AETIOPATHOLOGY OF

MADHUMEHA
I sivarama prq!94 I(ETHAMAKI4

When the pathology of Prameha is discussed in

Madhava Nidana, Madhavakara, who followed a
specific pattern has kept this (metabolic) disorder
belore l\fiedoroga (Obesity) and after the Ashmari
(Urinary caliculi). The chapter of prameha consists
of prameha pidika (boils). at the end as the
complications of prameha. There are twenty
pramehas explained, out of which 4 are vataia, 6
pittaja and 10 kaphaja

Because of Tulya dosha dooshyata
(Homologous etiologic factors of
vitiation of doshas and dooshyas)
kaphaja mehas are amenable to
treatment, where as vataja become
difficult for the same reason. The
medoroga is said to be the
nidanarthakara vyadhi for prameha
pidika'other than that of prameha.
Thus it is clgar, madhumeha -
Diabetes mellitus, -is a disorder
pertained to the lipid metabolism.
Today when we observe the patients,
many of them are non-insulin
dependent and very few are insulin
dependent. ln fact many of the
patients those who are having
madhumeha, secrete more insulin
(hyper insulinemia) than that ot
normal and still the glucose levels are
high (hyperglycemia). lt suggests
clearly, in insulin dependent patients,
there are other causes other than that
of insulin. Madhumeha literally means
madhuryata of mootra (r:enal
glycosuria).
SCAN:
When we look in to the pathogenesis
of meha vis a vis prameha it gives
priority for medas (fat?) as dooshya
along. with mamsa (muscle) and
shareera kleda (fluid contents"of the
body). The seat of accumulation of
fluid is vasti (bladder). ln the category
of shareera kleda, the other dooshyas
(vitiated tissues) are rakta (blood),
sukra(semen), ambu (fluids), vasa
(adipose tissue), lasika (lymph?),

li
Cover Etory
majja (bone marrow), rasa (plasma)
and ojas (essence of body tissues).
When we are analyzing the
pathogenesis, along witfr the dosha,
the sequencei of dooshya involvement
is to be followed.
It is explained in medoroga, how
the medagni gets the ama samjna
and dustamedas is accumulated in
the body. For the accurnulation of
the medas in the body
medovahasrotas avritatva
(encircling /covering), vata
vitiation, jathara$ni vriddi and
kapha medovardhaka nidana is
necessary. lt is a fact that, the obese
persons have the tendency of
developing prameha or madhumeha.
ln both prameha and medoroga
kapha rnedodusti appears in the
body.
Etiology:
The etiology includes intake of
navanna (newly harvested paddy)
which is rich of carbohydrates along
with the gudavikriti (items made of
jaggery and sugar), Payamsi, dadhini
(diary products) which have lactose
and less" number of carbohydrate
chains and are easily metabolized,
gramyaanupa rasa (meat and flesh
of the water and land animals) are
righ in proteins and lipids/tats, The
food which is ingested gets
assirnilated and'ulilized by jatharagni
and this gets impaired to begiri with.
Thus free glucose increases in the
blood which collects the seven water
11,
molecules for one.glncose molecule
and eicreted through, mootravaha
srotas (kidney, ureter, :bladder) and
ullirnately accumulates in vasti
(bladder), where re-absorption
mechanism fails (in Henley's loop)
and sweet urine or glycosuria is
witnessed ultimately in all mehas.
Ama auto corrective mechanism :
ln the process of pathogenesis first
jatharagni dowrbalyata is seen with
the above said etiology. lnitially
kaphavriddhi makes the Agni vitiation
with its seeta and guru gunas. The
agni dusthi leads to varieties of
Ajeerna according to the predominant
dosha associated. The Agni
disturbances follow with,Arna, in
pachakagni and spreads to Rasa, the
initial dhatu. lt further gets rooted in
the successive dhatui where first
three make one set and rear three
make another. ln between of these
two groups the Medas is not
accessible for treatment. Here the
Auto corrective mechanism:of the
body as protective mechanism act
(su.su.21l28) and makes the
rectification of Ama in uttana dhatus
(Rasa, Rakta and Mamsa). This can
be under the neural or secretary
control, or of'even both. But the
Medas is not going to be get
corrected by auto rectification,
Ojas in pathogenesis :
ln the nidana of pranieha, the cause
which increases sleshma, mootra. and
meda with a special reference to
sleshma, which is abundantly watery
(Bahudrava sleshma), is discussed.
Specificalty Madhumeha appears
when ojodusti.is seen a.nd because
the sweetness in Ojas gets depleted
by vata and reaches'the vasti, whicli
is the cause of the cardinal symptom,
sweet urine.: .
Browse the symptoms : to the dooshya alone. There by
Among the lakshanas mentioned in
Madhumeha the following are seen
as valuable for analysis.
.' Prabhootivila : mootrata
(polyuria) : Sweda vaha sroto
avarodhata causes increased
urinary output with turbidig
+ Madhuratwa ln mootra
Glycosuria (explained later in
Samprapti)
* Dantadinam mala sanchaya:
Becayge of ,Arra. depositions are
seen in mouth.
.'
Pani pada daha: Abundance of
glucose ayailable in the blood is
not utilized by body tissue causes
disturbance in the equillibrium of
dhatus and doshas. lt gives rise to
pada pani daha (burning sensation
of feet and palm).
$ Chikkanata (stickiness):
(explained later in Samprapti)
* Trishna (thirst - polydipsia): ln the
process of lypolysismore water is
utilized. lt results in to activation
of thirst center and Thirst.
s Swadasyata : Sweetness is
experienced in the mouth due to
increase in the sugar level.
Samprapti (Aetiopathology)
The description of pathogenesis in
Susruta Nidana 614 states
"Pravrittasyapaiipakwa" for which
Dalharra commenls as. Aparipakwa
Ama". lt refers both Amadosha and
Amadooshya. Further it is said as
'Medascha Aparipakwam' pertaining
Amatwa in dooshyas specifically
medas, isthe.meaning of "Medascha
Aparipakwamn.
Gayadasa explains it as "medascha
aparinama mili asamyakparinatam",
in this the process of formation of
medas is not interrupted but impaired,
with the qualities of ama; " Ama
:
rasavadati snigdham" , snigdhatwa
will be in medas by virtue, but here it
will become pichhilatwa with
atidravatwa. "Cha" usage indicates
not only medas but also other
dooshyas in the pathogenesis as
explained by Charaka. And Gayadasa
in his commentary said il is in
stanasamshritavasta, in which
amalakshana in medas and other
dooshyas are visualized. lmpaired
jatharagni and dhatwagnis causes
the atidravatwa of the dogshyas of
prameha. These draveebhootha
dhatus get dragged and excreted
through mootra vaha srotas.
" lt/ootrasya kledavahanam", there by
liquef ied waste/ non properly
metabolized or Ama/ Amadooshyas
dre excreted through mootravaha
srotas and its seat"is vasti, a place
l3
Caver Story

Table - 1

Showing auto rectification of Agni giving rise increased Medas

Mithya ahara and vihara '

Kaphaja Ahara

Jatharagni dourbalya

Ama in Jatharagni

Ama in Rasa, Rakta, Non restricted

Mamsa and Meda Medo ama

/ Aulo
\. rectilication Medoroga

, Samanavata
Nirama
Dhatu and Agni

Medo
deposition

Kindling
Jatharagni
Excessive
Metabollsm

'1
, Prabhoota mootrata 2. Avil mootrata
3. Madhura mootrata 4. Dantani mala sanchaya
5. Panipada daha 6. Chikkanata
7. Trishna 8. Abhishyanna deha
 Cover Story

Table - 2 Sweet urine genesis - Polyglycosuria

Kapha kara Ahara-->

+
Kapha

Vatavriddhi

Vi

i
MedovilayaRa
Break down of the
l-ligher level of
molecules to.lower
level molecules

Table -3 lnterference of fat metabolism developing Diabetes mellitus

Reaction inside outside of Mitochondria

@1 in the presence of Carnitine (Lysine derivative)

Helps iJcrossing
Mitochondrial membrane

Oxidised.f Iavoprotein
stimulates in Mitochondria
i
Red,.rced f lavoprotein, Alpha,
Beta unsaturated fatty acid CoA

Carnitine deficiency Defective-.r

^ ..)l
Garnnrne rncreaseY With the interaction of
Hypoketonemia Liver and acelyl CoA
Hypoglycemia Hyperketonemia gives rise beta
Hyperglycemia hydroxy butyrate +
Adversity or active production of Acetone along with
Beta oxidation of fatty acids .,-----\ Ketqne bodies
will produce Hyperglycemia /OtneefeS\
(fatty aeid synthesis slops WIELLITUS/
when the chains in Aminoacids -----'z
are more then 16 Carbon atoms long)
Cover Story
for accumulalion of urine. Chakrapani
on Cha.Ni.4/6comments as dravatwa
to kapha dosha. When kapha dosha
is in abundant liquefied form thenonly
capable of generating the prameha,
.by mixing with the medas which is
furiher liquefied and liquefy the
medas in association with ama
lakshana. lmportance of drava ahara/
pana in liquefying kapha and medas
along with lhe other dooshyas are to
be noticed. Kapha dosha is not
capable of causing the prameha roga
without pitta or vata. The dooshyas
are said to be medas, rakta, sukra,
ambu (sareera kleda), vasa, lasika
majja, rasa and ojas in chronological.
order.
lnmedoroga rasa, rakta and
mamsagni's are normal, where as
medagni is Vitiated orfat metabolism
is impaired: As medagni" is not
capable of assimilation of astayee
trnamsa, this agni is diverted. The
The author is Reader in Kayachikitsa,
Department of PG Sfudr'es, DGM Ayurvedic medical college,
Gadag, Karnatala
l6
kayagni amshas, which are
responsible lor catabolic activity in the
tissues, are also diminished. The.
dFiatus are subjected to increase.
Here not only jatharagni vriddhi but
also kayagni amshas of medodhatu
ksheenata is expected. As a result of
blockage of medovaha srotas,
increased agni (jatharagni/
pachakagni) and decreased medo
amshagnis cause the medoroga.
Lastly, there is a similarity between
prarneha and medoroga in etiology
with the factors capable ol causing
kapha vriddhi like madhura rasa,
snigdha guna dravyas. The process
of metabolism of fats in different
stages gives rise either medoroga or
prameha (santarpanothavikara).
Even in lakshanas of medoroga, we
see similarity with prameha
lakshanas.
Theflowcharts given will give clear
insight about the discussed topics.