Vasti madhumeha pk011-gdg

By

D.S.Swami

Dissertation Submitted to the Rajiv Gandhi University Of Health Sciences,Karnataka, Bangalore.

In partial fulfillment of the requirements for the degree of

AYURVEDA VACHASPATHI M.D.

In

PANCHAKARMA

Under the guidance of

Dr. G. Purushothamacharyulu,M.D. (Ayu)

And co-guidance of

Dr. Shashidhar.H. Doddamani,M.D. (Ayu)

Post graduate department of Panchakarma, Shri D. G. Melmalagi Ayurvedic Medical College,

Gadag – 582103.

2006.

Evaluation of efficacy of Madhutailaka BastikarmaEvaluation of efficacy of Madhutailaka BastikarmaEvaluation of efficacy of Madhutailaka BastikarmaEvaluation of efficacy of Madhutailaka BastikarmaEvaluation of efficacy of Madhutailaka Bastikarma

in the management of Madhumeha (NIDDM)in the management of Madhumeha (NIDDM)in the management of Madhumeha (NIDDM)in the management of Madhumeha (NIDDM)in the management of Madhumeha (NIDDM)

Ayurmitra

TAyComprehended

Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore.

DECLARATION BY THE CANDIDATE

hereby declare that this dissertation / thesis entitled “““““EEEEEvaluationvaluationvaluationvaluationvaluation

of of of of of the Efficacy of Madhutailika Bastikarama in the management ofthe Efficacy of Madhutailika Bastikarama in the management ofthe Efficacy of Madhutailika Bastikarama in the management ofthe Efficacy of Madhutailika Bastikarama in the management ofthe Efficacy of Madhutailika Bastikarama in the management of

Madhumeha (NIDDM)Madhumeha (NIDDM)Madhumeha (NIDDM)Madhumeha (NIDDM)Madhumeha (NIDDM)””””” is a bonafide and genuine research work carried out

by me under the guidance of Dr. G. Purushothamacharyulu, M.D. (Ayu), Pro-

fessor and H.O.D, Post-graduate department of Panchakarma and co-guid-

ance of Dr. Shashidhar. H. Doddamani, M.D.(Ayu), Assistant Professor, Post

graduate department of Panchakarma.

Date:Place: D.S.Swami

I

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “Evaluation of

the Efficacy of Madhutailika Bastikarama in the management of Madhumeha

(NIDDM)” is a bonafide research work done by D.S.Swami in partial fulfillment

of the requirement for the degree of Ayurveda Vachaspathi. M.D.

(Panchakarma).

Date:

Place: Dr. G. Purushothamacharyulu, M.D. (Ayu).

Professor & H.O.D

Post graduate department of Panchakarma.

ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF

THE INSTITUTION


the Efficacy of Madhutailika Bastikarama in the management of

Madhumeha (NIDDM)” is a bonafide research work done by D.S.Swami

under the guidance of Dr.G. Purushothamacharyulu, M.D. (Ayu), Professor and

H.O.D, Postgraduate department of Panchakarma and co-guidance of Dr.

Shashidhar.H. Doddamani, M.D. (Ayu), Assistant Professor, Post graduate de-

partment of Panchakarma.

Dr. G. Purushothamacharyulu, M.D. (Ayu) Dr. G. B. Patil.

Professor & H.O.D, Principal.

Post graduate department of Panchakarma.

CERTIFICATE BY THE CO- GUIDE


the Efficacy of Madhutailika Bastikarama in the management of

Madhumeha (NIDDM)” is a bonafide research work done by D.S.Swami

in partial fulfillment of the requirement for the degree of Ayurveda

Vachaspathi. M.D. (Panchakarma).

Date: Dr. Shashidhar.H. Doddamani, M.D. (Ayu).

Place: Assistant Professor,

Post graduate Department of Panchakarma.

COPYRIGHT

Declaration by the candidate

I hereby declare that the Rajiv Gandhi University of Health

Sciences, Karnataka shall have the rights to preserve, use and dissemi-

nate this dissertation / thesis in print or electronic format for academic /

research purpose.

Date: D.S.Swami

Place:

© Rajiv Gandhi University of Health Sciences, Karnataka.

I

Acknowledgement

By the grace of god, bless of eiders I take this opportunity to express my

regards to the persons who helped in completing this work.

I express my deep sense of gratitude to his great holiness Jagadguru Shri

Abhinava Shivananda mahaswamiji for their divine blessings.

Words fail miserably when I try to express my gratitude to my mentor, my

guide Dr.G.Purushottamacharylu M.D (Ayu), H.O.D of P.G.Department of Panchakarma.

For his incessant, untiring, round the clock guidance with all the diligence. His

sustained fostering and encouragement instilled considerable impetus in me enabling

to achieve this milestone which otherwise would have lacked this particular finish.

Indeed, I will cherish the affectionate guidance of my co-guide Dr.Shashidhar

H.Doddamani M.D (Ayu), Asst professor of P.G.Department of Panchakarm. For his

invincible and radical thinking were very valuable in achieving this research work

invoking scientific spirit throughout the course of the study.

I express my sincere and deep gratitude to Dr.G.B.Patil, Principal, D.G.M.A.M.C,

Gadag, for his wholehearted encouragement as well as providing all necessary facilities

for this research work.

I express my sincere gratitude to Dr.P.Shivaramudu M.D (Ayu), Assistant Professor and Dr.

Santhosh.N.Belavadi MD (Ayu), Lecturer of P.G.Department of Panchakarma for his

excellent advices.

I also express my sincere gratitude to Dr.S.D.Yargeri R.M.O. for his moral

support and special care in providing the all the facilities during this trail work.

I express my sincere gratitude to Dr.G.S.Hiremath, Dr. Anjaneya murthy

Dr.V.Varadacharyulu, Dr.M.C.Patil, Dr. Mulgund, Dr.Dilip Kumar, Dr.R.V.Shetter,

Dr.Basavaraj Hadapada,Dr. K.S.R.Prasad, Dr.G.Danappa Gowdar, Dr. Kuber Sankh,

II

Dr.J.G.Mitti, Dr.Shakanath.Nidagundi, and other PG staff for their constant

encouragement.

I thank Dr.U.V.Purad, Dr.S.H.Radder, Dr.B.M,Mulkipatil and other

undergraduate teachers for their support in the clinical work. I thank to Shri. Nandakumar

(Statistician), Shri.V.M.Mundinamani (Librarian), Mr.Surebana and other hospital and

office staff for their kind support during my study.

Indeed, I will cherish the affectionate of my Father, my elder brother Mr.

V.S.Kendadmath, and all my family members who has been a source of inspiration for

my entire carrier.

I express my sincere thanks to my friends Dr.H.T.Sangamesh, Dr.Basavaraj R.

Channappagoudar, Dr.Prakasha.Gunjal, Dr.shrikanth, Dr.Santhosh.L.Y, Dr.V.M.Hugar,

Dr.Jayaraj Basarigidad, Dr.Shivakumar.Sajjanar, Dr.Ashok.Bingi, Dr.B.H.Venkaraddi,

Dr.B.L.Kalmath, Dr.P.Chandramouleeswaran, Dr.Shaila.B. Dr.Uday Kumar, Dr.Ratna

Kumar, Dr.Ghanti, Dr.Pradeep, Dr.Babu.Sobagin, Dr.Suresh.Hakkandi,

Dr.Manjunath.Akki, Dr.Gavi, Dr.AshwinDev, Dr.V.S.Hiremath, Dr.L.M.Biradar,

Dr.Jagadisha.H., Dr.Sharanu, Dr.Anand, Dr.Umesh, Dr.Suvarna, Dr.Devendrappa,

Dr.Sibaprasad, Dr.Madhushree, Dr.Ashok.M.J, Dr.Payappagoudar, and other post

graduate scholars for their support.

I would like to mention the support and inspiration provided by my uncle

Shri.Shivashankarayya.S.Hiremath & family for their support and encouragement during

my stay at Gadag.

I acknowledge my patients for their wholehearted consent to participate in this

clinical trial. I express my thanks to all the persons who have helped me directly and

indirectly with apologies for my inability to identify them individually.

Finally I dedicate this work to my respected patients who are the prime reasons

for this study.

Date : Signature of the scholar

Place : (Dr. D.S.Swami)

III

ABSTRACT The study “Evaluation of the efficacy of Madhutailika Bastikarma in the

management of Madhumeha (NIDDM)” is focused on an important form of an siddha

basti and a common disease Madhumeha. Madhutailika basti is believed to have a note

worthy role in the management of such impaired metabolic condition by importing

equilibrium state of doshasa, nourishes the dhatu and maintains the blood sugar level.

Panchakarma is the popular term for shodhana chikitsa, among that Bastikarma is an

important one. In this the doshas are made to pass through the adhomarga i.e.

Gudamarga. In the Bastikarma doshas even from the all over body are removed through

gudamarga.

In the treatment of Sthoola Madhumeha Bastikarma has great importance

according to Ayurveda. In the modern system of medicine Madhumeha can be compared

to diabetes mellitus. And it can be classified as insulin dependent, non insulin dependent,

malnutrition related and other types of diabetes mellitus associated with certain

conditions and syndromes. Among this non-insulin dependent diabetes mellitus

constitutes 85 % or more of all cases of diabetes. Diabetes has become the disease of the

masses. Over 20 million people are reported to be suffering from this “Sweet Disease”.

Between 1995 and 2005 India will have about 2-3 crore diabetic patients.

Even though the scientific world has conducted extensive studies but couldn’t

find a safe and effective therapy or medicine for this disease. In Ayurveda we can offer

several treatment modalities among that Bastikarma is a good, result oriented and

economical therapy which can control the blood sugar level and prevent further

complications without any serious side effects.

BastiKarma is advised in Madhumeha patients having good body strength and

those who are sthoola in nature. The objective of this study was to assess the efficacy of

BastiKarma in such patients. The study was designed as a prospective clinical trial and 30

patients were selected and given Madhutailika Bastikarm

The treatment contains the following steps.

01. Deepana pachana

02. Sthanika Abhyanga and mridu sweda by Moorchita tila taila.

IV

03. Madhutailika basti in yogabasti pattern.

04. Sixteen days Parihara kala.

05. Follow-up for one month.

As a result of the proper administration of Madhutailika basti it was noted that, it

gives immediate and lasting results, both in sugar levels as well as in other complaints.

Among the 30 patients taken for the study, 17 patients (56.6%) responded well, 11

patients (36.6%), responded moderately and 2 patient’s (6.6%) showed poor response. A

close perusal of observation and inference that can be drawn leads to the conclusions

such as, Madhutailika basti is an effective treatment in Sthoola Madhuneha and it also

shows lasting results. In mild and moderate type of Sthoola Madhumeha classical

Madhutailika basti alone is enough to control it. Even though only Virechana was

administered in this study, it was also noted that along with Madhutailika basti,

administration of pathya ahara vihara and shamanoushadis might help more.

Key words –

Shodhana karma ; Madhutailik Bastikarma ; Sthoola Madhumeha ; Prameha ;

Diabetes mellitus ; Insulin resistance ; Obesity; Blood sugar.

V

LIST OF ABBREVIATIONS

⇒ C. S _ Charaka Samhitha.

⇒ A. H. – Ashtanga Hridaya.

⇒ B. P. – Bhavaprakasha

⇒ K.S _ Kashyapa Samhita

⇒ G. R. – Good response.

⇒ M. R. – Moderate response.

⇒ N. R. – No response.

⇒ P. R. – Poor response.

⇒ S. S. – Sushruta Samhita.

VI

TABLE OF CONTENTS

Chapters Page No.

1. Introduction 1-4

2. Objectives 5-7

3. Review of literature 8-108

4. Drug review 109-114

5. Methodology 115-121

6. Results 122 -139

7. Discussion 140-152

8. Conclusion 153-154

9. Summary 155 - 156

10. Bibliography 157- 170

11. Annexure 171 - 178

VII

LIST OF TABLES Page No.

1. Table showing patients showing indicated for matrabasti 37

2. Table showing showing ingredients of madhutailika basti 42

3. Table showing Measurements of Bastiyantra 45

4. Table showing Netra dosha and Putaka dosha. 46

5. Table showing patients showing indicated for anasthapya 47

6. Table showing patients showing indicated for asthapya 49

7. Table showing patients showing contra indicated for Anuvasana. 50

8. Table showing proper dose according to age 52

9. Table showing ahara samandi nidanas 70

10. Table showing vihara sambandi nidanas 70

11. Table showing the types kaphaja prameha 76

12. Table showing the types pittaja prameha 77

13. Table showing the types vataja prameha 77

14. Table showing the poorvaroopa of prameha 82

15. Table showing the roopa of prameha 85

16. Table showing the Prameha pidakas 106

15. Table showing the grades of blood sugar level 121

Table showing the Data of Age Group Incidence and Response 125

18. Table showing the distribution of sex group Incidence and Response 126

19. Table showing the Chronicity and response 127

20. Table showing the incidence of religion and response 128

21. Table showing the socioeconomic status and response 129

22. Table showing the incidence of religion and response 130

23. Table showing the incidence of occupation and response 131

24. Table showing the Family history and response 132

25. Table showing the Treatment history and response 133

26. Table showing the habits of the patients and response 134

27. Table showing the Nature of mala pravrithi and response 135

28. Table showing the Nidana status and response 136

29. Table showing the Nature of kostha and response 137

30. Table showing the Status of agni and reponse 138

VIII

31. Table showing the Prakruti of patient and response 139

32. Table showing the Statistical data 0f the study 140

LIST OF FIGURES, PHOTOGRAPHS

Title Page No.

1. Figure showing dilated anatomy of the rectum and anus 18

2. Figure grass anatomy of large intestine 20

3. Figure grass anatomy of intestinal villi 20

4. Figure grass anatomy of Pancreas 23

5. Figure anatomy and orientation of Pitutary 27

6. Figure grass anatomy of Adrenalin gland 29

7. Figure grass anatomy of liver 30

8. Photo of drugs used in Mdhutailika Bastikarma 118

LIST OF GRAPHS

Title Page No. 1. Graph showing distribution of age 125 2. Graph showing distribution of sex 126 3. Graph showing distribution of Chronicity and response 127 4. Graph showing distribution of religion and response 128 5. Graph showing distribution of socioeconomic status and response 129 6. Graph showing distribution of religion and response 130 7. Graph showing distribution of occupation and response 131 8. Graph showing distribution of Family history and response 132 9. Graph showing distribution of Treatment history and response 133 10. Graph showing distribution of habits of the patients and response 134 11. Graph showing distribution of Nature of mala pravrithi and response 135 12. Graph showing distribution of Nidana status and response 136 13. Graph showing distribution of Nature of kostha and response 137 14. Graph showing Status of agni and reponse 138 15. Graph showing Prakruti of patient and response 139

Introduction

INTRODUCTION

Ayurveda the life science; embedded with the treasure of ancient knowledge

unfolding the mystery of health and disease. It is a compilation of observation,

experience and research of so many mentors, and moreover it is a cross section of the

scientific thoughts of many generations. Due to its simplicity and scientific nature,

Ayurveda has drawn the attention of the global population. It is well known for its role in

the management of the chronic and incurable diseases. It survived all the downfalls and

fought with unfavorable conditions, flourished during favorable time and still holds its

place in the mainstream.

Research begins with doubts and ends with facts; facts which serve as new data to

be verified again. Thus the process of research never ends, but at the end of it the

researcher would have become wiser with plans to counter newer challenges. Recurrent

modeling and remodeling by time is inevitable for the fulfillment of this destination.

Ayurveda is one such attainment by the perspiration of many eminent Acharyas of the

past. The time tested science Ayurveda has its own everlasting principles regarding both

life and disease. It is applicable in every facet of human life, with its own unique

principles in understanding a disease by both preventive and curative view. This may be

the fact due to which this science is persisting through centuries beginning from time

immemorial.

Scientific and technological progress has made man highly sensitive and critical;

they’re by giving rise to different types of health problems. The advancement of

industrialization and communication is contributing towards sedentary life styles, in turn

causing chronic non- communicable diseases like diabetes mellitus, etc. In fact it is the

first life science, which identified diagnosed and managed diabetes (the Greek word for

siphon) while claiming it is incurable much earlier to famous Greek physician Aerated

“Evaluation of efficacy of Madhutailika basti In the management of Madhumeha”

1

Introduction

(1-2 AD). In spite of all sorts of advancement of science man is not able to stay himself

in the boat of happy and healthy life, so it is a disadvantage rather than an asset; of the

individual by imposing an extra burden on all the systems of body. Then the persons are

very much likely to acquire an infirmity by name: Madhumeha; Mother’s name: Kapha;

Father’s name: Vata; Ancestry: Sahaja & Apathya nimittaja; Qualification: Mahagada;

Character: Anushangi; Expertise: Dhatu karshana; Identification with: Prabhoota Avila

mootrata and tanu madhurya; Status: impairment in multi systems of the body;

complexity Vidradi, Alaji etc; ultimate result: Pranahani.

Madhumeha is a disease known to the mankind since Vedic period and it is

mentioned as one of the 20 obstinate urinary disorders. It is the present burning issue

alarming the world. With synonym of Richman’s disease,’ it is present particularly the

persons who are able to enjoy the pleasure of life with a machine power. Most of the

srotas are involved in the manifestation of the madhumeha. At the outset it becomes

pertinent to discuss the following issues related to Madhumeha. Whether Madhumeha &

Prameha are synonyms? Yes. Charaka has used the words Prameha & Madhumeha as

synonyms and Chakrapani has clarified this fact more than once. The term Prameha has a

broader connotation, indicating the increased quantity and quality of urination whereas

Madhumeha more specifically means a condition where the patient passes urine like

honey. Yet, both the terms convey the nature of the same disease. Madhumeha is an

Anushangi vyadhi, which means it is punarbhavi. In other words the disease has a

tendency to re-occur. It is sadhya vyadhi only in the initial stages where Vata is still

anubandha (secondarily associated) and Kapha is dominant, in a sthoola and balavan rogi.


2

Introduction

It is asadhya when Vata begins to dominate either as a result of beeja upatapa or as a

sequel to a long-standing, Kapha pradhana Madhumeha.

In Ayurveda chikitsa has been explained under two folds; they are langhana and

brimhana, due to Shodhana in nature Panchakarma comes under the langhana category.

Panchashodhanas well known and effective treatment modalities in the management of

many chronic diseases like Madhumeha, Kustha, etc shodhana techniques are acts as a

weapon’s, due to its simplicity panchakarmas will helps in attaining both the aim of

Ayurveda i.e. Swasthasya urjaskara and arthasya roganut again the treatment is broadly

divided into two categories: Shodhana and Shamana. Curing the disease by cleaning out

the impurities is called Shodhana chikitsa, which is the principle of Panchakarma. It

involves the clearing of vitiated doshas (vata, pitta and kapha) which cause the disease

and thereby the restoration of equilibrium of doshas.

Vamana Virechana, Bastikarma, Nasya karma and Raktamokshana are considered

as the five folded theropies.In brief the term panch means “Vistara” or mangalakar that is

elaborate .In classics our Acharyas have given prime importance to Basti karma. Basti is

a prosses by which doshas are eliminated through the Adhomarga.Acharyas also given

prime importance to it. Even it termed as Ardhachikitsa and it removes the vitiated

doshas from all systems of the body.

Though Basti has been indicated for almost all the disease, some specific types of

Basti have been explained in the management of Madhumeha. As the vata dosha is one of

the main contributing factors. The best way to analyze Bastikarma is by checking its

effect over multisystemic dissordes like Madhumeha.


3

Introduction

The whole study has been distributed into two major divisions - the conceptual

study & the clinical study. The conceptual study is grouped into a literary review of

(Basti and Madhumeha) drug review; the clinical study contains the Observations,

Results, Discussion and Conclusion and Bibliography.


4

NEED FOR STUDY

Diabetes mellitus is the third largest killer in the world behind the cardiac

ailments and cancer. It is becoming a great national catastrophe with a current prevalence

rate of 2.4% to 11.6% in urban dwellers.

The danger of this epidemic disease is not only confined to individual’s mortality

and morbidity but also extends to affect the national health care system and economy.

In spite of many advances in contemporary science, the management of diabetes

is still unsatisfactory. Consequent to such projections alarm bell are already ringing in the

circle of health care institutions. In spite of more and more chemical molecules flooding

the market with claims of better efficiency in the management of diabetes mellitus, but

the over all treatment scenario is not of confidant, drug related resistance and toxicity etc

are creating a opinion for provision of safe anti-diabetics. There is no doubt that attention

is coming back to our ancient Indian heritage of Ayurveda to explore its rich literature

and come out with some efficacious remedies, to co-fight the challenge of diabetes.

Among that madhutailik vasti is one of the jewel of Ayurveda, which gives tremendous

result in many diseases including madhumeha (Stoola Madhumeha), Even though it is

classified under Niroohabasti, Siddabasti. In this types of vasti patients need not follow

much restriction as in the case of Niroohabasti.

OBJECTIVES

Number of research works has already been conducted on evaluation of the effect

of some indigenous drugs on madhumeha. Only few research works have been

conducted on efficacy of Samshodhana karmas in the management of Madhumeha. It is

one of the multi systemic disorders where the maximum numbers of Srotases are

involved in the manifestation of the disease. So treating such disease with some time

tested and effective therapies like vasti is the better option. No studies are conducted on

the effect of madhutailika vasti in the management of sthoola madhumeha so for.

THE AIMS AND OBJECTIVES OF THE STUDY

To evaluate the efficacy of madhutailika vasti in the management of

madhumeha.

To evaluate the hypoglycemic effect of Madhutailika vasti.

INCIDENCE AND PREVELENCE

Diabetes is a disease of the masses. The incidence and prevalence rate of diabetes

itself suggests that it is burning issue alarming the world. As per recent WHO assessment

there are 150 million people are reported to be suffering from this Rich man’s sweet

disease. Among them 35% are living in India (>55 million). It is reported that at the end

of 2025, the incidence of diabetes in Indian continent is rising very fast at a rate of >3

times the entire world.

The disease prevalence was 2.4% in rural and 4% -11.6% in urban dwellers.

In world: -150 million persons are now affected and the expected prevalence will be

5.4% by the year 2025.

There are 50% in developed countries 10% in developing countries.

In India: - There were 102000 persons died because of this disease in the

Year

1997.

Review of Literature


8

Historical view

REVIEW OF LITERATURE

History in other words a function of a historian is neither to love the past nor to

emancipate himself from the past, but to master and understanding of the present. E. H. Carr

History of medicine in India in ancient period is actually the history of science of life

developed by the ancient seers & later systematized into carefully woven treatises

A careful insight into ancient treasure of knowledge makes a good beginning for any

study since we become proud to belong to be part of a heritage, which traces its roots into

times immemorial. Historical background itself base and back bone for the present

progressive development of Ayurveda.

A critical review of the history from the primitive stage to the new millennium

assists one to understand the future in a better way. Struggle and attempt made by a man

for the better future can achieve only with good prospective past and present experiences,

truths and planned in a proper time. History helps to reveal the hidden facts and ideas of

the concerned subject.

BASTI KARMA

Vyadhi has been defined as the state in which imbalance of three Dosha-

the three basic constituents of the living body, saptha dhatu and three malas. The

measures undertaken to restore these Doshika equilibrium is called as Chikitsa.1 the

ayurvedic approach to the treatment of a disease comprises mainly under the two folds

viz



9

• Shodhana

• Shamana

Shodhana Chikitsa is supposed to eliminate vitiated Doshas completely and thus prevents

the recurring of the diseases. On the other hand Shamana is the conservative treatment as

it doesn’t eliminate vitiated Dosha but it farcifies them. It is believed that there is no

possibility of relapse of the disease cured by Shodhana Chikitsa if followed proper

samsarjana karmas and pathyapathya during parihara kala, while the disease cured by

Shamana; may reoccur as explanation given by Charaka2 i.e.

The term Panchakarma is frequently used as synonyms of Shodhana. It consists of

Vamana, Virechana, Anuvasana Basti, Niruha Basti and Nasya Karma. Due to its

multiple effects Basti is the most important constituent among the Panchkarma.

According to Ayurvedic physiology Kapha and Pitta are depends on Vata, as it governs

their functions. Basti alleviates morbid Vata dosha from the root level along with other

associated Doshas, in addition it nourishes the body tissue.3 Therefore, Basti therapy

covers more than half of the treatment of all the disease, 4 while some authors consider it

as the complete remedy for all the ailments. Therefore, Basti is considered the best

remedy for morbid Vata, but it can also be used in Kapha and Pittaja disorders by using

different ingredients.5 Though the rout of drug administration in Basti karma and enema

of modern science is same but actions are entirely different, Basti posesses both

Samshodhana and Samshamana effects along with this it does the functions of

shukradharana, Brimhana in emaciated person; Karshana in obese person, Chakshushya,

prevents the aging, improves the luster, strength and helps longevity by acting locally as

well as systematically at cellular level. Thus, it has a wide application in treatment aspect.



10

In contemporary science mainly enema is given to remove the mala from the large

intestine.

Karma

History and medicine starts from the very moment when the human being came into

existence that’s why the ancient treatises are stands with description of disease and their

treatment.The evaluation of Basti can be traced from Vedic era viz Rigveda and

Atharvaveda which is considered as the oldest authentic manuscripts of the world.

Veda: - The Kaushika Sutra of Atharvaveda, Basti is indicated as a substitute for minor

operation.6

Purana: - In Agnipurana, Basti is indicated as a principle treatment in complaints

marked by predominance of Vata.7 It is also stated that according to season different

Sneha should be used for Basti.8 in Ashwa Chikitsa Kathana, Taila Basti is recommended

in horses to relieve their fatigue immediately.9

Yogic Literature: - In Gheranda Samhita, Basti is included in Satkarma. Two kind of

Basti’s has been described on the bases of their application.

Jala Basti – To be done in water.

Sushka Basti – To be done on land.

In samhita

All the classical treatises of Ayurveda have emphasized the importance and wide

application of Bastikarma as the most effective therapeutic measures than the other.

Acharya Charaka has nicely described the uses, advantages and complications of

Bastikarma, “shareera shreshta” Shusruta elaborately described about Bastiyantra,

Netra, Types of bastis, complications and its management in kalpasthana. Avasthanusara



11

basti vyapath has been beautifully explained by Acharya Vagbhata. Sharangadhara also

has given much importance to bastikarma and he explained Uttaravasti. Yogaratnakar,

Bhavaprakasha and Vangasena also dealt the bastikarma by adding newer combinations

like vaitharana vasti, ksheera basti, etc.

Kashyapa equated the word “Amrutam” to the Basti, 10 and he indicated basti in

children’s. The present renowned author of Ayurveda have also elaborately explained the

possible modification of equipments this is definitely encouraged us and helps in easy

practice less tedious work with minimized complication.

MADHUMEHA

The knowledge of madhumeha is very familiar to Indians since prevedic period

there is ample of descriptions are found in this period.

Prevedic period: -

The lord Ganesha was a stoola pramehi. He suffered from prameha due to excess

intake of “Moodaka” and lack of strenuous work. His father Lord Shiva advised him to

take ‘Kapitta, jambu, and Shiva Gutika’ as a treatment of stoola pramehi.

Vedic period: -

A study of ancient literature indicates that diabetes was fairly well known and

well conceived as an entity in ancient India. The knowledge of the system of diabetes

mellitus, as the history reveals, existed with the Indians since prehistoric age. Its earliest

reference (1000 BC in the Ayurvedic literature) is found in mythological form where it is

said to have originated by eating Havisha, a special food that used to be offered at the

times of yagna organized by Dakshaprajapati. The disease was known as ‘Asrava’ during



12

vedic era (6000 BC)

Vedas are the oldest literature of the universe. In Kousika su.26/6-10 of

Atharvaveda, we find a reference of Asravana and Prameha.

In Atharvaveda Asrava vyadhis are mentioned, in which some symptoms like

rasasrava, atimootra, atisara etc are included. The Vedic Commentators Sayana and

Keshava described Asrava as mootratisara i.e. excessive urination. Later in 1962 whintey

interpreted Aasrava as flux, while Griffith named it as morbid flow.

The word Pramehe is used so many times in Kautilya’s Arthashastra (321-296

BC) in the context of inducing Prameha to the enemies as a part the criminal customs of

the kings, to dominate over the opposite. Mentioned a method of producing prameha, i.e.

the spot is obtaining from burning Chan lion (Krukalaka) and house lizard (Gruha

Goulika) together with the intestines of mottled frog (Chitra bheka) and honey, if

administered it causes prameha.

In Atharvaveda 6/44/3 Vishanaka drug is indicated in Vatavyadhis, one of the

commentators Keshava commenting on this, he explained “Vaikruta nashani as vaikruta

asravya nashani.”

In the mantra 23-1-3 of Atharvanaveda the drug emerged from valmika are

indicated in atisara, atimootra and nadivranam.

SAMHITA PERIOD: -

The golden age of Ayurvedic history is Samhita Kala. The main classical texts of this era

are Brihatrayis.

Charaka samhita: -



13

Maharshi Atreya - the father of Indian Medicine conducted earliest scientific study on

madhumeha It is a point of historical importance that in Charaka samhita nidana sthana

4/37, he mentioned the loss of sweet substance from urine. In Sutrasthana 17/78, he has

described prameha as Anusangi, and the stoola madhumeha occurs due to avritatwa of

vayu and Samprapthi of madhumeha in the same chapter.

Sushruta samhita: -

Sushruta, the father of surgery has narrated the aetiopathogenesis of prameha on

the basis of an endogenous entity being caused due to “Dhatvagnimandya”. The course

and complications of the disease along with different line of treatment are discussed at

various places in Sushrutaa Samhita

The most notable contribution from Sushruta is seen; he dedicated a separate

chapter for the management of madhumeha. He has described nivritti lakshanas of

madhumeha, on the basis of pathogenesis. Madhumeha of two types dhatukshayajanya

anssd Avaranajanya madhumeha.

Astanga hridaya: -

Vagbhata has described some specific drugs like Dhatri, nisha for the treatment of

Prameha.

Astanga sangraha: -

He expressed the similar opinion of the Charaka and Sushruta; later he quoted the

symptom Tanu madhuryata.

Kashyapa samhita: -

In vedana adhyaya of Sutrasthana Acharya Kashyapa mentioned the signs and symptoms

related to Bala pramehi.11



14

Bhela samhita: -

Two types of prameha are given in Nidanasthana swakritija prameha and prakritija

prameha.12

Harita samhita: -

Acharya Harita enumerated 13 types of prameha with different nomenclature like puya

prameha, Takra prameha, Rasa prameha, Ghrita prameha etc.13

MEDIEVAL PERIOD: -

In this period no more classics have been written but this period of history of

Indian medicine is known as period of commentators.

Madhavakara: -

Madhavakara (9th century A.D) in his work madhava nidana compiled the thoughts of his

earlier acharyas without adding any thing new to the knowledge on madhumeha

Gayadas: -

Gayadas (11th century A.D) commentators of sushruta samhita elucidated that the

symptoms of Avilatwa of urine in prameha is due to the presence of dooshya like meda,

mamsa etc (Su.Ni. 6/6)

Chakrapanidatta: -

Chakrapanidatta in 35th chapter he documented the treatment of prameha.

Dallhana

Another 12th centurion commentator of Sushruta samhita; while commenting on Sushruta



15

samhita nidanasthana 6/3; he contributed a myth that females do not suffer from

madhumeha.

Sharangadhara

13th century A.D he belongs to 12th century, he described 20 types of prameha with some

new recipes for the management.

Bhavamishra

Acharya Bhavamishra added some new herbo-mineral preparations for the management.

Yogaratnakara: - Specific yogas are vividly explained.

Agnipurana

The Kshoudra and Kshoudraprameha are quoted; also some specific treatment is

mentioned for prameha.

Valmiki ramayana: -

There is a reference that the monkeys who were serving Rama, suffered from

madhumeha due to madhura Ahara sevana.

Ayurveda is well aware about the extent in which all the body tissues are involved in the

pathogenesis of Prameha. The outstanding pioneers of Ayurved Charaka, Sushruta and

Vagbhata better known as the holy triad made the earliest reference to diabetes as a

“diseased flow of urine” and “honey urine.” It seems, during this period no Greco-Roman

physicians were acquainted with symptoms of abnormal urine.

Vyutpatti


16

Etymology of Basti

The word ‘Basti’ has its origin from the root ‘Vas’ with the suffix of Pratyaya

‘Tich’ gives rise to the word ‘Basti’ and it belongs to masculine gender.

According to Siddhanta Kaumdi, the root ‘Vas’ gives following meaning:

1) “Vasu Nivase”13 - this means to stay, to reside and to dwell.

2) “Vas-aachadane” – which gives covering.

3) “Vas vasane surabhikarane”– Fragrance.

4) “Vasti vaste aavrunothi mootram” – which covers the urine.

5) “Nabheradhobhage mootradhare” – urinary bladder.

Paribhasha: -

The term basti can be used in different sense, in the context of Panchakaram; it

gives the following meaning.

1) “Vastinam deeyate vasti.”14

“Vastirabhideeyate yasmat tasmat vastiritismrita.”15

Basti means bladder and it is used as the measure devise for the bastikarma. The

medicines like decoction, Milk, oil, Ghee etc are taken in the basti and administered

through gudamarga by a basti netra. Hence the term basti is used to designate the process

in panchakarma.

Hence, Basti conveys the following meanings.

Medicine stays in large intestine for sometime after its introduction through the

rectum, which causes movements in large intestine and waste materials there in which

are begged for their elimination.

An organ where urine is collected i.e. urinary bladder, which is situated below the

umbilicus.

An instrument, which is used to introduce Basti drugs in the rectum.

Vyutpatti


17

Definition of Basti:

1) The apparatus used for introducing the medicated materials is made up of Basti

or animal urinary bladder16

2) The procedure in which the medicaments are introduced inside the body

through the rectum with the help of animal urinary bladder is termed as Basti17.

3) The bag made by animal bladder is termed as Basti.

4) Acharya Charaka has defined the Basti as the procedure in which the drug

prepared according to classical reference and administered through rectal canal

reaches upto the Nabhi Pradesha, Kati, Parshva, Kukshi churns the accumulated

Dosha and Purisha and spreads the potency of the drugs to all over the body and

easily comes out along with the Purisha and Doshas is called Basti.18

According to modern science, enema is the procedure in which any liquid

preparation is introduced through rectum by means of adequate instruments

(Ghosh) or injection as liquid or gas into the rectum.

Shareera

“Evaluation of efficacy of Madhutailika Bastikarma In the management of Madhumeha”

18

Shareera

Focus of this study is on Madhutailika Basti. Therefore, a discussion on the anatomy and

physiology of guda and pakwashaya where the Basti is administered is necessary prior to

the discussion on the anatomy and physiology of Pancreas, pituitary gland, adrenalin

gland and liver, these are the sites of this disease.

The word shareera composes both structural and functional aspects of the body. As basti

in considered importantly in the subject certain anatomical features of rectum and large

intestine is also described.

Guda / Rectum

Synonyms:

Amarkosha - Aapanam, Payu

Jatadharam – Guhyam, Gudavartma

Vijayarakshita – Apanah, Mahatsrotas

Gangadhara – Bradhanam

Vachaspati – Vitmarga

Other words that are mentioned in contact to Guda various Acharyas are

Charaka – Uttaraguda, Adharaguda, Sthulaguda (C. V5/4, Si 9/3), Gudamukha

Sushruta – Gudamandhala, Gudavalaya, Payuvalaya, Gudaustha.

Vagbhatta – Gudamarga

Dalhana – Gudantram

Sushrutha has explained elaborately on the anatomical structure of guda

while describing Arsoroga. Guda is a part, which is the extension of sthoolantra with 41/2

angula in length. It has got 3 valis (parts) named as Gudavalitrayam.19

Shareera


19

1.Pravahini – that which does pravahana.

2.Visarjini – that which does viasrajana

3.Samvarani – that which does samvarana

There is another structure called as Gudostha, which is about a distance of 1½

yavapramana from the end of hairs. The first vali samvarani starts at a distance of 1

angula from gudostha. The width of each vali will be 1 angula and of the colour of

elephant’s palate. 20

Charaka when described about the koshatagni has considered uttaraguda and adharaguda.

The modern commentators consider them as rectum and anus respectively.21 all Acharyas

have considered guda as one among the bahyasrotas and one among the dashajeevitha

dhamani. 22, 23, 24

The rectum forms the last 15cm of digestive tract and is an expandable organ for the

temporary storage of fecal material. Movement of fecal material into the rectum triggers

the urge to defecate.

The last portion of the rectum, the Ano-rectal canal, contains small longitudinal folds, the

rectal columns. The distal margins of rectal columns are joined by transverse folds that

mark the boundary between columnar epithelium of the proximal rectum and a stratified

squamous epithelium like that in the oral cavity. Very close to the anus or anal orifice, the

epidermis becomes keratinized and identical to the surface of the skin.

There is a network of veins in the lamina propria and submucosa of the ano-rectal canal.

The circular muscle layers of the muscularis externa in the region forms the internal

Shareera


20

sphincter and is not under voluntary control. The external anal sphincter guards the anus

and is under voluntary control. Pudental nerves carry the motor commands. 25

Pakwashaya / Large intestine

Pakwashaya is considered as one among the ashaya by Sushrutha,

Vagbhata.26,27 Arunadatta comments as pakwashaya is the seat of pakwa anna i.e. that

which attains pureeshatha.28 Charaka and Vagbhata considered this as one among the

koshtangas. 29, 30 Sharangadhara has specified the location of pakwashaya (pavanasaya)

as below the Tila i.e. the liver.31

The horseshoe shaped large intestine or large bowel begins at the end of

ileum and ends at anus. Average length is about 1.5 meters and width of 7.5cms. It is

divided into 3 parts: -

1.Cecum – T portion (pouch like)

2.Colon – large portion.

3.Rectum – the last – 15 cm portion.

Shareera


21

Absorption in the Large Intestine

The re-absorption of water is an important function of the large intestine. Although

roughly 1500 ml of material enters your colon each day, only about 200 ml of feces is

ejected. The remarkable efficiency of digestion can best be appreciated by considering

the average composition of fecal wastes: 75 percent water, 5 percent bacteria, and the rest

a mixture of indigestible materials, small quantities of inorganic matter, and the remains

of epithelial cells.32

In addition to reabsorbing water, the large intestine absorbs a number of other substances

that remain in the fecal material or that were secreted into the digestive tract along its

length:

Diabetes mellitus is a chronic disease due to the disordered carbohydrate metabolism and

results due to deficiency of insulin secreted by the beta cells of Islets of Langer Hans of

pancreas. But the hormones of pituitary and adrenal glands are also intimately related to

the development of this state. Apart form this liver had its own role in the manifestation

of this disease, because it stores the glucose in the form of glycogen under the influence

of insulin. Any alteration in this leads to diabetes. So following glands are involved in the

pathology of the diabetes mellitus –

Pancreas

Pituitary

Adrenal

Liver

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22

Pancreas33

The pancreas lines within the abdomino-pelvic cavity in the ‘J’ shaped loop between the

stomach and the small intestine. It is a slender, plane organ with a nodular consistency.

The adult pancreas is 20 –25 cm long and weights about 80 gm. The broad head of the

pancreas lines within the loop formed by the duodenum as it leaves the pylorus. The

slender body extends transversely towards the spleen and the tail is short and bluntly

rounded. The pancreas is retroperitoneal and is firmly bound to the posterior wall of

abdominal cavity.

The surface of the pancreas has a lumby, lobular texture. A thin, transparent connective

tissue capsule wraps the entire organ. You can see the pancreatic lobules, associated

blood vessels and excretory ducts through the anterior capsule and the overlying layer of

peritoneum.

Arterial blood reaches the pancreas by way of branches of the splenic, superior

mesenteric and common hepatic arteries. The pancreatic arteries and Pancreaticoduodenal

arteries are the major branches from these vessels. Splenic vein and its branches drain the

pancreas.

The pancreas is primarily an exocrine organ producing digestive enzymes and buffers.

The large pancreatic duct delivers these secretes to the duodenum. A small accessory

duct, or duct of Sanforini, may branch from the pancreatic duct. The Pancreatic duct

extends within the attached mesentery to reach the duodenum, where it meats the

common bile duct from the liver and gall bladder.

The pancreas has two distinct functions, one endocrine and other exocrine. The exocrine

pancreas roughly 99 percent of the pancreatic volume consists of clusters gland cells,

Shareera

pancreatic acini, and their attached ducts. Together the gland and duct cells secrete large

quantities of an alkaline, enzyme rich fluid. This secretion reaches the lumen of the

digestive tract by traveling along a network of secretary ducts.

The endocrine pancreas consists of small groups of cells scattered among the exocrine

cells. The endocrine clusters are known as pancreatic Islets, or the Islets of Langer Hans.

Pancreatic islets account for only about 1 percent of the pancreatic cell population.

Nevertheless, a typical pancreas contains roughly 2 million pancreatic Islets.

Each Islet contains four different cell types.

Alpha cells –

Produces the hormone Glucagon, it raises blood glucose levels by increasing the rates of

glycogen break down and glucose release by the liver.

Beta cells – Produce the hormone insulin. Insulin lowers blood glucose by increasing the

rate of glucose uptake and utilization by most body cells and increasing glycogen

synthesis in skeletal muscles and the liver. Beta cells also secrete amylin, a recently

discovered peptide hormone whose role is uncertain.

Delta cells – Produce a peptide hormone identical to somatostatin, a hypothalamic

regulatory hormone. Somatostatin produced in the pancreas suppresses glucagon and

insulin release by other islet cells and slows the rates of food absorption and enzyme

secretion along the digestive tract.

“Evaluation of efficacy of Madhutailika 23Bastikarma In the management of Madhumeha

”

Shareera


24

F cells –

Produce the hormone pancreatic polypeptide. It inhibits gallbladder contractions and

regulates the production of some pancreatic enzymes. It may help to control the rate of

nutrient absorption by the digestive tract.

Here focus is made on insulin and glucagon, the hormones responsible for the regulation

of blood glucose concentrations, which are given below. These hormones interact to

control blood glucose levels. When blood glucose levels rise, beta cells secrete insulin,

which then stimulates the transport of glucose across cell membranes. When blood

glucose levels decline, alpha cells secrete glucagon, which stimulates glucose release by

the liver.

Insulin

Insulin is a peptide hormone released by beta cells when glucose levels rise above normal

levels (70 to 110 m/c). Elevated levels of some amine acids, including arginine and

leucine, also stimulate insulin secretion. Insulin exerts its effects on cellular metabolism

in a series of steps that begins when insulin binds to receptor proteins on the cell

membrane. Binding heads to the activation of the receptor which functions as a kinease

and attaches phosphate groups to intracellular enzymes. Phosphorylation of enzymes then

produces Primary and secondary effects within the cell, the biochemical details remain

unresolved.

One of the most important effects is the enhancement of glucose absorption and

utilization. Insulin receptors are present in most cell membranes. Such cells are called

Shareera


25

insulin-dependent. However, cells in the brain and kidneys, cells in the lining of the

digestive tract, and red blood cells lack insulin receptors. These cells are called insulin

independent, because they can absorb and utilize glucose without insulin stimulation.

Effects of insulin on its target cells –

01. Acceleration of glucose up takes

This effect results from an increase in the number of glucose transport proteins in the cell

membrane. These proteins transport glucose into the cell by facilitated diffusion.

02. Acceleration of glucose utilization and enhanced ATP production

This effect occurs for two reasons –

(a) The rate of glucose use is proportional to its availability. when more glucose enters

the cells, more is used.

(b) Second messengers activate a key enzyme involved in the initial steps of glycolysis.

03. Stimulation of glycogen formation (skeletal muscles and Liver cells)

When excess glucose enters these cells, it is stored in the form of glycogen.

04. Stimulation of amino acid absorption and protein synthesis

05. Stimulation of triglyceride formation in adipose tissues

Insulin stimulates the absorption of fatty acids and glycerol by adipocytes. The adipose

cells then store these components as triglycerides. Adipocytes also increase their

absorption of glucose; excess glucose is used in the synthesis of additional triglycerides.

As whole (summary) insulin secreted when glucose is abundant and this hormone

stimulates glucose utilization to support growth and the establishment of carbohydrate

(glycogen) and lipid (tryglyceride) reserves. The accelerated use of glucose soon brings

circulating glucose levels with in normal limits.

Shareera


26

Glucagon

When glucose concentrations fall below normal, alpha cells release glucagons, and

energy reserves are mobilized. When glucagons binds to a receptor in the cell membrane;

it activates adenylate cyclase, and cAMP acts as a second messenger that activates

cytoplasmic enzymes. The primary effects of glucagons are –

Stimulation of glycogen breakdown in skeletal muscle and liver cells.

Stimulation of triglyceride breakdown in adipose tissues.

Stimulation of glucose production at the liver.

Gluconeogenesis

It is a process of glucose synthesis in the liver; the liver cells absorb amino acids from

blood stream, convert into glucose, and release the glucose into the circulation. The

results are a reduction in glucose use and the release of more glucose into the blood

stream consequently; blood glucose concentrations soon rise towards normal glycemic

level.

Pancreatic alpha cells and beta cells monitor blood glucose concentrations, and the

secretion of glucagon and insulin occur without endocrine or nervous instructions. Yet,

because the alpha cells and beta cells are very sensitive to changes in blood glucose

levels, any hormone that affects blood glucose concentration will indirectly affects the

production of insulin and glucagon. Insulin production is also influenced by autonomic

activity. Parasympathetic stimulation inhabits it.

Pituitary Gland 34

It is an important ductless gland with lot of functions, including the control of the other

ductless glands and of body growth. This gland measures 1.5 cm in the coronal plane, 1

Shareera


27

cm in the sagittal plane and 0.75 cm in vertical form. It lies within the cella tarsica of the

sphenoid bone and the posterio-superior to the sphenoid air sinuses, below the optic

chiasma. It is flattened ovoid laying the hypophysial fossa and connected to the inferior

surface of the hypothalamic part of the brain by the infundibulum.

Structurally it can be divided

into 2 parts –

1) Anterior lobe

2) Posterior lobe

Posterior lobe of the hypophysis is the expanded end of the infundibulum and is

developed from the brain. The anterior lobe is much larger than the posterior lobe and

consists of three parts, which partly surrounds that lobe and the infundibulum. The distal

part forms most of the anterior lobe. It is separated from the posterior lobe by the thin

seat of glandular tissue applied to the posterior lobe. The infundibular part is a narrow

upward projection of the distal part. The anterior lobe develops from the ectoderm and

has only vascular connection with brain.

Anterior lobe is the master gland of the endocrine system, because it produces protein

tropic hormones, which affects the other ductless glands. In these secretions two

hormones are having direct action on carbohydrate metabolism, which leads to

hyperglycemia or hypoglycemia. The two hormones are –

Growth Hormone or Somatotrophic hormone – (GH or STH)

Shareera


28

Adrenocorticotrophic hormone (ACTH)

The pituitary effect of STH on carbohydrate metabolism is to stimulate its storage.

Administration of growth hormone will produces hyperglycemia and glycosuria. The

high blood glucose level leads to its exhaustion and atrophy. So the growth hormone has

diabetogenic effect especially in man. The hormone is however increasing the glycogen

content of cardiac muscles.

Administration of ACTH possesses similar effects as induced by growth hormone. Both

STH and ACTH increase gluconeogenesis and diminish the rate of oxidation of glucose.

Thus the anterior pituitary has a diabetogenic role. GH is also known as Somatotrophin

and somatotrophic hormone causes cells to grow and multiply and it increases the rate of

protein synthesis. GH accelerates the rate at which glycogen stored in the liver is

converted to the glucose and released in the blood. GH raises blood glucose level and the

raise in the glucose, triggers insulin secretion. ACTH by stimulating secretion of gluco-

corticoids brings about hyperglycemia and also directly stimulates the release of GHIF

and inhibits the secretion of insulin. One stimulus that inhibits GH secretion is

hyperglycemia. An abnormally high blood sugar level stimulates the hypothalamus to

secret the regulating factor GHIF and it inhibits the release of GHAF and thus the

secretion of GH. As a result blood sugar level decreases.

Adrenal Gland 35

Adrenal glands are situated on the upper poles of the kidneys. Each gland weights about 4

gms. A distinct connective tissue capsule surrounds the parenchyma of the gland.

Beneath the capsule the cortex is arranged in three layers –

Shareera


29

Zona glomerulosa – Secretes mainly aldeosterone and it secretes less amount of gluco-

corticoids and sex hormones.

Zone fasciculata –

It secretes mainly gluco-corticoides.

Zona reticularis – Secretes the sex hormone

and glucocorticoids,

All the three zones of the adrenal gland can

synthesis the gluco-corticoids. The chief action

of the gluco-corticoids is to increase

glyconeogenesis in the liver and stimulates formation of glycogen in the liver and

muscles. The adrenal cortex also asserts diabetogenic affects. Proteins are converted into

carbohydrates i.e. glyconeogenesis occur through the action of gluco-corticoids.

Therefore, constant production of carbohydrates and the insulin is required to metabolize

the excess of carbohydrates. The excessive glyconeogenesis exerts continued strain upon

the cells of Islets leads to hyperglycemia. When it is severe, it damages the beta cells and

permanent insulin deficiency results. The adrenal action however depends upon the

action of anterior pituitary.

Liver 36

The liver is the largest gland in the body. The greater part of the liver lies under the

covering of the ribs and costal cartilage. The liver is a dark brown highly vascular soft

organ. It is approximately 1/50th of the body weight in the adults, but larger in the

newborn. The liver lies normally in the right hypochondrial and epigastric regions. The

Shareera


30

surrounding organs determine the shape of the liver; it retains the shape of a blunt wedge.

It has two surfaces – diaphragmatic surface and visceral surface.

Lobes of liver –

The main lobes of liver right

and left are demarcated form one another

above and in front by the falciform ligament

and below and behind by the fissures for the

ligamentum teres and ligamentum venosum.

The right lobe includes two subsidiary lobes.

The liver plays a central and crucial role in the regulation of carbohydrate

metabolism. Its normal functioning is essential for the maintenance of blood glucose

levels and of a continued supply to organs that require a glucose energy source. This

central role for the liver in glucose homeostasis offers a clue to the pathogenesis of

glucose intolerance in liver diseases but little insight into the mechanisms of liver disease

in diabetes mellitus.

The Role of the Liver in Glucose Homeostasis

An appreciation of the role of the liver in the regulation of carbohydrate homeostasis is

essential to understanding the many physical and biochemical alterations that occur in the

liver in the presence of diabetes The liver uses glucose as a fuel and also has the ability to

store it as glycogen and synthesize it from no carbohydrate precursors (gluconeogenesis).

Underscoring the important role the liver plays in maintaining normoglycemia.

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31

Glucose absorbed from the intestinal tract is transported via the portal vein to the liver.

Although the absolute fate of this glucose is still controversial, some authors suggest that

most of the absorbed glucose is retained by the liver so that the rise in peripheral glucose

concentration reflects only a minor component of postprandial absorbed glucose.

Therefore, it is possible that the liver plays a more significant role than does peripheral

tissue in the regulation of systemic blood glucose levels following a meal.37 Katz and

associates, 38 however, suggest that most absorbed glucose is not taken up by the liver but

is rather metabolized via glycolysis in the peripheral tissues.

Many cells in the body, including fat, liver, and muscle cells, have specific cell

membrane insulin receptors, and insulin facilitates the uptake and utilization of glucose

by these cells. Glucose rapidly equilibrates between the liver cytosol and the extra

cellular fluid. Transport into certain cells, such as resting muscle, is tightly regulated by

insulin, whereas uptake into the nervous system is not insulin-dependent.

Glucose can be used as a fuel or stored in a macromolecular form as polymers: starch in

plants and glycogen in animals. Glycogen storage is promoted by insulin, but the capacity

within tissues is physically limited because it is a bulky molecule.

Insulin is formed from a precursor molecule, preproinsulin, which is then cleaved to

proinsulin. Further maturation results in the conversion of proinsulin into insulin and a

smaller peptide called C-peptide.

A small amount of proinsulin enters the circulation. It has a half-life 3–4 times longer

than that of insulin because it is not metabolized by the liver. However, proinsulin has

<10% of the biological activity of insulin.

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32

Insulin is metabolized by insulinase in the liver, kidney, and placenta. About 50% of

insulin secreted by the pancreas is removed by first-pass extraction in the liver. Insulin

promotes glycogen synthesis (glycogenesis) in the liver and inhibits its breakdown

(glycogenolysis). It promotes protein, cholesterol, and triglyceride synthesis and

stimulates formation of very-low-density lipoprotein cholesterol. It also inhibits hepatic

gluconeogenesis, stimulates glycolysis, and inhibits ketogenesis. The liver is the primary

target organ for glucagon action, where it promotes glycogenolysis, gluconeogenesis, and

ketogenesis.39, 40

Bastikarma


33

BASTIKARMA: -

Among the shodhana Chikitsa basti has its unique importance in treating the major

disease like madhumeha, Vatavyadhis etc. due to the power and advantages it confers

on patients. It differs in many aspects like in principle, mode of application and in

wide advantages it renders. The term basti means bladder; it is used as a major device

for bastikarma. It is also said that the medicine in suspension, administered through

the bastiyantra, first reaches the lower abdominal part of the patient. The lower

abdominal area or the pelvis also contains the organ basti i.e.urinary bladder, due to

these reasons the term basti is used in Panchakarma.

Importance of Bastikarma: -

All the acharyas were appreciated basti has a unique form of treatment

modality considering the efficacy it generates in remodeling the hampered doshas. It is

uncomparable elimination therapy than the other because it expels the vitiated doshas

rapidly as well as it nourishes the body.41 It can be easily perform in all the age group

persons; where other shodhana procedures are difficult to perform.42 Bastikarma is the

best choice of treatment for vatadosha and vata associated with kapha and pitta. As vata

being chief among the three doshas and it is functional requirement for both kapha and

pitta, if once co-ordination gets disturbed then the disease is going to manifest.43 in

madhumeha kapha is arambhaka and vata is the preraka. Vata is responsible for gati

gamana, which is much requiring for shreera vyapara.44

Charaka very specifically given importance to treat the sthanika dosha first and

sthanantara dosha, Pakwasaya is said to the main seat of vata dosha. By adopting

treatment modality like bastikarma will helps in bringing vata into its normalsy, vata

Bastikarma


34

mainly involved in the pathogenesis of mandhumeha and ohter diseases.45 Hence, it is to

be considered as one of the suitable treatment for vata dosha predominant diseases,

supporting to this Vagbhata named it as “Ardhachikitsa.”46 Apart form this it is

considered as superior then the other therapeutic measures; on account of its varied

actions like samshodhana, samshamana and samgrahana, etc.47

Charaka explained nirooha Basti is contraindication in udara vyadhi,48 again

while explaining yogya for nirooha basti; he indicated in Bala, Varna, Mamsa and

Shukrakshaya condition nirooha basti can be given,49 it is clear that nirooha is

contraindicated in specific conditions like were excessive rookshatha is present in such

condition it versions the condition. Madhumeha is a condition; were the detoriation of

bala, varna and ojas are roetinly noticed. For maintaining Bala and Varna of a patient;

basti can be given in madhumeha patient.

Classification of Basti: -

Knowledge of the classification is very essential for the better understanding point

of view. In classics different types of Basti are explained based on the amount of the

drug, the quality of the substance and the expected action of the Basti, etc. there is

difference of opinion in classification. The term basti has been used for all types of

bastikarma, which includes nirooha, anuvasana, uttarabasti etc. Charaka used the term

basti exclusively for nirooha eventhough he is considred both nirooha and anuvasana as

shodhana procedures.50 finely bastikarma has been brought into the following

classifications.51

1) Adhishtana bheda : - The site of application viz abhyantara and bahya

2) Dravya bheda: - on the bases of medicine used viz madhutailika basti, kashaya basti,

taila basti, ksheera basti, pichha basti

3) Karma bheda: - on the bases the action it does viz shoadhana basti, shamana basti,

lekhanabasti, brihmana basti, etc

4) Sankhya bheda: - The number of bastis given as a course yaga basti i.e. 8 in number,

kala basti i.e. 16 in number

Bastikarma


35

5) Anushangika bheda: - miscellanios verities.

6) Matra bheda: - Based on quantity of vasti dravya used.

1. Adhishtana bheda: -

According to the site of application of basti it is of two types –

a. Internal

b. External

a. Internal

i) Pakwasayagata basti: - The administration of medicine via

ano-rectal route to pakwasaya.

ii) Garbhasayagata basti – The administration of medicine through

the vaginal route to garbhasaya.

iii) Mutrasayagata basti – The administration of medicine via

urethral route to mootrasaya.

iv) Vranagata basti – The medicine administered through the

vranamukha by the process of bastikarma.

b. External

In certain diseases the medicated oil is kept over the part of the body using

a cap or with flour paste for prescribed period of time and named after the site of

application of oil such as – Shirobasti, katibasti, urobasti, etc.

2. Dravya bheda: -

It is of two types

a) Nirooha basti (Evacuative or Un-unctuous Enema): -

The propornity of kwath is more, and it is the main ingredient among other

four common ingredients I.e.makshika, lavana, sneha and kalka. Nirooha basti

posseses varied therapeutic effects like shodhana; it makes the apakarshana of vit,

sleshma, pitta and anila. It restores the dridata, bala Varna, shukra and it prevents the

aging process; 52, it is named as asthapana basti, as it acts like a vaya and ayusthapaka.

Bastikarma


36

Madhutailika basti is the vikalpa of Nirooha; the synonyms of madhutailika vasti are

sidda basti, yapana basti and yuktarata basti.53

The effect of nirooha will spread all over the body; the potency of drug

reaches at the cellular cellular level thus it helps in eliminating the vitiated doshas

from all the srotases54,55.

ii) Anuvasana basti (Unctuous Enema): -

It is Sneha pradhana vasti hence auvasana is named as sneha basti. “Anuvasan api na

dushyatyanudivasam va deeyata ityanuvasana:” the peculiarity of this basti is no

adverse effects, it is safe, can be practice daily.56

Types

Based on the sneha matra it is of three types57

1) Sneha Basti: - 6 Pala (298ml)i.e.1/4th of the quantity of Nirooha.

2) Anuvasana Basti: - 3 Pala (144ml) i.e. half of the Sneha Basti.

3) Matra Basti: - 1½ Pala (72ml) and this is the minimum quantity of Sneha Basti

MATRA BASTI

Definition:

“Hrisvaya: sneha matraya: matrabasti: samo bhaveth” It is a type of Sneha Basti.

The Sneha matra is very less as compared to the Sneha Basti so it is named as matra basti,

56, 57, and .58

Indication:

Bastikarma


37

Ashtanga Samgrahakara emphasized on regular administration of the Matra Basti

and it can be administered at all times and in all seasons just as Madhutailika Basti,

vaitarana basti.

Table.No-1

Sr. Indications Ch. A.H. A.S.

1) Karma karshita + - -

2) Bhara karshita + + +

3) Adhva karshita + + +

4) Vyayama karshita + + +

5) Yana karshita + - +

6) Stri karshita + + +

7) Durbala + + +

8) Vata Rogi + + +

9) Bala - + +

10) Vriddha - + +

11) Chintatur - + +

12) Stri - - +

13) Nripa - + +

Sr. Indications Ch. A.H. A.S.

14) Sukumar - - +

15) Alpagni - + +

16) Sukhatma - + -

Contraindication:

Bastikarma


38

In classics, there are no major contraindications mentioned for matra Basti, but

Ashtanga Sangrahakara has stated that Matra Basti should not be administered in Ajirna

condition.

Qualities: The Matra Basti is promotive of strength, helps in easy elimination of Mala

and Mutra. Brimhana nature this basti helps in pacifying the Vata dosha.

Dose:

According to Vagbhata the dose of Hrsva Snehapana is recommended for matra

Basti. The matra which gets digeste in two Yama (i.e. 6 hours) is called as Hrsva matra.

Sushruta has explained the dose as ½ of the dose of Anuvasana Basti and according to

him the dose of Anuvasana Basti is ½ of the dose of Sneha Basti Hence, the does of

Matra Basti is 1½ Pala = 6 Tola = 72ml61.

According to Chakrapani the dose of Sneha Basti is 6 Pala, dose of Anuvasana

Basti is 3 Pala and of Matra basti is 1½ Pala47 (Ch. Si. 4/54).

On the basis of above references, it is clear that the dose of Matra Basti is 1½ Pala i.e.

6 Tola = 72ml.

3. Karma bheda: -

This classification is made baased on their action62, 63

a) Shodhana basti – Contains shodhana dravyas and removes dosha

and malas from the body.

b) Lekhana basti – Reduces medodhatu and produces lekhana in the body.

c) Sneha basti – Contains more of sneha and produces snehana

Bastikarma


39

in the body.

d) Brumhana basti – Increases the rasadi dhathus and indirectly it

helps in nurishing the body.

e) Utkleshana basti – Causes utklesha of malas and doshas by

increasing its Pramana.

f) Doshahara basti – Purificatory or eliminating type.

g) Shamana basti – Produces shamana of doshas.

Sharangadhara added, shodhana basti, lekhana, brimhana, deepana and

pachana types of bastis.64 Vataghna basti, balavarnakrita basti, snehaneeya basti,

sukrakrit basti, krimighna basti, vrushatvakrit basti has been explained by Charaka.65

4. Sankhya bheda: -

Charaka has made this classification based on the number of snehabastis

and niroohabastis in a treatment. That is totle 8 basti in yaga basti, 16 in kala basti and 30

in karma basti.66

5. Matra bheda: -

The quantity may vary from person to person and it depends on

rogi bala, roga bala and vaya of the patient.

a) Dvadashaprasruta basti – In nirooha, the maximum dose or quantity of

bastidravya prescribed is dvadashaprasruta i.e. 24

palas.67

b) Prasritayogika basti – Charaka has prescribed various types of

nirooha in different doses considering the strength

of the patient and condition of the disease.68

c) Padaheena basti – matra of this basti is 9 prasruthi.69

6. Anushangika bheda: -

Bastikarma


40

a) Yapana basti – Enhances bala, shukra and mamsa. In treating

the vyapats produced by excessive coitus. It can

be practice daily.70

b) Siddha basti – It increases the bala, varna, and prasanata.71

c) Yuktaratha basti – Mainly indicated for travelers on vehicles etc.72

d) Vaitharana basti –It is mainly concentrating on the elimination of

doshas.73

e) Ksheera basti – Explained for shoolam, vitsangam, anaha, and

mootrakrichra.74

f) Ardhamatrika nirooha basti –snehana and swedana karmas are not

required. Mainly it is indicated in

rajayakhsma, shoola, krimi and in vatarakta.

It improves sukrha and ojus.75

g) Picha basti – It is given with pichhila dravyas like

Shalmaliniryasa and lajjalu. It is indicated in

pichhalasrava and jeevashonita. It is acts as

Sangrahi.76

h) Mutra basti – It is Gomutra pradhana basti it is mridu in

nature, safe and pacifies the doshas.77

i) Rakta basti – it is indicated in adhika rakta srava.78

Drugs used in Basti Karma: -

Number of drugs belonging to animal and plant origin has been

described in the classics, which are used in bastikarma. For example, herbs, milk,

mutton juice, eggs, urine, alkalis, salts etc. The above lists suggest that almost all

available drugs can be used for bastikarma.80

1. Phalini drugs - Drugs useful for emesis can be used in

asthapanabasti. e.g: -phala, jeemutaka,

ikshwaku, dhamargava, kutaja, and

kritavedhana.

2. Sneha dravyas - Ghrita, taila, vasa, majja.

Bastikarma


41

3. Mutravarga dravyas - Aja, avi, go, mahisha, hasti, ushtra, haya, etc.

4. Asthapana & anuvasana gana - Dasamoola, bala, eranda, punarnava, yava,

kola, kulatha, guduchi, madanaphala, palasa

etc.

5. Adjuants for asthapanabasti - Trivrit, bilwa, pippali, kushta, sarshapa, vacha,

kutaja, satahwa, yashtimadhu, madanaphala.

6. Adjuants for anuvasanabasti - Rasna, devadaru, bilwa, madanaphala, satahwa,

swetapunarnava,raktapunarnava,gokshura,

agnimandha, syonaka.

Contents of niroohabasti82, 83, 84

The usual contents of nirooha basti are: -

1.Makshika (honey)

2.Lavana (rock salt)

3.Sneha (oil/ghee/taila)

4.Kalka (medicines made as paste)

5.Kwatha (decoction)

According to the condition of patient and disease other ingredients like

milk, mamsarasa, amla dravya, mutra and guda are also used.85 Taila is selected

considering the disease and condition of patient. Drugs for kalka, if no drug is

specifically mentioned shatapushpi choorna can be used.86 Kwatha is the decoction made

as per the ingredients selected rationally to suit the condition of the patient.

Contents and quantity of nirooha basti

The quantity of nirooha is 12 prasrita, out of this 5 prasrita kwatha i.e. 10

palas. The sneha should be 1/6th, 1/4th and 1/8th i.e. 4 pala, 6 pala, 8 pala in pitta, vata and

Bastikarma

kapha dosha respectively.87 in nirooha. 24 palas of nirooha dose may be adjusted as

follows:

1.Makshika – 4 palas.

2.Lavana – 1 karsha

3.Sneha – 4 palas.

4.Kalka – 2 palas.

5.Kwatha – 10 palas.

20 palas.

The remaining portion should be made up by avapa dravyas (or

prakshepaka dravyas) like gomutra, mamsarasa etc. i.e. 4 palas totals it to 24 palas.

According to Sushrutha88

1.Makshika – 4 palas.

2.Lavana – 1 karsha.

3.Sneha – 6 palas.

4.kalka – 2 palas.

5.Kwatha – 8 palas.

6.Avapadravya – 4 palas

Total quantity is 24 palas.

MADHUTALIKA BASTI

Nirukti: -

This unique basti contains madha and taila in equal proportionate hence this basti is

named as madhutailika basti89.

Paryaya: -90

Yapana basti

Yuktarata basti


42

Bastikarma


43

Doshahara basti

Siddha basti

Types of madhutailika basti

All the Acharyas have been explained, different types of madhutailika basti’s with

different ingredients, those are as follows: -

According to sushruta: -91

Table No-2

S.no Ingredients Dose

1 Madhu 1-karsha

2 Saindhava 1-tola

3 Taila 1-karsha

4 Shatapushpi choorna 1-tola

5 Erandamoola kwatha 1-karsha

Importance of madhutalika vasti.92

This basti can be practice even in female, sukumaras, etc

Dosha niraharanartha, bala, varnartha, it can be continuously given with ought any

marked complications, easy administration,

Bastikarma


44

Dashamoola madhutailika basti: -93

Vagbhata explains it in Astanga samgraha and in Astanga hridaya. The key ingredients are as follows: - Each 1 pala of Panchamoola and Gokshura,

Ksheera 1 adaka

Yastimadhu 1 prastha

Madhu, Taila, Seedhu, Sareeva, Bala, Sahachara, Darbha, etc

It is very mild and it is indicated in bala, sukumara, vrudda, and in female without

complication.

Vangasena also explained madhutailika basti and he mentioned its properties they are as

follows: -

Ingredients: - Madhu 1 Prakuncha

Taila 1 Prakincha

Eranda kashaya 6 Prakuncha

Saidhava 1 karsha

Shatapushpi ½ Phala

Madhutailika ksheera basti 94

It is explained by sangrahakara, considered as ksheerabasti. It is mainly indicated

in sukumara, sthree and mrudu persons.

Content of this basti are: - ksheera, guduchi, brihateedvaya and magadi (pippali)

Yastimadhu is used as kalka.

Bastikarma


45

Basti Yantra

The device used for basti karma is called as bastiyantra. It comprises by two parts –

1.Bastinetra

2.Bastiputaka

Bastinetra

The netra should be made of gold, silver, and copper or with other higher metals,

alloys, long bones, bamboo, wood etc. Generally netra must resemble like tail of cow

with a tapering end and a wider base, or like pyramid shape with round ends and smooth

surfaces.95 the dimensions are different for different age group.

Bastikarma


46

Table No: - 3

Measurements of Bastiyantra.96, 97,98.

Lumen of netra No. Age

in

years

Length

in

Angula

Diameter of narrow

end

Diameter of broad end

1. < 1 5 1 angula

2. 1 - 6 6 Size of green gram 1 angula

3. 7- 11 7 Size of black gram 1½ angula

4. 12-15 8 Size of kalayam 2 angula

5. 16- 20 9 Size of wet kalaya 2½ angula

6. > 20 12 Karkandhu 3 angula

Uttarabastiyantra

7. - 12 – 14 Sarshapa size -

Susrutha’s opinion

8. 1 6 Green gram Feather of kanku bird must pass

through.

9. 8 8 Black gram Feather of eagle must pass through.

10. 16 10 Kalayam Feather of peacock must through.

11 >25 21 Kolasthi Feather of vulture must pass

through.

Pramana of vranabasti netra

The hole should be of a mudga pramana, with 8 angulas of length.99

Karnika

In order to prevent undue penetration of the bastinetra deep in to the

rectum, a karnika or rim has to be made. It is to be placed at a required point above the

Bastikarma


47

distal end. Two karnikas are provided on the netra at distance of 2 angulas between one,

another at proximal end to tie the bastiputaka properly.100

Bastiputaka

The container of the bastidravya is known as bastiputaka. And it

should be made suitable for well fitting with the bastinetra and should not have any

bad smell. If good bladder is not available oter materials like skin of lower limb or

neck of monkeys or other animals; thick cloth with sufficient strength and size are

recommended for the purpose101

As the technology advances the development various types of

materials are available to make up of bastiputaka and even disposable bastinetra are

available. The rubber bladder and polythene bags are best choice these materials are

disposable, safe and easy to perform.

Table No: -4

Netradosha and putakadosha102,103

No. Netradosha Features Effect

1. Hraswata Too short Dravya will not reach pakwasaya

2. Deerghata Too long Dravya go beyond the pakwasaya

3. Tanuta Too thin Produces kshobha

4. Sthoolata Too big Produces lakshana

5. Jeernata Old dhatu used Injury to guda

6 Shithilabandhana Not fixed properly to the

putaka

Dravya comes out

7. Parshwachhidra Hole on side Leakage of dravya happens

8. Vakrata Curved / irregular Dravyagati becomes irregular

9. Assannakarnika Karnika too near Karma becomes of no use

Bastikarma


48

10. Prakrustakarnika Karnika too far Causes raktasrava by gudamarma

peedana

11. Anusrotata Small hole Cannot perform properly

12. Mahasrotrata Broad hole Cannot perform properly

No. Putakadosha Features Effect

1. Vishama Shape not in uniform Gati vishamata happens during

pressing

2. Mamsala Muscular tissue present Produces offensive small

3. Chinnachidrayukta Presence of hole Dravya comes out

4. Sthoola Thick one Does not push dravya

5. Jalayukta Anastamosis present Produces leakage

6. Vatala Excess air space Frothy type of dravya

7. Snigdha Unctuous Slip form the hand

8. Klinnata Wet Difficult to pass through

Indications and contra-indications of Bastikarma

As basti is one of the prime treatment modality of Ayurveda,

the knowledge of the indication and contraindication will make the sucsess in the

treatment.

A brief description has been made here.

Table No: -5

Ayogya / anasthapya104,105,106

Bastikarma

f “Evaluation oeffica hutailika sti cy of Mad ba In the mana adhum a”gement of M eh

49

No. Type of patient Cha. Su. Vag. Complication

1. Ajeerna + + -

2. Atisnigdha + - +

3. Peetasneha + - -

Dooshyodara, Moorchha, Shotha.

4. Utklishtadosha + - -

5. Alpagni + + +

Teevra aruchi

6. Yanaklanta + - -

7. Atidurbala + + -

8. Kshudhaarta + - -

9. Trishnaarta + + -

10. Sharmaarta + - -

Shaeerashosha, pranaparodha,

Kruchraswasa

11. Atikrisha + + +

12. Bhuktabhakta + - +

13. Pitodaka + - -

More karshya, utklesha of dosha

happens

14. Vamita + - +

15. Virikta + - +

More rookshata happens

16. Krita nasyakarma + - + Manovibhrama, Srotonirodha

17. Krudha + - -

18. Bheeta + - -

Bastidravya moves up

19. Matha + + -

20. Moorchita + + -

Samnjanasha and Hrudayopaghata

21. Prasaktachhardi + + +

22. Prasaktanishteeva + - +

23. Swasaprasakta + + +

24. Kasaprasakta + + +

25. Hikkaprasakta + - +

Bastidravya moves up because of the

existing urdhwagati of vata

26. Baddhagudodara + - +

27. Chhidrodara + - +

28. Dakodara + - +

29. Adhmana + - +

Leads to death by causing severe

distension of abdomen

30. Alasaka + - -

31. Visoochika + - -

32. Asmadosha + - -

33. Amatisara + - +

Causes teevra amavastha of the body

34. Madhumeha,

Prameha

+ + + Vyadhi vardhakam

35. Kushta + + +

Bastikarma


50

Table No: -6

yogya /asthapya107,108,109

No. Indication Ch. Su. Vag. No. Indication Ch. Su. Vag.

1. Sarvangaroga + + - 37. Rajakshaya + + +

2. Ekangaroga + + - 38. Vishamagni + - -

3. Kukshiroga + - - 39. Spikshoola + - -

4. Vatasanga + + + 40. Janushoola + - -

5. Mutrasanga + + + 41. Janghashoola + - -

6. Malasanga + + + 42. Urushoola + - -

7. Shukrasanga + - + 43. Gulphashoola + - -

8. Balakshaya + - - 44. Parshnishoola + - -

9. Mamsakshaya + - - 45. Prapadashoola + - -

10. Doshakshaya + - - 46. Yonishoola + + -

11. Shukrakshaya + + - 47. Bahushoola + - -

12. Aadhmana + + + 48. Angulishoola + - -

13. Angasupti + - - 49. Sthanashoola + - -

14. Krimikoshta + - - 50. Dantashoola + - -

15. Udavarta + + - 51. Nakhashoola + - -

16. Sudhatisara + + + 52. Parvasthishoola + - -

17. Parvabheda + - - 53. Shopha + - -

18. Abhitapa + - - 54. Sthmaba + - -

19. Pleehadosha + - + 55. Aantrakoojana + - -

20. Gulma + + + 56. Parikartika + - -

21. Shoola + + + 57. Maharogoktavatavyadhi + - +

Bastikarma


51

22. Hridroga + - - 58. Jwara - + +

23. Bhagandara + - - 59. Timira + + -

24. Unmad + - - 60. Pratishaya - + -

25. Jwara + - + 61. Adhimantha - + -

26. Bradhna + + + 62. Ardita + + -

27. Shirashoola + + + 63. Pakshaghata + + -

28. Karnaroga + - - 64. Ashmari - + -

29. Hritshoola + - - 65. Upadamsha - + -

30. Parshwashoola + - - 66. Vatarakta - + -

31. Prushtashoola + - - 67. Arshas - + -

32. Katishoola + - - 68. Stanyakshaya - + -

33. Vepana + - - 69. Manyagraha + + -

34. Aakshepa + + - 70. Hanugraha + + -

35. Angagaurava + - - 71. Ashmari - + +

36. Atilaghava + - - 72. Moodhagarbha - + +

Indications for anuvasana basti 110,111,112

Anuvasana is indicated in patients who are already indicated

for asthapana, but special mention has been given to certain conditions like rooksha,

kevala vataroga and atyagni where anuvasana is more beneficial.

Bastikarma


52

Table No: -7

Persons unfit for the anuvasana basti 113,114

No. Contraindications Ch. Su. Vag. Complications

1. Anasthapya + + +

2. Abhuktabhakta + - + Sneha moves upwards

3. Navajwara + - -

4. Kamala + - +

5. Prameha + - +

Leads to udara

6. Arshas + - - Leads to aadhmana

7. Pratishyaya + - -

8. Pandu + + +

9. Arochaka + - - Leads to more annabhilasha

10. Mandagni + - -

11. Durbala + - -

Increases the condition

12. Pleehodara + + +

13. Kaphodara + + +

Leads to more dosha vardhana

14. Oorustambha + - +

15. Garapeeta + - +

16. Kaphabhishyanda + - +

17. Gurukoshta + - +

18. Shleepada + - +

19. Galaganda + - +

20. Apachi + - +

21. Krimikoshta + - +

22. Prameha - + +

Bastikarma


53

23. Kushta - + +

24. Sthaulya - + +

25. Peenasa - - +

26. Krushna - - +

27. Varchobheda + - +

28. Vishapeeta + - +

Preparation and procedures of bastikarma

The preparation and procedures made before, during and after

administration of nirooha, anuvasana, uttarabasti with little differences. Generally, these

procedures are classified into three parts: -

1.Poorvakarma (pre-operative)

2.Pradhanakarma (operative)

3.Paschatkarma (post-operative)

in classics many complications are mentined that are produced due to

improper and in efficient administration. Better practical experience is necessary to

prevent the possible complications.

Selected patients for basti therapy have to undergo through clinical

examinations to ascertain the physical as well as the mental conditions. Usually the

following ten factors are to be considered for clinical examination.115

1.Dosha 2.Oushada 3.Desa 4.Kala 5.Satmya

6.Agni 7.Satwa 8.Vaya 9.Bala

This will enable the physician to decide, the type of basti, number of

bastis, basti dravya, etc to be administered in the particular patient.

Bastikarma


54

Dose schedule116,117,118

Table No: - 8

The adult dose of nirooha basti is dvadashaprasrita i.e. 24 palas.

Dose No. Age in

Years Ch. Vag. Su.

1. 1 ½ prasrita

i.e. 1 pala

1 pala 2 anjalis of patients hand

2. 2 2 pala 2 pala

3. 3 3 pala 3 pala

4. 4 4 pala 4 pala

5. 5 5 pala 5 pala

6. 6 6 pala 6 pala

7. 7 7 pala 7 pala

8. 8 8 pala 8 pala 4 anjalis of patients hand

9. 9 9 pala 9 pala

10. 10 10 pala 10 pala 8 anjalis of patients hand

11. 11 11 pala 11 pala

12. 12 12 pala 12 pala

13. 13 14 pala 14 pala

14. 14 16 pala 16 pala

15. 15 18 pala 18 pala

16. 16 20 pala 20 pala

17. 17 22 pala 22 pala

18. 18 – 70 24 pala 24 pala

19. Above 70 20 pala 20 pala

To be fixed based on netra,

dravya pramana, age, bala

and saralaswabhava

20. Above 25 12 prastha

Bastikarma


55

PROCEDURE OF BASTIKARMA: -

Anuvasanabasti

Pre-operative procedure

The patient should pass is natural urges then body of the patient should be

anointed with suitable sneha and mrudu sweda with hot water. He is advised to have his

prescribed meal it is madyama matra and made to take a short walk. Patient is asked to lie

over basti droni which is not very high, and the head must be at lower level. The patient

should be on his left side drawing up the right leg and straightening the left leg.

Operative procedure

The prescribed amount of taila should be taken in the bastiputaka and tied

well placing the bastinetra in position. Air is trapped from bastiyantra by gently pressing

the bastiputaka. Then the anal region and the netra should be smeared with oil to

minimize the pain and irritation. Gently probe the anal orifice with the index finger of the

left hand and introduce the bastinetra through it into the rectum up to the mark of first

karnika. Keeping in the same position press the bastiputaka by putting the adequate force

then withdraw from the sight.

Post-treatment procedures

The patient is kept in same position as long as it would take to count up to

hundred. The patient should be gently struck three times on each of the soles and over the

buttocks. The distal part of the cot should be raised thrice. Allow him to lie for sometime

in the same position, if given sneha passed immediately; another anuvasanabasti should

Bastikarma


56

be adopted. After passing the motion with sneha in proper time the patient is allowed to

take light food if he feels hungry. 9 hours is the maximum time for basti pratyagamana.

Niroohabasti

Pre-treatment procedure Sutable time to administer Niroohabasti is Madhyahne

kinchidavrute i.e is in noon, with an empty stomach. Abhyanga and swedana

should be done prior to the procedure and the patient is advised to be lie upon the

cot as in anuvasanabasti. Bastidravya prepared as per the direction should be taken

in bastiyantra and introduced; other procedures are as same in anuvasana basti.

Post-treatment procedures

After the pradhana karma patient is lie in supine position pillow should be

plced below the vankshana pradesha. The other procedures followed in anuvasana should

not be done in this codition. After passing motion he may be advised to take bath with hot

water and have normal food along with yusha, mamsarasa or milk in kapha, vata and pitta

predominant diseases respectively. The maximum time for bsati pratyagamana is one

muhurtha (48 minutes). If it did not pass out, giving basti, which consists of sneha,

kshara, mutra, amla dravyas and Phalavarti, can bring it out. It should have the properties

like snigdha, Ushna, and teekshna. If the nirooha is passed out instantly again 2 or 3

bastis can be given. But if the patient shows excited symptoms of vata, snehabasti should

be given immediately. As jataragni is not much hampered; so specific regimen is not

necessary during the pariharakala.119

Bastikarma


57

Complications of basti Generally basti vyapatas are classified under two catogaries:-

1) vaidya kruta 2) bastikruta

complications of Snehabasti 120

Six types of complications may occure due to the following factors

1. Vata, 2.Pitta, 3.Kapha, 4.Atibhukta, 5.Pureesha, 6.Abhukta Specific signs and symptoms with treatments are not mentioned

Basti vyapats:-121

Twelve bastikruta vyapats are explained in classics those are as follows:-

1. Ayoga: -

If administred less quantity of basti dravya, saidhava, add oil leads to

heaviness in abdomen, obstruction of flatus stool and urine, local burninsensation,

inflammation, itching, anorexia and dyspepsia.

2. Atiyog: -

Administration of teekshna basti in mridu koshta person leads to atiyoga and

symptoms are similar as in vamana-virechana atiyoga.

3. Klama: -

Conduction of mridu basti in ama avastha, pitta and kapha gets vitiated and

srotorodha; leads to dyspepsia. There after vata also become vitiated and causes

fatigue, syncope, burning sensation, colic, chest pain, heaviness.

Bastikarma


58

4) Adhmana: -

Due to administration of alpa veerya drugs to strong person, rooksha

person and costive bowel, the drugs not able to expel vitiated doshas and vata gets

vitiated leads to adhmana causing pain in basti and hridaya, severe burning sensation,

pain in testicles and groin.

5. Hikka:-

Hiccup results in administering teekshna basti to weak person and mrid

koshta with excessive expulsion of doshas.

6. Hritprapti:-

Bastidravya reaches the heart by entering into deeper levels due to

complete squeezing or improper handling of bastiputaka and causes

pain in chest andthe surroundings.

7. Urdhwagamana:-

Suppression of urges before or after bastikarma and squeezing bastiputaka with

high pressure leads to the upward movement and may come out through mouth.

8. Pravahika:-

Administration of less potent and insufficient quantity of bastidravya to the

person

suffering form intensive vitiated doshas leads to pravahika.

9. Shiroarti:-

Includes symptoms of headache, earache, deafness, tinnitus and coryza,

eye

disordersdue to administration of less potent sheetaveerya dravyas with

insufficient quantity toweak persons.

Bastikarma


59

10. Angarti:-

Administration of teekshna basti without conducting pre-operative procedures like

abhyanga and sweda leads to angarti with upward movement of vata and twisting and

pricking pain in the body.

11. Parikartika:-

Administration of ruksha and teekshna basti in excessive quantity to the person

having mridukoshta and in conduction of less vitiated doshas leads to the excessive

expulsion of doshas causing parikartika.

12. Parisrava:-

Administration of teekshna and ushna bastis to the person suffering from pitta

roga / raktapitta leads to parisrava and causes burning sensation, erosion and

Cutting pain in anal region, severe bleeding and fainting.

Defects of physician 122

1.Sa vata bastidana – Entry of an air into rectum leads to pain in

abdomen and colic.

2.Druta praneeta – Quick administration of basti dravya leads to pain

in hip, anus, thigh, calves and retention of urine.

3.Tiryak praneeta – Horizontal introduction leads to blockage at the

tip of bastinetra. Introduction of bastidravya by

pressing basti putaka more than once leads to chat

pains, headache, and pain in thighs.

4.Ullipta – Introduction of bastidravya by pressing

bastiputaka more than once leads to chat pains,

headache, and pain in thighs.

Bastikarma


60

5.Sakampa bastidana – Shivering while administration leads to erosion,

burning and swelling at anal region. Not deeply

introduced leads to burning pain in intestines.

6.Apraneeta – Not deeply introduced leads to burning pain in

intestines.

7.Atimanda data – If done too slowly drug does not reach till

intestines.

8.Ativega data – Forceful introduction leads to the dravya reaching

up to koshta and sometimes may come out through

upper orifices.

Basti Karmukata.

Bastikarma having mulitidimentional therapeutic effects as early mentioned

for better understanding it can be studied under the following headings.

The procedural effect

The rationality behind the left lateral position is the gud

valees becomes relaxed there by it helps in the administration of basti. Pakwashaya

resides in the given left side so the given basti dravya reaches the pakwasaya, as it

is the main seat of vata; hence the given drugs will counter act the vatadosha. He

also mentions that the grahani is situated in the left side. Chakrapani states that

Agni will be in the natural state in the posture while Gangadhara says; Agni,

grahani and nabhi are present in the left side. Jejjata comments Agni is present left

side over the nabhi, guda has got a left sided relation with sthoolantra. So

bastidravya can reach to the large intestine and grahani, as they are present in the

sequence.

Action based on drug effect

Action of bastidravya is due to its Anupravanabhava, which

contains sneha along with other dravyas like makshika, saidhavaSneha easily moves

up to grahani by anupravanabhava guna similar to that of dravya, which freely

Bastikarma


61

moves in the utensil. Charaka says bastidravya reach nabhi, katipradesha and

kukshi.

The Shodhana effect

The action of basti is mainly depends on its veerya. The drug

used in the basti karma will however spread in the body from pakwasaya due to

their veerya; through the appropriate channels and draws the vitiated doshas to

pakwashaya. It is like sun in the sky draws the water from earth. The veerya is

drawn into the body by vata dosha i.e. first by apana, then udana and throughout the

body by vyana. In charaka siddi he gives a simily like water sprinkled at the root of

tree circulates all over the tree and nourishes the body by its own specific property.

In the same way bastikarma eliminates the morbid doshas and dooshyas from all the

parts of the body.

Probable Mode of Action

Practically we can see that after appropriate administration of

bastikarma the signs and symptoms of vatavyadhi will be reduced.

Bastidravya enters into the pakwasaya, where the water and

minerals are absorbed in proximal colon. Sodium and potassium which are essential

fundamental factors of the body, it is prove that bioavilability of a drug is more in

rectal rout. The basti dravyas gets absorbed by intestinal microflora; their by it

maintains the electrolyte ballence in the body. It enhances the biodegradablity of the

drugs and it increases the absorption of colon. The pakwashaya contains the

maximum number of nerve plexuses originating from the hypo gastric plexus and

lumbosacral plexus etc. and spreads all over the body. The given drug gets star

absorbing in intestinal flora, through heammoroidle vein potency of drug enters in

to the systemic circulation. Bastidravya prepared by madhu, lavana, sneha etc helps

in formation of healthy bacteria in large intestine, it is essential for the absorption

and nourishment at cellular level.

Bastikarma


62

Another probable method is based on veerya. It is possible

the veerya of the bastidravya pass through the autonomic nervous system and

expels out vitiated dosha from the body, as we see in the pressure receptors. When

bastinetra is introduced in the rectum the same phenomenon may take place, which

results in initiation of defecation reflex due to visceral distention and pressure

response.

Saindhava contains NaCl and it is integral part of the body. It

is having properties like srotosravaka, srotoshodhaka, etc these are necessary in

generating the action potential, it maintaince the osmotic pressure. The release of

catecholamines during visceral distention initiates the pressure response and

ultimately helping in defecation. When hypertonic solution is given in the form of

bastidravya, it circulates from blood vessels to the outer fluid.

Absorption of bastidravya 60%-80% of water absorbed from the

gut, Absorption in the proximal colon is better than the distal part as a result this

rout substitute’s oral rout.

Madhumeha

Madhumeha

Charaka explained Madhumeha under “Prameha” in Sutrasthana 17th, Nidanasthana 4th

and Chikitsa 6th chapter. Sushruta Acharya also explained madhumeha in Nidana 6th

chikitsa 11-12th and 13th chapter. In Chikitsasthana Sushruta has dedicated an exclusive

chapter for madhumeha itself. Even Vagbhata also explained madhumeha in Nidana

stana and chikitsa stana.

Majority of the descriptions are available in the context of Prameha, such as

Nitukti samanya Nidana. Samanya samprati suits madhumeha and has it is one among 20

types of Pramehas and all the Pramehas in due course, if neglected or not treated attain

the stage of Madhumeha. Considering all the above points, the description of Prameha

will also be made along with Madhumeha. Diabetes mellitus has a nearest clinical entity

of a Madhumeha so a very brief description of diabetes mellitus will be made in this

particular study.

Nirukti (Etymology): -

Madhumeha is composed by two words madhu and meha. It is a masculine gender

formed by “Mihtghy”

The word Madhu is derived from the root ‘Mana’ and the meaning as

“manaava bhodane” i.e., which gives the psychic contentment (vachaspathyam); it

refers to the meaning Honey, Kshoudra, Madya, Pushparasa, Jala, and Madhurasa etc.

MEHA: - The word ‘Meha’ is derived from the “Miha” Dhatu124, which is employed in

the sence of Sinchana, Ksharana and Prasrava (excessive excretion), making

water and as a prameha RogaBheda (Vachaspathyam).

“Mehati ksharathi shukratiranena iti.”

“Evaluatio In the management of Madhumeha”

64

Madhumeha Prameha: - It is also a masculine gender formed by “Pra + miha”.

In Shbadha kalpadruma, Meha or Prameha is defined as follows.

“Prakarshena mehati ksharthi. Iti veerydiranaenaiti prameha.”

The literary meaning of Prameha is to micthurate, the verbal noun Mehanam

Signifies urination as well as acts of passes any morbid urethral secretion. Hence the

disease is named, as madhumeha ‘Meha’ is Synonym of Mutra dosha by Raja Nighantu

and bahumutrata by Hemachandra.

Paribhasha (Definition)

Madhumeha is a disease in which mutra of the patient attains similar property like

madhura (honey). The patient passes the urine like madhu, which is having Kashaya,

Rooksha Guna along with the Prabhoota Avila mutrata.125

Acharya Charaka has given a definition of madhmeha as the disease in which one

passes urine as astringent, sweet and rough (Cha.Ni). Sushruta used the word Kshoudra

meha as synonym for madhumeha and he defined it as the urine of patient resemble like

honey and acquires a sweet taste.

According to Vagbhata in any types of Prameha not only urine the whole body also

becomes sweet; it is to be named as madhumeha.126

Definition of diabetes mellitus

The term diabetes mellitus described as a metabolic disorder of multiple

etiology characterized by chronic hyperglycemia with disturbances of carbohydrate,

fat and protein metabolism resulting from defects in insulin secretion insulin action

or both. Although hyperglycemia is most outstanding of its biochemical measures,

diabetes means to be a pan metabolic disorder. It is generally accepted that all the

derangements result from either absolute or relative deficiency of insulin in

association with almost reciprocal changes in the activity of glucagons.127


65

Madhumeha Natural history of type 2 diabetes

Diabetes mellitus refers to a range of conditions that are all characterized by elevation of

the blood glucose level. It may be roughly divided into two principal varieties, type I and

type II, with different etiologies. Type I diabetes presents in childhood as an autoimmune

attack on the pancreatic ß-cells that result in their complete destruction: consequently, the

patient must take insulin for the rest of their life.128 It accounts for <10% of all diabetes

and will not be considered further here. Impaired glucose tolerance, which precedes

diabetes and is a risk factor for the disease, currently, affects a further 200 million

worldwide. Until recent years, type II diabetes was rarely observed in individuals under

the age of 50, but increasing numbers of children are now being diagnosed with the

disease.129 this probably reflects the growing prevalence of childhood obesity, as type 2

diabetes is exacerbated by obesity and a sedentary lifestyle.

Diabetes leads to a reduced life expectancy and quality of life, and a greater risk

of heart disease, stroke, peripheral neuropathy, renal disease, blindness and amputation.130

The direct health care costs of the disease are also considerable, and have been estimated

at around 5% of the total annual expenditure on health in Western societies. Both insulin

secretion and insulin action are impaired in type-2 diabetes (reviewed in. Their relative

importance has been hotly debated, but it is now recognized that ß-cell dysfunction is a

key element in the development of the disease.131 Abnormalities in insulin secretion

precede the onset of type-2 diabetes and may be present even when subjects show normal

glucose tolerance. By the time of diagnosis, insulin secretion is significantly reduced and

it continues to diminish inexorably throughout the course of the disease.132 Type 2


66

Madhumeha diabetes can also occur in the absence of insulin resistance and, conversely, some severe

forms of insulin resistance (such as those caused by mutations in the insulin receptor) may

not be accompanied by diabetes. It now appears that insulin resistance only leads to

diabetes if combined with a genetically determined propensity to ß-cell dysfunction.133 in

these individuals, however, insulin resistance plays an important role in the development

of diabetes by placing an increased demand upon the ß-cell that it is unable to match.

Theoretically, the insulin secretary defect could result from either a failure of ß-

cell function or a reduction in ß-cell mass (due to increased apoptosis or reduced ß-cell

replication). Most quantitative estimates of ß-cell density in post-mortem tissue indicate

that type-2 diabetics have either no change or <30% reduction in ß-cell mass, 134 that is

independent of the duration of the disease. A substantial reduction in ß-cell mass is only

found in association with amyloidosis, which occurs at later stages of the disease. In

baboons, a decrease in ß-cell mass of >50% is require to cause diabetes and

hyperglycemia does not occur in type-1 diabetics as long as ß-cell mass remains above

30–50%.135 It therefore seems that the insulin secretary defect in type 2 diabetes does not

result primarily from insufficient ß-cell mass but rather from impaired insulin secretion.


67

Madhumeha Paryaya (Synonym): -

Acharya Charaka and Sushruta used the term madhumeha, kshoudrameha in place of

madhumeha.

Some other synonyms are found in classics.

Ojomeha: -

It is enumerated as a subtype ofvataja prameha amongst the four. Acharya

Charaka has mentioned that the vitiated vata changes sweet taste of oja into kashaya

resulting in ojomeha (cha.si.6/17)

Pushpameha: -

In Anjana, Nidana the word paushpameha has been narrated paushpa rasa denotes

madhu. Above all synonyms postulated unanimously that all our Acharya’s have

mentioned the urine concordant with madhu.

NIDANA

Nidana (etiological factors) means the causative factors for producing a disease.

According to this any factor, which has a tendency or capacity to produce

disease, can be considered as nidana.

The knowledge of the causative factors is very essential to assess the

sadhyasadyata and chikitsa. It has been classified under various headings with different

views. Among them one classification reads as Bahya and abhyantara hetu. Bahya hetu is

an extrinsic factor to the shareera to cause a vyadhi and it includes ahara achare, kala etc.

Abhyantara hetu is an intrinsic factor and it comprises the doshas and

doshyas.

Charaka acharya classified specifically bahya nidana in to two types’ samanya

and vishesha. Specific nidana are explained for madhumeha. Samanya nidanas of


68

Madhumeha pramehas and vataja prameha nidana are attributed to madhumeha, as madhumeha is one

of the vataja prameha.

For all types of pramehas Kapha dosha is the key factor and it can be established

by gangadhara’s version. According to him Gulma is caused by vayu, raktapitta by pitta

and madhumeha caused invariably due to the vitition of kapha dosha. Especially in

madhumeha kaph is the arambhaka dosha and vata is the preraka dosha to kapha.

In sthoola the madhumeha is mainly due to doshavarana which is caused by the

vitition of kapha it avarana and leads to vataprakopa. Though the kapha is arambhaka or

main dosha in the samprapti of madhumeha pitta and vata also play an important role in

complicating the disease.

Samanya Nidanas are those, which are explained in general irrespective of the

concerned. This nidanas of various pramehas are discussed below can be grouped under

two main varieties.136

Sahaja (Hereditary)

Apathyaja (Acquired)

Sahaja (Hereditary Causes): - Charaka and Sushruta have explained that bheeja dosha

is also a cause for madhumeha. Sushruta included this disease under adhibala pravritaja

category. Here the term beeja considered as shukra and shonita. If beejas are vitiated with

dosha, it is responsible for causation of prameha they will produce a jatha prameha,

further prameha has also been considered as kulaja vikara.

Apathyaja (Acquired causes): -

Again it is classified into two groups,

Samanya (General).

Vishesha (According to dosha).

This samanya nidana can again be classified into types: -

Ahara Sambandha.

Vihara Samabandha.


69

Madhumeha Table No: -9

1) AHARA SAMANDI NIDANAS137: -

SL

NO. NIDANA Caraka Sushruta Vagbhata Ma.ni Bhe.Sam Bha.Pra Y.R

1 Dadhi + - + - + + 2 Gramya, Oudaka,

Mamasa + - - + - + +

3 Anupa Mamsa + - + + + + + 4 Payaha + - + 5 Navanna pana + - - + - + + 6 Guda vikara + - + + - + + 7 Sheeta,

Snigdha,

Madhura

Madya sevena

- + + - - - -

8 Dravannapana

sevena - + - - - - -

9 Swadu, Amla, Lavana,

Snigdha, Pichhila,

Shutala ahara

- + + - - - -

10 Sura sevana - - + 11 Ikshu rasam + + + - - - - 12 Adhyasana 13 Medovardhaka

AharaAtiSeven

a

Table No: -10

2) VIHARA SAMBANDI NIDANA’S137: -

S.no. Nidana Charaka Sushruta Vagbhata

1 Asya sukham + - -

2 Swapna Sukham + - -


70

Madhumeha 3 Diva Swapnam - + -

4 Avyayamam - + -

5 Alasyam - + -

6 Chinta Tyaga

7 Swapnaprasanga + - -

8 Shayanaprasanga + - -

9 Asanaprasanga + - -

Along with these nidanas the other factors, which affect the kapha dosha, are to be

considered as madumeha nidhana. In general the above factors, which are explained in

the table, are for prameha. Still the same factors are held responsible for the causation of

madhumeha.

The above said nidhanas can be classified under apathyanimittaja and it is termed

as swakruta.

Apathya is that which is unconducive to individual constitution.

Vishesha nidana: -

Except charaka other acharyas have explained the common causative factors and

they have particularly stressed on the factors, which affects the kapha, medas and mutra.

Charaka explained nidanas specific to the doshas concerned but he too has equally voiced

on those factors, which vitiate kapha and medas.

KAPHAJA PRAMEHA NIDANA138: -

Aharaja Nidanas: -

A) Rasa – Madhura padartha atisevana

B) Guna – Drava taruna dravya atisevana

C) Dravyas –


71

Madhumeha

Dhanya’s – Hanyaka, Chanak, Uddalaka, Naishada, Mukundaka,

Mahavrihi, Pramodaka, Sugandhaka, Sarpishmati, Masha etc

Mamsa: - gramya, Oudaka, Anupa, Mamsa, Rasa

Others – Shakas, Tila, Pistanaa, Payasa, Ksheera, Vilepi kshoudra,

Mandaka, Dadhi etc.

Vihara sambandhi nidanas: -

Swapna prasanga, Shaya prasanga, Asana prasanga Vyayama vruja varjana, Anya

kapha meda mutra Vridhikara Viharas.

PITTAJA PRAMEHA NIDANA139: -

Ahara sambandhi nidana: -

a) Rasa – Amla, Lavana, Katuadhika sevena

b) Guna – Ushna kshara adhika sevena

c) Anya – Ajeerna dravyas and Vishamaharam

Vihara Sambandi Nidana’s

• Ati teekshna atapa sevena

• Agni Santapa

• Shrama

• Krodha

VATAJA PRAMEHA NIDANA140: -

Ahara Sambandi Nidana’s

• Rasa – Kashaya, Katu rasa Ati sevena


72

Madhumeha

• Guna – Rooksha laghu sheeta Ati sevena

• Anya – Anashana

Vihara Sambandhi Nidana’s

Vyavaya, ativyayama Udvega

Shodhana atiyoga Atishoka

Vega sandharana Shonita ati seka

Abhighata Ratri Jagarana

Atapa Sevana Vishama Shareera Nasyam

All the pramehas at their initial stage are due to kapha dosha and kapha is an

inevitable factor to cause prameha perhaps on these lines, at first Nidanas related to

kapha dosha is seen.

The vitiated kapha then vitiates the dhatus of similar properties like medas,

mamsa etc. If the pramehas are neglected in this stage, the improper formation of dhatus

in due course leads to dhatu kshaya.

The affected person if consumes the pitta prakopak ahara and gets indulged in the

acts, which provokes pitta, resultes in pittaja prameha’s.

The Nidanas of vata prakopaka reveal that the severe deterioration of the dhatus is

the resultant, if one indulges in the aharas or viharas, which are told in it and in due

course, madhumeha, occurs because of dhatus kshaya.

MADHUMEHA NIDANA141: -

Charak very specifically explained Nidana responsible for the manifestation of

madhumeha, which can be narrated as follows: -

• Guru Snigdha Lavana rasatmaka dravya Atisevana


73

Madhumeha

• Navanna and Pana

• Atinidra

• Asya Sukhama

• Achentya

• Avyayama

• Asamshodhana

These factors contribute to the vikriti of the Kapha, Pitta, Meda and Mamsa.

These vitited factors cause avarodha to normal vayu gati. it in carries the ojus to vasti and

resulting in madhumeha.

STHOULYA AS A NIDANARTHAKARA ROGA

According to Acharya Sushruta Apathyanimittaja prameha’s are sthoola. Sthoulya is

the nidanarthakara roga for prameha142.

In sthoulya the vayu gati gets obstructed by the baddha medas, As a result there will

be the vitiation of vayu. Which in term stimulates the samana vayu resulting; in the

aggravation of jataragni and causes increased absorption of food and the Individual

becomes Adhika bhojya vyakti (excessive eater).

ETIOLOGY OF DIABETES MELLITUS143: -

A defective or deficient insulin secretary response, which translates in to

impaired carbohydrate use, is a characteristic feature of diabetes mellitus and resulting

into hyperglycemia.

The chronic hyperglycemia of diabetes in associated with long-term damage,

dysfunction and failure of various organs like Eyes, Kidney’s, Nerves, Heart and Blood

vessels.


74

Madhumeha Genetic factors: -

Genetic factors are even more important than Types I diabetes. Among

identical twins the concordance rate is 60% to 80% in first-degree relatives with type II

diabetes the risk of developing disease is 20% to 40%.

The two main defects that characterized in type II diabetes are –

01) A derangements in the beta cell secretion of Insulin

02) A decreased response of peripheral tissues to respond to Insulin.

Obesity: - Among the initiating events, which are proposed for type II diabetes. Obesity

is an extremely important environmental factor. Approximately 80% of type II diabetes

is obese.

Age: - As the age advances the number of beta cells in pancreas, which produce insulin

gets reduced. So the risk of diabetes increases with age especially after 40 years.

Sedentary life: - People with sedentary life style are more likely to have diabetes are

compared to those who lead an active life. It is believed that exercise and physical

activity increase the effect of insulin on the cells.

Heridatory: - According the famous diabetalogist Warren and Le Compet. When both

the parents have diabetes, all the children may expect to develop the disease, if they live

long enough. When one parent has diabetes and the other is diabetic carrier, 40% of their

children may develop the disease. If a diabetic or a carrier marries an individual who

neither has diabetes nor a diabetic carrier none of the children with have diabetes.

Obesity is one of the major causative factors for diabetes mellitus as it causes

insulin resistance. In Ayurveda, sthoulya is mentioned as a Nidanarthaka roga for

prameha, and this prameha falls under the santarpanajanya vyadhis.

Madhura, Snigdhadi, Bhojana are the main Nidana’s for madhumeha, in

contemporary science it is explained that the excess eating and sedentary life style are the

predisposing factors for diabetes mellitus.


75

Madhumeha CLASSIFICATION

Knowledge of classification will helps in proper understanding of the disease and

to formulate an effective treatment protocol.

In classics various types of prameha had been described based on many factors.

Though prameha is stated to be a condition due to the vitiation of all the three doshas, the

disease is mainly divided in to 3 groups. (Ref.Cha.Chi.6/7)

Kaphaja Pramehas - 10

Pittaja Prameha - 06

Vataja Prameha - 04

Though there is a similarity in the opinion of Brihatrayes regarding the numbers

of pramehas in each group. But they seem to be different in the nomenclature used by

them.

Table No: -11

TYPES KAPHAJA PRAMEHA: -

Sl.no Names Charaka Sushruta Vagbhata Ma.Ni

1 Udaka meha + + + +

2 Ikshu meha + + + +

3 Sandra meha + + + +

4 Sandraprasada

Meha

+ Sura meha Sura meha Surameha

5 Sukla meha + Pista meha Pista meha Pistameha

6 Sikata meha + + + +

7 Sita meha + Luvana meha + +


76

Madhumeha 8 Shanair meha + + + +

9 Lala meha + Phena meha Lala meha Lala meha

10 Shukra meha + + + +

Table No: -12

TYPES OF PITTAJA PRAMEHA: -

Sl.no. Names Charaka Sushruta Vagbhata Madhava

1 Kshara meha + + + +

2 Kala meha + Amla meha + +

3 Nila meha + + + +

4 Lohit meha + Ahinitameha Rakta meha Rakta meha

5 Manjishtha meha + + + +

6 Haridra meha + + + +

Table No: -13

TYPES OF VATAJA PRAMEHA: -

Sl.no. Names Charaka Sushruta Vagbhata Madhava

1 Vasa meha + - + +

2 Majja meha + Sarpi meha + +

3 Hasti meha + + +

4 Madhu meha + Kshaudra

meha

+ +


77

Madhumeha PROGNOSTIC CLASSIFICATION: -

Prognosis is an inevitable part of Chikitsa so far as a wise physician is concerned

and unbiased prognosis is the key factor for the success of treatment.

Sadhya Yapya Asadhya

Kaphaja Pittaja Vataja

Sthoola Not much obese Krisha

Apathya nimittaja Acquired Sahaja

Early stage Acute stage Advanced stage

Without complication With complication With complication

NOTE: - According to Vagbhat Avritajanya madhumeha is Kastha Sadhya and

dhatukshayajanya as Asadhya.

Based on etiological factors: -152

a) Sahaja b) Apatya nimittaja

c) Prakritija d) Swakritaja

Based on Samprapti of madhumeha153

a) Kashayaja b) Avaranajanya

a) Dhatukshayajanya b) Doshavritajanya

Based on Chikitsa, physical status and strength.154

• Sthoola

• Krisha

• Balawan

• Durbala.


78

Madhumeha In nut shell, sahaja and Apathyanimittaja are types of madhumeha. The Krisha,

Dhatukshayajanya and Apatarpanajanya can be correlated with sahaja madhumeha.

The sthool Avaranajanya and Santarpanajanya can be correlated with

Apathyanimittaja madhumeha.

CLASSIFICATION OF DIABETES MELLITUS

The current expert committee of American diabetes association has proposed

changes to the NDOG/WHO classification scheme. The revised Etiologic classification

of diabetes mellitus is as follows155: -

I) Primary Diabetes

Type I: - Beta-cell destruction, usually leading to absolute insulin Primary deficiency.

a) Immune mediated

b) Idiopathic

II) Type II diabetes (may range from predominantly insulin resistance with relative

deficiency to a predominantly secretary defect with insulin resistance.

Under this type II again 2 types can be seen

1) None obese NIDDM

2) Obese NIDDM

Genetic defects of beta cell function including maturity on set diabetes of young

known as MODY

III) Other specific types


79

Madhumeha

A) Genetic defect of beta cell function

a) Chromosome 12, HNF – 1 Alpha (MODY S)

b) Chromosome 07 Glucokinse (MODY 2)

c) Chromosome 20 HNF 4 Alpha (MODY 1)

d) Mitochondral DNA

e) Others

B) Genetic defects in insulin action: -

Type 4 insulin resistances, Lepsechaunism, Rabson Mendenhall

Syndrome. Lipoatrophic diabetes and others.

B) Disease of exocrine pancreas: - Pancreatic pathology

a) Pancreatitis

b) Hemochromatosis

c) Fibrocalculous

d) Neoplastic Disease

e) Pancreactetomy

f) Cystic fibrosis and others.

D) Iaotrogenic: - Drug induced or chemical induced.

a) Glucocorticoids

b) Thiazides

c) Alpha – Intrferon

d) Thyroid Hormone.

F) Endocrinopathies: - Endocrine disease induced.

a) Cushing’s Syndrome

b) Acromegaly

c) Thyrotoxicosis

d) Phaeoc hromocytoma

e) Glucogonoma.


80

Madhumeha

G) Infections: -

• Congenital rubella

• Cytomegalo virus and others

H) Other genetic syndromes sometimes associated with diabetes.

a) Dawn’s syndrome,

b) Klenefelter’s syndromes etc.

I) Gestational Diabetes Mellitus (GDM)

In classics the classification of a disease made it clear that for the sahaja

prameha beeja dosha have been mentioned as causative factors. Such patients are said to

be weak emaciated. Suffering from thirst, loss of appetite and are required to be treated

with a nourishing diet.

In contemporary science the genetic and hereditary factors are mentioned

as causative factor. Such patients are weak emaciated and they are asthenia. The above-

mentioned patient is juvenile diabetes and requires a nourishing diet, so sahaja prameha

can be consider as juvenile diabetes.

Poorvaroop

The Symptoms, which are produced during the process of sthanasamshraya avastha, are

called as poorva roopa, and the symptoms which appears prior to the manifestation of the

disease, are called poorvaroopa i.e. is “4th Kriyakala”.

There is no direct explanation of the poorva roopa of madhumeha as such. But

poorva roopa of prameha can be considered as poorva roopa of madhumeha.


81

Madhumeha Table No: -14

Showing the poorva roopas144

S.no Poorva roopa C.S S.S A.H A.S M.N B.P Y.R

1 Kesha Jatilibhava + + - + - - -

2 Asyamadhuryata + - + + + + +

3 Karapada daha + - - - - - -

4 Karapada suptata + - - - - - -

5 Mukha talu kantha

gala shosha

+ - - - - - -

6 Pipasa + + - + + + +

7 Alasya + - + - - - -

8 Kaye malam + - - + - - -

9 Angeshu paridaha + - - - - - -

10 Anga suptata + - - + - - -

11 Shatapada

Mutrashaya

abhisarana

+

+

-

-

-

-

-

12 Vishra shareera

gandha

+ + - + - - -

13 Atinidra + - - - - - -

14 Tandra + + - + - - -

15 Snigdha,Pichhila

guru gatratam

- + + + - - -

16 Madhura shukla

mutrala

- + - + - - -

17 Durgandha swara - + - + - - -

18 Talu, gala,

danteshu

malotpathi

-

+

-

-

-

-

-

19 Nakhati vriddhi + + - + - - -


82

Madhumeha 20 Swedam + - + - - - -

21 Keshathi vruddhi + - - - - - -

22 Sheetpriyatwan + - + + - - -

23 Mootra

abhidhavanti

pipeelakasha

+

-

-

-

-

-

-

24 Ghanangata + - + - - - -

25 Angashaithilatwa + - + - - - -

ROOPA

The vyakta or pradurbhoota lakshanas of the vyadhi is seen in the 5th kriyakala.

The vyadhi bodhaka linga of all 20 types of prameha is prabhoota and Avila mootrata.

The prabhoota mootrata can be considered in terms of increased volume of urine and

frequency of micturation.’Avita mootrata refers to increased turbidity of urine.

Roopa means symptoms of the actual manifestation of disease. At this stage dosha

dushya samoorchana would have been completed and the onset of the disese would have

been commenced. Madhavakara explains it as when symptoms in the stage of

poorvaroopa become fully or clearly manifested they are called roops. Roopa is the

prominent diagnostic key of a disease and hence thorough knowledge of the various

roopas of each disease essential for a physician.

Hence the lakshanas of madhumeha are mainly grouped under two categories that

is

1) Mootra Sambandi.

2) Sarvadaihika lakshanas.


83

Madhumeha MOOTRA SAMBANDHI LAKSHANAS: -

Clinical features of the prameha may be divided into two groups they are: -

• Samanya Lakshanas

• Vishesha Lakshanas

1) SAMANYA LAKSHANAS145: -

Samanya Lakshanans of madhumeha are those which are ascribed to prameha, they

are as follows

i) Prabhoota mootrata ii) Avila mootrata

Prabhoota mootrata: -

The increase in quantity and frequency is known as prabhoota mootrata.

It is manifested due to increase of sharreera kleda, the reasons for which are

explained in the context of Samprapti. The frequency is increased due to vitiation of

apana vayu. Due to hyperglycenia in madhumeha, glycosuria manifests which in terms

hampers the tubular absorption of water leading to polyuria.

Avila mootrata: - Moorta avilata is nothing but the turbidity of mootra, which is

manifested due to drava and guru guna vriddhi of kapha and medhas. This can be noticed

by the increase in the specific gravity of the urine.

VISHESHA MOOTR SAMBANDI LAKSHANAS

In madhumeha mootra is manifested with Kashaya, Madhura, Rooksha, Pandu

and madhu Sama lakshanas. Bhavaprakasha clarify the controversy of the word kashaya

as kashaya varna. The implication of this term is still debatable. The presence of madhura


84

Madhumeha rasa in mootra is mainly because of ojo visramsa into mootra, which can be easily

understood by pipeelika abhisarana and by qualitative analysis of urine test. Rooksha

guna is due to vitiation of vata. Pandu varnata of mootra is because of kleda dusti which

influences kapha to attain more liquid state. Madhusama mootra implies the colour, smell

and taste of mootra similar to that of madhu. It has to be understood that along with the

samanya lakshanas madhusama mootra is the pratyatmaka lakshanas of madhumeha.

Table No: -15

Showing the roopa of prameha:-

S.no Roopa C.S S.S A.H A.S M.Ni Y.R B.Ra G.Ni

1 Kashaya + - - + + + + +

2 Madhura + - - + + + + +

3 Pandu + - - - - - - -

4 Rooksha + - - + + + + +

5 Snigdha - - - + - - - -

6 Ojadhatu - - - + - - - -

7 Kshoudravat

Madhviva

- - + - - - + -

8 Kshoudra rasa - + - - - - - -

9 Kshoudra varna - + - - - - - -

SARVADAIHIKA LAKSHANAS: - On the basis of their occurrence, these lakshanas

can be grouped into two divisions.

• Apathya nimittaja

• Sahaja, as there is a difference in the pathogeneses of both the varieties, so

lakshanas vary from each other

LAKSHANAS OF APATHYA NIMITTAJA MADHUMEHA


85

Madhumeha

a) Sthoola

b) Bahu Ashee

c) Snigdha

d) Shaya

Asana, Swapnasheela the Samprapthi of Apathya Nimittaja madhumeha has been

explained earlier. The vitiation of Kapha, Kleda, Medas is due to the indiscreet food

habits. Thus leads to the medovaha Srotodusti due to medodhatwagni mandya. Thus

the person develops sthoulya. The samana voyu avarodha in koshta is the reason for

prabhoolagni from which the person desires and consumes more food. It has been

said earlier that the meda sthana is the pitta sthana and hence the vayu in kosta is

obstructed which later lead to the excessive secretions of pitta in amashaya which

results in the above said lakshanas. The affected person is termed as snigdha due to

the karmataha vriddi of shleshma. Madhumeha is one among the 20 types of

pramehas. So these may be present in madhumehi.

Kaphaja Pramehas146

1) Udaka meha: - The person passes clear urine, excessive in quantity, whitish, cool,

odourless and watery.

2) Ikshumeha: - The urine of person becomes sweat, cool slightly viscid, turbid and

resembling the juice of sugar cane.

3) Sandra meha: - The urine gets thickened if kept over night in a vessel.

4) Sandraprasada meha: - The character of urine manifests here partly dense and

partly clear after keeping in a vessel.

5) Shukla meha: - White urines are excreted here and appear as if mixed with flour,

and frequency of maturation takes place.

6) Shukra meha: - The person frequently passes urine, white, appears like shukra.


86

Madhumeha

7) Sheeta meha: - The person excretes here large quantities of urine, which is

exceedingly sweet and cold.

8) Sikata meha: - The passing of urine is mixed with hard and small particles.

9) Shanair meha: - There is no force of urine during the time of passing, more over

person feels difficulty at the time of excretion.

10) Alalameha: - The urine is full of mucus threads is slim and viscid.

Pittaja Pramehas147

1) Kshara meha: - The urine is alkali like in character.

2) Kala meha: - The provocation of pitta transforms the urine as warm and black in

colour.

3) Neela meha: - Passes urine of the colour of the wings of jaybird and is acidic in

reaction.

4) Lohita meha: - Urine smells like raw flesh and saltish warm and red.

5) Manjishta meha: - Person passes urine, which is profuse in quantity smells like

fresh meat.

6) Haridra meha: - Urine is of the colour of the colour of turneric water and is

pungent.

Vataja Pramehas148

1) Vasa meha: - Provoked vata passes urine mixed with or having the appearance of

fat.

2) Majja meha: - Discharges urine with majja frequently due to provoked vata.

3) Hasti meha: - Discharges frequently excusive amounts of urine like elephant.

4) Madhumeha: - Passes urine which is astringent and sweet in taste, yellowish and

whitish in colour Urine contains similar proportion of Honey.

Madhumeha Roopa149

Acharya Sushruta gives explanation regarding the lakshanas of Madhumeha, as

follows –

1) Gamanat sthananichati

2) Sthanat asananichati

3) Aasanat sayyamichati


87

Madhumeha

4) Shayanat swapnamichati.

Apart from the above lakshanas urine similar to honey in colour and taste are also

attributed to Madhumeha.

Clinical Features150

It is very difficult to sketch with brevity the diverse clinical presentation of

diabetes mellitus. Only a few characteristic patterns will be presented.

The type II (NIDDM) diabetes present with polyuria, polydipsia but unlike type I

diabetes patients are often older and frequently obese. Some times weakness or weight

loss also noted. Apart from these features others like, polyphagia, pruritis vulvae,

glycosuria, infections, delayed healing of wounds, impotency, are also noted.

Polyuria is due to the osmotic diuretic effect of glucose in kidney tubules. The

glycosuria induces an osmotic diuresis and thus polyuria, causing a profound loss of

water and electrolytes.

The obligatory renal water loss combined with the hyper osmolarity resulting

from the increased levels of glucose in the blood tends to deplete intracellular water,

triggering the osmoreceptors of the thirst centers of the brain. In this manner intense

thirst (polydipsia) appears.

The catabolism of proteins and fat tends to induce a negative energy balance,

which in turn leads to increasing appetite, i.e. polyphagia. Despite the increased appetite,

catabolic effects prevail, resulting in weight loss and muscle weakness. Frequently,

however the diagnosis made after routine blood or urine testing mainly in asymptomatic

persons.

Whenever the quantity of glucose entering the kidney tubules in the glomerular,

filtrate rises above approximately 225 mg/min, a significant proportion of the glucose

begins to spill in to the urine and when the quantity increases above about 325 mg/min,

which is tubular maximum for glucose. All the excess, above this is lost in to urine

(Glycosuria).

A comparative study of madhumeha lakshanas with the Diabetes mellitus

explained in the modern science reveals a lot of similarities between them.


88

Madhumeha

Prabhootaavilamootrata is considered as a prathyatma lakshana of Prameha. In

this the bahudrava kapha along with other dooshyas mainly kleda pradhana dooshyas in

the basti is the cause for prabhoota mootrata. The same reason has been given in modern

science for polyuria that the osmotic diuretic affects of glucose in the kidney tubules.

Glycosuria explained in the modern science can be taken as madhusama mootra.

The reason for this madhusama mootra is bahudrava kapha or ojus (Glucose), which is

excreted through moootra.

Pipasa or polydipsia mentioned in both sciences. Depletion of intracellular water

triggering the osmoreceptors of thirst center of brain and thirst is noted which is similar to

pipasa of Ayuredic science, here due to excessive loss of the urine; pipasa is noted.

Bahukankshata has been mentioned as a lakshana in apathya nimittaja

madhumeha, the same in modern science in terms of polyphagia.

In modern science the condition weakness is due to lack of glucose utilization,

loss of electrolyte and protein loss. In Ayurveda this same condition is due to aparipakwa

dhatus i.e., lack of proper nourishment of dhatus.

By considering the above similarities, we can come to a conclusion that

Madhumeha explained in Ayurvedic science and the diabetes mellitus mentioned in the

modern science are almost similar condition.

SAMPRAPTI: -

Only Charaka explains the sirect Samprapti of madhumeha. Charaka explained

the relevance of avarana in the samprapti or formation of madhumeha. He explained this

in the “Keeyantaha Shiraseeya Adhyaya” of Sutrasthana. On this contex he explained the

Nidasnas, which are almost Kapha and Pitta Vardaka.

After exposer to aetiological factors of prameha /madhumeha followed by vividha

dosha vyapara in the body, i.e.the morbid process-taking place in the production of

disease is called Samprapti.


89

Madhumeha There are three factors, which are responsible for the manifestation of the disease

in general. Charaka explains the Hetu vishasha, Dosha vishesha, Dushya vishesha are

held responsible for the vikar utpatti or Anutpathi.151

The main principle of Chikitsa, as said by Indu, is Samprapthi Vighatana.

“Yatha dustena doshena” conveys the meaning of the degree of morbidity of

bodily elements or vikalpa Samprapti. In which condition the organism suffers from

discomfort. The vitiation of dosha and dhatus in the disease varies from person to person

and the morbidity of these elements also differs for example-Samhata roopa Vriddhi,

Vilayana roopa vriddhi, gunatha vriddhi and karmatha vriddhi etc.

All these morbid changes will not essentionally occur in all the disesase.

“Kalenopadetaha Srvae”(A.Hr.Ni), justifying the necessity of mentioning prameha

samprapti. All the above refereces regarding the samanya prameha samprapti and

madhumeha samprapti will be made.

SAMPRAPTI GHATAKA: -

Dosha - Kapha is in Bahu abhaddha

Piita is in Vriddhavastha

Vata – Avrita.

Dushya – Rasa, Rakta, Mamsa, Meda, Asthi, Majja, Sukra

Oja, Lasika, Kleda, Sweda.

Srotas - Anna, Udaka, Meda, Mutra.

Dusti Prakara – Atipravritti, sanga, vimargagmana.

Agni – Vaishamya and Dhatwagni mandhya.

Ama - Sama Kapha and Sama Dhatus.

Udbhava Sthana – Medovaha srotomoola – vapavahana

Sanchara Sthana – Sarva Shareera, Sarva doshaja,

Meda, kleda sahita; mootra vaha sroto Anupravesha.

Vyakta Sthana – Sarva Shareera (mootravaha srotas).

Vyadhi Swabhava – Chirakari.


90

Madhumeha

Depending upon Hetu vishesha, Dosha vishesha, Dushya vishesha and their

degree of vitiation 4 types of disorders may occure based on vikara vighata bhava. Vikara

Vighata bhava is explained as that factor which participats in the formation and hence

does not allow the disease to manifest. So based on Vikara Vighta bhava the four types of

occuring disease are as follows.

a. When the hetu vishesha, dosha vishesha, dooshya vishasha are not

congenial they, then the formation of disease will not occure.

b. If these three become congenial to each other lately among them, then the

delay in formation of disease will takes place.

2) If these three are mild in vitiation, then they give rise to mild disorder or a

disorder with the presence of only few lakshanas or vice versa. So in all the

disorders the utpatti is based on vikara vighata bhava and abhva.

SAPEKSHA NIDANA

Proper diagnosis is the foundation to the success of a treatment because many

diseases affecting a srotas have similar manifestations, enough to confuse a physician but

picking up threadbare with a little difference to clinch a diagnosis is an art aspired by all.

Deep knowledge and untiring practice are the means to perfection as Vagbhata has

rightly mentioned “abhyasat prapyate dristihi karma siddhi prakashini”.

Madhumeha is a mootra. atipravruttaja vikara1 with prabhoota and avila mootrata

as pratyatma lakshanas, characterized by madhusama. Although there are many diseases

presenting with Atipravrutti of mootra, the diagnosis of madhumeha is usually a

straightforward proposition, because of its characteristic poorvaroopas.


91

Madhumeha Moreover within the perview of the disease madhumeha, the kapha, pitta and vata

have characteristic presentations, which have been described in such a way as not to

leave any scope for doubt. In other words, if a patient presents with mootra atipravrutti,

lakshanas of kapha, pitta or vata like shukla mootrata haridramootrata or vasa mootrata

and if they are associated with prameha poorvaroopas then the disease is per se prameha

or madhumeha. Charaka explains this concept giving the example of a situation where

one comes across a patient who is presenting with haridra or rakta mootrata. Here the

absence of prameha poorvaroopas will prove the existence of rakta pitta and exclude

prameha

In the presence of madhura and picchala lakshanas of prameha, one should

consider two possibilities for differentiation whether the condition is anilatmaka due to

dosha ksheenata or kaphasambhava as a result of santarpana

As discussed earlier, here one should essentially consider madhumeha as a

consequence of vata vruddhi as a result of dhatukshaya where vata is the anubandhya

dosha and madhumeha as a result of margavarana janya vata vruddhi where vata is a

anubandha dosha and is directly dependent upon kapha, which has undergone vruddhi

because of santarpana. The factors for differentiation are as follows

Madhumeha (anilatmaka) Madhumeha (Kaphasambhava)

Rogi : Krusha

Nidana a) Vatakara ahara vihara along

with vata vruddhi as a result of

chirakalina madhumeha

b) Beeja uapatapa

Sthoola

Kaphakara ahara vihara


92

Madhumeha Rogi avastha : Bala to madhyama vaya

Roopa : Vata pradhana

Samprapti : Madhumeharambhaka dosha

dusti leading to vapavahana

dusti especially in sahaja

madhumehi

Vyadhiswaroopa : Ashukari

Sadhyasadhyata : Asadhya

Upadrava : Vata pradhana upadravas

Chikitsa : Santarpana

Madhyama to vruddha

Kapha pradhana

Kaphamedodusti leads to

madhumeharambhaka dosha, dusti in

vapavahana

Chirakari

Sadhya in the beginning

Kapha pradhana upadravas

Apatarpana

Madhumeha is basically medovaha srotodustijanya vikara but its pratyatma

lakshanas become vyakta in the mootravaha srotas with abnormal changes in the rasa,

varna, gandha, sparsha of the mootra and it is characterized by prabhoota1 and avila

mootrata.

Prabhoota mootrata means atipravrutti of mootra. It goes without mentioning that

there is also an increased frequency of micturition and avila mootrata means Atyartha

Kalusha4 Samalam5 or Malinam akulam6 which means that there is a considerable change

in the quality of urine as per the above mentioned factors. Considering these factors, it

becomes contextual to enumerate the conditions where there is increased frequency of

urine and abnormality in its quality. Most of the times these symptoms are associated

with mootravaha srotodusti and other diseases where differentiating madhumeha is not a

problem for evident reasons.


93

Madhumeha

Mootralakshana (Pravartana Nimitta) Symptoms

1) Abhikshnam (Muhurh muhurh, Punah punah : a) Ashmari (C. Ci. 26/38)

Subahushah, vikiranam b) Mutratita (S. U. 58/12)

c) Vatika mootrakrichra (C. Ci

26/32)

d) Ushna vata (Ah. N. 9/36)

2) Atipravrutti a) Amavata (M. N. 25/9)

b) Arsha poorvaroopa (As. N. 7/7)

c) Sahaja arsha (C. Ci. 14/8)

d) Kaphaja arsha (C. Ci. 14/17)

e) Mutra praseka (S. Ci 7/36)

f) Upasthita prasava (S. Sa. 10/7)

g) Chidrodara (C. Ci. 13/44)

h) Asadhya masurika (M. N.

54/27)

i) Ama jwara (C. Ci. 3/135)

It becomes relevant to consider the following conditions where hyperglycemia is

common manifestation under the heading of differential diagnosis

I Diabetes mellitus & Endocrine disorders:

a) Pituitary gland

1) Pituitary diabetes due to growth hormone

2) Acromegaly


94

Madhumeha

3) Diabetes insipidus

b) Adrenal Cortex

1) Cushing’s Syndrome

2) Steroid diabetes due to administration of steroids

3) Primary Hyperaldosteronism

c) Adrenal Medulla

1) Phaeochromocytoma

2) Addison’s disease

3) Adrenalectomy

d) Thyroid

1) Hyperthyrodism

2) Myxoedema

II Pancreatic Diabetes

1) Acute pancreatitis

2) Mumps (rarely)

3) Chronic pancreatitis

4) Haemochromatosis

5) Total pancreatectomy

6) Carcinoma of pancreas

III Diabetes liver

1) Cirrhosis of liver

2) Gall Stones

IV Drugs & diabetes


95

Madhumeha 1) Thiazide, Chlorthalidone, frusemide, oestrogen containing oral contraceptives, β

blockers & catacholaminergic drugs

V Miscellaneous

1) Type I glycogen storage disease

2) Down’s syndrome

3) Turner’s Syndrome

4) Huntington’s chorea

5) Burns

Conditions where there is polyuria

Polyuria should not be confused with prostratic hypertrophy or cystitis because

here it is only increased frequency of micturition & not increased quantity.

I Polyurea due to water diuresis

Cranial or neurogenic diabetes insipidus: This is due to an identifiable lesion in the

hypothallamus pituitary or both leading to failure of A.D.H.

Nephrogenic diabetes insipidus:

Familial form seen in males only also as an accompaniment of Fanconi syndrome

Psychogenic polydipsia or compulsive water drinking this is a hysterical condition. There

is clinically marked fluctuation here.

II Polyurea due to increased solute load

Diuretic therapy

Chronic renal failure

SADHYA SADHYATA


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Madhumeha The prognosis of the disease is to be established only after the consideration of

Sadhya or Asadhya. The Vyadhis are classified on the basis of prabhava as sadhya and

Asadhya further Sadhya vyadhis are classified as Sukha Sadhya and Krichra Saadhya.

Asadhya vyadhis are bifurcated in to yapya and anapakramya Prathyukheya.

The assessment of Sadhya and Asadhyata of the disease arte depending upon the

following factors: -

1) Hetu

2) Poorvaroopa

3) Roopa

4) Dosha, Dushya, Kala, Prakruthi

5) Marga – Gati

6) Adhisthana

7) Upadrava

8) Aristha

9) Mental state

10) Bala

11) Chikitsa karma bhedha,

Vagbhatacharya adds the some new points

12) Vaya

13) Linga

14) Indriya Sthiti

15) Grahasthiti

16) Jitatmana

And also mamsa, upachaya are also be taken in to consideration.

The clear knowledge of the above factors will help one to assess the Saadhyata or

the Asadhyata of a vyadhi.

PROGNOSIS DEPENDING UPON DOSHA


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Madhumeha The ten Kaphaj prameha are said to Sadhya six types of Pittaja meha are yapya

and four types of Vataja meha are Asadhya.

As madhumeha is Vataja pramehas, Vataja pramehas are told as Asaadhya. Hence

madhumeha is also to be considered as Asaadhya. The factors that are considered as

pathya for vayu is an Apathya for meda. So due to Virudhopakrama or contradiction in

treatment eq. snigdha for vaya Kshaya it increases the medas.

Again this can be classified as yapya and anupakramya pratyakyeya.

ASADHYA MADHUMEHA

In the following condition the disease madhumeha will become asaadhya.

1) Kapha pittal prameha, which is long standing and

associated with poorva roopa if exhibited in Vataja

prameha then it should be demand as asaadhya.

2) If the madhumeha patient is durable, emaciated then it

should be Rx. As asaadhya.

3) Beeja doshaja madhumehas are asaadhya.

4) The manifestation of all poorva roopa in meha if the

Kaphaja, Pittaja, Prameha converted in to Vataja

prameha then it is said to be Asaadhya.

5) If pidikas are manifested in madhumeha should be

treated as Asaadhya.

KRICHRA SAADHYA MADHUMEHA

It seems that krichra Saadhyata of madhumeha is possible in Apathyanimittaja

madhumeha that too were there is an avarana of Vayu is present due to medas or Kapha

or Pitta. That is why in such conditions acharyas have advised to consume Lague Ahara


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Madhumeha and tikta rasa aharas along with exercises. If neglected in the earlier period of

Madhumeha then in later course it will become Asadhya due to dhatu Kshaya.

Basavarajeeyam a 16th centurion practical sound physician of Telengana invented

New test for urine for the prognosis of each dosha group the urine of prameha patients is

to be collected in a wide mouthed vessels and boiled on a mild flame till evaporation. The

incurability of the disease depends up on the amount of residue a Vataja prameha is

considered as incurable if the residue is 1/5th of the volume of urine taken for test. Pittaja

prameha is incurable if the residue is 1/4th and Kaphaja prameha is residue is 1/9th.

MADHUMEHA CHIKITSA VIVECHANA

The principles of chikitsa can hence be studied as, a) Nidana parivarjana,

b) Apakarshana, c) Prakruti Vighata. These principles of treatment are to be studied

separately with respect to dhatukshayajanya madhumeha & Margavarana janya

madhumeha.

Nidanaparivarjana in Margavarana janya Madhumehi:

An apathyanimittaja medhumehi usually sthoola, who likes Abhyavaharana & hates

chantramana a situation just like of the helpless eggs on a tree, they cannot move to avoid

their predators & hence fall victim to them. Here the patient should be made to avoid all

& Kaphakara ahara vihara either to prevent the occurrence or to cure the disease.

Nidana parivarjana in dhatu kshaya janya Madhumehi: - Nidana parivarjana in such

madhumehis is studied with special reference to sahaja madhumeha. It lies entirely on the

mata or pita as to how best they act to prevent the occurrence of the disease in them.

Apakarshana & Prakruti Vighata: - The apakarshana of doshas are mainly done

through samshodhana but only when roga & rogi bala are in pravaravastha and when


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Madhumeha either one or both are avara then it is done through langhana and langhana panchana,

which constitutes samshamana chikitsa, in other words prakruti vighata.

Apakarshana in Margavarana janya madhumeha: - Shodhana, when in such

madhumehi if the dhatukshaya is minimum & there are kapha & medodusti laxana then

vamana should be performed. & if there are pittaja laxanas & dhatu kshaya does not

render the patient durvirechya then virechana can be performed. Similarly if the

anubandha vata laxanas are more and the patient is samshodana arha then basti can be

performed.

Madhumeha is a swedana ayogya vyadhi but swedana can be administered. The

selection of yogas for samshodana & snehana should be selected as per the recipes

prescribed in kalpa shtana. After shodana shamana chikitsa can be done by,

Kaphamedohara dravya.

Prakruti vighata in dhatu Kshaya Janya madhumeha: - Dhatu kshaya avastha is the

result of beeja dusti in sahaja madhumeha & due to a state of atikarshita dhatus as a result

of continued dhatu kshaya, which is nothing but the progressed stage of margavarana

janya madhumeha both the situations are considered samshodana anarha. In such cases

samshamana chikitsa is advised, whereas madhumeha in both these cases are asadhya and

hence need not be treated. Notwithstanding this, the principles of chikitsa for vataja

pramehas are for vata anubandhadoshatva, which is still dependent on the kapha &

pittadoshas and not for vata anubandhya dosha janya madhumeha characterized by

atishaya karshana of dhatus. Hence samshamana chikitsa should be appropriately adopted

in such patients.

Avastha Anusara Chikitsa of Madhumeha: -


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Madhumeha Sushruta in the chapter of prameha pidaka chikitsa has indentified the stages of

madhumeha & accordingly advised the treatment, which can be discussed as, stage

I: Chikitsa in poorvaroopavastha; stage II: Chikitsa in Vyaktavastha; stage III:

Chikitsa in upadrava avastha; stage IV: Chikitsa in pravrudha upadrava avastha; stage

V: Chikitsa in asadhya avastha.

Stage I: Is the poorvaroopa avastha where the dosha dushya sammurchana has just begun

the disease should be treated with apatarpana, vanaspathi kashaya and chagamootra. If

left untreated the madhumeha it proceeds to the II stage.

Stage II: This is the vyakta avastha of madhumeha where due to continued madhura ahara

sevana. The sweda mootra and sleshma attain madhura bhava & hence should be treated

with ubhaya samshodana i.e vamana, virechana & basti. If left untreated the disease

progresses to stage III

Stage III: In this stage the mamsa & shonitha undergo pravrudha dusti causing shopha &

other upadravas and these should be appropriately treated as mentioned accordingly, like

siramokshana in shopha. If left untreated the disease progresses to stage IV.

Stage IV: In this stage the upadravas like shopha would have attained ativrudha avastha,

manifesting symptoms like Ruja & vidaha, where shastra chikitsa and vranakriya should

be performed. If neglected the disease proceeds into Asadhya avastha which is the V &

the final stage.

Stage V: In the asadhya avastha, the upadravas become mahantha and & makes the

disease asadhya, like here when the pooya of pidakas attain abhyantaraprapti and become

utsanga.


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Madhumeha Analysis: Though explained as prameha pidaka avastha chikitsa,description of stage wise

progression of the disease and the treatment has been done by sushruta on the pretext of

explaining the prameha pidaka chikitsa. This description seems to be chikitsa in case of

apathyanimittaja madhumeha, the course of this illness has been discussed already under

samprapti & accordingly in the poorvaroopavastha sushruta advises apatarpana & other

shamana dravyas as there is Alpadosha &alpa dhatu dusti, hence unless the need arise,

samshodana is not the treatement of choice and as the laxanas are predominantly due to

kapha, kaphahara chikithsa should be done & this seems to be the logic behind

prescribing apatarpana & tikshna dravyas like chaga mootra. Whereas in vyakta avastha

there is bahu dosha & a relatively alpa dhatu dusti like medas & rakta which warrants

shodhana, accordingly vamana, virechana&basti has been adviced as the rogi is still

balavan & sthoola & so shodanarha.

In the next stages there is a progressive dhatu kshaya & production of upadravas.

The patient is shodana anarha & there is vata pradhanyata. Hence only shamana chikitsa

& respective upadrava chikitsa should be done. Sushruta has stressed the importance of

timely intervention in madhumeha because in case of negligence the disease progresses

involving gambhira dhatus & the upadravas pervade the entire body making it asadhya.

Santarpana Apatarpana Chikitsa in Madhumeha: -

Madhumeha has been described as santarpanotha vyadhi as well as apatarpanotha

vyadhi. The former is apathya nimittaja madhumeha & later is sahaja madhumeha or

madhumeha due to dhatu karshana due to long standing prameha. Accordingly two forms

of madhmehis are ancountered one who is sthoola & balavan for whom Apatarpana is the

best & the other who is krusha & paridurbala for whom santarpana is the best.


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Madhumeha I. Apatarpana chikiatsa: is done in the form of langana langanapachana &

doshavaseehana. a) Langana this is done in alpadashavastha where only upavasa pipasa,

maruta atapa sevana1rooksha udvartana, pragada vyayama, Nishi Jagarana & so on,

which are kaphamedo hara are helpful. b) Langana pachana: This is done in

madhyamadoshavastha where along with langana, Ama pachana is done with tikshna

ushna dravyas. c) Doshavasechana: This is done in Bahudoshavastha where the shodana

of doshas are done from ubhaya margasII. Santarpana Chikitsa: Laghusantarpana chikitsa

is prashastha for krusha and durbala rogis the following can be administered in

madhumehi. a) Manthas,

b) Kashaya, c) Yava, d) Churna, e) Lehya, f) Laghu Bhakshya. These formulations

should be prepared such that they cause santarpana without causing vridhi of kapha &

medas. Among all these yava is considered as best for madhumehi which will be

discussed in the chapter of pathya apathya.

Shresta Aushadha prayoga in madhumeha: -

Shilajathu, guggulu & loharaja: These three dravyas are medicines par excellence in

madhumeha, either in krusha or sthoola, as they are virukshana & chedaneeya, which is

good for kapha, as well as Rasayana, which is good for dhatukshaya & vatavrudhi.

MANAGEMENT OF DIABETES MELLITUS

Management, rather than treatment, is the appropriate term in Diabetes mellitus,

and involves diet, exercise, insulin, oral hypoglycaemics, patient education and

counselling. Insulin and oral drugs are discussed here and the other aspects of

management in subsequent chapters.


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Madhumeha INSULIN: Insulin is required for treatment of all patients with IDDM & many patients

with NIDDM. No single standard exists for patterns of administration of insulin and

treatment plans vary from physician to physician. With a given physician for different

patients three treatment regimes will be described. Viz. Conventional, Multiple

subcutaneous injections (MSI) and Continuous subcutaneous insulin infusion (CSII).

Conventional Insulin Therapy: involves administration of one or two injections a day

of intermediate acting insulin such as zinc insulin (NPH insulin) with or without the

addition of small amounts of regular insulin. This practice is based on the concept that

regular insulin lowers the plasma glucose level rapidly after which more slowly absorbed

insulin maintains the lowered level. Here patients should be taught to decrease insulin

when extra exercise is anticipated.

Multiple subcutaneous insulin injection technique (MSI): Most commonly involves

administration of intermediate or long acting insulin in the evening as a single dose

together with regular insulin prior to each meal.

Continuous subcutaneous insulin infusion (CSII): This involves the use of a small battery

driven pump that delivers insulin subcutaneously into the abdominal wall. Adjustments in

dosage are made in response to measured capillary glucose values, as in MSI. Though

CSII provides better Diabetic control, there is a higher risk of Hypoglycaemia and

Diabetic Ketoacidosis.

ORAL AGENTS:

Sulphonyl ureas: NIDDM that cannot be controlled by diet & exercise often responds to

sulphonyl ureas. Sulphonylureas, like Chlorpropamide & Tolbutamide, act primarily by


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Madhumeha stimulating release of insulin from β cell, but are useful only in patients with relatively

mild disease.

Second generation drugs such as Glipizide & Glyburide are effective in smaller

doses and differ little from Sulphonylureas. Hypoglycemia occurs less often with oral

agents than with insulin. But when it occurs it tends to be severe & prolonged.

Biguanides: Metformin is useful in NIDDM patients who are not responsive to diet &

exercise. The primary action is thought to be inhibition of hepatic gluconeogenesis & it

also may enhance glucose disposal in muscle & adipose tissue. Melformin does not cause

hypoglycemia unlike sulphonylureas, metformin can cause lactic acidosis hence should

not be given in patients with renal disease.

Thiazolidinedione derivatives: Such as troglitazone, lower blood levels of glucose, free

fatty acids & triglycerides and appears to reduce insulin resistance. Troglitazone is

approved for use in obese patients with NIDDM who are poorly controlled on insulin.

SUMMARY:

Madhumeha Diabetes Mellitus

Margavarana Janya madhumehi

is sthoola & balavan so apatarpana

chikitsa in the form of langhana &

Nidana parivarjana

Dhatu Kshaya Janya madhumehi is

Krusha & durbala hence santarpana

Chikitsa.

NIDDM patient is obese, so diet exercise

and oral hypoglycemics (sometimes insulin

also)

IDDM – patient is thin so insulin therapy


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Madhumeha

Prameha Pidaka

Charka in his Suthrasthana explained special Samprapti for madhumeha and he

explains that the lakshanas manifest and vanish at times. He also states that if neglected,

this disease causes serious types of pidakas in subcutaneous, muscular area, vital parts

and joints of the body. Hence pidaka can be termed as upadrava of madhumeha.

There are different opinions among the acharyas regarding the number of pidakas

as follows.156

Table No: -16

Showing the list of prameha pidakas157,158

No. Charaka Sushruta Vagbhata

1. Sharavika Sharavika Sharavika

2. Kachapika Kachaptka Kachapika

3. Jalini Jalini Jalini

4. Sarshapika Sarshapika Sarshapika

5. Alaji Alaji Alaji

6. Vinata Vinata Vinata

7. Vidradi Vidhradi Vidhradi

8. - Masurika Kuluttika

9. - Putrini Putrini

10. - Vidarika Vidarika

COMPLICATION OF DIABETES MELLITUS159

It can be classified into two groups

1) Acute complications: -


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Madhumeha

a) Metabolic – Ketoacidosis, Hyper Osmolar non Ketotic coma, lactic

acidosis

b) Infective apisodes of RIT, UTI, Skin etc.,

c) Surgical complications – Gangrene, Carbuncles

2) Chroni Complications: -

a) CVS – Premature altheroma, Ischaemic or

CHD – Thromibosis, HT, Claudication etc

b) Nervous System – CVD, Peripheral neuropathey, Sensory and motor

neuropathises.

c) Excretory System – Recurrent UTI, RF, Chronic polynephritis

d) Eyes – Cataracts, Retinopathy

e) Respiratory System – Pulmonary kocks

f) Digestive System – Stomatitis, Dental sepsis, fatty filtration of lives

g) Bones and Joints – Osteoporosis, Frozen shoulder on, Neuropathic joints

h) Skin – Monitial infections, trophic ulcers, carbuncles

i) Gonad possible hormon changes.

Some upadravas can be correlated to some of the complications of modern sciences

for e.g.- thrishna, bhrama, shoola, tamapravesha, swasa etc with that of the

ketoacidosis in which all these symptom are seen and even in hypoglycemic condition

also.

ARISHTA LAKSHANAS

Only a few references regarding arishta lakshanas of madhumeha and prpamehas

can be found in the classics.

They are as follows: -


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Madhumeha If the bala and mamsa of a madhumeha rogi is severely deteriorated then he

should be considered as achikitsya.

Swapna vishayaka – If person dreams of drinking various types of snehas in

association with chandalas (that is out cast men) then he dies of prameha. If a

madhumeha rogi dreams of consuming water then he dies of prameha.

Doota vishayaka – The meeting of the messenger and the physician near the pond

or along with water then the prognosis will be bad. If the patient is suffering from

prameha.

Anya – In spite of regular bath and the application of perfumes if the flies attach

concurrently on a madhumeha rogi. Then he will die soon. If madhumeha is present with

the upadravas it is to be considered as arista. If he is lethargic obese, atisnigdha and is a

varacious eater. Then death impends in the form of prameha.

The knowledge of Arishta is very much essential to understand the prognosis of a

disease, which denotes death definitely.

PATHYA AND APATHYA

Very often, traditional medicinal systems are criticized for the strict

dietary restrictions. Many patients may not be inclined to embrace this

therapy, thinking that they will have to observe strict ‘Pathyam’.

It means ‘pathya‘ is one, which is beneficial to the path/channels.

‘Pathyam‘ includes those factors, which do not adversely affect the body

as well as mind, and which are favourable to maintain good health.


108

Madhumeha ‘Pathyam’ includes specific foods and drugs (from natural sources), which

are beneficial and are in accordance with the functioning of body channels

or pathways through which they pass. The chronic disease, ‘diabetes’, can

be controlled by giving comprehensive attention to three aspects i.e.

Ausadha (medicine), Aahar (diet and Vihar (exercise).

The term Pathya means that which compatible to health. Pathya plays a

significant role in controlling Madhumeha. If person who is a Madhumehi indulges in

the habit of taking Apathyas then certainly the effect of the medicine will prove futile and

the disease aggravates. If person follows the Apathya than are advised for him, then it

will help him certainly to bring down increased state of disease.

Some points are to be considered before framing Pathyas for Madhumehi patients.

1) Nidana parivarjana

2) Considerations towards Sthoola and Krisha Madhumeha

patients

3) Vata and Kapha Nashaka Ahara and Vihara.

1) Nidana parivarjana: - The aharas, which have been explained for Samanya

Pramehas. Or Vishista Prameha is to be termed as Apathuyas. So Nidhana

parivarjana will become pathya for the patients.

2) General considerations on sthoola and krisha madhumeha patients: -

Pathyas differ from patients to patient as difference in the treatment. It

depends on the Nidana Samprapthi of the disease. For example in Sthoola

Madhumeha there is a Margavarodha of vayu by Vridda Kapha and medas.

Patients should be advised to follow the following diet.


109

Madhumeha 1) The diet (Pathya) which aims towards the alleviation of Kapha Dosha and

Medodhatu

2) The diet, which inhabits the vitiation of Vayu.

3) The diet, which gives bala to the patient even with a low calorie value.

LIST OF PATHYAS

The following dravyas are having the qualities as mentioned in earlier description.

a) Jangal Mamsa

b) Shyamak

c) Uddalaka

d) Kodrava

e) Goodhooma

f) Chanaka

g) Tikta rasa Pradhana shakas that are grown in Jangal desha.

h) Yavanna

i) Kulattu

j) Purana shali dhanya-madhy.


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Nidana sevana

Vikrita bahudrava kapha (Shleshma)

Travels all over the body because of shareera shithilata

Medodhatwagni mandya

Vitiation of medovaha srotas

Bahu abaddha medas

Dosha dushya sammurchhana

Bahudrava shleshma with bahu abadhha meda

Vitiation of other dooshyas

Adhika kledata of dhatus

Basthi

MADHUMEHA

Beeja dosha

Sthoulya

Shleshma, pitta, meda, mamsa,

ativriddhi

Obstruction to vata due to

aavarana by vitiated kapha,

pitta and meda.

Squeezing of ojus

MADHUMEHA SAMPRAPTI

Genetic predispostion Envirnoment

Multi genetic defecets Obesity

Primary beta-cell defect Peripheral tissue insulin resistance

Deranged insulin Secretion Inadequate glucose utilization

Hyperglycemia

Beta cells exhaustion

Type II diabetes

PATHOLOGY OF TYPES II DIABETES

Drug review


111

Drug review

Madhu / Honey:

Honey obtained from the sealed comb cells is a naturally converted form of

sugary food from the nectar of flowers & other plant exudations systematically collected

and stored by honeybees. Honey is a thick, syrupy, translucent, pale, yellow or yellowish

brown to dark brown liquid. It chiefly contains dextrose and fructose, moisture & small

amounts of sucrose & mineral constituents. The presence of enzymes, vitamins

suspended matter proteins, acid and colouring matter. Dextrin maltose, melezitose,

pentosans & gums are also reported.

Property:-

It is guru, Ruksha, Kashaya and sheeta veerya & it is pitta, Rakta & Kaphahara,

Moreover it is yogavahi which means it has samananukari dravyaprabhodhita shakti. In

other words madhu due to its prabhava assumes & magnifies gunas of whatever dravya is

used along with it. Hence madhu is used along with most of the aharas & aushadhas

which are Kaphamedo and mehahara but madhu should be used in small quantities

otherwise it causes vatavrudhi.

Contents: Alkaloids:

Moisture – 20.6% Pyrolizidine alkaloids

Proteins – 0.3% Jacohne, Jacozine

Carbohydrates – 79.5% Jacobine, seneciphylline

Minerals – 0.2% & senecionine

Drug review


112

Calcium – 5%

Phosphorus – 16.0%

Iron - 0.9%

Riboflavin – 0.04%

Niacin – 0.2%

Vit C. - 4.0%

Energy – 319 K cal / 100g

Properties: Honey serves as mild laxative, bactericidal, sedative, antiseptic & alkaline

characteristics. It has ingredients which very similar to antibodies. Diet rich in honey is

recommended for infants, Convalescents & diabetic patients. It is generally

recommended as a remedy for cold, cough, fever, sore eyes & throat, tongue and

duodenal ulcers, liver disorders, constipation, diarrhea, kidney and other urinary

disorders, pulmonary T.B. rickets, marasmus, scurvy and insomnia. It is used as a remedy

on open wounds after surgery. It is reported to prevent infection & promote heating.

Pharmacotherapeutics of honey:-

It has been proposed that honey contains a sucralfate like substance that may be

responsible for its antioxidant property and gastric protection, deterioration in the

processes of lipids peroxidation and rise in the activity of antioxidant system of an

organism.

Saindhava Lavana. (Rock salt)

This is the best among lavana varga draya. Rock salt is the common

name for the mineral Halite.

Drug review


113

Components - NaCl can have impurities of gypsum or transparent cubes. It has a

pure saline taste.

Rasa - lavana

Guna - laghu, snigdha, sukshma.

Veerya - ushna.

Vipaka - madhura.

Properties - chakshushya, hridya, ruchikara, promotes appetite and assists the

Digestion, assimilation and purgative action.

Tilataila: Tilataila is best Snehadravya among sthavara sneha as explained by

Charaka. Taila is used widely for internal and external conditions. Taila is most easily

available fixed oil of herbal origin used extensively in the form of food and medicines.

Acharya charaka mentioned that Tilataila is best among the taila vargas. It

alleviates vata but, at the same time does not aggravate kapha. From therapeutic point of

view the quality of taila is “Na Anyaha Snehastatha Kwachitsamskaram nuvartate” ie.

When taila is subjected (samskara) with other dugs it takes the property of that drug.

Vagbhata explains the importance of Tilataila as “Krishanam Bhrimhanayalam

Sthoolanam Karshanaya Cha”. It does Bhrimahana Karya for Krisha persons and does

Karshana for sthoola persons.

In Krusha persons, Srotosankochana is present (i.e. constriction of channels).

Taila when administered, by its Tikshna Vyavayadi gunas enters the Sukshmatisukshma

Srotases and accomplishes Shodhana karya. By Shrotoshuddhi, shareera pusthi will

occur. Hence in this manner it does “Tasmath Krishanam Bhrimhanayalam mittupanam”.

Drug review


114

In Sthoola persons, by its sukshma, teekshnoshna gunas it enters Sukshmasrotases

does kshapana karya for meda. Due to kshapana of meda, the person becomes krisha.

Importance of murchana of tila taila: Crude oil contains Amadosha i.e, some enzyme

lipase and racine (toxic proteins), by morchana process Amadosha are removed and also

durgandhata & ugrata are removed. After doing Moorchana Samskara Sneha gets good

smell and colour. Apart from theses Sneha will gets the qualities of the drugs used for

Murchana. While by Sneha paka and Murchana the veerya of the Sneha is enhanced.

Before going to prepare any Aushadha siddha yogas, Taila Murchana is required.

Murchana means to enhance, to spread over. By this process amadosha is removed.

Usually Tailas are ushna veerya in nature. When treated with drugs like Amalaki,

Haritaki, etc., in the qualities of tailas changes takes place. i.e., Taila attains Sheeta

veerya. If Gritha & Tailas are treated with Rooksha, Ushna, Sheeta Dravyas, snehatwa

property will not be lost.

The drugs used for Murchana of Tilataila are Haritaki, Vibitaki, Amalaki,

Haridra, Mustha, Vatankura, Hrivera (Rasna), Ketaki pushpa, Manjistha, Lodra. With

their lekhaneeya property and also removes the Amadosh of Taila.

Beneficial effect of Moorchana sanskara reduces the degree of Saturation but enhances

the degree of Unsaturation. It indicates the role of unsaturated fatty acids in reducing

Serum Cholesterol, Serum Triglycerides and LDL levels which are other wise risk factor

for the development of Atherosclerosis, Hyper tension, Coronary heart diseases etc.

List drugs for murchana process:-

Manjistha - 1/16th part

Drug review


115

Haritaki - 1/64th part

Vibhitaki - 1/64th part

Amalaki - 1/64th part

Mustha - 1/64th part

Haridra - 1/64th part

Lodra - 1/64th part

Vatankura - 1/64th part

Hrivera - 1/64th part

Nalika - 1/64th part

Ketakipushpa - 1/64th part

Tila taila - 1 part

Jala - 4 part

Eranda

Ricinus communis Linn. (Euphorbiaceae)

Synonyms: - :erandah, tarunah, sukla, citra, gandharvahastaka, pancangula, vardhamana,

amanda, dirghadandakah,etc.

Rasa (taste):-tikta, svadu [dhn] madhuram [mpn] madhuram [bpn] katu, tikta [rjn]

guna (quality):-guru [dhn] guru [mpn] guru [bpn]

veerya (potency):-usna [dhn] usna [mpn] usna [bpn] usna [rjn]

Drug review


116

Karma (action):-sula hara [mpn] sula hara [bpn]. It is Vatashamaka, Rasayana, and

Medhya

Dosha-karma (action on doshas):-vata hara [dhn] kapha hara [mpn] kaphavata hara

[bpn] kaphavata hara [rjn]

roga-haratwa :

udavarta, pliha, gulma, bastisula, antravrddhi [dhn] sula, sopha, kati, vasti, sira pida,

udara, jwara, bradhma, svasa, anaha, kasa, kustha, amavata [mpn] sula, sopha, kati, vasti,

sirapida, udara, jwara, bradhma, svasa, anaha, kasa, kustha, amamarutha [bpn] jwara,

kasa [rjn]

Chemical Constituents of Root

Alkaloid -- Ricinine 1% ; Leaf --Ricinine, N-dimethylricinine, Kaempferol, Quercetin ;,

B- amyrin , Hyperoside , Quinic acid; gallic, skimmic, ellagic, ferulic and coumarinic

acids Seeds --- Ricinoleic acid ( 89% of fatty acids of castor oil ), Ricin; Seed cake --

Ricinine (Alkaloid ) ;. Seed- Toxic principles -2.8 - 3 %

Shatapushpi

(Anethum sowa)

Paryaya: - Shatapushpi, Chatra, Bahupushpa,etc

Properties:-

Guna: - laghu, ruksha, teekshna.

Rasa: - katu, tikta.

Veerya: - ushna

Drug review


117

Vipaka: - katu

Doshagnata: - due to its ushna and teekshna property it acts as a kapha vata shamaka.

Chemical composition: - a seed contains sainted oil.

Methodology


118

RESEARCH APPROACH: -

It is believed that success of the research work mainly depends on

its Methodology, so utmost care is in study design is very essential. Hence, in this

section, the researchers put forward the systemic procedures, which are followed by the

researcher’s right from the identification of the problem to the final conclusion.

In this work I aimed to evaluate the efficacy of Madhutailika bastikarma in Madhumeha.

The efficacy was determined by finding out the difference between the baseline

data of the parameters to the after treatment data.

Source of data: -

Patients suffering form madhumeha were selected from P.G. S. & R., Department

of Panchakarma O.P.D. of D.G.M. Ayurvedic Medical College and hospital, Gadag by

preset inclusion and exclusion criteria.

Study design: -

The study design selected for the present study was prospective

clinical trial. Demographic data and disease-specific data are collected according to the

case-record form given in the appendix.

The treatment modality used in this clinical study was Vasti karma, which

included sthanika abhyanga sweda, anuvasana vasti, and nirooha vasti i.e.

madhutailika vasti, and which was followed by parihara kala and follow up 15

days. During the follow-up period patients were given placebo capsules.

1) Abhyanga with murchita tila taila.

Methodology


119

2) Anuvasana vasti with murchita tila.

3) nirooha vasti i.e. madhutailika vasti.

A minimum of 30 patients was taken for study. All the patients received

classical vasti karma.

Inclusion criteria: -

Patients satisfying the following criteria were taken for study. They are –

The patients between the age group of 35 to 60 years.

Non-complicated NIDDM.

Patients having the clinical features of madhumeha.

Irrespective of sex.

Madhumeha patients having well body strength, sthoola and also fit for Vasti

karma.

Exclusion criteria: -

If any of the following conditions were noted, such patients were excluded form

the present study. They are –

Insulin dependant diabetes mellitus.

Patients complicated with other systemic disorders.

Patients less than 35 and above 60 years of age.

Patients with diabetic complications.

Duration of the Study



Methodology


120



Abhyanga with murchita tila taila.

Anuvasana vasti with murchita tila.

nirooha vasti i.e. madhutailika vasti.

A minimum of 30 patients was taken for study. All the patients received

classical vasti karma.

.

Plan of study: -





Selected patients were given basti karma.

A. Deepana-pachana – Deepana pachana till nirama laskhanas appears. For this the

drug administered was trikatu choorna, 3 gms 3 times a day before food.

B. Abhynaga– Sthanika abhynaga and ushna jala snana. For abhynaga moorchita tila

taila was used.

C. Basthi karma – five Anuvasana and three Madhutailika Basti

D. Parihara Kala – sixteen days parihara kala.

Methodology


121

E. Follow up – Follow up for one month. During this period of follow up the patient

was advised to follow the diet, which he had followed prior to our study.

Data Collection

Patients were thoroughly examined both subjectively and objectively. Detailed history

pertaining to the mode of onset, previous ailment, previous treatment history, family

history, habits, ashtavidhapareeksha and dashavidhapareeksha and physical examination

findings were noted. Routine investigations were done to exclude other pathologies

Investigations and Selection of Patients: -

Objective parameters:-

The following investigations were done prior to the study.

1. Blood – FBS, PPBS.

2. Urine – Urine sugar.

After interpretation of the laboratory investigations, mild and moderate types of

patients were taken for study. Mild and moderate criteria’s are given here.

Table No. 15. Showing the grades of the blood sugar level.

Sl. Level FBS RBS PPBS Urine

sugar

01. Normal 70-120 mg/dl. 100-140 120-180 Nil

02. Mild 121-170 mg/dl. 181-230 181-230 0.5%

03. Moderate 171-220 mg/dl. 231-280 231-280 1.0-1.5 %

04. Severe 221-mg/dl and 281 mg/dl and 281 mg/ dl and 2% and

Methodology


122

above above above above

Subjective parameters: -

Apart form the above parameters; the following parameters were also taken for

assessing the patient. They are –

Prabhuta mutrata

Kshudadhikya

Pipasadhikya

Karapada daha

Ati sweda

Method of Assessment and grading: -

The assessment of results is made by observing the severity of symptoms and

laboratory investigations.

The severity of the symptoms, urine sugar, fasting blood sugar and post prandial

blood sugar were assessed before the treatment, after Vasti karma, after parihara kala, and

follow up, i.e.15th day of period.

Grading of parameters: -

The results were evaluated by observing subjective and objective parameters by

grading method. The grading was done in the following manner.

1. Prabhuta mutrata: -

Grade 0 – 2-3 times / day, 0-1 times / night.


Methodology


123


Grade 3 – > 7 times / day, > 5 times / night.

2. Pipasadhikya: -

Grade 0 – Normal.

Grade 1 – Slightly increased.

Grade 2 – Severely increased.

3. Kshudhadhikya: -

Grade 0 – Normal.

Grade 1 – Increased, but can tolerate.

Grade 2 – Increased, but can’t tolerate without consuming food.

4. Kara pada daha: -

Grade 0 – Absent.

Grade 1 – Slightly present.

Grade 2 – Present.

4. Ati sweda: -

Grade 0 – Absent.

Grade 1 – Present.

5. F.B.S.: -

FBS levels,

Grade 0 - 120 and below

Grade 1 - 121-140

Grade 2 - 141-160

Grade 3 - 161-180

Methodology


124

Grade 4 - 181-200

Grade 5 - 201-220

6. PPBS (Post prandial Sugar): -

PPBS levels –

Grade 0 - 180 and below

Grade 1 - 181-200

Grade 2 - 201-220

Grade 3 - 221-240

Grade 4 - 241-260

Grade 5 - 261-280

7. Urine sugar: -

Urine sugar -

Grade 0 - Nil

Grade 1 - 0.5

Grade 2 - 1.0 - 1.5

Master Chart No 1 Sex Religion Occupation Socioeconomic status Diet Duration Sl.

No. OPD No.

Age (yrs) M F H M S A L P M UM HC Veg Mix ND > 1 > 2 > 3

01. 5204 40 - + + - + - - - + - - + - - + - - 02. 5235 50 + - + - + - - - - + - + - - - + - 03. 5311 35 - + + - + - - - - - + + - - + - - 04. 5324 58 + - + - + - - - + - - - + - + - - 05. 5337 43 + - + - + - - - + - - - + - + - - 06. 5383 62 + - + - + - - - - + - + - + - - - 07. 5385 59 + - + - + - - - - - + + - + - - - 08. 5451 46 + - + - + - - - - + - + - - - - - 09. 929 57 + - + - - - - + + - - - - + - + - 10. 945 50 + - + - + - - - - + - - + - + - - 11. 1140 55 - + + - + - - - + - - + - - - + - 12. 1141 62 + - + - + - - - - + - + - - - - + 13. 1184 40 + - + - + - - - - - + - + - - + - 14. 1613 38 - + + - - - + + - - - + - - + - - 15. 1718 49 + - + - + - - - + - - - + - - - + 16. 1413 58 + - - + - - + + - - - - + - - + - 17. 1221 46 + - + - - - + + - - - - + - - - + 18. 1519 52 + - + - + - - - - + - + - + - - - 19. 2906 54 + - + - - - + + - - - - + - - + - 20. 2933 43 + - - + + - - - - + - - + - - + - 21. 3062 51 + - + - + - - - - + - - + - - + - 22. 3094 63 - + + - + - - - + - - - + + - - - 23. 3603 52 + - - + + - - - - + - - + - + - - 24. 3227 57 + - + - + - - - + - - - + - - - + 25. 3375 49 + - + - + - - - + - - + - - + - - 26. 3438 44 + - + - + - - - - + - + - - + - - 27. 3495 57 + - - + + - - - - + - - + - + - - 28. 3630 56 + - + - + - - - - + - - + - - + - 29. 3750 53 + - + - + - - - - + - - + + - - - 30. 3751 48 + - + - + - - - - + - - + + - - -

M – Male; F- Female; H- Hindu; M- Muslim; S – Sedentary; A – Active; L – Labor;P- Poor; M – Middle class; Um – Upper middle class; HC – High class; ND – Newly diagnosed;.

Master Chart No 2 Family history Family

history Koshta Agni Bowel Habits Prakriti Sl.

No. OPD No.

Al Ay No Du P A Mr Ma Kr M T S F C S A T No KP KV VP 01. 5204 + - - 8

Mnts + - - + - - + - - + - - - - - - +

02. 5235 + - - 1 ½ yrs

+ - - + - - + - - + - + - - - + -

03. 5311 + - - 2 yrs + - - + - + - - - + - - - + + - - 04. 5324 + - - 2

mnts - + - + - - + - + - - + - - + - -

05. 5337 + - - 1 yr + - + - - - + - - + - + - - + - - 06. 5383 + - - 1 yr - + - + - - + - + - - + - - + - - 07. 5385 + - - 6

mnts + - - - - + - + - + - - - + + - -

08. 5451 + - - 6 mnts

+ - + - - - + - + - + - - - - + -

09. 929 - - + - - + - + - - + - - + + - - - - - + 10. 945 + - - 14 mnts - + - + - - + - - + + - - - - + - 11. 1140 + - - 1 mnt - + - + - + - - - + - + - - - + - 12. 1141 + - - 5

mnts + - - + - - + - - + - + - - - - +

13. 1184 + - - 1 yrs + - - - + + - - - + - + - - - - + 14. 1613 - + - 6

mnts + - - - + - + - - + - - - + - + -

15. 1718 + - - 3yrs + - + - - - + - - + - + - - - + - 16. 1413 - + - 4mnts + - + - - + - - + - - + - - + - - 17. 1221 + - - 6mnts - + - + - - + - - + - + - - + - - 18. 1519 + - - 1 yr + - - + - - + - - + - - - + + - - 19. 2906 + - - 2yrs - + - + - - + - + - - + - - + - - 20. 2933 + - - 2yrs + - - + - - + - + - - + - - + - - 21. 3062 + - - 1yr + - - + - + - - - + - + - - + - - 22. 3094 - - + - + - - + - + - - + - - - + - + - - 23. 3603 + - - 9

mnts + - + - - + - - - + + - - - + - -

24. 3227 + - - 1yr - + - + - - + - - + - - - + + - - 25. 3375 + - - 2yrs + - - + - - + - + - - - - + + - - 26. 3438 - + - 3 yrs + - - + - - - + - + - - - + - - + 27. 3495 + - - 1 ½

yrs + - - + - - + - - + + - - - - - +

28. 3630 + - - 3mnts - + - + - - + - - + + - - - - + - 29. 3750 + - - 8

mnts - + - + - - - + + - - + - - - + -

30. 3751 - + - 6 mnts

- + - + - - - + + - - - - + - + -

Al – Allopathy; Ay – Ayurveda; No. – No history; Du. – Duration; P – Present; A – Absent; Mr. – Mridu; Ma. – Madhyama; Kr. – Krura; M. – Manda; T. Teekshna; S. – Sama; F – Free; C. – Constipation; S. – Smoking; A. – Alcohol; T. – Tobacco; N. – No habits; KP. – Kapha-pitta; KV – Kapha-vata; VP – Vata-pitta.

Master Chart No 3 Prabhoota

mutrata Pipasadhikya Kshudadhikya Karapadadaha Ati Sweda FBS PPBS Urine sugar Body weight Sl. OPD

NO. BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF

01. 5204 2 1 0 2 1 1 1 0 0 1 1 0 0 0 0 126 125 98 197 170 149 1 1 0.5 63 62 62 02. 5235 1 1 0 1 0 0 2 0 1 0 0 0 0 0 0 120 112 110 158 132 126 1 0.5 0 80 77 78 03. 5311 1 0 0 2 1 1 1 1 0 2 1 0 1 1 1 106 110 104 145 150 138 0.5 0.5 0 70 68 65.5 04. 5324 2 1 0 2 1 0 1 0 0 1 1 0 0 0 0 132 125 127 225 198 175 1 1 0.5 74 73 73.5 05. 5337 2 1 0 2 1 1 2 1 0 2 1 0 1 0 0 138 136 117 180 170 153 1 0.5 0.5 95 92.5 93 06. 5387 1 0 1 1 0 0 2 1 0 2 1 1 0 0 0 110 110 98 193 170 142 0.5 0.5 0 65 63.5 62.5 07. 5385 2 1 1 2 1 0 2 0 1 1 1 0 0 0 0 105 100 98 150 164 130 0.5 0 0 72 71 70.5 08. 5451 1 0 0 1 0 1 1 0 0 1 0 0 1 0 1 130 120 111 230 198 160 1 0.5 0.5 68 67 67.5 09. 929 2 1 0 1 0 1 0 0 0 1 0 0 1 0 0 120 120 105 193 190 164 1 0.5 0.5 75 73.5 74 10. 945 1 0 0 2 1 0 1 0 1 1 0 1 0 0 0 135 130 115 246 255 190 0.5 0.5 0.5 68 66.5 67 11. 1140 1 0 0 2 1 1 2 1 0 1 0 0 1 1 0 118 118 100 173 160 128 0.5 0 0 76 77.58 73.5 12. 1141 2 1 0 1 0 0 1 0 0 0 0 0 1 0 0 105 105 100 154 185 130 0 0 0 68 68 68.5 13. 1184 1 0 0 1 0 0 2 1 0 1 0 0 1 1 1 138 125 107 197 230 160 0.5 0.5 0 78 78 77 14. 1613 1 0 0 2 1 0 1 0 0 1 1 0 0 0 0 156 150 138 363 400 330 1.5 1.5 1 64 64 63 15. 1718 1 0 0 1 0 0 1 0 0 1 0 1 0 0 0 160 134 126 257 260 211 1.5 0.5 1 62 61 60.5 16. 1413 2 1 0 1 0 0 0 0 0 1 1 0 0 0 0 141 116 102 222 230 191 1 0.5 1 59.5 59 59 17. 1221 1 0 0 2 1 0 1 1 0 0 0 0 0 0 0 170 139 159 265 238 204 1 0.5 1 63.5 64 62 18. 1519 2 1 0 2 1 0 2 1 0 1 0 0 0 0 0 118 138 115 193 205 183 0.5 0.5 0.5 73 72.5 72.5 19. 2906 2 1 1 1 0 1 2 1 1 1 1 0 1 1 1 170 139 158 298 310 271 1 1.5 1 89 88.5 88 20. 2933 2 2 1 1 0 0 2 1 1 1 0 0 0 0 0 130 140 123 273 248 203 0.5 0 0 61.5 62 61.5 21. 3062 1 0 0 1 0 0 0 0 0 0 01 0 1 0 0 107 85 94 215 225 183 0.5 0 0.5 58 58.5 58 22. 3094 3 2 1 2 1 1 2 1 0 0 0 0 1 1 0 188 152 141 305 330 268 1.5 1 1 76 75.5 74.5 23. 3603 1 0 0 1 0 0 1 1 0 1 1 0 1 0 0 116 113 94 275 164 141 1 0.5 0.5 67 66 63.5 24. 3227 1 1 0 1 0 1 2 1 0 1 0 0 0 0 0 118 115 108 183 170 145 0.5 0 0 55 53.5 53 25. 3375 2 1 1 2 1 1 2 1 1 1 1 0 1 0 0 138 135 120 140 213 174 1 0.5 0 58 57 56.5 26. 3438 3 2 1 2 1 0 1 0 0 0 0 0 1 1 1 102 104 90 147 179 143 0.5 0 0 85 82.5 83 27. 3495 3 2 1 1 1 0 2 1 0 1 0 1 1 0 0 220 216 178 444 372 370 1.5 1 1 63 61 61 28. 3630 3 2 1 2 1 0 1 0 1 0 0 0 0 0 0 141 125 103 198 189 163 0.5 0 0 62 61 60.5 29. 3750 3 1 1 2 1 1 2 1 1 1 1 0 1 1 0 195 180 138 236 240 181 0.5 0.5 0.5 64 64 63.5 30. 3751 2 2 1 1 0 0 2 1 1 1 0 0 1 1 0 133 119 116 276 220 174 0.5 0.5 0 65 63.5 63.5

BT – Before treatment; AT – After treatment; AF – After follow-up.

Results

Table. No- 17 Showing the Data of Age Group Incidence and Response

Sl.no.

Age.group.

No.of.pts.

%

GR

%

MR

%

PR

%

1

35-39

02

6.66

-

-

2

100

-

-

2

40-44

05

16.66

3

60

2

40

-

-

3

45-49

06

20

3

50

3

50

- -

4

50-54

07

23.33

2

28.57

3

42.85

2

28.57

5

55-59

07

23.33

2

28.57

4

57.14

1

14.28

6

60-64

03

10

1

33.33

1

33.33

1

33.33

Among age group 35-39 it contains 2 patients i.e. (6.66%) and 2 patients responded moderately (100%). 40-44 age groups include 5 patients i.e. 16.66% and in that all 3 patients i.e.60% responded well, 2 patients i.e. 40% responded moderately.

Age group 45-49 includes 6 patients i.e. 20% and in that 3 patients (50%) responded well, 3 patients (50%) responded moderately. Age group 50-54 includes 7 patients i.e. 23.33%. In those 2 patients i.e. 28.57% responded well, 4 patents i.e. 57.14% responded moderately and one patient showed poor response. 55-59 age group contains 7 patients i.e. 23.23% is in that 2 (28.57%) patients responded well, 4 patients responded moderately i.e. (57.14%) and 1 i.e. (33.33) patient showed poor response. Last 60-64 age group includes 3 patients i.e. 10% and in that 1 (33.33%) patient responded well, 1 patients responded moderately i.e. (33.33%) and 1 patient showed poor response.

Graph no-1

“Evaluation of efficacy of Madhutailika Bastikarma in the Management of Madhumeha’

125

Results

0

1

2

3

4

5

age

no o

f pts

GR 0 3 3 2 2 1MR 2 2 3 3 4 1PR 0 0 0 2 1 1

35-39 40-44 45-49 50-54 55-59 60-64

Table. No- 18 Showing the Sex Group Incidence and Response Sl.no.

Sex

No.of.pts.

%

GR

%

MR

%

PR

%

1

Male

25

83.33

10

40

12

48

3

12

2

Female

05

16.66

2

40

2

40

1

20

Out of 30 patients, 25 were males (83.33%) and 5 were females (16.66%). Among

males 10 patients (40%) responded well, 12 patients (48%) responded moderately and 1

patient showed poor response.

Among females 2 patients responded well i.e. (40%), 2 patients responded

moderately (40%) and 1 patient showed poor response.

Graph no-2


126

Results

0

5

10

15

GR MR PR

Sex group incidence and response

Male Female

Table. No- 19 Showing the Chronicity and Response

Sl.no. Duration No.of.pts % GR % MR % PR % 1 <1 06 20 2 33.33 2 33.33 2 33.33 2 >1 11 36.66 6 54.54 4 36.36 1 9.09 3 >2 09 30 2 22.22 6 66.66 1 11.11 4 >3 04 13.33 2 50 2 50 - -

Among 30 patients, 6 patients’ (20%) were newly diagnosed. In that category 2

patient’s (33.33%) responded well and 2 patients (33.33%) responded moderately and 2

patient’s showed poor response.

In the above 1 year group, 11 patients’ (36.66%) and in that 6 patients (54.54%)

responded well, 4 patient’s response was moderate (36.36%) and one patient i.e. (9.09%)

showed poor response.

In the >-2 year group contains 9 patients (30%). Among them 2 patient’s

(22.22%) responded well, 6 patients (66.66%) responded moderately and 1 patient

(11.11%) showed poor response.


127

Results

More than 3 year group contains 4 patients (13.33%) and in that 2 patients

responded well and 2 patient’s showed moderate response.

Graph no-3

chronicity and response

0

5

10

15

<1 yr >1yr >2 >3

No.of.pts GR MR PR

Table. No- 20

Showing the Incidence of Religion and Response

Sl.no.

Religion

No.of.pts.

%

GR

%

MR

%

PR

%

1

Hindu

26

86.66

12

46.15

11

42.30

3

11.53

2

Muslim

04

13.33

1

25

2

50

1

25

3

Others

-

-

-

-

-

-

-

-


128

Results

In religion 26 patients were Hindu (86.66%) and4 patients were Muslim

i.e.(13.33%). Among the Hindus, 12 patients (46.15%) responded well, 11 patients

(42.30%) responded moderately and 3 patients (11.53%) showed poor response.

Graph no-4

0

5

10

15

Hindu Muslim Others

religion and response

GR MR PR

Table. No- 21 Showing the Socioeconomic Status and Response Sl.no. Economic

Status. No.of. pts.

% GR % MR % PR %

1

Poor

05

16.66

-

-

4

80

1

20

2

Middle

08

26.66

5

62.5

2

25

1

12.5

3

Upper Middle

14

46.66

5

35.71

7

50

2

14.28

4

High Class

03

10

2

66.66

1

33.33

-

-


129

Results

Among 30 patients 5 patients was poor i.e. (16.66%), in that 4 (80%) patient’s

responded moderately and 1 patient (20%) showed poor response.

8 patients (26.66%) were middle class, among them 5 patient’s (62.5%) response

was good, 2 patient’s (25%) responded moderately and one patient (12.5%) showed poor

response.

14 patients were upper middle class and in that 5 patients (35.71%) responded

well, 7 patients (50%) responded moderately and 1 patient (14.28%) showed poor

response.

Among 3 high-class patient (10%). 2 Patients (66.66%) responded well and one

patient (33.33%) responded moderately.

Graph no-5

02468

Poor Middle UpperMiddle

HighClass

Economic status and response

GR

MR

PR

Table. No- 22

Showing the Incidence of Religion and Response

Sl.no.

Religion

No.of.pts.

%

GR

%

MR

%

PR

%

1

Hindu

26

86.66

12

46.15

11

42.30

3

11.53

2

Muslim

04

13.33

1

25

2

50

1

25

3

Others

-

-

-

-

-

-

-

-


130

Results

In religion 26 patients were Hindu (86.66%) and4 patients were Muslim

i.e.(13.33%). Among the Hindus, 12 patients (46.15%) responded well, 11 patients


Graph no-6

0

5

10

15

Hindu Muslim Others

religion and response

GR MR PR

Table. No- 23 Showing the Incidence of Occupation and Response Sl.no. occupation

No.of.pts.

%

GR

%

MR

%

PR

%

1

Sedentary

25

83.33

13

52

9

36

3

12

3

Labour

05

16. 66

-

-

4

80

1

20


131

Results

4

Others

-

-

-

-

-

-

-

-

In occupation status, 25 patients were sedentary (83.33%) and 5 patients were

labors (16.66%).

Among the sedentary category 13 patients (52%) responded well, 9 patients

(36%) responded moderately and 1 patient (12%) showed poor response.

Among labors 4patient’s (80%) responded moderately, and 1 patient (20%)


Graph no-7

0

5

10

15

Sedentary Labour others

Occupation and Response

GR MR PR

Table. No- 24 Showing the Family History and Response Sl.no. Family

History No.of.pts. % GR % MR % PR %

1

Present

19

63.33

8

42.10

09

47.36

2

10.52


132

Results

2

Absent

11

36.66

4

36.36

5

45.45

2

18.18

Among 30 patients, 19 patients’ (63.33%) had family history and in that 8 patients

i.e. (42.10%) responded well, 9 patient responded moderately and 2 patient’s showed

poor response.

Other 11 patients (36.66%) had no family history and in that 4 patient’s (36.36%)

responded well, 5 patients (45.45%) responded moderately and 2 patients (18.18%)


Graph no-8

0

5

10

Present Absent

Family history and response

GRMRPR

Table. No-25 Showing the Treatment History and Response Sl.no Treatment

History No.of.pts. % GR % MR % PR %

1

Allopathy

24

80

11

45.83 10

41.66 3

12.5


133

Results

2

Ayurveda

04

13.33

1

25

3

12.5

-

-

3

No treatment

02

6.66

-

-

1

50

1

50

Among 30 patients, 24 patients (80%) had undergone allopathic treatment, 4

patients (13.33%) had taken Ayurvedic treatment and 2 patients (6.66%) had no treatment

history.

Among the patients those who had taken allopathic treatment, 11 patients

(45.83%) responded well, 10 patients (41.66%) responded moderately and 3 patients


In Ayurvedic treatment group, 1 patient’s (50%) responded well and 3 patient’s

(50%) responded moderately.

In the no treatment history group, one patient (50%) responded moderate and 1 patient


Graph no-9

0

5

10

15

GR MR PR

Treatment history and response

Allopathy Ayurveda No treatment

Table. No-26 Showing the Habits of the Patient and Response

Sl.no. Habits No.of.pts % GR % MR % PR % 1 Smoking 06 20.00 2 33.33 3 50 1 16.66 2 Alcohol 14 46.66 5 35.71 7 50 2 14.28


134

Results

3 Tobacco 02 6.66 1 50 - - 1 50 4 No habbit 08 26.66 4 50 4 50 - -

Among 30 patients, 06 patients (20%) had the habit of smoking and in them, 2 patients (33.33%) responded well, 3 patients (50%) responded moderately and 1 patient (16.66%) showed poor response.

14 patients (46.66%) had the habit of drinking alcohol and in them 5 patients

(35.71%) responded well, 7 patients (50%), responded moderately and 2 patient’s


2 patients (6.66%) had the habit of tobacco chewing, one patient responded good

and one patient showed poor response.

8 patients (26.66%) had the no habit, in that 4 patients (50%) responded well and

4 patient’s (50%) responded moderately.

Graph no-10

0

5

10

15

Smoking Tobacco

Food habbits and Response

No.of.pts GR MR PR

Table. No- 27 Showing the Nature of Malapravrithi and Response


135

Results

Sl. no.

Malapravritti

No. of.pts.

%

GR

%

MR

%

PR

%

1

Free

11

36.66

4

36.36

4

36.36

3

27.27

2

Constipation

19

63.33

8

42.10

10

52.63

1

5.26

Among 30 patients, 11 patients (36.66%) had free bowel and in that 4 patients

(36.36%) responded well, 4 patients (36.36%) responded moderately and 3 patients


19 patients had constipation (63.33%) and in that 8 patients (42.10%) responded

well, 10 patients (52.63%) responded moderately and 1 patient (5.26%) showed poor

response.

Graph no-11

Free

GR37%

MR36%

PR27%

GR MR PR

C o n s t i p a t i o n

G R4 2 %

M R5 3 %

P R5 %

G R M R P R

Table. No – 28 Showing the Nidana Status and Response


136

Results


137

Among 30 patients, all of

them used to indulge in general

aharaja nidanas, like snigdha atyupayoga (100%) and guru ahara atyupayoga (100%).

Sl.no. Nidana No.of.pts.

% %

1 Snigdha 30 100 2 Guru 30 100 3 Asya Sukha 22 73.33 4 Swapna Sukha 20 66.66 5 Alpavyayam 24 80.00 6 Alpa Chinta 09 30.00

22 patients (73%) used to indulge in the vihara asyasukham.

20 patients (66.66%) indulge in more swapna sukham vihara

24 patients (80%) indulge in alpavyayama and 12 patients (40%) indulge in

alpachinta

Graph no-12

Types of Nidana

Swapna Sukha15%

Asya Sukha16%

Guru22%

Alpa Chinta7%

Snigdha22%Alpavyayam

18%

Results


138

Table. No – 29 Showing the Nature of Koshta and Response Sl.no.

Kostha

No.of.pts.

%

GR

%

MR

%

PR

%

1

Mrudu

08

26.66

4

50

3

37.5

1

12.5

2

Madhyama

19

63.33

7

36.84

9

47.36

3

15.78

3

Kroora

03

10

1

33.33

2

66.66

-

-

Among 30 patients, 8 patients (26.66%) had mrudu koshta, 19 patients had

(63.33%), madhyama koshta and 3 patient’s (10) had krura koshta.

In mrudu koshta patients, 4 patient’s (50%) response was well, 3 patients

responded moderately and one patient showed poor response.

Among madhyma koshta patients, 7 patients (36.84%) responded well, 9 patients


In 3 krura koshta patients one patient (33.33) responded well and 2 patients

(66.66%) responded moderately

Graph no-13 .

Results

0

2

4

6

8

10

Mrudu Madhyama Kroora

NATURE OF KOSHTA

GRMRPR

Table. No- 30 Showing the Status of Agni and Response

Sl.no.

Agni

No.of.pts.

%

GR

%

MR

%

PR

%

1

Mandagni

07

23.33

2

28.57

4

57.14

1

14.28

2

Teekshnagni

20

66.66

8

40

10

50

2

10

3

Samagni

03

10

1

33.33

1

33.33

1

33.33

Among 30 patients 7 patients (23.33%) had Mandagni and in that 2 patients

(28.57%) responded well. 4 patients (57.14%) responded moderately and one patient


In 20 Teekshanagni, 8 patients (40%) responded well. 10 patients (50%)

responded moderately and 2 patients (10%) showed poor response.

In 3 Samagni, one patient well responded, one patient responded moderately and one patient showed poor response.

Graph no-14


139

Results

0

2

4

6

8

10

Mandagni Samagni

Nature of Agni and Response

GR

MR

PR

Table. No – 31 Showing the Prakruiti of the Patient and Response

Sl. no.

Prakruiti

No.of. pts.

%

GR

%

MR

%

PR

%

1 Kapha Pitta

15

50

6

40

7

46.66

2

13.33

2 Kapha Vata

09

30

3

33.33

5

55.55

1

11.11

3

Vata Pitta

06

20

3

50

2

33.33

1

16.66

Among 30 patients, 15 patients (50%) came under kapha pitta, 9 patient’s kapha-

vata prakriti and 6 patient of vata pitta prakruti.

In first group 6 patients (40%) responded well, 7 patients (46.66%) responded

moderately and 2 patients’ (13.33%) showed poor response.

Among kapha-vata prakriti patients, 3 patients (33.33%) responded well, 5 patients

(55.55%) responded moderately and 1 patient (11.11%) response was poor.


140

Results

Graph no-15

0

2

4

6

8

Kapha Pitta Kapha Vata Vata Pitta

Prakruti and response

GR

MR

PR

Table. No- 32 Showing the Statastical data of the Study

Individual study of the parameters showing the significance effect before and after the treatment.


141

Results

Sl.no.

Parameters Mean S.D S.E T-Value P- Value Remarks

1

Prabhoota Mutrata

1.4

0.563

0.102

13.72

< 0.001

HS

2

Pipasadhikya

1.16

0.592

0.108

10.74

< 0.001

HS

3

Kshudhadikya

1.133

0.628

0.114

9.938

< 0.001

HS

4

Karapada Daha

0.733

0.583

0.106

6.915

< 0.001

HS

5

Atisweda

0.333

0.479

0.087

3.827

< 0.001

HS

6

FBS

21.766

15.31

2.795

7.787

< 0.001

HS

7

PPBS

45.43

26.234

4.789

9.486

< 0.001

HS

8

Urine Sugar

0.4

0.242

0.044

9.090

< 0.001

HS

9

Body Weight

1.316

0.793

0.144

9.138

< 0.001

HS

Conclusion on the statistical data.

All the parameters show highly significant, (as P<0.05). The subjective parameters

orderly prabhoota mutrata,pipasadhikya and kshudadhikya, shows highly significant than

karapada daha and atisweda,(by comparing t-values). The parameter prabhoota mootrata

shows net mean effect more,there atisweda shows low net mean effect. Similarly the

parameter kshudadhikya shows more variations and the parameter atisweda shows low

variations, (by comparing, mean and S.D).

The objective parameters orderly PPBS, Body weight, urine sugar shows highly

significant than FBS, (by comparing t-value) the PPBS shows high net mean effect with


142

Results


143

more variations, where as the parameter urine sugar shows low net mean effect with low

variation (by comparing, mean and S.D)

The parameter PPBS, shows high mean effect and urine sugar shows low mean effect

after the treatment. There is a more variation in PPBS and low variation in urine after the

treatment; the parameter body weight shows uniform effect on the patients, by comparing

mean, S.D, and C.V.

Discussion

DISCUSSION

Discussion part is divided into five sections.

1. Discussion on Madhumeha and diabetes mellitus.

2. Discussion on role of bastikarma in the management of Madhumeha.

3. Discussion on clinical study and over all response.

4. Discussion on importance of Madhutailik basti in Madhumeha.

5. Discussion on probable mode of action and mechanism of Madhutailik basti

Bastikarma and Madhumeha

Basti is a major shodhana therapy among panchakarmas. In the present study, the first

point to be discussed is how basti is helpful in sthooola Madhumehi.

In the classics samshodhana, shamanaushadhis and also pathyahara viharas are

mentioned for modhumehi among them, basti karma was taken here for the study.

Though it is kapha pradhana vyadhi, due the involvement of vata dosha, some

specific bastis are indicated in madhumeha, madhutailika basti is also one among

them. In the context of Basti yogya and ayogya it is contraindicated in madhumeha as

it is a kledajanya vyadhi, in the same time basti is indicated in bala, varna and mamsa

kshaya condition; so basti can be given in madhumeha where the bala of the patient is

detoriated and it is very difficult to Performa other shodhana procedures. The factors,

which help in the pacification of Madhumeha by madhumehara bastis are as follows,

Basthi causes shodhana of malas from all parts of the body

Madhumeha is a kapha vata vyadhi, Basti will help in normalizing the vata by

removing avarana, it helps in eliminating an amount of vitiated kleda, malas and

doshas from the body, which is very much helpful to clear or check the

dhathuparinama and there by helps in the reduction or pacification of the disease.


142

Discussion

As a result fat metabolism is checked and hence undigested and unutilized fat

will be excreted out.

Restriction of diet during basti will help in normalizing the digestion metabolism.

In the treatment of sthoolamehi reduction of weight is also have a role. Above-

mentioned factors are very much helpful in the reduction of weight, when there is

reduction of weight, then insulin resistance will be reduced and as a result relative

insulin deficiency will also get corrected.

Obesity is an extremely important factor in the formation of type –II diabetes.

Approximately 80% of type II diabetic patients are obese. In this impaired

binding is a result of decrease in the number of insulin receptors. Basti therapy

helps in diminishing the insulin resistance by the reduction of weight and

obviously it reduces the stress over beta cells.

.

Madhumeha v/s diabetes mellitus:

Madhumeha Richmans disease, since Vedic period it is familiar to mankind. It is

documented as one among the twenty obstinate urinary disorders. It abhishagaja vyadhi,

at the same time it is also explained that, when the other pramehas are left untreated,

these lead to the condition called Madhumeha. So Madhumeha can also be considered as

an advanced condition or stage of Pramehas are Nidanarthakara rogas of Madhumeha.

Traditionally, Madhumeha has been equated with diabetes mellitus. Madhumeha

is a disease in which certain pathological changes in urine are noted along with some

other changes, the most important being the presence of madhuryata ( glucose). Since the

disease is connected with the urinary system with the presence of sugar in urine. Apart


143

Discussion

from this, tanu madhuryata also mentioned, which can be taken as blood sugar. Like this

the equation of Madhumeha with diabetes mellitus is justifiable.

Also in view of the similarity in signs and symptoms Madhumeha has been

equated, with diabetes. Among them, some correlations are given below.

Obesity is mentioned as a major causative factor for diabetes mellitus, as it causes

insulin resistance. In Ayurveda Sthoulya is mentioned as a nidanarthakara roga for

Madhumeha and is included under santarpanajanya vyadhis.

Madhura, snigdha bhojana are mentioned as nidanas for madhumeha. In modern

science over eating and sedentary lifestyles are the predisposing factors for diabetes

mellitus. Those food articles and overeating, causes obesity and which may cause

Diabetes mellitus.

Prabhoota avila mootrata is considered as a pratyatma lakshana of madhumeha.

In this the bahudrava kapha along with other dooshyas mainly kleda pradhana dooshyas

in the basti is the cause for prabhoota avila mootrata. The same reason has been given in

modern science for Polyurea that is the osmotic diuretic effect of glucose in the kidney

tubules.

Glycosuria explained in the modern science can be taken as madhusama mootra.

The reason for this Madhusama mootra is bahudrava kapha or ojus, which is excreted

through mootra.

Pipasa or polydipsia mentioned in both sciences. Depletion of intracellular water

triggering the more receptors of thirst center of brain and thirst is noted, which is similar

to pipasa of Ayurvedic Science and here due to excessive loss of the urine, pipasa is

noted.


144

Discussion

In modern science the condition weakness is due to lack of glucose utilization,

loss of electrolyte and proteins. In Ayurveda this same condition is due to aparipakwa,

dhatu i.e. lack of proper nourishment.

Kulaja dosha and beeja dosha have been mentioned in the causative factors of

Sahaja Prameha type I diabetes mellitus Such patients are said to be weak, emaciated,

suffering from thirst, loss of appetite and are required to be treated with a nourishing diet.

In diabetes also genetic and hereditary factors are mentioned as causative factors.

In such patients weakness and emaciation are noted. The above-mentioned patients are

Juvenile diabetics and require a nourishing diet. Therefore Sahaja Pramehi and Juvenile

diabetes may be correlated.

Apathyanimittaja Madhumeha explained by sushruta, in such patients, atikshudha,

atinidra and aalasya are noted. And it is caused due to excessive intake of madhura

snigdha ahara and vihara, which favours kapha medovridhi. Maturity onset diabetes tend

to occure in people indulging in over eating and are lazy in nature, while explaining

chikitsa charaka have explained sthoola and krisha classification. The same type of

classification can be seen in modern science as obese and non-obese type.

Upadravas of Ayurveda can be correlated to some of the complications of modern

science. For Example Trishna, bhrama, shoola, tama pravesha and swasa can be

correlated to diabetic Ketoacidosis, in which thirst, weakness, blurred vision, abdominal

pain, air hunger etc are seen.

Insulin resistance and relative insulin deficiency are the main phenomenon in the

pathogenesis of the diabetes mellitus on obese individuals. Some recent ayurvedic

scholars have correlated medodhatwagni with insulin.


145

Discussion

In the normal state sthiratwa, dardya, utsaha, vrishata, budhi, etc are contributed

by kapha, which is also known as bala or oja. By seeing this, we can correlate this kapha

with glucose. In madhumeha, the kapha, which is vitiated and which is in bahudravata

flacid form travels all over the body in rasa produces tanu madhuryata, which can be

taken as hyperglycemia, i.e. increased blood glucose condition.

Discussion on Observation

All the trial cases of madhumeha were reported to OPD & IPD of Shri D.G.M.

Ayurvedic Medical College by pre-set inclusion and exclusion criteria. Special medical

camps were also conducted in the college for selecting the patient. Data of 30 patients

who had satisfied the diagnostic criteria, underwent the treatment and reported for the

follow-up are discussed here. There is no dropout in the study and all the 30 patients were

appeared for the assessment of results.

These observational findings are discussed below.

Age

Because of decrease in beta cells the Risk of diabetes increases as age advances;

especially after 40 years. It is well recorded fact that, the NIDDM occurs only after 3rd

decade of life. In this study, the above factors were proved, as all the patients were

between the age group of 30 to 60. It is also noted that maximum number of patients;

were between the age of 40 to 60 Years.

Sex

Acharya Sushruta had said that women wouldn’t get Madhumeha; because their

body gets cleaned every month by the raja pravrutti. But it is considered as a

controversial dialogue as women also getting madhumeha and they are also at high risk

of getting diabetes compared to men after 30 Years. From Sushruta’s statement we can

understand the importance of shodhana. But in this study majority of the patients were

male when compared to females i.e. 25 male patients and 5 female patients.


146

Discussion

Food Habits

In the manifestation of madhumeha, food habits had great importance. If we

check the nidana aspects we can see the importance of food habits. At the same time lot

of foods are also mentioned which are helpful in controlling madhumeha.

In the present study 13 Patients were vegetarians and 17 patients were non-

vegetarian’s (mixed). From these we can see that high calorie intake is the main risk

factor for diabetes and sthoulya. Food items, which increase the sleshma, medas and

mamsa, are the main reason behind madhumeha. Similar types of aharaja nidna are seen

in sthoulya.

Religion

In the present study majority of the patients were Hindus (25%), but it does not

mean that Hindus are more prone to this disease. This may be due to the local ratio of

difference religion. The patients were selected incidentally.

Occupation

Maximum numbers of patients were with sedentary type of occupations. In

sedentary type of occupations physical activities are very less and in both Ayurveda and

modern science, it is clearly mentioned that people with sedentary life styles are more

prone to diabetes mellitus or Madhumeha. In present study 25 patients were recorded

with sedentary life style.

Socioeconomic Status

Majority of the patients belongs to upper middle and high class. In these classes,

the people indulge in very less activities and ultimately with sedentary life styles and

such persons are more prone to diabetes.

Family History

In the present study 19 patients had family history and rest of the 11 the patients

had no family history of madhumeha. It is a well-proven factor that family history had a

main role in the manifestation of sthoola madhumeha.

Chronicity

In the present study only mild and moderate type of diabetes mellitus were taken

for the study and in this study 6 patients were newly diagnosed. In the remaining patients,

20 patients were suffering from this disease since 1-2 years, 11 patients below 2 year and


147

Discussion

9 patients were there in the above 3 years and 4 patients are above 3 year category. As it

is a chronic, relapsing type of disease, only mild and moderate types of cases were taken

for the study.

Deha Prakriti

Even though madhumeha is a disease with the involvement of 3 doshas, here an

attempt was made in this study to find out the doshik involvement based on the

symptoamatology dealt in classics. The study observed that involvement of both vata and

kapha was the most predominant feature 16 patients were with kapha pitta prakriti and

9patients were with kapha vata Prakriti, 6 patient were vata pitta prakruti From this we

can understand the involvement of Kapha and vata as a main dosha in the manifestation

of madhumeha.

Agni

Majority of the patients (20 patients) were with teekshnaagni followed by

Samagni (7 patients) and samagni (3patient). In this study the incidence of teekshnagni

justifies the significance of role of Agni in the pathogenesis of the disease madhumeha.

Nidanas

Most of the nidanas mentioned in the classics were elicited in this study by

detailed questioning. Among general nidanas, all patients used to take snigdha aharas and

guru aharas excessively. Among the viharas, asya sukham (27 patients), swapna sukham

(25 patients), alpa vyayama (26 patients) and alpa chinta (12 patients) were also noted.

From this we can say that snigdhadi ahara dravyas and asya sukhadi viharas had key role

among the nidanas.

Basavarajiyam a 16th century physician of Andhrapradesh has included the

excessive indulgence in alcoholic beverages as one of the nidana of prameha roga. In the

present study 14 patients had the habit of taking alcoholic drinks.

Lakshanas

In all the patients’ prabhoota mootrata was noted. Other symptoms like

pipasadhikya, kshudadhikya, karapada daha, atisweda, etc. were also seen in most of the

patients. Gayadasa says kara pada daha is due to vyadhi prabhava and other symptoms

like snigdha pichila guruta and madhurata shukla mootrata are due to kapha only.

Regarding other symptoms discussions were done already.


148

Discussion

Importance of mixing of bastidravya

In ayurveda many formulations have been explained for preparation of medicine

under the heading of panchavidha kashayakalpana. almost all different preparations of

modern science arebased on these formulations, vagbhata and other acharyas are

mentioned specific formulations in the form of mixing of basti dravyas in proper order

viz .Makshikam, lavanam, sneham, kalkam, kwatham. Here an attempt made to know the

rationality behind this

Makshika

Honey bee drinks the florescence’s of the different nectars. This nectar is

nothing but secretion of plants which contains mainly flavonoides, it is vomits. The

vomited substance of the honey bee contains bile products like bile pigment and bile salt,

this bile resembles as that of the pittantya as we commonly seen in samyaka vamana.

Basically bile salt rich in emulsification and bile pigments (sodium glycocolic acid) are

rich in saphonification.

Saidhava

By adding and churning with saindhava (NaCl2) the mixture becomes light and

liquid, it reduced surface tension of honey helps in increasing the dravya prasarana. The

sookshma srotogami property of madhu and saindhava makes biodegradable of micro

particles and it leads to precise amount of drug delivery at a local area. The main aim of

using saindhava is to increase the emulsification.

Sneha

By adding of sneha in to this mixture the sneha gets emulsification due to affinity

of sodium hydroxide towards fat. Here the saphonification helps in solubility of drug that


149

Discussion

is water in oil emulsification (one molecule of fat binds with the two molecules of water),

the whole sneha dravya converts in to water soluble and it will enhance the absorption of

drug.

Kalka

It makes whole mixture in to suspension form; the fine powder helps in uniform

molecule binding.

Kwatha

By adding and churning the kwath it will become same state without sedimentation, it

gives the selective permeability to mixture and helps in crossing the Blood brain barrier

(BBB), similar explanations also available in classics i.e.Charaka siddisthana 3/23.

Madhutalika vasti and madhumeha

This yoga has been selected for the study because of the direct indication

of madhutailika vasti by vagbhata, he has considered this under niroohabasti. The

treatment given to all the 30 patients includes abhyanga with moorchita tila taila,

swedana locally and madhutailika vasti 8 days. In this particular context

prabhootavilamootrata, pipasadhikya etc are the main symptoms and the aim of

management is to control it, as madhumeha is kapha pradhana vatavyadhi, along with

kleda and meda, as it is considered under sidda and yapana basti, the unique combination

of this basti is Makshikam, lavanama, taila ( moorchita tila taila ), shatapushpi and

Erandamoola.


150

Discussion

Shatapushpi and Eranda are having the vata shamaka, vatanulomaka and prameha hara

property. In madhumeha vata gets alleviated by basti along with this some amount of

kapha also expelled out.

The present work is aimed to evaluate the efficacy of madhutailika vasti only.

Hence, other shodhana karmas where not done. No specific pathya pathya has been

advised to be followed.

Probable mode of action of basti in madhumeha

Honey is rich dietary supplement and it is alkaline media, generally alkalines

(kshara) are beneficial in kapha dosha treatment, the antibiotic property of honey helps in

formation of healthy bacterial flora in the intestine it is very much needed for drug

absorption. Rectum is the moola for sharera as chakrapani explained “gudamoolam

shareerasya” and most of the capillaries are presentment in guda helps in absorption of

medicinal property and helps to enters in to the systemic circulation, as smaller channels

of the root absorbs the water and these are merge in large stream or channels and

nourishes the body, lavana (sodium chloride) is a integral part of body constituent, this

will inhibit thirst by maintains the electrolyte balances. Sookshma srotosravka property

acts as a vehicle for the chief ingredient. Tila is best remedy for vata vyadhi and

alleviates the kleda if it is administer internally, the ushna property of tila taila normalize

the kapha and vata, as it possesses both brihmana and karshna effect, shatapushpi

contains some amount of anti-oxidants these helps in the cellular nourishment. Eranda

having a tikta and madhura rasa with ushna veerya will nullify the vata and kaph. It is

rasayana, medhya and shoola hara. It contains anti-oxidants like gallic, skimmic, ellagic,

ferulic and coumarinic these are reduses the endoneural hypoxia which is the main factor

in the pathology.


151

Discussion

CONCLUSION

A close perusal of the observation and inference that can be drawn leads to the

following conclusions.

• Madhutailika basti is an effective treatment in the management of Madhumeha

and it shows long lasting result.

• Madhutailika basti can be administered without prior other procedures like

snehapana, swedana or virechana.

• Complications are rarely occurring during and after the course of bastikarma.

• It is easy to constitute, less time consuming and gives least discomfort to both

patient and physician.

• It is cheap compared to other conventional methods of management of

Madhumeha.

• Madhumeha can be undoubtedly compared with that of Diabetes mellitus on its

etiopathogenesis and symptomatologies etc.

• In mild and moderate type of sthoola madhumeha, Madhutailika basti alone is

enough to control it.

• Along with bastikarma, administration of pathya ahara viharas may give more

effect.

Suggestions for future study

1. Study is better to be conducted on a large sample.

Study has been conducted in yoga basti Sankhya and facts revealed in the study suggest

that the results will be more encouraging if the Vaitharanabasti is administered in the

Sankhya of kalabasti or karmabasti.


153

Summary

SUMMARY

The Panchakarma therapy is an important part of Ayurveda. The procedures of

Panchakarma therapy have thrown new light on the management of disease and have

provided effective weapons against them. The entire group of purification procedures is

based up on promoting the body’s natural methods of elimination of unwanted

substances. Among the Panchakarmas, the vasti is an important one, which had great

importance and at the same time it is highly effective therapy. It is a process by which

the doshas are made to pass through the guda marga. It is a specific treatment for vata

dosha, and vata associated with pitta as well as kapha doshas. Based on the property

Madhutalika vasti is fall under mrudu vasti, with a synonym of sidda vasti, yapana vasti,

vasti, though it is the type of nirooha patients are not much restricted.

Management of madhumeha is perhaps one of the most important and interesting

subject in the clinical practice considering its high prevalence as well as profound impact

the treatment has on long term morbidity and mortality of the patient. Increasing

urbanization industrialization and due to increased sedentary life styles seems to be

contributing to increasing prevalence of madhumeha.

Like the disease, the treatment of madhumeha is also prolonged one. Since the

patient of madhumeha have been divided in to the sthoola and krisha varities, the separate

methods of treatments are mentioned in classics, and from that vasti therapy was taken as

a choice of treatment in the present study and is adopted in sthoola madhumeha patients.

Keeping in mind, the objectives of this study was, “Evaluate the efficacy of

madhutailika vasti in the management of madhumeha (NIDDM)”. During 8 days basti


155

Summary

course 3 niroohas prepared with madhu,saindhava,morchita tila taila, shatapuspi kalka

and eranda moola kwath were administered along with 5 anuvasana vasti by using

morchita tila taila. Madhutalika vasti was selected for the study as its efficacy is

explained by vagbhata in astanga hridaya kalpa sthana 4/27-28.

The present work covered the following areas-

Introductory part regarding the present work and the objectives.

Historical aspect of basti, madhumeha and also the mile stones and previous

research works in the field of diabetes mellitus.

Basti karma in detail along with its modern concepts, anatomical and

physiological aspects.

Modern description regarding the diabetes mellitus along with the physiological

and anatomical descriptions of glands involved in it.

Nidana panchakas of madhumeha, simultaneously explanation of dibetes mellitus

in modern counterpart has been done along with the comparison and description

in the same context.

Description regarding the materials and methods used in the present study.

Observations of the present study, results, discussion, summery, conclusion and

finally bibliography and references.

The study was conducted in a single group and all the patients received classical.

The effect of the therapy was assessed statistically by using student t-test.

It was found that Basti shows long-termi effect. But, it was also noted that due to

food and activities of the patient there is gradual variation in sugar levels after Basti. So


156

Summary

after Basti if the person follows strict diet, sugar levels and other associated complaints

can be controlled. A significant response was obtained in majority of the cases, higher

percentage of reduction in the symptoms and FBS, RBS, PPBS and urine sugar level and

increase in general sense of well being shows that madhutalika vasti has significant role

in the management of madhumeha.


157

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SPECIAL CASESHEET FOR MADHUMEHA

Post Graduate Studies And Research Center (Panchakarma) Shree DGM Ayurvedic Medical College, Gadag.

Guide : Dr. G.Purushothamacharyalu, PG Scholar : MD (Ayu) D.S.Swami

Co- Guide : Dr. Shashidhar.H. Doddamani. MD (Ayu) 1. Name of the patient : Sl. No :

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2. Father’s / Husband’s Name : OPD No : 3. Age : IPD No : 4. Sex : 5. Religion :

M F

Hindu Muslim Christian Others

Poor Middle Upper middle class High class

Sedentary Active Labor Others 6. Occupation : 7. Economical Status : 8. Diet : 9. Address :_____________________________ Phone No : ____________________________ Email ID :

_____________________________ Pin

Veg Mixed

10. Date of Schedule Initiation :

Date of Schedule Completion :

11. Result : 12. Consent : I here by agree that, I have been fully educated with the disease and

Good Response Moderate Response

Poor Response

No Response

treatment, here by satisfied whole heartedly, and accept the medical trial over

me

Investigator’s Signature Patient’s Signature

13. COMPLAINTS WITH DURATION :-

Chief Complaints P/A Duration Prabhuta Mutrata Kshudadhikya Ati Sweda Pipasadhikya Karapada daha Other complaints P/A Duration Anga Saidhilyam Sareera ghanatwam Seeta Priyatwam Hrut-Netra-Jihwa Shravana upadeha Shareeradurgandha Chikkanata dehe

14. HISTORY OF PRESENT ILLNESS :- >Appearance of similar complaints before :

Yes No 15. HISTORY OF PAST ILLNESS Present Absent 16. TREATMENT HISTORY :- Modern Medicine :- If Yes :- Duration Drug Ayurvedic medicine :- If Yes :-

Drug

Duration Relief with previous

Yes No treatment :- 17. FAMILY HISTORY :- Present Absent

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18. PERSONAL HISTORY

Mrudu Madhya Kroora Koshta

Veg Mixed Diet Poor Moderate Good Appetite Bowels Free Constipated Urine Normal Abnormal

Day Night

Number of times

Sleep Normal Loss More Disturbed

Habit Smoking Alcohol Tobacco

chewing No

Habits

Duration Of Habits :-

19. ASHTASTHANA PAREKSHA

a. Nadee Dosha Gati Poornata Spandana Kathinya

b. Mootra : c. Malam : Constipation Loose Normal d. Jihwa : e. Sabdam : f. Sparsham : g. Drink :

Sthoola Krisha h. Akrithi :

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20. GENERAL EXAMINATION : - Appearance

Healthy Unwell Nutrition

Obese Moderate Poor

Orientation Good Poor

Memory Normal Medium Poor

Height in cms:- Weight in kg :- BMI :- Temperature in degree Farenheit:- Pulse Rate:- Heart rate:- Respiratory Rate:- Bloodpressure:- mmHg. 21. DASAVIDHA PAREEKSHA :-

A) Prakruthi Vata Pitha Kapha Vatapitha Vatakapha Pithakapha Sannipatha

B) Vikruthi

Hetu

Dosha

Dushya

Bala

Prakruthi

Desa

Kala

Linga

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C) Sara Pravara Madhyama Avara

D) Samhanana Susamhatha Madhyasamhata Asamhata

E) Pramana Sama Heena Adhika

F) Satmya Ekarasa Sarvarasa Vyamishra

Rooksha satmya Snigdha satmya

G) Satva Pravara Madhya Avara

H) Ahara shakthi

Abhyavahara Pravara Madhyama Avara

Jaranashakti Pravana Madhyama Avara

Pravara Madhyama Avara I) Vyayama shakthi

Bala Madhya Vruddha J) Vayaha

22. SROTOPAREEKSHA :-

Srotas Observed Lakshanas

Pranavaha

Annavaha

Udakavaha

Rasavaha

Rakthavaha

Mamsavaha

Medovaha

Asthivaha

Majjavaha

Shukravaha

Pureshavaha

Mutravaha

Swedovaha

Arthavavaha

174

175

23. NIDANA PANCHAKA :-

a. Nidana> General :- Ahara Vihara > Vataja Nidana :-

Ahara Vihara

> Pithaja Nidana :-

Ahara Vihara

Kaphaja Nidana :-

Ahara Vihara

b. Poorva roopa : c. Roopa :

d. Upashaya / Anupashaya : e. Samprapthi

24. OTHER INVESTIGATIONS. Blood-Hb- TC- DC- ESR- SERUM CHOLESTROL-

25. TREATMENT PROTOCOL :-

Deepana pachana Abhyanga & Mruduswedana :- Pradhanakarma :- Total 5 Anuvasana Basti and 3 Madhutailika Basti Paschathkarama- Basti nirgamana kala

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Observation Before Bastikarma

During Bastikarma

After Bastikarma

Pulse Blood Pressure Respiratory Rate Temperature

26.ASSESSMENT OF RESULTS A. Subjective Parameters

Symptoms Before

treatmentAfter

Bastikarma15th day of follow-up

30th day of follow-

up Prabhuthamutratha Kshudadhikya Pipasadhikya Karapada daha Ati Sweda

B. Objective Parameters

Body Weight

27. INVESTIGATORS NOTE :- Signature of Co-Guide Signature of Guide

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SCORE-SHEET A) Prabhuthamutratha : Grade O - 2-3 times/day time ; 0-1 times/night Grade 1 - 4-5 times/day time ; 2-3 times/night Grade 2 - 6-7 times/day time ; 4-5 times/night Grade 3 - > 7 times/day time ; >5 times/night B) Pipasadhikya: Grade O - Normal Grade 1 - Slightly Increased Grade 2 - Severely Increased C) Kshudadhikya: Grade O - Normal Grade 1 - Increased, but can tolerate Grade 2 - Increased, but cant tolerate without consuming food D) Karapada daha: Grade O - Absent Grade 1 - Slightly present Grade 2 - Present E) Ati Sweda: Grade O - Absent Grade 1 - Present

Vasti madhumeha pk011-gdg

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