Ayurveda Today Magazine Diwali Issue

 MANAGING DIABETES: AYURVEDA WAY

Dr. K. R. Kohli M.D (Ay), PhD

1. Dean

R. A. Podar Medical College & Hospital, Worli,

Mumbai- 400 018

2. Director of Ayurved, Maharashtra State

Contact: 022-4947144, 09869329777, 

Email: krkohli@rediffmail.com 

Web: www.ayurvedinstitute.com

Diabetes mellitus is one of the major killers of present times. The recent studies suggest that it is acquiring the status of an epidemic. The reasons of its fast spread in the urban as well as in the rural areas are ill understood. It is suggested that the increase in the occurrence of this disease possibly is due to changing food habits and the increased stress in the society. Use of pesticides may have some contributing factor in this particular context. Diabetes mellitus is all the more dreaded because of its complications in almost every parts or rather every cell of the body. Ayurveda recognized this disease right from the Vedic period. All the classical texts refer it to a disease known in Ayurvedic literature as Prameha which appears to have very strong co-relation and similarity to Diabetes mellitus. The name Prameha is self explanatory which means Prabhuta-mutrata (excessive urination) and Aavil-mutrata (turbid urine). Under the chapter of Prameha the causes (Hetuu) the symptoms (Purva-roopa & Roopa). The pathogenesis (Samprapti) and the treatment (Chikitsa) are astonishingly all very similar to the corresponding chapters on diabetes mellitus. From the following shloka it is evidenced that Ayurvedic physicians even three thousand years ago were aware of the extent to which all the body tissues are involved in the pathogenesis of Prameha.

“Kaphah Sapittah Pavanashcha Doshah, Medo Asra-shukrambu Vasa Lasika

Majja rasaujah Pishitam cha Dushyah Pramehinam Vimshatireva Meha.”

Madhav Ni. 33/4

A study of the ancient literature indicates that Diabetes was fairly well known and well conceived as an entity in ancient India. The aetiology, pathogenesis and the principles of management which are described in Ayurvedic classics resemble with the modern concepts almost in toto. Description of two types of Prameha from management point of view strikingly is same. Krisha Pramehi (Lean Diabetic) and Sthoola Pramehi (Obese Diabetic) are classified in Ayurveda on very similar grounds as Diabetics are classified in IDDM and NIDDM respectively. On the very similar pattern we find the classification asSahaj Prameha (Congenital) and Apathya-nimittaja Prameha (Due to overeating and wrong eating habits). The modern management of diabetes inspite of many advances still remains unsatisfactory. Drug intolerance, hypersensitivity and resistance to insulin, the danger of acute and chronic complications, the fear of hypoglycemic episodes with sulfonylureas makes it all the more important to search out safe, effective and cheaper remedies. Such remedies could be explored from the huge wealth of Ayurveda which still remains unexplored on the modern technological advances. At present, Ayurveda is enjoying a revival. There is already a swing back to the olden traditions. All the constituents of the modern society have begun to take greater interest in herbs and their utilities. In spite of the extraordinary thrust and our dependence being laid on the modern medicines, global estimate indicates that around 80% of the population cannot afford these products of Western Pharmaceutical Industry. Even in most of the nations of the Western World, there is an increasing interest in the use of herbs/plants as most of their own drugs are costly and tagged with serious side effects. The latest developments in the treatment of Diabetes Mellitus suggest that it is the average control over a longer duration which helps the diabetics in real sense. Ayuvedic physicians were well aware of the presence of hyperglycaemia in Prameha which is clear from several references which like ants getting attracted over patients urine, “Madhuryat Cha Tanoratah” meaning that sweetness is spread all over urine, patient passing urine which resembles in physical characters of Honey. Ayurvedic scholars laid more stress on correction of the whole internal environment which involves correction of deranged Dhatus and correcting the smechanism of pathogeniesi (Samprapti) involved there in rather than reducing the blood sugar levels alone.

Since thousands of years, the ancient physicians of this great nation have been successfully treating Prameha with the Ayurvedic measures and drugs. Many drugs have already been screened for their anti-diabetic property/blood sugar lowering property. The modes of management of Prameha includeVyaayam (Exercise), Pathya (dietary regulation), Panchakarma (Bio-purification procedures) and the use of therapeutic measures.

Role of Activity and Exercise:

Rigorous physical activity is advocated for Prameha patients. But while advising these activities, individuals have been catagorised according to their social status as per Chaturvarnya Vyavastha.

A poor and friendless patient should live on alms lead a life of perfect continence like an ascetic, forego use of shoes and umbrella and walk a hundred yojanas(A yojana is equal to eight miles)or more on foot without staying for more than one night at a single village. A rich man (suffering from Prameha.) should live on Shyamaka, Kapittha, Tinduka and Ashmantaka and live among the Deer. He should constantly follow the tracks of cows and take their urine (for food and drinks). A Brahmana patient should live on the grain spontaneonsly fallen from plants, constantly study the Vedas and draw chariots occupied by Brahamanas. A patient belonging to the lower orders of society (shudras) should sink wells (under such circumstances). All these references highlight the importance of exercise (body activity) in case of Prameha.

The basic principles of chikista of Prameha:

“Sthoola Pramehi Balwanhiekah, Krishas tathaikah Paridurbalash cha

Sam brimhanam tatra krishasya karyam, Samshodhanam Dosha baladhikasya.”

Charak Chikitsa 6/15

Major principle of management suggests two groups of patients, viz,

1) In obese pramehi with adequate body strength having intense increase of doshas, purification of the body is advocated depending on the dosha predominance viz. Kaphaja are advised to have emetics, Pittaja purgatives

2) Slender and weak patients are advised to have `Brimhana i.e. medications and diet which increase dhatus in the body.0iliative medications depending on the symptoms and pre-dominance of doshas are advocated and in case of weak pa-tients Charak has advised "Santarpana chikitsa".

SHAMANA (PALLIATION):

The herbal drugs used in the management of Prameha are bitter, astringent and pungent in taste. Because one has to check the extra fluidity of dhatus and, give them good strength and compactness.

The most commonly used drugs (Shortlist) are tabulated below according to Ayurveda:

Swaras: Guduchi, Amlaki (B.R.)

Churna: Ankolyadi Yoga, Katak Bijyoga (Nighantu Ratnakar)

Sphatik Churna (B.R.)

Kwath: Palash pushpa kwath, Phalatrika kwath. Vidangadi Kwath.Nyagrodhadi Kashaya.

Asava: Lodhrasav, Dantyaasav (C.S., Ci.)

Sneha: Trikantakadi tail, Simhamrit ghrit, haridradi tail dadimadhya ghrit.

Vati: Chandrakalavati, Chandraprabhavati, Shukraamritika Vati.

Bhasmas: Mandur bhasma, Loha bhasma, Nag bhasma, Vanga bhasma, Swarna makshik bhasma.

Rasayana: Panchaloha Rasayana Vasantakusumakar Rasa, Vangeshwar Rasa, Mehari Rasa, Trivang Bhasma

INDIVIDUAL DRUGS THAT HAVE BEEN SCREENED EXTENSIVELY.

1. Eugenia jambolana Jamun beej churna

2. Gymnema sylvestre Gudmar patra churna

3. Pterocarpus marsupium Vijaysar kashtha churna

3. Ficus bengalensis Nyagrodha twaka churna

4. Shilajattu (Shalsaradigan Bhavit)

5. C. Tamal Tejpatra

6. Fenugreek seeds Methika churna

7. Momordica chirantia Karvellaka

What stages one should expect Ayurvedic Medicines to be effective?

1. Newly diagnosed mild to moderate diabetic mellitus.

2. Non Insulin Dependent Diabetes.

3. Post prandial Blood sugar below 350 mgm%.

4. Obese Diabetics.

5. Uncomplicated Diabetes mellitus.

6. Those in which there is a secondary failure: in such cases Ayurvedic drugs can be combined to their regular hypoglycaemic agents.

7. Complications need to be assessed by modern means, although some good remedies are available for early nephropathies, neuropathies and retinopathies.