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Introduction

Prameha is disease well known since Vedic period. Prameha is included among Asthomahagada, in Brihattrayee which denotes its importance during those days. It is also described as Anushangi that is Punarbhavi. Prameha compared to Diabetes Mellitus because of having similarities of disease respect to etiopathogenesis& clinical features. Ayurvedic remedies for most deadly disorder Prameha (Diabetes mellitus) are the oldest among all the available therapies, which includes in the Prameha category. Prameha are a list of urinary disorders, especially characterized by profuse urination with several abnormal qualities due to imbalance of doshas. In Madhumeha the urine becomes (sweet and smells) like honey. It is of two distinct types, one due to the aggrevation of vata on account of the dhatukshaya and the other due to kapha-medaavarana (Blockage of channel) along with Vataprakopa. When there is condition of avarana (blockage of the channels / activity) there are the additional symptoms of the vitiation of the particular dosha without any other apparent cause.

Panchabhoutika Chikitsa is the treatment modality pioneered by Bruhatrayiratna Vaidyaraj Atmaram Vaman Datar Shastri. In this concept of using panchamahabhoota as basic principles for diagnosis and treatment of any disease were used in which imbalance of any one mahabhoot can create disease, here Pindi Bramhandi law is applied practically.

“Sarvamidam Panchabhautikamasminjagati.”

 Amla Kshar Siddhant [1]

Aims and objectives-

1. To understand the basic concept of Panchamahabhuta Siddanta to its full perspective.

2. To understand this concept and utilize it thoroughly in the management of Prameha and Madhumeha in clinical practice.

Materials and methods- In this study the review of Ayurveda literatures encompassed from Brihatrayi and Laghutrayi on Prameha and relative sources were compiled and brought less than   one   heading   for   better   assimilation.

Pathogenesis of Prameha – by Brihatrayiratna Vaidyaraj Atmaram Vaman Datar Shastri: Health is nothing but harmony in metabolic activities. Teja mahabhoota is enveloped by properties of Mahabhoota in 2 groups Aakash – Vayu and Prithvi – Aap. Every mahabhoota has its own digestive fire – Teja Mahabhoota is third mahabhoota in order of evaluation of mahabhoota. It has hot sharp, luster, upward movement properties which are incorporated in Jatharagni (Chief digestive fire). Jathargni is independently responsible for nourishment and support of other digestive fire of all dhatus and Panchmhabhuta.  Disease is nothing but loss of homoeostasis of properties of Panchmahabhutas. Also, disease process initiates from unnatural reception of from sense organs and increased Raja and Tama properties in th mind.  According to Acharya Charak – Kapha which is abnormally high in quantity has spread in each & every part of body. It has reached in all doshas, dhatus & malas in th body. Our food has majority in prithvi and Aap Mahabhuta dominant. So naturally Aap and Prithvi mahabhuta properties are dominant. In natural digestive process food entered in stomach attains first phase of digestion which is called as Madhuravastha pak. Then it acquires acidic phase. Then food passes through grahani where it is acted upon by Pachak Pitta (non liquid) from Liver. Pachak pitta has alkaline property which neutralises acidic food. Pancreas plays major role is maintaining neutralised stage of food mass. Intake of unwholesome food, improper food habits, excessive use of pungent, sour, salty substances, sleeping late at night, suppression of natural urges theses are major causes which creates disturbances in digestion process. When such food enters in stomach Madhuravastha of food becomes unnatural. Sometimes acidity increases rapidly feeling of burning sensation in stomach. Patients feel heavynes in abdomen Neutralisation by Pachak pitta gets disturbed. Pancreas regulates the acidity or alkalining and convert it to normal status by secreting its juices. Stomach region affected by immature kapha creating obstruction to digestion from Pachak Pitta leads to hyposecreation of Pachak pitta. Accumulation of immature kapha is long standing process and liquid, sticky, cold and voluminous Kapha diminishes power of Pachak Pitta. Water resides inside the earth. Prithvi and Aap mahabhutas are complimentary to each other. Mansa dhatu made up from solid, heavy properties of Aap mahabhutas. Medo dhatu made up from Prithvi and Aap mahabhuta with b ulky demulecent and slow speed properties. Because of immature kapha produced by digestion makes Mansa and medo dhatu lijkemarshy mud in nature. Immature kapha continuosly supplies liquidity tothis Aamvisha. Main region of Aap mahabhuta is from umbilicus to pelvic girdle. Immature liquidity of dhatus flow to urinary system and try to get it out of the body. Also the region of AAp Vayu also affected by immature kapha.So normal functioning of Apan vayu hampered. So drava dhatu of body line Rasa, Rakta, Mansa, Medo dhatu affected by this immature cold kapha.  When stagnant immature liquid cold kapaha stays for long period, decaying process starts in mansa and medo dhatu which results in appearance of boils like Shravika and kacchapika etc. This premhea pidika difficult to treat. Madhumeha is terminal stage of all urinary abnormilities.

Primararily background of causative factor, condition and extend of damage of each and every dosha, dhatu and mala should be understood. Reduce the effect of immature kapha is first step in treating Prameha. Immature Vaat, Pitta and kapha combined with immature cold, liquid meda dhatu and get unified, then flow downwords following urinary conducting channels and get located at neck of bladder. This is complete Prameha.  The digesion of immature kapha and drying of body elements is first step of management. Main goal in treatment of Premeha is digestion of immature kapha and drying up of body elements. Various drugs which are dominant in Teja, Vayu and Aakash Mahabhutas should be used to remove covering effect of Prithvi and Aap mahabhuta on digestive fire. They help in digestion, cleaning of body channels and reinstalling movement of Vaat dosha.[2]

Pathogenesis (Samprapti) - by Brihatrayiratna Vaidyaraj Atmaram Vaman Datar Shastri:

Madhumeha can originate in two ways:

1. Aggravation of vata caused due to Dhatukshaya (stress induced) –Teja, Vayu & Akash. Madhumeha which is caused by Dhatukshaya - Apatarpanottha manifests as thin and asthenic individual due to loss of Oja. All this is Ojakshaya meaning an imbalance in Oja.
2. Obstruction of Vata caused by Doshas (mainly Kapha) covering it, Prithvi & Aap. In Margavaranjanya Madhumeha the vitiated Kapha and Meda obstruct the passage of Vata. The Obstructed Vata is vitiated again and carries Oja to Basti thus manifests Madhumeha. In Madhumeha due to hetu (discussed above) the prithvyadi guna gets vitiated. It causes obstruction to the gati of vayu thus leading to Srotavaroda. Agni gets avarana by Prithvi & Aap Mahabhuta and which unable to digest the ingested food because Agni is in Mandavastha. Apakva Ahara Rasa circulates throughout the body, by natural phenomena of body will avoid it to gather so to throw it out, this Apakva Rasa, malabhag gathers at Mutravahastrotas and excretes out through basti as frequent micturition, Thus, Madhumeha gets manifested. Here parthi and jaliya guna is in vitiated state so it provides kledadhikya in the body leading to Prabhut, avilmutrata. The other type of samprapti is due to excessive stress i.e. Buddheindriyataanjanit. In this Mental Stress causes vitiation of doshas mainly Vata causing Malawshthambha which leads to Malasanchiti hence Kledasanchiti in the body leading to Awarodhajanyavataprakopa increases in return causes Ojovikruti and at last Madhumeha takes place in the body. In Panchabhoutika Chikitsa Yakrit, Pleeha and Mutrapinda, is given much importance because these are Agni Samsthana Pradhana Indriya. After continuation of those aggrevating factors, food does not get digested because of Mandagni, so Karma Abhava is found in these organs thus Madhumeha gets manifested. [3]

Treatment Protocol: Shareera as well as the Loka is made up of the panchamahobhoota. The variation in these mahabhoota will cause the disease. Intake of Prithvipradhana and Jalamahabhoota pradhanadravya will increases the same quality in the shareera. As per the Samanya Vishesha Siddhanta samanya is the main cause for the increase and vishesh is the cause for the decrease.

Santarpanottha madhumeha: Jala and Prithvi mahabhoota gets vitiated so to normalizes the parthivadravyas the teja, vayu and akasha mahabhoota dominated dravyas are used for chikitsa.

Apatarpanottha madhumeha: Tej, Vayu and Aakash Mahabhoota get vitiated so to normalizes tajadi dravyaa the prithavi, aap mahabhuta dominated dravyas are used in chikitsa.

Amla –Kshar balance: In order to facilitate proper function of body the balance of Amla – Kshar components of the body are of cardinal importance. Amlakshar are mixed to point of balance-neutralization, major factor in maintenance of homeostasis affecting respiratory urinary, digestive, nervous, etc. systems of the body. Any disturbance between them leads to disease so while treating any disease we should consider this concept and try to maintain the balance using respective dravyas. e.g. Haridra, Amalaki Amladharmi, Maka, kurdu, Apamarga- Kshardharmi, Raktadoshahar – Sariwa and Manjishtha.

Formulations

Laxminarayan Rasa

VasantaKusumakara Rasa

ChandraprabhaVati

PhalatrikadiKwatha

Arogyavardhini Vati

Single Plants: Can be used as per Rasa, Mahabhuta, Samanya and Vishesh guna of Dravyas

Amalaki (Emblicaofficinalis)

Meshasringi (Gymnemasylvestre)

Karavellaka (Momordica charantia)

Methika (Trigonellafoenum-graecum)

Shilajit (Black bitumen)

Vijaysar (Pterocarpusmarsupium)

Jambu (Syzygiumcumini)

Tejpatta (Cinnamomumtamala)

Tvak (Cinnamomumzeylanicum)

Guduci (Tinosporacordifolia)

Bimbi (Coccinia indica)

Khadirasara (Acacia catechu)

Katphala (Myricaesculenta)

Kakamachi (Solanumnigrum)

Discussion

There is vitiation of Prithvi and Aap mahabhoota in Prameha Vyadhi which increases bahu and drava guna of Kapha. This immature kapha Liquid kapha which is abnormally high in quantity has pervaded in and every part of the body. It has enveloped all the doshas, dushya (10), all malas in the body. Shareera as well as the Loka is made up of the Pancha Mahobhuta. The variation in these Mahabutaha will cause the disease.

Intake of Pritvi Pradhana and Jala Mahabhuta Pradhana Dravya will increase the same quality in the Shareera. As per the Samanya Vishesha Siddantha Samanya is the main cause for the increase and Vishesh is the cause for the decrease. So, in this condition Teja, Vayu and Aakash Mahabhoota pradhana drug should to used. They will help in digestion of immature kapha and drying of body element. Also help in cleaning of body channels and reinstating the momentum of Vata dosha.

Conclusion

The equilibrium of five elements Prithvi, Aap Teja, Vayu, Aakash in the body denotes health while their imbalance or disturbance denotes disease. Panchabhautikchikitsa is a branch of Ayurveda which bases the analysis and treatment based upon this principle. The word Panchabhautik chikitsa encompasses a variety of aspects regarding health, diet, exercise, profession, environment, drugs, and preparation of the medicines, diagnosis and treatment, based on Panchamahabhuta theory.

The core concept involves interpretation of the scientific knowledge and disease management approach on the background of Panchamahabhuta theory. In Prameha Jala and Prithvi mahabhuta gets vitiated so to normalizes the Parthiva Dravyas the Teja, Vayu and Akasha mahabhuta dominated Dravyas are used for Chikitsa.