Diabetic Neuropathy

Integrated Summary

Patient is a known case of Diabetes for past 16 yrs and has been on allopathic medications.He has pain in the calf muscles since about 6 yrs and increased blood pressure levels since 5 yrs.He also has elevated serum creatinine and uric acid levels.He occasionally has pain in the cervical region .

Past history:K/C/O DM,HTN,Neuropathy,Nephropathy,Maculopathy,Elevated Serum Creatinine and Uric Acid levels.Laser treatment for eye 3 yrs back

H/O:Cholelithiasis in 2010

Family History:HTN,CVA,DM

Current medication:Tab Cardace (Ramipril)OID, Tab Nemicard or Nebicard (Nebivolol) 2.5 g, Tab Ecospirin Gold (Atorvastatin) OID, Tab Trigenta 5 (Linagliptin) OID 1-0-0,Digtore 10 BID, Reminyl-D (Galantaine) OID,Insulin (Humaloy (Insulin Pump)160-165 IU

Clinical Status

Allopathy

Ayurveda

Vital Parameters

BP:140/80
Pulse:76
Weight:74.5 kg
BMI: 31.43

Asta Sthana Pariksha

Nadi:
Malam:Saama
Mutra:Athi
Jihva:
Shabda
Sparsha
Drik
Akruti:Pravara

Examinations

GC: Fair.
CVS: NAD
CNS:
RS: NAD
PA: NAD

Dasa Vidha Pariksha

Prakriti: Kapha pitha
Vikriti: Vatha, Pitha
Sara: Madhyama
Samhanana: Madhyama
Pramana: Pravara
Satmya: Lavana sthmya
Satva: Madhyama
Aharashakti: Madhyama
Vyayam Shakti: Mahyama
Vaya: Madhyama
Desha: Pitha, Madhyama desa bala
Kala: 16 years, Sharath ruthu, Vyaktha

Lab Test:

Lab Investigations	28/8/14	13/10/14
FBS mg/dl	214	90
HBA1C %	11.4	10
Fasting insulin mc U /mL	150	124.3
TLC gm/dl	-	13100
ESR	80	70 m/hr
S. Triglycerides mg/dl	210	170
LDL	72	78
HDL	34	25
Urine Protein sugar	++++	Protein Traces Glucose negative
Urea mg/dl	-	48
S. Creatinine	1.8	5/10/14-1.3 13/10/14-1.4
Uric acid mg/dl	8.0	9.40 mgm/dl
Total Bilirubin	-	0.8
Direct Bilirubin	-	0.3
Indirect Bilirubin	-	0.5
Total Protein	-	7.6
GGT	-	60
HB gm%	10.60	12.8

Rogi Bala- Madhyamam
Roga Bala- Balwan
DSQ findings Rating -ADRS Ultra High
Nidana Panchaka - Nidana:Ahitha ahara,Rathri jagarana,Asya sukha,Beeja Dosha,Sthoulya,Ati chinta - Purvaroopa: Prabhootha mootrata - Roopa:Anga marda, Anga sada, Prabhootha mootrata Updrava:Sthouya, Hasta suptata - Arishta Lakshana: Nil - Samprapti Dosha: Vata Pita - Dushya: Rasa, Meda, Kleda, Mamsa, Lasika - Ama: Jatharagnimandhya janya ama. - Srotas: Rasa, Mamsa, Meda and Mutra. - Sroto Dushti Prakara:Sanga. Roga Samprapti Flow Chart: Nidana Sevana \| Kapha aggravation \| Vitiates Moothrasaya gata kleda,mamsa,lasika. \| Vitiates Mutra vaha srotas \| Further vitiates with involment of vatha leads to Angasada, Angamarda,Suptata,Sthoulya,Prabhuta Mutrata.

Differential Diagnosis with reasoning
- DM
- Insomnia

Differential Diagnosis with reasoning
Prameha
Madhumeha

Evidence Based Diagnosis with References
DM + Insomnia

Evidence Based Diagnosis with References
Madhu meha + Nidra nasha

Details of Allopathy medicine if continued
Tab. Cardace 1-0-0,
Tab Nebicard 2.5 g,
Tab Ecospirin Gold 0-0-1 ,
Tab Trigenta 5 1-0-0,
Tab Digtore 10 1-0-1,
Tab Reminyl-D 1-0-0,
Insulin Humalog (Insulin Pump)160-165uts

• Tab Cardace reduced 1/2 tab from 8/`10/14 onwards.
• Insulin dose was reduced from 165 units to approximately 120 units per day.

Details of Insulin Pump: Medtronic minimed Paradigm
MMT-715 Pump
Humalog Lispro 100 u/mL

Chikitsa Vivechana:
Type – IPT
Duration – 4/10/14 to 18/10/14
Primary Treatments:Snehapana Udwarthanam+Bashpa sweda,Seka Main
Treatments:Virechanam,Yogavasthy,
Post Treatments:Thalam Internal medications

Dates	Total Insulin Units/24 hrs
5/10	165
6/10	124
7/10	125.5
8/10	119.75
9/10	119
10/10	-
11/10	116
12/10	70
13/10	106.5
14/10	120
15/10	115
16/10	120
17/10	124
18/10	117

Chikitsa Paddhati with details of dose of medicine

From Date	To Date	Procedure	Treatment Medicines
4/10/14	9/10/14	Sneha pana	Dhanwabtara Ghrita
4/10/14	18/10/14	Udwarthana + Bashpa swedam	Ellumnisadi Ch. +Triphala Ch.
10/10/14		Virechanam	Avipatti Ch.
11/10/14	16/10/14	Yoga Basti	Erandmooladi Kashaya
11/10/14	17/10/14	Kaya seka	Dhanwantaram + Narayana Taila
4/10/14	17/10/14	Mukhalepa	Elaadi Churnam
4/10/14	17/10/14	Hasta-pada Abhyanga	Dhanwantaram + Prabhanjana thaila
4/10/14	17/10/14	Thalam	Amlakadi yoga

Medications:
From 4/10/14 to 18/10/14 and after the treatment also.

- Punarnavadi Kashayam 15 ml+5 ml warm water on empty stomach at 6AM and 6 PM
- Kataka khadiradi kashayam 15 ml+45ml warm water twice daily before food at 11.30 AM and 7.30 PM
- T.Liv 52 1 tab thrice daily after food
- Amritha choornam 1 tsp with hot water twice daily before food (12.15 AM 7.45 PM)
- Elaneer Kuzhambu 2 drops as anjana followed by eye wash with normal temperature water
- Asanavilwadi thailam for external application on head one hour before bath
- Dhanwantharam thaila, for external application on body one hour before bath.

Referral Opinion Sought if any Not required.

Integrated View
Ayurveda approach of Ahara, Vihara, Aushadh and Kriya effectively managed the disease of diabetes and corrects the metabolism to maintain sugar levels.

Outcome

Samyak Lakshanas achieved
Samyak Snigdha Lakshanas achieved on 9/10/14.He got 15 vegas for virechanam,Samyak Shudhi lakshanas were achieved.
Other outcomes

Outcome Parameters	BT	AT	Follow-up
Sleep (Nidra)	Disturbed (duration ~ 3 hrs)	Sleep quality improved (duration ~ 6-7 hrs)	Improved and sound
Appetite (Agni)	Vishama	Sama	Sama
Bowels (Mala)	Regular	Regular	Regular
Urination (Mutra)	Prabhuta	Prabhuta	Normal
Stress (Manas)	Restless	Moderate	Mild
Pulse	76	72	72
Weight, Kg	74.3 kg	70.6kg	70.1kg
BMI	31.2	29.4	29.1
Pain in calf region	2	1	1
Tiredness	Yes	No	No
Desire to sit down or lie down	Yes	No	No
Numbness in palms	Present	Reduced	Absent

Condition during IP stay:

	4/10	5/10	6/10	7/10	8/10	9/10	10/10	11/10	12/10	13/10	14/10	15/10	16/10	17/10
FBS mg/dl	90	181	196	81	131	155	154	137	100	165	101	144	91
	D >6 N 1-2	D 4-5 N 1-2	D 4-5 N 1	D 4-5 N 1	D 5-6 N 1	D 4-5 N 1	D 5-6 N 1	D 4-5 N 1-2	D 3 N 1	D 4-5 N 1-2	D 4-5 N 1-2	D 4-5 N 1-2	D 4-5 N 1-2	D 4-5 N 1-2
BP	130/90	110/70	110/70	110/70	110/70	110/60	100/80	110/70	130/90	140/90	110/70	130/90	120/80	140/90

Standardised Outcome Scales

Standard Outcome scale	4/10/14	17/10/14
S-LANSS Pain Score	6
Pittsburgh Insomnia Rating Scale	67	74

Conclusion

Ayurveda effectively treats diabetes and its complications by improving body’s metabolism and addressing the root cause to maintain the normal sugar levels and prevent further complications.