Ayurvedic Management For Diabetic Nephropathy: A Case Study
Mar 24, 2022
Contact: Audrey Hu Whatsapp/hp: 0086 13880143964 Email: audrey.hu@wecistanche.com
Rishu Sharma, Alok Km. Srivastava, Gyanendra D Shukla
1 Department of Panchkarma, Rishikul Campus, U.A.U, Haridwar;
2 Department of Panchkarma, Main Campus, U.A.U,
3 Haridwar; Department of Panchkarma, Gurukul Campus, U.A.U, Haridwar.
Nephropathy is the significant complication of diabetes mellitus that affects about 40% of diabetics and is a major cause of death and disability among diabetics. It is observed that even the patients having well-controlled diabetes suffer from diabetic nephropathy. It needs intense management, such as dialysis, and badly affects the quality of life. A male patient of 45 years visited the outpatient department complaining of bilateral pedal edema, frequent micturition. nausea, especially during morning hours, reduced appetite, generalized weakness, and itching all over the body from the past 4 years. He was known for cases of diabetes mellitus for 4 years. Routine investigations of kidney function tests and urine microscopic findings were also found disturbed. The patient was taking an oral hypoglycemic drug (metformin 500 mg twice a day). He was diagnosed as a case of diabetic nephropathy on the basis of clinical signs & symptoms and with lab findings. According to Ayurveda, the symptoms resemble Prameha image tmpadraa (post-diabetic complications). The patient was given ayurvedic medication for a period of 30 days and investigations were done after 30 days. There was marked relief in the symptoms along with considerable improvement in renal investigations like blood urea, serum creatinine & uric acid profile. This management may bring some new hope to the patients with diabetic nephropathy, which usually terminates to chronic renal failure and ultimately to death.
Keywords: Chronic renal failure, diabetic nephropathy. Pedal edema.Prgmeha iamig upgdrang. Renal transplant
Background
It takes only a short span of time for diabetic kidney disease to become the leading cause of end-stage renal disease (ESRD) [1,2]. This microvascular complication develops in approximately 30% of patients with type 1 diabetes mellitus (DM) and approximately 40% of patients with type 2 DM [2,3]. Diabetic nephropathy (DN)is the leading cause of ESRD worldwide, and it is estimated that 20% of type 2 diabetic patients reach ESRD during their lifetime 4. This is also a major cause of chronic renal failure as it accounts for 20-40%patients of chronic renal failure [5]. Initially, it is manifested as a biochemical abnormality. Eventually, loss of excretory, metabolic, and endocrine function of the kidney leads to the development of the clinical symptoms and signs of renal failure, which are referred to as uremia [6].
As per classical texts of Ayurveda, Upadrarvas of Prameha are Hrillas (nausea), Chhardi(vomiting), Shotha (edema), Avipaka (indigestion), Hikka (hiccups). These symptoms are seen as a result of Upadravas due to Kapha and Pita(two out of three basic senses of humor of the human body). Though complications of Prameha are well written in all classical treatises yet there is no clear mention of pathology that can clarity Dosha-dushrya Samim Archana (pathophysiology) involved in the case. Also, clinical features of Vrikka yoga mentioned in 'Bhaishajyaratnavali'matches very well with signs and symptoms of DN. Acharyas have advised in this condition to use a combination of herbal medicines which have functions like Mutual (diuretics), Deepena (stimulant), Pachana (digestant), Raktaprasadak (blood purifiers), Virechaka(laxatives), and Rasayana (rejuvenators).
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Why need Ayurveda in this disease?
The social and economic consequences of the advanced stage of DN are considerable and the conventional approach of management includes dialysis and renal transplantation which is not affordable and acceptable by the Indian population. Therefore, exploration of a safe and alternative therapy is highly needed, which proves to be helpful in reducing the requirement of dialysis or postponing renal transplantation.
Case description
A male patient of 45 years presented in the outpatient department of Panchkarma unit, Rishikul Ayurvedic College in September 2019 with the following complaints. Increased frequency of micturition from last 4 years; swelling in bilateral feet since last 3 years; reduced appetite & generalized weakness from past 1-year severe nausea in the morning associated with the headache from past 6 months, and presence of itching all over the body from the last 4 months.
Personal history
The patient was not indulged in any form of substance use.
Treatment history
The patient was a known case of DM for the past 4 years and was taking the oral hypoglycemic drug(metformin 500 mg twice a day)for the same as prescribed by an allopathic physician for the past 4 years.
General examination
On general examination, the patient's nutrition was normal, pulse was 84/min, regular; blood pressure-120/80 mm of Hg,temperature-99.6 OF, respiratory rate-18/min. Another systemic examination was normal. Bilateral pedal edema (pitting type) was present.
The Sharirika Prakriti of the patient was Kapha-vataja, had Madhyama kosha(normal bowel habits), Madhyama Bala(optimum physical strength)with Pravara satva(psychological strength). He had Agnimandya(decreased digestion and appetite).
Investigations
Blood investigations revealed serum creatinine 6.95 milligram per deciliter(mg/dL), blood urea 99.0 mg/dL, blood sugar levels(fasting)was within normal limits, serum uric acid levels 7.6 mg/dL. Urine examination showed moderate protein (albumin +4)loss. The estimated glomerular filtration rate was 85.
Diagnosis
Ayurveda symptomatology of Prame ha apadravya shows Chhardi (vomiting), Hellas (vomiting), Daurbalyg(weakness). As per Ayurvedic classics, these Upadrava are due to Kapha and Pitta. By clinical examinations and supported investigations, he was diagnosed as a case of DN, which was evidenced by ultrasonography of the whole abdomen (including kidney and upper bladder).
Treatment plan
The patient received orally the following medication (Table 1).
Treatment outcome
After 10 days of treatment, bilateral pitting pedal edema, nausea, and vomiting were reduced. After 30 days of treatment, there was marked reduction in serum creatinine levels(1.41 mg/dL)& serum uric acid levels (5.1 mg/dL) and significant changes in blood urea levels(43.40 mg/dL). Also, significant relief was seen in Chhardi (vomiting),Hellas (nausea), Daurbalya (general weakness). The patient was advised to continue the treatment for 1 month. Albumin level in urine was also reduced to(+2). The before and after treatment (after 1 month) parameters are shown as under in Table 2.
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Discussion
According to Ayurveda, nephropathy is a disease of Mutravaha srotas. Though all the three Doshas are involved in the disease, Kapha is responsible for blocking microvessels and developing microangiopathy due to the fact that individuals with Kapha Prakriti are prone to obesity, diabetes, and atherosclerosis. Damage in tissue can be repaired and prevented by the use of Rasayana 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 macro vessels. The treatment plan was definite and all the medications were chosen due to their definite actions in this disease as:
Gokshuradi Guggulu having Gokshur, the main ingredient, is well known for its Rasaryana effect, especially on Mutravaha srotas. Guggulu (Commiphora Mukul), another main ingredient, is a Rasangn [7-9], and it has Lekhana(scraping) effect also. In addition, Guggulu has Tridoshahara property also, by which it pacifies all the three Doshas.
Conclusion
Thus, it can be concluded that ayurvedic approaches are helpful in managing complications like DN. This study emphasizes the importance of an integrated approach in healthcare. Considering such beneficial activities of Ayurveda approaches; there is a need to undertake collaborative research to generate pieces of evidence at a larger scale in the management of DN.
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