EVALUATION OF EFFICACY OF TWAK CHURNA IN  MADHUMEHA (NIDDM), A CLINICAL STUDY                                      BY     ...
DECLARATION BY THE CANDIDATEI hereby declare that this dissertation/thesis entitled “Evaluation of efficacy ofTwak churna ...
D.G.M. AYURVEDIC MEDICAL COLLEGE      POST GRADUATE STUDIES AND RESEARCH                                    CENTRE        ...
© Copy right        DECLARATION BY THE CANDIDATE        I here by declare that the Rajiv Gandhi University of HealthScienc...
J.S.V.V. SAMSTHE’S                     D.G.M. AYURVEDIC MEDICAL COLLEGE                POST GRADUATE STUDIES AND RESEARCH ...
ABSTRACT       Madhumeha is correlated with Diabetes mellitus. The disease is spreading rapidlyworldwide. DM has created a...
CONTENTSS.No.                     CONTENTS        PAGE NO. 1      Introduction                         1-3 2      Review o...
LIST OF ABBREVIATIONS USEDA.H.         Astanga HridayaA.K.         Amara KoshaA.P.I.       Ayurvedic Pharmacopoeia of Indi...
LIST OF TABLESS.No.                                      Tables                      Page. No.1       Varga of Twak accord...
26   Showing the nature of Occupation                                        8527   Showing the Socio-economic status     ...
LIST OF GRAPHSS.No.                                   Graphs                              Page No.1       Showing age rati...
25        Comparison of FBS before and after the treatment               10626        Comparison of PPBS before and after ...
Introduction                                  INTRODUCTION       The Indian system of medicine is almost as old as the Ind...
Introductiondealt with about 67 plants. Numbers of drugs have increased from Rigveda toAtharvaveda. At the end of post Ved...
Introductionevaluation of the action of any drug depends on the clinical trial on human beings.Clinical trial or study is ...
Drug review                                  DRUG REVIEWTWAK (Cinnamomum zeylanicum Breyn)       The drug consists of the ...
Drug reviewSYNONYMS OF TWAKiuÉMçü - iuÉcÉqÉç -- iuÉcÉ xÉÇuÉUhÉå | rÉ²É iÉlÉÉåÌiÉ ÌuÉxiÉÉUrÉiÉÏÌiÉ | uÉsMüsÉqÉç | mÉëzÉxiÉÉ...
Drug reviewsÉÉOûmÉhÉïqÉç -- Mostly in lata (Desa is identified as eastern Bengal)uÉlÉÌmÉërÉqÉç -- Growing wildaÉÑQûiuÉMçü ...
Drug reviewiuÉcÉliÉÑ MüOÒûMÇü zÉÏiÉÇ MüTüMüÉxÉÌuÉlÉÉzÉlÉqÉç |zÉÑ¢üÉqÉzÉqÉlÉÇ cÉæuÉ MühPûzÉÑήMüUÇ sÉbÉÑ || (UÉ.ÌlÉ. ÌmÉmmÉ...
Drug review                  Table 2: Showing synonyms according to different NighantuS.N        Synonyms                D...
Drug review                   Table 3: Showing properties according to different Nighantu          Properties             ...
Drug review                Table 4: Showing therapeutic actions according to different NighantuS.N              Karma     ...
Drug review          Table 5: Showing therapeutic uses according to different Nighantu    S.No.      Roga        D.N.49 K....
Drug reviewKannada: Lavanga patte, ChakkeTamil: Cannalavangapattai, ilavangam, ilavamgapattaiTelugu: Lavangamu, lanvangapa...
Drug reviewFEATURES OF LAURACEAEDiagnostic featuresShrubs or trees. Third row of stamens if present with the anthers – cel...
Drug reviewMORPHOLOGY OF Cinnamomum zeylanicum Breyn       A moderate sized evergreen tree, bark rather thick, smooth, pal...
Drug reviewCork and cortex are absent62. The inner surface is darker and striated. A characteristic,sweet, fragrant odor, ...
Drug reviewCOLLECTION OF BARK       The shoots are cut from the trees when they are about 18 months old, and the topsand t...
Drug reviewcaryophylline and esters of butyric acids75, cinnamic acid, resin, sugar, starch,mucilage76. Twak leaves contai...
Drug review  Bark is tonic, expectorant, useful in hydrocele, headache, piles and  strengthens the liver.  The oil is carm...
Drug review                     Its phanta kalpana is good in case of atisara.                     Its good for kampavata,...
Drug review                  Pippalyasava                  Astanga lavana                  Khadiraristha                  ...
Drug review  the characteristics can distinguish between the same which are mixed  as substitutes in the other95.  Saigon ...
Drug reviewRECENT RESEARCHES  •   Cinnamon bark extract improves glucose metabolism and lipid profile in the      fructose...
Drug review    administered in a regular and controlled manner. Methods: A total of 54 normal    subjects were divided int...
Drug review    by Gas Chromatography. The major constituent of the extracted oil solution was    cinnamaldehyde (66.2%). P...
Drug review•   Candida is inhibited by cinnamon bark or cinnamaldehyde (in vitro). 3 of 5 oral    candidiasis patients usi...
Disease review                               NIRUKTI AND PARIBHASHANIRUKTI    qÉkÉÑ+qÉåWû = qÉkÉÑqÉåWû, Madhumeha is a com...
Disease reviewHISTORY   Prameha, Meha or Madhumeha has been devoted separate chapters in Nidana as wellas Chikitsa sthana ...
Disease reviewby the Samhitakaras & Sangrahakaras, like commentaries of Chakrapanidatta onCharaka, Dalhana on Sushruta, In...
Disease review       For the convenience of the study nidanas are classified into Aharaja, Viharaja,Beejadoshaja or kulaja...
Disease reviewBEEJA DOSHA       eÉÉiÉ: mÉëqÉåWûÏ qÉkÉÑqÉåÌWûlÉÉå uÉÉ lÉ xÉÉkrÉ E£ü: xÉ ÌWû oÉÏeÉSÉåwÉÉiÉç |       rÉå cÉÉÌ...
Disease reviewexcessive increase of fat and muscle tissue causes insulin resistance. So insulin resistanceand relative ins...
Disease reviewhave been implicated, including mumps, Coxsackie B4, retrovirus, rubella (in utero) andEpstein-Barr virus.OB...
Disease reviewPREGNANCYDuring normal pregnancy, insulin sensitivity is reduced through the action of placentalhormones and...
ÌlÉSÉlÉEvaluation of efficacy of Twak churna in Madhumeha                                                                A...
Disease reviewSAMPRAPTI VIVECHANA         Samprapthi means the detailed description of all the morbid process that takespl...
Disease reviewfound because of shleshmagni and apyagni mandhya. As rasa is the ashrayasthana forkapha, this bahudrava kaph...
Disease reviewAs ojus is also considered as shleshma, the bahudravashleshma with kleda is brought tothe mootravahasrothas....
Disease review       An increasing body of evidence suggests that an early abnormality in this disorderis hyperinsulinamia...
Disease reviewThe inability of the beta cell to indefinitely secrete insulin at a higher rate may thereforedetermine those...
Disease reviewOther specific types       Genetic defects of beta cell function       Genetic defects of insulin function  ...
MüTüMüU AÉWûÉU ÌuÉWûÉU                                                     (AmÉjrÉÌlÉÍqɨÉeÉ)Evaluation of efficacy of Twa...
Disease reviewPOORVAROOPA VIVECHANA       Poorvaroopas are a set of mild symptoms signaling the arrival of a ratherunwelco...
Disease reviewTable 6: Showing poorvaroopa according to different Brihatrayees Sl. No.              Poorvaroopa      Chara...
Disease review                  26           zÉÑYsÉ qÉÔ§ÉiÉÉ                                      -                     + ...
Disease review       In ayurveda only mootra sambhandhi lakshanas are mentioned for Madhumeha.But samanya lakshanas of Pra...
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EVALUATION OF EFFICACY OF TWAK CHURNA IN MADHUMEHA (NIDDM), A CLINICAL STUDY - DR. SHALINI SHARMA, Department of Dravya Guna, Post Graduate Studies & Research Centre, D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE,GADAG

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  1. 1. EVALUATION OF EFFICACY OF TWAK CHURNA IN MADHUMEHA (NIDDM), A CLINICAL STUDY BY DR. SHALINI SHARMA Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfillment of the requirements for the degree of Ayurveda Vachaspati M.D. In DRAVYA GUNA Under the Guidance of DR. G. V. MULAGUND MD (AYU) And Co-guidance of DR. KUBER SANKH MD (AYU) Department of Dravya Guna Post Graduate Studies & Research Centre D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE GADAG - 582103 2005-2008
  2. 2. DECLARATION BY THE CANDIDATEI hereby declare that this dissertation/thesis entitled “Evaluation of efficacy ofTwak churna in Madhumeha (NIDDM) – A Clinical study” is a bonafideand genuine research work carried out by me under the supervision ofDr. G. V. Mulagund MD (AYU) Professor and co-guidance of Dr. Kuber SankhMD (AYU) Lecturer in Dravyaguna, DGMAMC, PGS&RC, GADAG.Date: (Dr. Shalini Sharma)Place: Gadag
  3. 3. D.G.M. AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTRE GADAG-582103This is to certify that the dissertation entitled “Evaluation of efficacy of Twak churnain Madhumeha (NIDDM) – A Clinical study” is a bonafide research work done byShalini Sharma in partial fulfillment of the requirements for the post graduationdegree of “Ayurveda Vachaspati M.D. (Dravya Guna)” Under Rajiv GandhiUniversity of Health Sciences, Bangalore, Karnataka. Co- Guide Guide DR. KUBER SANKH Dr. G.V. MULAGUND M.D. (Ayu) M.D. (Ayu) Professor & HOD Lecturer in Dravya Guna Dept. of Dravya Guna DGMAMC, PGS&RC, GADAG DGMAMC, PGS&RC, GADAG Date: Date: Place: Gadag Place: Gadag
  4. 4. © Copy right DECLARATION BY THE CANDIDATE I here by declare that the Rajiv Gandhi University of HealthSciences, Karnataka shall have the rights to preserve, use anddisseminate this dissertation / thesis in print or electronic format for theacademic / research purpose.Date: (Dr. Shalini Sharma)Place: Gadag © Rajiv Gandhi University of Health Sciences, Karnataka
  5. 5. 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 ofTwak churna in Madhumeha (NIDDM) – A Clinical study” is a bonafide researchwork done by Dr. Shalini Sharma under the guidance of Dr. G.V.MULAGUND MD(AYU) Professor and H.O.D Dept of Dravyaguna and DR. KUBER SANKH MD (AYU)in partial fulfillment of the requirements for the post graduation degree of “AyurvedaVachaspati M.D. (Dravya Guna)” Under Rajiv Gandhi University of HealthSciences, 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
  6. 6. ABSTRACT Madhumeha is correlated with Diabetes mellitus. The disease is spreading rapidlyworldwide. DM has created an alarming situation in India due to the following reasons.According to an ICMR survey, it is estimated that between 1995 and 2025, India willhave about 3.2 crore diabetics i.e. a seven fold increase rate, when compared to only twofold population increase rate. Which means, by 2005 every 5th diabetic in the world willbe an Indian. Ninety percent of diabetic cases are adult onset and evidence links itdirectly to drastic changes in life style. Once DM was confined only to the corridors ofold age. Today a person in his or her 2nd, 3rd or 4th decade are equally susceptible.Globalization and “Coca Cola”nization are responsible for changing socio-economic &cultural habits of people in countries like India, leading to a high incidence of DM. worldwill be an Indian. Twak (Cinnamomum zeylanicum) has been tried on NIDDM vis a visMadhumeha in the sample of 30 patients, for a duration of 30 days with dose of 6 gmsper day. Efficacy of the trial drug was evaluated on the basis of difference betweenbaseline and assessment data. Analysis of the data containing age, sex, occupation, familyhistory, treatment history, nidana, roopa etc. were done. The study showed that 53.33%patients well responded, 43.33% patients attained palliative results and 3.33% didn’trespond to the treatment. The significant reduction in all the parameters was observed. Hence in the presentstudy the efficacy of Twak churna in Madhumeha is evaluated. Key words: Twak, Cinnamomum zeylanicum, Madhumeha, Diabetes mellitus. II
  7. 7. CONTENTSS.No. CONTENTS PAGE NO. 1 Introduction 1-3 2 Review of literature 4-65 3 Methodology 66-74 4 Results 75-109 5 Discussion 110-115 6 Conclusion 116-117 7 Summary 118-119 8 Bibliography 120-137 9 Annexure (Case sheet) 137-142
  8. 8. LIST OF ABBREVIATIONS USEDA.H. Astanga HridayaA.K. Amara KoshaA.P.I. Ayurvedic Pharmacopoeia of IndiaBp.N. Bhavaprakasha NighnatuCh.S. Charaka SamhitaDM Diabetes mellitusD.N. Dhanvantari NighantuD.G.H Dravya guna HastamalakaFBS Fasting blood sugarIDDM Insulin dependent diabetes mellitusI.M.M Indian Materia MedicaI.M.P. Indian Medicinal PlantsK.N. Kaiyadeva NighantuM.N. Madhava NidanaM.N. Madanapala NighantuN.Ad. Nighantu AdarshaNIDDM Non-insulin dependent diabetes mellitusOHA Oral hypoglycemic agentsPPBS Post prandial blood sugarR.N. Raja NighantuSu.S. Sushrutha SamhitaCh. Chikitsa sthanaSu. Sutra sthanaSi. Sidhi sthanaUt. Uttara tantraSha. Shareera sthanaUS Urine sugarVi.S Vimana sthana IV
  9. 9. LIST OF TABLESS.No. Tables Page. No.1 Varga of Twak according to different Nighantu 052 Synonyms of Twak according to different Nighantu 093 Properties of Twak according to different Nighantu 104 Therapeutic actions of Twak according to different Nighantu 115 Therapeutic uses of Twak according to different Nighantu 126 Poorvaroopa of Madhumeha according to different Brihatrayees 447 Kaphaja prameha according to different Brihatrayees 518 Pittaja prameha according to different Brihatrayees 529 Vataja prameha according to different Brihatrayees 5310 Prameha pidakas according to different Brihatrayees 5511 The Drugs Mentioned For Madhumeha 5912 Different Yogas Mentioned For Madhumeha 6013 Sapeksha nadana for Madhumeha 6314 Differential diagnosis for Diabetes mellitus 6415 Diagnostic Criteria for objective parameters 7116 Gradation for subjective parameters to assess the results 7317 Demographic data 7518 Data related to complaints 7619 Data related to personal history 7720 Data related to srotodusti before and after the treatment 7821 Subjective parameters before and after the treatment 7922 Objective parameters before and after the treatment 8023 Showing the Age ratio 8224 Showing the Sex ratio 8325 Showing the incidence of Religion 84 V
  10. 10. 26 Showing the nature of Occupation 8527 Showing the Socio-economic status 8628 Showing the Diet 8729 Showing the chronicity of Madhumeha 8830 Showing the Complaints 8931 Showing the Family history 9032 Showing the Treatment history 9133 Showing the involvement of Agni 9234 Showing the Vyasana 9335 Showing Prakruti 9436 Showing the kind of Ahara 9537 Showing the Vihara 9638 Showing the involvement of Manasika chinta 9739 Showing the Comparison of Udakavaha srotodusti laxana before and 98 after the Treatment40 Showing the Comparison of Mootravaha srotodusti laxana before and 99 after the Treatment41 Showing the Comparison of Medovaha srotodusti laxana before and after 100 the Treatment42 Showing Prabhuta mootrata before and after the Treatment 10143 Showing Avila mootrata before and after the Treatment 10244 Showing Ashaktata before and after the Treatment 10345 Showing Trishna before and after the Treatment 10446 Showing Shareera Ghanatwam before and after the Treatment 10547 Showing the Result 10848 Showing the Statistical values 109 VI
  11. 11. LIST OF GRAPHSS.No. Graphs Page No.1 Showing age ratio 822 Showing sex ratio 833 Showing religion incidence 844 Showing nature of occupation 855 Showing the Socio-economic status 866 Showing the Diet 877 Showing the chronicity of Madhumeha 888 Showing the Complaints 899 Showing the Family history 9010 Showing the Treatment history 9111 Showing the involvement of Agni 9212 Showing the Vyasana 9313 Showing Prakruti 9414 Showing the kind of Ahara 9515 Showing the Vihara 9616 Showing the involvement of Manasika chinta 9717 Showing the Comparison of Udakavaha srotodusti laxana before and 98 after the Treatment18 Showing the Comparison of Mootravaha srotodusti laxana before and 99 after the Treatment19 Showing the Comparison of Medovaha srotodusti laxana before and 100 after the Treatment20 Showing Prabhuta mootrata before and after the Treatment 10121 Showing Avila mootrata before and after the Treatment 10222 Showing Ashaktata before and after the Treatment 10323 Showing Trishna before and after the Treatment 10424 Showing Shareera Ghanatwam before and after the Treatment 105 VII
  12. 12. 25 Comparison of FBS before and after the treatment 10626 Comparison of PPBS before and after the treatment 10627 Comparison of US before and after the treatment 10728 Showing the Result 108 LIST OF SCHEMATIC REPRESENTATIONS S.No. Schematic Presentations Page No. 1 Schematic Representation of Nidana 35 2 Schematic Representation of Samprapti 42 LIST OF PHOTOGRAPHS S.No. Photographs Page No. 1 Twak 4 2 Bark of Twak 66 VIII
  13. 13. Introduction INTRODUCTION The Indian system of medicine is almost as old as the Indian civilization and is apart of the rich heritage of India. The term Ayurveda is literally defined as the science oflife. The presence of the Ayurvedic principles in the hymns of the Vedas, which are theearliest records of human intellect, establishes the high antiquity of the origin ofAyurveda. The science of medicine is considered an upanga of Atharvaveda. It providesan approach to the prevention and cure of diseases; it emphasizes the philosophy ofmaintaining excellent health by normalizing the coordination between various cellularfunctions and between the body and the environment, as well as improving the inherentvitality of the body by using the Panchamahabutha and Tridosha theories. Research is the scientific and diligent study, including investigations orexperimentations in order to establish facts and analyze their significance. Ayurvedasystem consists of many preparations, which are derived from plant, animal and mineralsources. Of these, plants play an important role and have been used in the field oftreatment of various diseases from time immemorial. The Indian sages discovered drugs,invented combinations, studied potential toxic effects and prescribed therapeutic useslong ago. This was based on the observations of the effect of drug on human beings andanimals. Large numbers of drugs used in a similar manner have been found from Vedicperiod itself. This deep study by the Acharyas of ancient times lead to the formation ofbasic concepts of Dravyaguna shastra, which deals with the identification, properties,actions, uses, dosage, compatibility and methods of administration of drugs. Dravyaguna shastra has undergone a wide range of developments from Vedicperiod to the present modern period. Rigveda, the oldest drug formulary of Ayurveda Evaluation of efficacy of Twak churna in Madhumeha 1
  14. 14. Introductiondealt with about 67 plants. Numbers of drugs have increased from Rigveda toAtharvaveda. At the end of post Vedic period scientific study of drugs, that ismorphological and pharmacological studies were started and were recorded in Samhitasand Sangrahas. About 1100 and 1270 drugs have been described in Charaka Samhita andSushruta Samhita respectively. 1150 drugs have been mentioned in Astanga Hridaya. Inorder to have a perfect understanding of the plants it is therefore most essential to be wellacquainted with the branch of Ayurvedic pharmacology i.e. “Dravyaguna”. It enables usto know the scientific knowledge of the fundamentals of Ayurvedic pharmacology andthe plants. Pharmacodynamic principles of Ayurveda, i.e., the concepts of Rasa, Guna,Veerya, Vipaka and Prabhava were established in the Samhita period. These are the basicconcepts of Ayurvedic pharmacology and relevant even today. Nighantu period is the continuation of Sangraha period. Newer drugs wereidentified and included in the Nighantu by the Nighantukaras. It indicates that from timeto time researches in the field of medicine were in progress and the drugs, which werefound effective, were being recorded. The Nighantu period has been considered as thegolden period of Dravyagunashastrta. Research in Ayurveda should aim not only to help in preservation of health,longevity, cure and mitigation of diseases, but also to bring out the latent potentialitieslying unexplored in the vast literatures and thousands of manuscripts for the benefit ofhuman beings. Every body will agree with the fact that, to evaluate the particular actionof the drug on the particular symptoms, a clinical study is all most essential and keenobservation during the clinical study is the final aspect to prove the effect. The proper Evaluation of efficacy of Twak churna in Madhumeha 2
  15. 15. Introductionevaluation of the action of any drug depends on the clinical trial on human beings.Clinical trial or study is the last deciding factor. Modern luxurious life style and sedentary habits of people have been invited somany diseases such as Prameha, Amavata, Amlapitta etc. Madhumeha is a disease knownto mankind since Vedic period. Ayurvedic classics consider Madhumeha among thetwenty obstinate urinary disorders. The development of modern science hasrevolutionized the approach to this disease and its management. Charaka Samhitha andSushrutha Samhitha are the ancient medical compendia for the early detection andtreatment of this disease. Though Madhumeha is considered to be asadhya, Dosha-avrutthajanya Madhumeha is said to be Kruchra sadhya. Diabetes has become the diseaseof the masses. Over twenty million people are reported to be suffering from this ‘SweetDisease.’ It is projected that by another twenty years the number would rise to sixtymillion in India. The whole world is looking at diabetes as a threat to mankind. Hencesuccessful and efficient management of diabetes is the need of the hour. Although anumber of Herbal Preparations are currently available but they have certain limitations tocure Madhumeha but our approach is to prevent and provide the well being to theMadhumehi is fulfilled. In this regard here Twak is taken to evaluate its efficacy inMadhumeha, as it is therapeutically efficacious, safer, cost effective and easily availabledrug. Twak (Cinnamomum zeylanicum) is a tropical tree of family Lauraceae. It’s alsoknown as Ceylon Cinnamon or “true Cinnamon” and in Hindi “Dalchini”1,2. InCharaka Samhita it is told that Sarvada Sevana of Twak prevents Madhumeha3. It hasKatu-Tikta-Madhura Rasas and Usna Veerya, mainly acting in Bastivikaras4. Evaluation of efficacy of Twak churna in Madhumeha 3
  16. 16. Drug review DRUG REVIEWTWAK (Cinnamomum zeylanicum Breyn) The drug consists of the inner bark obtained from the shoots of tree ofCinnamomum zeylanicum of family Lauraceae5.HISTORY In Atharvavediya paippalada (20/37/7) the reference about Darupatra is given. Itis believed to be the Twak patra delineated by Bruhattrayi. It is extensively used intherapeutics and generally known for its Vrishya property. Charaka didn’t indicate it withthe synonym chocha, while Sushruta and Vagbhata did. Similarly the synonymVarangadala is mentioned only by Charaka but not by the other samhita writers6.MEANINGCinnamomum:Greek word, Kinnomonon,colour bright, brown, mixed with yellow & red.GANA/VARGA Table 1: Showing the varga according to different Nighantu Susruta Eladi gana Vagbhata Eladi gana, Trijataka Bhavaprakasha Nighantu7 Karpooradi varga Dhanwantari Nighantu8 Shatpushpadi varga Kaiyadev Nighantu9 Oushadhi varga Raj Nighantu10 Pippalyadi varga Madanpal Nighantu11 Karpooradi varga Nighantu Adarsh12 Karpooradi varga 13 Haritakyadi Nighantu Karpooradi varga Evaluation of efficacy of Twak churna in Madhumeha 5
  17. 17. Drug reviewSYNONYMS OF TWAKiuÉMçü - iuÉcÉqÉç -- iuÉcÉ xÉÇuÉUhÉå | rÉ²É iÉlÉÉåÌiÉ ÌuÉxiÉÉUrÉiÉÏÌiÉ | uÉsMüsÉqÉç | mÉëzÉxiÉÉ iuÉaÉxrÉÉÎxiÉ | it has the bark with best therapeutic and aromatic qualities14. iuÉcÉÌiÉ xÉÇuÉÚhÉÉåÌiÉ uÉÉrÉÑÌmɨÉÉSÏlÉç CìiÉ15 | It covers vata and pitta dosha.EiMüOûqÉç -- ESaiÉ: MüOû: AÉuÉUhÉÇ AÉuÉUMüÉå uÉÉ rÉxrÉ | AlrÉå iÉÑ EiMüOûaÉÎlkÉiuÉÉiÉç EiMüO: EcrÉliÉå | It is best among the barks used.cÉÉåcÉqÉç -- mÉëzÉxiÉÇ cÉÉåcÉqÉxrÉÉÎxiÉ | Its bark has very good taste.iuÉYmÉ§É -- iuÉÌaÉuÉ mɧÉqÉxrÉ | iuÉaÉÌmÉ lÉÉqÉÉxrÉ| It has thin flakes of bark.SÉÂÍcÉlÉÏ -- SÉÂÍhÉ pÉuÉÉ cÉÏlÉÏ zÉMïüUÉuÉiÉç qÉkÉÑUÇ iuÉaÉxrÉ CìÌiÉ | Its bark is sweet in taste.SÉÂÍxÉiÉÉ -- SÉÂÍhÉ ÍxÉiÉÉ zÉMïüUåuÉ | iuÉMç16 | Its bark is sweet like sugar. SÉÂZrÉÉÍxÉiÉÉ CÌiÉ | SÉÂÍhÉÍxÉiÉÉ CuÉ uÉåÌiÉ qÉÉkÉÑrÉÉïiÉç17 | Its bark is sweet like sita.uÉUÉ…qÉç -- uÉUqÉ….qÉxrÉ | uÉUÇ ´Éå¸Ç | Its every part is useful.xuÉÉ̲ -- xuÉÉSÒ uÉÉåiÉÉå aÉÑhÉuÉcÉlÉÉiÉç |18 Its very tasty.pÉÚ…qÉç -- ÌoÉpĘ́Éï EwhiÉÉÌS aÉÑhÉÉlÉç CÌiÉ | It does the dharana of ushna guna.xÉæÇWûsÉqÉç -- ÍxÉÇWûsɲÏmÉmÉëSåzÉå oÉÉWÒûsrÉålÉ pÉuÉiÉÏÌiÉ19 | Its found abudently in Ceylon.oÉWÒûaÉlkÉqÉç -- Highly aromatic smellqÉÑZÉzÉÉåkÉlÉqÉç -- Mouth-refreshing Evaluation of efficacy of Twak churna in Madhumeha 6
  18. 18. Drug reviewsÉÉOûmÉhÉïqÉç -- Mostly in lata (Desa is identified as eastern Bengal)uÉlÉÌmÉërÉqÉç -- Growing wildaÉÑQûiuÉMçü -- Bark is sweet like jaggerycÉqÉïlÉÉqÉÉ -- Leaves are like skinxuÉhÉïpÉÔÍqÉMüqÉç -- Found in swarnabhoomi20.¾èûŸ -- Bark is heart tonic21TWAK IN DIFFERENT NIGHANTU iuÉcÉÇ uÉUÉ….Ç pÉÚ…Ç. iuÉYcÉÉåcÉqÉç zÉMüsÉqÉÑiMüOûqÉç | xÉæÇWûsÉÇ sÉÉOûmÉhÉïÇ cÉ qÉÑZÉzÉÉåkrÉÇ uÉlÉÌmÉërÉqÉç || uÉUÉ…Ç. sÉbÉÑ iÉÏwhÉÉåwhÉÇ MüTüuÉÉiÉÌuÉwÉÉmÉWûqÉç | MühPûuÉY§ÉÂeÉÉå WûÎliÉ ÍzÉUÉå¾èSèoÉÎxiÉzÉÉåkÉlÉqÉç || (kÉ.ÌlÉ. zÉiÉmÉÑwmÉÉÌS uÉaÉï 51)22 aÉÑQûiuÉaÉÑiMüOÇû ¾èŸÇ iÉlÉÑMÇü xuÉhÉïpÉÔÍqÉMüqÉç || sÉÉOûmÉhÉïÇ cÉ zÉMüsÉÇ iuÉMçü cÉÉåcÉÇ uÉsMüsÉÇ iuÉcÉqÉç | bÉlÉÇ UÉqÉÉÌmÉërÉÇ pÉÚ…Ç. uÉUÉ…Ç. xÉÑUxÉÇ uÉUqÉç || uÉUÉ…Ç. MüOÒûMÇü ÌiÉ£Çü iÉÏwhÉÉåwhÉÇ qÉkÉÑUÇ sÉbÉÑ | ÌmɨÉsÉÇ MüTüuÉÉiÉblÉÇ ¾èSuÉÎxiÉaÉSeÉliÉÑÎeÉiÉç || mÉÏlÉxÉÉÂÍcÉMüMühQÕûuÉÉqÉuÉÉiÉSÒlÉÉïqÉzÉÑ¢ü¾èiÉç | (Mæü.ÌlÉ. AÉæwÉÍkÉ uÉaÉï 1335-1337)23 iuÉcÉÇ iuÉauÉsMüsÉÇ pÉÚ…Ç. uÉUÉ…Ç. qÉÑZÉzÉÉåkÉlÉqÉç | zÉMüsÉÇ xÉæÇWûsÉÇ uÉlrÉÇ xÉÑUxÉÇ UÉqÉuÉssÉpÉqÉç || EiMüOÇû oÉWÒûaÉlkÉgcÉ ÌuÉ‹ÑsÉgcÉ uÉlÉÌmÉërÉqÉç | sÉÉOûmÉhÉïÇ aÉlkÉuÉsMÇü uÉUÇ zÉÏiÉÇ aÉëWûͤÉiÉÏ || Evaluation of efficacy of Twak churna in Madhumeha 7
  19. 19. Drug reviewiuÉcÉliÉÑ MüOÒûMÇü zÉÏiÉÇ MüTüMüÉxÉÌuÉlÉÉzÉlÉqÉç |zÉÑ¢üÉqÉzÉqÉlÉÇ cÉæuÉ MühPûzÉÑήMüUÇ sÉbÉÑ || (UÉ.ÌlÉ. ÌmÉmmÉsrÉÉÌS uÉaÉï 170-172)24iuÉcÉÇ uÉUÉ…Ç. xÉMüsÉÇ iuÉMçü cÉÉåcÉÇ iÉlÉÑMÇü uÉUqÉç |sÉÉOûmÉhrÉïÇ bÉlÉÇ pÉÚ…Ç. aÉÑÂiuÉMçü xuÉhÉïpÉÔÍqÉMüqÉç ||iuÉcÉÇ sÉbÉÔwhÉÇ MüOÒûMÇü ÌuÉwÉSÇ xuÉÉSÒ ÌmɨÉsÉqÉç |¾è²ÎxiÉUÉåaÉuÉÉiÉÉzÉï: mÉÏlÉxÉÌ¢üÍqÉzÉÑ¢ülÉÑiÉç || (qÉ.ÌlÉ. MümÉÑïUÉÌS uÉaÉï 27, 28)25iuÉYxuÉÉ̲ iÉÑ iÉlÉÑiuÉYrÉxrÉɨÉjÉÉ SÉÂÍxÉiÉÉ qÉiÉÉ ||E£üÉ SÉÂÍxÉiÉÉ xuÉÉ²Ï ÌiÉ£üÉcÉÌlÉsÉÌmɨÉç¾èiÉç |xÉÑUÍpÉ: zÉÑ¢üsÉÉoÉsrÉÉ qÉÑZÉzÉÉåwÉiÉÚwÉÉmÉWûÉ || (pÉÉ.ÌlÉ. MümÉÑïUÉÌS uÉaÉï 66, 67)26iuÉYmÉ§É cÉ uÉUÉÇaÉÇ xrÉÉSè pÉÚÇaÉÇ cÉÉåcÉÇ qÉSÉåiMüiÉqÉç ||iuÉcÉÇ sÉbÉÑwhÉÇ MüOÒûMÇü xuÉÉSÒ ÌiÉ£Çü cÉ Â¤ÉMüqÉç |ÌmɨÉsÉÇ MüTüuÉÉiÉblÉÇ MühQÒûuÉÉqÉÉÂÍcÉlÉÉzÉlÉqÉç ||¾è²ÎxiÉUÉåaÉuÉÉiÉÉzÉï:Ì¢üÍqÉmÉÏlÉxÉzÉÑ¢ü¾èiÉç | (Wû.ÌlÉ. MümÉÑïUÉÌS uÉaÉï 64, 65)27 Evaluation of efficacy of Twak churna in Madhumeha 8
  20. 20. Drug review Table 2: Showing synonyms according to different NighantuS.N Synonyms D.N.28 K.N.29 R.N.30 M.N.31 N.Ad.32 B.N.33 H.N.34 1. iuÉMçü - + - - + + + 2. iuÉcÉqÉç + + + + - - - 3. iuÉauÉsMüsÉÇ - - + - - - - 4 pÉÚ…Ç. + + + + + - - 5. uÉUÉ…Ç. + + + + + - - 6. qÉÑZÉzÉÉåkÉlÉÇ + - + - - - - 7. xÉMüsÉ + + + + - - - 8. xÉæÇWûsÉ + - + - + - - 9. uÉlrÉ - - + - - - -10. xÉÑUxÉÇ - + + - - - -11. UÉqÉuÉssÉpÉqÉç - - + - - - -12. EiMüO - + + - - - -13. oÉWÒûaÉlkÉ - - + - - - -14. ÌuÉ‹ÑsÉ - - + - - - -15. uÉlÉÌmÉërÉÉ + - + - - - -16. sÉÉOûmÉhÉï + + + + - - -17. aÉlkÉuÉsMÇü - - + - - - -18. uÉUÇ - + + + - - -19. zÉÏiÉÇ - - + - - - -20. iuÉMçü cÉÉåcÉÇ - - - + - - -21. iÉlÉÑMÇü - + - + - - -22. bÉlÉÇ - + - + - - -23. aÉÑÂiuÉMçü - - - + - - -24. aÉÑQûiuÉMçü - + - - - - -25. xuÉhÉïpÉÔÍqÉMüqÉç - + - + - - -26. iÉeÉÇ - - - + - - -27. ¾èŸÇ û - + - - - - -28. cÉÉåcÉÇ + + - - + - -29. uÉsMüsÉç - + - - - - -30. UÉqÉÌmÉërÉÉ - + - - - - -31. EiMüsÉ + - - - - - -32. xuÉÉ²Ï - - - - - + +33. iÉlÉÑiuÉMçü - - - - - + +34. SÉÂÍxÉiÉÉ - - - - + + + Evaluation of efficacy of Twak churna in Madhumeha 9
  21. 21. Drug review Table 3: Showing properties according to different Nighantu Properties D.N.35 K.N.36 R.N.37 M.N.38 N.Ad.39 B.N.40 H.N.41 MüOÒû - + + + + - - ÌiÉ£ü - + - - + + + UxÉ qÉkÉÑU - + - - + + + sÉbÉÑ + + + + - - - aÉÑhÉ iÉϤhÉ + + - - - - - zÉÏiÉ - - + - - - - uÉÏrÉï EwhÉ + + - + + + - ÌuÉmÉÉMü MüOÒû - - - - + - - uÉÉiÉ + + - + + + + SÉåwblÉiÉÉ ÌmÉ¨É - - - - - + + MüTü + + + - + - -SUMMARIZING ALL THE PROPERTIESUxÉ : MüOÒû , ÌiÉ£ü , qÉkÉÑU aÉÑhÉ : sÉbÉÑ, iÉϤhÉÌuÉmÉÉMü : MüOÒû uÉÏrÉï : EwhÉSÉåwblÉiÉÉ : MüTüuÉÉiÉzÉÉqÉMü, ÌmɨÉuÉkÉïMü Evaluation of efficacy of Twak churna in Madhumeha 10
  22. 22. Drug review Table 4: Showing therapeutic actions according to different NighantuS.N Karma D.N.42 K.N.43 R.N.44 M.N.45 N.Ad.46 B.N. 47 H.N.48 1 MüÉxÉWûU - - + - - - - 2 Ì¢üÍqÉWûU - + - + - + - 3 ÌuÉwÉWûU + - - - - - - 4 ¾è±zÉÉåkÉlÉqÉç + - - - - - - 5 oÉÎxiÉzÉÉåkÉlÉqÉç + - - - - - - 6 zÉÑ¢üsÉ - - - - + + + 7 uÉhrÉï - - - - - + + 8 qÉÑZÉzÉÉåkÉlÉqÉç + - - - + + + 9 oÉsrÉ - - - - - + -10 uÉÉiÉlÉÑsÉÉåqÉMü - - - - - + -11 aÉëÉWûÏ - - - - - + -12 SÏmÉlÉ - - - - - + -13 mÉÉcÉlÉ - - - - - + -14 aÉpÉÉïzÉrÉ E¨ÉåeÉMü - - - - - + -15 xiÉqpÉlÉ - - - - - + -16 zÉÉåÍhÉiÉxjÉÉmÉlÉ - - - - - + -17 AɤÉåmÉMü - - - - - + -18 AÉiÉïuÉmÉëuÉiÉïMü - - - - - + -19 uÉåSlÉÉWûU - - - - - + -20 uÉëhÉzÉÉåkÉMü - - - - - + -21 uÉëhÉUÉåmÉMü - - - - - + - Evaluation of efficacy of Twak churna in Madhumeha 11
  23. 23. Drug review Table 5: Showing therapeutic uses according to different Nighantu S.No. Roga D.N.49 K.N.50 R.N. 51 M.N.52 N.Ad.53 B.N. 54 H.N.55 1 MüÉxÉ - - + - - - - 2 zÉÑ¢üSÉåwÉ - + + + - - - 3 AÉqÉSÉåwÉ - + + - + - - 4 ¾èSìÉåaÉ + + - + + - - 5 oÉÎxiÉUÉåaÉ + + - + + - - 6 AzÉï - + - + + - - 7 mÉÏlÉxÉ - + - + + - - 8 Ì¢üÍqÉ - + - + + - - 9 AÂÍcÉ - + - - + - - 10 MühQÒû - + - - - - - 11 MühPûÌuÉMüÉU + - - - - - - 12 qÉÑZÉUÉåaÉ + - - - - - - 13 iÉÚwhÉÉ - - - - + + +VERNACULAR NAMESLatin: Cinnamomum zeylanicumEnglish: True cinnamomHindi: Dalchini, darchiniGujrati: Dalchini, TajMarathi: Dalchini, darachini Evaluation of efficacy of Twak churna in Madhumeha 12
  24. 24. Drug reviewKannada: Lavanga patte, ChakkeTamil: Cannalavangapattai, ilavangam, ilavamgapattaiTelugu: Lavangamu, lanvangapattaMalayalam: Cheriyilaivannam, erikkolamBengali: Dalchini, qalamidarchiniPunjabi: DarchiniUrdu: DarchiniUriya: Dalochini, daruchiniCeylon: Kuruva56KULA: Karpoora kulaFAMILY: Lauracaeae (which contains glossy leaves)57TAXONOMICAL CLASSIFICATION Division: Magnoliophyta Class: Magnoliopsida SubClass: Magnoliid basal dicots Order: Laurales Family: Lauraceae Genus: Cinnamomum Species: zeylanicum58 Evaluation of efficacy of Twak churna in Madhumeha 13
  25. 25. Drug reviewFEATURES OF LAURACEAEDiagnostic featuresShrubs or trees. Third row of stamens if present with the anthers – cells opening outwardsby valves. Fruiting perianth with deciduous lobes and persistent base wholly or in part.Anthers four celled.DistributionThis family contains 40 genera and 1000 species, which are found in tropics andsubtropics. The chief centers are south East Asia and Brazil.Vegetative charactersHabit: These are aromatic trees or shrubs usually evergreen.Stem: Erect and branchedLeaves: Alternate (rarely opposite or deciduous), gland dotted, stipules absent.Floral charactersFlower: Regular, small, hermaphrodite (rarely unisexual), in axillary cymes, clusters,racemes or panicles, bracts deciduous, often involucrate or sometime absent.Perianth: Usually inferior, tube short, sometimes enlarging in fruits, lobes of limb usuallysix (rarely four), lobes of each series imbricate (rarely subvalvate), all similar small,herbaceous or petaloid and equal.Stamens: Usually a multiple of the perianth-lobes in 2-4 series on the tube, filamentsflattened anthers erect, two or four celled.Ovary: Sessile at the base of the perianth tube, one celled ovule solitary.Fruit: Dry or fleshy berry, naked or rarely enclosed in or adnate to the perianth tube, thestalk often thicken.Seed: Pendulous, testa membranes albumin absent. Cotyledons plano-convex, fleshy59. Evaluation of efficacy of Twak churna in Madhumeha 14
  26. 26. Drug reviewMORPHOLOGY OF Cinnamomum zeylanicum Breyn A moderate sized evergreen tree, bark rather thick, smooth, pale, brown or rough(in aged trees)60, twigs often compressed, young parts glabrous except the buds which arefinely silky. Leaves opposite or sub-opposite (rarely alternate), hard and coriaceous, 7.5-20 by 3.8-7.5 cm. ovate or ovate-lanceolate, subacute or shortly acuminate, glabrous andshining above, slightly paler beneath, base acute or rounded, main nerves 3-5 from thebase or nearly so, strong, with fine reticulate venation between, petioles 1.3-2.5 cm long,flattened above. Flowers numerous, in silky-pubescent lax panicles, usually longer thanleaves, peduncles long, often clustered, glabrous or pubescent, and pedicels long.Perianth 5-6 mm long, tube 2.5 mm long, segments pubescent on both sides, oblong,usually obtuse. Fruit 1.3-1.7 cm long, oblong or ovoid- oblong, dry or slightly fleshy,dark purple, surrounded by the enlarged perianth, which is 8 mm diameter61.Bark: Long, cylindrical quills deprived of the corky layer by scraping; compound,consisting of 8 or more thin, papery, light brownish-yellow, quilled layers, enclosed onewithin the other, their sides curling inward, giving the sticks a flattened appearance onone side; somewhat flexible, with a splintery fracture; the outer surface is marked withshining, wavy bast lines, and occasionally with small scars or perforations indicating theformer position of leaves; under the microscope it is seen to be formed by a layer of stonecells, which produces the light coloured wavy, longitudinal lines on the outside of thebark. Small groups of about 6-15 pericyclic fibres occur at intervals. 3 to 4 layers ofpitted sclerides with starch grains are seen. Secondary phloem is parenchymatous. Fewcells contain acicular calcium oxalate crystals and starch grains (diameter upto 10 μ). Evaluation of efficacy of Twak churna in Madhumeha 15
  27. 27. Drug reviewCork and cortex are absent62. The inner surface is darker and striated. A characteristic,sweet, fragrant odor, and a warm, aromatic, pungent, and sweetish taste run through thedifferent cinnamon barks, but the taste of the Ceylon cinnamon is the more delicate. Thebroken pieces, caused by repacking at custom-houses (sorted and sold as "smallcinnamon"), are commonly used in pharmacy.CULTIVATION Cinnamon can be propagated by planting the cuttings and layers commercially,but generally propagated by seed, as it is the easiest method to adopt. It needs sandy orsiliconous soils with an admixture of humus. The altitude at which it grows favourably is800-1000 meters. Sheltered situation with an annual rainfall of 200-250 cm is ideal forcultivation of cinnamon. The seeds are sown in well-prepared nursery beds located atsuitable places in June and July. The seeds are sown at a distance of 10 cm and coveredwith small layer of soil and watered properly. It takes approximately 20 days forgermination of seeds. Seedlings are provided with the shades and are aloowed to frow forabout 10-12 months. Transplantation is done in Oct / Nov, or in rainy season by keepingthe distance of 2 meters in between 2 plants. Shades are provided with the pendals ofcoconut leaves. The field is weeded 2 to 4 times in a year. The trees are allowed to growunless they turn to uniform brown by formation of cork. One-hectare plantation ofcinnamon, on an average, produces 200-300 kg bark and 2-3 kg of leaf oil per year63. Evaluation of efficacy of Twak churna in Madhumeha 16
  28. 28. Drug reviewCOLLECTION OF BARK The shoots are cut from the trees when they are about 18 months old, and the topsand twigs are removed. The bark and cork are removed by peeling with a brass knife. Theseparated bark is wrapped in coir matting and allowed to ferment overnight. The outerbark (cork and cortex) is scrapped off with the help of a curved steel scrapper. Manylayers of the thin inner bark are rolled into one quill. The quills are dried by keeping themin shade for about 24 hours, and on the second day are placed in the open air on woodenframes. After drying, the quills are sorted into grades and made into compact bales64.STORAGE Keep it in well-closed containers in cool place, away from light65.HABITAT Twak is found growing in China, Singapore, and India66. Its trees are found insouth India67 , Himalayas68 , especially in Malabar Coast69 and Burma70. Twak isconsidered to be the native of srilanka71, 72. It is also found in Brazil and Jamaica73. It’scultivated in Malay islands and elsewhere in the tropics74.PHYTOCHEMISTRY Twak bark contains volatile oil 0.5-1 %, tannins and gums. Its volatile oil remainslight yellow when collected fresh but it becomes reddish brown on storage. This contain60-75 % cinnamaldehyde, 10 % eugenol and In less quantity methyl-n-amyl ketone, p-cymene, l-phellandrene, l-alpha- pinene, l-linalool, cumic aldehyde, nonyl aldehyde, Evaluation of efficacy of Twak churna in Madhumeha 17
  29. 29. Drug reviewcaryophylline and esters of butyric acids75, cinnamic acid, resin, sugar, starch,mucilage76. Twak leaves contain slight dark color volatile oil, which has strong smell.Eugenol is also present in 70-95%77. Small amounts (1-5%) of cinnamaldehyde, benzylbenzoate, linalool and β-caryophyllene have also been found. Root oil is yellow colouredand water insoluble78. A completely different composition is found in the essential oil ofcinnamon root bark; here, camphor (60%) dominates. This oil is not used commercially.Seeds yield 33% fixed oil79.USES Twak oil is administered with mishreya in case of adhamana, shoola, pratishaya and vamana. Its decoction is given in nausea, vomiting, atisara, pravahika and grahani. Oil is given in rajyakshma both internally and externally. It is mixed with pippalimoola and bhanga and given for cervical dialysis during labor. In case of attyarthava, it’s administered with ashoka. In the hemorrhagic condition of uterus or lungs, its bark decoction is used. It is used as mild analgesic in case of tooth ache80. Commercially it is used as spice and condiment, and also in the preparation of candy, dentifrices and perfumes81. Evaluation of efficacy of Twak churna in Madhumeha 18
  30. 30. Drug review Bark is tonic, expectorant, useful in hydrocele, headache, piles and strengthens the liver. The oil is carminative, useful in inflammation and bronchitis82. Powders of Twak, Ela, Pippali, Twakshiri and sugar are mixed together and taken with honey in Kasa. Nasya with Twak kalka, patra and sarkara along with rice water is useful in pittaja shirashoola. Twak powder is given in 1gm dose in Pravahika83. Its used for mouth wash in bad breath and keeps the teeth healthy by chewing. The paste is applied in skin diseases like moles and skin tags etc84. The oil is used externally on tubercular wound for the shodhana and ropana purpose85. As a stimulant of uterine muscle fibre it’s employed in menorrhagia and in tedious labour due to defective uterine contractions. The crystalline cinnamic acid is anti-tubercular and is used as injection in phthisis. A 5% oily emulsion with yolk of egg is injected in lupus. The essential oil is used in flavouring sweets and as powerful stimulant in amenorrhoea. As an antiseptic it’s used as an injection in gonorrhoea. Its also used in massive doses with success in the treatment of cancer and other microbic diseases.86Evaluation of efficacy of Twak churna in Madhumeha 19
  31. 31. Drug review Its phanta kalpana is good in case of atisara. Its good for kampavata, apasmara, kasa, grahni, mandagni and jeerna atisara. It improves white blood cells count and purifies the blood. The oil is used externally in Dhwajbhanga. The bark and oil are given internally in the case of mootraghata, bastivikaras, pooyameha and kricchaarthava.CONTRAINDICATION Twak is contraindicated in pregnancy, as it increases the uterine spasm81.USEFUL PARTS AND POSOLOGYBark: Choorna 1-4 gm88Patra: Choorna 0.33-1gm89Taila: 1-3 drops90FORMULATIONS Twak is used profusely in number of formulations as prakshepaka dravya due toits aroma and sweet taste. Here is the little yoga in which Twak is been included fortherapeutic purpose. Eladi rasayana Sitopaladi choorna Samsarkara choorna91 Evaluation of efficacy of Twak churna in Madhumeha 20
  32. 32. Drug review Pippalyasava Astanga lavana Khadiraristha Chandraprabhavati92 Tvagadi leham Tvagadi tailam Talisadi choorna93CINNAMON OIL The oil from Cinnamomum zeylanicum is extracted from the bark or the leaves bysteam distillation and gives golden yellow or brown colour.ADULTERATION AND SUBSTITUTION Twak bark oil is detected due to excessive presence of eugenol and less percent of cinnameldehyde, which is a characteristic of leaves oil94. Stem bark of Cinnamomum tamala known in commerce as Indian Cassia Lignea or Tajchaal is sold as a cheap substitute. Chinese cassia obtained from Cinnamomum cassia Blume imported into India, via Singapore and Hongkong is sometimes used as substitute. Cinnamon bark from Cinnamomum cassia Blume, has the starch grain measuring from 10-20μ while cinnamon bark of Cinnamomum zeylanicum, has smaller starch grain of 6-8μ diameter, Evaluation of efficacy of Twak churna in Madhumeha 21
  33. 33. Drug review the characteristics can distinguish between the same which are mixed as substitutes in the other95. Saigon cinnamon consists of the bark of the trees of Cinnamomum loureirii (Lauraceae) is exported from the port of Saigon. It is also grown in China and Japan. The bark is greyish-brown in colour with light patches and sweet taste. Quills are 30×4×0.7 cm, unpeeled and contain 2.5% of volatile oil. Java cinnamon is derived from Cinnamomum burmanii (Lauraceae). Bark is less aromatic, peeled and found in the form of double quills. Histologically, medullary rays contain small tubular crystals of calcium oxalate, not found in Cinnamomum zeylanicum. It contains about 75% of cinnamaldehyde in the oil. It also gives poor yield to 90% alcohol96. Seychelles cinnamon is in roughly broken channeled pieces about 2-3 cm across and 10-20 cm long. More recently larger pieces of this bark are scraped and then rolled into sticks closely resembling Ceylon cinnamon. When soaked in water, these sticks openout into pieces of bark about 8 or more cm wide and 20 cm. Long. Oliver bark or Black Sassafras, is the dried bark of Cinnamomum oliveri Bailey (Lauraceae), a tre indigenous to New South Wales.it comes in flat strips 20×4×1 cm, outer surface brownish with patches of whitish cork. Odour aromatic, taste bitter and camphoraceous. It’s used as a substitute97.Evaluation of efficacy of Twak churna in Madhumeha 22
  34. 34. Drug reviewRECENT RESEARCHES • Cinnamon bark extract improves glucose metabolism and lipid profile in the fructose-fed rat by Kannappan S, Jayaraman T, Rajasekar P, Ravichandran M K and Anuradha CV. The present study was designed to investigate whether cinnamon bark extract (CBEt) mitigates the adverse effects of fructose loading on glucose metabolism and lipid profile in rats. Methods: Adult male albino rats of body weight 150-170 g were divided into five groups and fed with either control or high fructose diet (HFD). CBEt was administered to HFD-fed rats orally at two doses (a low and a high dose) while the control diet-fed rats were treated with a high dose of CBEt. The treatment protocol was carried out for 60 days after which the oral glucose tolerance test was carried out. Biochemical parameters related to glucose metabolism and lipid profile were assayed. Results: The levels of glucose, insulin and protein-bound sugars were higher and activities of enzymes of glucose metabolism were altered in HFD-fed rats, as compared to control animals. The levels were brought back to near normal when administered with CBEt at high dose. CBEt also prevented the hyperlipidaemia observed in fructose- fed rats and improved glucose tolerance. CBEt did not show any significant effect in fructose-fed rats when administered at low dose98. • Antioxidative stress potential of Cinnamomum zeylanicum in humans: A comparative cross-sectional clinical study by Akram Ranjbar, Sara Ghasmeinezhad, Hosnieh Zamani, Ali Akbar Malekirad, Akram Baiaty, Azadeh Mohammadirad & Mohammad Abdollahi. Objective: The objective of this study was to determine the antioxidative stress capacity of cinnamon in humans when Evaluation of efficacy of Twak churna in Madhumeha 23
  35. 35. Drug review administered in a regular and controlled manner. Methods: A total of 54 normal subjects were divided into three groups, receiving water, regular tea or cinnamon tea for 2 weeks. Blood samples were obtained before and after treatment and analyzed for lipid peroxidation levels, total antioxidant power and total thiol groups by standard methods. Results: The results indicated increased total antioxidant power and total thiols but a decrease in lipid peroxidation levels in individuals who received regular or cinnamon tea compared with controls. The extent of increase in total antioxidant power and decrease in lipid peroxidation levels were more evident in individuals who received cinnamon tea compared with those who received regular tea99.• Germanys Commission E approves cinnamon for improving appetite and relieving indigestion; however, these uses are not backed by reliable scientific evidence. Two animal studies weakly suggest that an extract of cinnamon bark taken orally may help prevent stomach ulcers. Preliminary results from test tube and animal studies suggest that cinnamon oil and cinnamon extract have antifungal, antibacterial, and antiparasitic properties. For example, cinnamon has been found to be active against Candida albicans, the fungus responsible for vaginal yeast infections and thrush (oral yeast infection), Helicobacter pylori (the bacteria that causes stomach ulcers), and even head lice.• Use of waste generated from cinnamon bark oil (Cinnamomum zeylanicum Blume) extraction as a post harvest treatment for Embul banana by Lakshmie S. Ranasinghe, Bimali Jayawardena and Krishanthi Abeywickrama. Waste water samples collected from a cinnamon bark oil distillery, was extracted and analyzed Evaluation of efficacy of Twak churna in Madhumeha 24
  36. 36. Drug review by Gas Chromatography. The major constituent of the extracted oil solution was cinnamaldehyde (66.2%). Previously isolated and identified fungal pathogens causing anthracnose and crown rot of Embul banana were treated in vitro with oil extract. The oil was fungistatic and fungicidal within the range of 0.64 mg/ml – 1.00 mg/ml. Spraying Embul banana with emulsions of the oil extract prior to storage, controlled crown rot enabling banana to be stored for up to 14 days at ambient temperature (28 ± 20C) and 21 days at 140C; 90% r.h. in modified atmosphere. A standard fungicide; benomyl treatment and control were included. There was no any detrimental effect of the physico-chemical properties such as percentage weight loss, fruit firmness, pH, total soluble solids and titratable acidity due to the treatment of oil extract. The evaluation of organoleptic properties showed higher acceptability of oil treated banana100.• Chemical Composition of Volatile Oil from Cinnamomum zeylanicum Buds by Guddadarangavvanahally K. Jayaprakasha, Lingamallu Jaganmohan Rao and Kunnumpurath K. Sakariah. Central Food Technological Research Institute, Mysore-570013, INDIA. The hydro-distilled volatile oil of the Cinnamomum zeylanicum buds was analyzed using GC and GC-MS for the first time. Thirty- four compounds representing 98% of the oil was characterized. It consists of terpene hydrocarbons (78%) and oxygenated terpenoids (9%). α-Bergamotene (27.38%) and α-copaene (23.05%) are found to be the major compounds. A comparison of the chemical composition of the oil was made with that of flowers and fruits101. Evaluation of efficacy of Twak churna in Madhumeha 25
  37. 37. Drug review• Candida is inhibited by cinnamon bark or cinnamaldehyde (in vitro). 3 of 5 oral candidiasis patients using cinnamon preparation for 1 week got better.• Genetic identification among four species of cinnamon (C.cassia, C. zeylanicum, C. burmannii and C. sieboldii) was studied by analyzing nucleotide sequences of chloroplast DNA from two regions, the intergenic spacer region between the trnL 3exon and trnF exon and the trnL intron region.• Ethanol extract of the bark of Cinnamomum zeylanicum enhanced the wound breaking strength in case of incision wound, rate of wound contraction and period of epithelization in case of excision wound when administered orally at a dose of 250 & 500 mg/kg body weight to wister rats.• Methylene chloride extract of cinnamon found to inhibit growth of H. pylori, while ethanol extract counteracted its urease activity.• Water-soluble polyphenol polymers from cinnamon that increase insulin- dependent in vitro glucose metabolism roughly 20-fold and display antioxidant activity were isolated and characterized by nuclear magnetic resonance and mass spectroscopy102. Evaluation of efficacy of Twak churna in Madhumeha 26
  38. 38. Disease review NIRUKTI AND PARIBHASHANIRUKTI qÉkÉÑ+qÉåWû = qÉkÉÑqÉåWû, Madhumeha is a compound word made up of Madhu & Meha. qÉkÉÑ: That which brings contentment to the mind, because of which it is popular among people as Madhu, is characterised by sweet taste. qÉåWû : Meha is derived from the root ‘Miha’, which has been used to convey the meaning “ to flow excessively”103. mÉëqÉåWû: is derived fro mÉë + ÍqÉWû. : A condition characterized by excessive outflow and a condition where there is excess urine flow.PARIBHASHA mÉëMüwÉåïhÉ qÉåWûÌiÉ ¤ÉUÌiÉ uÉÏrÉçrÉÉÌSïUÉlÉå lÉåÌiÉ mÉëqÉåWû: | mÉë + ÍqÉWû + ¤ÉUhÉå MüUhÉå kÉgÉç UÉååaÉÌuÉzÉåwÉ: || (zÉoSMüsmÉSìÓqÉ) qÉkÉÑUÇ rÉŠ qÉWåûwÉÑ mÉëÉrÉÉå qÉÎkuÉuÉ qÉåWûÌiÉ | xÉuÉåïÅÌmÉ qÉkÉÑqÉåWûÉZrÉÉ qÉÉkÉÑrÉÉïŠ iÉlÉÉåUiÉ: || (qÉÉ.ÌlÉ. 33/26) Madhumeha is a disease characterized by Bahumootrata, which resembles Madhu in Rasa or Varna and whole body, attains madhuryata104. eÉÉiÉ: mÉëqÉåWûÏ . . . . . . . . . . mÉëuÉSlirÉxÉÉkrÉÉlÉç || (cÉ.ÍcÉ. 6/57) This word has been used synonymously with Prameha105. ¤ÉÉæSìUxÉuÉhÉïÇ ¤ÉÉæSìqÉåWûÏ | (xÉÑ.ÌlÉ. 6/14) Kshoudrameha: Kshoudra is a synonym of Madhu106. Evaluation of efficacy of Twak churna in Madhumeha 27
  39. 39. Disease reviewHISTORY Prameha, Meha or Madhumeha has been devoted separate chapters in Nidana as wellas Chikitsa sthana in all the Brihatrayees, which indicates clearly the inheritance of well-known, well understood and well systematized information by the Samhitakaras.VEDIC PERIOD (2000BC to 1000BC) There appears to be a word Aastravam, which means mutratisara i.e. excessiveurination (polyuria). In Valmiki Ramayan description about this condition of urine isavailable. In Garuna puran it is described as the condition in which the whole bodybecomes sweet and it is called madhumeha107.POST-VEDIC PERIOD Samhita Period (1000BC to 100BC): Explanations of the disease are described indepth and their respective emphasis on that part of the disease. Apart from medicalmanagement, one can see Sushruta devoting a separate chapter on management ofPrameha pidaka, which requires surgical intervention too; unlike Charaka who in factadvises surgery in such cases & refers them to contemporaries of Dhanvantari school ofthought.SANGRAHA PERIOD: (500AD to 800AD) Vagbhata is considered to be the most important contributor during this period, as hereclassified the whole Science of Ayurveda systematically into eight angas. He for thefirst time recognized Tanu madhuryata as an important feature in Madhumeha.TRANSITIONAL PERIOD (800AD to 1100AD) This period saw an intensive contribution by many commentators to the Samhitasand Sangrahas. They have elaborated on the basic principles of the disease as propounded Evaluation of efficacy of Twak churna in Madhumeha 28
  40. 40. Disease reviewby the Samhitakaras & Sangrahakaras, like commentaries of Chakrapanidatta onCharaka, Dalhana on Sushruta, Indu on Vagbhata. Also people like, Madhavakara,Arunadutta, Vijayarakshita, Basavaraju, Srikantadutta, Sharangdhara, Bhavamishra & soon have contributed their lot in their respective works. However, no new observationswere made.NIDANA VIVECHANA Nidana is a factor, which is potent enough to produce a disease. The knowledge of which 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 Chikitsa. iɧÉåqÉå §ÉrÉÉå ÌlÉSÉlÉÉÌSÌuÉzÉåwÉÉ: . . . . . . . . . .xÉ xÉuÉÉåï ÌlÉSÉlÉÌuÉzÉåwÉ: || (cÉ.ÌlÉ. 4/5) AÉxrÉÉxÉÑZÉÇ xuÉmlÉxÉÑZÉÇ SkÉÏlÉÏ aÉëÉqrÉÉæSMüÉlÉÔmÉUxÉÉ: mÉrÉÉÇÍxÉ | lÉuÉɳÉmÉÉlÉ aÉÑQûuÉæMÚüiÉÇ cÉ mÉëqÉåWûWåûiÉÑ: MüTüMÚüŠ xÉuÉïqÉç || (cÉ.ÍcÉ.6/4) aÉÑÂÎxlÉakÉÉqsÉsÉuÉhÉÉlrÉÌiÉqÉɧÉÇ xÉqÉzlÉiÉÉqÉç | lÉuÉqɳÉÇ cÉ mÉÉlÉÇ cÉ ÌlÉSìÉqÉÉxrÉÉxÉÑZÉÉÌlÉ cÉ || irÉ£üurÉÉrÉÉqÉÍcÉliÉÉlÉÉÇ xÉÇzÉÉåkÉlÉqÉMÑüuÉïiÉÉqÉç | zsÉåwqÉÉ ÌmɨÉÇ cÉ qÉåS¶É qÉÉÇxÉÇ cÉÉÌiÉmÉëuÉiÉïiÉå || iÉæUÉuÉÚiÉaÉÌiÉuÉÉrÉÑïUÉåeÉ AÉSÉrÉ aÉcNûÌiÉ | rÉSÉ oÉÎxiÉÇ iÉSÉ MÚücNûÉ qÉkÉÑqÉååWèû: mÉëuÉiÉïiÉå || (cÉ.xÉÔ. 17/78-80) Among the Prameha nidanas that are mentioned in our classics samanyaPrameha nidanas108 and kaphaja Prameha nidanas109,110 may be considered as nidana forMadhumeha. Evaluation of efficacy of Twak churna in Madhumeha 29
  41. 41. Disease review For the convenience of the study nidanas are classified into Aharaja, Viharaja,Beejadoshaja or kulaja and Nidanarthakara rogaja.AHARAJA NIDANA Sheetala, guru, snigdha, picchila bhojana, amla, lavana, Madhurarasa pradhanaahara atisevana, Navanna, Navamadhya sevana, Atimatrabhojana, Ikshuvikara,ksheerati sevana, Dravanna, Dadhi sevana, Gramya Udaka, Anoopa mamsa sevana,Gudavikruthi, Hayanaka, yavaka, cheenaka, uddalaka, Nishadha, Itkata, Mukundaka,Mahavreehi, Pramodaka, Sugandaka, Sarpishmathi, masha, supyashaka, Tila, Palala,Pishtanna, Payasa, Krushara, Vilepi, Ikshuvikara. The above-mentioned aharas are predominant in Ap and Prithvi mahabhoothaand contain snigdhadi quality, which are similar to the qualities of kapha and medas.So, these food articles would aggravate kapha and medas. So these food articles wouldaggravate kapha, which is the initial cause for Madhumeha.They, also increase medas,which is the Khavaigunya Sthana in Madhumeha. As these aharas posess excessive apmahabhootha. Apbhoothagni vyapara vikruthi takes place and this leads to kleda vriddi,which is the prime cause for the pathogenesis of Madhumeha.VIHARAJA NIDANA Atinidra, Tyaktavyayama, Diwaswapna are the Viharaja Nidanas. These viharaja nidanas aggravate kapha and medas and causes Madhumeha.These are also the causes for Sthoulya and hence cause Madhumeha. Here, by thesenidanas, energy expenditure will be nil. This causes ineffective mobilization of fat fromthe adipose tissue, while synthesis and storage of the fat continues normally and causesobesity. This in turn leads to Madhumeha. Evaluation of efficacy of Twak churna in Madhumeha 30
  42. 42. Disease reviewBEEJA DOSHA eÉÉiÉ: mÉëqÉåWûÏ qÉkÉÑqÉåÌWûlÉÉå uÉÉ lÉ xÉÉkrÉ E£ü: xÉ ÌWû oÉÏeÉSÉåwÉÉiÉç | rÉå cÉÉÌmÉ MåüÍcÉiÉ MÑüsÉeÉÉ ÌuÉMüÉUÉ pÉuÉÎliÉ iÉÉÇ¶É mÉëuÉSlirÉxÉÉkrÉÉlÉç || (cÉ.ÍcÉ.6/57) rÉÌS cÉ qÉlÉÑwrÉÉå qÉlÉÑwrÉÉåmÉëpÉuÉ: ................ ÌmɧÉxÉSìèzÉÂmÉÉ pÉuÉÎliÉ || (cÉ.zÉÉ.3/17) This nidana is not mentioned in the context of nidana of Prameha. But whilementioning Sadhyasadyatva this has been mentioned. Acharya Charaka while explainingVikrutha Garbha caused by beeja dosha says that if a part of the beeja is defective, thebody part developing from that portion of beeja will be abnormal. He gives an examplethat a portion of the beeja of a kusthi, which is responsible for the formation of the skin,is defective, and then only the born child will have kusta. However if that part is notabnormal then the child will not suffer from kusta. Hence it can be understood that childborn to Madhumehi, may or may not suffer from Madhumeha. It depends on thebeejabhaga avayava which is defected111,112,113 .NIDANARTHAKARA ROGAJASthoulya: Sthoulya is a nidanarthakara roga for Prameha. It is obvious that the samanyanidana of Sthoulya and Prameha simulates each other. Sushrutha has stated thatapathyanimittaja Pramehis are Sthoola114. Sthoulya the path of vayu will be obstructed bymedas and hence vayu will get aggravated specially, that which is confined to kosta(samanavayu) resulting in the stimulation of digestive fire and consequently absorption offood. So the food digests quickly and the individual becomes veracious eater. By thismedodhatwagni becomes more mandha and puts pressure on its moolasthana i.e.vapavahana (pancreas). Hence there will be relative insulin deficiency. On the other hand Evaluation of efficacy of Twak churna in Madhumeha 31
  43. 43. Disease reviewexcessive increase of fat and muscle tissue causes insulin resistance. So insulin resistanceand relative insulin deficiency causes the pathogenesis of Madhumeha.Prameha: xÉuÉï LuÉ mÉëqÉåWûÉxiÉÑ MüÉsÉålÉÉmÉëÌiÉMüÉËUhÉÉ: | qÉkÉÑqÉåWûiuÉqÉÉrÉÉÎliÉ iÉSÉÅxÉÉkrÉÉ pÉuÉÎliÉ ÌWû || (xÉÑ.ÌlÉ. 6/30) All the other varieties of mehas if neglected in due course leads toMadhumeha115. So all the nidana factors, which are responsible for all other varieties ofprameha, are considered the nidana for madhumeha also. Pathogenesis and the srotasinvolved in Prameha and Madhumeha are similar. So, if the Prameha is not treated thenit causes more strain on the same srothases and causes Madhumeha. Here we mayconsider it as a khavaigunya karaka nidana.AETIOLOGY In both of the common types of diabetes, environmental factors interact withgenetic susceptibility to determine which people develop the clinical syndrome, and thetiming of its onset.GENETICS Genetic factors are important in the aetiology by studies in monozygotic twinswhere concordance rates for type 2 diabetes approach 100%.ENVIRONMENTAL FACTORS Viral Infections: The evidence that viral infection might cause some forms of type1 diabetes is derived from studies where virus particles known to cause cytopathic orautoimmune damage to beta cells have been isolated from the pancreas. Several viruses Evaluation of efficacy of Twak churna in Madhumeha 32
  44. 44. Disease reviewhave been implicated, including mumps, Coxsackie B4, retrovirus, rubella (in utero) andEpstein-Barr virus.OBESITY Epidemiological studies provide evidence that type 2 diabetes is associated withovereating, especially when combined with obesity and underactivity. Obesity probablyacts as a diabetogenic factor.AGE Type 2 diabetes is principally a disease of the middle-aged and elderly. The riskof diabetes increases with age especially after 40 years mainly because the number ofbeta cells in the pancreas that produce insulin decreases as age advances.STRESS Stress may precipitate diabetes by stimulating the secretion of counter-regulatory hormones and possibly by modulating immune activity.DIET Circumstantial evidence supports the proposition that dietary factors mayinfluence the development of diabetes. Bovine serum albumin (BSA), a majorconstituent of cow’s milk, has been implicated in triggering type 1 diabetes, sincechildren who are given cow’s milk early in infancy are more likely to develop diabetesthan those who are breast feaded. Various nitrosamines (found in smoked and cuedmeat) and coffee have been proposed as potentially diabetogenic toxins. Sweet foodsrich in refined carbohydrate consumed frequently may increase the demand for insulinsecretion, while high fat foods may increase free fatty acids and exacerbate insulinresistance. Evaluation of efficacy of Twak churna in Madhumeha 33
  45. 45. Disease reviewPREGNANCYDuring normal pregnancy, insulin sensitivity is reduced through the action of placentalhormones and this affects glucose tolerance. The insulin-secreating cells of the pancreaticislets may be unable to meet this increased demand in women. Repeated pregnancy mayincreaswe the likelihood of developing irreversible diabetes, particularly in obesewomen; 80% of women with gestational diabetes ultimately develop permanentdiabetes116. Evaluation of efficacy of Twak churna in Madhumeha 34
  46. 46. ÌlÉSÉlÉEvaluation of efficacy of Twak churna in Madhumeha AmÉjrÉÌlÉÍqɨÉeÉÌlÉSÉlÉ xÉWûeÉ ÌlÉSÉlÉ oÉÏeÉSÉåwÉÉiÉ xÉÉqÉÉlrÉ ÌuÉzÉåwÉ AÉWûÉU uÉaÉï ÌuÉWûÉU uÉÉiÉeÉ ÌmɨÉeÉ MüTüeÉ kÉÉlrÉ qÉÉÇxÉ zÉÉUÏËUMü qÉÉlÉÍxÉMü ÍcÉliÉÉirÉÉaÉç zÉÉMü ÌSuÉÉxuÉmlÉ TüsÉ AurÉÉrÉÉqÉ urÉpÉÉcÉÉUÏ WåûiÉÑ mÉëÉkÉÉÌlÉMü Wåû iÉÑ WûÉUÏiÉ AÉxrÉÉxÉÑZÉ qÉŸ xuÉmlÉxÉÑZÉ Disease review ¤ÉÏU AÉsÉxrÉ AxÉÉiqÉåÎlSìrÉÉjÉï xÉÇrÉÉåaÉ mÉë¥ÉÉmÉUÉkÉ mÉËUhÉÉqÉ MÚüiÉÉ³É xÉÇzÉÉåkÉlÉ uÉeÉïlÉ Illustration no. 1. Schematic Representation of Nidana35
  47. 47. Disease reviewSAMPRAPTI VIVECHANA Samprapthi means the detailed description of all the morbid process that takesplace in different stages of the disease. That means it deals with the process of vitiationof doshas and their spreading pattern in the body with the manifestation of signs andsymptoms of the disease. Thus it is the entire pathogenesis, which takes place in thebody under the influence of etiological factors, till the manifestation of the disease.SAMANYA SAMPRAPTHI §ÉrÉÉhÉÉqÉåwÉÉÇ ÌlÉSÉlÉÉÌSÌuÉzÉåwÉÉhÉÉ Ç. . . . . . . . . . . . mÉëMÚüÌiÉÌuÉMÚüÌiÉpÉÔiÉiuÉÉiÉç || (cÉ.ÌlÉ.4/8) iÉxrÉ cÉæuÉmÉëuÉÚ¨ÉxrÉÉmÉËUmÉYuÉÉ LuÉ uÉÉiÉÌmɨÉzsÉåwqÉÉhÉÉå rÉSÉ qÉåSxÉÉ xÉWæûMüiuÉqÉÑmÉåirÉ qÉÔ§ÉuÉÉÌWûxÉëÉåiÉÉÇxrÉlÉÑxÉëirÉÉkÉÉå aÉiuÉÉ oÉxiÉåqÉÑZÉïqÉÉÍ´ÉirÉ ÌlÉÍpÉïkrÉliÉå iÉSÉ mÉëqÉåWûÉlÉç eÉlÉrÉÎliÉ || (xÉÑ.ÌlÉ. 6/4) aÉÑÃÎxlÉakÉÉqsÉsÉuÉhÉÉlrÉÌiÉqÉÉ§É . . . . . . . aÉiuÉÉ ¤ÉrÉqÉÉmrÉÉrrÉiÉå mÉÑlÉ: || (cÉ.xÉÑ.17/78-81) In ayurvedic classics samanya samprapthi explained for Prameha explains thesamprapthi of Madhumeha itself rather than samprapthi of other Pramehas. So, by takingreferences of Prameha samanya samprapthi117,118 and Madhumeha samprapthi followingpart has been discussed. Due to the nidana sevana kapha gets aggravated immediately among threedoshas according to Sushruthacharya the aggravated doshas will be inaparipakwavastha. For which Dalhana comments as “aparipakwa ama”aparipakwavastha or amavastha of doshas is caused because of doshagni andbhoothagni mandhya. Here aparipakwa kapha should be considered as bahudrava kapha Evaluation of efficacy of Twak churna in Madhumeha 36
  48. 48. Disease reviewfound because of shleshmagni and apyagni mandhya. As rasa is the ashrayasthana forkapha, this bahudrava kapha vitiates rasadhatu and travels all over the body because ofshareera shithilatha. As these contain more madhura bhava and as it spreads all over thebody “Thanumadhuryatha” is noticed. Here two reasons can be attributed for shareerashithilatha.1. Because of nidana sevana bahuabaddamedas will be formed. Due to this otheruttorottaradhatu will not be nourished properly and hence produces shareera shithilata.2. Another reason is that, in the normal state kapha is responsible for the sthiratha of thebody. But in pathogenesis of Madhumeha is due to the vikrutha bahu drava shleshma,shareershithlatha is seen. Further this vitiated bahudravakapha vitiates medas by causing themedodhatvagni mandhya. As a result bahuabaddamedas (asamhata medas) is formed. Inaddition to this, nidana sevana also causes bahuabaddamedas and along with thisKhavaigunyakaraka nidanas like beeja dosha or kulaja dosha, Sthoulya and otherPramehas are also can cause bahuabaddamedas. Since medovahasrothas is vitiated themoolasthana of medosrothas that is vapavahana (pancreas) will also get affected. Due tothe khavaigunya in medovahasrothas this bahudravakapha takes sthanasamshraya thereand doshadooshya sammurchana occurs between kapha and medas as they are havingsimilar qualities. These two obstructs the path of vata and vitiates it. This vitiated vatafurther takes bahu drava kapha to all other dooshyas (i.e. mamsa, shareerajakleda, shukra,shonitha, vasa, majja, lasika and oja) and vitiates them and further gets vitiated resultingin the accumulation of excess of kleda. This leads to the improper nourishment of allother uttarottara dhatus and as ojus is the sapthadhatusara is not nourished properly. Evaluation of efficacy of Twak churna in Madhumeha 37
  49. 49. Disease reviewAs ojus is also considered as shleshma, the bahudravashleshma with kleda is brought tothe mootravahasrothas. As kleda vahana is the function of mootra, excessive kleda alongwith ojus present in basthi (kidney) is evacuated out through mootra and thus producesMadhumeha.VISHESHA SAMPRAPTI Charaka and vagbhata have described the pathogenesis of madhumeha asseparate from prameha. Constant use of the specific nidana leads to augmentation ofpitta, kapha, meda and mamasa, which obstructs the vata in its route. This dearrangedvata carries ojus along and drives it down through the mootravaha srotas-giving rise tomadhumeha119.SAMPRAPTI GHATAK Dosha: Vata, Pitta, Kapha (Kapha in predominance) Dushya: All Dhatus including Ojas and Mutra (Meda is mainly affected) Srotas: Medovaha srotas and Mutravaha srotas Srotodustilaxshanam: Atipravrutti120PATHOGENESIS The three major defects, which determine the final metabolic profile in NIDDM,include:1. Inefficient glucose utilization by the peripheral tissues, mainly contributing topostprandial hyperglycemia.2. Impaired basal and stimulated insulin secretion from the beta cells.3. An increase in the endogenous hepatic glucose production and release, primarilyresponsible for fasting hyperglycemia121 . Evaluation of efficacy of Twak churna in Madhumeha 38
  50. 50. Disease review An increasing body of evidence suggests that an early abnormality in this disorderis hyperinsulinamia, which is associated with insulin resistance. Initially these patientsare similar to obese nondiabetic adults, in that they are hyperinsulinemic but usually havenormal or near normal glucose tolerance. In addition they frequently have higher thannormal plasma triglyceride levels. Some of them have an upper body (android) pattern offat distribution with increased intraabdominal fat, even if they are not grossly obese.Current thinking holds that such individuals go on to develop overt type II Diabetes,hypertension, certain dyslipidemias, and premature atherosclerotic vascular disease,singly or in combination depending on their genetic makeup and environmental factorsuch as diet and physical activity. Type II Diabetes appears to develop in patients with acquired (diet or obesityrelated) and genetically programmed insulin resistance when the pancreatic beta cells areno longer able to produce extra insulin to counter the effect of resistance. Descriptively three phases can be recognized in the usual clinical sequence:In phase I, glucose levels are normal but only because hyperinsulinemia compensates forthe insulin resistance in muscle, liver and possibly other tissues.In phase II, insulin levels are somewhat diminished but are generally still higher than inindividuals of normal weight who are not diabetic. On the other hand the insulin levels inphase II are no longer sufficient to enhance glucose utilization by muscle and or restricthepatic glucose production and postprandial glucose levels are increased as a result. Finally, in phase III, plasma insulin levels fall even further and as a resulthyperglycemia occurs both in the fed and fasted states. Evaluation of efficacy of Twak churna in Madhumeha 39
  51. 51. Disease reviewThe inability of the beta cell to indefinitely secrete insulin at a higher rate may thereforedetermine those who ultimately develop type II Diabetes. One would predict from theabove statements that therapies designed to diminish insulin resistance and lessen thestress on beta cell (diet and regular exercise) would prevent or at least retard developmentof type 2 diabetes.INSULIN RESISTANCE Insulin resistance is a cardinal feature of NIDDM. The most common andimportant of insulin resistance is obesity. Yet little is known about the underlyingmechanism. The central pattern of fat distribution with its increased waist/hip ratio isassociated with more insulin resistance than in the peripheral pattern of distribution inwhich fat is more plentiful in the buttock and upper leg areas. This is an important issue,because individual with central pattern are more likely to have glucose tolerance. Themechanism through which central obesity causes insulin resistance is unknown, but onehypothesis suggests that release of free fatty acids by omental fat into the portalcirculation enhances gluconeogenesis and interferes with insulin action on the liver122.AETIOLOGICAL CLASSIFICATION OF DIABETES MELLITUSType 1 diabetes Immune-mediated IdiopathicType 2 diabetes Evaluation of efficacy of Twak churna in Madhumeha 40
  52. 52. Disease reviewOther specific types Genetic defects of beta cell function Genetic defects of insulin function Pancreatic disease (pancreatitis, pancreatectomy, neoplastic disease, cystic fibrosis etc.) Excess endogenous production of hormonal antagonists to insulin (growth hormone, glucocorticoids, glucagons, thyroid hormones) Drug induced (corticosteroids, thiazide diuretics, phenytoin) Viral infections (congenital rubella, mumps, Coxsackie B4) Associated with genetic syndromes (Down’s syndrome, Klinefelter’s syndrome, Turner’s syndrome) Gestational diabetes123. Evaluation of efficacy of Twak churna in Madhumeha 41
  53. 53. MüTüMüU AÉWûÉU ÌuÉWûÉU (AmÉjrÉÌlÉÍqɨÉeÉ)Evaluation of efficacy of Twak churna in Madhumeha uÉÉrÉÑ qÉÉaÉÉïuÉUhÉ zsÉåwqÉÉSÒ̹ & uÉÉiÉuÉ×ή uÉmÉÉuÉWûlÉ SÒ̹ oÉWÒûAoÉ®qÉÉÇxÉqÉåSxÉ AÉååeÉÉå AmÉËUmÉYuÉ zÉUÏU YsÉåSuÉ×ή kÉÉiÉÑ AÎalÉqÉÉDZ oÉÎxiÉ oÉÏeÉSÉåwÉÉiÉç (xÉWûeÉ) qÉ賈 kÉÉiÉѤÉrÉ qÉkÉÑqÉåW Disease review Illustration no. 2. Schematic Representation of qÉkÉÑqÉåWû xÉqmÉëÉÎmiÉ42
  54. 54. Disease reviewPOORVAROOPA VIVECHANA Poorvaroopas are a set of mild symptoms signaling the arrival of a ratherunwelcome guest. They are the manifestations of the Sthana samshrayavastha. Thephysician and the patient are both lucky if they happen to come across each otherduring Poorvaroopa avastha. The disease is Durbala and can be repulsed easily.Madhumeha essentially presents with Poorvaroopas before manifesting the Pratyatmalakshana & therefore they serve as an essential tool for differentiating Madhumehafrom other disease like Raktapitta. Brihatrayees have mentioned a comprehensive set ofPoorvaroopas. xuÉåSÉåÅ….lkÉ: ÍzÉÍjÉsÉÉ….iÉÉ cÉ zÉrrÉÉxÉlÉxuÉmlÉxÉÑZÉå UÌiÉ¶É | ¾è³Éå§ÉÎeÉÀûÉ´ÉuÉhÉÉåmÉSåWûÉå bÉlÉÉ….iÉÉ MåüzÉlÉZÉÉÌiÉuÉÚή: || zÉÏiÉÌmÉërÉiuÉÇ aÉsÉiÉÉsÉÑzÉÉåwÉÉå qÉÉkÉÑrÉïqÉÉxrÉå MüUmÉÉSSÉWû: | pÉÌuÉwrÉiÉÉå qÉåWûaÉSxrÉ ÂmÉÇ qÉÔ§ÉåÅÍpÉkÉÉuÉÎliÉ ÌmÉmÉÏÍsÉMüÉ¶É || (cÉ.ÍcÉ. 6/13, 14) WûxiÉmÉÉSiÉsÉSÉWèû: ÎxlÉakÉÌmÉÎcNûsÉaÉÑÂiÉÉ aÉɧÉÉhÉÉÇ qÉkÉÑUzÉÑYsÉqÉÔ§ÉiÉÉ iÉlSìÉ xÉÉS: ÌmÉmÉÉxÉÉ SÒaÉïlkÉ¶É μÉÉxÉxiÉÉsÉÑaÉsÉÎeÉÀûÉSliÉåwÉÑ qÉsÉÉåimĘ́ÉeÉïÌOûsÉÏpÉÉuÉ: MåüzÉÉlÉÉÇ uÉÚή lÉZÉÉlÉÉqÉç || (xÉÑ.ÌlÉ. 6/5) Evaluation of efficacy of Twak churna in Madhumeha 43
  55. 55. Disease reviewTable 6: Showing poorvaroopa according to different Brihatrayees Sl. No. Poorvaroopa Charaka124 Sushruta125 1 xuÉåS + - 2 AÇ….aÉÇlkÉ + + 3 AÇ….zÉæÍjÉsrÉ + - 4 AÇ….xÉÉS - + 5 zÉrrÉÉxÉÑZÉÇ + - 6 xuÉmlÉxÉÑZÉÇ + - 7 AÉxÉlÉxÉÑZÉÇ + - 8 ¾èSrÉÉåmÉSåWû + - 9 lÉå§ÉÉåmÉSåWû + - 10 ÎeÉÀûÉåmÉSåWû + + 11 ´ÉuÉhÉÉåmÉSåWû + - 12 iÉÉsÉÑaÉsÉ qÉsÉÉåimÉÌ¨É - + 13 SliÉåwÉÑ qÉsÉÉåimÉÌ¨É - + 14 bÉlÉÉ….iÉÉ + - 15 MåüzÉÉÌiÉuÉÚή + - 16 MåüzÉ eÉÌOûsÉpÉÉuÉ + + 17 lÉZÉÉÌiÉuÉÚή + + 18 zÉÏiÉÌmÉërÉiuÉÇ + - 19 aÉsÉzÉÉåwÉ + - 20 iÉÉsÉÑzÉÉåwÉ + - 21 AÉxrÉÉqÉÉkÉÑrÉï + - 22 MüUSÉWû + + 23 mÉÉSSÉWû + + 24 qÉÔ§ÉÌmÉmÉÏÍsÉMüÉÍpÉxÉUhÉ + - 25 qÉkÉÑU qÉÔ§ÉiÉÉ - + Evaluation of efficacy of Twak churna in Madhumeha 44
  56. 56. Disease review 26 zÉÑYsÉ qÉÔ§ÉiÉÉ - + 27 ÎxlÉakÉaÉɧÉiÉÉ - + 28 ÌmÉÎcNûsÉaÉɧÉiÉÉ - + 29 aÉÑÂaÉɧÉiÉÉ - + 30 ÌmÉmÉÉxÉÉ + + 31 μÉÉxÉSÉæaÉïlkrÉ - + 32 iÉlSìÉ + + 33 MüUxÉÑmiÉiÉÉ + - 34 mÉÉSxÉÑmiÉiÉÉ + - 35 AÇ…ûxÉÑmiÉiÉÉ + - 36 AÉsÉxrÉ + - 37 qÉÑZÉzÉÉåwÉ + - 38 xÉuÉïMüÉsÉåÌlÉSìÉ + -ROOPA VIVECHANA Under the heading roopa the signs and symptoms produced in individuals as aresult of sequential changes in the disease process can be studied. The signs andsymptoms of a disease will be produced in the fifth stage of samprapthi i.e. vyaktavasta.In this stage doshadooshya sammurchana will be capable to produce its lakshanas. iɧÉÉÌuÉsÉmÉëpÉÔiÉqÉÔ§ÉsɤÉhÉÉ: xÉuÉï LuÉ mÉëqÉåWûÉ: || (xÉÑ.ÌlÉ. 6/6) xÉÉqÉÉlrÉÇ sɤÉhÉÇ iÉåwÉÉÇ mÉëpÉÔiÉÉÌuÉsÉqÉÔ§ÉiÉÉ | SÉåwÉSÕwrÉÉÌuÉzÉåwÉåÅÌmÉ iÉixÉÇrÉÉåaÉÌuÉzÉåwÉiÉ: || qÉÔ§ÉuÉhÉÉÌSpÉåSålÉ pÉåSÉå qÉåWåûwÉÑ MüsmiÉå | (qÉÉ.ÌlÉ. 33/6) Evaluation of efficacy of Twak churna in Madhumeha 45
  57. 57. Disease review In ayurveda only mootra sambhandhi lakshanas are mentioned for Madhumeha.But samanya lakshanas of Prameha126,127 and also lakshanas of apathyanimittajaPrameha128 are also can be included under lakshanas of Madhumeha.SAMANYA LAKSHANAPrabhootha mootrata Increase in quantity and frequency of mootra is considered as prabhoothamootrata. Due to the apyagni vyapara vikruthi, kleda will get increased in the body andcollects in the basthi. As kledavahana is the function of mootra, excess of kleda in thebasthi will be excreted through mootra frequently by vitiated vata. So, prabhoothamootrata in terms of quantity and frequency is seen in Madhumeha.Avila mootrata Has been described as Samala mootra or Atyartha kalushita mootra, which means,there is an abnormality in the density and turbidity of urine129.VISHISTA LAKSHANAS MüwÉÉrÉÇqÉkÉÑUÇ mÉÉhQÒÇû ¤ÉÇ qÉåWûÌiÉ rÉÉå lÉU: | uÉÉiÉMüÉåmÉÉSxÉÉkrÉÇ iÉÇ mÉëiÉÏrÉÉlqÉkÉÑqÉåÌWûlÉqÉç || (cÉ.ÌlÉ. 4/44)Madhusama mootra: Varna, gandha, rasa of mootra will be similar to that of madhu. Itis due to the ojonissarana in mootra.Kashaya: Bhavamishra interprets it as kashaya varna, which cannot be elicited clinically.Madhura mootra: It is also because of excretion of ojus in mootra. Earlier they used todetect this by pipeelikas. Nowadays by urine examination one can understand mootramadhuryata.Rooksha: Due to vitiation of vata one can notice rookshata. Evaluation of efficacy of Twak churna in Madhumeha 46

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