MADHU MEHAM(DM)

Introduction:

Diabetes mellitus (DM) is described in Ayurveda as madhumeha kshaudrameha, which literally means “excessive urine with sweet taste like honey,” or dhatupak janya vikriti , which means a disease caused by a defective metabolism leading to derangement in body tissue (seven dhatus ) transformation process. Historically, Ayurvedic texts have described 20 types of urinary disorders ( pramehas ) based on the predominant dosas (10 kaphaja , 6 pittaja , and 4 vataja urinary disorders) and physical characteristics of the urine (e.g., volume, color, odor, taste, sediments, solid particles, presence of seminal fluid, and mucus).

The urine is discharged in excessive quantities and is generally turbid. DM is one of these pramehas that may occur in any of the three ( vata, kapha, or pitta) body constitutions.


Medicinal plants :
Gymnema sylvestere R.Br. (Asclepiadacea):
Gymnema sylvestere (GS), a plant popularly known as gurmara (meaning sugar destroyer), is derived from a large woody climber that grows in the hills of Behar, Orissa Madhya Pradesh, and the Deccan Peninsula of India. It has been used I n Ayurveda to treat DM for 2000 years. The whole plant, seeds, leaves, and roots are taken as a powder or as a decoction in combination with other herbs. The alcohol extract of GS (known as GS4) contains gymnemic acids (a chemically complex mixture of saponins and gurmarin, a polypeptide of 35 amino acids).


Momordica charantia (Cucurbitaceae):

Momordica charantia (MC), a climbing vine, has been widely used in Ayurveda as an antidiabetic, abortificient (whole plant), antirheumatic, and carminative (fruits) agent. It is believed to cure deranged kapha and pitta. The gourd produced by the plant, known as karela in India (bitter gourd), is traditionally eaten as a fried vegetable or as a fresh juice.

Trigonella foenum-graecum Linn. (Leguminose Family):

Trigonella foenum-graecum (TF), known as methika in Hindi and Sanskrit and methi in Tamil, is an erect aromatic herb, 30 to 50 cm tall. It is widely cultivated in many parts of India. Its seeds are used in cooking as well as treating diabetes, whereas its leaves are eaten as a vegetable. The endosperm of the seed is rich in galactomannan (14 to 15%), young seeds contain carbohydrates and sugar, and mature seeds yield amino acids and fatty acids on hydrolysis. TF seeds also contain carotene, vitamins, and saponins. It is used in Ayurveda as a diuretic, tonic, carminative, astringent, and emoliant. It is also used to treat diabetes, colic, dysentery, diarrhea, coughing, dropsy, rheumatism, rickets, and anemia and to
subdue deranged vata.

Coccinia indica Wight (C. grandis, C. cordifolia Cogn):
Coccinia indica (CI), known as Bimbi or Kundura in India, is a climber with branched leaves. CI is found wild in hedges and waste places in different parts of India. Fresh juice from leaves, stem, and roots is used to treat diabetes, glycosuria, enlarged glands, and skin diseases. The leaves and stem are also used as an antispasmodic and expectorant agent in bronchitis.

Pterocarpus marsupium (Papilionoidae):
Pterocarpus marsupium (PM), also known as pitsara, bijasal, pitasal, or red sandalwood in India, is a moderate to large deciduous tree up to 30 m in height. Cold, aqueous extract of the wood is used to treat diabetes. The paste of the leaves is used to treat abscesses and skin diseases, and the extract of the bark is used as an astringent for gum and is also useful in diarrhea.

Ficus bengalonsis L. (Moraceae):
Ficus bengalonsis (FB), also known as Vata, bor, bot, or Banyan tree, is a large evergreen tree that sends down aerial roots for lateral growth. It is effective in deranged kapha and pitta. Infusion of the bark is used to treat diabetes. The white milky juice of the plant is helpful when applied on sores, ulcers, and cracked soles of the feet; it is also helpful for inflammation and rheumatism. FB leaves contain quercetin-3-galactoside, rutin, and beta-sitosterol, and its bark contains leucoanthocyanin and two flavonoids.

Ayush-82:
Ayush-82 is a mixture of four herbs: the seeds of Mangifera indica,

Syzygium cuminii,

Momordica charantia,

leaves of Gymnema sylvestre.
One hundred type 2 DM patients (ages 40 to 70; 52% male) were given 5 g of Ayush-82 3 times a day for 6 weeks in conjunction with Shuddha Shilajit. Shuddha shilajit is a mineral preparation of black bitumen purified by triphala water. (Triphala is a mixture of Terminalia chebula, terminalia bellerica, and Emblica officinalis.) Shilajit was given 500 mg twice a day for 2 weeks.

Oral hypoglycemic drugs were withdrawn after 2 weeks of treatment with Ayush-82. All patients were advised to consume a a daily 1200-calorie diet.

Although the average blood sugar, FBS, and PPBS levels reduced significantly (p <>

M-93:
M-93 is a mixture of four herbs: Aegle marmelos (bilva),

Azadirachta indica,

Ocimum sanctum (tulsai),

and Piper longum (kalimircha).

Thirty type 2 DM patients (ages 41to 60) were treated with M-93, 1 g daily for 3 months.112 Patients with FBS >300 mg/day, chronic renal failure, diabetic neuropathy, and diabetic ketoacidosis were excluded from the study. The authors stated that M-93 showed a positive response after 30 days of therapy and no adverse effect was observed. The results need to be confirmed.

CONSTIPATIN

Constipation is the infrequent and difficult passage of stools.
Constipation is a common, often frustrating, anddifficult to manage problem in the elderly. Approximately 25% of all Americans over 65years old experience constipation.
Ayurvedic therapies are very effective treatments forconstipation.

In Ayurveda, constipation is called vibandha. The word vibandhais derived from “vi”prefixed to “bandh,” meaning that which is especially bound (in the intestine) or obstructed. Its synonyms are purishasanga, purishanaha(both meaning the accumulation of feces), vishtambha(obstruction),kricchravitka, alpavitka(both meaning the passing of a small quantity of stool), and anaha (bloated abdomen due to accumulation of stools). Constipation is derived from Latin, “con” meaning together and “stipare,” meaning to cram or pack.

CAUSES:

The following are some of the most common causes of constipation, according to conventionalmedicine:

1. Improper diet — The most common cause of constipation may be a diet high in
animal fats and refined sugar but low in fiber found in vegetables, fruits, and
whole grains.

2. Not enough liquids — Liquids like water and juice add fluid to the colon and
bulk to stools, making bowel movements softer and easier to pass. People who
have problems with constipation should drink enough of these liquids every day,
about eight 8-oz glasses. Other liquids that contain caffeine (e.g., coffee and cola)
seem to have a dehydrating effect.

3. Lack of exercise — Lack of exercise can lead to constipation, although doctors do not know precisely why. For example, constipation often occurs after an accident or during an illness when one must take bed rest and cannot exercise.

4. Changes in life or routine — During pregnancy, women may be constipated
because of hormonal changes or because the heavy uterus compresses the intestine.
Aging may also affect bowel regularity, because a slower metabolism results in less intestinal activity and muscle tone.
5. Ignoring the urge to have a bowel movement — People who ignore the urge to
have a bowel movement may eventually stop feeling the urge, which can lead to
constipation.

6. Laxative abuse — People who habitually take laxatives become dependent upon
them and may require increasing dosages until the intestine becomes insensitive
and fails to work properly.

7. Travel — People often experience constipation when traveling long distances,
which may relate to changes in lifestyle, schedule, diet, and drinking water.

8. Fissures and hemorrhoids — Painful conditions of the anus can produce a spasm
of the anal sphincter muscle, which can delay a bowel movement.

9. Specific diseases — Diseases that cause constipation include neurological disorders, metabolic and endocrine disorders, and systemic conditions that affect organ systems. These disorders can slow the movement of stool through the colon,
rectum, or anus.

10. Mechanical compression — Scarring, inflammation around diverticula, tumors,
and cancer can produce mechanical compression of the intestine and result in
constipation.

11. Irritable bowel syndrome (IBS) — Also known as spastic colon, IBS is one of the most common causes of constipation. Some people develop spasms of the colon that delay the speed with which the contents of the intestine move through the digestive tract, leading to constipation.

12. Nerve damage — Injuries to the spinal cord and tumors pressing on the spinal
cord can produce constipation by affecting the nerves that lead to the intestine.

13. Medications — Many medications can cause constipation. These include pain
medications (especially narcotics), antacids containing aluminum, antispasmodic
drugs, antidepressant drugs, tranquilizers, iron supplements, anticonvulsants
for epilepsy, antiparkinsonism drugs, and antihypertensive calcium channel blockers.

14. Problems with colon and rectum — The peristaltic activity of the intestine may
be ineffective and result in colonic inertia or outlet obstruction. Intestinal obstruction, scar tissue (adhesions), diverticulosis, tumors, colorectal stricture, Hirschsprung's disease, or cancer can compress, squeeze, or narrow the intestine and rectum and cause constipation.

Physical examination:

The important aspects are abdominal palpation and rectal examination. Palpation may reveal the craggy mass of a neoplasm, faecal retention (especially in the thin patient) or a tender spastic colon.

The perianal region should be examined for localised disease. The patient should be asked to bear down to demonstrate perianal descent, haemorrhoids or mucosal prolapse. Perianal sensation and the anal reflex should be tested. Digital rectal examination is mandatory, and may reveal a rectal tumour and faecal impaction, as well as testing for rectal size and tone. If there is a history from infancy, a normal or narrow rectum suggests congenital megacolon (Hirschsprung's disease) but, if dilated, acquired megacolon.


The rectal examination:

The most important first step is to do the examination.
Method
Explain to the patient what will happen.

After inspection with the patient in the left lateral position and with knees drawn up, a lubricated gloved index finger is placed over the anus.
Ask the patient to concentrate on slow deep breathing. With gentle backwards pressure the finger is then inserted slowly into the anal canal and then into the rectum (it helps patient comfort if they push down or squeeze to accommodate the finger). Rotate the finger anteriorly to feel the prostate in males and the cervix in females. The finger will reach to about 7-8 cm with gentle thrusting into the perineum. Gently withdraw the finger and examine the whole circumference of the rectum by sweeping
the finger from posterior on both sides.

Points to note:

any pain,

e.g. fissure, proctitis, excoriation from diarrhoea (a rectal examination will not be possible in the presence of a fissure)
induration
from a chronic fissure or fistula in the anal canal the sphincter tone the nature of the faeces (? impaction) the rectal wall carcinoma is usually indurated, elevated and ulcerated a villous adenoma has a soft velvety feel

posteriorly— the sacrum and coccyx

laterally—the side walls of the pelvis

anteriorly_ cervix and pouch of Douglas in the female
prostate and rectovesical pouch in the male

Single drugs for constipation:

Aloe vera (Aloe):

Barbaloin or aloin derived from the inner sheath cells of Aloe leaves is a laxative. In vitro studies have revealed the inhibitory effect on sodium and potassium pump and chloride channels at the colonic membrane. Aloe anthroquinones were reported to enhance large-intestinal propulsion and water secretion in rats and mice. Randomized controlled trials have documented its potency as a cathartic in chronically constipated adults.

Plantago ovata (Psyllium):

The ground seeds or husks of psyllium are used in dietary supplements for increased fiber, cholesterol reduction, and laxative activity. In a randomized double-blind placebo study, psyllium was found to be effective for stool frequency and consistency in patients with chronic constipation. In an open study, conducted in patients having manifestations of irritable bowel syndrome with constipation, psyllium showed good results.


Cassia senna (Senna):

Senna leaf contains 1.5 to 3% hydroxyanthracene glycosides, mainly sennosides A and B, which are rheindianthrones, and smaller amounts of sennosides C and D, which are rheinaloe- emodin-heterodianthrones.
Modern human studies have investigated the use of senna for the following:
1. Treating severe constipation
2. Treating chronic constipation in long-stay elderly patients
3. Managing morphine-induced constipation
4. Improving colonoscopy preparation with lavage
5. Managing constipation in the immediate postpartum period
6. Managing postoperative constipation in anorectal surgery
7. Treating disorders characterized by slow intestinal transit time or constipation
8. Using as a laxative for terminal cancer patients treated with opiates


Rheum officinale (Rhubarb):

The active chemical constituents of rhubarb are anthraquinone glycosides, aloe-emodin, and physcion. Experimental studies have revealed that the laxative effect is due to the inhibition of water and electrolyte reabsorption in the large colon and to a stimulant effect on intestinal motility. Clinically, it is used to soften stool in anal fissures and hemorrhoids and is used postoperatively for anorectal surgeries. It is also effective as a cathartic and therefore used for colonoscopy preparations.


Prunus persica (Almond):

The leaf decoction of almond is used traditionally as anthelmintic and laxative. An experimental study has revealed that the aqueous extract of leaves exhibits cholinomimetic activity, which may result in its laxative effect.


Terminalia chebula (Chebulic Myrobalan):

T. chebula is a commonly advocated agent in Ayurveda for improving gastrointestinal motility. Charles Foster rats were administered T. chebula (100 mg/kg/day for 15 days orally), metoclopramide, or atropine, which established prokinetic and antikinetic activities, respectively. T. chebula was found to increase the percent of gastric emptying. The enhancement of gastric emptying was comparable with that produced by metoclopramide. This indicates that T. chebula can be a useful alternative to the prokinetic drugs available today.


Cassia fistula (Indian Laburnum):

The seeds and dried pulp in the pod of this fruit act as a purgative. The flowers soothe the eyes and the pods suppress acidity, making it useful in treating constipation associated with burning pain in the stomach (pitta type). The water extract is also used for treating constipation in pregnant women, children, and elderly persons. The pulp, prepared from its fruits, is a laxative used in the treatment of constipation.


Mallotus philippinensis (Indian Kamala):

The kampillaka plant is excellent in treating constipation associated with worm infestation as it first kills worms and then, due to its purging effect, gets rid of them. A powder made of kampillaka is especially useful. Sometimes worm infestation causes itching of the skin. At such times, taking kampillaka powder at night in the dose of only 500 mg to 1 g is useful.


Ricinus communis (Castor):
Castor seed oil is a harmless laxative in small doses. In large doses it is and can be safely used throughout the year.

SAPTAMRITHA LOHAM

SAPTAMRITHA LOHAM:
A well known ayurvedic formula to every ayur physician which contains
1) Yashtimadhu (20%)
2) Loha bhasmam (20%)
3)Triphala churna(60%)
TRIPHALA CHURNA:
This is one of the great and dynamic formula which contains at about 60% of triphala churna which is made up of with the haritaki, vibhitaki and amalaki. All these three drugs contains
Chebulanic acid
Tannins
Chebulagic acid
Gallic acid
All these acids increases the concentration of the intestinal juices which inturn increases the motility of the intestines (it is laxative effect). By this property of the drug.
This is useful in
· Obstructive jaundice
· Constipation
· To attract doshas from shakas to koshtas
· For the normal maintanances of the peristalsis
YASHTIMADHU:
It has Madhura rasa
Guru,snigdha gunas
Sheeta virya
Madhura vipaka
Due to above property it acts on vata and pitta .
The best vata hara drug,
It is mentioned more times in the 50 kashaya gana dravyas in charaka samhita sutrastana, it indicates its importance.
Steroidal effect of this drug is already proved.
Hence it is useful in
Peripheral neuropathy
Neuropathy due to vascular causes
Diabetic neuropathy especially in vataja pramehas
DOC in vata pitta prakriti patients
Adhogata amla pitta
VP dominant arshas/rakt arshas
LOHA BHASMAM:
It has Ushna,Teekshna gunas,
Ushna virya,
Madhura vipaka.
DOC in
· Paandu
· For Rasa, Rakta dhatvagni pradeepaka
· For Deepana,Paachana
· For Aama hara

DHATRI LOHAM

It is frequently used in amlapitta and parinama sula, consists of
two herbs (amalakiand madhuyasthi) and
one mineral (iron).
This preparation has been found to alleviate the common clinical complaints like epigastric pain, acid eructation, epigastric and retrosternalburning in the majority of patients with amlapitta along with an appreciable reduction in free and total acidity.
Fruits of amalaki, apart from having proven efficacy in experimental study, relieved the symptoms significantly in patients with amlapitta having hyperchlorhydria when given in doses of 3 g three times/day for 7 days.

HYPERACIDITY(AMLA PITTAM)

Hyperacidity (Amlapitta):
Line of treatment:
In Ayurveda, the following procedures are used in treating hyperacidity:

1. Emesis therapy (vamana) with the water extracts of snake guard (Trichosanthesdioica) and neem (Azadirachta indica) followed by purgation (virecana) with powders of trivrit (Operculina turpethum) or any one of the following: avipattikara curna,
amalakyadi curna,
abhayarishta,
triphala curna.
2. If the burning pain is intensive, the patient is advised to apply whole body
massage with candana taila or lakshadi taila.

3. In conditions of regurgitation through the mouth, purgation is advised.


Lifestyle Changes:

Three factors are essential for good and balanced digestion. First, food must be fresh andgrown locally, or at least seasonally, and prepared with a caring and loving attitude.

Second, food must be eaten with attention and awareness. Our sense of taste both prepares and ignites the digestive process before food ever reaches the stomach, as does our sense of composure and calm. Being distracted with books, driving, computers, and phones during a meal negates any hope of a balanced digestive process.

Third, eating is best done during pitta period, between 10 A.M. and 2 P.M.; this is when the enzymes are the stronge stand digestion will be the most effective. Eating at other times will eventually compromise the body’s ability to digest and assimilate nutrition and give energy over a long period.

Home Remedies for Hyperacidity:

1. Take tender coconut (Cocus nucifera) water. A dose of 100 to 500 ml should be
taken twice/day.
2. Take the powdered fruit rind of emblic myrobalan (Emblica officinalis). A dose of 3 to 6 g should be taken with 100 to 250 ml milk twice/day.

3. Mix a gruel of rice corn, raw sugar, and honey in equal quantity. A dose of 100
to 200 g should be taken twice/day.

4. Take powdered fruit rind of chebulic myrobalan (Terminalia chebula) and whole plant of thistles (Eclipta alba) in equal quantity. A dose of 3 to 6 g should be taken with 12 g of jaggery and warm water twice/day.

5. Take dried rhizome of turmeric (Curcuma longa), leaf of snakeguard (Trichosanthesdioica), and fruit rind of emblic myrobalan (Emblica offcinalis) in equal parts and make the powder. A dose of 3 to 6 g should be taken with the fresh juice of ginger and 30 drops of papaya latex twice/day.

6. Prepare a decoction from the equal parts of stem of tinospora (Tinospora cordifolia),fruit of neem, leaf of snakeguard, and triphala. A dose of 14 to 28 ml should be taken twice/day.

7. Prepare a decoction of equal parts of dried ginger, fruit of coriander, and leaf of
Snake guard. A dose of 14 to 28 ml should be taken twice/day.

8. Prepare a decoction of equal parts of leaves of snake guard and vasaka, dried ginger, stem of tinospora, and rhizome of katuki (Picrorhiza curroa). A dose of 14 to 28 ml should be taken with 4 to 6 g honey twice/day.

9. Prepare mahasurdarshan churna, containing triphala (Emblica officinalis, Terminalia belerica, Terminalia chebula), guduci (Tinospora cordifolia), katuka (Picrorrhiza kurroa), fumaria (Fumaria officinalis), lime juice, etc. A dose of 1/2 tsp three times/day after meals is recommended.

10. Prepare avipattikara churna, containing ginger, black pepper, triphala, nut grass (Cyperus rotundus), embelia fruits (Embelia ribes), cardamom (Elettaria cardamomum), clove (Syzygium aromaticum), cinnamon (Cinnamomum cassia), and sugar. This is the medicine of choice in treating hyperacidity. A dose of 1 tsp before meals three times/day with lemon juice is recommended.

11. Use aloe vera (Aloe littoralis). Prepare 1 tbsp of fresh gel from the plant and take three times/day.

12. Drink coriander (Coriandrum sativum) and cumin (Cuminum cyminum) tea.

13. Take 1 tsp of psyllium (Plantago ovata) 1 h after meals with 8 oz of warm water.

14. Prepare a milk decoction of 1 tsp emblica myrobalan (Emblica officinalis), 1 tsp rawsugar, 1 cup of milk, and 1 cup of water. Boil to 1 cup. Drink as a tea with mealsor anytime three times/day.

15. Prepare a decoction of fenugreek (Trigonella foenum-graecum), honey, 1/2 tsp ofpowder with 1/2 tsp of turmeric on an empty stomach with warm water or warm
milk.

16. Prepare a licorice (Glycyrrhiza glabra) ghee. Make the decoction with 1 tsp of licoricein 2 cups of water. Boil to 1 cup. Add 1 cup ghee and 1 cup water. Boil off water.Take 1/2 tsp three times/day on an empty stomach with hot water. This ghee canbe used in cooking.

Herbs

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