A Comparative Study Of Anand Bhairav Rasa And Tribhuvana Kirti Rasa In The Management Of Vata Kaphaja Jwara.

A Comparative Study Of Anand Bhairav Rasa And
Tribhuvana Kirti Rasa In The Management Of
Vata Kaphaja Jwara.
* Dr.virendra Baburao Pawar P.G. (Scholar) Department of Kayachikitsa.
drvirendra7007@gmail.com cell-09096743333
**prof. Dr. B.b. Kadlaskar M.D., Ph.D. (Kayachikitsa) H.O.D. & Professor.,
Department of Kaya-Chikitsa, B.V.D.U., College of Ayurved, Pune : 43. .
drkadlaskar@gmail.comcell- 09422330084
ABSTRACT
Background and Objective :
1) To compile reference regardingAnandbhairav rasa &Tribhuvanakirtirasa from classical
&contemporary literature.
2) To compile earlier references from classical and contemporary literature inAyurveda on
VataKaphajaJwara.
Method : Comparative single blind study. 40 patients were selected for the study and divided
into Two groups randomly.
Group A was given Anandbhairav rasa 250 mginternally1Tab twice a day.
Group Bwas given Tribhuvanakirti rasa 250 mg internally 1Tab twice a day.
Duration oftreatment : 7 days and Follow upeveryday.
This study was carriedout in BVDU College of Ayurved&Hospital attached to BharatiMedical
Foundation in Year 2013 and 2014.
Result : The clinical trial of AnandbhairavRasa and TribhuvankirtiRasa observed equally effective
in VatakaphajaJwara. Both drugs were equally effective on symptoms of VataKaphajaJwara
i.e. Staimityam, Parwanambhed, Gauravam, Shirograha, Pratishyaya,Kasa,
Swedapravartanam&Santapa (Temperature)in both groups .The Nidrawas reduced in group B
due to TribhuvankirtiRasa as compared to group A.In all symptoms the
P-Value isless than 0.05.
Statistical Analysis : Both groups were equally effective in the management of
VataKaphajaJwara.
Conclusion :
The evaluation of drugs in both groups were equally effective in the management of
VataKaphajaJwara.
The Jwaravyadhihas been studied from different samhitasin detail &also detail study of
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AnandbhairavRasa and Tribhuvankirti Rasa was carried out.
INTRODUCTION
Ayurveda is a science of life which protects health and preventsdiseases. Certain diseases
may not be life threatening but increasingly annoying and irritation to the individual in his
routine activity.If more over neglected they may lead to a series of complications later into
Acute Respiratory Diseases (ARD).
Ayurveda has described so manyvyadhis and theirchikitsa‘Jwara’ occupies first place among
the physical.
Jwara isincluded in Ashtamahagadmentioned by AcharyaCharaka.Jwaravyadhiis topamongst
all Vyadhismentioned in Ayurvedic classics.
Sometimes Jwarais present in body asLakshan(Symptom) or sometime it is a separate
Vyadhi (disease).
In Ayurvedictext Jwaraismentioned with its different types of Chikitsaaccording
toAvastha&types.Bruhatrai andLaghutraihas given so many formulation to treat the Jwara in
the form of Kashaya, Churna, Guti, Vatiand Rasa kalpa.Yogratnakar and Rasendrasarsangrah
has mentioned the Anandbhairav&TribhuvanaKirtiRasa in the treatment of Vata.KaphajaJwara.
AIM : To evaluate the Comparative efficacy of AnandbhairavRasa and TribhuvanaKirti Rasa on
VataKaphajaJwara.
OBJECTIVES :
1) To compile reference regarding Anandbhairav Rasa&TribhuvanakirtiRasa from classical&
contemporary literature.
2) To compile earlier references from classical and contemporary literature in Ayurveda on
VataKaphajaJwara .
MATERIALS AND METHODS :
DRUG REVIEW :-
1) ANANDBHAIRAV RASA :- RasendrasarSangraha - Jwarachikitsa 104-106.
Drugs :- Vatsanabha ,Hingula ,Shunthi ,Marich ,Pippali, Tankan,Javitri.
Method of Preparation :- Purified and driedVatsanabha , Hingula , Shunthi , Marich ,
Pippali, Tankan, Javitrichurnataken in equal quantity and triturated withJambiriNimbu
rasa and prepared Vatiof 250 mgtaken along with luke warm water.
2) TRIBHUVANA KIRTI RASA :- Yogratnakar–JwaraAdhikara.
Drugs :- Vatsanabha, Hingula, Shunthi, Marich, Pippali, Tankan, PippaliMoola .
Method of Preparation :- Purified and driedVatsanabha, Hingula, Shunthi, Marich,
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Pippali, Tankan, PippaliMoolataken in equal quantity inchurna form and 3 Bhavna of
Tulasipatra rasa,Adrakrasa and Dhattura rasa given.TribhuvanKirti rasa 250 mg taken
along with luke warm water.
PLAN OFRESEARCH :-
• For clinical trial special caseproformawas prepared.
• The patients were selected form B.V.D.U BharatiAyurvedHospital,Pune Kayachikitsa
Department IPD &OPD .
The rawmaterials were brought fromAyurvedicStoreDhankawadi, Pune.
These materials were identified and authenticated as per Ayurvedicpharmacopia norms
by the experts in the Botanical Department of University of Pune,Prepared and standardized
by analytical lab R.S.B.K.V Dept.. of B.V.D.U, College Of Ayurevd PUNE-43.
• Total 40 patients were enrolled and divided into 2 groups. Each group had 20 complete
sample.
Type ofstudy : Comparative single blind study.
DRUG ADMINISTRATOR SCHEDULE :
Particulars Group A Group B
No. of Patients 20 20
Medicine Given Anandbhairav Rasa TribhuvanaKirti Rasa
Dose250 mg. each tablet 250 mg. each tablet
Time Abhakta1 Tab Twice a Abhakta1 Tab Twice a
day day
Duration 7 Day 7 Day
AnupanLuke warm water Luke warm water
Route of Drug Administration Oral Oral
Follow upEveryday Everyday
ASSESSMENT CRITERIA :-
DIAGNOSTIC CRITERIA :- Symptoms of VatakaphajJwara as follows:
· Staimityam
· ParvanamBheda
· Nidra
· Gauravam
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· Shirograha
· Pratishyaya
· Kasa
· Swedapravartanam
· Santap (Temperature)
SUBJECTIVE CRITERIA :-
Full detailed history and physical examination of the patients were recorded into the
specially prepared case record proformafor VataKaphajaJwara.
Main criteria of the assessment was relief insymptoms and clinical end point.
The efficacy wascompared ,analyzed and assessed in Group A (Anandbhairav Rasa) and
Group B (TribhuvanaKirti Rasa).
Follow up was taken everyday.
OBJECTIVE CRITERIA :-
Axillary bodytemperature recorded by using thermometer .(Range of temperature 98.7oF
to 101oF.)
Temperature Gradation :-
Normal = 0
Mild (Normal to 99oF) = 1
Moderate (99.1oF to 100oF) = 2
Severe (100.1oF to 101oF) = 3
Gradation of symptoms:-
· Staimityam :- Absent : 0
(A feelingof dampness) Present : 1
· ParvanamBheda :- Absent : 0
(Pain in the small joints) Mild(Occasionally) : 1
Moderate (Intermediate pain) : 2
Severe (Continuous Pain) : 3
· Nidra :- Absent : 0
( Sleepiness) Mild (4-5 hrs/Interrupted) : 1
Moderate (2-3 hrs/) : 2
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Severe (1 to 2 hrs) : 3
· Gauravam :- Absent : 0
(Feeling of heaviness) Mild (Desire toactivity) : 1
Moderate (Fatigue after
Small activities) : 2
Severe (Do not want to do Activity) : 3
· Shirograha :- Absent : 0
(Headache) Mild (Occasionally) : 1
Moderate (Intermediate pain) : 2
Severe (Continuous Pain) : 3
· Pratishyaya :- Absent : 0
Coryza) Mild (Sneezing) : 1
Moderate (Sneezing withmild
discharge) : 2
Severe (Continues discharge) : 3
· Kasa :- Absent : 0
(Cough) Mild (1-3 Vega) : 1
Moderate (4-6 Vega) : 2
Severe (7-10 Vega) : 3
· Swedapravartanam :- Absent : 0
(NoSweating) Mild (Occasional Sweating) : 1
Moderate (Intermediate
Sweating) : 2
Severe (Continues Sweating) : 3
INCLUSION CRITERIA :-
· Sample size(40 patients ) were divided in 2 groups.
· Age group :- 19 to 55 years
· Patients were diagnosed on the basis of symptoms ofVataKaphajaJwara as per mentioned
in Ayurvedictext book.
· Range of temperature 98.7oF to 101oF.
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· Complaint of fever less than 7 days.
· Patients withboth gender were included.
EXCLUSIONCRITERIA :-
· Pregnancy
· History ofchronic fever.
· Patients suffering from Enteric fever were excluded.
· Malaria .
INVESTIGATION (PRE TRIAL)
· Haemogramwith ESR
· Platelet Count
· Urine :- Routine&microscopic
· Widaltest
· PBS for M.P.
OBSERVATIONS
· STAIMITYAM :-
Staimityam Median Wilcoxon P-Value Result
Before After Signed Rank
Treatment Treatment Statistic ‘W’
Anandbhairav Rasa 1 0 -3.419 .001 Significant
TribhuvanKirti Rasa 1 0 -3.755 .000 Significant
Comparative Analysis of improvement between Groups :
Median Mean Score Mann-Whitney P- Value
Improvement U statistic
AnandbhairavRasa 1 20.63 197.5 0.947
TribhuvanKirtiRasa 1 20.38
Distribution of improvements in Staimityam for AnandbhairavRasa&TribhuvanKirti Rasa were
not significantly different (P = 0.947). Therefore, Anandbhairav Rasa andTribhuvanKirti
Rasa wereequally effective in Staimityam.
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· PARWANAMBHED :-
Parwanambhed Median Wilcoxon P-Value Result
Before After Signed Rank
Treatment Treatment Statistic ‘W’
Anandbhairav Rasa 1.5 0 -3.213 .001 Significant
TribhuvanKirti Rasa 2 0 -3.753 .000 Significant
Comparative Analysis of improvement between Groups :
Median Mean Score Mann-Whitney P- Value
Improvement U statistic
Anandbhairav Rasa 1.5 17.88
147.5 0.157
TribhuvanKirti Rasa 2 23.13
Distribution of improvements in Parwanambhedfor Anandbhairav Rasa&TribhuvanKirti Rasawere
not significantly different (P = 0.157). Therefore,Anandbhairav Rasa and TribhuvanKirti Rasa
were equally effective in Parwanambhed.
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· NIDRA :-
Nidra Median Wilcoxon P-Value Result
Before After Signed Rank
Treatment Treatment Statistic ‘W’
Anandbhairav Rasa 1 0 -3.416 .001 Significant
TribhuvanKirti Rasa 2 0 -3.977 .000 Significant
Comparative Analysisof improvement between Groups :
Median Mean Score Mann-Whitney P- Value
Improvement U statistic
Anandbhairav Rasa 1 16.58
121.5 0.033
TribhuvanKirti Rasa 2 24.43
Distribution of improvements in Nidra for AnandbhairavRasa&TribhuvanKirtiRasa
wassignificantly different (P = 0.033).Therefore,AnandbhairavRasa and TribhuvanKirtiRasa
were not equally effective in Nidra.
· GAURAVAM :-
Gauravam Median Wilcoxon P-Value Result
Before After Signed Rank
Treatment Treatment Statistic ‘W’
Anandbhairav Rasa 1 0 -3.153 .002 Significant
TribhuvanKirti Rasa 2 0 -3.602 .000 Significant
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Comparative Analysisof improvement between Groups :
Median Mean Score Mann-Whitney P- Value
Improvement U statistic
AnandbhairavRasa 1 17.65 143 0.127
TribhuvanKirtiRasa 2 23.35
Distribution of improvements in Gauravamfor Anandbhairav&TribhuvanKirtiwere not significantly
different (P = 0.127).Therefore,Anandbhairav andTribhuvanKirtiwere equally effective
in Gauravam.
· SHIROGRAHA :-
Shirograha Median Wilcoxon P-Value Result
Before After Signed Rank
Treatment Treatment Statistic ‘W’
Anandbhairav Rasa 2 0 -3.314 .001 Significant
TribhuvanKirti Rasa 2 0 -3.354 .001 Significant
Comparative Analysis of improvement between Groups :
Median Mean Score Mann-Whitney P- Value
Improvement U statistic
AnandbhairavRasa 2 21.38 182.5 0.64
TribhuvanKirtiRasa 2 19.63
Distribution of improvements in Shirograha for Anandbhairav Rasa&TribhuvanKirti Rasa
were not significantly different (P = 0.64). Therefore,Anandbhairav Rasa and
TribhuvanKirti Rasa were equally effective in Shirograha.
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· PRATISHYAYA :-
Pratishyaya Median Wilcoxon P-Value Result
Before After Signed Rank
Treatment Treatment Statistic ‘W’
Anandbhairav Rasa 2 0 -3.354 .001 Significant
TribhuvanKirti Rasa 0 0 -2.714 .007 Significant
Comparative Analysis of improvement between Groups:
Median Mean Score Mann-Whitney P- Value
mprovement U statistic
AnandbhairavRasa 2 23.05 149 0.174
TribhuvanKirtiRasa 0 17.95
Distribution of improvements in Pratishyaya for Anandbhairav&TribhuvanKirti were not
significantly different (P = 0.174). Therefore, Anandbhairav Rasa and TribhuvanKirtiRasa
were equally effective in Pratishyaya.
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· KASA :-
Kasa Median Wilcoxon P-Value Result
Before After Signed Rank
Treatment Treatment Statistic ‘W’
Anandbhairav Rasa 2 0 -3.502 .000 Significant
TribhuvanKirti Rasa 2 0 -3.919 .000 Significant
Comparative Analysis of improvement between Groups :
Median Mean Score Mann-Whitney P- Value
mprovement U statistic
AnandbhairavRasa 2 19.25 175 0.512
TribhuvanKirtiRasa 2 21.75
Distribution of improvements in Kasa for Anandbhairav Rasa &TribhuvanKirti Rasa were
not significantly different (P = 0.512), Therefore, Anandbhairav Rasa and TribhuvanKirti
Rasa were equally effective in Kasa.
• SWEDAPRAVARTANAM :-
Swedapravartanm Median Wilcoxon P-Value Result
Before After Signed Rank
Treatment Treatment Statistic ‘W’
Anandbhairav Rasa 3 0 -4.042 .000 Significant
TribhuvanKirti Rasa 3 0 -4.179 .000 Significant
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Comparative Analysis of improvement between Groups:
Median Mean Score Mann-Whitney P- Value
mprovement U statistic
AnandbhairavRasa 3 18.40 158 0.265
TribhuvanKirtiRasa 3 22.60
Distribution of improvements in Swedapravatanam for Anandbhairav&TribhuvanKirti were
not significantly different (P = 0.265), Therefore, Anandbhairav Rasa and TribhuvanKirti
Rasa were equally effective inSwedapravatanam.
· SANTAPA(TEMPERATURE) :-
Santapa Median Wilcoxon P-Value Result
Before After Signed Rank
Treatment Treatment Statistic ‘W’
Anandbhairav Rasa 2 0 -3.985 .000 Significant
TribhuvanKirti Rasa 2 0 -3.895 .000 Significant
Comparative Analysis of improvement between Groups :
Median Mean Score Mann-Whitney P- Value
mprovement U statistic
AnandbhairavRasa 2 21.10 188 0.758
TribhuvanKirti Rasa 2 19.90
Distribution of improvements in Temperature for Anandbhairav&TribhuvanKirti were not
significantly different (P = 0.758). Therefore, Anandbhairav Rasa and TribhuvKirti
Rasa were equally effective in Santapa.
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DISCUSSION
Prakruti-The study shows that,
Out of 20 Patients in Group A, 1(5%) was of KaphaPradhan Pitta Prakruti, 3(15%) were
of KaphaPradhanVataPrakruti, 1(5%) was of Pitta PradhanKaphaPrakruti, 3(15%) were of
Pitta PradhanVataPrakruti, 2(10%) were of VataPradhanKaphaPrakruti and 10(50%) were
of VataPradhanPitta Prakruti.
Out of 20 Patients in Group B, 3(15%) were of KaphaPradhan Pitta Prakruti, 1(5%)
was of KaphaPradhanVataPrakruti, 0(0%) of Pitta PradhanKaphaPrakruti, 7(35%)
were of Pitta PradhanVataPrakruti, 0(0%) of VataPradhanKaphaPrakruti and 9(45%)
were of VataPradhan Pitta Prakruti.
Symptomatology :-
1. Staymityam (A feeling of dampness) :-
According to Wilcoxon Signed Rank ‘W’, Anandbhairav Rasa and Tribhuvankirti Rasa
both were statistically significant in Staymityamwhich were equally effective.
This study shows that Anandbhairav rasa and Tribhuvankirti rasa were effective in
VataKaphajaJwara. Staymityamwas reduced mostly due to common ingredients of
both drugs like Pippali, Marich, Dhattur, Shunthi having
propertiesUshna,TikshnaGunaand Vata-Kaphaghna.
2. Parwanambhed (Pain in the small joints) :-
According to Wilcoxon Signed Rank Statistic ‘W’, Anandbhairav Rasa and Tribhuvankirti
Rasa both were statistically significantin Parwanambhedwhich were equally effective.
Parwanambhed is a symptom ofVataKaphajaJwara due to vitiated VataDosha. It
reduces due to vataghna property of common ingredients of both drugs like Pippali,
Marich, Shunti, Tulsi .
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3. Nidra (Sleepiness) :-
According to Wilcoxon signed rank test ‘W’, TribhuvanKirti Rasawas more effective
than Anandbhairav Rasa and was statistically significant in Nidra.
It was effective due to Kaphaghna properties of Pippali, Shunti and Vatsanabha and
Vyavayi and Vikasiguna of Dhattur of TribhuvanKirti Rasa.
4. Gauravam(Feeling of heaviness) :-
According to Wilcoxon signed rank test ‘W’, Anandbhairav Rasa and Tribhuvankirti
Rasa were statistically significant in Gauravamwhich were equally effective.
This may be due to Ushna and Tikshnaguna of Pippali, Marich, Dhattur, Shunthi and
also vata- kaphaghna property of Tulsi and Tankan .
5. Pratishyaya (Coryza) :-
According to Wilcoxon signed rank test ‘W’ , Anandbhairav Rasa and Tribhuvankirti
Rasa were statistically significant in Pratishyayawhich were equally effective.
The reason for good result, may be due toKanthya, Ushna, Tridoshahar properties of
ingredients of both drugs likeDhatura, Vatsanabha, Shunti,Pippali, Adark, PippaliMoola
and Prabhav of Tulsi.
6. Shirograha (Headache) :-
According to Wilcoxon signed rank test ‘W’, Anandbhairav Rasa and TribhuvanKirti
Rasa were statistically significant in Shirograhawhich were equally effective.
Shirograha is a symptom due to vitiated Kapha and Vatadosha. Result may be due
toVataghna property of ingredients of both drugs like Shunthi, Pippali, Marich, Tulsi.
7. Kasa (Cough) :-
According to Wilcoxon signed rank test ‘W’, Anandbhairav Rasa and TribhuvankirtiRasa
were statistically significant in Kasa which were equally effective.
This may be due to Kasaghna property of Tulsi, Marich, Pippali,Javitri and JambirNimbu.
8. Swedapravartanam (No Sweating):-
According to Wilcoxon signed rank test ‘W’, Anandbhairav Rasa and Tribhuvankirti
Rasa were statistically significant in swedapravartanam which were equally effective.
The reason for good result , because of YogvahiGuna of Hingul, Tankan and
VyavayiGuna of Vatsanabha, Dhattura.
9. Santapa (Temperature) :
According to Wilcoxon signed rank test ‘W’, Anandbhairav Rasa and Tribhuvankirti
Rasa were statistically significant in Santapa (Temperature)which were equally
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effective. This may be due to Swedaajananproperty of Hingul, Tankan and VyavayiGuna
of Vatsanabha, Dhattura.
RESULT
1) The clinical trial of Anandbhairav Rasa and Tribhuvankirti Rasa observed equally
effective in VataKaphajaJwara.
2) The effect on symptoms i.e.Staimityam, Parwanambhed, Gauravam, Shirograha,
Pratishyaya, Kasa, Swedapravartanam&Santapa (Temperature) of both drugs was
approximately equal .
3) Comparatively Nidra symptom was reduced effectively in group B (Tribhuvankirti Rasa
as compared to group A (Anandbhairav Rasa).
4) In all symptoms the P-Value is less than 0.05.
CONCLUSION
The evaluation of drugs in both groups were equally effective in the management of
VataKaphajaJwara.
Jwaravyadhi has been studied from different samhitasin detail.
Detail study of Kalpas i.e. Anandbhairav Rasa and Tribhuvankirti Rasa was carried
out.
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Study of Guduchi Kwath (Tinospora cordifolia) in patients Of Dengue Fever with Thrombocytopenia

Study of Guduchi Kwath (Tinospora cordifolia)  in patients Of Dengue Fever with Thrombocytopenia

Abstract

Keywords – Dengue fever,Vishamjwar, Platelet count, thrombocytopenia, Guduchi Kwath

Introduction

Dengue fever is an acute infectious disease caused bu an arbovirus in the Flavivirus genus & is transimitted mainly by bites of the Aedes aegypti and Aedes albopictus mosquito species.This disease can be correlated with Vishamjwar in Ayurved.

Aim

To study the effect of guduchi kwath in patients of dengue fever with thrombocytopenia

 Objectives

To study the clinical features ,laboratory profile in patients with dengue fever.

Material and Methods

Guduchi Kwath prepared as per Sharangdhar Samhita

180 patients with age > 18 years with Dengue NS1 positive or dengue IgM positive or IgG & IgM  positive with thrombocytopenia

Results

 100 % patients received Guduchi Kwath, whereas 16.66 % percentage of patients were purely on Guduchi Kwath while remaining 150 patients ,i.e. 83.33 % patients received Guduchi Kwath plus modern medicines as per need. Out of the 150 patients ,6 patients i.e.4% patients  were referred outside having severe hemorrhagic shock conditions for further management. All patients responded well.

Conclusion

            Guduchi Kwath in the dose of 40 ml mor-evening in the dengue fever showed improvement in the platelet count. All patients responded well.This can be used as a single drug in uncomplicated cases.

Introduction

            Dengue fever is an acute infectious disease caused bu an arbovirus in the Flavivirus genus & is transimitted mainly by bites of the Aedes aegypti and Aedes albopictus mosquito species. There are four serotypes (DEN-1, DEN-2, DEN-3 & DEN-4).

The disease manifestations ranges from a flu like illness known as dengue fever to a severe fatality known as dengue haemorrahagic fever and dengue shock syndrome.This disease can be correlated with Vishamjwar in Ayurved.

Objective

            Recently (June 2014-Oct. 2014) there was increased incidence of Dengue fever in urban as well as rural area.During the said period near about 190patients visited Bharati Ayurved Hospital. 180 patients (Age group -18-70 years)  which required admission in the hospital  were admitted whereas 10 patients were not admitted due to complicated medical conditions.Few of the patients referred from outside clinics having fever with thrombocytopenia and diagnosed dengue fever. 6 patients referred outside having Dengue shock syndrome after admissions .There is generalized misconception about use of Ayurvedic medicines in Dengue fever particularly thrombocytopenia and its outcome.Hence we decided to use Guduchi Kwath in few patients of Dengue fever with thrombocytopenia.

Materials and Methods

            A prospective study was conducted in our hospital in the IPD of Kayachikitsa department from June 2014-Oct.2014.Various symptoms and signs were found in the patients.High grade fever(ranging from 102^o F-104⁰F) with chills and break bone,headache, backake andache in the extremities accompanied by sore throat, prostration and malaise were found.

            Maximum patients had conjunctival suffusion (redness)and skin-flushed or blotched  with maculopapular rash sparing  palms & soles.After the rash fades ,localized clusters of petechiae (Petechial haemmoraghes ), on the extensor surface of the limbs and over chest and abdomen ,back were found. Few patients complained of itching all over the body in the beginning only and later showed thrombocytopenia.

            Few %  of patients found with signs of cardiac involvement.Showing cardiac suppression as bradycardia ,hypotension etc. Hepatitis with mild jaundice was found in few of the cases.Dengue hemorrhagic fever also found in children living in endemic areas.(Pune- Cases reported from urban as well as rural area in the Pune district.)

            Restlessness,epistaxis and abdominal pain –these symptoms were complained by the patients along with signs of hemorrhage –ecchymosis,gastrointestinal bleeding and epistaxis were also reported. Gasroenterologic complications –hemorrhage,tenderness & ascites were also found.Few of pts with secondary infection—dengue shock syndrome- acute fever,hemorrhagic manifestations & marked capillary leak- pleural effusion & ascitis – tendency for shock were treated very carefully with the help of experts in the field .

            Continuous abdominal pain with vomiting,bleeding ,a decrease ,in the level of consciousness,rash,conjunctival  congestion & hypothermia – dengue shock syndrome along with acute kidney injury in dengue shock syndrome were referred to ICU after consultation with the seniors.Complicated patients with pneumonia, bone marrow failure,hepatitis, iritis,retinal hemorrhages ,old age patients with bacterial superinfection ,higher fever ,gastrointestinal bleeding,kidney disease and altered consciousness were also referred to ICU from the casualty.

Laboratory  and Radiological Investigations

1) Thrombocytopenia, increased fibrinolysis and hemoconcentration – hemorrhagic form of disease

2) Haemogram with ESR .Leucopenia .ESR-normal

3) Detection of specific viral protein NS1 by ELISA } Platelet count < 100000/cmm

4) Dengue IgG,IgM in qualitative way} Platelet count < 100000/cmm

5) LFT deranged

6) Prothrombin Time

7) X-Ray Chest- in DHF-infiltrates &pleural effusions

8) USG –A-P – hepatitis, hepatomegalae,spleenomegalae,ascitis.

Treatment

Guduchi (Tinospora Cordiofolia)

Botanical Description –

Large,  glabrous, deciduous climbing shrub.

Stem   –   stem is covered by transperant layer that can be peeled off. Leaves   -  heart shaped 2-4 cm in diameter, individualized, pointed at tips and slimy, long petiolate.  

Flowers   - small yellow or green,  male flowers in clustered,  female flowers usually  solitary.       

Fruit -  drupes ovoid or subglobose, glossy red pea sized, appearing red on ripening.

Seeds – white,  bean shaped

Habitat   -   Found throughout tropical India, ascending to an altitude of 900 m from Kumaon eastwards as well as southwards upto Shri Lanka.

Properties -

Rasa             -     Titka,  Kashay

Virya            -     Ushna

Vipak           -     Madhur

Guna            -    Guru, Snigdha

Prabhav      -     Vishaghna

Karma   - 

Doshakarma   -  Tridoshashamak, Pittasarak

Other Karma     -  Kushthaghna, vedanasthapan, trushnanigrahan, dipan, pachan, anuloman, krimighna, hridya, rasayan, balya, vishaghna, vrushya, pramehaghna, mutrajanan, jwarahar, sangrahi

Chemical Composition –  Tinosporine, tinosporon, tinosporic acid, tinosporol, tinosporide, tinosporidine, columbin, chasmanthin, palmarin, berberine, geloin, giloinisin, 1,2 – substituted pyrrolidine, etc.

Pharmacological Actions –

Hypoglycemic, anti-inflammatory, antibacterial, antimicrobial, antipyretic, antiarthritic, antiallergic, hepatoprotective, analgesic, immunostimulant, antioxidant, hypotensive, adaptogenic, antitumor , antidiabetic, etc.

Use In Various Deseases – Gout, skin conditions, haemorrhoids, diabetes, fevers, rheumatoid  arthritis, eye diseases,  general debility, asthama, vomiting, flatulence, acid gastritis, fractures

Useful Parts – Stem, Leaves, Sattva, Root    

Pharmacognosy –

STEM – terete, sparcely lenticellate. Young stem green with smooth surfaces and swelling at nodes, older ones show a light brown surface marked with protuberances due to circular lenticels.

Dose  - stem powder – 3-6 gm, stem decoction – 50-100 ml, sattva – 1-2 gm

Substitutes And Adulterants – T. crispa ,  T. chinensis. are substituted or adulterated.  Guduchi sattva is adulterated with flour of potato, sweet potato, arrowroot, banana, etc.

Preparation Of Guduchi Kwath

            1 Pal (40 gm) of raw of Guduchi Kand (stem) taken and added with 16 times of water (640 ml ) ,boiled (on Mandagni) and reduced to 80 ml  (1/8^th part)  ,filtered and administered in the morning and evening.

Treatment

1) Isolation and beds with mosquito nets and mosquito repellent coils wherever necessary.

2) Tepid sponging

3) Guduchi Kwath 40 ml mor-eve after meals to every patient.(180 patients) . Out 0f 180 patients 30 patients were purely on Guduchi Kwath.They were given iv fluids wherever needed.These patients showed platelet counts in the range of 20000-100000/cmm and having no any other complications except mild ascitis and mild pleural effusion in few patients but still were stable. It is found that this Kwath helped in increasing the platelet counts .Also in lowering the temperature and also worked as analgesia.Improvement was seen in the appetite and also inrelieving maculopapular rash and itching .

4) Paracetamol than NSAID’s for analgesia and lowering temperature. Inj . Febrinil 2 cc iv as per need to lower down the temperature.

5) Volume support- RL and as per the need and monitoring vital signs and blood volume – complications of dengue hemorrhagic fever or shock syndrome

6) Blood products – RDP(Randomised donor platelets) ,SDP(Single donor platelets) , Fresh frozen plasma (FFP).Platelet transfusions for severe thrombocytopenia<10000/cmm or when there is evidence of bleeding

7) Corticosteroids- role not proven but it is in practice of giving short course of Inj .Dexamethasone in tapering dose. It is found to be very effective.It is given in the patients where platelet count showed downward trend and below < 50000 /cmm.

8)  Pressor agents

9) Antibiotics wherever needed to prevent second infections preferably Fluroquionolones

10) Antiemetics  and Antihistaminics whever needed.

Pathyapathya

Pathya - Manda, Peya,Vilepi,Siddha Dudgha, Phalarasa, Shadangodak,Siddha Jala

Vihar- Strict bed rest,no any kind of exertion or overexertion,toilets shoul be near to the bed or bed-pans advisable.

Apathya (Contraindicated) – During active and remission phase of fever till patient regains vigor and power,diet which is Vidahi ,Guru ,Virrudha and Asatyma in nature, sex indulgence, exercise ,exertion ,overeating ,bath and unnecessary exertion should be avoided.

Outcome

1) 100 % patients received Guduchi Kwath,whereas 16.66 % percentage of patients received were purely on Guduchi Kwath while remaining 150 patients ,i.e. 83.33 % patients received Guduchi Kwath plus modern medicines as per need. Out of the 150 patients ,6 patients i.e.4% patients  were referred outside having severe haemorrahagic shock conditionsfor further management.

2) All patients responded well.Patients required admissions in the hospital for 3-10 days depending upon the condition of the patient.

3) Platelet count showed improvement after giving Guduchi Kwath.

4)Helpful in hepatitis and hepatomegalae

5) Wherever RDP ,SDP given improvement was in the platelet count seen. Few patients needed multiple transfusions.

6) Patients were discharged after improvement in the platelet count > 150000/cmm.

7) Guduchi Kwath continued for 3-7 days after discharge to every patient.

8) Every patient asked for follow-up after 3 days after discharge and each and every patient was investigated for haemogram and specifically platelet count .LFT also was done .Improvement in the platelet count and leucocytes were noted. Deranged LFT’s showed improvement.

Role of Guduchi and Tikta Rasa

            Charakacharya has quoted that for Doshapachan and Shaman,decoctions made from Tikta Rasa are advisable.As Tikta Rasa is having  prominently  Vayu and Akash Mahabhuta ,the Dravyas having Tikta Rasa are Laghu,cleans the Strotas,have Sheetaveerya and does the Pachan.By Agnivardhan property,these Dravyas act on Agnimandhya,Aam and Pittanubandh,thus helps in the pathogenesis (Samnya Sampraptibhanga) of Jwar (fever). Thus Guduchi having Tikta and Katu Rasa does Agnideepan, Aampachan

            Guduchi is antibacterial,anti-pyretic, immunomodulator,analgesic,having no any kind of toxicity,hepatoprotective,anti-inflammatory,antimicrobacterial, Smooth muscle relaxant,antioxidant,cardioiprortective  hopoglycemic activity and thus helps in dengue haemmoraghic fever.

Conclusion

1) Guduchi Kwath in the dose of 40 ml mor-evening in the denguhaemorragic fever showed improvement in the platelet count

2) This can be used as a single drug in uncomplicated cases.

3) Helps in lowering the temperature.

4)Helps in relieving the maculopapular rash .

5) Helpful in hepatitis and hepatomegalae

6) Works as an  antiallergic and antihistaminic

7) No any kind of side effect of the Guduchi Kwath seen

8) It’s a good appetizer.Shows overall improvement.

9) No side effects seen

10) More blind studies are needed.

References

Modern

1) Robbins Basic Pathology;7^th edition ;2005;Saunders ;An Imprint of Elsevier; New Delhi

 2) Harrison’s Principles of Internal Medicine, 17th Edition, Vol I and II. Editors –

   Fauci.braunwald.Kasper.Hauser Longo. Jameson.Loscalzo; Mc Graw Hill Medical

 3) K sembulingam, 5^th edition, essentials of medical physiology,jaypee brothers,medical  publishers, new Delhi

4)  Dr. Sujit k. Chaudhari, 2^nd  edition, quintessence of medical    pharmacology, new central book agency,Calcutta

5)  Stephen j. McPhee, 51^st edition 2012 current medical diagnosis & treatment,  cenveo

      publisher services.

6)   Principles and practice of medicine; 16th edition.Davidson

Ayurved

1) Editor Pandyea G.S.(6^thedi.) Charak Samhita, Chaukhamba publications Varanasi

Nidan Sthana- 1/5,1/24 ,1/40,1/8,

Chikitsa Sthana -2/4 ,3/13, 3-26, , 3/29,3/31, 3/32,3/35,3/36,3/53-60,3/63-65,3/66,3/139, 3/329,3/330-335, 3/339-343

2) Dr.Ambikadatta Shastri, Editor,(14^th edi) Susruta Samhita ,Chaukhamba Publications

     Varanasi.

Uttartantra-39 /15,39/16-22,39/26, 39/163, 39/321,

3) Shri.Lalchandra Vaidya,Editor (6^th edi)Ashtang Hrudayam ,Motilal Banarasidas Varanasi4

Nidan Sthan- 1/1 1/60-63, 2/6,2/56-57,2/59,2/70

Chikitsa Sthan- 1/2 ,1/3 ,1/21,

4)  MadhavNidan -Narendranath Shastri (edi 5^th 2005),Motilal Banarasidas Varanasi

    1-Nidanpanchakam   

    2- Jwarnidanam- 32, 36-38, 74,75,78

5) Bhavprakash Nighantu Haritakyadi Varga .K.C.Chunekar Teeka, editor Dr.Gangasahay

     Pande, Chaukhamba Charati Academi ,Varanasi 2010 edition

6)   Sharandhardhar Samhita Madhyamkhand 2/1-2

Name                                  - Prof .Dr.D.L.Shinde

Educational Qualifications –MD;PhD (Kayachikitsa), Pune University

Permanent Address            - Bharati Vidyapeeth University ,College Of

                                              Ayurved,Katraj-Dhanakawadi,Pune-43

Date Of birth                      - 3^rd April, 1968

Family background            - I belong from a respectable farmer’s family.

Qualities                            – Hardwork,Honesty, Integrity, Peaceful, Enthusiastic,                                                                       Accommodative  & tough

Area Of Specilization Studies

1)      Diabetes, Hypertension, Atherosclerosis ,Metabolic Syndrome, cardiac diseases

2)       Muscosketal disorders,Spinal Cord injuries, Nervous System Disorders & Rehabilitation.

3)      AIDS & related infections

Work Experience

Teaching & clinical experience for 22 yrs. Research Guide for MD and PhD

Book published – Anna He PurnaBrahma, Executive Editor – Arogya Sarita –monthly magazine

Lectures on Pune Akashwani

Lectures at social organizations ,conducting  CME for medical fraternity

Organizing medical camps

Lectures as Resource person

Ongoing Research Projects

1) Studying the genotypic association of certain SNPs in patients with osteoarthritis of knee in Indian population for early diagnosis  of OA. At  IRSHA,BUU,Pune

2) The efficacy of Vangamrita-Yog in the management of Diabetic Neuropathy.At College of Ayurved ,BVU,Pune

3) Clinical Study to evaluate  the efficacy of Haritakyadi churna  in essential  hypertension. At College of Ayurved ,BVU,Pune.

Research paper- JANIYAAT PRAMEHI BHAVISHYATEETI - PREDIABETES

                JANIYAAT PRAMEHI BHAVISHYATEETI - PREDIABETES

Prof.Dr.Dattatraya L.Shinde MD; PhD

Dr.Virendra Baburao Pawar MD (Schlor)

Department Of Kayachikitsa ,Bharati Vidyapeeth University,College Of Ayurved , Katraj-Dhanakwadi , Pune -43 (MS),Cell No. -9890111954, Email- dshinde249@gmail.com; lords7007@yahoo.co.in

            Diabetes is a heterogenous disease of carbohydrate metabolism characterized by polyuria, polypepsia, and polydepsia, due to lack of secretion of insulin or resistance to insulin. Diabetes Mellitus (DM) comprises a group of common metabolic disorders that share the phenotype of hyperglycemia. Several distinct types of DM exist and are caused by  a complex interaction of genetics, environmental factors and lifestyle choices. DM is the leading cause of end- stage renal Disease (ERSD), non traumatic lower extremity amputations and adult blindness. Diabetes is raising an epidemic all over the world esp., in country like India. Increasing worldwide, DM will likely continue  to be the leading cause of morbidity and mortality in near future.

Epidemiology

            The worldwide prevalence of DM has risen dramatically over the past two decades. It is projected that

 the number of individuals with DM will continue to rise in the near future. It is believed to be one of the main

criteria for deaths all over the world. Important concern of concentrating on diabetes mellitus is its prevalence

particularly Type 2 diabetes is rising all over the world .Prevalence of type 2 diabetes rises with increasing age.

 More people may remain undiagnosed esp. in our country where we have very less health concern. If obese

people with impaired glucose tolerance (IGT) and pre-diabetic persons are included along with known

diabetics in India, we may find billions of   diabetics. Another important issue is medical expenditure on

medicines, investigations, regular follow-ups, any disability occurring in between, its surgical corrections   its

overall management, rehabilitation etc. is financial burden on diabetics. If one cannot afford it life remains

miserable and at risk. No doubt for survival & expectancy of life in these pts. finances are needed. Major

cardiovascular risk factors are usually present, before the diagnosis of type 2 diabetes as well as during the

course of the disease. Hence life span or life expectancy of diabetics lowered undoubtedly.

            On this background more research studies are needed in preventive & curative way which are directed

at the disease (DM) and complications of micro & macro vascular disease which will lead to reduced costs o

 diabetics in the future.

            Ayurved not only prescribes the management of diabetes & its complications but also advocated

preventive measures, so that there won’t be occurrence of the diseases & its complications.The principles and

teachings of Ayurveda should be hence followed in diabetes care.

            One interesting thing I have to mention here is the prediabetes or upcoming diabetes is defined by the

ADA( American Diabetes Association) in the year 2002.A person with impaired fasting glucose (IGF –BSL-

110-125 mg/dl) is defined as having pre-diabetes .Such people are at high risk for developing diabetes in the

next decade or coming years and have an increased risk for coronary heart disease.

            Charakacharya ,2000 years back defined the signs & symptoms of Prameha (DM) as’ Prameha

Purvarupan’which is the preclinical, asyptomatic stage of the diabetes ,where the disease may be delayed &

 may be reversed by intensive life style changes esp. diet & exercise.  

Pre- Diabetes

            Type 2 Diabetes Mellitus is preceded by a period of IGT (impaired glucose tolerance/ Glucose challenge Test). This test will diagnose whether diabetes exists or not by indicating whether or not the body is using glucose. Pre-diabetes, also known as“ impaired glucose tolerance” is a health condition with no symptoms, it is a state that occurs when a person’s blood glucose levels are higher than normal but not high enough for a diagnosis of Diabetes.

            It is found that people who develop Pre- diabetes develop type 2 diabetes during an average 3 yrs follow up. Other studies show that many people with Pre- diabetes develop type 2 diabetes in 10yrs.

            It is very important to diagnose pre-diabetes earlier as treatment of the condition may prevent more serious health problems. It is commonly seen that the health complications associated with type 2 diabetes often occur before the medical diagnosis is made. People with Pre- diabetes can prevent or delay the development of type 2 diabetes through changes in lifestyle that include modest weight loss and regular exercise. People with Pre- diabetes, intervening early can turn back the clock and return increased blood sugar levels to the normal range. By indentifying the signs of Pre- diabetes before diabetes occurs, one can prevent type 2 diabetes all together and lower the risk of complications associated with diabetes like cardiovascular disease, atherosclerosis, diabetic microangiopathy, diabetic neuropathy, nephropathy and retinopathy. Etc.

Studies have shown that people with pre- diabetes can prevent or delay the development of type 2 diabetes through changes to their lifestyle that include modest weight loss and regular exercise. Thus persons with Pre- diabetes, intervening early can actually turn back the clock and return increased blood sugar levels to normal range.

HETU

Addiction to the pleasure of sedentary habits, sleep, curds, soup of the meat of domesticated and aquatic animals and animals inhabitating marshy lands, milk preparations, freshly harvested food articles, freshly prepared alcoholic drinks, preparations of jaggary and all kapha aggravating factors are responsible  for the causation of Prameha .

Person’s sleeping during day time, not exercising (not doing any kind of physical work), addicted to the pleasure of sedentary habits, excess dietary habits like cold, oily, sweets, and fatty  food and more of liquid preparations are prone to get prameha in the future.

The following factors help in immediate manifestation of prameha due to kapha:

1. Frequent and excessive intake of fresh corns like hyanaka, yavaka (a variety of Hordeum Vulgare Linn.), Cinaka, uddalaka, naisadha, itkata, mukundaka, mahavrihi, pramodaka and sugandhaka.

2. Intake of pulses like fresh Harenu ( Pisum sativum Linn.) and Masa ( Phaseolus radiates Linn.) with ghee.

3, Intake of meat of domesticated, marshy, and aquatic animals.

4. Intake of vegetables, tila ( Sesamum indicum Linn.), oil cake of tila, pastry, payasa (kheer- a type of milk preparation), krushara ( gruel preparation of tila, rice and black gram), vilepi ( type of gruel preparation with four times of water) , and preparations of sugarcane.

5. Intake of milk, fresh wine, immature curd, and curd which are mostly liquid, sweet and immature in nature.

6. Avoidance of unction and physical exercise

7. Indulgence in sleep, bed rest and sedentary habits.

8. Resorting to even such regimens which produce more of kapha, fat (cholesterol) and urine.

The following factors help in immediate manifestation of Prameha due to aggravated Pitta:

1. Intake of hot, sour, saline, alkaline, and pungent food.

2. Intake of food before the digestion of previous meal (ajeerna bhojana).

3. Exposure to excessively hot temperature (hot climate) , heat of the fire, physical over exertion and anger.

4. Eating mutually contradictory food items.

Vata gets immediately aggravated in individual whose body is affected due to following reasons :

1. Excessive intake of astringent, pungent, bitter, rough, light, cold things.

2. Excessive indulgence in sex and physical pleasure.

3. Excessive administration of emesis, purgations, asthapana type of basti and nasya (oleation therapy).

4.Suppression of the manifested urges, fasting, assault, exposure to heat, anxiety, grief, excessive blood letting, staying awake at night and improper posture of the body.

Risk factors for Type 2 Diabetes mellitus:

(Should get tested for Pre- Diabetes)

1) Family History of diabetes (i.e. parent or sibling with type 2 diabetes)

            It is strongly believed that it is due to some genes, which pass from one generation to another. It depends upon closeness of blood relationship if mother is diabetic, risk is 2-3%, father is diabetic, risk is more than the previous case and if both the parents are diabetic, it has much greater risk for diabetes.

2) Obesity & fat distribution (i.e., .≥20% desired body weight or BMI≥27 kg/m² )

            Being overweight means increased insulin resistance that is if body fat is more than 30%, BMI 2  5+ , waist girth 35 inches in women or 40 inches in males.

3) History of GDM (Gestational Diabetes mellitus)

            Or, delivery of baby over 9 lbs. (1lbs. = 450gms)

4) Age≥45 yrs

Increased age is a factor, which gives more possibility than in younger age. This disease may occur at any age, but 80% of cases occur after 50yrs, incidences increases as age does in this group. Type 2 cases often (but not always) start after 40 yrs ( or still later), patients are often (but not always) obese and have physical under activity.

5) Previously identified IFG (Impaired Fasting Glucose) or IGT (Impaired Glucose Tolerance)

6) Hypertension

            (BP ≥140/90 mm of Hg)

7) Polycystic Ovarian Syndrome

8) Poor diet

Malnutrition related diabetes : Improper nutrition, low protein and fiber intake of refined products are the expected reasons for developing diabetes.

9) Sedentary lifestyle

Sedentary lifestyle is a global public health problem.  Persons with such lifestyle are more prone to diabetes, when compared to those who exercise thrice a week, are at lower risk of falling prey to diabetes.

10) Stress

Either physical injury or emotional disturbance is frequently blamed as the initial cause of the disease. Any disturbance in corticosteroid or ACTH therapy may lead to clinical signs of the disease.

11) Sex

It is commonly seen elderly esp. males but strong evidence of developing diabetes in females with multiple pregnancy has been observed or in females suffering from Polycystic Ovarian Syndrome (PCOS)

12) Drug induced

Clozapine, olanzapine, risperidone, quetiapine, & ziprasidone are known to induce type 2 DM

13) Infection

Some of the staphylococci are supposed to be responsible factor for infection in pancreas

PURVARUPA  (Premonitory signs and symptoms)

            The prodromal features are those, which appear before the onset of the disease, that is before the involvement of the specific dosha. The clinical features manifested incompletely due to the pathogenic process being minimal should be taken as the specific prodromal features of the disease.

1. Jatilibhavam kesheshu– matting of the hair
2. Madhurya masasya- sweet taste in the mouth
3. Karpadayo suptatadaahi- numbness & burning sensation in hands &legs
4. Mukha taalu kantha shosha-dryness of the mouth, throat & palate
5. Pipasaam-polypepsia
6. Aalasya-fatigue
7.  Malam kaaye- exudation of excreta from the body
8. Kayachhidreshu padeham- feeling as if the body covered with  extraneous material
9. Shatpada pipilikabhishcha- swarming of ants over the body, attraction of ants by the body
10.  Mutre abhidhawanti pipilikaashcha- swarming of ants on the urine, urine attracting ants
11.  Mutrecha mutradoshan- different doshas entered the urinary tract in vitiated conditions
12.  Swedo angagandha- sweating ,emanation of foul smell from the   body
13.  Snigdha picchil gurugatranaam- heaviness of the body
14.  Saada- fatigued, weakness
15.  Shwasa- breathlessness
16. Talu gala jivha danteshu malotapatti- excessive formation of excreta from palate, throat, tongue, dentures etc.
17.  Vruddhishcha nakhanaam- excessive growth of nails
18.  Sheetapriyatvam- liking for cold things
19.  Keshyavruddhi- excessive growth of the hair
20.  Hrunetra shravanopadeha- exudation of excreta from eyes, tongue and ears
21.  Shithilatvam ange- flabbiness of the body
22.  Sweda- sweating
23. Shayyasanswapnasukha tarbhashanga- liking for constantly lying on the bed, sitting, sleeping and leading an easy life , a feeling as if the cardic region is covered with extraneous material
24.  Ghanaangata- corpulence of the body
25.  Paridaaham- burning sensation
26.  Suptatachaangenshu- numbness of the body

SYMPTOMS OF PRE-DIABETES

            Although most people with pre- diabetes have no symptoms at all. Symptoms of Diabetes may include unusual thirst, a frequent desire to urinate, blurred vision, or extreme fatigue. Very obese children and very obese adolescents may show pre-diabetes & diabetes like symptoms. Medical investigations like Fasting Plasma Glucose (FPG), & Impaired Glucose Tolerance (IGT) may show signs that suggest pre- diabetes may be present.

Investigations and Diagnosis

Diagnostic tests  for Prediabetes are Fasting Plasma Glucose test (FPG) & the Oral Glucose Tolerance Test (OGTT) and are done for all ages and races .If blood glucose level is abnormal following the FPG, it is Impaired Fasting Glucose (IFG) .If  blood glucose level is abnormal following the OGTT,it is Impaired Glucose Tolerance (IGT).

                

         

            FPG                                       OGTT

Diabetes types & reversal

DIAGNOSIS OF PRAMEHA ACCORDING TO AYURVED

            In a person who finds premonitory signs & symptoms of Prameha also with excessive urination, should be diagnosed as Pramehi. Also who finds total or atleast half of these signs & symptoms with excessive urination, is diagnosed as Pramehi.

PRAMEHA UPADRAVAS

            Complications of prameha are thirst, diarrhea, fever, burning sensation, weakness, anorexia, and indigestion. Carbuncles which putriify the muscle tissues like alaji and vidradhi appear during the chronic stage of the disease.

Samprapti

All pramehas finally leads to madhumeha. Tridosha and rest sampratpti ghataks take part in the pathogenesis of madhumeha as follows:

TREATMENT OF PREDIABETES

1.      Lose modest amount of weight (5-10% of total body weight) through diet and moderate exercise, such as walking-30mins a day and 5 days a week.

2.      Treatment for cardiovascular risk factors, such as smoking, tobacco chewing, hypertension and high cholesterol.

           

            Pramehas get immediately cured by different types of strenuous exercises, unction, bath, sprinkling of water over the body and application of ointment made by sevya (ushira), tvak, ela, aguru,candana, etc.

            Factors responsible for the causation of different types of Prameha should be avoided even after these pramehas are manifested. For the prevention of the occurrence of a disease different etiological factors are described during the treatment of that particular diseases (even after its manifestation)

            Patients suffering from Prameha can be classified into two categories .viz.,

1)      Those who are Obese and strong

2)      Those who are Emaciated and weak

Patients belonging to the latter category should be given nourishing therapy. Patients of the former category who are strong and who have more doshas in the body should be administered elimination therapy.

For elimination therapy (Vamana, Virechana) , various recipes are described. After the excreta are eliminated from the body, the patient should be given santarpana or refreshing therapy because apatarpana (fasting) therapy in this condition may produce gulma (cystic tumour) , consumption, pain in phallus and urinary bladder including kidney and  retention of urine. Such patients should be given santarpana therapy depending upon their power of digestion.

Factors responsible for the causation of different types of Prameha should be avoided even after these pramehas are manifested. For the prevention of the occurrence of a disease different etiological factors are described to be avoided. These very causative factors are also required to be avoided during the treatment of that particular  diseases (even after its manifestation).

Pramehi should live like sanyasi (muni) without covering over the head and should walk bare footed 100 yojan (~300km) or should get in physical work like digging well, ponds etc. or should have their livelihood on urine and cowdung and should always live in the company of cows.

APATHYA (STRICTLY CONTRAINDICATED)

            Sitting on the same place continuously (not doing physical work), sleeping during day time, using new cereals, curd in meals, suppression of urge of passing urine, smoking, hot fomentation, blood letting, drinking alcohol, like sauvirak, sura etc taila (oils), ksharghruta (ghee), guda (jaggery), sour foods, sugarcane juice, pishtanna (food rich in carbohydrates) and meat of aquatic animals.

PATHYA (INDICATED)

            Vegetables having bitter taste, padawal,(bitter gourd) meat of non-domesticated animals, saidhav lavan (rock salt) and pippali (Piper longum), Shali type of rice, pulses  like moong, kulitha (pulses)

FOLLOW UP

            If a person’s blood sugar levels (BSL) is in normal range, it is advised and reasonable to be checked every 3 yrs, If one is diagnosed for having pre-diabetes, blood sugar levels are to be checked for type 2 diabetes every year at least for 3 years, after the diagnosis.

A large 3 year medical study in patients at risk of developing type 2 diabetes suggests that lifestyle changes with exercise and mild weight loss, and treatment with medications that work to sensitize a person to the actions of insulin, can decrease the chance that a person with pre-diabetes will get type 2 diabetes.

            Changing the person’s lifestyle habits with increased physical activities and mild weight loss was more effective than medications at reducing the risk of developing type 2 diabetes. For some people with pre-diabetes, intervening early can actually return increased blood sugar levels to the normal range.

References

1)      Dr.Ambikadatta shastri , Editor,(14^th edi)Susruta samhita nidan sthana chapter 6/3 chaukhamba publications Varanasi.

2)      Pandye G.S Editor,(6^thedi.)Charak samhita nidan sthana chapter  4/46 ,chaukhamba publications Varanasi

3)      Dr.Ambikadatta shastri , Editor,(14^th edi)Susruta samhita nidan sthana chapter 6/5 chaukhamba publications Varanasi.

4)      Shri.Lalchandra Vaidya,Editor (6^th edi)Ashtang Hrudayam of Vagbhat nidan  sthan chapter 10/38,Motilal Banarasidas Varanasi

5)      Pandye G.S Editor,(6^thedi.)Charak samhita sutra sthana chapter  21/8,chaukhamba publications Varanasi

6)                   

Narendranath shastri (edi 5^th 2005)Madhavnidanam medorog chapter ,Motilal Banarasidas Varanasi

7)      Pandye G.S Editor,(6^thedi.)Charak samhita sutra sthana chapter  21/20,chaukhamba publications Varanasi

8)      Pandye G.S Editor,(6^thedi.)Charak samhita sutra sthana chapter  28/29,chaukhamba publications Varanasi

9)      Dr.Ambikadatta shastri , Editor,(14^th edi)Susruta samhita sutra sthana chapter 24/9, chaukhamba publications Varanasi.

10)  Dr.Ambikadatta shastri , Editor,(14^th edi)Susruta samhita sutra sthana chapter 24/9, chaukhamba publications Varanasi.

11)  Dr.Ambikadatta shastri , Editor,(14^th edi)Susruta samhita sharir sthana chapter 9/12, chaukhamba publications Varanasi.

12)  Yoga Ratnakara, Edition 1^st , edited by Dr. Indradev Tripathi, Krishnadas Academy, Varanasi, India, 1998

13)  Harrison’s Principles of Internal medicines, edition 15^th, edited by – Eugene braunwald, Amthonys fauci etc, Published by Mc. Graw Hill New York, USA, 2001.

14)     K sembulingam, 5^th edition, essentials of medical physiology,jaypee brothers,medical publishers, new delhi

15)  Dr. sujit k. chaudhari, 2^nd  edition, quintessence of medical    pharmacology, new central book agency,Calcutta

16)  Stephen j. McPhee, 51^st edition 2012 current medical diagnosis & treatment,  cenveo publisher services.

17)   Principles and practice of medicine; 16th edition. Davidson

18)  Anthony S. Fancietal, 17th edition Harrison Principles of Medicines, edited by, McGraw Hill, Health Profession

19) www.diabetesinformationhub.com

20) http:/www.diabetes.org/pre-diabetes

21) http:/www.ndep.nhih.gov/campaigns/smallsteps

1)                                                                                                             

Name                                  - Prof .Dr.D.L.Shinde                     

Educational Qualifications –MD;PhD (Kayachikitsa), Pune University

Permanent Address            - Bharati Vidyapeeth University ,College Of Ayurved,Katraj-            

                                              Dhanakawadi,Pune-43

Date Of birth                      - 3^rd April, 1968

Family background            - I belong from a respectable farmer’s family.

Qualities                            – Hardwork,Honesty, Integrity, Peaceful, Enthusiastic, Accomodative  

                                             & tough

Area Of Specilization Studies

1)      Diabetes, Hypertension, Atherosclerosis ,Metabolic Syndrome, cardiac diseases

2)      Spinal Cord injuries, Nervous System Disorders & Rehabilitation.

3)      AIDS & related infections like Herpes Zooster, skin infections etc.

4)      Research –Osteoarthritis project at IRSHA ,Bharati Vidyapeeth

Work Experience

Teaching & clinical experience for 20 yrs.

Book published – Anna He PurnaBrahma, Executive Editor – Arogya Sarita –monthly magazine

Lectures on Pune Akashwani

Lectures at social organizations ,conducting CME for medical fraternity

Organizing medical camps

Lectures as Resource person