Whatsapp discussion series- 5 : Madumeha and Madhumehaja Pidaka

[25/03 6:14 PM] Dr Surendra A. Soni: 

Is it classical Prameha pidaka   ?
Some associated or supurative skin lesions...?

Case of DM. He had uncontrolled BS 400+. Now after routine OPD management more 2 months BS is 250+.

[25/03 7:51 PM] Dr Ranga Prasad Bhat:+919841218802

 Pitakas as of my understanding will be vesiculo-pustular in nature and broad at its base with a narrow mukha.

Plz correct me if I'm wrong. 

[25/03 8:06 PM] Dr. D. C. Katoch: +919968076668

 Dr Soni, the case appears to be of Lichen planus if itching is there, Ayurvedically Alasak. Such a condition irrespective of biochemistry results due to autoimmune disturbance with psychological background.

[25/03 8:10 PM] Dr. D. C. Katoch sir:

Manjishthadi kwath orally and topical application of Neem taila or Dermin oil of Dr Vasishth work successfully. Add Tagra or Jatamansi or Mental Relaxation technique, if stress factor is apparently present.

[25/03 8:17 PM] Dr Surendra A. Soni:

Thanks sir..

[25/03 8:18 PM] Dr Surendra A. Soni:

Mild itching was there ...later on reduced...

[25/03 8:18 PM] Dr Surendra A. Soni: 

Thanks Ranga Sir

[25/03 9:04 PM] Dr. Shastri BSRNL: +919948525677

 Prognosis will be poor if DM not under control

[25/03 9:25 PM] Dr Atul Kale: +919822400728

These are not looking like prameh pidaka. we found these as swatantra vyadhi. In pitta prakriti patients with vatika anubandha we may found pidaka like same appearance.

[25/03 9:45 PM] ‪Dr. Pradeep Jain AP‬:+919838887064

I think this is a case of diabetic dermopathy.
Diabetic dermopathy tends to occur in older patients or those who have had diabetes for at least 10-20 years. It also appears to be closely linked to increased glycosylated haemoglobin, an indicator of poor control of blood glucose levels.The exact cause of diabetic dermopathy is unknown but may be associated with diabetic neuropathic and vascular  complications, as studies have shown the condition to occur more frequently in diabetic patients with retinopathy, neuropathy (nerve/sensory damage) and nephropathy damage .Although diabetic dermopathy occurs frequently on shins or areas of repeared trauma but not always.

[25/03 10:06 PM] ‪Dr. Pradeep Jain AP‬:

These lesions cannot be reversed.Only good sugar control and reduction of HbA1c to below 7% is the only key which can prevent further progression. Guduchi swaras,Daruharidra kwath ,panchnimb churna along with antidiabetic medicines have provided good results in many of my pts.

[25/03 10:10 PM] Dr Ranga Prasad Ay Pith:+919841218802

 HbA1c beyond 8.1 --
Can it be brought under control with our remedies ?

Requesting the elite panel, opinion and guidelines regarding.

[25/03 10:10 PM] Amit Naknekar:

 Yes sir

[25/03 10:10 PM] Amit Naknekar:+919850233016

 It is possible

[25/03 10:11 PM] Dr Ranga Prasad Ay Pith:

Any guideline of protocol sir ?

[25/03 10:11 PM] M gopikrsnan Dr. Ay pith:+9845248757 

Yes sir

[25/03 10:11 PM] Amit Naknekar:

Sir it depends on what are other findings

[25/03 10:12 PM] Amit Naknekar:

What was BSl fasting pm

[25/03 10:12 PM] Amit Naknekar:

 Lipid profile

[25/03 10:12 PM] Dr Ranga Prasad Ay Pith:

If I may be excused with being asked for the exact numbers of the findings, probably I can recollect from my memory and give a short history.

[25/03 10:12 PM] Amit Naknekar:

And wht is rt

[25/03 10:13 PM] Amit Naknekar:

At least rough estimates can be taken

[25/03 10:13 PM] Amit Naknekar:

 Wheather pt is obese non obese

[25/03 10:15 PM] Dr Ranga Prasad Ay Pith:

Non obese, Female aged 40 yrs, with clerical position in a bank -/diabetic since 3 years.
Hypothyroid - 3 years
Lipid profile - increased triglycerides and ldl - 2 years.
RFT - WNL
LFT - WNL
BSL - FB & PP both on rise and fluctuating.
Currently presents a lichenoid lesion in shin.

[25/03 10:16 PM] Amit Naknekar:

Sir u can go with kiratikdadi churna charak pittaj grahani chikitsa

[25/03 10:17 PM] M gopikrsnan Dr. Ay pith:

Tridhatu garbha pottali with asanadi kwatha anupanam.
Chandraprabha/shilajit vati/gomutra shilajit triphala vati. aarogyavardhini Vasanthakusumakar ras (very effective).

[25/03 10:17 PM] Amit Naknekar:

It has shit jal and gud as anupan . U take ushna jal as anupan

[25/03 10:18 PM] Amit Naknekar:

If cardiac involvement is there I use krishnadi churna frm same adhyay

[25/03 10:18 PM] Dr Ranga prsad Ay Pith: 

Undertaken her case since 3 months.
Put her under Guduci in RasAyanam mode (using satva)
Provided Kālajāji churn
Both Since 3 months.
Hb1Ac is fluctuating between 8.1 to 7.1 by not getting reduced further.
Wth above protocol, the lid profile and thyroid profile was responding with  laboratory findings.

[25/03 10:19 PM] Amit Naknekar:

Sir Udvartan with trikatu and pramwhghna panchtika kshir basti also effective herwith

[25/03 10:19 PM] Dr Ranga Prasad Ay Pith:

Sirs, I usually go with minimum medicine maximum benefit protocol, only hence squared in with above 2 yogas..

[25/03 10:20 PM] Amit Naknekar:

 Ok sir !🏻

[25/03 10:20 PM] Amit Naknekar:

Thanks fr sharing

[25/03 10:21 PM] Dr. D. C. Katoch sir:

Dr Gopi, do you think Vasanthakusumakar Ras is antidiabetic/hypoglycaemic? I don't think so. VKR by design and properties (GunaKarma) is better known  as effective in Diabetic neuropathy.

[25/03 10:21 PM] Dr Ranga Prasad Ay Pith:

Amit Sir, can i get some more inputs behind the rationale of selecting pittaja grahani Chikitsa. I have heard about this protocol from some other physicians too, in getting mentioned.

[25/03 10:23 PM] Dr Ranga prsad Ay Pith:

 Gopi ji, Gomūtra shilajit will reduce BSL , sir ? Please enlighten. 

[25/03 10:23 PM] Amit Naknekar:

Sir Agni mandya and inflammation needs to be targeted

[25/03 10:24 PM] Dr Ranga Prasad Ay Pith: 

Inflammation in which ashaya Amit  sir ?

[25/03 10:25 PM] M gopikrsnan Dr. Ay pith:

Katoch sir, there are many references for vasanthakusumakar , few are in Diabetic neuropathy like cond.
Afi ref vasanthakusumakar, I am using in diabetic pts from last 12_15 yrs with very good responce.
One alteration is, along with the regular ingredients, I add navaratnas pisti as ingredients, based on a telugu text referance.but bhavana is same as afi.

[25/03 10:25 PM] Amit Naknekar:

 At level of Grahani

[25/03 10:26 PM] Amit Naknekar:

 Sir my Guide has done extensive work on Vasant kusumakar and Neuropathy and Retinopathy

[25/03 10:27 PM] Amit Naknekar:

Based on that Dhootpapeshwar has developed prameha kusumakar ras which contains vasant kusumakar

[25/03 10:27 PM] Dr. D. C. Katoch sir:

Any study of VKR on hypoglycaemic effect ?

[25/03 10:28 PM] M gopikrsnan Dr. Ay pith:

Yes Dr.Ranga garu, especially medovaha srotas affected pts or sthoulya pramehi pts , gomutra shilajit gives good responce.

[25/03 10:29 PM] Amit Naknekar:

 Not about hypoglycemic but as a adjutant in Retinopathy and Neuropathy

[25/03 10:31 PM] M gopikrsnan Dr. Ay pith:

 Katoch sir, there are my pts with 8 HbA1C to 7 only with vasanthakusumakar and asanadi kwatha anupanam , since yrs.with no allopathy medicines.

[25/03 10:32 PM] M gopikrsnan Dr. Ay pith:

 As prameha indication is there as per texts.

[25/03 10:35 PM] Dr. D. C. Katoch sir:

I feel then the hypoglycaemic effect is attributable to Asanadi Kwath, not to VKR. VKR might be providing Yogavahi effect enhancing the bioavailability of Asanaadi kwath.

[25/03 10:37 PM] ‪+91 94223 57002‬:

VKR works well in pure vatik n aptarpanjanya dm

[25/03 10:37 PM] Amit Naknekar:

 Yes sir

[25/03 10:38 PM] Dr. D. C. Katoch sir:

Dr Gopi, Study the effect on some patients with Asanaadi kwath only and some with VKR. Truth will come out.

[25/03 10:38 PM] Dr. Mayur Surana ay pth: +919503504200 

Can anybody tell with what and how ibcreased BSL is correlated in Ayurvedic terms?...why are we using tikta pradhan drugs in prameha when we know dat opposite of madhur is Katu rasa ?

[25/03 10:38 PM] Dr Ranga prsad Ay Pith: 

Thank you Amit Sir, I'll ponder upon P. Grahani factors in that case and correlate with her clinical presentation..??

[25/03 10:39 PM] Dr. Mayur Surana Ay pth:

How can there be uniform treatment for BSL without Ayurvedic nidan ?

[25/03 10:39 PM] Amit Naknekar:

Sir I am very junior to you plz don't say sir !

[25/03 10:40 PM] Dr Ranga prsad Ay Pith: 

Jaise aapki marzi Amit ji. So Aham. 

[25/03 10:40 PM] Dr. Mayur Surana Ay pth:

Amit sir, what if pt.has no symptoms of pittaj grahani?...still dat mode of treatment will work ? how ?

[25/03 10:43 PM] Amit Naknekar:

@ Mayur sir ! Vagbhat has mentioned Atisar and Grahani nidan in 1 adhyay followed by mutrghat and prameha adhyay.  Mutraghat is direct consequence of Atisar and Prameha is of Grahani.  I suppose this concept works. I may be wrong experts plz guide

[25/03 10:45 PM] Dr. Dipak Shirude AP:+919423488753

VKRas is not hypoglycemic. This is sure.

But ...

it has a great potential to rejuvenate the cells, each and every cell of the body including beta cells in pancreas which secrete insulin.

By this way, VKRas tends to result into hypoglycemia.

I have treated some insulin dependent patients with VKRas. When it is given in loading dose, it induces hypoglycemia. Few patients needed to stop insulin. Many are shifted to oral hypoglycemic drugs. In long term use if VKRas, doses of OHD is reduced in remarkable quantity.

This is true experience.

In newly detected diabetics, this is sure drug to repel the patient away from this long running disease.

[25/03 10:46 PM] Dr. Amit Naknekar:

Vasant sarva rogeshu..

[25/03 10:46 PM] ‪+91 94239 75874‬:

Sir so can we use Abhrak bhasma and Yashad bhasma in prameha

[25/03 10:47 PM] Dr. Amit Naknekar:

Yes Hitesh

[25/03 10:47 PM] Dr. Mayur Surana Ay pth:

Prameha and diabetes what correlation?...suppose a diabetic pt is not having urinary symptoms what to do ? how do we make d nidaan without ayurvediya mutra pareekshan ?

[25/03 10:48 PM] ‪+91 94239 75874‬:

I think we should also think of cost effective tt...

Can we CURE diabetes??

Metformin cost vs VKR cost

[25/03 10:49 PM] ‪+91 94239 75874‬: 

All factors should be considered.....

[25/03 10:49 PM] Dr. Mayur Surana Ay pth:

Vasantkusumakar with Nishaamalaki kashay/haridra kashay effective in Ayurvediya prameha which has increased BSL...Not in Diabetes without prameha...?!!

[25/03 10:49 PM] Amit Naknekar:

Sir I  am recording daily out put along with photo of urine collected in bislari bottle I have those phtos in my laptop will upload

[25/03 10:49 PM] Dr. Mayur Surana Ay pth:

Thanks Amit sir...plz do that

[25/03 10:50 PM] Amit Naknekar:

I have also uploaded some photos in Charakkulam group

[25/03 10:51 PM] Amit Naknekar:

Many times this is also observed as mayur sir mentioned

[25/03 10:52 PM] ‪+91 94239 75874‬:

Cost effective HERBAL tt should be investigated if our motto is to maintain blood sugar level...

Or

can use any ratna etc costlier tt to CURE diabetes...

Experts plz suggest further

[25/03 10:53 PM] M gopikrishnan Dr. Ay pith:

The dosage is very small, effective, safe, good maintenance of pt .

[25/03 10:53 PM] pawan madan Dr:+919530959828

 Deepak ji..

What do exactly mean by loading doses of VKR?

How much??

[25/03 10:57 PM] Dr. Dipak Shirude AP:

Loading dose = 125 mg twice a day. This I suppose and suggested to the patients. Later on, when we get satisfactory bsl and clinical improvement in patient, I reduce it gradually, even up to once in a week.

[25/03 10:58 PM] M gopikrsnan Dr. Ay pith:

Reserch Is very important, but when in clinic , we try to opt safe/proved drugs , so I use vasanthakusumakar with asanadi kwatha (weather its effect of either or any one of these !? I don't know ) but they are effective clinically.

Some times cp, avr, tridhatu pottali, hemagarbha pottali, lohagarbha pottali are also used according to pts condition and necessity.

[25/03 11:00 PM] pawan madan Dr:

Deepak ji ...that means about 5-6 gms a mnth...

I need to try...

I have used this in 3 g per mnth but didntget such results...

[25/03 11:01 PM] M gopikrsnan Dr. Ay pith:

Posology

Vkr initially there are cases where I used with 125 mg thrice daily or even 6 times daily , later reduced to 125 mg od as maintanence, if its costlier to pt, then I try to replace it with other drugs later.

[25/03 11:01 PM] Dr. Dipak Shirude AP:

 It depends on quality of drug also.

[25/03 11:01 PM] M gopikrsnan Dr. Ay pith:

Mine is self prepared vasanthakusumakar ras.

[25/03 11:02 PM] M gopikrsnan Dr. Ay pith:

Then I capsule it for dispensing

[25/03 11:02 PM] Dr. Amit Naknekar:

Sir sanjay tamoli has done nice work on vkr and Diabetic Retinopathy

[25/03 11:04 PM] ‪+91 73829 97328‬:

I studied that vanga is the ingredient of vkr which has prameha hara properties.

[25/03 11:05 PM] Amit Naknekar:

vanga also acts through its vrushya effects on prameha.

[25/03 11:05 PM] pawan madan Dr:

 I also think the same..

at least 125 mg bd is necessary..

Havent got any result qith lower doses

[25/03 11:05 PM]Dr.Ranjit Nimbalakar Prof.:+918087873115

I treat only resistant cases of dm...

If bsls r well controlled by ohas, i advice pts to continue the same...

[25/03 11:07 PM] Dr. Ranjit Nimbalakar Prof.:

I treat only those pts, who need insulin for their bsl control (type 2 dm)

[25/03 11:10 PM] M gopikrsnan Dr. Ay pith:

Vanga is an ingredient of vasanthakusumakar ras as well as tridhatu garbha pottali which I use in DM

[25/03 11:13 PM] M gopikrsnan Dr. Ay pith:

There are certain vaidhyas who prepare pottali with vasanthakusumakar ras and use it in Diabetes like conditions.

[25/03 11:16 PM] Amit Naknekar: 

Trivang is also useful

[25/03 11:16 PM] Upendr dixit Prof:+919850454751

I am having pottali of Vasantkusumakar prepared by a Rasavaidya , who was like  grandfather of my wife.

[25/03 11:20 PM] M gopikrsnan Dr. Ay pith:

I haven't used such pottali yet (vasanthakusumakar pottali)

But ill defanatly try some day

[25/03 11:21 PM] M gopikrsnan Dr. Ay pith:

 Dixit sir, how is the clinical responce with such pottali ?

[25/03 11:40 PM] ‪+91 94239 75874‬:

@Ranjit sir..  I m focusing the same issue . ..

Oral hypo glycemic agents are cheaper and well tolerated

We should work in Resistent cases...

Or should give such formulations which are cheaper than OHGAs

[26/03 12:06 AM] Amit Naknekar:

Sir I am thinking on different line we can also act on Pre diabetes

[26/03 12:09 AM] Amit Naknekar:

Sir where could I get pottali  VKR

[26/03 9:22 AM] Dr Atul Kale Ay pith:

Burning micturation as madhumeha upadrav can be treated with vasantkusumakar with chandan, musta, dhanyak, ushira phant.

[26/03 9:22 AM] Dr Atul Kale Ay pith:

Bilva patra kashayam, guduchi, kshira bhallatak, haridra, daruharidra are also very useful.

[26/03 9:22 AM] Dr Atul Kale Ay pith: 

Guneshasri strongly indicated nagabhasma for madhumeha. Banga bhasma is also one of the choice. Banga is ushna in nature so along with other sheeta rasayana medicines it works nicely. It has mainly shoshak property and acts on Kled. It also acts on shukradhatu prabhavena.

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Above discussion held on 'Ayurveda Peetha" a Famous Whatsapp group (initiated by Prof. S.N. Ojha) of  well known Vaidyas from all over the India. 

Compiled & edited by

Dr.Surendra A. Soni

M.D.,PhD (KC)

Associate Professor

Dept. of Kaya-chikitsa

Govt. Ayurveda College

Vadodara Gujarat, India.

EMAIL: surendraasoni@gmail.com

Mobile No. +91 9408441150