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Diabetes and its Management
|by Prof. Dr. Shailendra Naithani|
Diabetes Mellitus is ailment of modern era, which is creating havoc, and its prevalence is on rise with prompt pace, because of unhealthy food habits, lack of exercises and stress. Diabetes mellitus (DM) comprises a group of common metabolic disorders where hyperglycemia is the chief symptom. It is also called protean [widespread] disease because it affects every system and organ in body. Pathologically different sort of DM prevails depending upon complex interaction of genetics, environmental factors, and life-style choices. Etiological, factors contributing to hyperglycemia may include reduced insulin secretion, decreased glucose utilization, and increased glucose production.
The knowledge of DM syndrome has existed in India since pre-historic age. Its earliest reference [1000 BC] is found in mythological form where it is said that the origin of diabetes take place by eating Havishya [charak samhita nidan sthana 11]. Havishya is a special mixture of grains offered as oblation at the time of yagyna [fire ritual] and this yagyna was organized by daksha Prajapati. DM in Ayurveda is described under the heading Prameha and clinical picture is similar to Madhumeha [one type of 20 type of Prameha]. The word Prameha is derived from the root Miha Sechane means watering, excessive urine passing [quantity and frequency]. The word Prameha means Prabhut Avil Mutrata means excessive and turbid urination. The etiology, pathogenesis symptoms [roopa and proova roopa] and even principles of management described in Ayurvedic classics, got utmost parlance to those of DM. Ayurveda describe DM as Madhumeha ,which means urine like honey or sweet urine, similarly Diabetes Mellitus is a Latin word which also means honey like sweet urine.
Few cases of DM remain undiagnosed and accidentally at time of routine checkups come to notice. The revised criteria for the diagnosis of DM emphasize the FPG as a reliable and convenient test for diagnosing DM in asymptomatic individuals. A random plasma glucose concentration (200 mg/dl) accompanied by classic symptoms of DM (polyuria, polydipsia, weight loss) is sufficient for the diagnosis of DM; Fasting plasma glucose of >125 mg/dl and two hour post glucose load (75g), plasma glucose levels 200 mg/dl, and confirmed by repeat test is sufficient criterion to confirm the diagnosis Treatment. The basic principle or Chikitsa Sutra according to Ayurvedic point of view is Shodhana [purification] and Shamana [suppression]
Shodhana or purification is generally done in obese diabetic with adequate body strength and requires expertise in assessment of vitiated doshas and therapy to be applied. Mismanagement would lead to more harm than any good. Hence in general practice shaman Chikitsa is prevalent and popular.
Shaman Chikitsa: [pacificatory management]: The herbs used in the management of DM syndrome are bitter, astringent, and pungent in Rasa [taste]. All herbs having these tastes are having some anti-diabetic quality. While treating DM herbs are used either individually or with combination of other herbs or mineral [yoga or composite formulae].
Single drugs [herbs]:
1- Karvellaka or karela, Bitter gourd [Momoradia charantia ] also known as bitter melon, is one herb that has proven beneficial in the treatment of diabetes. Karavella has a long history of use as an herb for diabetes in Asia, Africa and Latin America. The plant extract was referred to the as vegetable insulin. Various studies have demonstrated the potent antioxidant activity of karavella. Treatment With karavella resulted in a significant increase in various antioxidant enzyme levels in the liver and kidney of diabetic rats. The extract of karavella exerted rapid protective effects against lipid per oxidation by scavenging free radicals, thereby reducing the risk of diabetic complications. Other studies have demonstrated the blood glucose lowering activity of karavella. The effect of karavella on fasting and post-prandial (two hours after food) blood glucose levels was studied in 100 cases of moderate non-insulin dependent diabetic subjects. Drinking of an aqueous homogenized suspension of the vegetable pulp led to significant reduction of both fasting and postprandial serum glucose levels. This hypoglycemic action was observed in 86 (86%) cases.
The active components in karavella are thought to be an alkaloid memordicine, glycosides charantin and vicine, and polypeptide-p. (Polypeptide-p is an Insulin like protein Karvellaka also reduces increased lipids specially cholesterol
2- Meshshringi [Gymnema sylvestre] also called Gudmar and madhunashini: It controls hyperglycemia and carbohydrate metabolism in in liver and in skeletal muscles. It causes complete obliteration of sweet perception by tongue due to excessive copper content in leaf. The active hypoglycemic agent is gymnemic acid and two crude saponins, gymnemosides-a and gymsemoside
3-Bimbi [coccinia indica] also called Durike bel or kunduru: The root of this herb contains hypoglycemic principle, and fruit contains a bitter glycoside containing cuceubirocin B. The expressed juice of tuberous root stem and leaves is used to control glucose in DM
4-Nimba [Azadirachta indica] also called Neem: Leaves and bark of this plant is used in DM, it is very good detoxifier, Liver stimulant and lowers the glycosuria. It is also good for keeping the blood vessels healthy and thus prevent diabetic vasculopathies.
Similarly different composite drug combination is also described in Ayurvedic texts, a few of them are Abhyadi kashyam, Nyogradhi churna, Nishaamalki kashyam, Asana bilvadi kashyam, Chandra prabha vati, Pramehantak Rasa and Vasant kusumakar rasa. Author of this paper has developed a composite herbal drug combination and found it very much effective in proper management of Type -2 DM.
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