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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

Ayurmitra

TAyComprehended

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.


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.


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


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




PPBS 120 to 180 mg/dl normal




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 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


% 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




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



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





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


% 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




40% [p <0.01] improvement which was significant in case of group A. The

Nutritional compound supplementation showed 52.94% [p <0.001] improvement


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


% 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







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



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




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


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


0

0.2

0.4

0.6

0.8

1

1.2

Group A Group B


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


0

0.2

0.4

0.6

0.8

1

1.2

1.4

Group A Group B


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



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



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



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



22.22% [p <0.3] improvement which was insignificant in case of group A. The

Nutritional compound supplementation showed 40% [p <0.01] improvement


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


% 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



as it reduced from 1.133 to 0.833in Group B. The Ayurvedic treatment showed




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


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.

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7. A.S. Ni 10/7

8. A.S. Ni 10/8

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34. C.S.Chi. 3

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48. A.S.Chi.12

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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

prameha nutrition-sw04 has

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