Diabetic carbuncle is called as Prameha Pidaka as per Ayurveda. Prameha means urinary disorder. Pidaka refers to blisters or boils. Carbuncle is a technical term for the blisters. Diabetic carbuncles (prameha pidakas) are the common complications of urinary disorders importantly Diabetes mellitus.
Important features of Diabetic carbuncle as per Ayurveda:
The uncured or long persisting blisters with discolored spots is the characteric feature.
Aetiological factors specified in the context of Prameha (urinary disorders) if continued further or followed excessively, it results in Prameha pidaka.
Origin of the disease:
In case of urinary disorders, due to long persisting Dosha imbalance, the body gets deteriorated owing to vitiated Medo Dhatu (fat / adipose tissue) and Kleda (metabolic waste/moisture). Ultimately, aggravated Doshas exhibit their symptoms in the surface of the skin. They are usually elevated or discolored in nature. Usually, they are present in muscle, joints or vital parts (such as groin, kidney, heart, head, face etc). These are termed as Prameha pidakas (diabetic carbuncles).
Types of Diabetic carbuncle as per Ayurveda :
Master Sushruta explained 10 kinds types as mentioned below-
1. Sharavika- Sharava means disc or earthenn pan in Sanskrit. The carbuncles or boils which are convex in the margins and concave (dipped) in centre, similar to an earthen pan are termed as ‘Sharavika’. It has elevated in the border and depressed in the center, grey in color and associated with slough and pains.
2. Sarshapika – Sarshapa means mustard. Such types of boils appear similar to white colored mustard and possess the same size too.
It is not very big, which suppurates quickly, which is very painful and associated with carbuncles of the size of mustard seeds is known as Sarshapi.
3. Kacchapika – Kacchapa means tortoise. The carbuncles which are elevated like the tortoise shell, with rough surface and causing burning sensation are called Kacchapika kind of Prameha pidakas.
As per Charaka, it is deep seated and painful combined with a splitting type of pain; it has very big base, it is smooth and resembling the back of tortoise. (Kacchapa means tortoise).
4. Jalini – Jala means mesh. The carbuncles which are causing severe burning sensation and appearing like the network of fiber occurring in the even surface of skin are termed as Jalini pidakas.
It is hard; it has network of vessels in its surface; its sticky; it has a very big base: it is very painful with splitting type of pain having subtle openings.
5. Vinata – Word meaning of vinata is sunken or bent inside. Here, the boils are deep rooted, large, painful, moist and appear in the back and abdomen. They are blue in color and occupy larger area.
It is also deep-seated: it is associated with slough: it occurs either in the back or abdomen; it is big in size, blue in color and having depression in the center.
6. Putrini – the blisters which are spread in large surface area where small multiple blisters are found in the middle are termed as Putrini pidakas.
7. Masurika- Masura means lentils. The blisters appear similar to the lentils.
8. Alaji – Red or white colored vesicles which appear as if they are ready for rupture and causing severe pain are called ‘Alaji’ prameha pidaka.
It causes burning sensation during eruption: when fully manifested, it causes thirst, unconsciousness, fever, it always spreads and is very painful due to burning sensation like fire.
9. Vidari- ‘Vidari’ is a herb and its botanical name is Ipomea tuberosa. The carbuncles which are having the shape of the tuber of Vidari are termed as Vidari pidakas. They are usually hard and round in shape.
10. Vidradhi – The carbuncles possessing the features of abscess are called as Vidradhi pidakas.
Abscess is of two types- the external and the internal.
The external one arise out of the skin, ligaments and muscles. In shape and size it resembles tendons and it is exceedingly painful.
Charaka explains about seven types of diabetic carbuncle: Reference: Charaka Samhita Sutrasthana 17/83-89
Prognosis / Curability:
According to Ayurveda, Sharavika, Kacchapika, Jalini, Putrini and Vidarika are difficult to cure. Other five varieties namely sarshapika, masurika, Alaji, Vinata, and Vidradhi are easy to cure.
Acharya Sushuta opines that the carbuncles which are associated with severe burning sensation, spread all around with red or black discoloration, possessing the complications like thirst, hallucination, fever etc are difficult to cure.
As per Charaka –
Sarshapi, Alaji, Viinata and Vidradhi types of carbuncles are on the other hand dominated by Pitta and occur in the case of such patients who have Meas in less quantity. These are curable.
A diabetic patient who suffers from abscesses occurring in vital organs, shoulder, anus, hands, breasts, joints and feet seldom survive.
Complications of Diabetic carbuncles:
Acharya Charaka referred following features under the heading of complications:
1. Trit (severe thirst)
2. Kasa (chronic cough)
3. Mamsa sankocha (contractures/gangrene)
4. Moha (fainting)
5. Hikka (hiccough)
6. Mada (intoxication)
7. Jwara (fever)
8. Visarpa (erysipelas) and
9. Mamsarodha (infarction in vital organs or blood vessels)
Management of Diabetic carbuncles:
At first, all efforts are carried to control the particular type of Prameha (urinary disorder).
In general, matured carbuncles should be subjected to incision and drainage (patana and shodhana).
In case, if it is in immature, Raktamokshana (blood letting) is carried preferably by leech application (jaloukavacharana).
According to the dosha dominance purification also can be undertaken.
Then, Shamana Aushadha (curative medicaments) are administered internally as well as externally.
Single drugs useful in Prameha pidaka:
Nimba – Neem – Azadirachta indica A. Juss.
Guggulu – Commiphora mukul (Hook. Ex. Stocks.) Engl.
Patola – Trichosanthes dioica Roxb.
Guduchi – Tinospora cordifolia (Willd.) Miers.
Manjishta – Rubia cordifolia Linn.
Khadira – Acacia catechu Willd.
Haritaki – Terminalia chebula Retz.
Trivrit – Operculina turpathum (Linn.) Silva Manso.
Sariva – Hemidesmus indicus Schult.
Mamajjaka – Enicostemna littorale Linn
Formulations used in Prameha pidaka:
- Triphala guggulu
- Panchatiktaghrita guggulu
- Aragwadhadhi kashaya
- Patola katukarohinyadi kashaya
- Amrita guggulu
- Swayambhava guggulu
- Kaishora guggulu
- Gandhaka rasayana
- Mamajjaka ghana vati
- Mahatiktaka kashaya etc
Ideal diet and habits:
Shigru – Moringa, drumstick
Haridra – turmeric
Amalaki – Indian gooseberry
Shyamaka- Setaria italica (L.) Beau .
Kodrava- Paspalum scrobiculatum, Linn.
Unwholesome diet and habits:
Kanda -moola (root-rhizome)
Ikshu (sugar cane juice)
Pishtanna(carbohydrate rich food/grain flour)
Anupa mamsa(marshy animals)
Navanna (new grain)
Divaswapna (day sleep etc)
The subject matter discussed above shows that priority should be given in checking the disease (particular type of urinary disorder / ddiabetes) in early stage itself.
Further, diabetic carbuncles must be treated with utmost care and diet restriction becomes mandatory.
If neglected, surely irreversible loss will occur. Is it not worth to understand the graveness of the disease and act accordingly instead of undue repenting thereafter!
Article by Prof. MS Krishnamurthy and Dr Hebbar