madhumeha kc041 gdg

Evaluation of the efficacy of Akulyadi yoga

in Madhumeha (Diabetes Mellitus) By

SHIVALEELA. S. KALYANI

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillment of the degree of

Ayurveda Vachaspati M.D. In

Kayachikitsa Under the Guidance of

Dr. Shiva Rama Prasad Kethamakka M.D. (Ayu) (Osm), C.O.P. (German) M.A., [Ph.D] (Jyotish)

Department of Kayachikitsa Post Graduate Studies & Research Center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG

2005-2008

Ayurmitra

TAyComprehended

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103

This is to certify that the dissertation “Evaluation of the efficacy of Akulyadi yoga

in Madhumeha (Diabetes Mellitus)” is a bonafide research work done by Shivaleela. S.

Kalyani in partial fulfillment of the requirement for the post graduation degree of “Ayurveda

Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health Sciences,

Bangalore, Karnataka.

Guide

Prof. Dr. Shiva Rama Prasad Kethamakka

M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish)

Professor in Kayachikitsa

DGMAMC, PGS&RC, Gadag

Date:

Place:

J.S.V.V. SAMSTHE’S

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103

Endorsement by the H.O.D, principal/ head of the institution

This is to certify that the dissertation entitled “Evaluation of the efficacy of

Akulyadi yoga in Madhumeha (Diabetes Mellitus)” is a bonafide research work done by

Shivaleela. S. Kalyani under the guidance of Prof. Dr. Shiva Rama Prasad

Kethamakka, M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish), Professor in

Kayachikitsa in partial fulfillment of the requirement for the post graduation degree of

“Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health

Sciences, Bangalore, Karnataka.

.

(Dr. G. B. Patil) Principal,

DGM Ayurvedic Medical College, Gadag

Date: Place:

(Dr. V. Varadacharyulu) Professor & HOD

Dept. of Kayachikitsa PGS&RC

Date: Place: Gadag

Declaration by the candidate

I here by declare that this dissertation / thesis entitled “Evaluation of the efficacy of

Akulyadi yoga in Madhumeha (Diabetes Mellitus)” is a bonafide and genuine research

work carried out by me under the guidance of Prof. Dr. Shiva Rama Prasad

Kethamakka, M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)], Professor in Kayachikitsa,

DGMAMC, PGS&RC, Gadag.

Date

Place

Shivaleela. S. Kalyani

Copy right

Declaration by the candidate

I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka

shall have the rights to preserve, use and disseminate this dissertation/ thesis in print or

electronic format for the academic / research purpose.

Date

Place


© Rajiv Gandhi University of Health Sciences, Karnataka

Acknowledgement

First and foremost, I salute almighty God who is omnipresent, omniscient and

omnipotent. He is the possessor of the ocean of knowledge and wisdom-to which I would

like to contribute a drop in the form of my dissertation. As it is said, each and every drop

goes to make an ocean; this is my humble endeavor towards its goal of wisdom. It gives

me in expressible pleasure to offer my sincere thanks to all who have rendered their

wholehearted support, guidance and co-operation in completing the thesis work.

I am extremely happy to express my deepest sense of gratitude to my beloved and

respected guide Prof. Dr. K. Shiva Rama Prasad, M.D., C.O.P. (German), M.A., [Ph.D.]

(Jyotish), Department of Kayachikitsa (PG), for his guidance and timely help.

I express my gratitude to Dr. V.V.Varadacharyulu M.D. (Ayu), Professor and

H.O.D of Kayachikitsa (PG) for his advice and encouragement in every step of this work.

I am sincerely gratefulness to Dr.G.B.Patil, Principal, for his encouragement and

providing all necessary facilities for this research work.

I extend my gratitude to Dr. R.V.Shettar, Dr.Mulki Patil, Dr. Shankaragouda,

Dr.P. Shivaramudu, Dr. G. Purushottamacharyulu, Late Dr. Dhilip, Dr.M.C. Patil, Dr. G.

Danappagoudar, Dr.S.H. Doddamani, Dr.S.N. Belawadi, Dr. Nedugundi, Dr. Samudri,

Dr, Kuber sankh. Dr.Mulgund, Dr.J.Mitti, Dr. Yasmin A.P. and all my U.G. Lecturers for

time-to-time help offered by them.

I express my immense gratitude to my statistician Nandakumar, librarian V.B.

Mundinamani and assistant Sureban for facilitating me in collection and production of

my thesis. I take this opportunity to thank Dr. Shrinivas. Vadeyar M.D (Ayu). Pvaman

Pharmacy, Bijapur, for the preparation of Akulyadi Yoga in the form of tablet.

I would like to thank my family members who have given love and care during

my studies. My deep sense of gratification is due for my Father Sangappa. B. Kalyani and

my mother Kalavati. S. Kalyani who are the architects of my career. The culture,

discipline and perseverance, which I could imbibe, are solely because of their

painstaking, upbringing and strong moral support. I express my deep gratitude to my

Father-in law Prof. Revanneppa. R. Honawad. And mother-in law, Shakuntala. R.

Honawad for their inspiration and valuable suggestions.

I express my heartfelt gratitude to my brother, Mahantesha and my Sisters,

Geetanjali. Savita, Sujata for constant help and encouragement to move ahead. My

deepest gratitude to my husband Dr. Chandrashekhar. R. Honawad for enormous love

and moral support.

I feel proud in expressing my gratitude to my best friends Dr. Seema, Dr. Neeta.

Dr. Radha, Dr. Mahantaleela, Dr. Prasad Shakti, Dr. Shivananda., Who not only helped

me but stood by during hours of stress and dejection.

I take this moment to express my thanks to all my Post gratude colleagues, Dr.

Kalmath, Dr. Ratnakumar, Dr. Venkareddy, Dr.Udaya, Dr. Umesha, Dr. G. G. patil, Dr.

Sarvi, Dr. Shaila, Dr. Sunita, Dr. Veena. Kotrashetter. Dr. Krishna, Dr. Ashoka, Dr.

Kamalaxi, Dr. Sulochana, Dr. prasann. Joshi, Dr. Sanjeeva, Dr.Neeraj, Dr. Veena.

Jigalur, Dr. Vijayalakshmi, Dr. Shivaleela. Kudari, Dr. Shalini. Sharma, Dr. Kataraki, Dr.

Ashwini, Dr. Rudrakshi, Dr. Jayashree, Dr. Kattimani, Dr. Suma Dr. Madhushree, Dr.

Kalmesha, Dr. Muttu, Dr. Seeba, Dr. Prasanna kumar, Dr. Mukta. Hiremath, Dr.

Sarvamangala, Dr. Anupama, Dr. Mukta. Arali Dr. UdayaGanesha, Dr. Adarsha, Dr.

Nataraj, Dr. Shaileja, Dr. Kavita Dr. Kalavati, Dr. Jaya, Dr.Savita, Dr. Shivakumar.

Finally I am thankful to all those who helped directly or in directly for the

completion of this work.

(Shivaleela S. Kalyani)

Abstract of “Evaluation of the efficacy of Akulyadi yoga in

Madhumeha (Diabetes Mellitus)” by Shivaleela. S. Kalyani

Key words:

Madhumeha, Prabhoota, Avila, Akulyadi yoga, Hypoglycemia, Hyperglycemia, DM, FBS, PPBS

The advancement of industrialization and communication is contributing towards

sedentary life styles; in turn causing chronic non-communicable diseases like Madhumeha vis-à-

vis Diabetes Mellitus, etc. in fact Ayurveda is the first life science, which identified, diagnosed

and managed Madhumeha. Madhumeha/DM is the present burning issue alarming the world.

Madhumeha is a disease characterized by Prabhoota, avila mootrata, Tanu and Mootra

madhuryata. Susruta only mentioned that in Madhumeha Sweda becomes Sweet in nature.

Abnormal bi-fold digestion causes aggravation of Vata in turn involves Dushya and metabolic

waste to form Madhumeha. The Madhumeha vis-à-vis diabetes mellitus has many theories of

occurrence, even the recent viral influence studies on diabetes. Madhumeha has Kapha Dosha is

the key factor along with Vata. The present study intended to focus on the disease evaluation i.e.

Madhumeha vis-à-vis. Diabetes Mellitus management with Akulyadi yoga as a Shamana

Chikitsa. Akulyadi yoga ingredients are hypoglycemic agents collected form local area and

prepared under GMP conditions, weighing about 500mg tablet form. Patients of Madhumeha

fulfilling the criteria of diagnosis were selected in the present study. The male female ratio in the

study is approximately 3:2 patients and 75% patients were recorded with sedentary life styles. In

the present study 60% patients had family history and rest of the 40% patients had no family

history of Madhumeha. Apart from the symptoms which show high significance in the study the

key parameters to assess “glycemic” condition of Madhumeha exhibit, FBS with a mean

difference of 48.605mg and PPBS with mean difference of 117.18mg for after to before data.

This is strong evidence to state that the Akulyadi yoga is good hypoglycemic agent combination

of Ayurveda.

- 1 -

Contents of

“Evaluation of the efficacy of Akulyadi yoga in Madhumeha

(Diabetes Mellitus)”

By


CHAPTER CONTENT PAGES

1 Introduction 1 to 5

2 Objectives 6 to 7

3 Review of literature 8 to 66

4 Methods 67 to 75

5 Results 76 to 93

6 Discussion 94 to 104

7 Conclusion 105 to 106

8 Summary 107 to 108

9 Bibliographic References 1 to 6

10 Annex – data of trial 1 to 9

11 Annex – Case sheet 1 to 6

- 2 -

Tables of

“Evaluation of the efficacy of Akulyadi yoga in Madhumeha

(Diabetes Mellitus)”

By


SN Title of Table Page 1 Showing the Vihara Nidana of Madhumeha 16

2 Showing the Ahara Nidana of Madhumeha 17

3 Types of kaphaja Prameha 36

4 Types of pittaja Prameha 36

5 Types of vataja Prameha 36

6 Showing Prognosis of Madhumeha 37

7 Showing the poorva roopa of Madhumeha 42

8 Lakshana of Madhumeha 45

9 Madhumeha upadrava 54

10 Results by Age in Madhumeha with Akulyadi yoga 77

11 Results by Gender in Madhumeha with Akulyadi yoga 78

12 Results by Religion in Madhumeha with Akulyadi yoga 79

13 Results by Occupation in Madhumeha with Akulyadi yoga 80

14 Results by Economic status in Madhumeha with Akulyadi yoga 81

15 Results by Diet in Madhumeha with Akulyadi yoga 82

16 Distribution of patients by presenting complaints 84

17 Distribution of patients by Associated features 85

18 Ahara Nidana observed in the study 86

19 Vihara Nidana observed in the study 86

20 Distribution of patients by Anya Nidana 87

- 3 -

21 Distribution of patients by Poorva roopa lakshana 87

22 Distribution of patients by Sroto dusti lakshana 88

23 Data of Family history in the study 89

24 Assessment of Subjective parameters 89

25 Assessment of Objective parameters 90

26 Result of Akulyadi yoga in Madhumeha 91

27 Statistical analysis of Akulyadi yoga 92

Figures and Photos of

“Evaluation of the efficacy of Akulyadi yoga in Madhumeha (Diabetes Mellitus)”

By Shivaleela. S. Kalyani

SN Title of Figures and photos Page

1 Madhumeha Samprapti 31

2 Composition of Akulyadi Yoga 64

3 Results by Age in Madhumeha with Akulyadi yoga 77

4 Results by Gender in Madhumeha with Akulyadi yoga 78

5 Results by Religion in Madhumeha with Akulyadi yoga 79

6 Results by Occupation in Madhumeha with Akulyadi yoga 80

7 Result Distribution of patients by Economic status 82

8 Results by Diet in Madhumeha with Akulyadi yoga 83

9 Distribution of patients by presenting complaints 84

10 Distribution of patients by Associated features 85

11 Result of Akulyadi yoga in Madhumeha 91

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Introduction 1

Chapter - 1

Introduction Ayurveda the heritage of Indian civilization is not only a medical system but also a

full-fledged science, consisting of all medical and ailed branches essential to lead a healthy

life. Being a science Ayurveda believes in supreme power.

The Ayurveda has attracted the attention of global population specially the developed

countries since ages. The main reason behind this was the holistic approach of Ayurveda,

humanitarian approach, simplicity of the procedures, cure of chronic and incurable disease

safer and non-toxic herbal resources1.

The purpose of Ayurveda is to maintain health and to treat diseases, in order to

achieve the ultimate goal. It is applicable in every fact of human life, with its own unique. A

principle in understanding any disease by either preventive or curative wedge is necessary.

This may be the fact due to which this science is persisting through centuries beginning from

time immemorial2.

Scientific and technological progress has made man highly sensitive and critical;

there by giving rise to different types of health problems. The advancement of

industrialization and communication is contributing towards sedentary life styles; in turn

causing chronic non-communicable diseases like diabetes mellitus, etc. in fact it is the first

life science, which identified diagnosed and managed diabetes. In spite of all sorts of

advancement of science man is not able to stay himself in the boat of happy and healthy life.

So it is disadvantage rather than an asset.

Madhumeha is a disease known to mankind since vedic period and it is mentioned as

one of the 20 obstinate urinary disorders. It is the present burning issue alarming the world.


With synonym of ‘Richman’s disease’, particularly because a person who is able to enjoy the

pleasure of life without any perceptible exercise is usually affected with this disease3.

Madhumeha is a chronic metabolic disorder and the symptom appears in relation with

mootravaha samsthana. Diabetes mellitus is a chronic metabolic endocrinal disorder, which

has similar pathogenesis as the Madhumeha. Thus the comparison between Madhumeha and

DM is justifiable4.

In Ancient treatise we find a vivid description of the disease solely attributed to

metabolic derangement along with genetic predisposition. Madhumeha subtype of Vataja

Prameha due to involvement of vital elements causes alarming health instability with higher

prevalence. Vata is the conductor of healthy life and vitality supporter of all the embodied

beings and sustains long life free of disorders5.

Susruta emphasized that Vyanavata and Apanavata vitiation cause Sukra Dosha and

Prameha. Vyanavata because of its potential to perform the functions related to each and

every body element and Apanavata due to its potential related with excretion. When we

exploit Madhumeha we cannot deny their credibility in the pathogenesis. This superior

consideration of Susruta proved to be essential before profound treatment modality6.

Changing life style, lack of exercise, fast foods, improper unbalanced diet, and

sedentary life are showing upward trend in India. This has lead to the emergence of Diabetes

Mellitus in the region. Iatrogenic or genetic predisposition and degenerative changes proved

fatal in diabetes mellitus7.

Purpose of the study

The prevalence of diabetes is approximately twice in the urban than in rural areas. It

is suggested that the increase in the occurrence of this disease is possibly due to changing life


style. Lack of exercise, fast foods, improper unbalanced diet, and sedentary life are showing

upward trend in India. This has lead to the emergence of diabetes mellitus in the region.

In spite of using oral hypoglycemic agents and insulin modern medicine is least

bother about the sedentary life style and improper diet, so struggling to provide better

management to counteract the complications and to provide better health.

So many research works have been carried out in relation to shamana treatment as

mentioned in classics and their therapeutic effect is proved. Present research work is intended

to evaluate the effect of herbal combinations used as different line of treatments.

Prevalence

Madhumeha has become a global problem in spite of much advancement in modern

medicine8. The World Health Organization stated in 1998 that a 122 % rise in the number of

adults with diabetes is projected by 2005, to reach 300 million adults worldwide. There are

four reasons for this two-fold global increase: Firstly, we are living longer; over-nutrition and

lack of exercise are prevalent; the disease being transmitted in a hereditary fashion; such

transformations have taken place within the Indian population also. In India, it is estimated

that 19 million cases occurred in 1995, rising to a projected 57 million by the year 2025 (1/6th

of the world total). According to recent epidemiological studies there has been a 40%

increase in diabetes prevalence amongst urban during the last five years9. Even the NIDDM a

commonest form of DM is most common accounting for 85-99% of the patient depending on

geography and ethnicity, occurs in adults, more so over 35 years of age10. The prevalence of

NIDDM is on the rise more alarmingly in the developing nations, ranked 7th among leading

cause of death. It has been rated 3rd when all its micro vascular, macro vascular, neuropathic


complications11 are taken into account. The cost of treating diabetes an associated

complication exceeds $ 100 billion per year12.

It has long been recognized that drugs represents only part of the management of

Madhumeha and other intervention such as education, modification of diet and promotion of

physical health play a crucial role. If the dietary control and exercise programmes do not

improve the condition then the medication is added. Many of patients won’t have patience

for long term therapies, complicated therapies like exercise etc13. The OHA viz.

Sulfonylurea, Bigunides have associated with adverse effect like nausea, vomiting, lactic

acidosis, hypersensitivity etc. After long term administration their action declines, up to 50%

patients of NIDDM initially treated with OHA ultimately need insulin. Hence we find no

satisfactory remedies for Madhumeha in contemporary medical science.

Previous research literatures

1. Bramachari M.D and Augusti K.T (1961) hypoglycemic agents from Indian

medicinal plants. Dried seeds of Eugenia jumbalana and dried bark of Ficus

bengalensis j. pharma, pharmacy. 13,181-2.

2. Chandala H.M Tripathi S.M and Udupa K.M (1980); effect of Tamala on plasma

insulin vis-à-vis blood sugar in patients of D.M-JRAS 1,345-357.

3. Gupta S.S and Variyar M.C (1963); effect of Gymnema sylvestre and Pterocurpus

marsapium glucose tolerance in albino-rats Indian J. Med. Sci. 17,501.

4. Lal. B.M and Chaudhary K.D (1968); observation on Mimordica charanita and

Eugenia jambalana as oral anti diabetic remedies. J. Res. Indian. Med. 2 (2), 161-4


About concept

The word Madhumeha in terms of ‘Diabetes Mellitus’ it is the present burning issue

alarming the world. With synonym of Richman’s disease,’ Madhumeha is a chronic

metabolic disorder and the symptom appears in relation with a mootravaha samsthana.

Diabetes mellitus is a chronic metabolic endocrinal disorder, which has similar pathogenesis

as the Madhumeha. Thus the comparison between Madhumeha and DM is justifiable14.

The present study was designed as ‘Evaluation of the efficacy of Akulyadi Yoga’.

Medicinal plants since time immemorial have been used virtually in all cultures as a source

of medicine. Several herbs have been described in Ayurvedic treasure of therapeutics, which

have a beneficial effect in the management of Madhumeha. Akulyadi Yoga is one such a

combination which acts as mootra sangrahaneeya and also reduces the high blood glucose15.

As the Madhumeha is Kapha Vata pradhana Vyadhi Akulyadi yoga seems to be very

effective. It contains Akuli, Amalaki and Haridra. All these drugs are Kapha and Vata

Shamana property with Ushna virya. Thus in the present study an attempt is made to

“Evaluation of the efficacy of Akulyadi Yoga”, with a view to find out a therapeutically

efficacious, safer, cost effective and easily available drugs.

The study description

The study description consists of the headings according to the RGUHS protocol

followed from 2nd chapter.

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Objectives 6

Chapter - 2

Objectives Ayurvedic science, a boon in today’s world, describes Swastha parayanata, which

means maintenance of health in the one hand and treatment of disease on the other. It has

been described in Ayurveda that it is not rational treatment where the medicine modifies one

disease; on the other hand it provokes new complications. So here, we are putting our step

forward to find safe and effective oral hypoglycaemic agent.

Madhumeha is a disease known to the mankind since Vedic period and it is

mentioned as one of the 20 obstinate urinary disorders, where “Prabhoota Mootrata” i.e.

polyuria is as the cardinal symptom16. Madhumeha/DM is the present burning issue alarming

the world. Madhumeha and its management through various methods are possible viz.

shodhana, Lekhana and Apatarpana Chikitsa. Considering the Chikitsa sutra the Akulyadi

yoga as a shamana Chikitsa is under taken for the trial that has almost all of these therapeutic

effects is opted for this study17.

The present study intended to focus on the disease evaluation i.e. Madhumeha vis-à-

vis. Diabetes Mellitus and the management with Akulyadi yoga as a shamana Chikitsa.

Akulyadi yoga ingredients are collected form local and prepared under GMP conditions,

weighing about 500mg tablet form. Hypothetically evaluated therapeutic efficacy on the

Madhumeha vis-à-vis Diabetes Mellitus is tested through the test under the following

objectives. In this regard the objectives proposed in the study are –

Objectives

1) To evaluate the efficacy of Akulyadi Yoga in the management of Madhumeha

2) To evaluate the efficacy of hypoglycaemic activity of Akulyadi Yoga in Madhumeha

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Objectives 7

1) To evaluate the efficacy of Akulyadi Yoga in the management of Madhumeha

The Madhumeha is a disease manifested from Mamsa, Meda and Shareera kleda with

the vitiation of the Kapha and Vata18. The Madhumeha vis-à-vis diabetes mellitus has many

theories of occurrence, recent viral influences studies on diabetes. This viral influence to

cause the DM is a new trend apart from the interventions of the pancreas and the metabolic

disturbences. The ingredients of the Akulyadi yoga are with Kapha Vata Doshahara and are

of Katu, Tikta Rasa predominance to pacify the Dosha. All ingredients of the yoga are of

Ushna veerya and also do the Kapha Vata shamana along with the gunas like Laghu,

Rookasha, Teekshna and Snigdha. Akulyadi yoga basically acts as Agni vardhaka, to

normalize the Agni is the motto of Kayachikitsa and also as it has the Krimihara Dravya and

Rasayana dravya the actions of such are helping the disease regulations. The Krimiharatwa in

terms of antiretroviral action over the causative organisms probably thought by the ancient

researchers thus the “Akulyadi Yoga” with such combination is used at the management of

the Madhumeha19. By observing all these characteristics of drugs Akulyadi yoga seems to be

very much beneficial in the management of Madhumeha which could be clinically observed

to understand such Krimihara and Mehahara actions.

2) To evaluate the efficacy of hypoglycaemic activity of Akulyadi Yoga in Madhumeha

As the Akulyadi yoga is hypothetically capable of inducing the hypoglycemic

activity, is evaluated through Blood Glucose testing. An attempt is made to measure the

Blood sugar, urine sugar at different times of relation to meal. The evidential estimations of

the blood sugars with corresponding urine sugars are recorded before and after the induction

of trial drug to estimate the hypoglycemic action of the test drug.

Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review

8

Chapter - 3

Review of Literature

Madhumeha is the disease of having merely metabolic derangement and genetic

predisposition related with each constituent of the body with systemic consideration though it

is a subtype of vataja Prameha having more prevalence in the society20. Susruta has used the

word Kshaudrameha. ‘Madhu’ and kshaudra are literally synonyms of each other, which

mean honey21. But he placed a different chapter for management of the ‘Madhumeha’ in his

Chikitsa. He has accredited Madhumeha to be a stage of complications of appearing in

Prameha22. When literal meaning of the word ‘Madhumeha’ is compared to the contemporary

Diabetes Mellitus, it exactly fits in the frame work.

General etiology of Prameha coincides with that of Madhumeha of Charaka, with its

aetio-pathogenesis dealt in Susruta and Vagbhata, who are at the common opinion of that all

Prameha left untreated or not properly treated leads to Madhumeha23. Two types of Prameha

namely Sahaja and Apathyanimittaja, can be compared to insulin dependent and non-insulin

dependent diabetes respectively. Whatever be the type of Madhumeha, as it is Madhyama

Rogamarga (Vasti – Marma) associated becomes incurable and needs very long active

management strategy.

To understand the etiology, patho-physiology, complications and management

methods, first it is merely necessary to emphasize the disease Prameha as a whole and

Madhumeha in particular.


9

Etymological Derivations

Nirukti of Prameha

The word ‘Prameha’ consists of two words, i.e. “pra” and “meha”. The word meha is

derived from the root ‘miha sechane by adding ‘Lue’ pratyaya to it ‘mehati sinchati

mutraretansi’ which means to excrete. Rigveda mentioned this word first is mehanadthanam

karanallium. The commentator of Rigveda, Sayana interpreted the word mehana as medhra,

which denotes to shishna (penis). In Sanskrit literature the ‘mih’ is used to denote, to make

water, to wet to emit semen. So this root ‘mih’ is added to prefix ‘pra’ the word becomes

‘Prameha’. In regard to above explanation we can easily understand that the disease Prameha

is resulted because of excessive excretion of urine24.

Nirukti of Madhumeha

Chakrapani opines that both words are used for each other. Madhu means honey or

sweet and Meha is passing urine. The word ‘madhu’ is derived from the root ‘mana’ and the

meaning as “manava bhodane” i.e., which gives the psychic contentment (vachaspathyeem); it

refers to the meaning honey, kshoudra, Madhya, pushpoarasa, jala and madhuranasa. Thus the

Madhumeha is a disease, in which the person passes the urine, which is similar to madhu

(honey), in colour, smell and taste25.

The word Madhumeha consists of two words, “Madhu” and “Meha”. The former is

replica of the honey and the second denotes the “Sechana” i.e. excessive urination. Term

‘meha’ is attributed to ‘Madhu’ is the relativity and as the all Prameha delayed are untreated

becomes “Madhumeha”, the generalization of Madhumeha is applied to all ‘Prameha’.


10

Definition of Madhumeha

So the meha word here mainly related with excessive excretion of urine. So the

definition is a clinical entity in which the patients’ voids the urine having comparison with

madhu i.e. of Kashaya and madhura rasa, ruksha texture and honey like colour, and at this

stage even the body acquires sweetness is called as Madhumeha. From above definitions we

can easily diagnose the disease and understand its progression26.

Susruta narrated the term in place of Madhumeha is kshaudrameha, ksudrameha

nothing but subtype and synonym of madhu (honey). So it is undoubtedly resembles with

Madhumeha. Further he asserted that when all the Prameha illustrated or neglected get

converted in to Madhumeha and especially he emphasized that the disease Prameha along

with pideka should termed as Madhumeha27.

Susruta and Vagbhata opine, if the patients of Prameha are not treated properly, all of

them reach to the stage of ‘Madhumeha’, which is asadhya28. It is natural history of the

disease that, every patient of kaphaja leads to pittaja and then to vataja stage. But Susruta says

that, the progression of the disease is not only time-oriented, it also depends on the

management of the disease. If the patients are properly managed well in time, the progression

of the disease can be slowed down. If not managed properly, of course-it may reach the stage

of Madhumeha quickly and becomes asadhya29.

In initial stage of Prameha, Kapha is in excess quantity but there is Kapha kshaya at

later stage. Similarly, there is excess of Pitta particularly in pittaja prameha, later, which also

leads to Pitta kshaya. So, ultimately there is Vata vriddi in the terminal stage of kaphaja and

pittaja Prameha. Thus all the types of Prameha lead to the stage of Madhumeha, which is

considered as a vataja Prameha.


11

Paryaya of Madhumeha

Kshoudrameha – Susruta used this term instead of Madhumeha30.

Ojomeha – Charaka31 and Vagbhata32 mentioned that, Vata changes the madhura rasa,

snigda guna of oja in to kashaya & ruksha.

Pushpameha – In Anjananidana, the word pushpa has been narrated as synonym for

Madhumeha where the Pushparasa means – madhu33.

All above synonyms postulates unanimously that, the urine concordant with madhu or

sweet taste is Madhumeha.

HISTORICAL REVIEW

Study of sequential evaluation is foremost step in the research field. History study is

important to know about the systematic development and progress of the subject to determine

the future plans for further establishment and research designing history of medicine starts

from the very moment when the human being come into existence that’s why the ancient

treatise are full with description of diseases and their treatment. Here the present review

related to Madhumeha is explained.

Pre-vedic and Vedic Period

The evolution of Madhumeha can be traced from Vedas but in rudimentary form,

when we go through the Atharvaveda there is a reference related to the disease 'Asrava' along

with its management. Sayanacharya opined that Asrava means 'Mutraatisara' the English

translator Whitney (1962) interpreted it as flux and Griffith (1962) as morbid flow, While

Leman has translated the meaning of Asarva as Diabetes Mellitus. Sayanacharya highlighted

the vatic nature of this ailment34.


12

Samhita Period:

(1) Charaka Samhita

In Charaka Samhita, ancient treatise of medical science, Charaka explained the

etiology, pathogenesis, symptomatology, complications and treatment. Even he not only

described Nirupasthambha Madhumeha but also the Avaranjanya Madhumeha which is a

unique contribution of this Samhita35.

(2) Susruta Samhita

Susruta also explained the Madhumeha in elaborative manner with separate chapter on

its management36. He used 'Ksaudrameha' synonym to Madhumeha inNidana6thchapter. He

typically mentioned the decoctions according to each type of Prameha and mentioned the

body constitution and symptoms related to Sahaja and Apathyanimittaja Prameha.

(3) Astanga Hridaya

Vagbhata categorized the Madhumeha as 'Mootra Atipravrttijja' and explained two

types of Madhumeha i.e. Dhatu kshyaja and Avartpathat. He further added Sweda as the

Dushysa37.

(4) Harita Samhita

Harita mentioned Madhumeha as Papajanya and enumerated 13 types of Prameha with

nomenclature different than Brihatrayi treatise viz. Puyameha, Ghrtameha etc38.

(5) Bhela Samhita

Bhela described Prameha is of two types i.e. Swakrita and Parakrita meha39.

(6) Kasyapa Samhita

Kashyapa mentioned the symptoms of Pramehi child in Vedanadhyaya and noted the

disease as Chirakari40.


13

Medieval Period

In this period validations and compilers of the ancient literature are more than the

original contributions. Many commentaries are entertained; out of them contents are mere

collection of thoughts from previous authors added fewer experiences along with.

(1) Madhava Nidana

Madhavakara collectively retold the description of Charaka, Susruta and Vagbhata41.

(2) Sarangadhara Samhita

Sarangadhara enumerated the Prameha bheda as 20 types. He further described the

many medicines at the context of different forms of the medicines conversation42.

(3) Bhavaprakasa

Bhavamishra described Prameha and Madhumeha along with some new herbo-mineral

preparations added to the old treasure43.

(4) Yogaratnakar

Yogaratnakara explained Prameha and Madhumeha along with treatment in general44.

Nidana – Aetiology

Nidana of the Prameha are expressed as general those are common for all kinds of

Prameha. Specific Nidana manifests the particular kind of Prameha such as Madhumeha. In

classics only Charaka has explained the specific Nidana for Madhumeha45.

For all types of Prameha especially Madhumeha, Kapha Dosha is the key factor and it

can be established by Gangadhara’s version. In that he says, Gulma is caused by Vata, Rakta

pitta by Pitta and Madhumeha caused invariably due to the Kapha46. By the above views, all

nidanas of Prameha are considered for Madhumeha. All ancient treatise mentioned the

common etiological factors of Prameha but Charaka mainly narrated the etiological factors


14

according to Dosha he also mentioned the specific etiological factors of Madhumeha. This is

the unique contribution. Thus the causative factors of Madhumeha can be discussed as -

Sahaja (Hereditary) and Apathyaja (Acquired) 47.

1) Sahaja (Hereditary) nidanas:

Charaka48 and Susruta49 have agreed that beejadosha (genetically devoid) is also a

cause for Madhumeha. Acharyas are explained, ‘Kulaja vikaras’, Madhumeha is one among

this. Susruta has included Madhumeha, in adibala pravritaja vyadhis.

While telling the vikrita Garbha caused by beejadosha, Charaka says that, if that

portion of beeja is defective, the body part developing from that portion of beeja will be

defective50. The term beeja has been considered as shukra and shonita. Hence it can be

understood that, the child born to Madhumehi, may or may not suffer from Madhumeha. It

depends on the beejabhagavayava, which is defected. It is caused, because of the vitiated

vatadi doshas present in the shukra and shonita of parents51.

2) Apathyaja (Acquired) causes:

It can be classified in to two types viz. Samanyaja (General) and Vishesha (According

to dosha).

Vishesha Nidana for Prameha

Except Charaka other authors have explained the common causative factors and they

have particularly stressed on the factors, which affects the Kapha, medas and mutra. Charaka

explained nidanas specific to the doshas concerned but he too has equally voiced on those

factors, which vitiate Kapha and medas. As the Kapha Prameha Nidana is equally important

as that of the Prameha thus the Kapha Prameha Nidana is enumerated here under.


15

a) KAPHAJA PRAMEHA NIDANA 52

Ahara Nidanas: -

A) Rasa – Madhura padartha atisevana

B) Guna – Drava taruna dravya atisevana

C) Dravyas –

i) Dhanya’s – Hanyaka, Chanak, Uddalaka, Naishada, Mukundaka, Mahavrihi,

Pramodaka, Sugandhaka, Sarpishmati, Masha etc

ii) Mamsa: - gramya, Oudaka, Anupa, Mamsa, Rasa

iii) Others – Shakas, Tila, Pistanaa, Payasa, Ksheera, Vilepi kshoudra,

Mandaka, Dadhi etc.

Vihara Nidanas -

• Swapna prasanga

• Shaya prasanga

• Asana prasanga

• Vyayama vruja varjana

• Anya kapha meda mutra and

• Vridhikara Viharas

b) PITTAJA PRAMEHA NIDANA53: -

Ahara Nidana -

A) Rasa – Amla, Lavana, Katuadhika sevena

B) Guna – Ushna kshara adhika sevena

C) Anya – Ajeerna dravyas and Vishamaharam

Vihara Nidana -

• Ati teekshna atapa sevena

• Agni Santapa

• Shrama

• Krodha


16

c) VATAJA PRAMEHA NIDANA54: -

Ahara Nidana’s

A) Rasa – Kashaya, Katu rasa Ati sevena

B) Guna – Rooksha laghu sheeta Ati sevena

C) Anya – Anashana

Vihara Nidana’s

Vyavaya, ativyayama

Udvega

Shodhana atiyoga

Atishoka

Vega sandharana

Shonita ati seka

Abhighata

Ratri Jagarana

Atapa Sevana

Vishama Shareera Nasyam

1) Samanyaja (General)

Along with the Nidana mentioned below which effect individual Dosha to vitiate the

other factors, which affect the Kapha and Vata Dosha, are to be considered as Madhumeha

Nidana.

Table – 1 Showing the Vihara Nidana of Madhumeha 55

S.no. Nidana Charaka Susruta Vagbhata

1 Swapna Sukham +

2 Diva Swapnam +

3 Avyayamam +

4 Alasyam +

5 Chinta Tyaga

6 Swapna prasanga +

7 Shayana prasanga +

8 Asana prasanga +


17

Table – 2 Showing the Ahara Nidana of Madhumeha 56

SN Ahara Nidana CS SS AH MN BS BP YR

1 Dadhi + + + +

2 Gramya, Oudaka, Mamasa + + + +

3 Anupa Mamsa + + + + + +

4 Payaha + +

5 Navanna pana + + + +

6 Guda vikara + + + + +

7 Sheeta, Snigdha, Madhura Madya sevena

+ +

8 Dravannapana sevena +

9 Swadu, Amla, Lavana, Snigdha, Pichhila, Shutala ahara

+ +

10 Sura sevana +

11 Ikshu rasam + + +

12 Adhyasana

13 Medovardhaka AharaAtiSevena

In general the factors pronounced here are self explanatory at the context, which are

tabulated in the table differentiated as Ahara and Vihara, are for Prameha in general and also

specific to the Madhumeha. Apart from the mentioned many factors are held responsible for

the causation of Madhumeha.

Madhumeha Nidana 57

Charaka affirms direct or specific Nidana responsible for the production of

Madhumeha, which are narrated is as follows –

• Guru, snigdha, lavana rasatmaka dravya atisevana

• Navanna and pana

• Atinidra

• Asya sukham


18

• Achinta

• Avyayama

• Asamshodhana

These factors contribute to the vikriti of the Kapha, Pitta, meda and mamsa. These

vitiated factors cause avarodha to normal Vata gati, which in turn carries the ojas to vasti thus

resulting in Madhumeha.

ETIOLOGY OF DIABETES MELLITUS58: -

A defective or deficient insulin secretary response, which translates in to impaired

carbohydrate use, is a characteristic feature of diabetes mellitus and resulting into

hyperglycemia. The chronic hyperglycemia of diabetes in associated with long-term damage,

dysfunction and failure of various organs like Eyes, Kidney’s, Nerves, Heart and Blood

vessels.

Genetic factors: - Genetic factors are even more important than Types I diabetes. Among

identical twins the concordance rate is 60% to 80% in first-degree relatives with type II

diabetes the risk of developing disease is 20% to 40%. The two main defects that

characterized in type II diabetes are – a) derangements in the beta cell secretion of Insulin and

the b) decreased response of peripheral tissues to respond to Insulin.

Obesity: - Among the initiating events, which are proposed for type II diabetes. Obesity is an

extremely important environmental factor. Approximately 80% of type II diabetes is obese.

Obesity is one of the major causative factors for diabetes mellitus as it causes insulin

resistance. In Ayurveda, sthoulya is mentioned as a Nidanarthaka roga for prameha, and this

prameha falls under the santarpanajanya vyadhis.

Age: - As the age advances the number of beta cells in pancreas, which produce insulin gets

reduced. So the risk of diabetes increases with age especially after 40 years.


19

Sedentary life: - People with sedentary life style are more likely to have diabetes are

compared to those who lead an active life. It is believed that exercise and physical activity

increase the effect of insulin on the cells.

Hereditary: - Warren and Le Compet , a famous Diabetalogist, when both the parents have

diabetes, all the children may expect to develop the disease, if they live long enough. When

one parent has diabetes and the other is diabetic carrier, 40% of their children may develop

the disease. If a diabetic or a carrier marries an individual who neither has diabetes nor a

diabetic carrier none of the children with have diabetes.

Madhura, Snigdhadi, Bhojana are the main Nidana’s for madhumeha, in contemporary

science it is explained that the excess eating and sedentary life style are the predisposing

factors for diabetes mellitus.

Samprapti of Prameha

The process of manifestation of disease is called Samprapti or pathogenesis. It

includes various stages as disease progresses. The detailed knowledge of pathogenesis is very

necessary to find of the extent of Dosha vitiation, involvement of dusya, avayava and srotus

along with the nature and prognosis of the disease. Vagbhata narrated pathogenesis of

Madhumeha very concisely, indicating two types i.e. Dosha avaranatmaka and Dhatu

kshayatmaka59. Susruta not mentioned the detailed Samprapti, he just informs that; if all

Prameha ill-treated or ignored get terminated in to Madhumeha60. Charaka explained the

pathogenesis in an elaborative manner.

Charaka enumerated the general Samprapti in Chikitsa sthana. He narrated that due to

over indulgence of etiological factors, Kapha along with meda, mamsa and Kleda get vitiated

and results into formation of metabolic waste which carried towards basti resulting Prameha.


20

In the same manner Pitta get vitiated resulting pittaja Prameha. Where in the Vata is provoked

in turn causes depletion of Dhatu due to the depletion of other two Dosha by which the

excretion of sweet urine resulting vataja Prameha61.

In Nidana Charaka described pathogenesis according to the type, where as the concise

pathogenesis further described in Chikitsa in regard to Doshic predominance i.e. Clinico-

pathological descriptions.

(1) Kaphaja prameha

Charaka narrated important explanation related to extent of nexus between Dosha,

Dushya and Nidana in the disease manifestation. When we understand the above factors and

their nexus we can easily diagnose the disease. We can understand the nature of the disease

and we can profound the prognosis too62. The above assertion is very important in Prameha

pathogenesis. An etiological factor first causes the provocation of Kapha because close

resembles to the related hetu. This provoked Kapha spreads all over the body quickly because

of the Sharira shaithilya (weak assemblage in between tissues). While spreading it get mixed

with meda dhatu, which is excess in quantity and Abadha and having more properties with

Kapha. That’s why get vitiated first. This annexation of vitiated meda and Kapha comes in

contact with sharira kleda and mamsa, which are already in excess quantity resulting

Putimamsa pidaka On the other hand the vitiated Kleda get converted into Mutra. The Kapha

along with meda and kleda covers the openings of mutravaha strotas resulting into Prameha63.

Susruta narrated dushya in each doshic type of Prameha. He narrated vitiation of Kapha along

with Vata, Pita and Meda in Kaphaja Prameha64.


21

(2) Pittaja Prameha:

Provoked Pitta due to its etiological factors manifests as pittaja Prameha Here same

pathogenesis occurs as described in kaphaja Prameha65. Susruta66 narrated Sonita along with

Vata, Kapha and Meda in the pathogenesis of Pittaja Prameha More or less similar pathology

is described by Ashtanga sangraha and Ashtanga Hridaya67.

(3) Vataja Prameha:

Susruta narrated the typical dusya sangraha according to dosha. He explained that, In

Vataja Prameha, Kapha, Pitta, meda, vasa and majja takes part in pathogenesis68. Detailed

Samprapti of Vataja prameha is described by Charaka as - Aggravated Vata because of its

own etiological factors draws out Sarabhuta dhatus from the body and carries them towards

Vasti resulting into four types of vataja Prameha69.

Another pathogenesis of vataja prameha is narrated in Chikitsa sthana is that, the

provoked Vata due to depletion of other two Dosha carries vital dhatus towards basti,

resulting into vataja Prameha70.

Pathogenesis of Madhumeha

According to the Vagbhata two types of pathogenesis get precipitate because of the

two types of etiological factors viz. (1) Dhatu ksaya janya, (2) Avarana janya and the third

type also persists is Kalaprabhavaja71.

(1) Dhatu ksaya: Due to depletion of the vital dhatus, the Pathogenesis in this regard can be

explained is as follows.

(a) Sahaja Prameha:

Susruta mentioned that Sahaja Prameha precipitate because of defect in

beeja72. Same thing explained by Charaka is that the Sahaja Madhumeha is a Kulaja


22

Vikara, because of the defect in beeja i.e. either Sperm or ovum73. Here the patient is

prone to Dhatu kshaya because of above discussed factors which cause the

Madhumeha.

(b) Madhumeha due to Dhatu kshaya

Charaka explained the pathogenesis in Nidana is that, due to specific

etiological factors provocated Vata draws out the vital dhatus and carries them

towards vasti resulting into Madhumeha74. Here the provocation of Vata is because of

its own etiological factors causes diminution of Dhatu, so it is called that as the

Samprapti visishta Anilatmaka Madhumeha. In this the pathogenesis is a genetic

predisposition in that patient makes him prone to get Madhumeha75

(Tathavidhasarire).

Madhumeha due to Sudha Vata:

Charaka enumerated that due to depletion of Kapha and Pitta Vata get

aggravate and causes the excretion of dhatus through urine resulting into

Madhumeha76. By observing above pathogenic processes, we can enumerate the

following things:

(a) Dhatu kshaya is the main factor present in each pathogenesis.

(b) The etiological factors mainly related to Vata.

(c) Vata provoked by its own etiological factors or by depletion of other Dosha and

dhatus. This in turn aggravates the Vata.

(d) Such types of pathogenesis occur in those patients, which are prone to this disease

because of genetic predispositions.

Remember here Vata is not aggravated by other Dosha etiological factors.


23

(2) Avaranjanya Madhumeha:

Though Vagbhata narrated the cause of Avarana janya Madhumeha type but not

explained the pathogenesis elaborately. Charaka emphasized this pathogenic process in well

elaborative manner. Due to excessive indulgence of heavy, unctuous, salty and sour diet,

Avoidance of worry, an exercise and purification measure, the Kapha and Pitta get provoked

and vitiates meda and mamsa. All are in excess quantity. They in turn cause obstruction to the

normal pathway of Vata. This obstructed Vata get aggravated and draws out the apara ojas

from all over the body and carries it towards vasti resulting Madhumeha. One thing to be very

clear here that the provocation of Vata is precipitated because of the Kapha Pitta etiological

factors. Here mainly Vyanavata and Apanavata get aggravated.

(3) Kalaprabhavaja Madhumeha:

This type of Madhumeha is described by Susruta. He does not mention the direct

pathogenesis but narrated that, when all types of Prameha if ignored or ill treated. They get

terminate into Madhumeha. This is not a separate entity but we can say that this is the last

stage or further progression of kaphaja and pittaja Prameha or complicate stage of the

disease78.

SAMPRAPTI GHATAKAS: -

Dosha Kapha pradhana Tridosha

Pitta is in Vriddhavastha

Vata – Avrita

Dushya Kleda (mootra), Meda, Mamsa, Lasika, Oja, Rakta, Majja, Sukra,

Rasa, Sweda

Srotas Medavaha, Mutravaha, Mamsavaha, Swedavaha and Udakavaha

Dusti Prakara Atipravritti, Sanga, Vimargagmana

Agni Vaishamyata and Dhatwagni mandhya


24

Ama Aparipakwa Dhatu

Udbhava Sthana Amashaya (Medovaha srotomoola – vapavahana)

Sanchara Sthana Sarva Shareera, (through Rasayani and Mootravahinis)

Adhisthana Vasti

Vyakta Sthana Sarva Shareera, Mootravaha srotas

Vyadhi Swabhava Chirakari

All these factors responsible for the Madhumeha can be discussed in detail with each

factor associations in the fallowing way.

a) Dosha involvement

• Kapha – having peculiar nature i.e., bahu drava described by Charaka. So we can

easily understand the ‘shaithilya’ manifestation in this disease. So this bahudravatva of

vitiated Kapha causes disruption in the assemblage of body elements and provide

ground for the accumulation of marbid matter in the tissues.

• Kapha having normal function as sthiratva, Chakrapani commented upon the word

sthiratva means ashaithilya79

• Again Kapha Dosha is the dominant factor in the pathogenesis of Madhumeha. It gets

vitiated primarily and causes the vitiation of concordant body elements like meda,

mamsa, kleda, rasa, vasa, lasika etc.

• The vitiation of Kapha here mainly is of excessive type. That’s why the following

symptoms manifest in Madhumeha. These are shaithilya, alasya, atinidra, gaurava, etc.

• Charaka clearly mentioned and Chakrapani opined that Kapha Dosha is dominant and

primarily vitiated because of its close resembles with the etiological factors80.

Pitta Dosha is not so dominant factor in the pathogenesis of Prameha. By the vitiation

of Pitta, avaranjanya Samprapti of Madhumeha resulted.


25

Rakta, sweda, lasika and rasa are the seats of Pitta Dosha so when Pitta get provoked,

it undoubtedly causes the vitiation of above dushyas. That’s why the symptoms

manifests are sweda vruddhi indirectly Agni vaishyam too.

Here mainly the symptoms manifests because of vruddhi of Pitta Dosha (trusna, daha,

ksudha and trunshavruddhi) 81

Pitta is in kshaya avastha in the vataja Prameha pathogenesis as compared to Vata.

Vata is the main predominant Dosha in the pathogenesis of Madhumeha here Vata get

aggravated either because of its own etiological factors or because of avarana caused

by Kapha, Pitta and meda.

This provoked Vata carries the vital constituents of the body like Vasa, majja and ojas

towards vasti and excretes them outside through urine resulting depletion of the

dhatus. Thus due to severe depletion of Dhatu, the symptom manifests are karsya,

daurbalya, angasuptata and parisaranasheela nature.

Charaka narrated that Dhatu gati is the function of normal Vata. Chakrapani opined

that this gati is related with the transfer of rasa etc. towards poshya i.e. main dhatus.

Thus these functions of Vata in bi fold digestion get hampered causing imbalance in

Dhatu formation and their transformation in the body82.

b) Dushya Involvement

All authors narrated dushya sangraha and their involvement in the pathogenesis but

Charaka specially enumerated a group and named it as a dushya vishesa again he

mentioned them in Chikitsa also83.

Susruta also narrated the dushya but he typically mentioned them along with the dosic

type but he commonly included meda in each type84.


26

Only Vagbhata mentioned sweda as a dushya along with the above dushyas85.

Rasa Dhatu: This is one of the Dhatu mainly vitiates. Here because of its close resemblance

with Kapha qualitatively. If Kapha get vitiate rasa also get vitiate, that’s why having same

symptomatalogy related to vruddhi. This is mentioned by Vagbhata i.e., “rasoapi

slesmavat86.” Susruta emphasized that sthaulya and karshya results due to vitiation of rasa

Dhatu and practically we can found both conditions in the Madhumeha87. So the role of rasa

Dhatu is very much important in the precipitation of the disease. Vitiated rasa shows

manifestations like alasya, gaurava, krushangata, klaibya and Agni nasa in context to

Madhumeha.

Rakta Dhatu: Rakta Dhatu having not much involvement in the precipitation of the

Madhumeha. It is mainly get vitiated prominently causing complication like pideeka, vidradhi

alasi88.

Mamsa Dhatu: One of the main dushya described by Charaka he narrated it especially in

kaphaja Prameha and avaranjaneya Madhumeha. Mamsa and Kapha have same qualities.

They both give strength to the body. When get vitiated, mamsa losses its normal consistency

and develops shaithilya and provide space in between for the accumulation of morbid matter.

Thus in turn results into the putimamsa pidaka89.

Meda Dhatu: Meda vitiation is common and dominant dushya in the pathogenesis of

Madhumeha. Kapha and meda having close resemblance in regard to functions as well as

qualitative parameters, thus both are getting vitiated more or less by same etiological factors.

In Madhumeha vitiation of meda results by two ways as either Qualitative – abadha

(asamhatam) normal function of meda is to produce unctuousness in the body along with


27

drahdhatva i.e., compactness so this abadhatva causes derangement in the structure of meda

producing shaithilya in the body.

The second is Quantitative as bahu, here in the pathogenesis meda is in excess

quantity. This medodhatu is aparipakva90. It obstructs the path of Vata along with Kapha. This

provoked Vata increases the Agni so patient unnecessary eats more and more food causing

excessive deposition of Aparipakva meda. This in turn cause severe depletion of the other

dhatus and produces various sign and symptoms. In Astanga sangraha, Vagbhata mentioned

that along with Prameha purvarupa excessive meda can cause diseases of sleshma, rakta and

mamsa.

Thus from above description it is clear that vitiated meda plays vital role in the

progress of pathogenesis and affects the normal physiology of various body elements.

Arundadatta comments it as it is necessary to occur vitiation in meda when Madhumeha

precipitates. So this deranged meda produces following signs and symptoms. These are

described as medo Dosha91.

Ayushor-hasa- life expectancy is get decrease because other dhatus could not get

nourished properly

Javoparodha – early manifestation of ageing

Kruchra vyavayata – difficulty to perform sexual act and impotency, this again related

with depletion of sukra i.e., abahutvat

Dourbalya – this results because of the deranged metabolism occurring to

malnourishment of the dhatus

Dourgandhya – bad smelling is results due to excessive sweating and combustion of

meda


28

Swedabadha – excessive sweating results because of the excessive meda and Kapha,

patient is intolerable to exercise.

Atikshuda and pipasa – excessive appetite and thrust because of the increased

digestive power and Vata vitiation. By observing above description undoubtedly we

can asser that, in Madhumeha pathogenesis meda plays leading role.

Majja Dhatu: Majja is not vitiated in maximum extent but Vata causes its khsaya i.e.,

depletion. Thus vitiated majja produces clinically symptoms like, netra gaurava and anga

gaurava in Madhumeha patient92.

Sukra Dhatu: Sukra also get vitiated in the pathogenesis produces symptoms like durbalya

and kruchra vyavayata, because normal functions of sukra is to maintain deha bala. It also

plays role in the precipitation of sahaja Prameha. Susruta narrated that sukra Dosha and

Prameha get precipitate because of the vitiation of Vyanavata and Apanavata93. Thus one can

easily understand the close relation of sukra dushti in Prameha and Madhumeha.

Vata cause depletion of shukradhatu and cause shukrameha.

Ojus: – oja as dushya mainly involved in vataja Prameha i.e., ojomeha (Madhumeha).

Provoked Vata due to its own etiological factors or due to avarana carries oja towards vasti

and excrete outside through urine94, so the symptoms of oja ksaya manifests, like guru gatrata

Nidra, tandra and daurbalya95. Charaka narrated ruksta i.e., related to ruksa shareera so one

can easily understand the manifestations of krusa pramehi or sahaja pramehi of course the

vitiation of apara oja occurs here. Hence it is prime concern to find out the oja vitiation in the

pathogenesis to assert the extent of severity.

Kleda: – The literary meanings of kleda are wetness. Moisture and dampness etc. the

physiology of kleda is mainly related with mutra and sweda along with meda. Thus when


29

kleda is involved then it directly affects the above factors. There is no direct reference

regarding to the function of kleda in the body but Arundatta commented that, if kleda is not

present then there is manifestation of dryness in the body. So indirectly we can say that the

kleda proper in quantity is important to maintain the unctuousness in between the tissues. In

normal physiology mutra and sweda maintain the balance of kleda. Especially sweda holds it

in the body and mutra excrete it outside the body96. According to the body condition and

requirement, if this kleda is get vitiated it directly affects the physiology of mutra and sweda

disrupts the assemblage of bodily elements causing shaithilya. Thus the symptoms manifests

due to kleda vitiation are prabhuta mutrata, sweda vruddhi, saithilya, daurgandhya and

avilumootrata.

Sweda – this is mentioned by Vagbhata, as Sweda is mainly related with meda and kleda.

When the Sweda vaha srotodusti occurs due to vitiation of meda and kleda., the normal

physiology of Sweda get disturbed resulting in manifestations like Sweda vruddhi,

dourgandhya, picchila gatrata, snigdha gatrata, etc. Susruta mentioned that even the Sweda

becomes sweet in nature97.

Vasa: Charaka described it as a subtype of vataja Prameha i.e. vasameha. Vasa is the

upadhatu of mamsa and the unctuousness present in the mamsa Dhatu is called vasa. Thus we

can easily understand that in Prameha mamsa is one of the main dooshya so in turns vasa too

get vitiate98.

Lasika: This is one of the liquid materials of body, present just beneath the skin. Lasika also

get vitiated by vata resulting lasikameha. There is no direct reference related to vasa and

lasika dushti99.


30

Srotas involvement

Madhumeha is the disease mainly of systemic consideration. In the pathogenesis there

is involvement of each and every constituent of the body. In the pathogenesis there is

reference of sroto dushti only related to mutravaha srotas. When we observe the pathogenesis

and symptomatalogy of Madhumeha, we can easily understand the involvement of medovaha

mamsavaha, swedavaha and udakavaha srotas too. In the pathogenesis we can found the two

types of srotodusti – Atipravrutti and Vimargagamana.

Thus we can find out the srotas involvement according to the symptoms observed is follows -

Purvarupa of Prameha – medovahasrotas dusti

Putimamsapidaka – mamsavaha srotodusti

Trsna mukha talu sosha – udakavaha srotodusti

Atisrusta abhiksna mutrapravrutti – mutravahasrotodusti

Agni and Ama

There is no direct reference related to the Agni condition but both Agnimandya and

tikshna Agni conditions present in the pathogenesis again without Ama it is impossible to

precipitate the pathogenesis of Madhumeha that’s why Susruta narrated that, aparipakva

condition of Dhatu is related with Ama mainly.


31

Figure – 1

Madhumeha Samprapti

Avarana janya Madhumeha

Apathyanimittaja Madhumeha

Sahaja Madhumeha

Nidana sevana Beeja Dosha

Vikruta bahudrava Kapha

Travels all over the body because of shareera shithilata

Medo dhatwagni mandya

Sthoulya Medovaha srotas vitiation

Bahu abaddha medas

Kapha Pitta Meda Mamsa Ativruddhi

Dosha dushya sammurchana

Bahudrava sleshma with bahu abaddha meda

Obstruction of Vata due to avarana by vitiated Kapha

Pitta and Meda

Vitiation of other dushya

Adhika kledata of Dhatu

Squeezing of Ojas in to vasti Vasti

Madhumeha


32

Manifestation of DM 100

Diabetes mellitus is characterized by glucose concentrations that are high enough to

over whelm the reapportion capabilities of the kidneys. Glucose appears in urine and urine

production generally become excessive. Other metabolic products, such as fatty acids and

other lipids are also present in abnormal concentrations.

While much has been learned in the recent years, the pathogenesis of type II diabetes

remains enigmatic. There is no evidence that autoimmune mechanisms are involved in this.

Life style clearly plays a role and clearly evident when obesity is considered. Genetic factors

are even more important than in type I diabetes. The two metabolic defects that characterize

type II diabetes are – 1) Deranged beta cell secretion of insulin and 2) Decreased response of

peripheral tissues to respond to insulin (insulin resistance).

a) Deranged beta cell secretion of Insulin

In populations at risk for developing type II diabetes, a modest hyperinsulinemia may

be observed, attributed to beta cell hyper responsiveness to physiologic elevations in blood

glucose. With the development of overt disease, the pattern of insulin secretion exhibits a

subtle change. Early in the course of type II diabetes, insulin secretion appears to be normal

and plasma insulin levels are not reduced. However normal pattern of insulin secretion is lost

and the rapid first phase of insulin secretion triggered by glucose is obtunded. Collectively

this and other observations suggest derangements in beta cell responses to hyperglycemia

early in type 2 diabetes rather than deficiencies in insulin synthesis.

A mild to moderate deficiency of insulin develops later in the course of type II

diabetes that is less severe than the- type I. The reason for this is not clearly known but

irreversible beta cell damage appears to be present. According to one view, all the somatic


33

cells of predisposing individual including pancreatic beta cells are genetically vulnerable to

injury, leading to accelerated cell turnover and premature aging and finally to reduction in

beta-cells mass. Chronic hyperglycemia may exhaust the ability of beta cells to function

(called glucose toxicity), as a consequence of persistent beta cell stimulation.

b) Insulin Resistance

Insulin deficiency is present in the course, of type II diabetes. Reduced

responsiveness of peripheral tissues i.e. insulin resistance, is a major factor in the

development of type II diabetes. In obesity it is very much prominent or clear. The molecular

basis of insulin resistance is not clear. There may be a decrease in the number of insulin

receptors and more important post receptor signaling by insulin is impaired. Also the insulin

resistance leads to -

1) The inability of circulating insulin to properly direct the disposition of glucose

2) A more persistent hyperglycemia

3) More Prolonged stimulation of the pancreatic beta cell

Insulin resistance and relative insulin deficiency are the major step in the pathogenesis

of the diabetes mellitus on obese individuals. If the pancreas is healthy and if it secretes

sufficient insulin even this obese people will also won’t get diabetes mellitus. There is no

explanation regarding insulin resistance in Ayurveda. Even in some recent literary works

medo dhatwagni is correlated with insulin. But, no proves are available for exact co-relation.

If we see the pathology, we can see that the concept of Agni plays a great role i.e. Agni

mandya is considered to play key role in the formation of aparipakwa Dosha and dushyas

which is the main defect behind Madhumeha.

The other factors responsible for manifestation of the DM are -


34

i) Obesity

Obesity is an extremely important environmental factor in the formation of type II

diabetes. Approximately 80% of type II debates are obese. In this, the impaired binding is a

result of decrease in the number of insulin receptors.

Ayurveda authors have given importance to the medovaha srotas in the pathogenesis

of Madhumeha. In classics it is mentioned that vapavahana is the moola sthana of medovaha

srotas, and which can be considered as pancreas. But there is no much description in

Ayurvedic classics regarding vapavahana. Charaka has explained that the vapa vahana is an

udarasthaanga and he also says, it is having the shape of taila varti. So on the basis of this

physio-anatomical similarity, we can co-relate the vapavahana with pancreas. But kloma also

considered as pancreas by some authors of Ayurveda. As pipasa mentioned as a kloma vikriti

lakshana, which is the main characteristics of the Madhumeha, here it can also co-relate with

the pancreas.

ii) Amylin

Among the pathological changes, which are happening in type II diabetes, the most

consistent of these changes is probably deposition of amyloid, which is accompanied by

atrophy of the normal tissue, particularly Islet epithelial cells. In more advanced lesions, the

Islet is more or less converted to amyloid and the reduction in the number of insulin secreting

cell is more pronounced than that of glucagons-secreting cells. Heavy deposition of amyloid

itself is rare without diabetes.

In normal state sthiratwa, dardya, utasaha, vrishada, buddhi, etc are contributed by

kapha, which is also known as bala or oja. By seeing this we can co-relate this Kapha with

glucose. In Madhumeha the Kapha which is vitiated and which is in bahu dravata form travels


35

all over the body in rasa produces tanu madhuryata, which can be taken as hyperglycemia i.e.

increased blood glucose condition.

Also in the Samprapti we can see the word vasti. In Ayurveda it has been used in

different contexts in different meaning i.e. as bladder, whole urinary tract and also kidney.

Sushrutaacharya says nabhi prishta madhyaha vasti. Anatomically kidney and ureters are

situated in this region. Also he says, the term “vastau” which indicates the plural sense i.e.

two kidneys. So, here an attempt is made to co-relate the pathogenic factors mentioned in

Ayurveda and in modern science. To prove the above ideas correctly, further studies are

needed.

Classification of Prameha

Knowledge of classification will helps in proper understanding of the disease and to

formulate an effective treatment protocol. In classics various types of Prameha had been

described based on many factors. Though Prameha is stated to be a condition due to the

vitiation of all the three doshas, the disease is mainly divided in to 3 groups101

Kaphaja Pramehas - 10

Pittaja Prameha - 06

Vataja Prameha - 04

Though there is a similarity in the opinion of Brihatrayes regarding the numbers of pramehas

in each group. But they seem to be different in the nomenclature used by them.


36

Table - 3

TYPES KAPHAJA PRAMEHA

Sl Names Charaka Susruta Vagbhata Madhava

1 Udaka meha + + + +

2 Ikshu meha + + + +

3 Sandra meha + + + +

4 Sandraprasada Meha + Sura meha Sura meha Surameha

5 Sukla meha + Pista meha Pista meha Pistameha

6 Sikata meha + + + +

7 Sita meha + Lavanameha + +

8 Shanair meha + + + +

9 Lala meha + Phena meha Lala meha Lala meha

10 Shukra meha + + + +

Table - 4

TYPES OF PITTAJA PRAMEHA


1 Kshara meha + + + +

2 Kala meha + Amla meha + +

3 Nila meha + + + +

4 Lohit meha + Ahinitameha Rakta meha Rakta meha

5 Manjishtha meha + + + +

6 Haridra meha + + + +

Table - 5

TYPES OF VATAJA PRAMEHA


1 Vasa meha + - + +

2 Majja meha + Sarpi meha + +

3 Hasti meha + + +

4 Madhu meha + Kshaudra meha

+ +


37

From above classification it is very necessary to find out the basic ideology behind

this. Vagbhata clearly narrated that these types result because of the nexus between Dosha,

Dushya and their specific combination according to concordance. That’s why in each subtype

specific urine is voided102 Charaka put forth his theory that all these types and their

nomenclature is because of the specific qualities and their combinations with each other but,

the nomenclature is mainly based apoun the predominance of one quality103.

Chakrapani also commented that the nomenclature is because close resembles of urine

with particular quality (guna) i.e. Sitameha, Suklameha etc. When we go through in detail

with this classification we can easily understand the Dosha predominance, Again dushya

involvement, again nature of urine voiding and we also can find out the etiological factors,

State of the disease and progression.

Classification According to Prognosis

Table – 6

Showing Prognosis of Madhumeha

Sadhya (curable) Yapya (Palliative) Asadhya (incurable)

Kaphaja Pittaja Vataja

Sthoulya Usually not much obese Krusha

Acquired Acquired Hereditary

Early stage Acute stage Advance stage

Without complications With complications With complications

Classification of Madhumeha

Madhumeha is one of the subtypes of Vataja Prameha, can result with various

etiological factors mainly. It can be classified according to the build related with genetic

predisposition.


38

(1) Based upon the etiological factor

(i) Sahaja (Hereditary)

(a) Etiology - Charaka and Susruta narrated Jata pramehi because of beeja Dosha

emphasized it as Kulaja Vikara. It is said as incurable. Defect in beeja i.e. in sperm /

ovum or defect in beeja Avayava i.e. in chromosome. This theory mainly supported by

the modern science too104.

(b) Body constitution:

Susruta along with etiology narrated the body constitution of Sahaja Prameha /

Madhumeha; Charaka mentioned the word Krusha especially for easy understanding

of the same along with the treatment.

(ii) Apathya nimittaja: (Acquired)

Susruta etiological factors denote the subtype Apathya Nimittaja. It can be again

classified into following manner, related with etiology and Patho-physiology105.

(a) Avarana janya and Dhatu apakarsanjanya

This type of classification mainly related with etiology and patho-physiology. In this,

Avarana janya pathogenesis is due to the etiological factors mainly corresponding with Kapha

and Pitta where the vitiation of Vata occurs due to avarana. Dhatu apakarshana janya

pathology occurs due to depletion of dhatus because of the vitiated Vata106.

(b) Santarpanjanja and Apatarpanjanya

This classification mainly narrated by Charaka when describing the treatment of the

Prameha. Classification mainly based apoun the overnutrition and undernutrition. So

Santarpanajanya Madhumeha can be correlated with Avaranjanya Madhumeha and

Apartarpanjanya can be correlated with Dhatuapakarshanjanya Madhumeha107.


39

(c) Anilatmaka and Kaphasambhava

Charaka mentioned that when we observed the urine of the patient Picchila, madhura

and Madhusamam. Then we should have to consider two factors i.e. this Madhumeha is either

of Vatatmaka or either of Kaphasamphava. Here what literally missed is the Pitta role, from

this description we can postulate the theory that in Madhumeha is mainly due to the Vata and

Kapha predominance though the disease is said as Tridosha janya.

CLASSIFICATION OF DIABETES MELLITUS 108

The current expert committee of American diabetes association has proposed

changes to the NDOG/WHO classification scheme. The revised Etiologic

classification of diabetes mellitus is as follows -

I) Primary Diabetes

Type I: - Beta-cell destruction, usually leading to absolute insulin Primary deficiency.

a) Immune mediated

b) Idiopathic

II) Type II diabetes (may range from predominantly insulin resistance with relative deficiency

to a predominantly secretary defect with insulin resistance.

Under this type II again 2 types can be seen

1) None obese NIDDM

2) Obese NIDDM

Genetic defects of beta cell function including maturity on set diabetes of young

known as MODY

III) Other specific types

A) Genetic defect of beta cell function

a) Chromosome 12, HNF – 1 Alpha (MODY S)

b) Chromosome 07 Glucokinse (MODY 2)

c) Chromosome 20 HNF 4 Alpha (MODY 1)

d) Mitochondral DNA

e) Others


40

B) Genetic defects in insulin action: -

Type 4 insulin resistances, Lepsechaunism, Rabson Mendenhall Syndrome.

Lipoatrophic diabetes and others.

B) Disease of exocrine pancreas: - Pancreatic pathology

a) Pancreatitis

b) Hemochromatosis

c) Fibrocalculous

d) Neoplastic Disease

e) Pancreactetomy

f) Cystic fibrosis and others.

D) Iaotrogenic: - Drug induced or chemical induced.

a) Glucocorticoids

b) Thiazides

c) Alpha – Intrferon

d) Thyroid Hormone.

F) Endocrinopathies: - Endocrine disease induced.

a) Cushing’s Syndrome

b) Acromegaly

c) Thyrotoxicosis

d) Phaeoc hromocytoma

e) Glucogonoma.

G) Infections: -

• Congenital rubella

• Cytomegalo virus and others

H) Other genetic syndromes sometimes associated with diabetes.

a) Dawn’s syndrome,

b) Klenefelter’s syndromes etc.

I) Gestational Diabetes Mellitus (GDM)


41

A comparative statement of Madhumeha and DM

Madhumeha Diabetes Mellitus

1) Margavarana Janya madhumehi

is sthoola & balavan so apatarpana

chikitsa in the form of langhana &

Nidana parivarjana

2) Dhatu Kshaya Janya madhumehi is

Krusha & durbala hence santarpana

Chikitsa.

NIDDM patient is obese, so diet exercise

and oral hypoglycemics (sometimes insulin

also)

IDDM – patient is thin so insulin therapy

In classics the classification of a disease made it clear that for the sahaja Prameha

beeja Dosha have been mentioned as causative factors. Such patients are said to be weak

emaciated. Suffering from thirst, loss of appetite and are required to be treated with a

nourishing diet.

In contemporary science the genetic and hereditary factors are mentioned as causative

factor. Such patients are weak emaciated and they are asthenia. The above-mentioned patient

is juvenile diabetes and requires a nourishing diet, so sahaja Prameha can be consider as

juvenile diabetes.

Poorva roopa of Madhumeha

The Symptoms, which are produced during the process of sthanasamshraya avastha,

are called as poorva roopa, and the symptoms which appears prior to the manifestation of the

disease, are called poorvaroopa i.e. is “4th Kriyakala”. Premonitory symptoms are very much

important to diagnose the disease as early as possible that in turn helps for good prognosis. In


42

ancient Ayurvedic treatises common premonitory symptoms are described but special

premonitory synmptoms of Madhumeha are not mentioned.

Table - 7

Showing the poorva roopa of Madhumeha

S.no Poorva roopa C.S S.S A.H A.S M.N B.P Y.R 1 Kesha Jatilibhava + + + 2 Asyamadhuryata + + + + + + 3 Karapada daha + 4 Karapada suptata + 5 Mukha talu kantha gala shosha + 6 Pipasa + + + + + + 7 Alasya + + 8 Kaye malam + + 9 Angeshu paridaha + 10 Anga suptata + + 11 Shatapada Mutrashaya

abhisarana

+

+

12 Vishra shareera gandha + + + 13 Atinidra + 14 Tandra + + + 15 Snigdha,Pichhila guru gatratam + + + 16 Madhura shukla mutrala + + 17 Durgandha swara + + 18 Talu, gala, danteshu malotpathi + 19 Nakhati vriddhi + + + 20 Swedam + + 21 Keshathi vruddhi + 22 Sheetpriyatwan + + + 23 Mootra abhidhavanti

pipeelakasha

+

24 Ghanangata + + 25 Angashaithilatwa + +

By clean observation of above Premonitory sign and symptoms we can postulate the

opinion that the disease having vast field of etio-pathology the patient shows very few

Premonitory sign and symptoms. So it is very hard to diagnose Prameha by means of above

description but Susruta makes it easy by narrating and shloka that a man with slight increase


43

in the urine output along with the premonitory symptoms showed is consider as the patient of

Prameha 109.

Apart from above premonitory symptoms and signs only few of them are cardinal sign

and symptoms of Madhumeha. These are pipasa madhura mootrata, asyamadhurya, anga

daha. There is no direct explanation of the poorva roopa of Madhumeha as such. But poorva

roopa of Prameha can be considered as poorva roopa of Madhumeha.

Lakshana (Roopa) of Prameha

The vyakta or pradurbhoota lakshanas of the Vyadhi is seen in the 5th kriyakala. The

vyadhi bodhaka linga of all 20 types of Prameha is prabhoota and Avila mootrata. The

prabhoota mootrata can be considered in terms of increased volume of urine and frequency of

micturition. Avila mootrata refers to increased turbidity of urine.

Roopa means symptoms of the actual manifestation of disease. At this stage Dosha

dushya samoorchana would have been completed and the onset of the disease would have

been commenced. Madhavakara explains it as when symptoms in the stage of poorvaroopa

become fully or clearly manifested they are called roopa110. Roopa is the prominent diagnostic

key of a disease and hence thorough knowledge of the various roopa of each disease essential

for a physician.

Signs and symptoms of the disease are the diagnostic tool manifests when the

pathology of the disease is in full context. The symptomatalogy of Madhumeha is ascertained

by Ayurveda in broad manner to understand them need to elaborate as follows. Susruta

narrated that the person should be diagnosed as pramehi when complete to partial prodromal

symptoms of Prameha accompanied by polyuria get manifested111. In this regard Gayadasa

opined that in this disease all prodromal symptoms get converted into rupa due to specific


44

nature of the disease i.e. vyadhiprabhava. From above description we can say that the

prodromal symptoms along with chief symptoms get continued as the disease progress.

1) SAMANYA LAKSHANAS 112: -

Samanya Lakshanans of Madhumeha are those which are ascribed to Prameha, they

are i) Prabhoota mootrata and ii) Avila mootrata.

i) Prabhoota mootrata: -

The increase in quantity and frequency is known as prabhoota mootrata. It is

manifested due to increase of sharreera kleda, the reasons for which are explained in the

context of Samprapti. The frequency is increased due to vitiation of apana vayu. Due to

hyperglycenia in madhumeha, glycosuria manifests which in terms hampers the tubular

absorption of water leading to polyuria.

ii) Avila mootrata: -

Moorta avilata is nothing but the turbidity of mootra, which is manifested due to drava

and guru guna vriddhi of kapha and medhas. This can be noticed by the increase in the

specific gravity of the urine.

2) VISHESHA LAKSHANAS 113

In Madhumeha mootra is manifested with Kashaya, Madhura, Rooksha, Pandu and

madhu Sama lakshanas. Bhavaprakasha clarify the controversy of the word kashaya as

kashaya varna. The implication of this term is still debatable. The presence of madhura rasa in

mootra is mainly because of ojo visramsa into mootra, which can be easily understood by

pipeelika abhisarana and by qualitative analysis of urine test. Rooksha guna is due to vitiation

of vata. Pandu varnata of mootra is because of kleda dusti which influences Kapha to attain

more liquid state. Madhusama mootra implies the colour, smell and taste of mootra similar to


45

that of madhu. It has to be understood that along with the samanya lakshanas madhusama

mootra is the pratyatmaka lakshanas of Madhumeha.

Table – 8

Lakshana of Madhumeha

SN Roopa C.S S.S A.H A.S M.Ni Y.R B.Ra G.Ni

1 Kashaya + + + + + +

2 Madhura + + + + + +

3 Pandu +

4 Rooksha + + + + + +

5 Snigdha +

6 Ojadhatu +

7 Kshoudravat

Madhviva

+ +

8 Kshoudra rasa +

9 Kshoudra varna +

Madhumeha patient excretes urine having kasaya and madhura taste, panduta in colour

and of ruksa quality commenting upon this assertion of Charaka, opines that natural madhura

rasa of oja is replaced by kasaya rasa in vasti Chakrapani opines on assertion that Vata

because of its prabhava converts madhura oja into kasaya rasa. Susruta mentioned the

resemblance of urine with honey as described above. Similar description in asserted.

In Chikitsa sthana Susruta before propounding the treatment of Prameha, asserted two

types of Prameha along with their features as follows114.

1) Sahaja Prameha (Krusha)

Rooksha

Alpashi


46

Bhrsa pipasa

Parisarana sheela

2) Apathya nimittaja (Sthoola)

Bahu ashi

Snigdha

Shayyasana swapna sheela

Asana, Swapnasheela the Samprapti of Apathya Nimittaja madhumeha has been

explained earlier. The vitiation of Kapha, Kleda, Medas is due to the indiscreet food habits.

Thus leads to the medovaha Srotodusti due to medodhatwagni mandya. Thus the person

develops sthoulya. The samana Vata avarodha in koshta is the reason for prabhuta agni from

which the person desires and consumes more food. It has been said earlier that the meda

sthana is the pitta sthana and hence the Vata in kosta is obstructed which later lead to the

excessive secretions of Pitta in Amashaya which results in the above said lakshanas. The

affected person is termed as snigdha due to the karmataha vruddi of Kapha. Madhumeha is

one among the 20 types of pramehas. So these may be present in madhumehi.

Madhumeha lakshana 115

Susruta gives explanation regarding the lakshanas of Madhumeha, as follows –

a) Gamanat sthananichati

b) Sthanat asananichati

c) Aasanat sayyamichati

d) Shayanat swapnamichati.

Apart from the above lakshanas urine similar to honey in colour and taste are also attributed

to Madhumeha.


47

Clinical Features of DM 116

It is very difficult to sketch with brevity the diverse clinical presentation of diabetes

mellitus. Only a few characteristic patterns will be presented. The type II (NIDDM) diabetes

present with polyuria, polydipsia but unlike type I diabetes patients are often older and

frequently obese. Some times weakness or weight loss also noted. Apart from these features

others like, polyphagia, pruritis vulvae, glycosuria, infections, delayed healing of wounds,

impotency, are also noted.

Polyuria is due to the osmotic diuretic effect of glucose in kidney tubules. The

glycosuria induces an osmotic diuresis and thus polyuria, causing a profound loss of water

and electrolytes.

The obligatory renal water loss combined with the hyper osmolarity resulting from the

increased levels of glucose in the blood tends to deplete intracellular water, triggering the

osmoreceptors of the thirst centers of the brain. In this manner intense thirst (polydipsia)

appears.

The catabolism of proteins and fat tends to induce a negative energy balance, which in

turn leads to increasing appetite, i.e. polyphagia. Despite the increased appetite, catabolic

effects prevail, resulting in weight loss and muscle weakness. Frequently, however the

diagnosis made after routine blood or urine testing mainly in asymptomatic persons.

Whenever the quantity of glucose entering the kidney tubules in the glomerular,

filtrate rises above approximately 225 mg/min, a significant proportion of the glucose begins

to spill in to the urine and when the quantity increases above about 325 mg/min, which is

tubular maximum for glucose. All the excess, above this is lost in to urine (Glycosuria).


48

A comparative study of madhumeha lakshanas with the Diabetes mellitus explained in

the modern science reveals a lot of similarities between them. Prabhoota avila mootrata is

considered as a prathyatma lakshana of Prameha. In this the bahudrava Kapha along with

other dooshyas mainly kleda pradhana dooshyas in the vasti is the cause for prabhoota

mootrata. The same reason has been given in modern science for polyuria that the osmotic

diuretic affects of glucose in the kidney tubules.

Glycosuria explained in the modern science can be taken as madhusama mootra. The

reason for this madhusama mootra is bahudrava kapha or ojus (Glucose), which is excreted

through moootra.

Pipasa or polydipsia mentioned in both sciences. Depletion of intracellular water

triggering the osmoreceptors of thirst center of brain and thirst is noted which is similar to

pipasa of Ayuredic science, here due to excessive loss of the urine; pipasa is noted.

Bahukankshata has been mentioned as a lakshana in apathya nimittaja madhumeha,

the same in modern science in terms of polyphagia.

In modern science the condition weakness is due to lack of glucose utilization, loss of

electrolyte and protein loss. In Ayurveda this same condition is due to aparipakwa dhatus i.e.,

lack of proper nourishment of dhatus.

By considering the above similarities, we can come to a conclusion that Madhumeha

explained in Ayurvedic science and the diabetes mellitus mentioned in the modern science are

almost similar condition.


49

Differential diagnosis for Madhumeha

Proper diagnosis is the foundation to the success of a treatment because many diseases

affecting a srotas have similar manifestations, enough to confuse a physician but picking up

threadbare with a little difference to clinch a diagnosis is an art aspired by all. Deep

knowledge and untiring practice are the means to perfection as Vagbhata has rightly

mentioned “abhyasat prapyate dristihi karma siddhi prakashini”.

Madhumeha is a mootra atipravruttaja vikara with prabhoota and avila madhusama

mootrata as pratyatma lakshana. Although there are many diseases presenting with

Atipravrutti of mootra, the diagnosis of Madhumeha is usually a straight forward proposition

by differential diagnosis of the following with its sweet uriantion.

Mootra lakshana (Pravartana Nimitta) Symptoms 1) Abhikshnam (Muhurh muhurh, Punah punah : Subahushah, vikiranam

a) Ashmari (C. Ci. 26/38) b) Mutratita (S. U. 58/12) c) Vatika mootrakrichra (C. Ci 26/32) d) Ushna vata (Ah. N. 9/36)

2) Atipravrutti a) Amavata (M. N. 25/9) b) Arsha poorvaroopa (As. N. 7/7) c) Sahaja arsha (C. Ci. 14/8) d) Kaphaja arsha (C. Ci. 14/17) e) Mutra praseka (S. Ci 7/36) f) Upasthita prasava (S. Sa. 10/7) g) Chidrodara (C. Ci. 13/44) h) Asadhya masurika (M. N. 54/27) i) Ama jwara (C. Ci. 3/135)

Moreover within the preview of the disease Madhumeha, the Kapha, Pitta and Vata

have characteristic presentations, which have been described in such a way as not to leave any

scope for doubt. In other words, if a patient presents with mootra atipravrutti, lakshanas of

Kapha, Pitta or Vata like shukla mootrata haridramootrata or vasa mootrata and if they are

associated with Prameha poorvaroopas then the disease is per se Prameha or Madhumeha.

Charaka explains this concept giving the example of a situation where one comes across a


50

patient who is presenting with haridra or rakta mootrata. Here the absence of Prameha poorva

roopas will prove the existence of rakta Pitta and exclude Prameha 117.

In the presence of madhura and picchala lakshanas of Prameha, one should consider

two possibilities for differentiation whether the condition is anilatmaka due to Dosha

ksheenata or kaphasambhava as a result of santarpana.

As discussed earlier, here one should essentially consider Madhumeha as a

consequence of vata vruddhi as a result of dhatukshaya where Vata is the anubandhya Dosha

and Madhumeha as a result of margavarana janya vata vruddhi where Vata is an anubandha

dosha and is directly dependent upon Kapha, which has undergone vruddhi because of

santarpana. The factors for differentiation are as follows –

Madhumeha (anilatmaka) Madhumeha (Kapha sambhava) Rogi : Krusha

Nidana a) Vatakara ahara vihara along

with vata vruddhi as a result of

chirakalina madhumeha

b) Beeja uapatapa

Rogi avastha : Bala to madhyama vaya

Roopa : Vata pradhana

Samprapti : Madhumeharambhaka dosha

dusti leading to vapavahana

dusti especially in sahaja

madhumehi

Vyadhiswaroopa : Ashukari

Sadhyasadhyata : Asadhya

Upadrava : Vata pradhana upadravas

Chikitsa : Santarpana

Sthoola

Kaphakara ahara vihara

Madhyama to vruddha

Kapha pradhana

Kaphamedodusti leads to Madhumeha

arambhaka dosha, dusti in vapavahana

Chirakari

Sadhya in the beginning

Kapha pradhana upadravas

Apatarpana


51

Madhumeha is basically medovaha srotodustijanya vikara but its pratyatma lakshanas

become vyakta in the mootravaha srotas with abnormal changes in the rasa, varna, gandha,

sparsha of the mootra and it is characterized by prabhoota and avila mootrata.

Prabhoota mootrata means atipravrutti of mootra. It goes without mentioning that

there is also an increased frequency of micturition and Avila mootrata means Atyartha

Kalusha Samalam or Malinam akulam which means that there is a considerable change in the

quality of urine as per the above mentioned factors. Considering these factors, it becomes

contextual to enumerate the conditions where there is increased frequency of urine and

abnormality in its quality. Most of the times these symptoms are associated with mootravaha

srotodusti and other diseases where differentiating Madhumeha is not a problem for evident

reasons. It becomes relevant to consider the following conditions where hyperglycemia is

common manifestation under the heading of differential diagnosis.

Differential diagnosis 118

1) Diabetes mellitus & Endocrine disorders:

a) Pituitary gland

1) Pituitary diabetes due to growth hormone

2) Acromegaly

3) Diabetes insipidus

b) Adrenal Cortex

1) Cushing’s Syndrome

2) Steroid diabetes due to administration of steroids

3) Primary Hyperaldosteronism

c) Adrenal Medulla

1) Phaeochromocytoma

2) Addison’s disease

3) Adrenalectomy


52

d) Thyroid

1) Hyperthyrodism

2) Myxoedema

2) Pancreatic Diabetes

1) Acute pancreatitis

2) Mumps (rarely)

3) Chronic pancreatitis

4) Haemochromatosis

5) Total pancreatectomy

6) Carcinoma of pancreas

3) Diabetes liver

1) Cirrhosis of liver

2) Gall Stones

4) Drugs & diabetes

Thiazide, Chlorthalidone, frusemide, oestrogen containing oral contraceptives, β

blockers & catacholaminergic drugs

V Miscellaneous

1) Type I glycogen storage disease

2) Down’s syndrome

3) Turner’s Syndrome

4) Huntington’s chorea

5) Burns

Conditions of polyuria

Polyuria should not be confused with prostratic hypertrophy or cystitis because here it

is only increased frequency of micturition & not increased quantity.


53

1) Polyurea due to water diuresis

Cranial or neurogenic diabetes insipidus: This is due to an identifiable lesion in the

hypo thalamus pituitary or both leading to failure of A.D.H. Nephrogenic diabetes insipidus:

Familial form seen in males only also as an accompaniment of Fanconi syndrome.

Psychogenic polydipsia or compulsive water drinking this is a hysterical condition. There is

clinically marked fluctuation here.

2) Polyurea due to increased solute load

Diuretic therapy

Chronic renal failure

Upadravas

Charaka enumerated the general complications while Susruta and Vagbhata described

according to the Dosha predominance.

(1) Samanya Upadrava

These are Trsna, Atisara, Jwara, Daha, Daurbalya, Arocaka, Avipaka,

Putimamsapidaka, Alaji and Vidrdhi. Chakrapani opined that these complications manifest

because of the long term Anubandha of Prameha disease119.

(2) Vishesha Upadrava

(a) Kaphajameha Janmanam: Makshikopasarpanam, Alasya, Mamsopacaya,

Pratisyaya, Shaithilya ,Arocaka, Avipaka, Kaphapraseka, Ccardi, Nidra, Kasa and

Swasa 120.

(b) Pittajameha Janmanam: Vrsandaavadaran, Bastibheda, Medhratoda, Hrdisula,

Amlika, Jwara, Atisara, Arocaka, Vamathu, Paridhupanam, Daha, Murcca, Pipasa,

Nidranasa, Panduroga, Pitvidmutranetratva and Vidbheda 121.


54

(c) Vatajameha Janmanam: Hrdgraha, Laulyam, Anidra, Stambha, Kampa, Sula,

Badhapurisatvam, Sosa, Kasa and swasa122.

When we observe the above complications, only few of them are looking fetal like, Moorcha,

Hrudgraha, otherwise all other complications seem to be associated symptoms or signs in the

disease progression.

Upadrava related to Madhumeha

Charaka mentioned the 'Sapta Pidaka' as complication, because of the negligence of

the Madhumeha123, while Susruta mentioned that Madhumeha along with Pidaka is Asadhya,

He quoted that these Pidaka causes because of the Tridosha and because of the vitiated Meda

and Vasa. Susruta and Vagbhata mentioned 10 Pidaka while Caraka mentioned only 7 Pidaka

these are also follows.

Table – 9

Madhumeha upadrava

SN Pidaka Charaka Susruta Vagbhata

1 Saravika + + +

2 Kaccapika + + +

3 Jalini + + +

4 Vinita + + +

5 Alaji + + +

6 Masurika + +

7 Sarsapi + + +

8 Putrini + +

9 Vidarika + +

10 Vidrdhika + + +


55

COMPLICATION OF DIABETES MELLITUS 124

Some upadravas can be correlated to some of the complications of modern sciences

for e.g.- thrishna, bhrama, shoola, tamapravesha, swasa etc with that of the ketoacidosis in

which all these symptom are seen and even in hypoglycemic condition also. It can be

classified into two groups

1) Acute complications: -

a) Metabolic – Ketoacidosis, Hyper Osmolar non Ketotic coma, lactic acidosis

b) Infective apisodes of RIT, UTI, Skin etc.,

c) Surgical complications – Gangrene, Carbuncles

2) Chroni Complications: -

a) CVS – Premature altheroma, Ischaemic or

CHD – Thromibosis, HT, Claudication etc

b) Nervous System – CVD, Peripheral neuropathey, Sensory and motor

neuropathises.

c) Excretory System – Recurrent UTI, RF, Chronic polynephritis

d) Eyes – Cataracts, Retinopathy

e) Respiratory System – Pulmonary kocks

f) Digestive System – Stomatitis, Dental sepsis, fatty filtration of lives

g) Bones and Joints – Osteoporosis, Frozen shoulder on, Neuropathic joints

h) Skin – Monitial infections, trophic ulcers, carbuncles

i) Gonad possible hormon changes.

Sadhyasadhyata of Madhumeha

(1) Sadhya - Kaphaja Prameha

Etiological factors are same to that of Dosha, Dushya and having same qualities and

same seat. So the treatment is same for both. That’s why Kaphaja Prameha is Sadhya125.

Charaka explained few things about prognosis of the disease that Sthairya i.e. Sadhyata

(Curability) results when Kapha get vitiated along with same quality dushya i.e. Prakrti


56

bhutatvat. Asadhyta incurability results because the vitiation of Kapha that occurs along with

different quality Dushya like Raktadi. The treatment proved to be Viruddha i.e. apposite to

each other, Vikrti bhutatvat as said by Chakrapani126.

(2) Kruchrasadhya (Difficult to treat):

Madhumeha resulted because of Avaranjanya pathogenesis is difficult treat i.e.

Kruchrasadhya. Here the provocation of Vata results, but the etiological factors mainly related

to the Kapha and Meda. So we should have to consider both of them, there are very few

measures, which act against the Vata and Kapha combined127.

(3) Yapya (palliative):

Pittaja Prameha is palliative that means the disease needs continuous treatment. Once

the treatment stopped, suddenly disease get provoke because of the apposite treatment

measures we have to profound here i.e. Visama kriyatvat.

(4) Asadhya (Incurable)

Vataja Prameha is incurable because there is involvement of vital Dhatus like Majja,

Oja in the pathogenesis and the treatment modalities quite apposite to Dosha and Dushya128.

Susruta mentioned that if Kaphaja and Pittaja Prameha or All types of Prameha if not treated

properly or ill-treated become Asadhya129.

(4) Prognosis related to Medodusya :

Charaka described that if there is less extent vitiation of Meda dhatu in Kaphaja and

Pittaja Prameha then Pittaja Prameha becomes curable but when there is more vitiation of

Meda then Kaphaja and Pittaja both Prameha become Asadhya. Charaka mentioned that

Madhumeha because of the Beeja Dosha i.e. genetic predisposition is incurable. Susruta

mentioned that Madhumeha in association with complication i.e. Pidaka is incurable130.


57

CHIKITSA IN MADHUMEHA

Chikitsa sutra (principles of treatments) and Chikitsa (Management Proper) are the

two divisions of this major part. Both these are described very well in classics. But the

concepts & methods are different in different conditions, considering the Vyadhi swabhava &

Atura. The Samprapti should be considered deeply before stepping to manage.

The eminent ancient ayurvedists, Charaka, Susruta and Vagbhata are considering the

body constitution and strength of the body of the patient when dealing with the management

aspect. Charaka considers two types of patients; one is that with stout body structure & with

strength and the other without strength and krusha. Sushrutacharya also says that sahaja meha

rogi will be krusha & apathyanimittaja rogi will be sthula.

In the context of medoroga, the managements described are parallel to that of meha

since the Dosha and dushyas are same to major extent. After considering all the factors the

two types of management emphasized are:

(1) Samshodhana Chikitsa (Elimination Therapy)

(2) Samshaman Chikitsa (Normalizing Therapy)

Like every disease, those factors which are responsible for the production of the diseases are

if eliminated and if further, causative factors are prevented meha can also be treated.

Madhumeha can be treated in this way although it is described as incurable. In Pratyakhyeya

vyadhis, symptomatic relief can be given by proper management.

1) KAPHAJA PRAMEHA 131

(i) Samshodhan Chikitsa

It is better to treat the patient with Vamana therapy. Charaka describes that shodhana,

vamana and langhana done at the proper time looking at the condition of the patient is able to


58

cure kaphaja meha. For vasti Chikitsa Vagbhata describes the utilization of Surasadi gana

kwatha. After explaining the shodhana the palliative treatment given is samshamana Chikitsa

in all types of Madhumeha.

(ii) Samshaman Chikitsa:

Charaka gives 10 combinations of drugs to all the mehas with Kapha predominance.

According to Susruta, after proper samshodhana the patient should use swarasa of amalaki

with Haridra powder with madhu. Susruta in this context explains single drug decoctions with

separate indications in 5 types of kaphaja meha and combinations in other 5 types. Vagbhata

describes three yogas in this aspect. They are as follows;

(i) Lodhradi- Lodhra, Abhaya, Musta, Katphala

(ii) Pathadi - Patha ,Vidanga ,Arjuna,Dhanyaka

(iii) Gayatrayadi - Khadirsara, Darvi, Vidanga ,Vacha

Importance of Apatarpana:

Charaka explains the cause of Prameha as due to increasing attitude of kleda, meda,

and Kapha. So he emphasizes the role of Apatarpana in kaphaja & Pittaja Prameha. Different

types of vyayama, kshut, udvartana, dhara & snana with churnas made of Chandana, Aguru,

Ela etc. are advised to use in kaphaja meha.

2) PITTAJA PRAMEHA 132


Virechana is best in pittaja pramehas. The drugs which are sufficient to eliminate

morbid Pitta can be used with sheeta and other tikta, kashaya rasa in this. Nyagrodhadi gana

kwatha is advised for Asthapanbasti by Vagbhata. Susruta has described that due to spreading

of medo dhatu all over the body, Madhumehi subjects are durvirechya.


59

(ii) Samshaman Chikitsa

Charaka explains 10 pada yogas in this aspect to treat pittaja pramehas. Susruta has

described 6 specific kwatha yogas for the specific type of pittaja Prameha.

The three kwatha yogas explained by Vagbhata are 133-

(i) Ushiradi : Ushira, Lodhra, Arjuna, Chandana.

(ii) Patoladi: Patola, Nimba, Amalaki, Amrita

(iii) Lodhradi : Lodhra, Ambu, Kaleyaka, Dhataki

3) VATAJA PRAMEHA 134

Although vataja mehas are incurable still Charaka explains to induce certain treatment

in Kapha Pitta anubandhi Vatika meha. Susruta has described that all types of Prameha if not

treated properly in time, gets converted into Madhumeha. So the treatment described for

vatika meha can be considered as treatment of Madhumeha.

MADHUMEHA 135

Susruta has separately mentioned one chapter for the treatment of Madhumeha.


Considering Sthula and krusha pramehi, Samshodhan Chikitsa should be administered

only to the sthula and Balvan Pramehi. Sarshapa, Nimba, Danti, Bibhitak & Karanja siddha

Taila or Trikantakadya Sneha (Ghrita or Taila according to Dosha predominance should be

used for Abhyantara Snehana. Here while explaining the Samshodhan, Charaka describes to

use the Malashodhan yogas from Kalpa sthana Both Pitta and Kapha are eliminated through

shodhana. It may be vamana or virechana, because of Pittantam Vamanam, Kaphantam

Virechanam. In Virechana Pitta is eliminated first, then Samyak lakshana of virechana is

kaphadarshan, so both Pitta and Kapha doshas which are vitiated are eliminated. Then the


60

described Anuvasana & Asthapana Basti chikitsas are able enough to control the provocation

of Vata. Like this all the doshas are normalized to keep the Dosha samyata. Anuvasana with

medicated oils and ghritas are prescribed in Madhumeha. After proper Shodhan Chikitsa,

Charaka details to give santarpana Chikitsa to the patients, to prevent the complications like

Gulma, Bastishula etc.

(ii)Samshaman Chikitsa

Samshaman Chikitsa includes mainly deepana (appetizers) , Pachana, (enhancing

digestion), Kshut (Hunger maintenance), Trit (Maintenance of thirst), Vyayama (Exercise),

Atapa (Having exposed to sunlight ) and Maruta ( Exposing oneself to wind).According to the

conditions of vitiated doshas and dushyas , a physician has to suggest proper Shaman Chikitsa

to the patient. Acharyas introduces different tarpana upakramas in vatika mehas. It is due to

the less strength of the patient. Acharya Charaka & Vagbhatta says that the kashaya yogas

should be enriched with sneha and given to vatika mehas .

Typical Madhumeha Chikitsa

Susruta explains that Shilajitu should be taken after triturating with Salsaradi gana

kwatha. After its digestion patient should take Jangala mamsa rasayukta Anna. He prescribes

to take 1 Tula of shilajatu.

Compound Preparations Used In Prameha:

Swarasa : Amalaki, Haridra, Nimbapatra, Bilwapatra, Guduchi

Kwatha : Vidangadi, Phalatrikadi, Mustadi, Manjishthadi, Pathadi

Churna : Triphaladi, Mustadi, Gokshuradi, Arkadi

Gutika : Chandraprabha, Indravati, Pramehantak Vati

Gugglu : Gokshuradi Guggulu


61

Modaka : Kastur Modaka

Avleha : kushavleha, Bangavleha

Paka : Pugapaka, Ashwagandhadi paka, Draksha Paka.

Asava Arishta: Lodhrasava, Dantyasava, Madhukasava, Devdarvyadiarishta, Lodhrarishta.

Ghrita: Dhanvantar ghrita, Trikantakadi ghrita, Sinhamrita ghrita, Dadimadi ghrita, Shalmali

ghrita

Rasaushadhi: Vasant kusumakar Rasa, Mehamudgar Rasa, Brihat Vangeshwar Rasa,

Prameha gajkesri Rasa, Trivanga Bhasma, Vasant tilaka Rasa.

MANAGEMENT OF DIABETES MELLITUS 136

Management, rather than treatment, is the appropriate term in Diabetes mellitus, and

involves diet, exercise, insulin, oral hypoglycemic, patient education and counseling. Insulin

and oral drugs are discussed here and the other aspects of management in subsequent

chapters.

INSULIN:

Insulin is required for treatment of all patients with IDDM & many patients with

NIDDM. No single standard exists for patterns of administration of insulin and treatment

plans vary from physician to physician. With a given physician for different patients three

treatment regimes will be described. Viz. Conventional, Multiple subcutaneous injections

(MSI) and Continuous subcutaneous insulin infusion (CSII).

Conventional Insulin Therapy:

Conventional therapy involves administration of one or two injections a day of

intermediate acting insulin such as zinc insulin (NPH insulin) with or without the addition of

small amounts of regular insulin. This practice is based on the concept that regular insulin


62

lowers the plasma glucose level rapidly after which more slowly absorbed insulin maintains

the lowered level. Here patients should be taught to decrease insulin when extra exercise is

anticipated.Multiple subcutaneous insulin injection technique (MSI): Most commonly

involves administration of intermediate or long acting insulin in the evening as a single dose

together with regular insulin prior to each meal.

Continuous subcutaneous insulin infusion (CSII): This involves the use of a small

battery driven pump that delivers insulin subcutaneously into the abdominal wall.

Adjustments in dosage are made in response to measured capillary glucose values, as in MSI.

Though CSII provides better Diabetic control, there is a higher risk of Hypoglycaemia and

Diabetic Ketoacidosis.

ORAL AGENTS:

Sulphonyl ureas: NIDDM that cannot be controlled by diet & exercise often responds

to sulphonyl ureas. Sulphonylureas, like Chlorpropamide & Tolbutamide, act

primarily by stimulating release of insulin from β cell, but are useful only in patients

with relatively mild disease.

Second generation drugs such as Glipizide & Glyburide are effective in smaller

doses and differ little from Sulphonylureas. Hypoglycemia occurs less often with oral

agents than with insulin. But when it occurs it tends to be severe & prolonged.

Biguanides: Metformin is useful in NIDDM patients who are not responsive to diet &

exercise. The primary action is thought to be inhibition of hepatic gluconeogenesis &

it also may enhance glucose disposal in muscle & adipose tissue. Melformin does not

cause hypoglycemia unlike sulphonylureas, metformin can cause lactic acidosis hence

should not be given in patients with renal disease.


63

Thiazolidinedione derivatives: Such as troglitazone, lower blood levels of glucose,

free fatty acids & triglycerides and appears to reduce insulin resistance. Troglitazone

is approved for use in obese patients with NIDDM who are poorly controlled on

insulin.

PATHYA-APATHYA 137

Those Aahara and vihara which are suitable to pramehi are called Pathya and those

which induce Prameha are called Apathya. Pathya is having a key role in the management of

Madhumeha. Even in modern science also Diet & Exercise are included in diabetes

management. So before stepping to manage we have to consider for the Pathya-Apathya.

Pathya and Apathya Aharas and Viharas according to different Ayurvedic classics are as

follows:

Pathya in Madhumeha

(a) Aahara:

Shook Dhanya: Jeerna Shali, Shashtika, Kodrava, Yava, Godhuma, Uddalaka,Shyamaka

Shimbi Dhanya:Chanaka, Adhaki, Kulattha, Mudga

Shaka Varga: The leafy vegetables with a predominance of tikta-kashaya rasa, Patola,

Karvellaka, Shigru

Phala Varga: Jambu, Dadima, Shringataka, Amalaki, Kapittha, Tinduka, Kharjura, Kalinga,

Navina Mocha.

Mamsa Varga:Vishkira mamsa,Pratuda, Jangala mamsa

Taila Varga: Danti, Ingudi, Sarshapa , Atasi

Udaka Varga: Sarodaka,Kushodaka,Madhudaka

Kritanna Varga: Apupa,Saktu,Yavodana,Vatya,Yusha


64

Others: Madhu, Hingu, Saindhava, Maricha, Lasuna

(b) Vihara: To have walk, traveling on elephants, horses and different plays, different form

of marshal arts, roaming in different places other than temples and umbrella

Apathya in Madhumeha

(a) Aahara: Jala, Milk, Ghee, Oils, Curd, Sugar, Different types of rice preparations, anupa,

gramya and audaka mamsa, Ikshurasa, Pishtanna, Navanna.

(b) Vihara: Eksthana asana, Divaswapa, Dhoompana, Sweda, Raktamoksha, Mutravega

dharana.

TRIAL DRUG (AKULYADI YOGA) REVIEW

Medicine is the prime concern when disease manifests. Madhumeha is the disease

primarily of metabolic derangement includes vitiation of various body elements. Excessive

formation or deranged Meda, Kleda, Vasa and Lasika along with the depletion of vital Dhatus

like Oja and Majja cause the Vata provocation and ultimately Madhumeha. Thus line of

treatment should be to reverse the pathogenesis with the help of Samana as well as Sodhana.

The medication should posses, as discussed in Chikitsa, Tikta and Kasaya Rasa along with

Kapha Vata hara, Medo hara, Kledaghna and Prameha hara properties. Thus the selected

combination – Akulyadi yoga is of the drug of choice for the present clinical trial.

Combination of Akulyadi Yoga 138

SN Drugs Name Latin Name Proportion

1 Akuli 139 Cassia auriculeta 1 Part

2 Amalaki140 Embilica officinalis 1 Part

3 Haridra141 Curcuma longa 1 Part


65

Name & Latin name Akuli – Cassia auriculeta 142

Gana Guduchyadi varga 143

Parts used Mukula

Rasa Kashaya ,Tikta

Guna Laghu ,Rooksh

Veerya Sheeta

Vipaka Katu

Prabhava Grahi, Rechaka

Doshaghnata Kapha Pitta shamaka,

Karma Pramehaghna, Atisarahara, Raktapitta hara

Chemical constituents Emodin, Rubradin, Festinidols

* Name & Latin name Amalaki – Embilica officinalis 144

Gana Vayasthapana145, Virechanopaga146

Parts used Phala

Rasa Madhura, Amla, Katu, Tikta, Kashaya

Guna Laghu, ruksha

Veerya Sheeta

Vipaka Adhura

Prabhava Rasayana

Doshaghnata Tridosaghna

Karma Raktapitta, Krimighna, Prameha hara

Chemical constituents Gallic acid Tannic acid, and Vit – C

*


66

Name & Latin name Haridra – Curcuma longa 147

Gana Lekhaneeya148, Kustaghna149, Krimighna150

Parts used Kanda

Rasa Tikta, Katu

Guna Rooksha, Laghu

Veerya Ushna

Vipaka Katu

Doshaghnata Kapha Vata hara

Karma Pramehaghna, Kustaghna, Krimighna

Chemical constituents Curcumene, Curcumenone, Camphor

All the ingredients of the Akulyadi yoga are well identified and collected from local

area; good manufacturing practice will be followed for preparation. Even though above yoga

mentioned in “churna kalpa” for easy administration it is tabulated after 3 times fortification.

The prepared drug is preserved in glass jars to protect the shelf life of the medicine. Later at

the time of distribution requisite quantity of the medicine is packed and given to patients. The

individual components of the composition are as follows under specified headings.

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Methods

67

Chapter - 4

Methods

The clinical study is based on the classical explanations with scientific well

designed research protocol, which enumerates the patient before to administrate the trial

drug to after effects in comparison.

Criteria for selecting drugs

1. The above mentioned Akulyadi yoga, which are taken from the Yogaratnakara

Pramehadhikara.

2. The pharmacological actions of the individual drugs are Pramehahara.

3. The trial drug, Akulyadi yoga is selected according to the pharmacological action

and properties of individual drugs with in.

4. Akulyadi yoga is purely herbal; they are cheaper and easily available as in the local

market.

5. Akulyadi yoga is very easy to process and vati making

6. Akulyadi yoga is very easy to dispense.

7. The said combination Akulyadi yoga is hypothetically effective in reversal of

Samprapti or the patho-physiological normalcy induction in Madhumeha.

Criteria for quantity of the drug

All the drugs which are selected has pharmacological action against Madhumeha

with therapeutic effects which are the equitant so it is considered to under take in equal

quantity of the Akulyadi yoga ingredients as said in the text.


68

Methods followed in trail

1) Method of Research design

Madhumeha vis-à-vis Diabetes mellitus is a major health problem for the world of

21st century. At least 50% of all people are with Madhumeha are undiagnosed and noticed

from a dentist. In spite of advanced medical research, it is still a burning problem for the

society. Recent studies reveal that the prevalence rate of type-2 diabetes is from 10-18% in

the urban Indian adult population and also increasing in rural population too.Thus the trail

is Simple Random sampling technique clinical study. In this Patients were taken in

randomized selection.

2) Posology of Trial drug

Internally: 3000 mg / 24hrs in divided two doses or 50mg /Kg body weight

distributed in equal doses

3) Anupana of Trial drug

Madhodaka is undertaken as it is stipulated for the medicine.

4) Study duration of Trial drug

Akulyadi yoga Simple Random sampling technique clinical study was conducted

for 21 days. The medicine was dispensed for 7 days to all patients and advised to report for

every 7 days interval, noted the nature, frequency and other symptoms of their disease

during their visits.

5) Follow up of Trial drug

Akulyadi yoga trail offered a further follow up 21 days. The effect of yoga was

analyzed according to clinical and functional response before and after the treatment is


69

compared to that of follow up data. In further the final declaration of the trail drug effect

and result is done on the basis of the follow up data.

6) Source of data of Trial drug

In spite of this much of prevalence and increasing nature of the disease all over the

world, still researchers are struggling for a good, effective and harmless remedial measure

of Madhumeha. Diet control, exercise, oral hypoglycemic agents and insulin have tried and

treated this public health threat, Madhumeha. The data was collected from the patients

suffering from Madhumeha in the OPD of post graduation and research center DGM

Ayurvedic medical college Gadag. The method of the present study consists of following

headings.

a) selection of the patient

b) examination of the patient

c) criteria of assessment

a) Selection of the patient

Patients of Madhumeha fulfilling the criteria of diagnosis were selected in the

present study. Patients were distributed based on preset inclusion and exclusion criteria.

Patients were excluded, as they are discontinuous at the treatment or unable to fulfill the

study design.

i) Inclusion criteria

Patients with symptoms of Madhumeha are included with classical

symptoms enumerated at the classical texts under the lime light of contemporary

medical context along with criteria of inclusion. The symptoms of inclusion are as

under.


70

• All patients other than that of exclusive criteria are included

• Age of patients between 25-65 years

• Irrespective of gender

• Non-insulin dependent diabetes mellitus

• Patient having clinical features of Madhumeha viz.

1. Prabhoota Mootrata

2. Avila Mootrata

3. Dourbalya

4. Shareera Bhaarahani

5. Janghamamsagraha

6. Karapada Daha

7. Pipasa

8. Kshudhadhikyata

ii) Exclusion criteria

Patients other than exclusion criteria are included in the present study. The

specified exclusions are as under with their causes.

i. Insulin dependent D.M Vis-à-vis Madhumeha

ii. Patients who develops complication with other systemic disease

iii. Juvenile diabetes

iv. Malnutrition D.M

v. Gestational D.M

b) Examination of the patient

Patient through examination is necessary to obtain clear picture of disease and also

the effect of trail drug – Akulyadi yoga. For that the following methods are obtained in the

study.


71

b-1) Physical signs of Madhumeha patients –

For diagnosis, a detailed medical history is taken and physical examination also

undertaken in detail according to Ayurvedic and contemporary clinical methods. Patients

are diagnosed according to diagnostic criteria given for Madhumeha vis-à-vis DM. A

special case sheet is prepared incorporating all Madhumeha aspects, which is placed as

annexure.

b-2) Diagnosis measurements

The signs and symptoms of Madhumeha mentioned in Ayurveda and contemporary

science were the main basis of diagnosis and criteria for assessing the response to the

treatment. Assessments of results were made according to clinical and functional

improvement observed in the study. Clinical assessment was made on the basis of

symptoms viz. prabhoota mootrata, kshudha etc., which are allotted grades according to

their severity or to that of normalcy. The grades are followed as under.

Grades of assessment

1) Prabhoota Mootrata

Grade 0 = 1000 – 1500 ml/ 24 hrs

Grade 1 = 1500 – 2000 ml/ 24 hrs

Grade 2 = 2000 – 2500 ml/ 24 hrs

Grade 3 = 2500 – 3000 ml/ 24 hrs

Grade 4 = 3000 – above ml/ 24 hrs

2) Avila Mootrata (Turbidity)

Grade 0 = Crystal clear fluids

Grade 1 = faintly cloudy or hazy with slight turbidity

Grade 2 = Turbidity clearly present but news print can be read

through the tube.

Grade 3 = More turbidity & news print can not be read.


72

3) Dourbalya

Grade 0 = No Dourbalya

Grade 1 = occasionally noticed

Grade 2 = periodically noticed

Grade 3 = daily noticed

Grade 4 = continuously noticed

4) Shareera Bhaarahani

Grade 0 = No Bhaarahani



Grade 3 = regularly noticed

5) Janghamamsagraha

Grade 0 = No Janghamamsagraha




Grade 4 = continuously observed

6) Karapada Daha

Grade 0 = No Karapada Daha





7) Pipasa

Grade 0 = No Pipasa






73

8) Kshudhadhikyata

Grade 0 = No Kshudhadhikyata





b-3) Assessment measures and Laboratory-investigations

The following investigations are under taken to fulfill the criteria of inclusions and

exclusions. The effective parameters which are considered for the assessment are as under.

a) Blood Sugar estimations

Blood glucose is determined by using Gluzyme glucose reagent set

Procedure

A blood sample is collected from patient into a sterilized container. Serum is

separated from the cells at the earliest possible time (within 30 minutes), then the serum

blood is mixed with the reagent (working solution) and heated at 37°C for 15 minutes. The

readings are observed from colorimeter under 520 nm.

Pipetting scheme for determination of blood sugar

Blank Standard Test

Working enzyme reagent (ml) 3.0 3.0 3.0

Distilled water (ml) 0.025 - -

Standard ( ml) - 0.025 -

Sample (ml) - - 0.025

Calculation

Glucose in mg/ dl = Absorbance of sample x 100 Absorbance of standard


74

The same procedure is applied for both FBS and PPBS. The FBS is done with

empty stomach and on the same day the PPBS is calculated after 2 hours of food and the

results are recorded in case sheet.

b) Urine Sugar estimations

A fresh urine sample is collected from the patient. 5 ml of Benedict solution is

taken in a test tube and 5-6 drops of urine sample in put in that. Then the test tube is heated

till until a boil in the solution and cooled at room temperature. The change is observed for

the presence of sugar.

Observations

Colour of test solution Urine sugar

Blue

Green

Yellow

Orange

Brick red

Nil

0.5 %

1.0 %

1.5 %

2.0 %

The following are investigations were done prior to the study according to the need

either to make an exclusion or inclusion in to the study, which are commonly undertaken

for the purpose of prognosis.

a) Erythrocyte Sedimentation Rate

b) Hemoglobin %

c) Blood Differential Count

c) Criteria of assessment

Over all assessment of results are done considering the cumulative

subjective and objective parameters assessments. As the disease is not


75

totally curable in the scheduled time span of the study, the grades of

assessments made for the results declaration are as follows -

1. Regulated –

i. Patient relieved with symptoms clinically

ii. PLBS controlled totally to normal with in schedule and continued even at

Follow up period

2. Palliative –

i. Incomplete Symptomatic relief for the patient clinically

ii. Reduced PLBS at schedule to normal and fluctuated at Follow up period

3. Responded –

i. Symptomatic relief for the patient is witnessed partially

ii. Partial Reduction of PLBS at schedule and increased at Follow up period

4. Not responded

i. None of the above conditions

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Results 76

Chapter - 5

Results Present study registers 20 patients, out of 55 approached patients. The percentages of

patients undertaken from the scrutinised are 36.36%. The 20 patients of Madhumeha viz.

Diabetes Mellitus, fulfilling the criteria of diagnosis and inclusive criteria were included in

the study. Fasting and Postprandial blood sugar (FBS and PPBS) along with corresponding

urine sugars (FUS and PPUS) are considered as an objective for the inclusion in the present

study.

All the patients were examined before and after the trail, according to the case sheet

format given in the annex. Both the subjective and objective criteria were recorded along with

validation of disease state. The data recorded are presented under the following headings.

A. Demographic data

B. Validation of disease Data

C. Result of the Akulyadi yoga and

D. Statistical analysis

A) Demographic data:

The details of Age, Gender, Religion, and Occupation etc. of the 20 patients are as

follows.

A1) distribution of patients by Age

Here in this study an attempt is made to understand the male female responses to the

management with respect to that of the age groups. An interval of 10 has considered from the

ages 25 to 65 as discussed in the methods. In the study it is revealed that Madhumeha is even

though thought that starts from the ages of 25 onwards and the fact found is not suggestive. At


the older age group of 55-65, 5 (25%) patients reported suggest the chronicity of the disease.

Where in 45-55 and 35-45 age groups reported with 9 (45%) and 6 (30%) patients in each

group respectively. It is interested to note that the active age group patients of 35-45 age

groups reported only 6 (30%) patients. Out of the 45-55 ages a maximum (7) patients

regulated the disease. The tabulations are depicted as under.

Table- 10

Results by Age in Madhumeha with Akulyadi yoga

Age Regulated Palliative Responded Not Responded Total %

25- 35 0 0 0 0 0 0

35 – 45 3 0 3 0 6 30

45 – 55 7 0 2 0 9 45

55 – 65 1 1 3 0 5 25

Total 11 1 8 0 20 100

% 55 5 40 0 100 *

Figure – 3


0000

30

30

702

011

30

0 2 4 6 8

25- 35

35 – 45

45 – 55

55 – 65


Not RespondedRespondedPalliativeRegulated


A2) Distribution of patients by Gender

Table- 11

Results by Gender in Madhumeha with Akulyadi yoga

Gender Regulated Palliative Responded Not Responded Total %

Male 6 0 6 0 12 60

Female 5 1 2 0 8 40

Total 11 1 8 0 20 100

% 55 05 40 0 100 *

The male female ratio in the study is approximately 3:2 patients. The percentage of the

distribution does not show any gender differentiation to get this Madhumeha in specific,

except a small lean towards male population. The observations are 12 Patients i.e. (60%) male

and 8 patients i.e. (40%) were female.

Figure - 4



Male60.00%Female

40.00%


A3) distribution of patients by Religion

For the convenience of the study, the religion groups are noted as Hindu, Muslim,

Christian and Others. The maximum number of patients are noticed from the Hindu

community as the ratio of community at the study area is more i.e. 16 (80%) along with

Muslim patients 4 (20%).

Table- 12

Results by Religion in Madhumeha with Akulyadi yoga

Religion Regulated Palliative Responded Not Responded Total %

Hindu 8 0 8 0 16 80

Muslim 3 1 0 0 4 20

Christian 0 0 0 0 0 0

Others 0 0 0 0 0 0

Total 11 1 8 0 20 100

% 55 5 40 0 100 *

Figure – 5

Results by Religion in Madhumeha with Akulyadi yoga

Results by Religion in Madhumeha with Akulyadi

yoga

Christian 0.00%

Hindu80.00%

Muslim20.00%

Others0.00%


At the results observed, out of 16 (80%) of Hindu patients, 8 (40%) patients regulated

and 8 (40%) patients fall under responded category. On the other hand the results observed at

Muslim community are, out of 4 (20%), 3 (15%) patients fall under the category of regulated

and one has palliative response. The tabulation and graphical representation is as under.

A4) Distribution of patients by Occupation

Table- 13

Results by Occupation in Madhumeha with Akulyadi yoga

Occupation Regulated Palliative Responded Not Responded Total % Sedentary 6 1 8 0 15 75

Active 2 0 0 0 2 10

Labor 3 0 0 0 3 15

Total 11 1 8 0 20 100

% 55 5 40 0 100 *

Figure - 6



Active10.00%

Sedentary75.00%

Labour15.00%


At the results observed, out of 15 (75%) of sedentary patients, strongly suggests that

the Madhumeha is a disease of the sedentary patients, out of which 6 (30%) patients

regulated, 1 (5%) patient is palliative responded and 8 (40%) patient were responded to the

treatment. At the active group, out of 2 (10%) patients all two are regulated. At the results are

observed, out of 3 (15%) of Labour all three are regulated in the treatment. The pictorial

representation is as above.

A5) Distribution of patients by economic status

At the results observed, out of 2 (10%) of poor patients, all two are regulated. Out of

2 (10%) of Middle class patients all are regulated. From higher middle class 8 (40%) patients

reported and out of them 3 (15%) patients are regulated, 1 (5%) patient have palliative

response and 4 (20%) patients are responded. 8 (40%) patients are reported from the higher

class of classification, show 4 (20%) regulated and the rest 4 (20%) responded. The tabulation

and pictorial graph is expressed as here.

Table- 14

Results by Economic status in Madhumeha with Akulyadi yoga

Economic status Regulated Palliative Responde

d

Not Responde

d Total %

Poor 2 0 0 0 2 10

Middle 2 0 0 0 2 10

Higher Middle 3 1 4 0 8 40

Higher 4 0 4 0 8 40

Total 11 1 8 0 20 100

% 55 5 40 0 100 *


Figure - 7

Result Distribution of patients by Economic status

A6) Distribution of patients by diet

Table- 15

Results by Diet in Madhumeha with Akulyadi yoga

Diet Regulated Palliative Responded Not Responded Total % Vegetarian 6 0 7 0 13 65

Mixed diet 5 1 1 0 7 35

Total 11 1 8 0 20 100

% 55 5 40 0 100 *

The vegetarian and mixed diet ratio in the study is approximately 2:1 patients. The

percentage of the distribution does not show any diet differentiation to get this Madhumeha a

disease in specific, except a small lean towards vegetarian population. The observations are

13 Patients i.e. (65%) vegetarian and 7 patients i.e. (35%) were mixed diet practitioners.

2 2

3

4

0 0

1

00 0

4 4

0 0 0 000

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Poor Middle Higher Middle Higher

Results by Economic status in Madhumeha with Akulyadi yoga

Patients


Figure - 8 Results by Diet in Madhumeha with Akulyadi yoga

As the results observed, out of 13 (65%) vegetarians, 7 (35%) patients are Responded

and 6 (30%) patients Regulated to the management. As the results observed in mixed diet

population, out of 7 (35%), 5 (25%) patient are regulated response, 1 (5%) patient responded

palliative and 1 (5%) patient responded to the treatment.

B) Data related to the disease.

B1) Distribution of patients by presenting complaints

Almost all the symptoms selected as the presenting complaint as analyzed reflects the

said complaints of the text and Prabhoota mootrata (20 patients), Dourbalya (20 patients),

Kshudha adhikyata (18 patients) and Pipasa (17 patients) are observed stating the cardinal

symptoms as polyuria, polydipsia and polyphasia. The graph and tabulations are shown as

below.

Results by Diet in Madhumeha with Akulyadi yoga

Vegetarian 65.00%

Mixed diet35.00%


Table –16

Distribution of patients by presenting complaints

Presenting complaints Patients %

Prabhoota Mootrata 20 100

Dourbalya 20 100

Kshudhadhikyata 18 90

Pipasa 17 85

Karapada Daha 16 80

Avila Mootrata 15 75

Shareera Bhaarahani 13 65

Janghamamsagraha 13 65

Figure - 9



Avila Mootrata, 15 Janghamamsag

raha, 13

Shareera Bhaarahani, 13

Karapada Daha, 16

Kshudhadhikyata, 18

Prabhoota Mootrata, 20

Dourbalya, 20

Pipasa, 17

0

5

10

15

20

25


B2) Distribution of patients by Associated features

Mukha talu sosha is said as associated symptom for Madhumeha, which is observed

here at the maximum. 11 each patients observed with Karapada spuptata and Sandhi Shoola.

Alasya is observed by the 50% of the patients. This study observes the rest of the associated

complaints enumerated in the table below along with the graph.

Table – 17

Distribution of patients by Associated features

Presenting Associated features Patients Percentage

Mukha/Talu shosha 19 95 Kara/Pada suptata 11 55 Sandhi Shula 11 55 Alasya 10 50 Gurugatrata 9 45 Klama 7 35 Tandra 5 25 Shithilangata 4 20

Figure – 10



Klama, 7 Shithilangata, 4

Tandra, 5Gurugatrata, 9

Sandhi Shula, 11

Mukha/Talu shosha, 19

Kara/Pada suptata, 11

Alasya, 10

0

2

4

6

8

10

12

14

16

18

20


B3) Distribution of patients by Ahara Nidana

Table – 18 Ahara Nidana observed in the study

Ahara Nidana Patients Percentage

Guda 20 100 Dadhi 20 100

Snigdha 17 85 Dugdha 16 80 Navanna 14 70 Sheeta 13 65

Gramya 5 25 Anoopa 4 20 Auduka 4 20

Ayurveda offered many causes especially in regard with food. The Guda and Dadhi

said as causes are observed 100% in the study. The other factors also observed in the study

are tabulated above.

B4) Distribution of patients by Vihara Nidana

Many regimens are told in Ayurveda, out of which Diwaswapna is observed 100% and

Avyayama 90% and swapna sukham for 50% of patients. The vihara tabulated are here under.

Table – 19 Vihara Nidana observed in the study

Vihara Nidana Patients Percentage

Diwaswapna 20 100

Avyayama 18 90

Swapnasukham 10 50

B5) Distribution of patients by Anya Nidana

The other Nidana told in texts are very less observed here. Only Sthoulya is observed

for 50% of patients.


Table – 20 Distribution of patients by Anya Nidana

Anya Nidana Patients Percentage Sthoulya 10 50

Manishika- Chinta 7 35 Krimi 0 0

Vegavarodha 0 0 Panchakarma Vibhramsha 0 0

B6) Distribution of patients by Poorva roopa lakshana

Table – 21 Distribution of patients by Poorva roopa lakshana

Poorva roopa Patients Percentage Mutra madhurata 20 100

Trishna 20 100 Talu kloma shosha 19 95

Swedadhikya 17 85 Shitalangata 16 80 Sheeta iccha 15 75

Nidra 14 70 Nakha vruddhi 13 65

Maldhikyata in bahya chidra 12 60 Shareera durgandha 11 55

Kesh jatilata 10 50 Alasya 10 50

Deha chikkanata 9 45 Mukha madhurta 9 45

Pada daha 8 40 Pani daha 8 40

Dantadeenam Malatvam 7 35 Tandra 7 35 Swasa 6 30

Mutra shuklata 5 25


The Poorva roopa mentioned in Ayurveda are observed here in the study. Mutra

madhuryata and Trishna are 100% and Talu kloma sosha is observed for 95%. The rest of the

symptoms observed are tabulated here along with percentage.

B7) Distribution of patients by Sroto dusti lakshana

Table – 22

Distribution of patients by Sroto dusti lakshana

Sroto dusti lakshana Patients Percentage

Jihwa shosha 20 100 Talu shosha 20 100 Osta shosha 14 70 Kloma shosha 18 90 U

daka

vaha

Pravruddha pipasa 20 100 Alpalpa mootrata 0 0 Mootara rodha 0 0 Adhika mootra 20 100 Sashoola mootra 4 20 M

ootra

vaha

Basti stabdhata 0 0 Arbuda 0 0 Arsha 0 0 Mamsa shosha 0 0

Mam

sava

ha

Shira granthi 0 0 Sweda 12 60 Snigdhanagata 6 30 Sthulashophata 1 05

Med

ovah

a

Pipasa 20 100 Out of different srotas included in the study explicit new dimensions. Out of

Udakavaha srotas – Pravruddha Pipasa, Jihwa and talu sosha, in Mootravaha srotas – Adhika


Mootrata, in Medovaha srotas the Pipasa are observed 100% in the study. It conform the

involvement of these srotases. The enlisted symptoms are at above table.

B8) Family history

Table – 23

Data of Family history in the study

Family history Patients Percentage

Present 12 60 Absent 8 40 Total 20 100

The Madhumeha observed as familial by researcher prove in study with 60% family

history. The rest of 40% show the instantaneous expression of the disease.

C) Result of the Akulyadi yoga

C1) Assessment of Subjective parameters

Table – 24

Presenting complaints

Patie

nts

Bef

ore

%

Patie

nts

Afte

r

%

Patie

nts

relie

ved

%

Dourbalya 20 100 2 10 18 90

Shareera Bhaarahani 12 60 3 15 9 75

Janghamamsagraha 13 65 3 15 10 77

Karapada Daha 17 85 3 15 14 82.3

Pipasa 17 85 7 35 10 58.8

Kshudhadhikyata 16 80 6 30 10 62.5

The assessments of the symptoms which are presented as the chief complaints are the

subjective parameters of the study observed initially Dourbaly as 100% is witnessed reduced

for 90% in the study. The Shareera bharahani initially for 60% of patients later observed it as


weight gain in 75% of patients. In the same way the Jangha mamsa graham initially observed

65%, the control rate observed as 77% at the completion of study. Karapada Daha is for 85%

of patients’ initially recorded 82.3% relief. Pipasa initially for 85% of patients exhibit the

58.8% of relief. Another major symptom Kshudhadhikyata is seen in 80% patients at the start

become reduced 62.5% in the study.

C2) Assessment of Objective parameters

Table - 25

Presenting complaints Pa

tient

s B

efor

e

%

Patie

nts

Afte

r

%

Patie

nts

relie

ved

%

Prabhoota Mootrata 20 100 3 15 17 85

Avila Mootrata 9 45 1 05 8 88.88

Fasting Blood Sugar 20 100 8 40 12 60

Post prandial Blood sugar 20 100 10 50 10 50

Fasting Urine Sugar 13 65 5 25 8 61.5

Post prandial Urine sugar 17 85 7 35 10 58.8

The objectives are very much important to assess a study. Here in the study Mootra

prabhootatva is reduced 85% and Avila mootrata for 88.88%. The FBS and PPBS exhibit

60% and 50% differences in the study, where in the FUS and PPUS show the 61.5% and

58.8% variances from the base line data.

C3) Results of the Akulyadi yoga

The result is based upon the cumulative effect of the subjective and objective

parameters together assessed. The result is drawn in four categories viz. Regulated, Palliative,

Responded and not responded. In the study at the follow up, if any increase of PPBS is

observed the patient is brought one step down to the declared result. The result of the


Akulyadi yoga declared is representing the efficiency of the drug with its embedded qualities.

The tabulation is as below along with the graph.

Table - 26

Result of Akulyadi yoga in Madhumeha

Result Number of patients Percentage

Regulated 11 55

Palliative 1 5

Responded 8 40

Not Responded 0 0

Total 20 100

Figure - 11



Responded40%

Regulated 55%

Palliative 5%

Not Responded0%


D) Statistical analysis

To compare the effectiveness of a drug before and after the treatment the statistical

analysis paired t-test, by assuming that the drug is not responsible for changes in the reading

before and after the treatment. The conclusion drawn is as highly significant if P <0.05.

Table – 27

Statistical analysis of Akulyadi yoga

Parameter Mean SD SE t value P value Remark

Dourbalya 2.45 1.145 0.256 9.57 <0.001 HS

Shareera bharahani 1.1 1.165 0.260 4.23 <0.001 HS

Janghamamsa graham

0.95 1.05 0.234 4.059 <0.001 HS

Karapada daha 1.4 0.94 0.21 6.666 <0.001 HS

Pipasa 2.2 1.281 0.286 7.69 <0.001 HS

Kshudhadhikyata 2.05 1.356 0.303 6.76 <0.001 HS

Prabhoota mootrata 3.2 0.894 0.2 16.0 <0.001 HS

Avila mootrata 0.5 0.606 0.135 3.703 <0.001 HS

FBS 48.605 30.41 6.80 7.147 <0.001 HS

PPBS 117.18 46.42 10.38 11.289 <0.001 HS

FUS 0.325 0.293 0.0656 4.954 <0.001 HS

PPUS 0.63 0.476 0.1066 5.9099 <0.001 HS

Among the subjective parameters dourbalya, pipasa, Kshudhadhikyata shows more

highly significant than other parameters. (Comparing p values) the parameters shareera

bharahani and jangamamsa graha are having almost equal effect before and after the treatment

(by comparing t-values). The parameters dourbalya having more net mean effect where as the

parameter jangamamsa graha is having less mean effect (comparing mean value) the variation

in the parameter karapada daha is less, where as in the parameter Kshudhadhikyata is more.


Among all the objective parameters all the parameters shows significant but in the

parameter prabhoota mootrata, PPBS, FBS are shows more highly significant (comparing p-

values). The parameters PPBS are having more net mean effect with more variation where as

in FUS having less mean effect will less variation (comparing mean and variations).

Among the subjective parameters the percentage improvement is in between 82% to

92%, which means that the percentage of improvement lies between these two values. Where

as in the objective parameter the more percentage improvement in the prabhoota mootrata

(94.1%) and where as in the parameter PPBS is least percentage improvement (14.312%).

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Discussion 94

Chapter - 6

Discussion A retrospective analysis of resource material reveals that various references relevant to

the topic are available under broad heading Prameha in the classics. The classical Ayurvedic

literature is sufficient with plenty of description of the disease and discussion regarding to

patho-physiology, symptomatology and the treatment modalities. Physiological and

pathological aspects of Dosha and Dushya regarding Madhumeha are available in detail.

Various pathological processes regarding Dosha and etiological factors defined in the classics

are under taken by various research studies carried out to find out the exact pathogenesis of

Madhumeha and its treatment.

Though the disease is of Tridosha predominant but Avrutta Vata and the Bahudrava

Shlesma are the main ailments. Madhumeha is the subtype of Vataja Prameha. Vata is the

originator and executor of the bio-motor functions. Vyanavata mainly pervades swiftly

through the body, effective transport and circulation is dependent upon him. Apanavata

related to the functions of Pakwashaya. In Madhumeha both are get vitiated leading to the

abnormal pathway and excessive elimination respectively. Kapha is the basis of structural

integrity of the body provides steadiness and strength in the body, keeping together various

structures.

All these function of Kapha get hampered in the Madhumeha. When Kapha get

vitiated it undoubtedly vitiates the body elements like Rasa Mamsa, Meda, Vasa, Lasika, Oja

etc. they in turns diminish the structured body integrity by providing excess of metabolic

waster because of faulty bi-fold digestion.


Pitta a somatic humour mainly related with the digestion and metabolism here due to

etiological factors Pitta also get vitiated it in turns affect the normal functions of Jathragni and

Dhatwagni leading to the excessive formation of deranged quality of Rasa, Mamsa, Meda,

Kleda etc. Thus in Madhumeha because of the above discussed patho-physiological

processes; i.e. Dushya obstructs the normal pathway of Vata causing Avarana to it that in

turns aggravate the Vyanavata leads to the transport of vital Dhatu Oja towards vasti where

already aggravated Apanavata excretes out it from the body resulting depletion of Dhatus and

generate disease Madhumeha. This pathogenesis mainly described by Charaka. Thus

aggravation of Vata excess of Dushya and metabolic waste due to abnormal bi-fold digestion

causes Madhumeha. Avarana is the essential part of any Vataja Samprapti. Another

pathogenesis of Madhumeha described in Ayurveda mainly related with the vitiation of Vata

due to its own etiological factors and genetics predisposition this entity is incurable mentioned

by Ayurveda because here severe diminution of Dhatus occurs. Thus Madhumeha having two

etiological factors one Santarpankara and second Apatarpankara. Excess of deranged

Shlesma, Meda ,Kleda, Vasa, Lasika etc. aggravated vata produces various

pahthophysiological changes in the body producing symptoms like Prabhata mootrata,

Avilamootra, Pipasa, Daurbalya, Alasaya etc, leads to the structural as well as functional

abnormalities in the body. In the pathogenesis more or less every body element is get

involved.

The present clinical study was planned in single group to manage the problem by trial

drug Akulyadi yoga. The subjects were treated with Akulyadi yoga for duration of 21days and

the yoga possesses Tikta, Kasaya Rasa, Vatakaphahara and Pramehaghna.


Discussion on demographic data

Because of decrease in beta cells the risk of diabetes increases as age advances;

especially after 40 years. It is well recorded fact that, the NIDDM occurs only after 3rd decade

of life. In this study, the above factors were proved, as all the patients were between the age

group of 30 to 62, suggestive of the age relation stress advancements and comforts at age

advancements to cause the Madhumeha. This reveals that maximum prevalence of the

disease is at Madhyama vayastha because at this stage of age there is natural aggravation of

Vata started and normal digestion / metabolism going to hamper. These findings were related

to the recent statistical data, which shows that the onset of type II diabetes mellitus in the

forties is most common.

Majority of the patient in the present study belongs to Hindu community i.e. 80%, but

it does not mean that Hindus are prone to this disease. This may be due to the local ratio of

difference religion. The patients were selected incidentally.

Susruta had said that women would not get Madhumeha; because their body gets

cleaned every month by the raja pravrutti. But it is seems as a controversial dialogue as

women also getting Madhumeha and they are also at high risk of getting diabetes compared to

men after 30years, especially after the pregnancy or at the time of pregnancy. In this study a

majority of the patients were male when compared to female, as shown in results chapter.

Majority numbers of patients were sedentary type of occupation. In sedentary type of

occupation physical activities are very less, it is clearly mentioned that people with sedentary

life styles more prone to diabetes mellitus or Madhumeha. In the present study 75% patients

were recorded with sedentary life styles.


In the present study 60% patients had family history and rest of the 40% patients had

no family history of Madhumeha. It is a well proven factor that family history had main role

in the manifestation of Sthoola Madhumeha.

In the manifestation of Madhumeha food habits had great importance. If we check the

Nidana aspects we can see the importance of food habits. At the same time lot of foods are

also mentioned which are helpful in controlling Madhumeha. In the present study 65%

patients were vegetarians and 35% patients were mixed. From these we can see that high

calorie intake is the main risk factor for diabetes.

Economics makes ones to susceptible for comforts. Majority of patients belongs to

upper middle and higher class, exhibiting richness. In these classes the people indulge in very

less physical activities and ultimately remain to sedentary life styles to get the a santarpanotha

Vyadhi, Madhumeha vis-à-vis Diabetes Mellitus.

Discussion on diseases components

Most of the Nidana mentioned in the classics were elicited in this study by detailed

questioning. Among general Nidana, all patients used to take snigdha and guru aharas

excessively. Among the viharas, Swapanasukham (10patients), Avyayama (18 patients) and

manasika karana (7patients) were also noted. From this we can say that snigdha ahara dravyas

and swapna sukhadi viharas had key role among the nidanas.

In ancient Ayurvedic treatises common premonitory symptoms are described but

special premonitory symptoms of Madhumeha are not mentioned. The disease having vast

field of etio-pathogenesis only few of them are cardinal sign and symptoms of Madhumeha.

These are pipasa, madhura mootrata, Asymadhurya, Panidaha, Padadaha. All patients shown

100% history of mutra madhurata and Talu kloma shosha observed almost all patients i.e.


95% Swedhadhikyata observed as 85%, Shithilangata is observed as 80% and sheeta iccha is

observed as 75%.

Prabhoota mootrata is observed as 100% in the study. This is a cardinal sign described

by all authors for Madhumeha. Vagbhata mentioned Prameha as disease of mootra

atipravruttaja. Avilamootrata is observed as 45%, for that Vagbhata emphasized that this

turbidity of the urine because of its annexation with the Dhatu.

Charaka enumerated the general Samprapti as it is due to over indulgence of

etiological factors, Kapha along with meda, mamsa and Kleda get vitiate and results into

formation of metabolic waste which carried towards vasti resulting Prameha. In same manner

Pitta get vitiated resulting pittaja Prameha. While Vata is due to depletion of other two Dosha

get provocative in turns causes depletion of dhatus by excrete them through urine resulting

vataja Prameha.

Susruta mentioned that Sahaja Prameha precipitate because of defect in beeja. This is

even explained by Charaka that Sahaja Madhumeha is a Kulaja Vikara, because of the defect

in beeja (Sperm / ovum). Here the patient is prone to Dhatu kshaya because of above factor.

Charaka explained the pathogenesis is due to specific etiological factors which vitiate Vata

draws out the vital dhatus and carries them towards vasti resulting into Madhumeha.

Charaka enumerated that due to depletion of Kapha and Pitta Vata get aggravate and

causes the excretion of dhatus through urine resulting into madhumeha. Though Vagbhata

narrated the cause of this type of Madhumeha but not explained the pathogenesis. Charaka

emphasized this pathogenic process in well elaborative manner. This is the unique

contribution of Charaka. Due to excessive indulgence of heavy, unctuous, salty and sour diet,

Avoidance of worry, exercise and purifying measures. Kapha and Pitta get provoked and


vitiates meda and mamsa. All are in excess quantity. They in turn cause obstruction to the

normal pathway of Vata. This obstructed Vata get aggravated and draws out the apara oja

from all over the body and carries it towards vasti resulting Madhumeha.

Majority of the patients shown symptoms and signs like Atisweda, Daurbalya, Alasya,

Arochaka, data suggestive of Vata dusti and Kapha dusti also present, medodosha were also

present here. Majority subjects shown Rasadusti, Medodusti, Kleda. Data suggestive that

medodusti is always present in Madhumeha and relevant to the quotation of Susruta that

sthaulya i.e. medoroga is because of Rasadusti, ojodusti suggestive of Dhatu depletion.

Kapha have peculiar nature i.e. Bahudrava described by Charaka. So it is easily

understand that the 'Shaithily' manifestation in this disease, as Kapha normally cause Sthiratva

in the body. Cakrapani commented upon the word Sthiratva means Ashaithilya. So this

bahudravatva of vitiated Kapha causes disruption in the assemblage of body elements and

provide ground for the accumulation of morbid matter in the tissues.

Again Kapha Dosha is the dominant factor in the pathogenesis of Madhumeha. It gets

vitiated primarily and causes the vitiation of concordant body elements like Meda, Mamsa,

Kleda, Rasa, Vasa, Lasika etc. The vitiation of Kapha here mainly is of excessive type. That’s

way the following symptoms manifests in madhumeha. These are shaithilya, Alasya, Atinidra,

Gaurava, etc. Charaka clearly mentioned and Cakrapani opined that Kapha Dosha is dominant

and primarily vitiated because of its close resembles with the etiological factors. This

excessive Kapha can be correlated with functions of growth hormone, which is antagonistic to

insulin, one of the causative factors for the precipitation of type- 2 Diabetes Mellitus.

Pitta Dosha is not so dominant factor in the pathogenesis of Prameha. By the vitiation

of Pitta, Avaranganya Samprapti of Madhumeha resulted. Rakta, Sweda, Lasika and Rasa are


the seats of Pitta Dosha so when Pitta get provoked, It undoubtedly causes the vitiation of

above Dusyas. That’s why the symptoms manifests are Sweda vruddhi, visra sharira gandha,

panidaha, pipasa and sosha indirectly Agni vaisyama too.

This is the main predominant Dosha in the pathogenesis of Madhumeha here is Vata

get aggravated either because of its own etiological factors or because of Avarana caused by

Kapha Pitta and Meda. This vitiated Vata carries the vital constituents of the body like Vasa,

majja, and oja towards vasti and excretes them outside through urine resulting depletion of the

dhatus. Thus due to severe depletion of Dhatu, the symptom manifests are Karsya, Daurbalya,

Angasuptata and Parisaransheela nature.

All authors narrated dushya sangraha and their involvement in the pathogenesis, but

caraka specially enumerated a group and named it as a Dushya visesa. Again he mentioned

them in Cikitsasthana also. Susruta also narrated the Dushyas but he typically mentioned them

along with the doshic type, but he commonly included meda in each type. Only Vagbhata

mentioned sweda as a dushya along with above dushyas.

This is one of the Dhatu mainly vitiates. Here because of its close resemblance with

Kapha qualitatively Again Rasa is one of the seats of Kapha Dosha and Pitta Dosha. So if

Kapha get vitiate Rasa also get vitiate. That’s why having same symptoms related to Vruddhi

as mentioned by Vagbhata i.e. Rasoapi Slesmavat'.

Susruta emphasized that Sthaulya and Karshya results due to vitiation of Rasa Dhatu

and practically we can found both conditions in the Madhumeha. So the role of Rasa Dhatu is

very much important in the precipitation of the disease. Vitiated Rasa shows manifestations

like Alasya, Gaurava, Krsangata, Klaibya and Agninasa in context to Madhumeha. Rakta

Dhatu have no much involvement in the manifestation of the Madhumeha. It is mainly getting


vitiated in pittaja Prameha. Not initially but in later stage Rakta also get vitiated prominantly

causing complications like Pidaka, Vidrdhi, Alasi.

One of the main Dushya described by Charaka is Mamsa. He narrated it especially in

Kaphaja Prameha and Avaranjanya Madhumeha, as Mamsa and Kapha have same qualities.

They both give strength to the body. When get vitiated, Mamsa losses its normal consistency

and develops Shaithilya and provide space in between for the accumulation of morbid matter.

That in turn results into the Putimamsa Pidika.

Medas vitiation is common and dominant Dushya in the pathogenesis of Madhumeha.

Kapha and Meda have close resemblance in regard to functions as well as qualitative

parameters. Both are getting vitiated more or less by same etiological factors. Meda vitiation

in Madhumeha appears in two ways i.e. the former is Qualitative - Abadha (Asamhatum)

Normal function of Meda is to produce unctuousness in the body along with Dradhatva i.e.

compactness. So this Abadhatva causes derangement in the structure of Meda producing

Shaithilya in the body. This can be well correlate with FFA excess. The later is Quantitative -

Here in the pathogenesis, Meda is in excess quantity. This Medo Dhatu is Aparivakva. It

obstructs the path of Vata along with Kapha. This provoked Vata increases the Agni so

patient unnecessary eats more and more food causing excessive deposition of Aparipakva

Meda. This in turns causes severe depletion of the other Dhatus and produces various sign and

symptoms.

In Ashtanga Sangraha, Vagbhata mentioned that along with Prameha Purvarupa

excessive Meda can causes diseases of Slesma, Rakta and Mamsa. Thus from above

description it is clear that vitiated Meda plays vital role in the progress of pathogenesis and

affects the normal physiology of various body elements.


Majja Dhatu is not vitiated in maximum extent but Vata causes its Ksaya i.e.

Depletion. Thus the vitiated Majja producing symptoms like, Netragaurava, Angagaurava in

Madhumehi patient clinically.

Shukra also get vitiated in the pathogenesis produces symptoms like daurbalya and

Kruchra vyavayata, because normal functions of Sukra is to maintain. Dehabala, it also plays

role in the precipitation of Sahaja Prameha. Susruta narrated that Sukra Dosha and Prameha

get precipitate because of the vitiation of Vyanavata and Apanavata. With this it is understand

that the relation of Sukra dushti as a component of Prameha formation. Sexual impotency and

testicular hypo functions have been reported in Diabetes Mellitus by Moses et.al .1979.

Oja as Dushya mainly involved in Vataja Prameha i.e. Ojomeha i.e. Madhumeha.

Provoked Vata due to its own etiological factors or due to Avaran carries Oja towards vasti

and excrete outside through urine so the symptoms of Ojaksaya manifests, like Gurugatrata,

Nidra, Tandra and Daurbalya. Charaka mentioned Ruksta i.e. related to Ruksa Sharira, so one

can easily understand the manifestations of Krusapramehi or Sahaja Pramehi.

This is one of the body component mainly involved in the pathogenesis. The literary

meanings of Kleda are wetness, moisture and dampness etc. The physiology of Kleda is

mainly related with Mutra and Sweda along with Meda. Thus when Kleda is involved then it

directly affects the above factors. There is no direct reference regarding to the function of

Kleda in the body but Arundatta commented that. According to his opinion, If Kleda is not

present then there is manifestation of dryness in the body, so indirectly we can say that the

Kleda proper in quantity is important to maintain the unctuousness in between the tissues. In

normal physiology Mutra and Sweda maintain the balance of Kleda.


Especially Sweda holds it in the body and Mutra excrete it outside the body.

According to the body condition and requirement, if this Kleda is get vitiated it directly

affects the physiology of Mutra and Sweda and disrupts the assemblage of bodily elements

causing Shaithilya. Thus the symptoms manifests due to Kleda vitiation are Prabhuta mutrata,

Sweda vruddhi, Saithilya, Daurgandhya and Avila mutrata.

This dooshya is separately mentioned by Vagbhata. Sweda is mainly related with

Meda and Kleda. When the Swedavaha Strotodusti occurs due to vitiation of Kleda and Meda,

the normal physiology and Sweda get disturbed resulting in manifestations like, Sweda

vruddhi, Daurgandhya. Picchila gatrata, Snigdha gatrata etc. Susruta only mentioned that in

Madhumeha Sweda becomes Sweet in nature.

Charaka described it as a subtype of Vataja Prameha i.e. Vasameha. “Vasa” is an

Upadhatu of Mamsa and the unctuousness present in the Mamsa Dhatu is called Vasa. Thus

we can easily understand that in Prameha Mamsa is one of the Main Dushya so in turns Vasa

too get vitiate.

This is one of the liquid components present just beneath the skin. Lasika also get

vitiated by Vata resulting Lasika meha. There is no direct reference related to Vasa and

Lasika Dushti.

Madhumeha is the disease mainly of systemic consideration. In the pathogenesis there

is involvement of each and every constituent of the body. In the pathogenesis there is

reference of strotodushti only related to Mutravaha strotas. But when we observe the

pathogenesis and symptoms, we can easily understand the involvement of Medovaha,

Mamsavaha, Svedavaha and Udakavaha Strotas too.

We can find out the strotas involvement according to the symptoms as follows -


(1) Purvarupa of Prameha - Medovahastrotus Dusti.

(2) Putimamsapidaka - Mamsavaha Srotusdusti.

(3) Trsna, Mukhatalu Kanthasosa - Udakavaha Srotusdusti.

(4) Atisrsta Abhiksna Mutrapravrti - Mutravaha Srotusdusti.

There is no direct reference related to the Agni condition but both Agnimandya and

Tiksnagni conditions present in the pathogenesis Again without Ama it is impossible to

precepitate the pathogenesis of Madhumeha that’s why Susruta narrated that,

Effect of Akulyadi yoga in Madhumeha

The drugs selected for the trial mainly having Tikta, Kasaya, Katu Rasa Usna Veerya

and Laghu, Ruksa Guna, Katu Vipaka and Kaphavatahara properties and each one is indicated

in Prameha Cikitsa. Thus Usna Veerya and Tikta Kasaya Rasa helps to normalise the function

of Jathragni and Dhatwagni. That in turn helps to form the Dhatus in proper proportion with

Samyak qualities. Laghu Ruksa Guna helps for the Sosan of Bahudrava Shlesma and

reduction of vitiated Meda Kleda.

Thus once these factors get normalized in the body they in turn make clear the Path of

Vata which stops the depletion of vital Dhatus and restore normal physiology. Thus disease

Madhumeha get Alleviate.

The result of the Akulyadi yoga declared is representing the efficiency of the drug

with its embedded qualities, is 11 (55%) Regulated, 1 (5%) palliative and 8 (40%) patients

responded in the trial. The conclusion drawn statistically for the present trial is as highly

significant as P <0.05.

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Conclusion 105

Chapter - 7

Conclusion

Madhumeha is a disease characterized by Prabhoota avila mootrata, Tanu

madhuryata & Mootra madhuryata.

The terms Prameha and Madhumeha are synonymous. They indicate the same

condition where in the former refers to Prabhoota and Avila mootrata (ill

understood) & the latter refers to Tanu & Mootra madhuryata.

Dhatu apakarshana & Sarva dhatu sara – Ojo dushti is a invariable manifestation

of the disease.

Aparipakva ojas is directly responsible for the Madhuryata of Tanu and Mootra

Kapha is the Arambhaka dosha & Vata is the Preraka.

Margavarana janya Madhumeha & Dhatukshaya janya Madhumeha are the two

forms of the disease. Apathya nimittaja Madhumeha & Sahaja Madhumeha are

the two independent forms of presentations, coming under the above classification

respectively.

Sadhyasadhyata of Madhumeha is directly dependent upon Dhatu apakarshana &

Vata anubandha anubadhyatva & Sahaja karana.

The Kaphaja, Pittaja & Vataja Pramehas are nothing but the range of varied

symptomatology of Madhumeha manifesting depending upon association of

favorable Nidanas for the respective Dosha during the course of the illness.

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Conclusion 106

Sahaja Madhumeha can manifest in the Balya avastha also & Apathya nimittaja

Madhumeha manifests in the Madhyama to Vriddha avastha.

Madhumeha with Kapha pradhana lakshana and Anati dushta dhatu is Sadhya in

the sense that it is Sadhya until under continuous medication; otherwise it recurs

justifying the term Anushangi meaning Punarbhavi.

Diet and exercise helps only in patients who comply fully and compliance is the

toughest part in the management of Madhumeha.

The significant improvement which was seen in subjective and objective

symptoms.

Blod glucose and urine sugar measurement is a useful tool to detect Mootra

madhuryata & Tanu madhuryata in Madhumeha. The advantage being in

identifying the disease before the manifestation of symptoms so pronounced as to

attract Pipeelikas, thus providing the physician an opportunity to prevent or cure

the disease before the patient develops complications.

The result of the Akulyadi yoga declared is representing the efficiency of the drug

with its embedded qualities, is 11 (55%) Regulated, 1 (5%) palliative and 8 (40%)

patients responded in the trial.

The conclusion drawn statistically for the present trial is as highly significant as P

<0.05.

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Summary

107

Chapter - 8

Summary The advancement of industrialization and communication is contributing towards

sedentary life styles; in turn causing chronic non-communicable diseases like

Madhumeha vis-à-vis Diabetes Mellitus, etc. in fact Ayurveda is the first life

science, which identified, diagnosed and managed Madhumeha.

Madhumeha/DM is the present burning issue alarming the world. Madhumeha is

a disease characterized by Prabhoota, avila mootrata, Tanu and Mootra

madhuryata.

Madhumeha is a chronic metabolic or endocrinal disorder and the symptom

appears in relation with sweet urine excreting Dhatu in it. In normal physiology

Mutra and Sweda maintain the balance of Kleda. Especially Sweda holds in the

body and Mutra excrete it outside the body. Sweda is mainly related with Meda

and Kleda. Susruta only mentioned that in Madhumeha Sweda becomes Sweet in

nature. Lasika also get vitiated by Vata resulting Lasika (lymph) meha which is

not substantiated even by the contemporary medicine. Abnormal bi-fold digestion

causes aggravation of Vata in turn involves Dushya and metabolic waste to form

Madhumeha.

Madhumeha is a subtype of Vataja Prameha, could appear either by Avarana or

Dhatu kshaya janya (degenerative changes). Apart from these Iatrogenic and

genetic dispositions are also recorded. The Madhumeha vis-à-vis diabetes mellitus

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Summary

108

has many theories of occurrence, even the recent viral influence studies on

diabetes.

Madhumeha has Kapha Dosha is the key factor along with Vata. Generally the

management, rather than treatment, is the appropriate term in Diabetes mellitus,

and involves diet, exercise, insulin, oral hypoglycemic, patient education and

counseling.

The present study intended to focus on the disease evaluation i.e. Madhumeha vis-

à-vis. Diabetes Mellitus management with Akulyadi yoga as a Shamana Chikitsa.

Akulyadi yoga ingredients are hypoglycemic agents collected form local area and

prepared under GMP conditions, weighing about 500mg tablet form. Present trial

is a Simple Random sampling technique clinical study was conducted for 21 days.

Patients of Madhumeha fulfilling the criteria of diagnosis were selected in the

present study. Patients were selected on preset inclusion and exclusion criteria.

The male female ratio in the study is approximately 3:2 patients and 75% patients

were recorded with sedentary life styles.

In the present study 60% patients had family history and rest of the 40% patients

had no family history of Madhumeha.

Apart from the symptoms which show high significance in the study the key

parameters to assess “glycemic” condition of Madhumeha exhibit, FBS with a

mean difference of 48.605mg and PPBS with mean difference of 117.18mg for

after to before data.

This is strong evidence to state that the Akulyadi yoga is good hypoglycemic

agent combination of Ayurveda.

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Bibliographic References 1

Bibliographic Refarences

1) Baghel MS, Ayurvedic Education – Global perspective, International

Congress on Ayurvedic Concepts and Treatment of Neurological Disorders, 2002, SDM College of Ayurveda and Hospital, Udupi, pp 25

2) Bhagawan Das, Charaka Samhita sutra, vol-1, 6th ed, 1999, Chaukhambha Sanskrit series, Varanasi, pp-600

3) Swami DS, Evaluation of efficacy of Madhutailika Vasti in the management of Madhumeha, 2005, PGSRC, dept. of Panchakarma, DGM Ayurvedic Medical College, Gadag, pp2

4) Mahesh Udup, Comprehensive Kayachikitsa and principles of Ayurveda, 1st ed. 2004, Laveena publication, Bangalore, pp 1123

5) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Nidana 4/39, 1st ed. Reprint, 1998, Chaukhambha Bharati Academy, Varanasi, pp-638

6) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana 1/20, 6th ed. 1987, Chaukhambha Sanskrit Sansthan, Varanasi, pp-230

7) Pawar Anand N, A comparative study on the role of vasti therapy and pramehaghna drugs in the management of Madhumeha (Diabetes mellitus), L-2857, pp

8) Khan weir, Joslins Diabetes mellitus, 13th ed. 1994, Pennsylvania USA, Lea and Febiger, pp 194

9) Sahshikala Bani, Evaluation of efficacy of Avartaki in Madhumeha, 2005, PGSRC, dept. of Dravyaguna, DGM Ayurvedic Medical College, Gadag, pp 1

10) Sainani GS ed, API textbook of medicine, 6th ed, 1994, Association of Physicians of India, Mumbai, pp 986

11) Khan weir, Joslins Diabetes mellitus, 13th ed. 1994, Pennsylvania USA, Lea and Febiger, pp 216

12) Sainani GS ed, API textbook of medicine, 6th ed, 1994, Association of Physicians of India, Mumbai, pp 986

13) AS Fauci, Harrison principles of internal medicine, Vol-2, 15th ed. 2001 Mcgraw Hill co, New York USA, pp 2129

14) Mahesh Udup, Comprehensive Kayachikitsa and principles of Ayurveda, 1st ed. 2004, Laveena publication, Bangalore, pp 1123

15) Bramhashankar Sastri ed, Yoga ratnakara, Uttarardha, Prameha Chikitsa, 4th ed, 1988, Choukhambha Sanskrit Samsthan, Varanasi, pp85-86

16) Yadunandan Upadhyaya, Astanga Hridaya, Nidana 10/6, 1st ed, Reprint, 2007, Chaukhambha Prakashan, Varanasi, pp-254


18) Ravidatta Tripati ed, Charaka samhita, Chikitsa, 6/5, 2nd ed. 2001, Choukhambha Sanskrit Pratistan, Varanasi, pp 167




22) Ibid, part 2, Chikitsa, 13/3-34, pp 65-67


23) Yadunandan Upadhyaya, Astanga Hridaya, Nidana 10/20-21, 1st ed, Reprint, 2007, Chaukhambha Prakashan, Varanasi, pp-255

24) Raja Radhakantadeve Bahadur, Shabdakalpadruma, vol-3, 3rd ed, 1967, Chaukhambha Sanskrit series, Varanasi, pp-421

25) Ibid, 26) Yadunandan Upadhyaya, Astanga Hridaya, Nidana 10/18, 1st ed, Reprint, 2007,

Chaukhambha Prakashan, Varanasi, pp-255 27) Ibid, 28) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana 6/14, 6th ed. 1987,

Chaukhambha Sanskrit Sansthan, Varanasi, pp-252 29) Ibid, Chikitsa, 11/6, pp 60-61 30) Ibid, Nidana, 6/14, pp 254 31) Yadavji Trikamji Acharya ed, Charaka Samhita, Chakrapani commentary, Chikitsa 6/11,

4th ed, 1994, Chaukhambha Sanskrit samsthan, Varanasi, pp 445 32) Yadunandan Upadhyaya, Astanga Hridaya, Nidana 10/18, 1st ed, Reprint, 2007,

Chaukhambha Prakashan, Varanasi, pp-255 33) Suresh Babu, Anjana Nidana, 1st ed, 2004, Chaukhambha Sanskrit series, Varanasi, pp

35-36 34) Raghunath, History of Diabetes from remote to recent times, 1st ed. 1985, Baidyanath

Ayurveda Bhavan, Nagpur, pp 58 35) Bhagawan Das, Charaka Samhita Chikitsa, vol-2, 6/1-61, 1st ed. 2004, Chaukhambha

Sanskrit series, Varanasi, pp-298-316 36) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Nidana 6/8, 2nd ed, 2005,

Choukhambha Orientalia, Varanasi, pp 503-510 37) Ibid, Chikitsa, 13/1-35, pp 135-140 38) Ramavalamba Sastri, Harita Samhita, Truteeya, 28/1-44, 1st ed, 1985, Prachya

Prakashan, Varanasi, pp 342-347 39) Priyavat Sharma, Bhela Samhita, Nidana, 6/1-6, 1st ed. Reprint, 2005, Chaukhambha

Visvabharati, Varanasi, pp-155-157 40) Tiwari PV ed, Kashyapa Samhita Sutra, 25/22, 1st ed. Reprint 2002, Chaukhambha

Vishwa Bharati, Varanasi, pp-52-58 41) Yadunandan Upadhyaya ed. Madhava Nidanam, Part-2, 33/1-36, 9th ed, 2004,

Chaukhambha Sanskrit Sansthan, Varanasi, pp-1-26 42) K. R Shrikanta Murthy ed, Sharangdhara samhita, Madhyama Khanda 7/60-64, 1st ed,

1984, Chaukambha Orientalia ,Varanasi, pp 36-37 43) Srikanta Murthy KR ed, Bhava Prakasha Madhyama Khanda, 38/1-129, 1st ed. Reprint,

2002, Chaukhambha Krishnadas Academy, Varanasi, pp-483-501 44) Bramhashankar Sastri ed, Yoga ratnakara, Uttarardha, Prameha Chikitsa, 4th ed, 1988,

Choukhambha Sanskrit Samsthan, Varanasi, pp 67-75 45) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Sutra 17/80-81, 1st ed. Reprint, 1998,

Chaukhambha Bharati Academy, Varanasi, pp-352-353 46) Brahmanad Tripati, Charaka Samhita, Part 1, Nidana 4/8, 2nd ed. Reprint, 1991,

Chaukhambha Sura Bharati Prakashan, Varanasi, pp- 614 47) Ambikadatta shastri ed, Susruta Samhita, Part-I, Chikitsa 11/3, 6th ed. 1987,

Chaukhambha Sanskrit Sansthan, Varanasi, pp-56 48) Brahmanad Tripati, Charaka Samhita, Part 2, Chikitsa 6/57, 1st ed. Reprint, 2007,

Chaukhambha Sura Bharati Prakashan, Varanasi, pp- 295 49) Ambikadatta shastri ed, Susruta Samhita, Part-I, Chikitsa 11/3, 6th ed. 1987,

Chaukhambha Sanskrit Sansthan, Varanasi, pp-56


50) Ravidutt Trippathi ed, Charaka Samhita Shareara, 4/30, 1st ed. Reprint 2006, Choukhambha Sanskrit Pratistan, Varanasi, pp 733

51) Brahmanad Tripati, Charaka Samhita, Part 2, Chikitsa 6/57, 1st ed. Reprint, 2007, Chaukhambha Sura Bharati Prakashan, Varanasi, pp- 295

52) Ravidutt Trippathi ed, Charaka Samhita Nidana, 4/5, 1st ed. Reprint 2007, Choukhambha Sanskrit Pratistan, Varanasi, pp 502

53) Ibid, 4/24, pp 505 54) Ibid, 4/36, pp 507 55) Ibid, Chikitsa 6/4, 2nd ed. 2001, pp 167 56) Ibid 57) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Sutra 17/80-81, 1st ed. Reprint, 1998,

Chaukhambha Bharati Academy, Varanasi, pp-352-353 58) Davidson Stanely, Principles and practice of medicine, 1995, Churchill Livingstone,

London, pp 728 59) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Sutra 17/80-81, 1st ed. Reprint, 1998,

Chaukhambha Bharati Academy, Varanasi, pp-352-353 60) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana 6/6, 6th ed. 1987, Chaukhambha

Sanskrit Sansthan, Varanasi, pp-255 61) Brahmanad Tripati, Charaka Samhita, Part 2, Chikitsa 6/6, 1st ed. Reprint, 2007,

Chaukhambha Sura Bharati Prakashan, Varanasi, pp- 280 62) Ravidutt Trippathi ed, Charaka Samhita Nidana, 4/4, 1st ed. Reprint 2006, Choukhambha

Sanskrit Pratistan, Varanasi, pp 501-502 63) Ibid, 4/8, pp 503 64) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana 6/4, 6th ed. 1987, Chaukhambha

Sanskrit Sansthan, Varanasi, pp-251-252 65) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Nidana 4/24, 1st ed. Reprint, 1998,

Chaukhambha Bharati Academy, Varanasi, pp-636 66) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana 6/9, 6th ed. 1987, Chaukhambha

Sanskrit Sansthan, Varanasi, pp-252 67) Yadunandan Upadhyaya, Astanga Hridaya, Nidana 10/5, 1st ed, Reprint, 2007,

Chaukhambha Prakashan, Varanasi, pp-253 68) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana 6/119, 6th ed. 1987,

Chaukhambha Sanskrit Sansthan, Varanasi, pp-253 69) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Nidana 4/371st ed. Reprint, 1998,

Chaukhambha Bharati Academy, Varanasi, pp-637-638 70) Ravidutt Trippathi ed, Charaka Samhita Chikitsa 6/5, vol-2, 2nd ed. Reprint 2006,

Choukhambha Sanskrit Pratistan, Varanasi, pp 167 71) Yadunandan Upadhyaya, Astanga Hridaya, Nidana 10/18, 1st ed, Reprint, 2007,

Chaukhambha Prakashan, Varanasi, pp-255 72) Ambikadatta shastri ed, Susruta Samhita, Part-I, Chikitsa 11/3, 6th ed. 1987,

Chaukhambha Sanskrit Sansthan, Varanasi, pp-59 73) Ravidutt Trippathi ed, Charaka Samhita Chikitsa 6/57, vol-2, 2nd ed. Reprint 2006,

Choukhambha Sanskrit Pratistan, Varanasi, pp 177 74) Ibid, vol 1, Nidana 4/37, pp 507 75) Ibid, 4/36, pp 507 76) Brahmanad Tripati, Charaka Samhita, Part 2, Chikitsa 6/6-11, 1st ed. Reprint, 2007,

Chaukhambha Sura Bharati Prakashan, Varanasi, pp- 280 77) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Sutra 17/80-8, 1st ed. Reprint, 1998,

Chaukhambha Bharati Academy, Varanasi, pp-352-353



79) Yadunandan Upadhyaya, Astanga Hridaya, Sutra 11/3, 1st ed, Reprint, 2007, Chaukhambha Prakashan, Varanasi, pp-85


81) Yadunandan Upadhyaya, Astanga Hridaya, Sutra 11/7, 1st ed, Reprint, 2007, Chaukhambha Prakashan, Varanasi, pp-86

82) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Sutra 18/49, 1st ed. Reprint, 1998, Chaukhambha Bharati Academy, Varanasi, pp-384

83) Ibid, Nidana, 4/7, pp 632 84) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana 6/11, 6th ed. 1987,

Chaukhambha Sanskrit Sansthan, Varanasi, pp-253 85) Yadunandan Upadhyaya, Astanga Hridaya, Nidana 10/4, 1st ed, Reprint, 2007,

Chaukhambha Prakashan, Varanasi, pp-253 86) Ibid, sutra, 11/8, pp 86 87) Ambikadatta shastri ed, Susruta Samhita, Part-I, Sutra 15/37, 6th ed. 1987,

Chaukhambha Sanskrit Sansthan, Varanasi, pp-62 88) Ravidatta Tripati ed, Charaka Samhita, Nidana, 4/48, 2nd ed. 2001, Choukhambha

Sanskrit Pratistan, Varanasi, pp 511 89) Ibid, sutra, 17/82, pp 267 90) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana, 6/4, 6th ed. 1987,

Chaukhambha Sanskrit Sansthan, Varanasi, pp-252 91) Yadunandan Upadhyaya, Astanga Hridaya, Nidana, 10/41, 1st ed, Reprint, 2007,

Chaukhambha Prakashan, Varanasi, pp-250 92) Ambikadatta shastri ed, Susruta Samhita, Part-I, Sutra,15/19, 6th ed. 1987,

Chaukhambha Sanskrit Sansthan, Varanasi, pp-60 93) Ibid, Nidana, 1/20, pp230 94) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Sutra 17/78, 1st ed. Reprint, 1998,

Chaukhambha Bharati Academy, Varanasi, pp-352-353 95) Yadunandan Upadhyaya, Astanga Hridaya, Sutra, 11/40, 1st ed, Reprint, 2007,

Chaukhambha Prakashan, Varanasi, pp-89 96) Ibid, 11/5, pp 86 97) Ambikadatta shastri ed, Susruta Samhita, Part-I, Chikitsa,12/4, 6th ed. 1987,

Chaukhambha Sanskrit Sansthan, Varanasi, pp-62 98) Ravidatta Tripati ed, Charaka Samhita, Chikitsa, 6/11, 2nd ed. 2001, Choukhambha

Sanskrit Pratistan, Varanasi, pp 170 99) Ibid, 6/8, pp 168-169

100) Cotran SR, Basic Pathology, 6th ed. 2003, Philadelphia Saunders, pp 913 101) Ravidatta Tripati ed, Charaka Samhita, Chikitsa, 6/7, 2nd ed. 2001, Choukhambha

Sanskrit Pratistan, Varanasi, pp 168 102) Yadunandan Upadhyaya, Astanga Hridaya, Nidana, 10/7, 1st ed, Reprint, 2007,

Chaukhambha Prakashan, Varanasi, pp-254 103) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Nidana 4/9, 1st ed. Reprint, 1998,

Chaukhambha Bharati Academy, Varanasi, pp-633 104) Ambikadatta shastri ed, Susruta Samhita, Part-I, Chikitsa,11/3, 6th ed. 1987,

Chaukhambha Sanskrit Sansthan, Varanasi, pp-59 105) Ibid 106) Yadunandan Upadhyaya, Astanga Hridaya, Nidana, 10/19, 1st ed, Reprint, 2007,

Chaukhambha Prakashan, Varanasi, pp-255


107) Ravidatta Tripati ed, Charaka Samhita, Chikitsa, 6/15, 2nd ed. 2001, Choukhambha Sanskrit Pratistan, Varanasi, pp 170

108) Cotran SR, Basic Pathology, 6th ed. 2003, Philadelphia Saunders, pp 913 109) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana,6/25-26, 6th ed. 1987,

Chaukhambha Sanskrit Sansthan, Varanasi, pp-255 110) Yadunandan Upadhyaya ed. Madhava Nidanam, Part-2, 1/7, 9th ed, 2004, Chaukhambha

Sanskrit Sansthan, Varanasi, pp-38 111) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana,6/25-26, 6th ed. 1987,

Chaukhambha Sanskrit Sansthan, Varanasi, pp-255 112) Yadunandan Upadhyaya, Astanga Hridaya, Nidana, 10/7, 1st ed, Reprint, 2007,

Chaukhambha Prakashan, Varanasi, pp-254 113) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Nidana 4/44, 1st ed. Reprint, 1998,

Chaukhambha Bharati Academy, Varanasi, pp-639 114) Ambikadatta shastri ed, Susruta Samhita, Part-I, Chikitsa, 11/3, 6th ed. 1987,

Chaukhambha Sanskrit Sansthan, Varanasi, pp-59 115) Ibid, Nidana, 6/28, pp 258 116) Cotran SR, Basic Pathology, 6th ed. 2003, Philadelphia Saunders, pp 913-916 117) Ravidatta Tripati ed, Charaka Samhita, Chikitsa, 6/54, 2nd ed. 2001, Choukhambha

Sanskrit Pratistan, Varanasi, pp 176 118) 8888 119) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Nidana 4/48, 1st ed. Reprint, 1998,

Chaukhambha Bharati Academy, Varanasi, pp-640 120) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana, 6/15, 6th ed. 1987,

Chaukhambha Sanskrit Sansthan, Varanasi, pp-254 121) Ibid, 122) Ibid 123) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Sutra 17/105-106, 1st ed. Reprint,

1998, Chaukhambha Bharati Academy, Varanasi, pp-362 124) Davidson Stanely, Principles and practice of medicine, 1995, Churchill Livingstone,

London, pp 754-757 125) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Nidana 4/11, 1st ed. Reprint, 1998,

Chaukhambha Bharati Academy, Varanasi, pp-634 126) Ibid, 4/8, pp 633 127) Ibid, sutra 17/80-81, pp 352-353 128) Ibid, Nidana, 4/38, pp 638 129) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana, 6/27, 6th ed. 1987,

Chaukhambha Sanskrit Sansthan, Varanasi, pp-255 130) Ravidatta Tripati ed, Charaka Samhita, Chikitsa, 6/47, 2nd ed. 2001, Choukhambha

Sanskrit Pratistan, Varanasi, pp 177 131) Ibid, 6/16-18, pp 171 132) Ibid, 6/25-26, pp 173 133) Yadunandan Upadhyaya, Astanga Hridaya, Chikitsa, 12/8, 1st ed, Reprint, 2007,

Chaukhambha Prakashan, Varanasi, pp-372 134) Ravidatta Tripati ed, Charaka Samhita, Chikitsa, 6/37, 2nd ed. 2001, Choukhambha

Sanskrit Pratistan, Varanasi, pp 174 135) Ambikadatta shastri ed, Susruta Samhita, Part-I, Chikitsa, 13/1-34, 6th ed. 1987,

Chaukhambha Sanskrit Sansthan, Varanasi, pp-65-67 136) AS Fauci, Harrison principles of internal medicine, Vol-2, 15th ed. 2001 Mcgraw Hill co,

New York USA, pp 2112


137) Ambikadatta shastri ed, Susruta Samhita, Part-I, Chikitsa, 11/6, 6th ed. 1987, Chaukhambha Sanskrit Sansthan, Varanasi, pp-60


139) Srinivasacharyulu Yetur ed, Yogaratnakaram (Tel), Vol 2, Prameha Nidanam, 80, 1st ed. 1940, Swatantra Printers, Nellore, pp 142

140) Pande GS, Bhavaprakasha, 1st ed. Reprint, 1998, Chaukhambha Bharati Academy, Varanasi, pp-10-11

141) Ibid, 114-116 142) K. M. Nadkarni, Indian Materia Medica, Vol-I, 3rd ed, 1976, Popular Prakashan,

Bombay, pp-284 143) Narahari, Raja Nighantu, Guduchyadi varga, 2nd ed. 1998, Krishnadas Academy,

Varanasi, pp 58 144) K. M. Nadkarni, Indian Materia Medica, Vol-I, 3rd ed, 1976, Popular Prakashan,

Bombay, pp-480 145) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Sutra 4/50, 1st ed. Reprint, 1998,

Chaukhambha Bharati Academy, Varanasi, pp-98 146) Ibid,4/24, pp 85 147) K. M. Nadkarni, Indian Materia Medica, Vol-I, 3rd ed, 1976, Popular Prakashan,

Bombay, pp-414 148) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Sutra 4/3, 1st ed. Reprint, 1998,

Chaukhambha Bharati Academy, Varanasi, pp-72 149) Ibid,4/13, pp 81 150) Ibid, 4/15, pp 82

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Master charts i

MS01 - Demographic Data of Akulyadi Yoga

SNo OPD No

Gender Religion Occupation Economical Condition

Result

M F Age

Food

V

/Mx

H M C O S A L P M Hg Hc 1 4773 + 40 Mx + + + 2 4775 + 50 V + + + 3 5068 + 35 V + + + 4 6013 + 58 Mx + + + 5 6016 + 43 Mx + + + 6 6021 + 62 V + + + 7 325 + 59 V + + + 8 333 + 46 V + + + 9 362 + 54 V + + + 10 409 + 50 Mx + + + 11 412 + 55 V + + + 12 418 + 62 V + + + 13 419 + 40 Mx + + + 14 442 + 38 V + + + 15 526 + 49 Mx + + + 16 629 + 58 V + + + 17 790 + 46 V + + + 18 834 + 52 V + + + 19 835 + 54 V + + + 20 873 + 43 Mx + + + Total 12 8 16 4 0 0 15 2 3 2 2 8 8

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Master charts ii

MS02 - Subjective Statistical Assessment Data of Akulyadi Yoga

S.No OPD Dourbalya Shareera Bharahani

Jangamamsa graham

Karapada daha

Pipasa Kshudhadhikyata

B A B A B A B A B A B A 1 4773 1 0 0 0 0 0 1 0 3 1 3 0 2 4775 3 1 3 1 2 1 1 0 3 2 3 1 3 5068 1 0 0 0 1 0 0 0 3 2 4 2 4 6013 1 0 1 0 2 1 2 0 3 0 4 0 5 6016 4 0 2 0 0 0 1 0 3 0 3 0 6 6021 4 0 3 1 0 0 0 0 3 0 4 1 7 325 3 0 1 1 1 0 2 1 4 1 3 2 8 333 2 0 3 0 1 0 3 0 4 1 4 0 9 362 3 0 2 0 1 0 3 0 4 0 3 0 10 409 4 0 0 0 4 0 3 1 3 0 0 0 11 412 2 0 1 0 1 0 2 0 4 0 3 0 12 418 3 0 2 0 1 0 2 0 3 0 3 1 13 419 1 0 0 0 0 0 1 0 0 0 0 0 14 442 4 0 0 0 0 0 4 1 0 0 0 0 15 526 3 0 3 0 3 0 1 0 3 1 3 0 16 629 3 0 1 0 1 0 1 0 3 0 3 0 17 790 1 0 0 0 0 0 1 0 0 0 0 0 18 834 1 1 0 0 1 0 0 0 2 1 3 2 19 835 3 0 3 0 3 1 2 0 3 0 1 0 20 873 3 0 0 0 0 0 1 0 2 0 3 0 Total 50 2 25 3 22 3 31 3 53 9 50 9 Mean 2.5 0.1 1.25 0.15 1.1 0.15 1.55 0.15 2.65 0.45 2.5 0.45 SD 1.147 0.307 1.25 0.366 1.165 0.366 1.099 0.366 1.26 0.686 1.432 0.759

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Master charts iii

MS03 - Objective Statistical Assessment of Akulyadi Yoga

S.No OPD Prabhuta mootrata

Avila mootrata

FBS PPBS FUS PPUS

B A B A B A B A B A B A 1 4773 3 0 0 0 198.4 110 240 142 0.5 0 1 0 2 4775 4 2 2 1 320 112 350 134.5 0.5 0 1 0.5 3 5068 4 0 0 0 235 113 347 165 1 0.5 1.5 1 4 6013 4 0 2 0 216 124 341 162 1.5 0.5 0.5 0.5 5 6016 3 1 0 0 188 120 305 216 1.5 1 0.5 0 6 6021 4 0 0 0 181 110 221 163 1 0.5 1.5 0 7 325 4 1 1 0 152 130 330 225 0.5 0.5 1 1 8 333 3 0 1 0 132 110 223 140 0 0 0.5 1 9 362 3 0 1 0 174 120 228 130 0 0 0.5 0 10 409 4 0 1 0 151.6 110 277.6 145 0.5 0 1 0 11 412 3 0 0 0 148 120 209 161 0 0 0.5 0 12 418 4 0 1 0 158.6 110.3 240 130 0.5 0 1.5 0 13 419 3 0 0 0 145.1 125 280.1 164 0.5 0 1.5 0 14 442 2 0 0 0 126.4 110 225.1 140 0 0 0.5 0 15 526 4 0 0 0 194 120 312 142 0.5 0 1 0 16 629 4 0 1 0 146.3 118 310.7 166 0 0 1 0 17 790 3 0 0 0 142 110 225 140 0 0 0.5 0.5 18 834 1 0 0 0 178 112 341 162 0.5 0 0 0 19 835 4 0 0 0 140 120 227 140 0 0 1 1 20 873 4 0 1 0 160 116 210 132 0.5 0 1 0 Total 68 4 11 1 3486.4 2320.3 5442.5 3099.5 9.5 3 17.5 5.5 Mean 3.4 0.2 0.55 0.15 164.62 116.015 272.15 154.97 0.475 0.5 0.86 0.255

SD 0.82 0.523 0.686 0.223 30.411 6.13 52.34 25.811 6.472 0.285 0.444 0.411

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Master charts iv

MS04 - Chief & Associated complaints of Akulyadi Yoga Complaints 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 T 1 Prabhoota Mootrata + + + + + + + + + + + + + + + + + + + + 20 2 Avila Mootrata + + + + + + + + + + + + + + + 15 3 Dourbalya + + + + + + + + + + + + + + + + + + + + 20 4 Shareera Bhaarahani + + + + + + + + + + + + + 13 5 Janghamamsagraha + + + + + + + + + + + + + 13 6 Karapada Daha + + + + + + + + + + + + + + + + 16 7 Pipasa + + + + + + + + + + + + + + + + + 17 8 Kshudhadhikyata + + + + + + + + + + + + + + + + + + 18 Associated Complaints 1 Kara/Pada suptata + + + + + + + + + + + 11 2 Klama + + + + + + + 7 3 Tandra + + + + + 5 4 Sandhi Shula + + + + + + + + + + + 11 5 Alasya + + + + + + + + + + 10 6 Gurugatrata + + + + + + + + + 9 7 Shithilangata + + + + 4 8 Mukha/Talu shosha + + + + + + + + + + + + + + + + + + + 19

MS05 - Upashaya/Anupashaya of Madhumeha

Poorvaroopa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 T Upashaya 1 Shita iccha + + + + + 5 2 Madhurrahit ahara + + + + + + + + + + + + + + + + + + + + 20 3 vyayama + + + + + + + + + + + + + + + + + + + + 20 Anupashaya 1 Ushna + + + 3 2 Madhuara ahara + + + + + + + + + + + + + + + + + + + + 20 3 Diwa swapana + + + + + + + + + + + + + + + + + 17

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Master charts v

MS06 - Poorvaroopa of Madhumeha

Poorvaroopa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 T 1 Dantadeenam

Malatvam + + + + + + + 7

2 Pada daha + + + + + + + + 8 3 Pani daha + + + + + + + + 8 4 Deha chikkanata + + + + + + + + + 9 5 Shareera durgandha + + + + + + + + + + + 11 6 Mutra madhurata + + + + + + + + + + + + + + + + + + + + 20 7 Mutra shuklata + + + + + 5 8 Mukha madhurta + + + + + + + + + 9 9 Talu kloma shosha + + + + + + + + + + + + + + + + + + + 19 10 Kesh jatilata + + + + + + + + + + 10 11 Nakha vriddhi + + + + + + + + + + + + + 13 12 Alasya + + + + + + + + + + 10 13 Tandra + + + + + + + 7 14 Nidra + + + + + + + + + + + + + + 14 15 Trishna + + + + + + + + + + + + + + + + + + + + 20 16 Maldhikyata in bahya

chidra + + + + + + + + + + + + + 12

17 Swedadhikya + + + + + + + + + + + + + + + + + 17 18 Sheeta iccha + + + + + + + + + + + + + + + 15 19 Swasa + + + + + + 6 20 Shitalangata + + + + + + + + + + + + + + + + 16

MS07 - Upadrava of Madhumeha Poorvaroopa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 T 1 Prameha pidika + + 2 2 Atisara + + 2 3 Jwara + + + + + 5 4 Daha + + + + + + + + 8 5 Arochaka + + + + + + + + + + + 11 6 Avipaka + + + + + + + + + 9 7 Chardi + 1 8 Kasa + + + 3 9 pratishyaya + + + 3

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Master charts vi

MS08 - Examination of srotas Sroto Lakshana 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 T Udakavaha 1 Jihwa shosha + + + + + + + + + + + + + + + + + + + + 20 2 Talu shosha + + + + + + + + + + + + + + + + + + + + 20 3 Osta shosha + + + + + + + + + + + + + + 14 4 Kloma shosha + + + + + + + + + + + + + + + + + + 18 5 Prawridha pipasa + + + + + + + + + + + + + + + + + + + + 20 Mootravaha 1 Alpalpa mootrata 2 Mootara rodha 3 Adhika mootra + + + + + + + + + + + + + + + + + + + + 20 4 Sashoola mootra + + + + 4 5 Basti stabdhata Mamsavaha 1 Arbuda 2 Arsha 3 Mamsa shosha 4 Shira granthi Medovaha 1 Sweda + + + + + + + + + + + + 12 2 Snigdhanagata + + + + + + 6 3 Sthulashophata 4 Pipasa + + + + + + + + + + + + + + + + + + + + 20

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Master charts vii

MS09 - History of present Illness S.No OPD Mode of detection Frequency of Micturition Family history 1 2 3 1 2 3 4 5 1 2 1 4773 + + + 2 4775 + + + 3 5068 + + + 4 6013 + + + 5 6016 + + + 6 6021 + + + 7 325 + + + 8 333 + + + 9 362 + + + 10 409 + + + 11 412 + + 12 418 + + + 13 419 + + + 14 442 + + + 15 526 + + + 16 629 + + + + 17 790 + + + 18 834 + + + 19 835 + + + 20 873 + + + Total 5 2 13 1 1 4 10 4 12 8

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Master charts viii

MS10 - Ahara Nidana S.No OPD Guda Navanna Dugdha Gramya

Mamsa Anoopa Mamsa

Auduka Mamsa

Snigdha Ahara

Dadhi Sheeta Ahara

1 4773 + + + + + + + 2 4775 + + + + + + 3 5068 + + + + + + + 4 6013 + + + 5 6016 + + + + + + 6 6021 + + + + + 7 325 + + + + + + + 8 333 + + + + + 9 362 + + + + 10 409 + + + + + + + 11 412 + + + + 12 418 + + + + + + 13 419 + + + + + + + 14 442 + + + + + 15 526 + + + + + + + 16 629 + + + + 17 790 + + + + + + 18 834 + + + + + + 19 835 + + + + + + 20 873 + + + + + Total 20 14 16 5 4 4 17 20 13

Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Master charts ix

MS11 - Vihara /Anya Nidana S.No OPD Avyaya

ma Diwaswa

pna Swapnasukham

Manishika

Krimi Vegavarodha

Panchakarma

Vibhramsha

Sthoulya

1 4773 + + + 2 4775 + + + + 3 5068 + + 4 6013 + + + 5 6016 + + + + 6 6021 + + + 7 325 + + + 8 333 + + + 9 362 + + + 10 409 + + 11 412 + + + + 12 418 + + + 13 419 + + + + 14 442 + + 15 526 + + + 16 629 + + + 17 790 + + + + 18 834 + + + + 19 835 + + + + 20 873 + + + + Total 18 20 10 7 10

Evaluation of the efficacy of Akulyadi yoga in Madhumeha (Diabetes Mellitus) 1

SPECIAL CASE SHEET FOR “Evaluation of the efficacy of Akulyadi yoga in Madhumeha

(Diabetes Mellitus)” POST GRADUATE STUDIES AND RESEARCH CENTER (KAYACHIKITSA) SHRI. D.G.M.AYURVEDIC MEDICAL COLLEGE, GADAG

Guide: Dr. K. Shiva Rama Prasad

Scholar: Shivaleela. S. Kalyani

1) Name of the Patient Sl.No

2) Sex Male Female OPD No

3) Age Years IPD No

4) Religion Hindu Muslim Christian Other

5) Occupation Sedentary Active Labor

6) Economical status Poor Middle Higher middle Higher class

7) Address

Pin

8) Birth data Place of Birth

AM Date Month Year Time

Hours Minutes PM

9) Selection Included Excluded

10) Schedule dates Initiation Completion / Discontinuation

11) Result Regulated Palliative Responded Not

Responded

INFORMED CONSENT I Son/Daughter/Wife of am

exercising my free will, to participate in above study as a subject. I have been informed to my

satisfaction, by the attending physician the purpose of the clinical evaluation and nature of the

drug treatment. I am also aware of my right to opt out of the treatment schedule, at any time

during the course of the treatment. EzÀÄ £Á£ÀÄ ²æÃ/²æÃªÀÄw _________________________________________________ £À£Àß ¸ÀéEZÀÑ ¬ÄAzÀ

PÉÆqÀÄªÀ aQvÁì ¸ÀªÀÄäw. ¥Àæ¸ÀÄÛvÀ £ÀqÉ¢gÀÄªÀ aQvÁì ¥ÀzÀÞw0iÀÄ §UÉÎ £À£ÀUÉ aQvÀìPÀjAzÀ ¸ÀA¥ÀÇtð ªÀiÁ»w zÉÆgÉwzÀÄÝ ªÀÄvÀÄÛ

0iÀiÁªÁUÁzÀÄgÀÄ aQvÀì¬ÄAzÀ »AwgÀÄUÀ®Ä ¸ÁévÀAvÀæ÷å «zÉ JAzÀÄ w½¢gÀÄvÀÛ£É.

gÉÆV0iÀÄ gÀÄdÄ / Patient's Signature


12) CHIEF COMPLAINTS WITH DURATION (Subjective Parameters) Complaints - Lakshana Duration Remarks

1 Prabhoota Mootrata

2 Avila Mootrata

3 Dourbalya

4 Shareera Bhaarahani

5 Janghamamsagraha

6 Karapada Daha

7 Pipasa

8 Kshudhadhikyata

13) ASSOCIATED COMPLAINTS Associated Complaints –

Anubandha Lakshana Duration Remarks

1 Kara/Pada suptata

2 Klama

3 Tandra

4 Sandhi Shula

5 Alasya

6 Gurugatrata

7 Shithilangata

8 Mukha/Talu shosha

14) Occupational History (if any) 15) PERSONAL HISTORY

Food habits Vegetarian Mixed diet

Taste preferred Sweet Sour Salty Pungent Bitter Astringent

Agni Sama Vishama Manda Teekshna

Kosta Mrudu Madhyama Krura

Nidra Day Night Sound Disturbed

Addictions Tobacco Alcohol Drugs

Bowel habits Normal Loose Constipated

Menstrual History Regular Irregular Amenorrhea Menopause

Other system medications Treatment history (if any)

Gynaecological History (if any)

History of past illness (if any)


Family history – Specify if any has the same disease 16) HISTORY OF PRESENT ILLNESS

Mode of detection Accidental / suspicious / At Regular check-up

Frequency of Micturition 3-4 times / 5-6 times /7-8 times /9-10 times /Above 10 /

17) Madhumeha Nidana

Ahara Vihara Anya Nidanarthakara Vyadhi

Guda Avyayama Manishika- Chinta Sthoulya

Navanna Diwaswapna Krimi

Madhura

Dugdha Swapnasukham Vegavarodha

Gramya

Anoopa

Panchakarma Vibhramsha

Mamsa

Auduka

Snigdha

Dadhi

Sheeta

18) Madhumeha Poorvaroopa Dantadeenam Malatvam Mukha madhurta Trishna

Pada daha Talu kloma shosha Maldhikyata in bahya chidra

Pani daha Kesh jatilata Swedadhikya

Deha chikkanata Nakha vriddhi Sheeta iccha

Shareera durgandha Alasya Swasa

Mutra madhurata Tandra Shitalangata

Mutra shuklata Nidra

19) EXAMINATION (a) Vitals

Temperature ºF Pulse / min Respiration rate / min

Height Cms Weight Kg Blood pressure mm Hg

Patient Brother Sister

Brother Father Mother

Grandfather Grandmother

Sister Sister Brother

Grandfather Grandmother


(b) Examination of srotas Udakavaha Mootravaha Mamsavaha Medovaha

Jihwa shosha Alpalpa mootrata Arbuda Sweda

Talu shosha Mootara rodha Arsha Snigdhanagata

Osta shosha Adhika mootra Mamsa shosha Sthulashophata

Kloma shosha Sashoola mootra Shira granthi Pipasa

Prawridha pipasa

Basti stabdhata

(c) Systemic Examination:

1. Respiratory 2. Cardiovascular 3. Gastro-Intestinal 4. Genito-Urinary

(d) Dashavidha pareeksha Nadi V P K VP VK PK VPK Prakruti V P K VP VK PK VPK Sara Pravara Avara Madhyama Samhanana Susamhita Asamhita Madhyma samhita Pramana Height in Cms Weight in Kgs Satmya Ekarasa Sarvarasa Ruksha Sneha Satwa Pravara Avara Madhyama Ahara Shakti Abhyavaharana Jarana Vyayam Shakti Pravara Avara Madhyama Vaya Balya Yauvana Vardhakya (e) Astasthana Pareeksha Nadi Dosha Pravrutti Gati Varna Purnata Gandha Spandana Kathinya

Mutra

Jihwa Ardra Sushka Sama Nirama Lepa Nirlepa

Mala

Shabda Sparsha Sheeta Ushna Drik Akruti 20) Upashaya and Anupashaya

Upashaya Anupashaya

Shita iccha Ushna

Madhurrahit ahara Madhuara ahara

vyayama

Diwa swapana


21) Upadravas Lakshanas Lakshanas Prameha pidika Avipaka Atisara Chardi Jwara Kasa Daha pratishyaya Arochaka

22) INVESTIGATIONS

Investigations for screening Erythrocyte Sedimentation Rate

Hb%

Lymphocytes

Neutrophils

Eosinophils

Basophils

Differential count

Monocytes

Albumin

Sugar

Urine Routine

Microscopic

23) Assessment of Trail

1) Subjective parameters Before After Follow-up Difference BA

1 Dourbalya

2 Shareera Bhaarahani

3 Janghamamsagraha

4 Karapada Daha

5 Pipasa

6 Kshudhadhikyata

2) Objective parameters

1 Prabhoota Mootrata

2 Avila Mootrata

3 Fasting Blood Sugar

4 Post prandial Blood sugar

5 Fasting Urine Sugar

6 Post prandial Urine sugar


24) Treatment schedule

Day Date Investigator’s Note Day 1

Day 7

Day 14

Day 21

Follow up Day 42

Grades of assessment

1) Prabhoota Mootrata Grade 0 = 1000 – 1500 ml/ 24 hrs Grade 1 = 1500 – 2000 ml/ 24 hrs Grade 2 = 2000 – 2500 ml/ 24 hrs Grade 3 = 2500 – 3000 ml/ 24 hrs Grade 4 = 3000 – above ml/ 24 hrs 2) Avila Mootrata (Turbidity) Grade 0 = Crystal clear fluids Grade 1 = faintly cloudy or hazy with slight turbidity Grade 2 = Turbidity clearly present but news print can be read through the tube. Grade 3 = More turbidity & news print can not be read. 3) Dourbalya Grade 0 = No Dourbalya Grade 1 = occasionally noticed Grade 2 = periodically noticed Grade 3 = daily noticed Grade 4 = continuously noticed 4) Shareera Bhaarahani Grade 0 = No Bhaarahani Grade 1 = occasionally noticed Grade 2 = periodically noticed Grade 3 = regularly noticed

5) Janghamamsagraha Grade 0 = No Janghamamsagraha Grade 1 = occasionally noticed Grade 2 = periodically noticed Grade 3 = daily noticed Grade 4 = continuously observed 6) Karapada Daha Grade 0 = No Karapada Daha Grade 1 = occasionally noticed Grade 2 = periodically noticed Grade 3 = daily noticed Grade 4 = continuously noticed 7) Pipasa Grade 0 = No Pipasa Grade 1 = occasionally noticed Grade 2 = periodically noticed Grade 3 = daily noticed Grade 4 = continuously noticed 8) Kshudhadhikyata Grade 0 = No Kshudhadhikyata Grade 1 = occasionally noticed Grade 2 = periodically noticed Grade 3 = daily noticed Grade 4 = continuously noticed

Investigators Note

Signature of Guide

(Dr. K. Shiva Rama Prasad)

Signature of Scholar

(Shivaleela. S. Kalyani)

madhumeha kc041 gdg

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