ISSN(O): 2320-5407 Int. J. Adv. Res.

13(06), June-2025, 835-849

Journal Homepage: - www.journalijar.com

Article DOI: 10.21474/IJAR01/21142

DOI URL: http://dx.doi.org/10.21474/IJAR01/21142

RESEARCH ARTICLE

THE GREAT REVERT OF UNCONTROLLED TYPE 2 DIABETES MELLITUS WITH

DIABETIC NEUROPATHY BY AYURVEDIC INTERVENTION: A CASE STUDY
RELATING TOPITTAJ PRAMEHA - SUBTYPE HARIDRA MEHA
Acharya Manish Ji1, Gitika Chaudhary2, Richa3 and Smita Sanjeev Nilamwar4
1. Director, Meditation Guru, Jeena Sikho Lifecare limited, India.
2. Senior Consultant, General Surgeon, BAMS, PGDIP, PGDGS, MS (Ay.), Jeena Sikho Lifecare limited, India.
3. Research officer, BAMS, PGDIP, CICR, CAIM Jeena Sikho Lifecare limited, India.
4. Consultant, BAMS, Jeena Sikho Lifecare limited Hospital Mumbai, Maharashtra, India.
……………………………………………………………………………………………………....
Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History Diabetes mellitus (DM) is a multi-factorial disease of disturbed
Received: 10 April 2025 metabolism with hyperglycemic condition. Among 2 types of diabetes,
Final Accepted: 13 May 2025 type 2 DM also named as non-insulin dependent diabetes is the most
Published: June 2025 common type causes due to sedentary lifestyle. In ayurveda DM can be
Key words:-
correlate with Prameha. Apathy-nimittaj Prameha is mentioned by
Type 2 Diabetes Mellitus, Apathy Acharya Sushruta which occurs due to unhealthy lifestyle of patient.
Nimittaj Prameha, Diabetic Neuropathy, This presenting article is about a case of type 2 DM or Apathy-nimittaj
Pittaj Prameha, HbA1c, Ayurvedic prameha, diagnosed to a male patient of age 45 years. He had come to
Therapeutics
JEENA SIKHO LIFECARE LIMITED HOSPITAL, NAVI MUMBAI,
MAHARASHTRA, on 12/09/2024 and showed symptoms like burning
micturition, pain and numbness of lower limb etc. He brought his
HbA1c report investigated prior to visit hospital. His symptomatology
and positive HbA1c had given a clue to diagnose uncontrolled type 2
DM with diabetic neuropathy/ Pittaj prameha. Later he starts to avail
ayurvedic therapeutics. After 74 days of treatment his HbA1c values
reduced to non-diabetic range and his symptoms also got completely
subsided. Treatment was included ayurvedic medicines along with diet
and exercise recommendation which shown an excellent result.

"© 2025 by the Author(s). Published by IJAR under CC BY 4.0. Unrestricted use allowed
with credit to the author."
……………………………………………………………………………………………………....
Introduction:-
As per the WHO, diabetes mellitus (DM) is defined as a heterogeneous metabolic disorder characterized by common
feature of chronic hyperglycemia with disturbance of carbohydrate, fat and protein metabolism. DM is a leading
cause of morbidity and mortality world over. It is estimated that approximately 1% of population suffers from DM.
The incidence is rising in the developed countries of the world at the rate of about 10% per year, especially of type 2
DM, due to rising incidence of obesity and reduced activity levels. Diabetes is expected to continue as a major
health problem owing to its serious complications. [1]There are two general types of diabetes mellitus as follows: [2]
1. Type I diabetes mellitus [Insulin-dependent DM] – Is caused by lack of insulin secretion.
2. Type II diabetes mellitus [Non-insulin-dependent DM] –Is initially caused by decreased sensitivity of target
tissues to the metabolic effect of insulin. This reduced sensitivity to insulin is often called insulin resistance.

Corresponding Author :- Gitika Chaudhary 835

Address:- Senior Consultant, General Surgeon, BAMS, PGDIP, PGDGS, MS (Ay.), Jeena Sikho
Lifecare limited, India.
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Type II Diabetes:
It is far more common than type I, accounting for about 90 to 95 percent of all cases of diabetes mellitus. Inmost
cases, the onset of type II diabetes occurs after age 30, often between the ages of 50 and 60 years, and the disease
develops gradually. Therefore, this syndrome is often referred to as adult-onset diabetes. In recent years, however,
there has been a steady increase in the number of younger individuals, including few younger than 20 years, with
type II diabetes. This trend appears to be related mainly to the changing lifestyle from healthy to unhealthy. Chronic
hyperglycemia leads to diabetic complications by causing tissue injury. When blood glucose is poorly controlled
over long periods in diabetes, blood vessels in multiple tissues through out the body begin to function abnormally
and undergo structural changes that result in inadequate blood supply to the tissues. This in turn leads to diabetic
complications like heart disease, kidney disease, retinopathy, blindness, ischemia and gangrene of the limbs etc.
Frequent complications of chronic, uncontrolled diabetes mellitus are peripheral neuropathy and autonomic
nervous system dysfunction. These abnormalities can result in impaired cardiovascular reflexes, impairedbladder
control, decreased sensation in the extremities, andother symptoms of peripheral nerve damage.[2]

According to Ayurveda Prameha is a santarpanottha vyadhi. It means that it occurs due to that factors which over
nourishes the body.[3] So the hetu of prameha also included those things which cause impairment in the metabolism
like madya (alcohol), guda (jaggery), navanna (new grains), udaka mansa (Sea food), snigdha anna (oily food) etc.
Hetu of prameha are mentioned later in discussion to understand the etiological factors. All aacharya’s mentioned
the main symptom of prameha is prabhuta mutrata [4] or prabhuta avila mutrata[5] (excess and/ turbid urine). In
ayurveda detailing of prameha hetu (etiological factors), purvaroopa’s (pre-symptomatic phase), roopa’s
(symptomatic phase), samprapti (pathogenesis), dosha-dushya sangraha (pathogenic factors involved), sadhya-
asadhyatva (prognosis) and prameha upadrvas (complications) are also mentioned. Management of prameha
included detoxification, oral medicines together with diet and exercise recommendation. Acharya Sushruta classified
Prameha in 2 types.[6]

1)Sahaja Prameha and 2) Apatthya nimittaja prameha

Among these types sahaja prameha is a genetic or hereditary type. Apathy nimittaja prameha has 3 types on the
basis of predominance of dosha. These 3 types again sub-classified into 20 different sub-types on the basis of urine
appearance. Types of Doshaj Prameha’s are given as below: [4]
1) Vataj prameha
2) Pittaj prameha
3) Kaphaj prameha

This article is going to present a significant reversal in a case of uncontrolled type 2 diabetes mellitus with diabetic
neuropathy in particular view of Pittaj prameha and its subtype Haridra meha. He was a male patient aging 45
years, who visited to Jeena Sikho Lifecare Limited Hospital, Navi Mumbai, Maharashtra, on 12/09/2024. By
ayurvedic intervention his uncontrolled diabetes gets reverted to normal within 74 days. All symptoms got subsided
along with normal shift in the HbA1c value. This treatment included, panchakarma therapies, oral medication, diet
and exercise recommendations. All the belongings are mentioned from here onwards that how disease occurs, how it
became uncontrolled and how ayurveda treated it accurately with ayurvedic conceptual study.

Case Report:
This is a case of male patient was aging 45 years. He had come to JEENA SIKHO LIFECARE LIMITED
HOSPITAL, NAVI MUMBAI, MAHARASHTRA, on 12/09/2024. On arrival, his chief complains were noted as
given below followed by history taking and examinations as well.
1. Chief complains:
 Pain while walking
 Numbness and tingling to bilateral lower limb
 Anorexia
 Nausea and vomiting
 Burning micturition on & off/ persistent
 General weakness
 Burning sensation to both feet and sole
 Headache or dizziness
 Feeling of fear

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2. History taking: He had no history of illness/ he was not taking any allopathic or other medicines/ no any
family history of diabetes etc.
3. Examinations:
Table no. 1:- General examination.
Particulars Remark
Blood Pressure 140/80 mm of Hg
Pulse 84/ min
Weight 69.2 kg
Nidra Prakrita
Kshudha Prakrita
Mutra Mutra daha (burning micturation)

Table no. 2:- Ashtavidh parikshan.

Particulars Remark
Nadi (pulse) Vata pitta
Mala (bowel) Asamyaka (not clear)
Mutra (urine) Mutra daha (burning micturation)
Jivha (tongue) Alpa Sama (mild coated)
Shabd (pronounciation) Spashta (clear)
Sparsh (touch) Anushna Sheeta (normal)
Drik (eyes) Prakrita (normal)
Aakriti (physique) Madhyam (average)

Local examination:
Bilateral pitting edema was found to lower limb.

4. Investigation:
He had already brought HbA1c report investigated on 15/08/2024 and showed elevated value of HbA1c, 10.4 %
which countedunder poor control range and together with this he had also brought RFT, LFT, lipid profile
reports.
Table no. 3:- HbA1c report.
Date HbA1c Eag
15/08/2024 10.4 % 251.78 mg/dL
03/10/2024 7.1 % 157 mg/Dl
05/11/2024 5.5 % 111.15 mg/dL
25/11/2024 4.9 % 94 mg/Dl

Table no. 4:- Other investigations.

Date Tests Result
15/08/2024 LFT (Liver function test) Direct bilirubin - 0.43 mg/dl (mild high)
Total Bilirubin, SGOT & SGPT normal

Urine analysis Specific gravity – 1.004

(Normal – 1.016 to 1.022)
Lipid profile Normal
13/09/2024 CBC (Complete blood count) Normal
LFT (Liver function test) Total Bilirubin - 1.79 mg/dl
Mild increase in bilirubin Direct Bilirubin - 0.69 mg/dl
Indirect Bilirubin - 1.1 mg/dl
RFT (Renal function test) Normal

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5. Diagnosis: On the basis of symptomatology, history, examination and blood report this case was diagnosed as
Uncontrolled Type 2 diabetes mellitus with Diabetic neuropathy. According to ayurvedic perspective same
case was diagnosed as Pittaj prameha – subtype Haridra meha.

Ayurvedic Intervention:
After the diagnosis patient wanted to avail ayurvedic therapy for further treatment. Therefore, he was admitted to
IPD for ayurvedic therapeutics which included oral medicines, panchakarma therapies (detoxification procedures),
pathy-apathy aahar vihar (do’s and don’ts of diet and activities).

1] Panchakarma Therapies (9 days of IPD):

Table no. 5:- Panchakarma procedures.
Therapy name Medicine used for therapy Quantity and time
1. Sarvang abhyang Ksheerbala taila 30 min.
2. Avgaha swedana Ushna jala (hot water) 20 min
3. Matra basti Punarnava taila 90 ml for 10 min
4. Shirodhara Bramhi taila 150 ml for 30 min.
.
2] Medicines prescribed during IPD period:
Table no. 6:- IPD prescription.
Formulation Dose and time
Divya Shakti powder ½ tsf HS (Nishakala with Koshna jala i.e. lukewarm water)
Prameha rog har powder ½ tsf TDS before meal (Pragbhakta kala with Koshna jala)
Syrup madhumeha nashak 20 ml BD (Adhobhakta kala with saman matra of Koshna jala i.e. equal
amount of lukewarm water)
Capsule DM 2 Capsule TDS (Adhobhakta kala with Koshna jala)
Yakrit shotha har vati 1Tablet BD (Pragbhakta kala with Koshna jala)
Syrup Nervine tonic 10 ml BD (Adhobhakta kala with Koshna jala)

3] Follow up during IPD:

Table no. 7:- IPD follow-up.
Date Follow-up of Symptoms Treatment Pain score 10
12/09/2024  Chief complains as mentioned in Mentioned in table no. 5 & 6 4
(1st day of IPD) Case report
13/09/2024  No fresh complains 1. Lepam over bilateral feet 4
 Recurrent vomiting++ Nimba + karvellaka powder
2. Arogya vati
3. Rest continued

14/09/2024 Recurrent vomiting+ Continue all 4
15/09/2024  No fresh complains Kansyathali – foot massage
16/09/2024  Morning 10.00 am: Per abdomen Tab. vomitab 2 stat 5
tenderness over whole abdomen
 Evening 8.30 pm: Vomiting and
edema reduced
17/09/2024  Per abdomen: Normal/ non- Continue all 4
tender
18/09/2024  Reduced burning sole, no Continue all 3
vomiting
19/09/2024  Reduced burning sole, Tab Dr. Sukoon 1BD 2
 Diminish numbness and tingling Rest continued
of lower limb,
 Pitting edema reduced
 General weakness reduced,
 Fear +

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20/09/2024  No giddiness, Continued all 2

(7th day of IPD)  No burning sole,
 General weakness+

4] Daily diet during IPD:

Table no. 8:- IPD diet.
Early morning Herbal tea + raw turmeric

Breakfast Fruits, sprouts and red juice

Lunch and dinner Salad and cooked food

Afternoon Green juice, Makhana, 4-5 almonds

5] Medicines prescribed to consume after discharge:

Table no. 9:- Medicines to consume after discharge.
Formulation Dose and time
Divya shakti powder ½ tsf HS (Nishakala with Koshna jala i.e. lukewarm water)
Syrup Nervine tonic 20ml BD (Adhobhakta kala with Koshna jala)
Tablet JS Diab 2BD before food (Pragbhakta kala with Koshna jala)
Tablet Immune pathy 1 BD after food (Adhobhakta kala with Koshna jala)
Tablet Liv DS 2 BD (Adhobhakta kala with Koshna jala)
Syrup Liver tonic 20 ml BD after food (Adhobhaktakala with saman matra of Koshna jala)
Syrup Telome 10 ml BD after food (Adhobhakta kala with saman matra of Koshna jala)
Syrup Madhumeha 10 ml BD after food (Adhobhakta kala with saman matra of Koshna jala i.e. equal
nashak amount of lukewarm water)
Tablet Dr. sukoon 1 BD before food (Pragbhakta kala with Koshna jala)

6] Diet suggested to follow after discharge:

Patient was advised to have DIP diet that was planned according to advanced method of diet plan named as DIP
(Discipline and Intelligent) diet. Per day diet included plate no. 1 of fruits, salad and plate no. 2 of millet diet in
lunch and dinner. Quantity of fruits and salad were calculated according to DIP diet plan formula’s and are given
below.[7] He was advised to have that food which is pathya for Prameha vyadhi, will be discuss later.

Formula of fruits: Patient s weight × 10 = fruits in grams

Formula of salad: Patient s weight × 5 = salad in grams

In this case weight of patient was 69.2 kg. So by the above formula calculated quantity of fruits and salad advised is
mentioned below in table no. 10. This table also noted the discipline in having food as per time which was suggested
to him:
Table no. 10:- DIP diet at home.
Diet Quantity/type of food Time
Fruits  All type of fruits especially citric fruits Till 12.00 pm
 ~ 700 grams
Salad (Plate 1)  All salads like cucumber, tomato, Just before lunch and dinner
beetroot etc.
 ~ 350 grams
Lunch (Plate 2) Millet diet, bitter and fruit vegetables, Between 1.00 to 2.00 pm
lentils etc.

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Dinner (Plate 2) Millet diet, bitter and fruit vegetables, In the evening before 7.30 pm
lentils etc.

7] Exercise: Regular exercise and meditation for 45 minutes was advised to him. He was told to practice Sun
salutations (Surya namaskara’s) along with Kapalbhati pranayam.

8] Pathya-apathya (Do’s and don’ts):

Table no. 11:- Pathya-apathya.
Pathya (Do’s) Apathya (Don’ts)
Should have millet diet like barley, sorghum etc. Eat all Skip dairy products, jaggery and their products, oily,
vegetables especially bitter taste and fruit vegetables like spicy food, packaged food, salty food.
Karvellaka (bitter guard), Methika (Trigonella foenum- Don’t eat non-veg.
graecum), Ivy guard etc.
Wake up early and sleep early Day sleeping and night awakening
Do exercise regularly and always stay physically active. Stale food, alcohol or any other addiction, avoid eating
new grains.
Eat only in day time Hold natural urge
Always eat homemade and fresh food. Stress and anger

Results:-
Weight decline:
By following DIP diet and exercise, his weight was reduced approximately by 5 kg within 2 and half months.

Before treatment • 69.2 kg

12/09/2024

After treatment • 64.8 kg

26/11/2024

Reversal in altered HbA1C assessment:

After 21 days of ayurvedic treatment HbA1c value reduced by more than 3% that is shifted to 7.1% from 10.4%.
From here HbA1C was decreased to near about half of pre-treatment value and reached to 5.5% in the next 33 days.
This is a border line reading of non-diabetic HbA1c value. After total 74 days of ayurvedic treatment it reduced to
4.9% successfully and it is within border line range of non-diabetic HbA1c. Tabular presentation of HbA1C
outcome is given below in table no. 12.
Table no. 12:- HbA1c outcome.
Date Before or after treatment Result
15/08/2024 Before treatment, 28 days prior to start treatment 10.4%
03/10/2024 After 21 days of treatment 7.1%
05/11/2024 After 33 days from 1st follow up 5.5 %
25/11/2024 After 20 days from 2nd follow up 4.9 %
(Within 74 days of treatment)

Below graph is showing how the graph of HbA1c was positively declining from diabetic to non-diabetic range
during the ayurvedic treatment.

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12.00%

10.4 %
10.00%

8.00%
7.1 %
6.00%
5.5 %
4.9%
4.00%

2.00%

0.00%
Before treatment After 21 days of After 33 days from 1st After 20 days from 2nd
treatment follow up follow up
Graph no. 1:- Declining percentage of HbA1c with downward slop.

Symptomatic outcome:
Table no. 13:- Symptomatic relief during IPD.
Date Day of IPD Result
18/09/2024 7th day  Mild reduction in burning sole,
 No vomiting
19/09/2024 8th day  Reduced burning sole,
 Diminish numbness and tingling of lower limb, mild reduction in
Pitting oedema
 General weakness reduced to some extent,
 Complain of mild fear yet.
20/09/2024 9th day  No giddiness,
 No burning sole,
 General weakness mild

Outcome of pain score during admission was as like below:

Table no. 14:- Progress in pain score.
Day of treatment Pain score
1st to 4th day 4
5th day 5
6th day 4
7th day 3
8th day 2
9th day (last day) 2

At the time of last follow up his all symptoms were subsided.

Table no. 15:- Last follow-up.
Symptoms Result
Pain while walking Diminishes
Numbness and tingling to bilateral lower limb He was started to feel sensations to lower limb.
Anorexia Normalized

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Nausea and vomiting Absent

Burning micturation on & off/ persistent Reduced
General weakness Recovered
Burning sensation to both feet and sole Absent
Headache or dizziness Absent
Feeling of fear Went off

Discussion:-
As we studied earlier diabetes mellitus is a syndrome of disturbed carbohydrate, fat and protein metabolism caused
by either lack of insulin secretion or decreased sensitivity of the tissues to insulin. In both types of diabetes mellitus
which are mentioned in introduction, metabolism of all the main foodstuffs is altered. The basic effect of insulin
lacks or insulin resistance on glucose metabolism is to prevent the efficient uptake and utilization of glucose by most
of the cells of the body, except those of the brain. It leads to increase in blood glucose concentration along with cell
utilization of glucose falls increasingly lower and utilization of fats and proteins increases. [8]According to Ayurveda
3 types of Doshaja Prameha as stated in introduction are again re-divided into 20 sub-types by the appearance of
urine. Kaphaj prameha have 10 subtypes, Pittaj have 6 and Vataj have 4 subtypes. This is a case of Pittaj prameha,
that’s why subtypes of Pittaj prameha are mentioned here as follows:[9]
1. Kshar meha
2. Kala meha
3. Neela meha
4. Lohita meha
5. Manjistha meha
6. Haridra meha

This article is a case of uncontrolled type 2 diabetes with diabetic neuropathy or Pittaj prameha sub-type Haridra
meha. A male patient of age 45 years had already investigated for HbA1c 28 days prior presented to JEENA SIKHO
LIFECARE LIMITED HOSPITAL, NAVI MUMBAI, MAHARASHTRA, INDIA on 12/09/2024. His case report is
already given. Now the detailed discussion on case study, diagnosis and patho-physiology of this case is as follows:

Etiological factors:
He was used to unhealthy lifestyle and not following the timings of eating and sleeping properly. He was not even
exercising. Even after elevated HbA1c value he ignored it and this ignorance lead to again triggering in symptoms
due to uncontrolled hyperglycemia. Acharya Vagbhata mentioned following causative factors to generate Prameha
as given in shloka no 1.

Food and activities which increases Meda (Lipid or fat), Mutra (urine) and Kapha dosha, food of sweet, sour and
salty taste, Snigdha (Oily), Guru (uneasy to digest), Pichchhila (Sticky or fermented), Sheetal (cold potency food),
Nava dhanya (new grains), sura (alcohol), Anoop mansa (sea food, meat of buffalo, goat etc. ), Ikshu (sugarcane),
Guda (jaggery), Gorasam (curd and milk), Eka sthana aasanarati (sitting continually at one place), Shayanam vidhi
varjitam (sleeping without following rules of sleep). [10]

श्लोक१:
“प्रमेहाव िंशवि: ित्र……िेषािं मेदोमूत्रकफा हम्॥१॥
अन्नपानवियाजाििंयत्प्रायःित्प्र ितकम्।
स्वादु अम्लल णःविग्धगुरुवपच्छिलशीिलम्॥२॥
न धान्य: सुराःअनू पमािं सेक्षुगुडगोरसम् |
एकस्थानासनरविः शयनम् व वध वजतिम्॥३॥”
अष्ािं गहृदयवनदानस्थान१०/०१

Symptomatology of case:
1. Pain while walking, Numbness and tingling at bilateral lower limb, burning sensation at both feet and
sole:
It is a symptom of diabetic neuropathy. As with other complications of DM, the development of neuropathy
correlates with the duration of diabetes and glycemic control. This case is of a Distal Symmetric Polyneuropathy

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(DSPN), the most common form of diabetic neuropathy, most frequently presents with distal sensory loss and pain.
Symptoms may include a sensation of numbness, tingling, sharpness, or burning that begins in the feet and spreads
proximally.[1] Pain typically involves the lower extremities. As per ayurvedic perspective, this symptom is
mentioned in poorvaroop (Pre-symptomatic phase) of Prameha vyadhi as below:

श्लोक१:
“स्वे दोअिंगगन्ाःवशवथलािं गिाचशय्यासनस्वप्नसुखेरविःच।
हृत्नेत्रवजव्हाश्र णउपदे होघनािं गिाकेशनखाविव्रुवधः॥१३॥
शीिवप्रयत्विंगलिालुशोषोमाधु यतमास्ये करपाददाहः।
भविष्यतोमेहगदस्यरुपं मुत्रेअविधा च्छिवपपीवलकाःच्॥१४॥
चरकसिंवहिावचवकत्सास्थान–६

Table no. 16:- Poorvaroopa.

Poorvaroop Elaboration
Kara-pada daha [4] Burning sensation to hands and legs
Hasta-pada-tala daha[5] Burning sensation to upper and lower limb with palm & sole

Karapadayoh suptata dahou[8] Numbness and burning to upper and lower limb

Modern science mentioned it as diabetic complication whereas ayurveda mentioned it as pre-symptomatic phase of
diabetes. In treatment Acharya already said that if prameha manifests with all its poorvarup’s then it is not curable.
And according to modern science also diabetes with complications is the chronic stage of diabetes which is not
curable.

2. Anorexia:
May be due to fear of gaining weight he was not eating enough food. Obese people are generally more prone to
diabetes. So some people may have this symptom of anorexia nervosa usually called anorexia.

3. Nausea and vomiting:

This may be due to disturbed metabolism because liver plays a key role in digestion and metabolism. It also has a
significant role in maintaining blood glucose level thereby causes homeostasis of blood. Nausea and vomiting are
the symptoms of disturbed functions of liver. All Acharya’s mentioned the different Upadravas of Prameha.
Upadravas means complications which produced by the same dosha of previous disease or the main disease can
become a causative factor of that upadrava. [11] In this case kaphapraseka (Nausea) and chardi/vaman (vomiting) were
the symptoms present in the patient. Kapha praseka, and chardi/vaman are the updrava’s of prameha. Piitaj Prameha
also involves rakta dhatu dushti. And rakta dushti means dushti of raktavaha srotas and their moolsthanas well. So in
this case it was found a border line alteration in LFT values but it was not a serious issue.

4. Burning micturation on &off, Persistent – It is due to high glucose level in the blood. It often causes
infection in urinary tract. Acharya Charaka and Sushruta mentioned the mutra daha as a roopa (symptom) of
haridra meha a subtype of pittaj prameha. Shloka by aacharya Charaka is given below:

“हाररद्र्मेही कटु कम् हाररद्रासवन्निम् दाहाि्॥१४॥“

5. General weakness –As body tissues cannot efficiently use the insulin they become unable to function properly.
So body tissues cannot utilize glucose and it leads to weakness. Acharya Charaka in prameha nidansthan
mentioned Dourbalya (weakness) as updrava of prameha.

6. Headache/dizziness and Feeling of fear

Due to weakness, he would be a feeling of fear. Because diabetes affects both physical and mental health. Nausea
and vomiting may cause headache. In prameha dosha dushya samurchana there is dushti of Oja dhatu. Bhaya i.e.
fear and dorubalya (weakness) are the symptoms of Ojo dushti. [12]

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Local examination:
As he had complaining that tingling numbness, burning and pain in the lower limb, his lower limb was examined.
There was pitting oedema over both legs. On pricking there was a sensation of numbness. Hyperglycemia from
uncontrolled diabetes can damage blood vessels in the legs. It leads to poor circulation and fluid accumulation
thereby resulting in pitting oedema.

Investigation:
He was already investigated for HbA1c on 15/08/2024. It showed increase in reading and marked under poor control
limit. So, he was not advised again for any blood glucose tests. After few days of treatment, he did HbA1c test to see
the effect of treatment and it showed a positive shift to normal by ayurvedic treatment. Findings are already noted in
result. Glycosylated hemoglobin (HbA1C) Long-term objective assessment of degree of glycemic control is better
monitored by measurement of glycosylated hemoglobin (HbA1C). This is because the non-enzymatic glycosylation
of hemoglobin takes place over 90-120 days, lifespan of red blood cells. HbA1C assay, therefore, gives an estimate
of diabetic control and compliance for the preceding 3-4 months. Since HbA1C assay has a direct relation between
poor control and development of complications, it is also a good measure of prediction of microvascular
complications.[1]

Pathogenesis of disease:
Samprapti of this case of pittaj prameha is like that, etiological factors cause increase in Pitta dosha (Kupita pitta)
which then vitiates to bastigat medodhatu, mansadhatu and sharirgat kleda and it leads to Pittaj prameha.[13] But
prameha vyadhi involves all 3 dosha’s (Vata, Pitta and Kapha) with specific predominance of any dosha.

Flow chart of Samprapti

Ayogya Bastigat Medo,

Kupita
Hetu aahar Mansa & Pittaj Haridra
pitta
sevana Sharirgat Kleda prameha meha
Avyayama dosha
dushti

Diagnosis:
Though Prameha involved all 3 dosha dushti with predominance of kapha dosha dushti, however, on the basis of
dosha which increased majorly than others due to their respective hetu sevana that type of Prameha is diagnosed. It
should be decided by observing symptoms.

Table no. 17:- Diagnosis of Pittaja prameha- Haridra meha.

Symptoms Ayurvedic terminology noted Prameha vyadhi correlation

in prameha vyadhi
Pain in legs while walking Due to dourbalya Poorvaroop
Numbness and tingling at bilateral Kara-padayo suptata Poorvaroop
lower limb
Nausea and persistent vomiting Kapha praseka, vaman Pittaj Prameha updrava
Burning micturition on & off Mutradaha Haridra meha lakshan
General weakness Dourbalya Poorvaroop
Burning sensation to both feet and Karapada daha/hasta-pada tala Poorvaroop
sole daha
Fear Bhaya Ojo kshaya lakshana

Prameha upadravas (Diabetic complications): [13]

Kaphaj Pittaj Vataj
Avipaka Basti mehanyo todo Udavarta

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Aruchi Mushka avadaranam Kampa

Chhardi Jwara Hrudgraha
Ati Nidra Daha Lolata
Kasa Trishna Shoola
Peenas Amlako udgar Nidranasha
Murcha Shosha
Kapha praseka [6] Vidbheda Shwasa- Kasa

Vaman[6]

Biological reference value for HbA1C test is as follows:

1. Non-diabetic: <5.7 %
2. Pre-diabetic: between 5.7 to 6.5 %
3. Diabetic: > 6.5 %

Hyperglycemia remains the fundamental basis for the diagnosis of diabetes mellitus. In symptomatic cases, the
diagnosis is not a problem and can be confirmed by finding glucosuria.[1] HbA1c of the patient was elevated to more
than poor control and it was 10.4% on 15/08/2024. Patient reached to this value means he was suffering by
diabetes from so many days but maybe he was in asymptomatic phase or if any symptom was there, he might have
ignored it. In between the time of investigation and initiation of treatment his symptoms got triggered and showed
complications.

Hence on the basis of symptomatology and investigation report he was diagnosed as uncontrolled type 2 diabetes
mellitus with diabetic neuropathy. According to ayurvedic criteria he was diagnosed as Pittaj Prameha with
subtype Haridra meha.

Prognosis (Sadhya-asadhyatva of Prameha):

All acharya’s said Pittaj Prameha is yapya means difficult to treat because of vishamkriyatvat. It means that, to
reduce piita dosha there is need of sheeta veerya dravyas (cool potency drugs) but it again increases meda kaphadi
dushy (lipid/fat/kapha etc.). These meda-kaphadi dushya needs ushna veerya dravyas (hot potency drug) to diminish
which again increases pitta dosha. But if there is fewer vitiation of kapha dosha and medo dhatu then pittaja
prameha can be Sadhya (easy to treat). This Medo dhatu dushti can be identified by observing poorvaroops of
prameha. Purvaroop like dantyadinam maladhyatvam explained as talugalajivha dantyeshu malotpatti by acharya
Sushruta it means that accumulation of dirt in all parts of mouth like throat, tongue, teeth etc. This poorvaroop
occurs by excessive vitiation of medo dhatu. In this patient medo dhatu is present but in less quantity so it showed
symptom of mild coated tongue. This patient had investigated for lipid profile which showed normal results. His
liver function test also showed a little bit changes. So this case of Pittaj Prameha became easy to treat. To reach this
prognosis fine review of case with deep study is needed.

Ayurvedic intervention:
Shodhan and shaman are the 2 ayurvedic treatments mentioned for the management of prameha. Acharya Charaka
stated that shodhan chikitsa should be conducted in sthula (Obese) and balvana pramehi (strong immunity). So this
patient had given shaman therapy along with panchakarma therapy which boosts immunity of patient. Panchakarma
treatment advised for patient during IPD period worked as like follows:
1. Abhyanga: He went through body massage by Ksheerbala taila. [14] Ksheerbala taila is mentioned by acharya
Vagbhatt, is used here due to its rasayan property [immunity booster]. It is also useful in Vataroga to reduce
pain.
2. Awgaha Swedan: In this procedure patient was asked to sit in a tub filled with hot water (42 degree
temperature).It is one of the type of body steam. [15]It relieves shoola (pain) and pacifies the diseases caused by
vata and kapha dosha.[16,17]
3. MatraBasti: Small amount of Punarnava taila basti was administered to the patient through rectum during IPD
period for 9 days. Acharya vagbhatt mentioned that matra basti is useful in abalarugna (whose
immunity/strength is low) as it promotes strength. [18] It leads to easy elimination of mala (stool) and mutra
(urine). Punarnava has Shophanut property (anti-inflammatory). [19] This patient had pitting edema at lower
limb. So this therapy was given to boost immunity by reducing edema of lower limbs.

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4. Shirodhara: Shirodhara is a form of independent snehana procedure, wherein involves gently pouring liquids
over the forehead. In this patient shirodhara with Bramhi oil was performed. It performed to overcome his fear.
Bramhi is said to be medhya rasayan. means it acts as immunity booster to brain. Thereby it helped to overcome
his feeling of fear. [20]
5. Lepam: Local application of Dashmoola powder paste over feet had been done during IPD period daily.
Absorption of drugs is taking place through body surface and provides the effect of herbs directly on the site of
action. Dashmool (group of 10 herbs) are named as Shothahar Mahakashaya by acharya Charaka. [21] Shothhara
means it reduces swelling. So to reduce pitting edema of patient rapidly, dashmoola was applied directly to
lower limb.
6. Kansyathali foot massage: It was given to increase circulation in the lower limb thereby reduce numbness and
tingling sensation.
7. Neem-Karela therapy: In this therapy patient was told to soak his feet in the paste of Nimba (Azadirachta
indica) and Karvellaka (Momordica charantia). This is also a local therapy. It was used to reduce burning
sensation in feet. Nimba and Karvellaka both have Sheeta virya (cool potency) and both are pittashamaka herbs.
[22,23]

Shaman chikitsa (Palliative drugs):

It included Herbo-mineral formulations which act as pramehahar (Ant-diabetic) and rasayan (boost immunity).
Formulations prescribed during IPD period and post-discharge along with ingredients and uses are given below.
1) Divya shakti powder –
Ingredients: Trikatu (Zingiber officinale, Piper nigrum, Piper longum), Triphala (Emblica officinalis,
Terminalia chebula, Terminalia bellirica), Musta (Cyperus rotundus), Vidang (Embelia ribes), Laghu ela
(Elettaria cardamomum), Tejpatr (Cinnamomum tamala), Lavang (Syzygium aromaticum), Trivrutta
(Operculina turpethum), Saindhav (Rock salt), Dhanyak (Coriandrum sativum), Pippali mul (Piper longum
root), Jeerak (Cuminum cyminum), Nagkeshar (Mesua ferrea), Dadim (Punica granatum), Brihat ela (Black
cardamom), Hingu (Ferula asfoetida), Ajmoda (Apium graveolens), Sajjikshar (Sodium bicarbonate),
Pushkarmool (Inula racemosa), Mishri (Rock sugar)
Indications: Boosts immunity and aids to treat indigestion

2) Capsule DM:
Ingredients: Aamragandhi Haridra (Curcuma amada), Guduchi (Tinospora cordifolia), Methika (Trigonella
foenum), Shweta musli (Chlorophytum borivilianum), Nimba (Azadirachta indica), Karvellak (Momordica
charantia), Jambu (Syzygium cumini), Bilva patra (Aegle marmelos leaves), Gudmar (Gymnema sylvestre),
Shilajeet (Asphaltum)
Indications: All types of diabetes and all diabetic complications.

3) Madhumehanashaka syrup:
Ingredients: Karvellak (Momordica charantia), Jambu, Nimba (Azadirachta indica), Kirattikta (Swertia
chirayta), Gudmar (Gymnema sylvestri), Kutaj (Holarrhena antidysenterica)
Indications: Diabetes mellitus, Diabetes neuropathy, Retinopathy, Hyperglycemia

4) Prameharoghar powder –
Ingredients: Kutaki (Picrorhiza kurrooa), Kirattikta (Swertia chirayta), Nimba (Azadirachta indica), Karvellak
(Momordica charantia), Rasanjan (Berberis aristat), Amlika beej (Tamarind seeds), Kala namak (Black salt),
Guduchi (Tinospora cordifolia), Shunthi (Zingiber officinale), Babul tvak and phal (Acacia Arabica bark and
fruit), Sarpagandha (Rauvolfia serpentine), Trivang bhasma, Yashad bhasma, Revandchini, Guggulu
(Commiphora mukul), Methika (Trigonella foenum), Jambu (Syzygium cumini), Karanj (Pongamia pinnata),
Shilajeet, Haridra (Curcumas longa), Haritaki (Terminalia chebula), Indrayava (Holarrhena antidysenterica
seeds), Vanshlochan (Bambusa arundinacea), Bibhitak (Terminalia Bellerica), Amalki (Emblica officinalis),
Shweta musli (Chlorophytum borivilianum), Gudmar (Gymnema sylvestre)
Indications: All types of diabetes, controls blood sugar level, relieves urinary problems, improves immunity,
useful in diabetic neuropathy and retinopathy

5) Nervine tonic syrup:

Ingredients:Ashwagandha (Withania somnifera), Musli (Chlorophytum borivilianum), Manjishtha (Rubia
cordifolia), Haritaki (Terminalia chebula), Haridra (Curcuma longa), Rasna (Pluchea lanceolata), Vidari

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(Pueraria) , Arjun (Terminalia arjuna), Musta (Cyperus rotundus), Trivritta (Operculina turpethum), Shweta
chandan (Santalum album), Rakta chandana (Pterocarpus santalinus), Sariva (Hemidesmus indicus), Chitrak
mula (Root of Plumbago zeylanica), Bramhi (Bacopa monnieri) , Shatavari (Asparagus racemosus), Shunthi
(Zingiber officinale), Shatpushpa, Renuka (Calamus vattayila), Madhu (Honey)
Indications:Nerve disorder, numbness, insomnia, memory loss, bone disease, weakness

6) Tablet JS Diab:
Ingredients: Karvellak (Momordica charantia), Gudmar (Gymnema sylvestri), Paneer dodi (Withania coagulens),
Jambu (Syzigiumcumini, Methika (Trigonella foenum-graceum), Nimba (Azadirachta indica), Kalmegha
(Andrographis paniculata), Bilva (Aegle marmelos), Mamajjak (Enicostema littorale), Guduchi (tinospora
cordifolia), Yashad bhasma, Vang bhasma
Indications: Diabetes, diabetes neuropathy, retinopathy

7) Tablet Immune pathy:

Ingredients: Nmba (Azadirachta indica), Guduchi (tinospora cordifolia), Haridra (Curcuma longa), Maricha (Piper
nigrum), Twak (Cinnamomum tamala), Shunthi (Zingiber officinalis), Ashwagandha (Withania somnifera)
Indications: Immunity booster, weakness, liver disease, kidney disease, CA

8) Capsule LIV DS:

Ingredients: Bhumyamalki (Phyllanthus niruri), Kasmard (Cassia oxidentalis), Hinsra (Capparis sepiaria),
Punarnava (Boerhavia diffusa), Guduchi (Tinospora cordifolia), Kakmachi (Solanum nigrum), Arjun (Terminalia
arjuna), Zabuk (Tamarix gallica), Vidang (Embelia ribes), Chitrak (Plumbago zeylanica), Kutaki (Picrorhiza
kurrooa), Haritaki (Terminalia chebula), Bhringraj (Eclipta prostrate)
Indications: Liver disease, GIT, GERD, loss of appetite

9) Yakrit shothahar vati

Ingredients:Punarnava (Boerhavia diffusa), Marich (Piper nigrum), Pippali (Piper nigrum), Vidang (Embelia ribes),
Devdaru (Cidrus deodara), Kushtha (Saussurea lappa), Haridra (Curcuma longa), Chitrak (Plmbago
zeylanica), Haritaki (Terminalia chebula), Bibhitak (Terminalia bellirica ), Aamalki (Emblica officinalis),
Danti (Baliospermum montanum), Chavya (Piper retrofractum), Indrayava (seeds of Holarrhena
antidysenterica), Pippali mula (root of Piper longum), Musta (Cyperus rotundus), Krishna jeerak (Carum
carvi), Kayphal (Myrica esculenta), Kutaki (Picrorhiza kurrooa), Trivritta (Operculina turpethum), Shunthi
(Zingiber officinale), Karkatshringi (Pistacia integerrima), Ajmoda (Apium graveolens), Mandoor bhasma
Indications: Deepan, Pachana, Rasayana

10) Syrup Telome:

Ingredients: Kumari (Aloe vera), Guduchi (Tinospora cordifolia), Bhringraj (Eclipta alba), Aamalki (Emblica
officinalis), Kutaki (Picrorriza kurroa), Vidang (Embelia ribes), Chitrak (Plumbago zeylanica), Daruharidra
(Berberis aristata), Kalmegha (Andrographis paniculata, Bhumyamalki (Phyllantyhes niruri), Pudina (mint leaves),
Tulsi (Ocimum sanctum), Pippali (Piper longum), Jeerak (Cuminum syminum), Punarnava (Boerrhvia diffusa),
Bilva (Aegle marmelos), Ela (Cinnamomum cardamom)
Indications: Liver disease, GIT, metabolic disorder, cell rejuvenation

11) Tablet Dr. Sukoon:

Ingredients: Apamarga (Acharanthes aspera), Shatavari (Asparagus racemosus), Ashwagandha (Withania
somnifera), Bramhi (Bacopa monnieri), Vacha (Acorus calamus), Shankhapushpi (Convolvulus pluricalis)
Indications: Sleeplessness, anxiety, headache, restlessness

12) Arogya vati:

Ingredients: Loha bhasma, Abhraka bhasma, Tamra bhasma, Aamalki (emblica officinalis), Bibhitak (Terminalia
bellerica), Haritaki (Terminalia chebula), Chitrak (Plumbago zeylanica), Kutaki (Picrorriza kurroa), Nimba
(Azadirachta indica)
Indications: Deepan, Pachana, Rasayana

Diet and Exercise:

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DIP diet plan was advised to him. This diet plan is helpful in managing disorders which caused by unhealthy
lifestyle. This diet gives discipline to the patient’s diet timing and it planned intelligently with how much quantity
should be advised for salad and fruit. Formulas for quantity of fruits and salad are mentioned previously in DIP diet
plan according to patient’s weight. It can be helpful in diseases like diabetes, hypertension, thyroid, liver diseases,
etc.

Following pathy-apathy aahar (Healthy and unhealthy diet) was advised to patient which is explained by acharya
Bhavmishra.

Pathy aahar:
Godhuma (Wheat), chanaka (Chickpeas), aadhaki (Pigeonpea), kulatth (Horse gram), purana anna (Old
grains/millets), tikta shaka (Bitter taste vegetables), yavanna vikriti (Barley recipes), mudga (Green gram), shali
(Rice)

Varjayeta:
Madira (Alcohol), taila (Oily food), takra (butter milk or curd), ksheera (milk), ghrita (ghee), guda (Jaggery), amla
(sore taste food), ikshurasa (Sugarcane juice), pishtanna (Starch food), anoop mans (non-veg)

Exercise is more necessary in diabetic patient as acharya Charaka mentioned in the treatment of prameha that,
“vyayamyogai vividhai” means different type of exercises should do.

Further Scope of Advance Research :-

This case study is of great value in its own as it gave a tremendous result in uncontrolled type 2 DM with its
complication named diabetic neuropathy and this result is just within 74 days without any adverse effect by
ayurvedic therapeutics. But this is a single case study with diabetic complication. There is a need to collect data on
large scale to analyze the average result of ayurvedic therapeutics in type 2 DM along with its all type of
complications and not only the diabetic neuropathy. This collective data will be a proof and be useful to treat the
patients of DM successfully with ayurvedic therapeutics.

Conclusion :-
This case is of uncontrolled type 2 diabetes mellitus and diagnosed as pittaj prameha-Haridra meha according to
ayurveda. Overview of the case concludes that though the case is of uncontrolled diabetes came with diabetic
complication also, he/she can be cured and get reversed to normal within short period. In this case after total 74 days
of ayurvedic treatment it reduced from 10.4% to 4.9% successfully and it is within border line range of non-diabetic
HbA1c. This treatment does not show any adverse effects.

References:-
1. Harsh Mohan, Textbook of pathology, Section 03, Systemic Pathology, Chapter 27, The The Endocrine System,
Endocrine Pancreas; Jaypee brother’s medical publishers (P) LTD, sixth edition 2010, page no. 821
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