AN OVERVIEW OF VIKALPA SAMPRAPTI IN MADHUMEHA W.S.R TO TYPE II DM.

Tahseen Ahmed.M 1 and Janaki.Y.S 2 . 1. PG Scholar, Dept. of Roga Nidana, G.A.M.C, Bengaluru. 2. Professor, Dept. of Roga Nidana, G.A.M.C, Bengaluru. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 08 February 2019 Final Accepted: 10 March 2019 Published: April 2019

However, Sushruta has used the term Ksaudra Meha in place of Madhumeha. Kshaudra is nothing but a variety of Madhu (honey), which is Kapila (tawny) in color. So it undoubtedly resembles with Madhumeha. Further, he asserted that when all the Pramehas ill-treated or neglected are converted to Madhumeha 4 .
In regard to the above explanation we can easily postulate that the disease prameha is resulted because of excessive excretion of something (Atipravrttija).

Synonyms: Ojomeha, Ksaudrameha, Paushpameha
Observation: Madhumeha involves the tridoshas, meda, mamsa, shareera kleda, shukra, shonita, vasa, majja, lasika, rasa and apara ojus. The vimshati pramehas manifest as 10 kaphaja pramehas involving mainly medas and tridosha with the predominance of dushta sleshma 5a , 6 pittaja pramehas mainly involving shonita, medas 5b and tridoshas with dushta pitta predominance and 4 vataja pramehas mainly involving vasa, majja, meda 5c and tridoshas with the predominance of dushta vata. Acharya Charaka put forth the theory that all these types and their nomenclature are because of the specific qualities and their combinations with each other but, the nomenclature is mainly based on the predominance of one quality 6 . Chakrapani also commented that the nomenclature is because there is close resemblance of urine with a particular quality (guna) i.e. Shitameha with Shita guna, Suklameha with Shukla guna etc. When we go through the above details, with this classification we can easily understand the dosha predominance, dusya involved, nature of urine voided and the disease progression.

Purvarupa:
Premonitory symptoms are very much important to diagnose the disease as early as possible. That in turn helps for good prognosis. In Ayurvedic treatises common premonitory symptoms are described but special premonitory symptoms of Madhumeha are not mentioned.

Rupa:
Signs and symptoms of the disease are the diagnostic tools which manifest when the pathology of the disease is in full swing. The symptomatology of madhumeha by the Acharyas is as follows. The disease madhumeha exhibits its characteristic features or roopa resulting from the dosha dushya vishesha through mutra varnadi bheda 7 . Here the word "adi" refers to Rasa, Gandha, Sparsha. Hence the disease prameha or madhumeha must be diagnosed based on the characterstics of dusta mutra.
The samanya lakshana of this roga are prabhoota mutra and avila mutrata 8 . Here prabhoota must be understood as excessive quantity and frequency of urine whereas avila refers to not clear or turbid and foul. The underlying pathology is the excessive increase in kapha and kledadi factors.

Specific symptomatology of Madhumeha: Urine Characteristics:
Madhumeha patient excretes urine having Kashaya and Madhura taste, Panduta in colour and of Ruksa Quality. (Cha. Ni. 4/44) Commenting upon this statement of Charaka, Gangadhara opines that the natural madhura rasa of oja is replaced by Kashaya rasa in Basti. Chakrapani opines that Vayu because of its Prabhava converts Madhura rasa of oja into Kashaya rasa 9 . Susruta mentioned the resemblance of urine with honey as described above, seconded by Vagbhata and Madhavakara.

Associated signs and symptoms:
In Chikitsasthana, Susruta before propounding the treatment of Prameha, asserted two types of prameha along with their features as follows.

Samprapti:
The processes which include the different stages of dosha dushti and disease progression till the complete manifestation of vyadhi are called samprapti.
Acharya Charaka explained the samprapti of madhumeha in detail as follows 10 . In kaphaja prameha, if patient indulges in pittakara ahara, vihara and manasika bhavas like: krodha  pitta dosha gets involved and leading to  further progression of samprapti towards yapya avastha and manifests 6 pittaja prameha.

Vataja Prameha 11c :
The prameha which has reached yapyavastha due to involvement of excessively vitiated pitta and kapha, if patient indulges in vatakara ahara, vihara and manasika bhavas like: Udvega and Shoka  vata dosha gets involved and leading to  further progression of samprapti towards asadhya avastha and manifests  4 vataja prameha.

Discussions & result:-
From the above observations we can arrive at these results: 1. The involvement of tridsoha suggests the seriousness of the illness. 2. Prameha is an acute illness manifested due to chronic pathology due to Nidana, dosha and dushya sammurchana-ashu abhinirvruttikaranam bhavati. It is a disease with an irreversible pathology-asadhyan iti utpattitaha. 3. The pattern and order of involvement of the dhatus indicates the transition of disease prameha from a state of curability towards the disease Madhumeha, a state of incurability. 4. The kaphaja prameha needs to be considered as pre-diabetic stage, since the dushyas involved are mainly medas with associates like mamsa and shareera kleda. Thus obesity with dyslipidaemia and polyuria should be considered as kaphaja meha. 5. In pittaja prameha, Shonita is being invaded by dushta kaphadi factors. This is the point where the pathognomonic feature of diabetes mellitus-hyperglycaemia sets in. Thus pittaja meha is the stage where actual pathologic mechanism of diabetes mellitus unfolds. 6. In vataja prameha, there is involvement of gambheera dhatus and apara ojus which is the dhatu sara, is being forced out of the body due to the indolent and irreversible pathology called Avarana at cellular level. Thus madhumeha is a stage where complications are seen which is again due to Apara ojo kshaya from the body through basti marga. Also insulin resistance can be considered as avarana to the vata dosha.

Conclusion:-
Conclusion in a nutshell is the essence of any study. Without finding a conclusion on any study, it would not become successful in its aims. Conclusions drawn from the present study are as follows: 1. Madumeha is tridoshaja vyadhi intiated by santarpana nidana leading to quantitative increase of malaroopi shleshma, pitta, meda and mamsa which leads to avarana of the gati of vayu which in turn leads to vimargagamana of apara ojus through basti by vayu leading to asadhya vyadhi as it involves gambhira dhatus.