Sushruta Samhita, Edited by Vaidya Acharya Yadavji Trikamji and Kavyatita chapter 6/ 27, pg Agnivesha, Charaka Samhitha, Edited by Vaidya Acharya Yadavji Trikamji, Chaukhambha Prakashan, Varanasi, Reprint 2007, Nidansthan 4/3, pg Sushruta, Sushruta Samhita, Edited by Vaidya Acharya Yadavji Trikamji and Kavyatita chapter 6/ 7, pg Astanga Hridaya, edited by Pt. Hari Sadashiva Shastri Paraḍakara Bhishagacharya, reprint, Chaukhamba Surbharati Prakashana, Varanashi 2011; Nidansthan 10/1, pg Agnivesha, Charaka Samhitha, Edited by Vaidya Acharya Yadavji Trikamji, Chaukhambha Prakashan, Varanasi, Reprint 2007, chikitsasthan 6/4, pg Agnivesha, Charaka Samhitha, Edited by Vaidya Acharya Yadavji Trikamji, Chaukhambha Prakashan, Varanasi, Reprint 2007, chikitsasthan 6/15,pg Sushruta, Sushruta Samhita, Edited by Vaidya Acharya Yadavji Trikamji and Kavyatita Acharya Narayan Ram, Chaukhambha Orientalia, Varanasi, VIII Edi. 2005, chikitsasthan chapter 11/ 3, pg Astanga Hridaya, edited by Pt. Hari Sadashiva Shastri Paraḍakara Bhishagacharya, reprint, Chaukhamba Surbharati Prakashana, Varanashi 2011; Nidansthan 10/8, pg Sushruta, Sushruta Samhita, Edited by Vaidya Acharya Yadavji Trikamji and Kavyatita chapter 6/ 4, pg Agnivesha, Charaka Samhitha, Edited by Vaidya Acharya Yadavji Trikamji, Chaukhambha Prakashan, Varanasi, Reprint 2007, Nidansthan 4/8, pg- 213.
8 Impact factor: 3.958/ICV: 4.10 ISSN: Madhavkar, Madhavnidan, edited by vd. Dayal Parmar, sarswati pustak bhandar, Ahmedabad,edition 1996, uttrardha, Prameha nidana 33/5, pg Agnivesha, Charaka Samhitha, Edited by Vaidya Acharya Yadavji Trikamji, Chaukhambha Prakashan, Varanasi, Reprint 2007, chikitsasthan 6/7,pg Agnivesha, Charaka Samhitha, Edited by Vaidya Acharya Yadavji Trikamji, Chaukhambha Prakashan, Varanasi, Reprint 2007, Nidansthan 4/48,pg Sushruta, Sushruta Samhita, Edited by Vaidya Acharya Yadavji Trikamji and Kavyatita 6/14, pg Astanga Hridaya, edited by Pt. Hari Sadashiva Shastri Paraḍakara Bhishagacharya, reprint, Chaukhamba Surbharati Prakashana, Varanashi 2011; Nidansthan 10/1-3, pg Sushruta, Sushruta Samhita, Edited by Vaidya Acharya Yadavji Trikamji and Kavyatita Acharya Narayan Ram, Chaukhambha Orientalia, Varanasi, VIII Edi. 2005, chikitsasthan chapter 11/ 3, pg Agnivesha, Charaka Samhitha, Edited by Vaidya Acharya Yadavji Trikamji, Chaukhambha Prakashan, Varanasi, Reprint 2007, chikitsasthan 6/15,pg Astanga Hridaya, edited by Pt. Hari Sadashiva Shastri Paraḍakara Bhishagacharya, reprint, Chaukhamba Surbharati Prakashana, Varanashi 2011; Nidansthan 10/8, pg Agnivesha, Charaka Samhitha, Edited by Vaidya Acharya Yadavji Trikamji, Chaukhambha Prakashan, Varanasi, Reprint 2007, chikitsasthan 6/8,pg Agnivesha, Charaka Samhitha, Edited by Vaidya Acharya Yadavji Trikamji, Chaukhambha Prakashan, Varanasi, Reprint 2007, chikitsasthan 6/10,pg Agnivesha, Charaka Samhitha, Edited by Vaidya Acharya Yadavji Trikamji, Chaukhambha Prakashan, Varanasi, Reprint 2007, chikitsasthan 6/11,pg Agnivesha, Charaka Samhitha, Edited by Vaidya Acharya Yadavji Trikamji, Chaukhambha Prakashan, Varanasi, Reprint 2007, chikitsasthan 6/15,pg Agnivesha, Charaka Samhitha, Edited by Vaidya Acharya Yadavji Trikamji, Chaukhambha Prakashan, Varanasi, Reprint 2007, chikitsasthan 6/15,pg Agnivesha, Charaka Samhitha, Edited by Vaidya Acharya Yadavji Trikamji, Chaukhambha Prakashan, Varanasi, Reprint 2007, chikitsasthan 6/20,pg-446.
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