WhatsApp Discussion Series 37: 'Shithilangata' and 'Ghanangata' in Madhumeh(Diabetes Mellitus) by Dr. D.C. Katoch, Dr. Anupama Patra, Dr. Mayur Surana, Dr. Pawan Madan, Vd. Raghuram Bhatta, Dr. Priya-ranjan Tiwari, Dr. Arvind Aggarwal and others.

[5/15, 6:12 PM] Dr. Bharat Delhi: 

Please discuss about sithilaanga and Ghanaanga both features.

 If both observed in patients

 Or manifests alternately?

[5/15, 7:10 PM] Prof. Kirtiprakash Upadhyay : 

As per my opinion:- Shithila angata- subjective feeling of patients. 

Ghanangta- objectively seen by others or by physician.

Due to shithilangta 

Shaiyyaasanaswapna sukhe ratischa.

[5/15, 9:25 PM] Prof. KSR Prasad Tachnoayurveda: 

Shithilanga is subluxed joints

 That is slathangata

[5/15, 9:34 PM] Arvind Aggarwal Dr.: 

Bcoz of Kapha - ghana and shithila angata

Ghanangata - Sthula/guru angata

Shithilangata- bcoz of that ghanata/sthulata

(As per understanding)

[5/15, 9:40 PM] Parul Ben Joshi:

 It's related with Madhumeha.

[5/15, 9:54 PM] Dr. Bharat Delhi:

I read all views but I am still unable to comprehend (shithilangata n ghanangata )

 In same purvarupa.

[5/15, 10:07 PM] Raghuram Dr Banguluru: 

Sir ji, immediately after this shloka, Charaka explains the treatment principles wherein he categorizes the *Prameha Atura* as 

1. *Sthula and Balavan* - *Ghanangata* may be considered as poorvarupa of this category

2. *Krusha and Paridurbala* - *Shithilaangata* may be considered as poorvarupa of this category.

Hope this helps.

[5/15, 10:15 PM] Dr. priy-ranjan tiwari: 

shithilangata means inactive or slow active body and ghanangata means dull sthool body.

 its not subluxation its neuropathic condition.

[5/15, 10:19 PM] Dr. Bharat Delhi: 

Sir, my query has two dimensions

 1st. Conceptual understanding of terms n their underlying samprapti ?

 2nd. Whether these are observed in clinical practice ?

[5/15, 10:23 PM] Dr. priy-ranjan tiwari: 

shithilangata is due to developing neuropathy which is mostly found in niddm which is still a ghanangata or sthul case.

we can also go for n.c.s. test.

 yes by clinical and through n.c.s.

it depends upon duration chronicity of hyperglycemia.

[5/15, 10:31 PM] Dr. Bharat Delhi: 

Sir in that case, we have to define first shithilangata n ghanangata in terms of hyperglycemia n muscle tissue involvement pathology

[5/15, 10:32 PM] pawan madan Dr: 

Shithila angataa...

Any condition in which some

or whole part of the body show laxity and weakness.

Can be due to many reasons and it may have some different meanings in reference to different contexts at various places in samhitas.

[5/15, 10:52 PM] Dr. priy-ranjan tiwari: 

i m telling about neuropathy not myopathy.

[5/15, 11:01 PM] Arvind Aggarwal Dr.: 

Why any conceptual point regarding prameha/madhumeha is always considered in reference of hyperglycemia ? E.g. the above said Purvarupa are for all types of prameha, not for DM or hyperglycemia. Regarding prameha and DM, this type of query is always in my mind but m not able to understand the fact. 😞

[5/16, 6:11 AM] Satish Sharma ji Dr: 

nidra tandra chha sarv kalam ko bhi samajhane ki kripa kare.

[5/16, 5:59 PM] Anupma Patra AIMS AYU: 

Dr Bharat perhaps this reference will help u to solve ur query. 👇👇

Ghanangata can be understood as a result of maansa and meda vridhi and shithilangata as a result of sukumar quality of meda dhatu .person became unable to perform all body activity perfectly.

In modern point of view it can be understood through the involvement of nervous tissue as explained by 

Priyaranjan sir.

As involvement of meda is common pathogenesis in prameha both purvaroop may be possible.

🙏🙏

[5/16, 6:52 PM] Dr Surendra A Soni: 

Very good question asked and very well replied by honourable experts.

There may be a one more aspect to understand the whole poornaroop scenario mentioned by Charak....

1. स्वेदोऽङ्गगन्धः शिथिलाङ्गता च शय्यासनस्वप्नसुखे रतिश्च ।

👆These may be taken as symptoms of Doshaja dominance headed by shleshma.

Circulating in srotas either in form of poshya or poshak dhatu (over nutrition). 

2. हृन्नेत्रजिह्वाश्रवणोपदेहो घनाङ्गता केशनखातिवृद्धिः ॥१३॥

Here maximum solidification of dhatus esp. Mansa and Meda along with excessive formation of Dhatu-malas according to intake of nidanas.

I infer that Charak has mentioned the pathogenesis systematically. Upto this stage simple Apatarpan should be applicable because of no clear cut samprapti visible except the vaishamya in dhatu poshan schedule in overloaded nutrition(kleda).

While next line indicates the pathogenesis caused by excessive kleda coming through the urine

शीतप्रियत्वं 👉गलतालुशोषो👉 माधुर्यमास्ये👉 करपाददाहः ।

भविष्यतो मेहगदस्य रूपं👉 मूत्रेऽभिधावन्ति पिपीलिकाश्च ॥१४॥

👆 This we can say the starting of the visible symptomatology that is described in  milder to moderate manner.

Now modern science advocates weight control identifying in form of 'Metabolic syndrome' that is Early.

🙏

[5/16, 7:06 PM] pawan madan Dr: 

@⁨Dr Surendra A Soni⁩ sir --- very nicely explained. The meanings should be according to the context. Thanks.

[5/16, 7:21 PM] Anupma Patra AIMS AYU: 🙏🙏

[5/16, 10:13 PM] Ashwini Kumar Sood Dr:

 Perfect explanation 👌

[5/16, 10:26 PM] D C Katoch sir: 

Can't शिथिलांड्गता be due to sodium loss resulted from अतिस्वेद (which is obvious) and  घनांड्गता (feeling of heaviness- अगंगौरव) due to सामदोष-धातुत्व    in  सन्तर्पणोत्थ प्रमेह ?

[5/16, 10:39 PM] Dr Surendra A Soni: 

I think that may be different because of presence of excessive nutrition. 

घनांगता is अति उपचय maximum as per genetic map /बलवृद्धि कर भाव mentioned. सामत्व is definitely there. I remember Once you explained the सार and किट्ट विभाजन very well. Here no koshthasth symptoms are there which is noticable. All saamatva gouravatva etc are shakhagata as per my small understanding.

This is my hypothesis regarding prameha.

🙏🙏

[5/16, 10:39 PM] Mayur Surana Dr. AP: 

शिथिलांगता simply implies flabbiness while घनांगता is स्थूलशरीरत्वम् (इति चंद्रतोडरौ) due to increased kleda and abaddha dhatus--

[5/16, 10:40 PM] Dr Surendra A Soni: 👆👌

[5/16, 10:40 PM] Mayur Surana Dr. AP: 

No need of confusion...its crystal clear...

[5/16, 10:43 PM] Ashwini Kumar Sood Dr: 

In low metabolic state of the body both may be present - in hypothyroidism

[5/16, 10:44 PM] Arvind Aggarwal Dr.: well

[5/16, 10:51 PM] D C Katoch sir: 

Ghan means dense and shithil means loose. Accordingly, we can derive the understanding of Ghanagata as heaviness of body parts and Shithilangata as laxity of muscles. I have no confusion on these obvious symptoms of prameha process.

[5/16, 10:54 PM] Dr Surendra A Soni: 🙏

[5/16, 10:55 PM] Mayur Surana Dr. AP: Katoch sir !👍👌

[5/16, 11:16 PM] Dr Surendra A Soni:

 स चापि गमनात् स्थानं स्थानादासनमिच्छति । 

आसनादृणुते शय्यां शयनात् स्वप्नमिच्छति ।।२५।।

Su. Prameha nidaan

How said physical/mental tendency can be categorised....??

May be another aspect शिथिलांगता ??

[5/17, 5:56 AM] D C Katoch sir: 

Loss of physical strength as seen in diabetic patients, loss of muscular tone as seen in LMN disease and  loss of muscular strength as seen in protein-calorie malnutrition are equivalent examples of Shithilangata. But in the context of Prameha it is best indicative of loss of natural muscular tone        (asthenia) mixed with loss of drive (अनुत्साह), which can be further termed as shram (fatigue) and klama (loss of strength with sense of tiredness without any physical activity) depending upon the causative process.

[5/17, 7:58 AM] Dr Surendra A Soni: 🙏👌

[5/17, 8:18 AM] D C Katoch sir: 

Ghanata causes Guruta. Excessive accumulation of parthiv & jal tatva leads to increased density and mass. Parthiv tatva is more responsible for enhancing density and both Parthiv & Jal tatva for gravity/guruta.

[5/17, 8:30 AM] Dr Surendra A Soni: Yes Sir !

🙏

Bahu abaddha dhatu and kleda, as pointed by dr mayur.

[5/17, 8:32 AM] vipul patel: 👍👍🙏🙏


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This simple discussion is uploaded to show that how simple words mentioned in Samhita has the depth to understand the clinical significance.
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Above discussion held on 'Kaysampraday" a Famous WhatsApp discussion group  of  well known Vaidyas from all over the India. 

Compiled & edited by

Dr.Surendra A. Soni

M.D.,PhD (KC)

Associate Professor

Dept. of Kaya-chikitsa

Govt. Ayurveda College

Vadodara Gujarat, India.

Email: surendraasoni@gmail.com

Mobile No. +91 9408441150