An analysis of Etiological factors of Prameha according to ...

An analysis of Etiological factors of Prameha according to Ayurveda

Priya Gupta*1, A. S. Baghel2, Swati Khandale3 , Kunal Ojha4

1. Ph. D. scholar, Department of Basic Principles, Institute for Post-Graduate Teaching and

Research in Ayurveda, Gujarat Ayurved University, Jamnagar-361008

2. Professor & HOD Department of Basic Principles, Institute for Post-Graduate Teaching

and Research in Ayurveda, Gujarat Ayurved University, Jamnagar-361008

3. Assistant Professor, Department of Kriya Sharir, Institute for Post-Graduate Teaching and


4. Ph. D. scholar, Department of Basic Principles, Institute for Post-Graduate Teaching and


Abstract: Introduction: Cause effect theory have great importance in Ayurveda from first.

Everything happens in entire universe have some definite cause. Hetu are given for both Health

and disease in Ayurveda. Specific Hetu have ability to produce particular diseases according to its

virtues. Identification of causes is the most important part in any disease especially in lifestyle

disorders. Prameha Cause important. Thus to understanding regarding the causes of Prameha is

need of era. Material & Method: Various types of Hetu of Prameha given in various places were

analyzed Discussion: Hetu have specific act and effect on body. Hetu works in three way for body.

Hetu causes Dosha vitiation, Dhatu vitiation & Khavaigunya ultimately causes disease

manifestation. Conclusion: Understanding of Hetu is the most important thing for health and

disease. Application of understanding of Hetu in daily life decrease the chance of occurrence of

lifestyle disorders.

Keywords: Hetu, Prameha, Causes of Prameha, Lifestyle diseases

Introduction: From ancient past Ayurveda serving as the oldest medical science ever since in the

world. The main objective of Ayurveda is restoration, promotion and maintenance of positive

health. The 21st century is the age of science, technology, computer and atomic energy. The

improper unbalanced diet and sedentary lifestyle are showing upward trend in India. This has led

to emergence of several health problems, among those diabetes mellitus is a giant disease

considered as one of the arch enemy of mankind. Diabetes and its complications pose a major

threat to future public health resources throughout the world. In Ayurvedic texts the given

High Technology Letters

Volume 26, Issue 10, 2020

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http://www.gjstx-e.cn/273

characteristic features of Madhumeha shows marked similarity with the syndrome of Type 2

Diabetes. It is Tridoshaja in origin with predominance of Kapha. According to Maharshi Charaka

major causative factor (Nidana) of Madhumeha are Sweet (Madhura), Sour (Amla), Salty

(Lavana) Rasa dominant diet mentioned as ‘Dadhini Gramya Udaka Aanupa Rasa Payansi’1 and

life style such as ‘Aasya Sukham Swapna Sukham’2 are similar to the causes quoted as over eating,

eating of large amount of carbohydrates mainly sugar rich substances, dairy products, practicing

sedentary life style, overweight in modern medical literature. Maharshi Sushruta has mentioned

Sahaja and Apathya-Nimattaja varieties of Madhumeha. All these factors described in different

texts of Ayurveda implies that life style and food habit plays important role in progression of

Madhumeha.

Aim and objectives:

1. To illustrate etiological factor of Prameha according to Ayurveda and its importance.

Materials & Methodology:

Materials: Primary Resources: In order to achieve the aim and objectives of the present review

work, Brihattrayi (Greater trio of Ayurveda classics) viz. Charaka Samhita, Sushruta Samhita and

Ashtanga Hridaya, along with their well-known available Sanskrit commentaries were used as

primary resources.

Secondary resources: Secondary resources were subject related published research papers, PG

and Ph.D. Dissertations and data compiled from web sources.

Methodology:

The above mentioned primary resources were thoroughly screened to collect the various

references of etiological factor of Prameha through a manual search strategy. Also separated the

importance of Nidana (Etiological factors) in prevention of Diseases.

Observation

What is Nidana and its Importance: Every event taking place anywhere in this cosmos

essentially has a cause. The definite existing factor prior to Karya is known as Karana. The cause

is that which invariably pre-cedes its effect or in other words cause is that from which the



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effect is produced3. Similarly, the disease manifestation has a causative factor called Nidana.

Ayurveda has explained the five tools for manifestation of disease known as Nidana Panchaka.

They are Hetu, Purvarupa, Rupa, Upashaya and Samprapti, which are the objective as well as

subjective for understanding of disease4. Nidana is defined as the external cause/causes of the

disease5. Explanation of Nidana (etiological factors) is necessary for the proper exploration about

Dosha, Disease (Roga), Strength of disease (Roga Bala), and prognosis (Sadhyata- Asadhyata) of

disease. Contrary to etiological factors (Hetu Viparita) type of treatment is also described in

classics. Even one can protect his health if he knows about the Etiological factors of various

diseases. According to the principle of Ayurveda, the first line of treatment is Nidana Parivarjana

(to avoid causative factors) of diseases. Manifestation of disease depends upon specific features or

etiological factors viz. Dosha and Dhatu. In these factors Nidana acquires the prime position due

to its significance.

Roga Hetu: Roga Hetu means the factors responsible for producing disease i.e. etiological factors.

Specific factor which has a tendency or capacity to produce disease can be considered as Roga

Hetu or Nidana.

Chakrapani tells that Nidana is the beginning point for any disease. He gives the following

example in substantiation – ‘Beeja (seed) is the Nidana (cause) for Ankura (sprout)’. No disease

occurs without Nidana. According to Acharya Sushruta that which depicts Hetu (causes of disease)

and Lakshana (symptoms of the disease) is called Nidana6.

According to Madhukosha commentary of Madhava Nidana7,8 (a) that which points towards or

helps to know about or diagnose a disease is called Nidana. (b) That which helps in confirmatory

diagnosis of a disease (without any doubt) is called Nidana. (c) That which supports in diagnosing

a disease (tools of diagnosis of a disease) is called Nidana.

In short – The tools of diagnosis of a disease are called Nidana. Nidana is a Vyadhi Janma Hetu

or Vyadhi Utpatti Hetu (cause of manifestation of diseases) – which is responsible for the origin

or manifestation of a disease. A particular factor can be called as Nidana only when it will develop

a complete disease process in the body either immediately or after a certain period.



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Nidana (etiological factors) of Prameha (Type 2 Diabetes) according to Ayurvedic literature:

Acharya Charaka mentioned specific Nidana that are responsible for aggravation of specific

Dosha and thereby specific Doshaj type of Prameha. Both Acharya Charaka and Acharya

Sushruta have described Sahaja and Kulaja origin of disease9,10. Ashtanga Hridaya, Ashtanga

Samgraha and Madhavakara have similar description regarding the etiology of the disease

Prameha.

Twenty types of Prameha have been classified into three groups – Kaphaja, Pittaja and Vataj.

Maharshi Charaka has clearly mentioned that this disease is Tridoshaj in origin. The production

of the disease and its different manifestations depends upon the predominance of Nidana (external

causes), Dosha and Dushya. If the availability of these factors is suitable for the causation of the

disease, the disease may manifest in its full form. On the other hand, suitability of these factors is

less, the manifestation is delayed or mild11.

According to Maharshi Charaka, among all three types of Prameha, Kaphaja type is more

common and easily producible as compared to Pittaja and Vataja types. The etiological factors,

i.e., exogenous causative factors are different for three types. As regards Dosha, their

predominance is also decided accordingly. As regards Dushays, Meda, Mamsa, Kleda, Shukra,

Shonita (Blood), Vasa (fat), Majja (marrow), Lasika (tissue fluid), Rasa (plasma) and ojas

(essence of all tisues)12. All are supposed to be affected in this disease at some stage. Among

these the body fat and fluids are supposed to be of greater importance in its pathogenesis. Thus

the three types of disease are dependent on external causative factors. According to Sushruta, in

addition to the predominance of Doshas, the role of Dushyas has been also emphasized in the

genesis of three types of Prameha. According to him, Kaphaja Prameha, develops when Kapha

is predominant among Dosha and is associated with Medadhatu as Dushya. In case of Pittaja

Prameha, Pitta is predominant among Dosha and Rakta is also associated as Dushya along with

Meda Dhatu. In case of Vatika Prameha, Vata is predominant among Doshas and Vasa and Majja

are associated with Meda-Dhatu instead of Rakta13. Thus the predominance of Dosha and the

type of Dushya involved both are deciding the type of Prameha.

Maharshi Vagbhatta is of the opinion that ordinarily vitiated Kapha along with respective

Dushyas causes Prameha. In case when Kapha and Kapha like substances are diminished in the

body, Pitta gets the lead in causing the disease, it also involves Rakta. When Pitta get exhausted,



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then Vata gets the lead and in this condition Dhatus of the body start to come in Basti, i.e., these

are passed in urine14.

Thus according to Maharshi Vagbhatta, the predominance of Kapha, Pitta and Vata, in three

types of Prameha is only a relative predominance. The predominance is apparent due to

exhaustion of Kapha and Kapha Pitta, respectively in Paitika and Vatika Prameha. The

subdivision of the three types is only based on the physical and chemical qualities of the urine,

which may develop due to different proportions of Dosha and Dushya in the body15.

Thus same type of Dosha and Dushya may cause different types of Prameha, depending upon the

quantity of morbid factors. In other words, the three types of Prameha possess not only qualitative

difference of morbid factors among themselves but also combination of different Dosha and

Dushyas. On the other hand the sub types of Prameha possess quantitative difference of morbid

factors; qualities or types of Doshas and Dushyas remaining the same.

According to Nidana (etiological factors) Prameha is mainly classified into Kulaja, Sahaja and

Apathyanimittaja.

NIDANA

SAHAJA APATHYANIMITTAJA

(Bijadosha) (Santarpanaja/Apatarpanaja)

Kaphaja Ahara-vihara Pittaja Ahara-vihara Vataja Aharavihara

1. Nidana of Sahaja Prameha:

Acharya Charaka has also written about inheritance nature of the disease According to him, a

person who is born with Prameha or a person who is suffering from Madhmeha is said to be



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incurable because the defect was present in the parents before his birth.16 If the Streebija and

Pumbija (Ovum and sperm) are defective, then the child also will be defective by birth.

Chakrapani opines that it may be from Pubeeja or Stribeeja.i.e. From mother or grandparents. It

means that disease inherited from generation to generation.

Maharshi Charaka mentions that excess intake of Madhura Rasa during pregnancy by mother

may cause Madhumeha and Sthaulya17.

This can be clearly correlated with the modern medical science. The theory of genetic

susceptibility in Type 1 D.M has been given in modern medicine also. Genetic factor is mainly

responsible in the etiology of diabetes as it is inherited disease. No doubt Ayurvedic Acharya of

the ancient India had the knowledge of heredity character of the disease.

2. Nidana of Apathyanimittaja Prameha :

In Sushruta Samhita, Ashtanga Samgraha, Ashtanga Hridaya, Madhava Nidana and Harita

Samhita only Samanya Nidana of Prameha has been enlisted. But Acharya Charaka has

explained general etiological factors in Nidana Sthana and specific etiological factors according

to Dosha in Chikitsa Sthana.

General etiological factors (Samanya Nidana)

In Ayurvedic classics the general causes of Prameha are:

All these Nidana are of Santarpanjanya or Aavaranjanya Prameha, as all of these Nidana are

productive of Kapha mainly and Kapha is the most important Dosha involved in the pathogenesis

of Santarpanjanya or Aavaranajanya Prameha. All these Nidana are divided into Aharaja,

Viharaja and Manasa Nidana as follows18,19,20:

Aharaj Nidana

Nidana Charaka Samhita Sushruta Samhita Ashtanga Hridaya

Guru (heavy food) - - +

Snigdha (unctuous) - + +

Sheeta (cold) - + +

Medya (fatty) + - +

Drava (liquid) - + +

Amla (sour) - - +



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Lavan (saline) - - +

Madhura (sweet) - + +

Navannapana

(new/fresh grains,

cereals and drinks)

+ - +

Dadhini (curd and its

preparations )

+ - +

Payansi (milk and its

preparations )

+ - +

Gudavaikrutam

(preparations of

jaggery )

+ - +

Gramyaudakanuparasa

( meat soup of the

domestic aquatic and

mashy animals)

+ - +

Navamadyapana (

fresh wine)

- - +

Kaphakrut (Anything

which produces

Kapha)

+ - +

Viharaja Nidana

Aasyasukham

(enjoying the

pleasure of

continuous sitting)

+ - +



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Swapnasukham

(enjoying the

pleasure of

excessive sleeping )

+ - +

Avyayam ( lack of

exercise and

physical activity )

- + -

Diwaswap

(sleeping in the

daytime/afternoon)

- + -

Aalasya (lazyness) - + -

Manas Nidana

Tyaktachinta

(abstinence from

mental work/ worry

)

+ - -

Evolution of disease: -

If the combination of Nidana, Dosha and Dushya gets favorable condition, the disease is

produced and when their combination doesn’t get favorable condition the disease can’t occur in

the body. This Siddhanta can be applied to the all diseases which occur in the body21.

Discussion:

Thus understanding of various types of causative factors (Roga Hetu) is having great

importance. If causes (Hetu) are stronger disease severity increase. Even severity of disease

(Vyadhi Bala) is also depends on strength of causative factors (Hetu Bala)22. During the

explanation of Swabhavoparam Vada23, Maharshi Charaka pointing that Dhatu Vaishamya i.e.

disease is nothing but the chain of causative factors (Rogakara Hetu). When one will stop



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Rogakara Hetu Sevana, the chain will be broken and due to Sevana of Arogyakara Hetu, disease

will subside by Swabhava. Thus causes having importance since before the starting of disease to

the end of treatment. Thus to prevent life style disease like Prameha one should understand Hetu

of Prameha with each and every aspect. Hetu of Prameha can be understood by various aspects

follows.

Asatmyeandriyartha Samyoga: Excessive use of Ahara Vihara which vitiates Kapha dominant

Tridosha.

Pragyaparadha: Excess use of Sweet taste based diet without considering that intake of other Rasa

are also important for the maintenance of health. Because balance use of each taste is the best

among all health causing factors.

Parinama: Repeated and Long-term use of Kapha aggravating Ahara and Vihara causes vitiation

of Kapha Dosha in body and ultimately causes Dhatu Shaithilya and create favorable condition

for Prameha.

Viprakrishta Hetu (causes of longer duration): Dosha accumulate in the body over the period of

long time and then produce diseases. Because the Prameha is lifestyle based disease, it is the

reason that continuous attachment with Hetu are Viprakrishta Hetu for disease.

Vyabhichari Hetu (feeble causes): In younger age, attachment of causative factors does not affect

health status of a person due to Sthira Dhatu, Proper Agni, good immunity etc. Later on, as soon

as they get a favorable condition they become the reason for disease manifestation.

Dosha Hetu: Most of the causes given as Prameha causes Kapha aggravation and leads to vitiation

in Kapha related component of body.

Vyadhi Hetu: These are specific causes like Avyayama, Alasya, Atichintana etc. can be consider

as primary factors for lifestyle disorder like Prameha.

Utpadaka Hetu: Causes that are directly responsible for creating diseases.

Vyanaka Hetu: With increasing age, the strength of body is reduced, status of Agni is impaired,

bodily tissue become weak and such factors act as stimulant for the disease condition.

Bahiranga Hetu: These are external causes like Kapha aggravating Ahara Vihara consider as

Bahya Hetu for Prameha.

Antaranga Hetu: Vitiated Kapha dominance three Dosha are responsible for manifestation of

disease can be consider as Antaranga Hetu for Prameha.



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The main causes of type 2 diabetes are sedentary lifestyle, unhealthy eating practices,

stress, substance use, alcohol and cigarette smoking, anxieties and genetics. In the era of

globalization and privatization, wherein there are innumerable number of packaged food varieties,

myriad of restaurants and fast food joints resisting one’s temptations has become a phenomenal

task. The advent of television, computer and other technological sources has turned a once active-

energetic man to a modern day lazy-dependent on machines-man. Sedentary lifestyle featuring

long working hours and lack of physical exercise also takes its toll on the young today24. This

disease, as a matter of fact all lifestyle diseases, are insidious in nature. They take years to progress

however, once they become active enough to cause problems; they become extremely difficult to

cure. Diabetes mellitus or type-2 diabetes, is one of the major non-communicable and fastest

growing public health problems in the world, is a condition difficult to treat and expensive to

manage. Ayurvedic management of Madhumeha (Type 2 Diabetes) aims not only to achieve a

good glycemic control but also to treat the root cause of disease and its prevention.

Conclusion:

Knowledge of Swasthya Hetu and Rog Hetu both are important to remain healthy. Roga Hetu

which is termed as Nidana having great impact on disease manifestation, disease strength and

treatment of disease. Nidana or Hetu can be understood as Nimitta Karana. The different types of

Hetu mentioned in classical text are based on different things like-that capacity to produce the

diseases, that specificity or generality etc. One should have complete knowledge of factors which

causes Prameha. Because causes of Prameha are the part of our daily routine and daily routine

should be changed according to Dosha, drugs, place, time, strength, body, constitutional

dominance of one or the other Dhatu, diet, suitability, psyche, constitution and age. Application

of understanding of Hetu in daily life decrease the chance of occurrence of lifestyle disorders.



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13 Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. Reprint edition , Nidana Sthana 6/9, Varanasi: Chaukhamba

Orientalia, 2008, pg-291


and Ayurveda Rasayana of Hemadri. Nidana sthana, 10/5 Chaukhambha Orientalia, Varanasi, 2014, pg-502


and Ayurveda Rasayana of Hemadri. Nidana sthana, 10/7-8 Chaukhambha Orientalia, Varanasi, 2014, pg-503





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17 Acharya YT, editor. Charakasamhita of Agnivesha Sharir Sthana. Reprint edition. 8/21, Varanasi: Chaukhamba




19 Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. Reprint edition , Nidana Sthana 6/3, Varanasi:

Chaukhamba Orientalia, 2008, pg-289


and Ayurveda Rasayana of Hemadri. Nidana sthana, 10/1,2 Chaukhambha Orientalia, Varanasi, 2014, pg-502



22 Acharya YT, editor. Charakasamhita of Agnivesha Vimana Sthana. Reprint edition. 8/101, Varanasi: Chaukhamba


23 Acharya YT, editor. Charakasamhita of Agnivesha Sutra Sthana. Reprint edition. 16/27, Varanasi: Chaukhamba


24 http://youthonhealth.com/type-2-diabetes-a-lifestyle-disease .



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