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Introduction

Ayurveda place great emphasis on prevention, cure and maintenance of good health through close attention to balance in once life, diet, right thinking, life style and use of herbal medicines. Prameha is included in mahagada diseases i.e difficult to treat1. It is an aanushangi vyadhi2. The cardinal symptoms of prameha are increased frequency, and quantity of urine along with turbidity of urine3,4. Classical text attributes multi-factorial etiology to the causation of prameha. The main etiological factors for prameha are dietary, excessive eating, life style, hereditary factors (Jatah-Pramehi), genetic association (Beeja Dosha), sedimentary life, freshly harvested foods and grains (Navannapana), consumption of sweet food articles (Gudavikrita), intake of certain foods from geographical areas enriched water resources (Anupadesha), and all the factors (food & lifestyle) that aggravate Kapha Dosha. Diabetes is a silent killer. Rapidly rising glycemic concentration are seen in population living in developed and developing countries5.Diabetes mellitus is a group of syndrome characterized by hyperglycemia caused by absolute or relative deficiency of insulin6. Diabetes is metabolic disorder in which carbohydrate utilization is reduced & that of lipid and protein increased due to deficiency of insulin which results in hypoglycaemia7. The main cause of diabetes is insufficient production of insulin or when the body cannot effectively use the insulin due to its resistance. Various complications which are commonly seen includes kidney damage (nephropathy), retina damage( retinopathy), nerve damage ( neuropathy), cardiovascular diseases, foot damage, hearing impartment, skin infection8. Increasing prevalence of diabetes mellitus is alarming and globally estimated to be 150 million and figured to be double by 20259. Prevalence of diabetes in India is 8.4%10. It is spreading epidemic all over the world. In India has more diabetics than any other country in the world. The disease affects more than 50 million Indians and kills about 1 million people a year.

Aim and Objective:

1. Conceptual and critical studies on prameha.
2. To compare the efficacy of Triphaladi vati and Mehamudgar vati along with OHA in the management of prameha patients.

MATERIAL & MATHOD:

Total 47 patients of the type 2 diabetes were randomly selected from the O.P.D. of Kayachikitsa of our institute. Case selection was random regardless of sex, age, socioeconomic status, occupation, etc. Informed consent was taken from the participating patients before starting the trial. Out of 47 registered patients only 40 patients turned up to complete follow up. All the 40 patients were divided into two groups randomly.

Group A:- 20 patients treated with Triphaladi vati along with OHA

Group B:- 20 patients treated with Mehamudgar vati along with OHA

Duration: 30 days.

Dose: 500mg twice day before lunch and dinner. Anupan: warm water.

Formulation of Triphaladi vati – Choornas of Triphaladi vati are taken in proportion as given in classical text and added in honey and binding agent. Tablets of 500mg will be prepared with help of tablet making machine11.

Formulation of Mehamudgar vati –Shuddha guggul dissolved in warm water and choornas of Mehamudgar vati added in it as per proportion given in classical text. Tablets of 500mg is prepared with tablet making12.

Inclusion criteria:

1. Patients having signs and symptoms of Prameha as mentioned in Ayurvedic

texts

1. Diagnosed patient with BSF between 125-200 & PPBS 200-280
2. Age of patients - 30-60 year
3. Gender - male and female

Exclusive criteria

1. Patient having DM below age 30 and above age 60
2. Gestational diabetes.
3. Patients having Acute Complications like Coronary Heart Disease, Acute Infective hepatitis, alcoholic hepatitis, HIV
4. Patients having disorders like Carcinoma anywhere in the body
5. Patients having any other major life-threatening disease.

CRITERIA FOR THE ASSESMENT OF PATIENTS

• • Daurbalya
  • Sweda-Adhikya
  • Prabhut-Murata
  • Kara-padatala daha
  • Kshudha-Adhikya
  • Pipasa-Adhikya

Investigations: BSL-fasting, BSL-post prandial

Observations and Results:

Total 47 patients were registered in this study and Random allocation was done to divide patient into two groups. Out of 47, 40 patients were studied and their observations were recorded as follow:

Group A– Triphaladi vati and  Group B –Mehamugdar vati.

Results within Group A and Group B

Comparison between Group A and B

Prabhoota Mutrata:  Mean rank of ‘Prabhoota Mutrata’ is less in group A than that of group B, but as p value > 0.05, there is no significant difference in grades of ‘Prabhoota Mutrata’ between the groups. So, both groups are equally effective to reduce grades of ‘Prabhoota Mutrata’.

Pipasa-Adhikya:

Mean rank of ‘Pipasa-Adhikya’ is less in group A than that of group B, but as p value > 0.05, there is no significant difference in grades of ‘Pipasa-Adhikya’ between the groups. So, both groups are equally effective to reduce grades of ‘Pipasa-Adhikya’.

Kshudha-Adhikya:

Mean rank of ‘Kshudha-Adhikya’ is less in group A than that of group B, but as p value > 0.05, there is no significant difference in grades of ‘Kshudha-Adhikya’ between the groups. So, both groups are equally effective to reduce grades of ‘Kshudha-Adhikya’.

Daurbalya:  Mean rank of ‘Daurbalya’ is less in group B than that of group A, but as p value > 0.05, there is no significant difference in grades of ‘Daurbalya’ between the groups. So, both groups are equally effective to reduce grades of ‘Daurbalya’.

Kar Pad Daha: Mean rank of ‘Kar Pad Daha’ is less in group B than that of group A, but as p value > 0.05, there is no significant difference in grades of ‘Kar Pad Daha’ between the groups. So, both groups are equally effective to reduce grades of ‘Kar Pad Daha’.

Swed-Adhikya: Mean rank of ‘Swed-Adhikya’ is less in group B than that of group A, but as p value > 0.05, there is no significant difference in grades of ‘Swed-Adhikya’ between the groups. So, both groups are equally effective to reduce grades of ‘Swed-Adhikya’.

BSL (F):Mean of ‘BSL (F)’ is less in group B than that of group A, but as p value > 0.05, there is no significant difference in ‘BSL (F)’ between the groups. So, both groups are equally effective to reduce ‘BSL (F)’.

BSL (PP):

Mean of ‘BSL (PP)’ is less in group B than that of group A, but as p value > 0.05, there is no significant difference in ‘BSL (PP)’ between the groups. So, both groups are equally effective to reduce ‘BSL (PP)’.

Overall results in both groups

Group A shows that on Prabhoota Mutrata, Pipasa-Adhikya, Kshudha- Adhikya, Daurbalya, Kar Pad Daha, Swed-Adhikya- 65.4%, 51.9%, 47.1%, 35%, 37.5% and 37.5% relief are observed respectively. On an average group A is 45.7% effective.Group B shows that on Prabhoota Mutrata, Pipasa-Adhikya, Kshudha-Adhikya, Daurbalya, Kar Pad Daha, Swed-Adhikya- 38.5%, 52.2%, 35.7%, 30.8%, 66.7% and 52.9% relief are observed respectively. On an average group B is 46.1% effective.

Discussion

Prameha is a multifactorial disease caused due to abnormal interaction of three doshas and ten dushyas predominantly kapha dosha and meda dhatu. While describing the pathogenesis of prameha the Ayurvedic texts have explained the involvement of ama (oxidative free radicals), agni (digestive fire), meda (adipose tissue) and ojas (immunity), which play a vital role in the development and progression of prameha and its complication. Prameha is included in Mutravaha Srotasa disease in which metabolism is hampered first and then disease evolves gradually. Incidence prameha increasing day by day.In this pilot study maximum cases registered were belonging from 4th decade. The study reveals that majority of cases were having siting jobs, services which indicates that persons having minimum physical activity and more stress are much prone to develop type-II diabetes. In present study maximum patients were belonging to urban area. It is well known that urbanization causes lifestyle modification which in turn increases the risk of metabolic disorders like type-II diabetes.

Probable mode of action Triphaladi Vati - Triphaladi Vati contains Triphala, Harataki, Guduchi, Shilajita and Lauha Bhasma. Most of the Drugs contains tikta-kashaya rasa, madhura vipaka and ushna veerya. Drugs containing Ruksha and laghu guna are more than as compared to the drugs containing snigdha and guru guna. All of these Drugs are agnideepana and amapachana, balya, rasayana in nature. Many of them act on kapha-pitaa, tridosha and are able to alleviate them. Thus, formulation possesses tridoshahara property but specifically Kapha-pittahara property. It can alleviate vitiated Meda and Kleda. It has capacity to improve tone of sapta-dhatus. With the help of agnideepana-amapachana properties, madhura vipaka and ushna veerya, it can cause nourishment of dhatus. Triphaladi Vati helps to improve metabolism and thus can be effective in lowering signs and symptoms of the disease. Shilajita has its action on Mutravaha Srotasa. Other Drugs when combined with Shilajita, it acts as a vehicle for them to reach to the place of pathology developed in Mutravaha Srotasa.

Probable mode of action of Mehamudgar vati - Mehamudgar vati contains rasanjana, vidlavan, devdaru, bilvaphala, gokshur, aanardana, chirayta, piparamool, trikatu, triphala, nishoth, lauha bhasma, guggul. Most of the drugs contains tikita katu kashya rasa, ushna veerya, katu vipak and laghu ruksha properties. Due to ushna veerya, katu vipak, tikshna, laghu guna it acts as agnideepan which help in reliving the agnimandya. Mehamudgar vati has ruksha, laghu, tikshna guna which reduces the picchilita and guruta of kapha dosha and meda dhatu and helps in kapha shaman. Some of the content of the mehamudgar vati like gokshur, anardana, shunti, haritaki have madhur vipak, shet veerya, rasayan and vrushya properties hence plays role in rejuvenation by nourishing the sapta dahtu and thus increase the dhatu bala and deha bala.

Conclusion

Prameha is a multifactorial metabolic disorder primarily involving Kapha dosha and Meda dhatu, often linked to sedentary lifestyle, stress, and urban living. Ayurvedic pathogenesis highlights roles of ama, agni, meda, and ojas in disease development. In the study, most patients were middle-aged, urban dwellers with sedentary jobs, indicating lifestyle as a key factor in type-II diabetes onset.

Triphaladi Vati is significantly effective in the management of prameha.Mehamugdar Vati is significantly effective in the management of prameha.Triphaladi Vati and Mehamugdar Vati are equally effective in the management of prameha.Triphaladi Vati and Mehamudgar Vati, with their agnideepana, amapachana, and tridoshahara properties, help improve metabolism, nourish dhatus, and target Mutravaha Srotasa, showing potential in managing Prameha effectively