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Evaluation of the efficacy of Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) By VIJAYALAXMI. B. BENAKATTI, Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103
Citation preview
Evaluation of the efficacy of Phalatrikadi Vati
in Madhumeha (Diabetes Mellitus) By
VIJAYALAXMI. B. BENAKATTI
Dissertation submitted to the
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial fu
Ayurved
KaUnde
Dr. Shiva RamM.D. (Ayu) (Osm), C
DepartmPost Graduate StD.G. MELMALAGI AYURV
lfillment of the degree of
a Vachaspati M.D. In
yachikitsa r the Guidance of
a Prasad Kethamakka .O.P. (German) M.A., [Ph.D] (Jyotish)
ent of Kayachikitsa udies & Research Center EDIC MEDICAL COLLEGE, GADAG 2006-2009
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103
This is to certify that the dissertation “Evaluation of the efficacy of Phalatrikadi
Vati in Madhumeha (Diabetes Mellitus)” is a bonafide research work done by
Vijayalaxmi. B. Benakatti in partial fulfillment of the requirement for the post graduation
degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of
Health Sciences, Bangalore, Karnataka.
Date:
Place:
Guide:
Prof. Dr. Shiva Rama Prasad Kethamakka
M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish)
Professor in Kayachikitsa
DGMAMC, PGS&RC, Gadag
J.S.V.V. SAMSTHE’S
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103
Endorsement by the H.O.D, principal/ head of the institution
This is to certify that the dissertation entitled “Evaluation of the efficacy of
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)” is a bonafide research work done
by Vijayalaxmi. B. Benakatti under the guidance of Prof. Dr. Shiva Rama Prasad
Kethamakka, M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish), Professor in
Kayachikitsa in partial fulfillment of the requirement for the post graduation degree of
“Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health
Sciences, Bangalore, Karnataka.
.
Profess
Dept. of K
PGS
Date:
Place: Gadag
(Dr. G. B. Patil) Principal,
DGM Ayurvedic Medical College,
Gadag
Date:
Place: Gadag
or & HOD
ayachikitsa
&RC
Declaration by the candidate
I here by declare that this dissertation / thesis entitled “Evaluation of the efficacy of
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)” is a bonafide and genuine research
work carried out by me under the guidance of Prof. Dr. Shiva Rama Prasad
Kethamakka, M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)], Professor in Kayachikitsa,
DGMAMC, PGS&RC, Gadag.
Date:
Place: Gadag
Vijayalaxmi. B. Benakatti
Copy right
Declaration by the candidate
I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka
shall have the rights to preserve, use and disseminate this dissertation/ thesis in print or
electronic format for the academic / research purpose.
Date:
Place:
Vijayalaxmi. B. Benakatti
© Rajiv Gandhi University of Health Sciences, Karnataka
Acknowledgement
Any research is not an individual effort. It is a contributory effort of many hearts,
hands and heads. I am very much thankful to the subjects of this study.
I am extremely happy to express my deepest sense of gratitude to my beloved and
respected guide and H.O.D Prof. Dr. K. Shiva Rama Prasad, M.D., C.O.P. (German),
M.A., [Ph.D.], for his guidance and timely help.
I express my gratitude to Dr. V. V. Varadacharyulu Professor and Ex H.O.D for his
advice and encouragement in every step of this work.
I am sincerely grateful to Dr. G. B. Patil, Principal, for his encouragement and
providing all necessary facilities for this research work.
I express my special thanks to Dr. R. V. Shettar, Dr. B. G .Swami, Dr. Kuber sankh
for their timely help and co-operation.
I extend my gratitude to Dr. G. Purushottamacharyulu, Dr. P. Shivaramudu, Dr. M.
C. Patil, and Dr. G. S. Hiremath, Dr. U. V. Purad, Dr. Mulgund. Dr. G. Danappagoudar.
Dr. S. N. Belawadi. Dr. Nedugundi, Dr. Samudri, Dr. J. Mitti. Dr. Shankargouda. Dr.
Mulki Patil. Dr. Yasmin A.P, Dr Veena. Kori and Dr. Yaregari RMO DGMAMC Gadag.
I express my immense gratitude to statistician Nandakumar, Tippanagoudar (Lab),
V.B. Mundinamani (librarian) and Kerur and Shyavi for facilitating me in collection and
production of my thesis.
I take this opportunity to thank Dr. Yadavannavar (M.D) lecturer in B. M. Nagur
College Bijapur who accompanied me at every step with his valuable suggestions and
moral support.
My deep senses of gratification to my inspirations of this study are my parents
Shri. Basavaraj. Benakatti and Smt. Saroja. B. Benakatti and my beloved husband Dr.
Rajeev. Karalingannavar, for their love, support with a constant enthusiastic and
affectionate push and who are the driving force.
I am extremely happy to express my deepest sense of gratitude to my beloved
daughter Neha, my mother-in-law Smt. Neelama Karalingannavar And my Brother in
law and co-sister, Aravinda and Ashawini Karalingannavar. I am extremely happy to
express my deepest sense of gratitude to my all uncles and aunties.
I express my heartfelt gratitude to my Sisters, Dr. Veena, Vishala, Sangeeta,
Shweta for constant help and encouragement to move ahead.
I take this moment to express my thanks to all my Post gratude senior friends, Dr.
Shivaleela. Kalyani, Dr. Kamalaxi, Dr. Sulochana, Dr. M. G. Ashok. Dr. Rudrakshi.
My in depth regards to my friends Dr. Prasann. Joshi, Dr. Sanjeev, Dr. Veena.
Jigalur, Dr. Neeraj, Dr. Mukta. Arali, Dr. Mukta. Hiremath, Dr. Anupama, Dr Trupti. Dr.
Ishawar, Dr. Praveen, Dr. V S Kanti, Dr. Bodake, Dr. Kavitha, Dr. Sarvamangala, Dr.
Jaya. M, Dr. Kalavati, Dr Savitha, Dr. Adarsha, Dr. Nataraja, Dr. Udaya, Dr. Shaileja,
Dr. Ravi, Dr. Shivakumar, Dr. Jyoti for their support and encouragement.
I express my immense thanks to my patients for their cooperation during the trial.
Last but not least I express my deepest thankfulness whose names are not taken
here but helped me a lot along with my kith and kilns to my family members.
(Vijayalaxmi. B. Benakatti)
Abstract of “Evaluation of the efficacy of Pkalatrikadi Vati in
Madhumeha (Diabetes Mellitus)” by
Vijayalaxmi. B. Benakatti Key words: Madhumeha, Prabhoota, avila mootrata, Phalatrikadi Vati, DM,
Hypoglycemia, Blood glucose.
Madhumeha vis-à-vis Diabetes mellitus is a common chronic metabolic disorder
prevalent all over the world. Although Madhumeha has been a known morbidity since
time immemorial, its incidence has been growing notably in recent years. Madhumeha
vis-à-vis Diabetes mellitus is a major health problem for the world in the 21st century.
The mortality rate due to Diabetes mellitus is very high and is ranked fifth amongst the
ten major causes of death in southern part of India. The rising prevalence of diabetes is
closely associated with industrialization and socio-economic development. In Ayurveda,
Madhumeha is explained under the heading of Prameha, Madhumeha is a disease of
systemic and deranged metabolism expressed in mootravaha srotus that result in to
vitiation of various body elements. Avarnjanya Madhumeha possesses vitiated Kapha,
Pitta and Meda caused due to Avarana of Vata aggravation causes Vital Dhatus
deprevation. Madhumeha is a disease characterized by Prabhoota, avila mootrata, Tanu
and Mootra madhuryata. The present study focused on the disease pathogenesis and its
regulation through Phalatrikadi vati as a Shamana Chikitsa. Apart from other symptoms
of Madhumeha, the glycemic condition of the Madhumeha assessed by parameters i.e.
FBS, PPBS, FUS and PPUS taken after to before data. These shows high significant with
FBS with a mean difference of 31.84mg and PPBS with mean difference of 63.92 mg,
This is evidence to state that the phalatrikadi Vati is hypoglycemic agent combination of
Ayurveda.
Contents of
“Evaluation of the efficacy of Phalatrikadi Vati in Madhumeha
(Diabetes Mellitus)”
By
Vijayalaxmi B Benakatti CHAPTER CONTENT PAGES
1 Introduction 1 to 5
2 Objectives 6 to 7
3 Review of literature 8 to 74
4 Methods 75to 82
5 Results 83 to 100
6 Discussion 101 to 118
7 Conclusion 119 to 120
8 Summary 121 to 122
9 Bibliographic References 1 to 11
10 Annex – data of trial 1 to 9
11 Annex – Case sheet 1 to 6
- 1 -
Tables of “Evaluation of the efficacy of Phalatrikadi Vati in Madhumeha
(Diabetes Mellitus)” SN Title of Table Page 1 Showing the Ahara Nidana of Madhumeha 13 2 Showing the Vihara Nidana of Madhumeha 14 3 Showing the Vishista Nidana of Madhumeha acco Dosha 15 4 Showing the Avarnajnya Nidana of Madhumeha 16 5 Showing the Roopas in relation to Dosha and Dushya 29-30 6 Types of kaphaja,pittaja, vataja Prameha 32 7 Showing the poorva roopa of Madhumeha 36 8 Lakshana of Madhumeha 38 9 Madhumeha samanya upadrava 40 10 Madhumeha Upadrava 41 11 Sapeksha nidana of Madhumeha 44-45 12 Results by Age in Madhumeha with Phalatrikadi Vati 84 13 Results by Gender in Madhumeha with Phalatrikadi Vati 85 14 Results by Religion in Madhumeha with Phalatrikadi Vati 86 15 Results by Occupation in Madhumeha with Phalatrikadi Vati 87 16 Results by Economic status in Madhumeha with Phalatrikadi Vati 88 17 Results by Diet in Madhumeha with Phalatrikadi Vati 89 18 Distribution of patients by presenting complaints 91 19 Distribution of patients by Associated features 92 20 Ahara Nidana observed in the study 93 21 Vihara Nidana observed in the study 93 22 Distribution of patients by Anya Nidana 94 23 Distribution of patients by Poorva roopa lakshana 94 24 Distribution of patients by Sroto dusti lakshana 95 25 Data of Family history in the study 96 26 Assessment of Subjective parameters 96 27 Assessment of Objective parameters 97 28 Result of Phalatrikadi Vati in Madhumeha 98 29 Statistical analysis of Phalatrikadi Vati 100
- 2 -
Figures and Photos of
“Evaluation of the efficacy of Phalatrikadi Vati in Madhumeha
(Diabetes Mellitus)”
SN Title of Figures and photos Page
1 Madhumeha Samprapti 31
2 Composition of Phalatrikadi Vati 70
3 Results by Age in Madhumeha with Phalatrikadi Vati 84
4 Results by Gender in Madhumeha with Phalatrikadi Vati 85
5 Results by Religion in Madhumeha with Phalatrikadi Vati 86
6 Results by Occupation in Madhumeha with Phalatrikadi Vati 87
7 Result Distribution of patients by Economic status 89
8 Results by Diet in Madhumeha with Phalatrikadi Vati 90
9 Distribution of patients by presenting complaints 91
10 Distribution of patients by Associated features 92
11 Result of Phalatrikadi Vati in Madhumeha 98
- 3 -
INTRODUCTION
Ayurveda is not only a system of Medicine rather it is the way of life. It
includes physical, mental and spiritual well being. Ayurveda is becoming more and
more acceptable globally as it is toxicity free, eco-friendly with its holistic approach.
Madhumeha is a disease known since ancient times to the mankind. Ayurveda
in fact is the first medical science, which identified, diagnosed & managed
Madhumeha. While claiming it is incurable much earlier to Greek physician aeratus
(1-2 AD).
Madhumeha is one of the Mahagadas 1 in which maximum number of Srotas
gets vitiated with the vitiation of almost all the Dhatus and Ojas due to which the
condition of the patient afflicted with Madhumeha goes on deteriorating.
Madhumeha is mentioned as one of the 20 types of Prameha. Madhumeha has
been classified under the Vatika type of Prameha 2. The Vata may be provoked either
directly by its etiological factors, Avarana by Kapha and Pitta to its path or by
continuous depletion of Dhatus. Vagbhata has classified the Madhumeha into two
categories viz. Dhatukshayajanya Madhumeha and Avaranajanya Madhumeha 3. The
factors which provoke the Vata directly cause Apatarpanajanya Madhumeha. while
the factors which provoke Kapha and Pitta cause Santarpanajanya Madhumeha.
The Apatarpanajanya Madhumeha patients are usually Krusha and are
equivalent to Type I Diabetes mellitus, while the Santarpanajanya Madhumeha
patients are stoola equivalent to Type II Diabetes mellitus. In Avaranajanya
Madhumeha, Kapha is the predominant Dosha while the important Dushyas are Meda
and Kleda. Type II Diabetes mellitus is mainly associated with Avaranajanya
Samprapti. In Madhumeha, the main Avaraka are Kapha, Pitta, Rasa, Mamsa and
Meda, and out of these Meda is predominant 4.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Introduction 1
Over the last 50 yr, changes in lifestyle have led to a dramatic increase in the
prevalence of type 2 diabetes in virtually every society around the world. Reductions
in physical activity, increases in dietary intake, westernization of diet and the aging of
the population are key factors in bringing about this rapid change 5.
In modern medical science, symptomatology of Madhumeha is equivalent to
the features of Diabetes mellitus 6. Diabetes mellitus remains one of the baffling
enigmas for clinical research. DM is expected to continue as a major health problem
owing to its serious complications, especially end stage of renal disease, IHD,
gangrene of the lower extremities & blindness in the adults 7.
Diabetes is a syndrome characterized by disordered metabolism and
abnormally high blood sugar resulting from insufficient levels of the hormone
insulin.The characteristic symptoms are excessive urine production (polyuria) due to
high blood glucose levels, excessive thirst and increased fluid intake (polydipsia)
attempting to compensate for increased urination 8.
Incidence Rate
Diabetes Mellitus is a leading cause of morbitidy & mortality the world over,
it is estimated that approximately 1% of population suffers from DM. the
incidence is rising in the developed countries of the world, especially of the
Type 2 DM, due to rising incidence of obesity & reduced activity levels 9.
The prevalence of Madhumeha is on the rise; more alarmingly in the
developing nations Ranked 7th among leading causes for death 10.
The prevalence of diabetes for all age-groups worldwide was estimated to be
2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is
projected to rise from 171 million in 2000 to 366 million in 2030 11.
India has been projected as the diabetic capital of the world 12. Diabetes and it
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Introduction 2
complications pose a major threat to future public health resources throughout
the world.
Recent survey by W.H.O. revealed that the Indian diabetic population at
present is 31.9 million and it is estimated to touch 79.4 million by the year
2030 13. It has been stated that in 1995 number of diabetics was 19.4 million in
India which rise to 30 million by the year 2002, but only 3.6 million Diabetics
in India received pharmacological treatment. In the early seventies only 2.1%
Urban Indians were suffering from type 2 Diabetes mellitus, which rise to
12.1% at present.
The recently concluded that National Urban Diabetes study (NUDS) carried
out by the Diabetes Epidemiology Study group in India (DESI) in six major
cities of India covering all the regions of the country estimated that the
prevalence rate of Diabetes in the adult population is 12.10%, while the
prevalence rate of Impaired Glucose Tolerance (IGT), a pre-diabetic condition
is 14%.
The above-mentioned figures point towards the alarming situation, which
suggests that the incidence of diabetes mellitus is increasing among the
general population. The top three countries for number of persons with
diabetes are India, China and United States of America. India has now been
declared by WHO as the Diabetes capital of the world.
Purpose of the study
Though, the discovery of Insulin and other hypoglycemic drugs has a great
achievement of modern medical science, but the hazardous side effects of
hypoglycemics after long term used are incurable and hence an ideal therapy is still
obscure. Recent data showing that control of hyperglycemia may prevent the onset or
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Introduction 3
slow down the progression of complications point to the importance of an appropriate
and efficacious treatment.
The Ayurvedic management of Madhumeha aims not only to achieve a strict
glycemic control but also to treat the root cause of the disease. Since the disease is not
curable, effective control is the need of the hour. For the prevention and control of the
diabetes, at various levels prevention is to be implemented. To reduce the incidence of
the cases that is in risk group, to reduce the associated signs and symptoms of the
disease and avoiding the further advancement of the disease leading to complications.
Here the present study aims to reduce the associated signs and symptoms of
the disease and avoiding the further advancement of the disease leading to
complications prevention by regularizing the blood glucose level with the help of
shamanaoushadi.
Previous research literatures
Soma S. Bhatia (2001) Jamnagar, A Clinical study on the role of Manas bhava
in the etiopathogenesis of Madhumeha. (Diabetes Mellitus) and its
Management by Sarasvatachurna (Manas Roga)
Sheetal Parmar (2002) Jamnagar, The role of Virechana & Trifaladi vati in the
management of Madhumeha (Diabetes Mellitus) (K.C.)
Anand Pawar (2003) Jamnagar, A comparative study of the role of basti
therapy and pramehaghna drugs in the management of madhumeha (Diabetes
mellitus)
Tushar Mandal (2001) Varanasi, A study on daruharidra (berberis aristata) in
no healing diabetic foot ulcers .(D.G.)
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Introduction 4
Pandey A K - 2003 Varanasi, A study of immune status in patient of
Madhumeha and role of pancha karma and naimmithika rasayana
Gowda Kirana M (1999) Mysore, Effect of salasaradi gana Basti on stool
madhumeha
The study description
The study description consists of the headings according to the RGUHS
protocol followed from 2nd chapter.
About concept
The word Madhumeha in terms of ‘Diabetes Mellitus’ it is the present burning
issue alarming the world. With synonym of Richman’s disease,’ Madhumeha is a
chronic metabolic disorder and the symptom appears in relation with a mootravaha
samsthana. Diabetes mellitus is a chronic metabolic endocrinal disorder, which has
similar pathogenesis as the Madhumeha. Thus the comparison between Madhumeha
and DM is justifiable 14.
The present study was designed as “Evaluation of the efficacy of Palatrikadi
Vati”. Several herbs have been described in Ayurvedic treasure of therapeutics, which
have a beneficial effect in the management of Madhumeha.
Madhumeha is a Vata Kapha pradhana Vyadhi. Phalatrikadi Vati 15 has been
mentioned in all most all authour under Kashaya form for Prameha Chikitsa. This
being Kapha & vata shamaka,Tikta, Katu,Kashaya Rasa, Katu Vipaka, Laghu, Ruksha
Guna Pradhana Aushadhi may easily help in the dissociation of Pathogenesis of
Madhumeha. They also possess Deepana and Pachana properties. That is why
Phalatrikadi Vati has been selected for the present study.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Introduction 5
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Objective 6
OBJECTIVES
Ayurveda system of medicinal aims at treating the human body as a whole and
not just the disease. Our Ayurvedic principles for the treatment, which reveals that the
medicine or treatment that cures one disease and creates some other is not a good therapy,
but the therapy which cures one disease and does not create any other, is the right
treatment 16. So here, we are putting our step forward to find safe and effective oral
hypoglycaemic agent.
Ayurveda is the first medical system, which mentions the Madhumeha / Diabetes
mellitus is incurable but it can be controlled with drug, diet. Diabetes mellitus, a chronic
disease unknown in developing world had emerged as a crucial health problem including
Asian countries. As people of developing countries were unaware of the nature of the
disease its occurrence increased rapidly. This alarming figure reminds the Diabetes
mellitus is an ice burg disease. Diabetics is more dreaded in these days because of
complications of this disease, the quality of life takes a backseat.
In Ayurveda Madhumeha and its management through various methods are
possible viz shodana, shamana. Considering the chikitsasutra the Phalatrikadi Vati as a
shamana chikitsa is under taken for the trial. As ayurvedic Madhumehahara drug which
are having safety in comparison with modern oral hypoglycemic drugs.
The present study intended to focus on the disease evaluation i.e. Madhumeha vis-
à-vis. Diabetes Mellitus and the management with Phalatrikadi Vati as a shamana
Chikitsa. Hypothetically evaluated therapeutic efficacy on the Madhumeha vis-à-vis
Diabetes Mellitus is tested through the test under the following objectives. In this regard
the objectives proposed in the study are –
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Objective 7
Objectives:
1) To evaluate the efficacy of Phalatrikadi Vati in the management of Madhumeha
2) To evaluate the efficacy of hypoglycaemic activity of Phalatrikadi Vati in
Madhumeha
1) To evaluate the efficacy of Phalatrikadi Vati in the management of Madhumeha
Dosha involvement in Madhumeha is Tridosha with predominance of Kapha and
vata with vitiation of dushy Mamsa, Meda and Shareera kleda. The ingredients of the
Phalatrikadi Vati are with Kapha Vata Doshahara and are of Katu, Tikta Rasa
predominance, Usna veerya to pacify Kapha Vata Dosha. Having gunas like Laghu,
Rookasha. Phalatrikadi Vati basically acts as Agni vardhaka, to normalize the Agni. By
observing all these characteristics of drugs Phalatrikadi Vati seems to be very much
beneficial in the management of Madhumeha which could be clinically observed to
understand Mehahara actions.
2) To evaluate the efficacy of hypoglycaemic activity of Phalatrikadi Vati in
Madhumeha
As the Phalatrikadi Vati is hypothetically capable of inducing the hypoglycemic
activity, is evaluated through Blood Glucose testing. An attempt is made to measure the
Blood sugar, urine sugar at different times of relation to meal. The evidential estimations
of the blood sugars with corresponding urine sugars are recorded before and after the
induction of trial drug to estimate the hypoglycemic action of the test drug.
HISTORICAL REVIEW
The knowledge of the ancient helps in having a better future. So the study of
history should be must for research purpose. So, careful insight into ancient treasure
of knowledge makes a good beginning for any study. The ancient treatise was full
with description of disease and their treatment. So here an attempt has been made to
explore the past literature to explain the historical aspects of the Madhumeha.
Vedic Period (2000BC to 1000BC):
The evolution of madhumeha can be traced from Vedas. Ayurveda is the
upanga of atharveda. In Atharva Veda (2500 B.C.) the disease is mentioned as
Ashravam, which means Mutra Atisara i.e., excessive urination 17.
a) Samhita Period (1000BC to 100BC)
(A) Samhita Period:
Explorative description of disease Madhumaha occurs at Samhita period.
(1) Caraka samhita:
Caraka samhita is a complete ancient treatise of medical science of its era; He
has given the detail description of the etiology, pathogenesis, symptomatology &
complications in Nidanastana 18. Where as detailed explanations of treatment is given
in Chikitsastana19. Aetiopathogenesis of madhumeha along with Complications are
narrated in Sutrastana 20.
(2) Susruta Samhita:
Achary Susruta has given elaborate explanations regarding Nidan Panchaka in
Madhumeha in the pramehaadhyaya. He used 'Ksaudrameha' synonym to Madhumeha
in Nidanastana21. He has described Pramehanivritti Lakshanas especially, i.e. how to
know that the patient is out of the disease. He has described the treatment in three
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 8
different chapters under the heading of Prameha-Chikitsit22, Prameha Pidaka
Chikitist23 & Madhumeha Chikitsit 24.
(3) Vagbhata:
Vagbhata mentioned two types of Madhumeha i.e. Dhatukshyat and
avartpathat and added Sveda in the Dusysangraha 25.
(4) Haritasamhita:
Explained13 types of Prameha with nomenclature different than above treatise
like, Puyameha, Ghrtameha etc 26.
(5) Bhela Samhita:
In Nidanasthana, description of two types of prameha is given i.e. swakritija
prameha and prakritija prameha 27.
(6) Kasyapa Samhita:
He just mentioned the symptoms of Pramehi child in Vedanadhyaya and noted
the disease as Chirakari 28.
(B) Medieval Period:
This period of history of Indian medicine is known as a period of
commentators. Most of them content only the collection of thoughts from previous
authours.
(1) Madhavanidana:
He collectively repeated the description of Charaka, Susruta and Vagbhata 29.
(2) Gayadas:
Explained the Avilamutrata becaue of the presence of Dusya in it 30.
(3) Chakrapanidatta:
Chakrapanidatta described the treatment of prameha in his documentation
Chakradatta 31.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 9
(4) Sarangadhara Samhita:
Mentioned the 20 types of Prameha and some yogas for the management of
prameha 32.
(5) Bhavaprakasa:
He described Prameha and Madhumeha along with some new herbomineral
preparations33.
(6) Yogratnakara:
Prameha chikista has been described vividly in Yogratnakara 34.
NIRUKTI AND PARIBHASHA
A) Nirukti –
Madhumeha is the combination of the two words Madhu and Meha. The word
Madhu is derived from the root ‘Mana’ has the meaning of ‘Manava Bhodane’-
.Which gives the psychic contentment [Vachspathya].
Madhu- The Madhu refers to honey, sweet, delicious, the juice or nectar of the
flowers, Soma also.
Meha- The word Meha is derived from the root ‘Miha’, which is employed in the
sense of Prasrave, excessive flow of urine, making water, passing urine, Sinchana, to
moisten, Ksharana. [Vachspathya].
Prameha - The word Prameha is derived from “Pra and Miha”
Pra + Miha Ksharane, Karane + Ganm 35
This is a general name for a urinary disease. It is a condition characterized by
excessive excretion of urine.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 10
B. Paribhasha:
Madhumeha is the clinical entity in which patient voids the urine having
concordance with Madhu i.e. of Kasaya and Madhura taste, ruksa (dry) texture and
honey like colour 36. Body acquires sweetness called madhumeha.
Susruta has defined Madhumeh as Ksaudrameha and stated that the urine in
this condition resembles honey and acquires a sweet taste 37. So it is undoubtedly
resembles with Madhumeha. Further he asserted that when all the Pramehas are
neglected get converted into Madhumeha and especially he emphasized that the
disease Prameha along with Pidaka should be termed as Madhumeha 38.
C. Paryaya:
Kshoudrameha: Kshoudra is a synonym of Madhu 39.
Ojomeha: Ojas is considered as Tejas or essence of all Dhatus, Madhura rasa of Oja
mixes with kashaya rasa of Vata and excreted out. Hence Ojomeha has been used by
Charaka 40 and Vagbhata 41 to describe this disease.
Pushpameha: In Anjananidana, the word pushpa has been narrated as synonym for
Madhumeha where the Pushparasa means madhu 42.
All above synonyms postulates unanimously that, the urine concordant with
madhu or sweet taste is Madhumeha
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 11
NIDANA
The knowledge of nidana is helpful for the proper understanding of the disease
and also for the management of the disease. Nidana parivarjana is also one of the
important measures in Chikitsa43. Only Charaka explains specific Nidanas for
Madhumeha. The Samanya Nidanas of Prameha and Vataja Prameha may attribute to
Madhumeha, as it is one of the types of Vataja Prameha.
Kaphaja Prameha nidanas may be considered as nidana for Madhumeha. As
Kapha dosha is the initial factor for the causation of all varieties of Prameha,
especially Madhumeha. This can be emphasized by Gangadhara’s version, where in
he says that Gulma is caused by vayu, Raktapitta by Pitta, like wise Madhumeha is
caused invariably due to the vitiation of Kapha dosha 44.
Mainly classified into 1) Sahaja
2) Apattanimityaja
Sahaja Madhumeha (Beeja dosha):
Charak 45 and Susruta 46 have explained that beeja dosha is also a cause for
Madhumeha. Acharya Charaka while explaining Vikrutha Garbha caused by
beeja dosha says that if a part of the beeja is defective, the body part developing
from that portion of beeja will be abnormal. He gives an example that a portion of
the beeja of a kusti man which is responsible for the formation of the skin is
defective, then only the born child will have kusta 47. However if that part is not
abnormal then the child will not suffer from kusta .Hence it can be understood that
child born to Madhumehi, may or may not suffer from Madhumeha. It depends on
the beejabhaga avayava which is defected by vitiated vatadidosha present in Sukra
and shonita of parent.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 12
2) Apattanimityaja:
a) Samanya Prameha Nidanas:
Table – 1
Showing the Aharaja Nidana of Madhumeha
S. N. Nidanas C.S. Su.S A.H M.Ni. Bhe.S B.P. Y.R
1 Dadhi Sevana + - - + - + +
2 Gramyarasa + - - + - + +
3 Audakarasa + - - + + + +
4 Anupa Rasa + - + + + + +
5 Kshira Sevana + - - + - + +
6 Nava Anna + - - + - + +
7 Nava Pana + - - + - + +
8 Guda Vaikruta + - + + - + +
9 Kaphakara Hetu + + + + + + +
10 Sheeta - + + - - - -
11 Snigdha - + + - + - -
12 Madhura + + + - - - -
13 Medovardhaka + + - - - - -
14 Drava Anna + + - - - - -
15 Drava Pana + + - - - - -
16 Nava Dhanya + - + - - - -
17 Nava Sura + - + - - - -
18 Ikshu + + + - - - -
19 Goorasa - + + - - - -
20 Amla - + + - - - -
21 Gura - + + - - - -
22 Picchila - + + - - - -
23 Mandaka + + - - - - -
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 13
Table - 2
Showing the Viharaja Nidana of Madhumeha
S. N. NIDANS C.S Su.S A.H M.Ni Bhe.S B.P Y.R
1 Asyasukha + - - + - + +
2 Swapnasukha + - - + - + +
3 Divaswapna - + - - + - -
4 Avyayama + + - - + - -
5 Alasya - + - - - - -
6 Ekasthanaasana - - + - - - -
7 Rathih - - + - - - -
8 Vidhirahitashayana - - + - - - -
9 Swapnaprasanga + - - - - - -
10 Shayanaprasanga + - - - - - -
11 Asanaprasanga + - - - - - -
12 Shareerashodhana
Varjya
+ - - - - - -
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 14
Table - 3
Showing the Vishista nidanas according to Doshaja
Nidana Kapha Pitta Vata
Ahara
sambhandi
Hayanaka,yavaka,chinaka
,uddalaka,naishada,ithakata,
mukunda,mahavrihi,
modaka,sughandaka,Sarpi,navaharenu,
masha,Anupa,udaka,gramyamamsa,
shaka,palala,tila,pistanna,
payasa,krushara,vilepi,ikshu,
sharkara,kshira,navamadhya,
mandaka,dadhi, madhura,drava
Ushna,amla,
lavana,kashaya,
Katu,ajirna,
vishamashana
Kashaya,Katu, Tikta,
Rooksha, Laghu,
Sheeta,
Vihara
sambhandi
Mrujavarjana,avyayama,
swapnashayana, aasanaprasanga
Atiatapasevana,
antapa,shrama,
kroda
Atiyoga of Vyavaya,
Vyayama, Vamana,
Virechana,Ashtapana,
Shiroovirechana,Shonita,
Atisheka,Sandharana,
Anashana,Abhighata,
Atapa,Udvega,Shokha,
Jagarana,Vishama
Shareera,Asana,
Upasevana.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 15
Table – 4
Showing the Avaranajanya Madhumeha nidanas.
Aharaja Viharaja
Guru
Snigdha
Amla
Lavana
Navanna
Navapana
Nidra Sukha
Asya Sukha
Tyakta Vyayama
Achintana
Samshodhana Akurvatam
Nidanarthakara rogaja:
A. Sthoulya:
Sthoulya is a nidanarthakara roga for Prameha. It is obvious that the
samanya nidana of Sthoulya and Prameha simulates each other. Sushrutha has stated
that apathyanimittaja Pramehis are Sthoola 48.
B. Prameha:
All the other types of mehas if neglected in its due course, lead into
Madhumeha49. Pathogenesis and the srotas involved in Prameha and Madhumeha
are similar. So, if the Prameha is not treated then it causes more strain on the
same srothases and causes
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 16
SAMPRAPTHI
The thorough knowledge of Samprapti is very essential to find the extent of
Dosha and Dushya vitiation, involvement of Avayava, Srotasa and prognosis of the
disease. For the manifestation of any disease in the body the association of main three
factors, Nidana, Dosha and Dushya is necessary otherwise disease will not occur.
According to Sushruta, too much indulgence in the etiological factors related
to Prameha results into Aparipakva Vata, Pitta, Kapha and Meda, which further
proceed through the Mutravaha Srotasa and get localized in the Basti Mukha and thus
leading to disease Prameha 50. Sushruta has stated that, all the Pramehas if left
untreated or treated improperly get terminated into Madhumeha. Vagbhata described
two types of pathogenesis of Madhumeha i.e. Dahtukshayatmaka and Dosha
Avaranatmaka. Further, Vagbhata interpreted that in all types of Prameha, the Dosha
and Dushya remain same but still the difference in Mutra Pravritti is due to specific
type of Samyoga between specific Dosha and Anukula Dushya 51. Charaka has
explained the pathogenesis in a detailed manner i.e. Samanaya Samprapti of Prameha
and specific Samprapti of Pramehas. Charaka enumerated the general samprapti in
cikitsasthana. He narrated that due to over indulgence of etiological factors, Kapha
along with meda, mamsa and Kleda get vitiated and results into formation of
metabolic waste which carried towards basti resulting into prameha. In same manner
pitta gets vitiated resulting into pittaja prameha. While Vata due to deplition of other
two dosa get provocated inturns causes deplition of dhatus by excrete them through
urine resulting vataja prameha 52. The later texts such as Yogaratnakara 53 and
Madhava Nidana 54 have followed the description of Charaka Samhita.
This is the concise pathogenesis described in Cikitsasthana but in
Nidanasthana caraka described pathogenesis according to the type.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 17
Samprapti according to doshika predominance:
1) Kaphaja Prameha:
The etiological factors first cause the provocation of Kapha because of its
close similarity to the related Hetu. This aggravated Kapha then spreads all over the
body rapidly due to Sharirashaithilya. Meda Dhatu being Bhahutva, Abadhdha and
having similar properties with Kapha, the provocated Kapha while spreading gets
amalgamated with Medha Dhatu causing its vitiation, This annexation of vitiated
Meda and Kapha comes in contact with Sharira-Kleda and Mamsa, which are already
in excess quantity resulting Putimamsapidaka On the other hand the vitiated Kleda
gets converted into Mutra. The Kapha along with Meda and Kleda impede the
openings of Mutravaha Srotasa resulting into Prameha 55. Sushruta narrated Dushyas
in each Doshika type of Prameha. He narrated vitiation of Kapha along with Vata,
Pita and Meda in Kaphaja Prameha 56. In Ashtanga Samgraha, Vagbhata explained
that Vitiation of Kapha along with meda, kleda, mamsa, shukra, rasa and get localized
in basti resulting into kaphaja prameha 57.
2) Pittaja Prameha:
Due to its etiological factors provoked Pitta manifests as Pittaja Prameha 58.
Here similar pathogenesis occurs as described in Kaphaja Prameha. Depending on
different properties of Pitta Dosha the Paittika Prameha develops into six types.
Pittaja Prameha is not entirely Paittika but it does have Pitta predominance as it is
mentioned in the very beginning of the 4th chapter of Nidana Sthana by Charaka that
there is dominance of Pitta Dosha in comparison to Kapha Dosha and Vata Dosha, in
Paittika Prameha. Sushruta related Shonita along with Vata, Kapha and Meda in the
pathogenesis of Pittaja Prameha 59. Almost similar pathology is described in Ashtanga
Samgraha and Ashtanga Hridaya. In Ashtanga Samgraha, Vagbhata explained that as
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 18
the disease Kaphaja Prameha gets chronic, Kshaya of Kaphadi Dhatus occurs and thus
Pitta gets vitiated resulting in the manifestation of Pittaja Prameha 60. Ashtanga
Hridaya mentions that Pitta vitiates the Rakta producing Pittaja Prameha 61 and rest
description is similar to Ashtanga Samgraha.
(3) Vataja Prameha:
Here Vata gets provoked due to its own etiological factors and draws out
Vasaadi Dhatus from the body towards Basti resulting into four types of Vataja
Prameha. When Oja is drawn towards Basti due to vitiation of Vata, the natural
Madhura Swabhava of Oja due to the Ruksha Guna of Vata gets transformed into
Kashya Rasa leading to the manifestation of Madhumeha 62. One more pathogenesis
of Vataja Prameha is described in Chikitsa Sthana. Here provoked Vata due to
depletion of other two Dosha carries vital Dhatus towards Basti, resulting into Vataja
Prameha 63. Similar description is available in Ashtanga Hridaya. As per Sushruta
Kapha, Pitta, Meda, Vasa and Majja take part in pathogenesis of Vataja Prameha 64. In
Ashtanga Samgraha, Vagbhata explained that vitiation of vata in association with
lasika, majja, and ojus 65.
Samprapti of madhumeha:
According to Vagbhata two types of pathogenesis get precipitated 66
1. Dhatukshayata
2. Avaranajanya
The different types of Samprapti which are mentioned by various Acharyas
are being described below.
1. Samprapti vishishta Anilatmaka Madhumeha:
The pathogenesis of madhumeha is explained in Charaka Samhita,
Nidanasthana. Due to causative factors in the person susceptible for prameha,
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 19
vataprakopa occurs. This prakopita vatadosha attracts the vital dhatus like vasa, majja,
lasika & oja to basti. Because of vata dosha rukshatva and madhura rasa of oja mix
with kashaya rasa of Vata, comes it into mootrashyaya. Then oja is excreted through
urinary tract later. This condition is termed as madhumeha 67.
2. Madhumeha due to Shuddha Vata
Due to depletion of Kapha and Pitta, Vata gets provoked and causes the
excretion of Dhatus (like Vasa, Majja, Oja and Lasika) through urinary tract resulting
into Madhumeha 68. I.e. this category of Madhumeha is Asadhya due to Vata as
Arambhaka Dosha and its further consequential provocation due to Dhatukshaya.
3. Dhatukshayajanya Madhumeha
The Kshaya of Gambhira and Sarabhuta Dhatus like Vasa, Majja, Oja and
Lasika lead to Vata Provocation. The expulsion of Sarabhuta Dhatus through urine
occurs in such excess amount that this Kshaya itself again acts as Nidana, for Vata
Prakopa. Hence this vicious cycle goes on and on, but due to Ashukaritva property of
Vata all the stages of Samprapti proceed so fast that it leads to Asadhya stage of
disease very quickly.
4. Avaranjanya Madhumeha:
The etiological factors of Avaranjanya Madhumeha have been described by
Vagbhata but he has not explained the pathogenesis of this type of Madhumeha.
Charaka has fully illustrated this type of Samprapti in detail, Due to excessive
indulgence in the etiological factors mentioned above, Kapha and Pitta get provoked
and vitiates Meda and Mamsa. All are in excess quantity. They in turn cause
obstruction to the normal pathway of Vata. This obstructed Vata get provoked and
draws out the Apara Oja from all over the body and carries it towards Basti causing
Madhumeha 69. The Kricchrasadhyata of this Avaranajanya Madhumeha is due to
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 20
provocation of Vata by Kapha-Pittakara etiological factors. Initially, the Vata Dosha
remains innocent in the pathology.
5. Kala Prabhavaja Madhumeha:
This type of Madhumeha is described by Sushruta & Vagbhata. Though direct
pathogenesis is not mentioned but it is said that when all types of Prameha are ignored
or not treated properly, they get transformed into Madhumeha 70. We can say that this
is the last stage or further progression of Kaphaja and Pittaja Prameha or complicated
stage of the diseases.
Samprapti ghataka of madhumeha:
On the basis of various references the Samprapti Ghataka of Madhumeha are
illustrated below:-
Dosha: Disease is Tridoshakopanimittaja 71.
Kapha: Bahu and Abadhdha – in Avaranajanya Madhumeha.
Kshina – in Kshayajanya Madhumeha
Pitta: Vriddha – in Avaranajanya Madhumeha
Kshina – in Kshayajanya Madhumeha
Vata : Avrita – in Avaranajanya Madhumeha
Vriddha – in Kshayajanya Madhumeha
Dushya: Rasa, Rakta, Mamsa, Meda, Majja, Shukra, Vasa, Oja, Lasika,
Kleda 72 and Sweda 73.
Srotodushti: Sanga & Ati Pravritti
Srotus: Medovaha, Mutravaha, Udakavaha, Mamsavaha
Agni: Vaishamya of all Agnis (or Dhatvagnimandya)
Ama: Jatharagnimandya and Dhatvagnimandya.
Adhisthana: Basti
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 21
Udbhavasthana: Amashaya
Swabhava: Chirakari 74.
(A) Dosha: All the three Doshas are responsible for manifestation of Prameha.
(i) Kapha:
Kapha plays the dominant role in the Samanya Samprapti of Prameha. It is the
first Dosha to get vitiated. Acharya Charaka while describing the causative factors
used the term ‘Kaphakrut Cha Sarvam’ in it 75. It indicates the significance of this
Doshadushti in Prameha. Sharirashaithilya is the consequence of Bahudrava Kapha.
Other manifestations are Alasya, Atinidra, Tandra, etc.
(ii) Pitta:
Here, in Avaranajanya Madhumeha mainly the symptoms manifest because of
Vriddhi of Pitta Dosha as Trisha, Daha, Kshudha and Trunshavriddhi 76. Chakrapani
commenting on, Samprapti of Vataja Prameha has been described as Pitta is in
Kshaya Avastha as compared to Vata in the Vataja Prameha pathogenesis 77. So,
Kshaya Lakshana of Kapha Dosha and Pitta Dosha may manifest in Kshayajanya
Madhumeha. Pitta Kshayajanya Lakshanas are Mandagni, Prabhahani, and Sheetata
etc 78.
(iii)Vata:
This is the prime Dosha in the pathogenesis of Madhumeha. Here Vata get
aggravated either because of its own etiological factors or because of Avarana caused
by Kapha Pitta and Meda. This provoked Vata carries the vital constituents of the
body like Vasa, Majja, and Oja towards Basti and excretes them outside through urine
resulting in kshaya of the Dhatus. Thus due to atikshaya of Dhatus, the symptom
manifests are Karshya, Daurbalya, Angasuptata and Parisaranshila nature 79.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 22
(B) Dushya:
Nidana, Dosha and Dushyas are the three factors responsible for the
manifestation of every disease. Charaka specially enumerated dushyas in a group and
named it as a dushya vishesa again he mentioned them in Chikitsa 80. Only Vagbhata
mentioned sweda as a dushya along with the above dushyas 81.
i) Rasa:
Rasa is the seat of Kapha Dosha and at the same time it is the Mala of
Rasadhatu. So prakopita Kapha has affinity towards the Rasadhatu. Susruta
emphasized that sthaulya and karshya results due to vitiation of rasa Dhatu and
practically we can found both conditions in the Madhumeha. So the role of rasa Dhatu
is very much important in the precipitation of the disease.The symptoms like Alasya,
Gaurava, Karshya, Hrillasa, Gaurava, Angamarda, Sada, Pandutva, Klaibya etc. are
produced as a result of Rasa Dushti.
ii) Rakta:
It mainly gets vitiated in Pittaja Prameha. The Rakta Dusti Lakshanas are
Daha, Pidika, etc. And skin diseases like Kustha, vidradi, Pidika, kotha are produced
as a result of Rakta Dusti 82.
iii) Mamsa:
Mamsa and Kapha are having the same qualities i.e. both give strength to the
body. When Kapha gets vitiated, Mamsa losses its normal consistency and develops
Shaithilya and provides space in between for the accretion of morbid matter. This
consequently results into the Puti Mamsa Pidika 83. "Mamsaleshu Arakasheshu" 84.
iv) Meda:
It is the dominant Dushya in all types of Pramehas. It gets vitiated both
quantitatively and qualitatively. Kapha and Meda have close resemblance as they
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 23
have the same qualities. Both get vitiated more or less by same etiological factors.
In Madhumeha vitiation of Meda results in two ways as already said:-
1. Qualitative [Abadhdha, (Asamhat)]:
Normal function of Meda is to produce snigdhata in the body along with
Dridhatva i.e. compactness. So this Abadhdhatva causes derangement in the structure
of Meda producing Shaithilya in the body.
2. Quantitative (Bahu):
Here in the pathogenesis, Meda is in excess quantity. This Medo Dhatu is
Aparipakva 85. Meda Dhatu is the most Anukula Dushya for provoked Kapha Dosha.
Guru Snigdhadi Ahara and Avyayamadi Vihara leads to Atimedovriddhi i.e. Bahutva
of Meda Dhatu, due to Dhatvagnimandya. Whatever obese persons take in food, it
gets converted into Meda and other Dhatus remains under-nourished leading to
Dhatukshaya. Along with Bahutva, Dhatvagnimandya also results into Abadhdhatva
of Meda. Such an Abadhdha Meda gives ‘Sharira Shaithilya’ and instead of doing
Asthi Poshana; Meda Dhatu gets itself over burdened which is harmful to the body.
Meda Dushti may manifest in many ways .The deranged Meda produces following
signs and symptoms which are the eight Doshas of Atisthula person 86.
1. Ayusorhrasa: Decreased life expectancy.
2. Javoparodha: Early manifestation of Ageing
3. Kricchravyavayata: Difficulty to perform sexual act and impotency
4. Daurbalya: General Debility
5. Daurgandhya: Bad smelling due to excessive sweating
6. Swedabaddha: Discomfort due to excessive sweating
7. Kshudha-Ati Matra : Polyphagia
8. Pipasa-Atiyoga: Polydipsia
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 24
By observing above description certainly it can be asserted that in Samprapti
of Madhumeha, Meda plays the foremost role.
v) Majja:
Due to Vata Prakopa Kshaya of Majja Dhatu occurs. Thus vitiated Majja
produces clinical symptoms like, Netragaurava, Angagauravata in patient 87.
vi) Shukra:
Shukra Dhatu gets affected in the pathogenesis of Prameha; Shukra due to its
vitiation produces symptoms like Daurbalya and Kricchravyavayata. In Sahaja
Prameha Shukra play an important role. Prameha is a Kulaja Vikara and occurs as
result of Beeja Dosha. Sushruta has described that Shukra Dosha and Prameha get
precipitated because of the vitiation of Vyana and Apana Vata 88. Vata causes
depletion of Shukra Dhatu and also Shukrameha 89. So, one can appreciate the
importance of Shukra Dushti in Prameha.
vii) Vasa:
Charaka described it as a subtype of vataja Prameha i.e. vasameha 90. It is an
Upadhatu of Mamsa and is ‘Sleshmika’ in character. The provoked Vata draws Vasa
towards Basti and excretes it through the urine in the form of Sneha. In case of
Madhumeha, the Dushti is illustrated in the form of Bahutva as well as
Abadhdhatva91.But still the manifestations are not described concerning Vasa Dushti.
viii) Lasika:
The aggravated Vata propels Lasika towards the Basti and then excretes it
through the urine leading to increased micturation. Lasika is a kind of fluid found
beneath the skin between it and Mamsa Dhatu 92. It is excreted from the skin in the
form of sweat. So the manifestation of Lasika Dushti may be in the form of excessive
sweating. Lasika is described as a Dushya in Hastimeha.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 25
ix) Oja:
Oja is supreme extract of all the Dhatus and gives strength and immune power
to the body. Oja is the purest quality of Sleshma in its constitution, Guna and Karma.
Oja is an important Dushya in the Samprapti of Madhumeha. Here provoked Vata
transforms the Madhuratwa of Oja into Kashayatwa and carries Oja towards Basti and
excretes through urine leading to Ojakshaya 93. So the symptoms of Ojakshaya like
Murccha, Mamsakshaya, Moha, Daurbalya (excessive weakness), Vyathita Indriya,
Rukshata, Gurugatrata, Nidra, Tandra etc may manifest 94.
x) Kleda:
It is also an important Dushya after Meda. The literal meanings of Kleda are –
wetness, moisture, dampness etc. In the commentary regarding Sharira Kleda in
Charaka samhita mentioned that Kleda gives Shaithilya to Sharira. Charka has given
Ambu as a synonym to Kleda. Normal function of Mutra and Sweda has been
described by Vagbhata as, under normal physiological conditions Mutra and Sweda
maintain balance of Kleda in the body. Especially Sweda holds it in the body and
Mutra excrete it outside the body 95. If this Kleda gets vitiated it directly affects the
Mutra and Sweda and disrupts the physiology of bodily elements causing Shaithilya.
Arundatta has mentioned that absence of Kleda may lead to the dryness of the body 96.
In the Samprapti, Kleda Dushti is in the form of ‘Vriddhi’ and not the Kshaya. Hence,
Bahu Kleda will manifest as Prabhuta Mutrata and Avila Mutrata because extensively
increased Kleda is excreated out of the body as Mutra. The other manifestations of
Kleda Dushti may be Shithilangata, Ati Sweda Pravritti, Visra Sharira Gandha (due to
excessive sweating), Sharira Mruduta, Snigdhata etc.
xi) Sweda:
This Dushya has been mentioned only by Vagbhata 97. Sweda is mainly
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 26
related with Meda and Kleda. Due to the vitiation of Meda and Kleda, Swedavaha
Srotodushti occurs leading to the manifestation of Ati Swedapravritti, Daurgandhya,
Picchilagatrata, Snigdhagatrata Visra- sharirgandha etc. Sushruta mentioned that in
Madhumeha (Prameha) Sweda becomes Sweet in nature 98. The whole pathological
phenomenon described in Kleda and Sweda Dusti can be correlated with water and
electrolyte imbalance.
C. Srotodushti:
In the Samprapati of Madhumeha there is reference of Mutravaha Srotodushti
only but keeping in mind the symptomatology etc. it can be easily understood that
there occurs Medovaha, Mamsavaha, Swedavaha and Udakavaha Srotodushti also. In
the Samprapti of Madhumeha two types of Srotodushti are found:
(1) Atipravritti
(2) Sanga
Thus we can find out the Srotasa involvement according to the symptoms as follows
(1) Mutravaha Srotodushti - Prabhuta Avila Mutrata
(2) Medovahasrotodushti - Purvarupa of Prameha, Snigdhagatrata etc
(3) Mamsavaha Srotodushti - Putimamsapidaka
(4) Udakavaha Srotodushti - Pipasa, Mukha-Talu-Kantha Shosha.
D) Agni:
There is no direct reference related to the Agni condition but both
Agnimandya and tikshna Agni conditions present in the pathogenesis.
E) Ama:
Sushruta has illustrated the role of Ama in the pathogenesis of various
disorders. He mentions that the Samprapti of Prameha takes its origin from the Ama
only 99. He states that is from the very beginning, Agnimandya has been developed
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 27
due to Guru, Snigdhadi Ahara and Avyayamadi Vihara which leads to production of
Ama. Dalhana adds that not only Dosha but Meda Dhatu is in the Ama form. Hence
Ama is a part and parcel of Samprapti. Ama means Aparinamittaja. Anything which
remains in undigested form, being harmful to the body is Ama. It is Apakva
(undigested), Asyaukta (Shithila), Durgandhi, Picchila in nature and it produces
Gatrasada. In the Samprapti of Madhumeha, we also get the dominance of Ama
regarding Kapha Dosha, Meda Dhatu, Mamsa Dhatu, and Kleda. The undigested
Kapha and Meda acts as Ama vitiating the Mutravaha Srotasa leading to Madhumeha.
This vitiation is in the form of Srotasa obstruction.
Below chart showing the symptomatology and their relation with Dosa and
Dusya. So Madhumeha is the disease clinically we can found with various
Presentation. Thus with the help of above chart we can easily find out the extent of
Dosa and Dusya involvement in the pathogenesis to profound the treatment modality
exactly according to the stage of the disease.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 28
Table - 5
Shows the Roopa and their relation with Dosha and Dushya.
Sl.
No.
Dosha nature ofVitiation Strotus Involved Lakshanotpati
1. Kapha Vriddhi Sarvasarira Jatilibhavakesesu
Madhuryamasasya
Alasya
Shithilangata
Snigdhagatrata
Picchilagatrata
Nidra, Tandra
Madhura and Suklamutrata
2. Pitta Vriddhi Sarvasarira Bahuashitva.
Pipasa.
Hastapadataladaha.
Paridaha.
Visrasarirgandha.
3 Vata Vriddhi Sarvasarira Sada.
Karasuptata.
Padasuptata.
Angasuptata.
Karsya.
Dusya
1. Rasa Vriddhi and Dushti Rasavaha, Udakavaha Gaurava.
Sada.
Tandra.
Sthaulya and Krusangata.
Mukha Tula Kanthasosa.
2. Rakta Dusti - Vidradhi
Raukshya (Sahaja Prameha)
3.
Mamsa
Dusti Mamsavaha Putimamsa Pidaka
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 29
Shaithilya
TalugalajivhaDateshu
Malotpatti
4 Meda Dusti ,Vriddhi Medovaha Sthaulya
Medodosha
Atikshudha
Atitrushna
Daurgandhya
Daurbaya
Svedavrdhi
5. Majja Dusti Vriddhi Majjavaha Netragaurava
Angagaurava
Murca
6. Shukra Dusti Ksaya Shukravaha Klaibya
7. Kleda Dusti Vriddhi Mutravhaa,Svedavaha Mutradosa
Prabhutamootrata
Avilamootrata
Svedavruddhi
8 Sveda Vriddhi, Dusti - Svedavruddhi
Daurgandhya
Paridaha
Shlaksnagatrata
9 Oja Ksaya. Sarvasarira. Daurbalya
Gurugatrata
Tandra, Nidra
Murcha
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 30
Figure – 1
Madhumeha Samprapti
Avarana janya Apathyanimittaja Sahaja Madhumeha
Madhumeha Madhumeha
Nidana sevana Beeja Dosha
Vikruta bahudrava Kapha
Travels all over the body because
of shareera shithilata
Medo dhatwagni mandya
Sthuolya Medovaha srotas vitiation
Bahu abaddha medas
Kapha Pitta Meda Mamsa Dosha dushya sammurchana
Ativruddhi
Bahudrava sleshma with bahu
Abaddha meda
Obstruction of Vata due
to avaranaby vitiated Vitiation of other dushya
Kapha Pitta and Meda
Adhika kledata of Dhatu
Squeezing of Ojas in to vasti
Vasti
Madhumeha
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 31
BHEDA Classification of a disease is mainly done for the purpose of proper
understanding of the disease and to formulate an effective treatment proptocol.
Through this different point of view, many classifications are available from our texts
of which most important is according to its dosha predominance. In classics twenty
types of prameha have been described according to its dosha predominance, as these
are precursor for Madhumeha. If these pramehas are not treated in time or properly,
they get converted into Madhumeha. They are,
Kaphaja Pramehas - 10
Pittaja Prameha - 06
Vataja Prameha - 04s
Table – 6
Types of Prameha
Kaphaja prameha Pittaja prameha Vataja prameha
Udaka meha Kshara meha Vasa meha
Ikshu meha Kala meha Majja meha
Sandra meha Nila meha Hasti meha
Sandraprasada Meha Lohit meha Madhu meha
Sukla meha Manjishtha meha
Sikata meha Haridra meha
Sita meha
Shanair meha
Lala meha
Shukra meha
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 32
Vagbhata clearly narrated that these types result because of the nexus
between Dosha, Dushya and their specific combination according to concordance.
Thus in each subtype of prameha specific urine is voided 101. Charaka put forth his
theory that all these types and their nomenclature is because of the specific qualities
and their combinations with each other but, the nomenclature is mainly based apoun
the predominance of one quality 102.
By observing the all classification we can easily understand the Dosha
predominance, dushya involvement, nature of urine voiding and we come know to
about the etiological factors, State of the disease and progression.
Classification of Madhumeha:
Clinicopathological status of a disease has an invariable relation with physical
constitution of the body in Madhumeha. This has to be taken into consideration when
treatment is formulated. According to this, in Ayurveda, Madhumeha is of two
types103.
• Sthula
• Krisha
The root cause of disease has enough importance for the prognosis &
treatment of the disease. The occurrence of Madhumeha according to this point of
view is of two types 104:
• Sahaja [Heriditary]
• Apathyanimittaja [Acquired]
Sahaja:
Sahaja prameha occurs as a result of Beejadosha i.e. genetic origin 105. While
describing prognosis, Acharya Charaka has narrated that prameha or Madhumeha
occurring due to Beeja dosha is incurable 106.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 33
Apathyanimittaja:
Apthyanimittaja type itself suggests its etiology. It occurs due to Ahitahara
vihara.
Sampraptighataka has manything to do with the prognosis & treatment of the
disease. On analyzing the samprapti, Apthyanimittaja madhumeha is of two types.
(A) According to Samprapti
• Avaranjanya
• Dhatukshayajanya:
1) Avaranjanya:
In Avaranjanya madhumeha, Kaphavardhaka nidanasevana leads to vata
avarana, this in turn leads to Ojas Karshana which comes to the basti & patient passes
Madhura, Kashaya, and Ruksha Mutra, which is said to be Madhumeha.
2) Dhatukshayajanya:
Where as in Dhatukshayajanya, due to vatavardhak nidana, vataprakopa
occurs & the Madhuratwa of Oja along with Kashaya rasa is brought to the basti
leading to Madhuvat Mutratyaga, leading to Madhumeha.
(B)According to Nidana:
• Santarpanjanya
• Apatarpanjanya
Santarpanjanya
Santarpanjanya madumeha which is directly occur due to intake of
kaphavardhaka ahara. The excess intake of such substances will primarily lead to the
vitiation of kapha, pitta, meda & mamasa, which in turn cause madhumeha by doing
avarana of vata 107.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 34
Apatarpanjanya
If the substances which deplete the dhatu & aggravate vata are consumed then
it leads to Apatarpanjanya Prameha. They act through vitiation of vata which in turn
leads to the manifestation of Madhumeha.
In nutshell, Sahaja & Apathyanimittja are types of Madhumeha. The Krisha,
Dhatukshayajanya & Apatarpanjanya can be correlated with Sahaja Madhumeha.The
Sthula; Avaranjanya & Santarpanjanya can be correlated with Apathyanimittaja
Madhumeha.
POORVA ROOPA
The poorvaroopas are helpful in diagnosing the disease as early as possible,
also to know prognosis, differential diagnosis of disease. The poorvaroopas explained
in the context of prameha are to be considered as the poorvaroopas of madhumeha.
Specific poorva roopa for Madhumeha have not been mentioned anywhere in classics.
In this context poorva roopa of Prameha are discussed.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 35
Table-7 Showing the poorva roopa of Madhumeha
Sl No Lakshana Ch Su AH AS Ma Ni
1 KesheshuJatilibhava + + - + -
2 Asya madhurya + - + + +
3 Karapadadaha + + + + +
4 Karapada Suptata + - - - -
5 MukhaTaluKanthaShosha + - + + -
6 Pipasa + + - + +
7 Alasya + - - + -
8 Kaye malam + - - + -
9 KayaChhidreshuUpadeha + - - +- -
10 Paridaha Angeshu + - - - -
11 Suptata Angeshu + - - + -
12 ShatpadaPipilikaMutrabhisaranam + - + + -
13 Visra sharir gandha + + + + -
14 MutrechaMutradosham + - - - -
15 Sarvakala Nidra + - - + -
16 Sarvakala Tandra + + - + -
17 Snigdha gatrata - + - + -
18 Pichhila & guru gatrata - + - - -
19 Madhur mutrata - + - - -
20 Shukla Mutrata - + - + -
21 Sada - + - + -
22 Shwasa - + - + -
23 Keshanakhativriddhi + + + - -
24 Sheeta Priyata + - + + -
25 Hridaya NetraJihwShravanopdeha + - + - -
26 Sweda + - + + -
27 Dehachikanata - - -
28 Ghanagatrata + + - - -
29 Dourghandya - + - - -
30 Danteshu malotpatti - + - - +
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 36
If all the Pramehas are neglected then it results into Madhumeha. This may be
the reason for not mentioning the specific poorva roopas by our Acharyas for
Madhumeha and most of the poorva roopa mentioned in our classics are the clinical
features and complications of madhumeha. So, the poorva roopas of Prameha in
general discussed here.
Our Acharyas have given more importance to poorva roopas. According to
Sushrutacharya, if all the poorva roopas are clearly exhibited and if the patient notice
a slight increase in mootra, then one can infer that patient may suffer from Prameha in
the near future. If half of the poorvaroopa are exhibited clearly and patient notice
adhikamootra pravritti, then it is the clear indication of the presence of Prameha 108.
In olden days vaidyas used to detect the presence of sugar in urine by
pipeelikaabisarana. A patient use to approach a vaidya only when he suffered from
prabhoothamootrapravritti. But he neglected the symptoms like snigdhata of the body,
atinidra etc. which occur much more earlier than the above mentioned cardinal
feature. Thus our Acharyas have considered these early stages as poorva roopa.
ROOPA
The signs and symptoms of a disease will be produced in the fifth stage of
samprapthi i.e. vyaktavasta. In this stage doshadooshya sammurchana will be capable
to produce its lakshanas.
In ayurveda only mootra sambhandhi lakshanas are mentioned for
Madhumeha. But samanya lakshanas of Prameha and also lakshanas of
apathyanimittaja Prameha are also can be included under lakshanas of Madhumeha.
The Rupa as described in Ayurveda includes both, sign and symptoms of the
disease. These are described under following headings:-
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 37
Mootra sambhandi lakshanas:
A. Samanya lakshana 109
1. Prabhootha mootrata:
This is the cardinal sign of prameha described by all acharyas. Increase in
quantity and frequency of mootra is considered as prabhootha mootrata. It is
manifested due to increased kleda in the body and collects in the basthi. As
kledavahana is the function of mootra, excess of kleda in the basthi will be excreted
through mootra frequently by vitiated apanavata. So, prabhootha mootrata in terms of
quantity and frequency is seen in Madhumeha.
2. Avila mootrata:
Turbidity of mootra is considered as Avila mootrata. Patient passes urine
having hazy consistency. Dalhana opine that, the characteristic features of urine are
because of the nexus between Mutra, Dosha & Dushya 110.
Table - 8 Showing the vishista lakshanas:
SN Roopa C.S S.S A.H A.S M.Ni Y.R B.Ra G.Ni
1 Kashaya + - - + + + + +
2 Madhura + - + + + + +
3 Pandu + - - - - - - -
4 Rooksha + - - + + + + +
5 Snigdha - - - + - - - -
6 Ojadhatu - - - + - - - -
7 Kshoudravat Madhviva - - + - - - + -
8 Kshoudra rasa - + - - - - - --
9 Kshoudra varna - + - - - - - -
1. Kashaya:
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 38
Bhavamishra interprets it as kashaya Varna which can not be elicited
clinically111.
2. Madhura mootra:
It is also because of excretion of ojus in mootra. Earlier they used to detect this
by pipeelikas. Now a day by urine examination one can understand mootra
madhuryata.
3. Pandu:
Pandu varnata of mootra may be due to excessive kleda in the mootra.
4. Rooksha:
Due to vitiation of vata one can notice rukshata.
5. Madhusama mootra:
Varna, gandha, rasa of mootra will be similar to that of madhu. It is due to the
ojonissarana in mootra.
Sarvadaihika lakshanas of apathyanimittaja prameha:
In Chikitsa sthana Susruta before propounding the treatment of Prameha,
asserted two types of Prameha along with their features as follows,
1) Sahaja Prameha 112
• Ruksha
• Alpashi
• Bhrsa pipasa
• Parisarana sheela
2) Apathya nimittaja 113
• Bahu ashi
• Snigdha
• Shayyasana swapna sheela
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 39
UPADRAVA
Upadrava is important in deciding the prognosis of the disease. In this context
samanaya upadrava of Prameha and vataja Prameha upadravas have been illustrated
in the tabular column, as Madhumeha is a variety of vataja Prameha.
Acharaya Charaka enumerated the general complications. Achraya Sushruta &
Acharya Vagbhatta described according to the Dosha predominance.
Table – 9
Showing the Samanya upadravas of prameha Sl.No Upadrava Charaka samhitha Bhela samhitha
1
2
3
4
5
6
7
8
9
10
11
12
Trishna
Athisara
Daha
Dourbalya
Arochaka
Avipaka
Angamardha
Shoola
Bhrama
Tama
Kandu
Pidakas
+
+
+
+
+
+
-
-
-
-
-
+
+
-
-
-
+
-
+
+
+
+
+
+
2) Specific Complications:
(a) Kaphaja meha 117:
Makshikopasarpanam, Alasya, Mamsopachaya, Pratishyaya, Shaithilya,
Arochaka, avipaka, Kaphapraseka, Chhardi, Nidra, Kasa & Shwasa.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 40
(b)Pittaja meha 118:
Vrushanayorvadaranam, Bastibheda, Medhra toda, Hridshula, Amlika, Jwara,
Atisara,Arochaka, Vamathu, Paridhumayanam, Daha, Murchha, Pipasa, Nidranasha,
Panduroga, Pittavidmutranetratva & Vidbheda
(c)Vataja meha 119:
Hridgraha, Laulya, Anidra, Stambha, Kampa, Shula, Baddha purishatva &
shosha, kasa, shwasa.
Complications of Madhumeha:
Acharaya Charaka has mentioned 7 types of pidaka as complication of
Madhumeha; While Sushruta & Vagbhatta has mentioned 10 pidakas. Sushruta has
mentioned that Madhumeha along with pidaka is asadhya 120. He narrated that these
pidaka occurs due to Tridosha and vitiated meda & vasa 121.
Table – 10
Showing the Madhumeha Upadrava
SN Pidaka Charaka Susruta Vagbhata
1 Saravika + + +
2 Kaccapika + + +
3 Jalini + + +
4 Vinita + + +
5 Alaji + + +
6 Masurika + + +
7 Sarsapi + + +
8 Putrini - + +
9 Vidarika - + +
10 Vidrdhika + + +
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 41
SADHYASADHYATHA
A forecast of the probable course and termination of a disease is prognosis or
sadhyasadhyatha.
In general by considering the factors responsible for deciding sadhyasadhyatha
given in texts, i.e. hetu, poorva roopa, roopa, dosha, dooshya, prakruthi, kala, desha,
upadrava, sarvoushadhakshmathwa, chatushpada etc, the prognosis or sadhyasadhyata
of the disease can be assessed122.
Generally the concept of prognosis in the case of prameha are given by all
acharyas as,
• Kaphaja Prameha - Sadhya
• Pittaja Prameha -Yapya
• Vataja Prameha -Asadhya when occurred due to dhatukshaya &
Krichrasadhya when Occured due to avarana.
(1) Sadhya - Kaphaja Prameha
Etiological factors are same to that of Dosha, Dushya and having same
qualities and same seat. So the treatment is same for both. Thus Kaphaja Prameha is
Sadhya 123. Charaka explained few things about prognosis of the disease that Sthairya
i.e. Sadhyata (Curability) results when Kapha get vitiated along with same quality
dushya i.e. Prakrti bhutatvat. Asadhyta incurability results because the vitiation of
Kapha that occurs along with different quality Dushya like Raktadi. The treatment
proved to be Viruddha i.e. apposite to each other, Vikrti bhutatvat as said by
Chakrapani 124.
2) Yapyatva - Pittaja Prameha
Pittamehas are explained to be with this status 125. The disease is requiring
continuous treatment. Once the treatment is stopped the disease is again provoked.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 42
Also vishamakriyatva i.e. the disease is cured by langhana therapy but the associated
vitiated dhatus are not. This also leads leads to yapyatva.
3) Krichrasadhyatva & Asadhyatva - Vataja Prameha
Madhumeha is included in vatajameha. Here vata provocation might be due to
Sarvadhatukshaya as it occurs after kaphaja & pittaja pramehas. The other important
cause is avarana. When vata provocation is due to dhatukshaya the type is included in
asadhya madhumeha 126, while the other produced by avaranjanaya vata is considered
as krichrasadhya127. Charakacharya mentioned that madhumeha produced due to
Beejadosha is incurable 128.
(4) Prognosis related to Medodusya:
Charaka described that if there is less extent vitiation of Meda dhatu in
Kaphaja and Pittaja Prameha then Pittaja Prameha becomes curable but when there is
more vitiation of Meda then Kaphaja and Pittaja both Prameha become Asadhya.
Charaka mentioned that Madhumeha because of the Beeja Dosha i.e. genetic
predisposition is incurable. Susruta mentioned that Madhumeha in association with
complication i.e. Pidaka is incurable.
VYAVACHEDAKA NIDANA
Charaka illustrated that if the urine of Pramehi patient is Madhura and Picchila
then differential diagnosis has to be made between Kaphaja Prameha and Vataja
Prameha on the basis of Nidana Sevana. Here if etiological factors are related with
Kapha provocation then it is Kaphaja Prameha but if etiological factors are related
with Vata provocation then it is Vataja Prameha 129. Prabhootha mootrata and
avilamootrata are the lakshanas which will manifest in all the 20 varieties of
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 43
Pramehas. So as to distinguish Madhumeha from other Pramehas, the study of them
should be made.
The following table illustrates the difference in different characteristic features
of other Pramehas.
Table – 11
Showing the Sapeksha nidana of Madhumeha
TYPES Lakshanas
Madhumeha Kashaya, Madhura, Pandu, Rooksha.
Ikshumeha Ikshu Valika, Madura, Sheeta, Eshat Picchila,
Avilam, Kandekshu rasavat
Sheetameha Madhura, Sheeta
Udakameha Accham, Bahu, Sitam, Sheeta, Nirgandha, Udakoo-pamam
Hastimeha Hastimatta ivajasram Mutram Ksharati.
Amavata Bahumootrata
Samajwara Bahumootrata
Surameha --
Sikatameha Mootran Mootragatan Doshan Anun Mehati
Shanairmeha Manda Manda, Avega, Kricchra, Shanai Shanai
Lavanameha --
Pishtameha --
Sandrameha Sandrayukta
Shukrameha Shukrabha, Shukra-mishrita
Phenameha --
Alalameha Tantubaddham, Picchilam.
Sandrameha Kinchit Sandra, Kinchit Prasada
Shuklameha Pishta Nibham,
Shukla
Kalameha Masi Varna, Ushna
Nilameha Chasha Pakshi Nibham Neela
Raktameha Visra, Lavana, Ushna, Raktam Mehati
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 44
Manjishtameha Manjisht Udakavat, Sankasha Visram
Haridrameha Haridra Udakavat, Katu
Amlameha --
Ksharmeha Ksharavat Gandha, Varna, Rasa Sparsha.
Vasameha Vasamishram, vasabham
Majjameha
CHIKITSA
In general Chikitsa is the method adopted for eradication of the disease from
the body. The aim of treatment is to restore swasthya. That means to restore normal
functions of Agni, dosha, dhatu, mala and maintain mental health. The primary
importance of Chikitsa lies in samprapti vighatana.
In ayurvedic classics, we will not get direct reference regarding the line of
treatment for Madhumeha but the line of treatment advocated for Prameha in general
can be considered here.
Chikitsa sutra:
While mentioning the Chikitsa sootra two varieties of Pramehi's are
mentioned. They are Sthoola -balavan and krusha-durbala. Two different lines of
treatment have been explained for these two varieties of Pramehi.
1) Stoola pramehi: Patients who are Sthoola, balvan and having bahudosha for such
patients Samshodhan therapy has been advised depending on the doshic
predominance. This has to be taken into consideration & accordingly the procedurei, e
Vamana, virechana, basti is decided. Swedana should be avoided, being
contraindicated in prameha. Basti is contraindicated in Madhumeha but patients
presenting symptoms of burning sensation are advised Nyagrodadi kashaya basti by
Susruta.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 45
2) Krushapramehi: Patients who are krusha, durbala, for such patient’s samshamana
and santharpana Chikitsa are advised 130. Here the ahara, oushada which will increase
dhatus, impart strength to the body.Depending on the symptoms and predominance of
the doshas sneha should be administered. The most of the drugs advised for the
treatment of prameha are tikta, kashaya, katu rasa.
Vaghbata attributes the following reason for advising samshodhan in Sthoola
Pramehi 131. According to him samshodhana (virechana) reduces excessive kleda and
meda in the body 132. Most probably the logic behind the above mentioned
justification for shodhana in Sthoolamehi was to reduce the weight in Sthoolamehis.
If shodhana is administered in a dhatu kshayajanya Madhumeha then it may lead to
further deterioration of the dhatu and may turn into a fatal one.
Kaphaja prameha :
(i) Samshodhan Chikitsa :
Samshodana is contraindicated, eventhough it is better to treat the patient with
vaman therapy. Charakacharya describes that shodhana, vamana & langhana done at
the proper time looking at the condition of the patient is able to cure kaphaja meha 133.
For Bastichikitsa vagbhtta describes the utilization of Surasadi gana kwatha. Acharyas
after explaining the shodhana treatment give samshaman Chikitsa in every types 134.
Dalhana further commented that after Vamana Karma, Virechana is essential to
alleviate the Prameha and also to reduce the Kleda vitiation. Arundatta specially
commented that after completion of Vamana and Virechana, if patient has strength
then Asthapana Basti should be administered 135.
(ii) Samshaman Chikitsa:
Charakacharya gives 10 combinations of drugs to all the mehas with kapha
predominance 136. According to Sushruta, after proper samshodhana the patient should
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 46
use swarasa of amalaki with Haridra powder with madhu 137. Acharya Sushruta in this
context explains single drug decoctions with separate indications in 5 types of kaphaja
meha & combinations in other 5 types 138. Vagbhattacharya describes three yogas in
this aspect 139, they are as follows;
(i) Lodhrad i- Lodhra, Abhaya, Musta, Katphala
(ii) Pathadi - Patha ,Vidanga ,Arjuna,Dhanyaka
(iii) Gayatrayadi - Khadirsara, Darvi, Vidanga ,Vacha
Importance of Apatarpana:
Charakacharya explains the cause of prameha as due to increasing attitude of
kleda, meda, and kapha. So he emphasise the role of Apatarpana in kaphaja &
Pittajaprameha 140. Different types of vyayama, kshut, udvartana, dhara & snana with
churnas made of Chandana, Aguru, and Ela etc. are advised to use in kaphaja meha 141
Pittaja prameha :
(i) Samshodhan Chikitsa :
Virechan is best in pittaja pramehas 142. The drugs which are sufficient to
eliminate morbid pitta can be used with sheeta and other tikta, kashaya rasa in this.
Nyagrodhadi gana kwatha is advised for Asthapanbasti by Acharya Vagbhatta143.
Acharya Sushruta has described that due to spreading of medo dhatu all over the
body, Madhumehi subjects are durvirechya 144
(ii) Samshaman Chikitsa:
Acharya Charaka explains 10 yogas in this aspect to treat pittaja pramehas 145
Sushrutacharya have described 6 specific kwatha yogas for the specific type of pittaja
prameha 146. The three kwatha yogas explained by Acharya Vagbhatta are 147,
(i) Ushiradi : Ushira, Lodhra, Arjuna, Chandana.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 47
(ii) Patoladi: Patola, Nimba, Amalaki, Amrita
(iii) Lodhradi : Lodhra, Ambu, Kaleyaka, Dhataki.
Vataja prameha:
Although vatika mehas are incurable still Acharya Charaka explains to induce
certain treatment in kaphapittanubandhi Vatika meha 148. Achrya Sushruta has
described that all types of prameha if not treated properly in time, gets converted into
madhumeha 149. So the treatment described for vatika meha can be considered as
treatment of Madhumeha.
In case of Vataja Prameha following points should be carefully noted:
(1) Type of Madhumeha i.e. either Kevala Vataja or Avaranjanya.
(2) Strength of the patient according to Doshabala, Agnibala and Vyadhibala.
(3) Involvement of genetic predisposition.
After observing the patient carefully following treatment modalities can be
administered.
(i) Samshodhan Chikitsa:
Considering Sthoola & krisha pramehi, Samshodhan Chikitsa should be
administered only to the sthoola & Balvan Pramehi. Sarshapa, Nimba, Danti, Bibhitak
& Karanja Siddha Taila or Trikantakadya Sneha (Ghrita or Taila) according to dosha
predominance, should be used for Abhyantara Snehana. Here while explaining the
Samshodhan, Charaka describes to use the Malashodhan yogas from Kalpasthana 150,
both Pitta & kapha are eliminated through shodhana. It may be vamana or virechana,
because of; Pittantam Vamanam, Kaphantam Virechanam. In Virechana pitta is
eliminated first, then Samyak lakshana of virechana is kaphadarshan, so both pitta &
kapha doshas which are vitiated are eliminated. Then the described Anuvasana &
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 48
Asthapana Basti chikitsas are able enough to control the provocation of vata. Like this
all the doshas are normalized to keep the dosha samyata. Anuvasana with medicated
taila & ghritas are prescribed in madhumeha. After proper Shodhan Chikitsa,
Charakacharya details to give santarpan chikitsa to the patients, to prevent the
complications like Gulma, Bastishula etc 151.
(ii) Samshaman Chikitsa:
Samshaman Chikitsa includes mainly deepana (appetizers), Pachana,
(enhancing Digestion), Kshut (Hunger maintenance), Trit (Maintenance of thirst),
Vyayama (Exercise), Atapa (Having exposed to sunlight) & Maruta (Exposing
oneself to Wind).According to the conditions of vitiated doshas & dushyas, vaidya
has to Suggest proper Shaman Chikitsa to the patient.
Acharyas introduces different tarpana upakramas in vatika mehas. It is due to
the less strength of the patient. Acharya Charaka & Vagbhatta says that the kashaya
yogas should be enriched with sneha and given to vatika mehas 152.
If there is nexus of Kapha with Vata, then medicated oil prepared by
Kaphahara drugs should be given.
If there is nexus of Pitta with Vata, then medicated Ghrita Prepared by
Pittahara drugs should be given.
If more or less equal vitiation of all Doshas occurs, then Yamaka Sneha i.e. oil
and Ghrita together prepared with respective herbs should be advised.
Typical Madhumeha Chikitsa:
Acharya Sushruta explains that Shilajit should be taken after triturating with
Salsaradi gana kwatha. After its digestion patient should take Jangalamamsarasayukta
Anna. He prescribes to take 1 Tula of shilajatu 153.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 49
Compound Preparations Used In Prameha:
Swarasa: Amalaki, Haridra, Nimbapatra, Bilwapatra, Guduchi
Kwatha: Vidangadi, Phalatrikadi, Mustadi, Manjishthadi, Pathadi
Churna : Triphaladi, Mustadi, Gokshuradi, Arkadi
Gutika : Chandraprabha, Indravati, Pramehantak Vati
Gugglu : Gokshuradi Guggul
Modaka : Kastur Modaka, Trikatukadyamodaka.
Avleha : kushavleha, vangavleha
Paka : Pugapaka, Ashwagandhadi paka, Draksha Paka.
Asava Arishta: Lodhrasava, Dantyasava, Madhukasava, Devdarvyadiarishta,
Lodhrarishta.Ballatakasava
Ghrita: Dhanvantar ghrita, Trikantakadi ghrita, Sinhamrita ghrita, Dadimadi
ghrita, Shalmali ghrita.
Rasaushadhi:Vasant kusumakar Rasa, Chandraprabha vatika, Mehamudgar Rasa,
Brihat vangeshwar Rasa, Prameha gajkesri Rasa, Trivanga Bhasma, Vasant tilaka
Rasa, Swarna makshika Bhasma.
PATHYA AHARA VIHARA
The ahara viharas which maintain the stability of physical and mental health
are to be considered as pathya. On the other hand ahara vihara which produces
imbalance in the equilibrium of dosha, dhatu, mala and manas are apathyas.
While treating the disease we should give importance to pathya and apathya in
that disease, other wise our treatment will not yield the desired effect. It is known fact
that pathya itself is capable in curing the disease without medicine. Pathya acts as a
catalyst in accelerating the action of the drug.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 50
Pathya ahara for madhumeha:
1. Annavarga: Puranashalyodhana with tiktashaka, puranashyamaka, kodrava,
uddalaka, godhooma, shalianna, yavanna, priyangu, shashtikashali, danthi, ingudi
taila yukta bhojana 154.
2. Jalavarga: Kashayodaka, madhodaka, sarodaka, kushodaka, triphalarasa, sidhu 155.
3. Dwidalavarga: Brustachanaka, tuvaraka, adaki, mudgayusha, kulattayusha, kalaya,
trunadhanya.
4. Shakavarga: All thikta shakas.
5. Mamsa varga: Jangala mamsa, Vishakira, Pratuda mamsa 156.
Pathya vihara for Madhumeha 157:
1. Vyayama.
2. Rooksha, praghada urdwarthana.
3. Nitya snana.
4. Jalavaseka.
5. Sadashramabyasa.
6. Lepa of agaru, ushira, twak, ela and chandana.
8. Nishijagarana.
Among the pathya ahara yava has been given much importance in our classics.
Vaghbatacharya mentioned yava as mootrabaddakara, kapha, pitta, medohara, and it
is sthairyakaraka and he has advised to take yava in the form of saktu, mantha,
apoopa, laja, vatya etc.
Sushruthacharya has given much importance to vyayama, which can be
understood by following verse. Person who is poor and has no relatives should walk
from village to village and walk without the protection of is head or legs. The person
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 51
should not remain in that village for more than one night and should walk atleast one
to three yojanas a day. He is suggested to lead a saint's life 158.
Apathya in Madhumeha
(a) Aahara:
Jala, Milk, Ghee, Oils, Curd, Sugar, Different types of rice preparations,
anupa, gramya and audaka mamsa, Ikshurasa, Pishtanna, Navanna.
(b) Vihara:
Eksthana asana, Divaswapa, Dhoompana, Sweda, Raktamoksha, Mutravega
dharana.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)-Literary Review 52
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 53
DIABETES MELLITUS
Diabetes mellitus is a syndrome characterized by disordered metabolism and
inappropriately high blood sugar (hyperglycemia) resulting from either low levels of the
hormone insulin or from abnormal resistance to insulin's effects coupled with inadequate
levels of insulin secretion to compensate159. The disease has a particular predisposition
for micro vascular complications and increased tendency for macro vascular
complications.
Diabetes mellitus in Modern Medical History 160:
Madhumeha can be literally translated as Diabetes Mellitus as both of them mean
honey urine. Siphon named it as Diabetes Mellitus meaning honey urine.
1) Abrus Papyrus: An Egyptian medical compilation (1000BC) has referred to a
condition called Polyuria.
2) Aratars of Coppadocea (150AD): A contemporary of Galen, has mentioned Polyuria
and thirst.
3) Thomas Willis (17th Century): First mentioned sweet taste of diabetic urine.
4) Mathew Dobson (18th Century): Diabetic serum contains sugar.
5) Jhon Ralo (1797) – One of the first to coin term mellitus.
6) William prout (1810-20) - Diabetic coma described
7) Michel cherreul (1857) – Excess sugar in Diabetes is glucose.
8) Wilhelm petters (1857) - Acetone found in diabetic urine.
9) Paul langerhans (1869) – Pancreatic islet identified
10) Adolf kussmaul (1974) – Acidotic breathing in diabetic coma.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 54
11) Minkowski & nonmering (1889) – Pancreatectomy cause Diabetic in dogs
12) Jean de meyer (1907) - Hypothetical glucose; lowering hormone named insulin.
13) Banting best Collip Macleod (1922) - Isolation & first clinked use of insulin.
14) JR Muslin (1923) – Discovered & named glucogens.
15) F Sanger (1955) – Sequencing of insulin.
16) Rothetal (1971) – Discovered insulin receptor
17) Wrich Etal (1977) – Insulin gene cloned.
AETIOLOGY
The aetiopathology of type II diabetes is unknown. Both increased peripheral
insulin resistance and decreased beta-cell function are involved in the path physiology
of the disease. However, it is unlikely that a single factor is the cause of this
heterogeneous disease.
Genetics:
Identical twins of a patient with NIDDM have a greater than 90% chance of
developing diabetes and about 25% of other patients have a first degree relative with
NIDDM. These observations suggest a strong genetic component, and it is now clear
that NIDDM is a polygenic disorder. A few families show abnormalities of the gene
which codes for the enzyme glucokinase on chromosome and other families have
been described with abnormalities of genes coding for hepatic nuclear factor1alpha
and 4 alphas, but genetic defects in most families with NIDDM are as yet unknown.
Environmental factors:
A strong association has been noted between low weight at birth and at 12
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 55
months of age and glucose intolerance later in life, particularly in those who gain
excess weight as adults. The concept is that poor nutrition during early life impairs
beta cell development and functions, predisposing to diabetes in later life.
Immunology:
There is no evidence of immune involvement in the pathogenesis of NIDDM,
but as noted earlier a proportion of late onset patients carry islet autoantibody ICA
and GAD at diagnosis and are more likely to progress to insulin therapy. These
presumably represent late onset IDDM.
Predisposing factors:
Predisposing factors are those that increase the risk of getting a particular
disease. There are many conditions that increase the risk of diabetes.
Hereditary:
A familial tendency to diabetes undoubtedly exists. The hereditary aspects of
diabetes is well summarized in the following statement by Warren and Le Compte,
when both the parents have diabetes, all the children may be expected to develop the
disease, if they live long enough. When one parent has diabetes and the other is
diabetic carrier, 40% of their children may develop the disease. If a diabetic or a
carrier marries an individual, who neither has diabetes nor a diabetic carrier, none of
the children will have diabetes.
Obesity:
The association of obesity and diabetes has long been recognized. Almost 80%
people who develop diabetes later in life are overweight. Excess weight increases the
bodies demand for insulin and obesity is the main cause for insulin resistance.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 56
Decreased numbers of insulin receptors are seen in obese individuals. Hence it is
major cause for Diabetes Mellitus. Symptoms of Diabetes Mellitus may disappear
with loss of weight. Elevated levels of free fatty acids and the hormones resistin and
leptin have been associated with insulin resistance at different phases. Such factors
are also present in obesity. It is not known yet if elevated levels are simply a product
of obesity or play some causal role in diabetes 161.
Age:
The diabetes may appear at any age, but 80% of cases occur after the age of 50,
and highest incidence of cases is in the 50 to 70 age group. The risk of diabetes
increases with age especially after 40 years mainly because the number of beta cells
in the pancreas that produce insulin decreases as age advances.
Gender:
Both men and women have the same risk of developing diabetes till early
adulthood, after 30 years women are at high risk as compared to men. Women who
develop diabetes during pregnancy are at higher risk of developing type II diabetes
later in life.
Viral Infection:
Some viral infections may destroy the beta cells in the pancreas and therefore
cause diabetes.
Stress:
Some hormones released during stress may block the effect of insulin on the
cells thus causing diabetes.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 57
Sedentary Life:
Some recent studies have indicated that people with sedentary life Style are
more likely to have diabetes as compared to those who lead an active life. It is
believed that exercise and physical activity increases the effect of insulin on the cells.
PATHOPHYSIOLOGY OF NIDDM 162
The basic metabolic defect in the type 2diabetes either a delayed insulin secretion
relative to glucose load (impaired insulin secretion) or the peripheral tissue are unable to
respond to insulin.
Type 2 DM is a heterogeneous disorder with a more complex etiology and is for
more common than type 1DM, but much less is known about its pathogenesis. A number
of factors have been implicated through, but HLA association & autoimmune phenomena
are not implicated these factors are as under.
1) Genetic factors – Genetic component has a stronger basis for type 2DM than
type 1DM. Although no definite & consistent genes have been identified.
Multifactorial inheritance is the most imp factor in development of type 2 DM.
2) Insulin resistance – One of the most prominent metabolic features of type 2 DM
is the lack of responsiveness of peripheral tissues to insulin, especially of skeletal
muscle with insulin resistance & hence type 2 DM. Mechanism of hyperglycemia
in these cases is explained as under
• Resistance to action of insulin resistance impairs glucose utilization &
hence hyperglycemia
• There is increase hepatic synthesis of glucose.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 58
• Hyperglycemia in obesity is related to high levels of free fatty acids &
cytokines affect peripheral tissue sensitivity to respond to insulin.
The precise underlying molecules defect responsible for insulin resistance in type
2DM has yet not fully identified. It is proposed that insulin resistance may be possibly
due to one of the following defects.
• Polymorphisms in various post receptor increase signal pathway
molecules.
• Elevated free fatty acids teen in obesity may contribute e.g. by impaired
glucose utilization in the skeletal muscle of glucose & by impaired beta
cell function
3) Impaired insulin secretion -
In type 2DM, insulin resistance & insulin secretion are interlinked.
• Early in the course of disease, in response to insulin resistance there is
compensatory increase secretion of insulin in an attempt to maintain normal
blood glucose level.
• Early in the course of disease, insulin secretion appears to be normal and plasma
insulin levels are not reduced. However, the normal pulsatile, oscillating pattern
of insulin secretion is lost and rapid first phase of insulin secretion triggered by
glucose is obtunded. Collectively, these and other observations implicate such
derangements in insulin secretion seen early in type 2diabetes, rather than
deficiencies in insulin synthesis 163.
• Eventually, however there is failure of beta cell function to secrete adequate
insulin, although there is some secretion of insulin i.e. cases of type 2DM have
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 59
mild to moderate deficiency of insulin but not its total absence.
The exact genetic mechanism why there is fall in insulin secretion in these cases
is under following possibilities are proposed
• Islet amyloid polypeptide which forms fibrillas protein deposits in pancreatic
islet in longstanding cases of type 2DM may be responsible for impaired
function of beta cell islet cells.
• Metabolic environment of chronic hyperglycemia surrounding the islet may
paradoxically impair islet cell function
• Elevated free fatty acid levels in these cases may worsen islet of function.
3) Hepatic glucose synthesis
One of the normal roles played by insulin is to promote hepatic storage of glucose
as glycogen & suppress gluconeogenesis. In type 2DM as a part of insulin resistance by
peripheral tissues. Liver also shows insulin resistance i.e. in spite of hyperglycemia in the
early stage of disease, gluconeogenesis in the liver is not suppressed. This results in
increase hepatic synthesis of glucose which contributes to hyperglycemia in these cases
CLINICAL FEATURES 164
The presenting features of diabetes vary widely. Age and nature of symptoms at
onset may be broadly indicative of the clinical type.
Most middle aged and elderly patients (NIDDM) have an indefinite or insidious
onset. Most often medical help is sought because of symptoms related to hyperglycemia
i.e. polyuria, polydypsia and hyperglycemia are detected during routine checkup. Others
get investigated for unexplained weakness, weight loss, aching or cramps in the legs,
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 60
delayed healing of wounds, recurrent crops of boils or appearance of a carbuncle often
calls for investigation. Even more common are early complaints of pruritus vulvae in
women and balanoposthetis in men. Not infrequently poor obstetric history of impotence
indicates the possibility of Diabetes. Investigation in cases presenting with neurological
deficits, visual disturbances or premature coronary peripheral or cerebrovascular disease
may reveal Diabetes for the first time.
Broad differences can be noticed in the age at onset of symptoms, mode of
presentation, body build, and family history, social and nutritional status and besides
findings among the common type of Diabetes laboratory investigations and follow up
studies are some times necessary to establish the category.
1. Polyuria:
Polyuria is due to the osmotic diuretic effect of glucose in the kidney tubules.
There may be nocturia also.
2. Polydipsia:
The diuresis in turn causes obligatory loss of electrolytes from the extra cellular
fluid, which then causes compensatory dehydration of the intracellular fluid and hence
produces polydipsia.
3. Polyphagia:
The failure of glucose utilization by the body because of deficiency and resistance
of insulin produces and sends a message to the center, so digestive enzymes will be
secreted more hence Diabetic patient will have polyphagia.
4. Weakness:
The failure of glucose utilization, loss of electrolyte and loss of body protein
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 61
contributes to weakness.
5. Weight loss:
Due to fluid depletion and the accelerated break down of fat and
Muscle secondary to insulin deficiency.
6. Glycosuria:
When ever the quantity of glucose entering the kidney tubules in the glomerular
filtrate rises above approximately 225 mg/min, a significant proportion of the glucose
begins to spill in to the urine and when the quantity increases above about 325mg/min
which is tubular maximum for glucose. All the excess above this is lost in to the urine.
7) Dryness of Mouth and Throat:
This is the effect of polyuria.
8) Constipation:
The stool becomes hard and bowel movement may take place after every 2-3
days.
Classification of Diabetes Mellitus 165
A. Primary:
a. Insulin dependent Diabetes Mellitus (IDDM, TYPE I)
b. Non-insulin dependent Diabetes Mellitus (NIDDM, TYPE II)
1. Non obese NIDDM.
2. Obese NIDDM
3. Maturity onset Diabetes of the young (MODY)
B. Secondary Diabetes:
1. Liver disease:
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 62
Cirrhosis.
2. Pancreatic disease:
Cystic fibrosis.
Chronic pancreatitis.
Malnutrition-related pancreatic disease.
Pancreatectomy.
Hereditary haemochromatosis.
Carcinoma of the pancreas.
3) Endocrine disease:
Cushing's syndrome
Acromegaly.
Thyrotoxicosis.
Phaeochromocytoma
Glucogonoma.
4. Drug induced disease:
Thiazide diuretics.
Corticosteroid therapy.
5. Insulin-receptor abnormalities
Congenital lipodystrophy.
Acanthosis nigrican
6. Genetic syndromes
.Friedreich's ataxia.
Myotonic dystrophy
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 63
COMPLICATIONS OF DIABETES MELLITUS 166
The disease has a particular predisposition for micro vascular complications and
increased tendency for macro vascular complications.
Acute Complications:
Hypoglycemia
Diabetic Ketoacidosis
Non Ketoic hyperosmolar state
Chronic Complications:
(1) Macrovascular Complications:
Coronary artery disease.
Peripheral Vascular disease.
Cerebro vascular disease.
(2) Microvascualar Complications :
Diabetic Eye disease
Retinopathy (non-proliferative/proliferative)
Macular edema
Glaucoma
Cataracts
Diabetic Neuropathy
Poly neuropathy /mono neuropathy
Autonomic neuropathy.
Diabetic Nephropathy
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 64
Pyelonephritis
Renal arteriosclerosis
Kimmelstiel
Micro albuminuria
Papilitis
(3) Other
Gastro intestinal [gastroparesis, diarrhoea]
Genito urinary [uropathy /sexual dysfunction]
Dermatologic infections.
Diabetic foot.
Differential diagnosis 167
1) Diabetes mellitus & Endocrine disorders:
a) Pituitary gland
1) Pituitary diabetes due to growth hormone
2) Acromegaly
3) Diabetes insipidus
b) Adrenal Cortex
1) Cushing’s Syndrome
2) Steroid diabetes due to administration of steroids
3) Primary Hyperaldosteronism
c) Adrenal Medulla
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 65
1) Phaeochromocytoma
2) Addison’s disease
3) Adrenalectomy
d) Thyroid
1) Hyperthyrodism
2) Myxoedema
2) Pancreatic Diabetes
1) Acute pancreatitis
2) Mumps (rarely)
3) Chronic pancreatitis
4) Haemochromatosis
5) Total pancreatectomy
6) Carcinoma of pancreas
3) Diabetes liver
1) Cirrhosis of liver
2) Gall Stones
4) Drugs & diabetes
Thiazide, Chlorthalidone, frusemide, oestrogen containing oral contraceptives, β
blockers & catacholaminergic drugs
V Miscellaneous
1) Type I glycogen storage disease
2) Down’s syndrome
3) Turner’s Syndrome
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 66
4) Huntington’s chorea
Conditions of polyuria
Polyuria should not be confused with prostratic hypertrophy or cystitis because
here it is only increased frequency of micturition & not increased quantity.
1) Polyurea due to water diuresis
Cranial or neurogenic diabetes insipidus: This is due to an identifiable lesion in
the hypo thalamus pituitary or both leading to failure of A.D.H. Nephrogenic diabetes
insipidus: Familial form seen in males only also as an accompaniment of Fanconi
syndrome. Psychogenic polydipsia or compulsive water drinking this is a hysterical
condition. There is clinically marked fluctuation here.
2) Polyurea due to increased solute load
Diuretic therapy
Chronic renal failure
TREATMENT 168:
The word treatment in Diabetes Mellitus seems incomplete instead management
of Diabetes Mellitus is an appropriate term as the disease can only be controlled and
constitutes a multidimensional approach namely Diet, exercise, oral hypoglycemic,
insulin & patient education are vital aspect which require due consideration in the
management of Diabetes Mellitus.
1) Diet:
Today there is no one diabetic diet. The recommended diet can only be defined as
a dietary prescription based on nutrition assessment & treatment goals. Medical nutrition
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 67
therapy for people with diabetes should individualized, with consideration given to eating
habits & other lifestyle factors. Nutrition recommendations are then developed to meet
treatment goal & desired outcomes. Monitoring metabolic parameters, including blood
glucose, glyceated haemoglobin, lipids & body weight as well as quality of life is crucial
to ensure successful outcomes 169.
Modification of diet is the most important aspect in the therapeutic plan for
patients with Diabetes Mellitus. Diet therapy consists of maintenance of proper nutrition
& monitoring of total number of calorie ingested, individual food sources that make up
these calories & distribution of calories thought the day.
The selection, modification & restriction are the key words in planning in a diabetic
subject depend on the judicious selection of carbohydrate, moderation in a diabetic in
protein intake & a determined restriction of total fat intake.
The obese & overweight must be encouraged to reduce weight. An energy deficit
of 500kcal daily will help the patient reduce ½ kg body weight.
Life style Daily calorie requirement
Sedentary 20-25 kcal/Kg of IBW
Moderate active 26-30 kcal/Kg of IBW
Strenous 31-35 kcal/Kg of IBW
2) Exercise:
Exercise is an important aspect of the management. It helps to improve glycaemic
control by increasing insulin sensitivity, maintaining body weight, reducing
cardiovascular risk factors & inducing a sense of well being.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 68
Type II Diabetes Mellitus subjects must be evaluated about the cardiovascular
risk factors before beginning the exercise programme. Aerobic exercise like walking,
swimming & cycling are more effective than isometric exercise in improving the
glycaemic status.
3) Oral hypoglycaemic agents(OHAs) –
Oral hypoglycaemic agents should be used in type II Diabetes Mellitus in the
extent of failure of diet & exercise.
Indications
The use of oral hypoglycaemic agents in the management of type II Diabetes
Mellitus has withstood the test of time, inspite of controversies; usually OHAs are
intiated when dietary modification & exercise facil to achieve euglycaemia in type II
Diabetes mellitus.
1) Sulphonyurea –
Sulphonylureas, like Chlorpropamide & Tolbutamide Glipizide & Glyburide, are
secretogogues having predominantly pancreatic action. This increases endogeneous
insulin levels. They are useful in averagely built or lean type 2 Diabetes Mellitus.
2) Biguanides –
Metformin a biguanide is widely regarded as the drug of choice overweight or
obese patients with type 2 Diabetes mellitus. It can also be used in normal weight
patients. Metformin can be used in combination with any OHAs
4) Alpha glucosidase inhibiters-
Alpha glucosidase inhibiters like acarbose are helpful in controlling post prandial
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus)- Literary Review 69
hyperglycaemia. Given along with meals. They can be combined with Sulphonyurea,
Biguanides and insulin
5) Meglitinides –
Meglitinides like repaglinide, nateglinide are also helpful in controlling post
prandial hyperglycaemia. They must be taken just prior to meals can be combined with
Sulphonyurea, Biguanides.
6) Thiazolidinedione derivatives –
Thiazolidinedione derivatives like Rosiglitazone are useful in subjects with
insulin resistance. They can be combined with Sulphonyurea, Biguanides and insulin. It
is widely regarded as the drug of choice for overweight, obese patients with type
2Diabetes mellitus. It can also be used in normal weight patients.
DRUG REVIEW
In madhumeha vitiation of Meda, Kleda, Vasa and Lasika along with the kshyaya
of vital Dhatus like Oja and Majja take place, so the dhatu kshyaya produce Vata
provocation and leads to madhumeha. So line of treatment should be to reverse the
pathogenesis with the help of Shamana as well as Sodhana. In Chikitsa, medicament
should posses Tikta and Kasaya Rasa along with Kapha Vata hara, Medo hara,
Kledaghna and Prameha hara properties.
Phalatrikadi vati 170 contains about 7 drugs. Properties of these drugs are tikta,
kashayarasa, laghu, rooksha guna and katuvipaka. Kaphavatahara. These are said to be
kaphagna, mehagna, medogna and mootrasangrahaneeya. Thus the selected combination
– Phalatrikadi vati is of the drug of choice for the present clinical trial.
Table – 12
Combination of Phalatrikadi Vati
S.No. Sanskrit Name Botanical Name Proportion
1 Haritaki Terminalia chebula 1 part
2 Bibitaki Terminalia bellirica 1 part
3 Amalaki Embcica officinals 1 part
4 Daruharidra Berberis aristata 1 part
5 Vishala Cirullus colocynthis 1 part
6 Musta Cyper rotundus 1 part
7 Haridra Curcuma longa 1 part
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Darg Review 70
HARITAKI 171 – Latin name – Terminalia chebula,
Gana – Prajastapana, Kustagna, Arshogna, Kasagna, Jwarahara
Prayojyanga- Phala, majja
Rasa – Pancha rasa , lavanavarjita kashayarasa pradhana
Guna – Laghu, Ruksha
Veerya - Usna
Vipaka - Madhura
Prabhava - Tridoshahara
Doshagnta - Tridoshahara
Rogagnta – Sotha, prameha, kusta, vruna, vatarakta, mutrakrcchra
Chimical constituents- Anthraquinone glycoside, chebulic acid, tannic acid, vit c.
BIBHITAKI 172– Latin name – Terminalia bellirica (pp239)
Gana – Jwarahara, Virecanopaga
Prayojyanga- Phala, majja, bija, seed kernal
Rasa – Pancha rasa kashayarasa pradhana
Guna – Laghu, Ruksha
Veerya - Usna
Vipaka - Madhura
Doshagnta Kapha-pittahara
Rogagnta – Jwara, kasa, shwasa, atisara, ashamari, trushna, chardi
Chimical constituents- Fructose, galactose, glucose, mannitol, thamnose, edible oil, gallic
acid, chebulagic acid, ellagic acid.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Darg Review 71
AMALAKI 173 - Latin name – Emblica officinalis
Gana - Vayastapana, Virecanopaga
Prayojyanga- Phala, majja
Rasa – Pancha rasa , lavanavarjita amlarasa pradhana
Guna – Laghu, Ruksha
Veerya – Sita
Vipaka – Madhura
Prabhava – Rasayan
Doshagnta – Tridoshahara
Rogagnta – Prameha, raktapitta, kusta, arsha, sula, mutrakrcchra
Chimical constituents- Ellagic acid, lupeol, oleanolic aldehyde, leucodelphinidin,
procyanidin, tannin, vit c, phyllembin, linolic acid, indole acetic acid.
MUSTA 174- Latin name – Cypers rotundus
Gana – Lekhaneeya, Kandugna, Trushananigraha, Truptigna
Prayojyanga- Tubers
Rasa – Tikta, katu, kashaya
Guna – Laghu, Ruksha
Veerya - Sita
Vipaka - Katu
Doshagnta – Kapha-pittahara
Rogagnta – Jwara, kasa, Kandu, atisara, grahani, trushna, kusta, rakta vikara, krimi
Chimical constituents- Lineol, copadiene, copaene, cyperen I & II, cypernone, rotundone,
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Darg Review 72
HARIDRA 175- Latin name – Curcuma longa
Gana - – Lekhaneeya, Kustagna, Vishagna, Tiktaskanda
Prayojyanga- Kanda
Rasa – Tikta, katu
Guna – Laghu, Ruksha
Veerya - Usna
Vipaka - Katu
Doshagnta – Kapha-vatahara
Rogagnta – prameha, Kandu, kusta, vruna, krimi, pandu, kamala
Chimical constituents – curcumene, curcumenone, curcone, curdione, lineole
curzerenone, epiprocurcumenol, eugenol, camphena, camphor, borneol, procurcumadiol.
DARUHARIDRA 176 – Latin name – Berberis aristata
Gana – Lekhaneeya, Kandugna, Arshogna
Prayojyanga- moola, stem, fruit
Rasa – Tikta, Kashaya
Guna – Laghu, Ruksha
Veerya - Usna
Vipaka - Katu
Doshagnta – Kapha-pittahara
Rogagnta – prameha, kusta, vruna, kamala, visarpa
Chimical constituents – Karachine, Taxilamire, berberine, palmatin, Jatrorrhizine,
oxycanthine.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Darg Review 73
INDRAVARUNI 177-
Latin name – Citrullus colocynthis
Prayojyanga- Root, fruit
Rasa – Tikta,
Guna – Laghu, Ruksha, Tiksna
Veerya - Usna
Vipaka - Katu
Doshagnta – Kapha-pittahara
Rogagnta – Prameha, kusta, Udara, kamala, unmada, aparmara, kasa, shwasa
Chimical constituents – Alkoloids I II & III, cholinecucurbitalin B, cucurbitalin E,
citrullol, citronellal, methyleugenol insitol.
Phalatrikadi vati ingredients are well identified and collected from local area.
Good manufacturing practice is followed for the preparation of Phalatrikadi vati after
fortification with the Phalatrikadi kwatha. . Later, at the time of distribution, requisite
quantity of the medicine was packed and given to patients. The individual components of
the composition are as follows under specified headings.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Darg Review 74
METHODOLOGY
1) Method of Research design
Madhumeha vis-à-vis Diabetes mellitus is the 3rd largest killer in the world behind
the cardiac ailments worldwide. It is becoming a great catastrophe with a current high
prevalence rate at in urban dwellers.
At least 50% of all people are with Madhumeha are undiagnosed and noticed
from a dentist. In spite of many advances in contemporary science, the management of
Madhumeha is unsatisfactory Recent studies reveal that the prevalence rate of type-2
diabetes is from 10-18% in the urban Indian adult population and also increasing in rural
population too.Thus the trail is Simple Random sampling technique clinical study. In this
Patients were taken in randomized selection.
2) Posology of Trial drug
Internally: 2000 mg / 24hrs in divided two doses or 33.3 mg /Kg body weight
distributed in equal doses
3) Anupana of Trial drug
Madhodaka is undertaken as it is stipulated for the medicine.
4) Study duration of Trial drug
Phalatrikadi vati Simple Random sampling technique clinical study was
conducted for 30 days. The medicine was dispensed for 7 days to all patients and advised
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Methods 75
to report for every 7 days interval, noted the nature, frequency and other symptoms of
their disease during their visits.
5) Follow up of Trial drug
Phalatrikadi vati trail offered a further follow up 30 days. The effect of yoga was
analyzed according to clinical and functional response before and after the treatment is
compared.
6) Source of data of Trial drug
The data was collected from the patients suffering from Madhumeha in the OPD
of post graduation and research center DGM Ayurvedic medical college Gadag by
present inclusion criteria & exclusion criteria.
a) Selection of the patient
Patients of Madhumeha fulfilling the criteria of diagnosis were selected in the
present study. Patients were distributed based on preset inclusion and exclusion criteria.
Patients were excluded, as they are discontinuous at the treatment or unable to fulfill the
study design.
i) Inclusion criteria
Patients with symptoms of Madhumeha are included with classical symptoms
enumerated at the classical texts under the lime light of contemporary medical context
along with criteria of inclusion. The symptoms of inclusion are as under.
• Age of patients between 25-65 years.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Methods 76
• All patients other than that of exclusive criteria are included.
• Irrespective of gender.
• Non insulin dependent diabetes mellitus.
• Patient having clinical features of Madhumeha.
• Patient having clinical features of Madhumeha viz.
Prabhuta mootrata
Avilamotrata
Karapadadaha
Kshudadhikya
Pipasa
Atisweda
Dourbalya
ii) Exclusion criteria
• Insulin dependent D.M Vis-à-vis Madhumeha
• Patients who develops complication with other systemic disease
• Juvenile diabetes
• Malnutritional D.M
• Gestational D.M
b-2) Diagnosis measurements
The signs and symptoms of Madhumeha mentioned in Ayurveda and
contemporary science were the main basis of diagnosis and criteria for assessing the
response to the treatment. Assessments of results were made according to clinical and
functional improvement observed in the study. Clinical assessment was made on the basis
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Methods 77
of symptoms viz. prabhoota mootrata, kshudha etc., which are allotted grades according
to their severity or to that of normalcy. The grades are followed as under.
Grades of assessment
1) Prabhoota Mootrata
Grade 0 - 1000 – 1500 ml/ 24 hrs
Grade 1 - 1500 – 2000 ml/ 24 hrs
Grade 2 - 2000 – 2500 ml/ 24 hrs
Grade 3 - 2500 – 3000 ml/ 24 hrs
Grade 4 - 3000 – above ml/ 24 hrs
2) Avila mootrata
Grade 0 - Crystal clear fluid
Grade 1 - Hazy with slight turbidity
Grade 3 - Turbidity clearly present but news
Print can be read through the tube.
Grade 4 - More turbidity news print cannot
be read.
3) Kara pada dhaha
Grade 0 - No kara padadadha
Grade 1 - Occasionally noticed
Grade 2 - Periodically noticed
Grade 3 - Daily noticed
Grade 4 - Continuously noticed
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Methods 78
4) Kshudhadikya
Grade 0 Normal
Grade 1 Actively hunger
Grade 2 Intermittent hunger
Grade 3 Bulimic hunger
5) Pipasa
Grade 0 Normal
Grade 1 Slight inclination
Grade 2 Temporarily suppressed
Grade 3 Unsuppressed
6) Atisweda
Grade 0 Normal sweating after doing
normal physical activities
Grade 1 Moderate sweating
Grade 2 Excessive sweating
Grade 3 Excessive sweating just by
doing little work
7) Dourbalya
Grade 0 No Dourbalya
Grade 1 Occasionally noticed
Grade 2 Periodically noticed
Grade 3 Continuously noticed
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Methods 79
B-3) Assessment measures and Laboratory-investigations
The following investigations are under taken to fulfill the criteria of inclusions
and exclusions. The effective parameters which are considered for the assessment are as
under.
a) Blood Sugar estimations
Blood glucose is determined by using Gluzyme glucose reagent set
Procedure
A blood sample is collected from patient into a sterilized container. Serum is
separated from the cells at the earliest possible time (within 30 minutes), then the serum
blood is mixed with the reagent (working solution) and heated at 37°C for 15 minutes.
The readings are observed from colorimeter under 520 nm.
Pipetting scheme for determination of blood sugar
Blank Standard Test
Working enzyme reagent (ml) 3.0 3.0 3.0
Distilled water (ml) 0.025 - -
Standard ( ml) - 0.025 -
Sample (ml) - - 0.025 Calculation
Glucose in mg/ dl = Absorbance of sample x 100
Absorbance of standard
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Methods 80
The same procedure is applied for both FBS and PPBS. The FBS is done with
empty stomach and on the same day the PPBS is calculated after 2 hours of food and the
results are recorded in case sheet.
b) Urine Sugar estimations
A fresh urine sample is collected from the patient. 5 ml of Benedict solution is
taken in a test tube and 5-6 drops of urine sample put in that. Then the test tube is heated
till until a boil in the solution and cooled at room temperature. The change is observed
for the presence of sugar.
Observations
Colour of test solution Urine sugar
Blue
Green
Yellow
Orange
Brick red
Nil
0.5 %
1.0 %
1.5 %
2.0 %
The following are investigations were done prior to the study just role out the
general condition of the patient.
a) Erythrocyte Sedimentation Rate
b) Hemoglobin %
c) Criteria of assessment
Over all assessment of results are done considering the cumulative subjective and
objective parameters assessments. As the disease is not totally curable in the scheduled
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Methods 81
time span of the study, the grades of assessments made for the results declaration are as
follows –
1. Regulated –
i. After Treatment if PPBS is less than 135mg/dl
ii. Patient relieved with symptoms clinically
2. Palliative –
i. After Treatment if PPBS is more than 136mg/dl and less than 160mg/dl
ii. Incomplete Symptomatic relief for the patient clinically
3. Responded –
i. If PPBS more than 161mg/dl, if there is a good difference in Baseline data
ii. Symptomatic relief for the patient is witnessed partially
4. Not responded
None of the above conditions
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Methods 82
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 83
RESULTS
Present study registers 25patients, out of 30 approached patients. Out of this, 5
patients not fulfilled the inclusion criteria hence their data has not been included in the
assessment. The remaining 25 patients of Madhumeha viz. Diabetes Mellitus, fulfilling
the criteria of diagnosis and inclusive criteria were included in the study. Fasting and
Postprandial blood sugar (FBS and PPBS) along with corresponding urine sugars (FUS
and PPUS) are considered as an objective for the inclusion in the present study.
All the patients were examined before and after the trail, according to the case
sheet format given in the annex. Both the subjective and objective criteria were recorded
along with validation of disease state. The data recorded are presented under the
following headings.
A. Demographic data
B. Evaluating disease Data and
C. Result of the Phalatrikadi Vati and
D. Statistical analysis
A) Demographic data:
The details of Age, Gender, Religion, and Occupation etc. of the 25 patients are as
follows.
A1) distribution of patients by Age
Here in this study an attempt is made to understand the male female responses to
the management with respect to that of the age groups. An interval of 10 has considered
from the ages 25 to 65 as discussed in the methods. In the study it is revealed that
Madhumeha is even though thought that starts from the ages of 25 onwards and the fact
found is not suggestive. At the older age group of 55-65, 8(32%) patients reported
suggest the chronicity of the disease. Where in 45-55 and 35-45 age groups reported with
9 (36%) and 8 (32%) patients in each group respectively.
Table- 12
Results by Age in Madhumeha with Phalatrikadi Vati
Age
Regulated Palliative Responded Not
Responded Total %
25- 35 0 0 0 0 0 0
35 – 45 1 2 4 1 8 32
45 – 55 0 2 7 0 9 36
55 – 65 1 1 5 1 8 32
Total 2 5 16 2 25 100
% 8 20 64 8 100
Figure – 3
Results by Age in Madhumeha with Phalatrikadi Vati
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 84
0
1
2
3
4
5
6
7
25- 35 35 – 45 45 – 55 55 – 65
RegulatedPalliativeRespondedNot Responded
2) Distribution of patients by Gender
Table - 13
Results by Gender in Madhumeha with Phalatrikadi Vati
Gender Regulated Palliative Responded Not Responded Total %
Male 1 5 8 0 14 56
Female 1 0 8 2 11 44
Total 2 5 16 2 25 100
% 8 20 64 8 100
The percentage of the distribution does not show any gender differentiation to get
this Madhumeha in specific, except a small lean towards male population. The
observations are 14 Patients i.e. (56%) were male and 11 patients i.e. (44%) were female.
Figure – 4
Results by Gender in Madhumeha with Phalatrikadi Vati
0
1
2
3
4
5
6
7
8
Male Female
RegulatedPalliativeRespondedNot Responded
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 85
A3) distribution of patients by Religion
For the convenience of the study, the religion groups are noted as Hindu, Muslim,
Christian and Others. The maximum number of patients are noticed from the Hindu
community as the ratio of community at the study area is more i.e. 24 (94%) along with
Muslim patients 1 (4%).
Table - 14
Results by Religion in Madhumeha with Phalatrikadi Vati
Religion Regulated Palliative Responded Not Responded Total %
Hindu 2 4 16 2 24 94
Muslim 0 1 0 0 1 4
Christian 0 0 0 0 0 0
Others 0 0 0 0 0 0
Total 2 5 16 2 25 100
% 8 20 64 8 100
Figure – 5
Results by Religion in Madhumeha with Phalatrikadi Vati
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 86
Christian 0%Muslim
4%
Others 0%
Hindu96%
HinduMuslimChristian Others
At the results observed, out of 24 (96%) of Hindu patients, 2 (8%) patients
regulated and 16 (64%) patients fall under responded category. On the other hand the
results observed at Muslim community, 1 (4%) patient comes under responded category.
The tabulation and graphical representation is as under.
A4) Distribution of patients by Occupation
Table - 15
Results by Occupation in Madhumeha with Phalatrikadi Vati
Occupation Regulated Palliative Responded Not Responded Total % Sedentary 1 4 7 2 14 56
Active 1 1 8 0 10 40
Labor 0 0 1 0 1 4
Total 2 5 16 2 25 100
% 8 20 64 8 100
Figure - 6 Results by Occupation in Madhumeha with Phalatrikadi Vati
0
1
2
3
4
5
6
7
8
Sedentary Active Labour
RegulatedPalliativeRespondedNot Responded
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 87
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 88
As the results observed, out of 25, 14 (56%) of sedentary patients, strongly
suggests that the Madhumeha is a disease of the sedentary patients, out of which 1 (4%)
patient isregulated, 4 patients are palliative and 7 patients were responded to the
treatment, 2 patients were not responded to treatment. At the active group, out of 10
patients 1 (4%) patient is regulated and 1 (4%) patient is palliative, 8 patients are
responded to treatment. At the results are observed, 1patient of Labour is responded to
the treatment.
A5) Distribution of patients by economic status
At the results observed, out of 3 (12%) of poor patients, all three are responded.
Out of 9 (36%) of Middle class patients reported 1 is regulated and 2 patients are
palliative, 6 patients are responded. From higher middle class 13 (52%) patients reported
and out of them 1 patient is regulated, 3 patients are responded palliative and 6 patients
are responded. 2 patients are under not responded category.
Table - 16
Results by Economic status in Madhumeha with Phalatrikadi Vati
Economic status Regulated Palliative Responde
d Not
Responded Total %
Poor 0 0 3 0 3 12
Middle 1 2 6 0 9 36
Higher Middle 1 3 7 2 13 52
Higher 0 0 0 0 0 0
Total 2 5 16 2 25 100
% 8 20 64 8 100 *
Figure - 7
Result Distribution of patients by Economic status
0
1
2
3
4
5
6
7
Poor Middle HigherMiddle
Higher
Regulated
Palliative
Responded
Not Responded
A6) Distribution of patients by diet
Table – 17
Results by Diet in Madhumeha with Phalatrikadi Vati
Diet Regulated Palliative Responded Not Responded Total %
Vegetarian 2 4 12 1 19 76
Mixed diet 0 1 4 1 6 24
Total 2 5 16 2 25 100
% 8 20 64 8 100 *
The percentage of the distribution does not show any diet differentiation to get
this Madhumeha a disease in specific, except a lean towards vegetarian population. The
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 89
observations are 19 Patients i.e. (76%) vegetarian and 6 patients i.e. (24%) were mixed
diet practitioners.
Figure - 8
Results by Diet in Madhumeha with Phalatrikadi Vati
0
2
4
6
8
10
12
Vegetarian Nonvegetarian
RegulatedPalliativeRespondedNot Responded
As the results observed, out of 19 (76%) vegetarians, 2 (8%) patients are
responded and 12 (30%) patients responded to the management and 4 patients are
palliative, 1 patient is not responded. As the results observed in mixed diet population,
out of 6 (24%), 4(25%) patient are responded, 1 (5%) patient responded palliative and 1
(5%) patient not responded to the treatment.
B) Data related to the disease.
B1) Distribution of patients by presenting complaints
Almost all the symptoms selected as the presenting complaint as analyzed reflects
the said complaints of the text and Prabhoota mootrata (25 patients), Dourbalya (21
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 90
patients), Kshudha adhikyata (24 patients) and Pipasa (23 patients) the cardinal
symptoms as polyuria, weakness, polydipsia and polyphasia. The graph and tabulations
are shown as below.
Table - 18
Distribution of patients by presenting complaints
Presenting complain % ts Patients
Prabhoota Mootrata 25 100
Avila Mootrata 18 72
Karapada Daha 15 60
Kshudhadhikyata 24 96
Pipasa 23 92
Atisweda 20 80
Dourbalya 21 84
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 91
Figure - 9
Distribution of patients by presenting complaints
Avila Mootrata
Kshudhadhikyata
Atisweda
0
5
10
15
20
25
PrabhootaMootrata
Karapada Daha Pipasa Dourbalya
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 92
B2) Distribution of patients by Associated features
Mukha talu sosha is said as associated symptom for Madhumeha, which is
observed here at the maximum. Alasya is observed by the 76 % of the patients. This
study observes the rest of the associated complaints enumerated in the table below along
with the graph.
Table - 19
Distribution of patients by Associated features
Presenting Associated features Patients Percentage
Kara/Pada suptata 2 8 Klama 16 64 Tandra 14 56 Alasya 19 76 Gur atrata 8 32 ug
Dantadi maladhyatwam 2 8 Shithilangata 2 8 Mukha/Talu shosha 22 88
Figure - 10
Distribution of patients by Associated features
Klama
Alasya
Dantadi maladyatwam
Mukha/Talu shosha
0
5
10
15
20
25
Kara/Padasuptata
Tandra Gurugatrata Shitilangata
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 93
B3) Distribution of patients by Ahara Nidana
Ahara Nidana observed in the study
Ahara Nidana Patients Percentage
Table – 20
Guda 25 100 Dadhi 19 76
Snigdha 25 100 Dugdha 17 68 Navanna 25 100 Sheeta 15 60 Mamsa 7 28
Ayurveda offered many causes especially in regard with food. The Guda and
Snigdha, navanna said as causes are observed 100% in the study. The other factors also
observed in the study are tabulated above.
B4) Distribution of patients by Vihara Nidana
Many regimens are told in Ayurveda, out of which Diwaswapna, Avyayama is
observed 56% and swapna sukham Asannaswapna for 52% of patients. The vihara
tabulated are here under.
Table - 21
Vihara Nidana observed in the study
Vihara Nidana Patients Percentage
Diwaswapna 14 56
Avyayama 14 56
Swapnasukham 13 52
Asannaswapna 13 52
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 94
B5) Distribution of patients by Anya Nidana
The other Nidana told in texts are very less observed here. Only Sthoulya is
observed for 20% of patients.
Table - 22
Distribution of patients by Anya Nidana
Percentage Anya Nidana Patients Sthoulya 5 20
Manishik a- Chinta 8 32Vegavarodha 2 8
Pancha ramsha 0 0 karma Vibh
B6) Distribution of patients
- 23
Poorva roopa Patients Percentage
by Poorva roopa lakshana
Table
Distribution of patients by Poorva roopa lakshana
M 25 100 utra madhurata
Trishna 24 96 Talujivha shosha 20 80
Swedadhikya 21 84 Shitalangata 6 24 Sheeta iccha 2 8
Nidra 6 24 Shareera durgandha 1 4
Alasya 21 84 Deha chikkanata 9 36 Mukha madhurta 1 4
Pada daha 4 16 Pani daha 4 16
Dantadeenam Malatvam 6 24 Tandra 11 44 Swasa 2 8
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 95
The Poorva roop Ayurveda are observed her the study. tra
madhuryata and Trishna are 100%, 96% and Alaysa is observed for 84%. The rest of the
symptoms observed are tabu ere along with percentage.
B7) Distribution of p lakshana
able - 24
Dis nts by Sroto dusti lakshan
Sroto dusti lakshana Patients Percentage
a mentioned in e in Mu
lated h
atients by Sroto dusti
T
tribution of patie a
Jihwa sho sha 23 92Talu shosha 23 92Kloma shosha 1 4
Uda
kava
ha
Pravruddha pipasa 17 68 Alpalpa mootrata 0 0 Mootara rodha 0 0 Adhika mootra 25 100 Sashoola mootra 0 0 M
ootra
vaha
Basti stabdhata 0 0 Arbuda 0 0 Arsha 0 0 Mamsa shosha 0 0
Mam
sava
ha
Shira granthi 0 0 Sweda 20 80 Snigdhanagata 7 28 Sthulashophata 0 0
Med
ovah
a
Pipasa 23 92
Out of different srotas included in the study explicit new ensions. Out of
Udakavaha srotas –Jihwa sosha observed 92% in study, in Mootravaha srotas – Adhika
dim
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 96
Mootrata, in Medovaha srotas the Pipasa are observed 100% in the st . It conform e
i vem these srotases. The enlisted symptoms are at above table.
B8) Fam
Table - 25
Data of Family history in the study
amily history Patients Percentage
udy th
nvol ent of
ily history
F
Present 20 80 Absent 05 20 Total 25 100
The Madhumeha observed as familial by researcher prove in study with 80%
family history. The rest of 20% show the instantaneous expression of the disease.
C) Result of the Phalatrikadi Vati
C1) Assessment of Subjective parameters
Assessment of Subjective parameters
nting complaints
Patie
nts
Bef
ore
%
Patie
nts
Afte
r
%
Patie
nts
relie
ved
Table – 26
Prese%
A otrata 20 80 6 24 14 56 vilam
Karapada Daha 16 60 4 16 12 16
Kshudhadhikyat a 24 96 3 12 19 76
Pipasa 24 92 3 12 21 84
Atisweda 22 68 4 16 18 72
Dourbalya 22 80 7 28 15 60
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 97
The assessments of the symptom esented as the chief complaints are
the subjective parameter ly as 80% is witnessed
reduced for 60% in the study. Karapada Daha is for 60% of patient’s initially recorded
16% of relief. Pipasa initially f atients t the % o . An er
Kshudhadhikyata is seen in 96% patients at the start become reduced
.
C2) Assessment of Objective parameters
Table – 27
s which are pr
s of the study observed initially Dourba
or 92% of p exhibi 84 f relief oth
major symptom
76% in the study
Assessment of Objective parameters
Presenting complaints
Patie
nts
Bef
ore
%
Patie
nts
Afte
r
%
Patie
nts
relie
ved
%
Prabhoota Mootrata 25 100 3 12 17 68
Fasting Blood Sugar 24 96 16 64 8 32
Post prandial Blood sugar 25 100 17 68 8 32
Fasting Urine Sugar 15 60 12 48 3 12
Post prandial Urine sugar 20 80 3 12 17 68
The objectives are very much assess a study. Here in the study
Mootra prabhootatva is exhibit 32% and 32%
differences in the study, where in the FUS and PPUS show the 12% and 68% variances
from the base line data.
important to
reduced 68%. The FBS and PPBS
C3) Results of the Phalatrikadi Vat
based upon t umul e effe f the ective d obj e
parame drawn in four categories viz. Regulated,
Palliative, Responded and not responded.
Number of patients Percentage
i
The result is he c ativ ct o subj an ectiv
ters together assessed. The result is
Table - 28
Result of Phalatrikadi Vati in Madhumeha
Result
Regulated 2 8
Palliative 5 20
Responded 16 64
Not Responded 2 8
Total 25 100
Figu
re - 11
Result of Phalatrikadi Vati in Madhumeha
Regulated 8%
Palliative 20%
Responded64%
Not Responded8%
Regulated Palliative RespondedNot Responded
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 98
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 99
D) Statistical analysis
To compare r the treatment the
tatistical analysis paired t-test, by assuming that the drug is not responsible for changes
the reading before and after the treatment. The conclusion drawn is as highly
ignificant if P <0.05.
Table - 29
Statistical analysis of Phalatrikadi Vati
arameter Mean SD SE t value P value Remark
the effectiveness of a drug before and afte
s
in
s
P
Avila mootrata 1.24 0.925 0.185 6.698 <0.001 HS
Karapada daha 0.64 0.637 0.127 5.018 <0.001 HS
Kshudhadhikyata 1.84 0.687 0.137 13,372 <0.001 HS
Pipasa 1.96 0.6110 0.122 16.039 <0.001 HS
Atisweda 1.12 0.7810 0.156 7.170 <0.001 HS
Dourbalya 2.0 0,816 0.163 12.247 <0.001 HS
Prabhoota mootrata 2.08 0.571 0.114 18.196 <0.001 HS
FBS 31.84 16.754 3.350 9.501 <0.001 HS
PPBS 63.92 39.159 7.831 8.162 <0.001 HS
FUS 0.36 0.3685 37 4.883 <0.001 HS 0.07
PPUS 0.54 0.518 0.103 5.204 <0.001 HS
sscess the ef ness o ug the s al an don g pai
g that dru ot re ble in anges ding after t
both subje objective param
0.05)
ong the subje par a, p shu yata ly sho
eters. (Comparing t values). The parameters
To a fective f dr tastic alysis is e by usin red t
test, by assumin g is n sponsi the ch of rea before & he
treatment. From analysis ctive & eters shows highly significant
(As p<
Am ctive ameters ipasa, K dhadhik , dourba ws
more highly significant than other param
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Results 100
pipasa having more net ffe as t meter avila mot aving le
ffect (comparing alu riati e pa kar ha is le
eter Kshudhadhikyata is more.
Among all the objective parameters all the parameters shows significant but in the
parameter prabhoota mootrata shows more highly significant than other objective
parameters With 89.65% of mean improvement. The parameters FBS shows more highly
significant than other parameter with 20.31% of mean improvement.
Among the subjective parameters the percentage improvement is in between
79.48% to 90%, which means that the percentage of improvement lies between these two
values. Where as in the objective parameter the more percentage improvement in the
prabhoota mootrata (89.65%) and where as in the parameter FBS is least percentage
improvement (20.317%).
mean e ct where he para rata is h ss
mean e mean v e) the va on in th rameter apada da ss,
where as in the param
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 101
DISCUSSION
The following headings are made to facilitate discussion.
I) Discussion on Disease aspect
II) Discussion on demographic data
III) Discussion on data of disease
IV) Discussion on probable mode of action of Phalatrikadi Vati
I) Discussion on Disease aspect:
Madhumeha with the clinical features of Diabetes has been recognized since
antiquity. Diabetes mellitus occurs throughout the world, but is more common (especially
type 2) in the more developed countries. The greatest increase in prevalence is, however,
expected to occur in Asia and Africa, where most patients will likely be found by 2030.
The increase in incidence of diabetes in developing countries follows the trend of
urbanization and lifestyle changes, perhaps most importantly a "Western-style" diet. This
has suggested an environmental (i.e., dietary) effect. In the present era, changing life
styles i.e. lack of exercise, sedentary life, unbalanced food and stress has lead to the
increased incidence of various diseases and one of them is Madhumeha.
In Madhumeha, mainly the Vata and Kapha are predominant though the disease is
tridoshakopanimittaja. The Vata may be provoked either directly by its etiological
factors, by dhatukshaya or by avarana of kapha & pitta to vata. Here the main dushyas are
Meda & Kleda and primarily Medhovahasrotodusti takes place.
Vagbhata has classified Madumeha into 2 categories, Dhatukshayajanya
Madhumeha and Avaranjanya Madhumeha. Similar type of classification is described by
Charaka - Apatarpanajanya and Santarpanajanya. The Dhatukshayajanya Madhumeha
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 102
can be correlated with Apatarpanajanya Madhumeha, while the Avaranjanya Madhumeha
can be correlated with Santarpanajanya Madhumeha.
In Dhatukshayajanya / Apatarpanajanya Madhumeha vata dosha gets vitiated
either due to its own etiological factors or by dhatukshaya. In avaranajanya and
santarpanajanya Madhumeha the kapha and pitta get vitiated due to etiological factors
mainly concordant with them, which obstruct the path of vata causing its provocation &
leading to the manifestation of the disease Madhumeha. Here vitiation of vata occurs due
to the Avarana. Thus this disease may be caused both by under nutrition as well as by
over nutrition. The first type of Madhumeha is considered to be asadhya and no precise
remedy has been suggested for it. But, the later type has been told as krichhra sadhya and
can be managed with extensive measurements.
In Diabetes mellitus there occurs disturbance in carbohydrate, protein and fat
metabolism due to the absolute or relative deficiency of Insulin secretion and/or insulin
action. Diabetes mellitus has been classified into Type I and Type II DM. Type I DM
patients are usually asthenic and need Insulin for treatment and Type II DM patient are
usually obese and are usually managed with oral hypoglycemic agents. So, it may be said
that Type I Diabetes mellitus is closer to dhatukshayajanya Madhumeha while the Type
II Diabetes mellitus is closer to avaranajanya Madhumeha. In the management of
avaranajanya Madhumeha (Sthula Madhumehi), the Shodhana therapy must be done
followed by Shamana Chikitsa
Beeja dosha and Kulaja dosha have been mentioned in the causative factors of
Sahaja Prameha. Such patients are said to be weak, emaciated, suffering from thirst, loss
of appetite and are required to be treated with a nourishing diet. In diabetes due to genetic
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 103
and hereditary factors, patients are weak, asthenic and emaciated. Such patients are
Juvenile Diabetics and require a nourishing diet. Therefore Sahaja Prameha and Juvenile
Diabetic may be correlated.
Apathyanimittaja Madhumeha is caused by excess indulgence in kapha
aggregating factors; such patients are sthoola and are afflicted with Polyphagia, excess
sleep and laziness. Maturity onset diabetes tends to over eat and is lazy. In Ayurvedic
classics age factor is not mentioned.
The Sthoola and Krisha classification is akin to obese and non-obese division.
We will not get much information regarding Sthoola and krisha Madhumeha in ayurveda.
While explaining Chikitsa, this type of classification has been mentioned.
Nidana:
The diet, which promotes Kapha dosha is included under apathyakara ahara for
prameha vyadhi. Excessive intake of Dugdha, Dadhi, Guda, Navanna, Sheeta Ahara,
Madhura-Amla-Lavana Rasa, Surapana are the causative factor of the Madhumeha.
Among mamsa sevan, most of the patients mainly indulge the Gramya and oudaka
mamsa. Both are Guru, drava, abhisyndi in nature cause vitiation of kapha & meda.
Navanna having abhisyandi, take longer time for the digestion and are major cause of
ama & kleda. Cause avaroda in srotus causing excessive formation of kleda. Asyasukha
literally means finding pleasure in diet and comfortable gadgets of living. Swapanasukha
means finding pleasure in oversleeping both these cause kapha vitiation and meda dhatu.
Dadhi Gudavaikruta ahara are kaphakaraka. . If madhura rasa is taken excessively then it
causes the Medo Vardhana, Shleshmaja Vikarakara, Sthaulya, and Meha kara 178. As it is
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 104
rich in carbohydrates if it is taken in excessively in the form of more refined products
then increases the total calorie consumption. Over eating causes the metabolic disorders.
Many similarities are found between nidanas explained in ayurveda and in
modern science. Beejadosha and kulajadoshas are mentioned in ayurveda which akin
with genetic and hereditary causes explained by modern science.
Obesity is mentioned as a major risk factor for Diabetes Mellitus as it causes
insulin resistance 179. In ayurveda also explained that atistoola person are more prone to
develop Prameha 180. This Prameha roga is included under santharponotta vyadhi.
Madhura, Snigdhadi bhojana are mentioned as nidanas for Madhumeha. In modern
science over eating is considered as a predisposing factor for Diabetes Mellitus. These
food articles and over eating causes obesity and which may cause Diabetes Mellitus.
Sedentary habit is also a predisposing factor. Asannasukha, swapnasuhka etc. can
be included under this.
In classics manasika bhavas like chinta, shoka, udwega etc are explained as cause
for madhumeha, similarly contemporary science also consider psychological factor like
stress as one of the predisposing factor.
Samprapti:
Any Vikara is a mutual interaction of Nidana, Dosha and Dushya under the
influence of Prakriti, Desha, Kala, Bala and Vaya. The extent of this Dosha Dushya
Sammurchana is dependent on the Vikara Vighata Bhava and its Abhava 181.
When a person indulges into Nidana of Madhumeha, the Kapha, Pitta, Meda,
Mamsa are increases excessively. They obstruct the path of Vata and so the Vata together
with Ojas comes down to reach the Basti producing Madhumeha. In the Madhumeha,
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 105
Tridosha (Vata, Pitta, Kapha), ten Dushyas (Meda, Mamsa, Kleda, Shukra, Shonita,
Vasa, Majja, Lasika, Raja and Oja). Three Srotasas (Mutravaha, Medovaha, Udakavaha)
and Dhatvagni plays an important role in the aetiopathogenesis of Madhumeha.
Kapha Dosha is the dominant factor in the pathogenesis of Madhumeha. It gets
vitiated primarily. Charaka clearly mentioned and Cakrapani opined that Kapha Dosha is
dominant and primarily vitiated because of its close resembles with the etiological
factors.
Kapha have peculiar nature i.e. Bahudrava described by Charaka. So it is easily
understand that the 'Shaithily' manifestation in this disease, as Kapha normally cause
Sthiratva in the body. Cakrapani commented upon the word Sthiratva means Ashaithilya.
So this bahudravatva of vitiated Kapha causes disruption in the assemblage of body
elements and provide ground for the accumulation of morbid matter in the tissues. Kapha
causes the vitiation of concordant body elements like Meda, Mamsa, Kleda, Rasa, Vasa,
Lasika etc. The vitiation of Kapha here mainly is of excessive type. That’s way the
following symptoms manifests in madhumeha. These are shaithilya, Alasya, Atinidra,
Gaurava, etc.
Pitta Dosha is not so dominant factor in the pathogenesis of Prameha. By the
vitiation of Pitta, Avaranjanya Samprapti of Madhumeha resulted. rakta, sweda, lasika
are the seats of pitta dosha. So when pitta gets provoked, it undoubtedly causes the
vitiation of above dusyas. Thus the symptoms manifests are sweda vruddhi, visra sharira
gandha, panidaha, pipasa and sosha indirectly Agni vaisyama too.
Vata is predominant dosha in the pathogenesis of Madhumeha, here is Vata get
aggravated either because of its own etiological factors or because of avarana caused by
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 106
kapha pitta and meda. This vitiated vata carries the vital constituents of the body like
Vasa, majja, and oja towards vasti and excretes them outside through urine resulting
depletion of the dhatus.
All authors narrated dushya sangraha and their involvement in the pathogenesis,
but Charaka specially enumerated a group and named it as a Dushya visesa. Again he
mentioned them in Cikitsasthana also. Susruta also narrated the Dushyas but he typically
mentioned them along with the doshic type, but he commonly included meda in each
type. Only Vagbhata mentioned sweda as a dushya along with above dushyas.
Rasa is the seat of Kapha Dosha and at the same time it is the Mala of Rasadhatu.
Rasa Dhatu mainly vitiates because of its close resemblance with Kapha qualitatively. So
if Kapha get vitiate Rasa also get vitiate. Thus having same symptoms related to Vruddhi
as mentioned by Vagbhata i.e. Rasoapi Slesmavat' 182. Susruta emphasized that Sthaulya
and Karshya results due to vitiation of Rasa Dhatu 183 and practically we can found both
conditions in the Madhumeha. So the role of Rasa Dhatu is very much important in the
precipitation of the disease. The symptoms like Alasya, Gaurava, Karshya, Hrillasa,
Gaurava, Angamarda, Sada, Pandutva, Klaibya etc. are produced as a result of Rasa
Dushti.
Rakta Dhatu has no much involvement in the manifestation of the Madhumeha. It
is mainly getting vitiated in pittaja Prameha. Not initially but in later stage Rakta also get
vitiated prominently causing complications like Pidaka, Vidrdhi, Alasi.
Mamsa dhatu is also one of the main dushya, vitiated especially in Kaphaja
Prameha and Avaranjanya Madhumeha, as Mamsa and Kapha have same qualities. They
both give strength to the body. When get vitiated, Mamsa losses its normal consistency
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 107
and develops shaithilya and provide space in between for the accumulation of morbid
matter. That in turn results into the putimamsa Pidika. "Mamsaleshu Arakasheshu".
Medas vitiation is common and dominant Dushya in the pathogenesis of
Madhumeha. Kapha and Meda have close resemblance in regard to functions as well as
qualitative parameters. Both are getting vitiated more or less by same etiological factors.
It gets vitiated both quantitatively and qualitatively Meda vitiation in Madhumeha
appears in two ways i.e. the Abadha (Asamhatum) Normal function of Meda is to
produce snigdhata in the body along with Dradhatva. So this Abadhatva causes
derangement in the structure of Meda producing Shaithilya in the body. In Madhumeha
vitiation of Meda results in two ways as already said.
Majja Dhatu is not vitiated in maximum extent but Vata causes its Ksaya i.e.
Depletion. Due to Vata Prakopa Kshaya of Majja Dhatu occurs. Thus vitiated Majja
produces clinical symptoms like, Netragaurava. Angagauravata in Madhumehi patient.
Shukra also get vitiated in the pathogenesis produces symptoms like daurbalya
and Kruchra vyavayata, because normal functions of Sukra is to maintain Dehabala. It
also plays role in the precipitation of Sahaja Prameha. Prameha is a Kulaja Vikara and
occurs as result of Beeja Dosha.Susruta described that Sukra Dosha and Prameha get
precipitate because of the vitiation of Vyanavata and Apanavata. Vata causes depletion of
Shukra Dhatu and also Shukrameha. So, one can appreciate the importance of Shukra
Dushti in Prameha With this it is understand that the relation of Sukra dushti as a
component of Prameha formation.
Oja is sarabhuta of all the Dhatus and gives strength and immune power to the
body. . Charaka mentions that life depends on Oja and therefore without Oja one cannot
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 108
live. Such Oja remains in the heart and called as Shareera Rasa Sneha184. In the
commentary Chakrapani has described two varieties of Oja i.e., Para and Apara Oja. Para
Oja is supreme and remains in the heart, while its Pramana is Ashta Bindu. Apara Oja is
of Ardha Anjali Pramana which is also called as Shleshmika Oja i.e. Shareera Bala185.
Further Chakrapani explained that, in Madhumeha Apara Oja Kshaya occurs, which is
Sleshmika in nature and not the Para Oja Kshaya186. Oja as Dushya mainly involved in
Vataja Prameha i.e. Ojomeha i.e. Madhumeha. Provoked Vata due to its own etiological
factors or due to Avarana carries Oja towards basti and excrete outside through urine.
Pathological conditions regarding Oja are of 3 types. So the symptoms of Ojakshaya like
Murccha, Mamsakshaya, Moha, Daurbalya (excessive weakness), Vyathita Indriya,
Rukshata, Gurugatrata, Nidra, Tandra etc may manifest. Charaka mentioned Rukashta i.e.
related to Ruksa Sharira, so one can easily understand the manifestations of
Krushapramehi or Sahaja Pramehi. Oja is an important Dushya in the Samprapti of
Madhumeha.
Kleda is one of the body component mainly involved in the pathogenesis. The
physiology of Kleda is mainly related with Mutra and Sweda along with Meda. Thus
when Kleda is involved then it directly affects the above factors. Kleda proper in quantity
is important to maintain the snigdhata in between the tissues. The literal meanings of
Kleda are – wetness, moisture, dampness etc. In the commentary regarding Sharira Kleda
in Charaka samhita mentioned that Kleda gives Shaithilya to Sharira. Normal function of
Mutra and Sweda has been described by Vagbhata as, under normal physiological
conditions Mutra and Sweda maintain balance of Kleda in the body. Especially Sweda
holds it in the body and Mutra excrete it outside the body. According to the body
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 109
condition and requirement, if this Kleda is get vitiated it directly affects the physiology of
Mutra and Sweda and disrupts the assemblage of bodily elements causing Shaithilya
Arundatta has mentioned that absence of Kleda may lead to the dryness of the body. In
the Samprapti, Kleda Dushti is in the form of ‘Vriddhi’ and not the Kshaya. Hence, Bahu
Kleda will manifest as Prabhoota Mootrata and Avila Mootrata because extensively
increased Kleda is excreated out of the body as Mutra. The other manifestations of Kleda
Dushti may be Shithilangata, Ati Sweda Pravritti, Visra Sharira Gandha (due to excessive
sweating), Sharira Mruduta, Snigdhata etc.
This dooshya is separately mentioned by Vagbhata. Sweda is mainly related with
Meda and Kleda. Due to the vitiation of Meda and Kleda, Swedavaha Srotodushti occurs
leading to the manifestation of Ati Swedapravritti, Daurgandhya, Picchilagatrata,
Snigdhagatrata Visra- sharirgandha etc. Sushruta mentioned that in Madhumeha
(Prameha) Sweda becomes Sweet in nature.
Charaka described Vasameha as a subtype of Vataja Prameha. “Vasa” is an
Upadhatu of Mamsa and the sneha in the Mamsa Dhatu is called Vasa. Thus we can
easily understand that in Prameha, Mamsa is one of the Main Dushya so in turns Vasa too
get vitiate. The provoked Vata draws Vasa towards Basti and excretes it through the urine
in the form of Sneha. In case of Madhumeha, the Dushti is illustrated in the form of
Bahutva as well as Abadhdhatva. But still the manifestations are not described
concerning Vasa Dushti. Lasika is a kind of fluid found beneath the skin between it and
Mamsa Dhatu. Lasika also gets vitiated by Vata resulting Lasika meha. There is no direct
reference related to Vasa and Lasika Dushti.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 110
Agni:
There is no direct reference related to the Agni condition but both Agnimandya
and tikshna Agni conditions present in the pathogenesis. In ayurveda agni has been given
more importance in the disease process of Madhumeha. Due to this, doshas and
dooshyas will be in aparipakwavastha. It indicates metabolic impairment in Madhumeha.
As all the metabolic activities are maintained by Agni and its Mandata leads many
disorders and Prameha is one of them in which Dhatvagnimandya is a major etiological
component. Dhatvagnimandya leads to Dhatu Vŗddhi and Dhatvagni Tikşņata causes
Dhatukşaya 187. In the Samanya Samprapti, Agnimandya develops due to nidana sevana
leads to Bahudrava Kapha and Bahuabaddha Meda as well as excessive quantity of
Mamsa and Kleda. But in case of Avaraņajanya Madhumeha due to Kaphakara Nidana,
Dhatvagnimandya develops and due to this Agnimandya excessive Dhatu can not be
assimilated properly leading to more vitiation of Dhatu. Such vitiated Dhatu obstructs the
gati of Vata leading to its provocation. But due to this provocation of Vata, Jaţharagni
gets stimulated demanding more food. Therefore, in Madhumeha the Duşya Duşţi mostly
occurs in the form of Vŗuddhi and not in the form of Kşhaya reflecting
Dhatvagnimandya. Kşhaya Lakşaņa of Majja and Śukra Dhatu may be seen as due to
Medodhatvagnimandya there is less nourishment to further Dhatus. So the role of
Dhatvagni in the Samprapti of Madhumeha is important. One may observe the difference
between two types of Agnimandya. In Samanya Samprapti one may get symptoms like
Kşudhamandya due to Jatharagnimandya, but in Avruta Vata Samprapti, Kşudhadhikya
will be prominent. Again without Ama it is impossible to precipitate the pathogenesis of
Madhumeha thus Susruta narrated that.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 111
Purvaroopa:
All Acharyas have accepted nearly same about the Purvarupa. Ghanagatrata,
Karpadadaha, Mukha-Talu-Kantha Shosha, Pipasa, Alasya, Visra Shariragandha etc.
Pipasadhikya, Kshudhadhikya, Alasyata, Tandra, Nidradhikya are the main poorvarupas.
Mukha-Talu-Kantha-Shosha & Pipasa is due to Rukshaguna of vata & also due to loss of
sheetata & snigdata caused by Udakakshya. Tandra & Nidra is due to Rasa & Oja.
Snigdha, Pichhila & Gurugatrata is due to kapha by corresponding qualities of Snigdha,
Pichhila & Guru. Karapada daha is due to pittadosha. It may be also due to loss of Ambu
which is sheeta in property and required for preenanam, failing to which results in Daha.
Karapada suptata is due to kapha. Asya madhurya is due to kapha prakopa by madhurata.
Kesheshu Jatilibhava & keshnakhativriddhi is due to involvement of meda, the precursor
dhatu of Asthi & Majja, which is second to meda. Increased Jatharagni is also responsible
for these symptoms. Shatpada pipilika mutrabhisaranam is due to presence of Madhurata
in the mootra. Kaye malam & Dantadidanam Maladhyatvam is because of their excessive
productions in defective metabolism (Dhatwagni & Bhutagni).
Roopa:
Prabhoota means increased in quantity, when dushyas are affected by kapha dosha
their kleda and fluidity increase. Excretion of kleda is the function of mootra and increase
in the quantity of kleda in turn causes increase in kleda amount of urine. Avila mootrata
is turbid, All shithla dushyas, come into basti, are excreted along with kleda via mootra.
A majority of the lakshanas explained in Madhumeha are explained in the modern
counterpart too. An attempt to correlate the same is made in here below.
Prabhoothaavila mootrata is considered as a prathyatma lakshana of Prameha.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 112
Bahudrava kapha along with other kledapradhana dooshyas in the basthi is the cause for
prabhootha mootrata. The same reason has been given in modern science for polyuria that
the osmotic diuretic affects of glucose in the kidney tubules.
Madhusama mootra, madhura mootra is because of ojadhatu kshrana through
mootra 188. These symptoms indicate the glycosuria. Whenever the quantity of glucose
entering the kidney tubules in the glomerular filtrate, rises above approximately 225
mg/min a significant proportion of the glucose begins to spill in to the urine and produces
glycosuria.
Bahu kankshata has been mentioned as a lakshana in apathyanimittaja
Madhumeha. Path of vata is obstructed by vitiated kapha and medas. As a result vata get
vitiated and produces theekshnagni. So patients develop bahukankshatha towards food.
The same is mentioned in modern science in terms of polyphagia.
In ayurveda pipasa is not mentioned as a lakshana but included under poorva
roopa. As it is already explained that most of the poorva roopas mentioned in ayurveda
are the roopas of Madhumeha. Polydipsia is mentioned as one of the symptom related to
hyperglycemia. This condition produces because of polyuria. So pipasa can be said as a
symptom which is similar to polydipsia.
Sushrutha has mentioned different conditions for delayed healing 189. Out of
which Madhumeha is one among them and commentator says ''dustadushyas'' are
responsible for them. Even in modern science delayed healing of wounds has been
mentioned as a symptom and the reasoning they give is the deficient formation of
granulation tissue. The failure of glucose utilization, loss of electrolyte and loss of body
protein causes weakness. Even in our classics it is mentioned that aparipakwa dhatus will
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 113
not nourish the body properly and hence causes weakness or klama. The nature and
extent of klama is explained by Acharya Sushrutha mentioned.
II) Discussion on demographic data
1) Age
Here in study, out of 25 patients Madhumeha exhibits 36% patients were from the
age of 46-55 and 32% patients were from the age group of 56-65 years. It reveals that the
individuals are more affected by type 2 DM after 4 decade. The reason for this may be
that the environmental factors like stress, food habit, life style etc. are common in this age
group. These environmental factors act as predisposing factor in the manifestation of DM
Although 32% patients were from group of 36-45, but in this 1(4%) patient having 36yr
other 28% were from age of 40 years.
2) Gender
In this study, 56% patients were males, 44% patients were females so females
are also having equal risk of getting Diabetes Mellitus, less incidence of female patients
in this study may be because of demographic facts or due to small sample.
Susruta had said that women would not get Madhumeha; because their body gets
cleaned every month by the raja pravrutti. But it is seems as a controversial dialogue as
women also getting Madhumeha and they are also at high risk of getting diabetes
compared to men after 30years.
3) Religion
The maximum patients of 96% were Hindus; this is because of Hindu dominated
area of the study.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 114
4) Economic status
Here in the study higher middle class as people are found more. So DM is called
as Richmans disease. Our study also supports this statement as we got more number of
patients belonging to higher class i, e 52%.
5) Occupation
Occupation plays major role in the manifestation of Madhumeha. The level
physical activity the patient has in daily routine play important roles in onset of Diabetes
Mellitus. The recent dramatic increase indicates that lifestyle factors (sedentary lifestyle)
may be particularly important in triggering the genetic elements that cause this type of
diabetes. Some recent studies show that people with sedentary life style are more likely to
have Diabetes mellitus as compared to those who lead an active life. In present study
maximum patients having sedentary type of occupation I.e. 56%.
6) Diet
Maximum number of patients I.e. 76% of this series were vegetarians, where as
24% patient had mixed diet. This may be due to the traditional vegetarian’s dietary habits
among the Hindus who formed the larger part of this study.
7) Family history
In the present study, 80% patients had family history. It suggests that type Ii
Diabetes Mellitus has a strong genetic component.
Discussion on disease data.
Nidana:
The nidana mentioned in the classics were elicited in this study by detailed
quationing. Among nidana , it was observed that Navanna and gudavaikrutha, snigdha
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 115
ahara formed major portion of food I.e. 100%. About 76% of them were taking curds
regularly. Among vihara, avyayama and diwaswapna were found in 56% patients.
Asanaswapna found in 52% of patient. These suggest that data is concordant with the
etiological factors described by classics for the disease Madhumeha. Obesity is major
cause for DM, as it is main cause for insulin resistance. But in present study 20% patients
were slightly overweight for their age & height. The rest had normal weight but reduction
in weight up to ½ to 1 kg was seen in them. It is however interesting that majority of
patients not obese. Among manasika chinta were found 32% of patients. It suggests that
any degree of the stress is related to the NIDDM. The sympathetic nervous activity is
stimulated by the stress and causes the hyper glycemia. If the stress persist for prolong
period it imbalances the homeostasis of the hormones
Purva roopa:
In the present study, alasya was found in 84% patients and Mukha-Talu-Kantha
Shosha was found in 32% patients, Mutramadhurya was found in 100% patients. Here
one thing is important that Madhavanidana mentioned that Padadaha and padasuptata as
Vatananatmaja Vyadhis in which Pitta, Rakta and Kapha obstructs the Patha of Vata
respectively 190. Here also in Avaranjanya Madhumeha these factors are dominant one so
above symptoms manifests in this disease.
Rupa:
Chief complaints
Among chief complaints 100% patients were having Prabhootmootrata both in
terms of quantity as well as frequency. Among these improvement was observed in
19(76%). In Phalatrikadi Vati, 68% relief was observed in Prabhuta Mutrata at
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 116
statistically highly significant level (P<0.001). Avila mootrata was found in 80% of
patients for that Vagbhata emphasized that this turbitidy of the urine because of its
annexation with the dhatu. Phalatrikadi Vati provided 56% relief in Avila Mutrata which
was statistically significant (P<0.05). Kshudhadhikya was observed in 96% patient. It
provided 76% relief in Kshudha Adhika which was statistically highly significant level
(P<0.001). Pipasa was observed 92% patient. Prabhootmootrata causes excessive loss of
fluids from body, leading to pipasa and dourbalya. Dourbalya was observed 80% patient.
It showed 84% reduction which was statistically highly significant (P<0.001). It showed
60% reduction in Daurbalya which was statistically highly significant (P<0.001).
KaraPadadaha was observed in 60% patients. It provided 48% relief which was
statistically highly significant (P<0.001). Atisweda was seen in 68% patient. The
Atisweda was reduced by 72% in Phalatrikadi Vati and it was statistically significant
(P<0.01)
Here the data is relevant to the classics. Also satisfying the modern diagnostic
criteria i.e. polyuria, polydipsia, polyphagia,but clinically various patients came with only
one or no symptoms so only blood sugar criteria is decisive for diagnosis.
Associated Signs and Symptoms:
Alasya was found in 76 %patients followed by Mukha-Talu-Kantha-Shosha
(88%). and gurugatrata (32%). Klama was found in 64% patients. The data implies that
Kapha & Medodushti account for presence of Alasya, Gurugatrata. While pitta Dusti
accounts for Mukha-Talu-Kantha-Shosha. These findings point towards the involvement
of all the three Doshas in the progression and manifestation of Madhumeha with the
dominancy of Kapha and Vata Dosha.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 117
Srotodushti
In this study, the Mutravaha Srotasa and Medovaha Srotasa were found afflicted
in all the patients. Other remarkable afflicted Srotasa were Udakavaha Srotodushti.
Involvement of Medovaha and Mutravaha Srotasa in all the patients may be due to the
Anukulatva between Nidana, Dosha and Dushya. All these observations reconfirm the
pathogenesis of Madhumeha mentioned in Ayurvedic classics.
Objective parameters:
There was reduction in FBS and PPBS 32%. It was found that in borderline cases,
the sugar levels came to normal, but in cases with levels near the upper limit of the range,
it did not return to the normal limits. This may give a hint about a probable requirement
of an extension in the duration of treatment. The mild increase in the urine sugar levels
came back to normal but in cases where there was higher range of increased urine sugar
levels, it did not come to normal limit. There was only a moderate reduction hinting at a
longer period of treatment. It was observed that the symptoms that were mild returned
back to normal after 30 days of treatment but those that were moderate came down to
mild. The Phalatrikadi Vati provided 32% relief in Fasting Blood Sugar & 32% relief in
PPBS at statistically significant level (P<0.01).
Probable Mode of Action:
Most of these drugs are having tikta, kashayarasa, laghu, rooksha guna and
katuvipaka. These are said to be kaphagna, mehagna, medogna and
mootrasangrahaneeya.
Tikta, kashayarasa, laghu, rooksha guna produces rookshana effect and they are
having opposite qualities to that of kapha and medas. Hence they act as mehagna and
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Discussion 118
kaphagna. So, this drug may have been effective on kapha and pitta and also on vata.
This tridoshashamaka property of this drug helped to correct the dhatudushti and
srotodushti leading to their normal functioning.
Bahudravata will be present in Madhumeha. These tikta rasa and kashaya rasa
drugs posses the kaphahara, Meda, Kleda Upashoshana properties191. Bahudravata will
be reduced by the absorption of excessive fluid from the body. When bahudravata
reaching basthi reduces then prabhoothamootrata pratyatmalakshana of Prameha also
reduces. Pipasa which is dependent on prabhoothamootrata also subsides. Musta by its
trishnanigrahana property, alleviates pipasadhikya in Madhumeha. Further Madhumeha is
a metabolic disease, dhatvagnimandhyjanita vyadhi. This metabolic disease demands
medadhatvagnivriddhi. When any agni is not proper, dhatus are not produced properly.
Phalatrikadi Vati having deepana & pachana drugs and katu rasa,ushna virya encounters
dhatvagnimandya & potentiates the dhatvagnimandhya and help in ama-pachana thereby
alleviates aparipakwa and ama. That in turn helps to form the dhatus in proper proportion
with samyak qualities. Their by it ensues sarvadhatuposhana thereby pacifies Daurbalya.
Phalatrikadi Vati produce malashodana (indravaruni, triphala) their by it eliminates the
metabolic wastes, vitiated pitta dosha along with kapha dosha & thus removes avarana of
vata there by normalizing the digestive power which helps to control the symptom. This
may account for better relief in Kshudha Adhika. Clinical & experimental studies depicts
that Amalaki, Haridra, Triphala reduces blood glucose significantly. Pramehahara
property of the ingredients of trial drug helps in alleviating the hyperglycemia.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Conclusion 119
CONCLUSION
Ayurveda in fact is the first medical science, which identified, diagnosed &
manged Madhumeha.
Madhumeha is mentioned as one of the 20 types of Prameha. Madhumeha has
been classified under the Vatika type of Prameha.
The terms Prameha and Madhumeha are synonymous. They indicate the same
condition where in the former refers to Prabhoota and Avila mootrata (ill
understood) & the latter refers to Tanu & Mootra madhuryata.
Kapha is the arambaka dosha & vata is the preraka.
Margavarana Janya Madhumeha & dhatukshaya Janya madhumeha are the two
forms of manifestation of the disease. The apatyanimittaja madhumeha & sahaja
madhumeha are the two-independent forms of presentations, coming under the
above classification respectively.
Madhumeha is a disease characterized by Prabhoota avila mootrata, Tanu
madhuryata & Mootra madhuryata
Diabetes Mellitus is correlated with Madhumeha especially Non insulin
Dependent Diabetes Mellitus which have the similar pathogenesis and
manifestion.
Madhumeha (Type II Diabetes mellitus) mostly affects the individuals after the
age of forty years.
Sex, martial status, religion bear no relation with Diabetes mellitus.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Conclusion 120
Changing life styles e.g.; sedentary life, increased stress, strain may contribute in
the establishment of the disease. Tendency towards sedentary life style and faulty
dietary habits, leads to vitiation of Kapha and Meda leading to Madhumeha.
The present study suggests that Type II DM has got a strong genetic component.
It also reveals the chronic nature of the disease.
The obesity is a risk factor associated with Type II DM. But majority of the pts
were not Overweight or obese here.
The study confirms the dominancy of Kapha Dosha, Meda Dhatu Dusti and
Medovaha Srotodushti in the pathogenesis of Madhumeha.
The line of treatment is based upon Tiktakasaya Rasa, Usna Virya Kaphavatahara
and Pramehaghna properties of the drugs for oral medication.
While majority of the patients having Prabhutamootrata (polyuria), Avila
Mootrata, Mutramadhurya, Pipasa and Kshudhadhikya.
The parameters both subjective and objective showed high significance rate
stastically.
Along with treatment patient is supposed to adopt the pathya-Apathya as
explainen in classics. This is nothing but essential tool in the management of
Madhumeha.
The result of the Phalatrikadi Vati declared is representing the efficiency of the
drug with its embedded qualities, is 2(8%) Regulated, 5 (20%) palliative and
11(54%) patients responded in the trial.
This is strong evidence to state that the phalatrikadi Vati is hypoglycemic agent
combination of Ayurveda
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Summary 121
Summary
Diabetes is a disease known from the dawn of civilization. Sedentary life style,
Lack of exercise, Faulty food habits and improper medication and Urbanization
precipitates the disease. On the basis of its symptomatology Madhumeha can be
correlated to the features of Diabetes mellitus.
Madhumeha is mentioned as one of the 20 types of Prameha, classified under the
Vatika type of Prameha. The Vata may be provoked either directly by its
etiological factors, Avarana by Kapha and Pitta to its path or by continuous
depletion of Dhatus.
In the pathogenesis of Madhumeha, Kapha & vata dosha, Meda & mamsa, kleda,
oja dushyas, mootavaha srotus and medovaha srotus are mainly involved.
Prabhoota mootrata and Avila mootrata are main cardinal symptoms of
Madhumeha.
The factors which provoke the Vata directly cause Apatarpanajanya Madhumeha
and are equivalent to Type I Diabetes mellitus. While the factors which provoke
Kapha and Pitta cause Santarpanajanya Madhumeha equivalent to Type II
Diabetes mellitus.
Generally the management, rather than treatment, is the appropriate term in
Diabetes mellitus, and involves diet, exercise, insulin, oral hypoglycemic, patient
education and counseling.
The prevention and control of the Madhumeha made by regularizing the blood
glucose level with the help of shamanaoushadi. The Phalatrikadi Vati is
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Summary 122
compound formulation comprises of 7 drugs explained by acharyas in
Madhumeha as a shamanoushadi.
The present study intended to focus on the disease evaluation i.e. Madhumeha vis-
à-vis. Diabetes Mellitus management with Phalatrikadi Vati as a Shamana
Chikitsa. Phalatrikadi Vati ingredients are hypoglycemic agents collected form
local area and prepared under GMP conditions, weighing about 500mg tablet
form. Present trial is a Simple Random sampling technique clinical study was
conducted for 30 days.
Patients of Madhumeha fulfilling the criteria of diagnosis were selected in the
present study. Patients were selected on preset inclusion and exclusion criteria.
30 patients of Madhumeha were registered in this study out of which total 25
patients completed treatment. 5 patients not fulfilled the inclusion criteria.
All the patients have complained of prabhoota mootrata, folled by 80% of patients
having avilamotrata, 96% and 62% of patients having kshudhadhikya & pipasa
respectively.
The results in this trail, out of 25 of patients, 2 (8%) regulated, 5(20%) patients
are palliative, 16(64%) patients are responded to treatment, 2(8%) not responded.
Thus phalatrikadi Vati having hypoglycemic effect.
Among the subjective parameters pipasa, kshudhadhikya, dourbalya shows more
highly significant than other parameter. Among objective parameter prabhoota
mootrata shows highly significant with 89.65% of mean improvement. FBS
shows highly significant with 20.31% of mean improvement.
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86) Kasinatha Sastri ed, Caraka samhita Sutrastana, 21/4 Reprint 2001; Chaukhambha Bharati
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87) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Sutra 15/14, Reprint ed, 2006,
Choukhambha Sanskrit sansthan, Varanasi, pp 252
88) Ibid, Nidana, 1/20, pp230
89) Kasinatha Sastri ed, Caraka samhita chikitsa 6/9,Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp 230.
90) Kasinatha Sastri ed, Caraka samhita chikitsa 6/11Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp 233.
91) Kasinatha Sastri ed, Caraka samhita Nidana 4/7 Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp 632
92) Vaidya Yadavaji Trikamji Acharya ed, Caraka samhita Commentary Cakrapanidatta Nidana
4/7 Reprint 2001; Chaukhambha Bharati Academy Varanas,i pp 213.
93) Kasinatha Sastri ed, Caraka samhita Nidana 4/37, Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp 638.
94) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Sutrastana 15/29,
Reprint ed, 2006, Choukhambha Sanskrit sansthan, Varanasi, pp 61.
95) Dr Brahmanand tripathi ed, Astanga Hridaya, Sutra 11/5 Reprint ed. 2007 Chaukhambha
Sanskrit pratishthan, Delhi pp-161
96) Harishastri oaradkar Vaidya ed, Astanga Hridaya Commentary Aunadatta & Hemadri ,
Sutra 11/5 Reprint ed. 2007 Krishnadas Academy, Varanasi, pp-183
97) Dr Brahmanand tripathi ed, Astanga Hridaya, Nidana 10/4, Reprint ed. 2007 Chaukhambha
Sanskrit pratishthan, Delhi pp-494.
98) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 12/49,
Reprint ed, 2006, Choukhambha Sanskrit sansthan, Varanasi, pp 62.
99) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 6/4, Reprint ed, 2006,
Choukhambha Sanskrit sansthan, Varanasi, pp 252
100) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/7 Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp 228
101) Dr Brahmanand tripathi ed, Astanga Hridaya, Nidana 10/7 Reprint ed. 2007 Chaukhambha
Sanskrit pratishthan, Delhi pp-495
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) - Bibliographic References 6
102) Kasinatha Sastri ed, Caraka samhita Nidana 4/9 Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp 633
103) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/15 Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp 235
104) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 11/3, Reprint ed,
2006, Choukhambha Sanskrit sansthan, Varanasi, pp 59
105) Ibid
106) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/57 Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp 244
107) Kasinatha Sastri ed, Caraka samhita Sutrastana, 17/78-81, Reprint 2001; Chaukhambha
Bharati Academy Varanasi pp355
108) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 11/25-26, Reprint ed,
2006, Choukhambha Sanskrit sansthan, Varanasi, pp 255
109) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 11/6 , Reprint ed, 2006,
Choukhambha Sanskrit sansthan, Varanasi, pp 252
110) Vaidya Yadavaji Trikamji Acharya, Sushruta sutra Commentary
Gayadasacharya,Nidanastana 6/6, Reprint 1980,4th ed, Chaukhambha orientalia,
Varanasi,pp290.
111) Bhisagratna Shri Brahmashanka Mishra ed, Bhava Prakasha Madhyama Khanda, 38/1-
129, 1st ed. Reprint, 2002, Chaukhambha Sanskrit Samsthan, Varanasi, pp-386 – 390
112) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, chikitsa 11/3 , Reprint ed, 2006,
Choukhambha Sanskrit sansthan, Varanasi, pp 59
113) Ibid
114) Yadunandan Upadhyaya ed. Madhava Nidanam, Part-2, 33/26, 9th ed, 2004, Chaukhambha
Sanskrit Sansthan, Varanasi, pp-22.
115) ) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Sutra 23/7 , Reprint ed, 2006,
Choukhambha Sanskrit sansthan, Varanasi, pp 98.
116) ) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 6/28 , Reprint ed,
2006, Choukhambha Sanskrit sansthan, Varanasi, pp 255.
117) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 6/15, Reprint ed, 2006,
Choukhambha Sanskrit sansthan, Varanasi, pp 254
118) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 6/15, Reprint ed, 2006,
Choukhambha Sanskrit sansthan, Varanasi, pp 254
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) - Bibliographic References 7
119) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 6/15, Reprint ed, 2006,
Choukhambha Sanskrit sansthan, Varanasi, pp 254.
120) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 6/16, Reprint ed, 2006,
Choukhambha Sanskrit sansthan, Varanasi, pp 254.
121) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 6/16, Reprint ed, 2006,
Choukhambha Sanskrit sansthan, Varanasi, pp 254.
122) Kasinatha Sastri ed, Caraka samhita Sutrastana, 20/13, Reprint 2001; Chaukhambha
Bharati Academy Varanasi pp204.
123) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/ 7 Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp 228.
124) Vaidya Yadavaji Trikamji Acharya ed, Caraka samhita Commentary Cakrapanidatta
Nidana 4/7 Reprint 2001; Chaukhambha Bharati Academy Varanasi pp 213.
125) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/ 7 Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp228.
126) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/ 7 Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp228.
127) Kasinatha Sastri ed, Caraka samhita Sutrastana, 17/80 Reprint 2001; Chaukhambha
Bharati Academy Varanasi pp352
128) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/57,Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp244.
129) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/55 Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp243.
130) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/15 Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp235.
131) Dr Brahmanand tripathi ed, Astanga Hridaya, Chikitsa 12/3 Reprint ed. 2007
Chaukhambha Sanskrit pratishthan, Delhi pp-715
132) Harishastri oaradkar Vaidya ed, Astanga Hridaya Commentary Aunadatta & Hemadri ,
Chikitsa 12/1 – 3, Reprint ed. 2007 Krishnadas Academy, Varanasi, pp-678
133) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/25 Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp237
134) Dr Brahmanand tripathi ed, Astanga Hridaya, Chikitsa 12/2 Reprint ed. 2007
Chaukhambha Sanskrit pratishthan, Delhi pp-715.
135) Harishastri oaradkar Vaidya ed, Astanga Hridaya Commentary Aunadatta & Hemadri ,
Chikitsa 12/1 – 3, Reprint ed. 2007 Krishnadas Academy, Varanasi, pp-678
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) - Bibliographic References 8
136) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/27-29 Reprint 2001; Chaukhambha
Bharati Academy Varanasi pp238.
137) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 11/8, Reprint ed, 2006,
Choukhambha Sanskrit sansthan, Varanasi, pp 60.
138 ) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 11/9, Reprint ed,
2006, Choukhambha Sanskrit sansthan, Varanasi, pp 61.
139) Dr Brahmanand tripathi ed, Astanga Hridaya, Chikitsa 12/7 Reprint ed. 2007
Chaukhambha Sanskrit pratishthan, Delhi pp-715.
140) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/51 Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp294.
141) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/50 Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp293.
142) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/25 Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp288.
143) Dr Brahmanand tripathi ed, Astanga Hridaya, Chikitsa 12/3 Reprint ed. 2007
Chaukhambha Sanskrit pratishthan, Delhi pp-715
144) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 12/6, Reprint ed, 2006,
Choukhambha Sanskrit sansthan, Varanasi, pp 63
145) ) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/30-32 Reprint 2001; Chaukhambha
Bharati Academy Varanasi pp238
146) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 11/9, Reprint ed, 2006,
Choukhambha Sanskrit sansthan, Varanasi, pp 60
147) Dr Brahmanand tripathi ed, Astanga Hridaya, Chikitsa 12/7-8, Reprint ed. 2007
Chaukhambha Sanskrit pratishthan, Delhi pp-715
148) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/52,Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp246.
149) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Nidana 6/30, Reprint ed, 2006,
Choukhambha Sanskrit sansthan, Varanasi, pp 255.
150) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/16,Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp235.
151)Kasinatha Sastri ed, Caraka samhita Chikitsa 6/17,Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp235.
152) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/34, Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp238.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) - Bibliographic References 9
153) ) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 13/10-11, Reprint
ed, 2006, Choukhambha Sanskrit sansthan, Varanasi, pp 65.
154) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/20, Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp236.
155) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/46, Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp241.
156) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/19, Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp236.
57) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/50, Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp242.
158) ) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Chikitsa 11/12, Reprint ed,
2006, Choukhambha Sanskrit sansthan, Varanasi, pp 62.
159) http: // Encyclopedia.thefreedictory.com
160) Siddharth N Shah ed, API Textbook of Medicine, 7th edition, 2003, Association of Physician
of India, Mumbai, pp 1096.
162) Harsha Mohan ed, Text book of Pathology, 5th ed 2005, Jaypee Brothers Medical
publishers New Delhi, pp 846
163) Robins ed, Basic pathology, 7th ed 2003, pp 645
164) P. C. Das, Text Book Of Medicine, 4th ed, 2000, Current books international, Calcutta, pp
522.
165) AS Fauci, Harrison principles of internal medicine, Vol-2, 15th ed. 2001 Mcgraw Hill co,
New York USA, pp 2112
166) P. C. Das, Text Book of Medicine, 4th ed, 2000, Current books international, Calcutta, pp
525.
167) P. C. Das, Text Book of Medicine, 4th ed, 2000, Current books international, Calcutta, pp
527.
168) Siddharth N Shah ed, API Textbook of Medicine, 7th edition, 2003, Association of Physician
of India, Mumbai, pp 1108-1009.
169) AS Fauci, Harrison principles of internal medicine, Vol-2, 15th ed. 2001 Mcgraw Hill co,
New York USA, pp 2064.
170) Kasinatha Sastri ed, Caraka samhita Chikitsa 6/40, Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp240.
171) P. V. Sharma, Dravyaguna Vijana, Vol-II, 16th ed, 1995, Chaukhambha Bharati Academy,
Varanasi, pp 753
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) - Bibliographic References 10
172) Ibid pp239
173) Ibid pp 758
174) Ibid pp 370
175) Ibid pp 162
176) Ibid pp 537
177) Ibid pp 436
178) Dr Brahmanand tripathi ed, Astanga Hridaya, Sutra 10/9 Reprint ed. 2007 Chaukhambha
Sanskrit pratishthan, Delhi pp-153.
179) Derek. Leroith, Simeon. I. Taylor, Jerrold. M. Olefsky Ed, Diabetes Mellitus – A
Fundamental and Clinical text, 3rd Ed, 2004, Lippincott Williams & Wilkins, pp 840.
180) Kasinatha Sastri ed, Caraka samhita Nidana 4/51, Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp 640.
181) Kasinatha Sastri ed, Caraka samhita Nidana 4, Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp 630.
182) ) Dr Brahmanand tripathi ed, Astanga Hridaya, Sutra 11/8 Reprint ed. 2007 Chaukhambha
Sanskrit pratishthan, Delhi pp-162.
183) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Sutra 15/37, Reprint ed, 2006,
Choukhambha Sanskrit sansthan, Varanasi, pp 62.
184) Kasinatha Sastri ed, Caraka samhita, Sutra 30/11,, Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp 582.
185) ) Vaidya Yadavaji Trikamji Acharya ed, Caraka samhita Commentary Cakrapanidatta,
Sutrastana 30/7, Reprint 2001; Chaukhambha Bharati Academy Varanasi pp 185.
186) Ibid.
187) Dr Brahmanand tripathi ed, Astanga Hridaya, Sutra 11/34 Reprint ed. 2007 Chaukhambha
Sanskrit pratishthan, Delhi pp-166.
188) Kasinatha Sastri ed, Caraka samhita, Nidana 4/37, Reprint 2001; Chaukhambha Bharati
Academy Varanasi pp 638.
189) Kaviraja Ambhikadutta shastri ed, Susruta Samhita, vol -1, Sutra 23/7, Reprint ed, 2006,
Choukhambha Sanskrit sansthan, Varanasi, pp 97.
190) Yadunandan Upadhyaya ed. Madhava Nidanam, Part-1, 22, 9th ed, 2004, Chaukhambha
Sanskrit Sansthan, Varanasi, pp
191) Dr Brahmanand tripathi ed, Astanga Hridaya, Sutra 10/20, Reprint ed. 2007 Chaukhambha
Sanskrit pratishthan, Delhi pp-154.
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) - Bibliographic References 11
Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts i
Demographic Data of Phalatrikadi Vati SNo OPD
No Gende
r Religion Occupation Economical
Condition Result
M F Age
Food
V
/Mx
H M C O S A L P M Hg
Hc
1 4905 + 40 Mx + + + Responded 2 5430 + 51 V + + + Palliative 3 5293 + 36 V + + + Responded 4 5029 + 68 V + + + Responded 5 5882 + 42 V + + + Not
Responded 6 5708 + 49 V + + + Responded 7 5935 + 59 V + + + Responded 8 6043 + 54 V + + + Responded 9 6205 + 55 V + + + Responded 10 6347 + 64 Mx + + + Not
Responded 11 6220 + 54 Mx + + + Palliative 12 6350 + 40 Mx + + + Responded 13 6416 + 59 Mx + + + Responded 14 1108 + 52 V + + + Palliative 15 1109 + 52 V + + + Responded 16 1196 + 43 V + + + Responded 17 298 + 49 V + + + Responded 18 1209 + 58 V + + + Responded 19 827 + 53 Mx + + + Responded 20 4939 + 52 Mx + + + Responded 21 1210 + 62 V + + + Responded 22 1363 + 42 V + + + Palliative 23 894 + 44 V + + + Regulated 24 558 + 57 V + + + Responded 25 1961 + 62 V + + + Regulated Total 1
3 12
24
1 0 0 14 10 1 3 9 13
Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts ii
Subjective Statistical Assessment Data of Phalatrikadi Vati
S.No OPD Avilamotrata Karapada
daha Kshudhadhikyata Pipasa Atisweda Dourbalya
B A B A B A B A B A B A 1 4905 2 0 0 0 2 0 2 0 2 0 2 0 2 5430 1 0 0 0 2 1 2 0 0 0 0 0 3 5293 2 0 0 0 3 0 2 0 1 0 3 0 4 5029 3 0 1 0 3 1 3 0 1 0 3 1 5 5882 1 0 0 0 2 0 2 0 1 0 2 0 6 5708 1 0 0 0 2 0 2 0 2 0 3 0 7 5935 1 0 2 0 2 0 3 1 1 0 3 1 8 6043 2 1 2 0 2 0 3 0 3 0 3 0 9 6205 3 1 1 0 3 0 2 0 1 0 3 1 10 6347 1 0 1 0 2 0 2 1 1 0 2 0 11 6220 3 0 1 0 2 0 2 0 2 0 3 0 12 6350 3 1 1 0 3 0 3 0 2 0 3 0 13 6416 2 0 1 0 2 0 3 0 1 0 3 1 14 1108 2 0 1 0 3 2 3 2 0 0 0 0 15 1109 1 1 2 1 2 1 2 0 1 1 2 0 16 1196 0 0 0 0 1 0 0 0 0 0 2 0 17 298 1 0 1 1 2 0 2 0 1 0 3 0 18 1209 1 0 1 1 2 0 2 0 1 1 2 0 19 827 1 2 1 1 2 1 2 1 2 1 3 1 20 4939 3 2 1 0 2 0 2 0 2 1 3 2 21 1210 1 0 1 0 2 0 2 0 2 0 0 0 22 1363 1 0 0 0 2 0 2 0 0 0 3 0 23 894 2 0 1 0 2 1 3 1 2 1 3 1 24 558 0 0 0 0 0 0 2 0 1 0 2 0 25 1961 1 0 1 0 2 0 2 0 2 0 2 0 Total 39 8 20 4 53 4 31 4 33 3 58 8 Mean 1.59 0.32 0.8 0.16 2.12 0.28 2.2 0.24 1.32 0.2 2.32 0.32
Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts iii
Objective Statistical Assessment of Phalatrikadi Vati
S.No OPD Prabhuta
mootrata FBS PPBS FUS PPUS
B A B A B A B A B A 1 4939 2 0 174.4 130 356.3 270 0.5 0 1.5 0.5 2 6043 2 0 129.6 125.2 310 260 0.5 0.5 1.5 1.5 3 5935 2 0 146.4 94.8 262.5 211.1 0 0 0 0 4 5708 3 1 215 160 326.5 251.1 1.5 1 2.0 1.5 5 4905 2 1 239.4 193.8 395.7 216 1.0 0 1.5 1.5 6 5430 3 0 121.5 110.0 187.3 159 0 0 0 0 7 5029 2 0 171.9 115.2 362 260 1.0 0 2 1.5 8 5882 2 0 151.2 144.3 248.1 275 0.5 0 1.5 1 9 5293 3 0 152.1 132 220.3 173.1 0.5 0 1.0 0.5 10 6205 2 0 175 125.3 317 240 1.0 0 1.5 0.5 11 6220 2 0 182 130 223.8 160.2 0 0 1.0 0 12 6350 3 0 120.7 105 267.5 195 0 0 1.0 0.5 13 6416 3 1 132.3 100 305.9 190 0.5 0 2.0 0 14 1196 3 0 155 120 205 160 0 0 0 0 15 298 3 1 148 125 225 198 0 0 1 0.5 16 1209 1 0 158 136 252.7 175.3 0.5 0 1 0.5 17 6347 2 0 180.3 156.8 268 286 1.5 0.5 1.5 1.5 18 558 2 0 135 76.4 192 134.9 0 0 0 0 19 827 2 1 240.5 195 351.6 255 1.5 0.5 2.0 1.5 20 894 3 0 92 80 190 140 0 0 0 0 21 1210 2 0 155.5 130 195.4 184 0.5 0 1.5 0.5 22 1363 2 0 112 80 227 157 0 0 0.5 0.5 23 1109 3 1 150 132 300 220 0.5 0 2.0 0.5 24 1108 2 0 150 115 185 153 0.5 0 1.0 0.5 25 1961 2 0 130 110 178 135 0 0 0.5 0 Total 58 6 3917.8 3121.8 6571.3 5058.7 11.5 2.5 27.5 14.0 Mean 2.32 0.24 156..71 124..87 265..85 201,.34 .44 0.08 1.1 .56
Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts iv
Chief & Associated complaints of Phalatrikadi Vati
Complaints 1 2 3 4 5 6 7 8 9 10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Total
1 Prabhoota Mootrata
+ + + + + + + + + + + + + + + + + + + + + + + + + 25
2 Avila Mootrata + + + + + + + + + + + + + + + + + + 18 3 Karapada Daha + + + + + + + + + + + + + + + 15 4 Kshudhadhikyata + + + + + + + + + + + + + + + + + + + + + + + + 24 5 Pipasa + + + + + + + + + + + + + + + + + + + + + + + 23 6 Atisweda + + + + + + + + + + + + + + + + + + + + 20 7 Dourbalya + + + + + + + + + + + + + + + + + + + + + 21 Associated
Complaints
1 Kara/Pada suptata + + + 3 2 Klama + + + + + + + + + + + + + + + + 16 3 Alasya + + + + + + + + + + + + + + 14 4 Tandra + + + + + + + + + + + + + + + + + + + 19 5 Gurugatrat a + + + + + + + + 8 6 Dantadimaladya + + 2 7 Shithilangata + + + + + 2 8 Mukha/Talu
shosha + + + + + + + + + + + + + + + + + + + + + 22
Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts v
Poorvaroopa of Madhumeha
Poorvaroopa 1 2 3 4 5 6 7 8 9 10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25 Total
1 Dantadeenam Malatvam
+ + + + + + 6
2 Pada daha + + + + 4 3 Pani daha + + + + 4 4 Deha chikkanata + + + + + + + + + 9 5 Shareera
durgandha + 1
6 Mutra madhurata + + + + + + + + + + + + + + + + + + + + + + + + + 25 7 Mutra shuklata 8 Mukha madhurta + 1 9 Talu jivhashosha + + + + + + + + 8 10 Kesh jatilata 11 Nakha vriddhi 12 Alasya + + + + + + + + + + + + + + + + + + + + + 21 13 Tandra + + + + + + + + + + + 11 14 Nidra + + + + + + 6 15 Trishna + + + + + + - + + + + + + + + + + + + + + + + + + 24 16 Maldhikyata in
bahya chidra
17 Swedadhikya + + + + + + + + + + + + + + + + + + + + + 21 18 Sheeta iccha + + 2 19 Swasa + + + 3 20 Shitalangata + + + + + + 6
Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts vi
Examination of srotas
Sroto Lakshana 1 2 3 4 5 6 7 8 9 10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25 T
Udakavaha 1 Jihwa shosha + + + + + + + + + + + + + + + + + + + + + + + 23 2 Talu shosha + + + + + + + + + + + + + + + + + + + + + + + 23 4 Kloma shosha + 1 5 Prawridha pipasa + + + + + + + + + + + + + + + + 17 Mootravaha 1 Alpalpa mootrata 2 Mootara rodha 3 Adhika mootra + + + + + + + + + + + + + + + + + + + + + + + + + 25 4 Sashoola mootra 5 Basti stabdhata Mamsavaha 1 Arbuda 2 Arsha 3 Mamsa shosha 4 Shira granthi Medovaha 1 Sweda + + + + + + + + + + + + 20 2 Snigdhanagata + + + + + + 6 3 Sthulashophata 4 Pipasa + + + + + + + + + + + + + + + + + + + + + + + 23
Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts i
History of present Illness S.No OPD Mode of detection Frequency of Micturition Family history 1 2 3 1 2 3 4 5 1 2 1 4905 + + 2 5430 + + + 3 5293 + + + 4 5029 + + + 5 5882 + + + 6 5708 + + + 7 5935 + + + 8 6043 + + + 9 6205 + + + 10 6347 + + + 11 6220 + + + 12 3650 + + + 13 6416 + + + 14 1108 + + + 15 1109 + + + 16 1196 + + + + 17 298 + + + 18 1209 + + + 19 827 + + + 20 4939 + + + 21 558 + + + 22 1210 + + + 23 1363 + + + 24 894 + + + 25 1961 + + + Total 7 16 2 00 5 11 9 2 19 6
Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts ii
Ahara Nidana S.No OPD Guda Navanna Dugdha Snigdha
Ahara Mamsa Dadhi Sheeta
Ahara 1 4905 + + + + + + + 2 5430 + + + + + + 3 5293 + + + + + + 4 5029 + + + + + + 5 5882 + + + + + + 6 5708 + + + + + 7 5935 + + + + + 8 6043 + + + + 9 6205 + + + + 10 6347 + + + + + + 11 6220 + + + + 12 3650 + + + + + 13 6416 + + + + + + 14 1108 + + + + + + 15 1109 + + + + + + 16 1196 + + + + + 17 298 + + + + 18 1209 + + + 19 827 + + + + + + + 20 4939 + + + + + + + 21 558 + + + + - + 22 1210 + + + + + 23 1363 + + + + + + 24 894 + + + + + 25 1961 + + + + Total 25 25 17 25 7 19 15
Phalatrikadi Vati in Madhumeha ( Diabetes Mellitus) – Master Charts iii
Vihara Nidana S.No OPD Avyaya
ma Diwasw
apna Swapnasukham
Manishika
Vegavarodha
Panchakarma
Vibhramsha
Sthoulya
Asannaswapna
1 4905 + + + + + 2 5430 + 3 5293 + + + + 4 5029 + + + 5 5882 + + + 6 5708 + + + 7 5935 + + + 8 6043 + 9 6205 + + + + + 10 6347 + + + + + + + 11 6220 + 12 3650 + + + 13 6416 14 1108 + + + + 15 1109 + + + + 16 1196 + + 17 298 18 1209 + 19 827 + + + 20 4939 + + + 21 558 + + + + + 22 1210 + + + + 23 1363 24 894 + + 25 1961 + + Total 14 14 13 8 2 0 5 13
SPECIAL CASE SHEET FOR “Evaluation of the efficacy of the Phaltrikadi Vati in Madhumeha” POST GRADUATE STUDIES AND RESEARCH CENTER (KAYACHIKITSA)
D.G.M.AYURVEDIC MEDICAL COLLEGE, GADAG
Guide:
Dr. K. Shiva Rama Prasad
Scholar:
Dr. Vijayalaxmi. B.Benakatti
1) Name of the Patient Sl.No
2) Sex Male Female OPD No
3) Age Years IPD No
4) Religion Hindu Muslim Christian Other
5) Occupation Sedentary Active Labor
6) Economical status Poor Middle Higher middle Higher class
7) Address
Pin
8) Birth data Place of Birth
AM
Date Month Year Time
Hours Minutes PM
9) Selection Included Excluded
10) Schedule dates Initiation completion
11) Result Regulated Palliative Responded Not responded
INFORMED CONSENT
I Son/Daughter/Wife of am
exercising my free will, to participate in above study as a subject. I have been informed to my satisfaction, by the attending
physician the purpose of the clinical evaluation and nature of the drug treatment. I am also aware of my right to opt out of the
treatment schedule, at any time during the course of the treatment. EzÀÄ £Á£ÀÄ ²æÃ/²æêÀÄw _________________________________________________ £À£Àß ¸ÀéEZÀÑ ¬ÄAzÀ PÉÆqÀĪÀ aQvÁì ¸ÀªÀÄäw. ¥Àæ¸ÀÄÛvÀ
£ÀqÉ¢gÀĪÀ aQvÁì ¥ÀzÀÞw0iÀÄ §UÉÎ £À£ÀUÉ aQvÀìPÀjAzÀ ¸ÀA¥ÀÇtð ªÀiÁ»w zÉÆgÉwzÀÄÝ ªÀÄvÀÄÛ 0iÀiÁªÁUÁzÀÄgÀÄ aQvÀì¬ÄAzÀ »AwgÀÄUÀ®Ä ¸ÁévÀAvÀæ÷å «zÉ JAzÀÄ
w½¢gÀÄvÀÛ£É.
gÉÆV0iÀÄ gÀÄdÄ / Patient's Signature
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Case Sheet 1
12) CHIEF COMPLAINTS WITH DURATION Sl no
Complaints Duration Remarks
1 Prabhutamootrata 2 Avilamootrata 3 Kara pada dhaha 4 Kshudadhikya 5 Pipasa 6 Atisweda 7 Dourbalya 13) ASSOCIATED COMPLAINTS Sl.No Associated complaints Duration Remarks 1 Kara pada suptata 2 Klama 3 Tandra 4 Alasya 5 Gurugatrata 6 Dantadi maladhyatwam 7 Shitilangata 8 Mukha shosa 9 Talu shosha 14) OCCUPATIONAL HISTORY (if any) 15) PERSONAL HISTORY Food habits Vegetarian Mixed diet
Taste preferred Sweet Sour Salty Pungent Bitter Astringent
Agni Sama Vishama Manda Teekshna
Kosta Mrudu Madhyama Krura
Nidra Day Night Sound Disturbed
Addictions Tobacco Alcohol Drugs
Bowel habits Normal Loose Constipated
Menstrual History Regular Irregular Amenorrhea Menopause
Other system medications Treatment history
Since how long
History of past illness
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Case Sheet 2
Family history - specify if any has the same disease 16) HISTORY OF PRESENT ILLNESS Mode of detection Accidental/Suspicious /At regular check Frequency of micturition 3-4 times/5-6times/7-8times/9-10 times/above 10 17) MADHUMEHA NIDANA Ahar Vihar Anya Nidanarthakara
vyadhi Madhura Guda vaikruta-Sugar items /M Avyayama Mansika chinta Sthoulya Jaggery items /M SugarcaneJuice Asanaswapna Vegadharana Navanna Diwaswapna Dugdha Swapnasukha Mamsa Chiken - / M Muton- /M Fish - /M
Panchakarma vibhramsha
Snigdha Dadhi Sheeta
Patient
Grandfather Grandmother Grandmother Grandfather
Father
Brother
Brother Mother Brother Sister
Sister
Sister
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Case Sheet 3
18) MADHUMEHA POORVAROOPA Dantadeenam malatvam Pada dhaha Shitilangata Mukha madharta Pani dhaha Maladhikyata in bahya chidra Trisna Kesh jatilata Swedadhikya Deha chikannata Alasya Sheeta iccha Shreera dugandhata Tandra Swasa Mutra madhurata Nidra Mutra shuklta Talu kloma shosha 19) EXAMINATION a) VITAL EXAMINATION Pulse /min Temp °F Respiration rate /min
Blood pressure
b) SYSTEMIC EXAMINATION Respiratory - Cardiovascular - Gastro-intestinal - Genito-urinary - c) EXAMINATION OF SROTAS Udakavaha Mootravaha Mamsavaha Medovaha Jihwa shosha
Alpalpa moortrata
Ardudha Sweda
Talu shosha Mootra rodha Arsha Snigdhanagata Kloma shosha
Adhikamootra Mamsa shosha Sthulashophata
Prawridha pipas
Sashoola mootra Shira granthi Pipasa
Basti stabdhata d) DASHVIDHA PARIKSHA
Prakruti V P K VP VK PK VPK
Sara Pravara Avara Madhyama Samhanana Susamhita Asamhita Madhyma samhita Pramana Height in
Cms Weight in Kgs
Satmya Ekarasa Sarvarasa Ruksha Sneha Satwa Pravara Avara Madhyama Ahara Shakti Abhyavaharana Jarana Vyayam Shakti Pravara Avara Madhyama Vaya Balya Yauvana Vardhakya
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Case Sheet 4
e) ASTA STHANA PARIKSHA
Nadi Dosha Pravrutti
Gati Varna
Purnata Gandha
Spandana Kathinya
Mutra
Jihwa Ardra Sushka Sama Nirama Lepa Nirlepa
Mala
Shabda Sparsha Sheeta Ushna Drik Akruti 20) UPASHAYA AND ANUPASHAYA Upashaya ita iccha Madhurrahita ahara Vyayama
Anupashaya Ushna Madhura ahara Diwaswapana
21) UPADRAVA – Present / Absent Mention (if any) - 22) INVESTIGATIONS Erythrocyte sedimentation rate
Hb%
Albumin Sugar
Urine routine
Microscopic 23) TREATMENT SCHEDULE Day Date Investigation’s note Day 1 Day 7 Day 14 Day 21 Day 30
Phalatrikadi Vati in Madhumeha (Diabetes Mellitus) – Case Sheet 5
24) ASSESMENT OF TRIAL 1) Subjective paramters Before After Follow-up Differance 1 Dourbalya 2 Avila mootrata 3 Kara pada dhaha 4 Pipasa 5 Kshudhadikyata
Grades 1) Prabhuta mootrata
Grade 0 1000ml – 1500ml/ 24hrs Grade 1 1500ml – 2000ml/ 24hrs Grade 2 2000ml – 2500ml/ 24hrs Grade 3 2500ml -3000ml/ 24hrs
1) Avila mootrata Grade 0 Crystal clear fluid Grade 1 Hazy with slight turbidity Grade 3 Turbidity clearly present but news
print can be read through the tube. Grade 4 More turbidity news print cannot be read.
2) Kara pada dhaha Grade 0 No kara padadadha
Grade 1 Occasionally noticed Grade 2 Periodically noticed Grade 3 Daily noticed Grade 4 Continuously noticed
3) Kshudhadikya Grade 0 No Kshudhadikya
Grade 1 Mild increased but tolerated Grade 2 Moderate increased but tolerated Grade 3 Severally increased but not tolerated
2) Objective parameters Before After Follow-up Differance 1 Fasting Blood Suger 2 Post prandial Blood suger 3 Fasting urine suger 4 Post pradial urine suger 5 Prabuta mootrata
Investigators note:
Signature of Guide (Dr K. Shiva Rama Prasad)
Phalatrikadi Vati in Madhumeha (Di
4) Pipasa Grade 0 Normal
Grade 1 Mild increased but tolerated Grade 2 Moderate increased but tolerated Grade 3 Severally increased but not tolerat
5) Atisweda Grade 0 Normal sweating after doing normal physical activities Grade 1 Moderate sweating Grade 2 Excessive sweating Grade 3 Excessive sweating just by doing little work 6) Dourbalya
Grade 0 No Dourbalya Grade 1 Occasionally noticed Grade 2 Periodically noticed Grade 3 Continuously noticed
Signature of Scholar ( Vijayalaxmi. B. Benakatti )
abetes Mellitus) – Case Sheet 6
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