MEHAHARA DASHEMANI- A NOVEL GROUP DEVELOPED BASED ON SUSHRUTA'S MEHAHARA DRUGS WITH SPECIAL REFERENCE TO DIABETES

Abstract

The cardinal signs of Prameha are Prabhuta and Avilamutrata (excessive and turbid urination). When Pramehi suffers from boils and had severe complications can be called as Madhumehi. Uncomplicated diabetes mellitus may be referred as Kshudrameha. WHO estimated 1.5 million deaths in 2012 making it the 8th leading cause of mortality. It is a life style disorder which cannot be cured completely, but life span of an individual can be made worthy by palliative treatment. Synthetic oral hypoglycemic agents are very popular to lower the blood sugar level but it's prolonged use may lead to Vit. B12 deficiency. Therefore, the need of an hour is to find out a natural hypoglycemic source for palliative treatment of Prameha. Sushruta's therapeutic classification can be explored for the Mehahara activity. In total 62 drugs have been incorporated under Mehahara activity categorized under 7 groups of drugs i.e. Aragvadhadi, Salasaradi, Mushkakadi, Trapvadi, Triphala, Vallipanchamoola, and Kantakapanchamoola.

Headnote

ABSTRACT

The cardinal signs of Prameha are Prabhuta and Avilamutrata (excessive and turbid urination). When Pramehi suffers from boils and had severe complications can be called as Madhumehi. Uncomplicated diabetes mellitus may be referred as Kshudrameha. WHO estimated 1.5 million deaths in 2012 making it the 8thleading cause of mortality. It is a life style disorder which cannot be cured completely, but life span of an individual can be made worthy by palliative treatment. Synthetic oral hypoglycemic agents are very popular to lower the blood sugar level but it's prolonged use may lead to Vit. B12 deficiency. Therefore the need of an hour is to find out a natural hypoglycemic source for palliative treatment of Prameha. Sushruta's therapeutic classification can be explored for the Mehahara activity. In total 62 drugs have been incorporated under Mehahara activity categorized under 7 groups of drugs i.e. Aragvadhadi, Salasaradi, Mushkakadi, Trapvadi, Triphala, Vallipanchamoola, and Kantakapanchamoola. Among these drugs 55 are herbal in origin and 7 are mineral in origin. In total 42 herbal and 2 mineral drugs have been evaluated for their antidiabetic property. These drugs act through different mechanism of action. Based upon the analysis of 62 drugs compiled from seven ganas and 43 drugs enlisted for the treatment of 20 varieties of Prameha, a broad spectrum formulation known as "Mehaharadashemani" (Haritaki, Amalaki, Bibhitaki, Guduchi, Haridra, Kiratatikta, Karavellaka, Asana, Meshashringi, and Shatavari) can be used as palliative formulation for all types of Prameha

KEY WORDS: Mehahara dashemani, Madhumeha, Prameha

INTRODUCTION:

The epidemiological survey regarding Diabetes suggests that it is 8th leading cause of mortility. As of 2013, 382 million people have diabetes worldwide. In 2014, the International Diabetes Federation (IDF) estimated that diabetes resulted in 4.9 million deaths. The greatest increase in rates was expected to occur in Asia and Africa, where most people with diabetes will probably live in 2030 (World Health Organization fact sheet, 2013)

Acharya Charaka described about a pathogenesis of Prameha as "the birds are attracted towards the trees where their nests lie, similarly, Prameha affects people who are voracious eaters and have aversion to bath and physical exercises." There are two types of Pramehi (suffering from Prameha) i.e. Sthoola (obese) and Krisha (lean) pramehi. The cardinal sign of Prameha is Prabhuta and Avilamutrata (Excessive turbid urination). Doshika dominance in the disease can be categorized basing on colour of urine. Objective assessment for doshas can be done by boiling the urine to the stage of solidification and the ratio of residual content should be estimated. If residual content as compared to its supernatant liquid is 1/5th portion, it is Vataja; 1/7th portion indicates Pittaja and 1/9th represents Kaphajadosha(K. Nishteswar, 2003).

Acharya Sushruta has allocated separate chapter for Madhumeha, keeping in view its prognosis. One who is suffering from boils and has severe complications is called madhumehi and that is considered incurable (Sushruta Nidana 6/24) (Trikamaji Yadavaji, 2008). Diagnostic criteria for Madhumehi was quoted as one who prefers to stand rather than move from place to place, prefers sitting to standing, lying down to standing, desires to sleep rather than lie down in bed. This observation portrays the extreme weakness of Madhumehi and refers to extreme weakness or asthenic which may be considered as bad prognostic sign. All types of urinary abnormalities if not treated in time develop Madhumeha and then become incurable (Sushruta nidana 6/25, 27) (Trikamaji Yadavaji, 2008). Uncomplicated diabetes mellitus (DM) should not be referred with the term Madhumeha. It is to be categorized under Kshaudrameha.

Modern science classified Diabetes as Type I and Type II. Type I DM It is due to beta cell islet destruction by autoimmune process, and these patients are prone to Ketoacidosis. Type II occurs over 40 years of age. It is associated with Hypertension, Dyslipidemia and Atherosclerosis. This is the most prevalent form and results from insulin resistance, mainly caused by visceral obesity, with a defect in compensatory insulin secretion (Harsh Mohan, 2010).

All oral hypoglycemic agents have side effects on their prolonged use. Sulfonylureas are associated with weight gain and hypoglycemia. It's not proved to be safe in pregnancy. Metformin's major side effects are seen in the gastrointestinal tract, with nausea, cramps and diarrhea. Vitamin B12 deficiency may occur after 1 year of drug administration (Bell DSH, 2002). To find out natural sources of hypoglycemic agent, one can make use of drugs mentioned in classics. Acharya Sushruta had classified drug basing on its pharmacotherapeutic implications. Some of the groups like Aragvadhadi, Salasaradi, Mushkakadi, Trapvadi, Triphala, Vallipanchamoola, and Kantakapanchamoola do possess Mehaghna (anti-diabetic) property. In the present study, an attempt is made to generate the general formulation which can be used in the management of 20 types of Prameha by reviewing these 62 drugs compiled from therapeutic classification of Sushruta. For analysis, the simple recipes quoted for 20 types Prameha by Sushruta were also taken into consideration. And drug's review had been carried out according to their Rasa (Taste), Veerya (Potency), Vipaka (Bio-transformation), Guna (Attributes) and Prabhava (principle responsible for specific action), action and indications mentioned in the classical texts and research works related to anti-diabetic activity.

MATERIAL AND METHOD:

The compilation of drugs had been done from Sushrutasamhita along with its commentary "Nibandhasamgraha" by Dalhana. Rasapanchaka (Rasa, Guna, Veerya, Vipaka, and Prabhava) action and indication of drugs were compiled from Bhavaprakashanighatu and Rajanighantu. Recent research studies were downloaded from Google scholar.

OBSERVATIONS

Sushruta had described total 62 drugs in 7 groups of drugs. Among them 55 are herbal and 7 are mineral in origin. These drugs are tabulated below (Table 1):

DISCUSSION

Among 55 herbal drugs of ganas, in total 42 drugs had been screened for their anti-diabetic activity. Still 13 drugs i.e. Tinisha, Gokshura, Snuhi, Vidari, Kakajangha, Salasara, Patala, Palasha, Vikankata, Kadara, Dasikurunta, Bhoorja, Ajakarna are yet to be evaluated for their anti-diabetic activity. Among mineral drugs only two drugs i.e. Naga (Lead) and Vanga (Tin) do possess anti-diabetic activity.

Analysis of these 62 drugs through various lexicons showed that in total 23 drugs has Mehahara activity. Among them 19 are herbal and 4 are mineral in origin. Acharya Sushruta had mentioned simple recipes in the management of 20 types of Prameha. In total 43 drugs are enlisted in its management. After comparing these two groups (Group of drugs incorporated by Sushruta for the management of 20 Prameha and another group of drugs drawn from therapeutic classification), there are 20 drugs common to both the groups. They are Aguru, Amalaki, Aragvadha, Vibhitaka, Chandana, Chitraka, Guduchi, Haritaki, Kadara, Karanja, Khadira, Kramuka, Kutaja, Moorva, Nimba, Palasha, Patha, Saptaparna, Shimshapa, and Shirisha. Sushruta developed a broad spectrum pramehahara formulation consisting of Amalaki juice and Haridra mixed with honey (Sushrutachikitsa11/8) (Trikamaji Yadavaji, 2008). Based on this observation Vagbhata included Dhatri (Amalaki) and Nisha (Haridra) in the list of prime drugs (Agryaushadhi) for the management of Prameha (Vagbhata Uttara 40/48) (Paradakar Hari Shashtri, 2010).

The person who get indulges constantly in day sleep, absence of physical activities and laziness, consumes foods and drinks which are cold, unctuous and sweet etc. should be understood as prone to Prameha. In such a person, vitiated Vata, Pitta and Kapha dosha (Bio-humours), when get mixed with Meda dhatu (adipose tissue) travel downward along with channels of urine and get localized in the the urinary bladder and begin to flow out through urine and give rise to Prameha. (Sushruta Nidan 6/4, pp) (Trikamaji Yadavaji, 2008). In prameha, all three doshas and dushyas like Meda, Rakta (Blood), Shukra (Semen), Ambu, Vasa (Muscle fat), Lasika (Lymph), Majja (Bone marrow), Rasa, Ojas and Mamsa (Muscle) are responsible for the pathogenesis. (Charaka Chikitsa 6/8,pp).

The drugs used for the management of the 20 types of Prameha should be of Katu (Pungent), Tikta (Bitter) and Kashaya (Astringent) Rasa; Katu Vipaka (Biotransformation) and Ushna Veerya (Hot potency) and should have Laghu (easy to digest), Ruksha (Rough), Vishada (Clear) etc. gunas, so that they can alleviate the vitiated Kapha dosha and dushya.

Majority of the drugs mentioned above are having Katu, Tikta, Kashaya Rasa; Ushna Veerya; Laghu, Ruksha guna which can able to alleviate vitiated doshas and dushyas of Prameha

The above mentioned drugs act through different mode of action. Some of them act by increasing activity of pancreatic cells, increasing insulin sensitivity, exhibiting insulin like activity, maintaining glucose homeostasis (increase of peripheral utilization of glucose, increasing synthesis of hepatic glycogen or decrease in gluconeogenolysis), inhibiting the intestinal glucose absorption, reducing glycemic index of carbohydrate, reducing the effect of glutathione, increasing glucose uptake of adipocytes, enhancing glucose uptake by skeletal muscles, decreasing insulin resistance, increasing glycogen storage, reducing lactate dehydrogenase, increasing activity of enzymes for utilization of glucose, and inhibiting carbohydrate digestion.

Majority of drugs may act by increasing insulin secretion or as insulinmimmetics. E.g. Aragvadha, Vibhitaka, Gopaghanta, Gridhranakhi, Haritaki, Karanja, Khadira, Kiratatikta, Kuruntaka, Kutaja, Madana, Patola, Chirabilva, Shatavari, Shirisha, Karavellaka, Tala. Some drugs like Arjuna, Latakaranja, Mushkaka, Karavellaka, Shaka, Shimshapamay produce their action by inhibiting glucose absorption from intestine and regenerating beta cells of Langerhans.

Out of 78 drugs (a combined list of Ganadravyas and drugs mentioned for 20 types of Pramehas), ten drugs are selected to formulate Mehahara dashemani based on its significant anti-diabetic and antihyperglycemic activities reported during recent research studies. The drugs included in Mehahara dashemani are Haritaki, Amalaki, Vibhitaki, Guduchi, Haridra, Kiratatikta, Karavellaka, Asana, Meshashringi, and Shatavari.

CONCLUSION:

Acharya sushruta had mentioned various groups of drugs for different disease conditions in his therapeutic classification. There are in total 62 drugs are mentioned for Mehahara activity among them 55 are of herbal origin and 7 are mineral in origin. Majority of drugs are screened for their anti-diabetic, hypoglycemic or anti-hyperglycemic activity. Vataja Prameha is not curable, due to contradiction in the treatment by Dosha and Dushya. Therefore, a lifelong treatment has to be taken for the palliation of disease. The need of an hour is to generate a potent herbal origin formulation with fewer side effects on its prolonged use. A potent broad spectrum formulation, Mehahara Dashemani, (Consisting of Haritaki, Amalaki, Bibhitaki, Guduchi, Haridra, Kiratatikta, Karavellaka, Asana, Meshashringi, and Shatavari) can be used as palliative treatment for all types of Prameha to reduce the side effects of prolonged use of synthetic antidiabetic drugs as well as to improve the life span of the patients.

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Cite this article:

Nishteswar K, Sushama Bhuvad (2015), MEHAHARA DASHEMANI- A NOVEL GROUP DEVELOPED BASED ON SUSHRUTA'S MEHAHARA DRUGS WITH SPECIAL REFERENCE TO DIABETES, Global J Res. Med. Plants & Indigen. Med., Volume 4(6): 111-124

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