madhumeha#dg01 gdg
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Evaluation of efficacy of Avartaki in Madhumeha (NIDDM) -Shashikala. B. Bani, Department of Dravya Guna, Post Graduate Studies & Research Centre, D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE,GADAGTRANSCRIPT
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
By
Shashikala. B. Bani
Dissertation submitted to the
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial fulfillment of the degree of
Ayurveda Vachaspati M.D. In
Dravya Guna Under the Guidance of
Dr. G.V. Mulagund
M.D. (Ayu) and Co- Guidance of
Dr. Kuber Sankh M.D. (Ayu)
Department of Dravya Guna Post Graduate Studies & Research Centre
D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG
2002-2005
Declaration by the candidate
I here by declare that this dissertation / thesis entitled
“Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)” is a
bonafide and genuine research work carried out by me under the
guidance of Dr. G. V. Mulagund M.D.(Ayu) Professor and Dr. Kuber
Sankh, M.D.(Ayu), Lecturer in Dravya Guna, DGMAMC, PGS&RC,
Gadag.
Date :
Place : Gadag
( SHASHIKALA . B. BANI )
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTRE
GADAG, 582 103
This is to certify that the dissertation entitled “Evaluation of efficacy Avartaki of in
Madhumeha (NIDDM)” a bonafide research work done by Shashikala. B. Bani in partial
fulfillment of the requirement for the post graduation degree of “Ayurveda Vachaspati M.D.
(Dravya Guna)” Under Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.
Dr. G.V. MULAGUND M.D. (Ayu)
Guide
Professor & HOD
Dept. of Dravya Guna
DGMAMC, PGS&RC, GADAG
Date:
Place: Gadag
Dr. KUBER SANKH M.D. (Ayu)
Co- Guide
Lecturer in Dravya Guna
DGMAMC, PGS&RC, GADAG
Date:
Place: Gadag
J.S.V.V. SAMSTHE’S
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTRE
GADAG, 582 103
Endorsement by the H.O.D, Principal/ head of the institution
This is to certify that the dissertation entitled “Evaluation of efficacy of
Avartaki in Madhumeha (NIDDM)” is a bonafide research work done by
Shashikala. B. Bani under the guidance of Dr. G. V. MULAGUND, M.D. (Ayu),
Professor & HOD and Dr. KUBER SANKH, M.D. (Ayu), in partial fulfillment of the
requirement for the post graduation degree of “Ayurveda Vachaspati M.D. (Dravya
Guna)” Under Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.
.
(Dr. G. B. Patil) Principal,
DGM Ayurvedic Medical College, Gadag
Date: Place: Gadag
(Dr. G. V. Mulagund) Professor & HOD
Dept. of Dravya Guna PGS&RC
Date: Place: Gadag
© 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 : Gadag
( SHASHIKALA . B. BANI )
© Rajiv Gandhi University of Health Sciences, Karnataka
ACKNOWLEDGEMENT
I am very much grateful to my guide, Dr. G.V. Mulagund M.D(Ayu) , Professor
& HOD Post Graduation Research & studies Dept. of Dravya Guna Shri D. G. M.
Ayurvedic Medical College , Gadag. for his valuable suggestions and guidance in
completion of this research successfully .
I am expressing my sincere thanks to my co-guide Dr. Kuber . Sankh M.D(Ayu)
Lecture, Post Graduation Research & studies Dept. of Dravya Guna Shri D. G. M.
Ayurvedic Medical College , Gadag. for his valuable suggestion ,guidelines & kind
co-operation at every moment of the preparations of dissertation .
I offer my sincere thanks to Dr. G.B. Patil Principal, Shri D. G. M. Ayurvedic
Medical College , Gadag. for facilitating the requirements needed during the work.
I am very much thankful to Dr. G. S. Hiremath. HOD Dept of Dravya guna ,
Shri D. G. M. Ayurvedic Medical College, Gadag for his valuable suggestions and
constant encouragement. I also thank Dr. Shashikant . B. N. for his kind co-operation.
I am very thankful to all my teachers of Shri D. G. M. Ayurvedic Medical
College, Gadag .who have given a foundation for this nobler profession.
I am thankful to all my friends for their kind co-operation in completing this
work.
I am highly indebted to my beloved parents, who framed a proper path for my
carrier. I remain ever great full to them.
I express my heartfelt gratitude to my brother, Prashant for constant help and
encouragement to move ahead.
My deepest gratitude to my husband , Dr. Rajendrakumar. Angadi for
enormous love & moral support.
I would like thank all my family members who have given love and care ,
during my studies.
It would not enough without remembering my lovely, sweet, little daughter,
Sanjana whose entry become turning point of life and brings cheerfulness throughout.
Finally I am thankful to all those persons who so helped directly or indirectly
for the completion of this work.
Date:
Place: Gadag Shashikala.B.Bani
LIST OF ABBREVIATION USED
A.H -Astanga hridayam
A.S - Astanga sangraha
C.S - Charaka samhita
D. Ni - Dhanwantari nighantu
DM - Diabetes mellitus
FBS -Fasting blood sugar
IDDM - Insulin dependent diabetes mellitus
K.Ni - Kaiyadeva nighantu
M. N - Madhava nidana
M. Ni -Madanapala nighantu
M.D.G - Madhava dravya guna
Ni. R - Nighantu ratnakara
Ni.A - Nighantu adarsha
NIDDM - Non-insulin dependent diabetes mellitus
OHA - Oral hypoglycemic agents
PPBS -Post partial blood sugar
R.Ni - Raja nighantu
S.K.D - Shabda kalpa druma
S.S - Sushruta samhita
US - Urine sugar
ABSTRACT
Background
Madhumeha which has been correlated with DM is a chronic metabolic disorder,
described more than 2000 years has become an epidemic with a world wide incidence
of 5% in the general population. The patients experiences significant morbidity and
mortality from microvascular, macrovascular complication .The drug from
contemporary science shows adverse effect and declines in their action after prolong
administration .Since immemorial time medicinal plants are used in such condition
and Avartaki (Cassia Auriculata ) is one among them, described as antidiabetic in
most of nighantu.
Objectives:
Evaluation of efficacy of Avartaki beeja and pushpa in the management of
Madhumeha and to evaluate the comparative hypoglycemic effect of Avartaki beeja
and Pushpa.
Methods:
In this prospective Comparative clinical study, 30 Patients of Madhumeha are selected
and randomly grouped as Group A and B receiving Avartaki beeja churna and
Avartaki Pushpa Churna respectively, for a duration of 30 days with dose of 2gms per
day. Efficacy was assessed by difference between baseline and assessment data.
Results:
A significant reduction in all the parameters was noted in both group. Individually
both groups are highly significant ( p< 0.001). But the comparison is non significant
except for 2 parameters trishna and ashaktata ( p <0.05 ) . Comparison of ‘t’ values
shows avartaki pushpa is more efficacious than beeja.
Interpretation :
The result shows both Avartaki beeja and pushpa are efficacious in the management
of madhumeha. The mean net effect of FBS is more in Group B .The mean effect of
trishna is same in both the groups
Conclusion:
The hypoglycemic effect of Avartaki pushpa and beeja is highly significant after
30days therapy and comparatively Avartaki pushpa is extremely effective in
management of madhumeha.
KEY WORDS
Avartaki beeja; Avartaki pushpa; Cassia auriculata; Madhumeha; Diabetes mellitus;
Antidiabetic; Hypoglycemic; FBS;
TABLE OF CONTENT
1. Introduction Page No.- 01
2. Objectives Page No.- 03
3. Review of Literature
• Drug review- Avartaki (Cassia auriculata) Page No.- 04
• Disease review- ►Madhumeha Page No.- 29
►Diabetes Mellitus (NIDDM) Page No.- 45
4. Methodology Page No.- 62
5. Result Page No.-75
6. Discussion Page No.- 119
7. Conclusion Page No.-123
8. Summary Page No.- 125
9. Bibliography Page No.- 127
10. Annexures Page No.- 141
List of Tables
SL No Tables Page No.
Drug review
1. Varga of Avartaki According to different nighantu 06
2. Synonyms according to different nighantu 08
3. Properties according to different nighantu 14
4. Therapeutic actions according to different nighantu 15
5. Therapeutic uses according to different nighantu 16
Disease review
6. Kaphaja Prameha according to Brihatrayess 38
7. Pittaja Prameha according to Brihatrayess 39
8. Vataja Prameha according to Brihatrayess 39
9. Aetiologic classification of Diabetes mellitus 47
10. Showing cells of islet of Langerhan and their relative hormones 50
11. Metabolic actions of insulin 52
12. Showing the symptoms of hyperglycemia 58
13. Showing the complications of DM 59
14. Showing the risk factors for type 2 DM 59
Methodology
15. Showing normal values of objective parameters 69
16. Pipetting scheme for determination of blood sugar 70
17. Observation for urine sugar 71
18. Gradation for subjective parameters to asses the result 73
SL No Tables Page No
Results
19. Demographic data 75
20. Data related to complaints 76
21. Data related to personal history 77
22. Data related to the srotodusti before and after the treatment 78
23. Subjective parameters of group A 79
24. Subjective parameters of group B 79
25. Objective parameters of group A 80
26. Objective parameters of group B 80
27. Showing the age ratio 81
28. Showing the sex ratio 82
29. Showing the incidence of religion 83
30. Showing the nature of occupation 84
31. Showing the socio economic state 85
32. Showing the diet 86
33. Showing the chronicity of madhumeha 87
34. Showing the complaints 88
35. Showing the family history 89
36. Showing the treatment history 90
37. Showing the ratio of involved agni 91
38. Showing the vyasana in relation with disease 92
39. Showing the Prakruti 93
40. Showing the kind of Ahara 94
41. Showing the vihara 95
SL No Tables Page No.
42. Showing the involvement of manasika chinta 96
43. Showing the comparison of udakavaha srotodusti lakshana before
and after the treatment 97
44. Showing comparison of medovaha srotodusti lakshanas before
and after the treatment 98
45. Showing the comparison of mootravaha srotodusti lakshana before
and after the treatment 99
46. Showing the Prabhoota mootrata before treatment in group A and group B 100
47. Showing the Prabhoota mootrata after the treatment in group A and group B 100
48. Showing the Avila mootrata before treatment in group A and group B 102
49. Showing the Avila mootrata after the treatment in group A and group B 102
50. Showing trishna before the treatment in group A and B 104
51. Showing trishna after the treatment in group A and B 104
52. Showing Ashaktata before treatment in group A and B 106
53. Showing Ashaktata After treatment in group A and B 106
54. Data showing the relief from complaint after treatment in both groups 108
55. Showing the result of group A 113
56. Showing the result of group B 114
57. Showing the total result 115
58. Individual study of Group A before and after the treatment 116
59. Individual study of Group B before and after the treatment 116
60. Comparative study of group A and group B after the treatment 117
List of Figures
SL .No Figures Page No
Graphs exhibited in the Results
1. Showing the age ratio 81
2. Showing the sex ratio 82
3. Sowing the incidence of religion 83
4. Showing the nature of occupation 84
5. Showing the socio economic state 85
6. Showing the diet 86
7. Showing the chronicity of madhumeha 87
8. Showing the complaints 88
9. Showing the family history 89
10. Showing the treatment history 90
11. Showing the ratio of involved agni 91
12. Showing the vyasana in relation with disease 92
13. Showing the Prakruti 93
14. Showing the kind of Ahara 94
15. Showing the vihara 95
16. Showing the involvement of manasika chinta 96
17. Comparison of udakavaha srotodusti lakshana before and after the treatment 97
18. Comparison of medovaha srotodusti lakshanas before and after the treatment 98
19. Comparison of mootravaha srotodusti lakshana before and after the treatment 99
20. Comparison of Prabhoota mootrata before and after treatment in group A 101
SL .No Figures Page No
21. Comparison of Prabhoota mootrata before and after treatment in group B 101
22. Comparison of Avila mootrata before and after treatment in group A 103
23. Comparison of Avila mootrata before and after treatment in group B 103
24. Comparison of trishna before and after treatment in group A 105
25. Comparison of trishna before and after treatment in group B 105
26. Comparison of Ashaktata before and after treatment in group A 107
27. Comparison of Ashaktata before and after treatment in group B 107
28. Showing the relief from complaint after treatment in both groups 108
29. Comparison of FBS before and after the treatment in group A 109
30. Comparison of FBS before and after the treatment in group B 109
31. Comparison of PPBS before and after the treatment in group A 110
32. Comparison of PPBS before and after the treatment in group B 110
33. Comparison of US before and after the treatment in group A 111
34. Comparison of US before and after the treatment in group B 112
35. Showing the result of group A 113
36. Showing the result of group B 114
37. Showing the total result 115
List of Photographs
1. Photograph showing the Avartaki pushpa and beeja 04
2. Photograph showing the steps of preparation of medicine 62
Introduction
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Introduction 1
INTRODUCTION
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 1.
Madhumeha has become a global problem in spite of much advancement in
modern medicine2. The World Health Organisation stated in 1998 that a 122 % rise in
the number of adults with diabetes is projected by 2005, to reach 300 million adults
worldwide. There are four reasons for this two-fold global increase: Firstly, we are
living longer; over-nutrition and lack of exercise are prevalent; the disease being
transmitted in a hereditary fashion; Such transformations have taken place within the
Indian population also. In India, it is estimated that 19 million cases occurred in 1995,
rising to a projected 57 million by the year 2025 (1/6th of the world total). According
to recent epidemiological studies there has been a 40% increase in diabetes prevalence
amongst urban during the last five years3. Even the NIDDM a commonest form of
DM is most common accounting for 85-99% of the patient depending on geography
and ethnicity, occurs in adults, more so over 35 years of age4. The prevalence of
NIDDM is on the rise more alarmingly in the developing nations, ranked 7th among
leading cause of death. It has been rated 3rd when all its micro vascular , macro
vascular, neuropathic complications5 are taken into account6. The cost of treating
diabetes an associated complication exceeds $ 100 billion per year7.
It has long been recognized that drugs represents only part of the management
of madhumeha and other intervention such as education , modification of diet and
promotion of physical health play a crucial role. If the dietary control and exercise
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Introduction 2
programmes do not improve the condition then the medication is added. Many of
patients won’t have patience for long term therapies, complicated therapies like
exercise etc8. The OHA viz Sulfonylurea, Bigunides have associated with adverse
effect like nausea, vomiting, lactic acidosis, hypersensitivity etc. After long term
administration their action declines, up to 50% patients of NIDDM initially treated
with OHA ultimately need insulin.9 Hence we find no satisfactory remedies for
madhumeha in contemporary medical science.
Medicinal plants since time immemorial have been used virtually in all
cultures as a source of medicine. Several herbs have been described in ayurvedic
treasure of therapeutics, which have a beneficial effect in the management of
madhumeha. Avartaki (Cassia auriculata) is one such drug which act as mootra
sangrahaneeya and also reduces the high blood glucose 10. The seeds and flowers of
this plant are indicated in the management of madhumeha11 .Thus in the present study
an attempt is made to evaluate the hypoglycemic action of Avartaki, with a view to
find out a therapeutically efficacious, safer, cost effective and easily available drug.
Objectives
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Objectives 3
OBJECTIVES
1. To evaluate the efficacy of Avartaki pushpa churna in the management of
madhumeha.
2. To evaluate the efficacy of Avartaki beeja churna in the management of
madhumeha.
3. To evaluate the comparative hypoglycemic effect of Avartaki pushpa and
beeja churna.
Review Of Literature Drug Review
Avartaki
(Cassia Auriculata)
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 5
DRUG REVIEW
AVARTAKI ►►CASSIA AURICULATA
Avartaki is a plant with yellow flowers and auricule shaped stipules exists
abundantly in country like India got a wide range of significance in social as well as
medicinal field since immemorial time.
HISTORY12
In vanaspati shastra by Jay Krishnan, Avartaki is explained as it exist since the
period of Ramayana. When Lord Ram was wandering in search of Sita towards
Lanka, saw this plant with bloomed flowers and his mind is pleased with beauty,
asked for any information regarding Sita. But flower with proud of its beauty not
answered . Rama got angry and cursed the flower to loose its fragrance and become
unfit for the worship , thus it should be used by leather workers.
Ramasiya se garva kiya jo te nara jagame haryo
Garva kiyo avalake phoolade , to jaye chamara kadame daryo
Later the flower begged apology. Humble hearted Rama put his feet on its head and
there fore foot mark appears on the seeds
Apart from above evidence there are few more literature. A Persian poet has
given simile to the flowers with his beloved’s eyes. A fairy tale popular in Marawad
region , that Avartaki grows so densely for which it become a border for two
kingdom.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 6
Meaning of Cassia auriculata ►
Cassia → Quetsiah (Hebrew):Kasia ( Greek ) – Old Name used for the plant ,
Auriculata→Auricula (Latin) –Ear of the lobe [large ear lobe shaped pair of stipules]
present on the stem 13 .
GANA/ VARGA
Table 1.1 Showing the varga according to different Nighantu :
Madhava dravya guna Vividhoushadhi varga14
Dhanwantari nighantu Oushadhi varga15
Kaiyadeva nighantu Oushadhi varga16
Raja nighantu
Guduchyadi varga17
& Shatavhadi varga18
Madanapala nighantu Abhayadi varga19
Nighantu adarsha Pootikaranja varga20
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 7
Synonyms of Avartaki with their meanings
1. Avartaki :Stipules are present on the stem
2. Peetapushpa : It bears yellow coloured flowers
3. Raktaphali : Legume is red in colour during riped condition
4. Peetakeela : Corolla or petals are yellow in colour
5. Shimbiphala : Legumes are present on the plant
6. Peetika : It bears a yellow coloured flowers
7. Supushpa : The flowers have beautiful appearance
8. Hemapushpa : The flowers have golden colour
9. Kanchanapushpa : The flowers have golden colour
10. Sharapushpa : Flowers blooms in the sharat ritu
11. Peetakeelaka : It bears yellow coloured flowers
12. Peeta pushpika : It bears yellow coloured flowers
13. Charmaranga : Its bark is used for dyeing the leather
14. Rangalata : A plant useful for leather dyeing
15. Mahajalini : The plant which form a network by their spread
16. Mahadadijali : The plant which form a network by their spread
17. Mahada : The plant which form a network by their spread
18. Tilapusphika : Flowers resembles like flowers of tila
19. Vamavarta : The legumes are often twisted in nature
20. Raktapushpika :The flowers bears red lines in it
21. Raktapushpa : The flowers bears red lines in it
22. Dantakashta :The twig is used for brushing
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 8
Some other synonyms are,
Mayhari ,Talopoda, Bindukini, Vibhandi, Tindukini, Vishanika, Manojna,
Ahulya, Avala, Tarawar, Halurakhya, kara, Tarawat, Arbar and Nripamangalyaka.
SYNONYMS ACCORDING TO DIFFERENT NIGHANTU Table 1.2 Showing synonyms according to different Nighantu
Sr.no Synonyms D.N K.N R.N M.N Ni.Ad Ni.R 1 Avartaki + + + + + + 2 Charmaranga + + + + + + 3 Peeta pushpa + - + - - - 4 Peetakeelaka + + - - + + 5 Vibhandi + + + + - - 6 Mahajalini + + - + - - 7 Bindukini + + - + - - 8 Raktaphali - + - - - - 9 Tindukini - - + - - - 10 Vishanika - - + - - - 11 Rangalata - - + - - - 12 Manojna - - + - - - 13 Raktapushpi - - + + - - 14 Mahadadijali - - + - - - 15 Peetakeela - - + - - - 16 Vamavarta - - + - - - 17 Tilapushpika - - - + - - 18 Ahulya - - + - + + 19 Halurakhya - - + - - - 20 Kara - - + - - - 21 Taravat - - + - - - 22 Shimbiphala - - + - - - 23 Supushpa - - + - - - 24 Arbar - - + - - - 25 Dantakashta - - + - - - 26 Hemapushpa - - + - - - 27 Kanchanapushpa - - + - - - 28 Nripamangalyaka - - + - - - 29 Sharapushpa - - + - - -
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 9
VERNACULAR NAMES
Latin : Cassia auriculata
English : Tanner’cassia , Mature tea tree, Tanner’s senna
Hindi : Taravar , Aval , Dantvan ,Tarota
Marathi : Tarabad ,Taroda , Tarawad
Gujarati : Avala, Aawar
Tamil : Avaram , Avarai , Avirae, Sadurguli, Semmara, Summai
Telagu : Tangedu, Avara gida, Merakatanageda ,tangeru
Malayalam : Avar , aveeram , Jimute ,Ponnaviram
Kannada :Tangedu, Taravara gida, Avarike, Chakusina gida,
Tangayaree, Avara, Tatwada , Olletanagida , Sakusina , Tangadi , Tangedi
Bengali :Taravar
Cutch : Aawala
Duk : Taravara , avala
Berara : Tarota
Burma : Peikthingata
Ceylon : Matura tea
Chines : Kiang Mang , Kiang Mang Kiue Min
Lambadi : Olaniyaro
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 10
KULA Shimbi Kula
UPAKULA Pootikaranja Upakula22
FAMILY Leguminosae
SUB –FAMILY Caeselpiniaceae
Taxonomical Classification of Cassia auriculata 23
Kingdom : Plantae
Division : Angiospermae
Class : Dicotyledonae
Series : Calciflora
Order : Rosale
Family : Leguminosae
Sub –family : Caesalpiniaceae
Genus : Cassia
Species : auriculata
FEATURES OF CAESALPINIACEAE 24
Diagnostic features►
Leaves paripinnate ; flowers zygomorphic ; Calyx and Corolla 5, ascending imbricate;
Stamens 10 or less, free, gynoecium monocarpellary with marginal placentation .
Distribution ►It is commonly called Cassia family. The sub –family contains 135
genera which are cosmopolitan in distribution. In India it is represented by 110
species and more than 21 genera.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 11
Vegetative Characters►
Habit→ It shows great variation in habit , i.e, may be trees , shrubs ,
undershrubs or herbs. Besides this sometimes all types of plants occurs in
same genus.
Root→ Tap and branched
Stem→ Erect, woody, herbaceous or climbing , branched , glabrous or
covered with prickles and spines.
Leaf→Alternate, leaf base pulvinate, compound unipinnate, bipinnate or
rarely simple ; stipules.
Floral Characters ►
Flower –Pedicellate, bractate , zygomorphic, complete , hermaphrodite,
slightly perigynous, pentamerous
Calyx – Sepals 5 , free, or connate, odd sepal anterior , imbricate aestivation.
Corolla – Petals 5.
Androecium – Stamens 10, free, reduction in number of stamens by the
formation of staminodes. In Cassia there are 3 posterior staminodes.
Gynoecium –Monocarpellary , ovary superior or slightly inferior , unilocular
with marginal placentation , straight or curved, hairy ; Style long ; Stigma
simple.
Fruit – Legume and never breaks up into one seeded parts
Seed – Non endospermic
Pollination – Entomophilous
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 12
MORPHOLOGY OF CASSIA AURICULATA25
A tall much-branched shrub; bark smooth, reddish-brown; branchlets finely
pubescent. Leaves 3/4 inch long; rachis densely fulvous-pubescent with an erect linear
gland between each pair of leaflets; stipules foliaceous, reflexed, very large,
rotundato-reniform, produced at the base on the side next the petiole into a long
subulate point, persistent. Leaflets 8-12 pairs, 1-1 by -3/8-1/2 inch, slightly
overlapping, oblong-obovate, obtuse or emarginate, mucronate, glabrous or finely
downy, dull green above, paler beneath, base usually rounded; petiolules 1/20 inch
long. Flowers large, reaching 2 inch across, in terminal and axillary corymbose
racemes; pedicels 3/4-1 inch long; bracts ovate, acuminate, caducous. Calyx glabrous;
segments leathery, concave, the 2 outer much smaller than the other 3. Petals with
long claws, crisped on the margin, bright yellow, veined with orange. Stamens 10, of
which the 3 upper are reduced to staminodes, the remaining 7 perfect, of which the 3
lower are larger than the 4 lateral ones. Pods 3-5 by 1/2-5/8 inch, flat, thin, papery,
oblong, obtuse, mucronate, pale brown, deeply depressed between the seeds, having a
crumpled appearance, transversely veined, pubescent. Seeds 10-20. Every leaf has an
ear-shaped leafy structure at the base of the stalk. Fruit turns brown when dry.
HABITAT
Avartaki is found in Maharastra , Gujarat ,Rajasthana and Madhya Pradesh 26. A tree
of height of 1-3 meters with yellow flowers grows wild in the central provinces,
western coast , South India and Ceylon 27.Apart from India it also grows in Ceylon or
Srilanka and Indomalaysia 28. A fairy tale popular in Gujarat states that it grows in
such a fashion that the King make over the border for his kingdom29.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 13
PHYTOCHEMISTRY
Plant contains pyrrolizidine, alkaloids. Root contains flavone glycoside. Bark
contains tannin 25% and ash 5%30. Flowers contain Beta – sitosterols , kaempferol .
Seeds yield fatty oil consisting of palmatic oleic linoleic acids31.
A new leucoanthocyanin- goratensidine, characterized as 4`, 5, 7-
trihydroxyflavan-3, 4-diol; Ariculacacidin characterized as 5, 2` 4`- trihydroxyflavan-
3, 4-dial 32.
It posses constituents like polysaccharides, flavonoids, anthracene derivatives
and some dimeric procyanidins33
Leaves contains saturated higher fatty keto alcohols and emodin. The leaves
were found to contain quinines, anthraquinones ( carmine , cascara, mitxanthobe),
benzoquinones, naphthaquinones34.
Recent research on cassia auriculata stem bark revealed the presence of sterol ,
triterpenoid glycosides like O-B- D- xylopyranosides35.
4.8% of light –yellow oil and oil has about 75% unsaturated fatty acids.
Palmatic and oleic acid are the major components of fatty acids. Oligosaccharides and
galactomanose were detected from seeds 36.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 14
PROPERTIES ACCORDING TO DIFFERENT NIGHANTU
Table 1.3 Showing properties according to different Nighantu
PROPERTIS D. Ni K.Ni R.Ni M.D Ni. R Ni. Ad
Kashaya + + + + + +
Tikta - + + + + +
RASA
Amla - - + - - -
VEERYA Sheeta + - + + + +
Rechaka - - - + + +
PRABHAVA Grahi - - - - + +
Vata + - - - + +
Pitta + + + + + +
DOSHAGHNATA
Kapha + + - + + +
Summarising all the properties 37
Guna- Laghu ,Rooksha
Rasa – Kashaya ,Tikta
Vipaka – Katu
Veerya – Sheeta
Doshaghnata- Kapha vata shamaka
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 15
THERAPEUTIC ACTIONS ACCORDING TO DIFFERENT NIGHANTU
Table Showing therapeutic action according to different Nighantu
Sr. no Karma D.Ni K.Ni M.Ni M. D Ni.R Ni. Ad R.Ni
1 Kustahara + - - - - - -
2 Urdhwabhagahara + - - + - - -
3 Adhobhagahara + - + + - - -
4 Shukravardhana + - - - - - -
5 Varnya - + - - + + -
6 Pramehahara - + - - + + -
7 Vamihara - + - - + + -
8 Krimihara - + - - + + -
9 Trishnahara - + - - + + -
10 Chakshushya - - - - + + +
11 Ruchya - - - - + + -
12 Vishahara - - - - + + -
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 16
THERAPEUTIC USES ACCORDING TO DIFFERENT NIGHANTU
Table Showing therapeutic uses according to different Nighantu
Sr.no Roga M.D D.Ni K.Ni M.Ni Ni.Ad Ni.R R.Ni
1 Kusta + + + + + + +
2 Atisara - + - - + + -
3 Shopha - + - + + + -
4 Gulma - + + - - - -
5 Udara - + + + - - -
6 Anaha - + + + - - -
7 Krimi - + + + - - +
8 Shotha - - + - + + -
9 Trishna - - + - - - -
10 Kandu - - + - + + +
11 Visha - - + - - - -
12 Vamana - - + - + + -
13 Shwasa - - + - - - -
14 Daha - - + + - - -
15 Rakta vikar - - + - - - -
16 Jwara - - + + + + -
17 Prameha - - + - - - -
18 Raktapitta - - + - - - -
19 Shukrakshaya - - + - - - -
20 Mukha roga - - - - + + +
21 Shoola - - - - + + +
22 Vrana - - - - + + +
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 17
USES
1. Decorticated seeds in fine powder or paste or valved local application to purulent
ophthalmia or conjunctivitis known as country sore eye.
2. Seeds with testa and their kernels are finely powered and blown into the eye or the
powder mixed with coconut or gigelly oil is applied to the sore eyes.
3. Seeds are also used in Diabetes and chylous urine.
4. The plant is used in the form of a powder mixed with honey or decoction
especially of flower buds, is administered in chylous urine and diabetes with
excellent results38.
5. Twigs are used as tooth brushes.
6. In the south of Ceylon, leaves are used as a substitute for tea
7. Coffee made from powdered seed or leaves is good substitute for coffee made
from seeds of coffee arabica and is prescribed in giddiness due to heart disease.
8. Flowers are used as pessaries in Gujarat to check excessive menstrual flow.
9. Infusion of bark is used for enemas, gargles etc as substitute for tannic acid or oak
galls.
10. Compound syrup is prescribed for nocturnal emission.
11. The infusion is used as a cooling drink in fever.
12. Kwatha prepared of root bark and stem bark is used for Andavriddhi.
13. In ancient period the people while roaming use as antidiarrhoeal ,they used to
chew the root bark and suck 2-3 drops of juice
14. The root bark is chewed with lavana and juice is sucked to get relief from the
Cholera, Ajeerna , Shoola , Vamana , Atisara.
15. If the animals suffers with Adhmana, Chichaka or Khasara, then the kwatha of
patra is given. In Atisara and Adhmana the patra kalka with lavana is given.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 18
16. Patra are tied over the abdomen in udarashoola.
17. The juice of stem bark is instilled into eyes in chakshu peeda.
18. The paste of patra, sarjikshara and tamarind leaves is applied in sprain and
inflammation.
19. The bhashpita patra is tied over the shotha
20. A bed covered with leaves and covered with a lining, angara is kept under that bed
and seka is given in Angasthabdata and any traumatic inflammation.
21. The patra swarasa is used as gandoosha in mukhapaka 39.
Useful parts
Root, Leaves, Flowers, Legume, Bark and Seeds.40
Posology
Churna – 3-6 gms41
Infusion of leaves (1 in 20 ) – 1-2 ounces
Infusion of bark - 2- 4 drachms
Compound syrup (of flower, mixed with Mocha Rasa & Sarsaparik) – 3-4 drachms
Decoction of root (1 in 2 ) - 2-8 drachms
Electuary of seed - 2-4 drachms
Medicated baths of leaves42
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 19
RECENT RESEARCHES ON AVARTAKI43
1.Antihyperglycaemic and antioxidant effect of hyponidd, an ayurvedic
herbomineral formulation in streptozotocin-induced diabetic rats. Babu PS,
Stanely Mainzen Prince P. Department of Biochemistry, Annamalai University,
Annamalai Nagar-608002 Tamil nadu, India.
Hyponidd is a herbomineral formulation composed of the extracts of ten medicinal
plants ( Momordica charantia, Melia azadirachta, Pterocarpus marsupium, Tinospora
cordifolia , Gymnema sylvestre, Enicostemma littorale, Emblica officinalis, Eugenia
jambolana, Cassia auriculata and Curcuma longa). We have investigated hyponidd for
its possible antihyperglycaemic and antioxidant effect in diabetic rats. Rats were
rendered diabetic by streptozotocin (STZ) (45 mg kg(-1) body weight). Oral
administration of hyponidd (100 mg kg(-1) and 200 mg kg(-1)) for 45 days resulted in
significant lowered levels of blood glucose and significant increased levels of hepatic
glycogen and total haemoglobin. An oral glucose tolerance test was also performed in
experimental diabetic rats in which there was a significant improvement in blood
glucose tolerance in the rats treated with hyponidd. Hyponidd administration also
decreased levels of glycosylated haemoglobin, plasma thiobarbituric acid reactive
substances, hydroperoxides, ceruloplasmin and alpha-tocopherol in diabetic rats.
Plasma reduced glutathione and vitamin C were significantly elevated by oral
administration of hyponidd. The effect of hyponidd at a dose of 200 mg kg(-1) was
more effective than glibenclamide (600 microg kg(-1)) in restoring the values to near
normal. The results showed that hyponidd exhibits antihyperglycaemic and
antioxidant activity in STZ-induced diabetic rats.
2.alpha-Glucosidase inhibitory activity of some Sri Lanka plant extracts, one of
which, Cassia auriculata, exerts a strong antihyperglycemic effect in rats
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 20
comparable to the therapeutic drug acarbose. Abesundara KJ, Matsui T,
Matsumoto K.Division of Food Biotechnology,Department of Bioscience and
Biotechnology, Faculty of Agriculture, Graduate School of Kyushu University, 6-10-1
Hakozaki, Higashi-ku ,Fukuoka 812-8581, Japan.
Some Sri Lanka plant stuffs were examined regarding in vitro and in vivo alpha-
glucosidase (AGH) inhibitory actions. According to the results, water extracts and
methanol extracts of dried fruits of Nelli (Phylanthus embelica), methanol extracts of
dried flowers of Ranawara (Cassia auriculata), and water extracts of latex of
Gammalu (Pterocarpus marsupium) were found to have a potential AGH inhibitory
activity. In particular, Ranawara methanol extract showed the strongest AGH
inhibitory activity in vitro preferably on maltase giving an IC(50) value of 0.023
mg/mL and inhibited the maltase activity competitively. As a result of single oral
administration of Ranawara (C. auriculata) methanol extract in Sprague-Dawley rats,
a significant and potent lowering of blood glycemic response toward maltose
ingestion was observed at 30 min after dosing of 5 mg/kg, thus, concurrently
suppressed insulin activity. The ED(50) of the extract (4.9 mg/kg) clearly indicated
that the antihyperglycemic effect was as potent as that of therapeuticdrug
acarbose(ED(50)3.1mg/kg).
3.The effects of Cassia auriculata and Cardiospermum halicacabum teas on the
steady state blood level and toxicity of carbamazepine.Thabrew I, Munasinghe J,
Chackrewarthi S, Senarath S.Department of Biochemistry and Clinical Chemistry,
Faculty of Medicine, University of Kelaniya, 6, Talagolla Road, Ragama, Sri Lanka.
A study was conducted using male Wistar rats as the experimental model, to compare
the effects of concurrent administration of herbal tea prepared from dried flowers of
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 21
Cassia auriculata or aerial parts of Cardiospermum halicacabum and carbamazepine,
on (a). steady state serum levels of the prescription drug, and (b). changes in toxicity
(as assessed by changes in general behaviour, haematological parameters, and liver
and kidney function) that may occur due to drug interaction. Results demonstrate that
in rats receiving the Cassia auriculata tea and carbamazepine, the blood levels of the
prescription drug were significantly enhanced by 47.1% (P<0.04), when compared
with the levels in animals receiving only carbamazepine for the same time period,
with no apparent changes in toxicity. In animals receiving the Cardiospermum
halicacabum tea, there were no significant changes in the blood levels of
carbamazepine or drug-related toxicity. Cassia auriculata tea has therefore the
potential to influence the bioavailability of carbamazepine, and hence its therapeutic
actions. Concurrent ingestion of carbamazepine with herbal teas containing Cassia
auriculata is therefore best avoided by patients under treatment for epilepsy.
4.Possible interaction of herbal tea and carbamazepine.Thabrew MI, Munasinghe
TM, Chackrewarthi S, Senarath S.Department of Biochemistry and Clinical
Chemistry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
A study was conducted using Wistar rats to determine the effect of concurrent
administration of a herbal tea prepared from dried flowers of Cassia auriculata and
carbamazepine on (a) blood levels of the prescription drug and (b) changes in toxicity
(as assessed by changes in hematological parameters, liver and kidney function, and
histology of major body organs) that may occur due to drug interaction. Results
demonstrate that in rats receiving the herbal tea and carbamazepine, the blood levels
of the prescription drug were significantly enhanced by 47.1% (p <0.04) when
compared with the levels in animals receiving only carbamazepine, with no apparent
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 22
changes in toxicity. Concurrent ingestion of the herbal tea prepared from Cassia
auriculata flowers with carbamazepine may therefore influence the bioavailability of
the prescribed drug and hence its therapeutic potential
5.Activity of Cassia auriculata leaf extract in rats with alcoholic liver injury.
Kumar Rajagopal S, Manickam P, Periyasamy V, Namasivayam N. Department of
Biochemistry, Annamalai University, Annamalainagar 608 002, Tamilnadu,India.
This study was undertaken to investigate the effect of Cassia auriculata leaf extract on
tissue lipid peroxidation and antioxidant status in experimental hepatotoxicity.
Administering ethanol to rats for 60 days resulted in significantly elevated levels of
serum total bilirubin, aspartate transaminase (AST), alanine transaminase (ALT) and
alkaline phosphatase (ALP) as compared with those of the experimental control rats.
Significantly elevated levels of tissue thiobarbituric acid reactive substances
(TBARS), hydroperoxides and lowered activities of superoxide dismutase (SOD),
catalase (CAT) and reduced glutathione (GSH) were also observed on alcohol
treatment as compared with those of experimental control rats. Concentration of
serum non-enzymic antioxidants such as vitamin E and vitamin C were also
significantly lowered on alcohol supplementation. Treatment with Cassia auriculata
leaf extract at a dose of 250 mg kg(-1) body weight and 500 mg kg(-1) body weight to
rats administered alcohol, lowered the levels of TBARS and hydroperoxides and
elevated the activities of SOD and CAT and the levels of reduced GSH in the liver,
brain, kidney and intestine significantly compared to unsupplemented alcohol treated
rats. Cassia auriculata leaf extract treatment restored the serum vitamin E, and vitamin
C levels also to near those of the experimental control animals. Our data indicate that
supplementation with Cassia auriculata leaf extract can offer protection against free
radical mediated oxidative stress in experimental hepatotoxicity. In addition,
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 23
histopathological studies of the liver and brain confirmed the beneficial role of Cassia
auriculata leaf extract.
6.Effect of Cassia auriculata flowers on blood sugar levels, serum and tissue
lipids in streptozotocin diabetic rats.Pari L, Latha M.Department of Biochemistry,
Faculty of Science Annamalai University, Annamalai Nagar Tamil Nadu-608 002,
India.
AIM OF THE STUDY: The main aim was to demonstrate the effects of Cassia
auriculata flowers on blood glucose and lipid levels in experimental diabetic rats.
METHODOLOGY: Aqueous extract of Cassia auriculata flowers was administered
orally and different doses of the extract on blood glucose, haemoglobin, glycosylated
haemoglobin, serum and tissue lipids, hexokinase and glucose-6-phosphatase in
streptozotocin-induced diabetic rats were studied. Glibenclamide was used as standard
reference drug. RESULTS: Cassia auriculata flower extract (CFEt), at doses of 0.15,
0.30 and 0.45 g/kg body weight for 30 days, suppressed the elevated blood glucose
and lipid levels in diabetic rats. Cassia auriculata at 0.45 g/kg was found to be
comparable to glibenclamide. CONCLUSION: Our findings indicate that the Cassia
auriculata flowers possess antihyperlipidaemic effect in addition to antidiabetic
activity
7.Preventive effects of Cassia auriculata L. flowers on brain lipid peroxidation in
rats treated with streptozotocin.Latha M, Pari L.Department of Biochemistry,
Faculty of Science, Annamalai University, Annamalai Nagar, Tamil Nadu, India.
The effect of aqueous extract of the flowers of Cassia auriculata were examined on
antioxidants and lipid peroxidation in the brain of streptozotocin diabetic rats.
Significant increase in the activities of superoxide dismutase, catalase, glutathione
peroxidase, glutathione-S-transferase and reduced glutathione were observed in brain
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 24
on treatment with Cassia auriculata flower extract (CFEt) and glibenclamide. Both the
treated groups showed significant decrease in thiobarbituric reactive substances
(TBARS) and hydroperoxide formation in brain, suggesting its role in protection
against lipid peroxidation induced membrane damage. Since the study of induction of
the antioxidant enzymes is considered to be a reliable marker for evaluating the
antiperoxidative efficacy of medicinal plant, these findings are suggestions of possible
antiperoxidative role played by Cassia auriculata flower extract.
8. Antihyperglycaemic effect of Cassia auriculata in experimental diabetes and
its effects on key metabolic enzymes involved in carbohydrate metabolism. Latha
M, Pari L. Department of Biochemistry, Faculty of Science, Annamalai University,
Annamalai Nagar, TamilNadu, India.
1. In experimental diabetes, enzymes of glucose and fatty acid metabolism are
markedly altered. Persistent hyperglycaemia is a major contributor to such metabolic
alterations, which lead to the pathogenesis of diabetic complications. To our
knowledge, there are no available reports on the enzymes of hepatic glucose
metabolism of Cassia auriculata flower against diabetes. The present study was
designed to study the effect of Cassia auriculata flower extract (CFEt) on hepatic
glycolytic and gluconeogenic enzymes. 2. Streptozotocin diabetic rats were given
CFEt (0.15, 0.30 and 0.45 g/kg) or 600 microg/kg glibenclamide for 30 days. At the
end of 30 days, blood glucose, plasma insulin, haemoglobin, glycosylated
haemoglobin, glycolytic and gluconeogenic enzymes were assessed. 3.
Administration of CFEt at 0.45 g/kg significantly decreased blood glucose,
glycosylated haemoglobin and gluconeogenic enzymes and increased plasma insulin,
haemoglobin and hexokinase activity. Similarly, administration of glibenclamide
showed a significant effect; however, CFEt at 0.15 and 0.30 g/kg did not show any
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 25
significant effect. 4. In conclusion, the observations show that the aqueous extract of
CFEt possesses an antihyperglycaemic effect and suggest that enhanced
gluconeogenesis during diabetes is shifted towards normal and that the extract
enhances the utilization of glucose through increased glycolysis. The effect of CFEt
was more prominent than that of glibenclamide.
9.Effect of Cassia auriculata leaf extract on lipids in rats with alcoholic liver
injury. Kumar RS, Ponmozhi M, Viswanathan P, Nalini N. Department of
Biochemistry, Annamalai University, Annamalainagar, Tamilnadu, India.
We studied the effect of administering Cassia auriculata leaf extract to rats with
experimentally induced liver damage. Hepatotoxicity was induced by administering
9.875 g/kg bodyweight ethanol for 30 days by intragastric intubation. C. auriculata
leaf extract was administered at a dose of 250 mg/kg bodyweight daily in one group
and 500 mg/kg bodyweight daily in another group of alcohol-treated rats. All rats
were fed with standard pellets. The control rats were also given isocaloric glucose
solution. The average bodyweight gain was significantly lower in alcohol-treated rats,
but improved on supplementation with C. auriculata leaf extract. Alcohol
supplementation significantly elevated the cholesterol, phospholipid and triglyceride
concentration in the liver, brain, kidney and intestine, as compared with those of the
normal control rats. Treatment with C. auriculata leaf extract and alcohol significantly
lowered the tissue lipid levels to almost normal levels. Microscopic examination of
alcohol-treated rat liver showed inflammatory cell infiltrates and fatty changes, which
were reversed on treatment with C. auriculata leaf extract. Similarly, alcohol-treated
rat brain demonstrated spongiosis, which was markedly reduced on treatment with C.
auriculata. In conclusion, this study shows that treatment with C. auriculata leaf
extract has a lipid-lowering effect in rats with experimentally induced, alcohol-related
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 26
liver damage. This is associated with a reversal of steatosis in the liver and of
spongiosis in the brain. The mechanism of C. auriculata leaf extract lipid-lowering
potential is unclear.
10.Effect of Cassia auriculata Linn. on serum glucose level, glucose utilization by
isolated rat hemidiaphragm.Sabu MC, Subburaju T.Amala Cancer Research Center,
Amala Nagar, Thrissur 680 553, Kerala, India. [email protected]
An aqueous leaf extract of Cassia auriculata (C. auriculata) was found to lower the
serum glucose level in normal rats. Maximum reduction in serum glucose level was
observed after 4 h at a dose levels of 100, 200, 400 mg/kg body weight of the extract.
In normal rats the serum glucose level reduction at 4th h was 23% by 100 mg/kg body
weight and 31% by 200 mg/kg body weight. In alloxan-induced diabetic rats, chronic
administration of the extract significantly reduced the serum glucose level from third
day to till the end of the experiment. The extract was also found to inhibit the body
weight reduction induced by alloxan administration. Glucose uptake and glycogen
deposition studies suggest that C. auriculata leaf extract probably has no direct insulin
like effect which can enhance the peripheral utilization of glucose.
11.Antihyperglycaemic effect of Diamed, a herbal formulation, in experimental
diabetes in rats. Pari L, Ramakrishnan R, Venkateswaran S.Department of
Biochemistry, Annamalai University, Tamil Nadu, India. [email protected]
Diamed is a herbal formulation composed of the aqueous extracts of three medicinal
plants (Azardirachta indica, Cassia auriculata and Momordica charantia). We have
investigated Diamed for its possible antihyperglycaemic action in rats with alloxan-
induced experimental diabetes. Oral administration of Diamed (1.39 (0.25 g), 1.67
(0.30 g) or 1.94 (0.35 g) mL kg(-1)) for 30 days resulted in a significant reduction in
blood glucose, glycosylated haemoglobin, and an increase in plasma insulin and total
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 27
haemoglobin. The effect was highly significant after administration of the 1.94 mL
(0.35 g) g(-1) body weight dose. Diamed also prevented a decrease in body weight.
An oral glucose tolerance test was performed in experimental diabetic rats in which
there was a significant improvement in glucose tolerance in the animals treated with
Diamed. The effect was compared with 600 microg kg(-1) glibenclamide. The results
showed that Diamed had antihyperglycaemic action in experimental diabetes in rats.
12.Constituents of Cassia auriculata.Nageswara Rao G, Mahesh Kumar P,
Dhandapani VS, Rama Krishna T, Hayashi T. Department of Chemistry, Sri Sathya
Sai Institute of Higher Learning, Prasanthi Nilayam 515 134, Andhra Pradesh, India.
The isolation and spectral data of di-(2-ethyl) hexyl phthalate (1) from Cassia
auriculata leaves are reported.
13.Antibacterial activity of some folklore medicinal plants used by tribals in
Western Ghats of India. Samy RP, Ignacimuthu S. Entomology Research Institute,
Loyola College, Chennai, India
A series of 30 Indian folklore medicinal plants used by tribal healers to treat
infections, were screened for antibacterial properties at 10 mg/ml concentration by
using disc diffusion method against Bacillus subtilis, Escherichia coli, Klebsiella
aerogenes, Proteus vulgaris, Pseudomonas aerogenes and Staphylococcus aureus.
Twenty plant species showed activity against one or more species of bacteria used in
this assay; among them the leaf extracts of Cassia occidentalis and Cassia auriculata
exhibited significant broad spectrum activity against B. subtilis and S. aureus. Ten
plant species were not found active against all tested bacteria. These results were
compared with results obtained using standard antibiotics, chloramphenicol (30
microg/disc) and streptomycin (30 microg/disc) which served as a reference for
inhibition zone diameter.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Drug review- Avartaki 28
14.Studies on medicinal plants of Sri Lanka: occurrence of pyrrolizidine
alkaloids and hepatotoxic properties in some traditional medicinal herbs.
Arseculeratne SN, Gunatilaka AA, Panabokke RG.
There is a paucity of data on the occurrence of hepatotoxic and hepatocarcinogenic
pyrrolizidine alkaloids in medicinal plants, and there are no data on the hepatotoxic
properties of herbal medicines that are used in the traditional pharmacopoiea of Sri
Lanka and other Asian and African countries. In view of the extensive consumption of
these herbs and the occurrence of chronic liver diseases including hepatocellular
cancer in this and other countries of South Asia, we have screened fifty medicinal
plants for pyrrolizidine alkaloids and have obtained positive results with three species,
namely Crotalaria verrucosa L., Holarrhena antidysenterica (L.) Br., and Cassia
auriculata L. Feeding trials in rats with materials from these three species produced
liver lesions--disruption of the centrilobular veins, congestion or haemorrhage in the
centrilobular sinusoids, centrilobular or focal hepatocellular necrosis--and
histopathology in the lungs and kidneys which were compatible with the action of
pyrrolizidine alkaloids. The presence of alkaloids in C. auriculata has not been
previously reported nor has the presence of pyrrolizidine alkaloids in H.
antidysenterica. It is suggested that the consumption of herbal medicines that contain
pyrrolizidine alkaloids could contribute to the high incidence of chronic liver disease
including primary hepatocellular cancer in Asian and African countries.
15.Chemical and spectral studies of novel keto-alcohols from the leaves of Cassia
auriculata.Varshney SC, Rizvi SA, Gupta PC.
16.[Presence of leucoanthocyanic chromogens in Cassia auriculata and C.
goratensis Fres., adulteration of official sennas.][Article in French]PARIS R,
CUBUKCU
Review Of Literature
Disease Review
Madhumeha
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review- Madhumeha 29
DISEASE REVIEW
MADHUMEHA
Madhumeha is a disease itself manifesting in one of the trimarma namely
basti. Though it is a endocrinal problem, disorder of metabolism it is included under
mootravaha srotovikara, because its manifestation is seen in mootravaha srotas 44.
Prameha literally formed by two words , Pra means the excessive, Meha
means the discharge. It means the frequent excretion of excessive urine45 , disease
where excessive dirty or contaminated (turbid ) urine is excreted46.
Synonyms for prameha
Meharoga,
Mehagada
Mehovikara
Bastiroga
Characteristics of prameharoga
1. Chirakaleena : chronic illness
2. Anushangitwa : relapsing type of illness
3. Mahagada : one of 8 mahagada mentioned by Sushruta
4. Beejadoshat-kulajavyadhi :may be congenital, hereditary inherited disease,
Nirukti for Madhumeha:
madhu upadan bhuto madhumeha
Madhumeha is also comprised of two words. Madhu- like honey, meha- discharge.
The patient passes urine similar in colour and taste of honey 47.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review- Madhumeha 30
HISTORY 48
In India the history of the disease madhumeha is recorded since immemorial
time. Purana etc. have defined the condition in which the whole body become sweet.
Vedic literature a oldest literature of the world, named the disease as Astravam
which means mutratisara. i.e. excessive micturation as in the Atharva veda.
In later period, all the Samhitas from Charaka to Vagbhata’s deal with the
aetiology symptomology, pathology, prognosis, complication , principles of the
treatment , and different kind of management , under the different contexts mainly in
the nidana and chikitsa sthana.
Further literatures of late period, Madhava, Sharngadhara, Bhvaprakash etc
have explained the different treatment modalities with the existing. After the 16th
centuray several books related to the Madhumeha are published with its advanced
treatment.
NIDANA
Nidana of the Prameha are expressed as general those are common for all
kinds of prameha. Specific nidana manifests the particular kind of prameha such as
madhumeha.
General :
Sedentary habits, excessive sleep, excessive use of curds, soup of meat of
domestic animals or aquatic or marshy animals, milk derivatives (processed milk)
new curds, drinks, various processed jaggery etc and kapha promoting regimes are the
aetiological factors of prameha 49.
Sushruta recognizes, day sleep, lack of exercise, sitting idle, cold intake of
cold, unctuous, sweet, fatty liquid food and drinks in excess gradually lead to the
occurrence of prameha50.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review- Madhumeha 31
Vagbhata’s, describes in a nut shell, that whatever food and regimes
promotive of kapha, meda, mootra are to be regarded as prameha hetu 51.
Specific nidana to madhumeha
As Charaka has stated in sutra sthana, the excessive intake of heavy,
unctuous, saline substances, use of new rice (freshly harvested crop) , fresh wine,
excessive sleep, injudicious use of varieties of dishes, who has given up physical and
mental exercise and taken to inactiveness, abandonment of elimination of procedures,
etc are the specific aetiological factors for madhumeha 52.
SAMPRAPTI
General :
Charaka had clearly explained the samprapti of the kaphaja prameha in the
prameha Nidana . Even though the disease prameha is stated to be due to the vitiation
of tri-doshas, the specific factors of the dosha is excessive fluidity of kapha . The
special features of the susceptible body elements (dushyas) are excessiveness and
diminished viscouness of Medas, Mamsa, Shareerakleda, Shukra, Rakta, Vasa, Majja,
Lasika, Rasa and Ojus.
When there is the simultaneous congress of these three pathological
conditions, the kapha is suddenly provoked since it is already in chaya stage. The
vitiated kapha quickly spreads throughout the body which is already in deranged
condition. In the path of its circulation the kapha first encounters and mixes with the
meda, owing to the pathological changes in the meda viz. excessiveness and
diminished viscous ness and also owing to the great similarity of the qualities
between the kapha and medas. Due to this combination of vitiated kapha and medas,
the latter is vitiated. The vitiated kapha coupled with the vitiated medas now comes in
contact with the shareera kleda and mamsa which are in excessive increase in the
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review- Madhumeha 32
body. The vitiated body fluid is changed into urine. The orifices or pores of the
mootravahasrotas, represented by the kidney and bladder are in a state of dilatation
due to the actions of vitiated medas and shareera kleda. The vitiated kapha , upon
reaching the mootravaha srotas gets localised there and thus develops the disease
called Prameha54.
The shareera kleda combined with the kapha and the medas while being
converted into urine on its entrance in to the mootrashaya acquires the following ten
pathological characteristics of kapha. They are unctuousness, heaviness, sweetness,
denseness and slowness. Then it acquires a special name accompanied with the
qualities of one or more of the other conditions by which it has been mainly
modified55.
The vitiated pitta and vata produces vataja and pittaja Prameha by the same
process as described above56.
If vata by its rooksha quality changes the ojus which is naturally of sweet
taste, in to one of astringent taste and carries it to the mootrashaya, then it causes the
condition called Madhumeha57.
Charaka in Prameha Chikitsa has explained the samprapti in brief 58. “The
kapha having vitiated the medas and mamsa dhatus and the body fluid, becomes
localised in the genito – urinary system and causes Pramehas59. The pitta, too, which
is provoked by ushna dravyas vitiating those very tissues, causes in the same manner
other varieties of prameha. On the diminution of the other two doshas the morbid vata
draws into the genito – urinary system the essential dhatus, and give rise to the third
group of Prameha. In every case the morbid humor, having reached the genitor
urinary system, vitiates the urine and generated Prameha corresponding to its specific
nature.
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Disease review- Madhumeha 33
In a person who indulges in the mithya ahara vihara the three doshas which are
vitiated and in an↓ immature state join the medas and travel to the mootravaha srotas,
gets localised at the entrance of the basti, when they are emitted through the urethra
the disease is known as Prameha.
“The deranged kapha, in conjunction with the (morbid) pitta, vayu and medas,
gives rise to all kaphaja types of Prameha. The deranged pitta, in conjunction with the
deranged vayu, kapha, rakta and medas produced the pittaja ones; while the deranged
vayu, in union with the deranged kapha, pitta ,medas ,majja and vasa, engenders the
types of vataj prameha60.
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Disease review- Madhumeha 34
Samprapti charka 61
Nidana sevana
↓ Kapha pradhana tridosha prokopa
↓ Agnimandya
↓ Amotpatti
↓ Samadosha kaphasthana anupravesha
↓ Rasam prapya (Oja sthana)
↓ The aggravated morbidity readily disperses as it can not be digested and assimilated
↓ due to deficient resistance or disintegrated body mechanism
↓ Augments while spreading and localizes where there is weakness
↓ Morbidity combined with medas, comes in contact with body fluids and muscles
↓ Increased quantity and decreased viscosity of medas, the intensified derangement of
kapha with more and identical proportion of medas
↓ This deranged dosha reaches the urinary system
↓ Exceed in normal quantity
↓ Apanadusti occurs due to obstruction and vitiates the vruk and brings about excessive
discharge of urine.
↓ diseased named as Prameha
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Specific samprapti of Madhumeha 62
Charaka and Vagbhata’s have described the pathogenesis of Madhumeha as
separate from Prameha .Constant use of the specific nidana , leads to augmentation of
pitta kapha meda and mamsa which obstructs the vata in its route. Thus enraged vata
carries ojus along and drives it down through the urinary system giving rise to
madhumeha. The sign and symptoms pertaining to vata or avruta doshas which occur
and disappear indefinitely (but the recurrence is in more severe form) and frequently.
Vagbhata’s state that the pathogenesis of Madhumeha is of two varities63
1. The depletion of the dhatu leading to the vitiation of vata
2. Obstruction to the normal circulation of vata by the other doshas leading to the
vitiation of the former
This particular information leads us to include that Madhumeha is mainly due to
the vitiation of vata. Even according to Charaka, madhumeha is enumerated as one of
the vataja Pramehas. Vagbhata’s has also stated that any prameha if not treated and
attended to at the outset, will ultimately develop into Madhumeha. He has also clearly
stated that there is an increase in the sweetness in the body, which is expressed
through the physical qualities of urine, being the colour and taste resembles honey 64
According to Vagbhata’s, there is an increase in the sweetness or sweet substances
in the body of a Madhumeha patient 65. This particular fact is noticed by the sweetness
of the urine that can be observed and recognised by attraction and assemblage of ants
near the urine66. The urine of a normal or healthy person is not sweet in taste. This
sweetness of the urine of a Madhumeha patient is due to the madhura dravya, which is
filtered by the mootravaha srotas.
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POORVARUPA
The state of prodroma or poorvarupa is expressed as when vitiated doshas
become localised due to srotovaigunya leading to the dosha-dushya-sammurchana.
Kapha predominant tridoshas and dhatus along with ojus are chiefly affected in
Prameha.
The following are the prodroma of Prameha.
1. Burning sensation of the palms of hands and the soles of the feet67.68,69 2. Sweet taste in the mouth.
3. Increased excretement in the body, increased discharged from the orifices in
the body70,71
4. Dryness in Coldness or sliminess of the skin and limbs, thermalgia and
numbness in the body.
5. Raw-meet odour in the body.
6. Somnolence and continuous torpor and lassitude.
7. Attraction of insects and ants to the body and urine72.
8. Matting of the hair and inordinate growth of the finger and toe nails73.74
9. Dryness in the mouth, palate and throat and thirst.
10. Slimy mucous deposit on the tongue, palate, pharynx and teeth.
11. Heaviness of the body.
12. Sweetness and whiteness of urine.
13. A bad odoured breath and shortness of breath75.
Vagbhata’s has mentioned additional prodroma for Prameha76
1. Excessive perspiration.
2. Laziness.
3. Liking of cold comforts.
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Disease review- Madhumeha 37
ROOPA In the Roopavastha or actual manifestation of the disease, dosha dushya sammurchana
completes, and the onset of the disease will be commenced. The Roopa may change
from time to time and certain symptoms may newly appear or some may disappear.
Madhumeha
Clinical features of the present disease Madhumeha are divided into two groups.
1. General features of Prameha
2. Specific features of the Madhumeha
Charaka has not described the general features of Prameha where as
Sushruta77 and Vagbhata78 have described the general features as
a. Avila mootrata
b. Prabhoota mootrata
Specific Lakshanas of Madhumeha
It is one among the four Vataja Pramehas. Charaka states that ojus is sweet by
instinct. The rookshata of aggravated vata transforms sweetness into astringent taste
and carries along to urinary system and brings about madhumeha. The person with
Madhumeha thus passes urine which is astringent and sweet in taste, yellowish or
whitish in colour. The urine contains similar properties of Honey79.80.81.Even some of
the poorvaroopa lakshana may present in this condition.
Apart from the above lakshanas, Sushruta described typical lakshanas for Madhumeha
rogi82, that he prefers-
1. To stay while walking.
2. To sit while staying
3. To take rest on bed while sitting
4. To go to sleep while taking rest.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review- Madhumeha 38
BHEDHA
Though Prameha is stated to be developed due to the vitiation
of all three doshas, the disease is mainly divided into three groups.
1. Kaphaja Pramehas – which are again subdivided into 10 types 83.
2. Pittaja Prameha – which are again subdivided into 6 types 84.
3. Vataja Prameha – which are again subdivided into 4 types 85.
Even though the three Ayurveda authorities Charaka, Sushruta And Vagbhata’s agree
the same number of Prameha in each group, there seems to be difference in the
nomenclature used by them. Increased quantity of urine and increased turbidity in the
urine are the main features in all varieties of Prameha.
The name of each variety of Prameha is based on the combination of dosha and
dushya, and the physical characters of the urine.
Kaphaja Prameha
Table showing Kaphaja prameha according to Brihatrayees
C.S86 S.S87 AS88
Udakameha Udakameha Udakameha
Ikshumeha Ikshumeha Ikshumeha
Sikatameha Sikatameha Sikatameha
Sanairmeha Sanairmeha Sanairmeha
Sandrameha Sandrameha Sandrameha
Sukrameha Sukrameha Sukrameha
Sandraprasadmeha ------------ -------------
Shuklameha Pishtameha Pishtameha
Sheetameha ------------ Sheetameha
Alalameha ------------ Alalameha
-------------- Surameha Surameha
-------------- Lavanameha Lavanameha
------------- Phenameha ---------------
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review- Madhumeha 39
Pittaja Prameha
Table showing Pittaja prameha according to Brihatrayees
CS 89 SS 90 AS 91
Ksharameha Ksharameha Ksharameha
Kalameha --------------- Kalameha
Neelameha Neelameha Neelameha
Lohitameha Shonitameha Raktameha
Manjishtameha Manjishtameha Manjishtameha
Haridrameha Haridrameha Haridrameha
--------------- Amlameha --------------
.
Vataja Prameha
Table showing prameha according to Brihatrayees
CS 92
SS93 AS94
Vasameha Vasameha
Vasameha
Majjameha -----------
Majjameha
Hastimeha Hastimeha Hastimeha
Madhumeha Kshoudrameha
Madhumeha
---------- Sarpirmeha -------------
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Disease review- Madhumeha 40
MADHUMEHA:
Madhumeha can be sub classified mainly into two types.
Type one a) Kulaja or Sahaja (Hereditary)
b) Doshaja or Apathya nimittaja (acquired) 95
Type two a) Dhatu kshaya janya Madhumeha96
b) Doshavruta janya Madhumeha
Charaka has divided the Madhumeha patient into two varieties based on the line of
treatment 97.
1. Sthoola (stout or strong)
2. Krisha ( emaciated or week)
Sushruta accepts Sahaja rogi as krisha and the Apathya nimitaaja rogi as sthoola rogi
in his classification
SADHYASADHYATA
As discussed earlier, Prameha is classified in to three verities i.e.
1. Kaphaja Pramehas - 10
2. Pittaja Prameha - 6
3. Vataja Prameha - 4
The ten kaphaja Prameha are said to be sadhya (curable) 98,99.
Because
The medas having homogenous properties is affected
The Kapha is dominant
Both these factors are amendable to the same type of treatment.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review- Madhumeha 41
The six pittaja Pramehas are only Yapya (palliable) 100,101 owing to the
proximity of the seat of the vitiated doshas and that of the medas and owing to the
antagonism involved in their treatment.
The four varieties of Vataja Prameha due to the vitiation of Vata are known to
be incurable 102, 103, because of their seriousness and also because of the contradiction
involved in their treatment.
Vagbhata’s adds to the above
• The kaphaja and Pittaja groups of Prameha if they are developed after full
expression of prodroma too are incurable104
• Kaphaja Pramehas gradually develops into pittaja pramehas and they both
transforms into vataja pramehas that are incurable
• If kaphaja pramehas gradually turns into pittaja pramehas these are yapya
• Even the pittaja pramehas are curable if there is no severe vitiation of medas
even this is applicable for vataja mehas 105
Charaka has stated that this disease is relapsing in nature .Though certain varieties
are stated to be curable they appear to be so only for certain period and relapse is
definite.
Madhumeha, which is a variety of vataja prameha is also to be considered, as
incurable but with specific line of treatment these can be palliable. Jata pramehi or
beeja doshaja are incurable due to leenata of dosha and as they themselves influence
on prakriti of patient.
Sushruta stated that if prameha patient suffering with pidikas and complications
like Hridgraha, then he should be considered as incurable106.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review- Madhumeha 42
UPADRAVA
If all the Prameha are not treated properly and attended, they may ultimately
develop into Madhumeha107. Madhumeha is considered to be one of the 20 Prameha
by Charaka. Apart form this charaka has been described the updravas of Prameha in
general. Where as Sushruta and Vagbhata’s have mentioned upadravas separately for
each doshik group.
The general upadravas of Prameha according to Charaka are as follows108.
Trishna, Atisara, Jwara, Daha, Dourabalya, Arochaka, Avipaka, Putimamsa, Pidika,
Alaji, Vidradhi.
Charaka mentioned the upadravas (complications) of Madhumeha as 109
Trishna, Shwasa, Mamsakotha, Moha, Hikka, Mada, Jwara, Visarpa among them
many of upadravas are seen in patient.
CHIKITSA
Madhumeha is a chronic disease and may also develop as a hereditary disease.
Madhumeha patients are divided in two varieties.
1.Sthoola and 2. Krisha
Sthoola patient are capable of withstanding the shodhana karma and the krisha patient
are incapable of withstanding it. Therefore a sthoola patient has to be treated with the
shodhana chikitsa and krisha with shamana chikitsa110.
Shodhana
For every Shodhana procedure the patient should undergo poorva karma. But
the Madhumeha patient is prohibited from undergoing sweda karma111. In sthoola
patient after completion of sneha karma the doshas should be eliminated through
sodhana vamana and virechana karma respectively.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review- Madhumeha 43
After the completion of the shodhana karma the patient has to be subjected for
samsarjana karma. Even though the Madhumeha is santarpana janya roga, the patient
should not be subjected to Apatarpana kriya, because it may result in to Gulma,
Kshaya, Mehanashoola, Vasti shoola and Mootra graha. The Brimhana chikitsa
should be carried out considering the strength of the individual patient112. A krisha or
emaciated, and Durbala or weak patient who is not capable of standing the shodhana
karma requires Bhrimhana chikitsa113.
Even though the vataja Pramehas are stated to be incurable the duty of
physician is to treat the patient and prevent the future complications. Therefore vataja
Prameha should be treated.
Samshamana Chikitsa
Samshamana chikitsa is indicated for a prameha patient who is not fit for
shodhana chikitsa, and also the patient who has completed the shodhana karma.
Many varieties of decoctions, choornas and lehyas have been described for the
treatment of the twenty varieties of Pramehas by all Ayurvedic authorities. Vyayama,
udvarthana, snana, jala sechana and the lepas with Twak, Ela, Agar and chandana are
useful in Prameha patient114.
Avoiding the causative factors (Nidana) is also treatment115. In our trial we
have used only shamana therapy, which has yielded a significant result.
The patient of Prameha who is not fit for evacuation should be subjected to
pacificator management for alleviation of the disease such as mantha (churned drink),
extracts, linctuses made of barley powder and light edibles. He should eat rough food
articles such as boiled barley, barley cakes, flour of parched grains and apupa with
palatable meat – soup of wild birds particularly gallinaceous and peckers. He should
take old shali rice with soup of mudga etc, and bitter vegetables added with oil of
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review- Madhumeha 44
danti and or linseed and mustard. In cereals, he should use shashtika and wild rice.
The diet of the patient of Prameha should consist mainly of barely. One suffering
form kaphaja Prameha should consist mainly of barley added with honey. Barley
grain dipped in decoction of Triphala for the whole night make a saturating food taken
with honey. The patient may also take them regularly mixed with vinegar for
alleviation of Prameha. He should use flour of parched grains, bolus, purchased
grains and other various edibles made of barley impregnated with decoction of drugs
prescribed in kaphaja Prameha, various preparations of barley mixed with the meat of
ass, horse, bull . Swan and spotted deer should be prescribed. The seeds of bamboo
and wheat may also be used in forms similar to those of barley116.
PRAMEHA NIVRUTTI LAKSHANA
The person is said to be free from prameha when his urine is devoid of
casts/deposits, but is clear ; non unctuous non dense, normal bitterness, pungent and
characteristically aromatic117.
Review Of Literature
Disease Review
Diabetes
Mellitus
(NIDDM)
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review-Diabetes mellitus (NIDDM) 45
DIABETES MELLITUS
Diabetes mellitus is a clinical syndrome characterised by hyperglycemia due
to absolute or relative deficiency of insulin118. Diabetes means the excessive discharge
that of urine119. DM comprises a group of common metabolic disorders that share the
phenotype of hyperglycemia. Several distinct types of DM exist and are caused by a
complex interaction e.g. genetics, environmental factors and life-style choice.
The metabolic deregulation associated with DM cause secondary
pathophysiologic changes in multiple organ system that impose a tremendous burden
on the individual with diabetes and on the health care system. With an increasing
incidence world wide, DM will likely continue to be a leading cause of morbidity and
mortality for the foreseeable future.
CLASSIFCATION120:
Recent advance in the understanding of the aetiology and pathogenesis of
diabetes have lead to a revised classification though all forms of DM are characterized
by hyperglycemia, the pathogenic mechanisms by which hyperglycemia arises differ
widely. Some forms of DM are characterized by an absolute insulin deficiency or a
genetic defect leading to defective insulin secretion, where as other forms share
insulin resistance as their underlying etiology.
The two broad categories of DM are designated as type 1 and type 2 . DM
results from autoimmune beta cell destruction, which usually leads to insulin
deficiency. Type 1A DM is also characterized by insulin deficiency as well as a
tendency to develop ketosis. However, individuals with type 1B DM, lack
immunologic markers indicative of autoimmune destructive process of the beta cells.
The mechanisms leading to beta cell destruction in these patients are unknown.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review-Diabetes mellitus (NIDDM) 46
Type 2 DM is a heterogeneous group of disorders usually characterized by
variable degrees of insulin resistance, impaired insulin secretion, and increased
glucose production. Distinct genetic and metabolic defects in insulin action and or
secretion give rise to the common phenotype of hyperglycemia in type 2 DM .The
identification of distinct pathogenic process in type 2 DM has important potential
therapeutic implications, as pharmacologic agents that target specific metabolic
derangements become available.
Two features of the current classification of DM diverge from previous
classifications, first, the terms insulin-dependent diabetes mellitus (IDDM) and non
insulin-dependent diabetes mellitus (NIDDM) are obsolete. These previous
designations reflected the observation that most individuals with type 1 DM
(previously IDDM) have an absolute requirement for insulin treatment, whereas many
individuals with type 2 DM (previously NIDDM) do not require insulin therapy to
prevent ketoacidosis. However, because many individuals with type 2 DM eventually
require insulin treatment for control of glyceamia, the use of the latter term generated
considerable confusion.
A second difference is that age is no longer used as a criterion in the new
classification system. Although type 1 DM most commonly develops before the age
of 30, an autoimmune beta cell destructive process can develop at any age. In fact, it
is estimated that between 5 and 10% of individuals who develop DM after age 30
have type 1A DM. Likewise, although type 2 DM more typically develops with
increasing age, it also occurs in children, particularly in obese adolescents .
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review-Diabetes mellitus (NIDDM) 47
Aetiologic classification of Diabetes mellitus 121
I. type 1 diabetes (b-cell destruction, usually leading to absolute insulin deficiency) A. Immune-mediated B. Idiopathic II. type 2 diabetes (may range from predominantly insulin resistance with relative insulin deficiency to a predominantly insulin secretary defect with insulin resistance) III. Other specific types of diabetes
A. Genetic defects of B-cells function characterized by mutations in: 1. Hepatocyte nuclear transcription factor (HNF) 4a(MODY !) 2. Glucokinase (MODY 2) 3. HNF-alpha (MODY 3) 4. Insulin promoter factor (IPF) 1(MODY 4) 5. HNF-1 Beta (MODY 5) 6. Mitochondrial DNA 7. Proinsulin or insulin conversion
B. Genetic defects in insulin action
1. Type A insulin resistance 2. Leprechaunism 3. rabson-Mendehall syndrome 4. Lipoatrophic diabetes
C. Diseases of the exocrine pancreas-pancreatitis, pancreatectomy. Neoplasia, cystic fibrosis, hemochromatosis, fibrocalculous pancreatopathy
D. Endocrinopathies—acromegaly, Cushing’s syndrome, glucagonoma.
Pheochromocytoma, hyperthyroidisom, somatostatiomnoma. Pheochromocytoma, hyperthyroidism somatostatinoma aldosterodnoma
E. Drug or chemical induced —Vacor, pentamidine, nicotinic acid, glucocorticoids,
thyroid hormone , diazoxide, B-adrenergic agonists, thiazides, phenytoin, a-interferon, protease inhibitors, clozapine beta blockers.
F. Infections—congenital rubella, cytomegalovirus, coxsakie
G. Uncommon forms of immune-mediated diabetes –“stiff-man” syndrome, anti-
insulin receptor antibodies. H. Other genetic syndromes sometimes associated with diabetes-Down’s
syndrome, Klinefelter’s syndrome, Turner’s syndrome. Wolfram’s syndrome, Friedreich’s ataxia. Huntington’s chorea, Laurence-Moon-Biedl syndrome, myotonic dystrophy, porphyria, Prader.Willi syndrome
IV. Gestational diabetes mellitus (GDM)
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review-Diabetes mellitus (NIDDM) 48
Pathophysiology of DM
Diabetes mellitus is a chronic disease. It results due to disturbance in
carbohydrate metabolism and deficiency of insulin 122 secreted by the Beta cells of
islets of Langerhan of pancreas, but hormones of pituitary and adrenal glands are also
intimately related to the development of diabetes mellitus. Liver plays an important
role in the metabolism for carbohydrate. It stores glucose in the form of glycogen
under the influence of insulin. Any alteration in this function leads to diabetes 123 .
PANCREAS124
The pancreas is a compound alveolar gland. It has got both endocrine and
exocrine functions. It lies against the posterior abdominal wall behind peritoneum.
The whole organ is about 15 cm long with the right margin of the head is in contact
with the descending part of the duodenum and the tail is in contact with the spleen.
The disease diabetes mellitus is considered only to its endocrine secretion that is
insulin, so it is more important to go through its endocrine part.
ISLETS OF LANGERHANS
The islets of Langerhans are composed of various components that are
organized to form micro-organs. The mass of islets within a pancreas is dynamic and
changes both with growth and development and with functional challenges.
Islets function both singly and in concert. Recent work has revealed greater
diversity in islets than that previously recognized. There is functional heterogeneity
between islets and beta cells within the same islet. Numerous peptides other than the
four main islet hormones (insulin, glucagon, somatostatin, and pancreatic
polypeptide) have been immuno-localized in islets.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review-Diabetes mellitus (NIDDM) 49
The islets Langerhans are clusters of endocrine tissue scattered throughout
the exocrine pancreas. In the adult mammal, the islets are 1 to 2% of the pancreatic
mass and thus comprise around 1 gm of tissue in the adult human. Islets are a
complex mixture of cells and function both separately as micro organs and in concert
as the endocrine pancreas. Although the direct secretion of insulin and glucagon from
islets into the portal vein has obvious advantages with respect to influence on hepatic
function. The islet mass is dynamic, adjusting to meet the changing needs of
individual, whose size and level of activity vary at different stages of life. When the
islet mass cannot adjust to meet the demand, diabetes results.
The pancreas of the adult human contains about 200 units, or 8mg, of insulin. The
size of an islet can range from only a few cells and less than 40 micrometer in
diameter to about 5000 cells and 400 micrometer in a diameter.
GROWTH OF ISLET
The growth capacity of the beta cell depends on the stimulus and the ability if
the cell to recognize the stimulus as well as the number of beta cells that can enter the
cell cycle and undergo mitosis. There is an increased incidence of polyploid beta cells
in the diabetic human. Although there may be numerous stimuli for beta-cell growth,
three major stimuli are known. Glucose has been shown to stimulate modest growth
of either neonatal or adult pancreatic beta-cells in culture. Pregnancy has been shown
to cause both increased replication and mass of beta – cells. As a parallel finding, in
vitro studies have shown that prolactin, placental lactogen and growth hormone can
stimulate replication of beta - cells. Diabetes results only if increased cell loss or
functional demands cannot be met.
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Disease review-Diabetes mellitus (NIDDM) 50
COMPONENTS OF THE ISLETS OF LANGERHANS
There are three major endocrine cell types in islets : the insulin producing
beta – cell, the glucagon producing alpha – cell, the somatostatin producing delta –
cell.
Alpha – cell
The alpha cells are usually smaller and more columnar than the beta cell and
well granulated with granules 200 to 250 nm in diameter. The granules are electron
dense with narrow halo of less – dense material and a tightly fitting granule – limiting
membrane.
Beta – cell
The beta cell are polyhedral, being truncated pyramids, and are usually well
granulated with secretary granules 250 to 350 nm in diameter.
Delta – cell
The delta-cells are usually smaller than either alpha or beta cells, are well
granulated and are often dendritic in shape. Within a delta cell the electron density of
granules varies greatly. Each granule 200 to 250 nm in diameter. contains material of
homogenous moderate density that fills the granule – limiting membrane
Table showing cells of islet of Langerhan and their relative hormones
Cell type Size of secretary granule (nm) % of cells Hormone
Beta 250 – 350 60 – 80 Insulin
Alpha 200 – 250 15 – 20 Glucagon
Delta 200 – 250 5 – 10 Somatostatin
Factors regulating islet blood flow may effect islet hormone secretion. High
concentrations of glucose have been shown to enhance pancreatic blood flow and to
preferentially increase islet blood flow125.
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Disease review-Diabetes mellitus (NIDDM) 51
Functions of hormones :
INSULIN:
The insulin is hypoglycemic, anti diabetic factor and the protein bound
hormone that regulates the blood glucose, It also increases the oxidation of glucose to
CO2 in the tissues and depresses gluconeogenesis i.e., formation of glucose from the
sources other than carbohydrates.
Insulin increases combustion of sugar in the tissue and also helps in the
treatment of glucose in the cells. It increases synthesis of glycogen from sugar and
lactate both in the liver and muscle. This is called the directive effect of insulin.
Insulin promotes the uptake of glucose inside the cells and the intercellular
phosphorylation of glucose to glucose-6-phosphate itself also appears to be a specific
activator of glycogen synthesis.
Insulin effect on protein metabolism:
In prevents gluconeogenesis, Glucose is normally formed from proteins and
lipids in the liver. In diabetes this process is enhanced. High blood sugar level in
diabetes is due to over production of glucose. In the starving diabetes dextrose
nitrogen ratios is fairly constant. This shows that both sugar and nitrogen are coming
from the same source i.e., proteins. When insulin is given both sugar and nitrogen
excretion fails, showing that formation of new glucose from proteins has been
interfered.
It prevents formation of ketone bodies (anti ketogenic). In advance diabetes,
excess ketone bodies are formed in liver, due to incomplete combustion of fatty acids.
After the administration of insulin more sugars burn and liver glycogen increases
displacing the lipids. Hence lipid combustion is discouraged and ketosis disappears.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review-Diabetes mellitus (NIDDM) 52
Insulin decreases the cholesteremia and lipademia. It also prevents accumulation of
excess lipid in the liver and breakdown of lipid in Adipose tissue.
METABOLIC ACTIONS OF INSULIN 126
Increase (anabolic effects) Decrease (anti catabolic effects)
Carbohydrate metabolism
Glucose transport(muscle, adipose tissue)
Glucose phosporylation
Glycogenesis
Glycolysis
Pyruvate dehydrogenase activity
Pentose phosphate shunt
Gluconeogenesis
Glycogenolysis
Lipid metabolism
Triglyceride synthesis
Fatty acid synthesis (liver)
Lipoprotein lipase activity
(adipose tissue)
Lipolysis
Lipoprotein lipase (muscle)
Ketogenesis
fatty acid oxidation (liver)
Protein metabolism
Amino acid transport
Protein synthesis
Protein degradation
GLUCOGON 127
The Alpha cells of the islets of Langerhans secrete Glucagons. It is a
polypeptide hormone with 29 amino acids having molecular weight of 3.485. This
polypeptide has been completely synthesized Glucagons causes glycogenolysis in the
liver and antagonist to liver by depriving the action of Insulin.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review-Diabetes mellitus (NIDDM) 53
The blood sugar level chiefly controls the secretary activity of Alpha and Beta
cells Hyperglycemia stimulates the release of Insulin where as, hypoglycemia will
release the glycogen. There is no good evidence that a tropic hormone secreted by the
pituitary, directly influences the secretary activity of the pancreatic islets, through
secretions derived form other endocrine glands for example, the adrenal gland have
some effects.If the islets are completely removed or extensively damaged. The lack of
or reduced Insulin formation results in hyperglycemia and the condition of diabetes
mellitus (Madhumeha). Relatively normal carbohydrates metabolism can then be
restored by supplementation of insulin.
It is necessary to point out however that though a deficiency of insulin
production and release may result in Diabetes, not all cases of Diabetes are due to a
deficiency in Insulin production. Even pituitary, Liver and Adrenals are also involved
in this process Clinical syndromes involving abnormal carbohydrate metabolism and
abnormal blood sugar levels may result from either deficiency or excess production of
insulin and Glycogen. The latter when injected result in an increase in blood
hypoglycemic and attains neurological changes, excess production of Gastrin, acidity
and peptic ulceration.
LIVER
Functions of liver in carbohydrate metabolism are :-
1. Storage of Glycogen
2. Conversion of Galactose and fructose into glucose
3. Gluconeogenesis
4. Formation of many important chemical compounds from the intermediate
products of Carbohydrate Metabolism.
Liver is especially important for maintaining a normal blood glucose
concentration. For instance storage of glycogen allows the liver to remove excess
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review-Diabetes mellitus (NIDDM) 54
glucose from blood, store it and then return it in to the blood when the blood glucose
concentration begins to fall too low. This is called the glucose buffer function of the
liver. As an example, immediately after a meal containing large amounts of
carbohydrates the blood glucose concentration raises about three times as much in the
person with a non functional liver as in a person with a normal liver.
Gluconeogenesis in the liver is also concerned with maintaining a normal blood
glucose concentration for glucose exogenesis occurs to a significant extent only when
the glucose concentration begins to fall below normal. In such case large amount of
amino acids are converted in to glucose, there by helping to maintain a relatively
normal blood glucose concentration.
TYPE 2 DIABETES 128
Type 2 diabetes commonly occurs in subjects who are obese and insulin-
resistant, but these two factors alone are two factors alone are insufficient to cause
diabetes unless accompanied by impaired beta cell function.
Genetics
Genetic factors are more important in the etiology of type 2 than type 1 diabetes. As
shown by studies in monozygotic twins where concordance rates for type 2 diabetes
approach 100%.
Environmental factors
Life styles
Overeating , especially when combined with obesity and under activity is associated
with the development of this kind. Middle aged people with diabetic eat, less active
acts as the diabetogenic factor.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review-Diabetes mellitus (NIDDM) 55
Malnutrition in utero
Malnutrion in utero may programme beta cell development and metabolic function at
a critical period ,so predisposing to type 2 diabetes in later period. smoking during the
pregnancy has also been implicated.
Age
Type 2diabetes is principally a disease of the middle aged and elderly.
Pregnancy
Repeated pregnancy may increase the like hood of developing irreversible diabetes,
particularly in obese women ; thus women with the gestational diabetes ultimately
develop permanent clinical diabetes.
Pathogenesis of type 2 diabetes
Insulin resistance
Increased hepatic production of glucose and resistance to the action of insulin
in muscle are invariable in both obese and non-obese patients with type 2 diabetes.
Insulin resistance may be due to any one of three general causes; an abnormal insulin
molecule, an excessive amount of circulating antagonists, or target tissue defects. The
last is the most common cause of insulin resistance in type 2 diabetes and seems to be
the predominant abnormality in those with more severe hyperglycemia
A characteristic feature of type 2 diabetes is that it is often associated with
other medical disorders including obesity. Hypertension and hyperlipidaemia. It has
been suggested that this cluster of conditions, all of which predispose to
cardiovascular disease, is a specific entity (the insulin resistance syndrome’ or
‘metabolic syndrome’ )
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review-Diabetes mellitus (NIDDM) 56
Pancreatic beta cell failure
In type 2 diabetes there is only moderate reduction in the total mass of pancreatic islet
tissue which is consistent with a measurable fall in plasma insulin concentration when
related to the blood glucose level. However, some pathological change are typical of
type 2 diabetes, the most consistent of which is deposition of amyloid. This is
accompanied by atrophy of the normal tissue, particularly islet epithelial cells, Islet
amyloid is composed of insoluble fibrils formed from islet amyloid polypeptide(also
known as amylin). Small quantities of islet amyloid are very common in elderly non-
diabetic patients, and the role of islet amyloid in the pathogenesis of type 2 diabetes is
uncertain. Deposition of amyloid is probably not a cause of diabetes but rather a
pathological process which is increased in type 2 diabetes. More extensive
amyloidosis is, however, found in patients who have progressed to insulin
replacement therapy, suggesting that islet function may become compromised by
amyloid deposition.
While beta cell numbers are reduced by 20-30% in type 2 diabetes, alpha cell
mass is unchanged and glucagon secretion is increased, which may contribute to the
hyperglycemia. Insulin resistance tends to raise blood glucose and this stimulates
insulin secretion to prevent hyperglycemia. When the maximal insulin secretary
capacity has been exceeded, any further increase in fasting blood glucose levels
caused a decline in insulin generation. Possible mechanisms for beta cell
decompensation include glucotoxicity, an intrinsic failure of insulin production, a
witch to abnormal processing pathways producing biologically inactive products and
chronic degranulation of the beta cells
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review-Diabetes mellitus (NIDDM) 57
Some people with type 2 diabetes, most of whom are not overweight have
advanced pancreatic beta cell failure at the time of presentation and require early
treatment with insulin.
The American Diabetes Association (ADA) 1997 revised criteria for diabetes129
The ADA-revised criteria for diagnosis are:-Typical symptoms of diabetes -
polydipsia, polyuria, and unexplained weight loss - plus a casual serum glucose level
greater than 200 mg/dl - "casual" meaning any random glucose obtained at any time
of the day without respect or non-fasting.
A fasting serum glucose greater than or equal to 126 mg/dl after no caloric
intake for at least 8 hours. Two hours serum glucose greater than or equal to 200
mg/dl during a 75-gram oral glucose tolerance test is also diagnostic of diabetes.
Any of these initial findings confirmed on a subsequent day can be considered
as diagnostic of diabetes, and any combination of the findings can be used for
confirmation. For example, a physician may observe a casual serum glucose greater
than 200 mg/dl in a patient with symptoms of diabetes on one day, and subsequently
document a fasting serum glucose greater than 126 mg/dl on another day. This
satisfies the requirement for confirmation by repeat testing.
The ADAs new criteria for diagnosing diabetes mellitus de-emphasize the glucose
tolerance test and favor diagnosis by fasting serum glucose.
HYPERGLYCAEMIA130
Hyperglycaemia is a very common biochemical abnormality. It is frequently
detected on routine biochemical analysis of asymptomatic patients. And is found
during conditions which impose a burden on pancreatic beta cells, such as pregnancy,
severe illness or treatment with drugs such corticosteroids (‘stress hyperglycaemia’)
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review-Diabetes mellitus (NIDDM) 58
Symptoms of hyperglycemia associated with diabetes The diabetes diagnosed accidentally, usually asymptomatic but shows the symptoms
of hyperglycemia accordingly. Thus the symptoms related to the hyperglycemia are
of DM.
Table showing the symptoms of hyperglycemia:
• Thirst, dry mouth
• Polyuria
• Nocturia
• Tiredness, fatigue, irritability, apathy
• Recent change in weight
• Blurring of vision
• Pruritus vulvae, balanitis (genital candidiasis)
• Nausea; headache
• Hyperphagia; predilection for sweet foods
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review-Diabetes mellitus (NIDDM) 59
Complications of DM131
Table showing the complications of DM
Microvascular/ neuropathic Macrovascular
Retinopathy, cataract
• Impaired vision
Nephropathy
• Renal failure
Peripheral neuropathy
• Sensory loss
• Motor weakness
Autonomic neuropathy
• Postural hypotension
• G I problems
Foot disease
• Ulceration
• Arthropathy
Coronary circulation
• Myocardial ischaemia/ infarction
Cerebral circulation
• Transient ischaemic attack
• Stroke
Peripheral circulation
• Claudication
• Ischaemia
Risk factors for type 2 DM132
Table showing the risk factors for type 2 DM
Family history of diabetes(i.e., parent or sibling with type 2 diabetes)
Obesity(i.e., > 20% desired body weight or BMI> 27 K\m2)
Age>45 years Race\ethnicity(e.g. African American, Hispanic American native American, Asian American, Pacific Islander)
Previously identified IFG of IGT History of GDM or deliver of baby over 9 lbs
Hypertension blood pressure > 140\90 mm, Hg
HDL. Cholesterol level > 0.90 mmol\L (35 mg\dl) and\ or a triglyceride level > 2.82 mmol|l (250mg\dl)
Polycystic ovary syndrome
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review-Diabetes mellitus (NIDDM) 60
MANAGEMENT OF DIABETES133
Three methods of treatment are available for diabetic patients; viz diet,
exercise, OHA and insulin.
The importance of life style changes such as taking regular exercise, observing
a healthy diet and reducing alcohol consumption should not be under-estimated in
improving glycaemic control, but many people, particularly the middle-aged and
elderly, find them difficult to sustain. Patients should also be encouraged to stop
smoking.
AIMS OF DIETARY MANAGEMENT
• Abolish symptoms of hyperglycemia
• Reduce overall blood glucose and minimise fluctuations
• Achieve weight reduction in obese patients to reduce insulin resistance,
hyperglycemia and dyslipidaemia
• Avoid hypoglycaemia associated with therapeutic agents (insulin, sulphonylureas)
• Avoid weight gain associated with therapeutic agents(insulin, sulphonylureas,
thiazolidinediones)
• Avoid ‘atherogenic’ diets or those which may aggravate diabetic complications
(e.g. high protein intake in nephropathy)
Low-energy, weight-reducing diets: Dietary prescriptions which cause a daily
deficit of 500 Kcal provide a realistic diet and induce a weekly weight loss of around
0.5 kg. Rapid weight reduction may provoke loss of lean body tissue. And care must
be taken in the elderly to avoid the omission of essential nutrients, vitamins and
minerals. Caloric restriction is essential for the obese diabetic patient treated with
insulin and most oral agents, to try to minimize the weight gain which these can
promote.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Disease review-Diabetes mellitus (NIDDM) 61
Exercise:
Exercise is necessary for the reduction of the weight. An acute bout of
exercise can place numerous metabolic demands on the human organism. To maintain
homeostasis, a person must meet increased requirement for the oxygen and metabolic
substrates through the precise functioning of several regulatory system. Typically,
circulating glucose concentration fall modesty during the exercise in person with the
NIDDM because insulin secretion is not inhibited while the peripheral utilization of
glucose is increased.
Oral hypoglycemic agents:
Various drugs are effective in reducing hyperglycemia in patients with type 2
diabetes. Although their mechanisms of action are different mostly depend upon a
supply of endogenous insulin and they therefore have no hypoglycaemic effects in
patients with type1 diabetes. The sulphonylureas and the Bigunides have been the
mainstay of treatment for many years but novel agents are now available, such as the
insulin enhancing agents , the thiazolidinediones, the alpha glucosidase inhibitors,
which delay carbohydrate digestion and absorption of glucose, and the prandial
glucose regulators which stimulate endogenous insulin secretion.
Educating the patients:
It is essential that people with diabetes should be made to learn to handle all
aspects of their management as quickly as possible , and this can be done on an OPD.
It is wise precaution for diabetic patients who are taking insulin or OHA to carry a
card stating their identity and about their medication. They should be aware about
their condition and the management of emergencies. They should be posses the
knowledge regarding complication and their preventive aspects.
Insulin:Insulin is the ultimate and final treatment for the DM, if OHA fails to control.
Methodology
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Methodology 63
MATERIALS
Source of Data
1.Literary source:
Literary aspect was collected from classical Ayurvedic texts , Modern texts,
Journals and those updated information regarding the study were collected from
internet search.
2.Drug :
Avartaki beeja (Cassia auriculata – seeds )
and Avartaki pushpa ( Cassia auriculata – flowers )
were taken for clinical trial .
Collection of raw materials
Botanically identified Avartaki pushpa and beeja were personally collected during
seasons (September –December ) respectively from the local areas.
Method of Preparation
• The flowers of Avartaki were collected and completely dried under the shade.
Then the fully dried flowers were finely powdered.
• The dried legumes of Avartaki were collected and seeds were separated from
them. These seeds were air dried and later finely powdered.
Place of Preparation of medicine
The preparation of medicine was done in PGR&S Dept of Dravya guna vijnana, Shri
D. G. M. Ayurvedic medical College Gadag
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Methodology 64
Form of medicine
The Avartaki pushpa and beeja were subjected for churna kalpana as per classics and
then finely powdered drug was filled within capsules.
METHODS
The trial drugs were subjected for the evaluation of physical contents. They found to
be as follows:
Avartaki beeja
1. Foreign matter : 0.36%w/w
2. Total ash : 9.05%w/w
3. Acid insoluble ash : 1.25%w/w
4. Water soluble ash : 6.48%w/w
5. Water soluble extractive : 65.2%w/w
6. Alcohol soluble extractive : 7.12%w/w
1.Foreign matter:
Weight of paper + sample : 10.6480gms
Weight of paper : 0.6480gms
Weight of paper + residue : 10.6120gms
= 100X 0.0360 10 = 0.36%w/w
2.Total ash :
Weight of dish + sample : 28.1670gms
Weight of dish : 26.1670gms
Weight of dish + residue : 26.3480gms
Weight of sample : 2.000gms
Weight of residue : 0.1810gms
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Methodology 65
= 100X 0.181 2 = 9.05%w/w
3. Acid insoluble ash :
Weight of sample : 2.000gms
Weight of dish + residue : 26.1920gms
Weight of dish : 26.1670gms
Weight of residue : 0.0250gms
= 100X 0.00250 2 = 1.25 %w/w
4.Water soluble ash :
Weight of sample : 2.000gms
Weight of ash : 0.1810gms
Weight of dish + residue : 26.2184gms
Weight of dish : 26.1670gms
Weight of insoluble matter : 0.0514gms
Weight of soluble matter : 0.1296gms
= 100X0.1296 2
=6.48%w/w
5.Water soluble extractive:
Weight of the sample : 5gms
Weight of dish + residue : 44.8400gms
Weight of dish : 44.0250gms
Weight of residue : 0.8150gms
= 100X100X0.8150 25X 5 = 65.2% w/w
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Methodology 66
6.Alcohol soluble extractive:
Weight of the sample : 5.00gms
Weight of dish + residue : 46.5140gms
Weight of dish : 46.4250gms
Weight of residue : 0.0890gms
= 100 X 100 X 0.0890 25 X 5 = 7.12 % w/w
Avartaki pushpa
1. Foreign matter : 0.45 %w/w
2. Total ash : 8.2%w/w
3. Acid insoluble ash : 0.93%w/w
4. Water soluble ash : 5.63%w/w
5. Water soluble extractive : 65.92%w/w
6. Alcohol soluble extractive : 7.312 %w/w
1.Foreign matter:
Weight of paper + sample : 10.6480gms
Weight of paper : 0.6480gms
Weight of paper + residue : 10.6030gms
= 100X 0.0450 10
= 0.45%w/w
2.Total ash :
Weight of dish + sample : 28.1670gms
Weight of dish : 26.1670gms
Weight of dish + residue : 26.3310gms
Weight of sample : 2.000gms
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Methodology 67
Weight of residue : 0.1640gms
= 100X 0.1640 2 = 8.2%w/w
3. Acid insoluble ash :
Weight of sample : 2.000gms
Weight of dish + residue : 26.1856gms
Weight of dish : 26.1670gms
Weight of residue : 0.01860gms
= 100X 0.01860 2 = 0.93%w/w
4.Water soluble ash :
Weight of sample : 2.000gms
Weight of ash : 0.1640gms
Weight of dish + residue : 26.2184gms
Weight of dish : 26.1670gms
Weight of insoluble matter : 0.0514gms
Weight of soluble matter : 0.1126gm
= 100X0.1126 2 =5.63%w/w
5.Water soluble extractive:
Weight of the sample : 5gms
Weight of dish + residue : 44.8490gms
Weight of dish : 44.0250gms
Weight of residue : 0.8240gms
= 100X100X0.8240 25X 5
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Methodology 68
= 65.92% w/w
6.Alcohol soluble extractive:
Weight of the sample : 5.00gms
Weight of dish + residue : 46.5164gms
Weight of dish : 46.4250gms
Weight of residue : 0.09140gms
= 100 X 100 X 0.09140 25 X 5 = 7.312 % w/w
Selection of a sample
Patients suffering from Madhumeha were randomly selected from OPD/IPD of
PGR&S. Dept of Dravya guna vijnana Shri D. G. M. Ayurvedic medical college
Gadag.
Criteria for selection of patients
1. The patients diagnosed as the madhumeha as per the classics
2. Both male and female patients were selected
3. The patients aged in between 25- 65 years
Inclusive criteria
1. The patients diagnosed as the Madhumeha depending on the signs and
symptoms as mentioned in the texts
2. The non insulin dependent patients
3. both obese and non-obese were included
4. NIDDM without complication
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Methodology 69
Exclusive criteria
1. Patients within 25 years and above 65 years of age
2. Insulin dependent ( type -1)
3. Patients associated with any other systemic disorders
4. Patients with upadrava of madhumeha
5. Non diabetic glycosuria
6. Malnutritional DM
7. Gestational DM
8. Secondary DM
Laboratory Investigations
The included patients were subjected for the following laboratory investigations
US
FBS
PPBS
Glucose tolerance test in case of border line sugar
Diagnostic criteria :
Diagnosis was made on the basis of subjective parameters mentioned in the
classics and objective parameters ( lab investigations ).
Table showing normal values of objective parameters.
Lab investigation Normal values
FBS 70-110 mg/dl
PPBS 110-140 mg/dl
Urine sugar Nil
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Methodology 70
Methods of lab investigations
1.Blood glucose
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 0 c for 15
minutes . Then observed in 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.
2.Urine sugar
A fresh urine sample is collected from the patient. 5 ml of Benedict solution is taken
in a test tube and 5-6 drops of urine sample in put in that. Then the test tube is heated
till until a boil in the solution and cooled at room temperature. The change is
observed for the presence of sugar.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Methodology 71
Observations
Colour of test solution Urine sugar
Blue
Green
Yellow
Orange
Brick red
Nil
0.5 %
1.0 %
1.5 %
2.0 %
Study design
Prospective comparative clinical study
Sample size
A minimum of 30 patients were selected and grouped randomly in two with 15 in
each. The grouping was as follows
Group A- Avartaki beeja churna
Group B- Avartaki pushpa churna
Posology
2gms in divided dose , 1 cap = 500 mg so 2 cap bid, Anupana ─ Sukhoshna jala
Study duration
Duration of the study was 30days
The patients were asked to report on every 10 days
1st assessment – before treatment
2nd assessment – 10th day after initiation of medicine
3rd assessment – 20th day after initiation of medicine
4th assessment – 30th day after initiation of medicine
These assessment were considered for the progressiveness of medication clinically.
But to asses the overall results 1st and 4th assessment are taken.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Methodology 72
Diet
Patients were asked to take their regular diet .
Assessment of results
Results of the treatment were assessed on the basis of difference between baseline
data and assessment data of both subjective and objective parameters. These
differences were subjected for the statistical analysis by applying student ‘t’ test and
paired / unpaired ‘t’ test
Subjective parameters
1. Prabhoota mootrata
2. Avila mootrata
3. Trishna
4. Ashaktata
Objective parameters
1. US
2. FBS
3. PPBS
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Methodology 73
Gradation for subjective parameters to asses the result
Sr. no Subjective parameter Gradation according to state
1 Prabhoota mootrata 0-no complaints
1- patient is not aware of complaint
2-patient is aware of complaint
3-patient is disturbed by the complaint
2 Avila mootrata 0-clear urine
1- turbid urine +
2-turbid urine ++
3-turbid urine +++
3 Trishna 0- no complaint
1-mild ( desire for water)
2-moderate ( frequently drinks water)
3-severe ( strongly needs water)
4 Ashaktata 0- no complaints
1- feels weakness
2- routine activities are not affected
3- routine activities are affected
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Methodology 74
Results
Results of the study are given as follows:
1. Relieved
2. Palliative
3. Not responded
To categorise the result as above following criteria are taken into consideration
1. Relieved
All the subjective parameters attain grade 0 after the treatment.
The FBS appears in the normal value or difference in baseline and
assessment data is more than or equal to 100.
2. Palliative
Two or more subjective parameters attain the grade 0.
The FBS level is decreased from the previous one.
3. Not responded
No subjective parameters attain the grade 0.
The blood sugar level is raised with the difference of the baseline data and
assessment data is 100 or more.
Result
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 75
Master charts
Demographic data
Sr.no A
(yrs) S R O S e
s D o I C
(yrs)
Fh T h
D Ag V Pr G Results
1. 59 M H A Hc 20.01.04 20 P Y V V AS Vp B P 2. 54 F H A Mc 04.03.04 5 M Y V V No K B P 3. 48 F H A Hc 08.03.04 10 A Y V V Bl Pk B P 4. 56 F H L Mc 15.04.04 1 A N M T Bl K B R 5. 48 F H A Hc 18.04.04 10 M Y V V Bl Pk A R 6. 54 F H A Mc 18.04.04 5 A Y V V No K A R 7. 56 F H L Mc 20.04.04 1 A N M T Bl K A R 8. 60 M H L P 17.05.04 1 A N M V No V B Nr 9. 49 M H A Mc 20.05.04 4 A Y M V At K B Nr 10 52 M M A Mc 20.05.04 1 A Y M T As P B R 11 49 M H A Mc 27.06.04 4 A Y M V At K A R 12 54 M M A Mc 30.06.04 1 A Y M T As P A Nr 13 53 M H L Mc 04.06.04 1 A Y V V T Pk B R 14 52 M H L Mc 19.06.04 1 A Y M T T Vp B P 15 60 M H L P 20.07.04 1 A N M V No V A Nr 16 53 M H L Mc 04.06.04 1 A Y V V T Pk A R 17 52 M H A Mc 30.07.04 1 A Y M T T Vp A P 18 56 M H A Hc 02.08.04 1 A N V V No K B P 19 55 M H A Mc 02.08.04 2 M Y V T S Vk B P 20 56 M H A Hc 12.09.04 1 A N V V No K A P 21 55 M H A Mc 12.09.04 2 M Y V T S Vk A R 22 48 M H A Hc 02.10.04 5 M Y V V No K B P 23 57 F H A Mc 09.10.04 8 P Y V V Bl K B R 24 46 M H A Mc 26.10.04 2 A N M T No K B P 25 48 F H A Hc 20.11.04 5 M Y V V No K A R 26 46 M H A Mc 01.12.04 2 A N M T No K A R 27 57 M H A Mc 20.12.04 8 P Y V T Bl K A R 28 44 M M A Mc 28.12.04 2 A Y M T A K B R 29 54 M H A Mc 30.12.04 4 A Y V T A Vk A P 30 50 F H A Hc 19.01.04 8 P Y V V No Vk A P
Key words: A- Age in years, S –Sex (M- Male, F – Female) R – Religion (H – Hindu. M – Muslim ,O – Others), O – Occupation ( L – Labour, A – Active) S e s- Socio Economic State ( Hc-high class, Mc –middle class , P – Poor )D o I – Date of initiation), C –Chronicity in years , Fh – Family history ( M- Maternal- Paternal, A – absent ) , Th- Treatment history( Y- Yes , N –No), D –Diet ( V- Vegetarian, M – mixed), Ag- Agni(V- Vishama, T- Teekshna ) ,V-Vyasana ( A- Alcohol, S-Smoking, T- Tobacco, B – Betal nut ), Pr – Prakruti ( V- Vataj , P- Pittaja, K- Kaphaja, VP- Vataj Pittaja , VK- Vataj Kaphaja ,PK - Pittaja Kaphaja ),G- group , Results ( R- Relived, P – Palliative, NR- Not respond
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 76
Data related to complaints
Sr .no Prabhoota mootrata
Avila mootrata
Ashaktata Sharira bhara hani
Janga mansa graha
Trishna
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. + + + - + + 26. + + + - + + 27. + + + - - + 28. + + + + - + 29. + + + + - + 30. + + + - + +
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 77
Data related to personal history
Ahara Vihara Sr .no M Sh Sn G
N
Du Da G .V D.V Ma Av A Ds Ss Mnasika chinta
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. + + + + + + + + + + + + - + - 26. + + + - + - + + + + - + + + - 27. + - + + + + + - - - - + + + - 28. + - + + + - + - - + + + + + + 29. + + + + + + + - - - + + - + - 30. + + + + + + + - - - + + + + -
- Key notes: M- Madhura , Sh – Sheeeta ,Sn - Snigdha, G – Guda ,N – Navanna , Du- Dugdha , Da – Dadhi, G.V – Guda vikruti ,D.V –Dugdha vikruti, Ma – Mamsa Av- Alpa vyayama, A – Avyayama ,Ds – Diwaswapna ,Ss – Swapna sukha
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 78
Data related to the srotodusti before and after the treatment
Udakavaha srotas Medovaha srotas Mootravaha srotas 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Sr. no
B A B A B A B A B A B A B A B A B A B A B A B A B A B A 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 + - + - - - - - + - + - + - - - + - - - + - - - - - - - 26 + - - - - - - - + - - - - - - - + - - - + - - - - - - - 27 + - - - - - - - + - + - - - - - + - - - + - - - - - - - 28 + - + - + - - - + - + - + - - - + - - - + - - - - - - - 29 + - + - + - - - + - + - - - - - + - - - + - - - - - - - 30 - - + - + - - - + - - - - - - - + - - - + - - - - - - -
Key words :-1.Jihwashosha ,2-Talushosha, 3- Ostashosha, 4- Klomashosha;5- Pipasa,
6-Sweda,7- Snigdhangata,8- Pipasa ,9-Alpalpa mootrata, 10-Mootrarodha ,11-Adhika
mootrata, 12-Sashoola mootrata, 13-Bastistabdhata
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 79
Subjective parameters of group A
Prabhoota mootrata Avila mootrata Trishna Ashaktata Sr.no BT AT BT AT BT AT BT AT
5 3 1 3 0 2 0 1 0 6 3 1 2 0 2 0 1 0 7 1 0 1 0 1 0 1 0 11 2 0 2 0 1 0 1 0 12 1 1 1 1 1 1 1 0 15 3 1 3 3 3 1 3 1 16 1 0 1 0 1 0 0 0 17 3 1 2 1 2 1 2 1 20 2 1 2 1 2 0 2 1 21 2 1 1 0 1 0 1 0 25 2 0 1 0 2 0 1 0 26 2 0 2 0 1 0 0 0 27 2 1 2 0 1 0 0 0 29 2 2 2 2 2 1 2 0 30 2 1 2 0 2 0 2 1
Subjective parameters of group B
Prabhoota mootrata Avila mootrata Trishna Ashaktata Sr.no BT AT BT AT BT AT BT AT
1 2 1 2 1 2 0 1 0 2 2 1 2 0 3 0 2 0 3 3 1 3 1 2 0 1 0 4 1 0 2 0 1 0 1 0 8 3 2 3 3 3 2 3 2 9 2 1 1 1 2 1 1 0 10 1 0 1 0 1 0 1 0 13 1 0 1 0 1 0 0 0 14 3 1 3 1 3 1 2 1 18 2 1 2 1 2 0 1 0 19 2 1 1 0 1 0 2 0 22 2 1 2 1 2 0 1 0 23 2 0 2 0 2 0 1 0 24 2 1 2 1 2 0 1 0 28 2 1 1 0 2 0 1 0
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 80
Objective parameters of group A
FBS in mg/dl PPBS in mg/dl US in % Sr.no BT AT BT AT BT AT
5 214 196 260 253 1 0.5 6 240 138 330 210 1.5 1 7 107 97 159 164 0 0 11 142 90 152 130 0 0 12 99 100 131 160 0 0 15 348 369 500 499 2 2 16 120 90 210 150 0 0 17 280 160 330 215 1.5 1 20 238 126 369 154 1.5 1 21 161 131 242 162 0.5 0 25 89 85 193 140 0 0 26 193 115 248 150 0.5 0 27 210 120 290 154 0.5 0 29 143 237 336 365 1 1.5 30 200 164 350 249 1.5 1
Objective parameters of group B
FBS in mg/dl PPBS in mg/dl US in % Sr.no BT AT BT AT BT AT
1 270 200 330 270 1.5 1 2 251 158 359 241 1.5 1 3 228 168 259 206 1 0.5 4 162 107 184 159 0 0 8 344 500 500 500 2 2 9 117 142 162 152 0.5 0.5 10 196 99 242 131 0.5 0 13 150 95 290 180 0.5 0 14 240 160 380 290 1.5 1 18 210 130 340 260 1.5 1 19 104 161 199 242 0 0.5 22 146 113 259 212 0.5 0 23 190 110 260 170 0 0 24 228 142 312 236 0.5 0 28 204 163 300 201 1 0.5
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 81
OBSERVATION
In the present study 30 patients were selected randomly and grouped as ‘A’ and ‘B’
each of fifteen each. All patients were observed closely during course of the
treatment. Changes both in subjective and objective parameters were recorded
according to the case sheet proforma. The data were collected as follows:
Section A- Demographic data
Section B- Data related to disease madhumeha
Section C – Data related to the response to the treatment
Section A – Demographic data
Age:
In the present study 30 patients of Madhumeha were included have age group of 25-
65 years. Maximum 20 (67%) were in between the age of 46-55 years , followed by 9
(30%) in between the 56-65 years and only 1(3%) falls in the age of 36-45 years .
Table showing the age ratio
Age (in years) No. of patient Percentage 26-35 0 0% 36 – 45 01 3% 46 – 55 20 67% 56 – 65 09 30%
Showing age ratio
26-350%
36 – 453%
46 – 5567%
56 – 6530%
26-3536 – 4546 – 5556 – 65
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 82
Sex:
Table showing the sex ratio
Sex No .of patient Percentage
Male 21 70%
Female 9 30%
Among the 30 patients , 21 ( 70%) patients were male and 9 (30 % ) were female
ones. This indicates the incidence of madhumeha is more in male.
Showing sex ratio
Male70%
Female30%
MaleFemale
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 83
Religion incidence
The data shows among 30 patients 27 (90%) belongs to religion Hindu, 3 (10% )
belongs to the Muslim category . It dos not mean that Hindus are more prone for this
disease. This may be due to the area from where sampling is being done.
Table showing the incidence of religion
Religion No . of patient Percentage
Hindu 27 90%
Muslim 3 10%
Others 0 0%
Showing the incidence of religion
Hindu90%
Muslim10%
Others0%
HinduMuslimOthers
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 84
Occupation This data shows among 30 patients 22 (73%) were belonging to active and 8(27%)
were belonging to the labour kind of occupation. This shows the less laborious work
might have more susceptibility to this disease.
Table showing the nature of occupation
Occupation No . of patient Percentage
Sedentary 0 0%
Active 22 73%
Labour 8 23%
showing the nature of occupation
Sedentary0%
Active73%
Labour27%
SedentaryActiveLabour
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 85
Socio economic state
Data related to socio economic state indicates that maximum 20 (66% ) falls in
middle class and 8 (27%) falls in the higher class. Only 2 (7%) falls in the category of
poor class. It suggest that poor class patient are not have the incidence of madhumeha
as compare to middle and higher class because chronic diet intake and less utility.
Table showing the socio economic state
Socio economic state No . of patient Percentage
Higher class 08 27%
Middle class 20 66%
Poor 02 7%
Showing the socio economic state
Higher class27%
Middle class66%
Poor7%
Higher classMiddle classPoor
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 86
Diet
The food habit distribution in the locality of research has more percentage of
vegetarians in comparison to mixed diet.
The ratio between vegetarian and mixed diet is 17:13 i.e., 57%:43% respectively.
Table showing the diet
Diet No . of patient Percentage
Veg 17 57%
Mixed 13 43%
Showing the diet
Veg57%
Mixed43% Veg
Mixed
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 87
Section B-Data related to disease Chronicity
The occurrence of disease varies for 0 years to more than 20 years. The incidence of
chronicity is not discriminate. The maximum 24 (80%) patients are have the
chronicity of 5years. 5 (16.67%) patients with the chronicity of 6-10 years and 1
(3.33%) with the 20 years chronicity.
Table showing the chronicity of madhumeha
Chronicity in years No . of patient Percentage
0-5 years 24 80%
6-10 years 05 16.67%
11-15 years 00 0%
16-20 years 01 3.33%
showing the chronicity of madhumeha
24
5
0 10
5
10
15
20
25
30
0-5 years 6-10years
11-15years
16-20years
No.
of p
atie
nts
Series1
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 88
Complaints
The data shows the 30(100%) patients with prabhoota mootrata, Avila mootrata and
trishna. 26(86.66%) patients shows Ashaktata, 10(33.33%) shows Janga Mansa
graham and only 5(16.66%)patients were with the sharira bhara hani. These
complaints drags the patients towards the disease.
Table showing the complaints
Complaints No . of patient Percentage
Prabhoota mootrata 30 100%
Avila mootrata 30 100%
Ashaktata 26 86.66%
Sharira bhara hani 5 16.66%
Janga mamsa graham 10 33.33%
Trishna 30 100%
30 3026
510
30
05
1015202530
NO. of patients
1
Complaints of Patient
Showing the complaints
PrabhootamootrataAvila mootrata
Ashaktata
SharirabharahaniJanga mansagrahamTrishna
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 89
Family history
The data related to family history shows maximum 20 (67%) patients without any
family history. 6(20%)patients were with maternal history and 4(13%) patients are
with the paternal history. These data suggest that the incidence of the disease not
depended on the hereditary factor but develops on aetiological factors.
Table showing the family history
Family history No . of patient Percentage
Maternal 06 20%
Paternal 04 13%
Absent 20 67%
showing the family history
Maternal20%
Paternal13%Absent
67%
MaternalPaternalAbsent
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 90
Treatment history
The data shows the presence of previous antidiabetic treatment confirms the disease
as madhumeha. Among 30 patients maximum 22(73%) shows the treatment history
different antidiabetic therapy and 8(27%) were freshly diagnosed and not shows any
medication.
Table showing the treatment history
Treatment history No . of patient Percentage
Present 22 73%
Absent 08 27%
Showing the treatment history
Present73%
Absent27%
PresentAbsent
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 91
Agni The data shows among the 30 patients 16(53%) are having Vishama Agni and
14(47%) are having Teekshna Agni. The involved both kind of are suggestive of the
disease as vikrutagnikruta(metabolic disorder).
Table showing the ratio of involved Agni
Agni No . of patient Percentage
Vishama 16 53%
Teekshna 14 47%
showing the involvement of agni
Vishama53%
Teekshna47% Vishama
Teekshna
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 92
Vyasana
Among the 30 patients maximum 13(44%) shows the Vyasana of tobacco and betal
nut, 10 (33%) are without any Vyasana , and 7 ( 23%) are having the Vyasana of
alcohol and smoking. The data suggest that vyasana are one the cause for the loss of
strength thus produce the disease.
Table showing the vyasana in relation with disease
Vyasana No . of patient Percentage
Alcohol & smoking 7 23%
Tobacco & betal nut 13 44%
No habit 10 33%
Showing the vyasana in relation with disease
Alcohol & smoking
23%
Tobacco & betal nut
44%
No habit33%
Alcohol & smoking
Tobacco & betalnutNo habit
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 93
Prakruti
In this study of 30 patients , maximum 15( 50%) are found of kapha prakruti,
pittakaphaj 5(16.67%) , vatapittaja and vatakaphaja 3(10%) each and vataja , pittaja
of 2(6.67%) each This data suggest that initially the madhumeha is found in kaphaja
Prakruti which is later makes avarana over the vata.
Table showing the prakruti
Prakruti No . of patient Percentage
Vataj 02 6.67%
Pittaj 02 6.67%
Kaphaja 15 50%
Vatapittaja 03 10%
Vatakaphaja 03 10%
Pittakaphaja 05 16.67%
0
5
10
15
no of patient
No . of patient
prakruti
showing the prakruti of the patient
VatajPittajKaphajaVatapittajaVatakaphajaPittakaphaja
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 94
Personal history
To asses the nidanas of the disease , detailed personal history is taken with more
concentration drawn towards ahara and vihara of the patients
1. Ahara
The data related to ahara for 30 patients shows that 26 (86.66%) consume
madhura ahara, 23(76.66%) sheeta, 28(93.33%) snigdha, 16(53.33%) guda,
26(86.66%) navanna , 21 (70%) dugdha , 28(93.33%) dadhi, 19(63.33%)
gudavikruti , 12(40%) dugdha vikruti ,13 (43.33%) Mamsa as a regular diet. All
these are prone to produce madhumeha.
Table showing the kind of ahara
Ahara No . of patient Percentage
Madhura 26 86.66% Sheeta 23 76.66% Snigdha 28 93.33% Guda 16 53.33% Navanna 26 86.66% Dugdha 21 70% Dadhi 28 93.33% Gudavikruti 19 63.33% Dugdhavikruti 12 40% Mamsa 13 43.33%
2.Vihara
2623
28
16
2621
28
19
12 13
05
1015202530
No. of patients
1
Ahara
showing the kind of ahara
MadhuraSheetaSnigdhaGudaNavannaDugdhaDadhiGudavikrutiDugdhavikrutiMamsa
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 95
2. Vihara
The data related to vihara shows among 30 patients 19 (63.33%) are performing
the alpavyayama,11 (36.33%) are avyayama. Lack of vyayama is leading the
condition towords the disease. About the state of nidra 12(40%) with diwaswapna
and 28 (93.33%) with the swapnasukha. This suggest the peaceful sleep may
agrrevate the diseased condition.
Table showing the vihara
Vihara No . of patient Percentage
Alpa vyayama 19 63.33%
Avyayama 11 36.33%
Diwaswapna 12 40%
Swapnasukha 28 93.33%
showing the vihara
19
11 12
28
05
1015202530
Alpa vy
ayam
a
Avyay
ama
Diwasw
apna
Swapna
sukha
vihara
No.
of p
atie
nts
Series1
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 96
3.Manasika chinta
When we notice the mental state , maximum27(90%) patients were noticed without
any mansaika chinta and only 3(10% ) patients were noticed with the manasika chinta
. It suggests that the happy life without any worries are causative factors for the
Madhumeha.
Table showing the involvement of manasika chinta
Manasika chinta No . of patient Percentage
Yes 3 10%
No 27 90%
showing the involvement of manasika chinta
Yes10%
No90%
YesNo
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 97
Section C-Data showing the response to the treatment
Data related to srotas
The three major srotas i.e, udakavaha , medovaha and mootravaha are generally
involved in the manifested disease. The srotodusti lakshana are usually found .
Udakavaha srotas
Among the 30 treated cases, Jihwashosha is in 28(93.33%) before treatment
and not found (0%) after the treatment. Talushosha is in 18 (60%)before treatment
and 2(6.66%)after the treatment. Ostashosha is in19(63.33%)before treatment and
3(%)after the treatment. Kloma shosha is not found. All 30(100%) suffer with pipasa
before treatment and only 2 (6.66%) are found after the treatment. Pipasa and
jihwashosha takes major improvement by the treatment.
Table showing the comparison of udakavaha srotodusti lakshana before and
after the treatment.
Before treatment After treatment Laxana No . of patient
Percentage No . of patient
Percentage
Jihwashosha 28 93.33% 00 0% Talushosha 18 60% 02 6.66% Ostashosha 19 63.33% 03 10% Klomashosha 00 0% 00 0% Pipasa 30 100% 02 6.66%
28
0
18
2
19
3 0 0
30
20
102030
No. of patients
Jihwashosha Klomashosha
Srotodusti laxana
Comparison of udakavaha srotodusti laxana before and after the treatment
BTAT
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 98
Medovaha srotas
The data related to medovaha srotas shows among 30 treated
patient,28(93.33%)are with sweda before treatment and 4(13.33% )after the treatment.
Snigdhangata is in 17(56.66 %) before treatment and only 2(6.66 %) after the
treatment. Pipasa is found in all 30(100 %) before treatment and only in 2 (6.66 %)
after the treatment. Thus the medovaha srotas is responded with the medication.
Table showing comparison of medovaha srotodusti lakshanas before and
after the treatment
Before treatment After treatment Laxana No . of patient Percentage No . of patient Percentage
Sweda 28 93.33% 04 13.33% Snigdhangata 17 56.66% 02 6.66% Sthoola shophata 00 0% 00 0% Pipasa 30 100% 02 6.66
28
4
17
2 0 0
30
2
05
1015202530
No. of patients
Sweda Sthoolashophata
srotodusti laxana
Comparision of medovaha srotodusti laxana before and after the treatment
BTAT
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 99
Mootravaha srotas
Among 30 patients all 30(100%) show the adhika mootrata before treatment
and only 2(6.66 %) shows after the treatment
Table showing the comparison of mootravaha srotodusti lakshana before and
after the treatment.
Before treatment After treatment Laxana No . of patient Percentage No . of patient Percentage
Alpalpa mootrata 00 0% 00 0% Mootrarodha 00 0% 00 0% Adhika mootrata 30 100% 02 6.66% Sashoola mootrata 00 0% 00 0% Basti stabdhata 00 0% 00 0%
0 0 0 0
30
2 0 0 0 005
1015202530
No. of patients
Alpalpamootrata
Adhikamootrata
bastistabdhata
srotodusti laxana
Comparision of mootravaha srotodusti laxana before and after the treatment
BTAT
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 100
Data showing the intensity of disease before and after treatment
The data related to intensity are given the gradation particular to each complaints.
1.Prabhoota mootrata
Table showing the Prabhoota mootrata before treatment in group A and group B
Grade 3 Grade 2 Grade 1 Grade 0 Group No. of patient
% No. of patient
% No. of patient
% No. of patient
%
A 4 26.66% 8 53.33% 3 20% - - B 3 20% 9 60% 3 20% - - These data reveals the complaint Prabhoota mootrata has the Grade 3, within 4
(26.66%)
patients of group A and of 3 (20%) in group B. There are 8(53.33%) patients of
group A and 9 (60%) patients of group B are in Grade 2. 3(20%)patients of each
group are in Grade 1 during before treatment.
Table showing the Prabhoota mootrata after the treatment in group A and
group B
Grade3 Grade 2 Grade 1 Grade 0 Group No. of patient
% No. of patient
% No. of patient
% No. of patient
%
A 0 0 % 1 6.66% 9 60 % 5 33.33%B 0 0 % 1 6.66% 10 66.66
% 4 26.66%
After the completion of treatment , in15 patients of each group, there no patients at
Grade 3.1(6.66%)each patients are at Grade 2. maximum 9 (60%)of group A and
10(66.66%) of group B have reached the grade 1.Thus there are 5(33.33%) and
4(26.66%) patients of group A and B respectively at grade 0.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 101
0
0.5
1
1.5
2
2.5
3
Grades
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Patients
comparision of prabhoota mootrata before and after the treatment in group A
Series1Series2
0
0.5
1
1.5
2
2.5
3
grades
1 3 5 7 9 11 13 15patients
Comparision of Pabhoota mootrata before and after the treatment in group B
Prabhoota mootrata BTPrabhoota mootrata AT
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 102
Avila mootrata
Table showing the Avila mootrata before treatment in group A and group B
Grade3 Grade 2 Grade 1 Grade 0 Group No. of patient
% No. of patient
% No. of patient
% No. of patient
%
A 2 13.33% 8 53.33% 5 33.33% 0 0%B 3 20% 7 46.66% 5 33.33% 0 0%
Before treatment among 15 patients of each group, 2(13.33%) and 3(20%) of group
A and group B respectively are at grade 3. Maximum 8(53.33%) of group A
and7(46.66%) of group B are on grade 2.5(33.33%) of each group are at the grade 1.
Table showing the Avila mootrata after the treatment in group A and group B
Grade3 Grade 2 Grade 1 Grade 0 Group No. of patient
% No. of patient
% No. of patient
% No. of patient
%
A 1 6.66% 1 6.66% 3 20% 10 66.66%B 1 6.66% 0 0% 8 53.33% 6 40% After the completion of the treatment , there are still 1 (6.66%) of each group are
resides at grade3. only 1(6.66%) patient of group A is on grade 2. Maximum
8(53.33%) patients of group B are at grade 1 and only 3 (20%) of group A at grade
1.Maximum 10 (66.66%) patients of group A are at grade 0, only 6(40%) of group B
are at this grade.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 103
00.5
11.5
22.5
3
Grades
1 3 5 7 9 11 13 15
Patients
Comparison of avila mootrata before and after treatment in group B
Avila mootrata BTAvila mootrata AT
00.5
11.5
22.5
3
grades
1 3 5 7 9 11 13 15
patients
comparison of avila mootrata before and after the treatment in group A
Avila mootrata BTAvila mootrata AT
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 104
Trishna
Table showing trishna before the treatment in group A and B
Grade3 Grade 2 Grade 1 Grade 0 Group No. of patient
% No. of patient
% No. of patient
% No. of patient
%
A 1 6.66% 7 46.66% 7 46.66% 0 0%B 3 20% 8 53.33% 4 26.66% 0 0% Before treatment the data relating to the trishna shows among the 15 patients of each
group ,at grade 3 there are 1 (6.66%) of group A and 3 (20%) of group B. Maximum
7(46.66%) of group A and 8 (53.33%) of group B are at grade2. 7 (46.66%) and 4
(26.66%) patients of group A and B are at grade 1 respectively.
Table showing trishna after the treatment in group A and B
Grade3 Grade 2 Grade 1 Grade 0 Group No. of patient
% No. of patient
% No. of patient
% No. of patient
%
A 0 0% 0 0% 4 26.66% 11 73.33%B 0 0% 1 6.66% 2 13.33% 12 80% After the treatment there are no patients in grade 3 of both groups. Only 1(6.66%) of
group B is at grade2. 4(26.66%)and 2(13.33%) of group A and B respectively at grade
1.Maximum 11 (73.33%) and 12(80%) of group A and B have reached the grade 0.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 105
0
0.5
1
1.5
2
2.5
3
grades
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Patients
Comparision of trishna before and after the treatment in group A
Trishna BTTrishna AT
0
0.5
1
1.5
2
2.5
3
Grades
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Patients
Comparision of trishna before and after treatment in group B
Trishna BT
Trishna AT
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 106
Ashaktata
Table showing Ashaktata before treatment in group A and B
Grade3 Grade 2 Grade 1 Grade 0 Group No. of patient
% No. of patient
% No. of patient
% No. of patient
%
A 1 6.66% 4 26.66% 7 46.66% 3 20% B 1 6.66% 3 20% 10 66.66% 1 6.66% Before treatment among the 15 patients of each group , there are1 (6.66%) patient
from each group is at grade 3. 4(26.66%) of group A and 3 (20%) of group B are at
grade 2.Maximum 7(46.66%) patient of group A and 10(66.66%) of group B are at
grade 1.Finally 3(20%) and 1 (6.66%)of group A and B respectively are at gra
Table showing Ashaktata After treatment in group A and B
Grade3 Grade 2 Grade 1 Grade 0
Group No. of patient
% No. of patient
% No. of patient
% No. of patient
%
A 0 0% 0 0% 4 26.6% 11 73.33%B 0 0% 1 6.66% 1 6.66% 13 86.6% After treatment none are at grade 3,only 1(6.66%) of group B at grade 2.4(26.66%)
and 1(6.66%)patientsof group A nad B are at grade 1 respectively . Maximum
11(73.33%) of group A and 13(86.6%) of group B are at grade 0.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 107
00.5
11.5
22.5
3
Grades
1 3 5 7 9 11 13 15
Patients
comparision of ashaktata before and after the treatment in group A
Ashaktata BTAshaktata AT
0
0.5
1
1.5
22.5
3
Grades
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Patients
Comparision of ashaktata before and after the treatment in group B
BTAT
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 108
Data showing the relief from complaint after treatment in both groups
Before treatment After treatment Parameters Group No. of patients
% No of patients(Relieved)
%
A 15 100% 05 33.33% Prabhoota mootrata B 15 100% 04 26.66%
A 15 100% 10 66.66% Avila mootrata B 15 100% 06 40% A 15 100% 11 73.33% Trishna B 15 100% 12 80% A 12 80% 08 66.66% Ashaktata B 14 93.33% 11 78.57%
To asses total relief the data collected as above shows that, among 15 patients of each
group , all 15( 100%)of each group are with the complaint of Prabhoota mootrata. In
this category, 5 (33.33%) of group A and 4 (26.66%) of group B are relieved . Avila
mootrata is found in all 15(100%) patients of each group before treatment, thus the10
(66.66%) patients of group A and 6 (40%) patients of group B are relieved after the
treatment. Trishna is also found with all 15(100%) patients of each group before
treatment, 11 (73.33%) of group A and 12(80%) patients of group B are relieved. But
Ashaktata is found in 12(80%) patients of group A and 14(93.33%) patients of group
B before treatment . After treatment the 08 (66.66%) are relieved from Ashaktata in
group A and 11 ( 78.57%) of group B are relieved from the complaint initially
suffering.
02468
10121416
no. of patients
A B A B A B A B
Prabhootamootrata
Avilamootrata
Trishna Ashaktata
complaints of both group before and after the treatment
Showing relief after the treatment
BT
AT
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 109
Comparison of FBS before and after the treatment in group A :
The comparison of FBS in group A , before and after the treatment shows great
variations. Among 15 patients , 3 (20%) shows increase in the values, with the
difference of maximum 94 mg/dl and minimum 1mg/dl. Remaining 12 (80%) shows
decrease , with maximum difference 120 mg/dl and minimum 4mg/dl.
Comparison of FBS before and after the treatment in group B
Among 15 patients of group B , the FBS shows the raise in 3 (20%) with highest
difference 156 mg/dl. and lowest 25mg/dl.the reduction is found in remaining 12
(80%) with highest difference of 97mg/dl and the lowest 33 mg/dl.
0100200300400500
FBS
1 3 5 7 9 11 13 15
Patients
Comparison of FBS before and after the treatment in group B
FBS in mg/dl BTFBS in mg/dl AT
0
100
200
300
400
FBS
1 3 5 7 9 11 13 15
Patients
Comparison of FBS before and after the treatment in group A
FBS in mg/dl BTFBS in mg/dl AT
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 110
Comparison of PPBS before and after the treatment in group A :
Among 15 patients of group A , the PPBS shows the raise in 3 (20%) with highest
difference 29 mg/dl. and lowest 5mg/dl.The reduction is found in remaining 12 (80%)
with highest difference of 215mg/dl and the lowest 1 mg/dl.
Comparison of PPBS before and after the treatment in group B
Among 15 patients of group B , the PPBS shows the raise in 3 (20%) with highest
difference 43mg/dl. and lowest 0mg/dl.The reduction is found in remaining 12 (80%)
with highest difference of 118 mg/dl and the lowest 10 mg/dl.
0100200300400500
PPBS
1 3 5 7 9 11 13 15
Patients
Comparision of PPBS before and after treatment in group A
PPBS in mg/dl BTPPBS in mg/dl AT
0
100
200
300
400
500
PPBS
1 3 5 7 9 11 13 15
Patients
comparision of PPBS before and after the treatnent in group B
PPBS in mg/dl BTPPBS in mg/dl AT
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 111
Comparison of US before and after the treatment in group A :
Among 15 patients of group A , the US is present in 10(66.66%) patients only
before the treatment. Among these 10(66.66%) patient , 1(6.66%) has the US at 2 %
before which is not changing even after the treatment. One( 6.66%)patient with nil
US showed 5% after the treatment. One(6.66%) with US 1% before treatment has
raised to1.5% after the treatment.5(33.33%) patients with nil US before treatment
remains unaltered after the treatment. 4 (26.66%) patients with 1.5% US before
treatment reduced to 1% after treatment. 1(6.66%) with1% US before treatment gets
0.5% after treatment. 3 (20%) patient with 0.5% US before treatment attains nil
after the treatment.
0
0.5
1
1.5
2
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Comparsion of US before and after treatment in group A
US in % BTUS in % AT
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 112
Comparison of US before and after the treatment in group A :
Among 15 patients of group A , the US is present in 12(80%) patients only
before the treatment. Among these 12(80%) patient , 1(6.66%) has the US at 2 %
before which is not changing even after the treatment. One( 6.66%)patient with nil
US showed 5% after the treatment. One(6.66%) with US 0.5% before treatment has
remained to0.5% after the treatment.2(13.33%) patients with nil US before treatment
remains unaltered after the treatment. 4 (26.66%) patients with 1.5% US before
treatment reduced to 1% after treatment. 2(13.33%) with1% US before treatment gets
0.5% after treatment. 3 (20%) patient with 0.5% US before treatment attains nil
after the treatment.
0
0.5
1
1.5
2
US
1 3 5 7 9 11 13 15
Patients
Comparision of US before and after the treatment in group B
US in % BTUS in % AT
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 113
Results
Result of the study on the basis the subjective and objective parameters is given
as follows:
Group A
Table showing the result of group A
Results related to group A shows , among 15 patients suffering with madhumeha,
9(60%) are relieved, 4 (27%) are palliative and 2 ( 13 %) are not responded.
Results No. of patients Percentage
Relieved 9 60%
Palliative 4 27%
Not responded 2 13%
showing the result in group A
Relieved60%
Palliative27%
Not responded13%
RelievedPalliativeNot responded
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 114
Group B
Table showing the result of group B
Results No. of patients Percentage
Relieved 7 47%
Palliative 6 40%
Not responded 2 13%
Among 15 patients , 7 (47%) are relieved, 6 (40%) are palliative and 2( 13%) are
found to be not responded in group B.
showing the results of group B
Relieved47%
Palliative40%
Not responded13%
RelievedPalliativeNot responded
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 115
Total result
Table showing the total result
The total result can be given as follows. Among total 30 patients 16(54%) are found
to be relieved ,10 (33.33%) are found to be palliative and 4 (13%) are found to be not
responded.
Results No. of patients Percentage
Relieved 16 54%
Palliative 10 33%
Not responded 4 13%
showing the results
Relieved54%Palliative
33%
Not responded13%
RelievedPalliativeNot responded
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 116
Statistical study of both groups is done to rule out the efficacy of both Avartaki
pushpa and avartaki beeja.
Individual study of Group A before and after the treatment
Parameters Mean S.D S.E t value P value Remarks
FBS 53.2 41.915 10.822 4.915 <0.001 H.S
PPBS 71.4 60.19 15.542 4.59 <0.001 H.S
US 0.3 0.253 0.065 4.615 <0.001 H.S
Prabhoota mootrata 1.33 0.723 0.186 7.15 <0.001 H.S
Avila mootrata 1.266 0.883 0.228 5.55 <0.001 H.S
Trishna 1.33 0.617 0.159 8.36 <0.001 H.S
Ashaktata 0.8 0.676 0.174 4.597 <0.001 H.S
Individual study of Group B before and after the treatment
Parameters Mean S.D S.E t value P value Remarks
FBS 71.66 32.23 8.323 8.609 <0.001 H.S
PPBS 67.466 37.26 9.62 7.013 <0.001 H.S
US 0.366 0.228 0.059 6.203 <0.001 H.S
Prabhoota mootrata 1.2 0.414 0.106 11.320 <0.001 H.S
Avila mootrata 1.2 0.676 0.174 6.896 <0.001 H.S
Trishna 1.533 0.743 0.191 8.026 <0.001 H.S
Ashaktata 1.0666 0.457 0.118 9.038 <0.001 H.S
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 117
Comparative study of group A and group B after the treatment
Parameters Group Mean S. D S. E P.S. E t- value P value Remarks
A 147.86 74.55 19.249FBS
B 162.7 98.22 25.36
31.837 0.466 >0.05 N.S
A 210.333 100.93 26.061PPBS
B 230.0 87.85 22.68
34.54 0.569 >0.05 N.S
A 0.466 0.667 0.172 US
B 0.533 0.581 0.150
0.228 0.293 >0.05 N.S
A 0.733 0.593 0.153 Prabhoota
mootrata B 0.8 0.5606 0.144
0.21 0.067 >0.05 N.S
A 0.533 0.915 0.236 Avila
mootrata B 0.666 0.816 0.210
0.315 0.422 >0.05 N.S
A 0.266 0.457 0.118 Trishna
B 0.266 0.593 0.153
0.193 2.41 <0.05 H.S
A 0.266 0.457 0.118 Ashaktata
B 0.733 0.593 0.153
0.193 2.41 <0.05 H.S
When we compare group A and B , all the parameters shows non significant except
trishna and ashaktata. The mean effect of trishna in both the groups is same. The
parameters PPBS , prabhoota mootrata and avila mootrata are having uniform
effecting group B the mean effect of FBS is more in Group B and shows more
variations.
Individually the Group B is having more effect then group A in all symptoms.
The prabhoota mootrata is much significant than the other s parameter FBS the mean
net effect is more in group B . The objective parameter FBS the mean net effect is
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Results 118
more in group B and correspondingly variance is more ( by using paired ‘ t’ test,
unpaired ‘t’ test, by comparing ‘t’ values, co- efficient of variation and ‘P’ value is <
0.05.
Discussion
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
119
DISCUSSION
The trail drug Avartaki is growing abundantly in the tropical country like
India, hence it is commonly found from Gujarat, Maharastra and southern India .The
drug is used commercially to dye the leather and medicinally in various disorders. The
different parts of the plant are used as medicine .Among them the flower, seeds and
leaves are frequently used . Most of the classical texts indicates the seeds in
conjunctivitis, chylous urine, etc. and flower in garbhasrava , kusta , trishna etc. But
both flowers and seeds are indicated in madhumeha.
The drug possesses the tikta, kashaya rasa, sheeta veerya , katu vipaka and
laghu , rooksha guna. Thus it may be said that its activity is based on these properties
can be mootrasangrahaneeya, as the most of mootrasangrahaneeya gana dravya with
such qualities do so.
Madhumeha is the disorder, where the madhura tatwa is discharged through
the urine giving sweetness to it. The pratyatma lakshana are Prabhoota mootrata and
Avila mootrata. Avilata is due to the presence of the madhura tatwa. Prabhoota
mootrata is the atipravrutti lakshana of the mootravaha srotas due to the accumulation
of vitiated dosha in the basti. Among the tridosha the kapha and pitta are causing
avarana to the vata leading to the disorder. Similarly in the NIDDM the beta cells of
the pancreas are acting deficiently thus due to increased secretion of glucogon as
proportional to insulin there is hyperglycemia. Thus the blood with high concentration
of glucose, undergone for filtration in the kidney, does not capable to regain the
filtrated glucose and the glucose thus passes out through the urine. Hence comparison
seems true and thus needs the alike medication. Avartaki is one such drug which
possesses the features that effective in madhumeha.
The line of the treatment in both condition can given as follows.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
120
Madhumeha: It is a chiefly due to the dosha avarana to the vata, hence considered
under the vataja prameha. For this purpose the drug choosen should be capable of the
elimination of the avarana and mitigate the avarakas. The Prabhoota mootrata causes
the excessive loss of fluid which results into trishna , and Ashaktata due to the
madhura tatwa hani. The dosha mainly avruta i.e. kapha and pitta can be subsided by
the tikta kashaya rasa, i.e. kapha and pitta shamana. Katu vipaka and laghu, rooksha
guna subsides the kapha and sheeta veerya subsides the pitta.
To over rule, the loss of urine should be prevented , which can be performed
by the tikta and kashaya rasa because of rookshana of the drava and sangrahana,
sheeta veerya because of the sroto sankuchana, sangrahana, katu vipaka because of
baddhata of mootra, and finally by laghu , rooksha guna because of the rookshana
karma of the vayu mahabhuta. As the prabhoota mootrata is stopped the loss of
madhura tatwa is also be prevented that leads to the regain of energy. The sheeta
veerya also provides the balya and jeeveneeya function. The tikta also acts as the
trishnahara , dahaprashamana , those appears associating the condition. The
prevention of loss of fluid also reduces the trishna. Even the overeating , one of the
causative factor is mitigated due to the tikta rasa .as the pathogenesis involves the
meda vruddhi can corrected by the tikta rasa and laghu , rooksha guna.
DM ;NIDDM: The deficiency of the insulin is to be fulfilled, either by promoting the
beta cells function, reducing the alpha cell function. in order to lower the blood
glucose level
The trial drug Avartaki possesses the properties as tikta , kashaya rasa, katu
vipaka ,sheeta veerya and laghu , rooksha guna. Thus it can be interpretated that the
avartaki is effective in the management of madhumeha as it is fulfilling the
requirements said above. Although the classical reference for the management of
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
121
madhumeha by avartaki , two parts are mentioned ,i.e. avartaki pushpa and avartaki
beeja. The efficacy of these two parts are evaluated by the clinical trial.
The design of the study on madhumeha is a comparative clinical study. Thus
this trail is carried out with the 2 groups receiving two kinds of medicines.
1. Group A- Avartaki beeja churna
2. Group B- Avartaki pushpa churna
Many of the hypoglycemic activity studies are carried out with various herbal drugs
and even with the avartaki itself. In comparison to synthetics, the safest and
efficacious , evaluation of a drug on madhumeha is required. Hence two parts of the
avartaki are indicated and many experimental studies of avartaki in madhumeha ,
Avartaki beeja and avartaki pushpa were selected for the comparative clinical study.
Group A- Avartaki beeja
Clinical study of group A, is carried out by administration of avartaki beeja churna in
15 patients showed its significant values at the level of probability as < 0.001.The
avartaki beeja is effective in all the parameters. The research works have shown that
these seeds contain palmatic oleic acid, Oligosaccharides and galactomanos which
have role in the hypoglycemic activity. But compare to the other group the gradation
have not much improvement.
Group B – Avartaki pushpa
The clinical study of group B was carried out by the administering avartaki pushpa
churna in other 15 patients. The significant value at the level of probability as <0.001
.All the parameters are highly significant .The known component of the flower is the
beta sitosterol which is effective anti inflammatory, anti neoplasmic and immune
modulator. Thus it is capable of reducing the elevated blood sugar level to the
normal. Hence avartaki pushpa seems to more effective than the beeja.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
122
Observations regarding the study are indicating the prevalence of the disease
in the following conditions among the study of 30 patient of madhumeha.
The disease is diagnosed on the subjective and objective parameters as
mentioned in the methodology. The data related to age suggests that middle aged
persons are more prone (67%) to Madhumeha. The male (70%) showed the incidence
of the disease. The majority of patients are of active (73%) with less laborious work
might have more susceptibility to the disease. All patients shows the vitiated agni
which suggests the disease manifestation due the vikrutagni. The family history is
absent 20 (67%) giving the clue for manifestation of the disease due to the
aetiological factor. The maximum 50% Kaphaja Prakruti of the patient gives hint for
the manifestation of by avarana. The data relating the personal history are identical to
the aetiological factor mentioned the texts for the madhumeha.
The data related to the response to the treatment showed the effectiveness of
both drug in all parameters with varying degree. In group A 9 (60%) are relieved , 4
(27%) are palliative and 2 ( 13%) are not responded. In group B 7 (47%) are relieved,
6 (40%) are palliative and 2(13%) are not responded. The selection of the patient is
randomised for both groups. The comparison of results indicates that group A is
efficacious on first look. But when the gradation of the parameters are subjected for
the statistical analysis the group B is found efficacious. The mean net effect of FBS is
more in group B and correspondingly variances are more .
Therefore the comparative study showed non significant but comparatively
the avartaki pushpa is extremely efficacious than the avartaki beeja.
Conclusion
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Conclusion 123
CONCLUSION
The dissertation entitled ‘Evaluation of efficacy of Avartaki in madhumeha
(NIDDM)’ is concluded as below:
Madhumeha is becoming a epidemic with high rate of morbidity and mortality.
The various kinds of managements could not satisfactorily control this condition .
Medicinal plants used since immemorial time, in many disorder. Avartaki is one
such drug with multidimensional actions used as medicine.
Medicinal values of avartaki ranges varyingly by utilization of different parts
avartaki pushpa and avartaki beeja are used chiefly in madhumeha (prameha).
Madhumeha is one of 20 varieties of prameha. It is vata predominant, or due the
doshavarana to vata, considered under the vataja prameha.
DM is co- related with the madhumeha especially the NIDDM (Type -2) which
have the similar pathogenesis and the manifestation.
The classical affirmed pathogenesis and the signs and symptoms in madhumeha
(NIDDM) are stand still even in 21st centaury . The pratyatma lakshana are
Prabhoota mootrata and Avila mootrata.
The multidimensional action of avartaki promotes the comparative clinical study
over the 30 patients in 2 groups
• Group A- Avartaki beeja
• Group B- Avartaki pushpa
The result of the study showed both the drugs are efficacious in the madhumeha.
The parameters shows high significance rate with respect to both groups. In group
A 9 patients are relieved, 4 are palliative, and 2 are not responded. In group B 7
are relieved 6 are palliative and 2 are not responded.
Avartaki pushpa is more efficacious than the avartaki beeja.
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Conclusion 124
As the classical literature the reason for the hypoglycemic effect is possible by the
property of tikta rasa and sheeta veerya of the drug. The antidiabetic activity may
be due to the presence of beta sitosterol, a phytosterol.
Finally the avartaki pushpa and avartaki beeja are the safer, therapeutically
efficacious, cost effective and easily available can be considered as the drug of
choice.
Future scope:
Though the clinical study shows high significance the study should be
conducted on the large sample.
The detailed phytochemical study is to be carried out.
The drugs should be evaluated in IDDM cases also.
Summary
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Summary 125
SUMMARY
The dissertation entitled ‘Evaluation of efficacy of avartaki in madhumeha
(NIDDM)’ is summarized as follows:
Under the heading of introduction the necessity of the assortment of the
research , significance of the drug in the present work is mentioned .
Aims and objectives of the study are dealt in the objectives.
Review of literature consists of literary review of drug avartaki and disease
madhumeha. The drug review deals with the history, synonyms, varga, guna,
karma, prayoga , taxonomical classification, family description, morphology ,
phyotochemistry etc. in detail.
The majority of the references describe, the avartaki has properties as tikta ,
kashaya rasa, katu vipaka, sheeta veerya, laghu, rooksha guna and action as
pramehaghna, trishnahara, chardighna, krimighna etc. because of this one can
conceptualize that drug must effective in the madhumeha and other related
condition.
The disease review has the detailed description of madhumeha in ayurvedic
aspect and DM in modern aspect as those are co related in each angle .
Materials and methods are described in detail in methodology which is
followed in the present study.
Observation related to demography , disease, and effect of medication are
presented in tables and graphs, the statistical analysis and results are included
Discussion of the clinical study about the results was done over it.
The thesis is concluded under the conclusion .The efficacy of avartaki pushpa
and avartaki beeja are comparatively studied, that reveals that both are highly
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Summary 126
significant and when compared the avartaki pushpa is found better than the
avartaki beeja.
Finally the essence of the thesis is summarized in the summary
Bibliography
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Bibliography 127
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Annexures
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Case sheet 141
PROFORMA FOR THE EVALUATION OF EFFICACY OF AVARTAKI IN
MADHUMEHA
Post Graduation Studies and Research Dept. Of Dravya Guna Vignana
D.G.M. Ayurvedic Medical College Gadag
Guide: Dr. G.V. Mulagund M.D (Ayu) Co –Guide: Dr. Kuber . Sankh M.D.(Ayu) Scholar: Dr. S.B.Bani Name of the patient: Address: Sr. no: Age: OPD.No
Sex : M F D.O.I
Religion H M C O D.O.C Occupation Sedentary Active Labour Socio-economic state HC MC Poor Results Relieved Palliative Not responded Discontinued Consent: I here by giving my consent
to be included as a subject in the above study. I have been informed to my satisfaction
, by investigator about the purpose of the clinical trail, nature of the drug treatment
and its follow up. I am also aware of my right to quit at any time during the course of
the trail without having to reason for doing so.
Signature of investigator Signature of patient
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Case sheet 142
CHIEF COMPLAINTS
No Complaints Duration Before treatment After treatment
1 Prabhoota mootrata 2 Avila mootrata 3 Ashaktata 4 Shareera bhara hani 5 Janga mamsa graham 6 Trishna
FAMILY HISTORY
Father Grand father Brother Uncle Mother Grand mother Sister Aunt
TREATMENT HISTORY Medication Dose Ayurvedic Specify
Glibendamide Sulfonylures Glipizide
Oral hypoglycemic agents Bigunides Metformin PERSONAL HISTORY
Veg Mixed Guda Gramya Mansa Navanna Dugdha vikruti Audaka
Form
Dugdha Dadhi Anupa Pramana Alpa Madhyama adhika Rasa Madhur Amla Lavana Tikta Katu Kashaya
Ahara
Guna Snigdha Sheeta Vyayama Alpa vyayama Avyayama Nidra Swapnasukha Diwaswapna Manasika chinta Yes No Agni Vishama Teekshna Vyasana ( if any)
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Case sheet 143
GENERAL EXAMINATION Pulse BP Height Akruti Temp Resp Weight Heart sounds SROTO PAREEKSHA
L Jihwashosha
Talushosha Ostashosha Klomashosha Pipasa
B
Udakavaha
A L Alpalpa
mootrata Adhika mootrata
Sashoola mootrata
Mootrarodha Basti stabdhata
B
Mootravaha
A L Sweda Snigdhangata Sthoola shophata Pipasa B
Medovaha
A ATURA BALA PAREEKSHA
Deha V P K VP VK PK S Prakruti Mana R S T RS RT ST S
Sara Rasa Mansa Meda Sarva Samvahana Susnhita Madhyama
sanhita Avara sanhita
Satmya Pravara Madhyama Avara Satwa Pravara Madhyama Avara Vaya Bala Proudha Vruddha Desha Jangala Anupa Sadharana SUBJECTIVE PARAMETER No Parameters 0th day 10th day 20th day 30th day 1 Prabhoota mootrata 2 Avila mootrata 3 Trishna 4 Ashaktata
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Case sheet 144
INVESTIGATIONS
Investigation Before After Urine sugar
FBS PPBS
Blood sugar
GTT TREATMENT PROTOCOL:
Medicine Dose Started on
INVESTIGATOR’ NOTE: Signature of scholar Signature of co-guide Signature of Guide
Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)
Case sheet 145
Gradation for subjective parameters to asses the result
Sr. no Subjective parameter Gradation according to state
1 Prabhoota mootrata 0-no complaints
1- patient is not aware of complaint
2-patient is aware of complaint
3-patient is disturbed by the complaint
2 Avila mootrata 0-clear urine
1- turbid urine +
2-turbid urine ++
3-turbid urine +++
3 Trishna 0- no complaint
1-mild ( desire for water)
2-moderate ( frequently drinks water)
3-severe ( strongly needs water)
4 Ashaktata 4- no complaints
5- feels weakness
6- routine activities are not affected
7- routine activities are affected