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Vasti madhumeha pk011-gdg
Vasti madhumeha pk011-gdg
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Vasti madhumeha pk011-gdg

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EVALUATION AND EFFICACY OF MADHUTAILIKA BASTI IN THE MANAGEMENT OF MADHUMEHA, S. KENDADMATH (D.S.Swami), Post graduate department of Panchakarma,Shri D. G. Melmalagi Ayurvedic Medical College,Gadag – …

EVALUATION AND EFFICACY OF MADHUTAILIKA BASTI IN THE MANAGEMENT OF MADHUMEHA, S. KENDADMATH (D.S.Swami), Post graduate department of Panchakarma,Shri D. G. Melmalagi Ayurvedic Medical College,Gadag – 582103.

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  • 1. EvaluationofefficacyofMadhutailakaBastikarma inthemanagementofMadhumeha(NIDDM) By D.S.Swami Dissertation Submitted to the Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore. In partial fulfillment of the requirements for the degree of AYURVEDA VACHASPATHI M.D. In PANCHAKARMA Under the guidance of Dr. G. Purushothamacharyulu, M.D. (Ayu) And co-guidance of Dr. Shashidhar.H. Doddamani, M.D. (Ayu) Post graduate department of Panchakarma, Shri D. G. Melmalagi Ayurvedic Medical College, Gadag – 582103. 2006.
  • 2. Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation / thesis entitled “Evaluationof the Efficacy of Madhutailika Bastikarama in the management of (NIDDM)”Madhumeha (NIDDM)” is a bonafide and genuine research work carried outby me under the guidance of Dr. G. Purushothamacharyulu, M.D. (Ayu), Pro-fessor and H.O.D, Post-graduate department of Panchakarma and co-guid-ance of Dr. Shashidhar. H. Doddamani, M.D.(Ayu) , Assistant Professor, Postgraduate department of Panchakarma.Date:Place: D.S.Swami
  • 3. CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “Evaluation ofthe Efficacy of Madhutailika Bastikarama in the management of Madhumeha(NIDDM)” is a bonafide research work done by D.S.Swami in partial fulfillmentof the requirement for the degree of Ayurveda Vachaspathi. M.D.(Panchakarma).Date:Place: Dr. G. Purushothamacharyulu, M.D. (Ayu). Professor & H.O.D Post graduate department of Panchakarma.
  • 4. ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF THE INSTITUTION This is to certify that the dissertation entitled “Evaluation ofthe Efficacy of Madhutailika Bastikarama in the management ofMadhumeha (NIDDM)” is a bonafide research work done by D.S.Swamiunder the guidance of Dr.G. Purushothamacharyulu, M.D. (Ayu), Professor andH.O.D, Postgraduate department of Panchakarma and co-guidance of Dr.Shashidhar.H. Doddamani, M.D. (Ayu), Assistant Professor, Post graduate de-partment of Panchakarma.Dr. G. Purushothamacharyulu, M.D. (Ayu) Dr. G. B. Patil. Professor & H.O.D, Principal.Post graduate department of Panchakarma.
  • 5. CERTIFICATE BY THE CO- GUIDE This is to certify that the dissertation entitled “Evaluation ofthe Efficacy of Madhutailika Bastikarama in the management ofMadhumeha (NIDDM)” is a bonafide research work done by D.S.Swamiin partial fulfillment of the requirement for the degree of AyurvedaVachaspathi. M.D. (Panchakarma).Date: Dr. Shashidhar.H. Doddamani, M.D. (Ayu).Place: Assistant Professor, Post graduate Department of Panchakarma.
  • 6. COPYRIGHT Declaration by the candidate I hereby declare that the Rajiv Gandhi University of HealthSciences, Karnataka shall have the rights to preserve, use and dissemi-nate this dissertation / thesis in print or electronic format for academic /research purpose.Date: D.S.SwamiPlace:© Rajiv Gandhi University of Health Sciences, Karnataka.
  • 7. I Acknowledgement By the grace of god, bless of eiders I take this opportunity to express myregards to the persons who helped in completing this work. I express my deep sense of gratitude to his great holiness Jagadguru ShriAbhinava Shivananda mahaswamiji for their divine blessings. Words fail miserably when I try to express my gratitude to my mentor, myguide Dr.G.Purushottamacharylu M.D (Ayu), H.O.D of P.G.Department of Panchakarma.For his incessant, untiring, round the clock guidance with all the diligence. Hissustained fostering and encouragement instilled considerable impetus in me enablingto achieve this milestone which otherwise would have lacked this particular finish. Indeed, I will cherish the affectionate guidance of my co-guide Dr.ShashidharH.Doddamani M.D (Ayu), Asst professor of P.G.Department of Panchakarm. For hisinvincible and radical thinking were very valuable in achieving this research workinvoking scientific spirit throughout the course of the study. I express my sincere and deep gratitude to Dr.G.B.Patil, Principal, D.G.M.A.M.C,Gadag, for his wholehearted encouragement as well as providing all necessary facilitiesfor this research work.I express my sincere gratitude to Dr.P.Shivaramudu M.D (Ayu), Assistant Professor and Dr.Santhosh.N.Belavadi MD (Ayu), Lecturer of P.G.Department of Panchakarma for hisexcellent advices. I also express my sincere gratitude to Dr.S.D.Yargeri R.M.O. for his moralsupport and special care in providing the all the facilities during this trail work. I express my sincere gratitude to Dr.G.S.Hiremath, Dr. Anjaneya murthyDr.V.Varadacharyulu, Dr.M.C.Patil, Dr. Mulgund, Dr.Dilip Kumar, Dr.R.V.Shetter,Dr.Basavaraj Hadapada,Dr. K.S.R.Prasad, Dr.G.Danappa Gowdar, Dr. Kuber Sankh,
  • 8. IIDr.J.G.Mitti, Dr.Shakanath.Nidagundi, and other PG staff for their constantencouragement. I thank Dr.U.V.Purad, Dr.S.H.Radder, Dr.B.M,Mulkipatil and otherundergraduate teachers for their support in the clinical work. I thank to Shri. Nandakumar(Statistician), Shri.V.M.Mundinamani (Librarian), Mr.Surebana and other hospital andoffice staff for their kind support during my study. Indeed, I will cherish the affectionate of my Father, my elder brother Mr.V.S.Kendadmath, and all my family members who has been a source of inspiration formy entire carrier. I express my sincere thanks to my friends Dr.H.T.Sangamesh, Dr.Basavaraj R.Channappagoudar, Dr.Prakasha.Gunjal, Dr.shrikanth, Dr.Santhosh.L.Y, Dr.V.M.Hugar,Dr.Jayaraj Basarigidad, Dr.Shivakumar.Sajjanar, Dr.Ashok.Bingi, Dr.B.H.Venkaraddi,Dr.B.L.Kalmath, Dr.P.Chandramouleeswaran, Dr.Shaila.B. Dr.Uday Kumar, Dr.RatnaKumar, Dr.Ghanti, Dr.Pradeep, Dr.Babu.Sobagin, Dr.Suresh.Hakkandi,Dr.Manjunath.Akki, Dr.Gavi, Dr.AshwinDev, Dr.V.S.Hiremath, Dr.L.M.Biradar,Dr.Jagadisha.H., Dr.Sharanu, Dr.Anand, Dr.Umesh, Dr.Suvarna, Dr.Devendrappa,Dr.Sibaprasad, Dr.Madhushree, Dr.Ashok.M.J, Dr.Payappagoudar, and other postgraduate scholars for their support. I would like to mention the support and inspiration provided by my uncleShri.Shivashankarayya.S.Hiremath & family for their support and encouragement duringmy stay at Gadag. I acknowledge my patients for their wholehearted consent to participate in thisclinical trial. I express my thanks to all the persons who have helped me directly andindirectly with apologies for my inability to identify them individually. Finally I dedicate this work to my respected patients who are the prime reasonsfor this study.Date : Signature of the scholarPlace : (Dr. D.S.Swami)
  • 9. IIIABSTRACT The study “Evaluation of the efficacy of Madhutailika Bastikarma in themanagement of Madhumeha (NIDDM)” is focused on an important form of an siddhabasti and a common disease Madhumeha. Madhutailika basti is believed to have a noteworthy role in the management of such impaired metabolic condition by importingequilibrium state of doshasa, nourishes the dhatu and maintains the blood sugar level.Panchakarma is the popular term for shodhana chikitsa, among that Bastikarma is animportant one. In this the doshas are made to pass through the adhomarga i.e.Gudamarga. In the Bastikarma doshas even from the all over body are removed throughgudamarga. In the treatment of Sthoola Madhumeha Bastikarma has great importanceaccording to Ayurveda. In the modern system of medicine Madhumeha can be comparedto diabetes mellitus. And it can be classified as insulin dependent, non insulin dependent,malnutrition related and other types of diabetes mellitus associated with certainconditions and syndromes. Among this non-insulin dependent diabetes mellitusconstitutes 85 % or more of all cases of diabetes. Diabetes has become the disease of themasses. Over 20 million people are reported to be suffering from this “Sweet Disease”.Between 1995 and 2005 India will have about 2-3 crore diabetic patients. Even though the scientific world has conducted extensive studies but couldn’tfind a safe and effective therapy or medicine for this disease. In Ayurveda we can offerseveral treatment modalities among that Bastikarma is a good, result oriented andeconomical therapy which can control the blood sugar level and prevent furthercomplications without any serious side effects. BastiKarma is advised in Madhumeha patients having good body strength andthose who are sthoola in nature. The objective of this study was to assess the efficacy ofBastiKarma in such patients. The study was designed as a prospective clinical trial and 30patients were selected and given Madhutailika Bastikarm The treatment contains the following steps. 01. Deepana pachana 02. Sthanika Abhyanga and mridu sweda by Moorchita tila taila.
  • 10. IV 03. Madhutailika basti in yogabasti pattern. 04. Sixteen days Parihara kala. 05. Follow-up for one month. As a result of the proper administration of Madhutailika basti it was noted that, itgives immediate and lasting results, both in sugar levels as well as in other complaints.Among the 30 patients taken for the study, 17 patients (56.6%) responded well, 11patients (36.6%), responded moderately and 2 patient’s (6.6%) showed poor response. Aclose perusal of observation and inference that can be drawn leads to the conclusionssuch as, Madhutailika basti is an effective treatment in Sthoola Madhuneha and it alsoshows lasting results. In mild and moderate type of Sthoola Madhumeha classicalMadhutailika basti alone is enough to control it. Even though only Virechana wasadministered in this study, it was also noted that along with Madhutailika basti,administration of pathya ahara vihara and shamanoushadis might help more.Key words – Shodhana karma ; Madhutailik Bastikarma ; Sthoola Madhumeha ; Prameha ;Diabetes mellitus ; Insulin resistance ; Obesity; Blood sugar.
  • 11. VLIST OF ABBREVIATIONS ⇒ C. S _ Charaka Samhitha. ⇒ A. H. – Ashtanga Hridaya. ⇒ B. P. – Bhavaprakasha ⇒ K.S _ Kashyapa Samhita ⇒ G. R. – Good response. ⇒ M. R. – Moderate response. ⇒ N. R. – No response. ⇒ P. R. – Poor response. ⇒ S. S. – Sushruta Samhita.
  • 12. VITABLE OF CONTENTS Chapters Page No. 1. Introduction 1-4 2. Objectives 5-7 3. Review of literature 8-108 4. Drug review 109-114 5. Methodology 115-121 6. Results 122 -139 7. Discussion 140-152 8. Conclusion 153-154 9. Summary 155 - 156 10. Bibliography 157- 170 11. Annexure 171 - 178
  • 13. VIILIST OF TABLES Page No.1. Table showing patients showing indicated for matrabasti 372. Table showing showing ingredients of madhutailika basti 423. Table showing Measurements of Bastiyantra 454. Table showing Netra dosha and Putaka dosha. 465. Table showing patients showing indicated for anasthapya 476. Table showing patients showing indicated for asthapya 497. Table showing patients showing contra indicated for Anuvasana. 508. Table showing proper dose according to age 529. Table showing ahara samandi nidanas 7010. Table showing vihara sambandi nidanas 7011. Table showing the types kaphaja prameha 7612. Table showing the types pittaja prameha 7713. Table showing the types vataja prameha 7714. Table showing the poorvaroopa of prameha 8215. Table showing the roopa of prameha 8516. Table showing the Prameha pidakas 10615. Table showing the grades of blood sugar level 121Table showing the Data of Age Group Incidence and Response 12518. Table showing the distribution of sex group Incidence and Response 12619. Table showing the Chronicity and response 12720. Table showing the incidence of religion and response 12821. Table showing the socioeconomic status and response 12922. Table showing the incidence of religion and response 13023. Table showing the incidence of occupation and response 13124. Table showing the Family history and response 13225. Table showing the Treatment history and response 13326. Table showing the habits of the patients and response 13427. Table showing the Nature of mala pravrithi and response 13528. Table showing the Nidana status and response 13629. Table showing the Nature of kostha and response 13730. Table showing the Status of agni and reponse 138
  • 14. VIII31. Table showing the Prakruti of patient and response 13932. Table showing the Statistical data 0f the study 140LIST OF FIGURES, PHOTOGRAPHS Title Page No. 1. Figure showing dilated anatomy of the rectum and anus 18 2. Figure grass anatomy of large intestine 20 3. Figure grass anatomy of intestinal villi 20 4. Figure grass anatomy of Pancreas 23 5. Figure anatomy and orientation of Pitutary 27 6. Figure grass anatomy of Adrenalin gland 29 7. Figure grass anatomy of liver 30 8. Photo of drugs used in Mdhutailika Bastikarma 118LIST OF GRAPHS Title Page No. 1. Graph showing distribution of age 125 2. Graph showing distribution of sex 126 3. Graph showing distribution of Chronicity and response 127 4. Graph showing distribution of religion and response 128 5. Graph showing distribution of socioeconomic status and response 129 6. Graph showing distribution of religion and response 130 7. Graph showing distribution of occupation and response 131 8. Graph showing distribution of Family history and response 132 9. Graph showing distribution of Treatment history and response 133 10. Graph showing distribution of habits of the patients and response 134 11. Graph showing distribution of Nature of mala pravrithi and response 135 12. Graph showing distribution of Nidana status and response 136 13. Graph showing distribution of Nature of kostha and response 137 14. Graph showing Status of agni and reponse 138 15. Graph showing Prakruti of patient and response 139
  • 15. Introduction INTRODUCTION Ayurveda the life science; embedded with the treasure of ancient knowledgeunfolding the mystery of health and disease. It is a compilation of observation,experience and research of so many mentors, and moreover it is a cross section of thescientific thoughts of many generations. Due to its simplicity and scientific nature,Ayurveda has drawn the attention of the global population. It is well known for its role inthe management of the chronic and incurable diseases. It survived all the downfalls andfought with unfavorable conditions, flourished during favorable time and still holds itsplace in the mainstream. Research begins with doubts and ends with facts; facts which serve as new data tobe verified again. Thus the process of research never ends, but at the end of it theresearcher would have become wiser with plans to counter newer challenges. Recurrentmodeling and remodeling by time is inevitable for the fulfillment of this destination.Ayurveda is one such attainment by the perspiration of many eminent Acharyas of thepast. The time tested science Ayurveda has its own everlasting principles regarding bothlife and disease. It is applicable in every facet of human life, with its own uniqueprinciples in understanding a disease by both preventive and curative view. This may bethe fact due to which this science is persisting through centuries beginning from timeimmemorial. Scientific and technological progress has made man highly sensitive and critical;they’re by giving rise to different types of health problems. The advancement ofindustrialization and communication is contributing towards sedentary life styles, in turncausing chronic non- communicable diseases like diabetes mellitus, etc. In fact it is thefirst life science, which identified diagnosed and managed diabetes (the Greek word forsiphon) while claiming it is incurable much earlier to famous Greek physician Aerated 1“Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 16. Introduction(1-2 AD). In spite of all sorts of advancement of science man is not able to stay himselfin the boat of happy and healthy life, so it is a disadvantage rather than an asset; of theindividual by imposing an extra burden on all the systems of body. Then the persons arevery much likely to acquire an infirmity by name: Madhumeha; Mother’s name: Kapha;Father’s name: Vata; Ancestry: Sahaja & Apathya nimittaja; Qualification: Mahagada;Character: Anushangi; Expertise: Dhatu karshana; Identification with: Prabhoota Avilamootrata and tanu madhurya; Status: impairment in multi systems of the body;complexity Vidradi, Alaji etc; ultimate result: Pranahani. Madhumeha is a disease known to the mankind since Vedic period and it ismentioned as one of the 20 obstinate urinary disorders. It is the present burning issuealarming the world. With synonym of Richman’s disease,’ it is present particularly thepersons who are able to enjoy the pleasure of life with a machine power. Most of thesrotas are involved in the manifestation of the madhumeha. At the outset it becomespertinent to discuss the following issues related to Madhumeha. Whether Madhumeha &Prameha are synonyms? Yes. Charaka has used the words Prameha & Madhumeha assynonyms and Chakrapani has clarified this fact more than once. The term Prameha has abroader connotation, indicating the increased quantity and quality of urination whereasMadhumeha more specifically means a condition where the patient passes urine likehoney. Yet, both the terms convey the nature of the same disease. Madhumeha is anAnushangi vyadhi, which means it is punarbhavi. In other words the disease has atendency to re-occur. It is sadhya vyadhi only in the initial stages where Vata is stillanubandha (secondarily associated) and Kapha is dominant, in a sthoola and balavan rogi. 2“Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 17. IntroductionIt is asadhya when Vata begins to dominate either as a result of beeja upatapa or as asequel to a long-standing, Kapha pradhana Madhumeha. In Ayurveda chikitsa has been explained under two folds; they are langhana andbrimhana, due to Shodhana in nature Panchakarma comes under the langhana category.Panchashodhanas well known and effective treatment modalities in the management ofmany chronic diseases like Madhumeha, Kustha, etc shodhana techniques are acts as aweapon’s, due to its simplicity panchakarmas will helps in attaining both the aim ofAyurveda i.e. Swasthasya urjaskara and arthasya roganut again the treatment is broadlydivided into two categories: Shodhana and Shamana. Curing the disease by cleaning outthe impurities is called Shodhana chikitsa, which is the principle of Panchakarma. Itinvolves the clearing of vitiated doshas (vata, pitta and kapha) which cause the diseaseand thereby the restoration of equilibrium of doshas. Vamana Virechana, Bastikarma, Nasya karma and Raktamokshana are consideredas the five folded theropies.In brief the term panch means “Vistara” or mangalakar that iselaborate .In classics our Acharyas have given prime importance to Basti karma. Basti isa prosses by which doshas are eliminated through the Adhomarga.Acharyas also givenprime importance to it. Even it termed as Ardhachikitsa and it removes the vitiateddoshas from all systems of the body. Though Basti has been indicated for almost all the disease, some specific types ofBasti have been explained in the management of Madhumeha. As the vata dosha is one ofthe main contributing factors. The best way to analyze Bastikarma is by checking itseffect over multisystemic dissordes like Madhumeha. 3“Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 18. Introduction The whole study has been distributed into two major divisions - the conceptualstudy & the clinical study. The conceptual study is grouped into a literary review of(Basti and Madhumeha) drug review; the clinical study contains the Observations,Results, Discussion and Conclusion and Bibliography. 4“Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 19. NEED FOR STUDY Diabetes mellitus is the third largest killer in the world behind the cardiacailments and cancer. It is becoming a great national catastrophe with a current prevalencerate of 2.4% to 11.6% in urban dwellers. The danger of this epidemic disease is not only confined to individual’s mortalityand morbidity but also extends to affect the national health care system and economy. In spite of many advances in contemporary science, the management of diabetesis still unsatisfactory. Consequent to such projections alarm bell are already ringing in thecircle of health care institutions. In spite of more and more chemical molecules floodingthe market with claims of better efficiency in the management of diabetes mellitus, butthe over all treatment scenario is not of confidant, drug related resistance and toxicity etcare creating a opinion for provision of safe anti-diabetics. There is no doubt that attentionis coming back to our ancient Indian heritage of Ayurveda to explore its rich literatureand come out with some efficacious remedies, to co-fight the challenge of diabetes.Among that madhutailik vasti is one of the jewel of Ayurveda, which gives tremendousresult in many diseases including madhumeha (Stoola Madhumeha), Even though it isclassified under Niroohabasti, Siddabasti. In this types of vasti patients need not followmuch restriction as in the case of Niroohabasti.
  • 20. OBJECTIVES Number of research works has already been conducted on evaluation of the effectof some indigenous drugs on madhumeha. Only few research works have beenconducted on efficacy of Samshodhana karmas in the management of Madhumeha. It isone of the multi systemic disorders where the maximum numbers of Srotases areinvolved in the manifestation of the disease. So treating such disease with some timetested and effective therapies like vasti is the better option. No studies are conducted onthe effect of madhutailika vasti in the management of sthoola madhumeha so for. THE AIMS AND OBJECTIVES OF THE STUDY To evaluate the efficacy of madhutailika vasti in the management of madhumeha. To evaluate the hypoglycemic effect of Madhutailika vasti.
  • 21. INCIDENCE AND PREVELENCE Diabetes is a disease of the masses. The incidence and prevalence rate of diabetesitself suggests that it is burning issue alarming the world. As per recent WHO assessmentthere are 150 million people are reported to be suffering from this Rich man’s sweetdisease. Among them 35% are living in India (>55 million). It is reported that at the endof 2025, the incidence of diabetes in Indian continent is rising very fast at a rate of >3times the entire world. The disease prevalence was 2.4% in rural and 4% -11.6% in urban dwellers.In world: -150 million persons are now affected and the expected prevalence will be 5.4% by the year 2025. There are 50% in developed countries 10% in developing countries.In India: - There were 102000 persons died because of this disease in theYear 1997.
  • 22. Review of Literature Historical view REVIEW OF LITERATURE History in other words a function of a historian is neither to love the past nor toemancipate himself from the past, but to master and understanding of the present. E. H. CarrHistory of medicine in India in ancient period is actually the history of science of lifedeveloped by the ancient seers & later systematized into carefully woven treatisesA careful insight into ancient treasure of knowledge makes a good beginning for anystudy since we become proud to belong to be part of a heritage, which traces its roots intotimes immemorial. Historical background itself base and back bone for the presentprogressive development of Ayurveda. A critical review of the history from the primitive stage to the new millenniumassists one to understand the future in a better way. Struggle and attempt made by a manfor the better future can achieve only with good prospective past and present experiences,truths and planned in a proper time. History helps to reveal the hidden facts and ideas ofthe concerned subject. BASTI KARMA Vyadhi has been defined as the state in which imbalance of three Dosha-the three basic constituents of the living body, saptha dhatu and three malas. Themeasures undertaken to restore these Doshika equilibrium is called as Chikitsa.1 theayurvedic approach to the treatment of a disease comprises mainly under the two foldsviz 8 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 23. Review of Literature • Shodhana • ShamanaShodhana Chikitsa is supposed to eliminate vitiated Doshas completely and thus preventsthe recurring of the diseases. On the other hand Shamana is the conservative treatment asit doesn’t eliminate vitiated Dosha but it farcifies them. It is believed that there is nopossibility of relapse of the disease cured by Shodhana Chikitsa if followed propersamsarjana karmas and pathyapathya during parihara kala, while the disease cured byShamana; may reoccur as explanation given by Charaka2 i.e.The term Panchakarma is frequently used as synonyms of Shodhana. It consists ofVamana, Virechana, Anuvasana Basti, Niruha Basti and Nasya Karma. Due to itsmultiple effects Basti is the most important constituent among the Panchkarma.According to Ayurvedic physiology Kapha and Pitta are depends on Vata, as it governstheir functions. Basti alleviates morbid Vata dosha from the root level along with otherassociated Doshas, in addition it nourishes the body tissue.3 Therefore, Basti therapycovers more than half of the treatment of all the disease, 4 while some authors consider itas the complete remedy for all the ailments. Therefore, Basti is considered the bestremedy for morbid Vata, but it can also be used in Kapha and Pittaja disorders by usingdifferent ingredients.5 Though the rout of drug administration in Basti karma and enemaof modern science is same but actions are entirely different, Basti posesses bothSamshodhana and Samshamana effects along with this it does the functions ofshukradharana, Brimhana in emaciated person; Karshana in obese person, Chakshushya,prevents the aging, improves the luster, strength and helps longevity by acting locally aswell as systematically at cellular level. Thus, it has a wide application in treatment aspect. 9 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 24. Review of LiteratureIn contemporary science mainly enema is given to remove the mala from the largeintestine.KarmaHistory and medicine starts from the very moment when the human being came intoexistence that’s why the ancient treatises are stands with description of disease and theirtreatment.The evaluation of Basti can be traced from Vedic era viz Rigveda andAtharvaveda which is considered as the oldest authentic manuscripts of the world.Veda: - The Kaushika Sutra of Atharvaveda, Basti is indicated as a substitute for minoroperation.6Purana: - In Agnipurana, Basti is indicated as a principle treatment in complaintsmarked by predominance of Vata.7 It is also stated that according to season differentSneha should be used for Basti.8 in Ashwa Chikitsa Kathana, Taila Basti is recommendedin horses to relieve their fatigue immediately.9Yogic Literature: - In Gheranda Samhita, Basti is included in Satkarma. Two kind ofBasti’s has been described on the bases of their application.Jala Basti – To be done in water.Sushka Basti – To be done on land.In samhita All the classical treatises of Ayurveda have emphasized the importance and wideapplication of Bastikarma as the most effective therapeutic measures than the other. Acharya Charaka has nicely described the uses, advantages and complications ofBastikarma, “shareera shreshta” Shusruta elaborately described about Bastiyantra,Netra, Types of bastis, complications and its management in kalpasthana. Avasthanusara 10 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 25. Review of Literaturebasti vyapath has been beautifully explained by Acharya Vagbhata. Sharangadhara alsohas given much importance to bastikarma and he explained Uttaravasti. Yogaratnakar,Bhavaprakasha and Vangasena also dealt the bastikarma by adding newer combinationslike vaitharana vasti, ksheera basti, etc. Kashyapa equated the word “Amrutam” to the Basti, 10 and he indicated basti inchildren’s. The present renowned author of Ayurveda have also elaborately explained thepossible modification of equipments this is definitely encouraged us and helps in easypractice less tedious work with minimized complication.MADHUMEHA The knowledge of madhumeha is very familiar to Indians since prevedic periodthere is ample of descriptions are found in this period.Prevedic period: - The lord Ganesha was a stoola pramehi. He suffered from prameha due to excessintake of “Moodaka” and lack of strenuous work. His father Lord Shiva advised him totake ‘Kapitta, jambu, and Shiva Gutika’ as a treatment of stoola pramehi.Vedic period: - A study of ancient literature indicates that diabetes was fairly well known andwell conceived as an entity in ancient India. The knowledge of the system of diabetesmellitus, as the history reveals, existed with the Indians since prehistoric age. Its earliestreference (1000 BC in the Ayurvedic literature) is found in mythological form where it issaid to have originated by eating Havisha, a special food that used to be offered at thetimes of yagna organized by Dakshaprajapati. The disease was known as ‘Asrava’ during 11 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 26. Review of Literaturevedic era (6000 BC) Vedas are the oldest literature of the universe. In Kousika su.26/6-10 ofAtharvaveda, we find a reference of Asravana and Prameha. In Atharvaveda Asrava vyadhis are mentioned, in which some symptoms likerasasrava, atimootra, atisara etc are included. The Vedic Commentators Sayana andKeshava described Asrava as mootratisara i.e. excessive urination. Later in 1962 whinteyinterpreted Aasrava as flux, while Griffith named it as morbid flow. The word Pramehe is used so many times in Kautilya’s Arthashastra (321-296BC) in the context of inducing Prameha to the enemies as a part the criminal customs ofthe kings, to dominate over the opposite. Mentioned a method of producing prameha, i.e.the spot is obtaining from burning Chan lion (Krukalaka) and house lizard (GruhaGoulika) together with the intestines of mottled frog (Chitra bheka) and honey, ifadministered it causes prameha. In Atharvaveda 6/44/3 Vishanaka drug is indicated in Vatavyadhis, one of thecommentators Keshava commenting on this, he explained “Vaikruta nashani as vaikrutaasravya nashani.” In the mantra 23-1-3 of Atharvanaveda the drug emerged from valmika areindicated in atisara, atimootra and nadivranam.SAMHITA PERIOD: -The golden age of Ayurvedic history is Samhita Kala. The main classical texts of this eraare Brihatrayis.Charaka samhita: - 12 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 27. Review of LiteratureMaharshi Atreya - the father of Indian Medicine conducted earliest scientific study onmadhumeha It is a point of historical importance that in Charaka samhita nidana sthana4/37, he mentioned the loss of sweet substance from urine. In Sutrasthana 17/78, he hasdescribed prameha as Anusangi, and the stoola madhumeha occurs due to avritatwa ofvayu and Samprapthi of madhumeha in the same chapter.Sushruta samhita: - Sushruta, the father of surgery has narrated the aetiopathogenesis of prameha onthe basis of an endogenous entity being caused due to “Dhatvagnimandya”. The courseand complications of the disease along with different line of treatment are discussed atvarious places in Sushrutaa Samhita The most notable contribution from Sushruta is seen; he dedicated a separatechapter for the management of madhumeha. He has described nivritti lakshanas ofmadhumeha, on the basis of pathogenesis. Madhumeha of two types dhatukshayajanyaanssd Avaranajanya madhumeha.Astanga hridaya: -Vagbhata has described some specific drugs like Dhatri, nisha for the treatment ofPrameha.Astanga sangraha: -He expressed the similar opinion of the Charaka and Sushruta; later he quoted thesymptom Tanu madhuryata.Kashyapa samhita: -In vedana adhyaya of Sutrasthana Acharya Kashyapa mentioned the signs and symptomsrelated to Bala pramehi.11 13 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 28. Review of LiteratureBhela samhita: -Two types of prameha are given in Nidanasthana swakritija prameha and prakritijaprameha.12Harita samhita: -Acharya Harita enumerated 13 types of prameha with different nomenclature like puyaprameha, Takra prameha, Rasa prameha, Ghrita prameha etc.13MEDIEVAL PERIOD: - In this period no more classics have been written but this period of history ofIndian medicine is known as period of commentators.Madhavakara: -Madhavakara (9th century A.D) in his work madhava nidana compiled the thoughts of hisearlier acharyas without adding any thing new to the knowledge on madhumehaGayadas: - Gayadas (11th century A.D) commentators of sushruta samhita elucidated that thesymptoms of Avilatwa of urine in prameha is due to the presence of dooshya like meda,mamsa etc (Su.Ni. 6/6)Chakrapanidatta: -Chakrapanidatta in 35th chapter he documented the treatment of prameha.DallhanaAnother 12th centurion commentator of Sushruta samhita; while commenting on Sushruta 14 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 29. Review of Literaturesamhita nidanasthana 6/3; he contributed a myth that females do not suffer frommadhumeha.Sharangadhara13th century A.D he belongs to 12th century, he described 20 types of prameha with somenew recipes for the management.BhavamishraAcharya Bhavamishra added some new herbo-mineral preparations for the management.Yogaratnakara: - Specific yogas are vividly explained.AgnipuranaThe Kshoudra and Kshoudraprameha are quoted; also some specific treatment ismentioned for prameha.Valmiki ramayana: - There is a reference that the monkeys who were serving Rama, suffered frommadhumeha due to madhura Ahara sevana.Ayurveda is well aware about the extent in which all the body tissues are involved in thepathogenesis of Prameha. The outstanding pioneers of Ayurved Charaka, Sushruta andVagbhata better known as the holy triad made the earliest reference to diabetes as a“diseased flow of urine” and “honey urine.” It seems, during this period no Greco-Romanphysicians were acquainted with symptoms of abnormal urine. 15 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 30. Vyutpatti Etymology of Basti The word ‘Basti’ has its origin from the root ‘Vas’ with the suffix of Pratyaya‘Tich’ gives rise to the word ‘Basti’ and it belongs to masculine gender. According to Siddhanta Kaumdi, the root ‘Vas’ gives following meaning: 1) “Vasu Nivase”13 - this means to stay, to reside and to dwell. 2) “Vas-aachadane” – which gives covering. 3) “Vas vasane surabhikarane”– Fragrance. 4) “Vasti vaste aavrunothi mootram” – which covers the urine. 5) “Nabheradhobhage mootradhare” – urinary bladder. Paribhasha: - The term basti can be used in different sense, in the context of Panchakaram; itgives the following meaning. 1) “Vastinam deeyate vasti.”14 “Vastirabhideeyate yasmat tasmat vastiritismrita.”15 Basti means bladder and it is used as the measure devise for the bastikarma. Themedicines like decoction, Milk, oil, Ghee etc are taken in the basti and administeredthrough gudamarga by a basti netra. Hence the term basti is used to designate the processin panchakarma.Hence, Basti conveys the following meanings. Medicine stays in large intestine for sometime after its introduction through the rectum, which causes movements in large intestine and waste materials there in which are begged for their elimination. An organ where urine is collected i.e. urinary bladder, which is situated below the umbilicus. An instrument, which is used to introduce Basti drugs in the rectum. 16 “Evaluation of efficacy of Madhutailika basti In themanagement of Madhumeha”
  • 31. Vyutpatti Definition of Basti: 1) The apparatus used for introducing the medicated materials is made up of Basti or animal urinary bladder16 2) The procedure in which the medicaments are introduced inside the body through the rectum with the help of animal urinary bladder is termed as Basti17. 3) The bag made by animal bladder is termed as Basti. 4) Acharya Charaka has defined the Basti as the procedure in which the drug prepared according to classical reference and administered through rectal canal reaches upto the Nabhi Pradesha, Kati, Parshva, Kukshi churns the accumulated Dosha and Purisha and spreads the potency of the drugs to all over the body and easily comes out along with the Purisha and Doshas is called Basti.18 According to modern science, enema is the procedure in which any liquid preparation is introduced through rectum by means of adequate instruments (Ghosh) or injection as liquid or gas into the rectum. 17 “Evaluation of efficacy of Madhutailika basti In themanagement of Madhumeha”
  • 32. ShareeraShareeraFocus of this study is on Madhutailika Basti. Therefore, a discussion on the anatomy andphysiology of guda and pakwashaya where the Basti is administered is necessary prior tothe discussion on the anatomy and physiology of Pancreas, pituitary gland, adrenalingland and liver, these are the sites of this disease.The word shareera composes both structural and functional aspects of the body. As bastiin considered importantly in the subject certain anatomical features of rectum and largeintestine is also described.Guda / RectumSynonyms:Amarkosha - Aapanam, PayuJatadharam – Guhyam, GudavartmaVijayarakshita – Apanah, MahatsrotasGangadhara – BradhanamVachaspati – Vitmarga Other words that are mentioned in contact to Guda various Acharyas areCharaka – Uttaraguda, Adharaguda, Sthulaguda (C. V5/4, Si 9/3), GudamukhaSushruta – Gudamandhala, Gudavalaya, Payuvalaya, Gudaustha.Vagbhatta – GudamargaDalhana – Gudantram Sushrutha has explained elaborately on the anatomical structure of gudawhile describing Arsoroga. Guda is a part, which is the extension of sthoolantra with 41/2angula in length. It has got 3 valis (parts) named as Gudavalitrayam.19 18 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  • 33. Shareera1.Pravahini – that which does pravahana.2.Visarjini – that which does viasrajana3.Samvarani – that which does samvaranaThere is another structure called as Gudostha, which is about a distance of 1½yavapramana from the end of hairs. The first vali samvarani starts at a distance of 1angula from gudostha. The width of each vali will be 1 angula and of the colour ofelephant’s palate. 20Charaka when described about the koshatagni has considered uttaraguda and adharaguda.The modern commentators consider them as rectum and anus respectively.21 all Acharyashave considered guda as one among the bahyasrotas and one among the dashajeevithadhamani. 22, 23, 24The rectum forms the last 15cm of digestive tract and is an expandable organ for thetemporary storage of fecal material. Movement of fecal material into the rectum triggersthe urge to defecate.The last portion of the rectum, the Ano-rectal canal, contains small longitudinal folds, therectal columns. The distal margins of rectal columns are joined by transverse folds thatmark the boundary between columnar epithelium of the proximal rectum and a stratifiedsquamous epithelium like that in the oral cavity. Very close to the anus or anal orifice, theepidermis becomes keratinized and identical to the surface of the skin.There is a network of veins in the lamina propria and submucosa of the ano-rectal canal.The circular muscle layers of the muscularis externa in the region forms the internal 19 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  • 34. Shareerasphincter and is not under voluntary control. The external anal sphincter guards the anusand is under voluntary control. Pudental nerves carry the motor commands. 25Pakwashaya / Large intestine Pakwashaya is considered as one among the ashaya by Sushrutha,Vagbhata.26,27 Arunadatta comments as pakwashaya is the seat of pakwa anna i.e. thatwhich attains pureeshatha.28 Charaka and Vagbhata considered this as one among the 29, 30koshtangas. Sharangadhara has specified the location of pakwashaya (pavanasaya)as below the Tila i.e. the liver.31 The horseshoe shaped large intestine or large bowel begins at the end ofileum and ends at anus. Average length is about 1.5 meters and width of 7.5cms. It isdivided into 3 parts: -1.Cecum – T portion (pouch like)2.Colon – large portion.3.Rectum – the last – 15 cm portion. 20 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  • 35. ShareeraAbsorption in the Large IntestineThe re-absorption of water is an important function of the large intestine. Althoughroughly 1500 ml of material enters your colon each day, only about 200 ml of feces isejected. The remarkable efficiency of digestion can best be appreciated by consideringthe average composition of fecal wastes: 75 percent water, 5 percent bacteria, and the resta mixture of indigestible materials, small quantities of inorganic matter, and the remainsof epithelial cells.32In addition to reabsorbing water, the large intestine absorbs a number of other substancesthat remain in the fecal material or that were secreted into the digestive tract along itslength:Diabetes mellitus is a chronic disease due to the disordered carbohydrate metabolism andresults due to deficiency of insulin secreted by the beta cells of Islets of Langer Hans ofpancreas. But the hormones of pituitary and adrenal glands are also intimately related tothe development of this state. Apart form this liver had its own role in the manifestationof this disease, because it stores the glucose in the form of glycogen under the influenceof insulin. Any alteration in this leads to diabetes. So following glands are involved in thepathology of the diabetes mellitus – Pancreas Pituitary Adrenal Liver 21 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  • 36. ShareeraPancreas33The pancreas lines within the abdomino-pelvic cavity in the ‘J’ shaped loop between thestomach and the small intestine. It is a slender, plane organ with a nodular consistency.The adult pancreas is 20 –25 cm long and weights about 80 gm. The broad head of thepancreas lines within the loop formed by the duodenum as it leaves the pylorus. Theslender body extends transversely towards the spleen and the tail is short and bluntlyrounded. The pancreas is retroperitoneal and is firmly bound to the posterior wall ofabdominal cavity.The surface of the pancreas has a lumby, lobular texture. A thin, transparent connectivetissue capsule wraps the entire organ. You can see the pancreatic lobules, associatedblood vessels and excretory ducts through the anterior capsule and the overlying layer ofperitoneum.Arterial blood reaches the pancreas by way of branches of the splenic, superiormesenteric and common hepatic arteries. The pancreatic arteries and Pancreaticoduodenalarteries are the major branches from these vessels. Splenic vein and its branches drain thepancreas.The pancreas is primarily an exocrine organ producing digestive enzymes and buffers.The large pancreatic duct delivers these secretes to the duodenum. A small accessoryduct, or duct of Sanforini, may branch from the pancreatic duct. The Pancreatic ductextends within the attached mesentery to reach the duodenum, where it meats thecommon bile duct from the liver and gall bladder.The pancreas has two distinct functions, one endocrine and other exocrine. The exocrinepancreas roughly 99 percent of the pancreatic volume consists of clusters gland cells, 22 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  • 37. Shareerapancreatic acini, and their attached ducts. Together the gland and duct cells secrete largequantities of an alkaline, enzyme rich fluid. This secretion reaches the lumen of thedigestive tract by traveling along a network of secretary ducts.The endocrine pancreas consists of small groups of cells scattered among the exocrinecells. The endocrine clusters are known as pancreatic Islets, or the Islets of Langer Hans.Pancreatic islets account for only about 1 percent of the pancreatic cell population.Nevertheless, a typical pancreas contains roughly 2 million pancreatic Islets.Each Islet contains four different cell types.Alpha cells –Produces the hormone Glucagon, it raises blood glucose levels by increasing the rates ofglycogen break down and glucose release by the liver.Beta cells – Produce the hormone insulin. Insulin lowers blood glucose by increasing therate of glucose uptake and utilization by most body cells and increasing glycogensynthesis in skeletal muscles and the liver. Beta cells also secrete amylin, a recentlydiscovered peptide hormone whose role is uncertain.Delta cells – Produce a peptide hormone identical to somatostatin, a hypothalamicregulatory hormone. Somatostatin produced in the pancreas suppresses glucagon andinsulin release by other islet cells and slows the rates of food absorption and enzymesecretion along the digestive tract. 23 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  • 38. ShareeraF cells –Produce the hormone pancreatic polypeptide. It inhibits gallbladder contractions andregulates the production of some pancreatic enzymes. It may help to control the rate ofnutrient absorption by the digestive tract.Here focus is made on insulin and glucagon, the hormones responsible for the regulationof blood glucose concentrations, which are given below. These hormones interact tocontrol blood glucose levels. When blood glucose levels rise, beta cells secrete insulin,which then stimulates the transport of glucose across cell membranes. When bloodglucose levels decline, alpha cells secrete glucagon, which stimulates glucose release bythe liver.InsulinInsulin is a peptide hormone released by beta cells when glucose levels rise above normallevels (70 to 110 m/c). Elevated levels of some amine acids, including arginine andleucine, also stimulate insulin secretion. Insulin exerts its effects on cellular metabolismin a series of steps that begins when insulin binds to receptor proteins on the cellmembrane. Binding heads to the activation of the receptor which functions as a kineaseand attaches phosphate groups to intracellular enzymes. Phosphorylation of enzymes thenproduces Primary and secondary effects within the cell, the biochemical details remainunresolved.One of the most important effects is the enhancement of glucose absorption andutilization. Insulin receptors are present in most cell membranes. Such cells are called 24 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  • 39. Shareerainsulin-dependent. However, cells in the brain and kidneys, cells in the lining of thedigestive tract, and red blood cells lack insulin receptors. These cells are called insulinindependent, because they can absorb and utilize glucose without insulin stimulation.Effects of insulin on its target cells –01. Acceleration of glucose up takesThis effect results from an increase in the number of glucose transport proteins in the cellmembrane. These proteins transport glucose into the cell by facilitated diffusion.02. Acceleration of glucose utilization and enhanced ATP productionThis effect occurs for two reasons –(a) The rate of glucose use is proportional to its availability. when more glucose entersthe cells, more is used.(b) Second messengers activate a key enzyme involved in the initial steps of glycolysis.03. Stimulation of glycogen formation (skeletal muscles and Liver cells)When excess glucose enters these cells, it is stored in the form of glycogen.04. Stimulation of amino acid absorption and protein synthesis05. Stimulation of triglyceride formation in adipose tissuesInsulin stimulates the absorption of fatty acids and glycerol by adipocytes. The adiposecells then store these components as triglycerides. Adipocytes also increase theirabsorption of glucose; excess glucose is used in the synthesis of additional triglycerides.As whole (summary) insulin secreted when glucose is abundant and this hormonestimulates glucose utilization to support growth and the establishment of carbohydrate(glycogen) and lipid (tryglyceride) reserves. The accelerated use of glucose soon bringscirculating glucose levels with in normal limits. 25 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  • 40. ShareeraGlucagonWhen glucose concentrations fall below normal, alpha cells release glucagons, andenergy reserves are mobilized. When glucagons binds to a receptor in the cell membrane;it activates adenylate cyclase, and cAMP acts as a second messenger that activatescytoplasmic enzymes. The primary effects of glucagons are – Stimulation of glycogen breakdown in skeletal muscle and liver cells. Stimulation of triglyceride breakdown in adipose tissues. Stimulation of glucose production at the liver.GluconeogenesisIt is a process of glucose synthesis in the liver; the liver cells absorb amino acids fromblood stream, convert into glucose, and release the glucose into the circulation. Theresults are a reduction in glucose use and the release of more glucose into the bloodstream consequently; blood glucose concentrations soon rise towards normal glycemiclevel.Pancreatic alpha cells and beta cells monitor blood glucose concentrations, and thesecretion of glucagon and insulin occur without endocrine or nervous instructions. Yet,because the alpha cells and beta cells are very sensitive to changes in blood glucoselevels, any hormone that affects blood glucose concentration will indirectly affects theproduction of insulin and glucagon. Insulin production is also influenced by autonomicactivity. Parasympathetic stimulation inhabits it.Pituitary Gland 34It is an important ductless gland with lot of functions, including the control of the otherductless glands and of body growth. This gland measures 1.5 cm in the coronal plane, 1 26 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  • 41. Shareeracm in the sagittal plane and 0.75 cm in vertical form. It lies within the cella tarsica of thesphenoid bone and the posterio-superior to the sphenoid air sinuses, below the opticchiasma. It is flattened ovoid laying the hypophysial fossa and connected to the inferiorsurface of the hypothalamic part of the brain by the infundibulum.Structurally it can be dividedinto 2 parts –1) Anterior lobe2) Posterior lobePosterior lobe of the hypophysis is the expanded end of the infundibulum and isdeveloped from the brain. The anterior lobe is much larger than the posterior lobe andconsists of three parts, which partly surrounds that lobe and the infundibulum. The distalpart forms most of the anterior lobe. It is separated from the posterior lobe by the thinseat of glandular tissue applied to the posterior lobe. The infundibular part is a narrowupward projection of the distal part. The anterior lobe develops from the ectoderm andhas only vascular connection with brain.Anterior lobe is the master gland of the endocrine system, because it produces proteintropic hormones, which affects the other ductless glands. In these secretions twohormones are having direct action on carbohydrate metabolism, which leads tohyperglycemia or hypoglycemia. The two hormones are –Growth Hormone or Somatotrophic hormone – (GH or STH) 27 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  • 42. ShareeraAdrenocorticotrophic hormone (ACTH)The pituitary effect of STH on carbohydrate metabolism is to stimulate its storage.Administration of growth hormone will produces hyperglycemia and glycosuria. Thehigh blood glucose level leads to its exhaustion and atrophy. So the growth hormone hasdiabetogenic effect especially in man. The hormone is however increasing the glycogencontent of cardiac muscles.Administration of ACTH possesses similar effects as induced by growth hormone. BothSTH and ACTH increase gluconeogenesis and diminish the rate of oxidation of glucose.Thus the anterior pituitary has a diabetogenic role. GH is also known as Somatotrophinand somatotrophic hormone causes cells to grow and multiply and it increases the rate ofprotein synthesis. GH accelerates the rate at which glycogen stored in the liver isconverted to the glucose and released in the blood. GH raises blood glucose level and theraise in the glucose, triggers insulin secretion. ACTH by stimulating secretion of gluco-corticoids brings about hyperglycemia and also directly stimulates the release of GHIFand inhibits the secretion of insulin. One stimulus that inhibits GH secretion ishyperglycemia. An abnormally high blood sugar level stimulates the hypothalamus tosecret the regulating factor GHIF and it inhibits the release of GHAF and thus thesecretion of GH. As a result blood sugar level decreases.Adrenal Gland 35Adrenal glands are situated on the upper poles of the kidneys. Each gland weights about 4gms. A distinct connective tissue capsule surrounds the parenchyma of the gland.Beneath the capsule the cortex is arranged in three layers – 28 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  • 43. ShareeraZona glomerulosa – Secretes mainly aldeosterone and it secretes less amount of gluco-corticoids and sex hormones.Zone fasciculata –It secretes mainly gluco-corticoides.Zona reticularis – Secretes the sex hormoneand glucocorticoids,All the three zones of the adrenal gland cansynthesis the gluco-corticoids. The chief actionof the gluco-corticoids is to increaseglyconeogenesis in the liver and stimulates formation of glycogen in the liver andmuscles. The adrenal cortex also asserts diabetogenic affects. Proteins are converted intocarbohydrates i.e. glyconeogenesis occur through the action of gluco-corticoids.Therefore, constant production of carbohydrates and the insulin is required to metabolizethe excess of carbohydrates. The excessive glyconeogenesis exerts continued strain uponthe cells of Islets leads to hyperglycemia. When it is severe, it damages the beta cells andpermanent insulin deficiency results. The adrenal action however depends upon theaction of anterior pituitary.Liver 36The liver is the largest gland in the body. The greater part of the liver lies under thecovering of the ribs and costal cartilage. The liver is a dark brown highly vascular softorgan. It is approximately 1/50th of the body weight in the adults, but larger in thenewborn. The liver lies normally in the right hypochondrial and epigastric regions. The 29 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  • 44. Shareerasurrounding organs determine the shape of the liver; it retains the shape of a blunt wedge.It has two surfaces – diaphragmatic surface and visceral surface.Lobes of liver – The main lobes of liver rightand left are demarcated form one anotherabove and in front by the falciform ligamentand below and behind by the fissures for theligamentum teres and ligamentum venosum.The right lobe includes two subsidiary lobes. The liver plays a central and crucial role in the regulation of carbohydratemetabolism. Its normal functioning is essential for the maintenance of blood glucoselevels and of a continued supply to organs that require a glucose energy source. Thiscentral role for the liver in glucose homeostasis offers a clue to the pathogenesis ofglucose intolerance in liver diseases but little insight into the mechanisms of liver diseasein diabetes mellitus. The Role of the Liver in Glucose Homeostasis An appreciation of the role of the liver in the regulation of carbohydrate homeostasis isessential to understanding the many physical and biochemical alterations that occur in theliver in the presence of diabetes The liver uses glucose as a fuel and also has the ability tostore it as glycogen and synthesize it from no carbohydrate precursors (gluconeogenesis). Underscoring the important role the liver plays in maintaining normoglycemia. 30 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  • 45. ShareeraGlucose absorbed from the intestinal tract is transported via the portal vein to the liver.Although the absolute fate of this glucose is still controversial, some authors suggest thatmost of the absorbed glucose is retained by the liver so that the rise in peripheral glucoseconcentration reflects only a minor component of postprandial absorbed glucose.Therefore, it is possible that the liver plays a more significant role than does peripheraltissue in the regulation of systemic blood glucose levels following a meal.37 Katz andassociates, 38 however, suggest that most absorbed glucose is not taken up by the liver butis rather metabolized via glycolysis in the peripheral tissues.Many cells in the body, including fat, liver, and muscle cells, have specific cellmembrane insulin receptors, and insulin facilitates the uptake and utilization of glucoseby these cells. Glucose rapidly equilibrates between the liver cytosol and the extracellular fluid. Transport into certain cells, such as resting muscle, is tightly regulated byinsulin, whereas uptake into the nervous system is not insulin-dependent.Glucose can be used as a fuel or stored in a macromolecular form as polymers: starch inplants and glycogen in animals. Glycogen storage is promoted by insulin, but the capacitywithin tissues is physically limited because it is a bulky molecule.Insulin is formed from a precursor molecule, preproinsulin, which is then cleaved toproinsulin. Further maturation results in the conversion of proinsulin into insulin and asmaller peptide called C-peptide.A small amount of proinsulin enters the circulation. It has a half-life 3–4 times longerthan that of insulin because it is not metabolized by the liver. However, proinsulin has<10% of the biological activity of insulin. 31 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  • 46. ShareeraInsulin is metabolized by insulinase in the liver, kidney, and placenta. About 50% ofinsulin secreted by the pancreas is removed by first-pass extraction in the liver. Insulinpromotes glycogen synthesis (glycogenesis) in the liver and inhibits its breakdown(glycogenolysis). It promotes protein, cholesterol, and triglyceride synthesis andstimulates formation of very-low-density lipoprotein cholesterol. It also inhibits hepaticgluconeogenesis, stimulates glycolysis, and inhibits ketogenesis. The liver is the primarytarget organ for glucagon action, where it promotes glycogenolysis, gluconeogenesis, andketogenesis.39, 40 32 “Evaluation of efficacy of MadhutailikaBastikarmaIn the management of Madhumeha”
  • 47. Bastikarma BASTIKARMA: - Among the shodhana Chikitsa basti has its unique importance in treating the major disease like madhumeha, Vatavyadhis etc. due to the power and advantages it confers on patients. It differs in many aspects like in principle, mode of application and in wide advantages it renders. The term basti means bladder; it is used as a major device for bastikarma. It is also said that the medicine in suspension, administered through the bastiyantra, first reaches the lower abdominal part of the patient. The lower abdominal area or the pelvis also contains the organ basti i.e.urinary bladder, due to these reasons the term basti is used in Panchakarma. Importance of Bastikarma: - All the acharyas were appreciated basti has a unique form of treatmentmodality considering the efficacy it generates in remodeling the hampered doshas. It isuncomparable elimination therapy than the other because it expels the vitiated doshasrapidly as well as it nourishes the body.41 It can be easily perform in all the age grouppersons; where other shodhana procedures are difficult to perform.42 Bastikarma is thebest choice of treatment for vatadosha and vata associated with kapha and pitta. As vatabeing chief among the three doshas and it is functional requirement for both kapha andpitta, if once co-ordination gets disturbed then the disease is going to manifest.43 inmadhumeha kapha is arambhaka and vata is the preraka. Vata is responsible for gatigamana, which is much requiring for shreera vyapara.44 Charaka very specifically given importance to treat the sthanika dosha first andsthanantara dosha, Pakwasaya is said to the main seat of vata dosha. By adoptingtreatment modality like bastikarma will helps in bringing vata into its normalsy, vata 33 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 48. Bastikarmamainly involved in the pathogenesis of mandhumeha and ohter diseases.45 Hence, it is tobe considered as one of the suitable treatment for vata dosha predominant diseases,supporting to this Vagbhata named it as “Ardhachikitsa.”46 Apart form this it isconsidered as superior then the other therapeutic measures; on account of its variedactions like samshodhana, samshamana and samgrahana, etc.47 Charaka explained nirooha Basti is contraindication in udara vyadhi,48 againwhile explaining yogya for nirooha basti; he indicated in Bala, Varna, Mamsa andShukrakshaya condition nirooha basti can be given,49 it is clear that nirooha iscontraindicated in specific conditions like were excessive rookshatha is present in suchcondition it versions the condition. Madhumeha is a condition; were the detoriation ofbala, varna and ojas are roetinly noticed. For maintaining Bala and Varna of a patient;basti can be given in madhumeha patient. Classification of Basti: - Knowledge of the classification is very essential for the better understanding pointof view. In classics different types of Basti are explained based on the amount of thedrug, the quality of the substance and the expected action of the Basti, etc. there isdifference of opinion in classification. The term basti has been used for all types ofbastikarma, which includes nirooha, anuvasana, uttarabasti etc. Charaka used the termbasti exclusively for nirooha eventhough he is considred both nirooha and anuvasana asshodhana procedures.50 finely bastikarma has been brought into the followingclassifications.511) Adhishtana bheda : - The site of application viz abhyantara and bahya2) Dravya bheda: - on the bases of medicine used viz madhutailika basti, kashaya basti, taila basti, ksheera basti, pichha basti3) Karma bheda: - on the bases the action it does viz shoadhana basti, shamana basti, lekhanabasti, brihmana basti, etc4) Sankhya bheda: - The number of bastis given as a course yaga basti i.e. 8 in number, kala basti i.e. 16 in number 34 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 49. Bastikarma5) Anushangika bheda: - miscellanios verities.6) Matra bheda: - Based on quantity of vasti dravya used. 1. Adhishtana bheda: - According to the site of application of basti it is of two types – a. Internal b. External a. Internal i) Pakwasayagata basti: - The administration of medicine via ano-rectal route to pakwasaya. ii) Garbhasayagata basti – The administration of medicine through the vaginal route to garbhasaya. iii) Mutrasayagata basti – The administration of medicine via urethral route to mootrasaya. iv) Vranagata basti – The medicine administered through the vranamukha by the process of bastikarma. b. External In certain diseases the medicated oil is kept over the part of the body using a cap or with flour paste for prescribed period of time and named after the site of application of oil such as – Shirobasti, katibasti, urobasti, etc. 2. Dravya bheda: - It is of two types a) Nirooha basti (Evacuative or Un-unctuous Enema): - The propornity of kwath is more, and it is the main ingredient among other four common ingredients I.e.makshika, lavana, sneha and kalka. Nirooha basti posseses varied therapeutic effects like shodhana; it makes the apakarshana of vit, sleshma, pitta and anila. It restores the dridata, bala Varna, shukra and it prevents the aging process; 52, it is named as asthapana basti, as it acts like a vaya and ayusthapaka. 35 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 50. Bastikarma Madhutailika basti is the vikalpa of Nirooha; the synonyms of madhutailika vasti are sidda basti, yapana basti and yuktarata basti.53 The effect of nirooha will spread all over the body; the potency of drug reaches at the cellular cellular level thus it helps in eliminating the vitiated doshas from all the srotases54,55.ii) Anuvasana basti (Unctuous Enema): - It is Sneha pradhana vasti hence auvasana is named as sneha basti. “Anuvasan api na dushyatyanudivasam va deeyata ityanuvasana:” the peculiarity of this basti is no adverse effects, it is safe, can be practice daily.56 Types Based on the sneha matra it is of three types571) Sneha Basti: - 6 Pala (298ml)i.e.1/4th of the quantity of Nirooha.2) Anuvasana Basti: - 3 Pala (144ml) i.e. half of the Sneha Basti.3) Matra Basti: - 1½ Pala (72ml) and this is the minimum quantity of Sneha BastiMATRA BASTI Definition: “Hrisvaya: sneha matraya: matrabasti: samo bhaveth” It is a type of Sneha Basti.The Sneha matra is very less as compared to the Sneha Basti so it is named as matra basti,56, 57, and .58Indication: 36 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 51. Bastikarma Ashtanga Samgrahakara emphasized on regular administration of the Matra Bastiand it can be administered at all times and in all seasons just as Madhutailika Basti,vaitarana basti. Table.No-1 Sr. Indications Ch. A.H. A.S. 1) Karma karshita + - - 2) Bhara karshita + + + 3) Adhva karshita + + + 4) Vyayama karshita + + + 5) Yana karshita + - + 6) Stri karshita + + + 7) Durbala + + + 8) Vata Rogi + + + 9) Bala - + + 10) Vriddha - + + 11) Chintatur - + + 12) Stri - - + 13) Nripa - + + Sr. Indications Ch. A.H. A.S. 14) Sukumar - - + 15) Alpagni - + + 16) Sukhatma - + -Contraindication: 37 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 52. Bastikarma In classics, there are no major contraindications mentioned for matra Basti, butAshtanga Sangrahakara has stated that Matra Basti should not be administered in Ajirnacondition.Qualities: The Matra Basti is promotive of strength, helps in easy elimination of Malaand Mutra. Brimhana nature this basti helps in pacifying the Vata dosha.Dose: According to Vagbhata the dose of Hrsva Snehapana is recommended for matraBasti. The matra which gets digeste in two Yama (i.e. 6 hours) is called as Hrsva matra.Sushruta has explained the dose as ½ of the dose of Anuvasana Basti and according tohim the dose of Anuvasana Basti is ½ of the dose of Sneha Basti Hence, the does ofMatra Basti is 1½ Pala = 6 Tola = 72ml61. According to Chakrapani the dose of Sneha Basti is 6 Pala, dose of AnuvasanaBasti is 3 Pala and of Matra basti is 1½ Pala47 (Ch. Si. 4/54). On the basis of above references, it is clear that the dose of Matra Basti is 1½ Pala i.e. 6 Tola = 72ml.3. Karma bheda: - This classification is made baased on their action62, 63a) Shodhana basti – Contains shodhana dravyas and removes dosha and malas from the body.b) Lekhana basti – Reduces medodhatu and produces lekhana in the body.c) Sneha basti – Contains more of sneha and produces snehana 38 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 53. Bastikarma in the body. d) Brumhana basti – Increases the rasadi dhathus and indirectly it helps in nurishing the body. e) Utkleshana basti – Causes utklesha of malas and doshas by increasing its Pramana.f) Doshahara basti – Purificatory or eliminating type.g) Shamana basti – Produces shamana of doshas. Sharangadhara added, shodhana basti, lekhana, brimhana, deepana andpachana types of bastis.64 Vataghna basti, balavarnakrita basti, snehaneeya basti,sukrakrit basti, krimighna basti, vrushatvakrit basti has been explained by Charaka.654. Sankhya bheda: - Charaka has made this classification based on the number of snehabastisand niroohabastis in a treatment. That is totle 8 basti in yaga basti, 16 in kala basti and 30in karma basti.665. Matra bheda: - The quantity may vary from person to person and it depends onrogi bala, roga bala and vaya of the patient. a) Dvadashaprasruta basti – In nirooha, the maximum dose or quantity of bastidravya prescribed is dvadashaprasruta i.e. 24 palas.67 b) Prasritayogika basti – Charaka has prescribed various types of nirooha in different doses considering the strength of the patient and condition of the disease.68 c) Padaheena basti – matra of this basti is 9 prasruthi.696. Anushangika bheda: - 39 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 54. Bastikarma a) Yapana basti – Enhances bala, shukra and mamsa. In treating the vyapats produced by excessive coitus. It can be practice daily.70 b) Siddha basti – It increases the bala, varna, and prasanata.71 c) Yuktaratha basti – Mainly indicated for travelers on vehicles etc.72 d) Vaitharana basti –It is mainly concentrating on the elimination of doshas.73 e) Ksheera basti – Explained for shoolam, vitsangam, anaha, and mootrakrichra.74 f) Ardhamatrika nirooha basti –snehana and swedana karmas are not required. Mainly it is indicated in rajayakhsma, shoola, krimi and in vatarakta. It improves sukrha and ojus.75 g) Picha basti – It is given with pichhila dravyas like Shalmaliniryasa and lajjalu. It is indicated in pichhalasrava and jeevashonita. It is acts as Sangrahi.76 h) Mutra basti – It is Gomutra pradhana basti it is mridu in nature, safe and pacifies the doshas.77 i) Rakta basti – it is indicated in adhika rakta srava.78Drugs used in Basti Karma: - Number of drugs belonging to animal and plant origin has beendescribed in the classics, which are used in bastikarma. For example, herbs, milk,mutton juice, eggs, urine, alkalis, salts etc. The above lists suggest that almost allavailable drugs can be used for bastikarma.801. Phalini drugs - Drugs useful for emesis can be used in asthapanabasti. e.g: -phala, jeemutaka, ikshwaku, dhamargava, kutaja, and kritavedhana.2. Sneha dravyas - Ghrita, taila, vasa, majja. 40 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 55. Bastikarma3. Mutravarga dravyas - Aja, avi, go, mahisha, hasti, ushtra, haya, etc.4. Asthapana & anuvasana gana - Dasamoola, bala, eranda, punarnava, yava, kola, kulatha, guduchi, madanaphala, palasa etc.5. Adjuants for asthapanabasti - Trivrit, bilwa, pippali, kushta, sarshapa, vacha, kutaja, satahwa, yashtimadhu, madanaphala.6. Adjuants for anuvasanabasti - Rasna, devadaru, bilwa, madanaphala, satahwa, swetapunarnava,raktapunarnava,gokshura, agnimandha, syonaka. , 83, 84Contents of niroohabasti82 The usual contents of nirooha basti are: - 1.Makshika (honey) 2.Lavana (rock salt) 3.Sneha (oil/ghee/taila) 4.Kalka (medicines made as paste) 5.Kwatha (decoction) According to the condition of patient and disease other ingredients likemilk, mamsarasa, amla dravya, mutra and guda are also used.85 Taila is selectedconsidering the disease and condition of patient. Drugs for kalka, if no drug isspecifically mentioned shatapushpi choorna can be used.86 Kwatha is the decoction madeas per the ingredients selected rationally to suit the condition of the patient.Contents and quantity of nirooha basti The quantity of nirooha is 12 prasrita, out of this 5 prasrita kwatha i.e. 10palas. The sneha should be 1/6th, 1/4th and 1/8th i.e. 4 pala, 6 pala, 8 pala in pitta, vata and 41 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 56. Bastikarmakapha dosha respectively.87 in nirooha. 24 palas of nirooha dose may be adjusted asfollows: 1.Makshika – 4 palas. 2.Lavana – 1 karsha 3.Sneha – 4 palas. 4.Kalka – 2 palas. 5.Kwatha – 10 palas. 20 palas. The remaining portion should be made up by avapa dravyas (orprakshepaka dravyas) like gomutra, mamsarasa etc. i.e. 4 palas totals it to 24 palas. According to Sushrutha88 1.Makshika – 4 palas. 2.Lavana – 1 karsha. 3.Sneha – 6 palas. 4.kalka – 2 palas. 5.Kwatha – 8 palas. 6.Avapadravya – 4 palas Total quantity is 24 palas. MADHUTALIKA BASTINirukti: -This unique basti contains madha and taila in equal proportionate hence this basti isnamed as madhutailika basti89.Paryaya: -90 Yapana basti Yuktarata basti 42 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 57. Bastikarma Doshahara basti Siddha bastiTypes of madhutailika basti All the Acharyas have been explained, different types of madhutailika basti’s withdifferent ingredients, those are as follows: -According to sushruta: -91Table No-2 S.no Ingredients Dose 1 Madhu 1-karsha 2 Saindhava 1-tola 3 Taila 1-karsha 4 Shatapushpi choorna 1-tola 5 Erandamoola kwatha 1-karshaImportance of madhutalika vasti.92 This basti can be practice even in female, sukumaras, etc Dosha niraharanartha, bala, varnartha, it can be continuously given with ought any marked complications, easy administration, 43 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 58. BastikarmaDashamoola madhutailika basti: -93 Vagbhata explains it in Astanga samgraha and in Astanga hridaya. The key ingredientsare as follows: -Each 1 pala of Panchamoola and Gokshura,Ksheera 1 adakaYastimadhu 1 prasthaMadhu, Taila, Seedhu, Sareeva, Bala, Sahachara, Darbha, etcIt is very mild and it is indicated in bala, sukumara, vrudda, and in female withoutcomplication.Vangasena also explained madhutailika basti and he mentioned its properties they are asfollows: -Ingredients: -Madhu 1 PrakunchaTaila 1 PrakinchaEranda kashaya 6 PrakunchaSaidhava 1 karshaShatapushpi ½ PhalaMadhutailika ksheera basti 94 It is explained by sangrahakara, considered as ksheerabasti. It is mainly indicatedin sukumara, sthree and mrudu persons.Content of this basti are: - ksheera, guduchi, brihateedvaya and magadi (pippali)Yastimadhu is used as kalka. 44 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 59. BastikarmaBasti YantraThe device used for basti karma is called as bastiyantra. It comprises by two parts –1.Bastinetra2.BastiputakaBastinetra The netra should be made of gold, silver, and copper or with other higher metals,alloys, long bones, bamboo, wood etc. Generally netra must resemble like tail of cowwith a tapering end and a wider base, or like pyramid shape with round ends and smoothsurfaces.95 the dimensions are different for different age group. 45 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 60. BastikarmaTable No: - 3Measurements of Bastiyantra.96, 97,98.No. Age Length Lumen of netra in in Diameter of narrow Diameter of broad end years Angula end1. <1 5 1 angula2. 1-6 6 Size of green gram 1 angula3. 7- 11 7 Size of black gram 1½ angula4. 12-15 8 Size of kalayam 2 angula5. 16- 20 9 Size of wet kalaya 2½ angula6. > 20 12 Karkandhu 3 angulaUttarabastiyantra7. - 12 – 14 Sarshapa size -Susrutha’s opinion8. 1 6 Green gram Feather of kanku bird must pass through.9. 8 8 Black gram Feather of eagle must pass through.10. 16 10 Kalayam Feather of peacock must through.11 >25 21 Kolasthi Feather of vulture must pass through.Pramana of vranabasti netra The hole should be of a mudga pramana, with 8 angulas of length.99Karnika In order to prevent undue penetration of the bastinetra deep in to therectum, a karnika or rim has to be made. It is to be placed at a required point above the 46 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 61. Bastikarmadistal end. Two karnikas are provided on the netra at distance of 2 angulas between one,another at proximal end to tie the bastiputaka properly.100Bastiputaka The container of the bastidravya is known as bastiputaka. And itshould be made suitable for well fitting with the bastinetra and should not have anybad smell. If good bladder is not available oter materials like skin of lower limb orneck of monkeys or other animals; thick cloth with sufficient strength and size arerecommended for the purpose101 As the technology advances the development various types ofmaterials are available to make up of bastiputaka and even disposable bastinetra areavailable. The rubber bladder and polythene bags are best choice these materials aredisposable, safe and easy to perform.Table No: -4Netradosha and putakadosha102,103No. Netradosha Features Effect1. Hraswata Too short Dravya will not reach pakwasaya2. Deerghata Too long Dravya go beyond the pakwasaya3. Tanuta Too thin Produces kshobha4. Sthoolata Too big Produces lakshana5. Jeernata Old dhatu used Injury to guda6 Shithilabandhana Not fixed properly to the Dravya comes out putaka7. Parshwachhidra Hole on side Leakage of dravya happens8. Vakrata Curved / irregular Dravyagati becomes irregular9. Assannakarnika Karnika too near Karma becomes of no use 47 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 62. Bastikarma10. Prakrustakarnika Karnika too far Causes raktasrava by gudamarma peedana11. Anusrotata Small hole Cannot perform properly12. Mahasrotrata Broad hole Cannot perform properlyNo. Putakadosha Features Effect1. Vishama Shape not in uniform Gati vishamata happens during pressing2. Mamsala Muscular tissue present Produces offensive small3. Chinnachidrayukta Presence of hole Dravya comes out4. Sthoola Thick one Does not push dravya5. Jalayukta Anastamosis present Produces leakage6. Vatala Excess air space Frothy type of dravya7. Snigdha Unctuous Slip form the hand8. Klinnata Wet Difficult to pass throughIndications and contra-indications of Bastikarma As basti is one of the prime treatment modality of Ayurveda,the knowledge of the indication and contraindication will make the sucsess in thetreatment.A brief description has been made here.Table No: -5Ayogya / anasthapya104,105,106 48 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 63. No. Type of patient Cha. Su. Vag. Complication1. Ajeerna + + - Bastikarma2. Atisnigdha + - + Dooshyodara, Moorchha, Shotha.3. Peetasneha + - -4. Utklishtadosha + - -5. Alpagni + + + Teevra aruchi6. Yanaklanta + - -7. Atidurbala + + -8. Kshudhaarta + - - Shaeerashosha, pranaparodha,9. Trishnaarta + + - Kruchraswasa10. Sharmaarta + - -11. Atikrisha + + +12. Bhuktabhakta + - + More karshya, utklesha of dosha13. Pitodaka + - - happens14. Vamita + - +15. Virikta + - + More rookshata happens16. Krita nasyakarma + - + Manovibhrama, Srotonirodha17. Krudha + - -18. Bheeta + - - Bastidravya moves up19. Matha + + -20. Moorchita + + - Samnjanasha and Hrudayopaghata21. Prasaktachhardi + + +22. Prasaktanishteeva + - +23. Swasaprasakta + + + Bastidravya moves up because of the24. Kasaprasakta + + + existing urdhwagati of vata25. Hikkaprasakta + - +26. Baddhagudodara + - +27. Chhidrodara + - + Leads to death by causing severe28. Dakodara + - + distension of abdomen29. Adhmana + - +30. Alasaka + - -31. Visoochika + - -32. Asmadosha + - - 49 Causes teevra amavastha of the body of “Evaluation efficacy of Madhutailika + sti -33. Amatisara ba + In the34. management of Madhum+ a” + Madhumeha, eh + Vyadhi vardhakam Prameha35. Kushta + + +
  • 64. BastikarmaTable No: -6yogya /asthapya107,108,109No. Indication Ch. Su. Vag. No. Indication Ch. Su. Vag.1. Sarvangaroga + + - 37. Rajakshaya + + +2. Ekangaroga + + - 38. Vishamagni + - -3. Kukshiroga + - - 39. Spikshoola + - -4. Vatasanga + + + 40. Janushoola + - -5. Mutrasanga + + + 41. Janghashoola + - -6. Malasanga + + + 42. Urushoola + - -7. Shukrasanga + - + 43. Gulphashoola + - -8. Balakshaya + - - 44. Parshnishoola + - -9. Mamsakshaya + - - 45. Prapadashoola + - -10. Doshakshaya + - - 46. Yonishoola + + -11. Shukrakshaya + + - 47. Bahushoola + - -12. Aadhmana + + + 48. Angulishoola + - -13. Angasupti + - - 49. Sthanashoola + - -14. Krimikoshta + - - 50. Dantashoola + - -15. Udavarta + + - 51. Nakhashoola + - -16. Sudhatisara + + + 52. Parvasthishoola + - -17. Parvabheda + - - 53. Shopha + - -18. Abhitapa + - - 54. Sthmaba + - -19. Pleehadosha + - + 55. Aantrakoojana + - -20. Gulma + + + 56. Parikartika + - -21. Shoola + + + 57. Maharogoktavatavyadhi + - + 50 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 65. Bastikarma22. Hridroga + - - 58. Jwara - + +23. Bhagandara + - - 59. Timira + + -24. Unmad + - - 60. Pratishaya - + -25. Jwara + - + 61. Adhimantha - + -26. Bradhna + + + 62. Ardita + + -27. Shirashoola + + + 63. Pakshaghata + + -28. Karnaroga + - - 64. Ashmari - + -29. Hritshoola + - - 65. Upadamsha - + -30. Parshwashoola + - - 66. Vatarakta - + -31. Prushtashoola + - - 67. Arshas - + -32. Katishoola + - - 68. Stanyakshaya - + -33. Vepana + - - 69. Manyagraha + + -34. Aakshepa + + - 70. Hanugraha + + -35. Angagaurava + - - 71. Ashmari - + +36. Atilaghava + - - 72. Moodhagarbha - + +Indications for anuvasana basti 110,111,112 Anuvasana is indicated in patients who are already indicatedfor asthapana, but special mention has been given to certain conditions like rooksha,kevala vataroga and atyagni where anuvasana is more beneficial. 51 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 66. BastikarmaTable No: -7Persons unfit for the anuvasana basti 113,114No. Contraindications Ch. Su. Vag. Complications1. Anasthapya + + +2. Abhuktabhakta + - + Sneha moves upwards3. Navajwara + - -4. Kamala + - + Leads to udara5. Prameha + - +6. Arshas + - - Leads to aadhmana7. Pratishyaya + - -8. Pandu + + +9. Arochaka + - - Leads to more annabhilasha10. Mandagni + - -11. Durbala + - - Increases the condition12. Pleehodara + + +13. Kaphodara + + + Leads to more dosha vardhana14. Oorustambha + - +15. Garapeeta + - +16. Kaphabhishyanda + - +17. Gurukoshta + - +18. Shleepada + - +19. Galaganda + - +20. Apachi + - +21. Krimikoshta + - +22. Prameha - + + 52 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 67. Bastikarma23. Kushta - + +24. Sthaulya - + +25. Peenasa - - +26. Krushna - - +27. Varchobheda + - +28. Vishapeeta + - +Preparation and procedures of bastikarma The preparation and procedures made before, during and afteradministration of nirooha, anuvasana, uttarabasti with little differences. Generally, theseprocedures are classified into three parts: - 1.Poorvakarma (pre-operative) 2.Pradhanakarma (operative) 3.Paschatkarma (post-operative) in classics many complications are mentined that are produced due toimproper and in efficient administration. Better practical experience is necessary toprevent the possible complications. Selected patients for basti therapy have to undergo through clinicalexaminations to ascertain the physical as well as the mental conditions. Usually thefollowing ten factors are to be considered for clinical examination.115 1.Dosha 2.Oushada 3.Desa 4.Kala 5.Satmya 6.Agni 7.Satwa 8.Vaya 9.Bala This will enable the physician to decide, the type of basti, number ofbastis, basti dravya, etc to be administered in the particular patient. 53 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 68. BastikarmaDose schedule116,117,118Table No: - 8 The adult dose of nirooha basti is dvadashaprasrita i.e. 24 palas.No. Age in Dose Years Ch. Vag. Su.1. 1 ½ prasrita 1 pala 2 anjalis of patients hand i.e. 1 pala2. 2 2 pala 2 pala3. 3 3 pala 3 pala4. 4 4 pala 4 pala5. 5 5 pala 5 pala6. 6 6 pala 6 pala7. 7 7 pala 7 pala8. 8 8 pala 8 pala 4 anjalis of patients hand9. 9 9 pala 9 pala10. 10 10 pala 10 pala 8 anjalis of patients hand11. 11 11 pala 11 pala12. 12 12 pala 12 pala13. 13 14 pala 14 pala14. 14 16 pala 16 pala15. 15 18 pala 18 pala16. 16 20 pala 20 pala17. 17 22 pala 22 pala To be fixed based on netra,18. 18 – 70 24 pala 24 pala dravya pramana, age, bala19. Above 70 20 pala 20 pala and saralaswabhava20. Above 25 12 prastha 54 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 69. BastikarmaPROCEDURE OF BASTIKARMA: -AnuvasanabastiPre-operative procedure The patient should pass is natural urges then body of the patient should beanointed with suitable sneha and mrudu sweda with hot water. He is advised to have hisprescribed meal it is madyama matra and made to take a short walk. Patient is asked to lieover basti droni which is not very high, and the head must be at lower level. The patientshould be on his left side drawing up the right leg and straightening the left leg.Operative procedure The prescribed amount of taila should be taken in the bastiputaka and tiedwell placing the bastinetra in position. Air is trapped from bastiyantra by gently pressingthe bastiputaka. Then the anal region and the netra should be smeared with oil tominimize the pain and irritation. Gently probe the anal orifice with the index finger of theleft hand and introduce the bastinetra through it into the rectum up to the mark of firstkarnika. Keeping in the same position press the bastiputaka by putting the adequate forcethen withdraw from the sight.Post-treatment procedures The patient is kept in same position as long as it would take to count up tohundred. The patient should be gently struck three times on each of the soles and over thebuttocks. The distal part of the cot should be raised thrice. Allow him to lie for sometimein the same position, if given sneha passed immediately; another anuvasanabasti should 55 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 70. Bastikarmabe adopted. After passing the motion with sneha in proper time the patient is allowed totake light food if he feels hungry. 9 hours is the maximum time for basti pratyagamana.NiroohabastiPre-treatment procedure Sutable time to administer Niroohabasti is Madhyahnekinchidavrute i.e is in noon, with an empty stomach. Abhyanga and swedanashould be done prior to the procedure and the patient is advised to be lie upon thecot as in anuvasanabasti. Bastidravya prepared as per the direction should be takenin bastiyantra and introduced; other procedures are as same in anuvasana basti.Post-treatment procedures After the pradhana karma patient is lie in supine position pillow should beplced below the vankshana pradesha. The other procedures followed in anuvasana shouldnot be done in this codition. After passing motion he may be advised to take bath with hotwater and have normal food along with yusha, mamsarasa or milk in kapha, vata and pittapredominant diseases respectively. The maximum time for bsati pratyagamana is onemuhurtha (48 minutes). If it did not pass out, giving basti, which consists of sneha,kshara, mutra, amla dravyas and Phalavarti, can bring it out. It should have the propertieslike snigdha, Ushna, and teekshna. If the nirooha is passed out instantly again 2 or 3bastis can be given. But if the patient shows excited symptoms of vata, snehabasti shouldbe given immediately. As jataragni is not much hampered; so specific regimen is notnecessary during the pariharakala.119 56 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 71. BastikarmaComplications of basti Generally basti vyapatas are classified under two catogaries:- 1) vaidya kruta 2) bastikrutacomplications of Snehabasti 120 Six types of complications may occure due to the following factors 1. Vata, 2.Pitta, 3.Kapha, 4.Atibhukta, 5.Pureesha, 6.Abhukta Specific signs and symptoms with treatments are not mentionedBasti vyapats:-121 Twelve bastikruta vyapats are explained in classics those are as follows:- 1. Ayoga: - If administred less quantity of basti dravya, saidhava, add oil leads to heaviness in abdomen, obstruction of flatus stool and urine, local burninsensation, inflammation, itching, anorexia and dyspepsia. 2. Atiyog: - Administration of teekshna basti in mridu koshta person leads to atiyoga and symptoms are similar as in vamana-virechana atiyoga. 3. Klama: - Conduction of mridu basti in ama avastha, pitta and kapha gets vitiated and srotorodha; leads to dyspepsia. There after vata also become vitiated and causes fatigue, syncope, burning sensation, colic, chest pain, heaviness. 57 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 72. Bastikarma 4) Adhmana: - Due to administration of alpa veerya drugs to strong person, rooksha person and costive bowel, the drugs not able to expel vitiated doshas and vata gets vitiated leads to adhmana causing pain in basti and hridaya, severe burning sensation, pain in testicles and groin. 5. Hikka:- Hiccup results in administering teekshna basti to weak person and mrid koshta with excessive expulsion of doshas. 6. Hritprapti:- Bastidravya reaches the heart by entering into deeper levels due to complete squeezing or improper handling of bastiputaka and causes pain in chest andthe surroundings. 7. Urdhwagamana:- Suppression of urges before or after bastikarma and squeezing bastiputaka with high pressure leads to the upward movement and may come out through mouth. 8. Pravahika:- Administration of less potent and insufficient quantity of bastidravya to the person suffering form intensive vitiated doshas leads to pravahika. 9. Shiroarti:- Includes symptoms of headache, earache, deafness, tinnitus and coryza, eye disordersdue to administration of less potent sheetaveerya dravyas with insufficient quantity toweak persons. 58 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 73. Bastikarma 10. Angarti:- Administration of teekshna basti without conducting pre-operative procedures like abhyanga and sweda leads to angarti with upward movement of vata and twisting and pricking pain in the body. 11. Parikartika:- Administration of ruksha and teekshna basti in excessive quantity to the person having mridukoshta and in conduction of less vitiated doshas leads to the excessive expulsion of doshas causing parikartika. 12. Parisrava:- Administration of teekshna and ushna bastis to the person suffering from pitta roga / raktapitta leads to parisrava and causes burning sensation, erosion and Cutting pain in anal region, severe bleeding and fainting.Defects of physician 122 1.Sa vata bastidana – Entry of an air into rectum leads to pain in abdomen and colic. 2.Druta praneeta – Quick administration of basti dravya leads to pain in hip, anus, thigh, calves and retention of urine. 3.Tiryak praneeta – Horizontal introduction leads to blockage at the tip of bastinetra. Introduction of bastidravya by pressing basti putaka more than once leads to chat pains, headache, and pain in thighs. 4.Ullipta – Introduction of bastidravya by pressing bastiputaka more than once leads to chat pains, headache, and pain in thighs. 59 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 74. Bastikarma 5.Sakampa bastidana – Shivering while administration leads to erosion, burning and swelling at anal region. Not deeply introduced leads to burning pain in intestines. 6.Apraneeta – Not deeply introduced leads to burning pain in intestines. 7.Atimanda data – If done too slowly drug does not reach till intestines. 8.Ativega data – Forceful introduction leads to the dravya reaching up to koshta and sometimes may come out through upper orifices.Basti Karmukata. Bastikarma having mulitidimentional therapeutic effects as early mentionedfor better understanding it can be studied under the following headings.The procedural effect The rationality behind the left lateral position is the gudvalees becomes relaxed there by it helps in the administration of basti. Pakwashayaresides in the given left side so the given basti dravya reaches the pakwasaya, as itis the main seat of vata; hence the given drugs will counter act the vatadosha. Healso mentions that the grahani is situated in the left side. Chakrapani states thatAgni will be in the natural state in the posture while Gangadhara says; Agni,grahani and nabhi are present in the left side. Jejjata comments Agni is present leftside over the nabhi, guda has got a left sided relation with sthoolantra. Sobastidravya can reach to the large intestine and grahani, as they are present in thesequence.Action based on drug effect Action of bastidravya is due to its Anupravanabhava, whichcontains sneha along with other dravyas like makshika, saidhavaSneha easily movesup to grahani by anupravanabhava guna similar to that of dravya, which freely 60 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 75. Bastikarmamoves in the utensil. Charaka says bastidravya reach nabhi, katipradesha andkukshi.The Shodhana effect The action of basti is mainly depends on its veerya. The drugused in the basti karma will however spread in the body from pakwasaya due totheir veerya; through the appropriate channels and draws the vitiated doshas topakwashaya. It is like sun in the sky draws the water from earth. The veerya isdrawn into the body by vata dosha i.e. first by apana, then udana and throughout thebody by vyana. In charaka siddi he gives a simily like water sprinkled at the root oftree circulates all over the tree and nourishes the body by its own specific property.In the same way bastikarma eliminates the morbid doshas and dooshyas from all theparts of the body.Probable Mode of Action Practically we can see that after appropriate administration ofbastikarma the signs and symptoms of vatavyadhi will be reduced. Bastidravya enters into the pakwasaya, where the water andminerals are absorbed in proximal colon. Sodium and potassium which are essentialfundamental factors of the body, it is prove that bioavilability of a drug is more inrectal rout. The basti dravyas gets absorbed by intestinal microflora; their by itmaintains the electrolyte ballence in the body. It enhances the biodegradablity of thedrugs and it increases the absorption of colon. The pakwashaya contains themaximum number of nerve plexuses originating from the hypo gastric plexus andlumbosacral plexus etc. and spreads all over the body. The given drug gets starabsorbing in intestinal flora, through heammoroidle vein potency of drug enters into the systemic circulation. Bastidravya prepared by madhu, lavana, sneha etc helpsin formation of healthy bacteria in large intestine, it is essential for the absorptionand nourishment at cellular level. 61 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 76. Bastikarma Another probable method is based on veerya. It is possiblethe veerya of the bastidravya pass through the autonomic nervous system andexpels out vitiated dosha from the body, as we see in the pressure receptors. Whenbastinetra is introduced in the rectum the same phenomenon may take place, whichresults in initiation of defecation reflex due to visceral distention and pressureresponse. Saindhava contains NaCl and it is integral part of the body. Itis having properties like srotosravaka, srotoshodhaka, etc these are necessary ingenerating the action potential, it maintaince the osmotic pressure. The release ofcatecholamines during visceral distention initiates the pressure response andultimately helping in defecation. When hypertonic solution is given in the form ofbastidravya, it circulates from blood vessels to the outer fluid. Absorption of bastidravya 60%-80% of water absorbed from thegut, Absorption in the proximal colon is better than the distal part as a result thisrout substitute’s oral rout. 62 “Evaluation ofefficacy of Madhutailika basti In themanagement of Madhumeha”
  • 77. Madhumeha MadhumehaCharaka explained Madhumeha under “Prameha” in Sutrasthana 17th, Nidanasthana 4thand Chikitsa 6th chapter. Sushruta Acharya also explained madhumeha in Nidana 6thchikitsa 11-12th and 13th chapter. In Chikitsasthana Sushruta has dedicated an exclusivechapter for madhumeha itself. Even Vagbhata also explained madhumeha in Nidanastana and chikitsa stana. Majority of the descriptions are available in the context of Prameha, such asNitukti samanya Nidana. Samanya samprati suits madhumeha and has it is one among 20types of Pramehas and all the Pramehas in due course, if neglected or not treated attainthe stage of Madhumeha. Considering all the above points, the description of Pramehawill also be made along with Madhumeha. Diabetes mellitus has a nearest clinical entityof a Madhumeha so a very brief description of diabetes mellitus will be made in thisparticular study.Nirukti (Etymology): -Madhumeha is composed by two words madhu and meha. It is a masculine genderformed by “Mihtghy” The word Madhu is derived from the root ‘Mana’ and the meaning as“manaava bhodane” i.e., which gives the psychic contentment (vachaspathyam); itrefers to the meaning Honey, Kshoudra, Madya, Pushparasa, Jala, and Madhurasa etc.MEHA: - The word ‘Meha’ is derived from the “Miha” Dhatu124, which is employed in the sence of Sinchana, Ksharana and Prasrava (excessive excretion), making water and as a prameha RogaBheda (Vachaspathyam). “Mehati ksharathi shukratiranena iti.” 64 “EvaluatioIn the management of Madhumeha”
  • 78. MadhumehaPrameha: - It is also a masculine gender formed by “Pra + miha”. In Shbadha kalpadruma, Meha or Prameha is defined as follows. “Prakarshena mehati ksharthi. Iti veerydiranaenaiti prameha.” The literary meaning of Prameha is to micthurate, the verbal noun MehanamSignifies urination as well as acts of passes any morbid urethral secretion. Hence thedisease is named, as madhumeha ‘Meha’ is Synonym of Mutra dosha by Raja Nighantuand bahumutrata by Hemachandra.Paribhasha (Definition) Madhumeha is a disease in which mutra of the patient attains similar property likemadhura (honey). The patient passes the urine like madhu, which is having Kashaya,Rooksha Guna along with the Prabhoota Avila mutrata.125 Acharya Charaka has given a definition of madhmeha as the disease in which onepasses urine as astringent, sweet and rough (Cha.Ni). Sushruta used the word Kshoudrameha as synonym for madhumeha and he defined it as the urine of patient resemble likehoney and acquires a sweet taste.According to Vagbhata in any types of Prameha not only urine the whole body alsobecomes sweet; it is to be named as madhumeha.126Definition of diabetes mellitus The term diabetes mellitus described as a metabolic disorder of multipleetiology characterized by chronic hyperglycemia with disturbances of carbohydrate,fat and protein metabolism resulting from defects in insulin secretion insulin actionor both. Although hyperglycemia is most outstanding of its biochemical measures,diabetes means to be a pan metabolic disorder. It is generally accepted that all thederangements result from either absolute or relative deficiency of insulin inassociation with almost reciprocal changes in the activity of glucagons.127 65 “EvaluatioIn the management of Madhumeha”
  • 79. MadhumehaNatural history of type 2 diabetesDiabetes mellitus refers to a range of conditions that are all characterized by elevation ofthe blood glucose level. It may be roughly divided into two principal varieties, type I andtype II, with different etiologies. Type I diabetes presents in childhood as an autoimmuneattack on the pancreatic ß-cells that result in their complete destruction: consequently, thepatient must take insulin for the rest of their life.128 It accounts for <10% of all diabetesand will not be considered further here. Impaired glucose tolerance, which precedesdiabetes and is a risk factor for the disease, currently, affects a further 200 millionworldwide. Until recent years, type II diabetes was rarely observed in individuals underthe age of 50, but increasing numbers of children are now being diagnosed with thedisease.129 this probably reflects the growing prevalence of childhood obesity, as type 2diabetes is exacerbated by obesity and a sedentary lifestyle. Diabetes leads to a reduced life expectancy and quality of life, and a greater riskof heart disease, stroke, peripheral neuropathy, renal disease, blindness and amputation.130The direct health care costs of the disease are also considerable, and have been estimatedat around 5% of the total annual expenditure on health in Western societies. Both insulinsecretion and insulin action are impaired in type-2 diabetes (reviewed in. Their relativeimportance has been hotly debated, but it is now recognized that ß-cell dysfunction is akey element in the development of the disease.131 Abnormalities in insulin secretionprecede the onset of type-2 diabetes and may be present even when subjects show normalglucose tolerance. By the time of diagnosis, insulin secretion is significantly reduced andit continues to diminish inexorably throughout the course of the disease.132 Type 2 66 “EvaluatioIn the management of Madhumeha”
  • 80. Madhumehadiabetes can also occur in the absence of insulin resistance and, conversely, some severeforms of insulin resistance (such as those caused by mutations in the insulin receptor) maynot be accompanied by diabetes. It now appears that insulin resistance only leads todiabetes if combined with a genetically determined propensity to ß-cell dysfunction.133 inthese individuals, however, insulin resistance plays an important role in the developmentof diabetes by placing an increased demand upon the ß-cell that it is unable to match. Theoretically, the insulin secretary defect could result from either a failure of ß-cell function or a reduction in ß-cell mass (due to increased apoptosis or reduced ß-cellreplication). Most quantitative estimates of ß-cell density in post-mortem tissue indicatethat type-2 diabetics have either no change or <30% reduction in ß-cell mass, 134 that isindependent of the duration of the disease. A substantial reduction in ß-cell mass is onlyfound in association with amyloidosis, which occurs at later stages of the disease. Inbaboons, a decrease in ß-cell mass of >50% is require to cause diabetes andhyperglycemia does not occur in type-1 diabetics as long as ß-cell mass remains above30–50%.135 It therefore seems that the insulin secretary defect in type 2 diabetes does notresult primarily from insufficient ß-cell mass but rather from impaired insulin secretion. 67 “EvaluatioIn the management of Madhumeha”
  • 81. MadhumehaParyaya (Synonym): - Acharya Charaka and Sushruta used the term madhumeha, kshoudrameha in place of madhumeha. Some other synonyms are found in classics. Ojomeha: - It is enumerated as a subtype ofvataja prameha amongst the four. AcharyaCharaka has mentioned that the vitiated vata changes sweet taste of oja into kashayaresulting in ojomeha (cha.si.6/17) Pushpameha: - In Anjana, Nidana the word paushpameha has been narrated paushpa rasa denotesmadhu. Above all synonyms postulated unanimously that all our Acharya’s havementioned the urine concordant with madhu. NIDANA Nidana (etiological factors) means the causative factors for producing a disease. According to this any factor, which has a tendency or capacity to producedisease, can be considered as nidana. The knowledge of the causative factors is very essential to assess thesadhyasadyata and chikitsa. It has been classified under various headings with differentviews. Among them one classification reads as Bahya and abhyantara hetu. Bahya hetu isan extrinsic factor to the shareera to cause a vyadhi and it includes ahara achare, kala etc. Abhyantara hetu is an intrinsic factor and it comprises the doshas anddoshyas. Charaka acharya classified specifically bahya nidana in to two types’ samanyaand vishesha. Specific nidana are explained for madhumeha. Samanya nidanas of 68 “EvaluatioIn the management of Madhumeha”
  • 82. Madhumehapramehas and vataja prameha nidana are attributed to madhumeha, as madhumeha is oneof the vataja prameha. For all types of pramehas Kapha dosha is the key factor and it can be establishedby gangadhara’s version. According to him Gulma is caused by vayu, raktapitta by pittaand madhumeha caused invariably due to the vitition of kapha dosha. Especially inmadhumeha kaph is the arambhaka dosha and vata is the preraka dosha to kapha. In sthoola the madhumeha is mainly due to doshavarana which is caused by thevitition of kapha it avarana and leads to vataprakopa. Though the kapha is arambhaka ormain dosha in the samprapti of madhumeha pitta and vata also play an important role incomplicating the disease. Samanya Nidanas are those, which are explained in general irrespective of theconcerned. This nidanas of various pramehas are discussed below can be grouped undertwo main varieties.136 Sahaja (Hereditary) Apathyaja (Acquired)Sahaja (Hereditary Causes): - Charaka and Sushruta have explained that bheeja doshais also a cause for madhumeha. Sushruta included this disease under adhibala pravritajacategory. Here the term beeja considered as shukra and shonita. If beejas are vitiated withdosha, it is responsible for causation of prameha they will produce a jatha prameha,further prameha has also been considered as kulaja vikara. Apathyaja (Acquired causes): - Again it is classified into two groups, Samanya (General). Vishesha (According to dosha). This samanya nidana can again be classified into types: - Ahara Sambandha. Vihara Samabandha. 69 “EvaluatioIn the management of Madhumeha”
  • 83. MadhumehaTable No: -9 1) AHARA SAMANDI NIDANAS137: - SL NIDANA Caraka Sushruta Vagbhata Ma.ni Bhe.Sam Bha.Pra Y.R NO. 1 Dadhi + - + - + + 2 Gramya, Oudaka, + - - + - + + Mamasa 3 Anupa Mamsa + - + + + + + 4 Payaha + - + 5 Navanna pana + - - + - + + 6 Guda vikara + - + + - + + 7 Sheeta, - + + - - - - Snigdha, Madhura Madya sevena 8 Dravannapana - + - - - - - sevena 9 Swadu, Amla, Lavana, - + + - - - - Snigdha, Pichhila, Shutala ahara 10 Sura sevana - - + 11 Ikshu rasam + + + - - - - 12 Adhyasana 13 Medovardhaka AharaAtiSeven aTable No: -102) VIHARA SAMBANDI NIDANA’S137: -S.no. Nidana Charaka Sushruta Vagbhata1 Asya sukham + - -2 Swapna Sukham + - - 70 “EvaluatioIn the management of Madhumeha”
  • 84. Madhumeha3 Diva Swapnam - + -4 Avyayamam - + -5 Alasyam - + -6 Chinta Tyaga7 Swapnaprasanga + - -8 Shayanaprasanga + - -9 Asanaprasanga + - -Along with these nidanas the other factors, which affect the kapha dosha, are to beconsidered as madumeha nidhana. In general the above factors, which are explained inthe table, are for prameha. Still the same factors are held responsible for the causation ofmadhumeha. The above said nidhanas can be classified under apathyanimittaja and it is termedas swakruta. Apathya is that which is unconducive to individual constitution.Vishesha nidana: - Except charaka other acharyas have explained the common causative factors andthey have particularly stressed on the factors, which affects the kapha, medas and mutra.Charaka explained nidanas specific to the doshas concerned but he too has equally voicedon those factors, which vitiate kapha and medas.KAPHAJA PRAMEHA NIDANA138: -Aharaja Nidanas: - A) Rasa – Madhura padartha atisevana B) Guna – Drava taruna dravya atisevana C) Dravyas – 71 “EvaluatioIn the management of Madhumeha”
  • 85. Madhumeha Dhanya’s – Hanyaka, Chanak, Uddalaka, Naishada, Mukundaka, Mahavrihi, Pramodaka, Sugandhaka, Sarpishmati, Masha etc Mamsa: - gramya, Oudaka, Anupa, Mamsa, Rasa Others – Shakas, Tila, Pistanaa, Payasa, Ksheera, Vilepi kshoudra, Mandaka, Dadhi etc.Vihara sambandhi nidanas: - Swapna prasanga, Shaya prasanga, Asana prasanga Vyayama vruja varjana, Anyakapha meda mutra Vridhikara Viharas.PITTAJA PRAMEHA NIDANA139: - Ahara sambandhi nidana: - a) Rasa – Amla, Lavana, Katuadhika sevena b) Guna – Ushna kshara adhika sevena c) Anya – Ajeerna dravyas and Vishamaharam Vihara Sambandi Nidana’s • Ati teekshna atapa sevena • Agni Santapa • Shrama • Krodha VATAJA PRAMEHA NIDANA140: - Ahara Sambandi Nidana’s • Rasa – Kashaya, Katu rasa Ati sevena 72 “EvaluatioIn the management of Madhumeha”
  • 86. Madhumeha • Guna – Rooksha laghu sheeta Ati sevena • Anya – Anashana Vihara Sambandhi Nidana’s Vyavaya, ativyayama Udvega Shodhana atiyoga Atishoka Vega sandharana Shonita ati seka Abhighata Ratri Jagarana Atapa Sevana Vishama Shareera Nasyam All the pramehas at their initial stage are due to kapha dosha and kapha is aninevitable factor to cause prameha perhaps on these lines, at first Nidanas related tokapha dosha is seen. The vitiated kapha then vitiates the dhatus of similar properties like medas,mamsa etc. If the pramehas are neglected in this stage, the improper formation of dhatusin due course leads to dhatu kshaya. The affected person if consumes the pitta prakopak ahara and gets indulged in theacts, which provokes pitta, resultes in pittaja prameha’s. The Nidanas of vata prakopaka reveal that the severe deterioration of the dhatus isthe resultant, if one indulges in the aharas or viharas, which are told in it and in duecourse, madhumeha, occurs because of dhatus kshaya.MADHUMEHA NIDANA141: - Charak very specifically explained Nidana responsible for the manifestation ofmadhumeha, which can be narrated as follows: - • Guru Snigdha Lavana rasatmaka dravya Atisevana 73 “EvaluatioIn the management of Madhumeha”
  • 87. Madhumeha • Navanna and Pana • Atinidra • Asya Sukhama • Achentya • Avyayama • Asamshodhana These factors contribute to the vikriti of the Kapha, Pitta, Meda and Mamsa.These vitited factors cause avarodha to normal vayu gati. it in carries the ojus to vasti andresulting in madhumeha.STHOULYA AS A NIDANARTHAKARA ROGA According to Acharya Sushruta Apathyanimittaja prameha’s are sthoola. Sthoulya isthe nidanarthakara roga for prameha142. In sthoulya the vayu gati gets obstructed by the baddha medas, As a result there willbe the vitiation of vayu. Which in term stimulates the samana vayu resulting; in theaggravation of jataragni and causes increased absorption of food and the Individualbecomes Adhika bhojya vyakti (excessive eater).ETIOLOGY OF DIABETES MELLITUS143: - A defective or deficient insulin secretary response, which translates in toimpaired carbohydrate use, is a characteristic feature of diabetes mellitus and resultinginto hyperglycemia. The chronic hyperglycemia of diabetes in associated with long-term damage,dysfunction and failure of various organs like Eyes, Kidney’s, Nerves, Heart and Bloodvessels. 74 “EvaluatioIn the management of Madhumeha”
  • 88. MadhumehaGenetic factors: - Genetic factors are even more important than Types I diabetes. Amongidentical twins the concordance rate is 60% to 80% in first-degree relatives with type IIdiabetes the risk of developing disease is 20% to 40%. The two main defects that characterized in type II diabetes are – 01) A derangements in the beta cell secretion of Insulin 02) A decreased response of peripheral tissues to respond to Insulin.Obesity: - Among the initiating events, which are proposed for type II diabetes. Obesityis an extremely important environmental factor. Approximately 80% of type II diabetesis obese.Age: - As the age advances the number of beta cells in pancreas, which produce insulingets reduced. So the risk of diabetes increases with age especially after 40 years.Sedentary life: - People with sedentary life style are more likely to have diabetes arecompared to those who lead an active life. It is believed that exercise and physicalactivity increase the effect of insulin on the cells.Heridatory: - According the famous diabetalogist Warren and Le Compet. When boththe parents have diabetes, all the children may expect to develop the disease, if they livelong enough. When one parent has diabetes and the other is diabetic carrier, 40% of theirchildren may develop the disease. If a diabetic or a carrier marries an individual whoneither has diabetes nor a diabetic carrier none of the children with have diabetes. Obesity is one of the major causative factors for diabetes mellitus as it causesinsulin resistance. In Ayurveda, sthoulya is mentioned as a Nidanarthaka roga forprameha, and this prameha falls under the santarpanajanya vyadhis. Madhura, Snigdhadi, Bhojana are the main Nidana’s for madhumeha, incontemporary science it is explained that the excess eating and sedentary life style are thepredisposing factors for diabetes mellitus. 75 “EvaluatioIn the management of Madhumeha”
  • 89. MadhumehaCLASSIFICATION Knowledge of classification will helps in proper understanding of the disease andto formulate an effective treatment protocol. In classics various types of prameha had been described based on many factors.Though prameha is stated to be a condition due to the vitiation of all the three doshas, thedisease is mainly divided in to 3 groups. (Ref.Cha.Chi.6/7) Kaphaja Pramehas - 10 Pittaja Prameha - 06 Vataja Prameha - 04 Though there is a similarity in the opinion of Brihatrayes regarding the numbersof pramehas in each group. But they seem to be different in the nomenclature used bythem.Table No: -11TYPES KAPHAJA PRAMEHA: -Sl.no Names Charaka Sushruta Vagbhata Ma.Ni1 Udaka meha + + + +2 Ikshu meha + + + +3 Sandra meha + + + +4 Sandraprasada + Sura meha Sura meha Surameha Meha5 Sukla meha + Pista meha Pista meha Pistameha6 Sikata meha + + + +7 Sita meha + Luvana meha + + 76 “EvaluatioIn the management of Madhumeha”
  • 90. Madhumeha8 Shanair meha + + + +9 Lala meha + Phena meha Lala meha Lala meha10 Shukra meha + + + +Table No: -12TYPES OF PITTAJA PRAMEHA: -Sl.no. Names Charaka Sushruta Vagbhata Madhava1 Kshara meha + + + +2 Kala meha + Amla meha + +3 Nila meha + + + +4 Lohit meha + Ahinitameha Rakta meha Rakta meha5 Manjishtha meha + + + +6 Haridra meha + + + +Table No: -13TYPES OF VATAJA PRAMEHA: -Sl.no. Names Charaka Sushruta Vagbhata Madhava1 Vasa meha + - + +2 Majja meha + Sarpi meha + +3 Hasti meha + + +4 Madhu meha + Kshaudra + + meha 77 “EvaluatioIn the management of Madhumeha”
  • 91. MadhumehaPROGNOSTIC CLASSIFICATION: - Prognosis is an inevitable part of Chikitsa so far as a wise physician is concernedand unbiased prognosis is the key factor for the success of treatment. Sadhya Yapya Asadhya Kaphaja Pittaja Vataja Sthoola Not much obese Krisha Apathya nimittaja Acquired Sahaja Early stage Acute stage Advanced stage Without complication With complication With complicationNOTE: - According to Vagbhat Avritajanya madhumeha is Kastha Sadhya anddhatukshayajanya as Asadhya.Based on etiological factors: -152 a) Sahaja b) Apatya nimittaja c) Prakritija d) SwakritajaBased on Samprapti of madhumeha153 a) Kashayaja b) Avaranajanya a) Dhatukshayajanya b) DoshavritajanyaBased on Chikitsa, physical status and strength.154 • Sthoola • Krisha • Balawan • Durbala. 78 “EvaluatioIn the management of Madhumeha”
  • 92. Madhumeha In nut shell, sahaja and Apathyanimittaja are types of madhumeha. The Krisha,Dhatukshayajanya and Apatarpanajanya can be correlated with sahaja madhumeha. The sthool Avaranajanya and Santarpanajanya can be correlated withApathyanimittaja madhumeha.CLASSIFICATION OF DIABETES MELLITUS The current expert committee of American diabetes association has proposedchanges to the NDOG/WHO classification scheme. The revised Etiologic classificationof diabetes mellitus is as follows155: -I) Primary Diabetes Type I: - Beta-cell destruction, usually leading to absolute insulin Primary deficiency. a) Immune mediated b) IdiopathicII) Type II diabetes (may range from predominantly insulin resistance with relativedeficiency to a predominantly secretary defect with insulin resistance. Under this type II again 2 types can be seen 1) None obese NIDDM 2) Obese NIDDM Genetic defects of beta cell function including maturity on set diabetes of young known as MODYIII) Other specific types 79 “EvaluatioIn the management of Madhumeha”
  • 93. Madhumeha A) Genetic defect of beta cell function a) Chromosome 12, HNF – 1 Alpha (MODY S) b) Chromosome 07 Glucokinse (MODY 2) c) Chromosome 20 HNF 4 Alpha (MODY 1) d) Mitochondral DNA e) Others B) Genetic defects in insulin action: - Type 4 insulin resistances, Lepsechaunism, Rabson Mendenhall Syndrome. Lipoatrophic diabetes and others. B) Disease of exocrine pancreas: - Pancreatic pathology a) Pancreatitis b) Hemochromatosis c) Fibrocalculous d) Neoplastic Disease e) Pancreactetomy f) Cystic fibrosis and others. D) Iaotrogenic: - Drug induced or chemical induced. a) Glucocorticoids b) Thiazides c) Alpha – Intrferon d) Thyroid Hormone. F) Endocrinopathies: - Endocrine disease induced. a) Cushing’s Syndrome b) Acromegaly c) Thyrotoxicosis d) Phaeoc hromocytoma e) Glucogonoma. 80 “EvaluatioIn the management of Madhumeha”
  • 94. Madhumeha G) Infections: - • Congenital rubella • Cytomegalo virus and others H) Other genetic syndromes sometimes associated with diabetes. a) Dawn’s syndrome, b) Klenefelter’s syndromes etc. I) Gestational Diabetes Mellitus (GDM) In classics the classification of a disease made it clear that for the sahajaprameha beeja dosha have been mentioned as causative factors. Such patients are said tobe weak emaciated. Suffering from thirst, loss of appetite and are required to be treatedwith a nourishing diet. In contemporary science the genetic and hereditary factors are mentionedas causative factor. Such patients are weak emaciated and they are asthenia. The above-mentioned patient is juvenile diabetes and requires a nourishing diet, so sahaja pramehacan be consider as juvenile diabetes.PoorvaroopThe Symptoms, which are produced during the process of sthanasamshraya avastha, arecalled as poorva roopa, and the symptoms which appears prior to the manifestation of thedisease, are called poorvaroopa i.e. is “4th Kriyakala”. There is no direct explanation of the poorva roopa of madhumeha as such. Butpoorva roopa of prameha can be considered as poorva roopa of madhumeha. 81 “EvaluatioIn the management of Madhumeha”
  • 95. MadhumehaTable No: -14Showing the poorva roopas144S.no Poorva roopa C.S S.S A.H A.S M.N B.P Y.R1 Kesha Jatilibhava + + - + - - -2 Asyamadhuryata + - + + + + +3 Karapada daha + - - - - - -4 Karapada suptata + - - - - - -5 Mukha talu kantha + - - - - - - gala shosha6 Pipasa + + - + + + +7 Alasya + - + - - - -8 Kaye malam + - - + - - -9 Angeshu paridaha + - - - - - -10 Anga suptata + - - + - - -11 Shatapada Mutrashaya + + - - - - - abhisarana12 Vishra shareera + + - + - - - gandha13 Atinidra + - - - - - -14 Tandra + + - + - - -15 Snigdha,Pichhila - + + + - - - guru gatratam16 Madhura shukla - + - + - - - mutrala17 Durgandha swara - + - + - - -18 Talu, gala, danteshu - + - - - - - malotpathi19 Nakhati vriddhi + + - + - - - 82 “EvaluatioIn the management of Madhumeha”
  • 96. Madhumeha20 Swedam + - + - - - -21 Keshathi vruddhi + - - - - - -22 Sheetpriyatwan + - + + - - -23 Mootra abhidhavanti + - - - - - - pipeelakasha24 Ghanangata + - + - - - -25 Angashaithilatwa + - + - - - -ROOPA The vyakta or pradurbhoota lakshanas of the vyadhi is seen in the 5th kriyakala.The vyadhi bodhaka linga of all 20 types of prameha is prabhoota and Avila mootrata.The prabhoota mootrata can be considered in terms of increased volume of urine andfrequency of micturation.’Avita mootrata refers to increased turbidity of urine. Roopa means symptoms of the actual manifestation of disease. At this stage doshadushya samoorchana would have been completed and the onset of the disese would havebeen commenced. Madhavakara explains it as when symptoms in the stage ofpoorvaroopa become fully or clearly manifested they are called roops. Roopa is theprominent diagnostic key of a disease and hence thorough knowledge of the variousroopas of each disease essential for a physician. Hence the lakshanas of madhumeha are mainly grouped under two categories thatis 1) Mootra Sambandi. 2) Sarvadaihika lakshanas. 83 “EvaluatioIn the management of Madhumeha”
  • 97. MadhumehaMOOTRA SAMBANDHI LAKSHANAS: -Clinical features of the prameha may be divided into two groups they are: - • Samanya Lakshanas • Vishesha Lakshanas 1) SAMANYA LAKSHANAS145: - Samanya Lakshanans of madhumeha are those which are ascribed to prameha, they are as follows i) Prabhoota mootrata ii) Avila mootrata Prabhoota mootrata: - The increase in quantity and frequency is known as prabhoota mootrata. It is manifested due to increase of sharreera kleda, the reasons for which areexplained in the context of Samprapti. The frequency is increased due to vitiation ofapana vayu. Due to hyperglycenia in madhumeha, glycosuria manifests which in termshampers the tubular absorption of water leading to polyuria.Avila mootrata: - Moorta avilata is nothing but the turbidity of mootra, which ismanifested due to drava and guru guna vriddhi of kapha and medhas. This can be noticedby the increase in the specific gravity of the urine.VISHESHA MOOTR SAMBANDI LAKSHANAS In madhumeha mootra is manifested with Kashaya, Madhura, Rooksha, Panduand madhu Sama lakshanas. Bhavaprakasha clarify the controversy of the word kashayaas kashaya varna. The implication of this term is still debatable. The presence of madhura 84 “EvaluatioIn the management of Madhumeha”
  • 98. Madhumeharasa in mootra is mainly because of ojo visramsa into mootra, which can be easilyunderstood by pipeelika abhisarana and by qualitative analysis of urine test. Rookshaguna is due to vitiation of vata. Pandu varnata of mootra is because of kleda dusti whichinfluences kapha to attain more liquid state. Madhusama mootra implies the colour, smelland taste of mootra similar to that of madhu. It has to be understood that along with thesamanya lakshanas madhusama mootra is the pratyatmaka lakshanas of madhumeha.Table No: -15Showing the roopa of prameha:-S.no Roopa C.S S.S A.H A.S M.Ni Y.R B.Ra G.Ni1 Kashaya + - - + + + + +2 Madhura + - - + + + + +3 Pandu + - - - - - - -4 Rooksha + - - + + + + +5 Snigdha - - - + - - - -6 Ojadhatu - - - + - - - -7 Kshoudravat - - + - - - + - Madhviva8 Kshoudra rasa - + - - - - - -9 Kshoudra varna - + - - - - - -SARVADAIHIKA LAKSHANAS: - On the basis of their occurrence, these lakshanascan be grouped into two divisions. • Apathya nimittaja • Sahaja, as there is a difference in the pathogeneses of both the varieties, so lakshanas vary from each otherLAKSHANAS OF APATHYA NIMITTAJA MADHUMEHA 85 “EvaluatioIn the management of Madhumeha”
  • 99. Madhumeha a) Sthoola b) Bahu Ashee c) Snigdha d) Shaya Asana, Swapnasheela the Samprapthi of Apathya Nimittaja madhumeha has been explained earlier. The vitiation of Kapha, Kleda, Medas is due to the indiscreet food habits. Thus leads to the medovaha Srotodusti due to medodhatwagni mandya. Thus the person develops sthoulya. The samana voyu avarodha in koshta is the reason for prabhoolagni from which the person desires and consumes more food. It has been said earlier that the meda sthana is the pitta sthana and hence the vayu in kosta is obstructed which later lead to the excessive secretions of pitta in amashaya which results in the above said lakshanas. The affected person is termed as snigdha due to the karmataha vriddi of shleshma. Madhumeha is one among the 20 types of pramehas. So these may be present in madhumehi. Kaphaja Pramehas146 1) Udaka meha: - The person passes clear urine, excessive in quantity, whitish, cool, odourless and watery. 2) Ikshumeha: - The urine of person becomes sweat, cool slightly viscid, turbid and resembling the juice of sugar cane. 3) Sandra meha: - The urine gets thickened if kept over night in a vessel. 4) Sandraprasada meha: - The character of urine manifests here partly dense and partly clear after keeping in a vessel. 5) Shukla meha: - White urines are excreted here and appear as if mixed with flour, and frequency of maturation takes place. 6) Shukra meha: - The person frequently passes urine, white, appears like shukra. 86 “EvaluatioIn the management of Madhumeha”
  • 100. Madhumeha 7) Sheeta meha: - The person excretes here large quantities of urine, which is exceedingly sweet and cold. 8) Sikata meha: - The passing of urine is mixed with hard and small particles. 9) Shanair meha: - There is no force of urine during the time of passing, more over person feels difficulty at the time of excretion. 10) Alalameha: - The urine is full of mucus threads is slim and viscid.Pittaja Pramehas147 1) Kshara meha: - The urine is alkali like in character. 2) Kala meha: - The provocation of pitta transforms the urine as warm and black in colour. 3) Neela meha: - Passes urine of the colour of the wings of jaybird and is acidic in reaction. 4) Lohita meha: - Urine smells like raw flesh and saltish warm and red. 5) Manjishta meha: - Person passes urine, which is profuse in quantity smells like fresh meat. 6) Haridra meha: - Urine is of the colour of the colour of turneric water and is pungent.Vataja Pramehas148 1) Vasa meha: - Provoked vata passes urine mixed with or having the appearance of fat. 2) Majja meha: - Discharges urine with majja frequently due to provoked vata. 3) Hasti meha: - Discharges frequently excusive amounts of urine like elephant. 4) Madhumeha: - Passes urine which is astringent and sweet in taste, yellowish and whitish in colour Urine contains similar proportion of Honey.Madhumeha Roopa149 Acharya Sushruta gives explanation regarding the lakshanas of Madhumeha, asfollows – 1) Gamanat sthananichati 2) Sthanat asananichati 3) Aasanat sayyamichati 87 “EvaluatioIn the management of Madhumeha”
  • 101. Madhumeha 4) Shayanat swapnamichati. Apart from the above lakshanas urine similar to honey in colour and taste are alsoattributed to Madhumeha.Clinical Features150 It is very difficult to sketch with brevity the diverse clinical presentation ofdiabetes mellitus. Only a few characteristic patterns will be presented. The type II (NIDDM) diabetes present with polyuria, polydipsia but unlike type Idiabetes patients are often older and frequently obese. Some times weakness or weightloss also noted. Apart from these features others like, polyphagia, pruritis vulvae,glycosuria, infections, delayed healing of wounds, impotency, are also noted. Polyuria is due to the osmotic diuretic effect of glucose in kidney tubules. Theglycosuria induces an osmotic diuresis and thus polyuria, causing a profound loss ofwater and electrolytes. The obligatory renal water loss combined with the hyper osmolarity resultingfrom the increased levels of glucose in the blood tends to deplete intracellular water,triggering the osmoreceptors of the thirst centers of the brain. In this manner intensethirst (polydipsia) appears. The catabolism of proteins and fat tends to induce a negative energy balance,which in turn leads to increasing appetite, i.e. polyphagia. Despite the increased appetite,catabolic effects prevail, resulting in weight loss and muscle weakness. Frequently,however the diagnosis made after routine blood or urine testing mainly in asymptomaticpersons. Whenever the quantity of glucose entering the kidney tubules in the glomerular,filtrate rises above approximately 225 mg/min, a significant proportion of the glucosebegins to spill in to the urine and when the quantity increases above about 325 mg/min,which is tubular maximum for glucose. All the excess, above this is lost in to urine(Glycosuria). A comparative study of madhumeha lakshanas with the Diabetes mellitusexplained in the modern science reveals a lot of similarities between them. 88 “EvaluatioIn the management of Madhumeha”
  • 102. Madhumeha Prabhootaavilamootrata is considered as a prathyatma lakshana of Prameha. Inthis the bahudrava kapha along with other dooshyas mainly kleda pradhana dooshyas inthe basti is the cause for prabhoota mootrata. The same reason has been given in modernscience for polyuria that the osmotic diuretic affects of glucose in the kidney tubules. Glycosuria explained in the modern science can be taken as madhusama mootra.The reason for this madhusama mootra is bahudrava kapha or ojus (Glucose), which isexcreted through moootra. Pipasa or polydipsia mentioned in both sciences. Depletion of intracellular watertriggering the osmoreceptors of thirst center of brain and thirst is noted which is similar topipasa of Ayuredic science, here due to excessive loss of the urine; pipasa is noted. Bahukankshata has been mentioned as a lakshana in apathya nimittajamadhumeha, the same in modern science in terms of polyphagia. In modern science the condition weakness is due to lack of glucose utilization,loss of electrolyte and protein loss. In Ayurveda this same condition is due to aparipakwadhatus i.e., lack of proper nourishment of dhatus. By considering the above similarities, we can come to a conclusion thatMadhumeha explained in Ayurvedic science and the diabetes mellitus mentioned in themodern science are almost similar condition.SAMPRAPTI: - Only Charaka explains the sirect Samprapti of madhumeha. Charaka explainedthe relevance of avarana in the samprapti or formation of madhumeha. He explained thisin the “Keeyantaha Shiraseeya Adhyaya” of Sutrasthana. On this contex he explained theNidasnas, which are almost Kapha and Pitta Vardaka. After exposer to aetiological factors of prameha /madhumeha followed by vividhadosha vyapara in the body, i.e.the morbid process-taking place in the production ofdisease is called Samprapti. 89 “EvaluatioIn the management of Madhumeha”
  • 103. Madhumeha There are three factors, which are responsible for the manifestation of the diseasein general. Charaka explains the Hetu vishasha, Dosha vishesha, Dushya vishesha areheld responsible for the vikar utpatti or Anutpathi.151 The main principle of Chikitsa, as said by Indu, is Samprapthi Vighatana. “Yatha dustena doshena” conveys the meaning of the degree of morbidity ofbodily elements or vikalpa Samprapti. In which condition the organism suffers fromdiscomfort. The vitiation of dosha and dhatus in the disease varies from person to personand the morbidity of these elements also differs for example-Samhata roopa Vriddhi,Vilayana roopa vriddhi, gunatha vriddhi and karmatha vriddhi etc. All these morbid changes will not essentionally occur in all the disesase.“Kalenopadetaha Srvae”(A.Hr.Ni), justifying the necessity of mentioning pramehasamprapti. All the above refereces regarding the samanya prameha samprapti andmadhumeha samprapti will be made.SAMPRAPTI GHATAKA: - Dosha - Kapha is in Bahu abhaddha Piita is in Vriddhavastha Vata – Avrita. Dushya – Rasa, Rakta, Mamsa, Meda, Asthi, Majja, Sukra Oja, Lasika, Kleda, Sweda. Srotas - Anna, Udaka, Meda, Mutra. Dusti Prakara – Atipravritti, sanga, vimargagmana. Agni – Vaishamya and Dhatwagni mandhya. Ama - Sama Kapha and Sama Dhatus. Udbhava Sthana – Medovaha srotomoola – vapavahana Sanchara Sthana – Sarva Shareera, Sarva doshaja, Meda, kleda sahita; mootra vaha sroto Anupravesha. Vyakta Sthana – Sarva Shareera (mootravaha srotas). Vyadhi Swabhava – Chirakari. 90 “EvaluatioIn the management of Madhumeha”
  • 104. Madhumeha Depending upon Hetu vishesha, Dosha vishesha, Dushya vishesha and theirdegree of vitiation 4 types of disorders may occure based on vikara vighata bhava. VikaraVighata bhava is explained as that factor which participats in the formation and hencedoes not allow the disease to manifest. So based on Vikara Vighta bhava the four types ofoccuring disease are as follows. a. When the hetu vishesha, dosha vishesha, dooshya vishasha are not congenial they, then the formation of disease will not occure. b. If these three become congenial to each other lately among them, then the delay in formation of disease will takes place. 2) If these three are mild in vitiation, then they give rise to mild disorder or a disorder with the presence of only few lakshanas or vice versa. So in all the disorders the utpatti is based on vikara vighata bhava and abhva.SAPEKSHA NIDANA Proper diagnosis is the foundation to the success of a treatment because manydiseases affecting a srotas have similar manifestations, enough to confuse a physician butpicking up threadbare with a little difference to clinch a diagnosis is an art aspired by all.Deep knowledge and untiring practice are the means to perfection as Vagbhata hasrightly mentioned “abhyasat prapyate dristihi karma siddhi prakashini”. Madhumeha is a mootra. atipravruttaja vikara1 with prabhoota and avila mootrataas pratyatma lakshanas, characterized by madhusama. Although there are many diseasespresenting with Atipravrutti of mootra, the diagnosis of madhumeha is usually astraightforward proposition, because of its characteristic poorvaroopas. 91 “EvaluatioIn the management of Madhumeha”
  • 105. Madhumeha Moreover within the perview of the disease madhumeha, the kapha, pitta and vatahave characteristic presentations, which have been described in such a way as not toleave any scope for doubt. In other words, if a patient presents with mootra atipravrutti,lakshanas of kapha, pitta or vata like shukla mootrata haridramootrata or vasa mootrataand if they are associated with prameha poorvaroopas then the disease is per se pramehaor madhumeha. Charaka explains this concept giving the example of a situation whereone comes across a patient who is presenting with haridra or rakta mootrata. Here theabsence of prameha poorvaroopas will prove the existence of rakta pitta and excludeprameha In the presence of madhura and picchala lakshanas of prameha, one shouldconsider two possibilities for differentiation whether the condition is anilatmaka due todosha ksheenata or kaphasambhava as a result of santarpana As discussed earlier, here one should essentially consider madhumeha as aconsequence of vata vruddhi as a result of dhatukshaya where vata is the anubandhyadosha and madhumeha as a result of margavarana janya vata vruddhi where vata is aanubandha dosha and is directly dependent upon kapha, which has undergone vruddhibecause of santarpana. The factors for differentiation are as followsMadhumeha (anilatmaka) Madhumeha (Kaphasambhava)Rogi : Krusha SthoolaNidana a) Vatakara ahara vihara along Kaphakara ahara vihara with vata vruddhi as a result of chirakalina madhumeha b) Beeja uapatapa 92 “EvaluatioIn the management of Madhumeha”
  • 106. MadhumehaRogi avastha : Bala to madhyama vaya Madhyama to vruddhaRoopa : Vata pradhana Kapha pradhanaSamprapti : Madhumeharambhaka dosha Kaphamedodusti leads to dusti leading to vapavahana madhumeharambhaka dosha, dusti in dusti especially in sahaja vapavahana madhumehiVyadhiswaroopa : Ashukari ChirakariSadhyasadhyata : Asadhya Sadhya in the beginningUpadrava : Vata pradhana upadravas Kapha pradhana upadravasChikitsa : Santarpana Apatarpana Madhumeha is basically medovaha srotodustijanya vikara but its pratyatmalakshanas become vyakta in the mootravaha srotas with abnormal changes in the rasa,varna, gandha, sparsha of the mootra and it is characterized by prabhoota1 and avilamootrata. Prabhoota mootrata means atipravrutti of mootra. It goes without mentioning thatthere is also an increased frequency of micturition and avila mootrata means AtyarthaKalusha4 Samalam5 or Malinam akulam6 which means that there is a considerable changein the quality of urine as per the above mentioned factors. Considering these factors, itbecomes contextual to enumerate the conditions where there is increased frequency ofurine and abnormality in its quality. Most of the times these symptoms are associatedwith mootravaha srotodusti and other diseases where differentiating madhumeha is not aproblem for evident reasons. 93 “EvaluatioIn the management of Madhumeha”
  • 107. MadhumehaMootralakshana (Pravartana Nimitta) Symptoms1) Abhikshnam (Muhurh muhurh, Punah punah : a) Ashmari (C. Ci. 26/38) Subahushah, vikiranam b) Mutratita (S. U. 58/12) c) Vatika mootrakrichra (C. Ci 26/32) d) Ushna vata (Ah. N. 9/36)2) Atipravrutti a) Amavata (M. N. 25/9) b) Arsha poorvaroopa (As. N. 7/7) c) Sahaja arsha (C. Ci. 14/8) d) Kaphaja arsha (C. Ci. 14/17) e) Mutra praseka (S. Ci 7/36) f) Upasthita prasava (S. Sa. 10/7) g) Chidrodara (C. Ci. 13/44) h) Asadhya masurika (M. N. 54/27) i) Ama jwara (C. Ci. 3/135)It becomes relevant to consider the following conditions where hyperglycemia iscommon manifestation under the heading of differential diagnosisI Diabetes mellitus & Endocrine disorders:a) Pituitary gland 1) Pituitary diabetes due to growth hormone 2) Acromegaly 94 “EvaluatioIn the management of Madhumeha”
  • 108. Madhumeha 3) Diabetes insipidusb) Adrenal Cortex 1) Cushing’s Syndrome 2) Steroid diabetes due to administration of steroids 3) Primary Hyperaldosteronismc) Adrenal Medulla 1) Phaeochromocytoma 2) Addison’s disease 3) Adrenalectomyd) Thyroid 1) Hyperthyrodism 2) MyxoedemaII Pancreatic Diabetes 1) Acute pancreatitis 2) Mumps (rarely) 3) Chronic pancreatitis 4) Haemochromatosis 5) Total pancreatectomy 6) Carcinoma of pancreasIII Diabetes liver 1) Cirrhosis of liver 2) Gall StonesIV Drugs & diabetes 95 “EvaluatioIn the management of Madhumeha”
  • 109. Madhumeha1) Thiazide, Chlorthalidone, frusemide, oestrogen containing oral contraceptives, βblockers & catacholaminergic drugsV Miscellaneous 1) Type I glycogen storage disease 2) Down’s syndrome 3) Turner’s Syndrome 4) Huntington’s chorea 5) BurnsConditions where there is polyuria Polyuria should not be confused with prostratic hypertrophy or cystitis becausehere it is only increased frequency of micturition & not increased quantity.I Polyurea due to water diuresisCranial or neurogenic diabetes insipidus: This is due to an identifiable lesion in thehypothallamus pituitary or both leading to failure of A.D.H.Nephrogenic diabetes insipidus:Familial form seen in males only also as an accompaniment of Fanconi syndromePsychogenic polydipsia or compulsive water drinking this is a hysterical condition. Thereis clinically marked fluctuation here.II Polyurea due to increased solute loadDiuretic therapyChronic renal failureSADHYA SADHYATA 96 “EvaluatioIn the management of Madhumeha”
  • 110. Madhumeha The prognosis of the disease is to be established only after the consideration ofSadhya or Asadhya. The Vyadhis are classified on the basis of prabhava as sadhya andAsadhya further Sadhya vyadhis are classified as Sukha Sadhya and Krichra Saadhya.Asadhya vyadhis are bifurcated in to yapya and anapakramya Prathyukheya. The assessment of Sadhya and Asadhyata of the disease arte depending upon thefollowing factors: - 1) Hetu 2) Poorvaroopa 3) Roopa 4) Dosha, Dushya, Kala, Prakruthi 5) Marga – Gati 6) Adhisthana 7) Upadrava 8) Aristha 9) Mental state 10) Bala 11) Chikitsa karma bhedha, Vagbhatacharya adds the some new points 12) Vaya 13) Linga 14) Indriya Sthiti 15) Grahasthiti 16) Jitatmana And also mamsa, upachaya are also be taken in to consideration. The clear knowledge of the above factors will help one to assess the Saadhyata orthe Asadhyata of a vyadhi.PROGNOSIS DEPENDING UPON DOSHA 97 “EvaluatioIn the management of Madhumeha”
  • 111. Madhumeha The ten Kaphaj prameha are said to Sadhya six types of Pittaja meha are yapyaand four types of Vataja meha are Asadhya. As madhumeha is Vataja pramehas, Vataja pramehas are told as Asaadhya. Hencemadhumeha is also to be considered as Asaadhya. The factors that are considered aspathya for vayu is an Apathya for meda. So due to Virudhopakrama or contradiction intreatment eq. snigdha for vaya Kshaya it increases the medas.Again this can be classified as yapya and anupakramya pratyakyeya.ASADHYA MADHUMEHA In the following condition the disease madhumeha will become asaadhya. 1) Kapha pittal prameha, which is long standing and associated with poorva roopa if exhibited in Vataja prameha then it should be demand as asaadhya. 2) If the madhumeha patient is durable, emaciated then it should be Rx. As asaadhya. 3) Beeja doshaja madhumehas are asaadhya. 4) The manifestation of all poorva roopa in meha if the Kaphaja, Pittaja, Prameha converted in to Vataja prameha then it is said to be Asaadhya. 5) If pidikas are manifested in madhumeha should be treated as Asaadhya.KRICHRA SAADHYA MADHUMEHA It seems that krichra Saadhyata of madhumeha is possible in Apathyanimittajamadhumeha that too were there is an avarana of Vayu is present due to medas or Kaphaor Pitta. That is why in such conditions acharyas have advised to consume Lague Ahara 98 “EvaluatioIn the management of Madhumeha”
  • 112. Madhumehaand tikta rasa aharas along with exercises. If neglected in the earlier period ofMadhumeha then in later course it will become Asadhya due to dhatu Kshaya. Basavarajeeyam a 16th centurion practical sound physician of Telengana inventedNew test for urine for the prognosis of each dosha group the urine of prameha patients isto be collected in a wide mouthed vessels and boiled on a mild flame till evaporation. Theincurability of the disease depends up on the amount of residue a Vataja prameha isconsidered as incurable if the residue is 1/5th of the volume of urine taken for test. Pittajaprameha is incurable if the residue is 1/4th and Kaphaja prameha is residue is 1/9th. MADHUMEHA CHIKITSA VIVECHANA The principles of chikitsa can hence be studied as, a) Nidana parivarjana,b) Apakarshana, c) Prakruti Vighata. These principles of treatment are to be studiedseparately with respect to dhatukshayajanya madhumeha & Margavarana janyamadhumeha.Nidanaparivarjana in Margavarana janya Madhumehi:An apathyanimittaja medhumehi usually sthoola, who likes Abhyavaharana & hateschantramana a situation just like of the helpless eggs on a tree, they cannot move to avoidtheir predators & hence fall victim to them. Here the patient should be made to avoid all& Kaphakara ahara vihara either to prevent the occurrence or to cure the disease.Nidana parivarjana in dhatu kshaya janya Madhumehi: - Nidana parivarjana in suchmadhumehis is studied with special reference to sahaja madhumeha. It lies entirely on themata or pita as to how best they act to prevent the occurrence of the disease in them.Apakarshana & Prakruti Vighata: - The apakarshana of doshas are mainly donethrough samshodhana but only when roga & rogi bala are in pravaravastha and when 99 “EvaluatioIn the management of Madhumeha”
  • 113. Madhumehaeither one or both are avara then it is done through langhana and langhana panchana,which constitutes samshamana chikitsa, in other words prakruti vighata.Apakarshana in Margavarana janya madhumeha: - Shodhana, when in suchmadhumehi if the dhatukshaya is minimum & there are kapha & medodusti laxana thenvamana should be performed. & if there are pittaja laxanas & dhatu kshaya does notrender the patient durvirechya then virechana can be performed. Similarly if theanubandha vata laxanas are more and the patient is samshodana arha then basti can beperformed. Madhumeha is a swedana ayogya vyadhi but swedana can be administered. Theselection of yogas for samshodana & snehana should be selected as per the recipesprescribed in kalpa shtana. After shodana shamana chikitsa can be done by,Kaphamedohara dravya.Prakruti vighata in dhatu Kshaya Janya madhumeha: - Dhatu kshaya avastha is theresult of beeja dusti in sahaja madhumeha & due to a state of atikarshita dhatus as a resultof continued dhatu kshaya, which is nothing but the progressed stage of margavaranajanya madhumeha both the situations are considered samshodana anarha. In such casessamshamana chikitsa is advised, whereas madhumeha in both these cases are asadhya andhence need not be treated. Notwithstanding this, the principles of chikitsa for vatajapramehas are for vata anubandhadoshatva, which is still dependent on the kapha &pittadoshas and not for vata anubandhya dosha janya madhumeha characterized byatishaya karshana of dhatus. Hence samshamana chikitsa should be appropriately adoptedin such patients.Avastha Anusara Chikitsa of Madhumeha: - 100 “EvaluatioIn the management of Madhumeha”
  • 114. Madhumeha Sushruta in the chapter of prameha pidaka chikitsa has indentified the stages ofmadhumeha & accordingly advised the treatment, which can be discussed as, stage I: Chikitsa in poorvaroopavastha; stage II: Chikitsa in Vyaktavastha; stage III:Chikitsa in upadrava avastha; stage IV: Chikitsa in pravrudha upadrava avastha; stageV: Chikitsa in asadhya avastha.Stage I: Is the poorvaroopa avastha where the dosha dushya sammurchana has just begunthe disease should be treated with apatarpana, vanaspathi kashaya and chagamootra. Ifleft untreated the madhumeha it proceeds to the II stage.Stage II: This is the vyakta avastha of madhumeha where due to continued madhura aharasevana. The sweda mootra and sleshma attain madhura bhava & hence should be treatedwith ubhaya samshodana i.e vamana, virechana & basti. If left untreated the diseaseprogresses to stage IIIStage III: In this stage the mamsa & shonitha undergo pravrudha dusti causing shopha &other upadravas and these should be appropriately treated as mentioned accordingly, likesiramokshana in shopha. If left untreated the disease progresses to stage IV.Stage IV: In this stage the upadravas like shopha would have attained ativrudha avastha,manifesting symptoms like Ruja & vidaha, where shastra chikitsa and vranakriya shouldbe performed. If neglected the disease proceeds into Asadhya avastha which is the V &the final stage.Stage V: In the asadhya avastha, the upadravas become mahantha and & makes thedisease asadhya, like here when the pooya of pidakas attain abhyantaraprapti and becomeutsanga. 101 “EvaluatioIn the management of Madhumeha”
  • 115. MadhumehaAnalysis: Though explained as prameha pidaka avastha chikitsa,description of stage wiseprogression of the disease and the treatment has been done by sushruta on the pretext ofexplaining the prameha pidaka chikitsa. This description seems to be chikitsa in case ofapathyanimittaja madhumeha, the course of this illness has been discussed already undersamprapti & accordingly in the poorvaroopavastha sushruta advises apatarpana & othershamana dravyas as there is Alpadosha &alpa dhatu dusti, hence unless the need arise,samshodana is not the treatement of choice and as the laxanas are predominantly due tokapha, kaphahara chikithsa should be done & this seems to be the logic behindprescribing apatarpana & tikshna dravyas like chaga mootra. Whereas in vyakta avasthathere is bahu dosha & a relatively alpa dhatu dusti like medas & rakta which warrantsshodhana, accordingly vamana, virechana&basti has been adviced as the rogi is stillbalavan & sthoola & so shodanarha. In the next stages there is a progressive dhatu kshaya & production of upadravas.The patient is shodana anarha & there is vata pradhanyata. Hence only shamana chikitsa& respective upadrava chikitsa should be done. Sushruta has stressed the importance oftimely intervention in madhumeha because in case of negligence the disease progressesinvolving gambhira dhatus & the upadravas pervade the entire body making it asadhya.Santarpana Apatarpana Chikitsa in Madhumeha: - Madhumeha has been described as santarpanotha vyadhi as well as apatarpanothavyadhi. The former is apathya nimittaja madhumeha & later is sahaja madhumeha ormadhumeha due to dhatu karshana due to long standing prameha. Accordingly two formsof madhmehis are ancountered one who is sthoola & balavan for whom Apatarpana is thebest & the other who is krusha & paridurbala for whom santarpana is the best. 102 “EvaluatioIn the management of Madhumeha”
  • 116. MadhumehaI. Apatarpana chikiatsa: is done in the form of langana langanapachana &doshavaseehana. a) Langana this is done in alpadashavastha where only upavasa pipasa,maruta atapa sevana1rooksha udvartana, pragada vyayama, Nishi Jagarana & so on,which are kaphamedo hara are helpful. b) Langana pachana: This is done inmadhyamadoshavastha where along with langana, Ama pachana is done with tikshnaushna dravyas. c) Doshavasechana: This is done in Bahudoshavastha where the shodanaof doshas are done from ubhaya margasII. Santarpana Chikitsa: Laghusantarpana chikitsais prashastha for krusha and durbala rogis the following can be administered inmadhumehi. a) Manthas,b) Kashaya, c) Yava, d) Churna, e) Lehya, f) Laghu Bhakshya. These formulationsshould be prepared such that they cause santarpana without causing vridhi of kapha &medas. Among all these yava is considered as best for madhumehi which will bediscussed in the chapter of pathya apathya.Shresta Aushadha prayoga in madhumeha: -Shilajathu, guggulu & loharaja: These three dravyas are medicines par excellence inmadhumeha, either in krusha or sthoola, as they are virukshana & chedaneeya, which isgood for kapha, as well as Rasayana, which is good for dhatukshaya & vatavrudhi.MANAGEMENT OF DIABETES MELLITUS Management, rather than treatment, is the appropriate term in Diabetes mellitus,and involves diet, exercise, insulin, oral hypoglycaemics, patient education andcounselling. Insulin and oral drugs are discussed here and the other aspects ofmanagement in subsequent chapters. 103 “EvaluatioIn the management of Madhumeha”
  • 117. MadhumehaINSULIN: Insulin is required for treatment of all patients with IDDM & many patientswith NIDDM. No single standard exists for patterns of administration of insulin andtreatment plans vary from physician to physician. With a given physician for differentpatients three treatment regimes will be described. Viz. Conventional, Multiplesubcutaneous injections (MSI) and Continuous subcutaneous insulin infusion (CSII).Conventional Insulin Therapy: involves administration of one or two injections a dayof intermediate acting insulin such as zinc insulin (NPH insulin) with or without theaddition of small amounts of regular insulin. This practice is based on the concept thatregular insulin lowers the plasma glucose level rapidly after which more slowly absorbedinsulin maintains the lowered level. Here patients should be taught to decrease insulinwhen extra exercise is anticipated.Multiple subcutaneous insulin injection technique (MSI): Most commonly involvesadministration of intermediate or long acting insulin in the evening as a single dosetogether with regular insulin prior to each meal.Continuous subcutaneous insulin infusion (CSII): This involves the use of a small batterydriven pump that delivers insulin subcutaneously into the abdominal wall. Adjustments indosage are made in response to measured capillary glucose values, as in MSI. ThoughCSII provides better Diabetic control, there is a higher risk of Hypoglycaemia andDiabetic Ketoacidosis.ORAL AGENTS:Sulphonyl ureas: NIDDM that cannot be controlled by diet & exercise often responds tosulphonyl ureas. Sulphonylureas, like Chlorpropamide & Tolbutamide, act primarily by 104 “EvaluatioIn the management of Madhumeha”
  • 118. Madhumehastimulating release of insulin from β cell, but are useful only in patients with relativelymild disease. Second generation drugs such as Glipizide & Glyburide are effective in smallerdoses and differ little from Sulphonylureas. Hypoglycemia occurs less often with oralagents than with insulin. But when it occurs it tends to be severe & prolonged.Biguanides: Metformin is useful in NIDDM patients who are not responsive to diet &exercise. The primary action is thought to be inhibition of hepatic gluconeogenesis & italso may enhance glucose disposal in muscle & adipose tissue. Melformin does not causehypoglycemia unlike sulphonylureas, metformin can cause lactic acidosis hence shouldnot be given in patients with renal disease.Thiazolidinedione derivatives: Such as troglitazone, lower blood levels of glucose, freefatty acids & triglycerides and appears to reduce insulin resistance. Troglitazone isapproved for use in obese patients with NIDDM who are poorly controlled on insulin.SUMMARY:Madhumeha Diabetes MellitusMargavarana Janya madhumehi NIDDM patient is obese, so diet exerciseis sthoola & balavan so apatarpana and oral hypoglycemics (sometimes insulinchikitsa in the form of langhana & also)Nidana parivarjanaDhatu Kshaya Janya madhumehi is IDDM – patient is thin so insulin therapyKrusha & durbala hence santarpanaChikitsa. 105 “EvaluatioIn the management of Madhumeha”
  • 119. MadhumehaPrameha Pidaka Charka in his Suthrasthana explained special Samprapti for madhumeha and heexplains that the lakshanas manifest and vanish at times. He also states that if neglected,this disease causes serious types of pidakas in subcutaneous, muscular area, vital partsand joints of the body. Hence pidaka can be termed as upadrava of madhumeha. There are different opinions among the acharyas regarding the number of pidakasas follows.156Table No: -16Showing the list of prameha pidakas157,158No. Charaka Sushruta Vagbhata1. Sharavika Sharavika Sharavika2. Kachapika Kachaptka Kachapika3. Jalini Jalini Jalini4. Sarshapika Sarshapika Sarshapika5. Alaji Alaji Alaji6. Vinata Vinata Vinata7. Vidradi Vidhradi Vidhradi8. - Masurika Kuluttika9. - Putrini Putrini10. - Vidarika VidarikaCOMPLICATION OF DIABETES MELLITUS159 It can be classified into two groups 1) Acute complications: - 106 “EvaluatioIn the management of Madhumeha”
  • 120. Madhumeha a) Metabolic – Ketoacidosis, Hyper Osmolar non Ketotic coma, lactic acidosis b) Infective apisodes of RIT, UTI, Skin etc., c) Surgical complications – Gangrene, Carbuncles 2) Chroni Complications: - a) CVS – Premature altheroma, Ischaemic or CHD – Thromibosis, HT, Claudication etc b) Nervous System – CVD, Peripheral neuropathey, Sensory and motor neuropathises. c) Excretory System – Recurrent UTI, RF, Chronic polynephritis d) Eyes – Cataracts, Retinopathy e) Respiratory System – Pulmonary kocks f) Digestive System – Stomatitis, Dental sepsis, fatty filtration of lives g) Bones and Joints – Osteoporosis, Frozen shoulder on, Neuropathic joints h) Skin – Monitial infections, trophic ulcers, carbuncles i) Gonad possible hormon changes. Some upadravas can be correlated to some of the complications of modern sciences for e.g.- thrishna, bhrama, shoola, tamapravesha, swasa etc with that of the ketoacidosis in which all these symptom are seen and even in hypoglycemic condition also.ARISHTA LAKSHANAS Only a few references regarding arishta lakshanas of madhumeha and prpamehascan be found in the classics.They are as follows: - 107 “EvaluatioIn the management of Madhumeha”
  • 121. Madhumeha If the bala and mamsa of a madhumeha rogi is severely deteriorated then heshould be considered as achikitsya. Swapna vishayaka – If person dreams of drinking various types of snehas inassociation with chandalas (that is out cast men) then he dies of prameha. If amadhumeha rogi dreams of consuming water then he dies of prameha. Doota vishayaka – The meeting of the messenger and the physician near the pondor along with water then the prognosis will be bad. If the patient is suffering fromprameha. Anya – In spite of regular bath and the application of perfumes if the flies attachconcurrently on a madhumeha rogi. Then he will die soon. If madhumeha is present withthe upadravas it is to be considered as arista. If he is lethargic obese, atisnigdha and is avaracious eater. Then death impends in the form of prameha. The knowledge of Arishta is very much essential to understand the prognosis of adisease, which denotes death definitely.PATHYA AND APATHYAVery often, traditional medicinal systems are criticized for the strictdietary restrictions. Many patients may not be inclined to embrace thistherapy, thinking that they will have to observe strict ‘Pathyam’.It means ‘pathya‘ is one, which is beneficial to the path/channels.‘Pathyam‘ includes those factors, which do not adversely affect the bodyas well as mind, and which are favourable to maintain good health. 108 “EvaluatioIn the management of Madhumeha”
  • 122. Madhumeha‘Pathyam’ includes specific foods and drugs (from natural sources), whichare beneficial and are in accordance with the functioning of body channelsor pathways through which they pass. The chronic disease, ‘diabetes’, canbe controlled by giving comprehensive attention to three aspects i.e.Ausadha (medicine), Aahar (diet and Vihar (exercise). The term Pathya means that which compatible to health. Pathya plays asignificant role in controlling Madhumeha. If person who is a Madhumehi indulges inthe habit of taking Apathyas then certainly the effect of the medicine will prove futile andthe disease aggravates. If person follows the Apathya than are advised for him, then itwill help him certainly to bring down increased state of disease. Some points are to be considered before framing Pathyas for Madhumehi patients. 1) Nidana parivarjana 2) Considerations towards Sthoola and Krisha Madhumeha patients 3) Vata and Kapha Nashaka Ahara and Vihara. 1) Nidana parivarjana: - The aharas, which have been explained for Samanya Pramehas. Or Vishista Prameha is to be termed as Apathuyas. So Nidhana parivarjana will become pathya for the patients. 2) General considerations on sthoola and krisha madhumeha patients: - Pathyas differ from patients to patient as difference in the treatment. It depends on the Nidana Samprapthi of the disease. For example in Sthoola Madhumeha there is a Margavarodha of vayu by Vridda Kapha and medas. Patients should be advised to follow the following diet. 109 “EvaluatioIn the management of Madhumeha”
  • 123. Madhumeha 1) The diet (Pathya) which aims towards the alleviation of Kapha Dosha and Medodhatu 2) The diet, which inhabits the vitiation of Vayu. 3) The diet, which gives bala to the patient even with a low calorie value.LIST OF PATHYASThe following dravyas are having the qualities as mentioned in earlier description. a) Jangal Mamsa b) Shyamak c) Uddalaka d) Kodrava e) Goodhooma f) Chanaka g) Tikta rasa Pradhana shakas that are grown in Jangal desha. h) Yavanna i) Kulattu j) Purana shali dhanya-madhy. 110 “EvaluatioIn the management of Madhumeha”
  • 124. MADHUMEHA SAMPRAPTI Nidana sevana Beeja dosha Vikrita bahudrava kapha (Shleshma) Travels all over the body because of shareera shithilata Medodhatwagni mandya Vitiation of medovaha srotasSthoulya Bahu abaddha medasShleshma, pitta, meda, mamsa, Dosha dushya sammurchhanaativriddhi Bahudrava shleshma with bahu abadhha medaObstruction to vata due to Vitiation of other dooshyasaavarana by vitiated kapha,pitta and meda. Adhika kledata of dhatusSqueezing of ojus Basthi MADHUMEHA
  • 125. PATHOLOGY OF TYPES II DIABETESGenetic predispostion EnvirnomentMulti genetic defecets ObesityPrimary beta-cell defect Peripheral tissue insulin resistanceDeranged insulin Secretion Inadequate glucose utilization Hyperglycemia Beta cells exhaustion Type II diabetes
  • 126. Drug review Drug reviewMadhu / Honey: Honey obtained from the sealed comb cells is a naturally converted form ofsugary food from the nectar of flowers & other plant exudations systematically collectedand stored by honeybees. Honey is a thick, syrupy, translucent, pale, yellow or yellowishbrown to dark brown liquid. It chiefly contains dextrose and fructose, moisture & smallamounts of sucrose & mineral constituents. The presence of enzymes, vitaminssuspended matter proteins, acid and colouring matter. Dextrin maltose, melezitose,pentosans & gums are also reported.Property:-It is guru, Ruksha, Kashaya and sheeta veerya & it is pitta, Rakta & Kaphahara,Moreover it is yogavahi which means it has samananukari dravyaprabhodhita shakti. Inother words madhu due to its prabhava assumes & magnifies gunas of whatever dravya isused along with it. Hence madhu is used along with most of the aharas & aushadhaswhich are Kaphamedo and mehahara but madhu should be used in small quantitiesotherwise it causes vatavrudhi.Contents: Alkaloids:Moisture – 20.6% Pyrolizidine alkaloidsProteins – 0.3% Jacohne, JacozineCarbohydrates – 79.5% Jacobine, seneciphyllineMinerals – 0.2% & senecionine 111 “Evaluation of efficacy ofMadhutailika basti Inthe management of Madhumeha”
  • 127. Drug reviewCalcium – 5%Phosphorus – 16.0%Iron - 0.9%Riboflavin – 0.04%Niacin – 0.2%Vit C. - 4.0%Energy – 319 K cal / 100gProperties: Honey serves as mild laxative, bactericidal, sedative, antiseptic & alkalinecharacteristics. It has ingredients which very similar to antibodies. Diet rich in honey isrecommended for infants, Convalescents & diabetic patients. It is generallyrecommended as a remedy for cold, cough, fever, sore eyes & throat, tongue andduodenal ulcers, liver disorders, constipation, diarrhea, kidney and other urinarydisorders, pulmonary T.B. rickets, marasmus, scurvy and insomnia. It is used as a remedyon open wounds after surgery. It is reported to prevent infection & promote heating.Pharmacotherapeutics of honey:- It has been proposed that honey contains a sucralfate like substance that may beresponsible for its antioxidant property and gastric protection, deterioration in theprocesses of lipids peroxidation and rise in the activity of antioxidant system of anorganism.Saindhava Lavana. (Rock salt) This is the best among lavana varga draya. Rock salt is the commonname for the mineral Halite. 112 “Evaluation of efficacy ofMadhutailika basti Inthe management of Madhumeha”
  • 128. Drug review Components - NaCl can have impurities of gypsum or transparent cubes. It has apure saline taste. Rasa - lavana Guna - laghu, snigdha, sukshma. Veerya - ushna. Vipaka - madhura. Properties - chakshushya, hridya, ruchikara, promotes appetite and assists the Digestion, assimilation and purgative action. Tilataila: Tilataila is best Snehadravya among sthavara sneha as explained byCharaka. Taila is used widely for internal and external conditions. Taila is most easilyavailable fixed oil of herbal origin used extensively in the form of food and medicines. Acharya charaka mentioned that Tilataila is best among the taila vargas. Italleviates vata but, at the same time does not aggravate kapha. From therapeutic point ofview the quality of taila is “Na Anyaha Snehastatha Kwachitsamskaram nuvartate” ie.When taila is subjected (samskara) with other dugs it takes the property of that drug. Vagbhata explains the importance of Tilataila as “Krishanam BhrimhanayalamSthoolanam Karshanaya Cha”. It does Bhrimahana Karya for Krisha persons and doesKarshana for sthoola persons. In Krusha persons, Srotosankochana is present (i.e. constriction of channels).Taila when administered, by its Tikshna Vyavayadi gunas enters the SukshmatisukshmaSrotases and accomplishes Shodhana karya. By Shrotoshuddhi, shareera pusthi willoccur. Hence in this manner it does “Tasmath Krishanam Bhrimhanayalam mittupanam”. 113 “Evaluation of efficacy ofMadhutailika basti Inthe management of Madhumeha”
  • 129. Drug review In Sthoola persons, by its sukshma, teekshnoshna gunas it enters Sukshmasrotasesdoes kshapana karya for meda. Due to kshapana of meda, the person becomes krisha.Importance of murchana of tila taila: Crude oil contains Amadosha i.e, some enzymelipase and racine (toxic proteins), by morchana process Amadosha are removed and alsodurgandhata & ugrata are removed. After doing Moorchana Samskara Sneha gets goodsmell and colour. Apart from theses Sneha will gets the qualities of the drugs used forMurchana. While by Sneha paka and Murchana the veerya of the Sneha is enhanced. Before going to prepare any Aushadha siddha yogas, Taila Murchana is required.Murchana means to enhance, to spread over. By this process amadosha is removed.Usually Tailas are ushna veerya in nature. When treated with drugs like Amalaki,Haritaki, etc., in the qualities of tailas changes takes place. i.e., Taila attains Sheetaveerya. If Gritha & Tailas are treated with Rooksha, Ushna, Sheeta Dravyas, snehatwaproperty will not be lost. The drugs used for Murchana of Tilataila are Haritaki, Vibitaki, Amalaki,Haridra, Mustha, Vatankura, Hrivera (Rasna), Ketaki pushpa, Manjistha, Lodra. Withtheir lekhaneeya property and also removes the Amadosh of Taila.Beneficial effect of Moorchana sanskara reduces the degree of Saturation but enhancesthe degree of Unsaturation. It indicates the role of unsaturated fatty acids in reducingSerum Cholesterol, Serum Triglycerides and LDL levels which are other wise risk factorfor the development of Atherosclerosis, Hyper tension, Coronary heart diseases etc. List drugs for murchana process:- Manjistha - 1/16th part 114 “Evaluation of efficacy ofMadhutailika basti Inthe management of Madhumeha”
  • 130. Drug review Haritaki - 1/64th part Vibhitaki - 1/64th part Amalaki - 1/64th part Mustha - 1/64th part Haridra - 1/64th part Lodra - 1/64th part Vatankura - 1/64th part Hrivera - 1/64th part Nalika - 1/64th part Ketakipushpa - 1/64th part Tila taila - 1 part Jala - 4 part Eranda Ricinus communis Linn. (Euphorbiaceae)Synonyms: - :erandah, tarunah, sukla, citra, gandharvahastaka, pancangula, vardhamana,amanda, dirghadandakah,etc.Rasa (taste):-tikta, svadu [dhn] madhuram [mpn] madhuram [bpn] katu, tikta [rjn]guna (quality):-guru [dhn] guru [mpn] guru [bpn]veerya (potency):-usna [dhn] usna [mpn] usna [bpn] usna [rjn] 115 “Evaluation of efficacy ofMadhutailika basti Inthe management of Madhumeha”
  • 131. Drug reviewKarma (action):-sula hara [mpn] sula hara [bpn]. It is Vatashamaka, Rasayana, andMedhyaDosha-karma (action on doshas):-vata hara [dhn] kapha hara [mpn] kaphavata hara[bpn] kaphavata hara [rjn]roga-haratwa :udavarta, pliha, gulma, bastisula, antravrddhi [dhn] sula, sopha, kati, vasti, sira pida,udara, jwara, bradhma, svasa, anaha, kasa, kustha, amavata [mpn] sula, sopha, kati, vasti,sirapida, udara, jwara, bradhma, svasa, anaha, kasa, kustha, amamarutha [bpn] jwara,kasa [rjn]Chemical Constituents of RootAlkaloid -- Ricinine 1% ; Leaf --Ricinine, N-dimethylricinine, Kaempferol, Quercetin ;,B- amyrin , Hyperoside , Quinic acid; gallic, skimmic, ellagic, ferulic and coumarinicacids Seeds --- Ricinoleic acid ( 89% of fatty acids of castor oil ), Ricin; Seed cake --Ricinine (Alkaloid ) ;. Seed- Toxic principles -2.8 - 3 % Shatapushpi (Anethum sowa)Paryaya: - Shatapushpi, Chatra, Bahupushpa,etcProperties:-Guna: - laghu, ruksha, teekshna.Rasa: - katu, tikta.Veerya: - ushna 116 “Evaluation of efficacy ofMadhutailika basti Inthe management of Madhumeha”
  • 132. Drug reviewVipaka: - katuDoshagnata: - due to its ushna and teekshna property it acts as a kapha vata shamaka.Chemical composition: - a seed contains sainted oil. 117 “Evaluation of efficacy ofMadhutailika basti Inthe management of Madhumeha”
  • 133. Methodology RESEARCH APPROACH: - It is believed that success of the research work mainly depends onits Methodology, so utmost care is in study design is very essential. Hence, in thissection, the researchers put forward the systemic procedures, which are followed by theresearcher’s right from the identification of the problem to the final conclusion.In this work I aimed to evaluate the efficacy of Madhutailika bastikarma in Madhumeha. The efficacy was determined by finding out the difference between the baselinedata of the parameters to the after treatment data. Source of data: - Patients suffering form madhumeha were selected from P.G. S. & R., Departmentof Panchakarma O.P.D. of D.G.M. Ayurvedic Medical College and hospital, Gadag bypreset inclusion and exclusion criteria. Study design: - The study design selected for the present study was prospectiveclinical trial. Demographic data and disease-specific data are collected according to thecase-record form given in the appendix. The treatment modality used in this clinical study was Vasti karma, which included sthanika abhyanga sweda, anuvasana vasti, and nirooha vasti i.e. madhutailika vasti, and which was followed by parihara kala and follow up 15 days. During the follow-up period patients were given placebo capsules. 1) Abhyanga with murchita tila taila. 118 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 134. Methodology 2) Anuvasana vasti with murchita tila. 3) nirooha vasti i.e. madhutailika vasti. A minimum of 30 patients was taken for study. All the patients received classical vasti karma. Inclusion criteria: - Patients satisfying the following criteria were taken for study. They are – The patients between the age group of 35 to 60 years. Non-complicated NIDDM. Patients having the clinical features of madhumeha. Irrespective of sex. Madhumeha patients having well body strength, sthoola and also fit for Vasti karma. Exclusion criteria: - If any of the following conditions were noted, such patients were excluded formthe present study. They are – Insulin dependant diabetes mellitus. Patients complicated with other systemic disorders. Patients less than 35 and above 60 years of age. Patients with diabetic complications. Duration of the Study The treatment modality used in this clinical study was Vasti karma, which included sthanika abhyanga sweda, anuvasana vasti, and nirooha vasti i.e. 119 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 135. Methodology madhutailika vasti, and which was followed by parihara kala and follow up 15 days. During the follow-up period patients were given placebo capsules. Abhyanga with murchita tila taila. Anuvasana vasti with murchita tila. nirooha vasti i.e. madhutailika vasti. A minimum of 30 patients was taken for study. All the patients received classical vasti karma. . Plan of study: - The treatment modality used in this clinical study was Vasti karma, which included sthanika abhyanga sweda, anuvasana vasti, and nirooha vasti i.e. madhutailika vasti, and which was followed by parihara kala and follow up 15 days. During the follow-up period patients were given placebo capsules.Selected patients were given basti karma. A. Deepana-pachana – Deepana pachana till nirama laskhanas appears. For this the drug administered was trikatu choorna, 3 gms 3 times a day before food. B. Abhynaga– Sthanika abhynaga and ushna jala snana. For abhynaga moorchita tila taila was used. C. Basthi karma – five Anuvasana and three Madhutailika Basti D. Parihara Kala – sixteen days parihara kala. 120 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 136. Methodology E. Follow up – Follow up for one month. During this period of follow up the patient was advised to follow the diet, which he had followed prior to our study.Data CollectionPatients were thoroughly examined both subjectively and objectively. Detailed historypertaining to the mode of onset, previous ailment, previous treatment history, familyhistory, habits, ashtavidhapareeksha and dashavidhapareeksha and physical examinationfindings were noted. Routine investigations were done to exclude other pathologiesInvestigations and Selection of Patients: -Objective parameters:- The following investigations were done prior to the study. 1. Blood – FBS, PPBS. 2. Urine – Urine sugar. After interpretation of the laboratory investigations, mild and moderate types ofpatients were taken for study. Mild and moderate criteria’s are given here.Table No. 15. Showing the grades of the blood sugar level.Sl. Level FBS RBS PPBS Urine sugar01. Normal 70-120 mg/dl. 100-140 120-180 Nil02. Mild 121-170 mg/dl. 181-230 181-230 0.5%03. Moderate 171-220 mg/dl. 231-280 231-280 1.0-1.5 %04. Severe 221-mg/dl and 281 mg/dl and 281 mg/ dl and 2% and 121 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 137. Methodology above above above aboveSubjective parameters: - Apart form the above parameters; the following parameters were also taken forassessing the patient. They are – Prabhuta mutrata Kshudadhikya Pipasadhikya Karapada daha Ati swedaMethod of Assessment and grading: - The assessment of results is made by observing the severity of symptoms andlaboratory investigations. The severity of the symptoms, urine sugar, fasting blood sugar and post prandialblood sugar were assessed before the treatment, after Vasti karma, after parihara kala, andfollow up, i.e.15th day of period.Grading of parameters: - The results were evaluated by observing subjective and objective parameters bygrading method. The grading was done in the following manner. 1. Prabhuta mutrata: - Grade 0 – 2-3 times / day, 0-1 times / night. Grade 1 – 4-5 times / day, 2-3 times / night. 122 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 138. Methodology Grade 2 – 6-7 times / day, 4-5 times / night. Grade 3 – > 7 times / day, > 5 times / night.2. Pipasadhikya: - Grade 0 – Normal. Grade 1 – Slightly increased. Grade 2 – Severely increased.3. Kshudhadhikya: - Grade 0 – Normal. Grade 1 – Increased, but can tolerate. Grade 2 – Increased, but can’t tolerate without consuming food.4. Kara pada daha: - Grade 0 – Absent. Grade 1 – Slightly present. Grade 2 – Present.4. Ati sweda: - Grade 0 – Absent. Grade 1 – Present.5. F.B.S.: - FBS levels, Grade 0 - 120 and below Grade 1 - 121-140 Grade 2 - 141-160 Grade 3 - 161-180 123 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 139. Methodology Grade 4 - 181-200 Grade 5 - 201-2206. PPBS (Post prandial Sugar): - PPBS levels – Grade 0 - 180 and below Grade 1 - 181-200 Grade 2 - 201-220 Grade 3 - 221-240 Grade 4 - 241-260 Grade 5 - 261-2807. Urine sugar: -Urine sugar - Grade 0 - Nil Grade 1 - 0.5 Grade 2 - 1.0 - 1.5 124 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 140. Master Chart No 1Sl. OPD Age Sex Religion Occupation Socioeconomic status Diet DurationNo. No. (yrs) M F H M S A L P M UM HC Veg Mix ND >1 >2 >301. 5204 40 - + + - + - - - + - - + - - + - -02. 5235 50 + - + - + - - - - + - + - - - + -03. 5311 35 - + + - + - - - - - + + - - + - -04. 5324 58 + - + - + - - - + - - - + - + - -05. 5337 43 + - + - + - - - + - - - + - + - -06. 5383 62 + - + - + - - - - + - + - + - - -07. 5385 59 + - + - + - - - - - + + - + - - -08. 5451 46 + - + - + - - - - + - + - - - - -09. 929 57 + - + - - - - + + - - - - + - + -10. 945 50 + - + - + - - - - + - - + - + - -11. 1140 55 - + + - + - - - + - - + - - - + -12. 1141 62 + - + - + - - - - + - + - - - - +13. 1184 40 + - + - + - - - - - + - + - - + -14. 1613 38 - + + - - - + + - - - + - - + - -15. 1718 49 + - + - + - - - + - - - + - - - +16. 1413 58 + - - + - - + + - - - - + - - + -17. 1221 46 + - + - - - + + - - - - + - - - +18. 1519 52 + - + - + - - - - + - + - + - - -19. 2906 54 + - + - - - + + - - - - + - - + -20. 2933 43 + - - + + - - - - + - - + - - + -21. 3062 51 + - + - + - - - - + - - + - - + -22. 3094 63 - + + - + - - - + - - - + + - - -23. 3603 52 + - - + + - - - - + - - + - + - -24. 3227 57 + - + - + - - - + - - - + - - - +25. 3375 49 + - + - + - - - + - - + - - + - -26. 3438 44 + - + - + - - - - + - + - - + - -27. 3495 57 + - - + + - - - - + - - + - + - -28. 3630 56 + - + - + - - - - + - - + - - + -29. 3750 53 + - + - + - - - - + - - + + - - -30. 3751 48 + - + - + - - - - + - - + + - - -M – Male; F- Female; H- Hindu; M- Muslim; S – Sedentary; A – Active; L – Labor;P- Poor; M – Middle class; Um – Upper middleclass; HC – High class; ND – Newly diagnosed;.
  • 141. Master Chart No 2Sl. OPD Family history Family Koshta Agni Bowel Habits PrakritiNo. No. history Al Ay No Du P A Mr Ma Kr M T S F C S A T No KP KV VP01. 5204 + - - 8 + - - + - - + - - + - - - - - - + Mnts02. 5235 + - - 1½ + - - + - - + - - + - + - - - + - yrs03. 5311 + - - 2 yrs + - - + - + - - - + - - - + + - -04. 5324 + - - 2 - + - + - - + - + - - + - - + - - mnts05. 5337 + - - 1 yr + - + - - - + - - + - + - - + - -06. 5383 + - - 1 yr - + - + - - + - + - - + - - + - -07. 5385 + - - 6 + - - - - + - + - + - - - + + - - mnts08. 5451 + - - 6 + - + - - - + - + - + - - - - + - mnts09. 929 - - + - - + - + - - + - - + + - - - - - +10. 945 + - - 14 mnts - + - + - - + - - + + - - - - + -11. 1140 + - - 1 mnt - + - + - + - - - + - + - - - + -12. 1141 + - - 5 + - - + - - + - - + - + - - - - + mnts13. 1184 + - - 1 yrs + - - - + + - - - + - + - - - - +14. 1613 - + - 6 + - - - + - + - - + - - - + - + - mnts15. 1718 + - - 3yrs + - + - - - + - - + - + - - - + -16. 1413 - + - 4mnts + - + - - + - - + - - + - - + - -17. 1221 + - - 6mnts - + - + - - + - - + - + - - + - -18. 1519 + - - 1 yr + - - + - - + - - + - - - + + - -19. 2906 + - - 2yrs - + - + - - + - + - - + - - + - -20. 2933 + - - 2yrs + - - + - - + - + - - + - - + - -21. 3062 + - - 1yr + - - + - + - - - + - + - - + - -22. 3094 - - + - + - - + - + - - + - - - + - + - -23. 3603 + - - 9 + - + - - + - - - + + - - - + - - mnts24. 3227 + - - 1yr - + - + - - + - - + - - - + + - -25. 3375 + - - 2yrs + - - + - - + - + - - - - + + - -26. 3438 - + - 3 yrs + - - + - - - + - + - - - + - - +27. 3495 + - - 1½ + - - + - - + - - + + - - - - - + yrs28. 3630 + - - 3mnts - + - + - - + - - + + - - - - + -29. 3750 + - - 8 - + - + - - - + + - - + - - - + - mnts30. 3751 - + - 6 - + - + - - - + + - - - - + - + - mntsAl – Allopathy; Ay – Ayurveda; No. – No history; Du. – Duration; P – Present; A – Absent; Mr. – Mridu; Ma. – Madhyama; Kr. –Krura; M. – Manda; T. Teekshna; S. – Sama; F – Free;C. – Constipation; S. – Smoking; A. – Alcohol; T. – Tobacco; N. – No habits; KP. – Kapha-pitta; KV – Kapha-vata; VP – Vata-pitta.
  • 142. Master Chart No 3Sl. OPD Prabhoota Pipasadhikya Kshudadhikya Karapadadaha Ati Sweda FBS PPBS Urine sugar Body weight NO. mutrata BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF01. 5204 2 1 0 2 1 1 1 0 0 1 1 0 0 0 0 126 125 98 197 170 149 1 1 0.5 63 62 6202. 5235 1 1 0 1 0 0 2 0 1 0 0 0 0 0 0 120 112 110 158 132 126 1 0.5 0 80 77 7803. 5311 1 0 0 2 1 1 1 1 0 2 1 0 1 1 1 106 110 104 145 150 138 0.5 0.5 0 70 68 65.504. 5324 2 1 0 2 1 0 1 0 0 1 1 0 0 0 0 132 125 127 225 198 175 1 1 0.5 74 73 73.505. 5337 2 1 0 2 1 1 2 1 0 2 1 0 1 0 0 138 136 117 180 170 153 1 0.5 0.5 95 92.5 9306. 5387 1 0 1 1 0 0 2 1 0 2 1 1 0 0 0 110 110 98 193 170 142 0.5 0.5 0 65 63.5 62.507. 5385 2 1 1 2 1 0 2 0 1 1 1 0 0 0 0 105 100 98 150 164 130 0.5 0 0 72 71 70.508. 5451 1 0 0 1 0 1 1 0 0 1 0 0 1 0 1 130 120 111 230 198 160 1 0.5 0.5 68 67 67.509. 929 2 1 0 1 0 1 0 0 0 1 0 0 1 0 0 120 120 105 193 190 164 1 0.5 0.5 75 73.5 7410. 945 1 0 0 2 1 0 1 0 1 1 0 1 0 0 0 135 130 115 246 255 190 0.5 0.5 0.5 68 66.5 6711. 1140 1 0 0 2 1 1 2 1 0 1 0 0 1 1 0 118 118 100 173 160 128 0.5 0 0 76 77.58 73.512. 1141 2 1 0 1 0 0 1 0 0 0 0 0 1 0 0 105 105 100 154 185 130 0 0 0 68 68 68.513. 1184 1 0 0 1 0 0 2 1 0 1 0 0 1 1 1 138 125 107 197 230 160 0.5 0.5 0 78 78 7714. 1613 1 0 0 2 1 0 1 0 0 1 1 0 0 0 0 156 150 138 363 400 330 1.5 1.5 1 64 64 6315. 1718 1 0 0 1 0 0 1 0 0 1 0 1 0 0 0 160 134 126 257 260 211 1.5 0.5 1 62 61 60.516. 1413 2 1 0 1 0 0 0 0 0 1 1 0 0 0 0 141 116 102 222 230 191 1 0.5 1 59.5 59 5917. 1221 1 0 0 2 1 0 1 1 0 0 0 0 0 0 0 170 139 159 265 238 204 1 0.5 1 63.5 64 6218. 1519 2 1 0 2 1 0 2 1 0 1 0 0 0 0 0 118 138 115 193 205 183 0.5 0.5 0.5 73 72.5 72.519. 2906 2 1 1 1 0 1 2 1 1 1 1 0 1 1 1 170 139 158 298 310 271 1 1.5 1 89 88.5 8820. 2933 2 2 1 1 0 0 2 1 1 1 0 0 0 0 0 130 140 123 273 248 203 0.5 0 0 61.5 62 61.521. 3062 1 0 0 1 0 0 0 0 0 0 01 0 1 0 0 107 85 94 215 225 183 0.5 0 0.5 58 58.5 5822. 3094 3 2 1 2 1 1 2 1 0 0 0 0 1 1 0 188 152 141 305 330 268 1.5 1 1 76 75.5 74.523. 3603 1 0 0 1 0 0 1 1 0 1 1 0 1 0 0 116 113 94 275 164 141 1 0.5 0.5 67 66 63.524. 3227 1 1 0 1 0 1 2 1 0 1 0 0 0 0 0 118 115 108 183 170 145 0.5 0 0 55 53.5 5325. 3375 2 1 1 2 1 1 2 1 1 1 1 0 1 0 0 138 135 120 140 213 174 1 0.5 0 58 57 56.526. 3438 3 2 1 2 1 0 1 0 0 0 0 0 1 1 1 102 104 90 147 179 143 0.5 0 0 85 82.5 8327. 3495 3 2 1 1 1 0 2 1 0 1 0 1 1 0 0 220 216 178 444 372 370 1.5 1 1 63 61 6128. 3630 3 2 1 2 1 0 1 0 1 0 0 0 0 0 0 141 125 103 198 189 163 0.5 0 0 62 61 60.529. 3750 3 1 1 2 1 1 2 1 1 1 1 0 1 1 0 195 180 138 236 240 181 0.5 0.5 0.5 64 64 63.530. 3751 2 2 1 1 0 0 2 1 1 1 0 0 1 1 0 133 119 116 276 220 174 0.5 0.5 0 65 63.5 63.5BT – Before treatment; AT – After treatment; AF – After follow-up.
  • 143. ResultsTable. No- 17 Showing the Data of Age Group Incidence and ResponseSl.no. Age.group. No.of.pts. % GR % MR % PR % 1 35-39 02 6.66 - - 2 100 - - 2 40-44 05 16.66 3 60 2 40 - - - - 3 45-49 06 20 3 50 3 50 4 50-54 07 23.33 2 28.57 3 42.85 2 28.57 5 55-59 07 23.33 2 28.57 4 57.14 1 14.28 6 60-64 03 10 1 33.33 1 33.33 1 33.33 Among age group 35-39 it contains 2 patients i.e. (6.66%) and 2 patientsresponded moderately (100%). 40-44 age groups include 5 patients i.e. 16.66% and in that all 3 patients i.e.60%responded well, 2 patients i.e. 40% responded moderately. Age group 45-49 includes 6 patients i.e. 20% and in that 3 patients (50%)responded well, 3 patients (50%) responded moderately. Age group 50-54 includes 7 patients i.e. 23.33%. In those 2 patients i.e. 28.57%responded well, 4 patents i.e. 57.14% responded moderately and one patient showed poorresponse. 55-59 age group contains 7 patients i.e. 23.23% is in that 2 (28.57%) patientsresponded well, 4 patients responded moderately i.e. (57.14%) and 1 i.e. (33.33) patientshowed poor response.Last 60-64 age group includes 3 patients i.e. 10% and in that 1 (33.33%) patientresponded well, 1 patients responded moderately i.e. (33.33%) and 1 patient showed poorresponse. Graph no-1125 “Evaluation of efficacyof Madhutailika Bastikarma inthe Management of Madhumeha’
  • 144. Results 5 4 no of pts 3 2 1 0 35-39 40-44 45-49 50-54 55-59 60-64 GR 0 3 3 2 2 1 MR 2 2 3 3 4 1 PR 0 0 0 2 1 1 ageTable. No- 18Showing the Sex Group Incidence and ResponseSl.no. Sex No.of.pts. % GR % MR % PR %1 Male 25 83.33 10 40 12 48 3 122 Female 05 16.66 2 40 2 40 1 20 Out of 30 patients, 25 were males (83.33%) and 5 were females (16.66%). Amongmales 10 patients (40%) responded well, 12 patients (48%) responded moderately and 1patient showed poor response. Among females 2 patients responded well i.e. (40%), 2 patients respondedmoderately (40%) and 1 patient showed poor response. Graph no-2126 “Evaluation of efficacyof Madhutailika Bastikarma inthe Management of Madhumeha’
  • 145. Results Sex group incidence and response 15 10 5 0 GR MR PR Male Female Table. No- 19 Showing the Chronicity and ResponseSl.no. Duration No.of.pts % GR % MR % PR %1 <1 06 20 2 33.33 2 33.33 2 33.332 >1 11 36.66 6 54.54 4 36.36 1 9.093 >2 09 30 2 22.22 6 66.66 1 11.114 >3 04 13.33 2 50 2 50 - - Among 30 patients, 6 patients’ (20%) were newly diagnosed. In that category 2 patient’s (33.33%) responded well and 2 patients (33.33%) responded moderately and 2 patient’s showed poor response. In the above 1 year group, 11 patients’ (36.66%) and in that 6 patients (54.54%) responded well, 4 patient’s response was moderate (36.36%) and one patient i.e. (9.09%) showed poor response. In the >-2 year group contains 9 patients (30%). Among them 2 patient’s (22.22%) responded well, 6 patients (66.66%) responded moderately and 1 patient (11.11%) showed poor response. 127 “Evaluation of efficacy of Madhutailika Bastikarma in the Management of Madhumeha’
  • 146. Results More than 3 year group contains 4 patients (13.33%) and in that 2 patientsresponded well and 2 patient’s showed moderate response. Graph no-3 chronicity and response 15 10 5 0 <1 yr >1yr >2 >3 No.of.pts GR MR PRTable. No- 20 Showing the Incidence of Religion and ResponseSl.no. Religion No.of.pts. % GR % MR % PR % 1 Hindu 26 86.66 12 46.15 11 42.30 3 11.53 2 Muslim 04 13.33 1 25 2 50 1 25 3 Others - - - - - - - -128 “Evaluation of efficacyof Madhutailika Bastikarma inthe Management of Madhumeha’
  • 147. Results In religion 26 patients were Hindu (86.66%) and4 patients were Muslim i.e.(13.33%). Among the Hindus, 12 patients (46.15%) responded well, 11 patients (42.30%) responded moderately and 3 patients (11.53%) showed poor response. Graph no-4 religion and response 15 10 5 0 Hindu Muslim Others GR MR PRTable. No- 21Showing the Socioeconomic Status and ResponseSl.no. Economic No.of. % GR % MR % PR % Status. pts.1 Poor 05 16.66 - - 4 80 1 202 Middle 08 26.66 5 62.5 2 25 1 12.53 Upper 14 46.66 5 35.71 7 50 2 14.28 Middle4 High 03 10 2 66.66 1 33.33 - - Class129 “Evaluation of efficacyof Madhutailika Bastikarma inthe Management of Madhumeha’
  • 148. Results Among 30 patients 5 patients was poor i.e. (16.66%), in that 4 (80%) patient’sresponded moderately and 1 patient (20%) showed poor response. 8 patients (26.66%) were middle class, among them 5 patient’s (62.5%) responsewas good, 2 patient’s (25%) responded moderately and one patient (12.5%) showed poorresponse. 14 patients were upper middle class and in that 5 patients (35.71%) respondedwell, 7 patients (50%) responded moderately and 1 patient (14.28%) showed poorresponse. Among 3 high-class patient (10%). 2 Patients (66.66%) responded well and onepatient (33.33%) responded moderately. Graph no-5 Economic status and response 8 GR 6 4 MR 2 0 PR Poor Middle Upper High Middle ClassTable. No- 22 Showing the Incidence of Religion and ResponseSl.no. Religion No.of.pts. % GR % MR % PR % 1 Hindu 26 86.66 12 46.15 11 42.30 3 11.53 2 Muslim 04 13.33 1 25 2 50 1 25 3 Others - - - - - - - -130 “Evaluation of efficacyof Madhutailika Bastikarma inthe Management of Madhumeha’
  • 149. Results In religion 26 patients were Hindu (86.66%) and4 patients were Muslim i.e.(13.33%). Among the Hindus, 12 patients (46.15%) responded well, 11 patients (42.30%) responded moderately and 3 patients (11.53%) showed poor response. Graph no-6 religion and response 15 10 5 0 Hindu Muslim Others GR MR PRTable. No- 23Showing the Incidence of Occupation and Response occupation No.of.pts. % GR % MR % PR %Sl.no.1 Sedentary 25 83.33 13 52 9 36 3 123 Labour 05 16. 66 - - 4 80 1 20131 “Evaluation of efficacyof Madhutailika Bastikarma inthe Management of Madhumeha’
  • 150. Results4 Others - - - - - - - - In occupation status, 25 patients were sedentary (83.33%) and 5 patients werelabors (16.66%). Among the sedentary category 13 patients (52%) responded well, 9 patients(36%) responded moderately and 1 patient (12%) showed poor response. Among labors 4patient’s (80%) responded moderately, and 1 patient (20%)showed poor response. Graph no-7 Occupation and Response 15 10 5 0 Sedentary Labour others GR MR PRTable. No- 24Showing the Family History and ResponseSl.no. Family No.of.pts. % GR % MR % PR % History 1 Present 19 63.33 8 42.10 09 47.36 2 10.52132 “Evaluation of efficacyof Madhutailika Bastikarma inthe Management of Madhumeha’
  • 151. Results 2 Absent 11 36.66 4 36.36 5 45.45 2 18.18 Among 30 patients, 19 patients’ (63.33%) had family history and in that 8 patientsi.e. (42.10%) responded well, 9 patient responded moderately and 2 patient’s showedpoor response. Other 11 patients (36.66%) had no family history and in that 4 patient’s (36.36%)responded well, 5 patients (45.45%) responded moderately and 2 patients (18.18%)showed poor response. Graph no-8 Family history and response 10 GR 5 MR PR 0 Present AbsentTable. No-25Showing the Treatment History and ResponseSl.no Treatment No.of.pts. % GR % MR % PR % History 45.83 41.661 Allopathy 24 80 11 10 3 12.5133 “Evaluation of efficacyof Madhutailika Bastikarma inthe Management of Madhumeha’
  • 152. Results2 Ayurveda 04 13.33 1 25 3 12.5 - -3 No treatment 02 6.66 - - 1 50 1 50 Among 30 patients, 24 patients (80%) had undergone allopathic treatment, 4patients (13.33%) had taken Ayurvedic treatment and 2 patients (6.66%) had no treatmenthistory. Among the patients those who had taken allopathic treatment, 11 patients(45.83%) responded well, 10 patients (41.66%) responded moderately and 3 patients(12.5%) showed poor response. In Ayurvedic treatment group, 1 patient’s (50%) responded well and 3 patient’s(50%) responded moderately.In the no treatment history group, one patient (50%) responded moderate and 1 patientshowed poor response. Graph no-9 Treatment history and response 15 10 5 0 GR MR PR Allopathy Ayurveda No treatmentTable. No-26Showing the Habits of the Patient and Response Sl.no. Habits No.of.pts % GR % MR % PR % 1 Smoking 06 20.00 2 33.33 3 50 1 16.66 2 Alcohol 14 46.66 5 35.71 7 50 2 14.28134 “Evaluation of efficacyof Madhutailika Bastikarma inthe Management of Madhumeha’
  • 153. Results 3 Tobacco 02 6.66 1 50 - - 1 50 4 No habbit 08 26.66 4 50 4 50 - - Among 30 patients, 06 patients (20%) had the habit of smoking and in them, 2patients (33.33%) responded well, 3 patients (50%) responded moderately and 1 patient(16.66%) showed poor response. 14 patients (46.66%) had the habit of drinking alcohol and in them 5 patients(35.71%) responded well, 7 patients (50%), responded moderately and 2 patient’s(14.28%) showed poor response. 2 patients (6.66%) had the habit of tobacco chewing, one patient responded goodand one patient showed poor response. 8 patients (26.66%) had the no habit, in that 4 patients (50%) responded well and4 patient’s (50%) responded moderately. Graph no-10 Food habbits and Response 15 10 5 0 Smoking Tobacco No.of.pts GR MR PRTable. No- 27Showing the Nature of Malapravrithi and Response135 “Evaluation of efficacyof Madhutailika Bastikarma inthe Management of Madhumeha’
  • 154. ResultsSl. No.no. Malapravritti of.pts. % GR % MR % PR %1 Free 11 36.66 4 36.36 4 36.36 3 27.272 Constipation 19 63.33 8 42.10 10 52.63 1 5.26 Among 30 patients, 11 patients (36.66%) had free bowel and in that 4 patients(36.36%) responded well, 4 patients (36.36%) responded moderately and 3 patientsshowed poor response. 19 patients had constipation (63.33%) and in that 8 patients (42.10%) respondedwell, 10 patients (52.63%) responded moderately and 1 patient (5.26%) showed poorresponse. Graph no-11 C o n s t ip a t io n Free PR P R 27% GR 5 % G R 37% 4 2 % M R 5 3 % MR 36% GR MR PR G R M R P RTable. No – 28 Showing the Nidana Status and Response136 “Evaluation of efficacyof Madhutailika Bastikarma inthe Management of Madhumeha’
  • 155. Results Sl.no. Nidana No.of.pts. % % 1 Snigdha 30 100 2 Guru 30 100 3 Asya Sukha 22 73.33 4 Swapna Sukha 20 66.66 Among 30 5 Alpavyayam 24 80.00 patients, all of 6 Alpa Chinta 09 30.00them used to indulge in generalaharaja nidanas, like snigdha atyupayoga (100%) and guru ahara atyupayoga (100%). 22 patients (73%) used to indulge in the vihara asyasukham. 20 patients (66.66%) indulge in more swapna sukham vihara 24 patients (80%) indulge in alpavyayama and 12 patients (40%) indulge inalpachinta Graph no-12 Types of Nidana Alpa Chinta Snigdha Alpavyayam 7% 22% 18% Swapna Sukha Guru 15% 22% Asya Sukha 16%137 “Evaluation of efficacyof Madhutailika Bastikarma inthe Management of Madhumeha’
  • 156. ResultsTable. No – 29 Showing the Nature of Koshta and ResponseSl.no. Kostha No.of.pts. % GR % MR % PR %1 Mrudu 08 26.66 4 50 3 37.5 1 12.52 Madhyama 19 63.33 7 36.84 9 47.36 3 15.783 Kroora 03 10 1 33.33 2 66.66 - - Among 30 patients, 8 patients (26.66%) had mrudu koshta, 19 patients had(63.33%), madhyama koshta and 3 patient’s (10) had krura koshta. In mrudu koshta patients, 4 patient’s (50%) response was well, 3 patientsresponded moderately and one patient showed poor response. Among madhyma koshta patients, 7 patients (36.84%) responded well, 9 patients(47.36%) responded moderately and 3 patients (15.78%) showed poor response. In 3 krura koshta patients one patient (33.33) responded well and 2 patients(66.66%) responded moderately Graph no-13 .138 “Evaluation of efficacyof Madhutailika Bastikarma inthe Management of Madhumeha’
  • 157. Results NATURE OF KOSHTA 10 8 6 GR 4 MR 2 PR 0 Mrudu Madhyama KrooraTable. No- 30 Showing the Status of Agni and Response Sl.no. Agni No.of.pts. % GR % MR % PR % 1 Mandagni 07 23.33 2 28.57 4 57.14 1 14.28 2 Teekshnagni 20 66.66 8 40 10 50 2 10 3 Samagni 03 10 1 33.33 1 33.33 1 33.33 Among 30 patients 7 patients (23.33%) had Mandagni and in that 2 patients(28.57%) responded well. 4 patients (57.14%) responded moderately and one patient(14.28%) showed poor response. In 20 Teekshanagni, 8 patients (40%) responded well. 10 patients (50%)responded moderately and 2 patients (10%) showed poor response. In 3 Samagni, one patient well responded, one patient responded moderately andone patient showed poor response. Graph no-14139 “Evaluation of efficacyof Madhutailika Bastikarma inthe Management of Madhumeha’
  • 158. Results Nature of Agni and Response 10 8 6 GR 4 2 MR 0 PR Mandagni SamagniTable. No – 31 Showing the Prakruiti of the Patient and Response Sl. No.of. no. Prakruiti pts. % GR % MR % PR % 1 Kapha Pitta 15 50 6 40 7 46.66 2 13.33 2 Kapha Vata 09 30 3 33.33 5 55.55 1 11.11 3 Vata Pitta 06 20 3 50 2 33.33 1 16.66 Among 30 patients, 15 patients (50%) came under kapha pitta, 9 patient’s kapha-vata prakriti and 6 patient of vata pitta prakruti. In first group 6 patients (40%) responded well, 7 patients (46.66%) respondedmoderately and 2 patients’ (13.33%) showed poor response. Among kapha-vata prakriti patients, 3 patients (33.33%) responded well, 5 patients (55.55%) responded moderately and 1 patient (11.11%) response was poor.140 “Evaluation of efficacyof Madhutailika Bastikarma inthe Management of Madhumeha’
  • 159. Results Graph no-15 Prakruti and response 8 6 GR 4 MR 2 0 PR Kapha Pitta Kapha Vata Vata PittaTable. No- 32 Showing the Statastical data of the Study Individual study of the parameters showing the significance effect before andafter the treatment.141 “Evaluation of efficacyof Madhutailika Bastikarma inthe Management of Madhumeha’
  • 160. ResultsSl. Parameters Mean S.D S.E T-Value P- Value Remarksno.1 Prabhoota Mutrata 1.4 0.563 0.102 13.72 < 0.001 HS2 Pipasadhikya 1.16 0.592 0.108 10.74 < 0.001 HS3 Kshudhadikya 1.133 0.628 0.114 9.938 < 0.001 HS4 Karapada Daha 0.733 0.583 0.106 6.915 < 0.001 HS5 Atisweda 0.333 0.479 0.087 3.827 < 0.001 HS6 FBS 21.766 15.31 2.795 7.787 < 0.001 HS7 PPBS 45.43 26.234 4.789 9.486 < 0.001 HS8 Urine Sugar 0.4 0.242 0.044 9.090 < 0.001 HS HS9 Body Weight 1.316 0.793 0.144 9.138 < 0.001 Conclusion on the statistical data.All the parameters show highly significant, (as P<0.05). The subjective parametersorderly prabhoota mutrata,pipasadhikya and kshudadhikya, shows highly significant thankarapada daha and atisweda,(by comparing t-values). The parameter prabhoota mootratashows net mean effect more,there atisweda shows low net mean effect. Similarly theparameter kshudadhikya shows more variations and the parameter atisweda shows lowvariations, (by comparing, mean and S.D).The objective parameters orderly PPBS, Body weight, urine sugar shows highlysignificant than FBS, (by comparing t-value) the PPBS shows high net mean effect with142 “Evaluation of efficacyof Madhutailika Bastikarma inthe Management of Madhumeha’
  • 161. Resultsmore variations, where as the parameter urine sugar shows low net mean effect with lowvariation (by comparing, mean and S.D)The parameter PPBS, shows high mean effect and urine sugar shows low mean effectafter the treatment. There is a more variation in PPBS and low variation in urine after thetreatment; the parameter body weight shows uniform effect on the patients, by comparingmean, S.D, and C.V.143 “Evaluation of efficacyof Madhutailika Bastikarma inthe Management of Madhumeha’
  • 162. Discussion DISCUSSION Discussion part is divided into five sections. 1. Discussion on Madhumeha and diabetes mellitus. 2. Discussion on role of bastikarma in the management of Madhumeha. 3. Discussion on clinical study and over all response. 4. Discussion on importance of Madhutailik basti in Madhumeha. 5. Discussion on probable mode of action and mechanism of Madhutailik basti Bastikarma and MadhumehaBasti is a major shodhana therapy among panchakarmas. In the present study, the firstpoint to be discussed is how basti is helpful in sthooola Madhumehi. In the classics samshodhana, shamanaushadhis and also pathyahara viharas arementioned for modhumehi among them, basti karma was taken here for the study. Though it is kapha pradhana vyadhi, due the involvement of vata dosha, some specific bastis are indicated in madhumeha, madhutailika basti is also one among them. In the context of Basti yogya and ayogya it is contraindicated in madhumeha as it is a kledajanya vyadhi, in the same time basti is indicated in bala, varna and mamsa kshaya condition; so basti can be given in madhumeha where the bala of the patient is detoriated and it is very difficult to Performa other shodhana procedures. The factors, which help in the pacification of Madhumeha by madhumehara bastis are as follows, Basthi causes shodhana of malas from all parts of the body Madhumeha is a kapha vata vyadhi, Basti will help in normalizing the vata by removing avarana, it helps in eliminating an amount of vitiated kleda, malas and doshas from the body, which is very much helpful to clear or check the dhathuparinama and there by helps in the reduction or pacification of the disease. 142 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 163. Discussion As a result fat metabolism is checked and hence undigested and unutilized fat will be excreted out. Restriction of diet during basti will help in normalizing the digestion metabolism. In the treatment of sthoolamehi reduction of weight is also have a role. Above- mentioned factors are very much helpful in the reduction of weight, when there is reduction of weight, then insulin resistance will be reduced and as a result relative insulin deficiency will also get corrected. Obesity is an extremely important factor in the formation of type –II diabetes. Approximately 80% of type II diabetic patients are obese. In this impaired binding is a result of decrease in the number of insulin receptors. Basti therapy helps in diminishing the insulin resistance by the reduction of weight and obviously it reduces the stress over beta cells.. Madhumeha v/s diabetes mellitus: Madhumeha Richmans disease, since Vedic period it is familiar to mankind. It isdocumented as one among the twenty obstinate urinary disorders. It abhishagaja vyadhi,at the same time it is also explained that, when the other pramehas are left untreated,these lead to the condition called Madhumeha. So Madhumeha can also be considered asan advanced condition or stage of Pramehas are Nidanarthakara rogas of Madhumeha. Traditionally, Madhumeha has been equated with diabetes mellitus. Madhumehais a disease in which certain pathological changes in urine are noted along with someother changes, the most important being the presence of madhuryata ( glucose). Since thedisease is connected with the urinary system with the presence of sugar in urine. Apart 143 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 164. Discussionfrom this, tanu madhuryata also mentioned, which can be taken as blood sugar. Like thisthe equation of Madhumeha with diabetes mellitus is justifiable. Also in view of the similarity in signs and symptoms Madhumeha has beenequated, with diabetes. Among them, some correlations are given below. Obesity is mentioned as a major causative factor for diabetes mellitus, as it causesinsulin resistance. In Ayurveda Sthoulya is mentioned as a nidanarthakara roga forMadhumeha and is included under santarpanajanya vyadhis. Madhura, snigdha bhojana are mentioned as nidanas for madhumeha. In modernscience over eating and sedentary lifestyles are the predisposing factors for diabetesmellitus. Those food articles and overeating, causes obesity and which may causeDiabetes mellitus. Prabhoota avila mootrata is considered as a pratyatma lakshana of madhumeha.In this the bahudrava kapha along with other dooshyas mainly kleda pradhana dooshyasin the basti is the cause for prabhoota avila mootrata. The same reason has been given inmodern science for Polyurea that is the osmotic diuretic effect of glucose in the kidneytubules. Glycosuria explained in the modern science can be taken as madhusama mootra.The reason for this Madhusama mootra is bahudrava kapha or ojus, which is excretedthrough mootra. Pipasa or polydipsia mentioned in both sciences. Depletion of intracellular watertriggering the more receptors of thirst center of brain and thirst is noted, which is similarto pipasa of Ayurvedic Science and here due to excessive loss of the urine, pipasa isnoted. 144 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 165. Discussion In modern science the condition weakness is due to lack of glucose utilization,loss of electrolyte and proteins. In Ayurveda this same condition is due to aparipakwa,dhatu i.e. lack of proper nourishment. Kulaja dosha and beeja dosha have been mentioned in the causative factors ofSahaja Prameha type I diabetes mellitus Such patients are said to be weak, emaciated,suffering from thirst, loss of appetite and are required to be treated with a nourishing diet. In diabetes also genetic and hereditary factors are mentioned as causative factors.In such patients weakness and emaciation are noted. The above-mentioned patients areJuvenile diabetics and require a nourishing diet. Therefore Sahaja Pramehi and Juvenilediabetes may be correlated. Apathyanimittaja Madhumeha explained by sushruta, in such patients, atikshudha,atinidra and aalasya are noted. And it is caused due to excessive intake of madhurasnigdha ahara and vihara, which favours kapha medovridhi. Maturity onset diabetes tendto occure in people indulging in over eating and are lazy in nature, while explainingchikitsa charaka have explained sthoola and krisha classification. The same type ofclassification can be seen in modern science as obese and non-obese type. Upadravas of Ayurveda can be correlated to some of the complications of modernscience. For Example Trishna, bhrama, shoola, tama pravesha and swasa can becorrelated to diabetic Ketoacidosis, in which thirst, weakness, blurred vision, abdominalpain, air hunger etc are seen. Insulin resistance and relative insulin deficiency are the main phenomenon in thepathogenesis of the diabetes mellitus on obese individuals. Some recent ayurvedicscholars have correlated medodhatwagni with insulin. 145 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 166. Discussion In the normal state sthiratwa, dardya, utsaha, vrishata, budhi, etc are contributedby kapha, which is also known as bala or oja. By seeing this, we can correlate this kaphawith glucose. In madhumeha, the kapha, which is vitiated and which is in bahudravataflacid form travels all over the body in rasa produces tanu madhuryata, which can betaken as hyperglycemia, i.e. increased blood glucose condition.Discussion on Observation All the trial cases of madhumeha were reported to OPD & IPD of Shri D.G.M.Ayurvedic Medical College by pre-set inclusion and exclusion criteria. Special medicalcamps were also conducted in the college for selecting the patient. Data of 30 patientswho had satisfied the diagnostic criteria, underwent the treatment and reported for thefollow-up are discussed here. There is no dropout in the study and all the 30 patients wereappeared for the assessment of results. These observational findings are discussed below. Age Because of decrease in beta cells the Risk of diabetes increases as age advances;especially after 40 years. It is well recorded fact that, the NIDDM occurs only after 3rddecade of life. In this study, the above factors were proved, as all the patients werebetween the age group of 30 to 60. It is also noted that maximum number of patients;were between the age of 40 to 60 Years. Sex Acharya Sushruta had said that women wouldn’t get Madhumeha; because theirbody gets cleaned every month by the raja pravrutti. But it is considered as acontroversial dialogue as women also getting madhumeha and they are also at high riskof getting diabetes compared to men after 30 Years. From Sushruta’s statement we canunderstand the importance of shodhana. But in this study majority of the patients weremale when compared to females i.e. 25 male patients and 5 female patients. 146 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 167. Discussion Food Habits In the manifestation of madhumeha, food habits had great importance. If wecheck the nidana aspects we can see the importance of food habits. At the same time lotof foods are also mentioned which are helpful in controlling madhumeha. In the present study 13 Patients were vegetarians and 17 patients were non-vegetarian’s (mixed). From these we can see that high calorie intake is the main riskfactor for diabetes and sthoulya. Food items, which increase the sleshma, medas andmamsa, are the main reason behind madhumeha. Similar types of aharaja nidna are seenin sthoulya. Religion In the present study majority of the patients were Hindus (25%), but it does notmean that Hindus are more prone to this disease. This may be due to the local ratio ofdifference religion. The patients were selected incidentally. Occupation Maximum numbers of patients were with sedentary type of occupations. Insedentary type of occupations physical activities are very less and in both Ayurveda andmodern science, it is clearly mentioned that people with sedentary life styles are moreprone to diabetes mellitus or Madhumeha. In present study 25 patients were recordedwith sedentary life style. Socioeconomic Status Majority of the patients belongs to upper middle and high class. In these classes,the people indulge in very less activities and ultimately with sedentary life styles andsuch persons are more prone to diabetes.Family History In the present study 19 patients had family history and rest of the 11 the patientshad no family history of madhumeha. It is a well-proven factor that family history had amain role in the manifestation of sthoola madhumeha. Chronicity In the present study only mild and moderate type of diabetes mellitus were takenfor the study and in this study 6 patients were newly diagnosed. In the remaining patients,20 patients were suffering from this disease since 1-2 years, 11 patients below 2 year and 147 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 168. Discussion9 patients were there in the above 3 years and 4 patients are above 3 year category. As itis a chronic, relapsing type of disease, only mild and moderate types of cases were takenfor the study. Deha Prakriti Even though madhumeha is a disease with the involvement of 3 doshas, here anattempt was made in this study to find out the doshik involvement based on thesymptoamatology dealt in classics. The study observed that involvement of both vata andkapha was the most predominant feature 16 patients were with kapha pitta prakriti and9patients were with kapha vata Prakriti, 6 patient were vata pitta prakruti From this wecan understand the involvement of Kapha and vata as a main dosha in the manifestationof madhumeha. Agni Majority of the patients (20 patients) were with teekshnaagni followed bySamagni (7 patients) and samagni (3patient). In this study the incidence of teekshnagnijustifies the significance of role of Agni in the pathogenesis of the disease madhumeha.Nidanas Most of the nidanas mentioned in the classics were elicited in this study bydetailed questioning. Among general nidanas, all patients used to take snigdha aharas andguru aharas excessively. Among the viharas, asya sukham (27 patients), swapna sukham(25 patients), alpa vyayama (26 patients) and alpa chinta (12 patients) were also noted.From this we can say that snigdhadi ahara dravyas and asya sukhadi viharas had key roleamong the nidanas. Basavarajiyam a 16th century physician of Andhrapradesh has included theexcessive indulgence in alcoholic beverages as one of the nidana of prameha roga. In thepresent study 14 patients had the habit of taking alcoholic drinks. Lakshanas In all the patients’ prabhoota mootrata was noted. Other symptoms likepipasadhikya, kshudadhikya, karapada daha, atisweda, etc. were also seen in most of thepatients. Gayadasa says kara pada daha is due to vyadhi prabhava and other symptomslike snigdha pichila guruta and madhurata shukla mootrata are due to kapha only.Regarding other symptoms discussions were done already. 148 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 169. Discussion Importance of mixing of bastidravya In ayurveda many formulations have been explained for preparation of medicineunder the heading of panchavidha kashayakalpana. almost all different preparations ofmodern science arebased on these formulations, vagbhata and other acharyas arementioned specific formulations in the form of mixing of basti dravyas in proper orderviz .Makshikam, lavanam, sneham, kalkam, kwatham. Here an attempt made to know therationality behind thisMakshika Honey bee drinks the florescence’s of the different nectars. This nectar isnothing but secretion of plants which contains mainly flavonoides, it is vomits. Thevomited substance of the honey bee contains bile products like bile pigment and bile salt,this bile resembles as that of the pittantya as we commonly seen in samyaka vamana.Basically bile salt rich in emulsification and bile pigments (sodium glycocolic acid) arerich in saphonification. Saidhava By adding and churning with saindhava (NaCl2) the mixture becomes light andliquid, it reduced surface tension of honey helps in increasing the dravya prasarana. Thesookshma srotogami property of madhu and saindhava makes biodegradable of microparticles and it leads to precise amount of drug delivery at a local area. The main aim ofusing saindhava is to increase the emulsification.Sneha By adding of sneha in to this mixture the sneha gets emulsification due to affinityof sodium hydroxide towards fat. Here the saphonification helps in solubility of drug that 149 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 170. Discussionis water in oil emulsification (one molecule of fat binds with the two molecules of water),the whole sneha dravya converts in to water soluble and it will enhance the absorption ofdrug. Kalka It makes whole mixture in to suspension form; the fine powder helps in uniformmolecule binding. KwathaBy adding and churning the kwath it will become same state without sedimentation, itgives the selective permeability to mixture and helps in crossing the Blood brain barrier(BBB), similar explanations also available in classics i.e.Charaka siddisthana 3/23.Madhutalika vasti and madhumeha This yoga has been selected for the study because of the direct indicationof madhutailika vasti by vagbhata, he has considered this under niroohabasti. Thetreatment given to all the 30 patients includes abhyanga with moorchita tila taila,swedana locally and madhutailika vasti 8 days. In this particular contextprabhootavilamootrata, pipasadhikya etc are the main symptoms and the aim ofmanagement is to control it, as madhumeha is kapha pradhana vatavyadhi, along withkleda and meda, as it is considered under sidda and yapana basti, the unique combinationof this basti is Makshikam, lavanama, taila ( moorchita tila taila ), shatapushpi andErandamoola. 150 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 171. DiscussionShatapushpi and Eranda are having the vata shamaka, vatanulomaka and prameha haraproperty. In madhumeha vata gets alleviated by basti along with this some amount ofkapha also expelled out. The present work is aimed to evaluate the efficacy of madhutailika vasti only.Hence, other shodhana karmas where not done. No specific pathya pathya has beenadvised to be followed. Probable mode of action of basti in madhumeha Honey is rich dietary supplement and it is alkaline media, generally alkalines(kshara) are beneficial in kapha dosha treatment, the antibiotic property of honey helps information of healthy bacterial flora in the intestine it is very much needed for drugabsorption. Rectum is the moola for sharera as chakrapani explained “gudamoolamshareerasya” and most of the capillaries are presentment in guda helps in absorption ofmedicinal property and helps to enters in to the systemic circulation, as smaller channelsof the root absorbs the water and these are merge in large stream or channels andnourishes the body, lavana (sodium chloride) is a integral part of body constituent, thiswill inhibit thirst by maintains the electrolyte balances. Sookshma srotosravka propertyacts as a vehicle for the chief ingredient. Tila is best remedy for vata vyadhi andalleviates the kleda if it is administer internally, the ushna property of tila taila normalizethe kapha and vata, as it possesses both brihmana and karshna effect, shatapushpicontains some amount of anti-oxidants these helps in the cellular nourishment. Erandahaving a tikta and madhura rasa with ushna veerya will nullify the vata and kaph. It israsayana, medhya and shoola hara. It contains anti-oxidants like gallic, skimmic, ellagic,ferulic and coumarinic these are reduses the endoneural hypoxia which is the main factorin the pathology. 151 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 172. Discussion CONCLUSION A close perusal of the observation and inference that can be drawn leads to thefollowing conclusions. • Madhutailika basti is an effective treatment in the management of Madhumeha and it shows long lasting result. • Madhutailika basti can be administered without prior other procedures like snehapana, swedana or virechana. • Complications are rarely occurring during and after the course of bastikarma. • It is easy to constitute, less time consuming and gives least discomfort to both patient and physician. • It is cheap compared to other conventional methods of management of Madhumeha. • Madhumeha can be undoubtedly compared with that of Diabetes mellitus on its etiopathogenesis and symptomatologies etc. • In mild and moderate type of sthoola madhumeha, Madhutailika basti alone is enough to control it. • Along with bastikarma, administration of pathya ahara viharas may give more effect. Suggestions for future study 1. Study is better to be conducted on a large sample.Study has been conducted in yoga basti Sankhya and facts revealed in the study suggestthat the results will be more encouraging if the Vaitharanabasti is administered in theSankhya of kalabasti or karmabasti. 153 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 173. Summary SUMMARY The Panchakarma therapy is an important part of Ayurveda. The procedures ofPanchakarma therapy have thrown new light on the management of disease and haveprovided effective weapons against them. The entire group of purification procedures isbased up on promoting the body’s natural methods of elimination of unwantedsubstances. Among the Panchakarmas, the vasti is an important one, which had greatimportance and at the same time it is highly effective therapy. It is a process by whichthe doshas are made to pass through the guda marga. It is a specific treatment for vatadosha, and vata associated with pitta as well as kapha doshas. Based on the propertyMadhutalika vasti is fall under mrudu vasti, with a synonym of sidda vasti, yapana vasti,vasti, though it is the type of nirooha patients are not much restricted. Management of madhumeha is perhaps one of the most important and interestingsubject in the clinical practice considering its high prevalence as well as profound impactthe treatment has on long term morbidity and mortality of the patient. Increasingurbanization industrialization and due to increased sedentary life styles seems to becontributing to increasing prevalence of madhumeha. Like the disease, the treatment of madhumeha is also prolonged one. Since thepatient of madhumeha have been divided in to the sthoola and krisha varities, the separatemethods of treatments are mentioned in classics, and from that vasti therapy was taken asa choice of treatment in the present study and is adopted in sthoola madhumeha patients. Keeping in mind, the objectives of this study was, “Evaluate the efficacy ofmadhutailika vasti in the management of madhumeha (NIDDM)”. During 8 days basti 155 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 174. Summarycourse 3 niroohas prepared with madhu,saindhava,morchita tila taila, shatapuspi kalkaand eranda moola kwath were administered along with 5 anuvasana vasti by usingmorchita tila taila. Madhutalika vasti was selected for the study as its efficacy isexplained by vagbhata in astanga hridaya kalpa sthana 4/27-28. The present work covered the following areas- Introductory part regarding the present work and the objectives. Historical aspect of basti, madhumeha and also the mile stones and previous research works in the field of diabetes mellitus. Basti karma in detail along with its modern concepts, anatomical and physiological aspects. Modern description regarding the diabetes mellitus along with the physiological and anatomical descriptions of glands involved in it. Nidana panchakas of madhumeha, simultaneously explanation of dibetes mellitus in modern counterpart has been done along with the comparison and description in the same context. Description regarding the materials and methods used in the present study. Observations of the present study, results, discussion, summery, conclusion and finally bibliography and references. The study was conducted in a single group and all the patients received classical. The effect of the therapy was assessed statistically by using student t-test. It was found that Basti shows long-termi effect. But, it was also noted that due tofood and activities of the patient there is gradual variation in sugar levels after Basti. So 156 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
  • 175. Summaryafter Basti if the person follows strict diet, sugar levels and other associated complaintscan be controlled. A significant response was obtained in majority of the cases, higherpercentage of reduction in the symptoms and FBS, RBS, PPBS and urine sugar level andincrease in general sense of well being shows that madhutalika vasti has significant rolein the management of madhumeha. 157 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
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  • 186. References136. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 11 sloka 3. Varanasi: Krishnadas Academy; 1980. p. 451. (Krishnadas Ayurveda series 51).137. Agnivesa, Charaka samhitha Shareerasthana chapter 3 sloka 17. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 350. (Krishnadas academic series vol 4).138. Agnivesa, Charaka samhitha Nidanasthana chapter 4 sloka 5. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 212. (Krishnadas academic series vol 4).139. Agnivesa, Charaka samhitha Nidanasthana chapter 04 sloka 24. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 214. (Krishnadas academic series vol 4).140. Agnivesa, Charaka samhitha Nidanasthana chapter 04 sloka 36. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 215. (Krishnadas academic series vol 4).141. Agnivesa, Charaka samhitha Sutrasthana chapter 17 sloka 79. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 203. (Krishnadas academic series vol 4).142. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 11 sloka 3. Varanasi: Krishnadas Academy; 1980. p. 451. (Krishnadas Ayurveda series 51).143. Cotran SR, Pathologic Basis of Disease chapter 20. 6th ed. Philadelphia: Saunders; 2003. p. 913. Davidson Stanley Sir, Principles and Practice of Medicine chapter 12. CRWEdwards ,editor. London: Churchill Livingston 1995. p. 728.144.Agnivesa, Charaka samhitha Nidanasthana chapter 04 sloka 47. 4th ed. Varanasi:Chaukhambha Kasi Sanskrit series; 1994. p. 215. (Krishnadas academic series vol 4). Sushrutha, Sushruthasamhitha Chikitsasthana chapter 6 sloka 5. Varanasi: Krishnadas Academy; 1980. p. 290. (Krishnadas Ayurveda series 51). Vagbhata, Ashtangahridaya Nidanasthana chapter 10 sloka 38. Varanasi: Krishnadas Academy; 1982. p. 505. (Krishnadas academic series 4).145. Vagbhata, Ashtangahridaya Nidanasthana chapter 10 sloka 7. Varanasi:Krishnadas Academy; 1982. p. 502. (Krishnadas academic series 4). Sushrutha, Sushruthasamhitha Chikiitsasthana chapter 6 sloka 6. Varanasi: Krishnadas Academy; 1980. p. 290. (Krishnadas Ayurveda series 51).146. Vagbhata, Ashtangahridaya Nidanasthana chapter 10 sloka 7. Varanasi:Krishnadas Academy; 1982. p. 502. (Krishnadas academic series 4). Sushrutha, Sushruthasamhitha Chikiitsasthana chapter 6 sloka 6. Varanasi: Krishnadas Academy; 1980. p. 290. (Krishnadas Ayurveda series 51). 168 “Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”
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  • 188. SPECIAL CASESHEET FOR MADHUMEHA Post Graduate Studies And Research Center (Panchakarma) Shree DGM Ayurvedic Medical College, Gadag.Guide : Dr. G.Purushothamacharyalu, PG Scholar : MD (Ayu) D.S.SwamiCo- Guide : Dr. Shashidhar.H. Doddamani. MD (Ayu)1. Name of the patient : Sl. No :2. Father’s / Husband’s Name : OPD No :3. Age : IPD No :4. Sex : M F5. Religion : Hindu Muslim Christian Others6. Occupation : Sedentary Active Labor Others7. Economical Status : Poor Middle Upper middle class High class8. Diet : Veg Mixed9. Address :_____________________________ Phone No : ____________________________ Email ID : _____________________________ Pin10. Date of Schedule Initiation : Date of Schedule Completion :11. Result : Good Response Moderate Poor No Response Response Response12. Consent : I here by agree that, I have been fully educated with the disease and treatment, here by satisfied whole heartedly, and accept the medical trial over meInvestigator’s Signature Patient’s Signature 170
  • 189. 13. COMPLAINTS WITH DURATION :- Chief Complaints P/A Duration Prabhuta Mutrata Kshudadhikya Ati Sweda Pipasadhikya Karapada daha Other complaints P/A Duration Anga Saidhilyam Sareera ghanatwam Seeta Priyatwam Hrut-Netra-Jihwa Shravana upadeha Shareeradurgandha Chikkanata dehe14. HISTORY OF PRESENT ILLNESS :- >Appearance of similar complaints before : Yes No15. HISTORY OF PAST ILLNESS Present Absent16. TREATMENT HISTORY :- Modern Medicine :- If Yes :- Drug Duration Ayurvedic medicine :- If Yes :- Drug Duration Relief with previous treatment :- Yes No17. FAMILY HISTORY :- Present Absent 171
  • 190. 18. PERSONAL HISTORY Koshta Mrudu Madhya Kroora Veg Mixed Diet Poor Moderate Good Appetite Bowels Free Constipated Urine Normal Abnormal Number of times Day Night Sleep Normal Loss More Disturbed Habit Smoking Alcohol Tobacco No chewing Habits Duration Of Habits :-19. ASHTASTHANA PAREKSHA a. Nadee Dosha Gati Poornata Spandana Kathinya b. Mootra : c. Malam : Constipation Loose Normal d. Jihwa : e. Sabdam : f. Sparsham : g. Drink : h. Akrithi : Sthoola Krisha 172
  • 191. 20. GENERAL EXAMINATION : - Appearance Healthy Unwell Nutrition Obese Moderate Poor Orientation Good Poor Memory Normal Medium Poor Height in cms:- Weight in kg :- BMI :- Temperature in degree Farenheit:- Pulse Rate:- Heart rate:- Respiratory Rate:- Bloodpressure:- mmHg.21. DASAVIDHA PAREEKSHA :- A) PrakruthiVata Pitha Kapha Vatapitha Vatakapha Pithakapha Sannipatha B) Vikruthi Hetu Dosha Dushya Bala Prakruthi Desa Kala Linga 173
  • 192. C) Sara Pravara Madhyama Avara D) Samhanana Susamhatha Madhyasamhata Asamhata E) Pramana Sama Heena Adhika F) Satmya Ekarasa Sarvarasa Vyamishra Rooksha satmya Snigdha satmya G) Satva Pravara Madhya Avara H) Ahara shakthi Abhyavahara Pravara Madhyama Avara Jaranashakti Pravana Madhyama Avara I) Vyayama shakthi Pravara Madhyama Avara J) Vayaha Bala Madhya Vruddha22. SROTOPAREEKSHA :- Srotas Observed Lakshanas Pranavaha Annavaha Udakavaha Rasavaha Rakthavaha Mamsavaha Medovaha Asthivaha Majjavaha Shukravaha Pureshavaha Mutravaha Swedovaha Arthavavaha 174
  • 193. 23. NIDANA PANCHAKA :- a. Nidana> General :- Ahara Vihara > Vataja Nidana :- Ahara Vihara > Pithaja Nidana :- Ahara Vihara Kaphaja Nidana :- Ahara Vihara b. Poorva roopa : c. Roopa : d. Upashaya / Anupashaya : e. Samprapthi24. OTHER INVESTIGATIONS. Blood-Hb- TC- DC- ESR- SERUM CHOLESTROL- 25. TREATMENT PROTOCOL :- Deepana pachana Abhyanga & Mruduswedana :- Pradhanakarma :- Total 5 Anuvasana Basti and 3 Madhutailika Basti Paschathkarama- Basti nirgamana kala 175
  • 194. Observation Before During After Bastikarma Bastikarma Bastikarma Pulse Blood Pressure Respiratory Rate Temperature 26.ASSESSMENT OF RESULTS A. Subjective Parameters Symptoms Before After 15th day of 30th day treatment Bastikarma follow-up of follow- up Prabhuthamutratha Kshudadhikya Pipasadhikya Karapada daha Ati Sweda B. Objective Parameters Body Weight27. INVESTIGATORS NOTE :-Signature of Co-Guide Signature of Guide 176
  • 195. SCORE-SHEETA) Prabhuthamutratha : Grade O - 2-3 times/day time ; 0-1 times/night Grade 1 - 4-5 times/day time ; 2-3 times/night Grade 2 - 6-7 times/day time ; 4-5 times/night Grade 3 - > 7 times/day time ; >5 times/nightB) Pipasadhikya: Grade O - Normal Grade 1 - Slightly Increased Grade 2 - Severely IncreasedC) Kshudadhikya: Grade O - Normal Grade 1 - Increased, but can tolerate Grade 2 - Increased, but cant tolerate without consuming foodD) Karapada daha: Grade O - Absent Grade 1 - Slightly present Grade 2 - PresentE) Ati Sweda: Grade O - Absent Grade 1 - Present 177

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