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Sunday, June 16, 2013

Scientific Basis for Ayurvedic Therapies -8

Scientific Basis for
Ayurvedic Therapies 

edited by
Brahmasree Lakshmi Chandra Mishra

20 The study was done under ischemia, which was induced by bilateral carotid
occlusion under phenobarbitone anesthesia. A number of antioxidant enzymes and lipid
arthritis. Some gold compounds used as medicine, in modern medicine are listed in Table
Gold has been used since the Vedic era in India to enhance strength and potency, promote
6.2. Of all these gold compounds, auranofin and gold sodium thiomalate (GST) are the

peroxidation were studied. Swarna bhasma (25 mg/kg) had a restorative effect, significantly
restoring antioxidant levels in ischemic animals. Biochemical findings supported the histological
examination of the brain. The free radical scavenging and antioxidant effects of
swarna bhasma have also been investigated recently by several groups. Two antioxidant
enzymes — superoxide dismutase (SOD) and catalase — were measured after oxidative
insult with acetic acid in both swarna bhasma-treated mice as well as control serum and
liver homogenate of mice.15 Swarna bhasma induced activity of SOD and catalase. Chronic
administration of swarna bhasma had no toxic effects as assessed by liver function test
enzymes and histological investigations.
Biological investigations on swarna bhasma are summarized in Table 6.3. Clinical Studies
Gold containing Ayurvedic preparation, swarna vasanti malti, was investigated for safety.
The bhasma was given to 20 male persons at a dose of 100 mg twice a day for 40 days
under supervision of Ayurvedic physicians. The total cumulative intake of 160 mg of gold
at the rate of 4 mg/day in this form did not have any toxic effect on human body, as
evidenced by clinical examination, unaltered body weight, absence of urinary pathology,
and by 30 sensitive biochemical and enzymatic tests.21
Biologically Active Gold Compounds on the Market
No. Generic Name Trade Name
Concentration (%)
1 Gold sodium thiomalate Myochristin,
Myocrisin, Tauredon
2 Gold thioglucose Solganal 50.5
3 Gold thioglycoanilid Lauron 54.2
4 Gold sodium thiosulphate Sanochrysine,
5 Calcium aurothiothioglycolate Myoral 64.1
6 Sodium 2-aurothiobenzidazole-4-carboxylalte Triphal 47.8
7 Sodium auroallylthiourea-m-benzoate Lapion 43.4
8 S-triethylphosphine gold 2,3,4,6-teta-O-acetyl-1
Auranofin 29.1
9 Chloro (triethylphosphine) gold SK&F 36914 56.2
Based on information from Lewis, A.J. and Walz, D.T., Progress in Medicinal Chemistry, Vol. 19, Elsevier
Biomedical Press, New York, 1982, 1–59, and Insel, P.A., Goodman's and Gilman's: The Pharmacological Basis of
Therpaeutics, 9th ed., McGraw-Hill, New York, 1996, 644.
Summary of Scientific Investigations on Swarna Bhasma
No. Investigation Model Ref.
1 Analgesic activity Mouse, rat 17
2 Immunomodulatory activity: specific
Mouse 18
3 Immunomodulatory activity: nonspecific
Mouse 19
4 Evaluation of safety Human 22
5 Antioxidant effect Rat 20
6 Analysis of chemical constituents — 16
7 Free radical scavenging activity Mouse 16

6.7.2 Loha Bhasma Indications
Loha bhasma is a powerful hematinic Ayurvedic drug indicated in anemia. It stimulates
the appetite and has a general vitalizing effect. It is readily assimilated in the body. Animal Studies
Various loha bhasmas made by different manufacturers were screened, and one representative
preparation was evaluated for its effect in managing experimentally induced anemia
in Charles Foster albino rats. Comparison was made with Fefol.,22 a widely used standard
drug. Anemia was induced by dietary means (agar gel treatment) and by bloodletting
(phlebotomy) through the tail vain. Various parameters of hemoglobin estimation, serum
ferritin estimation, and total iron and iron binding capacity of serum were studied. Loha
bhasma was helpful not only in resorting hemoglobin level, but in significantly increasing
body weight gain in bhasma-treated animals. In some parameters results were better that
those observed with Fefol.
No clinical study on iron bhasma was found in our literature search.
6.7.3 Copper (Tamra) Bhasma Indications
Tamra bhasma is used as a single drug and also in combination with many medicinal plant
extracts. Tamra bhasma is used for the management of liver disorder, arthritis, old age
disorders, leucoderma, etc. Animal Studies
The hepatoprotective effect of tamra bhasma has been studied on cumene hydroperoxideinduced
peroxidation, reduced glutathione content, and SOD in rat liver homogenate.23
The drug was orally given for 8 days at different dose levels (0.5, 1.0, and 5.0 mg/100 g
body weight). It showed significant reduction in the level of lipid peroxidation. The results
suggested that tamra bhasma is a strong antioxidant drug and could be used in the management
of lipid peroxidation. It showed no acute detectable adverse effects. Levels of
SOD were also enhanced by tamra bhasma.
The hepatoprotective effects of four Ayurvedic drugs — kumari asav, kumari kalp, arogyavardhini,
and tamra bhasma — against the toxicity of carbon tetrachloride (CCl4) was
established in a series of experiments in rats.23 The hepatoprotective effect of these drugs
was in the following order: tamra bhasma < arogyavardhini < kumari kalp < kumari asav.
Significant reduction in hepatic necrosis was recorded in all the treated animals.23,24 Effects
of these drugs on acid lipase, alkaline lipase, lipoprotein lipase of the liver and kidney,
adipose tissue and hormone-sensitive lipase, acid phosphatase, and beta-glucoridase were
also investigated in the animals treated with the above-mentioned drugs.24–26 Histologically,
all the above formulas showed hepatoprotective effects in CCl4-exposed animals.
6.7.4 Abhrak Bhasma Indications
Abhrak bhasma is prepared by treating biotite (mica) with the juices of a number of reconstituent
plants that make it a powerful cellular regenerator. It is a commonly used
Ayurvedic drug against many diseases, including hepatitis. It is also a nervine tonic and
is widely used in respiratory tract infections and anemia. It contains iron, magnesium,

potassium, calcium, and aluminum in traces. Abhrak bhasma is an amorphous powdery
drug. Mica mainly contains silicates of iron, magnesium, and aluminum.27 Animal Studies
The hepatoprotective action of abhrak bhasma has been reported in albino rats using a
model of hepatitis induced by a single dose of CCl4 (3 ml/kg body weight). Different
doses of abhrak bhasma (10, 20, 30, and 40 mg/kg body weight) were used.27 The centrolobular
necrosis induced by a single dose of CCl4 was reduced significantly by abhrak bhasma
(10 mg), and liver histology was also protected by a 20-mg dose. Liver acid lipase activity
was lowered, whereas alkaline and lipoprotein lipase activity was elevated due to the
treatment of CCl4. Abhrak bhasma-treated animals that were exposed to CCl4 showed
marked improvement in enzyme profile.
6.7.5 Mandur Bhasma Indications
Mandur bhasma is prepared by purifying and calcinating iron rust. It is especially useful
in anemia, amenorrhea, dysmenorrhea, menorrhagia, chlorosis, and hepatic and splenic
disorders. It is also used in diarrhea, chronic bowel complaints, dyspepsia, intestinal
worms, nervous system diseases, neuralgia, kidney diseases, and albuminuria. It is a
powerful hematinic and tonic and is valuable in the treatment of hemolytic jaundice and
microcytic anemia. Animal Studies
The protective effect of mandur bhasma (10 mg/kg body weight) has been demonstrated
in CCl4-treated rats.28 Bhasmas were orally administered to animals. Hepatoprotection was
established by various enzymatic parameters, lipid peroxidation, and a histological examination
of tissues.
6.7.6 Muktashukti Bhasma
Muktashukti bhasma is a compound bhasma consisting of pearl (moti), Aloe vera Linn. (guar
patha), and vinegar (kanji). The bhasma is prepared from the outer covering of the shell
(pearl-oyster), and is ground and triturated with A. vera and vinegar in sufficient quantity
to make a homogeneous paste. The recommended proportion of pearl-oyster and A. vera
is in the ratio of 1:4. Indications
Muktashukti bhasma has been used in the treatment of tuberculosis, cough, chronic fever,
conjuctivitis, abdominal discomfort, biliary disturbances, asthma, heart diseases, vomiting,
acidity, dyspepsia, dysmenorrhea, general weakness, arthritis, rheumatism, musculoskeletal
disorders, etc. Animal Studies
An anti-inflammatory effect of muktashukti bhasma has been shown in albino rats by
Chauhan et al.29 The bhasma inhibited acute and subacute inflammation in albino rats as
induced by subplanter injection of carageenan, histamine, serotonin (5-HT), nystatin, and
subcutaneous implants of cotton pellets. In all the test procedures, the anti-inflammatory

response of 1000 mg/kg of muktashukti bhasma was comparable with the response observed
with 300 mg/kg of acetyl salicylic acid, which was used as a standard anti-inflammatory
drug. Oral premedication with delayed castor oil-induced diarrhea in rats, indicating its
prostaglandin inhibitory activity.29
6.7.7 Sankha Bhasma
Sankha bhasma is a powder prepared from the calcinated conch shell. It consists mainly of
calcium, iron, and magnesium. Indications
Sankha bhasma is well known for its antacid and digestive properties. It is useful in
hyperchlorhydria, sprue, colic, and hepatosplenomegaly. Biological Studies
A mixture of some Ayurvedic medicines that contained sankha bhasma and the herbs
Glycrrhiza glabra, Terminalia chebula, and Piper longum showed protection against duodenal
ulcer in rats.30 These drugs act on Bruner's gland by improving its secretory status.
6.7.8 Miscellaneous Studies on Bhasmas
Yashada bhasma is a specially processed zinc. It is administered in sprue, diabetes, leucorrhea,
and hyperhydrosis. The role of the bhasma in arresting myopia has been examined
in one study.31
Contamination of bhasmas directly through the herbs used in the preparation and formation
of polycyclic aromatic hydrocarbons (PAHs) is expected. Sometimes bhasmas may
be contaminated with very harmful substances. Bhasmas were analyzed and found to
contain PAH. The levels of total PAH varied widely (2.32 to 9.55 ppm) among the preparation
tested. The benzo[a]pyrene level also varied, the highest concentration being 9.7
The studies presented here suggest bhasmas may have a hepatoprotective effect. However,
efforts should be made to study their beneficial effects on other systems. Especially,
evaluation of their immunomodulatory and neuroprotective actions may prove to be
A summary of scientific investigations on the above-mentioned bhasmas is provided in
Table 6.4.
Summary of Scientific Investigations on Other Bhasmas
Bhasma Investigation Animal Model Ref.
Abhrak bhasma Hepatoprotective activity Rat 28
Loha bhasma Antianemic Rat 23
Mandur bhasma Hepatoprotective activity Rat 29
Muktashukti bhsama Anti-inflammatory activity Rat 30
Sankha bhasma Antiulcerogenic activity Rat 31
Tamra bhasma Hepatoprotective activity Rat 24–27

6.8 Metal and Mineral Preparations of Unani-Tibb
Like Ayurveda, a large number of metal and mineral preparations are used in the Unani
system of medicine (Unani-tibb). In Unani-tibb, the procedures of calcination, purification,
and trituration are also undertaken to purify and enhance the therapeutic efficacy of drugs.
All the important metals (i.e., copper, gold, silver, lead, arsenic, mercury, etc.) are used in
this system of medicine. The calcinated drugs of Unani-tibb are termed kushta. Drugs
derived from shell, oyster, and coral are also used in Unani-tibb. Although there is some
similarity between the procedural details of calcination, purification, and trituration,
Ayurvedic and Unani-tibb systems of medicine have a number of differences.5,12 Some of
the most widely used drugs prepared from metals and minerals that are used in Unanitibb
are listed in Table 6.5.
6.9 Discussion
Various processes of marana and sodhana involve the incorporation of herbal juices that
presumably makes the drugs more efficacious. The drug that is presented in the final form
Metal and Mineral Drugs Used in Unani System of Medicine
No. Metal and Mineral (Unani Name) Name of Unani Drug (% of Metal and Mineral)
1 Aluminium Kushta-e-Zumurrud (16.55%)
2 Ammonium chloride (naushadar) Habbe Kabid Naushadri
3 Antimony (surma siyah) Kehul-ul-Jawahar
4 Arsenic (sankhya) Kushta Sam-ul-far (18.89%)
5 Borax (suhaga) Safoof-e-Chutki Atfal
6 Bromide Kushta-e-Sadaf (2.4458%)
7 Calcium Khameera-e-Zaharmohra (27.16 mg/g)
8 Copper Jawarish-e-Jalinoos (7.82 mg/g ash)
9 Coral (marjan) Kushta Marjan
10 Diamond (almas) Kushta Almas
11 Gold (sona) Kushta Tilan Kalan
12 Iron (loha) Kushta-e Sadaf (77 mg%), Kushta-e-Faulad (48.75%)
13 Iron rust (khabsul-hadid) Kushta Khabsul-Hadid
14 Lead Sharbat-e-Khas Khaash (8.333 mg/g)
15 Magnesium Kushta-e-Busud (44 mg/g)
16 Mercury (para) Marham Gulabi
17 Pearl (moti) Kushta Sadaf
18 Potassium Safoof-e-namak-e-shaikh-ur-raees (1190 mg%)
19 Shell (sadaf) Kushta Sankh
20 Silver Kushta-e-Nuqra (93%)
21 Strontium Kushta-e-Kharmohra (1.32%)
22 Sulphur (kibreet) Habbe Kibreet
23 Talc Kushta Abhrak
24 White lead (safeda kashgiri) Marham Kafoori
Based on information from Council for Research in Unani Medicine, Physicochemical Standards of Unani
Formulations, Parts I and II, Central India, New Delhi, India, 1986, and Ali, S.S., Unani Adviya Mafrada,
Turky Urdu Beaurou, New Delhi, India, 1982, chaps. 3 and 4 (in Urdu).

seems to have an enhanced bioavailability, especially through the digestive system. It is
also likely that most of the bhasmas act as adjuvants and thus may be potentiating the
nonspecific immune functions (macrophage activation). They may also activate drugmetabolizing
enzymes. Further scientific investigations are warranted. Studies should be
undertaken aiming at use of radio-labeled metallic compounds in Ayurvedic medicine
and subsequently their distribution and disposition should be tracked down.
Metal and mineral preparations used in Ayurveda, Siddha, and Unani-tibb are often
subjected to scientific scrutiny. Analytical laboratories sometimes publish news articles
about the existence of heavy metals like arsenic, lead, and mercury in Ayurvedic formulations.
This makes the public uneasy to use Ayurvedic and other traditional drugs.
However, it is necessary to note that many important metals are essential components of
vital molecules of the body; every year the essential nature of some hitherto nonessential
elements is established in biological systems.
In Ayurveda, a great emphasis is placed on shodhana (purification) and detoxification of
metals and other minerals. The process of shodhana is followed by the incorporation of
various herbal juices to get the final product. This alters the metallic salt forms and the
bioavailability. These processes can also convert the metalloids in emulsified form, acting
as an adjuvant and eliciting various responses, especially the immune responses. The
unabsorbed parts are normally eliminated in the stool after localized activities in the
receptor sites of the gut. The activity of any pharmacologically active substance is based
on the dose of administration, duration of administration, frequency of administration,
and the adjuvant, which may influence bioavailability. In Ayurveda, these principles are
the essential parts of therapy. Many of the bhasmas are recommended at very low doses
(often in divided doses) and for a specific period of time. Sometimes the dose levels of
elements may even normally occur in water sources. Thus, dose is a very important factor
in using bhasmas.
Metals and minerals in Ayurveda are not essentially the first line of treatment for
common diseases. Introduction of metallic preparations is the last resort only when all
other methods of treatment have not yielded desired results. One common criticism that
is associated with Ayurvedic preparations, particularly those prepared from metals and
minerals, is their nephrotoxicity. This may be due to self-medication, which is a common
practice because patients do not bother to consult an Ayurvedic physician for proper
prescription and, unlike modern medicine, no proper treatment regimen is followed.
Another problem relates to drug standardization. The sporadic incidence of environmental
contamination may ultimately find its way into plant parts. Due to the use of improper
apparatus, contamination may also occur. With the implementation of good manufacturing
practices (GMP) in Ayurvedic pharmaceutical industry, these problems will be overcome.
There is also a need to have preclinical and clinical investigations on some selected
bhasmas. World Health Organization guidelines clearly direct that it is not necessary to
carry out detailed toxicological evaluation of the herbs or their compounds originating
from traditional systems of medicine. Length of continuity of use is to be taken as testimony
of safety.
The author wishes to acknowledge contribution of his student, Mehboob Ali, who was
immensely helpful in collecting Ayurvedic literature from the library of the Central Council
for Research in Ayurveda and Siddha (CCRAS), New Delhi, and other libraries in Delhi.

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3. Rao, S.K.R., Encyclopedia of Indian Medicine: Historical Perspective, Popular Prakashan, Bombay,
India, 1985.
5. Chopra, A. and Doiphode, V.V., Ayurvedic medicine: core concept, therapeutic principles, and
relevance, Med. Clin. North Am., 86, 75, 2002.
6. Frawley, D. and Lad, V., The Yoga of Herbs, Motilal Banarsidass Publishers Pvt. Ltd., Delhi,
India, 1994.
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New Delhi, India, 1982, chap. 1.
9. Dash, B., Fundamentals of Ayurvedic Medicine, Bansal & Co., Delhi, India, 1980.
10. Sengupta, K.N., The Ayurvedic System of Medicine, 1906 reprint, Logos Press, New Delhi, India,
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Jaipur, India, 1988, chap. 1.
12. Said, M., Hamdard Pharmacopoeia of Eastern Medicine, Hamdard Foundation, Karachi, India,
13. Central Council for Research in Ayurveda and Siddha, Application of Standardised Namburi
Phased Spot Test in Identification of Bhasma and Sindura Preparations of Ayurveda, New Delhi,
India, 1991.
14. Raghunathan, K., Pharmacopoeial Standards for Ayurvedic Formulations, Central Council for
Research in Indian Medicine Homeopathy (CCRIMH), Publ. 15, New Delhi, India, 1976.
15. Mitra, A., Chakraborty, S., Auddy, B., Tripathi, P., Sen, S., Saha, A.V., and Mukherjee, B.,
Evaluation of chemical constituents and free radical scavenging activity of Swarna bhasma
(gold ash), an Ayurvedic drug, J. Ethnopharmacol., 80, 147, 2002.
16. Chopra, R.N., Chopra, I.C., Handa, K.L., and Kapur, L.D., Chopra’s Indigenous Drugs of India,
2nd ed., Academic Publishers, Calccutta, India, 1982.
17. Bajaj, S. and Vohora, S.B., Analgesic activity of gold preparations used in Ayurveda and Unani-
Tibb, Indian J. Med. Res., 108, 104, 1998.
18. Bajaj, S., Ahmad, I., Fatima, M., Raisuddin, S., and Vohora, S.B., Immunomodulatory activity
of a Unani gold preparations used in Indian system of medicine, Immunopharmacol. Immunotoxicol.,
21, 151, 1999.
19. Bajaj, S., Ahmad, I., Raisuddin, S., and Vohora, S.B., Augmentation of non-specific immunity
in mice by gold preparations used in traditional systems of medicine, Indian J. Med. Res., 113,
192, 2001.
20. Shah, Z.A. and Vohora, S.B., Antioxidant/restorative effects calcined gold preparations used
in Indian systems of medicine against global and focal models of ischaemia, Pharmacol. Toxicol.,
90, 254, 2002.
21. Sharma, D.C., Jha, J., Sharma, P., and Gaur, B.L., Evaluation of safety and efficacy of a gold
containing Ayurvedic drug, Indian J. Exp. Biol., 39, 892, 2001.
22. Pandit, S., Biswas, T.K., Debnath, P.K., Saha, A.V., Chowdhury, U., Shaw, B.P., Sen, S., and
Mukherjee, B., Chemical and pharmacological evaluation of different Ayurvedic preparations
of iron, J. Ethnopharmacol., 65, 149, 1999.
23. Tripathi, Y.B. and Singh, V.P., Role of tamra bhasma an Ayurvedic preparation, in the management
of lipid peroxidation in liver of albino rats, Indian J. Exp. Biol., 34, 66, 1996.
24. Patil, S., Kanase, A., and Varute, A.T., Effect of hepatoprotective Ayurvedic drugs on lipase
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Zysk, K.G., Traditional Ayurveda, http//:www.hindu.dk.
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100 Scientific Basis for Ayurvedic Therapies
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Diabetes Mellitus (Madhumeha)
Lakshmi Chandra Mishra and Tarek Adra

7.1 Introduction
Diabetes mellitus (DM) is described in Ayurveda as
literally means “excessive urine with sweet taste like honey,” or
dhatupak janya vikriti
which means a disease caused by a defective metabolism leading to derangement in body
tissue (seven
) transformation process. Historically, Ayurvedic texts have described
20 types of urinary disorders (
) based on the predominant dosas (10
, 6
, and 4
urinary disorders) and physical characteristics of the urine (e.g.,
volume, color, odor, taste, sediments, solid particles, presence of seminal fluid, and mucus).
The urine is discharged in excessive quantities and is generally turbid. DM is one of these
that may occur in any of the three (
) body constitutions.
DM is a very common health problem; almost 3% of the world population or 100 million
people suffer from it.
It is the fourth most common cause for patient visits to a physician
in the U.S. It accounts for nearly 15%
of health-care costs in the U.S. DM may result in
premature disability, mortality, blindness, end-stage renal disease (ESRD), and nontraumatic
limb amputations. DM is also known to increase the risk of heart, cerebral, and
vascular diseases by two- to sevenfold. Many of the complications of DM are preventable
or can be delayed by appropriate treatment of hyperglycemia and other cardiovascular
risk factors.
Synthetic drugs like sulphonyl ureas and biguanides may be effective in
controlling the blood sugar level for some time, but they may cause side effects like
hypoglycemia, nausea, vomiting, cholestatic jaundice, and other health problems. Most
type 2 DM patients initially respond to lowering of blood glucose levels (BGLs), but after
some time about 20% become resistant and do not benefit from these agents. Patients may
also not respond fully to these agents due to the loss of interest in regular diet and exercise,
the progression of beta cell failure, drug resistance, and other medical problems.
patients eventually require insulin treatment.
The Ayurvedic approach to DM management includes life-style dietary interventions,
exercise, and a variety of hypoglycemic herbs and herbal formulas depending upon the
Cleansing procedures are unique to the Ayurvedic approach to DM.
However, the Ayurvedic clinical description of DM, etiology, diagnosis, prognosis, and
recommended lifestyle changes are basically similar to those described in Western medicine.
The aim of this chapter is to explore the scientific basis for the Ayurvedic management
of DM with single herbs, herbal formulas, and dietary interventions, in addition to understanding
the Ayurvedic concept of DM and exploring the underlying science. Available
pharmacological, biochemical, and chemical studies on herbs are used to understand the
scientific basis of Ayurvedic therapies of DM.
7.2 Clinical Description (
Rog Viakhya
) and Etiology (
Vyadhi Haitu
The major signs and symptoms of DM described in classic Ayurvedic texts consist of
honeylike sweetness of urine, thirst, polyphagia, lassitude, tiredness, obesity, dysgeusia,
constipation, burning sensation in the skin, seizures, insomnia, and numbness of the body.
Boils, wounds, and abscesses are often difficult to heal in a diabetic patient and are
recognized in Ayurveda. All these symptoms are very similar to those currently described

in Western medicine. Ayurvedic physicians also use modern diagnostic chemical analysis
of urine and blood for confirmation.
The etiology of DM in Ayurveda is multifactorial. DM may be a familial trait, and
overweight (fat —
) patients with this diagnosis may be engaged in a lethargic lifestyle
and unhealthy diet (e.g., idle sitting, excessive sleep, overeating sweet and fatty food
items, and lack of physical exercise). All these factors are understandable because they all
can lead to type 2 DM.
Ayurveda divides DM in to two categories: (1) genetic (
occurring in young age from the very beginning of life that has some similarities with the
juvenile diabetes or insulin-dependent diabetes; and (2) acquired (
) due to an
unhealthy lifestyle
that occurs in old age and obese people and has similarities with type
2 DM. In addition, Charak Samhita (100 to 400
.) describes two types of DM: one that
occurs in very underweight people (
krsa prameha
) and one that occurs in obese people
). The former DM requires restorative
) treatment along the line of insulin
treatment and the latter requires fat-reducing
) treatment.
Type 1 DM is associated with the absence of insulin-secreting capacity of the patient,
and this problem accounts for less than 10% of DM patients in the U.S. Type 2 DM patients
have some degree of insulin-secreting capacity and account for more than 90% of DM
patients in the U.S. Miscellaneous types of DM are very small in number and have various
etiological factors (e.g., genetic defect of beta cells, defects in insulin action, diseases of
pancreas, endocrinopathies [Cushing’s syndrome, hyperthyroidism, and others], and
drugs and chemicals [glucocorticosteroids and others]). Other etiological factors are infections
(congenital rubella, cytomegalovirus), immune-mediated DM, other genetic syndromes
(Down, Klinnefelters, and others), and gestational disorders. Because all types of
diabetes may require insulin treatment at some point, the terms “insulin-dependent” and
“insulin-nondependent” DM are no longer used.
Recent studies have shown that there is a genetic component in the etiology of type 1
DM. In fact, Kyvik et al.
have shown that the cumulative concordance among twins (both
twins affected) from birth to age 25 is 70%, which indicates that genetic factors cannot
account for 100% of the incidence, but that environmental, immunity, and other factors
are contributory. Several genes (HLA-DR3 or HLA-DR4) have been found in 95% of
Caucasians with type 1 DM, whereas these genes are found in only 45% of the general
DM population.
Autoimmunity is suggested to be an important contributory factor
because a lymphocyte-rich infiltrate, an indicator of immunological response, was found
in pancreatic islets.
In addition, 70 to 80% of the patients are found to have islet cell
autoantibodies against intracellular islet cell antigens such as glutamic acid decarboxylase
islet auto-antigen 2, insulin, and gangliosides.
Support for the role of environmental
factors came from observations that Finnish children had 60- to 70-fold greater risk of
type 1 DM than did Korean children. The incidence of DM in children under 15 in the
northeastern U.S. has tripled since the late 1960s, indicating the involvement of environmental
Epidemiological studies have shown an association between Coxsackie
viruses of group B and pancreatic diseases, including DM, that indicates the possibility
of a contributory role of viruses in the etiology of DM.
Chemicals such as streptozotocin,
alloxan, and pentamidine have also been shown to produce DM by destroying the insulinproducing
islet cells.
Type 2 DM has even greater involvement of genetic factors than type 1 DM, but no
specific gene has been linked to DM to account for the role. There is no evidence available
to show the role of autoimmunity in type 2 DM. The two major problems in type 2 DM
are the reduced secretion of insulin from beta cells and development of resistance to insulin
in peripheral tissues. Obesity is another major etiological factor, for 80% of type 2 DM
patients are obese.

7.3 Pathogenesis (
According to classic Ayurvedic texts, DM and all
(urinary disorders) start with the
derangement of
that spreads throughout the body and mixes with fat (
) that is
similar in physical properties to
mixed with fat passes into the urinary
system, thereby interfering with normal urine excertion. Vitiated
, and other body
fluids (
) may also be involved in this blockade. This blockade is believed to be the
cause of frequent urination observed in DM.
left untreated may lead to deranged
development of the bone marrow, body tissues, nutritional materials (fat, proteins, and
carbohydrates), and hormones (
). The incurable stage of
, which
is insulin-dependent DM.
may not be described precisely in Ayurveda, but it
points in the direction of the current knowledge we have about the disease with respect to
neurological damage and insulin (
) malfunctioning at the production (degeneration of
islets of Langerhans in the pancreas) or at the utilization levels. The involvement of tissues
) leading to blood vessels, kidney, eye, and nerve damage is also described in
Ayurveda as major complications. DM is described not only as a condition of
(sugar loss in urine), but also as a condition of
(immunity and hormone loss) in
Ayurveda for the purpose of treatment.
DM is primarily a dysfunction of insulin, a hormone produced by beta cells in the
pancreas. Insulin is necessary for cellular uptake of glucose, glycogen formation in the
liver and skeletal muscles, conversion of glucose into triglycerides, as well as nucleic acid
and protein synthesis. The BGLs are maintained by three factors: (1) the production of
glucose by the liver, (2) the uptake and utilization of glucose by the peripheral tissues,
and (3) the production and release of insulin by the pancreas. The blood insulin levels are
maintained by glucose, which stimulates the synthesis of insulin, and calcium-dependent
secretion of insulin by other agents (e.g., amino acids and gastrointestinal hormones). The
key feature of DM is impaired glucose tolerance. In a normal person, the BGL returns to
normal within an hour after a glucose challenge dose, whereas the level remains high in
a diabetic or prediabetic person for many hours.
7.4 Clinical Course and Prognosis (
According to classical Ayurveda, all
have the potential to become incurable
) if left untreated. The
urinary disorders (
) are curable because
the causative
and the affected tissues (
) have the same properties, thus requiring
the same type of therapy. Although the
urinary disorders are controllable (palliative),
the resulting disorder may persist for life because the causative
, but the
tissues and waste products (
) are different, requiring a different type of therapy.
urinary disorders are considered incurable because tissues (
) and hormones
) undergo deterioration.
Recent studies have observed a relationship between the body constitution and relative
amounts of hyperglycemia and insulinemia consistent with the Ayurvedic prognosis.
constitution patients showed the highest level of insulinemia and the lowest levels
of FBS and PPBS.
patients showed the lowest level of insulinemia and the highest
levels of FBS and PPBS.
patients were in the middle. Further studies are necessary
to confirm these findings.

In Ayurveda the major complications of
urinary disorders are believed to be
poor digestion, anorexia, vomiting, drowsiness, coughing, and nasal catarrh.
disorder patients tend to exhibit a pricking pain in the urinary bladder, penis, and
scrotum, as well as fever, burning sensations, thirst, sourness of the throat, fainting, and
loose bowel movements.
urinary disorders (diabetes) patients often experience tremors,
pain in the cardiac region, abdominal tenderness, insomnia, and dryness of the mouth.
The major complications of
DM most commonly include ulcers (eruptions) over joints,
muscles, skin, blood vessels, as well as damage to the kidney and the retina.
7.5 Clinical Examination and Diagnosis (
Rog Pariksha
Historically, Ayurveda diagnosis of DM was primarily based on the sweetness of urine
that was identified by a swarm of flies and ants over the urine. Ayurvedic physicians
currently use urine, blood sugar, and glycohemoglobin (Hb A
) levels to confirm the
. Ancient Ayurvedic texts give the following signs and symptoms of
, and
for diagnosis. Recently, however, Ayurvedic doctors’
diagnostic tools evolved to more modern clinical and laboratory methods consistent with
those of Western medicine:
Kaphaja pramehas
a. Udaka meha — The urine is clear; is in large amounts; is white, cold, and
odorless; resembles water, sometimes with slight turbidity, and slimy.
b. Iksu meha — The urine is like sugarcane juice and is very sweet.
c. Sandra meha — The urine becomes thick when kept overnight.
d. Sura meha — The urine resembles beer (sura) with a clear top and a cloudy
bottom portion.
e. Pista meha — The urine is white and thick, similar to a solution of corn flour.
f. Sukra meha — The urine is like semen or mixed with semen.
g. Sita meha — The urine is sweet and very cold.
h. Sikata meha — The urine contains sandlike particles.
i. Sanair meha — The urine is passed very slowly.
j. Laala meha — The urine is slimy and contains threads like that of saliva.
2. Pittaja pramehas
a. Ksara meha — The urine is like a solution of alkali in smell, color, and taste.
b. Kala meha — The urine is black.
c. Nila meha — The urine is bluish.
d. Haridra meha — The urine is yellowish, similar to tumeric.
e. Manjistha meha — The urine is foul smelling resembling manjistha (Rubia cordifolia),
a slightly red solution.
f. Rakta meha — The urine is foul smelling, slightly salty, and blood red.
3. Vataja pramehas
a. Majja meha — The urine looks like marrow or marrow mixed.
diagnosis. The eight-point diagnosis discussed in Chapter 2 is applied to identify the

b. Ojas meha — The urine looks like honey.
c. Vasa meha — The urine looks like liquid muscle fat and may be passed frequently.
d. Hasti meha — The urine is like that of an elephant in rut, being discharged
continuously without force, mixed with lymph and without obstruction.
These urine characteristics may be found in a wide range of pathologies covering all
kinds of urinary infections, obstructive uropathies, renal failures, and other health conditions.
The kaphaja iksu meha and vataja ojas meha are the correlate of the modern understanding
of DM.
The results of diagnosis are correlated with body constitutions in order to design an
individualized therapy.
Decoctions to Treat Kaphaja Pramehas
Medicinal Plant Botanical Name Medicinal Plant Botanical Name
Decoction #1 Decoction #2
Katphala Myrica esculenta Patha Stephania japonica Miers
Musta Cyperus rotundus Vidanga Embelia ribes
Lodhra Symplocos cocchinchinensis Arjuna Terminalia arjuna
Haritaki Terminalia chebula
Decoction #3 Decoction #4
Haridra Curcuma longa Kadamba Anthocephalus chinensis
Daru haridra Berbers aristata Sala Shorea robusta Geartn.
Tagarai Cassia tora Linn. Arjuna Terminalia arjuna
Vidanga Embelia ribes Yavani Carium copticum Benth
Decoction #5 Decoction #6
Daruharidra Berbers aristata Devdaru Polyalthia longifolia
Vidanga Embelia ribes Kushta Saussurea
Khadira Acacia catechu willd Aguru Aqullaria agallocha roxb.
Dhava Anogeissus latifolia Candana Santalum album Linn.
Candana Santalum album Linn.
Decoction #7 Decoction #8
Daruharidra Berbers aristata Patha Stephania japonica Miers
Agnimantha Clerodendrum multiflorum Murva Celosia cristata Linn.
Triphala Terminalia chebula, terminalia
bellerica, and Emblica
officinalis (mixture)
Gokshura Tribulus lanuginosus
Patha Stephania japonica Miers
Decoction #9 Decoction #10
Yavani Carium copticum Benth Cavya Piper chaba Hunter
Usira Vativeria zizanoides Linn. Haritaki Terminalia chebula
Haritaki Terminalia chebula Chitraka Plumbago zeylanica
Guduci Tinospora cordifolia Saptaparna Alstonia scholaris

Om Tat Sat

(My humble salutations to H H Maharshi ji,  Brahmasri Sreeman Lakshmi Chandra Mishra ji and other eminent medical scholars and doctors   for the collection)


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