Abstract
Diabetic neuropathy is a relatively early and common complication affecting approximately 30% of diabetic patients. According to Ayurvedic principles there is involvement of Vata and Pitta Dosa in diabetic neuropathy. Bhumyamalaki (Phyllanthus niruri) is a plant which shows possibility to pacify these two Dosas. Another plant Atibala (Abutilon indicum) has also Vata pacifying qualities. Present study has been carried out to study the effects of Bhumyamalaki and Atibala on 33 patients of diabetic neuropathy. All the patients have been given Bhumyamalaki Churna 3 g twice a day and decoction of 10 g of Atibala-mula twice a day for 30 days. Neuropathy analyzer machine has been used for exact recording of sensory perception of vibration, cold and hot sensations before and after treatment. Changes in numbness, tingling, burning sensation and pain in lower limbs have also been assessed before and after treatment. Results have been analyzed statistically by applying the ‘t’ test. It can be stated from the results that use of Bhumyamalaki and Atibalamula in the patients of diabetic neuropathy can revert the diminished sensory perception and can reduce the symptoms significantly.
Keywords: Abutilon indicum, Atibala, Bhumyamalaki, Diabetic neuropathy, Phyllanthus niruri
Introduction
Diabetic neuropathy is a relatively early and common complication affecting approximately 30% of diabetic patients.[1] Although the invention of insulin and hypoglycemics have done a great service for diabetics, yet these patients do not get a proper solution for their neuropathic complications. The drugs used conventionally are mostly for relief in the symptoms and moreover they have certain side effects. Therefore it is necessary to explore the possibilities of safer and effective treatments from other sources.
In Ayurvedic classics symptoms like Suptata (numbness) and Daha (burning sensation) in body parts especially in hands and feet are described as Purvarupa of Prameha.[2] Daha is also described among the Upadravas(complications) of Prameha.[3] These are very common features of diabetic neuropathy. According to Ayurvedic principles, there is involvement of Vata and Pitta Dosa in diabetic neuropathy. Bhumyamalaki (Phyllanthus niruri) is a plant which shows possibility to pacify these two Dosas as it is described to be a Pitta and Kapha reducing plant[4,5,6] and in addition it is used in the treatment of Vata-related diseases.[7,8,9,10,11,12] Another plant Atibala (Abutilon indicum) is a good substitute of Bala (Sida cordifolia) which is well-known for its Vata reducing qualities. A preliminary study has been started to observe and evaluate the effect of Bhumyamalaki and Atibala-mula on diabetic neuropathy in PD Patel Ayurveda Hospital, Nadiad.
Aims and objectives
To study the effects of Bhumyamalaki and Atibala on diabetic neuropathy.
To observe the safety of the treatment.
Materials and Methods
Inclusion criteria for the patients
The patients for this study have been selected randomly irrespective of their age, sex, religion, etc.
Patients with clinical positive history of type 2 diabetes mellitus having the symptoms of diabetic neuropathy (peripheral) are selected for the present study.
Exclusion criteria for the patients
Patients having any other associated clinical conditions have not been included in the present study.
Patients having diabetic complications other than neuropathy were also excluded from the study.
Plan of the treatment
The patients have been treated in OPD as well as in IPD depending on the severity and the circumstances.
All the patients have been treated with Bhumyamalaki Churna 3 g twice a day and a decoction prepared from 10 g of Atibala mula twice a day.
Duration of the study was 30 days.
Total 33 patients have been taken for the study presently; however, the study is continued.
Criteria for assessment
Neuropathy analyzer which is specifically designed electronic machine by Diabetic foot care India, Chennai, can record the perceptions of vibration, heat and cold sensations exactly with the help of computer has been used to record these sensations before and after the treatment in all the 33 patients.
The criteria used to evaluate vibration, heat and cold sensations by neuropathy analyzer are as below [Table 1]:
Table 1.
Criteria used by neuropathy analyzer machine to assess perception of sensations
During the recording frequency of vibrating probe (which is to be kept in contact with the skin of the sole) is to be increased and when patient feels the vibration it is recorded in the computer, temperature of the probe is to be reduced from 30°C to 0°C to record perception of cold sensation and temperature of the probe is to be increased from 30°C up to 50°C to record perception of heat sensations.
All the symptoms have also been assessed before and after treatment according to the given score Table 2.
Table 2.
Scoring of symptoms
Results and Discussion
None of the patients have shown any new and unusual features during the course of treatment.
As we know that diabetic neuropathy is common complication amongst diabetics. In conventional medicine tricyclic antidepressants, anticonvulsants, opiates, membrane stabilizers and antioxidants are used in diabetic peripheral polyneuropathy for symptomatic relief.[13] All these drugs have their side effects. Hence there is need to find out safer and effective treatment from the sources other than conventional medicine.
According to Ayurvedic principles, the symptoms of diabetic neuropathy like paraesthesiae, pain and tingling sensation are indicating involvement of Vata Dosa. Whereas burning sensation is because of vitiation of Pitta Dosa. Hence drugs pacifying Vata and Pitta Dosas are useful in the treatment of diabetic neuropathy.
Bhumyamalaki is a plant having Sitavirya, Pitta-Kaphahara and Dahahara properties.[4,5,6]
It is also used in the treatment of Vata-related diseases.[7,8,9,10,11,12] It is also described as Mutraroga Nasini, Pittameha Nasini in the classics.[14] Another plant Atibala has Sita, Madhura, Balakrita properties[15,16] and also Tridosahara[17] properties. In addition it has Rasayana[18] effect which reduces all the three Dosas.[3] Hence these two plants have been selected for the present study.
The most common signs found in diabetic sensory polyneuropathy are diminished perception of vibration sensation and impairment of all other modalities of sensations.[1] Perception of vibration, heat and cold sensations are recorded with the help of neuropathy analyzer before and after treatment in all the 33 patients of diabetic neuropathy. Analysis of the results has shown highly significant to significant improvement in perception of these sensations.
Tables 3 and 4 show that perception of vibration sensations has been improved by 31% in right foot and 32% in left foot and it came in lower range of moderate affection from severe. Perception of cold sensation has been improved by 19.7% in right foot and 23% in left foot, which has come in to the normal range after treatment. Improvement in vibration and cold sensations are highly significant in both the feet. Perception of heat sensation is improved by 6.85% in right foot and it is highly significant whereas 3.9% improvement in left foot and it is significant. It has come in to mild from upper range of moderate affection.
Table 3.
Change in perception of sensations in right leg
Table 4.
Change in perception of sensations in left leg
In addition Table 5 shows highly significant improvement in symptoms also. Numbness is relieved by 70%, tingling is relieved by 72%, burning sensation is reduced by 77.5% whereas pain in lower limbs is relieved by 64%.
Table 5.
Improvement in symptoms
Conclusion
It can be stated from the results that Ayurvedic drugs used in present study are effective to revert the diminished perception of sensations like vibration, cold and heat. There is highly significant reduction in other symptoms including numbness, tingling, burning sensation and pain in lower limbs in the patients of diabetic neuropathy. Both of these drugs are also safe as did not produce any adverse features.
The study is continuous to get large number of patients.
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.
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