Journal of Ayurveda and Integrated Medical Sciences

Madhumeha (Diabetes Mellitus) is defined as a group of metabolic disorders characterized by a high blood sugar level over a prolonged period of time. In Ayurvedic classics, 20 types of Prameha are described and Madhumeha has been described as sub type of Vatik Prameha in which patient passes excessive amounts of urine (Bahumutrata) that tastes & looks like honey. Prameha has been described under eight Maharoga.^[1] It is one of the most alarming diseases and possesses a special place in medical science due to its high prevalence in the society and increased incidence. Though Madhumeha is a subtype of Vataja Prameha it has more prevalence in the society and may be considered to be diabetes mellitus of the modern medical sciences. India has been projected by WHO as the country with the fastest growing population of Diabetes patients. About 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year. Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades.^[2] Acharya Vagabhatt has classified Madhumeha into two categories these are Dhatukshaya-janaya Madhumeha and Avarana-janya Madhumeha. The factors which provoke Vata directly, cause Apatarparjanya Madhumeha and the factors which provoke Kapha and Pitta, cause Santarpanajanya Madhumeha.^[3] Acharya Charaka describe two types of Prameha Rogi i.e., Sthula Pramehi and Krisha Pramehi. Samshodhana therapy is indicated in Sthula Pramehi and Samshamana therapy is indicated in Krisha Pramehi.^[4] For elimination of vitiated Doshas, Virechana is appropriate Shodhana procedure. Virechana Karma though indicated for Pitta Dosha eliminates Vata Dosha by Pakwashaya Shuddhi (defecation) and Kapha Dosha by its Tikshana (pungent) Guna.

Patient Information: A male patient of age 57 years suffering from Diabetes Mellitus type-2 complaint of Polyuria (Increase in Urine frequency), Polydipsia (Increase thirst), Fatigue since 6 months came to OPD for Ayurvedic treatment. He has no history of CAD, hypothyroidism, hypertension or any other serious illness.

History of Past illness: Patient haven't any history of CAD/HTN/Thyroid disease/any major surgery.

In this case first Deepana Pachana is done with Vaishwanar Churna (3gm) + Shunthi Churna (1 gm) for 3 days then Panchatikta Ghrita is advised for Snehapana in increasing order according to Kostha of the Patient (Table 1). After Snehapana Abhayanga with Panchaguna Taila and Swedana Karma with Dashmoola Kwatha is done for 3 days and then Virechana Karma is advised with Erand Taila with Godugdha and Icchabhedi Rasa is given (Table 2). After Virechana Karma Samsarjana Karma is advised to patient for 7 days.

Table 1: Showing dose of Panchatikta Ghrita Pana

Table 2: Showing schedule of Virechana Karma

Diet before Virechana Karma

Diet which increases Kapha, should not be advised. Patient should be advised to take Laghu, Snigdha, Drava, Ushna Ahara, Jangala Mamsa Rasa.^[5] Acharya Sushruta advised a light diet and Phalamla juice.^[6]

Follow up

Patient is advised to Follow Up after end of Samsarjana Karma and second follow up done after 15 days i.e., patient will be clinically assessed on 0, 21^st and 36^th day.

Virechana Karma is indicated in Prameha in Charak Siddhi 2^nd Chapter in Virechana Yogya. Virechana Karma though indicated for Pitta Dosha eliminates Vata Dosha by Pakwashaya Shuddhi and Kapha Dosha by its Tikshana Guna. So, it brings normalcy of Tridosha. It acts at microcellular level and help to maintain normal physiology of tissues. Virechana Karma provides better result as far as Krura Kostha is concerned. Once the proper metabolism starts, it prevents Vata Avarana and Dhatu depletion, normalize the Agni and makes substratum suitable for the drug. Achaya Bhela has mentioned Virechana Karma in Sannipataja condition also. Acharya Vagbhata says that there are no vitiation of Doshas after doing Samshodhana i.e., Virechana Karma.^[7] Icchabhedi Rasa used in Virechana Karma contains Shunthi, Maricha, Kajjali, Tankan, Shuddha Parad, Shuddha Gandhak, Shuddha Jaipala having properties of Katu Rasa, Ushna, Teekshna, Sara Guna, Katu Vipaka and Vatanulomana Karma. All these properties attribute to Virechana action of Icchabhedi Rasa.^[8] According to Acharya Sushruta these properties helps in stimulation of Teekshna Virechana. Erand Tail clears obstruction in the Srotas (body channels) and relieves Vata vitiation. In Samhitas it is mentioned to be Vata Kapha Hara and Adhobhaga Doshahara (disorders of lower parts of the body).^[9]

Virechana mainly eliminates Pitta Dosha and it is assumed that liver and spleen is the main seat of Pitta Dosha. So, Virechana Karma may help to reduce hepatic glucose production and overcome the impaired insulin secretion. Thus, helps in reducing Blood sugar levels.

Also increased lipolysis, elevated free fatty acid levels, along with accumulation of intermediary lipid metabolites contributes to further increase glucose output, reduce peripheral glucose utilization, and impair beta-cell function. Virechana directly or indirectly corrects the whole metabolism of lipid formation and excretion thus normalizing beta-cell dysfunction. Beta cell of islets of Langerhans get dysfunctional due to Cytotoxic T cells, Natural killer lymphocytes and Nitric oxide (NO). The products of metabolism can be eliminated by Shodhana Karma (purification) as described by terms like Malapaham (excretion of toxins) and Visudha Kostha (clearing the gastrointestinal tract).