E-ISSN:2456-3110

Review Article

Etiological Factors

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 09 Number 06 JUNE
Publisherwww.maharshicharaka.in

Evaluation of etiological factors (Hetu) of Prameha w.s.r. to Bruhatrayee

Suman Sharma1
DOI:10.21760/jaims.9.6.35

1 Suman Sharma, Assistant Professor, Dept of Ayurveda Samhita Evum Siddhanta, Ayujyoti Ayurvedic College and Hospital, Sirsa, Haryana, India.

Objective: To evaluate etiological factors (Hetus) of Prameha with special reference to Bruhatrayee.

Methods: 75 Patients of Prameha and randomly ‘selected control group of 75 people were comprehensively investigated with a self-designed questionnaire. All the data obtained were transformed and analysed statistically by chi-square test.

Result: There is statistical difference between the Prameha patient group and the control group. Among the case group Pishtanna, Krushara, Vilepi, Ikshu-Vikar, Nava Madhya, Mandak Dadhi, Dravanna, Madhur Atisevan, Snigdha Aahar, Amla Atisevan, Lavan Atisevan, Samashan, Vyayama Varjanam, Swapna-Shayya-Aasana, Diwaswap have been found significant Hetus (Aaharaja) in occurrence of Prameha than those of control group (p<0.05). Dhanya Sevan, Sarpi Sevan, Mamsa Sevan, Shaak Sevan, Payas, Ksheer, Guru Aahar and Sheet Sevan, Mruja Varjanam, Tyakta Chintana, and Samshodhana Akurvatam have been not found significant Hetus (Viharaja) in occurrence of Prameha.

Conclusion: This study indicated that, Hetus (etiological factors) of Prameha which are actually responsible for manifestation of Prameha Vyadhi has been categorized in this study. Hence Hetu Siddhant has been revalidated

Keywords: Prameha, Hetu Siddhant, Case Control Study, Etiological factors

Corresponding Author How to Cite this Article To Browse
Sharma Suman, Assistant Professor, Dept of Ayurveda Samhita Evum Siddhanta, Ayujyoti Ayurvedic College and Hospital, Sirsa, Haryana, India.
Email: 		Suman Sharma, Evaluation of etiological factors (Hetu) of Prameha w.s.r. to Bruhatrayee. J Ayu Int Med Sci. 2024;09(06):226-230.
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https://jaims.in/jaims/article/view/3495

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Authors state no conflict of interest. Non Funded. The conducted research is not related to either human or animals use. 13.11 All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

© 2024by Suman Sharmaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Suman S. et al. Evaluation of etiological factors (Hetu)

Introduction

Prameha Roga is one of the important diseases described in Ayurveda. Prevalence of diabetes is increasing day by day throughout the world where India has been projected by the W.H.O. as the country with the fastest growing population of the diabetics. Prameha is a disease occurring mainly due to Agnimandhya. Faulty digestive fire unable to digest food properly. Agnimandhya causes Ama production, so that Adya Rasa Dhatu is not formed properly and its Prinana Karya is altered which hampers the Prakrut Dhatu Nirmiti causes production of excessive Mala which is nothing but the Kleda. This Agnimandhya and Kleda Nirmiti are the main cause for Prameha.[1]

Acharya Charak has explained that the simple baseline treatment is the avoidance of etiological factors (Nidana Parivarjana).[2] Rightly, it is said that prevention is better than cure. Hence the knowledge about the etiological factors is useful to provide proper guidance for treatment as well as in the prevention of disease. This fact itself triggered the need of the study to know about the etiological factors of Prameha.

Therefore, this study emphasises on awareness in the society about the ill health aspects of sedentary and modern lifestyle which are predisposing factors of major ailments like Prameha. How the ancient texts quote the causative factors in terms of Aahara and Vihara could be validated by this case control study. Clinician can suggest the dietary and behavioural regimen to avoid the disease. Eventually, the Hetu Siddhant would be revalidated.

Aim

To study the etiological factors (Hetu) of Prameha through Bruhatrayee.

Objectives

To study relevance of Hetus to cause Prameha from Bruhatrayee.

Review of literature

Prameha Vyadhi is said to be one of the “Astha Mahagadas”.[3] It is included in the ‘Maharogas’, which consists of the most fatal condition that are incurable.

All ancient treaties have mentioned the common etiological factors of Prameha but acharya Charaka has described the specific etiological factors of Prameha according to Doshas in detail.[4,5] This is the unique contribution of Acharya. He described Samanaya and Vishishatha Nidana for all types of Prameha but, in Sushruta Samhita, Astanga Sangraha, Astang Hridaya, Madhav Nidana, Harita Samhita and Yogaratnakar only Samanya Nidana have been enlisted.

There are three main causes has been described for producing any disease in ancient texts i.e., Artha, Karma and Kala.[6]Viharaja Nidana can be co-relating under Karma. It means improper physical, vocal and mental activities.[7]

Likewise, Viharaja Hetu’s of Prameha is classified as Sharirika and Mansika Bhava which can be further divided under two categories of Samanaya and Vishishtha Nidana by different Acharayas.[8,9]

Materials and Methods

A complete review of literature related to the study covers Classical references given in the texts have been collected from ayurvedic Samhita’s Bruhatrayee, Laghutrayee, Modern text books of Medicine and previous research paper and Journals.

Sample Size:
150 patients

Inclusion Criteria:
1. Age group - 25 years to 65 years.
2. Gender - Either.
3. Case: 75 Patients who are recently diagnosed (duration of at least 6 months) with Prameha (Diabetes Mellitus-II) on the basis of raised blood sugar level and taking treatment for it (irrespective of the pathy) will be considered as Case group.
4. Control: 75 individuals who were not suffering and was not suffering from

Exclusion Criteria:
1. Patients having Prameha with any severe and acute systemic disorder.
2. Gestational Diabetes.

Study evaluation:
Inclusion of the patients in this study was mainly on the basis of their increased blood sugar level and they were already diagnosed as a patient of Diabetes Mellitus-2.


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On the other hand, Sign and Symptoms of Prameha mentioned in Bruhatrayee were also evaluated to find out its presence in the diagnosed patients. It is not necessary that all Symptoms may or may not be present in the patient A specialized questionnaire containing 36 Hetus of Prameha was designed to assess the Hetus of Prameha mentioned in Nidana and Chikitsa Sthana of Bruhatrayee in both the groups.

Statical test and Study design
Chi square and Observational retrospective comparative study (Case Control Study)

Observation

Table 1: Distribution of Hetus between Case and Control

HetusChi-Square valuedfP-valueResult
Dhanya Sevan6.05310.372Not significant
Sarpi Sevan0.24610.620Not significant
Mamsa Sevan3.47910.053Not significant
Shaak Sevan0.00011.000Not significant
Til Sevan13.22810.000Significant
Pishtanna17.41710.000Significant
Payas1.06410.302Not significant
Krushra24.00810.000Significant
Vilepi7.87810.005Significant
Ikshu-vikaar6.25010.012Significant
Ksheer0.98110.322Not significant
Nava Madya16.66710.000Significant
Mandak Dadhi22.36310.024Significant
Dravanna31.34210.000Significant
Madhur Atisevan21.00710.016Significant
Mruja Varjanam1.00710.316Not significant
Vyayama Varjanam40.59210.000Significant
Swapn-Shayya-Aasana7.34310.007Significant
Guru Aahar3.06110.080Not significant
Snigdha Aahar4.11010.043Significant
Amla Atisevan31.37310.000Significant
Lavan Atisevan17.91010.000Significant
Tyakta Chinta011.000Not significant
Samshodhana Akurvatam0.15010.699Not significant
Samashan18.61010.000Significant
Diwaswap123.85710.000Significant
Sheet Atisevan1.99210.158Not significant

Result

Age: Incidence of Prameha has been found more in age groups 40-60 years.

Gender: Prameha has been more observed in female than male.

Occupation: Prameha has been more observed in housewives.

Lakshana: Mukh-Talu-Kanth Shosh, Pipasa and Tandra have been observed most than any other Lakshana.

Significant factors
Til sevan, Pishtanna, Krushara, Vilepi, Ikshu-Vikar, Nava Madhya, Mandak Dadhi, Dravanna, Madhur Atisevan, Snigdha Aahar, Amla Atisevan, Lavan Atisevan, Samashan have been found significant Hetus (Aaharaja) in occurrence of Prameha. Vyayama Varjanam, Swapna-Shayya-Aasana, Diwaswap have been found significant Hetus (Viharaja) in occurrence of Prameha.

Factors found not significant
Dhanya Sevan, Sarpi Sevan, Mamsa Sevan, Shaak Sevan, Payas, Ksheer, Guru Aahar and Sheet Sevan have been not found significant Hetus (Aaharaja) in occurrence of Prameha.

Mruja Varjanam, Tyakta Chintana, and Samshodhana Akurvatam have been not found significant Hetus (Viharaja) in occurrence of Prameha.

Discussion

A detail discussion on the consumption of etiological factors and their association with Prameha from Ayurvedic literature was done; detail discussion has also been done on the observation and result made in this study. With the help of Chi square test collected data was analyzed.

Prameha is a disease occurring mainly due to Agnimandhya. Faulty digestive fire unable to digest food properly. Agnimandhya causes Ama production, so that Adya Rasa Dhatu is not formed properly and its Prinana Karya is altered which hampers the Prakrut Dhatu Nirmiti causes production of excessive Mala which is nothing but the Kleda. This Agnimandhya and Kleda Nirmiti are the main cause for Prameha.

In context of Manasika Nidana - Chintana, Krodh, Bhaya causes vitiation of Vata Dosha which again leads to improper digestion of food by producing Ama Dosha and Dhatu - Agnimandhya in the body.


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Total 36 variables are considered for this study to evaluate Hetu‘s of Prameha and out of which the causes which are more effectively causing Prameha have been enlisted. This study reveals or support those habits like Dravanna, Nava Madhya, Mandak Dadhi, Madhur Rasa Atisevana, Vyayama Varjanam, Swapn-Shayya-Aasana, Snigdha Aahar, Diwaswapan etc. are found more significant as a causative agent for manifestation of Prameha. The study imparts that 96.0% individuals were found consuming Dravanna Sevan in the case group in comparison with 57.3% individuals of the control group.

An explanation for this association is that this food causes (Drav-yukta Aahar) disturbance in digestion of food properly due to Agnimandya which produces Ama Rasa instead of Prakrut Aahara Rasa and this ultimately leads to Kleda formation. In current study Dravanna includes intake of Butter milk, Tea, milk, Amti etc. with food. Likewise, Madhur, Amla (food like pickle, tamarind, pani puri, Kadhi, lemon, raw mango or chutney etc.), Lavan Rasa Atisevan, Snigdha (include vadapav, Bread pattis, Bhajia, papad, kachori, samosa, puri-bhaji etc.), Nava Madhya, Vyayama Varjanam, Diwasvapan were present in 100%, 89.3%, 100%, 100%, 20%, 13.3%, 98.7% of patients with Prameha respectively. These are the Hetu’s which were found statistically significant in manifestation of Prameha.

This Study highlights the need or importance of Nidan Parivarjan of Hetu by the patients with Prameha as a first line of treatment for prevention and cure of Prameha.

Summary

As per inclusion criteria, newly diagnosed patients of Prameha (duration of at least 6 months) were taken, it means that patients were suffering from Kaphaja Prameha in its initial stage; not by Pittaja or Vataja (Madhumeha) as these are the later stages of Prameha or when Prameha is not treated properly. So, Dhatu-Kshaya Janya Lakshana’s as in Vataja Prameha were not found in the taken population or sample size. When data has been observed according to age, gender and occupation then it was found that the female patients who were above age of 45 and they were maximum housewives; all were practiced Kapha Prakopak Aahar and Vihara with minimal physical activity leads to a cause for Prameha.

Also, according to Ayurveda, Vata gets aggravated simultaneously in Vridha-Avastha. This leads to vitiation of Agni results in Vikruti of Chaya-Upchaya Prakriya of Aahar. Prameha occurs due to defect in “Beej” i.e., Sahaja Prameha as described in Ayurveda. But in the current study, it has been observed that all Pramehi patients are of Santarpanajanya i.e., Apathya-Nimittaja. Prameha occurs in current taken population due to sedentary lifestyle or excessive eating of Kapha Prakopak Aahar.

Addiction to Tobacco, Alcohol was also found significant in this study. As these contribute major role to cause Prameha. In modern science also, alcohol causes impairment of liver functions; as it is a mediator of glucose utilisation and storage. Same in Ayurveda, addiction derange the normal function of Pachak Pitta, Kledak Kapha and Samana Vayu; as these play’s main role in digestion process. But in Prameha all these Dosha gets vitiated leads to Agnimandhya and impairment of Prakrut Dhatu Nirmiti which leads to formation of more and more Kleda in the body and ultimately causes Prameha. This data might differ when the population changes.

Prameha can be collectively called as Tridosha-Dushti, Agnimandhya, Dhatvagnimandhya, Dhatukshaya and Kledotpatti.

Conclusion

All those Hetus which are responsible for causing Prameha has been categorized in this study. Hence revalidation of Hetu Siddhant has been done.

Ethical approval

This study has been approved by ethical committee of the Sumatibhai Shah Ayurved Mahavidyalaya, Hadapsar, Pune.

References

1. Tripathi Brahmanand, Charak Samhita, 1st ed.Varanasi: Chaukhambha Sanskrit Pratishthan; 2010. Pp280

2. Tripathi Brahmanand, Charak Samhita, 1st ed.Varanasi: Chaukhambha Sanskrit Pratishthan; 2010. Pp294

3. Tripathi Brahmanand, Charak Samhita, 1st ed.Varanasi: Chaukhambha Sanskrit Pratishthan; 2010. Pp1030


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4. Tripathi Brahmanand, Charak Samhita, 1st ed.Varanasi: Chaukhambha Sanskrit Pratishthan; 2010. Pp613

5. Tripathi Brahmanand, Charak Samhita, 1st ed.Varanasi: Chaukhambha Sanskrit Pratishthan; 2010. Pp617

6. Tripathi Brahmanand, Charak Samhita, 1st ed.Varanasi: Chaukhambha Sanskrit Pratishthan; 2010. Pp240

7. Tripathi Brahmanand, Charak Samhita, 1st ed.Varanasi: Chaukhambha Sanskrit Pratishthan; 2010. Pp242

8. Tripathi Brahmanand, Charak Samhita, 1st ed.Varanasi: Chaukhambha Sanskrit Pratishthan; 2010. Pp617

9. Tripathi Brahmanand, Charak Samhita, 1st ed.Varanasi: Chaukhambha Sanskrit Pratishthan; 2010. Pp619


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