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A Clinical Study of the Effect of Somarajyadi Churnam In the Management of Prameha, G.KAVITHA REDDY, Department of Kayachikitsa, PG unit Dr.BRKR Govt. Ayurvedic College, HYDERABAD

A Clinical Study of the Effect of Somarajyadi Churnam In the Management of Prameha, G.KAVITHA REDDY, Department of Kayachikitsa, PG unit Dr.BRKR Govt. Ayurvedic College, HYDERABAD

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  • 1. A Clinical Study of the Effect of Somarajyadi Churnam In the Management of Prameha. THESIS SUBMITTED IN PARTIAL FULFILMENT FOR THE DEGREE OF Doctor Of Medicine (Ayurveda) By G.KAVITHA REDDY B.A.M.S Under the Guidence of Dr.V.VIJAYA BABU M.D.(Ay) Reader/Professor K.C Post Graduate Dept of Kayachikitsa. Co-Guide Dr.Vijaya Lakshmi M.D (Ay) Gaz.Lecturer Dept.of K.C. DEPARMENT OF KAYACHIKITSA POST GRADUATE UNIT GOVERNMENT AYURVEDIC COLLEGE Osmania University,Hyderabad-A.P.India.created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 2. CONTENTS Contents Page Nos. I Introduction Historical background of DiseaseII ShareeramIII The Disease 1) Nidana 2) Poorvaropa 3) Roopam 4) Classification of Disease 5) Samprapti 6) Upadravas & Aristalakshanas 7) Sadhyaasadhyata & Sapeksha nidana 8) Chikitsa and PathyaapathyaIV The Drug and its SelectionV Clinical Study 1) Method and Material 2) Observation and ResultsVI Discussion Conclusion Summary Bibliography Case Sheetcreated by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 3. Dr.N.T.R.UNIVERSITY OF HEALTH SCIENCES Vijayawada POST GRADUATE TRAINING & RESEARCH UNIT DEPARTMENT OF KAYA CHIKITSA Dr.B.R.K.R.Govt.Ayurvedic College / Hospital Hyderabad. CERTIFICATE This is to certify that Dr. KAVITHA REDDY, a final year Post Graduate Scholar ofM.D.(Ay) Kaya Chikitsa of this institute has worked for the thesis on the topic “A clinicalstudy on the effect of Somarajyadi Churnam in the Management of Prameha” for thedegree of Doctor of Medicine (Ayurveda). This work has been completed under my directsupervision after a series of scientific discussions. The scholar has put in commendable effort for designing and executing the methodsand plans for the study. Hence I recommend this dissertation to be submitted for adjudication.Signature of the Co-guide Signature of the GuideDR.K.VIJAYA LAXMI DR. V.VIJAYA BABU M.D.(Ayu) M.D.(Ay) Lecturer Reader Post Graduate Dept. of Kaya Chikitsa Dr.B.R.K.R.Govt.Ayurvedic College Hyderabad created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 4. Dr.N.T.R.UNIVERSITY OF HEALTH SCIENCES Vijayawada POST GRADUATE TRAINING & RESEARCH UNIT DEPARTMENT OF KAYA CHIKITSA Dr.B.R.K.R.Govt.Ayurvedic College / Hospital Hyderabad. CERTIFICATE This is to certify that Dr. KAVITHA REDDY, a final year Post Graduate Scholar ofM.D.(Ay) Kaya Chikitsa of this institute has worked for the thesis on the topic “A clinicalstudy on the effect of Somarajyadi Churnam in the Management of Prameha” as perrequirements of the order laid by the N.T.R.University of Health Sciences, for the purpose.The Hypothesis submitted by her in the First year M.D. (Ay) is one and the same to that ofthe dissertation submitted. I am fully satisfied with her work and hereby forward the dissertation for theevaluation of the adjudicators. Dr. PRAKASH CHANDERDate: M.D.(Ay)Place: Hyderabad. Professor & H.O.D Post Graduate Dept. of Kaya Chikitsa Dr.B.R.K.R.Govt. Ayurvedic College Hyderabad. created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 5. A CLINICAL STUDY OF THE EFFECT OFSOMARAJYADI CHURNAM IN THE MANAGEMENT OF PRAMEHA Dissertation submitted in partial fulfillment for the degree of DOCTOR OF MEDICINE (AYURVEDA) In KAYACHIKITSA By Dr. KAVITHA REDDY B.A.M.S GUIDE Dr. V.VIJAYA BABU M.D.(Ay) Reader Post Graduate Department of Kayachikitsa Dr. B.R.K.R.Govt.Ayurvedic College Hyderabad. Dr. N.T.R.UNIVERSITY OF HEALTH SCIENCES VIJAYAWADA Dr.B.R.K.R.Govt. Ayurvedic College, HYDERABAD. 2008created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 6. ACKNOWLEDGEMENTSAt the unforgettable moment, I prostrate my head on the feet of our aradhyadevaLAKSHMI NARASIMHA SWAMY for deputing me to serve the man kind.I take atmost pleasure and feel privileged to express my deep sense of gratitude andextreme and Indebtedness to my guru and guide Dr V. VIJAYA BABU M.D(Ayu),Reader, Post Graduate Dept. of Kayachikitsa, Dr B.R.K.R Govt Ayurvediccollege,Hyderabad. for his constant and valuable guidance, encouragement throughoutthe dissertation work and with thought provoking discussions, undoubtedly correct,affectionate and untiring guidance of my guru has been a greatest asset in completion.I expresss my heartful gratitude to Dr.PRAKASH CHANDER, M.D(Ayu), Professor andHead of the Dept, P.G Dept. of Kayachitsta, Dr.B.R.K.R Govt Ayurvediccollege,Hyderabad. For his constant support, guidance, encouragement and kind cooperation in all aspects.I am highly indebted to Dr. K.VIJAYA LAKSHMI for her valuable suggestions, being aco-guide.I take this opportunity to express my sincere thanks to Dr. Nageswer Babu, Dr.MRamalingeswar Rao, Dr.Vasudeva Rao, Dr. M.L Naidu, Dr.M.Satya Prasad and technicalassisatants Post Graduate Dept of Kayachikitsa,For their kind co-operation in my clinicalwork.I pay my sincere respect to Dr.M Sadasiva Rao Principal of Dr B.R.K.R Govt Ayurvediccollege,Hyderabad.for providing facilities for the research work.I am greatful to the Ex -Superintendent Dr L.R. K Murhty Govt Ayurvedic hospital, DrB.R.K.R Govt Ayurvedic college,Hyderabad. for their kind co-operation.I am thankful to Dr.V.L.N Sastry, Superintendent, Ayurvedichospital,Erragadda,Hyderabad for permitting me to conduct research work in the hospital.created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 7. I am highly thankful to Dr. Ananthasayanachari,HOD of P.G Dept. of SSP andDr.M.Philip Anandkumar, HOD of P.G Dept of Dravyaguna for their kindly co-opearttion.I cordially Acknowldge my friends and collegues Dr D.Usha Madhuri, Dr.Alibasha,Dr,Sreenivas Rao, Dr,.Nanda Kumar, Dr.Sivanarayana,Dr.Jaya Lakshmi,Dr.Lavanya, DrPadmaja and otheres who helped me in one way or other in completing this work.I thank to Mr Ramalingeswar Rao for typing this work type neatly.I thank to Mr Surendra Nath who helped me in statistic analysis.I express my special to thanks to K.Subba Reddy for contious co-operation andencoragemnt and concern and care.I pay homage to my beloved father Mr G.Sidda Reddy and Mrs G.Santhamma.& my beloved brother Mr. G .Bhanu prakash Reddy their incessant love and blessingswas constant driving force behind my progress.I am highly greatful to the authors of all the books and articles which have been utilizedby me as the source of information in the preparation of this thesis.Lastly I am thankful to all my patients of trial drug and all those persons, who havehelped me directly or indirectly for the project work.Date:Place: Hyderbad. Dr. Kavitha Reddycreated by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 8. INTRODUCTIONAyurveda is a science of life. This is most auspicious and scared of all sciences.It isoriginated from Atharva Veda.The Rig and Yajurveda also hold substantial role ofAyurveda. The word Ayurveda has not seen as such in the Vedas but a considerableportions of the Vedas is devoted for the promotion of long life, prevention of disease andto medical treatment thSince 19 centuary there has been noted progress in the Indian medicine. Currentlyprameha is considered to be due to metabolic disturbance and insulin, Ayurveda hasrequired an important place in the competitive world along with other branches ofmedicine by the special knowledge and modes of treatment of Madhumeha.Madhumeha is more or less found in all countries. However the incidence is more in thepersons addicted to unwholesome diet and action. A large population of the worldspecially persons of Asian subcontinent are afflicted by the disease.Diabetes was known to ancient Indians as early as 6th centuary2 .Charaka in his Charakasamhita has mentioned the sweetness of urine in addition to polturia.3 He collectedmaterial from much earlier workers of Agnivesha who based his writing on the teachings thof Atreya who lived in the 6 centuary B.C4.The Indian physician Susrutha in 500 A.Ddescribed the disease as Madhumeha with symptoms of foul breath, voracious appetiteand languor,besides Charaka and Susrutha samhitas. Other early Indian example:AstangaHrudaya, Bhavaprakasha, Madhava nidana ,Sarangadhara samhita etc. have alsodescribed Madhumeha as Diabetes.The Indian indigenous agents can be divided into groups according totheir source oforigin viz. vegetable or herbal and mineral preparations. Vegetable or herbal agentsadministered as “swarasa” “kwatha” “churna” “asavas” and “aristas” constitute themajority of Indian indigenous anti diabeticdrugs. Mineral preparation is given as“bhasmas” are comparatively fewer. The bulk of information on this indigenous drugs iscreated by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 9. scatered in fragments with many individuals and in age old books and manuscriptswhich are some time out of print.However a few books examples:- Vaman GaneshDesai’s Aushadi sangrah5, Nadkarnis Materia medica6,7 and Chopras indigenous drugsof India8 and some reviews of Mukerjee9,Ajgonkar10, Chowhan and Sen11 have givensome comprehensive lists of such drugs are claimed to be useful in Diabetes.A middle aged person, who is apparently normal, may start complaining of weakness,excessive urination during nights and increase of hunger. Unless these complaints arevoiced by the patients, it is difficult to notice that the person is suffering from disease. Ona through investigation, the person is diagnosed as suffering from Diabetes mellitus(Madhumeha). Generally Madhumeha is known as a “richmans disease” particularlybecause a person who is able to enjoy the pleasure of life (over nutrition) without anyperceptible exercise is usually affected with this disease. The importance of over nutritionis shown by the fact that over the age of 40, some 80% of the patients developingdiabetes are, have been considerably overweight. The question is relevant that “Everyexcess causes a defect, every defect an excess”12. Broadly speaking both the incidenceand mortality of diabetes after middle age vary directly with the degree of obesity.Madhumeha is achronic disease of relapsing nature13. The disease is also a debilitatingone. The treatment for the disease, at present, in modern science is based on theadditional supply of insulin, which is very disadvantageous to a patient to be continuedindefinetly. Researches are being conducted throughout the world to find permanent curefor this disease. The efficacy of the Ayurvedic treatment has to be scientificallyinvestigated thoroughly.Accordingly care has been taken not only to select a compound drug and simple yogafrom those prescribed for the disease in the sastra, but also to select and easily availabledrugs and a yoga which is easy to prepare and administer. The drug selected thus is“Somarajyadi churnam” and the yoga selected constitute of Bakuchi ,Avarthaki,Madhunashini, Sunti. It is anubhuta yoga. These drugs collective have got Madhumehahara property and also kapha medohara gunas.created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 10. Thus ,the aim and scope of the present work has been limited, 1. To a clinical study on prameha/ Madhumeha and, 2. To a clinical study of the effect of Somarajyadi churnam in the management of prameha. The disease , the drug and the clinical study are discussed in forth coming pages. REFERENCES1. CHARAKA SUTRASTANA 30-21SUSRUTHA SUTRASTANA 1-8ANTISEPTIC 57:221 AND 285 1980 BY CHOWHAN &SEN3.CHARAKA SAMHITA 1940 EDI. P. 675 SRI GULAB KUNVERABA4.WORLD CONGRESS ON DIABETES IN THE TROPICS, BOMBAY20TH &22ND JAN.1966 MADHUMEHA 6:289,19665.NAGARJUNA, CALCUTTA 4:275 19606.INDIAN MATERIAMEDICA VOL.I 548 POPULAR BOOK COMPANY,BOMBAY, 1954. RD7. INDIAN MATERIA MEDICA VOL.I 3 EDI.239,344 POPULAR BOOKCOMPANY, BOMBAY, 19548. CHOPRAS INDIGENOUS DRUGS OF INDIA 2 ND ED.P.505,604 ,673 UNDHERAND SONS PRIVATE LTD.CALCUTTA 19589. JOURNAL OF SCIENCE IN INDIAN MEDICINE REVIEW 10 A SUPPLEMENT1957-110. NAGARJUNA, CALCUTTA 4:275,196011. NAGARJUNA CALCUTTA 12. ANTISEPTIC57:221,285,196012. R.W.EMERSON13.CHARAKA SUTRASTANA 23/3-4created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 11. HISTORY Study of sequential evolution is primestep in research field. Study of history isimportant to know about the systematic development and progress of the subject todetermine the future plans for further establishment and research designing. Here presentreview related to prameha is explained. The evolution of Madhumeha can be traced from Vedas but in rudimentary form,when we go through the Athrvaveda there is a reference related to the disease ‘Asrava 1’along with its management. Sayanacharya opined that asrava means ‘Mutraatisara’ theEnglish translator Whitney (1962) interpreted it has Fulx and Griffith (1962) asmorbidflow, while layman has translated the meaning of asrava as Diabetes mellitus 2Sayanacharya highlighted the vatic nature of this ailment.A)Samhita period :- Explorative discretion of disease Madhumeha occurs atsamhitaperiod .1)Charaka samhita:- In this ancient treatise of medical science, charaka explained theetiology, pathogeness, symptomatology, complications and treatment modalites in detailin Nidana 4th and chikitsa 6th chapter. While in sutra sthana 17th chapter he described the 3avaranajanya pathogenesis of Madhumeha, this is the unique contribution of this treatise.2)Susruta samhita:- Susruta also explained Prameha in elaborative manner with separatechapter on its management. He used ‘Kshoudrameha’ synonym to Madhumeha in nidana6th chapter. He typically mentioned the kashayas according to each type of prameha andmentioned the body constitution and symptoms related to sahaja and apathyanimittajaprameha.3)Astangahridaya:- Detail description about the disease is given as in charaka andsusrutasamhatas with slight moderations. He added some new herbs and herbalcompounds as well as rasausadhis for the treatment.created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 12. 4)Harita samhita:- Harita mentioned it as papajanya and enumerated 13 types ofprameha with nomenclature different than above treatise like, puyameha, ghritameha etc.5)Bhela samhita:- He described prameha is of two types i.e svakrita and prakritameha4 .6)Kashyapa samhita:- He mentioned the symptoms of prameha child in vedanadhyanaand noted the disease as chirakari.B) Medievalperiod:- In this period commentaries mainly written, but most of themcontains only the collection of thoughts from previous authors.1)Madhavanidana:- He collectively repeated the description of charaka, susruta and rdvagbhata in 33 chapter.2)Gayadasa:- Explained the avilamutrata because of the presence of dooshya in it.3)Sarangadhara samhita:- Only mentioned the 20 types of prameha in prathama khanda7th chapter.4)Bhavaprakasha:- He described prameha and Madhumeha along with some newherbomineral preparations in madhyama khanda 38th chapter.5)Yogaratnakara:- Explained prameha and Madhumeha along with treatment.created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 13. Historical MilestonesYEAR SCIENTIST INVESTIGATION1500BC Eberuspapyrus Clinical description of disease.600BC Charaka Clinical description and noted sweetness in urine and roll of heredity.400BC Susruta Just as charakaBC30-38 Celsus(Greece) Clinical description.AD30-90 Aretaus(Greece) Name Diabetes was introduced which means run through.132-201AD Galen Introduced the term the diarrhoea of the urine.860-932AD Rohozes(Percia) Noted sweetness in urine and given clinical description.980-1038 Avicenna(Arab) Noted sweetness in urine and given clinical description.1135-1204 Smosesmaimomies Noted its prevalence in hot countries. (Moraco)1478-1555 Jaques Dubois Evoparated the specimen of urine of a sylvanus(philppines) diabetic patient and discovered a residue which was almost glucose.1511-1568 Arnatusluritanus Outlines dietery regulation for diabetes.1514-1644 Johanu Baptista Van Given first description of lipomia. Helmant(Belgian)1621-1699 Willis Thomas(Great Started treatment for D.M First. Britain)1637-1698 Mortan Richard(Britain) Roll of heredity in diabetes was observed.1653-1727 Brunner J.C(Swiss) Removal of pancreas causes thurst and polyuria.created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 14. 1712-1790 Gellura William(Great First to add mellitus to diabetes. Britain)1745-1821 Johanu Peth First to Separate Diabetes insipidus Frank(German) from diabetes mellitus.1788 Cawles(English) Described pathology of pancreas of diabetes.1858-1944 Vonnoorden evienna Belived that liver plays a role in diabetes.1869 Langerhan paul(Greek) Discovery of pancreatic islets.1870 Claude Bernard(France) Noted sugar storage in liver as glucagan and elevated sugar levels in blood in diabetic patients.1874 Kassmaul(German) First described over breathing in diabetic acidosis.1889 Von meing & Development of diabetes of after ninkovaski(German) removal of pancreas.1985 Nonmeyn(German) Hereditary diabetes and its distribution between juvenile and late onset of diabetes.1900 Opic, Observed islet lesions in D.M Weicuselbalen(American)1909 Demeyer Hypothetical view for harmone of is islets named insulin.1910-1920 Zulger(German) Insulin was almost discovered. Paulaski(Rumania)1921-1922 Banting and Best(Caneda) Insulin was discovered from dogs and pancreas.1923 Hoursay(Argentina) Lessening of pancreatic diabetes by hypophysectomy.1936 Longlukens(U.S.A) Lessening of pancreatic diabetes bycreated by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 15. adrenalectomi in cats.1970 onwards Merwin gliedman and Transplant of pancreas, culture of others isletscells of pancreas, transplant of B cells.1974-1975 Liebel-Selden(Canada) Artificial pancreas.References:-1.Ayurveda Itihas by Dr.P.V.Sharma2.History of Diabetes from remote to recent times by Dr.K.Raghunathan.3.Charaka Nidana 8/114.Bhelasamhita Nidana 6/1-4created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 16. Shareeram SHAREERAM The word pancreas means pan-all, kreas-fresh. It is a both exocrine & endocrine gland. It lies transversely across the exterior abdominal wall, behind the stomach, from duodenum to the spleen at the level of L1 & L2 vetebra. It is J-shaped. Measurements:- Length 6-8inches Breadth – 1- ½” Thickness – ½ - ¾” weight – 90gm1. Diabets mellitus is a chronic disease due to disordered carbohydrate metabolism and it results due to deficiency of insulin secreted by the Beta cells of islets of Langerhans of pancreas. But hormones of pituitary and adrenal glands are also intimately related to the development of disease state.2. So the involvement of organs in Diabetes are 1) Pituitary gland 2) Pancreas 3) Adrenal gland 4) Liver PANCREAS  The pancreas is a compound alveolargland. It has got both exocrine & endocrine function. During development pancreas lies in the mesoduodenum following the rotation & ultimate fixation of the gut the pancreas comes to lie against the posterior abdominal wall behind peritoneum.  The adult pancreas consists of the Head, neck, body & tail. The whole organ is about 15cm long with right margin of the head is in contact with the descending part of the duodenum & tail in contact with the spleen.  The head of the pancreas which is flattened from before backwards from an irregularly shaped disc which is thicker than the remainder & lies within the C shaped duodenal loop at the level of 2nd lumbar vertebrae.  The part of the head which extend to the left behind the superior mesenteric vessel is known as uncinate Process. The constricted portion or neck connects the head & body of the pancreas. The neck lies infront of the beginning of portal vein. 1 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 17. Shareeram The body is at first flattened back soon becomes some prismatic in shape with posteriosuperior and inferior surface and is continued into the tail which is in contact with spleen. Anteriorly the body of the pancreas in continued by peritoneum except along the live of reflexion of mesocolon at the border separating the superior and inferior surfaces. The superior surface of body and tail is covered by the peritoneum of posterior wall of the lessersac and is related to the stomach. The tip of the tail of pancreas is the only part of the whole organ to be completely surrounded by peritoneum The pancreas is deeply seated within the abdominal cavity. The normal pancreas is not palpable. Ducts of Pancreas The exocrine secretion of pancreas are discharged into the duodenum through the pancreatic duct. It commences at the tail of the organ by the union of small ducts in its course towards the duodenum. It receives numerous tributaries the ducts from lobules. The duct termination by giving the bileduct at the hepatopancreatic ampulla. Microscopic structure:- The exocrine portion of pancreas consists of acini grouped into lobules. The exocrine pancreas made up of isolated group of cells the islets of langerhans. The terminal acini may be tubular in form or rounded. The acini are lined with pyramidal epithelial cells which rest on a basement membrane and project toward the lumen of the acinus. The size of the lumen varies with the functional activities of the acini. During the secretory pahse granules accumulate in the cells which enlarge and encroach on the lumen. Several acini join on intercalated duct lined with cuboidal epithelium. Endocrine portion (Islets of langerhans) It is an endocrine organ which exert a profound effect on carbohydrate metabolism. 2 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 18. Shareeram The exocrine cells of pancreas are aggregated into small discrete collection of cells of which there are between one and 2 millions. Scattered either between acini, between acini & ductules or in interlobular connective tissue in all parts of pancreas. These cells groups are usually referred as the islets of langerhans. The islets are composed of aggregation of epithelial cells associated with capillary blood vessels. A thin peripheral connective tissue capsule separates the cells from adjacent exocrine tissue & fine connective tissue extends into the islets along blood vessels. In endocrine portion 4 cells are present 1) cells 2) cells 3) cells 4) F cells cells synthesise and secrete glucogon and cells produce insulin and D cells have been linked with either gastrin or secretin production. F cells secretes pancreatic polypeptide (PP) The first harmone to be identified as a product of the islet was insulin. Subsequently glucagon and gastrin have been identified. The endocrine pancreas consists of 0.7 – 1 million small endocrine glands – islets of langerhans – scattered within the glandular substance of the exocrine pancreas. The islet volume comprises 1-1.5% of the total mass of the pancreas and weighs about 1-2g in adult humans. F cells which secretes pancreatic polypeptide has been formed primarly in islets in the posterior portion of the head a discrete lobe of the pancreas separated from the anterior portion by a facial partition. The posteriorlobe receives its blood supply from the superior mesenteric artery, the remainder of the pancreas derives most of its blood flow from the celiac artery. 3 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 19. Shareeram Islets in the posterior lobe area consists of 80-85% F cells 15-20% cells,lessthan 0.5% glucagon producing A cells. The F cell volume varies with age and sex. The volume tends to be larger in men and in older persons. In contrast to the posterior lobe, the pp-poor islets located in the tail, arising from embryonic dorsalbud, contain predominantly insulin secreting betacells with approximately 20% of the cells being glucagon secreting A cells and about 3-5% D cells that produce somatostatin. Islet Vascularisation: The islets are richly vascularised, receiving 5-10 times the blood flow of a comparable portion of exocrine pancreatic tissues. The direction of the blood flow within the islet has been postulated to play a role in carrying insulin secreted from the antral region of an islet to its peripheralzone – where the insulin modulates and decreases glucagon release from A cells, which are mainly located on the periphery of islets. 4 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 20. Shareeram AGNI & ITS IMPORTANCE IN MADHUMEHA The definition of Kayachikista itself is a treatment to agni but not a disease. “Kayasya antaragne chikista kayachikista”Normal state of agni gives health & abnormal state of agni itself is a factor for all NijaVyadhis, hence one should protect agni very carefully. Ayurveda has given much importance to agni in the treatment of diseases, Ahara &Bhesaja both should be advised based on agnibala of that person. Aharapachana has been described in Avasthapaka indicating the stages through foodsubstances in the amasaya & Pakwasaya pass in the course of digestive process.1(Digestion & Metabolism – Dwarakanath Page.53) Avasthapaka is divided into two stages. Viz Prapaka has been defined by chakrapanias Pradhamapaka2 (cha–chi 15/9). The term vipaka meaning is the change to which the foodhas undergone. Pradhamaka is again subject to the influence of Jataragni. Prapaka is mainly related with the food stuff where as vipaka relates to the action ofJataragni on the drugs. Vipaka is three types: Madhura, Amla, Katu3 (A.H.Su 9/20) The Prapaka commenses from the time of the food is introduced into Mouth. ThePranavata main function has the aharagrahana and propels the food in to the Urdwaamasaya.4 (cha-chi 15/6) The tridoshas takes place in the digestion of food. If the digestion period is dividedinto 3 parts, the first part is having the predominance of Kapha, the second part ispredominance with pitta, and in the third the vata. Therefore the digestion of food orAharapachana is divided into 3 stages.5 (A.Hri.Su.1/8)Madhurabhava Avastha (1st Phase):- Even though the ingested food contains the 6 Rasas, the first stage of Pachana isMadhurapaka6 (Su.su–6/1.4) Just after ingestion of the food being digested in the amasayaattains first the MadhuraRasa and then leads to the formation of Kapha, which is phenila in 5 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 21. Shareeramappearance7 and the food that is propelled into amasaya mixes with drava.which is presentin this organ is doing bhinnasanghatam. 8(i.e the food is broken down and softened)Role of Kledakakapha:-Kledaka kapha is stated to be located in Amasaya. Its function is to moisterise food broughtto this site, disintegrates, breaks & liquefies9 (chakrapani on cha.su 20/8). Kledakakaphaprotects the amasaya from being digested by the pitta which is also located there10(A.H.Su.12/16).). It should be noted that the rasa of kapha is Madhura.11 (Su.su. 21/16).Amlabhava avastha (2nd Stage):- The partly digested food entering into adhoamasaya from urdwamasaya, enters intothe amlapaka with predominance of pitta. There will be abundant production of Achyapittain its immature stage is amla. 12(Cha.chi 15/9). The outcome of this phase of digestion isthe production of acidified change i.e. Pakwapakwa or kinchit Pakwa. 13(Digeston &Metabolism in Ayu. C.Dwaraka nath)The food in this stage is not yet fit for absorption & utilisation in metabolism14(Chakrapani on cha.chi 15/10)In this stage of digestion there will be two important events.1. The Rasa of the end product of this stage is amla.2. The end product of this stage is achyapitta.Samanavata & Pachakapitta play an important role in this process.Samanavata:- The function of Samanavata quoted by Charaka as stimulation to agni to digestion offood 15. After digestion is completed, helps in separation of Sara & Kitta. Sarangadharaquoted the meaning of Samyak, as it will spread equally to all directions 16. (Sa.poo. 5thChapter)According to Vagbhata, the Samanavata received the food into the annavahasrotas(grihnati), Retains it till the digestion is completed (pachati), separates the sara from kitta 6 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 22. Shareeram(vivechayati) & finally propels the kitta to the later parts of the annavaha srotas17(A.Hri.Su.12/8) (Munchati).Pachakapitta:- The Pachakapitta which digests the food is stated to be the Controller of remainspittas. Their functions are depended upon the increase and decrease of Pachaka pitta 18(cha.chi.15/39) Susruta & Vagbhata quoted its location in the interior of amasaya and Pakwasaya.19(Su.Su.21/10) Charaka mentioned these two asayas as kosta and here digestion takes place.Both these asayas have in inner layer called Pittadharakala20. (A.Hrisa.3/50)Whichproduces Pachakapitta which digests the ahara & separates it into Sarabhaga, Mutrabhaga &Pureeshabhaga.Pittadharakala:- Located in the amasaya & Pakwasaya this part of annavahasrotas retains the foodupto its completely digestion, it is called Grahani. The function of this kala is to support thePachakapitta which is helpful for digestion of food. It aids in seperation of the Sara &Kitta21. (Digestion & Metabolism –Dwarakanath)Katuavastha (3rd Stage):- The partial digested food then propelled from the adhoamasaya into the Pakwasayato complete its digestion. The digested food separated into Sara and Kitta. The annarasa isabsorbed from the Kudyas of Pakwasaya & Circulated through out the body by thedhamanies 22 (cha.chi.15/36) The fluid part of the Kitta is also absorbed, thereby rending it into a dry and lightmass, and pureesha in the Pakwasaya during this process is produced the vata which is katuin nature 23 (cha.chi.15/11) .The Sahajakrimis which reside here will help in the productionof vata. The fluid part of the kitta is absorbed by the kudyas of Pakwasaya, constitute themootra and is excreted through vasti. The Rasa of the pitta is katu. According to the third 7 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 23. Shareeramstage the digestion of the food is stated as Katuavastha 24. (Su.Ni.3/21-22)Its clear that theend products of this stage is katurasa, and vata which is pungent in nature. ***** 8 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 24. ShareeramINSULIN AND ITS ROLE IN DMInsulin Synthesis :- Robbins Pathology Gyton Physiology S.No. Site Activity 1. Rough Translation of m–RNA on beta cell of Pancreas itself where E.R Humaninsulin gene is expressed. 2. E.R Preproinsulin – mol. wt. 11,500 Proteolytic Clearage of Prepeptide Proinsulin Cleavage of c–peptede Insulin C–Peptide 3. Glogi apparatusInsulin and C–peptide will be secreted simultaneously after physiological stimulation.Chemistry of Insulin:- (Pharmacology & Pharmacotherapeutics) Insulin is a harmone secreted by the beta cells of this islets of Langerhans ofPancreas & derives its name from the Laitn word ‘Insula’ which means an island. It wasextracted from the pancreas by Banting & Best in 1921 & was isolated in crystalline formby Abel in 1930. Insulin is a polypeptide with a molecular weight of about 6000, consisting of twoamino acid chains, A&B, linked by two disulphide bridges. The Chains Contain 21 & 30 amino acids respectively, all in a known sequence. Thedisulphide bridges are essential for its biological activity. 9 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 25. Shareeram Insulin is soluble in water but undergoes molecular aggregation at extremities of PH(3.2 & 10) such aggregation is further enhanced by the presence of zinc which brings aboutcrystallisation of insulin.Transport, fate & excretion: - In the blood insulin circulates in unbound form. The average plasma half life ofinsulin is 6 minutes. So that it is mainly cleared from the circulation with in 10–15min.except for that portion of insulin which is combined with the receptors of the target cells.The remaining is mainly degraded by the enzyme insulinase in the liver and to a lesserextent in the Kidneys. Only traces of free insulin appear in the Urine. Insulin degradation is retarded inchronic renal disease.Factors influencing the insulin release:- Stimulators Inhibitors 1. Glucose 1. Somatostatin 2. Mannose 2. 2 – Deoxy Glucose 3. Amino acids (Leucin), arginnine etc) 3. Mannoheptulose 4. Intestinal Harmones  adrenergec stimulating – 4. agents (Norepinephrine, (GIP, Gastrin, Secretin, CCK, epinephrine) Glucagan & others) 5. – adrenergic stimulating  Keto acids – 5. agents (Propranolol) 6. Acetylcholines 6. Diazoxide 7. Glucagon 7. Thiazide diuretics 8. Cyclic AMP and various cyclic AMP 8. K+ depletion generating substances 9. B adrenergic stimulating agents 9. Phenytoin 10. Theophylline 10. Alloxan 11. Sulphonylureas 11. Microtubule inhibitors 10 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 26. ShareeramTissues in which insulin facilitates Glucose uptake:- 1. Skeletal Muscle 6. Crystalline lens of the eye 2. Cardiac Muscle 7. Pituitary Gland 3. Smooth Muscle 8. Fibroblast 4. Adipose tissue 9. Mammary glands 5. Leucocytes 10. Aorta 11.Alfa Cells of Pancreatic IsletsTissues in which Insulin does not facilitates Glucose uptake:-1. Brain except part of Hypothalamus.2. Kidney tubules.3. Intestinal Mucosa4. R.B.CMechanism of Insulin Secretion:- Increased Sugar level Translation GLUT (Insulin dependent Glucose Transporting protein) Uptake of Glucose by cells Release of Insulin If Stimulation Persist Active synthesis of Insulin 11 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 27. ShareeramD) On Iron Transport: It favours movement of K+ into cells.E) On Growth & development.F) Nucleus: Stimulation of DNA Synthesis, cell Proliferation & differentiation.G) Vascular endothelium:- Stimulates lipoprotein lipase on the surface of the vascular endothelium.Principal action of Insulin on Various tissues:-A) Adipose Tissue:- Increases Glucose entry Increases Fatty acid synthesis Increases Glycerol Phosphate synthesis Increases triglyceride deposition Activation of Lipoprotein lipase. Inhibition of harmone sensitive lipase Increases K + uptake.B) Muscle Tissue:- Increases Glucose entry. Increases Glycogen synthesis Increases amino acid uptake Increases Protein synthesis in ribosomes. Increases Protein Metabolism. Increases release of gluconeogenic amino acids. 12 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 28. Shareeram Increases Ketone uptake. Increases K + uptake.C) Liver:- Decreases ATP Decreases Ketogenesis Increases Protein synthesis Increases lipid synthesis Decreases glucose output by decreasing gluconeogenesis and increasing glycogensynthesis.Biological Effects of Insulin:-A) On Carbohydrate Metabolism:-1. Reduces the rate of release of glucose from liver. By inhibiting glycogenolysis By stimulating glycogen synthesis By stimulating Glycolysis By indirectly inhibiting gluconeogenesis via inhibition of fatty acidmobilisation from adipose tissue.2) Increases rate of glucose uptake into all insulin sensitive tissues notably muscles andadipose tissue. Directly by stimulating glucose transport across the PlasmaMembrane. Indirectly by reducing Plasma free fatty acid levels.B) On Lipid Metabolism:-1. Reduces the rate of release of free fatty acids from adipose tissue. 13 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 29. Shareeram2. Stimulates fatty acids synthesis and also conversion of fatty acids to triglyceridesin liver.C) On Protein Metabolism:-1. Stimulates transport of free amino acids across the plasma Membrane in liverand muscle.2. Stimulates protein bio synthesis and reduces release of amino acid from muscleReferences:-1.Digestion&metabolism- c.Dwarakanath page.532. CHA.CHI 15/93.A.H.SU 9/204.CHA.CHI 15/65.A.H.SU 1/86.SAR.POO 6/1-47.CHA.CHI 15/98.CHA.CHI 15/6SU.SU 21/169.SU.SU 21/1510.CHAKRAPANI ON CHA.SU 20/811.A.H.SU 12/1612.CHA.CHI 15/913.DIGESTION&METABOLISM-DWARAKANATH14.CHAKRHI 15/3915.SU.SU 21/10APANI ON CHA.CHI 15/1016.CHA.CHI 28/8 14 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 30. Shareeram17.SAR.POO 5 CHAP18.A.H.SU 12/819.CHA.CHI 15/3920. SU.SU 21/1021.A.H.SA 3/5022.DIGESTION&METABOLISM-BWARAKANATH23.CHA.CHI 15/1624.CHA.CHI 15/1125.SU.NI 3/21-22 15 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 31. Nidana NIDANA Nidana of prameha includes nidana factor mentioned for all 3 doshas as pathogenesisof Madhumeha involves three doshas. Individual Nidana for premeha of each dosha werementioned in Charaka Nidana 4th Chapter. Various etiological factors mentioned by Ayurvedic Acharyas. S.No Nidana Reference 1. Asyasukham Ch 2. Swapnasukham Ch 3. Dadhi Ch, B.P 4. Gramya, anupa, oudaka – Mamsa Rasa Sevana Cha, A.H., A.S. 5. Ksheeram Charaka 6. Navannapanam, Navadravyas, Navadhanya Ch, A.S., A.H. B.P. 7. Gudavikaras & Guda Ch, A.S., A.H., B.P 8. All the Ahara Vihara factors which vitiate Su, A.S., A.H. medas, Kapha, mutra 9. Madhura rasa, Amlarasa, Lavanarasa – Ahara Su, A.H., A.S. having these Rassas 10 Annapana having Snigdna, guru, picchila, Seeta, Ch, A.H., A.S., Su drava, Medokara gunas 11. Sura A.S., A.H. 12. Navamadhyam Ch., B.R 13. Gorasam Ch, A.H., A.S. 14. Ekasthanasanarati, Sayyasanaswapna Sukham Ch, A.S., A.H. 15. Diwaswapnam Ch. Su. 1 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 32. Nidana 16. Avyayamam Su. 17. Alasyam Su. 18. Recipes prepared with Guda & Pista Cha. 19. Chestadwesta Ch. Nidana 20. Mandostahata Ch. Nidana 21. Atisthulata Ch. Nidana 22. Atisnigdhata Ch. Nidana 23. Mahasanam Ch. Nidana 24. Beejadosha Ch.Chi. Stnana 25. Improper treatment of other Premehas Su 26. Dhumapanam B.R. 27. Ikshu A.S, A.H. 28. Sayanam Vidhivarjitam A.S, A.H. 29. Dustamedas Ch, Su 30. Abaddamedas & Mamsa Ch.Chi 31. Snanadwesham Ch. Nidana 32. Chankramana dwesham Ch. Nidana 33. Intercourse with animals like horse, elephant etc, Vaidhya chintamani mother, sister and intercourse in festival and odd days.  Ayurvedic Acharyars mentioned Hereditary origin of Madhumeha which involves genes, in those ancient days itself. It was mentioned as beejadosha and Madhumeha was mentioned as Kulajavikara. 2created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 33. Nidana  Dalhana mentioned that females are less prone to premeha or Madhumeha does not occur in females as Rutasrava in every eliminates all the impurities & purifies all dhatus. Author of yogaratnakara followed susruta’s version.Samanya Nidana:- The keyword in Samanyanidana of prameha is the hetu, which causes Kaphavridii(kaphakriccha sarvam)8 Kapha is the maindosha involved in prameha and hence all thosehetu that cause Kaphavriddi automatically becomes the hetu for prameha9. The Samanyanidana can again be classified as a) Ahara Sambandha b) Vihara Sambandhaa) Ahara10:- Any ahara which is Madhura & lavanarasa pradhana, guru, Manda, Sheeta, Snighdha, Slakshna, Sandra Stira, Madhuravipaka and Sheetaveerya, these effects mainly effects the medas and Kleda leading to madhumeha due to Avarana.b) Vihara11, 12:- 1) Atinidra: Aggravates Kapha and tamasa guna resulting in accumulation of medas 2) Asyasukha: Leading to Kaphavriddi. 3) Avyayam: Results in accumulation of medas & Kapha. 4) Alasyam: results in inactivity causing excessive nourishment. This mainly because of Kapha and meda. 5) Samasodhana varjana: Causes medas and Kaphakshaya, accumulation of kapha and medas.Visesha Nidana:- 1) Kaphaja prameha Nidana: Are the same as explained in samanyanidana because kapha is dosha visesha in prameha but it should be in bahudrava. 2) Pittaja prameha Nidana13: Ahara:- ushanagunaahara atisevana, Arularasa, Lavanarasa, katurasa ahara atisevana, vishamaaharasevana Vihara:- Ati atapasevana, Atisantapa, Shrama, Krodha 3) Vatajaprameha nidana: The causes for aggravation of vata can be mainly grouped into two categories 1) Margavarana 14 2) Dhatukshaya15. 3 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 34. Nidana  The margavarana is a result of accumulation of kapha or pittadosha in the vatavahasrotas due to respective Nidanasevana, this leads to vataja prameha.  In prameha, dhatukshaya is an invariable consequence of aparipakvata of dhatu. This leads to aggravation of vata causing vatajaprameha.Sahaja (Hereditary):- Susrutha mentioned the sahaja word showing genetic predisposition in the pathophysiology of the disease Madhumeha16. charaka while describing the prognosis of Madhumeha clearly noted that this is kulajavikara resulting due to defect in the beeja.  Chakrapani opines that it can cause by Father, Mother or Grandparents, it means the disease inherited from generation to generation.  Charaka narrated that sahaja type of diseases can occur due to defect in beeja, beejabhaga or beejabhaga avayava. We can correlate beeja to ovum and sperm, beejabaga to chromosomes & beejabhaga avayava to genetic coding. Charaka narrated that indulgence of madhurarasa by mother at time of pregnancy causes madhumeha & stoulya17. 4 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 35. Nidana NIDANA AND GUNA KARMA Nidana Predominant of Rasa, Guna Vitiates Veerya, vipaka1) Gurugunaahara Prithvi AP Madhurarasa Kapha, Medas2) Srigdhagunaahara Pritvi, AP Kleda3) Dravagunaahara AP Kapha & Kleda4) Pichilagunaahara Prithvi, AP Kapha & Kleda5) Seetagunaahara with AP Udaka & Vata dravaguna6) Madhurarasa ahara Snigdha, Guru Kapha, Rasa, Sheetaveerya Rakta mamsa, Madhuravipaka Medas. Majja, Sakra, ojus7) Lavanarasa ahara Kleda, KaphavilayanaMilk and Its Products8) Goksheera Kapha& medas9) Mahisha Ksheera Atisneha, Atinidra Kapha&Medas Mandagni Abhishyandi10) Avika ksheera Pitta and kapha11) Dadhi Kapha&Medas12) Godadhi Kapha&Medas13) Mahisha dadhi Kapha&Medas14) Avika dadhi More abhishyandi Kapha&Medas15) Mandaka Mootrala Tridosha 5 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 36. NidanaGhrita16) Goghrita Kapha&Medas17) Mahisha ghrita Kapha& medas18) Piyusha, Kilata Sugarcane & its Kapha products19) Ikshu Madhurarasa Kapha sheetaveerya snigdha&Saraguna20) Phanita Guruguna Guru in guna Tridosha abhishyundhi kshara, madhura in Kapha&Medas rasa, Snighdha sheeta in guna & veerya21) Matsyandika, Snigdha, guru Kapha&Medas Khandasarkara madhurarasaVegetables (Shaka)1) Trapusha (Cucumis sativa) Guruguna Kapha, Medas2) Kadamba Sheetaveerya, Kapha, Medas & Mootra madhura rasa3) Shrungataka Guruguna, Seetaveerya & Kapha & medas4) Shaluka vishtambhi in nature5) Kasheruka6) Kumudha Sheetaveerya Kapha & Vayu 6 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 37. Nidana7) Utphala, nala, phala & Madhura, Kashaya in Puspa rasa8) Vidarikanda Madhurarasa, Mootra & Kapha Sheetaveerya Balya, Mootrala in action9) Upodika Madhurarasa& vipaka, Kapha (Basellacordifolia) Snigdha SheetaveeryaVihara1) Nidraatisukha Increases tamoguna Sleshma vardhana2) Asyaatisukha Increases tamoguna Sleshma vardhana3) Diwaswapna Increases tamoguna Sleshma vardhana4) Mrujavarjana Inactiveness, Laziness Kapha & Medas5) Tyaktavyayama Increases agnimadhya Kapha & medas shareera gourava6) Alasyaprasakta Kapha7) Failure to perform Tridosha samsodhana therapy 7 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 38. Nidana AETIOLOGYGenetics18,19,20 :- The mechanism of inheritance of DM either insulindependant or noninsulindependent is unclear.Genetic Susceptibility of IDDM:- This probably involves more than onegene. Candidate loci have been proposed on chromosomes 2, 6, 11 & 15 though primary geneticsite in humans is believed to be located in the major histocompatability locous on the shortarm of the 6th chromosome. While definite associations exists between class I alleles & type I DM, the D locus is considered of primary importance encoded by the major histocompatibility complex (MHC) found to be closely associated with IDDMGenetic Susceptibity in NIDDM:- Modes of inheritance of NIDDM in variant called matarityomet DM of the young (MODY) have been more or less conclusive than the other forms The concordance rate for DM in monozygotictwins with type 2 disease may be as high as 80% risk of offspring and siblings of patients with NIDDM are higher than in type I DM.Autoimmurity:- The autoimmune destruction of the B cells may be best explained by the existence of B cell specific protein that for unknown reasons acquires autoantigenic properties and eventually becomes target for autotimmune reaction.Heredity:- The mechanism of inheritance of IDDM is unclear. The chance of a child developing type-1 DM when another first degree relative has the disease is only 5- 10%. HLA identity in a sibling increases the risk. The presence of NIDDM in a parent increases the risk for IDDM in the offspring The risk of type I DM is upto 5 times higher when the father has the disease than when the mother is a diabeticEnvironmental Factors:Viralinfection:- Preceding episodes of infections of Mumps, hepatitis, infectious mononucleosis and coxsackie virus. Support for viral theory comes from the observation, that about 1/5th of individuals with congenital rubella develop DM.Bovine albumin:- It has been suggested that exposure to cow’s milk or milk products early in life predisposes to autoimmune DM 8 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 39. NidanaObesity:- Type 2 DM is almost nonexistent in individuals with a body manindex (BMI) below 22kg/m2 and increased risk of DM with obesity has a strong familial tendency.Lifestyle:- Epidemiological studies of type 2DM provide evidence that overeating, especially when combined with obesity & underactivity associated with type 2 DM.Malnutrition:- It is proposed that malnutrition in utero and in infancy may damage Beta cell development and causes type 2 DM at a laterstage.Chemicals:- Alloxan, Glyoxal streptozotocin, Asparyinone, Pentamidine esthionate.References:-1.CHA.CHI 6/42.CHA.NI 4/43.A.H.NI 10/1-34.A.S.NI 10/35. SU.NI 6/36.CHA.NI 4/50-527.CHA.SU 23/3-78.CHA.NI 4/259.CHA.NI 4/3410.CHA.SU 17/77,78,7911.CHA.NI 4/3612.CHA.NI 4/3413.CHA.CHI 6/214.CHA.NI 4/4715.CHA.NI 6/316.CHA.CHI 6/5517.CHA.NI 6/318.Davidson’s principles of Medicine edition 199519.Harrison’s principles of Internal Medicine vol 1&220.Anderson’s pathology 10th edition,1996 9 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 40. Poorva Rupa POORVA RUPAPoorvaRupa (Premonitory Symptoms) mentioned by various (1, 2, 3) S.No Poorva Rupa Reference1. Jatileebhavam Kesheshu Ch.Ni, Su.Ni, A.S.Ni2. Asyamadhuryam Ch.Ni, Ch.Chi, A.S.ni, A.H., Ni3. Karapada suptata Ch. Ni4. Karapadadaha Chi.Ni, Cha.chi, Su.Ni, A.H.Ni5. Mukhatalukanta sosha, talugala sosha Ch.Ni, Ch.Chi. Su.Ni, A.S.Ni6. Pipasa Su.Ni, A.S.Ni. A.H.Ni7. Thrut Chi. Ni8. Kayemalam Ch.Ni, A.S.Ni9. Kayachidreshupadeham Ch.Ni10. Paridaham Ch.Ni. A.S.Ni11. Angeshusuptata Ch.Ni., A.S.Ni12. Mutrebhidravanti pipeelikanam Ch.Ni.ch.Chi, A.S.Ni Mutrechnamutradosham13. Shatpadapipeelikabiccha shareera Ch. Ni Mutrabhisaranam14. Shareeravisragandhata Ch.Ni15. Nidra Ch.Ni, A.S.Ni16. Tandra Ch.Ni. Su.Ni, A.S.Ni.17. Swedam Ch.Chi, A.H.Ni18. Angagandhata Ch.Chi, A.H.Ni19. Shitilanghata Ch.Chi, A.H.Ni 1 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 41. Poorva Rupa20. Sayyasanaswapnasukhe Rati Ch.chi, A.h.Ni21. Hrunnetrajihwasya Sravanopadeha Ch.Chi, A.h.Ni22. Ghanangata Ch.Chi, A.H.Ni23. Keshanakhavriddi Su.Ni,. A.H.Ni24. Seetapriyatwam Ch.Chi, Su.Ni, A.H.Ni25. Snigdha picchila gurugathram Su.Ni26. Madhurasukla mutrata Su.Ni, A.S.Ni27. Saada28. Durgandhata Su.Ni29. Swasa Su.Ni, A.S.Ni30. Talugalajihwa, Danteshu Malotpatti Su.Ni31. Snigdhangata A.S.Ni32. Alasyam A.S.Ni Prameha/Madhumeha involves dravarupa & abaddamedas and Mamsa which causespremonitory symptoms like 1) Sweda 2) Snigdhapicchilagurugatrata 3) Ghanangata 4) Durgandata 5) Visragandhata 6) Visragandanata 7) Alasyam 8) Sayyasanaswapnasukha Rati 9) Swasa 10) Snigdhangata 11) Trut 2 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 42. Poorva Rupa 12) Pipasa 13) Sithilangata Arambhaka dosha is kapha, aggrevation causes premonitory symptoms like 1) Asyamadhuryam 2) Nidra 3) tandra 4) Madhurasukla mutrata as mutra is a seat of kapha 5) Hrunnetra jihwasya sravanopadeham According to the involvement of dosha and dooshya combinations all premonitorysymptoms or half of the premonitory symptoms will develop.References:-1. CHA.NIi 4/41 CHA.CHI 6/12,13 SU.NI 6/5 A.H.NI 10-38/39 CHA.NI 4/472. Godbole,Aravinda. DM for practitioners 1st edition 1974. 3 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 43. Poorva Rupa Pre-diabetic States2Sometimes a patient with abnormal hyperglycemia may not have full clinical symptoms ofdiabetes mellitus and often pre-diabetic states are asymptomatic. Mildsymptoms ifmanifested go unrecognized but the identification of such stages can go a longway inprevention of an overt disease. The British diabetic association has suggested a classification that is accepted byWHO expert committee on diabetes. They are as follows:Potential Diabetes These are persons who have high probability of developing diabetes. They do notshow any evidence of impaired glucose tolerance. They include. 1) Identical twin of diabetic 2) Persons with both the parents are diabetic 3) Persons with one parent diabetic, the other non-diabetic parent having a diabeticparent or a diabetic sibling.Latent Diabetes:a) Persons with normal G.T.T. at present but had an abnormal G.T.T. sometime in the past viz, during pregnancy, infection when under stress or when obese.b) Persons with a normal G.T.T. understand conditions but an abnormal one with provocative tests.Asymptomatic Diabetes: This stage is variously known as clinical, sub clinical diabetes. They always show anabnormal G.T.T. but the fasting blood levels may be normal in the early stage. Later on, eventhese levels may be raised. 4 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 44. Roopa ROOPARoopa of a disease will be produced in the fifth stage of samprapti i.e., Vyaktavasta. Laxanaof Madhumeha mainly grouped under two categories i.e.,A) Samanyalakshanas: 1) Prabhootamootrata: This is the cordinal sign described by all acharyas. Vagbhatamentioned prameha as the disease of mutratipravritaja vikara. Patient voids urine more inquantity and frequency1 . Gayadas opines that this excess urine quantity is because ofliquification of the dushyas and their amalgamation2. 2) Avilamootrata: Patient voids urine having turbidity.B) Vishistalaxanas3: 1) Madhurata – This is entirely due to Apakva ojus. 2) Rooksha – Rookshaguna is due to vata 3) Pandu – The urine would have lost its normal varna as a result of abnormallyincreased shareerakleda. 4) Kashaya – It is a terminal manifestation of DM. 5) Madhusamamootra – Varna, Gandha, Rassa of mootra will be similar to that ofMadhu. It is due to ojonisraana in mootra.Sarvadaihika Laxana4. Sahaja Apathyanimihaja1) Krisha(Emaciated) 1) Stulatwa (obese)2) Ruksha (dryness of body) 2) Snigdha (Unctous)3) Alpasi (poor eatingdesire) 3) Bahwasi (polyphagia)4) Pipasabhrusam(intense thirst) 4) Shayya Asana Sukham (desirous for posture and lying down on bed)5) Parisaranasheela (Tendency of roming) 5) Swapnashila (constant tendency for sleeping) 1 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 45. Roopa 5, 6, 7PratyatmaroopaKaphajaprameha Prameha Mootralaxana1) Udakameha Accha, Bahusita, Sheeta, Nirgandha udakopama2) Ikshuvalika Atyantamadhura, Seeta, ishatpicchilam Avilam, Kandekshurasa Sankasham3) Sandrameha Paryushita, Sandribhavati bhajane4) Sandraprasadameha Samhayante mootram5) Shuklameha Shukla, Pishtanibham, Abhikshnam6) Sukrameha Athyantamadhuram, Seetam7) Sheetameha Athyantamadhuram, Seetam8) Sikatameha Katinamootrata9) Sanairmeha Mandam, Mandavegam, Kruchram10) Alalameha Tantubaddaiva, Alalam, Picchilam11) Surameha Suratulyam12) Lavanameha(su.ni6/8) Vishada, Lavanatulyam13) Pishtameha(su.ni68) Pishtarasa Tulyam14) Phenameha(su.ni6/8) Stokam Stokam, SaphenaPittajaprameha1) Ksharameha Ksharatulyavarna, rasa, Sparsha2) Kalameha Masivarna, Ajasram, Ushnamootra3) Neelameha Chashapakshinibham, Amlam4) Raktameha Visra, Lavanam, ushnam, Raktam5) Manjistameha Visra Lavanam, Ushnam, Raktam 2 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 46. Roopa6) Haridrameha Haridrodakasankasha, Katuka7) Amlameha(su.ni6/8) Amlarasa, AmlagandhaVataja Prameha1) Vasameha Vasamishram, vasabham2) Majjameha Majjabham3) Hastimeha Hastimattaiva ajasram, Lasika4) Madhumeha / Kshoudra meha(su.ni6/8) Kashaya, Madhura, panduvarnata, Ruksha5) Sarpirmeha Sarpiprakasham 3 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 47. Roopa 8 Clinical Features  The manifestation of symptomatic Diabetes mellitus vary from patient to patient. Most often, Symptoms are due to hyperglycemia (polyuria, polydipsia, polyphagia) but the first event may be on acute metabolic decompensation resulting in diabetic coma.  Typically, the clinical features of IDDM and NIDDM are distinctiveInsulin Dependent Diabetes:  IDDM usually begins before age 40. Some patients develop type 1 diabetes late in life with a fist episode of ketoacidosis occurring at age of 50 or even later in rare instances.  Onset of symptoms may be abrupt, with thirst, excessive urination, increased appetite and weightloss developing over several days.  In some cases, the disease is heralded by the appearance of ketoacidosis during an intercurrent illness or following surgery  As outlined in type 1 patient may have normal weight or may be wasted, depending on the length of time between onset of symptoms and start of treatment characteristically, the plasma insulinlevel is low or immeasurable.  Once symptoms develop, insulin therapy is required.Noninsulin Dependent Diabetes:  NIDDM usually begins in middle life or later. The typical patient is overweight. Symptoms begin gradually and the diagnosis is made frequently when an asymptomatic person is found to have an elevated plasmaglucoselevel.  In contrast to IDDM, plasma insulinlevels are normal to high in absoluteterms, although they are lower than predicted for the level of the plasma glucose stated in another way, if plasma glucose concentrations in nondiabetic subjects were raised to levels equivalent to those found in NIDDM patients, insulin values would be higher in the normal group. This relative deficiency reflects the previously mentioned insulin secretory defect in NIDDM.  For unknown reasons, patients with NIDDM do not develop ketoacidosis but are susceptible to development of hyperosmolar, nonketotic coma. 4 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 48. RoopaSymptoms:1) Excessive appetite and polyphagia8 Excessive hunger is due to inability of the tissue to use glucose and loss of fuel in the urine.2) Loss of Weight: Loss of weight in the diabetic may be attributed to the mobilization of fat stores and breakdown of protein. In addition there may be considerable calorie loss in the urine.3) Fatigue – Fatigue is due to inefficient utilization of glucose or electrolyte losses prone to muscular weakness which is the basis of fatigue.4) Thirst and polyuria – due to loss of water from osmotic diuresis5) Pruritis Valvae: it is a symptom in 2/3 or all women who develop diabetes Glucose favours the development of the mycosis and that glycosuria is the underlying cause.6) Balanitis7) Myopia8) Drymouth9) Nocturia10) Wasting11) Abnormalities of taste12) White marks on clothing13) Impotence14) Amenorrhoea15) Infection – especially in the skin or failure of wounds to heal 5 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 49. RoopaReferences: 1) A.NI – 10/7 2) SU.CHI 11/2 3) SU.CHI 11/3 4) SU.CHI 11/14 5) CHA.NI 4/41 6) SU.NI 6/8 7) A.H.Ni 10/35-34 6 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 50. Classification CLASSIFICATIONThough all the three doshas are involved in the pathogenesis of prameha, it is according tothe predominance of dosha the classification was made. The physical characters like varna,Rasa, Sparsa, of each type of prameha are according to the dosha, dooshya, mala, ahara &their combination.Classification of PramehaI 1) Kaphaja - 10 types - sadhya 2) Pitttaja - 6 types - Yapya 3) Vataja - 4 types - Asadhya (A/c to Charaka)II 1) Sahaja - Due to beejadosha 2) Apathyanimittaja Due to irregular & faulty diethabits (A/c Susruta)III A/c to the line of treatment 1) Stula 2) KrishaIV 1) Sadhya 2) Yapya 3) AsadhyaV Author Yogaratnakara has given the treatment of Dwandajaprameha in prameha chapter.Classification of Prameha Dosha Charaka Susruta VagwnataKaphaja 10 types 1) udakameha Udakameha Udakameha 2) Ikshumeha Ikshumeha Ikshumeha 3) Sikatameha Sikatameha Sikatameha 4) Sanairmeha Sanairmeha Sanairmeha 5) Sandrameha Sandrameha Sandrameha 6) Sukrameha Sukrameha Sukrameha 7) Shukla meha Pistameha(su.ni6/8) Pistameha 8) Sandraprasada Surameha(su.ni6/8) Seetameha 1 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 51. Classification 9) Seetameha Lavanameha Alalameha 10) Alalameha PhenamehaPittaja 6 types 1) Ksharameha Ksharameha Ksharameha 2) Kalameha Neelameha Kalameha 3) Neelameha Sonitameha Neelameha 4) Lohitameha(ch.ni Manjistameha Raktameha 4/24) Haridrameha Manjistameha 5) Manjistameha Amlameha(su.ni6/8) Haridrameha 6) HaridramehaVataja 4 types 1) Vasameha Vasameha Vasameha 2) Majjameha Majjameha 3) Hastimeha Hastimeha Hastimeha 4) Madhumeha Kshoudrameha(su.ni6/8) Madhumeha Sarpirmeha  Sandraprasadameha of charaka & Surameha of vagbhata & susruta can be considered as it.  Lohitameha of charaka, Sonitameta & Raktameha of susruta & vagbhata can be considered as it.  Majjameha of charaka & Sarpirmeha of susrata can be considered as it.Classification of MadhumehaI 1) Dosha Avrutajanya2. 2) Dhatukshayajanya Vagbhata & Y.R. mentioned this classification (A.H.N 10/21)1) Doshavrutajanya: This type of Madhumeha is due to Avruta of Vatamarga by the doshas. In this symptoms manifests according to the Avrutadosha. This type is kashtasadhya.2) Dhatukshayajanya: In this type of Madhumeha dhatukshya is due to 2 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 52. Classification i) Rukshaguna of vayu ii) Excretion of dhatus through urine along with ojus. This is asadhya.II 1) sahaja3 2) Apathya nimittaja1) Sahaja:- Charaka, Susruta, vagbhata & other authors mentioned this type. Sahaja madhumeha is due to beejadosha and was mentioned as Kulajavikaras by charaka. According to ayurveda sahaja madhumeha effects the persons from birthitself and is asadhya.2) Apathyanimittaja: This is due to indulgence in Apathyakara ahara and vihara. This type was mentioned by almost all acharyas of Ayurveda. Apathyanimittaja Madhumeha is sadhya/yapya if it is associated with other doshas i.e., kapha or pitta along with vata.III1) Madhumeha due to vata associated with kapha.2) Madhumeha due to vata associated with pitta4(ch-chi 6/34) while prescribing kashyayoga to pramehas according to dosha, charka mentioned that for vatajapramehas medicated taila and ghrita prepared drug of kaphaja and pittaja pramehahara kashyayoga should be given according to associated dosha.IV1) Madhumeha:- as one of the 4 varieties of vatajamehas2) Madhumeha as complications of other mehas if not treated properly. This type was considered asadhya 6. (A.H.Ni 10/2/2, Su.Ni chap 6)V 1) Sadhya / Yapya 2) Kastasadhya 3) Asadhya1) Sadhya/Yapya i) Madhumeha due to vata associated with other doshas ii) madhumeha due to gradual aggravation of vata iii) madhumeha due to apathyakara aharavihara i.e., apathyanimittaja 3 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 53. Classification2) Kastasadhya i) Doshavritajanya3) Asadhya i) Madhumeha due to beejadosha ii) Madhumeha as a complication of other mehas which were not treated properly. iii) Dhatukshayajanya iv) Madhumeha due to vata that is aggravated from the beginningVI1) Stula2) Krisa7 (ch. Chi. 6/15) This is given by charaka basing on the line of treatment. For stulapatient, sodhana therapy was prescribed which includes vamana, virechana and vasti .For krisapatient samsamana therapy was prescribed as they cannot tolerate sodhana therapy. Constitutional variation also come with specific hetu i.e., sahaja and Apathyanimihaja Madhumeharogi due to beejadosha is lean and madhumeharogi due to apathyarimittaja vihara is obese. 4 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 54. ClassificationClassification8A. Clinicalclasses Insulin dependent – Type – I Noninsulin dependent – Type – II a) nonobese b) obese Malnutrition related Diabetes Mellitus associated with certain Conditions and syndromes 1) Pancreatic disease 2) Harmonal disease 3) Drug or chemical induced 4) Insulin or insulin receptor abnormalities 5) Genetic syndromes 6) Miscellaneous Impaired glucose tolerance a) Nonobese b) Obese c) Associated with certain conditions & syndromes Gestational diabetesB. Statistical Risk classes (normal glucose tolerance with substantially increased risk of developing diabetes) Previous abnormality of glucose tolerance Potential abnormality of glucose tolerance. 5 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 55. ClassificationReferences:-1.CHA.CHI 6/9-12 A.H.NI 10/8-27 A.S.NI 10 SU.NI 6/18 CHA.NI 4/15-382.A.H.NI 10/213.CHA.CHI 6/574.CHA.CHI 6/525.CHA.CHI 6/346.A.H.NI 10/21SU.NI CHAP 67.CHA.CHI 6/158.MALIN’S CLINICAL DIABETES 6 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 56. Samprapti SAMPRAPTI  Samprapti is a process by which dosha dushyasamsarga will takes place and finally manifests the disease. It includes the vaishamya of dosha, dushya, agni, srotas.  According to susruta, too much indulgence in the eliological factors relate to prameha results into aparipakva vata, pitta, kapha and meda, which further proceed through the mutravahasrotas to get localized in the vastimukha this leading to disease prameha  Vagbhata described two types of pathogenisis of Madhumeha i.e dhatuhkshayajanya and doshavaranajanya3  Charaka has explained the samprapti in detailed manner it may be explained on the basis of shatkriyakalas. The samanya samprapti process commences from the nidanasevana1) Sanchaya – the excessive indulgence in nidanasevana of guru, snigdhaahara and avyayamadivihara leads to kaphadoshasanchaya having the quality of bahudravatha, sanchayam occurs.2) Prakopa – the bahudravatva kapha is prone to develop madhumeha and it is already presnt in excess quantity from the beginning hence it gets aggravated rapidly when the anukulanidana in there3) Prasara – In this stage, the provoked Kapha gets spread all over the body owing to sharirshaithilya. sharirashaithilya being one of the anukula factors for the nidana towards dosha.4) Sthanasamshraya – vikrita kapha has affinity towards bahu abadda meda due to their similar properties and gets lodged there. Vikrita kapha after combining with bahuabaddameda causes its vitiation. The other important dushyas are sharirakleda and mamsa which are already increased in quantity prior to vitiation of kapha. The provoked kapha with vitiated meda gets combined with sharirakleda or mamsa or both. This is an important stage because the prodromal symptoms of the disease are manifested in this stage.5) vyakta – In this stage, two types of manifestation will occur 1) putimamsa pidaka due to mamsadhatu vitiation. 2) Mutravaha srotodusti due to sharerakledadusti. 1 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 57. Samprapti6) Bheda – In this stage various complications of the disease manifest and the disease progress towards asadhyaSampraptighataka of madhumeha:Dosha : Sleshma pradhana tridosha sleshma is the main dosha responsible for Madhumehainspite of the fact that madhumeha is a tridoshajanyavyadhi. The other doshas like vata&pitta only trigger off this samprapti and associate as anubandha.Dushya : Rasa, Rakta, Mamsa, Meda, Majja, Sukra Vasa, lasika, ojus, kleda and accordingto vagbhata, swedaSrotodusti : The srotodusti laxana occur as sanga of kapha leading to vimargagamana andatipravritti of kleda through the mootra.Agni : Vaishamya of all agnis (or dhatvagnimandya)Ama : Medogata ama produced due to jataragni mandhya and dhatvagnimadhya.Adhistana : vastiUdbhavasthana : AmasayaBhedavastha : Occurance of upadravas such as puti mamsa,pidaka etc.Nature : chirakari, anusangi5Dosha - All the three doshas are responsible for manifestation of madhumeha.1) Kapha: It plays a dominant role in the samanya samprapti of madhumeha. It is the first dosha to get vitiated . Acharya charaka while describing the causative factors used the term kaphakriccha sarvam in it. It indicates the significance of this doshadusti in prameha2) Pitta: Here in avaranajanya madhumeha mainly the symptoms manifest because of vriddi of pittadosha6. Pitta is in Kshaya avastha as compared to vata in vatajaprameha samprapti .so Kshayalakshana of kapha and pittadosha may manifest in kshayajanya madhumeha.73) Vata : This is the primedosha in the pathogenesis of madhumeha. Here vata gets vitiated either because of its own etiological factors or because of avarana caused by kapha, pitta and meda. This provoked vata carries vasa, majja, ojus towards vasti and excretes them outside through urine resulting in depletion of dhatus, thus due to 2 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 58. Samprapti severe depletion of dhatus, the symptoms manifest are karshya, dourbalya, angasuptata, parisaranashila nature.In susrutha samhita it is described that vyana and apana are the main culprits in pramehathus in all the samprapti of prameha vyana acts as gatherer of kleda and apana as excretor.The function of apanavayu gets aggravated resulting excretion of vital dhatus through theurine outside the body8B) Dushya:-1) Rasa: Rasa is the seat of kapha and at the sometime it is the mala of rasadhatu. The symptoms like alasya, gurutwa, karshya, klaibya etc. are produced as a result of rasadusti.2) Rakta: It mainly gets aggravated in pittajaprameha. The raktadusti laxanas are daha visarpa, pidaka, dadru are produced as a result of Raktadusti9.3) Mamsa: Mamsa and Kapha are having the same qualities. when kapha gets vitiated mamsa looses its normal consistancy and develops shaithilya and provides space in between for the accretion of morbid matter. This consequently result into putimamsapidaka “ mamsaleshu avakasheshu “104) Meda: It is the dominant doosya in all types of prameha. kapha and meda have close resemblance as they have same qualities. In Madhumeha vitiation of medas results in two ways. Abadhtha (asamhata) (qualitative) :- Normal function of medas is to produce unctuousness in the body along with dridatva. so this abadhatva causes derangement in the structure of meda produing shaithilya in the body. Bahu (Qualitative) – Here in the pathogenesis meda is in excess quantity. This medodhatu is aparipakva (ama)115) Majja: Due to vataprakopa kshaya of majjadhatu occurs. Thus vitiated majja produced symptoms like netragaurava, angagaurava in madhumeha6) Sukra: Sukradhatu gets affected in the pathogenesis of prameha, which is due to its vitiation produces symptoms like dourbalya & kricchavyavayata. vata causes depletion of shukra dhatu and also sukrameha.7) Vasa: It is an upadhatu of mamsa and is sleshmika in character. The provoked vata draws vasa towards vasti and exerts it through urine in the form of sneha. 3 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 59. Samprapti8) Lasika : The aggravated vata proples lasika towards the vasti and then excretes it through urine leading to increased micutition. Lasika is described as a dushya in hastimeha.9) Ojus: ojus is an important dusya in the samprapti of madhumeha. Here aggravated vata transform the madhuratwa of ojus into kashayatwa and carries ojus towards vasti and excretes through unine leading to ojokshaya10) Kleda: it is also an important dusya after medas. In the samprapt,i kledadusti is in the form of vriddi and not the kshaya. Hence bahukleda is manifest as prabhuta mutrata and avilamutrata13 . 4 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 60. SampraptiPathogenesis of IDDM:14 Pathogenesis begins with genetic susceptibility to disease, with the destruction of isletBeta cells of pancreas almost due to autoimmune process.  viralinfetion is a triggering factor but noninfectious agents may also be involved. Autoimmune attack then follows.  The islet betacells become infiltrated by macrophages and activated cytotoxic T cells. The infiltration usually called insulitis. Multiple antibodies against beta cells antigens are present in the blood.  An autoimmune DM can develop in the absence of an environmental trigger i.e can be purely genetic. Usually however the pathogenetic sequence is Genetic predisposition  Environmental insult  Autoimmune destruction of Betacells  Diabetes mellitus (IDDM)Destruction of Beta cells and development of IDDM:  The loss of insulin reserve occurs over a few to many years .The earliest sign of abnormality is the development of islet cell antibodies when the bloodsugar and glucose tolerance are normal and when insulin rensponses to glucose load are intact.  Continued destruction of betacells then leads to insulin dependantstage and propensity of ketoacidosis The immunedirected destruction of beta cells probably involves both humoral & cell mediated mechanisms. Betacells have a lowcapacity for freeradical destruction and are especially vulnerable to oxygen toxicity. 5 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 61. SampraptiPathogenesis of NIDDM:–  NIDDM is more common than IDDM. Its pathogenesis is less well understood. The relation between the betacells abnormality and insulin resistance is not resolved. The major environmental factor is obesity.  Both betacell defects and insulin resistances are present in the overt disease, which more commonly exhibits familial aggregation, patients with type2DM have two psychological defects Viz. abnormal insulin secretion and resistance to insulin action in target tissues.  Insulin secretory defect and insulin resistance are both required for DM to be expressed since massively obese person with marked insulin resistance may have normal glucose tolerance. Presumably the Betacell lesion is not present in such persons. This fact suggests that the primary defect resides in the insulin producing cells.  Betacell mass is intact in type NIDDM in contrast with the situation in TypeI IDDM. The alfa cell population is increased resulting in an elevated ratio of a Alfa to Beta cells and an excess of glucagon relative to insulin that characterizes all hyperglycemic states including NIDDM 6 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 62. Samprapti Samprapti1. Sahaja Apathyanimittaja Beejadosha Incompatible diet and activities Ex: Mahasana, Ayrogyasana diwaswapna etcSukra dosha Arthavadosha Vatapradhana Tridosha Kapha Shareerakleda Pitta Sukra Vasa Medas Lasika Mamsa Ojus Rasa majja rakta Vasti Vataja Madhumeha Prabhoota mutrata Avila/Madhurya mutrata 7 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 63. Samprapti2. Chronicityof other mehas Excessive Rukhaguna of vata Elemination of dhatus through urine Excessive dhatukshaya Aggravation of vata Pradhana tridosha Avarana of vata by Vataja Madhumeha doshanReferences:-1.CHA.NI 4/52 CHA.NI 4/83.CHA.NI 4/114.CHA.CHI 6/45.SU.NI 6/46.SU.NI 6/97.A.H.NI 1O/88.A.H.NI 10/20,219.A.H.SHAREERA 3/610.CHA.SU 27/8,9,1011.CHA.SU 26/61,6212.A.H.NI 10/1813.CHA.CHI 6/714.Harrison’s principles of internal medicine vol 1&2 14th edition 1998. 8 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 64. UPADRAVAS & ARISHTALAKSHNAS According to vagbhata all pramehas if not properly treated ultimately develop intoMadhumeha. Therefore it is to be understood that the upadaravas of pramehas are also theupadravas of Madhumeha. However susrutsa and Vagbhata. have mentioned upadravasseparately for each doshaja group.  The general complications of prameha according to charaka as follows .1 1) Trishna 2) Atisara 3) Jwara 4) Daha 5) Dourbalya 6) Arochaka 7) Avipaka 8) putimamsa 9) Pidaka 10) Alaji 11) Vidradhi  Updravas mentioned in general by Basavaraju. 1) Aruchi 2) Angamardha 3) Trushna 4) Kasa 5) Bhrama 6) Shoda 7) Pidaka 8) KanduUpdravas mentioned according to dosha by various authors (2,3) kaphaja Pittaja Vataja Makshikopasarpanam Vrishanayoravadaranam Hritgraham Alashyam Vastibhedham Lohata Mamsopachaya Medhratoda Anidra Pratishyaya Amlika Kampa Saidhilyam Atisara Shoola Arochakam Jwara Badda purishatvam Avipaka Arochaka Shosha Kaphapraseka Vamadhu Udavartha Chardi Paridhumayanam Swasa 1 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 65. Nidra Daha Kasa Kasa Murcha Peenasa Nidranasa Panduroga Peeta vitmootranetrata Trishna VidbhedaVagbhata added the following vatajaprameha upadravas more than susrta. 1) Kantagraham 2) Kasa 3) Shosha 4) SwasaCharaka, vagbhata and the other author mentioned prameha pidaka but susruta coined themas madhumeha pidaka and allotted an individual chapter for the treatment of theseMadhumeha pidaka but both are same. These will develop as a complication to particularprameha was manifested.Prameha pidaka mentioned by different acharyas 4,5,6 S.No. Charaka Susruta Vagbhata Bhoja1) Sharavika Sharavika Sharavika Sharavika2) Kacchapika Kacchapika Kacchapika Kacchapika3) Jalini Jalini Jalini Jalini4) Sarshapika Sarshapika Sarshapika Sarshapika5) Alaji Alaji Alaji Alaji6) Vinata Vinata Vinata - 2 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 66. 7) Vidradhi Vidradhi Vidradhi Vidradhi 8) Masurika Masurika Masurika 9) Putrini Putrini Putrini 10) Vidarika Vidarika Vidarika These pidakas may develop even in the absence of prameha due to dushta medas(A.H.Ni 10/36)Prognosis of Prameha Pidaka: 7 Sharavika kacchapika Jalini These are with unbearable pain and develop on more fatty areas putrini vidarika Vinata Alaji Masurika These are bearable and develops on less fatty areas Sharshapika VidhradhiCharaka and Bhavamisra mentioned upadravas of pramehapidaka (Ch.17/109)1) Trishna 2) Kasa3) Mamasa sankocha 4) Moha5) Hikka 6) Mada7) Jwara 8) Visarpa9) Mamsa arbuda Prameha pidaka developed on guda, Hridaya, siras, Amsa, prusta, and Marmapradesha along with other upadrava to a patient with durbhalagni are incurable. 3 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 67. UPADRAVAS1) Trishna8 -due to excessive loss of kleda through mootra. pitta with its ushnaguna is the maindosha here9.2) Atisara - The longstanding vitiation of vata affects its sthana that is pakwasaya which inturn causes atisara.3) Paridhupana/daha - Manifest in kara and pada or sarvanga It is a pittaja nanatmaja vikara and is described as saravanga dahanamiva santapa104) Jwara - Mainly due to pittapradhanya. Here as a result of dhatukshaya and reduced vyadhikshamatva, jwara develops.5) Dourbalya - It is because of dhatvagnimandya which later results in ojokshaya, leads to dourbalya6) Arochaka - Maindosha involved is kapha but pitta also causes arochaka.7) Avipaka - is the ajeerna occurring as a result of agnimandhya by kapha8) Pootimamsapidaka11,12 - These pidakas manifest due to vitiation of mamsa, meda sonita with increased kleda result in development of pidakas, which develop shonita resulting in pooyavidhradhi.9) Bhrama- mainly due to pitta or vata or both and due to Rajodosha of Manas . This upadrava produced where gambhira dhatus like majja are involved13.10) Tama14- This develops during the terminalstage leading to death11) Shoola - due to vata along with majja involvement15. Udarashoola due to baddapurisha and udavarta.12) Kandu16 – due to kapha which has attained bahudrava avastha and due to excess sweda as a result of dusta medas13) Alasya – due to kapha and meda14) Pratisyaya17 – due to kapha, vata and ojokshya & pranavaha sroto dusti15) Shaithilya 18– The dhathukshaya leads to anibada samyogata (loss of compactness)16) Kaphapraseka – means excess lalasrava due to kaphabahudrava.17) Mamsopachaya19 – Characterized by mamsasanghata due to mamsapradosha18) Makshikopasarpana20 – this condition is the result of Tanumadhuryata and subsequent madhura bhava of sweda . 4 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 68. 19) Nidra – due to kapha dusti and Tamoguna .20) Kasa & Swasa – are result of pranavaha srotodusti by vriddha kapha & vata.21) Vrushanaavadharana – it may be result of kandu or kusta affecting vrishana22) Vastibheda – due to vatadusti23) Loulya – due to vyadhi prabhava and dhatukshaya.24) Shosha – occurs due to dhatukshaya and vataprakopa.25) Angamarda21 – udvestanamiva vedana due to vyanavatadustiReferences:1.CHA.NI 4/422.SU.NI 6/133.A.H.NI 10/224.CHA.SU 17/81-825.SU.NI 6/146.A.H.NI 10/25-267.CH.SU 17/102-1048.SU.NI 6/139.CHA.NI 4/4210.SU.NI 6/1311.CHA.NI 4/4212.SU.NI 6/1613.CHA.NI 4/3914.SU.NI 6/17,18,1915.CHA.CHI 6/716.A.H.NI 10/1817.SU.NI 6/1618.CH.NI 4/3219.SU.NI 6/1320.SU.NI 6/21 5 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 69. Complications of Diabetes mellitusThe complications of Diabetes mellitus can be acute or chronic. Acute complications are themedical emergency and need immediate medical management, other wise the patient may gointo coma and ultimately death may occur among the acute complications, hypoglycemia isthe most serious one.They can be classified as follows: I) Acute metabolic complications: i) Diabetic ketoacidosis ii) Hyperosmolar coma ii) Hypoglycemia II) Chronic complications: A) Angiopathic complications i) Microangiopathic – Retinopathy, cataract, glaucoma, Nephropathy, neuropathy ii) Macroangiopathic - coronary arterydisease, cerebrovascular disease B) Infections: Skin infections, pulmonary koch’s, urinary tract infections, vaginal candidiasis, gangrene of feet etc.Others – Gastroparesis, diarrhoea, sexual dysfunction.  Diabetic neuropathy occurs in approximately 50% of individuals with longstanding type-1 and Type-2 DM.  Diabetic peripheral neuropathy presents with distal sensoryloss, hyperesthesia, paresthesia & pain also occurs.  Diabetics have increased susceptibility to various infections such as tuberculosis, pneumonia, pyelonephritis, carbuncles and diabeticulcers.Diabetic ketoacidosis(DKA):-  DKA accounted for over40 percent of diabeticdeaths in the preinsulin era. A number of patients are already ketotic when diagnosed. Skipping injections of insulin is an Important antecedent. 6 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 70.  The clinicalpicture of DKA gradually develops over a period of 18hours to 3days. There is a marked increase in polyuria,thirst,weakness and painful musclecramps  Rapid deep and kussumal breathing is evident with increase in acidosis. Lethargy and drowsiness are followed by clouding of conciousness and confusionalstateDiabetic retinopathy:-  Retinopathy is one of the major riskfactors of DM. The incidence of blindness or poor vision is 20times more common in diabetic than in nondiabetics  Visual symptoms do not appear until late in the course of retinopathy.Excess of exudates,oedema or ischemia affecting the maculararea is a common cause of visualloss in NIDDM  Preproliferative retinopathy is more common in IDDM. This stage is heralded by the appearance of multiple cottonwool patches resulting from microinfarcts.Diabetic nephropathy:-  DN is a specific form of renaldisease. A major cause of death ,disability among diabetics,it accounts for 25-40percent of all cases with end stage renalfailure(ESRF)  Symptoms arise late in the course of nephropathy. Heavy proteinuria leads to oedema,hypoalbuminaemia and hypertension seen in 15-25percent.Diabetic neuropathy:-  Peripheral neuropathy is the commonest among longterm complications ofdiabetes.  Paraesthesia such as tingling,burning,numbness,coldareas,aches and pains may be the presenting symptoms of around 30 percent of patients 7 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 71. Sadhya Sadhyata SADHYA SADHYATA & SAPEKSHA NIDANA  Acharyas mentioned prognosis of prameha according to dosha. 1) Kaphajaprameha – Sadhya – due to Samakriya 2) Pittajaprameha – yapya – due to vishamakriya 3) vatajaprameha – Asadhya – due to virudhopakramata  Prameha with tulyadhushyata was mentioned as sukhasadhya i.e., easily curable  The four types of vataja pramehas are incurable owing to their great atyayikata (emergency) and the autogonism involved in the treatment  According to Vagbhata kaphaja prameha has if not treated gradually convert into pittaijaprameha and the both of may transform into vatajaprameha31) Sadhya / Yapya Vatajamehas 4 i) vatajamehas associated with either kapha or pitta ii) vatajameha. Due to gradual and secondary aggravation2) Kastasadhya – Doshavrutajanya 5Ch.Chi 6/13)3) Asadhya i) Dhatukshayajanya 6 ii) Kulaja – Madhumeha due to beejadosha iii)vatajameha / Madhumeha iv) Madhumeha with all poorvaroopas from earlystage. v) Madhumeha as a complication of other mehas that are untreated. vi) vatajameha / Madhumeha in which urine is syava and aruna varna  If the disease is developed due to vitiation of one dosha and the duration is less than one year, the disease is curable. If two doshas are involved, the disease can be 1 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 72. Sadhya Sadhyata controlled. If 3 or moredoshas are involved and associated with any group of complications is considered incurable.  According to susruta and vagbhata, madhumeha is itself a complication and it is a fact that madhumeha is a sannipata disease.References:-1.CHA.NI 4/342.SU.NI 6/83.A.H.NI 10/414.CHA.CHI 6/135.CHA.CHI 6/136. A.H.NI 10/21 2 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 73. CHIKITSA & PATHYAAPATHYAKRAMA In general chikitsa is the method adopted for eradication of the disease from the body. The aim of treatment is to restore swasthya. That means to normal functions of agni, dhatu, mala and maintain mental health. The primary importance of chikista lies in samprapti vighatana. General schedule of treatment of Prameha according to Dosha:- Dosha Name of the Therapy Kaphaja Prameha Samsodhana, lekhana, langhana, Apatarpana Pittaja Prameha Virechana, Santarpana, Samsamana Vataja prameha 1. If associated with Kapha, taila prepared from decoction of kaphaja pramehahara drugs should be given 2. If associated with pitta ghrita prepared from decoction of pittaja pramehahara drugs should be given. Charaka classified patients of prameha into two categories for treatment purpose.1 (cha.chi. 6/15 – 17& 18) 1. Stula – Samsodhana therapy was prescribed. 2. Krisha – Brumhana & Samsamana therapy was prescribed..While classifying the drugs susruta has given the following groups as useful in prameha2 (su.sutra 38 & 71,72,73) 1. Aragvadadi gana 2. Salasaradigana 3. Mushakadigana created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 74. 4. Triphala 5. Trikatu 6. Trapvadigana Since the pramehas are caused mainly because of the vitiation of Kaphadosha and the corruption of the medodhatu, the following groups of drugs which are stated to restore the normalcy of kapha and medas, may be used. 1. Salasaradigana 2. Varunadigana 3. Lodhradigana 4. Ushakadigana 5. Arkadigana The samsodhana kriya vamana, langhana adopted at appropriate times to cure kaphaprameha. The virechana kriya, Santarpana kriya, samanakriya cure pittajameha 3(cha.chi.6/23) After the sodhanakarma is completed the patient is to be subjected to santrapanakriya, although the prameha is a santarpanajanya roga, the patient should not be subjected to apatarpanakriya,because it may result in gulma,kshaya,suppression of urine.. The santarpanakriya should be carried out considering the strength of the agnibala. 4 (cha.chi.6/15) A krisha or emaciated patient who is not capable of with standing the purificatory procedures requires Brimhana kriya 5(cha.chi 6/15) The following oils may be used for snehakarma for a stula prameha. 1. Oil prepared with sarshapa, arista, Nikumbha and karanja. 2. Trikantaka taila.  A ghrita prepared out of Priyangvadigana drugs is to be used for vamanakriya. After samasarjanakriya is over, the patient is subjected to virechanakriya with appropriate dravyas. (su.chi.11/72)created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 75. Importance of Apatarpana:-Because of involvement of bahu and abadda mamsa & medas and dravarupa sleshma,apatarpana therapy was preferred.Importance of internal administration of oil in vatajameha:- 1. Charaka mentioned administration of taila and ghrita according to associated dosha for the treatment of vataja mehas (cha.chi. 6/35) 2. According to Astanga Hridaya chikitsa8, 12/9–10 “Vatolbaneshu snehamscha Prameheshu Prakalpayeth” For treatment of vataja prameha, internal administration of oils prepared from kaphaja and pittajapramehahara drugs was advised. 3. In Bhavaprakasha madhyamakanda, pramehaadhikaara internal administration of snehas in vatajamehas is advised. “Vatolbaneshu meheshu snehapanam visheshatah”. snehas prescribed in Bhavaprakasha. 1. Dadimadhya ghritam. 2. Dhanvantaram ghritam & tailam.Snehas prescribed in Yogaratnakaram 1. Simhamrutha ghritam. 2. Haridradi tailSamanachikista:-Samanachikista is indicated for a prameha patient who is fit and completed successfully thesodhanakarma and also who is not fit for sodhanakarma. created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 76. TREATMENT 9A) Goals of treatment of Diabetes:- Diabetes mellitus requires on going medical care as well as patient & familyeducation both to prevent acute illness and to reduce the risk of long-term complications. Thetherapeutic objective is to restore known metabolic derangements towards normal in order toprevent and delay progression of diabetic complications. The aims of treatment have beenvaried according to an arbitrary division of patients into three categories ranging from thosein whom symptomatic relief done seems the most appropriate or any attainable goal to thosein whom an attempt at maximal prophylaxis against future tissue damage seems desirable &possible.B) Treatment regimens:-i) Diet:- A well balanced nutritious diet remains a fundamental element of therapy. Inobese patient with mild hyperglycemia the major goal of diet therapy in weight reduction bycaloric restriction. 1. Intake of protein and carbohydrate according to the recommendation of American Diabetic Association. 2. Dietary fibres:- Food such as oatmeal, cereals and beans with relatively high soluble fibre content as staple component of the diet in Diabetes. These tend to retard nutrient absorption rates so that glucose absorption is slower and hyperglycemia may be slightly diminished. High soulbe fibre content in the diet may also have favourable effect on blood cholesterol levels. 3. Artificial sweetners:- Diabetes can use artificial sweetners like aspartame, sucralose, acesulfame. ii) Oral anti diabetic agents:- Oral drugs are used to lower blood glucose level by achieving following goals. 1. Drugs that primarily stimulate insulin secretion. 2. Drugs that after insulin action. 3. Drugs that principally affect absorption of glucose. created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 77. a) Sulfonylureas:- Mode of Action:- Stimulate production of insulin by increasing number of insulin receptors.Indication:- 1. Maturity onset diabetes of average weight not controlled by diet. 2. Diabetes or normal weight stabilized on insulin dosage not more than 30 units per day who have never been ketotic. 3. Failure to lose weight when this is indicated.Contra indication:- 1. Juvenile diabetes 2. Patients with ketosis 3. Obese adult onset uncontrolled diabetes. 4. Insulin taking diabetics. 5. Presence of renal, hepatic or cardio respiratory disease or alcoholic abuse.Adverse effects:- 1. Hypoglycemia 2. Dyspepsia 3. Skin rash 4. Facial flushing after ingestion of alcohol mostly ( chlorpropramide) 5. Cholestatic jaundice (chlorpropramide) 6. Blood dyscriasisDrug interactions with Sulfonylureas:-a) Increased hypoglycemic action:- –blockers, SulphonamidesPhenyl butazone, chloramphenicol, Cyclophospamide.b) Decreased hypoglycemic action:- Adrenergic compounds,Corticosteriods, oestrogen containing oral contraceptives, thiazideDiuretics, Phenytoin.Biguanides:-Mode of action:- Major effect is to increase peripheral uptake of glucose and in large dosesto delay or decrease intertinal absorption. Biguanides do not cause hypoglycemia. created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 78. Indication:- 1. Treatment of Maturity onset, diabetic who failed to lose weight on diet. 2. In Combination with Sulfonylureas – To enhance the inadequate or failing effects of sulfonylureas. 3. As an adjunct to insulin therapy in brittle diabetes whose blood sugar tends to swing unpredictably, one who is prone to ketosis and who develops hypoglycemia with only slight overdose of insulin.Adverse effects:- 1. Malaise, weakness, Drowsiness 2. Metallic taste in mouth, Anorexia, Nausea, dyspepsia, Diarrhoea 3. Lacticacidosisiii) Insulin:-Insulin is indicated for Type –1 diabetic as well as for Type–2 diabetic patients whosehypoglycemia does not respond to diet therapy either alone or combined with oralhypoglycemia drugs. Insulin injections are very much necessary in severe condition ofHyperglycemia.  There are various preparations are present depending upon their purity, solubility & species like( Human / Bovine) Four Principle types of Insulins are available:- 1. Ultra –short acting with very rapid onset & short duration. 2. Short acting with rapid onset of action. 3. Intermediate acting. 4. Long action with slow onset of action.The injection can be given with the help of syringes with half inched ultra fine needlesattached available in 1ml, 0.5ml, 0.25ml sizes.  For the injection any part of the body covered by loose skin can be used such as abdomen, thigh, upperarms, flanks & upper buttocks. iv) Insulin like growth factor –1 (IGF –I) therapy v) Aspirin therapy. ***** created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 79. References:- 1. CHA.CHI- 6/15-17&18 2. SU.SUTRA- 38/71,72,73 3.CHA.CHI- 6/23 4.CHA.CHI- 6/15 5.CHA.CHI- 6/15 6.SU.CHI- 11/62 7.CHA.CHI- 6/35 8.A.H.CHI- 12/9-10 9.MALINS CLINICAL DIABETES10.CHA.CHI 6/4611.CHA.CHI 6/20-2212.CHA.CHI 6/3913.CHA.CHI 6/4214.CHA.CHI 6/4615.SU.CHI 11/1616.SU.CHI11/3417.Dr.SHENOY,JOURNAL OF INDIANMEDICAL ASSOCIATION VOL.1 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 80. DRUG REVIEWDrug plays a vital role in the management of the disease.Due to this reason, it had beenplaced next to physician in the chatuspada.It has been well said by charaka is ‘a drug i.eunderstood perfectly is comparable to poison,weapon, fire and thunderbolt’. While theperfectly understood drug is comparable to ambrosia.  The best drug is that which cures the disease promptly and also preserves or sustains the helath of an individual.  The drug selected for present clinical study on prameha is “SOMARAJYADI CHURNAM”.SOMARAJYADI CHURNAM:-  Somrajyadi churnam is anubhutayoga to prove its scientific efficacy. I selected this yoga for trail.  It contains 4 ingredients. They are BAKUCHI,(Psoralea corylifolea) AVARTHAKI,(Cassia auriculata) MADHUNASHINI, (Gymnema sylvestris)SUNTI(Zingiber officinale). Most of the drug have tikta, kashayarasa,laghu , rooksha guna, katuvipaka.These are said to be kaphagna, mehagna, medogna.  Tikta, kashayarasa, laghu, rookshaguna produces rookshana effect and they are having opposite qualities to that kapha and medas. Hence they act as mehagna and kaphagna. When medas is reduced then the pressure on vapavahana is also reduced as it is the moolastana of medovahasrotas.  Bahudravatva is present in madhumeha. Tikta, kashayarasa produces shoshana effect and there by bahudravatva is reduced.When bahudravata reaching vasti reduces then prabhootamootrata, pratyatmalaxana of prameha also reduces.Pipasa which is depended on prabhootamootrata also reduces and there by somarajyadi churnam checks the pathogenesis of madhumeha.created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 81. INGREDIANTS:- 1. Bakuchi – 1 part 2. Avarthaki – 1 part 3. Madhushini – 1 part 4. Sunti – 1 partcreated by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 82. BAKUCHINomenclature of the drug:-Latin name - Psoralea corylifoliaFamily - PapillionaceaeSanskrit - Bakuchi,Sugandhikantaka,Somaraji.English - Babchi seedsTelugu - BavanchaluHindi - Babchi ,BhavajBengali - LatakantakiTamil - KarpokanethiPersian - VabkuchiSynonyms:-Bakuchi,Avalguja,Putiphala,Kustagni,Suparnika,Sisilekha,Kalameshi,Sita,ChandaParts used:-Seed,Seed oilPharmacodynamic principles of the drug:-Rasa - katu ,tiktaGuna - Laghu,RookshaVeerya – UshnaVipaka -katuKarmas:-Dosha - Vatakapha samanaDathu - RasayanaIndications:-Pramehahara,Madhumehahara,Mahakusta,Kshudra kustaIn Dhanvantari nighantu it is included in Guduchyadi varga.Charaka had included thisdrug in Tiktaskanda.Susruta had included this drug in Katuvarga.created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 83. Chemical composition:- Seeds contain an unsaponifiable oil.Chief active principles Ofthe seed is essential oil,resin,traces of substances of alkaloidal nature. Oil contianpsoralen,Bakuchiol,isopsoralencreated by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 84. MADHUNASHININomenclature of the drug:-Latin name - Gymnema sylvestrisFamily - AsclepiadaceaeSanskrit - Ajagandhini, Anyada, AvarthiniTelugu - PodapatriEnglish - Periploka of the woods,Small Indian ipecaunaHindi - Gurmar, MeshashringiUrdu - KakashingGujarathi - DhuletiBombay - Kavali, WakandiMarati - Bedaki, KalikardoriSynonyms:-Vishani, Ajashringika, Meshashringi ,SarpadarustrikaParts used:-Leaves, rootPharmacodynamic principles of the drug:-Rasa - Kashaya,TiktaGuna - Laghu,rookshaVeerya _ UshnaVipaka - KatuKarma:-Kaphavata shamaka, Sodhakara, Vedanahara ,Kaphagna, Mootrala.Indication:-Prameha. Kusta, Kasa, Krimicreated by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 85. Chemical composition:-Sundried leaves contain two resins, the resin insoluble in alcohol., the resin soluble inalcoholCalcium oxalatePararabinGlucoseCarbohydratesTartaric acidGymnemic acidLeaves on oral administration increased insulin levels in Alloxan rats(Pharmacologicalresearch communication 1981)created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 86. AVARTHAKINomenclature of the drug:-Latin name - Cassia auriculataFamily - CaesalpinaceaeSanskrit - AvarthakiEnglish - Mature tea tree,Tanners casseaTelugu - TangeduHindi - TarvarGujarath - AwalMaharastra - TaravedaBengal - TarwalMalayalam - AveeramSynonyms:-Avarthaki, Charmaranga, Peetakalaka, MayahariParts used:- Pulp,Root bark, Flowera, Leaves, RootPharmacodynamic principles of the drug:-Rasa - Kashaya, tiktaGuna - Laghu, rookshaVeerya - SeetaVipaka - KatuKarma:-Kapha pittahara,Tridoshagna,Stambhani,VrishyaIndications:-Prameha, Vrana,Natrabhishyanda,Atisaracreated by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 87. Chemical composition:-Fruit contains dark yellow volatile oil with honey like odour. Pulp contains sugar,gum,astringent matter,glutencreated by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 88. SUNTISunti is dried form of ardhraka.Nomenclature of the drug :-Latin name :- Gingiber officinale.Family :- GingideraceaeSanskrit :- NagaraTelugu :- SuntiEnglish :- GingerGerman :- InguuerUrdu :- ArdhrakaFrench :- GingembrePanjab :- AdaMalayalam :- AndrakamSynonyms:-Ardhraka , Shringavera, Katubadhra, Katukam, Katushringi, Katutoya, Visvabheshajam.Parts Used:- RhizomePharmacodynamic principles of the drug:- Rasa – Katu Guna – Laghu, Guru Veerya – Seeta Vipaka – MadhuraKarmas:Kaphavataharam, Deepana, pachana, vrishya,swaryam, jihwakantavishodanam.Indications:-Prameha, Amavata, Sopha, Gulmacreated by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 89. Gana:- Charaka included in deepaniya, triptigna, arshogna, stanyashodhana, soolagna,trishnanigraha, sirovirechana. Pippalyadi, triktatu(susruta).Chemical Composition:-Contains an aromatic, volatile oil.Camphene, phalladrene, zingeberene.Cineol, gingerol, oleoresin, gingerin.K-oxalate.created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 90. Materials and methodsMy dissertation entitled “A CLINICAL STUDY ON THE EFFECT OF SOMARAJYADICHURNAM IN THE MANAGEMENT OF PRAMEHA “ was carried out on 40 patientswho attended the OP and IP sections of Govt.Ayurvedic college/Hospital, Erragadda.HYD.during Jan 2007 to sep2007.Aim of study:-1.To evaluate the effect of “SOMARAJYADI CHURNAM”in patients suffering from stulaand krisha Madhumeha.2.To evaluate the effect of Somarajyadi churnam in NIDDM patients.3.Comprehensive literary study on prameha.1.Materials:- 1. patients 2. drugs 1. Patients :- 40 patients were taken for the study. 2. Drugs:- Somarajyadi churnam with sukoshna jalam2. Methods:-1.Location of study:- For the purpose of clinical trials 40 patients were selected from OP andIP department of Kayachikitsa of Dr.B.R.K.R Govt.Ayurvedic college/hospital,Erragadda,Hyderabad.2.Selection of patients:- 40 patients of different age groups were selected on the basis ofFBS&PLBSand corresponding urine sugars.Diagnostic criteria:-Criteria - 1:- patients presenting with pratyatma lakshana of Madhumeha –prabhoota andavilamootrata with mootra or tanumadhuryata with or without roopa are taken asMadhumehi. 1 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 91. Criteria -2:- FBS -80 -120mg/dl PLBS -140 -180mg/dlInclusion criteria:- patients fulfilling the following conditions were included. 1. patients between 30yrs -70yrs. 2. Stula and krisha Madhumehi. 3. Patients with Type 2DM with FBS greater than 120mg/dl and lesser than 180mg/dl and PLBS of more than 160mg/dl and less than 300mg/dl.Exclusion criteria:- The following patients were excluded from the study.1.patients below 30yrs.2.Jatapramehi3.IDDM patients4.Gestational diabetes5.DM secondary to drugs like corticosteroids or due to secondary disordersInvestigations:-The following investigations were done on a mandatory basis.1.FBS2. PLBS3.Urine sugarResearch design:-A single blind clinical trail with pre and post test design was adopted.Intervention:-Intervention was done with Somarajyadi churnam taken,the 4 drugs in equal parts and thepowder is given in 2 divided doses.i.e 6 grams in 2 doses with sukhoshnajalam before food.Assessment Criteria:-Any change in the following symptoms were noted and taken for assessment. 2 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 92. 1.Fasting blood sugar2.post prandial blood sugar3.post prandial urine sugar4.sweda adhikhya =>Sweating after heavy work and fast movement -- 0 => Profuse sweating after moderate work and movement --- 1 =>Sweating after little work and movement (stepping ladder etc…) ----2 =>Profuse sweating after little work and little movement ----3 =>Sweating even at rest or cold weather ----45.Prabhoota mootrata(quantity & in litres) 1.50 to 2.00 -0 2.00 to 2.50 -1 2.5 to 3.00 -2 3.00 onwords.. -36. Avila mootrata(Turbid Urine)  Crystal clear fluid -0  Failntly cloudy or smoky -1  Turbidity clearly present but newsprint easily read through testtube -2  Newsprint not easily read through testtube -3  Newsprint cannot be seen through the testtube -47. Stoulya assessed according to body mass index in (Kg/H in m2)  Undernourished (<20) -1  Normal weight (18.5 to 24.9) -0  Overweight (25 to 29.9) -1  Obese(30 to 39) -2  Morbid obesity (40 & above) -38. Dourbalya  Can do routine exercise/work -0  Can do moderate exercise with hesitancy -1 3 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 93.  Can do mild exercise only,with difficulty -2  Can’t do mild exercise too.. -39. Suptata (Numbness & Tingling sensation)  No Suptata -0  Karapadatala Suptata in continuous -1  Karapadatala Suptata in continuous But not severe -2  Karapadatala Suptata in continuous & severe -310.Daha(Burning sensation)  No daha --0  Karapadatala daha/supti in continuous –1  Karapadatala daha/supti in continuous But not severe –2  Karapadatala daha/supti in continuous & severe - 311.Bahvashita(polyphagia)  No Bahvashita as usual - 0  Slightly increased (1-2 meal) - 1  Moderately increased (3-4 meals) - 2  Markedly increased (5-6 meals) - 312.Trushna(Polydipsia)  Feeling of thirst 7-9 times/24 hours -0  Feeling of thirst 9-11times/24 hours -1  Feeling of thirst 11-13times/24 hours -2  Feeling of thirst > 13times -3 4 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 94. Observation OBSERVATION1. Age Incidence Age Group No of Pts % 31- 40 3 7.5% 41 – 50 12 30% 51- 60 20 50% 61-70 5 12.5% 31-40 41-50 51-60 61-702. Sex incidence Sex No of Pts % Male 26 65% Female 14 35% Male Female 1 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 95. Observation3. Marital Status Status No of Pts % Single 6 15% Married 34 85% Marital Status 34 35 30 25 20 Series1 15 10 6 5 0 Single Married4. Religion Incidence Religion No of Pts % Hindu 31 77.5% Muslim 4 10% Christian 5 12.5% Hindu Muslim Christian 2 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 96. Observation5. Socioeconomic status Status No of Pts % UP 0 0 P 5 12.5 LM 6 15 M 15 37.5 UM 10 25 R 4 10 Socioeconomic status 16 15 14 12 10 10 8 6 Series1 6 5 4 4 2 0 0 UP P LM M UM R6. Incidence of Addictions Habits No of Pts % Smoking 16 40 Tobacco 5 12.5 Alcohol 4 10 T/C 15 38.5 INCIDENCE OF ADDICTIONS 16 16 15 14 12 10 8 Series1 6 5 4 4 2 0 Sm oking Tobacco Alcohol T/C 3 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 97. Observation7. Dietary Habits Diet No of Pts % Veg 12 30 Mixed 28 70 Veg Mixed8. Deha prakriti Prakruti No of Pts % VP 6 15 PV 3 7.5 VK 14 35 KV 9 22.5 PK 3 7.5 KP 5 12.5 DEHA PRAKRITI 14 14 12 10 9 8 6 6 Series1 5 4 3 3 2 0 VP PV VK KV PK KP 4 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 98. Observation9. Satva Incidence Satvam No of Pts % Pravara 4 10 Madhyama 26 65 Avara 10 25 Pravara Madhyama Avara10. Status of Agni Agni No of Pts % Teekshna 14 35 Sama 0 0 Vishama 15 37.5 Manda 11 27.5 STATUS OF AGNI 16 15 14 14 12 11 10 8 Series1 6 4 2 0 0 Teekshna Sama Vishama Manda 5 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 99. Observation11. Bala Incidence Bala No of Pts % Pravara 8 20 Madhyama 26 65 Avara 6 15 BALA INCIDENCE 30 26 25 20 15 Series1 10 8 6 5 0 Pravara Madhyama Avara12. Family History Relations No of Pts % First Degree 18 45 Second degree 1 2.5 No familial history 21 52.5 First Degree Second degree No familial history 6 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 100. Observation 13. According to Chronicity Age No of Pts % Below 1 year 12 30 1 – 10 years 22 55 Above 10 years 6 15 ACCORDING TO CHRONICITY 25 22 20 15 12 10 Series1 6 5 0 Below 1 year 1 – 10 years Above 10 years 7created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 101. Observation ObservationsIn the present study, 40 patients suffering from prameha / Madhumeha, fulfilling theinclusion criteria were registered. Following are the detailed descriptive statistical analysis ofthe patients included in the study.Observations:-1. Age Incidence: The majority of the patients (50%) were reported in the age groups of 51-60 years followed by 30% in the age groups of 41-50 years, 12.5% in the age group of 61-70 years, 7.5% in the age group 31-40years.2. Sex Incidence: The majority of the patients (65%) were males compared to females (35%).3. Marital Status Incidence: 85% of patients were married only 15% of patients were unmarried.4. Religion Incidence: Maximum number of patients i.e., 77.5% were Hindus, 12.5% were Christians, 10% are Muslims.5. Socioeconomic status: It is observed that maximum patients belongs to middle class 37.5%, upper middle class is 25%, lower middle class is 15% and rich were 10%.6. Incidence of Addictions: Data depicts that maximum no of patients i.e., 40% were smokers, Habit of tea/coffee is 38.5%, Tobacco chewing is 12.5% and addiction to alcohol is 10%.7. Incidence of Dietary Habits: 70% of the patients were accustomed to mixed type of diet while 30% were vegetarians.8. Incidence of Dehaprakriti: A majority of the patients are vatakapha (35%) followed by 22.5% were Kaphavata, Kaphapitta 12.5%, vatapitta is 15%, Pittavata is 7.5%, pittakapha is 7.5%9. Incidence of Satva: Satva analysis of the patients revealed 65% of Madhyama satva, 25% avara, 10% pravara satva. 8 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 102. Observation10. Incidence of agni: Vishamagni is seen in 37.5%, teekshnagni 35%, Mandagni in 27.5%.11. Incidence of Family history: first degree family history is seen in 45% of the patients, second degree family history is seen in 2.5%, no familial history in 52.5%.12. Incidence of chronocity: 53% of the patients are having diabetes in 1-10 years, 30% of the patients are below 1 year, 15% of the patients are above 10 years. 9 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 103. EFFECT OF THE TREATMENT :The signs and symptoms recorded before the commencement of the treatment have beenreviewed finally at the end of the period of treatment in each case . The data of possessing thenumber of cases relieved, improved and unchanged. As regards to sign and symptom togetherwith the percentage are represented, the nearest round figures for the percentage were takeninto account to avoid fraction. Effect of Treatment Signs and Total No. of No. of CasesSN Symptoms Cases Relieved % Improved % Unchanged % 1 Prabhootamutrata 32 26 81% 4 13% 2 6% 2 Avilamutrata 6 4 66% 1 17% 1 17% 3 Atitrishna 28 19 67% 3 10% 6 23% 4 Atikshudha 30 16 54% 7 24% 7 24% 5 Mutramadharyata 34 21 61% 8 23% 5 16% 6 Tanohmadhuryata 22 16 74% 3 13% 3 13% 7 Suptata 18 12 66% 2 11% 4 23% 8 Dourbalya 33 24 73% 3 9% 6 18% 9 Karapadadaha 25 20 80% 4 16% 1 4% 10 Musclecramps 17 6 35% 5 29% 6 36% 11 Atisweda 12 10 84% 1 8% 1 8% 12 Stoulya 4 1 25% 2 50% 1 25% 1 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 104. Statement showing the blood & urine sugar levels & Weight Blood sugar before Blood sugar after Urine sugar before Urine sugar after treatment treatment treatment treatment Weight before weight after treatment treatmentS.No Regd No. FBS PLBS FBS PLBS FUS PLUS FUS PLUS 1 15481 172 245 110 146 1% 2 Nil Nil 59 58 2 15523 142 228 98 172 0.5 2 Nil Trace 67 67 3 506 145 198 124 142 0.5 1 Nil Nil 48 48 4 16426 110 200 114 162 0.5 1 Nil Trace 68 69 5 18233 195 300 105 199 2 2.5 Nil 1 62 62 6 21498 142 247 112 168 1 2 Nil Trace 63 62 7 25253 106 230 96 136 0.5 1.5 Nil Nil 74 73 8 25894 190 280 160 210 1 1.5 Nil 0.5 62 60 9 26543 140 194 100 140 0.5 1 Nil Nil 58 5910 26537 115 165 100 145 0.5 1 Nil Nil 44 4311 28437 120 223 80 130 1 1.5 Nil Nil 62 6212 29124 152 268 128 190 1 1 nil o.5 51 5113 29431 270 380 270 370 2 2.5 2 2.5 63 6214 42468 125 215 75 145 0.5 1 Nil Nil 72 7215 2799 155 230 105 165 1 1.5 Nil Nil 41 41 2 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 105. Blood sugar before Blood sugar after Urine sugar before Urine sugar after treatment treatment treatment treatment Weight before weight after treatment treatmentS.No Regd No. FBS PLBS FBS PLBS FUS PLUS FUS PLUS 16 3223 114 164 100 145 0.5 1 Nil 0.5 44 43 17 2723 140 300 118 174 0.5 2 Nil 1 64 64 18 2850 198 266 192 238 1 1.5 1 1.5 59 59 19 2797 145 205 114 156 0.5 1 Nil Nil 65 65 20 2798 166 222 88 142 1 1.5 Nil Trace 67 67 21 2853 118 192 108 177 0.5 1.5 Nil 1.5 55 54 22 2924 107 214 10 179 0.5 1.5 Nil 1 70 70 23 3056 141 215 140 215 0.5 1.5 0.5 1.5 79 79 24 2798 210 300 174 268 1.5 2 1.5 1.5 54 54 25 2622 230 294 106 157 1.5 2 Nil Trace 69 68 26 2597 258 305 202 305 2 2.5 2 2.5 57 57 27 2983 138 172 108 164 0.5 1 Nil 1 53 53 28 2384 155 235 98 148 1 1.5 Nil Nil 51 51 3 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 106. Blood sugar before Blood sugar after Urine sugar before Urine sugar after treatment treatment treatment treatment Weight before weight after treatment treatmentS.No Regd No. FBS PLBS FBS PLBS FUS PLUS FUS PLUS 29 2788 142 198 78 128 1% 1.5 Nil N 75 74 30 2580 181 264 95 153 1 1.5 Nil Trace 63 63 31 2932 160 290 172 216 1.5 2 1 2 40 39 32 3542 166 242 110 174 1 1.5 Nil 0.5 58 58 33 3849 128 176 114 158 0.5 1 Nil Nil 66 66 34 4057 170 260 140 200 1 1.5 Nil 1 59 59 35 4358 180 290 120 210 1 2 Nil 1 49 50 36 4298 140 230 100 160 0.5 2 Nil 1.5 64 65 37 4178 154 202 140 146 0.5 2 Nil Nil 52 52 38 3078 168 240 114 160 1 2 Nil 1 48 48 39 3199 132 218 168 238 0.5 2 1 2 69 69 40 4050 144 200 174 213 0.5 1.5 1.5 2 57 57 4 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 107. Results RESULTS TABLE1. Effect on Prabhoota Mutruta Mean Difference in Means BT AT 1.875 1.538 0.337 Effect on Prabhoota Mutruta 1.875 2 1.538 1.5 BT Mean 1 AT 0.5 0 BT AT 1 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 108. Results2. Effect on Avilamutrata Mean Difference in Means BT AT 1.5 1.25 0.25 Effect on Avilamutrata 1.5 1.5 1.45 1.4 1.35 BT Mean 1.3 1.25 AT 1.25 1.2 1.15 1.1 BT AT 2 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 109. Results3. Effect on Atitrushna Mean Difference in Means BT AT 1.286 1.158 0.128 Effect on Atitrushna 1.286 1.3 1.28 1.26 1.24 1.22 BT 1.2 Mean 1.158 1.18 AT 1.16 1.14 1.12 1.1 1.08 BT AT 3 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 110. Results4. Effect on Atikshudha Mean Difference in Means BT AT 1.333 1.25 0.083 Effect on Atikshudha 1.333 1.34 1.32 1.3 1.28 BT Mean 1.25 1.26 AT 1.24 1.22 1.2 BT AT 4 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 111. Results5. Effect on Karapadasuptata Mean Difference in Means BT AT 1.444 1.167 0.277 Effect on Karapadasuptata 1.444 1.6 1.4 1.167 1.2 1 BT Mean 0.8 AT 0.6 0.4 0.2 0 BT AT 5 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 112. Results6. Effect on Dourbalya Mean Difference in Means BT AT 1.400 0.200 1.200 Effect on Dourbalya 1.4 1.4 1.2 1 0.8 BT Mean 0.6 AT 0.4 0.2 0.2 0 BT AT 6 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 113. Results7. Effect on Karapadadaha Mean Difference in Means BT AT 1.2 0.85 0.35 Effect on Karapadadaha 1.2 1.2 1 0.85 0.8 BT Mean 0.6 AT 0.4 0.2 0 BT AT 7 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 114. Results8. Effect on Muscle Cramps Mean Difference in Means BT AT 1.152 0.1 1.050 Effect on Muscle Cramps 1.152 1.2 1 0.8 BT Mean 0.6 AT 0.4 0.1 0.2 0 BT AT 8 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 115. Results9. Effect on Atisweda Mean Difference in Means BT AT 0.833 0.4 0.433 Effect on Atisweda 0.833 0.9 0.8 0.7 0.6 0.5 0.4 BT Mean 0.4 AT 0.3 0.2 0.1 0 BT AT 9 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 116. Results10. Effect on Stoulya Mean Difference in Means BT AT 3 2 1 10 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 117. Results11. Effect on Tanohmadhuryata(FBS) Difference in S.D S.E Variance Mean Means BT AT 32.7 1.02 1.08 78.74 156.6 123.9 11 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 118. Results12. Effect on PLBS Difference in Mean S.D. S.E. Variance Means BT AT 56.32 3.04 0.48 288 237.42 181.1 Effect on PLBS 237.42 250 181.1 200 150 BT Mean AT 100 50 0 BT AT 12 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 119. Results13. Effect on Mutramadhuryata Mean Difference in Means BT AT 0.875 0.288 0.587 Effect on Mutramadhuryata 0.875 0.9 0.8 0.7 0.6 0.5 BT Mean 0.4 0.288 AT 0.3 0.2 0.1 0 BT AT 13 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 120. ResultsCriteria for assessment of results:-Taking into consideration of percentage of relief in clinical symptoms and clinicalparameters after the treatment.The total effect of therapy was assessed as follows. Result Criteria for assessment Cured 75% to 100% relief in signs and symptoms of prameha, was taken as cured. Moderate relief More than 50% to Less than 75% relief in signs and symptoms were taken as moderate relief Mild relief Patients with improvement in b/w 25 to 50%, in signs and symptoms were considered as mild relief No relief No change or less than 25% improvement in signs and symptoms were considered as no relief. 14 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 121. Results RESULTS The basis for the assessment of results was the response shown by the patients regardingin the signs and symptoms of Madhumeha along with improvement of laboratoryinvestigations. The overall effect of therapy is as follows.Result Number of Patients percentageCured 18 45%Moderate relief 14 35%Mild relief 6 15%No relief 2 5%Cured result was observed in 18 patients i.e 45% where patients got relief from 75% to 100%of symptoms after the treatment. Moderate relief was in 14 patients i.e 35%, where patientsgot relief from 50% to less than 75% of relief from 25% to less than 15% and mild relief wasseen in only 6 patients of all 2 patients i.e 5% where patients got relief less than 25% ofsymptoms after completion of treatment. 15 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 122. Discussion DISCUSSION Madhumeha is a widely evidential disease since ancient age till today and evidence isincreasing day by day with lips and bounce with their complications and complexes. Diabetesmellitus is similar to Madhumeha which is subtype of Vataja Prameha. Madhumeha is a disease in which the patient voids excessive quantity of urine havingconcordance with Madhu i.e., of Kashaya and Madhura taste, Ruksha texture and honey likecolor. In Madhumeha, mainly the Vata and Kapha are predominant though the disease isTridoshakopanimittaja. The Vata may be provoked either directly by its etiological factors orby the Avarana of its path by Kapha, Pitta or other Dushyas. So, Vagbhata has classified theMadhumeha into two categories i.e., Dhatuapakarshanajanya Madhumeha and AvarnajayaMadhumeha. Avaranajanya pathogenesis occurs due to etiological factors mainly concordantwith Kapha and Pitta, but the vitiation of Vata occurs due to Avarana.Dhatuapakarshanajanya pathology occurs due to depletion of Dhatus, because of the Vatavitiating etiological factors. Acharya Charaka has classified Madhumeha intoSantarpanajanya and Apatarpanajanya. The Apatarpanajanya Madhumeha can be correlatedwith Dhatuapakarshanajanya Madhumeha, while the Santarpanajanya Madhumeha correlateswith Avarnajanya Madhuemeha. Therefore, this disease may be caused both by the undernutrition as well as by over nutrition. The first type of madhumeha is considered to beAsadhya and no specific remedy is recommended for this. But the later type has been told asKrichhra Sadhya and can be cured with extensive measurements. The main pathophysiology behind Diabetes mellitus is the disturbed metabolism ofthe carbohydrates, fats and proteins due to either absolute or relative lack of Insulin. TheDiabetes mellitus has been broadly classified as type 1 and type 2. The type 1 Diabetesmellitus patients are usually asthenic in body constitution and suffer from it in the early yearsof life, while the type 2 Diabetes mellitus patients are usually obese and suffer from it in their40’s. The type 2 Diabetes mellitus patients can be managed easily by hypoglycemic drugswhereas in type 1 Diabetes mellitus patients besides hypoglycemic drugs, the Insulin therapyis obscure. So the type 1 diabetes mellitus is nearer to Dhatuapakarshanajanya Madhumehawhile the type 2 Diabetes mellitus resembles to Avaranajanya Madhumeha.  Prameha such a disease caused predominance by vatadosha though all the 3 doshas also take part besides ten dooshyas i.e., Rasa, Rakta, Mamsa, Medo, Majja, sukra, ojus, Lasika, Vasa, Kleda in resulting the disease. 1 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 123. Discussion  While deciding the inclusion criteria, the terms stula and krisha Madhumeha have been used in a much broader sense than to mean only abnormal states conveyed by them. Krusha covers the patient who were normal to under weight. The word stula covers the patients from normal to obese.  Somarajyadi churnam is anubhoota yoga. This preparation contains 4 drugs. They are Bakuchi, Madhunashini, Avarthaki, Sunti. These drugs possess hypoglycemic, neuroprotective, Medogna, Mootra Sangrahaneeyae, Rasayana, Deepana and pachana properties.  Patients who attended O.P and I.P sections of Dr. BRKR, Govt Ayurvedic hospital Hyd were selected randomly, irrespective of the sexes, fulfilling all the criteria for inclusion and exclusion.  The range of Fasting and post prandial blood sugar was fixed between 120mg/dl – 180mg/dl and 160mg/dl to 300mg/dl respectively considering the safe limits of the disease. This was done to avoid putting the patients into the risk of developing complications as in the case of higher sugar levels.  Pre and post test design was planned and the patients were asked to take 6gms of somarajyadi churnam half an hour before food twice daily. All the drugs are dried and fine powedered.  The pratyatma lakshana of Madhumeha including Tanumadhuryata and mutramadhuryata along with other common symptoms were taken for assessment. This included the WHO approved American Diabetic association diagnostic criteria. The symptoms were graded and scored.  Maximum number of patients belonged to the age group of 51-60 years Which supports the views that the prevalence of type 2 DM is more in the middle to old age. Males are more in the clinical study compared to females. Hindus were 77% which indicative of demographic situation of this region. More number of patients was from middle to upper middle class. This finding reflects the pattern of patients coming to the hospital of this institute according to their socioeconomic conditions. The incidence was also more in people who were involved in professions Who did not involve much physical work like businessmen, shop owners and so on.  Observation of addition in the present study revealed that maximum number of patients i.e., 40% were addicted to smoking, 10% patients were addicted to alcohol, 2created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 124. Discussion tobacco chewing 12.5%, tea / Coffee 38.5%. All of these conditions decreased the natural immunity and also provoke the vata to manifest the disease prameha earlier and with severity majority of the patients i.e., 55% were suffering from the disease for 1-10 years. 45% of the patients confirmed the family history of Madhumeha which reflects the fact that a familial trait is associated with the disease. Majority of the patients are vatakaphaprakruti. Majority of the patients were of Madhyama to avarsara which indicates the involvement of dhatus in Madhumeha.  On treatment with Somarajyadi churnam, the following results were observed on the subjective symptoms.1. Effect on Prabhootamootrata: Mild to severe prabhoota mootrata (both in terms of quantity and frequency) was seen in 80% of patients, 65% relief was observed in prabhutamutrata. This relief in prabhutamootrata may be due to the mutrasangrahani action of Avarthaki and kashaya Rasa Rookshguna of Madhunashini, avarthaki which exerts stambhana action. It may be possible that drug has acted upon apanavayu and corrected its vitiation.2. Effect on Avilamootrata: Only in 15% of patients avilamootrata is noted, relief was 10%.3. Effect on Trushna: Mild to severe Trushna was seen in 70% of patients and mild to maximum improvement was seen in 50% of patients. The relief in trushna may be because of kaphapitta samaka effect of Avarthaki, Bakuchi and stambhana action of avarthaki and also due to Trishnanigrahana action of sunti.4. Effect on Stoulya: 25% patients were obese 40% of patients were over weight for their age and height. The rest has normal weight. 25% of weight reduction is seen. This is due to tiktarasa, kashaya rasa katu vipaka and laghu, rooksha guna and they are having opposite qualities to that of kapha and medas . Almost 60% of the patients had an adipose abdomen, which corroborates the fact that Indians have inherited condition called central obesity (i.e., for a given body mass index, Indians have a higher amount of fact than other races). There have been strong evidences implicating this condition for the development of DM. .5. Effect on Sweda adhikhya: Atisweda was seen in 30% of patients and 25% of improvement was observed .vitiation of pittadosha causes swedaatipravritti. This 3 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 125. Discussion action may be due to kashaya Rasa and stambana of avarthaki Madhunashini might have checked the excessive sweating.6. Effect on Dourbalya: Mild to severe Dourbalya was seen on 83% of patients, improvement was seen in 60% of patients. Rasayana and anti oxidant properties of Bakuchi, prevent dhatu depletion. The pramehagna properties of the ingriedients of somarajyadi Churnam may facilitate the entry of glucose inside the cell for utilization, thus providing energy to the cells and the patient gets relief in Dourbalya.7. Effect on Karapadadaha: Mild to serve Karapadadaha was seen in 62% of the le patients and mild to moderate improvement was seen in 50% of the patients relief in Karapadadaha may be due to Kaphapitta samaka action of avarthaki, Bakuchi and seetaveerya action of Avarthaki.8. Effect on Karapadasuptata: 50% of the patients has mild to severe. Karapadasuptata and mild to maximum improvement was seen in 80% of them. This may be due to antidiabetic action of Bakuchi, Avarthaki, Madhunashini provided the relief in Karapadasuptata.9. Effect on Bahvashi: Mild to moderate Bahvashita was seen in 75% of the patients 16% improvement was observed. This is due to Kaphapitta samaka action of Bakuchi, Avarthaki. This may be the reason for the relief in atikshudha.10. Effect on Muscle cramps:Mild to moderate muscle cramps was seen in 85% of the patients 35% improvement was observed. This is due to vatahara action of Bakuchi and sunti. The following were the changes observed the objective symptoms after treatment:1. Effect on Fasting blood Sugar(FBS): The mean FBS score before treatment was 146.6 and after treatment 123.92. Effect on post prandial blood sugar(PPBS): The mean difference between before and after treatment is 56.6. Effect on FBS and PPBS may be due to the pramehagna action of Bakuchi, Avarthaki, Madhunashi by which FBS and PPBS have reduced.3. Effect on Urinesugar: The mean difference in the before treatment and after treatment was 0.58%. This relief obtained could be due to the Mehagna property of the Ingriedients of samarajyadi churnam. 4 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 126. Discussion It was observed that the symptoms that were mild returned back to normal after 2 months of treatment but those that were moderate came down to mild and severe symptoms reduced to moderate intensity. Moreover, the severity and number of symptoms seemed to be directly proportional to the increase in serum glucose levels at the upper limit of the range Usually presented with moderate to severe symptoms than those at the lower limit of the range. Even the number of symptoms varied in that manner. The most of the drugs of Somarajyadi churnam have Tikata, Kashaya Rassa, Laghu,Rookshaguna and Katuvipaka. These are said to be Kaphagna, Mehagna, Medogna andMootrasangrahaneeya. Tikta, Kashayarasa, Laghu, rookshaguna produces rookshana effect and they arehaving opposite qualities to that of kapha and medas. Both medas and kapha being the mainentity of Samprapti, thus by breaking the samprapti treats the disease. Hence they act asmehagna and kaphagna. Bahudravatva will be present in Madhumeha. Tikta, Kashayarasa present in this yogaproduces shoshana effect. Bahudravata will be reduced by the absorption of excessive fluidfrom the cells. When bahudravatra of Madhumeha also reduces. Pipasa which is dependenton Prabhutamootrata also reduces. Somarajyadi churna reduces medas there by stoulya and asit mutrasangrahaneeya, absorbs bahudrava and hence reduces polyuria, polydipsia andthereby checks the pathogenesis of prameha. 5 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 127. CONCLUSION 1. Madhumeha mostly affects the individuals after the age of forty years. 2. Sex, Marital status, Religion, Social status bear no relation in causation of Madhumeha. 3. Tendency towards Sedentary lifestyle, increased stress and strain are main contributing factors in the establishment of the disease. Tendency towards sedentary life style and faulty dietary habits, leads to vitiation of kapha and meda leadin g to Madhumeha. 4. Kapha is the arambhaka dosha and vata is preraka. 5. Etiological factors here mainly related with kapha pitta and meda vitiation but due to avarana vata also get vitiated. 6. Apathya nimittaja nidanas influence more to cause Madudmeha in stoulya. 7. The study confirms the dominancy of kapha dosha,meda medodhatu dusti,Rasavaha and Medovaha srotodusti in the pathogenesis of Madhumeha. 8. Madhumeha is a disease characterized by prabhoota avila mootrata, Tanu madhuryata and Mootra madhuryata. 9. The Madhumeha has been discussed in Prameha roga as a kind of vatika Prameha. 10. It can be concluded that on the basis of symptomatology of Madhumeha, the disease Madhumeha can be correlated with Diabetes mellitus. 11. Dhatu apakarshana and Ojo dushti is an invariable manifestation of the disease. 12. On the basis of result of the therapy it can be deduced that Asanadi qwatha provided relief in the chief complaints, associated signs and symptoms & was effective in reducing the blood sugar level. The mean difference in FBS was 32.7 and PPBS 56.32 13. The present study was carried on small sample for a limited time with out alteration in their routine dietary and physical and it showed encountering results. However to be more confirmative further study should be conducted on large sample for longer duration with diet and exercise.created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 128. Summary SUMMARY The frame of the dissertation work entitled “A clinical study of the effect ofsomarajyadi churnam on Prameha” may be summerised as follows: The entire thesis is mainly divided into six parts each part comprises different chapteras follows:Part – I: Introduction, Historical background of the Disease.Part - II: Shareeram.Part – III:Ayurvedic disease review was explained under subheads Nidana, Purvarupa, rupa, samprapti,vyavacchedaka nidana, Saadhyasaadhyata, upadravas, chikitsa yojana and pathyapathya,Modern disease reviews was explained regarding in definition, classification, pathogenesis,prediabetic state, signs and symptoms, treatment and lifestyle management of diabetesmellitus.Part- IV:The drug and its selection.Part-V;Method and material, observation and result.Part VI;Discussion, conclusion, summary, bibliography and casesheet were included.INTRODUCTION :The history of Madhumeha with special references to Vedas and Ayurveda are explained.SAREERAM :The Anatomy of pancreas and the importance of agni in Madhumeha were explained.The mode of action of insulin in Diabetes is explained.NIDANA:Nidana has been classified and the types have been explained.The basic etiology involved in the disease, has been summed-up. 1 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 129. SummaryPOORVA ROOPA:A table has been given presenting the poorvaroopas of the disease given in the classics ofAyurveda.ROOPA:A generalized lakshna of disease has been stated according to different Ayurvedic classics.The lakshnas of sahaja and apathyanimittaja prameha have been discussed in detail accordingto Susrutha.SAMPRAPTI:The role of nidana, doshas, dushyas in the process of samprapti were explained in detail.The samprapti in general with reference to kriyakalas have been stated.CLASSIFICATION:The division of 20 varietes of pramehas have been discussed in detail according toAyurvedic classics.The classification of Madhumeha according to Susrutha, Vagbhata have been referred.UPADRAVAS AND ARISTA LAKSHNAS:The upadravas in general and prameha pidakas in particular have been classified and thetypes have been discussed.Aristalakshnas and prognosis have been explained.SADHYAASADHYATA & SAPEKSHA NIDANA:General information for the sadyaasadhyata of disease have been discussed in detail withspecial reference to Madhumeha.Differential diagnosis of Madhumeha has been stated in detail.CHIKITSA & PATHYAAPATHTA KRAMA:There is a scope for the treatment by samsodhana and samsamana for the disease has beenexplained.Tha factors of pathya and apathya are discussed in detail according to Ayurvedic classics.THE DRUG AND ITS SELECTION:The Drug has been described.The criteria for the selection of the drug for the present study has been stated. 2 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 130. SummaryCLINICAL STUDY:Method and material:-The method of preparation of medicine and the method of treatmenthave been explained.The number and nature of cases taken up for the study has been stated.The method of observation has been explained and criteria for the assessment have beenstated.Age and sex incidence etc. were tabulated and discussed.The blood and urine sugar levels were recorded and tabulated. Mean, SD, SE, CHI-SQAREtest calculated.The results of each clinical trial is tabulated.The conclusions were drawn and are recorded.DISCUSSION:Total study on the disease, the drug and clinical work has been reviewed in a brief discussion.The efficacy of the drug as observed in the clinical study has been stated and conclusionsgiven. 3 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 131. BIBLIOGRAPHY1. Syar – Raja Radhakantha Deva – Bhaduryeana, Sabdakalpadruma, Nag Publishers New Delhi, 1987,2. Pandit Narahari, Raja Nihantu, Dreavyaprakashika, Hindi Vyakhaya by Indradev Tripathi, II Edition, 1998; Krishnadas Academy, Oriental Publishers and Distributors, Varanasi, Uttar Pradesh..3. Charakastanashatkam, printed& edited by Sri. P.K.M Sasry,IIedition, Rajahmundry 19784. Amara kosha— Raja Radhakantha Deva — Bhaduryeana, Sabdakalpadruma, Nag Publishers New Delhi, 1987,5. Kishore kumar., et al; Effect of Nisha amalki in Madhumehi (unpublished Doctoral dissertation, Rajiv Gandhi University of Health Sciences Karnataka, Bangalore, 1999).6. Charaka samhita(Telugu version) all parts published by V.R.S Sastulu&sons, printed at Vavilla press,Madras.1935,19397. Susruta Samhita(Telugu version) all parts published by V.R.S Sastulu&sons,printed at Vavilla press, Madras 1969, 1953 .8. Damjanov Ivan, Linder James; Ed Anderson’s pathology; 10th Edition, 1996; published on behalf of Mosley — year book Inc. St. Luis, Missouri. Page no.20469. Davidson, Sir Stanley; Davidson’s principles and practice of medicine, ed C. R. W. Edwards et al; 17th International Student edition 1995, reprinted 1998, Churchil Livingstone, Edinburgh10. Harrison T. R. et al; Ed. Harrison’s principles of Internal Medicine; Vol. I & II, 14th International Edition, 1998; published by McGraw-Hill Book Co. Singapore. Page no. 206211. Astangahridaya(Telugu version) all parts published by V.R.S Sastrulu&sons,printed by V.Venkateswarulu shasrulu at vavilla press, Maras 1954,1950,1948.12. Kashyapa, Kashyapa Samhita, Vrudrajivikiya Tantra Va, Pandit Hema Raj Sharma, Choukambar Sanskrit Sansthan 2000, Pp 36413. Harrison T. R. et al; Ed. Harrison’s principles of Internal Medicine; Vol. I & II, 14th International Edition, 1998; published by McGraw-Hill Book Co. Singapore 1 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 132. 14. Godbole, Aravinda S., Taiwalkar N. G.; Diabetes mellitus for practitioners. First edition, 1974; published by Bombay Popular Prakashan, Mumbai, Maharastra15. Madhava Nidanam, Uttarardha with Madhukosha Vyakhya by Vijayarakshita and Srikantadutta, Vidyotini tika by Ayurvedacharya Sri Sudarshana Shastri; 29th Edition, 1999; Chaukhambha Sanskrit Samsthan, Varanasi, Uttar Pradesh. Page no. 18516. Dr.virendra keshava shah, Diabetes millietus in Indian medicine, 1st edition 1985 Published by choukambha orientalia varnasi. Pp 616.17. Shenoy, Journal of Indian medical associationVol.100 No. 3 march 200218. Bhaishyaja Ratnavali Choukambha publication 2001 Varanasi. Pp 73819. Dr.J.L.N.Shastry, Dravya guna vignan Choukambha publication, 2005, Varanasi, 218.20. Charaka chikitsa stanam, printed by sri.P.K.M Sastry.III edition Rajahmundry, 197721. Sarangadhara samhita(Telugu version) published by V.R.S Sastrulu& sons vavilla press Madras 1952.22. Bhavaprakasha(Telugu version) published by M.Venkata sasry printed at panduranga works,vijayawada 1959.23. Yogaratnakaram(Telugu version) vol II by Y.Srinivasa charyulu IIedition 194024. Basavarajeeyam(Telugu version) by Vaidhya Basavaraju published by Konda Sankaraiah, Vani press , 195725. Charaka samhita with commentary of Chakrapani dutta, edited by Ganga sahayapandey Chowkambha publication, Varanasi 197026. Charaka samhita with commentary of Gangadhara C.K. Sen& co., Calcutta 197027. Susrutha samhita with commentary of Dalhana charya, edited by Yadavji Trikamji , atNirnaya sagar press, Bombay 193128. Susrutha samhita with commentary of Chakrapanidutta, edited by Nadkishore sharma193129. Astangahridaya with commentaries of Arunadutta & Hemadri, edited by Hari sastry,printed at nirnayasagar press, Bombay 193930. Astangahridaya with Indu commentary published by Vaidhya saradhi press, Kottamz195631. Astangasangraha by Vagbhata, published at Nirnayasagar press, Bombay 1951 2 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 133. 32. Bhela samhita edited by Girijadayal sukla published by Chowkambha publication,Varanasi 195933. Harita samhita by Harita printed at Sri Venkateswara press, Bombay 184934. Kashyapa samhita by Vrudda Jeevaka, Chowkambha publication, Varanasi 1953.35. Dhanvantari nighantu(Hindi) by Dr. P.V. Sharma, published by Chowkambha Sanskritsamstana, Varanasi.1975.36. Ayurveda sarasangraham by Baidhtanath Ayurvedabhavan LTD. Printed at Swathienterprises, Nagpur 1978.37. Dr. K.M.Nadkarni’s Indian Materia medica by P.K Nadkarni,III edition ,1954.38. Indian Medicinal plants by R.N Chopra, S.L Nayar,I.C Chopra 195639. Medicinal plants by S.KJain published by national book trust, Delhi. 196840. Indian medicinal plants by Kirthikar & Basu 1975.41. Introduction to Kayachikitsa by C.Dwarakanath Chowkambha Sanskrit samstana,Varanasi 195942. Vachaspatyam by Taranatha Bhattacharya 196243. Prices text book of practice of Medicine, editedby Sir.Ronald Bodly scott 10 th edition1966.44. Davidson’s principles&practice of medicine 12 th edition edited by John Macleod 1977.45. Principles and practice of medicine by Harvey and others 18th edition Amerind publishedcompany pvt. LTD 1974.46. Cecil text book of medicine bi Cecil 15th edition47.Greys Anatomy by Henry Gray, 35th edition 1973.48. Introduction to medical sciences by W.Boyd49.Text book of pathology by Stengel.50.Text book of pathology by Mc. Callum51.Treatment of Diabetes mellitus by P.Joslin, F.Rost, P.White52.Dorlands illustrated dictionary by Saunders53.Analysis & interpretation of symptoms by Mac.Bryde54.Pathlogy of internal disease by W.Boyd 3 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 134. 55.History of Diabetes mellitus56.Malin’s clinical diabetes57.Journal of research in Indian medicine 6:2:197158.Journal of research in Indian medicine 6:2:197259.Nidana chikitsa hastamalika - Ranajit Roy desai.60.Kayachikitsa - Ramaraksha pathak61.Vaidhyaka sabdasindu – Kaviraja Nagendranath sen62.Amarakosha - Parameshwara63.Kaiyyadeva nighantu - Kaiyyadeva krita64.Nigantu Adarsha - Vaidhya Bapalal65.Sabdakalpadruma - Raja Radhakantadeva66.Sabdastomamahodadhi-Tarachandra Bhattacharya67.Dravyaguna vignana - Yadavjitrikamji acharya68.Review of medical pathology - Ganong 4 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 135. MASTER CHARTS.No Name Age Sex 1 2 3 4 5 6 7 8 9 10 Total Relieved Result BT + + + + + + + 7 86% Cured 1 Ravinder Rao 54 M AT + 1 BT + + + + + + + 7 72% Mod. relief 2 Kahajamiye 50 M AT + + 2 BT + + + + + 5 100% Cured 3 Venkata Reddy 39 M AT - - - - - 0 BT + + + + + + + 7 57% Mod. Relief 4 Subba Laxmi 59 F AT + + + 3 BT + + + + + 5 40% Mild.relief 5 Narasimha Rao 49 M AT + + + 3 BT + + + + 4 75% Mod. Relief 6 Narsimhulu 56 M AT + 1 BT + + + + + + + 7 86% Cured 7 Kasturi 62 F AT + 1 BT + + + + + 5 80% Cured 8 Ranga 54 M AT + 1 BT + + + + + 5 60% Mod. Relief 9 Rajya Laxmi 56 F AT + + 2 BT + + + + 4 75% Mod. Relief 10 Ramanjulu 69 M AT + 1 BT + + + + 4 75% Mod. Relief 11 Ravi 55 M AT + 1 BT + + + + + + 6 67% Mod. Relief 12 Sathya 46 M AT + + 2 BT + + + + 4 80% Cured 13 Laxmi Reddy 48 M AT + 2 BT + + + + + + 6 50% Mild.relief 14 Ramaswamy 52 M AT + + + 3 BT + + + + 4 50% Mild.relief 15 Sri laxmi 47 F AT + + 2 BT + + + + 4 50% Mild.relief 16 Kupppuswamy 55 M AT + + 2 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 136. S.No Name Age Sex 1 2 3 4 5 6 7 8 9 10 Total Relieved Result BT + + + + + 5 60% Mod.Reilef 17 Jayalaxmi 60 F AT + + 2 BT + + + + 4 50% Mild.Relief 18 Somaiah 57 M AT - + - + 2 BT + + + + + + 5 80% Cured 19 Sitamahalaxmi 49 F AT + 1 BT + + + + 4 100% Cured 20 Radamma 71 F AT - - - - 0 BT + + + + 4 75% Mod. Relief 21 Prabhakar Rao 65 M AT + 1 BT + + + + 4 75% Mod. Relief 22 Bhikshapathy 46 M AT + 1 BT + + + + + 5 80% Cured 23 Narasimhulu 51 M AT + 1 BT + + + + 4 50% Mod. Relief 24 Jyothiprakash 40 M AT + + 2 BT + + + + + 5 100% Cured 25 AVRJ Raju 42 M AT - - - - - 0 BT + + + + + 5 80% Cured 26 Suresh 49 M AT + 1 BT + + + + + 5 60% Mod. Relief 27 Maqbool 58 M AT + + 2 BT + + + 3 67% Mod. Relief 28 Jagadeswari 46 F AT + 2 BT + + + + + 5 80% Cured 29 Sriramurthy 60 M AT + 1 BT - - - + - - - + + + 4 25% No Relief 30 Sreebabu Rao 60 M AT - - - + - - - + - + 3 BT + + + + 4 75% Mod.Relief 31 Subramanyam 63 M AT + 1 BT + + + + + 5 0 No relief 32 Kanaka Durga 47 F AT + + + + + 5 BT + + + + + 5 80% Cured 33 Nagaraj 52 M AT + 1 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 137. S.No Name Age Sex 1 2 3 4 5 6 7 8 9 10 Total Relieved Result BT + + + + + 5 100% Cured 34 Sandhya 60 F AT - - - - - 0 BT + + + + + + + 7 72% Mod. Relief 35 Nilina 45 F AT + + 2 BT + + + + 4 25% Mild relief 36 Prabhakar 50 M AT - + + + 3 BT + + + + + 5 80% Cured 37 Ramasastry 62 M AT + - - - 1 BT + + + + 4 25% Mild 38 Vinod 40 M AT - + + + 3 BT + + + + + 5 80% Cured 39 Raja 46 M AT + 1 BT + + + + 4 100% Cured 40 Swapna 40 F AT - - - - 01) Prabootamutrata 2) Avilamutrata 3) Atitishna 4) Atikshuudha 5) Suptata 6) Dourbulya 7) Karapadadana 8) Musclecramps9) Stoulya 10) Atisweda created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 138. A Clinical Study of the Effect of Somarajyadi Churnam In the Management of Prameha. By Dr. KAVITHA REDDY B.A.M.S Under the Guidence of Dr.V.VIJAYA BABU M.D.(Ay) Reader/Professor K.C Post Graduate Dept of KayachikitsaDr. B.R.K.R. Govt. Ayurvedic College, Hyd. created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 139. Charaka in his Charaka samhita has mentioned thesweetness of urine in addition to polturia.Susrutha in 500 A.D described the disease asMadhumeha with symptoms of foul breath,voracious appetite and languor.Generally Madhumeha is known as a “richmansdisease”Prameha is a chronic disease of relapsing nature. Thedisease is also a debilitating one. created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 140. HISTORYCharaka explained the etiology, pathogeness, symptomatology,complications and treatment modalites in detail in Nidana 4th and chikitsa6th chapter. While in sutra sthana 17th chapter he described theavaranajanya pathogenesis of Madhumeha, this is the unique contributionof this treatise.Susruta also explained Prameha in elaborative manner with separatechapter on its management. He used ‘Kshoudrameha’ synonym toMadhumeha in nidana 6th chapter.Harita mentioned it as papajanya and enumerated 13 types of prameha.Bhela described prameha is of two types.Kashyapa mentioned the symptoms of prameha child in vedanadhyana andnoted the disease as chirakari. created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 141. SHAREEM The pancreas is a compound alveolargland. It has gotboth exocrine & endocrine function. Diabets mellitus is achronic disease due to disordered carbohydrate metabolismand it results due to deficiency of insulin secreted by theBeta cells of islets of Langerhans of pancreas. The exocrine portion of pancreas consists of acinigrouped into lobules. The exocrine pancreas made up ofisolated group of cells the islets of langerhans. Endocrine portion (Islets of langerhans) It is an endocrine organ which exert a profoundeffect on carbohydrate metabolism. created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 142. In endocrine portion 4 cells are present (1) cells (2) cells (3) cells (4) F cells  cells synthesise and secrete glucogon and  cells produce insulin and D cells have been linked with either gastrin or secretin production. F cells secretes pancreatic polypeptide (PP) The islet volume comprises 1-1.5% of the total mass of the pancreas and weighs about 1-2g in adult humans. The first harmone to be identified as a product of the islet was insulin. created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 143. Mechanism of Insulin Secretion Increased Sugar Level Translation GLUT Uptake of Glucose by cells Release of Insulin If Stimulation Persists Active Synthesis of Insulin created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 144. Biological Effects of InsulinA) On Carbohydrate Metabolism:- Reduces the rate of release of glucose from liver. By inhibiting glycogenolysis By stimulating glycogen synthesis By stimulating Glycolysis By indirectly inhibiting gluconeogenesis via inhibition of fatty acid mobilisation from adipose tissue.B) On Lipid Metabolism:- Reduces the rate of release of free fatty acids from adipose tissue. Stimulates fatty acids synthesis and also conversion of fatty acids to triglycerides in liver.C) On Protein Metabolism:- Stimulates transport of free amino acids across the plasma Membrane in liver and muscle. Stimulates protein bio synthesis and reduces release of amino acid from muscle created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 145. NIDANA Nidana for premeha of each dosha were mentioned in Charaka Nidana 4th Chapter.S.No 9 Nidana Reference1 Asyasukham Ch2 Swapnasukham Ch3 Dadhi Ch, B.P4 Gramya, anupa, oudaka – Mamsa Rasa Cha, A.H., A.S. Sevana5 Ksheeram Charaka6 Navannapanam, Navadravyas, Navadhanya Ch, A.S., A.H. B.P.7 Gudavikaras & Guda Ch, A.S., A.H., B.P8 All the Ahara Vihara factors which vitiate Su, A.S., A.H. medas, Kapha, mutra9 Madhura rasa, Amlarasa, Lavanarasa – Su, A.H., A.S. Ahara having these Rassas10 Annapana having Snigdna, guru, picchila, Ch, A.H., A.S., Su Seeta, drava, Medokara gunas11 Sura A.S., A.H.12 Ekasthanasanarati, Sayyasanaswapna Ch, A.S., A.H. Sukham created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 146. Poorva RupaS.No Poorva Rupa Reference 1. Jatileebhavam Kesheshu Ch.Ni, Su.Ni, A.S.Ni 2. Asyamadhuryam Ch.Ni,Ch.Chi, A.S.ni, A.H., Ni 3. Karapada suptata Ch. Ni 4. Karapadadaha Chi.Ni,Cha.chi, Su.Ni, A.H.Ni 5. Mukhatalukanta sosha, talugala sosha Ch.Ni, Ch.Chi. Su.Ni, A.S.Ni 6. Pipasa Poorva Rupa Su.Ni, A.S.Ni. A.H.Ni 7. Thrut Chi. Ni 8. Kayemalam Ch.Ni, A.S.Ni 9. Kayachidreshupadeham Ch.Ni10. Paridaham Ch.Ni. A.S.Ni11. Angeshusuptata Ch.Ni., A.S.Ni12. Mutrebhidravanti pipeelikanam Mutrechnamutradosham Ch.Ni.ch.Chi, A.S.Ni13. Shatpadapipeelikabiccha shareera Mutrabhisaranam Ch. Ni created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 147. ROOPARoopa of a disease will be produced in the fifth stage of samprapti i.e., Vyaktavasta.Samanyalakshanas:-1) Prabhootamootrata:- Vagbhata mentioned prameha as the disease of mutratipravritaja vikara. Patient voids urine more in quantity and frequency. Gayadas opines that this excess urine quantity is because of liquification of the dushyas and their amalgamation.2) Avilamootrata: Patient voids urine having turbidity.Sarvadaihika Laxana:- Sahaja Apathyanimihaja1) Krisha(Emaciated) 1) Stulatwa (obese)2) Ruksha (dryness of body) 2) Snigdha (Unctous)3) Alpasi (poor eatingdesire) 3) Bahwasi (polyphagia)4) Pipasabhrusam(intense thirst) 4) Shayya Asana Sukham (desirous for posture and lying down on bed)5) Parisaranasheela (Tendency of 5) Swapnashila (constant tendency for roming) sleeping) created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 148. CLASSIFICATIONDosha Charaka Susruta VagwnataKaphaja 10 1) udakameha Udakameha Udakameha 2) Ikshumeha Ikshumeha Ikshumehatypes 3) Sikatameha Sikatameha Sikatameha 4) Sanairmeha Sanairmeha Sanairmeha 5) Sandrameha Sandrameha Sandrameha 6) Sukrameha Sukrameha Sukrameha 7) Shukla meha Pistameha(su.ni6/8) Pistameha 8) Sandraprasada Surameha(su.ni6/8) Seetameha 9) Seetameha Lavanameha Alalameha 10) Alalameha PhenamehaPittaja 6 types 1) Ksharameha Ksharameha Ksharameha 2) Kalameha Neelameha Kalameha 3) Neelameha Sonitameha Neelameha 4) Lohitameha(ch.ni Manjistameha Raktameha 4/24) Haridrameha Manjistameha 5) Manjistameha Amlameha(su.ni6/8) Haridrameha 6) HaridramehaVataja 4 types 1) Vasameha Vasameha Vasameha 2) Majjameha Hastimeha Majjameha 3) Hastimeha Kshoudrameha(su.ni6/8) Hastimeha 4) Madhumeha Sarpirmeha Madhumeha created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 149. SAMPRAPTISamprapti is a process by which dosha dushyasamsarga will takes place and finally manifests the disease.• Sampraptighataka of madhumeha:• Dosha : Sleshma pradhana tridosha sleshma is the main dosha responsible for Madhumeha inspite of the fact that madhumeha is a tridoshajanyavyadhi. The other doshas like vata& pitta only trigger off this samprapti and associate as anubandha.• Dushya : Rasa, Rakta, Mamsa, Meda, Majja, Sukra Vasa, lasika, ojus, kleda• Srotodusti : The srotodusti laxana occur as sanga of kapha leading to vimargagamana and atipravritti of kleda through the mootra.• Agni : Vaishamya of all agnis (or dhatvagnimandya)• Ama : Medogata ama produced due to jataragni mandhya and dhatvagnimadhya.• Adhistana : vasti• Udbhavasthana : Amasaya• Bhedavastha : Occurance of upadravas such as puti mamsa,pidaka etc.• Nature : chirakari, anusangi created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 150. CHIKITSAChikitsa sutra:-Stulapramehi balavanihaika krisastadaika paridurbalascha.Sam Brimhanam Tatra Krisasya karyam Samsodhanam Doshabaladhikasya.(Cha.Chi 6/1)• Charaka classified patients of prameha into two categories for treatment purpose.(cha.chi. 6/15 – 17& 18)• Stula – Samsodhana therapy was prescribed.• Krisha – Brumhana & Samsamana therapy was prescribed.• The samsodhana kriya vamana, langhana adopted at appropriate times to cure kaphaprameha.• The virechana kriya, Santarpana kriya, samanakriya cure pittajameha (cha.chi.6/23)• A krisha or emaciated patient who is not capable of with standing the purificatory procedures requires Brimhana kriya(cha.chi 6/15) created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 151. DRUGS Bakuchi Madhunashini NagaraAvarthaki created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 152. SOMARAJYADI CHURNAMcreated by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 153. DRUG REVIEWDrug plays a vital role in the management of the disease.Due to this reason, it had been placed next to physician in the chatuspada.• The best drug is that which cures the disease promptly and also preserves or sustains the helath of an individual.• The drug selected for present clinical study on prameha is “SOMARAJYADI CHURNAM”.SOMARAJYADI CHURNAM:-• Somrajyadi churnam is anubhutayoga to prove its scientific efficacy.Ingredients:-1. BAKUCHI,(Psoralea corylifolea) - 1 part2. AVARTHAKI,(Cassia auriculata) - 1part3. MADHUNASHINI, (Gymnema sylvestris) - 1 part4. SUNTI(Zingiber officinale) - 1partAll are taken in equal parts and fine powdered.DOSE:-6 grams/ dayANUPANA:-Sukoshna jalam Most of the drug have tikta, kashayarasa,laghu , rooksha guna, katuvipaka.These are said to be kaphagna, mehagna, medogna. Tikta, kashayarasa, laghu, rookshaguna produces rookshana effect and they are having opposite qualities to that kapha and medas. Bahudravatva is present in madhumeha. Tikta, kashayarasa produces shoshana effect and there by bahudravatva is reduced. created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 154. Materials and methodsMy dissertation entitled “A CLINICAL STUDY ON THE EFFECT OF SOMARAJYADI CHURNAM IN THE MANAGEMENT OF PRAMEHA “ was carried out on 40 patients who attended the OP and IP sections of Govt.Ayurvedic college/Hospital, Erragadda. HYD.during Jan 2007 to sep2007.Aim of study:-1.To evaluate the effect of “SOMARAJYADI CHURNAM”in patients suffering from stula and krisha Madhumeha.2.To evaluate the effect of Somarajyadi churnam in NIDDM patients.3.Comprehensive literary study on prameha.– 1.Materials:-– patients– drugs– Patients :- 40 patients were taken for the study.– Drugs:- Somarajyadi churnam with sukoshna jalam– 2. Methods:-– 1.Location of study:- For the purpose of clinical trials 40 patients were selected from OP and IP department of Kayachikitsa of Dr.B.R.K.R Govt.Ayurvedic college/ hospital,Erragadda,Hyderabad.– 2.Selection of patients:- 40 patients of different age groups were selected on the basis of FBS&PLBSand corresponding urine sugars.– Diagnostic criteria:-– Criteria - 1:- patients presenting with pratyatma lakshana of Madhumeha –prabhoota and avilamootrata with mootra or tanumadhuryata with or without roopa are taken as Madhumehi.– Criteria -2:-– FBS -80 -120mg/dl– PLBS -140 -180mg/dl created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 155. – Inclusion criteria:- patients fulfilling the following conditions were included.– patients between 30yrs -70yrs.– Stula and krisha Madhumehi.– Patients with Type 2DM with FBS greater than 120mg/dl and lesser than 180mg/dl and PLBS of more than 160mg/dl and less than 300mg/dl.– Exclusion criteria:- The following patients were excluded from the study.– 1.patients below 30yrs.– 2.Jatapramehi– 3.IDDM patients– 4.Gestational diabetes– 5.DM secondary to drugs like corticosteroids or due to secondary disorders– Investigations:-– 1.FBS– 2. PLBS– 3.Urine sugar– Research design:-– A single blind clinical trail with pre and post test design was adopted.– Intervention:-– Intervention was done with Somarajyadi churnam taken,the 4 drugs in equal parts and the powder is given in 2 divided doses.i.e 6 grams in 2 doses with sukhoshnajalam before food. created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 156. Observation 1.Age Incidence 2.Sex incidence 31-40 41-50 M a le 51-60 Fe m a le 61-70 3.Marital Status 4. Religion Incidence Marital Status 343530 Hindu2520 Muslim Series115 Christian10 650 Single Married created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 157. 5. Socioeconomic status 6. Incidence of Addictions Socioeconomic status INCIDENCE OF ADDICTIONS 16 16 15 16 15 14 14 12 12 10 10 10 8 8 Series1 6 Series1 6 5 6 5 4 4 4 4 2 2 0 0 0 UP P LM M UM R Sm oking Tobacco Alcohol T/C7. Socioeconomic status 8. Deha prakriti DEHA PRAKRITI 14 14 12 10 9 Ve g 8 M ixe d 6 6 Series1 5 4 3 3 2 0 VP PV VK KV PK KP created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 158. 9. Satva Incidence 10.Status of Agni STATUS OF AGNI 16 15 14 14 12 11 Pravara 10 Madhyama 8 Series1 Avara 6 4 2 0 0 Teeks hna Sam a Vis ham a Manda11. Bala Incidence 12.Family History BALA INCIDENCE30 26 F eg irstD ree2520 S o dd ree ec n eg15 Series1 N m l ofa ilia10 8 6 h ry isto 5 0 Pravara Madhyama Avara created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 159. EFFECT OF THE TREATMENT :-S.N Signs & SymptomsO Total No. of No.of Cases Cases Reliver Improve Unchanged d % d % %1 Prabhootamutr 32 26 81 4 13 2 6 ata2 Avilamutrata 6 4 66 1 17 1 173 Atitrishna 28 19 67 3 10 6 234 Atikshudha 30 16 54 7 24 7 245 Mutramadhary 34 21 61 8 23 5 16 ata6 Tanohmadhury 22 16 74 3 13 3 13 ata7 Suptata 18 12 66 2 11 4 238 Dourbalya 33 24 73 3 9 6 189 Karapadadaha 25 20 80 4 16 1 410 Musclecramps 17 6 35 5 29 6 36 created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 160. RESULTS Effect on Prabhoota Mutruta Mean Difference 1.875 2 in Means 1.538 1.5BT AT 1 BT Mean AT1.875 1.538 0.337 0.5 0 BT AT Effect on AvilamutrataMean Difference in Means 1.5 1.5BT AT 1.45 1.4 1.35 BT Mean 1.3 1.251.5 1.25 0.25 1.25 AT 1.2 1.15 1.1 BT AT created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 161. Effect on Atitrushna Difference Mean in Means 1.286 1.3 1.28BT AT 1.26 1.24 1.22 1.2 BT Mean 1.158 Mean 1.18 Difference AT1.286 1.158 0.128 1.16 1.14 in Means 1.12 1.1 BT 1.08 BT AT AT Effect on Atikshudha 1.5 1.25 0.25 1.333 1.34Mean Difference 1.32 in Means 1.3 1.28 BTBT AT Mean 1.26 1.25 AT 1.241.333 1.25 0.083 1.22 1.2 BT AT created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 162. Effect on Karapadasuptata Difference Mean in Means 1.6 1.444 1.4 1.167 1.2BT AT 1 Mean 0.8 BT AT 0.6 0.41.444 1.167 0.277 0.2 0 BT AT Effect on Karapadadaha Difference 1.2 Mean in Means 1.2 1 0.85 0.8BT AT Mean 0.6 BT AT 0.4 0.21.2 0.85 0.35 0 BT AT created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 163. Difference S.D S.E Vari in Means ance MeanBT AT 32.7 1.02 1.08 78.7156.6 123. 4 9 Differenc S.D S.E Vari Effect on PLBS e in ance Mean Means 237.42 250 181.1BT AT 200 150 BT Mean AT 0.48 288 100 56.32 3.04 50237.42 181.1 0 BT AT created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 164. Criteria for assessment of resultsResult Criteria for assessmenCured 75% to 100% relief in signs and symptomsModerate relief More than 50% to Less than 75%Mild relief Patients with improvement 25 to 50%, reliefNo relief No change or less than 25%Results Number of Patients percentage• Cured 18 45%• Moderate relief 14 35%• Mild relief 6 15%• No relief 2 5% created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 165. DISCUSSION• Prameha is a disease caused predominance by vatadosha though all the 3 doshas also take part besides ten dooshyas i.e., Rasa, Rakta, Mamsa, Medo, Majja, sukra, ojus, Lasika, Vasa, Kleda in resulting the disease.• The range of Fasting and post prandial blood sugar was fixed between 120mg/dl – 180mg/dl and 160mg/dl to 300mg/dl respectively.• The pratyatma lakshana of Madhumeha including Tanumadhuryata and mutramadhuryata along with other common symptoms were taken for assessment. The symptoms were graded and scored.• Maximum number of patients belonged to the age group of 51-60 years Which supports the views that the prevalence of type 2 DM is more in the middle to old age. Males are more in the clinical study compared to females.• Maximum number of patients i.e., 40% were addicted to smoking, 10% patients were addicted to alcohol, tobacco chewing 12.5%, tea / Coffee 38.5%. All of these conditions decreased the natural immunity and also provoke the vata to manifest the disease prameha.• Majority of the patients are vatakaphaprakruti. Majority of the patients were of Madhyama to avarsara which indicates the involvement of dhatus in Prameha.• Effect on Prabhootamootrata: Mild to severe prabhoota mootrata (both in terms of quantity and frequency) was seen in 80% of patients, 65% relief was observed in prabhutamutrata. This relief in prabhutamootrata may be due to the mutrasangrahani action of Avarthaki and kashaya Rasa Rookshguna of Madhunashini, avarthaki which exerts stambhana action. It may be possible that drug has acted upon apanavayu and corrected its vitiation.• Effect on Avilamootrata: Only in 15% of patients avilamootrata is noted, relief was 10%.• Effect on Trushna: mild to maximum improvement was seen in 50% of patients. The relief in trushna may be because of kaphapitta samaka effect of Avarthaki, Bakuchi and stambhana action of avarthaki and also due to Trishnanigrahana action of sunti. created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 166. Effect on Sweda adhikhya: Atisweda was seen in 30% of patients and 25% of improvement was observed .Effect on Karapadadaha: Mild to serve Karapadadaha was seen in 62% of the le patients and mild to moderate improvement was seen in 50% of the patients.Effect on Bahvashi: Mild to moderate Bahvashita was seen in 75% of the patients 16% improvement was observed. This is due to Kaphapitta samaka action of Bakuchi, Avarthaki. This may be the reason for the relief in atikshudha.Effect on Fasting blood Sugar(FBS): The mean FBS score before treatment was 146.6 and after treatment 123.9Effect on post prandial blood sugar(PPBS): The mean difference between before and after treatment is 56.6.Effect on Urinesugar: The mean difference in the before treatment and after treatment was 0.58%.The most of the drugs of Somarajyadi churnam have Tikata, Kashaya Rassa, Laghu, Rookshaguna and Katuvipaka. These are said to be Kaphagna, Mehagna, Medogna and Mootrasangrahaneeya.Tikta, Kashayarasa, Laghu, rookshaguna produces rookshana effect and they are having opposite qualities to that of kapha and medas. created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 167. CONCLUSION• Prameha mostly affects the individuals after the age of forty years.• Sex, Marital status, Religion, Social status bear no relation in causation of Madhumeha.• Tendency towards Sedentary lifestyle, increased stress and strain are main contributing factors in the establishment of the disease.• Kapha is the arambhaka dosha and vata is preraka.• Apathya nimittaja nidanas influence more to cause Madudmeha in stoulya.• Madhumeha is a disease characterized by prabhoota avila mootrata, Tanu madhuryata and Mootra madhuryata.• Dhatu apakarshana and Ojo dushti is an invariable manifestation of the disease. created by technoayurveda.wordpress.com of Dr.KSRPrasad
  • 168. created by technoayurveda.wordpress.com of Dr.KSRPrasad

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