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Prameha Chikitsa (view source)

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We shall ~~now~~ expound the chapter ~~on the treatment~~ of ~~''Prameha''~~. Thus, said Lord Atreya. [1-2]

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Now we shall expound the chapter "Prameha Chikitsa" (Management of Obstinate Urinary Disorders). Thus said Lord Atreya. [1-2]

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Punarvasu who is free from delusion, ego, hatred and attachment, and who has attained magnanimity because of his knowledge and penance, described the etiology, signs and symptoms, and treatment of ''meha'' (''prameha'') to Agnivesha at proper time (when query was asked).[3]

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==== Etiology of ''prameha'' ====

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=== Etiology of ''prameha'' ===

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Over-indulgence in the pleasure of sedentary habits, excess sleep, curds, soup of the meat of domesticated and aquatic animals and animals inhabiting marshy land, milk and its preparations, freshly harvested food articles, freshly prepared drinks, preparations of jaggery and all ''kapha''- aggravating factors are responsible for the causation of ''prameha''. [4]

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==== ''Dushya'' (vitiated factors) and pathogeneis ====

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=== ''Dushya'' (vitiated factors) and pathogeneis ===

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When other two ''doshas'' are in a relatively diminished state, the aggravated ''vayu'' draws tissues elements (viz. ''ojas, majja,'' and ''lasika'') into the urinary tract and vitiates them to cause ''vata'' dominant ''pramehas''. Different ''doshas'' having entered the urinary tract in vitiated condition give rise to the respective types of ''meha'' with their own dominance. [5-6]

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==== Classification and Prognosis ====

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=== Classification and Prognosis ===

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''Vatika pramehas'' are of four types and they are incurable because of their incompatibility with therapies and dreadful nature of ''vata'' leading to complications. [7]

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==== Vitiating factors involved in pathogenesis ====

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=== Vitiating factors involved in pathogenesis ===

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''Doshas'' like ''kapha, pitta'' and ''vata,'' and ''dushyas'' like ''medas, rakta, shukra, ambu'' (body fluid), ''vasa'' (muscle fat), ''lasika'' (lymph), ''majja, rasa, ojas'' and ''mamsa'' are responsible for the causation of ''prameha'' which is of twenty types. [8]

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==== Twenty types of ''dosha'' dominant ''prameha'' ====

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=== Twenty types of ''dosha'' dominant ''prameha'' ===

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Diminution of other ''dhatus'' or tissue elements (besides those described above) is responsible for the causation of the above mentioned four varieties of ''vatika prameha''. [9-11]

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==== Criteria for diagnosis ====

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=== Criteria for diagnosis ===

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Different types of ''prameha'' are characterized by the color, taste, touch and smell of the respective ''dosha''. ''Vatika'' varieties of ''prameha'' are characterized by grayish or reddish coloration of the urine, pain and attributes of ''majja'', etc. These types of ''vatika prameha'' are incurable. [12]

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==== Premonitory signs and symptoms ====

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=== Premonitory signs and symptoms ===

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Sweating, body odor, flabbiness of the body, liking for constantly lying on the bed, sitting, sleeping and leading an easy life, a feeling as if the cardiac region is covered with extraneous material, exudation of excreta from eyes, tongue and ears, corpulence of the body, excessive growth of hair and nails, liking for cold things, dryness of throat and palate, sweet taste in the mouth, burning sensation in hands and legs and swarming of ants on the urine- these are the premonitory signs and symptoms of ''prameha''. [13-14]

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==== Principles of management ====

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=== Principles of management ===

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For this purpose, the oleated patient should be given various recipes described in [[Kalpa Sthana]] with a view to eliminating metabolic waste products through both upward and downward tracts. After the waste products (excess metabolic bi-products) are eliminated from his body, the patient should be given ''santarpana'' or nourishment therapy. Because ''apatarpana'' (depletion) therapy in this condition may produce ''gulma'', consumption, pain in phallus and urinary bladder including kidneys and retention of urine. Such patients should be given ''santarpana'' therapy depending upon their power of digestion. [15-17]

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==== ''Samshamana'' ( pacification therapy) ====

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=== ''Samshamana'' ( pacification therapy) ===

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If the patient of ''prameha'' is not eligible for ''samshodhana'' or elimination therapy, ''samshamana'' or alleviation therapies should be given. [18]

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===== Diet =====

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==== Diet ====

The patient suffering from ''prameha'' should be given the following food:

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Various eatables prepared from the barley or bamboo seed or wheat previously eaten by asses, horses, cows, swans and deer and collected from their dung should be given to the patient suffering from ''prameha''. [18-24]

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==== Specific Therapies ====

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=== Specific Therapies ===

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Purificatory therapies including specifically emesis and fasting therapies, administered at the appropriate time, cure ''kaphaja'' types of ''prameha''. Similarly, ''pittaja'' types of ''prameha'' are overcome by purgation, ''santarpana'' (refreshing therapy) and alleviation therapies. [25]

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==== Various recipes ====

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=== Various recipes ===

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The patient suffering from ''prameha'' should take the decoction of ''darvi, surahva, triphala'' and ''musta'' mixed with honey. He may also take ''haridra'' along with the juice of ''amalaki''. [26]

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===== Decoctions for ''kaphaja prameha'' =====

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==== Decoctions for ''kaphaja prameha'' ====

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#Decoction of ''chavya, abhaya, chitraka'' and ''sapta parna''.

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===== Decoctions for ''pittaja prameha'' =====

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==== Decoctions for ''pittaja prameha'' ====

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#Decoction of ''katankateri'' (''daruharidra''), ''utpala'' and ''mustaka''. [30-32]

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===== Decoctions for all types of ''prameha'' =====

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==== Decoctions for all types of ''prameha'' ====

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Medicated oils and medicated ghee prepared by cooking with these decoctions should be administered to patients suffering from ''vatika prameha''. These decoctions correct the vitiated ''medas'' and ''kapha'', and the aggravated ''vayu'' in these patients gets alleviated by the unctuous ingredients (viz., oil and ghee) included in these recipes. [33-34]

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===== Formulations for ''kaphaja'' and ''pittaja prameha'' =====

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==== Formulations for ''kaphaja'' and ''pittaja prameha'' ====

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Powder of ''kampillaka'', barks of ''saptachchada, bibhitaka, rohitaka'' and ''kutaja'' and flower of ''kapittha'' should be added with honey, made to a linctus and taken by patients suffering from ''kaphaja'' and ''pittaja prameha''. One ''aksha'' of the paste of above mentioned drugs should be mixed with the juice of ''amalaki'' and given at the appropriate time to patients suffering from ''kaphaja'' and ''pittaja'' types of ''prameha''. After the digestion of this potion, the patient should be given to eat old rice cooked and mixed with the delicious soup of the meat of animals living in arid land.[35-36]

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===== Formulations for ''vata'' association in ''kaphaja'' and ''pittaja prameha'' =====

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==== Formulations for ''vata'' association in ''kaphaja'' and ''pittaja prameha'' ====

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The decoction of ''triphala, darunisha, vishala'' and ''musta'' should be mixed with the paste of ''haridra'' and honey. Intake of this potion cures all types of ''prameha'' even when these are manifested in acute form. [37-40]

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==== ''Madhvasava'' ====

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=== ''Madhvasava'' ===

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''Lodhra, shati, pushkaramula, ela, murva, vidanga, triphala, yamani, chavya, priyangu, kramuka, vishala, kiratatikta, katurohini, bharngi, nata, chitraka, pippalimula, kushtha, ativisha, patha, kalingaka, keshara, indravaruni, nakha, patra, maricha'' and ''plava''- one ''karsha'' of each of these drugs should be boiled in one ''drona'' of water till one fourth remains. This decoction along with half its quantity of honey should be kept inside a ghee smeared jar for a fort night. This is called ''madhvasava''. It instantaneously cures ''kaphaja'' and ''paittika'' types of ''meha'' when administered in a dose of two ''palas''. It also cures ''pandu, arsha, aruchi, grahani dosha, kilasa'' and different types of ''kushtha''.[41-44]

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==== ''Dantyasava'' and ''bhallatakasava'' ====

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=== ''Dantyasava'' and ''bhallatakasava'' ===

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In the above mentioned decoction, eight ''palas'' of ''danti'', eight ''palas'' of sugar and the same quantity of honey should be added and processed. Similarly, in the above mentioned decoction four ''palas'' of ''bhallataka'', eight ''palas'' of sugar and the same quantity of honey should be added and processed. These two ''asavas'' (namely ''dantyasava'' and ''bhallatokusava'') are useful in the treatment of ''prameha''. [45]

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==== Beneficial diet and drinks ====

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=== Beneficial diet and drinks ===

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Persons habitually taking roasted barley, dry corn- flour, ''mudga'' and ''amalaka'' do not suffer from ''prameha, shvitra'' (leucoderma), ''mutrakrucchra'' (dysuria) and ''kaphaja kushtha''. [46-48]

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==== Indications of above treatment ====

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=== Indications of above treatment ===

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Effective formulations for producing drying effect on obese patients while describing the management of diseases caused by over- nourishment are useful in the treatment of ''pramehas'' caused by ''kapha'' and ''pitta'' dominance. [49]

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==== Various external applications ====

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=== Various external applications ===

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''Pramehas'' get immediately cured by different types of exercises, unction, bath, sprinkling of water over the body and application of ointment made of ''sevya'' (''ushira''), ''tvak, ela, aguru, chandana'' etc. [50]

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==== Indication of ''apatarpana'' treatment ====

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=== Indication of ''apatarpana'' treatment ===

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Aggravated ''kleda'' (liquid element of the body), ''medas'' (adipose tissue) and ''kapha'' are responsible for the causation of ''prameha''. Keeping this in view, the physician, in the beginning, should administer depletion therapies to patients suffering with ''kapha'' and ''pitta'' dominant types of prameha. [51]

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==== ''Vata'' dominant ''prameha'' ====

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=== ''Vata'' dominant ''prameha'' ===

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Formulations described earlier for the ''vatika prameha'' are actually meant for ''vata'' dominant ''prameha'' where ''vayu'' is secondarily (subsequently) aggravated. If the ''vayu'' is primarily aggravated in ''prameha'' because of excessive depletion of tissue elements, then it is incurable and the physician need not make efforts to treat. [52]

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==== Prevention of ''prameha'' ====

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=== Prevention of ''prameha'' ===

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Etiological factors responsible for the causation of different types of ''prameha'' should be avoided even after ''prameha'' are manifested. The causative factors described shall be avoided during the treatment of those particular diseases (even after its manifestation). [53]

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==== Differentiation between ''raktapitta'' and ''prameha'' ====

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=== Differentiation between ''raktapitta'' and ''prameha'' ===

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If the color of the urine is yellow or if blood is excreted through the urine without the prior manifestation of premonitory signs and symptoms of ''prameha'', such a person should not be diagnosed as a patient of ''prameha''. He should be diagnosed as a case of ''rakta-pitta'' (a disease characterized by bleeding from different parts of body).[54]

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==== Two types of ''prameha'' patient ====

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=== Two types of ''prameha'' patient ===

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If the patient suffering from ''prameha'' passes urine which is sweet, slimy and honey-like, then there are two possibilities. It is caused either by the diminution of ''doshas'' having ''vata''-dominant type or by over- nourishment having ''kapha'' dominant type. [55]

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==== Prognosis ====

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=== Prognosis ===

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''Kapha'' dominant and ''pitta'' dominant types of ''prameha'', if preceded by their premonitory signs and symptoms, are incurable. Similarly, ''vatika prameha'', where ''vayu'' is aggravated right from the beginning is incurable. ''Pitta'' dominant types of ''prameha'' are generally palliable. But they are curable if ''medas'' (adipose tissue) is not vitiated. [56]

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==== In-curability of hereditary diseases ====

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=== In-curability of hereditary diseases ===

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Patients who suffer from ''prameha'' since birth (congenital) and those who are borne of ''prameha'' parents (hereditary) are not curable because of the morbidity in their ''bija'' (genes). Similarly, other hereditary (''kulaja''/familial) ailments are considered as incurable. [57]

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==== Treatment of ''prameha pidaka'' ====

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=== Treatment of ''prameha pidaka'' ===

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Seven types of ''prameha pidaka'' of patients suffering from ''prameha'' described in the quadrate on diseases (''rogadhikara'') are to be treated by expert surgeons with the help of ''shastras'' (surgical operations), ''samshodhana'' (cleansing) and ''ropana'' (healing therapies). [58]

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==== Summary ====

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=== Summary ===

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Thus, ends the sixth chapter dealing with the treatment of ''prameha'' of [[Chikitsa Sthana]] of Agnivesha’s work as redacted by Charak.[6]

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=== Tattva Vimarsha (Fundamental Principles) ===

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== Tattva Vimarsha (Fundamental Principles) ==

*Excess intake of curds, soup of the meat of domesticated, aquatic animals and animals inhabiting marshy land, milk and its preparations, freshly harvested food articles, freshly prepared drinks, preparations of jaggery and all ''kapha''- aggravating factors are responsible for the causation of ''prameha''.

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== Vidhi Vimarsha (Applied Inferences ) ==

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==== Role of ''kapha'' dominant diet ====

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=== Role of ''kapha'' dominant diet ===

In ''prameha, kapha'' is the main culprit both as ''dosha'' as well as ''dushya''. Diet having high contents of bad fat and carbohydrates like curd (Fat= 3g/ 100g, carbohydrate= 7.8g/100g, Protein= 5.25g, calories= 63), meat soup (calories= 902), jaggery (Fat= 0g/ 100g, carbohydrate= 97.2 g/100g, Protein= 0.5g/100g, calories= 367), newly harvested grains that are having high calories than old one (If dry grains are held for only a few months, minimum nutritional changes will take place, but if the grains are held with a higher amount of moisture, the grain quality can deteriorate because of starch degradation by grain and microbial amylases) etc., causes ''prameha''. All the causative factors are in diet that have high content of bad fat like saturated fats and no good fats like polyunsaturated or monounsaturated fats (which are mostly present in plant originated dietary products). It is advisable that maximum percentage of daily fat consumption should come from plant origin to lower the risk of dyslipidemia.

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#those related to sedentary life style that causes low energy expenditure (lack of exercise, etc). These two factors cause an imbalance between energy consumption and energy expenditure and ultimately cause obesity.

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==== Role of obesity and pathogenesis in ''sthula prameha'' ====

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=== Role of obesity and pathogenesis in ''sthula prameha'' ===

Excessive consumption of fats and sedentary life style causes obesity. Obesity causes derangement in lipid metabolism and storage which in turn leads to ''prameha'' as shown in the following chart:

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==== Diagnosis of ''prameha'' based on characteristics of urine ====

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=== Diagnosis of ''prameha'' based on characteristics of urine ===

Different categories of ''prameha'' are described to possess the color, taste, touch, and smell of the respective ''doshas''. For example, in ''kaphaja prameha'', the urine is characterized by white color, sweet taste; cold touch and ''ama gandha'' (smell like that of flesh). In the same way, the characteristic features of ''pittaja prameha'' are to be determined. ''Vayu'' itself is colorless. Therefore, different varieties of ''vata'' dominant ''prameha'' are characterized by grayish or reddish color of urine as a result of the ''prabhava'' (specific action) of the ''vayu''.

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''Vata'' dominant ''prameha'' is already described to be incurable (''asadhya''). Again repeating the statement regarding its incurability implies that the presence of several symptoms including the grayish and reddish coloration of urine right from the origin of disease is incurable; and if these signs and symptoms appear at later stage, then the condition is incurable. In the latter type, attributes of ''majja'' etc., need not to be present. Alternatively, it can be explained that when at a later stage, any type of ''prameha'' gets associated with ''vayu'' and characterized by grayish and reddish coloration of urine, and then it also becomes incurable. In addition when ''kaphaja'' and ''pittaja'' types of ''prameha'' are associated with the passage of ''majja'' etc., in the urine, they become incurable. It is stated, “All types of ''prameha'', if not treated in time, leads to ''madhumeha'' and become incurable” (Sushruta : Nidana 6).

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===== 1. ''Kaphaja prameha'' (progressive stage from pre-diabetic to diabetes mellitus type-2) =====

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==== 1. ''Kaphaja prameha'' (progressive stage from pre-diabetic to diabetes mellitus type-2) ====

*''Udakameha'' – Osmotic diuresis (having characteristic similar to that of water)

**Pre-diabetic stage - hyperglycemia causes decrease reabsorption of water and excessive loss of water through urine.

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**Autonomic diabetic neuropathy leading to retrograde ejaculation of sperm.

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===== 2.''Pittaja prameha''- (Stage of infection & inflammation in diabetes) =====

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==== 2.''Pittaja prameha''- (Stage of infection & inflammation in diabetes) ====

*''Ksharameha''- the patient passes urine having the smell, color, taste and touch like those of alkalies. (pH of urine become alkaline)

**Increased urinary pH due to UTI in diabetes.

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*''Haridrameha''- the patient passes urine having pungent taste and color like that of the juice of ''haridra'' (Curcuma longa Linn.)

**dark yellow color urine due to dehydration. Highly concentrated urine due to UTI/ dark yellow color due to jaundice.

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=====3. ''Vataja prameha''- (Type-1Diabetes mellitus) =====

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====3. ''Vataja prameha''- (Type-1Diabetes mellitus) ====

*''Vasameha'' - Lipiduria (prence of lipid in urine) in Nephrotic syndrome associated with type-1 diabetes mellitus (30-40%) known as Kimmelstiel –Wilsone Syndrome.

*''Majjameha''– presence of bone marrow.

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*''Ojomeha/ Madhumeha''- Type – 1 Diabetes mellitus

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==== Parameter of urinalysis used in above ====

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=== Parameter of urinalysis used in above ===

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===== 1. Physical parameters =====

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==== 1. Physical parameters ====

*Color

**''Raktameha, haridrameha, majjisthameha, kalameha'' etc.

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*Temperature

**''Shitameha''

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=====2. Chemical parameters =====

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====2. Chemical parameters ====

*pH

**''Ksharameha''

*Specific Gravity

**''Udakameha''

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=====3. Microscopic Examination=====

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====3. Microscopic Examination====

*Hematuria

**''Manjjisthameha''

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Vivid description of ''manjjisthameha, raktameha, siktameha'' clearly indicate evolved observation skills of physicians. Analyzing the details of urine characteristics the scientific approach of [[Ayurveda]] is established. It is really appreciable that a disease can be classified and identified at every stage merely by urinalysis.

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==== Importance of Barley ====

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=== Importance of Barley ===

Barley should constitute the principal ingredient of food of the patient suffering from ''prameha''. The patient suffering from ''kaphaja prameha'' should take eatable prepared of barley mixed with honey.

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Various eatables prepared from the barley or bamboo seed or wheat previously eaten by asses, horses, cows, swans and deer and collected from their dung should be given to the patient suffering from ''prameha''.

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===== Importance of Barley in Diabetes =====

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==== Importance of Barley in Diabetes ====

Charak gives much emphasis on the use of barley (''yava'') in ''prameha''. Barley has hypoglycemic effect along with its potent lipid reducing effect and it is best ''ruksha'' diet that helps in depleting excess of fat while providing essential energy required for maintaining daily life. Dutch researchers used a crossover study with 10 healthy men to compare the effects of cooked barley kernels and refined wheat bread on blood sugar control. The men ate one or the other of these grains at dinner, then were given a high glycemic index breakfast (50g of glucose) the next morning for breakfast. When they had eaten the barley dinner, the men had 30% better insulin sensitivity the next morning after breakfast<ref>American Journal of Clinical Nutrition. January 2010; 91(1):90-7. Epub 2009 Nov 4</ref>.

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Barley intake significantly reduced serum cholesterol and visceral fat, both accepted markers of cardiovascular risk<ref>Plant Foods and Human Nutrition. March 2008; 63(1):21-5. Epub 2007 Dec 12</ref>. 25 adults with mildly high cholesterol were fed whole grain foods containing 0g, 3g or 6g of barley beta-glucan per day for five weeks, with blood samples taken twice weekly. Total cholesterol and LDL (“bad”) cholesterol significantly decreased with the addition of barley to the diet<ref>American Journal of Clinical Nutrition. November 2004; 80(5):1185-93.</ref>. Thus use of barley is very beneficial in diabetes.

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==== Contemporary management of ''prameha'' ====

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=== Contemporary management of ''prameha'' ===

'''Disease management''': 1. Wholesome diet 2. Exercise 3. Pacification of ''dosha''

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'''Important medicines''': 1. ''Shilajatu'' 2. ''Asana'' 3. ''Jambu'' 4. ''Yashada'' 5. ''Kumbha'' 6. ''Haridra'' 7. ''Amalaki'' 8. ''Tikta rasa''

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==== Pacification Treatment ====

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=== Pacification Treatment ===

{| class="wikitable"

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|}

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==== Researches on effect of herbs on diabetes ====

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=== Researches on effect of herbs on diabetes ===

Research has shown that many of the herbs described have antioxidant properties, an anti-diabetic effect, and a beneficial effect on the lipid profile. Descriptions of few of them are as follows:

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===== ''Curcuma neilgherrensis'' =====

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==== ''Curcuma neilgherrensis'' ====

Curcuma neilgherrensis Wight, in the dose of 400mg/kg, showed a mild reduction in blood glucose level at 3rd and 5th hour in normoglycemic mice; however, the observed decrease in blood glucose level was found to be statistically insignificant. Even though the drug failed to cease the hypoglycemia in the first hour after the glucose overload, it attenuated the same in later hours, but not in a significant manner.

The study reveals that C. neilgherrensis is having mild hypoglycemic potential and moderate antihyperglycemic effect. A clinical trial investigating the effects of combining C. neilgherrensis treatment with conventional therapy compared to the C. neilgherrensis alone showed that C. neilgherrensis significantly reduces the level of fasting blood sugar, postprandial blood glucose level, glycosylated hemoglobin, serum cholesterol, LDL and urine sugar<ref>Mahalakshmipuram PS, Ramachandran A, Nishteswar K, Chandola HM. A preface study on exploring the pharmacodynamics of Curcuma neilgherrensis Wight- A folklore medicine. Indian J of Traditional Knowl 2013; 12(2): 288-294</ref><ref>M Prasad Shyam, Chandola HM, Ravishankar. A clinico- experimental study to evaluate the therapeutic efficacy of Curcuma neilgherrensis Weight in the management of MadhuMeha (Type 2 Diabete Mellitus). PhD thesis. Institute of Post Graduate Teaching and Resaerch in [[Ayurveda]], Gujarat [[Ayurveda]] University, Jamnagar, India, 2011</ref>

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===== ''Gymnema Sylvester'' =====

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==== ''Gymnema Sylvester'' ====

''Meshashringi'' (Gymnema Sylvester (Retz.) R.Br.; Gurmar) targets several of the etiological factors associated with diabetes, including chronic inflammation, obesity and pancreatic B-cell function<ref>Leach MJ. Gymnema sylvestre for diabetes mellitus: A systematic review. J Alter Complement Med 2007; 13: 977-983</ref>. In a study on rats with streptozotocin – induced diabetes, G. sylvestre treatment resulted in 30% increase in total pancreatic weight and a significant increase in the number of islets and number of B-cells per islet. The regenerated pancreatic tissue resulted in complete control of fasting blood glucose levels within 20-60 days. Normal rats in this study did not experience an increase in insulin release when treated with G. Sylvestre extract, indicating that this herb has a normalizing effect on the blood glucose and may, therefore, be safer than conventional oral hypoglycemic agents such as sulphonylureas<ref>Shanmugasundaram ER, Gopinath KL, Radha Shanmugasundaram K, Rajendran VM. Possible regeneration of the islets of Langerhans in streptozocin- diabetic rats given Gymnema sylvestre leaf extracts. J Ethnnopharmacol 1990; 30: 265-279</ref>. Several clinical studies have demonstrated that G. Sylvestre effective in decreasing blood glucose levels in patients with type 1 and type 2 diabetes<ref>Leach MJ. Gymnema sylvestre for diabetes mellitus: A systematic review. J Alter Complement Med 2007; 13: 977-983</ref><ref>Baskaran K, Kizar Ahamath B, Radha Shanmugasundaram K, Shanmugasundaram ER.Antidiabetic effect of a leaf extract from Gymnema sylvestre in non-insulin – dependent diabetes mellitus patients. J Ethnnopharmacol 1990; 30: 295-300</ref><ref>Shanmugasundaram ER, Rajeswari G, Baskaran K, et al. Use of Gymnema sylvestre leaf extract in the control of blood glucose in in insulin- dependent diabetes mellitus. J Ethnnopharmacol 1990; 30: 281-294</ref>. Two (2) clinical trials investigated the effects of combining G. Sylvestre treatment with conventional therapy compared to the conventional therapy alone. In 22 patients with type 2 diabetes, treatment with G. Sylvestre extract significantly reduced blood glucose, glycosylated hemoglobin, and glycosylated plasma proteins, whereas, with conventional treatment alone (i.e. glibenclamide or tolbutamide), these values increased or remain the same. The patients receiving the herbal extract were able to decrease the dosage of their conventional drug, and five patients were able to discontinue the drug entirely and maintain their glucose level using only G. sylvestre<ref>Baskaran K, Kizar Ahamath B, Radha Shanmugasundaram K, Shanmugasundaram ER.Antidiabetic effect of a leaf extract from Gymnema sylvestre in non-insulin – dependent diabetes mellitus patients. J Ethnnopharmacol 1990; 30: 295-300.</ref>. In 27 patients with type 1 diabetes, G. Sylvestre treatment reduced fasting blood glucose, glycosylated hemoglobin, and glycosylated plasma protein levels<ref>Shanmugasundaram ER, Rajeswari G, Baskaran K, et al. Use of Gymnema sylvestre leaf extract in the control of blood glucose in in insulin- dependent diabetes mellitus. J Ethnnopharmacol 1990; 30: 281-294</ref>.

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===== ''Tinospora cordifolia'' =====

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==== ''Tinospora cordifolia'' ====

Aqueous and alcoholic extracts of ''guduchi'' (Tinospora cordifolia (Willd.) Hook. f. & Thomson) reduced glucose levels in rats with alloxan- induced diabetes. The antihyperglycemic effect may be due to pancreatic islet free- radical- scavenging activity. This herb also lowers the levels of tissue and serum cholesterol, phospholipids, and free fatty acids<ref>Stanely P, Prince M, Menon VP. Hypoglycaemic and other related actions of Tinospora cordifolia roots in alloxan induced diabetic rats. J Ethnnopharmacol 2000; 70: 9-15</ref><ref>Stanely Mainzen Prince P, Menon VP. Antioxidant action of Tinospora cordifolia roots in alloxan induced diabetic rats. J Ethnnopharmacol 1999; 64: 53-57</ref>

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===== ''Swertia chirayita'' =====

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==== ''Swertia chirayita'' ====

''Kiratatikta'' (Swertia chirata (Roxb.) Buch.-Hum; also known as swertia chirayita (Roxb.) H. Karst.) is a potent anti-diabetic herb. In a pilot study, ''swertia chirata'' produced a significant decrease in fasting and postprandial blood glucose level in patients with diabetes. It contains swechirin, a xanthone found in the swertia species of plants. Xanthones are a unique class of biologically active compounds with antioxidant properties. Research has shown swerchirin produces a significant decrease in blood glucose levels in rat models<ref>Bajpai M, Asthana RK, Sharma NK, et al. Hypoglycemic effect of swerchirin from the hexane fraction of Swertia chirayita. Plant Med 1991; 57: 102-104</ref><ref>Sekar BC, Mukherjee B, Chakravarti RB, Mukherjee SK. Effect of different fractions of Swertia chirayita on the blood sugar level of albino rats. J Ethnnopharmacol 1987; 21: 175-181</ref><ref>Chandrasekar B, Bajpai MB, Mukherjee SK.Hypoglycemic activity of Swertia chirayita (Roxb ex Flem) Karst. Indian J Exp Bio. 1990; 28: 616-618</ref><ref>Saxena AM, Bajpai MB, Murthy PS, Mukherjee SK. Swerchirin induced blood sugar lowering of streptozotocin treated hypoglycemic rats. Indian J Exp Biol 1993; 31:178-181</ref>. A 60% decrease in blood glucose induced by swerchirin was accompanied by a marked depletion in B- granules and insulin in the pancreatic islets. Glucose uptake and glycogen synthesis in the diaphragm muscle was significantly enhanced in vitro by the serum of swerchirin- treated rats. It was therefore concluded that swerchirin lowers blood glucose levels by stimulating insulin release from the islets of Langerhans<ref>Saxena AM, Bajpai MB, Murthy PS, Mukherjee SK.Mechanism of blood sugar lowering by a swerchirin- containing hexane fraction (SWI) of Swertia chirayita. Indian J Exp Biol 1993; 31:178-181</ref>.

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===== ''Enicostema littorale'' =====

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==== ''Enicostema littorale'' ====

''Mamejjaka'' (Enicostema littorale Blume) is used as a single herb and also as a part of an anti-diabetic mixture<ref>Shanmugasundaram ER, Gopinath KL, Radha Shanmugasundaram K, Rajendran VM. Possible regeneration of the islets of Langerhans in streptozocin- diabetic rats given Gymnema sylvestre leaf extracts. J Ethnnopharmacol 1990; 30: 265-279</ref>. In a clinical study on patients with type 2 diabetes, E. littorale reduced blood glucose and prevented the progression of diabetic complications. There was a significant improvement in the lipid profile, blood pressure, and kidney function<ref>Upadhyay UM, Goyal RK. Efficacy of Enicostemma littorale in type-2 diabetic patients. Phytother Res 2004; 18:233-235</ref>. It significantly reduced blood glucose and lipid peroxides in rats with alloxan- induced diabetes, and increased superoxide dismutase, catalase, and glutathione peroxidase<ref>Prince PS, Srinivasan M. Enicostemma littorale Blume aqueous extract improves the antioxidant status in alloxan induced diabetic rat tissues. Acta Pol Pharm 2005; 62: 363-367</ref>. In studies on rats with streptozotocin- induced type 1 diabetes, E. littorale significantly reduced glucose, cholesterol, and triglyceride levels<ref>Vishwakarma SL, Sonawane RD, Rajani M, Goyal RK. Evaluation of effect of aqueous extract of Enicostemma littorale in streptozotocin –induced type-1 diabetic rats. Indian J Exp Biol 2010; 48:26-30</ref>, and ameliorated diabetic nephropathy. Serum creatinine and urea were significantly decreased and glomerular function improved<ref>Sonawane RD, Vishwakarma SL, Lakshmi S, et al. Amelirotion of STZ-induced type 1 diabetic nephropathy by aqueous extract of Enicostemma littorale Blume and swertiamarin in rats. Mol Cell Biochem 2010; 340:1-6</ref>. In rats fed a hypercholesterolemic diet, E. littorale decreased serum cholesterol, triglycerides, LDL, VLDL, liver, and kidney cholesterol levels, and lipid peroxidation levels. There was an increase in HDL and an increase in reduced glutathione levels<ref>Vasu VT, Modi H, Thaikoottathil JV,Gupta S. Hypolipidaemic and antioxidant effect of Enicostemma littorale Blume aqueous extract in cholesterol fed rats. J Ethnnopharmacol 2005; 101: 277-282.</ref>.

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* [[Prameha Nidana]]

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=== References ===

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== References ==

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