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==== Researches on effect of herbs on diabetes ====
Research has shown that many of the herbs described have antioxidant properties, an anti-diabetic effect, and a beneficial effect on the lipid profile. Descriptions of few of them are as follows:
===== ''Curcuma neilgherrensis'' =====
Curcuma neilgherrensis Wight, in the dose of 400mg/kg, showed a mild reduction in blood glucose level at 3rd and 5th hour in normoglycemic mice; however, the observed decrease in blood glucose level was found to be statistically insignificant. Even though the drug failed to cease the hypoglycemia in the first hour after the glucose overload, it attenuated the same in later hours, but not in a significant manner.
The study reveals that C. neilgherrensis is having mild hypoglycemic potential and moderate antihyperglycemic effect. A clinical trial investigating the effects of combining C. neilgherrensis treatment with conventional therapy compared to the C. neilgherrensis alone showed that C. neilgherrensis significantly reduces the level of fasting blood sugar, postprandial blood glucose level, glycosylated hemoglobin, serum cholesterol, LDL and urine sugar 12,13.
===== ''Gymnema Sylvester'' =====
''Meshashringi'' (Gymnema Sylvester (Retz.) R.Br.; Gurmar) targets several of the etiological factors associated with diabetes, including chronic inflammation, obesity and pancreatic B-cell function 14. In a study on rats with streptozotocin – induced diabetes, G. sylvestre treatment resulted in 30% increase in total pancreatic weight and a significant increase in the number of islets and number of B-cells per islet. The regenerated pancreatic tissue resulted in complete control of fasting blood glucose levels within 20-60 days. Normal rats in this study did not experience an increase in insulin release when treated with G. Sylvestre extract, indicating that this herb has a normalizing effect on the blood glucose and may, therefore, be safer than conventional oral hypoglycemic agents such as sulphonylureas 15. Several clinical studies have demonstrated that G. Sylvestre effective in decreasing blood glucose levels in patients with type 1 and type 2 diabetes 14,16,17. Two (2) clinical trials investigated the effects of combining G. Sylvestre treatment with conventional therapy compared to the conventional therapy alone. In 22 patients with type 2 diabetes, treatment with G. Sylvestre extract significantly reduced blood glucose, glycosylated hemoglobin, and glycosylated plasma proteins, whereas, with conventional treatment alone (i.e. glibenclamide or tolbutamide), these values increased or remain the same. The patients receiving the herbal extract were able to decrease the dosage of their conventional drug, and five patients were able to discontinue the drug entirely and maintain their glucose level using only G. sylvestre16. In 27 patients with type 1 diabetes, G. Sylvestre treatment reduced fasting blood glucose, glycosylated hemoglobin, and glycosylated plasma protein levels 17.
===== ''Tinospora cordifolia'' =====
Aqueous and alcoholic extracts of ''guduchi'' (Tinospora cordifolia (Willd.) Hook. f. & Thomson) reduced glucose levels in rats with alloxan- induced diabetes. The antihyperglycemic effect may be due to pancreatic islet free- radical- scavenging activity. This herb also lowers the levels of tissue and serum cholesterol, phospholipids, and free fatty acids 18,19.
===== ''Swertia chirayita'' =====
''Kiratatikta'' (Swertia chirata (Roxb.) Buch.-Hum; also known as swertia chirayita (Roxb.) H. Karst.) is a potent anti-diabetic herb. In a pilot study, ''swertia chirata'' produced a significant decrease in fasting and postprandial blood glucose level in patients with diabetes. It contains swechirin, a xanthone found in the swertia species of plants. Xanthones are a unique class of biologically active compounds with antioxidant properties. Research has shown swerchirin produces a significant decrease in blood glucose levels in rat models [20-24]. A 60% decrease in blood glucose induced by swerchirin was accompanied by a marked depletion in B- granules and insulin in the pancreatic islets. Glucose uptake and glycogen synthesis in the diaphragm muscle was significantly enhanced in vitro by the serum of swerchirin- treated rats. It was therefore concluded that swerchirin lowers blood glucose levels by stimulating insulin release from the islets of Langerhans [24].
===== ''Enicostema littorale'' =====
''Mamejjaka'' (Enicostema littorale Blume) is used as a single herb and also as a part of an anti-diabetic mixture [15]. In a clinical study on patients with type 2 diabetes, E. littorale reduced blood glucose and prevented the progression of diabetic complications. There was a significant improvement in the lipid profile, blood pressure, and kidney function [25]. It significantly reduced blood glucose and lipid peroxides in rats with alloxan- induced diabetes, and increased superoxide dismutase, catalase, and glutathione peroxidase [26]. In studies on rats with streptozotocin- induced type 1 diabetes, E. littorale significantly reduced glucose, cholesterol, and triglyceride levels [27], and ameliorated diabetic nephropathy. Serum creatinine and urea were significantly decreased and glomerular function improved [28]. In rats fed a hypercholesterolemic diet, E. littorale decreased serum cholesterol, triglycerides, LDL, VLDL, liver, and kidney cholesterol levels, and lipid peroxidation levels. There was an increase in HDL and an increase in reduced glutathione levels [29].
A pilot study on an herbal mixture containing ''tejapatra'' (Cinnamomum Tamala)30,31, ''pushkarmula'' (Inula racemosa), ''mamejjaka'' (E.littorale), ''meshashringi'' (Gymnema Sylvestre), and ''jambu'' (Syzygium cumini) seeds with ''karvellaka'' (bitter gourd; bitter melon; Momordica charantia) juice, administered at a dose of 5g twice a day before meals, decreased fasting and post- prandial blood glucose levels in patients with diabetes [32]. ''Avartaki'' (Cassia auriculata Linn.) and ''methika'' (Trigonella foenum- graecum) as single herbs and decoction of ''nimba'' or ''neem'' (Azadirachta indica A.juss;) have also demonstrated blood glucose- lowering action33. In a clinical study on patients with type 2 diabetes, neem showed significant hypoglycemic effect. The effect of ''neem'' was comparable to that of glibenclamide [34,35].
The herb ''gokshura'' (Tribulus Terrestris Linn.)36, ''asana'' (Pterocarpus marsupium Roxb.)37, ''kulatha'' (Vigna unguiculata (Linn.) Walp.), and saptaparna38 (Alstonia scholaris (Linn.) R.Br.) is also beneficial in treating ''prameha''. These herbs can be used in different combinations, depending on the doshic involvement and severity of illness. An herbal mixture comprised of one part each of ''karvellaka'' (bitter gourd; bitter melon; Momordica charantia), ''jambu'' (Syzygium cumini), ''gurmar'' (Meshashringi G.sylvestre), and ''amra'' (Moringa indica Linn.), taken along with ''shilajit'', was investigated in a clinical study on 805 patients with diabetes. The results showed a statistically significant reduction in fasting and postprandial blood glucose along with clinical improvement (website of India’s Central Council for Research in Ayurveda and Siddha).
''Prameha'' is described as a set of complex clinical disorders characterized by frequent abnormal micturition, with the etiology involving genetic predisposition as well as diet and life style. The role of stress and obesity in the pathogenesis is also elaborately described in ''prameha'' have much in common with those described for obesity, metabolic syndrome and diabetes mellitus. The management of ''prameha'' emphasizes dietary and life style recommendation and herbal preparations. Due to the richness and complexity of the compound in plants, herbal therapy has always been thought to act on multiple targets. Even one single compound can have multiple target which acts as a double edge sword in managing diabetes mellitus. ''Medhya'' or mental health promoting drugs, if added along with anti-diabetic therapy, will further potentiate anti-diabetic effect of the principal drug by counteracting stress. Ayurveda and modern medicine both are complimentary to each other. Simultaneous administration of Ayurvedic drug will not only potentiate therapeutic efficacy of modern drug rather it will also counteract or reduce the adverse effects of the modern drug, if any; to lead the patient a healthy and happy life. Moreover, organ specific ''rasayana'' may be added for prevention and cure of complications. Ayurvedic drugs should be use in its natural form without disturbing its natural combination/holistic principle of the drug. Single drug may have composite fractions and each fraction has its own medicinal value. Polyherbal combination potentiate therapeutic efficacy of a particular ingredient of the formulation and also counteract adverse effect if present in the combination. Instead of isolating a particular alkaloid it is suggested that the Ayurvedic drug should be use as a whole. All patients of diabetes are not similar, so a stepped care treatment is recommended. In early stage of disease and patients having ''kaphaja'' constitution, it is better to use Ayurvedic drugs alone. In acute stage and having ''pittaja'' constitution of patients wherever found necessary, oral insulin promoter may be added. In chronic stage and having ''vataja'' constitution, insulin therapy may also be added as these cases are insulin dependent.
Ayurveda has a vast array of herbs and herbal mixtures that are used in the treatment of ''prameha''. A large number of these herbs have demonstrated efficacy in research investigations. The herbs have various properties including hypoglycemic, antihyperglycemic, hypolipidemic, antihyperlipidemic, insulin promoting and antioxidant properties. Some of these herbs are capable of counteracting stress induced catecholamines, which are proven insulin antagonists. Hence, the choice of the herb or combination of herbs for the patient depends upon the stage of the disease, disturbances in the psychophysiologic constitution of the patient, and mode of action of the herbs. Further research is needed in the clinical setting to elucidate the Ayurvedic modalities that are effective in the management of obesity, metabolic syndrome and diabetes mellitus in light of their similarities with ''prameha''39.
=== Future Scope for Research ===
=== Future Scope for Research ===