E-ISSN:2456-3110

Case Report

Management of Diabetes

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 8 August
Publisherwww.maharshicharaka.in

Management of Diabetes Mellitus Type 2 through Panchakarma - A Case Study

Dhakar P1*, Sharma G2
DOI: DOI:10.21760/jaims.8.8.36

1* Pooja Kumari Dhakar, Pg, Panchkarma, Upgiasr, Jodhpur, Rajasthan, India.

2 Gyan Prakash Sharma, Head of Department, Panchakarma, Post Graduate Institute of Ayurveda, Jodhpur, Rajasthan, India.

Diabetes mellitus is a group of metabolic disorder characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Type 2 Diabetes Mellitus is one such type of Diabetes Mellitus which possesses a major risk factor for various other diseases. The chronic hyperglycaemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidney, nerves, heart, and blood vessels. Ayurvedic literatures vividly describe about the prognosis, complications and management of Diabetes Mellitus. Diabetes Mellitus has grown to such a status of global epidemic. Panchakarma (fivefold therapeutic) methods of Ayurveda have immense potential in context of tackling lifestyle disorders like Madhumeha. Here Panchakarma procedures like Basti (colon treatment) is mentioned in the treatment of Diabetes Mellitus. An attempt has been made to assess the role of Takra Dhara (Shirodhara) followed by Panchtikta Ksheerbasti in the management of type 2 diabetes mellitus in this case study. In result better improvement in subjective as well as objective parameters was observed.

Keywords: Ayurveda, Panchtikta Ksheerbasti, Diabetes mellitus, Panchkarma

Corresponding Author How to Cite this Article To Browse
Pooja Kumari Dhakar, Pg, Panchkarma, Upgiasr, Jodhpur, Rajasthan, India.
Email: 		Dhakar P, Sharma G, Management of Diabetes Mellitus Type 2 through Panchakarma - A Case Study. J Ayu Int Med Sci. 2023;8(8):234-237.
Available From
https://jaims.in/jaims/article/view/2709

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-06-05 2023-06-13 2023-06-21 2023-07-03 2023-07-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 21.58

© 2023by Dhakar P, Sharma Gand 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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Pooja Kumari Dhakar et al. Management of Diabetes Mellitus Type 2 through Panchakarma

Introduction

Diabetes is a Greek word meaning a passer through; a siphon. "Mellitus" comes from the Greek word "sweet". Apparently, the Greeks named it thus because the excessive amounts of urine diabetics produce (when blood glucose is too high) attracted flies and bees because of the glucose content. Changing life style, lack of exercise, improper and unbalanced diet, sedentary life style is showing an upward trend in India. This has led to the increase of Diabetes Mellitus in the region.[1] Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels.[2] Holistic approach of Ayurveda with regard to preventive, promotive and purificatory measures with due consideration of appropriate diet management has proven to be fruitful to provide better health to diabetes. Prameha has been quoted by Acharya Charaka as the most relapsing disease (Prameho‑Anushanginam).[3] It is mainly a Santarpanottha Vyadhi. Dushyas (pathogenetic factors) specially involved in the pathology of Prameha are Meda (fat), Mamsa (muscle tissue), Vasa (muscle fat), Majja (marrow), Kleda (body fluids), Shukra (semen), Rakta (blood), Lasika (lymph), and Rasa (plasma), and Oja.[4] In Kapha-Pittaja type of Prameha Aptarpanakarma (depletion therapy) is the main line of treatment. Considering the pathophysiology of the disease, Takradhara (Shirodhara) and Panchtikta Ksheer Basti to get Aptarpana result in DM.

Case Report

A 35‑year‑old thin male patient, with H/O DM‑Type 2 since 2 years, approached Panchakarma Outdoor Patient Department (OPD no. 3775), DSRRAU, JODHPUR with complaints of weight loss (since 3 years), backache, burning sensation in palm and sole. Drug history revealed that patient was on the injectable insulin (3.5 unit Before meal S/C).

Investigations: FBS, RBS
Management

After assessing Dosha, Dushya, Agni, Satmya, Satva, Aahar Shkti, Vyayam Shkti, Bala, Vaya

etc., Shirodhara with Takra - Aamalaki Churna Kwath (45 min) for 7 days was planned. After this, Basti Karma (Yoga Basti), Niruha with Panchtikta Ksheer Basti and Anuvasan with Triphla Ghrita was planned for 8 consecutive days as per mentioned in Ayurvedic Texts.

Table 1: Shodhan Chikitsa

SNProcedure Duration
1.Takra Dhara7 days
2.Panchtikta Ksheer Basti3 days
3.Triphla Ghrita Anuvasan Basti 5 days

Takra Dhara

Poorva karma (pre-operative)

Patient is made to lie on Shirodhara table. His body below the neck is draped with the cloth. 12 inches long and 2 inches wide cotton ribbon is placed along the lower border of ptient forehead. All the essentials to be collected such as Shirodhara Patra, table, stove, towel, cotton swabs, lukewarm water. Vitals to be recorded such as BP, weight, temperature, respiratory rate, heart rate. Consent of the patient to be taken.

Pradhan Karma (operative)

Pouring of the Takra with steady flow on the forehead for a 45 minute.

Paschat Karma (post-operative)

Patient is asked to take rest for about 15 minute and then take head bath with warm water.

Duration of Dhara - 7 days at morning hour for 45 min.

Basti Karma

In this, Yog Basti was administered specifically Panchatikta-Kshira Basti given as a Niruha-Basti in morning session, empty stomach. Patient was detained for 30 minutes in left lateral position for optimum effect of therapy. Panchtikta Ksheer Basti gives in the form of a Yapana Basti.

Ingredients of Panchatikta-Kshira Basti

The contents of Kwatha are Guduchi (Tinospora cordifolia), Nimba (Azadirachta indica), Patola (Luffa acutangula), Vasa (Adhatoda vasica) and Kantakari (Solanum xanthocarpum).

Drug used

Panchatikta Ksheer Basti (Yog pattern)


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Pooja Kumari Dhakar et al. Management of Diabetes Mellitus Type 2 through Panchakarma

Ksheerpaka Dravya:

Guduchi: Vasa: Nimba: 40grams + Godugdha (300ml) + Water (1280ml) = Reduced to Patola: Ksheeravashesha. Kantakari:

Basti formulation:

  • Madhu - 80ml
  • Saindhava - 10gms
  • Sneha - Panchtiktaka Ghrita - 120ml
  • Kalka - Shatapushpa 10gms + Yastimadhu 10gms
  • Panchatikta Ksheera Paka - 300ml

Anuvasana Basti - Triphla Ghrita - 120ml

Method

Form of Basti: Ksheer Basti

Dosage: 480ml

Kala: Pratah (10am to 11am), once a day.

Duration of Basti: 8 days

Route of Administration: per rectal

Before Basti, patient was subjected to Sarvanga Snehana (whole body oleation) with Dashmool Taila for 15 min and Bashpa Swedana (fomentation) for 2–3 min. During the Basti treatment, regular monitoring of blood sugar level (BSL) (fasting, just after administration of Basti, and postprandial) was done.

Table 1: Shamana Chikitsa

SNAyurvedic medicine Doses AnupanaDuration
1.Tab. BGR 341 bdUsnodak 20 days
2.Madhumehari ChurnaHalf tspUsnodak 20 days
3.Madhumehadaman ChurnaHalf tspUsnodak 20 days
4.Shivagutika (Chakra Datt)1 bdUsnodak 20 days
5.Tarunikusumakar Ras Half tspUsnodak 20 days

Table 2: Observation and Result

SymptomsScore before treatmentScore after treatment
Backache (visual analog scale)32
Heaviness in body31
Lethargy42
Swelling over legs00
Burning sensation over palms and soles20
Bad body odour31


Table 3: Effect of Therapy on Clinical Features

Clinical Features Grade
012345
Backache (visual analog scale)No painMild painMore than mild painModeratePainMore than moderate painSevere pain
Heaviness in bodyNo heavinessMild heavinessMore than mildModerateMore than moderateSevere
LethargyNo lethargyMildMore than mildModerateMore than moderateSevere
 Swelling over legsNo swellingMildMore than mildModerateMore than moderateSevere
Burning sensation over palms and solesNo burning sensationMildMore than mildModerateMore than moderateSevere
Bad body odorNo bad orderMildModerateSevere--

Table 4: Effect of Basti on Blood Sugar Level

Assessed onFasting BSL (mg/dl)BSL (mg/dl) just after BastiPostprandial BSL (mg/dl)
Day 1250200356
Day 2230210350
Day 3200198344
Day 4225200300
Day 5198180280
Day 6180170276
Day 7160150250
Day 8140130200

Effect of therapy was assessed on the basis of objective criteria such as BSL, body weight, anthropometric measures, body mass index (BMI); as well as subjective criteria such as Karpadadaha (burning sensation over palms and soles), Daurgandhya (bad body odor), Swedadhikya (increased sweating), Javoparodha (lethargy), Gurugatrata (heaviness in body)

Discussion

The biochemical composition of tissues changes with age, physiologic capacity decreases, the ability to maintain homeostasis in adapting to stressors decline, and vulnerability to disease processes increases with age.[5] There is Panchtikta Ksheer Basti was planned for Diabetes mellitus type 2 in the form of Yapna Basti. Yapana Basti is acting Srotoshodhaka as well as Brihmana at the same time. Panchatikta Ksheer Basti mitigates Vata-Pitta and maintains stability of Kapha. It acts on Rasa, Rakta, Mamsha, Medas, Asthi


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and Majja Dhatu. It removes Kleda and does Aampachan, Deepan therefore normalizes Medagni and Asthyagni and hence work as Srotoshodhan as well as due to presence of milk, Ghrita does Brihmana and Poshan. Panchatikta Ksheer Basti containing milk, Ghrita, and honey are used to cure the disease of Vata and these increases strength of body.[6] Its Rasayana property confirms its action on all body elements. Dhatu Poshana depends upon unimpeded Srotas. Dhatvagni and Vayu if nourishing factors are properly provided.[7] In Panchatikta Ksheer Basti Tikta drugs are used and because of Tikta drugs this Basti decrease blood glucose level. Thus Janan (formation of body elements) property of Yapana Basti is due to Srotoshodhana quality and nourishing substances used in it.

Conclusion

The drugs selected for Panchatikta Ksheer Basti have the property of anti-inflammatory, analgesic, antibacterial, antitoxin, antioxidant and antitumor, immunomodulator, hepato-protective. The compound formed by these drugs contained glycosides, saponins, essential amino acids like isoleucine. methionine etc. On the basis of above facts, we can assume that the drugs compound thus formed affected in the management of diabetes mellitus type 2.

References

1. Role Of Panchakarma in The Management of Madhumeha w.s.r. to Type 2 Diabetes Mellitus: A Review Vidyashree K, Karthikeya Prasad, Shilpa A. ISSN: 2320 5091 Impact Factor: 4.018

2. WHO-Programmes and projects media centre fact sheet no. 312 November 2009.

3. Acharya YT, editor. Charaka Samhita of Agnivesha, Sutra Sthana. Ch. 25, Ver. 40, Reprint Edition. Varanasi: Choukhambha Krishnadas Academy; 2006. p. 132.

4. Charaka Samhita of Agnivesha, Chikitshasthan. Ch. 6, Ver. 8, Reprint Edition. Varanasi: Choukhambha Bharti Academy; 2016. p. 229

5. Kavita B.S, Santosh. L. Yadahalli, A Clinical Study To Understand And Evaluate The Effect Of Panchatikta Ksheera Basti In The Prevention And Management Of Jarajanya Asthikshaya W.S.R.To Osteoporosis, Volume 6, Issue 11, 2018

6. Sharma RK, Dash B, editors. Charaka Samhita of Agnivesha, siddhisthan, Chapter 8, Verse no. 4. Varanasi; Choukhambha Sanskrit Series Office; 2012:324-5

7. Sharma RK, Dash B, editors. Charaka Samhita of Agnivesha, Sutrasthan, Chapter 28, Verse no. 3. And vimansthan of Charak Samhita, chapter 5, verse Varanasi; Choukhambha Sanskrit Series Office; 2012:324-5


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