MONTH: JULY: AUG:2015
VOLUME: 3, ISSUE: 2
ISSN: 2348-1846
TITLE
CLINICAL EVALUATION OF VIRECANA KARMA AND ORAL HYPOGLYCEMIC
AGENT IN THE MANAGEMENT OF PRAMEHA W.S.R TYPE-2 DIABETES
AGARWAL PRATEEK, SIPIKA SWATI , V.K SRIVASTAVA, DHIRAJ KISHORE
PunarnaV
ISSN: 2348 1846
AN INTERNATIONAL PEER REVIEWED AYURVED JOURNAL
CLINICAL EVALUATION OF VIRECANA KARMA AND ORAL
HYPOGLYCEMIC AGENT IN THE MANAGEMENT OF PRAMEHA W.S.R TYPE2 DIABETES
AGARWAL PRATEEK 1, SIPIKA SWATI 2, V.K SRIVASTAVA3, DHIRAJ
KISHORE4
1
JR-3 Department of Kayachikitsa, 2JR-3 Department of Stree Avum Prasuti Tantra
, Assistant Professor Department of Kayachikitsa, 4Assistant Professor Department of
Medicine Faculty of Medicine IMS,BHU, India.
3
ABSTRACT:
Diabetes Mellitus (DM) refers to a group of common metabolic disorders that share
the phenotype of hyperglycemia. Depending on the aetiology of the DM factors
contributing
hyperglycemia
reduced insulin
decreased glucose
VIRECANAtoKARMA
& ORAL include
HYPOGLYCEMIC
AGENTsecretion,
IN THE MANAGEMENT
OF
utilization, and increasedPRAMEHA
glucose production.
DM-2
is
a
heterogenous
group
of
W.S.R TYPE-2 DIABETES
disorders characterized by variable degree of insulin resistance, impaired insulin
secretion, and increased glucose production.
The Ayurvedic texts reflect two major categories of Prameha 1. Sahaja Prameha 2.
Apathyanimittaja Prameha, out of these two, Apathya nimittaja Prameha is closely
resemblance with the contemporary concepts of Type-2 Diabetes mellitus.
In modern medicine many oral hypoglycemic agents (OHA) has been used to control
blood sugar level. Inspite of meticulous use of OHA, in many cases complications
develop and there is no satisfactory control over blood sugar. In Ayurveda,
samsodhan therapy has been said before samana to cure diseases. Thus in this study,
Virecana Karma has been done either before or with OHA to control hyperglycemic
state and its complications.
KEY WORDS: Diabetes Mellitus, Prameha, Samshodhan, Samana,Virecana
INTRODUCTION
CORRESPONDANT:
DR. AGARWAL PRATEEK
JR-3
Department of Medicine
Faculty of Medicine
IMS,BHU,
India.
PUNARNAV :JULY :AUG 2015: VOL: 3 ISSUES: 2
Diabetes is associated with reduced life
expectancy, significant morbidity due to
specific diabetes related microvascular
complications
like
retinopathy,
neuropathy, nephropathy etc and increased
risk of macrovascular complications i.e
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VIRECANA KARMA & ORAL HYPOGLYCEMIC AGENT IN THE MANAGEMENT OF
PRAMEHA W.S.R TYPE-2 DIABETES
ischemic
heart
disease,
stroke
and
in hepatic glucose production lead to overt
peripheral vascular disease and diminished
diabetes
quality
Ultimately, beta cell failure may ensue.
of
life.
The
metabolic
with
fasting
hyperglycemia.
dysregulation associated with DM causes
Caraka has given exhaustive description
secondary pathophysiologic changes in
of the disease Prameha which ultimately
multiple organ systems that impose a
progresses towards Madhumeha or the
tremendous burden on the individual with
sweetness of urine in addition to Polyurea.
diabetes and on the health economy.
It is worth mentioning that Virecana
Type 2 DM is characterized by
Karma, unlike the modern purgatives, is
pathophysiologic
abnormalities:
not merely an act to open the bowel, but is
impaired insulin secretion, peripheral
a complete therapeutic measure which has
insulin resistance, and excessive hepatic
systemic as well as local effects. Virecana
glucose production. Obesity, particularly
Karma is considered the best treatment for
visceral or central, is very common in type
morbid and increased Pitta dosha. Pitta is
2 DM. Insulin resistance associated with
closely related with Agni, which is
obesity
genetically
responsible for the digestive and metabolic
determined insulin resistance of type 2
processes in the body. Diabetes is a
DM. Adipocytes secrete a number of
metabolic disorder hence Virecana karma
biologic products (leptin, tumor necrosis
has beneficial effect. Nowadays, Diabetes
factor, free fatty acids) that modulate
Mellitus is becoming a great problem for
processes such as insulin secretion, insulin
society causing impediment in normal life.
action
may
In present research work, an attempt is
contribute to the insulin resistance. In the
made to adjuvant effect of OHA by
early stages of the disorder, glucose
planning Virecana karma either before or
tolerance remains normal, despite insulin
with it.
three
augments
and
body
the
weight
and
resistance, because the pancreatic beta
cells compensate by increasing insulin
output.
As
insulin
resistance
and
AIMS AND OBJECTIVES
1.
To reflect an over view on the
compensatory hyperinsulinemia progress,
concept of Prameha w.s.r to type 2
the pancreatic islets become unable to
diabetes.
sustain
the
hyperinsulinemic
state.
2.
To evalvuate the synergistic effect
Impaired glucose tolerance marked by
of Virecana Karma with OHA on
elevations in postprandial glucose, and
subjective
then type 2 DM develops. A further
parameters.
decline in insulin secretion and an increase
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PAGE:
and
objectives
MATERIAL & METHOD
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VIRECANA KARMA & ORAL HYPOGLYCEMIC AGENT IN THE MANAGEMENT OF
PRAMEHA W.S.R TYPE-2 DIABETES
•
SELECTION OF CASES
Cases of DM-2 were selected
randomly
from
OPD
and
IPD
of
Type 2 Diabetes Mellitus with
complications.
•
Type
1
Diabetes
Kayacikitsa(Panchkarma), S. S. Hospital,
associated
IMS, B.H.U., Varanasi from august 2013
complications.
to September 2014 after thorough history
taking,
clinical
and
laboratory
•
with
and
Phaeochromocytoma,
Acromegaly, Cushing’s syndrome,
hyperthyroidism etc.
DIAGNOSTIC CRITERIA
Patients of different age group, sex and
•
Drug or chemical induced diabetes
socio-economic status were selected from
mellitus
e.g.
the Kayachikitsa (Panchkarma) OPD &
Thyroid
hormone,
IPD, S.S. Hospital, IMS, BHU, on the
Phenytoin etc.
basis of following criteria.
•
Thiazides,
genetic
syndromes
mellitus e.g. Down’s syndrome,
•Age 30-60 yrs.
History
Certain
Glucocorticoids,
sometimes associated with diabetes
INCLUSION CRITERIA
•Family
without
Diabetes due to endocrinopathies
e.g.
examination..
Mellitus
Klinefelter’s syndrome, Turner’s
of
Diabetes,
HTN,
Dyslipidemia
syndrome etc.
•
Patients suffering from any severe
•Plasma glucose level:
systemic disease.
Fasting: ≥ 126 mg/dl
•
Patient
having
fasting
blood
glucose level ≥ 250mg/dl and pp
Postprandial: ≥ 200 mg/dl
blood sugar ≥350.
HbA1c: ≥ 6.5%
INVESTIGATION
BMI: 18.5 – 29.9
1.
•Patients having classical symptom of

Blood Examination
Routine blood was examined for total
leukocyte count, differential leucocytes
diseases without marked weight loss.
count, hemoglobin percentage and
EXCLUSION CRITERIA
•
erythrocyte
sedimentation
rate
to
exclude any infection.
Age <30yrs. and >60yrs.
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VIRECANA KARMA & ORAL HYPOGLYCEMIC AGENT IN THE MANAGEMENT OF
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

Blood urea and serum creatinine were
a
prepared
protocol
to
assess
the
done to assess the renal status.
therapeutic response of trial treatment.
Liver function test.
The clinical gradations of symptoms were
Urine Examination
as follows.
Urine for each case was examined
0
:
No symptom present.
1
:
Mild symptoms present.
microscopic examination for crystals, casts
2
:
Moderate
and cells.
present
Study design and treatment schedule
3
:
Severe symptoms present.
2.
for
specific
albumin
gravity,
and
acetone
reaction,
sugar,
routinely
and
A total 20 patients with evidence of
symptoms
OBJECTIVE ASSESSMENT
DM-2 and fulfilling the proposed criteria
of selection were enrolled for clinical trial.
Objective assessment was done on the
following basis
All 20 cases will be treated with

Weight

BMI (body mass index)

Fasting blood Glucose

Postprandial blood Glucose
The assessment of the treatment

Serum Cholesterol
was based on both subjective and objective

Serum Triglyceride
parameters.

Serum LDL

HbA1c
Virecana Karma with Trivritadi Leham
(50gm) along with OHA as per need.
ASSESSMENT CRITERIA
SUBJECTIVE ASSESSMENT
FOLLOW UP STUDIES
This completely depends upon the
symptomatology
and
its
grades.
Improvement in symptoms is directly
proportional to the improvement in the
patient’s condition and his metabolic state.
To assess the subjective features of DM-2,
the clinical symptomatology was graded
into four grades (0-3) scale on the basis of
severity and duration. The changes in the
gradations of each symptom were noted on
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After the initial registration and
basal study, all the patients were recruited
randomly in respective trial groups and
given the treatment regularly as per
schedule. They were advised to come after
1 month interval for the assessment of
therapeutic response. Total duration of
study was 90 days. For each follow up of
30 days, the patients were assessed for
clinical symptoms, including physical
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VIRECANA KARMA & ORAL HYPOGLYCEMIC AGENT IN THE MANAGEMENT OF
PRAMEHA W.S.R TYPE-2 DIABETES
examination; Estimation of blood sugar
Triglyceride & Sr. LDL were assessed
(Fasting and Postprandial) and status of
before and after the treatment.
HbA1c,
I. Therapeutic Studies and Clinical Trial
BMI,
Sr.
Cholesterol,
Sr.
Table 1: Polydipsia
No. of Cases (%age)
Group
Group
(n=20)
Grade
BT
0
1
2
3
3
6
7
4
F1
Grade
BT
Group
(n=20)
0
1
2
3
2
8
6
4
Group
(n=20)
Group
Group
(n=20)
Grade
BT
0
1
2
3
2
6
9
3
F3
6
13
18
9
6
2
5
1
0
0
0
0
Table 2: Burning sensation
No. of Cases (%age)
Group
Group
F2
F1
F2
F3
3
8
10
10
7
2
0
0
Table 3: Weakness
No. of Cases (%age)
F1
F2
14
5
1
0
13
7
0
0
Grade
BT
F1
F2
F3
0
1
2
3
2
5
9
4
3
8
7
2
5
13
2
0
13
7
0
0
2 =39.61
p<0.001
HS
Within the group
comparison
(Friedman Chisquare)
χ2=29.20
p<0.001
NS
Within the group
comparison (Friedman
Chi-square)
F3
4
4
8
14
8
2
0
0
Table 4: Polyurea
No. of Cases (%age)
Within the group
comparison (Friedman
Chi-square)
χ2=30.05
p<0.001
HS
Within the group
comparison (Friedman
Chi-square)
χ2=31.89
P<0.001
HS
Table 5: Polyphagia
No. of Cases (%age)
Group
Group
Grade
BT
F1
F2
F3
0
0
5
11
16
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Within the group
comparison
(Friedman Chisquare)
χ2=40.10
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VIRECANA KARMA & ORAL HYPOGLYCEMIC AGENT IN THE MANAGEMENT OF
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(n=20)
P<0.001
HS
1
7
9
7
4
2
7
6
2
0
3
6
0
0
0
Table 6 : Effect of treatment on Fasting Blood Sugar (n=20)
FBS Mean SD
Within
the
group
comparison,
BT
FU1
FU2
FU3
Group
Paired ‘t’ test,
(BT - FU3)
106.60
35.61
197.15
121.60
97.35
90.55
Group
t
=
15.43
(n=20)
35.59
 31.50  15.14  8.47
p < 0.001 HS
Table 7 : Effect of treatment on Postprandial Blood Sugar (n=20)
PPBS Mean SD
Group
Group
(n=20)
BT
FU1
FU2
FU3
278.25
 48.89
150.75
 28.20
124.0
 17.29
124.15
 12.33
Within
the
group
comparison,
Paired ‘t’ test,
(BT - FU3)
154.10  53.76
t
=
12.81
p < 0.001 HS
Table 8: Effect of treatment on Sr. Cholesterol
Sr. Cholesterol Mean SD
Group
Group
(n=20)
BT
AT
266.25  46.44
201.35  9.77
Within the group
comparison,
Paired ‘t’ test,
(BT - AT)
64.8

42.48
t
=
6.81
p < 0.001 HS
Table 9: Effect of treatment on Sr. Triglyceride
Sr. Triglyceride Mean SD
Group
BT
AT
Group
(n=20)
214.75  33.10
158.4  9.6
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Within
the
group
comparison,
Paired ‘t’ test,
(BT - AT)
56.3  30.90
t
=8.15
p < 0.001 HS
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VIRECANA KARMA & ORAL HYPOGLYCEMIC AGENT IN THE MANAGEMENT OF
PRAMEHA W.S.R TYPE-2 DIABETES
Table 10 : Effect of Trial Treatment on Sr. LDL
Sr. LDL
Group
BT
AT
Group
(n=20)
182.25  29.66
128.4  7.81
Within the group
comparison,
Paired ‘t’ test, (BT
- AT)
53.8

27.22
t
=
8.84
p < 0.001 HS
Table 11: Effect of Trial Treatment on HbA1c
HbA1c
Within the group
comparison,
Paired
‘t’
test,
BT
AT
(BT - AT)
1.75

1.08
8.38  1.69
6.63  .899
t
=
7.22
p < 0.001 HS
Table 12 : Effect of treatment on BMI
Within the group
BMI Mean SD
comparison,
Paired ‘t’ test,
BT
AT
(BT - AT)
2.58

.888
27.05  1.80
24.49  1.69
t
=
12.98
p < 0.001 HS
Group
Group
(n=20)
Group
Group
(n=20)
OBSERVATION & DISSCUSSION
The majority of the patients were
The present study shows that the
registered with negative family history
duration of illness in patients of DM-2,
(68.33%). 31.67% of total cases had the
41.67% were newly diagnosed, 31.67%
positive family history of diabetes in their
had duration of illness > 3 years, 26.67%
first degree relatives (Bijadosha). Besides,
patients had duration of illness <3 years. In
it was also observed that maximum no. of
this, Incidence of clinical symptomatology
DM-2 fall in Rasa dominant Dusya
in patients of DM-2 revealed that the
(58.33%) followed by Meda (41.67%).
maximum number of patients (93.33%)
This indicates that not only familial
had Polydipsia followed by Polyurea,
impact but other factors also kept in mind
Burning sensation, Weakness (95.0%) and
at the time of describing etiopathogenesis
Polyphagia (96.67%). This refuse that the
of diabetes. This view is very relevant to
clinical features of DM-2 described in
concepts of Prameha / Madhumeha of
Ayurveda are very scientific & comparable
Ayurveda.
to the latest knowledge in this field.
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VIRECANA KARMA & ORAL HYPOGLYCEMIC AGENT IN THE MANAGEMENT OF
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The
changes
of
BMI
were
This indicates that Virecana karma
statistically highly significant (P<0.001).
along with OHA measures we can well
Virecana karma & OHA had showed a
control blood sugar level and improves the
good degree of difference in BMI level
clinical symptoms along with weight loss.
(2.58  .888), this indicates that not only
Besides this it is also interesting to
familial impact but other factors also kept
note that probably Virecana karma cleans
in mind at the time of describing
the
etiopathogenesis of diabetes. This view is
mobilization of blood sugar from central to
very relevant to concepts of Prameha /
peripheral
compartment
Madhumeha of Ayurveda.
decreasing
insulin
While studying body weight of the
body
channel
and
enhances
either
resistance
or
by
by
increasing insulin secretion due to which
patients it was found that most of them
there is decrement in the dose of OHA.
were having weight 71-80 kg (35%)
Lipid Profile
followed by 61-70 kg (31.67%).This is the
In the present study the serum
strong evidence for the obesity as a factor
cholesterol, serum triglyceride & serum
for DM-2. Body mass index was also
LDL level of patients showed highly
calculated to identify the exact level of
significant changes (P < 0.001) due to
obesity and it was found that maximum
Virecana karma & OHA. This study
patients (44%) were registered as normal
reveals that the trial treatment have
(18.5-24.9 kg/m2) followed by 37.33% in
tendency to reduce Serum Cholesterol &
over weight category (25.0-29.9 kg/m2)
Serum TG level in patients Type-2 DM,
and 18.67% patient were registered under
which is not possible only with the help of
obese category (30.0 – 39.9 kg/m2)
only OHA.
Fasting Blood Sugar
HbA1c
In this series the mean reduction in
In the present study, HbA1c shows
fasting blood sugar was found to be
difference of (1.75  1.08) BT to AT. So it
statistically
absolute
shows that Virecana karma with OHA
changes in fasting blood sugar was (106.60
measure can maintain blood sugar level for
35.61) (p<0.001).
long term.
Postprandial Blood Sugar
Safety Profile
significant.
The
The mean reduction in PP blood
For the safety profile of the patients, we
was
highly
have done Serum Creatinine & Blood
significant. The absolute fall in PP blood
Urea, LFT, CBC, ECG and CXR before &
sugar was 154.10  53.76 (P < 0.001)
after treatment & we did not get any
sugar
found
statistically
unwanted effect on the major metabolic
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VIRECANA KARMA & ORAL HYPOGLYCEMIC AGENT IN THE MANAGEMENT OF
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organs of the body. Therefore this is
(2)
Local
Evacuant
:
Which
is
suggesting that selected Virecana karma
concerned with the evacuation of
measures were safe in regards to renal
these Dosha in form of Mala from
function, liver function & cardiac function.
the gut by Purgation.
Probable Mode of action of Virecana
As said by Acharya Sushruta in
karma
the patients of madhumeha, kapha and
Action of Virecana Karma can be divided
pitta are vitiated excessively and they
in the following two ways.
remain in the lower part of the body.
Virecana karma is the best therapy to
(1)
Systemic - by which it brings down
the morbid Dosha, particularly
Pitta from the body to Amasaya or
eliminate doshas from the lower part of the
body and it also eliminate both kapha and
pitta.
Pakvasaya i.e. GIT.
CONCLUSION
With the help of Virecana karma
Prameha. In Ayurveda, Vyadhi Kriyakala
& OHA not only blood sugar level
described by Sushruta gives an idea about
decrease in Type-2 DM but lipid profile,
the consecutive stages of the disease and
BMI & clinical symptoms also improved
accordingly management measures can be
which is not possible only with OHA. This
contemplated to control DM-2 & also to
suggested the selected Virecana karma
overcome complications. Early diagnosis
measures cleans the body channels and
of disease helps to cure the disease
potentiate the peripheral utilization of
successfully
glucose and due to peripheral utilization of
Vyaktavastha stage of Kriyakala represents
glucose
automatically
symptomatic stage which indicates the
improved. The patients who were taking
presence of disease. So prescription of
OHA
after
medication in the form of Virechan karma
performing Virecana karma in classical
and OHA is more important for controlling
manner need less dose of OHA to achieve
the disease process and stop its progress
desirable blood glucose level in both
further to complication stages.
lipid
profile
initially in
higher
dose
fasting and post prandial states along with
good control on dyslipdemia.
without
its
progression.
In this study, the selected Virecana
karma
and
OHA
not
only
have
The Present study reveals that
encouraging results in terms of well
Type-2 DM was well conceived in
control blood sugar level along with
Ayurvedic lexicons in the context of
weight loss but also seems to be helpful to
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VIRECANA KARMA & ORAL HYPOGLYCEMIC AGENT IN THE MANAGEMENT OF
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check the complications in Type-2 DM by
Thus, this approach of Ayurvedic classics
controlling dyslipidemia. Besides, this
have significant preventive & curative role
studies also overview that if Virecana
in DM-2. The leads available from this
karma and OHA applying in DM-2, it
work open new Ayurveda-inspired holistic
normalise the blood sugar and also cut off
approach to the management of Type 2
its progression to insulin dependence.
Diabetes Mellitus.
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Stephen
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L.
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Surbharati
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Vishwabharati, Varanasi, Istedi., 2001.
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