PRAMEHA

By Dr Akhil.H.S

Dept of SHAREERA RACHANAALVAS AYURVEDIC COLLEGE.

PRAMEHA

• प्रकर्षे�ण मे�हति� जनयति� मे�त्रं� इति� प्रमे�ह� ॥• �त्रं आति�लप्रभू�� मे�त्रं लक्षण� स�� ए� प्रमे�ह� ॥ स�. तिन

६/५• One of mahagada.

• प्रत्य�त्मे लक्षण - प्रभू���ति�ल मे�त्रं�

DOSHAS AND DHAATUS

• All the three doshas are vitiated. • मे��स –मे�द –शु�क्र –मेज्जा� –रस –रक्त are vitiated.

• Other दूष्य�स+ are- ऒजस+ - उदक - �स� – लसिसक�.The doshas chiefly concerned is kapha and

among dhaatus मे�द, उदक, मे��स are principally involved. And रस –रक्त are moderately involved.

SROTAS

• स्रो0�स+ involved in prameha are- उदक�ह - मे�त्रं�ह – मे�द�ह- स्��द�हस्रो0�स+

मे�द�हस्रो0�स+

• मे�ल - �2क्क �पा��हन

• लक्षण- प्रमे�ह पा���रूपा+ (मे�ख,��ल�,कण्ठ शु0र्षे, तिपापा�स,आलस्य,मेलस�चय,अं�गस�प्ति=�,शुर>र ति�स्रोग�ध,�न्द्र, तिनद्र ...

मे�त्रं�हस्रो0�स+.

• Moola- basti and vankshana.

मे�त्रं�हस्रो0�स+ closely related to उदक�ह- रस�ह- स्��द�ह अंन्न�हस्रो0�स+.

मे�त्रं is on of the मेल of body. Which depends on अंग्निDन in अंन्न�हस्रो0�स+ and ध���s. This स्रो0�स+

determine the quantity and quality of urine to be excreted out.

उदक�हस्रो0�स+

• उदक�ह�न�� स्रो0�स�� ��ल� मे�ल� क्ल0मे� च ॥ च.ति� ५• उदक - अंपा+ ध���• Acc to charaka.sarira 7/15- • अंपा+ ध��� is 10 anjali.• It does sarira dhaarana.It forms part of

pureesha, mutra, sweda, lasika etc. and dhatus like rasa, rakta, mamsa etc.

• It helps in ahladana, kledana, bandhana , vishyandana.

स्��द�हस्रो0�स+

• मे�ल - मे�द and ल0मेक� पा

• लक्षण- अंति�स्��द, कण्डु� , दFगGध्य

• वृ�क्क• Acc to susruta एक0� ��मेपा�र्श्व�स्थिK�� तिL�>य दक्षिक्षण पा�र्श्व� स्थिK�� ।

स�.तिन • रक्त मे�द प्रस�द��+ �2क्कF ।• मे�द0�ह� L� �य0मे��ल� कटिP �2क्कF च ।• From above reference we can almost consider

it as kidneys.

• क्लो�म

• अं.हृ - कफा�धिधष्ठा�न• स�.तिन- क्ल0मे0 तिह आमे�शुयस्त्�ध�। क्ल0मे0 तिह शु0क्षिण�ज� क्ल0मे�

क�लखण्डु�दधस्���+ स्थिK�� दक्षिक्षणपा�र्श्व�K� ति�लक� प्रसिसध्द� ॥• Udaka vaha sroto moola.• Varuna is considered as creator of kloma.• Acc to srikantadatta - �2क्क�दूध्�G तिपापा�सK�न� ।• As a koshtanga it should come in thoracic/abdominal

cavity.• An organ Rt and Below liver is pancreas• Above kidney- Supra renal glands

• Basti

• अंल्पामे��सशु0क्षिण�0 आभ्यन्�र�� कट्या� धन���क्र एकL�र0 अंध0मे�ख0 बस्तिःस्�� ॥ अं.स�.शु� ७/१९

• बस्तिःस्� द�शु� अंय� नक्षिभूपा2ष्टकटिPमे�ष्कग�द�ङ्+ क्षणस�फास�� मेध्य�ऽलब्��क2 ति� सिसर�स्नय�पारिरग्रहस्�न�त्�क्कFऽध0मे�ख एकL�रश्च ॥ स�.तिन ३/२०

• Maana is 4 angula• A bag like structure that collect and store urine

before excretion, it can be Urinary Bladder.

LAKSHANA

• दन्��दgन�� मेल�ठ्यत्��• पा�क्षिण पा�द द�ह• जटिPल>भू�� क� शु• मेध�र�स्य�• करपा�द स�प्ति=�• मे�ख ��ल� शु0र्षे• तिपापा�स• आलस्य• ति�स्रो�शुर>र गन्ध• तिनद्र• �न्द्र�

DIABETES MELLITUS

• • What is DIABETES MELLITUS?• Acc to W.H.O –• It is heterogeneous metabolic disorder

characterized by common feature of chronic hyperglycemia with disturbance of carbohydrate, fat, and protein metabolism.

• Depending on the etiology, hyperglycaemia may result from

• a) reduced insulin secreation.• b) Decreased glucose use by the body.• c) increased glucose production.

INSULIN

• It’s a peptide hormone (a protien ) secreted by beta cells of islets of langerhans.

• It helps to transport glucose into the target cells of the body. And reduces the increased glucose level of blood.

PANCREAS

HISTOLOGY

ENDOCRINE PART

• MAJOR CELLS

MINOR CELLS

Beta cells 70% of islet cells INSULIN

Alpha cells 20% GLUCAGONE

Delta cells 5-10 % SOMATOSTATIN

Pancreatic Polypeptide cells

1-2 % PANCREATIC POLYPEPTIDE

D1 cells Vaso active Intestinal peptide

Entero chromaffin cells SEROTONIN

A- Alpha cell

B- Beta cell

D- Delta cell

F- PP cell

SOME MORPHOLOGICAL FEATURES IN PANCREATIC ISLETS

• Insulitis – Type 1 – In early stagethere is lymphatic infiltration of t-cells,

macrophages etc Type2 – Little fibrillous protien deposit.• Islet cell mass destruction – Type 1 – As DM become chronic there will be progressive Depletion of

beta cells, eventually result in total loss of pancreatic B-cell Type 2 –Mildly effected.• Amyloidosis. Type 1 –are absent. Type 2 - Amyloid deposit around capillaries of islet. Causing

compression and atrophy of islet tissue. Degranulation of B-cells.

FEATURES IN DM

• TYPE 1- Absence of insulin due to destruction of beta cell.

• TYPE 2- Insulin secreation is normal• a) Insulin resistance. b) failure of beta cells.

MECHANISM OF COMPLICATION

• The process of development of complications in D.M is explained by 2 mechanisms

1. Non – enzymatic protien glycosylation2. Polyol pathway mechanism

DIABETIC NEPHROPATHY

• Morphologically – 4 types of lesions1. Diabetic glomerulosclerosis2. Diabetic vascular lesion3. Diabetic polynephritis4. Tubular lesion

• Diabetic glomerulosclerosis

•Thickening of vessels•Increase matrix•Prolyferation of matrix

•1 or More .•Ovoid/spear• Surrounded by capillaries•Renal ischemia•Tubular atropy•Interstitial fibrosis•Small contracted kidney

DIFFUSE NODULAR

DIABETIC NEUROPATHY • Effects all nervous system.(peripheral neuropathy is more clear)

• Basic pathological changes – . . .

• Glucose deposit in micro capillaries.

• Demyelination Schwann cell injury Axonal damage

DIABETIC RETINOPATHY

BACKGROUND RETINOPATHY• Basement membrane

thickness increase.• Degeneration of pericytes

and loss of endothelial cells• Capillary micro-anurism• Waxy exudate accumilation near micro anurism.

(hyperlipidemia)• Dot and Blot – Retina• Soft Cotton-wool spot

PROLIFERATIVE RETINOPATHY• After long term• Neovascularisation of retina

at optic disc.• Friability of newly formed

B.V cause easy bleeding- haemorrhage of vitrous

• Also proliferation of fibrous tissue around B.V

• Contraction of fibro – vascular tissue = Retinal detachment

DISCUSSION• Prameha can not only be compared to D.M, but electrolyte

imbalance etc are also related to prameha.• The syndrome of D.M is largely covered under prameha. • Apathyanimitta prameha, sthula prameha in ayurvedic litrature has

similarities with D.M. Madhumeha can almost be Diabetes Mellitus. • But to understand remaining 19 types of prameha we need wide

discussion and proper reasoning.• In general destruction of B-cell mass and obesity are most

important cause of diabetes.• So approach in treating DM should be to control diet and good life

style. • Early diagnose and treatment can prevent complications due to

prameha.

THANK YOU