Understanding the difference in Ojas-kshayaja/ Aavaranaja-Madhumeha & Prameha/Madhumeha based on Charaka-samhita

Understanding the difference in Ojas-kshayaja/ Aavaranaja-Madhumeha & Prameha/Madhumeha based on Charaka-samhita

No.	Vibheda-Bindu (Differencial Point)	Aavaranaja Madhumeha	Prameha / Madhumeha
i.	Vyadhitva	Not eastablished, mentioned in Ch. Su. 17/78-82 as a cause of Prameha-pidakaa	Eastablished Vyadhi, mentioned among the  8 basic Sampraptis of Nidan-sthan Chapter-4. Detailed Management described in Ch. Chi. 6.
ii.	NidanPanchak	NidanPanchak is not mentioned systematically. But Nidans are of 18 types of kshyas mebtioned.	NidanPanchak is mentioned systematically. Bahudrava/ bahuslesma/ abadhamedaskarak nidanas.
iii.	Nidan	गुरु-स्निग्ध-अम्ल-लवणानि अतिमात्रं समश्नताम् ! नवम् अन्नं च पानं च निद्राम् आस्यसुखानि च !! त्यक्तव्यायामचिन्तानां संशोधनम् अकुर्वताम् ! च.सू.-17/78-79 these are immediate causes only same as in prameha	आस्यासुखं स्वप्नसुखं दधीनि ग्राम्यौदकानूपरसा: पयांसि ! नवान्नपानं गुडवैकृतं च प्रमेहहेतु: कफ़कृच्च सर्वम् !! च.चि.-6/4
iv.	Pramehatvam	Signs & Symptoms ‘Prameha’ is not Mentioned. Even the term ‘Prameha’ is not used. Direct manifestation of ‘Madhumeha’ is described. Madhu and pra both have commom in meha.	The symptoms of ‘Prameha’ are  Mentioned. Direct manifestation of ‘Madhumeha’ is not described. Described in tathavidhasharireshu And jatpramehimadhumehinova
	Prabhoota-aavilaMootrata	Not mentioned directly. No any sypmtoms mentioned	It is ‘Pratyatma-lakshana (Cardinal-feature) visible easily.
	Dosha	Shleshma, Pitta as ‘Aavarak’ & Vat as Aavritta. Vyanvayu&Apanvayu शुक्रदोषप्रमेहास्तुव्यानापानप्रकोपजाः ||सु.नि.१/२०	Shleshma- Main Dosha responsible Shleshma is at both places
	Doshaja Types	Not mentioned	Well mentioned in details with individual Symtomatology. Kaphaja-prameha- 10 Pittaja-prameha- 6 Vataja-prameha- 4
	Dooshya	3 Only- 1.Medas 2.Mansa & 3.Ojas	1.Medas 2.Mansa 3. Kleda 4.Shukra, 5.Shonita 6.Vasa 7.Majja 8.Lasika 9.Ras 10. Ojas
v.	SROTAS	Mutravaha, swedavaha, medovaha	Mutravahastrotas, medovahastrotas
vi.	ROGAMARGA	Shakha&Marmasthisandhi	Marmasthisandhi
vii.	ADHISHTHAN	Basti, twacha	Basti(mutravahasansthana)
viii.	AGNI	Dhatvagnimandhya	Dhatvagnimandhya
ix.	SAM/NIRAM	Sam	Sam
x.	AASHAY	Aam-Pakvashaya	Pakvashaya
xi.	SROTO-DUSHTI	Sanga	Sanga, Atipravriti
xii.	VYADHI-PRAKAR	Aashukari	Chirakari
xiii.	SADHYASADHYATA	Kritchhasadhya	Yapya/Asadhya
xiv.	SAMPRAPTI	श्लेष्मा पित्तं च मेदश्च मांसं चातिप्रवर्धते||तैरावृतगतिर्वायुरोजआदाय गच्छति| यदा बस्तिं तदा कृच्छ्रो मधुमेहः प्रवर्तते||स मारुतस्य पित्तस्य कफस्य च मुहुर्मुहुः| दर्शयत्याकृतिं गत्वा क्षयमाप्यायते पुनः|| च. सु.१७/७९, ८०,८१	ओजःपुनर्मधुरस्वभावं, तद्यदारौक्ष्याद्वायुःकषायत्वेनाभिसंसृज्यमूत्राशयेऽभिवहतितदामधुमेहंकरोति || च.नि.४/३७
xv.	POORVA-ROOPA	Not mentioned..... Direct glycosuria	त्रयस्तु खलु दोषाः प्रकुपिताः प्रमेहानभिनिर्वर्तयिष्यन्त इमानि पूर्वरूपाणि दर्शयन्ति; तद्यथा- जटिलीभावं केशेषु, माधुर्यमास्यस्य, करपादयोः सुप्ततादाहौ, मुखतालुकण्ठशोषं, पिपासाम्, आलस्यं,मलं काये, कायच्छिद्रेषूपदेहं, परिदाहं सुप्ततां चाङ्गेषु, षट्पदपिपीलिकाभिश्च शरीरमूत्राभिसरणं, मूत्रे च मूत्रदोषान्, विस्रं शरीरगन्धं, निद्रां, तन्द्रां च सर्वकालमितिच.नि.४/४७ स्वेदोऽङ्गगन्धः शिथिलाङ्गता च शय्यासनस्वप्नसुखे रतिश्च| हृन्नेत्रजिह्वाश्रवणोपदेहो घनाङ्गता केशनखातिवृद्धिः||च.चि.६/१३ शीतप्रियत्वं गलतालुशोषो माधुर्यमास्ये करपाददाहः| भविष्यतो मेहगदस्य रूपं मूत्रेऽभिधावन्ति पिपीलिकाश्च||च.चि.६/१४
xvi.	UPADRAVA	उपेक्षयाऽस्य जायन्ते पिडकाः सप्त दारुणाः| च. सु.१७/८२	उपद्रवास्तु खलु प्रमेहिणां तृष्णातीसारज्वरदाहदौर्बल्यारोचकाविपाकाः पूतिमांसपिडकालजीविद्रध्यादयश्च तत्प्रसङ्गाद्भवन्ति च. नि.4/४८
xvii.	VYADHI- DHATUGATATVA	May be seen if not treated properly	Seen
xviii.	DOSH PRAKOP PATTERN	विकृतिविषमसमवेत	प्रकृतिसमसमवेतपरक
xix.	Swatantra/ Paratantra Kartritva	स्वतन्त्रकर्तृत्व Due to Direct Ojasa-kshaya.	परतन्त्रकर्तृत्व Ojasa-kshaya is later event.
xx.	LAKSHAN-UTPATTI	Not mentioned because there is no fix clinical presentation because of avaranaFenomena.	कषायमधुरंपाण्डुरूक्षंमेहतियोनरः| वातकोपादसाध्यंतंप्रतीयान्मधुमेहिनम्||च.नि.४/४४
xxi.	CHIKITSA SIDDHANTA	As per Avaranchikitsa& symptomatic shoshan dominance. रसायनानां सर्वेषामुपयोगः प्रशस्यते||२४१|| शैलस्य जतुनोऽत्यर्थं पयसा गुग्गुलोस्तथा|२८/२४२ पित्तावृते तु पित्तघ्नैर्मारुतस्याविरोधिभिः| कफावृते कफघ्नैस्तु मारुतस्यानुलोमनैः||च. चि.२८/२४५	स्थूलःप्रमेहीबलवानिहैकःकृशस्तथैकःपरिदुर्बलश्च| सम्बृंहणंतत्रकृशस्यकार्यंसंशोधनंदोषबलाधिकस्य च. चि.१५
xxii.	PATHYAPATHY	Pathya:- आहार:-येविष्किरायेप्रतुदाविहङ्गास्तेषांरसैर्जाङ्गलजैर्मनोज्ञैः | यवौदनंरूक्षमथापिवाट्यमद्यात्ससक्तूनपिचाप्यपूपान् ||१९|| मुद्गादियूषैरथतिक्तशाकैःपुराणशाल्योदनमाददीत | दन्तीङ्गुदीतैलयुतंप्रमेहीतथाऽतसीसर्षपतैलयुक्तम् ||२०|| सषष्टिकंस्यात्तृणधान्यमन्नंयवप्रधानस्तुभवेत्प्रमेही | च. चि.६/२१ विहार:-व्यायामयोगैर्विविधैः प्रगाढैरुद्वर्तनैः स्नानजलावसेकैः| सेव्यत्वगेलागुरुचन्दनाद्यैर्विलेपनैश्चाशु न सन्ति मेहाः||च. चि.६/५० Apathya:- आहार:- दधीनि ग्राम्यौदकानूपरसाः पयांसि| नवान्नपानं गुडवैकृतं च प्रमेहहेतुः कफकृच्च सर्वम्||च. चि.६/४ हायनकयवकचीनकोद्दालकनैषधेत्कटमुकुन्दकमहाव्रीहिप्रमोदकसुगन्धकानांनवानामतिवेलमतिप्रमाणेनचोपयोगः, तथासर्पिष्मतांनवहरेणुमाषसूप्यानां, ग्राम्यानूपौदकानांचमांसानां, शाकतिलपललपिष्टान्नपायसकृशराविलेपीक्षुविकाराणां, क्षीरनवमद्यमन्दकदधिद्रवमधुरतरुणप्रायाणांचोपयोगः,च. नि.४/५ विहार:-आस्यासुखंस्वप्नसुखंच. चि.६/४ मृजाव्यायामवर्जनं, स्वप्नशयनासनप्रसङ्गः| च. नि.४/५	Same pathyapathya
xxiii.	Conclusions	1. Basically it is in ‘Kiyantahshirshiya’ chapter which deals with marmopghat due to dhatukshaya condition. 2. Ayurveda has no concept of organic pathology but on the sound basis of 7 dhatus and ojus, it is   there. 3. Ojus is the supreme dhatu. 4. Dhatus are in srotas until not  metabolized as desired state of dhatu  (Parinamapadyaman).  5. Avayava or organ is only shaped by  sthir-dhatu layer by layer dhatu evolve as avayava nothing else. 6. Even after organic repair or even transplant there is a strong need of correction in dhatuparinaman. 7. Poor dhatu constitute the poor organ and strong to strong. 8. That’s why this chapter is written for how dhatukshaya leads the marmopghtat. 9 Madhumeha is given as an example of ojuskshaya not as an example of pure aavarna. 10. This chapter is mainly written for 18 kshyas (3 dosha+ 7 dhatu 2 mala + 5  indriya mala + 1 ojus) and in result avayavanash. 11. Pl don’t consider prameha and madhumeha commonly only one type of partantra prameha is madhumeha Othervise madhumeha is poly factorial poly symptoms and tt.	1.      This is the details about 20 prameha        2.      Madhumeha can be the swatantra as in ch. Su. 17        3.      and partantra as in prameha        4.      jatapramehi and madhumehi are two different         diseases.        5.      Sthool-        6.      Balwan-        7.      Krisha-        8.      Durbal pramehi are further more variants.        9.      Sapoorvarupa or apoorvarupa are further more variants.         10.  Prakati-bhuyastwad means genrally they have long history of excessive and repeatative nidan but madhumeha can be immediately after with any reason of ojokshaya.
xxiv.	Practical aspect	The patients who don’t have family history  but they have sequence of Nidanas excessively like….  intake of Fast        junk         non-veg. food        wine or bear            anabolic steroids            irregular life style        Adulterated food           Irregular exercise        Excessive proteins etc are more close to Avarana-janit-madhumeha due to dhatvagni-mandya & Ojas-kshaya conditions. Gestation, Stress induced, Higher Steroids/antibiotics etc. induced, Hormonal therapy & Surgical stress induced Diabetes may be taken into consideration of Ojas-kshayaja/avaranaja Madhumeha.	The patients who don’t have avaran/ojas kshaya nidanas but their presentation is as per santarpaneeya concept are more close to classical Prameha/Madhumeha. This must be further understood as mentioned above before planning of Samprapti-vighatan.

Presented by

Dr. Keval Monapara
B.A.M.S., M.D. 1st Year
P.G. Dept. of K.C.
Govt. Akhandanand Ayurved College
Bhadra, Ahmedabad-1, Gujarat, India.

Guided by

Dr. Surendra A. Soni
M.D., PhD
Professor & Head
P.G. Dept. of  K.C.
Govt. Akhandanand Ayurved College
Bhadra, Ahmedabad-1, Gujarat, India.


Checked, Correctified & Verified by

1.Prof. Shri Krishna Khandel

M.D., PhD.
Ex-H.O.D.
Dept. of Roga & Vikriti Vigyan
National Institute of Ayurveda,
Amer Road, Jaipur, Raj. India


Arogya Laxmi Ayurvedic Health Care
D- 44, Roopvihar Colony, Block- D, 
Siddhartha Nagar, Jagatpura, Jaipur-302017
 Rajasthan., India.
www.arogyalaxmi.com
Phone: +91 141 4024645 
Mob. No. +91 9772828871   

2. Vaidyaraja Subhash Sharma

M. D. Kayachikitsa (Jamnagar)

New Delhi, India.

email- vaidyaraja@yahoo.co.in