E-ISSN:2456-3110

Review Article

Diabetes Mellitus

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 6 JUNE
Publisherwww.maharshicharaka.in

Management of type-2 Diabetes Mellitus - A Case Report

Pankaj Singh Kushwaha1*, Pooja Lekhak2, RK Joshi3, Harish Bhakuni4, Neha Agrawal5
DOI:10.21760/jaims.9.6.57

1* Pankaj Singh Kushwaha, Post Graduate Scholar, Department of Kayachikitsa, National Institute of Ayurveda, Jaipur, Rajasthan, India.

2 Pooja Lekhak, Post Graduate Scholar, Department of Kayachikitsa, National Institute of Ayurveda, Jaipur, Rajasthan, India.

3 RK Joshi, Professor HOD, PG Department of Kayachikitsa, National Institute of Ayurveda, Jaipur, Rajasthan, India.

4 Harish Bhakuni, Associate Professor, PG Department of Kayachikitsa, National Institute of Ayurveda, Jaipur, Rajasthan, India.

5 Neha Agrawal, Post Graduate Scholar, Department of Kayachikitsa, National Institute of Ayurveda, Jaipur, Rajasthan, India.

Type 2 Diabetes Mellitus (T2DM) is a prevalent metabolic disorder characterized by elevated blood glucose levels. Ayurveda identifies a similar condition known as Madhumeha, a type of Prameha associated with an imbalance in Kapha and Vata Doshas. This study explores the efficacy of Ayurvedic treatment in managing T2DM.

Methods: A 50-year-old male patient with T2DM and no significant history of major illness was treated using a holistic Ayurveda approach. The treatment regimen included Ayurvedic formulations such as Madhumehari Churna, Ojaswani Churna, Chandraprabha Vati, and Phaltrikadi Kwath and Basti procedure. Dietary and lifestyle modifications were also recommended, focusing on low glycemic foods and regular physical activity. The patient was monitored over three months, with assessments of fasting blood sugar (FBS), postprandial blood sugar (PPBS), and HbA1c levels before and after the treatment period.

Results: Post-treatment, the patient showed a significant reduction in blood sugar levels and improvement in diabetes-related symptoms. FBS decreased from 150 mg/dl to 126 mg/dl, PPBS from 217 mg/dl to 158 mg/dl, and HbA1c from 9.2% to 6.9%. These results indicate the effectiveness of the Ayurvedic regimen in managing T2DM.

Conclusion: The study demonstrates that Ayurvedic management, through a combination of Ayurvedic formulations, dietary interventions, and lifestyle modifications, can effectively control blood sugar levels and improve the quality of life for patients with T2DM.

Keywords: Type 2 Diabetes Mellitus, Madhumeha, Prameha, blood sugar control, Basti, lifestyle modification.

Corresponding Author How to Cite this Article To Browse
Pankaj Singh Kushwaha, Post Graduate Scholar, Department of Kayachikitsa, National Institute of Ayurveda, Jaipur, Rajasthan, India.
Email: 		Pankaj Singh Kushwaha, Pooja Lekhak, RK Joshi, Harish Bhakuni, Neha Agrawal, Management of type-2 Diabetes Mellitus - A Case Report. J Ayu Int Med Sci. 2024;9(6):344-350.
Available From
https://jaims.in/jaims/article/view/3518

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-04-11 2024-04-22 2024-05-02 2024-05-13 2024-05-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Authors state no conflict of interest. Non Funded. The conducted research is not related to either human or animals use. 12.13 All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

© 2024by Pankaj Singh Kushwaha, Pooja Lekhak, RK Joshi, Harish Bhakuni, Neha Agrawaland 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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Pankaj SK et al. Management of type-2 Diabetes Mellitus

Introduction

The term Prameha denotes the excessive discharge of turbid urine, characterized by Prabhuta Mutrata (excessive urination) and Avila Mutrata (turbid urine) within the category of Prameha, Madhumeha is identified as a Vataj Prameha, constituting one of the twenty distinct types of Prameha. Acharya Charak classified it as a Santarpanjanya Vyadhi (disease due to overnutrition). In Ayurveda, Prameha is considered an Anusangi Vyadhi (disease associated with various factors), with the strength of manifestation contingent on the robustness of the association between Nidana (causative factors), Dosha (bodily humors), and Dushya (affected tissues). Factors such as excessive sleeping, a sedentary lifestyle, and the consumption of specific food items, including curd, sweet products, and dairy, are implicated in Prameha. Ayurveda aims to treat Dosha imbalance and bring them into equilibrium.[1]

The concepts of Ahara (diet), Vihara (lifestyle intervention), and Yoga are essential in controlling diabetes and improving the quality of life for those affected by this condition. Lifestyle modifications, dietary interventions, Yoga, and holistic management play crucial roles in controlling diabetes, preventing complications, and enhancing the quality of life for individuals with Diabetes Mellitus. Modern literature establishes a correlation between Madhumeha and Diabetes Mellitus (DM), characterized by elevated plasma blood glucose levels leading to hyperglycemia. DM is a clinical syndrome that impacts the metabolism of carbohydrates, fats, and proteins due to defects in insulin action, insulin secretion, or both.

Type 1 diabetes arises from the autoimmune destruction of insulin- producing β-cells in the pancreas, resulting in absolute insulin deficiency. Conversely, Type 2 diabetes is marked by insulin resistance and insufficient insulin production to overcome this resistance. Persistent hyperglycemia in diabetes gives rise to microvascular complications such as retinopathy (affecting the eyes), nephropathy (affecting the kidneys), and neuropathy (affecting the feet). Diabetes Mellitus is a widespread metabolic disorder associated with symptoms such as excessive thirst, frequent urination, sweating, blurred vision, sudden weight loss, fatigue, and delayed wound healing.

Chronic complications of DM encompass nephropathy, retinopathy, neuropathy, and cardiovascular diseases, posing a significant risk of mortality.

The etiology of Diabetes Mellitus is multifaceted, with changes in lifestyle, dietary patterns, and stress playing pivotal roles. The rising prevalence of diabetes globally underscores its status as a major contributor to non-communicable disease mortality.

Diabetes affects an estimated 537 million adults worldwide between the ages of 20 to 79 (10.5% of all adults in this age range). By 2030, 643 million people are expected to have diabetes globally, increasing to 783 million by 2045. The prevalence rate is projected to exceed 12.8% by 2045.[2]

Past History

No any history of major illness

Family history

Father and mother has history DM-II

General Examination

1.PallorAbsent
2.IcterusAbsent
3.CynosisAbsent
4.ClubbingAbsent
5.Lymph NodesNot Enlarged
6.EdemaAbsent
7.Blood Pressure 120/70 mm of Hg
8.Pulse Rate76 / Min
9.Respiratory Rate18/ Min
10. Temperature96.2° F

Personal History

On examination, the patient was having Vata Kaphaj Prakriti (body constitution). Patient has dryness over body (Rukshata). Patient was moderately built with Body Mass Index of the patient was well oriented and there was no Pallor, Icterus, Cyanosis, clubbing, Lymphadenopathy or Edema, In systemic examination no abnormality was detected. Satva, Satmya and Vyayam Shakti were Madhyam.

Systemic Examination

Examination of respiratory system: no any abnormality detected in respiratory system

Examination of cardio vascular system: no any abnormality detected in cardio vascular system


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Pankaj SK et al. Management of type-2 Diabetes Mellitus

Examination of gastro intestinal system: scaphoid shaped abdomen centrally placed umbilicus, no tenderness, no organomegaly

Examination of nervous system: Higher mental functions were intact

Samprapti Ghatak

DoshaKapha
DushyaMeda, Mutra
StrotasMedovaha, Mutravaha, Annavaha
UdbhavasthanPakvashaya Samutthaja
Adhishthan Mutravaha Strotas
UpadravaNil
VyadhimargaAbhyantara

Diagnosis

Vataj Prameha (Madhumeha), Navina Avastha (type 2 DM)

Diagnostic assessment

It is based on subjective and objective criteria

1)  Subjective criteria

Prabhootamutrata

Grade 0: Up to 5 times in day hours 0-1 time at night

Grade 1: 6-7 times in day hours and 2- 3 times at night

Grade 2: 8-9 times in day hours and 4-5 times at night

Grade 3 - More than or equal to 10 times in day and more than 5 times at night

Daurbalyanubhuti

Grade 0: Ability to perform routine activity with no feeling of exhaustion

Grade 1: Unable to perform routine activity without feeling of exhaustion

Grade 2: Feeling of exhaustion even on accustomed work

Grade 3: Exhaustion even at rest

2) Objective criteria

  • FBS
  • PPBS
  • HbA1C
SNDrugDose and frequencyRoute of administrationAnupana
1.Madhumehari Churna +
Ojaswani Churan		4 GM +
2 GM		Oral, before mealLukewarm water
Chandraprabha Vati 500 mg
 Phaltrikadi Kwath20 ml
2.Pramehara Churna 3 gmOral, before mealLukewarm water
Chandraprabha Vati500 mgOral, After meal
Erand Bhrist Haritki Churan3 gmOral, After meal
3.Panchtiktpanch Prasratika Basti each day for 15 day400 mlAfter mealAnal root
Gokshura Kwath20 mlOral, before mealLukewarm water
Trikatika Gutika +
Ojaswani Churan		250 gm
2gm		Oral, before mealLukewarm water
Madumehari yoga + Tarkeshwar Ras + Udumber fruit Churan250 gm
125 gm
1 gm		Oral, before mealMilk

Pathya(Wholesome diet)

Yava (Barley), Godhoom (Wheat), Bajara (Pearl Millet), Mung Dal (Mung Bean), Lauki (Bottle Gourd), Karavellaka (Bitter Gourd), Rasona (Garlic), Udumbar (Cluster Fig), Haldi (Turmeric), Tinda (Indian Round Gourd), Turae (Ridge Gourd), Jambu (Java Plum/Black Plum), Aawla (Indian Gooseberry), Methika(Fenugreek), Nimba Patra (Neem Leaf), Shadabahar Patra (Periwinkle Leaf).

Exercise daily for 30 - 45 minutes or walk 3 - 5 km.

Low glycemic foods should be used and Tikta Rasa should be followed.

Eat small and frequent meals. Regularly eat more green vegetables, leafy vegetables and fiber rich foods

Apathyakar Ahara(Unwholesome)

Dugdha (cream Milk), Dadhi (Curd), Khir (Rice Pudding), Ikshurasa (Sugar Cane Juice), Guda (Jaggery), Pizza, Burger, Sandwich, Chicken, Cold drink water (Soft Drinks), Toast, Dhosa, Pasta, Idli Sambar, Chikki, Ice Cream, Potato, Aam (Mango), Kela (Banana), Chiku (Sapodilla), Sitaphal (Custard Apple), Shakarkand (Sweet Potato), Chukandar (Beet root), Paneer, Ghee Vegadharan (suppression of natural urges) smoking, - Sukha - Asana, Sukha - Sayana, Diva - Sayana, Ati - Maithuna.


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Pankaj SK et al. Management of type-2 Diabetes Mellitus

Yoga Asana: Bhujangasana, Mandukasana, Kapalbhati, Surya Namaskar, Tadasan, Paschimottanasan, Bhujangasan, Bhramari, Pavanmuktasan.

Before Treatment

SNInvestigationBefore Treatment
1.Fasting blood sugar150 mg /dl
2.Post prandial blood sugar217 mg/ dl
3.HbA1c9.20 %

After Treatment

SNInvestigationAfter Treatment
1.Fasting blood sugar126 mg /dl
2.Post prandial blood sugar158 mg/dl
3.HbA1c6.9 %

Anupashaya: Sukha - Asana, Sukha - Sayana, Diva - Sayana, Ati - Maithuna, Vegadharanad (suppression of natural urges)

This observation shows that Ayurvedic treatment shows significant result in management of Madhumeha

Patient perspective

Patient reported not only improved blood sugar levels but also enhanced overall well-being, including better digestion, increased energy levels, and reduced stress. Overall, from a patient's perspective, Ayurvedic treatment for Madhumeha offers a comprehensive, natural, and empowering approach to managing diabetes

Discussion

Present case is a case of Santarpanajanya Madhumeha (Type 2 DM) with Kapha dominant constitutional clinical presentation. As patient was overweight diabetic with constipation so Aptarpana (one with reducing properties) line of treatment was adopted in this case i.e., Aampachana (digesting the metabolic wastes), Deepana (stimulates digestive fire), Kapha & Kleda (water soluble wastes) pacifying treatment[3] Madhumehari Churna contains Jambu, Amra, Karvellaka, Mesasrngi, Methika, Bilva, Nimba, Sunthi, Satapushpa, Sonamukh, Bala and Babbula. Most of the ingredients of Madhumehari Churna have Kashaya and Tikta Rasa property due to this it helps to reduce the blood sugar level. It pacifies the symptoms of Kapha due to Kashaya and Tikta Rasa and also pacifies the symptoms of Pitta.[4]

Ojaswani Churna helps by regulating blood glucose, improving insulin function, enhancing digestive health, reducing inflammation and oxidative stress. Chandraprabha Vati an Ayurvedic composition offered in traditional Vati form. It is used in Ayurvedic system of medicine for various indications[5] such as Vibandha (Constipation), Anaha (Distension of abdomen due to obstruction to passage of urine and stools), Shula (Colicky Pain), Granthi (Cyst), Pandu (Anaemia), Kamala (Jaundice), Mutrakricchra (Dysuria), Ashmari (Calculus), Arsha (Hemorrhoids), Arbuda (Tumor), Mutraghata (Urinary obstruction), Antra-Vrddhi (Hernia) etc.[6]

The effects of Chandraprabha Vati are highly noteworthy in mitigating Prameha, which is closely associated with obesity, metabolic syndrome, and diabetes mellitus (Madhumeha ).[7] In experiments, the majority of these substances shown the ability to decrease cholesterol and glucose levels shown that Chandraprabha vati can treat diabetes induced by streptozotocin. Even though Chandraprabha Vati has been used for diabetes for a long time and its constituent plants have antidiabetic and lipid lowering properties, comprehensive scientific research are still needed to define and validate the plant's therapeutic value in managing diabetes. Thus, the current investigation shows how Chandraprabha Vati affects the hyperglycemia and altered lipid profile in rats that are caused by inducing alloxan.[8]

Phalatrikadi Kashaya works by enhancing Agni (all enzymatic activity) and eliminating the accumulated, hazardous metabolites and their purgative (Virechaka) effect.[9] Citrullus cholocynthis is one of Phalatrikadi Kashaya's ingredients.

It has been shown to have bowel clearance properties and to be effective in reducing the accumulation of advanced glycation end products by blocking the actions of amylase and a-glucosidase, which in turn slows down the progression of diabetes pathogenesis and rejuvenates the Islet of Langerhans' degenerated cells.[10]

Erandabhrisht Haritaki Churan has two ingredient, one is Eranda Tail and Haritaki Churna, Eranda Taila opens the bodily pathways that are clogged in the Srotas, relieving Vata vitiation. Vata Kaphahara and Adhobhaga Doshahara (disorders of lower regions of the body) are referenced in the Samhitas.[11]


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Pankaj SK et al. Management of type-2 Diabetes Mellitus

Because of all these qualities, the Eranda Taila is also employed in Madhumeha and aids in Virechana Karma. The body's blood sugar levels are significantly reduced by Haritaki's superior hypoglycemic quality. Taking this wonder fruit activates the ẞ-pancreatic cells' synthesis of insulin. It aids in slowing down the conversion of starch to glucose.

Thus, consistent use of Haritaki powder lowers blood sugar levels and cures a number of symptoms associated with diabetes, including increased thirst, frequent urination, weight loss, etc. Gokshura Churna has been shown to exhibit hypoglycemic properties. It helps in lowering blood glucose levels by increasing insulin sensitivity and improving glucose uptake by cells. Most of the drugs in Trikatu Gutika have Katu, Tikta Rasa, Laghu, Ruksha Guna, Ushna Virya, Vata-Kapha Shamaka and Dipana-Pachana properties.

Kapha on the other hand is Guru, Snigdha, Shita. Because of all these properties, Trikatu Gutika has the ability to counteract the effect of Kapha. Thus, the aggravated Kapha subsides resulting in proper functioning of Agni and hence preventing Marg Avarodhjanya Vata Prakopa thereby breaking the pathogenesis of the disease.

It not only helps by breaking the pathogenesis of Madhumeha but also has direct impact on various symptoms of Madhumeha like burning sensation in hands and feet, weakness, polyuria, sexual debility etc. The Rasayana effect of some drugs in Trikatu Gutika helps in restoration of Oja. Even various research works have shown the hypoglycemic effect of these constituents. So, we can say that Trikatu Gutika could be useful in the management of diabetes mellitus.[12]

Panchatikta Panchaprasutik Niruha Vasti: According to Charaka Samhita[13]

The ideal situation to apply this kind of Kledahara & Shodhana Vasti is Prameha. Additionally, a significant Dushya Sangraha is engaged in the Samprapti (pathogenesis) of this illness.[14]

This Vasti's contents are all Tikta Rasatmak, Katu Vipaki, and Ushna Viryatmak, which means that Deepan Pachan, Anulomak, and Krumighna are found in nature.[15] In diabetes, polyuria (excessive urination) is a common symptom due to high blood sugar levels leading to osmotic diuresis.

The diuretic action of Gokshura helps in regulating urine production and can assist in normalizing urine output by improving the kidneys' efficiency in fluid management.

DrugRasaGunaViryaVipakaDoshaghnata
Saindhav LavanaLavan, MadhuraLaghu, Snigdhdha, Tikta, SukhmaSheetaMadhuraTridosh shamak
Til TailMadhura, Katu, Tikta, KashayaGuru, SnighdhaUshnaMadhuraVata Shamak, Kapha - Pitta Shamak
Go GhritaMadhuraGuru, Snighdha, MruduSheetaMadhuraVata- Pittashamaka
RasnaTiktaGuruUshnaKatuKapha- Vatashamak
SarshapaTikta, KatuSnigdha, TikshnaUshnaKatuKapha- Pittashamak
PatolTiktaLaghu, RukshaUshnaKatuTridosh Shamak
NimbaTikta, KashayaLaghuUshnaKatu 
ChirayataTiktaLaghu, RukshaUshnaKatuTridosh shamak
SaptaparnaTikta, KashayaLaghu, RukshaUshnaKatu 

Conclusion

Ayurveda not only cures this disease but also prevents it by knowing Aharaja and Viharaja Nidana. Nidana Parivarajana helps control this disease. Diet plays an important r ole in the treatment of Madhumeha or diabetes. When we recommend a diet to a patient, we must consider the total carbohydrate content and glycemic index of the food, as well as its Ayurvedic properties.

Declaration of patient consent

The patient has given consent for reporting case along with images and other clinical information in the journal.

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