Efficacy of Antidiabetic Ayurvedic Medicine in Diabetes Mellitus (Type 2): A Case Study

Dimpal Gill; Amit Choudhary; Raja Ram Mahto

doi:10.4103/AYUHOM.AYUHOM_12_22

CASE REPORT

Year : 2022 | Volume : 9 | Issue : 1 | Page : 41-45

Efficacy of Antidiabetic Ayurvedic Medicine in Diabetes Mellitus (Type 2): A Case Study

Dimpal Gill¹, Amit Choudhary², Raja Ram Mahto¹
¹ Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi, India
² Department of Dravyaguna, National Institute of Ayurveda, Jaipur, India

Date of Submission	10-Feb-2022
Date of Decision	11-Mar-2022
Date of Acceptance	11-Apr-2022
Date of Web Publication	15-Sep-2022

Correspondence Address:
Dimpal Gill
Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/AYUHOM.AYUHOM_12_22

Abstract

Diabetes mellitus Type 2 (DM Type 2) is a major health problem in the present era. It is characterized by increased blood sugar level (BSL) with or without some classical features such as polydipsia, polyphagia, and polyuria. In Ayurveda, diabetes comes under a Vatic subtype of Prameha-called Madhumeha (~DM). The present study deals with a newly diagnosed case of Type 2 DM since February 22, 2019, with no family history of diabetes and oral hypoglycemic agent. His BSLs were high with associated symptoms such as pain in multiple joints, burning micturition, and pindikoudvesatna (~cramps while walking/calf muscle pain). Ayurveda-based pathogenesis suggested that the patient is of Kapha-Pittavrit-VataDosha (~a biohumor) is the chief vitiating factor and also vitiation of Meda, Kleda, Vasa, Ambu, and Ojas with Dhatwagnimandya are the co-factor. By considering the Nidana (~etiological factors), Dosha (~a biohumor), and Dusya (~tissue elements), a judicial combination of Ayurveda drugs such as Gokshuradi Guggulu, Gudmar Patra, Jamun Bija, Sudarshan, Nagarmotha Churna, and Chandraprabha Vati was advised to take orally in morning and evening with lukewarm water and proper diet and lifestyle modification was also prescribed. At the time of consultation, his fasting blood sugar (FBS) and postprandial blood sugar (PPBS) were 377 mg/dl and over 450 mg/dl, respectively, along with glycated hemoglobin (HbA1c) as 16.7%. After taking the prescribed formulation for 4 months, his FBS and PPBS levels came down to the normal range, but HbA1c level declined at 6 months to 6.4%. The prescribed antidiabetic Ayurvedic medicines showed good response by maintaining normal BSLs in a Type 2 DM case.

Keywords: Diabetes mellitus Type 2, Gokshuradi Guggulu, Gudmar Patra, glycated hemoglobin, Jamun Bija, Madhumeha, Nagarmotha Churna and Chandraprabha Vati, Sudarshan Churna

How to cite this article:
Gill D, Choudhary A, Mahto RR. Efficacy of Antidiabetic Ayurvedic Medicine in Diabetes Mellitus (Type 2): A Case Study. AYUHOM 2022;9:41-5

How to cite this URL:
Gill D, Choudhary A, Mahto RR. Efficacy of Antidiabetic Ayurvedic Medicine in Diabetes Mellitus (Type 2): A Case Study. AYUHOM [serial online] 2022 [cited 2022 Oct 7];9:41-5. Available from: http://www.ayuhom.com/text.asp?2022/9/1/41/356165

Introduction

Diabetes mellitus (DM) or Madhumeha is a metabolic disorder of multiple etiologies, marked by a high level of blood glucose with disturbances of carbohydrate, fat, and protein metabolism.^[1] In a diabetic patient, frequent urination (polyuria), increased hunger (polyphagia) and increased thirst (polydipsia), blurred vision, decreased body weight, tiredness, and itching are common symptoms.^[2] Samprapti (~pathophysiology) of Madhumeha is described by Acharya Vagbhatta as it can originate in two ways: by the aggravation of Vata caused by Dhatukshaya and by the obstruction of Vata caused by Doshas covering it (~Avarana).^[3] Although conventional medicines have remedy to reduce/control and treat diabetes but are unable to provide complete relief and sometimes cause adverse effects.^[4] Ayurveda through its armamentarium can be a potential source of hypoglycemic drugs that are safe, significantly potent and can improve quality of life (QoL).^[5]

Case Report/ Description

A 63-year-old male patient (UHID: No. 325168) visited the diabetes and metabolic care unit of a tertiary care Ayurveda hospital. He was a government servant and came with clinical history as a newly diagnosed case of Type 2 DM since February 22, 2019, with no family history of the patient had complaints of Pidiko-dvesatna (~cramps while walking/calf muscle pain), burning micturition, increased frequency of urination, generalized weakness, and body ache. Earlier, the patient visited the rheumatology outpatient department for the chief complaint of pain in multiple joints and burning sensation during micturition with loss of weight. The physician at the rheumatology clinic advised him for the blood investigation with random blood sugar. After seeing the raised blood sugar level (BSL), they referred him to the diabetic and metabolic care unit. There he was diagnosed (Madhumeha) after getting raised fasting blood sugar (FBS) of 377 mg/dl, postprandial blood sugar (PPBS) of >450 mg/dl, and glycated hemoglobin (HbA1c) of 16.7%. Thus, he was diagnosed to be suffering from DM Type 2. The patient was advised Ayurvedic medicines for 3 weeks aiming to control BSL and improve his health. After 3 weeks, the patient got complete relief in the main complaint of pain and burning sensation, thus he was advised to continue treatment. After 21 days, he was re-evaluated and it was seen that his BSL decreased to FBS – 281 mg/dl and PPBS – 301 mg/dl and thus again advised to continue the same treatment for 1 month. After 1 month, the BSL touched normal range (FBS – 133 mg/dl and PPBS – 126 mg/dl) and so the same treatment continued.

Examination

In tertiary care Ayurveda hospital, the patient was evaluated following Ayurveda principles of Rogapriksha (~examination of disease) and Rogipariksha (~examination of patient) as described in ancient Ayurveda literature. The Ayurveda assessment revealed the prominent Dosha of the disease as Kapha, Pitta, Vata with Dushya (~tissue elements) as Meda, Kleda (~intermediary fluid part), Vasa, Ambu, Ojas and the status of Agni was Dhatu-agnimandya (~disturbance in the metabolism). The patient's Prakriti was assessed as Kapha-Pitta and observed to be mild obese. The disease state was still in especially the vitiated Kapha spreads all over the body due to its laxity. Though his age was >60 years so, Dhatukshayajanya Samprapti (~ degeneration or decrement of quality and/or quality of body tissues) also considered.

Ayurveda drug regimen

Initially, the patient was administered with Pramehaghna (~antidiabetic) herbal drugs to control and to maintain the normal serum BSL. For this purpose, the patient was advised treatment, as described in [Table 1], mainly based on judicious formulation of Gokshuradi guggulu,^[6] Gudmar patra (Gymnema sylvestre R. Br.),^[7] Jamun bija (Syzygium cumini L.),^{[8],[9],[10],[11]} Sudarshan churn a (a herbal compound),^[12] Nagarmotha churna (Cyperus rotundus L.),^[13] Chandraprabha vati,^[14] and Nishakathakadi kwatha^[15] with lukewarm water as Anupan for accelerating the Pachana of drugs.

Table 1: Oral medications prescribed

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Follow-up and outcomes

At the time of reporting at the diabetes clinic at AIIA, the FBS, PPBS, and HbA1c levels were reported to be 377 mg/dL, >450 mg/Dl, and 16.7%, respectively, and he was not taking allopathy medicine. He was then advised the combination of Ayurveda drugs [Table 1]. After a period of 3 weeks, the FBS and PPBS levels reduced to 281 mg/dL and 301 mg/dl, respectively. After 7 weeks, on reviewing the health condition, it was observed that the levels of FBS and PPBS further reduced to 133 mg/dL and 126 mg/dL, respectively. The patient also reported improvement in the associated symptoms. After 13 weeks, the FBS and PPBS levels were observed and recorded 178 mg/dl and 223 mg/dl, respectively which shows slightly increased but HbA1c was 9.4% with decreased value. On inquiry, it was found that the patient had an episode of viral fever, thus discontinuity of treatment could have been the cause of raised sugar levels. However, as the patient resumed Ayurvedic treatment soon after recovery from viral fever at the end of 4 months, FBS and PPBS levels again declined to 103 mg/dl and 106 mg/dl along with HbA1c level to 6.4% at 6 months. At this stage, the patient's health conditions were good and complete relief in each of the symptoms and improvement in the QoL was reported. Thus, he was advised to continue the same treatment with slight modification of dose. The major Ayurveda parameters for evaluating Roga, Agni, Deha, and Chetas-bala were observed to have reached normal level [Table 2].^[16] Finally, the patient was completely satisfied with Ayurvedic medication and sugar levels were maintained at normal level for the last 4 months [Table 3] and [Figure 1],[Figure 2],[Figure 3].

Figure 1: Variation of fasting blood glucose levels during the course of treatment

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Figure 2: Variation of postprandial blood glucose levels during the course of treatment

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Figure 3: Variation of HbA1c during the course of treatment. HbA1c: Glycated hemoglobin

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Table 2: Major Ayurveda parameters for evaluating Roga, Agni, Deha, and Chetas-bala

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Table 3: Observations on blood sugar level

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Discussion

Most people are prone to be diabetic in the age group of 35–54 years.^[17] The main causes of Prameha are lack of exercise and consumption of excess food having Ushna (~hot), Snigdha (~oily), and Guru (~heavy) nature. Foods that increase Kapha, Medas (~fatty tissue), and Mootra (~urine) are the major factors for Prameha.^[18] Morbid Kleda (~intermediary fluid part) accumulation in the body is the chief reason along with primary vitiation of Kapha-dosha as per the principle of Dhatwagnimandhya. At the same time, this Samprapti is then associated with other Doshas producing either Kaphavata or kapha pitta symptomatology.^[19] Both are producing Dhatu depletion. The prescribed Ayurvedic medicine had resulted to control hyperglycemic index and respond timely.

The patient was a retired government officer and previously had only sedentary type of job and the timings of lunch and dinner were very late for the more duration and this affects the metabolism of the patient. After retirement, his daily schedule was suddenly changed and the patient used to sit at home for a longer duration of time without any exercise and sleeping habit in afternoon. Due to these factors aggravated disturbance in metabolism and increase the central obesity. This also caused insulin resistance and developed DM.

Initially, the patient came with a chief complaint of pain with burning in multiple joints and burning micturition, so the patient was advised to take Gokshura churna^[20],[21] and Nisakathkadi kwatha^[15] which acts mainly on Mutravaha Strotasa and resolve the burning micturition due to Vata-Pitta shamaka properties. After the improvement in chief complaints, he was put on antidiabetic drugs which have Kledashosak (~antifluidity) and Basti shodhak properties. On achieving good Rogi-bala, the patient was advised Jamun (Syzygium cumini L.),^{[8],[9],[10],[11]} and Nagarmotha churna (Cyprus rotundus L.),^[13] which is having Kashaya (~astringent), tikta (~bitter) pradhan rasa, Sangrahi, and Kleda shosaka action and later added Gudmar churna (Gymnema sylvestre R. Br.)^[7] which stimulated the secretion of insulin. Overall, Vatashamaka, Basti shodhaka, Kledashosaka, Mutra sangrahi, and Dhatuvardhak medicines were used to achieve low BSLs. Gokshuradi guggulu, Shilajatvadi lauha, and Chandraprabha vati was used for the purpose of Basti shodhana and maintained Rogi bala. Gokshuradi Guggulu, a polyherbal Ayurvedic formulation, is recommended in the management of Madhumeha.^[6] Gokshura shows Vatahara and basti shodhana action due to its Madhura Rasa, Mdhura Vipaka, Sheeta Veerya and Guru,snigdha properties.^[20],[21] The Gudmar also helps to rejuvenate the process of generating β-cells and produces insulin.^[22] By this process, the blood glucose level is reduced and disease progression is arrested. Jamun bija contains a glycoside (Jamboline) which supports pancreatic health and immunity and strengthens the body's defense mechanism,^[8] and due to high concentration of tannic and gallic acid, it helps in digestion.^[9] According to Ayurveda, Jamun is best vatakar^[10] and its Kashaya property possesses Sangrahi and Sharirkledashosak^[11] (~decreases fluidity) and thus decreases the frequency of urination. Sudarshan churna^[12] removes the obstructions along the dominant pathway for nutrients to cells. Inside the cell, insulin reaches mitochondria to take part in cell metabolism with the generation of ATP which gets converted to body energy and thereby increasing the level of Bala (~Oja or immunity) and working capabilities. Nagarmotha was used to reduce the levels of Kleda and Meda. Due to its Lekhana property, it reduces fat and fluid in the body.^[13] Chandraprabha vati was used to treat the Durbalya (weakness) and Prameha complications (diabetic neuropathy, diabetic retinopathy, etc.). The drug like Chandraprabha vati which has Yavakshara and Svarjikakshara acts as an alkalizer and decreases the acidity of urine and gives relief in burning micturition.^[14],[23] Nisakathkadi kwatha acts on the urinary system and has antidiabetic properties to help lower BSLs and improves insulin function by reducing insulin resistance. It also helps in preventing diabetic complications.^[15]

At the end of 4 months, the patient's FBS and PPBS reached normal levels. After that, some medicines were withdrawn and Gokshuradi guggulu^[6] and Shilajatvadi lauha^[24] continued. Gokshuradi guggulu and Shilajatvadi lauha act mainly on Mutravaha Strotasa, and it has Deepana-Pachana, Medohar property and thus acts as a Rasayana and helps to improve proper Dhatunirmana. Additionally, it helps to improve the muscles of Mutramarga (Basti). Shilajita have katu, kashaya and slight amla rasa, katu vipaka and veerya is slight sheeta, ushna. Katu and kashaya rasa is able to control Kapha dosha with Medodhatudushti and destroys sneha, sweda, kleda, and Malas in the body. Thus, it could be an effective drug in continence of urine, helps in delaying the aging process and also improves health.

Conclusion

This antidiabetic Ayurvedic treatment can be considered effective because of its ability to control BSLs with enhancing the QoL(quality of life). The study suggests that Ayurvedic medicines such as Gokshuradi guggulu, Gudmar, Jamun, Sudarshan, Nagarmotha churna, and Chandraprabha vati are effective medications to treat early-stage T2DM patients. These drugs may be useful for maintaining normal BSL as well as a better QoL and preventing diabetic complications. Because these drugs have quality to counter the pathogenesis who increases the Kapha, Meda and Mutra. Further study may be needed on a large number of patients to generate firm clinical evidence. During the whole treatment period and to date, the patient has no need to take any oral hypoglycemic agent. This would be a considerable thing that is indicating toward the reversal of diabetes symptoms.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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