The traditional medical system of South Asia is recorded in a set of texts known as the ayur-veda, which translates as “life-knowledge”.
Many of the most promising herbs for the treatment of diabetes originate in the ayurvedic tradition. A genetic predisposition to insulin resistance and vulnerable pancreas, combined with millennia of agriculture, have challenged South-Asian physicians to develop a highly sophisticated response featuring life-style changes and hypoglycemic agents.
Ayurvedic physiology is a humoral system based on three humors: kapha, vata, and pita. Kapha is cold and wet. Vata is cold and dry. Pita is hot and dry. Disease is explained as an imbalace between these humors.
Ayurvedic medicine recognizes a pathological condition called madhumeha, or “Honey urine”, one of twenty identified conditions involving urinary change (prameha). Madhumeha was first described by Sushruta, c. 1000 BC.
Ayurveda identifies two types of madhumeha: kapha-predominant and vata-predominant. The kapha-predominant type, in which kapha overwhelms the other humors, is caused by indolence, laziness, overeating of cold, sweet, and oily foods, or oversleeping during the day. The vata-predominant type is caused by defective sperm or ova.
The parallel to the current biomedical model of pathophysiology is striking. Our own term, diabetes mellitus, is roughly equivalent to madhumeha, both systems deriving the name of the condition from a cardinal symptom. Kapha predominant madhumeha, caused by lifestyle factors, corresponds to our “type 2″ diabetes. Vata predominant, linked to heredity, corresponds to type 1.
Ayurvedic tradition suggests several treatments for kapha predominant madhumeha. Exercise is devided into two types, vigorous and continuous. Foods which balance kapha include barley, millet, sorghum, bitter gourd, kulattha, mung beans, fenugreek, garlic, and onion, a reccomedation that might come from a biomedically-trained nutritionist. A partial list of Ayurvedic herbs for kapha-predominant madhumeha is listed in table.
For vata predominant madhumeha, Sushruta recommends bitter foods, calorie restriction and yoga to prevent complications. He mentions Vasanta Kusumakara, a mineral preparation, and detoxification therapies.
For vata predominant madhumeha, Sushruta emphasizes the herb, Pterocarpus marsupium (Asana). Preliminary studies have shown that P. marsupium may help by regenerating pancreatic beta cells1, but Sushruta says the herb is only effective in recently diagnosed cases. Peterocarpus also has hypoglycemic effects.
Pterocarpus marsupium is traditionally administered in a unique way. A wooden bowl is made from the bark of the tree. Every night it is filled with boiling water and placed under the patient’s bed. In the morning the patient drinks the water, now rich in chemical constituents absorbed from the bowl.
This traditional knowledge acquires a new significance in modern India. India today is in a rapid transition from an active agricultural village lifestyle to a sedentary urbanized economy. Given South-Asians’ hereditary predisposition to metabolic syndrome, diabetes rates are skyrocketing. The prevalence of diabetes in India is over 12%. It is estimated that there are 30 million diabetics in India today3. The overburdened healthcare system has difficulty providing means of glycemic control to the millions of patients. This failure today may lead to a future onslaught of complications, particularly cardiovascular complications, which further challenge the resources of the Indian health-care system.
Thinking about how India can meet this health-care challenge, I am reminded of Gandhi’s teachings about economic independence. He taught Indians that they could achieve economic independence by creating their own salt, textiles, and medicines, rather than importing manufactured versions. Perhaps India can meet the economic challenge of rising metabolic syndrome by reviving local health technology. The life-style prescriptions and hypoglycemic agents developed by Indians down through the centuries could be an economical answer to the health challenge inherent in economic development.
Response to Ernst
Ernst makes several valid and important points regarding complementary and alternative medicine (CAM) use . The benefit/risk ratio of CAM therapies should be evaluated in the same way that conventional therapies are. Patients often lack appropriate education to make these choices. Advice from untrained retail staff is often unreliable. The popular media often provides unsatisfactory coverage of health care issues.
However, through the use of anecdote, selective use of data, and oversimplification, Ernst reaches some unfounded conclusions. Consider that it would be easy to construct a similarly misleading portrayal of conventional medicine by focusing on the alarming rate of adverse drug reactions (the fourth leading cause of death in the USA) and ignoring conventional medicine’s great benefits.
Significantly, Ernst dismisses the potential benefits of CAM therapies in diabetic care. Implicitly, CAM therapies have not enjoyed the scientific attention conventional treatments have received. Increasingly, however, CAM therapies suggested for diabetes have been the subject of encouraging preliminary research into their efficacy, mechanisms of action, and safety. Each therapy should be rigorously evaluated using all available evidence, not dismissed collectively.
Ernst’s commentary bears a discouragingly hostile tone. The great majority of health care providers, be they alternative or conventional, are committed to serving their patients. Patients navigate a complex and shifting healthcare system to the best of their ability. Let all medical professionals strive to cultivate a cooperative relationship with their peers, respect their patients, and maintain an objective approach to medical science.