Changes

The word ''Prameha'' literally means urinary disorders with increased quantity of urine with turbidity in it. In the last chapter of [[Nidana Sthana]], ''prameha'' is said to have originated from excess consumption of ghee. This chapter deals with the detail etio-pathogenesis, clinical features, classification and management of ''prameha''. It is widely considered as diabetes mellitus. However, ''prameha'' covers various types of obstinate urinary disorders under its umbrella. The key to management of ''prameha roga'' is to attempt to stop its pathogenesis for which the etiological factors responsible for the origin of the disease are identified. These etiological factors include both faulty dietary habits and life style that cause imbalance between energy consumption and energy expenditure and ultimately cause obesity. Indulgence in high calorie diet including refined carbohydrate and bad fat associated with sedentary life style causes excessive storage of fatty tissue in body to disturb the body mass index. The disturbed body mass index reflects as obesity causing disturbed lipid metabolism and assimilation (FFAs, TG, HDL and VLDL) that in turn causes insulin resistance and produces type-2 DM.  

The word ''Prameha'' literally means urinary disorders with increased quantity of urine with turbidity in it. In the last chapter of [[Nidana Sthana]], ''prameha'' is said to have originated from excess consumption of ghee. This chapter deals with the detail etio-pathogenesis, clinical features, classification and management of ''prameha''. It is widely considered as diabetes mellitus. However, ''prameha'' covers various types of obstinate urinary disorders under its umbrella. The key to management of ''prameha roga'' is to attempt to stop its pathogenesis for which the etiological factors responsible for the origin of the disease are identified. These etiological factors include both faulty dietary habits and life style that cause imbalance between energy consumption and energy expenditure and ultimately cause obesity. Indulgence in high calorie diet including refined carbohydrate and bad fat associated with sedentary life style causes excessive storage of fatty tissue in body to disturb the body mass index. The disturbed body mass index reflects as obesity causing disturbed lipid metabolism and assimilation (FFAs, TG, HDL and VLDL) that in turn causes insulin resistance and produces type-2 DM.  

It is interesting to note that the ancient acharyas (preceptors, teachers) were aware of the fact that insulin resistance is secondary to the dyslipidemia. Therefore, the patients of ''prameha'' are classified as ''sthula pramehi'' and ''krisha pramehi'' which can be identified based on body mass index. All those factors, that cause vitiation of ''kapha'' will cause ''prameha''. At the end of the chapter, it is mentioned that ''jatah/ kulaja'' (hereditary) ''prameha'' and ''madhumeha'' are incurable. ''Prameha'' is also classified as (1) ''jatah pramehi'' (hereditary) and (2) ''sthula pramehi'' (acquired). Further justification  that acquired type of ''prameha'' (''apathyanimmitaja'') occurs only in obese persons i.e. obesity is the root cause for insulin resistance. But in addition to that it is stated that genetic predisposition is also required for the development of disease. There is difference of opinion within the Ayurvedic community on equating ''prameha'' with diabetes mellitus. Though it is not always feasible to accurately/exactly correlate or map Ayurvedic terms with modern medical concepts (e.g., there are no accurate medical terms to explain the concepts of ''gulma'' or ''prameha''), Ayurveda provides insights that can prove to be invaluable in exploring effective ways of the management of various chronic diseases, including diabetes. The medical community of today believes that raised FFAs cause insulin resistance leading to diabetes mellitus along with hypertension and atherogenic dislipidemias<ref>Boden G, Chen X, Ruiz J, et al. Mechanisms of fatty acid-induced inhibition of glucose uptake. J Clin Invest.1994;93:2438–2446. </ref><ref>Santomauro ATMG, Boden G, Silva M, et al. Overnight lowering of free fatty acids with acipimox improves insulin resistance and glucose tolerance in obese diabetic and nondiabetic subjects. Diabetes. 1999;48:1836–1841 </ref>. It is assumed that targeting FFA will help in mitigating insulin resistance more than using only hypoglycemic drugs. This chapter clearly depicts that the Ayurvedic approach for the management of ''prameha'' by ''apatarpana chikitsa'' (depleting therapy), drugs as well as diet that are helpful in lowering both fat as well as glucose such as ''yava'' (barley), ''triphala'' etc.  

It is interesting to note that the ancient acharyas (preceptors, teachers) were aware of the fact that insulin resistance is secondary to the dyslipidemia. Therefore, the patients of ''prameha'' are classified as ''sthula pramehi'' and ''krisha pramehi'' which can be identified based on body mass index. All those factors, that cause vitiation of ''kapha'' will cause ''prameha''. At the end of the chapter, it is mentioned that ''jatah/ kulaja'' (hereditary) ''prameha'' and ''madhumeha'' are incurable. ''Prameha'' is also classified as (1) ''jatah pramehi'' (hereditary) and (2) ''sthula pramehi'' (acquired). Further justification  that acquired type of ''prameha'' (''apathyanimmitaja'') occurs only in obese persons i.e. obesity is the root cause for insulin resistance. But in addition to that it is stated that genetic predisposition is also required for the development of disease. There is difference of opinion within the Ayurvedic community on equating ''prameha'' with diabetes mellitus. Though it is not always feasible to accurately/exactly correlate or map Ayurvedic terms with modern medical concepts (e.g., there are no accurate medical terms to explain the concepts of ''gulma'' or ''prameha''), [[Ayurveda]] provides insights that can prove to be invaluable in exploring effective ways of the management of various chronic diseases, including diabetes. The medical community of today believes that raised FFAs cause insulin resistance leading to diabetes mellitus along with hypertension and atherogenic dislipidemias<ref>Boden G, Chen X, Ruiz J, et al. Mechanisms of fatty acid-induced inhibition of glucose uptake. J Clin Invest.1994;93:2438–2446. </ref><ref>Santomauro ATMG, Boden G, Silva M, et al. Overnight lowering of free fatty acids with acipimox improves insulin resistance and glucose tolerance in obese diabetic and nondiabetic subjects. Diabetes. 1999;48:1836–1841 </ref>. It is assumed that targeting FFA will help in mitigating insulin resistance more than using only hypoglycemic drugs. This chapter clearly depicts that the Ayurvedic approach for the management of ''prameha'' by ''apatarpana chikitsa'' (depleting therapy), drugs as well as diet that are helpful in lowering both fat as well as glucose such as ''yava'' (barley), ''triphala'' etc.  

   

   

The chapter also gives the detailed description of urinalysis for the diagnosis, classification and assessment of prognosis of the disease. Distinctive description of ''raktameha'' and ''siktameha'' correlates with current method of microscopic examination of urine.

The chapter also gives the detailed description of urinalysis for the diagnosis, classification and assessment of prognosis of the disease. Distinctive description of ''raktameha'' and ''siktameha'' correlates with current method of microscopic examination of urine.

Description of ''Sahaja prameha'' and role of genetic predisposition in the development of disease clears all the dout about the scientific validity of Ayurveda.

Description of ''Sahaja prameha'' and role of genetic predisposition in the development of disease clears all the dout about the scientific validity of [[Ayurveda]].

===Sanskrit text, Transliteration and English Translation===

===Sanskrit text, Transliteration and English Translation===

**''Haridrameha''

**''Haridrameha''

Vivid description of ''manjjisthameha, raktameha, siktameha'' clearly indicate evolved observation skills of physicians. Analyzing the details of urine characteristics the scientific approach of Ayurveda is established. It is really appreciable that a disease can be classified and identified at every stage merely by urinalysis.

Vivid description of ''manjjisthameha, raktameha, siktameha'' clearly indicate evolved observation skills of physicians. Analyzing the details of urine characteristics the scientific approach of [[Ayurveda]] is established. It is really appreciable that a disease can be classified and identified at every stage merely by urinalysis.

==== Importance of Barley ====

==== Importance of Barley ====

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.  

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<ref>Mahalakshmipuram PS, Ramachandran A, Nishteswar K, Chandola HM. A preface study on exploring the pharmacodynamics of Curcuma neilgherrensis Wight- A folklore medicine. Indian J of Traditional Knowl 2013; 12(2): 288-294</ref><ref>M Prasad Shyam, Chandola HM, Ravishankar. A clinico- experimental study to evaluate the therapeutic efficacy of Curcuma neilgherrensis  Weight in the management of MadhuMeha  (Type 2 Diabete Mellitus). PhD thesis. Institute of  Post Graduate Teaching and Resaerch in Ayurveda, Gujarat Ayurveda University, Jamnagar, India, 2011</ref>

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<ref>Mahalakshmipuram PS, Ramachandran A, Nishteswar K, Chandola HM. A preface study on exploring the pharmacodynamics of Curcuma neilgherrensis Wight- A folklore medicine. Indian J of Traditional Knowl 2013; 12(2): 288-294</ref><ref>M Prasad Shyam, Chandola HM, Ravishankar. A clinico- experimental study to evaluate the therapeutic efficacy of Curcuma neilgherrensis  Weight in the management of MadhuMeha  (Type 2 Diabete Mellitus). PhD thesis. Institute of  Post Graduate Teaching and Resaerch in [[Ayurveda]], Gujarat [[Ayurveda]] University, Jamnagar, India, 2011</ref>

===== ''Gymnema Sylvester'' =====

===== ''Gymnema Sylvester'' =====

''Mamejjaka'' (Enicostema littorale Blume) is used as a single herb and also as a part of an anti-diabetic mixture<ref>Shanmugasundaram ER, Gopinath KL, Radha Shanmugasundaram K, Rajendran VM. Possible regeneration of the islets of Langerhans in streptozocin- diabetic rats given Gymnema sylvestre leaf extracts. J Ethnnopharmacol 1990; 30: 265-279</ref>. 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<ref>Upadhyay UM, Goyal RK. Efficacy  of Enicostemma littorale in type-2 diabetic patients. Phytother Res 2004; 18:233-235</ref>. It significantly reduced blood glucose and lipid peroxides in rats with alloxan- induced diabetes, and increased superoxide dismutase, catalase, and glutathione peroxidase<ref>Prince PS, Srinivasan M. Enicostemma littorale Blume aqueous extract improves the antioxidant status in alloxan induced diabetic rat tissues. Acta Pol Pharm 2005; 62: 363-367</ref>. In studies on rats with streptozotocin- induced type 1 diabetes, E. littorale significantly reduced glucose, cholesterol, and triglyceride levels<ref>Vishwakarma SL, Sonawane RD, Rajani M, Goyal RK. Evaluation of effect of aqueous extract of Enicostemma littorale in streptozotocin –induced type-1 diabetic rats. Indian J Exp Biol 2010; 48:26-30</ref>, and ameliorated diabetic nephropathy. Serum creatinine and urea were significantly decreased and glomerular function improved<ref>Sonawane RD, Vishwakarma SL, Lakshmi S, et al. Amelirotion of STZ-induced type 1 diabetic nephropathy by aqueous extract of Enicostemma littorale Blume and swertiamarin in rats. Mol Cell Biochem 2010; 340:1-6</ref>. 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<ref>Vasu VT, Modi H, Thaikoottathil JV,Gupta S. Hypolipidaemic and antioxidant effect of Enicostemma littorale Blume aqueous extract in cholesterol fed rats. J Ethnnopharmacol  2005; 101: 277-282.</ref>.

''Mamejjaka'' (Enicostema littorale Blume) is used as a single herb and also as a part of an anti-diabetic mixture<ref>Shanmugasundaram ER, Gopinath KL, Radha Shanmugasundaram K, Rajendran VM. Possible regeneration of the islets of Langerhans in streptozocin- diabetic rats given Gymnema sylvestre leaf extracts. J Ethnnopharmacol 1990; 30: 265-279</ref>. 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<ref>Upadhyay UM, Goyal RK. Efficacy  of Enicostemma littorale in type-2 diabetic patients. Phytother Res 2004; 18:233-235</ref>. It significantly reduced blood glucose and lipid peroxides in rats with alloxan- induced diabetes, and increased superoxide dismutase, catalase, and glutathione peroxidase<ref>Prince PS, Srinivasan M. Enicostemma littorale Blume aqueous extract improves the antioxidant status in alloxan induced diabetic rat tissues. Acta Pol Pharm 2005; 62: 363-367</ref>. In studies on rats with streptozotocin- induced type 1 diabetes, E. littorale significantly reduced glucose, cholesterol, and triglyceride levels<ref>Vishwakarma SL, Sonawane RD, Rajani M, Goyal RK. Evaluation of effect of aqueous extract of Enicostemma littorale in streptozotocin –induced type-1 diabetic rats. Indian J Exp Biol 2010; 48:26-30</ref>, and ameliorated diabetic nephropathy. Serum creatinine and urea were significantly decreased and glomerular function improved<ref>Sonawane RD, Vishwakarma SL, Lakshmi S, et al. Amelirotion of STZ-induced type 1 diabetic nephropathy by aqueous extract of Enicostemma littorale Blume and swertiamarin in rats. Mol Cell Biochem 2010; 340:1-6</ref>. 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<ref>Vasu VT, Modi H, Thaikoottathil JV,Gupta S. Hypolipidaemic and antioxidant effect of Enicostemma littorale Blume aqueous extract in cholesterol fed rats. J Ethnnopharmacol  2005; 101: 277-282.</ref>.

A pilot study on an herbal mixture containing  ''tejapatra'' (Cinnamomum Tamala)<ref>Chandola HM, Tripathi S N. Hypoglycemic response of C.tamala in diabetes. In: Bajaj JS,ed. Diabetes Mellitus in developing Countries. New Delhi: Interprint, 1984: 383-386.</ref><ref>Chandola HM, Tripathi S N, Udupa KN. Effect of C.tamala on plasma insulin vis-à-vis  blood sugar in patients of diabetes mellitus. J Res Ayurveda Siddha 1980;1:3455-357. </ref>, ''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<ref>Singh B, Singh G, Vyas SN, Chandola HM. The role of  Virechana and herbal drugs in the management of MadhuMeha (diabetes mellitus). MD (Ayu) thesis. Institute of  Post Graduate Teaching and Resaerch in Ayurveda, Gujarat Ayurveda University, Jamnagar, India, 1992</ref>. ''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<ref>Waheeda A, Miana GA, Ahmead SI. Clinical investigation of hypoglycemic effect of seeds of Azadirachata indica in type-2 (NIDDM) diabetes mellitus. Pak J Pharm Sci 2006; 19: 322-325</ref><ref>Khosla P, Bhanwra S,Singh J, et al. A study of hypoglycaemic effect of Azadirachata indica (Neem) in normal and alloxan diabetic rabbits. Indian J Physiol Pharmacol 2000:44:69-74</ref>.  

A pilot study on an herbal mixture containing  ''tejapatra'' (Cinnamomum Tamala)<ref>Chandola HM, Tripathi S N. Hypoglycemic response of C.tamala in diabetes. In: Bajaj JS,ed. Diabetes Mellitus in developing Countries. New Delhi: Interprint, 1984: 383-386.</ref><ref>Chandola HM, Tripathi S N, Udupa KN. Effect of C.tamala on plasma insulin vis-à-vis  blood sugar in patients of diabetes mellitus. J Res [[Ayurveda]] Siddha 1980;1:3455-357. </ref>, ''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<ref>Singh B, Singh G, Vyas SN, Chandola HM. The role of  Virechana and herbal drugs in the management of MadhuMeha (diabetes mellitus). MD (Ayu) thesis. Institute of  Post Graduate Teaching and Resaerch in [[Ayurveda]], Gujarat [[Ayurveda]] University, Jamnagar, India, 1992</ref>. ''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<ref>Waheeda A, Miana GA, Ahmead SI. Clinical investigation of hypoglycemic effect of seeds of Azadirachata indica in type-2 (NIDDM) diabetes mellitus. Pak J Pharm Sci 2006; 19: 322-325</ref><ref>Khosla P, Bhanwra S,Singh J, et al. A study of hypoglycaemic effect of Azadirachata indica (Neem) in normal and alloxan diabetic rabbits. Indian J Physiol Pharmacol 2000:44:69-74</ref>.  

The herb ''gokshura'' (Tribulus Terrestris Linn.)<ref>Amin A, Lotfy M, Shafiullah M, Adeghate E. The protective effect of Tribulus terreestris in diabetes. Ann NY Acad Sci 2006; 1084: 391-401</ref>, ''asana'' (Pterocarpus marsupium Roxb.)<ref>Anonymous. Sahasrayogam. 23rd ed. Alappuzha, Kerala, India: Vidyarambam Publisheres, 2000:93</ref>, ''kulatha'' (Vigna unguiculata (Linn.) Walp.), and saptaparna<ref>Dasa G. Bhaishajyaratnavali. Varanasi, India: Choukhamba Sanskrit Sansthan, 2000</ref> (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).

The herb ''gokshura'' (Tribulus Terrestris Linn.)<ref>Amin A, Lotfy M, Shafiullah M, Adeghate E. The protective effect of Tribulus terreestris in diabetes. Ann NY Acad Sci 2006; 1084: 391-401</ref>, ''asana'' (Pterocarpus marsupium Roxb.)<ref>Anonymous. Sahasrayogam. 23rd ed. Alappuzha, Kerala, India: Vidyarambam Publisheres, 2000:93</ref>, ''kulatha'' (Vigna unguiculata (Linn.) Walp.), and saptaparna<ref>Dasa G. Bhaishajyaratnavali. Varanasi, India: Choukhamba Sanskrit Sansthan, 2000</ref> (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.

''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''<ref>Sharma H, Chandola HM.Prameha in Ayurveda: Correlation with Obesity, Metabolic Syndrome, and Diabetes Mellitus.Part 2- Management of Prameha. The Journal of Alternative and Complementary Medicine.2011. 17(7):589-599</ref>.

[[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''<ref>Sharma H, Chandola HM.Prameha in [[Ayurveda]]: Correlation with Obesity, Metabolic Syndrome, and Diabetes Mellitus.Part 2- Management of Prameha. The Journal of Alternative and Complementary Medicine.2011. 17(7):589-599</ref>.

=== Future Scope for Research ===

=== Future Scope for Research ===