A Role of Herbal Formulationin the management of Diabetes mellitus...

[Full title: A Role of Herbal Formulationin the management of Diabetes mellitus (Madhumeha)- A Review Article]

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volume- 2, issue-3(May-June) IRJAY 23 IRJAY, vol- 2, issue-3, May-June:2019; 23-28 Dr. Deepak Suman 1 , Dr.DeveshJaiman 2 , Prof. Ram Kishore Joshi 3 Dr. Harish Bhakuni 4 1. M.D.Scholar, P.G Department of Kayachikitsa, National Institute of Ayurveda, Jaipur 2. Ph.D.Scholar, P.G Department of Kayachikitsa, National Institute of Ayurveda, Jaipur 3. Professor& H.O.D., P.G.Department of Kayachikitsa, National Institute of Ayurveda, Jaipur 4. Assistant Professor P.G. Department of Kayachikitsa, National Institute of Ayurveda, Jaipur ABSTRACT- Diabetes mellitus is a growing health hazard in developing countries.As a psychosomatic disease and due to most dangerous complications, DM has grabbed the attention of health community all over the world.Diabetes mellitus (DM) is a clinical syndrome characterized by hyperglycaemia due to absolute or relative deficiency of insulin.According to A etiological factor, pathogenesis and clinical features Diabetes mellitus correlated with Madhumeha in Ayurveda Madhumehi patients pass sweet urine in addition to excessive urine. Intake of Guru, Snigdha, Picchhila substances, intake of new grains, meat of Anupa and Jalchara animals, milk and milk products, jaggery and its products, flour, lack of exercises, sedentary life style are the causes of Madhumeha. Even the genetic basis of the disease has been highlighted in the Ayurveda . Similarly,Modern science also recognizes that sedentary lifestyle, Obesity and genetic factors also play an important role in its development. So due to lack of effective medicine,wide spectrum of disease, need of time is to go for cost effective, safe and efficient treatment of Madhumeha. Keeping all above points in mind aherbal formulationhas beenselected to know the effect in treating Madhumeha (Diabetes volume- 2, issue-3(May-June) Review Article A Role of Herbal Formulationin the management of Diabetes mellitus ( Madhumeha) - A Review Article Article received on- 25 June Article send to reviewer- 27 June Article received from reviewer- 2 July Corresponding author- Dr. Deepak Suman M.D.Scholar, P.G Department of Kayachikitsa, National Institute of Ayurveda, Jaipur, Emaildrdeepaksuman 11@gmail.com

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volume- 2, issue-3(May-June) IRJAY 24 IRJAY, vol- 2, issue-3, May-June:2019; 23-28 Mellitus).Harbal formulation contents are Gurmaara, Amalaki , Vijayasara, Karela, Guduchi, Neema, Jamuna, Methi, and Chirayata. Keywords– Diabetes Mellitus (DM), Madhumeha, herbal formulation INTRODUCTION- Diabetes is a disease of global concern. With increased modernization and materialism its incidence is increasing day by day.Diabetes mellitus (DM) is a clinical syndrome characterized by hyperglycaemia due to absolute or relative deficiency of insulin 1 In Ayurveda , this condition can be explained as Madhumeha.Madhumeha is a type of VatajaPrameha in which patient passes honey like sweet urine. It is considered as disease of vitiated Vata and Kaphadosha and Agnimandya is present in Madhumeha.AacharyaCharaka has used term “ bahudravashleshmatathaavabadhameda ” in the description of Prameha and Dushyas involved in it are mainly Meda, Mamsa, Kleda, Shukra, Shonita,Vasa, Majja etc. are all KaphaVargiya which indicates it is a multi-system disorder. WHO estimates that globally 422 million adults aged over 18 years were living with diabetes in 2014. The global prevalence of diabetes has grown from 4.7% in 1980 to 8.5% in 2014, during which time prevalence has increased or at best remained unchanged in every country 2 According to IDF Atlas 2017, 425 million over age 20-79 years are diabetics and 629 million individuals will have diabetes by the year 2045 . Though many studies have been carried out for this burning problem, still there is need of evaluation of certain drugs clinically on various scientific parameters which could be safe, effective, cheap & readily available in the management of Madhumeha . Rationale/Justification: Despite the immense investment in drugs and therapeutics for the management of Madhumeha , its prevalence is increasing at an alarming rate. Madhumeha does not come alone; it brings with itself the various metabolic complications of hyperglycaemia both acute and chronic affecting every organ from head to toe. Once an individual is diagnosed with Madhumeha the dosage of medicine is ever increasing and ultimately insulin has to be given for glycaemic control. As Madhumeha is often associated with obesity, dyslipidaemia, hypertension, insulin resistance, known as metabolic syndrome, an intervention capable of handling all these associated conditions is necessary. In Ayurveda ‘Madhumeha’ is Vata and KaphadoshapradhanVyadhi and Dushyas are all KaphaVargiya. So ideally in Shamanachikitsa such drugs should be used in its treatment which possess Agni deepana properties and should pacify the effects of aggravated dosha like Katu, Tikta, Kashaya, RukshaDravyas . The herbal formulation is having mainly the above said properties and the ingredients of theformulation are easily available, easy to administer in patients and cost effective. So it has beenselected to know the effect in treating Madhumeha. Aims and Objectives:

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volume- 2, issue-3(May-June) IRJAY 25 IRJAY, vol- 2, issue-3, May-June:2019; 23-28  To explore an Ayurvedic Oral Hypoglycaemic Formulation, which is safe, economical, easily accessible to the patients and also devoid of side effects.  To explore the Hypoglycaemic effects of the proposed medicine in Madhumeha on scientific level. Materials and Methods:  Ayurvedic textbooks were referred to collect the relevant materials.  The index, non-index medical journals were referred to collect relevant information. Symptoms of Hyperglycemia: (According to modern text book) 3  Polydipsia (Thirst, dry mouth)  Polyuria  Hyperphagia, predilection for sweet foods  Nocturia  Tiredness, fatigue, lethargy  Noticeable change in weight (usually weight loss)  Blurring of vision  Pruritus vulvae, balanitis (genital candidiasis)  Nausea, headache  Mood change, irritability, difficulty in concentrating, apathy Clinical Feature of Madhumeha ( Diabetes Mellitus ) by Ayurveda -  The clinical entity in which patient voids the urine having concordance with Madhu 4 i.e. of Kashaya and Madhura taste, Ruksha (dry) texture and honey like colour and body acquires sweetness called Madhumeha .  In Madhumeha which is incurable and caused by the aggravation of Vata , the patient passes urine, sweet and astringent in taste, pale in colour and unctuous 5 . Pathogenesis (Samprapti)- Samprapti of ‘ Madhumeha ’ is best described by AcharyaVagbhata Vagbhata has divided it into two types according to Samprapti 6 .  A . DhatukshayajaMadhumeha  B. AavaranjanyaMadhumeha In Aavaranjanya /SantarpanajanyaMadhumeha due to excessive indulgence of Guru , Snigdha , Amla , LavanAhara,Kapha and Pitta are vitiated. They block the natural pathway of Vata . Therefore aggravated Vata vitiates the Dushya like Kapha , Meda , Mamsa and the vital body components are excreted through urine. And Oja which is supreme part of all Dhatus is excreted ultimately. In case of Dhatukshayajanya / ApatarpanajanyaMad humeha , VataprakopakaAhara-Vihara leads to aggaravation and vitiation of Vata . Therefore in this type Vata is becomes more harmful than the previous type. This aggravated Vata disturbs the normal metabolism of body and cause Kshaya of all vital Dhatus . In both these types Aparaoja is excreted through urine. The first type of Madhumeha is considered to be Asadhya and no precise remedy has been suggested for it. But the later type has been told as KrichhraSadhya and can managed with extensive treatment. Besides this, one more process i.e. Dhatvagnimandya is important part of the Samprapti . As, in Prameha Agni is also

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volume- 2, issue-3(May-June) IRJAY 26 IRJAY, vol- 2, issue-3, May-June:2019; 23-28 disturbed due to various factors which disturb the balance of Tridosha . Therefore anything which is ingested is converted in Ama . So, the process of Dhatuposhana and Dhatu-utpatti is hampered. Again this Agnimandya is responsible for the Dhatvagnimandya of each Dhatu . In Prameha , especially Medodhatvagnimandya is observed. Therefore the treatment should be in path of restoration of Agni in its normal state and having Kaphamedohara property . It should also possess Rasayana and Balya effect as all Dhatus are involved and Ojakshaya is seen in the disease. Also in the Madhumeha (Diabetes Mellitus) there are degenerativechanges in the body especially in the islets cells of pancreas which resembles DhatuKshaya in Ayurveda. As per Ayurveda according to the potency of particular feature of etiology, Dosha (innate pathogenic factors) and Dushyas (substratum of pathology), response occurs in the form of nonmanifestation or otherwise of the disorders. When these three factors do not combine together or if combined after a long time or in weakened state, disorder will not be there, or it will manifest lately, or in a mild form or without all the said symptoms. On the contrary, the result will be contrary. Thus is said the cause of response in the form of none or otherwise of all disorders. DrugReview: Selection of drug is milestone in any research project because success of the project is totally depends on that. In Ayurveda, the action of drugs is determined on the basis of pharmacodynamics properties such as rasa, guna, veerya and vipaka along with certain unexplained specific properties called Prabhava ( karma ). These drugs in combination act as antagonist to the main morbid factors i.e. aggravated dosha and dushya to cause SampraptiVighatana so as to allay the symptoms of the disease. TableNo .1. Showing the In Ingredients of Herbal Formulation. S.No. Name of the drug Botanical Name Part Used 1. Gurmaar Gymnemasylvestre Whole plant 2. Amalaki Emblicaofficinalis Fruit 3. Vijayasara Pterocarpusmarsupium Stem 4. Karela MomordicaCharantia Fruit 5. Guduchi TinosporaCordifolia Stem 6. Neem Azadirachtaindica Bark 7. Jamun SyzgiulmJambos Seeds

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volume- 2, issue-3(May-June) IRJAY 27 IRJAY, vol- 2, issue-3, May-June:2019; 23-28 8. Methi TrigonellaFoenum Seeds 9. Chirayata Swaritiachirayata Whole plant Method of Preparation All the constituents of drugs should be taken in equal quantity and check out for their identity, quantity and quality. The individual drugs should be mixed and make into powder form. After that powder should be given bhavana with chirayata decoction for two times. Medicated powder should fully dried and then pack in small polythene bags. Probable Mode of Action ofHerbal formulation: Most of the drugs in herbal formulation have Katu, Tikta Rasa, Laghu, RukshaGuna, UshnaVirya , Vata- KaphaShamaka and Dipana- Pachana properties Kapha on the other hand is Guru , Snigdha , Shita. Because of all these properties, Herbal formulation has the ability to counteract the effect of Kapha . Thus the aggravated Kapha subsides resulting in proper functioning of Agni and hence preventing MargaavarodhjanyaVataPrakopa thereby breaking the pathogenesis of the disease Kashaya Rasa inherbal formulationwill act as a controller of excessive urination, Dhatukshaya and Ojakshaya through urine by their Stambhana properties. It will absorb Kleda , Meda , Vasa and KaphaDosha.UshnaVeerya,Katuand Tikta Rasa will helps to normalise the function of Jathragni and Dhatwagni. Laghu,RuksaGuna will help for the Shosan of BahudravaShlesma and reduction of vitiated Meda andKleda . Thus once these factor get normalized in the body they in turn make clear the Path of Vata which stops the depletion of vital Dhatus and restore normal physiology. Similarly due to Rasayana(Guduchi andVijayasara) properties like Dahashamana, Balya, Stambhana, Mootrasangrahana, etc it will also help in managing symptoms of diabetes mellitus like, weakness, fatigue, burning sensation in hands and feet, impotency, etc. There have been many researches of the individual plants of Herbal formulation showing hypoglycaemic action. So we can say that Herbal formulation could be used in the management of Diabetes Mellitus. Conclusion: Diabetes Mellitus is a common chronic metabolic disease associated with substantial risk for morbidity and premature mortality.Medical therapy is just a part of the diabetes management and not a whole treatment.There are so many drugs available in modern medical science for the treatment ofDiabetes Mellitus (Madhumeha) but they are associated with adverse effectsbut Ayurvedic principles of management can help the patient to have bettercontrol of blood sugar with noadverse effectsand makes free the dependency on medicine.So,Herbal formulationcould play this role and can show it’shypoglycemic effect.Further, various researches have already been conducted in favour of their hypoglycemic effect. So we can use this herbal formulation for the treatment of Madhumeha (Diabetes mellitus).

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volume- 2, issue-3(May-June) IRJAY 28 IRJAY, vol- 2, issue-3, May-June:2019; 23-28 REFERENCES 1 Colledge Nicki R. Et.al.: Davidson’s Principle and Practice of Medicine, Churchill Livingstone, 21 st Edition, Pg.798 2.Global Report on Diabetes, World Health Organization, 2016 3 Colledge Nicki R. Et.al.: Davidson’s Principle and Practice of Medicine, Churchill Livingstone, 21 st Edition, Pg.806 4. BrahmanandTripathi,AshtangaHridaya with NirmalaHindi commentary, Chaukhambha Sanskrit Pratishthan, Delhi,Reprinted, 2017, page 497 1. Sharma P.V. Caraka-Samhita (Vol. 1), Agnivesha; English translation; ChaukhambhaOrientalia Varanasi;Revised and Enlarged Edition 2014; Page.no. 274 6.Suman D, Joshi .R.K., A CLINICAL STUDY TO EVALUATE EFFICACY OF KATANKATERYADI KWATHA AND I NDRA VATI IN THE MANAGEMENT OF MADHUMEHA W.S.R. TO TYPE II DIABETES MELLITUS, 2019 Page No. 130-131

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