E-ISSN:2456-3110

Review Article

Diabetic Neuropathy

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 9 SEPTEMBER
Publisherwww.maharshicharaka.in

Rationality of using Ayurvedic interventions in Diabetic Neuropathy in Geriatric age group

Parveen R1*, Rahiman J2, Sowmiya V3, OP Singh4
DOI:10.21760/jaims.9.9.15

1* Rukhsar Parveen, Post Graduate Scholar, Department of Kayachikitsa, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

2 Jassim Rahiman, Assistant Professor, Department of Kayachikitsa, Apex Institute of Ayurvedic Medicine and Hospital, Chunar, Uttar Pradesh, India.

3 Sowmiya V, Post Graduate Scholar, Department of Kayachikitsa, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

4 OP Singh, Professor, Department of Kayachikitsa, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Diabetic Neuropathy is a damaging of Nervous system associated with Diabetes Mellitus. It occurs due to microvascular injury involving small blood vessels in addition to macrovascular conditions with a prevalence rate of almost 50% in individual with long standing type 1 and type2 Diabetes.[1] Symptoms may include tingling sensation, numbness, burning that starts from feet and spreads proximally etc. In Ayurveda there is no direct reference of Diabetic Neuropathy but it is mentioned as a symptom and complication of Prameha. Hence the most important thing is to be done in Diabetic Neuropathy is to maintain the blood sugar level to normal limits with proper medication, diet, and adequate physical exercises. This review article is to enlighten what ayurvedic interventions including dietary regimen (Ahara), medications (Aushadha) and purificatory method (Shamsodhana) has been used in Prameha to control and prevent its further complications.

Keywords: Diabetic neuropathy, Vatavyadhi, Prameha, Samsodhana, Sanshamana

Corresponding Author How to Cite this Article To Browse
Rukhsar Parveen, Post Graduate Scholar, Department of Kayachikitsa, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Email: 		Parveen R, Rahiman J, Sowmiya V, OP Singh, Rationality of using Ayurvedic interventions in Diabetic Neuropathy in Geriatric age group. J Ayu Int Med Sci. 2024;9(9):100-105.
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https://jaims.in/jaims/article/view/3486

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-08-15 2024-08-26 2024-09-05 2024-09-15 2024-09-27
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 10.15

© 2024by Parveen R, Rahiman J, Sowmiya V, OP Singhand 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

Diabetes Mellitus (DM) is a multifactorial metabolic disorder affecting millions of people all over world. It is one of most important medical problems of today because world-wide > 246 million people suffer from Diabetes mellitus all over world. By 2025 this figure could be expected to be 380 million. Diabetes as such does not kill patient but it is complications of diabetes that are responsible for mortality and Morbidity.[2] Diabetic Neuropathy is one of commonest complications associated with Diabetes mellitus which occurs in almost 50% of individuals with long standing type1 and type 2 DM, manifests as a diffuse neuropathy (distal symmetrical polyneuropathy or/and autonomic neuropathy), a mononeuropathy, or a polyradiculopathy. Symptoms may include a sensation of numbness, tingling sensation, sharpness, or burning that begins in feet and spreads proximally. Hyperesthesia, paraesthesia, and dysesthesia also may occur. Hyperglycaemia associated with diabetes a thought to be central to effect on nerve structure through a number of possible mechanisms including increased activity in polyol pathway, altered myo- inositol metabolism and non- Enzymatic glycation. Other mechanism may also be involved e.g. alterations in nerve growth factor activity, blood viscosity, circulating platelets and rate of synthesis and transport of intraaxonal protein. Diabetic neuropathy is not directly mentioned in Ayurvedic texts but Lakshanas of Diabetic neuropathy i.e., Daha (burning sensation), Chimchimayana (tingling sensation), Susuptta (numbness) are explained under Poorvaroopa (Prodromal symptoms) and Upadrava (Complications) of Prameha. When Prameha is neglected or illtreated it will lead to Madhumeha by Dhatukshayajanya Vata Prakopa as a Pratantra Vyadhi (Secondary disease). Diabetic neuropathy can be correlated to Vatavyadhi particularly Vyana Vayu is vitiated in case of neuropathy because Vyana Vayu is responsible for regulating circulation and movement throughout body. It is responsible for co-ordination of movement, sensation and communication between brain and peripheral tissues including organ, muscle and tissues. Vitiated Vata Symptoms include Gatrasuptata (numbness), Toda (excruciating pain) and Hasta Padatala Daha (burning sensation of hand, feet and soles) symptoms of Pitta.

Hence drugs pacifying Vata and Pitta Doshas are useful in treatment of Diabetic Neuropathy. In Ayurveda by giving comprehensive attention to four aspects which are Nidana Parivarjan, Ahara (diet), Vihara (exercise), and Aushadha (medicine) blood sugar level can be easily controlled to prevent its further complications.

Treatment Modalities for Diabetic Neuropathy:

1. Nidana Parivarjana: Nidana Parivarjana means avoidance of etiological factors which help in preventing disease or control disease in an individual. Acharya Sushruta give importance to a Siddhant by mentioning “Sankshepatah Kriyayoge Nidan Parivarjanam” means Nidana Parivarjana is one of type of treatment. Etiological factors describe by acharyas like Avyayam (Lack of exercise), Swapnashayana (Oversleeping), Pishta -Snigdha Annasevana (Consumption of starchy and fatty food) and all other Kapha increasing edibles should be avoided in order to prevent Prameha and its further complications.[3]

2. Ahara Vyavastha:There is three basic pillars of life mention in ayurveda Ahara, Nidra, Brahmacharya among them Ahara is considered as a best preventive medicine. If a person follows dietary regimen, then there is no need of medicine. By understanding importance of Ahara (Diet), both as a causative as well as curative agent in disease conditions prevention of disease is possible. Separate chapters have been allotted to dietetic items in classical texts under different group of food items such as[4]

Sukadhanya Varga (Monocotyledons)Shamidhanya Varga (Pulses)Mamsa Varga (Meat)Shaka Varga (vegetables)Phala Varga (Fruits)
Yava (Barley) (Glycaemic index (G.I)- 30) Mung bean (Green gram-G. I- 29Bater and Lavaka (Quail meat)Changeri Khajoor (G.I-42)
Godhuma (wheat flour)Chana daal (Bengal gram-G.I- 8)Kukkuta (Chicken meat)Varahikanda (Dioscorea bulbifera)Anjeer (G.I-51)
Shyamaka (Barnyard millet) (G.I-50)Chicken Peas (G.I-10)Kapinjala meat (type of Bird meat)Kakmachi (Solanum nigrum)Apple (G.I-36)
Kodrava (Kodo millet)Toor daal (G.I-22)Kapota meat (Pigeon meat)Patola (Trichosanthes diocea)Naranga Phala (citrus reticulata-G.I-47)
Bajra (Pearl millet)Black eye bean (cow peas- G.I-44)Paravata (Parrot meat)Chakra marda (Cassia tora)Amalaki
Jowar (Sorghum) - white jowar (G.I- 49)
Yellow jowar (G.I-52)		Soyabean pulse (G.I-15)Shashaka (rabbit meat)Mandukaparni (Centella asiatica)Orange (G.I-43)

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Shamsodhana Chikitsa in Diabetic Neuropathy

As Prameha is due to Ama in body so we should use the treatment for Niram. Snehana (Oleation therapy), Swedana (Sudation therapy), Sneha Virechana (Oleation-induced therapeutic purgation) is the line of treatment of Nirama Vatavyadhi acc. to Acharya Charaka. However, Swedana is contraindicated in Prameha so only controlled Swedana can be done in form of Patrapotali Sweda.

Abhyanga: Abhyanga controls the Vata Dosha, which is the root cause of neuropathy. Abhyanga stimulates Swedavaha Srotas causing dilation of the blood vessel, thereby increasing the blood circulation reducing pain and stiffness.[5] Oil use in abhyanga- Narayana Taila, Mahanarayana Taila, Bala Taila, Sahcharadi Taila etc.

Swedana: Swedana opens all the channels of body and clears the block, dilates the blood vessels improves blood circulation which help in delivering essential nutrients and oxygen to peripheral nerves, potentially alleviating symptoms of neuropathy. As Swedana was contraindicated in Prameha so only Mridu Sweda can be used in Prameha like Pottali Sweda, Shalishasti Sweda, Patrapinda Sweda etc.

Basti:Basti is supposed to be specific treatment for Vata Vyadhi but indirectly effective in Pitta and Kapha Dosha also. Acharya Charaka in Charak Siddhi Sthana 8/8, mention Panchatikta Prasritik Basti in Prameha-

Contents:

ContentsProperties[6]
Nimba (Azadirachta indica)Compound such as Rutin and Quercetin have been shown to have hypoglycaemic effect whereas Nimidin have the weight reducing effect. The leaf extract contains alkaloids that are responsible for facilitating the restoration of insulin secretion through the regeneration of pancreas islet. Anthraquinones are used to treat peripheral neuropathy and reduce the level of blood sugar.
Patola (Trichosanthes dioica)Antioxidant, low glycaemic index
Saptaparna (Alstonia scholaris)increase peripheral utilisation of glucose, improve sensitivity of target tissues for insulin. In its bark antiatherogenic potential is present which prevent the further complications of diabetes.
Rasana (Pleuchea lanceolate)Vata - Kapha Shamaka, reduce blood glucose level, antioxidant, increase insulin production.
Chirayata (Swertia chirayita)It has mangiferin, which directly stimulate the Beta cells of pancreas to release insulin, reduce intestinal uptake of glucose.

Other examples of Basti where Prameha is one of the indications[7]-

Saindhavadi AnuvasanaCharak Siddhi Sthan 4/13-16
Vidangadi AnuvasanaCharak Siddhi Sthan 4/18-22
Patoladi Anuvasana Charak Siddhi 8/8
Madhu Tailadi NiruhaCharak Siddhi 12/13
Patoladi Tikta BastiAstang Hridaya Kalpa 4/23-24
Saindhavadi AnuvasanaAstang Hridaya Kalpa4/62-65
Rasnadi NiruhaSushruta Chikitsa38/70-75
BhadraNimbadi NiruhaSushruta Chikitsa 38/59-62

3. Aushadha

Drugs and formulations use to manage the diabetic neuropathy have Vatahara properties, having potential to support nerve health and to reduce inflammation.

Drugs used:

Bala:Bala is considered as a nervine tonic because of its various properties like - Vatapitta Shamak, Vedanasthapana, Shotahara, Balya, Vatahara, Raktapitta Shamak, Brumhana, Ojovardhak etc.[8] Bala on nervous system having effect as analgesic, anti-inflammatory, hypoglycaemic activities etc.

Formulations of Bala used in neuropathy

Balaristha (Bhaishajya Ratnawali 26/607)

Ksheerbala 101 capsules

Balataila

Mamsabalaadi Tailam

Ashwagandha:it has properties of Kapha-Vatashamaka, Sothahara, Raktasodhaka, Vata Anulomana, Mastishka Shamaka, Deepana etc.

Flavonoids found in the roots and leaves of Ashwagandha are used to cure diabetes.[9],[10] It also has GABA mimetic effect and was shown to promote formation of dendrites. It has anxiolytic effect and improves energy levels and mitochondrial health. It also has anti-inflammatory action. Ashwagandha is commonly available as a Churna, a fine sieved powder that can be mixed with water, ghee (clarified butter) or honey. It enhances the function of the brain and nervous system and improves the memory. It also possesses potent antioxidant properties that help protect against cellular damage caused by free radicals.

Formulations used:Balarishta, Ashwagandharishta, Ashwagandha Rasayan etc.

Guduchi (Tinospora cordifolia) properties - Tridoshashamak, Dahashamaka, Raktasodhaka, Pramehaghana, Deepana, Anulomana etc.[11]


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T. cordifolia is an age-old renowned medicinal plant having different medicinal properties such as anti-hyperlipidaemic, anti-hyperglycaemic, antioxidant, anti-neoplastic, anti-stress, anti-inflammatory, anti-allergic and immunomodulatory properties.

Triphala:Triphala is an important Ayurvedic formulation consisting of the dried fruits of three medicinal plants Terminalia chebula, Terminalia bellerica, and Embelica officinalis. Pramehahara property of Triphala is very well described in Brihatrayee especially in Chikitsa of Prameha.[12] Individual drugs of Triphala contain glycosides, alkaloids, terpenoids, flavonoids, carotenoids, etc., and these all are frequently implicated to possess potential as antidiabetic.[13] Triphala has anti-inflammatory, antioxidant, immunomodulating, antibacterial, antimutagenic, hypoglycemic properties. Polyphenols present in Triphala modulate the human gut microbiome and therefore promote the growth of beneficial bacteria of gut (Bifidobacteria and Lactobacillus). The bioactivity of Triphala is elicited by gut microbiota to generate a variety of anti-inflammatory compounds. Gallic acid and ellagic acid are the hydrolyzable tannins present in Triphala Churna have reported for their beneficial effect on diabetic nephropathy. Gallic acid has shown a neuroprotective effect via reduction in inflammation and oxidative stress. Triphala Churna may show neuroprotective effect via inhibiting inflammation, oxidative stress, and by reducing neuronal damage.

Formulations of Triphala used:

Triphalaadi Kwatha

Gokshur Guggulu Vatika

Trikatvadi Guggulu etc.

Nisha Amalaki:It consist of 2 important drugs Nisha (Curcuma longa) and Amalaki (Indian gooseberry) prove to be very efficacious in the treatment of diabetes mellitus and its complications. Nishamalaki possess Antihyperglycemic, Antidiabetic, Insulinomimetic, α-Amylase inhibitory and α-glucosidase inhibitory, Antioxidant properties. It improves insulin sensitivity, increases glucose uptake by skeletal muscles and is beneficial in the management of Madhumeha, Prameha and Diabetes as well as prevention of its complication’s microvascular complications one of them is diabetic neuropathy.

Acharya Chakradutta in Vatavyadhi mention Jhinjhini Vatachikitsa which is use in the treatment of neuropathy:

Contents: Dashamoola, Pushkarmoola, Hingu Dashamoola consist of Brihatpanchamoola (Bilwa, Agnimantha, Shyonaka, Patala, Gambhari) and Laghupanchamoola (Brihati, Kantakari, Shalaparni, Prishnaparni, Gokshura).[14] Dashamoola has properties like - Tridoshahara, Rasayana, Dhatuposhaka, Shothahara, Balya, Deepana, Pachana etc. Ingredients of Dashamoola are rich in Sitosterols, Flavinoids and Glycosides that regulates the function of important hormones therefore regulate the status of neuroendocrine system. It has a powerful antioxidant effect; Stimulates Nervous system therefore use in diabetic Neuropathy.

Shilajatu:It is one of drug describe to use in treatment of Prameha having properties like Balya, Tridoshashamak, Yogavahi, Vrisya, Rasayan etc. It also has Dehadardhyakara property which can improve the consistency and quality of tissue elements. It helps in the removal of excess Meda and Kapha therefore reduce the obstruction of Srotas therefore use in treatment of Prameha and its complications.[15]

Formulations used: Chandraprabha Vati, Shilajatvadi Lauha etc. Bio Purifactory methods (Samshodhana) and (Samshamana) are the modes of treatment indicated for the complete eradication of Doshas and to eliminate the disease.

4. Vihara:By following Sadvritta exercising 30 minutes a day reduces the risk of diabetes. Some of exercises that one can perform are - Walking everyday, practising Yoga etc.

  • Lepana of Agaru, Usheera, Twaka, Ela and Chandana
  • Jalavaseka
  • Ruksha Praghada Udwartana (Triphala Churna, Kolakulathadi Churna)

Discussion

Ageing is defined as the time sequential deterioration that occur in most living beings, including weakness, increased susceptibility to disease and adverse environmental conditions, loss of mobility and agility and age-related physiological changes.


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Ayurvedic System of medicine is perhaps the first which efforts to shield life of human being from ailment and aging. Acharya’s classify age into 3 phases. Acc. to Acharya Charaka, Balyavastha (from birth up to 30 yrs of age with the dominance of Kapha), Madhyamavastha (30 yrs to 60yrs with dominance of Pitta), Vridhavasta (from 60 yrs to 100 yrs with dominance of Vata). Throughout this time individual loses the potency of Dhatus, potency of sense organs, energy, masculinity, courage and power of understanding, preservation, memory, language and ability to analyze facts. There is progressive reduction of Dhatus and governance of Vata in this present era causing various types of age-related disorders. One of them is Diabetic Neuropathy which is a chronic condition that results from uncontrolled diabetes. By using all the above-mentioned Ayurvedic regimen, one can easily be prevented from diabetes and its further complications occurred.

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