Introduction

Diabetic neuropathy is a type of nerve damage that can occur with uncontrolled diabetes. High blood sugar can injure nerves throughout the body. Diabetic neuropathy most often damages nerves in the legs and feet. Depending on the affected nerves, diabetic neuropathy symptoms include pain and numbness in legs, feet and hands. It can also cause problems with the digestive system, urinary tract, blood vessels and heart. Some people have mild symptoms. But for others, diabetic neuropathy can be quite painful and disabling.^[1]

No medical treatment has proven effective in preventing or arresting the disease process. The goal of the management is to prevention of diabetic foot or amputation. In Ayurveda, it can’t be straightforwardly corelated with any disease, but can be analogous with the symptoms of Prameha Upadrava or Madhumeha or Prameha Poorvarupa. Other scattered references are available in text, which are mainly Vata-Pitta dominant. So, treatment which is Vata-Pitta Shamaka should be initiated.

Case Report

Presenting Complaint

A 60-year-old female patient residing in Gujarat, Jamnagar district, belonging to middle economic class reported the Panchakarma outpatient department (OPD) ITRA, Jamnagar, with the chief complaints of tingling sensation and numbness over bilateral lower limbs, pain, burning sensation over bilateral soles for 3 years, chronic constipation, reduced appetite and psychological stress.

History of present illness

Patient was apparently healthy 5 years back. She was detected with diabetes mellitus 5 years ago. From past 3 years patient started complaining of tingling sensation and numbness over bilateral lower limbs, pain sensation over bilateral lower limbs, burning sensation over bilateral soles, generalised weakness, constipation, reduced appetite for which she consulted and took allopathy medicine but had not noticed any relief. Later, with Ayurveda treatment she had relief. Later, the complaints again aggravated from past 2 months, and hence patient got admitted for better management in ITRA Panchakarma hospital, Jamnagar.

Assessment Criteria

Modified Toronto clinical neuropathy score (mTCNS), Vibration and thermal threshold test by Neuropathy analyser Biothesiometer, Monofilament test., Fasting and Post prandial Blood sugar level.

Treatment Given

(on-going mediations of Diabetes mellitus ty-pe 2 were allow to continue during treatment)

Nitya Virechana with Castor oil and Cow milk, Utsadana with Triphala-Nimba Churna with Nimba Taila, Parisheka with Dashamoola Ksheera Kashaya for 15 days.

Neuropathy Analyzer’s readings

Before Treatment

but comparable to Lakshana of Poorva Rupa & Upadrava of Prameha/ Madhumeha. & some other scattered references in text. Diabetic peripheral neuropathy symptoms include: Pain at B/L lower limbs, tingling sensation, numbness at B/L L/L., Burning sensation at B/L soles so treatment should be initiated which pacifying Vata & Pitta dosha. In Diabetic neuropathy symptoms incorporate Lancinating pain, Numbness, tingling sensation are indicating association of Vata dosha, as per Ayurvedic classics Any kind of Pain which is always associated with Vata.^[2] whereas burning sensation is because of Ushna Guna of Ashayapkarshita Pitta Dosha.^[3] Tingling sensation i.e., Harsha is included in Vata Nanatmaja Vyadhi.^[4] Here, Chala guna of Vata is responsible for Hasha. Numbness i.e., Supti^[5] is a symptom of Snayu, Kandara, Sira Dushti^[6] & also it is Vata Nanatmaja Roga. Supti is produced by Sheeta & Chala guna of Vata. Hence drugs & treatment pacifying Vata & Pitta dosha are valuable in treatment of diabetic neuropathy. (For Assessment of Nitya Virechana, Utsadana & Parisheka - Samyakadi lakshana of classical Virechana, Snehana, Swedana were adopted respectively, as it is not validated yet.)

Nitya Virechana

As DPN considered as an Advance stage of Diabetes mellitus, & considered it as Bahudosha Avastha with predominance of Vata Dosha. & for treatment of Vata in text mentioned as Abhyanga, Swedana, Mridu Samsodhana.^[7] If Shodhana like Vamana, Virechana if done, it will further aggravate Vata & worsens condition. So, treatment like Vata Shamaka or Brimhana should be initiated. & in Vata Pradhana Vyadhi Mridu Samsodhana is line of treatment & Nitya Virechana is a Mridu samsodhana. So, in this study Eranda Taila & Milk was selected for Nitya Virechana purpose. Virechana with Eranda Taila & cow’s milk is indicated in Vatavyadhi^[8] & Vata Rakta Chikitsa Adhyaya,^[9] Ratio of 1:2 was taken. Eranda Taila possess Adhobhagdosha Harana (downward expulsion of Doshas), Bhedana, Ushna (hot), Tikshna (sharp) like properties along with ricinolic acid in chemical composition having tendency to active prostaglandin & act as an irritant which produces purgation.^[10]

Utsadana

In prameha Tridosha -Vata, Pitta, Kapha and 10 Dushyas (Rasa, Rakta, Mamsa, Meda, Vasa, Majja, Ambu, Lasika, Shukra, Oaj are involved.^[11]

Thus, it can be said that these treatments are effective in managing, but further study including a larger sample size and a longer duration will be required to prove this impact.

Informed consent: Informed consent for the publication of the data was taken from the patient.

References