SAHAJA PRAMEHA AND TYPE-1 DIABETES MELLITUS

SAHAJA PRAMEHA AND TYPE-1 DIABETES MELLITUS

SAHAJA PRAMEHA (CONGENITAL DIABETES IN AYURVEDA)

• Sahaja Prameha is one of the types of Prameha mentioned in Ayurvedic texts, manifesting since birth or in early childhood.

• "Sahaja" implies congenital or hereditary origin.

• It is considered Adibala Pravritta Vyadhi – a disorder transmitted through Shukra (sperm) and Shonita (ovum).

RELEVANT SHLOKAS

शुक्रशोणितदोषाच्च गर्भ दोषान् सृजत्यपि।
तान् चावस्थामुपाश्रित्य वायुस्तान् जनयेद्गदाः॥
(Ashtanga Hridaya, Uttarasthana 1/38)

Explanation: Due to defects in Shukra and Shonita, the fetus develops disorders, manifested at birth or later under the influence of Vata.

गर्भस्थस्य हि बालस्य यद्विकारं प्रचक्षते।
तदादिबलसमुत्थं स्यात्संश्रित्यात्मशरीरजम्॥
(Ashtanga Hridaya, Uttarasthana 1/36)

• Sahaja Prameha is characterized by excessive urination, sweetness in urine, and weakness in children.

• It is often compared with Type-1 Diabetes Mellitus in modern medicine.

ETIO-PATHOGENESIS OF TYPE-1 DIABETES MELLITUS (T1DM)

• It is an autoimmune disorder in which T-cells destroy pancreatic beta cells, leading to absolute insulin deficiency.

• Can occur at any age but more common in childhood and adolescence.

• Triggers may include genetic predisposition (HLA-DR3, DR4), viral infections (e.g., Coxsackie B), and environmental factors.

PATHOGENESIS (MODERN VIEW)

• Autoimmune attack → Insulitis → Beta-cell destruction

• Insulin deficiency → Hyperglycemia → Glucosuria → Polyuria → Polydipsia → Weight loss

AYURVEDIC PARALLEL

• Vitiation of Kapha and Medo Dhatu, along with Vata in Sahaja cases.

• Considered as a manifestation of Ojakshaya and Dhatu Kshaya in children.

CLINICAL FEATURES OF TYPE-1 DIABETES MELLITUS

• Polyuria (frequent urination)

• Polydipsia (increased thirst)

• Polyphagia (increased hunger)

• Weight loss despite good appetite

• Fatigue and weakness

• Dry mouth and skin

• Blurred vision

• Bed-wetting in a previously dry child

AYURVEDIC SYMPTOMS (LAKSHANA OF PRAMEHA)

• प्रमेहिणं तु यं दृष्ट्वा मद्यपं स्थूलमेव च।
  गन्धं चास्य विजानीयात्सुगन्धिं च विशेषतः॥
  (Ashtanga Hridaya, Nidanasthana 10/12)

• Frequent and turbid urination with a sweet odour

• Weakness and lethargy (similar to Ojakshaya)

DIAGNOSIS OF TYPE-1 DIABETES MELLITUS

MODERN INVESTIGATIONS

• Fasting blood glucose ≥ 126 mg/dL

• Random blood glucose ≥ 200 mg/dL with symptoms

• HbA1c ≥ 6.5%

• Urine glucose and ketones

• C-peptide levels: low or absent

• Islet cell autoantibodies (GAD, IA2, ZnT8) – positive

AYURVEDIC METHODS

• Observation of Madhuryata (sweetness) in urine

• Ant test: traditionally mentioned (not documented in classical texts but referenced in folk practice)

• Associated signs of Kapha-Meda dushti

COMPLICATIONS OF TYPE-1 DIABETES MELLITUS

ACUTE COMPLICATIONS

• Diabetic ketoacidosis (DKA)

• Hypoglycemia due to insulin therapy

CHRONIC COMPLICATIONS (IF UNCONTROLLED)

• Retinopathy

• Nephropathy

• Neuropathy

• Growth retardation

• Puberty delay

AYURVEDIC CONSIDERATION

• Unmanaged Prameha may lead to Pramehapidaka, Dhatukshaya, and Maranashana roga (life-threatening conditions)

MANAGEMENT OF TYPE-1 DIABETES MELLITUS

MODERN MANAGEMENT

• Insulin therapy (lifelong)

  • Basal-bolus regimen preferred in children

• Blood glucose monitoring

• Dietary management

  • Complex carbs, low sugar, adequate protein

• Exercise under guidance

• Management of DKA and infections

AYURVEDIC MANAGEMENT

• Focus on Dhatuposhana, Oja vriddhi, and Vata-Kapha-Meda balancing

OUSHADHA YOGA (as supportive care)

• Gudmaradi churna

• Chandraprabha vati

• Nishamalaki churna

• Shilajatu + Guggulu in purified form

• Yava (barley), Takra (buttermilk) in Ahara

SHLOKA ON MANAGEMENT

सर्वेषां प्रमेहाणां निदानं चोपशान्तये।
यवानां सर्वथा योगो बल्यः स्यान्न तु मेहिनाम्॥
(Charaka Samhita, Chikitsa Sthana 6/36)

REFERRAL CRITERIA

• Diabetic ketoacidosis at presentation

• Persistent hyperglycemia despite insulin

• Hypoglycemia episodes

• Failure to thrive or delayed puberty

• Associated autoimmune diseases (thyroiditis, celiac disease)

• Psychosocial concerns (depression, school issues)

ANALYSIS: PRAMEHA AND TYPE-1 DIABETES

• Sahaja Prameha shares features with Type-1 DM due to congenital onset, autoimmune pathogenesis, and childhood presentation.

• Prameha includes 20 types, but Sahaja is specifically congenital and occurs due to Adibala.

• Prameha = a spectrum of metabolic disorders, Type-1 DM is its juvenile form.

COMPARATIVE VIEW