Role of jalapan in the samprapti and vidhi vihit jalapan in the management of prameha w.s.r. to type-II diabetes mellitus

Present era of urbanization,industrialization is responsible for the stresssful, sendentary lifestyle that makes a person more susceptible to Diabetes Mellitus.The misconceptions about food consumption,indiscriminate intake of liquids are the causative factors of lifestyle disorders like diabetes.Ayurveda is the science which explains scientific process and general rules for the consumption of food through the aaharvidhivisheshayatana and aaharvidhividhan.It also highlights the effect of proper food consumption and effect of proper water intake on the body. An open labeled add on comparative clinical study was conducted in BSDT’s Ayurved hospital.Thirty diagnosed patients of type II Diabetes mellitus were randomly selected from the OPD of kayachikitsa and enrolled into two groups.Role of jalapan in the samprapti of prameha and vidhi vihit (as per rules described in samhita) jalapan along with the vyadhipratyanik chikitsa were assessed in the management of prameha with special reference to type II diabetes mellitus. Nidanparivarjana is an essential part in the management of disease. It is observed that there is an association between jalapan and prameha and vidhi vihit Jalapan plays an important role in the treatment of prameha.

patients up to 101.2 million till 2030. According to WHO Diabetes is predicted to become 7 th leading cause of death by year 2030. 1 Present era of urbanization, industrialization is responsible for the stressful, sedentary lifestyle. The rapid dietary and habitual changes in lifestyle make a person more susceptible to Diabetes. The ignorance of current generation about healthy food habits and exercise is displayed through the weight gain, hormonal disturbances, hyper activeness, increase medicinal dependency, occurrence of newer diseases etc. The misconceptions about food consumption, the indiscriminate intake of liquids like water, tea, coffee, cold drinks, addiction of junk food, inclination towards the taste of food instead of its usefulness for health are the causative factors of lifestyle disorders like diabetes now a days.
Many people are consuming water due to constipation, acidity, obesity, thyroid problems and diabetes or just as a habit since long term. Overuse of media is responsible for the prevalence of water intake especially in morning hours and also in the whole day. Water intake is blindly followed irrespective of the feeling of thirst, disease, constitution, regular exercise, climatic conditions etc. We conveniently neglect and choose the easiest way of indiscriminate drinking of water as a good, healthy habit for healthy lifestyle. Drinking water in early morning is advocated concurrent to proper and regular exercise on complete digestion of previously taken food, proper bowel and bladder evacuation and with feeling of freshness while awakening.
Ayurveda is the only science which highlights the effect of proper food consumption on the body. The effects of water intake on the body as well as the effects of process and technique of water consumption were also highlighted by Ayurveda. 2 Modern science emphasizes on the nutritional value of the food and energy requirements to the body in terms of deficiencies and calories. But Ayurveda describes on the basis of rasa, virya, vipaka, guna and karma of the dravyas. It also explains scientific process and general rules for the consumption of food through the "Aaharvidhivisheshayatana" and "Aaharvidhividhan" described in rasaviman adhaya of viman sthana of Charak Samhita. 3 Ayurveda has given evidence of the existence of prameha since vedic period. Prameha is basically apathyanimityaj and santarpanothha vyadhi. 4 The vikar vighatkar bhava-abhava are responsible for the prameha. 5 The absence of contrast factors to the causative factors of the disease is also responsible for immediate, delayed or severe manifestation of disease. The lack of regular exercise, absence of timely and restricted diet, atyambupan, and sedentary life style are the influential causative factors. The kaphakar (kapha vitiating) ahara and vihara are the causative factors for prameha. 6 According to Charka, kapha dosha which is vitiated by the drava guna and increased in quantity is the main culprit for the prameha. This vikalpa vishesh of kapha dosha is particularly seen in the samprapti of the prameha. The excess quantity of liquids and the drava, sheeta, guru, snigdha guna of liquid vitiate kapha dosha and further vitiates the meda, mansa, kleda, shrukra, shonita, vasa, majja, lasika, rasa,oja etc the dushyas of prameha. 7 This study is under taken with the perspective to find out the association and the effects of, incorrect techniques and time of water intake (jalapan) and prameha. The evaluation of effect of vyadhipratyanik chikitsa and vidhi vihit jalapan (water intake as per rules described in grantha) in prameha.
AIM AND OBJECTIVES:-Aim:-To study the role of jalapan in the samprapti of prameha and effects of vidhi vihit jalapan in the management of prameha with special reference to type II diabetes mellitus. Objectives:-1) To evaluate the matra and sevan kala of the jala (time of water intake) in diabetic patients.
2) To assess association between the vidhi virahit jalapan (not as per rules from grantha) and effects of vidhi vihit jalapan as chikitsa (Nidanpariwarjan) with vyadhipratyanik chikitsa in prameha with special reference to type II diabetes mellitus.

MATERIALS AND METHOD:-
Thirty diagnosed patients of type II Diabetes mellitus presenting with the classical symptoms of prameha from the OPD of Ayurved hospital were randomly selected and enrolled for the present study. On the basis of inclusion and exclusion criteria the thirty patients were classified into two groups with fifteen patients in each group. Jalapanvidhi (process of water intake) in diabetic patients was assessed by using specially prepared questionnaire with special emphasis on the ushapana, bhojanapashyat jalapan, nishapan, atyambupan (total water intake per day), jalapan was assessed on the basis of kala and matra. The patients from experimental group were subjected to vidhi vihit jalapan and vyadhipratyanik chikitsa (shamana aushadhi) and patients from control group were subjected to only vyadhi pratyanik chikitsa. In both the groups patients were subjected to continue the same antidiabetic allopathic treatment which they were taking as before. Modifications regarding water intake on the basis of vidhi vihit jalapan were explained to each patient in experimental group and were reviewed at every followup. At the end of duration of sixty days both the groups were assessed on the basis of assessment criteria. The follow-ups were conducted after every fifteen days. The symptoms of prameha like prabhutamutrata, avil mutrata, nakta mutrata, pipasadhikya, hastapadataldaha, alasya, sarvanga gaurava, malavibandha were selected for the assessment. 8,9 The biochemical parameters like fasting and postprandial blood sugar levels before and after the treatment of two months were evaluated. In vidhi vihit jalapan patients were advised the following modifications. They were instructed to avoid the water intake especially in the early morning, immediately after the food intake and at the bedtime. Patients were also asked to avoid excess water intake, not to drink water without the feeling of thirst and avoid drinking of liquids frequently. Not to pour water directly into the mouth. Avoid drinking large quantity at a time. Use normal boiled water for drinking. Not to re-boil the water once boiled properly. Drink the water as per requirement to quench the thirst, not to control and reduce the water intake even after the feeling of thirst. At every follow-up the suggested modifications about jalapan were monitored and reviewed. The association between the vidhi virahit jalapan and diabetes was evaluated. The effects of vidhi vihit jalapan and vyadhipratyanik chikitsa in diabetes were assessed on the basis of assessment criteria mentioned below. The Madhusudan vati and Arogyavardhini vati used were procured from Atharva nature health care private limited, Pune. Assessment Criteria: -Symptoms of Prameha, prabhuta mutrata, awil mutrata, nakta mutrata, pipasa, hastapadataladaha, alasya, gurugatra, malavibandha and blood sugar level (F and PP) were assessed before and after two months.The symptoms considered for evaluation were graded as follows.

Symptom
Frequency Grade Prabhutamutrata Less than 6 times per day 0 6-8 times per day 1 8 to 10 times per day 2 More than 10 times per day 3

Awil mutrata
Clear and transparent urine 0 Transparent but with suspended particles 1 Turbid with slight precipitation 2 Homogeneous turbid mixture 3 Naktamutrata Nocturnal urination absent 0 Urination less than 2 times in night 1 Urination 2 to 4 times in night 2 Urination more than 4 times in night 3 Pipasadhikya No urge of thirst 0 Urge of thirst every 3-4 hours The data showed that maximum patients 53.33% were from age group 41 to 50 years, while 13.33% patients from age group 31 to 40 years, 26.66% patients from 51 to 60 years and 6. 66% patients were from 61 to70 years of age. Occupation wise data shows maximum number of patients 46.66 % were belongs to service class (sedentary work) and suffering from mental stress. Housewives were also found 33.33% having sedentary work, day sleep, mental stress and vishamashana. Teachers were 6.66 %, drivers were 10 % and businessmen were 3.33%.In the present study, data related to jalapan shows that ushapan was found 83.33%, bhojanottar jalapan was 75%, nishapan 50% and atyambupan 58.33% was observed. Graph displays percentage of hetu related with jalapana (water intake) -Patient's response to the treatment was evaluated on the basis of improvement in the sign and symptoms of the disease.