|Year : 2019 | Volume
| Issue : 2 | Page : 54-62
Assessment of Pradhana Sharir and Manas Prakriti(bodily and mental constitution) in the manifestation of diabetes mellitus
Amin Hetalben1, Hitesh Vyas2, Mahesh Vyas3
1 Regional Ayurveda Research Institute for Skin Disorders, Ahmedabad, Gujarat; CCRAS, Ministry of AYUSH, Government of India, New Delhi, India
2 Department of Basic Principles, I.P.G.T. and R.A., Gujarat Ayurved University, Jamnagar, Gujarat, India
3 Department of Basic Principles, All India Institute of Ayurved, New Delhi, India
|Date of Submission||29-May-2019|
|Date of Decision||17-Jul-2019|
|Date of Acceptance||24-Sep-2019|
|Date of Web Publication||09-Dec-2019|
Regional Ayurveda Research Institute for Skin Disorders, Ahmedabad, Gujarat
Background and Aim: Diabetes mellitus (DM) is the most menacing disorder in Ayurveda, and it is equated to Madhumeha. The concept of Prakriti (human constitution) can be applied for manifestation and prognosis of diseases. Therefore, in this study, we intend to study Pradhana Sharira and Manas Prakriti (dominant bodily and mental constitution) in Madhumeha (DM)) participants.
Materials and Methods: Prakriti of 103 participants of DM was assessed as per Prakriti assessment pro forma. Vata-, Pitta-, and Kapha Dosha (bodily humors)-dominant Prakriti were analyzed according to the characteristics found in participants.
Results: Nearly 38.46% Kapha Pradhana Prakriti and 41.5% Tamas Pradhana Prakriti participants were found maximum.
Conclusion: Dominant Kapha and Tamas Prakriti have influence on the manifestation of Madhumeha (DM).
Keywords: Diabetes mellitus, Madhumeha, Manas, Prakriti, Sharira
|How to cite this article:|
Hetalben A, Vyas H, Vyas M. Assessment of Pradhana Sharir and Manas Prakriti(bodily and mental constitution) in the manifestation of diabetes mellitus. Yoga Mimamsa 2019;51:54-62
|How to cite this URL:|
Hetalben A, Vyas H, Vyas M. Assessment of Pradhana Sharir and Manas Prakriti(bodily and mental constitution) in the manifestation of diabetes mellitus. Yoga Mimamsa [serial online] 2019 [cited 2020 Jan 21];51:54-62. Available from: http://www.ym-kdham.in/text.asp?2019/51/2/54/272448
| Introduction|| |
Type 2 diabetes mellitus (DM) is an independent risk factor for coronary artery disease and is increased in patients with diabetes compared to nondiabetic population. Jamnagar is the fifth largest city in the Indian state of Gujarat after Ahmedabad, Surat, Vadodara, and Rajkot. Recently, Jamnagar has shot to prominence as Reliance Industries, India's largest private company, established the world's largest oil refinery near the village of Moti Khavdi in Jamnagar. It is also home to an Essar Oil refinery, located near the town of Vadinar. Chronic diet-related diseases are on rise around the world due to new lifestyles and eating habits. Therefore, studies about health promotion and its related factors certainly need to be conducted. Change in the life style is becoming a major problem for the prevention of noncommunicable diseases (Senjam & Singh, 2012). Lifestyle diseases such as DM are the major risk factors for the development of cardiovascular disease (Pappachan, 2011). The disease is psychosomatic and much common in the Jamnagar city; therefore, an attempt is made to assess Pradhana Sharira and Manas Prakriti (dominant bodily and mental constitution) of patients of this disease.
Sharira and Manas Prakriti have an important role in Hetu Skandha (diagnostic level), Linga Skandha (symptomatic level), and Aushadha Skandha (treatment level). Many works have been done on Sharira Prakriti, but researches on Manas and Sharira Prakriti with relation to Vyadhi Utpatti are very few or not available. For Sharira Prakriti, it is said that “Vataladya Sadatura” means that persons who have Vata Pradhana Prakriti are always sick (Acharya, 2004). Keeping this particular view in mind, the authors have selected Madhumeha disease to assess the role of Prakriti in the manifestation of the Madhumeha disease. On the basis of the manifestation of signs and symptoms and current evidences, these diseases namely DM can be equated to Madhumeha. According to Ayurvedic literatures, Madhumeha is Kapha and Tamas dominant (Acharya, 2004). Here, an attempt is made to find out the relationship of Sharira and Manas Prakriti in Vyadhi Utpatti through survey pro forma in diagnosed patients of DM.
| Materials and Methods|| |
Selection of subjects
A cross-sectional survey study was conducted on 103 DM participants, attending outpatient department and inpatient department of IPGT and RA, Gujarat Ayurved University, Jamnagar, Gujarat, India, from December 1, 2013, to February 28, 2014, after obtaining approval from the Institutional Ethics Committee. The participants were selected using simple random sampling, and written informed consent was taken as per Helsinki declaration after offering sufficient explanations about the study and its aims. All participants were interviewed in the local language by a single person. A short clinical pro forma was prepared which included the present and past medical history of first-degree relatives, medications, diet pattern, and lifestyle of patients in light of etiological factors explained for Madhumeha in ayurvedic classics. Ethical clearance was obtained from the Institutional Ethics Committee and Trial Registered Retrospectively in the Clinical Trials Registry of India, India.
Diagnosed participants with DM were selected without any bar of sex, religion, and cast. Participants in the age group of 20–60 years were included in the study. Patients with classical symptomatology of Madhumeha (Acharya, 2004) as well as type 2 DM were selected for the present study. We chose those participants whose fasting blood sugar and postprandial blood sugar blood sugar levels could be maintained at ≤126 mg/dL and ≤200 mg/dL, respectively.
Participants in the age group <20 and >60 years and with any systemic disorders were excluded from the study. Females with a history of pregnancy and lactation were also excluded. Patients having insulin-dependent DM; severe diabetic complications microvascular (retinopathy, neuropathy, and nephropathy) or macrovascular (coronary artery disease, peripheral vascular disease and cerebrovascular disease); pregnant patients; lactating mothers; and known cases of tuberculosis, AIDS, and malignancies were also excluded from the study.
Assessment of Prakriti
Standard criteria of the National Diabetes Data Group and WHO for DM were adopted (these criteria are also adopted by the American Diabetic Association) (Fauci, et al., 2008), and blood glucose level was estimated in all patients. The specific research pro forma was made to assess Sharira–Manasa Prakriti. Prakriti determination pro forma was prepared having Vatika, Paitika, and Kaphaja characters with reference to anatomical, physiological, and sociological characters by following Brihatrayi (Charaka, Sushruta and Ashtanga Hridayam) (Fauci, et al., 2008). Assessment was made by analyzing obtained data from filled questionnaire and physical examination of participants. All anatomical characteristics were assessed by visual and tactile examination. Vata, Pitta, and Kapha Pradhana Prakriti were analyzed with pro forma according to character found in individuals. Maximum characteristic of any Dosha indicates Pradhana Dosha Prakriti of that individual. After assessing Prakriti, the participants were further divided into three categories, i.e., Vata Pradhana, Pitta Pradhana, and Kapha Pradhana Prakriti. The same method is obtained to assess Pradhana Manas Prakriti, i.e., Sattva Pradhana, Rajas Pradhana, and Tamas Pradhana Prakriti.
| Results|| |
A total of 103 participants of DM were studied. Kapha-dominant Prakriti participants were found to be more prevalent (51.89%) in DM, whereas Pitta-dominant and Vata-dominant Prakriti participants were 40.57% and 7.54%, respectively. In Manas Prakriti, Tamas-dominant Prakriti was found to be more prevalent (53.47%), whereas Sattva- and Tamas-dominant Prakriti were found in 35.64% and 11.88%, respectively.
Baseline characters related to principle variables, namely, age, gender, religion, marital status, occupation, and socioeconomic status are depicted in [Table 1]. Sharira-Manas Prakriti-wise distribution, factors related to Sharira Prakriti and factors related to Manas Prakriti are mentioned in [Table 2], [Table 3], [Table 4], respectively.
|Table 2: Sharira- Manas Prakriti-wise distribution of diabetes mellitus patients|
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|Table 3: Factors related to Sharira Prakriti of diabetes mellitus patients|
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|Table 4: Factors related to Manas Prakriti of diabetes mellitus patients|
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| Discussion|| |
Majority of the patients were in the age group of 36–55 years. These results correspond with the fact of greater prevalence of risk factors of type 2 diabetes among middle- to old-age groups. At this particular age, dietetic incompatibilities such as Vishamashana (irregular timings of food), Viruddhashana (eating incompatible food articles), ignorance about Dinacharya (daily regimen), and Avyayama (lack of exercise) become the leading cause for metabolic disorders. This is the declining phase of life with Vata Dosha predominance. The physico-mental strengths and defense mechanism of body tend to decrease with growing age, and the body is no longer able to cope up with unhealthy life style choices, which, in turn, results in the manifestation of diseases such as DM. Worldwide estimation projects that in 2030, the greatest number of individuals with diabetes will be 45–64 years of age. In patients of DM, Vata Prakriti Lakshana, namely Parusha and Atyalpa Kesha/Shmashru/Loma, Anischita Trasa/Raga/Viraga, and Alpa Smriti were found in maximum number of patients. It may be because of Parusha and Laghu Guna of Vata.
Charaka has emphasized anxiety, anger, worry, grief, etc., as risk factors for the development of Prameha in susceptible individuals. This is supported by an experimental research done at Jamnagar in which diabetes was induced by stress in Albino rats, and their blood examination showed increased rate of catalase activity, suggesting the acceleration rate of cell injury and free radical generation, which, in turn, is a precursor to diabetes (Mohanty, 2001). High risk of complications of diabetes is associated with influence of psycho stressors and depressive disorders.
In patients of DM, Vata Prakriti Lakshana, namely, Madhura and Amla Rasa Sevana, was found in maximum number of patients. Amla Rasa is having Vata Guna dominancy which may vitiate Vata Dosha and further may lead to Samprapti of Madhumeha. In DM, more than half of the patients liked Madhura, Amla, and Lavana Rasayukta Ahara, which is mentioned in the etiology of Madhumeha (Bharti & Singh, 1995). Affliction to sweets in the form of jaggery products, milk products, and other sugar-enriched food is found. High sugar- or carbohydrate-rich products immediately burden the β-cells and lead to insulin resistance. In patients of DM, Vata Prakriti Lakshana, namely Dhusara/Alpa Pakshmala Akshi and Viyati Gacchati Swapna, was found maximum. It may be because of Parusha and Chala Guna of Vata.
In the present study, majority of the patients were having sitting occupation. Physical inactivity is associated with downregulation of insulin-sensitive kinase and may promote the accumulation of free fatty acid within skeletal muscles. Expansion of urban and industrial lifestyle spread the risk factor very fast. Machines have made us sluggish, and reduced activity levels may become potential risk factor. This may be the reason for the prevalence of DM in sitting occupation persons. A majority of the patients were educated. Ignorance or lack of knowledge about the possible complication of the diabetes may lead to poor glycemic control and can lead to early incidence of multiple complications of DM.
A majority of patients were from middle class. It is consistent with the predictions of WHO that currently more than 70% of people with diabetes live in low- and middle-income countries. These data show that DM is no more a disease of affluent society. In DM patients, Kapha Prakriti Lakshana was observed. This reveals the involvement of Kapha as a main Dosha in the manifestation of Prameha (Acharya, 2004).
In the present study, a majority of DM patients have Tamas Pradhana Prakriti. The characteristics of Tamas Prakriti, i.e., laziness, dullness, lack of interest in physical activity, carelessness toward maintaining physical hygiene, always having desire for heavy fatty sweet food, etc., are strongly associated with the manifestation of DM. It may be the reason for the manifestation of DM in Tamas Pradhana Prakriti persons. In present study, Dhriti (determination), Amitbhashitva (Pleasant speech) and Buddhinirodha (confusion) were found maximum in Sattva Pradhana, Rajas Pradhana and Tamas Pradhana Prakriti. In patients of DM, Kapha Prakriti Lakshana, namely, Snigdha Anga (moist body part), Avadata Varna (clear white color), Sthira Sharira Sandhi (stable body joints), and Mansa, was found in a majority of patients. It is because of Snigdha (moist), Mridu (soft), Accha (clear) (Acharya, 2004), and Guru Guna (heaviness property) of Kapha. In patients of DM, Kapha Prakriti Lakshana, namely, Manda Cheshta (slow activities) and Sara Adhisthita Gati (stable and slow gait), was found in a majority of patients. Manda (sluggish) and Guru Guna of Kapha are responsible for this (Acharya, 2004).
Particularly in Jamnagar region, most of the people do not engage in any work between 1 P.M and 4 P.M. It infers that they prefer to live more relaxed life. Majority of the patients never did any sort of regular exercises. With change in life style, walking habits are changed and supported by automobiles, two wheelers, etc. Physical activities are decreased more because of television and computer. Ayurveda describes sedentary lifestyle as one of the potential causative factors for the aggravation of Kapha, Meda (fat), and Mutra (urine), which, in turn, are responsible for the genesis of Madhumeha. Sedentary lifestyle is said to be a predisposing factor for Madhumeha (Tripathi, 2004). In patients of DM, Kapha Prakriti Lakshana, namely Alpa Aharamatra (less quantity of food), Kshudha (hunger), and Trishna (thirst), was found. This is because of Shita Guna (cold nature) of Kapha.
In DM, Bahu Drava (excessive liquidity), Shleshma Ahara (Kapha dominant diet), and Agni (digestive power) get vitiated and persons do not feel hungry. This may be the reason for the manifestation of DM in these people. People in Jamnagar region prefer to consume over oily, deep fried and sweet predominant food items. In Gujarat, a high dependence of milk products and oily foods coupled with genetic factors is responsible for diabetes (Tanna & Ila, 2011). Cottonseed oil is mostly used in cooking; however, it is reported to have considerably high polyunsaturated fatty acids levels which decrease the favorable high-density lipoprotein-cholesterol levels in the blood and may adversely affect the lipid profile of individual. Consumption of “Nava Anna” (fresh harvested grains) is common among the population which is stated as one of the causative factors for diabetes in Ayurveda (Acharya, 2004).
The people are fond of flour preparations; Farsaan (salty and spicy snacks); fermented food items (Dhokla, Khaman, Idli, Dosa, etc.); Bhajiya-puri (salty-oily feast); sweetened drinks; and refrigerated, preserved, and reheated food items. Due to increasing restaurant culture, people take their meals outside frequently. Dependency on packaged food such as chips has increased manifold owing to the busy schedules of the society today, wherein they hardly have time to eat at home. Grabbing a Mc-Donald's burger seems much easier than spending an hour cooking every morning. Fewer intakes of dietary fibers and high intake of starchy foods such as potatoes were observed in the participants. Consuming foods that are low in fiber and high in glycemic loads is associated with an increased risk of diabetes. In patients of DM, Kapha Prakriti Lakshana, namely, Alpa Bala, was found in a majority of patients.
Type 2 diabetics are usually obese (80%), but elderly individuals may be lean. Insulinemia and insulin resistant factor are insidious features of obesity, having direct correlation with BMI (Angela & Elizabeth, 1997). Similarly, in Ayurveda, Madhumeha is included under Medodhatu Dushti Vikara (channels related to fat are vitiated), which is justified by obtained data. The present study also supports the fact that around 90% of people with type 2 diabetes are overweight or obese. Central obesity is a strong risk factor for insulin resistance (Steppan, Bailey, & Bhat, 2001) which is found in 66% of the registered patients as Medo Vriddhi Lakshana – Udara Parshva Vriddhi. A pathway through which obesity causes insulin resistance has recently been discovered in mice, in the form of an adipose tissue-derived hormone named resistin – an important link between the adipocyte and diabetes (Shuldiner, Yang, & Gong, 2001).
Although basal metabolic index and physical activity are independent predictors of incident diabetes and mortality, the magnitude of the association with BMI is much greater than with physical activity (Hu & Willett, 2004). In a recent study, being overweight increased the risk of developing type 2 diabetes within 7 years by 3 times, being obese by 12 times. However, being obese but active still increased the risk by 11.5 times. In other words, fitness alone is not sufficient to prevent diabetes.
Adhika Nidra was found to be the maximum may be because of Guru Guna of Kapha. Swapnasukha is the main causative factor for the manifestation of disease Prameha. Irregular timings of meals and sleep are common habits in the community which signify their disturbed biological clock. It is often the result of daily life-related stress, and often associated with fast eating; both are the major risk factor for type 2 diabetes. A majority of patients had sleeping habit of 8–9 h including day sleep, which highlights the habit of Divasvapna (day sleeping) in Jamnagar region. Divasvapna is one of the causes of Prameha (Acharya, 2004).
Day napping is also proved as a risk factor for DM. Majority of patients were found to be indulged in Ratrijagrana (vigil) and having disturbed sleep. Though much evidences are not available on the role of Ratrijagarana in diabetes development, a study report showed that sleep deprivation severely affects the body's ability to metabolize glucose, which can lead to early stage type 2 DM. It was observed that a greater incidence among both short-term (<6 h) and long term (>8 h) sleepers (Ayas NT, 2003, 380), as well as sleep loss, has been related to glucose tolerance and to increased risk of type 2 diabetes (Sridhar & Madhu, 1994; Scheen, Byrne, Plat, Leproult, & Van Cauter, 1996).
In patients of DM, maximum Pitta Prakriti Lakshana, namely Sukumara Gatra, Shithila Sandhi Bandhana, Prabhuta Sweda, Prabhuta Sharira Gandha, and Ushna Asahishnu, is the result of Ushna, Drava, and Vistra Guna of Pitta (Acharya, 2004). According to Charaka, Pitta-dominant diet and lifestyle are the causative factors for the manifestation of DM (Acharya, 2004). In DM patients, Pitta Prakriti Lakshana, namely, Tamra Drishti-Nakha and Ushna Mukha, was found in a majority of patients. It is because of Ushna Guna of Pitta.
In patients of DM, Pitta Prakriti Lakshana, namely, Tikshna Agni, was found in a majority of patients. This is Agni Prakriti which is responsible for normal state of health in Pitta Prakriti person. In Madhumeha, because of vitiation of Agni, person takes food frequently, which again hamper the Dosha. Most patients have Agnidushti which signifies the imbalanced state of Dosha. The digestion and metabolism depends on Agni. In Madhumeha, due to Dhatvagni Mandhya (poor metabolism), lipid metabolism altered which may create high glycemic level.
In DM patients, Pitta Prakriti Lakshana, namely, Shita Aharaguna, was found in a majority of patients. Most of the patients are reported consuming Shita Guna dominant diet, namely, milk along with Khichadi (a type of food item predominant with rice, Moong daal, flavored with salt and spices); Gaathiya (a type of salty snack) with tea; cold drinks in lunch and dinner, and Shrikhanda (sweetened curd preparation), which are few of the dietary incompatibilities explained in the classics of Ayurveda, which can be understood under the heading of Guna Viruddham (Tripathi, 2004). These dietetic incompatibilities might be responsible for the vitiation of Kapha and Pitta Dosha and Dushti of Mamsa and Meda Dhatu which may in turn cause Madhumeha.
Adhyashana (over eating) is found to be common in participants of the present survey region. Overeating is proved as a risk factor for DM. In addition, a peculiar habit of consuming food in small amounts frequently (Nashta) is also prevalent in the region. Such dietary habits have been emphasized in classics as factors of disease provocation in Ayurveda with special reference to Madhumeha (Acharya, 2004). Hence, diet, both in quantity and quality and pattern of intake will affect the health. All these dietary irregularities further contribute to disturb the carbohydrate and lipid metabolism and consequently result in Madhumeha in susceptible individuals.
| Conclusion|| |
Prakriti plays an important role in predicting the susceptibility of the manifestation of disease, and it is also possible to predict the probable clinical features of each Prakriti type. To sum up, the present study provides an updated quantification of the growing public health burden of diabetes in Jamnagar region. This kind of study would further help in selecting the drugs and treatment modalities and also help in the prevention of progression of the disease. According to Charaka Samhita Prameha Chikitsa, it is said that all Prameha are Kapha and Pitta dominant in the beginning of the disease and after that they gradually become Vata dominant. Here, in this study, Kapha Pradhana and Tamas Pradhana Prakriti were found to be the manifestations of Madhumeha. Therefore, it is concluded that, the dominant Dosha involved in Sharirika and Manasika Prakriti of a person has more possibilities of manifestation of same Dosha-dominant disease.
Financial support and sponsorship
IPGT and RA, Jamnagar.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]