User:Parag khatavkar/sandbox

The Role of “Jalaukavacharan” in ‘P.A.D.’ with special reference to ‘Diabetic foot’ -Prof.Dr.P.V.Khatavkar. M.D., Ph.D.(K.C.) ‘Madhumeh’ i.e. Diabetes mellitus (especially type II) is growing vastly in India. Now India is on number 1 for diabetic population. Incoming few years 50% of total worldwide diabetic patients will Indian. So it is alarm to all medical sciences- pathies to eradicate or at least to prevent this. Just like slow poisoning, this disease kills the patients very slowly, by its slowly developing hazardous complications. P.A.D. i.e. Peripheral Arterial Disease is one hazardous complications of D.M.-II, in which- blood vessels in the legs are narrowed or blocked by fatty deposits (Med? Kled?) ; which tends to decreased blood flow in legs. P.A.D. increases the risk of coronary heart disease & stroke also. Unfortunately most of the researches or treatments on this disease are pointing towards glycemic control; hypoglycemic action of various drugs, herbal or herbo-mineral compounds. Good diabetic control is mostly estimated by good glycaemic control. But it is commonly observed that in spite of good glycaemic control (may be due to hypo-glycaemic drugs or insulin); many hazardous complications are occurred in such patients. So here is the proper time to think more than hypo-glycaemic treatment. According to Ayurvedic philosophy, diabetes may be correlated with Prameh or Madhumeh. Each type of Prameh, afterall converts into Madhumeh, after some years. According to latest study on type II diabetes; at the time of diagnosis, around 50% of ß-cell function has been lost. This loss starts about 10 years or more before the diagnosis. It may be correlated with Prameh and after diagnosis, as Madhumeh. According to latest research - High level of Free Fatty Acids ( F.F.A.) is one of the causes of D.M-II. During the process of ‘lypolysis’, fats stored in fat- cells are break down producing F.F.A., which are released into blood stream & circulated throughout the body. They affect pancreas & reduce β cell’s function & create insulin resistance. They also affect liver (fatty liver?) & the normal physiology of liver- decrease in glucose-storage capacity & releases more glucose in blood. Obstruction in blood-vessels which tends to Macro & Micro Vascular diseases like P.A.D., Coronary Heart Disease, stroke, diabetic foot etc. These F.F.A. may be correlated with Kled. As both are related with fat/ med & create obstruction in blood vessels. Decreased blood flow means poor blood circulation (macro & micro, both) is the main cause of  Non Healing Ulcer i.e. NHU, & infections (widely spread); & may tends to necrosis or gangrene. The condition is known as Diabetic foot & may require amputation of that part. Nerve damage like peripheral neuritis is one of the complications of D.M; tends to decrease the touch, pain & thermal sensation & causes tingling & numbness at end parts like toes. This results into small wounds, cuts, sores, lacerations. At the same time reduced pain sensation creates the negligence at those wounds. In addition with poor blood-circulation, small & simple wounds become badly infected, deep seated, non healing ulcers. Dhatushaithilya causes muscle wasting, which tends to Claudication of foot & unequal foot pressure & then after callus formation. Due to decreased perception of pains, after some time these calluses open & tend to ulcers & become open port for infections. Such wounds easily get infected & tend to N.H.U. In short, the causes of N.H.U. are- 	Poor Glycemic Control. 	Poor Blood Circulation. 	Immuno-suppretion. 	Reduction of Pain & Thermal Sensations. 	Unequal Foot-pressure And lastly N.H.U. may convert into necrosis or gangrene formation & may require amputation of that part. Around 80% of total number of patients with leg or foot amputation is diabetic. Clinical features of diabetic foot are of 2 types- Neurogenic & Ischemic. In neurogenic type- symptoms like paraesthesia, pain, numbness & tingling & symptoms like ulcers, sepsis, abscess, osteomyelitis, and digital gangrene & Charcot arthropathy. In Ischemic type, symptoms like- rest pain & signs like- claudication, ulcers, sepsis & gangrene. Many times mixed features present. Thinking the pathogenesis according to Ayurvedic philosophy; diabetes i.e. Prameh/ Madhumeh is the disease of the Medovah Strotas “Bahudrav Shleshma Doshavisheshah” It means the main causative Dosh for Prameh is Kaph, having specific quality- excess Drava, i.e. Kledak Kaph. While main pathogen of the Prameha is Kled. It is Sookshma Mal of Dhatu- especially Med Dhatu, produced as a bi-product of Sookshma Pachan at Medovah Strotas. Kledan, which is common term, related to Dravatva. Kled- duo to its Pichchhil gun, creates Margavarodh & hence Margavarodhajanya Vataprakop; resulting poor blood circulation, Shoth & Vranadushti duo to Krimiutpatti; which tends to N.H.U. & diabetic foot. The Samprapti becomes deep seated duo to poor blood circulation, infection & Dhatushaithilya.

While thinking on the treatment part of above mentioned condition, I remembered following references- 	Avagadhe Jalaukasyat. (Su. Sha. 8/25), (A.S.Ss. 35/11)

	Grathitam Tu Jalaukabhihi. (A.S.Ss. 35/10) It means, for deep seated & stagnated Dosha, Jalaukavacharan works best. The clinical study was carried out on small group of 8 pts. 	 Randomly selected- all male patients. 	 All known diabetic & age between 50 to75 yrs. 	Number of pts. according to D/D- Foot sores- 3, P.A.D.-2, Infected Absess-2 &  Callus formation-1 pt. 	 Total period of the treatment was 3 to 5 months. Jalaukavacharan: Vidhivat Jalaukavacharan was done in each & every patient 	Vidhivat Poorvakarma of both; Jalauka & patient. 	 Approx. 1 Jalauka per sq. inch of affected area. 	During sucking, cover the Jalauka with wet gauze piece (as they respire through wet skin). 	 Vidhivat Pashchyatkarma of both; Jalauka & patient. 	 Vranakarma with Haridra Choorna, after complete stop of oozing blood automatically. 	 Repeated Jalaukavacharan- 3 to 5 times having interval of 21 to 30 days accordingly. Some internal medicine- only Ayurvedic (except anti diabetic & anti hypertensive) like- Chandraprabha, Triphala Guggul, Sookshma Triphala Aarogyavardhini, Punarnavasav, KumariAasav etc., accordingly; No allopathic medicine was used- nighters’ antibiotics nor anti-inflammatory, nor pain killers. It was observed that, the condition was much better than previous one- according to following points- Reduction in- 1) Swelling 2) Discoloration 3) Pain 4) Infection & infected                                                       slough 5) Cracks, pilling & callus. Increase in- 1) Healing process 2) Movements 3) Skin texture 4) Normal sensations of skin.                 Hence avoids the further complications like gangrene & amputation.          Conclusions: In spite of small study-group, the results are very much hopeful. Jalauka worked in all the aspects to avoid further complications like gangrene & amputation. It needs more & detail study on large group of patients, to concrete the hopeful conclusions. Jalaukavacharan might be fruitful in Macro vascular diseases also.  Tough the case study group is small the results are quite hopeful & may work as the house-light.

Prof. Dr. P. V. Khatavkar                Mobile- 08755569691; 09422865044 M.D.; Ph.D.(K.C.)-Pune University Email- pvkhatavkar.ayurved@gmail.com parag_khatavkar@yahoo.com Professor & H.O.D.in K.C. Vd. Yagya Dutt Sharma Ayurved Mahavidyalaya. Khurja, Dist: BulandShahar (U.P.), Pin-203131

N.B.- An Ayurvedic terminology is printed in bold & italic style. Abbreviations used- pt. for patient, No. for number, K.C. for Kayachikitsa, Su. for Sushrut, Sh. for Sharir Sthan, A.S. for Ashtang Sangraha, Ss for Sootra Sthan, D.M. for Diabetes Mellitus, F.F.A. for Free Fatty Acids, N.H.U. for Non Healing Ulcer.