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.

6.7.1.3 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

TABLE 6.2

Biologically Active Gold Compounds on the Market

No. Generic Name Trade Name

Gold

Concentration (%)

1 Gold sodium thiomalate Myochristin,

Myocrisin, Tauredon

50.5

2 Gold thioglucose Solganal 50.5

3 Gold thioglycoanilid Lauron 54.2

4 Gold sodium thiosulphate Sanochrysine,

Aurothion,

Thiochrysine

402

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

thio-b-D-glycopyranoside

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.

TABLE 6.3

Summary of Scientific Investigations on Swarna Bhasma

No. Investigation Model Ref.

1 Analgesic activity Mouse, rat 17

2 Immunomodulatory activity: specific

immunity

Mouse 18

3 Immunomodulatory activity: nonspecific

immunity

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

6.7.2.1 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.

6.7.2.2 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

6.7.3.1 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.

6.7.3.2 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

6.7.4.1 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

6.7.4.2 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

6.7.5.1 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.

6.7.5.2 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.

6.7.6.1 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.

6.7.6.2 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.

6.7.7.1 Indications

Sankha bhasma is well known for its antacid and digestive properties. It is useful in

hyperchlorhydria, sprue, colic, and hepatosplenomegaly.

6.7.7.2 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

ppm.32

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

rewarding.

A summary of scientific investigations on the above-mentioned bhasmas is provided in

Table 6.4.

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

TABLE 6.5

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.

Acknowledgments

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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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

madhumeha

kshaudrameha

,

which

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

dhatus

) transformation process. Historically, Ayurvedic texts have described

20 types of urinary disorders (

pramehas

) based on the predominant dosas (10

kaphaja

, 6

pittaja

, and 4

vataja

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

pramehas

that may occur in any of the three (

vata,

kapha,

or

pitta

) body constitutions.

DM is a very common health problem; almost 3% of the world population or 100 million

people suffer from it.

1

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.

2

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.

2

Many

patients eventually require insulin treatment.

3

The Ayurvedic approach to DM management includes life-style dietary interventions,

exercise, and a variety of hypoglycemic herbs and herbal formulas depending upon the

predominant

dosa.

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

103

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 —

meda

) 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.

1

Ayurveda divides DM in to two categories: (1) genetic (

sahaja

),

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 (

apathyaja

) 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

A

.

D

.) describes two types of DM: one that

occurs in very underweight people (

krsa prameha

) and one that occurs in obese people

(

sthula

). The former DM requires restorative

(

santarpan

) treatment along the line of insulin

treatment and the latter requires fat-reducing

(

apatarparna

) treatment.

4

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.

2

Recent studies have shown that there is a genetic component in the etiology of type 1

DM. In fact, Kyvik et al.

5

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.

6

Autoimmunity is suggested to be an important contributory factor

because a lymphocyte-rich infiltrate, an indicator of immunological response, was found

in pancreatic islets.

7

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.

8

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

factors.

1

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.

9

Chemicals such as streptozotocin,

alloxan, and pentamidine have also been shown to produce DM by destroying the insulinproducing

islet cells.

1

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.

1

7.3 Pathogenesis (

Samprapti

)

According to classic Ayurvedic texts, DM and all

pramehas

(urinary disorders) start with the

derangement of

kapha

that spreads throughout the body and mixes with fat (

meda

) that is

similar in physical properties to

kapha

(mucus).

Kapha

mixed with fat passes into the urinary

system, thereby interfering with normal urine excertion. Vitiated

pitta

,

vata

, and other body

fluids (

malas

) may also be involved in this blockade. This blockade is believed to be the

cause of frequent urination observed in DM.

Pramehas

left untreated may lead to deranged

development of the bone marrow, body tissues, nutritional materials (fat, proteins, and

carbohydrates), and hormones (

ojas

). The incurable stage of

pramehas

is

madhumeha

, which

is insulin-dependent DM.

Madhumeha

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 (

ojas

) malfunctioning at the production (degeneration of

islets of Langerhans in the pancreas) or at the utilization levels. The involvement of tissues

(

dushyas

) 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

madhumeha

(sugar loss in urine), but also as a condition of

ojameha

(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.

1

7.4 Clinical Course and Prognosis (

Sadhyata

)

According to classical Ayurveda, all

pramehas

have the potential to become incurable

(

madhumeha

) if left untreated. The

kaphaja

urinary disorders (

pramehas

) are curable because

the causative

dosa

and the affected tissues (

dushya

) have the same properties, thus requiring

the same type of therapy. Although the

pittaja

urinary disorders are controllable (palliative),

the resulting disorder may persist for life because the causative

dosa

is

pitta

, but the

tissues and waste products (

dushya

) are different, requiring a different type of therapy.

Vataja

urinary disorders are considered incurable because tissues (

dhatus

) and hormones

(

ojas

) undergo deterioration.

Recent studies have observed a relationship between the body constitution and relative

amounts of hyperglycemia and insulinemia consistent with the Ayurvedic prognosis.

10–12

Kapha

constitution patients showed the highest level of insulinemia and the lowest levels

of FBS and PPBS.

Vata

patients showed the lowest level of insulinemia and the highest

levels of FBS and PPBS.

Pitta

patients were in the middle. Further studies are necessary

to confirm these findings.

In Ayurveda the major complications of

kaphaja

urinary disorders are believed to be

poor digestion, anorexia, vomiting, drowsiness, coughing, and nasal catarrh.

Pittaja

urinary

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.

Vata

urinary disorders (diabetes) patients often experience tremors,

pain in the cardiac region, abdominal tenderness, insomnia, and dryness of the mouth.

The major complications of

vata

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

and

Nidan

)

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

1c

) levels to confirm the

predominant

dosa

. Ancient Ayurvedic texts give the following signs and symptoms of

kaphaja

,

pittaja

, and

vataja

pramehas

for diagnosis. Recently, however, Ayurvedic doctors’

diagnostic tools evolved to more modern clinical and laboratory methods consistent with

those of Western medicine:

1.

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.

TABLE 7.1

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

Hook

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

                                                        

(Continued...) 

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