Journal of Ayurveda Case Reports

CASE REPORT
Year
: 2021  |  Volume : 4  |  Issue : 1  |  Page : 27--32

Add on effect of Somavalkala kashaya siddha basti in the management of diabetes mellitus: A case report


Nakul Vishwanathji Khode1, Maya V Gokhale2, Rashmi Prakash Gurao3,  
1 Department of Panchkarma, Mansarovar Ayurvedic Medical College, Bhopal, Madhya Pradesh, India
2 Department of Panchakarma, Sumatibhai Shah Ayurved College, Pune, Maharashtra, India
3 Department of Kriya Sharir, Mansarovar Ayurvedic Medical College, Bhopal, Madhya Pradesh, India

Correspondence Address:
Dr. Nakul Vishwanathji Khode
Assistant Professor, Depart-ment of Panchkarma, Mansa-rovar Ayurvedic Medical College, Bhopal, Madhya Pradesh
India

Abstract

Diabetes mellitus is a major health problem for the world in the 21st century. The side effects of medicines and persistent complaints make diabetic patients seek alternative therapy. Basti (~therapeutic enema) acclaimed as Ardha chikitsa, is an important Shodhana (~detoxification) procedure in Panchakarma. In general, Basti is contraindicated in Prameha, but many special types of Basti are described in the literature that can be used in distinct cases. This study aims to explore the prospects of Basti chikitsa in the treatment of Prameha. A 56-year-old male suffering from diabetes taking metformin 500 mg tablet twice daily for five years presented with the complaints of polyuria, burning sensation in both upper and lower limbs, weakness and cramps aggravating gradually. HbA1C level (11.6) revealed an uncontrolled blood sugar levels. He was treated with Somavalkala kashaya siddha basti regimen for three months. The patient had significant relief in symptoms such as Prabhuta mutrata, Pipasa, Karapada daha, Karapada supti, Avil mutrata, Klaibya, and Daurbalya after complete course of therapy. The HbA1C level of patient which was 11.5 at the time of registration which lowered to the 6.9, i.e. nearly normal range. Fasting blood sugar and postprandial blood sugar levels were 121 mg/dl and 232 mg/dl, respectively, at the time of registration which reduced after Basti regimen. Thus, Somvalkala kashaya siddha basti appears to be useful in the treatment of diabetes mellitus.



How to cite this article:
Khode NV, Gokhale MV, Gurao RP. Add on effect of Somavalkala kashaya siddha basti in the management of diabetes mellitus: A case report.J Ayurveda Case Rep 2021;4:27-32


How to cite this URL:
Khode NV, Gokhale MV, Gurao RP. Add on effect of Somavalkala kashaya siddha basti in the management of diabetes mellitus: A case report. J Ayurveda Case Rep [serial online] 2021 [cited 2021 Sep 16 ];4:27-32
Available from: http://www.ayucare.org/text.asp?2021/4/1/27/318655


Full Text



 Introduction



Diabetes is a leading cause of mortality, morbidity, and health system expenditure. A recent Lancet study reported a four-fold rise in the number of diabetic patients from 108 million in 1980 to 422 million in 2024. The number of diabetic patients climbed from 11.9 million in 1980 to 64.5 million in India. The prevalence of diabetes has more than doubled for men (3.7%–9.1%) and increased by 80% among women in India (4.6%–8.3%).[1] Although diabetes can be treated well with contemporary medicines, it has its share of side effects. The progression of disease into the insulin-dependent stage affects the quality of life of the people. All these factors make patients explore alternative therapy for diabetes.

Diabetes is explicitly described in Ayurveda as Prameha. The classical treatment of Prameha in Ayurveda is strictly adapted on the basis of individual constitution and pathology. The diabetic patient with augmentation of Dosha having optimal body strength, need Shodhana chikitsa (~detoxification) in the form of Panchkarma. Acharya Charaka has classified the Prameha into two types i.e. Sthula pramehi (~obese diabetic patient) and Krisha pramehi (~underweight diabetic patient) as well as Satarpanjannya (~due to over nourishment) and Apatapanjannya prameha (~due to under nourishment) at the other places. It can be correlated with classification given by Vagbhata, i.e. Dhatukshayajanya (~diabetes due to emaciating pathology) and Avaranajanya madhumeha (~diabetes due to obstructive pathology), respectively. Brimhana chikitsa (~nourishing therapy) is advised to the Krisha (~underweight) and Durbala (~weak) patients and Shodhana (~detoxification therapy) should precede Shamana chikitsa (~palliative therapy) in the obese patient due to excessive vitiation of Dosha. Acharya Sushruta has opined that of Apathya nimttaja pramehi (~diabetes due to unhealthy dietary practices) is always Sthula (~obese). For Shodhana (~detoxification) therapy, Vamana (~therapeutic emesis) is the best treatment followed by Virechana (~therapeutic purgation) and Asthapana basti (~therapeutic enema with decoction).

Basti (~therapeutic enema), one of the procedures of Shodhana therapy, is the best line of treatment to cure the imbalance of Vata dosha along with the abnormal accumulation of Pitta and Kapha dosha and thus have effect on all the three Doshas. Basti is easily administrable, well accepted by the patients as well as very effective in various disorders, hence acknowledged as Ardha chikista[2] (~ half of the treatment). The factors provoking Vata dosha directly cause Apatarpanjanya madhumeha (~diabetes due to under nourishment) while those aggravating Kapha and Pitta cause Satarpanajanya madhumeha (~diabetes due to over nourishment). In Avaranajanya madhumeha (~diabetes due to obstructive pathology), Kapha is predominant Dosha while the important Dushya are Meda and Kleda. The vitiated Kapha and Pitta instigate provocation of Vata by obstructing its pathway.

Basti is contraindicated in Prameha (~diabetes) in general, but many more special forms of Basti therapy are described in Ayurveda for special circumstances. Siddha basti connotes a combination of some of the herbs having proven efficacy in curing certain disorders that may be administered in the form of Basti.[3] Somvalkala [Acasia farnesiana (L.) Wild.]is indicated in Prameha (~diabetes) in the form of Siddha basti.[4] Being a special type of Basti, the duration, the dose of Basti and sequence of Matra basti (~therapeutic enema using oil) and Somvalkala kashaya basti (~therapeutic enema using decoctions) can be modified accordingly.

 Case Report



A 56-year-old male a known case of diabetes visited the Out Patient Department (OPD) of Panchakarma on 14/06/2019 with the complaints of bilateral Karapada daha (~burning sensation in both hands and feet), Pipasa (~polypepsia), Prabhuta mutrata (~polyuria), Pindikoudvesthana (~cramps), Klaibya (~loss of libido), and Daurbalya (~generalized weakness) exacerbating for three months even after treating with oral hypoglycemic drugs by private practitioner for five years. The patient visited the Panchakarma OPD to seek alternative therapy for diabetes. Detailed history revealed that the patient was having complaints of Prabhuta mutrata (~polyuria), Avil mutra (~turbid urine), Kshudha (~polyphagia), Pipasa (~polydypsia), Kar-pada-daha (~burning sensation in both hands and feet), Kara-pada-tala-supti (~altered sensation in both hands and feet) and Pindikodwestana (~cramps) which aggravated for six months and Daurbalya (~generalized weakness) and Klaibya (~loss of libido) from three months. He had no history of hypertension or any other major illness. There was no family history of diabetes in the patient. The patient had a sedentary lifestyle with no addiction. Previous biochemical reports revealed raised Postprandial Blood Sugar (PPBS) and HbA1C levels. Other hematological, biochemical, and microbiological reports were found to be within the normal limits. The patient was taking Metformin 500 mg twice a day for five years.

On physical examination, the general condition of the patient appeared to be healthy with body mass index - 32.17 (weight – 93 kg, height – 170 cm, and waist circumference – 106 cm). Blood pressure was 130/70 mmHg and his pulse was 78/min. No pallor and edema were present. The patient had Kapha pradhana vata prakriti (~body constitution) and Medovaha, Mutravaha, Udakavaha and Swedavaha srotodushti [Table 1]. Somavalkala kashaya siddha basti regimen [Table 2] and [Table 3] was planned in the patient for three months. The actual therapy was started on 30/06/19 as the patient was unable to attend the hospital for consecutive seven days due to personal reasons. The patient was kept on a normal diet with the continuation of Metformin daily throughout the therapy. The blood sugar monitoring using glucometer was done before and after every regimen along with the HbA1C examination before and after the completion of therapy.{Table 1}{Table 2}{Table 3}

Formulation of Somavalkala kashaya siddha basti

Somavalkala kashaya (~decoction) preparation

Coarse powder of Somavalkala one part (80 g) was added with 16 parts of water (1280 ml), boiled on the low flame without lid and reduced up to 1/8 parts (160 ml). Once ready, it was filtered and kept aside. 80 g of honey and 10 g of powdered rock salt were taken in another container and stirred well to make a homogenous mixture. 80 ml of sesame oil was added to this mixture and stirred well to make a homogenous mixture. 10 g of Shatapushpa (Anethum sowa L.) added as a Kalka dravya and stirred well. 160 ml of prepared Kashaya (~decoction) was finally added to this mixture with continuous stirring to make a homogenous mixture. A total of 320 ml Basti was prepared.[5]

Pre-Basti management

2 g Musta churna (powder of Cyperus rotundus L.) twice daily was given for three days in Vyanodankala (~after meals) for Pachana (~digestion of Ama). On the day of Basti, Sthanika snehana (~local external oleation) with sesame oil and Sthanika nadi swedana (~local sudation with steam) was done over the abdomen and gluteal region. For Somavalkala kashaya siddha basti, the patient was asked to remain empty stomach before the procedure while Matra basti was given after breakfast/meal.

Procedure of Basti

The patient was made to lie down on a table in the left lateral position, with his left leg placed straight and the right leg is flexed at the hip and knee drawn up to the chest. For Somavalkala kashaya siddha basti, Basti netra (~simple rubber catheter no - 10/11) was attached to Bastiputaka (~enema pot). The column of the catheter was filled with Somavalkala kashaya and air was removed. Sesame oil was applied to anal opening and catheter tip, 4 fingers (~ about 4“–6”) of rubber catheter inserted per rectum. The patient was asked to inhale deeply. Then the enema pot was kept upward to allow Basti to enter into the rectum by keeping little quantity behind. The Matra Basti of Tila taila was administered with Basti netra (~simple rubber catheter no-10/11) attached to a 100 ml glycerin syringe on 1st and the 7th day.

Post-Basti procedure

Sphiktadana (~tapping of gluteal region) was done. Then the patient was asked to lie down comfortably in Sapadapithashayana (~supine position) for 10 min in the case of Matra basti and until Basti pratyagamana (~expulsion) in Niruha basti. Basti pratyagamana was observed by Prashna pariksha. After Basti pratyagamana, the patient was advised to take bath with warm water and a light diet was advised.

Throughout the Basti regimen, specific restrictions were advised like drinking Ushna jala (~warm water), light diet, refraining from Atyasana (~sedentary habit), Asthana asana (~sitting in improper place), Ativachana (~excessive talking), Divaswapa (~day sleep), Yana (~traveling), Atapasevana (~exposure to sunlight), Shoka (~anguish), Krodha (~anger), Ahitabhojana (~improper meal), Vegavarodha (~suppression of natural urges), and Akala bhojana (~taking meals at the improper time).

 Timeline



The patient was treated with three regimens of Siddha basti for 90 days. The detailed timeline of the treatment is given [Table 4]. {Table 4}

 Follow up and outcome



The patient was examined and assessed on day 0 and after 90 days by observing changes in the signs and symptoms of the disease based on subjective and objective parameters namely symptom score[6] for Prameha [Table 5], blood sugar [Graph 1] and HbA1C levels [Graph 2] to evaluate the effect of the therapy. The patient had significant symptomatic relief along with HbA1c and blood sugar levels lowering to normal levels. This shows that Somavalkala kashaya siddha basti has a encouraging effect in treating diabetes mellitus.{Table 5}[INLINE:1][INLINE:2]

 Discussion



Diabetes mellitus is a group of metabolic disorders that are caused by the improper function of insulin hormone secreted by the pancreas. It is characterized by hyperglycemia resulting from the defect in insulin secretion, insulin action, or both. The anti-diabetic medications usually act by increasing peripheral insulin sensitivity or decreasing the action of glucagon effects or decreasing intestinal glucose absorption. Metformin is the first line of drug for treating Type II diabetes. It is a biguanide antihyperglycemic agent. The main mechanism of action of Metformin is the decrease in hepatic glucose production.[7]

Ayurvedic principles of treatment mainly revolve around correcting the underline pathology of the disease rather than symptomatic management. The pathophysiology of Prameha[8] (~diabetes) emphasizes the excessive indulgence in the etiological factors of Prameha disturbing Kapha and Pitta dosha at first thereby leading to an imbalance of Kleda (~intra and intercellular fluids). The disturbed Dosha move towards Meda dhatu (~fat), affect the fat metabolism and lead to the extensive imbalance of Kleda (~intra and intercellular fluids). Gradually this excess and vitiated Kleda moves towards the urinary system, increase the production of urine with subsequent frequent and excess urination finally culminating in Prameha (~polyuria). Almost all types of Prameha when ignored or treated improperly consequently gives rise to Madhumeha[9] (~a form of diabetes).

The pathogenesis of Prameha can be either Dhatukshayajanya (~catabolic) or Avaranjanya[10] (~obstructive). The factors directly provoking the Vata dosha cause Dhatukshayajanya madhumeha while the factors provoking Kapha and Pitta dosha vitiate Vata dosha by obstructing its normal course and cause Avaranjanya madhumeha. In Avaranjanya madhumeha, Kapha is the predominant Dosha while the important Dushya are Meda (~fat) and Kleda (~intra and intercellular fluids).

Samshodhana is the best treatment for the elimination of Doshas. Though Vamana (~therapeutic emesis) and Virechana (~therapeutic purgation) are ideal therapies for Kapha and Pitta dosha respectively, these procedures are demanding with strict guidelines that may not be tolerated by certain patients. However, Basti is one such procedure specially designed for vitiated Vata dosha and it is easily acknowledged by most of the patients. Basti is usually contraindicated in Prameha however, Siddha basti which is not exactly a Niruha basti was planned in the given patient. Siddha basti means some of the combination of herbs having proven efficacy in curing certain disorder may be administered in the form of Basti. Acharya Sushruta has described Yapan basti as one of the synonym for Madhutailik basti and other synonyms are Yuktaratha and Siddha basti. These types of Basti are useful in sustenance of the life, nourishment of the tissues, alleviation of diseases, support and maintenance of the life, preservation of the homeostasis in the body constituents, checking of ageing process and enhancement the deprived tissues.

In Siddha basti, Mridu veerya drugs are being used and it is used in 3/4th dose of usual Niruha basti and does not required any regimen of diet and lifestyle. Its provides satisfactory results even by administration of single Basti and does not produce any complication. This type of Basti can be planned according to the condition of disease and patient. Somavalkala being Tikta-kashaya rasatmaka (~bitter and astringent properties) acts as Deepana (~ignites digestive fire), Pachana (~digestion of Ama), Kleda shoshana (~absorption of excess intra and intercellular fluid) and Kapha pitta prashamana[11] (~ pacification). The single Basti regimen is comprised of a total of seven Basti as it acts on Meda dhatu (~fat) by that time.[12] In the preparation of Somvalkal kashaya siddha basti, 80 ml of Sneha was used. Hence, it can be helpful in similar way as Sneha basti action so its act on Meda dhatu. Due to excessive vitiation of the Meda (~fat) and Kleda (~intra and intercellular fluid) in the given patient, the Somvalkala kashaya siddha basti was planned for consecutive five days for Shodhana. The dose of Basti used was 320 ml which was lesser than the normal Niruha basti (~therapeutic enema using decoction) dose to avoid Vata prakopa (~vitiation). The Matra basti (~therapeutic enema using oils) was given instead of Anuvasana basti (~therapeutic enema using oils with a higher dose) on the first and the last (seventh) day for Snehana. The low dose of Matra basti (~therapeutic enema using oils) keeps the condition of Kapha and Pitta in check. This arrangement of Snehana (~oleation) and Shodhana (~detoxification) resulted in easy expulsion of Doshas without any complications.

Somavalkala shows probable action on Meda and Kleda dushti (~vitiation of fat and intra and intercellular fluids) due to Tikta, Kashaya rasa (~bitter-astringent taste); Ruksha, Laghu guna (~property of dryness and lightness) and Ushna virya[13] (~active principle producing warmth/heat in the body). This combination alleviates the disease by the virtue of Kapha nashaka and Mutra sangrahaniya karma (~urine concentrating action). The Basti dravya (ingredients of therapeutic enema)– honey, Saindhava, Sneha, and Shatapushpa kalka along with Somavalkala kashaya form emulsion due to churning. The Basti (~therapeutic enema) is given in Guda (~rectum) which has a rich blood supply and thus the active principles of drugs used in Basti reach systemic circulation bypassing hepatic metabolism. Basti is administered in the patient lying on the left lateral side as Grahani (~small intestine) and Guda (~rectum) are situated on the left side of the body. When Bastidravya reaches up to Grahini (~small intestine) they act on Samana vayu and thereby stimulate Jatharagni (~digestive fire) present in Grahani. This prevents the Amavastha (~impaired digestion and metabolism) and maintains the Prakruta (~normal) status of Kleda in the body. This in turn improves Dhatvagnimandya (~impaired tissues metabolism) thereby inhibiting further Medo vriddhi (~accumulation of fat) and alleviates the Vata dosha. This justifies the significant effect observed in Prabhuta– Avila mutrata (~excess and turbid urine), Pipasa, Kshudhadhikya and Pindikodveshtana.

Somavalkala kashaya siddha basti shows probable action on the alleviation of Pitta by Tikta, kashaya rasa thereby arresting the Ashayapakarsha gati (~progression outside its normal abode) of Pitta dosha and useful in alleviating Kara-pada-tala-daha (~burning sensation in both hands and feet). The gradual improvement in Dhatwagnimandya (~exhaustion of digestive fire of tissues) amend the normal production and quality of all the Dhatu including Meda (~fat), Mamsa (~muscle) and Shukra (~semen), consequently improving the Klaibya (~impotency) and Daurbalya (~generalized weakness).

The study in rodents shows Acacia farnesiana has a direct stimulatory effect on glucose uptake without the involvement of insulin.[14] It was observed that the Acacia farnesiana directly or indirectly inhibits glucose absorption or transport from the intestinal tract. The result of this study justifies the significant improvement in blood sugar level and HbA1c level, thus establishing the effect of therapy on diabetes.

 Conclusion



As per this case study, a three month regimen of seven days of Somavalkala kashaya siddha basti is found to be efficient in the treatment of diabetes and to prevent further complications. The patient had significant relief in symptoms such as Prabhuta mutrata, Pipasa, Karapada daha, Karapada supti, Avil mutrata, Klaibya, and Daurbalya after complete course of therapy. Changes in HbA1C, FBS, and PPBS are encouraging. It was used concurrently with Metformin. No herb-drug interactions were noticed during the period. Therefore, it can be concluded that Somavalkala kashaya siddha basti along with conventional antihyperglycemic therapy has a good effect on the signs and symptoms of diabetes. However, further study on the large scale of diabetic patients is needed for comprehensive inference.

Declaration of patient consent

Authors certify that they have obtained patient consent form, where the patient/caregiver has given his/her consent for reporting the case along with the images and other clinical information in the journal. The patient/caregiver understands that his/her name and initials will not be published and due efforts will be made to conceal his/her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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