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International Journal of Ayurveda
and Pharma Research

Research Article

A COMPARATIVE PLACEBO, CONTROL CLINICAL EVALUATION OF PHALATRIKADI KWATH
IN MADHUMEHA WITH SPECIAL REFERENCE TO DIABETES MELLITUS TYPE 2
Sonalika Jena1*, B.B.Khuntia2, Kamdev Das3
*1PhD scholar, 2Proffesor & HOD, PG Dept. of Kayachikitsa, Gopabandhu Ayurveda Mahavidyalaya, Puri, Odisha,
India. 3Professor, Ex-Principal, Gopabandhu Ayurveda Mahavidyalaya, Puri, Odisha, India. Received on: 18/09/2015 Revised on: 15/10/2015 Accepted on: 24/10/2015 ABSTRACT
The study was aimed to have a conceptual review of the disease Madhumeha and its treatment in
particular to the use of an herbal drug" Phalatrikadi Kwath" and to compare its efficacy with the control drug (metformin) and placebo through scientific parameters in a double blind clinical control trial. Madhumeha, also known as Diabetes Mellitus is one of the types of Vataja prameha, that has been considered as an incurable disease (Mahagada). Due to indulgence in etiological factors it results in the incomplete formation of Kapha and Meda which further proceeds downward through the channels of Mutravaha srotas and get localized at Basti mukha leading to the symptoms like Prabhoota mutrata (polyurea), Avila mutrata (tubidity of urine) etc. As the disease is Chirakari, it requires an effective treatment which can be continued for a long time without any ill effects. Among the many treatment measures mentioned, Phalatrikadi kwath has been selected in this study and the effect was evaluated. The clinical study includes 50 patients of either sex between 30-60 years of age with Madhumeha (Type2 Diabetes Mellitus) were recruited having range of blood sugar (fasting 126-180 mg/dl, postprandial sugar, 200-250 mg/dl) attending the OPD of G.A.M Puri, Odisha and were divided into three groups. Group I (30 patients) were treated with trial drug (Phalatrikadi kwatha), Group II (10 patients) were treated with control drug (Metformin) and Group III (10 patients) were treated with placebo. All the three groups were recommended with uniform classically described diet (Ahara) & regimen (Vihara). Patients were evaluated in an interval of 15 days for one month. FBS, PPBS with clinical sign & symptoms were assayed. After evaluating the total effects of the treatment, it was
observed that Phalatrikadi kwath along with diet and regimen gave satisfactory relief in comparison
to control drug (metformin)which is an established drug.
KEYWORDS: Madhumeha, Diabetes Mellitus, Diet, lifestyle, Ahara vihara, Phalatrikadi kwath.
Madhumeha, from time immemorial is acting excessive hunger etc. The mortality rate due to as a malady troubling the mankind till the present era Diabetes is high and is ranked 5th among the ten major and continues to increase in numbers and significance causes of death in India. Globally as of 2013, an as it is a multifactorial disease develops due to estimated 382 million people have diabetes worldwide, abnormal interaction of Vata dominant Tridosha with with type2 diabetes making up about 90% of the ten Dusyas[1,2]. Changing lifestyles lead to reduced cases.[5] The rising prevalence of DM is adults globally physical activity and increased obesity. Estimates of the estimated to be 150 million and figured to be double by current and future burden of diabetes are important to 2025[6]. Although the prevalence of type1 and type 2 allocate community and health resources and to DM is increasing worldwide, but the prevalence of type emphasize the role of lifestyles and encourage 2 DM is expected to increase more rapidly in future measures to counteract trends for increasing because of increasing obesity and reduced physical prevalence. Amongst the many dreadful conditions activity. The modern concept of DM implicates the arising because of modern-day living, Madhumeha, a impairment of carbohydrates (Kapha) and fat (Meda), comparable condition of Diabetes Mellitus Diabetes and protein (Mamsa) metabolism. The classical Mellitus is a metabolic disorder in which carbohydrate description had not touched the concept of insulin, but utilization is reduced and that of lipid and protein they have wider concept of Agni which includes all enhanced due to deficiency of insulin characterized by enzymes and hormones responsible for all the hyperglycemia.(4) The high blood sugar produces the metabolic activities of the body. Moreover implication symptoms of frequent urination, increased thirst, of insulin in DM has not fully succeeded in clearing the IJAPR October 2015 Vol 3 Issue 10


Sonalika Jena et al. Evaluation of Phalatrikadi Kwath in Madhumeha with Special Reference to Diabetes Mellitus Type2 doubts. Hence all Pramehas (including Madhumeha) three groups randomly Group I: - 30 patients were can be considered metabolic disorder manifested as treated with Trial drug (Phalatrikadi Kwath) in a dose physical abnormalities of urine. In spite of tremendous of 50ml twice daily 1/2hr before principal meal. (in advancement of modern system of medicine i.e., oral 12hrs interval) with 1gm of Haridra Churna (Turmeric hypoglycemic agent and insulin, till date there is no powder) and 10ml of Madhu (Honey). Group II: 10 such curative remedies owing to its complexity. And patients were treated with Control drug (metformin)- 1 still scientists are struggling to search an effective and tab (500mg) twice daily 1/2hr before principal meal harmless therapy. So to have a safe and effective (in 12hrs interval) Group III: 10 patients were treated Medicare for a long term use, Phalatrikadi Kwath[7], with placebo in a dose of 50ml twice daily 1/2hr before reverses or breaks the Samprapti is ideal for the principal meals (in 12hrs interval) with 1gm of Haridra particular disease. It is evident that the total effect of all Churna (Turmeric powder) and 10ml of honey. All the the 6 ingredients in case of the formulation rather than above 50 patients were advised with recommended the action of individual drugs plays a vital role in the classical diet regimen. The patients were registered and therapeutics; the drugs in this formulation have anti their data for demographic and clinical profile was diabetic properties as well as having Kaphahara, Pittahara and Medohara properties hence helpful in the Duration: 1 month.
Samprapti Vighatana of the disease. So to get a better management in patients of Madhumeha by palliative Type of Study: Double blind control clinical trial.
management, this clinical study is planned. Trial Drug Review
AIMS AND OBJECTIVES
Formulation of Phalatrikadi kwath
A comparative, placebo control clinical The Kwath containing six drugs Fruit of evaluation of Phalatrikadi Kwath in Madhumeha with Haritaki (Terminalia Chebula), Bibhitaki (Terminalia special reference to Diabetes Mellitus Type 2. bellarica), Amalaki (Emblica officinalis), Root of Musta MATERIALS & METHODS
(Cyperus rotundus), Stem of Daruharidra (Berberis aristata), and Root of Indrayaan mula (Citrullus Plan Protocol: Present study was done in 50 number
colocynthis), were taken in equal quantity[7]. All the of patients suffering from Madhumeha (DM Type2) individual drugs were checked for their safety profile in were selected from the OPD of Gopabandhu Ayurveda identity, quality and quantity. The individual drugs Mahavidyalaya and Hospital, following the selection were mixed and subjected to size reduction in a criteria's were finally enrolled in the study after pulverize to get coarse powder. The coarse powder thorough baseline screening. Informed consent was (Kwatha Churna) of 25gm was packed and the 14 taken from the patient before including them in the packets are sealed in a single pack. This pack can be trial. viz. Patients were selected respective of duration used for a week. The medicine was dispensed for 30 of disease (not more than 1 years chronicity) and days to all patients and advised to report after 15 days therapeutic status as per the plan protocol and interval and noted the nature of frequency and other excluding criteria. All the 50 patients were divided into symptoms of the disease. Table 1: Diet and lifestyle modification[8]
Name of Pathya Ahara (Advisable)
Apathya Ahara(non advisable)
Old barley, wheat, rice New Urad dal, Rajma, kabuli chana Bitter guard, brinjal, carrot, Lauki Potato, sea foods, cabbage, Arbi Jamun, guava, Amla some dry fruits like Fruits having high sugar content, cashew nut, almond, walnut Luke warm water, Triphala water, Amla All types of cold & sweet drinks Mustard, flax seed Ground nut oil, Til oil Milk & Milk Double toned milk Full cream milk, curd ghee, cheese Physical Exercise
The disease Prameha disappear quickly by use types of physical exercises, walking, jogging were of various physical exercises including Yogasanas, advised to do regularly according to the age, gender massage, anointing, bathing and sprinkling with the infusion of some drugs like Vijayasara. Khadira Sara Follow up: The patients were followed- up once in 15
also anointing the paste of Ushira, Dalchini, Ela, Aguru, days up to 1 month. Chandan etc destroys the disease at an early date otherwise accepting these procedures daily prevents Laboratory Investigations: Blood sugar level was
the person being affected from the disease. [7] different tested in FBS, PPBS was tested for presence of sugar. Available online at : http://ijapr.in


Int. J. Ayur. Pharma Research, 2015;3(10):71-79 The above mentioned laboratory investigations were  Pindikavestanam (Cramping in legs) carried out before and after treatment. Objective
Study Sample- Patients of either gender between 30-
Avila Mutrata (turbidity of urine) 60 years of either age, satisfying the inclusion criteria  Prabhuta Mutrata (excessive urination) were enrolled for the clinical trial. Assessment of the condition will be done based Study Settings: All the patients attending the OPD of
on detailed Performa adopting standard scoring G.A.M. & Hospital, Puri & were selected for the study. methods of subjective & objective parameters & will be Trial was started on march 2014 and completed on analyzed statistically. April 2015. Informed consent was taken from the patients before including them in the trial. The selected Statistical Assessment of Result
patients were categorized randomly. The mean value ± standard deviation (S.D) of Diagnostic Criteria: Diagnosis was made on the basis
different sign and symptoms before treatment was of classical features of Prameha with elevated blood compared with mean ± S.D after 15th (A.T1) and 30th days (A.T2) of treatment. For the purpose of the test of significance I have used unpaired ‘t' test of significance. Inclusion Criteria
The effectiveness of the trial drug, Control drug,  Willing to give consent to participate in the study. Placebo was assessed through the ‘P' value.  Age Group limit -30-60 years Severity Assessment Scales
 Sex- Both male and female For the purpose of the assessment of results I  Type of disease- Madhumeha (DM Type2) have used some grade points taking into consideration  Fasting blood sugar range- 126mg/dl-180mg/dl the different sign and symptoms as follows.  Post Prandial blood sugar range- 200mg/dl- Severity Grade points
Highly severe (++++) G4  Recently diagnosed not more than 1 year Exclusion criteria
Moderate (++) G2  Patients with severe grade blood glucose levels No sign/symptoms (-) G0  Madhumeha (DM type 2) patients with Alike other sign and symptoms polyurea, complications like Nephropathy, Neuropathy, and fasting blood sugar (FBS), and Post prandial blood sugar (PPBS) values were converted into range and  Patients with any other chronic disease that grades for statistical analysis, thus given below. would interfere with the clinical study. 1) Prabhuta Mutrata (Polyuria)
 Atherosclerosis, pregnancy, pyrexia, UTI, diabetic Frequency of urine
 Thyroid disorders 0 : 3 – 6 times per day, no or rarely at night
1 : 7 – 10 times per day, 1 – 2 times per night
lactating mothers 2 : 11– 14times per day, 3 – 4 times per night
 Any other current acute illness 3 : > 15 times per day, > 4 times per night
 Patient not willing to participate in the study or 2) Pipasa - Adhika (Polydipsia)
not in a position to give consent. Clinical features
0 : Feeling of thirst 5– 6 times/24 hours
1 : Feeling of thirst 7- 8 times/24 hours
Subjective
2 : Feeling of thirst 9 – 10 times/24 hours
Pipasa Adhikyata (Polydipsia) 3 : Feeling of thirst 11-12 times/24 hours
Khudha Adhikyata (Polyphagia) 4 : Feeling of thirst 13-14 times/24 hours
Alasyata (Lethargy) 3) Avila Mutrata (Turbidity in urine)
Atisweda (Excessive perspiration ) 0 : Crystal clear fluid
Karapada daha (Burning sensation in palms and 1 : Faintly cloudy or hazy with slight turbidity.
2 : Turbidity clearly present and newsprint
Karapada suptata (Numbness in palms and soles) easily read through test tube 3 : Newsprint not easily read through test tube
Dourbalya (Weakness) 4 : Newsprint cannot be visualized through test
Kandu (Itching)  Nidraadhikyata (Excessive sleep) IJAPR October 2015 Vol 3 Issue 10


Sonalika Jena et al. Evaluation of Phalatrikadi Kwath in Madhumeha with Special Reference to Diabetes Mellitus Type2 4) Kshudha- Adhika ( Appetite)
10) Pindikodveshtana (Cramps)
0 : As usual / routine ( 0-1 meals)
0 : No cramps
1 : Slightly increased (2 – 3meals)
1 : Cramps after walking more than 1 km.
2 : Moderately increased (4 – 5 meals )
2 : Cramps after walking ½ km
3 : Markedly increased (6 – 7 meals)
3 : Inability in walking even ½ km
5) Kara-Pada Suptata
11) Fasting blood sugar (mg/dl)
0 : No Suptata
0 : <126
1 : Kara-Pada Suptata incontinuous
1 : 127- 142
2 : Kara-Pada Suptata continuous but bearable
2 : 143- 158
3 : 159-174
3 : Kara-Pada Suptata severe & unbearable
4 : 175- 190
6) Swedadhikya (Perspiration)
12) Postprandial blood sugar (mg/dl)
0 : Sweating after some strenuous or heavy work
0 : < 200
or in hot & humid weather 1 : 201 – 216
1 : Profuse sweating after moderate work and
2 : 217 – 232
3 : 233 – 348
2 : Sweating after little extra work than routine
4 : 249 – 264
Biochemical Assessment
3 : Profuse sweating after routine work
4 : Sweating even at rest or in cold climate
It was done by assessing change in blood sugar level in fasting and postprandial state before and after 7) Daurbalya (Weakness)
0 : Can do routine exercise/work
Observation and Result
1 : Can do moderate exercise with hesitancy
2 : Can do mild exercise only, with difficulty
In this study, out of total 50 enrolled patients 3 : Cannot do mild exercise too
were enrolled who were between the age of 30-60 years it was observed that 37 (74%) were found in the 8) Alasya/Utsahahani (General Debility)
age group of 40-60 years in which males (62%) are 0 : No Alasya (doing satisfactory work with
more prone to the disease than females. Which proper vigor and in time) supports to the statement and corroborates with the 1 : Doing satisfactory work with late initiation,
outcome of the research reference that Diabetes likes to stand in comparison to walk Mellitus is a disease of middle age group which is also Doing unsatisfactory work with late prone to weight gain and now a days to overcome initiation, likes to sit in comparison to stand social burdens one has to bear utmost stress and 3 : Doing unsatisfactory work with very late
monotonous food which favors for the disease initiation, likes to lie down in comparison to condition? As regards to occupation, higher incidence among the sedentary habits (50%) was observed than 4 : Does not want to do work with no initiation,
the physically active individuals. Thus observation likes to sleep in comparison to lie down bears striking with the verse of authentic text books 9) Nidradhikya (Sleep)
that Swapna Sukham and Asaya Sukham (sedentary habits) is a major causative factor for the disease. In 0 : Normal & sound sleep for 6 – 8 hrs. /24 hrs.
consideration to socio economic status it has been with feeling of lightness observed that the maximum cases i.e., middle class, 1 : Sleep> 8 -9 hrs. /24 hrs. with slight heaviness
56% and higher economic class 36% people are more prone to the disease due to under the utmost stress & 2 : Sleep >9- 10 hrs. /24 hrs. with heaviness in
strain both socially and economically which is a the body associated with Jrimbha. predisposing factor of Madhumeha. 3 : Sleep >10 hrs. /24 hrs. with heaviness in the
body associated with Jrimbha & Tandra Table 2: Showing the pattern of causative factor (Nidan) in patients of Madhumeha (n=50)
S.No. Nidan (causative factor)
No. of patients
percentage
Asayasukham (enjoying long sitting) Swapnasukham (enjoying long sleeping) Dadhi Sevan (taking curd) Gramya, Anupa, Udaka Mamsa sevan (meat) Paya(Milk and milk products) Navanna (>1 year old cereals) Guda vikar (jagerry and its products) Available online at : http://ijapr.in


Int. J. Ayur. Pharma Research, 2015;3(10):71-79 On analyzing the Nidan sevan, habit of enjoying long sitting was found to be present in 82% patients, while taking milk & its products etc in 66% of patients, eating Mamsa (flesh) was found in 66% of patients, eating of curd was found in 23% of patients and 18% was found in the patients who were taking jagerry products, Navanna and enjoying sleeping habits. Table 3: Showing the incidence of clinical sign and symptoms among 50 Madhumeha patient
Signs & Symptoms
Prabhuta Mutrata Pipasa Adhikya Khuda Adhikya Avila Mutrata Daha & Suchikidhavat Pida 8 Dourbalya Kara- pada Suptata Utsahahani/ Alasyata Pindikaveshtam Nidradhikya Swedadhikya Table 4: Showing the percentages of the patient got improvement (on totality) of different sign and
symptoms after treatment
Group-II
Group-III
Group-II
Group-III
Prabhuta mutrata 100% Dourbalya Pindikaveshtam Pipasa adhikyata Table 5: Showing the percentages of change (improvement) to the sign & symptoms after treatment
Signs & Symptoms
Group-II
Group-III
Group-II
Group-III
Prabhuta mutrata Dourbalya Pindikaveshtam Pipasa adhikyata %=percentage Change
Table 6: Showing the Clinical Assessment of the Result
After 15 days of treatment
After 30 days of treatment
Clinical Assessment
Group III Group I
Group II Group III
75-99% (Max. improved) 50-74% (Mod. improved) 25-49% (Mild. improved) <25% (Unsatisfactory) Above clinical assessment has been made below. Clinical assessment of the result shows that, basing on the sign and symptoms along with two after 15days of treatment 3.33% of Group I, 80% in cardinals laboratory investigation. The percentage of Group II got unsatisfactory result, 36% in Group I, 30% results obtained was made into range and described in Group II and 20% in Group III got mild improvement, IJAPR October 2015 Vol 3 Issue 10


Sonalika Jena et al. Evaluation of Phalatrikadi Kwath in Madhumeha with Special Reference to Diabetes Mellitus Type2 60% in both Group I & II got moderate improvement, improvement, 23.33% in Group I and 20% in Group III 10% in Group II got maximum improvement and no got moderate improvement,70% in both Group I & II one in all the three groups got totally cure. But after 30 got maximum improvement and only 10% in Group I days of treatment, 80% in Group III got mild and 30% in Group II got totally cure. Table 7: Statistical Analysis Showing the Effectiveness of the Group-I (30 Patients), Group-II (10 Patients)
and Group- III (10 Patients) According to Sign and Symptoms
Treatment
Duration of
‘T' value (test of P- value
Symptoms
treatment in
(n-1) significance)
(Probability of
Available online at : http://ijapr.in


Int. J. Ayur. Pharma Research, 2015;3(10):71-79 From the above table it is revealed that These amyloid bodies are also responsible for unpaired test of significance shows that the apoptosis of the islet cells by two mechanisms, first by effectiveness of trial drug as compared to control drug calcium deregulation and second is mitochondrial & placebo after 30 days of treatment in case of dysfunction in the beta cells.[12] polyurea and FBS is highly significant with p value As regarding the trial drug i.e., Phalatrikadi 0.001, where as in case of weakness, muscle cramps Kwath, the 6 drugs present in it acts on the basic and polydipsia is insignificant with p value> 0.05 and in pathology of Prameha. The Triphala (Haritaki, case of PPBS the result is significant with (p Bibhitaki, Amalaki) is Kaphapitta Samak, Prameha Nasak, Deepan etc. Triphala is having Rasayan DISCUSSION
property[13]. It enhances free radicals and reduce oxidative stress and alleviate diabetic complications[19]. Madhumeha is a widely evidential disease The methanolic extract of Triphala inhibit lipid since ancient age till today and evidence is increasing peroxide formation and to scavenge hydroxyl and day by day with lips and bound with their superoxide radicals in vitro and oral administration of complications and complexes. It is known as diabetes the extract reduced the blood sugar levels in normal mellitus in modern medicine which is a metabolic and alloxan diabetic rats.[14] disorder having a deep relation with diet and lifestyle habits. The chronic nature of diabetes and its tendency Daruharidra (Berberis artistata) root extract to affect various organs and damages the organs very also have potential anti hyperglycemic and antioxidant slowly and on average reduces the life span of the effect that was found in a study done in CSIR, patient by a decade. It has been appropriately termed Lucknow[15].The extract of Daruharidra has strong as "silent killer" and some people call it ‘a disease of potential to regulate glucose homeostasis through complications'. The prevalence of this dreadful disease decreases gluconeogenesis and oxidative stress. The is almost increased due to the incorporation of fast roots of Indrayaan Mula (Citrullus colocynthis) have food, junk food, lack of physical activity etc. it is no hypoglycemic effect. As well as insulin tropic action in longer considered as a disease of rich rather it has been alloxan induced diabetic rats. Musta (Cyperus rotundus) rapidly in increasing among the poor, in the urban slum have anti diabetic effect and was found in a study that it dwellers, middle class group and even in the rural significantly lowers the blood sugar levels. This areas. It may be due to rapid changes in the physical antihyperglycemic activity can be attributed to its activity and the dietary habits even among the poorer antioxidant activity as it showed the strong DPPH sections of the society. Significant improvement was radical scavenging action in vitro[17]. Mustak is well observed following 1 month of administration of drugs known Amapachak & Deepan[9]. in all assessment parameters of Prameha. The trial drug The trial drug is considered to be fit for easy is indicated in all types of Prameha(7). Prameha is
administration having no side effect. Inspite of its bitter caused by vitiation of all the three Dosasa, i.e Vata. Pitta and astringent taste it was well tolerated accepted & and Kapha along with ten Dusyas they are Meda, Rakta, accomplish by the patients. Sukra, Jala, Vasa, Lasika, Majja, Rasa, Oja and Mamsa.(10) Physiochemical analysis demonstrated that the In its clinical feature there is increase in amount and PH is favorable for early absorption in stomach as it frequency of abnormal urine. The main cause given for remains acidic. Moreover the qualitative test reveals Prameha mainly are sedentary lifestyle and abnormal that the Kwath contains tannins, steroids. Alkaloids in food habits which is responsible for the formation of abundant. Recently tannins have received considerable Aama in the body. This Aama reduces the digestive attention as health promoting component in various power and vitiates the three Dosas in the body. This plant foods and several studies have reported on its Aama produces Aalasyata, Tandra, Hridaya Vishudhi, nutraceutical properties, the candebsed tannin extracts Dosha Pravritti, Akulmutrata, Guru Udaratva, Aruchi, showed promising antidiabeteic effects.[18] Suptata[11]. Also if we analyze the pathogenesis in modern point of view there is two types of mechanism Thus along with the trial drug, the rigid dietary responsible for the DM, that is insulin resistant and restriction and suitable physical exercise programme another is pancreatic beta cell failure. In both these helps at maximum levels. The observation recorded in causes, target tissue defect and deposition of amyloid the present study suggest that though the trial drug body are found as the main cause. These amyloid body possess hypoglycemic activity and treats the basic are found as the main cause. These amyloid bodies pathology of type2 DM and further additional studies deposit on the tissues and disrupt them physically by may be performed on this formulation to reduce the coating the channels thus causing insulin resistance(11). IJAPR October 2015 Vol 3 Issue 10 Sonalika Jena et al. Evaluation of Phalatrikadi Kwath in Madhumeha with Special Reference to Diabetes Mellitus Type2 over load of the medicine & to overcome the side 8. Charak samhita of Agnivesha by charak and effects of modern medicine. dridhbala, with introduction by shri satyanarayan CONCLUSION
Sastri, with hindi commentary by pt, kasiinath sastri and Dr.Gorakhnath chaturvedi, second part, Madhumeha is caused due to Sedentary life chaukamba bhrti academy Varanasi, reprint 2011, style, increased stress and strain, and inclusion of junk Prameha Chikitsa chapter 6, pd236, slok 20-21. and high calorie diet. The causative factor of Prameha reduces the digestive power and promotes the 9. Charak samhita of Agnivesha by charak and formation of Aama (undigested substances) which is dridhbala, with introduction by shri satyanarayan responsible for the vitiation of all the three Doshas. The Sastri, with Hindi commentary by pt, kasiinath study confirms in the pathogenesis of the disease that sastri and Dr.gorakhnath chaturvedi, second part, there is dominancy of Kapha Dosha, Medo Dusti, chaukamba bharti academy Varanasi, reprint Rasavaha and Medovaha Srotodusti. The study confirms 2011, Grahani chikitsa chapter 15, pd461, that Phalatrikadi Kwath is effective in treatment of Madhumeha as it has the property of Aama Pachana. 10. Charak samhita of agnivesha by charak and Along with this Kwath the Pathya and apathy are dridhbala, with introduction by shri satyanarayan equally important in controlling diabetes. People Sastri, with hindi commentary by pt, kasiinath between the age group of 40-60 are more prone to the sastri and Dr. gorakhnath chaturvedi, second part, disease so they should be aware of the causative factors chaukamba bharti academy Varanasi, reprint of the disease with its Pathya Apathya. Thus 2011, Prameha chikitsa chapter 6, pd229, slok8. Phalatrikadi Kwath treats the basic pathology of type 2 11. Kayachikitsa 2nd part, by prof Ram harsh singh, DM and definitely reduces the symptoms of the illness edition 2007, chukambha Sanskrit pratisthan, that include polyurea, weakness, muscle cramps, polydipsia, FBS and PPBS. 12. Westermark P.Andersson A, Westermark GT Islet amyloid polypeptide, islet amyloid, and diabetes Authors would like to acknowledge to the mellitus Physiol Rev.2011 jul;91(3):795-826. dispensing and pharmacy staff for their technical support for the study. 13. Sushrut Samhita of maharsi Sushrut, edited with REFERENCE
Ayuveda Tatva sandipika, hindi commentary by Kaviraj Ambikadutta Shastri, Chaukamba Sanskrit Agnivesha Prameha Chikitsa(2007) Acharya Trikamji jadavji. In: Charaka, et al.(Eds.), Charaka Sansthan Varanasi, reprint2010, first part, sutra Samhita Chowkhamba Prakahsan, Varanasi, sthan, 38th chapter Dravya sangrahaniya, pd 188/ 14. Sabu Mc, Kuttan r, Antidiabetic activity of Susrut Prameha nidanam(2007) Ayurveda Tattva Sandipika. Kaviraja Ambikadutta Sastri(Ed.), medicinal plants and its relationship with their antioxidant property. Amala cancer research Varanasi, India, pp.251. centre, amals Nagar, kerela Trichur 680553, India.J Ethnopharmacol. 2002 jul:81(2): 155-60. 3. Madhav nidan of Shri madhavakara, vidyotini 15. Singh j, kakkar P, Antihyperglycemic and chaukhambhasanskrit sansthan, Varanasi, 30th antioxidant effect of Berberis aristata root extract edition Uttarardha, Prameha Nidan.PP25 and its role in regulating carbohydrate metabolism in diabetic rats: J Ethnopharmacol. 4. Williams Textbook of Endocrinology (12th ed ) 2009 May 4;123(1):22-6 dol:10.1016/j.jep- 2009.02.038.Epub 2009 Mar 5. 16. Vipin Agarwal, Ashish Kumar Sharma, Ansu 5. Davidsons principles and practice of medicine, upadhya, Gopendra Singh and Rajiv Gupta. 19th edition, editor:john AA hunter, chapter 15 Hypoglycemic effects of Citrullus colocynthis Diabettis Mellitus. By B.M.Fisher, pd:655 roots. Acta Poloniae Pharmaceutica and Drug 6. Shi, yuanki; Hu frank B."The global implications of Research. Vol.69 No.1 pp.75n79, 2012 ISSN 0001- 6837.Polish Pharmaceutical Society. 17. Nishikant a Raut, naresh J Gaikwad. Antidiabetic 6736914060886-2.PMID 24910221. activity of hydro ethanolic extract of Cyperus 7. Sharangdhar Samhita of Acharya Sharandhar, rotundus in alloxan induced diabetes in rats. J jiwanprada hindi commentary by dr. Smt shailaja Fitoterapia, volume 77, issues 7-8, December Shrivastav, Chaukamba Orientalla Varanasi,forth 2006, pages 585-588. edition 2005, Madhyamkhand, chapter 2, pp152, 18. J Food.2011 may;76(4):c560-7.doi:10.1111/j. 1750-3841.2011.02116.x.Epub 2011 Apr 5, Available online at : http://ijapr.in Int. J. Ayur. Pharma Research, 2015;3(10):71-79 Antioxidant & antidiabetic properties of 19. Roja Rahimi, Shekufeh Nikfer Bagher Larijani. A condensed tannins in acetonic extract of selected review on the role of antioxidants in the raw & processed indegeneous food ingredients management of diabetes and its complications, from Kenya.kuyangaCN, Imugi JK, Okoth M, Biomedicine and pharmacotherapy, volume 59, issue 7, August 2005, pd 365-373. *Address for correspondence
Cite this article as:
Dr. Sonalika Jena
Sonalika Jena, B.B.Khuntia, Kamdev Das. A Comparative Placebo, Control Clinical Evaluation of Phalatrikadi Kwath in Madhumeha with Special Bodhi Bhavan, At-Chandmari padia Reference to Diabetes Mellitus Type2. International Journal of Ayurveda Po-Sahadevkhunta, Dist- Balasore and Pharma Research. 2015;3(10):71-79. Pin- 756001, Odisha, India Source of support: Nil, Conflict of interest: None Declared
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Annual litigation report 2004

• Counterfeiting of Cartier products restrained Cartier International B.V v Choosy corner Name of firm not determinative of its statusZuko Engineers v Ministry of Commerce & Industries • Deception/confusing similarity not found in use of 'BLACK LABEL' on beer products United Breweries Ltd. v Khodays Brewing and Infringement of Mitsubishi pen design restrained

Doi:10.1016/s0885-3924(02)00675-9

Journal of Pain and Symptom Management Vol. 25 No. 4 April 2003 Treatment of Tremors in Complex Regional Pain Syndrome Annu Navani, MD, Lynn M. Rusy, MD, Richard D. Jacobson, MD, PhD,and Steven J. Weisman, MDDepartments of Anesthesiology (A.N., L.M.R.), Neurology (R.D.J.), Anesthesiology (S.J.W.),and Pediatrics (S.J.W.), Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin, USA