Critical Analysis of Shilajatu in Diabetic Peripheral Neuropathy – A Review Article

Introduction

Neuropathies are among the most prevalent longterm complications of diabetes, affecting up to 50% of patients. Distal symmetrical polyneuropathy (DSPN) is the most common form, accounting for 75% of diabetic neuropathy cases. Diabetic neuropathy (DN) is a frequently occurring disorder, defined as the signs and symptoms of peripheral nerve dysfunction in a patient with diabetes mellitus (DM), where other causes of peripheral nerve dysfunction have been excluded. Diabetic neuropathy is the most common complication of diabetes, with a prevalence of 45-50% compared to 25 30% for retinopathy and 20% for nephropathy. National or population-based studies on diabetic complications are scarce in India. Long-standing peripheral neuropathic pain associated with peripheral neuropathy occurs in one in six people with diabetes. Systematic studies have established that peripheral nerve pathology in diabetic patients is characterised by progressive nerve fibre loss with a pan-modal fibre size pattern. In particular, the nerve fibre degeneration is length dependent and conspicuous in the distal portion. It has recently been shown that tiny fibres are preferentially affected in the early stages of diabetic patients, followed by the involvement of large f ibres related to reduced nerve conduction velocity or decreased vibration threshold.¹

Peripheral nervous system cannot be compared to any particular structural component in Ayurveda. However, the Prakruta-Vikrutha Karmas of Vatadosha provide a sufficient explanation for both the healthy and pathological symptoms of the peripheral nervous system, respectively.

Vata in its balanced and unvitiated state controls Chesta or motor and reflex activities and results in Akshanaam patavam, or intact sensory capabilities.² Vata is Sookshma, Swayambhu and Sarvagata. Although Vata is Avyaktha, Vata karmas  are Vyaktha.³ These qualities of Vata dosha can be compared with that of a nerve impulse. A nerve impulse is invisible, self-originated and self-propagated. Vata dosha functions as a receptor and stimulant. According to Acharya Charaka, without Vata's stimulation, all Dhathus, Malas and Pitta-kapha dosha are incapable of carrying out their functions and might be regarded as Pangu. At the same time, Vata acts as a receptor receiving the stimulation from external environment. A nerve impulse can act as a stimulator and receptor as well. Efferent nerve fibres transmitting impulses from CNS to rest of the body stimulates the muscles to contract and   glands to secrete hormones, while afferent nerve fibres conveying impulses from periphery to CNS act as a receptor for external stimuli like touch, temperature, pressure.

Diabetic Peripheral Neuropathy - Ayurvedic Under standing

Diabetic symptoms can be recognized by characteristics such as, Karapadadaha (burning sensation), Cumcumayana (tingling sensation) and Suptata (numbness), which are observed in Prameha at any point during the disease's Purvarupa (prodromal), Rupa (sign and symptom) or Upadrava (complication stages). Apart from the conditions like Padadaha, Padasupti, Padaharsha, Twak gatavata and Raktaavrita vata, Mamsavrita  lakshanas, Vyanarita vata, Pittavrita prana, Pittavrita vyana, Pittavrita samana, Kapavrita vata coincide well with the symptomatology of diabetic peripheral neuropathy (DPN). DPN is often regarded as Madhumeha janya upadrava for the following reasons:

a)Diabetes mellitus is comparable to Madhumeha due to ‘Madhu sama mootra’ (Glycosuria) and its Asadhyatwam. Hence DPN which is the earliest complication of diabetes mellitus is to be considered as its Upadrava.

b) Vata predominance observed in clinical spectrum of DPN marks its probable  relation to Madhumeha which is a Vataja prameha.

Shilajatu belongs to Maharasa and is a herbo-mineral compound. Shila and Jatu are the two terms that make up the term Shilajatu. Jatu indicates blackish-brown material, while Shila means rock. On hot, sunny days, Shilajatu is an exudation from rocks. India is the first country to emphasize immense medicinal significance of Shilajatu for many centuries BC, even though it may occur in many regions across the world. It states that even Asadhya vyadhi (non-curable illnesses) can be healed by Shodhita Shilajatu following bhavana, which is the addition of drug ingredients in the form of watery extract, etc. According to Dr. H. C. Sen, Shilajatu should be widely used in the treatment of obesity, diabetes, dyspepsia, anasarca, liver and spleen enlargements, bleeding piles, and asthma.

Aim and Objectives

This article critically analyse the effect of Shilajatu on diabetic peripheral neuropathy.

Information regarding DPN and Shilajatu was collected from various classical Ayurvedic text books, articles and research papers from journals.

Shilajatu

Shilajatu has been known to mankind since time immemorial. The detail description of Shilajatu, its sources, method of purification and therapeutic properties are available right from Samhita period. In Charaka Samhita and Sushruta Samhita, Shilajatu is explained in Karaprateechiyam Rasayanapaadam and Chikitsasthana Madhumeha Chikitsa, respectively. In Astanga Hrudaya,  Shilajatu is explained in Uttarasthana chapter as Rasayana vidhi.

Types of Shilajatu

There are four types of Shilajatu: Swarna, Rajata, Tamra, Lohaja in Charaka Samhita,Sushruta Samhita,and Astanga Hrudaya has added other two, Naga, Vanga.^5,6,7

Importance of Shodhana of Shilajatu

Shodhana means purification. Shilajatu is to be utilized therapeutically, and the contaminants that are accumulated by interaction with metals, dirt, and water must be eliminated.

The main intention and advantages of drug processing are:

1. To purify the drug.

2. To enhance and restore the therapeutic property of drug.

3. To make drug easily digestible, absorbable and adaptable to body.

4. To add properties of drugs intended for specific action by Bhavana, Kshalana Prakshepana.

Indications of Shilajatu

Shilajatu was indicated in various diseases such as Shotha, Pandu, Kshaya, Shwasa, Philavruddhi, Jwara, Agnimaandhya, Apasmara, Unmada, Udara roga, Arshas, Mutrkrichra, Prameha, Ashmari, Kusta, Gulma, Vatarakta.¹³

Dose / Matra

The dose of Shilajatu can be divided as, Aushadha matra and Rasayana matra.

Aaushada matra

Rasa Tarangini:¹⁴ 2-8 Ratti (250 mg to 1 g), Rasa chikitsa¹⁵ - 2 tola (24 g)

Pathya-apathya

Pathya - Rain water, water from well, water from fountains.¹⁶

Apathya - Ahara - Vidhahi, Mamsa, Matsya, Madhya, Guru, Atiamla, more - Guda, salt, oil. Kapota mamsa, Kulattha.¹⁷

Vihara - Ativyayama, Atiatapa sevana, Atimaruta sevana, awakening at night time, sleeping in day time, Vegadharana, Stree prasanga, Manasika santapa

Pathya and Apathya should be followed not just during the treatment, but also double the time period preceding the treatment.¹⁸

For Meha rogi, Shali anna with Jangala mamsa is advised after the digestion of Shilajatu to prevent from Vataprakopa, as Shilajatu exhibits Shoshana and Chedana properties.

Discussion

Concept of administration of Shilajatu over DPN

Shilajatu (asphaltum) has Madhura-tikta rasa, Laghu yoghavahi guna, Katuvipaka and Ushna veerya. It is Kapha-vatahara having Chedana, Medhohara, Mehahara and Rasayana actions.

Action of Shilajatu in DPN can be explained in two ways

1. Shoshana and Chedana properties of Shilajatu helps in the removal of excessive Medodhatu which is the first Dushya affected in the Samprapti of Medodhatu. Neuropathic features are explained in Prameha purvarupa. In Madhumeha sthanasamshraya of Prakupita, Kapha dosha occurs at Medodhatu level. By the virtue of above said properties of Shilajatu, the Khavaigunya of Medovaha srotas and Dushti in Medodhatu can be corrected. Even in modern science, peripheral resistance due to excessive fat deposition is the first pathology in diabetes mellitus type 2. Shilajatu is proven to be effective in the reduction of lipids as well as in the management of obesity. Neuropathic symptoms are predominantly caused due to Prakupita pitta and Vata. Although the Doshic origin of the disease is Kapha predominant, equal importance should be given for Pitta and Vata doshas for effective management of the condition. Shilajatu with its Madhura tikta rasa pacifies Prakupita pitta and promotes Rakta prasadana. This may be beneficial in treating the burning sensation.

2. Shilajatu is explained as a prime Rasayana dravya in the management of Avruta vata. Guru-sheeta guna, Tikta madhura rasa, Sheeta veerya, etc., may be helpful in removing the Pitta avarana and thus bringing Vatadosha to its normalcy. Thus, the Pitta-vata shamaka property of Shilajatu is effective in correcting the vascular and neurological pathologies involved in DPN.

Shilajatu is a bituminous material made out of a compact mass of vegetable matter with vegeable fibers scattered over a dark, crimson, sticky matrix. Fulvic acid, dibenzo-alpha-pyrones, and dibenzo-alpha-pyrone chromoproteins are the active ingredients in Shilajatu. Pharmacological actions of Shilajatu include, antiaging (promotes the formation of new cells), nutritive (maintain and nourishes cell life), antioxidant, immunomodulatory, anti-inflammatory, and adaptogenic properties.¹⁹

Pharmacological actions of Shilajatu²⁰

Anti-inflammatory

Shilajatu has strong anti-inflammatory properties. It had demonstrated a 77% reduction in acute, chemically induced oedema. Additionally, the antioxidant qualities aid in reducing inflammation. When taken orally, Shilajatu (50 mg/kg) significantly reduced inflammation in response to Carrageenan induced pedal oedema.

Analgesic

The antioxidant and anti-inflammatory qualities aid in reducing and relieving joint pain and inflammation. Additionally, the impact on brain’s neurotransmitters appear to alleviate joint discomfort.

For Prameha and Madhumeha (diabetes), it is regarded as the best Naimittika (specific) rasayana. According to Acharya Charaka, Shilajatu has the following qualities: Kashaya (astringent), Tikta (bitter) rasa (taste), Sheeta virya (cold potency), Vrishya (aphrodisiac), Balya (strength promoting), Mutrala (diuretic), Lekhana (scraping), Yogavahi (bio-availability enhancer) and Rasayana properties. Shilajatu has been shown to have antioxidant  properties. Resonance stabilized soft-spin semiquinone free radicals which make up processed Shilajatu, have been demonstrated to have antioxidant and free radical scavenging properties against SO₃- and OH radicals, as well as paramagnetic nitric oxide (NO). Additionally, it has been reported that Andean Shilajatu in Chile has demonstrated an Oxygen Radical Absorbance Capacity (ORAC) index of 50 to 500 Trolox units/g of material, which is significantly greater than that of noni and blueberries. Shilajatu appears to be a potent antioxidant phyto-complex in this regard. Shilajtu possesses anti-inflammatory qualities according to a study. It has been demonstrated that Shilajatu can lessen inflammation caused by Carrageenan in rats, including granuloma pouch and pedal oedema. It has strong nootropic and antioxidant properties. Charaka Samhita recommends Shilajatu as a cure for almost every human ailment. Its active  ingredients quickly neutralizes toxins, restores electrical balance and regenerates cells, while delaying the deterioration of vital nutrients.

Conclusion

Shilajatu, as described in classical Ayurvedic literature and substantiated by modern research, plays a significant role in the management of Madhumeha due to its multifaceted pharmacological actions. Its Rasayana and Lekhana properties help rejuvenate Dhatus and reduce excessive Meda (fat). Shilajatu possesses the ability to eliminate Avarana, has Srotoshodana, Rasayana properties, and is rich in antioxidants, anti-inflammatory agents, immunomodulatory, chelating compounds, and memory-enhancing properties, and fluvic acid. These qualities help in promoting nerve cell regeneration and reduce the risk of degeneration. Thus it is beneficial in managing diabetic peripheral neuropathy.

Conflict of Interest

There are no conflicts of interest