(Polyuria) – the main symptoms of Prameha
are caused by an excess of vitiated Kleda
, which gets converted into mutra
. From the modern point of view, due to a lack of the action of insulin, glucose is not utilized, causing a high blood glucose level. When it crosses the renal threshold (180 mg/ dl), blood glucose starts to excrete through the urine. Thus, in diabetic patients, increased frequency of urine is seen commonly. MMV is dominant in Tikta
(bitter) – Kashaya
among which Tikta
is said to be “kleda upashoshana
” while Kashaya
to be “sharira kledasya upayokta
] The word Ruksha
itself indicates dryness, which in turn means lack or decrease of Kleda
. Thus, all the three dominant properties show a Kleda
-reducing effect. Bahu drava Shleshma
is the dosha vishesha
is one of the dushya vishesha
; thus, the dominating three properties directly affect both the dosha
and the dushya vishesha
and hence effectively counteract the Samprapti
Because of sedentary lifestyle and excessive intake of foods, which increases Kapha
, the end product of digestion becomes abnormally sweet, which in turn causes an increase of medas
(fat). This obstructs the nutrient channel of the remaining tissue, depriving them of nutrition. Therefore, only fat accumulates in large quantities in the body, making the person incapable of all activities. The channels of Vata
become obstructed by the increased fat inside the abdomen; Vata
then begins to act fast inside the abdomen, increasing the digestive capacity, making for voracious hunger and craving for large quantity of food,[7
] which is presented as Kshudhadhikya
(polyphagia) occurs due to tikshna
and ushna guna
. In the pathophysiology of NIDDM, due to lack of insulin utilization, glucose consumption in muscle tissues is reduced, which is an essential requirement for energy. When muscle tissue does not get glucose and it demands for glucose, this is represented as polyphagia in patients. Due to Dipana
properties of the drugs present in MMV, like Triphala, Trikatu, Dadima
] Bidalavana, Kiratatikta
] etc., it might have improved the digestive process by correcting Dhatvagnimandya
, resulting in prevention of further medo vriddhi
and by Vatashamaka
property of Guggulu
] etc. it alleviates the Vata dosha
responsible for atiagnisandhukshana
. If Kshudhadhikya
has occurred due to tikshna
and ushna guna
, MMV may act by pacifying it with the help of its Sheeta veerya
(polydypsia) and Gala talu shosha
(dryness in mouth) occur due to Pitta vriddhi
and udaka kshaya
, which may be pacified by Tikta
(sweet) and Kashaya
of the MMV that affects the condition by correcting Pitta dosha
or due to the trishna nigrahana
effect of Kiratatikta
] and Devadaru
] Polyuria is commonly found in diabetics. Through polyuria, a lot of body fluid is excreted. Therefore, to compensate for this loss, the body demands for liquid, and this is called polydypsia. Because MMV significantly reduces polyuria, it in turn mechanically also reduces polydypsia. In same manner, it also shows an effect on Gala talu shosha
(dryness in mouth).
and Karapadatala Suptata
(burning sensation and numbness in the palm and foot) are both common neurological complications of diabetes described in the Ayurvedic
literature as Purvarupa
. They reflect one′s glycemic control. Therefore, when hyperglycemia is corrected with hypoglycemic activity of Amalaki
] etc. ingredients of MMV, relief was obtained in these neuropathic complications like Karapadatala daha
and Karapadatala Suptata
(burning sensation and numbness in palm and foot). Amalaki
] and Guggulu
] are said to be Nadibalya
, and are thus beneficial in neurological symptoms.
Karapadatala Daha (burning sensation in palm and foot) is due to Pitta by provocation of Ushna quality or may be due to loss of Udaka, which might have been pacified by Sheeta quality of MMV. Karapadatala suptata (numbness in palm and foot) is due to Vata – decrease in Chala guna of Vyana vayu that might have been compensated by Sara guna of MMV.
(leg cramps) and Shrama
(fatigue) conditions were found in many of diabetic patients because of less glucose uptake by muscle tissue for energy due to an insulin antagonist effect.[19
] In the etiopathogenesis of Prameha
, the Dhatus
get vitiated and vitiated apyamsha
of dhatus get converted into Sharira kleda
and is excreted through urine.[20
] As a result, Dhatukshaya
takes place with manifestation of Daurbalya, Shrama
. Therefore, significant results were obtained by the Rasayana
effect of Triphala
] and shunthi
. But, this samprapti
can be true in IDDM patients, whereas in NIDDM patients, obesity (Sthaulya
) may be the cause for manifestation of these symptoms as, due to Medodhatvagnimandya
, only fat accumulates in large quantities in the body making the person incapable of all activities. MMV, through its tikta-kashaya
(bitter – astringent) rasa
of the abaddha medas
and through the Dipana
properties present in its ingredients like Triphala, Trikatu, Dadima
] Bidalavana, Devadaru
] etc. may have corrected digestive process resulting in correction of medodhtvagni
and reducing the baddha meda
. The ingredients like Lauha bhasma
] Guggulu, Maricha, Devadaru
etc. present in MMV have Medohara properties, which may help in reducing excessive meda and, thereby, relieving these complaints.
Atisweda (excessive sweating) is the symptom that arises due to medo mala vriddhi. The MMV due to its ruksha (dry) guna, Kashaya (astringent) rasa, Tikta (bitter) rasa has medohara property due to which it decreases meda and, ultimately, its mala, i.e. sweda. These properties directly, also, contribute to the adsorption of sweda.
Stress blocks the body from releasing insulin in people with type 2 diabetes; therefore, cutting stress is very essential for effective control of the blood sugar level. The ingredients present in the formulation MMV have different properties that may be helpful in minimizing the stress response or cutting stress. As Haritaki and Bibhitaki
] are antistress agents and Shunthi
is an antidepressant, they might have been cutting the stress directly. Rasayana
effect of Lauha bhasma
] and Pippali
] antioxidant properties of Amalaki
] and Dadima
] and immunomodulatory properties of Amalaki
] and Devadaru
] might have helped in minimizing the stress response, and in the manner controlling the disease.
High blood sugar is the main characteristic and diagnostic feature of diabetes. The MMV decreased this elevated blood glucose level, which may be by its ingredients such as Amalaki
] Daruharidra (Rasanjana)
] and Devadaru
] which are proven hypoglycemic agents, whereas Lauha bhasma
] and Haritaki
] have Pramehahara
properties. Oral administration of the extracts of Triphala
significantly reduced the blood sugar level in normal and in alloxan diabetic rats. It may decrease the effect of inflammatory cytokine release in diabetics, which in turn might reduce the insulin resistance. Interestingly, the authors note that traditional medications used to treat diabetes also have significant antioxidant effects.[25
When glucose and FFA increase, they cause oxidative stress-sensitive signaling pathways. Activation of these pathways, in turn, worsens both insulin action and secretion, leading to overt type 2 diabetes.[26
] Furthermore, insulin-resistant patients, with and without type 2 diabetes, are at an increased risk for developing metabolic syndrome, a major cause of heart disease, hypertension and dyslipidemia.[27
] Thus, treatment aimed at reducing the degree of oxidative stress signaling pathways might appear to warrant consideration for inclusion as part of the treatment program for patients with type 2 diabetes. Some of the drugs like Amalaki
] and Dadima
] present in MMV are proven antioxidants and Lauha bhasma
] and Pippali
] due to their Rasayana
properties, might have reduced the degree of oxidative stress signaling pathways and, by that, preventing insulin resistance and Beta cell dysfunction and, ultimately, controlling the blood sugar level.
The contents of MMV – Lauha bhasma
] and Devadaru
] have Medohara
effect, and Guggulu
] and Shunthi
] have a proven hypolipidemic effect due to which they may have decreased the high lipid level and BMI .
Group A has shown 3.15% decrease in S. creatinine whereas Group B has decreased S. creatinine significantly by 5.33%. Blood Urea was decreased in Group A by 2.93% whereas it was increased by 1.83%. [Tables –]. Even during the follow-up period, they have not gone beyond the normal limit. The patients having abnormally high serum creatinine and blood urea levels were excluded from the study. Thus, decrease and increase in the physiological value of serum creatinine has no value, but not going beyond the normal limit after administration of MMV for 3 months, it certainly gives the safety profile of the drug as Lauha bhasma is the main ingredient of this formulation.
When the blood sugar level crosses the renal threshold, i.e. 180 mg/dl, then it starts its excretion through the urine to decrease the load of blood sugar. Although by MMV, the blood sugar level was found to have decreased, it could not come within the normal limit in all the patients; thus, urine sugar also was not found to be nil in all the patients. Therefore, on examination, urine sugar is found to be present in these patients also after the treatment.
An increased level of serum insulin gives the indication toward an insulin-secretagaug effect of the ingredients of the trial formulation – MMV. An increased level of serum insulin with a decreased blood sugar level gives the idea that the drug has worked through its insulin-secretagauge effect. Where the blood sugar level is decreased and serum insulin is also decreased, it shows that MMV might have decreased insulin resistance and increased peripheral utilization or increased insulin sensitivity. Where the blood sugar level is increased although the serum insulin level is also increased, the role of anti-insulin antibody can be thought of in the etiopathogenesis of the disease, which is not counteracted by this formulation.
Probable mode of action of Mehamudgara vati
Probable Rasapanchaka of MMV according to cumulative properties
Rasa: Tikta (bitter) (29.41%), Madhura (sweet) (27.06%), Kashaya (astringent) (24.7%)
Guna: Ruksha (dry) (22.05%), Guru (20.47%) (heavy), Sara (14.17%), Sheeta (cold) (12.60%)
Veerya: Sheeta (cold) (51.52%)
Vipaka: Katu (pungent) (76.47%)
Doshaghnata: Kaphapittashamaka (51.43%)
The active principle of MMV can also be divided into two parts: Acting part and defensive part.
Acting part: Rasa: Tikta (bitter), Kashaya (astringent); Guna: Ruksha.
Defending part: Rasa: Madhura (sweet); Guna: Guru (heavy); Veerya: Sheeta (cold) (Otherwise, the acting part can lead to Dhatukshaya, Vata prakopaka, Vatanubandha, Upadrava etc.).
Role of the defending part
Madhura (sweet) rasa
MMV contains the highest amount of Lauha bhasma, which has Madhura rasa. Here, the purpose of using Lauha bhasma in such a great proportion is getting the Lekhana effect. That is why it can be thought that Lauha bhasma will do Lekhana and thus reduce Meda and Shleshma more effectively by its Lekhana karma rather than by increasing them by Madhura rasa. Madhura rasa prevents Dhatukshaya and Vata Prakopa. Moreover, it may show a shamana effect on Pitta and Vata in Pittanubandhaja and Vatanubandhaja Kaphaja Prameha, respectively.
Guru (heavy) guna
It can be deduced that Guru guna acts as Aviruddha vishesha and thus prevents dhatu kshaya and vata vriddhi. As MMV is dominant in Ruksha and Sheeta guna, if it would be laghu, it would certainly increase vata and cause dhatukshaya, which will further progress to Prameha.
Sheeta (cold) veerya
As Dosha vishesha in pathogenesis of this disease is Bahu drava shleshma and Dushya vishesha is bahu and abaddha meda, including other dushyas involved, i.e., Ap pradhana. If more heat energy would be provided, then, by liquefaction of dosha, it will cause more Prakopa of the already present drava shleshma. Therefore, to prevent this doshic calamity, the drugs having sheeta veerya may be combined as a remedy for Prameha.
Role of the acting part
Kashaya (Astringent) rasa:
It seems that both Tikta and Kashaya (bitter and astringent) rasa play both acting and defending roles. By the virtue of Ruksha (dry) property, they especially do Kleda shoshana and Kledopayoga, which is one of the prime dushya in pathogenesis of Prameha. Whereas by Sheeta (cold) property, they prevents liquefaction of the already drava shleshma, abaddha meda and other Ap pradhana dushyas involved in the pathogenesis hence also participating in a defending phenomenon.
Ruksha (dry) guna:
In Samprapti of Prameha, Bahu drava shleshma is important among the dosha and Abaddha meda among the dushyas. Other dushyas involved are either Bahu or Bahu and Abaddha, indicating excessive Ap dhatu in the body and main line of treatment for excessive fluid is their shoshana, which is done by Ruksha (dry) guna. Thus, directly or indirectly, Ruksha guna plays a very important role in Samprapti vighatana starting from the very initial stage, i.e. first kriyakala of Sanchaya.
The mode of action of the ingredients of MMV on the basis of pharmacological activity is shown in .
Mode of action of MMV in type 2 diabetes on the basis of pharmacological activity