Ayurveda Treatment Methods

A Guide Line To Ayurveda Treatments & Principles

 MADHUMEHA (DIABETES MELLITUS)  Treatment Protocol by Ayush

 

 

INTRODUCTION

Prameha is one among the eight Maharoga (disorders needing serious concern) and explained as most important among Anushangi Roga (chronic disorders) manifested as polyuria with turbidity in urine occurs due to vitiation of Kapha Dosha and Meda Dhatu. Madhumeha the commonest clinical presentation of Prameha can be compared to Diabetes Mellitus. All such diet and life style factors which increase Kapha, Meda and Kleda, contribute in the pathogenesis of Madhumeha. Prameha can be classified into two as Sthula Pramehi or Apathya Nimittaja Pramehi with clinical features of obesity along with excessive frequency of urination. In the second variety, Vata may be dominantly involved, and such patients are lean and termed as Krisha Pramehi. Further Prameha can be further classified into Kapha Prameha, Pitta Prameha and Vata Prameha according Dosha involvement. Kapha Prameha is Sadhya (curable), Pitta Parmeha is Yapya (manageable) and Vata Prameha is Asadhya (incurable).

Case Definition:

Excessive urination which may be associated with excessive thirst and hunger, lethargy, numbness or burning sensation in the extremities, calf muscle cramps or sudden loss of weight with raised blood sugar levels (BSL).

General Diagnostic criteria

  1. Increased frequency of urine
  2. Turbidity in urine
  3. Excessive thirst & hunger
  4. Lethargy
  5. FBS >125 mg/dl and (or) PPBS >200 mg/dl1

Along with, any 2 or more of the following symptoms:

  1. Like cool surroundings (Subjective)
  2. Sweetness in mouth (Subjective)
  3. Burning / Numbness in palms & soles (Subjective)
  4. Ants noted in the toilet (Subjective)

Sthula Pramehi: General Diagnostic criteria + BMI > 25

Krisha Pramehi: General Diagnostic criteria + BMI < 18

Kapha Pramehi: General Diagnostic criteria + BMI > 25 with some of the following features

  • Recent onset of Diabetes (< 2 years)
  • Take excessive sweets and high calorie diet
  • Bulk eating habit
  • Indigestion, predominant upper GIT symptoms and recurrent Upper Respiratory Tract symptoms

 

 

Pitta Pramehi: General Diagnostic criteria + BMI >18 and <25 with some of the following features

  • Medium onset of Diabetes (2-6 years)
  • Use of excessive spicy and salty diet
  • Moderate eating habit
  • Acidity predominant, upper GIT symptoms and recurrent Urinary Tract Infections

Vata Pramehi: General Diagnostic criteria + BMI < 18 with some of the following features

  • Chronic onset of Diabetes (> 6 years)
  • Use of dry low nutritional diet
  • Less eating habit

Differential Diagnosis:

  • Sthoulya
  • Mutratisara

LEVEL 1: AT SOLO AYURVEDA PHYSICIAN CLINIC/PHC

Clinical Diagnosis: On the basis of history and clinical presentation patient can be diagnosed provisionally as with subtypes as Sthula / Krisha and Doshik variety Kapha/ Pitta/ Vata. Patients diagnosed as Sthula / Kapha / Pitta and having at least moderate physical strength and blood sugar level as follows may be treated at this level.

  • FBS >110 upto 180
  • PPBS > 200 upto 280

Investigation:

  • Blood-sugar level
  • Urine- sugar

Treatment: In the initial stage when the patient is having mild raised blood sugar levels and not associated with major complications, along with diet restriction, two or more of following drugs may be given as in table 11.1:

 

Table 11.1: Medicines at level 1 for Madhumeha

 

 

Drugs

Dosage form

Dose

Time of administration

Dosha Specification

Anupana

Vijayasaradi Kwatha

Decoction

10-15 ml

Before meal / twice a day

Kapha / Pitta

-

Phalatrikadi

Kwatha1

Decoction

10-15 ml

Before meal / twice daily

Kapha / Pitta

-

Kathakakhadiradi Kashaya

Decoction

10-15 ml

Before meal / twice a day

Kapha

-

Nisha Katakadi Kashaya

Decoction

10-15 ml

Before meal / twice a day

Pitta

-

Nisha-Amalaki2

Powder

6 gm

After meal / twice a day

Irrespective of Dosha

With water

Mamajjaka Ghana Vati

Vati

2-3 Tab

Before meal /

thrice a day

-

With water

 

Sapta Rgangyadi Vati3

Vati

2-3 Tab

Before meal /

thrice a day

-

With water

Gokshuradi Guggulu4

Vati

2-3 tablet

Before meal /

thrice a day

Paittika with UTI

With water

Triphala5

Powder / Tab

3-6 gm /

2-3 Tab

Before meal /

thrice a day

With warm water

                   

 

 

 

Pathya - Apathya (Diet and life style education):

Do’s-

  • Ahara: Use of Purana Dhanya (grains harvested 1 year back), Bharjit Dhanya (roasted grains), Yava (Barley), Mudga (Green grams) and Kulattha (Horse grams), Adhaki, Masura (Lentils), Makushtha are recommended. Bitter leafy vegetables like fenugreek, Atasi (Flaxseed), Sarshapa (mustard) are recommended; roasted meat of dry habitats animals

Table 11.2: Chart Showing various diet Useful in Prameha

 

 

Type of Diet

Name

Cereals

Yava (Barley) (Hordeum vulgare), godh£ma (wheat), kodrava (grain variety –Paspolum scrobiculatum) udd¡laka (according to dhanvantari Nighantu forest variety of k°drava), Kangu (Seteria italica), Madhulika (Elusine coracana), Shyamaka (Echinochloea frumentacea), Jurnahva (Sorghum vulgare), Vajranna (Pennisatum typhoides), Purana shali (old rice),.

Pulses

Adhaki (red gram-Cajamus cajan), kulattha (horse gram) and mudga (green gram), Masura (Lentils), Makushtha (Moth Bean/Acpnite bean), Chanaka (Cicer arietinum) should be taken with bitter and astringent leafy vegetables.

Vegetables

Navapatola (young Tricosanthus dioica), young vegetables variety of banana, tanduleyaka (Amaranthus spinosus), vastukam (bathuva), all bitter vegetables (tiktasakam) like methika (Fenugreek leaves), Karavellaka (Bitter gourd), Bimbi (Kovai), Shigru fruits and leaves (Drum stick), Vrintaka (Brinjal), Rakta vrintaka (Tomato), Putiha (mint leaves), Suran (amorhophellus), Curry leaves, Mulaka (radish), Kushmanda (Ash Gourd), Kritavedhana (Ridge gourd), Alabu (Bottle gourd),

Fruits

Jambu (Syzigium cumini), Kapitha (Feronia limonia), Amlaki (Phyllanthus embilica), Bilva (Bael - Aegle marmelos), Dadima (Pomegranate - Punica granatum), Naranga (Orange - Citrus aurantium), Parushaka (Falsa - Gravia asiatica), Udumbara (Cluster Fig – Ficus racemosa) etc fruits.

Flesh

Birds like Kapota (Pigeon), Titira (Grey Francolin)

 

Oils

Condiments

Atasi (Linum usitatisimum), Sarshapa (mustard).

Haridra (Turmeric), Maricha (Pepper), Tvak (Cinnamon), Lashuna (Garlic), Shunthi (Ginger), Methika (Fenugreek), Dhanyaka (Coriander), Jeeraka (Cumin seeds)

 

 

 

 

  • Vihara: Ayurvedic texts suggest Long walks, swimming, hard labor like pulling carts, digging wells, serving animals etc. All this involves muscular activity, which will help in maintaining muscle tone and peripheral utilization of glucose. Today, weight training exercises can be done. Following norms should be followed before or after exercise:
  • Exercise should be initiated at low intensity and should be gradually increased
  • It should not be done after eating heavy meals.
  • It should be done regularly at fixed timings.
  • Before exercise, a person should have taken proper sleep, his diet should have been digested properly.

Don’ts –

  • Ahara: Excessive use of sweets, fruit salad, Sugarcane, fruits like Mango, Watermelon, Chikoo, Dates, Jack fruits, Custard apple, Banana, Grapes, Cashew nuts, and other fruits with high glycemic index, use of cold drinks, intake of oil, Hydrogenated Ghee, fried food, over indulgence of meat especially of wet land animals, to take food before complete digestion of previous food, to take food in improper time and in varied quantity.
  • Vihara: Day time sleep especially just after taking heavy meal, irregular pattern of sleep i.e. less than 5 hours or more than 10 hours in a day or in improper way, no or less or infrequent exercise.

Referral Criteria: Patient not responding to above mentioned management in terms of symptomatology and reduction in blood sugar levels and developing signs of compli­cation of Diabetes may be referred to the next level.

LEVEL 2: AYURVEDIC HOSPITAL WITH INDOOR FACILITIES:

All patients referred from level 1 and those patients diagnosed as Krisha Parmehi / Vata / Durbala / Pitta with Medo Dushti may be treated at this level

Clinical Diagnosis: Same as level 1for a fresh case reporting directly.

Investigation: Same as level 1; in addition

  1. Hb A1C
  2. Lipid profile

Treatment: In addition to the management mentioned in Level 1, few of the following drugs may be added as per the require­ment and status of the patient (Table 11.3). Rasaushadhi (Herbo-mineral drugs) or herb­al drugs of potential pharmaco-vigilance importance can be used at this level. Patient may be kept under observation while pre­scribing these kinds of medicines.

 

 

 

Table 11.3: Medicines at level 2 for Prameha

 

Drugs

Dosage form

Dose

Time of administration

Specific indications

Anupana

Shiva Gutika6

Vati

1-2 tablet

Before meal / twice a day

Diabetic Impotence, Neuropathy

-

Vanga Bhasma7

Powder

125-250 mg

After meal / twice a day

Water

Trivanga Bhasma8

Powder

125-250 mg

After meal / twice a day

Water

Vasanta Kusumakara Rasa9

Powder

125-250 mg

After meal / twice a day

Diabetic peripheral neuropathy

Water

Arogyavardhini Vati10

Vati

1-2 tablet

Before meal / thrice a day

With water

Chandraprabha Vati11

Vati

2-3 tablet

Before meal / thrice a day

Diabetic nephropathy

With water

                   

 

 

 

Pathya-Apathya (Diet and life style education): Same as level 1

Referral Criteria: Patients’ blood sugar not well under control and having associated conditions like Macrovascular complications like Ischemic heart disease, microvascular complications like diabetic kidney disease, retinopathy, neuropathy etc may be referred to the next level.

LEVEL 3: HOSPITALS WITH INDOOR FACILITIES LIKE

PANCHAKARMA, KSHARASUTRA ETC. AND HAVE

INTEGRATIVE FACILITIES

All patients referred from level 2 should be treated at this level. All patients come under Sthula Pramehi / Balavan / Kapha / Pitta Pramehi and willing to undergo Shodhana line of management for better recovery should be treated at this level. All patients of Krisha Pramehi / Vata / Durbala should be treated at this level. Patients having HbA1c above 9 should be treated at this level.

Clinical Diagnosis: Same as level 1 for a fresh case reporting directly

Investigation:

  1. Serum electrolytes
  2. Blood urea and serum creatinine
  3. Urine for Micro albumin
  4. ECG
  5. Fundus examination

Treatment: In addition to the management of Level 1 and Level -2, if needed Panchakarma procedures can be performed.

 

 

 

  • Udavartana with Yava Kolakulatha Churna, Triphala powder or Yava powder
  • Snehapana with Sarshapa Taila, Dhanwantaram Ghrita, Kalyanakam Ghrita
  • Vamana Karma with Madanaphala Churna (5-10 gm), Pippali Churna (1-2 gm), Vacha Churna (2-3 gm), Rock salt (5-6 gm), Honey (Q.S.), for Vamanopaga - Nimba Kashaya.
  • Virechana with Brihat Triphala Churna, Mishraka Sneha,
  • Asthapana Basti prepared with decoction of drugs from Surasadi Gana or Nyagrodhadi Gana.

Patient with Apatarpana Janya presentation (Vata predominance)

  1. Yapana Basti / Madhutailika Basti with Erandamoola Decoction, Shatapushpa paste, Honey and oil in equal quantity, Rock salt.
  2. Anuvasana Basti with Dhanwantaram Ghrita, Dhanwntaram Taila, Guggulu Tiktaka Ghrita
  3. Shirodhara
  4. Sarvanga taila / Kseeradhara

Pathya - Apathya (Diet and life style education): Same as level 1, along with modifications in diet and exercise should be made as per the strength and built of the concerned patient. Moderately nourishing article which do not aggravate Kapha and Meda can be advised.

 

 

  • Udavartana with Yava Kolakulatha Churna, Triphala powder or Yava powder
  • Snehapana with Sarshapa Taila, Dhanwantaram Ghrita, Kalyanakam Ghrita
  • Vamana Karma with Madanaphala Churna (5-10 gm), Pippali Churna (1-2 gm), Vacha Churna (2-3 gm), Rock salt (5-6 gm), Honey (Q.S.), for Vamanopaga - Nimba Kashaya.
  • Virechana with Brihat Triphala Churna, Mishraka Sneha,
  • Asthapana Basti prepared with decoction of drugs from Surasadi Gana or Nyagrodhadi Gana.

Patient with Apatarpana Janya presentation (Vata predominance)

  1. Yapana Basti / Madhutailika Basti with Erandamoola Decoction, Shatapushpa paste, Honey and oil in equal quantity, Rock salt.
  2. Anuvasana Basti with Dhanwantaram Ghrita, Dhanwntaram Taila, Guggulu Tiktaka Ghrita
  3. Shirodhara
  4. Sarvanga taila / Kseeradhara

Pathya - Apathya (Diet and life style education): Same as level 1, along with modifications in diet and exercise should be made as per the strength and built of the concerned patient. Moderately nourishing article which do not aggravate Kapha and Meda can be advised.

 

  1. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, 2nd Revised English ed. Part I (20/42), 2003, pg 273.
  2. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, 2nd Revised English ed. Part I (20/4), 2003, pg 258.
  3. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, 2nd Revised English ed. Part I (12/10), 2003, pg 185.

 

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