Co esponding au ho : Vi aj. V. Shukla
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
An O e iew o P amehjanya Upad a a wi h special e e ence o Ch onic
complica ions o Diabe es Melli us
Vi aj. V. Shukla 1, *, Sh ikan G. Deshmukh 2 and Sonali V. Shukla 3
1 Depa men o Kayachiki sa, LKR Ayu ed College, Gadhinglaj, Kolhapu , Maha ash a, INDIA.
2 Depa men o Kayachiki sa, CSMSS Ayu ed College, Cha. Sambhaji naga , Maha ash a, INDIA.
3 Depa men o K iya sha ee , LKR Ayu ed College, Gadhinglaj, Kolhapu , Maha ash a, INDIA.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(01), 1320-1327
Publica ion his o y: Recei ed on 07 June 2025; e ised on 13 July 2025; accep ed on 15 July 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.1.2663
Abs ac
Acco ding o Ayu eda in he disease P ameha wo ca dinal ea u es a e desc ibed i.e. ‘P abhu a mu a a’ and ‘A ila
mu a a’ which means excessi e and u bid u ine. The disease P ameha is said o be kapha dominan , idoshaja, and
ch onic in na u e in ol ing mul iple dushyas p edominan ly ‘Meda’. Upad a as o complica ions a e he mo bid e en s
which de elops due o igno ance o inadequa e managemen . De ailed discussion on p obable upad a as is a ailable in
classical ex s. Mode n science has classi ied he disease diabe es melli us as ype 1 and ype 2 on he basis o syn hesis
and ac ion o he ho mone insulin. Va ious acu e and ch onic complica ions leading o mo bidi y and mo ali y caused
by uncon olled hype glycemia a e also men ioned. In his a icle an a emp has been made o o e iew he
complica ions quoa ed in Ayu eda li e a u e and mode n medical ex .
Keywo ds: P ameha; Upad a a; Diabe es Melli us; Ch onic Complica ion o Diabe es Melli us
1. In oduc ion
As quo ed in Cha ak Chiki sa s han Upad a as a e mani es ed only in he la e o e minal s age i.e. wi h he Dush i o
all Dha us. The mild o m o Upad a a can be conside ed as Anu Upad a a and se e e o m o Upad a a can be e med
as S hoola Upad a a.[1]
The o igin o upad a a is ei he due o imp ope managemen o disease o he con inua ion o yadhi nidanas. The
desc ip ion o doshaja Upad a as is no limi ed only o he espec i e P amehas so he Kaphaja, Pi aja and Va aja
Upad a as a e he esul o he disease acco ding o he p edominance o he espec i e Doshas in he se e e o m o
P ameha. Upad a a mani es s upon ano he disease and also due o same ac o s which a e esponsible o he
mani es a ion o he main disease. Hence managemen o upad a a is ha ing a mos impo ance o signi icance in
Ayu eda.Va ious Upad a as quo ed in di e en classical Ayu eda ex s can be enlis ed as ollows [2]
A ipaka, A uchi, Chha di, Nid a, Kasa, Pinasa, P a ishyaya, Sha i Shai hilya Makshika Sa pana, Bas i Toda, Mehana oda,
Mushka ada an, Jwa a, Daha,T ishna Amlika, Mu ccha, Vee bheda, Klama, Pandu, Ud a a, Kampa - H idg aha –
Loulyam, Shula, Anid a, Sosha,Shwasa, Baddhapu ish, Pu imansa, Pidaka, Alaji, Vid adhi Dau balya, S ambha.[3]
•A ipaaka (Indiges ion): Due o inc eased Bahud a a Sleshma in Sha ee a leads o p oduc ion o Ama and
A ipaaka.
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• A ochaka (Ano exia): I is a diso de o as e pe cep ion whe e in spi e o no mal appe i e he pe son is
incapaci a ed o pe cei e as e and dislikes o ea ood. I is mainly due o inc eased Pichhila and Gu u Guna o
Kapha and also due o Pi a Dosha i ia ion.Rasadha u Kshaya also causes A ochaka.
• 3)Cha di (Vomi ing): I is de ined as Bahi gamana (expelling) o Dosha h ough Mukha due o U klesha
(inc ease con en in s omach) in Amashaya [4]. This Upad a a can also be a symp om o Ma ma P apeedana
[5], (i i a ion o i al o gans) which occu s in P ameha.
• Nid a (Sleep): I is caused as a esul o Kapha Dus i and Tamoguna in P ameha.
• Kasa (Cough): This Upad a a is a esul o P ana aha S o odus i by V iddha Kapha and Va a. Kasa esul s as a
consequence o ex ensi e Dha u Kshaya.
• P a ishyaya (Peenasa): This is caused due o Kapha and Va a, Oja Kshaya and P ana aha S o odus i.
• Shai hilya: The Dha u Kshaya leads o Anibida Samyoga a (loss o compac ness) leading o shai hilya.
• Makshikopasa pana: This condi ion is he esul o sha ee Madhu ya a and consequen Madhu a Bha a o
Sweda [6] (Swea ). This a ac s mo e Makshikas ( lies). This condi ion he e should be conside ed as a symp om
indica ing Asadhya A as ha, which is likely o be p eceded o succeeded by Mu chha Adi Upad a as.
• Bas ibheda / Mehana oda (Pain in pubis): This is due o Va a Dus i causing Toda
• Mushka ada ana: (wounds o es icula a ea) This is de ined as Vida ana (b eak/ ea ) o Vishee ana o
V ushana and may be a esul o Kandu o Kus a a ec ing V ushana o due o V anashopha as a esul o Pi a
and Rak a Dus i causing A ada ana o V ushana.
• Jwa a (Fe e ): Jwa a is mainly due o Pi a dominance [7] among T idoshas.In Pi aja P ameha ela i ely he e
is mo e in ol emen o Medas (adipose issue) and Rak a dha u Kshaya which u he leads o Ojonasha. Due
o his he e will be dec eased Vyadhikshama a (immuni y) leading o Jwa a.
• Daha (Bu ning sensa ion): Sa anga Dahanami a is conside ed as Daha and i is a Pi aja Nana maja Vika a [8].
Acco ding o Sush u ha Daha is mani es ed due o Dha ukshaya. In P ameha he e is se e e Dha ukshaya which
is he leading cause o Daha especially in Has a (palm) and Pada (sole) simila o Agnidagdha V ana (bu n
wound).moo ama ga daha is also seen as a esul o a i-p a u i o moo a.
• T ishna (Thi s ): T ishna o pipasa is de ined as Paneeya Se ana Iccha I,e inc eased desi e o d ink wa e
(polydypsia), I is one o he impo an Upad a a o P ameha. This is expe ienced by mos o he pa ien s du ing
he cou se o he illness.Wo d P ameha i sel deno es ha he e is excess S a ana o Moo a (polyu ia). Due o
his Kleda Amsha ( luid) in he Sha ee a ge s deple ed. This dec eased Kledamsha in u n causes inc eased
Rukhas a which leads o Apdha u kshaya which leads o Shoshana (d yness) o Gala, Taalu and Os ha leading
o T ishna. I is also men ioned ha Upasa gaja T ushna is one o he complica ions o P ameha. He e Ushna
Guna o Pi a and Ruksha Guna o Va a play a i al ole o b ing abou T ishna. I has been desc ibed as Asadhya
(incu able) i T ushna de elops as a Upad a a o P ameha and Cha aka says ha i is a Di gha Roga and esul s
in Ma ana (dea h) i neglec ed o i de eloped as Upad a a [9].
• Amlika (Sou belching): Means Amlodga a as a esul o Shuk a paaka o aha due o Agnimandya caused by
Pi a.
• Moo cha (Fain ing): This is de ined as Che anachyu i whe e he e is Kas ha a pa ana [10] o he pa ien and he
is unable o expe ience Sukha and Dukha. This is mainly due o Pi a and Rak a Dus i. This phenomenon is a
e y common Upad a a o P ameha due o Dha ukshaya.
• Vi bheda (cons ipa ion): Va a V uddhi leading o shoshana o d a amsha due o i s uksha guna esul in o
Baddha a o pu isha a o idbheda.
• Pandu oga (Anaemia): This is a Pi ap adhana Vyadhi whe e due o Dha agnimandya leading o asa Rak a
Dha u leading o Pandu oga.
• Uda a a: Baddha Pu eesha and Va a i ia ion causes Uda a a i.e.upwa d mo emen o a a.
• Kampa (T emo ): Kampa is called as A i epanam [11]. Bo h hese lakshanas a e due o a a dosha i ia ion in
di e en o ms o due o a ia ion in gunas
• H idg aha: A condi ion whe e pa ien expe iences as i his hea is being pulled ou . This is a symp om o
H id oga ha is clinically e iden as Upad a a o P ameha. H idg aha is mainly due o Va a Dus i due o Kshaya
o due o Kaphapi a A a ana
• Loulya: A condi ion whe e he e is an abno mal desi e o ha e all Rasas (Tas e) desc ibed as Sa a aseshu
Lolup am due o Va a V iddhi as a esul o Dha u Kshaya[12]
• Shoola (Pain): I is de ined as uja which is peculia ea u e caused by Va a when he disease p oceeds o in ol e
Gambi a Dha us like Majja [13]. Apa om his, Shoola occu s in Kosh a when he e is Baddha Pu eesha a
(ha d s ool) which is also an Upad a a o P ameha.
• Anid a (Dis u bed sleep): Due o Pi a and Va a iddhi.
• Shosha (Deple ion): I is due o he Dha u Kshaya occu ing in p ameha especially a aja leading o shoshana
o sha ee a.
• Shwasa (Dyspnoea): Shwasa due o Doshaja Ma mabhigha a like H idaya, which is P ana ahas o omoola
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• Poo i Mamsa Pidaka Alaji Vid adhi (Ca bunle and simila skin lesions): The i ia ed Pi a a e i ia ing wacha
and Rak a leads o Ragayuk a Shopha and hence called as Pidaka
• Dau balya (Debili y): Sha ee a Balahaani may be due o Alpap ana a due o Manasika Dau balya and
Mamsopachaya [14] (inadequa e nou ishmen o Muscle) as a esul o a i kleda Vahana h ough Moo a
p a u i. These causes in o al lead o Ojonasha causing Dau balya
• Alasya (Laziness): Alasya is cha ac e ized by Ka ma Abha a due o Mandaguna o Kapha and as a esul o
Dou balya. He e he e will be c a e o desi able ouch, displeasu e o discom o and lack o en husiasm o do
wo k [15].
• Kandu (P u i is): Kandu as an Upad a a in P ameha is p ima ily due o Kapha Dosha and also pa ly by Va a
Dosha i ia ion.
The classi ica ion o he a ious complica ions o Diabe es melli us as pe mode n ex s [16]
1.1. Acu e Complica ions
• Diabe ic ke oacidosis
• Hype osmola coma
• Hypoglycemia
1.2. Ch onic complica ions
Mic o ascula
1.2.1. Eye disease
Re inopa hy (p oli e a i e/ nonp oli e a i e)
• Macula oedema
• Ca a ac
• Glaucoma
1.2.2. Neu opa hy
• Senso y and mo o (mono and polyneu opa hy)
• Au onomic
(Gas opa esis, Al e ed bowel habi , Pos u al hypo ension)
1.2.3. Neph opa hy (Renal Failu e)
Foo disease (Ulce a ion, A h opa hy)
1.3. Mac o ascula
• CAD-co ona y a e y disease
• Myoca dial ischaemia/in a c ion
• PVD-Pe iphe al ascula disease
• Claudica ion, Ischemia
• CVD-Ce eb o ascula disease
• T ansien Ischaemic a ack, S oke
1.3.1. O he s
• Gas oin es inal
• Geni ou ina y
• De ma ologic
• Ca diomyopa hy
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2. A mic o ascula diabe ic complica ion
Diabe ic mic o ascula complica ions mainly a ise due o uncon olled, poo ly con olled o long-s anding Diabe es
Melli us. These a e mainly associa ed wi h impai men o ascula pe meabili y ha a ec s di e en issues and o gans
o he body including he kidneys, e ina and ne es [17]. Ch onic, un ea ed and p olonged Hype glycemia can u he
cause inc eased ascula pe meabili y, dis up ion o glycocalyx s uc u e, inc ease in wa e and p o ein e en ion,
esul ing in gene alized edema [18] Vascula endo helial g ow h ac o (VEGF) is an impo an elemen in issue
neogenesis and ascula healing VEGF-inhibi ion can also lead o an inc ease in DM-induced hype ension and
glome ula p o einu ia, wi h diminished ascula wound healing [19 a-b].
2.1. Diabe ic Neph opa hy
Diabe ic neph opa hy is associa ed wi h mo phological impai men o he glome ula endo helial cell ba ie [20]and
he glome ula basemen memb ane. This, in u n, leads o an ele a ion o p o ein il a ion in u ine, e lec ing dis u bed
p o ein deg ada ion in he diabe ic pa ien [21]. Oxida i e s ess p og ession in DM can induce gene exp ession o
angio ensinogen, leading o enal unc ion impai men [22 a-b].
App oxima ely one- hi d o all uncon olled diabe ic pa ien s will su e om diabe ic neph opa hy ending wi h enal
dialysis. This can ei he be due o he p e iously men ioned gene ic suscep ibili y and/o he eac ion o cy okines wi h
eac i e oxygen species o ad anced glyca ion end p oduc s. The ea ly indica o o diabe ic neph opa hy is inc eased
u ina y albumin exc e ion [23].
2.2. Diabe ic Re inopa hy
DM is indi ec ly diagnosed ia an eye es o impai ed ision. The isk o blindness in diabe ic subjec s is associa ed
wi h p olonged incidence o eno ascula changes’ [24]
Hype glycemia induced ac i a ion o PKC can esul in ele a ion o many me abolic pa hways, s imula ion o cell g ow h
and apop osis, and inc ease in cellula pe meabili y. Hype glycemia and s a es o oxida i e s ess associa ed wi h
diabe ic e inopa hy also s imula e ce ain apop o ic g ow h ac o s ha may con ibu e o diabe ic ca a ac o ma ion
[25]. Fu he mo e, he ele a ed glucose le el in e inal cells o diabe ic indi iduals may lead o inc eased isk o
e inopa hy and accompanying blindness [26].
2.3. Diabe ic Neu opa hy
Ch onic Hype glycemia may lead o ei he senso y o mo o neu opa hic p oblems o au onomic ne ous sys em
dys unc ion, including a hy hmias, gas opa esis, incon inence and sexual dys unc ion [27]. pa ien s wi h long- e m
diabe es may ha e one o mo e ypes o neu opa hies.
2.3.1. Pe iphe al Neu opa hy
Diabe ic pe iphe al neu opa hy is one o he majo complica ions a ec ing pa ien s wi h DM. This can lead o ei he
senso y o senso imo o neu opa hies ha inc ease he isk o oo ulce a ion and ampu a ion in some cases o
uncon olled diabe ic pa ien s [28]. Ch onically ele a ed blood glucose le els and he esul ing ac i a ed polyol
pa hway, wi h educed blood supply o endoneu ial issues, a e all associa ed wi h educed p o ec i e ni ic oxide
o ma ion and Na+/K+- ATPase dys unc ion [29]. I leads o wo sening o oxida i e s ess and accele a ion o
neu odeg ada ion. Mo eo e , ele a ion o in aneu al so bi ol can induce ne e cell nec osis and subsequen ly, cellula
deg ada ion [30]. Glyca ion o p o eins wi hin ne es in pa ien s wi h DM accele a es ne e degene a ion [31].
2.4. Au onomic neu opa hy
2.4.1. Diabe es and Gas oin es inal Dys unc ion
Au onomic neu opa hy may cause dis unc ion o he diges i e sys em p oducing symp oms such as ea ly sa ie y,
bloa ing, nausea, omi ing, abdominal pain and hea bu n. Slowed s omach emp ying, o gas opa esis, is usually
de ec ed in diabe ic pa ien s wi h p olonged HG. Diabe ic en e opa hy also leads o acid e lux disease, delayed bowel
mo emen , cons ipa ion, dia hoea, and inc eased a e o bac e ial, i al and ungal gas oin es inal ac in ec ions.
Fu he mo e, diabe es-induced HG is associa ed wi h sali a y and exoc ine panc ea ic insu iciencies due o a educ ion
in he syn hesis and sec e ion o amylase, an impo an diges i e enzyme esponsible o he b eakdown o
ca bohyd a es [32].
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2.4.2. Diabe es and E ec ile Dys unc ion
E ec ile dys unc ion is a common complica ion o DM, and is mainly ela ed o dis u bed communica ion be ween
ascula and neu onal sys ems due o ei he weakened blood ci cula ion in penile issue o impai men o neu onal
s imula ion [33]. Impo ence ela ed o DM is much mo e equen in diabe ic han in non-diabe ic men. Inc eased ee
adicals, such as malondialdehyde, a e belie ed o dis up he neu onal and ascula ac i i ies con olling penile
e ec ion. Impai ed ejacula ion and diminished sa is ac ion a e o he symp oms ha diabe ic pa ien s may encoun e
[34].
3. Diabe ic Foo and Wound Healing
Diabe ic oo occu s as an in e play o abno mal s uc u e and unc ion o blood essels and ne es leading o educed
angiogenesis, loss o sensa ion, unhealed seconda y wound in ec ions, ulce a ion and subsequen ly oo ampu a ion.
Diabe ic oo ulce a ion is mainly due o neu opa hy and ischemia occu ing oge he . Diabe ic oo is associa ed wi h
inc eased incidence o oo auma due o dec eased p op iocep ion. The unde lying ischemia esul s in impai ed
wound-healing in he inju ed a ea(s), and supe imposed in ec ions lead o ulce a ion [35].
All s ages o he complex wound-healing cascade a e impai ed in DM and compounded by many ac o s including
in lamma ion, p oli e a ion, angiogenesis, apop osis, educed chemo axis and ma ix o ma ion, diminished bac e ial
esis ance, and de e io a ion o he an ioxidan p o ec i e sys em.
4. Non-classical ch onic complica ions o diabe es melli us
4.1. Pe iodon al Disease
Impai men o he immune sys em in diabe ic pa ien s enhances he de elopmen o pe iodon al disease due o
inc eased bac e ial accumula ion be ween ee h and gingi a, accele a ing gum in ec ion and p omo ing bone
demoli ion. Ch onic pe iodon i is can lead o gum e ac ion, swelling, bleeding, and oo h loss. Diabe ic pa ien s also
expe ience sali a y insu iciency, which is associa ed wi h a educ ion in sali a y amylase and luid sec e ion [36].
4.2. Diabe es and Skin Diso de s
Mani es a ions o diabe es can also in ol e he skin. Ch onic de mal in ec ions a e due o inc eased blood glucose supply
o he skin. The HG in u n inc eases he occu ence o bac e ial and ungal in ec ions, leading o p u i us and
o he symp oms o skin disease. In addi ion o HG, inc eased accumula ion o subcu aneous adipose issue ela ed o
obesi y s imula es coloniza ion and g ow h o Candida albicans. Also, skin dehyd a ion may lead o changes in he
no mal de mal lo a, and gi e way o coloniza ion by pa hogenic bac e ia. Fu he mo e, DM is associa ed wi h delayed
wound-healing [37]
5. O he condi ions ha may be associa ed wi h diabe es melli us
5.1. Hype ension
I is now known ha DM is a majo isk ac o in he de elopmen o hype ension. Mo eo e , diabe es-induced
hype ension is one o he in luencing causes o ca dio ascula disease, including hea ailu e and o he long- e m
complica ions, such as e inopa hy, neph opa hy and ce eb o ascula acciden s [38]. The e is ex ensi e e idence
showing ha con olling hype ension in DM can signi ican ly diminish hese diabe ic complica ions [39]. End-s age
enal disease is mainly associa ed wi h inc eased hype ension in DM, HG and glyca ed haemoglobin, all o which can
lead o mic oalbuminu ia due o educed glome ula il a ion [40].
5.2. Obesi y and dyslipidemias
Obesi y is a leading isk ac o o many ch onic diseases including insulin- esis ance, ype 2 DM, gas oesophageal
e lux, hype ension, dyslipidemia, ca dio ascula diseases and ce ain ypes o cance s [41]. Obesi y can de elop due
o mode n li es yle habi s such as excessi e ood in ake, educed physical ac i i y, en i onmen al ac o s, psychological
e ec s and gene ic suscep ibili y, which all ha e an e ec on gene al heal h and mo ali y [42]. In addi ion o he ha m ul
e ec o HG on he p og ession o ca dio ascula diseases, inc eased le els o choles e ol, LDL, o al choles e ol,
iglyce ides and low le el o HDL choles e ol may con ibu e o he de elopmen o hea disease in diabe ic pa ien s
[43].
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6. Conclusion
In Ayu eda classics he e m p ameha clea ly e e s ypically o ‘P abhu a’ i.e. excessi e and ‘a il’ i.e. u bid u ina ion.
Excessi e u ina ion e en ually leading o a iable deg ee o dehyd a ion and hypo olemia which gi es ise o T ishna
dou balya, Bh ama, aalasya, i bheda, shosha e c.The e m ‘A il’ i.e. inc ease u bidi y e e s o abno mal con en
p esen in he u ine which a e e acua ed
inad e en ly om he body leading o ob ious loss o dhaa uposhakansh like phospha es, p o eins glucose e c. leading
o deple ion o hem and con ibu ing in upad a as like dou abalya, shosha, Balahani, anid a, Pandu and a ious kinds
o pain indica ing dhaa u shai hliya.The upad a as like a ochak, a ipak, chha di, kapha p aseka, p a ishaaya, amlika,
Pandu, jwa a a e due o de angemen s p oduced in kapha a ibu es leading o aamashay dush i and agnimandya. Daha
is pa icula ly obse ed as ka a pada daha o moo ama ga daha and on he con a y some imes sup a a indica es yan
dush i. P ameha nidanas causing asa – ak a dha u dush i leads o wak dush i p oduces symp oms like pu i mamsa,
a ious p ameha pidakas. alaji and id adhi which explain he equen mani es a ion.
Aacha ya cha ak men ioned madhumeha as ojomeha indica ing ojo is amsa i.e. loss o he sup eme dhaa u ‘Oja’ leading
o upd awas like wi h h id-g aha, moo chha, klama. Shosha, pandu dau balya e c. Thus, i can be concluded ha long-
e m complica ions o DM co- ela ed wi h p ameha upad a as may lead o se e e mo bidi y o dea h.
Mode n ad anced in he labo a o y in es iga ions ha e d as ically changed he app oach owa ds he disease now
be o e he complica ions a ises he mani es a ions o he disease can be managed well in ime and mo bidi y and
mo ali y can be p e en ed o delayed.
This o e iew p o ides p ecise in o ma ion abou ch onic complica ions o diabe es melli us and a p obable co ela ion
wi h Ayu ed aspec .
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
The au ho s con i m ha his a icle con en has no con lic o in e es .
Re e ences
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2013, Page no.-509
[2] D . Anan a aam Sha ma, Acha ya P iy a Sha ma, Sush u a Samhi a, Pa -2, Chap e -11, P amehanidana
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[3] Agni esh, D .B ahmanand T ipa hi,Cha ak Samhi a edi ed wi h Cha ak Chand ika Commen a y, Vol-1, Chap e -
4, Shloka 42, Chaukhamba Su bha a i P akashan Va anasi, Edi ion-2012, Page no.-621
[4] Agni esha, Cha aka samhi a, Acha ya Yada ji T ikamji, Choukambha publica ion 2001 Va anasi.Pp.738, Page no-
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