1 OVER VIEW OF AYURVEDIC DRUGS AND PANCH KARMA THERAPY IN THE MANAGEMENT OF - PowerPoint Presentation

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OVER VIEW OF AYURVEDIC DRUGS AND PANCH KARMA THERAPY IN THE MANAGEMENT OF PRAMEHA ROG

(DIABETES MELLITUS- Type 2)

Prof.Ramkishor

Joshi

M.D(

Ayu.),Ph.D, WHO Fellow in Thailand HEAD&DMS-Hospitals P.G. Deptt. Of Kayachikitsa National Institute of Ayurveda, Jaipur

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Need Of Study

The WHO estimated that more than 180 million people have Diabetes. This number is likely to be

more than double by 2030.

Deaths-80% amongst low and middle

income group

- 55% in women - half of deaths up to the age of 70 Prevalence of DM in adult Rajasthan population was estimated as 4% in 1995 which is expected rise to 5.4 by the 2025.

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Diabetes Mellitus

Not so sweet

Modern Review

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What is DM ?

Diabetes mellitus

is a group of

metabolic diseases

characterized by elevated blood glucose levels (hyperglycemia) Hyperglycemia lead to spillage of glucose into the urine, hence the term Diabetes -sweet urine is given. This results due to defects in

insulin secretion

,

insulin action

or

both

.

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Types of DM

There are three main types of diabetes

:

Type 1 DM (IDDM)

Type 2 DM (NIDDM)

Gestational Diabetes Other types:LADA (Latent Autoimmune Diabetes in Adults)MODY (Maturity-onset Diabetes of Youth)Secondary Diabetes Mellitus

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Diabetes Mellitus Type 2

It is formerly

non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes –

i.e. is a metabolic disorder which is characterized by

high blood glucose

in the context of insulin resistance and relative insulin deficiency7

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Etiologies

Urbanization

Lifestyle changes

Western- style Diets

Genes

Lack of Exercise

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Symptoms of Diabetes Mellitus

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Polyuria

Polyphasia

Polydipsia

Lethargy

Blurred Vision

Infection

Numbness and Tingling Sensation In feet

Long healing Ulcers

Unexplained Weight loss

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Organs with severe Complications

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Diagnostic criteria

Diabetes

Fasting plasma glucose ≥7.0mmol/l (126mg/dl)

or

2–h plasma glucose* ≥11.1mmol/l (200mg\dl)

Impaired Glucose Tolerance (IGT)

Fasting plasma glucose <7.0mmol/l (126mg/dl) &2–h plasma glucose* ≥7.8 and <11.1mmol/l (140mg/dl and 200mg/dl)GLYCATED HAEMOGLOBIN (HbA1c)

An HbA1c of 6.5% is recommended as the cut point for diagnosing diabetes mellitus.

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Management

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Education

Oral Medicine

Insulin

Management of complication

Diet

Exercise

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Ayurvedic View

Prameha Rog

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Definition of Prameha

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Tatravilprabhutmutralakshanah

Sarva

eva Prameha | (

Sushruta

,

Nidan

6/6)

Samanyam

lakshanam

tesham

prabhutavilmutrata

|

Doshadushyavisheshepi

tatsamyog

visheshatah

||

Mutravarnadibheden

medo

meheshu

kalpate

|

(

Ashtanghridaya

Nidan

10/7)

Slide20

Etiology Of Prameha

20

Asyasukham

swapnasukham

dadhini gramyodak

anuprasah

payansi

,|

Navannapanam

gudvaikratam

ch

Pramehahetuh kaphakrichh

sarvam. || (

Charak

,

Chikitsa

6/4)

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Prodromal Features

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Swedoangagandhah

shithilangata

ch shayya sanswapna sukhe ratishch

|

Hrinetrajivhashravanopadeho

ghanangata

kesha

nakhativridhih

||

Sheetapriyatvam

galatalushoshomadhuryamasye

karpadadahah

|Bhavishyato meha

gadasyarupam

mutre

abhidhavanti

pipilikashcha

||

Charak

,

Chikitsa

6/13-14)

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Clinico

-pathological Classification

Kaphaja

Prameha -10 (Early Diabetes)

Pittaja

Prameha -6 (Acute Diabetes)

Vataja Prameha -4 (Chronic Diabetes)22

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Etiological Classification of Prameha

Sahaja

Prameha (Growth onset/ IDDM/ Juvenile)

Apathyanimittaja

Prameha (NIDDM)

(

Shusrura)23

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Therapeutic classification based on body constitution

(

Charak)

Sthula

Pramehi (Obese- NIDDM)Manageable with diet control and exercises Krisha Pramehi (Asthenic

- IDDM)

Not manageable with diet control alone rather requires nutritive treatment (

Bringhana

chikitsa

)

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Prognostic classification

Sadhya

(Manageable)

Apathyanimittaja

Prameha (NIDDM)

Kaphaja Prameha (Early Diabetes)Sthula Pramehi (Obese Diabetics) Yapya (Palliative)

Pittaja

Prameha (Acute Diabetes)

Asadhya

(Unmanageable)

Sahaja

Prameha (IDDM)

Vataja

Prameha (Chronic Diabetes)

Krisha

Pramehi

(

Asthenic

Diabetics)

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Diabetes as Prameha

Upekshayasya

jayante

pidaka

Madhumehikah | (Ch.Su.17)

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Sarva

ev

Pramehastu

Kalena

parti

karinah

|

Madhumehatvamayanti

Tadasadhya

bhavantihi

|

(

Sush

.

Nidana

6/29)

Jatah

Pramehi

Madhumehinova

na

Sadhyauktah

sahi

Beejadoshat

|

Ye

chapi

kechitkulaja

vikara bhavantitamstan

Pravadantya

sadyan

||

(

Ch.Chi

. 6)

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Schema showing correlation of different types /stages of Prameha with Diabetes Mellitus

Diabetes Mellitus

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NIDDM

(

Kaphaja, Pittaja Prameha)

IDDM

(

Vataja

Prameha/

Madhumeha

)

Early Diabetes



G.H.

Kaphaja

Prameha

Kapha

+++



Pitta

++



Vata

+++

Acute Diabetes

Chronic Diabetes



Catecholamine

Cortisol



Insulin

Pittaja

Prameha



Pitta

+++

 Kapha

++



Vata

++

Vataja

Prameha

 Kapha +++ 

Pitta

+++ 

Vata

+++

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Panch

Tikta

Pancha

Prasratika Basti

(Panchakarma Group)(

Charaka Siddhi 8/8) Contents Quantity

Trichosanthus

dioca

80 gm

Melia

azadirchta

80 gm

Swertia

chiraita

80 gm

Pluchea

lanceolata

80 gm

Alstonia

scholaris

80 gm

Brassica

campestris

10 gm

Cow's Ghrita 80 ml.

Dose :

400 - 450 ml.

Retension

time

:

10-12 minutes.

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Panchtikta

Panchaprasratika

Basti

Latin Name

Hindi

NamePart UsedForm UsedTrichosanthus

dioca

Patol

Leaves

Coarse Powder

Melia

azadirchta

Neem

Bark

Coarse Powder

Swertia

chiraita

Chiraita

Fruit

Coarse Powder

Pluchea

lanceolata

Rasna

Leaves

Coarse Powder

Alstonia

scholaris

Sapta

carba

Leaves

Coarse Powder

Brassica

campestris

Sarson

Fruits

Powder

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Content of

Panchatikta

Panchprasratika

Basti

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Trichosanthus

Dioca

Pluchea

Lanceolata

Alstonia

scholaris

MELIA AZADIRCHTA

SWERTIA CHIRAITA

Brassica

Campestris

Ghee

7 Drugs

Ficus

glomerata

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Tarkeswara

Rasa

(Medicinal Group)

(BR 46/ 115-116)

Contents

Quantity Rasa Sindura

Loha

Bhasma

in

Abhraka

Bhasma

equal

Vanga

Bhasma

quantity

Dose :

250 Mg TDS with

Udumbarphala

Churna

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Contents of

Tarkeshwar

Ras

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Trikatu Capsule

(Medicine group)

(BP 30 /74-75)

Contents Quantity

Zingiber

officinalis 500 gmPiper

nigruma

500 gm

Piper

longum

500gm

Terminalia

chebula

500 gm

Terminalia

belerica

500 gm

Phyllanthus

emblica

500 gm

Commiphota

mukul

500 gm

Ribulus

torrostris

4

litres

Dose:

250 mg. T.D.S. with

luke

warm water

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Trikatu Capsule

Latin Name

Hindi Name

Part Used

Form Used

Zingiber

officinalisShunthiTuberFine P

owder

Piper

nigruma

Krishna

Marlcha

Fruit

Fine

P

owder

Piper

longum

Pippali

Fruit

Fine

P

owder

Terminalia

chebula

Haritaki

Fruit

Fine

P

owder

Terminalia

belerica

Vibhitaka

Fruit

Fine

P

owder

Phyllanthus

emblica

Amala

Fruit

Fine

P

owder

Commiphota

mukul

Purfled

guggulu

Resin

Fine

P

owder

Ribulus

torrostris

Gokharu

Seed

Decoction

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Contents of Trikatu Capsule

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Ribulus

torrostris

Commiphota

mukul

Terminalia

chebula

Phyllanthus

emblica

Zingiber

officinalis

Piper

nigruma

Piper

longum

Terminalia

belerica

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Aims and Objectives

For conceptual and detailed study of Diabetes Mellitus and

Madhumeha

. To understand the effect of

Tarkeshwar

Ras with

Udumbarphala Churna, Trikatu Capsule and Panchatikta Panchprasratika Basti in curing Diabetes Mellitus (Madhumeha). To manage patients of Prameha Rog.

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Material and Methods

Study design- Randomized, open

clinical trial.

Study Population- Patients collected from the OPD & IPD of P.G. Department of Kayachikitsa at NIA Hospital, Jaipur. Sample size and selection criteria- Sample size is 55 out of which 14 patients in Group A, 25 Patients in Group B and 11 Patients in Group C.

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Inclusion Criteria

Age 20 yrs or above.Uncomplicated case of Type 2 DM

with mildly raised blood sugar

level i.e. FBS close to 127 mg/dl

and PPBS close to 200mg/dlPatients with cardinal symptoms of the disease based on the Ayurvedic and modern texts.40

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Exclusion Criteria

Type 1 DM & Gestational DM

Complicated and very high blood sugar level in DM

Any other associated disease

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Duration of trial-

Oral medications for 30 days and Vasti for 15 days

Dose -

Tarkeshwar Ras 250 mg with 3 gms of Udumbarphala Churna TDS - Trikatu Churna 250 mg TDS -

Panchatikta

Panchprasratika

Basti

450-500 ml for 15 days

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Experimental Grouping

Three Groups were made:--

Group A

Group B Group C

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Group A-

14 registered

pateint

of DM type 2 were administered

Tarkeshwara Rasa 250 mg with Udumbarphala Churna 3 gms thrice a day before meal for 30 days. Group B – 25 registered patients of DM type 2 were given Trikatu Gutika

250 mg thrice a day before meal for 30 days.

Group C-

11

registered patients of DM type 2 were administered

Tarkeshwara

Rasa

250 mg,

Udumbaraphala

Churna

3gms,

Trikatu Gutika

250 mg thrice a day before meal for 30 days and Panchatikta Panchaprasrutika

Vasti

for 15 days as a Kala Vasti karma.

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Criteria for assessment

Subjective Assessment

– On the basis of clinical features of Prameha written in texts.

Objective Assessment

----Blood Sugar Fasting

(FBS), Blood Sugar

Postprandrial (PPBS), Urine Sugar, S. Cholesterol, Blood Urea, Haemoglobin gm%, ESR mm/hr.45

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RESULT and

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The pattern of clinical recovery in 14 patients of Group A

S. No.

Symptoms

MeanB.T.

Mean A.T.

Difff

S.D.

S.E.

t

p

1.

Prabhuta

Mutrata

(

polyuria

)

3.28

0..35

2.93

.61

0.16

1.56

< 0.1

2.

Avila

Mutrata

(Dissolved impurities in Urea)

3.64

0.42

1.21

0.80

0.21

1.25

< 0.2

3.

Pipasadhikya (Polydipsia)

2.71

0.28

2.42

0.85

0.22

1.67

< 0.1

4.

Kshudhadhikya (Polyphagia)

2.57

0.71

1.85

0.65

0.17

0.44

< 0.5

5.

Shosha mukha (Dryness of mouth)

2.50

0.42

2.07

0.72

0.28

1.67

< 0.1

6.

Kandu Janananga (Pruritis Vulva)

1.62

0.28

1.11

1.51

0.86

0.85

< 0.4

7.

Vivandha (Constipation)

2.50

0.42

2.11

0.73

0.13

1.26

< 0.2

8.

Sarvanga shoola (Malaise)

1.92

0.35

2.56

0.47

0.13

1.70

< 0.1

9.

Atiweda Pravrati (Excessive sweat)

2.64

0.28

2.35

1.00

0.28

1.67

< 0.1

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The pattern of Laboratory Changes in 14 patients of Group A

S.No

.

Laboratory

Mean B.T.

Mean

A.T.

Diff.

S.D.

S.E.

t

p

1.

Blood Sugar Fasting

184.5

102.3

82.2

39.30

10.5

2.58

< 0.01

2.

Blood Sugar

Pst

prandial

253.9

156.2

97.7

51.00

13.6

3.00

< 0.01

3.

Urine Sugar

2.71

0.29

2.42

0.70

0.20

2.66

< 0.01

4.

S. Cholesterol

181.1

171.60

9.5

23.10

6.17

0.68

< 0.5

5.

B. Urea

31.07

30.28

0.79

3.49

0.93

0.46

< 0.5

6.

Heamoglobin

gm%

13.50

14.20

0.70

0.90

0.20

1.90

< 0.05

7.

ESR mm/hr

10.70

7.78

2.79

8.40

0.20

1.25

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< 0.2

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The pattern of clinical recovery in 25 patients of group B

S.No

.

Symptoms

Mean B.T.

Mean A.T.

Difff

S.D.

S.E.

t

p

1.

Prabhuta

Mutrata

(

polyuria

)

2.8

1.12

1.68

1.06

0.2

2.75

< 0.01

2.

Avila

Mutrata

(Dissolved impurities in Urea)

2.28

1.08

1.20

0.70

0.14

2.68

< 0.01

3.

Pipasadhikya

(

Polydipsia

)

1.64

0.48

1.16

0.46

0.09

2.56

< 0.01

4.

Kshudhadhikya

(

Polyphagia

)

1.72

0.64

1.08

0.27

0.05

3.60

< 0.001

5.

Shosha mukha (Dryness of mouth)

1.76

0.60

1.16

0.70

0.14

2.58

< 0.01

6.

Kandu Janananga (Pruritis Vulva)

1.92

0.80

1.12

0.48

0.096

2.78

< 0.01

7.

Vivandha (Constipation)

1.76

0.88

0.88

0.40

0.088

1.5

< 0.05

8.

Sarvanga shoola (Malaise)

1.72

0.96

0.76

0.44

0.092

2.48

< 0.01

9.

Atiweda

Pravrati

(Excessive sweat)

1.8

0.64

1.16

0.49

0..097

2.62

< 0.01

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The pattern of laboratory recovery in 25 patients of group B

S. No.

Laboratory

Mean B.T.

Mean A.T.

Difff

S.D.

S.E.

t

p

1.

Urinary Sugar

130.99

101.25

29.74

16.33

3.32

2.47

< 0.01

2.

Blood Sugar Fasting

221.32

194.00

27.32

15.95

3.19

2.29

< 0.025

3.

Blood Sugar Post prandial

183.80

176.48

12.34

14.51

2.90

2.56

< 0.01

4.

S.

Chlesterol

33.84

33.84

0.00

0.00

0.00

1.28

< 0.2

5.

Blood Urea

2.32

1.48

0.84

0.97

0.19

0.76

< 0.4

6.

Haemoglobin gm%

3.50

13.66

0.16

0.55

0.11

1.87

< 0.05

7.

ESR in mm/hr.

8.48

8.24

0.24

0.55

3.11

1.18

< 0.1

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The pattern of clinical recovery in 11 patients of Group C

S. No.

Symptoms

Mean B.T.

Mean A.T.

Difff

S.D.

S.E.

t

p

1.

Prabhuta

Mutrata

(

polyuria

)

3.50

0.50

3.00

1.00

0.30

6.55

< 0.001

2.

Avila

Mutrata

(Dissolved impurities in Urea)

2.90

0.40

2.50

0.70

0.2

9.67

< 0.001

3.

Pipasadhikya (Polydipsia)

2.63

0.10

2.53

0.90

0.28

18.20

< 0.001

4.

Kshudhadhikya (Polyphagia)

2.63

0.02

2.50

0.09

0.28

7.79

< 0.001

5.

Shosha mukha (Dryness of mouth)

2.81

0.33

2.51

0.90

0.27

4.49

< 0.001

6.

Kandu

Janananga

(

PruritisVulva

)

1.81

0.59

1.27

0.90

0.27

2.95

< 0.01

7.

Vivandha (Constipation)

2.81

0.45

1.27

0.80

0.24

8.42

< 0.001

8.

Sarvanga shoola (Malaise)

2.36

0.99

2.36

1.17

0.35

10.52

< 0.001

9.

Atiweda Pravrati (Excessive sweat)

3.00

0.36

2.64

3.29

0.99

6.67

< 0.001

51

Slide52

The pattern of Laboratory Changes in 14 patients of Group

C

S. No.

Laboratory

MeanB.T.

Mean A.T.

Difff

S.D.

S.E.

t

p

1.

Urinary Sugar

2.71

0.29

2.42

0.70

0.20

2.66

< 0.01

2.

Blood Sugar Fasting

184.5

102.3

82.2

39.30

10.5

2.58

< 0.01

3.

Blood Sugar Pst prandial

253.9

156.2

97.7

51.00

13.6

3.00

< 0.01

4.

Serum Chlesterol

181.1

171.60

9.5

23.10

6.17

0.68

< 0.5

5.

Blood Urea

31.07

30.28

0.79

3.49

0.93

0.46

< 0.5

6.

Haemoglobin gm%

13.50

14.20

0.70

0.90

0.20

1.90

< 0.05

7.

ESR in mm/hr.

10.70

7.78

2.79

8.40

0.20

1.25

< 0.2

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Slide53

Fasting Blood Sugar in different body constitutions in diabetics

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Duration of illness

Slide54

Ponderal

Index and Body Surface Area in Different Constitutions of Diabetics

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Slide56

Prameha is described as a set of complex clinical disorders characterized by frequent abnormal micturition, with the etiology involving genetic predisposition as well as improper diet and life style.

The clinical conditions described in Prameha have much in common with those described in allopathic medicine for Diabetes Mellitus. The Ayurvedic management of Prameha emphasizes dietary and lifestyle recommendations and herbal preparations with

Panchkarma

Therapy (Vasti) .

56

Slide57

Poly herbal combination potentiate therapeutic efficacy of a particular ingredient of formulation and also counter act adverse effect if present in the combination. Instead of isolating a particular alkaloid it is suggested that the Ayurvedic Drugs should be used as a whole.

57

Slide58

Pharmaco

Dynamic properties of

Tarkeshwara Ras

The contents of

tarkeshwara

Rasa

possesse 100% Kashaya Rasa, 80% Tikta Rasa and 60% katu Rasa in their preponderance. Similarly 100% drugs had Ushna Virya and Katu Vipaka.70% drugs have

Deepana

, and Kapha

Vatahara

, properties; 80% drugs are

Amadosha

hara

and 90% drugs posses

Lekhana

and

Agani

Pradipaka

actions.

58

Slide59

Udumbaraphala

Churna acts due to its Deepana, Pachana and

Agnideepana property. Trikatu Gutika

acts by

Agnideepana

due to its Deepana and Aamapachana activity Panchatikta Panch Prashritika Vasti acts by destroying Aavarana due to its Kapha-pittashamaka property.59

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