Effective management of newly diagnosed case of Prameha with Vasanthika Vamana - A single case study

Bhagyashree; Shaila Borannavar

Effective management of newly diagnosed case of Prameha with Vasanthika Vamana - A single case study

Bhagyashree.^1*, Borannavar S.²

DOI:

^1* Bhagyashree, Post Graduate Scholar, Department of PG Studies in Panchakarma, Govt. Ayurveda Medical College, Bengaluru, Karnataka, India.

² Shaila Borannavar, Associate Professor, Department of PG Studies in Panchakarma, Govt. Ayurveda Medical College, Bengaluru, Karnataka, India.

Diabetes mellitus is the group of metabolic conditions with constant hyperglycaemia results from defects in insulin production or uptake. Type 2 Diabetes is the most common reason for hyperglycaemia mainly affecting people around age of 40 with lack of exercises and sedentary lifestyle. The increase in incidence of disease and its easy growing complications have become threat to healthcare sector even after the discovery of various hypoglycaemic agents and synthetic insulin. These medicines with long term use are reported to have hazardous side effects. In Ayurveda similar condition has been mentioned under the disease spectrum of Prameha. The line of management of Prameha is to aim at the control of hyperglycaemia along with removing the root cause of the disease. Samshodhana is the line of treatment mentioned for the treatment of Prameha and proper Rutu Shodhana will help to get rid of many Santharpanotha Vyadhis as they do timely elimination of vitiated Dosha. The purpose of this study to evaluate the efficacy of Vasanthika Vamana in Diabetes mellitus in preventing and curative way. In present study, Vasanthika Vamana Karma proved as best treatment in controlling subjective symptoms and blood sugar levels.

Keywords: Case Report, Diabetes mellitus, Vasanthika Vamana Karma, Emesis, Shodhana

Corresponding Author	How to Cite this Article	To Browse
Bhagyashree, Post Graduate Scholar, Department of PG Studies in Panchakarma, Govt. Ayurveda Medical College, Bengaluru, Karnataka, India. Email:	Bhagyashree, Shaila Borannavar, Effective management of newly diagnosed case of Prameha with Vasanthika Vamana - A single case study. J Ayu Int Med Sci. 2022;7(11):255-260. Available From https://jaims.in/jaims/article/view/2106

Introduction

Diabetes mellitus is a syndrome of disordered metabolism and inappropriate hyperglycaemia secondary to an absolute relative deficiency of insulin or reduction in biological effectiveness of insulin or both.^[1]

It is considered as the fastest growing disorder of present era in public sector, affecting about 9.3% of world population (2019) and may rise up to 10.2% by the end of 2030.^[2]

By the year 2035, nearly 592 million people are predicted to die of diabetes.^[3] Listed under metabolic disorder, DM caused mainly by improper lifestyle and with very high rate of morbidity and mortality.

Based on pathology the disease is classified into two types:

1. Type 1 DM (insulin deficiency) - Autoimmune condition due to reduced or complete absence of insulin production.

2. Type 2 DM - a heterogeneous group of disorder characterised by variable degree of insulin resistance, impaired insulin secretion and excessive hepatic glucose production.

The signs and symptoms of the disease are polyuria, polydipsia, weight loss, fatigue, increased frequency of micturition, frequent infection, poor wound healing etc. In early type 2 DM, symptoms may be more subtle and consist of fatigue, poor wound healing, and paresthesias. The lack of symptoms is the main reason for the delayed diagnosis of type 2 DM.

Without the proper treatment, the disease will easily move into grievous compilatory stages like

Ocular: Diabetic retinopathy, macular oedema, glaucoma.
Renal: Proteinuria, end-stage renal disease (ESRD), type IV renal tubular acidosis
Neurologic: Distal symmetric polyneuropathy, polyradiculopathy, mononeuropathy, autonomic neuropathy
Gastrointestinal: Gastroparesis, diarrhoea, constipation
Genitourinary: Cystopathy, erectile dysfunction, female sexual dysfunction, vaginal candidiasis

Cardiovascular: Coronary artery disease, congestive heart failure, peripheral vascular disease, stroke
Lower extremity: Foot deformity (hammer toe, claw toe, Charcot foot), ulceration, amputation
Dermatologic: Infections (folliculitis, furunculosis, cellulitis), necrobiosis, poor healing, ulcers, gangrene.^[4]

Even with highly developed medical field, with the existing treatment strategies it has been difficult to stop the progress of the disease and to prevent the development of complications. Thus, effective prevention and management of disease has become the need of an hour.

The disease is considered under the broad spectrum of the Prameha Vyadhi in Ayurveda which is given as common name for collective group of 20 disease condition with similar Prathyatma Lakshana. It is characterised by increased excessive turbid urine.^[5] The vitiation Kapha along with Kleda, Abaddha Meda and other Dhatu leads to Prameha. As the disease progress, involvement of Tridosha and Dasha Dushyas i.e., Rasa, Rakta, Mamsa, Meda, Majja, Shukra, Shareera Kleda, Vasa, Laseeka and Ojus are also seen.^[6] When aggravated Kapha vitiates Meda, Mamsa, increased Kleda in body, brings them to Moothrashaya and forms 10 types of Kaphaja Prameha.^[7] Similarly other types of Prameha with vitiation of Pitta and Vata Dosha causes 6 types Pittaja Prameha and 4 types of Vataja Prameha respectively.

For Chikitsa purpose this Pramehi can be further classified into Sthula Pramehi and Krisha Pramehi.^[8] Samshodhana is the line of treatment in Sthula Pramehi where as in Krisha Pramehi Santharpana is the main line of treatment. Further Sushrutha Acharya mentions when the disease is fully developed with signs and symptoms one should do Shodhana Chikitsa.^[9] Under Shodhana both Vamana and Virechana is indicated for which Dalhana Acharya specifies, in Kaphaja Meha Vamana is the indicated treatment whereas in Pittaja Meha Virechana.^[10] For the understanding the pathology, Madhumeha a type of Vataja Meha can be considered as 2 types-Apatarpaniya or Dhatukshayaja Samprapti and Santarpaniya or Avarana Janya Samprapti. With the factors causing vitiation of Vata dosha causes vitiation of other Dhatus and leads to Dhatukshayaja Prameha. Tha nidanas causing vitiation of Kapha and Pitta leads

to Dusti of Dhatus and leads to Avarana Janya Prameha.^[11] Samshodhana specilly Vamana is helpful in the Sthula Pramehi with Avarana Janya Samprapti.Thus, for prevention and control of the disease Samshodhana especially Rutu Shodhana, Pathya Ahara and proper Vyayama plays important role.

Case Report

A female patient of 47 years age is K/c/o Hypothyroidism for 5 years, under regular Ayurvedic medication for the same. She was complaining of generalised body ache, increased thirst and appetite, dryness of mouth for 4 months along with increased frequency nocturnal micturition and excessive sweating. There were no complaints of burning sensation or numbness over bilateral feet, weight loss etc.

Along with these symptoms she was also having pain in low back region radiating to right thigh. For all these complaints she consulted Panchakarma Opd (6A) of SJIIM Bengaluru. After analysing all the complaints, we asked her to undergo haematological investigation, where results showed there was increase in Fasting blood sugar and Post Prandial blood sugar, and HbA1C was 6.4. After assessing all the symptoms, we conducted Vasanthika Vamana.

Past history: K/c/o Hypothyroidism since years and is taking Ayurvedic medications.

Family history: Mother was k/c/o Hypothyroidism.

Menstrual history

2-3 days /30-35 days – regular cycle, No dysmenorrhea, white discharge.

Personal history

Diet: Both veg and non veg food. She has the habit of taking curd daily, food article with dominance of sweet taste and Occasionally bakery food item.

Appetite: Increased. (Abhyavarana Shakti - Pravara, Jarana Shakti - Madhyama)

Mala: Baddha, once in 2 days

Mutra: Increased frequency (9-10 times /day, 2-3 times / night), Colour - whitish yellow (burning micturition occasionally, no foul smell) Nidra - Sound sleep. Habit of taking day sleep of 30min.

Examinations
Table 1: Showing Examination finding in the patient

General Examination
Appearance - Healthy
Consciousness - Alert
Height - 5.3 feet (158.5 cm)
Weight - 80 kg
BMI - 32
BP - 110/70 mm hg
Pulse - 64/min
Temperature - 98.6°F
Pallor - absent
Icterus - absent
Cyanosis - absent
Clubbing - absent
Lymphadenopathy - absent
Central Nervous System Examination
§ Higher mental functions - normal
§ Oriented to time place and person
§ No abnormality detected.
Gastro Intestinal System Examination
Shape of abdomen - slightly protuberant Palpation No Abnormality detected
Cardio Vascular System Examination
S1 S2 heard, no abnormality detected
Respiratory System Examination
NVBS heard, no abnormality detected
Musculoskeletal system examination
Doorbel sign - + ve at L3-L4 level
SLR – negative
Gait- Normal
ROM of spine - Restricted.

Astasthana Pareeksha
Table 2: Showing Astasthana Pareeksha

Pareeksha	Findings
Nadi	Manda Gati, 64b/min
Moothra	Prabhoota, 9-10 times / day; 2-3 times / night
Mala	Baddha (once in 2 days)
Jihva	Ishat Liotta
Shabda	Prakrita
Sparsha	Prakritha
Drik	Prakrita
Akriti	Sthula

Dashavidha Pareeksha
Table 3: Showing Dashavidha Pareeksha

Prakruthi	Kapha Vata
Vikrathi	Kaphapradhana Tridosha
Sara	Twak, Mamsa, Medo Sara
Samhanana	Uttama
Satva	Madhyama
Sathmya	Madhyama
Ahara	Abhyavaharana Shakthi - Pravara Jarana Shakthi - Madhyama
Vyayama Shakti	Avara
Pramana	Supramanitha
Vaya	Madhyama

Investigations
Table 4: Showing investigations

Investigation (20/4/2022)	Findings
FBS	169
PPBS	232
HbA1C	6.4%

Treatment Protocol
Table 5: Showing treatment protocol

Deepana Pachana	For 3 days with Bhoonimbadi Choorna : 5gm-5gm-5gm B/f with Warm water
Shodananga Snehapana	Varunadi Gritha
	D1-30 ml
	D2-70 ml
	D3-130 ml
	D4-180 ml
	D5-200 ml
Vishramakala	1 day - Abhyanga with Dhanvantaram Taila f/b Ushnajala Snana
Vishramakala	2 day - Kaphotkleshakara Ahara (Idli, curd rice, Dhoodpeda, Ksheera Payasa )
Vamana Karma	With Madnaphala Yoga - 15 gm
	(Madanaphala Pippali Choorna: 5gm
	Yesti Madhu Choorna: 3 gm
	Vacha: 1 gm
	Honey: 5 gm
	Saindhava: 1gm)
Samsarjana Krama	For 5 days
Shamanoushadhi	Nishakatakadi Kashyaya 15ml -0-15 ml b/f
	Shilajithwadi Vati 1-1-1 A/F
	Simhanada Guggulu 2-2-2 A/F for 2 months

Assessment
Objective Criteria
Table 6: Showing objective assessment of criteria

	Before Treatment	After Treatment
Date	20/4/2022	08/05/2022	8/6/2022	18/6/2022	09/09/2022
FBS	169	96	70	87	72
PPBS	232	110	101	119	112
HbA1c	6.4%	-	-	-	5.5 %

Subjective Criteria
Table 7: Showing subjective assessment of criteria

	Before Treatment	After Treatment
Fatigue	+++	+
Excessive nocturnal micturition	+++	0
Increased hunger	+++	+
Excessive sweating	+++	0

+++ : severe form of symptoms, ++ : moderate form of symptoms, + : mild form of symptoms, 0 : absence of symptoms.

Discussion

Diabetes mellitus (DM) comprises a group of metabolic disorder that share the common feature of inappropriately elevated blood glucose levels. Among two types, type 2 DM is most common and mainly affecting people around the age group 40. Diabetes mellitus has already become a leading threat to public health globally with its increased incidence. In India over the past 3 decades, the burden of DM in terms of deaths and disabilities has reached more than double.

In Ayurveda the disease is mentioned under the category of Prameha. Prameha is one among Astamahagada considered as Agrya among Anushangi Vyadhi. It is mentioned in Brihatrayis with well elaborated etiologies, prodromal symptoms, Lakshanas and complications. While considering Chikitsa of any Vyadhi we come across Nidanaparivarjana Chikitsa, Samprapti Vighatana Chikitsa and Lakshanika Chikitsa etc. classifications. In the disease like Prameha, achieving the Nidana Parivarjana and Samprapti Vighatana are utmost important.

When we look into Samprapti, Kapha Pradhana Tridosha along with Shareera Kleda, Meda and Mamsa are predominantly vitiated leading to symptoms of Prabhoota Avila Moothrata. To breakdown the Samprapti, Shodhana especially Vamana Karma is useful. Samshodhana Karma plays important role in eliminating the vitiated doshas out of the body from its root there by leaving less chance for its reoccurrence.^[12] Vasanthika Vamana helps in removing the Prakupitha Kapha Dosha which is accumulated and aggravated due to Rutu Prabhava of previous Sheetha Rutus, also easy elimination of Dosha with proper Shuddhi and without complications compared to other Rutu.^[13]

In the present study, the patient of Kapha Pitta Prakriti, we conducted classical Vasanthika Vamana. As part of Poorvakarma, Deepana Pachana was given with Bhoonimbadi Choorna. It is helpful in increasing Jataragni, causes Amapachana and thereby prepares the body for Snehapana.

Arohana Krama Shodananga Snehapana in Madhyama Matra is given using Varunadi Gritha which is having drugs mainly acts as Kapha Medohara.

This helps the Doshas undergo Vridhi, Vishyandhana there by helps in bringing Doshas from Kosta To Shaka.

After proper Samyak Snigdha Lakshanas, patient was given two days of Vishramakala during which Abhyanga with Ksheerabala Taila and Ushna Jala Snana was advised. Second day of Vishrama Kala patient was given with Kaphotkleshakara Ahara. Bahyasnehana and Swedana helps in liquefaction and disintegration of Dosha and brings them to Kosta. Kaphotkleshakara Ahara aids in smooth conduction of Vamana Karma.

Vamana Karma was conducted in early morning 6 to 8 AM, Akanta Pana was given with Ksheera as it was palatable to patient and Madanaphala Yoga is given as Vamaka Dravya along with Yastimadhu Phanta as Vamanopaga Dravya till Pittanta Darshana. There were 7 Vega and 3 Upavega with Uttama Shudhi and followed the Samsarjana Krama of 5 days by following the food articles mentioned in the Ayurvedic classics.

After Samsarjana it was found out that there was marked reduction in signs and symptoms in patients especially increased frequency of urination, fatigue, excessive hunger and after completion of Samsarjana Krama, previously increased FBS and PPBS came to normal range and maintained within normal limit for consecutive 3 months with Shamanoushadhi.

Conclusion

Rutu Shodhana helps to remove the embedded Doshas out of the body timely, Vasanthika Vamana does the abolishment of Kaphadosha thus helps in breakdown the Samprapti of the disease Prameha. It was observed the Vasanthika Vamana showed significant effect in controlling blood glucose level and managing signs and symptoms of Prameha like Prahoota Moothrata, Ati Kshud, Galatalu Shosha, Atisweda etc. With proper Samshodhana along with Vyayama and dietary habits one can prevent and control the disease Prameha without the use of any antiglycemic agents.

Reference

1. DL Kasper et al. 19th edition, Harrisons Manual of medicine, Endocrinology- Diabetes mellitus, MC Graw Hill Education, 2016, P904.

2. https://www.diabetesresearchclinicalpractice.com/article/SO168-8227(19)31230-6/fulltext.

3. Tao Z, Shi A, Zhao J. Epidemiological perspectives of diabetes, Cell Biochem Biophys 20015;73:181-5.

4. L Kasper et al., 19th edition, Harrisons Manual of Medicine, Endocrinology - Diabetes mellitus, MC Graw Hill Education, 2016, P905-6.

5. Acharya YT (ed.), Susruta Samhita of Susruta with the Nibandhasangraha Commentary of Sri Dalhanacharya and the Nyayachandrika Panjika of Sri Gayadasacharya on Nidanastana, Nidana sthana 32nd chapter, 6th verse Varanasi: Chaukhamba Surbharati Prakashan, 2014, Pn.290.

6. Acharya YT (ed.), Charaka Samhita of Agnivesha elaborated by Charaka and Drdhabala with Ayurveda Dipika commentary by Sri Chakrapanidatta, Nidana sthana 4th chapter 7th verse, Varanasi: Chaukhamba Surbharati Prakashan, 2014, pn.212.

7. Acharya YT (ed.), Charaka Samhita of Agnivesha elaborated by Charaka and Drdhabala with Ayurveda Dipika commentary by Sri Chakrapanidatta, Nidana sthana 4th chapter 9 verse, Varanasi: Chaukhamba Surbharati Prakashan, 2014, pn.213.

8. Acharya YT (ed.), Charaka Samhita of Agnivesha elaborated by Charaka and Drdhabala with Ayurveda Dipika commentary by Sri Chakrapanidatta, Chikitsa sthana 6th chapter 15th verse, Varanasi: Chaukhamba Surbharati Prakashan, 2014, p446.

9. Acharya YT (ed.), Susruta Samhita of Susruta with the Nibandhasangraha Commentary of Sri Dalhanacharya and the Nyayachandrika Panjika of Sri Gayadasacharya on Nidanastana, Chikitsasthana 12th chapter 4th verse, Varanasi: Chaukhamba Surbharati Prakashan, 2014, P454.

10. Acharya YT (ed.), Susruta Samhita of Susruta with the Nibandhasangraha Commentary of Sri Dalhanacharya and the Nyayachandrika Panjika of Sri Gayadasacharya on Nidanastana,chikitsa sthana 11th chapter, Varanasi: Chaukhamba Surbharati Prakashan, 2014, P452.

11. Paradakara HSS (ed.), Astanga Hrdaya of Vagbhata with the commentaries Sarvangasudara of Arunadatta and Ayurvedarasayana of Hemadri, Nidanastana 10th chapter 18-19th verse, Chaukhamba Sanskrit Samsthan, Varanasi, 2016, P504.

12. Acharya YT (ed.), Charaka Samhita of Agnivesha elaborated by Charaka and Drdhabala with Ayurveda deepika commentary by Sri Chakrapanidatta, Sutrasthana 16th chapter 21st verse, Varanasi: Choukamba Surbharati Prakashan, 2014,P97.

13. Paradakara HSS (ed.), Astanga Hrdaya of Vagbhata with the commentaries Sarvangasudara of Arunadatta and Ayurveda Rasayana of Hemadri, Sutrasthana 4th Chapter, 35th verse, Chaukhamba Sanskrit Samsthan, Varanasi, 2016, P59.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-10-24	2022-10-26	2022-11-02	2022-11-09	2022-11-16
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	19%

Case Report

Prameha

Journal of Ayurveda and Integrated Medical Sciences