An analytical review on the concept of Dhatukshaya and Avarana in the pathogenesis of Madhumeha

Abstract

Madhumeha, a subtype of Vataja prameha, is described in Ayurveda as a chronic and progressive metabolic disorder that parallels Type 2 Diabetes Mellitus (T2DM). According to the World Health Organization, over 422 million people globally are affected by T2DM, with nearly one in five adults in Sri Lanka being diabetic or pre-diabetic. Ayurvedic pathogenesis of Madhumeha is primarily attributed to two mechanisms: Dhatukṣaya (depletion of body tissues such as medas-fat, Mamsa-muscle, and Ojas-vital essence) and Avaraṇa (obstruction of srotas—bodily channels-by Kapha, Medas or Mamsa). Classical texts such as the Caraka Samhita, Susruta Samhita, and Ashtanga Hridaya describe these concepts, though their individual and interactive contributions to clinical practice remain underanalyzed. This review examines both Ayurvedic interpretations and biomedical parallels: Avaraṇa is comparable to insulin resistance and lipid-induced metabolic dysfunction, while Dhatukṣaya aligns with cellular degeneration and energy depletion observed in uncontrolled diabetes. The paper also discusses Prameha (a pre-diabetic condition) and its progression to Madhumeha, emphasizing factors such as diminished ojas, disturbed doṣas, and impaired agni (digestive/metabolic fire). The study highlights inconsistencies between classical and modern interpretations to support integrative diagnostics and therapeutic approaches. A model is proposed recognizing Dhatukshaya and Avarana as complementary pathological factors, guiding Ayurvedic treatment methods like Apatarpana (depleting therapies), Brimhana (nourishing therapies), and Shodhana (purificatory procedures). This integrated approach enhances understanding of Madhumeha and supports the development of personalized, collaborative management strategies between Ayurveda and biomedicin