Madhumeha is one among the Vataja Prameha that has been considered as Mahagada¹. Sthoola Madhumeha is Tridoshajanya, Atisantarpanajanya, Keldaudbhajanya Vyadhi. It is Yapya vyadhi because of Saptadushya and Apara ojus involved^2,3,4.

Sthoola Madhumeha is having extensive etiological factors like improper food habits, genetic, life style etc.. Sthoola Madhumeha is of two types viz.. Avaranajanya and Dhatu kshayajanya Sthoola Madhumeha^5,6,7. On the basis of Nidana Panchaka, Avaranjanya Sthoola Madhumeha can be corelated to Non Insulin Dependent Diabetes Mellitus (NIDDM)^8,9

Diabetes Mellitus has emerged as a global health hazard and is having tremendous socio-economic impact to the individual as well as society as awhole. According to international diabetic federation (IDF) in the year 2014, worldwide about 387 million people were afflicted with Diabetes, the majority of which are aged between 40 and 59, and 80% of them live in low and middle income countries. According to a study carried out in the year 2013 by the Indian council of medical research, India has 62.4 million people with Diabetes, out of which 90% have Type II Diabetes Mellitus^10,11.

Type II Diabetes Mellitus is a heterogeneous disorder with varying prevalence among different ethnic groups. The pathophysiology of T2DM is characterized by peripheral insulin resistance, impaired regulation of hepatic glucose production and declining β-cell function, eventually leading to β-cell failure^12,13.

As Atisantarpana is pradhana nidana for Sthoola Madhumeha, Apatarpana chikitsa is pradhana chikitsa siddhanta which includes Vamana, Virechana, Basti, Shamanaushadis and Rasayana. Udvartana, Abhyanga, Swedana, Seka and many Bahirparimarjana chikitsa are few contemporary treatment modalities for Sthoola Madhumeha^14,15,16.

Udvartana having qualities like Rukshana, Lekhana, Kledahara, hence it is considered as best line of treatment for Sthoola Madhumeha^17,18.

            Panchatikta Panchaprasrutika Basti helps to manage impaired metabolic condition by impacting equilibrium state of dosha, nourishing the dhatu and maintain thereby blood sugar level^19,20,21. 

Nishamalaki Yoga with its gunas laghu, ruksha, tikta rasa, Usna veerya as well as Rasayana effect helps to treat Sthoola Madhumeha^22,23. Keeping the above protocol in mind, here in an effort is made for holistic approach towards Sthoola Madhumeha by evaluating the combined effect of shodhana karma, Bahirparimarjana chikitsa with Shamanaushadi yoga.

Hence this study is aimed to Evaluate the Combined Efficacy of Udvartana, Panchatikta Panchaprasrutika Basti and Nishamalaki Yoga in the management of Sthoola Madhumeha with special reference to Type II Diabetes Mellitus.