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Abstract
Ayurveda, the ancient science of life, is a holistic healing system that originated in India over 5,000 years ago. Rooted
in nature and timeless wisdom, it seeks to balance the body, mind, and spirit through personalized diets, herbal
medicines, and mindful living. Rather than just treating symptoms, Ayurveda aims to eliminate the root cause of
disease, promoting true wellness and harmony. Ayurveda describes four types of disease on the basis of prognosis and
emphasizes the importance of knowledge of prognosis for successful management of diseases. According to Acharya
ch.arak, before initiating any treatment in a patient the assessment of prognosis of disease is very important. There are
various criteria which are explained for of evaluation Sadhyasadhyatva of any disease, one of them
is Doshpaka and Dhatupaka. It is described by Madhavacharya in Madhukosh Tika in Jwara Nidan Adhyaya. The
knowledge of Pakwa Doshas and symptoms of Doshapaka will help the physician to make appropriate choices in
treatment and follow the chronology of treatment. , it is very important for the physician to know about the concept
of Dhatupaka i.e., tissue/cellular destruction and its role in development of diseases. The knowledge of tissue/cellular
destruction and its symptoms would be helpful for physician to plan a proper protocol of treatment and to control
destruction and suppuration of tissues/cells. This critical review insight on how the evaluation of
Dhatupaka Lakshana helps in assessment of Sadhya-asadhyatva of disease like Madhumeha..[1]
In the context of diabetes mellitus, "Dhatupaka" refers to the pathological destruction or damage to bodily tissues
caused by the disease, essentially signifying the complications that arise from uncontrolled high blood sugar levels. In
Ayurveda, where diabetes is called "Madhumeha" and is considered a result of disturbed "Dhatus" (body tissues) due
to imbalanced Doshas; essentially meaning that prolonged diabetes can lead to significant tissue damage throughout
the body.So in this article we aim to study the applied aspect of Dhatupaka in Madhumeha (Diabetes Mellitus)
Keywords: Dhatu,Dhatupaka,Prameha,Madhumeha
P
ISSN No. : 2584-2757
Volume : 02
Issue : 04
DOI
: 10.5281/zenodo.16044338
Reg. No. : MAHA-703/16(NAG)
Year of Establishment – 2016
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH
Corresponding author: Dr.Rita Chute Article Info: Published on : 15/07/2025
Impact Factor : 1.013
Applied Aspects Of Dhatupaka In Madhumeha W.S.R. To Diabetes Mellitus-A
Review
Dr.Rita Chute 1 , Dr.Sapna Upadhyay2 , Dr. Vipul Kanani 3
1Third year P.G. Scholar (Rognidan & V.V. Dept.) RTM Ayurved College , Akola.
2Associate Professor (Rognidan & V.V. Dept.) RTM Ayurved College , Akola.
3Professor & HOD (Rognidan & V.V. Dept.) RTM Ayurved College , Akola.
Cite this article as: - Dr.Rita Chute (2025) ; Applied Aspects Of Dhatupaka In Madhumeha W.S.R. To Diabetes Mellitus-A
Review;Inter.J.Dignostics and Research 2 (4) 128-136 , DOI : 10.5281/zenodo.16044338
G
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R
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Introduction :
Ayurveda is an ancient science of healing which is
accepted worldwide. Ayurveda has its own principals
and unique diagnostic treatise. Nowadays, due to
urbanization and sedentary life style ,there is
increased in development of life style disorder like
Diabetes Mellitus ,obesity ,stroke ,heart disease etc.
People with major non communicable diseases like,
diabetes mellitus, obesity, stroke, heart diseases,
kidney disorders are preferring Ayurvedic
management. After certain time period, all these
diseases are having progressive pathogenesis and may
be incurable.
There are various basic principles for evaluation of
sadhyasadhyatva,one of them is “ Doshapaka and
Dathupaka.”In Doshapaka concept,the knowledge of
pakwa Doshas and symptoms of Doshapaka will
guide the physician in order to plan appropriate
choices in treatment and follow the chronology of
treatment. The Doshapaka is an indicator of reversal
of disease process. Most importantantly, the
physician must know about Dhatupaka i.e. tissue or
cellular destruction and its role in the formation of
diseases. The knowledge of tissue/cellular destruction
and its symptoms would be helpful for physician to
plan a proper protocol of treatment and to control
destruction and suppuration of tissue.
Doshapaka is a Vyadhi Avastha where Doshas attain
pakwata and reverse to their Prakrut Avastha.
Doshapaka is a stage which is favorable for treatment
of diseases. The reason behind reversal is beacause
,Ama is separated from the Doshas. The Doshas get
digested and vitiation of Doshas get settled down, and
tend to become normal. On the flip side, Dhatupaka is
a pathological and unfavorable condition of the body
,in which tissues are severely destructed quickly.
This leads to manifestation of many diseases like
DM,TB etc. Knowledge of Dhatupaka helps physician
to diagnosed this condition as early as possible, which
support tissue with tissue forming and balancing
intervention and to save life of patient. In
Madhumeha( diabetes mellitus) "Dhatupaka" refers to
the pathological destruction or damage to bodily
tissues caused by the disease, essentially signifying
the complications that arise from uncontrolled high
blood sugar level. According to Ayurveda,
Madhumeha,is developed as a result of disturbed
"Dhatus" , due to imbalanced Doshas; essentially it
meaning that prolonged diabetes can lead to
significant tissue damage throughout the body.So in
this article we try to study the applied aspect of
Dhatupaka in Madhumeha(Diabetes Mellitus)
Aim And Objectives :
To study the applied aspect of Dhatupaka in
Madhumeha w.s.r to Diabetes mellitus
Material And Method :
In this review study, we have collected information
from the available Ayurvedic Samhitas, Modern
medical books, Reliable journals, publication and
citation available on internet have also been
considered for references.
Dhatupaka Avastha
Dhatu=Tissues Paka=Suppuration/Destruction.
Dhatu Paka is a pathological and unfavorable
condition for body. Rapid tissue destruction
,characterizes this condition, resulting in the onset of
numerous diseases and a compromised immune
system and strength. Vitiation of any dosha may cause
either a temporary damage to or permanent
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destruction of dhatus , because they are subjected to a
process of digestion. This is called as Dhatupaka –
avastha. As it is a process of digestion or pachana,
pitta plays a prominent role, whichever be the dosha
taking part in samprapti. Dhatus being the essential
components of the body, the general body-strength is
entirely dependent on them. Hence dhatupataka is
taken as a serious stage in the progress of samprapti.
The only exception to this phenomenon is the case of
raktadhatu. The sitakana or WBC play an important
role in digesting and destroying any foreign matter
(agantu hetu substances). eg. Pathogenic organisms,
foreign proteins and other substances. They also
swallow and digest the dying or decaying tissue
(dhatu)- cells which have also become foreign to the
body. Unless this phenomenon takes place Dhatupaka
of other dhatus will not be controlled. Even though
the digestion of sitakana (WBC) also takes place
which is in fact a Dhatupaka. The process is essential
for controlling the pathology. Secondly, when the
srotas and agni of raktadhatu are functioning very
well, this transient Dhatupaka is corrected quickly by
the formation of new sitakanas and thus swasthya is
maintained. Dhatupaka causes a damage or
destruction of dhatus(body tissue), cells and body
substances. Hence this stage must be controlled as
early as possible. A Physician must always bear in
mind the role of Dhatupaka in formation of disease.
And during treating any disease, he should attempt to
prevent Dhatupaka as much as possible.Dhatupaka is
one among the least explained concepts in Ayurveda.
But this state is closely related to the patho-
physiology of multiple systemic disorders like
Madhumeha.
Symptoms of Dhatupaka [2] :
    
    
(
Bhavprakash
1/536)
Therefore mentioned symptoms of tissue destruction
can serve as indicators of tissue damage, aiding
physicians in recognizing this critical aspect of disease
pathogenesis and promptly preventing tissue
suppuration.
Nidranasha–Loss of sleep
Hrudi stambha–Unusual feeling of pressure
or constriction in region of heart
Vishtambha–Dhatupaka causes damage to
cell and tissues which results in
sluggishness in circulation and slow
elimination due to abnormal metabolism
causes constipation and also obstruction of
different passages of body.
Gourava–The stasis of metabolic waste
produces heaviness in body.
Aruchi–Tastelessness
Arati–Anxiety, dullness
Balahani–As the Dhatus are diseased the
Poshanakarma to the body is absent. Hence
there is Balakshaya (loss of strength and
immunity).
We can correlate the symptoms of Dhatupaka in
Diabetes as follows-[3,4,5,6,7,8]
1. Nidranasha -- Insomnia with Short Sleep
Duration is Associated with Type 2 Diabetes.
Insomnia with short sleep duration is
associated with increased odds of diabetes.
Objective sleep duration may predict cardio
metabolic morbidity of chronic
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insomnia, whose medical impact has been
underestimated.
2. Aruchi --Anorexia nervosa and bulimia is
associated with insulin dependent diabetes
mellitus. These disorders and their partial
syndromes were found in 19.5% of this
population. Anorexia nervosa and Bulimic
symptoms were associated with poor
metabolic control as reflected in blood levels
of glycosylated hemoglobin (HbA1C ). These
findings have important implications both for
the pathogenesis of anorexia nervosa and
bulimia and for the management of some cases
of DM with unstable metabolic control.
3. Arati—Studies have shown that depression
and anxiety in diabetic patients are strongly
co-related with factors like comorbidity,
complications, BMI.
4. Hrudi Stambha- The incidence of Angina in
patients with D.M. is extraordinarily high
5. Vishtambha- In patients of D.M. Gastro-
intestinal symptoms like vomiting,
constipation, diarrhea & faecal incontinence
occur frequently
The advanced devices of modern technology are very
helpful in tracing the symptoms of Dhatupaka when
they are hidden. For example,
The presence of albumin in urine suggests
mamsa Dhatupaka
High level of serum glutamic oxaloacetic
transaminase (S.G.O.T) in blood suggest
Dhatupaka of the muscles of the heart
High level S.G.P.T in blood is suggestive of
Dhatupaka of the liver tissue
Ketone bodies in urine suggests Dhatupaka
of medodhatu.
Under conditions in which the occurrence of
Dhatupaka is not traceable by the above methods of
investigation and there are no specific symptoms of a
particular Dhatupaka, one may rely on the group of
symptoms given in Bhavaprakasha which definitely
suggest, the condition of Dhatupaka occurring in the
body. Very often physicians ignore such symptoms
considering them as minor ones, because of their lack
of knowledge they often miss important symptoms of
Dhatupaka,which leads to development of diabetic
complications leading to a stage which is extremely
difficult to treat
Diabetes Mellitus: [9 ]
Diabetes Mellitus is a chronic metabolic disease of
multifaceted etiology prevalent all over the world.
However, in the recent years the prevalence of
Diabetes is on rise, more upsetting in developed
countries. It is a leading cause of morbidity and
mortality all over the world. The global prevalence of
Diabetes among adults has risen from 4.7% in 1980 to
8.5% in 2014. In India, cases of Diabetes Mellitus
have shown surprisingly higher susceptibility which is
a matter of great concern. The prevalence of total
diabetes is projected to grow 54% from 35,644,000 to
54,913,000 between 2015 to 2030. Diabetes mellitus
is a common group of metabolic disorders that are
characterized by chronic hyperglycaemia resulting
from relative insulin deficiency, insulin resistance or
both. Diabetes is usually primary but may be
secondary to other conditions, which include
pancreatic (eg. total pancreatectomy, chronic
pancreatitis, haemochromatosis) and endocrine
diseases (eg. acromegaly and Cushing’s syndrome). It
may also be drug induced, most commonly by thiazide
diuretics and corticosteroids. Primary diabetes is
divided into type1 and type 2 diabetes. In practice the
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two diseases are a spectrum, distinct at the two ends
but overlapping in the middle. At one end of the
spectrum there is type 1 diabetes comprising of
insulin deficiency with no resistance. Type 1 diabetes
is most prevalent in Northern European countries,
particularly Finland, and the incidence is increasing in
most populations, particularly in young children. Type
2 diabetes is common in all populations enjoying an
affluent lifestyle and is also increasing in frequency,
particularly in adolescents. The beta cells of the islets
of Langerhans in the pancreas gland are responsible
for the production of the hormone insulin. The
hormone insulin is extremely crucial for the proper
utilization of carbohydrates in our body. If insulin is
absent either due to metabolic disorder, or if it is not
carrying out its functions properly, then these
carbohydrates accumulates in the bloodstream in the
form of glucose. The glucose then passes into the
urine, which is one of the primary features of diabetes
mellitus. Hence, this can be supposed to be either a
deficiency in the making of insulin by the pancreas or
a dysfunction of the insulin formed by the pancreas.
Madhumeha :[10,11,12,13,]
Madhumeha known as silent killer needs to be treated
as early as possible to stop onset of
complications. Madhumeha is a Tridosha
dominant Vyadhi but Avrutta Vata and Bahudrava
Shlesma is the main ailments. It is a subtype of Vataja
Prameha According to bruhatrayees and lagutrayees,
prameha is divided into 20 types among them one is
Madhumeha (Diabetes Mellitus). All these pramehas
are diagnosed with the help of Gandha, Varna, Rasa,
Sparsha of mutra. Majority of the ayurvedic
physicians are diagnosing prameha with the help of
poorvarupa lakshanas such as malas accumulated in
the dantha, pani-daha, pada-daha, trishna, excessive
sweda, madhuryamasyata. Madhumeha is one of the
twenty types of Prameha. . If these Prameha are not
cured properly then they might convert into
Madhumeha and become incurable. Ojomeha is a
subtype of vātaja prameha. The depletion of oja
through the urine changes its taste and texture by
vitiated vata consequences in Ojomeha. Alteration in
qualities of Oja is due to 'Vata Prabhava'. At the
gross level, Prameha is viewed as an endocrinal and
metabolic problem. Characterization of Prameha as
Sahaja (innate) and Apathyanimittaja (acquired)
favours the connection of madhumeha as diabetes
mellitus. According to Jalpakalpataru commentary on
charaka samhitha by Gangadhara, in prameha
adhyaya mentioning about changes in Ojas swarupa.
Ojo swarupalakshanas are sarpi varnam, madhu
rasam, laja gandhi. Among these lakshanas madhura
rasa is converted into kashaya rasa as mentioned in
madhumeha by Charaka and Madhavanidana.
Madhumeha comes under the group of vataja
prameha where the involvement of dasha dushyas can
be found in its severe grade. Therefore dushti
lakshanas of dushyas may be mostly found in
Dhatupaka.
Hetu Of Prameha / Madhumeha : [14]
  
   ...6
According to Ayurveda etiological factors like
Aasyasukham( physical inactivity, excessive
sitting),Swapnasukham(excessive sleeping specially
during daytime) Navannapanam (excessive
consumption of newly harvested crops and new
liquor) which increases the Kapha Dosha are
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contributed to develop the risk of Prameha .All those
etiological factors of Prameha mentioned in our
Ayurvedic text are also the contributing factors of
Madhumeha as it is one of the varieties of Prameha.
Lack of exercise and consumption of food that
aggravates Kapha, Meda and Mootra are major
causative factors of the disease.
Samprapti of Madhumeha :
Image 1: Samprapti of Madhumeha .
Fate of Dhatupaka:
Tissue destruction in Dhatupaka is caused due to Pitta
in intial stage and Vata in later stage.The process of
Dhatupaka leads to decrease in quantity of tissue
which in turn leads to Vata vitiation,manifestation of
above mentioned symptoms of tissue damage is due to
vitiation of Vata.Though process of suppuration is
initiated by morbid Pitta,it is carried ahead to
irreversible properties by vitiated Vata, unless
destruction is controlled by suitable
measures.Depletion of Aaharrasa and lymph(Rasa
Dhatu) also hastens tissue destruction in Dhatupaka.
Moreover ,vitiatin of Vata is also responsible for
destruction of Aahar rasa and lymph.Aahar rasa and
lymph is mainly used for liberation of energy essential
for body activities. Consequent decrease in quantity of
tissues triggers the symptoms of Dhatupaka.
Eventually each Prameha,whether it is kaphaj,Pittaj
or Vataj ,if not treated appropriately will lead to
Madhumeha and thus Dhatugat Avastha in
Madhumeha can be observed. Complications of
Vataja prameha is mostly similar to the symptoms of
Dhatupaka. So a retrospective study is needed to
access the symptoms of madhumeha in relation to
Dhatupaka, which is not elaborately explained in our
classics. While going through the literature of modern
medicine symptoms like Insomnia, Tightness of chest
(Angina), disorders of gastro intestinal motility,
Anorexia Nervosa, Anxiety, Lassitude, Loss of
Strength is mainly observing in Type2 diabetes
mellitus which are similar to Dhathupaka Lakshanas
told by Bhavaprakasha. Diabetes mellitus may lead to
various longstanding complications like diabetic
Retinopathy, Nephropathy, Neuropathy etc. Hence
prevention of Type -2 diabetes is a crucial issue
nowadays Oja is a essence of all seven Dhatus.Due to
hyperglycemia ,lakshanas of Ojakshaya have also
been found in advance stage of Madhumeha (Diabetes
Mellitus) .Hence Ojakshaya can be correlated with
Dhatupaka,as the depletion of tissues affects the
overall strength and immunity of the body.Conversly ,
a reduced Ojas can also make the body more
vulnerable to tissue damage and disease,further
exacerbating Dhatupaka.
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Discussion:
'Shareera dharanat dhatavaha' as per definition of
word dhatu, these are the elements of body which
form, guard and take care of entire body. General
body strength and immunity of our body is entirely
dependent on healthy condition, qualitative and
quantitative balance of tissues of body. Dhatupaka is a
pathological and unfavorable state characterized by
rapid tissue destruction, resulting in various diseases
and loss of immunity and strength.Destruction of
tissues is considered as an alarming or threatening
condition. It is a serious stage in pathogenesis of
disease like Madhumeha.Type II Diabetes mellitus
patients relating to Dhatupaka lakshanas such as
NidraNasham,Hridistambham,Vishtambham,Gourava
m ,Aruchi,Arathi,Balahani etc.These lakshanas will
be assessed by gradings during the course of study
understand the symptoms of Madhumeha (Diabetes
Mellitus type II) In contrast, Dhatupaka describes a
condition characterized by rapid tissue destruction,
which poses significant risks to health. Symptoms
associated with Dhatupaka serve as vital diagnostic
criteria, enabling physicians to identify and address
tissue damage proactively. Understanding the signs of
Dhatupaka is essential for timely interventions to
prevent rapid deterioration of health and to preserve
the integrity of bodily functions. This concept
underscores the critical nature of tissue health in the
overall prognosis and management of diseases like
Madhumeha (Diabetes Mellitus)
Conclusion:
It is very important for the physician to know about
tissue destruction and its role in formation of diseases
.With knowledge of tissue destruction and its
symptoms it would be easy for physician to plan a
proper protocol of treatment to not only control and
expel morbid Doshas but also to control destruction
and suppuration of tissues. In chronic diseases like
Madhumeha there is continuous destruction of tissues.
If this destruction of tissues is progressive, condition
of patient becomes incurable. But if pathology and
destruction of tissues is checked, condition of dhatu
paka gets restricted. Stoppage of tissue destruction is a
sign of good chances of recovery. Knowledge of
tissue destruction –Dhatupaka would help the
physician to diagnose this condition as early as
possible ,support tissue with tissue formation and also
save the life of patient .So we have to think about the
concept of Dhatupaka beyond Jwara.Tissue
destruction is an emergency condition as integrity of
physical body and its stability is at stake. The life is
also in danger.The exploration of Dhatupaka within
the framework of Sadhyasadhyatva illustrates their
importance in Ayurvedic diagnosis and treatment
planning. Dhatupaka represents a critical threat to
health due to tissue deterioration. By integrating these
concepts into clinical practice, Ayurvedic practitioners
can more effectively assess and communicate
prognosis to patients. Providing accurate prognostic
information not only aligns with ethical medical
practice but also enhances the therapeutic relationship
and patient outcomes in managing chronic
diseases.,like Madhumeha. Thus, the principles of
Dhatupaka remain applicable beyond fever and can
guide the clinical approach to various medical
conditions today.
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