madhumeha kc048 gdg

Evaluation of the efficacy of Phalatrikadi Vati

in Madhumeha (Diabetes Mellitus) By

VIJAYALAXMI. B. BENAKATTI

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fu

Ayurved

KaUnde

Dr. Shiva RamM.D. (Ayu) (Osm), C

DepartmPost Graduate StD.G. MELMALAGI AYURV

lfillment of the degree of

a Vachaspati M.D. In

yachikitsa r the Guidance of

a Prasad Kethamakka .O.P. (German) M.A., [Ph.D] (Jyotish)

ent of Kayachikitsa udies & Research Center EDIC MEDICAL COLLEGE, GADAG 2006-2009

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 Phalatrikadi

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

Vijayalaxmi. B. Benakatti 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.

Date:

Place:

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

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

Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)” is a bonafide research work done

by Vijayalaxmi. B. Benakatti 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.

.

Profess

Dept. of K

PGS

Date:

Place: Gadag

(Dr. G. B. Patil) Principal,

DGM Ayurvedic Medical College,

Gadag

Date:

Place: Gadag

or & HOD

ayachikitsa

&RC

Declaration by the candidate

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

Phalatrikadi Vati 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: Gadag

Vijayalaxmi. B. Benakatti

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:

Vijayalaxmi. B. Benakatti

© Rajiv Gandhi University of Health Sciences, Karnataka

Acknowledgement

Any research is not an individual effort. It is a contributory effort of many hearts,

hands and heads. I am very much thankful to the subjects of this study.

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

respected guide and H.O.D Prof. Dr. K. Shiva Rama Prasad, M.D., C.O.P. (German),

M.A., [Ph.D.], for his guidance and timely help.

I express my gratitude to Dr. V. V. Varadacharyulu Professor and Ex H.O.D for his

advice and encouragement in every step of this work.

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

providing all necessary facilities for this research work.

I express my special thanks to Dr. R. V. Shettar, Dr. B. G .Swami, Dr. Kuber sankh

for their timely help and co-operation.

I extend my gratitude to Dr. G. Purushottamacharyulu, Dr. P. Shivaramudu, Dr. M.

C. Patil, and Dr. G. S. Hiremath, Dr. U. V. Purad, Dr. Mulgund. Dr. G. Danappagoudar.

Dr. S. N. Belawadi. Dr. Nedugundi, Dr. Samudri, Dr. J. Mitti. Dr. Shankargouda. Dr.

Mulki Patil. Dr. Yasmin A.P, Dr Veena. Kori and Dr. Yaregari RMO DGMAMC Gadag.

I express my immense gratitude to statistician Nandakumar, Tippanagoudar (Lab),

V.B. Mundinamani (librarian) and Kerur and Shyavi for facilitating me in collection and

production of my thesis.

I take this opportunity to thank Dr. Yadavannavar (M.D) lecturer in B. M. Nagur

College Bijapur who accompanied me at every step with his valuable suggestions and

moral support.

My deep senses of gratification to my inspirations of this study are my parents

Shri. Basavaraj. Benakatti and Smt. Saroja. B. Benakatti and my beloved husband Dr.

Rajeev. Karalingannavar, for their love, support with a constant enthusiastic and

affectionate push and who are the driving force.

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

daughter Neha, my mother-in-law Smt. Neelama Karalingannavar And my Brother in

law and co-sister, Aravinda and Ashawini Karalingannavar. I am extremely happy to

express my deepest sense of gratitude to my all uncles and aunties.

I express my heartfelt gratitude to my Sisters, Dr. Veena, Vishala, Sangeeta,

Shweta for constant help and encouragement to move ahead.

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

Shivaleela. Kalyani, Dr. Kamalaxi, Dr. Sulochana, Dr. M. G. Ashok. Dr. Rudrakshi.

My in depth regards to my friends Dr. Prasann. Joshi, Dr. Sanjeev, Dr. Veena.

Jigalur, Dr. Neeraj, Dr. Mukta. Arali, Dr. Mukta. Hiremath, Dr. Anupama, Dr Trupti. Dr.

Ishawar, Dr. Praveen, Dr. V S Kanti, Dr. Bodake, Dr. Kavitha, Dr. Sarvamangala, Dr.

Jaya. M, Dr. Kalavati, Dr Savitha, Dr. Adarsha, Dr. Nataraja, Dr. Udaya, Dr. Shaileja,

Dr. Ravi, Dr. Shivakumar, Dr. Jyoti for their support and encouragement.

I express my immense thanks to my patients for their cooperation during the trial.

Last but not least I express my deepest thankfulness whose names are not taken

here but helped me a lot along with my kith and kilns to my family members.

(Vijayalaxmi. B. Benakatti)

Abstract of “Evaluation of the efficacy of Pkalatrikadi Vati in

Madhumeha (Diabetes Mellitus)” by

Vijayalaxmi. B. Benakatti Key words: Madhumeha, Prabhoota, avila mootrata, Phalatrikadi Vati, DM,

Hypoglycemia, Blood glucose.

Madhumeha vis-à-vis Diabetes mellitus is a common chronic metabolic disorder

prevalent all over the world. Although Madhumeha has been a known morbidity since

time immemorial, its incidence has been growing notably in recent years. Madhumeha

vis-à-vis Diabetes mellitus is a major health problem for the world in the 21st century.

The mortality rate due to Diabetes mellitus is very high and is ranked fifth amongst the

ten major causes of death in southern part of India. The rising prevalence of diabetes is

closely associated with industrialization and socio-economic development. In Ayurveda,

Madhumeha is explained under the heading of Prameha, Madhumeha is a disease of

systemic and deranged metabolism expressed in mootravaha srotus that result in to

vitiation of various body elements. Avarnjanya Madhumeha possesses vitiated Kapha,

Pitta and Meda caused due to Avarana of Vata aggravation causes Vital Dhatus

deprevation. Madhumeha is a disease characterized by Prabhoota, avila mootrata, Tanu

and Mootra madhuryata. The present study focused on the disease pathogenesis and its

regulation through Phalatrikadi vati as a Shamana Chikitsa. Apart from other symptoms

of Madhumeha, the glycemic condition of the Madhumeha assessed by parameters i.e.

FBS, PPBS, FUS and PPUS taken after to before data. These shows high significant with

FBS with a mean difference of 31.84mg and PPBS with mean difference of 63.92 mg,

This is evidence to state that the phalatrikadi Vati is hypoglycemic agent combination of

Ayurveda.

Contents of

“Evaluation of the efficacy of Phalatrikadi Vati in Madhumeha

(Diabetes Mellitus)”

By

Vijayalaxmi B Benakatti CHAPTER CONTENT PAGES

1 Introduction 1 to 5

2 Objectives 6 to 7

3 Review of literature 8 to 74

4 Methods 75to 82

5 Results 83 to 100

6 Discussion 101 to 118

7 Conclusion 119 to 120

8 Summary 121 to 122

9 Bibliographic References 1 to 11

10 Annex – data of trial 1 to 9

11 Annex – Case sheet 1 to 6

- 1 -

Tables of “Evaluation of the efficacy of Phalatrikadi Vati in Madhumeha

(Diabetes Mellitus)” SN Title of Table Page 1 Showing the Ahara Nidana of Madhumeha 13 2 Showing the Vihara Nidana of Madhumeha 14 3 Showing the Vishista Nidana of Madhumeha acco Dosha 15 4 Showing the Avarnajnya Nidana of Madhumeha 16 5 Showing the Roopas in relation to Dosha and Dushya 29-30 6 Types of kaphaja,pittaja, vataja Prameha 32 7 Showing the poorva roopa of Madhumeha 36 8 Lakshana of Madhumeha 38 9 Madhumeha samanya upadrava 40 10 Madhumeha Upadrava 41 11 Sapeksha nidana of Madhumeha 44-45 12 Results by Age in Madhumeha with Phalatrikadi Vati 84 13 Results by Gender in Madhumeha with Phalatrikadi Vati 85 14 Results by Religion in Madhumeha with Phalatrikadi Vati 86 15 Results by Occupation in Madhumeha with Phalatrikadi Vati 87 16 Results by Economic status in Madhumeha with Phalatrikadi Vati 88 17 Results by Diet in Madhumeha with Phalatrikadi Vati 89 18 Distribution of patients by presenting complaints 91 19 Distribution of patients by Associated features 92 20 Ahara Nidana observed in the study 93 21 Vihara Nidana observed in the study 93 22 Distribution of patients by Anya Nidana 94 23 Distribution of patients by Poorva roopa lakshana 94 24 Distribution of patients by Sroto dusti lakshana 95 25 Data of Family history in the study 96 26 Assessment of Subjective parameters 96 27 Assessment of Objective parameters 97 28 Result of Phalatrikadi Vati in Madhumeha 98 29 Statistical analysis of Phalatrikadi Vati 100

- 2 -

Figures and Photos of

“Evaluation of the efficacy of Phalatrikadi Vati in Madhumeha

(Diabetes Mellitus)”

SN Title of Figures and photos Page

1 Madhumeha Samprapti 31

2 Composition of Phalatrikadi Vati 70

3 Results by Age in Madhumeha with Phalatrikadi Vati 84

4 Results by Gender in Madhumeha with Phalatrikadi Vati 85

5 Results by Religion in Madhumeha with Phalatrikadi Vati 86

6 Results by Occupation in Madhumeha with Phalatrikadi Vati 87

7 Result Distribution of patients by Economic status 89

8 Results by Diet in Madhumeha with Phalatrikadi Vati 90

9 Distribution of patients by presenting complaints 91

10 Distribution of patients by Associated features 92

11 Result of Phalatrikadi Vati in Madhumeha 98

- 3 -

INTRODUCTION

Ayurveda is not only a system of Medicine rather it is the way of life. It

includes physical, mental and spiritual well being. Ayurveda is becoming more and

more acceptable globally as it is toxicity free, eco-friendly with its holistic approach.

Madhumeha is a disease known since ancient times to the mankind. Ayurveda

in fact is the first medical science, which identified, diagnosed & managed

Madhumeha. While claiming it is incurable much earlier to Greek physician aeratus

(1-2 AD).

Madhumeha is one of the Mahagadas 1 in which maximum number of Srotas

gets vitiated with the vitiation of almost all the Dhatus and Ojas due to which the

condition of the patient afflicted with Madhumeha goes on deteriorating.

Madhumeha is mentioned as one of the 20 types of Prameha. Madhumeha has

been classified under the Vatika type of Prameha 2. The Vata may be provoked either

directly by its etiological factors, Avarana by Kapha and Pitta to its path or by

continuous depletion of Dhatus. Vagbhata has classified the Madhumeha into two

categories viz. Dhatukshayajanya Madhumeha and Avaranajanya Madhumeha 3. The

factors which provoke the Vata directly cause Apatarpanajanya Madhumeha. while

the factors which provoke Kapha and Pitta cause Santarpanajanya Madhumeha.

The Apatarpanajanya Madhumeha patients are usually Krusha and are

equivalent to Type I Diabetes mellitus, while the Santarpanajanya Madhumeha

patients are stoola equivalent to Type II Diabetes mellitus. In Avaranajanya

Madhumeha, Kapha is the predominant Dosha while the important Dushyas are Meda

and Kleda. Type II Diabetes mellitus is mainly associated with Avaranajanya

Samprapti. In Madhumeha, the main Avaraka are Kapha, Pitta, Rasa, Mamsa and

Meda, and out of these Meda is predominant 4.

Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Introduction 1

Over the last 50 yr, changes in lifestyle have led to a dramatic increase in the

prevalence of type 2 diabetes in virtually every society around the world. Reductions

in physical activity, increases in dietary intake, westernization of diet and the aging of

the population are key factors in bringing about this rapid change 5.

In modern medical science, symptomatology of Madhumeha is equivalent to

the features of Diabetes mellitus 6. Diabetes mellitus remains one of the baffling

enigmas for clinical research. DM is expected to continue as a major health problem

owing to its serious complications, especially end stage of renal disease, IHD,

gangrene of the lower extremities & blindness in the adults 7.

Diabetes is a syndrome characterized by disordered metabolism and

abnormally high blood sugar resulting from insufficient levels of the hormone

insulin.The characteristic symptoms are excessive urine production (polyuria) due to

high blood glucose levels, excessive thirst and increased fluid intake (polydipsia)

attempting to compensate for increased urination 8.

Incidence Rate

Diabetes Mellitus is a leading cause of morbitidy & mortality the world over,

it is estimated that approximately 1% of population suffers from DM. the

incidence is rising in the developed countries of the world, especially of the

Type 2 DM, due to rising incidence of obesity & reduced activity levels 9.

The prevalence of Madhumeha is on the rise; more alarmingly in the

developing nations Ranked 7th among leading causes for death 10.

The prevalence of diabetes for all age-groups worldwide was estimated to be

2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is

projected to rise from 171 million in 2000 to 366 million in 2030 11.

India has been projected as the diabetic capital of the world 12. Diabetes and it


http://en.wikipedia.org/wiki/Syndrome

http://en.wikipedia.org/wiki/Metabolism

http://en.wikipedia.org/wiki/Blood_sugar

http://en.wikipedia.org/wiki/Hormone

http://en.wikipedia.org/wiki/Insulin

http://en.wikipedia.org/wiki/Polyuria

http://en.wikipedia.org/wiki/Polydipsia

complications pose a major threat to future public health resources throughout

the world.

Recent survey by W.H.O. revealed that the Indian diabetic population at

present is 31.9 million and it is estimated to touch 79.4 million by the year

2030 13. It has been stated that in 1995 number of diabetics was 19.4 million in

India which rise to 30 million by the year 2002, but only 3.6 million Diabetics

in India received pharmacological treatment. In the early seventies only 2.1%

Urban Indians were suffering from type 2 Diabetes mellitus, which rise to

12.1% at present.

The recently concluded that National Urban Diabetes study (NUDS) carried

out by the Diabetes Epidemiology Study group in India (DESI) in six major

cities of India covering all the regions of the country estimated that the

prevalence rate of Diabetes in the adult population is 12.10%, while the

prevalence rate of Impaired Glucose Tolerance (IGT), a pre-diabetic condition

is 14%.

The above-mentioned figures point towards the alarming situation, which

suggests that the incidence of diabetes mellitus is increasing among the

general population. The top three countries for number of persons with

diabetes are India, China and United States of America. India has now been

declared by WHO as the Diabetes capital of the world.

Purpose of the study

Though, the discovery of Insulin and other hypoglycemic drugs has a great

achievement of modern medical science, but the hazardous side effects of

hypoglycemics after long term used are incurable and hence an ideal therapy is still

obscure. Recent data showing that control of hyperglycemia may prevent the onset or


slow down the progression of complications point to the importance of an appropriate

and efficacious treatment.

The Ayurvedic management of Madhumeha aims not only to achieve a strict

glycemic control but also to treat the root cause of the disease. Since the disease is not

curable, effective control is the need of the hour. For the prevention and control of the

diabetes, at various levels prevention is to be implemented. To reduce the incidence of

the cases that is in risk group, to reduce the associated signs and symptoms of the

disease and avoiding the further advancement of the disease leading to complications.

Here the present study aims to reduce the associated signs and symptoms of

the disease and avoiding the further advancement of the disease leading to

complications prevention by regularizing the blood glucose level with the help of

shamanaoushadi.

Previous research literatures

Soma S. Bhatia (2001) Jamnagar, A Clinical study on the role of Manas bhava

in the etiopathogenesis of Madhumeha. (Diabetes Mellitus) and its

Management by Sarasvatachurna (Manas Roga)

Sheetal Parmar (2002) Jamnagar, The role of Virechana & Trifaladi vati in the

management of Madhumeha (Diabetes Mellitus) (K.C.)

Anand Pawar (2003) Jamnagar, A comparative study of the role of basti

therapy and pramehaghna drugs in the management of madhumeha (Diabetes

mellitus)

Tushar Mandal (2001) Varanasi, A study on daruharidra (berberis aristata) in

no healing diabetic foot ulcers .(D.G.)


Pandey A K - 2003 Varanasi, A study of immune status in patient of

Madhumeha and role of pancha karma and naimmithika rasayana

Gowda Kirana M (1999) Mysore, Effect of salasaradi gana Basti on stool

madhumeha

The study description

The study description consists of the headings according to the RGUHS

protocol followed from 2nd chapter.

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 justifiable 14.

The present study was designed as “Evaluation of the efficacy of Palatrikadi

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

have a beneficial effect in the management of Madhumeha.

Madhumeha is a Vata Kapha pradhana Vyadhi. Phalatrikadi Vati 15 has been

mentioned in all most all authour under Kashaya form for Prameha Chikitsa. This

being Kapha & vata shamaka,Tikta, Katu,Kashaya Rasa, Katu Vipaka, Laghu, Ruksha

Guna Pradhana Aushadhi may easily help in the dissociation of Pathogenesis of

Madhumeha. They also possess Deepana and Pachana properties. That is why

Phalatrikadi Vati has been selected for the present study.


Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Objective 6

OBJECTIVES

Ayurveda system of medicinal aims at treating the human body as a whole and

not just the disease. Our Ayurvedic principles for the treatment, which reveals that the

medicine or treatment that cures one disease and creates some other is not a good therapy,

but the therapy which cures one disease and does not create any other, is the right

treatment 16. So here, we are putting our step forward to find safe and effective oral

hypoglycaemic agent.

Ayurveda is the first medical system, which mentions the Madhumeha / Diabetes

mellitus is incurable but it can be controlled with drug, diet. Diabetes mellitus, a chronic

disease unknown in developing world had emerged as a crucial health problem including

Asian countries. As people of developing countries were unaware of the nature of the

disease its occurrence increased rapidly. This alarming figure reminds the Diabetes

mellitus is an ice burg disease. Diabetics is more dreaded in these days because of

complications of this disease, the quality of life takes a backseat.

In Ayurveda Madhumeha and its management through various methods are

possible viz shodana, shamana. Considering the chikitsasutra the Phalatrikadi Vati as a

shamana chikitsa is under taken for the trial. As ayurvedic Madhumehahara drug which

are having safety in comparison with modern oral hypoglycemic drugs.

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

à-vis. Diabetes Mellitus and the management with Phalatrikadi Vati as a shamana

Chikitsa. 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 –

Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Objective 7

Objectives:

1) To evaluate the efficacy of Phalatrikadi Vati in the management of Madhumeha

2) To evaluate the efficacy of hypoglycaemic activity of Phalatrikadi Vati in

Madhumeha

1) To evaluate the efficacy of Phalatrikadi Vati in the management of Madhumeha

Dosha involvement in Madhumeha is Tridosha with predominance of Kapha and

vata with vitiation of dushy Mamsa, Meda and Shareera kleda. The ingredients of the

Phalatrikadi Vati are with Kapha Vata Doshahara and are of Katu, Tikta Rasa

predominance, Usna veerya to pacify Kapha Vata Dosha. Having gunas like Laghu,

Rookasha. Phalatrikadi Vati basically acts as Agni vardhaka, to normalize the Agni. By

observing all these characteristics of drugs Phalatrikadi Vati seems to be very much

beneficial in the management of Madhumeha which could be clinically observed to

understand Mehahara actions.

2) To evaluate the efficacy of hypoglycaemic activity of Phalatrikadi Vati in

Madhumeha

As the Phalatrikadi Vati 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.

HISTORICAL REVIEW

The knowledge of the ancient helps in having a better future. So the study of

history should be must for research purpose. So, careful insight into ancient treasure

of knowledge makes a good beginning for any study. The ancient treatise was full

with description of disease and their treatment. So here an attempt has been made to

explore the past literature to explain the historical aspects of the Madhumeha.

Vedic Period (2000BC to 1000BC):

The evolution of madhumeha can be traced from Vedas. Ayurveda is the

upanga of atharveda. In Atharva Veda (2500 B.C.) the disease is mentioned as

Ashravam, which means Mutra Atisara i.e., excessive urination 17.

a) Samhita Period (1000BC to 100BC)

(A) Samhita Period:

Explorative description of disease Madhumaha occurs at Samhita period.

(1) Caraka samhita:

Caraka samhita is a complete ancient treatise of medical science of its era; He

has given the detail description of the etiology, pathogenesis, symptomatology &

complications in Nidanastana 18. Where as detailed explanations of treatment is given

in Chikitsastana19. Aetiopathogenesis of madhumeha along with Complications are

narrated in Sutrastana 20.

(2) Susruta Samhita:

Achary Susruta has given elaborate explanations regarding Nidan Panchaka in

Madhumeha in the pramehaadhyaya. He used 'Ksaudrameha' synonym to Madhumeha

in Nidanastana21. He has described Pramehanivritti Lakshanas especially, i.e. how to

know that the patient is out of the disease. He has described the treatment in three

Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 8

different chapters under the heading of Prameha-Chikitsit22, Prameha Pidaka

Chikitist23 & Madhumeha Chikitsit 24.

(3) Vagbhata:

Vagbhata mentioned two types of Madhumeha i.e. Dhatukshyat and

avartpathat and added Sveda in the Dusysangraha 25.

(4) Haritasamhita:

Explained13 types of Prameha with nomenclature different than above treatise

like, Puyameha, Ghrtameha etc 26.

(5) Bhela Samhita:

In Nidanasthana, description of two types of prameha is given i.e. swakritija

prameha and prakritija prameha 27.

(6) Kasyapa Samhita:

He just mentioned the symptoms of Pramehi child in Vedanadhyaya and noted

the disease as Chirakari 28.

(B) Medieval Period:

This period of history of Indian medicine is known as a period of

commentators. Most of them content only the collection of thoughts from previous

authours.

(1) Madhavanidana:

He collectively repeated the description of Charaka, Susruta and Vagbhata 29.

(2) Gayadas:

Explained the Avilamutrata becaue of the presence of Dusya in it 30.

(3) Chakrapanidatta:

Chakrapanidatta described the treatment of prameha in his documentation

Chakradatta 31.


(4) Sarangadhara Samhita:

Mentioned the 20 types of Prameha and some yogas for the management of

prameha 32.

(5) Bhavaprakasa:

He described Prameha and Madhumeha along with some new herbomineral

preparations33.

(6) Yogratnakara:

Prameha chikista has been described vividly in Yogratnakara 34.

NIRUKTI AND PARIBHASHA

A) Nirukti –

Madhumeha is the combination of the two words Madhu and Meha. The word

Madhu is derived from the root ‘Mana’ has the meaning of ‘Manava Bhodane’-

.Which gives the psychic contentment [Vachspathya].

Madhu- The Madhu refers to honey, sweet, delicious, the juice or nectar of the

flowers, Soma also.

Meha- The word Meha is derived from the root ‘Miha’, which is employed in the

sense of Prasrave, excessive flow of urine, making water, passing urine, Sinchana, to

moisten, Ksharana. [Vachspathya].

Prameha - The word Prameha is derived from “Pra and Miha”

Pra + Miha Ksharane, Karane + Ganm 35

This is a general name for a urinary disease. It is a condition characterized by

excessive excretion of urine.


B. Paribhasha:

Madhumeha is the clinical entity in which patient voids the urine having

concordance with Madhu i.e. of Kasaya and Madhura taste, ruksa (dry) texture and

honey like colour 36. Body acquires sweetness called madhumeha.

Susruta has defined Madhumeh as Ksaudrameha and stated that the urine in

this condition resembles honey and acquires a sweet taste 37. So it is undoubtedly

resembles with Madhumeha. Further he asserted that when all the Pramehas are

neglected get converted into Madhumeha and especially he emphasized that the

disease Prameha along with Pidaka should be termed as Madhumeha 38.

C. Paryaya:

Kshoudrameha: Kshoudra is a synonym of Madhu 39.

Ojomeha: Ojas is considered as Tejas or essence of all Dhatus, Madhura rasa of Oja

mixes with kashaya rasa of Vata and excreted out. Hence Ojomeha has been used by

Charaka 40 and Vagbhata 41 to describe this disease.

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

Madhumeha where the Pushparasa means madhu 42.

All above synonyms postulates unanimously that, the urine concordant with

madhu or sweet taste is Madhumeha


NIDANA

The knowledge of nidana is helpful for the proper understanding of the disease

and also for the management of the disease. Nidana parivarjana is also one of the

important measures in Chikitsa43. Only Charaka explains specific Nidanas for

Madhumeha. The Samanya Nidanas of Prameha and Vataja Prameha may attribute to

Madhumeha, as it is one of the types of Vataja Prameha.

Kaphaja Prameha nidanas may be considered as nidana for Madhumeha. As

Kapha dosha is the initial factor for the causation of all varieties of Prameha,

especially Madhumeha. This can be emphasized by Gangadhara’s version, where in

he says that Gulma is caused by vayu, Raktapitta by Pitta, like wise Madhumeha is

caused invariably due to the vitiation of Kapha dosha 44.

Mainly classified into 1) Sahaja

2) Apattanimityaja

Sahaja Madhumeha (Beeja dosha):

Charak 45 and Susruta 46 have explained that beeja dosha is also a cause for

Madhumeha. Acharya Charaka while explaining Vikrutha Garbha caused by

beeja dosha says that if a part of the beeja is defective, the body part developing

from that portion of beeja will be abnormal. He gives an example that a portion of

the beeja of a kusti man which is responsible for the formation of the skin is

defective, then only the born child will have kusta 47. However if that part is not

abnormal then the child will not suffer from kusta .Hence it can be understood that

child born to Madhumehi, may or may not suffer from Madhumeha. It depends on

the beejabhaga avayava which is defected by vitiated vatadidosha present in Sukra

and shonita of parent.


2) Apattanimityaja:

a) Samanya Prameha Nidanas:

Table – 1

Showing the Aharaja Nidana of Madhumeha

S. N. Nidanas C.S. Su.S A.H M.Ni. Bhe.S B.P. Y.R

1 Dadhi Sevana + - - + - + +

2 Gramyarasa + - - + - + +

3 Audakarasa + - - + + + +

4 Anupa Rasa + - + + + + +

5 Kshira Sevana + - - + - + +

6 Nava Anna + - - + - + +

7 Nava Pana + - - + - + +

8 Guda Vaikruta + - + + - + +

9 Kaphakara Hetu + + + + + + +

10 Sheeta - + + - - - -

11 Snigdha - + + - + - -

12 Madhura + + + - - - -

13 Medovardhaka + + - - - - -

14 Drava Anna + + - - - - -

15 Drava Pana + + - - - - -

16 Nava Dhanya + - + - - - -

17 Nava Sura + - + - - - -

18 Ikshu + + + - - - -

19 Goorasa - + + - - - -

20 Amla - + + - - - -

21 Gura - + + - - - -

22 Picchila - + + - - - -

23 Mandaka + + - - - - -


Table - 2

Showing the Viharaja Nidana of Madhumeha

S. N. NIDANS C.S Su.S A.H M.Ni Bhe.S B.P Y.R

1 Asyasukha + - - + - + +

2 Swapnasukha + - - + - + +

3 Divaswapna - + - - + - -

4 Avyayama + + - - + - -

5 Alasya - + - - - - -

6 Ekasthanaasana - - + - - - -

7 Rathih - - + - - - -

8 Vidhirahitashayana - - + - - - -

9 Swapnaprasanga + - - - - - -

10 Shayanaprasanga + - - - - - -

11 Asanaprasanga + - - - - - -

12 Shareerashodhana

Varjya

+ - - - - - -


Table - 3

Showing the Vishista nidanas according to Doshaja

Nidana Kapha Pitta Vata

Ahara

sambhandi

Hayanaka,yavaka,chinaka

,uddalaka,naishada,ithakata,

mukunda,mahavrihi,

modaka,sughandaka,Sarpi,navaharenu,

masha,Anupa,udaka,gramyamamsa,

shaka,palala,tila,pistanna,

payasa,krushara,vilepi,ikshu,

sharkara,kshira,navamadhya,

mandaka,dadhi, madhura,drava

Ushna,amla,

lavana,kashaya,

Katu,ajirna,

vishamashana

Kashaya,Katu, Tikta,

Rooksha, Laghu,

Sheeta,

Vihara

sambhandi

Mrujavarjana,avyayama,

swapnashayana, aasanaprasanga

Atiatapasevana,

antapa,shrama,

kroda

Atiyoga of Vyavaya,

Vyayama, Vamana,

Virechana,Ashtapana,

Shiroovirechana,Shonita,

Atisheka,Sandharana,

Anashana,Abhighata,

Atapa,Udvega,Shokha,

Jagarana,Vishama

Shareera,Asana,

Upasevana.


Table – 4

Showing the Avaranajanya Madhumeha nidanas.

Aharaja Viharaja

Guru

Snigdha

Amla

Lavana

Navanna

Navapana

Nidra Sukha

Asya Sukha

Tyakta Vyayama

Achintana

Samshodhana Akurvatam

Nidanarthakara rogaja:

A. Sthoulya:

Sthoulya is a nidanarthakara roga for Prameha. It is obvious that the

samanya nidana of Sthoulya and Prameha simulates each other. Sushrutha has stated

that apathyanimittaja Pramehis are Sthoola 48.

B. Prameha:

All the other types of mehas if neglected in its due course, lead into

Madhumeha49. Pathogenesis and the srotas involved in Prameha and Madhumeha

are similar. So, if the Prameha is not treated then it causes more strain on the

same srothases and causes


SAMPRAPTHI

The thorough knowledge of Samprapti is very essential to find the extent of

Dosha and Dushya vitiation, involvement of Avayava, Srotasa and prognosis of the

disease. For the manifestation of any disease in the body the association of main three

factors, Nidana, Dosha and Dushya is necessary otherwise disease will not occur.

According to Sushruta, too much indulgence in the etiological factors related

to Prameha results into Aparipakva Vata, Pitta, Kapha and Meda, which further

proceed through the Mutravaha Srotasa and get localized in the Basti Mukha and thus

leading to disease Prameha 50. Sushruta has stated that, all the Pramehas if left

untreated or treated improperly get terminated into Madhumeha. Vagbhata described

two types of pathogenesis of Madhumeha i.e. Dahtukshayatmaka and Dosha

Avaranatmaka. Further, Vagbhata interpreted that in all types of Prameha, the Dosha

and Dushya remain same but still the difference in Mutra Pravritti is due to specific

type of Samyoga between specific Dosha and Anukula Dushya 51. Charaka has

explained the pathogenesis in a detailed manner i.e. Samanaya Samprapti of Prameha

and specific Samprapti of Pramehas. Charaka enumerated the general samprapti in

cikitsasthana. 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 into prameha. In same manner

pitta gets vitiated resulting into pittaja prameha. While Vata due to deplition of other

two dosa get provocated inturns causes deplition of dhatus by excrete them through

urine resulting vataja prameha 52. The later texts such as Yogaratnakara 53 and

Madhava Nidana 54 have followed the description of Charaka Samhita.

This is the concise pathogenesis described in Cikitsasthana but in

Nidanasthana caraka described pathogenesis according to the type.


Samprapti according to doshika predominance:

1) Kaphaja Prameha:

The etiological factors first cause the provocation of Kapha because of its

close similarity to the related Hetu. This aggravated Kapha then spreads all over the

body rapidly due to Sharirashaithilya. Meda Dhatu being Bhahutva, Abadhdha and

having similar properties with Kapha, the provocated Kapha while spreading gets

amalgamated with Medha Dhatu causing its vitiation, This annexation of vitiated

Meda and Kapha comes in contact with Sharira-Kleda and Mamsa, which are already

in excess quantity resulting Putimamsapidaka On the other hand the vitiated Kleda

gets converted into Mutra. The Kapha along with Meda and Kleda impede the

openings of Mutravaha Srotasa resulting into Prameha 55. Sushruta narrated Dushyas

in each Doshika type of Prameha. He narrated vitiation of Kapha along with Vata,

Pita and Meda in Kaphaja Prameha 56. In Ashtanga Samgraha, Vagbhata explained

that Vitiation of Kapha along with meda, kleda, mamsa, shukra, rasa and get localized

in basti resulting into kaphaja prameha 57.

2) Pittaja Prameha:

Due to its etiological factors provoked Pitta manifests as Pittaja Prameha 58.

Here similar pathogenesis occurs as described in Kaphaja Prameha. Depending on

different properties of Pitta Dosha the Paittika Prameha develops into six types.

Pittaja Prameha is not entirely Paittika but it does have Pitta predominance as it is

mentioned in the very beginning of the 4th chapter of Nidana Sthana by Charaka that

there is dominance of Pitta Dosha in comparison to Kapha Dosha and Vata Dosha, in

Paittika Prameha. Sushruta related Shonita along with Vata, Kapha and Meda in the

pathogenesis of Pittaja Prameha 59. Almost similar pathology is described in Ashtanga

Samgraha and Ashtanga Hridaya. In Ashtanga Samgraha, Vagbhata explained that as


the disease Kaphaja Prameha gets chronic, Kshaya of Kaphadi Dhatus occurs and thus

Pitta gets vitiated resulting in the manifestation of Pittaja Prameha 60. Ashtanga

Hridaya mentions that Pitta vitiates the Rakta producing Pittaja Prameha 61 and rest

description is similar to Ashtanga Samgraha.

(3) Vataja Prameha:

Here Vata gets provoked due to its own etiological factors and draws out

Vasaadi Dhatus from the body towards Basti resulting into four types of Vataja

Prameha. When Oja is drawn towards Basti due to vitiation of Vata, the natural

Madhura Swabhava of Oja due to the Ruksha Guna of Vata gets transformed into

Kashya Rasa leading to the manifestation of Madhumeha 62. One more pathogenesis

of Vataja Prameha is described in Chikitsa Sthana. Here provoked Vata due to

depletion of other two Dosha carries vital Dhatus towards Basti, resulting into Vataja

Prameha 63. Similar description is available in Ashtanga Hridaya. As per Sushruta

Kapha, Pitta, Meda, Vasa and Majja take part in pathogenesis of Vataja Prameha 64. In

Ashtanga Samgraha, Vagbhata explained that vitiation of vata in association with

lasika, majja, and ojus 65.

Samprapti of madhumeha:

According to Vagbhata two types of pathogenesis get precipitated 66

1. Dhatukshayata

2. Avaranajanya

The different types of Samprapti which are mentioned by various Acharyas

are being described below.

1. Samprapti vishishta Anilatmaka Madhumeha:

The pathogenesis of madhumeha is explained in Charaka Samhita,

Nidanasthana. Due to causative factors in the person susceptible for prameha,


vataprakopa occurs. This prakopita vatadosha attracts the vital dhatus like vasa, majja,

lasika & oja to basti. Because of vata dosha rukshatva and madhura rasa of oja mix

with kashaya rasa of Vata, comes it into mootrashyaya. Then oja is excreted through

urinary tract later. This condition is termed as madhumeha 67.

2. Madhumeha due to Shuddha Vata

Due to depletion of Kapha and Pitta, Vata gets provoked and causes the

excretion of Dhatus (like Vasa, Majja, Oja and Lasika) through urinary tract resulting

into Madhumeha 68. I.e. this category of Madhumeha is Asadhya due to Vata as

Arambhaka Dosha and its further consequential provocation due to Dhatukshaya.

3. Dhatukshayajanya Madhumeha

The Kshaya of Gambhira and Sarabhuta Dhatus like Vasa, Majja, Oja and

Lasika lead to Vata Provocation. The expulsion of Sarabhuta Dhatus through urine

occurs in such excess amount that this Kshaya itself again acts as Nidana, for Vata

Prakopa. Hence this vicious cycle goes on and on, but due to Ashukaritva property of

Vata all the stages of Samprapti proceed so fast that it leads to Asadhya stage of

disease very quickly.

4. Avaranjanya Madhumeha:

The etiological factors of Avaranjanya Madhumeha have been described by

Vagbhata but he has not explained the pathogenesis of this type of Madhumeha.

Charaka has fully illustrated this type of Samprapti in detail, Due to excessive

indulgence in the etiological factors mentioned above, 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 provoked and

draws out the Apara Oja from all over the body and carries it towards Basti causing

Madhumeha 69. The Kricchrasadhyata of this Avaranajanya Madhumeha is due to


provocation of Vata by Kapha-Pittakara etiological factors. Initially, the Vata Dosha

remains innocent in the pathology.

5. Kala Prabhavaja Madhumeha:

This type of Madhumeha is described by Sushruta & Vagbhata. Though direct

pathogenesis is not mentioned but it is said that when all types of Prameha are ignored

or not treated properly, they get transformed into Madhumeha 70. We can say that this

is the last stage or further progression of Kaphaja and Pittaja Prameha or complicated

stage of the diseases.

Samprapti ghataka of madhumeha:

On the basis of various references the Samprapti Ghataka of Madhumeha are

illustrated below:-

Dosha: Disease is Tridoshakopanimittaja 71.

Kapha: Bahu and Abadhdha – in Avaranajanya Madhumeha.

Kshina – in Kshayajanya Madhumeha

Pitta: Vriddha – in Avaranajanya Madhumeha

Kshina – in Kshayajanya Madhumeha

Vata : Avrita – in Avaranajanya Madhumeha

Vriddha – in Kshayajanya Madhumeha

Dushya: Rasa, Rakta, Mamsa, Meda, Majja, Shukra, Vasa, Oja, Lasika,

Kleda 72 and Sweda 73.

Srotodushti: Sanga & Ati Pravritti

Srotus: Medovaha, Mutravaha, Udakavaha, Mamsavaha

Agni: Vaishamya of all Agnis (or Dhatvagnimandya)

Ama: Jatharagnimandya and Dhatvagnimandya.

Adhisthana: Basti


Udbhavasthana: Amashaya

Swabhava: Chirakari 74.

(A) Dosha: All the three Doshas are responsible for manifestation of Prameha.

(i) Kapha:

Kapha plays the dominant role in the Samanya Samprapti of Prameha. It is the

first Dosha to get vitiated. Acharya Charaka while describing the causative factors

used the term ‘Kaphakrut Cha Sarvam’ in it 75. It indicates the significance of this

Doshadushti in Prameha. Sharirashaithilya is the consequence of Bahudrava Kapha.

Other manifestations are Alasya, Atinidra, Tandra, etc.

(ii) Pitta:

Here, in Avaranajanya Madhumeha mainly the symptoms manifest because of

Vriddhi of Pitta Dosha as Trisha, Daha, Kshudha and Trunshavriddhi 76. Chakrapani

commenting on, Samprapti of Vataja Prameha has been described as Pitta is in

Kshaya Avastha as compared to Vata in the Vataja Prameha pathogenesis 77. So,

Kshaya Lakshana of Kapha Dosha and Pitta Dosha may manifest in Kshayajanya

Madhumeha. Pitta Kshayajanya Lakshanas are Mandagni, Prabhahani, and Sheetata

etc 78.

(iii)Vata:

This is the prime 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 Oja towards Basti and excretes them outside through urine

resulting in kshaya of the Dhatus. Thus due to atikshaya of Dhatus, the symptom

manifests are Karshya, Daurbalya, Angasuptata and Parisaranshila nature 79.


(B) Dushya:

Nidana, Dosha and Dushyas are the three factors responsible for the

manifestation of every disease. Charaka specially enumerated dushyas in a group and

named it as a dushya vishesa again he mentioned them in Chikitsa 80. Only Vagbhata

mentioned sweda as a dushya along with the above dushyas 81.

i) Rasa:

Rasa is the seat of Kapha Dosha and at the same time it is the Mala of

Rasadhatu. So prakopita Kapha has affinity towards the Rasadhatu. 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.The symptoms like Alasya,

Gaurava, Karshya, Hrillasa, Gaurava, Angamarda, Sada, Pandutva, Klaibya etc. are

produced as a result of Rasa Dushti.

ii) Rakta:

It mainly gets vitiated in Pittaja Prameha. The Rakta Dusti Lakshanas are

Daha, Pidika, etc. And skin diseases like Kustha, vidradi, Pidika, kotha are produced

as a result of Rakta Dusti 82.

iii) Mamsa:

Mamsa and Kapha are having the same qualities i.e. both give strength to the

body. When Kapha gets vitiated, Mamsa losses its normal consistency and develops

Shaithilya and provides space in between for the accretion of morbid matter. This

consequently results into the Puti Mamsa Pidika 83. "Mamsaleshu Arakasheshu" 84.

iv) Meda:

It is the dominant Dushya in all types of Pramehas. It gets vitiated both

quantitatively and qualitatively. Kapha and Meda have close resemblance as they


have the same qualities. Both get vitiated more or less by same etiological factors.

In Madhumeha vitiation of Meda results in two ways as already said:-

1. Qualitative [Abadhdha, (Asamhat)]:

Normal function of Meda is to produce snigdhata in the body along with

Dridhatva i.e. compactness. So this Abadhdhatva causes derangement in the structure

of Meda producing Shaithilya in the body.

2. Quantitative (Bahu):

Here in the pathogenesis, Meda is in excess quantity. This Medo Dhatu is

Aparipakva 85. Meda Dhatu is the most Anukula Dushya for provoked Kapha Dosha.

Guru Snigdhadi Ahara and Avyayamadi Vihara leads to Atimedovriddhi i.e. Bahutva

of Meda Dhatu, due to Dhatvagnimandya. Whatever obese persons take in food, it

gets converted into Meda and other Dhatus remains under-nourished leading to

Dhatukshaya. Along with Bahutva, Dhatvagnimandya also results into Abadhdhatva

of Meda. Such an Abadhdha Meda gives ‘Sharira Shaithilya’ and instead of doing

Asthi Poshana; Meda Dhatu gets itself over burdened which is harmful to the body.

Meda Dushti may manifest in many ways .The deranged Meda produces following

signs and symptoms which are the eight Doshas of Atisthula person 86.

1. Ayusorhrasa: Decreased life expectancy.

2. Javoparodha: Early manifestation of Ageing

3. Kricchravyavayata: Difficulty to perform sexual act and impotency

4. Daurbalya: General Debility

5. Daurgandhya: Bad smelling due to excessive sweating

6. Swedabaddha: Discomfort due to excessive sweating

7. Kshudha-Ati Matra : Polyphagia

8. Pipasa-Atiyoga: Polydipsia


By observing above description certainly it can be asserted that in Samprapti

of Madhumeha, Meda plays the foremost role.

v) Majja:

Due to Vata Prakopa Kshaya of Majja Dhatu occurs. Thus vitiated Majja

produces clinical symptoms like, Netragaurava, Angagauravata in patient 87.

vi) Shukra:

Shukra Dhatu gets affected in the pathogenesis of Prameha; Shukra due to its

vitiation produces symptoms like Daurbalya and Kricchravyavayata. In Sahaja

Prameha Shukra play an important role. Prameha is a Kulaja Vikara and occurs as

result of Beeja Dosha. Sushruta has described that Shukra Dosha and Prameha get

precipitated because of the vitiation of Vyana and Apana Vata 88. Vata causes

depletion of Shukra Dhatu and also Shukrameha 89. So, one can appreciate the

importance of Shukra Dushti in Prameha.

vii) Vasa:

Charaka described it as a subtype of vataja Prameha i.e. vasameha 90. It is an

Upadhatu of Mamsa and is ‘Sleshmika’ in character. The provoked Vata draws Vasa

towards Basti and excretes it through the urine in the form of Sneha. In case of

Madhumeha, the Dushti is illustrated in the form of Bahutva as well as

Abadhdhatva91.But still the manifestations are not described concerning Vasa Dushti.

viii) Lasika:

The aggravated Vata propels Lasika towards the Basti and then excretes it

through the urine leading to increased micturation. Lasika is a kind of fluid found

beneath the skin between it and Mamsa Dhatu 92. It is excreted from the skin in the

form of sweat. So the manifestation of Lasika Dushti may be in the form of excessive

sweating. Lasika is described as a Dushya in Hastimeha.


ix) Oja:

Oja is supreme extract of all the Dhatus and gives strength and immune power

to the body. Oja is the purest quality of Sleshma in its constitution, Guna and Karma.

Oja is an important Dushya in the Samprapti of Madhumeha. Here provoked Vata

transforms the Madhuratwa of Oja into Kashayatwa and carries Oja towards Basti and

excretes through urine leading to Ojakshaya 93. So the symptoms of Ojakshaya like

Murccha, Mamsakshaya, Moha, Daurbalya (excessive weakness), Vyathita Indriya,

Rukshata, Gurugatrata, Nidra, Tandra etc may manifest 94.

x) Kleda:

It is also an important Dushya after Meda. The literal meanings of Kleda are –

wetness, moisture, dampness etc. In the commentary regarding Sharira Kleda in

Charaka samhita mentioned that Kleda gives Shaithilya to Sharira. Charka has given

Ambu as a synonym to Kleda. Normal function of Mutra and Sweda has been

described by Vagbhata as, under normal physiological conditions Mutra and Sweda

maintain balance of Kleda in the body. Especially Sweda holds it in the body and

Mutra excrete it outside the body 95. If this Kleda gets vitiated it directly affects the

Mutra and Sweda and disrupts the physiology of bodily elements causing Shaithilya.

Arundatta has mentioned that absence of Kleda may lead to the dryness of the body 96.

In the Samprapti, Kleda Dushti is in the form of ‘Vriddhi’ and not the Kshaya. Hence,

Bahu Kleda will manifest as Prabhuta Mutrata and Avila Mutrata because extensively

increased Kleda is excreated out of the body as Mutra. The other manifestations of

Kleda Dushti may be Shithilangata, Ati Sweda Pravritti, Visra Sharira Gandha (due to

excessive sweating), Sharira Mruduta, Snigdhata etc.

xi) Sweda:

This Dushya has been mentioned only by Vagbhata 97. Sweda is mainly


related with Meda and Kleda. Due to the vitiation of Meda and Kleda, Swedavaha

Srotodushti occurs leading to the manifestation of Ati Swedapravritti, Daurgandhya,

Picchilagatrata, Snigdhagatrata Visra- sharirgandha etc. Sushruta mentioned that in

Madhumeha (Prameha) Sweda becomes Sweet in nature 98. The whole pathological

phenomenon described in Kleda and Sweda Dusti can be correlated with water and

electrolyte imbalance.

C. Srotodushti:

In the Samprapati of Madhumeha there is reference of Mutravaha Srotodushti

only but keeping in mind the symptomatology etc. it can be easily understood that

there occurs Medovaha, Mamsavaha, Swedavaha and Udakavaha Srotodushti also. In

the Samprapti of Madhumeha two types of Srotodushti are found:

(1) Atipravritti

(2) Sanga

Thus we can find out the Srotasa involvement according to the symptoms as follows

(1) Mutravaha Srotodushti - Prabhuta Avila Mutrata

(2) Medovahasrotodushti - Purvarupa of Prameha, Snigdhagatrata etc

(3) Mamsavaha Srotodushti - Putimamsapidaka

(4) Udakavaha Srotodushti - Pipasa, Mukha-Talu-Kantha Shosha.

D) Agni:

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

Agnimandya and tikshna Agni conditions present in the pathogenesis.

E) Ama:

Sushruta has illustrated the role of Ama in the pathogenesis of various

disorders. He mentions that the Samprapti of Prameha takes its origin from the Ama

only 99. He states that is from the very beginning, Agnimandya has been developed


due to Guru, Snigdhadi Ahara and Avyayamadi Vihara which leads to production of

Ama. Dalhana adds that not only Dosha but Meda Dhatu is in the Ama form. Hence

Ama is a part and parcel of Samprapti. Ama means Aparinamittaja. Anything which

remains in undigested form, being harmful to the body is Ama. It is Apakva

(undigested), Asyaukta (Shithila), Durgandhi, Picchila in nature and it produces

Gatrasada. In the Samprapti of Madhumeha, we also get the dominance of Ama

regarding Kapha Dosha, Meda Dhatu, Mamsa Dhatu, and Kleda. The undigested

Kapha and Meda acts as Ama vitiating the Mutravaha Srotasa leading to Madhumeha.

This vitiation is in the form of Srotasa obstruction.

Below chart showing the symptomatology and their relation with Dosa and

Dusya. So Madhumeha is the disease clinically we can found with various

Presentation. Thus with the help of above chart we can easily find out the extent of

Dosa and Dusya involvement in the pathogenesis to profound the treatment modality

exactly according to the stage of the disease.


Table - 5

Shows the Roopa and their relation with Dosha and Dushya.

Sl.

No.

Dosha nature ofVitiation Strotus Involved Lakshanotpati

1. Kapha Vriddhi Sarvasarira Jatilibhavakesesu

Madhuryamasasya

Alasya

Shithilangata

Snigdhagatrata

Picchilagatrata

Nidra, Tandra

Madhura and Suklamutrata

2. Pitta Vriddhi Sarvasarira Bahuashitva.

Pipasa.

Hastapadataladaha.

Paridaha.

Visrasarirgandha.

3 Vata Vriddhi Sarvasarira Sada.

Karasuptata.

Padasuptata.

Angasuptata.

Karsya.

Dusya

1. Rasa Vriddhi and Dushti Rasavaha, Udakavaha Gaurava.

Sada.

Tandra.

Sthaulya and Krusangata.

Mukha Tula Kanthasosa.

2. Rakta Dusti - Vidradhi

Raukshya (Sahaja Prameha)

3.

Mamsa

Dusti Mamsavaha Putimamsa Pidaka


Shaithilya

TalugalajivhaDateshu

Malotpatti

4 Meda Dusti ,Vriddhi Medovaha Sthaulya

Medodosha

Atikshudha

Atitrushna

Daurgandhya

Daurbaya

Svedavrdhi

5. Majja Dusti Vriddhi Majjavaha Netragaurava

Angagaurava

Murca

6. Shukra Dusti Ksaya Shukravaha Klaibya

7. Kleda Dusti Vriddhi Mutravhaa,Svedavaha Mutradosa

Prabhutamootrata

Avilamootrata

Svedavruddhi

8 Sveda Vriddhi, Dusti - Svedavruddhi

Daurgandhya

Paridaha

Shlaksnagatrata

9 Oja Ksaya. Sarvasarira. Daurbalya

Gurugatrata

Tandra, Nidra

Murcha


Figure – 1

Madhumeha Samprapti

Avarana janya Apathyanimittaja Sahaja Madhumeha

Madhumeha Madhumeha

Nidana sevana Beeja Dosha

Vikruta bahudrava Kapha

Travels all over the body because

of shareera shithilata

Medo dhatwagni mandya

Sthuolya Medovaha srotas vitiation

Bahu abaddha medas

Kapha Pitta Meda Mamsa Dosha dushya sammurchana

Ativruddhi

Bahudrava sleshma with bahu

Abaddha meda

Obstruction of Vata due

to avaranaby vitiated Vitiation of other dushya

Kapha Pitta and Meda

Adhika kledata of Dhatu

Squeezing of Ojas in to vasti

Vasti

Madhumeha


BHEDA Classification of a disease is mainly done for the purpose of proper

understanding of the disease and to formulate an effective treatment proptocol.

Through this different point of view, many classifications are available from our texts

of which most important is according to its dosha predominance. In classics twenty

types of prameha have been described according to its dosha predominance, as these

are precursor for Madhumeha. If these pramehas are not treated in time or properly,

they get converted into Madhumeha. They are,

Kaphaja Pramehas - 10

Pittaja Prameha - 06

Vataja Prameha - 04s

Table – 6

Types of Prameha

Kaphaja prameha Pittaja prameha Vataja prameha

Udaka meha Kshara meha Vasa meha

Ikshu meha Kala meha Majja meha

Sandra meha Nila meha Hasti meha

Sandraprasada Meha Lohit meha Madhu meha

Sukla meha Manjishtha meha

Sikata meha Haridra meha

Sita meha

Shanair meha

Lala meha

Shukra meha


Vagbhata clearly narrated that these types result because of the nexus

between Dosha, Dushya and their specific combination according to concordance.

Thus in each subtype of prameha specific urine is voided 101. 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 quality 102.

By observing the all classification we can easily understand the Dosha

predominance, dushya involvement, nature of urine voiding and we come know to

about the etiological factors, State of the disease and progression.

Classification of Madhumeha:

Clinicopathological status of a disease has an invariable relation with physical

constitution of the body in Madhumeha. This has to be taken into consideration when

treatment is formulated. According to this, in Ayurveda, Madhumeha is of two

types103.

• Sthula

• Krisha

The root cause of disease has enough importance for the prognosis &

treatment of the disease. The occurrence of Madhumeha according to this point of

view is of two types 104:

• Sahaja [Heriditary]

• Apathyanimittaja [Acquired]

Sahaja:

Sahaja prameha occurs as a result of Beejadosha i.e. genetic origin 105. While

describing prognosis, Acharya Charaka has narrated that prameha or Madhumeha

occurring due to Beeja dosha is incurable 106.


Apathyanimittaja:

Apthyanimittaja type itself suggests its etiology. It occurs due to Ahitahara

vihara.

Sampraptighataka has manything to do with the prognosis & treatment of the

disease. On analyzing the samprapti, Apthyanimittaja madhumeha is of two types.

(A) According to Samprapti

• Avaranjanya

• Dhatukshayajanya:

1) Avaranjanya:

In Avaranjanya madhumeha, Kaphavardhaka nidanasevana leads to vata

avarana, this in turn leads to Ojas Karshana which comes to the basti & patient passes

Madhura, Kashaya, and Ruksha Mutra, which is said to be Madhumeha.

2) Dhatukshayajanya:

Where as in Dhatukshayajanya, due to vatavardhak nidana, vataprakopa

occurs & the Madhuratwa of Oja along with Kashaya rasa is brought to the basti

leading to Madhuvat Mutratyaga, leading to Madhumeha.

(B)According to Nidana:

• Santarpanjanya

• Apatarpanjanya

Santarpanjanya

Santarpanjanya madumeha which is directly occur due to intake of

kaphavardhaka ahara. The excess intake of such substances will primarily lead to the

vitiation of kapha, pitta, meda & mamasa, which in turn cause madhumeha by doing

avarana of vata 107.


Apatarpanjanya

If the substances which deplete the dhatu & aggravate vata are consumed then

it leads to Apatarpanjanya Prameha. They act through vitiation of vata which in turn

leads to the manifestation of Madhumeha.

In nutshell, Sahaja & Apathyanimittja are types of Madhumeha. The Krisha,

Dhatukshayajanya & Apatarpanjanya can be correlated with Sahaja Madhumeha.The

Sthula; Avaranjanya & Santarpanjanya can be correlated with Apathyanimittaja

Madhumeha.

POORVA ROOPA

The poorvaroopas are helpful in diagnosing the disease as early as possible,

also to know prognosis, differential diagnosis of disease. The poorvaroopas explained

in the context of prameha are to be considered as the poorvaroopas of madhumeha.

Specific poorva roopa for Madhumeha have not been mentioned anywhere in classics.

In this context poorva roopa of Prameha are discussed.


Table-7 Showing the poorva roopa of Madhumeha

Sl No Lakshana Ch Su AH AS Ma Ni

1 KesheshuJatilibhava + + - + -

2 Asya madhurya + - + + +

3 Karapadadaha + + + + +

4 Karapada Suptata + - - - -

5 MukhaTaluKanthaShosha + - + + -

6 Pipasa + + - + +

7 Alasya + - - + -

8 Kaye malam + - - + -

9 KayaChhidreshuUpadeha + - - +- -

10 Paridaha Angeshu + - - - -

11 Suptata Angeshu + - - + -

12 ShatpadaPipilikaMutrabhisaranam + - + + -

13 Visra sharir gandha + + + + -

14 MutrechaMutradosham + - - - -

15 Sarvakala Nidra + - - + -

16 Sarvakala Tandra + + - + -

17 Snigdha gatrata - + - + -

18 Pichhila & guru gatrata - + - - -

19 Madhur mutrata - + - - -

20 Shukla Mutrata - + - + -

21 Sada - + - + -

22 Shwasa - + - + -

23 Keshanakhativriddhi + + + - -

24 Sheeta Priyata + - + + -

25 Hridaya NetraJihwShravanopdeha + - + - -

26 Sweda + - + + -

27 Dehachikanata - - -

28 Ghanagatrata + + - - -

29 Dourghandya - + - - -

30 Danteshu malotpatti - + - - +


If all the Pramehas are neglected then it results into Madhumeha. This may be

the reason for not mentioning the specific poorva roopas by our Acharyas for

Madhumeha and most of the poorva roopa mentioned in our classics are the clinical

features and complications of madhumeha. So, the poorva roopas of Prameha in

general discussed here.

Our Acharyas have given more importance to poorva roopas. According to

Sushrutacharya, if all the poorva roopas are clearly exhibited and if the patient notice

a slight increase in mootra, then one can infer that patient may suffer from Prameha in

the near future. If half of the poorvaroopa are exhibited clearly and patient notice

adhikamootra pravritti, then it is the clear indication of the presence of Prameha 108.

In olden days vaidyas used to detect the presence of sugar in urine by

pipeelikaabisarana. A patient use to approach a vaidya only when he suffered from

prabhoothamootrapravritti. But he neglected the symptoms like snigdhata of the body,

atinidra etc. which occur much more earlier than the above mentioned cardinal

feature. Thus our Acharyas have considered these early stages as poorva roopa.

ROOPA

The signs and symptoms of a disease will be produced in the fifth stage of

samprapthi i.e. vyaktavasta. In this stage doshadooshya sammurchana will be capable

to produce its lakshanas.

In ayurveda only mootra sambhandhi lakshanas are mentioned for

Madhumeha. But samanya lakshanas of Prameha and also lakshanas of

apathyanimittaja Prameha are also can be included under lakshanas of Madhumeha.

The Rupa as described in Ayurveda includes both, sign and symptoms of the

disease. These are described under following headings:-


Mootra sambhandi lakshanas:

A. Samanya lakshana 109

1. Prabhootha mootrata:

This is the cardinal sign of prameha described by all acharyas. Increase in

quantity and frequency of mootra is considered as prabhootha mootrata. It is

manifested due to increased kleda in the body and collects in the basthi. As

kledavahana is the function of mootra, excess of kleda in the basthi will be excreted

through mootra frequently by vitiated apanavata. So, prabhootha mootrata in terms of

quantity and frequency is seen in Madhumeha.

2. Avila mootrata:

Turbidity of mootra is considered as Avila mootrata. Patient passes urine

having hazy consistency. Dalhana opine that, the characteristic features of urine are

because of the nexus between Mutra, Dosha & Dushya 110.

Table - 8 Showing the vishista lakshanas:

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 - + - - - - - -

1. Kashaya:


Bhavamishra interprets it as kashaya Varna which can not be elicited

clinically111.

2. Madhura mootra:

It is also because of excretion of ojus in mootra. Earlier they used to detect this

by pipeelikas. Now a day by urine examination one can understand mootra

madhuryata.

3. Pandu:

Pandu varnata of mootra may be due to excessive kleda in the mootra.

4. Rooksha:

Due to vitiation of vata one can notice rukshata.

5. Madhusama mootra:

Varna, gandha, rasa of mootra will be similar to that of madhu. It is due to the

ojonissarana in mootra.

Sarvadaihika lakshanas of apathyanimittaja prameha:

In Chikitsa sthana Susruta before propounding the treatment of Prameha,

asserted two types of Prameha along with their features as follows,

1) Sahaja Prameha 112

• Ruksha

• Alpashi

• Bhrsa pipasa

• Parisarana sheela

2) Apathya nimittaja 113

• Bahu ashi

• Snigdha

• Shayyasana swapna sheela


UPADRAVA

Upadrava is important in deciding the prognosis of the disease. In this context

samanaya upadrava of Prameha and vataja Prameha upadravas have been illustrated

in the tabular column, as Madhumeha is a variety of vataja Prameha.

Acharaya Charaka enumerated the general complications. Achraya Sushruta &

Acharya Vagbhatta described according to the Dosha predominance.

Table – 9

Showing the Samanya upadravas of prameha Sl.No Upadrava Charaka samhitha Bhela samhitha

1

2

3

4

5

6

7

8

9

10

11

12

Trishna

Athisara

Daha

Dourbalya

Arochaka

Avipaka

Angamardha

Shoola

Bhrama

Tama

Kandu

Pidakas

+

+

+

+

+

+

-

-

-

-

-

+

+

-

-

-

+

-

+

+

+

+

+

+

2) Specific Complications:

(a) Kaphaja meha 117:

Makshikopasarpanam, Alasya, Mamsopachaya, Pratishyaya, Shaithilya,

Arochaka, avipaka, Kaphapraseka, Chhardi, Nidra, Kasa & Shwasa.


(b)Pittaja meha 118:

Vrushanayorvadaranam, Bastibheda, Medhra toda, Hridshula, Amlika, Jwara,

Atisara,Arochaka, Vamathu, Paridhumayanam, Daha, Murchha, Pipasa, Nidranasha,

Panduroga, Pittavidmutranetratva & Vidbheda

(c)Vataja meha 119:

Hridgraha, Laulya, Anidra, Stambha, Kampa, Shula, Baddha purishatva &

shosha, kasa, shwasa.

Complications of Madhumeha:

Acharaya Charaka has mentioned 7 types of pidaka as complication of

Madhumeha; While Sushruta & Vagbhatta has mentioned 10 pidakas. Sushruta has

mentioned that Madhumeha along with pidaka is asadhya 120. He narrated that these

pidaka occurs due to Tridosha and vitiated meda & vasa 121.

Table – 10

Showing the 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 + + +


SADHYASADHYATHA

A forecast of the probable course and termination of a disease is prognosis or

sadhyasadhyatha.

In general by considering the factors responsible for deciding sadhyasadhyatha

given in texts, i.e. hetu, poorva roopa, roopa, dosha, dooshya, prakruthi, kala, desha,

upadrava, sarvoushadhakshmathwa, chatushpada etc, the prognosis or sadhyasadhyata

of the disease can be assessed122.

Generally the concept of prognosis in the case of prameha are given by all

acharyas as,

• Kaphaja Prameha - Sadhya

• Pittaja Prameha -Yapya

• Vataja Prameha -Asadhya when occurred due to dhatukshaya &

Krichrasadhya when Occured due to avarana.

(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. Thus Kaphaja Prameha is

Sadhya 123. 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 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

Chakrapani 124.

2) Yapyatva - Pittaja Prameha

Pittamehas are explained to be with this status 125. The disease is requiring

continuous treatment. Once the treatment is stopped the disease is again provoked.


Also vishamakriyatva i.e. the disease is cured by langhana therapy but the associated

vitiated dhatus are not. This also leads leads to yapyatva.

3) Krichrasadhyatva & Asadhyatva - Vataja Prameha

Madhumeha is included in vatajameha. Here vata provocation might be due to

Sarvadhatukshaya as it occurs after kaphaja & pittaja pramehas. The other important

cause is avarana. When vata provocation is due to dhatukshaya the type is included in

asadhya madhumeha 126, while the other produced by avaranjanaya vata is considered

as krichrasadhya127. Charakacharya mentioned that madhumeha produced due to

Beejadosha is incurable 128.

(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 incurable.

VYAVACHEDAKA NIDANA

Charaka illustrated that if the urine of Pramehi patient is Madhura and Picchila

then differential diagnosis has to be made between Kaphaja Prameha and Vataja

Prameha on the basis of Nidana Sevana. Here if etiological factors are related with

Kapha provocation then it is Kaphaja Prameha but if etiological factors are related

with Vata provocation then it is Vataja Prameha 129. Prabhootha mootrata and

avilamootrata are the lakshanas which will manifest in all the 20 varieties of


Pramehas. So as to distinguish Madhumeha from other Pramehas, the study of them

should be made.

The following table illustrates the difference in different characteristic features

of other Pramehas.

Table – 11

Showing the Sapeksha nidana of Madhumeha

TYPES Lakshanas

Madhumeha Kashaya, Madhura, Pandu, Rooksha.

Ikshumeha Ikshu Valika, Madura, Sheeta, Eshat Picchila,

Avilam, Kandekshu rasavat

Sheetameha Madhura, Sheeta

Udakameha Accham, Bahu, Sitam, Sheeta, Nirgandha, Udakoo-pamam

Hastimeha Hastimatta ivajasram Mutram Ksharati.

Amavata Bahumootrata

Samajwara Bahumootrata

Surameha --

Sikatameha Mootran Mootragatan Doshan Anun Mehati

Shanairmeha Manda Manda, Avega, Kricchra, Shanai Shanai

Lavanameha --

Pishtameha --

Sandrameha Sandrayukta

Shukrameha Shukrabha, Shukra-mishrita

Phenameha --

Alalameha Tantubaddham, Picchilam.

Sandrameha Kinchit Sandra, Kinchit Prasada

Shuklameha Pishta Nibham,

Shukla

Kalameha Masi Varna, Ushna

Nilameha Chasha Pakshi Nibham Neela

Raktameha Visra, Lavana, Ushna, Raktam Mehati


Manjishtameha Manjisht Udakavat, Sankasha Visram

Haridrameha Haridra Udakavat, Katu

Amlameha --

Ksharmeha Ksharavat Gandha, Varna, Rasa Sparsha.

Vasameha Vasamishram, vasabham

Majjameha

CHIKITSA

In general Chikitsa is the method adopted for eradication of the disease from

the body. The aim of treatment is to restore swasthya. That means to restore normal

functions of Agni, dosha, dhatu, mala and maintain mental health. The primary

importance of Chikitsa lies in samprapti vighatana.

In ayurvedic classics, we will not get direct reference regarding the line of

treatment for Madhumeha but the line of treatment advocated for Prameha in general

can be considered here.

Chikitsa sutra:

While mentioning the Chikitsa sootra two varieties of Pramehi's are

mentioned. They are Sthoola -balavan and krusha-durbala. Two different lines of

treatment have been explained for these two varieties of Pramehi.

1) Stoola pramehi: Patients who are Sthoola, balvan and having bahudosha for such

patients Samshodhan therapy has been advised depending on the doshic

predominance. This has to be taken into consideration & accordingly the procedurei, e

Vamana, virechana, basti is decided. Swedana should be avoided, being

contraindicated in prameha. Basti is contraindicated in Madhumeha but patients

presenting symptoms of burning sensation are advised Nyagrodadi kashaya basti by

Susruta.


2) Krushapramehi: Patients who are krusha, durbala, for such patient’s samshamana

and santharpana Chikitsa are advised 130. Here the ahara, oushada which will increase

dhatus, impart strength to the body.Depending on the symptoms and predominance of

the doshas sneha should be administered. The most of the drugs advised for the

treatment of prameha are tikta, kashaya, katu rasa.

Vaghbata attributes the following reason for advising samshodhan in Sthoola

Pramehi 131. According to him samshodhana (virechana) reduces excessive kleda and

meda in the body 132. Most probably the logic behind the above mentioned

justification for shodhana in Sthoolamehi was to reduce the weight in Sthoolamehis.

If shodhana is administered in a dhatu kshayajanya Madhumeha then it may lead to

further deterioration of the dhatu and may turn into a fatal one.

Kaphaja prameha :

(i) Samshodhan Chikitsa :

Samshodana is contraindicated, eventhough it is better to treat the patient with

vaman therapy. Charakacharya describes that shodhana, vamana & langhana done at

the proper time looking at the condition of the patient is able to cure kaphaja meha 133.

For Bastichikitsa vagbhtta describes the utilization of Surasadi gana kwatha. Acharyas

after explaining the shodhana treatment give samshaman Chikitsa in every types 134.

Dalhana further commented that after Vamana Karma, Virechana is essential to

alleviate the Prameha and also to reduce the Kleda vitiation. Arundatta specially

commented that after completion of Vamana and Virechana, if patient has strength

then Asthapana Basti should be administered 135.

(ii) Samshaman Chikitsa:

Charakacharya gives 10 combinations of drugs to all the mehas with kapha

predominance 136. According to Sushruta, after proper samshodhana the patient should


use swarasa of amalaki with Haridra powder with madhu 137. Acharya Sushruta in this

context explains single drug decoctions with separate indications in 5 types of kaphaja

meha & combinations in other 5 types 138. Vagbhattacharya describes three yogas in

this aspect 139, they are as follows;

(i) Lodhrad i- Lodhra, Abhaya, Musta, Katphala

(ii) Pathadi - Patha ,Vidanga ,Arjuna,Dhanyaka

(iii) Gayatrayadi - Khadirsara, Darvi, Vidanga ,Vacha

Importance of Apatarpana:

Charakacharya explains the cause of prameha as due to increasing attitude of

kleda, meda, and kapha. So he emphasise the role of Apatarpana in kaphaja &

Pittajaprameha 140. Different types of vyayama, kshut, udvartana, dhara & snana with

churnas made of Chandana, Aguru, and Ela etc. are advised to use in kaphaja meha 141

Pittaja prameha :

(i) Samshodhan Chikitsa :

Virechan is best in pittaja pramehas 142. 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 Acharya Vagbhatta143.

Acharya Sushruta has described that due to spreading of medo dhatu all over the

body, Madhumehi subjects are durvirechya 144


Acharya Charaka explains 10 yogas in this aspect to treat pittaja pramehas 145

Sushrutacharya have described 6 specific kwatha yogas for the specific type of pittaja

prameha 146. The three kwatha yogas explained by Acharya Vagbhatta are 147,

(i) Ushiradi : Ushira, Lodhra, Arjuna, Chandana.


(ii) Patoladi: Patola, Nimba, Amalaki, Amrita

(iii) Lodhradi : Lodhra, Ambu, Kaleyaka, Dhataki.

Vataja prameha:

Although vatika mehas are incurable still Acharya Charaka explains to induce

certain treatment in kaphapittanubandhi Vatika meha 148. Achrya Sushruta has

described that all types of prameha if not treated properly in time, gets converted into

madhumeha 149. So the treatment described for vatika meha can be considered as

treatment of Madhumeha.

In case of Vataja Prameha following points should be carefully noted:

(1) Type of Madhumeha i.e. either Kevala Vataja or Avaranjanya.

(2) Strength of the patient according to Doshabala, Agnibala and Vyadhibala.

(3) Involvement of genetic predisposition.

After observing the patient carefully following treatment modalities can be

administered.

(i) Samshodhan Chikitsa:

Considering Sthoola & krisha pramehi, Samshodhan Chikitsa should be

administered only to the sthoola & 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 Kalpasthana 150,

both Pitta & 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 &

kapha doshas which are vitiated are eliminated. Then the 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

taila & ghritas are prescribed in madhumeha. After proper Shodhan Chikitsa,

Charakacharya details to give santarpan chikitsa to the patients, to prevent the

complications like Gulma, Bastishula etc 151.


Samshaman Chikitsa includes mainly deepana (appetizers), Pachana,

(enhancing Digestion), Kshut (Hunger maintenance), Trit (Maintenance of thirst),

Vyayama (Exercise), Atapa (Having exposed to sunlight) & Maruta (Exposing

oneself to Wind).According to the conditions of vitiated doshas & dushyas, vaidya

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 152.

If there is nexus of Kapha with Vata, then medicated oil prepared by

Kaphahara drugs should be given.

If there is nexus of Pitta with Vata, then medicated Ghrita Prepared by

Pittahara drugs should be given.

If more or less equal vitiation of all Doshas occurs, then Yamaka Sneha i.e. oil

and Ghrita together prepared with respective herbs should be advised.

Typical Madhumeha Chikitsa:

Acharya Sushruta explains that Shilajit should be taken after triturating with

Salsaradi gana kwatha. After its digestion patient should take Jangalamamsarasayukta

Anna. He prescribes to take 1 Tula of shilajatu 153.


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 Guggul

Modaka : Kastur Modaka, Trikatukadyamodaka.

Avleha : kushavleha, vangavleha

Paka : Pugapaka, Ashwagandhadi paka, Draksha Paka.

Asava Arishta: Lodhrasava, Dantyasava, Madhukasava, Devdarvyadiarishta,

Lodhrarishta.Ballatakasava

Ghrita: Dhanvantar ghrita, Trikantakadi ghrita, Sinhamrita ghrita, Dadimadi

ghrita, Shalmali ghrita.

Rasaushadhi:Vasant kusumakar Rasa, Chandraprabha vatika, Mehamudgar Rasa,

Brihat vangeshwar Rasa, Prameha gajkesri Rasa, Trivanga Bhasma, Vasant tilaka

Rasa, Swarna makshika Bhasma.

PATHYA AHARA VIHARA

The ahara viharas which maintain the stability of physical and mental health

are to be considered as pathya. On the other hand ahara vihara which produces

imbalance in the equilibrium of dosha, dhatu, mala and manas are apathyas.

While treating the disease we should give importance to pathya and apathya in

that disease, other wise our treatment will not yield the desired effect. It is known fact

that pathya itself is capable in curing the disease without medicine. Pathya acts as a

catalyst in accelerating the action of the drug.


Pathya ahara for madhumeha:

1. Annavarga: Puranashalyodhana with tiktashaka, puranashyamaka, kodrava,

uddalaka, godhooma, shalianna, yavanna, priyangu, shashtikashali, danthi, ingudi

taila yukta bhojana 154.

2. Jalavarga: Kashayodaka, madhodaka, sarodaka, kushodaka, triphalarasa, sidhu 155.

3. Dwidalavarga: Brustachanaka, tuvaraka, adaki, mudgayusha, kulattayusha, kalaya,

trunadhanya.

4. Shakavarga: All thikta shakas.

5. Mamsa varga: Jangala mamsa, Vishakira, Pratuda mamsa 156.

Pathya vihara for Madhumeha 157:

1. Vyayama.

2. Rooksha, praghada urdwarthana.

3. Nitya snana.

4. Jalavaseka.

5. Sadashramabyasa.

6. Lepa of agaru, ushira, twak, ela and chandana.

8. Nishijagarana.

Among the pathya ahara yava has been given much importance in our classics.

Vaghbatacharya mentioned yava as mootrabaddakara, kapha, pitta, medohara, and it

is sthairyakaraka and he has advised to take yava in the form of saktu, mantha,

apoopa, laja, vatya etc.

Sushruthacharya has given much importance to vyayama, which can be

understood by following verse. Person who is poor and has no relatives should walk

from village to village and walk without the protection of is head or legs. The person


should not remain in that village for more than one night and should walk atleast one

to three yojanas a day. He is suggested to lead a saint's life 158.

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.


Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 53

DIABETES MELLITUS

Diabetes mellitus is a syndrome characterized by disordered metabolism and

inappropriately high blood sugar (hyperglycemia) resulting from either low levels of the

hormone insulin or from abnormal resistance to insulin's effects coupled with inadequate

levels of insulin secretion to compensate159. The disease has a particular predisposition

for micro vascular complications and increased tendency for macro vascular

complications.

Diabetes mellitus in Modern Medical History 160:

Madhumeha can be literally translated as Diabetes Mellitus as both of them mean

honey urine. Siphon named it as Diabetes Mellitus meaning honey urine.

1) Abrus Papyrus: An Egyptian medical compilation (1000BC) has referred to a

condition called Polyuria.

2) Aratars of Coppadocea (150AD): A contemporary of Galen, has mentioned Polyuria

and thirst.

3) Thomas Willis (17th Century): First mentioned sweet taste of diabetic urine.

4) Mathew Dobson (18th Century): Diabetic serum contains sugar.

5) Jhon Ralo (1797) – One of the first to coin term mellitus.

6) William prout (1810-20) - Diabetic coma described

7) Michel cherreul (1857) – Excess sugar in Diabetes is glucose.

8) Wilhelm petters (1857) - Acetone found in diabetic urine.

9) Paul langerhans (1869) – Pancreatic islet identified

10) Adolf kussmaul (1974) – Acidotic breathing in diabetic coma.

http://encyclopedia.thefreedictionary.com/syndrome

http://encyclopedia.thefreedictionary.com/metabolism

http://encyclopedia.thefreedictionary.com/blood+sugar

http://encyclopedia.thefreedictionary.com/hyperglycaemia

http://encyclopedia.thefreedictionary.com/hormone

http://encyclopedia.thefreedictionary.com/insulin

http://encyclopedia.thefreedictionary.com/insulin+resistance


11) Minkowski & nonmering (1889) – Pancreatectomy cause Diabetic in dogs

12) Jean de meyer (1907) - Hypothetical glucose; lowering hormone named insulin.

13) Banting best Collip Macleod (1922) - Isolation & first clinked use of insulin.

14) JR Muslin (1923) – Discovered & named glucogens.

15) F Sanger (1955) – Sequencing of insulin.

16) Rothetal (1971) – Discovered insulin receptor

17) Wrich Etal (1977) – Insulin gene cloned.

AETIOLOGY

The aetiopathology of type II diabetes is unknown. Both increased peripheral

insulin resistance and decreased beta-cell function are involved in the path physiology

of the disease. However, it is unlikely that a single factor is the cause of this

heterogeneous disease.

Genetics:

Identical twins of a patient with NIDDM have a greater than 90% chance of

developing diabetes and about 25% of other patients have a first degree relative with

NIDDM. These observations suggest a strong genetic component, and it is now clear

that NIDDM is a polygenic disorder. A few families show abnormalities of the gene

which codes for the enzyme glucokinase on chromosome and other families have

been described with abnormalities of genes coding for hepatic nuclear factor1alpha

and 4 alphas, but genetic defects in most families with NIDDM are as yet unknown.

Environmental factors:

A strong association has been noted between low weight at birth and at 12


months of age and glucose intolerance later in life, particularly in those who gain

excess weight as adults. The concept is that poor nutrition during early life impairs

beta cell development and functions, predisposing to diabetes in later life.

Immunology:

There is no evidence of immune involvement in the pathogenesis of NIDDM,

but as noted earlier a proportion of late onset patients carry islet autoantibody ICA

and GAD at diagnosis and are more likely to progress to insulin therapy. These

presumably represent late onset IDDM.

Predisposing factors:

Predisposing factors are those that increase the risk of getting a particular

disease. There are many conditions that increase the risk of diabetes.

Hereditary:

A familial tendency to diabetes undoubtedly exists. The hereditary aspects of

diabetes is well summarized in the following statement by Warren and Le Compte,

when both the parents have diabetes, all the children may be expected 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 will have diabetes.

Obesity:

The association of obesity and diabetes has long been recognized. Almost 80%

people who develop diabetes later in life are overweight. Excess weight increases the

bodies demand for insulin and obesity is the main cause for insulin resistance.


Decreased numbers of insulin receptors are seen in obese individuals. Hence it is

major cause for Diabetes Mellitus. Symptoms of Diabetes Mellitus may disappear

with loss of weight. Elevated levels of free fatty acids and the hormones resistin and

leptin have been associated with insulin resistance at different phases. Such factors

are also present in obesity. It is not known yet if elevated levels are simply a product

of obesity or play some causal role in diabetes 161.

Age:

The diabetes may appear at any age, but 80% of cases occur after the age of 50,

and highest incidence of cases is in the 50 to 70 age group. The risk of diabetes

increases with age especially after 40 years mainly because the number of beta cells

in the pancreas that produce insulin decreases as age advances.

Gender:

Both men and women have the same risk of developing diabetes till early

adulthood, after 30 years women are at high risk as compared to men. Women who

develop diabetes during pregnancy are at higher risk of developing type II diabetes

later in life.

Viral Infection:

Some viral infections may destroy the beta cells in the pancreas and therefore

cause diabetes.

Stress:

Some hormones released during stress may block the effect of insulin on the

cells thus causing diabetes.


Sedentary Life:

Some recent studies have indicated that people with sedentary life Style are

more likely to have diabetes as compared to those who lead an active life. It is

believed that exercise and physical activity increases the effect of insulin on the cells.

PATHOPHYSIOLOGY OF NIDDM 162

The basic metabolic defect in the type 2diabetes either a delayed insulin secretion

relative to glucose load (impaired insulin secretion) or the peripheral tissue are unable to

respond to insulin.

Type 2 DM is a heterogeneous disorder with a more complex etiology and is for

more common than type 1DM, but much less is known about its pathogenesis. A number

of factors have been implicated through, but HLA association & autoimmune phenomena

are not implicated these factors are as under.

1) Genetic factors – Genetic component has a stronger basis for type 2DM than

type 1DM. Although no definite & consistent genes have been identified.

Multifactorial inheritance is the most imp factor in development of type 2 DM.

2) Insulin resistance – One of the most prominent metabolic features of type 2 DM

is the lack of responsiveness of peripheral tissues to insulin, especially of skeletal

muscle with insulin resistance & hence type 2 DM. Mechanism of hyperglycemia

in these cases is explained as under

• Resistance to action of insulin resistance impairs glucose utilization &

hence hyperglycemia

• There is increase hepatic synthesis of glucose.


• Hyperglycemia in obesity is related to high levels of free fatty acids &

cytokines affect peripheral tissue sensitivity to respond to insulin.

The precise underlying molecules defect responsible for insulin resistance in type

2DM has yet not fully identified. It is proposed that insulin resistance may be possibly

due to one of the following defects.

• Polymorphisms in various post receptor increase signal pathway

molecules.

• Elevated free fatty acids teen in obesity may contribute e.g. by impaired

glucose utilization in the skeletal muscle of glucose & by impaired beta

cell function

3) Impaired insulin secretion -

In type 2DM, insulin resistance & insulin secretion are interlinked.

• Early in the course of disease, in response to insulin resistance there is

compensatory increase secretion of insulin in an attempt to maintain normal

blood glucose level.

• Early in the course of disease, insulin secretion appears to be normal and plasma

insulin levels are not reduced. However, the normal pulsatile, oscillating pattern

of insulin secretion is lost and rapid first phase of insulin secretion triggered by

glucose is obtunded. Collectively, these and other observations implicate such

derangements in insulin secretion seen early in type 2diabetes, rather than

deficiencies in insulin synthesis 163.

• Eventually, however there is failure of beta cell function to secrete adequate

insulin, although there is some secretion of insulin i.e. cases of type 2DM have


mild to moderate deficiency of insulin but not its total absence.

The exact genetic mechanism why there is fall in insulin secretion in these cases

is under following possibilities are proposed

• Islet amyloid polypeptide which forms fibrillas protein deposits in pancreatic

islet in longstanding cases of type 2DM may be responsible for impaired

function of beta cell islet cells.

• Metabolic environment of chronic hyperglycemia surrounding the islet may

paradoxically impair islet cell function

• Elevated free fatty acid levels in these cases may worsen islet of function.

3) Hepatic glucose synthesis

One of the normal roles played by insulin is to promote hepatic storage of glucose

as glycogen & suppress gluconeogenesis. In type 2DM as a part of insulin resistance by

peripheral tissues. Liver also shows insulin resistance i.e. in spite of hyperglycemia in the

early stage of disease, gluconeogenesis in the liver is not suppressed. This results in

increase hepatic synthesis of glucose which contributes to hyperglycemia in these cases

CLINICAL FEATURES 164

The presenting features of diabetes vary widely. Age and nature of symptoms at

onset may be broadly indicative of the clinical type.

Most middle aged and elderly patients (NIDDM) have an indefinite or insidious

onset. Most often medical help is sought because of symptoms related to hyperglycemia

i.e. polyuria, polydypsia and hyperglycemia are detected during routine checkup. Others

get investigated for unexplained weakness, weight loss, aching or cramps in the legs,


delayed healing of wounds, recurrent crops of boils or appearance of a carbuncle often

calls for investigation. Even more common are early complaints of pruritus vulvae in

women and balanoposthetis in men. Not infrequently poor obstetric history of impotence

indicates the possibility of Diabetes. Investigation in cases presenting with neurological

deficits, visual disturbances or premature coronary peripheral or cerebrovascular disease

may reveal Diabetes for the first time.

Broad differences can be noticed in the age at onset of symptoms, mode of

presentation, body build, and family history, social and nutritional status and besides

findings among the common type of Diabetes laboratory investigations and follow up

studies are some times necessary to establish the category.

1. Polyuria:

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

There may be nocturia also.

2. Polydipsia:

The diuresis in turn causes obligatory loss of electrolytes from the extra cellular

fluid, which then causes compensatory dehydration of the intracellular fluid and hence

produces polydipsia.

3. Polyphagia:

The failure of glucose utilization by the body because of deficiency and resistance

of insulin produces and sends a message to the center, so digestive enzymes will be

secreted more hence Diabetic patient will have polyphagia.

4. Weakness:

The failure of glucose utilization, loss of electrolyte and loss of body protein


contributes to weakness.

5. Weight loss:

Due to fluid depletion and the accelerated break down of fat and

Muscle secondary to insulin deficiency.

6. Glycosuria:

When ever 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 325mg/min

which is tubular maximum for glucose. All the excess above this is lost in to the urine.

7) Dryness of Mouth and Throat:

This is the effect of polyuria.

8) Constipation:

The stool becomes hard and bowel movement may take place after every 2-3

days.

Classification of Diabetes Mellitus 165

A. Primary:

a. Insulin dependent Diabetes Mellitus (IDDM, TYPE I)

b. Non-insulin dependent Diabetes Mellitus (NIDDM, TYPE II)

1. Non obese NIDDM.

2. Obese NIDDM

3. Maturity onset Diabetes of the young (MODY)

B. Secondary Diabetes:

1. Liver disease:


Cirrhosis.

2. Pancreatic disease:

Cystic fibrosis.

Chronic pancreatitis.

Malnutrition-related pancreatic disease.

Pancreatectomy.

Hereditary haemochromatosis.

Carcinoma of the pancreas.

3) Endocrine disease:

Cushing's syndrome

Acromegaly.

Thyrotoxicosis.

Phaeochromocytoma

Glucogonoma.

4. Drug induced disease:

Thiazide diuretics.

Corticosteroid therapy.

5. Insulin-receptor abnormalities

Congenital lipodystrophy.

Acanthosis nigrican

6. Genetic syndromes

.Friedreich's ataxia.

Myotonic dystrophy


COMPLICATIONS OF DIABETES MELLITUS 166

The disease has a particular predisposition for micro vascular complications and

increased tendency for macro vascular complications.

Acute Complications:

Hypoglycemia

Diabetic Ketoacidosis

Non Ketoic hyperosmolar state

Chronic Complications:

(1) Macrovascular Complications:

Coronary artery disease.

Peripheral Vascular disease.

Cerebro vascular disease.

(2) Microvascualar Complications :

Diabetic Eye disease

Retinopathy (non-proliferative/proliferative)

Macular edema

Glaucoma

Cataracts

Diabetic Neuropathy

Poly neuropathy /mono neuropathy

Autonomic neuropathy.

Diabetic Nephropathy


Pyelonephritis

Renal arteriosclerosis

Kimmelstiel

Micro albuminuria

Papilitis

(3) Other

Gastro intestinal [gastroparesis, diarrhoea]

Genito urinary [uropathy /sexual dysfunction]

Dermatologic infections.

Diabetic foot.

Differential diagnosis 167

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

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

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.

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

TREATMENT 168:

The word treatment in Diabetes Mellitus seems incomplete instead management

of Diabetes Mellitus is an appropriate term as the disease can only be controlled and

constitutes a multidimensional approach namely Diet, exercise, oral hypoglycemic,

insulin & patient education are vital aspect which require due consideration in the

management of Diabetes Mellitus.

1) Diet:

Today there is no one diabetic diet. The recommended diet can only be defined as

a dietary prescription based on nutrition assessment & treatment goals. Medical nutrition


therapy for people with diabetes should individualized, with consideration given to eating

habits & other lifestyle factors. Nutrition recommendations are then developed to meet

treatment goal & desired outcomes. Monitoring metabolic parameters, including blood

glucose, glyceated haemoglobin, lipids & body weight as well as quality of life is crucial

to ensure successful outcomes 169.

Modification of diet is the most important aspect in the therapeutic plan for

patients with Diabetes Mellitus. Diet therapy consists of maintenance of proper nutrition

& monitoring of total number of calorie ingested, individual food sources that make up

these calories & distribution of calories thought the day.

The selection, modification & restriction are the key words in planning in a diabetic

subject depend on the judicious selection of carbohydrate, moderation in a diabetic in

protein intake & a determined restriction of total fat intake.

The obese & overweight must be encouraged to reduce weight. An energy deficit

of 500kcal daily will help the patient reduce ½ kg body weight.

Life style Daily calorie requirement

Sedentary 20-25 kcal/Kg of IBW

Moderate active 26-30 kcal/Kg of IBW

Strenous 31-35 kcal/Kg of IBW

2) Exercise:

Exercise is an important aspect of the management. It helps to improve glycaemic

control by increasing insulin sensitivity, maintaining body weight, reducing

cardiovascular risk factors & inducing a sense of well being.


Type II Diabetes Mellitus subjects must be evaluated about the cardiovascular

risk factors before beginning the exercise programme. Aerobic exercise like walking,

swimming & cycling are more effective than isometric exercise in improving the

glycaemic status.

3) Oral hypoglycaemic agents(OHAs) –

Oral hypoglycaemic agents should be used in type II Diabetes Mellitus in the

extent of failure of diet & exercise.

Indications

The use of oral hypoglycaemic agents in the management of type II Diabetes

Mellitus has withstood the test of time, inspite of controversies; usually OHAs are

intiated when dietary modification & exercise facil to achieve euglycaemia in type II

Diabetes mellitus.

1) Sulphonyurea –

Sulphonylureas, like Chlorpropamide & Tolbutamide Glipizide & Glyburide, are

secretogogues having predominantly pancreatic action. This increases endogeneous

insulin levels. They are useful in averagely built or lean type 2 Diabetes Mellitus.

2) Biguanides –

Metformin a biguanide is widely regarded as the drug of choice overweight or

obese patients with type 2 Diabetes mellitus. It can also be used in normal weight

patients. Metformin can be used in combination with any OHAs

4) Alpha glucosidase inhibiters-

Alpha glucosidase inhibiters like acarbose are helpful in controlling post prandial


hyperglycaemia. Given along with meals. They can be combined with Sulphonyurea,

Biguanides and insulin

5) Meglitinides –

Meglitinides like repaglinide, nateglinide are also helpful in controlling post

prandial hyperglycaemia. They must be taken just prior to meals can be combined with

Sulphonyurea, Biguanides.

6) Thiazolidinedione derivatives –

Thiazolidinedione derivatives like Rosiglitazone are useful in subjects with

insulin resistance. They can be combined with Sulphonyurea, Biguanides and insulin. It

is widely regarded as the drug of choice for overweight, obese patients with type

2Diabetes mellitus. It can also be used in normal weight patients.

DRUG REVIEW

In madhumeha vitiation of Meda, Kleda, Vasa and Lasika along with the kshyaya

of vital Dhatus like Oja and Majja take place, so the dhatu kshyaya produce Vata

provocation and leads to madhumeha. So line of treatment should be to reverse the

pathogenesis with the help of Shamana as well as Sodhana. In Chikitsa, medicament

should posses Tikta and Kasaya Rasa along with Kapha Vata hara, Medo hara,

Kledaghna and Prameha hara properties.

Phalatrikadi vati 170 contains about 7 drugs. Properties of these drugs are tikta,

kashayarasa, laghu, rooksha guna and katuvipaka. Kaphavatahara. These are said to be

kaphagna, mehagna, medogna and mootrasangrahaneeya. Thus the selected combination

– Phalatrikadi vati is of the drug of choice for the present clinical trial.

Table – 12

Combination of Phalatrikadi Vati

S.No. Sanskrit Name Botanical Name Proportion

1 Haritaki Terminalia chebula 1 part

2 Bibitaki Terminalia bellirica 1 part

3 Amalaki Embcica officinals 1 part

4 Daruharidra Berberis aristata 1 part

5 Vishala Cirullus colocynthis 1 part

6 Musta Cyper rotundus 1 part

7 Haridra Curcuma longa 1 part

Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Darg Review 70

HARITAKI 171 – Latin name – Terminalia chebula,

Gana – Prajastapana, Kustagna, Arshogna, Kasagna, Jwarahara

Prayojyanga- Phala, majja

Rasa – Pancha rasa , lavanavarjita kashayarasa pradhana

Guna – Laghu, Ruksha

Veerya - Usna

Vipaka - Madhura

Prabhava - Tridoshahara

Doshagnta - Tridoshahara

Rogagnta – Sotha, prameha, kusta, vruna, vatarakta, mutrakrcchra

Chimical constituents- Anthraquinone glycoside, chebulic acid, tannic acid, vit c.

BIBHITAKI 172– Latin name – Terminalia bellirica (pp239)

Gana – Jwarahara, Virecanopaga

Prayojyanga- Phala, majja, bija, seed kernal

Rasa – Pancha rasa kashayarasa pradhana


Veerya - Usna

Vipaka - Madhura

Doshagnta Kapha-pittahara

Rogagnta – Jwara, kasa, shwasa, atisara, ashamari, trushna, chardi

Chimical constituents- Fructose, galactose, glucose, mannitol, thamnose, edible oil, gallic

acid, chebulagic acid, ellagic acid.


AMALAKI 173 - Latin name – Emblica officinalis

Gana - Vayastapana, Virecanopaga

Prayojyanga- Phala, majja

Rasa – Pancha rasa , lavanavarjita amlarasa pradhana


Veerya – Sita

Vipaka – Madhura

Prabhava – Rasayan

Doshagnta – Tridoshahara

Rogagnta – Prameha, raktapitta, kusta, arsha, sula, mutrakrcchra

Chimical constituents- Ellagic acid, lupeol, oleanolic aldehyde, leucodelphinidin,

procyanidin, tannin, vit c, phyllembin, linolic acid, indole acetic acid.

MUSTA 174- Latin name – Cypers rotundus

Gana – Lekhaneeya, Kandugna, Trushananigraha, Truptigna

Prayojyanga- Tubers

Rasa – Tikta, katu, kashaya


Veerya - Sita

Vipaka - Katu

Doshagnta – Kapha-pittahara

Rogagnta – Jwara, kasa, Kandu, atisara, grahani, trushna, kusta, rakta vikara, krimi

Chimical constituents- Lineol, copadiene, copaene, cyperen I & II, cypernone, rotundone,


HARIDRA 175- Latin name – Curcuma longa

Gana - – Lekhaneeya, Kustagna, Vishagna, Tiktaskanda

Prayojyanga- Kanda

Rasa – Tikta, katu


Veerya - Usna

Vipaka - Katu

Doshagnta – Kapha-vatahara

Rogagnta – prameha, Kandu, kusta, vruna, krimi, pandu, kamala

Chimical constituents – curcumene, curcumenone, curcone, curdione, lineole

curzerenone, epiprocurcumenol, eugenol, camphena, camphor, borneol, procurcumadiol.

DARUHARIDRA 176 – Latin name – Berberis aristata

Gana – Lekhaneeya, Kandugna, Arshogna

Prayojyanga- moola, stem, fruit

Rasa – Tikta, Kashaya


Veerya - Usna

Vipaka - Katu


Rogagnta – prameha, kusta, vruna, kamala, visarpa

Chimical constituents – Karachine, Taxilamire, berberine, palmatin, Jatrorrhizine,

oxycanthine.


INDRAVARUNI 177-

Latin name – Citrullus colocynthis

Prayojyanga- Root, fruit

Rasa – Tikta,

Guna – Laghu, Ruksha, Tiksna

Veerya - Usna

Vipaka - Katu


Rogagnta – Prameha, kusta, Udara, kamala, unmada, aparmara, kasa, shwasa

Chimical constituents – Alkoloids I II & III, cholinecucurbitalin B, cucurbitalin E,

citrullol, citronellal, methyleugenol insitol.

Phalatrikadi vati ingredients are well identified and collected from local area.

Good manufacturing practice is followed for the preparation of Phalatrikadi vati after

fortification with the Phalatrikadi kwatha. . Later, at the time of distribution, requisite

quantity of the medicine was packed and given to patients. The individual components of

the composition are as follows under specified headings.


METHODOLOGY

1) Method of Research design

Madhumeha vis-à-vis Diabetes mellitus is the 3rd largest killer in the world behind

the cardiac ailments worldwide. It is becoming a great catastrophe with a current high

prevalence rate at in urban dwellers.

At least 50% of all people are with Madhumeha are undiagnosed and noticed

from a dentist. In spite of many advances in contemporary science, the management of

Madhumeha is unsatisfactory 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: 2000 mg / 24hrs in divided two doses or 33.3 mg /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

Phalatrikadi vati Simple Random sampling technique clinical study was

conducted for 30 days. The medicine was dispensed for 7 days to all patients and advised

Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Methods 75

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

Phalatrikadi vati trail offered a further follow up 30 days. The effect of yoga was

analyzed according to clinical and functional response before and after the treatment is

compared.

6) Source of data of Trial drug

The data was collected from the patients suffering from Madhumeha in the OPD

of post graduation and research center DGM Ayurvedic medical college Gadag by

present inclusion criteria & exclusion criteria.

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.

• Age of patients between 25-65 years.


• All patients other than that of exclusive criteria are included.

• Irrespective of gender.

• Non insulin dependent diabetes mellitus.

• Patient having clinical features of Madhumeha.

• Patient having clinical features of Madhumeha viz.

Prabhuta mootrata

Avilamotrata

Karapadadaha

Kshudadhikya

Pipasa

Atisweda

Dourbalya

ii) Exclusion criteria

• Insulin dependent D.M Vis-à-vis Madhumeha

• Patients who develops complication with other systemic disease

• Juvenile diabetes

• Malnutritional D.M

• Gestational D.M

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

Grade 0 - Crystal clear fluid

Grade 1 - Hazy with slight turbidity

Grade 3 - Turbidity clearly present but news

Print can be read through the tube.

Grade 4 - More turbidity news print cannot

be read.

3) Kara pada dhaha

Grade 0 - No kara padadadha

Grade 1 - Occasionally noticed

Grade 2 - Periodically noticed

Grade 3 - Daily noticed

Grade 4 - Continuously noticed


4) Kshudhadikya

Grade 0 Normal

Grade 1 Actively hunger

Grade 2 Intermittent hunger

Grade 3 Bulimic hunger

5) Pipasa

Grade 0 Normal

Grade 1 Slight inclination

Grade 2 Temporarily suppressed

Grade 3 Unsuppressed

6) Atisweda

Grade 0 Normal sweating after doing

normal physical activities

Grade 1 Moderate sweating

Grade 2 Excessive sweating

Grade 3 Excessive sweating just by

doing little work

7) Dourbalya

Grade 0 No Dourbalya

Grade 1 Occasionally noticed

Grade 2 Periodically noticed

Grade 3 Continuously noticed


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


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 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 just role out the

general condition of the patient.

a) Erythrocyte Sedimentation Rate

b) Hemoglobin %

c) Criteria of assessment

Over all assessment of results are done considering the cumulative subjective and

objective parameters assessments. As the disease is not 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. After Treatment if PPBS is less than 135mg/dl

ii. Patient relieved with symptoms clinically

2. Palliative –

i. After Treatment if PPBS is more than 136mg/dl and less than 160mg/dl

ii. Incomplete Symptomatic relief for the patient clinically

3. Responded –

i. If PPBS more than 161mg/dl, if there is a good difference in Baseline data

ii. Symptomatic relief for the patient is witnessed partially

4. Not responded

None of the above conditions


Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 83

RESULTS

Present study registers 25patients, out of 30 approached patients. Out of this, 5

patients not fulfilled the inclusion criteria hence their data has not been included in the

assessment. The remaining 25 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. Evaluating disease Data and

C. Result of the Phalatrikadi Vati and

D. Statistical analysis

A) Demographic data:

The details of Age, Gender, Religion, and Occupation etc. of the 25 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, 8(32%) patients reported

suggest the chronicity of the disease. Where in 45-55 and 35-45 age groups reported with

9 (36%) and 8 (32%) patients in each group respectively.

Table- 12

Results by Age in Madhumeha with Phalatrikadi Vati

Age

Regulated Palliative Responded Not

Responded Total %

25- 35 0 0 0 0 0 0

35 – 45 1 2 4 1 8 32

45 – 55 0 2 7 0 9 36

55 – 65 1 1 5 1 8 32

Total 2 5 16 2 25 100

% 8 20 64 8 100

Figure – 3

Results by Age in Madhumeha with Phalatrikadi Vati


0

1

2

3

4

5

6

7

25- 35 35 – 45 45 – 55 55 – 65

RegulatedPalliativeRespondedNot Responded

2) Distribution of patients by Gender

Table - 13

Results by Gender in Madhumeha with Phalatrikadi Vati

Gender Regulated Palliative Responded Not Responded Total %

Male 1 5 8 0 14 56

Female 1 0 8 2 11 44

Total 2 5 16 2 25 100

% 8 20 64 8 100

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 14 Patients i.e. (56%) were male and 11 patients i.e. (44%) were female.

Figure – 4

Results by Gender in Madhumeha with Phalatrikadi Vati

0

1

2

3

4

5

6

7

8

Male Female



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. 24 (94%) along with

Muslim patients 1 (4%).

Table - 14

Results by Religion in Madhumeha with Phalatrikadi Vati

Religion Regulated Palliative Responded Not Responded Total %

Hindu 2 4 16 2 24 94

Muslim 0 1 0 0 1 4

Christian 0 0 0 0 0 0

Others 0 0 0 0 0 0

Total 2 5 16 2 25 100

% 8 20 64 8 100

Figure – 5

Results by Religion in Madhumeha with Phalatrikadi Vati


Christian 0%Muslim

4%

Others 0%

Hindu96%

HinduMuslimChristian Others

At the results observed, out of 24 (96%) of Hindu patients, 2 (8%) patients

regulated and 16 (64%) patients fall under responded category. On the other hand the

results observed at Muslim community, 1 (4%) patient comes under responded category.

The tabulation and graphical representation is as under.

A4) Distribution of patients by Occupation

Table - 15

Results by Occupation in Madhumeha with Phalatrikadi Vati

Occupation Regulated Palliative Responded Not Responded Total % Sedentary 1 4 7 2 14 56

Active 1 1 8 0 10 40

Labor 0 0 1 0 1 4

Total 2 5 16 2 25 100

% 8 20 64 8 100

Figure - 6 Results by Occupation in Madhumeha with Phalatrikadi Vati

0

1

2

3

4

5

6

7

8

Sedentary Active Labour




As the results observed, out of 25, 14 (56%) of sedentary patients, strongly

suggests that the Madhumeha is a disease of the sedentary patients, out of which 1 (4%)

patient isregulated, 4 patients are palliative and 7 patients were responded to the

treatment, 2 patients were not responded to treatment. At the active group, out of 10

patients 1 (4%) patient is regulated and 1 (4%) patient is palliative, 8 patients are

responded to treatment. At the results are observed, 1patient of Labour is responded to

the treatment.

A5) Distribution of patients by economic status

At the results observed, out of 3 (12%) of poor patients, all three are responded.

Out of 9 (36%) of Middle class patients reported 1 is regulated and 2 patients are

palliative, 6 patients are responded. From higher middle class 13 (52%) patients reported

and out of them 1 patient is regulated, 3 patients are responded palliative and 6 patients

are responded. 2 patients are under not responded category.

Table - 16

Results by Economic status in Madhumeha with Phalatrikadi Vati

Economic status Regulated Palliative Responde

d Not

Responded Total %

Poor 0 0 3 0 3 12

Middle 1 2 6 0 9 36

Higher Middle 1 3 7 2 13 52

Higher 0 0 0 0 0 0

Total 2 5 16 2 25 100

% 8 20 64 8 100 *

Figure - 7

Result Distribution of patients by Economic status

0

1

2

3

4

5

6

7

Poor Middle HigherMiddle

Higher

Regulated

Palliative

Responded

Not Responded

A6) Distribution of patients by diet

Table – 17

Results by Diet in Madhumeha with Phalatrikadi Vati

Diet Regulated Palliative Responded Not Responded Total %

Vegetarian 2 4 12 1 19 76

Mixed diet 0 1 4 1 6 24

Total 2 5 16 2 25 100

% 8 20 64 8 100 *

The percentage of the distribution does not show any diet differentiation to get

this Madhumeha a disease in specific, except a lean towards vegetarian population. The


observations are 19 Patients i.e. (76%) vegetarian and 6 patients i.e. (24%) were mixed

diet practitioners.

Figure - 8

Results by Diet in Madhumeha with Phalatrikadi Vati

0

2

4

6

8

10

12

Vegetarian Nonvegetarian


As the results observed, out of 19 (76%) vegetarians, 2 (8%) patients are

responded and 12 (30%) patients responded to the management and 4 patients are

palliative, 1 patient is not responded. As the results observed in mixed diet population,

out of 6 (24%), 4(25%) patient are responded, 1 (5%) patient responded palliative and 1

(5%) patient not 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 (25 patients), Dourbalya (21


patients), Kshudha adhikyata (24 patients) and Pipasa (23 patients) the cardinal

symptoms as polyuria, weakness, polydipsia and polyphasia. The graph and tabulations

are shown as below.

Table - 18

Distribution of patients by presenting complaints

Presenting complain % ts Patients

Prabhoota Mootrata 25 100

Avila Mootrata 18 72

Karapada Daha 15 60

Kshudhadhikyata 24 96

Pipasa 23 92

Atisweda 20 80

Dourbalya 21 84


Figure - 9

Distribution of patients by presenting complaints

Avila Mootrata

Kshudhadhikyata

Atisweda

0

5

10

15

20

25

PrabhootaMootrata

Karapada Daha Pipasa Dourbalya


B2) Distribution of patients by Associated features

Mukha talu sosha is said as associated symptom for Madhumeha, which is

observed here at the maximum. Alasya is observed by the 76 % of the patients. This

study observes the rest of the associated complaints enumerated in the table below along

with the graph.

Table - 19

Distribution of patients by Associated features

Presenting Associated features Patients Percentage

Kara/Pada suptata 2 8 Klama 16 64 Tandra 14 56 Alasya 19 76 Gur atrata 8 32 ug

Dantadi maladhyatwam 2 8 Shithilangata 2 8 Mukha/Talu shosha 22 88

Figure - 10

Distribution of patients by Associated features

Klama

Alasya

Dantadi maladyatwam

Mukha/Talu shosha

0

5

10

15

20

25

Kara/Padasuptata

Tandra Gurugatrata Shitilangata


B3) Distribution of patients by Ahara Nidana

Ahara Nidana observed in the study

Ahara Nidana Patients Percentage

Table – 20

Guda 25 100 Dadhi 19 76

Snigdha 25 100 Dugdha 17 68 Navanna 25 100 Sheeta 15 60 Mamsa 7 28

Ayurveda offered many causes especially in regard with food. The Guda and

Snigdha, navanna 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, Avyayama is

observed 56% and swapna sukham Asannaswapna for 52% of patients. The vihara

tabulated are here under.

Table - 21

Vihara Nidana observed in the study

Vihara Nidana Patients Percentage

Diwaswapna 14 56

Avyayama 14 56

Swapnasukham 13 52

Asannaswapna 13 52


B5) Distribution of patients by Anya Nidana

The other Nidana told in texts are very less observed here. Only Sthoulya is

observed for 20% of patients.

Table - 22

Distribution of patients by Anya Nidana

Percentage Anya Nidana Patients Sthoulya 5 20

Manishik a- Chinta 8 32Vegavarodha 2 8

Pancha ramsha 0 0 karma Vibh

B6) Distribution of patients

- 23

Poorva roopa Patients Percentage

by Poorva roopa lakshana

Table

Distribution of patients by Poorva roopa lakshana

M 25 100 utra madhurata

Trishna 24 96 Talujivha shosha 20 80

Swedadhikya 21 84 Shitalangata 6 24 Sheeta iccha 2 8

Nidra 6 24 Shareera durgandha 1 4

Alasya 21 84 Deha chikkanata 9 36 Mukha madhurta 1 4

Pada daha 4 16 Pani daha 4 16

Dantadeenam Malatvam 6 24 Tandra 11 44 Swasa 2 8


The Poorva roop Ayurveda are observed her the study. tra

madhuryata and Trishna are 100%, 96% and Alaysa is observed for 84%. The rest of the

symptoms observed are tabu ere along with percentage.

B7) Distribution of p lakshana

able - 24

Dis nts by Sroto dusti lakshan

Sroto dusti lakshana Patients Percentage

a mentioned in e in Mu

lated h

atients by Sroto dusti

T

tribution of patie a

Jihwa sho sha 23 92Talu shosha 23 92Kloma shosha 1 4

Uda

kava

ha

Pravruddha pipasa 17 68 Alpalpa mootrata 0 0 Mootara rodha 0 0 Adhika mootra 25 100 Sashoola mootra 0 0 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 20 80 Snigdhanagata 7 28 Sthulashophata 0 0

Med

ovah

a

Pipasa 23 92

Out of different srotas included in the study explicit new ensions. Out of

Udakavaha srotas –Jihwa sosha observed 92% in study, in Mootravaha srotas – Adhika

dim


Mootrata, in Medovaha srotas the Pipasa are observed 100% in the st . It conform e

i vem these srotases. The enlisted symptoms are at above table.

B8) Fam

Table - 25

Data of Family history in the study

amily history Patients Percentage

udy th

nvol ent of

ily history

F

Present 20 80 Absent 05 20 Total 25 100

The Madhumeha observed as familial by researcher prove in study with 80%

family history. The rest of 20% show the instantaneous expression of the disease.

C) Result of the Phalatrikadi Vati

C1) Assessment of Subjective parameters

Assessment of Subjective parameters

nting complaints

Patie

nts

Bef

ore

%

Patie

nts

Afte

r

%

Patie

nts

relie

ved

Table – 26

Prese%

A otrata 20 80 6 24 14 56 vilam

Karapada Daha 16 60 4 16 12 16

Kshudhadhikyat a 24 96 3 12 19 76

Pipasa 24 92 3 12 21 84

Atisweda 22 68 4 16 18 72

Dourbalya 22 80 7 28 15 60


The assessments of the symptom esented as the chief complaints are

the subjective parameter ly as 80% is witnessed

reduced for 60% in the study. Karapada Daha is for 60% of patient’s initially recorded

16% of relief. Pipasa initially f atients t the % o . An er

Kshudhadhikyata is seen in 96% patients at the start become reduced

.

C2) Assessment of Objective parameters

Table – 27

s which are pr

s of the study observed initially Dourba

or 92% of p exhibi 84 f relief oth

major symptom

76% in the study

Assessment of Objective parameters

Presenting complaints

Patie

nts

Bef

ore

%

Patie

nts

Afte

r

%

Patie

nts

relie

ved

%

Prabhoota Mootrata 25 100 3 12 17 68

Fasting Blood Sugar 24 96 16 64 8 32

Post prandial Blood sugar 25 100 17 68 8 32

Fasting Urine Sugar 15 60 12 48 3 12

Post prandial Urine sugar 20 80 3 12 17 68

The objectives are very much assess a study. Here in the study

Mootra prabhootatva is exhibit 32% and 32%

differences in the study, where in the FUS and PPUS show the 12% and 68% variances

from the base line data.

important to

reduced 68%. The FBS and PPBS

C3) Results of the Phalatrikadi Vat

based upon t umul e effe f the ective d obj e

parame drawn in four categories viz. Regulated,

Palliative, Responded and not responded.

Number of patients Percentage

i

The result is he c ativ ct o subj an ectiv

ters together assessed. The result is

Table - 28

Result of Phalatrikadi Vati in Madhumeha

Result

Regulated 2 8

Palliative 5 20

Responded 16 64

Not Responded 2 8

Total 25 100

Figu

re - 11

Result of Phalatrikadi Vati in Madhumeha

Regulated 8%

Palliative 20%

Responded64%

Not Responded8%

Regulated Palliative RespondedNot Responded



D) Statistical analysis

To compare r the treatment the

tatistical analysis paired t-test, by assuming that the drug is not responsible for changes

the reading before and after the treatment. The conclusion drawn is as highly

ignificant if P <0.05.

Table - 29

Statistical analysis of Phalatrikadi Vati

arameter Mean SD SE t value P value Remark

the effectiveness of a drug before and afte

s

in

s

P

Avila mootrata 1.24 0.925 0.185 6.698 <0.001 HS

Karapada daha 0.64 0.637 0.127 5.018 <0.001 HS

Kshudhadhikyata 1.84 0.687 0.137 13,372 <0.001 HS

Pipasa 1.96 0.6110 0.122 16.039 <0.001 HS

Atisweda 1.12 0.7810 0.156 7.170 <0.001 HS

Dourbalya 2.0 0,816 0.163 12.247 <0.001 HS

Prabhoota mootrata 2.08 0.571 0.114 18.196 <0.001 HS

FBS 31.84 16.754 3.350 9.501 <0.001 HS

PPBS 63.92 39.159 7.831 8.162 <0.001 HS

FUS 0.36 0.3685 37 4.883 <0.001 HS 0.07

PPUS 0.54 0.518 0.103 5.204 <0.001 HS

sscess the ef ness o ug the s al an don g pai

g that dru ot re ble in anges ding after t

both subje objective param

0.05)

ong the subje par a, p shu yata ly sho

eters. (Comparing t values). The parameters

To a fective f dr tastic alysis is e by usin red t

test, by assumin g is n sponsi the ch of rea before & he

treatment. From analysis ctive & eters shows highly significant

(As p<

Am ctive ameters ipasa, K dhadhik , dourba ws

more highly significant than other param


pipasa having more net ffe as t meter avila mot aving le

ffect (comparing alu riati e pa kar ha is le

eter Kshudhadhikyata is more.

Among all the objective parameters all the parameters shows significant but in the

parameter prabhoota mootrata shows more highly significant than other objective

parameters With 89.65% of mean improvement. The parameters FBS shows more highly

significant than other parameter with 20.31% of mean improvement.

Among the subjective parameters the percentage improvement is in between

79.48% to 90%, 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 (89.65%) and where as in the parameter FBS is least percentage

improvement (20.317%).

mean e ct where he para rata is h ss

mean e mean v e) the va on in th rameter apada da ss,

where as in the param

Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 101

DISCUSSION

The following headings are made to facilitate discussion.

I) Discussion on Disease aspect

II) Discussion on demographic data

III) Discussion on data of disease

IV) Discussion on probable mode of action of Phalatrikadi Vati

I) Discussion on Disease aspect:

Madhumeha with the clinical features of Diabetes has been recognized since

antiquity. Diabetes mellitus occurs throughout the world, but is more common (especially

type 2) in the more developed countries. The greatest increase in prevalence is, however,

expected to occur in Asia and Africa, where most patients will likely be found by 2030.

The increase in incidence of diabetes in developing countries follows the trend of

urbanization and lifestyle changes, perhaps most importantly a "Western-style" diet. This

has suggested an environmental (i.e., dietary) effect. In the present era, changing life

styles i.e. lack of exercise, sedentary life, unbalanced food and stress has lead to the

increased incidence of various diseases and one of them is Madhumeha.

In Madhumeha, mainly the Vata and Kapha are predominant though the disease is

tridoshakopanimittaja. The Vata may be provoked either directly by its etiological

factors, by dhatukshaya or by avarana of kapha & pitta to vata. Here the main dushyas are

Meda & Kleda and primarily Medhovahasrotodusti takes place.

Vagbhata has classified Madumeha into 2 categories, Dhatukshayajanya

Madhumeha and Avaranjanya Madhumeha. Similar type of classification is described by

Charaka - Apatarpanajanya and Santarpanajanya. The Dhatukshayajanya Madhumeha


can be correlated with Apatarpanajanya Madhumeha, while the Avaranjanya Madhumeha

can be correlated with Santarpanajanya Madhumeha.

In Dhatukshayajanya / Apatarpanajanya Madhumeha vata dosha gets vitiated

either due to its own etiological factors or by dhatukshaya. In avaranajanya and

santarpanajanya Madhumeha the kapha and pitta get vitiated due to etiological factors

mainly concordant with them, which obstruct the path of vata causing its provocation &

leading to the manifestation of the disease Madhumeha. Here vitiation of vata occurs due

to the Avarana. Thus this disease may be caused both by under nutrition as well as by

over nutrition. The first type of Madhumeha is considered to be asadhya and no precise

remedy has been suggested for it. But, the later type has been told as krichhra sadhya and

can be managed with extensive measurements.

In Diabetes mellitus there occurs disturbance in carbohydrate, protein and fat

metabolism due to the absolute or relative deficiency of Insulin secretion and/or insulin

action. Diabetes mellitus has been classified into Type I and Type II DM. Type I DM

patients are usually asthenic and need Insulin for treatment and Type II DM patient are

usually obese and are usually managed with oral hypoglycemic agents. So, it may be said

that Type I Diabetes mellitus is closer to dhatukshayajanya Madhumeha while the Type

II Diabetes mellitus is closer to avaranajanya Madhumeha. In the management of

avaranajanya Madhumeha (Sthula Madhumehi), the Shodhana therapy must be done

followed by Shamana Chikitsa

Beeja dosha and Kulaja dosha have been mentioned in the causative factors of

Sahaja Prameha. 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 diabetes due to genetic


and hereditary factors, patients are weak, asthenic and emaciated. Such patients are

Juvenile Diabetics and require a nourishing diet. Therefore Sahaja Prameha and Juvenile

Diabetic may be correlated.

Apathyanimittaja Madhumeha is caused by excess indulgence in kapha

aggregating factors; such patients are sthoola and are afflicted with Polyphagia, excess

sleep and laziness. Maturity onset diabetes tends to over eat and is lazy. In Ayurvedic

classics age factor is not mentioned.

The Sthoola and Krisha classification is akin to obese and non-obese division.

We will not get much information regarding Sthoola and krisha Madhumeha in ayurveda.

While explaining Chikitsa, this type of classification has been mentioned.

Nidana:

The diet, which promotes Kapha dosha is included under apathyakara ahara for

prameha vyadhi. Excessive intake of Dugdha, Dadhi, Guda, Navanna, Sheeta Ahara,

Madhura-Amla-Lavana Rasa, Surapana are the causative factor of the Madhumeha.

Among mamsa sevan, most of the patients mainly indulge the Gramya and oudaka

mamsa. Both are Guru, drava, abhisyndi in nature cause vitiation of kapha & meda.

Navanna having abhisyandi, take longer time for the digestion and are major cause of

ama & kleda. Cause avaroda in srotus causing excessive formation of kleda. Asyasukha

literally means finding pleasure in diet and comfortable gadgets of living. Swapanasukha

means finding pleasure in oversleeping both these cause kapha vitiation and meda dhatu.

Dadhi Gudavaikruta ahara are kaphakaraka. . If madhura rasa is taken excessively then it

causes the Medo Vardhana, Shleshmaja Vikarakara, Sthaulya, and Meha kara 178. As it is


rich in carbohydrates if it is taken in excessively in the form of more refined products

then increases the total calorie consumption. Over eating causes the metabolic disorders.

Many similarities are found between nidanas explained in ayurveda and in

modern science. Beejadosha and kulajadoshas are mentioned in ayurveda which akin

with genetic and hereditary causes explained by modern science.

Obesity is mentioned as a major risk factor for Diabetes Mellitus as it causes

insulin resistance 179. In ayurveda also explained that atistoola person are more prone to

develop Prameha 180. This Prameha roga is included under santharponotta vyadhi.

Madhura, Snigdhadi bhojana are mentioned as nidanas for Madhumeha. In modern

science over eating is considered as a predisposing factor for Diabetes Mellitus. These

food articles and over eating causes obesity and which may cause Diabetes Mellitus.

Sedentary habit is also a predisposing factor. Asannasukha, swapnasuhka etc. can

be included under this.

In classics manasika bhavas like chinta, shoka, udwega etc are explained as cause

for madhumeha, similarly contemporary science also consider psychological factor like

stress as one of the predisposing factor.

Samprapti:

Any Vikara is a mutual interaction of Nidana, Dosha and Dushya under the

influence of Prakriti, Desha, Kala, Bala and Vaya. The extent of this Dosha Dushya

Sammurchana is dependent on the Vikara Vighata Bhava and its Abhava 181.

When a person indulges into Nidana of Madhumeha, the Kapha, Pitta, Meda,

Mamsa are increases excessively. They obstruct the path of Vata and so the Vata together

with Ojas comes down to reach the Basti producing Madhumeha. In the Madhumeha,


Tridosha (Vata, Pitta, Kapha), ten Dushyas (Meda, Mamsa, Kleda, Shukra, Shonita,

Vasa, Majja, Lasika, Raja and Oja). Three Srotasas (Mutravaha, Medovaha, Udakavaha)

and Dhatvagni plays an important role in the aetiopathogenesis of Madhumeha.

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

vitiated primarily. Charaka clearly mentioned and Cakrapani opined that Kapha Dosha is

dominant and primarily vitiated because of its close resembles with the etiological

factors.

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. Kapha

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.

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

vitiation of Pitta, Avaranjanya Samprapti of Madhumeha resulted. rakta, sweda, lasika

are the seats of pitta dosha. So when pitta gets provoked, it undoubtedly causes the

vitiation of above dusyas. Thus the symptoms manifests are sweda vruddhi, visra sharira

gandha, panidaha, pipasa and sosha indirectly Agni vaisyama too.

Vata is 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.

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

but Charaka 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.

Rasa is the seat of Kapha Dosha and at the same time it is the Mala of Rasadhatu.

Rasa Dhatu mainly vitiates because of its close resemblance with Kapha qualitatively. So

if Kapha get vitiate Rasa also get vitiate. Thus having same symptoms related to Vruddhi

as mentioned by Vagbhata i.e. Rasoapi Slesmavat' 182. Susruta emphasized that Sthaulya

and Karshya results due to vitiation of Rasa Dhatu 183 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. The symptoms like Alasya, Gaurava, Karshya, Hrillasa,

Gaurava, Angamarda, Sada, Pandutva, Klaibya etc. are produced as a result of Rasa

Dushti.

Rakta Dhatu has 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 prominently causing complications like Pidaka, Vidrdhi, Alasi.

Mamsa dhatu is also one of the main dushya, vitiated 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. "Mamsaleshu Arakasheshu".

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.

It gets vitiated both quantitatively and qualitatively Meda vitiation in Madhumeha

appears in two ways i.e. the Abadha (Asamhatum) Normal function of Meda is to

produce snigdhata in the body along with Dradhatva. So this Abadhatva causes

derangement in the structure of Meda producing Shaithilya in the body. In Madhumeha

vitiation of Meda results in two ways as already said.

Majja Dhatu is not vitiated in maximum extent but Vata causes its Ksaya i.e.

Depletion. Due to Vata Prakopa Kshaya of Majja Dhatu occurs. Thus vitiated Majja

produces clinical symptoms like, Netragaurava. Angagauravata in Madhumehi patient.

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. Prameha is a Kulaja Vikara and

occurs as result of Beeja Dosha.Susruta described that Sukra Dosha and Prameha get

precipitate because of the vitiation of Vyanavata and Apanavata. Vata causes depletion of

Shukra Dhatu and also Shukrameha. So, one can appreciate the importance of Shukra

Dushti in Prameha With this it is understand that the relation of Sukra dushti as a

component of Prameha formation.

Oja is sarabhuta of all the Dhatus and gives strength and immune power to the

body. . Charaka mentions that life depends on Oja and therefore without Oja one cannot


live. Such Oja remains in the heart and called as Shareera Rasa Sneha184. In the

commentary Chakrapani has described two varieties of Oja i.e., Para and Apara Oja. Para

Oja is supreme and remains in the heart, while its Pramana is Ashta Bindu. Apara Oja is

of Ardha Anjali Pramana which is also called as Shleshmika Oja i.e. Shareera Bala185.

Further Chakrapani explained that, in Madhumeha Apara Oja Kshaya occurs, which is

Sleshmika in nature and not the Para Oja Kshaya186. 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 Avarana carries Oja towards basti and excrete outside through urine.

Pathological conditions regarding Oja are of 3 types. So the symptoms of Ojakshaya like

Murccha, Mamsakshaya, Moha, Daurbalya (excessive weakness), Vyathita Indriya,

Rukshata, Gurugatrata, Nidra, Tandra etc may manifest. Charaka mentioned Rukashta i.e.

related to Ruksa Sharira, so one can easily understand the manifestations of

Krushapramehi or Sahaja Pramehi. Oja is an important Dushya in the Samprapti of

Madhumeha.

Kleda is one of the body component mainly involved in the pathogenesis. 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. Kleda proper in quantity

is important to maintain the snigdhata in between the tissues. The literal meanings of

Kleda are – wetness, moisture, dampness etc. In the commentary regarding Sharira Kleda

in Charaka samhita mentioned that Kleda gives Shaithilya to Sharira. Normal function of

Mutra and Sweda has been described by Vagbhata as, under normal physiological

conditions Mutra and Sweda maintain balance of Kleda in the body. 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

Arundatta has mentioned that absence of Kleda may lead to the dryness of the body. In

the Samprapti, Kleda Dushti is in the form of ‘Vriddhi’ and not the Kshaya. Hence, Bahu

Kleda will manifest as Prabhoota Mootrata and Avila Mootrata because extensively

increased Kleda is excreated out of the body as Mutra. The other manifestations of Kleda

Dushti may be Shithilangata, Ati Sweda Pravritti, Visra Sharira Gandha (due to excessive

sweating), Sharira Mruduta, Snigdhata etc.

This dooshya is separately mentioned by Vagbhata. Sweda is mainly related with

Meda and Kleda. Due to the vitiation of Meda and Kleda, Swedavaha Srotodushti occurs

leading to the manifestation of Ati Swedapravritti, Daurgandhya, Picchilagatrata,

Snigdhagatrata Visra- sharirgandha etc. Sushruta mentioned that in Madhumeha

(Prameha) Sweda becomes Sweet in nature.

Charaka described Vasameha as a subtype of Vataja Prameha. “Vasa” is an

Upadhatu of Mamsa and the sneha 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. The provoked Vata draws Vasa towards Basti and excretes it through the urine

in the form of Sneha. In case of Madhumeha, the Dushti is illustrated in the form of

Bahutva as well as Abadhdhatva. But still the manifestations are not described

concerning Vasa Dushti. Lasika is a kind of fluid found beneath the skin between it and

Mamsa Dhatu. Lasika also gets vitiated by Vata resulting Lasika meha. There is no direct

reference related to Vasa and Lasika Dushti.


Agni:

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

and tikshna Agni conditions present in the pathogenesis. In ayurveda agni has been given

more importance in the disease process of Madhumeha. Due to this, doshas and

dooshyas will be in aparipakwavastha. It indicates metabolic impairment in Madhumeha.

As all the metabolic activities are maintained by Agni and its Mandata leads many

disorders and Prameha is one of them in which Dhatvagnimandya is a major etiological

component. Dhatvagnimandya leads to Dhatu Vŗddhi and Dhatvagni Tikşņata causes

Dhatukşaya 187. In the Samanya Samprapti, Agnimandya develops due to nidana sevana

leads to Bahudrava Kapha and Bahuabaddha Meda as well as excessive quantity of

Mamsa and Kleda. But in case of Avaraņajanya Madhumeha due to Kaphakara Nidana,

Dhatvagnimandya develops and due to this Agnimandya excessive Dhatu can not be

assimilated properly leading to more vitiation of Dhatu. Such vitiated Dhatu obstructs the

gati of Vata leading to its provocation. But due to this provocation of Vata, Jaţharagni

gets stimulated demanding more food. Therefore, in Madhumeha the Duşya Duşţi mostly

occurs in the form of Vŗuddhi and not in the form of Kşhaya reflecting

Dhatvagnimandya. Kşhaya Lakşaņa of Majja and Śukra Dhatu may be seen as due to

Medodhatvagnimandya there is less nourishment to further Dhatus. So the role of

Dhatvagni in the Samprapti of Madhumeha is important. One may observe the difference

between two types of Agnimandya. In Samanya Samprapti one may get symptoms like

Kşudhamandya due to Jatharagnimandya, but in Avruta Vata Samprapti, Kşudhadhikya

will be prominent. Again without Ama it is impossible to precipitate the pathogenesis of

Madhumeha thus Susruta narrated that.


Purvaroopa:

All Acharyas have accepted nearly same about the Purvarupa. Ghanagatrata,

Karpadadaha, Mukha-Talu-Kantha Shosha, Pipasa, Alasya, Visra Shariragandha etc.

Pipasadhikya, Kshudhadhikya, Alasyata, Tandra, Nidradhikya are the main poorvarupas.

Mukha-Talu-Kantha-Shosha & Pipasa is due to Rukshaguna of vata & also due to loss of

sheetata & snigdata caused by Udakakshya. Tandra & Nidra is due to Rasa & Oja.

Snigdha, Pichhila & Gurugatrata is due to kapha by corresponding qualities of Snigdha,

Pichhila & Guru. Karapada daha is due to pittadosha. It may be also due to loss of Ambu

which is sheeta in property and required for preenanam, failing to which results in Daha.

Karapada suptata is due to kapha. Asya madhurya is due to kapha prakopa by madhurata.

Kesheshu Jatilibhava & keshnakhativriddhi is due to involvement of meda, the precursor

dhatu of Asthi & Majja, which is second to meda. Increased Jatharagni is also responsible

for these symptoms. Shatpada pipilika mutrabhisaranam is due to presence of Madhurata

in the mootra. Kaye malam & Dantadidanam Maladhyatvam is because of their excessive

productions in defective metabolism (Dhatwagni & Bhutagni).

Roopa:

Prabhoota means increased in quantity, when dushyas are affected by kapha dosha

their kleda and fluidity increase. Excretion of kleda is the function of mootra and increase

in the quantity of kleda in turn causes increase in kleda amount of urine. Avila mootrata

is turbid, All shithla dushyas, come into basti, are excreted along with kleda via mootra.

A majority of the lakshanas explained in Madhumeha are explained in the modern

counterpart too. An attempt to correlate the same is made in here below.

Prabhoothaavila mootrata is considered as a prathyatma lakshana of Prameha.


Bahudrava kapha along with other kledapradhana dooshyas in the basthi is the cause for

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

the osmotic diuretic affects of glucose in the kidney tubules.

Madhusama mootra, madhura mootra is because of ojadhatu kshrana through

mootra 188. These symptoms indicate the glycosuria. 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 produces

glycosuria.

Bahu kankshata has been mentioned as a lakshana in apathyanimittaja

Madhumeha. Path of vata is obstructed by vitiated kapha and medas. As a result vata get

vitiated and produces theekshnagni. So patients develop bahukankshatha towards food.

The same is mentioned in modern science in terms of polyphagia.

In ayurveda pipasa is not mentioned as a lakshana but included under poorva

roopa. As it is already explained that most of the poorva roopas mentioned in ayurveda

are the roopas of Madhumeha. Polydipsia is mentioned as one of the symptom related to

hyperglycemia. This condition produces because of polyuria. So pipasa can be said as a

symptom which is similar to polydipsia.

Sushrutha has mentioned different conditions for delayed healing 189. Out of

which Madhumeha is one among them and commentator says ''dustadushyas'' are

responsible for them. Even in modern science delayed healing of wounds has been

mentioned as a symptom and the reasoning they give is the deficient formation of

granulation tissue. The failure of glucose utilization, loss of electrolyte and loss of body

protein causes weakness. Even in our classics it is mentioned that aparipakwa dhatus will


not nourish the body properly and hence causes weakness or klama. The nature and

extent of klama is explained by Acharya Sushrutha mentioned.

II) Discussion on demographic data

1) Age

Here in study, out of 25 patients Madhumeha exhibits 36% patients were from the

age of 46-55 and 32% patients were from the age group of 56-65 years. It reveals that the

individuals are more affected by type 2 DM after 4 decade. The reason for this may be

that the environmental factors like stress, food habit, life style etc. are common in this age

group. These environmental factors act as predisposing factor in the manifestation of DM

Although 32% patients were from group of 36-45, but in this 1(4%) patient having 36yr

other 28% were from age of 40 years.

2) Gender

In this study, 56% patients were males, 44% patients were females so females

are also having equal risk of getting Diabetes Mellitus, less incidence of female patients

in this study may be because of demographic facts or due to small sample.

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.

3) Religion

The maximum patients of 96% were Hindus; this is because of Hindu dominated

area of the study.


4) Economic status

Here in the study higher middle class as people are found more. So DM is called

as Richmans disease. Our study also supports this statement as we got more number of

patients belonging to higher class i, e 52%.

5) Occupation

Occupation plays major role in the manifestation of Madhumeha. The level

physical activity the patient has in daily routine play important roles in onset of Diabetes

Mellitus. The recent dramatic increase indicates that lifestyle factors (sedentary lifestyle)

may be particularly important in triggering the genetic elements that cause this type of

diabetes. Some recent studies show that people with sedentary life style are more likely to

have Diabetes mellitus as compared to those who lead an active life. In present study

maximum patients having sedentary type of occupation I.e. 56%.

6) Diet

Maximum number of patients I.e. 76% of this series were vegetarians, where as

24% patient had mixed diet. This may be due to the traditional vegetarian’s dietary habits

among the Hindus who formed the larger part of this study.

7) Family history

In the present study, 80% patients had family history. It suggests that type Ii

Diabetes Mellitus has a strong genetic component.

Discussion on disease data.

Nidana:

The nidana mentioned in the classics were elicited in this study by detailed

quationing. Among nidana , it was observed that Navanna and gudavaikrutha, snigdha


ahara formed major portion of food I.e. 100%. About 76% of them were taking curds

regularly. Among vihara, avyayama and diwaswapna were found in 56% patients.

Asanaswapna found in 52% of patient. These suggest that data is concordant with the

etiological factors described by classics for the disease Madhumeha. Obesity is major

cause for DM, as it is main cause for insulin resistance. But in present study 20% patients

were slightly overweight for their age & height. The rest had normal weight but reduction

in weight up to ½ to 1 kg was seen in them. It is however interesting that majority of

patients not obese. Among manasika chinta were found 32% of patients. It suggests that

any degree of the stress is related to the NIDDM. The sympathetic nervous activity is

stimulated by the stress and causes the hyper glycemia. If the stress persist for prolong

period it imbalances the homeostasis of the hormones

Purva roopa:

In the present study, alasya was found in 84% patients and Mukha-Talu-Kantha

Shosha was found in 32% patients, Mutramadhurya was found in 100% patients. Here

one thing is important that Madhavanidana mentioned that Padadaha and padasuptata as

Vatananatmaja Vyadhis in which Pitta, Rakta and Kapha obstructs the Patha of Vata

respectively 190. Here also in Avaranjanya Madhumeha these factors are dominant one so

above symptoms manifests in this disease.

Rupa:

Chief complaints

Among chief complaints 100% patients were having Prabhootmootrata both in

terms of quantity as well as frequency. Among these improvement was observed in

19(76%). In Phalatrikadi Vati, 68% relief was observed in Prabhuta Mutrata at


statistically highly significant level (P<0.001). Avila mootrata was found in 80% of

patients for that Vagbhata emphasized that this turbitidy of the urine because of its

annexation with the dhatu. Phalatrikadi Vati provided 56% relief in Avila Mutrata which

was statistically significant (P<0.05). Kshudhadhikya was observed in 96% patient. It

provided 76% relief in Kshudha Adhika which was statistically highly significant level

(P<0.001). Pipasa was observed 92% patient. Prabhootmootrata causes excessive loss of

fluids from body, leading to pipasa and dourbalya. Dourbalya was observed 80% patient.

It showed 84% reduction which was statistically highly significant (P<0.001). It showed

60% reduction in Daurbalya which was statistically highly significant (P<0.001).

KaraPadadaha was observed in 60% patients. It provided 48% relief which was

statistically highly significant (P<0.001). Atisweda was seen in 68% patient. The

Atisweda was reduced by 72% in Phalatrikadi Vati and it was statistically significant

(P<0.01)

Here the data is relevant to the classics. Also satisfying the modern diagnostic

criteria i.e. polyuria, polydipsia, polyphagia,but clinically various patients came with only

one or no symptoms so only blood sugar criteria is decisive for diagnosis.

Associated Signs and Symptoms:

Alasya was found in 76 %patients followed by Mukha-Talu-Kantha-Shosha

(88%). and gurugatrata (32%). Klama was found in 64% patients. The data implies that

Kapha & Medodushti account for presence of Alasya, Gurugatrata. While pitta Dusti

accounts for Mukha-Talu-Kantha-Shosha. These findings point towards the involvement

of all the three Doshas in the progression and manifestation of Madhumeha with the

dominancy of Kapha and Vata Dosha.


Srotodushti

In this study, the Mutravaha Srotasa and Medovaha Srotasa were found afflicted

in all the patients. Other remarkable afflicted Srotasa were Udakavaha Srotodushti.

Involvement of Medovaha and Mutravaha Srotasa in all the patients may be due to the

Anukulatva between Nidana, Dosha and Dushya. All these observations reconfirm the

pathogenesis of Madhumeha mentioned in Ayurvedic classics.

Objective parameters:

There was reduction in FBS and PPBS 32%. It was found that in borderline cases,

the sugar levels came to normal, but in cases with levels near the upper limit of the range,

it did not return to the normal limits. This may give a hint about a probable requirement

of an extension in the duration of treatment. The mild increase in the urine sugar levels

came back to normal but in cases where there was higher range of increased urine sugar

levels, it did not come to normal limit. There was only a moderate reduction hinting at a

longer period of treatment. It was observed that the symptoms that were mild returned

back to normal after 30 days of treatment but those that were moderate came down to

mild. The Phalatrikadi Vati provided 32% relief in Fasting Blood Sugar & 32% relief in

PPBS at statistically significant level (P<0.01).

Probable Mode of Action:

Most of these drugs are having tikta, kashayarasa, laghu, rooksha guna and

katuvipaka. These are said to be kaphagna, mehagna, medogna and

mootrasangrahaneeya.

Tikta, kashayarasa, laghu, rooksha guna produces rookshana effect and they are

having opposite qualities to that of kapha and medas. Hence they act as mehagna and


kaphagna. So, this drug may have been effective on kapha and pitta and also on vata.

This tridoshashamaka property of this drug helped to correct the dhatudushti and

srotodushti leading to their normal functioning.

Bahudravata will be present in Madhumeha. These tikta rasa and kashaya rasa

drugs posses the kaphahara, Meda, Kleda Upashoshana properties191. Bahudravata will

be reduced by the absorption of excessive fluid from the body. When bahudravata

reaching basthi reduces then prabhoothamootrata pratyatmalakshana of Prameha also

reduces. Pipasa which is dependent on prabhoothamootrata also subsides. Musta by its

trishnanigrahana property, alleviates pipasadhikya in Madhumeha. Further Madhumeha is

a metabolic disease, dhatvagnimandhyjanita vyadhi. This metabolic disease demands

medadhatvagnivriddhi. When any agni is not proper, dhatus are not produced properly.

Phalatrikadi Vati having deepana & pachana drugs and katu rasa,ushna virya encounters

dhatvagnimandya & potentiates the dhatvagnimandhya and help in ama-pachana thereby

alleviates aparipakwa and ama. That in turn helps to form the dhatus in proper proportion

with samyak qualities. Their by it ensues sarvadhatuposhana thereby pacifies Daurbalya.

Phalatrikadi Vati produce malashodana (indravaruni, triphala) their by it eliminates the

metabolic wastes, vitiated pitta dosha along with kapha dosha & thus removes avarana of

vata there by normalizing the digestive power which helps to control the symptom. This

may account for better relief in Kshudha Adhika. Clinical & experimental studies depicts

that Amalaki, Haridra, Triphala reduces blood glucose significantly. Pramehahara

property of the ingredients of trial drug helps in alleviating the hyperglycemia.

Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Conclusion 119

CONCLUSION

Ayurveda in fact is the first medical science, which identified, diagnosed &

manged Madhumeha.

Madhumeha is mentioned as one of the 20 types of Prameha. Madhumeha has

been classified under the Vatika type of Prameha.

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.

Kapha is the arambaka dosha & vata is the preraka.

Margavarana Janya Madhumeha & dhatukshaya Janya madhumeha are the two

forms of manifestation of the disease. The apatyanimittaja madhumeha & sahaja

madhumeha are the two-independent forms of presentations, coming under the

above classification respectively.

Madhumeha is a disease characterized by Prabhoota avila mootrata, Tanu

madhuryata & Mootra madhuryata

Diabetes Mellitus is correlated with Madhumeha especially Non insulin

Dependent Diabetes Mellitus which have the similar pathogenesis and

manifestion.

Madhumeha (Type II Diabetes mellitus) mostly affects the individuals after the

age of forty years.

Sex, martial status, religion bear no relation with Diabetes mellitus.

Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Conclusion 120

Changing life styles e.g.; sedentary life, increased stress, strain may contribute in

the establishment of the disease. Tendency towards sedentary life style and faulty

dietary habits, leads to vitiation of Kapha and Meda leading to Madhumeha.

The present study suggests that Type II DM has got a strong genetic component.

It also reveals the chronic nature of the disease.

The obesity is a risk factor associated with Type II DM. But majority of the pts

were not Overweight or obese here.

The study confirms the dominancy of Kapha Dosha, Meda Dhatu Dusti and

Medovaha Srotodushti in the pathogenesis of Madhumeha.

The line of treatment is based upon Tiktakasaya Rasa, Usna Virya Kaphavatahara

and Pramehaghna properties of the drugs for oral medication.

While majority of the patients having Prabhutamootrata (polyuria), Avila

Mootrata, Mutramadhurya, Pipasa and Kshudhadhikya.

The parameters both subjective and objective showed high significance rate

stastically.

Along with treatment patient is supposed to adopt the pathya-Apathya as

explainen in classics. This is nothing but essential tool in the management of

Madhumeha.

The result of the Phalatrikadi Vati declared is representing the efficiency of the

drug with its embedded qualities, is 2(8%) Regulated, 5 (20%) palliative and

11(54%) patients responded in the trial.

This is strong evidence to state that the phalatrikadi Vati is hypoglycemic agent

combination of Ayurveda

Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Summary 121

Summary

Diabetes is a disease known from the dawn of civilization. Sedentary life style,

Lack of exercise, Faulty food habits and improper medication and Urbanization

precipitates the disease. On the basis of its symptomatology Madhumeha can be

correlated to the features of Diabetes mellitus.

Madhumeha is mentioned as one of the 20 types of Prameha, classified under the

Vatika type of Prameha. The Vata may be provoked either directly by its

etiological factors, Avarana by Kapha and Pitta to its path or by continuous

depletion of Dhatus.

In the pathogenesis of Madhumeha, Kapha & vata dosha, Meda & mamsa, kleda,

oja dushyas, mootavaha srotus and medovaha srotus are mainly involved.

Prabhoota mootrata and Avila mootrata are main cardinal symptoms of

Madhumeha.

The factors which provoke the Vata directly cause Apatarpanajanya Madhumeha

and are equivalent to Type I Diabetes mellitus. While the factors which provoke

Kapha and Pitta cause Santarpanajanya Madhumeha equivalent to Type II

Diabetes mellitus.

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 prevention and control of the Madhumeha made by regularizing the blood

glucose level with the help of shamanaoushadi. The Phalatrikadi Vati is

Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Summary 122

compound formulation comprises of 7 drugs explained by acharyas in

Madhumeha as a shamanoushadi.

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

à-vis. Diabetes Mellitus management with Phalatrikadi Vati as a Shamana

Chikitsa. Phalatrikadi Vati 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 30 days.

Patients of Madhumeha fulfilling the criteria of diagnosis were selected in the

present study. Patients were selected on preset inclusion and exclusion criteria.

30 patients of Madhumeha were registered in this study out of which total 25

patients completed treatment. 5 patients not fulfilled the inclusion criteria.

All the patients have complained of prabhoota mootrata, folled by 80% of patients

having avilamotrata, 96% and 62% of patients having kshudhadhikya & pipasa

respectively.

The results in this trail, out of 25 of patients, 2 (8%) regulated, 5(20%) patients

are palliative, 16(64%) patients are responded to treatment, 2(8%) not responded.

Thus phalatrikadi Vati having hypoglycemic effect.

Among the subjective parameters pipasa, kshudhadhikya, dourbalya shows more

highly significant than other parameter. Among objective parameter prabhoota

mootrata shows highly significant with 89.65% of mean improvement. FBS

shows highly significant with 20.31% of mean improvement.

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68) Kasinatha Sastri ed, Caraka samhita chikitsa 6/6 Reprint 2001; Chaukhambha Bharati


69 Kasinatha Sastri ed, Caraka samhita Sutrastana, 17/80-81 Reprint 2001; Chaukhambha

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75) Kasinatha Sastri ed, Caraka samhita chikitsa 6/4,Reprint 2001; Chaukhambha Bharati


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81) Dr Brahmanand tripathi ed, Astanga Hridaya, Nidana10/4,Reprint ed. 2007 Chaukhambha


82) Kasinatha Sastri ed, Caraka samhita, Sutrastana 28/13,Reprint 2001; Chaukhambha

Bharati Academy Varanasi pp 571.



84) Kasinatha Sastri ed, Caraka samhita Sutrastana, 17/80 Reprint 2001; Chaukhambha





86) Kasinatha Sastri ed, Caraka samhita Sutrastana, 21/4 Reprint 2001; Chaukhambha Bharati


87) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Sutra 15/14, Reprint ed, 2006,


88) Ibid, Nidana, 1/20, pp230



90) Kasinatha Sastri ed, Caraka samhita chikitsa 6/11Reprint 2001; Chaukhambha Bharati




92) Vaidya Yadavaji Trikamji Acharya ed, Caraka samhita Commentary Cakrapanidatta Nidana

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94) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Sutrastana 15/29,

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96) Harishastri oaradkar Vaidya ed, Astanga Hridaya Commentary Aunadatta & Hemadri ,

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97) Dr Brahmanand tripathi ed, Astanga Hridaya, Nidana 10/4, Reprint ed. 2007 Chaukhambha


98) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 12/49,

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100) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/7 Reprint 2001; Chaukhambha Bharati


101) Dr Brahmanand tripathi ed, Astanga Hridaya, Nidana 10/7 Reprint ed. 2007 Chaukhambha







104) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 11/3, Reprint ed,

2006, Choukhambha Sanskrit sansthan, Varanasi, pp 59

105) Ibid



107) Kasinatha Sastri ed, Caraka samhita Sutrastana, 17/78-81, Reprint 2001; Chaukhambha


108) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 11/25-26, Reprint ed,

2006, Choukhambha Sanskrit sansthan, Varanasi, pp 255

109) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 11/6 , Reprint ed, 2006,


110) Vaidya Yadavaji Trikamji Acharya, Sushruta sutra Commentary

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111) Bhisagratna Shri Brahmashanka Mishra ed, Bhava Prakasha Madhyama Khanda, 38/1-

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112) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, chikitsa 11/3 , Reprint ed, 2006,


113) Ibid

114) Yadunandan Upadhyaya ed. Madhava Nidanam, Part-2, 33/26, 9th ed, 2004, Chaukhambha

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115) ) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Sutra 23/7 , Reprint ed, 2006,


116) ) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 6/28 , Reprint ed,

2006, Choukhambha Sanskrit sansthan, Varanasi, pp 255.












122) Kasinatha Sastri ed, Caraka samhita Sutrastana, 20/13, Reprint 2001; Chaukhambha

Bharati Academy Varanasi pp204.

123) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/ 7 Reprint 2001; Chaukhambha Bharati


124) Vaidya Yadavaji Trikamji Acharya ed, Caraka samhita Commentary Cakrapanidatta

Nidana 4/7 Reprint 2001; Chaukhambha Bharati Academy Varanasi pp 213.


Academy Varanasi pp228.



127) Kasinatha Sastri ed, Caraka samhita Sutrastana, 17/80 Reprint 2001; Chaukhambha


128) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/57,Reprint 2001; Chaukhambha Bharati






131) Dr Brahmanand tripathi ed, Astanga Hridaya, Chikitsa 12/3 Reprint ed. 2007



Chikitsa 12/1 – 3, Reprint ed. 2007 Krishnadas Academy, Varanasi, pp-678






Chikitsa 12/1 – 3, Reprint ed. 2007 Krishnadas Academy, Varanasi, pp-678


136) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/27-29 Reprint 2001; Chaukhambha

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137) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 11/8, Reprint ed, 2006,


138 ) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 11/9, Reprint ed,














145) ) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/30-32 Reprint 2001; Chaukhambha




147) Dr Brahmanand tripathi ed, Astanga Hridaya, Chikitsa 12/7-8, Reprint ed. 2007








151)Kasinatha Sastri ed, Caraka samhita Chikitsa 6/17,Reprint 2001; Chaukhambha Bharati


152) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/34, Reprint 2001; Chaukhambha Bharati



153) ) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 13/10-11, Reprint

ed, 2006, Choukhambha Sanskrit sansthan, Varanasi, pp 65.









158) ) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 11/12, Reprint ed,


159) http: // Encyclopedia.thefreedictory.com

160) Siddharth N Shah ed, API Textbook of Medicine, 7th edition, 2003, Association of Physician

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162) Harsha Mohan ed, Text book of Pathology, 5th ed 2005, Jaypee Brothers Medical

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163) Robins ed, Basic pathology, 7th ed 2003, pp 645

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166) P. C. Das, Text Book of Medicine, 4th ed, 2000, Current books international, Calcutta, pp

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167) P. C. Das, Text Book of Medicine, 4th ed, 2000, Current books international, Calcutta, pp

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168) Siddharth N Shah ed, API Textbook of Medicine, 7th edition, 2003, Association of Physician

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169) AS Fauci, Harrison principles of internal medicine, Vol-2, 15th ed. 2001 Mcgraw Hill co,

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171) P. V. Sharma, Dravyaguna Vijana, Vol-II, 16th ed, 1995, Chaukhambha Bharati Academy,

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172) Ibid pp239

173) Ibid pp 758

174) Ibid pp 370

175) Ibid pp 162

176) Ibid pp 537

177) Ibid pp 436



179) Derek. Leroith, Simeon. I. Taylor, Jerrold. M. Olefsky Ed, Diabetes Mellitus – A

Fundamental and Clinical text, 3rd Ed, 2004, Lippincott Williams & Wilkins, pp 840.



181) Kasinatha Sastri ed, Caraka samhita Nidana 4, Reprint 2001; Chaukhambha Bharati


182) ) Dr Brahmanand tripathi ed, Astanga Hridaya, Sutra 11/8 Reprint ed. 2007 Chaukhambha




184) Kasinatha Sastri ed, Caraka samhita, Sutra 30/11,, Reprint 2001; Chaukhambha Bharati


185) ) Vaidya Yadavaji Trikamji Acharya ed, Caraka samhita Commentary Cakrapanidatta,

Sutrastana 30/7, Reprint 2001; Chaukhambha Bharati Academy Varanasi pp 185.

186) Ibid.







190) Yadunandan Upadhyaya ed. Madhava Nidanam, Part-1, 22, 9th ed, 2004, Chaukhambha

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191) Dr Brahmanand tripathi ed, Astanga Hridaya, Sutra 10/20, Reprint ed. 2007 Chaukhambha



Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts i

Demographic Data of Phalatrikadi Vati SNo OPD

No Gende

r Religion Occupation Economical

Condition Result

M F Age

Food

V

/Mx

H M C O S A L P M Hg

Hc

1 4905 + 40 Mx + + + Responded 2 5430 + 51 V + + + Palliative 3 5293 + 36 V + + + Responded 4 5029 + 68 V + + + Responded 5 5882 + 42 V + + + Not

Responded 6 5708 + 49 V + + + Responded 7 5935 + 59 V + + + Responded 8 6043 + 54 V + + + Responded 9 6205 + 55 V + + + Responded 10 6347 + 64 Mx + + + Not

Responded 11 6220 + 54 Mx + + + Palliative 12 6350 + 40 Mx + + + Responded 13 6416 + 59 Mx + + + Responded 14 1108 + 52 V + + + Palliative 15 1109 + 52 V + + + Responded 16 1196 + 43 V + + + Responded 17 298 + 49 V + + + Responded 18 1209 + 58 V + + + Responded 19 827 + 53 Mx + + + Responded 20 4939 + 52 Mx + + + Responded 21 1210 + 62 V + + + Responded 22 1363 + 42 V + + + Palliative 23 894 + 44 V + + + Regulated 24 558 + 57 V + + + Responded 25 1961 + 62 V + + + Regulated Total 1

3 12

24

1 0 0 14 10 1 3 9 13

Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts ii

Subjective Statistical Assessment Data of Phalatrikadi Vati

S.No OPD Avilamotrata Karapada

daha Kshudhadhikyata Pipasa Atisweda Dourbalya

B A B A B A B A B A B A 1 4905 2 0 0 0 2 0 2 0 2 0 2 0 2 5430 1 0 0 0 2 1 2 0 0 0 0 0 3 5293 2 0 0 0 3 0 2 0 1 0 3 0 4 5029 3 0 1 0 3 1 3 0 1 0 3 1 5 5882 1 0 0 0 2 0 2 0 1 0 2 0 6 5708 1 0 0 0 2 0 2 0 2 0 3 0 7 5935 1 0 2 0 2 0 3 1 1 0 3 1 8 6043 2 1 2 0 2 0 3 0 3 0 3 0 9 6205 3 1 1 0 3 0 2 0 1 0 3 1 10 6347 1 0 1 0 2 0 2 1 1 0 2 0 11 6220 3 0 1 0 2 0 2 0 2 0 3 0 12 6350 3 1 1 0 3 0 3 0 2 0 3 0 13 6416 2 0 1 0 2 0 3 0 1 0 3 1 14 1108 2 0 1 0 3 2 3 2 0 0 0 0 15 1109 1 1 2 1 2 1 2 0 1 1 2 0 16 1196 0 0 0 0 1 0 0 0 0 0 2 0 17 298 1 0 1 1 2 0 2 0 1 0 3 0 18 1209 1 0 1 1 2 0 2 0 1 1 2 0 19 827 1 2 1 1 2 1 2 1 2 1 3 1 20 4939 3 2 1 0 2 0 2 0 2 1 3 2 21 1210 1 0 1 0 2 0 2 0 2 0 0 0 22 1363 1 0 0 0 2 0 2 0 0 0 3 0 23 894 2 0 1 0 2 1 3 1 2 1 3 1 24 558 0 0 0 0 0 0 2 0 1 0 2 0 25 1961 1 0 1 0 2 0 2 0 2 0 2 0 Total 39 8 20 4 53 4 31 4 33 3 58 8 Mean 1.59 0.32 0.8 0.16 2.12 0.28 2.2 0.24 1.32 0.2 2.32 0.32

Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts iii

Objective Statistical Assessment of Phalatrikadi Vati

S.No OPD Prabhuta

mootrata FBS PPBS FUS PPUS

B A B A B A B A B A 1 4939 2 0 174.4 130 356.3 270 0.5 0 1.5 0.5 2 6043 2 0 129.6 125.2 310 260 0.5 0.5 1.5 1.5 3 5935 2 0 146.4 94.8 262.5 211.1 0 0 0 0 4 5708 3 1 215 160 326.5 251.1 1.5 1 2.0 1.5 5 4905 2 1 239.4 193.8 395.7 216 1.0 0 1.5 1.5 6 5430 3 0 121.5 110.0 187.3 159 0 0 0 0 7 5029 2 0 171.9 115.2 362 260 1.0 0 2 1.5 8 5882 2 0 151.2 144.3 248.1 275 0.5 0 1.5 1 9 5293 3 0 152.1 132 220.3 173.1 0.5 0 1.0 0.5 10 6205 2 0 175 125.3 317 240 1.0 0 1.5 0.5 11 6220 2 0 182 130 223.8 160.2 0 0 1.0 0 12 6350 3 0 120.7 105 267.5 195 0 0 1.0 0.5 13 6416 3 1 132.3 100 305.9 190 0.5 0 2.0 0 14 1196 3 0 155 120 205 160 0 0 0 0 15 298 3 1 148 125 225 198 0 0 1 0.5 16 1209 1 0 158 136 252.7 175.3 0.5 0 1 0.5 17 6347 2 0 180.3 156.8 268 286 1.5 0.5 1.5 1.5 18 558 2 0 135 76.4 192 134.9 0 0 0 0 19 827 2 1 240.5 195 351.6 255 1.5 0.5 2.0 1.5 20 894 3 0 92 80 190 140 0 0 0 0 21 1210 2 0 155.5 130 195.4 184 0.5 0 1.5 0.5 22 1363 2 0 112 80 227 157 0 0 0.5 0.5 23 1109 3 1 150 132 300 220 0.5 0 2.0 0.5 24 1108 2 0 150 115 185 153 0.5 0 1.0 0.5 25 1961 2 0 130 110 178 135 0 0 0.5 0 Total 58 6 3917.8 3121.8 6571.3 5058.7 11.5 2.5 27.5 14.0 Mean 2.32 0.24 156..71 124..87 265..85 201,.34 .44 0.08 1.1 .56

Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts iv

Chief & Associated complaints of Phalatrikadi Vati

Complaints 1 2 3 4 5 6 7 8 9 10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

Total

1 Prabhoota Mootrata

+ + + + + + + + + + + + + + + + + + + + + + + + + 25

2 Avila Mootrata + + + + + + + + + + + + + + + + + + 18 3 Karapada Daha + + + + + + + + + + + + + + + 15 4 Kshudhadhikyata + + + + + + + + + + + + + + + + + + + + + + + + 24 5 Pipasa + + + + + + + + + + + + + + + + + + + + + + + 23 6 Atisweda + + + + + + + + + + + + + + + + + + + + 20 7 Dourbalya + + + + + + + + + + + + + + + + + + + + + 21 Associated

Complaints

1 Kara/Pada suptata + + + 3 2 Klama + + + + + + + + + + + + + + + + 16 3 Alasya + + + + + + + + + + + + + + 14 4 Tandra + + + + + + + + + + + + + + + + + + + 19 5 Gurugatrat a + + + + + + + + 8 6 Dantadimaladya + + 2 7 Shithilangata + + + + + 2 8 Mukha/Talu

shosha + + + + + + + + + + + + + + + + + + + + + 22

Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts v

Poorvaroopa of Madhumeha

Poorvaroopa 1 2 3 4 5 6 7 8 9 10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25 Total

1 Dantadeenam Malatvam

+ + + + + + 6

2 Pada daha + + + + 4 3 Pani daha + + + + 4 4 Deha chikkanata + + + + + + + + + 9 5 Shareera

durgandha + 1

6 Mutra madhurata + + + + + + + + + + + + + + + + + + + + + + + + + 25 7 Mutra shuklata 8 Mukha madhurta + 1 9 Talu jivhashosha + + + + + + + + 8 10 Kesh jatilata 11 Nakha vriddhi 12 Alasya + + + + + + + + + + + + + + + + + + + + + 21 13 Tandra + + + + + + + + + + + 11 14 Nidra + + + + + + 6 15 Trishna + + + + + + - + + + + + + + + + + + + + + + + + + 24 16 Maldhikyata in

bahya chidra

17 Swedadhikya + + + + + + + + + + + + + + + + + + + + + 21 18 Sheeta iccha + + 2 19 Swasa + + + 3 20 Shitalangata + + + + + + 6

Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts vi

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

21

22

23

24

25 T

Udakavaha 1 Jihwa shosha + + + + + + + + + + + + + + + + + + + + + + + 23 2 Talu shosha + + + + + + + + + + + + + + + + + + + + + + + 23 4 Kloma shosha + 1 5 Prawridha pipasa + + + + + + + + + + + + + + + + 17 Mootravaha 1 Alpalpa mootrata 2 Mootara rodha 3 Adhika mootra + + + + + + + + + + + + + + + + + + + + + + + + + 25 4 Sashoola mootra 5 Basti stabdhata Mamsavaha 1 Arbuda 2 Arsha 3 Mamsa shosha 4 Shira granthi Medovaha 1 Sweda + + + + + + + + + + + + 20 2 Snigdhanagata + + + + + + 6 3 Sthulashophata 4 Pipasa + + + + + + + + + + + + + + + + + + + + + + + 23

Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts i

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 4905 + + 2 5430 + + + 3 5293 + + + 4 5029 + + + 5 5882 + + + 6 5708 + + + 7 5935 + + + 8 6043 + + + 9 6205 + + + 10 6347 + + + 11 6220 + + + 12 3650 + + + 13 6416 + + + 14 1108 + + + 15 1109 + + + 16 1196 + + + + 17 298 + + + 18 1209 + + + 19 827 + + + 20 4939 + + + 21 558 + + + 22 1210 + + + 23 1363 + + + 24 894 + + + 25 1961 + + + Total 7 16 2 00 5 11 9 2 19 6

Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts ii

Ahara Nidana S.No OPD Guda Navanna Dugdha Snigdha

Ahara Mamsa Dadhi Sheeta

Ahara 1 4905 + + + + + + + 2 5430 + + + + + + 3 5293 + + + + + + 4 5029 + + + + + + 5 5882 + + + + + + 6 5708 + + + + + 7 5935 + + + + + 8 6043 + + + + 9 6205 + + + + 10 6347 + + + + + + 11 6220 + + + + 12 3650 + + + + + 13 6416 + + + + + + 14 1108 + + + + + + 15 1109 + + + + + + 16 1196 + + + + + 17 298 + + + + 18 1209 + + + 19 827 + + + + + + + 20 4939 + + + + + + + 21 558 + + + + - + 22 1210 + + + + + 23 1363 + + + + + + 24 894 + + + + + 25 1961 + + + + Total 25 25 17 25 7 19 15

Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts iii

Vihara Nidana S.No OPD Avyaya

ma Diwasw

apna Swapnasukham

Manishika

Vegavarodha

Panchakarma

Vibhramsha

Sthoulya

Asannaswapna

1 4905 + + + + + 2 5430 + 3 5293 + + + + 4 5029 + + + 5 5882 + + + 6 5708 + + + 7 5935 + + + 8 6043 + 9 6205 + + + + + 10 6347 + + + + + + + 11 6220 + 12 3650 + + + 13 6416 14 1108 + + + + 15 1109 + + + + 16 1196 + + 17 298 18 1209 + 19 827 + + + 20 4939 + + + 21 558 + + + + + 22 1210 + + + + 23 1363 24 894 + + 25 1961 + + Total 14 14 13 8 2 0 5 13

SPECIAL CASE SHEET FOR “Evaluation of the efficacy of the Phaltrikadi Vati in Madhumeha” POST GRADUATE STUDIES AND RESEARCH CENTER (KAYACHIKITSA)

D.G.M.AYURVEDIC MEDICAL COLLEGE, GADAG

Guide:

Dr. K. Shiva Rama Prasad

Scholar:

Dr. Vijayalaxmi. B.Benakatti

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

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

Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Case Sheet 1

12) CHIEF COMPLAINTS WITH DURATION Sl no

Complaints Duration Remarks

1 Prabhutamootrata 2 Avilamootrata 3 Kara pada dhaha 4 Kshudadhikya 5 Pipasa 6 Atisweda 7 Dourbalya 13) ASSOCIATED COMPLAINTS Sl.No Associated complaints Duration Remarks 1 Kara pada suptata 2 Klama 3 Tandra 4 Alasya 5 Gurugatrata 6 Dantadi maladhyatwam 7 Shitilangata 8 Mukha shosa 9 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

Since how long

History of past illness


Family history - specify if any has the same disease 16) HISTORY OF PRESENT ILLNESS Mode of detection Accidental/Suspicious /At regular check Frequency of micturition 3-4 times/5-6times/7-8times/9-10 times/above 10 17) MADHUMEHA NIDANA Ahar Vihar Anya Nidanarthakara

vyadhi Madhura Guda vaikruta-Sugar items /M Avyayama Mansika chinta Sthoulya Jaggery items /M SugarcaneJuice Asanaswapna Vegadharana Navanna Diwaswapna Dugdha Swapnasukha Mamsa Chiken - / M Muton- /M Fish - /M

Panchakarma vibhramsha

Snigdha Dadhi Sheeta

Patient

Grandfather Grandmother Grandmother Grandfather

Father

Brother

Brother Mother Brother Sister

Sister

Sister


18) MADHUMEHA POORVAROOPA Dantadeenam malatvam Pada dhaha Shitilangata Mukha madharta Pani dhaha Maladhikyata in bahya chidra Trisna Kesh jatilata Swedadhikya Deha chikannata Alasya Sheeta iccha Shreera dugandhata Tandra Swasa Mutra madhurata Nidra Mutra shuklta Talu kloma shosha 19) EXAMINATION a) VITAL EXAMINATION Pulse /min Temp °F Respiration rate /min

Blood pressure

b) SYSTEMIC EXAMINATION Respiratory - Cardiovascular - Gastro-intestinal - Genito-urinary - c) EXAMINATION OF SROTAS Udakavaha Mootravaha Mamsavaha Medovaha Jihwa shosha

Alpalpa moortrata

Ardudha Sweda

Talu shosha Mootra rodha Arsha Snigdhanagata Kloma shosha

Adhikamootra Mamsa shosha Sthulashophata

Prawridha pipas

Sashoola mootra Shira granthi Pipasa

Basti stabdhata d) DASHVIDHA PARIKSHA

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) ASTA STHANA PARIKSHA

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 ita iccha Madhurrahita ahara Vyayama

Anupashaya Ushna Madhura ahara Diwaswapana

21) UPADRAVA – Present / Absent Mention (if any) - 22) INVESTIGATIONS Erythrocyte sedimentation rate

Hb%

Albumin Sugar

Urine routine

Microscopic 23) TREATMENT SCHEDULE Day Date Investigation’s note Day 1 Day 7 Day 14 Day 21 Day 30


24) ASSESMENT OF TRIAL 1) Subjective paramters Before After Follow-up Differance 1 Dourbalya 2 Avila mootrata 3 Kara pada dhaha 4 Pipasa 5 Kshudhadikyata

Grades 1) Prabhuta mootrata

Grade 0 1000ml – 1500ml/ 24hrs Grade 1 1500ml – 2000ml/ 24hrs Grade 2 2000ml – 2500ml/ 24hrs Grade 3 2500ml -3000ml/ 24hrs

1) Avila mootrata Grade 0 Crystal clear fluid Grade 1 Hazy with slight turbidity Grade 3 Turbidity clearly present but news

print can be read through the tube. Grade 4 More turbidity news print cannot be read.

2) Kara pada dhaha Grade 0 No kara padadadha

Grade 1 Occasionally noticed Grade 2 Periodically noticed Grade 3 Daily noticed Grade 4 Continuously noticed

3) Kshudhadikya Grade 0 No Kshudhadikya

Grade 1 Mild increased but tolerated Grade 2 Moderate increased but tolerated Grade 3 Severally increased but not tolerated

2) Objective parameters Before After Follow-up Differance 1 Fasting Blood Suger 2 Post prandial Blood suger 3 Fasting urine suger 4 Post pradial urine suger 5 Prabuta mootrata

Investigators note:

Signature of Guide (Dr K. Shiva Rama Prasad)

Phalatrikadi Vati in Madhumeha (Di

4) Pipasa Grade 0 Normal

Grade 1 Mild increased but tolerated Grade 2 Moderate increased but tolerated Grade 3 Severally increased but not tolerat

5) Atisweda Grade 0 Normal sweating after doing normal physical activities Grade 1 Moderate sweating Grade 2 Excessive sweating Grade 3 Excessive sweating just by doing little work 6) Dourbalya

Grade 0 No Dourbalya Grade 1 Occasionally noticed Grade 2 Periodically noticed Grade 3 Continuously noticed

Signature of Scholar ( Vijayalaxmi. B. Benakatti )

abetes Mellitus) – Case Sheet 6

madhumeha kc048 gdg

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