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VOL 3

ISSUE 4 (2015) INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE eISSN-2348-0173 pISSN-2395-3985

Shah Bhairavi S., Study of Medovaha Srotasa Dushti in Madhumeha with special reference to Lipid Profile, Int. J. Ayu. Alt. Med., 2015; 3(4):220-227

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RESEARCH ARTICLE Impact Factor (2014) – 0.815 by International Scientific Indexing (ISI) UAE

STUDY OF MEDOVAHA SROTASA DUSHTI IN MADHUMEHA WITH SPECIAL

REFERENCE TO LIPID PROFILE

Shah Bhairavi Suresh1*

1. Assistant Professor, Dept. of Rognidan & Vikrutivigyan, Dr. D. Y. Patil College of Ayurved & Research Institute, Nerul, Navi Mumbai, Contact No. +918879599695, E-mail-dr.bhairavee@gmail.com

Article Received on - 2nd July 2015 Article Revised on - 25th Aug 2015 Article Accepted on - 27th Aug 2015

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Shah Bhairavi S., Study of Medovaha Srotasa Dushti in Madhumeha with special reference to Lipid Profile, Int. J. Ayu. Alt. Med., 2015; 3(4):220-227

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RESEARCH ARTICLE

*Corresponding Author Shah Bhairavi S. Assistant Professor, Dept. of Rognidan & Vikrutivigyan, Dr. D. Y. Patil College of Ayurved & Research Institute, Nerul, Navi Mumbai, Contact No. +918879599695, E-mail- dr.bhairavee@gmail.com

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ABSTRACT: Madhumeha Vyadhi (disease) described in Ayurveda can be co-related with

diabetes. Meda (lipid) plays a major role in the pathogenesis of madhumeha (diabetes). Meda (lipid) kshaya (decrease), vriddhi (increase) and dushtijanya (abnormal) lakshanas (symptoms) are seen in madhumehi (diabetic) Patients. There are two types of Madhumeha – Santarpanjanya (over nourished) & Apatarpanjanya (malnourished). The treatment of madhumeha (diabetes) is described on the basis of santarpanjya (over nourished) and apatarpanjanya (malnourished) samprapti (pathogenesis). The features of diabetes mellitus are associated with central obesity, hypertension and dyslipidemia. Coexistence of this cluster of condition, predispose to complication. For early diagnosis of madhumeha, to decide proper line of treatment & avoid complication, this study was selected with an aim to study the medovaha srotasa dushtiin madhumeha in relation with santarpanjanya or aptarpanjanya samprapti of madhumeha with the help of pathological laboratory investigations. Medodushtijanya (abnormal lipid) lakshanas (symptoms) were present in madhumehi patients. Raised levels of lipid profile were observed in these patients. Medodushtijanya lakshana- Snigdhaangata (oiliness) and Shrama (excretion) had association with raised Sr. Cholesterol levels, Kasashwasadi (respiratory disorder) had association with raised Sr. Triglyceride levels, Daurgandhya (perspiration with foul smell) and Shaithilya (looseness of body) had association with raised Sr. VLDL levels, which was also Statistically significant (X2 value >1 and P value <0.05) Hence, lipid profile can be used as a diagnostic and prognostic tool for madhumeha, to observe the medodushti.

Key Words: Madhumeha, Medovaha Srotasa, lipid profile

INTRODUCTION Health is supreme foundation of virtue, wealth is enjoyment and salivation. Therefore, the preservation and promotion of health is principle goal of Ayurveda. Madhumeha described in Ayurveda can be correlated with Diabetes Mellitus. Diabetes mellitus has becomes major problem in developed and developing countries. It is estimated that, in year 2013 worldwide 382 million people had D.M. [1] and this is expected to be double by year 2030, due to lack of awareness in society about DM and its complications. It finds place in eight ‘Mahagada ’ (Difficult to treat).[2] Madhumeha (diabetes)is described as subtype of vataj prameha (diabetes). According to Sushruta all types of pramehas if not treated properly ultimately turns into ‘Madhumeha’.[3,4] In Ayurveda classical text ten dushyas (vitiated) of prameha are explained.[5]

Meda (lipid) plays a major role in the pathogenesis of madhumeha (diabetes). Meda (lipid) kshaya (decrease), vruddhi (increase) and dushtijanya (abnormal) lakshanas (symptoms) are seen in madhumehi (diabetic) patients. Sushruta described

two type of prameha: Sahaja (hereditary) and Apathyanimittaja (due to abnormal diet & lifestyle). According to Sushruta, sahaja rogi is krusha (lean), durbala (weak) and ruksha (dry) while apathyanimittaja rogi is sthula (obese), snigdha (oily) and bahuwashi (polyphagia).[6] The treatment of prameha is described on the basis of santarpanjya (over nourished) and apatarpanjanya (malnourished) samprapti (pathogenesis).[7,8]

According to modern science, the features of diabetes mellitus are associated with central obesity, hypertension and dyslipidemia (elevated LDL and triglyceride and HDL). Coexistence of this cluster of condition, predispose to cardio-vascular disease. Presence of obesity being powerful amplifier of insulin resistance.[9,10] On the basis of recent studies, poshaka (nurture) meda dhatu (lipid) can be correlated with cholesterol and lipid which are present in circulating blood and poshya (nourished) meda dhatu (lipid) can correlate with adipose tissue or fat. Therefore with the curiosity, is there any co-relation with the alteration in lipid profile and meda (lipid) dushti (abnormality), the topic ‘Study of medovaha srotasa dushti

STUDY OF MEDOVAHA SROTASA DUSHTI IN MADHUMEHA WITH SPECIAL REFERENCE TO LIPID PROFILE

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ISSUE 4 (2015) INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE eISSN-2348-0173 pISSN-2395-3985

Shah Bhairavi S., Study of Medovaha Srotasa Dushti in Madhumeha with special reference to Lipid Profile, Int. J. Ayu. Alt. Med., 2015; 3(4):220-227

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(abnormality in lipid channels) in madhumeha (diabetes) with special reference to lipid profile’ was selected for the study. AIM & OBJECTIVES To study the Medovaha Srotasa dushti in Madhumeha in relation with santarpanjanya or apatarpanjanya samprapti with the help of lab investigation Type of study: This is an open, retrospective study. Sample size 50 diagnosed patient of madhumeha were selected for study. Duration of study: 3 years Institution Ethics Committee Clearance No: RSTH/PG/IEC/429/2011 Sampling method: Simple random sampling Inclusion criteria: Patients of Madhumeha irrespective of age, sex, marital status, economical status and social status were selected for study. Diagnostic criteria:

1. Patient with complain of Prabhoot (excesses quantity) & Aavil (Turbid) Mutrata (Urine)

2. BSL – F>110mg/dl PP>140mg/dl Exclusion criteria:

Patient suffering from the major illness e.g. HIV, Hepatitis, malignancy, and tuberculosis were excluded from this study. Plan of study:

1. Informed consent was taken from patients. History of all patients was taken thoroughly, with the help of special case format.

2. Clinical observations were noted according to the case report format.

3. The Laboratory Investigations (BSL F/PP, Haemogram with ESR, Blood Urea level, Serum Creatinine, Urine R/M, Lipid profile) were done on the next day of the clinical examinations.

4. This was strictly a Survey-based study and no medication was given to any of the patients. Hence, in this study no bio-medical hazard was observed in the patients.

CRITERIA OF ASSESSMENT: 1. Assessment was done on the basis of clinical examinations, symptoms of medovaha srotasa dushti described in ayurveda and observations of pathological investigations. 2. On the basis of the data obtained medovaha srotasa dushti in madhumeha with reference to the lipid profile was studied thoroughly. Observations and Results:

Table no 1 -Showing distribution of BMI of the patient in study group.

B.M.I No. of patients Percentage (%)

Less than 18.5 1 2 18.5-24.9 19 38 25-29.9 20 40

More than 30 10 20

Figure 1 -Showing distribution of BMI of the patient in study group.

2

3840

20

0

51015

202530

3540

Less than18.5

18.5-24.9 25-29.9 More than30

Distribution of B.M. I

Percentage (%)

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Table:2: Showing distribution of Medodushti Lakshana in study group

VRIDDHIJANYA (Increase)

KSHAYAJANYA (Decrease)

DUSHTIJANYA (Abnormal)

Med

odus

hti L

aksh

ana

Snig

dhan

gata

Kasa

shw

asad

i

Daur

gand

ya

Shai

thily

a

Shra

ma

Plih

avri

ddhi

Sand

hisp

huta

nam

Rauk

shya

Med

urm

amsa

prar

than

a

Swap

nam

Kty

a

Glan

i Aks

hno

Gran

thi

Vidr

adhi

Arbu

d

Atis

thou

lya

Atis

wed

Adhi

mam

sa

Putim

amsa

Asht

auni

ndit

No. o

f cas

es (%

)

36 46 38 44 62 24 68 38 30 30 62 10 4 0 30 62 28 18 30

Figure 2: Showing distribution of Medodushti Lakshana in study group

Table3: Showing changes in Lipid profile in study group

Lipi

d pr

ofile

Cholesterol (mg/dl)

Triglyceride (mg/dl)

HDL (mg/dl)

LDL (mg/dl)

VLDL (mg/dl)

<200

201-

250

251-

300

301-

350

<150

151-

200

201-

250

251-

300

301-

350

>40

<40

60-1

30

>130

<38

>38

No. O

f cas

es (%

)

64 26 6 4 46 38 6 6 4 48 52 66 34 70 30

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Figure 3: Showing changes in Lipid profile in study group

STATISTICAL ANALYSIS Chi-square statistic (with Yates correction) is applied. The two-sided P value is considered at level of 0.01 Degrees of freedom = 1 Relative risk: 95% Confidence Interval: (Using the approximation of Katz.) For this test E.g. H0: Patient having symptom of snigdhaangata have normal value of cholesterol. H1: Patient having symptom of snigdhaangata have raised value of cholesterol.

LAKSHANAS STATISTICS CHOLESTEROL TRIGLYCERIDE HDL LDL VLDL SNIGDHAANGATA χ2 value 4.668 0.2982 1.034 3.209 0.1488 (Oiliness) P value 0.0307 0.5850 0.3093 0.0733 0.6997 Significance

Significant

Not Significant

Not Significant

Not Significant

Not Significant

KASASWASADI χ2 value 1.034 4.919 2.158 0.3489 1.384 (Respiratory symptoms) P value 0.3093 0.0266 0.1419 0.5547 0.2394 Significance

Not Significant

Significant

Not Significant

Not Significant

Not Significant

DAURGANDHYA χ2 value 1.719 1.919 0.1871 0.3626 7.474 (Foul smell of perspiration)

P value 0.1898 0.1660 0.6653 0.5471 0.0063

Significance

Not Significant

Not Significant Not Significant

Not Significant

Very Significant

SHAITHILYA χ2 value 0.2170 0.9298 4.919 0.8357 4.468 (Looseness of body) P value 1.524 0.3349 0.0266 0.3606 0.0345 Significance

Not Significant Not Significant Not

Significant Not Significant

Significant

SHRAMA χ2 value 2.972 0.1411 02310 2.289 1.168 (Weakness) P value 0.0847 0.7072 0.8792 0.1303 0.2798 Significance

Significant

Not Significant

Not Significant

Not Significant

Not Significant

PLIHAVRIDHI χ2 value 0.04873 0.6310 0.1017 0.003127 1.337 (Spleenomegaly) P value 0.8253 0.2307 0.7498 0.9554 0.2476 Significance

Not Significant

Not Significant

Not Significant

Not Significant

Not Significant

SANDHI SPHUTANAM

χ2 value 0.02298 3.447 0.1516 0.07930 4.482

(crepitates in joints) P value 0.8795 0.0634 0.6971 0.7783 0.0343 Significance Not Significant Not Significant Not Not Not

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Significant Significant Significant MEDURMAMSA PRARTHANA

χ2 value 2.794 0.1391 1.236 1.058 1.020

(Urge of Non-veg) P value 0.0946 0.7091 0.2662 0.3036 0.3124 Significance

Not Significant

Not Significant

Not Significant

Not Significant

Not Significant

RAUKSHYA χ2 value 0.2600 0.9266 1.035 0.08005 0.1981 (Dryness of skin) P value 0.6101 0.3357 0.3091 0.7772 0.6563 Significance

Not Significant

Not Significant

Not Significant

Not Significant

Not Significant

SWAPANAM KATYA

χ2 value 0.1488 0.06184 0.3106 0.3438 1.020

(Numbness of lumbar region)

P value 0.6997 0.8036 0.5773 0.5577 0.3124

Significance

Not Significant

Not Significant

Not Significant

Not Significant

Not Significant

GLANIR AKSHANO

χ2 value 0.2600 0.9266 1.746 0.4550 2.947

(heaviness in eyes) P value 0.6101 0.3357 0.1864 0.5000 0.0860 Significance

Not Significant

Not Significant

Not Significant

Not Significant

Not Significant

GRANTHI χ2 value 1.389 0.5772 0.2188 0.1958 0.2646 (Cyst) P value 0.2386 0.4474 1.512 1.674 0.6070 Significance

Not Significant

Not Significant

Not Significant

Not Significant

Not Significant

ATISTHAULYA χ2 value 0.1488 0.06184 0.4639 0.004244 0.1134 (Obesity) P value 0.6997 0.8036 0.4958 0.9481 0.7363 Significance

Not Significant

Not Significant

Not Significant

Not Significant

Not Significant

ATISWEDA χ2 value 1.247 0.1411 1.035 0.8064 1.168 (Perspiration) P value 0.2640 0.7072 0.3091 0.3692 0.2798 Significance

Not Significant

Not Significant

Not Significant

Not Significant

Not Significant

ADHIMAMSA χ2 value 0.0006889 0.2841 0.8282 0.2554 0.01890 (Swelling) P value 0.9791 0.5940 0.3628 0.6133 0.8907 Significance

Not Significant

Not Significant

Not Significant

Not Significant

Not Significant

PUTIMAMSA χ2 value 0.009301 0.1633 1.044 0.05199 4.790 (Ulcers) P value 0.9232 0.6861 0.3069 0.8196 0.0286 Significance

Not Significant

Not Significant

Not Significant

Not Significant

Not Significant

ASHTAUNINDITA χ2 value 0.1488 0.9895 0.4639 0.004244 0.9876 P value 0.6997 0.3199 0.4958 0.9481 0.5462 Significance

Not Significant

Not Significant

Not Significant

Not Significant

Not Significant

DISCUSSION 1. BMI: -In the present study patients were observed and their Body mass index was calculated by measuring their height and weight. In this study 40% patients were overweight (BMI 25.0-29.9), 20% were obese (BMI>30.0), 38% patients had normal BMI (18.5-24.9) while minimum i.e. 2% patient were underweight (BMI<18.5). -The causative factors described for santarpanotha vyadhi (diseases due to over nutrition)[7] and hetusevana (causative factors )by these 60% patients are similar i.e. Navannapan (new grains), Ikshuvikaras (made from sugarcane), mamsa sevana (non-veg ), dugdhvikara (made from milk), diwaswapana (day sleep), avyayam (no exercise)etc. This data suggests medodushti (abnormality in lipid) and santarpanaja samprapti (pathogenesis due to over nutrition) in these 60%

patients. Also it supports that the obese patients are prone to madhumeha (diabetes). -While in underweight patients’ apatarpanaja samprapti (pathogenesis due to malnutrition) was observed due to consumption of kashaya (astringent), katu (spicy) rasa (taste), vyayam atiyoga (excessive exercise), prajagarana (late sleep) etc. This leads to dhatukshaya (decrease of body elements) and apatarpanaja samprapti (pathogenesis due to malnutrition). -Increased BMI suggests the abaddhatva of mamsa and meda (abnormality in muscles & lipid) which are responsible for medovaha srotasa dushti. 2. Santarpanjanya madhumeha (diabetes due to over nutrition): - In the present study, 80% patients were of santarpanjanya madhumeha (diabetes due to over nutrition) having B.M.I.>23.0.

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- Mamsa sevana (non-veg) (52%), navannapana (new grains) (50%), kshiravikara (made from milk) (48%), Snigdha gunatmaka ahara (oily food) (40%), madhura rasatmaka ahara (sweets) (30%), ikshuvikara (made from sugarcane) (30%), ek sthana asana (sitting in one place) (58%), diwaswapa (day sleep) (52%), avyama (no exercise) (44%) are common etiological factors observed in present study. - Among these following poorvaroopas were observed; snigdha guru gatrata (heaviness in body) (56%), galatalu shosha (dryness of mouth) (46%), tandra (giddiness) (44%), hastapadatala daha (burning in extremities) and supti (numbness) (42%), deha chikkanata (stickiness of body) (34%), dantadina maladhyatva (pluck formation on teeth) (28%), swaduasyata (sweetness of mouth) (20%). - Atisweda (perspiration) (54%), shrama (tiredness) (52%), sandhisphutanam (crepitates in joints) (46%), shaithilya (looseness of body) (44%), kasaswasadi (respiratory symptoms) (36%), dauragandya (foul smell of sweat) (32%), atisthaulya (obesity) (28%), adhimamsa (swelling) (24%) are the common medodushtijanya lakshanas (symptoms due to abnormal lipid) observed in these patients. 3. Apatarpanjanya madhumeha (diabetes due to malnutrition): - In the present study, 20% patients were of apatarpanjanya madhumeha having B.M.I.<23.0. - Amlalavana rasatmaka aharaa (sour) (80%), tilapalala (made from sesame) (70%), madyapana (alcohol) (50%), alasya (no work) (60%), mrujavarjanam (uncleanliness) (60%) are common etiological factors observed in present study. - Among these following poorvaroopas were observed; hastatala daha (burning in extremities) (90%), tandra (giddiness) (80%), pipasa (polypepsia) (50%), keshanakhativruddhi (over growth of nails hairs etc.) (42%). -Sandhi sphutanam (crepitates in joints) (90%), raukshya (dryness) (84%), glanirakshno (heaviness in eyes) (84%), kati swapa (numbness in lumbar region) (78%), plihavruddhi (spleenomegaly) (50%), kasaswasadi (respiratory symptoms) (40%), shrama (weakness) (36%) are the common medodushtijanya lakshanas (symptoms due to abnormal lipid) observed in these patients. 4. Lipid profile: i. The Sr. Cholesterol value of 64% patients

were within normal range (<200mg/dl) and 36% patient had raised level of Sr. Cholesterol. In present data it is observed that

raised level of Sr. Cholesterol had association with symptom snigdhangata (oiliness) and Shrama (weakness).

ii. The Sr. Triglyceride were found normal (up to 130mg/dl) in 46% patients and it was elevated in 54%. In present data it is observed that raised level of Sr. Triglyceride had association with symptom kasashwasadi (respiratory symptoms).

iii. Sr. HDL value found normal (>40mg/dl) in 48% patients and it was decreased (<40mg/dl) in 52%. In present data it is observed that abnormal level of Sr. HDL had no association with any symptom.

iv. Sr. LDL value were normal (130-160mg/dl) in 58% patients. They were decreased in 8% patients and 34% patients were having increased value of LDL. In present data it is observed that abnormal level of Sr. LDL had no association with any symptom.

v. Sr. VLDL value was found normal (<38%mg/dl) in 70% patients and 30% patients had raised value. In present data it is observed that raised level of Sr. VLDL had association with symptoms shaithilya (looseness of body) and Daurgandhya (foul smell of perspiration).

CONCLUSION Medodushtijanya lakshanas (symptoms of abnormal lipid) are present in madhumehi (diabetic) patients. In santarpanjanya madhumehi (diabetes due to over nutrition) patients, atisweda (perspiration), shrama (weakness), sandhisphutanam (crepitates in joint), shaithilya (looseness of body), kasaswasadi (respiratory symptoms), dauragandhya (foul smell of sweat) , atisthaulya (obesity), adhimamsa (swelling), snigdhaangata (oiliness of body)are the common medodushtijanya lakshanas (symptoms of abnormal lipid) observed. In apatarpanjanya madhumehi (diabetes due to malnutrition) patients, sandhi sphutanam (crepitates in joint), raukshya (dryness of skin), glanirakshno (heaviness in eyes), kati swapa (numbness in lumbar region), plihavruddhi (spleenomegaly), kasaswasadi (respiratory symptoms), shrama (weakness) are the common medodushtijanya lakshanas (symptoms of abnormal lipid) were observed. Raised levels of lipid profile are observed in these patients. Medodushtijanya lakshana- Snigdhaangata (oiliness) and Shrama (weakness) have association with raised Sr. Cholesterol levels, Kasaswasadi (respiratory symptoms) has association with raised Sr. Triglyceride levels, Daurgandhya (foul smell of sweat) and Shaithilya (looseness of body) have association with raised

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Sr. VLDL levels, which is also statistically significant (X2 value >1 and P value <0.05 ) Therefore, lipid profile is helpful to observe the degree of medodushti (abnormality in lipid) in madhumehi (diabetic) patients. Hence, lipid profile can be used as a diagnostic and prognostic tool for madhumeha (diabetes), to observe the medodushti (abnormality in lipid). REFERENCES

1. Nam Han Cho, David Whiting , Leonor Guariguata, Pablo Aschner Montoya, editor IDF diabetes atlas, Sixth edition 2013 www.idf.org/diabetesatlas p. 7

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7. Yadavji Trikmaji Acharya editor Charaka Samhita with Ayurved Dipika by Chakrapani Chikitsa sthan Chaukhambha Sanskrit Sansthan 2001 p. 446

8. Yadavji Trikmaji Acharya editor Charaka Samhita with Ayurved Dipika by Chakrapani Nidan Sthan Chaukhambha Sanskrit Sansthan 2001 p.122

9. Tripathy H.B. RSSDI Textbook of Diabetes mellitus Vol. I and II B. Chandalia Nizam’s Institute of Medical Sciences Hyderabad. 2nd Edition 2008.p.367

10. C. Haslett, F. Chilvers , John Hunter N. Boon Churchill Livingstone David son’s principles and practices of medicine 18th Edition 1999 p.813

CITE THIS ARTICLE AS – Shah Bhairavi S., Study of Medovaha Srotasa Dushti in Madhumeha with special reference to Lipid Profile, Int. J. Ayu. Alt. Med., 2015; 3(4):220-227 Source of Support – Nil Conflict of Interest – None Declared

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