A A M J Anveshana Ayurveda Medical Journal

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1 A A M J Anveshana Ayurveda Medical Journal ISSN: Research Article A Clinical Study to Evaluate the role of Śilājithu in the Pathogenesis of Kaphaja Pramēha Deepak Rahangdale 1 Mukesh chaudhari 2 Baldev Kumar 3 A b s t r a c t Context: Ayurveda is a science of life and more than just a medical system. Ayurveda has taken the foremost place in the management of crippling disease. Pramēha, which can be compared with Diabetes mellitus- II due to its clinical appearance. Due to wide spectrum of disease, much prevalence in the society and lack of effective medicine, so disease being chosen for the study. Prevalence of approx.0.8% of the population. Aims: to understand concept of śarīra śaitilyata in samprāpti of kaphaja Pramēha and to evaluate ayurvedic fundamental principles of udakavaha srōtōduṣṭhi in its treatment. Methods and Material: 40 Registered and clinically diagnosed cases were divided into 4 groups; Group A- patients having symptom of kaphaja Pramēha and udakavaha srōtōduṣṭhi (Triṣṇāhara yoga), Group B- cases of kaphaja Pramēha only excluding symptoms of udakavaha srōtōduṣṭhi (Triṣṇāhara yoga), Group C (Śaitilyahara yoga) and Group D (Sarva Pramēhara yoga). Result: Statistically significant improvement was observed in objective and subjective parameters in all 4 groups after completion of the course of treatment. Conclusion: Acharya have mentioned the mūlas of srōtas, so that while treating the disease we can pay attention to the treatment of srōtōduṣṭhi and its mūla also. It seems that, it is an effective therapeutic regimen in the management of uncomplicated cases of kaphaja Pramēha. Key words: Kaphaja Pramēha, Udakavaha srōtas, śarīra śaitilya, Diabetes mellitus-ii, srōtōmūla. 1 Assistant Professor, PG Dept. of Basic Principles, 2 Assistant Professor, PG Dept. of Rasashastra & Bhaishajyakalpana, Mahaveer Ayurvedic Medical College & Hospital, Meerut, U.P, 3 Director, Department of AYUSH, Haryana, India. CORRESPONDING AUTHOR Dr. Deepak Rahangdale Assistant Professor, PG Dept. of Basic Principles, Mahaveer Ayurvedic Medical College & Hospital, Meerut, U. P, (India). liveayubest@gmail.com sue2/aamj_1219_1224.pdf AAMJ / Vol. 3 / Issue 2 / March April 2017

2 INTRODUCTION Ayurveda recognized, Pramēha as a disease entity in distant past. Among several health problems Pramēha, is considered as one of the arch enemy of the mankind. Pramēha comprises a number of diseases with various physical and chemical changes in urine. The manifestation of the disease is described as Prabhūtāvilamūtratā, which means frequent and copious urine with turbidity [i,ii]. It is also believed that, if not cured or treated properly in due course of time, Pramēha changes in Madhumēha, which is very similar to diabetes mellitus, the most debilitating disease. [iii,iv] Diabetes mellitus is a metabolic disorder characterized by polyurea, polydipsia, hyperglycemia, glycosuria, and generalized weakness may be associated with weight loss. This is the disease that affects every tissue and every organ of the body and is responsible for significant morbidity, reduced life expectancy, and diminished quality of life. It has been seen that there is no any organ or system spared from the diabetic complications, such as nephropathy, neuropathy, retinopathy, and so on. So there is a need for effective drugs for controlling Diabetes and preventing undesirable complications. Although the introduction of many oral hypoglycemic agents and insulin in modern medical science have great importance in the management of Diabetes, the hazardous effects of these drugs after long term use are incurable or proves many times fatal, hence an ideal therapy is still obscure. Ayurvedic management of Diabetes aims not only to achieve a euglycemic state but also to treat the root cause of disease. There are many medicinal plants mentioned in Ayurvedic texts, particularly in Nighantus and Samhitas having Pramēhahara property. In the present work, with the concept of srōtōduṣṭhihara, śaitilyahara and vyādhi pratyātmika chikitsa drugs have been used for the management of kaphaja Pramēha. [v] Aims and objectives Conceptual and clinical study on kaphaja Pramēha to understand śarīra śaitilyata in its samprāpti and to evaluate ayurvedic fundamental principles of udakavaha srōtōduṣṭhi in treatment of kaphaja Pramēha. Drug review: The drug Triṣṇāharaa yoga (powder in dose of 5 gm daily in 2 divided doses) from Bhaishjyaratnawali Triṣṇa chikitsa was selected. It has Pitta śāmaka property (mainly), Dīpana Pāchana, it also enhances digestive power (appetizer effect), enhances food absorption consequently it rectifies the vitiation of udakavaha srōtas. The second drug Śaitilyahara yoga (Śilājithu 3 gm powder daily in 2 divided doses) was selected from Charaka Chikitsasthana 1:3/48-65 and the third drug Sarva Pramēhara yoga (40 ml kwātha twice a day) was selected from Charak Sutrasthana 23/10. All the drugs were purchased and prepared through pharmacy of NIA, Jaipur. MATERIALS & METHODS A series of 40 patients with Diabetes Mellitus were selected from the Outpatient Department (OPD) and Inpatient Department (IPD) of NIA Hospital, Jaipur. Most of these cases were known diabetics while some were diagnosed for the first time when they came with other complaints. Inclusion criteria: Patients between the age group of years. Presence of cardinal symptoms of Udakavaha srōtōduṣṭhi in pūrvarūpa or rūpa of Kaphaja Pramēha described in Ayurveda texts. Presence of cardinal symptoms of Kaphaja Pramēha described in Ayurveda texts. Confirmed cases of DM type II on the basis of laboratory investigations and observed sign and symptoms. [vi,vii] Exclusion criteria: Patient having age below 20 and above 60 years. Patient suffering from complication of DM. Patient having Type-I DM (IDDM). Patient having Type-II DM with any other serious systemic disease. Patient having a FBS more than 150 mg/dl and PPBS more than 200 mg/dl. Grouping of the patients: Registered patients were divided into 4 groups as fol- lows- Group A: patients were kaphaja pramēhi symptoms of uakavdāha srōtōduṣṭhi in pūrvarūpa or rūpa of kaphaja Pramēha has been given the triṣṇāharaa yoga. Group B: Patients were kaphaja pramēhi without the presence of cardinal symptoms of uakavdāha srōtōduṣṭhi in pūrvarūpa or rūpa of kaphaja Pramēha has been given the triṣṇāharaa yoga. Group C: Patients were kaphaja pramēhi described in Ayurveda texts and they have been administered with Śaitilyahara yoga. Group D: patients were kaphaja pramēhi and they have been administered with Sarva Pramēhahara Yoga kwātha. AAMJ / Vol. 3 / Issue 2 / March April

3 Criteria to assess the effect of trial drugs All the selected patients have been advised to come for the follow-up for 2 months at regular intervals of 15 days. The clinical grades were decided as follows: A. Subjective Criteria Clinical parameters for Assessment of kaphaja Pramēha: 1. Prabhūta mūtrata (Polyuria) Score 3 6 times/day, rarely at night times/day, 0-2 times/night times/day, 2-4 times/night 2 >12 times/day, >4 times/night 3 2. Āvila mūtrata (Turbidity in urine) Scores Clear urine (can be visible through glass) 0 Get turbid on keeping 1 Turbidity seen on collection 2 Very turbid 3 3. Pipāsādhikya (Polydipsia) Scores 3 6 glass of water daily glass of water daily glass of water daily 2 Unable to have sound sleep due to excessive thirst 4. Kṣudhādhikya (Polyphagia) Scorers 2 chapati/per meal chapati/per meal chapati/per meal 2 > 5 chapati/per meal 3 5. Karapādadāha (Burning sensation in hands & feet) 3 Scores Absent 0 Occasional 1 Continuous with tolerance 2 Continuous without tolerance 3 6. Śithilāñgatā Scores Absence of Chalatva 0 Little visible movement (in above areas) after 1 Rapid movement 2 Little visible movement (in above areas) after 3 B. Objective Assessment: It was assessed mainly on the basis of biochemical investigations before and after completion of treatment in terms of percentage relief and statistical evaluations. a.) Blood Examinations- CBC Lipid profile FBS (Fasting Blood Sugar) in mg/dl PPBS (Post Prandial Blood Sugar) in mg/dl b.) Urine Examination Routine examination - Colour, Smell, Specific gravity Microscopic examination - Epithelial Cells, Albumin, Sugar, Cast OBSERVATION & RESULTS The observations and results in the study are made on the basis of demographic, constitutional, and clinical profiles of 40 patients having type II diabetes mellitus. Maximum cases reported in the study were male (72%). Maximum cases (40%) were of the age group years. Most cases (about 75%) were from middle socioeconomic group and maximum cases (about 28%) were housewives. 40% cases registered were from above higher secondary education group. The study revealed that higher incidence was found in urban dwellers (82.5%), and incidence in dietary habits was found more in persons with vegetarian diet (72.5%). Regarding incidence in physical activities, more patients are mild active (49%). About 52.5% cases belonged to Tāmasa Prakriti, and about 65% cases were belonging to kapha vāta prakriti. Maximum cases were reported with a positive family history (40%), and the duration of illness was less than 1 year in maximum cases (about 77.5%). Table 1: Therapy wise details of the groups Group Group Completed Lama Drug Group-A 10 0 Triṣṇāharaa yoga Group-B 10 0 Triṣṇāharaa yoga Group-C 10 0 Śaitilyahara yoga Group-D 10 0 Sarva Pramēhara yoga AAMJ / Vol. 3 / Issue 2 / March April

4 Prabhūtaa mūtrata Table 2: change in Prabhūtaa mūtrata Diff. Relief% SD SE P S A <0.01 VS B <0.05 S C >0.05 NS D <0.001 HS Āvilaa mūtrata Table 3: change in Āvilaa mūtrata Diff. Relief% SD SE P S A <0.05 S B <0.01 VS C <0.05 S D <0.01 VS Pipāsādhikya Table 4: change in Pipāsādhikya Diff. Relief% SD SE P S A <0.01 VS B <0.05 S C >0.05 NS D <0.01 VS Kṣudhādhikya Table 5: change in Kṣudhādhikya Diff. Relief% SD SE P S A <0.05 S B <0.05 S C <0.05 S D <0.05 S Karapādatala dāha Table 6: change in Karapādatala dāha Diff. Relief% SD SE P S A <0.01 VS B <0.01 HS C <0.05 S D <0.01 VS Table 7: change in Śithilāñgatā Diff. Relief% SD SE P S Śithilāñgatā A <0.05 S B >0.05 NS C <0.05 S D <0.01 VS AAMJ / Vol. 3 / Issue 2 / March April

5 FBS Table 8: Effect of treatment on fasting blood sugar Diff. Relief% SD SE T P S A S B VS C S D VS PPBS Table 9: Effect of treatment on post prandial blood sugar Diff. Relief% SD SE T P S A VS B VS C S D HS Effect of treatment as per wilcoxon signed ranks test and paired t test in all the 4 groups (group A, B, C and D) showed statistically significant results in the above-mentioned subjective and objective parameters. Group A showed significant relief on prabhūta mūtrata (37.38%), āvila mūtrata (38.09%), pipāsādhikya (47.36%), kṣudhādhikya (43.75%), karapādataladāha (63.15%) and śithilāñgatā (38.09%). Group B showed significant result on prabhūta mūtrata (36.36%), āvila mūtrata (42.84%), pipāsādhikya (33.33%), kṣudhādhikya (37.5%), karapādataladāha (63.15%) and śithilāñgatā (19.04%). Group C also showed significant relief on prabhūta mūtrata (30.43%), āvila mūtrata (33.33%), pipāsādhikya (27.77%), kṣudhādhikya (31.57%), karapādataladāha (41.17%) and śithilāñgatā (40.9%). Group D also showed highly significant relief on prabhūta mūtrata (40%), āvila mūtrata (52.38%), pipāsādhikya (55.55%), kṣudhādhikya (38.88%), karapādataladāha (57.14%) and śithilāñgatā (57.14%) [Tables 2-7]. In case of subjective parameters, in FBS maximum percentage relief showed by group D (15.71%) followed by group A (8.82%), group B (8.10%) and group C (0.87%). In PPBS relief showed by group D (19.82%), group A (15.50%), group B (8.22%) and group C (2.3%) respectively [Tables 8-9]. Probable mode of action of drugs: On analysis of the pharmacological properties of all the contents of Triṣṇāharaa yoga illustrates that the maximum of the drugs is of kaṭu, tikta and madhura rasa. Maximum guṇa of the drugs are laghu and rūkṣa. Maximum of the drugs are of śīta vīrya and madhura vipāka. Kaṭu rasa and rūkṣa guṇa of drug will help in the upaśōṣaṇa of sweda, kleda and mala along with śamana of kapha. Likewise, Tikta rasa will normalize the excess kleda, meda, vasā, majja, sweda, mūtra and purīṣa. Ṣaḍiñdriya prasādana effect of madhura rasa will prevent patients from early incidence of complications. Thus the drug (triṣṇāharaa yoga) appeared successful in breaking the doṣa - dūṣya sammūrchana. Dīpana and pāchana effect of kaṭu and tikta rasa would have acted upon dhātvāgnimāndya and helped in normalizing the body metabolism. On the other hand, the Śaitilyahara yoga contains Shuddha śilājithu itself. It is having kaṣāya rasa, madhura rasa and tikta rasa predominately. The guṇa of śilājithu are laghu, śīta vīrya and madhura vipāka along with kapha doṣahara property. Kaṣāya and tikta rasa of drug would have helped in the upaśōṣaṇa of sweda, kleda and mala along with śamana of kapha. The srōtōrodha due to vitiated kapha and vāta aggravation, srōtōavrodha again vitiates the medo dhātu which leads to increase in śithilatva, the kaphahara karma and dārdhtvya property of śilājithu helps to counter the pathogenesis and stops the further progress of disease kaphaja Pramēha. The drug Sarva Pramēhara yoga (kwātha) contains 10 drugs triphala, ārgvadha, pātha, saptaparṇa, vatsaka (kutaja), musta, madanphala and nimbi. On analysis of the pharmacological properties of all the contents of yoga illustrates that the maximum of the drugs is of tikta, kaṣāya and madhura rasa including remaining rasa in small proportion except lavaṇa rasa. Maximum guṇa of the drugs are laghu and rūkṣa. Maximum of the drugs are of śīta vīrya and 50% of drugs having madhura vipāka and 50% of drugs are having kaṭu vipāka in property. This drug has shown wonderful effect on the symptoms of kaphaja Pramēha. Tikta, kaṣāya madhura rasa and śīta vīrya, pacified the sara and uṣṇa guṇa of pitta. Kaṣāya rasa acted as sthambhana along with dīpana effect of tikta rasa. Tikta rasa would have normalized the excess kleda, meda, vasā, majja, sweda, mūtra and purīṣa. Thus the drug AAMJ / Vol. 3 / Issue 2 / March April

6 would have shown noteworthy effects against kaphaja Pramēha. DISCUSSION The maximum improvement in the group D (sarva Pramēhara yoga), implied that the group having absolutely kaphaja pramēhi patients showed better results than all other groups the reason may be behind that, the kaphaja Pramēha vyādhi is Santarpaṇajanya also the yoga is indicated in classical text for Santarpaṇajanya vyādhi so it s obvious that the drug Sarva Pramēhara yoga shows better results on the other hand in case of group A and group B which are taken in this clinical study with the concept that they will act on udakavaha srōtōduṣṭhi also show better results in fact the drug of group A showed better results than group B. In case of group C, the drug used to counter the pathogenesis (samprāpti vightana) so that further progress of disease may not occur also shows significant results. The drugs were used in this trial, acted on srōtōmūla as well as disease. Results were found good in that group of patients which had taken medicine prescribed for vitiated srōtōmūla. Most of the symptoms were also subsided in that same group (group A). So on the basis of results of subjective parameters; it may say that srōtōmūla Chikitsa will give better response to cure of any srōtō - Duṣṭhijanya Vyādhi. CONCLUSION Acharya have mentioned the Mūlas of Srōtas, so that while treating the disease we can pay attention to the treatment of Mūla also. Hence srōtōduṣṭhi and pathogenic factor need to be kept in consideration while treating the diabetic patients, so that while treating the disease we can pay attention to the treatment of srōtōduṣṭhi and its mūla also. It seems that, it is an effective therapeutic regimen in the management of uncomplicated cases of kaphaja Pramēha. REFERENCES i. Ashtanga Hridyam of Vagbhata: Vidyotini Hindi Commentary by Kaviraja Atrideva Gupta Edited by Vaidya Yadunandana Upadhyaya. Reprint ed. Nidanasthana 10/7. Varanasi: Chowkhamba Sanskrit Sansthan; p.254. ii. Madhava Nidana: Vidyotini Hindi Commentary by Shastri S, Upadhyaya YN. Vol. 2,31st ed. Chapter 33/6. Varanasi: Chaukhambha Sanskrit Sansthan; p. 8. iii. Sushruta Samhita with AyurvedaTattva Sandipika-Hindi commentary edited by Kaviraj Ambikadatta Shastri. 13th ed. Purvardha, Nidanasthana 6/30. Varanasi: Chaukhambha Sanskrit Sansthan; p iv. Charaka Samhita with Vidyotini Hindi Commentary. Vol. 1 and 2. Sastri KN, Caturvedi GN. (Sashtri RP, et al. editor)., Reprint: 1998 Sutrasthana 5/2, Varanasi: Caukhambha Bharati Academy;p. 72 v. Charaka Samhita with Vidyotini Hindi Commentary. Vol. 1 and 2. Sastri KN, Caturvedi GN. (Sashtri RP, et al. editor)., Reprint: 1998, Vimanasthana 8/139, Varanasi: Caukhambha Bharati Academy;p. 789 vi. Kirtikar KR, A D Basu BD. Indian Medicinal Plants (VoI , VoI3-1984). Delhi-32: Periodical Expert Book Agency; vii. Harrison s Principles of Internal Medicine. Vol. 2.ed. Chapter 333, (Diagnostic criteria for Diabetes Mellitus). U.S.A: Mc Graw-Hill Medical Publishing House; p viii. Charaka Samhita with Vidyotini Hindi Commentary. Vol. 1 and 2. Sastri KN, Caturvedi GN. (Sashtri RP, et al. editor)., Reprint: 1998, Chikitsasthana 6/15, Varanasi: Caukhambha Bharati Academy; p Source of Support: Nil. Conflict of Interest: None declared How to cite this article: Deepak et.al,. : A Clinical Study to Evaluate the role of Śilājithu in the Pathogenesis of Kaphaja Pramēha. AAMJ 2017; 2: ΛΛΛΛ ΛΛΛΛ AAMJ / Vol. 3 / Issue 2 / March April