PRESENT SCENARIO OF

MADHUMEHA VIS A VIS DIABETES

MELLITUS

Dr. R. SHRIPATHI
M.B.B.S. M.D. (Chest), D.T.C.D., M.D. (Ayu),
Chest Specialist & Ayurvedic Consultant,
UDUPI.
 DIABETIC EPIDEMIC
(1) Both Global & Indian
At,present India has 35million diabetics
which is likely to reach 80million by 2030.
Every 5th patient visiting a physcian is
diabetic.
Every 5th diabetic patient in the world is
Indian.
The India would be the disease capital of
the world i.e. TB, AIDS & Diabetecs.
Fortunately 90 to 95% are Type 2 Diabetics
insulin not needed for survival.
80% of Type 2 diabetics are obese.
 What is Diabetes ?
A group of metabolic disorders with outword common
expression of elevated blood glucose level
(hyperglycemia) resulting in secondary patho-
physiological changes in multiple organ systems creating
tremendous burden on the patient. It is the end result of
complex interaction of
Genetics

Environmental Factors LifeStyle choices

3. Basic Mechanisms of Hyperglycemia
Insulin Secretion

Glucose utilisation

Glucose production
ETIOLOGIC CLASSIFICATION OF DIABETES
MELLITUS
1. Type 1 Diabetes (B cell destruction, usually leading to absolute insulin
deficiency)
A. Immune mediated
B. Idiopathic

2. Type 2 Diabetes (insulin resistance with relative insulin deficiency or insulin

secretory defect with insulin resistance.

3. Other Specific Types of Diabetes

A. Genetic defects of B Cell function.
B. Genetic defects of Insulin action.
c. Diseases of the exocrine pancreas
D. Endocrinopathies
E. Drug or chemical induced
F. Infections
G. Uncommon forms stiff man syndrome
H. Other genetic syndrome associated with diabetes
e.g. Downs syndrome, Turners syndrome.

4. Gestational diabetes mellitus (GDM)

 CLINICAL FEATURES OF DIABETES AT
DIAGNOSIS.
Type 1 Diabetes Type 2 Diabetes
Polyuria and thirst ++ +

Weakness or fatigue ++ +

Polyphagia with weight ++ -

loss
Recurrent blurred vision + ++

Vulvovaginitis or pruritus + ++

Peripheral neuropathy + ++

Nocturnal enuresis ++ -

Often asymptomatic - ++
 Criteria for the Diagnosis of
Diabetes Mellitus

Symptoms of diabetes plus random blood glucose

concentration >=11.1 mmol/L (200 mg/dL)a or

Fasting plasma glucose >=7.0 mmol/L (126 mg/dL)b or

Two-hour plasma glucose >=11.1 mmol/L (200 mg/dL)

during an oral glucose tolerance test c
 Chronic Complications of Diabetes
mellitus
Microvascular
Eye disease
Retinopathy (nonproliferative/proliferative)
Macular edema
Neuropathy
Sensory and motor(mono - and polyneuropathy)
Autonomic
Nephropathy
Microvascular
Coronary artery disease
Peripheral Vascular disease
Cerebrovascular disease
Other
Gastrointestinal (gastroparesis, diarrhoea)
Genitourinary (uropathy/sexual dysfunction)
Dermatologic
Infectious
Cataracts
Glaucoma
 MECHNISM OF DIABETIC COMPLICATIONS
Hyper Glycemia

Intercellular Glucose

AGE Sorbitol DAG Fru-6 Phos

Cytokines & Growth ROS Growth Factors Growth Factors &

Factors Increased PAI-1

DIABETIC COMPLICATIONS
FACTORS DETERMINING THE
COMPLICATIONS

1. Genetic susceptibility

2. Duration and degree of hyperglycemia

3. Maintenance of B.P. below 130/80

4. Obesity and fat levels

5. Hyper Insulinemia
FACTORS CONTRIBUTING TO INSULIN
RESISTANCE
1. Anti Insulin Anti bodies.

2. Insulin receptor anti bodies.

3. Down regulation of receptors by hyper insulinemia.

4. Obesity Visceral Adiposity & FFA

5. Muscle inactivity and muscular diseases like myotonia.

6. Harmonal excess Glucocorticoids, growth harmone, Oes

progest, Catecholamine & Thyroxine.

7. Hepatic diseases like Cirrhosis and Haemochromatosis.

 Features of SYNDROME X

TARGETS FOR CONTROL OF DIABETES

 CONCEPT OF DIABETES IN AYURVEDA
PRAMEHA Characterised by Prabhoothavilamoothratha

20 Subtypes (10 Kaphaja, 6 Pittaja, 4 Vataja)

Ikshuvalika Rasa Meha, Sheetha Meha &

Madhumeha exhibit Moothra Madhuryatha

Only Madhumeha shows Tanu Madhuryatha &

incurable
Genetic & Hereditary Concept of Prameha can be
applied to Madhumeha perfectly than to other
subtypes of Prameha
Other Sub types (excluding Madhumeha) of
Prameha represent abnormal constituents or
characters of urine as visible to naked eye.

Hence, Madhumeha represents Diabetes mellitus.

 MADUMEHA
Sahaja (Jatha) Apathyaja

Mathr-Pithra Beeja Mitya ahara &

Dosha vihara

Durbala Tridoshaja with involvement of Balavan

all Dhatus except Asthi
Vata Kapha Predominent initially
Predominent (Vata dominates later)

Santharpana & Samshamana Apatharpana & Samshamana

20 different Kashaya by Charaka

Sarasaladi Ghana kashaya
Kadira Kramukadi kashaya Sushrutha
Advent of Rasaoushadha has made
Madhumeha manageable.
 CHALLENGES IN THE PRESENT DAY
AYU MANGEMENT OF DIABETES
1. No easy going approach
2. Ayurvedic Medicines

Type Combination or Formulation Late results Quality & Supply Cost

single (Evaluation) Problems
3. Patients Education
4. Avoid making tall claims
i. Not all diabetes can be treated by Ayu drugs
alone
ii. Success depends on chronicity of the disease &
regularity of drug intake, exercise & diet.
 ANTI DIABETIC ACTIVITY OF AYU MEDICINES

ANTI HYPERGLYCEMIC ACTIVITY Moderate antihyperglycemic Activity

1. Intestinal absorption of glucose but useful in diabetes by other
mechanisms
Break down Of Gel formation in Glucose
Oligo sacharides the intestine absorption across
the l wall
e.g. Ekanayaka e.g. Gaur gum
e.g Ekanayaka
2. B Cell Stimulation Gymnemla, Karela

Jambu Guduchi Bilva Nimba Methi

3. B Cell rejuvenation & regeneration

Gymnema Asana Karela

4. Insulin receptor action

Insulinominetic Direct
Dalchini
Asana Methi Kalamegha Trivang
 ANTI DIABETIC ACTIVITY OF AYU MEDICINES

ANTI HYPERGLYCEMIC ACTIVITY Moderate antihyperglycemic Activity

but useful in diabetes by other
mechanisms
a) Modification of fat metabolism

Dalchini Methi AV Chandraprabha Karela

b) Antioxidant Triphala
c) Reducing the impact of advanced
glycated end Products Haridra
d) Immunomodulation

Guduchi Haridra
e) Uncertain mechanisms
i. Vasanth Kusumakar
ii. Khadir Kramukha Yoga
 Practical treatment of Diabetes depends on
stages of the disease at which Ayurvedic
Physician enters tha cycle.

1.Prediabetic or Early diabetic

Asana 30gm
Ekanayaka 10gm Aqueous decoction (1:4) daily
Triphala 10gm
In fact any other combination may be used. When the above
combination does not work or PPBs is above 300 mgm% the following
strong combination is useful.
Asana + Ekanayaka + Gudmar + Karela + Jambhu
1gm 1gm 500 mgm 500 mgm 500 mgm
Ext Ext Ext Ext Ext

Unsuitable for Choorna Unsuitable for Kwatha

formulation formulation
 2. Moderately Chronic Diabetic on oral
Hypoglycemics (5 -10 years) or labile diabetic (severe
variations in sugar levels).

Improving Insulin receptors

Above Combination + Trivanga Methi Sprouted

125 mgm Ext 1 gm BD
Insulinomimetic Dalchini 1 6 gms/day
3. Chronic Diabetic (>-10 years) or on
Insulin with possible complications
Basic combination + Vasanth Kusumakar 125 mgs/day
+
Nisha 1gm Srothoshodhak
Dhathri 1gm &
Guduchi 2.5gm Rasayani
 PRECAUTIONS While treating a Diabetic
Patient on Modern Medicine

a) No abrupt stopping of modern medicine as Ayu medicine are slow

to act.

b) Gradual reduction of dosage of allopathic medicine depending on

blood sugar level.

c) No other drug interaction occur between allopathic & ayurvedic

medicines.

d) MOTTO IN CHRONIC CASES is to maintain blood sugar (PP<180

FBS< 130mg % by HOOK or CROOK
 When to call for the help of a Modern
Consultant in Ayu Management of
Madhumeha

1. Acute metabolic complications

like DKA
Hyperosmolar Hyperglycemic Coma
2. Stressful situations
like Major Sepsis
Burns
Major Trauma
Preoperative
Pregnancy (Not an abosolute indication)
Ayu drugs may be tried if FBS maintained
<95mg% and PP<120mg%.
 Diet & Exercise in Madhumeha
a) Quality Avoid direct sweet & oily food)
Fruits & Honey also raise sugar but less extent)
b) Quantity Plate meal concept
c) Exercise [1/2 hr. jogging & cycling. 1 hr. walking]
Regularity a must.

d) Life Style Modifications Yoga & Meditation

Sincerity a must
Neuroendocrinal
Tranquility
Avoid smoking
 Management of Diabetic Complications
1) Retinopathy Triphala Gugula
SMV 125 mgm/day

2) Nephropathy Punanrava Choorna 2gms/day

Guduchi Choorna 2gms/day
Chandraprabha 500 mgm/day
in Sapthaparna Kwatha
3) Neuropathy & Impotence Vanga Bhasma 250 mgm/day
Vasantha Kusumakar125mgm/day

4) Diabetic Wounds & Pidaka Asanadi Decoction

KaishoraG & Gandhaka Rasayana
SMV
5) Diabetic Dyslipidemia [ Methi & Dalchini 2gm + 3gm
Arogyavardhini 500 mgm/day
 Research in Diabetes
Modern Medicine
a) Type 1 Diabetes is preventable
Metformin 31%
Diet & exercise alone 58%
Trials with
Acarbose
Rosiglitazone
b) Designer Insulin like Lispro have been useful.
c) GLP 1, Exenatide have shown B cell regeneration potential.
d) Stem cell transplantation One type insulin delivery
Graft rejection to be addressed.
Limited value in Both Type 1 &
linsulin resistence
Ayurveda

1. More research on B cell regeneration potential

of plants.

2. Insulinomimetic action of Dalchini promising.

3. Role of drugs acting on Medho-dhathu to be

reassessed in the light of the finding that
FFA increase insulin resistance
Thank
You