Upload
ayurmitra-ksrprasad
View
1.365
Download
19
Embed Size (px)
DESCRIPTION
Evaluation of the efficacy of Akulyadi yoga in Madhumeha (Diabetes Mellitus) By SHIVALEELA. S. KALYANI, Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103
Citation preview
Evaluation of the efficacy of Akulyadi yoga
in Madhumeha (Diabetes Mellitus) By
SHIVALEELA. S. KALYANI
Dissertation submitted to the
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial fulfillment of the degree of
Ayurveda Vachaspati M.D. In
Kayachikitsa Under the Guidance of
Dr. Shiva Rama Prasad Kethamakka M.D. (Ayu) (Osm), C.O.P. (German) M.A., [Ph.D] (Jyotish)
Department of Kayachikitsa Post Graduate Studies & Research Center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG
2005-2008
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103
This is to certify that the dissertation “Evaluation of the efficacy of Akulyadi yoga
in Madhumeha (Diabetes Mellitus)” is a bonafide research work done by Shivaleela. S.
Kalyani in partial fulfillment of the requirement for the post graduation degree of “Ayurveda
Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health Sciences,
Bangalore, Karnataka.
Guide
Prof. Dr. Shiva Rama Prasad Kethamakka
M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish)
Professor in Kayachikitsa
DGMAMC, PGS&RC, Gadag
Date:
Place:
J.S.V.V. SAMSTHE’S
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103
Endorsement by the H.O.D, principal/ head of the institution
This is to certify that the dissertation entitled “Evaluation of the efficacy of
Akulyadi yoga in Madhumeha (Diabetes Mellitus)” is a bonafide research work done by
Shivaleela. S. Kalyani under the guidance of Prof. Dr. Shiva Rama Prasad
Kethamakka, M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish), Professor in
Kayachikitsa in partial fulfillment of the requirement for the post graduation degree of
“Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health
Sciences, Bangalore, Karnataka.
.
(Dr. G. B. Patil) Principal,
DGM Ayurvedic Medical College, Gadag
Date: Place:
(Dr. V. Varadacharyulu) Professor & HOD
Dept. of Kayachikitsa PGS&RC
Date: Place: Gadag
Declaration by the candidate
I here by declare that this dissertation / thesis entitled “Evaluation of the efficacy of
Akulyadi yoga in Madhumeha (Diabetes Mellitus)” is a bonafide and genuine research
work carried out by me under the guidance of Prof. Dr. Shiva Rama Prasad
Kethamakka, M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)], Professor in Kayachikitsa,
DGMAMC, PGS&RC, Gadag.
Date
Place
Shivaleela. S. Kalyani
Copy right
Declaration by the candidate
I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka
shall have the rights to preserve, use and disseminate this dissertation/ thesis in print or
electronic format for the academic / research purpose.
Date
Place
Shivaleela. S. Kalyani
© Rajiv Gandhi University of Health Sciences, Karnataka
Acknowledgement
First and foremost, I salute almighty God who is omnipresent, omniscient and
omnipotent. He is the possessor of the ocean of knowledge and wisdom-to which I would
like to contribute a drop in the form of my dissertation. As it is said, each and every drop
goes to make an ocean; this is my humble endeavor towards its goal of wisdom. It gives
me in expressible pleasure to offer my sincere thanks to all who have rendered their
wholehearted support, guidance and co-operation in completing the thesis work.
I am extremely happy to express my deepest sense of gratitude to my beloved and
respected guide Prof. Dr. K. Shiva Rama Prasad, M.D., C.O.P. (German), M.A., [Ph.D.]
(Jyotish), Department of Kayachikitsa (PG), for his guidance and timely help.
I express my gratitude to Dr. V.V.Varadacharyulu M.D. (Ayu), Professor and
H.O.D of Kayachikitsa (PG) for his advice and encouragement in every step of this work.
I am sincerely gratefulness to Dr.G.B.Patil, Principal, for his encouragement and
providing all necessary facilities for this research work.
I extend my gratitude to Dr. R.V.Shettar, Dr.Mulki Patil, Dr. Shankaragouda,
Dr.P. Shivaramudu, Dr. G. Purushottamacharyulu, Late Dr. Dhilip, Dr.M.C. Patil, Dr. G.
Danappagoudar, Dr.S.H. Doddamani, Dr.S.N. Belawadi, Dr. Nedugundi, Dr. Samudri,
Dr, Kuber sankh. Dr.Mulgund, Dr.J.Mitti, Dr. Yasmin A.P. and all my U.G. Lecturers for
time-to-time help offered by them.
I express my immense gratitude to my statistician Nandakumar, librarian V.B.
Mundinamani and assistant Sureban for facilitating me in collection and production of
my thesis. I take this opportunity to thank Dr. Shrinivas. Vadeyar M.D (Ayu). Pvaman
Pharmacy, Bijapur, for the preparation of Akulyadi Yoga in the form of tablet.
I would like to thank my family members who have given love and care during
my studies. My deep sense of gratification is due for my Father Sangappa. B. Kalyani and
my mother Kalavati. S. Kalyani who are the architects of my career. The culture,
discipline and perseverance, which I could imbibe, are solely because of their
painstaking, upbringing and strong moral support. I express my deep gratitude to my
Father-in law Prof. Revanneppa. R. Honawad. And mother-in law, Shakuntala. R.
Honawad for their inspiration and valuable suggestions.
I express my heartfelt gratitude to my brother, Mahantesha and my Sisters,
Geetanjali. Savita, Sujata for constant help and encouragement to move ahead. My
deepest gratitude to my husband Dr. Chandrashekhar. R. Honawad for enormous love
and moral support.
I feel proud in expressing my gratitude to my best friends Dr. Seema, Dr. Neeta.
Dr. Radha, Dr. Mahantaleela, Dr. Prasad Shakti, Dr. Shivananda., Who not only helped
me but stood by during hours of stress and dejection.
I take this moment to express my thanks to all my Post gratude colleagues, Dr.
Kalmath, Dr. Ratnakumar, Dr. Venkareddy, Dr.Udaya, Dr. Umesha, Dr. G. G. patil, Dr.
Sarvi, Dr. Shaila, Dr. Sunita, Dr. Veena. Kotrashetter. Dr. Krishna, Dr. Ashoka, Dr.
Kamalaxi, Dr. Sulochana, Dr. prasann. Joshi, Dr. Sanjeeva, Dr.Neeraj, Dr. Veena.
Jigalur, Dr. Vijayalakshmi, Dr. Shivaleela. Kudari, Dr. Shalini. Sharma, Dr. Kataraki, Dr.
Ashwini, Dr. Rudrakshi, Dr. Jayashree, Dr. Kattimani, Dr. Suma Dr. Madhushree, Dr.
Kalmesha, Dr. Muttu, Dr. Seeba, Dr. Prasanna kumar, Dr. Mukta. Hiremath, Dr.
Sarvamangala, Dr. Anupama, Dr. Mukta. Arali Dr. UdayaGanesha, Dr. Adarsha, Dr.
Nataraj, Dr. Shaileja, Dr. Kavita Dr. Kalavati, Dr. Jaya, Dr.Savita, Dr. Shivakumar.
Finally I am thankful to all those who helped directly or in directly for the
completion of this work.
(Shivaleela S. Kalyani)
Abstract of “Evaluation of the efficacy of Akulyadi yoga in
Madhumeha (Diabetes Mellitus)” by Shivaleela. S. Kalyani
Key words:
Madhumeha, Prabhoota, Avila, Akulyadi yoga, Hypoglycemia, Hyperglycemia, DM, FBS, PPBS
The advancement of industrialization and communication is contributing towards
sedentary life styles; in turn causing chronic non-communicable diseases like Madhumeha vis-à-
vis Diabetes Mellitus, etc. in fact Ayurveda is the first life science, which identified, diagnosed
and managed Madhumeha. Madhumeha/DM is the present burning issue alarming the world.
Madhumeha is a disease characterized by Prabhoota, avila mootrata, Tanu and Mootra
madhuryata. Susruta only mentioned that in Madhumeha Sweda becomes Sweet in nature.
Abnormal bi-fold digestion causes aggravation of Vata in turn involves Dushya and metabolic
waste to form Madhumeha. The Madhumeha vis-à-vis diabetes mellitus has many theories of
occurrence, even the recent viral influence studies on diabetes. Madhumeha has Kapha Dosha is
the key factor along with Vata. The present study intended to focus on the disease evaluation i.e.
Madhumeha vis-à-vis. Diabetes Mellitus management with Akulyadi yoga as a Shamana
Chikitsa. Akulyadi yoga ingredients are hypoglycemic agents collected form local area and
prepared under GMP conditions, weighing about 500mg tablet form. Patients of Madhumeha
fulfilling the criteria of diagnosis were selected in the present study. The male female ratio in the
study is approximately 3:2 patients and 75% patients were recorded with sedentary life styles. In
the present study 60% patients had family history and rest of the 40% patients had no family
history of Madhumeha. Apart from the symptoms which show high significance in the study the
key parameters to assess “glycemic” condition of Madhumeha exhibit, FBS with a mean
difference of 48.605mg and PPBS with mean difference of 117.18mg for after to before data.
This is strong evidence to state that the Akulyadi yoga is good hypoglycemic agent combination
of Ayurveda.
- 1 -
Contents of
“Evaluation of the efficacy of Akulyadi yoga in Madhumeha
(Diabetes Mellitus)”
By
Shivaleela. S. Kalyani
CHAPTER CONTENT PAGES
1 Introduction 1 to 5
2 Objectives 6 to 7
3 Review of literature 8 to 66
4 Methods 67 to 75
5 Results 76 to 93
6 Discussion 94 to 104
7 Conclusion 105 to 106
8 Summary 107 to 108
9 Bibliographic References 1 to 6
10 Annex – data of trial 1 to 9
11 Annex – Case sheet 1 to 6
- 2 -
Tables of
“Evaluation of the efficacy of Akulyadi yoga in Madhumeha
(Diabetes Mellitus)”
By
Shivaleela. S. Kalyani
SN Title of Table Page 1 Showing the Vihara Nidana of Madhumeha 16
2 Showing the Ahara Nidana of Madhumeha 17
3 Types of kaphaja Prameha 36
4 Types of pittaja Prameha 36
5 Types of vataja Prameha 36
6 Showing Prognosis of Madhumeha 37
7 Showing the poorva roopa of Madhumeha 42
8 Lakshana of Madhumeha 45
9 Madhumeha upadrava 54
10 Results by Age in Madhumeha with Akulyadi yoga 77
11 Results by Gender in Madhumeha with Akulyadi yoga 78
12 Results by Religion in Madhumeha with Akulyadi yoga 79
13 Results by Occupation in Madhumeha with Akulyadi yoga 80
14 Results by Economic status in Madhumeha with Akulyadi yoga 81
15 Results by Diet in Madhumeha with Akulyadi yoga 82
16 Distribution of patients by presenting complaints 84
17 Distribution of patients by Associated features 85
18 Ahara Nidana observed in the study 86
19 Vihara Nidana observed in the study 86
20 Distribution of patients by Anya Nidana 87
- 3 -
21 Distribution of patients by Poorva roopa lakshana 87
22 Distribution of patients by Sroto dusti lakshana 88
23 Data of Family history in the study 89
24 Assessment of Subjective parameters 89
25 Assessment of Objective parameters 90
26 Result of Akulyadi yoga in Madhumeha 91
27 Statistical analysis of Akulyadi yoga 92
Figures and Photos of
“Evaluation of the efficacy of Akulyadi yoga in Madhumeha (Diabetes Mellitus)”
By Shivaleela. S. Kalyani
SN Title of Figures and photos Page
1 Madhumeha Samprapti 31
2 Composition of Akulyadi Yoga 64
3 Results by Age in Madhumeha with Akulyadi yoga 77
4 Results by Gender in Madhumeha with Akulyadi yoga 78
5 Results by Religion in Madhumeha with Akulyadi yoga 79
6 Results by Occupation in Madhumeha with Akulyadi yoga 80
7 Result Distribution of patients by Economic status 82
8 Results by Diet in Madhumeha with Akulyadi yoga 83
9 Distribution of patients by presenting complaints 84
10 Distribution of patients by Associated features 85
11 Result of Akulyadi yoga in Madhumeha 91
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Introduction 1
Chapter - 1
Introduction Ayurveda the heritage of Indian civilization is not only a medical system but also a
full-fledged science, consisting of all medical and ailed branches essential to lead a healthy
life. Being a science Ayurveda believes in supreme power.
The Ayurveda has attracted the attention of global population specially the developed
countries since ages. The main reason behind this was the holistic approach of Ayurveda,
humanitarian approach, simplicity of the procedures, cure of chronic and incurable disease
safer and non-toxic herbal resources1.
The purpose of Ayurveda is to maintain health and to treat diseases, in order to
achieve the ultimate goal. It is applicable in every fact of human life, with its own unique. A
principle in understanding any disease by either preventive or curative wedge is necessary.
This may be the fact due to which this science is persisting through centuries beginning from
time immemorial2.
Scientific and technological progress has made man highly sensitive and critical;
there by giving rise to different types of health problems. The advancement of
industrialization and communication is contributing towards sedentary life styles; in turn
causing chronic non-communicable diseases like diabetes mellitus, etc. in fact it is the first
life science, which identified diagnosed and managed diabetes. In spite of all sorts of
advancement of science man is not able to stay himself in the boat of happy and healthy life.
So it is disadvantage rather than an asset.
Madhumeha is a disease known to mankind since vedic period and it is mentioned as
one of the 20 obstinate urinary disorders. It is the present burning issue alarming the world.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Introduction 2
With synonym of ‘Richman’s disease’, particularly because a person who is able to enjoy the
pleasure of life without any perceptible exercise is usually affected with this disease3.
Madhumeha is a chronic metabolic disorder and the symptom appears in relation with
mootravaha samsthana. Diabetes mellitus is a chronic metabolic endocrinal disorder, which
has similar pathogenesis as the Madhumeha. Thus the comparison between Madhumeha and
DM is justifiable4.
In Ancient treatise we find a vivid description of the disease solely attributed to
metabolic derangement along with genetic predisposition. Madhumeha subtype of Vataja
Prameha due to involvement of vital elements causes alarming health instability with higher
prevalence. Vata is the conductor of healthy life and vitality supporter of all the embodied
beings and sustains long life free of disorders5.
Susruta emphasized that Vyanavata and Apanavata vitiation cause Sukra Dosha and
Prameha. Vyanavata because of its potential to perform the functions related to each and
every body element and Apanavata due to its potential related with excretion. When we
exploit Madhumeha we cannot deny their credibility in the pathogenesis. This superior
consideration of Susruta proved to be essential before profound treatment modality6.
Changing life style, lack of exercise, fast foods, improper unbalanced diet, and
sedentary life are showing upward trend in India. This has lead to the emergence of Diabetes
Mellitus in the region. Iatrogenic or genetic predisposition and degenerative changes proved
fatal in diabetes mellitus7.
Purpose of the study
The prevalence of diabetes is approximately twice in the urban than in rural areas. It
is suggested that the increase in the occurrence of this disease is possibly due to changing life
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Introduction 3
style. Lack of exercise, fast foods, improper unbalanced diet, and sedentary life are showing
upward trend in India. This has lead to the emergence of diabetes mellitus in the region.
In spite of using oral hypoglycemic agents and insulin modern medicine is least
bother about the sedentary life style and improper diet, so struggling to provide better
management to counteract the complications and to provide better health.
So many research works have been carried out in relation to shamana treatment as
mentioned in classics and their therapeutic effect is proved. Present research work is intended
to evaluate the effect of herbal combinations used as different line of treatments.
Prevalence
Madhumeha has become a global problem in spite of much advancement in modern
medicine8. The World Health Organization stated in 1998 that a 122 % rise in the number of
adults with diabetes is projected by 2005, to reach 300 million adults worldwide. There are
four reasons for this two-fold global increase: Firstly, we are living longer; over-nutrition and
lack of exercise are prevalent; the disease being transmitted in a hereditary fashion; such
transformations have taken place within the Indian population also. In India, it is estimated
that 19 million cases occurred in 1995, rising to a projected 57 million by the year 2025 (1/6th
of the world total). According to recent epidemiological studies there has been a 40%
increase in diabetes prevalence amongst urban during the last five years9. Even the NIDDM a
commonest form of DM is most common accounting for 85-99% of the patient depending on
geography and ethnicity, occurs in adults, more so over 35 years of age10. The prevalence of
NIDDM is on the rise more alarmingly in the developing nations, ranked 7th among leading
cause of death. It has been rated 3rd when all its micro vascular, macro vascular, neuropathic
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Introduction 4
complications11 are taken into account. The cost of treating diabetes an associated
complication exceeds $ 100 billion per year12.
It has long been recognized that drugs represents only part of the management of
Madhumeha and other intervention such as education, modification of diet and promotion of
physical health play a crucial role. If the dietary control and exercise programmes do not
improve the condition then the medication is added. Many of patients won’t have patience
for long term therapies, complicated therapies like exercise etc13. The OHA viz.
Sulfonylurea, Bigunides have associated with adverse effect like nausea, vomiting, lactic
acidosis, hypersensitivity etc. After long term administration their action declines, up to 50%
patients of NIDDM initially treated with OHA ultimately need insulin. Hence we find no
satisfactory remedies for Madhumeha in contemporary medical science.
Previous research literatures
1. Bramachari M.D and Augusti K.T (1961) hypoglycemic agents from Indian
medicinal plants. Dried seeds of Eugenia jumbalana and dried bark of Ficus
bengalensis j. pharma, pharmacy. 13,181-2.
2. Chandala H.M Tripathi S.M and Udupa K.M (1980); effect of Tamala on plasma
insulin vis-à-vis blood sugar in patients of D.M-JRAS 1,345-357.
3. Gupta S.S and Variyar M.C (1963); effect of Gymnema sylvestre and Pterocurpus
marsapium glucose tolerance in albino-rats Indian J. Med. Sci. 17,501.
4. Lal. B.M and Chaudhary K.D (1968); observation on Mimordica charanita and
Eugenia jambalana as oral anti diabetic remedies. J. Res. Indian. Med. 2 (2), 161-4
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Introduction 5
About concept
The word Madhumeha in terms of ‘Diabetes Mellitus’ it is the present burning issue
alarming the world. With synonym of Richman’s disease,’ Madhumeha is a chronic
metabolic disorder and the symptom appears in relation with a mootravaha samsthana.
Diabetes mellitus is a chronic metabolic endocrinal disorder, which has similar pathogenesis
as the Madhumeha. Thus the comparison between Madhumeha and DM is justifiable14.
The present study was designed as ‘Evaluation of the efficacy of Akulyadi Yoga’.
Medicinal plants since time immemorial have been used virtually in all cultures as a source
of medicine. Several herbs have been described in Ayurvedic treasure of therapeutics, which
have a beneficial effect in the management of Madhumeha. Akulyadi Yoga is one such a
combination which acts as mootra sangrahaneeya and also reduces the high blood glucose15.
As the Madhumeha is Kapha Vata pradhana Vyadhi Akulyadi yoga seems to be very
effective. It contains Akuli, Amalaki and Haridra. All these drugs are Kapha and Vata
Shamana property with Ushna virya. Thus in the present study an attempt is made to
“Evaluation of the efficacy of Akulyadi Yoga”, with a view to find out a therapeutically
efficacious, safer, cost effective and easily available drugs.
The study description
The study description consists of the headings according to the RGUHS protocol
followed from 2nd chapter.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Objectives 6
Chapter - 2
Objectives Ayurvedic science, a boon in today’s world, describes Swastha parayanata, which
means maintenance of health in the one hand and treatment of disease on the other. It has
been described in Ayurveda that it is not rational treatment where the medicine modifies one
disease; on the other hand it provokes new complications. So here, we are putting our step
forward to find safe and effective oral hypoglycaemic agent.
Madhumeha is a disease known to the mankind since Vedic period and it is
mentioned as one of the 20 obstinate urinary disorders, where “Prabhoota Mootrata” i.e.
polyuria is as the cardinal symptom16. Madhumeha/DM is the present burning issue alarming
the world. Madhumeha and its management through various methods are possible viz.
shodhana, Lekhana and Apatarpana Chikitsa. Considering the Chikitsa sutra the Akulyadi
yoga as a shamana Chikitsa is under taken for the trial that has almost all of these therapeutic
effects is opted for this study17.
The present study intended to focus on the disease evaluation i.e. Madhumeha vis-à-
vis. Diabetes Mellitus and the management with Akulyadi yoga as a shamana Chikitsa.
Akulyadi yoga ingredients are collected form local and prepared under GMP conditions,
weighing about 500mg tablet form. Hypothetically evaluated therapeutic efficacy on the
Madhumeha vis-à-vis Diabetes Mellitus is tested through the test under the following
objectives. In this regard the objectives proposed in the study are –
Objectives
1) To evaluate the efficacy of Akulyadi Yoga in the management of Madhumeha
2) To evaluate the efficacy of hypoglycaemic activity of Akulyadi Yoga in Madhumeha
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Objectives 7
1) To evaluate the efficacy of Akulyadi Yoga in the management of Madhumeha
The Madhumeha is a disease manifested from Mamsa, Meda and Shareera kleda with
the vitiation of the Kapha and Vata18. The Madhumeha vis-à-vis diabetes mellitus has many
theories of occurrence, recent viral influences studies on diabetes. This viral influence to
cause the DM is a new trend apart from the interventions of the pancreas and the metabolic
disturbences. The ingredients of the Akulyadi yoga are with Kapha Vata Doshahara and are
of Katu, Tikta Rasa predominance to pacify the Dosha. All ingredients of the yoga are of
Ushna veerya and also do the Kapha Vata shamana along with the gunas like Laghu,
Rookasha, Teekshna and Snigdha. Akulyadi yoga basically acts as Agni vardhaka, to
normalize the Agni is the motto of Kayachikitsa and also as it has the Krimihara Dravya and
Rasayana dravya the actions of such are helping the disease regulations. The Krimiharatwa in
terms of antiretroviral action over the causative organisms probably thought by the ancient
researchers thus the “Akulyadi Yoga” with such combination is used at the management of
the Madhumeha19. By observing all these characteristics of drugs Akulyadi yoga seems to be
very much beneficial in the management of Madhumeha which could be clinically observed
to understand such Krimihara and Mehahara actions.
2) To evaluate the efficacy of hypoglycaemic activity of Akulyadi Yoga in Madhumeha
As the Akulyadi yoga is hypothetically capable of inducing the hypoglycemic
activity, is evaluated through Blood Glucose testing. An attempt is made to measure the
Blood sugar, urine sugar at different times of relation to meal. The evidential estimations of
the blood sugars with corresponding urine sugars are recorded before and after the induction
of trial drug to estimate the hypoglycemic action of the test drug.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
8
Chapter - 3
Review of Literature
Madhumeha is the disease of having merely metabolic derangement and genetic
predisposition related with each constituent of the body with systemic consideration though it
is a subtype of vataja Prameha having more prevalence in the society20. Susruta has used the
word Kshaudrameha. ‘Madhu’ and kshaudra are literally synonyms of each other, which
mean honey21. But he placed a different chapter for management of the ‘Madhumeha’ in his
Chikitsa. He has accredited Madhumeha to be a stage of complications of appearing in
Prameha22. When literal meaning of the word ‘Madhumeha’ is compared to the contemporary
Diabetes Mellitus, it exactly fits in the frame work.
General etiology of Prameha coincides with that of Madhumeha of Charaka, with its
aetio-pathogenesis dealt in Susruta and Vagbhata, who are at the common opinion of that all
Prameha left untreated or not properly treated leads to Madhumeha23. Two types of Prameha
namely Sahaja and Apathyanimittaja, can be compared to insulin dependent and non-insulin
dependent diabetes respectively. Whatever be the type of Madhumeha, as it is Madhyama
Rogamarga (Vasti – Marma) associated becomes incurable and needs very long active
management strategy.
To understand the etiology, patho-physiology, complications and management
methods, first it is merely necessary to emphasize the disease Prameha as a whole and
Madhumeha in particular.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
9
Etymological Derivations
Nirukti of Prameha
The word ‘Prameha’ consists of two words, i.e. “pra” and “meha”. The word meha is
derived from the root ‘miha sechane by adding ‘Lue’ pratyaya to it ‘mehati sinchati
mutraretansi’ which means to excrete. Rigveda mentioned this word first is mehanadthanam
karanallium. The commentator of Rigveda, Sayana interpreted the word mehana as medhra,
which denotes to shishna (penis). In Sanskrit literature the ‘mih’ is used to denote, to make
water, to wet to emit semen. So this root ‘mih’ is added to prefix ‘pra’ the word becomes
‘Prameha’. In regard to above explanation we can easily understand that the disease Prameha
is resulted because of excessive excretion of urine24.
Nirukti of Madhumeha
Chakrapani opines that both words are used for each other. Madhu means honey or
sweet and Meha is passing urine. The word ‘madhu’ is derived from the root ‘mana’ and the
meaning as “manava bhodane” i.e., which gives the psychic contentment (vachaspathyeem); it
refers to the meaning honey, kshoudra, Madhya, pushpoarasa, jala and madhuranasa. Thus the
Madhumeha is a disease, in which the person passes the urine, which is similar to madhu
(honey), in colour, smell and taste25.
The word Madhumeha consists of two words, “Madhu” and “Meha”. The former is
replica of the honey and the second denotes the “Sechana” i.e. excessive urination. Term
‘meha’ is attributed to ‘Madhu’ is the relativity and as the all Prameha delayed are untreated
becomes “Madhumeha”, the generalization of Madhumeha is applied to all ‘Prameha’.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
10
Definition of Madhumeha
So the meha word here mainly related with excessive excretion of urine. So the
definition is a clinical entity in which the patients’ voids the urine having comparison with
madhu i.e. of Kashaya and madhura rasa, ruksha texture and honey like colour, and at this
stage even the body acquires sweetness is called as Madhumeha. From above definitions we
can easily diagnose the disease and understand its progression26.
Susruta narrated the term in place of Madhumeha is kshaudrameha, ksudrameha
nothing but subtype and synonym of madhu (honey). So it is undoubtedly resembles with
Madhumeha. Further he asserted that when all the Prameha illustrated or neglected get
converted in to Madhumeha and especially he emphasized that the disease Prameha along
with pideka should termed as Madhumeha27.
Susruta and Vagbhata opine, if the patients of Prameha are not treated properly, all of
them reach to the stage of ‘Madhumeha’, which is asadhya28. It is natural history of the
disease that, every patient of kaphaja leads to pittaja and then to vataja stage. But Susruta says
that, the progression of the disease is not only time-oriented, it also depends on the
management of the disease. If the patients are properly managed well in time, the progression
of the disease can be slowed down. If not managed properly, of course-it may reach the stage
of Madhumeha quickly and becomes asadhya29.
In initial stage of Prameha, Kapha is in excess quantity but there is Kapha kshaya at
later stage. Similarly, there is excess of Pitta particularly in pittaja prameha, later, which also
leads to Pitta kshaya. So, ultimately there is Vata vriddi in the terminal stage of kaphaja and
pittaja Prameha. Thus all the types of Prameha lead to the stage of Madhumeha, which is
considered as a vataja Prameha.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
11
Paryaya of Madhumeha
Kshoudrameha – Susruta used this term instead of Madhumeha30.
Ojomeha – Charaka31 and Vagbhata32 mentioned that, Vata changes the madhura rasa,
snigda guna of oja in to kashaya & ruksha.
Pushpameha – In Anjananidana, the word pushpa has been narrated as synonym for
Madhumeha where the Pushparasa means – madhu33.
All above synonyms postulates unanimously that, the urine concordant with madhu or
sweet taste is Madhumeha.
HISTORICAL REVIEW
Study of sequential evaluation is foremost step in the research field. History study is
important to know about the systematic development and progress of the subject to determine
the future plans for further establishment and research designing history of medicine starts
from the very moment when the human being come into existence that’s why the ancient
treatise are full with description of diseases and their treatment. Here the present review
related to Madhumeha is explained.
Pre-vedic and Vedic Period
The evolution of Madhumeha can be traced from Vedas but in rudimentary form,
when we go through the Atharvaveda there is a reference related to the disease 'Asrava' along
with its management. Sayanacharya opined that Asrava means 'Mutraatisara' the English
translator Whitney (1962) interpreted it as flux and Griffith (1962) as morbid flow, While
Leman has translated the meaning of Asarva as Diabetes Mellitus. Sayanacharya highlighted
the vatic nature of this ailment34.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
12
Samhita Period:
(1) Charaka Samhita
In Charaka Samhita, ancient treatise of medical science, Charaka explained the
etiology, pathogenesis, symptomatology, complications and treatment. Even he not only
described Nirupasthambha Madhumeha but also the Avaranjanya Madhumeha which is a
unique contribution of this Samhita35.
(2) Susruta Samhita
Susruta also explained the Madhumeha in elaborative manner with separate chapter on
its management36. He used 'Ksaudrameha' synonym to Madhumeha inNidana6thchapter. He
typically mentioned the decoctions according to each type of Prameha and mentioned the
body constitution and symptoms related to Sahaja and Apathyanimittaja Prameha.
(3) Astanga Hridaya
Vagbhata categorized the Madhumeha as 'Mootra Atipravrttijja' and explained two
types of Madhumeha i.e. Dhatu kshyaja and Avartpathat. He further added Sweda as the
Dushysa37.
(4) Harita Samhita
Harita mentioned Madhumeha as Papajanya and enumerated 13 types of Prameha with
nomenclature different than Brihatrayi treatise viz. Puyameha, Ghrtameha etc38.
(5) Bhela Samhita
Bhela described Prameha is of two types i.e. Swakrita and Parakrita meha39.
(6) Kasyapa Samhita
Kashyapa mentioned the symptoms of Pramehi child in Vedanadhyaya and noted the
disease as Chirakari40.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
13
Medieval Period
In this period validations and compilers of the ancient literature are more than the
original contributions. Many commentaries are entertained; out of them contents are mere
collection of thoughts from previous authors added fewer experiences along with.
(1) Madhava Nidana
Madhavakara collectively retold the description of Charaka, Susruta and Vagbhata41.
(2) Sarangadhara Samhita
Sarangadhara enumerated the Prameha bheda as 20 types. He further described the
many medicines at the context of different forms of the medicines conversation42.
(3) Bhavaprakasa
Bhavamishra described Prameha and Madhumeha along with some new herbo-mineral
preparations added to the old treasure43.
(4) Yogaratnakar
Yogaratnakara explained Prameha and Madhumeha along with treatment in general44.
Nidana – Aetiology
Nidana of the Prameha are expressed as general those are common for all kinds of
Prameha. Specific Nidana manifests the particular kind of Prameha such as Madhumeha. In
classics only Charaka has explained the specific Nidana for Madhumeha45.
For all types of Prameha especially Madhumeha, Kapha Dosha is the key factor and it
can be established by Gangadhara’s version. In that he says, Gulma is caused by Vata, Rakta
pitta by Pitta and Madhumeha caused invariably due to the Kapha46. By the above views, all
nidanas of Prameha are considered for Madhumeha. All ancient treatise mentioned the
common etiological factors of Prameha but Charaka mainly narrated the etiological factors
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
14
according to Dosha he also mentioned the specific etiological factors of Madhumeha. This is
the unique contribution. Thus the causative factors of Madhumeha can be discussed as -
Sahaja (Hereditary) and Apathyaja (Acquired) 47.
1) Sahaja (Hereditary) nidanas:
Charaka48 and Susruta49 have agreed that beejadosha (genetically devoid) is also a
cause for Madhumeha. Acharyas are explained, ‘Kulaja vikaras’, Madhumeha is one among
this. Susruta has included Madhumeha, in adibala pravritaja vyadhis.
While telling the vikrita Garbha caused by beejadosha, Charaka says that, if that
portion of beeja is defective, the body part developing from that portion of beeja will be
defective50. The term beeja has been considered as shukra and shonita. Hence it can be
understood that, the child born to Madhumehi, may or may not suffer from Madhumeha. It
depends on the beejabhagavayava, which is defected. It is caused, because of the vitiated
vatadi doshas present in the shukra and shonita of parents51.
2) Apathyaja (Acquired) causes:
It can be classified in to two types viz. Samanyaja (General) and Vishesha (According
to dosha).
Vishesha Nidana for Prameha
Except Charaka other authors have explained the common causative factors and they
have particularly stressed on the factors, which affects the Kapha, medas and mutra. Charaka
explained nidanas specific to the doshas concerned but he too has equally voiced on those
factors, which vitiate Kapha and medas. As the Kapha Prameha Nidana is equally important
as that of the Prameha thus the Kapha Prameha Nidana is enumerated here under.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
15
a) KAPHAJA PRAMEHA NIDANA 52
Ahara Nidanas: -
A) Rasa – Madhura padartha atisevana
B) Guna – Drava taruna dravya atisevana
C) Dravyas –
i) Dhanya’s – Hanyaka, Chanak, Uddalaka, Naishada, Mukundaka, Mahavrihi,
Pramodaka, Sugandhaka, Sarpishmati, Masha etc
ii) Mamsa: - gramya, Oudaka, Anupa, Mamsa, Rasa
iii) Others – Shakas, Tila, Pistanaa, Payasa, Ksheera, Vilepi kshoudra,
Mandaka, Dadhi etc.
Vihara Nidanas -
• Swapna prasanga
• Shaya prasanga
• Asana prasanga
• Vyayama vruja varjana
• Anya kapha meda mutra and
• Vridhikara Viharas
b) PITTAJA PRAMEHA NIDANA53: -
Ahara Nidana -
A) Rasa – Amla, Lavana, Katuadhika sevena
B) Guna – Ushna kshara adhika sevena
C) Anya – Ajeerna dravyas and Vishamaharam
Vihara Nidana -
• Ati teekshna atapa sevena
• Agni Santapa
• Shrama
• Krodha
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
16
c) VATAJA PRAMEHA NIDANA54: -
Ahara Nidana’s
A) Rasa – Kashaya, Katu rasa Ati sevena
B) Guna – Rooksha laghu sheeta Ati sevena
C) Anya – Anashana
Vihara Nidana’s
Vyavaya, ativyayama
Udvega
Shodhana atiyoga
Atishoka
Vega sandharana
Shonita ati seka
Abhighata
Ratri Jagarana
Atapa Sevana
Vishama Shareera Nasyam
1) Samanyaja (General)
Along with the Nidana mentioned below which effect individual Dosha to vitiate the
other factors, which affect the Kapha and Vata Dosha, are to be considered as Madhumeha
Nidana.
Table – 1 Showing the Vihara Nidana of Madhumeha 55
S.no. Nidana Charaka Susruta Vagbhata
1 Swapna Sukham +
2 Diva Swapnam +
3 Avyayamam +
4 Alasyam +
5 Chinta Tyaga
6 Swapna prasanga +
7 Shayana prasanga +
8 Asana prasanga +
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
17
Table – 2 Showing the Ahara Nidana of Madhumeha 56
SN Ahara Nidana CS SS AH MN BS BP YR
1 Dadhi + + + +
2 Gramya, Oudaka, Mamasa + + + +
3 Anupa Mamsa + + + + + +
4 Payaha + +
5 Navanna pana + + + +
6 Guda vikara + + + + +
7 Sheeta, Snigdha, Madhura Madya sevena
+ +
8 Dravannapana sevena +
9 Swadu, Amla, Lavana, Snigdha, Pichhila, Shutala ahara
+ +
10 Sura sevana +
11 Ikshu rasam + + +
12 Adhyasana
13 Medovardhaka AharaAtiSevena
In general the factors pronounced here are self explanatory at the context, which are
tabulated in the table differentiated as Ahara and Vihara, are for Prameha in general and also
specific to the Madhumeha. Apart from the mentioned many factors are held responsible for
the causation of Madhumeha.
Madhumeha Nidana 57
Charaka affirms direct or specific Nidana responsible for the production of
Madhumeha, which are narrated is as follows –
• Guru, snigdha, lavana rasatmaka dravya atisevana
• Navanna and pana
• Atinidra
• Asya sukham
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
18
• Achinta
• Avyayama
• Asamshodhana
These factors contribute to the vikriti of the Kapha, Pitta, meda and mamsa. These
vitiated factors cause avarodha to normal Vata gati, which in turn carries the ojas to vasti thus
resulting in Madhumeha.
ETIOLOGY OF DIABETES MELLITUS58: -
A defective or deficient insulin secretary response, which translates in to impaired
carbohydrate use, is a characteristic feature of diabetes mellitus and resulting into
hyperglycemia. The chronic hyperglycemia of diabetes in associated with long-term damage,
dysfunction and failure of various organs like Eyes, Kidney’s, Nerves, Heart and Blood
vessels.
Genetic factors: - Genetic factors are even more important than Types I diabetes. Among
identical twins the concordance rate is 60% to 80% in first-degree relatives with type II
diabetes the risk of developing disease is 20% to 40%. The two main defects that
characterized in type II diabetes are – a) derangements in the beta cell secretion of Insulin and
the b) decreased response of peripheral tissues to respond to Insulin.
Obesity: - Among the initiating events, which are proposed for type II diabetes. Obesity is an
extremely important environmental factor. Approximately 80% of type II diabetes is obese.
Obesity is one of the major causative factors for diabetes mellitus as it causes insulin
resistance. In Ayurveda, sthoulya is mentioned as a Nidanarthaka roga for prameha, and this
prameha falls under the santarpanajanya vyadhis.
Age: - As the age advances the number of beta cells in pancreas, which produce insulin gets
reduced. So the risk of diabetes increases with age especially after 40 years.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
19
Sedentary life: - People with sedentary life style are more likely to have diabetes are
compared to those who lead an active life. It is believed that exercise and physical activity
increase the effect of insulin on the cells.
Hereditary: - Warren and Le Compet , a famous Diabetalogist, when both the parents have
diabetes, all the children may expect to develop the disease, if they live long enough. When
one parent has diabetes and the other is diabetic carrier, 40% of their children may develop
the disease. If a diabetic or a carrier marries an individual who neither has diabetes nor a
diabetic carrier none of the children with have diabetes.
Madhura, Snigdhadi, Bhojana are the main Nidana’s for madhumeha, in contemporary
science it is explained that the excess eating and sedentary life style are the predisposing
factors for diabetes mellitus.
Samprapti of Prameha
The process of manifestation of disease is called Samprapti or pathogenesis. It
includes various stages as disease progresses. The detailed knowledge of pathogenesis is very
necessary to find of the extent of Dosha vitiation, involvement of dusya, avayava and srotus
along with the nature and prognosis of the disease. Vagbhata narrated pathogenesis of
Madhumeha very concisely, indicating two types i.e. Dosha avaranatmaka and Dhatu
kshayatmaka59. Susruta not mentioned the detailed Samprapti, he just informs that; if all
Prameha ill-treated or ignored get terminated in to Madhumeha60. Charaka explained the
pathogenesis in an elaborative manner.
Charaka enumerated the general Samprapti in Chikitsa sthana. He narrated that due to
over indulgence of etiological factors, Kapha along with meda, mamsa and Kleda get vitiated
and results into formation of metabolic waste which carried towards basti resulting Prameha.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
20
In the same manner Pitta get vitiated resulting pittaja Prameha. Where in the Vata is provoked
in turn causes depletion of Dhatu due to the depletion of other two Dosha by which the
excretion of sweet urine resulting vataja Prameha61.
In Nidana Charaka described pathogenesis according to the type, where as the concise
pathogenesis further described in Chikitsa in regard to Doshic predominance i.e. Clinico-
pathological descriptions.
(1) Kaphaja prameha
Charaka narrated important explanation related to extent of nexus between Dosha,
Dushya and Nidana in the disease manifestation. When we understand the above factors and
their nexus we can easily diagnose the disease. We can understand the nature of the disease
and we can profound the prognosis too62. The above assertion is very important in Prameha
pathogenesis. An etiological factor first causes the provocation of Kapha because close
resembles to the related hetu. This provoked Kapha spreads all over the body quickly because
of the Sharira shaithilya (weak assemblage in between tissues). While spreading it get mixed
with meda dhatu, which is excess in quantity and Abadha and having more properties with
Kapha. That’s why get vitiated first. This annexation of vitiated meda and Kapha comes in
contact with sharira kleda and mamsa, which are already in excess quantity resulting
Putimamsa pidaka On the other hand the vitiated Kleda get converted into Mutra. The Kapha
along with meda and kleda covers the openings of mutravaha strotas resulting into Prameha63.
Susruta narrated dushya in each doshic type of Prameha. He narrated vitiation of Kapha along
with Vata, Pita and Meda in Kaphaja Prameha64.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
21
(2) Pittaja Prameha:
Provoked Pitta due to its etiological factors manifests as pittaja Prameha Here same
pathogenesis occurs as described in kaphaja Prameha65. Susruta66 narrated Sonita along with
Vata, Kapha and Meda in the pathogenesis of Pittaja Prameha More or less similar pathology
is described by Ashtanga sangraha and Ashtanga Hridaya67.
(3) Vataja Prameha:
Susruta narrated the typical dusya sangraha according to dosha. He explained that, In
Vataja Prameha, Kapha, Pitta, meda, vasa and majja takes part in pathogenesis68. Detailed
Samprapti of Vataja prameha is described by Charaka as - Aggravated Vata because of its
own etiological factors draws out Sarabhuta dhatus from the body and carries them towards
Vasti resulting into four types of vataja Prameha69.
Another pathogenesis of vataja prameha is narrated in Chikitsa sthana is that, the
provoked Vata due to depletion of other two Dosha carries vital dhatus towards basti,
resulting into vataja Prameha70.
Pathogenesis of Madhumeha
According to the Vagbhata two types of pathogenesis get precipitate because of the
two types of etiological factors viz. (1) Dhatu ksaya janya, (2) Avarana janya and the third
type also persists is Kalaprabhavaja71.
(1) Dhatu ksaya: Due to depletion of the vital dhatus, the Pathogenesis in this regard can be
explained is as follows.
(a) Sahaja Prameha:
Susruta mentioned that Sahaja Prameha precipitate because of defect in
beeja72. Same thing explained by Charaka is that the Sahaja Madhumeha is a Kulaja
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
22
Vikara, because of the defect in beeja i.e. either Sperm or ovum73. Here the patient is
prone to Dhatu kshaya because of above discussed factors which cause the
Madhumeha.
(b) Madhumeha due to Dhatu kshaya
Charaka explained the pathogenesis in Nidana is that, due to specific
etiological factors provocated Vata draws out the vital dhatus and carries them
towards vasti resulting into Madhumeha74. Here the provocation of Vata is because of
its own etiological factors causes diminution of Dhatu, so it is called that as the
Samprapti visishta Anilatmaka Madhumeha. In this the pathogenesis is a genetic
predisposition in that patient makes him prone to get Madhumeha75
(Tathavidhasarire).
Madhumeha due to Sudha Vata:
Charaka enumerated that due to depletion of Kapha and Pitta Vata get
aggravate and causes the excretion of dhatus through urine resulting into
Madhumeha76. By observing above pathogenic processes, we can enumerate the
following things:
(a) Dhatu kshaya is the main factor present in each pathogenesis.
(b) The etiological factors mainly related to Vata.
(c) Vata provoked by its own etiological factors or by depletion of other Dosha and
dhatus. This in turn aggravates the Vata.
(d) Such types of pathogenesis occur in those patients, which are prone to this disease
because of genetic predispositions.
Remember here Vata is not aggravated by other Dosha etiological factors.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
23
(2) Avaranjanya Madhumeha:
Though Vagbhata narrated the cause of Avarana janya Madhumeha type but not
explained the pathogenesis elaborately. Charaka emphasized this pathogenic process in well
elaborative manner. Due to excessive indulgence of heavy, unctuous, salty and sour diet,
Avoidance of worry, an exercise and purification measure, the Kapha and Pitta get provoked
and vitiates meda and mamsa. All are in excess quantity. They in turn cause obstruction to the
normal pathway of Vata. This obstructed Vata get aggravated and draws out the apara ojas
from all over the body and carries it towards vasti resulting Madhumeha. One thing to be very
clear here that the provocation of Vata is precipitated because of the Kapha Pitta etiological
factors. Here mainly Vyanavata and Apanavata get aggravated.
(3) Kalaprabhavaja Madhumeha:
This type of Madhumeha is described by Susruta. He does not mention the direct
pathogenesis but narrated that, when all types of Prameha if ignored or ill treated. They get
terminate into Madhumeha. This is not a separate entity but we can say that this is the last
stage or further progression of kaphaja and pittaja Prameha or complicate stage of the
disease78.
SAMPRAPTI GHATAKAS: -
Dosha Kapha pradhana Tridosha
Pitta is in Vriddhavastha
Vata – Avrita
Dushya Kleda (mootra), Meda, Mamsa, Lasika, Oja, Rakta, Majja, Sukra,
Rasa, Sweda
Srotas Medavaha, Mutravaha, Mamsavaha, Swedavaha and Udakavaha
Dusti Prakara Atipravritti, Sanga, Vimargagmana
Agni Vaishamyata and Dhatwagni mandhya
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
24
Ama Aparipakwa Dhatu
Udbhava Sthana Amashaya (Medovaha srotomoola – vapavahana)
Sanchara Sthana Sarva Shareera, (through Rasayani and Mootravahinis)
Adhisthana Vasti
Vyakta Sthana Sarva Shareera, Mootravaha srotas
Vyadhi Swabhava Chirakari
All these factors responsible for the Madhumeha can be discussed in detail with each
factor associations in the fallowing way.
a) Dosha involvement
• Kapha – having peculiar nature i.e., bahu drava described by Charaka. So we can
easily understand the ‘shaithilya’ manifestation in this disease. So this bahudravatva of
vitiated Kapha causes disruption in the assemblage of body elements and provide
ground for the accumulation of marbid matter in the tissues.
• Kapha having normal function as sthiratva, Chakrapani commented upon the word
sthiratva means ashaithilya79
• Again Kapha Dosha is the dominant factor in the pathogenesis of Madhumeha. It gets
vitiated primarily and causes the vitiation of concordant body elements like meda,
mamsa, kleda, rasa, vasa, lasika etc.
• The vitiation of Kapha here mainly is of excessive type. That’s why the following
symptoms manifest in Madhumeha. These are shaithilya, alasya, atinidra, gaurava, etc.
• Charaka clearly mentioned and Chakrapani opined that Kapha Dosha is dominant and
primarily vitiated because of its close resembles with the etiological factors80.
Pitta Dosha is not so dominant factor in the pathogenesis of Prameha. By the vitiation
of Pitta, avaranjanya Samprapti of Madhumeha resulted.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
25
Rakta, sweda, lasika and rasa are the seats of Pitta Dosha so when Pitta get provoked,
it undoubtedly causes the vitiation of above dushyas. That’s why the symptoms
manifests are sweda vruddhi indirectly Agni vaishyam too.
Here mainly the symptoms manifests because of vruddhi of Pitta Dosha (trusna, daha,
ksudha and trunshavruddhi) 81
Pitta is in kshaya avastha in the vataja Prameha pathogenesis as compared to Vata.
Vata is the main predominant Dosha in the pathogenesis of Madhumeha here Vata get
aggravated either because of its own etiological factors or because of avarana caused
by Kapha, Pitta and meda.
This provoked Vata carries the vital constituents of the body like Vasa, majja and ojas
towards vasti and excretes them outside through urine resulting depletion of the
dhatus. Thus due to severe depletion of Dhatu, the symptom manifests are karsya,
daurbalya, angasuptata and parisaranasheela nature.
Charaka narrated that Dhatu gati is the function of normal Vata. Chakrapani opined
that this gati is related with the transfer of rasa etc. towards poshya i.e. main dhatus.
Thus these functions of Vata in bi fold digestion get hampered causing imbalance in
Dhatu formation and their transformation in the body82.
b) Dushya Involvement
All authors narrated dushya sangraha and their involvement in the pathogenesis but
Charaka specially enumerated a group and named it as a dushya vishesa again he
mentioned them in Chikitsa also83.
Susruta also narrated the dushya but he typically mentioned them along with the dosic
type but he commonly included meda in each type84.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
26
Only Vagbhata mentioned sweda as a dushya along with the above dushyas85.
Rasa Dhatu: This is one of the Dhatu mainly vitiates. Here because of its close resemblance
with Kapha qualitatively. If Kapha get vitiate rasa also get vitiate, that’s why having same
symptomatalogy related to vruddhi. This is mentioned by Vagbhata i.e., “rasoapi
slesmavat86.” Susruta emphasized that sthaulya and karshya results due to vitiation of rasa
Dhatu and practically we can found both conditions in the Madhumeha87. So the role of rasa
Dhatu is very much important in the precipitation of the disease. Vitiated rasa shows
manifestations like alasya, gaurava, krushangata, klaibya and Agni nasa in context to
Madhumeha.
Rakta Dhatu: Rakta Dhatu having not much involvement in the precipitation of the
Madhumeha. It is mainly get vitiated prominently causing complication like pideeka, vidradhi
alasi88.
Mamsa Dhatu: One of the main dushya described by Charaka he narrated it especially in
kaphaja Prameha and avaranjaneya Madhumeha. Mamsa and Kapha have same qualities.
They both give strength to the body. When get vitiated, mamsa losses its normal consistency
and develops shaithilya and provide space in between for the accumulation of morbid matter.
Thus in turn results into the putimamsa pidaka89.
Meda Dhatu: Meda vitiation is common and dominant dushya in the pathogenesis of
Madhumeha. Kapha and meda having close resemblance in regard to functions as well as
qualitative parameters, thus both are getting vitiated more or less by same etiological factors.
In Madhumeha vitiation of meda results by two ways as either Qualitative – abadha
(asamhatam) normal function of meda is to produce unctuousness in the body along with
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
27
drahdhatva i.e., compactness so this abadhatva causes derangement in the structure of meda
producing shaithilya in the body.
The second is Quantitative as bahu, here in the pathogenesis meda is in excess
quantity. This medodhatu is aparipakva90. It obstructs the path of Vata along with Kapha. This
provoked Vata increases the Agni so patient unnecessary eats more and more food causing
excessive deposition of Aparipakva meda. This in turn cause severe depletion of the other
dhatus and produces various sign and symptoms. In Astanga sangraha, Vagbhata mentioned
that along with Prameha purvarupa excessive meda can cause diseases of sleshma, rakta and
mamsa.
Thus from above description it is clear that vitiated meda plays vital role in the
progress of pathogenesis and affects the normal physiology of various body elements.
Arundadatta comments it as it is necessary to occur vitiation in meda when Madhumeha
precipitates. So this deranged meda produces following signs and symptoms. These are
described as medo Dosha91.
Ayushor-hasa- life expectancy is get decrease because other dhatus could not get
nourished properly
Javoparodha – early manifestation of ageing
Kruchra vyavayata – difficulty to perform sexual act and impotency, this again related
with depletion of sukra i.e., abahutvat
Dourbalya – this results because of the deranged metabolism occurring to
malnourishment of the dhatus
Dourgandhya – bad smelling is results due to excessive sweating and combustion of
meda
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
28
Swedabadha – excessive sweating results because of the excessive meda and Kapha,
patient is intolerable to exercise.
Atikshuda and pipasa – excessive appetite and thrust because of the increased
digestive power and Vata vitiation. By observing above description undoubtedly we
can asser that, in Madhumeha pathogenesis meda plays leading role.
Majja Dhatu: Majja is not vitiated in maximum extent but Vata causes its khsaya i.e.,
depletion. Thus vitiated majja produces clinically symptoms like, netra gaurava and anga
gaurava in Madhumeha patient92.
Sukra Dhatu: Sukra also get vitiated in the pathogenesis produces symptoms like durbalya
and kruchra vyavayata, because normal functions of sukra is to maintain deha bala. It also
plays role in the precipitation of sahaja Prameha. Susruta narrated that sukra Dosha and
Prameha get precipitate because of the vitiation of Vyanavata and Apanavata93. Thus one can
easily understand the close relation of sukra dushti in Prameha and Madhumeha.
Vata cause depletion of shukradhatu and cause shukrameha.
Ojus: – oja as dushya mainly involved in vataja Prameha i.e., ojomeha (Madhumeha).
Provoked Vata due to its own etiological factors or due to avarana carries oja towards vasti
and excrete outside through urine94, so the symptoms of oja ksaya manifests, like guru gatrata
Nidra, tandra and daurbalya95. Charaka narrated ruksta i.e., related to ruksa shareera so one
can easily understand the manifestations of krusa pramehi or sahaja pramehi of course the
vitiation of apara oja occurs here. Hence it is prime concern to find out the oja vitiation in the
pathogenesis to assert the extent of severity.
Kleda: – The literary meanings of kleda are wetness. Moisture and dampness etc. the
physiology of kleda is mainly related with mutra and sweda along with meda. Thus when
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
29
kleda is involved then it directly affects the above factors. There is no direct reference
regarding to the function of kleda in the body but Arundatta commented that, if kleda is not
present then there is manifestation of dryness in the body. So indirectly we can say that the
kleda proper in quantity is important to maintain the unctuousness in between the tissues. In
normal physiology mutra and sweda maintain the balance of kleda. Especially sweda holds it
in the body and mutra excrete it outside the body96. According to the body condition and
requirement, if this kleda is get vitiated it directly affects the physiology of mutra and sweda
disrupts the assemblage of bodily elements causing shaithilya. Thus the symptoms manifests
due to kleda vitiation are prabhuta mutrata, sweda vruddhi, saithilya, daurgandhya and
avilumootrata.
Sweda – this is mentioned by Vagbhata, as Sweda is mainly related with meda and kleda.
When the Sweda vaha srotodusti occurs due to vitiation of meda and kleda., the normal
physiology of Sweda get disturbed resulting in manifestations like Sweda vruddhi,
dourgandhya, picchila gatrata, snigdha gatrata, etc. Susruta mentioned that even the Sweda
becomes sweet in nature97.
Vasa: Charaka described it as a subtype of vataja Prameha i.e. vasameha. Vasa is the
upadhatu of mamsa and the unctuousness present in the mamsa Dhatu is called vasa. Thus we
can easily understand that in Prameha mamsa is one of the main dooshya so in turns vasa too
get vitiate98.
Lasika: This is one of the liquid materials of body, present just beneath the skin. Lasika also
get vitiated by vata resulting lasikameha. There is no direct reference related to vasa and
lasika dushti99.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
30
Srotas involvement
Madhumeha is the disease mainly of systemic consideration. In the pathogenesis there
is involvement of each and every constituent of the body. In the pathogenesis there is
reference of sroto dushti only related to mutravaha srotas. When we observe the pathogenesis
and symptomatalogy of Madhumeha, we can easily understand the involvement of medovaha
mamsavaha, swedavaha and udakavaha srotas too. In the pathogenesis we can found the two
types of srotodusti – Atipravrutti and Vimargagamana.
Thus we can find out the srotas involvement according to the symptoms observed is follows -
Purvarupa of Prameha – medovahasrotas dusti
Putimamsapidaka – mamsavaha srotodusti
Trsna mukha talu sosha – udakavaha srotodusti
Atisrusta abhiksna mutrapravrutti – mutravahasrotodusti
Agni and Ama
There is no direct reference related to the Agni condition but both Agnimandya and
tikshna Agni conditions present in the pathogenesis again without Ama it is impossible to
precipitate the pathogenesis of Madhumeha that’s why Susruta narrated that, aparipakva
condition of Dhatu is related with Ama mainly.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
31
Figure – 1
Madhumeha Samprapti
Avarana janya Madhumeha
Apathyanimittaja Madhumeha
Sahaja Madhumeha
Nidana sevana Beeja Dosha
Vikruta bahudrava Kapha
Travels all over the body because of shareera shithilata
Medo dhatwagni mandya
Sthoulya Medovaha srotas vitiation
Bahu abaddha medas
Kapha Pitta Meda Mamsa Ativruddhi
Dosha dushya sammurchana
Bahudrava sleshma with bahu abaddha meda
Obstruction of Vata due to avarana by vitiated Kapha
Pitta and Meda
Vitiation of other dushya
Adhika kledata of Dhatu
Squeezing of Ojas in to vasti Vasti
Madhumeha
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
32
Manifestation of DM 100
Diabetes mellitus is characterized by glucose concentrations that are high enough to
over whelm the reapportion capabilities of the kidneys. Glucose appears in urine and urine
production generally become excessive. Other metabolic products, such as fatty acids and
other lipids are also present in abnormal concentrations.
While much has been learned in the recent years, the pathogenesis of type II diabetes
remains enigmatic. There is no evidence that autoimmune mechanisms are involved in this.
Life style clearly plays a role and clearly evident when obesity is considered. Genetic factors
are even more important than in type I diabetes. The two metabolic defects that characterize
type II diabetes are – 1) Deranged beta cell secretion of insulin and 2) Decreased response of
peripheral tissues to respond to insulin (insulin resistance).
a) Deranged beta cell secretion of Insulin
In populations at risk for developing type II diabetes, a modest hyperinsulinemia may
be observed, attributed to beta cell hyper responsiveness to physiologic elevations in blood
glucose. With the development of overt disease, the pattern of insulin secretion exhibits a
subtle change. Early in the course of type II diabetes, insulin secretion appears to be normal
and plasma insulin levels are not reduced. However normal pattern of insulin secretion is lost
and the rapid first phase of insulin secretion triggered by glucose is obtunded. Collectively
this and other observations suggest derangements in beta cell responses to hyperglycemia
early in type 2 diabetes rather than deficiencies in insulin synthesis.
A mild to moderate deficiency of insulin develops later in the course of type II
diabetes that is less severe than the- type I. The reason for this is not clearly known but
irreversible beta cell damage appears to be present. According to one view, all the somatic
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
33
cells of predisposing individual including pancreatic beta cells are genetically vulnerable to
injury, leading to accelerated cell turnover and premature aging and finally to reduction in
beta-cells mass. Chronic hyperglycemia may exhaust the ability of beta cells to function
(called glucose toxicity), as a consequence of persistent beta cell stimulation.
b) Insulin Resistance
Insulin deficiency is present in the course, of type II diabetes. Reduced
responsiveness of peripheral tissues i.e. insulin resistance, is a major factor in the
development of type II diabetes. In obesity it is very much prominent or clear. The molecular
basis of insulin resistance is not clear. There may be a decrease in the number of insulin
receptors and more important post receptor signaling by insulin is impaired. Also the insulin
resistance leads to -
1) The inability of circulating insulin to properly direct the disposition of glucose
2) A more persistent hyperglycemia
3) More Prolonged stimulation of the pancreatic beta cell
Insulin resistance and relative insulin deficiency are the major step in the pathogenesis
of the diabetes mellitus on obese individuals. If the pancreas is healthy and if it secretes
sufficient insulin even this obese people will also won’t get diabetes mellitus. There is no
explanation regarding insulin resistance in Ayurveda. Even in some recent literary works
medo dhatwagni is correlated with insulin. But, no proves are available for exact co-relation.
If we see the pathology, we can see that the concept of Agni plays a great role i.e. Agni
mandya is considered to play key role in the formation of aparipakwa Dosha and dushyas
which is the main defect behind Madhumeha.
The other factors responsible for manifestation of the DM are -
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
34
i) Obesity
Obesity is an extremely important environmental factor in the formation of type II
diabetes. Approximately 80% of type II debates are obese. In this, the impaired binding is a
result of decrease in the number of insulin receptors.
Ayurveda authors have given importance to the medovaha srotas in the pathogenesis
of Madhumeha. In classics it is mentioned that vapavahana is the moola sthana of medovaha
srotas, and which can be considered as pancreas. But there is no much description in
Ayurvedic classics regarding vapavahana. Charaka has explained that the vapa vahana is an
udarasthaanga and he also says, it is having the shape of taila varti. So on the basis of this
physio-anatomical similarity, we can co-relate the vapavahana with pancreas. But kloma also
considered as pancreas by some authors of Ayurveda. As pipasa mentioned as a kloma vikriti
lakshana, which is the main characteristics of the Madhumeha, here it can also co-relate with
the pancreas.
ii) Amylin
Among the pathological changes, which are happening in type II diabetes, the most
consistent of these changes is probably deposition of amyloid, which is accompanied by
atrophy of the normal tissue, particularly Islet epithelial cells. In more advanced lesions, the
Islet is more or less converted to amyloid and the reduction in the number of insulin secreting
cell is more pronounced than that of glucagons-secreting cells. Heavy deposition of amyloid
itself is rare without diabetes.
In normal state sthiratwa, dardya, utasaha, vrishada, buddhi, etc are contributed by
kapha, which is also known as bala or oja. By seeing this we can co-relate this Kapha with
glucose. In Madhumeha the Kapha which is vitiated and which is in bahu dravata form travels
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
35
all over the body in rasa produces tanu madhuryata, which can be taken as hyperglycemia i.e.
increased blood glucose condition.
Also in the Samprapti we can see the word vasti. In Ayurveda it has been used in
different contexts in different meaning i.e. as bladder, whole urinary tract and also kidney.
Sushrutaacharya says nabhi prishta madhyaha vasti. Anatomically kidney and ureters are
situated in this region. Also he says, the term “vastau” which indicates the plural sense i.e.
two kidneys. So, here an attempt is made to co-relate the pathogenic factors mentioned in
Ayurveda and in modern science. To prove the above ideas correctly, further studies are
needed.
Classification of Prameha
Knowledge of classification will helps in proper understanding of the disease and to
formulate an effective treatment protocol. In classics various types of Prameha had been
described based on many factors. Though Prameha is stated to be a condition due to the
vitiation of all the three doshas, the disease is mainly divided in to 3 groups101
Kaphaja Pramehas - 10
Pittaja Prameha - 06
Vataja Prameha - 04
Though there is a similarity in the opinion of Brihatrayes regarding the numbers of pramehas
in each group. But they seem to be different in the nomenclature used by them.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
36
Table - 3
TYPES KAPHAJA PRAMEHA
Sl Names Charaka Susruta Vagbhata Madhava
1 Udaka meha + + + +
2 Ikshu meha + + + +
3 Sandra meha + + + +
4 Sandraprasada Meha + Sura meha Sura meha Surameha
5 Sukla meha + Pista meha Pista meha Pistameha
6 Sikata meha + + + +
7 Sita meha + Lavanameha + +
8 Shanair meha + + + +
9 Lala meha + Phena meha Lala meha Lala meha
10 Shukra meha + + + +
Table - 4
TYPES OF PITTAJA PRAMEHA
Sl Names Charaka Susruta Vagbhata Madhava
1 Kshara meha + + + +
2 Kala meha + Amla meha + +
3 Nila meha + + + +
4 Lohit meha + Ahinitameha Rakta meha Rakta meha
5 Manjishtha meha + + + +
6 Haridra meha + + + +
Table - 5
TYPES OF VATAJA PRAMEHA
Sl Names Charaka Susruta Vagbhata Madhava
1 Vasa meha + - + +
2 Majja meha + Sarpi meha + +
3 Hasti meha + + +
4 Madhu meha + Kshaudra meha
+ +
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
37
From above classification it is very necessary to find out the basic ideology behind
this. Vagbhata clearly narrated that these types result because of the nexus between Dosha,
Dushya and their specific combination according to concordance. That’s why in each subtype
specific urine is voided102 Charaka put forth his theory that all these types and their
nomenclature is because of the specific qualities and their combinations with each other but,
the nomenclature is mainly based apoun the predominance of one quality103.
Chakrapani also commented that the nomenclature is because close resembles of urine
with particular quality (guna) i.e. Sitameha, Suklameha etc. When we go through in detail
with this classification we can easily understand the Dosha predominance, Again dushya
involvement, again nature of urine voiding and we also can find out the etiological factors,
State of the disease and progression.
Classification According to Prognosis
Table – 6
Showing Prognosis of Madhumeha
Sadhya (curable) Yapya (Palliative) Asadhya (incurable)
Kaphaja Pittaja Vataja
Sthoulya Usually not much obese Krusha
Acquired Acquired Hereditary
Early stage Acute stage Advance stage
Without complications With complications With complications
Classification of Madhumeha
Madhumeha is one of the subtypes of Vataja Prameha, can result with various
etiological factors mainly. It can be classified according to the build related with genetic
predisposition.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
38
(1) Based upon the etiological factor
(i) Sahaja (Hereditary)
(a) Etiology - Charaka and Susruta narrated Jata pramehi because of beeja Dosha
emphasized it as Kulaja Vikara. It is said as incurable. Defect in beeja i.e. in sperm /
ovum or defect in beeja Avayava i.e. in chromosome. This theory mainly supported by
the modern science too104.
(b) Body constitution:
Susruta along with etiology narrated the body constitution of Sahaja Prameha /
Madhumeha; Charaka mentioned the word Krusha especially for easy understanding
of the same along with the treatment.
(ii) Apathya nimittaja: (Acquired)
Susruta etiological factors denote the subtype Apathya Nimittaja. It can be again
classified into following manner, related with etiology and Patho-physiology105.
(a) Avarana janya and Dhatu apakarsanjanya
This type of classification mainly related with etiology and patho-physiology. In this,
Avarana janya pathogenesis is due to the etiological factors mainly corresponding with Kapha
and Pitta where the vitiation of Vata occurs due to avarana. Dhatu apakarshana janya
pathology occurs due to depletion of dhatus because of the vitiated Vata106.
(b) Santarpanjanja and Apatarpanjanya
This classification mainly narrated by Charaka when describing the treatment of the
Prameha. Classification mainly based apoun the overnutrition and undernutrition. So
Santarpanajanya Madhumeha can be correlated with Avaranjanya Madhumeha and
Apartarpanjanya can be correlated with Dhatuapakarshanjanya Madhumeha107.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
39
(c) Anilatmaka and Kaphasambhava
Charaka mentioned that when we observed the urine of the patient Picchila, madhura
and Madhusamam. Then we should have to consider two factors i.e. this Madhumeha is either
of Vatatmaka or either of Kaphasamphava. Here what literally missed is the Pitta role, from
this description we can postulate the theory that in Madhumeha is mainly due to the Vata and
Kapha predominance though the disease is said as Tridosha janya.
CLASSIFICATION OF DIABETES MELLITUS 108
The current expert committee of American diabetes association has proposed
changes to the NDOG/WHO classification scheme. The revised Etiologic
classification of diabetes mellitus is as follows -
I) Primary Diabetes
Type I: - Beta-cell destruction, usually leading to absolute insulin Primary deficiency.
a) Immune mediated
b) Idiopathic
II) Type II diabetes (may range from predominantly insulin resistance with relative deficiency
to a predominantly secretary defect with insulin resistance.
Under this type II again 2 types can be seen
1) None obese NIDDM
2) Obese NIDDM
Genetic defects of beta cell function including maturity on set diabetes of young
known as MODY
III) Other specific types
A) Genetic defect of beta cell function
a) Chromosome 12, HNF – 1 Alpha (MODY S)
b) Chromosome 07 Glucokinse (MODY 2)
c) Chromosome 20 HNF 4 Alpha (MODY 1)
d) Mitochondral DNA
e) Others
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
40
B) Genetic defects in insulin action: -
Type 4 insulin resistances, Lepsechaunism, Rabson Mendenhall Syndrome.
Lipoatrophic diabetes and others.
B) Disease of exocrine pancreas: - Pancreatic pathology
a) Pancreatitis
b) Hemochromatosis
c) Fibrocalculous
d) Neoplastic Disease
e) Pancreactetomy
f) Cystic fibrosis and others.
D) Iaotrogenic: - Drug induced or chemical induced.
a) Glucocorticoids
b) Thiazides
c) Alpha – Intrferon
d) Thyroid Hormone.
F) Endocrinopathies: - Endocrine disease induced.
a) Cushing’s Syndrome
b) Acromegaly
c) Thyrotoxicosis
d) Phaeoc hromocytoma
e) Glucogonoma.
G) Infections: -
• Congenital rubella
• Cytomegalo virus and others
H) Other genetic syndromes sometimes associated with diabetes.
a) Dawn’s syndrome,
b) Klenefelter’s syndromes etc.
I) Gestational Diabetes Mellitus (GDM)
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
41
A comparative statement of Madhumeha and DM
Madhumeha Diabetes Mellitus
1) Margavarana Janya madhumehi
is sthoola & balavan so apatarpana
chikitsa in the form of langhana &
Nidana parivarjana
2) Dhatu Kshaya Janya madhumehi is
Krusha & durbala hence santarpana
Chikitsa.
NIDDM patient is obese, so diet exercise
and oral hypoglycemics (sometimes insulin
also)
IDDM – patient is thin so insulin therapy
In classics the classification of a disease made it clear that for the sahaja Prameha
beeja Dosha have been mentioned as causative factors. Such patients are said to be weak
emaciated. Suffering from thirst, loss of appetite and are required to be treated with a
nourishing diet.
In contemporary science the genetic and hereditary factors are mentioned as causative
factor. Such patients are weak emaciated and they are asthenia. The above-mentioned patient
is juvenile diabetes and requires a nourishing diet, so sahaja Prameha can be consider as
juvenile diabetes.
Poorva roopa of Madhumeha
The Symptoms, which are produced during the process of sthanasamshraya avastha,
are called as poorva roopa, and the symptoms which appears prior to the manifestation of the
disease, are called poorvaroopa i.e. is “4th Kriyakala”. Premonitory symptoms are very much
important to diagnose the disease as early as possible that in turn helps for good prognosis. In
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
42
ancient Ayurvedic treatises common premonitory symptoms are described but special
premonitory synmptoms of Madhumeha are not mentioned.
Table - 7
Showing the poorva roopa of Madhumeha
S.no Poorva roopa C.S S.S A.H A.S M.N B.P Y.R 1 Kesha Jatilibhava + + + 2 Asyamadhuryata + + + + + + 3 Karapada daha + 4 Karapada suptata + 5 Mukha talu kantha gala shosha + 6 Pipasa + + + + + + 7 Alasya + + 8 Kaye malam + + 9 Angeshu paridaha + 10 Anga suptata + + 11 Shatapada Mutrashaya
abhisarana
+
+
12 Vishra shareera gandha + + + 13 Atinidra + 14 Tandra + + + 15 Snigdha,Pichhila guru gatratam + + + 16 Madhura shukla mutrala + + 17 Durgandha swara + + 18 Talu, gala, danteshu malotpathi + 19 Nakhati vriddhi + + + 20 Swedam + + 21 Keshathi vruddhi + 22 Sheetpriyatwan + + + 23 Mootra abhidhavanti
pipeelakasha
+
24 Ghanangata + + 25 Angashaithilatwa + +
By clean observation of above Premonitory sign and symptoms we can postulate the
opinion that the disease having vast field of etio-pathology the patient shows very few
Premonitory sign and symptoms. So it is very hard to diagnose Prameha by means of above
description but Susruta makes it easy by narrating and shloka that a man with slight increase
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
43
in the urine output along with the premonitory symptoms showed is consider as the patient of
Prameha 109.
Apart from above premonitory symptoms and signs only few of them are cardinal sign
and symptoms of Madhumeha. These are pipasa madhura mootrata, asyamadhurya, anga
daha. There is no direct explanation of the poorva roopa of Madhumeha as such. But poorva
roopa of Prameha can be considered as poorva roopa of Madhumeha.
Lakshana (Roopa) of Prameha
The vyakta or pradurbhoota lakshanas of the Vyadhi is seen in the 5th kriyakala. The
vyadhi bodhaka linga of all 20 types of Prameha is prabhoota and Avila mootrata. The
prabhoota mootrata can be considered in terms of increased volume of urine and frequency of
micturition. Avila mootrata refers to increased turbidity of urine.
Roopa means symptoms of the actual manifestation of disease. At this stage Dosha
dushya samoorchana would have been completed and the onset of the disease would have
been commenced. Madhavakara explains it as when symptoms in the stage of poorvaroopa
become fully or clearly manifested they are called roopa110. Roopa is the prominent diagnostic
key of a disease and hence thorough knowledge of the various roopa of each disease essential
for a physician.
Signs and symptoms of the disease are the diagnostic tool manifests when the
pathology of the disease is in full context. The symptomatalogy of Madhumeha is ascertained
by Ayurveda in broad manner to understand them need to elaborate as follows. Susruta
narrated that the person should be diagnosed as pramehi when complete to partial prodromal
symptoms of Prameha accompanied by polyuria get manifested111. In this regard Gayadasa
opined that in this disease all prodromal symptoms get converted into rupa due to specific
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
44
nature of the disease i.e. vyadhiprabhava. From above description we can say that the
prodromal symptoms along with chief symptoms get continued as the disease progress.
1) SAMANYA LAKSHANAS 112: -
Samanya Lakshanans of Madhumeha are those which are ascribed to Prameha, they
are i) Prabhoota mootrata and ii) Avila mootrata.
i) Prabhoota mootrata: -
The increase in quantity and frequency is known as prabhoota mootrata. It is
manifested due to increase of sharreera kleda, the reasons for which are explained in the
context of Samprapti. The frequency is increased due to vitiation of apana vayu. Due to
hyperglycenia in madhumeha, glycosuria manifests which in terms hampers the tubular
absorption of water leading to polyuria.
ii) Avila mootrata: -
Moorta avilata is nothing but the turbidity of mootra, which is manifested due to drava
and guru guna vriddhi of kapha and medhas. This can be noticed by the increase in the
specific gravity of the urine.
2) VISHESHA LAKSHANAS 113
In Madhumeha mootra is manifested with Kashaya, Madhura, Rooksha, Pandu and
madhu Sama lakshanas. Bhavaprakasha clarify the controversy of the word kashaya as
kashaya varna. The implication of this term is still debatable. The presence of madhura rasa in
mootra is mainly because of ojo visramsa into mootra, which can be easily understood by
pipeelika abhisarana and by qualitative analysis of urine test. Rooksha guna is due to vitiation
of vata. Pandu varnata of mootra is because of kleda dusti which influences Kapha to attain
more liquid state. Madhusama mootra implies the colour, smell and taste of mootra similar to
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
45
that of madhu. It has to be understood that along with the samanya lakshanas madhusama
mootra is the pratyatmaka lakshanas of Madhumeha.
Table – 8
Lakshana of Madhumeha
SN Roopa C.S S.S A.H A.S M.Ni Y.R B.Ra G.Ni
1 Kashaya + + + + + +
2 Madhura + + + + + +
3 Pandu +
4 Rooksha + + + + + +
5 Snigdha +
6 Ojadhatu +
7 Kshoudravat
Madhviva
+ +
8 Kshoudra rasa +
9 Kshoudra varna +
Madhumeha patient excretes urine having kasaya and madhura taste, panduta in colour
and of ruksa quality commenting upon this assertion of Charaka, opines that natural madhura
rasa of oja is replaced by kasaya rasa in vasti Chakrapani opines on assertion that Vata
because of its prabhava converts madhura oja into kasaya rasa. Susruta mentioned the
resemblance of urine with honey as described above. Similar description in asserted.
In Chikitsa sthana Susruta before propounding the treatment of Prameha, asserted two
types of Prameha along with their features as follows114.
1) Sahaja Prameha (Krusha)
Rooksha
Alpashi
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
46
Bhrsa pipasa
Parisarana sheela
2) Apathya nimittaja (Sthoola)
Bahu ashi
Snigdha
Shayyasana swapna sheela
Asana, Swapnasheela the Samprapti of Apathya Nimittaja madhumeha has been
explained earlier. The vitiation of Kapha, Kleda, Medas is due to the indiscreet food habits.
Thus leads to the medovaha Srotodusti due to medodhatwagni mandya. Thus the person
develops sthoulya. The samana Vata avarodha in koshta is the reason for prabhuta agni from
which the person desires and consumes more food. It has been said earlier that the meda
sthana is the pitta sthana and hence the Vata in kosta is obstructed which later lead to the
excessive secretions of Pitta in Amashaya which results in the above said lakshanas. The
affected person is termed as snigdha due to the karmataha vruddi of Kapha. Madhumeha is
one among the 20 types of pramehas. So these may be present in madhumehi.
Madhumeha lakshana 115
Susruta gives explanation regarding the lakshanas of Madhumeha, as follows –
a) Gamanat sthananichati
b) Sthanat asananichati
c) Aasanat sayyamichati
d) Shayanat swapnamichati.
Apart from the above lakshanas urine similar to honey in colour and taste are also attributed
to Madhumeha.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
47
Clinical Features of DM 116
It is very difficult to sketch with brevity the diverse clinical presentation of diabetes
mellitus. Only a few characteristic patterns will be presented. The type II (NIDDM) diabetes
present with polyuria, polydipsia but unlike type I diabetes patients are often older and
frequently obese. Some times weakness or weight loss also noted. Apart from these features
others like, polyphagia, pruritis vulvae, glycosuria, infections, delayed healing of wounds,
impotency, are also noted.
Polyuria is due to the osmotic diuretic effect of glucose in kidney tubules. The
glycosuria induces an osmotic diuresis and thus polyuria, causing a profound loss of water
and electrolytes.
The obligatory renal water loss combined with the hyper osmolarity resulting from the
increased levels of glucose in the blood tends to deplete intracellular water, triggering the
osmoreceptors of the thirst centers of the brain. In this manner intense thirst (polydipsia)
appears.
The catabolism of proteins and fat tends to induce a negative energy balance, which in
turn leads to increasing appetite, i.e. polyphagia. Despite the increased appetite, catabolic
effects prevail, resulting in weight loss and muscle weakness. Frequently, however the
diagnosis made after routine blood or urine testing mainly in asymptomatic persons.
Whenever the quantity of glucose entering the kidney tubules in the glomerular,
filtrate rises above approximately 225 mg/min, a significant proportion of the glucose begins
to spill in to the urine and when the quantity increases above about 325 mg/min, which is
tubular maximum for glucose. All the excess, above this is lost in to urine (Glycosuria).
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
48
A comparative study of madhumeha lakshanas with the Diabetes mellitus explained in
the modern science reveals a lot of similarities between them. Prabhoota avila mootrata is
considered as a prathyatma lakshana of Prameha. In this the bahudrava Kapha along with
other dooshyas mainly kleda pradhana dooshyas in the vasti is the cause for prabhoota
mootrata. The same reason has been given in modern science for polyuria that the osmotic
diuretic affects of glucose in the kidney tubules.
Glycosuria explained in the modern science can be taken as madhusama mootra. The
reason for this madhusama mootra is bahudrava kapha or ojus (Glucose), which is excreted
through moootra.
Pipasa or polydipsia mentioned in both sciences. Depletion of intracellular water
triggering the osmoreceptors of thirst center of brain and thirst is noted which is similar to
pipasa of Ayuredic science, here due to excessive loss of the urine; pipasa is noted.
Bahukankshata has been mentioned as a lakshana in apathya nimittaja madhumeha,
the same in modern science in terms of polyphagia.
In modern science the condition weakness is due to lack of glucose utilization, loss of
electrolyte and protein loss. In Ayurveda this same condition is due to aparipakwa dhatus i.e.,
lack of proper nourishment of dhatus.
By considering the above similarities, we can come to a conclusion that Madhumeha
explained in Ayurvedic science and the diabetes mellitus mentioned in the modern science are
almost similar condition.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
49
Differential diagnosis for Madhumeha
Proper diagnosis is the foundation to the success of a treatment because many diseases
affecting a srotas have similar manifestations, enough to confuse a physician but picking up
threadbare with a little difference to clinch a diagnosis is an art aspired by all. Deep
knowledge and untiring practice are the means to perfection as Vagbhata has rightly
mentioned “abhyasat prapyate dristihi karma siddhi prakashini”.
Madhumeha is a mootra atipravruttaja vikara with prabhoota and avila madhusama
mootrata as pratyatma lakshana. Although there are many diseases presenting with
Atipravrutti of mootra, the diagnosis of Madhumeha is usually a straight forward proposition
by differential diagnosis of the following with its sweet uriantion.
Mootra lakshana (Pravartana Nimitta) Symptoms 1) Abhikshnam (Muhurh muhurh, Punah punah : Subahushah, vikiranam
a) Ashmari (C. Ci. 26/38) b) Mutratita (S. U. 58/12) c) Vatika mootrakrichra (C. Ci 26/32) d) Ushna vata (Ah. N. 9/36)
2) Atipravrutti a) Amavata (M. N. 25/9) b) Arsha poorvaroopa (As. N. 7/7) c) Sahaja arsha (C. Ci. 14/8) d) Kaphaja arsha (C. Ci. 14/17) e) Mutra praseka (S. Ci 7/36) f) Upasthita prasava (S. Sa. 10/7) g) Chidrodara (C. Ci. 13/44) h) Asadhya masurika (M. N. 54/27) i) Ama jwara (C. Ci. 3/135)
Moreover within the preview of the disease Madhumeha, the Kapha, Pitta and Vata
have characteristic presentations, which have been described in such a way as not to leave any
scope for doubt. In other words, if a patient presents with mootra atipravrutti, lakshanas of
Kapha, Pitta or Vata like shukla mootrata haridramootrata or vasa mootrata and if they are
associated with Prameha poorvaroopas then the disease is per se Prameha or Madhumeha.
Charaka explains this concept giving the example of a situation where one comes across a
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
50
patient who is presenting with haridra or rakta mootrata. Here the absence of Prameha poorva
roopas will prove the existence of rakta Pitta and exclude Prameha 117.
In the presence of madhura and picchala lakshanas of Prameha, one should consider
two possibilities for differentiation whether the condition is anilatmaka due to Dosha
ksheenata or kaphasambhava as a result of santarpana.
As discussed earlier, here one should essentially consider Madhumeha as a
consequence of vata vruddhi as a result of dhatukshaya where Vata is the anubandhya Dosha
and Madhumeha as a result of margavarana janya vata vruddhi where Vata is an anubandha
dosha and is directly dependent upon Kapha, which has undergone vruddhi because of
santarpana. The factors for differentiation are as follows –
Madhumeha (anilatmaka) Madhumeha (Kapha sambhava) Rogi : Krusha
Nidana a) Vatakara ahara vihara along
with vata vruddhi as a result of
chirakalina madhumeha
b) Beeja uapatapa
Rogi avastha : Bala to madhyama vaya
Roopa : Vata pradhana
Samprapti : Madhumeharambhaka dosha
dusti leading to vapavahana
dusti especially in sahaja
madhumehi
Vyadhiswaroopa : Ashukari
Sadhyasadhyata : Asadhya
Upadrava : Vata pradhana upadravas
Chikitsa : Santarpana
Sthoola
Kaphakara ahara vihara
Madhyama to vruddha
Kapha pradhana
Kaphamedodusti leads to Madhumeha
arambhaka dosha, dusti in vapavahana
Chirakari
Sadhya in the beginning
Kapha pradhana upadravas
Apatarpana
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
51
Madhumeha is basically medovaha srotodustijanya vikara but its pratyatma lakshanas
become vyakta in the mootravaha srotas with abnormal changes in the rasa, varna, gandha,
sparsha of the mootra and it is characterized by prabhoota and avila mootrata.
Prabhoota mootrata means atipravrutti of mootra. It goes without mentioning that
there is also an increased frequency of micturition and Avila mootrata means Atyartha
Kalusha Samalam or Malinam akulam which means that there is a considerable change in the
quality of urine as per the above mentioned factors. Considering these factors, it becomes
contextual to enumerate the conditions where there is increased frequency of urine and
abnormality in its quality. Most of the times these symptoms are associated with mootravaha
srotodusti and other diseases where differentiating Madhumeha is not a problem for evident
reasons. It becomes relevant to consider the following conditions where hyperglycemia is
common manifestation under the heading of differential diagnosis.
Differential diagnosis 118
1) Diabetes mellitus & Endocrine disorders:
a) Pituitary gland
1) Pituitary diabetes due to growth hormone
2) Acromegaly
3) Diabetes insipidus
b) Adrenal Cortex
1) Cushing’s Syndrome
2) Steroid diabetes due to administration of steroids
3) Primary Hyperaldosteronism
c) Adrenal Medulla
1) Phaeochromocytoma
2) Addison’s disease
3) Adrenalectomy
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
52
d) Thyroid
1) Hyperthyrodism
2) Myxoedema
2) Pancreatic Diabetes
1) Acute pancreatitis
2) Mumps (rarely)
3) Chronic pancreatitis
4) Haemochromatosis
5) Total pancreatectomy
6) Carcinoma of pancreas
3) Diabetes liver
1) Cirrhosis of liver
2) Gall Stones
4) Drugs & diabetes
Thiazide, Chlorthalidone, frusemide, oestrogen containing oral contraceptives, β
blockers & catacholaminergic drugs
V Miscellaneous
1) Type I glycogen storage disease
2) Down’s syndrome
3) Turner’s Syndrome
4) Huntington’s chorea
5) Burns
Conditions of polyuria
Polyuria should not be confused with prostratic hypertrophy or cystitis because here it
is only increased frequency of micturition & not increased quantity.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
53
1) Polyurea due to water diuresis
Cranial or neurogenic diabetes insipidus: This is due to an identifiable lesion in the
hypo thalamus pituitary or both leading to failure of A.D.H. Nephrogenic diabetes insipidus:
Familial form seen in males only also as an accompaniment of Fanconi syndrome.
Psychogenic polydipsia or compulsive water drinking this is a hysterical condition. There is
clinically marked fluctuation here.
2) Polyurea due to increased solute load
Diuretic therapy
Chronic renal failure
Upadravas
Charaka enumerated the general complications while Susruta and Vagbhata described
according to the Dosha predominance.
(1) Samanya Upadrava
These are Trsna, Atisara, Jwara, Daha, Daurbalya, Arocaka, Avipaka,
Putimamsapidaka, Alaji and Vidrdhi. Chakrapani opined that these complications manifest
because of the long term Anubandha of Prameha disease119.
(2) Vishesha Upadrava
(a) Kaphajameha Janmanam: Makshikopasarpanam, Alasya, Mamsopacaya,
Pratisyaya, Shaithilya ,Arocaka, Avipaka, Kaphapraseka, Ccardi, Nidra, Kasa and
Swasa 120.
(b) Pittajameha Janmanam: Vrsandaavadaran, Bastibheda, Medhratoda, Hrdisula,
Amlika, Jwara, Atisara, Arocaka, Vamathu, Paridhupanam, Daha, Murcca, Pipasa,
Nidranasa, Panduroga, Pitvidmutranetratva and Vidbheda 121.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
54
(c) Vatajameha Janmanam: Hrdgraha, Laulyam, Anidra, Stambha, Kampa, Sula,
Badhapurisatvam, Sosa, Kasa and swasa122.
When we observe the above complications, only few of them are looking fetal like, Moorcha,
Hrudgraha, otherwise all other complications seem to be associated symptoms or signs in the
disease progression.
Upadrava related to Madhumeha
Charaka mentioned the 'Sapta Pidaka' as complication, because of the negligence of
the Madhumeha123, while Susruta mentioned that Madhumeha along with Pidaka is Asadhya,
He quoted that these Pidaka causes because of the Tridosha and because of the vitiated Meda
and Vasa. Susruta and Vagbhata mentioned 10 Pidaka while Caraka mentioned only 7 Pidaka
these are also follows.
Table – 9
Madhumeha upadrava
SN Pidaka Charaka Susruta Vagbhata
1 Saravika + + +
2 Kaccapika + + +
3 Jalini + + +
4 Vinita + + +
5 Alaji + + +
6 Masurika + +
7 Sarsapi + + +
8 Putrini + +
9 Vidarika + +
10 Vidrdhika + + +
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
55
COMPLICATION OF DIABETES MELLITUS 124
Some upadravas can be correlated to some of the complications of modern sciences
for e.g.- thrishna, bhrama, shoola, tamapravesha, swasa etc with that of the ketoacidosis in
which all these symptom are seen and even in hypoglycemic condition also. It can be
classified into two groups
1) Acute complications: -
a) Metabolic – Ketoacidosis, Hyper Osmolar non Ketotic coma, lactic acidosis
b) Infective apisodes of RIT, UTI, Skin etc.,
c) Surgical complications – Gangrene, Carbuncles
2) Chroni Complications: -
a) CVS – Premature altheroma, Ischaemic or
CHD – Thromibosis, HT, Claudication etc
b) Nervous System – CVD, Peripheral neuropathey, Sensory and motor
neuropathises.
c) Excretory System – Recurrent UTI, RF, Chronic polynephritis
d) Eyes – Cataracts, Retinopathy
e) Respiratory System – Pulmonary kocks
f) Digestive System – Stomatitis, Dental sepsis, fatty filtration of lives
g) Bones and Joints – Osteoporosis, Frozen shoulder on, Neuropathic joints
h) Skin – Monitial infections, trophic ulcers, carbuncles
i) Gonad possible hormon changes.
Sadhyasadhyata of Madhumeha
(1) Sadhya - Kaphaja Prameha
Etiological factors are same to that of Dosha, Dushya and having same qualities and
same seat. So the treatment is same for both. That’s why Kaphaja Prameha is Sadhya125.
Charaka explained few things about prognosis of the disease that Sthairya i.e. Sadhyata
(Curability) results when Kapha get vitiated along with same quality dushya i.e. Prakrti
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
56
bhutatvat. Asadhyta incurability results because the vitiation of Kapha that occurs along with
different quality Dushya like Raktadi. The treatment proved to be Viruddha i.e. apposite to
each other, Vikrti bhutatvat as said by Chakrapani126.
(2) Kruchrasadhya (Difficult to treat):
Madhumeha resulted because of Avaranjanya pathogenesis is difficult treat i.e.
Kruchrasadhya. Here the provocation of Vata results, but the etiological factors mainly related
to the Kapha and Meda. So we should have to consider both of them, there are very few
measures, which act against the Vata and Kapha combined127.
(3) Yapya (palliative):
Pittaja Prameha is palliative that means the disease needs continuous treatment. Once
the treatment stopped, suddenly disease get provoke because of the apposite treatment
measures we have to profound here i.e. Visama kriyatvat.
(4) Asadhya (Incurable)
Vataja Prameha is incurable because there is involvement of vital Dhatus like Majja,
Oja in the pathogenesis and the treatment modalities quite apposite to Dosha and Dushya128.
Susruta mentioned that if Kaphaja and Pittaja Prameha or All types of Prameha if not treated
properly or ill-treated become Asadhya129.
(4) Prognosis related to Medodusya :
Charaka described that if there is less extent vitiation of Meda dhatu in Kaphaja and
Pittaja Prameha then Pittaja Prameha becomes curable but when there is more vitiation of
Meda then Kaphaja and Pittaja both Prameha become Asadhya. Charaka mentioned that
Madhumeha because of the Beeja Dosha i.e. genetic predisposition is incurable. Susruta
mentioned that Madhumeha in association with complication i.e. Pidaka is incurable130.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
57
CHIKITSA IN MADHUMEHA
Chikitsa sutra (principles of treatments) and Chikitsa (Management Proper) are the
two divisions of this major part. Both these are described very well in classics. But the
concepts & methods are different in different conditions, considering the Vyadhi swabhava &
Atura. The Samprapti should be considered deeply before stepping to manage.
The eminent ancient ayurvedists, Charaka, Susruta and Vagbhata are considering the
body constitution and strength of the body of the patient when dealing with the management
aspect. Charaka considers two types of patients; one is that with stout body structure & with
strength and the other without strength and krusha. Sushrutacharya also says that sahaja meha
rogi will be krusha & apathyanimittaja rogi will be sthula.
In the context of medoroga, the managements described are parallel to that of meha
since the Dosha and dushyas are same to major extent. After considering all the factors 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 meha 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.
1) KAPHAJA PRAMEHA 131
(i) Samshodhan Chikitsa
It is better to treat the patient with Vamana therapy. Charaka describes that shodhana,
vamana and langhana done at the proper time looking at the condition of the patient is able to
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
58
cure kaphaja meha. For vasti Chikitsa Vagbhata describes the utilization of Surasadi gana
kwatha. After explaining the shodhana the palliative treatment given is samshamana Chikitsa
in all types of Madhumeha.
(ii) Samshaman Chikitsa:
Charaka gives 10 combinations of drugs to all the mehas with Kapha predominance.
According to Susruta, after proper samshodhana the patient should use swarasa of amalaki
with Haridra powder with madhu. Susruta in this context explains single drug decoctions with
separate indications in 5 types of kaphaja meha and combinations in other 5 types. Vagbhata
describes three yogas in this aspect. They are as follows;
(i) Lodhradi- Lodhra, Abhaya, Musta, Katphala
(ii) Pathadi - Patha ,Vidanga ,Arjuna,Dhanyaka
(iii) Gayatrayadi - Khadirsara, Darvi, Vidanga ,Vacha
Importance of Apatarpana:
Charaka explains the cause of Prameha as due to increasing attitude of kleda, meda,
and Kapha. So he emphasizes the role of Apatarpana in kaphaja & Pittaja Prameha. Different
types of vyayama, kshut, udvartana, dhara & snana with churnas made of Chandana, Aguru,
Ela etc. are advised to use in kaphaja meha.
2) PITTAJA PRAMEHA 132
(i) Samshodhan Chikitsa
Virechana is best in pittaja pramehas. The drugs which are sufficient to eliminate
morbid Pitta can be used with sheeta and other tikta, kashaya rasa in this. Nyagrodhadi gana
kwatha is advised for Asthapanbasti by Vagbhata. Susruta has described that due to spreading
of medo dhatu all over the body, Madhumehi subjects are durvirechya.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
59
(ii) Samshaman Chikitsa
Charaka explains 10 pada yogas in this aspect to treat pittaja pramehas. Susruta has
described 6 specific kwatha yogas for the specific type of pittaja Prameha.
The three kwatha yogas explained by Vagbhata are 133-
(i) Ushiradi : Ushira, Lodhra, Arjuna, Chandana.
(ii) Patoladi: Patola, Nimba, Amalaki, Amrita
(iii) Lodhradi : Lodhra, Ambu, Kaleyaka, Dhataki
3) VATAJA PRAMEHA 134
Although vataja mehas are incurable still Charaka explains to induce certain treatment
in Kapha Pitta anubandhi Vatika meha. Susruta has described that all types of Prameha if not
treated properly in time, gets converted into Madhumeha. So the treatment described for
vatika meha can be considered as treatment of Madhumeha.
MADHUMEHA 135
Susruta has separately mentioned one chapter for the treatment of Madhumeha.
(i) Samshodhan Chikitsa
Considering Sthula and krusha pramehi, Samshodhan Chikitsa should be administered
only to the sthula and Balvan Pramehi. Sarshapa, Nimba, Danti, Bibhitak & Karanja siddha
Taila or Trikantakadya Sneha (Ghrita or Taila according to Dosha predominance should be
used for Abhyantara Snehana. Here while explaining the Samshodhan, Charaka describes to
use the Malashodhan yogas from Kalpa sthana Both Pitta and Kapha are eliminated through
shodhana. It may be vamana or virechana, because of Pittantam Vamanam, Kaphantam
Virechanam. In Virechana Pitta is eliminated first, then Samyak lakshana of virechana is
kaphadarshan, so both Pitta and Kapha doshas which are vitiated are eliminated. Then the
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
60
described Anuvasana & Asthapana Basti chikitsas are able enough to control the provocation
of Vata. Like this all the doshas are normalized to keep the Dosha samyata. Anuvasana with
medicated oils and ghritas are prescribed in Madhumeha. After proper Shodhan Chikitsa,
Charaka 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 ) and Maruta ( Exposing oneself to wind).According to the
conditions of vitiated doshas and dushyas , a physician has to suggest proper Shaman Chikitsa
to the patient. Acharyas introduces different tarpana upakramas in vatika mehas. It is due to
the less strength of the patient. Acharya Charaka & Vagbhatta says that the kashaya yogas
should be enriched with sneha and given to vatika mehas .
Typical Madhumeha Chikitsa
Susruta explains that Shilajitu should be taken after triturating with Salsaradi gana
kwatha. After its digestion patient should take Jangala mamsa rasayukta Anna. He prescribes
to take 1 Tula of shilajatu.
Compound Preparations Used In Prameha:
Swarasa : Amalaki, Haridra, Nimbapatra, Bilwapatra, Guduchi
Kwatha : Vidangadi, Phalatrikadi, Mustadi, Manjishthadi, Pathadi
Churna : Triphaladi, Mustadi, Gokshuradi, Arkadi
Gutika : Chandraprabha, Indravati, Pramehantak Vati
Gugglu : Gokshuradi Guggulu
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
61
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 Vangeshwar Rasa,
Prameha gajkesri Rasa, Trivanga Bhasma, Vasant tilaka Rasa.
MANAGEMENT OF DIABETES MELLITUS 136
Management, rather than treatment, is the appropriate term in Diabetes mellitus, and
involves diet, exercise, insulin, oral hypoglycemic, patient education and counseling. Insulin
and oral drugs are discussed here and the other aspects of management in subsequent
chapters.
INSULIN:
Insulin is required for treatment of all patients with IDDM & many patients with
NIDDM. No single standard exists for patterns of administration of insulin and treatment
plans vary from physician to physician. With a given physician for different patients three
treatment regimes will be described. Viz. Conventional, Multiple subcutaneous injections
(MSI) and Continuous subcutaneous insulin infusion (CSII).
Conventional Insulin Therapy:
Conventional therapy involves administration of one or two injections a day of
intermediate acting insulin such as zinc insulin (NPH insulin) with or without the addition of
small amounts of regular insulin. This practice is based on the concept that regular insulin
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
62
lowers the plasma glucose level rapidly after which more slowly absorbed insulin maintains
the lowered level. Here patients should be taught to decrease insulin when extra exercise is
anticipated.Multiple subcutaneous insulin injection technique (MSI): Most commonly
involves administration of intermediate or long acting insulin in the evening as a single dose
together with regular insulin prior to each meal.
Continuous subcutaneous insulin infusion (CSII): This involves the use of a small
battery driven pump that delivers insulin subcutaneously into the abdominal wall.
Adjustments in dosage are made in response to measured capillary glucose values, as in MSI.
Though CSII provides better Diabetic control, there is a higher risk of Hypoglycaemia and
Diabetic Ketoacidosis.
ORAL AGENTS:
Sulphonyl ureas: NIDDM that cannot be controlled by diet & exercise often responds
to sulphonyl ureas. Sulphonylureas, like Chlorpropamide & Tolbutamide, act
primarily by stimulating release of insulin from β cell, but are useful only in patients
with relatively mild disease.
Second generation drugs such as Glipizide & Glyburide are effective in smaller
doses and differ little from Sulphonylureas. Hypoglycemia occurs less often with oral
agents than with insulin. But when it occurs it tends to be severe & prolonged.
Biguanides: Metformin is useful in NIDDM patients who are not responsive to diet &
exercise. The primary action is thought to be inhibition of hepatic gluconeogenesis &
it also may enhance glucose disposal in muscle & adipose tissue. Melformin does not
cause hypoglycemia unlike sulphonylureas, metformin can cause lactic acidosis hence
should not be given in patients with renal disease.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
63
Thiazolidinedione derivatives: Such as troglitazone, lower blood levels of glucose,
free fatty acids & triglycerides and appears to reduce insulin resistance. Troglitazone
is approved for use in obese patients with NIDDM who are poorly controlled on
insulin.
PATHYA-APATHYA 137
Those Aahara and vihara which are suitable to pramehi 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.
Pathya and Apathya Aharas and Viharas according to different Ayurvedic classics are as
follows:
Pathya in Madhumeha
(a) Aahara:
Shook Dhanya: Jeerna Shali, Shashtika, Kodrava, Yava, Godhuma, Uddalaka,Shyamaka
Shimbi Dhanya:Chanaka, Adhaki, Kulattha, Mudga
Shaka Varga: The leafy vegetables with a predominance of tikta-kashaya rasa, Patola,
Karvellaka, Shigru
Phala Varga: Jambu, Dadima, Shringataka, Amalaki, Kapittha, Tinduka, Kharjura, Kalinga,
Navina Mocha.
Mamsa Varga:Vishkira mamsa,Pratuda, Jangala mamsa
Taila Varga: Danti, Ingudi, Sarshapa , Atasi
Udaka Varga: Sarodaka,Kushodaka,Madhudaka
Kritanna Varga: Apupa,Saktu,Yavodana,Vatya,Yusha
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
64
Others: Madhu, Hingu, Saindhava, Maricha, Lasuna
(b) Vihara: To have walk, traveling on elephants, horses and different plays, different form
of marshal arts, roaming in different places other than temples and umbrella
Apathya in Madhumeha
(a) Aahara: Jala, Milk, Ghee, Oils, Curd, Sugar, Different types of rice preparations, anupa,
gramya and audaka mamsa, Ikshurasa, Pishtanna, Navanna.
(b) Vihara: Eksthana asana, Divaswapa, Dhoompana, Sweda, Raktamoksha, Mutravega
dharana.
TRIAL DRUG (AKULYADI YOGA) REVIEW
Medicine is the prime concern when disease manifests. Madhumeha is the disease
primarily of metabolic derangement includes vitiation of various body elements. Excessive
formation or deranged Meda, Kleda, Vasa and Lasika along with the depletion of vital Dhatus
like Oja and Majja cause the Vata provocation and ultimately Madhumeha. Thus line of
treatment should be to reverse the pathogenesis with the help of Samana as well as Sodhana.
The medication should posses, as discussed in Chikitsa, Tikta and Kasaya Rasa along with
Kapha Vata hara, Medo hara, Kledaghna and Prameha hara properties. Thus the selected
combination – Akulyadi yoga is of the drug of choice for the present clinical trial.
Combination of Akulyadi Yoga 138
SN Drugs Name Latin Name Proportion
1 Akuli 139 Cassia auriculeta 1 Part
2 Amalaki140 Embilica officinalis 1 Part
3 Haridra141 Curcuma longa 1 Part
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
65
Name & Latin name Akuli – Cassia auriculeta 142
Gana Guduchyadi varga 143
Parts used Mukula
Rasa Kashaya ,Tikta
Guna Laghu ,Rooksh
Veerya Sheeta
Vipaka Katu
Prabhava Grahi, Rechaka
Doshaghnata Kapha Pitta shamaka,
Karma Pramehaghna, Atisarahara, Raktapitta hara
Chemical constituents Emodin, Rubradin, Festinidols
* Name & Latin name Amalaki – Embilica officinalis 144
Gana Vayasthapana145, Virechanopaga146
Parts used Phala
Rasa Madhura, Amla, Katu, Tikta, Kashaya
Guna Laghu, ruksha
Veerya Sheeta
Vipaka Adhura
Prabhava Rasayana
Doshaghnata Tridosaghna
Karma Raktapitta, Krimighna, Prameha hara
Chemical constituents Gallic acid Tannic acid, and Vit – C
*
Akulyadi yoga in Madhumeha (Diabetes Mellitus) – Literary Review
66
Name & Latin name Haridra – Curcuma longa 147
Gana Lekhaneeya148, Kustaghna149, Krimighna150
Parts used Kanda
Rasa Tikta, Katu
Guna Rooksha, Laghu
Veerya Ushna
Vipaka Katu
Doshaghnata Kapha Vata hara
Karma Pramehaghna, Kustaghna, Krimighna
Chemical constituents Curcumene, Curcumenone, Camphor
All the ingredients of the Akulyadi yoga are well identified and collected from local
area; good manufacturing practice will be followed for preparation. Even though above yoga
mentioned in “churna kalpa” for easy administration it is tabulated after 3 times fortification.
The prepared drug is preserved in glass jars to protect the shelf life of the medicine. Later at
the time of distribution requisite quantity of the medicine is packed and given to patients. The
individual components of the composition are as follows under specified headings.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Methods
67
Chapter - 4
Methods
The clinical study is based on the classical explanations with scientific well
designed research protocol, which enumerates the patient before to administrate the trial
drug to after effects in comparison.
Criteria for selecting drugs
1. The above mentioned Akulyadi yoga, which are taken from the Yogaratnakara
Pramehadhikara.
2. The pharmacological actions of the individual drugs are Pramehahara.
3. The trial drug, Akulyadi yoga is selected according to the pharmacological action
and properties of individual drugs with in.
4. Akulyadi yoga is purely herbal; they are cheaper and easily available as in the local
market.
5. Akulyadi yoga is very easy to process and vati making
6. Akulyadi yoga is very easy to dispense.
7. The said combination Akulyadi yoga is hypothetically effective in reversal of
Samprapti or the patho-physiological normalcy induction in Madhumeha.
Criteria for quantity of the drug
All the drugs which are selected has pharmacological action against Madhumeha
with therapeutic effects which are the equitant so it is considered to under take in equal
quantity of the Akulyadi yoga ingredients as said in the text.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Methods
68
Methods followed in trail
1) Method of Research design
Madhumeha vis-à-vis Diabetes mellitus is a major health problem for the world of
21st century. At least 50% of all people are with Madhumeha are undiagnosed and noticed
from a dentist. In spite of advanced medical research, it is still a burning problem for the
society. Recent studies reveal that the prevalence rate of type-2 diabetes is from 10-18% in
the urban Indian adult population and also increasing in rural population too.Thus the trail
is Simple Random sampling technique clinical study. In this Patients were taken in
randomized selection.
2) Posology of Trial drug
Internally: 3000 mg / 24hrs in divided two doses or 50mg /Kg body weight
distributed in equal doses
3) Anupana of Trial drug
Madhodaka is undertaken as it is stipulated for the medicine.
4) Study duration of Trial drug
Akulyadi yoga Simple Random sampling technique clinical study was conducted
for 21 days. The medicine was dispensed for 7 days to all patients and advised to report for
every 7 days interval, noted the nature, frequency and other symptoms of their disease
during their visits.
5) Follow up of Trial drug
Akulyadi yoga trail offered a further follow up 21 days. The effect of yoga was
analyzed according to clinical and functional response before and after the treatment is
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Methods
69
compared to that of follow up data. In further the final declaration of the trail drug effect
and result is done on the basis of the follow up data.
6) Source of data of Trial drug
In spite of this much of prevalence and increasing nature of the disease all over the
world, still researchers are struggling for a good, effective and harmless remedial measure
of Madhumeha. Diet control, exercise, oral hypoglycemic agents and insulin have tried and
treated this public health threat, Madhumeha. The data was collected from the patients
suffering from Madhumeha in the OPD of post graduation and research center DGM
Ayurvedic medical college Gadag. The method of the present study consists of following
headings.
a) selection of the patient
b) examination of the patient
c) criteria of assessment
a) Selection of the patient
Patients of Madhumeha fulfilling the criteria of diagnosis were selected in the
present study. Patients were distributed based on preset inclusion and exclusion criteria.
Patients were excluded, as they are discontinuous at the treatment or unable to fulfill the
study design.
i) Inclusion criteria
Patients with symptoms of Madhumeha are included with classical
symptoms enumerated at the classical texts under the lime light of contemporary
medical context along with criteria of inclusion. The symptoms of inclusion are as
under.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Methods
70
• All patients other than that of exclusive criteria are included
• Age of patients between 25-65 years
• Irrespective of gender
• Non-insulin dependent diabetes mellitus
• Patient having clinical features of Madhumeha viz.
1. Prabhoota Mootrata
2. Avila Mootrata
3. Dourbalya
4. Shareera Bhaarahani
5. Janghamamsagraha
6. Karapada Daha
7. Pipasa
8. Kshudhadhikyata
ii) Exclusion criteria
Patients other than exclusion criteria are included in the present study. The
specified exclusions are as under with their causes.
i. Insulin dependent D.M Vis-à-vis Madhumeha
ii. Patients who develops complication with other systemic disease
iii. Juvenile diabetes
iv. Malnutrition D.M
v. Gestational D.M
b) Examination of the patient
Patient through examination is necessary to obtain clear picture of disease and also
the effect of trail drug – Akulyadi yoga. For that the following methods are obtained in the
study.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Methods
71
b-1) Physical signs of Madhumeha patients –
For diagnosis, a detailed medical history is taken and physical examination also
undertaken in detail according to Ayurvedic and contemporary clinical methods. Patients
are diagnosed according to diagnostic criteria given for Madhumeha vis-à-vis DM. A
special case sheet is prepared incorporating all Madhumeha aspects, which is placed as
annexure.
b-2) Diagnosis measurements
The signs and symptoms of Madhumeha mentioned in Ayurveda and contemporary
science were the main basis of diagnosis and criteria for assessing the response to the
treatment. Assessments of results were made according to clinical and functional
improvement observed in the study. Clinical assessment was made on the basis of
symptoms viz. prabhoota mootrata, kshudha etc., which are allotted grades according to
their severity or to that of normalcy. The grades are followed as under.
Grades of assessment
1) Prabhoota Mootrata
Grade 0 = 1000 – 1500 ml/ 24 hrs
Grade 1 = 1500 – 2000 ml/ 24 hrs
Grade 2 = 2000 – 2500 ml/ 24 hrs
Grade 3 = 2500 – 3000 ml/ 24 hrs
Grade 4 = 3000 – above ml/ 24 hrs
2) Avila Mootrata (Turbidity)
Grade 0 = Crystal clear fluids
Grade 1 = faintly cloudy or hazy with slight turbidity
Grade 2 = Turbidity clearly present but news print can be read
through the tube.
Grade 3 = More turbidity & news print can not be read.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Methods
72
3) Dourbalya
Grade 0 = No Dourbalya
Grade 1 = occasionally noticed
Grade 2 = periodically noticed
Grade 3 = daily noticed
Grade 4 = continuously noticed
4) Shareera Bhaarahani
Grade 0 = No Bhaarahani
Grade 1 = occasionally noticed
Grade 2 = periodically noticed
Grade 3 = regularly noticed
5) Janghamamsagraha
Grade 0 = No Janghamamsagraha
Grade 1 = occasionally noticed
Grade 2 = periodically noticed
Grade 3 = daily noticed
Grade 4 = continuously observed
6) Karapada Daha
Grade 0 = No Karapada Daha
Grade 1 = occasionally noticed
Grade 2 = periodically noticed
Grade 3 = daily noticed
Grade 4 = continuously noticed
7) Pipasa
Grade 0 = No Pipasa
Grade 1 = occasionally noticed
Grade 2 = periodically noticed
Grade 3 = daily noticed
Grade 4 = continuously noticed
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Methods
73
8) Kshudhadhikyata
Grade 0 = No Kshudhadhikyata
Grade 1 = occasionally noticed
Grade 2 = periodically noticed
Grade 3 = daily noticed
Grade 4 = continuously noticed
b-3) Assessment measures and Laboratory-investigations
The following investigations are under taken to fulfill the criteria of inclusions and
exclusions. The effective parameters which are considered for the assessment are as under.
a) Blood Sugar estimations
Blood glucose is determined by using Gluzyme glucose reagent set
Procedure
A blood sample is collected from patient into a sterilized container. Serum is
separated from the cells at the earliest possible time (within 30 minutes), then the serum
blood is mixed with the reagent (working solution) and heated at 37°C for 15 minutes. The
readings are observed from colorimeter under 520 nm.
Pipetting scheme for determination of blood sugar
Blank Standard Test
Working enzyme reagent (ml) 3.0 3.0 3.0
Distilled water (ml) 0.025 - -
Standard ( ml) - 0.025 -
Sample (ml) - - 0.025
Calculation
Glucose in mg/ dl = Absorbance of sample x 100 Absorbance of standard
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Methods
74
The same procedure is applied for both FBS and PPBS. The FBS is done with
empty stomach and on the same day the PPBS is calculated after 2 hours of food and the
results are recorded in case sheet.
b) Urine Sugar estimations
A fresh urine sample is collected from the patient. 5 ml of Benedict solution is
taken in a test tube and 5-6 drops of urine sample in put in that. Then the test tube is heated
till until a boil in the solution and cooled at room temperature. The change is observed for
the presence of sugar.
Observations
Colour of test solution Urine sugar
Blue
Green
Yellow
Orange
Brick red
Nil
0.5 %
1.0 %
1.5 %
2.0 %
The following are investigations were done prior to the study according to the need
either to make an exclusion or inclusion in to the study, which are commonly undertaken
for the purpose of prognosis.
a) Erythrocyte Sedimentation Rate
b) Hemoglobin %
c) Blood Differential Count
c) Criteria of assessment
Over all assessment of results are done considering the cumulative
subjective and objective parameters assessments. As the disease is not
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Methods
75
totally curable in the scheduled time span of the study, the grades of
assessments made for the results declaration are as follows -
1. Regulated –
i. Patient relieved with symptoms clinically
ii. PLBS controlled totally to normal with in schedule and continued even at
Follow up period
2. Palliative –
i. Incomplete Symptomatic relief for the patient clinically
ii. Reduced PLBS at schedule to normal and fluctuated at Follow up period
3. Responded –
i. Symptomatic relief for the patient is witnessed partially
ii. Partial Reduction of PLBS at schedule and increased at Follow up period
4. Not responded
i. None of the above conditions
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Results 76
Chapter - 5
Results Present study registers 20 patients, out of 55 approached patients. The percentages of
patients undertaken from the scrutinised are 36.36%. The 20 patients of Madhumeha viz.
Diabetes Mellitus, fulfilling the criteria of diagnosis and inclusive criteria were included in
the study. Fasting and Postprandial blood sugar (FBS and PPBS) along with corresponding
urine sugars (FUS and PPUS) are considered as an objective for the inclusion in the present
study.
All the patients were examined before and after the trail, according to the case sheet
format given in the annex. Both the subjective and objective criteria were recorded along with
validation of disease state. The data recorded are presented under the following headings.
A. Demographic data
B. Validation of disease Data
C. Result of the Akulyadi yoga and
D. Statistical analysis
A) Demographic data:
The details of Age, Gender, Religion, and Occupation etc. of the 20 patients are as
follows.
A1) distribution of patients by Age
Here in this study an attempt is made to understand the male female responses to the
management with respect to that of the age groups. An interval of 10 has considered from the
ages 25 to 65 as discussed in the methods. In the study it is revealed that Madhumeha is even
though thought that starts from the ages of 25 onwards and the fact found is not suggestive. At
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Results 77
the older age group of 55-65, 5 (25%) patients reported suggest the chronicity of the disease.
Where in 45-55 and 35-45 age groups reported with 9 (45%) and 6 (30%) patients in each
group respectively. It is interested to note that the active age group patients of 35-45 age
groups reported only 6 (30%) patients. Out of the 45-55 ages a maximum (7) patients
regulated the disease. The tabulations are depicted as under.
Table- 10
Results by Age in Madhumeha with Akulyadi yoga
Age Regulated Palliative Responded Not Responded Total %
25- 35 0 0 0 0 0 0
35 – 45 3 0 3 0 6 30
45 – 55 7 0 2 0 9 45
55 – 65 1 1 3 0 5 25
Total 11 1 8 0 20 100
% 55 5 40 0 100 *
Figure – 3
Results by Age in Madhumeha with Akulyadi yoga
0000
30
30
702
011
30
0 2 4 6 8
25- 35
35 – 45
45 – 55
55 – 65
Results by Age in Madhumeha with Akulyadi yoga
Not RespondedRespondedPalliativeRegulated
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Results 78
A2) Distribution of patients by Gender
Table- 11
Results by Gender in Madhumeha with Akulyadi yoga
Gender Regulated Palliative Responded Not Responded Total %
Male 6 0 6 0 12 60
Female 5 1 2 0 8 40
Total 11 1 8 0 20 100
% 55 05 40 0 100 *
The male female ratio in the study is approximately 3:2 patients. The percentage of the
distribution does not show any gender differentiation to get this Madhumeha in specific,
except a small lean towards male population. The observations are 12 Patients i.e. (60%) male
and 8 patients i.e. (40%) were female.
Figure - 4
Results by Gender in Madhumeha with Akulyadi yoga
Results by Gender in Madhumeha with Akulyadi yoga
Male60.00%Female
40.00%
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Results 79
A3) distribution of patients by Religion
For the convenience of the study, the religion groups are noted as Hindu, Muslim,
Christian and Others. The maximum number of patients are noticed from the Hindu
community as the ratio of community at the study area is more i.e. 16 (80%) along with
Muslim patients 4 (20%).
Table- 12
Results by Religion in Madhumeha with Akulyadi yoga
Religion Regulated Palliative Responded Not Responded Total %
Hindu 8 0 8 0 16 80
Muslim 3 1 0 0 4 20
Christian 0 0 0 0 0 0
Others 0 0 0 0 0 0
Total 11 1 8 0 20 100
% 55 5 40 0 100 *
Figure – 5
Results by Religion in Madhumeha with Akulyadi yoga
Results by Religion in Madhumeha with Akulyadi
yoga
Christian 0.00%
Hindu80.00%
Muslim20.00%
Others0.00%
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Results 80
At the results observed, out of 16 (80%) of Hindu patients, 8 (40%) patients regulated
and 8 (40%) patients fall under responded category. On the other hand the results observed at
Muslim community are, out of 4 (20%), 3 (15%) patients fall under the category of regulated
and one has palliative response. The tabulation and graphical representation is as under.
A4) Distribution of patients by Occupation
Table- 13
Results by Occupation in Madhumeha with Akulyadi yoga
Occupation Regulated Palliative Responded Not Responded Total % Sedentary 6 1 8 0 15 75
Active 2 0 0 0 2 10
Labor 3 0 0 0 3 15
Total 11 1 8 0 20 100
% 55 5 40 0 100 *
Figure - 6
Results by Occupation in Madhumeha with Akulyadi yoga
Results by Occupation in Madhumeha with Akulyadi yoga
Active10.00%
Sedentary75.00%
Labour15.00%
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Results 81
At the results observed, out of 15 (75%) of sedentary patients, strongly suggests that
the Madhumeha is a disease of the sedentary patients, out of which 6 (30%) patients
regulated, 1 (5%) patient is palliative responded and 8 (40%) patient were responded to the
treatment. At the active group, out of 2 (10%) patients all two are regulated. At the results are
observed, out of 3 (15%) of Labour all three are regulated in the treatment. The pictorial
representation is as above.
A5) Distribution of patients by economic status
At the results observed, out of 2 (10%) of poor patients, all two are regulated. Out of
2 (10%) of Middle class patients all are regulated. From higher middle class 8 (40%) patients
reported and out of them 3 (15%) patients are regulated, 1 (5%) patient have palliative
response and 4 (20%) patients are responded. 8 (40%) patients are reported from the higher
class of classification, show 4 (20%) regulated and the rest 4 (20%) responded. The tabulation
and pictorial graph is expressed as here.
Table- 14
Results by Economic status in Madhumeha with Akulyadi yoga
Economic status Regulated Palliative Responde
d
Not Responde
d Total %
Poor 2 0 0 0 2 10
Middle 2 0 0 0 2 10
Higher Middle 3 1 4 0 8 40
Higher 4 0 4 0 8 40
Total 11 1 8 0 20 100
% 55 5 40 0 100 *
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Results 82
Figure - 7
Result Distribution of patients by Economic status
A6) Distribution of patients by diet
Table- 15
Results by Diet in Madhumeha with Akulyadi yoga
Diet Regulated Palliative Responded Not Responded Total % Vegetarian 6 0 7 0 13 65
Mixed diet 5 1 1 0 7 35
Total 11 1 8 0 20 100
% 55 5 40 0 100 *
The vegetarian and mixed diet ratio in the study is approximately 2:1 patients. The
percentage of the distribution does not show any diet differentiation to get this Madhumeha a
disease in specific, except a small lean towards vegetarian population. The observations are
13 Patients i.e. (65%) vegetarian and 7 patients i.e. (35%) were mixed diet practitioners.
2 2
3
4
0 0
1
00 0
4 4
0 0 0 000
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Poor Middle Higher Middle Higher
Results by Economic status in Madhumeha with Akulyadi yoga
Patients
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Results 83
Figure - 8 Results by Diet in Madhumeha with Akulyadi yoga
As the results observed, out of 13 (65%) vegetarians, 7 (35%) patients are Responded
and 6 (30%) patients Regulated to the management. As the results observed in mixed diet
population, out of 7 (35%), 5 (25%) patient are regulated response, 1 (5%) patient responded
palliative and 1 (5%) patient responded to the treatment.
B) Data related to the disease.
B1) Distribution of patients by presenting complaints
Almost all the symptoms selected as the presenting complaint as analyzed reflects the
said complaints of the text and Prabhoota mootrata (20 patients), Dourbalya (20 patients),
Kshudha adhikyata (18 patients) and Pipasa (17 patients) are observed stating the cardinal
symptoms as polyuria, polydipsia and polyphasia. The graph and tabulations are shown as
below.
Results by Diet in Madhumeha with Akulyadi yoga
Vegetarian 65.00%
Mixed diet35.00%
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Results 84
Table –16
Distribution of patients by presenting complaints
Presenting complaints Patients %
Prabhoota Mootrata 20 100
Dourbalya 20 100
Kshudhadhikyata 18 90
Pipasa 17 85
Karapada Daha 16 80
Avila Mootrata 15 75
Shareera Bhaarahani 13 65
Janghamamsagraha 13 65
Figure - 9
Distribution of patients by presenting complaints
Distribution of patients by presenting complaints
Avila Mootrata, 15 Janghamamsag
raha, 13
Shareera Bhaarahani, 13
Karapada Daha, 16
Kshudhadhikyata, 18
Prabhoota Mootrata, 20
Dourbalya, 20
Pipasa, 17
0
5
10
15
20
25
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Results 85
B2) Distribution of patients by Associated features
Mukha talu sosha is said as associated symptom for Madhumeha, which is observed
here at the maximum. 11 each patients observed with Karapada spuptata and Sandhi Shoola.
Alasya is observed by the 50% of the patients. This study observes the rest of the associated
complaints enumerated in the table below along with the graph.
Table – 17
Distribution of patients by Associated features
Presenting Associated features Patients Percentage
Mukha/Talu shosha 19 95 Kara/Pada suptata 11 55 Sandhi Shula 11 55 Alasya 10 50 Gurugatrata 9 45 Klama 7 35 Tandra 5 25 Shithilangata 4 20
Figure – 10
Distribution of patients by Associated features
Distribution of patients by Associated features
Klama, 7 Shithilangata, 4
Tandra, 5Gurugatrata, 9
Sandhi Shula, 11
Mukha/Talu shosha, 19
Kara/Pada suptata, 11
Alasya, 10
0
2
4
6
8
10
12
14
16
18
20
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Results 86
B3) Distribution of patients by Ahara Nidana
Table – 18 Ahara Nidana observed in the study
Ahara Nidana Patients Percentage
Guda 20 100 Dadhi 20 100
Snigdha 17 85 Dugdha 16 80 Navanna 14 70 Sheeta 13 65
Gramya 5 25 Anoopa 4 20 Auduka 4 20
Ayurveda offered many causes especially in regard with food. The Guda and Dadhi
said as causes are observed 100% in the study. The other factors also observed in the study
are tabulated above.
B4) Distribution of patients by Vihara Nidana
Many regimens are told in Ayurveda, out of which Diwaswapna is observed 100% and
Avyayama 90% and swapna sukham for 50% of patients. The vihara tabulated are here under.
Table – 19 Vihara Nidana observed in the study
Vihara Nidana Patients Percentage
Diwaswapna 20 100
Avyayama 18 90
Swapnasukham 10 50
B5) Distribution of patients by Anya Nidana
The other Nidana told in texts are very less observed here. Only Sthoulya is observed
for 50% of patients.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Results 87
Table – 20 Distribution of patients by Anya Nidana
Anya Nidana Patients Percentage Sthoulya 10 50
Manishika- Chinta 7 35 Krimi 0 0
Vegavarodha 0 0 Panchakarma Vibhramsha 0 0
B6) Distribution of patients by Poorva roopa lakshana
Table – 21 Distribution of patients by Poorva roopa lakshana
Poorva roopa Patients Percentage Mutra madhurata 20 100
Trishna 20 100 Talu kloma shosha 19 95
Swedadhikya 17 85 Shitalangata 16 80 Sheeta iccha 15 75
Nidra 14 70 Nakha vruddhi 13 65
Maldhikyata in bahya chidra 12 60 Shareera durgandha 11 55
Kesh jatilata 10 50 Alasya 10 50
Deha chikkanata 9 45 Mukha madhurta 9 45
Pada daha 8 40 Pani daha 8 40
Dantadeenam Malatvam 7 35 Tandra 7 35 Swasa 6 30
Mutra shuklata 5 25
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Results 88
The Poorva roopa mentioned in Ayurveda are observed here in the study. Mutra
madhuryata and Trishna are 100% and Talu kloma sosha is observed for 95%. The rest of the
symptoms observed are tabulated here along with percentage.
B7) Distribution of patients by Sroto dusti lakshana
Table – 22
Distribution of patients by Sroto dusti lakshana
Sroto dusti lakshana Patients Percentage
Jihwa shosha 20 100 Talu shosha 20 100 Osta shosha 14 70 Kloma shosha 18 90 U
daka
vaha
Pravruddha pipasa 20 100 Alpalpa mootrata 0 0 Mootara rodha 0 0 Adhika mootra 20 100 Sashoola mootra 4 20 M
ootra
vaha
Basti stabdhata 0 0 Arbuda 0 0 Arsha 0 0 Mamsa shosha 0 0
Mam
sava
ha
Shira granthi 0 0 Sweda 12 60 Snigdhanagata 6 30 Sthulashophata 1 05
Med
ovah
a
Pipasa 20 100 Out of different srotas included in the study explicit new dimensions. Out of
Udakavaha srotas – Pravruddha Pipasa, Jihwa and talu sosha, in Mootravaha srotas – Adhika
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Results 89
Mootrata, in Medovaha srotas the Pipasa are observed 100% in the study. It conform the
involvement of these srotases. The enlisted symptoms are at above table.
B8) Family history
Table – 23
Data of Family history in the study
Family history Patients Percentage
Present 12 60 Absent 8 40 Total 20 100
The Madhumeha observed as familial by researcher prove in study with 60% family
history. The rest of 40% show the instantaneous expression of the disease.
C) Result of the Akulyadi yoga
C1) Assessment of Subjective parameters
Table – 24
Presenting complaints
Patie
nts
Bef
ore
%
Patie
nts
Afte
r
%
Patie
nts
relie
ved
%
Dourbalya 20 100 2 10 18 90
Shareera Bhaarahani 12 60 3 15 9 75
Janghamamsagraha 13 65 3 15 10 77
Karapada Daha 17 85 3 15 14 82.3
Pipasa 17 85 7 35 10 58.8
Kshudhadhikyata 16 80 6 30 10 62.5
The assessments of the symptoms which are presented as the chief complaints are the
subjective parameters of the study observed initially Dourbaly as 100% is witnessed reduced
for 90% in the study. The Shareera bharahani initially for 60% of patients later observed it as
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Results 90
weight gain in 75% of patients. In the same way the Jangha mamsa graham initially observed
65%, the control rate observed as 77% at the completion of study. Karapada Daha is for 85%
of patients’ initially recorded 82.3% relief. Pipasa initially for 85% of patients exhibit the
58.8% of relief. Another major symptom Kshudhadhikyata is seen in 80% patients at the start
become reduced 62.5% in the study.
C2) Assessment of Objective parameters
Table - 25
Presenting complaints Pa
tient
s B
efor
e
%
Patie
nts
Afte
r
%
Patie
nts
relie
ved
%
Prabhoota Mootrata 20 100 3 15 17 85
Avila Mootrata 9 45 1 05 8 88.88
Fasting Blood Sugar 20 100 8 40 12 60
Post prandial Blood sugar 20 100 10 50 10 50
Fasting Urine Sugar 13 65 5 25 8 61.5
Post prandial Urine sugar 17 85 7 35 10 58.8
The objectives are very much important to assess a study. Here in the study Mootra
prabhootatva is reduced 85% and Avila mootrata for 88.88%. The FBS and PPBS exhibit
60% and 50% differences in the study, where in the FUS and PPUS show the 61.5% and
58.8% variances from the base line data.
C3) Results of the Akulyadi yoga
The result is based upon the cumulative effect of the subjective and objective
parameters together assessed. The result is drawn in four categories viz. Regulated, Palliative,
Responded and not responded. In the study at the follow up, if any increase of PPBS is
observed the patient is brought one step down to the declared result. The result of the
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Results 91
Akulyadi yoga declared is representing the efficiency of the drug with its embedded qualities.
The tabulation is as below along with the graph.
Table - 26
Result of Akulyadi yoga in Madhumeha
Result Number of patients Percentage
Regulated 11 55
Palliative 1 5
Responded 8 40
Not Responded 0 0
Total 20 100
Figure - 11
Result of Akulyadi yoga in Madhumeha
Result of Akulyadi yoga in Madhumeha
Responded40%
Regulated 55%
Palliative 5%
Not Responded0%
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Results 92
D) Statistical analysis
To compare the effectiveness of a drug before and after the treatment the statistical
analysis paired t-test, by assuming that the drug is not responsible for changes in the reading
before and after the treatment. The conclusion drawn is as highly significant if P <0.05.
Table – 27
Statistical analysis of Akulyadi yoga
Parameter Mean SD SE t value P value Remark
Dourbalya 2.45 1.145 0.256 9.57 <0.001 HS
Shareera bharahani 1.1 1.165 0.260 4.23 <0.001 HS
Janghamamsa graham
0.95 1.05 0.234 4.059 <0.001 HS
Karapada daha 1.4 0.94 0.21 6.666 <0.001 HS
Pipasa 2.2 1.281 0.286 7.69 <0.001 HS
Kshudhadhikyata 2.05 1.356 0.303 6.76 <0.001 HS
Prabhoota mootrata 3.2 0.894 0.2 16.0 <0.001 HS
Avila mootrata 0.5 0.606 0.135 3.703 <0.001 HS
FBS 48.605 30.41 6.80 7.147 <0.001 HS
PPBS 117.18 46.42 10.38 11.289 <0.001 HS
FUS 0.325 0.293 0.0656 4.954 <0.001 HS
PPUS 0.63 0.476 0.1066 5.9099 <0.001 HS
Among the subjective parameters dourbalya, pipasa, Kshudhadhikyata shows more
highly significant than other parameters. (Comparing p values) the parameters shareera
bharahani and jangamamsa graha are having almost equal effect before and after the treatment
(by comparing t-values). The parameters dourbalya having more net mean effect where as the
parameter jangamamsa graha is having less mean effect (comparing mean value) the variation
in the parameter karapada daha is less, where as in the parameter Kshudhadhikyata is more.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Results 93
Among all the objective parameters all the parameters shows significant but in the
parameter prabhoota mootrata, PPBS, FBS are shows more highly significant (comparing p-
values). The parameters PPBS are having more net mean effect with more variation where as
in FUS having less mean effect will less variation (comparing mean and variations).
Among the subjective parameters the percentage improvement is in between 82% to
92%, which means that the percentage of improvement lies between these two values. Where
as in the objective parameter the more percentage improvement in the prabhoota mootrata
(94.1%) and where as in the parameter PPBS is least percentage improvement (14.312%).
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Discussion 94
Chapter - 6
Discussion A retrospective analysis of resource material reveals that various references relevant to
the topic are available under broad heading Prameha in the classics. The classical Ayurvedic
literature is sufficient with plenty of description of the disease and discussion regarding to
patho-physiology, symptomatology and the treatment modalities. Physiological and
pathological aspects of Dosha and Dushya regarding Madhumeha are available in detail.
Various pathological processes regarding Dosha and etiological factors defined in the classics
are under taken by various research studies carried out to find out the exact pathogenesis of
Madhumeha and its treatment.
Though the disease is of Tridosha predominant but Avrutta Vata and the Bahudrava
Shlesma are the main ailments. Madhumeha is the subtype of Vataja Prameha. Vata is the
originator and executor of the bio-motor functions. Vyanavata mainly pervades swiftly
through the body, effective transport and circulation is dependent upon him. Apanavata
related to the functions of Pakwashaya. In Madhumeha both are get vitiated leading to the
abnormal pathway and excessive elimination respectively. Kapha is the basis of structural
integrity of the body provides steadiness and strength in the body, keeping together various
structures.
All these function of Kapha get hampered in the Madhumeha. When Kapha get
vitiated it undoubtedly vitiates the body elements like Rasa Mamsa, Meda, Vasa, Lasika, Oja
etc. they in turns diminish the structured body integrity by providing excess of metabolic
waster because of faulty bi-fold digestion.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Discussion 95
Pitta a somatic humour mainly related with the digestion and metabolism here due to
etiological factors Pitta also get vitiated it in turns affect the normal functions of Jathragni and
Dhatwagni leading to the excessive formation of deranged quality of Rasa, Mamsa, Meda,
Kleda etc. Thus in Madhumeha because of the above discussed patho-physiological
processes; i.e. Dushya obstructs the normal pathway of Vata causing Avarana to it that in
turns aggravate the Vyanavata leads to the transport of vital Dhatu Oja towards vasti where
already aggravated Apanavata excretes out it from the body resulting depletion of Dhatus and
generate disease Madhumeha. This pathogenesis mainly described by Charaka. Thus
aggravation of Vata excess of Dushya and metabolic waste due to abnormal bi-fold digestion
causes Madhumeha. Avarana is the essential part of any Vataja Samprapti. Another
pathogenesis of Madhumeha described in Ayurveda mainly related with the vitiation of Vata
due to its own etiological factors and genetics predisposition this entity is incurable mentioned
by Ayurveda because here severe diminution of Dhatus occurs. Thus Madhumeha having two
etiological factors one Santarpankara and second Apatarpankara. Excess of deranged
Shlesma, Meda ,Kleda, Vasa, Lasika etc. aggravated vata produces various
pahthophysiological changes in the body producing symptoms like Prabhata mootrata,
Avilamootra, Pipasa, Daurbalya, Alasaya etc, leads to the structural as well as functional
abnormalities in the body. In the pathogenesis more or less every body element is get
involved.
The present clinical study was planned in single group to manage the problem by trial
drug Akulyadi yoga. The subjects were treated with Akulyadi yoga for duration of 21days and
the yoga possesses Tikta, Kasaya Rasa, Vatakaphahara and Pramehaghna.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Discussion 96
Discussion on demographic data
Because of decrease in beta cells the risk of diabetes increases as age advances;
especially after 40 years. It is well recorded fact that, the NIDDM occurs only after 3rd decade
of life. In this study, the above factors were proved, as all the patients were between the age
group of 30 to 62, suggestive of the age relation stress advancements and comforts at age
advancements to cause the Madhumeha. This reveals that maximum prevalence of the
disease is at Madhyama vayastha because at this stage of age there is natural aggravation of
Vata started and normal digestion / metabolism going to hamper. These findings were related
to the recent statistical data, which shows that the onset of type II diabetes mellitus in the
forties is most common.
Majority of the patient in the present study belongs to Hindu community i.e. 80%, but
it does not mean that Hindus are prone to this disease. This may be due to the local ratio of
difference religion. The patients were selected incidentally.
Susruta had said that women would not get Madhumeha; because their body gets
cleaned every month by the raja pravrutti. But it is seems as a controversial dialogue as
women also getting Madhumeha and they are also at high risk of getting diabetes compared to
men after 30years, especially after the pregnancy or at the time of pregnancy. In this study a
majority of the patients were male when compared to female, as shown in results chapter.
Majority numbers of patients were sedentary type of occupation. In sedentary type of
occupation physical activities are very less, it is clearly mentioned that people with sedentary
life styles more prone to diabetes mellitus or Madhumeha. In the present study 75% patients
were recorded with sedentary life styles.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Discussion 97
In the present study 60% patients had family history and rest of the 40% patients had
no family history of Madhumeha. It is a well proven factor that family history had main role
in the manifestation of Sthoola Madhumeha.
In the manifestation of Madhumeha food habits had great importance. If we check the
Nidana aspects we can see the importance of food habits. At the same time lot of foods are
also mentioned which are helpful in controlling Madhumeha. In the present study 65%
patients were vegetarians and 35% patients were mixed. From these we can see that high
calorie intake is the main risk factor for diabetes.
Economics makes ones to susceptible for comforts. Majority of patients belongs to
upper middle and higher class, exhibiting richness. In these classes the people indulge in very
less physical activities and ultimately remain to sedentary life styles to get the a santarpanotha
Vyadhi, Madhumeha vis-à-vis Diabetes Mellitus.
Discussion on diseases components
Most of the Nidana mentioned in the classics were elicited in this study by detailed
questioning. Among general Nidana, all patients used to take snigdha and guru aharas
excessively. Among the viharas, Swapanasukham (10patients), Avyayama (18 patients) and
manasika karana (7patients) were also noted. From this we can say that snigdha ahara dravyas
and swapna sukhadi viharas had key role among the nidanas.
In ancient Ayurvedic treatises common premonitory symptoms are described but
special premonitory symptoms of Madhumeha are not mentioned. The disease having vast
field of etio-pathogenesis only few of them are cardinal sign and symptoms of Madhumeha.
These are pipasa, madhura mootrata, Asymadhurya, Panidaha, Padadaha. All patients shown
100% history of mutra madhurata and Talu kloma shosha observed almost all patients i.e.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Discussion 98
95% Swedhadhikyata observed as 85%, Shithilangata is observed as 80% and sheeta iccha is
observed as 75%.
Prabhoota mootrata is observed as 100% in the study. This is a cardinal sign described
by all authors for Madhumeha. Vagbhata mentioned Prameha as disease of mootra
atipravruttaja. Avilamootrata is observed as 45%, for that Vagbhata emphasized that this
turbidity of the urine because of its annexation with the Dhatu.
Charaka enumerated the general Samprapti as it is due to over indulgence of
etiological factors, Kapha along with meda, mamsa and Kleda get vitiate and results into
formation of metabolic waste which carried towards vasti resulting Prameha. In same manner
Pitta get vitiated resulting pittaja Prameha. While Vata is due to depletion of other two Dosha
get provocative in turns causes depletion of dhatus by excrete them through urine resulting
vataja Prameha.
Susruta mentioned that Sahaja Prameha precipitate because of defect in beeja. This is
even explained by Charaka that Sahaja Madhumeha is a Kulaja Vikara, because of the defect
in beeja (Sperm / ovum). Here the patient is prone to Dhatu kshaya because of above factor.
Charaka explained the pathogenesis is due to specific etiological factors which vitiate Vata
draws out the vital dhatus and carries them towards vasti resulting into Madhumeha.
Charaka enumerated that due to depletion of Kapha and Pitta Vata get aggravate and
causes the excretion of dhatus through urine resulting into madhumeha. Though Vagbhata
narrated the cause of this type of Madhumeha but not explained the pathogenesis. Charaka
emphasized this pathogenic process in well elaborative manner. This is the unique
contribution of Charaka. Due to excessive indulgence of heavy, unctuous, salty and sour diet,
Avoidance of worry, exercise and purifying measures. Kapha and Pitta get provoked and
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Discussion 99
vitiates meda and mamsa. All are in excess quantity. They in turn cause obstruction to the
normal pathway of Vata. This obstructed Vata get aggravated and draws out the apara oja
from all over the body and carries it towards vasti resulting Madhumeha.
Majority of the patients shown symptoms and signs like Atisweda, Daurbalya, Alasya,
Arochaka, data suggestive of Vata dusti and Kapha dusti also present, medodosha were also
present here. Majority subjects shown Rasadusti, Medodusti, Kleda. Data suggestive that
medodusti is always present in Madhumeha and relevant to the quotation of Susruta that
sthaulya i.e. medoroga is because of Rasadusti, ojodusti suggestive of Dhatu depletion.
Kapha have peculiar nature i.e. Bahudrava described by Charaka. So it is easily
understand that the 'Shaithily' manifestation in this disease, as Kapha normally cause Sthiratva
in the body. Cakrapani commented upon the word Sthiratva means Ashaithilya. So this
bahudravatva of vitiated Kapha causes disruption in the assemblage of body elements and
provide ground for the accumulation of morbid matter in the tissues.
Again Kapha Dosha is the dominant factor in the pathogenesis of Madhumeha. It gets
vitiated primarily and causes the vitiation of concordant body elements like Meda, Mamsa,
Kleda, Rasa, Vasa, Lasika etc. The vitiation of Kapha here mainly is of excessive type. That’s
way the following symptoms manifests in madhumeha. These are shaithilya, Alasya, Atinidra,
Gaurava, etc. Charaka clearly mentioned and Cakrapani opined that Kapha Dosha is dominant
and primarily vitiated because of its close resembles with the etiological factors. This
excessive Kapha can be correlated with functions of growth hormone, which is antagonistic to
insulin, one of the causative factors for the precipitation of type- 2 Diabetes Mellitus.
Pitta Dosha is not so dominant factor in the pathogenesis of Prameha. By the vitiation
of Pitta, Avaranganya Samprapti of Madhumeha resulted. Rakta, Sweda, Lasika and Rasa are
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Discussion 100
the seats of Pitta Dosha so when Pitta get provoked, It undoubtedly causes the vitiation of
above Dusyas. That’s why the symptoms manifests are Sweda vruddhi, visra sharira gandha,
panidaha, pipasa and sosha indirectly Agni vaisyama too.
This is the main predominant Dosha in the pathogenesis of Madhumeha here is Vata
get aggravated either because of its own etiological factors or because of Avarana caused by
Kapha Pitta and Meda. This vitiated Vata carries the vital constituents of the body like Vasa,
majja, and oja towards vasti and excretes them outside through urine resulting depletion of the
dhatus. Thus due to severe depletion of Dhatu, the symptom manifests are Karsya, Daurbalya,
Angasuptata and Parisaransheela nature.
All authors narrated dushya sangraha and their involvement in the pathogenesis, but
caraka specially enumerated a group and named it as a Dushya visesa. Again he mentioned
them in Cikitsasthana also. Susruta also narrated the Dushyas but he typically mentioned them
along with the doshic type, but he commonly included meda in each type. Only Vagbhata
mentioned sweda as a dushya along with above dushyas.
This is one of the Dhatu mainly vitiates. Here because of its close resemblance with
Kapha qualitatively Again Rasa is one of the seats of Kapha Dosha and Pitta Dosha. So if
Kapha get vitiate Rasa also get vitiate. That’s why having same symptoms related to Vruddhi
as mentioned by Vagbhata i.e. Rasoapi Slesmavat'.
Susruta emphasized that Sthaulya and Karshya results due to vitiation of Rasa Dhatu
and practically we can found both conditions in the Madhumeha. So the role of Rasa Dhatu is
very much important in the precipitation of the disease. Vitiated Rasa shows manifestations
like Alasya, Gaurava, Krsangata, Klaibya and Agninasa in context to Madhumeha. Rakta
Dhatu have no much involvement in the manifestation of the Madhumeha. It is mainly getting
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Discussion 101
vitiated in pittaja Prameha. Not initially but in later stage Rakta also get vitiated prominantly
causing complications like Pidaka, Vidrdhi, Alasi.
One of the main Dushya described by Charaka is Mamsa. He narrated it especially in
Kaphaja Prameha and Avaranjanya Madhumeha, as Mamsa and Kapha have same qualities.
They both give strength to the body. When get vitiated, Mamsa losses its normal consistency
and develops Shaithilya and provide space in between for the accumulation of morbid matter.
That in turn results into the Putimamsa Pidika.
Medas vitiation is common and dominant Dushya in the pathogenesis of Madhumeha.
Kapha and Meda have close resemblance in regard to functions as well as qualitative
parameters. Both are getting vitiated more or less by same etiological factors. Meda vitiation
in Madhumeha appears in two ways i.e. the former is Qualitative - Abadha (Asamhatum)
Normal function of Meda is to produce unctuousness in the body along with Dradhatva i.e.
compactness. So this Abadhatva causes derangement in the structure of Meda producing
Shaithilya in the body. This can be well correlate with FFA excess. The later is Quantitative -
Here in the pathogenesis, Meda is in excess quantity. This Medo Dhatu is Aparivakva. It
obstructs the path of Vata along with Kapha. This provoked Vata increases the Agni so
patient unnecessary eats more and more food causing excessive deposition of Aparipakva
Meda. This in turns causes severe depletion of the other Dhatus and produces various sign and
symptoms.
In Ashtanga Sangraha, Vagbhata mentioned that along with Prameha Purvarupa
excessive Meda can causes diseases of Slesma, Rakta and Mamsa. Thus from above
description it is clear that vitiated Meda plays vital role in the progress of pathogenesis and
affects the normal physiology of various body elements.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Discussion 102
Majja Dhatu is not vitiated in maximum extent but Vata causes its Ksaya i.e.
Depletion. Thus the vitiated Majja producing symptoms like, Netragaurava, Angagaurava in
Madhumehi patient clinically.
Shukra also get vitiated in the pathogenesis produces symptoms like daurbalya and
Kruchra vyavayata, because normal functions of Sukra is to maintain. Dehabala, it also plays
role in the precipitation of Sahaja Prameha. Susruta narrated that Sukra Dosha and Prameha
get precipitate because of the vitiation of Vyanavata and Apanavata. With this it is understand
that the relation of Sukra dushti as a component of Prameha formation. Sexual impotency and
testicular hypo functions have been reported in Diabetes Mellitus by Moses et.al .1979.
Oja as Dushya mainly involved in Vataja Prameha i.e. Ojomeha i.e. Madhumeha.
Provoked Vata due to its own etiological factors or due to Avaran carries Oja towards vasti
and excrete outside through urine so the symptoms of Ojaksaya manifests, like Gurugatrata,
Nidra, Tandra and Daurbalya. Charaka mentioned Ruksta i.e. related to Ruksa Sharira, so one
can easily understand the manifestations of Krusapramehi or Sahaja Pramehi.
This is one of the body component mainly involved in the pathogenesis. The literary
meanings of Kleda are wetness, moisture and dampness etc. The physiology of Kleda is
mainly related with Mutra and Sweda along with Meda. Thus when Kleda is involved then it
directly affects the above factors. There is no direct reference regarding to the function of
Kleda in the body but Arundatta commented that. According to his opinion, If Kleda is not
present then there is manifestation of dryness in the body, so indirectly we can say that the
Kleda proper in quantity is important to maintain the unctuousness in between the tissues. In
normal physiology Mutra and Sweda maintain the balance of Kleda.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Discussion 103
Especially Sweda holds it in the body and Mutra excrete it outside the body.
According to the body condition and requirement, if this Kleda is get vitiated it directly
affects the physiology of Mutra and Sweda and disrupts the assemblage of bodily elements
causing Shaithilya. Thus the symptoms manifests due to Kleda vitiation are Prabhuta mutrata,
Sweda vruddhi, Saithilya, Daurgandhya and Avila mutrata.
This dooshya is separately mentioned by Vagbhata. Sweda is mainly related with
Meda and Kleda. When the Swedavaha Strotodusti occurs due to vitiation of Kleda and Meda,
the normal physiology and Sweda get disturbed resulting in manifestations like, Sweda
vruddhi, Daurgandhya. Picchila gatrata, Snigdha gatrata etc. Susruta only mentioned that in
Madhumeha Sweda becomes Sweet in nature.
Charaka described it as a subtype of Vataja Prameha i.e. Vasameha. “Vasa” is an
Upadhatu of Mamsa and the unctuousness present in the Mamsa Dhatu is called Vasa. Thus
we can easily understand that in Prameha Mamsa is one of the Main Dushya so in turns Vasa
too get vitiate.
This is one of the liquid components present just beneath the skin. Lasika also get
vitiated by Vata resulting Lasika meha. There is no direct reference related to Vasa and
Lasika Dushti.
Madhumeha is the disease mainly of systemic consideration. In the pathogenesis there
is involvement of each and every constituent of the body. In the pathogenesis there is
reference of strotodushti only related to Mutravaha strotas. But when we observe the
pathogenesis and symptoms, we can easily understand the involvement of Medovaha,
Mamsavaha, Svedavaha and Udakavaha Strotas too.
We can find out the strotas involvement according to the symptoms as follows -
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Discussion 104
(1) Purvarupa of Prameha - Medovahastrotus Dusti.
(2) Putimamsapidaka - Mamsavaha Srotusdusti.
(3) Trsna, Mukhatalu Kanthasosa - Udakavaha Srotusdusti.
(4) Atisrsta Abhiksna Mutrapravrti - Mutravaha Srotusdusti.
There is no direct reference related to the Agni condition but both Agnimandya and
Tiksnagni conditions present in the pathogenesis Again without Ama it is impossible to
precepitate the pathogenesis of Madhumeha that’s why Susruta narrated that,
Effect of Akulyadi yoga in Madhumeha
The drugs selected for the trial mainly having Tikta, Kasaya, Katu Rasa Usna Veerya
and Laghu, Ruksa Guna, Katu Vipaka and Kaphavatahara properties and each one is indicated
in Prameha Cikitsa. Thus Usna Veerya and Tikta Kasaya Rasa helps to normalise the function
of Jathragni and Dhatwagni. That in turn helps to form the Dhatus in proper proportion with
Samyak qualities. Laghu Ruksa Guna helps for the Sosan of Bahudrava Shlesma and
reduction of vitiated Meda Kleda.
Thus once these factors get normalized in the body they in turn make clear the Path of
Vata which stops the depletion of vital Dhatus and restore normal physiology. Thus disease
Madhumeha get Alleviate.
The result of the Akulyadi yoga declared is representing the efficiency of the drug
with its embedded qualities, is 11 (55%) Regulated, 1 (5%) palliative and 8 (40%) patients
responded in the trial. The conclusion drawn statistically for the present trial is as highly
significant as P <0.05.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Conclusion 105
Chapter - 7
Conclusion
Madhumeha is a disease characterized by Prabhoota avila mootrata, Tanu
madhuryata & Mootra madhuryata.
The terms Prameha and Madhumeha are synonymous. They indicate the same
condition where in the former refers to Prabhoota and Avila mootrata (ill
understood) & the latter refers to Tanu & Mootra madhuryata.
Dhatu apakarshana & Sarva dhatu sara – Ojo dushti is a invariable manifestation
of the disease.
Aparipakva ojas is directly responsible for the Madhuryata of Tanu and Mootra
Kapha is the Arambhaka dosha & Vata is the Preraka.
Margavarana janya Madhumeha & Dhatukshaya janya Madhumeha are the two
forms of the disease. Apathya nimittaja Madhumeha & Sahaja Madhumeha are
the two independent forms of presentations, coming under the above classification
respectively.
Sadhyasadhyata of Madhumeha is directly dependent upon Dhatu apakarshana &
Vata anubandha anubadhyatva & Sahaja karana.
The Kaphaja, Pittaja & Vataja Pramehas are nothing but the range of varied
symptomatology of Madhumeha manifesting depending upon association of
favorable Nidanas for the respective Dosha during the course of the illness.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Conclusion 106
Sahaja Madhumeha can manifest in the Balya avastha also & Apathya nimittaja
Madhumeha manifests in the Madhyama to Vriddha avastha.
Madhumeha with Kapha pradhana lakshana and Anati dushta dhatu is Sadhya in
the sense that it is Sadhya until under continuous medication; otherwise it recurs
justifying the term Anushangi meaning Punarbhavi.
Diet and exercise helps only in patients who comply fully and compliance is the
toughest part in the management of Madhumeha.
The significant improvement which was seen in subjective and objective
symptoms.
Blod glucose and urine sugar measurement is a useful tool to detect Mootra
madhuryata & Tanu madhuryata in Madhumeha. The advantage being in
identifying the disease before the manifestation of symptoms so pronounced as to
attract Pipeelikas, thus providing the physician an opportunity to prevent or cure
the disease before the patient develops complications.
The result of the Akulyadi yoga declared is representing the efficiency of the drug
with its embedded qualities, is 11 (55%) Regulated, 1 (5%) palliative and 8 (40%)
patients responded in the trial.
The conclusion drawn statistically for the present trial is as highly significant as P
<0.05.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Summary
107
Chapter - 8
Summary The advancement of industrialization and communication is contributing towards
sedentary life styles; in turn causing chronic non-communicable diseases like
Madhumeha vis-à-vis Diabetes Mellitus, etc. in fact Ayurveda is the first life
science, which identified, diagnosed and managed Madhumeha.
Madhumeha/DM is the present burning issue alarming the world. Madhumeha is
a disease characterized by Prabhoota, avila mootrata, Tanu and Mootra
madhuryata.
Madhumeha is a chronic metabolic or endocrinal disorder and the symptom
appears in relation with sweet urine excreting Dhatu in it. In normal physiology
Mutra and Sweda maintain the balance of Kleda. Especially Sweda holds in the
body and Mutra excrete it outside the body. Sweda is mainly related with Meda
and Kleda. Susruta only mentioned that in Madhumeha Sweda becomes Sweet in
nature. Lasika also get vitiated by Vata resulting Lasika (lymph) meha which is
not substantiated even by the contemporary medicine. Abnormal bi-fold digestion
causes aggravation of Vata in turn involves Dushya and metabolic waste to form
Madhumeha.
Madhumeha is a subtype of Vataja Prameha, could appear either by Avarana or
Dhatu kshaya janya (degenerative changes). Apart from these Iatrogenic and
genetic dispositions are also recorded. The Madhumeha vis-à-vis diabetes mellitus
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Summary
108
has many theories of occurrence, even the recent viral influence studies on
diabetes.
Madhumeha has Kapha Dosha is the key factor along with Vata. Generally the
management, rather than treatment, is the appropriate term in Diabetes mellitus,
and involves diet, exercise, insulin, oral hypoglycemic, patient education and
counseling.
The present study intended to focus on the disease evaluation i.e. Madhumeha vis-
à-vis. Diabetes Mellitus management with Akulyadi yoga as a Shamana Chikitsa.
Akulyadi yoga ingredients are hypoglycemic agents collected form local area and
prepared under GMP conditions, weighing about 500mg tablet form. Present trial
is a Simple Random sampling technique clinical study was conducted for 21 days.
Patients of Madhumeha fulfilling the criteria of diagnosis were selected in the
present study. Patients were selected on preset inclusion and exclusion criteria.
The male female ratio in the study is approximately 3:2 patients and 75% patients
were recorded with sedentary life styles.
In the present study 60% patients had family history and rest of the 40% patients
had no family history of Madhumeha.
Apart from the symptoms which show high significance in the study the key
parameters to assess “glycemic” condition of Madhumeha exhibit, FBS with a
mean difference of 48.605mg and PPBS with mean difference of 117.18mg for
after to before data.
This is strong evidence to state that the Akulyadi yoga is good hypoglycemic
agent combination of Ayurveda.
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Bibliographic References 1
Bibliographic Refarences
1) Baghel MS, Ayurvedic Education – Global perspective, International
Congress on Ayurvedic Concepts and Treatment of Neurological Disorders, 2002, SDM College of Ayurveda and Hospital, Udupi, pp 25
2) Bhagawan Das, Charaka Samhita sutra, vol-1, 6th ed, 1999, Chaukhambha Sanskrit series, Varanasi, pp-600
3) Swami DS, Evaluation of efficacy of Madhutailika Vasti in the management of Madhumeha, 2005, PGSRC, dept. of Panchakarma, DGM Ayurvedic Medical College, Gadag, pp2
4) Mahesh Udup, Comprehensive Kayachikitsa and principles of Ayurveda, 1st ed. 2004, Laveena publication, Bangalore, pp 1123
5) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Nidana 4/39, 1st ed. Reprint, 1998, Chaukhambha Bharati Academy, Varanasi, pp-638
6) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana 1/20, 6th ed. 1987, Chaukhambha Sanskrit Sansthan, Varanasi, pp-230
7) Pawar Anand N, A comparative study on the role of vasti therapy and pramehaghna drugs in the management of Madhumeha (Diabetes mellitus), L-2857, pp
8) Khan weir, Joslins Diabetes mellitus, 13th ed. 1994, Pennsylvania USA, Lea and Febiger, pp 194
9) Sahshikala Bani, Evaluation of efficacy of Avartaki in Madhumeha, 2005, PGSRC, dept. of Dravyaguna, DGM Ayurvedic Medical College, Gadag, pp 1
10) Sainani GS ed, API textbook of medicine, 6th ed, 1994, Association of Physicians of India, Mumbai, pp 986
11) Khan weir, Joslins Diabetes mellitus, 13th ed. 1994, Pennsylvania USA, Lea and Febiger, pp 216
12) Sainani GS ed, API textbook of medicine, 6th ed, 1994, Association of Physicians of India, Mumbai, pp 986
13) AS Fauci, Harrison principles of internal medicine, Vol-2, 15th ed. 2001 Mcgraw Hill co, New York USA, pp 2129
14) Mahesh Udup, Comprehensive Kayachikitsa and principles of Ayurveda, 1st ed. 2004, Laveena publication, Bangalore, pp 1123
15) Bramhashankar Sastri ed, Yoga ratnakara, Uttarardha, Prameha Chikitsa, 4th ed, 1988, Choukhambha Sanskrit Samsthan, Varanasi, pp85-86
16) Yadunandan Upadhyaya, Astanga Hridaya, Nidana 10/6, 1st ed, Reprint, 2007, Chaukhambha Prakashan, Varanasi, pp-254
17) Bramhashankar Sastri ed, Yoga ratnakara, Uttarardha, Prameha Chikitsa, 4th ed, 1988, Choukhambha Sanskrit Samsthan, Varanasi, pp85-86
18) Ravidatta Tripati ed, Charaka samhita, Chikitsa, 6/5, 2nd ed. 2001, Choukhambha Sanskrit Pratistan, Varanasi, pp 167
19) Bramhashankar Sastri ed, Yoga ratnakara, Uttarardha, Prameha Chikitsa, 4th ed, 1988, Choukhambha Sanskrit Samsthan, Varanasi, pp85-86
20) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Nidana 4/39, 1st ed. Reprint, 1998, Chaukhambha Bharati Academy, Varanasi, pp-638
21) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana 6/14, 6th ed. 1987, Chaukhambha Sanskrit Sansthan, Varanasi, pp-252
22) Ibid, part 2, Chikitsa, 13/3-34, pp 65-67
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Bibliographic References 2
23) Yadunandan Upadhyaya, Astanga Hridaya, Nidana 10/20-21, 1st ed, Reprint, 2007, Chaukhambha Prakashan, Varanasi, pp-255
24) Raja Radhakantadeve Bahadur, Shabdakalpadruma, vol-3, 3rd ed, 1967, Chaukhambha Sanskrit series, Varanasi, pp-421
25) Ibid, 26) Yadunandan Upadhyaya, Astanga Hridaya, Nidana 10/18, 1st ed, Reprint, 2007,
Chaukhambha Prakashan, Varanasi, pp-255 27) Ibid, 28) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana 6/14, 6th ed. 1987,
Chaukhambha Sanskrit Sansthan, Varanasi, pp-252 29) Ibid, Chikitsa, 11/6, pp 60-61 30) Ibid, Nidana, 6/14, pp 254 31) Yadavji Trikamji Acharya ed, Charaka Samhita, Chakrapani commentary, Chikitsa 6/11,
4th ed, 1994, Chaukhambha Sanskrit samsthan, Varanasi, pp 445 32) Yadunandan Upadhyaya, Astanga Hridaya, Nidana 10/18, 1st ed, Reprint, 2007,
Chaukhambha Prakashan, Varanasi, pp-255 33) Suresh Babu, Anjana Nidana, 1st ed, 2004, Chaukhambha Sanskrit series, Varanasi, pp
35-36 34) Raghunath, History of Diabetes from remote to recent times, 1st ed. 1985, Baidyanath
Ayurveda Bhavan, Nagpur, pp 58 35) Bhagawan Das, Charaka Samhita Chikitsa, vol-2, 6/1-61, 1st ed. 2004, Chaukhambha
Sanskrit series, Varanasi, pp-298-316 36) Srikantha Murthy KR ed, Susruta Samhita, vol -1, Nidana 6/8, 2nd ed, 2005,
Choukhambha Orientalia, Varanasi, pp 503-510 37) Ibid, Chikitsa, 13/1-35, pp 135-140 38) Ramavalamba Sastri, Harita Samhita, Truteeya, 28/1-44, 1st ed, 1985, Prachya
Prakashan, Varanasi, pp 342-347 39) Priyavat Sharma, Bhela Samhita, Nidana, 6/1-6, 1st ed. Reprint, 2005, Chaukhambha
Visvabharati, Varanasi, pp-155-157 40) Tiwari PV ed, Kashyapa Samhita Sutra, 25/22, 1st ed. Reprint 2002, Chaukhambha
Vishwa Bharati, Varanasi, pp-52-58 41) Yadunandan Upadhyaya ed. Madhava Nidanam, Part-2, 33/1-36, 9th ed, 2004,
Chaukhambha Sanskrit Sansthan, Varanasi, pp-1-26 42) K. R Shrikanta Murthy ed, Sharangdhara samhita, Madhyama Khanda 7/60-64, 1st ed,
1984, Chaukambha Orientalia ,Varanasi, pp 36-37 43) Srikanta Murthy KR ed, Bhava Prakasha Madhyama Khanda, 38/1-129, 1st ed. Reprint,
2002, Chaukhambha Krishnadas Academy, Varanasi, pp-483-501 44) Bramhashankar Sastri ed, Yoga ratnakara, Uttarardha, Prameha Chikitsa, 4th ed, 1988,
Choukhambha Sanskrit Samsthan, Varanasi, pp 67-75 45) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Sutra 17/80-81, 1st ed. Reprint, 1998,
Chaukhambha Bharati Academy, Varanasi, pp-352-353 46) Brahmanad Tripati, Charaka Samhita, Part 1, Nidana 4/8, 2nd ed. Reprint, 1991,
Chaukhambha Sura Bharati Prakashan, Varanasi, pp- 614 47) Ambikadatta shastri ed, Susruta Samhita, Part-I, Chikitsa 11/3, 6th ed. 1987,
Chaukhambha Sanskrit Sansthan, Varanasi, pp-56 48) Brahmanad Tripati, Charaka Samhita, Part 2, Chikitsa 6/57, 1st ed. Reprint, 2007,
Chaukhambha Sura Bharati Prakashan, Varanasi, pp- 295 49) Ambikadatta shastri ed, Susruta Samhita, Part-I, Chikitsa 11/3, 6th ed. 1987,
Chaukhambha Sanskrit Sansthan, Varanasi, pp-56
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Bibliographic References 3
50) Ravidutt Trippathi ed, Charaka Samhita Shareara, 4/30, 1st ed. Reprint 2006, Choukhambha Sanskrit Pratistan, Varanasi, pp 733
51) Brahmanad Tripati, Charaka Samhita, Part 2, Chikitsa 6/57, 1st ed. Reprint, 2007, Chaukhambha Sura Bharati Prakashan, Varanasi, pp- 295
52) Ravidutt Trippathi ed, Charaka Samhita Nidana, 4/5, 1st ed. Reprint 2007, Choukhambha Sanskrit Pratistan, Varanasi, pp 502
53) Ibid, 4/24, pp 505 54) Ibid, 4/36, pp 507 55) Ibid, Chikitsa 6/4, 2nd ed. 2001, pp 167 56) Ibid 57) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Sutra 17/80-81, 1st ed. Reprint, 1998,
Chaukhambha Bharati Academy, Varanasi, pp-352-353 58) Davidson Stanely, Principles and practice of medicine, 1995, Churchill Livingstone,
London, pp 728 59) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Sutra 17/80-81, 1st ed. Reprint, 1998,
Chaukhambha Bharati Academy, Varanasi, pp-352-353 60) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana 6/6, 6th ed. 1987, Chaukhambha
Sanskrit Sansthan, Varanasi, pp-255 61) Brahmanad Tripati, Charaka Samhita, Part 2, Chikitsa 6/6, 1st ed. Reprint, 2007,
Chaukhambha Sura Bharati Prakashan, Varanasi, pp- 280 62) Ravidutt Trippathi ed, Charaka Samhita Nidana, 4/4, 1st ed. Reprint 2006, Choukhambha
Sanskrit Pratistan, Varanasi, pp 501-502 63) Ibid, 4/8, pp 503 64) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana 6/4, 6th ed. 1987, Chaukhambha
Sanskrit Sansthan, Varanasi, pp-251-252 65) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Nidana 4/24, 1st ed. Reprint, 1998,
Chaukhambha Bharati Academy, Varanasi, pp-636 66) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana 6/9, 6th ed. 1987, Chaukhambha
Sanskrit Sansthan, Varanasi, pp-252 67) Yadunandan Upadhyaya, Astanga Hridaya, Nidana 10/5, 1st ed, Reprint, 2007,
Chaukhambha Prakashan, Varanasi, pp-253 68) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana 6/119, 6th ed. 1987,
Chaukhambha Sanskrit Sansthan, Varanasi, pp-253 69) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Nidana 4/371st ed. Reprint, 1998,
Chaukhambha Bharati Academy, Varanasi, pp-637-638 70) Ravidutt Trippathi ed, Charaka Samhita Chikitsa 6/5, vol-2, 2nd ed. Reprint 2006,
Choukhambha Sanskrit Pratistan, Varanasi, pp 167 71) Yadunandan Upadhyaya, Astanga Hridaya, Nidana 10/18, 1st ed, Reprint, 2007,
Chaukhambha Prakashan, Varanasi, pp-255 72) Ambikadatta shastri ed, Susruta Samhita, Part-I, Chikitsa 11/3, 6th ed. 1987,
Chaukhambha Sanskrit Sansthan, Varanasi, pp-59 73) Ravidutt Trippathi ed, Charaka Samhita Chikitsa 6/57, vol-2, 2nd ed. Reprint 2006,
Choukhambha Sanskrit Pratistan, Varanasi, pp 177 74) Ibid, vol 1, Nidana 4/37, pp 507 75) Ibid, 4/36, pp 507 76) Brahmanad Tripati, Charaka Samhita, Part 2, Chikitsa 6/6-11, 1st ed. Reprint, 2007,
Chaukhambha Sura Bharati Prakashan, Varanasi, pp- 280 77) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Sutra 17/80-8, 1st ed. Reprint, 1998,
Chaukhambha Bharati Academy, Varanasi, pp-352-353
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Bibliographic References 4
78) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana 6/30, 6th ed. 1987, Chaukhambha Sanskrit Sansthan, Varanasi, pp-255
79) Yadunandan Upadhyaya, Astanga Hridaya, Sutra 11/3, 1st ed, Reprint, 2007, Chaukhambha Prakashan, Varanasi, pp-85
80) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Nidana 4/8, 1st ed. Reprint, 1998, Chaukhambha Bharati Academy, Varanasi, pp-633
81) Yadunandan Upadhyaya, Astanga Hridaya, Sutra 11/7, 1st ed, Reprint, 2007, Chaukhambha Prakashan, Varanasi, pp-86
82) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Sutra 18/49, 1st ed. Reprint, 1998, Chaukhambha Bharati Academy, Varanasi, pp-384
83) Ibid, Nidana, 4/7, pp 632 84) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana 6/11, 6th ed. 1987,
Chaukhambha Sanskrit Sansthan, Varanasi, pp-253 85) Yadunandan Upadhyaya, Astanga Hridaya, Nidana 10/4, 1st ed, Reprint, 2007,
Chaukhambha Prakashan, Varanasi, pp-253 86) Ibid, sutra, 11/8, pp 86 87) Ambikadatta shastri ed, Susruta Samhita, Part-I, Sutra 15/37, 6th ed. 1987,
Chaukhambha Sanskrit Sansthan, Varanasi, pp-62 88) Ravidatta Tripati ed, Charaka Samhita, Nidana, 4/48, 2nd ed. 2001, Choukhambha
Sanskrit Pratistan, Varanasi, pp 511 89) Ibid, sutra, 17/82, pp 267 90) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana, 6/4, 6th ed. 1987,
Chaukhambha Sanskrit Sansthan, Varanasi, pp-252 91) Yadunandan Upadhyaya, Astanga Hridaya, Nidana, 10/41, 1st ed, Reprint, 2007,
Chaukhambha Prakashan, Varanasi, pp-250 92) Ambikadatta shastri ed, Susruta Samhita, Part-I, Sutra,15/19, 6th ed. 1987,
Chaukhambha Sanskrit Sansthan, Varanasi, pp-60 93) Ibid, Nidana, 1/20, pp230 94) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Sutra 17/78, 1st ed. Reprint, 1998,
Chaukhambha Bharati Academy, Varanasi, pp-352-353 95) Yadunandan Upadhyaya, Astanga Hridaya, Sutra, 11/40, 1st ed, Reprint, 2007,
Chaukhambha Prakashan, Varanasi, pp-89 96) Ibid, 11/5, pp 86 97) Ambikadatta shastri ed, Susruta Samhita, Part-I, Chikitsa,12/4, 6th ed. 1987,
Chaukhambha Sanskrit Sansthan, Varanasi, pp-62 98) Ravidatta Tripati ed, Charaka Samhita, Chikitsa, 6/11, 2nd ed. 2001, Choukhambha
Sanskrit Pratistan, Varanasi, pp 170 99) Ibid, 6/8, pp 168-169
100) Cotran SR, Basic Pathology, 6th ed. 2003, Philadelphia Saunders, pp 913 101) Ravidatta Tripati ed, Charaka Samhita, Chikitsa, 6/7, 2nd ed. 2001, Choukhambha
Sanskrit Pratistan, Varanasi, pp 168 102) Yadunandan Upadhyaya, Astanga Hridaya, Nidana, 10/7, 1st ed, Reprint, 2007,
Chaukhambha Prakashan, Varanasi, pp-254 103) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Nidana 4/9, 1st ed. Reprint, 1998,
Chaukhambha Bharati Academy, Varanasi, pp-633 104) Ambikadatta shastri ed, Susruta Samhita, Part-I, Chikitsa,11/3, 6th ed. 1987,
Chaukhambha Sanskrit Sansthan, Varanasi, pp-59 105) Ibid 106) Yadunandan Upadhyaya, Astanga Hridaya, Nidana, 10/19, 1st ed, Reprint, 2007,
Chaukhambha Prakashan, Varanasi, pp-255
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Bibliographic References 5
107) Ravidatta Tripati ed, Charaka Samhita, Chikitsa, 6/15, 2nd ed. 2001, Choukhambha Sanskrit Pratistan, Varanasi, pp 170
108) Cotran SR, Basic Pathology, 6th ed. 2003, Philadelphia Saunders, pp 913 109) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana,6/25-26, 6th ed. 1987,
Chaukhambha Sanskrit Sansthan, Varanasi, pp-255 110) Yadunandan Upadhyaya ed. Madhava Nidanam, Part-2, 1/7, 9th ed, 2004, Chaukhambha
Sanskrit Sansthan, Varanasi, pp-38 111) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana,6/25-26, 6th ed. 1987,
Chaukhambha Sanskrit Sansthan, Varanasi, pp-255 112) Yadunandan Upadhyaya, Astanga Hridaya, Nidana, 10/7, 1st ed, Reprint, 2007,
Chaukhambha Prakashan, Varanasi, pp-254 113) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Nidana 4/44, 1st ed. Reprint, 1998,
Chaukhambha Bharati Academy, Varanasi, pp-639 114) Ambikadatta shastri ed, Susruta Samhita, Part-I, Chikitsa, 11/3, 6th ed. 1987,
Chaukhambha Sanskrit Sansthan, Varanasi, pp-59 115) Ibid, Nidana, 6/28, pp 258 116) Cotran SR, Basic Pathology, 6th ed. 2003, Philadelphia Saunders, pp 913-916 117) Ravidatta Tripati ed, Charaka Samhita, Chikitsa, 6/54, 2nd ed. 2001, Choukhambha
Sanskrit Pratistan, Varanasi, pp 176 118) 8888 119) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Nidana 4/48, 1st ed. Reprint, 1998,
Chaukhambha Bharati Academy, Varanasi, pp-640 120) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana, 6/15, 6th ed. 1987,
Chaukhambha Sanskrit Sansthan, Varanasi, pp-254 121) Ibid, 122) Ibid 123) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Sutra 17/105-106, 1st ed. Reprint,
1998, Chaukhambha Bharati Academy, Varanasi, pp-362 124) Davidson Stanely, Principles and practice of medicine, 1995, Churchill Livingstone,
London, pp 754-757 125) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Nidana 4/11, 1st ed. Reprint, 1998,
Chaukhambha Bharati Academy, Varanasi, pp-634 126) Ibid, 4/8, pp 633 127) Ibid, sutra 17/80-81, pp 352-353 128) Ibid, Nidana, 4/38, pp 638 129) Ambikadatta shastri ed, Susruta Samhita, Part-I, Nidana, 6/27, 6th ed. 1987,
Chaukhambha Sanskrit Sansthan, Varanasi, pp-255 130) Ravidatta Tripati ed, Charaka Samhita, Chikitsa, 6/47, 2nd ed. 2001, Choukhambha
Sanskrit Pratistan, Varanasi, pp 177 131) Ibid, 6/16-18, pp 171 132) Ibid, 6/25-26, pp 173 133) Yadunandan Upadhyaya, Astanga Hridaya, Chikitsa, 12/8, 1st ed, Reprint, 2007,
Chaukhambha Prakashan, Varanasi, pp-372 134) Ravidatta Tripati ed, Charaka Samhita, Chikitsa, 6/37, 2nd ed. 2001, Choukhambha
Sanskrit Pratistan, Varanasi, pp 174 135) Ambikadatta shastri ed, Susruta Samhita, Part-I, Chikitsa, 13/1-34, 6th ed. 1987,
Chaukhambha Sanskrit Sansthan, Varanasi, pp-65-67 136) AS Fauci, Harrison principles of internal medicine, Vol-2, 15th ed. 2001 Mcgraw Hill co,
New York USA, pp 2112
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Bibliographic References 6
137) Ambikadatta shastri ed, Susruta Samhita, Part-I, Chikitsa, 11/6, 6th ed. 1987, Chaukhambha Sanskrit Sansthan, Varanasi, pp-60
138) Bramhashankar Sastri ed, Yoga ratnakara, Uttarardha, Prameha Chikitsa, 4th ed, 1988, Choukhambha Sanskrit Samsthan, Varanasi, pp85-86
139) Srinivasacharyulu Yetur ed, Yogaratnakaram (Tel), Vol 2, Prameha Nidanam, 80, 1st ed. 1940, Swatantra Printers, Nellore, pp 142
140) Pande GS, Bhavaprakasha, 1st ed. Reprint, 1998, Chaukhambha Bharati Academy, Varanasi, pp-10-11
141) Ibid, 114-116 142) K. M. Nadkarni, Indian Materia Medica, Vol-I, 3rd ed, 1976, Popular Prakashan,
Bombay, pp-284 143) Narahari, Raja Nighantu, Guduchyadi varga, 2nd ed. 1998, Krishnadas Academy,
Varanasi, pp 58 144) K. M. Nadkarni, Indian Materia Medica, Vol-I, 3rd ed, 1976, Popular Prakashan,
Bombay, pp-480 145) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Sutra 4/50, 1st ed. Reprint, 1998,
Chaukhambha Bharati Academy, Varanasi, pp-98 146) Ibid,4/24, pp 85 147) K. M. Nadkarni, Indian Materia Medica, Vol-I, 3rd ed, 1976, Popular Prakashan,
Bombay, pp-414 148) Rajeshwaradatta Sastri, Charaka Samhita, Part 1, Sutra 4/3, 1st ed. Reprint, 1998,
Chaukhambha Bharati Academy, Varanasi, pp-72 149) Ibid,4/13, pp 81 150) Ibid, 4/15, pp 82
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Master charts i
MS01 - Demographic Data of Akulyadi Yoga
SNo OPD No
Gender Religion Occupation Economical Condition
Result
M F Age
Food
V
/Mx
H M C O S A L P M Hg Hc 1 4773 + 40 Mx + + + 2 4775 + 50 V + + + 3 5068 + 35 V + + + 4 6013 + 58 Mx + + + 5 6016 + 43 Mx + + + 6 6021 + 62 V + + + 7 325 + 59 V + + + 8 333 + 46 V + + + 9 362 + 54 V + + + 10 409 + 50 Mx + + + 11 412 + 55 V + + + 12 418 + 62 V + + + 13 419 + 40 Mx + + + 14 442 + 38 V + + + 15 526 + 49 Mx + + + 16 629 + 58 V + + + 17 790 + 46 V + + + 18 834 + 52 V + + + 19 835 + 54 V + + + 20 873 + 43 Mx + + + Total 12 8 16 4 0 0 15 2 3 2 2 8 8
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Master charts ii
MS02 - Subjective Statistical Assessment Data of Akulyadi Yoga
S.No OPD Dourbalya Shareera Bharahani
Jangamamsa graham
Karapada daha
Pipasa Kshudhadhikyata
B A B A B A B A B A B A 1 4773 1 0 0 0 0 0 1 0 3 1 3 0 2 4775 3 1 3 1 2 1 1 0 3 2 3 1 3 5068 1 0 0 0 1 0 0 0 3 2 4 2 4 6013 1 0 1 0 2 1 2 0 3 0 4 0 5 6016 4 0 2 0 0 0 1 0 3 0 3 0 6 6021 4 0 3 1 0 0 0 0 3 0 4 1 7 325 3 0 1 1 1 0 2 1 4 1 3 2 8 333 2 0 3 0 1 0 3 0 4 1 4 0 9 362 3 0 2 0 1 0 3 0 4 0 3 0 10 409 4 0 0 0 4 0 3 1 3 0 0 0 11 412 2 0 1 0 1 0 2 0 4 0 3 0 12 418 3 0 2 0 1 0 2 0 3 0 3 1 13 419 1 0 0 0 0 0 1 0 0 0 0 0 14 442 4 0 0 0 0 0 4 1 0 0 0 0 15 526 3 0 3 0 3 0 1 0 3 1 3 0 16 629 3 0 1 0 1 0 1 0 3 0 3 0 17 790 1 0 0 0 0 0 1 0 0 0 0 0 18 834 1 1 0 0 1 0 0 0 2 1 3 2 19 835 3 0 3 0 3 1 2 0 3 0 1 0 20 873 3 0 0 0 0 0 1 0 2 0 3 0 Total 50 2 25 3 22 3 31 3 53 9 50 9 Mean 2.5 0.1 1.25 0.15 1.1 0.15 1.55 0.15 2.65 0.45 2.5 0.45 SD 1.147 0.307 1.25 0.366 1.165 0.366 1.099 0.366 1.26 0.686 1.432 0.759
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Master charts iii
MS03 - Objective Statistical Assessment of Akulyadi Yoga
S.No OPD Prabhuta mootrata
Avila mootrata
FBS PPBS FUS PPUS
B A B A B A B A B A B A 1 4773 3 0 0 0 198.4 110 240 142 0.5 0 1 0 2 4775 4 2 2 1 320 112 350 134.5 0.5 0 1 0.5 3 5068 4 0 0 0 235 113 347 165 1 0.5 1.5 1 4 6013 4 0 2 0 216 124 341 162 1.5 0.5 0.5 0.5 5 6016 3 1 0 0 188 120 305 216 1.5 1 0.5 0 6 6021 4 0 0 0 181 110 221 163 1 0.5 1.5 0 7 325 4 1 1 0 152 130 330 225 0.5 0.5 1 1 8 333 3 0 1 0 132 110 223 140 0 0 0.5 1 9 362 3 0 1 0 174 120 228 130 0 0 0.5 0 10 409 4 0 1 0 151.6 110 277.6 145 0.5 0 1 0 11 412 3 0 0 0 148 120 209 161 0 0 0.5 0 12 418 4 0 1 0 158.6 110.3 240 130 0.5 0 1.5 0 13 419 3 0 0 0 145.1 125 280.1 164 0.5 0 1.5 0 14 442 2 0 0 0 126.4 110 225.1 140 0 0 0.5 0 15 526 4 0 0 0 194 120 312 142 0.5 0 1 0 16 629 4 0 1 0 146.3 118 310.7 166 0 0 1 0 17 790 3 0 0 0 142 110 225 140 0 0 0.5 0.5 18 834 1 0 0 0 178 112 341 162 0.5 0 0 0 19 835 4 0 0 0 140 120 227 140 0 0 1 1 20 873 4 0 1 0 160 116 210 132 0.5 0 1 0 Total 68 4 11 1 3486.4 2320.3 5442.5 3099.5 9.5 3 17.5 5.5 Mean 3.4 0.2 0.55 0.15 164.62 116.015 272.15 154.97 0.475 0.5 0.86 0.255
SD 0.82 0.523 0.686 0.223 30.411 6.13 52.34 25.811 6.472 0.285 0.444 0.411
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Master charts iv
MS04 - Chief & Associated complaints of Akulyadi Yoga Complaints 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 T 1 Prabhoota Mootrata + + + + + + + + + + + + + + + + + + + + 20 2 Avila Mootrata + + + + + + + + + + + + + + + 15 3 Dourbalya + + + + + + + + + + + + + + + + + + + + 20 4 Shareera Bhaarahani + + + + + + + + + + + + + 13 5 Janghamamsagraha + + + + + + + + + + + + + 13 6 Karapada Daha + + + + + + + + + + + + + + + + 16 7 Pipasa + + + + + + + + + + + + + + + + + 17 8 Kshudhadhikyata + + + + + + + + + + + + + + + + + + 18 Associated Complaints 1 Kara/Pada suptata + + + + + + + + + + + 11 2 Klama + + + + + + + 7 3 Tandra + + + + + 5 4 Sandhi Shula + + + + + + + + + + + 11 5 Alasya + + + + + + + + + + 10 6 Gurugatrata + + + + + + + + + 9 7 Shithilangata + + + + 4 8 Mukha/Talu shosha + + + + + + + + + + + + + + + + + + + 19
MS05 - Upashaya/Anupashaya of Madhumeha
Poorvaroopa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 T Upashaya 1 Shita iccha + + + + + 5 2 Madhurrahit ahara + + + + + + + + + + + + + + + + + + + + 20 3 vyayama + + + + + + + + + + + + + + + + + + + + 20 Anupashaya 1 Ushna + + + 3 2 Madhuara ahara + + + + + + + + + + + + + + + + + + + + 20 3 Diwa swapana + + + + + + + + + + + + + + + + + 17
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Master charts v
MS06 - Poorvaroopa of Madhumeha
Poorvaroopa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 T 1 Dantadeenam
Malatvam + + + + + + + 7
2 Pada daha + + + + + + + + 8 3 Pani daha + + + + + + + + 8 4 Deha chikkanata + + + + + + + + + 9 5 Shareera durgandha + + + + + + + + + + + 11 6 Mutra madhurata + + + + + + + + + + + + + + + + + + + + 20 7 Mutra shuklata + + + + + 5 8 Mukha madhurta + + + + + + + + + 9 9 Talu kloma shosha + + + + + + + + + + + + + + + + + + + 19 10 Kesh jatilata + + + + + + + + + + 10 11 Nakha vriddhi + + + + + + + + + + + + + 13 12 Alasya + + + + + + + + + + 10 13 Tandra + + + + + + + 7 14 Nidra + + + + + + + + + + + + + + 14 15 Trishna + + + + + + + + + + + + + + + + + + + + 20 16 Maldhikyata in bahya
chidra + + + + + + + + + + + + + 12
17 Swedadhikya + + + + + + + + + + + + + + + + + 17 18 Sheeta iccha + + + + + + + + + + + + + + + 15 19 Swasa + + + + + + 6 20 Shitalangata + + + + + + + + + + + + + + + + 16
MS07 - Upadrava of Madhumeha Poorvaroopa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 T 1 Prameha pidika + + 2 2 Atisara + + 2 3 Jwara + + + + + 5 4 Daha + + + + + + + + 8 5 Arochaka + + + + + + + + + + + 11 6 Avipaka + + + + + + + + + 9 7 Chardi + 1 8 Kasa + + + 3 9 pratishyaya + + + 3
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Master charts vi
MS08 - Examination of srotas Sroto Lakshana 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 T Udakavaha 1 Jihwa shosha + + + + + + + + + + + + + + + + + + + + 20 2 Talu shosha + + + + + + + + + + + + + + + + + + + + 20 3 Osta shosha + + + + + + + + + + + + + + 14 4 Kloma shosha + + + + + + + + + + + + + + + + + + 18 5 Prawridha pipasa + + + + + + + + + + + + + + + + + + + + 20 Mootravaha 1 Alpalpa mootrata 2 Mootara rodha 3 Adhika mootra + + + + + + + + + + + + + + + + + + + + 20 4 Sashoola mootra + + + + 4 5 Basti stabdhata Mamsavaha 1 Arbuda 2 Arsha 3 Mamsa shosha 4 Shira granthi Medovaha 1 Sweda + + + + + + + + + + + + 12 2 Snigdhanagata + + + + + + 6 3 Sthulashophata 4 Pipasa + + + + + + + + + + + + + + + + + + + + 20
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Master charts vii
MS09 - History of present Illness S.No OPD Mode of detection Frequency of Micturition Family history 1 2 3 1 2 3 4 5 1 2 1 4773 + + + 2 4775 + + + 3 5068 + + + 4 6013 + + + 5 6016 + + + 6 6021 + + + 7 325 + + + 8 333 + + + 9 362 + + + 10 409 + + + 11 412 + + 12 418 + + + 13 419 + + + 14 442 + + + 15 526 + + + 16 629 + + + + 17 790 + + + 18 834 + + + 19 835 + + + 20 873 + + + Total 5 2 13 1 1 4 10 4 12 8
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Master charts viii
MS10 - Ahara Nidana S.No OPD Guda Navanna Dugdha Gramya
Mamsa Anoopa Mamsa
Auduka Mamsa
Snigdha Ahara
Dadhi Sheeta Ahara
1 4773 + + + + + + + 2 4775 + + + + + + 3 5068 + + + + + + + 4 6013 + + + 5 6016 + + + + + + 6 6021 + + + + + 7 325 + + + + + + + 8 333 + + + + + 9 362 + + + + 10 409 + + + + + + + 11 412 + + + + 12 418 + + + + + + 13 419 + + + + + + + 14 442 + + + + + 15 526 + + + + + + + 16 629 + + + + 17 790 + + + + + + 18 834 + + + + + + 19 835 + + + + + + 20 873 + + + + + Total 20 14 16 5 4 4 17 20 13
Akulyadi yoga in Madhumeha (Diabetes Mellitus) - Master charts ix
MS11 - Vihara /Anya Nidana S.No OPD Avyaya
ma Diwaswa
pna Swapnasukham
Manishika
Krimi Vegavarodha
Panchakarma
Vibhramsha
Sthoulya
1 4773 + + + 2 4775 + + + + 3 5068 + + 4 6013 + + + 5 6016 + + + + 6 6021 + + + 7 325 + + + 8 333 + + + 9 362 + + + 10 409 + + 11 412 + + + + 12 418 + + + 13 419 + + + + 14 442 + + 15 526 + + + 16 629 + + + 17 790 + + + + 18 834 + + + + 19 835 + + + + 20 873 + + + + Total 18 20 10 7 10
Evaluation of the efficacy of Akulyadi yoga in Madhumeha (Diabetes Mellitus) 1
SPECIAL CASE SHEET FOR “Evaluation of the efficacy of Akulyadi yoga in Madhumeha
(Diabetes Mellitus)” POST GRADUATE STUDIES AND RESEARCH CENTER (KAYACHIKITSA) SHRI. D.G.M.AYURVEDIC MEDICAL COLLEGE, GADAG
Guide: Dr. K. Shiva Rama Prasad
Scholar: Shivaleela. S. Kalyani
1) Name of the Patient Sl.No
2) Sex Male Female OPD No
3) Age Years IPD No
4) Religion Hindu Muslim Christian Other
5) Occupation Sedentary Active Labor
6) Economical status Poor Middle Higher middle Higher class
7) Address
Pin
8) Birth data Place of Birth
AM Date Month Year Time
Hours Minutes PM
9) Selection Included Excluded
10) Schedule dates Initiation Completion / Discontinuation
11) Result Regulated Palliative Responded Not
Responded
INFORMED CONSENT I Son/Daughter/Wife of am
exercising my free will, to participate in above study as a subject. I have been informed to my
satisfaction, by the attending physician the purpose of the clinical evaluation and nature of the
drug treatment. I am also aware of my right to opt out of the treatment schedule, at any time
during the course of the treatment. EzÀÄ £Á£ÀÄ ²æÃ/²æêÀÄw _________________________________________________ £À£Àß ¸ÀéEZÀÑ ¬ÄAzÀ
PÉÆqÀĪÀ aQvÁì ¸ÀªÀÄäw. ¥Àæ¸ÀÄÛvÀ £ÀqÉ¢gÀĪÀ aQvÁì ¥ÀzÀÞw0iÀÄ §UÉÎ £À£ÀUÉ aQvÀìPÀjAzÀ ¸ÀA¥ÀÇtð ªÀiÁ»w zÉÆgÉwzÀÄÝ ªÀÄvÀÄÛ
0iÀiÁªÁUÁzÀÄgÀÄ aQvÀì¬ÄAzÀ »AwgÀÄUÀ®Ä ¸ÁévÀAvÀæ÷å «zÉ JAzÀÄ w½¢gÀÄvÀÛ£É.
gÉÆV0iÀÄ gÀÄdÄ / Patient's Signature
Evaluation of the efficacy of Akulyadi yoga in Madhumeha (Diabetes Mellitus) 2
12) CHIEF COMPLAINTS WITH DURATION (Subjective Parameters) Complaints - Lakshana Duration Remarks
1 Prabhoota Mootrata
2 Avila Mootrata
3 Dourbalya
4 Shareera Bhaarahani
5 Janghamamsagraha
6 Karapada Daha
7 Pipasa
8 Kshudhadhikyata
13) ASSOCIATED COMPLAINTS Associated Complaints –
Anubandha Lakshana Duration Remarks
1 Kara/Pada suptata
2 Klama
3 Tandra
4 Sandhi Shula
5 Alasya
6 Gurugatrata
7 Shithilangata
8 Mukha/Talu shosha
14) Occupational History (if any) 15) PERSONAL HISTORY
Food habits Vegetarian Mixed diet
Taste preferred Sweet Sour Salty Pungent Bitter Astringent
Agni Sama Vishama Manda Teekshna
Kosta Mrudu Madhyama Krura
Nidra Day Night Sound Disturbed
Addictions Tobacco Alcohol Drugs
Bowel habits Normal Loose Constipated
Menstrual History Regular Irregular Amenorrhea Menopause
Other system medications Treatment history (if any)
Gynaecological History (if any)
History of past illness (if any)
Evaluation of the efficacy of Akulyadi yoga in Madhumeha (Diabetes Mellitus) 3
Family history – Specify if any has the same disease 16) HISTORY OF PRESENT ILLNESS
Mode of detection Accidental / suspicious / At Regular check-up
Frequency of Micturition 3-4 times / 5-6 times /7-8 times /9-10 times /Above 10 /
17) Madhumeha Nidana
Ahara Vihara Anya Nidanarthakara Vyadhi
Guda Avyayama Manishika- Chinta Sthoulya
Navanna Diwaswapna Krimi
Madhura
Dugdha Swapnasukham Vegavarodha
Gramya
Anoopa
Panchakarma Vibhramsha
Mamsa
Auduka
Snigdha
Dadhi
Sheeta
18) Madhumeha Poorvaroopa Dantadeenam Malatvam Mukha madhurta Trishna
Pada daha Talu kloma shosha Maldhikyata in bahya chidra
Pani daha Kesh jatilata Swedadhikya
Deha chikkanata Nakha vriddhi Sheeta iccha
Shareera durgandha Alasya Swasa
Mutra madhurata Tandra Shitalangata
Mutra shuklata Nidra
19) EXAMINATION (a) Vitals
Temperature ºF Pulse / min Respiration rate / min
Height Cms Weight Kg Blood pressure mm Hg
Patient Brother Sister
Brother Father Mother
Grandfather Grandmother
Sister Sister Brother
Grandfather Grandmother
Evaluation of the efficacy of Akulyadi yoga in Madhumeha (Diabetes Mellitus) 4
(b) Examination of srotas Udakavaha Mootravaha Mamsavaha Medovaha
Jihwa shosha Alpalpa mootrata Arbuda Sweda
Talu shosha Mootara rodha Arsha Snigdhanagata
Osta shosha Adhika mootra Mamsa shosha Sthulashophata
Kloma shosha Sashoola mootra Shira granthi Pipasa
Prawridha pipasa
Basti stabdhata
(c) Systemic Examination:
1. Respiratory 2. Cardiovascular 3. Gastro-Intestinal 4. Genito-Urinary
(d) Dashavidha pareeksha Nadi V P K VP VK PK VPK Prakruti V P K VP VK PK VPK Sara Pravara Avara Madhyama Samhanana Susamhita Asamhita Madhyma samhita Pramana Height in Cms Weight in Kgs Satmya Ekarasa Sarvarasa Ruksha Sneha Satwa Pravara Avara Madhyama Ahara Shakti Abhyavaharana Jarana Vyayam Shakti Pravara Avara Madhyama Vaya Balya Yauvana Vardhakya (e) Astasthana Pareeksha Nadi Dosha Pravrutti Gati Varna Purnata Gandha Spandana Kathinya
Mutra
Jihwa Ardra Sushka Sama Nirama Lepa Nirlepa
Mala
Shabda Sparsha Sheeta Ushna Drik Akruti 20) Upashaya and Anupashaya
Upashaya Anupashaya
Shita iccha Ushna
Madhurrahit ahara Madhuara ahara
vyayama
Diwa swapana
Evaluation of the efficacy of Akulyadi yoga in Madhumeha (Diabetes Mellitus) 5
21) Upadravas Lakshanas Lakshanas Prameha pidika Avipaka Atisara Chardi Jwara Kasa Daha pratishyaya Arochaka
22) INVESTIGATIONS
Investigations for screening Erythrocyte Sedimentation Rate
Hb%
Lymphocytes
Neutrophils
Eosinophils
Basophils
Differential count
Monocytes
Albumin
Sugar
Urine Routine
Microscopic
23) Assessment of Trail
1) Subjective parameters Before After Follow-up Difference BA
1 Dourbalya
2 Shareera Bhaarahani
3 Janghamamsagraha
4 Karapada Daha
5 Pipasa
6 Kshudhadhikyata
2) Objective parameters
1 Prabhoota Mootrata
2 Avila Mootrata
3 Fasting Blood Sugar
4 Post prandial Blood sugar
5 Fasting Urine Sugar
6 Post prandial Urine sugar
Evaluation of the efficacy of Akulyadi yoga in Madhumeha (Diabetes Mellitus) 6
24) Treatment schedule
Day Date Investigator’s Note Day 1
Day 7
Day 14
Day 21
Follow up Day 42
Grades of assessment
1) Prabhoota Mootrata Grade 0 = 1000 – 1500 ml/ 24 hrs Grade 1 = 1500 – 2000 ml/ 24 hrs Grade 2 = 2000 – 2500 ml/ 24 hrs Grade 3 = 2500 – 3000 ml/ 24 hrs Grade 4 = 3000 – above ml/ 24 hrs 2) Avila Mootrata (Turbidity) Grade 0 = Crystal clear fluids Grade 1 = faintly cloudy or hazy with slight turbidity Grade 2 = Turbidity clearly present but news print can be read through the tube. Grade 3 = More turbidity & news print can not be read. 3) Dourbalya Grade 0 = No Dourbalya Grade 1 = occasionally noticed Grade 2 = periodically noticed Grade 3 = daily noticed Grade 4 = continuously noticed 4) Shareera Bhaarahani Grade 0 = No Bhaarahani Grade 1 = occasionally noticed Grade 2 = periodically noticed Grade 3 = regularly noticed
5) Janghamamsagraha Grade 0 = No Janghamamsagraha Grade 1 = occasionally noticed Grade 2 = periodically noticed Grade 3 = daily noticed Grade 4 = continuously observed 6) Karapada Daha Grade 0 = No Karapada Daha Grade 1 = occasionally noticed Grade 2 = periodically noticed Grade 3 = daily noticed Grade 4 = continuously noticed 7) Pipasa Grade 0 = No Pipasa Grade 1 = occasionally noticed Grade 2 = periodically noticed Grade 3 = daily noticed Grade 4 = continuously noticed 8) Kshudhadhikyata Grade 0 = No Kshudhadhikyata Grade 1 = occasionally noticed Grade 2 = periodically noticed Grade 3 = daily noticed Grade 4 = continuously noticed
Investigators Note
Signature of Guide
(Dr. K. Shiva Rama Prasad)
Signature of Scholar
(Shivaleela. S. Kalyani)