Introduction

Ayurveda, the science of life, has the great heritage of healing disease and protecting the life. Prameha, a well-known illness since the Vedas(1), is characterised by turbidity and frequent, excessive urine. It is classified into two types: sahaja (congenital) and apathyanimittaja (caused by overindulgence in food and bad behaviors). (2) The condition is caused by unhealthy food and lifestyle, such as improper eating habits and sedentary behaviors. Prameha's symptoms can be linked to Type II Diabetes Mellitus, a chronic illness causing high blood sugar levels. Ayurveda has gained worldwide popularity, with numerous studies being conducted to assess safe and affordable medications for difficult conditions like diabetes and cancer.(3) Diabetes is a metabolic disease characterised by high blood sugar levels and disruptions in carbohydrate, fat, and protein metabolism due to insulin deficiency, a growing public health concern in both industrialised and developing nations. (4) Diabetes prevalence in India is increasing rapidly, with the WHO forecasting a 6% annual increase to 9.40 million by 2030, from 32 million in 2000 to 80 million by 2030. (5)

Case Report 

A 49-year-old female patient came to the OPD  section of the Kayachikitsa department in SMBT Ayurved Hospital, Dhamangaon, Nashik. Patient name: ABCD OPD/IPD No.: 122...with complaints of Prabhuta mutrata (frequent nocturnal urination) 7-8 times, Avilam mutrata, Pipasa (excessive thirst) and excessive hunger, Dourbalya (generalised weakness), and Ati-sweda (excessive sweating) since 2 months. A blood investigation showed an increased level of blood sugar and urine. Blood sugar fasting -128 mg/dl and postprandial 204 mg/dl and urine sugar show nil. She was not taking any oral hypoglycemic agent. So we treated this patient with a freshly prepared decoction of Pramehahara Kwatha, 40 ml BD, before meal. This treatment was advised for 45 days. This patient showed good glucemic control and clinical improvement after 45 days of treatment. After 20 days of follow-up, i.e., on 65th day, none of the above complaints were reported.

Personal History:

1. Bowel movement –Samyaka

2. Appetite – Excessive Hunger,Irregular meal time

3. Sleep- .Sleep disturbed

4. No history of any type of addiction like smoking, alcohol, tobacco.

History of past illness:

 1-Medical history- No Past History of Hypertension,Asthma or any other major illness.

 2-History of Blood Transfusion – No history of blood transfusion.

 3-Drug History- He was not taking any other treatment .

 4-Family History –No significant history.

5-Surgical History- No significant history.

Samanya Pariksha

Appearance-Fair

Pulse rate -80/min

B.P.-130/80 mm hg

R.R.- 19/min

Weight – 152 cm

Height-76 kg

BMI-32

Temperature –Afebrile

Systemic Examination:

CNS: Conscious and well oriented to person, place, and time.

CVS: S1, S2 is audible, No murmur sound.

Respiratory System: B/L Symmetrical,Normal vesicular Breathing heard ,No added Sounds heard.

P/A:-Umbilicus Centrally placed ,Soft ,non-tenderness,no-organomegaly.

Digestive System: Normal

 

Objective:

• To study the efficacy of Pramehahara Kwatha in the management of prameha w.s.r. to diabetes mellitus – type 2.
• To Study Etiopathogenis of Prameha w.s.r. to diabetes mellitus – type 2.

Material and methods:

• Drug - Freshly prepared Pramehahara Kwatha
• Dose - 40 ml twice a day before meal(Pragbhakta)
• Duration – 45th days
• Follow up - for 65th days

Study type: Simple Random Single Case Study.

Centre of study: OPD section of the Kayachikitsa department in SMBT Ayurved Hospital, Dhamangaon, Nashik. The patient is chosen on the basis of the following criteria: Prameha signs and symptoms are present in this patient.

Pramehahara Kwatha :

Pramehahara Kwatha is given to patients for orally Pragabhakta(before meal)  in quantity of 40 ml orally for 45th  day and after treatment follow up is 65th  day.

Assessment criteria:

Subjective Criteria –

1.  Prabhuta Mutra

2.  Avil Mutra

3.  Ati-sweda

4.  Daurbalya

5.  Pipasa

Objective Criteria –(13)

 1. BSL – Fasting blood glucose level range of 120 - 200 mg/dl

 2. BSL – Post prandial blood glucose level range of 170 - 250 mg/dl

 3. Urine sugar

Gradation of Subjective symptoms:(14)

1. Prabhuta Mutrata ( Polyuria ) –

Grade Description

0          Normal frequency i.e 1-4 times in a day and 0-2 times at night with normal volume

1          Frequency 5-7 times per day and 3-5 times at night with normal volume        

2          Frequency 8-10 times per day and 3-5 times at night with increased volume    

3          Frequency > 10 times per day and > 8 times at night with increased volume    

2.   Avila Mutrata :

Grade             Description 

0          Crystal clear fluid   

1          Faintly cloudy or smoky    

2          Turbidity clearly present   

3          Darkly cloudy

3. Ati-sweda :

Grade             Description 

0          Sweating after heavy work and fast movement or in weather        

1          Profuse sweating after moderate work and movement

2          Sweating after little work & movement

3          Sweating even in rest or in cold weather

4.Daurbalya:

Grade            Description

0          Can do routine work

1          Can do routine work but feels tired

2          Can do routine work with lot of tiredness

3          Cannot do routine work

5. Pipasa :

Grade             Description

0          Feeling of thirst 7-9 times/day Quantity 1-1.5 liter / day

1          Feeling of thirst 9-11 times/day Quantity 2-2.5 liter / day

2          Feeling of thirst 9-11 times/day Quantity 2.5-3.0 liter / day

3          Feeling of thirst 11-13 times/day More than 3.0 liter / day

Observation and Result:

Assessment of Clinical result: (Subjective criteria):

Observational table – Objective criteria

In this case study, observations were made using Prameha's subjective and objective parameters both before and after treatment. Here, we can observe that the patient's prameha's subjective and objective indicators are progressively declining.

Discussion

The patient in this case is 49 years old, married, and has kaph-pitta prakriti. She followed a mixed diet. It was discovered that the consumption of Madhura, Snigdha Ahar, was the causative reason. Irregular eating times, restless nights, a reserved way of living, and a sedate attitude towards Chintya. It is classified as panchvidh Kashaya kalpana in Ayurvedic kwatha kalpana, which is also known as Anta parimarjana Chikista and is beneficial in treating Prameha Vyadhi.Prameha is a Tridoshaj Vyadhi, a Kaphapradhana. Ayurvedic medicine states that Samprapti of Prameha results from Strotodusthi, or channel vitiation, mostly from Mutravaha Strotas, which is brought on by vitiation of all Doshas, principally Bahudrava Shleshma, and manifests as Prabhut Avil Mutrata. (17) Pramehahara Kwatha, a traditional compound medication, was chosen for a study because it combines the properties of Musta, which has Lekhana, Shoshak, and Pachak properties, and Triphala, which has Kaphapittashamaka, Mehagna, Deepana, Pachana, and Rasayana properties. Daruharidra and Devdaru are having Mehaghna qualities. (18)

Probable mode of drug action of Pramehahara Kwatha:

Each portion of content is taken in equal quantities.
Among the well-known prickly deciduous shrubs in the Sub-Himalayan regions are Daruharidra, which includes Katu-Tikta Rasa, Katu-Vipaka, and Ushna-Veerya. It is primarily recommended for the treatment of skin conditions, dysentery, anaemia, jaundice, and diabetes mellitus, among other conditions.(19) Devdaru, triphala, and musta reduce the gastrointestinal fire's augumentation, allowing the rasadi seven dhatus to form properly. Triphala and musta also break down amdosha. Since Prameha is a kaphapradhan tridoshaj vyadi, Haritik has premehghna qualities like lavanrahit panchras, ushna virya, laghu, and ruksha in guna. The Indian Ayurvedic Pharmacopoeia states that mature fruits can be used to treat polyuria. It contains immune-modulating and hypolipidemic qualities. (20) Triphala has a mild purgative action that ends the vata pradhana samprapti by causing annulomana of vayu. It is known that haridra act on medo and associated dhatus. It has hepatoprotective, anti-inflammatory, anti-diabetic, and hypolipidemic properties. (21) Thus, by functioning on kapha-pitta, musta - it is tikta, katu, kashya in rasa, katu in vipaka, and sheeta in virya that may rectify the vitiation of pitta. (22) Treat Prameha illness with alleviation. Its nature also makes it diuretic. The tuber extracts in both alcoholic and aqueous form have lipolytic properties that help lower obesity by releasing higher amounts of biogenic amines from brain terminals that inhibit the appetite centre. According to some, isocyperol is crucial for the metabolism of fats.

In this way, these drugs relieve the body excess of kapha, meda and protect the body from further injury due to disease.

• The antioxidant capacity and decreased inflammatory response of E. officinalis Gaertn, T. bellirica (Gaertn), and C. longa L may be responsible for their anti-hyperglycemic action.
• Pharmacological research has demonstrated that C. rotundus possesses alpha-amylase and alpha-glucosidase inhibitory effects, making it a potent herb for treating hyperglycemia.
• Preclinical research conducted earlier has verified that T. chebula Retz treatment results in increased adiponectin secretion and amplification of GLUT gene mRNA expression.
• In addition, C. deodara (Roxb.) has the ability to affect the pancreatic islet of Langerhans cellular regeneration and restore its normal size.
• Complications will rise in tandem with the global increase in diabetes patients. Treatment plans must be improved. In one example, ayurvedic medication significantly reduced blood sugar levels after 45 days. Further research is required.

Mode of action on basis of herbal ingredients of Pramehahara Kwatha formulation(6)

The mechanism by which herbal ingredients of Pramehahara Kwatha bring about their anti- diabetic activities.

Conclusion

Pramehahara Kwatha, a drug mentioned in Charak Chikista 6 Adhayaya, contains six drugs with medical properties and biologically active constituents. This review explores its therapeutical and pharmacological application. A case study of a type 2 diabetes patient found that Pramehahara Kwatha, when used properly, can effectively manage the disease without side effects. This case study provides valuable insights for further research on Pramehahara Kwatha's potential for diabetic patients.