Diabetic Mellitus (DM) is a most widespread disease in existence. As the civilization developed, lifestyle disorders evolved as a negative effect. Diabetes has got  a prime  place among them according to WHO, an  estimated 285  million people  of world’s adult  population, live with Diabetes Mellitus  till 2010, The  number is expected to be 438 million by 2030¹. In India alone, the prevalence of diabetes is expected to increase from 31.7 million in 2000 to 79.4 million in 2030². WHO has declared India as the “Diabetic capital of the World”³.

Neuropathy means nerve disease or damage. Diabetic Neuropathy is nerve damage by diabetes. This is of three kinds, Autonomic, Focal and Peripheral neuropathy. Diabetic peripheral neuropathy (DPN), a micro vascular complication of diabetes, is one the most common forms of neuropathic pain. Neuropathic pain⁴ as defined by the International Association for the Study of Pain,is pain initiated or caused by a primary lesion or dysfunction in the nervous system. Neuropathies are classified as symmetrical or asymmetrical (focal or multifocal) involving either the proximal or distal limb. The distal symmetrical DPN is common form, and is known by multiple names including Diabetic sensor motor peripheral neuropathy or distal symmetric diabetic peripheral neuropathy⁵. Around 3.2 million deaths every year are attributable to complication of diabetes mellitus.

Neuropathy develops in 28% to 55% of patients with diabetes mellitus⁶, The prevalence of diabetic neuropathy has been estimated as high as 62% of diabetics based on subjective complaints, 55% by signs and 100% by nerve conduction studies⁷. The prevalence of diabetic mellitus increases with time and poor glycemic control⁸, prevalence may depend impart upon patient age, which itself is a risk factor. Cigarette smoking, alcohol consumption, hypertension, height and hypercholesteromia are all considered independent risk factors for diabetic neuropathy⁹. Recent studies in patients with impaired glucose tolerance provide important insights in to the role of the degree of glucose dysmetabolism in the development of neuropathy¹⁰.

The American Academy of Family Physicians (AAFP)  reports that this is characterized by Distal, bilateral, symmetrical, loss of sensation in a “stocking – glove” pattern, affecting the longest nerves first, starting with toes and feet, and spreading towards the trunk, It usually presents with sensory symptoms, which range from numbness(“deadness”) to severe pain. Burning, alterations of temperature sensation, parathiasias, and shooting, or stabbing pains are common. Pain may worsen especially at night. And in other hand, it decreases the quality of life of the patients¹¹. These conditions are thought to result from diabetic micro vascular injury involving small blood vessels that supply nerves (Vasanervorum) in addition to the macro vascular complication that can culminate in DPN. All these are the result of metabolic derangements contributing to Hyperglycemia, which in turn causes increased production of superoxide, as a result of oxidative stress. Due to excessive production superoxide, the enzymes like superoxide dismutase etc., fail to neutralize. Thus their excess accumulation, contribute to neuronal ischemia by activating the four major pathways of hyperglycemic damage.

The direct comparison of Diabetic neuropathy is not available in Ayurvedic texts. On review of previous research works, many scholars have coined this disease by various names such asMadhumehaJanyaUpadrava, TwakgataVata, Jhinjhinivata, Vatanadi Pradhana Shotha etc., The explanation of symptoms are scattered in the Purvarupa and Upadravas ofMadhumeha.

In Prameha, the manifestation of the disease to a mild or severe form is dependant mainly on the degree ofDoshadushyaSammurchana by the Nidan¹². Madhumeha, is one of the Vataja pramaeha, which involves three Doshas andDasha Dushyas, where Chakrapani explains the involvement of all these Dushyasare seen from the initial stage of Sampraptiitself¹³.As the disease progresses the involvement of Dushyaslike Majja get evident to a greater extent. The excess of Medainvolvement in the very pathogenesis attributed to the excess increase of  Bahudrava Kapha in Madhumeaha due toGunasadharmyata¹⁴ and thereby excess Abaddhameda. Abaddhameda results in medodhatwagnimandya, which in turn leads to uttarottara dhtu¹⁵ kshaya, ie., affecting the formation of  majjadhatu. As a result, further Vataprakopa, due to excessive Dhatukshaya, which initiates the nerve injury.

DM is caused by spectrum of diverse etiologies resulting in Chronic Hyperglycemia and complication attribute to it. Principally this is a metabolic disorder with variable clinical  manifestation  and progression, majority of the cases are detected  after the manifestation of complications.

Here is an attempt to find out a suitable Ayurvedic Medicine to manage the Diabetic  polyneuropathy  Neuropathy (DPN). By keeping this in view, the present study is planned to segregate the pathology of this malady by the drugs, which possesses pramehaghna, kaphamedahara, srotoshodhana andRasayana property.

Shilajatu vataka¹⁶, prepared after giving bhavana to shilajatu, from the kashaya of kutaj, triphala, nimbi, patola, musta and sunthi. These drugs possess chhedana, medoghna, Neuro protective, Rasayana property, Mutradoshahara quality where as Gokshuradi Guggulu¹⁷ contains Gokshura and Guggulu are the main drugs possess the kaphamedahara, srotoshodhana, pramehaghna, and Rectifies the vata, hence their action in Diabetic Polyneuropathy will be clinically evaluated.