E-ISSN:2456-3110

Review Article

Diabetic Neuropathy

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 12 December
Publisherwww.maharshicharaka.in

The systematic review on Madhumeha w.r.t. Diabetic Neuropathy and its management: A review article

Megha S1*, Shweta B2, Singh NR3
DOI:10.21760/jaims.8.12.23

1* Sain Megha, Post Graduate Scholar, Dept of Kayachikitsa, Ch Brahm Prakash Ayurved Charak Sansthan, Khera Dabar, New Delhi, India.

2 Bisht Shweta, Post Graduate Scholar, dept of Kayachikitsa, Ch Brahm Prakash Ayurved Charak Sansthan, Khera Dabar, New Delhi, India.

3 N R Singh, Professor and HOD, Dept of Kayachikitsa, Ch Brahm Prakash Ayurved Charak Sansthan, Khera Dabar, New Delhi, India.

<p>The world''s fastest-growing major illness is diabetes mellitus. It''s a metabolic illness that could lead to an insufficiency or malfunction in the production of insulin. Many of the Samhitas contain detailed descriptions of Madhumeha. Diabetic neuropathy is most common complication of Diabetes, approximately 50% of patients with diabetes eventually develop neuropathy. Symptoms of diabetic neuropathy not directly mentioned in Ayurveda but symptoms like Suptata, Chumchumayan, Karpada Daha, seen in Prameha either in Prameha prodomal stage, exhibition stage or in complication stage. As Samprapti of diabetic neuropathy not clearly mentioned in Samhitas so, after reviewing different Samhitas, a Samprapti has been suggested with possible management of Diabetic neuropathy in Ayurveda i.e., Shodhan and Samana Chikitsa and mode of action of Shodhan Chikitsa.</p>

Keywords: Diabetes, Diabetic Neuropathy, Radiculopathy.

Corresponding Author How to Cite this Article To Browse
Sain Megha, Post Graduate Scholar, Dept of Kayachikitsa, Ch Brahm Prakash Ayurved Charak Sansthan, Khera Dabar, New Delhi, India.
Email: 		Megha S, Shweta B, Singh NR, The systematic review on Madhumeha w.r.t. Diabetic Neuropathy and its management: A review article. J Ayu Int Med Sci. 2023;8(12):145-150.
Available From
https://jaims.in/jaims/article/view/2961

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-10-06 2023-10-18 2023-10-28 2023-11-08 2023-11-18
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared. Nil. yes. 15.32 Nnone

© 2023by Megha S, Shweta B, Singh NRand 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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Introduction

‘Maheshu Uccha Madhu Ev Madhuram Mehati’ which means that one which is superior to all other Meha and is categorized by passage of urine as sweet as honey i.e., Madhumeha.[1] ‘Mahatyaya’[2] is the term given to Madhumeha in classical Samhitas which means Mahavyapattikara (causing severe complication).

It shows complex disease process involving all three Dosha’s (Vata, Pitta, Kapha) and most of the body components i.e., Dushyas (Rasa, Asrika, Mamsa, Meda, Majja, Shukra, Ambu, Vasa, Lasika, Ojas and Sweda).[3] Moreover, the involvement of Asthi cannot be ignored

as growth of Kesha and Nakha which is described in Purvarupa.[4]

Nidana of Madhumeha

Avyayma[5] (lack of exercise), Atapasevana[6] (exposure to sunlight), Agni Santapa (Proximity to fire), Ajirna Bhojana (indigestion), Anashana (fasting),Vega Dharana (controlling natural urges), Abhighata (Injury), Divaswapna (day sleep), Alasya (lazy), Krodha (anger), Shoka (sad), Atiyoga of Vamana, Virechana, Asthapana Nasya.[7]

Dietary factors: Overindulgence in yoghurt, fish, milk, new grains, sugar-containing foods and beverages, and jaggery (raw cane sugar) foods that are cold, sweet, difficult to digest, and slimy in nature.[8]

Lifestyle factors: A sedentary way of life, excessive sitting, sleeping too much, napping during the day, indolence, and lack of exercise.[9]

Psychological factors: Mental illness brought on by psychological extremes like bipolar disorder and Vishada (depression).

Samprapti (Etiological factors)

The person intaking food substances which are having Guru, Snigdha quality, Amla and Lavana Rasa, Navannapana, in large quantity and indulge in excessive sleep, avoiding exercises, sitting in a same place for longer duration, abstinence of mental activity and also not performing the Shodhana process in a proper time are prone to get Prameha. According to Acharya Sushruta, if Prameha is left untreated, it gets converted into Madhumeha and becomes incurable.

Acharya Vagbhatta says that the urine of Madhumehi will be similar to that of Madhu. Prakupita Vata plays an important role in Samprapti of Madhumeha. Vata Prakopa occurs mainly due to two causes - Dhatu Kshaya and Marga Avarodha.

Madhumeha Samprapti can be can be broadly classified into 2 types - Avaranjanya and another is Kshayatmaka. Avarnajanya is by Pitta and Kapha and Kshyatmaka is due to Vata. Chala Guna of Vata declines by Avarana of Kapha and pitta and hindering normal nerve impulse conduction and worsening of myelin sheath.

The fatty white matter that surrounds nerve cells' axons to form the electrically insulating layer is known as the myelin sheath of neurons. Proteins make up 15-30% of myelin, lipids make up 70-85% of the dry mass, and water makes up about 40%.

On later stage of disease due to Vata-Prakopa occurs which causes Dhatukshaya and eventually leads to Ojakshaya.

As Ojas is the essence of Sapta Dhatus. Oja is of two type Para and Apara Ojas, Pramana of Apara Oja is Ardha Anjali Pramana and is Sleshmika in nature, and this Apara Oja losses through urine in this Vata Prakopa stage of Madhumeha. In both stages, Avaranjanya and Kshyajanya proper functioning of Vyana Vayu doesn’t occur which leading to signs and symptoms of diabetic neuropathy. Long-term exposure to the same Nidana causes ongoing vitiation of Dosha, Dhatu and Mala. As a result, the disease advances to the point of complications that can lead to a number of different diseases collectively referred to as Upadrava. The different references of neuropathy symptoms of Diabetes featured as Purvarupa, Roopa, Updravas of Prameha are mentioned as:

Numbness

  • Supti Prameha Purvaroopa (C.S),
  • Tawkgata Vata (S.S)
  • Karasupti Prameha Purvaroopa (C.S)
  • Padasupti Vatajananatmajvikara (C.S)
  • Angasupti Twakgata Vata (S.S)

Tingling sensation

  • Chumuchumayana Tawkgata Vata (S.S)
  • Harsha/Roma-Harsha Kaphayukta-Udana (S.S)
  • Samanayukta-Kapha (S.S)

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  • Harsha-Pippilika Mamsavrita Vata Sancharan (C.S)

Needling sensation

  • Suchiribhiv-Nistodam Shonitavrita Vata (S.S)
  • Suchiribhiv-tudyate Asthiavrita Vata (C.S)

Burning sensation

  • Daha Prameha-Purvarupa (C.S)
  • Prameha Updrava (C.S)
  • Vidaha Pittananatmaja Vikar

Diabetic Neuropathy

India is the diabetes capital of the world with approximately about 109 million individuals are affected with the diabetes by 2035. Patients with Diabetic mellitus about 7.5% to 24% experience significant neuropathic pain. Diabetic neuropathy is the nerve damage happening in the body due to uncontrolled blood glucose.

Depending on the affected nerve, symptoms of diabetic neuropathy can range from pain and numbness in bilateral or unilateral lower limbs especially soles and may affect the digestive system, urinary tract, blood vessels and heart. The symptoms range from mild to severely painful and disabling which may hamper the quality of life of the patient.

Small unmyelinated nerve fibers are affected in diabetic mellitus which is responsible for pain and temperature sensation.

Although it can occur in both type 1 and type 2 diabetes mellitus, there is a higher prevalence in type 2. Globally, diabetic neuropathy affects approximately 132 million people as of 2010 (1.9%) of the population. There is a higher prevalence (60.4%) and incidence 8.76% of sensory peripheral neuropathy in diabetic patients.

It may go on increasing as the age progress. It is an upcoming global problem which affects the daily life of the patients.

There are mainly four types of neuropathies. Symptoms will depend upon the type of nerves affected. The symptoms usually develop gradually.

1. Peripheral neuropathy

  • Commonest type
  • 1st affect the legs and feet then hand and arms
  • Worsen at night

2. Autonomic neuropathy

The heart, bladder, stomach, colon, sex organs, and eyes are all under the control of the autonomic nervous system. These organ-related symptoms will manifest if diabetes mellitus has an impact on the autonomic nervous system.

3. Radiculoplexus neuropathy (Diabetic amyotrophy)

  • Common in patient of type 2 Diabetes and older adults.
  • Affects nerves in thigh, hip, buttock and legs.

4. Mononeuropathy; This neuropathy focal in nature and damage to a specific nerve in the face, middle of the body(torso)or legs. Its more common in the older adults.

Symptoms may present as follows;

Peripheral neuropathyAutonomic neuropathy
1.  Loss or reduced sensation of pain and temperature and numbness.1.  Incontinence, UTI and urine retention when it affects bladder.
2.  Tingling or burning sensation2.  GI symptoms like nausea, vomiting, bloating, loss of appetite, dysphagia, slow stomach emptying, constipation, diarrhoea or both.
3.  Sharp pain or cramps3.  Increased or decreased perspiration, difficulty in controlling body temperature
4.  Hyper-sensitivity to touch-for some people even the weight of the thin blanket can be painful.4.  Increased heart rate at rest
5.  Muscle weakness and areflexia specially in the ankle.5.  Decreased sexual response.
6.  Loss of balance and coordination--------
Radiculoplexus neuropathyMononeuropathy
1.  Severe pain in hip and thigh or buttocks that occurs in a day or more.1.  Pain in sheen or foot.
2.  Eventual weak and shrinking thigh muscles2.  Pain in lower back or pelvic
3.  Difficulty in raising from a sitting position3.  Pain in front of thigh
4.  Abdominal swelling if the abdomen is affected.4.  Pain in chest or abdomen
5.  Weight loss----------

Aim and Objectives

1. To review the available literature in ayurvedic text and its correlation with modern literature on Diabetic Neuropathy


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2. To review Madhumeha in the context of Diabetic neuropathy and its management.

Materials and Methods

Madhumeha has been explained decoratively in Brihatrayi by Acharya Charak, Sushruta, Vagbhata. From the period of Charak, Madhumeha has been described as a separate disease which usually occurs as the result of untreated Prameha.

Management of Diabetic Neuropathy

Shodhana Chikitsa

Vata Dosha is always involved in cases of diabetic polyneuropathy. Vata Prakopa is primarily responsible for nerve degeneration, and Madhumeha is of Vataja Prameha. A major manifestation of Majja Dushti, which causes demyelination of nerve fibers due to microvasculopthy and hyperglycemic injury to nerve cells, is diabetic polyneuropathy. This condition is caused by the morbid increase in Dhatus prior to Medas and the consequent lack of Poshana of Uttara Dhatus, i.e., Asthi, Majja, and Shukra.

In Majja Dushti, Arumshika, Timira has been mentioned which can be correlated to diabetic retinopathy and diabetic carbuncles. In Shodhana Chikitsa, Basti Karma and Virechana procedures will help to reduce the symptoms of diabetic neuropathy.

Probable role of Basti in Diabetic neuropathy

Shodhana Chikitsa breaks the pathogenesis of disease and balances vitiated Doshas. For the purpose of managing Avaranajanya Madhumeha, Basti Karma aids in the normalization of Vata, Kapha, Meda, Kleda, and Sneha.

Basti plays a major role in the pathophysiology of Madhumeha by assisting in the control of Vyana and Apana Vayus. Basti lowers Santapa, Anidra, Bhrama, and Shirahshoola, all of which can cause diabetes.

Probable role of Virechana in Diabetic neuropathy

Virechana helps to subside Pittaja Lakshana like Karapada-Daha, Suptata (Numbness) and Daha (Burning sensation). Thus, Diabetic neuropathy symptoms will be pacified.

And other procedures like Abhyanga, Udvartan, Potali Sweda.[10]

Shaman Chikitsa

Effective drugs in Diabetic NeuropathyForm
1.  Dashamoola
2.  Balaguduchi Ksheer[11]		Kwath
3.  Jeevaniya- Balya GanaKwath
4.  Sudha ShilajatuVati, Gutika, Lauha
5.  TriphalaChurna
6.  Ashwagandha[12]Churna,Vati
7.  Atibala MoolaKwath
8.  Bhumyamalaki Churna
9.  Guduchi SatwaVati,Churna
10.  Yashada Bhasma

Discussion

There isn't a direct reference to DNP in the classic Ayurvedic texts. According to Acharya Charak, a Vaidya should take into account Samuthana Vishesha (the disease's causal factor), Adhishthana (the location of the disease's manifestation), and Vikara Prakruti (the nature of the disease) when diagnosing a patient. DPN should be interpreted in light of the Dosha predominance and is regarded as the Upadrava of Madhumeha.

As a Prabhuta-Avila Mutrata resulting from Vataprakopaka Samprapti and loss of Saumya Dhatu, DPN, according to Ayurveda, is a progressive complication phase of diabetes and can be understood as a Vata-Pitta dominant stage of Prameha. Vata becomes more vitiated and eventually transforms into Madhumeha (excessive turbid urination), which leads to the degeneration of the nerve's myelin sheath and pathological brittleness in the body.

As it is Margavarodhajanya Vyadhi, due to which further Dhatu Poshana does not occur, Shodhana and Shamana Chikitsa plays significant role in management of Diabetic neuropathy.

As it is it Vata-Pitta Pradhana pathological condition, Use of Basti and Virechana Karma plays significant role in management as it pacifies Vata-Pittakara symptoms such as Karapada Daha, Suptata, Chimchimayana. In Shamana Chikitsa, above mentioned drugs contains Laghu, Ushna, Tiksha Guna. Katu Rasa and the Karma of Katu Rasa plays significant role in Samprapti Bhanga of DPN as its Karma are as follows - Shodhayati, Agni Deepayati, Sneha-Sweda-Kleda Hanati, Margan Vivaranoti, Shleshma Shamayanti.


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These drugs will clear the Srotas and due to Rasayana, Balya, Vrishya properties, Poshana of Dhatu will occur, which might initiate the process of nerve regeneration and further there will be improvement in nerve conduction.

Conclusion

In current era due to desk bound lifestyle, Diabetes is one of the common metabolic diseases. Due to its chronicity, it is turning into painful DPN. In day-to-day practice, it is high time to find out the best solution to treat this condition. It is a big time to probe the list of application of Ayurvedic Shodhana and Shamana Chikitsa. Shamana Chikitsa act as a primary mode of care. The approach of Shamana Chikitsa helps to enhance the overall health of the body. Thus, Ayurveda is a better treatment option available to improve the quality of life of patients with Diabetic polyneuropathy.

References

1. Kasinatha Sastri PT. The Caraka Samhita of Agnivesha with Vidyotini Hindi Commentary: Prameha Nidana Adhyaye. Nidana Sthana Chapter 4/44. Varanasi: Chaukhambha Sanskrit Sansthan; 2007. Reprint.

2. Kasinatha Sastri PT. The Caraka Samhita of Agnivesha with Vidyotini Hindi Commentary: Prameha Nidana Adhyaye. Nidana Sthana Chapter 4/38. Varanasi: Chaukhambha Sanskrit Sansthan; 2007. Reprint.

3. Shastri K, Chaturvedi G. Prameha Nidana Adhyaya. Nidana Sthana. In: Pandeya G, editor. Charak Samhita. Vidyotini vyakhya Vol. 2. Varanasi: Chaukhamba Bharti Academy; 2011. p. 632.

4. Kasinatha Sastri PT. The Caraka Samhita of Agnivesha with Vidyotini Hindi Commentary: Prameha Chikitsa Adhyaye. Chikitsa Sthana Chapter 6/13. Varanasi: Chaukhambha Sanskrit Sansthan; 2007. Reprint.

5. Kasinatha Sastri PT. The Caraka Samhita o­-­f Agnivesha with Vidyotini Hindi Commentary: Prameha Nidana Adhyaye. Nidana Sthana Chapter 4/05. Varanasi: Chaukhambha Sanskrit Sansthan; 2007. Reprint.

6. Ambikadattashastri Kaviraj Dr. Sushruta Samhita Ayurvedatatvasandipika: Prameha Nidana Adhyaye. Nidana Sthana Chapter 6/3. Varanasi: Chaukhambha Sanskrit Sansthan; 2020. Reprint.

7. Kasinatha Sastri PT. The Caraka Samhita of Agnivesha with Vidyotini Hindi Commentary: Prameha Nidana Adhyaye. Nidana Sthana Chapter 4/36. Varanasi: Chaukhambha Sanskrit Sansthan; 2007. Reprint.

8. Kasinatha Sastri PT. The Caraka Samhita of Agnivesha with Vidyotini Hindi Commentary: Prameha Chikitsa Adhyaye. Chikitsa Sthana Chapter 6/04. Varanasi: Chaukhambha Sanskrit Sansthan; 2007. Reprint.

9. Ambikadatta Shastri Kaviraj. Sushruta Samhita Ayurvedatatvasandipika: Prameha Nidana Adhyaya. Nidana Sthana Chapter 6/28. Varanasi: Chaukhambha Sanskrit Sansthan; 2020. Reprint.

10. Rao K, Krishnaindu; Kumar S, P.P. Nair; Radhakrishnan P. Management of diabetic peripheral neuropathy through Ayurveda. Journal of Ayurveda Case Reports. 2020 Jul 14;3. DOI: 10.4103/JACR.JACR_2_20.

11. Rao K, Krishnaindu; Kumar S, P.P. Nair; Radhakrishnan P. Management of diabetic peripheral neuropathy through Ayurveda. Journal of Ayurveda Case Reports. 2020 Jul 14;3. DOI: 10.4103/JACR.JACR_2_20.

12. Surendran S, Goyal M. Ayurvedic management of idiopathic small fiber neuropathy: A case report. Journal of Ayurveda and Integrative Medicine. 2023 Mar-Apr;14(2).


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