PRAMEHA By Dr Akhil H S Dept of

PRAMEHA By Dr Akhil. H. S Dept of SHAREERA RACHANA ALVAS AYURVEDIC COLLEGE.

DOSHAS AND DHAATUS • All the three doshas are vitiated. • म स –मद –शकर –मजज –रस –रकत are vitiated. • Other दषय स are ऒजस - उदक - वस – लस क . The doshas chiefly concerned is kapha and among dhaatus मद , उदक, म स are principally involved. And रस –रकत are moderately involved.

मतरवहसर तस . • Moola- basti and vankshana. मतरवहसर तस closely related to उदकवह - रसवह- सवदवह अननवहसर तस. मतर is on of the मल of body. Which depends on अगन in अननवहसर तस and ध त s. This सर तस determine the quantity and quality of urine to be excreted out.

उदकवहसर तस • उदकवह न सर तस त ल मल कल म च ॥ च. व ५ • उदक - अप ध त • Acc to charaka. sarira 7/15 • अप ध त is 10 anjali. • It does sarira dhaarana. It forms part of pureesha, mutra, sweda, lasika etc. and dhatus like rasa, rakta, mamsa etc. • It helps in ahladana, kledana, bandhana , vishyandana.

DIABETES MELLITUS • • What is DIABETES MELLITUS? • Acc to W. H. O – • It is heterogeneous metabolic disorder characterized by common feature of chronic hyperglycemia with disturbance of carbohydrate, fat, and protein metabolism. • Depending on the etiology, hyperglycaemia may result from • a) reduced insulin secreation. • b) Decreased glucose use by the body. • c) increased glucose production.

INSULIN • It’s a peptide hormone (a protien ) secreted by beta cells of islets of langerhans. • It helps to transport glucose into the target cells of the body. And reduces the increased glucose level of blood.

PANCREAS

HISTOLOGY

ENDOCRINE PART

• MAJOR CELLS Beta cells 70% of islet cells INSULIN Alpha cells 20% GLUCAGONE Delta cells 5 -10 % SOMATOSTATIN Pancreatic Polypeptide cells 1 -2 % PANCREATIC POLYPEPTIDE MINOR CELLS D 1 cells Vaso active Intestinal peptide Entero chromaffin cells SEROTONIN

A- Alpha cell B- Beta cell D- Delta cell F- PP cell

SOME MORPHOLOGICAL FEATURES IN PANCREATIC ISLETS • Insulitis – Type 1 – In early stagethere is lymphatic infiltration of t-cells, macrophages etc Type 2 – Little fibrillous protien deposit. • Islet cell mass destruction – Type 1 – As DM become chronic there will be progressive Depletion of beta cells, eventually result in total loss of pancreatic B-cell Type 2 –Mildly effected. • Amyloidosis. Type 1 –are absent. Type 2 - Amyloid deposit around capillaries of islet. Causing compression and atrophy of islet tissue. Degranulation of B-cells.

FEATURES IN DM • TYPE 1 - Absence of insulin due to destruction of beta cell. • TYPE 2 - Insulin secreation is normal • a) Insulin resistance. b) failure of beta cells.

MECHANISM OF COMPLICATION • The process of development of complications in D. M is explained by 2 mechanisms 1. Non – enzymatic protien glycosylation 2. Polyol pathway mechanism

DIABETIC NEPHROPATHY • Morphologically – 4 types of lesions 1. Diabetic glomerulosclerosis 2. Diabetic vascular lesion 3. Diabetic polynephritis 4. Tubular lesion

• Diabetic glomerulosclerosis DIFFUSE NODULAR • Thickening of vessels • Increase matrix • Prolyferation of matrix • 1 or More. • Ovoid/spear • Surrounded by capillaries • Renal ischemia • Tubular atropy • Interstitial fibrosis • Small contracted kidney

DIABETIC NEUROPATHY • Effects all nervous system. (peripheral neuropathy is more clear) • Basic pathological changes –. . . • Glucose deposit in micro capillaries. • Demyelination Schwann cell injury Axonal damage

DIABETIC RETINOPATHY BACKGROUND RETINOPATHY • Basement membrane thickness increase. • Degeneration of pericytes and loss of endothelial cells • Capillary micro-anurism • Waxy exudate accumilation near micro anurism. (hyperlipidemia) • Dot and Blot – Retina • Soft Cotton-wool spot PROLIFERATIVE RETINOPATHY • After long term • Neovascularisation of retina at optic disc. • Friability of newly formed B. V cause easy bleedinghaemorrhage of vitrous • Also proliferation of fibrous tissue around B. V • Contraction of fibro – vascular tissue = Retinal detachment

DISCUSSION • Prameha can not only be compared to D. M, but electrolyte imbalance etc are also related to prameha. • The syndrome of D. M is largely covered under prameha. • Apathyanimitta prameha, sthula prameha in ayurvedic litrature has similarities with D. M. Madhumeha can almost be Diabetes Mellitus. • But to understand remaining 19 types of prameha we need wide discussion and proper reasoning. • In general destruction of B-cell mass and obesity are most important cause of diabetes. • So approach in treating DM should be to control diet and good life style. • Early diagnose and treatment can prevent complications due to prameha.

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