• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Virechana madhumeha pk006-gdg
 

Virechana madhumeha pk006-gdg

on

  • 443 views

CLINICAL EVALUATION OF VIRECHANA KARMA IN MADHUMEHA (NIDDM), Febin. K. Anto. Post graduate department of Panchakarma, Shri D. G. Melmalagi Ayurvedic Medical College, Gadag – 582103.

CLINICAL EVALUATION OF VIRECHANA KARMA IN MADHUMEHA (NIDDM), Febin. K. Anto. Post graduate department of Panchakarma, Shri D. G. Melmalagi Ayurvedic Medical College, Gadag – 582103.

Statistics

Views

Total Views
443
Views on SlideShare
443
Embed Views
0

Actions

Likes
1
Downloads
9
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Virechana madhumeha pk006-gdg Virechana madhumeha pk006-gdg Document Transcript

    • Clinical Evaluation of Virechana Karma InMadhumeha(NIDDM) By Febin. K. Anto.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. (PANCHAKARMA) 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. 2005.
    • Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation / thesis entitled “ClinicalEvaluation of Virechanakarma in madhumeha (NIDDM)” is a bonafideand genuine research work carried out by me under the guidance of Dr. G.Purushothamacharyulu, M.D. (Ayu), Professor and H.O.D, Post-graduate de-partment of Panchakarma and co-guidance of Dr. Shashidhar. H. Doddamani,M.D.(Ayu) , Assistant Professor, Post graduate department of Panchakarma.Date:Place: Febin. K. Anto.
    • CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “Clinical Evalua-tion of Virechanakarma in madhumeha (NIDDM)” is a bonafide researchwork done by Febin. K. Anto. in partial fulfillment of the requirement for thedegree of Ayurveda Vachaspathi. M.D. (Panchakarma).Date:Place: Dr. G. Purushothamacharyulu, M.D. (Ayu). Professor & H.O.D Post graduate department of Panchakarma.
    • ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF THE INSTITUTION This is to certify that the dissertation entitled “Clinical Evalua-tion of Virechanakarma in madhumeha (NIDDM)” is a bonafide researchwork done by Febin. K. Anto. under the guidance of Dr.G.Purushothamacharyulu, M.D. (Ayu), Professor and H.O.D, Postgraduate de-partment of Panchakarma and co-guidance of Dr. Shashidhar.H. Doddamani,M.D. (Ayu), Assistant Professor, Post graduate department of Panchakarma.Dr. G. Purushothamacharyulu, M.D. (Ayu) Dr. G. B. Patil. Professor & H.O.D, Principal.Post graduate department of Panchakarma.
    • CERTIFICATE BY THE CO- GUIDE This is to certify that the dissertation entitled “Clinical Evalu-ation of Virechanakarma in madhumeha (NIDDM)” is a bonafide researchwork done by Febin. K. Anto. in partial fulfillment of the requirement forthe degree of Ayurveda Vachaspathi. M.D. (Panchakarma).Date: Dr. Shashidhar.H. Doddamani, M.D. (Ayu).Place: Assistant Professor, Post graduate Department of Panchakarma.
    • 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: Febin. K. Anto.Place:© Rajiv Gandhi University of Health Sciences, Karnataka.
    • I Acknowledgement “Many hands make light work”. This work carries some memories toexpress and record about some distinguished personalities with whom I had inspiredduring the course of this thesis. I express my obligation to my honorable H.O.D and Guide Dr. GPurushothamacharyulu M.D (Ayu), in the P.G Department of Panchakarma, P.G.S&R,D.G.M.A.M.C, Gadag for his critical suggestions and expert guidance for the completionof this work. I am extremely grateful and obliged to my co-guide Dr. Shashidhar.H.Doddamani, Asst. Professor, P.G.S.&R, D.G.M.A.M.C, Gadag for his guidance andencouragement at every step of this work. I express my deep gratitude to Dr .G.B Patil, Principal, D.G.M.A.M.C,Gadag, for his encouragement as well as providing all necessary facilities for thisresearch work. I express my sincere gratitude to Dr.Shivaramudu M.D (Ayu), AssistantProfessor and Dr. Santhosh. N.Belavadi MD (Ayu), Lecturer for their sincere advices andassistance. I express my sincere gratitude to Dr. V. Varadacharyulu M.D (Ayu),Dr.M.C.Patil M.D (Ayu), Dr. Mulgund M.D (Ayu), Dr. K.S.R Prasad M.D (Ayu), Dr.Dilip Kumar M.D (Ayu), Dr. R.V. Shetter M.D (Ayu), Dr. Kuber Sankh M.D (Ayu),Dr.G.Danappa Gowda M.D (Ayu) for their constant encouragement. I also express my sincere gratitude to Dr.B.G.Swamy, Dr.V.M.Sajjan,Dr.U.V.Purad, Dr.Mallagowder, Dr.K.S.Paraddi, Dr.G.Yargeri, Dr.S.H.Radder and otherundergraduate teachers for their support in the clinical work. I thank to Shri. Nandakumar (Statistician), Dr. Arun Baburao Biradar ,Shri. V.M. Mundinamani (Librarian), Shri. B.S. Tippanagoudar (lab technician), Shri.Basavaraj (X-Ray technician) and other hospital and office staff for their kind support inmy study. I express my sincere thanks to my colleagues and friends Dr. Satheesh. R.Warrier, Dr. Subin Vaidyamadham, Dr. Renjith. P. Gopinath, Dr. Shajil. N, Dr. ShyjuOllakode, Dr. Sreenivasa Reddy, Dr. Hadimani, Dr. C. S. Hanumanta Gouda, Dr.Sankadal, Dr. Vanitha, Dr. Naveen, Dr. Santhosh. L. Y, Dr. Varsha. S. Kulkarni, Dr. P.Chandramouleeswaran, Dr. Uday Kumar, Dr. K. Krishnakumar, Dr. Ashwini Dev, Dr.Ratna Kumar, Dr. Jayaraj Basarigidad, Dr. Kendadamath, Dr. V. M. Hugar, Dr. Shyla. B,Dr. Suresh Hakkandi, Dr. Manjunath Akki, Dr. L. R. Biradar, Dr. Vijay Hiremath, andother post graduate scholars for their support.
    • II I take this opportunity to remember my late ancestors Shri. PouloseVaidyan, Shri. Francis Vaidyan and Shri. Pathrose Vaidyan whose lives have inspired meto take Ayurveda as my profession. I acknowledge Mrs. Annam Poulose, Mr. Renil Anto, Mrs. Lidiya Renil,Mr. Vinil Anto, Master. Andrews Renil for their inspiration and whole-hearted support. Ialso acknowledge Dr. Jose Kandamkulathy, Dr. Wilson Kandamkulathy, Dr. DavisKandamkulathy, Mr. Wilson Kandamkulathy (Managing Director, Pathrose Vaidyan’sKandamkulathy Vaidyasala), Dr. Rose Marry Wilson and Mr. Dipu Karuthedath for theirinspiration and moral support. I would like to mention the support and inspiration provided by Dr.R.Ramabhadran, Director (ISM, Kerala) and Dr. P. S. Gopi, Retd. DMO (ISM, Kerala). Ialso acknowledge the support and inspiration provided by my teachers Dr. K.P.Muralidharan, Principal, S.J.S. Ayurveda College, Chennai, Dr. S. Swaminathan, H.O.D.,Samhita & Siddhanta, S.J.S. College, Dr. S. Venugopal, Reader in Sanskrit, Dr.Vasudevareddy H.O.D. Shalya department and Dr. Ramdas Maganti, H.O.D., Kayachikitsa, S.J.S. College. I also thank Shri. C. S. Bhatt and family and Shri. Prasad and family forthe support and encouragement provided during my stay at Gadag. I acknowledge my patients for their wholehearted consent to participate inthis clinical 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 parents Mr. AntoKandamkulathy and Mrs. Rosily Anto, for their wholehearted inspiration and support tofulfill this dream.Date : Signature of the candidatePlace : Febin. K. Anto.
    • III ABSTRACT Panchakarma is the popular term for shodhana chikitsa, among that virechana isan important one. Virechana is the therapy by which the doshas are made to pass throughthe adhomarga i.e. Gudamarga. In virechana the doshas even from the amasaya are takento the pakvashaya and they are removed through gudamarga. In the treatment of Sthoola Madhumcha Virechana therapy has great importanceaccording to Ayurveda. In the modern system of medicine Madhumcha can be compairedto 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 these 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 virechana therapy is a good, result oriented andeconomical therapy which can control the blood sugar level and prevent furthercomplications without any side effects. Virechana Karma is advised in Madhumeha patients having good body strengthand those who are sthoola in nature. The objective of this study was to assess the efficacyof virechana in such patients. The study was designed as a prospective clinical trial and30 patients were selected and given classical Virechana karma.
    • IV The treatment contains the following steps. 01. Deepana pachana by Trikatu Choorna. 02. Shehapana by Thrikandakadyam Ghritam. 03. Abhyanga and mridu sweda by Moorchita tila taila and ushnajala snana. 04. Virechana by Vidanga Tanduladi choorna. 05. Samsarjana krama. 06. Follow-up for one month. As a result of the proper administration of Virechana karma 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 good, 11patients (36.6%), responded moderately and 2 patient’s (6.6%) response was poor. Aclose perusal of observation and inference that can be drawn leads to the conclusionssuch as, Virechana is an effective treatment in Sthoola Madhuneha and it also showslasting results. In mild and moderate type of Sthoola Madhumeha classical Virechanaalone is enough to control it. Even though only Virechana was administered in this study,it was also noted that along with Virechana karma, administration of pathya ahara viharaand shamanoushadis might help more. Also administration of repeated virechana maygive lasting results.Key words – Shodhana karma ; Virechana karma ; Sthoola Madhumeha ; Prameha ; Diabetesmellitus ; Insulin resistance ; Obesity; Vidangatanduladi churna ; Thrikandakadyamghritam ; Blood sugar.
    • V LIST OF ABBREVIATION USED⇒ Ch. – Charaka Samhita.⇒ G. R. – Good response.⇒ M. R. – Moderate response.⇒ P. R. – Poor response.⇒ Su. – Sushruta Samhita.⇒ Vag. – Ashtanga Hridaya.
    • VI TABLE OF CONTENTSChapters Page No.1. Introduction 1-32. Objectives 43. Review of literature 5-724. Methodology 73-925. Results 93-1236. Discussion 124-1367. Conclusion 1378. Summary 138-1399. Bibliography 140-15310. Annexure
    • VII LIST OF TABLES Page No.Table No. 01. Historical milestones in the field of Diabetes mellitus. 8Table No. 02. Showing the virechana yogyas. 12Table No. 03. Showing the virechana ayogyas. 15Table No. 04. showing the samyak snigdha lakshanas. 17Table No. 05. Showing the virechana dravya jeeranoushadha and ajeeranoushadha lakshanas. 19Table No. 06. Showing the vega nirnaya. 20Table No. 07. Showing the ayoga and atiyoga 21Table No. 07a. Showing the samanya nidana of prameha. 43Table No. 08. Showing the poorvaroopa of prameha 48Table No. 08a. Showing are the Prameha according to the major classics. 60Table No. 09. Showing the Vyavachedaka nidana. 67Table No. 10. Upadravas of prameha according to Vagbhata and Sushruta on dosha basis. 69Table No. 11. Showing the properties of the ingredients of Trikatu churna 74Table No. 12. Showing the properties of the ingredients of Thrikandya ghritam. 75Table No. 13. Showing the properties of the ingredients of Moorchhita tila taila. 79Table No. 14. Showing the properties of drugs used in Vidangataduladi churna. 80Table No. 15. Showing the grades of the blood sugar level. 88Table No. 16. Showing the demographic data. 94Table No. 17. Showing the data related to disease. 95Table No. 18. Showing the data of parameters. 96Table No. 19. Showing the treatment protocol and observation. 97Table No. 20. Showing the age group incidence and response. 98Table No. 21. Showing the Sex group incidence and response. 99Table No. 22. Showing the incidence of religion and response. 100Table No. 23. Showing the incidence of occupation and response. 101Table No. 24. Showing the Socioeconomic Status and response. 102Table No. 25. Showing the food habits and response. 103Table No. 26. Showing the chronicity and response. 104Table No. 27. Showing the treatment history and response. 105Table No. 28. Showing the family history and response. 106Table No. 29. Showing the nature of koshta and response. 107Table No. 30. Showing the Status of agni and response. 108Table No. 31. Showing the nature of malapravritti in the patient and response. 109Table No. 32. Showing the habits of the patient and response. 110Table No. 33. Showing the prakriti of the patient and response. 111Table No. 34. Showing the nidana status and response. 112Table No. 35. Showing the days of deepana pachana and response. 113Table No. 36. Showing the days of snehapana and response. 114Table No. 37. Showing the incidence of samyak snigdha lakshanas and response. 115Table No. 38. Showing the incidence of samyak virechana lakshanas and response.117Table No. 39. Showing the number of vegas attained by patient and response. 119Table No. 40. Showing the incidence of antaki and response. 120Table No. 41. Showing the incidence of manaki and response. 121Table No. 42. Showing the Overall assessment. 122Table No. 43. Showing the Statistical results. 123
    • VIIILIST OF FIGURES, PHOTOGRAPHS AND GRAPHS Title Page No. 1) Figure showing digestive system 26 2) Photo showing the drugs used in the study 73 3) Photo showing Vidangatanduladi churna and ingredients 80 4) Graph showing the age group incidence and response. 98 5) Graph showing the Sex group incidence and response. 99 6) Graph showing the incidence of religion and response. 100 7) Graph showing the incidence of occupation and response. 101 8) Graph showing the Socioeconomic Status and response. 102 9) Graph showing the food habits and response. 103 10) Graph showing the chronicity and response. 104 11) Graph showing the treatment history and response. 105 12) Graph showing the family history and response. 106 13) Graph showing the nature of koshta and response. 107 14) Graph showing the Status of agni and response. 108 15) Graph showing the nature of malapravritti in the patient and response. 109 16) Graph showing the habits of the patient and response. 110 17) Graph showing the prakriti of the patient and response. 111 18) Graph showing the nidana status and response. 112 19) Graph showing the days of deepana pachana and response. 113 20) Graph showing the days of snehapana and response. 114 21) Graph showing the incidence of samyak snigdha lakshanas and response. 115 22) Graph showing the incidence of samyak virechana lakshanas and response.117 23) Graph showing the number of vegas attained by patient and response. 119 24) Graph showing the incidence of antaki and response. 120 25) Graph showing the incidence of manaki and response. 121 26) Graph showing the Overall assessment. 122
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Ayurveda the heritage of Indian civilization is not only a medical pathy but also afull-fledged Science, consisting of all medical and allied branches essential to lead ahealthy life. Being a Science Ayurveda believes in supreme power. This concept isessential to know the limitations of human efforts and to accept the existence of thingsbeyond the perception of our sense. Ayurveda considers the prime living principle i.e.atma and the importance of which is now accepted by all. The purpose of Ayurveda is to maintain health and to treat diseases, in order toachieve the ultimate goal i.e. distraction from worldly things. Ayurveda is consisting oftwo words ayu and veda. Ayu means life, which is a proper combination of body, mind,sense organs and soul. Veda means knowledge. Preservation of health and its maintenance are the main aim of Ayurveda. Itsattainment is due to personal, social and moral hygiene, which is very sophisticated andhighly developed. The regimens of day, night and seasons, if observed properly lead topositive health. The disease is manifested when extrinsic factors provoke the bodilydoshas and this provocation is the stage proceed by accumulation and followed bypacification and the provoked doshas are eliminated in fixed particular seasons byemetics, purgatives etc. This application prohibits the recurrence of disease. The Panchakarma therapy is an important part of Ayurveda. The procedures ofPanchakarma therapy have thrown new light on the management of diseases and haveprovided effective weapons against many of them. The Panchakarma therapy or five-fold purification procedures include, Vamana,Virechana, Basthi, Nasya and Raktamokshana. This entire group of purification producesis based up on promoting the body’s natural methods of elimination of unwanted 1 Introduction
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”substances. Thus the Panchakarma therapies of Ayurveda form a unique system oftherapy, which not only aims at physical correction and rehabilitation, but also aim atimparting local medication and transdermal nourishment of the tissues. Among the panchakarmas, virechana is an important one, which had greatimportance. At the same time it is a highly effective therapy, which gives tremendousresults. It is a process by which the doshas are made to pass through the adhomarga i.e.Guda. Virechana is a specific treatment for pitta dosha, and pitta samsarga doshas. It isalso the treatment for kapha and vata doshas. In the process of virechana, the person willnot have that much amount of trouble and exhaustions as in normal purgation, as he hasbeen subjected to snehana, swedana etc. Madhumeha is a disease known to mankind since vedic period. Ayurvedicclassics consider madhumeha among the twenty obstinate urinary disorders. Thedevelopment of modern science has revolutionized the approach to this disease and it’smanagement. Traditionally madhumeha is correlated with diabetes mellitus, which is known as“Richman’s disease”, particularly because a person who is able to enjoy the pleasure oflife without any perceptible exercise is usually affected with this disease. The importanceof over nutrition is shown by the fact that, over the age of 40 some 80 percent of patientsdeveloping diabetes are considerably over weight. Obesity is considered to be a important risk factor for diabetes mellitus. In factAyurveda considers sthoulya as a nidanarthakara roga for madhumeha. 2 Introduction
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”INCIDENCE AND PREVALENCE Diabetes has become the disease of the masses. Over twenty million people arereported to be suffering from this “sweet disease”. It is projected that by another twentyyears the number would rise to 60 million in India. In the past 16 years our populationhas roughly doubled from about 68 million to the 1 billion mark and the number ofdiabetics has increased by more than 7 fold. According to I.C.M.R. survey, it isestimated that between 1995 and 2005, India will have about 2-3 crore diabetic patients. 3 Introduction
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Need For Study : The modern management of diabetes inspite of many advances still remainsunsatisfactory. Drug intolerance, hypersensitivity, resistance to insulin, the danger ofacute and chronic complications, the fear of hypoglycemic episodes make it all the moreimportant to search out safe, effective and cheaper remedies. Such remedies could beexplored form the huge wealth of Ayurveda. Among that virechana is one of the jewel,which gives tremendous results in many diseases including sthoola madhumeha.Objectives : Even though many research works are conducted on the effect of some indigenousdrugs on Madhumeha, only few have been conducted on samshodhana karma. So far onlyless studies are conducted on the effect of virechana on sthoola madhumehi. So theobjective of this study is “Clinical evaluation of virechana karma in sthoolamadhumeha (NIDDM)” in order to evaluate its effect. 4 Objectives of the study
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”HISTORICAL REVIEW Madhumeha is one of the ancient diseases and is as old as humanity and thisdisease is well known to vedic period also.Vedic Period : Vedas are the oldest literature of civilization. Atharva veda is having closerelation to Ayurveda. In Vedas we find two words Asrava and Prameha. In Atharvaveda asrava vyadhis are mentioned in which nasasrava, atimootra and atisara areincluded1. The term asrava is formed from A-Srava means to flow. Whitney (Atharvaveda translated and commented) interpreted this as “Flux” and Griffith (also translatedand commented) as “Morbid flow” 2. In Koushika sutra of the Atharvanaveda we find reference of the work Prameha3. In Atharvaveda 6/44/3 Visanaka drug is indicated in vatavyadhi. Kesavacommenting on this, explained “Vaikruta nasani” as “Vaikruta asravya nasani”,means it is indicated in asrava vyadhis. In the Manthra 23-1-3 of Atharvanaveda, the drugs emerged from valmika areindicated in atisara, atimootra and nadivranam4. This clearly indicates the prevalence of this disease with its remedy in the vedicperiod.Samhita Period : It is a point of historical importance that Charaka samhita mentions the loss ofsweet substance from urine5. Charaka also mentioned in sutrasthana that the Madhumeha occurs due toavritatwa of vayu6. 5 Historical review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Charaka also mentioned the importance of ojus in Madhumeha samprapti7. Bhela samhita which is contemporary to Charaka samhita describes the two typesof Madhumeha i.e. prakruta (congenital) and swakrita (acquired) 8. The most notable contribution of Sushruta was to devote a separate chapter for themanagement of Madhumeha and he mentioned some specific preparations of mineral andvegetables. He has also given more importance to Shilajatu9. Further he also described aseparate chapter for the management of Carbuncles, which are the upadravas ofMadhumeha10. After Sushruta, Vagbhata has given great contribution to Indian medicine. Hecompiled the existing knowledge and added some new preparations and ideas to thiscontext. He mentioned two types of Madhumeha on the basis of pathogenesis, one isDhatukshayajanya and another is Avaranajanya11. Arthashastra of Koutilya (321 – 296 BC) mentions a method to produce Pramehain the section dealing with the means to injure the enemy. The spot obtained fromburning Chanclion (Krukalaka) and house lizard (Gruha Goulika) together with theintestines of mottled frog (Chitra Bheka) and honey, if administered causes Prameha.This evidently points the existence of diabetogenic technique in the ancient times12.Medieval Period : This period of history of Indian medicine is known as a period of commentators. Madhavakara (9th century A.D.) in his book Madhava nidana compiled thethoughts of his earlier authors without adding any thing new to the knowledge onMadhumeha13. 6 Historical review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Gayadasa (11th Century A.D.) commentator of Sushruta samhita elucidated thatavilatva of urine in Prameha is due to the presence of some components of dooshya i.e.meda, mamsa, etc14. Dalhana, another commentator of Sushruta samhita (12th century) contributed amyth that females do not suffer from Madhumeha15. Sharangadhara (13th century A.D.) prescribed some new recipes for themanagement of Prameha16. Bhavamishra (16th century A.D) contributed to the history of prameha by addingsome new vegetables and metallic preparations for the management of prameha. Ayurvedic physicians even three thousand years ago were aware of the extent towhich all the body tissues are involved in the pathogenesis of Prameha. Claims have beenmade by China, Egypt and India as the home of discovery of this vast disease. But allevidences points to the fact that, it is in ancient Sanskrit texts that the earliest referenceare found. These Sanskrit texts in turn were translated to Latin and became the source ofEuropean medicine. Three outstanding physicians of Ayurveda, Charaka, Sushruta and Vagbhatabetter known as the Holy Triad made the earliest reference to diabetes as a “diseasedflow of urine” and “honey urine”. Charaka mentions that ants are attracted by Person’surine afflicted with this disease. Sushruta specifically mentions that the urine of thediabetic person is sweet nature. It seams, during this period no Greco-Roman physicians were acquainted withsymptoms of abnormal urine. 7 Historical review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Historical milestones in the field of Diabetes Mellitus The relationship between the pancreas, an organ lying behind the upper intestinesand diabetes are firmly established by “Von Mering” and “Minkouski” in 1889. It wason the mid night of July 30,1921, that a pancreatic extract produced in this manner wasinjected to a depancreatised diabetic dog on the verge of coma and one hour later bloodsugar came down and urine sugar disappeared, Insulin was born!.Table No.01. Historical milestones in the field of Diabetes mellitus17.Sl. Invention Name Period01. Clinical description document Eberus papyrus 1500 BC02. Clinical description, noted sweetness in urine Charaka 600 BC and role of hereditary03. Clinical description, noted sweetness in chine Sushruta 400 BC and role of hereditary04. Clinical description Celsus 30 BC - 38 AD05. Name diabetes Aretaus 30 - 90 AD06. Introduce the term diarrhoea of urine Galan 132 - 201 AD07. Evaporated specimen of Urine of patient and Jaques Dubois 1478 – 1555 discovered a residue which was almost sylvanus Glucose08. Dietary regulation for diabetes Arnatus 1511 – 1568 Luritanus09. Role of heredity in diabetes Mortan Richard 1637 – 169810. Role of hereditary in diabetes Mortan Richard 1637 – 1698 8 Historical review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Sl. Invention Name Period11. Removed pancreas from the dogs and found Burunner J.C. 1653 – 1727 that they developed thirst and polyurea12. First to add mellitus to diabetes Cellura William 1712 – 179013. First to separate diabetes incipidus from Johanu Frank 1745 – 1821 mellitus14. Described pathology of pancreas Cawley 178815. Liver’s role in diabetes Von Noorden 1858 – 194416. Described pancreatic Islets Langerhan paul 196917. Sugar storage in liver as glucagons and Clande Bernad 1870 elevated blood sugar in diabetes18. Experimental diabetes after removal of Von Mering and 1889 pancreas Minkovasski19. Insulin almost discovered Zulger, Panlaski 1910 – 192020. Insulin from dog pancreas Banting and 1921 - 1922 Best21. Transplant of beta cells Downwards 1970 Mervin and Gliedman22. Artificial pancreas Liebel selden 1974 - 1975 9 Historical review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”VIRECHANA KARMANirukti And Paribhasha Virechana18 : - Virehana shabda is formed by the root “Rich” dhatu and “Vi”upasasga. “Nich and “Lout” pratyaya are also take part in the derivation of the wordvirechana. “Visheshena rechateeti” “Vi + rich + Nich + Lyu.”Virechana karma Panchakarma is the popular term for shodhana chikitsa, and among that virechanais an important one. Virechana is a process by which the doshas are made to pass throughthe adhomarga i.e. Guda21. Its general meaning is to remove the doshas from the body,but in Ayurveda removal of the doshas from the body trough guda is called as virechana. Virechana is a specific therapy for pitta dosha and pitta samsarga doshas. It isalso the treatment for kapha in the pittasthana. Virechana is also useful in vata dosha assneha, sweda and mridu virechana are the main upakramas of vata dosha22.Virechana karma In Major Classics In the treatment of madhumeha virechana therapy has great importance. All theBrihathrayies of Ayurveda has mentioned about Madhumeha and other classis likeBhavaprakasha, Bhaishajya ratnavali, Yogaratnakara and Vangasena mentioned aboutthis disease and the importance of virechana in this condition23. All the classics have given detailed description regarding Virechanakarma. InCharaka samhita we can get the explanation of different virechana dravyas and kalpas inkalpasthana and in sutrasthana. In siddhi sthana he explained the importance ofVirechana in different diseases, yogyas, ayogyas, siddhis, vyapats and pariharas etc. indetail24. Virechana karma
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” In Sushrutasamhita sutrasthana he gives explanation regarding adhobhagaharadravyas in detail. Also in the sutrasthana he explains virechana pradhanani dravyas. Inchikitsasthana acharya gives information regarding method of application of virechana,oushadha panavidhi, dosha nirharana karma, samyakyoga, atiyoga, vyapats, and theirchikitsa in detail25. Vagbhata acharya in Ashtanga Hridaya Kalpasthana gives explanation ofvirechana dravyas and their different kalpas. Apart from this in Sutrasthana, he givesexplanation of virechana vidhi, yogyas, ayogyas, etc. in detail26. In the same way other acharyas like Yogaratnakara, Bhavaprakasha,Sharangadhara, Vangasena, all gives explanations regarding Virechanakarma.Types of Adhobhagahara Karma Sharangadhara has explained 4 types of adhobhagahara karmas, they are27 01. Anulomana 02. Sramsana 03. Bhedana 04. Rechana Among these, rechana karma expels pakva or apakva mala in drava form which isconsidered as more good.Virechana Dravyas Virechana dravyas will have all the properties of vamana dravyas i.e., ushna,teekshna, sookshma, yogavahi, vikashi etc. These drugs consisting of pritvi and jalamahabhootas. Virechana dravyas have a specific property of removing the doshas fromthe lower part of body i.e. Adhobhaga28. Virechana karma
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Virechana Vidhi As a first step one has to observe whether the patient is fit for virechanakarma ornot. For this in classics criterias are given such as virechana yogyas, virechana ayogyasetc. Those who are fit for virechana should only be given with virechana other wise itwill lead to lot of complications. At the same time one has to see whether the patient isfit for snehana and swedana also, as they are the poorvakarmas of virechanakarma.Table No. 02. Showing the Virechana Yogyas29.Sl. Virechya Charaka Susruta Vagabata01. Jwara + + +02. Kushta + + +03. Prameha + + +04. Urdvaga raktapitta + + +05. Bhagandara + + +06. Arsha + + +07. Pleeha dosha + + +08. Gulma + + +09. Arbuda + + -10. Galaganda + + -11. Grandhi + + +12. Gara + + +13. Vishoochika - + +14. Alasaka + + -15. Mootraaghhata + + +16. Krimikoshta + + + Virechana karma
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”17. Visarpa + + +18. Pandu + + +19. Sirashoola + + daha +20. Parshva shoola + - -21. Udaavartha + - -22. Netra daha + + -23. Aasya daha + + -24. Hridroga + + -25. Vyanga + - +26. Neelika + - -27. Aruchi + + -28. Netrasrava + - -29. Nasasrava + - -30. Haleemaka + - +31. Swasa + - +32. Kasa + - +33. Kamala + - +34. Apachi + - +35. Apasmara + - -36. Unmada + - -37. Vata rakta + + +38. Yonidosha + + +39. Retodosha + - +40. Timira + + + Virechana karma
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”41. Udara + + +42. Avipaka + - -43. Chardi + + +44. Visphota + + +45. Pakwashaya ruja - + +46. Vibhanda - + +47. Vidradhi - + +48. Shvayadhu + + +49. Shastra ksheena kshara agni dagdha - + -50. Dushta Vrana - + +51. Akshipaka - + -52. Abhishyanda - + +53. Kaacha - + +54. Guda daha - + -55. Medhra daha - + -56. Nasa Karna daha - + -57. Aanaha - + -58. Shleepada - - -59. Stanyadosha - - +60. Hrullasa + - + Virechana karma
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 03. Showing the Virechana Ayogyas30.Sl. Avirechya Charaka Susruta Vagbata01. Subhaga + - -02. Kshataguda + - +03. Bhuktaanala + - -04. Adhoga vaktapitta + + +05. Langhita + - -06. Durbalendriya + - -07. Alpagni + + +08. Niruda + - +09. Kamadi vyagra + - -10. Ajeerna + + +11. Nava jwara + + +12. Madatyaya + + +13. Aadhmana + - +14. Shalyardita + - +15. Abhighata + - +16. Atisnigdha + + +17. Atirooksha + + +18. Daruna Koshta + + -19. Kshata ksheena + + +20. Atisthoola + + +21. Atiruksha + - + Virechana karma
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”22. Bala, Vrudha + + +23. Durbala + + +24. Shranta + + -25. Pipasita + + -26. Karma, bhara Advahana + - -27. Upavasita + + -28. Maithunaprasakta + - -29. Adhyayana Prasakta + - -30. vyayama Prasakta + - -31. Chinta prasakta + - -32. Kshama + - -33. Garbhini + + +34. Nava prasuti - + +35. Nava pratishyaya - + +36. Rajayakshma - - -37. Atisara - - -38. Kshudhita + - +39. Nitya dukhita - - +40. Hrudrogi, Bhayabhoota - - + Compared to other karmas like vamana, vasthi, nasya and raktamokshana,virechana is less complicated and easy to administer, if administered in proper way.Before the administration of virechana, the patient is made to undergo snehana andswedana. Before the above two karmas i.e., snehana and swedana, deepana pachana Virechana karma
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”should be administered in order to get niramata. After getting niramata patient should begiven shehana in arohana krama till he attains samyak snigdha lakshana, normally till 7days. The sneha should be vyadyanuroopa and vyadyanukoola.Table No. 04. Showing the Samyak Snigdha Lakshanas31.Sl. Lakshanas Charaka Susruta Vagbata01. Agnideepthi + + +02. Snehodvega + - +03. Asamhata varcha + + +04. Anga laghava + + -05. Gatra mardava + + -06. Gatra snigdhata + +` +07. Pureesha snigdhata + + +08. Twak snigdhata - + -09. Vatanuloma + - +10. Adhomarga sneha srava - + +11. Klama - + +12. Shaithilya - + - As a next step, patient should be given swedana till samyak swinna lakshanas.After attaining swinnata, he should be given Virechana dravya. Before this a proper doseand form should be fixed for the Virechana dravya and the total body condition shouldalso be assessed carefully in order to avoid further complications. For Virechana dravya, uttama, madyama and alpamatras are mentioned, from thatone dose suitable to the patient should be selected. Also vaidya has to see whether any Virechana karma
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”avirechya diseases are manifested in the patient during the day of the virechana. Both thesneha used for the snehapana and the drug used for Virechana should be vyadhyanukoolaand vyadyanuroopa. Apart from the above factors like desha, kaala, bala, shareera, aharasaatmya, satva, prakriti and vayaha should be considered32. Pradhana Karma inVirechana vidhi consists of administration of Virechana dravya to till the stoppage ofvirechana vegas. The following ideas are necessarily kept in mind such as, 01. The administration of Virechana Yoga. 02. Deciding the Vegas. 03. Observation of the signs and Symptoms of samyak yoga, ayoga and atiyoga. 04. Examination of the patient who have undergone virechana therapy. 05. Vyapats if any, and their treatment. Vagbhata Says, the patient has to take Virechana dravya just after kapha kala. Assoon as the drug meant to produce Virechana is administered, in some sensitive patientsthere will be the sensation of nausea or vomiting. It is due to either bad taste of the drugor due to utkleshana leading to anorexia. The properties of emetics and purgatives willhave stimulating properties. Hence the Purgatives may sometimes produce vomiting. Assoon as the patient drinks the purgative drug the patients face must be sprinkled with coldwater and the mouth should be washed with hot water. The patient must also be made to lie on a bed and to allow him to take rest. Alittle hot water must be given to the patient to drink so that the vega must come properly.He must not allow touching even cold water up to last vega33. Virechana karma
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” In a proper Virechana the patient passes mutra, purisha, pitta, kapha etc. in asequence. When there is no purgation, then instantaneously the hot water must be givento drink and the hand must be made warm and sweda must be done on stomach. Vaidyamust observe the signs and symptoms of jeernoushadha and ajeernoushadha etc. that aregiven in the following table34.Table No. 05. Showing the Virechana dravya jeeranoushadha and ajeeranoushadhalakshanasSl. Jeernoushadha Lakshana Ajeernoushadha lakshana01. Vatanulomana Dourbalya02. Swasthya Daha03. Kshut Angasaada04. Pipasa Bhrama05. Mana prasannata Moorcha06. Indriya prasannata07. Shudha udgara, etc. Here ajeernoushadha lakshanas indicates that the virechanoushadha undergonepachana without doing its virechana effect. Apart from the above lakshanas the hrit dosha lakshana also should be taken intoconsideration. As told previously, in a proper virechana there will be expulsion of mala,pitta and kapha in sequence i.e. “kaphantam virechanam”. After this only vatanirgamana occurs. Also the appearance of dourbalyata and laghuta indicates that doshashave properly gone out35. Virechana karma
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” If ajeerna lakshanas are noted but ayoga of virechana happens, the patient shouldnever be given further dose of oushadha because it may lead to atiyoga. When theoushadha undergone pachana and there is no hrit dosha lakshanas, then he should begiven food and again virechana oushadha should be administered on next day. Even thenvirechana does not happen, after 10 days again virehana oushadha can be given afterproper snehana and swedana36.Vega Nirnaya For Veganirnaya the physician has to leave the first two three malayukta vegasand then counting should be done. By observing the vegiki, maniki, antaki and laingikilakshanas, one has to decide whether virechana is pravara, madhyama or avara.Table No.06. Showing the Virechana vega nirnaya37.Sl. Vega vishaya Pravara Madhyama Avara01. Vegiki lakshana 30 vega 20 vega 10 Vegas02. Miniki lakshana 4 Prastha 3 Prastha 2 Prastha.03. Antaki lakshana Kaphantam04. Laigiki lakshana General signs and symptoms of virechana A proper or well-performed Virechanakarma leads to samyak Virechanalakshanas. i.e. 38, Indriya prasannata. Shareera laghuta. Expulsion of vit, pitta, kapha and Agnideepti vata in sequence. Absence of atiyoga and ayoga Sroto shuddhi. virechana lakshanas. Vatanulomana. Virechana karma
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Like the knowledge of virechana samyak lakshanas, the knowledge of ayoga andatiyoga lakshanas are also very essential39.Table No. 07. Showing the Virechana ayoga and atiyoga laxanas. Virechana ayoga lakshansa Virechana atiyoga lakshanas Lakshanas Ch. Su. Vag. Lakshanas Ch. Su. Vag.Kapha Praseka + + + Kapha Kshaya vikara + + -Pitta Prakopa + + + Pitta kshaya vikara + - -Vata Prakopa + - - Vata Kshaya vikaya + - -Agni mandya + + - Anga marda + - _Gaurava + + - Klama + - -Pratishyaya + - + Vepathu + - _Tandra + - _ Nidra + - -Chardi + - - Dourbalya + - -Aruchi + + + Tama pravesha + - -Vata pratilomata + - - Unmada + - -Daha - + + Hikka + - -Hridaya Ashudhi - + + Moorcha - - -Kukshi Ashudhi - + + Guda bhramsha - - -Kandu - + + Shoola - + -Vit sanga - - + Kapha pitta rahita, - - + sweta, lohita udaka + nissaranamMutra Sanga - + - Mamsa udaka srava - - +Pidaka - - + Medo gandhavat - - + srava Virechana karma
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Trishana - - + Bhrama - - + Netra Praveshana - - + Ati vamana vyapat - - + Rakta kshaya vikara + - - Due to Kaphotklesha, aruchi and ajeernata, the virechanoushadha may producevamana. In such conditions, patient should be given snehana and swedana and againoushadha should be given. Even then virechana is not possible, if oushadha is not satmyato the patient and dravya is not producing any apriyata, once again oushadha can be givenfor attaining Virechana40. Soon after the samyak virechanakarma digestive power gets impaired. So thepeyadi samsarjana krama should be followed in order to bring back the normal agni41.Except in the following conditions, in others peyadi samsarjana karma can be done. They are, Pitta kapha parisrava Madatyaya Vata pitta prakriti In the above conditions tarpana can be administered. Improper conduction of Virechana leads to the vyapats (complication) Like42, Aadhmana Parisrava Stambha Jeevadana Anga graha Parikartika Hrit graha Vibhrama Klama Virechana karma
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Sushruta has given 15 vyapaths (complications) of Virechana43, Vamana occurs with Virechana Vata ruk dravya and vise versa Parisrava Shesha oushadatwam Ayoga Jeerna oushadhatwam Pravahika Aadhmana Atiyoga Heena oushadha apahritatwam Hridyopasarana Jeevadhana Vibandha Parikartika As seen above, acharyas have clearly mentioned the ayoga, atiyoga and vyapats indetail and their treatment.Mode of Action of Virechana Drugs As explained earlier, the virechana dravyas have the properties like ushna,teekshna, sookshma, vyavayi and vikashi gunas. The drug having these properties willreach the heart by its potency and there by to the entire dhamanis. Also it reaches to bigsmall and minute srotases of the body. Due to the presence of ushna veerya, vishyandanais produced; teekshna guna produces chedana of dosha samoohas and brings it to thekoshta. From there due to prithvi and jala mahabhoota gunas and also due toadhobhagahara prabhava the doshas are get eliminated through guda marga. Bothvirechana and vamana oushadha having the same properties, but virechana drugsproduces virechana and vamana drugs produces vamana only and it is only because of itsprabhava. Virechana dravyas produce uttejana in the sotases, dhamanies, koshta andultimately on hridaya kendra. Sushruta added sara guna along with the ushnadi gunas andthis sara guna is helpful in anulomana procedure44. Virechana karma
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Acharya Charaka says, the drugs acts not only due to its prabhava but also due toit’s dravyatwa prabhava, gunatwa prabhava and both dravyatwa and gunatwa prabhava.And the factors mentioned here may change based on conditions. The effect produceddue to above is called karma. The factor responsible for manifestation of effect isveerya45.Modern Concept of Purgatives46 The terms purgative, cathartic, laxative, and evacuant may be consideredsynonymous. They are medicines that promote defecation largely by reducing theviscosity of the contents of the lower colon. Purgatives may be classified as: 01. Bulk purgatives. 02. Osmotic Purgatives. 03. Fecal softeners. 04. Stimulants.01. Bulk purgatives : These comprise indigestible vegetable fiber and hydrophilic colloids. Bulkpurgatives act by increasing the volume and lowering the viscosity of intestinal contentsto promote a large soft, solid stool. The substances thus encourage normal reflex bowelactivity, rendering it more effective and generally acting within 1-3 hours. Dietary fibersare essentially the cell walls and supporting structures of vegetables and fruits.Increasingly reference is made to non-starch polysaccharide (NSP), which refers tocarbohydrates that are not digestible by human enzymes and which can be assayed. NSPcomprises most of the fiber in our diet. Virechana karma
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”02. Osmotic laxatives : These are but little absorbed and increases the bulk and reduces viscosity ofintestinal contents to promote a fluid stool. Some inorganic salts retain water in theintestinal lumen or, if given as hypertonic solution withdrawn it from the body. Lactuloseis a synthetic disaccharide, taken orally, it is unaffected by small intestinal disaccharides,is not absorbable and this acts as an osmotic laxative.03. Fecal softeners (emollient) : The softening purposes of these agents are useful in the management of analfissures and hemorrhoids. In this the feces is softened by lowering the surface tension offluids in the bowel, which allows more water to remain in the feces.04. Stimulant purgatives (contact laxatives) : These increase intestinal motility by various mechanisms. They may causeabdominal cramps and should not be used where there is intestinal obstruction.After giving the explanation of virechana karma along with its modern aspects, it isnecessary to narrate the normal anatomical and physiological activities that are going onin the stomach, small intestine, large intestine and rectum, which are given below. Virechana karma
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”SHAREERAStomach 47 The stomach has the shape of an expanded “J”. The stomach performs 4 majorfunctions. Viz. 01. The bulk storage of the ingested food. 02. Disruption of chemical bonds in chemical materials through the action of acids and enzymes. 03. Mechanical breakdown of ingested food. 04. Production of intrinsic factor, a glycoprotein whose presence in the digestive tract is required for the absorption of the vitamin B12.Regulation of Gastric phase – The CNS, regulated by the short reflexes coordinated in the wall of stomach andregulated by the digestive tract hormones can control the production of acids andenzymes by the gastric mucous.01. The cephahlic phase – Function – Prepare stomach for arrival of food. Duration – short. (minutes) Mechanism – Neural via preganglionic fibers in vagus nerve and synapse insubmucosal plexus (by seeing, smell, taste or thoughts of food) Actions – Primary – Increased volume of gastric juice by stimulatingmucous, enzyme and acid production. Secondary – Stimulation of gastrin release by G cells. 26 Shareera
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”02. Gastric phase – Enhance secretion started in cephalic phase, homogenizes and acidify the chyme.It initiates the digestion of proteins by pepsin. Duration of the phase is long i.e. 3-4 hours. Mechanism – Neural – Short reflexes triggered by stimulation of stretch receptors as stomach fills. There is also stimulation of chemo-receptors as PH increases. Hormonal – Stimulation of gastrin release by G cells byparasympathetic activity and presence of peptide and amino acids in chyme. Also therelease of histamine by mast cells as stomach fills. As a result there is an increased acidand pepsinogen production, increased motility and initiation of mixing waves. Themixing waves occur several times per minute and they gradually increase in intensity.After an hour, the material with in the stomach is churning like the clothing in thewashing machine.03. Intestinal phase – The main function of this phase is controlled rate of chyme entry into duodenum.The duration of this process is long. i.e. hours. Mechanism – Neural – short reflexes (entero-gastric reflex) triggered by the extension of duodenum. Hormonal – Primary – Stimulation of CCK, GIP, and secretin release by presence of acid, carbohydrate and lipids. 27 Shareera
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Secondary – Release of gastrin stimulated by presence of undigestedproteins and peptides and finally there is feed back inhibition of gastric acid andpepsinogen production, reduction of gastric motility. The intestinal phase of gastric secretion begins when chyme starts to enter thesmall intestine. The intestinal face generally starts after several hours of mixingcontractions, when the wave of contraction begins sweeping down the length of thestomach. Each time the pylorus contracts, a small quantity of chyme squits through thepyloric sphincter. The purpose of intestinal phase is to control the rate of gastricemptying and ensure that the secretary, digestive functions of the small intestine canproceed with reasonable efficacy. The arrival of chyme in the small intestine also triggersother neural and hormonal events that co-ordinate the activities of intestinal tract,pancreas, liver, and gall bladder.Small Intestine48 The stomach is a holding tank where food is saturated with gastric juices andexposed to stomach acids and the digestive effects of pepsin. These are the primary steps,for most of the digestive and absorption functions occur in the small intestine, where theproducts of digestion are absorbed. The mucosa of the small intestine produces only a few of the enzymes involved.The pancreas provides digestive enzymes as well as buffers that assist in theneutralization of acidic chyme. The liver and the gall bladder provide bile, a solution thatcontains additional buffers and bile salts, compounds that facilitates digestion andabsorption of lipids. 28 Shareera
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” The small intestine averages 6 m. in length and has a diameter ranging from 4 cmat the stomach and about 2.5 cm at the junction to the large intestine. It accompanies allabdominal regions except the right and left hypochondriac regions. It has 3 subdivisions.duodenum, jejunum and ileum.Intestinal Movements After chyme has arrived in the duodenum weak peristaltic contractions move itslowly towards the jejunum. These contractions are mesenteric reflexes not under CNScontrol. Their effects are limited to with in a few centimeters of the site of the originalstimulus. These short reflexes are controlled by motor neurons in the submucosal andmesenteric plexus. In addition, some of smooth muscle cells contract periodically evenwithout stimulation, establishing a basic contractile rhythm that then spreads from cell tocell. The stimulation of the parasympathetic system increases the sensitivity of thesemesenteric reflexes and accelerates both local peristalsis and segmentation. Moreelaborate reflexes coordinate activities along the entire length of small intestine. Tworeflexes are triggered by the stimulation of the stretch receptors in the stomach as it fills.The gastro-enteric reflexes stimulates motility and secretion along the entire length of thesmall intestine, the gastro-ilial reflex triggers the relaxation of the iliocecal valve. The netresult is that, the materials pass form small intestine to the large intestine. Thus thegastro-enteric and the gastro-ilial reflexes accelerate movements along with smallintestine, the opposite effect of the entero-gastric reflex. Hormones released by thedigestive tract can enhance or suppress reflex responses. 29 Shareera
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Large Intestine 49 The horseshoe shaped large intestine begins at the end of the ilium and ends at theanus. The large intestine lies inferior to the stomach and liver and almost completelyframes the small intestine. The major functions are – 01.Absorption of water and compactness of intestinal contents into faeces. 02. Absorption of important vitamins liberated by the bacterial action. 03. Storing of fecal material before defecation. It has the following parts – 01. Caecum 02. Colon 03. RectumMovements of large intestine The gastro-ilial and gastro-enteric reflexes move materials into the caecum atmealtime. Movement form the caecum to the transverse colon occurs very slowly,allowing hours for water absorption to convert the already thick material into a sludgypaste. Peristaltic waves move material along the length of colon. Movements from thetransverse colon through the rest of the large intestine results form powerful peristalticcontractions called “Mass movements” which occur a few times each day. The stimulus is distention of the stomach and the duodenum and the commandsare relayed over the intestinal nerve plexus. The contractions force the fecal materialsinto the rectum and produce the conscious urge to defecate. 30 Shareera
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Defecation The rectal chamber is usually empty except when one of those powerful peristalticcontractions forces fecal material out of the sigmoid colon. Distention of the rectal wallthen triggers the defecation reflex. The defecation reflex involves two positive feed back loops both are triggered bystretch receptor stimulation in the walls of the rectum. The first loop is a shorter reflexthat triggers a series of peristaltic contractions in the rectum that moves the feces towardsthe anus. The second loop is a long reflex coordinated by the sacral parasympatheticsystem. This reflex stimulates mass movements that push the fecal material to the rectumfrom the descending colon and the sigmoid colon. Rectal stretch receptors also trigger two reflexes important to the voluntarycontrol of defecation. 01. Visceral reflex – Mediated by the parasympathetic innervations with in the pelvic nerves. Thisreflex causes the relaxation of the internal anal sphincter, a smooth muscle sphincter thatcontrols the movements of the feces into the anorectal canal. 02. Somatic reflex – That stimulates the immediate contraction of the external anal sphincter. Theelimination of the feces requires that both the internal and external anal sphincter to berelaxed, but these reflexes open the internal sphincter and close the external sphincter.The urge to defecate usually develops when rectal pressure reaches about 15 mm of Hg.When it exceeds 55 mm of Hg external sphincter will relax and the defecation occurs. Diabetes mellitus is a chronic disease due to the disordered carbohydratemetabolism and results due to deficiency of insulin secreted by the beta cells of Islets of 31 Shareera
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Langer Hans of pancreas. But the hormones of pituitary and adrenal glands are alsointimately related to the development of this state. Apart form this liver had its own rolein the manifestation of this disease, because it stores the glucose in the form of glycogenunder the influence of insulin. Any alteration in this leads to diabetes. So following arethe glands involved in the pathology of manifestation of the diabetes mellitus – 01. Pancreas 02. Pituitary 03. Adrenal 04. LiverPancreas50 The pancreas lines within the abdomino-pelvic cavity in the ‘J’ shaped loopbetween the stomach and the small intestine. It is a slender, plane organ with a nodularconsistency. The adult pancreas is 20 –25 cm long and weights about 80 gms. The broadhead of the pancreas lines within the loop formed by the duodenum as it leaves thepylorus. The slender body extends transversely towards the spleen and the tail is shortand bluntly rounded. The pancreas is retroperitonal and is firmly bound to the posteriorwall of abdominal cavity. The surface of the pancreas has a lumby, lobular texture. A thin, transparentconnective tissue capsule wraps the entire organ. You can see the pancreatic lobules,associated blood vessels and excretory ducts through the anterior capsule and theoverlying layer of peritoneum. 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. 32 Shareera
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” The pancreas is primarily an exocrine organ producing digestive enzymes andbuffers. The large pancreatic duct delivers these secretes to the duodenum. A smallaccessory duct, or duct of Sanforini, may branch from the Pancreatic duct. The Pancreaticduct extends 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. Theexocrine pancreas roughly 99 percent of the pancreatic volume consists of clusters ofgland cells, pancreatic acini, and their attached ducts. Together the gland and duct cellssecrete large quantities of an alkaline, enzyme rich fluid. This secretion reaches thelumen of the digestive tract by traveling along a network of secretary ducts. The endocrine pancreas consists of small groups of cells scattered among theexocrine cells. The endocrine clusters are known as pancreatic Islets, or the Islets ofLanger Hans. Pancreatic islets account for only about 1 percent of the pancreatic cellpopulation. Nevertheless, a typical pancreas contains roughly 2 million pancreatic Islets. Each Islet contains four different cell types. 01. Alpha cells – Produce the hormone Glucagon. Glucagon raises blood glucose levels byincreasing the rates of glycogen break down and glucose release by the liver. 02. Beta cells – Produce the hormone insulin. Insulin lowers blood glucose by increasing the rateof glucose uptake and utilization by most body cells and increasing glycogen synthesis inskeletal muscles and the liver. Beta cells also secrete amylin, a recently discoveredpeptide hormone whose role is uncertain. 33 Shareera
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” 03. Delta cells – Produce a peptide hormone identical to somatostatin, a hypothalamic regulatoryhormone. Somatostatin produced in the pancreas suppresses glucagon and insulin releaseby other islet cells and slows the rates of food absorption and enzyme secretion along thedigestive tract. 04. F cells – Produce the hormone pancreatic polypeptide. It inhibits gallbladder contractionsand regulates the production of some pancreatic enzymes. It may help to control the rateof nutrient absorption by the digestive tract. Here focus is made on insulin and glucagon, the hormones responsible for theregulation of blood glucose concentrations, which are given below. These hormonesinteract to control blood glucose levels. When blood glucose levels rise, beta cells secreteinsulin, which then stimulates the transport of glucose across cell membranes. Whenblood glucose levels decline, alpha cells secrete glucagon, which stimulates glucoserelease by the liver.Insulin Insulin is a peptide hormone released by beta cells when glucose levels rise abovenormal levels (70 to 110 m/c). Elevated levels of some amine acids, including arginineand leucine, also stimulate insulin secretion. Insulin exerts its effects on cellularmetabolism in a series of steps that begins when insulin binds to receptor proteins on thecell membrane. Binding heads to the activation of the receptor which functions as akinease and attaches phosphate groups to intracellular enzymes. Phosphorylation ofenzymes then produces Primary and secondary effects within the cell, the biochemicaldetails remain unresolved. 34 Shareera
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” One of the most important effects is the enhancement of glucose absorption andutilization. Insulin receptors are present in most cell membranes. Such cells are calledinsulin-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 takes This effect results from an increase in the number of glucose transport proteins inthe cell membrane. These proteins transport glucose into the cell by facilitated diffusion.02. Acceleration of glucose utilization and enhanced ATP production This effect occurs for two reasons – (a) The rate of glucose use is proportional to its availability. when more glucose enters the 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 tissues Insulin stimulates the absorption of fatty acids and glycerol by adipocytes. Theadipose cells then store these components as triglycerides. Adipocytes also increase theirabsorption of glucose; excess glucose is used in the synthesis of additional triglycerides. As a whole (summary) insulin secreted when glucose is abundant and thishormone stimulates glucose utilization to support growth and the establishment of 35 Shareera
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”carbohydrate (glycogen) and lipid (tryglyceride) reserves. The accelerated use of glucosesoon brings circulating glucose levels with in normal limits.Glucagon When glucose concentrations fall below normal, alpha cells release glucagons,and energy reserves are mobilized. When glucagons binds to a receptor in the cellmembrane; it activates adenylate cyclase, and cAMP acts as a second messenger thatactivates cytoplasmic enzymes. The primary effects of glucagons are – 01. Stimulation of glycogen breakdown in skeletal muscle and liver cells. 02. Stimulation of triglyceride breakdown in adipose tissues. 03. Stimulation of glucose production at the liver. The liver cells absorb amino acids from blood steam, convert them to glucose,and release the glucose into the circulation. This process of glucose synthesis in the liveris called gluconeogenesis. The results are a reduction in glucose use and the release of more glucose into theblood steam consequently; blood glucose concentrations soon rise towards normal levels. Pancreatic alpha cells and beta cells monitor blood glucose concentrations, andthe secretion 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 concentrations will indirectly affect theproduction of both insulin and glucagon. Insulin production is also influenced byautonomic activity. Parasympathetic stimulation inhabits it. 36 Shareera
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Pituitary Gland 51 This is an important ductless gland with lot of functions, including the control ofthe other ductless glands and of body growth. This gland measures 1.5 cm in the coronalplane, 1 cm in the sagittal plane and 0.75 cm in vertical form. It lies within the cellatarsica of the sphenoid bone and the posterio-superior to the sphenoid air sinuses, belowthe optic chiasma. It is flattened ovoid lying the hypophysial fossa and connected to theinferior surface of the hypothalamic part of the brain by the infundibulum. Structurally the gland can be divided into 2 main parts – 01. Anterior lobe – Which is composed of adenohypophyseas tissue. 02. Posterior lobe – Which is neurohypophyseas. Posterior 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 producesprotein tropic hormones, which affects the other ductless glands. In this secretions twohormones are having direct action on carbohydrate metabolism. If any disturbance, whichleads to hyperglycemia or hypoglycemia. The two hormones are – 01. Growth Hormone or Somatotrophic hormone – (GH or STH) 02. Adrenocorticotrophic hormone (ACTH) 37 Shareera
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” The pituitary effect of STH on carbohydrate metabolism is to stimulate itsstorage. Administration of growth hormone in the animal or in man producehyperglycemia and glycosuria. The high blood glucose level leads to its exhaustion andatrophy. So the growth hormone has diabetogenic effect especially in man. The hormoneis however increase the glycogen content of cardiac muscles. Administration of ACTH produces similar effects as induced by growth hormone.Both STH and ACTH increase gluconeogenesis and diminish the rate of oxidation ofglucose. Thus the anterior pituitary has a diabetogenic role. GH is also known asSomatotrophin and somatotrophic hormone causes cells to grow and multiply and itincreases the rate of protein synthesis. GH accelerates the rate at which glycogen storedin the liver is converted to the glucose and released in the blood. GH raises blood glucoselevel and the raise in the glucose, triggers insulin secretion. ACTH by stimulatingsecretion of gluco-corticoids brings about hyperglycemia and also directly stimulates therelease of GHIF and inhibits the secretion of insulin. One stimulus that inhibits GHsecretion is hyperglycemia. An abnormally high blood sugar level stimulates thehypothalamus to secret the regulating factor GHIF and it inhibits the release of GHAFand thus the secretion of GH. As a result blood sugar level decreases.Adrenal Gland 52 Adrenal glands are situated on the upper poles of the kidneys. Each gland weightsabout 4 gms. A distinct connective tissue capsule surrounds the parenchyma of the gland. Beneath the capsule the cortex is arranged in three layers – 01. Zona glomerulosa – Secretes mainly aldeosterone and small amount of gluco-corticoids and sexhormones. 38 Shareera
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” 02. Zone fasciculata – Secretes mainly gluco-corticoide. 03. Zona reticularis – Secretes sex hormone and small amount of the glucocorticoids, All the three zones of the adrenal gland can synthesis the gluco-corticoids. Thechief action of the gluco-corticoids is to increase glyconeogenesis in the liver andstimulates formation of glycogen in the liver and muscles. The adrenal cortex also assertsdiabetogenic affects. Proteins are converted into carbohydrates i.e. glyconeogenesis occurthrough the action of gluco-corticoids. Therefore, constant production of carbohydrates and the insulin is required tometabolize the excess of carbohydrates. The excessive glyconeogenesis exerts continuedstrain upon the cells of Islets leads to hyperglycemia. When it is severe, causes damage tobeta cells and permanent insulin deficiency results. The adrenal action however dependsupon the action of anterior pituitary.Liver 53 The liver is the largest gland in the body. The greater part of the liver lies underthe covering 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. Thesurrounding 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 right and left are demarcated form one another above andin front by the falciform ligament and below and behind by the fissures for theligamentum teres and ligamentum venosum. The right lobe includes two subsidiary lobes. 39 Shareera
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Important functions of liver with the special attention to carbohydrate metabolismare - 01. Glycogen storage 02. Conversion of galactose and fructose in the glucose. 03. Gluconeogenesis 04. Formations of many important chemical components from the intermediate products of carbohydrate metabolism. The liver is especially important for maintaining a normal blood glucoseconcentration. For instant storage of glycogen allows the liver to remove excess glucoseform blood, store it and return it to the blood when the blood glucose concentrationbegins to fall too low. This is called Glucose buffer function of the liver.Gluconeogenesis in the liver is also concerned with maintaining a normal blood glucoseconcentration. Gluconeogenesis occurs to a significant extend only when the glucoseconcentration begins to fall below normal. In such a case large amounts of amino acidsare converted into glucose, there by helping to maintain a relatively normal blood glucoseconcentration. 40 Shareera
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”DISEASE REVIEW Meha19 - It is a pum-Linga vachana formed by “Mih + Ghaj” “Mehati Ksharati Shukratiranena iti” Prameha : - It is also a masculin vachana formed by “Pra + Miha” “Ksharane + Karane Khaj.” It is a roga vishesha. Its paryayas are “Meha” as a mutra dosha by Raja Nighnatuand as bahumutrata by Hemachandra. Diabetes is derived from a Greek word whichmeans “To siphon through” and mellitus a Latin word which means “Honey” 20.Nidana Nidana means the factor responsible for producing disease i.e. etiologicalfactors54. According to this any factor, which has a tendency or capacity to produce diseasecan be considered as Nidana. In classics only Charaka explains specific nidana formadhumeha55. Among the prameha nidanas that are mentioned in our classics samanya pramehanidanas and kaphaj prameha nidanas can be considered as nidana for Madhumeha insthoola. For all types of Prameha especially madhumeha, kapha dosha is the key factor,and it can be established by Gangadhara’s version. In that he says, Gulma is caused byvayu, raktapitta by pitta and madhumeha caused invariably due to the vitiation of kaphadosha56. In case of sthoola the madhumeha is due to doshavarana. And in this type ofdoshavrita janya madhumeha, vataprakopa is due to avarana caused mainly by thevitiation of kapha. If we take sthoulya here also kapha vardhaka factors are the mainfactors behind57. 41 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Though kapha is the arambhaka or main dosha in the samprapti of madhumeha,pitta and vata also play an important role in complicating the disease58. It is worthwhileto note the textual reference, that madhumeha will occur in due coarse, if Pramehas areuntreated and at the same time, it is better to note that madhumeha is a tridoshajavyadhi59. In view of the above, all Prameha nidanas should be assessed clearly whileconsidering, the madhumeha. Hence the nidanas of various pramehas are discussed belowcan be grouped under 2 main varieties60. 01.Sahaja (Hereditary) 02.Apathyaja (Acquired).01. Sahaja (Hereditary Causes) Charaka and Sushruta have agreed that beeja dosha is also a cause formadhumeha. Sushruta has included madhumeha in the adibala pravritaja category ofdisease. The term beeja has been considered as shukra and shonita61. If beejas are vitiatedwith dosha responsible for causation of prameha, they will produce a jatha pramehapatient. Jatha pramehi has also been considered as a kulaja vikara. The diseases includedunder this category are kushta, arsha, mehas, kshaya, etc.02. APATHYAJA (ACQUIRED CAUSE) Apathyaja causes of prameha can be further classified in to two groups 01. Samanya (General) 02. Vishesha (According to dosha) 42 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 07a. Showing the Samanya Nidana of prameha61 –Sl. Nidana Charaka Sushruta Vagbhata Aaharaja Nidanas01. Dadhi + - -02. Gramya, oudaka mamsa + - -03. Anupa mamsa + - +04. Payaha + - +05. Nava anna pana + - +06. Guda Vikara + - +07. Sheeta, Snigdha, Madhura - + - Madya sevana08. Dravanna pana Sevanam - + -09. Swadu, Amla, Lavana, Snigdha, - - + Pichila, Sheetala ahara.10. Sura Sevana - - +11. Ikshu rasam - - + Viharaja Nidanas12. Asya sukham + - -13. Swapna sukham + - -14. Diva swapnam - + -15. Avyayamam - + -16. Alasyam - + - 43 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Kaphaja Prameha Nidana 63 AHARAJA NIDANASA. Rasa - Madhura padartha atisevana.B. Guna - Drava taruna dravya atisevana.C. Dravyas - Dhanyas - Hayanaka, yavaka, navanna, cheena, uddalaka, naishada,mukundaka, mahavrihi, pramodaka, sugandhaka, masha soopa added with ghrita. Mamsa - Gramya, oudaka, anupa, mamsa rasa.D. Others - Shakas, tila, pishtanna, payasa, krishara, vilepi, ikshu rasa, kshaudra,mandaka, dadhi. VIHARAJA NIDANAS Vyayama varjana, adhika Nidra, shayana. Asanasthaha. Anya kapha meda mutra vridhikara viharasPittaja Prameha Nidana64 AHARAJA NIDANASA. Rasa - Amla, lavana, katu adhika sevana.B. Guna - Ushna kshara adhika sevana.C. Any - Ajeerna dravyas and vishamaharam. VIHARAJA NIDANAS Ati teekshna atapa sevana Shrama Agni sevana. Krodha. Santapa 44 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Vataja Prameha Nidana65 AHARAJA NIDANASA. Rasa - Kashaya katu tikta ati sevanaB. Guna - Rooksha laghu sheeta ati sevanaC. Anya - Anashana VIHARAJA NIDANAS Vyavaya, ativyayama Udvega Vamana, virechana, aasthapana, Atishoka shirovirechana ati upayoga Shonitatisekha Vega sandharana Ratri jagarana Abhighata Vishama shareera asana Atapa sevanaMadhumeha Nidana 66 Only Charaka gives direct nidana or specific nidana responsible for theproduction of Madhumeha, which can be narrated as follows – Guru, snigdha, lavana rasatmaka Asya sukham dravya atisevana Achinta Navanna and pana Avyayama Atinidra Asamshodhana These factors contribute to the vikriti of the kapha, pitta, meda and mamsa. Thesevitiated factors cause avarodha to normal vayu gati, which in turn carries the ojas to vastithus resulting in Madhumeha. 45 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Sthoulya as a nidanarthakara Roga Sushruta has stated that apthyanimittaja pramehi’s are sthoola67. Sthoulya is thenidanarthakara roga for prameha. It is clear that samanya nidana of sthoulya and pramehastimulates each other. In sthoulya, the pathway of the vata gets obstructed by medas, as a result therewill be the vitiation of vayu, which in term stimulates the samana vayu resulting in theaggravation of digestive fire and causes increased absorption of food and the individualbecomes heavy eater.Etiology of Diabetas Mellitus68 A defective or deficient insulin secretary response, which translates in to impairedcarbohydrate use is a characteristic feature of diabetes mellitus and resulting in tohyperglycemia.Genetic Factors Genetic factors are even more important than in type I diabetes. Among identicaltwins, the concordance rate is 60% to 80%. In first-degree relatives with type II diabetesthe risk of developing disease is 20% to 40%. The two main defects that characterize type II diabetes are 01. A derangement in beta cell secretion of Insulin. 02. A decreased response of peripheral tissues to respond to Insulin (Insulin resistance).Obesity Among the initiating events, which are proposed for type II diabetes, obesity is anextremely important environmental factor. Approximately 80% of type II diabetes isobese. 46 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Age As the age advances the number of beta cells in pancreas, which produce insulin,gets reduced. So the risks of diabetes increase with age especially after 40 years.Sedentary Life Some recent studies have indicated that people with sedentary life style are morelikely to have diabetes as compared to those who lead an active life. It is believed thatexercise and physical activity increase the effect of insulin on the cells.Hereditary The hereditary aspects of diabetes is well summarized in the following statementby warren and Le Compte, when both the parents have diabetes, all the children mayexpected to develop the disease, if they live long enough. When one parent has diabetesand the other is diabetic carrier, 40% of their children may develop the disease. Where as,if a diabetic or a carrier marries an individual who neither has diabetes nor a diabeticcarrier none of the children will have diabetes. Obesity is mentioned as a major causative factor for diabetes Mellitus, as it causesinsulin resistance. In Ayurveda sthoulya is mentioned as a nidanarthakara roga ofprameha, and this prameha is included under santharpanajanya vyadhi. Madhura, snigdhaadi bhojana are mentioned as nidanas for madhumeha. Inmodern science over eating and sedentary lifestyles are the predisposing factors fordiabetes mellitus. This food articles and over eating causes obesity and which may causediabetes mellitus. 47 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Poorva Roopa The symptoms which are produced during the process of sthanasamshraya byvitiated doshas are called as poorva roopa69.Table No. 08. Showing the poorva roopas70.Sl. Poorva roopa Charaka Sushruta Vagbhata01. Kesha Jatilibhava + + -02. Asya Madhuryata + - -03. Kara, pada, Daha + + +04. Kara, pada, Suptata + - -05. Mukha, talu, gala, Kantha Shosha + - -06. Pipasa + + +07. Alasya + - -08. Kaye Malam + - -09. Paridaham + - -10. Anga suptata + - -11. Shatpada pipilikadhi shareera + - - Mootrabhi Saranam12. Visra shareera ganda + - -13. Atinidra + - -14. Tantra + + -15. Snigdha, pichhila, guru, gatrata - + +16. Madhura, Sukla, Mutrata - + -17. Durgandha Swasa - + - 48 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Sl. Poorva roopa Charaka Sushruta Vagbhata18. Talu, gala, jihwa, danteshu Malotpatti - + +19. Nakhaati vridhi - + +20. Swedam - - +21. Shareera daurgandha + - -22. Keshaathi vridhi - - +23. Sheeta priyatvam - - +24. Mootre abhidhavanti Pipeelikascha + - -25. Ghanangata - - +26. Anga shithilatvam - - + Madhavakara, Bhavaprakasha, Yogaratnakara and Bhela are also described thepoorva roopas, which are same as that of above description.Roopa Means symptoms of the actual manifestation of disease. At this stage doshadooshya Samoorchana would have been completed and the onset of the disease wouldhave been commenced. Madhavakara explains it as, when symptoms in the stage ofpoorvaroopa become fully or clearly manifested they are called roopas. Roopa is theprominent diagnostic key of a disease and hence thorough knowledge of the variousroopas of each disease is essential for a physician71. Sushruta classified Prameha in to two types they are72, 01. Sahaja 02. Apathya nimittaja He also explained the specific lakshanas of both the prameha as follows, 49 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Sahaja Sahaja pramehis are krisha, ruksha, alpashi, pipasa brusam (intense thirst) andparisarana sheela (tendency for roaming).Apathya Nimittaja Apathya nimittaja pramehi’s are sthoola, snigdha, bhahwashi (polyphagia),shayyasana sukhalu, and swapna sheela. Clinical features of the Prameha may be divided in to 2 groups they are, 01. Samanya Lakshanas. 02. Vishesha Lakshanas.Samanya Lakshanas73 Charaka has not described the general or samanya lakshanas of Prameha where asSushruta and Vagbhata have given the samanya lakshanas clearly. They are – 01. Prabhoota mootrata 02. Avila moootrataVishesha Lakshanas Charaka, Sushruta and Vagbhata mentioned the vishesha lakshanas.Kaphaja Pramehas 74 01. Udaka meha : - The person passes clear urine, excessive in quantity, whitish, cool, odourless and watery. 02. Ikshumeha : - The urine of person becomes sweat, cool slightly viscid, turbid and resembling the juice of sugar cane. 03. Sandra meha : - The urine gets thickened if kept over night in a vessel. 50 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” 04. Sandraprasada meha : - The character of urine manifests here partly dense and partly clear after keeping in a vessel. 05. Shukla meha : - White urines are excreted here and appear as if mixed with flour, and frequency of maturation takes place. 06. Shukra meha : - The person frequently passes urine, white, appears like shukra. 07. Sheeta meha : - The person excretes here large quantities of urine, which is exceedingly sweet and cold. 08. Sikata meha : - The passing of urine is mixed with hard and small particles. 09. 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 Pramehas 75 01. Kshara meha : - The urine is alkali like in character. 02. Kala meha : - The provocation of pitta transforms the urine as warm and black in colour. 03. Neela meha : - Passes urine of the colour of the wings of jaybird and is acidic in reaction. 04. Lohita meha : - Urine smells like raw flesh and saltish warm and red. 05. Manjishta meha : - Person passes urine, which is profuse in quantity smells like fresh meat. 06. Haridra meha : - Urine is of the colour of the colour of turneric water and is pungent. 51 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Vataja Pramehas76 01. Vasa meha : - Provoked vata passes urine mixed with or having the appearance of fat. 02. Majja meha : - Discharges urine with majja frequently due to provoked vata. 03. Hasti meha : - Discharges frequently excusive amounts of urine like elephant. 04. Madhumeha : - Passes urine which is astringent and sweet in taste, yellowish and whitish in colour Urine contains similar proportion of Honey.Madhumeha Roopa77 Acharya Sushruta gives explanation regarding the lakshanas of Madhumeha, asfollows – 01. Gamanat sthananichati 02. Sthanat asananichati 03. Aasanat sayyamichati 04. Shayanat swapnamichati. Apart from the above lakshanas urine similar to honey in colour and taste are alsoattributed to Madhumeha78.Clinical Features79 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. 52 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” 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/minwhich 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. 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 effect of glucose in the kidney tubules. 53 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” 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 similarto pipasa 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 All the stages from the very contact of the body with hetus to the development ofthe disease, including all its avasthas are together called the samprapti of disease. Everyfact connected with the process of disease at its various stages is considered in detailunder samprapti. Thus it is the entire pathogenesis, which takes place in the body underthe influence of etiological factors till the manifestation of disease80. Acharya Charaka says, disease may manifest in various intensity or in differentways based on the vikara vighata bhava and vikara vighata abhava i.e. based on nidana,dosha, dooshya and their degree of vitiation disease may manifest on different ways. 54 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”When the equilibrium of these factors are disturbed or when they do not support eachother or when they are weak due to temporal factors then, either the disease does notmanifest it self or there is delay in manifestation or the disease is very mild or all itssymptoms are not properly manifested. From this we can conclude that manifestations ofdiseases are based on the vikara vighata bhava and abhava81. Even though acharya explained this in the context of Prameha, it is applicable toall diseases.Madhumeha Samprapti82 Only Charaka explains the direct 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 context he explainedthe nidanas, which are almost kapha and pitta vardaka. Over use of Snigdha ahara, avyayama, etc. leads to provocation of kapha and pittaintern causes increase in the quantity of meda and mamsa. Increased above factorsobstruct the path of vata leading to its provocation and thereby, leads ojas to basti causesmadhumeha roga. In this signs and symptoms of vata, pitta and kapha are manifestedfrequently. They vanish at times and appear again. If neglected leads to furthercompilations. As explained earlier only Charaka explains the direct Samprapti of Madhumeha.In classis, samanya Samprapti has also explained which is applicable to madhumeha alsoas it is one among the 20 types of Prameha. Based on the both Symprapti, madhumehaSamprapti can be explained in the following manner. 55 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Due to nidana sevana kapha gets aggravated immediately, among three doshasand here kapha that is vikruta and bahudrava in nature is due to agnimandya. As rasa is the ashrayasthana of kapha and rasa is the aadya dhatu, the bahudravakapha vitiates rasa dhatu and travels all over body because of shithilata and“Thanumaduryata noted”. Here the Shareera shithilata is due to the formation of bahuabadha medas which isformed due to nidana sevana and as a result there is no uttarottara dhatu pushti and leadsto shareera shaithilyata. Bahudravata of shleshma also seen in this condition. As kapha is responsible forshareera sthirata and when bahudravata or vitiation happens shareera shithilata results. Further the buhudrava kapha vitiates medas and causes bahuabadha medas, whichis asamhata in nature. Apart from this bahudrava kapha condition, other factors likenidanas like beeja dosha or kulaja dosha and in sthoulya condition also these abadhamedas is seen. As there is the medovaha srotodushti there is the occurrence ofsthanasamshraya between the kapha and medas as they are having same qualities. Thesedosha dushya samoorchana causes obstruction in the path of vata and vitiates it. This vatatakes bahu drava kapha to all other dooshyas and vitiates them and further aggravationleads to adhika kledata. Thus the increased kleda vitiates other dooshyas and moves, tothe basti and Madhumeha occurs.Samprapti according to Modern83 Diabetes mellitus is characterized by glucose concentrations that are high enoughto over whelm the reapportion capabilities of the kidneys. Glucose appears in urine andurine production generally become excessive. Other metabolic products, such as fattyacids and other lipids are also present in abnormal concentrations. 56 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” While much has been learned in the recent years, the pathogenesis of type IIdiabetes remains enigmatic. There is no evidence that autoimmune mechanisms areinvolved in this. Life style clearly plays a role and clearly evident when obesity isconsidered. Genetic factors are even more important than in type I diabetes. The two metabolic defects that characterize type II diabetes are 01. Derangent on beta cell secretion of insulin. 02. Decreased response of peripheral tissues to respond to insulin (insulin resistance)Deranged beta cell secretion of Insulin In populations at risk for developing type II diabetes, a modest hyperinsulinemiamay be observed, attributed to beta cell hyper responsiveness to physiologic elevations inblood glucose. With the development of overt disease, the pattern of insulin secretionexhibits a subtle change. Early in the course of type II diabetes, insulin secretion appearsto be normal and plasma insulin levels are not reduced. However normal pattern ofinsulin secretion is lost and the rapid first phase of insulin secretion triggered by glucoseis obtunded. Collectively this and other observations suggest derangements in beta cellresponses to hyperglycemia early in type 2 diabetes rather than deficiencies in insulinsynthesis. A mild to moderate deficiency of insulin develops later in the course of type IIdiabetes that is less severe than the- type I. The reason for this is not clearly known butirreversible beta cell damage appears to be present. According to one view, all thesomatic cells of predisposing individual including pancreatic beta cells are geneticallyvulnerable to injury, leading to accelerated cell turnover and premature aging and finallyto reduction in beta-cells mass. Chronic hyperglycemia may exhaust the ability of betacells to function (called glucose toxicity), as a consequence of persistent beta cellstimulation. 57 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Insulin Resistance Insulin deficiency is present in the course, of type II diabetes. Reducedresponsiveness of peripheral tissues i.e. insulin resistance, is a major factor in thedevelopment of type II diabetes. In obesity it is very much prominent or clear. Themolecular basis of insulin resistance is not clear. There may be a decrease in the numberof insulin receptors and more important post receptor signaling by insulin is impaired.Also the insulin resistance leads to, 01. The inability of circulating insulin to properly direct the disposition of glucose. 02. A more persistent hyperglycemia. 03. More Prolonged stimulation of the pancreatic beta cell.Obesity Obesity is an extremely important environmental factor in the formation of type IIdiabetes. Approximately 80% of type II debates are obese. In this, the impaired binding is aresult of decrease in the number of insulin receptors.Amylin Among the pathological changes, which are happening in type II diabetes, themost consistent of these changes is probably deposition of amyloid, which isaccompanied by atrophy of the normal tissue, particularly Islet epithelial cells. In moreadvanced lesions, the Islet is more or less converted to amyloid and the reduction in thenumber of insulin secreting cell is more pronounced than that of glucagons-secretingcells. Heavy deposition of amyloid itself is rare without diabetes. 58 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Acharyas have given importance to the medovaha srotas in the pathogenesis ofmadhumeha. In classics it is mentioned that vapavahana is the moola sthana of medovahasrotas, and which can be considered as pancreas. But there is no much description inAyurvedic classics regarding vapavahana. Charaka has explained that the vapavahana isan udarasthaanga and he also says, it is having the shape of taila varti. So on the basis ofthis physio-anatomical similarity, we can co-relate the vapavahana with pancreas. Butkloma also considered as pancreas by some acharyas. As pipasa mentioned as a klomavikriti lakshana, which is the main characteristics of the madhumeha, here it can also co-relate with the pancreas. Insulin resistance and relative insulin deficiency are the major step in thepathogenesis of the diabetes mellitus on obese individuals. If the pancreas is healthy andif it secretes sufficient insulin even this obese people will also won’t get diabetesmellitus. There is no explanation regarding insulin resistance in Ayurveda. Even thoughin some recent literary works medodhatwagni is correlated with insulin. But, no provesare available for exact co-relation. If we see the pathology, we can see that the concept ofagni plays a great role i.e. agni mandya is considered to play key role in the formation ofaparipakwa dosha and dushyas which is the main defect behind madhumeha. In normal state sthiratwa, dardya, utasaha, vrishada, buddhi, etc are contributed bykapha, which is also known as bala or oja. By seeing this we can co-relate this kapha withglucose. In madhumeha the kapha which is vitiated and which is in bahudravata formtravels all over the body in rasa produces tanu madhuryata, which can be taken ashyperglycemia i.e. increased blood glucose condition. 59 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Also in the Samprapti we can see the word basti. In Ayurveda it has been used indifferent contexts in different meaning i.e. as bladder, whole urinary tract and alsokidney. Sushrutaacharya says nabhi prishta madhyaha basti. Anatomically kidney andureters are situated in this region. Also he says, the term “Bastau” which indicates theplural sense i.e. two kidneys. So, here an attempt is made to co-relate the pathogenic factors mentioned inAyurveda and in modern science. To prove the above ideas correctly, further studies areneeded.Bheda Though prameha is stated to be a condition due to the vitiation of all three doshas,the disease is mainly divided in to 3 groups84 – 01. Kaphaja Pramehas - 10 in number. 02. Pittaja Pramehas - 6 in number. 03. Vataja Pramehas - 4 in number. Even though the three Ayurvedic authorities Charaka, Sushruta and Vagbhataagree the same number of pramehas in each group, they seems to be different in thenomenclature used by them.Table No. 08a. Showing are the Pramehas according to the major classics85,86,87..No. Charaka Sushruta Vagbhat Kaphaja Prameha (10)01. Udaka Meha Udaka Meha Udaka Meha02. Ikshu Meha Ikshu Meha Ikshu Meha03. Sikata Meha Sikata Meha Sikata Meha 60 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”04. Sanair Meha Shanair Meha Shanair Meha05. Sandra Meha Sandra Meha Sandra Meha06. Shukra Meha Shukra Meha Shukra Meha07. Sandra Prasada Meha -- --08. Shukla meha Pishta Meha Pishta Meha09. Sheeta meha -- Sheeta Meha10. Aalala Meha -- Aalala Meha11. -- Sura Meha Sura Meha12. -- Lavana Meha Lavana Meha13. -- Phena Meha -- Pittaj Prameha (06)01. Kshara Meha Kshara Meha Kshara meha02. Kala Meha -- Kala meha03. Neela Meha Neela Meha Neela Meha04. Lohita Meha Shonita Meha Rakta Meha05. Manjishta Meha Manjishta Meha Manjishta Meha06. Haridra Meha Haridra Meha Haridra Meha07. -- Amla Meha -- Vataja Meha (04)01. Vasa Meha Vasa Meha Vasa Meha02. Majja Meha -- Majja Meha03. Hasti Meha Hasti Meha Hasti Meha04. Madhu Meha Kshaudra Meha Madhu Meha05. -- Sarpir Meha -- 61 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Apart from the above classifications, the following types of classification can alsobe given, such as, I. Based on hetu bheda88 01. Sahaja 02. Apathya nimittaja II. Based on chikitsa89 01. Sthoola - balavan 02. Krusha – durbala III. Based on samprapti90 01. Dhatukshayajanya 02. Doshavruttajanya Vagbhata explains that, avritajanya madhumeha is kashta sadhya anddhatukshayajanya as asadya.Classification Of Diabetes Mellitus91I) Primary diabetes (i) Type I Insulin dependent diabetes Mellitus (IDDM) (ii) Type II Non-Insulin dependent diabetes Mellitus (NIDDM) Under this type II again 2 types can be seen 01. Non obese NIDDM 02. Obese NIDDM Genetic defects of beta cell function including maturity on set diabetes of youngknown as MODY (1,2,3). 62 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”II) Secondary Diabetes 01. Pancreatic Pathology (a) Pancreatitis (b) Haemochromatosis (c) Neoplastic disease (d) Pancreactectomy (e) Cystic fibrosis. 02. Iaotrogenic (a) Corticosteroid (b) Thiazide diuretics (c) Phenytoin. 03. Endocrine disease Induced (a) Cushing’s Syndrome (b) Acromegaly (c) Thyrotoxicosis (d) Phaeochromocytoma (e) Glucogonoma. 04. Liver disease 05. Excess endogenous production of hormonal antagonists to insulin (a) Growth hormone (Acromegaly) (b) Glucocorticoids (Cushing’s syndrome) (c) Thyroid hormones (Hyperthyroidism) (d) Catecholaminus (Phalochromocytma) (e) Human placental lactogen (Pregnancy) (f) Glucagon (Glucagonoma) (g) Counter regulatory hormones (Severe burns, trauma). 06. Gestational diabetes mellitus 63 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Kulaja dosha and beeja dosha have been mentioned in the causative factors ofsahaja Prameha. Such patients are said to be weak, emaciated, suffering from thirst, lossof appetite and are required to be treated with a nourishing diet. In diabetes also genetic and hereditary factors are mentioned as causative factor.In such patients, weakness and emaciation are noted. They are also asthenic. The above-mentioned patients are juvenile diabetics and require a nourishing diet. There for sahajaprameha and Juvenile diabetes may be correlated. Apathya nimittaja Madhumeha explained on Ayurveda, in such patient’satikshudha, atinidra and aalasya are noted. And it is caused due to over intake ofmadhura snigdha aahara and vihara which favours kapha-medovriddhi Maturity onsetdiabetes tend to over eat and are lazy in nature, even though age factor is not mentionedin Ayurveda while explaining chikitsa in Ayurveda, acharya have explained sthoola andkrisha classification. The same type of classification can be seen in Modern Science asobese and non-obese type. Apart from the above, doshika type of classification is widely explained inAyurveda. But detailed explanation of sthoola and krisha types explained above is notavailable in classics.Sadhyaasadhyata The physician who knows the difference between curable and incurable diseaseand begins treatment in time with a thorough knowledge of the case, succeeds in hisefforts without any doubt. Those who lack the above knowledge invariably suffer loss ofincome and fame. Like other diseases, the knowledge of Sadhyaasadhyata is veryimportant in case of madhumeha. The sadhyaasadhyata or prognosis should be assessed 64 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”based on the following factors such as hetu, poorvaroopa, roopa, dosha, dooshya, prakriti,kala, desha upadrava, sarvoushadhakshamata, Chatushpada, etc. As discussed earlier, Prameha is commonly classified is to three verities92. 01. Kaphaja Prameha -10 in number. 02. Pittaja Prameha - 6 in number. 03. Vataja Prameha - 4 in number. Among the above 3 verities kaphaja types are considered as curable (sadhya),because, the meda having homogenous properties is affected and the kapha is dominant.Both these factors are amendable to the same type of treatment93. The Six-pittaja pramehas are only yapya. Because the dosha involved are mainlypitta and when it associates with kapha-medas leads to antagonism in the treatment. Themain reason for this yapyata is contradiction in the treatment due to opposite treatmentinvolvement among pitta and meda94. The four verities of vataja prameha due to vitiation of vata are known to beincurable or asadhya, because of their seriousness and also due to the contradictioninvolved in the treatment95. The factors that are considered as pathya for vayu is an apathya for meda. Sodue to virudhopakrama or contradiction in treatment, vataja prameha is considered asasadhya. As madhumeha is a variety of vataja prameha, it is also considered as asadya.But Vagbhata and Charaka acharya termed avruttajanya madhumeha as kruchra sadhyavyadhi96. 65 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Apart from the above considerations following situation should also be taken into consideration. 01. The Kaphaja and pittaja groups of prameha, if they are developed after full expression of poorvaroopas, they are asadhya97. 02. Kaphaja prameha gradually develop in to pittaja prameha and they both transform in to vataja prameha, which are incurable98. 03. If kaphaja prameha gradually turns in to pittaja prameha these are yapya. 04. Even the pittaja pramehas are curable if there is no severe vitiation of medas. 05. The patients who are pramehi right from birth (Jata pramehi) and those who have prameha due to beeja dosha are treated as asadhya99. 06. All the prameha if untreated or neglected, it ends in madhumeha in their due course and it is considered as asadhya. 07. It is stated that prameha patent suffering with pidakas and complications like hridgraha, then he should be considered as madhumeha rogi and this type of madhumeha is incurable100. Basavaraja a 16th century physician of Andra Pradesh has mentioned a test forurine for finding the prognosis of each dosha group. The urine of a prameha patient is tobe collected in a wide mouthed vessel 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 ¼th and kaphaja prameha is incurable if the residueis 1/9th. 101 66 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Vyavachedaka Nidana Vyavachedaka nidana or differential diagnosis helps a physician to establishaccurate diagnosis of the disease. This is a method to diagnose the particular disease bycomparing its signs and symptoms with other diseases. Prabhoota mootrata and Avila mootrata are the lakshanas, which will manifests inall the 20 varieties of pramehas. So as to distinguish madhumeha from other pramehasthe study of them should be made. In Ayurveda the acharyas mentioned 20 types of pramehas and among thatmadhumeha is the one. Detailed descriptions regarding the each type along with itscharacteristics are already discussed. As sthoola madhumeha is considered as apathya nimittaja variety of pramehas,sahaja prameha has to be differentiated form this102.Table No. 09. Showing the Vyavachedaka nidana. Apathyanimittaja Sahaja Mithyaahara and vihara Beeja dosha Snigdha RookshaNidana Lakshanas Bahuashee Alpashee Sthoola Krisha Shayyasana Paribhramana sheela Swapna sheela 67 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Upadrava Upadrava is a disease produced after the manifestation of the original disease anddepends on that disease irrespective of whether upadrava is major or minor103. After the occurrence of the original disease the dosha or doshas are furthervitiated owing to abnormal ahara, vihara etc, thus leading to a secondary disease orcomplication which is known as an upadrava in Ayurveda. Acharya Charaka has described the upadrava of prameha in general where asSushruta and Vagbhata have mentioned updravas separately for each doshic group. General upadvas of prameha according to Charaka 104 01. Trishna 02. Dourbalya 03. Arochaka 04. Avipaka 05. Vidradhi 06. Jwara 07. Pidaka 08. Atisara 09. Daha 10. Puti mamsa 11. Alaji 68 Disease Review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”ClassificationTable No. 10.Upadravas of prameha according to Vagbhata and Sushruta on doshabasis105.No. Upadrava Vagbhata Sushruta Kaphaja prameha updravas01. Aalasyam - +02. Pratishyaya + +03. Shaithilya - +04. Aruchi + +05. Avipaka + +06. Kapha Prasekam - +07. Chardi + +08. Nidra + +09. Kasa + +10. Swasa - + Pittaja prameha upadravas01. Vrishana vedana + +02. Vasti shoola + +03. Medhra todha + +04. Hrit shoola - +05. Amlodgara + +06. Jwara + +07. Atisara - + 69 Disease review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”08. Arochaka - +09. Daha + +10. Moorcha + +11. Pipasa - +12. Nidranasha - +13. Pandu roga - +14. Trishna + -15. Peeta mootra netra twak - + Vataja prameha Upadravas01. Hrid graha + +02. Loulya + +03. Anidra + +04. Sthambha - +05. Kampa - +06. Shoola + +07. Badda pureeshatwam - +08. Udavarta + -09. Kanthagraha + -10. Sosha + -11. Kasa + -12. Swasa + - Madhavakara and Bhavamishra also mentioned the same in Vagbhata way. 70 Disease review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Prameha 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 madhumeha106. There are different opinions among the acharyas regarding the number of pidakasas follows. 107,108,109.No. Charaka Sushruta Vagbhata01. Sharavika Sharavika Sharavika02. Kachapika Kachaptka Kachapika03. Jalini Jalini Jalini04. Sarshapika Sarshapika Sarshapika05. Alaji Alaji Alaji06. Vinata Vinata Vinata07. Vidradi Vidhradi Vidhradi08. - Masurika Kuluttika09. - Putrini Putrini10. - Vidarika VidarikaComplications Of Diabetes110 01. Hypoglycemia 02. Diabetic ketoacidosis 03. Non-ketotic hyperosmolar diabetic coma 04. Diabetic macro angiopathy etc. 71 Disease review
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Long-term complications of Diabetes are, 01. Diabetic Nephropathy. 02. Diabetic Retinopathy. 03. Diabetic Neuropathy. 04. Diabetic foot etc. Same of the upadravas of Ayurveda can be correlated to some of thecomplications of modern science. For eg. trishana, bhrama, shoola, tamapravesha, shwasacan be correlated to Diabetic ketoacidosis, in which thirst, weakness, blurring vision,abdominal pain, airhunger, etc are seen. Above conditions are seen in hypoglycemiccondition also. Reticulopathy, a type of diabetic neuropathy is a sensory syndrome in which, painoccurs over the distribution of one or more spinal nerves usually in chest wall orabdomen. It mimics acute surgical abdomen. Shoola (Udarashoola) explained inAyurveda can be correlated to this. 72 Disease review
    • 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
    • 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
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”CHIKITSAChikitsa paribhasha The term chikitsa is derived from the root “Kit rogapanayane” according toShabda stoma mahanidhi, According to Amarakosha chikitsa is “Ruk Pratikriya”. So the ultimate aim of chikitsa is “Swasthasya Swasthya Rakshanam andAaturasya roga nivaranam”. Acharya Charaka while explaining the line of treatment, or chikitsa sootraexplains 2 varieties of pramehis. They are as follows111. 01. Sthoola - balavan 02. Krusha - durabala. For above two types, two different line of treatments are explained. Among thesetwo, the first one is the sthoola-balavan and having doshabaladhikya should be given withsamshodhana therapies, and the second one i.e. Krusha-durbala should be treated withsamshamana therapies. Vagbhata also says that, the pramehis those who are having goodbala should be administered with shodhana kriyas. Sushruta acharya mentions 2 types of pramehis. They are112 01. Sahaja Pramehi 02. Apathya Nimittaja Pramehi. Among there, sahaja prameha is due to beeja dosha and such patient are krusha innature. They should be treated with shamana oushadhas and annapanas, which are treatedwith pramehahara oushadhis. 72 I Chikitsa
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” The apathya nimttaja sthoola pramehi should be given apatarpana chikitsa. Afterthe completion of samshodhana kriya, the patient is to be subjected to santarpana Kriya. Again Charaka described the special chikitsa for each type of prameha i.e.kaphaja, pittaja and vataja. Proper vamana kriya and langhana kriya administered atproper time cures kaphaja prameha. The virechana kriya, the santarpana kriya andsamshamana kriyas cures the pittaja variety of prameha113. Even though the vatajapramehas are stated to be incurable, the duty of a physician is to help the patient to livelonger by preventing the complications. So the vataja prameha should also be treatedaccordingly. Shamana chikitsa is indicated for a prameha patient who is not eligible forshodhana chikitsa and also the patient who has completed the shodhana karmasuccessfully. Many verities of decoctions, choornas and lehyas have been described for thetreatment of the twenty varieties of prameha by all Ayurvedic authorities. Sushruta has separately devoted one chapter for the treatment of madhumeha114. In that he has prescribed shilajatu, makshika and tuvarka exclusively in thetreatment of Madhumeha.Treatment In Kriyakalas Sushruta has explained prameha chikitsa based kriyakalas115. In the poorvaroopacondition (Sthana samsrayam), Vanaspati kashaya, basthi mootra, etc should be administered. If the above kriyasare not done and if the person continues madhurahara sevana, his urine, sweat andshleshma become sweet and the prameha lakshanas become clear i.e, vyakta stage. 72II Chikitsa
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” In this condition urdwa, adha, shodhana should be done. If it is not done thedoshas become pravridha and vitiates mamsa, shonita and causes shopha. In this stageshopha chikitsa and sira moksha should be done i.e. bheda stage. If this condition is leftuntreated the shopha becomes big with increased pain and in this condition shastra kriyashould be done and also vranakriyaopaseva. In this condition also, the treatment is not adopted the condition become asadhya.Pathyaapathya The term pathya means that which is compatible to health and apathyam is thatwhich is incompatible to health116. It has already been stated that the main etiology of madhumeha is excessiveindulgence of guru, snigdha, amla, lavana padarthas and by using new food grain anddrinks. Because of this, for a madhumeha patient of recent origin dietary control is themain one. The principal diet of the patient should be yavadhanya or barley117. The patient should be given mantha, kashayas and linctuses made of the powderof barley and the food, which is easily digestible. Cooked barley mixed with snigdhadravya, saktu and apoopa made of barley mixed with the soups of the flesh of the birds ofvishkira and pratuda group and also the meat juice of jangala animals should be given asdiet. The patient should be given cooked old rice with the soup of green-gram and otherpulses and bitter vegetables. A patient suffering from kaphaja prameha should eat variouspreparations of barley mixed with honey118. The barley steeped over night in the decoction of triphala and taken with honeyand seedhu wine is the best nutrient diet for prameha patient. The patient should usebarley soaked in the various decoctions prescribed for the cure of the kaphaja prameha. 72III Chikitsa
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Patient should use various eatables prepared of barley which have been previously give todonkeys, horses, cows, swans and deer and excreted by them in their dung, should beused119. Patient should drink water prepared with kusha, darba or madhukam or triphalakashayam or seedu madya. The man who habituated to roasted barely, dry baked barley,barley powder, green-gram and amalaki, does not get prameha, switra, mootrakrichra andkaphaja kushta120.Pathya Viharas Prameha can be controlled by vyayama, udvartana, snana, jalasechana and lepaswith twak, ela, agaru, chandana, etc. Sushruta explains wrestling, active sports, riding on a horse or elephant, longwalking, javelin throwing, etc. as good viharas in prameha. He also suggested a walk ofhundred yojanas simply without paricharakas, shoe and umbrella. A rich man sufferingfrom prameha should live by taking amalaki, kapitta, tinduka and mantaka and live alongwith deer. He should walk with cow and should take mala mootra of cows as diet121. Aweak and emaciated patient should not be advised any physical exercise.Pathya according to Yogaratnakara122 Shalidhanya, patola, tanduliyaka, vastuka, mudga, yoosha, apakva kadaliphalam,kodrava, godhuma, kulattha, tikta shakha like klaravellaka, jangala mamsa rasa,saindhava and maricha, etc.Apathya Aharas Navanna, dadhi, souvirakam, sura, shuktam, kshara, ghrita, ikshurasa vikaras,pishtanna, anoopa mamsam, doomapanam, swedanam, raktamoksham, mootra vegadharana, diwaswapnam and sadaasana. 72 IV Chikitsa
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”DRUG REVIEW After describing the details regarding various aspects of virechana karma andmadhumeha, it is necessary to go through the details of treatment adopted in the presentstudy. The treatment adopted is virechana karma and for this, as a poorva karma deepanapachana, arohana snehapana and swedana are necessary. For this purposes the followingyogas are used – 01. Deepana pachana – Trikattu churna123. 02. Snehapana – Thrikantakadyam ghritam124. 03. Abhynaga and swedwa – Moorchita tila taila and ushnajala snana 125 04. Virechana – Vidanga tanduladi churna126. The drugs used to prepare the above yogas along with its properties are givenbelow – 73 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 11. Showing the properties of the ingredients of Trikatu churnaSl. San. Latin Family Rasa Guna Veerya Vipaka Doshaghnata Karma Name Name01. Pippali127 Piper Piperaceae Katu Laghu, Anushna Madhura Kapha-vata Anulomana, Pachana, longum snigdha, sheeta Yakrit pleeha teekshna vikaraghnam02. Marich128 Piper Piperaceae Katu Laghu, Ushna Katu Vata-kapha Deepana-pachana, nigrum teekshna yakritottejaka, vatanulomana03. Shunthi129 Zinziber Zinziberaceae katu Laghu, Ushna Madhura Kapha-vata Agni deepana, officinali snigdha pachana, vatanulomana 74 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 12. Showing the properties of the ingredients of Thrikantakadyam ghritam.Sl. San. Name Latin Name Family Rasa Guna Veerya Vipaka Doshaghnata Karma01. Manjishta130 Rubi cordifolia Rubiacea Kashaya, Guru, Ushna Katu Kapha, Pitta Pramehahara, tikta, ruksha deepana, madhura pachana, balya, jwaraghna, rakta shodhaka02. Musta131 Cyprus Cyperaceae Tikta Laghu, Sheeta Katu Kapha, Pitta Kledahara, rotandus ruksha deepana, pachana, rakta prasadana, mutrala, trishnahara03. Patola132 Trichocanthes Cucurbitaceae Tikta Laghu, Ushna Katu Tridosha Deepana, dioica ruksha pachana, anulomana, rakta shodhaka, virechana, trishnanigrahana 75 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Sl. San. Name Latin Name Family Rasa Guna Veerya Vipaka Doshaghnata Karma04. Ativisha133 Aconitum Cucurbitaceae Tikta Laghu Ushna Katu Tridosha Medohara, kaphahara, heterophyllum ajeernaghnam vrishya, raktashodhaka05. Gokshura134 Tribulus Zygophyllaceae Madhura Guru, Sheeta Madhura Tridosha Anulomana, terrestris snigdha mutrala, pleehaghna06. Haridra135 Curcuma longa Sciataminae Tikta, Ruksha, Ushna Katu Tridosha Amahara, mutra katu laghu virajaneeya, pramehahara, raktaprasadana07. Lodhra136 Symplocos Symplocaceae Kashaya Ruksha, Sheeta Katu Kapha, pitta Shophahara, racemosa laghu raktavikara prashamana, kushtaghna.08. Vacha137 Acorus Araceae Tikta, Laghu, Ushna Katu Kapha, vata Medohara, calamus katu teekshna, anulomana, sara mutrajanana, reducesrakta bhara 76 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Sl. San. Name Latin Name Family Rasa Guna Veerya Vipaka Doshaghnata Karma09. Arjuna138 Terminalia Combertaceae Kashaya Laghu, Sheeta Katu Kapha, pitta Hridya, arjuna ruksha medohara, pramehahara, mutradoshahara10. Padmaka139 Prunus Rosaceae Kashaya, Laghu, Sheeta Katu Tridosha Hridya, cirasoidus tikta snigdha medohara, antipruritic, ashmarighna11. Arishta140 Azadirachta Meliaceae Tikta, Laghu Sheeta Katu Kapha, pitta Pramehahara, indica kashaya anulomana, kushtaghna12. Chandana141 Santalum alba Santalacae Tikta, Laghu, Sheeta Katu Pitta, kapha Basti shodhaka, madhura ruksha rakta vikarahara, yakrit uttejaka13. Agaru142 Aquilaria Thymelecea Katu, Laghu, Ushna Katu Kapha vata Mutrashaya shithila nashana, agallocta tikta rooksha, anulomana, teekshna rakta shodhaka, shoshahara, 77 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Sl. San. Name Latin Name Family Rasa Guna Veerya Vipaka Doshaghnata Karma14. Deepyaka Carum Umbellifere Katu,tikta Laghu, Ushna Katu Kapha-vata Mutra (Ajamoda) roxburghianum rooksha, pravartaka, 143 teekshna deepana, vidahi, hridayottejaka15. Bhallataka144 Semacarpus Anacardiaceae Madhura, Laghu, Ushna Madhura Tridosha Deepana, anacardium kashaya snigdha, pachana, teekshna, yakrittotejaka, ushna hridayottejaka, nadibalaprada.16. Khadira145 Acacia catechu Legumineseae Tikta, Laghu, Sheeta Katu Kapha, pitta Pramehaghna, kashaya ruksha Kushtaghna, Medohara 78 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 13. Showing the properties of the ingredients of Moorchita tila taila.Sl. Sankrit Latin name Family Rasa Guna Veerya Vipaka Doshaghnata Karma name01. Tila taila Sesamum Pedaliaceae Madhura, Sookshma, Ushna Madhura Tridoshaghna Deepana, indicum kashaya, vyavayi, pachana, tikta vikashi, pramehahara, vishada, vrinahara, guru, sara, mamsadhatu teekshna, pushtikara, hima keshya, netrya. sparsha 79 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No.14. Showing the properties of drugs used in Vidangatanduladi churna.Sl. Sankrit Latin name Family Rasa Guna Veerya Vipaka Doshaghnata Karma name01. Vidanga Embelia Myrsinacae Katu, Laghu, Ushna Katu Vata kapha Medohara, 146 ribes kashaya rookhsa, Kushtaghna, teekshna anuloma, deepana, pachana02. Amalaki Emblica Euphorbiaceae Pancharasa Guru, Sheeta Madhura Tidosha Anulomana, 147 officinalis amla sheeta, pramehaghna pradhana rooksha03. Vibhitaki Terminalia Combertaceae Kashaya Laghu, Ushna Madhura Tridosha Anulomana, 148 bellerica ruksha virechaka04. Haritaki Terminalia Combertaceae Pancharasa Laghu, Ushna Madhura Tridosha Vibandhaghna, lavana rooksha pachana, 149 chabula varjita yakritpleehottej aka 80 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Sl. Sankrit Latin name Family Rasa Guna Veerya Vipaka Doshaghnata Karma name05. Pippali150 Piper Piperaceae Katu Laghu, Anushnas Madhura Kapha vata Virechaka, longum snigdha, heeta pachana, teekshna yakritpleehottej aka06. Trivrit151 Operculina Convoluaceae Katu, tikta, Laghu, Ushna Katu Kapha pitta Virechaka, turpentum madhura, rooksha, medohara kashaya teekshna07. Yavaskha Horadeum Katu Laghu, Ushna Katu Kapha vata Kaphavata roga, pleehodara, ra152 velgar ash snigdha, shukra- sookshma shleshma- vibandhahara, mutraghatahara, mootrakrichhrah ara 81 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Chemical composition of virechana drugsVidanga – Embelia ribes153 Part used – Berries, leaves and rook bark. Chemical composition – Contains embelic acid, a volatile and fixed oil, colouring matter, tannin, a resinoidbody acid and an alkaloid called christembine. Crystalline compounds of embolic acidwith soda, potash and ammonia are obtained. Berries contain vidangin. Embolic acid contains the following derivations, 01. A monoacetyl derivative. 02. A monosemicarbazone 03. A dihydrazone 04. An oxime 05. A di-semicarbazone. Action – Fruits or dried berries are carminative, antihelminthic, stimulant and alterative.Pulp is purgative. Fresh juice is cooling, diuretic and laxative.Amalaki – Emblica officinalis 154 Parts used – Dried fruits, nut or seed, leaves, root, bark, and flowers. Chemical composition – Fruits contain tannic acid, albumin, cellulose, calcium, etc. it contains vitamin Cin large amount. Also contains protein, carbohydrate, red phosphorus, iron and nicotinicacid. Seeds contain yellow oil. 82 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Action – Fresh fruit is refrigerant, diuretic and laxative. Green fruit is exceedingly acid.Fruit is also carminative and stomachic. Dried fruit is sour and astringent. Flowers arecooling and aperient. Bark is astringent.Haritaki – Teminalia chebula155 Parts used – Dried fruits, immature fruits, myrobalans, and mature fruit. Mostly outer skin of fruit. Chemical composition – Myrobalans contain astringent principles, tannin and a large amount of gallic acid,lucilage, a brown yellow colouring matter, chebulic acid which when heated in watersplits up in to tannic and gallic acids. Actions – Myrobalans are safe and affective. Purgative, astringent and alterative. Unripefruits are more purgative and the ripe are astringent. Rangari harade are alternative,stomachic, laxative and tonic. Suvari harade is a valuable purgative. Bala harade is a mildand safe aperient and antibilious, through astringent. Ripe fruit is considered as purgativeremoving bile and phlegm and to adjust bile.Vibhitaki – Termianlia bellerica156 Part used – Fruits. Chemical composition – Beleric myrobalans consist of gallo-tannic acid, colouring matter, resins andgreenish yellow oil. 83 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Action – Astringent tonic, expectorant and laxative.Pippali – Piper longum 157 Parts used – Immature berries (i.e. dried unripe fruits or fruiting spikes) dried in the sun andstems (roots). Chemical constituents – Resin, volatile oil, starch, gum, fatty oil, inorganic matter and an alkaloid,piperine 1-2 p.c. Action – Infusion is stimulant, carminative and alternative tonic more powerful than blackpepper, also aphrodisiac, diuretic, vermifuge and emmenagogue. Root is stimulant.Trivrit – Operculina turpentum 158 Part used – Root bark. Chemical composition – Resin, volatile oil, starch, gum, fatty oil, inorganic matter and resin piperine 1-2%. Also contain resin, albumin, iron, lignanine and some salts. Action – Root bark contains turpethine, which causes purgation. 84 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Yavakshara – Hordeum vulgare ash. 159 Part used – Ash. Ripped barley plants should be cut, dried, and then burnt to ashes and thealkaline material, obtained form that ash by kshara vidhi, is known as yavakshara. Forburning, spikes or whole plant may be taken. Chemical composition – Mainly contain potassium chloride 50.8%, potassium sulphate 20.2%, potassiumbicarbonate 12.6% and potassium carbonate 6.8%. Thus it is a mixture of potassium salts. 85 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Research approach In this work, the aim was to evaluate the efficacy of virechana karma clinically inMadhumeha roga. After the completion of the full treatment the results were assessed by comparingthe before treatment data with 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 was done in a single group. Prospective clinical trial. The treatment modality used in this clinical study was virechana karma, whichincluded deepana-pachana with trikatu choorna, snehapana with thrikantakadym ghritam,abhyanga sweda with moorchhita tila taila and ushna jala snana. Virechana usingVidanga tanduladi choorna, which was followed by samsarjana karma and follow – upfor one month. During the follow-up period patients were given placebo capsules.Sample size A minimum of 30 patients were taken for study. All the patients received classicalvirechana 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. 86 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Patients having the clinical features of madhumeha. Irrespective of sex. Madhumeha patients having good body strength, sthoola and also fit for virechana 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.Plan of study Selected patients were given virechana 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. Snehapana – For snehapana thrikantakadyam ghrita was selected. After attaining appropriate niramata, the snehapana was started with hrasveeyasi matra i.e. 30 ml and gradually increased to 3 or 4 days. It is mentioned in classics that for madhumeha rogis, less sneha is enough, as kaphotklesha is already there. C. Abhynaga and sweda – As sweda is contraindicated in Madhumeha, the patients were administered with abhynaga and ushna jala snana. For abhynaga moorchita tila taila was used. 87 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” D. Virechana karma – On fourth day the patients were given with virechana yoga after assessing status of patient’s koshta, bala, etc. The medicine used was Vidanga tanduladi choorna. E. Samsarjana karma – Samsarjana karma was performed depending upon the shuddhi. F. 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.Investigations and Selection of PatientsObjective parameters The following investigations were done prior to the study. 01. Blood – FBS, PPBS. 02. 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. 160Sl. Level FBS RBS PPBS Urine sugar01. Normal 70-120 mg/dl. 120-180 120-180 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 above above above above 88 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Subjective parameters Apart form the above parameters; the following parameters were also taken forassessing the patient. They are – 01. Prabhuta mutrata 02. Kshudadhikya 03. Pipasadhikya 04. Karapada daha 05. Ati swedaMethod of Assessment and grading The assessment of results by observing the severity of symptomatology as well asthe laboratory investigations. The severity of the symptoms, urine sugar, fasting blood sugar and post prandialblood sugar were assessed before the treatment, after snehapana, after virechana, after15th and 30th day of follow up.Grading of parameters The results were evaluated by observing subjective and objective parameters bygrading method. The grading was done in the following manner. 01. Prabhuta mutrata – Grade 0 – 2-3 times / day, 0-1 times / night. Grade 1 – 4-5 times / day, 2-3 times / night. Grade 2 – 6-7 times / day, 4-5 times / night. Grade 3 – > 7 times / day, > 5 times / night. 02. Pipasadhikya – 89 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Grade 0 – Normal. Grade 1 – Slightly increased. Grade 2 – Severely increased.03. Kshudhadhikya – Grade 0 – Normal. Grade 1 – Increased, but can tolerate. Grade 2 – Increased, but can’t tolerate without consuming food.04. Kara pada daha – Grade 0 – Absent. Grade 1 – Slightly present. Grade 2 – Present.05. Ati sweda – Grade 0 – Absent. Grade 1 – Present.06. F.B.S. – FBS levels, Grade 0 - 120 and below Grade 1 - 121-140 Grade 2 - 141-160 Grade 3 - 161-180 Grade 4 - 181-200 Grade 5 - 201-22007. PPBS (Post prandial Sugar) – 90 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” 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 - 261-28008. Urine sugar – Urine sugar - Grade 0 - Nil Grade 1 - 0.5 Grade 2 - 1.0 - 1.5 91 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Overall Assessment – The overall assessment of the study was performed by considering all theparameters of assessment and for that following method of overall grading was used.01. Good response - Patients with 60% and above results, by considering all subjective and objective parameters.02. Moderate response - Patients with 30% to 59% results, by considering all subjective and objective parameters.03. Poor response - Patient with 1% to 29% of results by considering all subjective and objective parameters.04. No response - Patients with no change after considering all subjects and objective parameters. 92 Study plan
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” In the present clinical study subjective and objective changes wereconsidered for the assessment of Ayurvedic management of Sthoola madhumeha withclassical virechana karma. Thirty patients were selected and were administered withvirechana. All the patients were assessed before and after the treatment. Both subjectiveand objective changes were recorded according to the guidelines of proforma of casesheet. The data were collected as follows: - 1. Demographic data 2. Data related to etiological factors, type, duration, etc. 3. Data related to incidence of disease and response to treatment. 4. Data related to subjective and objective parameters before and after treatment. 5. Statistical analysis and assessment for response. 93 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 20 Showing the age group incidence and response.Sl. Age No. of % GR % MR % PR %NO Groups Pts.01. 35-39 5 16 3 60 2 40 - -02. 40-44 3 10 3 100 - - - -03. 45-49 7 23 4 57 2 28.5 1 14.204. 50-54 6 20 3 50 3 50 - -05. 55-59 7 23 2 28 4 57 1 14.206. 60-64 2 6.6 2 100 - - - - Among age group 35-39 it contains 5 patients i.e. (16%) and in that 3 patientsresponded good (60%), and 2 patients responded moderately (40%). 40-44 age group includes 3 patients i.e. 10% and in that all 3 patients respondedgood. Age group 45-49 includes 7 patients i.e. 23% and in that 4 patients (57%)responded god, 2 patient (28.5%) responded moderately and 1 patient’s response waspoor (14.2%) Age group 50-54 includes 6 patients i.e. 20%. In that 3 patients responded goodand 3 patents moderately i.e. each 50%. 55-59 age group contains 7 patients i.e. 23% is in that 2 patients responded good(28.6%), 4 patients responded moderately (57%) and 1 patient response was poor(14.2%). Last 60-64 age group includes 2 patients i.e. 6.6% and in that all 2 patentsresponded good (100%).Figure No. 04. Ag e gr oup inc id e nc e & r e s pons e 8 7 7 7 6 6 5 No. of Pt.s 5 4 4 4 3 33 33 3 2 2 2 22 2 1 1 1 0 00 0 00 0 35-39 40 - 4 4 45-49 50-54 55-59 60 - 6 4 No . o f Pt.s GR MR PR Age group 94 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 21. Showing the Sex group incidence and response.Sl.No Sex No. of % GR % MR % PR % Pts. 01. Male 22 73.33 12 54.5 9 40.9 1 4.5 02. Female 8 26.66 5 62.5 2 25 1 12.5 Out of 30 patients, 22 were males (73.33%) and 8 were females (26.66%). Amongmales 12 patients (54.5%) responded good, 9 patients (40.4%) responded moderately and1 patient’s (4.5%), response was poor. Among females 5 patients responded good (62.5%), 2 patients respondedmoderately (25%) and 1 patient’s (12.5%) response was poor.Figure No. 05. S e x inc ide nc e & re s pons e 25 22 20 No. of Pt.s 15 12 9 8 10 5 5 2 1 1 0 Male Female No. of pts . GR MR PR Se x 95 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 22. Showing the incidence of religion and response.Sl. Religion No. of pts. % GR % MR % PR %No01 Hindu 25 83.33 14 56 9 36 2 802 Muslim 4 13.33 3 75 1 25 - -03 Christian 1 3.33 - - 1 100% - -04 Others 0 0% - - - - - - In religion 25 patients were hindu (83.33%), 4 patients were muslim (13.33%)and 1 patient was Christian (3.33%). Among the hindus, 14 patients (56%) respondedgood, 9 patients (36%) responded moderately and 2 patients (8%) response was poor. Theonly one Christian patient responded moderately (100%).Figure No. 06. Re ligion incide nce & re sponse 30 25 25 No. of Pt.;s 20 14 15 9 10 4 3 5 2 1 0 1 0 1 0 0 0 0 0 0 Hindu Musilin Christain Others No. of Pt.s GR MR PR Re ligion 96 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 23 Showing the incidence of occupation and response.Sl. Occupation No. of Pts % GR % MR % PR %No01 Sedentary 17 56.66 10 58.8 6 35.2 1 5.802 Active 0 0 - - - - - -03 Labor 13 43.33 7 53.8 5 38.4 1 7.604 Others 0 0 - - - - - - In occupation status, 17 patients were sedentary (56.66%), and 13 patients werelabors (43.33%). Among the sedentary category 10 patients (58.8%) responded good, 6 patients(35.2%) responded moderately and 1 patient’s (5.8%) response was poor. Among labors 7 patients responded good (53.8%), 5 patients (38.4%) respondedmoderately, and 1 patient (7.6%) response was poor.Figure No. 07. Occua ption incide nce & re sponse 20 17 15 13 No. of Pt.s 10 10 6 7 5 5 1 0 0 0 0 1 0 0 0 0 0 Sedentary Active Labor Others No. of Pt.s GR MR PR Occupation 97 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 24 Showing the Socioeconomic Status and response. Sl. Eco. Status No. % Goo % Mod. % Poo % of d r Pts.01. Poor 1 3.33 1 100 - -02. Middle 6 20 3 50 3 50 - -03. Upper 13 43.33 8 61.5 4 30.7 1 7.6 middle04. High class 10 33.33 6 60 3 30 1 10 Among 30 patients 1 patient was poor (3.33%) and that patient respondedmoderately. 6 patients (20%) were middle class, among them 3 patients (50%) response wasgood and remaining 3 patients (50%) responded moderately. 13 patients were upper middle class and in that 8 patients (61.5%) respondedgood, 4 patients (30.7%) responded moderately and 1 patient’s (7.6%) response was poor. Among 10 high-class patient (33.33%). 6 Patients (60%) responded good, 3patients (30%) responded moderately and one patient (10%) response was poor.Figure No. 08. Socio-economical status & response 15 13 10 No. of Pt.s 10 8 6 6 5 3 3 4 3 1 1 0 0 1 1 0 Poor Middle Upper middle High class No. of Pts. Good Mod. Poor Economical satus 98 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 25. Showing the food habits and response.Sl. Diet No. of pts. % GR % MR % PR %01. Veg. 15 50 11 73.3 3 20 1 6.602. Mixed 15 50 6 40 8 53.3 1 6.6 Among 30 patients, 15 patients were vegetarians (50%) and remaining 15 patients(50%) used to consume mixed food. Among vegetarian 11 patients (73.3%) respondedgood, 3 patients (20%) responded moderately and I patient’s reponse was poor. Among patients consuming mixed diet, 6 patients (40%) responded good, 8patients (53.3%) responded moderately and 1 patient’s (6.6%) response was poor.Figure No. 09. 16 15 Food habits & response 15 14 12 11 No. of Pt.s 10 8 8 6 6 4 3 2 1 1 0 Veg. Mixed No. of pts. GR MR PR Food habit 99 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 26. Showing the chronicity and response.Sl. Duration No. of % GR % MR. % PR % pts.01. Newly diagnosed 8 26.6 5 62.5 3 37.5 - -02. Below 1 yr. 3 10.0 2 66.6 1 33.3 1 -03. 1-2 yrs. 16 53.33 9 56.2 6 37.5 1 6.204. More than 2 yrs. 3 10.0 1 33.3 1 33.3 1 33.3 Among 30 patients, 8 patients (26.66%) were newly diagnosed. In that category, 5patients (62.5%) responded good and 3 patients (37.5%) responded moderately. In the below 1 year group which contains 3 patients (10%) and in that 2 patients(66.6%) responded good and 1 patient’s response was moderate (33.3%). In the 1-2 year group contains 16 patients (53.33%). Among them 9 patients(56.2%) responded good, 6 patients (37.5%) responded moderately and 1 patient’s(6.26%) response was poor. More than 2 year group contains 3 patients (10%) and in that 3 patients respondedgood, moderate and poor respectively i.e. (33.3%) each.Figure No. 10. C h r o n ic ity & r e s p o n s e 20 16 15 No. of Pt. 9 10 8 5 6 5 3 3 2 3 0 1 0 1 1 1 1 0 ND <1 yr. 1 -2 yrs . >2 yrs . N o . o f P ts GR MR PR Chronic ity 100 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 27. Showing the treatment history and response.Sl. Treatment history No. of % GR % MR. % PR % pts.01. Allopathic treatment 20 66.66 11 55 7 35 2 1002. Ayurvedic treatment 2 6.66 1 50 1 50 - -03. Both 0 0 - - - - - -04. No history 8 26.66 5 62.5 3 37.5 - - Among 30 patients, 20 patients (66.66%) had undergone allopathic treatment, 2patients (6.66%) had taken Ayurvedic treatment an 8 patients (26.66%) had no treatmenthistory. Among the patients those who had taken allopathic treatment, 11 patients (55%)responded good, 7 patients (35%) responded moderately and 2 patients (10%) respondedpoorly. In Ayurvedic treatment group, 1 patient’s (50%) responded good and 1 patient’s(50%) responded moderately.In the no treatment history group 5 patients (62.5%) responded good and 3 patients(37.5%) responded moderately.Figure No. 11. Treatment history & response 25 20 20 No. of Pt.s 15 11 10 7 8 5 5 2 2 1 1 3 0 0 0 0 0 0 0 A llo.treat A yu.treat Both No hist. No. of GR MR. PR Treatment 101 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 28. Showing the family history and response.Sl. Family history No. of % GR % MR % PR % pts.01. Present 15 50 8 53.3 7 46.6 - -02. Absent 15 50 10 66.6 3 20 2 13.3 Among 30 patients, 15 patients (50%) had family history and in that 8 patients(53.3%) responded good and 17 patients responded moderately. Other 15 patients (50%) had no family history and in that 10 patients (66.6%)responded good, 3 patients (20%) responded moderately an 2 patients (13.3%) responsewas poor.Figure No. 12. Family history & response 16 15 15 14 12 10 No. of Pt.s 10 8 8 7 6 4 3 2 2 0 0 Present Absent No. of GR MR. PR Family history 102 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 29. Showing the nature of koshta and response.Sl. Koshta No. of % GR % MR. % PR % pts.01. Mrudu 2 6.66 1 50 1 50 - -02. Madhyama 27 30 16 29.2 9 33.3 2 7.403. Krura 1 3.33 1 100 6 100 1 6.2 Among 30 patients, 2 patients (6.66%) had mrudu koshta, 27 patient had (30%),madhyama koshta and 1 patient’s had krura koshta. In mrudu koshta patients, 1 patient’s (50%) response was good and 1 patientresponded moderately. Among madhyma koshta patients, 16 patients (30%) responded good, 2 patients(33.3%) responded moderately and 2 patients (7.4%) responded poorly. 1 krura koshta patient (100%) responded good.Figure No. 13. Nature of koshta & response 30 27 25 No. of Pt.s 20 16 15 9 10 6 5 2 1 1 2 1 1 1 0 0 Mrudu Madhyama Krura No. of GR MR. PR Koshta 103 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 30. Showing the Status of agni and response.Sl. Agni No. of % GR % MR. % PR % pts.01. Manda 1 3.33 1 100 - - - -02. Teekshna 21 70 9 42.8 10 47.6 2 9.5203. Sama 8 26.66 8 100 - - - -04. Vishama 0 0 - - - - - - Among 30 patients 21 patients (70%) had teeskhna agni and in that 9 patients(42.8%) responded good. 10 patients (47.6%) responded moderately and 2 patient’s(9.52%) response was poor. Only one patient had (33.33%). manda agni and he responded good. 8 patients(26.66%) had sama agni and in them all 8 patients (100%) responded good.Figure No. 14. Nature of agni & response 25 21 No. of Pt.s 20 15 9 10 8 8 10 5 1 1 0 0 2 0 0 0 0 0 0 0 Manda Teekshna Sama Vishama No. of GR MR. PR Agni 104 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 31. Showing the nature of malapravritti in the patient and responseSl. Malapravritti No. of % GR % MR. % PR % pts.01. Free 16 53.55 10 62.5 6 37.5 - -02. Constipation 14 46.66 7 50 5 35.7 2 14.2 Among 30 patients, 16 patients (53.33%) had free bowel and in that 10 patients(62.5%) responded good and 6 patients (37.5%) responded moderately. 16 patients had constipation (46.66%) and in that 7 patients (50%) respondedgood, 5 patients (35.7%) responded moderately and 2 patients (14.2%) response waspoor.Figure No. 15. Nature of M alapravritti 20 16 14 15 No. of Pt. 10 10 7 6 5 5 2 0 0 Free Constipation No. of GR MR. PR Malapravritti 105 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 32. Showing the habits of the patient and response.Sl. Habits No. of % GR % MR. % PR % pts.01. Smoking 17 36.6 6 54.5 4 36.6 1 902. Alcohol 12 40 9 75 2 16.6 1 8.303. Tobacco 2 6.66 1 50 1 50 - -04. Alc. + Smk. 7 23.33 5 71.4 1 14.2 1 14.205. No habits 12 40 6 50 5 41.6 1 8.3 Among 30 patients, 11 patients (36.6%) had the habit of smoking and inthem, 6 patients (54.5%) responded good, 4 patients (36.3%) responded moderately and 1patient’s (9.0%) response was poor. 12 patients (40%) had the habit of drinking alcohol and in them 12 patients (75%)responded good, 2 patients (16.6%), responded moderately and 1 patient’s (8.37%)response was poor. 2 patients (6.66%) had the habit of tobacco chewing and they responded good andmoderate respectively (50%) each. 7 patients (23.33%) had the habit of alcohol and smoking and in them 5 patients(71.4%) responded good 1 patient’s (14.2%) responded moderately and remaining 1(14.2%) responded poorly. In the no habit group 6 patients (50%) responded good, 5 patients (46.6%)responded moderately and 1 patient’s (8.3%0 response was poor.Figure No. 16. Habits & response 18 17 16 14 12 12 12 10 9 No. of Pt.s 8 7 6 5 65 6 4 4 21 2 11 1 11 1 2 0 0 Smoking Alcohol Tobacco Alc. + Smk. No habits No. of GR MR. PR Habits 106 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 33. Showing the prakriti of the patient and response.Sl. Prakriti No. of % GR % MR. % PR % pts.01. Kapha-pitta 15 50 9 60 5 33.3 1 6.602. Kapha-vata 15 50 8 53.3 6 40 1 6.603. Vata-pitta 0 0 - - - - - - Among 30 patients, 15 patients (50%) each came under kapha pitta and kapha-vata prakrities. In first group 9 patients (60%) responded good, 5 patients (33.3%) respondedmoderately and 1 patient’s (6.6%) response was poor. Among kapha-vata prakriti patients, 8 patients (53.3%) responded good, 6patients (40%) responded moderately and 1 patient’s (6.6%) response was poor.Figure No. 17. Prakriti incidence & response 16 15 15 14 12 No. of Pt.s 10 9 8 8 6 6 5 4 2 1 1 0 0 0 0 0 Kapha-pitta Kapha-vata Vata-pitta No. of GR MR. PR Prakriti 107 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 34. Showing the Nidana status and response.Sl. Nidana No. of % GR % MR. % PR % pts.01. Snigdha 30 100 17 56.6 11 36.6 2 6.602. Guru ahara 30 100 17 56.6 11 36.6 2 6.603. Asya sukha 27 90 15 55.5 10 37 2 7.404. Swapna sukha 25 83.3 12 48 11 44 2 805. Alpavyayama 26 86.6 14 53.8 10 38.4 2 7.606. Alpa chinta 12 40 8 66.6 4 33.3 - - Among 30 patients, all of them used to indulge in general aharaja nidanas, likesnigdha atyupayoga (100%) and guru ahara atyupayoga (100%). Among them 17 patients(56.6%) responded good, 11 patients (36.6%) responded moderately and 2 patients(6.6%) response was poor. 27 patients (90%) used to indulge in the vihara asyasukham and in that 15 patients(55.5%) respomded good, 10 patients (37%) responded moderately and 2 patients (7.4%)responded poorly. 25 patients (83.3%) indulge in more swapna sukham vihara and in that 12 patients(48%) responded good, 11 patients (44%) responded moderately and 2 patients (8%)responded poorly. 26 patients (86.6%) indulge in alpavyayama and in that 14 patients (53.8%)responded good, 10 patients (38.4) responded moderately and 2 patients (8%) respondedpoorly. 12 patients (40%) indulge in alpachinta and in that 8 patients (66.6%) respondedgood, 4 patients (33.3%) responded moderately.Figure No. 18. Nid a n a in cid e n ce & re sp o n se 35 30 30 30 27 26 25 No. of pt.s 25 20 17 17 15 14 15 11 11 12 11 12 10 10 10 8 4 5 2 2 2 2 2 0 0 Sng Guru A sya Sw apna A l vya A l c hi Nid a n a No. of GR M R. PR 108 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 35. Showing the days of deepana pachana and response.Sl. Deepana pachana No. of % GR % MR. % PR % pts.01. Up to 3 days 18 60 11 61.1 6 33.3 1 5.502. 4 days 12 40 6 50 5 41.6 1 8.3 Among 30 patients (60%), 18 patients were given deepana pachana for 3 days. Inthat 11 patients (61.1%) responded good, 6 patients (33.3%), responded moderately and 1patient’s (8.3%) response was poor. 12 patients (40%), took deepana pachana for 4 days. In that 6 patients (50%)responded good, 5 patients (41.6%0 responded moderately and 1 patient’s (8.3%)response was poor.Figure No. 19. Da ys o f De e p a n a -p a ch a n a & re sp o n se 20 18 15 No. of Pt.s 11 12 10 6 6 5 5 1 1 0 Up to 3 day s 4 day s No. of GR M R. PR D ays 109 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 36. Showing the days of snehapana and response.Sl. Snehapana No. of % GR % MR. % PR % pts.01. Up to 3 days 21 70 12 57.14 8 38.09 1 4.7602. More than 3 days 9 30 5 55.5 3 33.3 1 11.11 Among 30 patients 21 patients (57.14) received snehapana for 3 days and in that12 patients (57.14) responded good, 8 patients (38.09) responded moderately and 1patient’s (7.6%) responded poorly. 9 patients (30%) received snehapana for 4 days in that, 5 patients responded good(55.55%), 3 patients (33.3%) responded moderately and 1 patient (11.11%) respondedpoor.Figure No. 20. D a ys o f S n e h a p a n a & re sp o n se 25 21 20 No. of Pt.s 15 12 8 9 10 5 5 3 1 1 0 Up to 3 day s Mor e than 3 day s N o. of GR M R. PR D a ys 110 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 37. Showing the incidence of samyak snigdha lakshanas and response.Sl. Samyak snigdha lashana No. of % GR % MR. % PR % pts.01. Vatanulomana 26 86 14 53.8 10 38.4 2 7.602. Agni deepti 30 100 17 56.6 11 36.6 2 6.603. Purisha snigdhata 30 100 17 56.6 11 36.6 2 6.604. Asamhat varcha 26 86 14 53.8 10 38.4 2 7.605. Twak snigdhata 28 93 16 57.1 10 35.7 2 7.106. Anga laghuta 20 66.6 11 55 7 35 2 1007. Gatra mardava 24 80 12 50 11 45 1 4.108. Klama 29 96.6 17 58.6 10 41.6 2 6.809. Shaithilya 10 33.3 6 60 4 40 0 - Among 30 patients 26 patients (86%) showed vatanulomata. In that 14 patients(58.8%) responded good, 10 patients (38.4%) responded moderately and 2 patients(7.6%) response was poor. All patients (100%) showed agni deepti. In that 17 patients (56.6%) respondedgood, 11 patients (36.6%) responded moderately and 2 patients (6.6%) responded poorly. All patients (100%) showed purisha snigdhata and in that 17 patients (56.6%)responded good, 11 patients (36.6%) responded moderately and 2 patients (6.6%)responded poorly. 111 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” 26 patients (86%) showed asamahat varcha in that 14 patients (53.8%) respondedgood, 10 patients (38.4%) responded moderately and 2 patients (7.%) responded poorly. 28 patients (93%) showed twak snigdhata. In that 16 patients (57.1%) respondedgood, 10 patients (35.7%0 responded moderately and 2 patients (7.1%) responded poorly. 20 patients (66.6%) showed anga laghuta and in that 11 patients (55%) respondedgood, 7 patients (35%) responded moderately and 2 patients (10%) responded poorly. 24 patients (80%) showed gatra mardava and in that 12 patients (50%) respondedgood, 11 patients (45%) responded moderately and 1 patient (4.1%) responded poorly. 29 patients (96.6%) showed klama and in that 17 patients (58.6%) respondedgood, 10 patients (41.6%) responded moderately and 2 patients (6.8%) responded poorly. 10 patients (33.3%) showed shaithilya and in that 6 patients (60%) respondedgood and 4 patients (40%) responded moderately.Figure No. 21. Indence of samyak snigdha lakshana & response 35 30 30 29 30 26 26 28 24 No. of pts. 25 20 20 17 17 16 17 14 14 15 11 11 11 12 11 10 10 10 10 10 10 7 6 4 5 2 2 2 2 2 2 1 2 0 0 VA AD PS AV TS AL GM Kl Sh No. of pts. GR MR. PR Samyka snigdha lakshana 112 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 38. Showing the incidence of samyak virechana lakshanas and response.Sl. Samyak virechana lakshanas No. of % GR % MR. % PR % pts.01. Indriya prasannata 25 83.3 14 56 10 40 1 402. Sroto shuddhi 28 93.3 15 53.5 11 39.2 2 7.103. Agni deepti 24 80 14 58.3 9 37.5 1 4.104. Exp. Vit pitta, kapha, vata 30 100 17 56.6 11 36.6 2 6.605. Vatanulomana 24 80 14 58.3 8 33.3 2 8.306. Absence of ayoga and atoyoga 27 90 14 51.8 11 40.7 2 7.407. Shareera laghuta 25 83.3 16 64 7 28 2 8 Among 30 patients 25 patients (83.3%) showed indriya prasannata in that 14patients (56%) responded good, 10 patients (40%) responded moderately and 1 patient(4%) responded poorly. 28 patients (93.3%) showed sroto shuddhi and in that 15 patients (53.3%)responded good, 11 patients (39.2%) responded moderately and 2 patients (7.1%)responded poorly. 24 patients (80%) showed agni deepti and in that 14 patients (58.3) respondedgood, 9 patients (37.5) responded moderately and 1 patient (4.1%) responded poorly. All patients (100%) passed vit, pitta, kapha, and vata in sequence and in that 17patients (56.6%) responded good. 11 patients (36.6%) responded moderately and 2patients (6.6%) responded poorly. 113 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” 24 patients (80%) showed vatanulomana in that 14 patients (58.3%) respondedgood, 8 patients (33.3%) responded moderately and 2 patients (8.3%) responded poorly. 27 patients (90%) showed no atiyoga and ayoga and in that 14 patients (51.8%)responded good, 11 patients (40.7%) responded moderately and 2 patients (7.4%)responded poorly. 25 patients (83%) showed shareera laghuta in that 16 patients (64%) respondedgood, 7 patients (28%) responded moderately and 2 patients (8%) responded poorly.Figure No. 22. Incidence of samyak lakshanas of virechana & response 30 30 28 27 25 25 24 24 25 20 No. 17 15 16 of 15 14 14 14 14 pts. 10 11 11 11 10 9 8 7 5 1 2 1 2 2 2 2 0 IP SS AD Ex.V.P.K VA AAA SL No. of GR MR. PR Samyak virechana lakshanas 114 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 39. Showing the number of Vegas attained by patient and response.Sl. Vega No. of % GR % MR. % PR % pts.01. 5-10 3 10 2 66.6 1 33.3 - -02. 11-15 13 43.3 6 46.15 6 46.15 1 7.603. 16-20 14 46.6 9 64.2 4 28.5 1 7.14 Among 30 patients 3 patients (10%) comes under 5-10 vegas group, and in that 2patients (66.6%) responded good and 1 patient’s (33.3%) responded moderately. Among the 13 patients on 11-15 vega group (43.3%), 6 patients, (46.15%)responded good, 6 patients (46.15%), responded moderately and 1 patient’s response waspoor. Among the 14 patients (46.6%) in 16-20 group, 9 patients (64.2%) respondedgood, 4 patients (28.5%), responded moderately and 1 patient’s response (7.14%) waspoor.Figure No. 23. No. of vega s & re sponse 16 14 14 13 12 No. of Pt.s 10 9 8 6 6 6 4 4 3 2 2 1 1 1 0 0 5 - 10 vega 11 - 15 vega 16 - 20 vega No. of GR MR. PR Vegas 115 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 40. Showing the incidence of Antaki and response.Sl. Antaki No. of % GR % MR. % PR % pts.01. Kaphantam observed`` 30 100 17 56.6 11 36.6 2 6.602. Kaphantam not observed - - - - - - - - Among 30 Patients (100 %), all Patients (100 %) attained KaphanthamVirechanam. In that 17 patients (56.6 %) responded good, 11 Patients (36.6 %)responded moderately and 2 Patients (6.6%) responded poorly.Figure No. 24. Incidence of antaki vega & response 35 30 30 25 No. of pts. 20 17 15 11 10 5 2 0 0 0 0 0 K.O. K.nO. No. of GR MR. PR Antaki vega 116 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 41. Showing the incidence of manaki and response.Sl. Manaki No. of % GR % MR. % PR % pts.01. 2000 ml & below 7 23.23 3 42.8 3 42.8 1 14.202. Above 2000 ml 23 76.6 14 60.8 8 34.7 1 4.3 Among 30 Patients 7 Patients (23.3 %) passed Vegas of 2000 ml and below,inthat 3 Patients (42.8 %) responded good, 3 Patients ( 42.8 %) responded moderately and1 Patient (14.4 %) responded poorly23 Patients (76.6 %) passed Vegas of above 2000ml, in that 14 patients (60.8%)responded good, 8 Patients (34.7 %) responded moderately and 1 Patient (4.3 %)responded poorly.Figure No. 25. Incidence of manaki & response 25 23 20 No. 15 14 of pts. 10 7 8 5 3 3 1 1 0 2000 ml & below Above 2000 ml No. of GR MR. PR Manaki 117 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Table No. 42. Showing the Overall assessment. Sl. Assessment No. of pts. % 01. Good response 17 56.6 02. Moderate response 11 36.6 03. Poor response 2 6.6 04. No response 0 0 Among the 30 Patients, 17 Patients (56.6 %) responded good, 11 Patients (36.6%) responded moderately and 2 Patient’s (6.6 %) response was poor.Figure No. 26. Assessment of results PR NR 7% 0% MR 37% GR 56% GR MR PR NR 118 Results
    • Table No. 16. Showing the demographic data.Sl. OPD Age Sex Religion Occupation Socioeconomic status Diet DurationNo. No. (yrs) M F H M C O S A L O P M UM HC V M ND <1 1-2 >201. 3909 60 + - + - - - + - - - - - + - + - + - - -02. 3847 35 + - + - - - - - + - - + - - + - - - + -03. 3912 35 - + + - - - + - - - - - + - + - + - - -04. 3951 43 + - + - - - + - - - - - - + + - - - + -05. 3010 58 + - - + - - + - - - - - - + - + - - + -06. 4004 36 + - + - - - - - + - - - - + - + + - - -07. 4030 60 + - + - - - + - - - - + - - + - - - - +08. 4019 49 + - + - - - - - + - - - + - + - - - + -09. 4000 53 + - + - - - + - - - - + - - + - - - + -10. 4667 53 + - + - - - + - - - - - + - - + - - - +11. 087 38 + - + - - - - - + - - - - + - + + - - -12. 041 43 + - + - - - - - + - - + - - - + - - + -13. 090 37 + - - + - - - - + - - - - + - + - + - -14. 042 40 + - + - - - - - + - - - + - - + - - + -15. 0578 52 + - + - - - + - - - - - - + + - - - + -16. 047 52 + - - + - - - - + - - - + - - + + - - -17. 060 54 - + + - - - + - - - - - + - + - - + - -18. 0891 58 - + + - - - + - - - - - - + + - - - + -19. 0844 48 - + + - - - + - - - - - + - + - - - + -20. 0922 47 + - + - - - - - + - - - - + - + - - + -21. 1095 59 - + + - - - + - - - - - + - + - - - - +22. 1179 42 + - + - - - - - + - + - - - - + - - + -23. 2481 47 - + + - - - - - + - - + - - + - - - + -24. 1304 52 - + + - - - + - - - - + - - - + + - - -25. 1332 57 - + + - - - + - - - - - + - + - - - + -26. 1317 58 + - + - - - + - - - - - - + - + - - + -27. 073 55 + - + - - - + - - - - - + - + - - - + -28. 1301 59 + - + - - - - - + - - - + - - + - + - -29. 1023 49 + - - - + - - - + - - - + - - + + - - -30. 089 54 + - - + - - + - - - - - - + - + + - - -M – Male; F- Female; H- Hindu; M- Muslim; C – Christian; O – Others; S – Sedentary; A – Active; L – Labor; O – Others; P- Poor;M – Middle class; Um – Upper middle class; HC – High class;V- Vegetarian; M – Mixed; ND – Newly diagnosed; < 1 – Below 1 year; 1-2 – 1-2 years; > 2 – More than 2 years. 94
    • Table No. 17. Showing the data related to disease.Sl. 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. 3909 - - + - + - - + - - - + - + - + - - + - -02. 3847 + - - 2y + - - + - - + - + - + - - - - + -03. 3912 - - + - + - - + - - + - + - - - - + + - -04. 3951 + - - 1y + - - + - - - + + - - + - - - + -05. 3010 + - - 1½y + - - + - - + - - + - - - + + - -06. 4004 - - + - + - + - - - - + + - + + - - - + -07. 4030 + - - 3y + - - + - - + - - + - - + - - + -08. 4019 + - - 1y - + - + - - - + + - + + - - + - -09. 4000 + - - 1y + - - + - - + - - + - - + - - + -10. 4667 + - - 2½y + - - + - - + - - + - - - + - + -11. 087 - - + - + - - + - - + - + - + - - - + - -12. 041 + - - 8m - + - + - - - + + - + + - - + - -13. 090 + - - 5m - + - + - - + - + - + + - - + - -14. 042 + - - 1y - + - + - - - + + - + + - - + - -15. 0578 + - - 1½y + - - + - - + - - + + - - - - - -16. 047 - - + - - + - + - - - + + - - + - - + + -17. 060 + - - 9m - + - + - - + - + - - - - + + + -18. 0891 + - - 1y + - - + - - + - + - - - - + + + -19. 0844 + - - 1y - + - + - - + - - + - - - + - - -20. 0922 + - - 1½ y - + - + - - + - - + + + - - - - -21. 1095 + - - 3y - + - + - - + - - + - - - + + + -22. 1179 + - - 1½ + - - + - - + - - + - + - - - - -23. 2481 - + - 8m - + - + - - + - - + - - - + - - -24. 1304 - - + - + - - + - - + - + - - - - + - - -25. 1332 + - - 1½ y - + - + - - + - + - - - - + + + -26. 1317 + - - 2y - + - + - - + + - + - - - + - - -27. 073 + - - 8m - + - + - - + - - + - + - - - - -28. 1301 - + - 2m + - - + - - + - + - + + - - + + -29. 1023 - - + - - + - - - - - - + - + - - - + + -30. 089 - - + - - + + - + + - - - + - - - + - - -Al – 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. 95
    • Table No. 18. Showing the data of parameters.Sl. OPD Prabhoota Pipasadhikya Kshudadhikya Karapadadaha Ati Sweda FBS PPBS Urine sugar Body weight NO. mutrata BT AV AF BT AV AF BT AV AF BT AV AF BT AV AF BT AV AF BT AV AF BT AV AF BT AV AF01. 3909 1 0 0 2 0 0 1 0 0 1 0 0 0 0 0 131 85 93 213 125 140 .5 0 0.0 78 76 7402. 3847 3 1 1 2 1 1 2 1 1 1 1 1 1 0 0 180 127 140 260 227 240 1.5 1 .5 86.5 85 8303. 3912 2 0 0 1 0 0 2 1 1 2 1 1 0 0 0 132 85 92 212 170 177 .5 0 .5 58 57 5404. 3951 2 0 0 2 1 1 2 0 0 1 0 0 0 0 0 106 81 94 210 182 192 .5 .5 0 68 67.5 66.505. 3010 2 1 1 2 1 1 2 1 1 0 0 0 1 0 0 188 146 156 270 200 212 1.5 .5 .5 56 85 8406. 4004 3 1 1 1 0 0 2 0 0 1 0 0 1 0 0 170 110 120 260 202 207 1.5 .5 1 74 73 7007. 4030 3 1 1 2 1 1 2 0 0 1 0 0 1 0 0 152 117 129 242 208 230 1.5 .5 1 86 85 8308. 4019 2 0 1 1 0 0 2 0 1 1 0 0 1 1 1 142 106 114 248 181 194 1.5 .5 .5 67 67 6509. 4000 3 1 2 2 0 1 1 0 1 1 0 0 0 0 0 160 124 133 252 190 200 1.5 .5 1 71 70 6710. 4667 2 1 1 1 0 1 2 0 1 0 0 0 1 0 1 139 98 110 222 180 192 1 .5 .5 84 82 8211. 087 2 0 1 2 1 1 1 1 1 2 1 1 1 0 0 140 79 88 245 171 184 1 .5 .5 76 74 7112. 041 2 0 1 2 1 1 2 1 1 1 0 0 1 0 0 140 79 89 234 170 183 1 .5 .5 84 84 8213. 090 3 1 1 1 0 0 2 1 1 1 0 0 1 0 0 160 111 120 258 190 205 1.5 .5 1 86 85 8414. 042 2 1 1 1 0 0 2 1 1 1 1 1 1 0 0 132 71 80 208 141 153 1 0 .5 74 72 7215. 0578 2 0 1 1 0 0 2 0 1 1 0 1 1 0 0 156 106 120 230 170 182 1.5 .5 .5 69 68 6516. 047 2 1 1 1 0 0 2 0 1 1 0 0 1 0 1 127 75 86 201 151 168 1 .5 .5 68 67 6617. 060 3 1 1 1 0 0 2 0 0 1 0 0 0 0 0 141 102 116 222 157 165 1 .5 .5 72 71 6918. 0891 2 1 1 1 0 0 2 0 1 0 0 0 1 0 0 150 120 123 240 202 215 1.5 .5 .5 58 57 5519. 0844 2 0 0 2 1 1 1 0 0 2 1 1 1 0 0 126 81 97 187 118 134 .5 0 0 57 57 55.520. 0922 2 1 1 2 2 2 2 2 2 1 0 0 1 0 1 149 151 160 220 220 230 1 1 1 72 78 7721. 1095 2 1 1 1 0 1 2 1 1 0 0 0 0 0 0 166 140 148 242 118 222 .5 0 .5 76 65 6422. 1179 2 0 0 2 1 1 2 1 1 2 0 0 1 1 1 160 126 134 257 211 223 1.5 .5 1 68 67 6523. 2481 2 1 1 2 1 1 1 0 0 2 1 1 1 0 0 160 132 139 223 177 189 1 .5 .5 57 56 5324. 1304 2 0 1 2 0 1 1 0 1 0 0 0 1 0 1 145 88 98 189 117 134 .5 0 0 59 58 5625. 1332 3 1 2 2 1 1 2 1 1 2 0 2 0 0 0 151 130 139 240 210 221 1.5 .5 .5 60 59 5826. 1317 3 1 1 2 0 1 2 1 1 2 1 1 1 0 1 170 139 150 260 219 233 1.5 1 1 64 63 6027. 073 3 1 1 2 1 1 1 0 0 2 0 1 0 0 0 149 81 89 230 154 164 1 .5 .5 92 90 8828. 1301 2 1 1 2 0 1 1 1 1 2 0 1 1 0 1 129 72 79 215 150 160 1.5 .5 1 85 84 8229. 1023 3 1 1 2 0 1 2 1 1 0 0 0 1 0 0 126 68 78 235 180 186 1 .5 1 67 66 6430. 089 2 0 1 2 0 2 2 1 1 2 1 1 0 0 0 111 80 89 200 150 157 .5 0.0 0 78 78 78BT – Before treatment; AV – After virechana; AF – After follow-up. 96
    • Table No.19. Showing the treatment protocol and observation.Sl. OPD Deepana Snehapana – details Virechana detailsNo. No. pachana 3D 4D 1D 2D 3D 4D T N3 N4 Dose TiA 1V LV A B C KA NKA B2000 A200001. 3909 + - 30 ml 60 ml 90 ml 120 ml 300 - + 12 gr 7 am 8.30 11.00 - + - + - - +02. 3847 - + 30 ml 60 ml 90 ml 120 ml 300 - + 12 gr 7 am 8.30 11.15 - + - + - + -03. 3912 - + 30 ml 60 ml 90 ml 120 ml 300 - + 10 gr 7 am 9.00 11.45 + - - + - - +04. 3951 - + 30 ml 60 ml 90 ml 120 ml 300 - + 15 gr 7 am 8.45 11.45 - - + + - + -05. 3010 - + 30 ml 60 ml 90 ml 120 ml 300 - + 15 gr 7 am 8.00 11.30 + - - + - - +06. 4004 + - 30 ml 60 ml 90 ml 120 ml 300 - + 15 gr 7 am 9.00 12.00 + - - + - - +07. 4030 + - 30 ml 60 ml 90 ml - 180 - + 15 gr 7 am 9.00 1.30 + - - + - - +08. 4019 + - 30 ml 60 ml 90 ml 120 ml 300 + - 15 gr 7 am 8.30 12.30 + - - + - - +09. 4000 + - 30 ml 60 ml 90 ml - 180 - + 15 gr 7 am 8.30 12.30 - + - + - + -10. 4667 + - 30 ml 60 ml 90 ml - 180 + - 12 gr 7 am 9.00 11.30 - + - + - - +11. 087 + - 30 ml 60 ml 90 ml - 180 + - 15 gr 7 am 9.00 12.00 + - - + - - +12. 041 + - 30 ml 60 ml 90 ml - 180 + - 15 gr 7 am 9.00 2.30 + - - + - - +13. 090 + - 30 ml 60 ml 90 ml - 180 + - 12 gr 7 am 8.30 12.30 + - - + - - +14. 042 + - 30 ml 60 ml 90 ml - 180 + - 1v gr 7 am 9.45 12.00 - + - + - + -15. 0578 + - 30 ml 60 ml 90 ml - 180 + - 15 gr 7 am 9.30 11.30 + - - + - - +16. 047 + - 30 ml 60 ml 90 ml - 180 + - 15 gr 7 am 9.00 12.00 - + - + - - +17. 060 + - 30 ml 60 ml 90 ml - 180 + - 15 gr 7 am 8.30 12.30 - + - + - - +18. 0891 - + 30 ml 60 ml 90 ml - 180 + - 15 gr 7 am 9.00 12.40 + - - + - - +19. 0844 - + 30 ml 60 ml 90 ml - 180 - + 15 gr 7 am 9.00 12.00 + - - + - - +20. 0922 + - 30 ml 60 ml 90 ml 120 ml 300 - + 15 gr 7 am 8.45 2.30 + - - + - - +21. 1095 - + 30 ml 60 ml 90 ml - 180 + - 12 gr 7 am 9.00 12.00 - + - + - + -22. 1179 + - 30 ml 60 ml 90 ml - 180 + - 15 gr 7 am 10.00 1.00 - + - + - - +23. 2481 - + 30 ml 60 ml 90 ml - 180 + - 12 gr 7 am 9.30 12.00 - + - + - - +24. 1304 + - 30 ml 60 ml 90 ml - 180 + - 15 gr 7 am 9.30 1.00 + - - + - - +25. 1332 - + 30 ml 60 ml 90 ml - 180 + - 15 gr 7 am 9.00 11.45 - + - + - - +26. 1317 + - 30 ml 60 ml 90 ml - 180 + - 15 gr 7 am 9.45 12.30 - + - + - - +27. 073 - + 30 ml 60 ml 90 ml - 180 + - 12 gr 7 am 8.45 12.30 - + - + - +28. 1301 - + 30 ml 60 ml 90 ml - 180 + - 15 gr 7 am 9.00 12.40 + - - + - - +29. 1023 - + 30 ml 60 ml 90 ml 120 ml 300 - + 12 gr 7 am 8.30 1.00 - - + + - + -30. 089 + - 30 ml 60 ml 90 ml - 180 + - 15 gr 7 am 9.30 12.30 - - + + - + -3 D – 3 Days; 4 D – 4 Days; 1 D – 1 Day; 2 D – 2 Days; 3 D – 3 Days; 4 D – 4 Days; T – Total dose; N 3 – No. of patients takensneha for 3 days; N 4 – No. of patients taken sneha for 4 days; TiA – Time of administration; 1 V – First vega; LV – Last vega; A –Grade A in which patient had passed 15-20 vegas; B – Grade B in which patients had passed 10-15 vegas; C – Group C in whichpatient had passed 5-10 vegas. KA – Kaphantam observed; NKA – No kaphantama observed; B2000 – The mana of 2000 ml andbelow; A2000 – The mana of above 2000 ml. 97
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Statistical resultsTable No. 43. Showing the Statistical results.Sl. Parameters Mean S.D. S.E. t-value p-value Remarks01. Prabhoota mutrata 1.633 0.49 0.089 18.348 < 0.001 H.S.02. Kshuda adhikya 1.1 0.481 0.087 12.643 < 0.001 H.S.03. Pipasa adhikya 1.266 0.521 0.95 13.326 < 0.001 H.S.04. Karapada daha 0.9 0.481 0.087 10.344 < 0.001 H.S.05. Ati Sweda 0.66 0.479 0.087 7.742 < 0.001 H.S.06. Post Prandial Blood Sugar 41.433 18.329 3.346 12.382 < 0.001 H.S07. Fasting Blood Sugar 29.8333 22.696 4.143 7.079 < 0.001 H.S08. Urine sugar 0.55 0.3037 0.055 10.00 < 0.001 H.S.S09. Body weight 3.7 1.95 0.356 10.39 < 0.001 H.S.Statistical conclusion 01. All the subjective parameters shows highly significance, specially the parameter prabhootra mutrata, as p value is 0.001. 02. The parameters kshudadhikya pipasadhikya, atisweda and karapadadaha shows highly significance as p value is 0.001. 03. The mean effect of atisweda before and after treatment is low as compared with other parameters. 04. The objective parameters FBS, PPBS, Urine sugar, and body weight also shows highly significant, as p value is 0.001. 05. The mean affect of PPBS before and after treatment is more and also there is a much variation in PPBS. 06. The mean and variants is more in the parameter FBS. There is a least variation in urine sugar as compared to others, (By Comparing S.D) These are form the above mentioned table using paired t test. 123 Results
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Virechana is one of the purificatory therapy among panchakarmas. In the presentstudy, the first point to be discussed is how virechana is helpful in sthooola Madhumehi.Mode of action of Virechana in sthoola madhumehi In the classics samshodhana, shamanaushadhis and also pathyahara viharas arementioned for sthoola modhumehi from that, classical virechana karma was taken herefor the study. Among samshodhana, vamana is indicated for kaphaja Prameha, butcontraindicated in sthoulya. But virechana is indicated for both sthoulya and Prameha. The factors which helps in the pacification of sthoola Madhumeha by virechanaare, 01. Elimination of doshas along with mala. 02. Madhumeha is a kledajanya vyadhi, even though other doshas are involved in the Samprapthi of this disease, kapha is the main factor especially along with medas, mamsa and pitta. Virechana expels excess amount of vitiated kleda, malas and doshas from the body, which is very much helpful to clear or check the dhadhuparinama and there by helps in the reduction or pacification of the disease. 03. Excretion of pitta (bile) takes place, as a result fat metabolism is checked and hence undigested and unutilized fat will be excreted out. 04. Restriction of diet during snehapana, virechana and samsarjana krama helps or brings about mobilization of fat from its deposits. 05. 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. 124 Summary
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” 06. Obesity is an extremely important environmental factor in the formation of type – 2 diabetes. Approximately 80% of type 2 diabetes are obese. In this impaired binding is a result of decrease in the number of insulin receptors. Virechana therapy diminishes the insulin resistance by the reduction of weight and there by reduces the stress on beta cells. 07. Among the pathological changes which are happening in type 2 diabetes the most consistent of these changes is probably deposit of amyloid which is accompanied by atrophy of the normal tissue particularly Islets of epithelial cells. These amyloids are fibrillar proteins in various organs and tissues, in such that vital functions are compromised. The associated disease state may be inflammatory, hereditary or neoplastic and deposition can be local, generalized or systemic. In more advanced lesions, the Islets are more or less converted to amyloid and the reduction in the number of insulin secreting cells are more propounded than that of glucagon secreting cells. Heavy deposition of amyloids itself are rare without diabetes. The amyloids arefat soluble and when snehapana and Swedana are administered in the patient, theseamyloids get dissolved in snehana, as a result of Swedana it moves to koshta and geteliminated by virechana karma. Above said factors may be the reason why virechana is effective in sthoolamadhumehi. 125 Summary
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Madhumeha v/s diabetes mellitus: Madhumeha is a disease Known to mankind since Vedic period. Ayurvedicclassics consider madhumeha among the twenty obstinate urinary disorders. At the sametime it is also explained that, when prameha are left untreated, it leads to the conditioncalled Madhumeha. So Madhumeha can also be considered as an advanced condition orstage of prameha apart from the 20- types and also Prameha is a Nidanarthakara roga ofMadhumeha. 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 sugar (mootra madhuryata).Since the disease is connected with the urinary system with the presence of sugar inurine. Apart from this, tanu madhuryata also mentioned, which can be taken as bloodsugar. Like this the 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 cause,insulin resistance. In Ayurveda Sthoulya is mentioned as a nidanarthakara roga forMadhumeha and is included under santarpanajanya vyadhi. Madhura, snigdha bhojana are mentioned as nidanas for madhumeha. In modernscience over eating and sedentary life styles are the predisposing factor for diabetesmellitus. Those food articles and overeating, causes obesity and which may causeDiabetes mellitus. 126 Summary
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” 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. 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 aparipakwa,dhatus i.e., lack of proper nourishment of dhatus. Kulaja dosha and beeja dosha have been mentioned in the causative factors ofSahaja Prameha. Such patients are said to be weak, emaciated, suffering from thirst, lossof appetite and are required to be treated with a nourishing diet. In diabetes 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. 127 Summary
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Apathyanimittaja Madhumeha explained on Ayurveda, in such patients,atikshudha, atinidra and aalasya are noted. And it is caused due to over intake ofmadhura snigdha ahara and vihara which favours kapha medovridhi. Maturity onsetdiabetes tend to over eat and are lazy in nature, even though age factor is not mentionedin Ayurveda, while explaining chikitsa acharya have explained sthoola and krishaclassification. The same type of classification can be seen in modern science as obeseand non-obese type. Upadravas of Ayurveda can be correlated to some of the complications of modernscience. For eg. Trishna, bhrama, shoola, tama pravesha, shwasa can be correlated todiabetic Ketoacidosis, in which thirst, weakness, blurred vision, abdominal pain, airhunger etc are seen. Insulin resistance and relative insulin deficiency are the major step in thepathogenesis of the diabetes mellitus on obese indviduals. There is no explanationregarding insulin resistance in Ayurveda. Even though in some recent literary works,medodhatwagni is correlated with insulin. But no proves are available for exactcorrelation. 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 bahudravataform travels all over the body in rasa produces tanu madhuryata, which can be taken ashyperglycemia, i.e. increased blood glucose condition. 128 Summary
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” 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.Discussion On Inclusion And Exclusion Criteria And Diagnosis Mild and moderate type of obese NIDDM cases are taken for the study. Becauseof the same reason, complications are very rarely observed during the treatment period inpatients. For the mild, moderate sugar level selection, gradings were given and the patientselection was mainly based on that criteria. Apart from this, other inclusive and exclusivecriterias are explained, which are explained in the exclusion and inclusion criterias. Themain idea behind the exclusion and inclusion of particular cases are to avoidcomplications. For example insulin dependency and even patients who have developedcomplications were excluded from the study, because of lack of emergency treatment. For the diagnosis of patient, mainly mootramadhuryata and tanumadhuryata aretaken which are confirmed by blood and urine sugar examination. Apart from thesefactors, patients who are sthoola and having prabhoota mootra Pravruti with otherassociated symptoms of madhumeha are selected. Sushruta had given the explanationthat, if a patient had praboota mootrapravruti along with half of poorvaroopas, then wecan consider him as a madhumeha rogi. 129 Summary
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Discussion On Observation All the cases were reported to DGM Ayurveda medical college hospital, postgraduation department. Special medical camps were also conducted in the college forselecting the patient. 42 cases were registered and from that 30 cases were selected forthe study. Observed features in the patients during the study were recorded in the casesheets and these observations were analyzed and tabulated after completion of clinicalstudy. These observational findings are discussed below. Age Risk of diabetes increases as age advances; because of decrease in beta cellsespecially after 40 years. It is also a recorded fact that, the NIDDM occurs only after 3rddecade of life. In this study, above factors were proved, as all the patients were betweenthe age group of 30 to 60. And also it is noted that maximum number of patients; werebetween the age of 40 to 60 Years. Sex Acharya Sushruta had said that women won’t get Madhumeha; because their bodygets cleaned every month by the raja pravrutti. But it is considered as a controversialdialogue as women also getting madhumeha and they are also at high risk of gettingdiabetes compared to men after 30 Years. From Sushruta’s statement we an understandthe importance of shodhana. But in this study male patients were more compared tofemales i.e. 22 male patients and 8 female patients. 130 Summary
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” 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 15 Patients were vegetarians and 15 patients were nonvegetarians (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. In the same way sthoulya also having thesame type of aharaja nidna. 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 method ofsampling. The patients were selected incidentally. Occupation Maximum number 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. Socioeconomic Status In the present study majority of the patients belongs to upper middle and highclass. In these classes, the people indulge in very less activities and ultimately withsedentary life styles and such persons are more prone to diabetes. 131 Summary
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Family History In the present study 15 patients had family history and rest of the 15 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 8 patients were newly diagnosed. In the remaining patients,16 patients were suffering from this disease since 1-2 years, 3 patients below 1 year and 3patients were there in the above 2 years category. As it is a chronic, relapsing type ofdisease, only mild and moderate types of cases were taken for the study. Deha Prakriti Even though madhumeha is a disease with the involvement of 3 doshas, it ismainly a disease of kaphaja origin. In the present study 15 patients were with kapha pittaprakriti and 15 patients were with kapha vata Prakriti. From this we can understand theinvolvement of Kapha as a main dosha in the manifestation of madhumeha. Agni Majority of the patients (21 patients) were with teekshna agni followed bySamagni (8 patients) and mandagni (1 patient). Presence of teekshnaagni patients inmajority may be due to the disease process and in sthoulya also teekshnaagni is acharacteristic feature. 132 Summary
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Nidanas Most of the nidanas mentioned in the classics were elicited in this study. Amonggeneral nidanas, all patients used to take snigdha aharas and guru aharas excessively.Among the viharas, asya sukham (27 patients), swapna sukham (25 patients), alpavyayama (26 patients) and alpa chinta (12 patients) were also noted. From this we can seethat snigdhadi ahara dravyas and asya sukhadi viharas had key role among the nidanas. Basavaraja a 16th century physician of Andhrapradesh has included the excessiveindulgence in alcoholic beverages as one of the nidana of prameha roga. In the presentstudy 18 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 prabhava of roga and other symptomslike snigdha pichila guruta and madhurata shukla mootrata are due to kapha only.Regarding other symptoms discussions were done already. Deepana pachana Done for a period of maximum 4 days. The medicine used were Trikatu churnaand is deepana pachana in property. Snehapana After the niramata by deepana pachana, senhapana was started with 30 ml andincreased 3 or 4 days in increasing doses. In the present clinical study maximum dosegiven in a patient was 300 ml and a minimum of 180 ml. 133 Summary
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” Like the other cases, in madhumeha snehapana is not needed for more days. Thesame explanation is given in classics that in madhumeha, less snehana is enough, askaphotklesha is already there. Abhyanga and Sweda For abhyanga moorchita tila taila was used and for swedana ushna jala snana wasperformed. In madhumeha swedana is contraindicated. Even though swedna iscontraindicated, in classics, it is mentioned that, if necessary, we can do mridu swedana.So, here mridu Sweda was performed i.e. Ushna jala snana. Virechana Virechana dravyas were administered just after kapha kala. Before theadministration, observations like pulse, B.P., respiratory rate and temperature were noted.All these were also noted during and after the completion of virechana karma, becausethere may be variations in that readings, during virechana. So, one has to observe whetherit is in normal limits or not. Parameters like vegiki, manaki, antaki and laingiki were alsonoted by intorogation with patient. In the present study 13 patients passed Vegas between10-15, 14 patients passed in between the 15-20 vegas and 3 patients passed between 5-10vegas. In classics it is mentioned that in uttama shodhana 30 vegas, in madhyamashodhana 20 vegas and in avara 10 vegas noted. So in this study majority of the patientsgot madhyama shodhana. In the present day and in the present health conditionmadhyama shodhana can be considered as good shodhana. 134 Summary
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)”Discussion On Treatment And Results Samshodhana has been given more importance in our classics. And it gives longstanding effect. In madhumeha samshodhana is advised especially for sthoola andbalavan in order to correct agni and to reduce the kleda and medas, which are increasedin the disease process of madhumeha. In the present study it was noted that virechana had immediate and long standingeffect. During the follow-up period only placebo capsules were given in order to knowthe long standing effect of virechana. It was noted that the increase of sugar levels weregradual and other symptoms were very minute. It was also a notable point that out of 30patients 8 patients were newly diagnosed in our college, 16 patients were suffering frommadhumeha since 1-2 years, 3 patients below 1 year and only 3 patients were sufferingform this disease since 2 or more than 2 years. In this present study 42 patients were registered, and in that 4 patients were notsatisfying the criteria of study, 3 patients were not able to come for follow up and 5patients discontinued the treatment before virechana karma. The result of the study confirmed that virechana is highly effective in sthoolamadhumeha. As explained, the study was a single grouped and prospective clinical trial.And the group showed remarkable reduction in the symptoms as well as in blood sugarlevels. Body weight of the patient was also observed before and after the study and in thatalso reduction was noted, which was statistically significant. (As p-value less than 0.05). From this we can assume that virechana corrects the agni and reduces kleda andmedas which are increased in this condition. Modern science also agreed the factor that,obesity leads to insulin resistance. 135 Summary
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” In this study all parameters showed marked response. Among the subjectiveparameters prabhoota mootrata showed maximum significance compaired to others (p-value 0.001). The mean effect of atisweda , before and after the treatment was low ascompaired to others. Even then it was statistically significant. Objective parameters showed high significance. Among them PPBS and FBSshowed more mean variation in before and after treatments as compaired to urine sugar. 136 Summary
    • A close perusal of the observation and inference that can be drawn leads to thefollowing conclusions – 01. Virechana is an effective treatment in sthoola madhumeha. And it also shows lasting results. 02. In mild and moderate type of sthoola madhumeha classical virechana alone is enough to control it. 03. Along with virechana karma, administration of pathya ahara viharas may give more effect. 04. In order to reduce the over weight of patient and to bring down the madhumeha condition to normalcy, repeated virechana at specific intervals should be adopted, keeping in mind that bala of the patient does not deteriorate. This would help in obtaining positive results in the management of madhumeha. 05. Even though severe cases were not there in this study, it can be assessed that, in severe cases of madhumeha reapeated virechana, intake of shamanoushadhis and pathya ahara viharas are essential to control the condition.Suggestions For The Future Study 01. Study on large sample. 02. Study on repeated virechana in madhumeha. 137
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” 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 virechana 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 adhomarga i.e. guda. Virechana is a specifictreatment for pitta dosha, and pitta samsarga doshas. It is also the treatment for kapha andvata doshas. In the process of virechana, the person will not have that much amount oftrouble and exhaustion as in normal purgation, as he has been subjected to snehana,swedana, etc. Management of madhumeha is perhaps one of the most important and interestingsubject in clinical practice considering its high prevalence as well as profound impact thetreatment has on long term morbidity and mortality of the patient. Increasing urbanizationindustrialization and changing life styles seems to be contributing to increasingprevalence of sthoola madhumeha. Like the disease, the treatment also is a prolonged one. Since the patient ofmadhumeha have been divided in to the sthoola and krisha varities, the separate methodsof treatments are mentioned in classics, and from that virechana therapy was taken as achoice of treatment in the present study and is adopted in sthoola madhumeha patients.So, the objectives of this study was, Evaluate the efficacy of virechana karma inmadhumeha (NIDDM)The present work covered the following areas- 138 Summary
    • “Clinical Evaluation of Virechana Karma In Madhumeha (NIDDM)” 01. Introductory part regarding the present work and the objectives. 02. Historical aspect of virechana, madhumeha and also the mile stones in the field of diabetes mellitus. 03. Virechana karma in detail along with its modern concepts, anatomical and physiological aspects. 04. Modern description regarding the diabetes mellitus along with the physiological and anatomical descriptions of glands involved in it. 05. 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. 06. Description regarding the materials and methods used in the present study. 07. 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 classicalvirechana. The effect of the therapy was assessed statistically by using paired t-test. It was found that virechana shows long term effect. But, it was also noted that dueto food and activities of the patient there is gradual variation in sugar levels aftervirechana. So after virechana if the person follows strict diet, sugar levels and otherassociated complaints can be controlled. 139 Summary
    • 1. Shastry. VVS, Ayurveda Prabandhavali Diabetes and treatment (vol. 6) chapter 1. Kottakkal: Arya Vaidya Shala Publications; 1993. p. 10.2. Raghunath Dr, History of Diabetes from Remote to Recent times chapter 2. Nagpur: Baidyanath Ayurveda Bhavan Ltd; 1985. p. 56.3. Raghunath Dr, History of Diabetes from Remote to Recent times chapter 2. Nagpur: Baidyanath Ayurveda Bhavan Ltd; 1985. p. 58.4. Raghunath Dr, History of Diabetes from Remote to Recent times chapter 2. Nagpur: Baidyanath Ayurveda Bhavan Ltd; 1985. p. 62.5. Agnivesa, Charakasamhitha Nidanasthana chapter 4 sloka 37. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit Sansthan; 1994. p. 215. (Kasi Sanskrit series 228).6. Agnivesa, Charaka samhitha Sutrasthana chapter 17 sloka 78. 4th ed. Varanasi: Chaukhambha kasi Sanskrit series; 1994. p. 103. (Krishnadas academic series; vol 4).7. Agnivesa, Charaka samhitha Sutrasthana chapter 17 sloka 78. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit Sansthan; 1994. p. 103. (Krishnadas academic series vol 4).8. Bhelacharya, Bhela Samhita Nidanasthana chapter 6 sloka1-4. 1st ed.Girija Dayal Sukla ,editor. Varanasi: Chaukhambha Vidya Bhavan; 1959. p. 65.9. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 13. Varanasi: Krishnadas Academy; 1980.p.456. (Krishnadas academic series vol 51).10. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 12. Varanasi: Krishnadas Academy; 1980. p. 450. (Krishnadas academic series; vol 51).11. Vagbhata, Ashtangahridaya Nidanasthana chapter 10 sloka 18. Varanasi: Krishnadas Academy; 1982. p.504. (Krishnadas Ayurvedic series 4).12. Koutilya, Arthashastra Chapter 16 sloka 179. Varanasi: Chaukhambha Sanskrit Sansthan: 1978.13. Madhavakara, Madhavanidana Madhukosha chapter 33 sloka1-32 Varanasi: Chaukhambha Surbharathi Prakashan; 1998.p.38. (Chaukhambha Ayurvijnana Granthamala 46).14. Sushrutha, Sushruthasamhitha Nidanasthana Nyayachandrika Commentary chapter 6 sloka 6. Varanasi: Krishnadas Academy; 1980. p. 290. (Krishnadas Ayurveda series 51). 140 Bibliographic references
    • 15. Sushrutha, Sushruthasamhitha Nidanasthana Nibandha samgraha commentary chapter 6 sloka 3. p.290. Varanasi: Krishnadas Academy; 1980. p. 268. (Krishnadas Ayurveda series 51).16. Bhavamishra, Bhavaprakasha Utharakhanda chapter 38 sloka 4. 5th ed. Varanasi: Chaukhambha Orientalia; 1988. p. 367. (Chaukhambha Sanskrit series 130).17. Raghunath Dr, History of Diabetes from Remote to Recent times chapter 3 Nagpur: Baidyanath Ayurveda Bhavan Ltd; 1985. p. 70.18. Raja Radhakantha Deva Bahadur, Shabdakalpadruma vol 4, 3rd ed. Varanasi:Chaukambha Sanskrit Series; p. 255.(Chaukambha Samskrita Granthamala-93).19. Raja Radhakantha Deva Bahadur, Shabdakalpadruma vol 3, 3rd ed. Varanasi: Chaukambha Sanskrit Series; p. 421.(Chaukambha Samskrita Granthamala-93).20. Kahn Ronald C MD, Weir GC, Joslin’s Diabetes Mellitus. Chapter 1. 13th ed. USA. Lea & Febiger; 1994.p. 36.21. Agnivesa, Charaka samhitha Kalpasthana chapter 1 sloka 4. 4th ed. Varanasi: Chaukhambha kasi Sanskrit series; 1994. p. 651. (Krishnadas academic series vol 4).22. Vagbhata, Ashtangahridaya Sutrasthana chapter 13 sloka 4-11. Varanasi: Krishnadas Academy; 1982. p. 211-213. (Krishnadas Academic series 4).23. Agnivesa, Charaka samhitha Chikitsasthana chapter 6 sloka 15. 4th ed. Varanasi: Chaukhambha kasi Sanskrit series; 1994. p. 446. (Krishnadas academic series vol 4). Vagbhata, Ashtangahridaya Chikitsasthana chapter 12 sloka 3. Varanasi: Krishnadas Academy; 1982. p. 678. (Krishnadas Academic series 4). Bhavamishra, Bhavaprakasha Uttarakhanda chapter 38 sloka 44. 5th ed. Varanasi: Chaukhambha Orientalia; 1988. p. 367. (Chaukhambha Sanskrit series 130). Yogaratnakara Uttarardha Prameha chikitsaprakarana. Vaidya Lakshmipatisastry, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 82-96. (Kasi Sanskrit series 160).24. Agnivesa, Charaka samhitha Sutrasthana chapter 2 sloka 9. 4th ed. Varanasi: Chaukhambha kasi Sanskrit series; 1994. p. 24. (Krishnadas academic series vol 4). Agnivesa, Charaka samhitha Kalpasthana chapter 7,12. 4th ed. Varanasi: Chaukhambha kasi Sanskrit series; 1994.p.362-366, 370-376. (Krishnadas academic series vol 4). 141 Bibliographic references
    • Agnivesa, Charaka samhitha Sidhisthana chapter 6. 4th ed. Varanasi: Chaukhambha kasi Sanskrit series; 1994.p703-708. (Krishnadas academic series vol 4).25. Sushrutha, Sushruthasamhitha Sutrasthana chapter 44. Varanasi: Krishnadas Academy; 1980.p.186-189. (Krishnadas Ayurveda series 51). Sushrutha, Sushruthasamhitha Chikitsasthana chapter 33,34 Varanasi: Krishnadas Academy; 1980.p.514-524. (Krishnadas Ayurveda series 51).26. Vagbhata, Ashtangahridaya Sutrasthana chapter 15,18. Varanasi: Krishnadas Academy; 1982.p.229-240,260-270. (Krishnadas academic series 4). Vagbhata, Ashtangahridaya Kalpasthana chapter 2,3 Varanasi: Krishnadas Academy; 1982.p.741-748,748-752. (Krishnadas academic series 4).27. Sharangadhara, Sarngadhara samhitha Poorvakhanda chapter 4 sloka 3-6. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983. p. 35-36. (Jaikrishnadas Ayu. Granthamala 53).28. Agnivesa, Charaka samhitha Kalpasthana chapter 1 sloka 5. 4th ed. Varanasi: Chaukhambha kasi Sanskrit series; 1994. p. 651. (Krishnadas academic series vol 4).29. Agnivesa, Charaka samhitha Sidhisthana chapter 2 sloka 13. 4th ed. Varanasi: Chaukhambha kasi Sanskrit series; 1994. p. 688. (Krishnadas academic series vol 4). Sushrutha, Sushruthasamhitha Chikitsasthana chapter 33 sloka 32. Varanasi: Krishnadas Academy; 1980. p. 519. (Krishnadas Ayurveda series 51) Vagbhata, Ashtangahridaya Sutrasthana chapter 18 sloka 10. Varanasi: Krishnadas Academy; 1982. p. 261. (Krishnadas academic series 4).30. Agnivesa, Charaka samhitha Sidhisthana chapter 2 sloka 11. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 688. (Krishnadas academic series vol 4). Sushrutha, Sushruthasamhitha Chikitsasthana chapter 33 sloka 34. Varanasi: Krishnadas Academy; 1980. p. 519. (Krishnadas Ayurveda series 51). Vagbhata, Ashtangahridaya Sutrasthana chapter 18 sloka 7. Varanasi: Krishnadas Academy; 1982. p. 261. (Krishnadas academic series 4).31. Vagbhata, Ashtangahridaya Sutrasthana chapter 16 sloka 17,18,19,. Varanasi: Krishnadas Academy; 1982. p. 247- 249. (Krishnadas Academic series 4).32. Agnivesa, Charaka samhitha Sutrasthana chapter 15 sloka 5. 4th ed. Varanasi: Chaukhambha kasi Sanskrit series; 1994. p. 96. (Krishnadas academic series vol 4).33. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 33 sloka 22. Varanasi: Krishnadas Academy; 1980. p. 518. (Krishnadas Ayurveda series 51). 142 Bibliographic references
    • 34. Agnivesa, Charaka samhitha Sidhisthana chapter 6 sloka 26-27. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 705. (Krishnadas academic series vol 4).35. Agnivesa, Charaka samhitha Sidhisthana chapter 6 sloka 20. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 705. (Krishnadas academic series vol 4).36. Vagbhata, Ashtangahridaya Sutrasthana chapter 18 sloka 37. Varanasi: Krishnadas Academy; 1982. p. 247, 167. (Krishnadas academic series 4).37. Agnivesa, Charaka samhitha Sidhisthana chapter 1 sloka 13-14. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 679. (Krishnadas academic series vol 4).38. Agnivesa, Charaka samhitha Sidhisthana chapter 1 sloka 17. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 680. (Krishnadas academic series vol 4).39. Agnivesa, Charaka samhitha Sidhisthana chapter 1 sloka 18-19. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 680. (Krishnadas academic series vol 4). Sushrutha, Sushruthasamhitha Chikitsasthana chapter 33 sloka 24. Varanasi: Krishnadas Academy; 1980. p. 518. (Krishnadas Ayurveda series 51). Vagbhata, Ashtangahridaya Sutrasthana chapter 18 sloka 39-40. Varanasi: Krishnadas Academy; 1982. p. 268. (Krishnadas Academic series 4).40. Agnivesa, Charaka samhitha Sidhisthana chapter 6 sloka 31-32. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 706. (Krishnadas academic series; vol 4).41. Vagbhata, Ashtangahridaya Sutrasthana chapter 18 sloka 42-45. Varanasi: Krishnadas Academy; 1982. p. 267. (Krishnadas academic series 4).42. Agnivesa, Charaka samhitha Sidhisthana chapter 6 sloka 29-30. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 705. (Krishnadas academic series vol 4).43. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 34 sloka 3. Varanasi: Krishnadas Academy; 1980. p. 521. (Krishnadas Ayurveda series 51).44. Agnivesa, Charaka samhitha Sutrasthana chapter 26 sloka 67. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 141. (Krishnadas academic series vol 4). 143 Bibliographic references
    • 45. Agnivesa, Charaka samhitha Sutrasthana chapter 26 sloka 13. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 138. (Krishnadas academic series vol 4).46. Dr. Laurence, Clinical Pharmacology chapter 33. 8th ed. London: Churchil Livingstone; 1997. p. 579-583.47. Martini.F.H, Fundamentals of Anatomy and Physiology chapter 24. 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 877-878.48. Martini.F.H, Fundamentals of Anatomy and Physiology chapter 24. 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 884-885.49. Martini.F.H, Fundamentals of Anatomy and Physiology chapter 24. 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 898-899.50. Martini.F.H, Fundamentals of Anatomy and Physiology chapter 18. 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 621-622.51. Martini.F.H, Fundamentals of Anatomy and Physiology chapter 18. 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 601-602.52. Martini.F.H, Fundamentals of Anatomy and Physiology chapter 18. 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 614-615.53. Martini.F.H, Fundamentals of Anatomy and Physiology chapter 24. 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 891-892.54. Madhavakara, Madhavanidana chapter 1 sloka 5. Varanasi: Chaukhambha Surbharathi Prakashan; 1998. p. 16. (Chaukhambha Ayurvijnana Granthamala 46).55. Agnivesa, Charaka samhitha Sutrasthana chapter 17 sloka 79. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 203. (Krishnadas academic series vol 4).56. Agnivesa, Charaka samhitha Nidanasthana chapter 04 sloka 3. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 211. (Krishnadas academic series vol 4).57. Madhavakara, Madhavanidana chapter 34 sloka 1. Varanasi: Chaukhambha Surbharathi Prakashan; 1998. p. 35. (Chaukhambha Ayurvijnana Granthamala 46).58. Sushrutha, Sushruthasamhitha Nidanasthana chapter 6 sloka 27. Varanasi: Krishnadas Academy; 1980. p. 294. (Krishnadas Ayurveda series 51). 144 Bibliographic references
    • 59. Agnivesa, Charaka samhitha Nidanasthana chapter 04 sloka 3. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 211. (Krishnadas academic series vol 4).60. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 11 sloka 3. Varanasi: Krishnadas Academy; 1980. p. 451. (Krishnadas Ayurveda series 51).61. Agnivesa, Charaka samhitha Shareerasthana chapter 3 sloka 17. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 350. (Krishnadas academic series vol 4).62. Agnivesa, Charaka samhitha Chikitsasthana chapter 6 sloka 4. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 444. (Krishnadas academic series vol 4). Sushrutha, Sushruthasamhitha Nidanaasthana chapter 6 sloka 3. Varanasi: Krishnadas Academy; 1980. p. 289. (Krishnadas Ayurveda series 51). Vagbhata, Ashtangahridaya Nidanasthana chapter 10 sloka 3. Varanasi: Krishnadas Academy; 1982. p. 502. (Krishnadas academic series 4).63. Agnivesa, Charaka samhitha Nidanasthana chapter 4 sloka 5. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 212. (Krishnadas academic series vol 4).64. Agnivesa, Charaka samhitha Nidanasthana chapter 04 sloka 24. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 214. (Krishnadas academic series vol 4).65. Agnivesa, Charaka samhitha Nidanasthana chapter 04 sloka 36. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 215. (Krishnadas academic series vol 4).66. Agnivesa, Charaka samhitha Sutrasthana chapter 17 sloka 79. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 203. (Krishnadas academic series vol 4).67. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 11 sloka 3. Varanasi: Krishnadas Academy; 1980. p. 451. (Krishnadas Ayurveda series 51).68. 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. CRW Edwards ,editor. London: Churchill Livingston 1995. p. 728.69. Madhavakara, Madhavanidana chapter 1 sloka 6. Varanasi: Chaukhambha Surbharathi Prakashan; 1998. p. 32. (Chaukhambha Ayurvijnana Granthamala 46). 145 Bibliographic references
    • 70. 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).71. Madhavakara, Madhavanidana chapter 1 sloka 7. Varanasi: Chaukhambha Surbharathi Prakashan; 1998. p. 39. (Chaukhambha Ayurvijnana Granthamala 46).72. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 11 sloka 3. Varanasi: Krishnadas Academy; 1980. p. 451. (Krishnadas Ayurveda series 51).73. 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).74. Agnivesa, Charaka samhitha Nidanasthana chapter 04 sloka 13-22. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 214. (Krishnadas academic series vol 4).75. Agnivesa, Charaka samhitha Nidanasthana chapter 04 sloka 29-34. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 214. (Krishnadas academic series vol 4).76. Agnivesa, Charaka samhitha Nidanasthana chapter 04 sloka 41-45. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 215. (Krishnadas academic series vol 4).77. Sushrutha, Sushruthasamhitha Nidanasthana chapter 6 sloka 25. Varanasi: Krishnadas Academy; 1980. p. 294. (Krishnadas Ayurveda series 51).78. Vagbhata, Ashtangahridaya Nidanasthana chapter 10 sloka 18. Varanasi: Krishnadas Academy; 1982. p. 504. (Krishnadas Academic series 4).79. Cotran SR, Pathologic Basis of Disease chapter 20. 6th ed. Philadelphia: Saunders; 2003. p. 913-916.80. Madhavakara, Madhavanidana chapter 1 sloka 10. Varanasi: Chaukhambha Surbharathi Prakashan; 1998. p. 58. (Chaukhambha Ayurvijnana Granthamala 46). 146 Bibliographic references
    • 81. Agnivesa, Charaka samhitha Nidanasthana chapter 04 sloka 4. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 212. (Krishnadas academic series vol 4).82. Agnivesa, Charaka samhitha Sutrasthana chapter 17 sloka 78-79. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 203. (Krishnadas academic series; vol 4). Agnivesa, Charaka samhitha Chikitsasthana chapter 6 sloka 5. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 444. (Krishnadas academic series vol 4).83. Cotran SR, Pathologic Basis of Disease chapter 20. 6th ed. Philadelphia: Saunders; 2003. p. 913.84. Agnivesa, Charaka samhitha Chikitsasthana chapter 6 sloka 7. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 445. (Krishnadas academic series vol 4).85. Agnivesa, Charaka samhitha Nidanasthana chapter 4 sloka 13-22. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 214. (Krishnadas academic series vol 4). Agnivesa, Charaka samhitha Nidanasthana chapter 4 sloka 29-34. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 214. (Krishnadas academic series vol 4). Agnivesa, Charaka samhitha Nidanasthana chapter 4 sloka 41-44. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 215. (Krishnadas academic series vol 4).86. Sushrutha, Sushrutha samhitha Nidanasthana chapter 6 sloka 10-12. Varanasi: Krishnadas Academy; 1980. p. 291. (Krishnadas Ayurveda series 51).87. Vagbhata, Ashtangahridaya Nidanasthana chapter 10 sloka 13-19. Varanasi: Krishnadas Academy; 1982. p. 503-504. (Krishnadas academic series 4).88. Sushrutha, Sushrutha samhitha Chikitsasthana chapter 11 sloka 3. Varanasi: Krishnadas Academy; 1980. p. 451. (Krishnadas Ayurveda series 51).89. Agnivesa, Charaka samhitha Chikitsasthana chapter 6 sloka 15-16. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 446. (Krishnadas academic series vol 4).90. Vagbhata, Ashtangahridaya Nidanasthana chapter 10 sloka 18. Varanasi: Krishnadas Academy; 1982. p. 504. (Krishnadas academic series 4).91. Cotran SR, Pathologic Basis of Disease chapter 20. 6th ed. Philadelphia: Saunders; 2003. p. 913. 147 Bibliographic references
    • Davidson Stanley Sir, Principles and Practice of Medicine chapter 12. CRW Edwards, editor. London: Churchill Livingston 1995. p. 725.92. Agnivesa, Charaka samhitha Chikitsasthana chapter 6 sloka 7. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 445. (Krishnadas academic series vol 4).93. Agnivesa, Charaka samhitha Nidanasthana chapter 4 sloka 11. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 213. (Krishnadas academic series vol 4).94. Agnivesa, Charaka samhitha Nidanasthana chapter 4 sloka 27. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 214. (Krishnadas academic series vol 4).95. Agnivesa, Charaka samhitha Nidanasthana chapter 4 sloka 38. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 215. (Krishnadas academic series vol 4).96. Vagbhata, Ashtangahridaya Nidanasthana chapter 10 sloka 19. Varanasi: Krishnadas Academy; 1982. p. 504. (Krishnadas academic series 4).97. Vagbhata, Ashtangahridaya Nidanasthana chapter 10 sloka 41. Varanasi: Krishnadas Academy; 1982. p. 506. (Krishnadas academic series 4).98. Vagbhata, Ashtangahridaya Nidanasthana chapter 10 sloka 41. Varanasi: Krishnadas Academy; 1982. p. 506. (Krishnadas academic series 4).99. Yogaratnakara – Pramehachikitsa Vaidya Lakshmipatisastry,editor. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 82. (Kasi Sanskrit series 160).100. Sushrutha, Sushrutha samhitha Nidanasthana chapter 6 sloka 24. Varanasi: Krishnadas Academy; 1980. p. 294. (Krishnadas Ayurveda series 51).101. Vaidya Basavaraja, Basavarajeeya 9th prakarana. Varanasi: Chaukhambha vidya Bhavana; p. 156.102. Sushrutha, Sushrutha samhitha Chikitsasthana chapter 11 sloka 3. Varanasi: Krishnadas Academy; 1980. p. 451. (Krishnadas Ayurveda series 51).103. Agnivesa, Charaka samhitha Chikitsasthana chapter 21 sloka 40. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 561. (Krishnadas academic series vol 4).104. Agnivesa, Charaka samhitha Nidanasthana chapter 4 sloka 48. 4th ed. Varanasi: 148 Bibliographic references
    • Chaukhambha Kasi Sanskrit series; 1994. p. 250. (Krishnadas academic series vol 4).105. Vagbhata, Ashtangahridaya Nidanasthana chapter 6 sloka 22-24. Varanasi: Krishnadas Academy; 1982. p. 504. (Krishnadas academic series 4). Sushrutha, Sushrutha samhitha Nidanasthana chapter 6 sloka 13. Varanasi: Krishnadas Academy; 1980. p. 291. (Krishnadas Ayurveda series 51).106. Agnivesa, Charaka samhitha Sutrasthana chapter 17 sloka 78-82. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 103. (Krishnadas academic series vol 4).107. Agnivesa, Charaka samhitha Sutrasthana chapter 17 sloka 105-106. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 105. (Krishnadas academic series vol 4).108. Sushrutha, Sushrutha samhitha Nidanasthana chapter 6 sloka 14. Varanasi: Krishnadas Academy; 1980. p. 292. (Krishnadas Ayurveda series 51).109. Vagbhata, Ashtangahridaya Nidanasthana chapter 10 sloka 24. Varanasi: Krishnadas Academy; 1982. p. 504. (Krishnadas academic series 4).110. 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. CRW Edwards, editor. London: Churchill Livingston 1995. p. 754-757.111. Agnivesa, Charaka samhitha Chikitsasthana chapter 6 sloka 7-8. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 445. (Krishnadas academic series vol 4).112. Sushrutha, Sushrutha samhitha Nidanasthana chapter 11 sloka 3. Varanasi: Krishnadas Academy; 1980. p. 451. (Krishnadas Ayurveda series 51).113. Agnivesa, Charaka samhitha Chikitsasthana chapter 6 sloka 25. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 447. (Krishnadas academic series vol 4).114. Sushrutha, Sushrutha samhitha Nidanasthana chapter 13. Varanasi: Krishnadas Academy; 1980. p. 451. (Krishnadas Ayurveda series 51).115. Sushrutha, Sushrutha samhitha Chikitsasthana chapter 12 sloka 4-5. Varanasi: Krishnadas Academy; 1980. p. 454. (Krishnadas Ayurveda series 51). 149 Bibliographic references
    • 116. Agnivesa, Charaka samhitha Sutrasthana chapter 25 sloka 45. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 133. (Krishnadas academic series vol 4).117. Agnivesa, Charaka samhitha Chikitsasthana chapter 6 sloka 46. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 448. (Krishnadas academic series vol 4).118. Agnivesa, Charaka samhitha Chikitsasthana chapter 6 sloka 48. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 448. (Krishnadas academic series vol 4).119. Agnivesa, Charaka samhitha Chikitsasthana chapter 6 sloka 24. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 446. (Krishnadas academic series; vol 4).120. Agnivesa, Charaka samhitha Chikitsasthana chapter 6 sloka 48. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. p. 448. (Krishnadas academic series vol 4).121. Sushrutha, Sushrutha samhitha Chikitsasthana chapter 11 sloka 12. Varanasi: Krishnadas Academy; 1980. p. 453. (Krishnadas Ayurveda series 51).122. Yogaratnakara Prameha chikitsa prakarana shloka 2-4. Vaidya Lakshmipatisastry ,editor. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 35, 36. (Kasi Sanskrit series 160).123. Vagbhata, Ashtangahridaya Suthrasthana chapter 6 sloka 164. Varanasi: Krishnadas Academy; 1982. p. 119. (Krishnadas academic series 4). Nadkarni KM Dr, Indian Materia Medica vol 1. 3rd ed. Bombay: Popular prakashan; 1983. p. 1308. Nadkarni KM Dr, Indian Materia Medica vol 1. 3rd ed. Bombay: Popular prakashan; 1983. p. 969. Nadkarni KM Dr, Indian Materia Medica vol 1. 3rd ed. Bombay: Popular prakashan; 1983. p.985.124. Vagbhata, Ashtangahridaya Chikitsasthana chapter 12 sloka 27-28. Varanasi: Krishnadas Academy; 1982. p. 679. (Krishnadas academic series 4).125. Govindadasa, Bhaishajyaratnavali Jwarachikitsa prakarana. 7th ed. Kaviraj Ambikadatta Shastri editor. Varanasi: Chaukhambha Orientalia; 1983. p. 130. (Kasi Sanskrit series 152). Sushrutha, Sushruthasamhitha Chikitsasthana chapter 32 sloka 27. Varanasi: Krishnadas Academy; 1980. p. 512. (Krishnadas Ayurveda series 51). 150 Bibliographic references
    • 126. Vagbhata, Ashtangahridaya Kalpasthana chapter 2 sloka 15-16. Varanasi: Krishnadas Academy; 1982. p. 743. (Krishnadas academic series 4).127. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 424.128. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 459.129. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 313.130. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 464.131. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 462.132. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 415.133. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 291.134. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 361.135. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 514.136. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 477.137. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 479.138. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 299.139. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 653.140. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 409.141. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 366. 151 Bibliographic references
    • 142. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 288, 574.143. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 290.144. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 444.145. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 245,547.146. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 487.147. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 309.148. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 438.149. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 515.150. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 424.151. Gogte. VM, Ayurvedic Pharmacology. Bombay: Bharatheeya Vidya Bhavan; 2000. p . 383.152. Vaidya Yadavji Trikamji Acharya, Rasamrita Lavana kshara vignaneeya, chapter 2. Varanasi: Chaukhamba Sanskrita Bhavan; 1998. p. 137.(Chaukambha Sanskit Bhavan Series 2) Agnivesa, Charaka samhitha Sutrasthana chapter 27. 4th ed. Varanasi: Chaukhambha Kasi Sanskrit series; 1994. (Krishnadas academic series vol 4). Sushrutha, Sushrutha samhitha Sutrasthana chapter 46. Varanasi: Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51).153. Nadkarni KM Dr, Indian Materia Medica vol 1. 3rd ed. Bombay: Popular prakashan; 1976. p. 478.154. Nadkarni KM Dr, Indian Materia Medica vol 1. 3rd ed. Bombay: Popular prakashan; 1976. p. 1208. 152 Bibliographic references
    • 155. Nadkarni KM Dr, Indian Materia Medica vol 1. 3rd ed. Bombay: Popular prakashan; 1976. p. 1202.156. Nadkarni KM Dr, Indian Materia Medica vol 1. 3rd ed. Bombay: Popular prakashan; 1976. p. 480.157. Nadkarni KM Dr, Indian Materia Medica vol 1. 3rd ed. Bombay: Popular prakashan; 1976. p. 985.158. Nadkarni KM Dr, Indian Materia Medica vol 1. 3rd ed. Bombay: Popular prakashan; 1976. p. 1015.159. Rasamrita Lavana kshara vignaneeya, chapter 2. Varanasi: Chaukhamba Sanskrita Bhavan. p. 137.(Chaukambha Sanskrit Bhavan series 2).160. Goud Kiran Dr, Effect of Salasaradigana basti in Sthoola Madhumehi (Un published doctoral dissertation). Bangalore: Rajiv Gandhi University of Health Sciences; 1999. 153 Bibliographic references
    • 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) Febin.K.AntoCo- 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
    • 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 No Incidental Gradual Hereditary >Onset :15. HISTORY OF PAST ILLNESS Hypertension Jaundice Cardiac disorders Asthma T.B Others :16. TREATMENT HISTORY :- Modern Medicine :- Yes No If Yes :- Drug Duration Ayurvedic medicine :- Yes No If Yes :- Drug Duration Relief with previous Yes No Duration of relief
    • treatment :-17. FAMILY HISTORY :- Present Absent Father Mother Brother Spouse Children Sister Others18. 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 :- Menstrual Cycle Regular Irregular Menopause19. 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 Krisha20. 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 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 Arthavavaha23. NIDANA PANCHAKA :- a. Nidana > General :- Ahara Snigdhaahara Atyupayoga Guru Ahara Atyupayoga Vihara Asyasukham Swapnasukham Alpavyayamam Alpachintha > Vataja Nidana :- Ahara Ruksha Atyupayoga Katu Atyupayoga Kashaya Atyupayoga Tiktha Atyupayoga Vihara Vamana Atiprayoga Virechana Atiprayoga Basthi Atiprayoga Atimaithunasheela Ativyayamasheela Atyupavasasheela Rakthamokshana Atiprayoga Vegadharanasheela > Pithaja Nidana :- Ahara Ushna Atyupayoga Amla Atyupayoga Lavana Atyupayoga Katu Atyupayoga Vishamaaharasevana Ajeernaaharasevana
    • Vihara Teekshna Atapasevana Atishrama > Kaphaja Nidana :- Ahara Gramyamamsa Atyupayoga Anupamamsa Atyupayoga Oudakamamsa Atyupayoga Sakaahara Atypayoga Ksheera Atyupayoga Dadhi Atypayoga Vihara Avyayama Divaswapnam Aasanasheela b. Poorva roopa : c. Roopa : d. Upashaya / Anupashaya : e. Samprapthi24. OTHER INVESTIGATIONS. Blood-Hb- TC- DC- ESR- SERUM CHOLESTROL-25. TREATMENT PROTOCOL :- Procedure Day Dose Observations Deepanana Pachana (By Trikatuchurna) Snehapana (By Trikandakadyam Gritham) :- OBSERVATION OF JEERYAMANA LAKSHANAS Lakshanas I II III IV V VI VII Shiroruja Bhrama Lalasrava Murcha Angasada Klama Trishna Daha Arati
    • SNEHA JEERNA LAKSHANAS Lakshanas I II III IV V VI VII Jeeryamanalakshana Prashamana Vatanulomana Kshudha pravrutti Trisha pravrutti Udgara shuddhi Shareeralaghutha UtsaahaOBSERVATION OF SAMYAK SNIGDHA LAKSHANAS Lakshanas I II III IV V VI VII Vatanulomana Agnideepti Purisha snigdhata Asamhata Varchas Twak snigdhata Anga laghava Gatra mardhava Klama Shaithilya Abhyanga & Mruduswedana :- Day 1 Day 2 Day 3 Day 4 Pradhanakarma :- Poorva Nireekshana : Nidra :- Malavegotsarga :- Jeernaahara :- Mangalacharana :- Tatkaleena Nireekshana : > Virechanayoga Dose : gms. > Time of first Vega : > Time of last Vega : > Total No. of Vegas :
    • Vital Data : Observation Before During After Virechana Virechana Virechana Pulse Blood Pressure Respiratory Rate TemperatureVirechanakarma Parimana : Laingiki Maaniki Vaigiki Aanthiki Day 1 Day 2 Day 3 Samsarjana karma Day 4 Day 5 Day 6 Day 7
    • 26. ASSESSMENT OF RESULTS A. Subjective Parameters Symptoms Before After After 15th day of 30th day treatment Snehapana Virechana follow-up of follow- up Prabhuthamutratha Kshudadhikya Pipasadhikya Karapada daha Ati Sweda B. Objective Parameters Investigation Before After After 15th day 30th treatment Snehana Virechana of day of follow- follow- up up F.B.S PPBS Urine sugar Body Weight27. INVESTIGATORS NOTE :-Signature of Co-Guide Signature of Guide
    • 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