|Year : 2022 | Volume
| Issue : 4 | Page : 166-169
Management of Vata pradhana prameha with Darvyadi ghrita: A case report
Asha Malviya1, Vitthal G Huddar2, P Shinsha3
1 Department of Kayachikitsa, Mansarovar Ayurvedic Medical College, Bhopal, Madhya Pradesh, India
2 All India Institute of Ayurveda, New Delhi, India
3 National Institute of Ayurveda, Jaipur, Rajasthan, India
|Date of Submission||19-May-2021|
|Date of Acceptance||22-Nov-2022|
|Date of Web Publication||29-Dec-2022|
Dr. Asha Malviya
Department of Kayachikitsa, Mansarovar Ayurvedic Medical College, Bhopal, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
Understanding Diabetes Mellitus (DM) in Ayurveda as Prameha, is always challenging as the diagnosis is made based on the clinical presentation of patients during the course of illness, not merely based on the blood glucose levels. All types of Prameha if not managed, will manifest as Vata pradhana prameha and later become Asadhya (~incurable) phase of Vataja prameha. A 41-year-old known diabetic (type 2) presented with complaints of generalized weakness, loss of weight, and loss of appetite. His blood sugar level was within normal limits at the time of the first visit. Considering the Vata predominance, Brimhana chikitsa (~nourishment therapy) with oral administration of Darvyadi ghrita for 60 days was prescribed in the case. The assessment was based on subjective and objective parameters. The improvements are significant and infer that Ayurveda medicines can satisfactorily help in the management of noncommunicable diseases like DM.
Keywords: Brimhana, Darvyadi Ghrita, Diabetes mellitus
|How to cite this article:|
Malviya A, Huddar VG, Shinsha P. Management of Vata pradhana prameha with Darvyadi ghrita: A case report. J Ayurveda Case Rep 2022;5:166-9
|How to cite this URL:|
Malviya A, Huddar VG, Shinsha P. Management of Vata pradhana prameha with Darvyadi ghrita: A case report. J Ayurveda Case Rep [serial online] 2022 [cited 2023 Jan 28];5:166-9. Available from: http://www.ayucare.org/text.asp?2022/5/4/166/365934
| Introduction|| |
Diabetes Mellitus (DM) is taken into consideration as Prameha due to similarities with the cardinal symptoms such as Prabhoota mootrata (~excessive urination) and Avila mootrata (~turbid urination). The long-term damage associated with DM includes altered functioning of various organs, and other effects including lethargy and weight loss. The goal of the treatment of DM is to control blood glucose and ultimately prevent long-term complications. While managing the condition through Ayurveda, a proper understanding of Ayurveda perspective becomes essential. In the later stages of uncontrolled DM 2, Vata gets predominantly vitiated, and accordingly, the treatment is to be planned. If Vata gets subsequently aggravated in patients suffering from Kaphaja and Pittaja prameha, such conditions are treatable. Shodhana (~purification therapy) and Brimhana chikitsa (~nourishment therapy) have been mentioned in the management of Prameha based on body constitution such as Sthoola pramehi (~obese diabetic patient) and Krisha pramehi (~asthenic diabetic patient), respectively. Medicated Taila and Ghrita prepared with Kashaya (~decoction) of Kaphaja and Pittaja prameha nashaka drugs to combat the Vata pradhana prameha. Here, an effort has been made to understand Vata pradhana avastha in course of T2DM in a case report treated with the principle of Brimhana chikitsa using Darvyadi ghrita shown significant improvement.
| Patient Information|| |
A 41 years old diabetic (type 2) since 2017 presenting with complaints of generalized weakness, loss of weight, and loss of appetite for the past six months, without any other comorbidities has visited the outpatient department (OPD). The patient was asymptomatic until six months ago. Gradually he noticed weight loss, weakness, and loss of appetite. His blood sugar levels were within the range. He was prescribed some Ayurveda medicines, and diet and lifestyle changes were advised by an Ayurvedic physician; however, not much improvement was noticed. By this time, no Oral Hypoglycemic Agents (OHA) were started by the patient. With no sign of improvement, he approached Kayachikitsa OPD on January 22, 2020. The personal history of the patient includes constipated bowels and moderately reduced appetite. Micturition and sleep were normal. He had no history of smoking, alcohol, or any other substance abuse. No positive family history of DM was reported by the patient.
| Clinical Findings|| |
On examination, vitals were found to be within normal limits. He appears to be thin and lean with a weak body build. Normal gait. No pallor and no signs of icterus were seen. Systemic examination revealed no abnormalities.
Dashavidh pareeksha (~tenfold of examination)
The patient has Pitta kaphaja prakruti (~physical constitution). Vikruti (~morbidity) was Vata prakopaja (~vata aggravation) with Dhatukshaya (~depletion of body tissues). Sara (~excellence of tissues elements or Dushya), Samhanana (~compactness or tissues or organs), Pramana (~ measurement of body constituents), Satmya (~homologation), Satwa (~ psychic condition), and Vayah (~age) of the patient were Madhyama (~moderate). Aaharashakti (~power of intake and digestion of food) and Vyayamashakti (~power of performing exercise) were Avara. The Bala (~strength) of the patient was Madhyama.
| Diagnostic Assessment|| |
Assessment criteria are based on the effect of the intervention on subjective and objective parameters. Subjective parameters comprised of clinical features such as Krisha (~asthenic), Angamarda (~body ache), Ruksha (~dryness of body parts), Alpashi (~loss of appetite), Pipasubhrisham (~excessive thirst), Parisaranshila (~restlessness), Dourbalya (~weakness), Gadhavarchastavam (~ hard/compact stool), Toda (~pricking type of pain) and other Vata aggravated Lakshanas. Based on these symptoms, the patient was diagnosed with Vata pradhana prameha. Objective parameters included: Fasting blood sugar, postprandial blood sugar, lipid profile, and Body Mass Index (BMI). The assessment was recorded on the 1st day, 30th day, and 60th day and after two months of withdrawal of medicines.
| Timeline|| |
The timeline is described in [Table 1].
| Therapeutic Intervention|| |
Management of Vata pradhana prameha was planned with 15 ml of Darvyadi ghrita twice daily with lukewarm water 30 minutes before food for 60 days. Ghrita in general improves Agni (~appetite). Darvyadi ghrita contains Devadaru [Cedrus deodara (Roxb.) G. Don.], Daruharidra (Berberis aristata DC.), Amalaki (Phyllanthus emblica L.), Vibhitaki [Terminalia bellerica (Gaertn.) Roxb.], , Haritaki (Terminalia chebula Retz.), and Musta (Cyperus rotundus L.). During the treatment period, no conventional medicines were used by the patient. He was advised to follow Pathya (~wholesome) diet and Yogasana during the treatment and follow-up period [Table 1]. During the follow-up period of two months, Amalaki churna (3 g) after food twice daily, Nishakathakadi kwatha (20 ml) twice daily before food, and Jambu beeja churna (3 g) twice daily before food were also prescribed.
| Follow-Up and Outcome|| |
All subjective and objective parameters were assessed before treatment, after 30 days and after 60 days of intervention. The gradation pattern to assess the outcomes followed, in this case, is being adopted in the department to evaluate the efficacy of the intervention in the case of Prameha. The results on the subjective and objective parameters observed are mentioned in [Table 2] and [Table 3], respectively. Considerable improvement was observed in all parameters. The drug was palatable and no inconvenience was reported by the patient during the treatment. The patient was followed up for the next two months (April–May 2020), during which no exacerbations in the symptoms or the blood sugar levels were noticed.
| Discussion|| |
Acharyas advised treatment as per different stages of the manifestation. The success of treatment depends on the selection of therapy as per the stage of the disease. As per the classics Kapha dosha, Meda dhatu, and Kleda (~watery waste) are the main culprit of Prameha but Vata dosha is secondarily aggravated when Kapha and Pitta dosha are diminished and disease turns into Vata pradhana prameha. Acharya charaka mentioned that in the case of Vata pradhana prameha, one has to use Ghirta prepared out of the drugs mentioned in Kashaya preparations. In the present study, Darvyadi ghrita was selected considering the concept of Brimhana chikitsa (~nourishment therapy) in Vata pradhana prameha. The drugs used in this formulation have Tridosha shamaka (~pacification of three humors) properties and also pacify vitiated Kapha, Meda, and Kleda. Using the drugs in the form of Ghrita further facilitate pacifying Vata dosha, without increasing the Kapha, Meda, and Kleda. Angamarda is reduced due to the Vata shamana and Dhatuposhana effects of the drug. Darvyadi ghrita due to its Brimhana and Vata shamana properties increased the BMI of the patient from 23 to 25.3 kg/m2. Dourbalya is reduced as it has Dhatuposhana effect. Gadhavarchastavam has reduced due to Snigdha (~unctuous property) and Vatashmana effect of the drug. Jaranashakti and Abhyavaharana shakti have increased due to Deepana (~enhancing metabolic fire) property of the drug. This approach infers that Brimhana treatment is to be followed till the subsidence of Vata lakshanas followed by treatment strategy as per the predominance of the Doshas.
| Conclusion|| |
Ayurveda gave prime importance to personalized medicine with a proper understanding of the stage of the illness. Acharyas have described stage-wise treatment for almost all diseases. It is applicable for Prameha too. In this study, the administration of Darvyadi ghrita has shown noteworthy results in terms of subjective well-being along with the desired reduction in biochemical parameters. Hence, the concept of understanding of Brimhana line of management in particular stages of Prameha which is a Santarpanajanya vyadhi (~disease due to nourishing procedure) where usually Ghrita preparations are rarely used in practice with the fear of the increase of Kapha, Kleda, and Medas, is made easy to understand and practice with supporting case report and original research work is also taken up in this regard to reassure the concept. The case also infers that newly diagnosed Vata predominant cases can be managed by Ayurveda interventions. In the current case, the requirement of conventional antidiabetic drugs was not observed even during the follow-up period giving hope to the case of freshly diagnosed cases.
Declaration of patient consent
Authors certify that they have obtained a patient consent form, where the patient has given his consent for reporting the case along with the images and other clinical information in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Shastri HP, editor. Nidana sthana. In: Ashtanga Hridayam of Vagbhata. Ch. 10., Ver. 7-8. Varanasi: Choukhambha Sanskritha Sansthana; 2016. p. 825.
WHO. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications: Report of a WHO Consultation. Part 1, Diagnosis and Classification of Diabetes Mellitus. Geneva: World Health Organization; 1999. p. 14. Available from: https://apps.who. int/iris/handle/10665/66040/
. [Last accessed on 2022 Nov 09].
WHO. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications: Report of a WHO Consultation. Part 1, Diagnosis and Classification of Diabetes Mellitus. Geneva: World Health Organization; 1999. p. 34. Available from: https://apps.who.int/iris/handle/10665 /66040/
. [Last accessed on 2022 Nov 09].
Sharma RK, Bhagwan D. editors. Chikitsa sthana. In: Charaka Samhita of Agnivesha. Ch. 6., Ver. 6. English Translation. Varanasi: Choukhambha Sanskrit Series Office; 2015. p. 299.
Sharma RK, Bhagwan D, editors. Chikitsa sthana. In: Charaka Samhita of Agnivesha. Ch. 6., Ver. 15. English Translation. Varanasi: Choukhambha Sanskrit Series Office; 2015. p. 302.
Sharma RK, Bhagwan D, editors. Chikitsa sthana. In: Charaka Samhita of Agnivesha. Ch. 6., Ver. 34. English Translation. Varanasi: Choukhambha Sanskrit Series Office; 2015. p. 307.
Acharya YT, editor. Chikitsa Sthana. In: Sushruta Samhita of Sushruta. Ch. 11., Ver. 3. Varanasi: Choukhambha Orientalia; 2014. p. 507.
Sharma RK, Bhagwan D, editors. Chikitsa sthana. Charaka Samhita of Agnivesha. Ch. 6., Ver. 26. Varanasi: Choukhambha Sanskrit Series Office; 2015. p. 305.
[Table 1], [Table 2], [Table 3]