E-ISSN:2456-3110

Research Article

Clinical Trial

Journal of Ayurveda and Integrated Medical Sciences

2021 Volume 6 Number 1 Jan-Feb
Publisherwww.maharshicharaka.in

Clinical management of Madhumeha with Akulyadi Yoga

Kalyani S.1*
DOI: 10.21760/jaims.6.1.4

1* Shivaleela S Kalyani, Professor, Department of Kayachikitsa, B.V.V.S Ayurved Medical College and Hospital, Bagalkot, Karnataka, India.

Introduction: The advancement of industrialization and communication is contributing towards sedentary life styles; in turn causing chronic non-communicable diseases like Madhumeha vis-à-vis Diabetes Mellitus, etc. in fact Ayurveda is the first life science, which identified, diagnosed and managed Madhumeha. Madhumeha / DM are the present burning issue alarming the world. Aim & Objective: Management of Madhumeha with Akulyadi Yoga. Methodology: It is a clinical study. Diabetes Mellitus management with Akulyadi Yoga as a Shamana Chikitsa. Akulyadi Yoga ingredients are hypoglycemic agents collected from local area and prepared under GMP conditions, weighing about 500mg tablet form. Patients of Madhumeha fulfilling the criteria of diagnosis were selected in the present study. Observation: The male female ratio in the study is approximately 3:2 patients and 75% patients were recorded with sedentary life styles. In the present study 60% patients had family history and rest of the 40% patients had no family history of Madhumeha. Discussion: The key parameters to assess “glycemic” condition of Madhumeha exhibit, FBS with a mean difference of 48.605mg and PPBS with mean difference of 117.18mg for after too before data. Conclusion: This is strong evidence to state that the Akulyadi Yoga is good hypoglycemic agent combination of Ayurveda.

Keywords: Madhumeha, Akulyadi Yoga, Diabetes Mellitus

Corresponding Author How to Cite this Article To Browse
Shivaleela S Kalyani, Professor , Department of Kayachikitsa, B.V.V.S Ayurved Medical College and Hospital, Bagalkot, Karnataka, India.
Email: 		Shivaleela S Kalyani, Clinical management of Madhumeha with Akulyadi Yoga. J Ayu Int Med Sci. 2021;6(1):24-29.
Available From
https://jaims.in/index.php/jaims/article/view/1177

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2021-01-18 2021-01-25 2021-02-03 2021-02-09 2021-02-12
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 12%

© 2021 by Shivaleela S Kalyani and Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Shivaleela. S. Kalyani. Clinical management of Madhumeha with Akulyadi Yoga

Introduction

Ayurveda the heritage of Indian civilization is not only a medical system but also a full-fledged science, consisting of all medical and ailed branches essential to lead a healthy life. Being a science Ayurveda believes in supreme power.

The Ayurveda has attracted the attention of global population specially the developed countries since ages. The main reason behind this was the holistic approach of Ayurveda, humanitarian approach, simplicity of the procedures, cure of chronic and incurable disease safer and non-toxic herbal resources.[1]

The purpose of Ayurveda is to maintain health and to treat diseases, in order to achieve the ultimate goal. It is applicable in every fact of human life, with its own unique. A principle in understanding any disease by either preventive or curative wedge is necessary. This may be the fact due to which this science is persisting through centuries beginning from time immemorial.[2]

Scientific and technological progress has made man highly sensitive and critical; there by giving rise to different types of health problems. The advancement of industrialization and communication is contributing towards sedentary life styles; in turn causing chronic non-communicable diseases like diabetes mellitus, etc. in fact it is the first life science, which identified diagnosed and managed diabetes. In spite of all sorts of advancement of science man is not able to stay himself in the boat of happy and healthy life. So it is disadvantage rather than an asset.

Madhumeha is a disease known to mankind since Vedic period and it is mentioned as one of the 20 obstinate urinary disorders. It is the present burning issue alarming the world. With synonym of ‘Rich man’s disease’, particularly because a person who is able to enjoy the pleasure of life without any perceptible exercise is usually affected with this disease.[3]

Madhumeha is a chronic metabolic disorder and the symptom appears in relation with 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.[4]

In Ancient treatise we find a vivid description

of the disease solely attributed to metabolic derangement along with genetic predisposition. Madhumeha subtype of Vataja Prameha due to involvement of vital elements causes alarming health instability with higher prevalence. Vata is the conductor of healthy life and vitality supporter of all the embodied beings and sustains long life free of disorders.[5]

Susruta emphasized that Vyanavata and Apanavata vitiation cause Sukra Dosha and Prameha. Vyanavata because of its potential to perform the functions related to each and every body element and Apanavata due to its potential related with excretion. When we exploit Madhumeha we cannot deny their credibility in the pathogenesis. This superior consideration of Susruta proved to be essential before profound treatment modality.[6]

Changing life style, lack of exercise, fast foods, improper unbalanced diet, and sedentary life are showing upward trend in India. This has lead to the emergence of Diabetes Mellitus in the region. Iatrogenic or genetic predisposition and degenerative changes proved fatal in diabetes mellitus.[7]

Purpose of the study

The prevalence of diabetes is approximately twice in the urban than in rural areas. It is suggested that the increase in the occurrence of this disease is possibly due to changing life style. Lack of exercise, fast foods, improper unbalanced diet, and sedentary life are showing upward trend in India. This has lead to the emergence of diabetes mellitus in the region. In spite of using oral hypoglycemic agents and insulin modern medicine is least bother about the sedentary life style and improper diet, so struggling to provide better management to counteract the complications and to provide better health.

So many research works have been carried out in relation to Shamana treatment as mentioned in classics and their therapeutic effect is proved. Present research work is intended to evaluate the effect of herbal combinations used as different line of treatments.

Prevalence

Madhumeha has become a global problem in spite of much advancement in modern medicine.[8] The World Health Organization stated in 1998 that a 122 % rise in the number of adults with diabetes is projected by 2005, to reach 300 million adults


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Shivaleela. S. Kalyani. Clinical management of Madhumeha with Akulyadi Yoga

worldwide. There are four reasons for this two-fold global increase: Firstly, we are living longer; over-nutrition and lack of exercise are prevalent; the disease being transmitted in a hereditary fashion; such transformations have taken place within the Indian population also. In India, it is estimated that 19 million cases occurred in 1995, rising to a projected 57 million by the year 2025 (1/6th of the world total). According to recent epidemiological studies there has been a 40% increase in diabetes prevalence amongst urban during the last five years.[9] Even the NIDDM a commonest form of DM is most common accounting for 85-99% of the patient depending on geography and ethnicity, occurs in adults, more so over 35 years of age.[10] The prevalence of NIDDM is on the rise more alarmingly in the developing nations, ranked 7th among leading cause of death. It has been rated 3rd when all its micro vascular, macro vascular, neuropathic complications is taken into account.[11] The cost of treating diabetes an associated complication exceeds $ 100 billion per year.[12]

It has long been recognized that drugs represents only part of the management of Madhumeha and other intervention such as education, modification of diet and promotion of physical health play a crucial role. If the dietary control and exercise programmes do not improve the condition then the medication is added. Many of patients won’t have patience for long term therapies, complicated therapies like exercise etc.[13] The OHA viz, Sulfonylurea, Bigunides have associated with adverse effect like nausea, vomiting, lactic acidosis, hypersensitivity etc.  After long term administration their action declines, up to 50% patients of NIDDM initially treated with OHA ultimately need insulin. Hence we find no satisfactory remedies for Madhumeha in contemporary medical science.

About Concept

The word Madhumeha in terms of ‘Diabetes Mellitus’ it is the present burning issue alarming the world. With synonym of Rich man’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 Akulyadi Yoga’.  Medicinal plants since time immemorial have been

used virtually in all cultures as a source of medicine. Several herbs have been described in Ayurvedic treasure of therapeutics, which have a beneficial effect in the management of Madhumeha.  Akulyadi Yoga is one such a combination which acts as Mootra Sangrahaneeya and also reduces the high blood glucose.[15]

As the Madhumeha is Kapha Vata Pradhana Vyadhi, Akulyadi Yoga seems to be very effective. It contains Akuli, Amalaki and Haridra. All these drugs are Kapha and Vata Shamana property with Ushna Virya. Thus, in the present study an attempt is made to “Evaluation of the efficacy of Akulyadi Yoga”, with a view to find out a therapeutically efficacious, safer, cost effective and easily available drugs.

Materials and Methods

Criteria for selecting drugs

The above mentioned Akulyadi Yoga, which is taken from the Yogaratnakara Pramehadhikara. It is considered to undertake in equal quantity of the Akulyadi Yoga ingredients as said in the text.

Method of Research design

The trail is Simple Random sampling technique clinical study. In this Patients were taken in randomized selection.

Posology of Trial drug

Internally: 3000 mg / 24hrs in divided two doses or 50mg /Kg body weight distributed in equal doses

Anupana of Trial drug

Madhodaka is undertaken as it is stipulated for the medicine.

Study duration of Trial drug

Akulyadi Yoga Simple Random sampling technique clinical study was conducted for 21 days. The medicine was dispensed for 7 days to all patients and advised to report for every 7 days interval, noted the nature, frequency and other symptoms of their disease during their visits.

Follow up of Trial drug

Akulyadi Yoga trail offered a further follow up 21 days.

Source of data of Trial drug


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Shivaleela. S. Kalyani. Clinical management of Madhumeha with Akulyadi Yoga

The data was collected from the patients suffering from Madhumeha in the OPD of Post-Graduation and Research Center DGM Ayurvedic Medical College, Gadag. The method of the present study consists of following headings.

  1. Selection of the patient
  2. Examination of the patient
  3. Criteria of assessment

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.

Inclusion criteria

  • All patients other than that of exclusive criteria are included
  • Age of patients between 25-65 years
  • Irrespective of gender
  • Non-insulin dependent diabetes mellitus
  • Patient having clinical features of Madhumeha
  • Prabhoota Mootrata
  • Avila Mootrata
  • Dourbalya 
  • Shareera Bhaarahani
  • Janghamamsagraha
  • Karapada Daha
  • Pipasa
  • Kshudhadhikyata

Exclusion criteria

  • Insulin dependent D.M Vis-à-vis Madhumeha
  • Patients who develop complication with other systemic disease
  • Juvenile diabetes
  • Malnutrition D.M
  • Gestational D.M

Observations and Results

To compare the effectiveness of a drug before and after the treatment the statistical analysis paired t-test, by assuming that the drug

is not responsible for changes in the reading before and after the treatment. The conclusion drawn is as highly significant if P <0.05.

Statistical analysis of Akulyadi Yoga

Parameter Mean SD SE t value P value Remark
Dourbalya 2.45 1.145 0.256 9.57 <0.001 HS
Shareera Bharahani 1.1 1.165 0.260 4.23 <0.001 HS
Janghamamsa Graham 0.95 1.05 0.234 4.059 <0.001 HS
Karapada Daha 1.4 0.94 0.21 6.666 <0.001 HS
Pipasa 2.2 1.281 0.286 7.69 <0.001 HS
Kshudhadhikyata 2.05 1.356 0.303 6.76 <0.001 HS
Prabhoota Mootrata 3.2 0.894 0.2 16.0 <0.001 HS
Avila Mootrata 0.5 0.606 0.135 3.703 <0.001 HS
FBS 48.605 30.41 6.80 7.147 <0.001 HS
PPBS 117.18 46.42 10.38 11.289 <0.001 HS
FUS 0.325 0.293 0.0656 4.954 <0.001 HS
PPUS 0.63 0.476 0.1066 5.9099 <0.001 HS

Among the subjective parameters Dourbalya, Pipasa, Kshudhadhikyata shows more highly significant than other parameters (Comparing p values) the parameters Shareera Bharahani and Jangamamsa Graha are having almost equal effect before and after the treatment (by comparing t-values). The parameters Dourbalya having more net mean effect whereas the parameter Jangamamsa Graha is having less mean effect (comparing mean value) the variation in the parameter Karapada Daha is less, where as in the parameter Kshudhadhikyata is more.

Among all the objective parameters all the parameters show significant but, in the parameter, Prabhoota Mootrata, PPBS, FBS are shows more highly significant (comparing p-values). The parameters PPBS are having more net mean effect with more variation where as in FUS having less mean effect will less variation (comparing mean and variations).

Among the subjective parameters the percentage improvement is in between 82% to 92%, 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 (94.1%) and where as in the parameter PPBS is least percentage improvement (14.312%).

Discussion

The drugs selected for the trial mainly having Tikta, Kasaya, Katu Rasa, Usna Veerya and Laghu, Ruksa Guna, Katu Vipaka


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Shivaleela. S. Kalyani. Clinical management of Madhumeha with Akulyadi Yoga

and Kaphavatahara properties and each one is indicated in Prameha Chikitsa. Thus, Usna Veerya and Tikta Kasaya Rasa helps to normalize the function of Jathragni and Dhatwagni. That in turn helps to form the Dhatus in proper proportion with Saimyak qualities. Laghu Ruksa Guna helps for the Sosan of Bahudrava Shlesma and reduction of vitiated Meda Kleda.

Thus, once these factors get normalized in the body, they in turn make clear the Path of Vata which stops the depletion of vital Dhatus and restore normal physiology. Thus, disease Madhumeha get Alleviate.

The result of the Akulyadi Yoga declared is representing the efficiency of the drug with its embedded qualities, is 11 (55%) Regulated, 1 (5%) palliative and 8 (40%) patients responded in the trial. The conclusion drawn statistically for the present trial is as highly significant as P <0.05.

Conclusion

Margavarana Janya Madhumeha & Dhatukshaya Janya Madhumeha are the two forms of the disease. Apathya Nimittaja Madhumeha & Sahaja Madhumeha are the two independent forms of presentations, coming under the above classification respectively. Sadhyasadhyata of Madhumeha is directly dependent upon Dhatu Apakarshana & Vata Anubandha Anubadhyatva & Sahaja Karana. The Kaphaja, Pittaja & Vataja Pramehas are nothing but the range of varied symptomatology of Madhumeha manifesting depending upon association of favorable Nidanas for the respective Dosha during the course of the illness. Sahaja Madhumeha can manifest in the Balya Avastha also & Apathya Nimittaja Madhumeha manifests in the Madhyama to Vriddha Avastha. Madhumeha with Kapha Pradhana Lakshana and Anati Dushta Dhatu is Sadhya in the sense that it is Sadhya until under continuous medication; otherwise, it recurs justifying the term Anushangi meaning Punarbhavi. Diet and exercise help only in patients who comply fully and compliance is the toughest part in the management of Madhumeha. The significant improvement which was seen in subjective and objective symptoms. The result of the Akulyadi Yoga declared is representing the efficiency of the drug with its embedded qualities, is 11 (55%) Regulated, 1 (5%) palliative and 8 (40%) patients responded in the trial. The conclusion drawn statistically for the present trial is as highly significant as P <0.05.

Reference

01. Baghel MS. Ayurvedic Education – Global perspective, International Congress on Ayurvedic Concepts and Treatment of Neurological Disorders. SDM College of Ayurveda and Hospital. Udupi, 2002;pp25. [Crossref][PubMed][Google Scholar]

02. Bhagawan Das. Charaka Samhita Sutrasthana. Chaukhambha Sanskrit Series, Varanasi. vol-1, 6th ed, 1999;pp600. [Crossref][PubMed][Google Scholar]

03. Swami DS. Evaluation of efficacy of Madhutailika Vasti in the management of Madhumeha. PGSRC, Dept. of Panchakarma, DGM Ayurvedic Medical College, Gadag. 2005,pp2 [Crossref][PubMed][Google Scholar]

04. Mahesh Udup. Comprehensive Kayachikitsa and Principles of Ayurveda. Laveena Publication, Bangalore. 1st ed. 2004;pp1123 [Crossref][PubMed][Google Scholar]

05. Rajeshwaradatta Sastri. Charaka Samhita. Chaukhambha Bharati Academy, Varanasi. Part 1, Nidanasthana 4/39, 1st ed. Reprint, 1998,pp638 [Crossref][PubMed][Google Scholar]

06. Ambikadatta Shastri ed. Susruta Samhita. Chaukhambha Sanskrit Sansthan, Varanasi. Part-I, Nidanasthana 1/20, 6th ed, 1987;pp-230. [Crossref][PubMed][Google Scholar]

07. Pawar Anand N. A comparative study on the role of vasti therapy and Pramehaghna drugs in the management of Madhumeha (Diabetes mellitus). Department of Kayachikitsa, IPGT&RA Jamnagar. L-2857;pp24. [Crossref][PubMed][Google Scholar]

08. Khan Weir, Joslins. Diabetes mellitus. Pennsylvania USA, Lea and Febiger. 13th ed. 1994;pp194 [Crossref][PubMed][Google Scholar]

09. Sahshikala Bani. Evaluation of efficacy of Avartaki in Madhumeha. Dept. of Dravyaguna, DGM Ayurvedic Medical College, Gadag, 2005;pp1. [Crossref][PubMed][Google Scholar]

10. Sainani GS ed. API textbook of medicine. Association of Physicians of India, Mumbai. 6th ed, 1994;pp986. [Crossref][PubMed][Google Scholar]

11. Khan Weir, Joslins. Diabetes mellitus. Pennsylvania USA, Lea and Febiger. 13th ed. 1994;pp216 [Crossref][PubMed][Google Scholar]


Journal of Ayurveda and Integrated Medical Sciences 2021;6(1)28
Shivaleela. S. Kalyani. Clinical management of Madhumeha with Akulyadi Yoga

12. Sainani GS ed. API textbook of Medicine. Association of Physicians of India, Mumbai. 6th ed, 1994;pp986. [Crossref][PubMed][Google Scholar]

13. AS Fauci. Harrison principles of Internal Medicine. Mcgraw Hill Co, New York USA. Vol-2, 15th ed. 2001;pp 2129 [Crossref][PubMed][Google Scholar]

14. Mahesh Udup. Comprehensive Kayachikitsa and principles of Ayurveda. Laveena publication, Bangalore. 1st ed. 2004;pp1123 [Crossref][PubMed][Google Scholar]

15. Bramhashankar Sastri ed. Yogaratnakara. Choukhambha Sanskrit Samsthan, Varanasi. Uttarardha, Prameha Chikitsa. 4th ed, 1988;pp85-86 [Crossref][PubMed][Google Scholar]


Journal of Ayurveda and Integrated Medical Sciences 2021;6(1)29