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| REVIEW ARTICLES |
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| Year : 2023 | Volume
: 11
| Issue : 1 | Page : 51-59 |
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Prameha (diabetes): A scoping review of updates from Keraliya Ayurveda literature
Arun K Mahapatra1, Rajagopala Shrikrishna1, Nisha K Ojha2, Prasanth Dharmarajan3, Aparna Dileep1, Karthik Kasimadom Parameswaran1
1 Department of Kaumarabhritya, All India Institute of Ayurveda, New Delhi, India
2 Department of Kaumarabhritya, National Institute of Ayurveda, Jaipur, Rajasthan, India
3 Department of Panchakarma, All India Institute of Ayurveda, New Delhi, India
| Date of Submission | 22-Jul-2023 |
| Date of Decision | 17-Mar-2023 |
| Date of Acceptance | 17-Mar-2023 |
| Date of Web Publication | 15-Apr-2023 |
Correspondence Address:
Karthik Kasimadom Parameswaran
Department of Kaumarabhritya, All India Institute of Ayurveda, Delhi, G77X+7R4, Mathura Rd, Gautam Puri, Sarita Vihar, New Delhi 110076
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jism.jism_63_22
The term “Prameha” denotes a wide variety of diseases, among which diabetes is the most widely used one. There are several regional variations in the pieces of knowledge and practices about Prameha. This article compiles the contributions of Kerala’s Ayurvedic textbooks in the diagnosis and management of Prameha and their relevance in the current scenario for their availability and evidence to substantiate their effectiveness. Textbooks written by physicians of Kerala were screened for eligibility (relevant contributions in Prameha). Eleven texts were found eligible and scrutinized. The diagnostic and therapeutic contributions were categorized, and the therapeutic contributions were searched on PubMed, Scopus, and Google Scholar for supporting evidence. The 128 contributions obtained were as follows: diagnostic: etiological factors (1), clinical features (4), and diagnoses (3); and therapeutic: lines of management (8), pharmacological interventions (50), nonpharmacological interventions (7), procedures (15), and diet and regimen modifications (40). All single drugs and six formulations were available, and supporting evidence was available for 13 drugs mentioned and two proprietary medicines containing these drugs. The contributions have raw material availability and preclinical evidence. Further research and availability of these are to be ensured for these leads to be useful in managing Prameha on larger scale. Keywords: Ayurveda, diabetes, ethnopharmacology, Keralya Ayurveda, Prameha
How to cite this article:
Mahapatra AK, Shrikrishna R, Ojha NK, Dharmarajan P, Dileep A, Parameswaran KK. Prameha (diabetes): A scoping review of updates from Keraliya Ayurveda literature. J Indian Sys Medicine 2023;11:51-9 |
How to cite this URL:
Mahapatra AK, Shrikrishna R, Ojha NK, Dharmarajan P, Dileep A, Parameswaran KK. Prameha (diabetes): A scoping review of updates from Keraliya Ayurveda literature. J Indian Sys Medicine [serial online] 2023 [cited 2023 Jun 7];11:51-9. Available from: https://www.joinsysmed.com/text.asp?2023/11/1/51/374256 |
| Introduction | |  |
Prameha is the term used in Ayurveda to denote a group of pathologies characterized by polyuria and turbidity of urine. Diabetes mellitus, obesity, and metabolic syndrome are the major entities grouped under Prameha.[1] Other diseases such as nephrotic syndrome are also sometimes considered variants of the same.[2] The condition that is mostly correlated with Prameha is diabetes mellitus. Diabetes is a global health challenge that has been rising in terms of prevalence (463 million in 2019) and economic burden to the healthcare sector (US$760 billion, 2019) throughout the past 4 decades.[3] To deal with this crisis, traditional and complementary medicines are also being incorporated into the national healthcare systems as a part of the universal health coverage movement.[4] In this context, the indigenous pieces of knowledge and practices that play a major role in health promotion and disease cure in remote areas are also to be studied and made use of. It is of pivotal role in societies such as India that has a great diversity in terms of geography, climate, culture, ethnobotany, and ethnopharmacology. Kerala is one such region that has a wide collection of knowledge and practices, which have been documented in the form of both textbooks and research works.[5] This article aims at exploring the salient contributions of Keralya Ayurveda texts and additions to the existing corpus of knowledge in the context of Prameha in both diagnostic and treatment aspects, and analyzing them in terms of availability of evidence and prevalence in market and practice.
| Materials and Methods | | |
The study mainly included a literature review. Textbooks (N = 26) of general Ayurvedic practice authored by Keralite physicians who were in practice over different regions were collected irrespective of their period of authorship. Among them, the texts that were incomplete (with relevant portions missing), that which do not contribute to the domain of Prameha, that containing only reinstatements of the ideas in Br̥hattrayīs or contemporary texts, that which contain only complex, multidrug preparations were excluded (NR = 15). The included texts (NA = 11) were searched for diagnostic and therapeutic contributions relevant to the context of Prameha. The diagnostic advances were quoted as such, and therapeutic contributions were analyzed further for their current status in society in terms of evidence and availability in the market. Research papers from various journals indexed by PubMed, Scopus, or Google Scholar were also collected and scrutinized irrespective of their period for evidence analysis. Keywords used were the botanical name of the drugs obtained from the text search: Prameha, diabetes, Ayurveda, Kerala, ethnopharmacology, and ethnobotany. For finding out the availability in the market, the catalogs of pharmaceutical companies and online stores were searched for [Figure 1].
| Observations and Results | | |
These were the 11 texts from which data regarding Prameha were collected.
The highest number of formulations of interest were obtained from the text Cikitsmañjari, the author and period of which is unknown (Some Vaidyas consider Pulmantol Mooss as its author). The commentary by Sri. D. Sreeman Nambūtiri has been referred here. The book has been divided into two parts comprising 46 chapters in the first part and 19 in the second. The first part follows Cikitsāsthāna of Aṣṭāṅga Hr̥daya, except for these: after Raktapittachikitsā (treatment of bleeding disorder) and Asr̥gdaracikitsā (treatment of Menorrhagia) have been placed. After Rājayakṣmā (~tuberculosis) comes Bhaktarodha (~anorexia) and Chardi (~emesis). Viṣūcikā (~indigestion with vomiting and diarrhea with colicky pain) has been mentioned after Grahaṇīcikitsā (treatment of malabsorption syndrome). Somaroga (~leucorrhea) and Mūtrātisāra (polyuria) have been mentioned following Pramehacikitsā. Visarpacikitsā (treatment of herpes zoster) is succeeded by the treatment of Masūrikā (pustular lesions), Visphoṭa (vesicles), and Śītapitta (urticaria). In the second part, parts of other branches of Ayurveda except Agadatantra, Rasāyana, and Vājīkaraṇa have been mentioned in brevity. The text contains an elaborate explanation of both Brihattrayi-based and vernacular formulations, but there are repetitions of the same formulas at different locations with the same indication sometimes facilitating repurposing but at times making the text less concise. For instance, the formulation Ārukālādi mentioned in Prameha is a duplication of the Ārukālādi mentioned in Jvara, with just Prameha as the addition in indication. Kalyāṇakaghr̥ta, Piṇḍataila, etc. have been mentioned in diseases different from their original contexts. An annexure of medicine preparations and procedures has also been added.[6]
Vaidyamanōramā is a text that was edited, commented, and published by TC Parameśvaran Moossat, printed at Bhārativilāsaṃ Press, Thrissur, in 1931.[7] The text has the skeleton of Cikitsāṃañjari. Small differences were observed: Viṣūcikā has been mentioned under Grahaṇīcikitsā. Somaroga and Mūtrātisāra have been mentioned under the main heading of Pramehacikitsā. Kakṣyā and its treatment have been mentioned in addition to other dermatological conditions such as Śītapitta. After Vātaraktacikitsā (treatment of rheumatism), the last chapter of Vāgbhaṭa’s Cikitsāsthāna, comes the treatment of Uraḥkṣata (chest injury), Sthaulya (obesity), Kārśya (malnutrition), Vandhyata (sterile), Prasūti, Bāla, Unmāda (mental disorders), Apasmāra (epilepsy), and diseases of eye, ear, and nose. Under the last chapter, diseases such as Ślīpada (elephantiasis) have also been included. Each chapter is in the form of disease peculiarity, line of management, and formulations.
The khal̥a or mukkuṭi formulations have been primarily quoted from Navakhaṇḍaṃ, of an anonymous author, edited by CN Vasudevan Moossath (Government Press, Trivandrum, Kerala, 1939).[8]Navakhaṇḍam is a purely pharmaceutical text that has been organized in the form of sections named after dosage forms. A section dedicated to Khal̥a Kalpana, the preparation of Āvartitatailas (oils fortified with the medicine multiple times), are some major contributions of Navakhaṇḍam.
The text Yōgasāraṃ, written by K. Kēlan Vaidyan,[9] edited by Dr. M. K. Vaidyar, hard copy of which is available at Government Oriental Manuscript Library, Chennai (Printed 1952), had contributed to both diagnostic and therapeutic aspects. Bheṣajapaddhati authored by Puruṣōttaman Nambūtiri is a highly condensed text based on Aṣṭāṅga Hr̥daya and contains additions based on local knowledge and the author’s experiences. It has been divided into four major sections dealing with body and diseases (Rogavicārakhaṇḍa), drugs and pharmacology (Bheṣajavikalpakhaṇḍa), therapeutic procedures (Kriyābhedakhaṇḍa), and disease-specific management (Upakramakhaṇḍa).[10]
Cikitsākramaṃ with Bhāṣāvyākhyāna, author of which is anonymous, with the commentary by K. Vasudevan Moossath, Bhārativilāsaṃ Press, Thrissur, 1939, is another text that has been quoted. The text consists of 42 chapters, following a very similar sequence to that of Vaidyamanorama, except for the part after Vātaśoṇita. In this text, Vātarakta is followed by Sthūlādicikitsā (containing treatment of obesity, emaciation, and loss of sleep) and Garbhacikitsā (management of normal pregnancy, miscarriage, and measures for comfortable and normal delivery).[11]
Cikitsakacintāmaṇi is a text written by P. Nārāyaṇa Pilla, printed at Śrīrāmavilāsaṃ Press, Kollaṃ, 1953. The text has been divided into two parts with an annexure. The first part consists of four chapters. The first chapter contains mainly fundamental principles and the Śārīravijñāna (knowledge of body). The basics of pulse diagnosis, concepts of the 10 vital forces, 96 principles of life, and the 6 energy plexuses have been mentioned, and they all have been linked to the basics of Ayurveda. For example, Vāta doṣa has been identified to reside in the Iḍānāḍi, Pitta in Piṅgal̥a, and Kapha in Suṣumnā. The second chapter consists of prognostication based on various principles such as clinical presentations, omens, and messengers. The third chapter mainly describes Ayurvedic therapeutics, both herbal and mineral. The fourth chapter is about Daivavyapāśrayacikitsā and various types of the same. The second part is composed of seven chapters, which cover the diseases in a sequence similar to that of the above-mentioned texts. Each chapter contains a basic nosology, line of management, therapeutic contributions of the texts, and mentioning of the formulations mentioned in other texts, which have been detailed in the annexure. The text also includes the deeds or sinful acts that form the cause of each disease and also their remedies.[12]
Sahasrayogaṃ Sujanapriyāvyākhyā, edited by K. V. Krishnapillai and A. Gopalapillai, published by Vidyarambham publishers, 2012 edition, has also been referred to as it is one of the most prevalent formulation-centric texts not only in Kerala but the whole of India. The core of the text mainly dealt with multiple dosage forms, and the order followed was that of Mādhavanidāna. The annexure contained ophthalmology and otorhinolaryngology, properties of various food articles, purification of various minerals, and also the text Dhārākalpa related to different Pañcakarma procedures.[13]
Vaidyatārakaṃ, a pediatric text by N. Nārāyaṇan Vaidyar, has given a depiction of the disease kl̥ōmarōga, which has some similarities to diabetes. Vaidyatāraka also has incorporated both the Western knowledge of its periods such as development, breastfeeding recommendations, and child psychology, and vernacular strongholds in Ayurveda such as dermatology, epilepsy, and rheumatic disorders in children.[14]
Among the recent texts, Ayurveda Auṣadharahasyaṃ by PPA Khādar Vaidyar, taken to the public by Capital International Publishers, Kozhikode (2000), was referred for single drugs. The book is written in an order completely different from other texts. The order goes as Śiraḥśūla (headache), Śirobhrama (dizziness), Jvara (fever), Pīnasa (catarrh), Agnimāndya, Ajīrṇa (indigestion), etc.[15]
Sukhasādhaka of Vaikkatt Pāccumūttat is also a text about general medicine containing 12 sections dealing with fever, bleeding-respiratory-cardiac diseases, vomiting and polydipsia, gastrointestinal, edematous, dermatological, locomotor-neurological-rheumatological disorders, and diseases of head and eye, ear-nose-oral cavity, surgical conditions, toxicology, and mother-child care, respectively.[16]
Fifteen other texts of Kerala were also referred, but a little or no relevant additions regarding Prameha were obtained from them and, hence, not considered for further scrutiny. They were Sarvarogacikitsāratnaṃ, Sarvarogacikitsānūl, Yogāmr̥ta, Siddhavaidyasaṅgraham, Hr̥dayapriyaṃ (related to general medicine), Ārogyakalpadruma, Ārogyacintāmaṇi, Bālacikitsā, Bālacikitsā (bhāṣā), Vaidyasārasaṅgrahaṃ (pediatrics), Viṣajyotsnikā, Prayogasamuccayaṃ, Koḍaśśeri Mārgam (toxicology), Śirassekādividhiḥ (Pañcakarma), and Netrarogacikitsāratnaṃ (ophthalmology).
A total of 128 contributions were obtained, which were grouped as follows: diagnostic: one etiological factor, four clinical features, and three diagnoses; and therapeutic: 8 lines of management, 50 pharmacological interventions, 7 nonpharmacological interventions, 15 procedures, and 40 diet and regimen modifications.
Etiological Factors
One who involves in sexual activity with his mother or sister due to ignorance develops Prameha.[14]
Diagnosis
Kl̥ōmarōga
Excessive consumption of unctuous and heavy food items or injury/assault to the organ leads to this disease.[17] Though the organ kl̥ōma is a controversial one, the undeniable relation between kl̥ōma and udakavahasrotas or the channels carrying aqueous elements of the body (hence the diseases about them), and between Prameha and tṛṣṇā (that is a pathology of udakavahasrotas) points toward the fact that Kl̥ōmarōga and the management modalities of the same finds an important place in understanding and treating Prameha, especially Jātaprameha or the congenital form of Prameha.
Somaroga
Due to grief, exertion, excessive sexual intercourse, or toxin accumulation in body, the aqueous content of the body gets eliminated via urine, resulting in whitish, cold, and painless discharge associated with dryness of the oral cavity and face, coated tongue, headache, polyphagia, lethargy, and polydipsia.[18] It is called Somaroga as it involves the loss of Soma or the aqueous content of the body.
Mūtrātisāra
Chronic Somaroga associated with polyuria and increased weakness is termed Mūtrātisāra.[9]
Clinical Features
Urine that resembles clear water associated with polyuria is said to be diagnostic of Kapha-predominant Prameha, and that resembling sesame oil, ginger juice, or cow urine is of the Pitta-dominant one.[10]
Treatment Principles
Prameha
In Prameha, stambhana (the therapeutic procedure of arresting the excessive motility or flow of different components in the body, similar to styptic action) is advised, and śodhana is advised (biopurification) for individuals with sufficient strength. Śoṣaṇa (desiccation) of medas (fat) and mūtra (urine) is to be done using tablets in obese and ghee in lean people.[19]
Pramehapiṭaka (diabetic carbuncles)
The treatment of Pramehapiṭaka is similar to that of Prameha. Pariṣeka (therapeutic streaming), lepa (anointment), and other external applications of cold potency are to be used. Decoctions and gruels advised in Raktapitta (bleeding disorders) are to be used. Biopurification is to be done in strong patients. Piṭakās that have single or multiple openings get pacified if biopurification is administered at the very time of their onset. On administration of cold topical therapies, they seldom get suppurated, and if that happens, the management modalities of vraṇa or ulcer are to be followed.[20]
Pharmacological and Nonpharmacological Interventions
The texts referred to contained both medical and nonmedical managements. Medical management consisted of both single drugs and formulations but less of herbomineral preparations. Medicines when used for śamana (pacifying) in Prameha are most effective when used in the form of kalka, that is, in paste rather than in their aqueous form.[21] Seven single drugs have been mentioned. All of them have specific adjuvants for administration [Table 1]. Nonpharmacological management (seven methods mentioned) mainly includes spiritual and prosocial activities. Nine powders, fourteen decoctions, four tablets, three electuaries, seven preparations of ghee, and five of buttermilk were identified among compound formulations. Specific indications, time of administration, and adjuvants were noted wherever available. | Table 1: Pharmacological and nonpharmacological interventions in Prameha
Click here to view |
Procedures
Three procedures were found indicated at various stages of Prameha [Table 2]. They included Abhyaṅga (oil massage), Takradhāra (therapeutic streaming using buttermilk), and Kabala (gargling). Thirteen formulations were identified to be recommended for Abhyaṅga and one for Kabala. For Takradhāra, the procedure was mentioned in the annexure, wherein decoction of Āmalakī was indicated to be added to sour buttermilk and to be streamed from the appropriate height and at appropriate temperatures. It was specifically indicated in diseases above neck, pins, and needle sensation, fatigue, laxity of joints, and generalized decrease in vitality, all of which are associated with Prameha.[8]
Diet and Regimen
Unique recommendations in diet and regimen were seen in three texts: Cikitsāmañjari, Vaidyamanoramā, and Navakhaṇḍaṃ. Repetitions of recommendations in Br̥hattrayīs such as sugarcane and curd were excluded. Forty recommendations were observed, among which 38 were regarding diet and 2 regarding regimen, with 19 each of indications and contraindications, respectively. Ten single foods, eight preparations, and one dietary habit were indicated. Among the contraindications, 15 were single entities, 4 were groups (meats, fishes, salts, and tubers), and 1 was a habit (excess eating). Āpūpa or pancakes are generally contraindicated in Prameha unless fortified as in Nandyāvartaāpūpa. Four versions of a therapeutic diet called Khal̥a (medicated buttermilk) were found in Navakhaṇḍaṃ[22] [Table 3].
Evidence Status
Four formulations from the list cited above have been subjected to clinical studies: Niśākatakādikaṣāyaṃ,[23]Katakakhadirādikaṣāyaṃ,[24]Palāśapuṣpakvātha,[25] and Nīrūryādiguṭikā.[26] Among single drugs and dietary recommendations, Saptraṅgī (Salacia reticulata), Campakā (Magnolia champaca),[27]Sadāphala (Ficus carica),[28]Guḍūci, and Āmalakī were studied clinically and Strychnos potatorum, Peristrophebi calyculata, Trichosanthes dioica, Aervalanata, Cycleapeltata, Symplocos cochinchinensis, Acacia, and Moringa oleifera have been subjected to animal studies and identified to possess antidiabetic activities of varying levels.[29],[30],[31],[32],[33],[34],[35],[36] Two formulations containing the above drugs have been studied in human subjects.[37],[38] Indirect evidence was obtained for nonpharmacological interventions in the form of clinical trials.[39] Both supporting and contradicting evidences were obtained regarding the contraindications in diet.
Availability in Market
Of the above-mentioned contributions, all the single drugs mentioned were available, either in the form of raw drugs or processed pharmaceutic products. Among the formulations, Niśākatakādikaṣāyaṃ, Katakakhadirādikaṣāyaṃ, Palāśapuṣpakvātha, Nīrūryādiguṭikā, and the oils Ārukālādi and Niśośirādi were available in the market. Among the dietary recommendations, all were available in the raw product form, but those such as Śārṅgeṣṭikā, Pattūra, and Kaśeruka are not part of a regular diet. One proprietary preparation containing the single drugs mentioned above was found available in the market.
| Discussion | | |
Most of the literary works in Keralya Ayurveda have been retrieved from dilapidated manuscripts. Other than the fact that they have been authored by someone from the lineage of the family who stockaded or donated it, there is very less information available regarding the author or his period. The works predominantly append Aṣṭāṅga Hr̥daya of Vāgbhaṭa, which has been given supreme position throughout the medical history of Kerala (Sahasrayogaṃ is an exception, as it follows the disease pattern of Mādhavanidānaṃ and allied texts).
As most of these texts were documentation of the prevalent practices along with personal experiences, they share common and similar principles and formulations. Some of them have even been written in their vernacular dialects. In addition to the modification in classical preparations (~Ṣaḍaṅgatōya), regional variations were observed even within the formulations of these texts. Considering Niśākatakādikaṣāya, which is a very commonly practiced formulation in Prameha, the standard formulation in practice is the form seen in Cikitsāmañjari and Sahasrayogaṃ: Niśā (Curcuma longa), Kataka (Strychnospotatorum), Nellikka (Phyllanthus emblica), Tecci (Ixora coccinea), Pāccōṭṭi (Symplocos cochinchinensis), Bhadrikā (Aervalanata), Ekanayaka (Salacia reticulata), and Rāmaccam (Vetiveria zizanioides). In Cikitsākramaṃ and Yogasāraṃ, bhadrikā (Aervalanata) is substituted by Gōpika (Hemidesmus indicus),[40],[41] and in Navakhaṇḍaṃ, Tecci has been substituted by Veṭṭi, a wild variety of Lodhra.[42]
Diagnostics (Etiological Factors, Clinical Features, and Diagnoses)
Descriptions have been given regarding the Prameha variants on a Tridoṣa basis, which is more feasible practically. The presentation similar to Prameha, called Kl̥ōmarōga, resembling that of the descriptions in Bhaiṣajya Ratnāvalī, must be inspired from the same. Insulitis or the immune infiltration in and around islets has been recognized to play a significant role in type-1 diabetes mellitus.[43] The relevance of Kl̥ōmarōga needs to be assessed on these lines. The association between pancreatic trauma and diabetes is poorly studied. Somaroga and Mutratisara are diseases that have slight resemblance to Prameha in terms of cardinal features. But they have been excluded due to major differences in the line of management, i.e., use of Satavari (Asparagus racemosus) in Somaroga and Talaphala (Borassus flabellifer) in Mutratisara. Hence, the congruity between these pathogeneses and Prameha is doubtful.
Therapeutics
Line of treatment
The line of treatment is mostly in congruence with that mentioned in the Br̥hattrayīs. Stambhana specifically mentioned signifies the contraindication of sudation therapies in Prameha. Medomūtraviśoṣana or desiccation of the Medas and Mūtra has been indicated, with special mention of Guṭikās for obese, and ghee for lean. Kalka kalpana has been mentioned to be of higher efficacy compared with aqueous forms. In the Pramehapiṭakas, modalities such as Kaṣāyas and Peyas mentioned in the disease Raktapitta have been recommended. Śodhana is advised for the strong, and if done in the initial stage of Pramehapiṭakas, and lessens their intensity; and cold Lepa and Seka reduce burning sensation and suppuration; and for those who have attained suppuration, ulcer management shall be given. The fried form of Yamakas has been advised in the stage of Piṭakas where they have erupted or broke open.
Pharmacological and nonpharmacological interventions
Among drugs, Ficus carica was found to significantly reduce glucose, lipid profile, kidney, and liver enzyme levels in diabetic rats.[44]Guḍūci (Tinospora cordifolia) and Āmalakī (Emblica officinalis) powders when used with Māmajjaka (Enicostemma littorale), lifestyle modifications, and Yoga practice were found to be effective in reducing fasting blood sugar as well as subjective symptoms such as polyuria, polydipsia, and polyphagia in prediabetic and diabetic patients (type 2).[37]Saptrangyadi ghan vati, with Saptraṅgi as the major ingredient, was found to significantly reduce both fasting and postprandial blood sugar as a standalone treatment in newly detected type 2 diabetes mellitus cases and in addition to conventional diabetes treatment in chronic diabetes cases.[33]Symplocos cochinchinensis, one of the ingredients of Niśākatakādi kaṣāya and several other formulations used in diabetes, has been identified to act mainly through alpha-glucosidase inhibition, improving insulin sensitivity, antiglycation, and antioxidant activity.[31]Aervalanata and Cyclea peltata have also been found to be hypoglycemic in rats.[32],[36]Rajanyāmalakādi tablet, containing Haridrā (Curcuma longa), Āmalakī (Emblica officinalis), and Saptraṅgi (Salacia reticulata) (in the ratio 1:1:2 administered for 3 months) were found to significantly reduce fasting blood sugar, glycated hemoglobin (HbA1c), total cholesterol, triglycerides, low density lipoprotein, and very low density lipoprotein cholesterol and free fatty acids and also increase high density lipoprotein cholesterol, insulin, and glutathione reductase activity in type 2 diabetes mellitus patients as a standalone medication.[45]
The role of nonpharmacological interventions such as exercise has been well established in the management of diabetes. The virtuous deeds mentioned among them were activities of prosocial behavior and spirituality enhancement, which have been found effective in various physical and psychosocial illnesses.[46] A study specific to diabetes and such activity was also obtained wherein a mindfulness and self-compassion program of 8 weeks was found to significantly reduce depression, diabetes distress, and HbA1c levels among type 2 diabetes mellitus patients.[34] Assessment of specific psychoneuroendocrine impacts of these activities requires further studies.
Diet and regimen
Acacia bark extract contains proanthocyanidins, which are responsible for its antidiabetic activity.[35] The hypoglycemic activity of Moringa oleifera and its ability to prevent chronic metabolic derangements have been studied in 33 animal studies and 8 human studies.[47] Among the dietary contraindications, ghee, nonvegetarian diet, and potatoes (among Vidāhikandas) were observed to be consumed by 80.00%, 23.34%, and 77.33% among 150 type 2 diabetes mellitus patients in Gujarat.[48] Coconut is contraindicated in diabetes as per Cikitsāmañjari, but outcomes from an animal study show that its oil has a protective effect in diabetes against microvascular complications such as retinopathy and nephropathy accounting for the presence of lauric acid, which inhibits aldol reductase and sorbitol dehydrogenase of the polyol pathway. Viśva or dried ginger and Marica have been contraindicated probably due to their Madhura vipāka (sweet in postdigestive effect), but the systematic reviews and meta-analysis on their impact on diabetes have shown their effectiveness in a significant reduction of diabetic parameters including blood sugar and HbA1c. Both recommended and contraindicated diets are sufficiently available, but the contraindicated items are more in practice in day-to-day life than the former.
| Conclusion | | |
There are several contributions about various domains of Prameha from the Kerala Ayurvedic literature. Their availability is predominantly in the form of raw materials, and preclinical evidence is available regarding their utility in diabetes. Further studies in proving or disproving the effectiveness of these measures are needed for their further streamlining. By doing so, these leads can be utilized in the public health domain to improve the reach, specificity, and comprehensiveness of initiatives such as the National Protocol for Prevention and Control of Diabetes through Ayurveda.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1]
[Table 1], [Table 2], [Table 3]
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