Issue : 01 DOI :
INTERNATIONAL
JOURNAL
OF
DIAGNOSTICS
AND
RESEARCH
Volume : 02
Copyright @ : - Dr.Abhijeet Bageshwar Inter. J.Digno. and Research IJDRMSID00030 |ISSN :2584-2757
55
Abstract
Madhumeha is one of the subtypes of Vataj Prameha, characterised by [honey] Madhu like properties
of urine of patient. Clinical features of Madhumeha like polyuria, sweetened and turbid urine can be
correlated to that of type 2 Diabetes mellitus, which has proved be major prevalent health issue
worldwide. Uncontrolled and unhealthy regimen further worsens the disease by landing patients into
complications. 20% of total deaths caused by Diabetes mellitus are due to development of
complications like cardiovascular diseases, nephropathies and neuropathies. Concept of Dhatugat
Avastha described in Ayurveda and it resemblance with development of complications of Type 2
Diabetes mellitus. This is not only help to keep far these complications but also to bring forth
improvised line of treatment for the disease and its complications. Thus, an attempt is made to explore
Dhatugat Avstha of Madhumeha based on complications of type 2 Diabetes mellitus and enlighten the
preventive and curative measures for the same.
Keywords : Dhatugat Avastha, Madhumeha, complications, Diabetes mellitus
Corresponding author: Dr. Abhijeet Bageshwar
Article Info: Published on : 15/10/2024
P
Publisher
ROGANIDAN VIKRUTIVIGYAN PG ASSOCIATION
FOR PATHOLOGY AND RADIODIGNOSIS
DOI
: 1 0 . 5 2 8 1 / z e n o d o . 1 3 9 3 6 8 8 1
Reg. No. : MAHA-703/16(NAG)
Year of Establishment – 2016
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH
A Study Of Concept Of Dhatugat Avashta In Madhumeha And Its Resemblance
To Complication Of Type 2 Diabetes Mellitus
Dr. Abhijeet Bageshwar
1
, Dr. Vijay Potdar
2
1
PG Scholar Dept. of Roga Nidana Government Ayurved College , Nanded.
2
Associate Professor Dept. of Roga Nidana Government Ayurved College , Nanded.
Cite this article as: - Dr. Abhijeet Bageshwar (2024) ; A Study Of Concept Of Dhatugat Avashta In Madhumeha And Its
Resemblance To Complication Of Type 2 Diabetes Mellitus; Inter.J.Dignostics and Research 2 (1) 55-64,
DOI: 1 0 . 5 2 8 1 / z e n o d o . 1 3 9 3 6 8 8 1
G
A
R
V
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56
Introduction:
Madhumeha is described in Ayurveda under the
category of Vataj Prameha. & identified as Type 2
Diabetes Mellitus in modern medical terms. This
condition is characterized by excessive urination of
sweet, slightly turbid, and pale urine. It is linked with
vitiation of Vata and Kapha Doshas and affects fat
and other body tissues along with vital energy known
as Oja, manifesting through the Mutravaha Srotas
(urinary channels).
[1]
Madhumeha involves a complex interplay of Doshas
(bodily energies), Dushyas (vitiating factors) and
Dhatus (tissues) that can lead to various symptoms if
not properly managed. When a patient with
Madhumeha does not adhere to the prescribed
treatment and dietary guidelines, the Doshas and
Dushyas can become aggravated and start affecting
different Dhatus in the body. When Doshas and
Dushyas become imbalanced, they can lodge in
particular Dhatus and manifest symptoms specific to
that Dhatu, this is known as Dhatugat Avastha for the
particular disease.
This Dhatugat Avstha in Madhumeha can be
correlated to complications of Type 2 diabetes
mellitus which further can increase your risk of
developing complications such as cardiovascular
disease, atherosclerosis, stroke, peripheral artery
disease and chronic kidney disease.
Type 2 Diabetes Mellitus is characterized by chronic
high blood sugar levels due to insulin resistance or
insufficient insulin production and highlights a
disturbance in metabolic processes leading to excess
and altered urine production.
As a consequence of
hyperglycaemia of diabetes, every tissue and organ of
the body under goes biochemical and structural
alterations which account for the major complications
in diabetic which may be acute metabolic or chronic
systemic symptoms.
[2]
This can be studied the
umbrella of Dhatugat Avstha and to develop
improvised line of treatment for both Madhumeha as
well as to prevent type 2 Diabetes mellitus.
Aim:
To study of concept of Dhatugat Avashta in
Madhumeha and its resemblance to complication of
type 2 diabetes mellitus
OBJECTIVE:
1. To study of concept of Dhatugat Avashta in
Madhumeha and its resemblance to complication
of type 2 diabetes mellitus
2. To study the Dhatugat Avastha in Madhumeha in
detail
3. To study Complication of type 2 Diabetes Mellitus
in detail
Review Of Literature: Madhumeha
Definition:
The disease in which the patient passes urine like
honey and sweetness remains in the body is called
Madhumeha. It is predominantly Tridoshaj Vyadhi but
Avrutta Vaat and Bahudrava Sleshma are main
elements.
[3]
Prameha is a group of disorders in which there is an
increased frequency and volume of micturition, and
the urine appears turbid. 20 types of Prameha have
been mentioned. It is a silent killer and needs to be
treated as early as possible to stop onset of
complications. If Prameha is not treated properly, may
convert into Madhumeha.
[4]
Samprapti (Pathogenesis):
Madhumeha can originate in two ways-
[5]
1) Avaran Janya (By the obstruction of Vata caused
by Doshas covering it)
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2) Dhatukshaya Janya (Depletion in body tissues
causes aggravation of Vata)
In Avaranjanya Madhumeha the vitiated Kapha Dosha
and Meda Dhatu (Fat tissue) obstruct the passage of
Vata Dosha. In the process of manifestation of
Madhumeha, the obstructed Vata is vitiated again and
carries Oja to Basti (Urinary Bladder).
Figure 1: Madhumeha Samprapti Avaran Janya &
Dhatukshaya Janya
Though Prameha can be caused by any Dosha, some
pathological changes are common in all types of
Prameha. These are – Dhatu Shaithilya (flaccidity of
body constituents) and strain on Basti (urinary
bladder). Dosha is accumulated at Basti or there is
abnormal movement of Dhatu in Basti that alters the
normal properties of urine. Though different
etiological factors for each Dosha are mentioned for
causing Prameha, the end result is same due to similar
pathological procedure. If Prameha is not treated
properly then it can land into Madhumeha.
When vata get immediately aggravated in an
individual who's Hetu Sevan is ongoing and already
Pramehi but not taken proper treatment and diet. The
aggravated Vata in that body spreads along with Oja
which is sweet in taste by nature. When due to the
Hetu Vata convert into astringent taste and it take into
urinary bladder due to its roughness, this causes
Madhumeha.
[6]
Figure 2: Madhumeha Samprapti:
(If Prameha is not treated properly, may convert into Madhumeha )
Dhatugat Avastha:
Vata immediately aggravates in Prameha patient
who is consuming the cause and is not on proper
medication and diet. The aggravated Vata in that
body spreads along with Oja which is sweet in taste
by nature. When due to the Hetu Vata convert into
astringent taste and it take into urinary bladder due
to its roughness, this causes Madhumeha.
Eventually each Prameha, whether it is Kaphaj,
Pittaj or Vataj, if not treated appropriately will land
into Madhumeha and thus Dhatugat Avastha in
Madhumeha can be observed. Although, it is not
precisely described in texts, in day-to-day practice,
patients suffering from diabetic complications can
be seen undergoing Dhatugat Avastha.
[7]
In
pathophysiology of Madhumeha, Dhatvya-
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Agnimandya and Dhatu Shaithilya of every Dhatu
is major event. But one particular Dhatu is seen
affected to more extent and can thus be identified as
Dhatugat Avastha in that patient.
Figure 3: Dhatugat Avastha.
Chikitsa:
Madhumeha Chkitsa can be classified under 4
groups
1. Krush Durbal
2. Krush Balvan
3. Sthul Durbal
4. Sthul Balvan
Shodhan Karma, Shaman Chikitsa, Santarpan,
Aptarpan and Pathya should be planned for
Madhumeha Chkitsa accordingly.
In Sthul Balvan patient, Shodhan Upkrama
according to their Dosh; and that in Krush Durbal,
Santarpan and Shaman Chikitsa is considered.
Pramehaa is a chronic disease and hence Shodhan
must be followed by Santarpan Upkram. If not
done orderly, can lead to complications like Gulma,
Kshay, Bastiand Shool
[8]
Internal medications :
 Arogya Vardini – for Dhatu Lekhan (will
repair Dhatu Shaithilya)
ï‚· Vasantkusmakar
ï‚· Suvarnraj Vangeshwar
ï‚· Nisha Amalaki Ghan
Diabetes Mellitus Type 2:
Diabetes mellitus is one of the most common
endocrine disorders characterized by common
feature of chronic hyperglycemia with disturbance
of carbohydrate, fat and protein metabolism.
Diabetes classified into –
1) Type 1 (B cell destruction, usually leading
to absolute insulin deficiency)
2) Type 2 (May range from relative insulin
deficiency to predominantly secretory defect
with insulin resistance)
Diabetes is a chronic disease that occurs either
when the pancreas does not produce enough insulin
or when the body cannot effectively use the insulin
it produces. Insulin is a hormone that regulates
blood glucose. Hyperglycemia, also called raised
blood glucose is a common effect of uncontrolled
diabetes and over time leads to serious damage to
many of the body's systems, especially the nerves
and blood vessels. Type 2 diabetes can increase
your risk of developing complication, such as
cardiovascular disease, atherosclerosis, stroke,
peripheral artery disease and chronic kidney
disease. In 2019, diabetes was the direct of 1.5
million death and 48% of all the deaths due to
diabetes occurred before the age of 70 years.
Another 4,60,000 kidney disease deaths were
caused by diabetes and 20 % cardiovascular
death.
[9]
Pathogenesis :
Pathogenesis Diabetes Mellitus Type 2 is shown in
below figure No.4
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Figure 4: Pathogenesis Diabetes Mellitus Type 2
Complications Of Diabetes:
[11]
As a consequence of hyperglycemia of diabetes,
every tissue and organ of the body undergoes
biochemical and structural alterations which
account for the major complications in diabetics
which may be acute metabolic or chronic systemic.
Both types of diabetes mellitus may develop
complications which are broadly divided into 2
major groups
:
1. Acute metabolic complications: These
include diabetic ketoacidosis, hyperosmolar
non-ketonic coma, and hypoglycemia.
2. Late systemic complications: These are
atherosclerosis. diabetic microangiopathy,
diabetic nephropathy, diabetic neuropathy,
diabetic retinopathy and infections.
Treatment:
Management of type 2 diabetes includes:
1. Diet planning
2. Regular exercise.
3. Weight loss
4. Medication
Diet planning:
[12]
Diet control is an endogenous insulin preserver
Primary therapeutic goal is weight loss in obese
individuals; Reduction in weight eliminates the
need for oral hypoglycemic drugs or insulin,
especially if normal body weight is achieved.
Consistency in composition and timing of meals is
important particularly for patients using fixed
insulin regimens or oral hypoglycemic drugs.
A. Hypocaloric diets: Caloric calculations are
done for ideal body weight. Total calories
should be kept ideally between 1000 and
1200 kcal/day;
B. Carbohydrates: Carbohydrate should
constitute 50 to 60% of total calories.
Concentrated sugars are avoided except in
the treatment of hypoglycemia.
C. Fibers: About 25 gm of fibers per 1000 kcal
is advised. Complex high-fiber
carbohydrates (bran, whole grain cereals,
legumes, vegetables and whole fruit) are
recommended.
TYPE 2 DIABETES MELLITUS
HYPERGLYACEMIA
INCRESED HEPATIC GLUCOSE SYNTHESIS
DECREASED INSULIN SECRETION
AMYLIN
GLUSCOSE
TOXICITY OF
ISLETS
LIPOTOXICIT
Y
INSULINE RESISTANCE
RECEPTOR AND POST
RECEPTOR DEFECT
IMPAIRED GLUCOSE
UTILISATION
CONSTITUTIONAL FACTORS
OBESITY
HYPERTENSI
ON
LOW
PHYSICAL
ACTIVITY
GENETIC FACTORS
CONCORDANCE IN
IDENTICAL TWINS 80%
BOTH PARENTS DIABETIC
50% RISK TO THE CHILD
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D. Proteins: The total protein content of the
diabetic meal plan should be 25 to 30%.
E. Fats: Total fat content should be between 25
and 30% of total calories. Skimmed or low-
fat milk is advised; only 2 to 3 eggs per
week are allowed. Margarine should be
taken instead of butter. Red and brown meat
should be taken in reduced amounts. Fish
and skimmed milk-based cheeses can be
taken.
Physical activity :
Exercise is important for losing weight or
maintaining a healthy weight. It also helps with
managing blood sugar. Aerobic exercise such as
walking, swimming, biking or running. Adults
should aim for 30 minutes or more of moderate
aerobic exercise on most days of the week, or at
least 150 minutes a week.Resistance training
includes weightlifting, yoga. type 2 diabetes patient
should aim for 2 to 3 sessions of resistance exercise
each week.
Weight loss:
In obese patient weight loss should be most
important thing. Diet, physical activity will help to
lose weight.
Medications:
[13]
1) Oral Antidiabetic Agents-
A. Sulfonylureas:
Sulfonylureas act by stimulating release
of insulin from the pancreatic ẞ cell.
Possible side effects include
hypoglycemia and weight gain.
a. Meglitinide
b. Insulin sensitisers:
- Biguanides: The drugs under this group
are phenformin and metformin. These
are drugs of choice for obese type II
diabetes. They have no effect on insulin
secretion.
- Thiazolidinediones: They improve
insulin sensitivity in muscle, liver and
adipose issue. There is no
hypoglycemia, as they do not affect
pancreatic insulin secretion. Patients
with little pancreatic insulin reserve do
not respond adequately.
B. Alpha glucosudase inhibitiors:
Delaying digestion and absorption of
sucrose and complex carbohydrates may
be advantageous. Example: Acarbose
and Voglibose
C. Fatty Acid Oxidation Inhibitors
(Acipiomox):
In Type 2 DM, due to decreased insulin
action on adipocytes, excess fatty acids
are released. These may stimulate
hepatic gluconeogenesis and lead to
fasting hyperglycemia. Acipiomox, a
nicotinic acid derivative (20 times more
potent than nicotinic acid), decreases
free fatty acid levels. It also lowers
fasting hyperglycemia and triglyceride
levels.
D. Sitagliptin:
It increases insulin secretion. It lowers
glucagon secretion and can be combined
with metformin and thiazolidinediones
E. SGLT-Inhibitors:
By inhibiting sodium glucose
cotransporter 2, renal glucose
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reabsorption is prevented, urinary loss of
glucose is promoted and this decreases
glucose level in type 2 DM. Example:
Dapagliflozin and canagliflozin
2) Principles of Insulin Therapy
Insulin dosage and pattern of
administration are adjusted until
reasonable control of blood glucose is
achieved. Then the frequency of blood
glucose monitoring is decreased to 3 to
4 times a day, later once or twice weekly
sugar estimation is sufficient.
Discussion:
The concept of Dhatugat Avastha is nothing but
progression of diseases from macro to micro level
biologically. It is clearly mentioned in diseases like
Jwara, Kushtha, Masurika and Vatavyadhi.
Madhumeha being a disease with Vata
predominancy, shows Avrittatva i.e., obscurity in its
pathophysiology; however, no obvious description
related to it is mentioned in classical texts. Also, its
correlation with DM, which comes with group its
complications, makes it significant to study and
analyse whether any Ayurvedic interpretation can
be made.Some of the commonly found
complications of Type 2 DM and its Ayurvedic
interpretation can be explained as follows –
Table No. 1. Interpretation of Rasa Dhatugat avastha
Complication
Causes
Symptoms
Ayurvedic
interpretation
Diabetic
ketoacidosis
(DKA)
[14]
Severe lack
of insulin
causes
lipolysis in
the adipose
tissues,
resulting in
release of
free fatty
acids into the
plasma.
deep and fast
breathing
with fruity
odour
Mukha
daurgandhya
Hypoglycemia
Excessive
administratio
n of insulin
Dizziness,
fainting,
generalized
weakness
Daurbalya
Infections
due to
impaired
leucocyte
functions
Susceptibility
to various
infections
like fungal,
bacterial and
parasitic
Krimi roga
Table No. 2. .Interpretation of Rakta Dhatugat Avastha
Complication
Causes
Symptoms
Ayurvedic
interpretation
Diabetic
microangiopathy
[15]
Due to
impaired
blood
flow
Thickening
of vessels
in skin,
skeletal
muscles
Dhamani
upalepa
Diabetic
retinopathy
Lesions
involving
retinal
vessels
Blindness
Drishtimandya
Table No. 3. Interpretation of Mamsa Dhatugat avastha
Complication
Causes
Symptoms
Ayurvedic
interpretation
Diabetic
gangrene of
foot
[16]
Trauma,
Lack of
blood flow
to tissues
with or
without
infection
Ulceration,
deformation
of foot
(Charcot foot)
and
amputation)
Pramehaaj
vrana
Diabetic
dermopathy
[17]
Previous
trauma
Pigmented
round or oval
spots (Shin
spots)
Pramehaa
pidaka
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Table No. 4.Interpretation of Meda Dhatugat Avastha
Complicatio
n
Causes
Symptoms
Ayurvedic
interpretati
on
Atherosclero
sis,
Embolism
Due to
recurrent
hyperglyce
mia that
causes
increased
glycosylatio
n of
hemoglobin
and other
proteins,
building up
of plaque in
inner lining
of vessels
coronary artery
disease,
silent
myocardial
infarction,
cerebral stroke
Dhamani
pratichaya
Dyslipidemia
Disturbance
in
production
and
clearance of
plasma
lipoproteins
Shortness of
breath,
cardiovascular
disease
Sthaulya
Diabetes
nephropathy
[18]
Hyperglyce
mia with
hypertension
Renal
involvement
(Diabetic
glomerulosclero
sis, atheroma of
renal arteries,
Diabetic
pyelonephritis,
Tubular lesions)
Vrukka
Amaya
Table No. 5 Interpretation of Asthi Dhatugat Avastha
Complicatio
n
Causes
Symptoms
Ayurvedic
interpretatio
n
Osteoporosis
Decrease
in
function
of
osteoblast
leading to
accelerate
d bone
loss
Back pain,
spine
malformatio
n
Asthi
saushirya
Table No. 6. Interpretation of Majja Dhatugat Avastha
Complicatio
n
Causes
Symptoms
Ayurvedic
interpretatio
n
Diabetic
neuropathy
[19]
Due to
accumulation
of sorbitol
and fructose
as a result of
hyperglycemi
a leading to
deficiency of
myoinositol
Tingling or
burning
sensation
especially in
extremities
Kara pada
daha and
suptata
Hyperosmola
r
hyperglycemi
c coma
Severe
dehydration
resulting
from
sustained
hyperglycemi
c diuresis
Loss of
consciousnes
s, confusion,
dehydration
Murccha,
Sanyasa
Table No. 7 Interpretation of Shukra Dhatugat avastha
Complicatio
n
Causes
Symptoms
Ayurvedic
interpretatio
n
Infertility/
Impotency
Hyperglycemi
a leads to
increase in
oxidative
stress and
DNA damage
Male:
oligospermi
a or
azoospermia
Female:
disturbed
menstrual
cycle
Vandhyatva
/
Klaibya
As described above, each Dhatu when gets vitiated
& develop its own group of symptoms that can be
correlated accurately with contemporary
complications of persistent hyperglycaemia. Thus,
Dhatugat Avastha can be seen commonly occurring
in patients of Madhumeha or DM and need to have
proper line of treatment that avoids progression of
disease and impairment of tissues.
Conclusion:
Therefore, study of Dhatugat Avastha in
Madhumeha and its correlation with type 2 DM not
only help to frame precise pathophysiology and
severity of disease for that particular individual but
also guide in selection of drug and regimen to be
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executed for that particular individual. As most of
death occurring due to diabetes are seen in patients
with diabetic complications, this study can help to
control both morbidity and mortality rate of DM by
implication of diagnosis and prognosis. Insulin
resistance playing the major role in succession of
disease, can be annihilated by diagnosing the
Dhatugat Avastha of disease which can further
enlighten physician to build appropriate line of
treatment. Hence, the study of Dhatugat Avastha in
Madhumeha and its correlation with complication
of DM can improvise physicians skill of diagnosis
and prognosis of disease, by controlling the chances
of advancement of disease to complications and can
help to elevate the life expectancy of patients
suffering from DM.
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