Importance of Stress Factor in Prameha

S Aswathy; Chittaranjan Das

Importance of Stress Factor in Prameha

Aswathy S.^1*, Das C.²

DOI:

^1* S Aswathy, PhD Scholar, Sri Chandrasekharendra Saraswathy Viswa Mahavidyalaya, Enathur, Kanchipuram, Tamilnadu, India.

² Chittaranjan Das, Guide and Professor, Sri Jayendra Saraswathi Ayurveda College & Hospital, Poonamalle, Chennai, Tamilnadu, India.

Prameha is burning problems of the decade. According to the latest data from World Health Organization, a Global estimate of 422 million adults is living with Prameha. It belongs to the category of chronic Non-Communicable Diseases (NCD) Prameha more specifically Madhumeha can be correlated to the features of Diabetes mellitus. Considering the etiology of Diabetes mellitus, Stress has been found to have a prime place. It not only acts as an etiological factor but also as a triggering factor. Today stress has become an inevitable part of modern life. In today’s materialistic world, there is unhealthy competition in every field and man is compelled to act like a machine. This deteriorates the equilibrium of mind and the person comes under the influence of stress.

Keywords: Stress, Prameha, Diabetes mellitus, Sahasa, Ayurveda

Corresponding Author	How to Cite this Article	To Browse
S Aswathy, PhD Scholar, , Sri Chandrasekharendra Saraswathy Viswa Mahavidyalaya, Enathur, Kanchipuram, Tamilnadu, India. Email:	S Aswathy, Chittaranjan Das, Importance of Stress Factor in Prameha. J Ayu Int Med Sci. 2022;7(5):128-131. Available From https://jaims.in/jaims/article/view/1826

Introduction

Diabetes mellitus is a group of lifestyle metabolic disorders characterized by chronic hyperglycemia associated with disturbances of carbohydrate, fat and protein metabolism due to absolute or relative deficiency in insulin secretion and/or action. The hormone insulin moves sugar from the blood into the cells to be stored or used for energy. In diabetes, body either doesn't make enough insulin or can't effectively use the insulin it makes.^[3,4]

Prevalence: The number of people with diabetes mellitus in India has increased from 26 million in 1990 to 65 million in 2016. According to the 2019 National

Diabetes and Diabetic Retinopathy Survey report released by the Ministry of Health and Family Welfare, the prevalence was found to be 11.8% in people over the age of 50.

Types of Diabetes

1. Type 1 Diabetes mellitus

The previously used terminology is Insulin Dependent Diabetes Mellitus (IDDM). It is also called juvenile-onset diabetes, since it often begins in childhood and adolescence.

The genetic factors, autoimmunity and environmental factors play a role in causation and precipitation of Type I DM. People with type 1 Diabetes mellitus have a higher risk of heart disease and stroke.

2. Type 2 Diabetes Mellitus^[3.5]

The previously used terminology is Non-Insulin Dependent Diabetes Mellitus (NIDDM). It is the most common type of diabetes. The pathophysiological basis is that the cells of the body become resistant to insulin (insulin resistance). Insulin works like a key to let glucose (blood sugar) move out of the blood and into the cells where it is used as fuel for energy. When the cells become insulin resistant, moving sugar into the cells requires more and more insulin, and too much sugar stays in the blood.

Over time, if the cells require more and more insulin, the pancreas can't make enough insulin to keep up and begins to fail. Type 2 diabetes is further classified into obese and non- obese types.

Other types include Gestational Diabetes Mellitus (GDM), Maturity-Onset Diabetes of the Young (MODY) etc.

Etiology^[2]

The more fatty tissue, the more insulin resistant cells become.
Inactivity
Family history
Race or ethnicity
Age
Pregnancy
Polycystic ovary syndrome
High blood pressure
Stress

Stress is proved to be a potential contributor to chronic hyperglycemia…How?

Stress can be of two types - Eustress and Distress

Eustress: The individual is able to cope with it and it improves the performance.

Distress: The individual is unable to cope with it and it forms the major etiology for diseases like Hypertension, Migraine, Ulcerative colitis, Diabetes mellitus, Coronary Artery Disease, Peptic Ulcer, Asthma etc.

In this article, we are dealing with Distress^[3]

Blood sugar levels are controlled by two groups of hormones. First group include insulin which reduces the sugar level. Second group include cortisol, adrenaline, noradrenaline, glucagon and growth hormone which increases the blood sugar. Stress tends to increase the level of counter regulatory hormones especially cortisol, adrenaline and nor adrenaline which can precipitate diabetes in a predisposed individual or worsen the condition in someone who already have this disorder. i.e., In a diabetic person, increase in glucose which is induced by stress cannot be metabolized properly.

Again, the onset of diabetes mellitus can be a factor of stress in daily life which inversely affects the glucose metabolism thereby increasing blood sugar level. High as well as low sugar level affects mood. High sugar level may cause nervousness, anxiety and confusion and vague thinking. Low sugar level contributes symptoms like Euphoria,

confusion, difficulty in co-ordination and decision making, aggressiveness and irritability, personality and behavior changes, low concentration level etc. Euphoria is produced by the hormone Adrenaline in an attempt to convert any available glycogen in liver back to glucose.

The mental health condition in Diabetes is called as Diabetic distress. This, condition share features of depression, anxiety and stress which affect the quality of life of patient. The reason for distress may be the person’s concern about the responsibilities of managing the lifelong disease and worrying about it’s potential complications. The rigorous insulin schedule might disrupt person’s daily routine. The concern about missing a dose is a factor. The need to make dietary adjustments and checking blood sugar regularly can add to stress. The feeling that the disease may interrupt leisure and relaxation time lead to further anxiety and depression. The person become more frustrated and tensed which cause mood swings and thereby cause conflict in relationships.

High blood sugar leads to sexual problems especially erectile dysfunction in males which reduce the enjoyment of sexual life.

The flight and fight response triggered by stress elevate adrenalin and cortisol levels in blood stream. So respiratory rate increases, blood supply to muscles and limbs increases, and the body can’t process the glucose and result in hyperglycemia. Any physical or mental tension can be the cause of diabetes mellitus. Stress has been shown to have major effects on metabolic activity.

Evidence characterising the effect of stress in Type I diabetes is contradictory Animal studies have shown that stressors of various kind can precipitate or prevent the various experimental models of the disease. Human studies have shown that stress can increase, decrease or have no effect at all on glycaemic status in Type I diabetes. This is attributable to the autonomic neuropathy which is common in Type I Diabetes mellitus. In contrast, the role of stress in Type II Diabetes is more evident. More animal studies are present than Human studies to establish the relation between stress and Diabetes.

How to overcome stress?

One should accept stressful situation as challenges and not as threats.

The root cause of stress must be tackled first (Anxiolytic and Anti-depressive medication without tackling the root cause will not do good)
Practice better time management
Improve organizational skill
Resolve conflicts
Regular exercise
Practice of Yoga/meditation/Pranayama
Relaxation techniques
Eat moderately at proper times
Proper sleep
Seek support from professionals or from family

Ayurvedic interpretation of the relation between stress and Diabetes mellitus^[6,7,8]

In Ayurveda, body is considered as a conjugation of Panchamahabhuta, soul and mind. Stress can be interpreted in different ways according to Ayurveda^.Stressors (stress inducing factors) recognized in Ayurveda can be

a. Physical stress - Excessive exercise, trauma, fasting etc.

b. Psychological stress - Anger, fear, anxiety, grief etc.

c. Environmental stress - Exposure to intense heat of sun, high altitude etc.

Stress can be correlated with the word ‘Sahasa’ which can be defined as the excessive exertion compared to one’s physical/mental strength. Sahasa is mentioned in Charaka Samhita Nidanastana in the context of Sosha Nidana. Charaka says clearly that Sahasa will affect the body adversely. Sahasa cause depletion of Ojas which is the essence of Sapta Dhatus and represent the strength of body. Ojakshaya leads to Dhatu Kshaya and the person becomes weak and emaciated which causes Vata Kopa causing Vishamagni. Vishamagni causes Ama formation leading to Dhatu Dushti.^[14] If Medo Dhatu is affected, prodromal symptoms of Prameha can be seen. While explaining Prameha Samprapti, it is told that Ojas, more precisely Apara Ojus is expelled out from the body through sweat and urine since Atipravarthi of Sweda and Mootra is seen in Prameha. So, Ojakshaya can lead to Prameha and vice versa.^[9]

Charakacharya mentioned ‘Krodha’ in Pittaprameha Nidana and ‘Udwega’ and ‘Soka’ in Vata Prameha Nidana.^[12,13] The terms Krodha (anger), Udwega (anxiety) and Soka (grief) can be included as Psychological stress factors. Ayurveda consider these as Manodoshas. Manodoshas inturn cause the vitiation of Sareerika Doshas which vitiate Rasa Dhatu leading to Agnimandya and subsequent formation of Ama.^[10] According to Susruthacarya, in disturbed state of mind, a person is not able to digest the food even if taken in normal quantity which can lead to Ama formation. This Ama settles in Vasti leading to Prameha. Patients with stress often avoid their daily routine, get depressed and show a sedentary life style which is mentioned as a cause for Kaphaja Prameha. Thus, Acharya Charaka and Susrutha have highlighted that mind and body are the seat of diseases and they are interrelated.

Harita Samhita has mentioned that stress and wrong behavior can lead to diabetes Mellitus.^[11]

Ayurvedic guidelines for stress induced Prameha

1. Dinacharya - Daily routine

2. Use of Rasayana drugs

Example:

a. Aswagandha which is anti-diabetic as well as useful in anxiety.

b. Guduchi which is anti-diabetic and also lowers stress

c. Amalaki useful in Oxidative stress and in metabolic disorders like Diabetes mellitus and Dyslipidaemia

d. Jatamansi - Medhya Rasayana which is antidiabetic and lowers intellectual stress^[15]

2. Sirodhara

This is a procedure in which medicated oil is poured over scalp for stipulated time. Stress causes imbalance of Prana, Udana and Vyana Vayu, Sadhaka Pitta and Tarpaka Kapha. Sirodhara re-establishes the functional integrity of these Doshas thereby reducing stress as well as sugar level.^[16]

Conclusion

Thus, Diabetes mellitus can be considered as a disease that is initiated and provoked by physical

as well as psychological factors and most of the signs and symptoms can be placed under the broad heading of stress. Stress especially Distress was proved to be a potential factor for Hyperglycemia. This can be attributed mainly to hormonal changes.

In Ayurveda, depletion of Ojus takes place in stressed persons which can increase blood sugar. Stress can be correlated as Sahasa in Ayurveda and can be controlled by lifestyle modification especially adequate exercise, wholesome diet, regular sleep and proper use of Rasayana drugs which keep a person mentally and physically fit.

Reference

1. doi:https//www.researchgate.net/publication/228860949-synopsis of diabetes Mellitus

2. Harsh Mohan, Text book of Pathology, 6th edition, published by Jaypee brothers Medical Publishers (P) Ltd

3. Hall & Guyton, Text book of Medical Physiology, ed John.E.Hall, 8th edition, New Delhi, JP Brothers Medical Publishers

4. Harrisons principles of Internal Medicine, Fauci. Braunwald. Kasper etal,18th edition, Part 15,Section 1 Endocrinology, diabetes Mellitus 2069-2087,Mc Graw Hill Company 2008

5. Richard L Drake et al Gray’s anatomy, 3rd edition, published by Churchill Livingstone Elsevier

6. Charaka Samhita, Ed. Jadavji Trikamji Acharya, 5th edition, Varanasi, Choukhamba, Surbharti Prakashan, Reprint 2011, Chikitsastana chapter 6, verse 8, & chapter 15 verse 44-48.

7. Vagbhata (reprint 2008) pramehanidana adyaya, Sri Taradatta pant Ayurvedacharya, Ashtanga Hridaya, Varanasi: Chaukamba Sanskrit series, Nidanastana 10/1p 312-313

8. Agnivesa (reprint 2008) Prameha nidana adyayam, Dr.Ram Karan Sharma and Vaidya Bhagavan Dash, Charaka samhita, Varanasi, Choukhamba Sanskrit series Nidanastana 4/6 p 54

9. Arunadatta, sarvangasundari vyakhya of Ashtanga Hridaya, edited by Harishastri Paradkar, published by Krishnadas Academy

10. Bhavamisra ,Bhavaprakasa translation by Srikantamurthy K R, 1st edition, published by Chaukhamba Viswabharati Oriental publishers and distributors ,Varanasi 2000

11. C. Dwarakanatha, Introduction to Kayachikitsa, published by Chaukhamba orientalia, Varanasi

12. Chakrapani, Ayurveda deepika commemtary of charaka samhita, edited by Vaidya Yadavji Trikamji Acharya, Published by Chaukhamba Prakashan, Varanasi, Reprint 2013

13. Chakradatta with Goodartha Depika vyakhya, commentary by Cheppadu K Achutavarrier, published by S T Reddiar and Sons

14. JSBO Journal DOI -10.7897/2321-6328.0331-Study of Prameha vis a vis Metabolic syndrome

15. World Journal of Pharmaceutical Research, volume 6, Issue 3,970-971, ISSN 2277-7105, Clinical study of Jatamansi choorna with Sirodhara in the management of Prameha with special ref to Diabetes mellitus, Edited by Vimala Madhudhara

16. Prameham (Diabetes) edited by DR t Damodharan Unni, Vasudevavilasam Publications, Thiruvananthapuram.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-04-28	2022-04-30	2022-05-07	2022-05-14	2022-05-21
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	18%

Review Article

Prameha

Journal of Ayurveda and Integrated Medical Sciences