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Evaluation of the efficacy of Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) By VIJAYALAXMI. B. BENAKATTI, Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI …

Evaluation of the efficacy of Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) By VIJAYALAXMI. B. BENAKATTI, Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103

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  • 1. Evaluation of the efficacy of Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) By VIJAYALAXMI. B. BENAKATTI 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 KayachikitsaPost Graduate Studies & Research CenterD.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2006-2009
  • 2. 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 Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)” is a bonafide research work done by Vijayalaxmi. B. Benakatti 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.Date: Guide:Place: 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
  • 3. 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 ofPhalatrikadi Vati in Madhumeha (Diabetes Mellitus)” is a bonafide research work doneby Vijayalaxmi. B. Benakatti under the guidance of Prof. Dr. Shiva Rama PrasadKethamakka, M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish), Professor inKayachikitsa in partial fulfillment of the requirement for the post graduation degree of“Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of HealthSciences, Bangalore, Karnataka.. (Dr. G. B. Patil) Professor & HOD Principal, Dept. of Kayachikitsa DGM Ayurvedic Medical College, PGS&RC Gadag Date: Date: Place: Gadag Place: Gadag
  • 4. Declaration by the candidate I here by declare that this dissertation / thesis entitled “Evaluation of the efficacy ofPhalatrikadi Vati in Madhumeha (Diabetes Mellitus)” is a bonafide and genuine researchwork carried out by me under the guidance of Prof. Dr. Shiva Rama PrasadKethamakka, M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)], Professor in Kayachikitsa,DGMAMC, PGS&RC, Gadag.Date:Place: Gadag Vijayalaxmi. B. Benakatti
  • 5. Copy right Declaration by the candidate I here by declare that the Rajiv Gandhi University of Health Sciences, Karnatakashall have the rights to preserve, use and disseminate this dissertation/ thesis in print orelectronic format for the academic / research purpose.Date:Place: Vijayalaxmi. B. Benakatti© Rajiv Gandhi University of Health Sciences, Karnataka
  • 6. Acknowledgement Any research is not an individual effort. It is a contributory effort of many hearts, hands and heads. I am very much thankful to the subjects of this study. I am extremely happy to express my deepest sense of gratitude to my beloved and respected guide and H.O.D Prof. Dr. K. Shiva Rama Prasad, M.D., C.O.P. (German), M.A., [Ph.D.], for his guidance and timely help. I express my gratitude to Dr. V. V. Varadacharyulu Professor and Ex H.O.D for his advice and encouragement in every step of this work. I am sincerely grateful to Dr. G. B. Patil, Principal, for his encouragement and providing all necessary facilities for this research work. I express my special thanks to Dr. R. V. Shettar, Dr. B. G .Swami, Dr. Kuber sankhfor their timely help and co-operation. I extend my gratitude to Dr. G. Purushottamacharyulu, Dr. P. Shivaramudu, Dr. M. C. Patil, and Dr. G. S. Hiremath, Dr. U. V. Purad, Dr. Mulgund. Dr. G. Danappagoudar. Dr. S. N. Belawadi. Dr. Nedugundi, Dr. Samudri, Dr. J. Mitti. Dr. Shankargouda. Dr. Mulki Patil. Dr. Yasmin A.P, Dr Veena. Kori and Dr. Yaregari RMO DGMAMC Gadag. I express my immense gratitude to statistician Nandakumar, Tippanagoudar (Lab), V.B. Mundinamani (librarian) and Kerur and Shyavi for facilitating me in collection and production of my thesis. I take this opportunity to thank Dr. Yadavannavar (M.D) lecturer in B. M. Nagur College Bijapur who accompanied me at every step with his valuable suggestions and moral support.
  • 7. My deep senses of gratification to my inspirations of this study are my parentsShri. Basavaraj. Benakatti and Smt. Saroja. B. Benakatti and my beloved husband Dr.Rajeev. Karalingannavar, for their love, support with a constant enthusiastic andaffectionate push and who are the driving force. I am extremely happy to express my deepest sense of gratitude to my beloved daughter Neha, my mother-in-law Smt. Neelama Karalingannavar And my Brother in law and co-sister, Aravinda and Ashawini Karalingannavar. I am extremely happy to express my deepest sense of gratitude to my all uncles and aunties. I express my heartfelt gratitude to my Sisters, Dr. Veena, Vishala, Sangeeta, Shweta for constant help and encouragement to move ahead. I take this moment to express my thanks to all my Post gratude senior friends, Dr.Shivaleela. Kalyani, Dr. Kamalaxi, Dr. Sulochana, Dr. M. G. Ashok. Dr. Rudrakshi. My in depth regards to my friends Dr. Prasann. Joshi, Dr. Sanjeev, Dr. Veena.Jigalur, Dr. Neeraj, Dr. Mukta. Arali, Dr. Mukta. Hiremath, Dr. Anupama, Dr Trupti. Dr.Ishawar, Dr. Praveen, Dr. V S Kanti, Dr. Bodake, Dr. Kavitha, Dr. Sarvamangala, Dr.Jaya. M, Dr. Kalavati, Dr Savitha, Dr. Adarsha, Dr. Nataraja, Dr. Udaya, Dr. Shaileja,Dr. Ravi, Dr. Shivakumar, Dr. Jyoti for their support and encouragement. I express my immense thanks to my patients for their cooperation during the trial. Last but not least I express my deepest thankfulness whose names are not taken here but helped me a lot along with my kith and kilns to my family members. (Vijayalaxmi. B. Benakatti)
  • 8. Abstract of “Evaluation of the efficacy of Pkalatrikadi Vati in Madhumeha (Diabetes Mellitus)” by Vijayalaxmi. B. BenakattiKey words: Madhumeha, Prabhoota, avila mootrata, Phalatrikadi Vati, DM,Hypoglycemia, Blood glucose. Madhumeha vis-à-vis Diabetes mellitus is a common chronic metabolic disorderprevalent all over the world. Although Madhumeha has been a known morbidity sincetime immemorial, its incidence has been growing notably in recent years. Madhumehavis-à-vis Diabetes mellitus is a major health problem for the world in the 21st century.The mortality rate due to Diabetes mellitus is very high and is ranked fifth amongst theten major causes of death in southern part of India. The rising prevalence of diabetes isclosely associated with industrialization and socio-economic development. In Ayurveda,Madhumeha is explained under the heading of Prameha, Madhumeha is a disease ofsystemic and deranged metabolism expressed in mootravaha srotus that result in tovitiation of various body elements. Avarnjanya Madhumeha possesses vitiated Kapha,Pitta and Meda caused due to Avarana of Vata aggravation causes Vital Dhatusdeprevation. Madhumeha is a disease characterized by Prabhoota, avila mootrata, Tanuand Mootra madhuryata. The present study focused on the disease pathogenesis and itsregulation through Phalatrikadi vati as a Shamana Chikitsa. Apart from other symptomsof Madhumeha, the glycemic condition of the Madhumeha assessed by parameters i.e.FBS, PPBS, FUS and PPUS taken after to before data. These shows high significant withFBS with a mean difference of 31.84mg and PPBS with mean difference of 63.92 mg,This is evidence to state that the phalatrikadi Vati is hypoglycemic agent combination ofAyurveda.
  • 9. Contents of“Evaluation of the efficacy of Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)” By Vijayalaxmi B BenakattiCHAPTER CONTENT PAGES 1 Introduction 1 to 5 2 Objectives 6 to 7 3 Review of literature 8 to 74 4 Methods 75to 82 5 Results 83 to 100 6 Discussion 101 to 118 7 Conclusion 119 to 120 8 Summary 121 to 122 9 Bibliographic References 1 to 11 10 Annex – data of trial 1 to 9 11 Annex – Case sheet 1 to 6 -1-
  • 10. Tables of “Evaluation of the efficacy of Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)”SN Title of Table Page1 Showing the Ahara Nidana of Madhumeha 132 Showing the Vihara Nidana of Madhumeha 143 Showing the Vishista Nidana of Madhumeha acco Dosha 154 Showing the Avarnajnya Nidana of Madhumeha 165 Showing the Roopas in relation to Dosha and Dushya 29-306 Types of kaphaja,pittaja, vataja Prameha 327 Showing the poorva roopa of Madhumeha 368 Lakshana of Madhumeha 389 Madhumeha samanya upadrava 4010 Madhumeha Upadrava 4111 Sapeksha nidana of Madhumeha 44-4512 Results by Age in Madhumeha with Phalatrikadi Vati 8413 Results by Gender in Madhumeha with Phalatrikadi Vati 8514 Results by Religion in Madhumeha with Phalatrikadi Vati 8615 Results by Occupation in Madhumeha with Phalatrikadi Vati 8716 Results by Economic status in Madhumeha with Phalatrikadi Vati 8817 Results by Diet in Madhumeha with Phalatrikadi Vati 8918 Distribution of patients by presenting complaints 9119 Distribution of patients by Associated features 9220 Ahara Nidana observed in the study 9321 Vihara Nidana observed in the study 9322 Distribution of patients by Anya Nidana 9423 Distribution of patients by Poorva roopa lakshana 9424 Distribution of patients by Sroto dusti lakshana 9525 Data of Family history in the study 9626 Assessment of Subjective parameters 9627 Assessment of Objective parameters 9728 Result of Phalatrikadi Vati in Madhumeha 9829 Statistical analysis of Phalatrikadi Vati 100 -2-
  • 11. Figures and Photos of “Evaluation of the efficacy of Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)”SN Title of Figures and photos Page1 Madhumeha Samprapti 312 Composition of Phalatrikadi Vati 703 Results by Age in Madhumeha with Phalatrikadi Vati 844 Results by Gender in Madhumeha with Phalatrikadi Vati 855 Results by Religion in Madhumeha with Phalatrikadi Vati 866 Results by Occupation in Madhumeha with Phalatrikadi Vati 877 Result Distribution of patients by Economic status 898 Results by Diet in Madhumeha with Phalatrikadi Vati 909 Distribution of patients by presenting complaints 9110 Distribution of patients by Associated features 9211 Result of Phalatrikadi Vati in Madhumeha 98 -3-
  • 12. INTRODUCTION Ayurveda is not only a system of Medicine rather it is the way of life. Itincludes physical, mental and spiritual well being. Ayurveda is becoming more andmore acceptable globally as it is toxicity free, eco-friendly with its holistic approach. Madhumeha is a disease known since ancient times to the mankind. Ayurvedain fact is the first medical science, which identified, diagnosed & managedMadhumeha. While claiming it is incurable much earlier to Greek physician aeratus(1-2 AD). Madhumeha is one of the Mahagadas 1 in which maximum number of Srotasgets vitiated with the vitiation of almost all the Dhatus and Ojas due to which thecondition of the patient afflicted with Madhumeha goes on deteriorating. Madhumeha is mentioned as one of the 20 types of Prameha. Madhumeha hasbeen classified under the Vatika type of Prameha 2. The Vata may be provoked eitherdirectly by its etiological factors, Avarana by Kapha and Pitta to its path or bycontinuous depletion of Dhatus. Vagbhata has classified the Madhumeha into twocategories viz. Dhatukshayajanya Madhumeha and Avaranajanya Madhumeha 3. Thefactors which provoke the Vata directly cause Apatarpanajanya Madhumeha. whilethe factors which provoke Kapha and Pitta cause Santarpanajanya Madhumeha. The Apatarpanajanya Madhumeha patients are usually Krusha and areequivalent to Type I Diabetes mellitus, while the Santarpanajanya Madhumehapatients are stoola equivalent to Type II Diabetes mellitus. In AvaranajanyaMadhumeha, Kapha is the predominant Dosha while the important Dushyas are Medaand Kleda. Type II Diabetes mellitus is mainly associated with AvaranajanyaSamprapti. In Madhumeha, the main Avaraka are Kapha, Pitta, Rasa, Mamsa and 4Meda, and out of these Meda is predominant . Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Introduction 1
  • 13. Over the last 50 yr, changes in lifestyle have led to a dramatic increase in theprevalence of type 2 diabetes in virtually every society around the world. Reductionsin physical activity, increases in dietary intake, westernization of diet and the aging ofthe population are key factors in bringing about this rapid change 5. In modern medical science, symptomatology of Madhumeha is equivalent tothe features of Diabetes mellitus 6. Diabetes mellitus remains one of the bafflingenigmas for clinical research. DM is expected to continue as a major health problemowing to its serious complications, especially end stage of renal disease, IHD,gangrene of the lower extremities & blindness in the adults 7. Diabetes is a syndrome characterized by disordered metabolism andabnormally high blood sugar resulting from insufficient levels of the hormoneinsulin.The characteristic symptoms are excessive urine production (polyuria) due tohigh blood glucose levels, excessive thirst and increased fluid intake (polydipsia)attempting to compensate for increased urination 8.Incidence Rate Diabetes Mellitus is a leading cause of morbitidy & mortality the world over, it is estimated that approximately 1% of population suffers from DM. the incidence is rising in the developed countries of the world, especially of the Type 2 DM, due to rising incidence of obesity & reduced activity levels 9. The prevalence of Madhumeha is on the rise; more alarmingly in the developing nations Ranked 7th among leading causes for death 10. The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030 11. India has been projected as the diabetic capital of the world 12. Diabetes and it Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Introduction 2
  • 14. complications pose a major threat to future public health resources throughout the world. Recent survey by W.H.O. revealed that the Indian diabetic population at present is 31.9 million and it is estimated to touch 79.4 million by the year 2030 13. It has been stated that in 1995 number of diabetics was 19.4 million in India which rise to 30 million by the year 2002, but only 3.6 million Diabetics in India received pharmacological treatment. In the early seventies only 2.1% Urban Indians were suffering from type 2 Diabetes mellitus, which rise to 12.1% at present. The recently concluded that National Urban Diabetes study (NUDS) carried out by the Diabetes Epidemiology Study group in India (DESI) in six major cities of India covering all the regions of the country estimated that the prevalence rate of Diabetes in the adult population is 12.10%, while the prevalence rate of Impaired Glucose Tolerance (IGT), a pre-diabetic condition is 14%. The above-mentioned figures point towards the alarming situation, which suggests that the incidence of diabetes mellitus is increasing among the general population. The top three countries for number of persons with diabetes are India, China and United States of America. India has now been declared by WHO as the Diabetes capital of the world.Purpose of the study Though, the discovery of Insulin and other hypoglycemic drugs has a greatachievement of modern medical science, but the hazardous side effects ofhypoglycemics after long term used are incurable and hence an ideal therapy is stillobscure. Recent data showing that control of hyperglycemia may prevent the onset or Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Introduction 3
  • 15. slow down the progression of complications point to the importance of an appropriateand efficacious treatment. The Ayurvedic management of Madhumeha aims not only to achieve a strictglycemic control but also to treat the root cause of the disease. Since the disease is notcurable, effective control is the need of the hour. For the prevention and control of thediabetes, at various levels prevention is to be implemented. To reduce the incidence ofthe cases that is in risk group, to reduce the associated signs and symptoms of thedisease and avoiding the further advancement of the disease leading to complications. Here the present study aims to reduce the associated signs and symptoms ofthe disease and avoiding the further advancement of the disease leading tocomplications prevention by regularizing the blood glucose level with the help ofshamanaoushadi.Previous research literatures Soma S. Bhatia (2001) Jamnagar, A Clinical study on the role of Manas bhava in the etiopathogenesis of Madhumeha. (Diabetes Mellitus) and its Management by Sarasvatachurna (Manas Roga) Sheetal Parmar (2002) Jamnagar, The role of Virechana & Trifaladi vati in the management of Madhumeha (Diabetes Mellitus) (K.C.) Anand Pawar (2003) Jamnagar, A comparative study of the role of basti therapy and pramehaghna drugs in the management of madhumeha (Diabetes mellitus) Tushar Mandal (2001) Varanasi, A study on daruharidra (berberis aristata) in no healing diabetic foot ulcers .(D.G.) Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Introduction 4
  • 16. Pandey A K - 2003 Varanasi, A study of immune status in patient of Madhumeha and role of pancha karma and naimmithika rasayana Gowda Kirana M (1999) Mysore, Effect of salasaradi gana Basti on stool madhumehaThe study description The study description consists of the headings according to the RGUHSprotocol followed from 2nd chapter.About concept The word Madhumeha in terms of ‘Diabetes Mellitus’ it is the present burningissue alarming the world. With synonym of Richman’s disease,’ Madhumeha is achronic metabolic disorder and the symptom appears in relation with a mootravahasamsthana. Diabetes mellitus is a chronic metabolic endocrinal disorder, which hassimilar pathogenesis as the Madhumeha. Thus the comparison between Madhumehaand DM is justifiable 14. The present study was designed as “Evaluation of the efficacy of PalatrikadiVati”. Several herbs have been described in Ayurvedic treasure of therapeutics, whichhave a beneficial effect in the management of Madhumeha. 15 Madhumeha is a Vata Kapha pradhana Vyadhi. Phalatrikadi Vati has beenmentioned in all most all authour under Kashaya form for Prameha Chikitsa. Thisbeing Kapha & vata shamaka,Tikta, Katu,Kashaya Rasa, Katu Vipaka, Laghu, RukshaGuna Pradhana Aushadhi may easily help in the dissociation of Pathogenesis ofMadhumeha. They also possess Deepana and Pachana properties. That is whyPhalatrikadi Vati has been selected for the present study. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Introduction 5
  • 17. OBJECTIVES Ayurveda system of medicinal aims at treating the human body as a whole andnot just the disease. Our Ayurvedic principles for the treatment, which reveals that themedicine or treatment that cures one disease and creates some other is not a good therapy,but the therapy which cures one disease and does not create any other, is the right 16treatment . So here, we are putting our step forward to find safe and effective oralhypoglycaemic agent. Ayurveda is the first medical system, which mentions the Madhumeha / Diabetesmellitus is incurable but it can be controlled with drug, diet. Diabetes mellitus, a chronicdisease unknown in developing world had emerged as a crucial health problem includingAsian countries. As people of developing countries were unaware of the nature of thedisease its occurrence increased rapidly. This alarming figure reminds the Diabetesmellitus is an ice burg disease. Diabetics is more dreaded in these days because ofcomplications of this disease, the quality of life takes a backseat. In Ayurveda Madhumeha and its management through various methods arepossible viz shodana, shamana. Considering the chikitsasutra the Phalatrikadi Vati as ashamana chikitsa is under taken for the trial. As ayurvedic Madhumehahara drug whichare having safety in comparison with modern oral hypoglycemic drugs. The present study intended to focus on the disease evaluation i.e. Madhumeha vis-à-vis. Diabetes Mellitus and the management with Phalatrikadi Vati as a shamanaChikitsa. Hypothetically evaluated therapeutic efficacy on the Madhumeha vis-à-visDiabetes Mellitus is tested through the test under the following objectives. In this regardthe objectives proposed in the study are – Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Objective 6
  • 18. Objectives: 1) To evaluate the efficacy of Phalatrikadi Vati in the management of Madhumeha 2) To evaluate the efficacy of hypoglycaemic activity of Phalatrikadi Vati in Madhumeha1) To evaluate the efficacy of Phalatrikadi Vati in the management of Madhumeha Dosha involvement in Madhumeha is Tridosha with predominance of Kapha andvata with vitiation of dushy Mamsa, Meda and Shareera kleda. The ingredients of thePhalatrikadi Vati are with Kapha Vata Doshahara and are of Katu, Tikta Rasapredominance, Usna veerya to pacify Kapha Vata Dosha. Having gunas like Laghu,Rookasha. Phalatrikadi Vati basically acts as Agni vardhaka, to normalize the Agni. Byobserving all these characteristics of drugs Phalatrikadi Vati seems to be very muchbeneficial in the management of Madhumeha which could be clinically observed tounderstand Mehahara actions.2) To evaluate the efficacy of hypoglycaemic activity of Phalatrikadi Vati inMadhumeha As the Phalatrikadi Vati is hypothetically capable of inducing the hypoglycemicactivity, is evaluated through Blood Glucose testing. An attempt is made to measure theBlood sugar, urine sugar at different times of relation to meal. The evidential estimationsof the blood sugars with corresponding urine sugars are recorded before and after theinduction of trial drug to estimate the hypoglycemic action of the test drug. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Objective 7
  • 19. HISTORICAL REVIEW The knowledge of the ancient helps in having a better future. So the study ofhistory should be must for research purpose. So, careful insight into ancient treasureof knowledge makes a good beginning for any study. The ancient treatise was fullwith description of disease and their treatment. So here an attempt has been made toexplore the past literature to explain the historical aspects of the Madhumeha.Vedic Period (2000BC to 1000BC): The evolution of madhumeha can be traced from Vedas. Ayurveda is theupanga of atharveda. In Atharva Veda (2500 B.C.) the disease is mentioned asAshravam, which means Mutra Atisara i.e., excessive urination 17.a) Samhita Period (1000BC to 100BC)(A) Samhita Period: Explorative description of disease Madhumaha occurs at Samhita period.(1) Caraka samhita: Caraka samhita is a complete ancient treatise of medical science of its era; Hehas given the detail description of the etiology, pathogenesis, symptomatology &complications in Nidanastana 18. Where as detailed explanations of treatment is givenin Chikitsastana19. Aetiopathogenesis of madhumeha along with Complications arenarrated in Sutrastana 20.(2) Susruta Samhita: Achary Susruta has given elaborate explanations regarding Nidan Panchaka inMadhumeha in the pramehaadhyaya. He used Ksaudrameha synonym to Madhumehain Nidanastana21. He has described Pramehanivritti Lakshanas especially, i.e. how toknow that the patient is out of the disease. He has described the treatment in three Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 8
  • 20. different chapters under the heading of Prameha-Chikitsit22, Prameha PidakaChikitist23 & Madhumeha Chikitsit 24.(3) Vagbhata: Vagbhata mentioned two types of Madhumeha i.e. Dhatukshyat andavartpathat and added Sveda in the Dusysangraha 25.(4) Haritasamhita: Explained13 types of Prameha with nomenclature different than above treatiselike, Puyameha, Ghrtameha etc 26.(5) Bhela Samhita: In Nidanasthana, description of two types of prameha is given i.e. swakritijaprameha and prakritija prameha 27.(6) Kasyapa Samhita: He just mentioned the symptoms of Pramehi child in Vedanadhyaya and notedthe disease as Chirakari 28.(B) Medieval Period: This period of history of Indian medicine is known as a period ofcommentators. Most of them content only the collection of thoughts from previousauthours.(1) Madhavanidana: He collectively repeated the description of Charaka, Susruta and Vagbhata 29.(2) Gayadas: Explained the Avilamutrata becaue of the presence of Dusya in it 30.(3) Chakrapanidatta: Chakrapanidatta described the treatment of prameha in his documentationChakradatta 31. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 9
  • 21. (4) Sarangadhara Samhita: Mentioned the 20 types of Prameha and some yogas for the management ofprameha 32.(5) Bhavaprakasa: He described Prameha and Madhumeha along with some new herbomineralpreparations33.(6) Yogratnakara: Prameha chikista has been described vividly in Yogratnakara 34. NIRUKTI AND PARIBHASHAA) Nirukti – Madhumeha is the combination of the two words Madhu and Meha. The wordMadhu is derived from the root ‘Mana’ has the meaning of ‘Manava Bhodane’-.Which gives the psychic contentment [Vachspathya].Madhu- The Madhu refers to honey, sweet, delicious, the juice or nectar of theflowers, Soma also.Meha- The word Meha is derived from the root ‘Miha’, which is employed in thesense of Prasrave, excessive flow of urine, making water, passing urine, Sinchana, tomoisten, Ksharana. [Vachspathya].Prameha - The word Prameha is derived from “Pra and Miha” Pra + Miha Ksharane, Karane + Ganm 35This is a general name for a urinary disease. It is a condition characterized byexcessive excretion of urine. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 10
  • 22. B. Paribhasha: Madhumeha is the clinical entity in which patient voids the urine havingconcordance with Madhu i.e. of Kasaya and Madhura taste, ruksa (dry) texture andhoney like colour 36. Body acquires sweetness called madhumeha. Susruta has defined Madhumeh as Ksaudrameha and stated that the urine in 37this condition resembles honey and acquires a sweet taste . So it is undoubtedlyresembles with Madhumeha. Further he asserted that when all the Pramehas areneglected get converted into Madhumeha and especially he emphasized that thedisease Prameha along with Pidaka should be termed as Madhumeha 38.C. Paryaya:Kshoudrameha: Kshoudra is a synonym of Madhu 39.Ojomeha: Ojas is considered as Tejas or essence of all Dhatus, Madhura rasa of Ojamixes with kashaya rasa of Vata and excreted out. Hence Ojomeha has been used byCharaka 40 and Vagbhata 41 to describe this disease.Pushpameha: In Anjananidana, the word pushpa has been narrated as synonym forMadhumeha where the Pushparasa means madhu 42. All above synonyms postulates unanimously that, the urine concordant withmadhu or sweet taste is Madhumeha Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 11
  • 23. NIDANA The knowledge of nidana is helpful for the proper understanding of the diseaseand also for the management of the disease. Nidana parivarjana is also one of theimportant measures in Chikitsa43. Only Charaka explains specific Nidanas forMadhumeha. The Samanya Nidanas of Prameha and Vataja Prameha may attribute toMadhumeha, as it is one of the types of Vataja Prameha. Kaphaja Prameha nidanas may be considered as nidana for Madhumeha. AsKapha dosha is the initial factor for the causation of all varieties of Prameha,especially Madhumeha. This can be emphasized by Gangadhara’s version, where inhe says that Gulma is caused by vayu, Raktapitta by Pitta, like wise Madhumeha iscaused invariably due to the vitiation of Kapha dosha 44.Mainly classified into 1) Sahaja 2) ApattanimityajaSahaja Madhumeha (Beeja dosha): 45 46 Charak and Susruta have explained that beeja dosha is also a cause for Madhumeha. Acharya Charaka while explaining Vikrutha Garbha caused by beeja dosha says that if a part of the beeja is defective, the body part developing from that portion of beeja will be abnormal. He gives an example that a portion of the beeja of a kusti man which is responsible for the formation of the skin is defective, then only the born child will have kusta 47. However if that part is not abnormal then the child will not suffer from kusta .Hence it can be understood that child born to Madhumehi, may or may not suffer from Madhumeha. It depends on the beejabhaga avayava which is defected by vitiated vatadidosha present in Sukra and shonita of parent. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 12
  • 24. 2) Apattanimityaja:a) Samanya Prameha Nidanas: Table – 1 Showing the Aharaja Nidana of MadhumehaS. N. Nidanas C.S. Su.S A.H M.Ni. Bhe.S B.P. Y.R1 Dadhi Sevana + - - + - + +2 Gramyarasa + - - + - + +3 Audakarasa + - - + + + +4 Anupa Rasa + - + + + + +5 Kshira Sevana + - - + - + +6 Nava Anna + - - + - + +7 Nava Pana + - - + - + +8 Guda Vaikruta + - + + - + +9 Kaphakara Hetu + + + + + + +10 Sheeta - + + - - - -11 Snigdha - + + - + - -12 Madhura + + + - - - -13 Medovardhaka + + - - - - -14 Drava Anna + + - - - - -15 Drava Pana + + - - - - -16 Nava Dhanya + - + - - - -17 Nava Sura + - + - - - -18 Ikshu + + + - - - -19 Goorasa - + + - - - -20 Amla - + + - - - -21 Gura - + + - - - -22 Picchila - + + - - - -23 Mandaka + + - - - - - Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 13
  • 25. Table - 2 Showing the Viharaja Nidana of MadhumehaS. N. NIDANS C.S Su.S A.H M.Ni Bhe.S B.P Y.R1 Asyasukha + - - + - + +2 Swapnasukha + - - + - + +3 Divaswapna - + - - + - -4 Avyayama + + - - + - -5 Alasya - + - - - - -6 Ekasthanaasana - - + - - - -7 Rathih - - + - - - -8 Vidhirahitashayana - - + - - - -9 Swapnaprasanga + - - - - - -10 Shayanaprasanga + - - - - - -11 Asanaprasanga + - - - - - -12 Shareerashodhana + - - - - - - Varjya Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 14
  • 26. Table - 3 Showing the Vishista nidanas according to DoshajaNidana Kapha Pitta VataAhara Hayanaka,yavaka,chinaka Ushna,amla, Kashaya,Katu, Tikta,sambhandi ,uddalaka,naishada,ithakata, lavana,kashaya, Rooksha, Laghu, mukunda,mahavrihi, Katu,ajirna, Sheeta, modaka,sughandaka,Sarpi,navaharenu, vishamashana masha,Anupa,udaka,gramyamamsa, shaka,palala,tila,pistanna, payasa,krushara,vilepi,ikshu, sharkara,kshira,navamadhya, mandaka,dadhi, madhura,dravaVihara Mrujavarjana,avyayama, Atiatapasevana, Atiyoga of Vyavaya,sambhandi swapnashayana, aasanaprasanga antapa,shrama, Vyayama, Vamana, kroda Virechana,Ashtapana, Shiroovirechana,Shonita, Atisheka,Sandharana, Anashana,Abhighata, Atapa,Udvega,Shokha, Jagarana,Vishama Shareera,Asana, Upasevana. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 15
  • 27. Table – 4 Showing the Avaranajanya Madhumeha nidanas.Aharaja ViharajaGuru Nidra SukhaSnigdha Asya SukhaAmla Tyakta VyayamaLavana AchintanaNavanna Samshodhana AkurvatamNavapanaNidanarthakara rogaja: A. Sthoulya: Sthoulya is a nidanarthakara roga for Prameha. It is obvious that thesamanya nidana of Sthoulya and Prameha simulates each other. Sushrutha has statedthat apathyanimittaja Pramehis are Sthoola 48. B. Prameha: All the other types of mehas if neglected in its due course, lead into Madhumeha49. Pathogenesis and the srotas involved in Prameha and Madhumeha are similar. So, if the Prameha is not treated then it causes more strain on the same srothases and causes Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 16
  • 28. SAMPRAPTHI The thorough knowledge of Samprapti is very essential to find the extent ofDosha and Dushya vitiation, involvement of Avayava, Srotasa and prognosis of thedisease. For the manifestation of any disease in the body the association of main threefactors, Nidana, Dosha and Dushya is necessary otherwise disease will not occur. According to Sushruta, too much indulgence in the etiological factors relatedto Prameha results into Aparipakva Vata, Pitta, Kapha and Meda, which furtherproceed through the Mutravaha Srotasa and get localized in the Basti Mukha and thus 50leading to disease Prameha . Sushruta has stated that, all the Pramehas if leftuntreated or treated improperly get terminated into Madhumeha. Vagbhata describedtwo types of pathogenesis of Madhumeha i.e. Dahtukshayatmaka and DoshaAvaranatmaka. Further, Vagbhata interpreted that in all types of Prameha, the Doshaand Dushya remain same but still the difference in Mutra Pravritti is due to specific 51type of Samyoga between specific Dosha and Anukula Dushya . Charaka hasexplained the pathogenesis in a detailed manner i.e. Samanaya Samprapti of Pramehaand specific Samprapti of Pramehas. Charaka enumerated the general samprapti incikitsasthana. He narrated that due to over indulgence of etiological factors, Kaphaalong with meda, mamsa and Kleda get vitiated and results into formation ofmetabolic waste which carried towards basti resulting into prameha. In same mannerpitta gets vitiated resulting into pittaja prameha. While Vata due to deplition of othertwo dosa get provocated inturns causes deplition of dhatus by excrete them through 52 53urine resulting vataja prameha . The later texts such as Yogaratnakara andMadhava Nidana 54 have followed the description of Charaka Samhita. This is the concise pathogenesis described in Cikitsasthana but inNidanasthana caraka described pathogenesis according to the type. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 17
  • 29. Samprapti according to doshika predominance:1) Kaphaja Prameha: The etiological factors first cause the provocation of Kapha because of itsclose similarity to the related Hetu. This aggravated Kapha then spreads all over thebody rapidly due to Sharirashaithilya. Meda Dhatu being Bhahutva, Abadhdha andhaving similar properties with Kapha, the provocated Kapha while spreading getsamalgamated with Medha Dhatu causing its vitiation, This annexation of vitiatedMeda and Kapha comes in contact with Sharira-Kleda and Mamsa, which are alreadyin excess quantity resulting Putimamsapidaka On the other hand the vitiated Kledagets converted into Mutra. The Kapha along with Meda and Kleda impede theopenings of Mutravaha Srotasa resulting into Prameha 55. Sushruta narrated Dushyasin each Doshika type of Prameha. He narrated vitiation of Kapha along with Vata, 56Pita and Meda in Kaphaja Prameha . In Ashtanga Samgraha, Vagbhata explainedthat Vitiation of Kapha along with meda, kleda, mamsa, shukra, rasa and get localizedin basti resulting into kaphaja prameha 57.2) Pittaja Prameha: Due to its etiological factors provoked Pitta manifests as Pittaja Prameha 58.Here similar pathogenesis occurs as described in Kaphaja Prameha. Depending ondifferent properties of Pitta Dosha the Paittika Prameha develops into six types.Pittaja Prameha is not entirely Paittika but it does have Pitta predominance as it ismentioned in the very beginning of the 4th chapter of Nidana Sthana by Charaka thatthere is dominance of Pitta Dosha in comparison to Kapha Dosha and Vata Dosha, inPaittika Prameha. Sushruta related Shonita along with Vata, Kapha and Meda in thepathogenesis of Pittaja Prameha 59. Almost similar pathology is described in AshtangaSamgraha and Ashtanga Hridaya. In Ashtanga Samgraha, Vagbhata explained that as Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 18
  • 30. the disease Kaphaja Prameha gets chronic, Kshaya of Kaphadi Dhatus occurs and thus 60Pitta gets vitiated resulting in the manifestation of Pittaja Prameha . Ashtanga 61Hridaya mentions that Pitta vitiates the Rakta producing Pittaja Prameha and restdescription is similar to Ashtanga Samgraha.(3) Vataja Prameha: Here Vata gets provoked due to its own etiological factors and draws outVasaadi Dhatus from the body towards Basti resulting into four types of VatajaPrameha. When Oja is drawn towards Basti due to vitiation of Vata, the naturalMadhura Swabhava of Oja due to the Ruksha Guna of Vata gets transformed intoKashya Rasa leading to the manifestation of Madhumeha 62. One more pathogenesisof Vataja Prameha is described in Chikitsa Sthana. Here provoked Vata due todepletion of other two Dosha carries vital Dhatus towards Basti, resulting into Vataja 63Prameha . Similar description is available in Ashtanga Hridaya. As per SushrutaKapha, Pitta, Meda, Vasa and Majja take part in pathogenesis of Vataja Prameha 64. InAshtanga Samgraha, Vagbhata explained that vitiation of vata in association withlasika, majja, and ojus 65.Samprapti of madhumeha: According to Vagbhata two types of pathogenesis get precipitated 661. Dhatukshayata2. Avaranajanya The different types of Samprapti which are mentioned by various Acharyasare being described below.1. Samprapti vishishta Anilatmaka Madhumeha: The pathogenesis of madhumeha is explained in Charaka Samhita,Nidanasthana. Due to causative factors in the person susceptible for prameha, Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 19
  • 31. vataprakopa occurs. This prakopita vatadosha attracts the vital dhatus like vasa, majja,lasika & oja to basti. Because of vata dosha rukshatva and madhura rasa of oja mixwith kashaya rasa of Vata, comes it into mootrashyaya. Then oja is excreted throughurinary tract later. This condition is termed as madhumeha 67.2. Madhumeha due to Shuddha Vata Due to depletion of Kapha and Pitta, Vata gets provoked and causes theexcretion of Dhatus (like Vasa, Majja, Oja and Lasika) through urinary tract resulting 68into Madhumeha . I.e. this category of Madhumeha is Asadhya due to Vata asArambhaka Dosha and its further consequential provocation due to Dhatukshaya.3. Dhatukshayajanya Madhumeha The Kshaya of Gambhira and Sarabhuta Dhatus like Vasa, Majja, Oja andLasika lead to Vata Provocation. The expulsion of Sarabhuta Dhatus through urineoccurs in such excess amount that this Kshaya itself again acts as Nidana, for VataPrakopa. Hence this vicious cycle goes on and on, but due to Ashukaritva property ofVata all the stages of Samprapti proceed so fast that it leads to Asadhya stage ofdisease very quickly.4. Avaranjanya Madhumeha: The etiological factors of Avaranjanya Madhumeha have been described byVagbhata but he has not explained the pathogenesis of this type of Madhumeha.Charaka has fully illustrated this type of Samprapti in detail, Due to excessiveindulgence in the etiological factors mentioned above, Kapha and Pitta get provokedand vitiates Meda and Mamsa. All are in excess quantity. They in turn causeobstruction to the normal pathway of Vata. This obstructed Vata get provoked anddraws out the Apara Oja from all over the body and carries it towards Basti causing 69Madhumeha . The Kricchrasadhyata of this Avaranajanya Madhumeha is due to Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 20
  • 32. provocation of Vata by Kapha-Pittakara etiological factors. Initially, the Vata Dosharemains innocent in the pathology.5. Kala Prabhavaja Madhumeha: This type of Madhumeha is described by Sushruta & Vagbhata. Though directpathogenesis is not mentioned but it is said that when all types of Prameha are ignoredor not treated properly, they get transformed into Madhumeha 70. We can say that thisis the last stage or further progression of Kaphaja and Pittaja Prameha or complicatedstage of the diseases.Samprapti ghataka of madhumeha: On the basis of various references the Samprapti Ghataka of Madhumeha areillustrated below:-Dosha: Disease is Tridoshakopanimittaja 71.Kapha: Bahu and Abadhdha – in Avaranajanya Madhumeha.Kshina – in Kshayajanya MadhumehaPitta: Vriddha – in Avaranajanya MadhumehaKshina – in Kshayajanya MadhumehaVata : Avrita – in Avaranajanya MadhumehaVriddha – in Kshayajanya MadhumehaDushya: Rasa, Rakta, Mamsa, Meda, Majja, Shukra, Vasa, Oja, Lasika,Kleda 72 and Sweda 73.Srotodushti: Sanga & Ati PravrittiSrotus: Medovaha, Mutravaha, Udakavaha, MamsavahaAgni: Vaishamya of all Agnis (or Dhatvagnimandya)Ama: Jatharagnimandya and Dhatvagnimandya.Adhisthana: Basti Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 21
  • 33. Udbhavasthana: AmashayaSwabhava: Chirakari 74.(A) Dosha: All the three Doshas are responsible for manifestation of Prameha.(i) Kapha: Kapha plays the dominant role in the Samanya Samprapti of Prameha. It is thefirst Dosha to get vitiated. Acharya Charaka while describing the causative factors 75used the term ‘Kaphakrut Cha Sarvam’ in it . It indicates the significance of thisDoshadushti in Prameha. Sharirashaithilya is the consequence of Bahudrava Kapha.Other manifestations are Alasya, Atinidra, Tandra, etc.(ii) Pitta: Here, in Avaranajanya Madhumeha mainly the symptoms manifest because ofVriddhi of Pitta Dosha as Trisha, Daha, Kshudha and Trunshavriddhi 76. Chakrapanicommenting on, Samprapti of Vataja Prameha has been described as Pitta is in 77Kshaya Avastha as compared to Vata in the Vataja Prameha pathogenesis . So,Kshaya Lakshana of Kapha Dosha and Pitta Dosha may manifest in KshayajanyaMadhumeha. Pitta Kshayajanya Lakshanas are Mandagni, Prabhahani, and Sheetataetc 78.(iii)Vata: This is the prime Dosha in the pathogenesis of Madhumeha. Here Vata getaggravated either because of its own etiological factors or because of Avarana causedby Kapha Pitta and Meda. This provoked Vata carries the vital constituents of thebody like Vasa, Majja, and Oja towards Basti and excretes them outside through urineresulting in kshaya of the Dhatus. Thus due to atikshaya of Dhatus, the symptommanifests are Karshya, Daurbalya, Angasuptata and Parisaranshila nature 79. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 22
  • 34. (B) Dushya: Nidana, Dosha and Dushyas are the three factors responsible for themanifestation of every disease. Charaka specially enumerated dushyas in a group andnamed it as a dushya vishesa again he mentioned them in Chikitsa 80. Only Vagbhatamentioned sweda as a dushya along with the above dushyas 81.i) Rasa: Rasa is the seat of Kapha Dosha and at the same time it is the Mala ofRasadhatu. So prakopita Kapha has affinity towards the Rasadhatu. Susrutaemphasized that sthaulya and karshya results due to vitiation of rasa Dhatu andpractically we can found both conditions in the Madhumeha. So the role of rasa Dhatuis very much important in the precipitation of the disease.The symptoms like Alasya,Gaurava, Karshya, Hrillasa, Gaurava, Angamarda, Sada, Pandutva, Klaibya etc. areproduced as a result of Rasa Dushti.ii) Rakta: It mainly gets vitiated in Pittaja Prameha. The Rakta Dusti Lakshanas areDaha, Pidika, etc. And skin diseases like Kustha, vidradi, Pidika, kotha are producedas a result of Rakta Dusti 82.iii) Mamsa: Mamsa and Kapha are having the same qualities i.e. both give strength to thebody. When Kapha gets vitiated, Mamsa losses its normal consistency and developsShaithilya and provides space in between for the accretion of morbid matter. Thisconsequently results into the Puti Mamsa Pidika 83. "Mamsaleshu Arakasheshu" 84.iv) Meda: It is the dominant Dushya in all types of Pramehas. It gets vitiated bothquantitatively and qualitatively. Kapha and Meda have close resemblance as they Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 23
  • 35. have the same qualities. Both get vitiated more or less by same etiological factors.In Madhumeha vitiation of Meda results in two ways as already said:-1. Qualitative [Abadhdha, (Asamhat)]: Normal function of Meda is to produce snigdhata in the body along withDridhatva i.e. compactness. So this Abadhdhatva causes derangement in the structureof Meda producing Shaithilya in the body.2. Quantitative (Bahu): Here in the pathogenesis, Meda is in excess quantity. This Medo Dhatu isAparipakva 85. Meda Dhatu is the most Anukula Dushya for provoked Kapha Dosha.Guru Snigdhadi Ahara and Avyayamadi Vihara leads to Atimedovriddhi i.e. Bahutvaof Meda Dhatu, due to Dhatvagnimandya. Whatever obese persons take in food, itgets converted into Meda and other Dhatus remains under-nourished leading toDhatukshaya. Along with Bahutva, Dhatvagnimandya also results into Abadhdhatvaof Meda. Such an Abadhdha Meda gives ‘Sharira Shaithilya’ and instead of doingAsthi Poshana; Meda Dhatu gets itself over burdened which is harmful to the body.Meda Dushti may manifest in many ways .The deranged Meda produces followingsigns and symptoms which are the eight Doshas of Atisthula person 86.1. Ayusorhrasa: Decreased life expectancy.2. Javoparodha: Early manifestation of Ageing3. Kricchravyavayata: Difficulty to perform sexual act and impotency4. Daurbalya: General Debility5. Daurgandhya: Bad smelling due to excessive sweating6. Swedabaddha: Discomfort due to excessive sweating7. Kshudha-Ati Matra : Polyphagia8. Pipasa-Atiyoga: Polydipsia Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 24
  • 36. By observing above description certainly it can be asserted that in Sampraptiof Madhumeha, Meda plays the foremost role.v) Majja: Due to Vata Prakopa Kshaya of Majja Dhatu occurs. Thus vitiated Majjaproduces clinical symptoms like, Netragaurava, Angagauravata in patient 87.vi) Shukra: Shukra Dhatu gets affected in the pathogenesis of Prameha; Shukra due to itsvitiation produces symptoms like Daurbalya and Kricchravyavayata. In SahajaPrameha Shukra play an important role. Prameha is a Kulaja Vikara and occurs asresult of Beeja Dosha. Sushruta has described that Shukra Dosha and Prameha get 88precipitated because of the vitiation of Vyana and Apana Vata . Vata causes 89depletion of Shukra Dhatu and also Shukrameha . So, one can appreciate theimportance of Shukra Dushti in Prameha.vii) Vasa: Charaka described it as a subtype of vataja Prameha i.e. vasameha 90. It is anUpadhatu of Mamsa and is ‘Sleshmika’ in character. The provoked Vata draws Vasatowards Basti and excretes it through the urine in the form of Sneha. In case ofMadhumeha, the Dushti is illustrated in the form of Bahutva as well asAbadhdhatva91.But still the manifestations are not described concerning Vasa Dushti.viii) Lasika: The aggravated Vata propels Lasika towards the Basti and then excretes itthrough the urine leading to increased micturation. Lasika is a kind of fluid found 92beneath the skin between it and Mamsa Dhatu . It is excreted from the skin in theform of sweat. So the manifestation of Lasika Dushti may be in the form of excessivesweating. Lasika is described as a Dushya in Hastimeha. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 25
  • 37. ix) Oja: Oja is supreme extract of all the Dhatus and gives strength and immune powerto the body. Oja is the purest quality of Sleshma in its constitution, Guna and Karma.Oja is an important Dushya in the Samprapti of Madhumeha. Here provoked Vatatransforms the Madhuratwa of Oja into Kashayatwa and carries Oja towards Basti and 93excretes through urine leading to Ojakshaya . So the symptoms of Ojakshaya likeMurccha, Mamsakshaya, Moha, Daurbalya (excessive weakness), Vyathita Indriya,Rukshata, Gurugatrata, Nidra, Tandra etc may manifest 94.x) Kleda: It is also an important Dushya after Meda. The literal meanings of Kleda are –wetness, moisture, dampness etc. In the commentary regarding Sharira Kleda inCharaka samhita mentioned that Kleda gives Shaithilya to Sharira. Charka has givenAmbu as a synonym to Kleda. Normal function of Mutra and Sweda has beendescribed by Vagbhata as, under normal physiological conditions Mutra and Swedamaintain balance of Kleda in the body. Especially Sweda holds it in the body and 95Mutra excrete it outside the body . If this Kleda gets vitiated it directly affects theMutra and Sweda and disrupts the physiology of bodily elements causing Shaithilya.Arundatta has mentioned that absence of Kleda may lead to the dryness of the body 96.In the Samprapti, Kleda Dushti is in the form of ‘Vriddhi’ and not the Kshaya. Hence,Bahu Kleda will manifest as Prabhuta Mutrata and Avila Mutrata because extensivelyincreased Kleda is excreated out of the body as Mutra. The other manifestations ofKleda Dushti may be Shithilangata, Ati Sweda Pravritti, Visra Sharira Gandha (due toexcessive sweating), Sharira Mruduta, Snigdhata etc.xi) Sweda: This Dushya has been mentioned only by Vagbhata 97. Sweda is mainly Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 26
  • 38. related with Meda and Kleda. Due to the vitiation of Meda and Kleda, SwedavahaSrotodushti occurs leading to the manifestation of Ati Swedapravritti, Daurgandhya,Picchilagatrata, Snigdhagatrata Visra- sharirgandha etc. Sushruta mentioned that in 98Madhumeha (Prameha) Sweda becomes Sweet in nature . The whole pathologicalphenomenon described in Kleda and Sweda Dusti can be correlated with water andelectrolyte imbalance.C. Srotodushti: In the Samprapati of Madhumeha there is reference of Mutravaha Srotodushtionly but keeping in mind the symptomatology etc. it can be easily understood thatthere occurs Medovaha, Mamsavaha, Swedavaha and Udakavaha Srotodushti also. Inthe Samprapti of Madhumeha two types of Srotodushti are found:(1) Atipravritti(2) SangaThus we can find out the Srotasa involvement according to the symptoms as follows(1) Mutravaha Srotodushti - Prabhuta Avila Mutrata(2) Medovahasrotodushti - Purvarupa of Prameha, Snigdhagatrata etc(3) Mamsavaha Srotodushti - Putimamsapidaka(4) Udakavaha Srotodushti - Pipasa, Mukha-Talu-Kantha Shosha.D) Agni: There is no direct reference related to the Agni condition but bothAgnimandya and tikshna Agni conditions present in the pathogenesis.E) Ama: Sushruta has illustrated the role of Ama in the pathogenesis of variousdisorders. He mentions that the Samprapti of Prameha takes its origin from the Ama 99only . He states that is from the very beginning, Agnimandya has been developed Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 27
  • 39. due to Guru, Snigdhadi Ahara and Avyayamadi Vihara which leads to production ofAma. Dalhana adds that not only Dosha but Meda Dhatu is in the Ama form. HenceAma is a part and parcel of Samprapti. Ama means Aparinamittaja. Anything whichremains in undigested form, being harmful to the body is Ama. It is Apakva(undigested), Asyaukta (Shithila), Durgandhi, Picchila in nature and it producesGatrasada. In the Samprapti of Madhumeha, we also get the dominance of Amaregarding Kapha Dosha, Meda Dhatu, Mamsa Dhatu, and Kleda. The undigestedKapha and Meda acts as Ama vitiating the Mutravaha Srotasa leading to Madhumeha.This vitiation is in the form of Srotasa obstruction. Below chart showing the symptomatology and their relation with Dosa andDusya. So Madhumeha is the disease clinically we can found with variousPresentation. Thus with the help of above chart we can easily find out the extent ofDosa and Dusya involvement in the pathogenesis to profound the treatment modalityexactly according to the stage of the disease. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 28
  • 40. Table - 5 Shows the Roopa and their relation with Dosha and Dushya.Sl. Dosha nature ofVitiation Strotus Involved LakshanotpatiNo. 1. Kapha Vriddhi Sarvasarira Jatilibhavakesesu Madhuryamasasya Alasya Shithilangata Snigdhagatrata Picchilagatrata Nidra, Tandra Madhura and Suklamutrata 2. Pitta Vriddhi Sarvasarira Bahuashitva. Pipasa. Hastapadataladaha. Paridaha. Visrasarirgandha. 3 Vata Vriddhi Sarvasarira Sada. Karasuptata. Padasuptata. Angasuptata. Karsya. Dusya 1. Rasa Vriddhi and Dushti Rasavaha, Udakavaha Gaurava. Sada. Tandra. Sthaulya and Krusangata. Mukha Tula Kanthasosa. 2. Rakta Dusti - Vidradhi Raukshya (Sahaja Prameha) 3. Dusti Mamsavaha Putimamsa Pidaka Mamsa Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 29
  • 41. Shaithilya TalugalajivhaDateshu Malotpatti4 Meda Dusti ,Vriddhi Medovaha Sthaulya Medodosha Atikshudha Atitrushna Daurgandhya Daurbaya Svedavrdhi5. Majja Dusti Vriddhi Majjavaha Netragaurava Angagaurava Murca6. Shukra Dusti Ksaya Shukravaha Klaibya7. Kleda Dusti Vriddhi Mutravhaa,Svedavaha Mutradosa Prabhutamootrata Avilamootrata Svedavruddhi8 Sveda Vriddhi, Dusti - Svedavruddhi Daurgandhya Paridaha Shlaksnagatrata9 Oja Ksaya. Sarvasarira. Daurbalya Gurugatrata Tandra, Nidra Murcha Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 30
  • 42. Figure – 1 Madhumeha SampraptiAvarana janya Apathyanimittaja Sahaja MadhumehaMadhumeha Madhumeha Nidana sevana Beeja Dosha Vikruta bahudrava Kapha Travels all over the body because of shareera shithilata Medo dhatwagni mandyaSthuolya Medovaha srotas vitiation Bahu abaddha medasKapha Pitta Meda Mamsa Dosha dushya sammurchanaAtivruddhi Bahudrava sleshma with bahu Abaddha medaObstruction of Vata dueto avaranaby vitiated Vitiation of other dushyaKapha Pitta and Meda Adhika kledata of DhatuSqueezing of Ojas in to vasti Vasti Madhumeha Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 31
  • 43. BHEDA Classification of a disease is mainly done for the purpose of properunderstanding of the disease and to formulate an effective treatment proptocol.Through this different point of view, many classifications are available from our textsof which most important is according to its dosha predominance. In classics twentytypes of prameha have been described according to its dosha predominance, as theseare precursor for Madhumeha. If these pramehas are not treated in time or properly,they get converted into Madhumeha. They are, Kaphaja Pramehas - 10 Pittaja Prameha - 06 Vataja Prameha - 04s Table – 6 Types of PramehaKaphaja prameha Pittaja prameha Vataja pramehaUdaka meha Kshara meha Vasa mehaIkshu meha Kala meha Majja mehaSandra meha Nila meha Hasti mehaSandraprasada Meha Lohit meha Madhu mehaSukla meha Manjishtha mehaSikata meha Haridra mehaSita mehaShanair mehaLala mehaShukra meha Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 32
  • 44. Vagbhata clearly narrated that these types result because of the nexusbetween Dosha, Dushya and their specific combination according to concordance. 101Thus in each subtype of prameha specific urine is voided . Charaka put forth histheory that all these types and their nomenclature is because of the specific qualitiesand their combinations with each other but, the nomenclature is mainly based apounthe predominance of one quality 102. By observing the all classification we can easily understand the Doshapredominance, dushya involvement, nature of urine voiding and we come know toabout the etiological factors, State of the disease and progression.Classification of Madhumeha: Clinicopathological status of a disease has an invariable relation with physicalconstitution of the body in Madhumeha. This has to be taken into consideration whentreatment is formulated. According to this, in Ayurveda, Madhumeha is of twotypes103. • Sthula • Krisha The root cause of disease has enough importance for the prognosis &treatment of the disease. The occurrence of Madhumeha according to this point ofview is of two types 104: • Sahaja [Heriditary] • Apathyanimittaja [Acquired]Sahaja: 105 Sahaja prameha occurs as a result of Beejadosha i.e. genetic origin . Whiledescribing prognosis, Acharya Charaka has narrated that prameha or Madhumehaoccurring due to Beeja dosha is incurable 106. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 33
  • 45. Apathyanimittaja: Apthyanimittaja type itself suggests its etiology. It occurs due to Ahitaharavihara. Sampraptighataka has manything to do with the prognosis & treatment of thedisease. On analyzing the samprapti, Apthyanimittaja madhumeha is of two types.(A) According to Samprapti • Avaranjanya • Dhatukshayajanya:1) Avaranjanya: In Avaranjanya madhumeha, Kaphavardhaka nidanasevana leads to vataavarana, this in turn leads to Ojas Karshana which comes to the basti & patient passesMadhura, Kashaya, and Ruksha Mutra, which is said to be Madhumeha.2) Dhatukshayajanya: Where as in Dhatukshayajanya, due to vatavardhak nidana, vataprakopaoccurs & the Madhuratwa of Oja along with Kashaya rasa is brought to the bastileading to Madhuvat Mutratyaga, leading to Madhumeha.(B)According to Nidana: • Santarpanjanya • ApatarpanjanyaSantarpanjanya Santarpanjanya madumeha which is directly occur due to intake ofkaphavardhaka ahara. The excess intake of such substances will primarily lead to thevitiation of kapha, pitta, meda & mamasa, which in turn cause madhumeha by doingavarana of vata 107. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 34
  • 46. Apatarpanjanya If the substances which deplete the dhatu & aggravate vata are consumed thenit leads to Apatarpanjanya Prameha. They act through vitiation of vata which in turnleads to the manifestation of Madhumeha. In nutshell, Sahaja & Apathyanimittja are types of Madhumeha. The Krisha,Dhatukshayajanya & Apatarpanjanya can be correlated with Sahaja Madhumeha.TheSthula; Avaranjanya & Santarpanjanya can be correlated with ApathyanimittajaMadhumeha. POORVA ROOPA The poorvaroopas are helpful in diagnosing the disease as early as possible,also to know prognosis, differential diagnosis of disease. The poorvaroopas explainedin the context of prameha are to be considered as the poorvaroopas of madhumeha.Specific poorva roopa for Madhumeha have not been mentioned anywhere in classics.In this context poorva roopa of Prameha are discussed. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 35
  • 47. Table-7 Showing the poorva roopa of MadhumehaSl No Lakshana Ch Su AH AS Ma Ni1 KesheshuJatilibhava + + - + -2 Asya madhurya + - + + +3 Karapadadaha + + + + +4 Karapada Suptata + - - - -5 MukhaTaluKanthaShosha + - + + -6 Pipasa + + - + +7 Alasya + - - + -8 Kaye malam + - - + -9 KayaChhidreshuUpadeha + - - +- -10 Paridaha Angeshu + - - - -11 Suptata Angeshu + - - + -12 ShatpadaPipilikaMutrabhisaranam + - + + -13 Visra sharir gandha + + + + -14 MutrechaMutradosham + - - - -15 Sarvakala Nidra + - - + -16 Sarvakala Tandra + + - + -17 Snigdha gatrata - + - + -18 Pichhila & guru gatrata - + - - -19 Madhur mutrata - + - - -20 Shukla Mutrata - + - + -21 Sada - + - + -22 Shwasa - + - + -23 Keshanakhativriddhi + + + - -24 Sheeta Priyata + - + + -25 Hridaya NetraJihwShravanopdeha + - + - -26 Sweda + - + + -27 Dehachikanata - - -28 Ghanagatrata + + - - -29 Dourghandya - + - - -30 Danteshu malotpatti - + - - + Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 36
  • 48. If all the Pramehas are neglected then it results into Madhumeha. This may bethe reason for not mentioning the specific poorva roopas by our Acharyas forMadhumeha and most of the poorva roopa mentioned in our classics are the clinicalfeatures and complications of madhumeha. So, the poorva roopas of Prameha ingeneral discussed here. Our Acharyas have given more importance to poorva roopas. According toSushrutacharya, if all the poorva roopas are clearly exhibited and if the patient noticea slight increase in mootra, then one can infer that patient may suffer from Prameha inthe near future. If half of the poorvaroopa are exhibited clearly and patient noticeadhikamootra pravritti, then it is the clear indication of the presence of Prameha 108. In olden days vaidyas used to detect the presence of sugar in urine bypipeelikaabisarana. A patient use to approach a vaidya only when he suffered fromprabhoothamootrapravritti. But he neglected the symptoms like snigdhata of the body,atinidra etc. which occur much more earlier than the above mentioned cardinalfeature. Thus our Acharyas have considered these early stages as poorva roopa. ROOPA The signs and symptoms of a disease will be produced in the fifth stage ofsamprapthi i.e. vyaktavasta. In this stage doshadooshya sammurchana will be capableto produce its lakshanas. In ayurveda only mootra sambhandhi lakshanas are mentioned forMadhumeha. But samanya lakshanas of Prameha and also lakshanas ofapathyanimittaja Prameha are also can be included under lakshanas of Madhumeha. The Rupa as described in Ayurveda includes both, sign and symptoms of thedisease. These are described under following headings:- Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 37
  • 49. Mootra sambhandi lakshanas:A. Samanya lakshana 1091. Prabhootha mootrata: This is the cardinal sign of prameha described by all acharyas. Increase inquantity and frequency of mootra is considered as prabhootha mootrata. It ismanifested due to increased kleda in the body and collects in the basthi. Askledavahana is the function of mootra, excess of kleda in the basthi will be excretedthrough mootra frequently by vitiated apanavata. So, prabhootha mootrata in terms ofquantity and frequency is seen in Madhumeha.2. Avila mootrata: Turbidity of mootra is considered as Avila mootrata. Patient passes urinehaving hazy consistency. Dalhana opine that, the characteristic features of urine arebecause of the nexus between Mutra, Dosha & Dushya 110. Table - 8 Showing the vishista lakshanas:SN Roopa C.S S.S A.H A.S M.Ni Y.R B.Ra G.Ni1 Kashaya + - - + + + + +2 Madhura + - + + + + +3 Pandu + - - - - - - -4 Rooksha + - - + + + + +5 Snigdha - - - + - - - -6 Ojadhatu - - - + - - - -7 Kshoudravat Madhviva - - + - - - + -8 Kshoudra rasa - + - - - - - --9 Kshoudra varna - + - - - - - -1. Kashaya: Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 38
  • 50. Bhavamishra interprets it as kashaya Varna which can not be elicitedclinically111.2. Madhura mootra: It is also because of excretion of ojus in mootra. Earlier they used to detect thisby pipeelikas. Now a day by urine examination one can understand mootramadhuryata.3. Pandu: Pandu varnata of mootra may be due to excessive kleda in the mootra.4. Rooksha: Due to vitiation of vata one can notice rukshata.5. Madhusama mootra: Varna, gandha, rasa of mootra will be similar to that of madhu. It is due to theojonissarana in mootra.Sarvadaihika lakshanas of apathyanimittaja prameha: In Chikitsa sthana Susruta before propounding the treatment of Prameha,asserted two types of Prameha along with their features as follows,1) Sahaja Prameha 112 • Ruksha • Alpashi • Bhrsa pipasa • Parisarana sheela2) Apathya nimittaja 113 • Bahu ashi • Snigdha • Shayyasana swapna sheela Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 39
  • 51. UPADRAVA Upadrava is important in deciding the prognosis of the disease. In this contextsamanaya upadrava of Prameha and vataja Prameha upadravas have been illustratedin the tabular column, as Madhumeha is a variety of vataja Prameha. Acharaya Charaka enumerated the general complications. Achraya Sushruta &Acharya Vagbhatta described according to the Dosha predominance. Table – 9 Showing the Samanya upadravas of pramehaSl.No Upadrava Charaka samhitha Bhela samhitha 1 Trishna + + 2 Athisara + - 3 Daha + - 4 Dourbalya + - 5 Arochaka + + 6 Avipaka + - 7 Angamardha - + 8 Shoola - + 9 Bhrama - + 10 Tama - + 11 Kandu - + 12 Pidakas + +2) Specific Complications:(a) Kaphaja meha 117: Makshikopasarpanam, Alasya, Mamsopachaya, Pratishyaya, Shaithilya,Arochaka, avipaka, Kaphapraseka, Chhardi, Nidra, Kasa & Shwasa. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 40
  • 52. (b)Pittaja meha 118: Vrushanayorvadaranam, Bastibheda, Medhra toda, Hridshula, Amlika, Jwara,Atisara,Arochaka, Vamathu, Paridhumayanam, Daha, Murchha, Pipasa, Nidranasha,Panduroga, Pittavidmutranetratva & Vidbheda(c)Vataja meha 119: Hridgraha, Laulya, Anidra, Stambha, Kampa, Shula, Baddha purishatva &shosha, kasa, shwasa.Complications of Madhumeha: Acharaya Charaka has mentioned 7 types of pidaka as complication ofMadhumeha; While Sushruta & Vagbhatta has mentioned 10 pidakas. Sushruta has 120mentioned that Madhumeha along with pidaka is asadhya . He narrated that thesepidaka occurs due to Tridosha and vitiated meda & vasa 121. Table – 10 Showing the 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 + + + Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 41
  • 53. SADHYASADHYATHA A forecast of the probable course and termination of a disease is prognosis orsadhyasadhyatha. In general by considering the factors responsible for deciding sadhyasadhyathagiven in texts, i.e. hetu, poorva roopa, roopa, dosha, dooshya, prakruthi, kala, desha,upadrava, sarvoushadhakshmathwa, chatushpada etc, the prognosis or sadhyasadhyataof the disease can be assessed122. Generally the concept of prognosis in the case of prameha are given by allacharyas as, • Kaphaja Prameha - Sadhya • Pittaja Prameha -Yapya • Vataja Prameha -Asadhya when occurred due to dhatukshaya & Krichrasadhya when Occured due to avarana.(1) Sadhya - Kaphaja Prameha Etiological factors are same to that of Dosha, Dushya and having samequalities and same seat. So the treatment is same for both. Thus Kaphaja Prameha isSadhya 123. Charaka explained few things about prognosis of the disease that Sthairyai.e. Sadhyata (Curability) results when Kapha get vitiated along with same qualitydushya i.e. Prakrti bhutatvat. Asadhyta incurability results because the vitiation ofKapha that occurs along with different quality Dushya like Raktadi. The treatmentproved to be Viruddha i.e. apposite to each other, Vikrti bhutatvat as said byChakrapani 124.2) Yapyatva - Pittaja Prameha 125 Pittamehas are explained to be with this status . The disease is requiringcontinuous treatment. Once the treatment is stopped the disease is again provoked. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 42
  • 54. Also vishamakriyatva i.e. the disease is cured by langhana therapy but the associatedvitiated dhatus are not. This also leads leads to yapyatva.3) Krichrasadhyatva & Asadhyatva - Vataja Prameha Madhumeha is included in vatajameha. Here vata provocation might be due toSarvadhatukshaya as it occurs after kaphaja & pittaja pramehas. The other importantcause is avarana. When vata provocation is due to dhatukshaya the type is included inasadhya madhumeha 126, while the other produced by avaranjanaya vata is consideredas krichrasadhya127. Charakacharya mentioned that madhumeha produced due toBeejadosha is incurable 128.(4) Prognosis related to Medodusya: Charaka described that if there is less extent vitiation of Meda dhatu inKaphaja and Pittaja Prameha then Pittaja Prameha becomes curable but when there ismore vitiation of Meda then Kaphaja and Pittaja both Prameha become Asadhya.Charaka mentioned that Madhumeha because of the Beeja Dosha i.e. geneticpredisposition is incurable. Susruta mentioned that Madhumeha in association withcomplication i.e. Pidaka is incurable. VYAVACHEDAKA NIDANA Charaka illustrated that if the urine of Pramehi patient is Madhura and Picchilathen differential diagnosis has to be made between Kaphaja Prameha and VatajaPrameha on the basis of Nidana Sevana. Here if etiological factors are related withKapha provocation then it is Kaphaja Prameha but if etiological factors are related 129with Vata provocation then it is Vataja Prameha . Prabhootha mootrata andavilamootrata are the lakshanas which will manifest in all the 20 varieties of Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 43
  • 55. Pramehas. So as to distinguish Madhumeha from other Pramehas, the study of themshould be made. The following table illustrates the difference in different characteristic featuresof other Pramehas. Table – 11 Showing the Sapeksha nidana of MadhumehaTYPES LakshanasMadhumeha Kashaya, Madhura, Pandu, Rooksha.Ikshumeha Ikshu Valika, Madura, Sheeta, Eshat Picchila, Avilam, Kandekshu rasavatSheetameha Madhura, SheetaUdakameha Accham, Bahu, Sitam, Sheeta, Nirgandha, Udakoo-pamamHastimeha Hastimatta ivajasram Mutram Ksharati.Amavata BahumootrataSamajwara BahumootrataSurameha --Sikatameha Mootran Mootragatan Doshan Anun MehatiShanairmeha Manda Manda, Avega, Kricchra, Shanai ShanaiLavanameha --Pishtameha --Sandrameha SandrayuktaShukrameha Shukrabha, Shukra-mishritaPhenameha --Alalameha Tantubaddham, Picchilam.Sandrameha Kinchit Sandra, Kinchit PrasadaShuklameha Pishta Nibham, ShuklaKalameha Masi Varna, UshnaNilameha Chasha Pakshi Nibham NeelaRaktameha Visra, Lavana, Ushna, Raktam Mehati Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 44
  • 56. Manjishtameha Manjisht Udakavat, Sankasha VisramHaridrameha Haridra Udakavat, KatuAmlameha --Ksharmeha Ksharavat Gandha, Varna, Rasa Sparsha.Vasameha Vasamishram, vasabhamMajjameha CHIKITSA In general Chikitsa is the method adopted for eradication of the disease fromthe body. The aim of treatment is to restore swasthya. That means to restore normalfunctions of Agni, dosha, dhatu, mala and maintain mental health. The primaryimportance of Chikitsa lies in samprapti vighatana. In ayurvedic classics, we will not get direct reference regarding the line oftreatment for Madhumeha but the line of treatment advocated for Prameha in generalcan be considered here.Chikitsa sutra: While mentioning the Chikitsa sootra two varieties of Pramehis arementioned. They are Sthoola -balavan and krusha-durbala. Two different lines oftreatment have been explained for these two varieties of Pramehi.1) Stoola pramehi: Patients who are Sthoola, balvan and having bahudosha for suchpatients Samshodhan therapy has been advised depending on the doshicpredominance. This has to be taken into consideration & accordingly the procedurei, eVamana, virechana, basti is decided. Swedana should be avoided, beingcontraindicated in prameha. Basti is contraindicated in Madhumeha but patientspresenting symptoms of burning sensation are advised Nyagrodadi kashaya basti bySusruta. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 45
  • 57. 2) Krushapramehi: Patients who are krusha, durbala, for such patient’s samshamanaand santharpana Chikitsa are advised 130. Here the ahara, oushada which will increasedhatus, impart strength to the body.Depending on the symptoms and predominance ofthe doshas sneha should be administered. The most of the drugs advised for thetreatment of prameha are tikta, kashaya, katu rasa. Vaghbata attributes the following reason for advising samshodhan in Sthoola 131Pramehi . According to him samshodhana (virechana) reduces excessive kleda and 132meda in the body . Most probably the logic behind the above mentionedjustification for shodhana in Sthoolamehi was to reduce the weight in Sthoolamehis.If shodhana is administered in a dhatu kshayajanya Madhumeha then it may lead tofurther deterioration of the dhatu and may turn into a fatal one.Kaphaja prameha :(i) Samshodhan Chikitsa : Samshodana is contraindicated, eventhough it is better to treat the patient withvaman therapy. Charakacharya describes that shodhana, vamana & langhana done atthe proper time looking at the condition of the patient is able to cure kaphaja meha 133.For Bastichikitsa vagbhtta describes the utilization of Surasadi gana kwatha. Acharyas 134after explaining the shodhana treatment give samshaman Chikitsa in every types .Dalhana further commented that after Vamana Karma, Virechana is essential toalleviate the Prameha and also to reduce the Kleda vitiation. Arundatta speciallycommented that after completion of Vamana and Virechana, if patient has strengththen Asthapana Basti should be administered 135.(ii) Samshaman Chikitsa: Charakacharya gives 10 combinations of drugs to all the mehas with kaphapredominance 136. According to Sushruta, after proper samshodhana the patient should Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 46
  • 58. use swarasa of amalaki with Haridra powder with madhu 137. Acharya Sushruta in thiscontext explains single drug decoctions with separate indications in 5 types of kaphaja 138meha & combinations in other 5 types . Vagbhattacharya describes three yogas inthis aspect 139, they are as follows;(i) Lodhrad i- Lodhra, Abhaya, Musta, Katphala(ii) Pathadi - Patha ,Vidanga ,Arjuna,Dhanyaka(iii) Gayatrayadi - Khadirsara, Darvi, Vidanga ,VachaImportance of Apatarpana: Charakacharya explains the cause of prameha as due to increasing attitude ofkleda, meda, and kapha. So he emphasise the role of Apatarpana in kaphaja &Pittajaprameha 140. Different types of vyayama, kshut, udvartana, dhara & snana withchurnas made of Chandana, Aguru, and Ela etc. are advised to use in kaphaja meha 141Pittaja prameha :(i) Samshodhan Chikitsa : 142 Virechan is best in pittaja pramehas . The drugs which are sufficient toeliminate morbid pitta can be used with sheeta and other tikta, kashaya rasa in this.Nyagrodhadi gana kwatha is advised for Asthapanbasti by Acharya Vagbhatta143.Acharya Sushruta has described that due to spreading of medo dhatu all over thebody, Madhumehi subjects are durvirechya 144(ii) Samshaman Chikitsa: Acharya Charaka explains 10 yogas in this aspect to treat pittaja pramehas 145Sushrutacharya have described 6 specific kwatha yogas for the specific type of pittajaprameha 146. The three kwatha yogas explained by Acharya Vagbhatta are 147,(i) Ushiradi : Ushira, Lodhra, Arjuna, Chandana. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 47
  • 59. (ii) Patoladi: Patola, Nimba, Amalaki, Amrita(iii) Lodhradi : Lodhra, Ambu, Kaleyaka, Dhataki.Vataja prameha: Although vatika mehas are incurable still Acharya Charaka explains to induce 148certain treatment in kaphapittanubandhi Vatika meha . Achrya Sushruta hasdescribed that all types of prameha if not treated properly in time, gets converted into 149madhumeha . So the treatment described for vatika meha can be considered astreatment of Madhumeha.In case of Vataja Prameha following points should be carefully noted:(1) Type of Madhumeha i.e. either Kevala Vataja or Avaranjanya.(2) Strength of the patient according to Doshabala, Agnibala and Vyadhibala.(3) Involvement of genetic predisposition. After observing the patient carefully following treatment modalities can beadministered.(i) Samshodhan Chikitsa: Considering Sthoola & krisha pramehi, Samshodhan Chikitsa should beadministered only to the sthoola & Balvan Pramehi. Sarshapa, Nimba, Danti, Bibhitak& Karanja Siddha Taila or Trikantakadya Sneha (Ghrita or Taila) according to doshapredominance, should be used for Abhyantara Snehana. Here while explaining theSamshodhan, Charaka describes to use the Malashodhan yogas from Kalpasthana 150,both Pitta & kapha are eliminated through shodhana. It may be vamana or virechana,because of; Pittantam Vamanam, Kaphantam Virechanam. In Virechana pitta iseliminated first, then Samyak lakshana of virechana is kaphadarshan, so both pitta &kapha doshas which are vitiated are eliminated. Then the described Anuvasana & Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 48
  • 60. Asthapana Basti chikitsas are able enough to control the provocation of vata. Like thisall the doshas are normalized to keep the dosha samyata. Anuvasana with medicatedtaila & ghritas are prescribed in madhumeha. After proper Shodhan Chikitsa,Charakacharya details to give santarpan chikitsa to the patients, to prevent thecomplications like Gulma, Bastishula etc 151.(ii) Samshaman Chikitsa: Samshaman Chikitsa includes mainly deepana (appetizers), Pachana,(enhancing Digestion), Kshut (Hunger maintenance), Trit (Maintenance of thirst),Vyayama (Exercise), Atapa (Having exposed to sunlight) & Maruta (Exposingoneself to Wind).According to the conditions of vitiated doshas & dushyas, vaidyahas to Suggest proper Shaman Chikitsa to the patient. Acharyas introduces different tarpana upakramas in vatika mehas. It is due tothe less strength of the patient. Acharya Charaka & Vagbhatta says that the kashayayogas should be enriched with sneha and given to vatika mehas 152. If there is nexus of Kapha with Vata, then medicated oil prepared by Kaphahara drugs should be given. If there is nexus of Pitta with Vata, then medicated Ghrita Prepared by Pittahara drugs should be given. If more or less equal vitiation of all Doshas occurs, then Yamaka Sneha i.e. oil and Ghrita together prepared with respective herbs should be advised.Typical Madhumeha Chikitsa: Acharya Sushruta explains that Shilajit should be taken after triturating withSalsaradi gana kwatha. After its digestion patient should take JangalamamsarasayuktaAnna. He prescribes to take 1 Tula of shilajatu 153. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 49
  • 61. Compound Preparations Used In Prameha:Swarasa: Amalaki, Haridra, Nimbapatra, Bilwapatra, GuduchiKwatha: Vidangadi, Phalatrikadi, Mustadi, Manjishthadi, PathadiChurna : Triphaladi, Mustadi, Gokshuradi, ArkadiGutika : Chandraprabha, Indravati, Pramehantak VatiGugglu : Gokshuradi GuggulModaka : Kastur Modaka, Trikatukadyamodaka.Avleha : kushavleha, vangavlehaPaka : Pugapaka, Ashwagandhadi paka, Draksha Paka.Asava Arishta: Lodhrasava, Dantyasava, Madhukasava, Devdarvyadiarishta,Lodhrarishta.BallatakasavaGhrita: Dhanvantar ghrita, Trikantakadi ghrita, Sinhamrita ghrita, Dadimadighrita, Shalmali ghrita.Rasaushadhi:Vasant kusumakar Rasa, Chandraprabha vatika, Mehamudgar Rasa,Brihat vangeshwar Rasa, Prameha gajkesri Rasa, Trivanga Bhasma, Vasant tilakaRasa, Swarna makshika Bhasma. PATHYA AHARA VIHARA The ahara viharas which maintain the stability of physical and mental healthare to be considered as pathya. On the other hand ahara vihara which producesimbalance in the equilibrium of dosha, dhatu, mala and manas are apathyas. While treating the disease we should give importance to pathya and apathya inthat disease, other wise our treatment will not yield the desired effect. It is known factthat pathya itself is capable in curing the disease without medicine. Pathya acts as acatalyst in accelerating the action of the drug. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 50
  • 62. Pathya ahara for madhumeha:1. Annavarga: Puranashalyodhana with tiktashaka, puranashyamaka, kodrava,uddalaka, godhooma, shalianna, yavanna, priyangu, shashtikashali, danthi, inguditaila yukta bhojana 154.2. Jalavarga: Kashayodaka, madhodaka, sarodaka, kushodaka, triphalarasa, sidhu 155.3. Dwidalavarga: Brustachanaka, tuvaraka, adaki, mudgayusha, kulattayusha, kalaya,trunadhanya.4. Shakavarga: All thikta shakas.5. Mamsa varga: Jangala mamsa, Vishakira, Pratuda mamsa 156.Pathya vihara for Madhumeha 157:1. Vyayama.2. Rooksha, praghada urdwarthana.3. Nitya snana.4. Jalavaseka.5. Sadashramabyasa.6. Lepa of agaru, ushira, twak, ela and chandana.8. Nishijagarana. Among the pathya ahara yava has been given much importance in our classics.Vaghbatacharya mentioned yava as mootrabaddakara, kapha, pitta, medohara, and itis sthairyakaraka and he has advised to take yava in the form of saktu, mantha,apoopa, laja, vatya etc. Sushruthacharya has given much importance to vyayama, which can beunderstood by following verse. Person who is poor and has no relatives should walkfrom village to village and walk without the protection of is head or legs. The person Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 51
  • 63. should not remain in that village for more than one night and should walk atleast oneto three yojanas a day. He is suggested to lead a saints life 158.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, Mutravegadharana. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 52
  • 64. DIABETES MELLITUS Diabetes mellitus is a syndrome characterized by disordered metabolism andinappropriately high blood sugar (hyperglycemia) resulting from either low levels of thehormone insulin or from abnormal resistance to insulins effects coupled with inadequatelevels of insulin secretion to compensate159. The disease has a particular predispositionfor micro vascular complications and increased tendency for macro vascularcomplications.Diabetes mellitus in Modern Medical History 160: Madhumeha can be literally translated as Diabetes Mellitus as both of them meanhoney urine. Siphon named it as Diabetes Mellitus meaning honey urine.1) Abrus Papyrus: An Egyptian medical compilation (1000BC) has referred to a condition called Polyuria.2) Aratars of Coppadocea (150AD): A contemporary of Galen, has mentioned Polyuria and thirst.3) Thomas Willis (17th Century): First mentioned sweet taste of diabetic urine.4) Mathew Dobson (18th Century): Diabetic serum contains sugar.5) Jhon Ralo (1797) – One of the first to coin term mellitus.6) William prout (1810-20) - Diabetic coma described7) Michel cherreul (1857) – Excess sugar in Diabetes is glucose.8) Wilhelm petters (1857) - Acetone found in diabetic urine.9) Paul langerhans (1869) – Pancreatic islet identified10) Adolf kussmaul (1974) – Acidotic breathing in diabetic coma. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 53
  • 65. 11) Minkowski & nonmering (1889) – Pancreatectomy cause Diabetic in dogs12) Jean de meyer (1907) - Hypothetical glucose; lowering hormone named insulin.13) Banting best Collip Macleod (1922) - Isolation & first clinked use of insulin.14) JR Muslin (1923) – Discovered & named glucogens.15) F Sanger (1955) – Sequencing of insulin.16) Rothetal (1971) – Discovered insulin receptor17) Wrich Etal (1977) – Insulin gene cloned. AETIOLOGY The aetiopathology of type II diabetes is unknown. Both increased peripheral insulin resistance and decreased beta-cell function are involved in the path physiology of the disease. However, it is unlikely that a single factor is the cause of this heterogeneous disease. Genetics: Identical twins of a patient with NIDDM have a greater than 90% chance of developing diabetes and about 25% of other patients have a first degree relative with NIDDM. These observations suggest a strong genetic component, and it is now clear that NIDDM is a polygenic disorder. A few families show abnormalities of the gene which codes for the enzyme glucokinase on chromosome and other families have been described with abnormalities of genes coding for hepatic nuclear factor1alpha and 4 alphas, but genetic defects in most families with NIDDM are as yet unknown. Environmental factors: A strong association has been noted between low weight at birth and at 12 Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 54
  • 66. months of age and glucose intolerance later in life, particularly in those who gainexcess weight as adults. The concept is that poor nutrition during early life impairsbeta cell development and functions, predisposing to diabetes in later life.Immunology: There is no evidence of immune involvement in the pathogenesis of NIDDM,but as noted earlier a proportion of late onset patients carry islet autoantibody ICAand GAD at diagnosis and are more likely to progress to insulin therapy. Thesepresumably represent late onset IDDM.Predisposing factors: Predisposing factors are those that increase the risk of getting a particulardisease. There are many conditions that increase the risk of diabetes.Hereditary: A familial tendency to diabetes undoubtedly exists. The hereditary aspects ofdiabetes is well summarized in the following statement by Warren and Le Compte,when both the parents have diabetes, all the children may be expected to develop thedisease, if they live long enough. When one parent has diabetes and the other isdiabetic carrier, 40% of their children may develop the disease. If a diabetic or acarrier marries an individual, who neither has diabetes nor a diabetic carrier, none ofthe children will have diabetes.Obesity: The association of obesity and diabetes has long been recognized. Almost 80%people who develop diabetes later in life are overweight. Excess weight increases thebodies demand for insulin and obesity is the main cause for insulin resistance. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 55
  • 67. Decreased numbers of insulin receptors are seen in obese individuals. Hence it ismajor cause for Diabetes Mellitus. Symptoms of Diabetes Mellitus may disappearwith loss of weight. Elevated levels of free fatty acids and the hormones resistin andleptin have been associated with insulin resistance at different phases. Such factorsare also present in obesity. It is not known yet if elevated levels are simply a productof obesity or play some causal role in diabetes 161.Age: The diabetes may appear at any age, but 80% of cases occur after the age of 50,and highest incidence of cases is in the 50 to 70 age group. The risk of diabetesincreases with age especially after 40 years mainly because the number of beta cellsin the pancreas that produce insulin decreases as age advances.Gender: Both men and women have the same risk of developing diabetes till earlyadulthood, after 30 years women are at high risk as compared to men. Women whodevelop diabetes during pregnancy are at higher risk of developing type II diabeteslater in life.Viral Infection: Some viral infections may destroy the beta cells in the pancreas and thereforecause diabetes.Stress: Some hormones released during stress may block the effect of insulin on thecells thus causing diabetes. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 56
  • 68. Sedentary Life: Some recent studies have indicated that people with sedentary life Style are more likely to have diabetes as compared to those who lead an active life. It is believed that exercise and physical activity increases the effect of insulin on the cells. PATHOPHYSIOLOGY OF NIDDM 162 The basic metabolic defect in the type 2diabetes either a delayed insulin secretionrelative to glucose load (impaired insulin secretion) or the peripheral tissue are unable torespond to insulin. Type 2 DM is a heterogeneous disorder with a more complex etiology and is formore common than type 1DM, but much less is known about its pathogenesis. A numberof factors have been implicated through, but HLA association & autoimmune phenomenaare not implicated these factors are as under. 1) Genetic factors – Genetic component has a stronger basis for type 2DM than type 1DM. Although no definite & consistent genes have been identified. Multifactorial inheritance is the most imp factor in development of type 2 DM. 2) Insulin resistance – One of the most prominent metabolic features of type 2 DM is the lack of responsiveness of peripheral tissues to insulin, especially of skeletal muscle with insulin resistance & hence type 2 DM. Mechanism of hyperglycemia in these cases is explained as under • Resistance to action of insulin resistance impairs glucose utilization & hence hyperglycemia • There is increase hepatic synthesis of glucose. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 57
  • 69. • Hyperglycemia in obesity is related to high levels of free fatty acids & cytokines affect peripheral tissue sensitivity to respond to insulin. The precise underlying molecules defect responsible for insulin resistance in type2DM has yet not fully identified. It is proposed that insulin resistance may be possiblydue to one of the following defects. • Polymorphisms in various post receptor increase signal pathway molecules. • Elevated free fatty acids teen in obesity may contribute e.g. by impaired glucose utilization in the skeletal muscle of glucose & by impaired beta cell function3) Impaired insulin secretion - In type 2DM, insulin resistance & insulin secretion are interlinked. • Early in the course of disease, in response to insulin resistance there is compensatory increase secretion of insulin in an attempt to maintain normal blood glucose level. • Early in the course of disease, insulin secretion appears to be normal and plasma insulin levels are not reduced. However, the normal pulsatile, oscillating pattern of insulin secretion is lost and rapid first phase of insulin secretion triggered by glucose is obtunded. Collectively, these and other observations implicate such derangements in insulin secretion seen early in type 2diabetes, rather than deficiencies in insulin synthesis 163. • Eventually, however there is failure of beta cell function to secrete adequate insulin, although there is some secretion of insulin i.e. cases of type 2DM have Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 58
  • 70. mild to moderate deficiency of insulin but not its total absence. The exact genetic mechanism why there is fall in insulin secretion in these casesis under following possibilities are proposed • Islet amyloid polypeptide which forms fibrillas protein deposits in pancreatic islet in longstanding cases of type 2DM may be responsible for impaired function of beta cell islet cells. • Metabolic environment of chronic hyperglycemia surrounding the islet may paradoxically impair islet cell function • Elevated free fatty acid levels in these cases may worsen islet of function. 3) Hepatic glucose synthesis One of the normal roles played by insulin is to promote hepatic storage of glucoseas glycogen & suppress gluconeogenesis. In type 2DM as a part of insulin resistance byperipheral tissues. Liver also shows insulin resistance i.e. in spite of hyperglycemia in theearly stage of disease, gluconeogenesis in the liver is not suppressed. This results inincrease hepatic synthesis of glucose which contributes to hyperglycemia in these cases CLINICAL FEATURES 164 The presenting features of diabetes vary widely. Age and nature of symptoms atonset may be broadly indicative of the clinical type. Most middle aged and elderly patients (NIDDM) have an indefinite or insidiousonset. Most often medical help is sought because of symptoms related to hyperglycemiai.e. polyuria, polydypsia and hyperglycemia are detected during routine checkup. Othersget investigated for unexplained weakness, weight loss, aching or cramps in the legs, Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 59
  • 71. delayed healing of wounds, recurrent crops of boils or appearance of a carbuncle oftencalls for investigation. Even more common are early complaints of pruritus vulvae inwomen and balanoposthetis in men. Not infrequently poor obstetric history of impotenceindicates the possibility of Diabetes. Investigation in cases presenting with neurologicaldeficits, visual disturbances or premature coronary peripheral or cerebrovascular diseasemay reveal Diabetes for the first time. Broad differences can be noticed in the age at onset of symptoms, mode ofpresentation, body build, and family history, social and nutritional status and besidesfindings among the common type of Diabetes laboratory investigations and follow upstudies are some times necessary to establish the category.1. Polyuria: Polyuria is due to the osmotic diuretic effect of glucose in the kidney tubules.There may be nocturia also.2. Polydipsia: The diuresis in turn causes obligatory loss of electrolytes from the extra cellularfluid, which then causes compensatory dehydration of the intracellular fluid and henceproduces polydipsia.3. Polyphagia: The failure of glucose utilization by the body because of deficiency and resistanceof insulin produces and sends a message to the center, so digestive enzymes will besecreted more hence Diabetic patient will have polyphagia.4. Weakness: The failure of glucose utilization, loss of electrolyte and loss of body protein Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 60
  • 72. contributes to weakness.5. Weight loss: Due to fluid depletion and the accelerated break down of fat andMuscle secondary to insulin deficiency.6. Glycosuria: When ever the quantity of glucose entering the kidney tubules in the glomerularfiltrate rises above approximately 225 mg/min, a significant proportion of the glucosebegins to spill in to the urine and when the quantity increases above about 325mg/minwhich is tubular maximum for glucose. All the excess above this is lost in to the urine.7) Dryness of Mouth and Throat: This is the effect of polyuria.8) Constipation: The stool becomes hard and bowel movement may take place after every 2-3days. Classification of Diabetes Mellitus 165A. Primary:a. Insulin dependent Diabetes Mellitus (IDDM, TYPE I)b. Non-insulin dependent Diabetes Mellitus (NIDDM, TYPE II) 1. Non obese NIDDM. 2. Obese NIDDM 3. Maturity onset Diabetes of the young (MODY)B. Secondary Diabetes:1. Liver disease: Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 61
  • 73. Cirrhosis.2. Pancreatic disease: Cystic fibrosis. Chronic pancreatitis. Malnutrition-related pancreatic disease. Pancreatectomy. Hereditary haemochromatosis. Carcinoma of the pancreas.3) Endocrine disease: Cushings syndrome Acromegaly. Thyrotoxicosis. Phaeochromocytoma Glucogonoma.4. Drug induced disease: Thiazide diuretics. Corticosteroid therapy.5. Insulin-receptor abnormalities Congenital lipodystrophy. Acanthosis nigrican6. Genetic syndromes .Friedreichs ataxia. Myotonic dystrophy Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 62
  • 74. COMPLICATIONS OF DIABETES MELLITUS 166 The disease has a particular predisposition for micro vascular complications andincreased tendency for macro vascular complications.Acute Complications: Hypoglycemia Diabetic Ketoacidosis Non Ketoic hyperosmolar stateChronic Complications:(1) Macrovascular Complications: Coronary artery disease. Peripheral Vascular disease. Cerebro vascular disease.(2) Microvascualar Complications : Diabetic Eye disease Retinopathy (non-proliferative/proliferative) Macular edema Glaucoma Cataracts Diabetic Neuropathy Poly neuropathy /mono neuropathy Autonomic neuropathy. Diabetic Nephropathy Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 63
  • 75. Pyelonephritis Renal arteriosclerosis Kimmelstiel Micro albuminuria Papilitis(3) Other Gastro intestinal [gastroparesis, diarrhoea] Genito urinary [uropathy /sexual dysfunction] Dermatologic infections. Diabetic foot. Differential diagnosis 1671) Diabetes mellitus & Endocrine disorders: a) Pituitary gland 1) Pituitary diabetes due to growth hormone 2) Acromegaly 3) Diabetes insipidusb) Adrenal Cortex 1) Cushing’s Syndrome 2) Steroid diabetes due to administration of steroids 3) Primary Hyperaldosteronismc) Adrenal Medulla Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 64
  • 76. 1) Phaeochromocytoma 2) Addison’s disease 3) Adrenalectomyd) Thyroid 1) Hyperthyrodism 2) Myxoedema2) Pancreatic Diabetes 1) Acute pancreatitis 2) Mumps (rarely) 3) Chronic pancreatitis 4) Haemochromatosis 5) Total pancreatectomy 6) Carcinoma of pancreas3) Diabetes liver 1) Cirrhosis of liver 2) Gall Stones4) Drugs & diabetes Thiazide, Chlorthalidone, frusemide, oestrogen containing oral contraceptives, βblockers & catacholaminergic drugsV Miscellaneous 1) Type I glycogen storage disease 2) Down’s syndrome 3) Turner’s Syndrome Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 65
  • 77. 4) Huntington’s choreaConditions of polyuria Polyuria should not be confused with prostratic hypertrophy or cystitis becausehere it is only increased frequency of micturition & not increased quantity.1) Polyurea due to water diuresis Cranial or neurogenic diabetes insipidus: This is due to an identifiable lesion inthe hypo thalamus pituitary or both leading to failure of A.D.H. Nephrogenic diabetesinsipidus: Familial form seen in males only also as an accompaniment of Fanconisyndrome. Psychogenic polydipsia or compulsive water drinking this is a hystericalcondition. There is clinically marked fluctuation here.2) Polyurea due to increased solute load Diuretic therapy Chronic renal failure TREATMENT 168: The word treatment in Diabetes Mellitus seems incomplete instead managementof Diabetes Mellitus is an appropriate term as the disease can only be controlled andconstitutes a multidimensional approach namely Diet, exercise, oral hypoglycemic,insulin & patient education are vital aspect which require due consideration in themanagement of Diabetes Mellitus.1) Diet: Today there is no one diabetic diet. The recommended diet can only be defined asa dietary prescription based on nutrition assessment & treatment goals. Medical nutrition Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 66
  • 78. therapy for people with diabetes should individualized, with consideration given to eatinghabits & other lifestyle factors. Nutrition recommendations are then developed to meettreatment goal & desired outcomes. Monitoring metabolic parameters, including bloodglucose, glyceated haemoglobin, lipids & body weight as well as quality of life is crucialto ensure successful outcomes 169. Modification of diet is the most important aspect in the therapeutic plan forpatients with Diabetes Mellitus. Diet therapy consists of maintenance of proper nutrition& monitoring of total number of calorie ingested, individual food sources that make upthese calories & distribution of calories thought the day.The selection, modification & restriction are the key words in planning in a diabeticsubject depend on the judicious selection of carbohydrate, moderation in a diabetic inprotein intake & a determined restriction of total fat intake. The obese & overweight must be encouraged to reduce weight. An energy deficitof 500kcal daily will help the patient reduce ½ kg body weight. Life style Daily calorie requirement Sedentary 20-25 kcal/Kg of IBW Moderate active 26-30 kcal/Kg of IBW Strenous 31-35 kcal/Kg of IBW2) Exercise: Exercise is an important aspect of the management. It helps to improve glycaemiccontrol by increasing insulin sensitivity, maintaining body weight, reducingcardiovascular risk factors & inducing a sense of well being. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 67
  • 79. Type II Diabetes Mellitus subjects must be evaluated about the cardiovascularrisk factors before beginning the exercise programme. Aerobic exercise like walking,swimming & cycling are more effective than isometric exercise in improving theglycaemic status.3) Oral hypoglycaemic agents(OHAs) – Oral hypoglycaemic agents should be used in type II Diabetes Mellitus in theextent of failure of diet & exercise.Indications The use of oral hypoglycaemic agents in the management of type II DiabetesMellitus has withstood the test of time, inspite of controversies; usually OHAs areintiated when dietary modification & exercise facil to achieve euglycaemia in type IIDiabetes mellitus.1) Sulphonyurea – Sulphonylureas, like Chlorpropamide & Tolbutamide Glipizide & Glyburide, aresecretogogues having predominantly pancreatic action. This increases endogeneousinsulin levels. They are useful in averagely built or lean type 2 Diabetes Mellitus.2) Biguanides – Metformin a biguanide is widely regarded as the drug of choice overweight orobese patients with type 2 Diabetes mellitus. It can also be used in normal weightpatients. Metformin can be used in combination with any OHAs4) Alpha glucosidase inhibiters- Alpha glucosidase inhibiters like acarbose are helpful in controlling post prandial Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 68
  • 80. hyperglycaemia. Given along with meals. They can be combined with Sulphonyurea,Biguanides and insulin5) Meglitinides – Meglitinides like repaglinide, nateglinide are also helpful in controlling postprandial hyperglycaemia. They must be taken just prior to meals can be combined withSulphonyurea, Biguanides.6) Thiazolidinedione derivatives – Thiazolidinedione derivatives like Rosiglitazone are useful in subjects withinsulin resistance. They can be combined with Sulphonyurea, Biguanides and insulin. Itis widely regarded as the drug of choice for overweight, obese patients with type2Diabetes mellitus. It can also be used in normal weight patients. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 69
  • 81. DRUG REVIEW In madhumeha vitiation of Meda, Kleda, Vasa and Lasika along with the kshyayaof vital Dhatus like Oja and Majja take place, so the dhatu kshyaya produce Vataprovocation and leads to madhumeha. So line of treatment should be to reverse thepathogenesis with the help of Shamana as well as Sodhana. In Chikitsa, medicamentshould posses Tikta and Kasaya Rasa along with Kapha Vata hara, Medo hara,Kledaghna and Prameha hara properties. 170 Phalatrikadi vati contains about 7 drugs. Properties of these drugs are tikta,kashayarasa, laghu, rooksha guna and katuvipaka. Kaphavatahara. These are said to bekaphagna, mehagna, medogna and mootrasangrahaneeya. Thus the selected combination– Phalatrikadi vati is of the drug of choice for the present clinical trial. Table – 12 Combination of Phalatrikadi Vati S.No. Sanskrit Name Botanical Name Proportion 1 Haritaki Terminalia chebula 1 part 2 Bibitaki Terminalia bellirica 1 part 3 Amalaki Embcica officinals 1 part 4 Daruharidra Berberis aristata 1 part 5 Vishala Cirullus colocynthis 1 part 6 Musta Cyper rotundus 1 part 7 Haridra Curcuma longa 1 part Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Darg Review 70
  • 82. HARITAKI 171 – Latin name – Terminalia chebula,Gana – Prajastapana, Kustagna, Arshogna, Kasagna, JwaraharaPrayojyanga- Phala, majjaRasa – Pancha rasa , lavanavarjita kashayarasa pradhanaGuna – Laghu, RukshaVeerya - UsnaVipaka - MadhuraPrabhava - TridoshaharaDoshagnta - TridoshaharaRogagnta – Sotha, prameha, kusta, vruna, vatarakta, mutrakrcchraChimical constituents- Anthraquinone glycoside, chebulic acid, tannic acid, vit c. 172BIBHITAKI – Latin name – Terminalia bellirica (pp239)Gana – Jwarahara, VirecanopagaPrayojyanga- Phala, majja, bija, seed kernalRasa – Pancha rasa kashayarasa pradhanaGuna – Laghu, RukshaVeerya - UsnaVipaka - MadhuraDoshagnta Kapha-pittaharaRogagnta – Jwara, kasa, shwasa, atisara, ashamari, trushna, chardiChimical constituents- Fructose, galactose, glucose, mannitol, thamnose, edible oil, gallicacid, chebulagic acid, ellagic acid. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Darg Review 71
  • 83. AMALAKI 173 - Latin name – Emblica officinalisGana - Vayastapana, VirecanopagaPrayojyanga- Phala, majjaRasa – Pancha rasa , lavanavarjita amlarasa pradhanaGuna – Laghu, RukshaVeerya – SitaVipaka – MadhuraPrabhava – RasayanDoshagnta – TridoshaharaRogagnta – Prameha, raktapitta, kusta, arsha, sula, mutrakrcchraChimical constituents- Ellagic acid, lupeol, oleanolic aldehyde, leucodelphinidin,procyanidin, tannin, vit c, phyllembin, linolic acid, indole acetic acid.MUSTA 174- Latin name – Cypers rotundusGana – Lekhaneeya, Kandugna, Trushananigraha, TruptignaPrayojyanga- TubersRasa – Tikta, katu, kashayaGuna – Laghu, RukshaVeerya - SitaVipaka - KatuDoshagnta – Kapha-pittaharaRogagnta – Jwara, kasa, Kandu, atisara, grahani, trushna, kusta, rakta vikara, krimiChimical constituents- Lineol, copadiene, copaene, cyperen I & II, cypernone, rotundone, Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Darg Review 72
  • 84. HARIDRA 175- Latin name – Curcuma longaGana - – Lekhaneeya, Kustagna, Vishagna, TiktaskandaPrayojyanga- KandaRasa – Tikta, katuGuna – Laghu, RukshaVeerya - UsnaVipaka - KatuDoshagnta – Kapha-vataharaRogagnta – prameha, Kandu, kusta, vruna, krimi, pandu, kamalaChimical constituents – curcumene, curcumenone, curcone, curdione, lineolecurzerenone, epiprocurcumenol, eugenol, camphena, camphor, borneol, procurcumadiol.DARUHARIDRA 176 – Latin name – Berberis aristataGana – Lekhaneeya, Kandugna, ArshognaPrayojyanga- moola, stem, fruitRasa – Tikta, KashayaGuna – Laghu, RukshaVeerya - UsnaVipaka - KatuDoshagnta – Kapha-pittaharaRogagnta – prameha, kusta, vruna, kamala, visarpaChimical constituents – Karachine, Taxilamire, berberine, palmatin, Jatrorrhizine,oxycanthine. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Darg Review 73
  • 85. INDRAVARUNI 177-Latin name – Citrullus colocynthisPrayojyanga- Root, fruitRasa – Tikta,Guna – Laghu, Ruksha, TiksnaVeerya - UsnaVipaka - KatuDoshagnta – Kapha-pittaharaRogagnta – Prameha, kusta, Udara, kamala, unmada, aparmara, kasa, shwasaChimical constituents – Alkoloids I II & III, cholinecucurbitalin B, cucurbitalin E,citrullol, citronellal, methyleugenol insitol. Phalatrikadi vati ingredients are well identified and collected from local area.Good manufacturing practice is followed for the preparation of Phalatrikadi vati afterfortification with the Phalatrikadi kwatha. . Later, at the time of distribution, requisitequantity of the medicine was packed and given to patients. The individual components ofthe composition are as follows under specified headings. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Darg Review 74
  • 86. METHODOLOGY1) Method of Research design Madhumeha vis-à-vis Diabetes mellitus is the 3rd largest killer in the world behindthe cardiac ailments worldwide. It is becoming a great catastrophe with a current highprevalence rate at in urban dwellers. At least 50% of all people are with Madhumeha are undiagnosed and noticedfrom a dentist. In spite of many advances in contemporary science, the management ofMadhumeha is unsatisfactory Recent studies reveal that the prevalence rate of type-2diabetes is from 10-18% in the urban Indian adult population and also increasing in ruralpopulation too.Thus the trail is Simple Random sampling technique clinical study. In thisPatients were taken in randomized selection.2) Posology of Trial drug Internally: 2000 mg / 24hrs in divided two doses or 33.3 mg /Kg body weightdistributed in equal doses3) Anupana of Trial drug Madhodaka is undertaken as it is stipulated for the medicine.4) Study duration of Trial drug Phalatrikadi vati Simple Random sampling technique clinical study wasconducted for 30 days. The medicine was dispensed for 7 days to all patients and advised Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Methods 75
  • 87. to report for every 7 days interval, noted the nature, frequency and other symptoms oftheir disease during their visits.5) Follow up of Trial drug Phalatrikadi vati trail offered a further follow up 30 days. The effect of yoga wasanalyzed according to clinical and functional response before and after the treatment iscompared.6) Source of data of Trial drug The data was collected from the patients suffering from Madhumeha in the OPDof post graduation and research center DGM Ayurvedic medical college Gadag bypresent inclusion criteria & exclusion criteria.a) Selection of the patient Patients of Madhumeha fulfilling the criteria of diagnosis were selected in thepresent 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 thestudy design.i) Inclusion criteria Patients with symptoms of Madhumeha are included with classical symptomsenumerated at the classical texts under the lime light of contemporary medical contextalong with criteria of inclusion. The symptoms of inclusion are as under. • Age of patients between 25-65 years. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Methods 76
  • 88. • All patients other than that of exclusive criteria are included. • Irrespective of gender. • Non insulin dependent diabetes mellitus. • Patient having clinical features of Madhumeha. • Patient having clinical features of Madhumeha viz. Prabhuta mootrata Avilamotrata Karapadadaha Kshudadhikya Pipasa Atisweda Dourbalyaii) Exclusion criteria • Insulin dependent D.M Vis-à-vis Madhumeha • Patients who develops complication with other systemic disease • Juvenile diabetes • Malnutritional D.M • Gestational D.Mb-2) Diagnosis measurements The signs and symptoms of Madhumeha mentioned in Ayurveda andcontemporary science were the main basis of diagnosis and criteria for assessing theresponse to the treatment. Assessments of results were made according to clinical andfunctional improvement observed in the study. Clinical assessment was made on the basis Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Methods 77
  • 89. of symptoms viz. prabhoota mootrata, kshudha etc., which are allotted grades accordingto 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 Grade 0 - Crystal clear fluid Grade 1 - Hazy with slight turbidity Grade 3 - Turbidity clearly present but news Print can be read through the tube. Grade 4 - More turbidity news print cannot be read. 3) Kara pada dhaha Grade 0 - No kara padadadha Grade 1 - Occasionally noticed Grade 2 - Periodically noticed Grade 3 - Daily noticed Grade 4 - Continuously noticed Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Methods 78
  • 90. 4) Kshudhadikya Grade 0 Normal Grade 1 Actively hunger Grade 2 Intermittent hunger Grade 3 Bulimic hunger 5) Pipasa Grade 0 Normal Grade 1 Slight inclination Grade 2 Temporarily suppressed Grade 3 Unsuppressed 6) Atisweda Grade 0 Normal sweating after doing normal physical activities Grade 1 Moderate sweating Grade 2 Excessive sweating Grade 3 Excessive sweating just by doing little work7) Dourbalya Grade 0 No Dourbalya Grade 1 Occasionally noticed Grade 2 Periodically noticed Grade 3 Continuously noticed Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Methods 79
  • 91. B-3) Assessment measures and Laboratory-investigations The following investigations are under taken to fulfill the criteria of inclusionsand exclusions. The effective parameters which are considered for the assessment are asunder.a) Blood Sugar estimations Blood glucose is determined by using Gluzyme glucose reagent setProcedure A blood sample is collected from patient into a sterilized container. Serum isseparated from the cells at the earliest possible time (within 30 minutes), then the serumblood 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 TestWorking enzyme reagent (ml) 3.0 3.0 3.0Distilled water (ml) 0.025 - -Standard ( ml) - 0.025 -Sample (ml) - - 0.025Calculation Glucose in mg/ dl = Absorbance of sample x 100 Absorbance of standard Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Methods 80
  • 92. The same procedure is applied for both FBS and PPBS. The FBS is done withempty stomach and on the same day the PPBS is calculated after 2 hours of food and theresults are recorded in case sheet.b) Urine Sugar estimations A fresh urine sample is collected from the patient. 5 ml of Benedict solution istaken in a test tube and 5-6 drops of urine sample put in that. Then the test tube is heatedtill until a boil in the solution and cooled at room temperature. The change is observedfor the presence of sugar.ObservationsColour of test solution Urine sugar Blue Nil Green 0.5 % Yellow 1.0 % Orange 1.5 % Brick red 2.0 % The following are investigations were done prior to the study just role out thegeneral condition of the patient. a) Erythrocyte Sedimentation Rate b) Hemoglobin %c) Criteria of assessment Over all assessment of results are done considering the cumulative subjective andobjective parameters assessments. As the disease is not totally curable in the scheduled Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Methods 81
  • 93. time span of the study, the grades of assessments made for the results declaration are asfollows – 1. Regulated – i. After Treatment if PPBS is less than 135mg/dl ii. Patient relieved with symptoms clinically 2. Palliative – i. After Treatment if PPBS is more than 136mg/dl and less than 160mg/dl ii. Incomplete Symptomatic relief for the patient clinically 3. Responded – i. If PPBS more than 161mg/dl, if there is a good difference in Baseline data ii. Symptomatic relief for the patient is witnessed partially 4. Not responded None of the above conditions Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Methods 82
  • 94. RESULTS Present study registers 25patients, out of 30 approached patients. Out of this, 5patients not fulfilled the inclusion criteria hence their data has not been included in theassessment. The remaining 25 patients of Madhumeha viz. Diabetes Mellitus, fulfillingthe criteria of diagnosis and inclusive criteria were included in the study. Fasting andPostprandial blood sugar (FBS and PPBS) along with corresponding urine sugars (FUSand 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 casesheet format given in the annex. Both the subjective and objective criteria were recordedalong with validation of disease state. The data recorded are presented under thefollowing headings. A. Demographic data B. Evaluating disease Data and C. Result of the Phalatrikadi Vati and D. Statistical analysisA) Demographic data: The details of Age, Gender, Religion, and Occupation etc. of the 25 patients are asfollows.A1) distribution of patients by Age Here in this study an attempt is made to understand the male female responses tothe management with respect to that of the age groups. An interval of 10 has consideredfrom the ages 25 to 65 as discussed in the methods. In the study it is revealed thatMadhumeha is even though thought that starts from the ages of 25 onwards and the fact Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 83
  • 95. found is not suggestive. At the older age group of 55-65, 8(32%) patients reportedsuggest the chronicity of the disease. Where in 45-55 and 35-45 age groups reported with9 (36%) and 8 (32%) patients in each group respectively. Table- 12 Results by Age in Madhumeha with Phalatrikadi VatiAge Not Regulated Palliative Responded Total % Responded25- 35 0 0 0 0 0 035 – 45 1 2 4 1 8 3245 – 55 0 2 7 0 9 3655 – 65 1 1 5 1 8 32Total 2 5 16 2 25 100% 8 20 64 8 100 Figure – 3 Results by Age in Madhumeha with Phalatrikadi Vati 7 6 5 Regulated 4 Palliative 3 Responded Not Responded 2 1 0 25- 35 35 – 45 45 – 55 55 – 65 Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 84
  • 96. 2) Distribution of patients by Gender Table - 13 Results by Gender in Madhumeha with Phalatrikadi VatiGender Regulated Palliative Responded Not Responded Total %Male 1 5 8 0 14 56Female 1 0 8 2 11 44Total 2 5 16 2 25 100% 8 20 64 8 100 The percentage of the distribution does not show any gender differentiation to getthis Madhumeha in specific, except a small lean towards male population. Theobservations are 14 Patients i.e. (56%) were male and 11 patients i.e. (44%) were female. Figure – 4 Results by Gender in Madhumeha with Phalatrikadi Vati 8 7 6 5 Regulated 4 Palliative Responded 3 Not Responded 2 1 0 Male Female Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 85
  • 97. 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 Hinducommunity as the ratio of community at the study area is more i.e. 24 (94%) along withMuslim patients 1 (4%). Table - 14 Results by Religion in Madhumeha with Phalatrikadi VatiReligion Not Regulated Palliative Responded Total % Responded Hindu 2 4 16 2 24 94Muslim 0 1 0 0 1 4Christian 0 0 0 0 0 0 Others 0 0 0 0 0 0 Total 2 5 16 2 25 100 % 8 20 64 8 100 Figure – 5 Results by Religion in Madhumeha with Phalatrikadi Vati Christian 0% Others Muslim 0% 4% Hindu Muslim Christian Others Hindu 96% Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 86
  • 98. At the results observed, out of 24 (96%) of Hindu patients, 2 (8%) patientsregulated and 16 (64%) patients fall under responded category. On the other hand theresults observed at Muslim community, 1 (4%) patient comes under responded category.The tabulation and graphical representation is as under.A4) Distribution of patients by Occupation Table - 15 Results by Occupation in Madhumeha with Phalatrikadi VatiOccupation Regulated Palliative Responded Not Responded Total %Sedentary 1 4 7 2 14 56Active 1 1 8 0 10 40Labor 0 0 1 0 1 4Total 2 5 16 2 25 100% 8 20 64 8 100 Figure - 6 Results by Occupation in Madhumeha with Phalatrikadi Vati 8 7 6 5 Regulated Palliative 4 Responded 3 Not Responded 2 1 0 Sedentary Active Labour Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 87
  • 99. As the results observed, out of 25, 14 (56%) of sedentary patients, stronglysuggests that the Madhumeha is a disease of the sedentary patients, out of which 1 (4%)patient isregulated, 4 patients are palliative and 7 patients were responded to thetreatment, 2 patients were not responded to treatment. At the active group, out of 10patients 1 (4%) patient is regulated and 1 (4%) patient is palliative, 8 patients areresponded to treatment. At the results are observed, 1patient of Labour is responded tothe treatment.A5) Distribution of patients by economic status At the results observed, out of 3 (12%) of poor patients, all three are responded.Out of 9 (36%) of Middle class patients reported 1 is regulated and 2 patients arepalliative, 6 patients are responded. From higher middle class 13 (52%) patients reportedand out of them 1 patient is regulated, 3 patients are responded palliative and 6 patientsare responded. 2 patients are under not responded category. Table - 16 Results by Economic status in Madhumeha with Phalatrikadi VatiEconomic Responde Not Regulated Palliative Total %status d RespondedPoor 0 0 3 0 3 12Middle 1 2 6 0 9 36Higher Middle 1 3 7 2 13 52Higher 0 0 0 0 0 0Total 2 5 16 2 25 100% 8 20 64 8 100 * Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 88
  • 100. Figure - 7 Result Distribution of patients by Economic status 7 6 5 Regulated 4 Palliative 3 Responded 2 Not Responded 1 0 Poor Middle Higher Higher MiddleA6) Distribution of patients by diet Table – 17 Results by Diet in Madhumeha with Phalatrikadi VatiDiet Not Regulated Palliative Responded Total % RespondedVegetarian 2 4 12 1 19 76Mixed diet 0 1 4 1 6 24Total 2 5 16 2 25 100% 8 20 64 8 100 * The percentage of the distribution does not show any diet differentiation to getthis Madhumeha a disease in specific, except a lean towards vegetarian population. The Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 89
  • 101. observations are 19 Patients i.e. (76%) vegetarian and 6 patients i.e. (24%) were mixeddiet practitioners. Figure - 8 Results by Diet in Madhumeha with Phalatrikadi Vati 12 10 8 Regulated Palliative 6 Responded Not Responded 4 2 0 Vegetarian Nonvegetarian As the results observed, out of 19 (76%) vegetarians, 2 (8%) patients areresponded and 12 (30%) patients responded to the management and 4 patients arepalliative, 1 patient is not responded. As the results observed in mixed diet population,out of 6 (24%), 4(25%) patient are responded, 1 (5%) patient responded palliative and 1(5%) patient not 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 reflectsthe said complaints of the text and Prabhoota mootrata (25 patients), Dourbalya (21patients), Kshudha adhikyata (24 patients) and Pipasa (23 patients) the cardinal Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 90
  • 102. symptoms as polyuria, weakness, polydipsia and polyphasia. The graph and tabulationsare shown as below. Table - 18 Distribution of patients by presenting complaints Presenting complaints Patients % Prabhoota Mootrata 25 100 Avila Mootrata 18 72 Karapada Daha 15 60 Kshudhadhikyata 24 96 Pipasa 23 92 Atisweda 20 80 Dourbalya 21 84 Figure - 9 Distribution of patients by presenting complaints 25 Kshudhadhikyata Atisweda Avila Mootrata 20 15 10 5 0 Prabhoota Karapada Daha Pipasa Dourbalya Mootrata Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 91
  • 103. B2) Distribution of patients by Associated features Mukha talu sosha is said as associated symptom for Madhumeha, which isobserved here at the maximum. Alasya is observed by the 76 % of the patients. Thisstudy observes the rest of the associated complaints enumerated in the table below alongwith the graph. Table - 19 Distribution of patients by Associated features Presenting Associated features Patients Percentage Kara/Pada suptata 2 8 Klama 16 64 Tandra 14 56 Alasya 19 76 Gurugatrata 8 32 Dantadi maladhyatwam 2 8 Shithilangata 2 8 Mukha/Talu shosha 22 88 Figure - 10 Distribution of patients by Associated features 25 Mukha/Talu shosha Alasya 20 Klama 15 10 Dantadi 5 maladyatwam 0 Kara/Pada Tandra Gurugatrata Shitilangata suptata Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 92
  • 104. B3) Distribution of patients by Ahara Nidana Table – 20 Ahara Nidana observed in the study Ahara Nidana Patients Percentage Guda 25 100 Dadhi 19 76 Snigdha 25 100 Dugdha 17 68 Navanna 25 100 Sheeta 15 60 Mamsa 7 28 Ayurveda offered many causes especially in regard with food. The Guda andSnigdha, navanna said as causes are observed 100% in the study. The other factors alsoobserved in the study are tabulated above.B4) Distribution of patients by Vihara Nidana Many regimens are told in Ayurveda, out of which Diwaswapna, Avyayama isobserved 56% and swapna sukham Asannaswapna for 52% of patients. The viharatabulated are here under. Table - 21 Vihara Nidana observed in the study Vihara Nidana Patients Percentage Diwaswapna 14 56 Avyayama 14 56 Swapnasukham 13 52 Asannaswapna 13 52 Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 93
  • 105. B5) Distribution of patients by Anya Nidana The other Nidana told in texts are very less observed here. Only Sthoulya isobserved for 20% of patients. Table - 22 Distribution of patients by Anya Nidana Anya Nidana Patients Percentage Sthoulya 5 20 Manishika- Chinta 8 32 Vegavarodha 2 8 Panchakarma Vibhramsha 0 0B6) Distribution of patients by Poorva roopa lakshana Table - 23 Distribution of patients by Poorva roopa lakshana Poorva roopa Patients Percentage Mutra madhurata 25 100 Trishna 24 96 Talujivha shosha 20 80 Swedadhikya 21 84 Shitalangata 6 24 Sheeta iccha 2 8 Nidra 6 24 Shareera durgandha 1 4 Alasya 21 84 Deha chikkanata 9 36 Mukha madhurta 1 4 Pada daha 4 16 Pani daha 4 16 Dantadeenam Malatvam 6 24 Tandra 11 44 Swasa 2 8 Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 94
  • 106. The Poorva roopa mentioned in Ayurveda are observed here in the study. Mutramadhuryata and Trishna are 100%, 96% and Alaysa is observed for 84%. The rest of thesymptoms observed are tabulated here along with percentage.B7) Distribution of patients by Sroto dusti lakshana Table - 24 Distribution of patients by Sroto dusti lakshana Sroto dusti lakshana Patients Percentage Jihwa shosha 23 92 Udakavaha Talu shosha 23 92 Kloma shosha 1 4 Pravruddha pipasa 17 68 Alpalpa mootrata 0 0 Mootravaha Mootara rodha 0 0 Adhika mootra 25 100 Sashoola mootra 0 0 Basti stabdhata 0 0 Arbuda 0 0 Mamsavaha Arsha 0 0 Mamsa shosha 0 0 Shira granthi 0 0 Sweda 20 80 Medovaha Snigdhanagata 7 28 Sthulashophata 0 0 Pipasa 23 92 Out of different srotas included in the study explicit new dimensions. Out ofUdakavaha srotas –Jihwa sosha observed 92% in study, in Mootravaha srotas – Adhika Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 95
  • 107. Mootrata, in Medovaha srotas the Pipasa are observed 100% in the study. It conform theinvolvement of these srotases. The enlisted symptoms are at above table.B8) Family history Table - 25 Data of Family history in the study Family history Patients Percentage Present 20 80 Absent 05 20 Total 25 100 The Madhumeha observed as familial by researcher prove in study with 80%family history. The rest of 20% show the instantaneous expression of the disease.C) Result of the Phalatrikadi VatiC1) Assessment of Subjective parameters Table – 26 Assessment of Subjective parameters Presenting complaints relieved Patients Patients Patients Before After % % %Avilamotrata 20 80 6 24 14 56Karapada Daha 16 60 4 16 12 16Kshudhadhikyat a 24 96 3 12 19 76Pipasa 24 92 3 12 21 84Atisweda 22 68 4 16 18 72Dourbalya 22 80 7 28 15 60 Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 96
  • 108. The assessments of the symptoms which are presented as the chief complaints arethe subjective parameters of the study observed initially Dourbaly as 80% is witnessedreduced for 60% in the study. Karapada Daha is for 60% of patient’s initially recorded16% of relief. Pipasa initially for 92% of patients exhibit the 84% of relief. Anothermajor symptom Kshudhadhikyata is seen in 96% patients at the start become reduced76% in the study.C2) Assessment of Objective parameters Table – 27 Assessment of Objective parameters Presenting complaints relieved Patients Patients Patients Before After % % %Prabhoota Mootrata 25 100 3 12 17 68Fasting Blood Sugar 24 96 16 64 8 32Post prandial Blood sugar 25 100 17 68 8 32Fasting Urine Sugar 15 60 12 48 3 12Post prandial Urine sugar 20 80 3 12 17 68 The objectives are very much important to assess a study. Here in the studyMootra prabhootatva is reduced 68%. The FBS and PPBS exhibit 32% and 32%differences in the study, where in the FUS and PPUS show the 12% and 68% variancesfrom the base line data. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 97
  • 109. C3) Results of the Phalatrikadi Vati The result is based upon the cumulative effect of the subjective and objectiveparameters together assessed. The result is drawn in four categories viz. Regulated,Palliative, Responded and not responded. Table - 28 Result of Phalatrikadi Vati in Madhumeha Result Number of patients Percentage Regulated 2 8 Palliative 5 20 Responded 16 64 Not Responded 2 8 Total 25 100 Figure - 11 Result of Phalatrikadi Vati in Madhumeha Not Responded Regulated 8% 8% Palliative 20% Regulated Palliative Responded Not Responded Responded 64% Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 98
  • 110. D) Statistical analysis To compare the effectiveness of a drug before and after the treatment thestatistical analysis paired t-test, by assuming that the drug is not responsible for changesin the reading before and after the treatment. The conclusion drawn is as highlysignificant if P <0.05. Table - 29 Statistical analysis of Phalatrikadi VatiParameter Mean SD SE t value P value RemarkAvila mootrata 1.24 0.925 0.185 6.698 <0.001 HSKarapada daha 0.64 0.637 0.127 5.018 <0.001 HSKshudhadhikyata 1.84 0.687 0.137 13,372 <0.001 HSPipasa 1.96 0.6110 0.122 16.039 <0.001 HSAtisweda 1.12 0.7810 0.156 7.170 <0.001 HSDourbalya 2.0 0,816 0.163 12.247 <0.001 HSPrabhoota mootrata 2.08 0.571 0.114 18.196 <0.001 HSFBS 31.84 16.754 3.350 9.501 <0.001 HSPPBS 63.92 39.159 7.831 8.162 <0.001 HSFUS 0.36 0.3685 0.0737 4.883 <0.001 HSPPUS 0.54 0.518 0.103 5.204 <0.001 HS To asscess the effectiveness of drug the stastical analysis is done by using paired ttest, by assuming that drug is not responsible in the changes of reading before & after thetreatment. From analysis both subjective & objective parameters shows highly significant(As p< 0.05) Among the subjective parameters a, pipasa, Kshudhadhikyata, dourbaly showsmore highly significant than other parameters. (Comparing t values). The parameters Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 99
  • 111. pipasa having more net mean effect where as the parameter avila motrata is having lessmean effect (comparing mean value) the variation in the parameter karapada daha is less,where as in the parameter Kshudhadhikyata is more. Among all the objective parameters all the parameters shows significant but in theparameter prabhoota mootrata shows more highly significant than other objectiveparameters With 89.65% of mean improvement. The parameters FBS shows more highlysignificant than other parameter with 20.31% of mean improvement. Among the subjective parameters the percentage improvement is in between79.48% to 90%, which means that the percentage of improvement lies between these twovalues. Where as in the objective parameter the more percentage improvement in theprabhoota mootrata (89.65%) and where as in the parameter FBS is least percentageimprovement (20.317%). Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 100
  • 112. DISCUSSIONThe following headings are made to facilitate discussion. I) Discussion on Disease aspect II) Discussion on demographic data III) Discussion on data of disease IV) Discussion on probable mode of action of Phalatrikadi VatiI) Discussion on Disease aspect: Madhumeha with the clinical features of Diabetes has been recognized sinceantiquity. Diabetes mellitus occurs throughout the world, but is more common (especiallytype 2) in the more developed countries. The greatest increase in prevalence is, however,expected to occur in Asia and Africa, where most patients will likely be found by 2030.The increase in incidence of diabetes in developing countries follows the trend ofurbanization and lifestyle changes, perhaps most importantly a "Western-style" diet. Thishas suggested an environmental (i.e., dietary) effect. In the present era, changing lifestyles i.e. lack of exercise, sedentary life, unbalanced food and stress has lead to theincreased incidence of various diseases and one of them is Madhumeha. In Madhumeha, mainly the Vata and Kapha are predominant though the disease istridoshakopanimittaja. The Vata may be provoked either directly by its etiologicalfactors, by dhatukshaya or by avarana of kapha & pitta to vata. Here the main dushyas areMeda & Kleda and primarily Medhovahasrotodusti takes place. Vagbhata has classified Madumeha into 2 categories, DhatukshayajanyaMadhumeha and Avaranjanya Madhumeha. Similar type of classification is described byCharaka - Apatarpanajanya and Santarpanajanya. The Dhatukshayajanya Madhumeha Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 101
  • 113. can be correlated with Apatarpanajanya Madhumeha, while the Avaranjanya Madhumehacan be correlated with Santarpanajanya Madhumeha. In Dhatukshayajanya / Apatarpanajanya Madhumeha vata dosha gets vitiatedeither due to its own etiological factors or by dhatukshaya. In avaranajanya andsantarpanajanya Madhumeha the kapha and pitta get vitiated due to etiological factorsmainly concordant with them, which obstruct the path of vata causing its provocation &leading to the manifestation of the disease Madhumeha. Here vitiation of vata occurs dueto the Avarana. Thus this disease may be caused both by under nutrition as well as byover nutrition. The first type of Madhumeha is considered to be asadhya and no preciseremedy has been suggested for it. But, the later type has been told as krichhra sadhya andcan be managed with extensive measurements. In Diabetes mellitus there occurs disturbance in carbohydrate, protein and fatmetabolism due to the absolute or relative deficiency of Insulin secretion and/or insulinaction. Diabetes mellitus has been classified into Type I and Type II DM. Type I DMpatients are usually asthenic and need Insulin for treatment and Type II DM patient areusually obese and are usually managed with oral hypoglycemic agents. So, it may be saidthat Type I Diabetes mellitus is closer to dhatukshayajanya Madhumeha while the TypeII Diabetes mellitus is closer to avaranajanya Madhumeha. In the management ofavaranajanya Madhumeha (Sthula Madhumehi), the Shodhana therapy must be donefollowed by Shamana Chikitsa Beeja dosha and Kulaja dosha have been mentioned in the causative factors ofSahaja Prameha. Such patients are said to be weak, emaciated, suffering from thirst, lossof appetite and are required to be treated with a nourishing diet. In diabetes due to genetic Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 102
  • 114. and hereditary factors, patients are weak, asthenic and emaciated. Such patients areJuvenile Diabetics and require a nourishing diet. Therefore Sahaja Prameha and JuvenileDiabetic may be correlated. Apathyanimittaja Madhumeha is caused by excess indulgence in kaphaaggregating factors; such patients are sthoola and are afflicted with Polyphagia, excesssleep and laziness. Maturity onset diabetes tends to over eat and is lazy. In Ayurvedicclassics age factor is not mentioned. The Sthoola and Krisha classification is akin to obese and non-obese division.We will not get much information regarding Sthoola and krisha Madhumeha in ayurveda.While explaining Chikitsa, this type of classification has been mentioned.Nidana: The diet, which promotes Kapha dosha is included under apathyakara ahara forprameha vyadhi. Excessive intake of Dugdha, Dadhi, Guda, Navanna, Sheeta Ahara,Madhura-Amla-Lavana Rasa, Surapana are the causative factor of the Madhumeha.Among mamsa sevan, most of the patients mainly indulge the Gramya and oudakamamsa. Both are Guru, drava, abhisyndi in nature cause vitiation of kapha & meda.Navanna having abhisyandi, take longer time for the digestion and are major cause ofama & kleda. Cause avaroda in srotus causing excessive formation of kleda. Asyasukhaliterally means finding pleasure in diet and comfortable gadgets of living. Swapanasukhameans finding pleasure in oversleeping both these cause kapha vitiation and meda dhatu.Dadhi Gudavaikruta ahara are kaphakaraka. . If madhura rasa is taken excessively then itcauses the Medo Vardhana, Shleshmaja Vikarakara, Sthaulya, and Meha kara 178. As it is Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 103
  • 115. rich in carbohydrates if it is taken in excessively in the form of more refined productsthen increases the total calorie consumption. Over eating causes the metabolic disorders. Many similarities are found between nidanas explained in ayurveda and inmodern science. Beejadosha and kulajadoshas are mentioned in ayurveda which akinwith genetic and hereditary causes explained by modern science. Obesity is mentioned as a major risk factor for Diabetes Mellitus as it causes 179insulin resistance . In ayurveda also explained that atistoola person are more prone to 180develop Prameha . This Prameha roga is included under santharponotta vyadhi.Madhura, Snigdhadi bhojana are mentioned as nidanas for Madhumeha. In modernscience over eating is considered as a predisposing factor for Diabetes Mellitus. Thesefood articles and over eating causes obesity and which may cause Diabetes Mellitus. Sedentary habit is also a predisposing factor. Asannasukha, swapnasuhka etc. canbe included under this. In classics manasika bhavas like chinta, shoka, udwega etc are explained as causefor madhumeha, similarly contemporary science also consider psychological factor likestress as one of the predisposing factor.Samprapti: Any Vikara is a mutual interaction of Nidana, Dosha and Dushya under theinfluence of Prakriti, Desha, Kala, Bala and Vaya. The extent of this Dosha DushyaSammurchana is dependent on the Vikara Vighata Bhava and its Abhava 181. When a person indulges into Nidana of Madhumeha, the Kapha, Pitta, Meda,Mamsa are increases excessively. They obstruct the path of Vata and so the Vata togetherwith Ojas comes down to reach the Basti producing Madhumeha. In the Madhumeha, Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 104
  • 116. Tridosha (Vata, Pitta, Kapha), ten Dushyas (Meda, Mamsa, Kleda, Shukra, Shonita,Vasa, Majja, Lasika, Raja and Oja). Three Srotasas (Mutravaha, Medovaha, Udakavaha)and Dhatvagni plays an important role in the aetiopathogenesis of Madhumeha. Kapha Dosha is the dominant factor in the pathogenesis of Madhumeha. It getsvitiated primarily. Charaka clearly mentioned and Cakrapani opined that Kapha Dosha isdominant and primarily vitiated because of its close resembles with the etiologicalfactors. Kapha have peculiar nature i.e. Bahudrava described by Charaka. So it is easilyunderstand that the Shaithily manifestation in this disease, as Kapha normally causeSthiratva in the body. Cakrapani commented upon the word Sthiratva means Ashaithilya.So this bahudravatva of vitiated Kapha causes disruption in the assemblage of bodyelements and provide ground for the accumulation of morbid matter in the tissues. Kaphacauses 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 thefollowing symptoms manifests in madhumeha. These are shaithilya, Alasya, Atinidra,Gaurava, etc. Pitta Dosha is not so dominant factor in the pathogenesis of Prameha. By thevitiation of Pitta, Avaranjanya Samprapti of Madhumeha resulted. rakta, sweda, lasikaare the seats of pitta dosha. So when pitta gets provoked, it undoubtedly causes thevitiation of above dusyas. Thus the symptoms manifests are sweda vruddhi, visra shariragandha, panidaha, pipasa and sosha indirectly Agni vaisyama too. Vata is predominant dosha in the pathogenesis of Madhumeha, here is Vata getaggravated either because of its own etiological factors or because of avarana caused by Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 105
  • 117. kapha pitta and meda. This vitiated vata carries the vital constituents of the body likeVasa, majja, and oja towards vasti and excretes them outside through urine resultingdepletion of the dhatus. All authors narrated dushya sangraha and their involvement in the pathogenesis,but Charaka specially enumerated a group and named it as a Dushya visesa. Again hementioned them in Cikitsasthana also. Susruta also narrated the Dushyas but he typicallymentioned them along with the doshic type, but he commonly included meda in eachtype. Only Vagbhata mentioned sweda as a dushya along with above dushyas. Rasa is the seat of Kapha Dosha and at the same time it is the Mala of Rasadhatu.Rasa Dhatu mainly vitiates because of its close resemblance with Kapha qualitatively. Soif Kapha get vitiate Rasa also get vitiate. Thus having same symptoms related to Vruddhias mentioned by Vagbhata i.e. Rasoapi Slesmavat 182. Susruta emphasized that Sthaulyaand Karshya results due to vitiation of Rasa Dhatu 183 and practically we can found bothconditions in the Madhumeha. So the role of Rasa Dhatu is very much important in theprecipitation of the disease. The symptoms like Alasya, Gaurava, Karshya, Hrillasa,Gaurava, Angamarda, Sada, Pandutva, Klaibya etc. are produced as a result of RasaDushti. Rakta Dhatu has no much involvement in the manifestation of the Madhumeha. Itis mainly getting vitiated in pittaja Prameha. Not initially but in later stage Rakta also getvitiated prominently causing complications like Pidaka, Vidrdhi, Alasi. Mamsa dhatu is also one of the main dushya, vitiated especially in KaphajaPrameha and Avaranjanya Madhumeha, as Mamsa and Kapha have same qualities. Theyboth give strength to the body. When get vitiated, Mamsa losses its normal consistency Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 106
  • 118. and develops shaithilya and provide space in between for the accumulation of morbidmatter. That in turn results into the putimamsa Pidika. "Mamsaleshu Arakasheshu". Medas vitiation is common and dominant Dushya in the pathogenesis ofMadhumeha. Kapha and Meda have close resemblance in regard to functions as well asqualitative parameters. Both are getting vitiated more or less by same etiological factors.It gets vitiated both quantitatively and qualitatively Meda vitiation in Madhumehaappears in two ways i.e. the Abadha (Asamhatum) Normal function of Meda is toproduce snigdhata in the body along with Dradhatva. So this Abadhatva causesderangement in the structure of Meda producing Shaithilya in the body. In Madhumehavitiation of Meda results in two ways as already said. Majja Dhatu is not vitiated in maximum extent but Vata causes its Ksaya i.e.Depletion. Due to Vata Prakopa Kshaya of Majja Dhatu occurs. Thus vitiated Majjaproduces clinical symptoms like, Netragaurava. Angagauravata in Madhumehi patient. Shukra also get vitiated in the pathogenesis produces symptoms like daurbalyaand Kruchra vyavayata, because normal functions of Sukra is to maintain Dehabala. Italso plays role in the precipitation of Sahaja Prameha. Prameha is a Kulaja Vikara andoccurs as result of Beeja Dosha.Susruta described that Sukra Dosha and Prameha getprecipitate because of the vitiation of Vyanavata and Apanavata. Vata causes depletion ofShukra Dhatu and also Shukrameha. So, one can appreciate the importance of ShukraDushti in Prameha With this it is understand that the relation of Sukra dushti as acomponent of Prameha formation. Oja is sarabhuta of all the Dhatus and gives strength and immune power to thebody. . Charaka mentions that life depends on Oja and therefore without Oja one cannot Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 107
  • 119. live. Such Oja remains in the heart and called as Shareera Rasa Sneha184. In thecommentary Chakrapani has described two varieties of Oja i.e., Para and Apara Oja. ParaOja is supreme and remains in the heart, while its Pramana is Ashta Bindu. Apara Oja isof Ardha Anjali Pramana which is also called as Shleshmika Oja i.e. Shareera Bala185.Further Chakrapani explained that, in Madhumeha Apara Oja Kshaya occurs, which isSleshmika in nature and not the Para Oja Kshaya186. Oja as Dushya mainly involved inVataja Prameha i.e. Ojomeha i.e. Madhumeha. Provoked Vata due to its own etiologicalfactors or due to Avarana carries Oja towards basti and excrete outside through urine.Pathological conditions regarding Oja are of 3 types. So the symptoms of Ojakshaya likeMurccha, Mamsakshaya, Moha, Daurbalya (excessive weakness), Vyathita Indriya,Rukshata, Gurugatrata, Nidra, Tandra etc may manifest. Charaka mentioned Rukashta i.e.related to Ruksa Sharira, so one can easily understand the manifestations ofKrushapramehi or Sahaja Pramehi. Oja is an important Dushya in the Samprapti ofMadhumeha. Kleda is one of the body component mainly involved in the pathogenesis. Thephysiology of Kleda is mainly related with Mutra and Sweda along with Meda. Thuswhen Kleda is involved then it directly affects the above factors. Kleda proper in quantityis important to maintain the snigdhata in between the tissues. The literal meanings ofKleda are – wetness, moisture, dampness etc. In the commentary regarding Sharira Kledain Charaka samhita mentioned that Kleda gives Shaithilya to Sharira. Normal function ofMutra and Sweda has been described by Vagbhata as, under normal physiologicalconditions Mutra and Sweda maintain balance of Kleda in the body. Especially Swedaholds it in the body and Mutra excrete it outside the body. According to the body Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 108
  • 120. condition and requirement, if this Kleda is get vitiated it directly affects the physiology ofMutra and Sweda and disrupts the assemblage of bodily elements causing ShaithilyaArundatta has mentioned that absence of Kleda may lead to the dryness of the body. Inthe Samprapti, Kleda Dushti is in the form of ‘Vriddhi’ and not the Kshaya. Hence, BahuKleda will manifest as Prabhoota Mootrata and Avila Mootrata because extensivelyincreased Kleda is excreated out of the body as Mutra. The other manifestations of KledaDushti may be Shithilangata, Ati Sweda Pravritti, Visra Sharira Gandha (due to excessivesweating), Sharira Mruduta, Snigdhata etc. This dooshya is separately mentioned by Vagbhata. Sweda is mainly related withMeda and Kleda. Due to the vitiation of Meda and Kleda, Swedavaha Srotodushti occursleading to the manifestation of Ati Swedapravritti, Daurgandhya, Picchilagatrata,Snigdhagatrata Visra- sharirgandha etc. Sushruta mentioned that in Madhumeha(Prameha) Sweda becomes Sweet in nature. Charaka described Vasameha as a subtype of Vataja Prameha. “Vasa” is anUpadhatu of Mamsa and the sneha in the Mamsa Dhatu is called Vasa. Thus we caneasily understand that in Prameha, Mamsa is one of the Main Dushya so in turns Vasa tooget vitiate. The provoked Vata draws Vasa towards Basti and excretes it through the urinein the form of Sneha. In case of Madhumeha, the Dushti is illustrated in the form ofBahutva as well as Abadhdhatva. But still the manifestations are not describedconcerning Vasa Dushti. Lasika is a kind of fluid found beneath the skin between it andMamsa Dhatu. Lasika also gets vitiated by Vata resulting Lasika meha. There is no directreference related to Vasa and Lasika Dushti. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 109
  • 121. Agni: There is no direct reference related to the Agni condition but both Agnimandyaand tikshna Agni conditions present in the pathogenesis. In ayurveda agni has been givenmore importance in the disease process of Madhumeha. Due to this, doshas anddooshyas will be in aparipakwavastha. It indicates metabolic impairment in Madhumeha.As all the metabolic activities are maintained by Agni and its Mandata leads manydisorders and Prameha is one of them in which Dhatvagnimandya is a major etiologicalcomponent. Dhatvagnimandya leads to Dhatu Vŗddhi and Dhatvagni Tikşņata causes 187Dhatukşaya . In the Samanya Samprapti, Agnimandya develops due to nidana sevanaleads to Bahudrava Kapha and Bahuabaddha Meda as well as excessive quantity ofMamsa and Kleda. But in case of Avaraņajanya Madhumeha due to Kaphakara Nidana,Dhatvagnimandya develops and due to this Agnimandya excessive Dhatu can not beassimilated properly leading to more vitiation of Dhatu. Such vitiated Dhatu obstructs thegati of Vata leading to its provocation. But due to this provocation of Vata, Jaţharagnigets stimulated demanding more food. Therefore, in Madhumeha the Duşya Duşţi mostlyoccurs in the form of Vŗuddhi and not in the form of Kşhaya reflectingDhatvagnimandya. Kşhaya Lakşaņa of Majja and Śukra Dhatu may be seen as due toMedodhatvagnimandya there is less nourishment to further Dhatus. So the role ofDhatvagni in the Samprapti of Madhumeha is important. One may observe the differencebetween two types of Agnimandya. In Samanya Samprapti one may get symptoms likeKşudhamandya due to Jatharagnimandya, but in Avruta Vata Samprapti, Kşudhadhikyawill be prominent. Again without Ama it is impossible to precipitate the pathogenesis ofMadhumeha thus Susruta narrated that. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 110
  • 122. Purvaroopa: All Acharyas have accepted nearly same about the Purvarupa. Ghanagatrata,Karpadadaha, Mukha-Talu-Kantha Shosha, Pipasa, Alasya, Visra Shariragandha etc.Pipasadhikya, Kshudhadhikya, Alasyata, Tandra, Nidradhikya are the main poorvarupas.Mukha-Talu-Kantha-Shosha & Pipasa is due to Rukshaguna of vata & also due to loss ofsheetata & snigdata caused by Udakakshya. Tandra & Nidra is due to Rasa & Oja.Snigdha, Pichhila & Gurugatrata is due to kapha by corresponding qualities of Snigdha,Pichhila & Guru. Karapada daha is due to pittadosha. It may be also due to loss of Ambuwhich is sheeta in property and required for preenanam, failing to which results in Daha.Karapada suptata is due to kapha. Asya madhurya is due to kapha prakopa by madhurata.Kesheshu Jatilibhava & keshnakhativriddhi is due to involvement of meda, the precursordhatu of Asthi & Majja, which is second to meda. Increased Jatharagni is also responsiblefor these symptoms. Shatpada pipilika mutrabhisaranam is due to presence of Madhuratain the mootra. Kaye malam & Dantadidanam Maladhyatvam is because of their excessiveproductions in defective metabolism (Dhatwagni & Bhutagni).Roopa: Prabhoota means increased in quantity, when dushyas are affected by kapha doshatheir kleda and fluidity increase. Excretion of kleda is the function of mootra and increasein the quantity of kleda in turn causes increase in kleda amount of urine. Avila mootratais turbid, All shithla dushyas, come into basti, are excreted along with kleda via mootra. A majority of the lakshanas explained in Madhumeha are explained in the moderncounterpart too. An attempt to correlate the same is made in here below. Prabhoothaavila mootrata is considered as a prathyatma lakshana of Prameha. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 111
  • 123. Bahudrava kapha along with other kledapradhana dooshyas in the basthi is the cause forprabhootha mootrata. The same reason has been given in modern science for polyuria thatthe osmotic diuretic affects of glucose in the kidney tubules. Madhusama mootra, madhura mootra is because of ojadhatu kshrana through 188mootra . These symptoms indicate the glycosuria. Whenever the quantity of glucoseentering the kidney tubules in the glomerular filtrate, rises above approximately 225mg/min a significant proportion of the glucose begins to spill in to the urine and producesglycosuria. Bahu kankshata has been mentioned as a lakshana in apathyanimittajaMadhumeha. Path of vata is obstructed by vitiated kapha and medas. As a result vata getvitiated and produces theekshnagni. So patients develop bahukankshatha towards food.The same is mentioned in modern science in terms of polyphagia. In ayurveda pipasa is not mentioned as a lakshana but included under poorvaroopa. As it is already explained that most of the poorva roopas mentioned in ayurvedaare the roopas of Madhumeha. Polydipsia is mentioned as one of the symptom related tohyperglycemia. This condition produces because of polyuria. So pipasa can be said as asymptom which is similar to polydipsia. 189 Sushrutha has mentioned different conditions for delayed healing . Out ofwhich Madhumeha is one among them and commentator says dustadushyas areresponsible for them. Even in modern science delayed healing of wounds has beenmentioned as a symptom and the reasoning they give is the deficient formation ofgranulation tissue. The failure of glucose utilization, loss of electrolyte and loss of bodyprotein causes weakness. Even in our classics it is mentioned that aparipakwa dhatus will Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 112
  • 124. not nourish the body properly and hence causes weakness or klama. The nature andextent of klama is explained by Acharya Sushrutha mentioned.II) Discussion on demographic data1) Age Here in study, out of 25 patients Madhumeha exhibits 36% patients were from theage of 46-55 and 32% patients were from the age group of 56-65 years. It reveals that theindividuals are more affected by type 2 DM after 4 decade. The reason for this may bethat the environmental factors like stress, food habit, life style etc. are common in this agegroup. These environmental factors act as predisposing factor in the manifestation of DMAlthough 32% patients were from group of 36-45, but in this 1(4%) patient having 36yrother 28% were from age of 40 years.2) Gender In this study, 56% patients were males, 44% patients were females so femalesare also having equal risk of getting Diabetes Mellitus, less incidence of female patientsin this study may be because of demographic facts or due to small sample. Susruta had said that women would not get Madhumeha; because their body getscleaned every month by the raja pravrutti. But it is seems as a controversial dialogue aswomen also getting Madhumeha and they are also at high risk of getting diabetescompared to men after 30years.3) Religion The maximum patients of 96% were Hindus; this is because of Hindu dominatedarea of the study. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 113
  • 125. 4) Economic status Here in the study higher middle class as people are found more. So DM is calledas Richmans disease. Our study also supports this statement as we got more number ofpatients belonging to higher class i, e 52%.5) Occupation Occupation plays major role in the manifestation of Madhumeha. The levelphysical activity the patient has in daily routine play important roles in onset of DiabetesMellitus. The recent dramatic increase indicates that lifestyle factors (sedentary lifestyle)may be particularly important in triggering the genetic elements that cause this type ofdiabetes. Some recent studies show that people with sedentary life style are more likely tohave Diabetes mellitus as compared to those who lead an active life. In present studymaximum patients having sedentary type of occupation I.e. 56%.6) Diet Maximum number of patients I.e. 76% of this series were vegetarians, where as24% patient had mixed diet. This may be due to the traditional vegetarian’s dietary habitsamong the Hindus who formed the larger part of this study.7) Family history In the present study, 80% patients had family history. It suggests that type IiDiabetes Mellitus has a strong genetic component.Discussion on disease data.Nidana: The nidana mentioned in the classics were elicited in this study by detailedquationing. Among nidana , it was observed that Navanna and gudavaikrutha, snigdha Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 114
  • 126. ahara formed major portion of food I.e. 100%. About 76% of them were taking curdsregularly. Among vihara, avyayama and diwaswapna were found in 56% patients.Asanaswapna found in 52% of patient. These suggest that data is concordant with theetiological factors described by classics for the disease Madhumeha. Obesity is majorcause for DM, as it is main cause for insulin resistance. But in present study 20% patientswere slightly overweight for their age & height. The rest had normal weight but reductionin weight up to ½ to 1 kg was seen in them. It is however interesting that majority ofpatients not obese. Among manasika chinta were found 32% of patients. It suggests thatany degree of the stress is related to the NIDDM. The sympathetic nervous activity isstimulated by the stress and causes the hyper glycemia. If the stress persist for prolongperiod it imbalances the homeostasis of the hormonesPurva roopa: In the present study, alasya was found in 84% patients and Mukha-Talu-KanthaShosha was found in 32% patients, Mutramadhurya was found in 100% patients. Hereone thing is important that Madhavanidana mentioned that Padadaha and padasuptata asVatananatmaja Vyadhis in which Pitta, Rakta and Kapha obstructs the Patha of Vatarespectively 190. Here also in Avaranjanya Madhumeha these factors are dominant one soabove symptoms manifests in this disease.Rupa:Chief complaints Among chief complaints 100% patients were having Prabhootmootrata both interms of quantity as well as frequency. Among these improvement was observed in19(76%). In Phalatrikadi Vati, 68% relief was observed in Prabhuta Mutrata at Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 115
  • 127. statistically highly significant level (P<0.001). Avila mootrata was found in 80% ofpatients for that Vagbhata emphasized that this turbitidy of the urine because of itsannexation with the dhatu. Phalatrikadi Vati provided 56% relief in Avila Mutrata whichwas statistically significant (P<0.05). Kshudhadhikya was observed in 96% patient. Itprovided 76% relief in Kshudha Adhika which was statistically highly significant level(P<0.001). Pipasa was observed 92% patient. Prabhootmootrata causes excessive loss offluids from body, leading to pipasa and dourbalya. Dourbalya was observed 80% patient.It showed 84% reduction which was statistically highly significant (P<0.001). It showed60% reduction in Daurbalya which was statistically highly significant (P<0.001).KaraPadadaha was observed in 60% patients. It provided 48% relief which wasstatistically highly significant (P<0.001). Atisweda was seen in 68% patient. TheAtisweda was reduced by 72% in Phalatrikadi Vati and it was statistically significant(P<0.01) Here the data is relevant to the classics. Also satisfying the modern diagnosticcriteria i.e. polyuria, polydipsia, polyphagia,but clinically various patients came with onlyone or no symptoms so only blood sugar criteria is decisive for diagnosis.Associated Signs and Symptoms: Alasya was found in 76 %patients followed by Mukha-Talu-Kantha-Shosha(88%). and gurugatrata (32%). Klama was found in 64% patients. The data implies thatKapha & Medodushti account for presence of Alasya, Gurugatrata. While pitta Dustiaccounts for Mukha-Talu-Kantha-Shosha. These findings point towards the involvementof all the three Doshas in the progression and manifestation of Madhumeha with thedominancy of Kapha and Vata Dosha. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 116
  • 128. Srotodushti In this study, the Mutravaha Srotasa and Medovaha Srotasa were found afflictedin all the patients. Other remarkable afflicted Srotasa were Udakavaha Srotodushti.Involvement of Medovaha and Mutravaha Srotasa in all the patients may be due to theAnukulatva between Nidana, Dosha and Dushya. All these observations reconfirm thepathogenesis of Madhumeha mentioned in Ayurvedic classics.Objective parameters: There was reduction in FBS and PPBS 32%. It was found that in borderline cases,the sugar levels came to normal, but in cases with levels near the upper limit of the range,it did not return to the normal limits. This may give a hint about a probable requirementof an extension in the duration of treatment. The mild increase in the urine sugar levelscame back to normal but in cases where there was higher range of increased urine sugarlevels, it did not come to normal limit. There was only a moderate reduction hinting at alonger period of treatment. It was observed that the symptoms that were mild returnedback to normal after 30 days of treatment but those that were moderate came down tomild. The Phalatrikadi Vati provided 32% relief in Fasting Blood Sugar & 32% relief inPPBS at statistically significant level (P<0.01).Probable Mode of Action: Most of these drugs are having tikta, kashayarasa, laghu, rooksha guna andkatuvipaka. These are said to be kaphagna, mehagna, medogna andmootrasangrahaneeya. Tikta, kashayarasa, laghu, rooksha guna produces rookshana effect and they arehaving opposite qualities to that of kapha and medas. Hence they act as mehagna and Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 117
  • 129. kaphagna. So, this drug may have been effective on kapha and pitta and also on vata.This tridoshashamaka property of this drug helped to correct the dhatudushti andsrotodushti leading to their normal functioning. Bahudravata will be present in Madhumeha. These tikta rasa and kashaya rasadrugs posses the kaphahara, Meda, Kleda Upashoshana properties191. Bahudravata willbe reduced by the absorption of excessive fluid from the body. When bahudravatareaching basthi reduces then prabhoothamootrata pratyatmalakshana of Prameha alsoreduces. Pipasa which is dependent on prabhoothamootrata also subsides. Musta by itstrishnanigrahana property, alleviates pipasadhikya in Madhumeha. Further Madhumeha isa metabolic disease, dhatvagnimandhyjanita vyadhi. This metabolic disease demandsmedadhatvagnivriddhi. When any agni is not proper, dhatus are not produced properly.Phalatrikadi Vati having deepana & pachana drugs and katu rasa,ushna virya encountersdhatvagnimandya & potentiates the dhatvagnimandhya and help in ama-pachana therebyalleviates aparipakwa and ama. That in turn helps to form the dhatus in proper proportionwith samyak qualities. Their by it ensues sarvadhatuposhana thereby pacifies Daurbalya.Phalatrikadi Vati produce malashodana (indravaruni, triphala) their by it eliminates themetabolic wastes, vitiated pitta dosha along with kapha dosha & thus removes avarana ofvata there by normalizing the digestive power which helps to control the symptom. Thismay account for better relief in Kshudha Adhika. Clinical & experimental studies depictsthat Amalaki, Haridra, Triphala reduces blood glucose significantly. Pramehaharaproperty of the ingredients of trial drug helps in alleviating the hyperglycemia. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 118
  • 130. CONCLUSIONAyurveda in fact is the first medical science, which identified, diagnosed &manged Madhumeha.Madhumeha is mentioned as one of the 20 types of Prameha. Madhumeha hasbeen classified under the Vatika type of Prameha.The terms Prameha and Madhumeha are synonymous. They indicate the samecondition where in the former refers to Prabhoota and Avila mootrata (illunderstood) & the latter refers to Tanu & Mootra madhuryata.Kapha is the arambaka dosha & vata is the preraka.Margavarana Janya Madhumeha & dhatukshaya Janya madhumeha are the twoforms of manifestation of the disease. The apatyanimittaja madhumeha & sahajamadhumeha are the two-independent forms of presentations, coming under theabove classification respectively.Madhumeha is a disease characterized by Prabhoota avila mootrata, Tanumadhuryata & Mootra madhuryataDiabetes Mellitus is correlated with Madhumeha especially Non insulinDependent Diabetes Mellitus which have the similar pathogenesis andmanifestion.Madhumeha (Type II Diabetes mellitus) mostly affects the individuals after theage of forty years.Sex, martial status, religion bear no relation with Diabetes mellitus. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Conclusion 119
  • 131. Changing life styles e.g.; sedentary life, increased stress, strain may contribute inthe establishment of the disease. Tendency towards sedentary life style and faultydietary habits, leads to vitiation of Kapha and Meda leading to Madhumeha.The present study suggests that Type II DM has got a strong genetic component.It also reveals the chronic nature of the disease.The obesity is a risk factor associated with Type II DM. But majority of the ptswere not Overweight or obese here.The study confirms the dominancy of Kapha Dosha, Meda Dhatu Dusti andMedovaha Srotodushti in the pathogenesis of Madhumeha.The line of treatment is based upon Tiktakasaya Rasa, Usna Virya Kaphavataharaand Pramehaghna properties of the drugs for oral medication.While majority of the patients having Prabhutamootrata (polyuria), AvilaMootrata, Mutramadhurya, Pipasa and Kshudhadhikya.The parameters both subjective and objective showed high significance ratestastically.Along with treatment patient is supposed to adopt the pathya-Apathya asexplainen in classics. This is nothing but essential tool in the management ofMadhumeha.The result of the Phalatrikadi Vati declared is representing the efficiency of thedrug with its embedded qualities, is 2(8%) Regulated, 5 (20%) palliative and11(54%) patients responded in the trial.This is strong evidence to state that the phalatrikadi Vati is hypoglycemic agentcombination of Ayurveda Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Conclusion 120
  • 132. SummaryDiabetes is a disease known from the dawn of civilization. Sedentary life style,Lack of exercise, Faulty food habits and improper medication and Urbanizationprecipitates the disease. On the basis of its symptomatology Madhumeha can becorrelated to the features of Diabetes mellitus.Madhumeha is mentioned as one of the 20 types of Prameha, classified under theVatika type of Prameha. The Vata may be provoked either directly by itsetiological factors, Avarana by Kapha and Pitta to its path or by continuousdepletion of Dhatus.In the pathogenesis of Madhumeha, Kapha & vata dosha, Meda & mamsa, kleda,oja dushyas, mootavaha srotus and medovaha srotus are mainly involved.Prabhoota mootrata and Avila mootrata are main cardinal symptoms ofMadhumeha.The factors which provoke the Vata directly cause Apatarpanajanya Madhumehaand are equivalent to Type I Diabetes mellitus. While the factors which provokeKapha and Pitta cause Santarpanajanya Madhumeha equivalent to Type IIDiabetes mellitus.Generally the management, rather than treatment, is the appropriate term inDiabetes mellitus, and involves diet, exercise, insulin, oral hypoglycemic, patienteducation and counseling.The prevention and control of the Madhumeha made by regularizing the bloodglucose level with the help of shamanaoushadi. The Phalatrikadi Vati is Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Summary 121
  • 133. compound formulation comprises of 7 drugs explained by acharyas inMadhumeha as a shamanoushadi.The present study intended to focus on the disease evaluation i.e. Madhumeha vis-à-vis. Diabetes Mellitus management with Phalatrikadi Vati as a ShamanaChikitsa. Phalatrikadi Vati ingredients are hypoglycemic agents collected formlocal area and prepared under GMP conditions, weighing about 500mg tabletform. Present trial is a Simple Random sampling technique clinical study wasconducted for 30 days.Patients of Madhumeha fulfilling the criteria of diagnosis were selected in thepresent study. Patients were selected on preset inclusion and exclusion criteria.30 patients of Madhumeha were registered in this study out of which total 25patients completed treatment. 5 patients not fulfilled the inclusion criteria.All the patients have complained of prabhoota mootrata, folled by 80% of patientshaving avilamotrata, 96% and 62% of patients having kshudhadhikya & pipasarespectively.The results in this trail, out of 25 of patients, 2 (8%) regulated, 5(20%) patientsare palliative, 16(64%) patients are responded to treatment, 2(8%) not responded.Thus phalatrikadi Vati having hypoglycemic effect.Among the subjective parameters pipasa, kshudhadhikya, dourbalya shows morehighly significant than other parameter. Among objective parameter prabhootamootrata shows highly significant with 89.65% of mean improvement. FBSshows highly significant with 20.31% of mean improvement. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Summary 122
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  • 139. 85) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 6/4, Reprint ed, 2006,Choukhambha Sanskrit sansthan, Varanasi, pp 25286) Kasinatha Sastri ed, Caraka samhita Sutrastana, 21/4 Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp40987) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Sutra 15/14, Reprint ed, 2006,Choukhambha Sanskrit sansthan, Varanasi, pp 25288) Ibid, Nidana, 1/20, pp23089) Kasinatha Sastri ed, Caraka samhita chikitsa 6/9,Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp 230.90) Kasinatha Sastri ed, Caraka samhita chikitsa 6/11Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp 233.91) Kasinatha Sastri ed, Caraka samhita Nidana 4/7 Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp 63292) Vaidya Yadavaji Trikamji Acharya ed, Caraka samhita Commentary Cakrapanidatta Nidana4/7 Reprint 2001; Chaukhambha Bharati Academy Varanas,i pp 213.93) Kasinatha Sastri ed, Caraka samhita Nidana 4/37, Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp 638.94) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Sutrastana 15/29,Reprint ed, 2006, Choukhambha Sanskrit sansthan, Varanasi, pp 61.95) Dr Brahmanand tripathi ed, Astanga Hridaya, Sutra 11/5 Reprint ed. 2007 ChaukhambhaSanskrit pratishthan, Delhi pp-16196) Harishastri oaradkar Vaidya ed, Astanga Hridaya Commentary Aunadatta & Hemadri ,Sutra 11/5 Reprint ed. 2007 Krishnadas Academy, Varanasi, pp-18397) Dr Brahmanand tripathi ed, Astanga Hridaya, Nidana 10/4, Reprint ed. 2007 ChaukhambhaSanskrit pratishthan, Delhi pp-494.98) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 12/49,Reprint ed, 2006, Choukhambha Sanskrit sansthan, Varanasi, pp 62.99) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 6/4, Reprint ed, 2006,Choukhambha Sanskrit sansthan, Varanasi, pp 252100) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/7 Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp 228101) Dr Brahmanand tripathi ed, Astanga Hridaya, Nidana 10/7 Reprint ed. 2007 ChaukhambhaSanskrit pratishthan, Delhi pp-495 Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) - Bibliographic References 6
  • 140. 102) Kasinatha Sastri ed, Caraka samhita Nidana 4/9 Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp 633103) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/15 Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp 235104) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 11/3, Reprint ed,2006, Choukhambha Sanskrit sansthan, Varanasi, pp 59105) Ibid106) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/57 Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp 244107) Kasinatha Sastri ed, Caraka samhita Sutrastana, 17/78-81, Reprint 2001; ChaukhambhaBharati Academy Varanasi pp355108) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 11/25-26, Reprint ed,2006, Choukhambha Sanskrit sansthan, Varanasi, pp 255109) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 11/6 , Reprint ed, 2006,Choukhambha Sanskrit sansthan, Varanasi, pp 252110) Vaidya Yadavaji Trikamji Acharya, Sushruta sutra CommentaryGayadasacharya,Nidanastana 6/6, Reprint 1980,4th ed, Chaukhambha orientalia,Varanasi,pp290.111) Bhisagratna Shri Brahmashanka Mishra ed, Bhava Prakasha Madhyama Khanda, 38/1-129, 1st ed. Reprint, 2002, Chaukhambha Sanskrit Samsthan, Varanasi, pp-386 – 390112) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, chikitsa 11/3 , Reprint ed, 2006,Choukhambha Sanskrit sansthan, Varanasi, pp 59113) Ibid114) Yadunandan Upadhyaya ed. Madhava Nidanam, Part-2, 33/26, 9th ed, 2004, ChaukhambhaSanskrit Sansthan, Varanasi, pp-22.115) ) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Sutra 23/7 , Reprint ed, 2006,Choukhambha Sanskrit sansthan, Varanasi, pp 98.116) ) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 6/28 , Reprint ed,2006, Choukhambha Sanskrit sansthan, Varanasi, pp 255.117) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 6/15, Reprint ed, 2006,Choukhambha Sanskrit sansthan, Varanasi, pp 254118) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 6/15, Reprint ed, 2006,Choukhambha Sanskrit sansthan, Varanasi, pp 254 Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) - Bibliographic References 7
  • 141. 119) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 6/15, Reprint ed, 2006,Choukhambha Sanskrit sansthan, Varanasi, pp 254.120) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 6/16, Reprint ed, 2006,Choukhambha Sanskrit sansthan, Varanasi, pp 254.121) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 6/16, Reprint ed, 2006,Choukhambha Sanskrit sansthan, Varanasi, pp 254.122) Kasinatha Sastri ed, Caraka samhita Sutrastana, 20/13, Reprint 2001; ChaukhambhaBharati Academy Varanasi pp204.123) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/ 7 Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp 228.124) Vaidya Yadavaji Trikamji Acharya ed, Caraka samhita Commentary CakrapanidattaNidana 4/7 Reprint 2001; Chaukhambha Bharati Academy Varanasi pp 213.125) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/ 7 Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp228.126) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/ 7 Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp228.127) Kasinatha Sastri ed, Caraka samhita Sutrastana, 17/80 Reprint 2001; ChaukhambhaBharati Academy Varanasi pp352128) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/57,Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp244.129) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/55 Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp243.130) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/15 Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp235.131) Dr Brahmanand tripathi ed, Astanga Hridaya, Chikitsa 12/3 Reprint ed. 2007Chaukhambha Sanskrit pratishthan, Delhi pp-715132) Harishastri oaradkar Vaidya ed, Astanga Hridaya Commentary Aunadatta & Hemadri ,Chikitsa 12/1 – 3, Reprint ed. 2007 Krishnadas Academy, Varanasi, pp-678133) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/25 Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp237134) Dr Brahmanand tripathi ed, Astanga Hridaya, Chikitsa 12/2 Reprint ed. 2007Chaukhambha Sanskrit pratishthan, Delhi pp-715.135) Harishastri oaradkar Vaidya ed, Astanga Hridaya Commentary Aunadatta & Hemadri ,Chikitsa 12/1 – 3, Reprint ed. 2007 Krishnadas Academy, Varanasi, pp-678 Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) - Bibliographic References 8
  • 142. 136) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/27-29 Reprint 2001; ChaukhambhaBharati Academy Varanasi pp238.137) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 11/8, Reprint ed, 2006,Choukhambha Sanskrit sansthan, Varanasi, pp 60.138 ) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 11/9, Reprint ed,2006, Choukhambha Sanskrit sansthan, Varanasi, pp 61.139) Dr Brahmanand tripathi ed, Astanga Hridaya, Chikitsa 12/7 Reprint ed. 2007Chaukhambha Sanskrit pratishthan, Delhi pp-715.140) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/51 Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp294.141) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/50 Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp293.142) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/25 Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp288.143) Dr Brahmanand tripathi ed, Astanga Hridaya, Chikitsa 12/3 Reprint ed. 2007Chaukhambha Sanskrit pratishthan, Delhi pp-715144) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 12/6, Reprint ed, 2006,Choukhambha Sanskrit sansthan, Varanasi, pp 63145) ) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/30-32 Reprint 2001; ChaukhambhaBharati Academy Varanasi pp238146) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 11/9, Reprint ed, 2006,Choukhambha Sanskrit sansthan, Varanasi, pp 60147) Dr Brahmanand tripathi ed, Astanga Hridaya, Chikitsa 12/7-8, Reprint ed. 2007Chaukhambha Sanskrit pratishthan, Delhi pp-715148) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/52,Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp246.149) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 6/30, Reprint ed, 2006,Choukhambha Sanskrit sansthan, Varanasi, pp 255.150) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/16,Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp235.151)Kasinatha Sastri ed, Caraka samhita Chikitsa 6/17,Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp235.152) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/34, Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp238. Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) - Bibliographic References 9
  • 143. 153) ) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 13/10-11, Reprinted, 2006, Choukhambha Sanskrit sansthan, Varanasi, pp 65.154) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/20, Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp236.155) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/46, Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp241.156) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/19, Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp236.57) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/50, Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp242.158) ) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 11/12, Reprint ed,2006, Choukhambha Sanskrit sansthan, Varanasi, pp 62.159) http: // Encyclopedia.thefreedictory.com160) Siddharth N Shah ed, API Textbook of Medicine, 7th edition, 2003, Association of Physicianof India, Mumbai, pp 1096.162) Harsha Mohan ed, Text book of Pathology, 5th ed 2005, Jaypee Brothers Medicalpublishers New Delhi, pp 846163) Robins ed, Basic pathology, 7th ed 2003, pp 645164) P. C. Das, Text Book Of Medicine, 4th ed, 2000, Current books international, Calcutta, pp522.165) AS Fauci, Harrison principles of internal medicine, Vol-2, 15th ed. 2001 Mcgraw Hill co,New York USA, pp 2112166) P. C. Das, Text Book of Medicine, 4th ed, 2000, Current books international, Calcutta, pp525.167) P. C. Das, Text Book of Medicine, 4th ed, 2000, Current books international, Calcutta, pp527.168) Siddharth N Shah ed, API Textbook of Medicine, 7th edition, 2003, Association of Physicianof India, Mumbai, pp 1108-1009.169) AS Fauci, Harrison principles of internal medicine, Vol-2, 15th ed. 2001 Mcgraw Hill co,New York USA, pp 2064.170) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/40, Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp240.171) P. V. Sharma, Dravyaguna Vijana, Vol-II, 16th ed, 1995, Chaukhambha Bharati Academy,Varanasi, pp 753Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) - Bibliographic References 10
  • 144. 172) Ibid pp239173) Ibid pp 758174) Ibid pp 370175) Ibid pp 162176) Ibid pp 537177) Ibid pp 436178) Dr Brahmanand tripathi ed, Astanga Hridaya, Sutra 10/9 Reprint ed. 2007 ChaukhambhaSanskrit pratishthan, Delhi pp-153.179) Derek. Leroith, Simeon. I. Taylor, Jerrold. M. Olefsky Ed, Diabetes Mellitus – AFundamental and Clinical text, 3rd Ed, 2004, Lippincott Williams & Wilkins, pp 840.180) Kasinatha Sastri ed, Caraka samhita Nidana 4/51, Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp 640.181) Kasinatha Sastri ed, Caraka samhita Nidana 4, Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp 630.182) ) Dr Brahmanand tripathi ed, Astanga Hridaya, Sutra 11/8 Reprint ed. 2007 ChaukhambhaSanskrit pratishthan, Delhi pp-162.183) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Sutra 15/37, Reprint ed, 2006,Choukhambha Sanskrit sansthan, Varanasi, pp 62.184) Kasinatha Sastri ed, Caraka samhita, Sutra 30/11,, Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp 582.185) ) Vaidya Yadavaji Trikamji Acharya ed, Caraka samhita Commentary Cakrapanidatta,Sutrastana 30/7, Reprint 2001; Chaukhambha Bharati Academy Varanasi pp 185.186) Ibid.187) Dr Brahmanand tripathi ed, Astanga Hridaya, Sutra 11/34 Reprint ed. 2007 ChaukhambhaSanskrit pratishthan, Delhi pp-166.188) Kasinatha Sastri ed, Caraka samhita, Nidana 4/37, Reprint 2001; Chaukhambha BharatiAcademy Varanasi pp 638.189) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Sutra 23/7, Reprint ed, 2006,Choukhambha Sanskrit sansthan, Varanasi, pp 97.190) Yadunandan Upadhyaya ed. Madhava Nidanam, Part-1, 22, 9th ed, 2004, ChaukhambhaSanskrit Sansthan, Varanasi, pp191) Dr Brahmanand tripathi ed, Astanga Hridaya, Sutra 10/20, Reprint ed. 2007 ChaukhambhaSanskrit pratishthan, Delhi pp-154.Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) - Bibliographic References 11
  • 145. Demographic Data of Phalatrikadi VatiSNo OPD Gende Religion Occupation Economical Result V/Mx Food No r Condition Age M F H M C O S A L P M H H g c1 4905 + 40 Mx + + + Responded2 5430 + 51 V + + + Palliative3 5293 + 36 V + + + Responded4 5029 + 68 V + + + Responded5 5882 + 42 V + + + Not Responded6 5708 + 49 V + + + Responded7 5935 + 59 V + + + Responded8 6043 + 54 V + + + Responded9 6205 + 55 V + + + Responded10 6347 + 64 Mx + + + Not Responded11 6220 + 54 Mx + + + Palliative12 6350 + 40 Mx + + + Responded13 6416 + 59 Mx + + + Responded14 1108 + 52 V + + + Palliative15 1109 + 52 V + + + Responded16 1196 + 43 V + + + Responded17 298 + 49 V + + + Responded18 1209 + 58 V + + + Responded19 827 + 53 Mx + + + Responded20 4939 + 52 Mx + + + Responded21 1210 + 62 V + + + Responded22 1363 + 42 V + + + Palliative23 894 + 44 V + + + Regulated24 558 + 57 V + + + Responded25 1961 + 62 V + + + RegulatedTotal 1 1 2 1 0 0 14 10 1 3 9 13 3 2 4 Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts i
  • 146. Subjective Statistical Assessment Data of Phalatrikadi VatiS.No OPD Avilamotrata Karapada Kshudhadhikyata Pipasa Atisweda Dourbalya daha B A B A B A B A B A B A1 4905 2 0 0 0 2 0 2 0 2 0 2 02 5430 1 0 0 0 2 1 2 0 0 0 0 03 5293 2 0 0 0 3 0 2 0 1 0 3 04 5029 3 0 1 0 3 1 3 0 1 0 3 15 5882 1 0 0 0 2 0 2 0 1 0 2 06 5708 1 0 0 0 2 0 2 0 2 0 3 07 5935 1 0 2 0 2 0 3 1 1 0 3 18 6043 2 1 2 0 2 0 3 0 3 0 3 09 6205 3 1 1 0 3 0 2 0 1 0 3 110 6347 1 0 1 0 2 0 2 1 1 0 2 011 6220 3 0 1 0 2 0 2 0 2 0 3 012 6350 3 1 1 0 3 0 3 0 2 0 3 013 6416 2 0 1 0 2 0 3 0 1 0 3 114 1108 2 0 1 0 3 2 3 2 0 0 0 015 1109 1 1 2 1 2 1 2 0 1 1 2 016 1196 0 0 0 0 1 0 0 0 0 0 2 017 298 1 0 1 1 2 0 2 0 1 0 3 018 1209 1 0 1 1 2 0 2 0 1 1 2 019 827 1 2 1 1 2 1 2 1 2 1 3 120 4939 3 2 1 0 2 0 2 0 2 1 3 221 1210 1 0 1 0 2 0 2 0 2 0 0 022 1363 1 0 0 0 2 0 2 0 0 0 3 023 894 2 0 1 0 2 1 3 1 2 1 3 124 558 0 0 0 0 0 0 2 0 1 0 2 025 1961 1 0 1 0 2 0 2 0 2 0 2 0Total 39 8 20 4 53 4 31 4 33 3 58 8Mean 1.59 0.32 0.8 0.16 2.12 0.28 2.2 0.24 1.32 0.2 2.32 0.32 Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts ii
  • 147. Objective Statistical Assessment of Phalatrikadi VatiS.No OPD Prabhuta FBS PPBS FUS PPUS mootrata B A B A B A B A B A1 4939 2 0 174.4 130 356.3 270 0.5 0 1.5 0.52 6043 2 0 129.6 125.2 310 260 0.5 0.5 1.5 1.53 5935 2 0 146.4 94.8 262.5 211.1 0 0 0 04 5708 3 1 215 160 326.5 251.1 1.5 1 2.0 1.55 4905 2 1 239.4 193.8 395.7 216 1.0 0 1.5 1.56 5430 3 0 121.5 110.0 187.3 159 0 0 0 07 5029 2 0 171.9 115.2 362 260 1.0 0 2 1.58 5882 2 0 151.2 144.3 248.1 275 0.5 0 1.5 19 5293 3 0 152.1 132 220.3 173.1 0.5 0 1.0 0.510 6205 2 0 175 125.3 317 240 1.0 0 1.5 0.511 6220 2 0 182 130 223.8 160.2 0 0 1.0 012 6350 3 0 120.7 105 267.5 195 0 0 1.0 0.513 6416 3 1 132.3 100 305.9 190 0.5 0 2.0 014 1196 3 0 155 120 205 160 0 0 0 015 298 3 1 148 125 225 198 0 0 1 0.516 1209 1 0 158 136 252.7 175.3 0.5 0 1 0.517 6347 2 0 180.3 156.8 268 286 1.5 0.5 1.5 1.518 558 2 0 135 76.4 192 134.9 0 0 0 019 827 2 1 240.5 195 351.6 255 1.5 0.5 2.0 1.520 894 3 0 92 80 190 140 0 0 0 021 1210 2 0 155.5 130 195.4 184 0.5 0 1.5 0.522 1363 2 0 112 80 227 157 0 0 0.5 0.523 1109 3 1 150 132 300 220 0.5 0 2.0 0.524 1108 2 0 150 115 185 153 0.5 0 1.0 0.525 1961 2 0 130 110 178 135 0 0 0.5 0Total 58 6 3917.8 3121.8 6571.3 5058.7 11.5 2.5 27.5 14.0Mean 2.32 0.24 156..71 124..87 265..85 201,.34 .44 0.08 1.1 .56 Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts iii
  • 148. Chief & Associated complaints of Phalatrikadi Vati 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 Tot Complaints 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 al 1 Prabhoota + + + + + + + + + + + + + + + + + + + + + + + + + 25 Mootrata 2 Avila Mootrata + + + + + + + + + + + + + + + + + + 18 3 Karapada Daha + + + + + + + + + + + + + + + 15 4 Kshudhadhikyata + + + + + + + + + + + + + + + + + + + + + + + + 24 5 Pipasa + + + + + + + + + + + + + + + + + + + + + + + 23 6 Atisweda + + + + + + + + + + + + + + + + + + + + 20 7 Dourbalya + + + + + + + + + + + + + + + + + + + + + 21 Associated Complaints 1 Kara/Pada suptata + + + 3 2 Klama + + + + + + + + + + + + + + + + 16 3 Alasya + + + + + + + + + + + + + + 14 4 Tandra + + + + + + + + + + + + + + + + + + + 19 5 Gurugatrat a + + + + + + + + 8 6 Dantadimaladya + + 2 7 Shithilangata + + + + + 2 8 Mukha/Talu + + + + + + + + + + + + + + + + + + + + + 22 shosha Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts iv
  • 149. Poorvaroopa of Madhumeha 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 Poorvaroopa 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 Total1 Dantadeenam + + + + + + 6 Malatvam2 Pada daha + + + + 43 Pani daha + + + + 44 Deha chikkanata + + + + + + + + + 95 Shareera + 1 durgandha6 Mutra madhurata + + + + + + + + + + + + + + + + + + + + + + + + + 257 Mutra shuklata8 Mukha madhurta + 19 Talu jivhashosha + + + + + + + + 810 Kesh jatilata11 Nakha vriddhi12 Alasya + + + + + + + + + + + + + + + + + + + + + 2113 Tandra + + + + + + + + + + + 1114 Nidra + + + + + + 615 Trishna + + + + + + - + + + + + + + + + + + + + + + + + + 2416 Maldhikyata in bahya chidra17 Swedadhikya + + + + + + + + + + + + + + + + + + + + + 2118 Sheeta iccha + + 219 Swasa + + + 320 Shitalangata + + + + + + 6 Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts v
  • 150. Examination of srotas 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 Sroto Lakshana 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 T Udakavaha1 Jihwa shosha + + + + + + + + + + + + + + + + + + + + + + + 232 Talu shosha + + + + + + + + + + + + + + + + + + + + + + + 234 Kloma shosha + 15 Prawridha pipasa + + + + + + + + + + + + + + + + 17 Mootravaha1 Alpalpa mootrata2 Mootara rodha3 Adhika mootra + + + + + + + + + + + + + + + + + + + + + + + + + 254 Sashoola mootra5 Basti stabdhata Mamsavaha1 Arbuda2 Arsha3 Mamsa shosha4 Shira granthi Medovaha1 Sweda + + + + + + + + + + + + 202 Snigdhanagata + + + + + + 63 Sthulashophata4 Pipasa + + + + + + + + + + + + + + + + + + + + + + + 23 Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts vi
  • 151. History of present IllnessS.No OPD Mode of detection Frequency of Micturition Family history 1 2 3 1 2 3 4 5 1 21 4905 + +2 5430 + + +3 5293 + + +4 5029 + + +5 5882 + + +6 5708 + + +7 5935 + + +8 6043 + + +9 6205 + + +10 6347 + + +11 6220 + + +12 3650 + + +13 6416 + + +14 1108 + + +15 1109 + + +16 1196 + + + +17 298 + + +18 1209 + + +19 827 + + +20 4939 + + +21 558 + + +22 1210 + + +23 1363 + + +24 894 + + +25 1961 + + +Total 7 16 2 00 5 11 9 2 19 6 Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts i
  • 152. Ahara NidanaS.No OPD Guda Navanna Dugdha Snigdha Mamsa Dadhi Sheeta Ahara Ahara1 4905 + + + + + + +2 5430 + + + + + +3 5293 + + + + + +4 5029 + + + + + +5 5882 + + + + + +6 5708 + + + + +7 5935 + + + + +8 6043 + + + +9 6205 + + + +10 6347 + + + + + +11 6220 + + + +12 3650 + + + + +13 6416 + + + + + +14 1108 + + + + + +15 1109 + + + + + +16 1196 + + + + +17 298 + + + +18 1209 + + +19 827 + + + + + + +20 4939 + + + + + + +21 558 + + + + - +22 1210 + + + + +23 1363 + + + + + +24 894 + + + + +25 1961 + + + +Total 25 25 17 25 7 19 15 Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts ii
  • 153. Vihara NidanaS.No OPD Avyaya Diwasw Swapna Manishi Vegavar Panchak Sthouly Asannas ma apna sukham ka odha arma a wapna Vibhra msha1 4905 + + + + +2 5430 +3 5293 + + + +4 5029 + + +5 5882 + + +6 5708 + + +7 5935 + + +8 6043 +9 6205 + + + + +10 6347 + + + + + + +11 6220 +12 3650 + + +13 641614 1108 + + + +15 1109 + + + +16 1196 + +17 29818 1209 +19 827 + + +20 4939 + + +21 558 + + + + +22 1210 + + + +23 136324 894 + +25 1961 + +Total 14 14 13 8 2 0 5 13 Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts iii
  • 154. SPECIAL CASE SHEET FOR “Evaluation of the efficacy of the Phaltrikadi Vati in Madhumeha” POST GRADUATE STUDIES AND RESEARCH CENTER (KAYACHIKITSA) D.G.M.AYURVEDIC MEDICAL COLLEGE, GADAG Guide: Scholar: Dr. K. Shiva Rama Prasad Dr. Vijayalaxmi. B.Benakatti 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 Month Year Time Date Hours Minutes PM 9) Selection Included Excluded 10) Schedule dates Initiation completion 11) Result Regulated Palliative Responded Not responded INFORMED CONSENT I Son/Daughter/Wife of amexercising my free will, to participate in above study as a subject. I have been informed to my satisfaction, by the attendingphysician the purpose of the clinical evaluation and nature of the drug treatment. I am also aware of my right to opt out of thetreatment 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 JAzÀÄw½¢gÀÄvÀÛ£É. gÉÆV0iÀÄ gÀÄdÄ / Patients Signature Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Case Sheet 1
  • 155. 12) CHIEF COMPLAINTS WITH DURATIONSl no Complaints Duration Remarks1 Prabhutamootrata2 Avilamootrata3 Kara pada dhaha4 Kshudadhikya5 Pipasa6 Atisweda7 Dourbalya13) ASSOCIATED COMPLAINTSSl.No Associated complaints Duration Remarks1 Kara pada suptata2 Klama3 Tandra4 Alasya5 Gurugatrata6 Dantadi maladhyatwam7 Shitilangata8 Mukha shosa9 Talu shosha14) OCCUPATIONAL HISTORY (if any)15) PERSONAL HISTORYFood habits Vegetarian Mixed dietTaste preferred Sweet Sour Salty Pungent Bitter AstringentAgni Sama Vishama Manda TeekshnaKosta Mrudu Madhyama KruraNidra Day Night Sound DisturbedAddictions Tobacco Alcohol DrugsBowel habits Normal Loose ConstipatedMenstrual History Regular Irregular Amenorrhea MenopauseTreatment history Other system medications Since how longHistory of past illness Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Case Sheet 2
  • 156. Family history - specify if any has the same disease Patient Sister BrotherBrother Father Sister Brother Mother SisterGrandfather Grandmother Grandfather Grandmother 16) HISTORY OF PRESENT ILLNESS Mode of detection Accidental/Suspicious /At regular check Frequency of micturition 3-4 times/5-6times/7-8times/9-10 times/above 10 17) MADHUMEHA NIDANA Ahar Vihar Anya Nidanarthakara vyadhi Madhura Guda vaikruta-Sugar items /M Avyayama Mansika chinta Sthoulya Jaggery items /M SugarcaneJuice Asanaswapna Vegadharana Navanna Diwaswapna Dugdha Swapnasukha Mamsa Chiken - /M Panchakarma vibhramsha Muton- /M Fish - /M Snigdha Dadhi Sheeta Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Case Sheet 3
  • 157. 18) MADHUMEHA POORVAROOPADantadeenam malatvam Pada dhaha ShitilangataMukha madharta Pani dhaha Maladhikyata in bahya chidraTrisna Kesh jatilata SwedadhikyaDeha chikannata Alasya Sheeta icchaShreera dugandhata Tandra SwasaMutra madhurata NidraMutra shuklta Talu kloma shosha19) EXAMINATION a) VITAL EXAMINATIONPulse /min Temp °F Respiration rate /minBlood pressureb) SYSTEMIC EXAMINATION Respiratory - Cardiovascular - Gastro-intestinal - Genito-urinary - c) EXAMINATION OF SROTASUdakavaha Mootravaha Mamsavaha MedovahaJihwa Alpalpa Ardudha Swedashosha moortrataTalu shosha Mootra rodha Arsha SnigdhanagataKloma Adhikamootra Mamsa shosha SthulashophatashoshaPrawridha Sashoola mootra Shira granthi Pipasapipas Basti stabdhatad) DASHVIDHA PARIKSHAPrakruti V P K VP VK PK VPKSara Pravara Avara MadhyamaSamhanana Susamhita Asamhita Madhyma samhitaPramana Height in Weight in Kgs CmsSatmya Ekarasa Sarvarasa Ruksha SnehaSatwa Pravara Avara MadhyamaAhara Shakti Abhyavaharana JaranaVyayam Shakti Pravara Avara MadhyamaVaya Balya Yauvana Vardhakya Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Case Sheet 4
  • 158. e) ASTA STHANA PARIKSHA Dosha PravruttiNadi Mutra Gati Varna Purnata Gandha Spandana KathinyaJihwa Ardra Sushka Mala Sama Nirama Lepa NirlepaShabda Sparsha Sheeta UshnaDrik Akruti20) UPASHAYA AND ANUPASHAYAUpashayaita iccha AnupashayaMadhurrahita ahara UshnaVyayama Madhura ahara Diwaswapana21) UPADRAVA – Present / Absent Mention (if any) -22) INVESTIGATIONSErythrocyte sedimentation rateHb%Urine routine Albumin Sugar Microscopic23) TREATMENT SCHEDULEDay Date Investigation’s noteDay 1Day 7Day 14Day 21Day 30 Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Case Sheet 5
  • 159. 24) ASSESMENT OF TRIAL1) Subjective paramters Before After Follow-up Differance1 Dourbalya2 Avila mootrata3 Kara pada dhaha4 Pipasa5 Kshudhadikyata2) Objective parameters Before After Follow-up Differance1 Fasting Blood Suger2 Post prandial Blood suger3 Fasting urine suger4 Post pradial urine suger5 Prabuta mootrataGrades 1) Prabhuta mootrata 4) Pipasa Grade 0 1000ml – 1500ml/ 24hrs Grade 0 Normal Grade 1 1500ml – 2000ml/ 24hrs Grade 1 Mild increased but tolerated Grade 2 2000ml – 2500ml/ 24hrs Grade 2 Moderate increased but Grade 3 2500ml -3000ml/ 24hrs tolerated 1) Avila mootrata Grade 3 Severally increased but not Grade 0 Crystal clear fluid tolerat Grade 1 Hazy with slight turbidity 5) Atisweda Grade 3 Turbidity clearly present but news Grade 0 Normal sweating after doing print can be read through the tube. normal physical activities Grade 4 More turbidity news print cannot Grade 1 Moderate sweating be read. Grade 2 Excessive sweating 2) Kara pada dhaha Grade 3 Excessive sweating just by Grade 0 No kara padadadha doing little work Grade 1 Occasionally noticed Grade 2 Periodically noticed 6) Dourbalya Grade 3 Daily noticed Grade 0 No Dourbalya Grade 4 Continuously noticed Grade 1 Occasionally noticed 3) Kshudhadikya Grade 2 Periodically noticed Grade 0 No Kshudhadikya Grade 3 Continuously noticed Grade 1 Mild increased but tolerated Grade 2 Moderate increased but tolerated Grade 3 Severally increased but not toleratedInvestigators note: Signature of Guide Signature of Scholar(Dr K. Shiva Rama Prasad) ( Vijayalaxmi. B. Benakatti ) Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Case Sheet 6