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Diabetes Mellitus in Ayurveda: A scientific approach

Article · December 2019

DOI: 10.1186/2251-

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NOVEMBER 2019

Diabetes Mellitus in Ayurveda-

A Scientific Approach

Abstract:
Diabetes mellitus (DM) is a dreadful lifestyle metabolic
disorder with an estimate of 8.7% of diabetic population
in India.The difference in number of cases being affected
in urban population with respect to rural is 8% because
of changes in lifestyle and consumption patterns. In
Ayurveda, DM can be interpreted under the broad clinical
entity described as Prameha. DM requires long-term
medical attention to limit the development of its devastating
complications. Treatment modalities in Ayurveda are
focused on avoidance of causative factors, correction
of metabolism at multi systemic level using various
drugs and therapies, diet management, modifications in
Dr. Seetha Chandran lifestyle etc. The disease which is manifested as a result
(BAMS, MD, Ph.D) of sedentary lifestyle and unhealthy food habits can be
eliminated by following the natural regimes advised
Course Coordinator by Ayurveda. Current article focuses on the scientific
Kottakkal School of relevance of available alternatives in Ayurveda on the
Excellence (KASE) prevention and management of diabetes.
KASRS, VPSV Ayurveda
Keywords: Ayurveda; Diabetes mellitus; Prameha
College, Kottakkal
1. Introduction
Globally, an estimated 422 million adults are living with
diabetes, according to the latest 2016 data of World Health
Organization (WHO).[1] India has a diabetic population of
8.7%. (40.9 million diabetics in India expected to be 69.9
million by 2025).[2] The overall prevalence of diabetes
and prediabetes in all the 15 states of India were 7•3%
and 10.3% respectively.The prevalence of diabetes varied
from 4•3% in Bihar to 10•0% in Punjab and was higher in
urban areas (11•2%) than in rural areas (5•2%). States
with higher per-capita GDP seemed to have a higher
prevalence of diabetes (eg, Chandigarh had the highest
prevalence, 13.6%).[3] In India, the difference in number
of cases being affected in urban population with respect to

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 NOVEMBER 2019

rural is 8%.[4] The rising prevalence of diabetes channels of lipid metabolism is the major vitiated
and other noncommunicable diseases is driven one in prameha and its moola sthana (primary
by a combination of factors - rapid urbanization, focus of pathogenesis) is explained as urinary
sedentary lifestyles, unhealthy diets, tobacco system and adipose tissue. This explains the
use, and increasing life expectancy5. role of increased abdominal adiposity in the
susceptibility of metabolic syndrome and DM.
In Ayurveda, both Diabetes mellitus and insipidus
can be interpreted under the broad clinical entity In Ayurveda Prameha is classified on the basis
described as Prameha. Because Prameha is a of etiology; clinicopathology; body constitution
multi systemic disease caused by the imbalance and of prognosis. Causative factors which
of Tridosha, initially mediated through Kapha increase meda (fatty acid), mutra (urine) and
affect urinary system and manifest as polyuria, kapha (body humour), generally leads to the
polydypsia etc.The present review provides pathogenesis of Prameha. They are high calorie
an in depth analysis of scientific relevance of diet, sedentary habits and absence of exercise.
management strategies mentioned in Ayurveda [9] Prameha is classified in to three based on
for Diabetes. tridoshas (three body humours)ie, vata, pitta and
kapha. And some etiological factors are identified
2. Materials and methodology
for separate doshik varieties. Kapha Prameha
Ayurvedic classics, Textbooks of clinical
is caused by fresh cereals, dairy and sugar
medicine and e- publications were consulted
products, meat and reduced physical activities.
and reviewed for carrying out the present work.
[10] Rather the opposite of above etiological
3. Observation and Discussion factors like spicy food, hot environment, physical
3.1 Aetiology exersion, anger, intake of contradictory food
The most common form of diabetes in the articles etc are the causes of paittika Prameha.
general population is type 2 diabetes, which [11]Similarly vatika prameha is caused by
often develops from pre-diabetes. Presumably low calorie diet, skipping of meals, excessive
type 2 DM develops when a diabetogenic physical activity, suppression of manifested
lifestyle (ie., excessive caloric intake, inadequate urges, stress etc.[12]
caloric expenditure, obesity) is superimposed
It has been reported that one of the causative
on a susceptible genotype.[6] Obesity and
factors responsible for the pathophysiology of
weight gain are important determinants of
chronic diabetes includes free radical induced
insulin resistance in type 2 DM.[7] Autoimmunity
oxidative stress, analogous to radiation-induced
is considered as the major factor in the patho
acute multi-organ dysfunction syndrome.[13]
physiology of type 1 DM.[8] In Ayurveda,

References: [8] . http:// www.merckmanuals.com

[1] World Health Organization, Global Report on Diabetes. [9] .Vagbhata. Ashtangahrdaya, Sarvangasundara
Geneva, 2016. Accessed 30 August 2016 and Ayurveda Rasayana Commentary, Edited by
Pt.HariSadasivasastriParadakara, Nidanasthana, Chapter-
[2]. Sicree R, Shaw J, Zimmet , Diabetes and impaired glucose 10, verse:1,2,3, Varanasi: Chowkhambhasanskritsansthan;
tolerance. In: Gan D, editor. Diabetes Atlas. International 2012:502
Diabetes Federation. 2006: 15-1
[10]. Agnivesha. Carakasamhitha with Ayurveda deepika
[3] Ranjit Mohan Anjana, Mohan Deepa, Rajendra Pradeepa commentary by chakrapanidutta, Edited by Vaidya Ja
etal., Prevalence of diabetes and prediabetes in 15 states of
India: results from the ICMR–INDIAB population-based cross- davjiTrikamji Acharya, NidanaSthana, Chapter-4,verse: 5,
sectional study, Lancet Diabetes Endocrinol 2017, lancet.com/ Varanasi:Chowkhambhakrishnadas Academy Publication;
diabetes-endocrinology. http://dx.doi.org/10.1016/ S2213- 2010: 212
8587(17)30190-0 [11] . Agnivesha. Carakasamhitha with Ayurveda deepika
[4] . Diabetes action now”. Booklet- Designed by WHO; 2004: commentary by chakrapanidutta, Edited by Vaidya
20. JadavjiTrikamji Acharya, NidanaSthana, Chapter-4,verse: 25,
Varanasi:Chowkhambhakrishnadas Academy Publication;
[5] http://www.searo.who.int/india/topics/diabetes_mellitus/en/ 2010: 214
[6]. http://www.emedicine.medscape.com/ article/ 117853 [12] . Agnivesha. Carakasamhitha with Ayurveda deepika
[7] . http://www.emedicine.medscape.com/ article/ 117853 commentary by chakrapanidutta, Edited by Vaidya
JadavjiTrikamji Acharya, NidanaSthana, Chapter-4,verse: 36,

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 NOVEMBER 2019

Alteration of metal status in the body have a vital diagnosed for fixing shodana and shamana
role in causing oxidative stress.[14] treatment. Obesity treatment principles can
be adopted in early onset and obese diabetic
3.2 Management strategies
patients. For them, dietary articles should be
Diabetes mellitus is a chronic disease that
of minimum nutritional value and heavy to
requires long-term medical attention to limit the
digest, to pacify the hunger of a diabetic patient.
development of its devastating complications
Emaciated diabetic patient should be nourished
and to manage them when they do occur.
without causing increase of (meda) fat and mutra
Though there are many synthetic drugs used for
(urine). Different doshik varieties should be kept
the treatment of diabetes in Modern medicine,
in mind before designing the treatment, because
it has many documented side effects and
the line of treatment of each types vary. Many
complications. Treatment modalities in Ayurveda
types of herbal decoctions, powders, arishta
are focused on avoidance of causative factors
(medicated fermented products) and single drugs
and correction of metabolism at multi systemic
are used as shamana in Prameha. In due course,
level, than merely focusing on hyperglycemia,
on chronicity; patient requires nourishment
thereby preventing emerging complications.
by means of support through micronutrients.
In addition to various drugs and therapies, diet
Mineral drugs like Yashada bhasma, Swarna
management, routine exercise, exposure to
makshika bhasma, Shilajatu rasayana etc, help
sun and wind etc are also mentioned. Type I
to compensate such conditions. Rasayanas
diabetes is incurable in Ayurveda and insulin
can offer a new and promising approach in the
therapy is mandatory in such patients. A proper
long-term management of diabetes mellitus,
planning of Ayurvedic drug and diet is very
because of its multifaceted action. Few of the
useful in type II Diabetics, even helps to reduce
herbs used in Ayurveda, have proven efficacy
the insulin dosage or even to stop the same.
in regeneration of β-cells and overcoming
Shodana cikitsa (cleansing of system/ insulin resistance, some of them also possess
detoxification) through panchakarma, Shamana antioxidant activity.[15] Such distinguishing
cikitsa (pacifying the disease), rasayana factors makes it unique compared to treatment
(rejuvenating) and satwavajaya (it refers to modalities in other science, where a single
meditation and mental hygiene) helps to yield treatment is prescribed in all types of Diabetes
better glycemic control. These are designed in aiming to decrease hyperglycemia only.
such a way that they not only cure the illness,
Diet and regime
but maintain health, vigour and vitality, which is
Disease specific dietary measure is a unique
humiliated in a diabetic. The two therapeutic
concept of Ayurveda.[16] Food is the first and
varieties as obese and lean is essentially

Varanasi: Chowkhambhakrishnadas Academy Publication; chapter-4, verse-6 , Pune: Choukamba Sanskrit sansthan
2010: 215 publishers; 2015:700
[13] . Raman Chawla, Pallavi Thakur, Ayush Chowdhry, Sarita [18] . Vagbhata. Ashtangahrdaya,WithSarvangasundara
Jaiswal, Anamika Sharma, Rajeev Goel et al., Evidence and Ayurveda Rasayana Commentary, Edited by Pt.Hari
based herbal drug standardization approach in coping with Sadasivasastri Paradakara, Nidanasthana, Chapter- 12,
challenges of holistic management of diabetes: a dreadful verse:10-14, Varanasi: Chowkhambhasanskritsansthan;
lifestyle disorder of 21st century, J Diabetes Metab Disord. 2012:678
2013; 12: 35. Published online 2013 Jul 4. doi: 10.1186/2251-
[19] . Prakash Mangalassery, Diabetes Mellitus- Ayurvedic
6581-12-35
diagnostic approach and management, Nhanamrtha Souvenir,
[14]. Bonnefont-Rousselot D, The role of antioxidant National seminar on Diabetes mellitus, Ayurveda and
micronutrients in the prevention of diabetic panchkarma practitioners association; Thiruvananthapuram:
complications,TreatEndocrinol, 2004:3(1); 41-52 2014: 19-23
[15] . Jarald E, Joshi SB, Jain DC. Diabetes and herbal [20]. Sridhar Reddy , Ashok , Anand Katti, Shreevathsa, Yava
medicines. Iran J Pharmacol Ther. 2008;7(1):97–106 (Barley) the disease specific diet in prameha, IAMJ: 2014
[16] . Sridhar Reddy , Ashok , Anand Katti, Shreevathsa, Yava November- December;2(6): 2014
(Barley) the disease specific diet in prameha, IAMJ: 2014 [21] . Sridhar Reddy , Ashok , Anand Katti, Shreevathsa, Yava
November- December;2(6): 2014 (Barley) the disease specific diet in prameha, IAMJ: 2014
[17]. Vridha Jeevaka, Kashyapa Samhitha, vidyothinihindhi November- December;2(6): 2014
commentary of sree satyapalabhishagacharya, Khilasthana; [22] . Raman Chawla, Pallavi Thakur, Ayush Chowdhry, Sarita

32
 NOVEMBER 2019

most important form of medicine.[17] This is the fiber intake of more than 30g/d was shown to
reason, why Acharya has specifically prescribed represent an effective preventive approach. [23]
some special diets for Prameha rogi. Black gram This will justify the pathyahara mentioned in
baked in steam, corn flour mixed with milk sugar Ayurvedic classics.
and ghee, paste of pulses fried in oil prepared The practice of regular exercise like long walk of
from barley, meat of animals of desert like about 800- 900 miles, bare footedly without an
regions roasted on a rod or which is well dried umbrella, Udwarthana (mild massage with dry
in sun, honey water etc are advised.[18] The herbal powder), adhering to an ascetic way of life
patient is advised to avoid the specific causative (disciplined and hard life), or dig a reservoir of
factors mentioned in different doshik varieties. It water by himself or wander along with a herd of
means spicy food, hot environment etc are more cows substing on the dung, urine etc is said.[24]
important than restriction of sweet articles in Through this, it is well understood that, a natural
paittika prameha. Same is true in case of vatika habitat of living is a must for the well being of a
prameha too.[19] On analyzing, this diet chart is diabetic. It is now established that participation
poor in fat and rich in carbohydrate particularly in regular physical activities (PA) improves blood
that of cereal origin. And the cereal products glucose control and can prevent or delay type
mentioned here are having very low glycemic 2 diabetes, along with positively affecting lipids,
index, rich in fibre content and resistant starch. blood pressure, cardiovascular events, mortality,
[20] Compared to other cereals yava (barley) and quality of life. But PA results in lowering
contains more dietary fibres that too the soluble fasting blood glucose levels only and that too
fibre- beta glucon. When this soluble fibre is for at least 24 hrs after exercise.[25] Avoiding
taken with a meal, it increases the viscosity the usage of umbrella increase the availability
of meal bolus and delays the absorption, of Vitamin –D in Diabetic patients, which further
so there will be no sudden fluctuations of helps in improved pancreatic B cell function.
blood sugar.[21] The enzymes responsible [26] Furthermore, vitamin D plays an important
for carbohydrate hydrolysis are excluded by part in the regulation of calcium which helps
the fibre components in food thereby slowing to control the release of insulin. [27]. Walking
down the rate of hydrolysis, impersonating barefoot is mentioned as a risk factor for diabetic
resistant starch metabolism.[22] Intake of foot disease as per modern medicine. [28]
medicated gruels prepared out of Dashamoola But going barefoot allows to “ground” with the
etc have found to decrease the dose of insulin Earth and grounding has one of the most potent
or OHA(oral hypoglycemic drugs) and will antioxidant effects and also reduce inflammation
even prevent the unforeseen complications by ,stress, sleep disturbance etc.[29]Antimicrobial
metabolic correction. A low-fat diet with a dietary properties of cow dung and cows urine will

Jaiswal, Anamika Sharma, Rajeev Goel et al., Evidence sensitivity, and glycemia in adults at high risk of diabetes:
based herbal drug standardization approach in coping with the Calcium and Vitamin D for Diabetes Mellitus (CaDDM)
challenges of holistic management of diabetes: a dreadful randomized controlled trial. Am J Clin Nutr, 2011. 94(2): 486-
lifestyle disorder of 21st century, J Diabetes Metab Disord. 94.
2013; 12: 35. Published online 2013 Jul 4. doi: 10.1186/2251- [27] . https://www.vitamindcouncil.org/health-conditions/type-
6581-12-35 ii-diabetes/
[23] . Kaline K, Bornstein SR, Bergmann A, Hauner H, [28] . https//:www.ncbi.nlm.nih.gov/pubmed/17571928
Schwarz PE, The importance and effect of dietary fiber in
diabetes prevention with particular consideration of whole [29] . https//:www. articles.mercola.com/sites/articles/.../
grain products, Horm Metab Res. 2007 Sep;39(9):687-93. barefoot-on-electron-deficiency.aspx
[24] . Vagbhata. Ashtangahrdaya,WithSarvangasundara [30] . Sheri R Colberg etal, Exercise and Type 2 Diabetes,
and Ayurveda Rasayana Commentary, Edited by Diabetes Care 2010 Dec; 33(12): e147-e 167.
Pt.HariSadasivasastriParadakara, Nidanasthana, Chapter- [31] . Prakash Mangalassery, Diabetes Mellitus- Ayurvedic
12, verse:36-37, Varanasi: Chowkhambhasanskritsansthan; diagnostic approach and management, Nhanamrtha Souvenir,
2012: 681 National seminar on Diabetes mellitus, Ayurveda and
[25] . Sheri R Colberg etal, Exercise and Type 2 Diabetes, panchkarma practitioners association; Thiruvananthapuram:
Diabetes Care 2010 Dec; 33(12): e147-e 167. 2014: 19-23
[26] . Mitri, J., et al., Effects of vitamin D and calcium [32] . Kheranda, Kheranda Samhitha, Edited and commented
supplementation on pancreatic beta cell function, insulin by Swami niranjananandha saraswati, Chapter-2 , verse-40

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 NOVEMBER 2019

give special protection to an immune deficient physical work in daily schedule is essential to
diabetic. [30] channelize the energy and also to revitalize the
cells of the body.[39] The regimes mentioned in
Effect of specific yogasana, pranayama
Ayurveda is a combination of these two lifestyle
(breathing practices), shanka prakshalana ( yogic
modifications i.e.,diet and exercise. They were
purgation), dyana (meditation) etc are clinically
aimed to reduce the sedentary lifestyle and
proved in various stages of Prameha.[31]Yoga
prevent the onset of Diabetes mellitus in a
improves all sorts of metabolism in the body.
healthy individual. So a “do or die” approach
Yogasanas like makarasana, Bhujangasana etc
should be followed for preventing the onset of
are agnivardhaka asana.[32] Mrithasana is said
Diabetes or its complications in a Diabetic.
to be chitha vishranthikara. [33] Similary many
asasanas are practiced in prameha rogi as they 4. CONCLUSION
have a major role in relieving stress. [34] This Ayurveda is a life science not merely a
also help to increase the circulation, so that medical science. India, with pluralistic health
complications like nephropathy, neuropathy etc care system, have extensive expertise in all
can be prevented to a great extent. As per recent systems of medicine. Among those, Ayurveda
study findings, pranayama and yoga-asana advises the most natural method of treatment
showed a significant improvement in the P in all ailments. And in the case of a diabetic
300 latency and the amplitude of N200, which patient, the most important causes are
improves cognitive brain functions in Diabetes. sedentary lifestyle and junk food. By following
[35] the Ayurvedic regime, he will return to the
natural lifestyle unknowingly,preventing the
Do or Die – A preventive approach
complications of diabetes. Though most of the
Many people first become aware that they have
Ayurvedic treatments are feasible to elite class,
diabetes only when they develop one of its
management regimes mentioned for diabetic
potentially life-threatening complications. Around
patient can be easily made practical by all social
3.2 million deaths (six deaths/minute) every year
class, as natural method of treatment regimes
is attributable to complications of diabetes.[36]
are prescribed for Prameha.Even the remote
Heart disease is the leading cause of diabetic
complications, are being taken care in Prameha
related death. The risk of stroke is 2-4 times
treatment in Ayurveda, which prevents the
higher among people with Diabetes. In addition
patient landing in to morbidity and mortality. So
diabetes causes 12,000 to 14,000 cases of
the proposed regimes of Ayurveda is a key to
blindness per year. It is a major contributor to
meet the probable challenge of diabetes in this
kidney disease and causes nerve damage to
arena.
extremities, sometimes leading to amputation.
[37] WHO reports (1997) showed that between Conflict of interest: Nil
20%-50% of people with type-2 diabetes can
Acknowledgement : The author acknowledge
control their blood glucose levels by dietary
Dr. Prakash Mangalasseri for his consistent
modification alone, thereby preventing/delaying
support
the onset of Diabetes. [38] However exercise/

-43, 1st ed. Bihar, Swami satyasanganand saraswathi [36] . Raman Chawla, Pallavi Thakur, Ayush Chowdhry, Sarita
publishers;1997:192 ,197 Jaiswal, Anamika Sharma, Rajeev Goel et al., Evidence
[33] . Kheranda, Kheranda Samhitha, Edited and commented based herbal drug standardization approach in coping with
by Swami niranjananandha saraswati, Chapter-2 , verse- challenges of holistic management of diabetes: a dreadful
20, 1st ed. Bihar, Swami satyasanganand saraswathi lifestyle disorder of 21st century, J Diabetes Metab Disord.
publishers;1997:154. 2013; 12: 35. Published online 2013 Jul 4. doi: 10.1186/2251-
6581-12-35
[34] . P Srinivas*, k Prameela devi, B Shailaja , Diabetes
mellitus (madhumeha)-an ayurvedic review , Int J Pharm [37] . https//www.books.google.co.in>books
Pharm Sci, 20146 (1): 107-110 [38] . “Diabetes action now”. Booklet- Designed by WHO;
[35] . Tenzin Kyizom, Savita Singh, K.P. Singh, O.P. tandon & 2004: 20.
Rahul Kumar, Effect of pranayama & yoga-asana on cognitive [39] . “Diabetes action now”. Booklet- Designed by WHO;
brain functions in type 2 diabetes-P3 event related evoked 2004: 20.
potential (ERP). Indian J Med Res 131, May 2010, pp 636-640

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