|Year : 2022 | Volume
| Issue : 4 | Page : 176-182
Possible management of type 2 diabetes mellitus through patient-centered Ayurvedic approach: An experience
Kundan Sushilkumar Wasnik, Archana Umashankar Shukla, Raja Ram Mahto
Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi, India
|Date of Submission||02-Feb-2022|
|Date of Acceptance||14-Nov-2022|
|Date of Web Publication||29-Dec-2022|
Dr. Kundan Sushilkumar Wasnik
Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi
Source of Support: None, Conflict of Interest: None
Diabetes mellitus attributes to a heavy disease burden over the globe due to its high prevalence and the extensive morbidity it causes, impacting individuals, health systems, and national economies. The aim of the management is to prevent or delay complications through an individualized patient-centered approach and improve the quality of life. Ayurvedic principles of treatment focus on the body as well as the mind through medicines, Ahara (~diet)-Vihara (~lifestyle intervention), yoga, and Satvavajaya chikitsa (~psychotherapy) which can be considered a holistic approach. A 58-year-old female homemaker presented with chief complaints of weight loss, pain in bilateral calf muscles, tingling sensation in bilateral soles, excessive thirst, dryness in mouth, palate, and throat, generalized weakness, knee joint pain, blurred vision, excessive urination, and burning micturition that subsided with the present treatment. Fasting Blood Sugar (FBS) was 372 mg/dl and Post Prandial Blood Sugar (PPBS) was >500 mg/dl. The patient was given Gokshuradi guggulu, Panchavalkala kwatha, Nisha amalaki churna, Kutaja churna, Shilajatvadi lauha, and tablet M Liv for Vyadhi pratyanika (~disease antagonistic treatment) as well as Rasayana (~rejuvenative) purposes. The FBS and PPBS came to normal range after a four month Ayurveda therapeutic intervention. HbA1c reduced from 12.3% to 6.7% and all the symptoms subsided. Obtaining glycemic control in a diabetic patient remains a critical clinical challenge and even exerting a regulation on HbA1C is possible only through a precise patient-centered treatment approach.
Keywords: Holistic approach, Madhumeha, Nisha amalaki churna, Prameha, Shilajatvadi lauha
|How to cite this article:|
Wasnik KS, Shukla AU, Mahto RR. Possible management of type 2 diabetes mellitus through patient-centered Ayurvedic approach: An experience. J Ayurveda Case Rep 2022;5:176-82
|How to cite this URL:|
Wasnik KS, Shukla AU, Mahto RR. Possible management of type 2 diabetes mellitus through patient-centered Ayurvedic approach: An experience. J Ayurveda Case Rep [serial online] 2022 [cited 2023 Jan 28];5:176-82. Available from: http://www.ayucare.org/text.asp?2022/5/4/176/365935
| Introduction|| |
Diabetes is a complex and chronic illness requiring continuous medical care with multifactorial risk reduction management beyond glycemic control. Diabetes Mellitus (DM) presents with chronic hyperglycemia affecting protein, fat, and carbohydrate metabolism, resulting in defects in insulin action, insulin secretion, or both. DM is one of the major causes of death in a group of noncommunicable disorders. About 1.6 million people die annually due to diabetes all over the world. Recent global estimates indicate that 463 million adults have the condition, of whom 80% reside in low- and middle-income countries. Changes in lifestyle, dietary patterns, and stress mainly lead to diabetes, and its prevalence is rising very rapidly. A major concern in DM is varying manifestations that arise due to microvascular and macrovascular pathologies, which may result in blindness, kidney failure, heart attack, and wounds. Many treatment modalities are available for the management of diabetes in modern medical science but have certain limitations.
Owing to the similarity in clinical presentation, type 2 DM (T2DM) and Prameha are mostly correlated. Excessive sleeping, sedentary lifestyle, excessive and unrestrained consumption of sweet food items, curd, etc., contribute to the manifestations of Prameha. Studies suggested that a high intake of red meat, sweets, and fried foods increases the risk of insulin resistance and T2DM. Prameha in Ayurvedic literature is described as Anushangi vyadhi (~chronic disease) which requires a long time for management. When the association between the Nidana (~causative factor)-Dosha (~ humor)-Dushya (~vitiated Dhatus) is weak, it can manifest the weak disease, and if the association is strong, it manifests the stronger disease. With raising awareness about signs and symptoms related to DM, the detection rate of newly diagnosed cases increased and management became appropriate. Information regarding the role of Oral Hypoglycemic Agent (OHA) and its side effects is well known, which leads toward the acceptance of traditional medicine in the management of DM and its complications. This gives a ray of hope for the patient as well as the community.
Ayurveda specifically aims at treating the Dosha imbalance and thereby bringing a state of homeostasis in terms of Dosha and Dhatu. The concept of Ahara (~diet), Vihara (~lifestyle intervention), yoga, and lifestyle management are crucial in controlling diabetes as well as preventing complications and improving the quality of life in patients with DM. A multidimensional approach and comprehensive care are required for the management of DM. One case that was diagnosed early and wanted to seek Ayurvedic treatment is presented here. Most of her symptoms as well as a significant reduction in her blood sugar levels were noticed after the management.
| Patient Information|| |
A 58-year-old female homemaker patient visited the diabetic and metabolic Outpatient Department (OPD) with chief complaints of weight loss of about 5 kg in the last one month, Udwestana (~cramping pain in bilateral calf muscles), Ubhaya pada chimchimayana (~tingling sensation in bilateral soles), Pipasadhikya (~excessive thirst), Mukha ostha talu kantha sushkata (~dryness in mouth, palate, and throat), Sharira balakshaya (~diminished strength), and Janu sandhi shoola (~knee joint pain) since 15 days. She also complained of Avila darshana (~blurred vision) and Prabhuta mutrata (~excessive urination) mainly at night time and Mutradaha (~burning micturition). The patient had a history of hypothyroidism for 25 years. The patient did not have any positive family history of DM or thyroid disorders. The patient was taking tablet Thyroxin (75 μg) and her thyroid profile was within the normal limit. For the management of T2DM, the patient took OHA (metformin 500 mg OD before meal) for five days and then discontinued it due to gastric upset. The patient was apparently healthy before two months and then gradually developed symptoms. One of her friends suggested her to take Ayurvedic medicine, thus she visited the OPD.
| Clinical Findings|| |
On examination, the patient was identified as having Vata kaphaja prakruti (~body constitution) with the predominance of Pitta and Vata nadi (~pulse). The tongue was normal with mild coating. The patient had normal eye movements and clear speech, but some Rukshata (~dryness) over the body was visible. The patient was moderately built with a body mass index of 21.5 with a dull appearance over the face, suggestive of stress. The patient was well-oriented but appeared anxious. There was no pallor, icterus, clubbing, cyanosis, lymphadenopathy, or edema. A systemic examination was done and no abnormality was detected. Satva (~psyche), Satmya (~suitability), and Vyayama shakti (~physical strength) are of Madhyama (~medium).
| Timeline|| |
The timeline is depicted in [Table 1].
| Diagnostic Assessment|| |
The patient had raised fasting blood sugar (FBS) (351 mg/dl), postprandial blood sugar (PPBS) (>500 mg/dl), and HbA1c (12.3%). The patient also presented with the cardinal features of diabetes such as polyphagia, polyuria, and polydipsia. Prabhuta mutrata and Sadaha mutrapravritti (~burning micturition) with Purvaroopa (~premonitory symptoms) such as Alasya (~laziness), Shithilangata (~flabbiness of body parts), Pipasa (~thirst), Karapada suptata (~numbness over palm and soles), Mukha kantha talu shosha (dryness at mouth, throat, and palate), and pain in bilateral calf muscles were present. Samprapti of disease suggested the involvement of Kapha predominant Tridosha (~three body humors) along with the vitiation of Mamsa (~muscle tissue), Meda (~fat tissue), Kleda (~stickiness), and Mutra (~urine) in the Basti (~urinary bladder) resulting in the manifestation of Kaphadhika prameha. All these symptoms confirmed the diagnosis.
| Therapeutic Intervention|| |
On detailed assessment, the patient was found to be Durbala (~weak) and was stressed because of the raising sugar levels. Shodhana chiktsa excluded as patient not suitable for Shodhana due to Durbala and stress thus Shamana (~palliative treatment considering the Samprapti along with the medication, diet, and lifestyle changes are also suggested [Table 2] and [Table 3]. In yoga, Mandukasana, Hastapadasana, and Pavanamuktasana were suggested.
| Follow-Up and Outcome|| |
After one month of treatment, the symptoms subsided along with marked reduction in hyperglycemia. For the next three months, Gokshuradi guggulu, Nisha amalaki churna, and Shilajatvadi lauha were continued for assessing the improvement in each follow-up on the basis of subjective and objective parameters.
The complaints of reduced strength, pain in the back of bilateral muscles, knee joint pain, excessive thirst, polyuria, and burning micturition were reduced in two months, but the tingling sensation in bilateral soles was reduced to a great extent but not completely subsided. The patient's weight also improved up to 2 kg, and the patient regains her strength. The blood sugar level was reduced [Table 1] and [Graph 1]. The HbA1c level reduced from 12.3% to 6.7% during the treatment. During the course of the administration of Ayurveda medications, no other complaints were observed and had strictly adhered to the advised medications, diet, and lifestyle.
| Discussion|| |
DM is one of the world's most challenging public health problems due to its high and growing prevalence and the diverse and extensive morbidity it causes, impacting individuals, health systems, and national economies. Customized therapeutic approaches are important in such cases. Thus, a patient-centered approach is planned customizing treatment schedules. As per the available literature, different treatment modalities are found to be used in each case following the principle of “Purusham purusham vikshyam” (~each and every person is different) and “Amshamsha samprapti” (~permutations and combinations of Doshas). The key to disease management is Nidana parivarjana (~avoidance of causative factors) which can be attributed to the concept of lifestyle modifications.
Prameha is a chronic disorder that requires a strong association of Nidana-dosha-dushya to manifest. The most probable mechanism leading to T2DM in thyroid dysfunction could be attributed to the perturbed genetic expression of a constellation of genes along with physiological aberrations leading to impaired glucose utilization and disposal in muscles, overproduction of hepatic glucose output, and enhanced absorption of splanchnic glucose. These factors contribute to insulin resistance. Hence, hypothyroidism may be considered Sannikrusta hetu (~direct cause) of Prameha. The patient presented with Rasavaha srotas dushti (~deformity in channels carrying nutrient fluids) which occurred due to Ati chinta (~excessive stress).
To achieve the equilibrium of Dosha and Dushya, Samprapti vighatana (~breakdown of pathophysiology) of disease should be done, which includes Shodhana, Shamana along with yoga, Ahara-vihara, and Satvavajaya chikitsa. This constitutes the holistic approach toward managing Prameha. After examining, the Rogi bala (~patient's strength) was found to be Avara (~low) because the patient experienced weakness while doing routine household work, as well as difficulty in doing exercises and dyspnea on exertion. Hence, Shodhana procedure was excluded even though Vyadhi bala (~disease strength) was good and Bahudoshavastha was present. For Shamana purpose, Gokshuradi guggulu, Panchavalkala kwatha, Nisha amalaki chura, Kutaja twak churna, Shilajatvadi lauha, and tablet M Liv were prescribed.
Gokshuradi guggulu is commonly used in diseases of Mootravaha srotas (~urinary system) and is indicated in Prameha. It has Rasayana (~rejuvenation), Balya (~strength promoter), Raktaprasadaka (~purification of the blood), Basti-shodhaka (~clears urinary bladder), Kledaghna (minimizes stickiness), Medoghna (~anti-obesity), Mehaghna (~anti-diabetic), Tridoshaghna (~balancing three humors), Shothaghna (~anti-edematous), and Lekhana (~scraping) properties. It acts through Kledaghna, Medoghna, and Tridoshaghna properties to affect the pathogenesis of Madhumeha. For the removal of any blockage in micro- as well as macrovessels, Lekhana property is useful. Thus, it helps in correcting Srotorodha (~obstruction of body channels) in Mootravaha as well as Medovahasrotas. Gokshuradi guggulu improves nourishment, maintains the effectiveness of Mootravahasrotas, and improves the resistance of kidney tissues against any adversity, thus helping in refurbishing and preventing damage to kidney vasculatures and tissues.
Nisha amalaki churna has Tridoshahara (~balancing three humors) property, especially Kaphahara (~Kapha pacifying property). Due to its Deepana (~enhancing metabolic fire) and Pachana (~enhancing digestion) properties, Nisha amalaki churna works on Jatharagni (~digestive fire) and Dhatwagni (~metabolic factors located in Dhatu), which reduces the Ama (~metabolic toxins) and Kleda present in the body as well as improves metabolism. By Deepana, Pachana, and Anulomana (~smooth evacuation) properties, it works on Srotodushti (~deformity in body channels). Thus, it acts on vitiated Kapha, Meda, and Kleda. With this, it reverses the Samprapti of Prameha. Nisha amalaki may regulate T2DM by modulating various mechanisms including glucose and lipid metabolism, β-cell survival and proliferation, regulation of insulin resistance, inflammation, apoptosis, and cell cycle through PI3Kakt, TNF, FoxO, Jak-STAT, MAPK, and NF-kappa B signaling pathway.
Based on the results, it may be inferred that the anti-diabetic effect may be due to the influence on multiple targets and pathways. Kutaja is having Katu (~pungent), Tikta (~bitter), Kashaya (~astringent) taste, Ruksha (~dryness), Sheeta (~cold), Guna (~property), and Deepana karma. Kutaja is also best for Bahumutrata (~excessive urination) or Mutratisara (~excessive urination) and is Mehanashaka (~decreases diabetic condition), thus helpful in this case.
Shilajatvadi lauha, referred in Rajayakshma rogadhikara, helps in nourishing the Rakta dhatu., It also exhibits Rasayana as well as Brumhana (~nourishing therapy) action that reverses the Kshayajanya samprapti (~degenerative pathophysiology). The weight gain as well as reduced weakness also infers the action of the drug.
Shilajatvadi lauha has been reported for hypoglycemic effect; Shilajatu is having pancreatotrophic action, which means that it increases the number of β-cells of the pancreas, which results in better sensitivity of β-cells with the prompt secretion of a large quantity of insulin in response to hyperglycemia. Lauha bhasma reduces the degree of oxidative stress signaling pathways and, by that, prevents insulin resistance and β-cell dysfunction, ultimately, controlling the blood sugar level, and its Medohara (~anti-obesity) effect decreases the high lipid level. Shilajatvadi lauha possesses anti-diabetic, antioxidant, and rejuvenator activities. M Liv tablet was administered to stimulate the liver and to correct Dhatvagnimandya. When Dhatvagnimandya is corrected, it helps in reducing the FBS level.
Panchavalkala kwatha having Grahi guna (~absorptive property) acts as Kleda shoshaka (~absorb watery proportion) and reduces the frequency of micturition. It is having Shothagna property and exerts action on Twak (~skin tissue) and Mamsa (~muscle tissue) and corrects Kaphadusti as Kapha is having Ashraya ashrayi bhava (~mutual interdependence). By Lekhana property, it helps in reducing the PPBS.
Yoga enhances physical wellness by stretching exercises and facilitates general body movements by reducing muscle fatigue and body stiffness. It also improves mental clarity and self-comprehension. Glucagon secretion is enhanced by stress. Yoga effectively reduces stress, thus reducing glucagon and possibly improving insulin action. Muscular relaxation, development, and improved blood supply to muscles might enhance insulin receptor expression on muscles, causing increased glucose uptake by muscles and thus reducing blood sugar. In previous studies, yoga improves the Satva guna (~purity) as well as helps to reduce Rajas (~passion) and Tamas (~delusion) Doshas and thus yoga may reduce negativity and develops a positive attitude in the patient. Mandukasana, Hastapadasana, and Pavanamuktasana mainly activate the liver and pancreas, thus regulating glucose metabolism and helping to reduce blood sugar levels.
| Conclusion|| |
By following a holistic patient-centered approach (Shamana, yoga, and Ahara-vihara), DM can be managed in a satisfactory level. The current case also infers that the level of satisfaction might be more if the patient visited in the initial phases of the pathology. The strategies followed, in this case, may be applied in other similar cases too.
Declaration of patient consent
Authors certify that they have obtained 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.
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[Table 1], [Table 2], [Table 3]