Udgharshana (an Ayurvedic therapeutic intervention) in improving vibration perception threshold in diabetic distal symmetric polyneuropathy: An observation

Abstract

Diabetic Distal Symmetrical Polyneuropathy (DSPN), affects the sensation of vibration, a major risk factor for diabetic foot ulcers that raises the likelihood of lower limb amputation among the diabetic population. The effectiveness of existing therapeutic approaches in its management is limited, necessitating exploring alternative therapy approaches. A 61-year-old female, a known Type 2 Diabetic for five years, presented with complaints of numbness and tingling sensation in bilateral lower limbs below the knee joint associated with aching pain in the bilateral foot region for the last two years. On assessment, she was found to be positive on the Michigan Neuropathy Screening Instrument that indicates the probable diagnosis of diabetic DSPN. The patient was treated with an Ayurvedic topical therapeutic intervention, Udgharshana (~therapeutic coarse powder massage) with a combination of Triphala (~a polyherbal Ayurvedic formulation) powder and Dhanyamla (~fermented sour liquid prepared from gruel of husked grains). Improvement in clinical features was observed on Neuropathy Total Symptom Score-6 and in Semmes-Weinstein monofilament reading in the bilateral foot (right 7/10 vs. 9/10 and left 7/10-10/10). The intervention also improved the vibration perception threshold bilaterally (right 31.5V vs. 20.1V; left 30.5V vs. 22.8V). Inferring the observations, it is suggested that early disease management of diabetic DSPN with Ayurveda might arrest further disease progression and help in reversing the pathogenesis, with a positive effect on improving vibration perception threshold.