Introduction
Diabetes is the burning problem in medical science as well as Ayurvedic science. It has become a challenge in the medical field. So many researches have been done at various institutes in different places & in different way but till now no concrete results have been achieved.
Prameha is mentioned in Santarpanajanya Vyadhi (Ch. Su.-23/6) and the line of treatment for Santarpanjanya Vyadhi is Apatarpana and Sanshodhana which include Vamana, Virechana, Basti, Nasya. Acharya Charaka and Vagbhata has mentioned Sanshodhana therapy as line of treatment for the management of Sthula Pramehi.
Diabetes being a metabolic disease needs to be corrected by correcting metabolism. The metabolic activities are primarily regulated by Pitta Dosha, for the correction of Pitta Dosha Virechana Karma is the first and foremost treatment modality.
As the disease Prameha advances it result in aggravation of Vata and Madhumeha in particular a type of Prameha involve mainly Vata dosha and for the correction of Vata dosha, Basti karma is the first and foremost treatment modality.
Acharya Charaka specially mentioned Panchatikta Pancha Prashritika Basti for the management of Prameha.
It is need of hour to put some clinical & experimental data to support & evaluate their efficacy. With this background the present research entitled “A Comparative Clinical Study On The Effect Of Virechana Karma And Panchatikta Pancha Prashritika Basti Karma In The Management Of Prameha W.S.R. To Type II Diabetes” was undertaken with following aims & objectives.
Material and Methods
The research work has been carried out in three groups as follows
Group-A: The Patients of this group were treated with Virechana Karma followed by Madhumehari churna.
Group-B: In this group patients were treated with Panchatikta Pancha Prashritika Basti Karma followed by Madhumehari churna.
Group-C: In this group patient were continued on modern medicine for 3 months (Standard control group)
For this study 30 patients for each group were selected from inpatient and outpatient department of National institute of Ayurveda, Jaipur, Rajasthan.
Table 1
Distribution of 30 patients according to total amount of sneha needed
|
Total Amount of Sneha (ML.) |
No of patient in Group ‘A’ |
Percentage |
|
350-550 |
15 |
50 |
|
>550-750 |
06 |
20 |
|
>750-950 |
09 |
30 |
Table 2
Distribution of 30 patients according to days required for snehana
|
No. of Days |
No. of patients |
Percentage |
|
5 |
13 |
43.33 |
|
6 |
1 |
3.33 |
|
7 |
16 |
53.33 |
Table 3
Duration of sneha pachana in group A
|
Group A |
Mean Duration/ Day (in hrs) |
Total |
||||||
|
1st |
2nd |
3rd |
4th |
5th |
6th |
7th |
||
|
N=30 |
4.13 |
6.7 |
8.26 |
10.00 |
11.13 |
11.4 |
12.38 |
9.14 |
% acquire Samyaka Snigdhata in 6 days, where as 16 % of them with in 7 days.amyaka Snigdhata was achieved in 5 days
Observation on virechana karma
Table 4
Distribution of 30 patients of Group A according to time required for onset of virechana vega
|
Time required for onset of Vega |
No. of Patients |
Percentage |
|
>0 to 1 hour |
08 |
26.66 |
|
>1 to 1½ hour |
09 |
30 |
|
>1½ to 2 hour |
09 |
30 |
|
>2 to 2½ hour |
04 |
13.33 |
Table 5
Distribution of 30 patients of group ‘A’ according to virechana vega
|
Virechana Vega |
No. of Patient |
Percentage |
|
1- 10 |
06 |
20 |
|
11-20 |
16 |
53.33 |
|
21- 30 |
07 |
23.33 |
|
>30 |
01 |
3.33 |
Table 6
Distribution of 30 patients of group ‘A’ according to shuddhi
|
Suddhi |
No. of Patients |
Percentage |
|
Pravara |
08 |
26.67 |
|
Madhyama |
17 |
56.67 |
|
Avara |
05 |
16.67 |
Table 7
Distribution of 30 patients of Group‘A’ according to antiki shuddhi
|
Suddhi |
No. of Patients |
Percentage |
|
Kaphant |
25 |
83.33 |
|
Pittant |
05 |
16.67 |
Table 8
Distribution of 30 patients of Group ‘A’ according to laingiki shuddhi
|
Shuddhi lakshana |
No. of Patients |
Percentage |
|
Srotoshuddhi |
27 |
90 |
|
Indriya Prasada |
09 |
30 |
|
Laghuta |
25 |
83.33 |
|
Agni Vriddhi |
13 |
43.33 |
|
KramaVita,Pitta,Kapha,VataAgamana |
14 |
46.66 |
|
Anamayata |
00 |
00 |
Table 9
Average retention time of anuvasana basti found in 30 patients of madhumeha
|
<6 hrs |
6 To 12 hrs |
>12 hrs |
|||
|
No. of Patients |
% |
No. of Patients |
% |
No. of Patients |
% |
|
19 |
63.33 |
11 |
36.67 |
0 |
0 |
Table 10
Average retention time of niruha basti found in 30 patients of madhumeha
|
5 To 10 Min |
10 To 15 Min |
>15 Min |
|||
|
No. of Patients |
% |
No. of Patients |
% |
No. of Patients |
% |
|
13 |
43.33 |
16 |
53.33 |
01 |
0 |
Table 11
Yoga-ayoga-atiyoga after niruha basti administration
|
Yoga |
Found in every Basti |
|
|
No. of Patients |
% |
|
|
Samyak Yoga |
28 |
93.33 |
|
Ayoga |
00 |
00 |
|
Atiyoga |
02 |
6.67 |
Table 12
Yoga-ayoga-atiyoga after anuvasana basti administration
|
Yoga |
Found in every Basti |
|
|
No. of Patients |
% |
|
|
Samyak Yoga |
30 |
100 |
|
Ayoga |
0 |
0 |
|
Atiyoga |
0 |
0 |
Table 13
Improvement in symptoms of madhumeha in virechana group
Table 14
Improvement in symptoms of madhumeha (type 2 DM) in basti group
Table 15
Change in biochemical parameters in virechana group
Objective
Evaluate the effect of Virechana karma and Panchatikta Pancha Prashritika(PPP)Basti Karma in the management of Madhumeha (Type 2 DM).
Inclusion criteria
Patient of NIDDM with blood sugar level; FBS- 126 to 300 mg/dl or PPBS-180 to 400 mg/dl.
Patient having classical signs and symptoms of the Prameha(Diabetes) according to Ayurveda as well as modern medicine.
Age group of 20-60 years patient otherwise healthy and fit for Virechana karma and Basti Karma as per the ayurvedic classics.
Exclusion criteria
Age < 20 yrs and > 60 yrs
Patients of Prameha (Diabetes having disease chronicity of more than 20 yrs
Patients of Type-1 Diabetes or the patients of Type-2 Diabetes taking Insulin
Patients having serious complications of Diabetes like Nephropathy, Neuropathy, Retinopathy, Diabetic Foot, Carbuncles etc
Patients having drug or chemical induced Type II Diabetes, like glucocorticoids induced or thyroid hormone induced etc.
Diabetes associated with Carcinoma or any other disease affecting multiple body systems
Pregnancy
Virechana karma
In Ayurveda Virechana Karma(Purgative Therapy) is indicated for the treatment of Madhumeha(Type 2 DM).1 30 Patients of Non Insulin Dependent Diabetes Mellitus were registered in this group. All the patients were examined for general condition and for assessment criteria’s. In this group patients are given Virechana Karma in following manner.
Deepana-pachana
Panchakola Churna 3Gms 2 times a day was given with Sukhoshna Jala Anupana for 3 to 7 days till Nirama Lakshana achieved. During this period Laghu, Rooksha, Pathya and easily digestible Aahar (diet) was advised.
Snehapana
After observing Diptagni, patients were given Triphal Siddha Taila for Snehapana starting with Hrasiyasi Matra (30- 50ml) which was increased in Arohana Krama till Samyak Snigdha Lakshana appeared.
Vishrama kala
During Vishrama Kala Sarvanga Abhyanga with Dashamoola Taila was done for 30 minutes followed by Mrudu Bashpa Sveda for 3 days.
Pradhana karma
In the morning after ascertaining the digestion of previous night meal, Virechana Yoga (10 gm) was given after administering Sarvanga Abhyanga and Mrudu Bashpa Sveda to the patients and advised for drinking of warm water from time to time to potentiate the action of Virechana. A constant observation was made and recorded the initiation of Vega, associated features and completion of Vega etc.
Virechana yoga
Virechana yoga was selected from charak samhita i.e
Table 17
Pashchat karma
For deciding the type of Shuddhi Laingiki, Vaigiki and Antiki parameters were considered. After completion of Virechana, the patients were asked to have complete physical and mental rest and to follow the diet and code of conduct. The Samsarjana Krama was decided on the basis of Shuddhi grade and it was started from the evening meal on the day of Virechana.2
Panchatikta pancha prashritika basti (PPP Basti) karma
In Ayurveda Panchatikta pancha prashritika Basti (PPP Basti) is specially indicated for Madhumeha.3 30 Patients of Non Insulin Dependent Diabetes Mellitus were registered in this group. All the patients were examined for general condition and for sign and symptoms of Diabetes mellitus. In this group patients were given PPP Basti Karma.
Panch tikta panch prashritika Basti is specifically indicated for the treatment of Prameha Hence this Basti was administered in Kala Basti schedule which consist of total 16 number of Basti out of which 6 were Niruha Basti and 10 were Anuvasana Basti.4
Table 18
Niruha Basti
Preparation of panchtikta panch prashritika bast5
Pancha Tikta pancha prashritika basti contain following ingredients in different proportion as shown below:
Raw material for kashaya (decoction)
Patol patra (Trichosanthes dioica leaf)
Nimba twak (Azadirachta indica bark)
Kiratatikta (Swertia chirata whole plant)
Rasna (Pluchea lanceolata leaf)
Saptaparna (Alstonia scholaris bark)
Honey and rock salt were mixed together in the beginning followed by addition of warm ghee and thoroughly triturated. The finely wet grinded paste of Sarshapa was then added; lastly decoction was added to it. The mixture was then again triturated thoroughly. Mixture is than filtered through sieve and made warm indirectly in water bath. The filtrate so obtained was used as Basti dravya.
Anuvasana basti
Triphala Siddha Tila taila 60 ml mixed with one gram each of Shatpushpa and Saindhava Lavana was used for Anuvasana Basti.
Yoga-Atiyoga and ayoga of Niruha and Anuvashana Basti arePresented in Table 1-4.
Madhu mehari churna (Shaman drug)
Madhu mehari churna is the commonly prescribed yoga at National institute of Ayurveda, Jaipur for the treatment of Diabetes (Madhumeha). This is prepared by taking equal amount of each of following 12 drugs.
Table 20
Results
The important findings of the present clinical study are presented below:
Sthula madhumeha a type of Prameha can be correlated to type 2 Diabetes mellitus based on sign and symptoms
Bahudosha, Agnimandhya particularly Dhatwagnimandhya, Medasavruta Marga, Margavarana Janya Vata Prakopa are important factors involved in pathogenesis of Madhumeha
Samshodhana is the first line of treatment for Sthula Pramehi
Virechana is the best among Samshodhana for elimination of Bahu Dosha in general and Pitta dosha in particular along with it have effect on Kapha Dosha also and regulates the movement of Vata and improves Agni
Basti is best to correct Vata Dosha to remove the Avarana of Vata and PPP Basti is specially advised for Prameha, the drugs of PPP Basti are lekhana in nature their by reduces Meda and Kleda which are the basic factor in Prameha
Triphala Taila for Snehapana in Virechana group and for Anuvasana Basti in Basti group and Triphala Trivrit, Danti Trikatu, Chitraka Choorna, with Snuhi Kshira for Virechana and Pancha Tikta Pancha Prasrutika Niruha Basti, were used as these drugs are specifically mentioned for the treatment of Prameha. Madhumehari churna contains drugs Jambu Beeja, Amra Patra, Karavellaka, Gudmar, Bilva Patra, Neem Beeja, Bala Beeja which are dominant in Tikta, Kashaya Rasa, Katu Vipaka Ushna Virya, Kapha Pitta hara and lekhana and Rukshana action and proven for anti diabetic, hypolipidemic, and hypoglycemic action.
In this study 44.44% patient were in the age group of 51- 60 years, 64.44% were males, 33.33% were house wives, 36.67% of patients had family history of Madhumeha, 66.67% patients were having Vishamagni, 61.11% 65.56% patients were having Madhyama Koshtha, Vata Pitta and Pitta Kapha prakriti were predominant in 27.78% and 26.67% patients respectively, Madhura rasa Aahara in 77.78%, Snigdha Ahara (milk products etc) in 85.56 %, sedentary nature of work in 83.33% of patients.
In group A 26.66 % patients were having FBS between 126 to 150 mgm/dl, 53.33 % between 151- 200 mgm/dl and 20 % between 201- 250 mgm/dl. In group B 23.33 % patients were having FBS between 126 to 150 mgm/dl, 60 % between 151- 200 mgm/dl and 16.66 % between 201- 250 mgm/dl and in group C 20 % patients were having FBS between 126 to 150 mgm/dl, 70 % between 151- 200 mgm/dl , 3.33 % between 201- 250 mgm/dl and 6.66% between 251- 300 mgm/dl.
In group A 46.66 % patients were having PPBS between 181 to 230 mgm/dl, 40 % between 231- 280 mgm/dl and 10 % between 281- 330 mgm/dl and 3.33% between 331- 380 mgm/dl. In group B 50 % patients were having FBS between 181 to 230 and mgm/dl, 43.33 % between 231- 280 mgm/dl and 3.33 % both between 281- 330 and 331-380mgm/dl respectively. In group C 56.66 % patients were having FBS between 181 to 230 mgm/dl, 30 % between 231- 280 mgm/dl, 10 % between 281- 330 mgm/dl and 3.33% between 331- 380 mgm/dl.
In group A 46.66% had urine sugar nil, 33.33% had 1+,10 % each had urine sugar 2+ and 4+.in group B 40% had urine sugar nil, 26.66% had 1+,20 % each had urine sugar 2+ , 6.66% each had 3+and 4+. In group C 50% had urine sugar nil, 30% had 1+,6.66 % had urine sugar 2+ and 13.33% had urine sugar 4+.
In group A Virechana reduced Prabhutamutrata by 66.69%, Aavilamutrata by 88.83%, Kshudhadhikya by 46.94%, Trishnadhikya by 70.79%, Karapadataladaha by 71.66%, Karapadatalasuptata by 78.98%, Atisweda by 75.11% FBS by 22.68%, PPBS by 20.15% and Urine sugar by 57.12%. All these results were statistically highly significant (P=0.001)
In group B PPP basti reduced Prabhutamutrata by 44.07%,Aavilamutrata by 90%, Kshudhadhikya by 23.27%, Trishnadhikya by 69.72%, Karapadataladaha by 41.17%, Karapadatalasuptata by 78.45%, Atisweda by 20.38% FBS by 23.50%, PPBS by 16.51% Urine sugar by 59.02%. All these results were statistically highly significant (P=0.001).
In group C oral hypoglycaemic drugs reduced FBS by 15.64%, PPBS by 17.98%, Prabhutmurata by 57.80%, Avila Mutrata by 94.0%, All these results were statistically highly significant. Trishnadhikya was reduced by 53.40%, Karapada Daha and Karapada Suptata by 27.77%, All these results were statistically significant.
Percentagewise Virechana was better than PPP Basti and PPP Basti was better than oral hypoglycemic drugs for Prabhutamutarata, Kshudadhikya, Karapadataladaha, Atisweda, Alashya, Sheetpriata, Pindikodvestana, Nidradhikya, Tamodarshan, BMI, Serum Cholesterol, HDL and LDL; whereas PPP Basti was better than Virechana and Virechana was better than oral hypoglycemic drugs in Aavilmutrata, Karapada suptata, Dourbalya, Klaibya, FBS and VLDL.
Group comparison by ANNOVA test showed that the difference in the results in between the groups is statistically insignificant.
Virechana was found better to reduce FBS and PPP Basti was found better to reduce PPBS
Statistical test
The data obtained on the basis of observation was subjected to statistical analysis in the term of mean, standard deviation error by applying the unpaired ‘t’ test. The results were interpreted at p<0.05, p<0.01 and p<0.001 significance levels
The effect of the Virechana karma on Madhumeha (type2DM) are presented in table and Chart.
Discussion
Virechana Dravya leads to inflammation in mucosal cell. Due to inflammatory changes vaso active amines and polypeptides increases membrane permeability in GIT and cause vaso dilation thus waste products where so ever present in the body either in extra-cellular, intracellular or in plasma can be brought into intestine to maintain the homogeneity from where it can be eliminated out of body by the increased propulsive movement of G.I tract, which is induced by Virechana Dravya.
Bahu Drava Shleshma, Abadda Medas, Agnimandhya, and Srotorodha are important factors in the pathogenisis of Sthula Madhumeha. Virechana eliminates the vitiated Dosha and Mala and clears the channels,6 which are obstructed by Shleshma and Medas and removes the Avarana and regulates the Vata.
Acharya Charaka mentioned that Basti reaches the Nabhi Pradesha, Kati, Parshva and Kukshi expels out the Pureesha and accumulated Dosha after mixing with them.7 On the other hand Acharya Sushruta has clearly mentioned that though Basti is administered in the Pakvashaya, the active principles of Basti Dravya spreads all over the body through the minute Srotas in the same way as water reaches to all parts of the plant from its root.8
According to modern science
Enteric nervous system (ENS) normally communicate with the central nervous system through the parasympathetic (eg. via the Vagus nerve) and sympathetic (e.g. via the Prevertebral ganglia) nervous system. Sensory neurons of the ENS monitor chemical changes within the GIT as well as pressure of its wall. Enteric motor neurons govern contraction of GI tract smooth muscle and activity of GI tract endocrine cells. ENS also makes use of more than thirty neurotransmitters, most of which are identical to the ones found in CNS such as acetylcholine, dopamine, serotonine etc. The enteric nervous system has the capacity to alter its response depending on factors such as bulk and nutrient composition. As the total nervous system is interrelated so this regular stimulation to ENS may have some positive effect over the CNS also and in this way the neuro- endocrine regulation may take place.9
Basti corrects the Vata Dosha and by virtue of the lekhana property of the drugs used in PPP Basti it cleanses the channels removes the Medasa Avarana and regulates the movement of vata.
Conclusion
The important findings of the present clinical study are presented below:
Sthula madhumeha a type of Prameha can be correlated to type 2 Diabetes mellitus based on sign and symptoms
Bahudosha, Agnimandhya particularly Dhatwagnimandhya, Medasavruta Marga, Margavarana Janya Vata Prakopa are important factors involved in pathogenesis of Madhumeha
Samshodhana is the first line of treatment for Sthula Pramehi
Virechana is the best among Samshodhana for elimination of Bahu Dosha in general and Pitta dosha in particular along with it have effect on Kapha Dosha also and regulates the movement of Vata and improves Agni
Basti is best to correct Vata Dosha to remove the Avarana of Vata and PPP Basti is specially advised for Prameha, the drugs of PPP Basti are lekhana in nature their by reduces Meda and Kleda which are the basic factor in Prameha
Triphala Taila for Snehapana in Virechana group and for Anuvasana Basti in Basti group and Triphala Trivrit, Danti Trikatu, Chitraka Choorna, with Snuhi Kshira for Virechana and Pancha Tikta Pancha Prasrutika Niruha Basti, were used as these drugs are specifically mentioned for the treatment of Prameha. Madhumehari churna contains drugs Jambu Beeja, Amrasthi, Karavellaka, Gudmar, Bilva Patra, Neem Beeja, Bala Beeja which are dominant in Tikta, Kashaya Rasa, Katu Vipaka Ushna Virya, Kapha Pitta hara and lekhana and Rukshana action and proven for anti diabetic, hypolipidemic, and hypoglycemic action.
Percentagewise Virechana was better than PPP Basti and PPP Basti was better than oral hypoglycemic drugs for Prabhutamutarata, Kshudadhikya, Karapadataladaha, Atisweda, Alashya, Sheetpriata, Pindikodvestana, Nidradhikya, Tamodarshan, BMI, Serum Cholesterol, HDL and LDL; whereas PPP Basti was better than Virechana and Virechana was better than oral hypoglycemic drugs in Aavilmutrata, Karapada suptata, Dourbalya, Klaibya, FBS and VLDL.
Group comparison by ANNOVA test showed that the difference in the results in between the groups is statistically insignificant.
Virechana was found better to reduce FBS and PPP Basti was found better to reduce PPBS
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