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A Clinical Study on the Efficacy of a Nutritional Compound In Prameha, Arora Manish T., DEPARTMENT OF POST GRADUATE STUDIES IN SWASTHAVRITHA S.D.M. COLLEGE OF AYURVEDA AND HOSPITAL,HASSAN – 573201, 2006TRANSCRIPT
A Clinical Study on the Efficacy of a Nutritional Compound
In Prameha
By
Arora Manish T.
Dissertation Submitted to the
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES; KARNATAKA,
BANGALORE
In partial fulfilment of the requirements for the degree of
AYURVEDA VACHASPATI (M.D. AYURVEDA)
In
SWASTHAVRITHA
Under the guidance of
Dr. Ramana G.V. M.D (Ayu)
Prof & HOD. PG studies in Dept of Swasthavritha
DEPARTMENT OF POST GRADUATE STUDIES IN SWASTHAVRITHA
S.D.M. COLLEGE OF AYURVEDA AND HOSPITAL,
HASSAN – 573201
2006
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation / thesis entitled “A clinical study on the efficacy of
a nutritional compound in Prameha” is a bonafide and genuine research work carried
out by me under the guidance of Dr. Ramana G.V. Professor, Department of Post
Graduate Studies In Swasthavritha, S. D. M. College of Ayurveda and Hospital, Hassan –
573 201.
Hassan
Arora Manish T.
DEPARTMENT OF POST GRADUATE STUDIES IN SWASTHAVRITHA
S. D. M. COLLEGE OF AYURVEDA & HOSPITAL, HASSAN – 573 201.
(Affiliated to Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka)
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “A clinical study on the efficacy of
a nutritional compound in Prameha” is a bonafide research work done by “Arora
Manish T.” under my guidance in partial fulfilment for the degree of Ayurveda
Vachaspati (M.D. Ayurveda) in Swasthavritha.
Date: Hassan Dr. Ramana G V. Professor P. G. Studies in Swasthavritha.
S D M College of Ayurveda, Hassan.
DEPARTMENT OF POST GRADUATE STUDIES IN SWASTHAVRITHA
S. D. M. COLLEGE OF AYURVEDA & HOSPITAL, HASSAN – 573 201
(Affiliated to Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka)
ENDORSEMENT BY THE H O D; PRINCIPAL / HEAD OF THE INSTITUTION
This is to certify that the dissertation entitled “A clinical study on the efficacy of a
nutritional compound in Prameha” is a bonafide research work done by “Arora
Manish T.” under the guidance of Dr. Ramana G.V, Professor, Department of Post
Graduate Studies In Swasthavritha, S.D.M. College of Ayurveda, Hassan - 573201.
Dr. Ramana G.V Dr. Prasanna N Rao Professor and HOD Principal P G Studies in Swasthavritha, S D M College of Ayurveda, S D M College of Ayurveda, Hassan. Hassan.
COPYRIGHT
DECLARATION BY THE CANDIDATE
I hereby 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 academic / research purpose.
Hassan Arora Manish T.
© Rajiv Gandhi University of Health Sciences, Karnataka.
ACKNOWLEDGEMENT
I offer my salution to Lord Bhagawan Dhanvantari and Lord
Manjunatha with whose showering of blessings this task was ventured without
any hindrances.
On this solemn occasion of successful accomplishment of my work, my reverence
and deep sense of gratification is due for my parents Mr. Tirthram Arora & Mrs.
Laxmi Devi Arora, who are the architects of my career. The perseverance, discipline and
culture, which I could imbibe, is solely because of their painstaking upbringing and
strong moral support
I take this opportunity to express my deep sense of gratitude towards
Dharmadhikari Pujya Padmabhushana Dr. VIRENDRA HEGDEJI, the founder
president of SDM Educational Society, who provides me an opportunity of joining in this
esteemed institution.
I am very much thankful to Prof. PRASANNA .N. RAO, Principal, who
provided the necessary facilities & their timely help, inspiration, encouragement,
valuable suggestions for the completion of this work.
I express my profound gratitude towards my heartiest revered guide Dr.
RAMANA G.V. Professor Department of Swasthavritta, S.D.M. college of Ayurveda
who is a back bone of my success and whose valuable guidance, inspiring thoughts and
appropriate suggestions helped me in accomplishing my dissertation.
I would like to acknowledge Dr. Sajitha K. Asst. Professor Department of
Swasthavritha, S.D.M. college of Ayurveda for her kind assistance and encouragement.
It gives me pleasure to express my gratitude towards my colleagues, Dr. Uday
Patil, Dr. Aditi Bana, Dr. Shrikanth Sajjanar, who provided all the help and support
through friendly discussion.
I would like to express my gratitude towards all my friends and juniors for their
brotherly affection & helping hand when ever I needed.
All of the patients deserve special mention without whose co-operation the entire
study would stalemated.
I am very much thankful to librarian for his timely help and co-operation at all
instances. I am highly obliged to the staff of Laboratory, Hospital & College for their co-
operation. I am ever grateful to those who have helped me directly & indirectly to
complete this dissertation successfully.
Dr. Arora Manish
ABBREVIATIONS A.H. - Ashtanga Hridaya
A.S. - Ashtanga Sangraha
B.P. - Bhavaprakasha
B.R. - Bhaishajya Ratnavali
Bh.S. - Bhela Samhita
C.S. - Charaka Samhita
Chi. - Chikitsa
C.P. - Chakrapani
Dal. - Dalhana
Dal.T. - Dalhana Tika
Eng. - English
H.S. - Harita Samhita
Ind. - Indriya
K.S. - Kashyapa Samhita
Ma.Ni. - Madhava Nidana
Ni. - Nidana
San. - Sanskrit
Sh.S. - Sharangadhara Samhita
S.S. /Su.S - Sushruta Samhita
Su. - Sutra
V./ Vi. - Vimana
Y.R. - Yogaratnakara
Other
Dr. Doctor
Prof. Professor
P.G. Post Graduation
i.e. That is
Dept. Department
Pb. Publication
Ref. Reference
In Tables
Veg. Vegetarian
B.T. Before Treatment
A.T. After Treatment
F.B.S. Fasting blood sugar
P.P.B.S. Post prandial blood sugar
R.B.S. Random blood sugar
F.U.S. Fasting blood sugar.
S.No. / S.N. Serial Number
0,1,2,3 Grades of severity.
t Test of significance
p Probability
S.D. Standard Deviation
S.E. Standard Error
dif. Difference
Symbols used
+ Present
- Absent
% Present
< Smaller than
> Greater than
ABSTRACT
BACKGROUND
Diabetes mellitus has emerged as an important public health problem globally. It
is estimated that around 150 million people are suffering from diabetes through out the
world. Majority of which are Type II i.e. NIDDM. Madhumeha is a type of Prameha
which resembles the clinical picture of Diabetes Mellitus. In India approximately 32
million people are suffering from diabetes.
The management of Diabetes Mellitus is to be based on three main aspects i.e.
diet, exercise and drugs.
In Ayurveda, diet is given the foremost place in management of Prameha.
Different kinds of Pathya Ahara like Yava, Mudga, Godhuma etc are advised.
Here an attempt is made to analyze the efficacy of Pathya Dravya’s mentioned in
Ayurvedic classics in Prameha.
OBJECTIVES
1. To study the effect of various Pathya Ahara in the form of a nutritional
compound in Prameha
2. To study the improvement in nutritional status, and over all health status of
patients.
METHODS
This is a comparative study with pre-test and post-test design undertaken in two groups.
GROUP A
Consist of 15 patients who are advised with standard Ayurvedic treatment with Asanadi
Gana Kashaya 30 ml twice daily before food and Nisha-Amalaki tablet 2 tab twice a day
for two months and kept as control.
GROUP B
15 patients of this group were given same line of treatment as in Group A along with the
nutritional compound prepared from various Pathya Ahara in 15gm twice daily before
food along with warm water.
RESULTS
The overall effect was noted as marked Improvement in 0 % patients in Group A
and 6.66 % in Group B. Moderate improvement in 20 % in Group A and 33.34 % in
Group B. While mild improvement in 60 % in Group A and 40 % in Group B. No relief
was observed in 20 % patients in Group A and 20 % in Group B.
CONCLUSION
Statistical analysis reveals that administration of nutritional compound along with
Ayurvedic treatment was more effective when compared to Ayurvedic treatment alone.
Nutritional compound helped in relieving the signs and symptoms of the disease
and provided feeling of well being.
CONTENTS
INTRODUCTION 1 - 3
LITERARY REVIEW 4 - 58
HISTORICAL REVIEW 4 - 5
ETYMOLOGY 6 - 9
NIDANA 10 - 14
POORVAROOPA 15 - 16
ROOPA 17 - 18
SAMPRAPTI 19 - 21
UPADRAVA 22 - 24
ARISHTA 25
SADHYA ASADHYATA 26 - 27
CHIKITSA 28 - 32
PATHYA APATHYA 33 - 36
DIABETES MELLITUS 37 - 48
DRUG REVIEW 49 - 58
OBJECTIVES 59
METHODOLOGY 59 - 65
OBSERVATION AND RESULTS 66 - 84
DISCUSSION 85 - 93
CONCLUSION 94 - 96
SUMMARY 97 - 99
BIBLIOGRAPHIC REFERENCES 100 - 103
ANNEXURE 104 - 108
LIST OF TABLES CHARTS AND FIGURES
LIST OF TABLES
Sr. No. Content Page no.
1 showing different classification of Prameha 07
2 showing General Aharaja Nidana of Prameha 13
3 showing general Viharaja Nidana of Prameha 14
4 showing Specific Nidana of Madhumeha 14
5 Showing Poorva Roopa mentioned in various text 15
6 showing various Pidakas in Prameha as Upadrava 24
7 showing various Pathya Ahara in Prameha 34
8 showing various Pathya Ahara mentioned in classics 35
9 showing Characteristics of oral drugs for diabetes 46
10 showing description of Dravya’s 50
11 showing Nutritional values of the ingredients in supplement 53
12 showing the properties and action of Dravya’s 57
13 Showing Age wise distribution 65
14 showing the sex ratio of both the groups 66
15 shows Religion wise distribution 66
16 showing the marital status 68
17 showing diet patterns 68
18 showing Distribution of patients according to the Prakriti 69
19 Showing patients based on the occupation 71
20 showing Distribution of the patients according to Pipasadhikyata 72
21 showing distribution of patients according to Kshudhadhikyata 73
22 showing Distribution of patients according to Karapada Daha 74
23 showing distribution of patients according to Adhika Mootrata 75
24 showing distribution of 20 patients according to Daurbalya 76
25 showing distribution of patients according to Atisweda 77
26 showing F.B.S. distribution of patients 79
27 showing P.P.B.S. distribution of patients 80
28 Showing F.U.S. Distribution of patients 81
29 Showing P.P.U.S. Distribution of patients 82
30 Showing over all effect of the treatment 84
LIST OF CHARTS
Sr. No. Content Page no.
01 Showing Age wise distribution 67
02 showing the sex ratio of both the groups 67
03 shows Religion wise distribution 67
04 showing the marital status 70
05 showing diet patterns 70
06 showing Distribution of patients according to the Prakriti 70
07 Showing patients based on the occupation 71
08 showing improvement according to Pipasadhikyata 78
09 showing improvement according to Kshudhadhikyata 78
10 showing improvement according to Adhika Mootrata 78
11 Showing improvement according to Daurbalya
78
12 showing improvement according to Atisweda
78
13 Showing improvement according to Karapada Daha 78
14 showing improvement in F.B.S. of patients
83
15 showing improvement in P.P.B.S. of patients 83
16 Showing improvement in F.U.S. of patients
83
18 showing improvement in P.P.U.S. of patients 83
19 showing over all effect of the treatment 84
LIST OF FIGURES
Sr.No. Contents Page no.
1 YAVA 55
2 GODHUMA 55
3 KULATHA 55
4 MUDGA 55
5 RAJASHIMBI 55
6 AMALAKI 55
7 HARITAKI 56
8 BIBHITAKI 56
9 PREAPRED NUTRITIONAL COMPOUND 56
10 PREAPRED NUTRITIONAL COMPOUND 56
INTRODUCTION
The purpose of human life is the achievements of Chaturvidha Purushartha i.e.
Dharma, Artha, Kama and Moksha. Ayurveda advocates that ‘Excellence of health’ is the
basic need for achieving these Purushartha. It aims at preserving and promoting the
health of an individual as first goal and then to treat the disease. Due to various reasons
and due to negligence of rules and regulation mentioned in Ayurveda for healthy living,
man has become a victim to different kinds of diseases.
A middle aged person apparently normal may start complaining of weakness,
increased frequency of urination, burning sensation in hands and feet, it is very difficult
to notice that the person may be suffering from any kind of disease. But on thorough
examination and investigations the person may be diagnosed as suffering from Diabetes
Mellitus.
Diabetes mellitus has emerged as an important public health problem globally. It
has become an endemic disease affecting people irrespective of their age, sex, socio-
economic status. Diabetes Mellitus is a metabolic disorder characterized by
hyperglycemia due to deficiency or diminished activity of insulin. It is a clinical
syndrome with cardinal features of polyurea, polydypsia and polyphagia.
Diabetes mellitus is growing at an alarming rate all over the world especially in
India. It is estimated that currently around 150 million people are suffering from diabetes
through out the world. Majority of which are of Type II i.e. NIDDM type of diabetes
mellitus. In India at present approximately about 32 million people are suffering from
diabetes and the future affliction is projected to 80 million by the year 2030.
In Ayurveda Diabetes Mellitus is known to be a ‘rich man’s disease’ which can be
understood by etiological factors of Prameha mentioned as enjoying the pleasures of life
with reduced or no physical activity.
Madhumeha a type of Vataja Prameha is the nearest resembling condition with
Diabetes Mellitus. Prameha is a disease concerned with abnormalities manifested in the
urine. Qualitative and quantitative disturbances of urine occur in Prameha. Madhumeha
being type of Prameha is manifested as in which patient passes excessive sweet and
astringent urine and exhibits sweetness all over the body. Hence Madhumeha can be
entitled clinically with Diabetes Mellitus from the above description.
Diabetes is a disease of deficiency or decreased activity of insulin. There is no
such specification of insulin in Ayurvedic science but the theory that all diseases develop
from Agnimandya i.e. disturbance in metabolism can be understood in pathology of this
disease. Insulin being one of the metabolic product helps in regulating the amount of
glucose in blood, similarly Bhutagni’s and Dhatvagni are responsible for the maintenance
of normal functioning in the body.
Analyzing the etiological factors and pathogenesis mentioned in Ayurveda for
Prameha, consuming excessive, irregular and unwholesome food leads to disturbance of
Agni and thereby vitiation of Dosha in manifestation of the disease.
The management of Diabetes Mellitus is to be based on three main aspects i.e. management of
diet, exercise and drugs. These are the three main pillars on which whole management of patient is
dependent. Being a metabolic disorder diet plays a major role in management of diabetes.
Majority cases of type II diabetes can be effectively managed and controlled just by modification diet and
with regular exercise only. Control of body weight, blood lipids and controlling blood glucose are
important for reducing the long term complications of diabetes.
In Ayurvedic classics, while explaining the management of Prameha, diet has
been given the foremost place. Different kinds of Pathya Ahara like Yava, Mudga,
Godhuma etc have been advised to be taken by the patient suffering from Prameha.
Along with that various exercises like bare foot long walks, predestrial journeys, digging wells
etc. are indicated to be followed by patients. Apart from Diet i.e. Pathya Dravya’s and exercise various
medicinal preparations are advised according to the Dosha Avastha and disease condition.
In Ayurveda dietetic management has been mentioned under heading of Pathya.
And those which are harmful or worsen the disease conditioned are said to be Apathya.
All the diet and activities which are beneficial to that patient and which help in pacifying
the disease are mentioned under Pathya.
In Prameha various kinds of Pathya Ahara Dravya’s have been mentioned and are
advised to be used by the patients suffering from Prameha. It is very important to analyze
the do’s and don’ts while treating the disease. Though it is easy to prescribe or advise the
do’s and don’ts to the patients but it is difficult to follow it for the life time.
Hence an attempt is made here to analyze the various Pathya Ahara Dravya’s
mentioned in different Ayurvedic classics and to confirm its efficacy in the management
of Madhumeha or diabetes mellitus.
HISTORICAL REVIEW
The disease Prameha is known to mankind since long back. We can find various
references regarding Prameha in Vedas, Upanishads and Ayurvedic literatures.
Even we get references of pre-Vedic Kala that lord Ganesha too suffered from
this disease and was treated with Kapitha and Shiva Gutika advised by lord Shiva 1.
In Atharvaveda the disease is mentioned under the term ‘Aastravam’ i.e.
excessive urination (polyuria) 2.
In Garuda Purana it is described as condition in which whole body becomes sweet
and it is called Madhumeha3.
In various Ayurvedic literatures i.e. Bruhata-trayi and Laghu-trayi, there is detail
description regarding etiology, pathology, symptomatology prognosis and management
of Prameha in a much elaborated manner.
The Egyptian Papyrus Ebers (1500 B.C) described illness associated with passage
of excessive urine but did not mention name of the disease.
In 2nd century A.D. a Greek physician Aretaeus of Cappodocia named the disease
as “Diabetes”
In 1674 Willis named the disease as “Diabetes Mellitus” as per his observation
that the urine passed by such patients is like honey and sugar.
Thomas Cowley (1781 AD) suggested that pancreas may be the cause of disease
diabetes.
Poul Langarhans (1869 AD) Name itself suggests that he described the group of
cells in pancreas. Gusteve Edouard Laguosse (1893 AD) Named after Langerhans as
“islets of Langerhans”
In 1921 Insulin was discovered. A depancreatized dog is successfully treated with insulin.
In 1959 two major types of diabetes were recognized. Type-1 (Insulin dependent)
diabetes and Type-2 (Non- Insulin dependent) diabetes.
In 1998 the United Kingdom prospective Diabetes Study (UKPDS) results
identify the importance of glucose control & blood pressure control in the delay and /or
prevention of complications in type 2 diabetes.
ETYMOLOGY
In almost all Samhita, Prameha, a disease concerned with abnormalities in urine has been
mentioned. There are qualitative as well as quantitative disturbances in the urine of
patients suffering from Prameha.
Nirukthi: -
Prameha word is derived from combination of
“Pra and Miha”
Pra + Miha Ksharane + Karane + Ganm 4.
The word Meha means to pass urine,
‘Pra’ meaning increased intensity.
It is the general name for urinary disease 5.
Paryaya:-
Prameha - - Charaka
Meha - - Amarkosha
Definition:-
Prameha means passage of large quantity of urine6.
Prameha is defined as the disease characterized by passage of ‘Prabhutavila Mutra’ i.e.
large quantity of turbid urine7.
Types: -
Prameha has been classified into 20 types depending on the constitution of urine and
dosha involved 8.
All Samhita have classified Prameha into 20 types, out of which 10 types are of Kaphaja
Prameha, 6 of Pittaja and 4 types of Vataja Prameha.
There is a difference between nomenclatures of these 20 types but still the total number
remains same in all Samhita. Though Prameha is a Tridoshaja Vyadhi, the relative
predominance of any one Dosha and Dushya enables its classification in to Vataja, Pittaja
and Kaphaja Prameha. 10 Kaphaja and 6 Pittaja Prameha seem to be sub classified based
on the physical characteristics of urine that is Colour, density and volume depending up
on the different Gunas of Kapha and Pitta respectively. Vataja Prameha seems to be sub
classified in to four types depending up on Dhatu being excreted through urine. The
various classifications of Prameha mentioned in the different contexts in the classical
texts are as follow:
Classification of Prameha
Table 1 showing different classification of Prameha
Prognosis Etiological factor Body Strength Dosha
Sadhya Apathyanimittaja Balvana Kaphaja
Yapya Pittaja
Asadhya Sahaja Krisha Vataja
Avaranjanya and Apakarsanjanya :
This type of classification mainly related with etiology and patho-physiology.
Avaranjanya pathogenis occurs duet to etiological factors mainly concordant with Kapha
and Pitta but the vitiation of Vata occurs due to Avarana. Apakarshanjanya pathology
occurs due to depletion of Dhatus because of the Vata vitiated etiological factors 9.
Santarpanjanya and Apatarpanjanya :
This classification mainly narrated by Charaka when describing the treatment of the
Prameha. Classification is mainly based upon the over nutrition and under nutrition10. So
Santarpanajanya Madhumeha can be correlated with Avaranajanya Madhumeha and
Apartarpanajanya can be correlated with Dhatu-apakarshanajanya Madhumeha.
Madhumeha:
Madhu + Meha
Madhu: - resembles honey, sweet, juice or nectar of flowers or soma 11.
Meha: - derived from the word Miha meaning to pass urine 12.
Excess flow of urine 13.
Paryaya:-
Kshaudra Meha - - Sushruta
Ojomeha - - Charaka
Definition:-
Charaka defines Madhumeha, in which patient passes urine as astringent, sweet, pale and
rough 14.
Vagbhata classified Madhumeha into two main types
DhatuKshayajanya
Avaruttajanya
NIDANA
The Nidana (causative factors) of any disease play a major role in manifestation of
disease. Etiological factors can be classified into Sahaja & Apathyanimittaja15.
Prameha Nidana
Sahaja (Hereditary) Apathya Nimittaja (Acquired)
Sushruta mentioned the Sahaja word showing genetic predisposition in the patho-
physiology of the disease Madhumeha
Charaka while describing the prognosis of the disease Madhumeha clearly noted that this
is Kulaja Vikara resulting due to defect in the Beeja 16.
The three basic causes of any disease are described in Ayurveda as
1. Samavayi Karana (material/inherent cause)
2. Asamavayi Karana (non-inherent cause)
3. Nimitta Karana (instrumental, initiating cause.) Pradhanika Karana.
All the body tissues (Dhatu) are Samavayi causes of disease. In Madhumeha the body
tissues or the Dhatu’s i.e. Meda, Mamsa, Kleda, Lasika, Majja, Rasa, Oja, and Pishita are
the Samavayi Karana’s.
While the three Dosha’s i.e. Vata, Pitta, and Kapha are the Nimitta
Karana’s of the disease.
The Dosha-Dushya Sammurcchana is the Asamavayi Karana of the
disease i.e. Interaction between the above said Meda etc. Dhatu’s and Vatadi Dosha’s.
Different causes like excessive indulgence in food, consuming excess of
sweet, heavy food, sleeping etc. are the Sahakari Karana’s or the accessory causes which
have influence on the Dosha’s thereby leading to development of disease or symptoms.
In Prameha there is imbalance of all the three Dosha’s but Kapha plays a
predominant role in manifestation of the disease.
Only Samanya Nidana of Prameha has been enlisted in all Samhita but Charaka
has described the specific etiological factors of Madhumeha and that of Vatika Prameha
in Nidanasthana 17.
General nidana of Prameha 18
Asyasukham
Swapnasukham
Excessive indulgence in Dadhini i.e. various preparation of curd.
Gramya, Audaka, Anupa Mamsa i.e. meat of domestic, aquatic, wet land animals.
Payamsi i.e. excessive use of milk & its preparation
Navannapanam i.e. new grains & drinks
Guda Vaikrutam i.e. various preparation of sugar & jaggery.
Other substances which increases Kapha may cause Prameha
According to Vagbhata, the diet & activities which increase Meda, Mutra & kapha are
supposed to cause Prameha19.
Specific nidana of Madhumeha:
The person indulging in food substances having Guru, Snigdha qualities & excessive
indulgence of Amla & Lavana Rasa substances & Navanna Pana, excessive sleep, sitting
in a same place for longer duration, avoiding exercises & thinking process & also not
performing the Shodhana process in a proper time 20.
Acharya Sushruta has narrated that untreated Prameha in its initial stage, gets converted
into Madhumeha & becomes incurable 21.
According to Acharya Vagbhata, the urine of Madhumehi will be simulating with that of
Madhu. Two type of vata vitiation has been mentioned, one is due to Dhatukshaya &
second due to Margavarana.
Table 2 showing General Aharaja Nidana of Prameha
Nidana C.S S.S A. S. A. H.
Ahara
Dadhi + - - +
Gramya, Anupa, Audaka Mamsa + - - +
Payaha + - - +
Navapana + - - +
Navanna + - - +
Guda Vikrita + - - +
Shleshmajanaka Ahara + - + +
Sheeta Dravya - + - +
Madhura Dravya - + - +
Amla Lavana Rasa + - - -
Snigdha Dravya - + - +
Drava Annapana - + - +
Guru Dravya - - - +
Picchila Dravya - - - +
Mutrajanaka Dravya - - + +
Tikta, Katu, Kashaya Rasa - - - +
Table 3 showing general Viharaja Nidana of Prameha
Vihara
Asya Sukham + - - +
Swapna Sukham + - - -
Diwaswapna - + - -
Avyayayama - + - -
Alasya - + - -
Beeja Dosha + + + +
Table 4 showing Specific Nidana of Madhumeha22
Ahara Vihara
Excessive intake of - Excessive indulgence in -
Guru
Snigdha
Amla
Lavana
Navannapana
Nidra
Asyasukha
Tyakta Vyayama Chinta
Sanshodhana Akurvatam
POORVA ROOPA
Symptoms produced before the manifestation of the disease i.e. when the
Sthana Samshraya takes place, some predisposing symptoms are manifested. These
symptoms can be considered as warning signs of the disease developing in the body. As
Madhumeha is classified under the Vatika type of Prameha, Poorvaroopa of Prameha can
be taken as Poorvaroopa of Madhumeha. Following table elaborates the various Poorva
Roopa seen in Prameha.
Table 5 Showing Poorva Roopa mentioned in various text
Cha Su. A.H. A.S. Ma. Ni.
Kesheshu Jatilibhava + + - + -
Asya Madhurya + - + + +
Karapadadaha + + + + +
Karapada Suptata + - - - -
Mukha Talu KanthaShosha + - + + -
Pipasa + + - + +
Alasya + - - + -
Kaye malam + - - + -
Kaya Chhidreshu Upadeha + - - + -
Paridaha Angeshu + - - - -
Suptata Angeshu + -- - + -
Shatpada Pipilika
Mutrabhisaranam
+ - + + -
Visra sharir gandha + + + + -
Nidra + - - + -
Tandra + + - + -
Snigdha gatrata - + - + -
Pichhila & guru gatrata - + - - -
Madhur mutrata - + - - -
Sada - + - + -
Keshanakhativriddhi + + + - -
Sheeta Priyata + - + + -
Sweda + - + + -
Karapada Daha is due to loss of Ambu which is Sheeta in property and required for
Preenanam, failing to which results in Daha. This may also be due to peripheral
neuritis.
Tandra & Nidra is due to loss of Rasa & Oja.
Snigdha, Pichhila & Gurugatrata is due to kapha by corresponding qualities of
Snigdha, Pichhila & Guru.
Shatpada pipilika mutrabhisaranam is due to presence of Madhurata in the Mutra.
Sushruta makes it easy by narrating that a man with slight increase in urine output
along with the premonitory symptoms should be considered as patient of Madhumeha23.
ROOPA
According to Sushrutacharya, the person should be diagnosed as Pramehi when
complete or partial prodromal symptoms of Prameha accompanied by polyuria get
manifested. These are characteristic of Vyakta Avastha of a Vyadhi 24.
From, above description, it can be postulated that the prodromal symptoms along
with main symptoms continues as disease progresses.
General Symptomatology:
(1) Prabhuta Mutrata (Quantity):
This is the cardinal sign of Prameha described by all Acharyas.
(2)Avila Mutrata (Turbidity):
Patient passes urine having hazy consistency.
(3)Pichhila Mutrata (Consistency):
Acharya Sushruta has described two types of Prameha along with their
manifestations as follows:
(i) Sahaja Pramehi (Krisha-)
Ruksha (Dry body )
Alpashi(consumes less food)
Bhrish Pipasa (Voracious thirst)
Parisarpansheelata (Restless, always desires to wander)
(ii) Apathyanimittaja (Sthula-Obese)
Bahuashi (Voracious eater)
Snigdha (Unctuous body texture)
Shayyasanswapnasheela (Like to sit down & sleep always)
Acharya Kashyapa has described the symptoms listed here.
(a) Akasmata Mutra Nirgama: Child excretes urine suddenly without any intention.
(b) Makshika Akranta Mutra: Flies get attracted towards the urine.
(c) Shweta & Ghana Mutrata: Child passes urine having shweta colour & turbidity
(d) Gaurava (Heaviness of the body), Baddhata (tightness) & Jadata (Steadiness,
Laziness).
Specific Symptomatology of Madhumeha:
Madhumehi passes urine having Kashaya & Madhura taste, Pandu Varna &
Ruksha quality25. Chakrapani opines that Vayu, because of its Prabhava converts
Madhura Oja into Kashaya Oja.
According to Sushruta, the urine of Madhumehi resembles with that of honey, as
described above. Similar description is found in Ashtanga Hridaya & Ashtanga
Samgraha.
The special manifestation related to behavioral pattern is depicted by Sushruta
that, Madhumehi prefers standing to walk, sitting to stand, lying down to sit, & sleeping
to lying down 26.
SAMPRAPTI
Prameha is considered as a type of Santarpanajanya Vikara. Charaka in
Nidanasthana gives the detailed explanation of Nidana and other Samprapti Ghataka in
detail. Charaka has explained elaborately that how this disease develops in the body.
For the establishment of any disease in the body the important three factors
connected are Nidana, Dosha and Dushya under the influence of Prakruti, Desha, Kala,
Bala & Linga. When these three factors are not interconnected properly, the disease will
not occur. The Nidana, Dosha (Vatadi Tridosha), Dushya (Rasadi Dushya) are
responsible for the production and manifestation of any disease in the body.
When Sadhya Roga changes into Krichrasadhya or Asadhya it can be called as
Vidhi Samprapti. It commonly occurs in the untreated condition. As far as Madhumeha is
concerned, we can partly include it in Vidhi Samprapti. Acharya Sushruta explains it as if
all the Prameha are not treated first, they will gradually pass to stage of Madhumeha.
Acharya Charaka has described Madhumeha vividly. Vagbhattacharya divides
Madhumeha into two types, according to Samprapti. The Madhumeha is included in
Vataja type. If Vataprakopa occurs due to Sarvadhatukshya, it is called
Dhatukshayajanya Madhumeha. And if Vataprakopa manifests as result of Vatavarana, it
is called Avaranjanya Madhumeha. Acharya Sushruta explains it as if all the Prameha are
not treated first, they will gradually pass the stage of Madhumeha.
SAMPRAPTI OF MADHUMEHA:
The pathogenesis of Madhumeha is explained in Charaka Samhita, Nidanasthana
4th chapter. Due to causative factors in the person susceptible for Prameha, vata Prakopa
occurs. This kupita Vata dosha attracts the vital Dhatus like Vasa, Majja, Lasika & Oja to
Basti. The Vata dosha is having Rukshatva and it again changes the Madhura Rasa of Oja
into Kashaya Rasa. This Kashaya Oja is excreted through urinary tract later. This
condition is termed as Madhumeha.
Ahara with a predominance of Guru, Snigdha, Amla and other kaphapittakara
substances, leads to the provocation of kapha and Pitta Doshas, Which in turn vitiates
Medas and Mamsa. These increased Dosha-Dushya cause’s vata Avarana by which Gati
or movement of Vata Dosha is obstructed. Finally vitiated vata attracts and carry the Oja
towards Basti resulting in the Madhumeha 27.
The Samprapti of Madhumeha as described under Samanya Samprapti is the basic
mechanism governing the production of the disease. Vata essentially triggers this process.
Therefore Madhumeha is a Kapha Vata dosha Pradhana Vyadhi in which the Vata Dushti
occurs in two different pathologic mechanisms:
a) Margavarana janya Vata Dushti and
b) Dhatukshaya janya Vata Dushti.
SAMPRAPTI GHATAKAS:
Dosha:
Kapha: Bahu +Abaddha in Avaranjanya Madhumeha
Kshina in Dhatukshayajanya Madhumeha
Pitta: Vriddha-in Avaranjanya Madhumeha
Kshina- in Dhatukshayajanya Madhumeha
Vata: Avritta- in Avaranjanya Madhumeha
Vriddha-in Dhatukshayajanya Madhumeha
Dushya:
Rasa,Rakta,Mamsa,Meda,Majja,Vasa,Lasika,Oja,Shukra,Ambu 28
Sweda 29.
Srotas : Medovaha, Mutravaha, Udakavaha
Srotodushti: Atipravritti, Sanga
Sanchaya :Tissue level
Prakopa: Sarva Sharira
Prasara: Rasayani
Sthanasamshraya.: Mutravaha Srotas
Agni : Dhatwagnimandya
Ama:Dhatugata (Aparipakwa Dhatu)
Udbahva: Amashaya
Swabhava : Chirkari
UPADRAVA
The term Upadrava is applied to a disease which has taken place on, produced by
the Samprapti Ghatakas of original disease & be cured if original disease is treated
successfully.
The disease Madhumeha, when severe, involves almost all Dhatus and the
respective Srotases. Accordingly, Upadravas appear as and when a particular Srotas is
affected
Charaka and Bhela have listed and described common Upadrava at random.
Sushruta, Vagbhata and Bhavaprakasha have described them separately as Kaphaja,
Pittaja and Vataja.
(1) General Complications 30:
Trushna, Atisara, Daha, Daurbalya, Arochaka, Avipaka, Putimamsa Pidaka, Alaji,
Vidradhi etc.
Trushna: Is defined as Paneeya sevana iccha31. It has been described as Asadhya if
Trushna develops as an Upadrava of Madhumeha32 and Charaka says that it is a Dirgha
Roga and results in Marana if neglected or if developed as Upadrava33.
Jwara 34: As a result of Dhatu kshaya and reduced Vyadhikshamatva, Jwara develops.
Daha 35: Clinically, Daha is seen especially in Hasta- Pada tala.
Dourbalya: as a result of Dhatu Kshaya and Oja Kshaya in the form of Kleda through
Mutra.
Putimamsa Pidaka: The Pidaka are the most important Upadrava of Madhumeha as
negligence in treating them makes the disease Asadhya.
The Dushita Medas, Mamsa and Shonita with increased Dravata of Sleshma results in
development of Pidakas.
(2) Specific Complications:
(a) Kaphaja meha 36:
Makshikopasarpanam, Alasya, Mamsopachaya, Pratishyaya, Shaithilya,Arochaka,
avipaka, Kaphapraseka, Chhardi, Nidra, Kasa & Shwasa.
(b)Pittaja meha 37:
Vrushanayorvadaranam, Bastibheda, Medhra toda, Hridshula, Amlika, Jwara, Atisara,
Arochaka, Vamathu, Paridhumayanam, Daha, Murchha, Pipasa, Nidranasha, Panduroga,
Pittavidmutranetratva & Vidbheda38.
(c)Vataja meha 39:
Hridgraha, Laulya, Anidra, Stambha, Kampa, Shula, Baddha purishatva and shosha, kasa,
shwasa.
Acharya Charaka has mentioned 7 types of Pidaka as complication of Madhumeha.
While Sushruta and Vagbhata has mentioned 10 Pidakas. Sushruta has mentioned that
Madhumeha along with Pidaka is Asadhya. While describing about the Pidaka Sushruta
opines that these Pidaka occurs due to Tridosha and vitiated Meda & Mamsa.
These Pidaka are as follows.
Table 6 showing various Pidakas developed in Prameha as Upadrava
Pidaka Charaka Sushruta Vagbhata
Sharavika + + +
Kacchhapika + + +
Jalini + + +
Sarshapi + + +
Alaji + + +
Vinata + + +
Vidradhi + + +
Putrini - + +
Masurika - + +
Vidarika - + +
ARISHTA LAKSHANA
When a disease pervades a patient such that he may die, nature signals his departure with
precision in varied forms. The concept of Arishta Lakshana hence co-relates with this
concept. It helps a physician to predict imminent death.
The following two features are mentioned by Charaka as Arishta Lakshana i.e. the signs
of incurability or indication of ensured death.
1. The person in whose body, the flies are attracted after bath also is sure to die due to
Prameha 40.
2. The person who drinks various kinds of oils & Ghee or other unctuous preparations
with Chandala in his dreams may die of Prameha in future.
SADHYASADHYATA
Madhumeha or Prameha has been described as Anushangi, which means it is
Punarbhavi, in other words once a person is affected with Madhumeha, the disease last
life long i.e. till the patient is alive. Therefore, one should make all efforts to prevent and
control it.
In General prognosis of Prameha given by all Acharyas is as follows,
Kaphaja Prameha - Sadhya
Pittaja Prameha - Yapya
Vataja Prameha - Asadhya when occurred due to Dhatu kshaya &
Krichrasadhya when established due to Avarana
Charakacharya illustrated the prognosis of Prameha considering the presence or
absence of Poorvaroopa. Kaphaja Meha with Poorvaroopa is considered Krichrasadhya
while that associated with Pittaja Meha is detailed as Pratyakhyeya.
Pittaja Prameha is considered as Yapya, while Vataja Prameha having the status
of Asadhya. This is the result of the nature of disease & associated Dhatus. Kaphaja
Prameha can be treated with Katu, Tikta & Kashaya Rasa, both the kapha dosha and the
associated Dushya (Sama Dhatus) can also be treated with the same treatment at the same
time.
In case of Pittaja Prameha & Vataja Prameha, the disease and associated vitiated
Dhatus are having opposite qualities. So they are Yapya and Asadhya respectively.
Krichrasadhya/Asadhya Madhumeha:
Madhumeha is included in Vataja Prameha. Here Vata Prakopa might be due to
Dhatukshaya as it occurs after Kaphaja & Pittaja Prameha. Another important cause is
Avarana. When Vata Prakopa is due to Dhatukshaya the type is included in Asadhya
Madhumeha, while the other produced by Avaranjanya Vata is considered as
Krichrasadhya.
Charakacharya mentioned that Madhumeha produced due to Beejadosha is
incurable (Asadhya)
Madhumeha is considered Asadhya due to the following reasons.
a) Mahatyayatvat.
b) Viruddhopakramatvat.
Madhumeha with all Poorvaroopa: It has been said by Charaka that if a disease in
Roopavastha has all the Poorvaroopa manifested then the disease becomes Asadhya.
Madhumeha patients who have Bala Mamsa kshaya can be left untreated. Madhumeha
with Pidakas is Asadhya. All Prameha if left untreated terminate into Madhumeha which
is Asadhya.
CHIKITSA
Chikitsa means all types of medical procedures, administration of drugs and diet
which gives relief from disease and helps to maintain healthy state of the body42.
Chikitsa Sutra (principles of treatments) and Chikitsa (Management) are the two
divisions of Chikitsa. Both these are described very well in classics. But the concepts and
methods are different in different conditions, considering the Vyadhi Swabhava and
Atura. The samprapti should be considered deeply before stepping to manage.
CHIKITSA SUTRA:
In Charaka Samhita it has been described that in all types of prameha the
respective etiological factors should be avoided. The treatment of the disease starts with
abstinence from the etiological factors, which is described under the heading of Nidana
Parivarjana. It is the first and fore most principle in treating the disease.
Charaka, Sushruta and Vagbhata consider the body constitution and strength of
the body of the patient when dealing with the management aspect. Charakacharya
considers two types of patients; one is that with obese (sthoola) and strong (Balwan) and
the other without weak (Durbala) and lean (Krisha). The treatment principle for these
kinds of patients is Samshodhana and Samshaman respectively.
Sushruta Acharya also says that Sahaja Prameha rogi will be Krisha &
Apathyanimittaja Rogi will be Sthoola43.
The two types of management emphasized are:
(1) Samshodhana Chikitsa [Elimination Therapy]
(2) Samshaman Chikitsa [Normalizing Therapy]
Like every disease, those factors which are responsible for the production of the
diseases are if eliminated and if further, causative factors are prevented prameha can also
be treated. Madhumeha can be treated in this way although it is described as incurable. In
Pratyakhyeya vyadhis, symptomatic relief can be given by proper management.
Although Vataja Prameha is incurable still Acharya Charaka explains to induce
certain treatment in kaphapittanubandhi Prameha 44.
Treatment described for Vataja Prameha can be considered as treatment of madhumeha.
MADHUMEHA:
(i) Samshodhan Chikitsa:
Considering Sthoola and Krisha Pramehi, Samshodhan Chikitsa should be
administered only to the sthoola and Balwan Pramehi. Sarshapa, Nimba, Danti, Bibhitaki
& Karanja Siddha Taila or Trikantakadya Sneha (Ghrita or Taila according to dosha
predominance should be used for Abhyantara Snehana. Here while explaining the
Samshodhan, Charaka describes to use the Malashodhan Yogas from Kalpasthana.
Both Pitta and kapha are eliminated through shodhana. Either it may be Vamana
or virechana, so both pitta or kapha doshas which are vitiated are eliminated. Then the
Vagbhata advised to give Anuvasana and Asthapana Basti Chikitsa after Vamana and
virechana to control the provocation of Vata.Anuvasana with medicated oils and Ghrita
are prescribed in madhumeha.
After proper Shodhana Chikitsa, Charakacharya details to give Santarpana
Chikitsa to the patients, to prevent the complications like Gulma, Bastishula etc.
(ii)Samshaman Chikitsa :
Samshaman Chikitsa includes mainly Deepana (appetizers), Pachana, (enhancing
digestion), Kshut (Hunger maintenance), Trit (Maintenance of thirst), Vyayama
(Exercise), Atapa (Having exposed to sunlight) & Maruta (Exposing oneself to
wind).According to the conditions of vitiated doshas & Dushyas.
Acharya Sushruta explains that Shilajit should be taken along with Salsaradi Gana
kwatha. After its digestion patient should take Jangalamamsarasayukta Anna. He
prescribes to take 1 Tula of Shilajatu.
Principles of treatment of madhumeha
Santarpanajanya Apatarpanajanya
Stoola Pramehi Krisha Pramehi
Balwan Durbala
Samshodhana Chikitsa Samshaman Chikitsa
Vamana, virechana, Santarpana
Asthapana basti
Santarpana
Compound Preparations Used In Prameha:
Swarasa: Amalaki, Haridra, Nimbapatra, Bilwapatra, Guduchi
Kwatha: Vidangadi, Phalatrikadi, Mustadi, Manjishthadi, Pathadi
Churna: Triphaladi, Mustadi, Gokshuradi, Arkadi
Gutika: Chandraprabha, Indravati, Pramehantak Vati
Guggulu: Gokshuradi Guggul
Modaka: Kastur Modaka
Avleha: kushavleha, Bangavleha
Paka: Pugapaka, Ashwagandhadi paka, Draksha Paka.
Asava Arishta: Lodhrasava, Dantyasava, Madhukasava, Devdarvyadiarishta,
Lodhrarishta.
Ghrita: Dhanvantar ghrita, Trikantakadi ghrita, Sinhamrita ghrita, Dadimadi ghrita,
Shalmali ghrita.
Rasaushadhi: Vasant kusumakar Rasa, Mehamudgar Rasa, Brihat Bangeshwar Rasa,
Prameha gajkesri Rasa, Tribanga Bhasma, Vasant tilaka Rasa.
PREVENTION OF PRAMEHA:
Acharya Charaka while explaining the nidana of prameha has described condition
or the people who are more prone to acquire the disease they are as follows:-
Manda Utsahi
Ati sthoola
Ati snigdha
Mahashana (genetic defect)
The above said conditions lead to the development of Prameha which in turn is
the cause of death in such persons.
Hence to prevent the occurrence of disease one should consume the diet which is
beneficial and which is Dhatusamyakara i.e. which maintains equilibrium in the body and
daily regimes should be such that it will maintain the health.
And to avoid all the etiological factors i.e. Nidana Parivarjana helps to prevent the
development of disease thereby maintaining the health of an individual, especially in
those above said who are more prone for this disease45.
Similarly adopting Dinacharya, Rutu charya and other hygiene measures
described in various classics will help a person to overcome the etiological factors like
Asyasukham, Swapnasukham etc. and to prevent the disease formation.
PATHYA – APATHYA
The word “Pathya” is derived from the word “Patha” which means roads or
bodily channels and the methods adopted in maintaining the integrity of the bodily
channels or “Srothas” is called as “Pathya”. “Pathya” also means those foods and deeds,
which does not do any harm to the body and which gives happiness to body and mind46.
While commenting on Charaka Samhita, Chakrapani describes the meaning of
‘Patha’ as the channels or Srotas of the body and ‘Pathya’ as that which protects the
healthy state of an individual and cures diseased condition and promotes or restores
health.
According to Ayurveda every food we consume have its own effect in either
increasing or decreasing the Dosha. So when such foods or deeds are done which is not
“Pathya” that means which is Apathya-Ahara then the vitiated “Doshas” aggravates the
diseases.
Those Ahara’s and Vihara which are suitable to Prameha patients are called
Pathya and those which induce Prameha are called Apathya. Pathya is having a key role
in the management of Madhumeha. Even in modern science also Diet & Exercise are
included in diabetes management. So before stepping to manage we have to consider for
the Pathya-Apathya.
Madhumeha has been described as Anushangi, which means Punarbhavi i.e. a
tendency to recur. Hence a Madhumeha patient should stick to Pathya throughout his life.
The Pathya-Apathya Nirdesha according to different authors and their Guna and Karma
have been classified into Ahara, Vihara and Achara.
Table 7 showing various Pathya Ahara in Prameha
ITEMS PATHYA / BENEFICIAL
Cereals Puranashali, shashtikashali,
Pulses PuranaYava, puranagodhuma, mudga,
kulatahTila, chanaka, sarshapa, masoora
Vegetables & leaves Guduchi leaves, kadalisaara, karavellaka,
shigru, patola, mulaka, pata, lashuna,
Fruits Apakvakadali, cucumber, jambu, udumbara,
vrukshamla, bilva, dadima, kharjura.
Oils Tila taila, dantitaila, inguditaila.
Milk & milk products Takra, mastu, chagadugdha.
Sugars, honey etc. Kshaudra madhu, chhatramadhu, dala madhu,
old jaggery.
Fish, meat, etc. Harina, ena, lava, tittira, shuka, mayura
Salts & ksharas Bidalavana, yavakshara, sarjikshara
Tubers Varahi kanda
Taste of food Pungent, bitter, astringent.
Food preparations & rinks Madhudaka, navaneeta, mudgadi yusha,
kulattha vikalpa
Miscellaneous Cow’s urine
Table 8 showing various Pathya Ahara mentioned in different classics
Dravya’s C. S S. S A. S. A. H. B.P. Y.R. B. R.
Yava + - - + + + +
Shastika Shali + + - - + + -
Purana Shali + - - + - + +
Mudga + + - + + + +
Tikta Shaka + + - + + + +
Danti taila + + - - - - -
Ingudi taila + + - - - - -
Atasi taila + + - - - - -
Sharshapa taila + + - - - - +
Jangala mamsa + + - - + + +
Sarodaka + - + - - - -
Madhuodaka + - - - - - +
Triphala + - + + - - +
Godhuma - + - - + + +
Chanaka - + - - + + +
Adhaki - + - - + + +
Kulatha - + - - + + +
Amalaka + + + - - - +
Jambuka - - - + - - +
Shyamaka - - - - + + +
Yava: Yava is Ruksha, Sheeta, Guru, Madhura Rasa Pradhana, Kashaya Rasa Yukta. It is
Vatahara, Sthiryakara and Balya and so is ideal for both Krusha and Sthoola
Madhumeha. It is considered as the principle pathya Ahara in management of Prameha
That is the reason numerous preparations of Yava have been advised.
Tikta Shaka : It is Ruksha, Laghu and Pitta -Vata Shamaka and hence is helps in
pacifying the Kapha dosha and being Vata Shamaka is beneficial in Madhumeha.
Pathya Vihara:
Sushruta has described that practice of regular physical exercise, wrestling, actual sports,
riding on a horse, or a elephant, long walks, predestrial journeys, practising archery,
casting of javelins etc.47
Vagbhata has advised Rukshamudvartna, heavy exercises like digging a well and not to
take sleep even in night for the patient of Prameha. Also walking on bare foot is
described as the best treatment for the poor patients48.
Apathya:
(a) Ahara:
Jala, Milk, Ghee, Oils, Curd, Sugar, Different types of rice preparations, Anupa, Gramya
and Audaka Mamsa, Ikshurasa, Pishtanna, Navanna, Guda, Amla Padartha.
(b) Vihara:
Eksthana Asana, Divaswapa, Dhoompana, Swedana, Maithuna, Mutravega dharana.
MODERN REVIEW
DEFINITION:
Diabetes mellitus is a group of metabolic disease characterized by hyperglycemia
resulting from defects in insulin secretion, insulin action or both.
CLASSIFICATION:
The current expert committee of American diabetes association has proposed
changes to the WHO classification scheme. The revised Etiologic classification of
diabetes mellitus is as follows:
1. Type 1 diabetes (beta -cell destruction, usually leading to absolute insulin deficiency.)
A. Immune mediated.
B. Idiopathic
2. Type 2 diabetes (may range from predominantly insulin resistance with relative
insulin deficiency to a predominantly secretory defect with insulin resistance.
3. Other specific Types:
A. Genetic defect of beta-cell function:
a. Chromosome 12, HNF-1 Alpha (MODY 3)
b. Chromosome 7, Glucokinase (MODY 2)
c. Chromosome 20, HNF 4 Alpha (MODY 1)
d. Mitochondrial DNA
e. Others
B. Genetic defects in insulin action:
Type A insulin resistance, Rabson Mendenhall Syndrome, Lipoatrophic,
C. Diseases of exocrine pancreas:
Pancreatitis, Trauma / Pancreatectomy, Neoplasia, Cystic Fibrosis,
Hemochromatosis, fibrocalculous pancreatopathy.
D. Endrocrinopathies:
Acromegaly, Cushing’s syndrome, Glucagonoma, Pheochromocytoma,
Hyperthyroidism, Somatostatinoma, Aldosteronoma.
E. Drug or Chemical induced :
Vacor, Pentamidine, Nicotinic Acid, Glucocorticoids, Thyroid Hormone
Diazoxide, beta -adrenergic agonists, Thiazides, Dilantin, Alpha-Interferon.
F. Infections:
Congenital rubella, Cytomegalovirus & Others
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, Huntigtion’s
Chorea, Laurence-Monn-Biedl syndrome, Myotonic dystrophy,
Porphyria, Prader-Willi syndrome & others.
4. Gestational Diabetes Mellitus (GDM)
CRITERIA FOR DIAGNOSIS
The revised criteria for diagnosis according to American diabetes association is as under
(1) Symptoms of diabetes plus random plasma glucose concentration > 200 mg/dl
(11.1 mol/l), random is defined as any time of day without regard to time since last
meal.
Or
(2) FPG >126 mg/dl (7.0 mmol/l). Fasting is defined as no caloric intake for at least 8hrs.
Or
(3) 2-hr PG > 200 mg/dl or (11.1 mmol/l) during an OGTT. The test should be performed
using a glucose load containing the equivalent 75g anhydrous glucose dissolved in water.
INVESTIGATIONS:
1. Blood Glucose Tests:
Fasting
Postprandial
Tolerance Tests
HbA1c
2. Urine Glucose Tests
3. Insulin Tests
S. Insulin
Insulin Sensitivity Test
4. Other complimentary Tests:
Glycated Serum Protein (GSP),
S. Fructosamine,
EPIDEMIOLOGY & PREVALENCE :
Diabetes has been described as an epidemic, but predications for future increases
in prevalence, especially in developing countries point to a major health care crisis for the
future. Current estimates suggest that the prevalence of type 2 diabetes worldwide is set
to increase from its present level of 150 million to 250 million by the end of the decade
and 300 million by 2025. These figures represent only clinically diagnosed diabetes &
many of more cases of diabetes remain undiagnosed and untreated.
The long term complications associated with type 2 diabetes carries a crushing
burden of morbidity and mortality. The Indian diabetic population is predicted to rise
>80.9 million by the year 2030.
Current prevalence rates are 10-18% in the urban Indian adult population & there
is evidence that the prevalence of type 2 diabetes is increasing in rural population also.
INSULIN BIOSYNTHESIS, SECRETION & ACTION :
BIOSYNTHESIS:
Insulin is produced in the beta cells of the pancreatic islets. It is initially
synthesized as a single chain 86 amino acid precursor polypeptide, preproinsulin. The
mature insulin molecule and C peptide are stored together and co secreted from secretory
granules in the beta cells.
SECRETION:
Glucose levels > 70 mg/dl stimulate insulin synthesis, primarily by enhancing
protein translation and processing, as well as inducing insulin secretion. Glucose
stimulates insulin secretion through a series of regulatory steps that begin with transport
into the beta cell by the GLUT2 glucose transporter. Glucose physophorylation by
glucokinase controls glucose regulated insulin secretion.
ACTION:
Once insulin is secreted into the portal vein approximately 50% is removed and
deranged by the liver. Unextracted insulin enters the systemic circulation and binds to its
receptor in target sites. The insulin receptor belongs to the tyrosine kinase class of
membrane bound receptors. Insulin binding to the receptor stimulates intrinsic tyrosine
kinase activity, leading to receptor autophosphorylation and the recruitment of intra
cellular signaling molecules, such as insulin receptor substrates (IRS) 1 and 2. These and
other adaptor proteins initiate a complex cascade of phosphorylation and
dephosphirylation reactions. Ultimately resulting in the wide spread metabolic and
mitogenic effects of insulin. Activation of other insulin receptor signaling pathways
induces glycogen synthesis, protein synthesis, lipogenesis and regulation of various genes
in insulin responsive cells.
In fasting state, low insulin levels promote hepatic gluconeogenesis and
glycogenolysis, decrease glycogen synthesis, reduce glucose uptake in insulin sensitive
tissues, promote mobilization of stored precursors, allows glucagons to stimulate
glycogenolysis and gluconeogenesis by the liver and renal medulla.
AETIOPATHOGENESIS: TYPE 1 DIABETES MELLITUS:
Type 1 diabetes develops as a result of the synergistic effects of genetic,
environmental and immunologic factors that ultimately destroy the pancreatic beta cells.
When diabetes becomes overt clinically, majority of beta cells are destroyed. Type 1
diabetes is a multi-factorial autoimmune disorder showing familial aggregation, the rate
of familial aggregation being consistent with the significance of the genetic contribution
to the disease.
AETIOPATHOGENESIS: TYPE 2 DIABETES MELLITUS
Genetic Factors:
Among monogenic forms of type 2 diabetes, Various phenotypes in
MODY(maturity onset diabetes mellitus) patients suggest the disorder to be genetically
heterogeneous MODY 1 diabetes is caused by mutation of the nuclear factor-4a gene
(HNF-4a/MODY1), MODY 2 by mutation of the glucokinase gene (GCK/MODY2), and
MODY 3 by mutation of the hepatocyte nuclear factor-1a gene (HNF-1a/MODY3)
MODY 1 and MODY 3 are characterized by severe disturbance of insulin secretion and
severe hyperglycemia associated with microvascular complications.
Metabolic abnormalities :
Insulin resistance :
Insulin resistance is a diminished ability of insulin to perform its biological
function. Although individuals with insulin resistance secrete abnormally high amounts
of insulin to compensate for the disturbance, to stimulate glucose transport to the
muscular and adipose tissue, and to inhibit the hepatic production of glucose, the plasma
concentration of glucose is on a continuous rise. Although insulin resistance is an
important factor for the development of type 2 diabetes, a majority of people with insulin
resistance do not develop diabetes.
Impaired Insulin Secretion :
In type 2 diabetes mellitus, insulin secretion initially increases its response to
insulin resistance to maintain normal glycemia. Eventually the insulin secretory defect
progresses to a state of grossly inadequate insulin secretion. The reason for decline in
insulin secretory capacity in type 2 diabetes mellitus is unclear.
Obesity:
The state of obesity is associated with dyslipidaemia, hyperinsulinemia, insulin
resistance and impaired glucose tolerance
Environmental Factors :
The migration of populations to more urban settings, as well as increasing
affluence in developing countries contributes for the establishment of diabetes. Foods
highly rich in carbohydrate and fat, sedentary life style, Stress & Strain are triggering
factors for type 2 diabetes.
CLINICAL FEATURES :
The classic symptoms of diabetes are as follows:
Polyuria
Polydipsia
Unexplained Weight loss
These are sometimes associated with polyphagia and blurred vision. Pruritis
valvae or balanitis is a common presenting symptom since the external genitalia are
especially prone to infection by fungi which flourish on skin & mucous membranes
contaminated by glucose. Acute, life threatening consequence of diabetes are
hyperglycemia with ketoacidosis or the non-ketoic hypersmolar syndrome.
TREATMENT:
The goals of therapy for type 1 or type 2 diabetes mellitus:
1. Eliminate symptoms related to hyperglycemia.
2. Reduce or eliminate long term micro vascular, macro vascular complications.
3. Allow the patient to achieve as normal a life style as possible.
So the management can be planned as under:
(1) Education of Patient about diabetes mellitus, Nutrition and Exercise.
(2) Monitoring the level of glycaemic Control.
(3) Assessment of glycaemic Control.
(4) Oral Hypoglycemic Agents
(5) Insulin
NUTRITON:
Medical Nutrition Therapy (MNT) is an integral component of Diabetes
Management.
Nutritional Recommendations for Diabetics:
Carbohydrate: Whole grains, fruits, vegetables and low fat milk should be included in
the healthy diet. The total amount of carbohydrate in diet is more important than
source or type. As sucrose does not increase glycaemic index to a greater extent than
is caloric amounts of starch, sucrose and sucrose containing foods do not need to be
restricted.
Protein – Protein intakes > 20% of total daily energy should be avoided.
Fat – Less than 10% of energy intake should be derived from saturated fats.
Vitamins & Minerals – As there is no evidence of benefit from it, vitamins &
minerals are not advisable if person do not have underlying deficiencies.
Antioxidant – Routine supplementation of antioxidants is not advised because of
uncertainties related to long term efficacy & safety.
EXERCISE:
The possible benefits of physical activity for the patient with type 2 diabetes are
substantial, and recent studies strengthen the importance of long term physical activity
programs for the treatment & prevention of Diabetes mellitus. It reduces the risk of
cardiovascular disease, Hyperlipidaemia, Hypertension & Obesity.
A great deal of evidence has been accumulated supporting the hypothesis that
physical activity among other therapies, may be useful in preventing or delaying the onset
of type 2 DM
INSULIN ADMINISTRATION:
Insulin is available in rapid, short, intermediate and long acting types.
Conventional insulin administration involves subcutaneous injection with syringes
marked in insulin units. Several pen like devices and insulin containing catridges are
available that deliver insulin subcutaneously. The appropriate insulin dosage is dependent
on the glycemic response of the individual to food intake & exercise regimens. All
insulin requiring individuals should be instructed to carry at least 15 gm carbohydrate to
be eaten or taken in liquid form in the event of a hypoglycemic reaction
ORAL HYPOGLYCEMIC AGENTS :
Table 9 showing Characteristics of oral drugs for diabetes
Mechanism of
Action
Example Anticipated
Reduction
in HbA1C%
Agent Specific
Advantages
Insulin
Secretagogues
Sulfonylureas
increases Insulin
secretion
Glipizide
1-2
Lower fasting
blood glucose
Meglitinide
Repaglinide
Short onset of
action, lower
PPBG
Biguanides Decreases
Hepatic glucose
production, weight
loss,
increases glucose
utilization
Metformin
1-2
Weight loss,
Improve lipid
profile, No
hypoglycemca
Alpha-
Glucosidase
inhibitors
Decreases
Glucose
absorption
Acarbose
miglitol
0.5-1 No risk of
hypoglycemia
Thizolidinediones Decreases
Insulin resistance,
increases glucose
utilization
Rosiglitazone
Proglitazone
1-2 Insulin &
Sulfonylurea
requirements,
triglycerides.
COMPLICATIONS OF DIABETES MELLITUS:
Complications of Diabetes mellitus fall into two major divisions i.e. Acute Complications
& Chronic Complications.
Acute Complications:
Hypoglycemia
Diabetic Ketoacidosis
Non Ketoic hyperosmolar state
Chronic Complications :
(1)Macro vascular Complications:
Coronary artery disease.
Peripheral Vascular disease.
Cerebro vascular disease.
(2)Micro vascular Complications :
Diabetic Eye disease
Retinopathy (non-proliferative / proliferative)
Macular edema
Glaucoma
Cataracts
Diabetic Neuropathy
Poly neuropathy /mono neuropathy
Diabetic Nephropathy
(3) Other
Gastro intestinal [gastro paresis, diarrhea]
Genito urinary [uropathy /sexual dysfunction]
Dermatologic infections.
Diabetic foot.
Management of Type 2 Diabetes
Diagnosis of type 2 DM: use one of three test
RBS > 200 mg per dl + symptoms
FBS > 126 mg per dl
OGTT - 2-hr PG > 200 mg per dl
Patient education/ diet and exercise
Goal: FBS < 126 mg per dl
Initiative Monotherapy (if diet and exercise alone are inadequate)
Options for Monotherapy
Sulphonylureas Meglitinide Biguanides Thizolidinediones Alpha-Glucosidase
Inhibitors
Initiate combination therapy if single agent is inadequate
If therapeutic goals are not achieved using above combination:
Adopt insulin therapy with or without oral drugs
DRUG REVIEW
Management of diabetes mellitus or Prameha is based on three main aspects i.e.
Diet, Exercise and Drugs. Diet management holds first and the foremost place in the
management of type 2 diabetes or NIDDM. Majority of the cases of type II diabetes can
be treated or controlled just by modifying diet and exercise only.
All the classics have emphasized on regulation of diet in Prameha patient and
have indicated various Ahara Dravya’s which are beneficial for Prameha patients. These
beneficial Ahara Dravya’s are mentioned under the heading of Pathya Ahara i.e. which
does not vitiates the Dosha responsible for the disease but in turn help in pacifying the
Dosha’s and helping the body to over come the disease for speedy recovery. There are
plenty of Pathya Dravya’s mentioned in different texts.
Keeping this in view these Pathya Dravya’s were analyzed and the common
dravya’s were selected like: - Yava (barley), Mudga (green gram), Kulatha (horse gram),
Rajashimbi (soybean), Godhuma (wheat bran) and Triphala and were combined to form a
compound.
The above said Dravya’s were made into fine powder and then made into granules
form. This compound is named as Nutritional compound which was administered to the
patients in the dose of 15 gm twice daily with warm water.
Table 10 showing description of Dravya’s
Dravya’s Varga Family Latin Name
Yava Shuka Dhanya Gramineae Hordeum vulgare
Godhuma Shuka Dhanya
Gramineae
Triticum
aestivum
Mudga Shimbi Dhanya
Leguminacae
Sub Family– Papilionacae
Vigna radiate
Kulatha Shimbi Dhanya
Dolichos biflorus
Rajashimbi Shimbi Dhanya Leguminacae
Sub Family– Papilionacae
Glycine Max
Merrill
Haritaki Combretacae Terminalia -
Chebula
Bibhitaka Combretacae Terminalia -
Bellirica
Amalaki Euphorbiacae Emblica -
Officinalis
Prameha is a disease of Kapha predominance, and Madhumeha of Vata Dosha
predominance with formation of Kleda in the body. Hence the management should be of
Kapha- Vata Shamana and Kleda Nashaka.
Keeping this in View even the various Pathya mentioned in different text have
properties of Kapha-Vata Shamana and Kleda Nashaka.
Action or Karma of any Dravya depends on its Rasa, Virya, Vipaka or Prabhva.
Which Guna is responsible for the Karma of the particular Dravya is dependent on the
Panchabhoutika combination of that Dravya. Hence it has been mentioned that some
Dravya’s act by its Rasa, some by its Virya or Vipaka or in some cases by the Prabhava
of that Dravya.
Yava has been mentioned as the important Pathya for Prameha Patients. Though
Yava is Madhura and Guru but the properties of Yava, which are generally Kapha
vitiating properties but Yava is an exception for it as it helps in pacifying the Kapha
Dosha. Similarly Godhuma is Madhura, Guru and Sheeta, old variety of it helps in
pacifying Kapha Dosha.
Yava is Ruksha, Sheeta, Guru, Madhura Rasa Pradhana, Kashaya Rasa Yukta. It
is Vatahara, Sthairyakara and Balya and so is ideal for both Krusha and Sthoola
Madhumehis.
Kulatha, Bibhitaka, Mudga, Haritaki are Kashaya Rasatmaka and Yava
Rajashimbi are having Kashaya as Anurasa. Kashaya Rasa is Vayu and Prithvi
Mahabhuta Pradhana which helps in Pitta and Kapha Shamana. Kashaya Rasa is
Stambhaka, Shoshaka, Ropaka and Mutra-Sangrahaniya also helps in Kleda Nashaka
which is the major factor in Samprapti of Mahumeha.
Haritaki though is Kashaya; it is Mrudurechaka and Anulomaka which helps in
Vatanulomana. Kulatha though being Kashaya, due to its Snigdha Virya it helps in Vata
Shamana. Yava and Kulatha helps in absorption of Kleda in the body thereby helps in
Rokshana Karma.
The Guna’s of all the dravya’s mentioned above are Ruksha, Laghu which are
opposite to that of Kapha which help in pacifying the Kapha Dosha.
In Dhatukshayajanya Madhumeha, Dravya’s like Godhuma, Amalaki, Rajashimbi
which are Madhura, Sheeta, Balya, Tarpaka help in over coming the Dhatukshaya and
there by relieving the symptoms like Daurbalya, Alasya etc.
Triphala i.e. Haritaki, Bhibhitaka and Amalaki, though are Aushadi Dravya’s, are
mentioned as Pathya for Prameha. Triphala is Pathya, deepana, Kapha-Pittahara,
Rasayana and Mehahara. Properties of various Dravya’s in Triphala not only help in
Pacifying the Prameha disease as such but help in preventing the complication of
Madhumeha also. Charakacharya gives importance to Triphala by mentioning that if a
person is consuming Triphala regularly he won’t suffer from Prameha.
Hence various factors like Rasa, Virya, Vipaka of Dravya’s help in pacifying the
vitiated Dosha’s thereby establishing normalcy of Dosha’s and relieving the disease.
Table 11 showing Nutritional values of the ingredients in supplement
(Per 100 g)
Dravya CHO Protein Fats Fibre Calorie Gly. index
Barley 69.6 11.5 1.3 3.9 336 22
Wheat bran 71.2 11.8 1.5 1.2 346 54
Green gram 59.9 24.5 1.2 0.8 348 54
Horse gram 57.3 22 5.3 0.5 322 73
Soybean 20.9 43.2 19.5 3.7 432 14
Analyzing the nutritive value’s of above dravya’s, they are mainly low in fat, rich
in fibre content, have low glycaemic index and moderate in carbohydrate i.e. mainly
contain complex carbohydrates and rich in caloric values which help diabetes patients in
various aspects.
The rich fibre content of barley (Yava), soybean (Rajashimbi), and wheat bran
(Godhuma) slows down the carbohydrate digestion and absorption and so improves
glycemic control.
Glycemic index: - Jenkins and wolever (1981) coined term glycemic index to describe in
quantitative way the rise in blood sugar that different carbohydrate foods produced.
The glycemic index is rise in blood glucose induced by test food expressed as percentage
of that induced by same amount of pure glucose.
Factors affecting glycemic index of isolated food are-
Speed of digestion of carbohydrates.
Amount and type of dietary fibre.
Presence of monosaccharide such as fructose, which are slowly absorbed in gut.
Glycemic index = Blood glucose area of test food X 100
Blood glucose area of reference food
White bread is preferred as reference food because it is palatable and generally accepted.
A 100% value is given to mean blood glucose for three hours following ingestion of 50g
carbohydrate in white bread. The glycemic index value in commonly consumed foods is
compared with 50g carbohydrate in white bread.
The Dravya’s like barley (Yava), soybean (Rajashimbi), and wheat bran
(Godhuma) have a low glycemic index of 22, 14 and 54 respectively which helps in
controlling the raise in post prandial blood glucose levels.
The protein contents in these Dravya’s helps the patients to over come the
emaciation caused by utilization of fats and proteins for energy needs of the body, in turn
avoids formation of ketone bodies and further complications.
The rich fibre content in these dravya’s also helps in reducing the LDL
cholesterol levels in the body, thereby helps in preventing the complication like heart
diseases, hypertension, etc.
There are plenty of researches available proving the efficacy of rich fibre and
complex carbohydrate diet in lowering blood glucose levels and avoiding long term
complications of the disease.
FIG. 1 YAVA FIG. 2 GODHUMA
FIG. 3 KULATHA FIG. 4 MUDGA
FIG. 5 RAJASHIMBI FIG. 6 AMALAKI
FIG. 7 HARITAKI FIG. 8 BIBHITAKI
FIG.9 FIG.10
Table 12 showing the properties and action of Dravya’s
Dravya’s Guna Rasa Virya Vipaka Doshaghanata Karma
Yava Ruksha,
Guru
Madhura,
Kashaya
Sheeta Madhura Kaphashamaka,
Vatavardhaka
Balya,
Sthairyakara,
Purishajanana
Godhuma Guru,
Snigdha
Madhura Sheeta Madhura Vatapittashamaka Sandhanakara,
Jeevaniya, Balya,
Brimhana,
Vrushya,
Sthairyakara,.
Mudga Laghu,
Ruksha,
Vishada
Kashaya,
Madhura
------ Katu Kaphapittahara Chaksushya,
Kulatha Ushna,
Ruksha
Kashaya Ushna Amla Kaphavatashamaka Grahi,
Netraroganashaka
Rajashimbi Guru,
Snigdha
Madhura,
Kashaya
Ushna Madhura Vatashamaka Balya
Table 11 showing the properties and action of Dravya’s
Dravya’s Guna Rasa Virya Vipaka Doshaghanata Karma
Haritaki Laghu,
Ruksha
Kashaya
Pradhan
Pancharasa
Ushna Madhura Tridoshahara,
Vatashamaka
Rasayana, Pathya,
Mrudurechana,
Balya, Mehahara,
Hrudya,
Vranaropana,
Santarpana,
Medohara
Bibhitaka Laghu,
Ruksha
Kashaya Ushna Katu Kaphahara,
Tridoshghna
Chedana,
Sleshmahara,
Deepana, Grahi,
Rechana,
Dhatuvardhaka,
Dahaprashamana
Amalaki Laghu,
Ruksha,
Sheeta
Pancharasa Sheeta Madhura Pittashamaka,
Tridoshahara
Rasayana, Medhya,
Rochana, Deepana,
Hrudya, Vrushya,
Mehahara,
Chaksushya.
METHODOLOGY
Among the several health problems existing today, Diabetes mellitus is a major
disease considered as one of the arch enemy of mankind. Though, the discovery of
insulin and other hypoglycemic drugs is a great achievement of modern science, but the
hazardous side effects of hypoglycemic drugs after long term use are incurable and hence
an ideal therapy is still obscure.
In Ayurveda, Diabetes mellitus closely resembles a disorder called Madhumeha,
which is a subtype of Vataja Prameha. The Ayurvedic management of Diabetes aims not
only to achieve a strict glycemic control, but also to treat the root cause of the disease.
For it various modalities of treatment are developed, which depends upon the underlying
pathology.
AIMS AND OBJECTIVES OF THE STUDY
3. To study the effect of various Pathya Ahara in the form of nutritional compound
in Prameha
4. To study the improvement in nutritional status, and over all health status of
patients by administration of adjuvant nutritional compound.
MATERIALS AND METHODS SELECTION OF PATIENTS
Patients attending the OPD and IPD of S.D.M. college of Ayurveda and Hospital,
Hassan were randomly selected irrespective of age, sex, religion, occupation, marital
status etc. and were divided in two groups considering the inclusion criteria for the study.
INCLUSION CRITERIA
1. Mild to moderate cases of diabetes mellitus having fasting blood sugar within
range of 121 mg/dl to 220 mg/dl and post prandial blood sugar within range of
181 mg/dl to 280 mg/dl were selected.
2. Patients above the age group of 25 years and below 60 years of age were selected
3. Patients within 5 years of diagnosis for diabetes mellitus were selected for the
study.
EXCLUSION CRITERIA
1. Severe form i.e. patients having fasting blood sugar above 221 mg/dl and post
prandial blood sugar above 281 were excluded.
2. Patients with uncontrolled blood sugars were excluded.
3. Patients with other systemic disorders and complications of diabetes mellitus were
excluded from the study.
DIAGNOSTIC CRITERIA
Diagnosed cases of diabetes mellitus within 5 years of detection were selected for
the study. Mild to moderate diabetic cases were selected based on the following standard
reference chart for classification along with the clinical signs and symptoms mentioned in
the classics.
FBS 70 to 120 mg/dl normal
121 to 170 mg/dl mild
171 to 220 mg/dl moderate
221 and above severe
RBS 120 to 180 mg/dl normal
181 to 230 mg/dl mild
231 to 280 mg/dl moderate
281 and above severe
PPBS 120 to 180 mg/dl normal
181 to 230 mg/dl mild
231 to 280 mg/dl moderate
281 and above severe
As per classification of S.N Khosle at al.nagarjuna
LABORATORY INVESTIGATIONS 1. Hematological – Total count, Differential count, E.S.R., Hb%.
2. Fasting blood sugar
3. Post prandial blood sugar
4. Urine – microscopic, albumin, sugar.
RESEARCH DESIGN The randomly selected patients were divided into two groups, each having 15
patients. A comparative study based on the pre-test and post-test design was undertaken
with following two groups.
GROUP A:-
Group A consist of patients with standard Ayurvedic drug treatment with
Asanadigana Kashaya 30 ml twice daily before food and Nisha-Amalaki tablet 2 tab.
twice a day for period of two months. The patients were asked to follow the exercise and
diet recommended.
GROUP B:-
Group B patients were asked to follow the same line of treatment as in Group A
along with the exercise and diet recommended in Group A. Addition to this the patients
in Group B were given a nutritional compound prepared from various Pathya Ahara.
The nutritional compound was prepared in the form of granules and was
administered to the patients 15gm twice a day with warm water before food for a period
of one month.
The patients were provided with standard diet chart which was similar to all the patients.
ASSESMENT CRITERIA
Efficacy of treatment was assessed in the reduction of signs and symptoms before
and after the course of study with the help of self-graded assessment scale. Changes in
the following symptoms were noted & taken for assessment.
(1) Fasting Blood sugar
(2) Post Prandial Blood Sugar
(3) Fasting Urine sugar
(4) Post Prandial Urine sugar
Pippasa:-
Normal thirst up to 1.5 liters per day 0
Feels thirsty up to 2 liters per day 1
Feels very thirsty 3 liters per day 2
Always thirsty more than 3 liters per day 3
Kshuddha:-
Normal timely manifestation /can control hunger 0
Slightly increased/Can control hunger up to 1 hr. 1
Excessive hunger / cannot withstand 2
Feels hungry even after consuming food 3
Mutra Vega:-
Frequency of Micturation at night 0-1 0
Frequency of Micturation at night 2-3 1
Frequency of Micturation at night 4-5 2
Frequency of Micturation at night more than 5 3
Karpadadaha:-
No burning sensation in hands or feet 0
Occasional burning sensation in hands or feet 1
Frequent burning sensation in hands and feet 2
Persistent/continuous burning sensation 3
Daurbalya:-
No weakness 0
Feels tiredness after strenuous work 1
Feels frequent tiredness even after mild work 2
Always associated with tiredness 3
Sweda:-
No sweating 0
Profuse sweating after hard work 1
Profuse sweating even after mild work 2
Sweating even at rest 3
FOLLOW UP OF THE STUDY Patients were asked report once in 15 days from the starting of the course of the
study for a period of two months.
OBSERVATIONS
A clinical study was conducted in 30 patients who were classified into 2 groups,
15 patients kept as control group (Group A) and 15 in trail group (Group B). Each and
every case was studied as per age, sex, socio-economic status, religion, occupation, etc.
All the data is presented in the form of tables. Signs and symptoms are studied for
improvement in individual factors and the results were subjected to statistical analysis.
Table 13 Showing Age wise distribution
Age group Group-A % Group- B % Total %
25-30 00 00 01 6.67 01 3.33
30-35 01 6.67 00 00 01 3.33
35-40 00 00 02 13.33 02 6.67
40-45 04 26.67 00 00 04 13.33
45-50 00 00 04 26.67 04 13.33
50-55 03 20 04 26.67 07 23.33
55-60 07 46.67 04 26.67 11 36.67
Among both the groups out of 30 patients 11 [36.67%] were in age group of 55-60
years, 07 patients [23.33 % ] in the age group of 50-55 years, and 04 patients [13.33 %]
in the age group 45-50 and 40-45 each, 02 [6.67% ] in age group of 35-40, and 01
[3.33 %] each in 30-35 and 25-30 age groups.
Table 14 showing the sex ratio of both the groups
Sex Group A % Group B % Total %
Male 12 80 8 53.33 20 66.67
Female 03 20 7 46.67 10 33.33
Total 15 15 30
Out of 30 patients 20 [66.67 %] patients were male and 10 [33.33 %] patients were of
female sex.
Table 15 shows Religion wise distribution
Religion Group A % Group B % Total %
Hindu 14 93.33 15 100 29 96.67
Muslim 01 6.67 00 00 01 3.33
Total 15 15 30
Out of 30 patients 29 [96.67 %] patients belongs to Hindu and 01 [3.33%] patients
belongs to the Muslim religion.
Chart no. 01 Showing Age wise distribution
0
5
10
15
20
25
30
35
40
45
50
25-30 30-35 35-40 40-45 45-50 50-55 55-60
Group-A
%
Group- B
%
Chart no. 02 showing the sex ratio of both the groups
0
10
20
30
40
50
60
70
80
90
Group A % Group B %
Male
Female
Total
Chart no. 03 shows Religion wise distribution
0
20
40
60
80
100
120
Group A % Group B %
Hindu
Muslim
Total
Table 16 showing the marital status
Group A % Group B % Total %
Married 15 100 14 93.33 29 96.67
Unmarried 00 00 01 6.67 01 3.33
Total 15 15 30
In this series out of 30 patients 29 [96.67 %] were married and 01 [3.33 %] was
unmarried.
Table 17 showing diet patterns
Type of food Group A % Group B % Total %
Vegetarian 10 66.67 08 53.33 18 60
Mixed 05 33.33 07 46.67 12 40
Total 15 15 30
Out of 30 patients 18 [60 %] patients were taking the vegetarian diet;
12 [40%] patients were accustomed to the mixed diet..
Table 18 showing Distribution of patients according to the Prakriti
Prakriti Group A % Group B % Total %
Vata Kapha 00 00 01 6.67 01 3.33
Vata Pitta 04 26.67 04 26.67 08 26.67
Kapha Pitta 04 26.67 03 20 07 23.33
Kapha Vata 00 00 00 00 00 00
Pitta Kapha 03 20 02 13.33 05 16.67
Pitta Vata 04 26.67 05 33.33 09 30
Total 15 15 30
Out of 30 patients of this series 09 [30 %] were of Pitta -Vata Prakriti; 08 [26.67
%] were of Vata-Pitta Prakriti, 07[23.33 %] were of Kapha-Pitta Prakriti; 05 [16.67
%] were of Pitta-Kapha Prakriti and 01 [3.33 %] of Vata-Kapha.
Chart no. 04 showing the marital status
0
20
40
60
80
100
120
Group A % Group B %
Married
Unmarried
Total
Chart no. 05 showing diet patterns
0
10
20
30
40
50
60
70
80
Group A % Group B %
Vegetarian
Mixed
Total
Chart no. 06 showing Distribution of patients according to the Prakriti
0
5
10
15
20
25
30
Group A % Group B %
Vata Kapha
Vata Pitta
Kapha Pitta
Table 19 Showing patients based on the occupation
Occupation Group A % Group B % Total %
Business 04 26.67 02 13.33 06 20
House wife 03 20 06 40 09 30
Teacher 01 6.67 02 13.33 03 10
Agriculture 03 20 02 13.33 05 16.67
Officer 03 20 02 13.33 05 16.67
Others 01 6.67 01 6.67 02 6.67
Total 15 15 30
Depending upon the occupational distribution 09 [30%] were accustomed to the house
work; 06 [20%] were in the business; 05 [16.67%] to the agriculture work; 05 [16.67%]
were of office work; 03 [10%] were teachers; 02 [6.67%] were in others category.
Table 20 showing Distribution of the patients according to Pipasadhikyata
Results of Pipasa Group A Group B
Mean BT 0.867 1.00
Mean AT 0.6 0.467
Mean difference 0.34 0.534
% of improvement 30.67 % 53.34 %
S.D. 0.4879 0.6398
S.E. 0.1259 0.1652
t value 2.645 3.227
P value P < 0.02 P < 0.01
Inference Significant Significant
The initial mean score was reduced from 0.867 to 0.6 in group A, where
as it reduced from 1.00 to 0.467 in Group B. The Ayurvedic treatment showed
30.67 % [p <0.02] improvement which was significant in case of group A. The
Nutritional compound supplementation showed 53.34 % [p <0.01] improvement
which was also significant in case of group B.
Table21 showing distribution of patients according to Kshudhadhikyata
Results of Kshudha Group A Group B
Mean BT 0.733 0.8
Mean AT 0.466 0.4
Mean difference 0.266 0.4
% of improvement 36.36% 50%
S.D. 0.4577 0.5070
S.E. 0.1181 0.1309
T value 2.256 3.055
P value P < 0.05 P < 0.01
Inference Significant Significant
The initial mean score was reduced from 0.733 to 0.466 in group A, where
as it reduced from 0.8 to 0.4 in Group B. The Ayurvedic treatment showed
36.36% [p <0.05] improvement which was significant in case of group A. The
Nutritional compound supplementation showed 50% [p <0.01] improvement
which was significant in case of group B.
Table 22 showing Distribution of patients according to Karapada Daha
Results of Karapada Daha Group A Group B
Mean BT 0.8 1.33
Mean AT 0.466 0.66
Mean difference 0.33 0.66
% of improvement 41.66% 50%
S.D. 0.4879 0.4879
S.E. 0.1259 0.1259
t value 2.645 5.291
P value P < 0.02 P < 0.001
Inference Significant Significant
The initial mean score was reduced from 0.8 to 0.466 in group A, where
as it reduced from 1.33 to 0.66 in Group B. The Ayurvedic treatment showed
41.66% [p <0.02] improvement which was significant in case of group A. The
Nutritional compound supplementation showed 50% [<0.001] improvement which
was significant in case of group B.
Table23 showing distribution of patients according to Adhika Mootrata
Results of Adhika Mootrata Group A Group B
Mean BT 1.00 1.133
Mean AT 0.60 0.533
Mean difference 0.40 0.6
% of improvement 40% 52.94%
S.D. 0.5070 0.5070
S.E. 0.1309 0.1309
t value 3.055 4.582
P value P < 0.01 P < 0.001
Inference Significant Significant
The initial mean score was reduced from 1.00 to 0.60 in group A, where
as it reduced from 1.133 to 0.533 in Group B. The Ayurvedic treatment showed
40% [p <0.01] improvement which was significant in case of group A. The
Nutritional compound supplementation showed 52.94% [p <0.001] improvement
which was significant in case of group B.
Table 24 showing distribution of 20 patients according to Daurbalya
Results of Shrama Group A Group B
Mean BT 0.933 1.133
Mean AT 0.66 0.8
Mean difference 0.266 0.33
% of improvement 28.57% 29.41%
S.D. 0.4577 0.4879
S.E. 0.1181 0.1259
t value 2.256 2.645
P value P < 0.05 P < 0.02
Inference Significant Significant
The initial mean score was reduced from 0.933 to 0.66 in group A, where
as it reduced from 1.133 to 0.8 in Group B. The Ayurvedic treatment showed
28.57% [p <0.05] improvement which was significant in case of group A. The
Nutritional compound supplementation showed 29.41% [p <0.02] improvement
which was significant in case of group B.
Table 25 showing distribution of patients according to Atisweda
Results of Atisweda Group A Group B
Mean BT 0.8 0.66
Mean AT 0.533 0.466
Mean difference 0.266 0.2
% of improvement 33.33% 30%
S.D. 0.4577 0.4140
S.E. 0.1181 0.1069
t value 2.256 1.870
P value P < 0.05 P > 0.05
Inference Significant Insignificant
The initial mean score was reduced from 0.8 to 0.533 in group A, where
as it reduced from 0.66 to 0.466 in Group B. The Ayurvedic treatment showed
33.33% [p <0.05] improvement which was significant in case of group A. The
Nutritional compound supplementation showed 30% [p >0.05] improvement
which was insignificant in case of group B.
Chart no.09 showing improvement Chart no. 10 Showing improvement according to Pipasadhikyata according to Kshudhadhikyata
0
0.2
0.4
0.6
0.8
1
Group A Group B
Mean BT Mean AT % of improvement
0
0.2
0.4
0.6
0.8
1
1.2
1.4
Group A Group B
Mean BT Mean AT % of improvement
Chart no. 11 showing improvement Chart no. 12 Showing improvement
according to Adhika Mootrata according to Daurbalya
0
0.2
0.4
0.6
0.8
1
1.2
Group A Group B
Mean BT Mean AT % of improvement
0
0.2
0.4
0.6
0.8
1
1.2
Group A Group B
Mean BT Mean AT % of improvement
Chart no. 13 showing improvement Chart no. 14 Showing improvement according to Atisweda according to Karapada Daha
0
0.2
0.4
0.6
0.8
1
Group A Group B
Mean BT Mean AT % of improvement
0
0.2
0.4
0.6
0.8
1
1.2
1.4
Group A Group B
Mean BT Mean AT % of improvement
Table 26 showing F.B.S. distribution of patients
Results of F.B.S. Group A Group B
Mean BT 146.6 134.52
Mean AT 137.54 119.8
Mean difference 9.04 14.7
% of improvement 6.184 % 10.93 %
S.D. 32.99 32.74
S.E. 8.519 8.453
t value 1.061 1.739
P value P < 0.3 P < 0.1
Inference Insignificant Insignificant
The initial mean score was reduced from 146.6 to 137.54 in group A,
where as it reduced from 134.52 to 119.8 in Group B. The Ayurvedic treatment
showed 6.184 % [p <0.3] improvement which was insignificant in case of group
A. The Nutritional compound supplementation showed 10.93 % [p <0.1]
improvement which was insignificant in case of group B.
Table 27 showing P.P.B.S. distribution of patients
Results of P.P.B.S. Group A Group B
Mean BT 233.68 226.06
Mean AT 223.69 206.7
Mean difference 9.98 24.146
% of improvement 4.27 % 8.54 %
S.D. 26.93 38.386
S.E. 6.955 9.911
t value 1.435 2.436
P value P > 0.1 P < 0.05
Inference Insignificant Significant
The initial mean score was reduced from 233.68 to 223.69in group A,
where as it reduced from 226.06 to 206.7in Group B. The Ayurvedic treatment
showed 4.27 % [p >0.1] improvement which was insignificant in case of group A.
The Nutritional compound supplementation showed 8.54 % [p <0.05]
improvement which was significant in case of group B.
Table 28 showing F.U.S. Distribution of patients
Results of F.U.S. Group A Group B
Mean BT 0.6 0.5
Mean AT 0.466 0.3
Mean difference 0.133 0.2
% of improvement 22.22% 40%
S.D. 0.399 0.2535
S.E. 0.1031 0.0654
t value 1.2929 3.055
P value P < 0.3 P < 0.01
Inference Insignificant Significant
The initial mean score was reduced from 0.6 to 0.466 in group A, where
as it reduced from 0.5 to 0.3 in Group B. The Ayurvedic treatment showed
22.22% [p <0.3] improvement which was insignificant in case of group A. The
Nutritional compound supplementation showed 40% [p <0.01] improvement
which was significant in case of group B.
Table 29 showing P.P.U.S. Distribution of patients
Results of F.U.S. Group A Group B
Mean BT 1.066 1.133
Mean AT 0.866 0.833
Mean difference 0.2 0.3
% of improvement 18.75% 26.47%
S.D. 0.253 0.4928
S.E. 0.0654 0.1272
t value 3.055 2.357
P value P < 0.01 P < 0.05
Inference Significant Significant
The initial mean score was reduced from 1.066 to 0.866 in group A, where
as it reduced from 1.133 to 0.833in Group B. The Ayurvedic treatment showed
18.75% [p <0.01] improvement which was significant in case of group A. The
Nutritional compound supplementation showed 26.47% [p <0.05] improvement
which was significant in case of group B.
Chart no. 15 showing improvement in Chart no. 16 showing improvement in F.B.S. of patients P.P.B.S. of patients
020406080
100120140160
Group A Group B
Mean BT Mean AT
190
200
210
220
230
240
Group A Group B
Mean BT Mean AT
Chart no. 18 showing improvement in Chart no. 19 showing improvement in F.U.S. Of patients P.P.U.S. of patients
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
Group A Group B
Mean BT Mean AT
0
0.2
0.4
0.6
0.8
1
1.2
Group A Group B
Mean BT Mean AT
Table 30 showing over all effect of the treatment
Relief Group A % Group B %
No relief 3 20 % 3 20 %
Mild 9 60 % 6 40 %
Moderate 3 20 % 5 33.34 %
Marked 0 0 % 1 6.66 %
The overall Effect of the therapy in both the groups was observed as stated below.
Marked Improvement was observed in 0 % patients in Group A and 6.66 % in Group B.
Moderate improvement was found in 20 % in Group A and 33.34 % in Group B. While
mild improvement was seen in 60 % in Group A and 40 % in Group B. No relief was
observed in 20 % patients in Group A and 20 % patients in Group B towards therapy
given.
Chart no. 08 showing over all effect of the treatment
0
1
2
3
4
5
6
7
8
9
10
Group A % Group B %
No relief
Mild
Moderate
Marked
DISCUSSION
Diabetes mellitus has become the disease of more concern in recent years.
Because of its increasing incidence through out the world, makes it a major health
problem.
The reasons for this can be understood under the heading of urbanization and
sedentary lifestyle adopted by the new generation. But along with the above said reasons
genetic inheritance cannot be over looked. This supports the thrifty gene inheritance
theory of NIDDM proposed by W.H.O. Indians have evolved a thrifty gene since our
ancestors lived through centuries of famine. Indians are now genetically programmed.
India has distinction of having largest number of diabetic patients through out the world,
and is set to become diabetic capital of world.
The introduction of oral hypoglycemic drugs in modern therapeutics appeared to
be a break through initially but, subsequently it was experienced that most of drugs were
inadequately effective and associated with side effects. Moreover managing diabetes only
with drugs is found to be ineffective unless and until other factors like diet and exercise
are taken into consideration.
To achieve an effective management of Madhumeha various Pathya Ahara are
mentioned along with drugs. Different kinds of exercises are also mentioned to be
followed by the patients.
Hence for proper management of Madhumeha or Diabetes Mellitus an attempt is
made here to employ various Pathya Ahara and to observe their efficacy.
DISCUSSION ON GENERAL OBSERVATIONS-
Age –
All the cases were reported in the out patient department of S.D.M.C.A. Hospital.
From both the groups out of 30 patients 36.67 % patients were from the age group of 55-
60 years, 23.33 % were from the age group 50-55 years of age, 13.33 % of patients were
from the age group 45-50 and 40-45 each,6.67% in age group of 35-40, and 3.33% each
in 30-35 and 25-30 age group. The incidence and prevalence of NIDDM is more after 40
years. It reveals that the individuals are more affected by Type 2 diabetes after forties.
This might be due to decreased physical activity after this age. Madhumeha being the
Vata predominant type, it may be the reason for more cases after forties where Vata
Pradhanya starts in the body. The present study also supports this fact.
Sex-
In the present study Majority of the patients were male [66.67 %]] and less
females were reported [33.33 %]. It is similar with the fact that in south-east Asia, male
patients were observed in more number than females. Acharya Dalhana and
Bhavaprakasha mentioned that females do not develop the Prameha, because they are
purified by monthly flow of Raja Srava [Su.Chi.11 Dal. Tika]. This is to be further
evaluated in a bigger sample. Also the stress and strain at physical and mental aspects are
more in females which may be contributing factor.
Religion-
In the present study, 96.67 % were Hindus and only 3.33% from Muslim religion.
It does not mean that Hindus are more prone to get Madhumeha. This may be due to the
ratio of patients attending the hospital is more from Hindu community.
Marital status –
In this study 96.67 % were married and 3.33 % unmarried. It does not indicating
that married are more surely to get the Madhumeha [NIDDM]. This may be due to the
manifestation of the disease after middle age. So the percentage of married patients who
were reported is more than unmarried.
Occupation-
Depending upon the occupational distribution 30% were belonging to the house
hold work; 20% in the business; 16.67% to the agriculture work; 16.67% were having
official work; 10% were teachers and 6.67% were in others category. This shows that the
patients who are doing less physical activity like house work and business were afflicted
more due to the sedentary life style, increased mental activity and stress & strain. It is
said in etiological factors that sitting for long time in comfortable posture are one of the
causative factor for the disease.
Family history –
There were 55 % of the cases had the history of Madhumeha in family. This
supports that Type 2 diabetes mellitus has a strong genetic component. This justifies that
Madhumeha being mentioned as Beejadoshaja and that it is a Kulaja Vikara.
Diet Pattern:
60 % patients were of the vegetarian group; 40% patients of the mixed group.
This may be due to the traditional vegetarian dietary habits among the Hindus who
formed the greater part of this study.
Socio economical status –
The majority of the cases were reported from the middle class. This finding
reflects the pattern of patients coming to the hospital of this institute according to their
socio-economic conditions and also the increasing substantial sedentary habits among
them.
Prakriti –
Out of 30 patients 30 % were of Pitta-Vata Prakriti; 26.67 % were of Vata-Pitta
Prakriti, 23.33 % were of Kapha Pitta Prakriti; 16.67 % were of Pitta Kapha Prakriti and
3.33 % of Vata-Kapha. Majority of cases were from the Dwandva Prakriti. Vata and Pitta
dominant Prakruti associated with Kapha Dosha were seen which resembles the
involvement of Vata dosha in Madhumeha along with the Kapha Dosha as the main
Dosha involved in Samprapti of the disease.
DISCUSSION ON EFFECT OF THERAPY-
On Adhika Kshudha-
The group A i.e. Ayurvedic treatment showed 36.36% improvement and group B
i.e. nutritional compound supplementation showed 50% improvement which was
significant in case of group B. There is much improvement in B than A group. The
nutritional supplement was given before food and has Dravya like Yava and Kulatha
which are Guru and by there supplementation of other Ahara Dravya’s decreases the
symptom of Adhika Kshudha.
The protein contents in these Dravya’s helps the patients to overcome the
emaciation caused by utilization of fats and proteins for energy needs of the body thereby
relieving the symptom of Adhika Kshudha.
On Adhika Pipasa-
The group A showed 30.67 % improvement and group B showed 53.34 %
improvement. Madhura Vipaka of Yava, Amalaki, and Rajashimbi pacifies vitiated Vata
& Pitta Dosha thereby relieves the symptom.
On Karapada Daha-
The group A showed 41.66% improvement while group B supplementation
showed 50% improvement. Karapadasupti is a manifestation of vitiated vata.
Karapadadaha occurs as a result of Ashayapakarsha Gati of Pitta. Guru, Snigdha Guna of
Godhuma, Rajashimbi and Ushna Virya of Haritaki and Bibhitaka helps in Pacifying the
Vata Dosha. The Madhura Vipaka of Yava, Godhuma, Amalaki and Sheeta Virya helps
in Pacifying the Pitta Dosha thereby reducing the symptom of Karapadadaha.
On Adhika Mootrata-
The group A showed 40% improvement while group B showed 52.94%
improvement. Most of the Dravya’s in nutritional supplement given to group B patient
are of Kashaya Rasa which is having properties of Shoshana, Kaphaghana and Mutra
Sangrahaniya. And also Dravya’s like Yava and Kulatha are having properties of Kleda
Shoshana and Rukshana Karma which probably must have helped in relieving the
symptoms.
The protein contents in Nutritional supplement overcomes the emaciation and
thereby decreases formation of ketone bodies which helps in decreasing symptoms of
polyuria.
On Daurbalya –
The group A showed 28.57% improvement, group B showed 29.41%
improvement. Both are significant in reducing the Lakshana of Daurbalya. The Balya,
Brihmana, Santarpana properties of Godhuma, Rajashimbi and Yava as Balya helps in
Nourishment of body and Rasayana properties of Amalaki and Haritaki helps in
preventing the Dhatu Kshaya thereby Pacifying Vata Dosha and overcoming the
Daurbalya.
On Atisweda-
The group A showed 33.33% improvement where as in group B showed 30%
improvement
On Weight-
There was not much change in weight of patients in either of the groups. In group
B i.e. nutritional supplement group in only three patients there was increase in the weight
by 2 kilogram. Neither of them were obese. Out of three patients two were newly
diagnosed and had a history of weight loss and weakness. Utilization of fat and protein
for energy needs and no treatment initially must have lead to loss of weight. After
diagnosis and treatment these patients must have regained there weight due to control
over the disease.
On B.M.I.-
Not much variation in BMI was noticed, as there were no variations in the weight
of the patients.
On F.B.S. –
The group showed 6.184 % improvement where as group B showed 10.93 %
improvement. There was much reduction and greater control in the group B patients. The
properties of different Dravya’s helps in better control of blood glucose levels. Most of
the Dravya’s have Laghu, Ruksha Guna and properties like Kapha Shamana and Kleda
Nashaka which helps in Pacifying the Kapha Dosha there by maintaining the blood
glucose levels.
On P.P.B.S. –
The group A showed 4.27 % improvement where as in group B showed 8.54 %
improvement. There was greater control of post prandial blood glucose levels in group B.
the properties of Yava being Guru but Apatarpana helps in reducing the Satiety and does
the Atarpana there by Pacifying the Kapha dosha without vitiating the Vata Dosha.
Majority of Dravya’s are Kashaya Rasatmaka. Kashaya Rasa is Vayu and Prithvi
Mahabhuta Pradhana which helps in Pitta and Kapha Shamana. Kashaya Rasa is
Stambhaka, Shoshaka, Ropaka and Mutra-Sangrahaniya also helps in Kleda Nashaka.
The rich fibre content of barley (Yava), soybean (Rajashimbi), and wheat bran
(Godhuma) slows down the carbohydrate digestion and absorption and so improves
glycemic control. These Dravya’s i.e. barley (Yava), soybean (Rajashimbi), and wheat
bran (Godhuma) have a low glycemic index of 22, 14 and 54 respectively which helps in
controlling the raise in the post prandial blood glucose levels.
On F.U.S. -
The group A showed 22.22% improvement where as in group B showed 40%.
There was a marked improvement in group B patients in FUS. The properties of Dravya’s
in nutritional compound like Kapha Shamana, Kleda Nashaka, Mutra Sangrahaniya helps
in controlling the FUS.
On P.P.U.S. –
The group A showed 18.75% improvement as compared to the group B which
showed 26.47%. There was better control in group B patients post prandial blood glucose
levels.
The low Glycemic index of the Dravya’s like barley (Yava), soybean
(Rajashimbi), and wheat bran (Godhuma) i.e. of 22, 14 and 54 respectively delays the
digestion process and slows down the absorption of carbohydrate from intestine thereby
helps to maintain the sudden rise in blood glucose levels soon after food intake. As the
sudden increase in post prandial blood sugar is controlled the post prandial urine sugar
also is thereby controlled.
OVERALL EFFECT OF THERAPY:
Marked Improvement was observed in 0 % patients in Group A and 6.66 % in
Group B. Moderate improvement was found in 20 % in Group A and 33.34 % in Group
B. While mild improvement was seen in 60 % in Group A and 40 % in Group B. No
relief was observed in 20 % patients in Group A and 20 % patients in Group B towards
therapy given. Over all better relief was seen in group B patient who were treated with
Ayurvedic drugs along with nutritional compound than in group A patient who were
treated with Ayurvedic drugs only.
CONCLUSION
The present study “A clinical study on the efficacy of nutritional compound” was
undertaken with two group having 15 patients each. Group A was given Ayurvedic
treatment and group B was given Ayurvedic treatment as in group A along with
nutritional compound prepared from various Pathya Dravya’s. Following conclusions can
be drawn from the clinical study.
1. Among 30 patients who underwent the study 26 patients were above the age
group of 40. It reveals that the individuals are more affected by Type 2 diabetes
after forties.
2. Occurrence of the disease was seen more in house wives, business men and
people accustomed to office work which shows that the patients doing less
physical activity were afflicted more due to the sedentary life style, increased
mental activity and stress & strain.
3. Out of 30 patients 17 patients had a positive history of disease in the family. the
hereditary nature or the Sahaja (Kulaja) nature of the disease can be understood
from the above observation.
4. Management of Madhumeha can be understood under the headings of diet,
exercise and drugs.
5. Various Pathya Ahara Dravya’s i.e. which are beneficial to the body are
mentioned in different Ayurvedic text while treating Prameha.
6. Diet plays a key role in the management of diabetes mellitus.
7. Diet helps in better glycemic control when used along with exercise and anti-
diabetic drugs in needed cases.
8. Newly diagnosed and mild cases of diabetes can be effectively managed by
advising proper diet and exercise only.
9. A low fat, high fibre and complex carbohydrate diet should facilitate good
glycemic control in diabetes.
10. Various Pathya Ahara mentioned in Ayurveda helps in better glycemic control
and relief from the symptoms of diabetes.
11. Over all effect of study showed Marked Improvement was observed in 0 %
patients in Group A and 6.66 % in Group B. Moderate improvement was found in
20 % in Group A and 33.34 % in Group B. While mild improvement was seen in
60 % in Group A and 40 % in Group B. No relief was observed in 20 % patients
in Group A and 20 % patients in Group B.
12. Statistical analysis reveals that administration of nutritional compound along with
Ayurvedic treatment was more effective when compared to Ayurvedic treatment
alone.
13. Nutritional compound helped in relieving the signs and symptoms of the disease
and provided feeling of well being.
14. The nutritional compound formulated can be undertaken for a large trial
considering its efficacy obtained in the present study.
SUMMARY
The frame of the dissertation work entitled “A clinical study on the efficacy of
nutritional compound in Prameha” is designed in five sections viz.
Literary review
Drug review
Methodology
Discussion
Summary & Conclusion
The present study has been undertaken with following aims and objectives:
5. To study the effect of various Pathya Ahara in the form of nutritional compound
in Prameha
6. To study the improvement in nutritional status, and over all health status of
patients by administration of adjuvant nutritional compound.
The literary review consists of overall view of the disease and therapeutics from
the Ayurvedic point of view as well as modern point of view. Historical review brings us
the information about the disease since Vedic period and from different branches of
medicine existing in past. The disease review comprises an elaborate coverage of
Prameha and Madhumeha with detailed description about Nidana, Poorvarupa, Roopa,
Samprapti, Sadhyasadhyata, Chikitsa and Pathya-Apathya. The disease review from
modern point of view deals with definition, classification, Insulin bio-synthesis, secretion
and action, Aetiopathogenesis, complications and treatment of Diabetes mellitus.
The second section comprises of drug review with detailed description of drugs
under trial. Description about the various Dravya’s used in trail, family, Latin names,
Rasa, Virya, Vipaka, Karma of the Dravya’s as per Ayurvedic classics are mentioned.
Details regarding the constitution of each drug in terms of its nutritional values have been
elaborated. Analyzing the Ayurvedic Classics and references regarding modern clinical &
experimental studies the Probable made of action of the selected drugs has been put forth
for the Dravya’s used in the trial nutritional compound.
The third section deals with the clinical study comprising the selection of patients,
diagnostic criteria, assessment criteria, laboratory investigations and results obtained
from the study.
30 patients of Madhumeha i.e. NIDDM were included for the present study and
were randomly divided into two groups with 15 patients each.
The patients were investigated for sugar levels and the assessment parameters were
recorded. For group A patients standard Ayurvedic treatment with Asanadigana Kashaya
30 ml twice daily before food and Nisha-Amalaki tablet 2 tab twice a day for period of
two months was given. For the trial group i.e. group B the nutritional compound prepared
from various Pathya Ahara Dravya’s in the form of granules was administered to the
patients 15gm twice a day with warm water before food was given along with same
Ayurvedic treatment as in group A for a period of one month. The patients were provided
with standard diet chart which was similar to all the patients
Patients were followed once in 15 days for a period of 2 months. After completion
of the treatment, effect of therapy on each and every sign and symptom as well as sugar
levels was recorded and analyzed statistically.
Results obtained after completion of therapy were compared after statistical
analysis. Final results were graded as Marked Improvement, Moderate Improvement,
Mild Improvement and No relief.
Over all Effect of Both Therapies:
The overall Effect of the therapy in both the groups was observed as stated below.
Marked Improvement was observed in 0 % patients in Group A and 6.66 % in Group B.
Moderate improvement was found in 20 % in Group A and 33.34 % in Group B. While
mild improvement was seen in 60 % in Group A and 40 % in Group B. No relief was
observed in 20 % patients in Group A and 20 % patients in Group B towards therapy
given.
Interpretation of observations and results is done in the discussion.
Statistical analysis of total effect of therapies reveals that administration of
nutritional compound along with Ayurvedic treatment was more effective when
compared to Ayurvedic treatment alone.
BIBLIOGRAPHIC REFERENCES LIST OF REFERENCES
1. Chakradutta, Rasayana Adhikara 90
2. Atharvaveda
3. Garuda Purana
4. Sha. Kal. Dru
5. San. Eng. Dic V.S. Apte
6. Su. Ni 6/6
7. A.S. Ni 10/7
8. A.S. Ni 10/8
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10. C.S Chi 6/15
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12. San. Eng. Dic V.S. Apte
13. San. Eng. Dic( M. Monier Williams)
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15. Su. Chi 11/3
16. C.S. Chi 6/57
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18. C.S.Chi. 6/4
19. A.H. Ni. 10/1-3
20. C.S. Su. 17/78
21. Su.S.Ni. 6/30
22. C.S. Su. 17/78-79
23. Su.S.Ni.6/22-23
24. Su.S.Ni. 6/25-26
25. C.S.Ni. 4/44
26. Su.S.Ni.6/28
27. C.S.Su. 17/78-80
28. C.S.Chi. 6/8
29. A.H.Ni. 10/4
30. C.S.Ni. 4/48
31. C.S.Su. 16/5
32. C.S.Chi. 22/60
33. C.S.Chi. 22/60
34. C.S.Chi. 3
35. Su.S.Ni. 6/13
36. Su.S.Ni. 6/15
37. Su.S.Ni. 6/15
38. A.H.
39. Su.S.Ni.6/15
40. C.S.In. 5/16
41. C.S.In. 5/17
42. Bh.Pr.
43. C.S. Chi. 6/16, Su.Chi. 12/6, A.H.Chi. 12/1
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45. C.S.Ni.4/51-52
46. C.S.Su. 24/45
47. Su. Chi. 11/11
48. A.S.Chi.12
BiblIography
1. Agnivesha (2004), Charakasamhita (Hindi Commentary by Vidyothini), Vol-I,
Reprint 2004. Chaukamba Bharati Academy Publication, Varanasi, Vol-I & Vol-II,
2. Agnivesha (2000), Charakasamhita with English Translation [by Bhagwandasha
R.K. Sharma], Volume IV, II Edition, Chowkamba Sanskrit Series Office,
Varanashi,
3. Anonymous, Yogaratnakara with Vaidyaprabha, Hindi Commentary, 1st Edition,
1998. Edr. Dr. Indradevi Tripathi and Dr. Daya Shankar Tripathi, Krishnadas
Academy, Varanasi,
4. Ada.P.Kahn: Diabetes Causes, Prevention and treatment, 13th Printing – 2002,
Published by Orient Paperbacks, Delhi.
5. Apte V.S. (1997), The Students Sanskrit English Dictionary, Motilal
banarasidass Publishers Private limited. Delhi.
6. Bhava Misra; Bhavaprakash; Vidyotini, Hindi Commentary, First Edition 1993,
Choukambha Sanskrit Sansthan, Varanasi, Part II.
7. Brahmanand Tripathi (1999), Astanga Hridaya, Nirmal Hindi Commentary, 1st
Edition, Edr. Bramhanand Tripathi, Chaukamba Sanskrit Pratisthana, Delhi.
8. Brhmananda. Tripathy; Pathyapathya Vivechana ; 1st Edition –1998, Published
by Chaukambha Orientalia, Varanasi.
9. Braunwald, Harrison’s Principle’s of Internal Medicine, 13th Edition, McGraw
Hill Medical Publications, Vol. II, pp. 1167-1172.
10. Chakrapani (1994), Charakasamhita, Edition IV, Edtr.. Vaidya Jadavaji Trikamji
Acharya, Chaukamba Sanskriti Sansthan Publisher, Varanasi.
11. Christopher Halsett et. al., Davidson’s Principles of Medicine, Edtr. Christopher
Halsett et.al, 19th Edition, 2002. Churchil Livingstone, U.K.
12. Dalhana, Sushruta Samhita, Nibandha Sangraha Sanskrit Commentary, Editor
Jadavaji Trikamaji Acharya, Reprint 1999. Chaukambha Surabharati Prakashana,
Varanasi,
13. David H. Alpers, William F. Stenson, Dennis M.Bier: Manual of Nutritional
Therapeutics 3rd Edition; Little Bown and Company, London.
14. F.P.Antia & Philip Abraham: Clinical dietetics and nutrition 4th edition; oxford
university press.
15. Gangadhar, Charaka Samhita, Part IV, 1st Edition, 1999, Chaukamba Orientalia,
Varanasi
16. Geoffrey D. Webb ; Nutritional a Health Promotion Approach 2nd edition
17. Harrison; Harrison’s [1991] Principles of internal medicine, edr. Willson etal; Mc
Graw hill Inc, Health Professions division.
18. Indu (1980), Astanga Sangraha, Shashilekha Sanskrit Commentry, Editor
Athavale A.P. Shrimad Atreya Prakashana.
19. Kumar Gupta, Dr.L.C.Gupta, Abhishekha Gupta; Food and Nutrition; 4th edition
1992, Published by Jatpee Brothers, Medical publishers, Pvt.Limited.Delhi
20. Monilial William, A Sanskrit English Dictionary, 5th Edition, 1997 Motilal
Banarasidas Publishers Private Limited, Delhi.
21. Park.K.; Text Book of Preventive & Social Medicine; 17th edi. M/S Banarasi das
Bhanot Publishers, Jabalpur.
22. Raja Radha Kanta Deva; Shabda Kalpadrum, 3rd Edition, Chaukamba Sanskrit
Series Office, Varanasi, part-II, Part-IV
23. Sainani G.S., API Text Book of Medicine, 6th Edition, 1999, Published by
Association of Physicians of India, Bombay.
24. Sharma P.V.; Chakradatta; Edtr. P.V. Sharma, 2nd Edition, 1998, Chaukamba
Publishers, Varanasi.
25. Sushruta, Sushruta Samhita Ayurveda TattvaSandipika, Hindi Commentary, 11th
Edition, 1997. Editor, Kaviraja Ambikadutta Shastri, Chaukamba Sanskrit Bhavana,
26. Vriddha Jeevaka; Kashyapa Samhita; revised by Vatsya with Sanskrit introduction
by Nepal Rajaguru Pan. Hemaraja Sharma with the Hindi commentary & Hindi
translation of Samskrit introduction by Ayurvedalankara Sri. Sthyapala
Bhishagacharya; 8th edi. 2002 ; Chaukaumbha Publication –New Delhi.
ANNEXURE
CASE PROFORMA
S.D.M. COLLEGE OF AYURVEDA, HASSAN.
DEPT. OF P.G. STUDIES IN SWASTHVRITTA
TOPIC: - A clinical study on the efficacy of nutritional compound in Prameha.
GUIDE: - Dr. G. V. Ramana
DATE: - OPD no.:-
NAME:-
AGE: - SEX:-
ADDRESS: - OCCUPATION: -
PHONE: - IPD no.:-
Pradhana vedana:-
Anupandha vedana:-
kulaj vrittanta:-
Date of diagnosis:-
Atura Charya:-
Atura pariksha:-
Nadi:- B.P.:- / mmof hg
Mala:- Prakruti:-
Mutra:-
Jiwha:-
Sabda:-
Sparsh:-
Druk:-
Akruti:-
Satmya /Asatmya:-
Ahara:- veg / non veg./ mixed
Vysana: - alcohol / tobacco / smoking
Weight: - Height: - B.M.I:-
Laboratory Investigations-
Blood routine: - HB%:- ESR:-
E: - B:-
N: - M: - L:-
Blood sugar level: - Fasting:-
Post prandial:-
Urine sugar:-
Lipid profile:-Total:-
HDL:-
LDL:-
Current treatment: -
Treatment given:-
Follow up:-
Date / / / / / / / /
Mutra vega
Pippasa
KShudha
Karpada daha
Daurbalya
Atisweda
Shrama
Laboratory investigations:-
DATE / / / / / / / /
HB%
ESR
FBS
PPBS
Urine sugar
LIPIDS
Serum protein
Anthropometric measurements
DATE / / / / / / / /
Height
Weight
B.M.I
Mid arm circumfer.
Mid thigh ircumfer.
Model diet sheet
On rising coffee / tea 120 ml (without sugar)
Idli 4 no.s or
Dosa/chapatti 2 no.s or chutney
8:00 Upma/pulao 2 no.s or +
A.M Rava idli 2 no.s or sambar
Bread 4 slices
With tea/coffee
11:00 butter milk 1 glass + vegetable salad or
A.M coffee/tea 120ml (without sugar)
Rice 2 cup or chapatti 2 no.s
or or
1:00 ragiball 1 no.s rice 1 cup
P.M or
Rice 1 cup chapatti 1 no.s
Sambar 1 cup rasam: 1 cup vegetables: 4 cups
Coffee/tea 120ml (without sugar)
Idli 4 no.s or
Dosa/chapatti 2 no.s or chutney
4:00 Upma/pulao 2 no.s or +
P.M rava idli 2 no.s or sambar
Bread 4 slices
With tea/coffee
6:00 butter milk 1 glass + vegetable salad or
P.M coffee/tea 120ml (without sugar)
8:00 same as lunch or breakfast
P.M
Bed time: milk 120ml (without sugar)
Non – veg allowance in place of Dhal/ pulses
Chicken 200 gms
Or
Fish 200 gms daily
Or
Egg white 1 no.s
Mutton 100 gms
Or once in week
Egg 1 no.s