Journal of Ayurveda and Integrated Medical Sciences

Introduction

Diabetic Peripheral Neuropathy (DPN) can cause significant health concerns and decreases the quality of life. If left untreated it may even lead to debilitating consequences like loss of motor activity, foot ulcers, progress to gangrene and amputation. Prevalence^[1] of DPN in south India is about 26.1%. Now it is the duty of Vaidya, to try to understand the cause of this disease well enough to design rational therapy to manage it. In Ayurveda, although there is no direct correlation for DPN but the most basic symptoms mentioned under Purvaroopa and Upadrava of Prameha such as Karapada Daha, Karapadasuptata, Toda (Shoola), Harsha/ Chuchumaya (tingling sensation), Shosha (wasting), Dourbalya (weakness), and Angasaad (malaise) all these resemble the condition of DPN.

Pathology behind it is can be studied under Madhumeha Upadrava caused by Avarana Janya Vata Prakopa. And Upadravas are those which develop after the onset of main disease and are dependent on Pradhaana Vyadhi. It will have the same Nidaana, Dosha, and Dushyas as that of the main Disease, though they have Samprapti of its own.

When main Disease is managed well, complications will disappear. With this intention, Rajanidvandvadi Kwatha^[2] one of the classical Ayurvedic formulations mentioned under Prameha whose all the ingredients are herbal in origin and are known to have Pitta and Vatahara effects but its efficacy has not been documented. Also, Rajani (Nisha) is considered to be Agraoushadha (Drug of choice) in Prameha hence an effort has been made to evaluate the efficacy of Rajanidvandvadi Kwatha in Prameha Upadrava.

Objectives

1. The present study is intended to understand the aetiopathogenesis of Prameha Upadrava vis-à-vis Diabetic Peripheral Neuropathy.

2. To evaluate the efficacy of Rajanidvandvadi Kwatha in the treatment of Prameha Upadrava vis-à-vis Diabetic Peripheral Neuropathy.

3. To evaluate the efficacy of Nishamalaki Kwatha in the treatment of Prameha Upadrava vis-à-vis Diabetic Peripheral Neuropathy.

Exclusion criteria

1. Type 1 Diabetes Mellitus patients
2. Gestational diabetes
3. Diabetes Mellitus produced due to other illnesses like Acromegaly, Cushing’s syndrome, pancreatic disorders etc.
4. Autonomic and focal neuropathic patients will be excluded

Investigations

Blood: FBS, PPBS,

Glycosylated haemoglobin (HbA1c) (before treatment)

Urine: FUS {if required}

Assessment criteria

1. Daha
2. Chumachumayana
3. Toda (Shoola)
4. Dourbalya
5. Suptata

Objective criteria^[4-6]

1. Toranto clinical neuropathy screening system
2. Young et al criteria diabetic neuropathy symptom score

Intervention

Group A (Study group)

Rajanidvandvadi Kwatha Choorna with lukewarm water will be given 30mins before food twice a day (Morning and Night) for 30 days.

Group B (Control group)

Nisha Amalaki Kwatha Choorna with Lukewarm water will be given 30minutes before food twice a day (Morning and Night) for 30 days

Observations

Among the 40 patients taken for the study 40% of the patients were 50-60 years. 80% patients were males and 20% were females. 90% of the patients belonged to Hindu Religion.

90% of patients were married. Majority of the patient belonged to upper middle class i.e. 90%. 95% of the patients had the dietary habit of taking mixed diet. 60% of the patients had the habit of taking coffee or tea regularly.

Table 1: Effect of Rajanidvandvadi Kwatha and Amalaki Kwatha on the symptoms of Prameha Upadrava

Table 2: Effects of Rajanidvandvadi Kwatha and Amalaki Kwatha on objective criteria

.

in excess and become accumulated in tissues which causes damage to nerve tissue and produces axon degeneration which leads to neuropathy.Here axon degeneration and demyelination of nerve sheath may be attributed to Vata Prakopa and Kapha Kshaya. The rapid rate of activity of enzyme sorbitol dehydrogenase may be attributed to Pitta Vriddhi. Normalcy of Vayu is needed for proper healing, growth, and proper maintenance of tissue. Thus, involvement of Tridoshas is apparent in DPN. Rajanidvandvadhi Kwatha is having Tikta, Kashaya Rasa Rasa and Ruksha Guna among which Tikta (bitter) Rasa is said to be “Kleda Upashoshana” Meda Shoshana and Kapha Harana while Kashaya (astringent) Rasa to be “Sharira Kledasya Upayokta.” helps in Sthireekarana of Dhatus and also does Kleda, Meda,Vasa, Majja, Lasika, Sweda, Mutra, Pitta, Shleshma, Upashoshana. They are having opposite qualities to that of Kapha and Medas which is the main entity of the pathogenesis of Prameha so these together is helpful in Sthulapramehi & effectively counteract the Samprapti. Most of the ingredients in the formulations are having the properties like Rakthaprasadana, Kushtahara & Vranaropana etc. along with Dahaprashamana, Sheeta Veerya which are helpful for Kara Pada Daha and Kara Pada Supthi.

Here, Peripheral Neuropathies and vasculopathies which are quite in accordance with the late complications of Diabetes Mellitus & for the skin lesions in modern science which are produced in the disease Prameha can be treated. Also, Tikta Rasa removes Sroto Rodha, does Sroto Vivarana & the action of Lekhana might be seen and thereby helps in alleviating Kapha Prakopa. It can be understood in terms of an elevated glycated end product at the cellular level which activates polyol pathway or sorbitol/aldose reductase pathway that decreases the level of glutathione and nitric oxide which is an important vasodilator in turn increase in reactive O2 radicals.This sorbitol cannot cross cell membrane, accumulates & causes osmotic stress on cells by drawing water into cells causing inflammation. Correlating it to Diabetic neuropathy which is a Vatapradhana Tridoshaja Vyadhi having Anubandha with Pitta and Kapha. Where, Kapha, Pitta that are mainly responsible factor for Avarana of Vata, in Madhumeha Samprapti. Vidanga has Nadibalya effect and thus useful when there is neuropathy.