CASE 8: INFERTILITY – OBESITY – DIABETES 

BACKGROUND

31 yo female presenting for follow-up consultation for diabetes, previous cough, obesity and headaches. Client reports that since her first Ayurvedic consultation 1 month ago, the cough has completely cleared up and that her fasting sugar levels are now regularly at the range of around 6.6. She still has headaches explain location for tension headaches, which go away after a head massage. The client has also lost 4 kg in the last month (now 99.8kg). She now wants to conceive her second child.

 

HISTORY OF PRESENTING COMPLAINTS

  • 2019 client was fine, then started having high sugar levels. Managing the diabetes.
  • Since 5 months started having headaches – client thought linked to diabetes.
  • Has a bad cough. On prednisone for the cough. Every year she gets the same issue with cough.

 

  • Headaches around forehead. Tightness. Sore eyes. Pulsing feeling. Headaches go away after a head massage. Client says she has too many thoughts.

 

  • Enrolled in nursing aged care. Study. Financial and study stress.

 

PAST MEDICAL HISTORY

  • Lower section Caesarean section. Has a six year old girl. Child had fever at birth was in ICU.
  • Client put on weight since childbirth.
  • Last period 14th Bled for 6 days. No clotting. Last few moths regular. Before this irregular period and last 2-3 days.

 

  • Client is going to gym and exercising.

 

SURGICAL HISTORY

Lower section Caesarean section.

 

MEDICATIONS

  • Was on prednisolone and Clarityne. Has recently stopped these.
  • Ayuna Joint-S
  • Ayuna Revive-M
  • Ayubna Ashwaganda
  • Ayuna Tripahala
  • Vitamin D3 drops

 

FAMILY HISTORY

  • Diabetes Mellitus
  • High Blood pressure
  • Ulcers
  • High Cholesterol

 

SOCIAL HISTORY

  • Non-smoker – never smoked
  • Does not drink- tried once only

 

PHYSICAL EXAMINATION

Nadi Pariksha (Pulse Examination)

  • VP

 

Mutra Pariksha (Examination of Urine)

  • NAD

Mala Pariksha (Stool Examination)

  • Normal

Jihwa Pariksha (Tongue Examination)

  • White coating and toxin dots.

Shabda Pariksha (Voice Examination)

  • NAD

Sparsha Pariksha (Touch Examination)

  • NAD

Drik Pariksha (Eye Examination)

  • NAD

 

Akrti Pariksha (Physical Appearance Examination)

  • Obese 103 kg
  • Breathing difficulty, cough

Akruti (volume and tension of pulse)

  • Not in client notes.

 

Water intake currently less than 2 litres per day.

 

INVESTIGATION (BASED ON CURRENT CONSULTATION AFTER PANCHKARMA)

 

Prakruthi:            VP

Vikruthi:              KV

Agni:                     Imbalanced

 

Sub dosha Vata (Prana, Udana, Samana, Vyana, Apana):

Vyana vayu (involved in pathological disease processes)

 

Sub dosha Pitta (Sadhaka, Alochaka, Pachaka, Bhrajaka, Ranjaka):

 

Sub dosha Kapha (Tarpaka, Bodhaka, Kledaka, Sleshaka, Avalambaka):

Bodhaka kapha (diabetes)

Avalambhaka Kapha (overweight/obesity)

 

Dhatus (Rasa, Rakta, Mamsa, Meda, Asti, Majja, Shukra):

Rasa vruddhi (Kpaha accumulation)

Mamsa vruddhi (overweight)

Meda vruddhi (overweight, obesity, diabetes)

Meda dhatu dushti (overweight, diabetes)

 

Srotas (Annavaha {Digestive}, Pranavaha {Respiratory}, Udakavaha {Fluid}, Rasavaha, Raktavaha, Mamsavaha, Asthivaha, Majjavaha, Sukravaha, Swedavaha, Purishsvaha, Mutravaha, Manovavaha, Arthavavaha {Menstruation}, Stanyavaha {Lactation}: 

Rasa vaha sroto dushti (ama tongue coating)

Meda vaha sroto dishti (obesity, diabetes)

 

 

Prana, Tejas, Ojas:

Ojo vruddhi (diabetes), Tejo kshaya (Kapha disorders)

 

Pathway (Internal, external, middle): Middle

 

Kriyakala (Accumulation (Sanchaya); Aggravation (Prakopa); Overflow (Prasara); Relocation (Sthyana Samsraya); Manifestation (Vyakti);  Complications (Bheda): Manifestation

 

Dosha gati (Direction): Tiryag kapha, urdhava kapha

 

Purvaroopa (Prodormal Signs and symptoms): Stress headache

 

Roopa (Disease Manifest Signs and symptoms): Diabetes, Obesity

 

Ayurvedic Pathogenesis:  

Ayurvedic Pathogenesis diabetes: Maharoga (difficult to cure) (Kapha Pramehi) Tridoshaja Vyadhi, it is basically a disease with Kapha predominance.

 

A prolonged Kapha provoking diet and lifestyle habits have led to the disturbance of the digestive fire and the production of ama in the GI tract and vitiation of Kapha. The blockage of Ama in the GI tract has also led to a Vata imbalance, with Vata continuing to stimulate the digestive fire, increasing appetite, so a person eats more and more (leading to obesity). The vitiated Kapha (Bahudrava Kapha) has the similarity to characteristics of Meda, anf these interact with each other, thus allowing for the flow of loose Medas into the system. During the course of this, the vitiated Kapha further interacts with Mamsa and Kleda. The association with Mamsa produces Prameha Pidika. The association with Kleda converts the Kleda in to Mutra and the vitiated Meda and Kleda obstruct the opening of Mutravaha Srotas. They stay remain for some time and this retention for considerable duration causes Kaphaja type of Prameha (Diabetes).

 

Conventional Perspective:

Type 2 diabetes: here, insulin secretion is inadequate as patients have developed resistance to insulin. Hepatic insulin resistance leads to an inability to suppress hepatic glucose production, and peripheral insulin resistance thus impairs the peripheral glucose uptake, which gives rise to fasting and postprandial hyperglycemia. Pathogenesis is complex and incompletely understood. Long term uncontrolled hyperglycemia leads to vascular complications that affect both small and large vessels.

 

Ayurvedic herbs:

 

PRESCRIBED HERBS FOR THIS CLIENT:

  • Ayuna Joint-S 1—–1
  • Ayuna Ashwaganda 1—–1
  • Ayuna Triphala 1—2—2
  • Revive-M 1 x after breakfast

 

Take these herbs up until and including first 5 days of panchakarma. Then stop until your follow up visit, where you will receive new instructions.

 

IN ADDTION, BENEFICIAL AYURVEDIC HERBS FOR THE FOLLWING INCLUDE:

 

OVERWEIGHT/OBESITY (MEDOROGA):

Vata Pitta Balancing:  Aloe vera juice, coriander, amalaka, barley water, pippali, bhibitaki,

Vata Kapha Balancing: Aloe vera juice, coriander, amalaki, barley water, ajwain, guggulu, bhibitaki, agnimantha,  shilajat, vidanga

Pitta Vata Balancing: Aloe vera juice, coriander, amalaki, barley water, bhibitaki

Pitta Kapha Balancing: Aloe vera juice, coriander, amalaka, barley water, daruhardira, bhibitaki, gentian,

Kapha Vata Balancing: Aloe vera juice, coriander, amalaki, barley water, ajwain, pipplai, gugguli, bhibitaki, agnimantha, black pepper, vidanga

Kapha Pitta Balancing: Aloe vera juice, coriander, amalaki, barley water, dariuharidra, bhibitaki, gentian, sjhilajat

 

DIABETES (PRAMEHA):

Vata Pitta Balancing: Guduchi; Gokshura; Amalaki; Aragvadha; Bilwa; Ashwaganda;

Vata Kapha Balancing: Fenugreek; Pippali; Shilajat; Guggulu; Haritaki; Juniper berries; Amalaki; Aragvadha; Agnimantha, Madhuashini; Cinnamon

Pitta Vata Balancing: Guduchi; Gokshura; Amalaki; Aragvadha; Bilwa

Pitta Kapha Balancing: Amalaki; Gentian; Daruharidra; Aragvadha; Bitter gourd; Bilwa; Neem

Kapha Vata Balancing: Fenugreek; Pippali; Shilajat; Guggulu; Haritaki; Juniper berries; Amalaki; Aragvadha; Madhuashini; Bilwa; Cinnamon

Kapha Pitta Balancing: Amalaki; Aragvadha; Bitter gourd; Bilwa; Cinnamon (small doses)

 

 

Traditional Ayurvedic Treatment(s) for these conditions:

  • For this client, now that she is managing her sugar levels, Panchakarma treatment is now advised to help her to clear up the toxins, add in a small amount of extra weight loss, and will also form the first step in aiding conception.

 

Ayurvedic treatment approach for diabetes: Multi layered approach to both control blood sugar levels, stimulating the pancreas and preventing complications associated with DM. This is done through using diet modifications (food restriction and diet modification), , lifestyle modifications,  herbs, and Panchakarma to cleanse the system (depending on the phase of the disease and the strength of the patient).

 

Ayurvedic treatment approach for overweight/obesity: Facilitating weight loss, reduce ama and rebalancing the digestive fire, through improved diet and lifestyle practices, medicinal herbs and bodywork therapies such as dry powder or herbal paste massage, and steam sauna. Panchakarma can also be beneficial if deemed appropriate for the client.

 

 

Ayurvedic Diet for this client:

–              Client needs to be on a Kapha Vata balancing/pacifying diet, and needs to avoid all rice, wheat, sugar and milk, as well as minimise intake of white and sweet potatoes.

–              Client also needs to take no solid foods after 2.30pm each day. Instead have vegetable soups, mung dahl etc.

–              ½ hour before food drink ½ cup of buttermilk (500ml water, 1tsp yoghurt, salt, pepper and ginger and blend well).

–              Drink lemon ginger tea as much as possible.

–              This means that all the food substances should be dry and light to digest, without too much oil or fat.

–              See the general diet chart at the end of this advice form – taking into consideration any contraindicated food that are listed here.

–              In general, you need to eat on time, keep eating healthy food, eat warm food, wholefoods, cooked food, steamed veggies, boiled eggs or whites, soaked almonds, soaked walnuts. Keep aggravating spices to a minimum and do not over-spice meals. Keep food combinations and preparation methods simple and nutritious.

–              Use small amounts of ghee in cooking.

–              Upon waking: Drink a glass of warm water with 1 tsp powdered fenugreek, ginger and lemon lemon juice.

–              (Allow 6 hours between meals and snack 3 hours after a meal, and only if hungry).

 

–              AVOID: Cold foods, raw foods, leftover foods (24 hours), frozen foods, cold water, processed and packaged foods, soft drinks, alcohol, coffee, wine, high fat foods, greasy foods, potatoes.  No rice, no wheat, No sugar. No milk.

–              WATER INTAKE: Drink 2-3 litres warm water during the day. This will also help to keep system clear of toxins and help avoid constipation.

–              Use all of the five senses at mealtimes. Create a ritual of eating to bring back the sacredness of eating. Stop eating when ¾ full.

–              Eat in a pleasant environment. Eat seated. No TV, no electronic devices.

–              Eat slowly, eat with respect/reverence for what you are eating, chew thoroughly. Savour the food. This helps prevent overeating and helps to retrain the brains wrings in relationship to food.

–              Avoid excess eating (emotional eating), eating during indigestion and eating while previous meal is being digested.

 

Ayurvedic Lifestyle advice for this client:

–              Regular daily routines are essential – and stick to them.

–              Daily exercise is important (yoga, gym, swimming, walking, tai chi etc.).

–              Add in sun salutations to your daily routine, preferably early in the morning. Start on 24 and can increase slowly to 48.

–              Avoid stress.

–              Look at introducing meditation and more yoga into your lifestyle to help combat stress.

–              Consider seeing a holistic counsellor to help with the emotional issues around food and to help learn techniques to help combat and deal with stress.

 

REVIEW: Once panchakarma treatment is  completed.

 

Note: It is always advised to continue any and all prescribed conventional medicine as advised by one’s healthcare practitioner. Should one use Ayurvedic herbs alongside conventional medicines, be sure to consult with your GP and/or medical specialist and your qualified Ayurvedic practitioner about any possible drug interactions and potential side effects.