The Gerson Institute of Ayurvedic Medicine                                                           

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Treatment of Adult-Onset Non-Insulin Dependent Diabetes Mellitus Type 2 with a Randomized Controlled Ayurvedic Protocol

Scott Gerson, MD, M. Phil. (Ayu), Ph.D. (Ayu)
Ayurvda.MD, Brewster, New York

Abstract:
102 patients with kaphaja-type prameha (non-insulin dependent diabetes) were seen in our clinic between June 2003 and February 2007. Of these, fifty-seven patients were randomized to the treatment group and forty-five patients served as the control group. The sampraptis (specific disease features) in all cases involved doshas: kledaka kapha, pachaka pitta, and samana/apana vata; dushyas (tissues): rakta, mamsa, meda, and majja; strotasas: medovaha, mutravaha. All patients displayed vikritis (imbalances) of the atipravritti type (excessive flow). Because kapha-type prameha is generally curable, and the bala (vitality) of each patient selected was strong we decided to treat them for four months with a modified one-week regimen of Panchakarma including vamana karma (physician-supervised vomiting procedure) followed by thirty days of rasayana chikitsa (metabolic tonics) and an additional ninety days of maintenance herbal medicines. Pre-study diet and exercise regimens were unchanged.
Of the 57 patients in the treatment group, 13 (23%) were able to discontinue all their allopathic medicines after four months, 27 (47%) were able to reduce their allopathic medicines by at least fifty percent, and 17 (30%) patients still required their medications in pre-treatment dosages.

Methods:

Throughout the entire four months, all patients monitored their blood sugars with finger sticks twice each day and reported them to the physician each week. Any values above 180 mg% were reported by telephone immediately. Baseline Hb1Ac levels were measured on Day 1 and again at the conclusion of the study (4 months).

Sarvaabhyanga (whole body massage) with a mixture of ashwagandha taila (massage oil) and narayana taila was given for seven days. Svedana karma (fomentation therapy) with steam box was performed following the massage on days 4 through 7.
Vamana chikitsa (physician-supervised vomiting procedure) was initiated with increasing dosages of mahatikta ghrita one hour prior to breakfast as follows:


Day       Dosage of Mahatikta Ghrita     Lakshana (symptom observed)

Day 1                   3 tsp                          Normal appetite
Day 2                   6 tsp                          Slight loss of appetite
Day 3                   9 tsp                          Sticky bowel movements
Day 4                  12 tsp                         Sticky and loose bowel movements
Day 5                  15 tsp                         Mild nausea, loose bowel movements
Day 6                  18 tsp                         Increased nausea
Day 7        Vamaka Dravya Given               Number of vegas recorded

Pradhana karma (principal intervention) of vamana was performed on Day 7 with the following vamaka dravya (emetic medicine):

Madana phala powder (Randia dumentorium Lam.)---3 grams
Vacha powder (Acorus calamus L.)----------------------3 grams
Yastimadhu powder (Glycyrrhiza glabra L.)-----------3 grams
Black salt-----------------------------------------------------1 gram

These powders were mixed together and taken with one liter of cold milk.
All patients had satisfactory responses to this vamana regimen with the number of Vegas ranging from 12 to 20. Large quantities of kapha material initially were eliminated followed by pitta at the end of the procedure.

Following the vamana karma, patients were given samsarjana krama (post-treatment diet) as detailed below.

ALL ALLOPATHIC MEDICINES WERE DISCONTINUED at this stage. Blood and urine glucose levels were monitored morning and evening before meals.
Samsarjana krama was as follows:

Day Diet

Day 1               Ushnodaka, spice tea (no sugar)
Day 2               Peya (rice soup), spice tea (no sugar)
Day 3               Mung dal soup, spice tea (no sugar)
Day 4               Kichadi (2 parts rice +1 part mung dal), spice tea (no sugar)
Day 5               Kichadi, fruits, steamed vegetables
Day 6               Same as Day 5
Day 7               Regular diabetic diet

Rasayana Chikitsa (Metabolic Tonics)

Following completion of the Vamana/Samsarjana Krama phase, rasayana chikitsa was started.
The two rasayanas used in this study for thirty days were:

(1) vasant kumsakar vati 125 mg 1 hour before breakfast and before bedtime x 30 days.
(2) shudda shilajit starting with 23 days of a pulsed dosage schedule, then continuing at 1 gram daily for 7 days (30 day total). See below.

Pulsed Dosage Schedule of Shuddha Shilajit Rasayana (30 days):

Grams Grams Grams
Day 1   1 g                  Day 9   8 g              Day 17  7 g
2   2 g                        10 8 g                    18  6 g
3   3 g                        11 8 g                    19  5 g
4   4 g                        12 8 g                    20  4 g
5   5 g                        13 8 g                    21  3 g
6   6 g                        14 8 g                    22  2 g
7   7 g                        15 8 g                    23  1 g
8   8 g                        16 8 g             thru 30  1 g

If symptoms of intolerance developed the dosage was decreased starting at that point.

Maintenance Medicines

After completion of vamana karma and rasayana chikitsa, daily maintenance treatment was started. The following medicines were administered to each patient for three months. The dosage was one teaspoon BID with warm water 30 minutes before meals. Each teaspoon (5 grams) contained:

Gurmar Powder (Gymnema sylvestre)        500 mg
Bael Powder (Aegle marmelos)                 500 mg
Jambu Beej Powder (Syzygium Cuminii)     500 mg
Trivang bhasma (oxide powder)               100 mg
Kutuki Powder (Picrorrhiza kurroa)            500 mg
Karela Powder (Momordica charantia)        500 mg
Shilajit Powder (Asphaltum negrum)         500 mg
Haridra Powder (Curcuna longa)               500 mg

Throughout the entire three months, patients monitored their blood sugars with finger sticks twice each day and reported them to the physician each week. Any values above
180 mg% were reported by telephone immediately. All patients maintained their standard diabetic diets and their current exercise programs.

Results

Of the 57 treated patients, 13 (23%) were able to discontinue all their allopathic medicines after four months, 27 (47%) were able to reduce their allopathic medicines by at least fifty percent, and 17 (30%) patients still required their medications in pre-treatment dosages. Seventy percent (70%) of the subjects were able to reduce their allopathic medicines by at least 50% after four months of treatment (p≤0.05).

Conclusion

Prameha is classified as one of the eight maharogas and therefore considered as a general group of diseases, it is difficult to treat. However, doshic stratification reveals that while vataja prameha is asadhya and without definitive methods of cure, kaphaja prameha may at times be curable with difficulty. Pittaja prameha is considered intermediate in this regard.

A Panchakarma regimen including vamana chikitsa (physician-supervised vomiting procedure) and properly selected and administered rasayanas (metabolic tonics) and aushadis (herbal medicines) it is possible to normalize blood sugars in a significant proportion of kaphaja prameha patients without their allopathic medicines. In the past, this has been attempted unsuccessfully by many other investigators using only samshamana methods (gentle techniques).

Samshodana (radical purificatory) techniques are necessary to adequately purify the body, deliver the medicines, and rejuvenate the endocrine tissues. This study demonstrated the efficacy of an Ayurvedic protocol in the treatment of kaphaja-type prameha. Seventy percent (70%) of the subjects were able to reduce their allopathic medicines by at least 50% after four months of treatment (p≤0.05).