Clinical Efficacy Of Bhudhatryadi Yoga In The Management Of Prameha Roga...

[Full title: Clinical Efficacy Of Bhudhatryadi Yoga In The Management Of Prameha Roga W.S.R. To Diabetes Mellitus]

P a g e | 17 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION International Research Journal of Ayurveda & Yoga An International Peer Reviewed Journal for Ayurveda & Yoga Clinical Efficacy Of Bhudhatryadi Yoga In The Management Of Prameha Roga W.S.R. To Diabetes Mellitus Dr. Anil Badhoria 1 Dr. Ramesh Kaundal 2 ICV-70.44- ISRA-1.31 VOLUME 4 ISSUE 3 March 2021 1 Reader, Govt. Ayurvedic Medical College J&K, UT. 2 Lecturer Dept. Of Shalya tantra Govt. Ayurvedic College Patiala Punjab. Corresponding Author : Dr. Anil Badhoria, Reader Govt. Ayurvedic Medical College J&K UT, Email id: anildrbadhoria@gmail.com Article received on 27 th Feb 2021 Article Accepted 19 th March 2021 Article published 31 st March 2021 ABSTRACT: - Background -In spite of all sorts of advancements of science, in this world, man is not able to sail himself in the boat of happy & healthy life. Unnatural ways of life style, increased population and moreover world of machines has created unlimited desires in human mind on the one hand, while on the other hand, it has originated anxiety, anger, hostility & grief directly or indirectly. So many diseases are there which are output of unnatural dietary habits, restless lifestyle and stress, one of such is Diabetes. The syndrome of Diabetes Mellitus is largely covered under the broad heading of Prameha. Prameha is a disease which is revealed by Mutravaha Srotasa [Urinary system]. Aim - To assess the clinical efficacy of Bhudhatryadi Yoga in in the management of Prameha Roga w.s.r. to Diabetes Mellitus Material and Method -30 Patients were selected randomly from OPD and IPD of Kayachiktisa Deptt. of Jammu Institute of Ayurveda and Research hospital. Selected patients were administered Bhudhatryadi yoga 3 gm bid for a period of 45 days along with life style modifications. Weekly follow up of patients was done, while biochemical investigations were carried out before and after trial. Result-. Marked Improvement was seen in 16.66% patients. 40% of cases presented Moderate Improvement and 36.66% were categorized as Mildly Improved after the treatment. Conclusion- Bhudhatryadi yoga has better effects in reducing blood sugar level . Keywords : Diabetes Mellitus, Bhudhatryadi yoga, Gramya Ahara

P a g e | 18 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION This work is licensed under a creative attribution -Non-commercial-No derivatives 4.0 International License commons How to cite this article: - Dr. Anil Badhoria, Dr. Ramesh Kaundal Clinical Efficacy Of Bhudhatryadi Yoga In The Management Of Prameha Roga W.S.R. To Diabetes Mellitus, IRJAY, March: 2021, Vol-4, Issue-3; 17-26; DOI: https://doi.org/10.47223/IRJAY.2021.4326 INTRODUCTION Ayurveda is one of the most ancient medical sciences of the world. It conceives and describes the basic and applied aspects of life process, health, disease and its management in terms of its own principles and approaches 1 Prameha described in Ayurvedic literature have similarity with Type-2 Non-Insulin Dependent Diabetes Mellitus (NIDDM) 2 Here the study is focused on Type-2 Diabetic patients only to understand its etiopathogenesis and actual line of treatment from Ayurvedic view point. Diabetes Mellitus (DM) is a chronic disease marked `by elevated blood glucose level 3 It affects 5-6% of the global adult population. Type 2 diabetes prevalence is rising at alarming rates worldwide because of increased urbanization, high prevalence of obesity, sedentary lifestyles and stress, among other factors 4 Up to 80% of type 2 Diabetes is preventable by adopting a healthy diet and increasing physical activity. India has the largest diabetes population in the world with an estimated 41 million people, amounting to 6% of the adult population. India is the kingdom of Diabetes, having more than 5 crore patients of it 5 Diabetes has shifted down a generation as with rapid increase in prevalence of diabetes, the age of susception is decreasing promptly and has touched the thirties which are economically most productive years. The study drug selected for this clinical trial is Bhudhatryadi Yoga stated by Yoga Ratnakar 6 The effect of the compound may be synergistic or antagonist depending upon the similar qualities and opposite qualities of the Dravyas respectively 7 The final effect of combination of substances having similar properties i.e. Prakratisamasmaveta can be inferred due to similarity of properties of individual exhibits synergistic effects while effect of combination of substances having different properties i.e. Vikrativisamasamveta can’t be inferred through knowing properties of individual substances. Our Aim is to study the clinical efficacy of Bhudhatryadi Yoga in Prameha Roga (Diabetes Mellitus) AIMS AND OBJECTIVE To assess the efficacy of Bhudhatryadi yoga in Prameha Roga w.s.r. to Diabetes Mellitus MATERIAL AND METHOD Selection of Case • 30 Patients were selected randomly from OPD and IPD of Kayachikitsa Deptt. of Jammu Institute of Ayurveda and Research hospital. • All the patients were clinically diagnosed cases of Diabetes Mellitus and were properly registered. • Details of examination and investigations were carefully recorded in the proforma. Inclusion Criteria • Mild to moderate cases of Diabetes Mellitus having fasting blood sugar within range:- Mild –126 to 140 mg/dl Moderate –140 to 160 mg/dl • Patients above the age group of 18 years and below 60 years were selected. • Patients within 1 yr of diagnosis for diabetes mellitus were selected for the study. Exclusion Criteria • Patients with type 1 D.M.

P a g e | 19 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION • Type 2 D.M. patients who were insulin dependent. • Patients with F.B.S. more than 160 mg/dl & P.P.B.S. more than 220 mg/dl. • Diabetic patients with severe complications like cardiovascular diseases, Nephropathy, Retinopathy, Diabetic foot etc. • Patients of Gestational diabetes. • Diabetes due to endocrinopathy e.g. Cushing’s syndrome, Hyperthyroidism, Acromegaly etc. • Patients with certain genetic syndromes which are sometimes associated with diabetes mellitus e.g. Down’s syndrome, Klinefelter’s syndrome, Turner’s syndrome etc. • Patients suffering from terminal sickness. • Patients who don’t adopt or follow the instructions regarding life style modifications during the trial period. Investigations – Following investigations were carried out in all the patients. 1 Fasting blood sugar (F.B.S) and Post prandial blood sugar (P.P.B.S.). 2 Routine examination of blood like Hb%, T.L.C., D.L.C., E.S.R. , C.T, B.T. to exclude any pathology. 3 Routine examination of urine. • Special investigation were done in few Patient ie.HbA 1 c PLAN OF STUDY: Patients randomly selected for the study were taken in single group. Research Proforma was filled. In the patients who were taking oral hypoglycemic drugs, blood sugar level at that time was taken as basal level. Study drug was administered. Effect of study drug was observed in relation to basal sugar level and sign and symptoms. Design: It is a single blind clinical study with a pre-test and post-test design. In this study, 30 patients diagnosed of diabetes mellitus of either sex were subjected to clinical study. Intervention: Bhudhatryadi yoga was orally administered in a dose of 3 gm twice daily after meals for 45 days. Recently diagnosed patients, mild to moderate cases of type 2 Diabetes ( NIDDM- Apathya Nimittaja Prameha ) were kept on Bhudhatryadi yoga along with controlled diet and physical activity from pathya point of view. These patients were provided a proper diet chart planned according to our classics. Duration of study- 45 days Criteria for Assessment: Assessment of result has been made on the basis of following criteria, after completion of treatment. 1 Sign and symptoms before and after treatment. 2 F.B.S. and P.P.B.S. before and after treatment. 3 Assessment of changes observed in sign and symptoms and biochemical parameter is done on the basis of specific scoring pattern. 4 Depending upon severity, following symptoms score was utilized and assessment of clinical sign and symptoms was done. OBSERVATIONS Total 30 patients were registered for the present study. Table 1: Age wise distribution of patients: Age(Years) No. of patients Percentage 0-10 0 0 11-20 0 0 21-30 0 0 31-40 3 10 41-50 15 50 51-60 12 40

P a g e | 20 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION Patients selected for study were in the range of 31- 60 yrs of age. Maximum no. of patients i.e. 60% belonged to the age group 41-50 yrs. 30% of patients belonged to 51-60 yrs age group and 10% of patients were in between 31-40 yrs of age Table 2: Ahara wise distribution of patients: Ahara No. of patients Percentage Veg 17 56.67 Non-veg 0 00.00 Mixed 13 43.33 Out of 30 patients, 56.67% of patients were purely Vegetarian, 43.33% of patients were taking Mixed (Veg. & Non-veg.) diet. Table 3: Addiction wise distribution of patients: Addiction No. of patients Percentage Tea 15 50 Coffee 0 00.00 Tobacco 4 13.33 Smoking 5 16.67 Alcohol 4 13.33 Soft drinks 0 00.00 No addiction 2 6.67 Maximum no. of patients (50%) were found habituated to Tea, 16.66% were addicted to Smoking, 13.33% were addicted to Tobacco and Alcohol and 6.66% were not having any kind of addiction. Table 4: Sleeping pattern wise distribution of patients: Nidra (sleep) No. of patients Percentage Samyaka (proper) 20 66.67 Asamyaka (improper) 10 33.33 Diwaswapa (day sleep) No diwaswapa (day sleep) 10 33.33 Regular 15 50 Irregular 5 16.67

P a g e | 21 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION Ratrijagarana (awake during night) No Ratrijagarana 23 76.67 Regular 1 3.33 Irregular 6 20 Data shows that 33.33% of the patients were having Asamyaka Nidra (improper sleep) and 66.67% were having Samyaka Nidra (proper sleep). 50% of the patients were having Regular Diwaswapa , 16.66% were having Irregular Diwaswapa (day sleep) and 33.33% of them were not habituated to Diwaswapa (day sleep) . Max. no.of patients (76.67%) were not habituated to Ratrijagarana , 3.33% were having Regular Ratrijagarana and 20% were doing Irregular Ratrijagarana. Table 4: Distribution of patients according to Nature of work: Nature of work No. of patients Percentage Sedentary 24 80 Active 4 13.33 Heavy 2 6.67 Data reveals that out of 30 patients, 80% of the patients were having Sedentary nature of work, 13.3% were performing Active work and 6.66% were having Heavy physical work load. Table 5: Distribution of patients according to Bowel-habit: Bowel-habit No. of patients Percentage Regular 10 33.33 Irregular 5 16.67 Constipated 15 50 Table 5 shows that, 50% of the patients were having Constipated bowel habit, 33.33% of them were having Regular bowel-habit and 16.67% had Irregular bowel-habit. Table 6: Prakriti wise (Constitution) distribution of patients: Prakriti (Sharira) No. of patients Percentage Vata pitta 4 13.33 Vata kapha 10 33.33 Kapha pitta 16 53.34 Table 6 indicates that, 53.34% of patients were having Kapha-pitta dominance in their Prakriti , 33.33% were having Vata-kaphaja Prakriti and 13.33% had Vata-pittaja Prakriti.

P a g e | 22 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION Table 7: Aharashakti wise distribution of patients: Aharashakti No. of patients Percentage Abhyavaharanashakti Pravara (finest) 8 26.67 Madhyama (medium) 20 66.67 Avara (weak) 2 6.66 Jaranashakti Pravara (finest) 8 26.67 Madhyama (medium) 21 70 Avara (weak) 1 3.33 Table 7 gives information of Aharashakti of 30 patients which can be assessed with the help of Abhyavaharanashakti and Jaranashakti . Majority of patients i.e. 66.67% were having Madhyama Abhyavaharanashakti , 26.67% had Pravara and 6.66% had Avara Abhyavaharana-shakti . 70% of the patients had Madhyama Jaranashakti , 26.67% had Pravara and 3.33% had Avara Jaranashakti . Table 8: Signs and Symptoms observed in patients: Main Signs and Symptoms No. of patients Percentage Prabhuta mutrata ( Polyurea) 30 100 Avila mutrata (Turbid urine) 10 33.33 Trishnadhikya & Gal-talu shosha (excessive thirst and drynesss of throat) 30 100 Table 8 indicates observations of Main Sign and Symptoms specific to Prameha . Data reveals that Prabhuta mutrata and Avila mutrata were found in 100% and 33.33% of patients respectively. Trishnadhikya and Gal-talu shosha were found in 100% of patients. RESULT EFFICACY OF TREATMENT • Main Signs and Symptoms of Prameha. Table 10: Effect on Prabhuta Mutrata ( Polyurea) : Mean Score % Relief S.D. ( ± ) S.E. ( ± ) t P B.T. A.T. N=30 1.86 0.53 71.50 0.479 0.087 15.23 <0.001

P a g e | 23 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION The table 21 shows that mean initial score for Prabhuta mutrata was 1.86, which reduced to 0.53, showing 71.50% improvement. Statistical analysis shows that the improvement was highly significant at P < 0.001. Table 11: Effect on Avila Mutrata (Turbid urine) : Mean Score % Relief S.D. ( ± ) S.E. ( ± ) t P B.T. A.T. N=10 2.20 1.70 22.72 0.71 0.22 2.236 >0.05 In this group, mean score before starting treatment was 2.20 which reduced to 1.70 with 22.72% relief and gives calculated t value 2.23 which is insignificant at p >0.05 Table 12: Effect on Trishnadhikya & Gala-talu-shosha Mean Score % Relief S.D. ( ± ) S.E. ( ± ) t P B.T. A.T. N=30 2.20 0.93 57.72 0.45 0.08 15.42 <0.001 Table 12 shows mean score before starting treatment was 2.20 which reduced to 0.93 with relief of 57.72% and calculated ‘t’ value was 15.42 which was found highly significant at P<0.001. Table 13: Effect on F.B.S. : Mean Score % Relief S.D. ( ± ) S.E. ( ± ) t P B.T. A.T. N=30 147.96 109.33 26.11 4.73 0.86 44.66 <0.001 Mean score before starting treatment was 147.96 which reduced to 109.33 with relief of 26.11% and calculated ‘t’ value was 44.66 which was found highly significant at P<0.001. Table 14: Effect on P.P.B.S. : Mean Score % Relief S.D. ( ± ) S.E. ( ± ) t P B.T. A.T. N=30 195.23 154.40 20.91 2.26 0.41 98.95 <0.001 Mean score before starting treatment was 195.23 which reduced to 154.40 with relief of 20.91% and calculated ‘t’ value was 98.95 which was found highly significant at P<0.001.

P a g e | 24 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION Table 15 OVERALL EFFECT OF THERAPY • Improvement In Signs and Symptoms: RESULTS Patients Percentage Controlled 2 6.66 Marked Improvement 5 16.66 Moderate Improvement 12 40 Mild Improvement 11 36.66 Unchanged 0 0.00 2 patients (6.66%) assessed as controlled and 5 patients (16.66%) as Markedly Improved. Moderate Improvement was seen in 12 patients (40%) whereas Mild Improvement was observed in 11 patients (36.66%). All patients responded to treatment to some extent and no patient assessed as unchanged Improvement In Blood Sugar Level RESULTS F.B.S. P.P.B.S. Patients Percentage Patients Percentage Controlled 7 23.33 3 10 Marked Improvement 10 33.34 6 20 Moderate Improvement 9 30 9 30 Mild Improvement 4 13.33 10 33.33 Unchanged 0 0 2 6.67 Control in F.B.S. was achieved by 7 patients (23.33%) and that of in P.P.B.S. by 3 patients (10%). Marked Improvement in F.B.S. was observed in 10 patients (33.34%) while 6 patients (20%) for P.P.B.S. was categorized under this grade. Moderate Improvement in F.B.S. and in P.P.B.S. was observed in 9 patients (30%). Mild improvement in F.B.S. and in P.P.B.S. was observed in 4 patients (13.33%) and 10 patients (6.67%) respectively. P.P.B.S. of 2 patients (6.67%) remained unchanged DISCUSSION Prameha (Diabetes Mellitus) has been mentioned as Aanushangi Vyadhi (hereditary disease) by Maharishi Charaka Chakrapani explained the term Aanushangi as ‘ Punarbhavi ’, means a disease that presents itself again and again. 8 The rising burden of Type 2 diabetes and other non-communicable diseases which has occurred with modernization can be understood in the context of ‘epidemiological transition’ 9 . Rapid socio-economic development and coca colonization have resulted in a life style transition from traditional to modern 10 In virtually all populations, higher fat diets and decreased physical activity have accompanied the benefits of modernization. Exercise has been engineered out of our daily lives, both in the work place & leisure. These lifestyle changes when combined with increasing longevity form the basis of the dynamic Type 2 diabetes epidemic that we are witnessing

P a g e | 25 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION today 11 The western lifestyle must have unmasked the effects of pre-existing genes because the consistent result has been diabetes within a few decades. The present study was completed to evaluate the efficacy of an Bhudhatryadi Yoga in Prameha Roga ( diabetes mellitus). The outcome of the study showed ample evidence in regard to the action of the drug. The drug was prepared using fresh ingredients. Ayurvedic pharmacology depends on five principles of Rasa (essence)- Guna- (quality) ,Virya (potency)- Vipaka (post-digestive effect) and Prabhava (special effect) 12 Acharya Charaka has mentioned that any dravya (drugs) can have similar Rasa (essence)- Guna- (quality) ,Virya (potency)- Vipaka (post-digestive effect) but a different mode of action which can be explained on the basis of prabhava 13 50% patients belonged to age group 41-50 yrs. 60% were Males and 40% females. 53.34% of total cases were having Kaphapitta prakriti . Majority of cases were having Madhyama Samhanana (medium) (66.67%) and Madhyama Satva (60%).Majority of patients were presenting Prabhuta Mutrata (polyurea) (100%) as chief complaint. Trishnadhikya & Gala-talu-shosha were also found in 100% patients. Avila mutrata was observed in 33.33% of the cases. Among Main Signs and Symptoms, highly significant relief (P<0.001) was obtained in Prabhuta mutrata (71.50%) and Trishnadhikya & Galatalushosha (57.72%). Effect on Avila mutrata (Turbid urine) was statistically insignificant.6.66% patients obtained control over diseased condition 16.66% patients provided Marked Improvement, Moderate Improvement was observed in 40% of cases, 36.66% cases showed Mild Improvement in Signs and Symptoms. Total improvement in Fasting Blood Sugar was 26.11% and that of in Postprandial sugar was 20.91% which are statistically highly significant. Among them, 23.33% patients obtained Control in F.B.S. value and 10% in P.P.B.S. value. Marked Improvement in F.B.S. was seen in 33.34% cases and 20% in P.P.B.S. Moderate Improvement in F.B.S. and P.P.B.S. was seen in 30% cases. P.P.B.S. of 6.67% patients remained unchanged. Not any adverse effects of Brhutayadi yoga were reported in this study. PROBABLE MODE OF ACTION : As far as mode of action is concerned, Ayurvedic view has already been discussed in Drug Contrive. According to modern medical science, the mechanism of action of the drug may be one of these: 1. By decreasing absorption of glucose from the gut. 2. By increasing peripheral utilization of glucose. 3. By stimulating Beta cells to produce more insulin. 4. By increasing insulin sensitivity. CONCLUSION Present study was conducted with limited time, limited facilities and limited number of patients. A study of larger group of patients may help to comprehend the mode of action of the Study drug has capacity to improve signs-symptoms and biochemical parameters Acknowledgement-None Conflict of interest-None Financial Support-None REFERENCE 1 https://www.ncbi.nlm.nih.gov/pmc/articles/PM C 5198827/,downloadedon 12/01/2021. 2 https://www.researchgate.net/publication/3419 77856_AN_OUTLOOK_OF_DIABETES_ME LLITUS_IN_CONTEXT_OF_PRAMEHA_R OGA_IN_AYURVEDA , downloaded on 5/02/2021. 3 https://www.sciencedirect.com/topics/engineeri ng/diabetes-mellitus# , downloaded on 6/02/2021. 4 https://www.ncbi.nlm.nih.gov/pmc/articles/PM C 3068646/ , downloaded on 6/02/2021. 5 https://www.ncbi.nlm.nih.gov/pmc/articles/PM C 5426415/ , downloaded on 10/02/2021. 6 Brahmashankar Shastri Yogaratnakara: - Vidyotini Tika, Chaukhambha Sanskrit Sansthana, 6 th Edi. 1997.pp-786

P a g e | 26 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION 7 Narhari pandit: Raj Nighantu - With Dravyaguna Prakachika Vyakhya, I.D. Tripathi, Ed.1982.pp-876 8 Kashinath Shastri and Gorakha Nath , Charaka Samhita with Vidyotini Hindi, chapter 7 verse 45, Chaukhambha Bharati Academy Varanasi.1999 pp-564 9 Dr. Anil Bhadoria, Dr. Sakshi Gupta, A clinical Study on Role of Gramya Ahara (Dietetics & Life Style) in aetiopathogenesis of Prameha (Type 2 Diabetes Mellitus) and evaluation of hypoglycaemic effect of Bhudhatryadi yoga, IRJAY, December : 2020 Vol- 3, Issue-12; 1-15; 10 https://www.ncbi.nlm.nih.gov/pmc/articles/PM C 2687091/ , downloaded on 17/ 02/2021. 11 https://apps.who.int/iris/bitstream/handle/1066 5/42609/9241590416.pdf;sequence=1 , downloaded on 17/ 02/2021. 12 https://www.ncbi.nlm.nih.gov/pmc/articles/PM C 3068646/ , downloaded on 20/ 02/2021. 13 Kashinath Shastri and Gorakha Nath , Charaka Samhita with Vidyotini Hindi, chapter 7 verse 45, Chaukhambha Bharati Academy Varanasi.1999 pp-564

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