|Year : 2011 | Volume
| Issue : 1 | Page : 55-58
Effect of Ayurvedic management in 130 patients of diabetic nephropathy
Kalapi Patel1, SN Gupta2, Namrata Shah3
1 Reader, Department of Panchakarma, J. S. Ayurveda College, Nadiad, Gujarat, India
2 Professor and Head, Department of Kayachikitsa, J. S. Ayurveda College, Nadiad, Gujarat, India
3 Medical Officer, J. S. Ayurveda College, Nadiad, Gujarat, India
|Date of Web Publication||5-Oct-2011|
Doctors' Staff Quarters, J. S. Ayurved Mahavidyalaya, College Road, Nadiad 387 001
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Diabetic nephropathy is a specific form of renal disease. It is a major cause of renal insufficiency and ultimately of death. The present study has been carried out to prove the efficacy of Ayurvedic drugs in the management of diabetic nephropathy, which can be helpful in reducing the need of dialysis and avoiding or delaying renal transplantation. A total of 130 patients of this disease were treated in IPD (Group A) and OPD (Group B). Ayurvedic formulations including Gokshuradi Guggulu, Bhumyamalaki, Vasa and Shilajatvadi Vati were given to all the patients for 2 months. Group A patients were given special planned food. Results were analyzed statistically using "t" test. In group A patients, highly significant reduction was found in the values of serum creatinine, blood urea and urinary excretion of albumin. Marked improvement was found in the patients' general physical well-being, together with reduction in symptoms, in group A patients. This shows the importance of Pathyapathya in Ayurvedic management of the disease. This management may bring some new hope to the patients of diabetic nephropathy, which usually terminates to chronic renal failure and ultimately to death. Further studies are being carried out in this regard.
Keywords: Ayurveda , diabetic nephropathy, albuminuria
|How to cite this article:|
Patel K, Gupta S N, Shah N. Effect of Ayurvedic management in 130 patients of diabetic nephropathy. AYU 2011;32:55-8
| Introduction|| |
Diabetic nephropathy is a specific form of renal complication of Diabetes Mellitus (DM), a major cause of death and disability among diabetics. It is observed that even the patients having well-controlled diabetes suffer from diabetic nephropathy. Diabetic nephropathy accounts for approximately 14% of all deaths in diabetic patients, and some 25% of those developing diabetes under the age of 30 die from renal failure due to diabetic nephropathy.  This is also a major cause of chronic renal failure as it accounts for 20-40% patients of chronic renal failure. 
The authors found some encouraging results in the patients of diabetic nephropathy with certain Ayurvedic treatments during clinical practice. These significantly correct albuminuria, which is the cardinal feature of diabetic nephropathy, and improve renal function which is evident by reduction in serum creatinine. In addition, the treatments also improve the general condition of the patient. Further studies are being carried out in this regard.
Aims and objectives
- To prove the efficacy of the Ayurvedic preparations in the management of diabetic nephropathy.
- To give the scientific establishment to the observations which show that certain Ayurvedic treatments significantly correct albuminuria which is the cardinal feature of diabetic nephropathy and improve the renal function. This can provide a future possibility of a treatment to a large group of population suffering form diabetic nephropathy, which can be helpful in reducing the need of dialysis, avoiding or delaying renal transplantation.
| Materials and Methods|| |
Criteria for inclusion
Criteria for exclusion
- All the patients were selected from the OPD and IPD of P. D. Patel Ayurveda Hospital, Nadiad, Gujarat.
- Patients with a clinical positive history of type 2 DM having the clinical features of diabetic nephropathy like albuminuria, raised serum creatinine and blood urea were included.
- Patients having any other associated clinical conditions, except complications of diabetes, were not included in the present study.
Preparation of medicines
- The patients were being treated in OPD as well as IPD.
- A total of 130 patients of diabetes nephropathy had been registered for the study during the last 5 years.
- The patients were treated with the following:
Gokshuradi Guggulu (containing mainly Goksura, Guggulu, Triphala, Trikatu, Musta): 1 g three times a day;
Bhumyamalaki : 3 g two times a day;
Vasa leaves' powder: 3 g two times a day; and
Shilajatvadi Vati (modified) (containing mainly Shilajatu, Guggulu and Guduchi): 1 g thrice a day.
- The patients were kept under two categories. Group A patients, treated as indoor patients, were kept under strict supervision and were given a special planned diet (no grains except rice, no beans except mung beans, no oil except sesame oil, no ghee except cow ghee, cow's milk up to 350 ml/day, chyavanprash with milk in breakfast, no sharp spices, no sour food, no deep fried or fermented food, no viruddhahara). Group B patients were treated as outdoor patients. Group A included 94 patients and group B included 36 patients. Five patients from group A and 12 from group B were dropped out due to various reasons.
- The administration of antidiabetic drugs (if the patient was taking them) was not interfered with.
Medicines were prepared under expert supervision and purchased from Sunder Ayurveda pharmacy, Nadiad.
Duration of the treatment
The duration of the treatment was for 2 months.
Assessment of the results
- All the patients were clinically assessed before and after treatment.
- Changes in symptoms, albuminuria, blood urea and serum creatinine were observed.
- Results were analyzed statistically.
| Results|| |
The results obtained have been shown in [Table 1], [Table 2], [Table 3] and [Table 4].
| Discussion|| |
In the diabetic patients, nephropathy develops mainly due to glomerular sclerosis and arteriosclerosis in kidneys. Kidney tissues get damaged after some period. According to Ayurveda, nephropathy is a disease of Mutravaha Srotas. Though all the three doshas are involved in the disease, Kapha is responsible in blocking microvessels and developing microangiopathy. Damage in tissue can be repaired and prevented by the use of Rasayanas as they improve the nourishment, maintain the patency of the Srotas and improve the resistance of the tissues against any adversity. Any blockage can be removed by the preparations having Lekhana (scraping) effect on blocked microvessels as well as macrovessels.
Gokshuradi Guggulu (a combined Ayurvedic preparation) is a well-known and commonly used medicine in diseases of Mutravaha Srotas. It is specially indicated in Prameha, Mutrakriccha and Mutraghata along with other indications of Mutra and Shukravaha Srotasa.  Gokshura, the main ingredient, is well known for its Rasayana effect, especially on Mutravaha Srotas. Guggulu (Commiphora mukul), another main ingredient, is a Rasayana,, and it has Lekhana, (scraping) effect also. In addition, Guggulu has Tridoshahara, property also, by which it pacifies all the three doshas. Bhumyamalaki (Phyllanthus niruri) is a Rasayana and has been described as Mutraroga Nashini as well as Pittameha Nashini in Rajnighantu. Vasa (Adhatoda vasica) is described as Mehahara, and Rasayana, in classics. Practically, it is found effective in preventing albuminuria. Shilajatvadi Vati is indicated for Prameha. Since it is a combination of Shilajatu, Guggulu and Guduchi, it also works on Mutravaha Srotas. Hence, these preparations have been selected for the treatment of diabetic nephropathy.
During the assessments, it was observed that the patients of group A who were under strict supervision benefited well, whereas the patients of group B who were treated as outdoor patients and were not under strict supervision and did not follow instructions for diet and regimen did not benefit well.
[Table 1] shows that in group A, serum creatinine reduced by 14.79%. This beneficial effect was statistically highly significant. Blood urea reduced by 23.41% and it is also statistically highly significant. This is encouraging and shows improvement in kidney functions. Urine albumin also significantly reduced by 18.88%. Serum total protein and serum albumin increased slightly around 4%, whereas serum globulin decreased by 2.71% which is expected. Though the effects on serum proteins are statistically insignificant, the results are promising.
[Table 2] shows that all the signs and symptoms improved significantly in group A patients.
[Table 3] shows that in Group B patients, the results were not encouraging. In this group of patients, serum creatinine raised by 22.6% and blood urea increased by 3.9%. Urine albumin raised by 25.61%, whereas total serum protein decreased by 7.16%, serum albumin decreased by 9.52% and serum globulin decreased by 8.33%. All the results in this group were statistically insignificant except the rise in serum creatinine.
[Table 4] shows that in this group also, signs and symptoms like urine output, edema, weakness and loss of appetite significantly improved, but % of improvement was less in comparison to group A patients.
| Conclusion|| |
Ayurvedic preparations used in the present study are very much effective in improving the kidney functions and retarding the progression of diabetic nephropathy, especially with strict diet restriction and regimen. It may be concluded that treatment is effective if the patient is on healthy food which is supportive enough to act against disease process. This type of food may be creating a favorable atmosphere in the body for better activity of the medicaments being used. This management may bring some new hope to the patients of diabetic nephropathy which usually terminates to chronic renal failure and ultimately to death.
Further studies to get much more data to establish the facts with more statistical and scientific strength are needed.
| Acknowledgment|| |
Authors are thankful to the Management and the Principal of J. S. Ayurveda College and P. D. Patel Ayurveda Hospital, Nadiad, for providing the permission and the facilities for this study.
| References|| |
|1.||Davidson S. Davidson's Principles and Practice of Medicine. 17 th ed. Philadelphia: Churchil Livingstone Elsevier publication; 1995. p. 759. |
|2.||Ibid Davidson's Principles and Practice of Medicine. 20 th ed. p. 486. |
|3.||Shri Sarangadharacharya, Sarangdhara Samhita (gujarati bhasantara sahita), Madhyamakhanda, Adhyaya 7/85-88, edited by harishankara bhatta. 2 nd ed. Mumbai: Pandit Narayan Mulaji Sanskrit pustakalaya; 1928. |
|4.||Pandit Bhavamishra, Bhavaprakash Nighantu, Purvakhanda, Karpuradi Varga/38, commentated by Vishvanath dvivedi. 9th ed. Varanasi: Motilal Banarasidas prakashan; 1998. |
|5.||Shri Narahari Pandit, Raj Nighantu, Candanadi Varga/105. In: Tripathi I, editor. 1st ed. Varansi; Krishnadas Academy; 1982. |
|6.||Kaiyadev, Kaiyadev Nighantu, Aushadhi Varga/1418. In: Sharma AP, Sharma G, editors. 1st ed. Varanasi: Caukhambha orientalia; 1979. |
|7.||Ibid Bhavaprakash Nighantu, Purvakhanda, Karpuradi Varga/38. |
|8.||Ibid Kaiyadev Nighantu ,Aushadhi Varga/14-15. |
|9.||Ibid Bhavaprakash Nighantu, Purvakhanda, Karpuradi Varga/40. |
|10.||Ibid,Kaiyadev Nighantu/Aushadhi Varga/14-16. |
|11.||Agnivesha, Charaka, Dridhabala, Charaka samhita, Cikitsasthana, Rasayana Adhyaya 1/63 (Chyavanprash). Vaidya Jadavaji Trikamji Aacharya. 2 nd ed. Varanasi; Chaukhamba Sanskrit sansthan; 1990. |
|12.||Ibid, Raj Nighantu/Parpatadi Varga/93. |
|13.||Ibid, Bhavaprakash Nighantu, Purvakhanda, Guduchyadi Varga/85. |
|14.||Sushruta, Sushruta Samhita, Sutrasthana, Adhyaya 46/263, edited by Vaidya Jadavaji Trikamji Aacarya and Narayanram Acarya. 4th ed. Varanasi: Caukhambha orientalia; 1980. |
|15.||Ibid, Kaiyadev Nighantu/Aushadhi Varga/14. |
|16.||Ibid Sushruta samhita,Cikitsasthana, 28/18. |
|17.||Bheshaja Samhita (Ayurvedic pharmacopoeia), Gutika - Guggulu kalpa. Yoga No/56. edited by Gujarat State-Bheshaj Samiti. 1st ed. Ministary of Health Gujarat State; 1966. P. 468-9. |
[Table 1], [Table 2], [Table 3], [Table 4]
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