HEARTY WELCOME

GUIDED by:Dr. S.N.BELWADI

Astt. ProfessorSCHOLAR:-Dr. Vidhu B. Maheshwari

Department of P.G. studies in KayachikitsaD.G.M Ayurveda Medical College

GADAG-582103 KARNATAKAMOBILE–7829212073.

Email id: drvidhumaheshwari@gmail.com

“EFFECT of BALA and AMALAKI sidha TAKRADHARA in the MANAGEMENT of MADHUMEHA janya UPADRAVA”

CONTENTSINTRODUCTION

BRIEF ABOUT CASE REPORT OF THE PATIENT

MATERIAL AND METHODS

INGREDIENTS OF SHIRO DHARA

PREPARATION OF AMALAKI KWATHA

PREPARATION OF BALA KWATHA

PREPARATION OF TAKRA

METHODS

Purva Karma

Pradhan karma

Paschat karma

FOLLOW UP

ASSESSMENT OF RESULT

Neuropathy Disability score

RESULT

CONCLUSION

CONT…

INTRODUCTION• So many diseases are there which output of unnatural

dietary habits, restless lifestyle is and stress, one of such is diabetes.

• It has turned out to be the biggest “silent killer” today in the world. The mortality rate due to Diabetes mellitus is very high and is ranked fifth amongst the ten major causes of death in southern part of India.

• According to WHO, an estimated 438 million people of world’s adult population, live with Diabetes mellitus till 2030.

• Diabetic neuropathy is a family of nerve disorder caused by DM. Around 3.2 million deaths every year are attributable to complication of diabetes mellitus.

• In Ayurveda the Aacharyas have invariably given detailed description of the disease diabetes, its causes, types, pathology and the line of treatment.

• The features such as KarPada Daha (burning sensation), Cumcumayana (tingling sensation), KarPada Suptata (numbness) are symptoms seen in Prameha rogi either in prodromal stage or in the actual exhibition stage or in complication stage is identified as Diabetic peripheral neuropathy.

BRIEF ABOUT CASE REPORT OF THE PATIENT

SHANKARAPPA 65 years old male patient having weight of 71 kg presented in the DGM Ayurvedic Medical College Gadag O.P.D. with complaints of:• Burning sensation• Numbness• Cramps in his both lower extremities• Tingling sensation in right hand

more since 15 days.

Detailed history of present illness revealed that Progressive tingling sensation in Lt. Lower limb and burning sensation started approximately 1 year ago. Then it developed in both Rt. and Lt. Upper and Lower limb. He Reports frequent episodes of numbness below calves, cramps in both calf muscles.

After that he consulted to his family doctor. Where he investigated for his B.P. and Blood sugar level and the investigation revealed High blood Sugar level and since then he is regularly taken his oral hypoglycemic drug (allopathic).

No H/O tremors, twitching, swelling, redness, or tenderness in muscles or joints. No H/O arthritis, or musculoskeletal trauma and no history of Allergies to any known drugs.

MATERIAL AND METHODS• Sarvang Abhyanga with – BALAASHWAGANDHA Taila• Mrudu Swedana• Shiro Dhara with – Bala and Amalaki sidha Takra

(prepared freshly)• Shaman yoga – TAB.MEHANIL 2 B.D. (After food)

MADHUMEHAHARA KASHAYAM 20ml B.D. with equal quantity of water (Before food)

• Duration – Shaman yoga for 20 days

Dhara for 7 days• Follow up- 15 days

INGREDIENTS OF SHIRO DHARA

Takra

Amalaki

Bala

Preparation of Amalaki kwatha

• 125 gm of the dry Amalaki Yavkuta churna to this 2000 ml of water is added and Reduced to 250ml.

Preparation of Bala kwatha

• 125 gm of the dry Bala Yavkuta churna to this 2000 ml of water is added and Reduced to 250ml.

Preparation of Takra• 1.5 liters of milk diluted with 4 times water is

boiled with 100g of skinned and crushed Musta tied in a muslin bag, and is reduced to the original quantity of milk. The bag of medicament is taken out and squeezed well. When cooled, this prepared milk is fermented by the addition of a little sour buttermilk overnight. Next morning the fermented medicated curd is churned by adding 250ml of Amalaki kwatha and 250ml of Bala kwatha. The butter is removed completely and this mixture is used for dhara after filtering.

METHODS

Purva karma

Pradhan karma

Paschat karma

Sarvang abhyanga with Bala-ashwagandha Taila

Mrudu swedana

Purva Karma

Bala and Amalaki sidha Takradhara was administered for seven consecutive days in the morning hours between 7:30 am - 8:30 am. The duration of the dhara was taken in the arohana karma for the first 4 days with a specific time of 5 mins and on the 5th day onwards reduce the duration by the same. The flow of dhara was maintained constant.

Pradhan karma

After the Dhara process is completed, the head of the patient is wiped out and dried and apply Rasana Churna over scalp. The patient is advised to have a light diet and as per indication he can continue his daily routine.

Paschat karma

The patient was asked to report on 7thday & 15th day counting from the day of discharge for follow up and observation.

Follow up

ASSESSMENT OF RESULT

Scoring was given to all the symptoms patient complained about i.e.

Grade 3 • Severe Symptoms

Grade 2 •Moderate Symptoms

Grade 1 • Mild Symptoms

Grade 0 • No Symptoms

Along with this, the objective assessment was done using Neuropathy Disability score. Neuropathy Disability score is the commonly employed bed side examination procedure to find out vibration perception using tuning fork, ankle reflex (the most common reflex to be affected in Peripheral Neuropathy) using knee hammer, temperature perception using cold tuning fork on sole and light touch using pin.

NEUROPATHY DISABILITY SCORE

Parameter Grade 0 Grade 1 Grade 2Total sum for both rt and lt lower limbs

Ankle Reflex Normal reflex

Present on reinforcement

Absent 4

Vibration Present Absent - 2

Pin Prick Present Absent - 2

Temperature Present Absent - 2

Maximum abnormal score is 10, Score of 3-5: symptoms of mild Neuropathy, Score of 6-8: symptoms of moderate Neuropathy, Score of 9 or 10: symptoms of severe Neuropathy

RESULT

Scoring of Neuropathic symptoms before and after treatment

Burnin

g Sen

satio

n

Numbn

ess

Cram

ps in

Low

er E

xtrem

ities

Tinglin

g Sen

satio

n0

1

2

3

B.T.A.T.

Scoring of NDS before and after Treatment

ParameterRt side Lt side Total score

BT AT BT AT BT AT

Ankle Reflex 1 1 1 1 2 2

Vibration 1 0 1 1 2 1

Pin Prick 0 0 1 0 1 0

Temperature 1 0 1 1 2 1

Total NDS score before treatment was 7 and after treatment was 4. Percentage of relief in both Symptoms and NDS after treatment was 52.18% (moderate relief) Lab Investigations (FBS and PPBS) were done before and after treatment as well;

RBS and Urine Sugar before and after treatment

  Before Treatment

After Treatment

RBS 224mg/dl 163mg/dl

Urine Sugar 1.5% 0.5%

APATHYA IN MADHUMEHAAahara:

Jala, Milk, Ghee, Oils, Curd, Sugar, Different types of rice preparations, anupa, gramya and audaka mamsa, Ikshurasa, Pishtanna, Navanna etc..

Vihara:

Eksthanasana, Divaswapa, Dhoompana, Sweda,

Raktamoksha, Mutravega dharana etc..

CONCLUSIONAfter discharge the patient was maintained on TAB.MEHANIL 2 B.D. (After food) MADHUMEHAHARA KASHAYAM 20ml B.D.(before food) along with his regular allopathic medication.

No exacerbation/ aggravation of symptoms is noted after the follow up period.

Hence it can be concluded that AMALAKI BALASIDHA TAKRA DHARA is safe and efficacious treatment modality for Diabetic Peripheral Neuropathy.

As all the drugs used in this procedure have Anti-oxidant, Analgesic, Neuro preventive and hypoglycemic properties in common, making them the best set of available drugs for Diabetic Peripheral Neuropathy.Further studies are to be conducted on this as the present paper is a single case study. Trial in a larger sample is required to generalize the outcome.