E-ISSN:2456-3110

Review Article

Ayurvedic management

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 12 December
Publisherwww.maharshicharaka.in

Ayurvedic management of Prameha - A Single Case Study

Sreeraj P1*, Veeraj PH2
DOI:10.21760/jaims.8.12.44

1* P Sreeraj, Assistant Professor, Department of Swasthavritta and Yoga, Yenepoya Ayurveda Medical College and Hospital, Mangaluru, Karnataka, India.

2 P Hegde Veeraj, Professor and HOD, Department of Swasthavritta and Yoga, Yenepoya Ayurveda College and Hospital, Mangaluru, Karnataka, India.

Diabetes mellitus (DM) type 2 is one of the global problems of the present day and it is gaining more attention. It is expected to continue as a major health problem and leads to serious complications. India is one of the top 5 countries with the highest prevalence of DM. The IDF Diabetes Atlas (2021) reports that 10.5% of the adult population (20-79 years) has diabetes, with almost half unaware that they are living with the condition. By 2045, IDF projections show that 1 in 8 adults, approximately 783 million, will be living with diabetes, an increase of 46%.[1] The signs and symptoms of diabetes can be correlated to Prameha of Ayurveda. The management of Prameha is mentioned in Ayurveda as preventive and curative aspects. Ayurveda has recommended an appropriate use of Oushadha Yogas along with proper Pathya (wholesome) Ahara, and Viharas. On the same principles a patient was treated at OPD basis, this case report analyses the same. A male patient, aged 45 years, diagnosed case of Prameha 5 years back presented with dryness in the mouth, increased frequency of micturition, Excessive thirst, weakness of the body, and burning sensation at the sole. The treatment planned was use of Shamana Oushadhis along with proper Pathya (wholesome) Ahara, and Vihara for three months. After three months of treatments results were compared. There was a marked reduction in signs and symptoms like burning sensation, numbness, excessive thirst, and increased micturition.

Keywords: Madhumeha, Type-2 diabetes mellitus, Prameha Chikitsa, Pathya Ahara Vihara

Corresponding Author How to Cite this Article To Browse
P Sreeraj, Assistant Professor, Department of Swasthavritta and Yoga, Yenepoya Ayurveda Medical College and Hospital, Mangaluru, Karnataka, India.
Email: 		Sreeraj P, Veeraj PH, Ayurvedic management of Prameha - A Single Case Study. J Ayu Int Med Sci. 2023;8(12):291-294.
Available From
https://jaims.in/jaims/article/view/2974

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-10-14 2023-10-22 2023-11-01 2023-11-14 2023-11-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared. Nil. yes 14.32 none

© 2023by Sreeraj P, Veeraj PHand 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].

J Ayu Int Med Sci 2023;8(12)291
Sreeraj P. et al. Ayurvedic management of Prameha - A Single Case Study

Introduction

Prameha, which is explained as increased frequency and altered turbidity of urine.[2] According to Ayurveda Prameha is considered as one among the Mahagada.[3] Prameha can be correlated with diabetes mellitus based on signs and symptoms. Over-indulgence in the pleasure of a sedentary lifestyle, excess sleep, a diet like curds, soup of the meat of domesticated and aquatic animals and animals residing marshy land, milk and its preparations, freshly harvested food articles, preparations of jaggery and all Kapha aggravating factors are responsible for the causation of Prameha.[4] It is classified into three types Kaphaja, Pittaja and Vataja, and again subdivided into 10, 6 and 4 types respectively.[5] The types of Doshas, which have entered the urinary tract in vitiating the condition give rise to the respective types of Meha with their dominance.[6] The treatment of diabetes without adverse side effects remains a major challenge, and Ayurvedic science can play an important role in it. Ayurvedic treatment for diabetes includes using herbal medicines, lifestyle modifications, and dietary changes.

Aims and Objectives
To establish an effective Medicare for metabolic diseases which have chronic Systems illness.

Materials and Methods

Intervention

Table 1

SNMedicinesDosageDuration
1.Amruthothara Kashaya15 ml + 45 ml Luke warm water, 2 times, empty stomachFirst 15 days
2.Chandraprabha Vati1 BD with KashayaFirst 45 days
3.Dia P tablet (Saptachakra, Triphala, Asana, Guduchi etc..)1 Tid after food90 days
4.Nishakatakadi Kashaya15 ml + 45 ml Luke warm water, 2 times, empty stomach15th day - 60th day
5.Nishamlaki tablet2 bd before food15th day - 90th day
6.Asanadigana Kashaya15 ml + 45 ml Luke warm water, 2 times, empty stomach60th day - 90th day

Table 2

SNPathya AharaPathya Vihara
1.Barley Ganji for nightLight aerobic exercises
2.Fenugreek mixed in water
(10 glass water, roughly 1.5 liters mixed with 10 grams fenugreek, reduced to 6 glasses roughly, 1 liters) drink whenever feels thirst		Yogaasanas
Padahastasan, Setubandhasana, Vakrasana, Ardhamatsyendrasana

Observations

Table 3: Subjective Criteria

Criteria1st day15th day30th day45th day60th day75th day90th day
Debility+++++++++++++-
Dryness in mouth++++++++++++++-
Excessive thirst++++++++++++-
Burning sensation at sole++++++++++++++++
Increased frequency of micturition++++++++++++++

(+ Mild ++ Moderate +++ Severe )

Table 4: Objective Criteria

Criteria1st day15th day30th day45th day60th day75th day90th day
FBS160mg/dl155mg/dl150mg/dl140mg/dl120mg/dl110mg/dl102mg/dl
PPBS180mg/dl170mg/dl160mg/dl155mg/dl145mg/dl130mg/dl125mg/dl
HbA1C7.5%5.5%

Results

Three months after treatments patient felt complete relief from previous problems and also attained a normal range of blood glucose levels.

Discussion and Conclusion

The treatment was planned considering 3 main factors Medicine, Diet, and Lifestyle modification. The present study includes medications Amruthothara Kashaya, Chandraprabha Vati, Nisha Katakadi Kashaya, Asanadi Kashaya, Tab. Nishamalaki and Tab Dia P.

Amruthotharam Kashayam (AK) was taken as the drug of choice as it is Amahara and Vatanulomana due to the presence of Shunti (Zingiber officinale) and Haritaki (Terminalia chebula), hence bringing


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Sreeraj P. et al. Ayurvedic management of Prameha - A Single Case Study

Margavishodhana (clearing the pathways) since patient initially presented with indigestion and hard stools, so for the Pachana of Ama, Amruthothara Kashaya was advised.[7]

Asanadi Gana Kashaya contains Asana (Pterocarpus marsupium), Tinisha (Ougeinia dalbergioides), Bhurja (Betula utilis), Meshashringi (Gymnema sylvestre), Daruharidra (Berberis aristata) etc. It is indicated in Prameha, Medo Roga since it has Kaphahar, Mehaghna, and Medohara properties.[8]

Many pharmacological studies, on the drugs of Asanadigana, has proved that almost all the constituents of Asanadigana, possess antihyperglycemic, hypolipidemic, antioxidant, and other therapeutic properties.[9]

Nishamalaki tablet, contains Nisha (Curcuma longa), Amalaki (Phyllanthus emblica), Nimba Patra (Azadirachta indica), Jambu Beeja (Syzygium cumini), Madhunashini (Gymnema sylvestre). All the drugs possess Mehahara Karma and it is indicated in Prameha[10] and also it is for attenuation of hyperglycemia like insulin-mimetic properties, enhancement of peripheral tissue glucose uptake, improvement of insulin sensitivity, regulation (reduction) of Hepatic glucose production, regulation of glucose production by kidneys etc.[11]

Nisha Katakadi Kashaya contains Kataka (Strychnos potatorum), Khadira (Acacia catechu), Dhatri (Emblica officinalis), Vairi (Salacia chinensis), Darvi (Berberis aristata), Samanga (Mimosa pudica), Vidula (Salex caprea), Rajani (Curcuma longa), Patha (Cissam pelespariera), Chutabija (Mangifera indica), Haritaki (Terminalia chebula) and Mustaka (Cyperus rotundus). The majority of the drugs having Kashaya Tikta Rasa, hence it helps to reduce Kapha and Medas thus helping to alleviate the disease.[12]

Dia P, Ayurveda patent medicine which contains Salacia reticulata: 200 mg, Vijayasara : 100 mg, Mass extracts of (Triphala, Khadira Kramukadi Kashaya, Salasarasadi Gana Kashaya): 200 mg, It helps in stimulating β cells of the pancreas for the secretion of insulin to balance blood sugar level.[13]

Forward bending Aasanas, massage the pancreas and stimulate the secretion of insulin. Twisting poses, such as Vakrasana and Ardhamatsyendrasana (seated spinal twist) squeeze the intestines and massage them to prevent the stagnation of colonic contents.[14]

Yava Prayoga is highlighted by all the Acharyas in the context of Prameha Chikitsa. Kashaya Rasa, Ruksha Guna, and Lekhana Karma reduce excess Kleda and excess Medho Dhathu respectively.[15]

The soluble fiber β-glucan and micronutrients in Barley are effective in lowering blood glucose.[16]

The use of Methika (Trigonella foenum-graecum) in Prameha is an ancient traditional practice, which is a folklore practice in India. Fenugreek contains galactomannan and as of the viscous property it has the potential to reduce the intestinal absorption of low or high concentrations of glucose and; therefore, for the benefit of blood glucose control.[17]

If all these measures are undertaken in an early stage of borderline blood sugar diabetes mellitus type 2 patients the course of illness can be efficiently managed with the least clinical symptoms.

References

1. IDF Diabetes Atlas. International Diabetes Federation. Available from: https://idf.org/about-diabetes/facts-figures/

2. Textbook of Roga Nidana & Vikriti Vigyana; First Edition; Nagpur; Rashtra Gaurav Publication; 2019. p. 204.

3. Astanga Hrudaya, Nidanasthana, Atisaara grahaniroga Nidana, 8/30, edited by Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya, Chaukhamba Sanskrit Sansthan, Varanasi, Reprint: 2009. p. 497.

4. Vidhyadhara Shukla, Ravidatta Tripathi. Charaka Samhita of Acharya Charaka. Reprint edition, Varanasi; Chaukhambha Sanskrit Pratishthan; 2006. p. 169.

5. Bramhanand Tripathi. Madhav Nidana of Acharya Madhava. Varanasi; Chaukhambha Surbharati Pratishthana; 2011. p. 4.

6. Vidhyadhara Shukla, Ravidatta Tripathi. Charaka Samhita of Acharya Charaka. Reprint edition. Varanasi; Chaukhambha Sanskrit Pratishthan; 2006. p. 168.

7. Sahasrayogam (3rd ed.) Dr Ramnivas Sharma, Surendra Sharma (Eds.), Vol. 318, Chaukambha Sanskrit Sansthan, Delhi (2002). p. 4.


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Sreeraj P. et al. Ayurvedic management of Prameha - A Single Case Study

8. Tripathi Brahmanand, editor. Sharangadhara Samhita, Sutrasthana, 1st ed. Ch. 15, Ver. 19-20. Varanasi: Choukambha Sanskrit Pratisthana; 2013. p. 200.

9. http://aamjournal.in/fulltext/70-1528447830.

10. R H Singh. Charak Samhita of Agnivesha, Chawkhambha Surabharati Prakashana, Varanasi. 1st edition, reprint, 2011; 2: 1042.

11. Bedarkar PB, Ranpara N, Sawaliya V, Nariya MB, Prajapati PK, Patgiri B. Antihyperglycemic activity of Nishamalaki-An Ayurvedic formulation of Turmeric and Emblica officinalis. EJBPS. 2017; 4: 853-6.

12. Dr G. Prabhakar Rao (Ed.), Sahasrayogam: compendium of 1000 ayurvedic formulations (1st ed.), Chaukhambha Publications (2016), pp. 106-107.

13. https://www.ayurmedinfo.com/2017/12/21/dia-p-capsule/

14. https://www.researchgate.net/publication/327076993_Therapeutic_Role_of_Yoga_in_Type_2_Diabetes

15. Shastri Satya Narayana, Charaka Samhita, Chaukhambha Bharti Academy, Reprint edition, 2016 Sutra Sathana ch 27.20, P-529.

16. https://journals.indexcopernicus.com/api/file/viewByFileId/396435.pdf

17. Srichamroen A, Thomson ABR, Field CJ, Basu TK. In vitro intestinal glucose uptake is inhibited by galactomannan from Canadian fenugreek seed (Trigonella foenum graecum L) in genetically lean and obese rats. Nutrition Research, 29, 2008, 49-54.


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