594glibenclamide or metform<strong>in</strong> significantly enhanced rhability to Jower glucose <strong>and</strong> improve the lipid pr<strong>of</strong>ile, co:pared to adm<strong>in</strong>ister<strong>in</strong>g the drugs alone.''"1 Shilajit atlemuit^treptozotoc<strong>in</strong>-<strong>in</strong>duced hyperglycemia <strong>in</strong> rats <strong>and</strong> reducthe decrease <strong>in</strong> superoxide dismutase activity <strong>in</strong> pancreaislet cells. It was postulated that Shilajit acts as a free-radkscavenger."Oiaraka Samhita recommends Madlm-asnva, a polyhertfermented preparation, for patients with Pramcha. Hypoglcemic effects <strong>in</strong> animal models have been noted for somethe <strong>in</strong>gredients <strong>of</strong> Mudluoasava, <strong>in</strong>clud<strong>in</strong>g Tcjapatra [Cim;momum Umiak (Bueh.-Ham.) T. Nees & Eberm.J, Pushkarmu(hiuJa racemosa Hook. f.), <strong>and</strong> Chirauata (Kiratatikta, Swerichirata).l3lV5'm'wl As discussed previously, <strong>in</strong> a pilot stucon patients with diabetes, S. chirata produced a significaidecrease <strong>in</strong> fast<strong>in</strong>g <strong>and</strong> postpr<strong>and</strong>ial blood glucose levels.A pilot study on Tcjapatra showed <strong>in</strong>sul<strong>in</strong>-releas<strong>in</strong>g activila? well as a decrease <strong>in</strong> fast<strong>in</strong>g <strong>and</strong> postpr<strong>and</strong>ial blood gUcose levels <strong>in</strong> patients with diabetes.102'103Mamejjaka {Eritcoslema Uttoralc Blume) is used as a s<strong>in</strong>g]herb <strong>and</strong> also as part <strong>of</strong> an antidiabetic mixture.KH Incl<strong>in</strong>ical study on patients with type 2 diabetes, E lit lorn,reduced blood glucose <strong>and</strong> prevented the progression cdiabetic complications. There was significant improvemer<strong>in</strong> the lipid pr<strong>of</strong>ile, blood pressure, <strong>and</strong> kidney function.10" jsignificantly reduced blood glucose <strong>and</strong> lipid peroxides i.rats with alloxan-<strong>in</strong>duced diabetes, <strong>and</strong> <strong>in</strong>creased superoxiddismutase, catalase, <strong>and</strong> glutafchione peroxidase.106 In sludieon rats with sbeptozotoc<strong>in</strong>-<strong>in</strong>dueed type 1 diabetes, C. littarak significantly reduced glucose, cholesterol, <strong>and</strong> triglyc^ride levels,10' <strong>and</strong> ameliorated diabetic nephropathy. Sei'un:reat<strong>in</strong><strong>in</strong>e <strong>and</strong> urea were signiricantly decreased, mid glomerular function improved.1 * In rats'fed a hypercfiolestci"Dlemic diet, E. Uttoralc decreased serum cholesterolxiglycerides, LDL, VLDL, liver <strong>and</strong> kidney diolesteroJ levds<strong>in</strong>d lipid pera.xidation levels. There was an <strong>in</strong>crease <strong>in</strong> HDLmd an <strong>in</strong>crease <strong>in</strong> reduced glutatJiione levels.10?A pilot study on an herbal mixture am tabl<strong>in</strong>g TejapatnC<strong>in</strong>namomum tamala), Pushkarmula (Jnula racemosa), h/nimejjak:,E. littoruk), Mesliaskrhig; (Gytnneiiw sylvustre), <strong>and</strong> Jaitibu (Syyghuitaivunf) seeds with Kctravrtlnka (bitter gourd; bitte<strong>in</strong>elon; Montordica chanmtia) juice, adm<strong>in</strong>istered at a dose oJig twice a day before meals, decreased fast<strong>in</strong>g <strong>and</strong> postnundialblood glucose le\els <strong>in</strong> patients with diabetes (S<strong>in</strong>ght al., 1992; see Box 1). Avurtaki {Cassia auriculata L<strong>in</strong>n.) <strong>and</strong>'lethika {Trigondla foenum-gmecum) as s<strong>in</strong>gle herbs <strong>and</strong> deoction<strong>of</strong> Nimbn {Azadiradila <strong>in</strong>dies A. Juss.; Nsj/jO have alsoSHARMA AND CHANDOLAemonstrated blood glucose-lower<strong>in</strong>g action (Marwah et al.,990; see Box 1). In a d<strong>in</strong>ical study on patients with type 2iabetes, Neem shewed significant hj'poglycemic activity.110i rabbits witli alloxan-mduced diabetes, the hypoglycemictfect <strong>of</strong> Neeiit was comparable to that <strong>of</strong> glibunelamide.111The herbs Cokshura (Tribuluz terrestris L<strong>in</strong>n.),112 Asana"teracarpiis mavtuyuun Roxb.),6i Kulatha [Vigrm unguicuhta-b<strong>in</strong>.) VValp.], <strong>and</strong> Saptapama [Alstonia scholaris (L<strong>in</strong>n.) R.Br.]re also beneficial <strong>in</strong> treat<strong>in</strong>g <strong>Prameha</strong>. These herbs can besed <strong>in</strong> different comb<strong>in</strong>ations, depend<strong>in</strong>g on the Doshicivolvemcnt <strong>and</strong> severity <strong>of</strong> the illness. An herbal mixtureimprised <strong>of</strong> one part each <strong>of</strong> Ktirnvdhikn (bitter gourd: bitter.elon; M. chanvitia), Jambu (S. cwn'mi), Gummr (Meshae-hr<strong>in</strong>gi,. svlviisire), <strong>and</strong> Awra (Mangifera iudica L<strong>in</strong>n.), taken alongith Shilajit, was <strong>in</strong>vestigated <strong>in</strong> a cibiical study on 805 patientswith diabetes. The results showed a statistical!}' si;nificnnt reduction <strong>in</strong> fast<strong>in</strong>g <strong>and</strong> postpr<strong>and</strong>ial blood glucosalong with cl<strong>in</strong>ical improvement (website <strong>of</strong> India's CentrCouncil for Research <strong>in</strong> Ayurveda <strong>and</strong> Siddha; see Box IVijayit&iradi Kiuatha, Nishakatnkadi Kumtha,u? KatakagadmuKioatha, Saptaranguadi Vati, <strong>and</strong> Ch<strong>and</strong>raprabha Vati acefew oUVr polyherbal comb<strong>in</strong>ations that have an antidiabet:effect. Given the abundance <strong>of</strong> Ajairvedic herbs that are useto treat Pramcha, further research <strong>and</strong> cl<strong>in</strong>ical trial? <strong>in</strong> thfield may determ<strong>in</strong>e which are most effective <strong>in</strong> manag<strong>in</strong>diabetes mellitus.Management <strong>of</strong> complicationsPatients with diabetes are at high risk for a number <strong>of</strong> con:jliostiond. Ayurvedic herbs that target specific organ functionire helpful <strong>in</strong> manag<strong>in</strong>g these disorders. A large bod)' <strong>of</strong> research has been conducted cm these herbs. For cardiovasciilaimplications, Arjuna {Tennmalia arjunn L<strong>in</strong>n.),113'116 GugguhConimtphora wighsi't (Am.) Bh<strong>and</strong>ari],11' Pttsliki<strong>in</strong>nula (hurfa <strong>in</strong>@cmosa),ll'~u9 <strong>and</strong> Kushiha [Snussurea lappa (Decne.) C.Baailicj'120'121 can be utilized. Bitva [Aeglc marmclos (L<strong>in</strong>n.) Corricrr.],1^'1"3 Kutaju [Holarrhena antidyscutericn (Roxb. ox Flem<strong>in</strong>gVail, ox A. DC.],12*125 <strong>and</strong> Haritaki'{Tennmalia chebuh)126-@ arcLelpful <strong>in</strong> manag<strong>in</strong>g diabetic cntcropatrry. For diabetic nc-@liropathy, Pimamaz>a (Boorliai'ia diffusn L<strong>in</strong>n.),126'1'9 GokshwiTribulus h'rrestris)^^'1'^' <strong>and</strong> Varuna {Cratacva nuivala Buch.-fam.)'W35 are useful. Knpiknc.chu [Mua<strong>in</strong>a pruriais (L<strong>in</strong>n.)Cl,13^178 Ashwngmdha (Withaiw sarrmifera)@ SltPeta Mush'1rf/wjntvjs aiiscertdens Roxb.) (Deka et al, 2004; see Box 1),shwunha (Ficus rdigiosa L<strong>in</strong>n.) (Virani et a]., 2009; see Box 1),ltd Jntiphxla {Mymlica fragrant Houtt.) (Deka et af,, 2004; seeox 1) can be utilized lor erectile dysfunction. For diabeticriunipathy, Dashnmuh Kwalha (Dwjvedi, 1986; see Box 1) <strong>and</strong>(jgy/i/-based formulations are helpful. For diabetic ret<strong>in</strong>opaiy,Sapti<strong>in</strong>irita Lntlut fUpadhyaya <strong>and</strong> S<strong>in</strong>gh, 1993; see Box I)140id Mnhatriphrtla Ghiita (Gupta Diu-gesh, 2IJ09; see Box 1) are@commended. Lucal <strong>and</strong> <strong>in</strong>ternal adm<strong>in</strong>istration <strong>of</strong> MaliaanjishthadsKtvathn (Anil Kumar, 1985; see Box 1) <strong>and</strong> Kaishorugguhi (Shr<strong>in</strong>gi, 1996; Hota, 1997; see Box 1) can be utilized furirioiLS sk<strong>in</strong> manifestations. For cerebral diseases such as deefitia<strong>and</strong> Alzlieimer disease, Shankhapnshpi (Convolvulusuriaiulis),71-^41^42 Mnndukaparni [CentcHti asiatiat (L<strong>in</strong>n.)rb-1,1*3""5 Brtthwi (B. monnieri),73U6M7 Vitcha {Acorns cnlnu$)/^M9fyoHshwati (Celastruf pauiculatus Willd.),150']51 <strong>and</strong>iduchi (Titiospora cordifol<strong>in</strong>)152'1'' are recommended,<strong>in</strong>clusionsIn At/nrveda, <strong>Prameha</strong> is described as a set <strong>of</strong> complexnical disorders characterized by frequent abnormal micriu'on,with tlie etiology <strong>in</strong>volv<strong>in</strong>g genetic predisposition as;]| as improper diet <strong>and</strong> lifestyle. The role oi stress <strong>and</strong>esity <strong>in</strong> its pathogenesis it, also elaborately discussed <strong>in</strong> the'iirvedic texts. The cl<strong>in</strong>ical conditions described <strong>in</strong> Pn<strong>in</strong>iehnve much <strong>in</strong> common with those
PRAMEHA IN AYURVEDA, PART 2595Ayurveda has a vast array <strong>of</strong> herbs <strong>and</strong> herbal mixtures thatare used <strong>in</strong> the treatment <strong>of</strong> Pramehi. A large number <strong>of</strong> theseherbs have demonstrated efficacy <strong>in</strong> research <strong>in</strong>vestigations.The herbs have various properties, <strong>in</strong>clud<strong>in</strong>g hypoglycemic,anrihyperglycemic, hypolipidemtc, antihyperlipidemic, <strong>in</strong>sul<strong>in</strong>promot<strong>in</strong>g,<strong>and</strong> antioxidant properties. Some <strong>of</strong> these herbs arecapable <strong>of</strong> counteract<strong>in</strong>g stress-<strong>in</strong>duced catecholam<strong>in</strong>es, whichare established <strong>in</strong>sul<strong>in</strong> antagonists. Hence, the selection <strong>of</strong> theherb or comb<strong>in</strong>ation <strong>of</strong> herbs for the patient depends upon the.stage <strong>of</strong> the disease, disturbances <strong>in</strong> the psychophysiologicconstitution <strong>of</strong> the patient, <strong>and</strong> mode <strong>of</strong> action <strong>of</strong> the herbs.Further research is needed <strong>in</strong> the cl<strong>in</strong>ical sett<strong>in</strong>g to elucidate theAyurvedic modalities that are effective <strong>in</strong> the management oiobesity, metabolic <strong>syndrome</strong>, <strong>and</strong> diabetes mellitus, <strong>in</strong> light <strong>of</strong>their similarities with Pramchn.AcknowledgmentsThe authors are very thankful to Dr. Kamayani Shukla,MD(Ayu) for her outst<strong>and</strong><strong>in</strong>g contributions <strong>in</strong> giv<strong>in</strong>g f<strong>in</strong>alshape to the manuscript- We ate also thankful to Dr. ShyamPrasad <strong>and</strong> Dr. Anju P. Ramach<strong>and</strong>ran, PhD scholars, Department <strong>of</strong> Kayachikitsa, Institute for Post GraduateTeach<strong>in</strong>g & Research <strong>in</strong> Ayurveda, Gujarat Avurved University, Jamnagar, for facilitat<strong>in</strong>g the completion <strong>of</strong> themanuscript. We also thank Ellen Kauffman for her assistance<strong>in</strong> the preparation <strong>of</strong> the manuscript.Disclosure StatementNo compet<strong>in</strong>g f<strong>in</strong>ancial <strong>in</strong>terests exist.1. Sharma H, Ch<strong>and</strong>ola HM. Ayurvedic concept <strong>of</strong> obesity,metabolic <strong>syndrome</strong>, <strong>and</strong> diabetes mcllitus. 1 Aitern Complement Med 20U;17:549-552.2. Sharma H, Ch<strong>and</strong>ola HM. Pramdni <strong>in</strong> Ayurveda: Correlation with obesity, metabolic <strong>syndrome</strong>, <strong>and</strong> diabetes mellitus.Part 1@Etiology, classification, <strong>and</strong> pathogenc-sis. ]Altcm Complement Mcd 2011; 17:491-496.3. Acharya VJT, ed. Agnivesha, Charaka Samhita. Varanasi,India: Chaukhambha Sanskrit Sansthan, 2004.4. Shaslri KN, Chaturvedi GN. Agnivesha, Charaka Samhita,Vidyot<strong>in</strong>i commentary. Varanasi, India: ChaukhambaBharati Academy, 2004.5. Shastri A. Sushruta Samhita, Ayurveda-Tattva-SamdipikaCommentary. 14th ed. Varanasi, India: ChaukhambhaPublications, 2003.6. Dijsselbloem N, V<strong>and</strong>en Berghe W, De Nacyer A, HaegemanC. Soy is<strong>of</strong>lavone phyto-pharmaceuticals <strong>in</strong> <strong>in</strong>terleuk<strong>in</strong>-6affections: Multi-purpose nutraceuticals at the crossroad <strong>of</strong>hormone replacement, anti-cancer <strong>and</strong> anti-<strong>in</strong>flammatorytherapy. 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