Hyperglycemia – Ayurvedic Analysis, Treatment Strategies

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Hyperglycemia means abnormal rise in blood sugar levels. This is common in diabetes mellitus. Prameha or Madhumeha explained in Ayurveda are the terms often compared with diabetes mellitus. Apart from this, many other conditions explained in Ayurveda have reflection of hyperglycemia and diabetes in them.

Acute hyperglycemia

Dealing with acute / acute over chronic hyperglycemia conditions When there are acute symptoms of hyperglycemia, measures to immediately reduce sugar levels should be done. This is achieved by the administration of Ayurvedic anti-diabetic medicines such as Nisha Katakadi kashayam, Nishamalaki churna, Chandraprabha vati etc.

Fresh cases – In cases where there are symptoms of hyperglycemia and the case is a fresh one, not of prolonged history or not a known case of diabetes mellitus, with or without family history, conventional treatment with medicines which cure prameha / madhumeha as explained in classics will yield good results.
Read related: Prameha: Ayurvedic Approach To Urinary Disorders

After the initial symptoms have been addressed, the patient shall be evaluated later to see if he or she is a potential diabetic or is prone to be one.

Pre-diabetes shall be evaluated. Patient education and proper guidance with respect to dietetic and lifestyle changes will help these cases. Blood tests and biological values, especially HbA1C shall answer few queries so as to in which direction the strategies shall be planned.
Read related: Pre Diabetes: Symptoms, Ayurvedic Treatment, Home Remedies

Many patients might have reported with a coincident hyperglycemia related to stress or change of food habits or after consuming high calorie foods for many days. A word of caution shall be given to them and they should be educated to keep a check on their blood sugar levels by means of healthy food and lifestyle.

Old Cases – Chronic cases, when found out with symptoms of hyperglycemia shall be treated immediately. Thorough history shall be taken and prompt line of treatment is drawn after the initial symptoms of hyperglycemia have settled down. Care should be taken not to stop the modern medications and insulin immediately since the patient is accustomed to these medications.

The consulting modern physician shall also be kept informed about inclusion of Ayurveda medicine.

Chronic hyperglycemia

2. Dealing with chronic hyperglycemia conditions –
In chronic cases of hyperglycemia associated with chronic diabetes mellitus a thorough history of the patient from Ayurvedic perspective is needed.

If the physician can check the further progression of the disease, try to keep the sugar levels at bay, avoid complications and keep the patient healthy and immune he would have done a great job in tackling hyperglycemia.
Read – Charaka Prameha Chikitsa – 6th chapter

General line of hyperglycemia treatment

• Deepana / Pachana chikitsa – medicines and treatments which would increase the digestive fire and enhance the digestion capacity in the stomach and also digest the immature juices of digested food which might accumulate in the body / blood and cause hyperglycemia on long run
• Rasa / Rakta pachana yogas – medicines which exclusively kindle the metabolic functions in plasma and blood tissue and digest the immature tissues therein
  Read – Rasa Dhatu: Definition, Formation, Circulation, Imbalance Diseases, Treatment
• Agnimandhya and Ajirna chikitsa – treatment of sluggish digestion capacity and indigestion
• Arochaka chikitsa – treatment of tastelessness
• Rasa pradosha vikara chikitsa / raktavaha sroto dushti chikitsa – treating the diseases caused due to contamination of lymph tissue and channels related to it, including heart diseases
• Rakta pradoshaja vikara chikitsa / raktavaha sroto dushti chikitsa – treating the diseases caused due to contamination of blood tissue and channels related to it, including the liver and spleen

In post-prandial hyperglycemia –

• Treatment should be given on the lines of treating high kapha and ama conditions, if hyperglycemia is present almost immediately following food. This occurs during the madhura avastha paka i.e. first part of digestion of food wherein the food acquires sweetness; ama and kapha are formed in the stomach. This ama or kapha absorbed into the blood with sweetness obtained in the stomach will cause hyperglycemia. If hyperglycemia is present during the process of digestion or almost around completion of digestion, approximately 1.5-2 hours after food, i.e. in the amla avastha paka wherein pitta is formed, pitta controlling measures shall be taken. In these patients the hyperglycemic episodes may be associated with high pitta symptoms during digestion of food and also flaring up of symptoms of gastritis or GERD.
  Read – GERD, Heartburn: Causes, Symptoms, Ayurvedic Treatment, Tips, Remedies

Hyperglycemia – Ayurveda, Doshas

Understanding and treating hyperglycemia by taking Doshas into consideration –

Pramehas are 20 types. Among them, 10 types i.e. half of manifestations are due to predominant vitiation of kapha. Kapha type of pramehas are 10 in number, those of pitta are 6 and vata type 4 in number. This too reflects the importance of kapha in the causation and manifestation of hyperglycemia.

Treating Prameha with Kapha aggravation

All pramehas are said to be caused by kapha initially. The predominance or association of other doshas can take place in a later stage. Immaterial of the type of prameha, kaphaja, pittaja or vataja, they have the involvement of kapha as it is the causative dosha. Kapha type of pramehas are explained first in Ayurveda treatises. Later pittaja and vataja pramehas are explained. This breaks the conventional rule of explaining the types of a disease in the order of vataja, pittaja and kaphaja as done in the context of other diseases. This explains the importance of kapha in the manifestation of prameha.

Kapha is the main dosha involved in the causation of prameha, if this condition is closely compared to hyperglycemia. If the patient has high kapha symptoms and if hyperglycemia is associated with metabolic disorders like obesity, hypothyroidism etc, it shall be treated on the lines of treating vitiated kapha.
Read: Activities And Diet For Kapha Balance

Therapeutic emesis which would expel morbid kapha, medicines, foods and lifestyle changes and adaptation to kapha aggravating seasons which would bring about kapha balance shall be adopted along with disease specific treatments. In this condition, the disease shall also be addressed on lines of treating kapha type of prameha.

Treatment principles of Kapha associated hyperglycemia –
Udwarthana i.e. massage with herbal powders, lightening therapies and light foods, therapeutic emesis, depleting treatments, good exercises, kapha mitigating foods and lifestyle practices will help.

Other strategies which need to be considered here –

• Treating on the basis of mandagni i.e. hypo-functioning of digestive fire – in hyperglycemic patients with high kapha condition there will inevitably be less digestion capacity and indigestion along with aversion of food.
• Treating ama – Increased ama in the blood will cause high blood sugar levels. Ama is the immature juice of food formed due to improper digestion. Ama when put into circulation depletes the tissues fires and damages them. This leads to accumulation of waste products in the tissues. In hyperglycemia, the ama and the sweetness produced by it are in high proportions in the blood. Treatment strategies are same as that of increased kapha in blood as explained above.
• Treating amajirna – A state of indigestion caused by excessive ama and kapha is called amajirna. This condition should be treated in case if it is associated with hyperglycemia.
• Treating on the lines of santarpanotta vyadhis – Hyperglycemia, is caused due to excessive saturation of the body with high caloric foods and carbs and over-satiety and sedentary habits. Prameha is also caused due to over-satiety and sedentary habits. Hyperglycemia should therefore be treated on the lines of treating disorders caused due to over-saturation.
• Treating on the lines of kaphaja prameha i.e. kapha type of urinary disorders / diabetes

Prameha with Pitta

If hyperglycemia is associated with inflammatory conditions and if the patient is showing high pitta conditions, it is treated on the lines of pitta. Therapeutic purgation would work wonders. The condition shall also be treated on the lines of treating pitta type of prameha.
Read related: How To Balance Pitta Dosha? Line Of Treatment

Treatment principles – Treat for morbid pitta. High pitta conditions in pitta constitution people with symptoms of hyperglycemia shall be treated with pitta alleviating and expelling treatment. Therapeutic emesis and purgation shall work wonders in this case. Medicines in the form of ghee prepared with pitta alleviating herbs, bitter medicines and bitter ghee, enema prepared with bitter herbs and treatments like dhara i.e. stream pouring of medicated liquids will be extremely helpful.

Other strategies which need to be considered here –

• Treating on the basis of tikshnagni i.e. hyper-functioning of digestive fire – in hyperglycemic patients with high pitta condition there will inevitably be severe and quick digestion of foods, in fact burnouts and indigestion along with frequent hunger. This is not a healthy hunger.
• Treating vidagdhajirna – A state of indigestion caused by excessive pitta is called vidagdhajirna.
• Treating on the lines of pittaja prameha i.e. pitta type of urinary disorders / diabetes / hyperglycemia
• Treating on the lines of treating fever

High blood sugar, with Vata

If the hyperglycemia patients present with degeneration symptoms or is associated with musculo-skeletal, neuro-muscular or autoimmune disorders, they should be treated on the lines of vata vitiation.
Read related: How To Balance Vata Dosha? Line Of Treatment And Reasoning

Treating on the basis of vishamagni i.e. perverted-functioning of digestive fire – in hyperglycemic patients with high vata condition there will inevitably be variable and perverted type of metabolism including hunger, digestion and bowel habits. Nothing is consistent. The health of the person too will be variable. This abnormal activity of digestive fire should be controlled and balanced with vata mitigating measures.

Treating vistabdhajirna – A state of indigestion caused by excessive vata is called vistabdhajirna. This condition should be treated in case if symptoms of vata type of indigestion are associated with hyperglycemia.

Treating on the lines of vataja prameha and madhumeha i.e. vata type of urinary disorders / diabetes / hyperglycemia

Treating on the lines of dhatu kshaya i.e. excessive tissue damage and destruction is an important strategy because tissue loss leads to increase in vata. The vice versa is also possible. When hyperglycemia is associated with tissue loss, vata should be treated.
Read – Vata Increase Caused Due to Tissue Depletion: Dhatu kshaya

Treating on the lines of karshya chikitsa i.e. treatment of emaciation

Treating on the lines of apatarpanotta vyadhis – Hyperglycemia, as we know is not only found in obese individuals, but is also found to be caused in thin and emaciated individuals. Ayurveda has also mentioned krisha pramehi i.e. thin patients needing replacement and replenishment of tissues which have been lost. Nutritious and balanced foods which support tissues and medicines which help in building the tissues are helpful in this condition. Hyperglycemia, in these conditions should therefore be treated on the lines of treating disorders caused due to under-nutrition.

Treatment on the lines of Rajayakshma and Kshaya Chikitsa – Rajayakshma is a condition wherein there is severe tissue loss leading to deteriorating immunity and endurance. Kshaya too is a condition wherein there is decrease in body tissues. The treatment of these two conditions shall be adopted in unresolved cases of hyperglycemia

Chronic conditions of hyperglycemia, especially in adult may need –
more of Rasayanas i.e. rejuvenating medicines,
snehana / snehapana i.e. consumption of medicated fats and
sneha vasti fat enemas
brimhana vasti i.e. nutritive and bulk promoting enemas
balya vasti i.e. strengthening enemas which also enhance quality and quantity of tissues
Read – Basti Chikitsa: Benefits, Routes, Types, Indications, Equipment

Type 1 Diabetes Mellitus – Ayurvedic Treatment

This condition is manifested with the presence of severe dehydration caused due to excessive urination, weight loss, ketoacidosis i.e. presence of broken fat cells, excessive sugar and dehydration, excessive thirst and increased hunger, dry mouth, nausea, pain in belly, fatigue, blurred vision, labored breathing and frequent infections. In chronic and progressive conditions, it may lead to damage of eyes, nerves, arteries, heart and kidney. It may be secondary to autoimmune disorders.

From an Ayurvedic perspective hyperglycemia associated with T1DM looks like a vata predominant condition wherein most of the symptoms appear to be due to abnormal increase in vata. This condition shall be treated on the lines of –

• krisha pramehi chikitsa – treating on-obese hyperglycemic subjects
• apatarpanottha vikara chikitsa – treating disorders and symptoms caused by deficit nutrition / starvation
• medo kshaya / karshya chikitsa – treating conditions caused due to destruction of fat and on lines of treating emaciation
• trishna chikitsa – treating excessive thirst
• vishamagni and tikshnagni chikitsa – treating conditions caused by erratic, fluctuant and severe digestion fire
• vishtabdajirna / vidagdhajirna chikitsa – treating indigestion caused by vata and pitta vitiation
  Read – 120 Remedies For Indigestion Caused By Specific Foods

Snehana i.e. oleation therapy, brimhana i.e. bulk promoting and nourishing therapies, rasayana chikitsa i.e. rejuvenating treatment shall be adopted at various stages of treatment of hyperglycemia. Panchakarma treatments based on dosha predominance shall be adopted due to the involvement of auto-immune component in this condition. Since there are high proportions of ketones and there is acidosis in this condition, therapeutic purgation should be handy. The primary diseases causing hyperglycemia shall be treated accordingly.

Hyperglycemia – Dhatus

Understanding hyperglycemia by taking into consideration the tissues –

Ayurveda has stated the involvement of multiple tissues in the causation of prameha. In kapha predominant hyperglycemic subjects there will be accumulation of unwanted tissues, which should be eliminated.
On the contrary there will be burnouts and depletion of tissues in pitta and vata type of pramehas respectively.

Here the lost tissues need to be replenished. Therefore the strategy of treating different cases of hyperglycemia depends on the amount of contaminated tissues and also the involved doshas.

Hyperglycemia – treatment considering excreta

Treating hyperglycemia by taking into consideration the excreta –

When the gut, liver and kidney are cleansed of their wastes and when the tissues are detoxified through various therapies and medicines, the blood sugar and insulin will strike balance. Cleansing the urinary passages which are the chief sites of manifestation of the disease according to Ayurveda principles is a key component of treatment protocol.
Bowel too needs to be cleansed regularly and the constipation should be treated promptly.
Read related: Constipation Causes, Ayurvedic Treatment, Home Remedies

Considering contamination of urine
In hyperosmolar nonketotic syndrome associated with type 2 diabetes mellitus, wherein there is excessive urination at the beginning. Later it comes down. In later conditions one may have dark urine and severe dehydration. Excessive urination and increased thirst (which indicates dehydration) are part the classical diabetic triad of symptoms according to Ayurveda.

Ayurveda too has explained prameha on the basis of varied presentations of urine in terms of quality, quantity, color and consistency. Urine was in fact taken as the diagnostic tool to diagnose and differentiate various forms of prameha, different doshas and tissues involved in the formation of the disease in Ayurveda. Therefore the importance of urine shall not be ignored in the discussion of pathogenesis of hyperglycemia. The patients of hyperglycemia coming with predominant urine disorders and infections shall be treated on the lines of

• treating prameha i.e. urinary disorders & diabetes
• treating mutrakrichra i.e. dysuria and mutraghata i.e. obstruction of urine
• treating mutravaha sroto dushti janya / mutra pradoshaja vikaras i.e. diseases caused due to contamination of urine and the channels of transportation and excretion of urine
  Read – Dysuria: Causes, Remedies, Tips, Diet, Ayurvedic Treatment

Understanding and treating hyperglycemia by taking into consideration the digestive fire –

Kapha predominant hyperglycemic subjects will usually have sluggish digestive fire, pitta subjects would have intense digestive fire and vata subjects have unpredictable and erratic digestive fire. Many times correcting the digestive fire and balancing it will reduce the symptoms of hyperglycemia.

Understanding and treating hyperglycemia by taking into consideration the nutritional status and activity –
Nutritional status, quantity of activity in one’s life and hyperglycemia go hand in hand. The nutrition has a major role to play in the manifestation of hyperglycemia so does deficit exercise. Prameha is supposed to be a disease caused by excessive nutrition and satiety added with sedentary life and less indulgence in physical activities and exercise.

These factors will lower the metabolism, increase sugar level in the blood and insulin resistance in the tissues. Balancing the nutritional status and advocating good physical exercise will help the patient recover from hyperglycemic attacks. The blood sugar levels too will come down. Conscious eating in terms of quality, quantity and time and a good physical exercise are mandatory inclusions in the treatment of hyperglycemia.
Read – Exercise And Diabetes Treatment – Recent Guidelines And Ayurvedic Perspective

Obese and Non-obese Hyperglycemic patients

The obese types are treated on the lines of treating santarpanotta diseases (caused by over nutrition).
Panchakarma – Body purifying treatments and palliative treatments are useful.

Non-obese patients should be treated on the lines of apatarpanottha diseases (caused by under-nutrition). Here nourishing and replenishing treatments are helpful. Morbid vata and pitta are mainly addressed here.

Sthoola Prameha treatment

From an Ayurvedic perspective this type of hyperglycemia is caused due to over satiety i.e. atisantarpana. The elaborate explanation of the premonitory symptoms of prameha in Ayurveda indicates the tools of early diagnosis of this condition and may also explain pre-diabetes. Depending on the predominant symptoms or doshas involved, this condition shall be treated on the lines of –

• treating prameha / kaphaja prameha chikitsa – urinary disorders caused specifically by predominant vitiation of kapha
• treating obesity
• treating medoroga i.e. disorders caused by erroneous fat metabolism
• treating indigestion caused by ama
• treating indigestion  
• treating santarpanottha vikaras i.e. diseases caused by excessive satiety
• sthula pramehi chikitsa i.e. lines of treating obese diabetics
• treating excessive thirst

If the patient’s strength is good the person may be administered with strong cleansing treatments including therapeutic emesis and therapeutic purgation after considering the strength of doshas, digestive capacity and strength of the disease. Rasayanas i.e. immune modulators and tissue rejuvenators shall be considered in the follow up. External treatments like massage with herbal powders and herbal oils, sudation therapies, dhara i.e. stream pouring of herbal liquids over the body of the patient etc will be extremely helpful.
Read – How Turmeric Helps in Diabetes Treatment: 7 Ways

Immediate control of high blood sugar levels
The patient shall be put immediately on the sugar lowering Ayurvedic medications and dietetic protocol. Only after the sugar levels are brought into control, other methods of approaching the disease shall be considered.
The patient shall be instructed not to stop allopathic oral sugar lowering medicines or insulin shots all of a sudden without bringing it to the notice of the physician.

Considering the tissues and channel systems
After having controlled the doshas and bringing them into balance, we try to expel the morbid doshas by purifying measures and later strengthen the tissues so as to enhance immunity and to prevent recurrence of hyperglycemic episodes.

There are lots of tissues involved in the pathogenesis of prameha, if we are comparing hyperglycemia to this condition.
Read – Diseases Due To Pathological Fat Tissue – Meda Pradoshaja Rogas

The elements participating in the causation of prameha excessively –

• loosened fat,
• muscle tissue,
• the fluids of the body,
• semen,
• blood,
• muscle fat,
• bone marrow,
• lymph,
• plasma and
• the essence of all the tissues i.e. ojas

In kapha types of hyperglycemia there will be building up of unnecessary tissues. Here the tissues need to be depleted. In vata and pitta type of hyperglycemia, there is severe tissue loss and the tissues need to be replaced and replenished. Key is bringing balance in the tissues and reinstalling the support system of the body. While addressing the tissues, the respective channels responsible for transportation of these tissues too will be addressed.

a. Hyperglycemia associated with contamination of rasa tissue – shall be treated on the lines of –

• Rasa pradoshaja vikara / rasavaha sroto dushti chikitsa – diseases caused due to contamination of lymph tissue and the channels transporting the same
• Kushta chikitsa – treatment of skin diseases
• Hrud roga chikitsa – treatment of heart diseases

b. Hyperglycemia associated with contamination of blood tissue – shall be treated on the lines of –

• Rakta pradoshaja vikara / Raktavaha sroto dushti chikitsa – diseases caused due to contamination of blood tissue and the channels
• Rakta kshaya & Pandu Chikitsa – loss of blood and anemia, liver disorders
• Kushta chikitsa – skin diseases
• Krimi chikitsa – worm infestation
• Yakrutodara / Plihodara Chikitsa – enlargement of liver / spleen
• Gulma Chikitsa – abdominal tumors

c. Hyperglycemia associated with contamination of muscle tissue – shall be treated on the lines of –

• Mamsa pradoshaja vikara / Mamsavaha sroto dushti chikitsa – diseases caused due to contamination of muscle tissue and the channels

d. Hyperglycemia associated with contamination of fat tissue – shall be treated on the lines of –

• Medo pradoshaja vikara / Medovaha sroto dushti chikitsa – diseases caused due to contamination of fat tissue and the channels
• Medoroga chikitsa – disorders of fat metabolism
• Sthoulya chikitsa – obesity

e. Hyperglycemia associated with contamination of bone marrow tissue -shall be treated on the lines of –

• Majja pradoshaja vikara / Majjavaha sroto dushti chikitsa – diseases caused due to contamination of bone marrow tissue and the channels
• Bhrama / murcha chikitsa – fainting
  Read – Srotas: Body Channels and Duct systems – Easy Explanation

f. Hyperglycemia associated with contamination of semen tissue – shall be treated on the lines of –

• Shukra pradoshaja vikara / Shukravaha sroto dushti chikitsa – diseases caused due to contamination of semen tissue and the channels
• Klaibya / napumsakata chikitsa – impotence
• Rajayakshma / kshaya chikitsa – tuberculosis / tissue destruction

g. Hyperglycemia associated with contamination of ojus – shall be treated on the lines of –

• Rasayana and Vajikarana Chikitsa – rejuvenating and aphrodisiacs
• Balya and Brimhana Chikitsa – strengthening and bulk promoting
• Rajayakshma / kshaya / shosha chikitsa – treatment of phthisis / tuberculosis / tissue depletion
• Correction of imbalances in digestive fire
• Manasika chikitsa – treatment to the mind
• Hridroga chikitsa – heart diseases

h. If there are excessive and unnecessary fluids –they should be treated on the lines of –

• Mutra pradoshaja vikara / Mutravaha sroto dushti chikitsa – diseases caused due to contamination of urine and its transporting channels
• Sweda pradoshaja vikara / Swedavaha sroto dushti chikitsa – diseases caused due to contamination of sweat and its transporting channels
• Udakavaha sroto dushti chikitsa – diseases caused due to contamination of watery ingredients of the body and the channels transporting the same
• Prameha Chikitsa – treatment of urinary diseases and diabetes
• Mutraghata chikitsa – treatment of urinary obstruction
• Shota and udara chikitsa – treatment of swelling / abdominal enlargement
• Jwara chikitsa – treatment of fever
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