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INDEX – GJRMI - Volume 6, Issue 5, May 2017 INDIGENOUS MEDICINE Ayurveda – Dravya Guna – Review article A CRITICAL REVIEW ON PRAMEHA MANAGEMENT FROM VARIOUS COMPENDIA Kavita Kumari*, Suman Singh, Bhupesh Patel
75–87
COVER PAGE PHOTOGRAPHY: DR. HARI VENKATESH K R, PLANT ID – BRANCH OF GYMNOSPORIA MONTANA (ROTH) BENTH.* OF THE FAMILY CELASTRACEAE PLACE – OFF KANAKAPURA ROAD, BANGALORE, KARNATAKA, INDIA *BOTANICAL NAME VALIDATED FROM www.theplantlist.org AS ON 30/05/2017
Global J Res. Med. Plants & Indigen. Med. | Volume 6, Issue 5 | May 2017 | 75–88
ISSN 2277-4289│ www.gjrmi.com │International, Peer reviewed, Open access, Monthly online Journal
Review Article A CRITICAL REVIEW ON PRAMEHA MANAGEMENT FROM VARIOUS COMPENDIA Kavita Kumari1, Suman Singh2, Bhupesh Patel3 1
M.D. Scholar, Department of Dravyaguna, I.P.G.T & R.A., Gujarat Ayurved University, Jamnagar, Gujarat, India -361 008 2 PhD Scholar, Department of Dravyaguna, I.P.G.T & R.A., Gujarat Ayurved University, Jamnagar, Gujarat, India -361 008 3 Assistant Professor, Department of Dravyaguna, I.P.G.T & R.A., Gujarat Ayurved University, Jamnagar, Gujarat, India -361 008 *Corresponding Author: Email: kavitasohu702@gmail.com; Mobile: +91-7284021574
Received: 09/04/2017; Revised: 24/05/2017; Accepted: 30/05/2017
ABSTRACT Prameha is defined as a disease, with excessive urination and turbidity. 20 types of Prameha is described by Acharyas, 4 are due to Vata, 6 due to Pitta and 10 are caused by Kapha. Though it is Yapya (not totally curable / difficult to cure) disease, but the prolonged Ayurvedic treatment will help the person to prevent its complication and lead a healthy life. This review work is an attempt to compile and present Prameha management in systematic manner with scientific observations from various compendia and web searches. In present study, different formulations as well as single drugs were compiled from 10 different compendia, for the treatment of Prameha. Analysis of the compiled data shows that, about 150 formulations (Rasa-43, Kwatha-41, Vati-15, Ghrita-12, Churna-11, Avleha-10, Taila-6) has been described and 40 single drugs are being used, among them maximum drugs are of plants origin (28) followed by minerals (10) and animal origin (1). Some of these drugs are reported for various pharmacological activities like antidiabetic (13), anti-hyperlipidaemic (4), antioxidant (10), immune-modulatory activity (7) etc. Prameha can be correlated with the disease Diabetes mellitus of modern science. Different properties and mode of action of these drugs compiled, may give a lead to find out new approaches for the treatment of Prameha and helpful to prevent its complications. KEYWORDS: Antidiabetic, Diabetes, Madhu, Prameha, Yapya Cite this article: Kavita Kumari*, Suman Singh, Bhupesh Patel (2017), A CRITICAL REVIEW ON PRAMEHA MANAGEMENT FROM VARIOUS COMPENDIA, Global J Res. Med. Plants & Indigen. Med., Volume 6 (5): 75–88
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INTRODUCTION: Ayurvedic classics have laid importance upon the etiological factors, their role in vitiations of Dosha (body humour) and Dushya (body tissues) which manifest disease conditions. Besides this, some conditions are also considered due to Beeja dushti (defects in the gametes) i.e. Prameha (urinary disorder) and Arsha (piles). Prameha are categorized into two types based upon its origin i.e. Sahaja (congenital) and Apathyanimittaja (due to over eating and poor habits). In these two categories, former occurs due to Beeja dushti and latter one due to improper diet and lifestyle. In Ayurvedic classics, detail description of etiological factors like excessive intake of heavy, unctuous and saline foods, new cereals and fresh wine consumption in large quantity, sedentary life style, not indulging in any sort of physical and mental exercise and not undergoing bio-purification of body are mentioned for Prameha (Acharya YT, 2011). These etiological factors aggravate Kapha (watery element), Pitta (fiery elements or bile), Meda (fatty tissue), Mamsa (muscles) and obstruct the normal pathway of Vata (air elements), agitated Vata carries the Ojas (immunity) to Basti (urinary bladder) and causes Prameha. Which ultimately leads to Madhumeha (Acharya YT, 2011). Prameha is defined to be characterized with excessive urination (both in frequency & quantity) and turbidity (Acharya YT, 2009). Acharya Vagbhata further clarifies that nature of the turbidity may vary depending upon the body reaction with the Doshas (Shashtri Harisadashiva, 2010). Acharyas have classified Prameha into two categories on management basis, first who are Sthula (obese) and strong and second one those who are emaciated (Krisha) and weak. The patient belonging to the latter category should be given Brimhana (nourishing) and Shamana chikitsa (pacifying therapy) while patients of the former category have more Dosha in the body, should be administered Shodhana Chikitsa (elimination therapy) (Acharya YT, 2011). Seers of Ayurveda have considered that every Prameha with passage of time is converted into
Madhumeha. Therefore, Prameha can be correlated with the early stage of diabetes mellitus. Diabetes describe as a metabolic disorder of multiple etiologies characterized by chronic hyperglycemia with disturbance of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action or both. Diabetes is a growing public health problem in both developed and developing countries. Globally, an estimated 422 million adults are living with diabetes mellitus, according to the latest 2016 data from the World Health Organization (WHO) (WHO, 2016). Diabetes prevalence is increasing rapidly; the number is projected to almost double by 2030 (Wild S, 2004). Type 2 diabetes makes up about 85–90% of all cases (Shlomo Melmed, Kenneth Polonsky, P.Reed Larsen, Henry Kronenberg, 2011). Until recently, India had more diabetics than any other country in the world, according to the International Diabetes Foundation (Gale, 2010), although the country has now been surpassed China to the top spot (BBC, 2010). Diabetes currently affects more than 62 million Indians, which is more than 7.1% of the adult population (IANS, 2014). Nearly one million Indians die due to diabetes every year (Gale, 2010). The high incidence is attributed to a combination of genetic susceptibility plus adoption of a high-calorie, low-activity lifestyle by India's growing middle class (Kleinfield NR, 2006). Though patho-physiology of diabetes remains to be fully understood, experimental evidences suggest the involvement of free radicals in the pathogenesis of diabetes (Matteucci E, 2000) and more importantly in the development of diabetic complications (Oberley LW, 1988, Lipinski B, 2001). In search of natural origin medicines for combating such metabolic syndromes with fewer side effects, there has been an exponential growth in the field of herbal medicine and these drugs are gaining popularity both in developing and developed countries. Many traditional medicines in use are derived from medicinal plants, minerals and organic matter (Grover JK et al., 2002). Hence,
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present review is an attempt to update information regarding management of Prameha from various compendia of medieval period with evidence based experimental and clinical studies on diabetes mellitus. MATERIAL AND METHODS In present study, compound formulations as well as single drugs, indicated for Prameha management were compiled from Vaidyajeevana (Sharma PV, 2013), Bhavaprakashasamhita (Mishra Brahmasankar, 2005), Basvarajeeyam (Pandey Gyanedra, 2010), Vyadhinigraha (Giri Kapildev, 1999), Chamatkara chintamani (Brahmananda Tripathi, 2006), Yogachintamani (Dattaram, 2003), Yogaratnakara (Shashtri Lakshmipati, 2010), Vaidyarahasya (Tripathi Indradev, 2000), Bhaishjyaratanavali (Mishra Siddhinandan, 2011), Sahasrayoga (Arya mahendrapalsingh, 1990). Various research journals and books were referred to gather the update information regarding scientific documentation of the role of these drugs in the prevention and management of Prameha. The recorded data are presented in a scientific manner with regards to their Sanskrit name, dosage form, dose, vehicle and reported research activity. RESULTS & DISCUSSION Analysis of the compiled data shows that, about 150 compound formulations (Rasa-43, Kwatha-41, Vati-15, Ghrita-12, Churna-11, Avleha-10, Taila-6) and 40 single drugs has been described, among them maximum drugs are of herbal origin (28) followed by mineral (10) and animal origin (1). Mainly used dosage form is Kwatha (decoction) and Anupana (vehicle) is Madhu (Honey) among the observed data (Table 1). Honey possesses Kapha-Medanashaka property and it is best vehicle described in Ayurvedic classics as they aid in channelizing the drugs to every Dhatu (body tissues) and Srotas (channels of the body) of the body (Acharya YT, 2011). Honey has been shown to scavenge reactive oxygen species, ameliorate oxidative stress and reduce hyperglycaemia. (Beretta G et al., 2007,
Erejuwa OO et al., 2010a). While honey supplementation in diabetic rats ameliorates renal oxidative stress independent of the dose, its hypoglycaemic effect is dose-dependent (Erejuwa OO et al., 2010b). It is hypothesized that the fructose and oligosaccharides present in honey might in some way contribute to the observed hypoglycaemic effect. (Erejuwa OO et al., 2012, Erejuwa OO et al., 2011a). In addition, honey supplementation ameliorates several metabolic derangements commonly observed in diabetes. These include reduced levels of hepatic transaminases, triglycerides and glycosylated haemoglobin (HbA1c) as well as increased HDL cholesterol. (Erejuwa OO et al., 2011b, Chepulis L, 2008, Busserolles J, 2002). Most of these drugs possess Rasayana (rejuvenator) action which is followed by Deepana (appetizer), Chakshushya (good for eye health), Balya (improves strength) etc. Some of these drugs are reported for various pharmacological activities like antidiabetic (13), anti-hyperlipidaemic (4), antioxidant (10), immunomodulatory (7) etc. (Table 1) One of the etiologic factors implicated in the development of diabetes and its complications is the damage induced by free radicals. Free radicals are capable of damaging cellular molecules, DNA, proteins and lipids leading to altered cellular functions. Natural antioxidants strengthen the endogenous antioxidant defenses from reactive oxygen species (ROS) and restore the optimal balance by neutralizing the reactive species. Many recent studies reveal that antioxidants capable of neutralizing free radicals are effective in preventing experimentally induced diabetes in animal models (Kubisch HM, et al.,1997, Naziroglu M et al., 2001) as well as reducing the severity of diabetic complications (Lipinski B, 2001) hence an anti-diabetic compound with antioxidant properties would be more beneficial. Components of the immune system are altered in type-2 diabetes (T2D), with the most apparent changes occurring in adipose tissue, liver, pancreatic islets, in vasculature and circulating leukocytes. These immunological changes include altered levels of specific cytokines and chemokines, changes in the number and activation state of various
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leukocyte populations and increased apoptosis and tissue fibrosis. Preliminary results from clinical trials with salicylates and interleukin-1 antagonists (Claus ML et al., 2007) support this notion and have opened the door for immunemodulatory strategies for the treatment of T2D that simultaneously lower blood glucose levels and potentially reduce the severity and prevalence of the associated complications of this disease (Marc YD and Steven ES, 2011). Hence, drugs like Haridra (Curcuma longa)
(Jennifer RA et al., 2012), Guduchi (Tinospora cordifolia) (K. Salkar et al., 2014), Amalaki (Phyllanthus emblica) (Chatterjee A, 2011), Bala (Sida cordifolia) (Meera Sumanth and SS Mustafa, 2009), Shatavari (Asparagus racemosus) (Gautam M et al., 2009) etc. possess immune-modulatory activity which can be helpful in preventing various associated complications of diabetes thereby maintains quality of life. (Table 1)
Table 1 – Single drugs of plant origin indicated in the management of Prameha S.n o. 1.
Drugs
2.
Haridra
Curcuma longa Kwatha Linn. (Decocti (Zingiberaceae) on)
3.
Palasha pushpa (flower)
Butea monosperma (Lamk.)Taub. (Fabaceae)
Kwatha (Decocti on)
Sugar
Deepana Anti-oxidant (Prasad (appetizer), Vrishya GJ et al., 2013), (aphrodisiac), Sara Antidiabetic (Chusri Talubmook and Nopparat B, 2012)
4.
Guduchi
Tinospora cordifolia Willd.
Swarasa (Juice)
Madhu (Honey)
Tridoshahara, Deepana (appetizer), Rasayana (rejuvenator), Grahi, Chakshushya, Medhya (nootropic)
Haritaki
Botanical source Terminalia chebula Linn. (Combretaceae)
(Menispermaceae)
Dosage form Churna (Powder)
Vehicle
Actions
Reported activity
Madhu (Honey)
Deepana (appetizer), Medhya (nootropic), Rasayana (rejuvenator), Chakshushya, Anulomana
Hypolipidaemic (V. Maruthappan and K. Sakthi Shree, 2010), Antioxidant (Bibhabasu Hazra et al., 2010), Antidiabetic (MuraliYK et al., 2007)
Raktashodhaka, Twakdoshahara, Shothahara, Deepana (appetizer), Grahi, Vishaghna
Antioxidant (R.Selvam et al., 1995), Immunomodulator (Jennifer RA et al., 2012), Anti-diabetic (Rai PK et sal., 2010), Hypolipidaemic (Faizal IP et al., 2009)
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Immunomodulator (K. Salkar et al., 2014),Antidiabetic and hyperglycemic (Wadood N et al., 1992), Antioxidant (Methew S and Kuttan G, 1997)
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5.
Guduchi satva
Tinospora cordifolia Willd.
Satva
Madhu (Honey)
(Menispermaceae)
Tridoshahara, Deepana (appetizer), Rasayana (rejuvenator),Grahi, Chakshushya, Medhya (nootropic)
Immunomodulator (Bhatnagar SP et al., 2010), Antioxidant (Rachana Dwivedi et al., 2014)
Chakshushya
Antidiabetic (Dhasarathan P, 2011), Antioxidant (Sanmugapriya E and Venkataraman, 2006)
6.
Kataka
Strychnos potatorum Linn.f. (Loganiaceae)
Seed powder
7.
Aamalaki
Phyllanthus emblica Linn.
Swarasa (Juice)
Madhu (Honey)and haridra churna (turmeric powder)
Rasayana(rejuvenat or), Vrishya(aphrodisiac ), Chakshushya, Deepana (appetizer)
Antioxidant (Satio K et al., 2008), Antidiabetic (Suryanarayana P et al., 2007), Hypocholesteromic (Kim HJ et al., 2005), Hypolipidaemic (Mathur R et al., 1996), Immunomodulatory (Chatterjee A, 2011)
(Euphorbiaceae)
8.
Bala
Sida cordifolia Kwatha Linn. (Decocti (Malvaceae) on)
Lodhra churna (lodhra powder)and Madhu (Honey)
Balya(improves strength), Vrishya (aphrodisiac), Grahi, Brimhana, Prajasthapana
Antioxidant (Sharma HM et al.,1992), Antidiabetic (Kanth VR and Diwan PV, 1999) and Hypercholesteromic (Kaur G et al., 2011), Adaptogenic (Meera Sumanth and SS Mustafa, 2009), Immunomodulator (Meera Sumanth and SS Mustafa, 2009)
9.
Shatavari
Asparagus racemosus Willd. (Liliaceae)
Milk
Balya (improves strength), Rasayana (rejuvenator), Netrya, Shukrala, Stanyakara
Antioxidant (Lalana Kongkaneramit et al., 2011), immunomodulator (Gautam M et al., 2009)
Swarasa (Juice)
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10.
Bhumiama laki
Phyllanthus amarus Schum.et.Thon n
Churna (Powder)
Maricha churna (Piper powder)
Kasahara, Shwasahara, Rasayana (rejuvenator)
Hypoglycemic (AA Adeneye et al, 2006), Antidiabetic (AA Shetti et al., 2012), Antioxidant (Lim Y and Murtijaya, 2007)
(Euphorbiaceae)
11.
Bilvapatra
Aegle marmelos Swarasa Linn.(Rutaceae) (Juice
Sugar
Balya (improves strength),Grahi, Deepana (appetizer), Pachana
Antidiabetic (M. C.Sabu and Ramadasan Kuttan, 2004),Antioxidant (Sharmila upadhya et al., 2004),Immunomodulator (HV Govinda and SMB Asdaq, 2011)
12.
Parijata
Nyctanthes arbortristis Linn.
Madhu (Honey)
Anulomana
Antioxidant (Rathee JS et al., 2007), Antidiabetic (Pattanayak C et al., 2012), Immunomodulator (Marikani kannan and Ranjit Singh AJA, 2010)
Kwatha (Decocti on)
(Nyctanthaceae)
13.
Agnimanth a
Clerodendrum Kwatha phlomidis Linn. (Decocti (Verbenaceae) on)
-
14.
Nimba
Azadirachta Kwatha indica A. Juss. (Decocti (Meliaceae) on)
-
Minerals and herbo-mineral preparations are fewer in Samhita period with succession of time their uses are increased which reflects in compendia of medieval periods. It is observed that herbo-mineral complexes are more stable and more interactive which results in faster therapeutic action and have a longer shelf life. In the management of Prameha, individual uses of 9 different minerals were found in referred
Anti-hyperlipidemic (MJ Patel and JK Patel, 2012), Antioxidant (Gokani RH et al., 2010) Deepana (appetizer), Netrya
Antioxidant(Rao AD et al., 1998), Immuno-stimulant (Ujjwal KD and Mukherjee R, 2009) Antidiabetic (Rasheda Akter, et al., 2013)
compendia (Table 2). These minerals were prescribed with various Anupana (vehicle) like Madhu (honey), milk, Triphala etc. In classical texts, a great emphasis is laid on dosage and Anupana (vehicle) with which a Bhasma should be administered. Anupana may possibly play the key role in the safety of the Bhasma. In absence of such caution, adverse reaction is likely (Kapoor R, 2010). Madhu (honey) as
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Anupana (vehicle) brings about quick action due to its Yogavahi (super-advenient) property (Chunekar KC, 2004). Minerals were reported for their antioxidant activity, antidiabetic activity, immunomodulatory effect etc. in experimental studies mentioned in table 2.
Frequently used 30 important compound formulations described in table 3, were found in referred compendia with different dosage forms and vehicles. These formulations are indicated in Prameha, its various types and many other conditions.
Table 2-Single drugs of mineral origin indicated in the management of Prameha. S.N Drug
1. 2. 3. 4.
5. 6. 7. 8. 9.
Lauha Bhasma Vanga Bhasma Naga Bhasma Shilajitu
Abhraka Bhasma Gandhaka yoga Swarna Makshika Roupya Makshika Sphatika Churna
Botanical /English Name Iron
Anupana (Vehicle)
Reported activity
Madhu (Honey)
-
Calx of Tin
Pure Shilajitu
Antidiabetic (Soni Chandan et al., 2011)
Lead Calx
Madhu,Haridra,Amalaki
Antidiabetic (Deshmukh SM, 2013)
Asphaltum
Milk,Sugar,Honey
Calx of Mica
Honey,Triphala,Haridra
Sulphur
Puranaguda (Jaggery),Milk Madhu,Guduchisatva
Immunomodulatory (Ghosal S, 2009), Hypolipidemic (Trivedi NA, 2004), Antidiabetic (Trivedi NA, 2004) Hypoglycemic activity (Raghava Rao Gundimeda, 2010) -
Copper Pyrite Iron Pyrite Quartz Stone
Saradiganabhavna (Levigation) -
Antidiabetic (Singh Neetu et al., 2014) Antioxidant -
Table 3-Compound formulations indicated in Prameha S.no
Name
1.
Mehantaka rasa
2.
Harishankara 1,2 Pramehakalanala rasa Pramehakulantaka rasa Vasantakusumakara rasa Vangeshwara rasa 1,2,3,4
3. 4. 5. 6.
Dose & Vehicle
Indication
Kshnamatravati, Vinshati Prameha Mushali, Shatavari rasa, Navneeta rasa Honey Vinshati Prameha
Referenc es of books* 7,9
7,9
250 mg, Gunjakwatha
Vinshati Prameha
Milk,Amalakiswarasa Ghrita, Madhu(Honey)
Vinshati Prameha,Pandu,Kamla, 9 Mutrakricchra, Ashmari Prameha,Ekadasakshaya, Soma roga 7,9
Pippalichurna,Madhu
Vinshati Prameha
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9
7,8,9
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8.
Maha Vangeshwara rasa Jalajamrita rasa Sugar
Vinshati Prameha, Pandu, 7 Somaroga, Mutrakricchra, Ashmari Mutrakricchra, Vinshati Prameha 7
9.
Pramehasetu rasa
Vinshati Prameha
10. 11. 12. 13. 14. 15.
Phalatrikadikwatha Triphaladikwatha Aakulyadikwatha SarjadiKwatha Manjisthadikwatha Chandraprabhavati 1,2
16. 17. 18.
Gokshuradivati/gug gulu Induvati Panchananavati
19. 20. 21.
Eladi Churna Sinhamritaghrita Dhanvantraghrita
22.
Shalmalighrita
23. 24. 25.
Arjunadyaghrita Dadimadyaghrita 1,2,3 Ashvagandhapaka
26.
Gokshuradyavleha
27. 28.
Drakshapaka Ashwagandhapaka
29.
Lodhrasava
30.
Devdarvyadiarishta
7.
3 rati (415), with Triphalachurna-Honey Honey(Madhu) Honey (Madhu) Honey (Madhu) Honey (Madhu) Honey (Madhu) Karsha, with GhritaMadhu(Honey)
All chronic Prameha Vinshati Prameha Vinshati Prameha Udakameha Shukra, Raktameha Mutradosha,Pradara, Prameha, Arsha, Ashmari, Vidradhi, Pandu,Udararoga Vataroga, Vatarakta, Mutradosha, Pradara 60mg,Honey Madhumeha 1 Rati (125mg) Vinshati Prameha, Kushtha, Shoola, Gulma, Jwara With Rice water Vinshati Prameha Madhumeha, Kushtha, Bhagandara 6-12gm,With hot milk or Prameha, Kushtha, hot water Bhagandara,Unmada, Apasmara 12 gm, With hot milk or Vinshati Prameha (Shukrameha), hot water Napuskata, Dhatukshya,Kasa Pittaja Prameha 6-12gm,With hot milk or Prameha, Kushtha, Kasa, Shwasa, hot water Hikka, Ashmari Prameha,JeernaJwara, Shotha, Gulma,Vata-Pitta roga 4 Tola(96gm) Ashmari, Madhumeha, Mutradaha, Vibandha 2 Karsha(48gm) Prameha,Vibandha,Pittajaroga Prameha, Jwara, Shotha, Agnideepaka 1 Pala (96gm) Kapha-Pitta prameha, Grahani, Arsha,Pandu Prameha, Vataroga, Grahani, Arsha, Dadru
9 2,7,9 4,6,7,9 10 9 9 6,7,8,9
2,6,7 8 8 9 2,7 2,9,10 9 2,7 2,9 6,7 2,7 7 7 7 7,9
*Vaidyajeevana (1), Bhavaprakashasamhita (2), Basvarajeeyam (3), Vyadhinigraha (4), Chamatkarachintamani (5), Yogachintamani (6), Yogaratnakara (7), Vaidyarahasya (8), Bhaishjyaratanavali (9), Sahasrayoga (10)
CONCLUSION Plants have always been an important source for finding new remedies for human diseases. Among hundreds of plants that have been studied for diabetes, only a small fraction has been tested in animal studies and is under clinical trials. The drugs described in this paper, particularly Terminalia chebula, Butea monosperma, Shilajatu and Vanga Bhasma had
some clinical evidence for their antidiabetic effects. Therefore, it seems that physicians can rely on these single drugs as well as formulation, at least as complementary therapeutics, along with current hypoglycemic drugs to improve management of diabetic patients. The observed result may be helpful in planning further scientific studies about the efficacy of these drugs on prevention as well as management of Prameha (Diabetes).
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Source of Support: NIL
Wadood N, Wadood A , Shah S A W. (1992), Effect of Tinospora cordifolia on blood glucose and total lipid levels of Normal and Alloxan-diabetic rabbits, Planta Medica. 58 (2), 131. WHO (2016), Global Report on Diabetes. Geneva, 2016. Accessed 30 August 2016. Wild S, Roglic G, Green A, Sicree R, King H (2004). "Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030". Diabetes Care. 27 (5), 1047–53
Conflict of Interest: None Declared
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