E-ISSN:2456-3110

Review Article

Pathya-Apathya

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 10 OCTOBER
Publisherwww.maharshicharaka.in

Role of Pathya-Apathya in the management of Prameha (Type-2 Diabetes Mellitus)

Lohar T1*, Kulkarni M2
DOI:10.21760/jaims.9.10.11

1* Tejaswini Lohar, Post Graduate Scholar, Dept of Kayachikitsa, Ayurveda Mahavidyalaya and Hospital, Hubballi, Karnataka, India.

2 Madhusudan Kulkarni, Associate Professor, Dept of Kayachikitsa, Ayurveda Mahavidyalaya and Hospital, Hubballi, Karnataka, India.

Diabetes mellitus is one among the metabolic disease caused by environmental factors such as obesity, unsatisfactory diet, sedentary lifestyle, increasing urbanisation and economic development as well as genetic factors, which is characterized by hyperglycemia, insulin resistance or relative insulin deficiency. According to WHO about 422 million people worldwide have diabetes and In India, there are estimated 77 million people above the age of 18 years are suffering from diabetes (type 2). In Ayurveda it can be correlated to Prameha by its clinical manifestation, which is caused due to Kapha Vardhaka Ahara and Vihara leading to vitiation of Meda, Mamsa and Kleda further leading to manifestation of Prameha.

Materials and Methods: In this article with the support of both Ayurvedic and modern literature the information about the role of Pathya Sevana and avoiding Apathya Ahara Vihara in Prameha is dealt.

Result: Prameha occurs by derangement of Kapha Pradhana Tridosha and Dasha Dushya where as in Sthula Pramehi the dominance of Kapha Meda Kleda Dushti has occurred so there needs application of Chikitsasutra mentioned by Acharya Sushruta says - स्थूलम अपतर्पनयुक्ताभि:| Apatarpana Chikitsa along with Pathya Sevana and avoiding Apathya Ahara and Vihara.

Discussion: The majority of the Pathya in Prameha possesses Kapha Medohara, Tikta Kashaya Katu Rasa, Laghu Ruksa Guna, Ushna Veerya and Katu Vipaka properties which restores normal physiology of Prameha.

Keywords: Prameha, Pathya, Apathya, Diabetes mellitus

Corresponding Author How to Cite this Article To Browse
Tejaswini Lohar, Post Graduate Scholar, Dept of Kayachikitsa, Ayurveda Mahavidyalaya and Hospital, Hubballi, Karnataka, India.
Email: 		Lohar T, Kulkarni M, Role of Pathya-Apathya in the management of Prameha (Type-2 Diabetes Mellitus). J Ayu Int Med Sci. 2024;9(10):75-80.
Available From
https://jaims.in/jaims/article/view/3933

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-09-12 2024-10-22 2024-10-02 2024-10-12 2024-10-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 80

© 2024by Lohar T, Kulkarni Mand 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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Introduction

Sedentary behaviour (Physical inactivity), along with improper diet and nutrition are increasingly becoming part of today’s lifestyle leading to the rapid rise of diseases such as diabetes, cardiovascular diseases or obesity. According to WHO Approximately 2 million deaths per year are attributed to physical inactivity. It reduces lipoprotein lipase activity, muscle glucose, protein transporter activities, impair lipid metabolism and diminish carbohydrate metabolism.[1] A majority of factors that are implicated in metabolic diseases are largely influenced by psychological stress including dysregulated glucose metabolism, neuroendocrine function accompanied with low-grade inflammation, and elevated blood pressure. Insulin resistance and subsequent appearance of type 2 diabetes mellitus are closely linked with high intake of sugars, fried food and red meat. On the contrary, reduced risk of type 2 diabetes mellitus development is observed in case of intake of vegetables having high content of antioxidants, fiber and other nutrient.[2]

Ayurveda is a science that has given importance to Pathya (diet and regimen) as a part of Chikitsa. Pathya is that entity which does not cause harm to the body and which is Hitakara to the Manas.[3] Acharya Charaka mentions the importance of Pathya as it does the Mruduta and Alpata of both Kathinya Dosha (accumulation of Chaya Rupa Doshas) and Una Dosha (vitiation of Dosha without attaining the stage of accumulation) resulting in inhibition of progression of disease.[4] Acharya Kashyapa described Pathya Ahara as "Mahabheshaja".[5] And Yogaratnakara states that physician should give due consideration to Nidana (aetiology of the disease), Aushadhi (medicine), and Pathya while treating the patients, as these three destroys the disease, just like stoppage of water results in damage of Ankura (crop), and one should not indulge in Apathya Ahara, Vihara as these will worsen the prognosis of disease, like Virudha (Lata) grows up by the water derived from clouds.[6] Acharya Charaka quotes, one should take food in such a way that among three parts of the stomach, one part should be filled with solid food, one part filled with liquid and the last part should be left empty. Also Guru Ahara should be taken three fourth or half of the stomach capacity, whereas Laghu Ahara should not be consumed in excessive quantity.[7]

Diabetes mellitus is one among the metabolic disease, caused by environmental factors such as obesity, unsatisfactory diet, sedentary lifestyle, increasing urbanisation and economic development as well as genetic factors, which is characterized by hyperglycemia, insulin resistance or relative insulin deficiency, further leading to serious damage to the heart, blood vessels, eyes, kidneys and nerves over time.[8] The most common is type 2 diabetes, usually in adults which occurs when the body becomes resistant to insulin or doesn't produce enough insulin.

In the past 3 decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels. According to WHO about 422 million people worldwide have diabetes, the majority living in low-and middle-income countries and 1.5 million deaths are directly attributed to diabetes each year. In India, there are estimated 77 million people above the age of 18 years who are suffering from diabetes (type 2) and nearly 25 million people are prediabetics. More than 50% of people are unaware of their diabetic status which leads to health complications if not detected and treated early. India is one of the five countries which have highest sufferers of diabetes mellitus. Therefore, India is declared as "Diabetes Capital".[9]

In Ayurveda it can be correlated to Prameha by its clinical manifestations, Prameha is considered as one among the Medavaha Srotodushti Vikara, the word meaning of Prameha is "to flow" which is derived from the Sanskrit root "Mih-Sechane" The Sanskrit term Meha literally means to micturate. It (Prameha) is qualified by prefix “Pra” meaning excess both in quantity and frequency.[10] Prameha is characterized by copious flow of cloudy or turbid urine, although the turbidity varies depending upon involvement of different proportion of Doshas and Dushyas.[11] On the basis of aetiology, Acharya Sushruta has classified Prameha as Sahaja and Apathyanimittaja.

1. Sahaja: Sahaja Prameha occurs as a result of Beeja Dosha (genetic origin) and are Krusha Pramehi.
2. Apathyanimittaja: It occurs due to unwholesome Ahara & Vihara (Faulty diet & life style errors) and are Sthula Pramehi.[12]

Prameha Nidana mentioned in Samhita can be categorized into Aharaja, Viharaja and Manasika Nidana.


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Aharaja Nidana

Atidadhisevana (excessive consumption of curd), Gramya, Audaka and Anupa Mamsa Atisevana (excessive intake of meat of domestic, aquatic and marshy animals), Paya Sevana (excessive consumption of milk), Navanna Sevana (freshly harvested food articles), Navapana Sevana (freshly harvested food in the form of drinks), Guda Vikara Atisevana (preparations of Jaggery), Ikshu Vikara Sevana (sugarcane and its products), Snigdha Dravya Sevana (unctuous food), Medavardhaka Dravya (excessive intake of fat and fatty preparations), Dravannapana (consumption of liquids).[13]

High Sugar and Refined Carbohydrates: Diets high in sugars and refined carbs can lead to spikes in blood glucose and insulin levels, promoting a cycle of insulin resistance. High Fat Intake: Diets rich in saturated fats can disrupt insulin signalling pathways.

Excessive fat can lead to lipid accumulation in muscle and liver, which negatively affects insulin sensitivity. Overeating, regardless of macronutrient composition, can lead to weight gain and increased fat deposition, particularly in the abdomen, exacerbating insulin resistance.[14]

Viharaja Nidana

Asya-Sukham (sitting in a comfortable position on chair with back support), Swapna-Sukham (Excessive sleep), Avyayama (avoidance of physical Exercise), Tyakta Chinta (no tension), Alasya Prasakta (lassitude), Diwaswapna (Sleep at day time).[15]

Sedentary behaviour reduces muscle mass and alters muscle composition, leading to decreased glucose uptake. Muscle tissue is a primary site for glucose disposal; less muscle leads to less ability to utilize glucose effectively. Physical Inactivity also contributes to increased body fat, particularly visceral fat. This type of fat secretes inflammatory cytokines, which can impair insulin signalling.[16]

Manasika Nidana

Amongst Manasika Nidana mentioned Shrama-Krodha, Shoka-Udvega[17] are given importance as they play a major role in inducing the vitiation of the Manasika Doshas as well as Shareerika Doshas. These Manasika Bhavas vitiate the Mano Doshas - Rajas and Tamas.

Vriddhi of Tamo Guna leading to loss of control over oneself further indulging in Avyayama, Alasya, Ati Matra Sevana and Tamasa Prakruti individuals possess qualities like Vishaditvam, Ajyaanam, Akarma Sheelata, Nidralutvam thereby raising the chances of an individual to develop a Vyadhi.

Due to Nidana Sevana, it leads to Agnimandya resulting in Ama Utpatti further leading to vitiation of Kapha Pradhana Tridosha, these combine with Meda, Mamsa and Kleda (body liquid), enters to Mutravaha Srotas and through Adhomuka it enters into Basti Pradesh, resulting in Nisarana of Naanavarna Mutra through Bastimukha leading to manifestation of Prameha.[18] When Purvaroopa (prodromal symptoms) of the disease is left unnoticed, their manifest the Pratyatma Lakshana such as Prabhuta Mootrata, Avila Mootrata (turbid urination) along with Lakshana pertaining to specific Dosha predominance. Prameha occurs by derangement of Kapha Pradhana Tridosha and Dasha Dushya where as in Sthula Prameha the dominance of Kapha Meda Kleda Dushti has occurred so there needs application of Chikitsasutra mentioned by Acharya Sushruta says - स्थूलम अपतर्पनयुक्ताभि:|[19] Apatarpana Chikitsa along with Pathya Sevana and avoiding Apathya Ahara and Vihara is the most acceptable Chikitsa.

Aharaja Pathya

Patients with Prameha are advised to consume foods that are light to digest, such as Yava (barley), Mudga (green gram), Tiktha Shaka (bitter vegetables), Purana Shali (old rice), Shashtika Shali (Oryza sativa), Truna Dhanya (Shyamaka), Purana Madhu (old honey), Chanaka (Bengal gram), Adhaki (Pigeon pea), Kulattha (Horse gram), Kapitta (wood apple), Jambu (Syzygium cumini), Tinduka (Diospyros tomentosa), In oils Danti (Baliospermum montanum), Atasi (Linum usitatissimum) and Sarshapa (mustard oil) can be used.[20]

Viharaja Pathya

In Pathya Vihara, Prameha suffers should get up early in the morning and do physical exercise. Acharya Charaka detailed a variety of Vyayama (physical activities), Udwartana (powder massage), Snana (baths), and Jalaavaseka (sprinkling of water), Lepa with Twak (Cinnamomum zeylanica), Ela (Elettaria cardamomum), Agaru (Aquilaria agallocha), Chandana (Santalum album) and Ratri Jagarana.[21].


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Acharya Sushruta advised walking 100 Yojana in 100 days barefoot (1 Yojana = 7.5km) is the best preventive measure to avoid Prameha which means withdrawal of leisure life.[22]

Aharaja Apathya

Prameha patients should avoid Gramya Mamsa (meat of domestic animals), Audaka Mamsa (meat of aquatic animals), Anupa Mamsa (meat of marshy animals), Madhura, Amla and Lavana Dravya Sevana (sweet, sour and salty food),

Snigdha Dravya Sevana (oily food consumption),Guru Ahara Sevana (heavy food consumption), Picchila Ahara Sevana, Nava Dhanya Sevana (newly harvested grains), Ghrita (ghee), Taila (oil), Dadhi (milk) and Pishtanna (highly carbohydrate rich food).[23]

Viharaja Apathya

In Apathya Vihara of Prameha patients should refrain from lengthy periods of comfortable sitting, long periods of sleep, Divaswapna (sleeping during the day).

Discussion

Aharaja Pathya

Shuka Dhanya1. Yava (barley)Kashaya Rasa, Laghu Ruksha Guna, and it is Kaphagna, Lekhana, Medohara. low in glycemic index 28+/-2.
2. Shastika Shali (Oryza sativa) (rice which is harvested in 60 days)Madhura Rasa, Laghu Snigdha Guna, Shita Virya and Tridoshagna.
Shami Dhanya1. Mudga (Green gram)Kashaya Madhura Rasa, Laghu Ruksha Guna, Katu Vipaka and it is Kaphahara. With low Glycemic index-38
2. Kulattha (Dolichos biflorus)Kashaya Rasa, Laghu Ruksha and Tikshna Guna, Ushna Virya, Katu Vipaka it is Kaphahara and it acts as Medohara, Bhedana and Lekhana.
It is hypolipidaemic, hypoglycaemic and hypocholesterolemic.
3. Adhaki (pigeon pea)Kashaya Rasa, Laghu Ruksha Guna, Sheeta Virya, Katu Vipaka Kaphahara. With low Glycemic index- 30.99+/- 4.1
4. Chanaka (Bengal gram)Kashaya Rasa, Laghu Ruksha Guna, Sheeta Virya, and it is Kaphahara. With low Glycemic index- 8
Mamsa VargaGramya Kukkuta Mamsa (Domestic chicken)Tiktarasa, Laghu Guna, Ushna Virya, Kaphahara. With low Glycemic index
Shaka Varga1. Patola (Pointed gourd)Tikta Katu Rasa, Laghu Ruksha Guna, Ushna Virya and Katu Vipaka it is Kaphahara. Glycemic index- 76+/- 24.
2. Karavellaka (Bitter gourd)Tikta Katu Rasa, Laghu Ruksha Guna, Anushna Sheeta Virya and Katu Vipaka. It is Kaphahara, Pramehagna.
A compound called charantin in bitter gourd keeps the sugar levels low, Bitter gourd contains an insulin-like compound called Polypeptide-p or p-insulin which has been shown to control diabetes naturally. With low Glycemic index- 18.
3. Shigru (Drum stick)Katu Rasa, Laghu Ruksha Guna and Ushna Virya, Katu Vipaka, it is Kaphahara, Medohara, Krimihara, Deepana and Pachana.
And it acts as antioxidant, diuretic. With low Glycemic index- 49.
4. Koshataki (Ridge gourd)Tikta Rasa, Laghu Ruksha Tikshna Guna, Ushna Virya, Katu Vipaka and it is Kaphahara.
Acts as hypoglycemic, With low Glycemic index
5. Kakamachi (Solanum nigrum)Katu Tikta Rasa, Anushna Shita Virya and Tridoshagna.
Phala Varga1. Jambu (Gauva)Kashaya Madhura Amla Rasa, Laghu Ruksha Guna, Katu Vipaka, Sheeta Virya it acts as Kaphagna, Lekhana, Medohara. It is Antidiabetic, anti-inflammatory. Glycemic index- 12-24.
2. Kapitha (wood apple)Kashaya Rasa and Laghu Guna act as Kaphahara. With low Glycemic index- 38
3. Amalaki (Indian gooseberry)Amla Pradhana Lavana Varjita Pancha Rasa and Laghu Ruksha Guna, Sheeta Virya, Madhura Vipaka it is Tridoshahara and acts as Medohara, Pramehagna. With low Glycemic index- 15.
It acts antioxidant, antiulcerogenic, antihypercholesterolaemic.
4. Tinduka (Diospyros tomentosa)Kashaya Rasa, Laghu Ruksha Guna, Sheeta Virya, Katu Vipaka and it is Kaphahara and Pramehagna.
Gorasa VargaTakra (butter milk)Kashaya Amla Rasa, Laghu Guna, Kaphahara is Pathya for Prameharogi. It is rich in source of Potassium, calcium, phosphorus, vitamin B12 & riboflavin. With low Glycemic index- 35.

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Truna Dhanya (millets)1. Syamaka (little millet)Kashaya Rasa, Ruksha Guna, Kinchit Ushna Virya, Katu Vipaka, it is Kaphahara, Kledahara. With low Glycemic index-50
2. Kodrava (kodo millet)Tikta Rasa, Laghu Ruksha Guna, Sheeta Virya it is acts as Lekhana, Kaphahara, With low Glycemic index-50.
Purana Madhu (Honey which is 12 months old)Kashaya Anurasa, Laghu Ruksha Guna and it is Kaphahara, Atilekhana, Ropana, Medogna, Pramehahara, Stoulyahara, Yogavahi (catalyst substance).

Viharaja Pathya

1. VyayamaIt improves ability to do work, lightness of the body, increases digestive capacity, burns excess fat. It prevents and minimizes weight gain, reduction in blood pressure, improvement in insulin sensitivity and glucose control and optimization of lipoprotein profile.
2. Udvartanam (upward massage with powdered drugs)Kaphagna and Medohara in action, removes heaviness of body. It opens up the minute channels and improves blood circulation and lymphatic drainage.
3. Snana (bath)Sramahara (removes fatigue), Swedagna (eliminates sweat), it does Agni Deepana (stimulate the digestive capacity), Ojaskara (promotes strength and vitality). According to Yogaratnakara hot water bath destroys the Kapha and Vata.
4. Nisijagarana (awaking at night)Those who suffering from Kapha, Medha Vikara and Visha awaking at night is beneficial. Sleep is induced due to Kapha and Tamas.

Regular Physical Activity: Incorporating aerobic and resistance training can improve insulin sensitivity, promote muscle growth, and enhance glucose uptake,

Balanced Diet: Emphasizing whole foods, including fruits, vegetables, whole grains, lean proteins, and healthy fats, can help maintain stable blood sugar levels and reduce inflammation.

Conclusion

The majority of the Pathya in Prameha possesses Kapha Medohara, Tikta Kashaya Katu Rasa, Laghu Ruksa Guna, Ushna Veerya and Katu Vipaka properties. As a result, Ushna Veerya and Tikta Kashaya Rasa contribute to the normalization of Agnimandya. In turn, this aids in the development of Dhatus that are proportional to Samyak qualities. Bahudrava Shlesma Soshan and the reduction of vitiated Meda- Kleda are helped by Laghu Ruksa Guna. Thus, once these factors get normalised in the body, they in turn make the Srotas (path) clear, which stops the depletion of Dhatus and restores normal physiology. Prameha disease is thus alleviated.

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