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Introduction

Prameha (Diabetes mellitus) which has been a global problem is well described in the ancient Indian classics1. Prameha is Kapha pradhan tridoshaja vyadhi characterized by frequent, turbid & excessive urination.
Depending upon Mutra Vikara (changes in urine) and predominancy of Doshas, Prameha is classified into2

1) Kaphaja prameha -10 types

2) Pittaja Prameha - 6 types

3) Vataja prameha-4 types

Depending upon Deha Prakruti (Body Constitution) its classified into
 1)  Sthula Pramehi

 2)  Krusha Pramehi

Depending upon Hetu

1)  Sahaja Prameha

2)  Kulaja Prameha

3)  Apathyaja Prameha2

Clinical features of Prameha corelates with Diabetes mellitus (DM).  Diabetes Mellitus is a complex metabolic syndrom characterized by involvement of multiple body systems. It is caused due to absolute or relative insulin deficiency. The characteristic features of DM have close resemblance with different varieties of a disease named as Prameha in all Ayurveda texts. Acharya Charaka has mentioned Prameha under Maharoga (Major disease) as important dhatus (body tissues) are vitiated. The disease in which formation of urine and frequency of urination is more is called as Prameha. All doshas (vitiating factors) and dushyas (tissues) get invariably vitiated in all types of Prameha. The line of treatment for Prameha is dependent on various factors such as Prakriti of the patient, dosha dominance in disease, dooshya vitiation, obstruction in Srotus (channels), Manasika prakruti (mental status), ahara (food habits), vihara (life style) and hereditary factors etc. The Ayurvedic concept of management of Prameha emphasizes on dietary and lifestyle modifications for its prophylaxis and treatment3. The Incidence of diabetes are rising, it is estimated that in the year 2000, 171 million people had diabetes & this is expected to double by 2030. Diabetes is a major burden upon health care facilities in all countries4. DM is a metabolic disease involving inappropriately elevated blood glucose levels6. The diagnostic criteria for DM as recommended by WHO in 2000 are tests urine for glucose, fasting blood sugar, random plasma glucose, HbA1c, Oral glucose tolerance test4. The first line of therapy involves advice about dietary and life style modifications along with the Pramehahara dravyas (anti diabetic drugs) described in ancient Indian classics in different forms & formulations. Depending upon Nidana(cause), lakshana (Signs and symptoms), involvement of doshas, rogi bala (strength of patient), roga bala (strength of disease), prakruti etc one has to choose/plan the chikitsa (treatment)

MATERIALS & METHODS.

A 30 years old, Married female patient of vata pittaja prakruti having normal obstetrical history of G3P3L3A0 with normal menstrual history approached OPD with Chief complaints of burning micturition, yellowish urine, increased frequency of urination at night, excessive urination and associated complaint of loss of strength since 1 month, detailed history taking revealed that the patient is following  poor life style & dietery choices

PERSONAL HISTORY

Diet -Non Vegetarian (excess spicy) Madhura- Snigdha-dugdhahara ati sevana. (Excess intake of sweet, unctuous food, milk and milk products)
Appetite - Excess.

Sleep – Divaswapna (day sleeping), Atinidra (Excess sleeping), sound sleep
Bowel - Regular (once a day).

Micturation – Frequency - > 12 times/day.

Excess Quantity of urine.

Yellowish discolouration.

Burning micturition.

ASSESSMENT CRITERIA.

Subjective criteria - (quantity of urine) (in litres)

1) showing gradings of Prabhuta Mootrata (excess quantity of urine)
  0 - 1-5 to 2.0

  1 - 2.0 to 2.5

  2 - 2.5 to 3.0

  3 - 3.0 liters onwards

 2) Showing gradings of Haridra varna Mootrata (Yellowish discolouration of Urine)

  0 - No yellowishness

  1 - mild yellow

  2 - Moderate yellow.

  3 - Termeric dark yellow colour

3) Showing gradings of mootradaha (Burning micturation)

  0 - no mootradaha

  1 - mild

  2 – moderate

  3 – severe

4) Showing gradings of dourbalya (Lack of strength to work).

 0 - can do routine work without difficulty. 

 1 - can do moderate work with difficulty.

 2 - can do mild work with difficulty.

 3 - cannot do routine work.

 5) Showing gradings of Frequency of urine.

 0 - 3-6 times/day, 0-1/night.

1 - 6-9 times/day, 0-2 times/night.

2 - 9-12 times/day, 2-4 times/ night.

3 - >12 times/day, > 4 times / night.

TREATMENT  
1) Chandraprabha vati (CPV ) 500 mg 8

 Dosage 1-1-1 before food with warm water

2) Pramehagna churna formulation

Haritaki Churna (Terminalia chebula) 7 - 1p.                              +
Bibhitak Churna (Terminalia bellirica) 7 - 1p                               +                                                                                         

Amalaki Churna (Emblica officinalis )7 - 2p                                  +
Haridra Churna (Curcuma longa) 7 - 2p 

Dosage - 1 Karsha (12 gms) 3 times before breakfast, lunch & dinner with

warm water

3)  Avipattikar Churna 8

Dosage - 1 karsha 3 times after breakfast, lunch & dinner for a month.

Follow up during Treatment

 → Starting from the day of the treatment the follow up has been done every month after 30 days

 → Total duration of treatment was 6 months.

 → After a month  Avipattikar Churna has stoped. Based on assessment of subjective Citeria

 → CPV &  Pramehagna  Churna has been continued for next 2 months with the same dosage

 → On 4th month based on assessment of subjective & objective criteria dosage has been made from TDS to BD dose & the   same has been continued  upto 6 months.

Discussion

1) Based on hetus such as excessive spicy, unctuous, oily, sweet foods, day sleeping, lack of excercise, sedentary life style caused Prameha. It was due to Apathya (Not following dietary regimen). Based on hetu and mootra lakshanas it is diagnosed as "Apathya nimittaja Pittaja Prameha"
2)In Pittaja Prameha, prakopa avastha of pitta dosha (Agravation of  Pitta dosha), dushita mamsa, medo dhatu and kleda is seen. So for Pitta shamana drugs should be choosen having madhura, tikta, kashaya rasa, madhura vipaka and sheeta virya.

3)For Meda and mamsa dushya shamana the drugs should be choosen which are Ushna virya, laghu, ruksha Guna, katu rasa.
4)Chandraprabha Vati is best antidiabetic medicine described in classics. It is tridosha shamaka which is indicated especially in all 20 types of Prameha.

5)Haritaki churna is Pancharasa dravya (alavana) kashaya rasa Pradhan, madhura vipaka is best tridoshagna and by its Ushna virya property it is best dushya shamaka which best acts on vitiated mamsa and medo dhatu. Bhavaprakash mentioned it as pramehagna dravya along with Amalaki.

6)Bibhitak churna having kashaya rasa, madhura vipaka is best Tridoshahara and being Ushna virya it is best dushya shamaka

7) Amalaki Churna having Pancharasa, laghu, ruksha, sheeta Guna, sheeta virya, madhura vipaka is best Tridoshahara dravya. Best advised in classics for Prameha, pittavikara, trushna, daha etc

8) Haridra churna having katu rasa, ushna virya, katu vipaka is best dushya shamaka, pitta rechaka and pramehagna as described by Charak in Prameha chikitsa

9)Avipattikar churna was given only for a month to improve digestive metabolism and to avoid complications produced by pitta

10)CPV and Pramehagna churna formulation was used throughout 6 months with tapering doses. Along with medications proper diet and good life style made this case a success story

Conclusion

1) In Ayurveda Pittaja Prameha is described as Yapya vyadhi (difficult to manage) because of dosha-dushya paraspara viparita chikitsa but proper diagnosis at initial stage and treatment given at proper time along with the proper diet advice & changes in life style can give singnificant results.

2) Acharya charaka mentioned it as Yapya vyadhi because of its vishama chikitsa but Pramehagna drugs along with good life style & proper diet has removed the disease from its root cause and the patient is advised to follow healthy diet & life style throughout the life to prevent reoccurance.

3)  In Ayurveda ahara (Food habits), vihara (Life style), dinacharya  (daily routine) ,rutucharya ( Seasonal routine ),sadvritta  ( Code of conduct ) are described in detail which have good role in prevention and cure of lifestyle disorders like Prameha.