Clinical Observation on the Adverse Effect of Panch Tikta Panch Prashritika Vasti : A Case Report

Diabetes Mellitus is metabolic disorder having bad impact on almost all the systems, organ and cells of human body, for the treatment of this disease one must plan the treatment which will correct the basic pathology, checks the complications and acts on various systems. Panchakarma therapy which is the most famous bio-purification process of Ayurveda includes Vasti treatment for the complete remedy of all the ailments. It is such a unique treatment which can correct the basic pathology. Panch tikta panch prashritika Vasti (PPP Vasti) is specifically indicated for Prameha (Diabetes). Hence this Vasti was planned in Kala Vasti schedule and dose was as per text, by this patient complained for burning micturition after analyzing ingredient of PPP Vasti, Sarshapa kalka which was used as Kalka dravya in the preparation of PPP Vasti thought to be a cause behind burning micturition. After reducing quantity of Sarshapa kalka from 40 g to 10 g burning micturition was relieved. So, the dose of sharshapa kalka is the main cause for the adverse effect of PPP Vasti. *Corresponding author: Rajeev Kumar Pandey, Department of Panchakarma, National Institute of Ayurveda, Jaipur, 302002 Rajasthan, India, Tel: 9887902143; E-mail: rajeevpanchakarma@gmail.com Received June 04, 2013; Accepted November 25, 2013; Published November 27, 2013 Citation: Pandey RK, Bhatted S (2013) Clinical Observation on the Adverse Effect of Panch Tikta Panch Prashritika Vasti: A Case Report. J Homeop Ayurv Med 2: 139. doi:10.4172/2167-1206.1000139 Copyright: © 2013 Pandey RK, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Introduction
Diabetes mellitus is a syndrome with disturbed metabolism and hereditary immune mediated involvement.The changing life style, lack of exercise, fast foods and sedentary habits, stress and tension are major reasons for causing fresh disease and aggravating an existing condition.Diabetes becomes worse with evident of life threatening complications like Neuropathy, Nephropathy, Retinopathy along with pathological changes that involves small and large vessels leading to myocardial problems and cerebrovascular accidents.
Ayurveda emphasizes on the radical treatment by the use of Panchakarma therapies, which are primarily bio-cleansing in nature and corrects the basic pathological factors involved in the disease and regularize metabolism.PPP Vasti was planned for the treatment of Madhumeha (Diabetes) and during this therapy a severe adversities were observed.

Case Report
A female subject "X" aged 40 years old, house wife, admitted in IPD (registration no.1316) in Panchakarma Department for the treatment of type II Diabetes (Sthula Prameha) in the month of June 2012.
She was obese and weighing 85 kg with BMI 37.78 kg/m 2 , having kapha-pitta Prakriti, Madhyam sara and samhanan.She was suffering from Diabetics since last one year and have associated complain of Vaginal itching, poly urea, polydipsia , heaviness of body, loss of appetite, pain in the joints, excessive perspiration, excessive sleep and lethargy.Detail of bio-chemical, haematological and urine investigations are as shown in (Tables 1 and 2) respectively.

Treatment
Panch tikta panch prashritika Vasti is specifically indicated for the treatment of Prameha [1]

Preparation of Vasti
Honey and rock salt were mixed together in the beginning followed by addition of warm ghee and thoroughly triturated.The finely wet grinded paste of Sarshapa was then added; lastly decoction was added to it.The mixture was then again triturated thoroughly.Mixture is then filtered through sieve.The filtrate so obtained was used as Vasti dravya.

Observation
For the treatment, PPP Vasti in Kala Vasti schedule was planned consisting of 16 number of Vasti in which first Vasti was Anuvasana Vasti (oil enema) followed by alternate administration of six Anuvasana and six Niruha Vasti (decoction enema) and lastly three Anuvasana Vasti were administered as shown in Table 3.
After 1 st Niruha Vasti, patient was feeling better as heaviness of body and vaginal itching was reduced.
After 2 nd Niruha Vasti, she complains for burning micturition which was further increased after 3 rd Niruha Vasti.
After analyzing ingredient of PPP Vasti, Sarshapa kalka which was used as Kalka dravya in the preparation of PPP Vasti thought to be a cause behind burning micturition.
Hence, in 4 th Niruha Vasti the dose of Sarshapa Kalka was reduced from 40 g to 10 g, on that day she got mild relief in burning micturition.
Hence, there after the same dose of Sarshapa Kalka was continued.
After 5 th Niruha Vasti, she got complete relief in burning micturition.
On reducing Sarshapa kalka symptoms of burning micturition was reduced so we confirm that Sarshapa is the causative factor for the burning micturition.

Discussion
Diabetes Mellitus is metabolic disorder having bad impact on almost all the systems, organ and cells of human body, for the treatment of this disease one must plan the treatment which will correct the basic pathology, checks the complications and acts on various systems.Vasti is such a unique treatment which can correct the basic pathology at the level of Koshtha, Dosha, Dhatu, nourish the body from head to toe and acts on various systems [3].Hence Vasti Chikitsa was planned for the treatment of Madhumeha, further to have specific effect on Madhumeha special Vasti described for Madhumeha under the name of Panch tikta Panch Prashritka Vasti was selected and administered in the schedule of Kala Vasti, in which Panch tikta Panch Prashritka Vasti was administered as Niruha Vasti and triphala siddha tila tail was used for Anuvashana Vasti, both Vasti are primarily indicated for treatment of Prameha (Madhumeha which is a type of Vataj Prameha).
After giving 2 nd PPP Niruha Vasti, patient complained of burning micturition which was increased further after 3 rd Niruha and relieved by reducing quantity of sarshapa kalka.

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Anti diabetic property:
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Conclusion
So, on the basis of above discussion, Sarshapa have anti diabetic effect may be due to its Agnideepan and Vata-Kapha Shamak properties but if used in excesses quantity it may result into Pitta Prakopa in the body due to its Tikshana and Ushna properties and that may cause burning micturition etc.This is an important observation with a clear message that Ayurvedic therapies require a careful consideration both on conventional and contemporary grounds before they can really be administered.Merely following the classical text without seeing it into the light of contemporary relevance may lead to adversities as was observed in this case or even more severe adversities.

Table 3 :
On the 5 th and 7 th day (2 nd and 3 rd Niruha Vasti day) adverse effect was noted.