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Evaluation of efficacy of Avartaki in Madhumeha (NIDDM) -Shashikala. B. Bani, Department of Dravya Guna, Post Graduate Studies & Research Centre, D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE,GADAG

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Madhumeha#dg01 gdg

  1. 1. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM) By Shashikala. B. Bani Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfillment of the degree of Ayurveda Vachaspati M.D. In Dravya Guna Under the Guidance of Dr. G.V. Mulagund M.D. (Ayu) and Co- Guidance of Dr. Kuber Sankh M.D. (Ayu) Department of Dravya GunaPost Graduate Studies & Research CentreD.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2002-2005
  2. 2. Declaration by the candidate I here by declare that this dissertation / thesis entitled“Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)” is abonafide and genuine research work carried out by me under theguidance of Dr. G. V. Mulagund M.D.(Ayu) Professor and Dr. KuberSankh, M.D.(Ayu), Lecturer in Dravya Guna, DGMAMC, PGS&RC,Gadag.Date :Place : Gadag ( SHASHIKALA . B. BANI )
  3. 3. D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTRE GADAG, 582 103 This is to certify that the dissertation entitled “Evaluation of efficacy Avartaki of inMadhumeha (NIDDM)” a bonafide research work done by Shashikala. B. Bani in partialfulfillment of the requirement for the post graduation degree of “Ayurveda Vachaspati M.D.(Dravya Guna)” Under Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.Dr. KUBER SANKH Dr. G.V. MULAGUND M.D. (Ayu) M.D. (Ayu)Co- Guide GuideLecturer in Dravya Guna Professor & HODDGMAMC, PGS&RC, GADAG Dept. of Dravya GunaDate: DGMAMC, PGS&RC, GADAGPlace: Gadag Date: Place: Gadag
  4. 4. J.S.V.V. SAMSTHE’S D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTRE GADAG, 582 103 Endorsement by the H.O.D, Principal/ head of the institution This is to certify that the dissertation entitled “Evaluation of efficacy ofAvartaki in Madhumeha (NIDDM)” is a bonafide research work done byShashikala. B. Bani under the guidance of Dr. G. V. MULAGUND, M.D. (Ayu),Professor & HOD and Dr. KUBER SANKH, M.D. (Ayu), in partial fulfillment of therequirement for the post graduation degree of “Ayurveda Vachaspati M.D. (DravyaGuna)” Under Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.. (Dr. G. V. Mulagund) (Dr. G. B. Patil) Professor & HOD Principal, Dept. of Dravya Guna DGM Ayurvedic Medical College, PGS&RC Gadag Date: Date: Place: Gadag Place: Gadag
  5. 5. © Copy right Declaration by the candidate I here by declare that the Rajiv Gandhi University of Health Sciences,Karnataka shall have the rights to preserve, use and disseminate thisdissertation/ thesis in print or electronic format for the academic / researchpurpose.Date :Place : Gadag ( SHASHIKALA . B. BANI ) © Rajiv Gandhi University of Health Sciences, Karnataka
  6. 6. ACKNOWLEDGEMENT I am very much grateful to my guide, Dr. G.V. Mulagund M.D(Ayu) , Professor& HOD Post Graduation Research & studies Dept. of Dravya Guna Shri D. G. M.Ayurvedic Medical College , Gadag. for his valuable suggestions and guidance incompletion of this research successfully . I am expressing my sincere thanks to my co-guide Dr. Kuber . Sankh M.D(Ayu)Lecture, Post Graduation Research & studies Dept. of Dravya Guna Shri D. G. M.Ayurvedic Medical College , Gadag. for his valuable suggestion ,guidelines & kindco-operation at every moment of the preparations of dissertation . I offer my sincere thanks to Dr. G.B. Patil Principal, Shri D. G. M. AyurvedicMedical College , Gadag. for facilitating the requirements needed during the work. I am very much thankful to Dr. G. S. Hiremath. HOD Dept of Dravya guna ,Shri D. G. M. Ayurvedic Medical College, Gadag for his valuable suggestions andconstant encouragement. I also thank Dr. Shashikant . B. N. for his kind co-operation. I am very thankful to all my teachers of Shri D. G. M. Ayurvedic MedicalCollege, Gadag .who have given a foundation for this nobler profession. I am thankful to all my friends for their kind co-operation in completing thiswork. I am highly indebted to my beloved parents, who framed a proper path for mycarrier. I remain ever great full to them. I express my heartfelt gratitude to my brother, Prashant for constant help andencouragement to move ahead. My deepest gratitude to my husband , Dr. Rajendrakumar. Angadi forenormous love & moral support.
  7. 7. I would like thank all my family members who have given love and care ,during my studies. It would not enough without remembering my lovely, sweet, little daughter,Sanjana whose entry become turning point of life and brings cheerfulness throughout. Finally I am thankful to all those persons who so helped directly or indirectlyfor the completion of this work.Date:Place: Gadag Shashikala.B.Bani
  8. 8. LIST OF ABBREVIATION USEDA.H -Astanga hridayamA.S - Astanga sangrahaC.S - Charaka samhitaD. Ni - Dhanwantari nighantuDM - Diabetes mellitusFBS -Fasting blood sugarIDDM - Insulin dependent diabetes mellitusK.Ni - Kaiyadeva nighantuM. N - Madhava nidanaM. Ni -Madanapala nighantuM.D.G - Madhava dravya gunaNi. R - Nighantu ratnakaraNi.A - Nighantu adarshaNIDDM - Non-insulin dependent diabetes mellitusOHA - Oral hypoglycemic agentsPPBS -Post partial blood sugarR.Ni - Raja nighantuS.K.D - Shabda kalpa drumaS.S - Sushruta samhitaUS - Urine sugar
  9. 9. ABSTRACTBackgroundMadhumeha which has been correlated with DM is a chronic metabolic disorder,described more than 2000 years has become an epidemic with a world wide incidenceof 5% in the general population. The patients experiences significant morbidity andmortality from microvascular, macrovascular complication .The drug fromcontemporary science shows adverse effect and declines in their action after prolongadministration .Since immemorial time medicinal plants are used in such conditionand Avartaki (Cassia Auriculata ) is one among them, described as antidiabetic inmost of nighantu.Objectives: Evaluation of efficacy of Avartaki beeja and pushpa in the management ofMadhumeha and to evaluate the comparative hypoglycemic effect of Avartaki beejaand Pushpa.Methods:In this prospective Comparative clinical study, 30 Patients of Madhumeha are selectedand randomly grouped as Group A and B receiving Avartaki beeja churna andAvartaki Pushpa Churna respectively, for a duration of 30 days with dose of 2gms perday. Efficacy was assessed by difference between baseline and assessment data.Results:A significant reduction in all the parameters was noted in both group. Individuallyboth groups are highly significant ( p< 0.001). But the comparison is non significantexcept for 2 parameters trishna and ashaktata ( p <0.05 ) . Comparison of ‘t’ valuesshows avartaki pushpa is more efficacious than beeja.
  10. 10. Interpretation :The result shows both Avartaki beeja and pushpa are efficacious in the managementof madhumeha. The mean net effect of FBS is more in Group B .The mean effect oftrishna is same in both the groupsConclusion:The hypoglycemic effect of Avartaki pushpa and beeja is highly significant after30days therapy and comparatively Avartaki pushpa is extremely effective inmanagement of madhumeha.KEY WORDSAvartaki beeja; Avartaki pushpa; Cassia auriculata; Madhumeha; Diabetes mellitus;Antidiabetic; Hypoglycemic; FBS;
  11. 11. TABLE OF CONTENT1. Introduction Page No.- 012. Objectives Page No.- 033. Review of Literature • Drug review- Avartaki (Cassia auriculata) Page No.- 04 • Disease review- ►Madhumeha Page No.- 29 ►Diabetes Mellitus (NIDDM) Page No.- 454. Methodology Page No.- 625. Result Page No.-756. Discussion Page No.- 1197. Conclusion Page No.-1238. Summary Page No.- 1259. Bibliography Page No.- 12710. Annexures Page No.- 141
  12. 12. List of TablesSL No Tables Page No.Drug review1. Varga of Avartaki According to different nighantu 062. Synonyms according to different nighantu 083. Properties according to different nighantu 144. Therapeutic actions according to different nighantu 155. Therapeutic uses according to different nighantu 16Disease review6. Kaphaja Prameha according to Brihatrayess 387. Pittaja Prameha according to Brihatrayess 398. Vataja Prameha according to Brihatrayess 399. Aetiologic classification of Diabetes mellitus 4710. Showing cells of islet of Langerhan and their relative hormones 5011. Metabolic actions of insulin 5212. Showing the symptoms of hyperglycemia 5813. Showing the complications of DM 5914. Showing the risk factors for type 2 DM 59Methodology15. Showing normal values of objective parameters 6916. Pipetting scheme for determination of blood sugar 7017. Observation for urine sugar 7118. Gradation for subjective parameters to asses the result 73
  13. 13. SL No Tables Page NoResults19. Demographic data 7520. Data related to complaints 7621. Data related to personal history 7722. Data related to the srotodusti before and after the treatment 7823. Subjective parameters of group A 7924. Subjective parameters of group B 7925. Objective parameters of group A 8026. Objective parameters of group B 8027. Showing the age ratio 8128. Showing the sex ratio 8229. Showing the incidence of religion 8330. Showing the nature of occupation 8431. Showing the socio economic state 8532. Showing the diet 8633. Showing the chronicity of madhumeha 8734. Showing the complaints 8835. Showing the family history 8936. Showing the treatment history 9037. Showing the ratio of involved agni 9138. Showing the vyasana in relation with disease 9239. Showing the Prakruti 9340. Showing the kind of Ahara 9441. Showing the vihara 95
  14. 14. SL No Tables Page No.42. Showing the involvement of manasika chinta 9643. Showing the comparison of udakavaha srotodusti lakshana before and after the treatment 9744. Showing comparison of medovaha srotodusti lakshanas before and after the treatment 9845. Showing the comparison of mootravaha srotodusti lakshana before and after the treatment 9946. Showing the Prabhoota mootrata before treatment in group A and group B 10047. Showing the Prabhoota mootrata after the treatment in group A and group B 10048. Showing the Avila mootrata before treatment in group A and group B 10249. Showing the Avila mootrata after the treatment in group A and group B 10250. Showing trishna before the treatment in group A and B 10451. Showing trishna after the treatment in group A and B 10452. Showing Ashaktata before treatment in group A and B 10653. Showing Ashaktata After treatment in group A and B 10654. Data showing the relief from complaint after treatment in both groups 10855. Showing the result of group A 11356. Showing the result of group B 11457. Showing the total result 11558. Individual study of Group A before and after the treatment 11659. Individual study of Group B before and after the treatment 11660. Comparative study of group A and group B after the treatment 117
  15. 15. List of FiguresSL .No Figures Page NoGraphs exhibited in the Results1. Showing the age ratio 812. Showing the sex ratio 823. Sowing the incidence of religion 834. Showing the nature of occupation 845. Showing the socio economic state 856. Showing the diet 867. Showing the chronicity of madhumeha 878. Showing the complaints 889. Showing the family history 8910. Showing the treatment history 9011. Showing the ratio of involved agni 9112. Showing the vyasana in relation with disease 9213. Showing the Prakruti 9314. Showing the kind of Ahara 9415. Showing the vihara 9516. Showing the involvement of manasika chinta 9617. Comparison of udakavaha srotodusti lakshana before and after the treatment 9718. Comparison of medovaha srotodusti lakshanas before and after the treatment 9819. Comparison of mootravaha srotodusti lakshana before and after the treatment 9920. Comparison of Prabhoota mootrata before and after treatment in group A 101
  16. 16. SL .No Figures Page No21. Comparison of Prabhoota mootrata before and after treatment in group B 10122. Comparison of Avila mootrata before and after treatment in group A 10323. Comparison of Avila mootrata before and after treatment in group B 10324. Comparison of trishna before and after treatment in group A 10525. Comparison of trishna before and after treatment in group B 10526. Comparison of Ashaktata before and after treatment in group A 10727. Comparison of Ashaktata before and after treatment in group B 10728. Showing the relief from complaint after treatment in both groups 10829. Comparison of FBS before and after the treatment in group A 10930. Comparison of FBS before and after the treatment in group B 10931. Comparison of PPBS before and after the treatment in group A 11032. Comparison of PPBS before and after the treatment in group B 11033. Comparison of US before and after the treatment in group A 11134. Comparison of US before and after the treatment in group B 11235. Showing the result of group A 11336. Showing the result of group B 11437. Showing the total result 115 List of Photographs1. Photograph showing the Avartaki pushpa and beeja 042. Photograph showing the steps of preparation of medicine 62
  17. 17. Introduction
  18. 18. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM) INTRODUCTION Madhumeha is a chronic metabolic disorder and the symptom appears inrelation with a mootravaha samsthana. Diabetes mellitus is a chronic metabolicendocrinal disorder, which has similar pathogenesis as the madhumeha .Thus thecomparison between madhumeha and DM is justifiable 1. Madhumeha has become a global problem in spite of much advancement inmodern medicine2. The World Health Organisation stated in 1998 that a 122 % rise inthe number of adults with diabetes is projected by 2005, to reach 300 million adultsworldwide. There are four reasons for this two-fold global increase: Firstly, we areliving longer; over-nutrition and lack of exercise are prevalent; the disease beingtransmitted in a hereditary fashion; Such transformations have taken place within theIndian population also. In India, it is estimated that 19 million cases occurred in 1995,rising to a projected 57 million by the year 2025 (1/6th of the world total). Accordingto recent epidemiological studies there has been a 40% increase in diabetes prevalenceamongst urban during the last five years3. Even the NIDDM a commonest form ofDM is most common accounting for 85-99% of the patient depending on geographyand ethnicity, occurs in adults, more so over 35 years of age4. The prevalence ofNIDDM is on the rise more alarmingly in the developing nations, ranked 7th amongleading cause of death. It has been rated 3rd when all its micro vascular , macrovascular, neuropathic complications5 are taken into account6. The cost of treatingdiabetes an associated complication exceeds $ 100 billion per year7. It has long been recognized that drugs represents only part of the managementof madhumeha and other intervention such as education , modification of diet andpromotion of physical health play a crucial role. If the dietary control and exercise Introduction 1
  19. 19. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)programmes do not improve the condition then the medication is added. Many ofpatients won’t have patience for long term therapies, complicated therapies likeexercise etc8. The OHA viz Sulfonylurea, Bigunides have associated with adverseeffect like nausea, vomiting, lactic acidosis, hypersensitivity etc. After long termadministration their action declines, up to 50% patients of NIDDM initially treatedwith OHA ultimately need insulin.9 Hence we find no satisfactory remedies formadhumeha in contemporary medical science. Medicinal plants since time immemorial have been used virtually in allcultures as a source of medicine. Several herbs have been described in ayurvedictreasure of therapeutics, which have a beneficial effect in the management ofmadhumeha. Avartaki (Cassia auriculata) is one such drug which act as mootra 10sangrahaneeya and also reduces the high blood glucose . The seeds and flowers ofthis plant are indicated in the management of madhumeha11 .Thus in the present studyan attempt is made to evaluate the hypoglycemic action of Avartaki, with a view tofind out a therapeutically efficacious, safer, cost effective and easily available drug. Introduction 2
  20. 20. Objectives
  21. 21. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)OBJECTIVES 1. To evaluate the efficacy of Avartaki pushpa churna in the management of madhumeha. 2. To evaluate the efficacy of Avartaki beeja churna in the management of madhumeha. 3. To evaluate the comparative hypoglycemic effect of Avartaki pushpa and beeja churna. Objectives 3
  22. 22. Review Of LiteratureDrug Review Avartaki (Cassia Auriculata)
  23. 23. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM) DRUG REVIEWAVARTAKI ►►CASSIA AURICULATA Avartaki is a plant with yellow flowers and auricule shaped stipules existsabundantly in country like India got a wide range of significance in social as well asmedicinal field since immemorial time.HISTORY12 In vanaspati shastra by Jay Krishnan, Avartaki is explained as it exist since theperiod of Ramayana. When Lord Ram was wandering in search of Sita towardsLanka, saw this plant with bloomed flowers and his mind is pleased with beauty,asked for any information regarding Sita. But flower with proud of its beauty notanswered . Rama got angry and cursed the flower to loose its fragrance and becomeunfit for the worship , thus it should be used by leather workers. Ramasiya se garva kiya jo te nara jagame haryo Garva kiyo avalake phoolade , to jaye chamara kadame daryoLater the flower begged apology. Humble hearted Rama put his feet on its head andthere fore foot mark appears on the seeds Apart from above evidence there are few more literature. A Persian poet hasgiven simile to the flowers with his beloved’s eyes. A fairy tale popular in Marawadregion , that Avartaki grows so densely for which it become a border for twokingdom. Drug review- Avartaki 5
  24. 24. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)Meaning of Cassia auriculata ►Cassia → Quetsiah (Hebrew):Kasia ( Greek ) – Old Name used for the plant ,Auriculata→Auricula (Latin) –Ear of the lobe [large ear lobe shaped pair of stipules]present on the stem 13 . GANA/ VARGA Table 1.1 Showing the varga according to different Nighantu : Madhava dravya guna Vividhoushadhi varga14 Dhanwantari nighantu Oushadhi varga15 Kaiyadeva nighantu Oushadhi varga16 Raja nighantu Guduchyadi varga17 & Shatavhadi varga18 Madanapala nighantu Abhayadi varga19 Nighantu adarsha Pootikaranja varga20 Drug review- Avartaki 6
  25. 25. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)Synonyms of Avartaki with their meanings 1. Avartaki :Stipules are present on the stem 2. Peetapushpa : It bears yellow coloured flowers 3. Raktaphali : Legume is red in colour during riped condition 4. Peetakeela : Corolla or petals are yellow in colour 5. Shimbiphala : Legumes are present on the plant 6. Peetika : It bears a yellow coloured flowers 7. Supushpa : The flowers have beautiful appearance 8. Hemapushpa : The flowers have golden colour 9. Kanchanapushpa : The flowers have golden colour 10. Sharapushpa : Flowers blooms in the sharat ritu 11. Peetakeelaka : It bears yellow coloured flowers 12. Peeta pushpika : It bears yellow coloured flowers 13. Charmaranga : Its bark is used for dyeing the leather 14. Rangalata : A plant useful for leather dyeing 15. Mahajalini : The plant which form a network by their spread 16. Mahadadijali : The plant which form a network by their spread 17. Mahada : The plant which form a network by their spread 18. Tilapusphika : Flowers resembles like flowers of tila 19. Vamavarta : The legumes are often twisted in nature 20. Raktapushpika :The flowers bears red lines in it 21. Raktapushpa : The flowers bears red lines in it 22. Dantakashta :The twig is used for brushing Drug review- Avartaki 7
  26. 26. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)Some other synonyms are, Mayhari ,Talopoda, Bindukini, Vibhandi, Tindukini, Vishanika, Manojna, Ahulya, Avala, Tarawar, Halurakhya, kara, Tarawat, Arbar and Nripamangalyaka.SYNONYMS ACCORDING TO DIFFERENT NIGHANTUTable 1.2 Showing synonyms according to different Synonyms D.N K.N R.N M.N Ni.Ad Ni.R 1 Avartaki + + + + + + 2 Charmaranga + + + + + + 3 Peeta pushpa + - + - - - 4 Peetakeelaka + + - - + + 5 Vibhandi + + + + - - 6 Mahajalini + + - + - - 7 Bindukini + + - + - - 8 Raktaphali - + - - - - 9 Tindukini - - + - - - 10 Vishanika - - + - - - 11 Rangalata - - + - - - 12 Manojna - - + - - - 13 Raktapushpi - - + + - - 14 Mahadadijali - - + - - - 15 Peetakeela - - + - - - 16 Vamavarta - - + - - - 17 Tilapushpika - - - + - - 18 Ahulya - - + - + + 19 Halurakhya - - + - - - 20 Kara - - + - - - 21 Taravat - - + - - - 22 Shimbiphala - - + - - - 23 Supushpa - - + - - - 24 Arbar - - + - - - 25 Dantakashta - - + - - - 26 Hemapushpa - - + - - - 27 Kanchanapushpa - - + - - - 28 Nripamangalyaka - - + - - - 29 Sharapushpa - - + - - - Drug review- Avartaki 8
  27. 27. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)VERNACULAR NAMES Latin : Cassia auriculata English : Tanner’cassia , Mature tea tree, Tanner’s senna Hindi : Taravar , Aval , Dantvan ,Tarota Marathi : Tarabad ,Taroda , Tarawad Gujarati : Avala, Aawar Tamil : Avaram , Avarai , Avirae, Sadurguli, Semmara, Summai Telagu : Tangedu, Avara gida, Merakatanageda ,tangeru Malayalam : Avar , aveeram , Jimute ,Ponnaviram Kannada :Tangedu, Taravara gida, Avarike, Chakusina gida, Tangayaree, Avara, Tatwada , Olletanagida , Sakusina , Tangadi , Tangedi Bengali :Taravar Cutch : Aawala Duk : Taravara , avala Berara : Tarota Burma : Peikthingata Ceylon : Matura tea Chines : Kiang Mang , Kiang Mang Kiue Min Lambadi : Olaniyaro Drug review- Avartaki 9
  28. 28. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)KULA Shimbi KulaUPAKULA Pootikaranja Upakula22FAMILY LeguminosaeSUB –FAMILY CaeselpiniaceaeTaxonomical Classification of Cassia auriculata 23 Kingdom : Plantae Division : Angiospermae Class : Dicotyledonae Series : Calciflora Order : Rosale Family : Leguminosae Sub –family : Caesalpiniaceae Genus : Cassia Species : auriculataFEATURES OF CAESALPINIACEAE 24Diagnostic features►Leaves paripinnate ; flowers zygomorphic ; Calyx and Corolla 5, ascending imbricate;Stamens 10 or less, free, gynoecium monocarpellary with marginal placentation .Distribution ►It is commonly called Cassia family. The sub –family contains 135genera which are cosmopolitan in distribution. In India it is represented by 110species and more than 21 genera. Drug review- Avartaki 10
  29. 29. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)Vegetative Characters► Habit→ It shows great variation in habit , i.e, may be trees , shrubs , undershrubs or herbs. Besides this sometimes all types of plants occurs in same genus. Root→ Tap and branched Stem→ Erect, woody, herbaceous or climbing , branched , glabrous or covered with prickles and spines. Leaf→Alternate, leaf base pulvinate, compound unipinnate, bipinnate or rarely simple ; stipules.Floral Characters ► Flower –Pedicellate, bractate , zygomorphic, complete , hermaphrodite, slightly perigynous, pentamerous Calyx – Sepals 5 , free, or connate, odd sepal anterior , imbricate aestivation. Corolla – Petals 5. Androecium – Stamens 10, free, reduction in number of stamens by the formation of staminodes. In Cassia there are 3 posterior staminodes. Gynoecium –Monocarpellary , ovary superior or slightly inferior , unilocular with marginal placentation , straight or curved, hairy ; Style long ; Stigma simple. Fruit – Legume and never breaks up into one seeded parts Seed – Non endospermic Pollination – Entomophilous Drug review- Avartaki 11
  30. 30. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)MORPHOLOGY OF CASSIA AURICULATA25A tall much-branched shrub; bark smooth, reddish-brown; branchlets finelypubescent. Leaves 3/4 inch long; rachis densely fulvous-pubescent with an erect lineargland between each pair of leaflets; stipules foliaceous, reflexed, very large,rotundato-reniform, produced at the base on the side next the petiole into a longsubulate point, persistent. Leaflets 8-12 pairs, 1-1 by -3/8-1/2 inch, slightlyoverlapping, oblong-obovate, obtuse or emarginate, mucronate, glabrous or finelydowny, dull green above, paler beneath, base usually rounded; petiolules 1/20 inchlong. Flowers large, reaching 2 inch across, in terminal and axillary corymboseracemes; pedicels 3/4-1 inch long; bracts ovate, acuminate, caducous. Calyx glabrous;segments leathery, concave, the 2 outer much smaller than the other 3. Petals withlong claws, crisped on the margin, bright yellow, veined with orange. Stamens 10, ofwhich the 3 upper are reduced to staminodes, the remaining 7 perfect, of which the 3lower are larger than the 4 lateral ones. Pods 3-5 by 1/2-5/8 inch, flat, thin, papery,oblong, obtuse, mucronate, pale brown, deeply depressed between the seeds, having acrumpled appearance, transversely veined, pubescent. Seeds 10-20. Every leaf has anear-shaped leafy structure at the base of the stalk. Fruit turns brown when dry.HABITATAvartaki is found in Maharastra , Gujarat ,Rajasthana and Madhya Pradesh 26. A treeof height of 1-3 meters with yellow flowers grows wild in the central provinces,western coast , South India and Ceylon 27.Apart from India it also grows in Ceylon or 28Srilanka and Indomalaysia . A fairy tale popular in Gujarat states that it grows insuch a fashion that the King make over the border for his kingdom29. Drug review- Avartaki 12
  31. 31. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)PHYTOCHEMISTRY Plant contains pyrrolizidine, alkaloids. Root contains flavone glycoside. Barkcontains tannin 25% and ash 5%30. Flowers contain Beta – sitosterols , kaempferol .Seeds yield fatty oil consisting of palmatic oleic linoleic acids31. A new leucoanthocyanin- goratensidine, characterized as 4`, 5, 7-trihydroxyflavan-3, 4-diol; Ariculacacidin characterized as 5, 2` 4`- trihydroxyflavan-3, 4-dial 32. It posses constituents like polysaccharides, flavonoids, anthracene derivativesand some dimeric procyanidins33 Leaves contains saturated higher fatty keto alcohols and emodin. The leaveswere found to contain quinines, anthraquinones ( carmine , cascara, mitxanthobe),benzoquinones, naphthaquinones34. Recent research on cassia auriculata stem bark revealed the presence of sterol ,triterpenoid glycosides like O-B- D- xylopyranosides35. 4.8% of light –yellow oil and oil has about 75% unsaturated fatty acids.Palmatic and oleic acid are the major components of fatty acids. Oligosaccharides andgalactomanose were detected from seeds 36. Drug review- Avartaki 13
  32. 32. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)PROPERTIES ACCORDING TO DIFFERENT NIGHANTUTable 1.3 Showing properties according to different Nighantu PROPERTIS D. Ni K.Ni R.Ni M.D Ni. R Ni. Ad Kashaya + + + + + +RASA Tikta - + + + + + Amla - - + - - -VEERYA Sheeta + - + + + + Rechaka - - - + + +PRABHAVA Grahi - - - - + + Vata + - - - + +DOSHAGHNATA Pitta + + + + + + Kapha + + - + + + 37Summarising all the propertiesGuna- Laghu ,RookshaRasa – Kashaya ,TiktaVipaka – KatuVeerya – SheetaDoshaghnata- Kapha vata shamaka Drug review- Avartaki 14
  33. 33. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)THERAPEUTIC ACTIONS ACCORDING TO DIFFERENT NIGHANTUTable Showing therapeutic action according to different NighantuSr. no Karma D.Ni K.Ni M.Ni M. D Ni.R Ni. Ad R.Ni1 Kustahara + - - - - - -2 Urdhwabhagahara + - - + - - -3 Adhobhagahara + - + + - - -4 Shukravardhana + - - - - - -5 Varnya - + - - + + -6 Pramehahara - + - - + + -7 Vamihara - + - - + + -8 Krimihara - + - - + + -9 Trishnahara - + - - + + -10 Chakshushya - - - - + + +11 Ruchya - - - - + + -12 Vishahara - - - - + + - Drug review- Avartaki 15
  34. 34. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)THERAPEUTIC USES ACCORDING TO DIFFERENT NIGHANTU Table Showing therapeutic uses according to different Roga M.D D.Ni K.Ni M.Ni Ni.Ad Ni.R R.Ni1 Kusta + + + + + + +2 Atisara - + - - + + -3 Shopha - + - + + + -4 Gulma - + + - - - -5 Udara - + + + - - -6 Anaha - + + + - - -7 Krimi - + + + - - +8 Shotha - - + - + + -9 Trishna - - + - - - -10 Kandu - - + - + + +11 Visha - - + - - - -12 Vamana - - + - + + -13 Shwasa - - + - - - -14 Daha - - + + - - -15 Rakta vikar - - + - - - -16 Jwara - - + + + + -17 Prameha - - + - - - -18 Raktapitta - - + - - - -19 Shukrakshaya - - + - - - -20 Mukha roga - - - - + + +21 Shoola - - - - + + +22 Vrana - - - - + + + Drug review- Avartaki 16
  35. 35. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM) USES1. Decorticated seeds in fine powder or paste or valved local application to purulent ophthalmia or conjunctivitis known as country sore eye.2. Seeds with testa and their kernels are finely powered and blown into the eye or the powder mixed with coconut or gigelly oil is applied to the sore eyes.3. Seeds are also used in Diabetes and chylous urine.4. The plant is used in the form of a powder mixed with honey or decoction especially of flower buds, is administered in chylous urine and diabetes with excellent results38.5. Twigs are used as tooth brushes.6. In the south of Ceylon, leaves are used as a substitute for tea7. Coffee made from powdered seed or leaves is good substitute for coffee made from seeds of coffee arabica and is prescribed in giddiness due to heart disease.8. Flowers are used as pessaries in Gujarat to check excessive menstrual flow.9. Infusion of bark is used for enemas, gargles etc as substitute for tannic acid or oak galls.10. Compound syrup is prescribed for nocturnal emission.11. The infusion is used as a cooling drink in fever.12. Kwatha prepared of root bark and stem bark is used for Andavriddhi.13. In ancient period the people while roaming use as antidiarrhoeal ,they used to chew the root bark and suck 2-3 drops of juice14. The root bark is chewed with lavana and juice is sucked to get relief from the Cholera, Ajeerna , Shoola , Vamana , Atisara.15. If the animals suffers with Adhmana, Chichaka or Khasara, then the kwatha of patra is given. In Atisara and Adhmana the patra kalka with lavana is given. Drug review- Avartaki 17
  36. 36. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)16. Patra are tied over the abdomen in udarashoola.17. The juice of stem bark is instilled into eyes in chakshu peeda.18. The paste of patra, sarjikshara and tamarind leaves is applied in sprain and inflammation.19. The bhashpita patra is tied over the shotha20. A bed covered with leaves and covered with a lining, angara is kept under that bed and seka is given in Angasthabdata and any traumatic inflammation.21. The patra swarasa is used as gandoosha in mukhapaka 39.Useful partsRoot, Leaves, Flowers, Legume, Bark and Seeds.40PosologyChurna – 3-6 gms41Infusion of leaves (1 in 20 ) – 1-2 ouncesInfusion of bark - 2- 4 drachmsCompound syrup (of flower, mixed with Mocha Rasa & Sarsaparik) – 3-4 drachmsDecoction of root (1 in 2 ) - 2-8 drachmsElectuary of seed - 2-4 drachmsMedicated baths of leaves42 Drug review- Avartaki 18
  37. 37. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM) RECENT RESEARCHES ON AVARTAKI431.Antihyperglycaemic and antioxidant effect of hyponidd, an ayurvedicherbomineral formulation in streptozotocin-induced diabetic rats. Babu PS,Stanely Mainzen Prince P. Department of Biochemistry, Annamalai University,Annamalai Nagar-608002 Tamil nadu, India.Hyponidd is a herbomineral formulation composed of the extracts of ten medicinalplants ( Momordica charantia, Melia azadirachta, Pterocarpus marsupium, Tinosporacordifolia , Gymnema sylvestre, Enicostemma littorale, Emblica officinalis, Eugeniajambolana, Cassia auriculata and Curcuma longa). We have investigated hyponidd forits possible antihyperglycaemic and antioxidant effect in diabetic rats. Rats wererendered diabetic by streptozotocin (STZ) (45 mg kg(-1) body weight). Oraladministration of hyponidd (100 mg kg(-1) and 200 mg kg(-1)) for 45 days resulted insignificant lowered levels of blood glucose and significant increased levels of hepaticglycogen and total haemoglobin. An oral glucose tolerance test was also performed inexperimental diabetic rats in which there was a significant improvement in bloodglucose tolerance in the rats treated with hyponidd. Hyponidd administration alsodecreased levels of glycosylated haemoglobin, plasma thiobarbituric acid reactivesubstances, hydroperoxides, ceruloplasmin and alpha-tocopherol in diabetic rats.Plasma reduced glutathione and vitamin C were significantly elevated by oraladministration of hyponidd. The effect of hyponidd at a dose of 200 mg kg(-1) wasmore effective than glibenclamide (600 microg kg(-1)) in restoring the values to nearnormal. The results showed that hyponidd exhibits antihyperglycaemic andantioxidant activity in STZ-induced diabetic rats.2.alpha-Glucosidase inhibitory activity of some Sri Lanka plant extracts, one ofwhich, Cassia auriculata, exerts a strong antihyperglycemic effect in rats Drug review- Avartaki 19
  38. 38. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)comparable to the therapeutic drug acarbose. Abesundara KJ, Matsui T,Matsumoto K.Division of Food Biotechnology,Department of Bioscience andBiotechnology, Faculty of Agriculture, Graduate School of Kyushu University, 6-10-1Hakozaki, Higashi-ku ,Fukuoka 812-8581, Japan.Some Sri Lanka plant stuffs were examined regarding in vitro and in vivo alpha-glucosidase (AGH) inhibitory actions. According to the results, water extracts andmethanol extracts of dried fruits of Nelli (Phylanthus embelica), methanol extracts ofdried flowers of Ranawara (Cassia auriculata), and water extracts of latex ofGammalu (Pterocarpus marsupium) were found to have a potential AGH inhibitoryactivity. In particular, Ranawara methanol extract showed the strongest AGHinhibitory activity in vitro preferably on maltase giving an IC(50) value of 0.023mg/mL and inhibited the maltase activity competitively. As a result of single oraladministration of Ranawara (C. auriculata) methanol extract in Sprague-Dawley rats,a significant and potent lowering of blood glycemic response toward maltoseingestion was observed at 30 min after dosing of 5 mg/kg, thus, concurrentlysuppressed insulin activity. The ED(50) of the extract (4.9 mg/kg) clearly indicatedthat the antihyperglycemic effect was as potent as that of therapeuticdrugacarbose(ED(50)3.1mg/kg).3.The effects of Cassia auriculata and Cardiospermum halicacabum teas on thesteady state blood level and toxicity of carbamazepine.Thabrew I, Munasinghe J,Chackrewarthi S, Senarath S.Department of Biochemistry and Clinical Chemistry,Faculty of Medicine, University of Kelaniya, 6, Talagolla Road, Ragama, Sri Lanka.mrthab@dynaweb.lkA study was conducted using male Wistar rats as the experimental model, to comparethe effects of concurrent administration of herbal tea prepared from dried flowers of Drug review- Avartaki 20
  39. 39. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)Cassia auriculata or aerial parts of Cardiospermum halicacabum and carbamazepine,on (a). steady state serum levels of the prescription drug, and (b). changes in toxicity(as assessed by changes in general behaviour, haematological parameters, and liverand kidney function) that may occur due to drug interaction. Results demonstrate thatin rats receiving the Cassia auriculata tea and carbamazepine, the blood levels of theprescription drug were significantly enhanced by 47.1% (P<0.04), when comparedwith the levels in animals receiving only carbamazepine for the same time period,with no apparent changes in toxicity. In animals receiving the Cardiospermumhalicacabum tea, there were no significant changes in the blood levels ofcarbamazepine or drug-related toxicity. Cassia auriculata tea has therefore thepotential to influence the bioavailability of carbamazepine, and hence its therapeuticactions. Concurrent ingestion of carbamazepine with herbal teas containing Cassiaauriculata is therefore best avoided by patients under treatment for epilepsy.4.Possible interaction of herbal tea and carbamazepine.Thabrew MI, MunasingheTM, Chackrewarthi S, Senarath S.Department of Biochemistry and ClinicalChemistry, Faculty of Medicine, University of Kelaniya, Ragama, Sri A study was conducted using Wistar rats to determine the effect of concurrentadministration of a herbal tea prepared from dried flowers of Cassia auriculata andcarbamazepine on (a) blood levels of the prescription drug and (b) changes in toxicity(as assessed by changes in hematological parameters, liver and kidney function, andhistology of major body organs) that may occur due to drug interaction. Resultsdemonstrate that in rats receiving the herbal tea and carbamazepine, the blood levelsof the prescription drug were significantly enhanced by 47.1% (p <0.04) whencompared with the levels in animals receiving only carbamazepine, with no apparent Drug review- Avartaki 21
  40. 40. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)changes in toxicity. Concurrent ingestion of the herbal tea prepared from Cassiaauriculata flowers with carbamazepine may therefore influence the bioavailability ofthe prescribed drug and hence its therapeutic potential5.Activity of Cassia auriculata leaf extract in rats with alcoholic liver injury.Kumar Rajagopal S, Manickam P, Periyasamy V, Namasivayam N. Department ofBiochemistry, Annamalai University, Annamalainagar 608 002, Tamilnadu,India.This study was undertaken to investigate the effect of Cassia auriculata leaf extract ontissue lipid peroxidation and antioxidant status in experimental hepatotoxicity.Administering ethanol to rats for 60 days resulted in significantly elevated levels ofserum total bilirubin, aspartate transaminase (AST), alanine transaminase (ALT) andalkaline phosphatase (ALP) as compared with those of the experimental control rats.Significantly elevated levels of tissue thiobarbituric acid reactive substances(TBARS), hydroperoxides and lowered activities of superoxide dismutase (SOD),catalase (CAT) and reduced glutathione (GSH) were also observed on alcoholtreatment as compared with those of experimental control rats. Concentration ofserum non-enzymic antioxidants such as vitamin E and vitamin C were alsosignificantly lowered on alcohol supplementation. Treatment with Cassia auriculataleaf extract at a dose of 250 mg kg(-1) body weight and 500 mg kg(-1) body weight torats administered alcohol, lowered the levels of TBARS and hydroperoxides andelevated the activities of SOD and CAT and the levels of reduced GSH in the liver,brain, kidney and intestine significantly compared to unsupplemented alcohol treatedrats. Cassia auriculata leaf extract treatment restored the serum vitamin E, and vitaminC levels also to near those of the experimental control animals. Our data indicate thatsupplementation with Cassia auriculata leaf extract can offer protection against freeradical mediated oxidative stress in experimental hepatotoxicity. In addition, Drug review- Avartaki 22
  41. 41. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)histopathological studies of the liver and brain confirmed the beneficial role of Cassiaauriculata leaf extract.6.Effect of Cassia auriculata flowers on blood sugar levels, serum and tissuelipids in streptozotocin diabetic rats.Pari L, Latha M.Department of Biochemistry,Faculty of Science Annamalai University, Annamalai Nagar Tamil Nadu-608 002,India.AIM OF THE STUDY: The main aim was to demonstrate the effects of Cassiaauriculata flowers on blood glucose and lipid levels in experimental diabetic rats.METHODOLOGY: Aqueous extract of Cassia auriculata flowers was administeredorally and different doses of the extract on blood glucose, haemoglobin, glycosylatedhaemoglobin, serum and tissue lipids, hexokinase and glucose-6-phosphatase instreptozotocin-induced diabetic rats were studied. Glibenclamide was used as standardreference drug. RESULTS: Cassia auriculata flower extract (CFEt), at doses of 0.15,0.30 and 0.45 g/kg body weight for 30 days, suppressed the elevated blood glucoseand lipid levels in diabetic rats. Cassia auriculata at 0.45 g/kg was found to becomparable to glibenclamide. CONCLUSION: Our findings indicate that the Cassiaauriculata flowers possess antihyperlipidaemic effect in addition to antidiabeticactivity7.Preventive effects of Cassia auriculata L. flowers on brain lipid peroxidation inrats treated with streptozotocin.Latha M, Pari L.Department of Biochemistry,Faculty of Science, Annamalai University, Annamalai Nagar, Tamil Nadu, India.The effect of aqueous extract of the flowers of Cassia auriculata were examined onantioxidants and lipid peroxidation in the brain of streptozotocin diabetic rats.Significant increase in the activities of superoxide dismutase, catalase, glutathioneperoxidase, glutathione-S-transferase and reduced glutathione were observed in brain Drug review- Avartaki 23
  42. 42. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)on treatment with Cassia auriculata flower extract (CFEt) and glibenclamide. Both thetreated groups showed significant decrease in thiobarbituric reactive substances(TBARS) and hydroperoxide formation in brain, suggesting its role in protectionagainst lipid peroxidation induced membrane damage. Since the study of induction ofthe antioxidant enzymes is considered to be a reliable marker for evaluating theantiperoxidative efficacy of medicinal plant, these findings are suggestions of possibleantiperoxidative role played by Cassia auriculata flower extract.8. Antihyperglycaemic effect of Cassia auriculata in experimental diabetes andits effects on key metabolic enzymes involved in carbohydrate metabolism. LathaM, Pari L. Department of Biochemistry, Faculty of Science, Annamalai University,Annamalai Nagar, TamilNadu, India.1. In experimental diabetes, enzymes of glucose and fatty acid metabolism aremarkedly altered. Persistent hyperglycaemia is a major contributor to such metabolicalterations, which lead to the pathogenesis of diabetic complications. To ourknowledge, there are no available reports on the enzymes of hepatic glucosemetabolism of Cassia auriculata flower against diabetes. The present study wasdesigned to study the effect of Cassia auriculata flower extract (CFEt) on hepaticglycolytic and gluconeogenic enzymes. 2. Streptozotocin diabetic rats were givenCFEt (0.15, 0.30 and 0.45 g/kg) or 600 microg/kg glibenclamide for 30 days. At theend of 30 days, blood glucose, plasma insulin, haemoglobin, glycosylatedhaemoglobin, glycolytic and gluconeogenic enzymes were assessed. 3.Administration of CFEt at 0.45 g/kg significantly decreased blood glucose,glycosylated haemoglobin and gluconeogenic enzymes and increased plasma insulin,haemoglobin and hexokinase activity. Similarly, administration of glibenclamideshowed a significant effect; however, CFEt at 0.15 and 0.30 g/kg did not show any Drug review- Avartaki 24
  43. 43. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)significant effect. 4. In conclusion, the observations show that the aqueous extract ofCFEt possesses an antihyperglycaemic effect and suggest that enhancedgluconeogenesis during diabetes is shifted towards normal and that the extractenhances the utilization of glucose through increased glycolysis. The effect of CFEtwas more prominent than that of glibenclamide.9.Effect of Cassia auriculata leaf extract on lipids in rats with alcoholic liverinjury. Kumar RS, Ponmozhi M, Viswanathan P, Nalini N. Department ofBiochemistry, Annamalai University, Annamalainagar, Tamilnadu, India.We studied the effect of administering Cassia auriculata leaf extract to rats withexperimentally induced liver damage. Hepatotoxicity was induced by administering9.875 g/kg bodyweight ethanol for 30 days by intragastric intubation. C. auriculataleaf extract was administered at a dose of 250 mg/kg bodyweight daily in one groupand 500 mg/kg bodyweight daily in another group of alcohol-treated rats. All ratswere fed with standard pellets. The control rats were also given isocaloric glucosesolution. The average bodyweight gain was significantly lower in alcohol-treated rats,but improved on supplementation with C. auriculata leaf extract. Alcoholsupplementation significantly elevated the cholesterol, phospholipid and triglycerideconcentration in the liver, brain, kidney and intestine, as compared with those of thenormal control rats. Treatment with C. auriculata leaf extract and alcohol significantlylowered the tissue lipid levels to almost normal levels. Microscopic examination ofalcohol-treated rat liver showed inflammatory cell infiltrates and fatty changes, whichwere reversed on treatment with C. auriculata leaf extract. Similarly, alcohol-treatedrat brain demonstrated spongiosis, which was markedly reduced on treatment with C.auriculata. In conclusion, this study shows that treatment with C. auriculata leafextract has a lipid-lowering effect in rats with experimentally induced, alcohol-related Drug review- Avartaki 25
  44. 44. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)liver damage. This is associated with a reversal of steatosis in the liver and ofspongiosis in the brain. The mechanism of C. auriculata leaf extract lipid-loweringpotential is unclear.10.Effect of Cassia auriculata Linn. on serum glucose level, glucose utilization byisolated rat hemidiaphragm.Sabu MC, Subburaju T.Amala Cancer Research Center,Amala Nagar, Thrissur 680 553, Kerala, India. sabu_mc@rediff.comAn aqueous leaf extract of Cassia auriculata (C. auriculata) was found to lower theserum glucose level in normal rats. Maximum reduction in serum glucose level wasobserved after 4 h at a dose levels of 100, 200, 400 mg/kg body weight of the extract.In normal rats the serum glucose level reduction at 4th h was 23% by 100 mg/kg bodyweight and 31% by 200 mg/kg body weight. In alloxan-induced diabetic rats, chronicadministration of the extract significantly reduced the serum glucose level from thirdday to till the end of the experiment. The extract was also found to inhibit the bodyweight reduction induced by alloxan administration. Glucose uptake and glycogendeposition studies suggest that C. auriculata leaf extract probably has no direct insulinlike effect which can enhance the peripheral utilization of glucose.11.Antihyperglycaemic effect of Diamed, a herbal formulation, in experimentaldiabetes in rats. Pari L, Ramakrishnan R, Venkateswaran S.Department ofBiochemistry, Annamalai University, Tamil Nadu, India. paribala@sancharnet.inDiamed is a herbal formulation composed of the aqueous extracts of three medicinalplants (Azardirachta indica, Cassia auriculata and Momordica charantia). We haveinvestigated Diamed for its possible antihyperglycaemic action in rats with alloxan-induced experimental diabetes. Oral administration of Diamed (1.39 (0.25 g), 1.67(0.30 g) or 1.94 (0.35 g) mL kg(-1)) for 30 days resulted in a significant reduction inblood glucose, glycosylated haemoglobin, and an increase in plasma insulin and total Drug review- Avartaki 26
  45. 45. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)haemoglobin. The effect was highly significant after administration of the 1.94 mL(0.35 g) g(-1) body weight dose. Diamed also prevented a decrease in body weight.An oral glucose tolerance test was performed in experimental diabetic rats in whichthere was a significant improvement in glucose tolerance in the animals treated withDiamed. The effect was compared with 600 microg kg(-1) glibenclamide. The resultsshowed that Diamed had antihyperglycaemic action in experimental diabetes in rats.12.Constituents of Cassia auriculata.Nageswara Rao G, Mahesh Kumar P,Dhandapani VS, Rama Krishna T, Hayashi T. Department of Chemistry, Sri SathyaSai Institute of Higher Learning, Prasanthi Nilayam 515 134, Andhra Pradesh, India.The isolation and spectral data of di-(2-ethyl) hexyl phthalate (1) from Cassiaauriculata leaves are reported.13.Antibacterial activity of some folklore medicinal plants used by tribals inWestern Ghats of India. Samy RP, Ignacimuthu S. Entomology Research Institute,Loyola College, Chennai, IndiaA series of 30 Indian folklore medicinal plants used by tribal healers to treatinfections, were screened for antibacterial properties at 10 mg/ml concentration byusing disc diffusion method against Bacillus subtilis, Escherichia coli, Klebsiellaaerogenes, Proteus vulgaris, Pseudomonas aerogenes and Staphylococcus aureus.Twenty plant species showed activity against one or more species of bacteria used inthis assay; among them the leaf extracts of Cassia occidentalis and Cassia auriculataexhibited significant broad spectrum activity against B. subtilis and S. aureus. Tenplant species were not found active against all tested bacteria. These results werecompared with results obtained using standard antibiotics, chloramphenicol (30microg/disc) and streptomycin (30 microg/disc) which served as a reference forinhibition zone diameter. Drug review- Avartaki 27
  46. 46. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)14.Studies on medicinal plants of Sri Lanka: occurrence of pyrrolizidinealkaloids and hepatotoxic properties in some traditional medicinal herbs.Arseculeratne SN, Gunatilaka AA, Panabokke RG.There is a paucity of data on the occurrence of hepatotoxic and hepatocarcinogenicpyrrolizidine alkaloids in medicinal plants, and there are no data on the hepatotoxicproperties of herbal medicines that are used in the traditional pharmacopoiea of SriLanka and other Asian and African countries. In view of the extensive consumption ofthese herbs and the occurrence of chronic liver diseases including hepatocellularcancer in this and other countries of South Asia, we have screened fifty medicinalplants for pyrrolizidine alkaloids and have obtained positive results with three species,namely Crotalaria verrucosa L., Holarrhena antidysenterica (L.) Br., and Cassiaauriculata L. Feeding trials in rats with materials from these three species producedliver lesions--disruption of the centrilobular veins, congestion or haemorrhage in thecentrilobular sinusoids, centrilobular or focal hepatocellular necrosis--andhistopathology in the lungs and kidneys which were compatible with the action ofpyrrolizidine alkaloids. The presence of alkaloids in C. auriculata has not beenpreviously reported nor has the presence of pyrrolizidine alkaloids in H.antidysenterica. It is suggested that the consumption of herbal medicines that containpyrrolizidine alkaloids could contribute to the high incidence of chronic liver diseaseincluding primary hepatocellular cancer in Asian and African countries.15.Chemical and spectral studies of novel keto-alcohols from the leaves of Cassiaauriculata.Varshney SC, Rizvi SA, Gupta PC.16.[Presence of leucoanthocyanic chromogens in Cassia auriculata and C.goratensis Fres., adulteration of official sennas.][Article in French]PARIS R,CUBUKCU Drug review- Avartaki 28
  47. 47. Review Of Literature Disease Review Madhumeha
  48. 48. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM) DISEASE REVIEW MADHUMEHA Madhumeha is a disease itself manifesting in one of the trimarma namelybasti. Though it is a endocrinal problem, disorder of metabolism it is included undermootravaha srotovikara, because its manifestation is seen in mootravaha srotas 44. Prameha literally formed by two words , Pra means the excessive, Mehameans the discharge. It means the frequent excretion of excessive urine45 , diseasewhere excessive dirty or contaminated (turbid ) urine is excreted46.Synonyms for prameha Meharoga, Mehagada Mehovikara BastirogaCharacteristics of prameharoga 1. Chirakaleena : chronic illness 2. Anushangitwa : relapsing type of illness 3. Mahagada : one of 8 mahagada mentioned by Sushruta 4. Beejadoshat-kulajavyadhi :may be congenital, hereditary inherited disease,Nirukti for Madhumeha: madhu upadan bhuto madhumeha Madhumeha is also comprised of two words. Madhu- like honey, meha- discharge.The patient passes urine similar in colour and taste of honey 47. Disease review- Madhumeha 29
  49. 49. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)HISTORY 48 In India the history of the disease madhumeha is recorded since immemorialtime. Purana etc. have defined the condition in which the whole body become sweet. Vedic literature a oldest literature of the world, named the disease as Astravamwhich means mutratisara. i.e. excessive micturation as in the Atharva veda. In later period, all the Samhitas from Charaka to Vagbhata’s deal with theaetiology symptomology, pathology, prognosis, complication , principles of thetreatment , and different kind of management , under the different contexts mainly inthe nidana and chikitsa sthana. Further literatures of late period, Madhava, Sharngadhara, Bhvaprakash etchave explained the different treatment modalities with the existing. After the 16thcenturay several books related to the Madhumeha are published with its advancedtreatment.NIDANA Nidana of the Prameha are expressed as general those are common for allkinds of prameha. Specific nidana manifests the particular kind of prameha such asmadhumeha.General : Sedentary habits, excessive sleep, excessive use of curds, soup of meat ofdomestic animals or aquatic or marshy animals, milk derivatives (processed milk)new curds, drinks, various processed jaggery etc and kapha promoting regimes are the 49aetiological factors of prameha . Sushruta recognizes, day sleep, lack of exercise, sitting idle, cold intake ofcold, unctuous, sweet, fatty liquid food and drinks in excess gradually lead to theoccurrence of prameha50. Disease review- Madhumeha 30
  50. 50. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM) Vagbhata’s, describes in a nut shell, that whatever food and regimespromotive of kapha, meda, mootra are to be regarded as prameha hetu 51.Specific nidana to madhumeha As Charaka has stated in sutra sthana, the excessive intake of heavy,unctuous, saline substances, use of new rice (freshly harvested crop) , fresh wine,excessive sleep, injudicious use of varieties of dishes, who has given up physical andmental exercise and taken to inactiveness, abandonment of elimination of procedures,etc are the specific aetiological factors for madhumeha 52.SAMPRAPTIGeneral : Charaka had clearly explained the samprapti of the kaphaja prameha in theprameha Nidana . Even though the disease prameha is stated to be due to the vitiationof tri-doshas, the specific factors of the dosha is excessive fluidity of kapha . Thespecial features of the susceptible body elements (dushyas) are excessiveness anddiminished viscouness of Medas, Mamsa, Shareerakleda, Shukra, Rakta, Vasa, Majja,Lasika, Rasa and Ojus. When there is the simultaneous congress of these three pathologicalconditions, the kapha is suddenly provoked since it is already in chaya stage. Thevitiated kapha quickly spreads throughout the body which is already in derangedcondition. In the path of its circulation the kapha first encounters and mixes with themeda, owing to the pathological changes in the meda viz. excessiveness anddiminished viscous ness and also owing to the great similarity of the qualitiesbetween the kapha and medas. Due to this combination of vitiated kapha and medas,the latter is vitiated. The vitiated kapha coupled with the vitiated medas now comes incontact with the shareera kleda and mamsa which are in excessive increase in the Disease review- Madhumeha 31
  51. 51. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)body. The vitiated body fluid is changed into urine. The orifices or pores of themootravahasrotas, represented by the kidney and bladder are in a state of dilatationdue to the actions of vitiated medas and shareera kleda. The vitiated kapha , uponreaching the mootravaha srotas gets localised there and thus develops the diseasecalled Prameha54. The shareera kleda combined with the kapha and the medas while beingconverted into urine on its entrance in to the mootrashaya acquires the following tenpathological characteristics of kapha. They are unctuousness, heaviness, sweetness,denseness and slowness. Then it acquires a special name accompanied with thequalities of one or more of the other conditions by which it has been mainlymodified55. The vitiated pitta and vata produces vataja and pittaja Prameha by the sameprocess as described above56. If vata by its rooksha quality changes the ojus which is naturally of sweettaste, in to one of astringent taste and carries it to the mootrashaya, then it causes thecondition called Madhumeha57. 58 Charaka in Prameha Chikitsa has explained the samprapti in brief . “Thekapha having vitiated the medas and mamsa dhatus and the body fluid, becomeslocalised in the genito – urinary system and causes Pramehas59. The pitta, too, whichis provoked by ushna dravyas vitiating those very tissues, causes in the same mannerother varieties of prameha. On the diminution of the other two doshas the morbid vatadraws into the genito – urinary system the essential dhatus, and give rise to the thirdgroup of Prameha. In every case the morbid humor, having reached the genitorurinary system, vitiates the urine and generated Prameha corresponding to its specificnature. Disease review- Madhumeha 32
  52. 52. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM) In a person who indulges in the mithya ahara vihara the three doshas which arevitiated and in an↓ immature state join the medas and travel to the mootravaha srotas,gets localised at the entrance of the basti, when they are emitted through the urethrathe disease is known as Prameha. “The deranged kapha, in conjunction with the (morbid) pitta, vayu and medas,gives rise to all kaphaja types of Prameha. The deranged pitta, in conjunction with thederanged vayu, kapha, rakta and medas produced the pittaja ones; while the derangedvayu, in union with the deranged kapha, pitta ,medas ,majja and vasa, engenders thetypes of vataj prameha60. Disease review- Madhumeha 33
  53. 53. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)Samprapti charka 61 Nidana sevana ↓ Kapha pradhana tridosha prokopa ↓ Agnimandya ↓ Amotpatti ↓ Samadosha kaphasthana anupravesha ↓ Rasam prapya (Oja sthana) ↓ The aggravated morbidity readily disperses as it can not be digested and assimilated ↓ due to deficient resistance or disintegrated body mechanism ↓ Augments while spreading and localizes where there is weakness ↓ Morbidity combined with medas, comes in contact with body fluids and muscles ↓ Increased quantity and decreased viscosity of medas, the intensified derangement of kapha with more and identical proportion of medas ↓ This deranged dosha reaches the urinary system ↓ Exceed in normal quantity ↓Apanadusti occurs due to obstruction and vitiates the vruk and brings about excessive discharge of urine. ↓ diseased named as Prameha Disease review- Madhumeha 34
  54. 54. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)Specific samprapti of Madhumeha 62 Charaka and Vagbhata’s have described the pathogenesis of Madhumeha asseparate from Prameha .Constant use of the specific nidana , leads to augmentation ofpitta kapha meda and mamsa which obstructs the vata in its route. Thus enraged vatacarries ojus along and drives it down through the urinary system giving rise tomadhumeha. The sign and symptoms pertaining to vata or avruta doshas which occurand disappear indefinitely (but the recurrence is in more severe form) and frequently.Vagbhata’s state that the pathogenesis of Madhumeha is of two varities63 1. The depletion of the dhatu leading to the vitiation of vata 2. Obstruction to the normal circulation of vata by the other doshas leading to the vitiation of the former This particular information leads us to include that Madhumeha is mainly due tothe vitiation of vata. Even according to Charaka, madhumeha is enumerated as one ofthe vataja Pramehas. Vagbhata’s has also stated that any prameha if not treated andattended to at the outset, will ultimately develop into Madhumeha. He has also clearlystated that there is an increase in the sweetness in the body, which is expressedthrough the physical qualities of urine, being the colour and taste resembles honey 64 According to Vagbhata’s, there is an increase in the sweetness or sweet substancesin the body of a Madhumeha patient 65. This particular fact is noticed by the sweetnessof the urine that can be observed and recognised by attraction and assemblage of antsnear the urine66. The urine of a normal or healthy person is not sweet in taste. Thissweetness of the urine of a Madhumeha patient is due to the madhura dravya, which isfiltered by the mootravaha srotas. Disease review- Madhumeha 35
  55. 55. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)POORVARUPA The state of prodroma or poorvarupa is expressed as when vitiated doshasbecome localised due to srotovaigunya leading to the dosha-dushya-sammurchana.Kapha predominant tridoshas and dhatus along with ojus are chiefly affected inPrameha.The following are the prodroma of Prameha. 1. Burning sensation of the palms of hands and the soles of the feet67.68,69 2. Sweet taste in the mouth. 3. Increased excretement in the body, increased discharged from the orifices in the body70,71 4. Dryness in Coldness or sliminess of the skin and limbs, thermalgia and numbness in the body. 5. Raw-meet odour in the body. 6. Somnolence and continuous torpor and lassitude. 7. Attraction of insects and ants to the body and urine72. 8. Matting of the hair and inordinate growth of the finger and toe nails73.74 9. Dryness in the mouth, palate and throat and thirst. 10. Slimy mucous deposit on the tongue, palate, pharynx and teeth. 11. Heaviness of the body. 12. Sweetness and whiteness of urine. 13. A bad odoured breath and shortness of breath75.Vagbhata’s has mentioned additional prodroma for Prameha76 1. Excessive perspiration. 2. Laziness. 3. Liking of cold comforts. Disease review- Madhumeha 36
  56. 56. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)ROOPAIn the Roopavastha or actual manifestation of the disease, dosha dushya sammurchanacompletes, and the onset of the disease will be commenced. The Roopa may changefrom time to time and certain symptoms may newly appear or some may disappear.MadhumehaClinical features of the present disease Madhumeha are divided into two groups. 1. General features of Prameha 2. Specific features of the Madhumeha Charaka has not described the general features of Prameha where asSushruta77 and Vagbhata78 have described the general features as a. Avila mootrata b. Prabhoota mootrataSpecific Lakshanas of Madhumeha It is one among the four Vataja Pramehas. Charaka states that ojus is sweet byinstinct. The rookshata of aggravated vata transforms sweetness into astringent tasteand carries along to urinary system and brings about madhumeha. The person withMadhumeha thus passes urine which is astringent and sweet in taste, yellowish orwhitish in colour. The urine contains similar properties of Honey79.80.81.Even some ofthe poorvaroopa lakshana may present in this condition.Apart from the above lakshanas, Sushruta described typical lakshanas for Madhumeharogi82, that he prefers- 1. To stay while walking. 2. To sit while staying 3. To take rest on bed while sitting 4. To go to sleep while taking rest. Disease review- Madhumeha 37
  57. 57. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)BHEDHA Though Prameha is stated to be developed due to the vitiationof all three doshas, the disease is mainly divided into three groups. 1. Kaphaja Pramehas – which are again subdivided into 10 types 83. 2. Pittaja Prameha – which are again subdivided into 6 types 84. 3. Vataja Prameha – which are again subdivided into 4 types 85.Even though the three Ayurveda authorities Charaka, Sushruta And Vagbhata’s agreethe same number of Prameha in each group, there seems to be difference in thenomenclature used by them. Increased quantity of urine and increased turbidity in theurine are the main features in all varieties of Prameha.The name of each variety of Prameha is based on the combination of dosha anddushya, and the physical characters of the urine.Kaphaja PramehaTable showing Kaphaja prameha according to BrihatrayeesC.S86 S.S87 AS88Udakameha Udakameha UdakamehaIkshumeha Ikshumeha IkshumehaSikatameha Sikatameha SikatamehaSanairmeha Sanairmeha SanairmehaSandrameha Sandrameha SandramehaSukrameha Sukrameha SukramehaSandraprasadmeha ------------ -------------Shuklameha Pishtameha PishtamehaSheetameha ------------ SheetamehaAlalameha ------------ Alalameha-------------- Surameha Surameha-------------- Lavanameha Lavanameha------------- Phenameha --------------- Disease review- Madhumeha 38
  58. 58. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)Pittaja PramehaTable showing Pittaja prameha according to BrihatrayeesCS 89 SS 90 AS 91Ksharameha Ksharameha KsharamehaKalameha --------------- KalamehaNeelameha Neelameha NeelamehaLohitameha Shonitameha RaktamehaManjishtameha Manjishtameha ManjishtamehaHaridrameha Haridrameha Haridrameha--------------- Amlameha --------------.Vataja PramehaTable showing prameha according to BrihatrayeesCS 92 SS93 AS94Vasameha Vasameha VasamehaMajjameha ----------- MajjamehaHastimeha Hastimeha HastimehaMadhumeha Kshoudrameha Madhumeha---------- Sarpirmeha ------------- Disease review- Madhumeha 39
  59. 59. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)MADHUMEHA: Madhumeha can be sub classified mainly into two types.Type one a) Kulaja or Sahaja (Hereditary) b) Doshaja or Apathya nimittaja (acquired) 95Type two a) Dhatu kshaya janya Madhumeha96 b) Doshavruta janya MadhumehaCharaka has divided the Madhumeha patient into two varieties based on the line oftreatment 97. 1. Sthoola (stout or strong) 2. Krisha ( emaciated or week)Sushruta accepts Sahaja rogi as krisha and the Apathya nimitaaja rogi as sthoola rogiin his classificationSADHYASADHYATAAs discussed earlier, Prameha is classified in to three verities i.e. 1. Kaphaja Pramehas - 10 2. Pittaja Prameha -6 3. Vataja Prameha -4The ten kaphaja Prameha are said to be sadhya (curable) 98,99.Because The medas having homogenous properties is affected The Kapha is dominant Both these factors are amendable to the same type of treatment. Disease review- Madhumeha 40
  60. 60. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM) 100,101 The six pittaja Pramehas are only Yapya (palliable) owing to theproximity of the seat of the vitiated doshas and that of the medas and owing to theantagonism involved in their treatment. The four varieties of Vataja Prameha due to the vitiation of Vata are known tobe incurable 102, 103, because of their seriousness and also because of the contradictioninvolved in their treatment.Vagbhata’s adds to the above • The kaphaja and Pittaja groups of Prameha if they are developed after full expression of prodroma too are incurable104 • Kaphaja Pramehas gradually develops into pittaja pramehas and they both transforms into vataja pramehas that are incurable • If kaphaja pramehas gradually turns into pittaja pramehas these are yapya • Even the pittaja pramehas are curable if there is no severe vitiation of medas even this is applicable for vataja mehas 105 Charaka has stated that this disease is relapsing in nature .Though certain varietiesare stated to be curable they appear to be so only for certain period and relapse isdefinite. Madhumeha, which is a variety of vataja prameha is also to be considered, asincurable but with specific line of treatment these can be palliable. Jata pramehi orbeeja doshaja are incurable due to leenata of dosha and as they themselves influenceon prakriti of patient. Sushruta stated that if prameha patient suffering with pidikas and complicationslike Hridgraha, then he should be considered as incurable106. Disease review- Madhumeha 41
  61. 61. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)UPADRAVA If all the Prameha are not treated properly and attended, they may ultimatelydevelop into Madhumeha107. Madhumeha is considered to be one of the 20 Pramehaby Charaka. Apart form this charaka has been described the updravas of Prameha ingeneral. Where as Sushruta and Vagbhata’s have mentioned upadravas separately foreach doshik group. The general upadravas of Prameha according to Charaka are as follows108.Trishna, Atisara, Jwara, Daha, Dourabalya, Arochaka, Avipaka, Putimamsa, Pidika,Alaji, Vidradhi. 109 Charaka mentioned the upadravas (complications) of Madhumeha asTrishna, Shwasa, Mamsakotha, Moha, Hikka, Mada, Jwara, Visarpa among themmany of upadravas are seen in patient.CHIKITSAMadhumeha is a chronic disease and may also develop as a hereditary disease.Madhumeha patients are divided in two varieties. 1.Sthoola and 2. KrishaSthoola patient are capable of withstanding the shodhana karma and the krisha patientare incapable of withstanding it. Therefore a sthoola patient has to be treated with theshodhana chikitsa and krisha with shamana chikitsa110.Shodhana For every Shodhana procedure the patient should undergo poorva karma. Butthe Madhumeha patient is prohibited from undergoing sweda karma111. In sthoolapatient after completion of sneha karma the doshas should be eliminated throughsodhana vamana and virechana karma respectively. Disease review- Madhumeha 42
  62. 62. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM) After the completion of the shodhana karma the patient has to be subjected forsamsarjana karma. Even though the Madhumeha is santarpana janya roga, the patientshould not be subjected to Apatarpana kriya, because it may result in to Gulma,Kshaya, Mehanashoola, Vasti shoola and Mootra graha. The Brimhana chikitsashould be carried out considering the strength of the individual patient112. A krisha oremaciated, and Durbala or weak patient who is not capable of standing the shodhanakarma requires Bhrimhana chikitsa113. Even though the vataja Pramehas are stated to be incurable the duty ofphysician is to treat the patient and prevent the future complications. Therefore vatajaPrameha should be treated.Samshamana Chikitsa Samshamana chikitsa is indicated for a prameha patient who is not fit forshodhana chikitsa, and also the patient who has completed the shodhana karma. Many varieties of decoctions, choornas and lehyas have been described for thetreatment of the twenty varieties of Pramehas by all Ayurvedic authorities. Vyayama,udvarthana, snana, jala sechana and the lepas with Twak, Ela, Agar and chandana areuseful in Prameha patient114. Avoiding the causative factors (Nidana) is also treatment115. In our trial wehave used only shamana therapy, which has yielded a significant result. The patient of Prameha who is not fit for evacuation should be subjected topacificator management for alleviation of the disease such as mantha (churned drink),extracts, linctuses made of barley powder and light edibles. He should eat rough foodarticles such as boiled barley, barley cakes, flour of parched grains and apupa withpalatable meat – soup of wild birds particularly gallinaceous and peckers. He shouldtake old shali rice with soup of mudga etc, and bitter vegetables added with oil of Disease review- Madhumeha 43
  63. 63. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM)danti and or linseed and mustard. In cereals, he should use shashtika and wild rice.The diet of the patient of Prameha should consist mainly of barely. One sufferingform kaphaja Prameha should consist mainly of barley added with honey. Barleygrain dipped in decoction of Triphala for the whole night make a saturating food takenwith honey. The patient may also take them regularly mixed with vinegar foralleviation of Prameha. He should use flour of parched grains, bolus, purchasedgrains and other various edibles made of barley impregnated with decoction of drugsprescribed in kaphaja Prameha, various preparations of barley mixed with the meat ofass, horse, bull . Swan and spotted deer should be prescribed. The seeds of bambooand wheat may also be used in forms similar to those of barley116.PRAMEHA NIVRUTTI LAKSHANA The person is said to be free from prameha when his urine is devoid ofcasts/deposits, but is clear ; non unctuous non dense, normal bitterness, pungent andcharacteristically aromatic117. Disease review- Madhumeha 44
  64. 64. Review Of LiteratureDisease Review Diabetes Mellitus (NIDDM)
  65. 65. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM) DIABETES MELLITUS Diabetes mellitus is a clinical syndrome characterised by hyperglycemia dueto absolute or relative deficiency of insulin118. Diabetes means the excessive dischargethat of urine119. DM comprises a group of common metabolic disorders that share thephenotype of hyperglycemia. Several distinct types of DM exist and are caused by acomplex interaction e.g. genetics, environmental factors and life-style choice. The metabolic deregulation associated with DM cause secondarypathophysiologic changes in multiple organ system that impose a tremendous burdenon the individual with diabetes and on the health care system. With an increasingincidence world wide, DM will likely continue to be a leading cause of morbidity andmortality for the foreseeable future.CLASSIFCATION120: Recent advance in the understanding of the aetiology and pathogenesis ofdiabetes have lead to a revised classification though all forms of DM are characterizedby hyperglycemia, the pathogenic mechanisms by which hyperglycemia arises differwidely. Some forms of DM are characterized by an absolute insulin deficiency or agenetic defect leading to defective insulin secretion, where as other forms shareinsulin resistance as their underlying etiology. The two broad categories of DM are designated as type 1 and type 2 . DMresults from autoimmune beta cell destruction, which usually leads to insulindeficiency. Type 1A DM is also characterized by insulin deficiency as well as atendency to develop ketosis. However, individuals with type 1B DM, lackimmunologic markers indicative of autoimmune destructive process of the beta cells.The mechanisms leading to beta cell destruction in these patients are unknown. Disease review-Diabetes mellitus (NIDDM) 45
  66. 66. Evaluation of efficacy of Avartaki in Madhumeha (NIDDM) Type 2 DM is a heterogeneous group of disorders usually characterized byvariable degrees of insulin resistance, impaired insulin secretion, and increasedglucose production. Distinct genetic and metabolic defects in insulin action and orsecretion give rise to the common phenotype of hyperglycemia in type 2 DM .Theidentification of distinct pathogenic process in type 2 DM has important potentialtherapeutic implications, as pharmacologic agents that target specific metabolicderangements become available. Two features of the current classification of DM diverge from previousclassifications, first, the terms insulin-dependent diabetes mellitus (IDDM) and noninsulin-dependent diabetes mellitus (NIDDM) are obsolete. These previousdesignations reflected the observation that most individuals with type 1 DM(previously IDDM) have an absolute requirement for insulin treatment, whereas manyindividuals with type 2 DM (previously NIDDM) do not require insulin therapy toprevent ketoacidosis. However, because many individuals with type 2 DM eventuallyrequire insulin treatment for control of glyceamia, the use of the latter term generatedconsiderable confusion. A second difference is that age is no longer used as a criterion in the newclassification system. Although type 1 DM most commonly develops before the ageof 30, an autoimmune beta cell destructive process can develop at any age. In fact, itis estimated that between 5 and 10% of individuals who develop DM after age 30have type 1A DM. Likewise, although type 2 DM more typically develops with .increasing age, it also occurs in children, particularly in obese adolescents Disease review-Diabetes mellitus (NIDDM) 46