A Clinical Study of the Effect of Somarajyadi Churnam In the Management of Prameha. THESIS SUBMITTED IN PARTIAL FULFILMENT FOR THE DEGREE OF Doctor Of Medicine (Ayurveda) By G.KAVITHA REDDY B.A.M.S Under the Guidence of Dr.V.VIJAYA BABU M.D.(Ay) Reader/Professor K.C Post Graduate Dept of Kayachikitsa. Co-Guide Dr.Vijaya Lakshmi M.D (Ay) Gaz.Lecturer Dept.of K.C. DEPARMENT OF KAYACHIKITSA POST GRADUATE UNIT GOVERNMENT AYURVEDIC COLLEGE Osmania University,Hyderabad-A.P.India. created by technoayurveda.wordpress.com of Dr.KSRPrasad
A Clinical Study of the Effect of Somarajyadi Churnam In the Management of Prameha, G.KAVITHA REDDY, Department of Kayachikitsa, PG unit Dr.BRKR Govt. Ayurvedic College, HYDERABAD
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A Clinical Study of the Effect of SomarajyadiChurnam In the Management of Prameha.
THESIS SUBMITTED IN PARTIAL FULFILMENTFOR THE DEGREE OF
Doctor Of Medicine (Ayurveda)
ByG.KAVITHA REDDY
B.A.M.S
Under the Guidence of
Dr.V.VIJAYA BABUM.D.(Ay)
Reader/Professor K.CPost Graduate Dept of Kayachikitsa.
Co-GuideDr.Vijaya Lakshmi
M.D (Ay)Gaz.Lecturer Dept.of K.C.
DEPARMENT OF KAYACHIKITSA POST GRADUATE UNITGOVERNMENT AYURVEDIC COLLEGEOsmania University,Hyderabad-A.P.India.
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Ayurmitra
TAyComprehended
CONTENTS
Contents Page Nos.
I Introduction
Historical background of Disease
II Shareeram
III The Disease
1) Nidana
2) Poorvaropa
3) Roopam
4) Classification of Disease
5) Samprapti
6) Upadravas & Aristalakshanas
7) Sadhyaasadhyata & Sapeksha nidana
8) Chikitsa and Pathyaapathya
IV The Drug and its Selection
V Clinical Study
1) Method and Material
2) Observation and Results
VI Discussion
Conclusion
Summary
Bibliography
Case Sheet
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Dr.N.T.R.UNIVERSITY OF HEALTH SCIENCESVijayawada
POST GRADUATE TRAINING & RESEARCH UNITDEPARTMENT OF KAYA CHIKITSA
Dr.B.R.K.R.Govt.Ayurvedic College / HospitalHyderabad.
CERTIFICATE
This is to certify that Dr. KAVITHA REDDY, a final year Post Graduate Scholar of
M.D.(Ay) Kaya Chikitsa of this institute has worked for the thesis on the topic “A clinical
study on the effect of Somarajyadi Churnam in the Management of Prameha” for the
degree of Doctor of Medicine (Ayurveda). This work has been completed under my direct
supervision after a series of scientific discussions.
The scholar has put in commendable effort for designing and executing the methods
and plans for the study.
Hence I recommend this dissertation to be submitted for adjudication.
Signature of the Co-guide Signature of the Guide
DR.K.VIJAYA LAXMI DR. V.VIJAYA BABUM.D.(Ayu) M.D.(Ay)Lecturer Reader
Post Graduate Dept. of Kaya ChikitsaDr.B.R.K.R.Govt.Ayurvedic College
Hyderabad
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Dr.N.T.R.UNIVERSITY OF HEALTH SCIENCESVijayawada
POST GRADUATE TRAINING & RESEARCH UNITDEPARTMENT OF KAYA CHIKITSA
Dr.B.R.K.R.Govt.Ayurvedic College / HospitalHyderabad.
CERTIFICATE
This is to certify that Dr. KAVITHA REDDY, a final year Post Graduate Scholar of
M.D.(Ay) Kaya Chikitsa of this institute has worked for the thesis on the topic “A clinical
study on the effect of Somarajyadi Churnam in the Management of Prameha” as per
requirements of the order laid by the N.T.R.University of Health Sciences, for the purpose.
The Hypothesis submitted by her in the First year M.D. (Ay) is one and the same to that of
the dissertation submitted.
I am fully satisfied with her work and hereby forward the dissertation for the
evaluation of the adjudicators.
Date:Place: Hyderabad.
Dr. PRAKASH CHANDERM.D.(Ay)
Professor & H.O.DPost Graduate Dept. of Kaya ChikitsaDr.B.R.K.R.Govt. Ayurvedic College
Hyderabad.
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A CLINICAL STUDY OF THE EFFECT OFSOMARAJYADI CHURNAM IN THE MANAGEMENT OF PRAMEHA
Dissertation submitted in partial fulfillment for the degree of
DOCTOR OF MEDICINE (AYURVEDA)
In
KAYACHIKITSA
By
Dr. KAVITHA REDDYB.A.M.S
GUIDE
Dr. V.VIJAYA BABUM.D.(Ay)
ReaderPost Graduate Department of Kayachikitsa
Dr. B.R.K.R.Govt.Ayurvedic CollegeHyderabad.
Dr. N.T.R.UNIVERSITY OF HEALTH SCIENCESVIJAYAWADA
Dr.B.R.K.R.Govt. Ayurvedic College, HYDERABAD.
2008
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ACKNOWLEDGEMENTS
At the unforgettable moment, I prostrate my head on the feet of our aradhyadeva
LAKSHMI NARASIMHA SWAMY for deputing me to serve the man kind.
I take atmost pleasure and feel privileged to express my deep sense of gratitude and
extreme and Indebtedness to my guru and guide Dr V. VIJAYA BABU M.D(Ayu),
Reader, Post Graduate Dept. of Kayachikitsa, Dr B.R.K.R Govt Ayurvedic
college,Hyderabad. for his constant and valuable guidance, encouragement throughout
the dissertation work and with thought provoking discussions, undoubtedly correct,
affectionate and untiring guidance of my guru has been a greatest asset in completion.
I expresss my heartful gratitude to Dr.PRAKASH CHANDER, M.D(Ayu), Professor and
Head of the Dept, P.G Dept. of Kayachitsta, Dr.B.R.K.R Govt Ayurvedic
college,Hyderabad. For his constant support, guidance, encouragement and kind co
operation in all aspects.
I am highly indebted to Dr. K.VIJAYA LAKSHMI for her valuable suggestions, being a
co-guide.
I take this opportunity to express my sincere thanks to Dr. Nageswer Babu, Dr.M
Ramalingeswar Rao, Dr.Vasudeva Rao, Dr. M.L Naidu, Dr.M.Satya Prasad and technical
assisatants Post Graduate Dept of Kayachikitsa,For their kind co-operation in my clinical
work.
I pay my sincere respect to Dr.M Sadasiva Rao Principal of Dr B.R.K.R Govt Ayurvedic
college,Hyderabad.for providing facilities for the research work.
I am greatful to the Ex -Superintendent Dr L.R. K Murhty Govt Ayurvedic hospital, Dr
B.R.K.R Govt Ayurvedic college,Hyderabad. for their kind co-operation.
I am thankful to Dr.V.L.N Sastry, Superintendent, Ayurvedic
hospital,Erragadda,Hyderabad for permitting me to conduct research work in the hospital.
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I am highly thankful to Dr. Ananthasayanachari,HOD of P.G Dept. of SSP and
Dr.M.Philip Anandkumar, HOD of P.G Dept of Dravyaguna for their kindly co-
opearttion.
I cordially Acknowldge my friends and collegues Dr D.Usha Madhuri, Dr.Alibasha,
Dr,Sreenivas Rao, Dr,.Nanda Kumar, Dr.Sivanarayana,Dr.Jaya Lakshmi,Dr.Lavanya, Dr
Padmaja and otheres who helped me in one way or other in completing this work.
I thank to Mr Ramalingeswar Rao for typing this work type neatly.
I thank to Mr Surendra Nath who helped me in statistic analysis.
I express my special to thanks to K.Subba Reddy for contious co-operation and
encoragemnt and concern and care.
I pay homage to my beloved father Mr G.Sidda Reddy and Mrs G.Santhamma.
& my beloved brother Mr. G .Bhanu prakash Reddy their incessant love and blessings
was constant driving force behind my progress.
I am highly greatful to the authors of all the books and articles which have been utilized
by me as the source of information in the preparation of this thesis.
Lastly I am thankful to all my patients of trial drug and all those persons, who have
helped me directly or indirectly for the project work.
Date:
Place: Hyderbad. Dr. Kavitha Reddy
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INTRODUCTION
Ayurveda is a science of life. This is most auspicious and scared of all sciences.It is
originated from Atharva Veda.The Rig and Yajurveda also hold substantial role of
Ayurveda. The word Ayurveda has not seen as such in the Vedas but a considerable
portions of the Vedas is devoted for the promotion of long life, prevention of disease and
to medical treatment
Since 19th centuary there has been noted progress in the Indian medicine. Currently
prameha is considered to be due to metabolic disturbance and insulin, Ayurveda has
required an important place in the competitive world along with other branches of
medicine by the special knowledge and modes of treatment of Madhumeha.
Madhumeha is more or less found in all countries. However the incidence is more in the
persons addicted to unwholesome diet and action. A large population of the world
specially persons of Asian subcontinent are afflicted by the disease.
Diabetes was known to ancient Indians as early as 6th centuary2 .Charaka in his Charaka
samhita has mentioned the sweetness of urine in addition to polturia.3 He collected
material from much earlier workers of Agnivesha who based his writing on the teachings
of Atreya who lived in the 6th centuary B.C4.The Indian physician Susrutha in 500 A.D
described the disease as Madhumeha with symptoms of foul breath, voracious appetite
and languor,besides Charaka and Susrutha samhitas. Other early Indian example:Astanga
Hrudaya, Bhavaprakasha, Madhava nidana ,Sarangadhara samhita etc. have also
described Madhumeha as Diabetes.
The Indian indigenous agents can be divided into groups according totheir source of
origin viz. vegetable or herbal and mineral preparations. Vegetable or herbal agents
administered as “swarasa” “kwatha” “churna” “asavas” and “aristas” constitute the
majority of Indian indigenous anti diabeticdrugs. Mineral preparation is given as
“bhasmas” are comparatively fewer. The bulk of information on this indigenous drugs is
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scatered in fragments with many individuals and in age old books and manuscripts
which are some time out of print.However a few books examples:- Vaman Ganesh
Desai’s Aushadi sangrah5, Nadkarnis Materia medica6,7 and Chopras indigenous drugs
of India8 and some reviews of Mukerjee9,Ajgonkar10, Chowhan and Sen11 have given
some comprehensive lists of such drugs are claimed to be useful in Diabetes.
A middle aged person, who is apparently normal, may start complaining of weakness,
excessive urination during nights and increase of hunger. Unless these complaints are
voiced by the patients, it is difficult to notice that the person is suffering from disease. On
a through investigation, the person is diagnosed as suffering from Diabetes mellitus
(Madhumeha). Generally Madhumeha is known as a “richmans disease” particularly
because a person who is able to enjoy the pleasure of life (over nutrition) without any
perceptible exercise is usually affected with this disease. The importance of over nutrition
is shown by the fact that over the age of 40, some 80% of the patients developing
diabetes are, have been considerably overweight. The question is relevant that “Every
excess causes a defect, every defect an excess”12. Broadly speaking both the incidence
and mortality of diabetes after middle age vary directly with the degree of obesity.
Madhumeha is achronic disease of relapsing nature13. The disease is also a debilitating
one. The treatment for the disease, at present, in modern science is based on the
additional supply of insulin, which is very disadvantageous to a patient to be continued
indefinetly. Researches are being conducted throughout the world to find permanent cure
for this disease. The efficacy of the Ayurvedic treatment has to be scientifically
investigated thoroughly.
Accordingly care has been taken not only to select a compound drug and simple yoga
from those prescribed for the disease in the sastra, but also to select and easily available
drugs and a yoga which is easy to prepare and administer. The drug selected thus is
“Somarajyadi churnam” and the yoga selected constitute of Bakuchi ,Avarthaki,
Madhunashini, Sunti. It is anubhuta yoga. These drugs collective have got Madhumeha
hara property and also kapha medohara gunas.
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Thus ,the aim and scope of the present work has been limited,
1. To a clinical study on prameha/ Madhumeha and,
2. To a clinical study of the effect of Somarajyadi churnam in the management of
prameha.
The disease , the drug and the clinical study are discussed in forth coming pages.
REFERENCES
1. CHARAKA SUTRASTANA 30-21
SUSRUTHA SUTRASTANA 1-8
ANTISEPTIC 57:221 AND 285 1980 BY CHOWHAN &SEN
3.CHARAKA SAMHITA 1940 EDI. P. 675 SRI GULAB KUNVERABA
4.WORLD CONGRESS ON DIABETES IN THE TROPICS, BOMBAY
20TH &22ND JAN.1966 MADHUMEHA 6:289,1966
5.NAGARJUNA, CALCUTTA 4:275 1960
6.INDIAN MATERIAMEDICA VOL.I 548 POPULAR BOOK COMPANY,
BOMBAY, 1954.
7. INDIAN MATERIA MEDICA VOL.I 3RD EDI.239,344 POPULAR BOOK
COMPANY, BOMBAY, 1954
8. CHOPRAS INDIGENOUS DRUGS OF INDIA 2ND ED.P.505,604 ,673 UNDHER
AND SONS PRIVATE LTD.CALCUTTA 1958
9. JOURNAL OF SCIENCE IN INDIAN MEDICINE REVIEW 10 A SUPPLEMENT
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Gana:- Charaka included in deepaniya, triptigna, arshogna, stanyashodhana, soolagna,
trishnanigraha, sirovirechana.
Pippalyadi, triktatu(susruta).
Chemical Composition:-
Contains an aromatic, volatile oil.
Camphene, phalladrene, zingeberene.
Cineol, gingerol, oleoresin, gingerin.
K-oxalate.
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1
Materials and methods
My dissertation entitled “A CLINICAL STUDY ON THE EFFECT OF SOMARAJYADI
CHURNAM IN THE MANAGEMENT OF PRAMEHA “ was carried out on 40 patients
who attended the OP and IP sections of Govt.Ayurvedic college/Hospital, Erragadda.
HYD.during Jan 2007 to sep2007.
Aim of study:-
1.To evaluate the effect of “SOMARAJYADI CHURNAM”in patients suffering from stula
and krisha Madhumeha.
2.To evaluate the effect of Somarajyadi churnam in NIDDM patients.
3.Comprehensive literary study on prameha.
1.Materials:-
1. patients
2. drugs
1. Patients :- 40 patients were taken for the study.
2. Drugs:- Somarajyadi churnam with sukoshna jalam
2. Methods:-
1.Location of study:- For the purpose of clinical trials 40 patients were selected from OP and
IP department of Kayachikitsa of Dr.B.R.K.R Govt.Ayurvedic college/
hospital,Erragadda,Hyderabad.
2.Selection of patients:- 40 patients of different age groups were selected on the basis of
FBS&PLBSand corresponding urine sugars.
Diagnostic criteria:-
Criteria - 1:- patients presenting with pratyatma lakshana of Madhumeha –prabhoota and
avilamootrata with mootra or tanumadhuryata with or without roopa are taken as
Madhumehi.
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2
Criteria -2:-
FBS -80 -120mg/dl
PLBS -140 -180mg/dl
Inclusion criteria:- patients fulfilling the following conditions were included.
1. patients between 30yrs -70yrs.
2. Stula and krisha Madhumehi.
3. Patients with Type 2DM with FBS greater than 120mg/dl and lesser than 180mg/dl
and PLBS of more than 160mg/dl and less than 300mg/dl.
Exclusion criteria:- The following patients were excluded from the study.
1.patients below 30yrs.
2.Jatapramehi
3.IDDM patients
4.Gestational diabetes
5.DM secondary to drugs like corticosteroids or due to secondary disorders
Investigations:-The following investigations were done on a mandatory basis.
1.FBS
2. PLBS
3.Urine sugar
Research design:-
A single blind clinical trail with pre and post test design was adopted.
Intervention:-
Intervention was done with Somarajyadi churnam taken,the 4 drugs in equal parts and the
powder is given in 2 divided doses.i.e 6 grams in 2 doses with sukhoshnajalam before food.
Assessment Criteria:-
Any change in the following symptoms were noted and taken for assessment.
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1.Fasting blood sugar
2.post prandial blood sugar
3.post prandial urine sugar
4.sweda adhikhya
=>Sweating after heavy work and fast movement -- 0
=> Profuse sweating after moderate work and movement --- 1
=>Sweating after little work and movement
(stepping ladder etc…) ----2
=>Profuse sweating after little work and little movement ----3
=>Sweating even at rest or cold weather ----4
5.Prabhoota mootrata(quantity & in litres)
1.50 to 2.00 - 0
2.00 to 2.50 -1
2.5 to 3.00 -2
3.00 onwords.. -3
6. Avila mootrata(Turbid Urine)
Crystal clear fluid - 0
Failntly cloudy or smoky -1
Turbidity clearly present but newsprint easily
read through testtube -2
Newsprint not easily read through testtube -3
Newsprint cannot be seen through the testtube -4
7. Stoulya assessed according to body mass index in (Kg/H in m2)
Undernourished (<20) - 1
Normal weight (18.5 to 24.9) - 0
Overweight (25 to 29.9) -1
Obese(30 to 39) -2
Morbid obesity (40 & above) -3
8. Dourbalya
Can do routine exercise/work -0
Can do moderate exercise with hesitancy -1
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Can do mild exercise only,with difficulty -2
Can’t do mild exercise too.. -3
9. Suptata (Numbness & Tingling sensation)
No Suptata - 0
Karapadatala Suptata in continuous - 1
Karapadatala Suptata in continuous
But not severe -2
Karapadatala Suptata in continuous & severe - 3
10.Daha(Burning sensation)
No daha --0
Karapadatala daha/supti in continuous – 1
Karapadatala daha/supti in continuous
But not severe –2
Karapadatala daha/supti in continuous & severe - 3
11.Bahvashita(polyphagia)
No Bahvashita as usual - 0
Slightly increased (1-2 meal) - 1
Moderately increased (3-4 meals) - 2
Markedly increased (5-6 meals) - 3
12.Trushna(Polydipsia)
Feeling of thirst 7-9 times/24 hours - 0
Feeling of thirst 9-11times/24 hours - 1
Feeling of thirst 11-13times/24 hours - 2
Feeling of thirst > 13times - 3
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Observation
1
OBSERVATION1. Age Incidence
Age Group No of Pts %
31- 40 3 7.5%
41 – 50 12 30%
51- 60 20 50%
61-70 5 12.5%
31-40
41-50
51-60
61-70
2. Sex incidence
Sex No of Pts %
Male 26 65%
Female 14 35%
Male
Female
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Observation
2
3. Marital Status
Status No of Pts %
Single 6 15%
Married 34 85%
6
34
0
5
10
15
20
25
30
35
Single Married
Marital Status
Series1
4. Religion Incidence
Religion No of Pts %
Hindu 31 77.5%
Muslim 4 10%
Christian 5 12.5%
Hindu
Muslim
Christian
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Observation
3
5. Socioeconomic status
Status No of Pts %UP 0 0
P 5 12.5
LM 6 15
M 15 37.5
UM 10 25
R 4 10
0
56
15
10
4
0
2
4
6
8
10
12
14
16
UP P LM M UM R
Socioeconomic status
Series1
6. Incidence of Addictions
Habits No of Pts %Smoking 16 40
Tobacco 5 12.5
Alcohol 4 10
T/C 15 38.5
16
54
15
0
2
4
6
8
10
12
14
16
Smoking Tobacco Alcohol T/C
INCIDENCE OF ADDICTIONS
Series1
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Observation
4
7. Dietary Habits
Diet No of Pts %
Veg 12 30
Mixed 28 70
Veg
Mixed
8. Deha prakriti
Prakruti No of Pts %
VP 6 15
PV 3 7.5
VK 14 35
KV 9 22.5
PK 3 7.5
KP 5 12.5
6
3
14
9
3
5
0
2
4
6
8
10
12
14
VP PV VK KV PK KP
DEHA PRAKRITI
Series1
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Observation
5
9. Satva Incidence
Satvam No of Pts %
Pravara 4 10
Madhyama 26 65
Avara 10 25
Pravara
Madhyama
Avara
10. Status of Agni
Agni No of Pts %Teekshna 14 35
Sama 0 0
Vishama 15 37.5
Manda 11 27.5
14
0
15
11
0
2
4
6
8
10
12
14
16
Teekshna Sama Vishama Manda
STATUS OF AGNI
Series1
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Observation
6
11. Bala Incidence
Bala No of Pts %
Pravara 8 20
Madhyama 26 65Avara 6 15
8
26
6
0
5
10
15
20
25
30
Pravara Madhyama Avara
BALA INCIDENCE
Series1
12. Family HistoryRelations No of Pts %
First Degree 18 45
Second degree 1 2.5
No familial history 21 52.5
First Degree
Second degree
No familial history
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Observation
7
13. According to Chronicity
Age No of Pts %
Below 1 year 12 30
1 – 10 years 22 55
Above 10 years 6 15
12
22
6
0
5
10
15
20
25
Below 1 year 1 – 10 years Above 10years
ACCORDING TO CHRONICITY
Series1
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Observation
8
Observations
In the present study, 40 patients suffering from prameha / Madhumeha, fulfilling the
inclusion criteria were registered. Following are the detailed descriptive statistical analysis of
the patients included in the study.
Observations:-1. Age Incidence: The majority of the patients (50%) were reported in the age groups of
51-60 years followed by 30% in the age groups of 41-50 years, 12.5% in the age
group of 61-70 years, 7.5% in the age group 31-40years.
2. Sex Incidence: The majority of the patients (65%) were males compared to females
(35%).
3. Marital Status Incidence: 85% of patients were married only 15% of patients were
unmarried.
4. Religion Incidence: Maximum number of patients i.e., 77.5% were Hindus, 12.5%
were Christians, 10% are Muslims.
5. Socioeconomic status: It is observed that maximum patients belongs to middle class
37.5%, upper middle class is 25%, lower middle class is 15% and rich were 10%.
6. Incidence of Addictions: Data depicts that maximum no of patients i.e., 40% were
smokers, Habit of tea/coffee is 38.5%, Tobacco chewing is 12.5% and addiction to
alcohol is 10%.
7. Incidence of Dietary Habits: 70% of the patients were accustomed to mixed type of
diet while 30% were vegetarians.
8. Incidence of Dehaprakriti: A majority of the patients are vatakapha (35%) followed
by 22.5% were Kaphavata, Kaphapitta 12.5%, vatapitta is 15%, Pittavata is 7.5%,
pittakapha is 7.5%
9. Incidence of Satva: Satva analysis of the patients revealed 65% of Madhyama satva,
25% avara, 10% pravara satva.
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Observation
9
10. Incidence of agni: Vishamagni is seen in 37.5%, teekshnagni 35%, Mandagni in
27.5%.
11. Incidence of Family history: first degree family history is seen in 45% of the
patients, second degree family history is seen in 2.5%, no familial history in 52.5%.
12. Incidence of chronocity: 53% of the patients are having diabetes in 1-10 years, 30%
of the patients are below 1 year, 15% of the patients are above 10 years.
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EFFECT OF THE TREATMENT :
The signs and symptoms recorded before the commencement of the treatment have beenreviewed finally at the end of the period of treatment in each case . The data of possessing thenumber of cases relieved, improved and unchanged. As regards to sign and symptom togetherwith the percentage are represented, the nearest round figures for the percentage were takeninto account to avoid fraction.
Effect of TreatmentNo. of Cases
SN Signs andSymptoms
Total No. ofCases Relieved % Improved % Unchanged %
1 Prabhootamutrata 32 26 81% 4 13% 2 6%
2 Avilamutrata 6 4 66% 1 17% 1 17%
3 Atitrishna 28 19 67% 3 10% 6 23%
4 Atikshudha 30 16 54% 7 24% 7 24%
5 Mutramadharyata 34 21 61% 8 23% 5 16%
6 Tanohmadhuryata 22 16 74% 3 13% 3 13%
7 Suptata 18 12 66% 2 11% 4 23%
8 Dourbalya 33 24 73% 3 9% 6 18%
9 Karapadadaha 25 20 80% 4 16% 1 4%
10 Musclecramps 17 6 35% 5 29% 6 36%
11 Atisweda 12 10 84% 1 8% 1 8%
12 Stoulya 4 1 25% 2 50% 1 25%
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Statement showing the blood & urine sugar levels & Weight
Blood sugar beforetreatment
Blood sugar aftertreatment
Urine sugar beforetreatment
Urine sugar aftertreatment
S.No Regd No. FBS PLBS FBS PLBS FUS PLUS FUS PLUS
Weight beforetreatment
weight aftertreatment
1 15481 172 245 110 146 1% 2 Nil Nil 59 58
2 15523 142 228 98 172 0.5 2 Nil Trace 67 67
3 506 145 198 124 142 0.5 1 Nil Nil 48 48
4 16426 110 200 114 162 0.5 1 Nil Trace 68 69
5 18233 195 300 105 199 2 2.5 Nil 1 62 62
6 21498 142 247 112 168 1 2 Nil Trace 63 62
7 25253 106 230 96 136 0.5 1.5 Nil Nil 74 73
8 25894 190 280 160 210 1 1.5 Nil 0.5 62 60
9 26543 140 194 100 140 0.5 1 Nil Nil 58 59
10 26537 115 165 100 145 0.5 1 Nil Nil 44 43
11 28437 120 223 80 130 1 1.5 Nil Nil 62 62
12 29124 152 268 128 190 1 1 nil o.5 51 51
13 29431 270 380 270 370 2 2.5 2 2.5 63 62
14 42468 125 215 75 145 0.5 1 Nil Nil 72 72
15 2799 155 230 105 165 1 1.5 Nil Nil 41 41
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3
Blood sugar beforetreatment
Blood sugar aftertreatment
Urine sugar beforetreatment
Urine sugar aftertreatment
S.No Regd No. FBS PLBS FBS PLBS FUS PLUS FUS PLUS
Weight beforetreatment
weight aftertreatment
16 3223 114 164 100 145 0.5 1 Nil 0.5 44 43
17 2723 140 300 118 174 0.5 2 Nil 1 64 64
18 2850 198 266 192 238 1 1.5 1 1.5 59 59
19 2797 145 205 114 156 0.5 1 Nil Nil 65 65
20 2798 166 222 88 142 1 1.5 Nil Trace 67 67
21 2853 118 192 108 177 0.5 1.5 Nil 1.5 55 54
22 2924 107 214 10 179 0.5 1.5 Nil 1 70 70
23 3056 141 215 140 215 0.5 1.5 0.5 1.5 79 79
24 2798 210 300 174 268 1.5 2 1.5 1.5 54 54
25 2622 230 294 106 157 1.5 2 Nil Trace 69 68
26 2597 258 305 202 305 2 2.5 2 2.5 57 57
27 2983 138 172 108 164 0.5 1 Nil 1 53 53
28 2384 155 235 98 148 1 1.5 Nil Nil 51 51
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4
Blood sugar beforetreatment
Blood sugar aftertreatment
Urine sugar beforetreatment
Urine sugar aftertreatment
S.No Regd No. FBS PLBS FBS PLBS FUS PLUS FUS PLUS
Weight beforetreatment
weight aftertreatment
29 2788 142 198 78 128 1% 1.5 Nil N 75 74
30 2580 181 264 95 153 1 1.5 Nil Trace 63 63
31 2932 160 290 172 216 1.5 2 1 2 40 39
32 3542 166 242 110 174 1 1.5 Nil 0.5 58 58
33 3849 128 176 114 158 0.5 1 Nil Nil 66 66
34 4057 170 260 140 200 1 1.5 Nil 1 59 59
35 4358 180 290 120 210 1 2 Nil 1 49 50
36 4298 140 230 100 160 0.5 2 Nil 1.5 64 65
37 4178 154 202 140 146 0.5 2 Nil Nil 52 52
38 3078 168 240 114 160 1 2 Nil 1 48 48
39 3199 132 218 168 238 0.5 2 1 2 69 69
40 4050 144 200 174 213 0.5 1.5 1.5 2 57 57
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Results
1
RESULTS TABLE
1. Effect on Prabhoota Mutruta
Mean
BT ATDifference in Means
1.875 1.538 0.337
1.875
1.538
0
0.5
1
1.5
2
Mean
BT AT
Effect on Prabhoota Mutruta
BT
AT
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Results
2
2. Effect on Avilamutrata
Mean
BT ATDifference in Means
1.5 1.25 0.25
1.5
1.25
1.1
1.15
1.2
1.25
1.3
1.35
1.4
1.45
1.5
Mean
BT AT
Effect on Avilamutrata
BTAT
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Results
3
3. Effect on Atitrushna
Mean
BT ATDifference in Means
1.286 1.158 0.128
1.286
1.158
1.081.1
1.121.141.161.181.2
1.221.241.261.281.3
Mean
BT AT
Effect on Atitrushna
BTAT
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Results
4
4. Effect on Atikshudha
Mean
BT ATDifference in Means
1.333 1.25 0.083
1.333
1.25
1.2
1.22
1.24
1.26
1.28
1.3
1.32
1.34
Mean
BT AT
Effect on Atikshudha
BTAT
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Results
5
5. Effect on Karapadasuptata
Mean
BT ATDifference in Means
1.444 1.167 0.277
1.444
1.167
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
Mean
BT AT
Effect on Karapadasuptata
BTAT
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Results
6
6. Effect on Dourbalya
Mean
BT ATDifference in Means
1.400 0.200 1.200
1.4
0.2
0
0.2
0.4
0.6
0.8
1
1.2
1.4
Mean
BT AT
Effect on Dourbalya
BTAT
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Results
7
7. Effect on Karapadadaha
Mean
BT ATDifference in Means
1.2 0.85 0.35
1.2
0.85
0
0.2
0.4
0.6
0.8
1
1.2
Mean
BT AT
Effect on Karapadadaha
BTAT
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Results
8
8. Effect on Muscle Cramps
Mean
BT ATDifference in Means
1.152 0.1 1.050
1.152
0.1
0
0.2
0.4
0.6
0.8
1
1.2
Mean
BT AT
Effect on Muscle Cramps
BTAT
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Results
9
9. Effect on Atisweda
Mean
BT ATDifference in Means
0.833 0.4 0.433
0.833
0.4
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
Mean
BT AT
Effect on Atisweda
BTAT
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Results
10
10. Effect on Stoulya
Mean
BT ATDifference in Means
3 2 1
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Results
11
11. Effect on Tanohmadhuryata(FBS)
MeanDifference in
Means
S.D S.E Variance
BT AT
156.6 123.932.7 1.02 1.08 78.74
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Results
12
12. Effect on PLBS
MeanDifference in
MeansS.D. S.E. Variance
BT AT
237.42 181.156.32 3.04 0.48 288
237.42
181.1
0
50
100
150
200
250
Mean
BT AT
Effect on PLBS
BTAT
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Results
13
13. Effect on Mutramadhuryata
Mean
BT ATDifference in Means
0.875 0.288 0.587
0.875
0.288
00.10.20.30.40.50.60.70.8
0.9
Mean
BT AT
Effect on Mutramadhuryata
BTAT
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Results
14
Criteria for assessment of results:-
Taking into consideration of percentage of relief in clinical symptoms and clinicalparameters after the treatment.The total effect of therapy was assessed as follows.
Result Criteria for assessment
Cured 75% to 100% relief in signs and symptoms
of prameha, was taken as cured.
Moderate relief More than 50% to Less than 75% relief in
signs and symptoms were taken as moderate
relief
Mild relief Patients with improvement in b/w 25 to 50%,
in signs and symptoms were considered as
mild relief
No relief No change or less than 25% improvement in
signs and symptoms were considered as no
relief.
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Results
15
RESULTS
The basis for the assessment of results was the response shown by the patients regarding
in the signs and symptoms of Madhumeha along with improvement of laboratory
investigations. The overall effect of therapy is as follows.
Result Number of Patients percentage
Cured 18 45%
Moderate relief 14 35%
Mild relief 6 15%
No relief 2 5%
Cured result was observed in 18 patients i.e 45% where patients got relief from 75% to 100%
of symptoms after the treatment. Moderate relief was in 14 patients i.e 35%, where patients
got relief from 50% to less than 75% of relief from 25% to less than 15% and mild relief was
seen in only 6 patients of all 2 patients i.e 5% where patients got relief less than 25% of
symptoms after completion of treatment.
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Discussion
1
DISCUSSION
Madhumeha is a widely evidential disease since ancient age till today and evidence is
increasing day by day with lips and bounce with their complications and complexes. Diabetes
mellitus is similar to Madhumeha which is subtype of Vataja Prameha.
Madhumeha is a disease in which the patient voids excessive quantity of urine having
concordance with Madhu i.e., of Kashaya and Madhura taste, Ruksha texture and honey like
color. In Madhumeha, mainly the Vata and Kapha are predominant though the disease is
Tridoshakopanimittaja. The Vata may be provoked either directly by its etiological factors or
by the Avarana of its path by Kapha, Pitta or other Dushyas. So, Vagbhata has classified the
Madhumeha into two categories i.e., Dhatuapakarshanajanya Madhumeha and Avarnajaya
Madhumeha. Avaranajanya pathogenesis occurs due to etiological factors mainly concordant
with Kapha and Pitta, but the vitiation of Vata occurs due to Avarana.
Dhatuapakarshanajanya pathology occurs due to depletion of Dhatus, because of the Vata
vitiating etiological factors. Acharya Charaka has classified Madhumeha into
Santarpanajanya and Apatarpanajanya. The Apatarpanajanya Madhumeha can be correlated
with Dhatuapakarshanajanya Madhumeha, while the Santarpanajanya Madhumeha correlates
with Avarnajanya Madhuemeha. Therefore, this disease may be caused both by the under
nutrition as well as by over nutrition. The first type of madhumeha is considered to be
Asadhya and no specific remedy is recommended for this. But the later type has been told as
Krichhra Sadhya and can be cured with extensive measurements.
The main pathophysiology behind Diabetes mellitus is the disturbed metabolism of
the carbohydrates, fats and proteins due to either absolute or relative lack of Insulin. The
Diabetes mellitus has been broadly classified as type 1 and type 2. The type 1 Diabetes
mellitus patients are usually asthenic in body constitution and suffer from it in the early years
of life, while the type 2 Diabetes mellitus patients are usually obese and suffer from it in their
40’s. The type 2 Diabetes mellitus patients can be managed easily by hypoglycemic drugs
whereas in type 1 Diabetes mellitus patients besides hypoglycemic drugs, the Insulin therapy
is obscure. So the type 1 diabetes mellitus is nearer to Dhatuapakarshanajanya Madhumeha
while the type 2 Diabetes mellitus resembles to Avaranajanya Madhumeha.
Prameha such a disease caused predominance by vatadosha though all the 3 doshas
also take part besides ten dooshyas i.e., Rasa, Rakta, Mamsa, Medo, Majja, sukra,
ojus, Lasika, Vasa, Kleda in resulting the disease.
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Discussion
2
While deciding the inclusion criteria, the terms stula and krisha Madhumeha have
been used in a much broader sense than to mean only abnormal states conveyed by
them. Krusha covers the patient who were normal to under weight. The word stula
covers the patients from normal to obese.
Somarajyadi churnam is anubhoota yoga. This preparation contains 4 drugs. They are
Bakuchi, Madhunashini, Avarthaki, Sunti. These drugs possess hypoglycemic,
neuroprotective, Medogna, Mootra Sangrahaneeyae, Rasayana, Deepana and pachana
properties.
Patients who attended O.P and I.P sections of Dr. BRKR, Govt Ayurvedic hospital
Hyd were selected randomly, irrespective of the sexes, fulfilling all the criteria for
inclusion and exclusion.
The range of Fasting and post prandial blood sugar was fixed between 120mg/dl –
180mg/dl and 160mg/dl to 300mg/dl respectively considering the safe limits of the
disease. This was done to avoid putting the patients into the risk of developing
complications as in the case of higher sugar levels.
Pre and post test design was planned and the patients were asked to take 6gms of
somarajyadi churnam half an hour before food twice daily. All the drugs are dried and
fine powedered.
The pratyatma lakshana of Madhumeha including Tanumadhuryata and
mutramadhuryata along with other common symptoms were taken for assessment.
This included the WHO approved American Diabetic association diagnostic criteria.
The symptoms were graded and scored.
Maximum number of patients belonged to the age group of 51-60 years Which
supports the views that the prevalence of type 2 DM is more in the middle to old age.
Males are more in the clinical study compared to females. Hindus were 77% which
indicative of demographic situation of this region. More number of patients was from
middle to upper middle class. This finding reflects the pattern of patients coming to
the hospital of this institute according to their socioeconomic conditions. The
incidence was also more in people who were involved in professions Who did not
involve much physical work like businessmen, shop owners and so on.
Observation of addition in the present study revealed that maximum number of
patients i.e., 40% were addicted to smoking, 10% patients were addicted to alcohol,
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Discussion
3
tobacco chewing 12.5%, tea / Coffee 38.5%. All of these conditions decreased the
natural immunity and also provoke the vata to manifest the disease prameha earlier
and with severity majority of the patients i.e., 55% were suffering from the disease for
1-10 years. 45% of the patients confirmed the family history of Madhumeha which
reflects the fact that a familial trait is associated with the disease. Majority of the
patients are vatakaphaprakruti. Majority of the patients were of Madhyama to avarsara
which indicates the involvement of dhatus in Madhumeha.
On treatment with Somarajyadi churnam, the following results were observed on the
subjective symptoms.
1. Effect on Prabhootamootrata: Mild to severe prabhoota mootrata (both in terms of
quantity and frequency) was seen in 80% of patients, 65% relief was observed in
prabhutamutrata. This relief in prabhutamootrata may be due to the mutrasangrahani
action of Avarthaki and kashaya Rasa Rookshguna of Madhunashini, avarthaki which
exerts stambhana action. It may be possible that drug has acted upon apanavayu and
corrected its vitiation.
2. Effect on Avilamootrata: Only in 15% of patients avilamootrata is noted, relief was
10%.
3. Effect on Trushna: Mild to severe Trushna was seen in 70% of patients and mild to
maximum improvement was seen in 50% of patients. The relief in trushna may be
because of kaphapitta samaka effect of Avarthaki, Bakuchi and stambhana action of
avarthaki and also due to Trishnanigrahana action of sunti.
4. Effect on Stoulya: 25% patients were obese 40% of patients were over weight for
their age and height. The rest has normal weight. 25% of weight reduction is seen.
This is due to tiktarasa, kashaya rasa katu vipaka and laghu, rooksha guna and they
are having opposite qualities to that of kapha and medas . Almost 60% of the patients
had an adipose abdomen, which corroborates the fact that Indians have inherited
condition called central obesity (i.e., for a given body mass index, Indians have a
higher amount of fact than other races). There have been strong evidences implicating
this condition for the development of DM. .
5. Effect on Sweda adhikhya: Atisweda was seen in 30% of patients and 25% of
improvement was observed .vitiation of pittadosha causes swedaatipravritti. This
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Discussion
4
action may be due to kashaya Rasa and stambana of avarthaki Madhunashini might
have checked the excessive sweating.
6. Effect on Dourbalya: Mild to severe Dourbalya was seen on 83% of patients,
improvement was seen in 60% of patients. Rasayana and anti oxidant properties of
Bakuchi, prevent dhatu depletion. The pramehagna properties of the ingriedients of
somarajyadi Churnam may facilitate the entry of glucose inside the cell for utilization,
thus providing energy to the cells and the patient gets relief in Dourbalya.
7. Effect on Karapadadaha: Mild to serve Karapadadaha was seen in 62% of the le
patients and mild to moderate improvement was seen in 50% of the patients relief in
Karapadadaha may be due to Kaphapitta samaka action of avarthaki, Bakuchi and
seetaveerya action of Avarthaki.
8. Effect on Karapadasuptata: 50% of the patients has mild to severe. Karapadasuptata
and mild to maximum improvement was seen in 80% of them. This may be due to
antidiabetic action of Bakuchi, Avarthaki, Madhunashini provided the relief in
Karapadasuptata.
9. Effect on Bahvashi: Mild to moderate Bahvashita was seen in 75% of the patients
16% improvement was observed. This is due to Kaphapitta samaka action of Bakuchi,
Avarthaki. This may be the reason for the relief in atikshudha.
10. Effect on Muscle cramps:Mild to moderate muscle cramps was seen in 85%
of the patients 35% improvement was observed. This is due to vatahara action of
Bakuchi and sunti.
The following were the changes observed the objective symptoms after treatment:
1. Effect on Fasting blood Sugar(FBS): The mean FBS score before treatment was
146.6 and after treatment 123.9
2. Effect on post prandial blood sugar(PPBS): The mean difference between before
and after treatment is 56.6.
Effect on FBS and PPBS may be due to the pramehagna action of Bakuchi, Avarthaki,
Madhunashi by which FBS and PPBS have reduced.
3. Effect on Urinesugar: The mean difference in the before treatment and after
treatment was 0.58%. This relief obtained could be due to the Mehagna property of
the Ingriedients of samarajyadi churnam.
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Discussion
5
It was observed that the symptoms that were mild returned back to normal after 2
months of treatment but those that were moderate came down to mild and severe
symptoms reduced to moderate intensity. Moreover, the severity and number of
symptoms seemed to be directly proportional to the increase in serum glucose levels
at the upper limit of the range Usually presented with moderate to severe symptoms
than those at the lower limit of the range. Even the number of symptoms varied in that
manner.
The most of the drugs of Somarajyadi churnam have Tikata, Kashaya Rassa, Laghu,
Rookshaguna and Katuvipaka. These are said to be Kaphagna, Mehagna, Medogna and
Mootrasangrahaneeya.
Tikta, Kashayarasa, Laghu, rookshaguna produces rookshana effect and they are
having opposite qualities to that of kapha and medas. Both medas and kapha being the main
entity of Samprapti, thus by breaking the samprapti treats the disease. Hence they act as
mehagna and kaphagna.
Bahudravatva will be present in Madhumeha. Tikta, Kashayarasa present in this yoga
produces shoshana effect. Bahudravata will be reduced by the absorption of excessive fluid
from the cells. When bahudravatra of Madhumeha also reduces. Pipasa which is dependent
on Prabhutamootrata also reduces. Somarajyadi churna reduces medas there by stoulya and as
it mutrasangrahaneeya, absorbs bahudrava and hence reduces polyuria, polydipsia and
thereby checks the pathogenesis of prameha.
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CONCLUSION
1. Madhumeha mostly affects the individuals after the age of forty years.
2. Sex, Marital status, Religion, Social status bear no relation in causation of
Madhumeha.
3. Tendency towards Sedentary lifestyle, increased stress and strain are main
contributing factors in the establishment of the disease. Tendency towards
sedentary life style and faulty dietary habits, leads to vitiation of kapha and meda
leadin g to Madhumeha.
4. Kapha is the arambhaka dosha and vata is preraka.
5. Etiological factors here mainly related with kapha pitta and meda vitiation but due
to avarana vata also get vitiated.
6. Apathya nimittaja nidanas influence more to cause Madudmeha in stoulya.
7. The study confirms the dominancy of kapha dosha,meda medodhatu
dusti,Rasavaha and Medovaha srotodusti in the pathogenesis of Madhumeha.
8. Madhumeha is a disease characterized by prabhoota avila mootrata, Tanu
madhuryata and Mootra madhuryata.
9. The Madhumeha has been discussed in Prameha roga as a kind of vatika Prameha.
10. It can be concluded that on the basis of symptomatology of Madhumeha, the
disease Madhumeha can be correlated with Diabetes mellitus.
11. Dhatu apakarshana and Ojo dushti is an invariable manifestation of the disease.
12. On the basis of result of the therapy it can be deduced that Asanadi qwatha
provided relief in the chief complaints, associated signs and symptoms & was
effective in reducing the blood sugar level. The mean difference in FBS was 32.7
and PPBS 56.32
13. The present study was carried on small sample for a limited time with out
alteration in their routine dietary and physical and it showed encountering results.
However to be more confirmative further study should be conducted on large
sample for longer duration with diet and exercise.
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Summary
1
SUMMARY
The frame of the dissertation work entitled “A clinical study of the effect of
somarajyadi churnam on Prameha” may be summerised as follows:
The entire thesis is mainly divided into six parts each part comprises different chapter
as follows:
Part – I: Introduction, Historical background of the Disease.
Part - II: Shareeram.
Part – III:
Ayurvedic disease review was explained under subheads Nidana, Purvarupa, rupa, samprapti,
vyavacchedaka nidana, Saadhyasaadhyata, upadravas, chikitsa yojana and pathyapathya,
Modern disease reviews was explained regarding in definition, classification, pathogenesis,
prediabetic state, signs and symptoms, treatment and lifestyle management of diabetes
mellitus.
Part- IV:
The drug and its selection.
Part-V;
Method and material, observation and result.
Part VI;
Discussion, conclusion, summary, bibliography and casesheet were included.
INTRODUCTION :
The history of Madhumeha with special references to Vedas and Ayurveda are explained.
SAREERAM :
The Anatomy of pancreas and the importance of agni in Madhumeha were explained.
The mode of action of insulin in Diabetes is explained.
NIDANA:
Nidana has been classified and the types have been explained.
The basic etiology involved in the disease, has been summed-up.
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Summary
2
POORVA ROOPA:
A table has been given presenting the poorvaroopas of the disease given in the classics of
Ayurveda.
ROOPA:
A generalized lakshna of disease has been stated according to different Ayurvedic classics.
The lakshnas of sahaja and apathyanimittaja prameha have been discussed in detail according
to Susrutha.
SAMPRAPTI:
The role of nidana, doshas, dushyas in the process of samprapti were explained in detail.
The samprapti in general with reference to kriyakalas have been stated.
CLASSIFICATION:
The division of 20 varietes of pramehas have been discussed in detail according to
Ayurvedic classics.
The classification of Madhumeha according to Susrutha, Vagbhata have been referred.
UPADRAVAS AND ARISTA LAKSHNAS:
The upadravas in general and prameha pidakas in particular have been classified and the
types have been discussed.
Aristalakshnas and prognosis have been explained.
SADHYAASADHYATA & SAPEKSHA NIDANA:
General information for the sadyaasadhyata of disease have been discussed in detail with
special reference to Madhumeha.
Differential diagnosis of Madhumeha has been stated in detail.
CHIKITSA & PATHYAAPATHTA KRAMA:
There is a scope for the treatment by samsodhana and samsamana for the disease has been
explained.
Tha factors of pathya and apathya are discussed in detail according to Ayurvedic classics.
THE DRUG AND ITS SELECTION:
The Drug has been described.
The criteria for the selection of the drug for the present study has been stated.
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Summary
3
CLINICAL STUDY:
Method and material:-The method of preparation of medicine and the method of treatment
have been explained.
The number and nature of cases taken up for the study has been stated.
The method of observation has been explained and criteria for the assessment have been
stated.
Age and sex incidence etc. were tabulated and discussed.
The blood and urine sugar levels were recorded and tabulated. Mean, SD, SE, CHI-SQARE
test calculated.
The results of each clinical trial is tabulated.
The conclusions were drawn and are recorded.
DISCUSSION:
Total study on the disease, the drug and clinical work has been reviewed in a brief discussion.
The efficacy of the drug as observed in the clinical study has been stated and conclusions
given.
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1
BIBLIOGRAPHY
1. Syar – Raja Radhakantha Deva – Bhaduryeana, Sabdakalpadruma, Nag Publishers New
Delhi, 1987,
2. Pandit Narahari, Raja Nihantu, Dreavyaprakashika, Hindi Vyakhaya by Indradev
Tripathi, II Edition, 1998; Krishnadas Academy, Oriental Publishers and Distributors,
Varanasi, Uttar Pradesh..
3. Charakastanashatkam, printed& edited by Sri. P.K.M Sasry,IIedition, Rajahmundry
1978
4. Amara kosha— Raja Radhakantha Deva — Bhaduryeana, Sabdakalpadruma, Nag
Publishers New Delhi, 1987,
5. Kishore kumar., et al; Effect of Nisha amalki in Madhumehi (unpublished Doctoral
dissertation, Rajiv Gandhi University of Health Sciences Karnataka, Bangalore, 1999).
6. Charaka samhita(Telugu version) all parts published by V.R.S Sastulu&sons, printed at
Vavilla press,Madras.1935,1939
7. Susruta Samhita(Telugu version) all parts published by V.R.S Sastulu&sons,printed at
Vavilla press, Madras 1969, 1953 .
8. Damjanov Ivan, Linder James; Ed Anderson’s pathology; 10th Edition, 1996; published
on behalf of Mosley — year book Inc. St. Luis, Missouri. Page no.2046
9. Davidson, Sir Stanley; Davidson’s principles and practice of medicine, ed C. R. W.
Edwards et al; 17th International Student edition 1995, reprinted 1998, Churchil
Livingstone, Edinburgh
10. Harrison T. R. et al; Ed. Harrison’s principles of Internal Medicine; Vol. I & II, 14th
International Edition, 1998; published by McGraw-Hill Book Co. Singapore. Page no.
2062
11. Astangahridaya(Telugu version) all parts published by V.R.S Sastrulu&sons,printed by
V.Venkateswarulu shasrulu at vavilla press, Maras 1954,1950,1948.
12. Kashyapa, Kashyapa Samhita, Vrudrajivikiya Tantra Va, Pandit Hema Raj Sharma,
Choukambar Sanskrit Sansthan 2000, Pp 364
13. Harrison T. R. et al; Ed. Harrison’s principles of Internal Medicine; Vol. I & II, 14th
International Edition, 1998; published by McGraw-Hill Book Co. Singapore
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2
14. Godbole, Aravinda S., Taiwalkar N. G.; Diabetes mellitus for practitioners. First
edition, 1974; published by Bombay Popular Prakashan, Mumbai, Maharastra
15. Madhava Nidanam, Uttarardha with Madhukosha Vyakhya by Vijayarakshita and
Srikantadutta, Vidyotini tika by Ayurvedacharya Sri Sudarshana Shastri; 29th Edition,
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A Clinical Study of the Effect of Somarajyadi
Churnam In the Management of Prameha.
By
Dr. KAVITHA REDDY B.A.M.S
Under the Guidence of
Dr.V.VIJAYA BABU M.D.(Ay)
Reader/Professor K.C
Post Graduate Dept of Kayachikitsa
Dr. B.R.K.R. Govt. Ayurvedic College, Hyd.
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Charaka in his Charaka samhita has mentioned thesweetness of urine in addition to polturia.
Susrutha in 500 A.D described the disease asMadhumeha with symptoms of foul breath,voracious appetite and languor.
Generally Madhumeha is known as a “richmansdisease”
Prameha is a chronic disease of relapsing nature. Thedisease is also a debilitating one.
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HISTORY
Charaka explained the etiology, pathogeness, symptomatology,complications and treatment modalites in detail in Nidana 4th and chikitsa6th chapter. While in sutra sthana 17th chapter he described theavaranajanya pathogenesis of Madhumeha, this is the unique contributionof this treatise.
Susruta also explained Prameha in elaborative manner with separatechapter on its management. He used ‘Kshoudrameha’ synonym toMadhumeha in nidana 6th chapter.
Harita mentioned it as papajanya and enumerated 13 types of prameha.
Bhela described prameha is of two types.
Kashyapa mentioned the symptoms of prameha child in vedanadhyana andnoted the disease as chirakari.
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SHAREEMThe pancreas is a compound alveolargland. It has got
both exocrine & endocrine function. Diabets mellitus is achronic disease due to disordered carbohydrate metabolismand it results due to deficiency of insulin secreted by theBeta cells of islets of Langerhans of pancreas.
The exocrine portion of pancreas consists of acinigrouped into lobules. The exocrine pancreas made up ofisolated group of cells the islets of langerhans.
Endocrine portion (Islets of langerhans)It is an endocrine organ which exert a profound
effect on carbohydrate metabolism.
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In endocrine portion 4 cells are present(1) cells (2) cells (3) cells (4) F cells
cells synthesise and secrete glucogon and cellsproduce insulin and D cells have been linked with eithergastrin or secretin production. F cells secretes pancreaticpolypeptide (PP)
The islet volume comprises 1-1.5% of the total massof the pancreas and weighs about 1-2g in adult humans.
The first harmone to be identified as a product of theislet was insulin.
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Mechanism of Insulin Secretion
Increased Sugar Level
Translation GLUT
Uptake of Glucose by cells
Release of Insulin
If Stimulation Persists
Active Synthesis of Insulin
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Biological Effects of Insulin
A) On Carbohydrate Metabolism:-Reduces the rate of release of glucose from liver.
By inhibiting glycogenolysis By stimulating glycogen synthesis By stimulating Glycolysis By indirectly inhibiting gluconeogenesis via inhibition of fatty acid
mobilisation from adipose tissue.B) On Lipid Metabolism:- Reduces the rate of release of free fatty acids from adipose tissue. Stimulates fatty acids synthesis and also conversion of fatty acids to
triglycerides in liver.C) On Protein Metabolism:- Stimulates transport of free amino acids across the plasma Membrane in
liver and muscle. Stimulates protein bio synthesis and reduces release of amino acid from
muscle
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NIDANANidana for premeha of each dosha were mentioned in Charaka Nidana 4th
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ROOPARoopa of a disease will be produced in the fifth stage of samprapti i.e., Vyaktavasta.
Samanyalakshanas:-
1) Prabhootamootrata:- Vagbhata mentioned prameha as the disease ofmutratipravritaja vikara. Patient voids urine more in quantity and frequency.Gayadas opines that this excess urine quantity is because of liquification ofthe dushyas and their amalgamation.
2) Avilamootrata: Patient voids urine having turbidity.
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SAMPRAPTISamprapti is a process by which dosha dushyasamsarga will takes
place and finally manifests the disease.• Sampraptighataka of madhumeha:• Dosha : Sleshma pradhana tridosha sleshma is the main dosha
responsible for Madhumeha inspite of the fact that madhumeha is atridoshajanyavyadhi. The other doshas like vata& pitta only trigger offthis samprapti and associate as anubandha.
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Bakuchi
DRUGS
Madhunashini
AvarthakiNagara
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SOMARAJYADI CHURNAM
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DRUG REVIEWDrug plays a vital role in the management of the disease.Due to this reason, it had been
placed next to physician in the chatuspada.• The best drug is that which cures the disease promptly and also preserves or sustains
the helath of an individual.• The drug selected for present clinical study on prameha is “SOMARAJYADI
CHURNAM”.SOMARAJYADI CHURNAM:-• Somrajyadi churnam is anubhutayoga to prove its scientific efficacy.Ingredients:-1. BAKUCHI,(Psoralea corylifolea) - 1 part2. AVARTHAKI,(Cassia auriculata) - 1part3. MADHUNASHINI, (Gymnema sylvestris) - 1 part4. SUNTI(Zingiber officinale) - 1partAll are taken in equal parts and fine powdered.DOSE:-6 grams/ dayANUPANA:-Sukoshna jalam
Most of the drug have tikta, kashayarasa,laghu , rooksha guna, katuvipaka.These aresaid to be kaphagna, mehagna, medogna.
Tikta, kashayarasa, laghu, rookshaguna produces rookshana effect and they are havingopposite qualities to that kapha and medas.
Bahudravatva is present in madhumeha. Tikta, kashayarasa produces shoshana effectand there by bahudravatva is reduced.
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Materials and methodsMy dissertation entitled “A CLINICAL STUDY ON THE EFFECT OF SOMARAJYADI
CHURNAM IN THE MANAGEMENT OF PRAMEHA “ was carried out on 40 patientswho attended the OP and IP sections of Govt.Ayurvedic college/Hospital, Erragadda.HYD.during Jan 2007 to sep2007.
Aim of study:-1.To evaluate the effect of “SOMARAJYADI CHURNAM”in patients suffering from stula and
krisha Madhumeha.2.To evaluate the effect of Somarajyadi churnam in NIDDM patients.3.Comprehensive literary study on prameha.– 1.Materials:-– patients– drugs– Patients :- 40 patients were taken for the study.– Drugs:- Somarajyadi churnam with sukoshna jalam– 2. Methods:-– 1.Location of study:- For the purpose of clinical trials 40 patients were selected from OP and
IP department of Kayachikitsa of Dr.B.R.K.R Govt.Ayurvedic college/hospital,Erragadda,Hyderabad.
– 2.Selection of patients:- 40 patients of different age groups were selected on the basis ofFBS&PLBSand corresponding urine sugars.
– Diagnostic criteria:-– Criteria - 1:- patients presenting with pratyatma lakshana of Madhumeha –prabhoota and
avilamootrata with mootra or tanumadhuryata with or without roopa are taken as Madhumehi.– Criteria -2:-– FBS -80 -120mg/dl– PLBS -140 -180mg/dl
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– Inclusion criteria:- patients fulfilling the following conditions wereincluded.
– patients between 30yrs -70yrs.– Stula and krisha Madhumehi.– Patients with Type 2DM with FBS greater than 120mg/dl and lesser than
180mg/dl and PLBS of more than 160mg/dl and less than 300mg/dl.– Exclusion criteria:- The following patients were excluded from the
study.– 1.patients below 30yrs.– 2.Jatapramehi– 3.IDDM patients– 4.Gestational diabetes– 5.DM secondary to drugs like corticosteroids or due to secondary
disorders– Investigations:-– 1.FBS– 2. PLBS– 3.Urine sugar– Research design:-– A single blind clinical trail with pre and post test design was adopted.– Intervention:-– Intervention was done with Somarajyadi churnam taken,the 4 drugs in
equal parts and the powder is given in 2 divided doses.i.e 6 grams in 2doses with sukhoshnajalam before food.
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Observation1.Age Incidence 2.Sex incidence
31-40
41-50
51-60
61-70
M a le
Fe m a le
6
34
0
5
10
15
20
25
30
35
Single Married
Marital Status
Series1
3.Marital Status 4. Religion Incidence
Hindu
Muslim
Christian
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5. Socioeconomic status
0
56
15
10
4
0
2
4
6
8
10
12
14
16
UP P LM M UM R
Socioeconomic status
Series1
6. Incidence of Addictions
16
54
15
0
2
4
6
8
10
12
14
16
Smoking Tobacco Alcohol T/C
INCIDENCE OF ADDICTIONS
Series1
7. Socioeconomic status 8. Deha prakriti
Veg
Mixed 6
3
14
9
3
5
0
2
4
6
8
10
12
14
VP PV VK KV PK KP
DEHA PRAKRITI
Series1
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9. Satva Incidence
Pravara
Madhyama
Avara
14
0
15
11
0
2
4
6
8
10
12
14
16
Teekshna Sama Vishama Manda
STATUS OF AGNI
Series1
8
26
6
0
5
10
15
20
25
30
Pravara Madhyama Avara
BALA INCIDENCE
Series1
FirstDegree
Seconddegree
Nofamilialhistory
10.Status of Agni
11. Bala Incidence 12.Family History
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EFFECT OF THE TREATMENT:-
41164802025Karapadadaha9
1711716646Avilamutrata2
234112661218Suptata7
36629535617Musclecramps10
18693732433Dourbalya8
133133741622Tanohmadhuryata
6
165238612134Mutramadharyata
5
247247541630Atikshudha4
236103671928Atitrishna3
62134812632Prabhootamutrata
1
%Unchanged%Improved%Reliver
d
No.of CasesTotalNo. ofCases
Signs & SymptomsS.NO
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RESULTS
1.875
1.538
0
0.5
1
1.5
2
Mean
BT AT
Effect on Prabhoota Mutruta
BT
AT
1.5
1.25
1.1
1.15
1.2
1.25
1.3
1.35
1.4
1.45
1.5
Mean
BT AT
Effect on Avilamutrata
BT
AT
0.3371.5381.875
ATBT
Differencein Means
Mean
0.251.251.5
ATBT
Differencein Means
Mean
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0.251.251.5
ATBT
Differencein Means
Mean
1.286
1.158
1.081.1
1.121.141.161.181.2
1.221.241.261.281.3
Mean
BT AT
Effect on Atitrushna
BTAT
1.333
1.25
1.2
1.22
1.24
1.26
1.28
1.3
1.32
1.34
Mean
BT AT
Effect on Atikshudha
BTAT
0.1281.1581.286
ATBT
Differencein MeansMean
0.0831.251.333
ATBT
Differencein Means
Mean
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0.2771.1671.444
ATBT
Differencein MeansMean 1.444
1.167
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
Mean
BT AT
Effect on Karapadasuptata
BT
AT
1.2
0.85
0
0.2
0.4
0.6
0.8
1
1.2
Mean
BT AT
Effect on Karapadadaha
BTAT
0.350.851.2
ATBT
Differencein MeansMean
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123.9
156.678.74
1.081.0232.7
ATBT
Variance
S.ES.DDifference
in MeansMean
237.42
181.1
0
50
100
150
200
250
Mean
BT AT
Effect on PLBS
BTAT
181.1237.42
2880.483.0456.32
ATBT
Variance
S.ES.DDifference in
MeansMean
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Criteria for assessment of resultsResult Criteria for assessmen
Cured 75% to 100% relief in signs andsymptoms
Moderate relief More than 50% to Less than 75%Mild relief Patients with improvement 25 to
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DISCUSSION• Prameha is a disease caused predominance by vatadosha though all the 3 doshas also
take part besides ten dooshyas i.e., Rasa, Rakta, Mamsa, Medo, Majja, sukra, ojus,Lasika, Vasa, Kleda in resulting the disease.
• The range of Fasting and post prandial blood sugar was fixed between 120mg/dl –180mg/dl and 160mg/dl to 300mg/dl respectively.
• The pratyatma lakshana of Madhumeha including Tanumadhuryata andmutramadhuryata along with other common symptoms were taken for assessment. Thesymptoms were graded and scored.
• Maximum number of patients belonged to the age group of 51-60 years Which supportsthe views that the prevalence of type 2 DM is more in the middle to old age. Males aremore in the clinical study compared to females.
• Maximum number of patients i.e., 40% were addicted to smoking, 10% patients wereaddicted to alcohol, tobacco chewing 12.5%, tea / Coffee 38.5%. All of these conditionsdecreased the natural immunity and also provoke the vata to manifest the diseaseprameha.
• Majority of the patients are vatakaphaprakruti. Majority of the patients were ofMadhyama to avarsara which indicates the involvement of dhatus in Prameha.
• Effect on Prabhootamootrata: Mild to severe prabhoota mootrata (both in terms ofquantity and frequency) was seen in 80% of patients, 65% relief was observed inprabhutamutrata. This relief in prabhutamootrata may be due to the mutrasangrahaniaction of Avarthaki and kashaya Rasa Rookshguna of Madhunashini, avarthaki whichexerts stambhana action. It may be possible that drug has acted upon apanavayu andcorrected its vitiation.
• Effect on Avilamootrata: Only in 15% of patients avilamootrata is noted, relief was10%.
• Effect on Trushna: mild to maximum improvement was seen in 50% of patients. Therelief in trushna may be because of kaphapitta samaka effect of Avarthaki, Bakuchi andstambhana action of avarthaki and also due to Trishnanigrahana action of sunti.
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Effect on Sweda adhikhya: Atisweda was seen in 30% of patients and25% of improvement was observed .
Effect on Karapadadaha: Mild to serve Karapadadaha was seen in 62%of the le patients and mild to moderate improvement was seen in 50%of the patients.
Effect on Bahvashi: Mild to moderate Bahvashita was seen in 75% of thepatients 16% improvement was observed. This is due to Kaphapittasamaka action of Bakuchi, Avarthaki. This may be the reason for therelief in atikshudha.
Effect on Fasting blood Sugar(FBS): The mean FBS score beforetreatment was 146.6 and after treatment 123.9
Effect on post prandial blood sugar(PPBS): The mean differencebetween before and after treatment is 56.6.
Effect on Urinesugar: The mean difference in the before treatment andafter treatment was 0.58%.
The most of the drugs of Somarajyadi churnam have Tikata, KashayaRassa, Laghu, Rookshaguna and Katuvipaka. These are said to beKaphagna, Mehagna, Medogna and Mootrasangrahaneeya.
Tikta, Kashayarasa, Laghu, rookshaguna produces rookshana effect andthey are having opposite qualities to that of kapha and medas.
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CONCLUSION• Prameha mostly affects the individuals after the age of forty
years.• Sex, Marital status, Religion, Social status bear no relation
in causation of Madhumeha.• Tendency towards Sedentary lifestyle, increased stress and
strain are main contributing factors in the establishment ofthe disease.
• Kapha is the arambhaka dosha and vata is preraka.• Apathya nimittaja nidanas influence more to cause
Madudmeha in stoulya.• Madhumeha is a disease characterized by prabhoota avila
mootrata, Tanu madhuryata and Mootra madhuryata.• Dhatu apakarshana and Ojo dushti is an invariable
manifestation of the disease.
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