Journal of Drug Research in Ayurvedic Sciences

REVIEW ARTICLE
Year
: 2022  |  Volume : 7  |  Issue : 4  |  Page : 213--220

A narrative literary review on design of anti-diabetic (Prameha) formulations from various Ayurveda treatises


Amulya Kannan, Raghavendra Naik, N Kavya, KP Monica, Sulochana Bhat 
 Centre of Excellence in Research and Clinical Services for Madhumeha (Diabetes Mellitus), Central Ayurveda Research Institute, Bengaluru, Karnataka, India

Correspondence Address:
Dr. Amulya Kannan
Centre of Excellence in Research and Clinical Services for Madhumeha (Diabetes Mellitus), Central Ayurveda Research Institute, Bengaluru, Karnataka
India

Abstract

Ayurveda texts spanning from 100 BC to 18th AD, which have not been frequently scrutinised for management of Prameha (Diabetes mellitus) have been selected. This review is expected to enrich the documentary evidences about classical references on formulations related to Prameha (Diabetes mellitus) as add on to future researches. A total of 524 formulations out of 15 Ayurveda texts have been considered to observe drug design methods in this review paper. Formulations with Phalashruti (verse with indications) of “Prameha” were scrutinised. The preliminary data was categorised based on their dosage forms, indications of formulations in accordance to Doshas (regulatory functional factors of the body), adjuvants etc and the result have been substantiated. Drugs and formulations most enumerated amongst these 15 texts have been presented. Kwatha (decoction) is most enumerated dosage form (241 formulations). Honey is most enumerated adjuvant (172 formulations). Nyagrodadhi gana (kwatha or churna) and Dhanvantara ghrita were the most frequently mentioned formulation. Triphala was the most enlisted drug amongst 323 formulations (in formulation with less than 10 ingredients). Vidanga (Embelia ribes Burm.f.), Arjuna (Terminalia arjuna (Roxb.) Wight and Arn.) Patha (Cissampelos pareira L.) were most repeated drugs indicated in Kaphaja Prameha, Pittaja Prameha and Vataja Prameha respectively (in formulation with less than 10 ingredients). This review gives comprehensive detail related to formulations indicated in Prameha (Diabetes mellitus) compiled from 15 Ayurveda treatises.



How to cite this article:
Kannan A, Naik R, Kavya N, Monica K P, Bhat S. A narrative literary review on design of anti-diabetic (Prameha) formulations from various Ayurveda treatises.J Drug Res Ayurvedic Sci 2022;7:213-220


How to cite this URL:
Kannan A, Naik R, Kavya N, Monica K P, Bhat S. A narrative literary review on design of anti-diabetic (Prameha) formulations from various Ayurveda treatises. J Drug Res Ayurvedic Sci [serial online] 2022 [cited 2022 Nov 30 ];7:213-220
Available from: http://www.jdrasccras.com/text.asp?2022/7/4/213/361576


Full Text



 Introduction



The International Diabetes Federation’s 10th edition of Diabetes atlas estimated that approximately 537 million adults aged 20–79 years are living with diabetes.[1] The prevalence of diabetes in India has remained at 11.8% in the last four years, according to the National Diabetes and Diabetic Retinopathy Survey (2015–2019) report released by the Ministry of Health and Family Welfare.[2] Thus a shift in currently practised methodology of generalised treatment to personalised treatment is needed to cater such huge needs in management of diabetes. Ayurveda, with such vast database of drugs and formulations whence validated scientifically may hold the key to this problem. Currently available therapies for diabetes include insulin and oral antidiabetic agents such as sulfonylureas, biguanides, glinides etc. Many of them have a number of serious adverse effects; therefore, the search for more effective and safer hypoglycaemic agents is one of the important areas of investigation.[3]Ayurveda drug database when validated scientifically may help in management of Diabetes holistically. Ayurveda documentation in the form of scriptures has transpired over many centuries. Depending on its era, prevalent treatment practises and personal interest of the author each scripture/text would have certain unique contributions towards management of Prameha. Few attempts on understanding formulations related to Prameha have been done previously, consolidated understanding of 15 Ayurveda texts other than Brihattrayis is an unique attempt.[4],[5] Hence, present review was taken up as an attempt to understand drug/formulation design process in the management of Prameha (Diabetes mellitus) through a compilation of data from various Ayurveda treatises.

 Material and Methods



Fifteen Ayurveda texts [Table 1] have been thoroughly scrutinised and various formulations indicated for Prameha management were compiled. Texts other than Brihattrayis (the great triads of Ayurveda i.e., Sushruta Samhita, Charaka Samhita and Ashtanga Hridaya) ranging mostly from medieval period (8th to 15th century AD) to modern period (16th century onwards) were studied due to limited compilation work related to Prameha previously done from these texts. Chapters dedicated independently to Prameha (diabetes mellitus), Prameha Pidaka (diabetic carbuncles), Sthoulya (obesity) and Mutravikara (urinary system diseases) were thoroughly scrutinised as chances of finding Prameha indicated formulations were more in these chapters, and remaining chapters were glanced. In texts with consolidated formulations list like Sharangadhara, Sahasrayoga etc the whole text was searched for formulations with indication of Prameha. Key words searched in Phalashruti (verse with indications) included “Prameha”, “Meha”, “Madhumeha” with suffixes like “Hanti”, “Harati”, “Jayati”, “Jit”, “Shanti”, “Upashanti”, “Moksha”, “Nihanti”, “Ghna”. Data was compiled and details like name of text, name of formulation (if provided by author), ingredients of formulation with less than 10 drugs only were recorded for the sake of elementariness (for those formulations with ingredients more than 10 drugs rest of the information were recorded), adjuvants, dosage forms and indications were recorded digitally. In this review paper the formulations names are excluded and analysis through the ingredients (and their inclusion in multiple formulation), dosage forms and indications have been presented.{Table 1}

 Results



A total of 524 formulations out of 15 Ayurveda texts have been compiled [Table 1].

 Discussion



Amongst a total of 524 formulations with Prameha (diabetes mellitus) management, Sahasrayoga text offered maximum number of formulations followed by Abhinava Chintamani text [Figure 1].{Figure 1}

Panchavidha Kashaya Kalpana (dosage forms of medicine):

Total count of Panchavidha Kashaya Kalpanas (basic 5 dosage forms of medicine) and their related dosage forms were compiled [Table 2]. Kwatha kalpana (decoctions) was the highest enumerated dosage form with a total of 241 formulations. This might have been a preferred dosage form because of its better absorption and assimilation in body system and good retaining capacity of water soluble constituents present in raw materials.[21]{Table 2}

Dosage forms like Ghrita (ghee), Taila (oils) are mentioned less when compared to other dosage forms. Ghrita (ghee) and Taila (oil) may have been mentioned as an apathya (inconducive diet) in Prameha due to its kleda (moisture), snigdha (unctuous) properties, as it may propel the disease forward.[22] Although Ghrita and Taila mentioned in management of Prameha are medicated with anti-diabetic drugs, innate nature of base material (ghee and oil) would have remained, hence minimal enumerations.

Asava and Arishta (medicinal herbs alcoholic preparations) also have been mentioned less. Alcoholic preparations like Sura (cereal’s fermentation), Souvira (de-husked barley’s fermentation) and Shukta (vinegar fermentation) have been mentioned as Apathya (inconducive diet) in Prameha.[23]Kalyanakaraka text mentions, Asava (herbal fermentations without boiling ingredients) and Arishta (herbal fermentations from boiled ingredients) as apathya (inconducive diet) too.[24]Madya’s (alcohol) ushna (hot) and teekshna (penetrating) properties may not be suitable to flabby condition of body diseased through Prameha. Amla (sour) being a common taste of any alcoholic preparation could also contribute in weakening the body tissues. Asava and Arishta have longer shelf life, quick absorption and maximum bioavailability, hence in preserving certain drugs for longer time or in condition of quick relief this dosage form can be opted.[25]

Guda (jaggery) and Sarkara (sugar) are considered Apathya in Prameha.[23] In total 20 Avaleha kalpana (semisolid preparation with jaggery or sugar as its base ingredient) are recorded in the compiled data which includes Upakalpanas (derivable forms) of Avaleha like Paka (sugar granules). Yogaratnakara mentions Puga paka, Ashvagandha paka, Salam paka and Draksha paka. Sahasrayoga enumerates highest count of Leha Kalpana, 9 formulations in total. Agastya rasayana, Gandira rasayana, Dashamoola Leha, Bahushala guda, Madhusnuhi rasayana (two varieties), Shatavari guda (two varieties). Exploring of Avaleha kalpana in management of Prameha both experimental and clinical will help in understanding the therapeutic capabilities, as not much work has been done in this regard. Avaleha is usually opted as Rasayana (rejuvenators) line of treatment or to increase body’s strength, when some of famous Avaleha’s indications are observed. Use of Avaleha as strength promoter in debilitating diabetic cases can be explored. Avaleha kalpana can be compared with neutraceutical supplement in a diabetic with controlled glucose levels.[26]

Arka prakasha has enumerated 12 Arka (distillate of drugs) formulations in the management of Prameha (Diabetes mellitus). Each of these formulation has been mentioned with a single drug as its ingredient. Guduchi (Tinospora cordifolia (Thunb.) Miers), Gokshura (Tribulus terrestris L.), Sthambini (source not clear), Pippali (Piper longum L.), Amalaki (Phyllanthus emblica L.), Aragvadha (Cassia fistula L.), Katphala (Myrica esculenta Buch.-Ham. ex D.Don), Haridra (Curcuma longa L.), Vasa (Justicia adathoda L.), Murva (Marsdenia tenacissima (Roxb.) Moon) and Arka (Calotropis procera (Ait.) R.Br. Arka has good potency, less dose, more shelf-life, and easy absorption due to volatile components and patient compliance due to its tastelessness.[27] This review may help in further exploration of this dosage form in management of Prameha.

In Kashyapa samhita only one formulation, Lashuna kalka (paste of garlic) with Prameha indication was found. Although this text is predominantly based on paediatric science, garlic has been contra-indicated for a child dependant on milk only (Ksheerapa). Hence efficacy of garlic in a child accustomed to eating food other than milk (Ksheer-annada and Annada) in form of food and medicine can be explored to be validated scientifically in management of juvenile diabetes.[28]

Most repeated formulation

Amongst formulations with a designated name by the author himself (not all formulations were designated a name), most enumerated formulation were scrutinised. Nyagrodadhi gana (drugs of this group either in the form of churna or kwatha) and Dhanvantara ghrita were the most repeated formulation (8 formulations each). Gokshuradi guggulu was second highest (5 formulations). These formulations are already clinically practised widely and proven scientifically too.[29],[30]

Adjuvant

Madhu (honey) has been mentioned majorly as an adjuvant in 172 formulations, Kshoudra (honey collected from small type of honey bees) in 57 formulations, Makshika (honey collected from red variety of honey bees) in 18 formulations, Sita/Sarkara (sugar candy) in 12 formulations in the available compilation. Madhu, Makshika and Kshoudra are synonymous terms referring to honey, synonyms indicating collection from different sources. Honey may have been opted as a prime adjuvant due to its proven anti-diabetic activity,[31] subject to the availability of pure and authentic honey.

Formulations with less than 10 drugs:

Amongst 524 formulations compiled, those formulations with less than 10 ingredients were grouped separately counting up to 323 formulations. Ingredients were listed for individual formulation to observe drugs which were most included [Table 3]. Formulations with fewer ingredients are modest to understand, economical to prepare and easy to procure, keeping this view formulations with less than 10 ingredients were scrutinised.{Table 3}

Triphala (combination of three fruits; Phyllanthus emblica L., Terminalia bellerica L., and Terminalia chebula L.) was included as one compounded ingredient, as in majority references it was enumerated as a single unit. Numerous experimental researches have been carried out to understand the drug action of Triphala in Diabetes mellitus.[32]Triphala contains active ingredients like menthol and sorbitol which is believed to have hypoglycemic effect.[33]

The alcoholic and aqueous extracts of the tubers of Musta (Cyperus rotundus L.) possess lipolytic action and reduces obesity by releasing enhanced concentrations of biogenic amines from terminals of the brain which suppress the appetite centre. Isocyperol is said to play important role in lipid metabolism.[34]

Arjuna (Terminalia arjuna (Roxb.) Wight and Arn.) possess anti-diabetic activity which can be understood by its activity of enhancement of granulocytes count and decrease in free haemoglobin content in diabetic human whole blood and plasma samples.[35]

Daruharidra (Berberis aristata DC.) possesses active principle called as berberine. This has shown its efficacy in the reduction of fasting blood glucose, HbA1C, and triglycerides in patients with Diabetes mellitus – II. Berberine lowers blood glucose in type 2 diabetes mellitus patients through increasing insulin receptor expression.[36]

Haritaki (Terminalia chebula Retz.) possess hypolipidemic as well as immunomodulatory properties, thus beneficial in management of diabetes mellitus.[37]

Pharmacological research reports on Amalaki (Phyllanthus emblica L.) reveals its antidiabetic[38] and nephroprotective[39] activities which shows the drug’s potency in management of diabetes.

Patha (Cissampelos pareira L.) has proven its efficacy in management of diabetes through experimental in-vivo models.[40]

Clinical evaluation of Haridra (Curcuma longa L.) in lowering postprandial plasma glucose and significant effect on insulin secretion has been validated.[41] Thus its holistic effect in diabetes can be deduced.

Various studies on Guduchi (Tinospora cordifolia (Thunb.) Miers)) demonstrates amelioration of experimental diabetic neuropathy and gastropathy in rats, reduction of blood sugar, increase in glucose tolerance in rodents, increase in glucose metabolism and significant hypoglycemic effect in experimental models.[42]

Aqueous and ethanolic extract of Khadira (Senegalia catechu (L.f.) P.J.H. Hurter and Mabb.) shows reduction in hyperglycaemia and hypercholesterolemia.[43]

Drugs in accordance with Doshaja (regulatory functional factors of the body) classification of Prameha

Amongst 524 formulations compiled, those formulations with specific doshaja indication were grouped separately counting up to 205 formulations. 100 formulations were indicated in Kaphaja Prameha (diabetes due to Kapha Dosha as origin), 79 formulations in Pittaja Prameha (diabetes due to Pitta Dosha as origin) and 26 formulations in Vataja Prameha (diabetes due to Vata Dosha as origin) were grouped separately and the drugs based on their highest number of enumerations are enlisted [Table 4]. {Table 4}

Most repeated drugs in accordance to Doshas may help in targeting the specific causative factor and thus resulting in quick management. Complimentary Rasapanchaka (five attributes of Dravya (drug) viz., Rasa (taste), Guna (qualities), Virya (potency), Vipaka (bio-transformed rasa), Prabhava (exceptional activity)) towards the specific causative Dosha, innate nature of drug to act through the specific pathological pathways leading to the disease Prameha (diabetes mellitus), preferred dosage form, combination with other drugs etc matter in classification of management of Doshaja Prameha. If laboratory studies are to be considered in proving anti-diabetic activity like inhibition of glucose uptake etc, even Kushmanda (Benincasa hispida Thunb.) is proven to have anti-diabetic properties[44] although mentioned to be an apathya[45] (inconducive) in Prameha.

Vidanga in Kaphaja Prameha (diabetes with Kapha origin) is most enumerated with a count of 22 formulations. Indicated in Pishta meha (urine with paste like consistency), Jala meha (urine similar to water), Sikata meha (urine with powdery material), Lavana meha (urine with salt like material and taste) by Bhavaprakasha. Remaining references as indication in Kaphaja Prameha. In all these references Vidanga has been enumerated with combination of other drugs and never as single drug management.

Arjuna is most repeated in Pittaja Prameha (diabetes with pitta origin), in 19 formulations. Yogaratnakara has indicated in Rakta Meha (urine with reddish colour). Arjuna too has been mentioned in a combination with other drugs in all references. In remaining references Arjuna has been indicated in Pittaja Prameha.

Patha (Cissampelos pareira L.) is most repeated drug in Vataja Prameha with 8 formulations. It has been mentioned in Sarpi meha (urine with ghee like consistency) and Hasti meha (urine with huge quantity, like an elephant’s) in all the references and has been mentioned in a combination with other drugs only.

As no clear understanding of clinical differentiation between 20 types of Prameha (with respect to dosha involvement and urine analysis) has been arrived till date through research activities, considerations of these drugs to act against predominant Dosha (regulatory functional factors of body) causative factor will be more beneficial.

Although the data mentioned in these 15 Ayurveda treatises are compiled and analysed, scientific clinical analysis behind drug/formulation design is yet to be validated. Network pharmacology, omics-technologies and concept of synergy are promising strategies too in understanding complex formulations targeted at multiple systems.[46],[47] Such advanced technologies help to explore the mode of action of combinatory drug formulations.

 Conclusion



The present review may be of help in further scientific studies about the efficacy of these formulations or drugs in prevention or management of Prameha (diabetes mellitus). Fifteen Ayurveda texts were thoroughly scrutinised to compile 524 formulations in management of Prameha. Sahasrayoga text had maximum enumerations of drugs/formulations (82 formulations) in management of Prameha followed by Abhinava Chintamani (72 formulations). Nyagrodadhi gana (kwatha or churna) and Dhanvantara ghrita were the most frequently mentioned formulation (8 formulations each). Triphala (69 formulations) was the most enlisted drug amongst 323 formulations (in formulation with less than 10 ingredients). In formulation with less than 10 ingredients; Vidanga (22 formulations) was most repeated drug indicated in Kaphaja prameha, Arjuna (19 formulations) in Pittaja prameha and Patha (8 formulations) in Vataja prameha. Detailed laboratory and clinical analysis of these formulations/drugs may yield understanding in definitive usage of such varied choices of management in Prameha (Diabetes mellitus).

Acknowledgement

None.

Financial support and sponsorship

Nil.

Conflicts of interest

None.

[INLINE:1]

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