Role of Ayurveda Treatment of Type 2 Diabetes Mellitus: A Case Report

P a g e | 48 Case Study. 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 VOLUME 4 ISSUE 6 1 Assistant Professor, Department of Kayachiktsa, Shri Shirdi Sai Baba Ayurved College and Hospital, Mundiyagarh, Kishangarh - Renwal, Jaipur -303603, Mo 7615050724, Email id: drneetu 90@gmail.com 2 Assistant Professor, Department of Dravyaguna Vigyana, Shri Shirdi Sai Baba Ayurved College & Hospital, Mundiyagarh, Kishangarh-Renwal, Jaipur, Mo. 9462095197, Email id - drsrk 0777@gmail.com Corresponding Author:- Neetu Sharma, Assistant Professor, Department of Kayachiktsa, Shri Shirdi Sai Baba Ayurved College and Hospital, Mundiyagarh, Kishangarh - Renwal, Jaipur -303603, Mo 7615050724, Email id: drneetu 90@gmail.com Article received on 2 June 2021 Article Accepted 27 June 2021 Article published 30 June 2021 ABSTRACT: - Background: A 49-year-old woman having earlier history of type 2 diabetes with a random sugar level of 323 mg dLG 1 Methodology: On the basis of pathology reports, The doctor prescribed metformin HCl (1000 mg) with glimepiride 2 mg BD and tenegliptin (20 mg) once a day to patient, even after 7 years, patient complaining to blood sugar raised and doctor advised her for insulin injections. Results: The above treatment was not found satisfactory for the patient, as there was problem in maintaining the sugar level. However, after starting Ayurveda treatment with Chandraprabha Vati, Aamalaki Rasayana, Madhumehari Churna and Pathya Ahara - Vihara followed by yoga practice and morning walk, the patient started to recover very fast and within one month, she achieved better results in blood sugar level. Conclusion: The Ayurveda treatment can be considered as most effective because of its ability to control blood sugar level and also having fewer side effects as compared to that of allopathic medicines. Keywords: Aamalaki Rasayana, Chandraprabha Vati, Madhumehari Churna, Genetic factor, Hyperglycaemia, Yoga . Role of Ayurveda Treatment of Type 2 Diabetes Mellitus: A Case Report Neetu Sharma 1 Sukha ram 2

P a g e | 49 Case Study. 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: Sharma N, Ram S, Role of Ayurveda Treatment of Type 2 Diabetes Mellitus: A Case Report, IRJAY. [Online] 2021;4(6): 48-53. Available from: http://irjay.com ; DOI: https://doi.org/10.47223/IRJAY.2021.4607 INTRODUCTION Diabetes Mellitus (DM) is one of the most leading chronic, heterogeneous and life – threatening diseases and today it has spread to every region of the globe. In 2019, an estimated 1.5 million deaths were directly caused by diabetes [1] The prevalence of diabetes mellitus will be 5.4% by the year 2025, with the global diabetic population reaching to 300 million [2] In a diabetic patient, frequent urination, increased hunger and thirst, decreased body weight, blurred vision, itching and tiredness are common symptoms [3] Diabetes, particularly type - 2 is associated with various cardiovascular diseases such as ischemic heart diseases and stroke and it is the major cause of non-traumatic blindness and renal failure [4] Nowadays, there are a lot of options available to treat type - 2, diabetes with the help of various anti-hyperglycemic medications, such as insulin, sulfonylureas and metformin. Although, these drugs have ability to reduce blood sugar level but the recommendation of one class of anti-hyperglycemic agents or a certain combination to treat complications of diabetes is still difficult. Ayurveda, a science of living has ability to treat diabetes in various ways like diet planning, exercise and yoga practice; as good lifestyle, healthy food and exercise will always remain effective in the management of diabetes. This case study is discussed based on the treatment of type 2 diabetes with the help of both allopathic and Ayurveda medicines in which Ayurveda treatment were found more effective. CASE REPORT A 49-year-old Indian woman was diagnosed with type 2 diabetes (hyperglycemia) having history of diabetes since 7 years with a random sugar level of 323 mg dLG 1 as measured by a blood glucose monitoring device (Accu - Chek instant, Roche Diagnostics GmbH, Germany). She already taken allopathic medicines but didn’t get better relief even doctors advise her for insulin injections so she came here for better treatment. She was suffering with other problems like generalised weakness, pain in calf muscles, sleeplessness, mood swings, pricking sensation in eyes. In the next day observation, the Fasting (F) blood glucose level was found to 278 mg dLG 1 and Post Prandial (PP) glucose level was measured to 320 mg dLG 1. She is taking tenegliptin (20 mg) at breakfast time and metformin HCl (1000 mg) with glimepiride (2 mg) twice a day before meal and Atorvastatin (10 mg) once in a day since 5 years. As per measurement, her weight was 68 kg, height 161 cm, Body Mass Index (BMI) 26.23, waist 94 cm, hip 101 cm, pulse rate 110 bpm and blood pressure was 140/90 mm Hg. After 3 days, the HbA 1 c value was found to 9.9% (a range between 4 and 5.6% is normal, between 5.7 and 6.4% indicates increased risk of diabetes and 6.5 or above indicates diabetes). Ashta Sthana Pariksha : 1. Nadi – Vatapitta 110/min. 2. Mootra – 8 - 9 times /day and 2- 3 times / night 3. Mala – 1 time / day

P a g e | 50 Case Report ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION 4. Jivha – uncoated 5. Shabda – Spashta 6. Sparsha - Samanya 7. Drika - Samanya 8. Akrati – Sthula After examining all the reports and earlier prescription, I advised a 30 days course to treat diabetes in which prescribed Chandraprabha Vati two tablets (250 mg each tablet) three times a day, Aamalaki Rasayana 250 mg with Madhumehari Churna 3 gm twice a day at least half an hour before meal) and Karela, Bilva patra swaras (25 ml early morning empty stomach) . Also focused on Pathya Ahar - Vihar , in which Kapalbhati, Pranayam, Mandukasana advised mandatory Yoga practice for 30 min and morning walk for 60 min daily and chapatti of mix flour (Barley, Soybean, Fenugreek, Gram and wheat). Pathyapathya : For dietary changes, the patients were asked to stop sugar completely. She was also made to curtail the use of energyrich foods like rice, potatoes, fried foods, and bakery products. Chapatti of mix flour (Barley, Soybean, Fenugreek, Gram and wheat) was mandatory. Table No. 1: Laboratory data of the patient with reference values of tests before and after treatment. Examination Observed value Before treatment Observed value After treatment Unit Reference range Hb% 11.8 11.5 Gm/dl 11 – 13 Blood sugar (F) (PP) 278 320 124 154 mg dLG 1 70 - 110 110-140 Blood urea 18 16 mg dLG 1 10 – 50 Serum creatinine 0.8 0.7 mg dLG 1 0.7-1.5 Serum Calcium 9.9 10.2 mg dLG 1 8.7-11 Phosphorus 4.3 4.3 mg dLG 1 3.5-5.5 Serum uric acid 4.5 4.3 mg dLG 1 2.8-5.7 (Female) 3.8-7 (Male) Serum cholesterol 161 156 mg dLG 1 <200 Serum triglycerides 85 98 mg dLG 1 <150 Serum HDL cholesterol 58 42 mg dLG 1 32-65 Serum LDL cholesterol 120 102 mg dLG 1 100-190 Serum VLDL cholesterol 17 18 mg dLG 1 10-30 TSH 4.3 4.5 µIU mLG 1 0.5-4.70 HDL: High density lipoprotein, LDL: Low density lipoprotein, VLDL: Very low density lipoprotein and TSH: Thyroid stimulating hormone.

P a g e | 51 Case Report ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION RESULTS After one month of treatment, a blood test report shows improvements. This was showing remarkable improvement in blood sugar i.e. fasting blood sugar 124 mg dlg and post prandial blood sugar was 154 mg dlg [5] . There was relief in generalized weakness and muscular pain. As per patient, now she was able to do her routine work and nowadays she was completing her sleep too. DISCUSSION After 30 days treatment with Chandraprabha Vati, Madhumahari Churna, Aamalaki Rasayana, Karela, Bilva patra swaras and Yoga practice with Pathya Ahara - Vihara ‘a reduction in blood sugar level fasting 278 to 124 and post prandial 320 to 154 mg dlG 1 was seen’. Many other improvements were seen in other symptoms like weakness, body ache, sleeplessness. Chandraprabha Vati has glucose and lipid lowering effect. This medicine mainly purified Guggulu and Shilajatu . Chandraprabha (Karpura), Vacha, Musta, Maricha, Pippali, Haridra and majority of drugs has Katu, Tikta, Kashaya and Madhura Rasa and main Guna is Laghu, Ruksha, Tikshna and Ushna mostly effective in Kapha and Vata Dosha . According to pharmacodynamics actions Raktaprasadana (help to purifying the blood), Shothahara, Krimighna and Rasayana action [6] In Madhumehari Churna, Most of the drugs are having Ushna Virya, Katu Vipaka and Vata-Kaphahara properties. Chitraka acts as a Deepana Pachana drug, thus reduces Ama at both Dhatuvagni and Jatharagni level. Jambubeeja, Haridra, Daruharidra, Musta, Haritaki, Bhibhitaki, Meshashringi, Vijaysara, Karvellaka due to their Laghu-Ruksha properties reduces Kleda in the body that in turn corrects the Dhatushaithilya . Most of the drugs in the formulation are having Tikta- Kashaya Rasa which reduces Madhurya in the Rasa, Rakta and other Jaliya Dhatu. [7] Aamalaki Rasayana works as antioxidants to diabetic is able to prevent the development of retinopathy and also retinal metabolic abnormalities postulated to be involved in the development of retinopathy. Studies in humans suggested that antioxidant therapy with vitamin C might normalize diabetic retinal hemodynamic [8] Pancreatic cells may be rejuvenated and pancreatic β-cell sensitivity may be increased by the alternating abdominal contractions and relaxations involved in yoga practice. Improved blood supply to muscles may enhance insulin receptor expression in the muscles, causing increased glucose uptake. The abdominal pressure created during exhalation in Kapalbhati improves the efficiency of β- cells of the pancreas [9] Anuloma Viloma Pranayama (alternate nostril breathing) has been shown to yield significant improvements in components of health-related fitness (i.e. cardiorespiratory endurance, flexibility, and percentage of body fat) [10] Yoga effectively reduces stress, thereby helping diabetes control [11] Yava is having Kashayarasa, Rukshaguna which reduces the excess Kelda from body by its Shoshana effect. Lekhana Guna of Yava makes Medodhatu Vilayana , which helps in reducing Medodusti and beneficial in obesity. Due to Pureeshavardhaka property it acts as Doshanulomana. [12] Karela is a potent antioxidant, antiinflammatory and hypoglycemic agent. Karela prevents the damage and helps in the formation of new β cells in the pancreas. Karela lowers the blood glucose level by increasing insulin secretion and glucose utilization [13] The main constituents of Karela ( Momordica charantia ) which are responsible for the anti-diabetic

P a g e | 52 Case Report ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION effects are triterpene, proteid, steroid, alkaloid, inorganic, lipid, and phenolic compounds Charantin is a typical cucurbitane-type triterpenoid in Karela and is a potential substance with anti-diabetic properties [14] Karela is one of the most commonly used vegetable that contains polypeptide-p and is used to control diabetes naturally. Polypeptidep or p-insulin is an insulin-like hypoglycemic protein, shown to lower blood glucose levels in gerbils, langurs and humans when injected subcutaneously [15] Bilva is effective as insulin in restoration of blood glucose and body weight to normal levels. The leaf juice of Bilva was effective in diabetes mellitus and possibly it was due to presence of bioactive components, aegelin 2, scopoletin and sitosterol in the leaves [16] CONCLUSION Use of Ayurveda medicines i.e., Chandraprabha Vati, Madhumahari Churna, Aamalaki Rasayana, Karela, Bilva patra swaras and Yoga practice with Pathya Ahara - Vihara was found effective to control blood sugar This alternative treatment can be considered as most effective because of its ability to control blood sugar level and also having fewer side effects as compared to that of allopathic medicines. Acknowledgment: Nil Financial Support: Nil. Conflict of Interest: Nil REFERENCES 1 https://www.who.int/health-topics, Diabetes, 13 April 2021, world health organization. 2 Semwal D.K., U. Rawat, R. Semwal , R. Singh and G.J.P. Singh, Anti-hyperglycemic effect of 11-hydroxypalmatine, a palmatine derivative from Stephania glabra tubers. J. Asian Nat. Prod. Res., 2010; 7(12) 99-105. 3 Semwal, D.K., Semwal R.B., Chauhan A, Treatment of Type 2 Diabetes with Ayurveda: A Case Report, Pharmacologia, 2016; 7 (4) : 239-242. 4 Semwal, D.K., Semwal R.B., Chauhan A, Treatment of Type 2 Diabetes with Ayurveda: A Case Report, Pharmacologia, 2016; 7 (4) : 239-242. 5 Weerasekera KR, Dhammarathana I, Tissera, Evaluation of the therapuetic effect of Chandraprabha Vati on Phenameha – Acase study, International Ayurvedic Medical Journal, 2014; 2 (6) : 944-948. 6 Nakade M., Chaudhary K., Dhakar N.S. A case report of type 1- diabetes mellitus - An Ayurvedic approach, International Ayurvedic Medical Journal, 2015; 3 (5) : 1553-1558. 7 Tanvir Patel T., Golecha S., Mahetre D., Amalaki Rasayan as antioxidant in diabetic retinopathy –Review, European journal of pharmaceutical and medical research, 2019; 6(1) : 520-527. 8. Raveendran A.V., Deshpandae A., Joshi S.r.,Therapeutic Role of Yoga in Type 2 Diabetes, Endocrinology and metabolism, 2018 ;33(3) : 307–317 9 Bal B.S, Effects of short term practice of Anuloma Viloma Pranayama on components of health-related fitness. Educ Prac Innov, 2018; 6(2) : 10–18. 10. Kosuri M, Sridhar GR, Yoga practice in diabetes improves physical and psychological outcomes, Metab Syndr Relat Disord, 2009; 7(6) : 515-7

P a g e | 53 Case Report ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION 11 Gharge A.R., The study of yavasevan in the ahara management of Prameha w.s.r.t. NIDDM, Ayurlog: National Journal of Research in Ayurved Science, 2015; 3 (3) : 5173-179. 12 https://www.1 mg.com/ayurveda/karela-62 13. Joseph B, Jini D , Antidiabetic effects of Momordica charantia (bitter melon) and its medicinal potency, APJTD, 2008; 3(2): 93– 102 14 Joseph B, Jini D Antidiabetic effects of Momordica charantia (bitter melon) and its medicinal potency, APJTD, 2013; 3(2): 93– 102. 15 Rahul S, Singh D, Pharmacological Properties of Aegle marmelos: A Review, IJCMAS 2010 ; 8: 1600-1608. 16 Joseph B, Jini D , Antidiabetic effects of Momordica charantia (bitter melon) and its medicinal potency, APJTD, 2008; 3(2): 93– 102

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Yoga, Ayurveda, Karela, Pranayam, Yogic practice, Diabetes mellitus, Allopathic medicine, Ayurveda treatment, Morning walk, Case report, Case study, Kapalbhati, Type 2 Diabetes Mellitus, Type 2 diabetes, Anuloma Viloma Pranayama, Hyperglycemia, Chandraprabha vati, Blood sugar level, Genetic factor, Madhumehari Churna, Insulin injection.