Diabetic carbuncle – Ayurvedic Understanding And Treatment Modalities

Diabetic carbuncle is called Prameha Pidaka as per Ayurveda. Prameha means urinary disorder. Pidaka refers to blisters or boils. Carbuncle is a technical term for blisters. Diabetic carbuncles (prameha pidakas) are the common complications of urinary disorders importantly Diabetes mellitus.

Features of diabetic carbuncle

Important features of Diabetic carbuncle as per Ayurveda:
The uncured or long persisting blisters with discoloured spots is the characteristic feature.

Causes

Etiological factors specified in the context of Prameha (urinary disorders) if continued further or followed excessively, 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 on the surface of the skin. They are usually elevated or discoloured in nature. Usually, they are present in muscles, joints or vital parts (such as groin, kidney, heart, head, face etc). These are known as Prameha pidakas (diabetic carbuncles).

Types

Types of Diabetic carbuncle as per Ayurveda :
Master Sushruta explained 10 types as mentioned below-

Sharavika

1. Sharavika – Sharava means disc or earthen pan in Sanskrit. The carbuncles or boils which are convex in the margins and concave (dipped) in the centre, similar to an earthen pan are termed as ‘Sharavika’. It has elevated borders and a depressed the centre, grey in colour and associated with slough and pain.

Sarshapika

2. Sarshapika – Sarshapa means mustard. Such types of boils appear similar to white coloured mustard and possess the same size too.
It is not very big, suppurates quickly, is very painful and associated with  carbuncles of the size of mustard seeds is known as Sarshapi.

Kacchapika

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 splitting type of pain; it has a very big base, it is smooth and resembles the back of the tortoise. (Kacchapa means tortoise).

Jalini

4. Jalini – Jala means mesh. The carbuncles which cause severe burning sensation and appears like anetwork of fibre occurring in the even surface of skin are termed as Jalini pidakas.
It is hard; it has a network of vessels on its surface; is sticky; it has a very big base: it is very painful with splitting type of pain having subtle openings.

Vinata

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 colour 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 colour and has a depression in the centre.

Putrini

6. Putrini – the blisters which are spread over a large surface area where small multiple blisters are found in the middle are termed as Putrini pidakas.

Masurika

7. Masurika- Masura means lentils. The blisters appear similar to lentils.

Alaji

8. Alaji – Red or white coloured vesicles which appear as if they are about to rupture and cause 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.

Vidari

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.

Vidradhi

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, exhibiting 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 food 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

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 out 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 immature, Raktamokshana (blood letting) is carried out 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 for Prameha Pidaka

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 turpethum (Linn.) Silva Manso.
Sariva – Hemidesmus indicus Schult.
Mamajjaka – Enicostemna littorale Linn

Ayurvedic formulations

Formulations used in Prameha pidaka:

1. Triphala guggulu
2. Panchatiktaghrita guggulu
3. Aragwadhadhi kashaya
4. Patola katukarohinyadi kashaya
5. Amrita guggulu
6. Swayambhuva guggulu
7. Kaishora guggulu
8. Gandhaka rasayana
9. Mamajjaka ghana vati
10. Mahatiktaka kashaya etc

Ideal diet and habits

Shigru – Moringa, drumstick
Haridra – turmeric
Amalaki – Indian gooseberry
Shyamaka – Setaria italica (L.) Beau .
Kodrava – Paspalum scrobiculatum, Linn.
Yava – barley
Godhuma – wheat
Mudga – green gram
Kulattha – horse gram
Patola – snake gourd
Karavellaka – bitter gourd
Maricha – pepper
Lashuna – garlic
Jambu – blue berry
Vyayama – exercise etc

Unwholesome diet and habits

Kanda -moola (root-rhizome)
Ikshu (sugar cane juice)
Taila (oily food)
Ghrita (ghee)
Guda (jaggery)
Kanjika / shukta (sour gruel)
Madya (alcohol)
Pishtanna (carbohydrate rich food / grain flour)
Anupa mamsa (marshy animals)
Dadhi (curd)
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 / diabetes) 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