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INDIGENOUS FOODS IN THE TREATMENT OF DIABETES MELLITUS
G SUBBULAKSHMI,* MRIDULA NAIK**
Department of *Post Graduate Studies and **Research in Home Science, SNDT Women’s University, Juhu, Mumbai - 400 049.
The term diabetes mellitus was recognized as ‘Madhumeha’ in primeval times. Our ancient Hindu Physicians had mastered the science of managing this disorder with effective balance of ‘Aushada’ some herbs or plant food sources) as medicine, ‘Ahar’ (Pathyam) in modern terms therapeutic diets and ‘Vihar’ (exercise). Those indigenous food alone may not be as effective as insulin in lowering the blood sugar but the combination therapy seem to equate with the modern methods of drug, diet and exercise. However, down the line, in the quest of advancement the indigenous food therapy is extinguishing. This article throws light on the possibilities of using those as supportive to allopathic treatment if scientifically proved effective.
It is not too distant past, a variety of small medical emergencies and ailments were surprisingly effectively controlled and cured by the elders in our families through application of home remedies. They had their own valued recipes passed down from one generation to another, for treating a wide array of health problems - from cough and cold to asthma and diabetes. A bruise ointment, a variety of brews for cold and fevers, pain relief balms, antiseptic lotions, growth tonics were all made at home from commonly available herbs and minerals. Happily, in spite of capsule cures being available, the last few years have seen a growing revival of interest in natural cures and home remedies. Common sense and simple treatments developed through generations of observations, once discarded, are being examined and investigated afresh. The undesirable side effects of certain drugs have unnerved the patients. Furthermore, the population living below the poverty line is not able to afford the exorbitant cost of drugs and thus rely on herbal medicines, Ayurveda, Unani and Siddha which were neglected for centuries and which have now been given a new life.
Mankind has a long history in the use of herbal medicines. Rigveda and Ayurveda (4500-1600 BC) reveal that ancient Indians had a rich knowledge of the use of medicinal plants. India unquestionably occupies the topmost position in the use of herbal drugs since ancient times utilizing nearly 600 plant species in different formulations. Great majorities of people in India have been depending on crude drugs for the treatment of various diseases as evidenced from well-documented indigenous system of medicines, Ayurveda and Unani. The Materia Medica of these systems contains a rich heritage of indigenous herbal drugs. [1]
Traditional Medicines Today
The role of traditional medicines in the solution of health problems is invaluable on a global level. This is all the more striking when we consider the fact that approximately 80% of the people living in less developed countries rely exclusively on traditional medicine for their health care needs.2 Traditional Indian and Ayurvedic medical system for example, have been evolved during thousands of years and have left for posterity a well documented literary legacy which permits us to recognize immediately a theoretical base whose conceptual framework even if were more or less archaic is found to be logical. In other countries the ethnomedical heritage has not reached a high status. However, many useful points can still be found in them.
The sources, which support the popular pharmacopoeia, are raw materials of vegetable, animal and mineral origin. However, the most important therapeutic resource is that of vegetable origin. They are qualitatively and quantitatively superior to the other two. Often impregnated with contradictory religious creeds we find plants used as proper medicines, food and no less importantly plants used in religious rituals acknowledged as ‘placebo’ or those used in ‘baths’. The last two specifically plants as ‘foods’ are not considered by scholars in their truthful magnitude and they are relegated to the background unfortunately. Well documented is the hot-cold dichotomy at least in relation to plants considered in such manner. There is abundant data on the role of wind, hot, humidity and cold in the genesis of many afflictions. In general, the plants are used fresh, mainly as decoction, even though the plant has therapeutically active volatile components. [3]
The rich cultural reservoir of traditional Indian medicine is supported by diverse cultural sources, which have to be evaluated fully. It represents the people. The popular therapeutic habits and successes have to be retrieved and validated in order to use this information to develop new cost-effective, safe and efficacious system of medicines. A national congress on traditional sciences and technologies of India during 1993 was organized specifically to comprehend and evaluate our traditions in diverse domains of knowledge and practice. This was considered an important issue in our developmental efforts at the grass-root levels, as many of these living traditions still have the potential to contribute to the physical well being of our people. [4]
Ancient Concepts of Diabetes
A study of ancient literature indicates that diabetes was fairly well known and well conceived as an entity in ancient India. The knowledge of the system of diabetes mellitus, as the history reveals, existed with the Indians since prehistoric age. Its earliest reference (1000 BC in the Ayurvedic literature) is found in mythological form where it is said to have originated by eating Havisha, [5] a special food which used to be offered at the times of yagna organized by Dakshaprajapati. The disease was known as ‘Asrava’ during vedic era (6000 BC) and a detailed description of it is available in Brahattrai viz. Charak Samhita, Sushruta Samhita and Vagbhatta. Asthanga Haridaya (600 AD) is the first medical treatise in which one gets clear definition of madhumeha/diabetes mellitus by mentioning glycosuria (madhviv mehati-honey like urine). The word Prameha (diabetes) is derived from the root ‘miha sechane’ meaning watering. In reference to disease of human beings, it may have a meaning of passing urine, qualified by prefix ‘pra’ meaning excess in both frequency and quantity. (Prameha = Pra (excessive + Meha (Urination)). [6] This derivation of word is again substantiated when the clinical features of ‘Prameha‘ are described as ‘prabhuta-mutrata and Avil mutrata‘ [7,8] i.e. excessive urination with increased turbidity of urine. Also discussed by ancient Hindu physicians like Charaka, Shushruta, Vagbhata etc. as ‘Madhumeha’ (Honey urine), diabetes mellitus is :
"Mudhura Yachch Mehesu Proyo Madhvint Maihati"
"Sarve Api Madhumehachya Madhuyachchi Manorath" [9]
It means, ‘Madhumeha‘ is a disease in which a patient passes sweet urine and exhibits sweetness all over the body i.e. in sweat, mucus, breath, blood etc. The ancient Hindu physicians knew of the fact that the urine of a Madhumeha Patient tastes sweet. They have recorded in their observations that, - ‘if too many ants swarm around a spot of urine, one can state that Prameha (diabetes) of any variety, if neglected will finally lead to ‘Madhumeha‘ and in due course become incurable. [10] The whole description of prameha from the aetiology, pathogenesis, clinical features, complications and management all look to be comparable withthe syndrome of diabetes mellitus as known in modern medicine.
Classifications of Prameha
Prameha i.e. diabetes mellitus in Ayurvedic literature has been studied extensively and classified under several classes depending upon its aetiology, constitution, management, and therapy. Aetiological classification describes diabetes as either i) Sahaj of genetic origin with lean, thin and emaciated physical state (IDDM) or ii) Apathyanimittaja of dietary irregularities, lack of exercise (NIDDM). [11] Charaka [12,13] has categorized Prameha according to doshik prakritis (viz. vataja, pittaja and kaphaja) and also by its prognosis. The later involving three types as sadhya (curable), yapya (pliable) and asadhya (incurable). It [14] also emphasizes constitutional and managerial differences. Sthula/balvan (obese) patient needs Sodhana therapy (weight control) and Krisha paridurbala (asthenic) patient requires Brimhana therapy to provide him strength.
Prognosis of Prameha
Aetiological factors that play role in the diseases are now fairly known and it is almost decided that it is the resultant of the interaction of multiple aetiological factors. It is the prime duty of a physician to detect the nidan and adopt appropriate chikitsa. A proper diagnosis form the basis for proper treatment where the ignorance of the disease or improper diagnosis leads to haphazard or ineffective treatment. The approach of Indian medicine towards the aetiopathogenesis of prameha is little different from that prevalent in modern medicines. Of course, many of the new concepts are very much akin to them. Even 3000 years back our ancient physicians were capable of diagnosing diseases by their foresight just as they were knowing the role of "Beeja Dosha" (genetic origin) in causation of prameha what one calls as the genetic theory of today. The prognostic study [15] on the basis of insulin level revealed that there is relative hyperinsulinism in kaphaj prameha, relative hypoinsulinism in pittaj prameha and relative ainsulinism in vataj prameha. Thus the prognosis will be better in kaphaj prameha in comparison to pittaj and vataj. The prognosis of pittaj prameha will be good in comparison to kaphaj and pittaj and the prognosis of vataj prameha will be poor in comparison to kaphaj and pittaj and may require insulin therapy for the control of hyperglycaemia. In the text it has been mentioned that the kaphaj prameha is sadhya, pittaj and vataj prameha is yapya and Asadhya respectively.
Concept of ‘Pathyam‘
Very often, traditional medicinal systems are criticized for the strict dietary restrictions. Many patients may not be inclined to embrace this therapy, thinking that they will have to observe strict ‘Pathyam’. In Ayurveda, ‘Pathyam‘ is defined as :
"Pathi Hitam Pathyam"
It means ‘pathya‘ is one which is beneficial to the path/channels. ‘Pathyam‘ includes those factors, which do not adversely affect the body as well as mind, and which are favourable to maintain good health. ‘Pathyam’ includes specific foods and drugs (from natural sources) which are beneficial and are in accordance with the functioning of body channels or pathways through which they pass. The chronic disease, ‘diabetes’, can be controlled by giving comprehensive attention to three aspects i.e. Ausadha (medicine), Aahar (diet and Vihar (exercise). [16] Interestingly, the modern medical scientists are also following the above three fold approach, though the traditional system is criticized. The discovery of medicines like oral hypoglycaemic agents and insulin have been controlling the diabetes, to a big extent, but still the role of Aahar (diet) and Vihar (exercise) cannot be underrated.
In Ayurveda, ‘Yoga‘ is explained as an outstanding tradition of health care. As it is called as ‘sarvanga sadhana‘ (exercising whole body andmind, it is an essential aspect in the treatment of Madhumeha. At metabolic, level, physical exercise and relaxation exercise are used to stimulate the inner organs, to improve flexibility, stamina and power of forbearance. [5] Jain et al [17] , Sahay [18] , and Sahaya et al [19] have reported that yoga therapy is of special use in reverting the typical hyperglycaemic conditions, while some ‘Asanas‘ have proved to be helpful to revitalize the pancreas by localized stretch and relaxation inherent in these postures effectively. ‘Asanas‘ like ‘Bhujangasan‘ ‘Shalabhasan‘, ‘Ardhamatsyandriyasan‘ are believed to be effective.
Dietary Management in madhumeha
Ayurvedic antidiabetic herbs improve digestive power, increasing one of the Rasas (gastric secretions); being Laghu, gets easily digested in the body; and being Ruksha, decreases output of overall body fluids e.g. urine, sweat etc. "Ushna virya" helps further to decrease ‘Kapha’ in the body and also to alleviate burning sensation in all extremities. Katu veepaka helps improve digestion and also has ‘Medaghna‘ property. [20] Thus use of food items which are ‘madhumehaghna‘ (antidote) is an important underlying principle of therapy for the prameha patient. Food items which try to correct the metabolic imbalance by their action e.g. foods exhibiting ‘rasa‘, ‘katu‘, ‘laghu‘, ‘medaghna‘, properties. Foods included are old cereals, roasted cereals, barley, jawar, ragi, mung dal, horsegram, tur dal, drumstick leaves, bittergourd, jamun, amla, fig, raw papaya, milk, meat of animals who live in dry region etc. The Aahar dravyas as described in ayurvedic samhitas covering all the food groups are given in Tables 1 and 2.
TABLE 1
Pathya Aahar as described in Samhitas, covering all food groupsS. No. Aahar Group Name of Pathyaahar 1. Cereals Yava (barley - LN = Chenopodium album)(Charaka gave more stress on this food) Godhuma (wheat), Shyamaka, kodrava, bajra 2. Pulses Chanaka (gram), Adhaki, mudga (green gram) 3. Vegetable Tikta Shakas - Nimba - LN = Azadirachta indica, Sarshap - (mustard) - LN = Brassica camprestris, methika - LN = Trigonella Foenum Graecum, Karabelak - LN = Momordica charantia, Kulaka - (patola) - LN = Trichosanthas anguina, Sobhanjana - LN = Mringa Pterygosparma, Karkotaka = LN Momordica, Udumbara - LN = Ficus racemosa, Rasona - (garlic) - LN = Allium Sativam, Kadali - (plantain) = Musa paradisiaca 4. Fruits Jambu (black berry) - LN = Syzygium cumini, Talaphala - LN = Borassus Flabellifer, Kharjura (wild date) - LN = Phoenix sylvestris, Timduka - LN = Disospyros embrayoptesis 5. Seeds Kamala (lotus) LN = Nelumbo nucifera, Utpala (foxnut) LN = Nymphoea stellata 6. Flesh Harina (deer flesh), Shashaka (rabit), Birds like : Kapota, Titira, Lavaka 7. Liquids Old sura (old wine) 8. Oils Sarashapa, Danti - LN = Baliospermum montanum, Ingudi - LN = Balanitis aegyotiaca, best for vatik and kaphaj prameha. Ghrita (ghee) may be used in Pittaja Prameha; ghritta antaila in sannipatika prameha 9. Exercise Paribhraman, Exposure to Sun, wrestling Source : Acharya et al (1996)
Food choices according to doshik prakriti for a diabetic patientKapha dosha Pitta dosha Yava, Chana, Mudga, kulatha, karvellak, eranda karati, sovanjan patola, ladies, finger, methika shak, Takra ,Amaki, Usnodak Yava, godhuma, mudga, , adhaki, masura, , kusmanda, karvellak, kadali,amalaki, tumbi, karkati, ,uruntak, skimmed milk, curd, apple, methika, sarsupa shak, kukuta mamsa (chicken) Source : Acharya et al, 1996
The indigenous diet may not be useful in lowering the blood sugar to the same extent as insulin and other hypoglycaemic agent. But it has some other influences, which may be useful for the management of the disease and its complications. In practice use of juices of bitter gourd, decoction of chiraita, neem leaves, betel leaves, fenugreekseeds and sada bahar flowers achieve 10-20% lowering of blood glucose. It is thus advised to allow such remedial measures as supplement to other modes of therapy. Acharya et al [20] have reported that the Aahar chikitsa (dietary management) is highly effective in early onset of diseases and in case of kapha dosha predominant non-insulin dependent diabetes mellitus (NIDDM). Dietary management is a supportive/accessory treatment for vata dosha predominant and insulin dependent diabetes mellitus patients, which requires a long-term follow-up.
Use of ‘Jugupsit anna‘ was a very old belief for madhumeha therapy and is not followed presently. In this system food grains are pretreated and then included in the diet. In the pretreatment, all cereals and pulses are administered to a cow. Grains excreted in the dung are collected, cleaned and used as ‘jugupsit anna‘ for diabetes patients. Although the above statement creates as aversion in the minds of the readers, the possibility of undigested grains from the animal being rich in fiber can not be ruled out. The present concept of glycaemic index may find its root in this unusual practice.
Vegetables are among the numerous plant adjuncts tried for the treatment of the diabetes mellitus. A few vegetables that are commonly consumed in India have been claimed to possess antidiabetic potency. In recent years, there has been a renewed interest to screen such plant food materials, for a possible beneficial use. Considerable amount of work has been carried out in this regard with bitter gourd (Momordica charantia) [21] and ivy gourd (Coccinia indica) [22] both in experimental animals and human diabetic subjects. The hypoglycaemic influence is claimed to be mediated through an insulin secretagogue effect or through an influence on enzymes involved in glucose metabolism. The limited number of studies on other vegetables such as cabbage (brassica oleracia), capsicum (Capsicum annum) [23] green leafy vegetables, beans and tubers have shown the beneficial hypoglycaemic influence in both experimental animals and humans.24 Other plants like Memecylon umbellatum, [25] Eucalaptus globulus, [26] Agrimony eupatoria (agrimony), [27] Agaricus campestris (mushrooms), [28] Nelumbo nucifera rhizome (lotus, [29] Caesalpinia bonducella (leguminose), [30] Medicago sativa (alfa alfa), [31] Basil leaves [32] etc are available in our country. Preliminary studies demand further inquiry so that their novel possibilities as a source of oral hypoglycaemic agents could be investigated. There is scope for more extensive research in this field, especially to examine the long term beneficial effect of dietary vegetables, to identify the active principle and to understand the mechanism of action, which is presently unclear. Since diet forms the mainstay in the management of diabetes mellitus, there is scope for exploiting the antidiabetic potency of vegetables to the maximum extent. Such plant food adjuncts possessing hypoglycaemic activity appear to hold promise as potential antidiabetic agents.
The active principles of plants are often definite substances but in other cases they are complicated mixtures. The first class of these substances with medicinal properties are vegetable bases which include amines and alkaloids. A considerable number of medicinal drugs owe their curative properties to these bitter alkaloids. Another class of these active principles include glycosides, essential or volatile oils, resins and antibiotic each having their own functional significance. Lewis [33] has reported the use of Stevia rebaudiana (Asteraceae) leaves as a sweetener as well as for the treatment of diabetes mellitus since 1887 in India and other countries. Ivorra et al [34] has extensively reviewed active natural principles (polysaccharides, protein, flavonoids and related compounds, steroids, terpenoids and alkaloids) and crude extracts of 45 plant species which have been experimentally studied in last 10 years. Table 3 illustrates in detail about various plants known for their antidiabetic action and Fig. 1 compiles possible mode of action of these plants. Medicinal plants used in indigenous medicines in crude forms for the management of diabetes mellitus, contain both the organic and inorganic constituents. It is known that certaininorganic mineral elements (potassium, zinc, calcium, traces of chromium, etc.) play an important role in the maintenance of normal glucose tolerance and in the release of insulin from b cells of islets of Langerhans. Cucuma longa, Acacia arabica (babul), Vinca rosea (shada-phul), Cordia myxa (naruvali), Musa paradisiaca (plantain) and phyllanthus emblica used in Islamic systems of medicine have been reported to have large amounts (1.0 to 6.5 ppm) of chromium as compared to carbohydrates. [35]
Commonly used antidiabetic foods in the indigenous system of health careBotanical name Common Name Symptoms treated with Active principle Possible mode of action Form and dosage Research studies Aegel marmelos Bilva Bael fruitBengal quince Diabetes ? Improves digestion Reduces blood sugar and urea Juices of leaves Krishnan (1968) [49]
Santhoshumari et a (1990) [50]
Shiva (1998) [51]
S. Sadashiv Tirtha(1998) [52]Azadirachta indica Indian liliac, Neem Diabetes Bitter principles nimbin, nimbinin, nimbidin47 Lowers blood glucose Juice of leaves, bark and flowers, seed oil. Siddiqui (1942) [53] Murthy et al (1978) [54] Pillai and Santhakumari (1981) [55]
Shiva (1998) [51]Butea monosperma Palash Diabetes Phytochemical substances ? Flowers kept in water overnight and water taken every day for 11/2 to 2 months Shiva (1998) [51] Cassia auriculata Mature tea tree Diabetes Tannins ? Seed powder, decoction of flower buds Shiva (1998) [51] Cedrus deodara Pinus deodara, Himalayan cedar Kelankatel – an aleoresin ? In combination with other herbs S. Sadashiv
Tirtha (1998) [52]Cephalandra / Coccinia indica Tondli Kovai glycosuria Glucoside alkaloids, glucokenin Reduces blood and urine sugar Fresh juice of leaves stem or roots Kamble et al (1996) [56] Citrulluscolocynthis Indian wild gourd, bitter apple, bitter cucumber Diabetes Colocynthin-a bitter principle ? Pulp Nadkarni (1954) [1] Coscinium fenestratum Tree turmeric Dyspepsia Berberines and saponin ? Infusion/ tincture Mahapatra (1997) [57] Curuma longa Saffron turmeric Diabetes Turmerone curcumin Blood purifier powder Tank et al (1990) [58]
S. Sadashiv Tirtha (1998) [52]Embilica aplicenel Indian gooseberry Diabetes ? Stimulates pancreas 1 tbsp of amla juice with a cup of bitter gourd juice Upadhyay et al (1996) [59]
S. Sadashiv Tirtha (1998) [52]Eugenia Jambolana Black plum/berry, Jambul Diabetes Jamboline - a glucoside Prevents pathological conversion of starch to glucose Jambu seeds Sepha (1956) [60] Shrotri et al (1963) [61]
Lal and Chaudhary (1968) [62] Antarkar (1975) [63]
Kohli (1983) [64] Kohli and Singh (1993) [65] Upadhyay et al (1996) [59]Ficus bengalensis Banyan Tree Diabetes ? Lowers blood sugar, cholesterol, and urea Infusion of bark Chopra and Chopra (1955).[66] Deshmuk (1960) [68]
Shrotri and Aiman (1960) [68]
Joglekar (1962) [69]
Vora et al (1969 and 1970) [70,71] Singh et al (1992) [7]Gymnema sylvestre Periploca of the woods, small Indian ipecacuanha Glycosuria Gymnema saponins I-II and gymnemic acids I-IX Neutralizes excess sugar - Gupta and Variyar (1964) [73]
Chakravarti et al (1966) [74]
Gupta (1983) [75]
Khare et al (1983) [76] Baskaran et al (1990) [77] Murakami et al (1996) [78]Madhuca indica Honey tree, Mahua of South India Diabetes ? ? Bark Shiva (1998) [51] Momordica charantia Bitter gourd Diabetes Momordicine-a bitter glucoside anthelmintic principle Increases glucose uptake in the liver cells acts as a plant insulin Fruits, leaves and roots Lal and Chaudhary (1968) [62] Upadhyay et al (1996) [59] Kavikumar et al (1997) [21] Ocimum sanctum Tulsi Holy basi Reduces blood glucose, uric acid, Total amino acid, cholesterol Triglycerides, phospholipids, triglycerides ? ? - Agrawal et al (1996) [79]
Rai et al (1997) [80]
S. Sadashiv Tirtha (1998) [52]Pterocarpus marsupium Vijaysar Pterostilbene isoliquiritigenin ? - Gupta (1983) [75]
Shah (1967) [81] Kohli (1994) [82]Trigonella foenum graecum Fenugreek Glycosuria Mucilaginous fiber, trigonelline - an alkaloid Lower cholesterol and triglycerides Seeds (25 g per day) Raghuram et al (1993) [83]
Shiva (1998) [51]
Role of dietary fiber
The use of roughage in foods has been receiving attention more recently, since the establishment of therapeutic benefits of fibers. It is shown to be useful in controlling diabetes. Among the unconventional dietary fibers, guar gum and pectin have been recommended to be more useful. [36,37] Anmar et al studied the hypoglycaemic activity of extracts of Xanthiun pungens, Compositae. The authors could hypothesize that the strong hypoglycaemic activity of the plant extracts and fractions may be due to great extent to the presence of the polysaccharide with the combination of other compounds. It is evident that the polysaccharide has a significant hypoglycaemic activity while other fractions may act synergistically or as vehicles enhancing the biological activity. The resultsagreed with some other researchers. [37, 39 , 40] Some authors [41] reported that the different polysaccharide or fibers affected blood glucose differently and reduced postprandial blood glucose levels. The mechanism of action is suggested to be due to impaired glucose absorption in both duodenum and jejunum [42] which may be due to the increases in the retention time of digest [43] and in the volume of intestinal contents. [44] It has been proved that the more viscous the dietary fibers, the more effective in suppressing the postprandial rise in blood glucose. [45] Dietary fibers may change hormonal profiles (especially for insulin and gastrointestinal polypeptides) and likely to influence carbohydrate metabolism. [46] Haber et al [47] suggested the possibility of other factors acting in the alterations of glucose homoeostasis. Highest amount of dietary fiber (80.01 æ 2.92 g/ 100 g dry weight) present in hairy basil seeds (Ocimum canum) could have been responsible for its beneficial action. [31] Eleusine coracana (ragi) had a better hypoglycaemic effect compared to other millets zea mays (maize), Sorghum vulgare (jowar) when incorporated into breakfast items. [48]
Indian materia medica [1] has mentioned numerous dravyas, which have been reported effective in Madhumeha. These medicines are prescribed in different forms; most commonly used are - choorna, vati, bhasma, arka, quath, etc.
1.Choorna (powder) : It is in powdered form of medicine and can be of herbal, mineral, animal origin e.g. ‘Dhatrinisha choorna‘, ‘Nimba seed choorna‘ etc. It can be made out of only a single herb or a compound composition.
2.Vati (tablet) : It is in tablet form. It is most acceptable form of medicine at present e.g. Phalatrikadivati.
3.Bhasma (metal ashes) : This is primarily from metal origin e.g. Vanga Bhasm, Suvarna Bhasma, etc.
4.Arka (distilled essence) : Distilled essence of herbs/plants can be extracted and used as the medicine e.g. Arka of Tulsi leaves. Arka is in liquid form.
5.Quath (decoction) : Quath is also in the liquid form in which the extracts are boiled e.g. ‘Devdarvyadi quath‘ etc. These can be made out of single drug or of mixture of drugs.
Although all above mentioned antidiabetic drugs from herba [l] and mineral origin are used as a single medicine as well as in combination with others,1 these compound medicines seem to be more effective than a single drug. These combinations can be administered as herbal medicine or can be a combination of herbal and mineral based medicines depending upon the choices and need. Numerous medicinal preparations in varied forms have been tried out and are used in Ayurvedic medicines (Table 4).
TABLE 4
Most commonly used compound preparationsName Constituents Dhatrinisha Amla, Haridra Chandraprabha vati Haridra, devdar, daru haridra, musta, haritaki, vishala, amalaki Vasant kusumakar Minerals and herbs Devdarvyadi Devdar, amla, daru haridra, harda, baheda, musta Phalatrikadi vati Triphala, musta, indrayana and daruharidra Nagabhasma Lead Shilajeet Liquid storax with Zn, Pb, Cu, Ag, Black Fe, Gold
Diabetic Diet Based on the Indigenous Concepts of Treatment
Ayurvedic system of medicine relies much onthe administration of remedial plant in its concentrated extract for the reasons of convenience, compliance and faster results. Effective dietary foods can be administered wholesome without any pre-treatment. Further studies are needed to explore this aspect. However, it is expected to have beneficial effect if taken regularly. With this view, the following diet chart is recommended for NIDDM with no complications of the disease (Table 5). The following diet plan is suggestive of ingredients only which can be consumed in any form that an individual is used to. It is worth consulting a dietician before adopting the same.
Sample diet plan for NIDDM patientsMeal and Menu Latin name Amount Energy (kcal) Breakfast 8 am Barley or Hordeum vulgare 25 g 84 Wheat Triticum sativum 25 g 87 Boiled egg one 86 Fruit - Black berry or Orange Citrus reticulata 50 gone 3012 Skimmed milk with ginger powder
TamalZingiber officiale
Garcinia moreua150 ml
1 tsp
1 tsp44
--
-Tea with ginger and no sugar 1 cup - 245 Lunch 12:30 pm 4 no. (100 g) 340 Chapati with barley/ wheat, chana, methi powder (2 tsp) Leafy vegetable : Mustard leaves or, Methi leaves or, Kulaka (patola) or, Radish leaves 75 g 30 Seasonal vegetables : (any one) MorinaPterigosperma 50 g - Drumstick Musa sapientum Plantain Cucumis utilissimus Tarkakdi Trichosanthus dioica Snakegourd Carica papaya Papaya Luffa acutangula Towel gourd (dodka) Solanum melongena Egg plant Lagenaria vulgaris Bitter bottlegourd Vigna catiang Cowpea Cucurbita pepo Safed kaddu Benincasa hispida White gourd melon Pulses : (any one) Kidney beans Lentil
Redgram
HorsegramPhaseolus aureus Ervum lens
Cajanus indicus Dolichos biflorus30 g 105 Curd (skimmed) with methi powder,saindhav salt (1 tsp each) 150 g 44 539 Bed time 10:30 pm Skimmed milk 200 ml 58 Total 1496 1500
Future demands
The list of Indian plant food adjuncts with anti-diabetic activity is formidable. It is beyond ourcapacity to capture what our ancient culture has gathered over thousand of years in a few pages. This is our humble attempt to acknowledge all those known and the unknown scientists whose contributions have led to an existence of such a huge ocean of knowledge on this subject. Each piece of research work leads to another research and hence the quest for further knowledge continues. In spite of having enormous data on the subject, certain aspects of it still need further probe. Given below in Table 6, are less known plant foods, potential of which needs to be proven further.
Plant foods requiring further researchBotanical name Common name Mode of action Research study Aloe vera Savila/mussabarIndian aloes hypoglycaemic Noel et al (1997) [84]
Akhtar and Shah (1993) [85]Asparagus racemosus Shatavari Reduces blood sugar Rana et al (1994) [86] Butea monosperma Palas ? Budhe et al (1996) [87] Bougainvillea spectabilis - Reduces blood sugar Deshmukh et al (1992) [88] Cinnamomum tamala
Clitoria ternateaDalchini Tamal
Butterfly pea
Gokurna mulaInhibits b -
galactocidase and a - glucocidaseSharma et al (1990) [90] Ferula foetida Asafoetida Reduces blood sugar Akhtar and Shah (1993) [85] Ficus carica Fig tree Improves glycaemic balance Perez et al (1996) [91] Hibiscus vitifolius ? A flavonol bioside- isolated from fresh petals proved to lower blood glucose Ragunathan et al (1994) [92] Murraya/Bergaria koenigi Curry leaves Glucoside - koenigin
reduces blood glucoseShiva (1998) [51] Nelumbo nuciferrhizome KamalLotus Potentiates the action of exogenously injected insulin Mukharjee et al (1997) [29] Nigella sativa Kalongi Reduces blood glucose, total lipids, triglycerides Srivastav et al (1990) [93] Salacia macrosperma - Reduces blood sugar Venkateshwarlu et al (1990) [94]
Nair et al (1982) [95]Syzygium cumini - - Teixeira (1997) [96]
Prince et al (1998) [97]Swertia chirayita Chiretta Insulin releasing effect Chandrashekhar et al (1990) [98] Tricosanthes diodica Wild snakegourd Hypoglycaemic Mukharji (1996) [99]
The above mentioned plants have been considered for their possible hypoglycaemic actions and some preliminary investigations have been carried out by the respective researchers. However, there are numerous other plants which have been found to have a mention in the indigenous systems of health care [1] but still await scientific inquiry. Gracnium wallichianum (Shephard’s needle), Lagenaria vulgaris (Bitter bottlegourd), Orchis mascula (salep/orchids), Tinospora cordifolia (Giloyi, Gurdia, Galo), terminalia chebula (Ink nut), Termilliana balerica (Beleric myrobalans), Lactuca sativa (lettuce), Manggifera indica (mango leaves), Zingiber officinate rose (ginger) are just a few to mention these so-called wait listed plant adjuncts.
The above literature proves that many of our important pharmacopoeia drugs were known and used long before they were introduced into the Western medicine and before their actions wereinvestigated on scientific lines. The scientific mind is not satisfied with empirical facts; it demands a rational justification. This traditional system of medicine will be accepted by the modern professionals in the field only with clinical and pharmacological corroboration. Therefore, efforts have to be initiated for its improvement and development as a branch of medicine. There are many Grey areas, which need substantial amount of work. Much more could be done in furthering the cause of indigenous foods in the treatment of diabetes mellitus and other diseases and making it really useful to the people in this country. It is clear that a holistic approach to the problem of diabetes is needed, which could be accompanied by the combination of modern scientific knowledge and traditional folk knowledge. Medical treatment of diabetes could prosper with the practitioners of these two approaches working side by side. Thus, the time has come to take stock of our achievements, prospects and further potential in this field of indigenous systems of health care and take strong actions to strengthen and revitalize the same.
REFERENCES
1.Nadkarni M. Indian materia medica, Popular Book Depot, Mumbai. 1954; I.
2. Farnsworth NR. Ethnopharmacology and drug development. In : Ethnobotany and the search for new drugs, Wiley, Chichester (Ciba Foundation Symposium 185) : 1994; 42-59.
3.Santana RM. Some notes on urban traditional medicines, Ancient Sc. of Life 1996; 16 (1) : 34-40.
4.Seshadri CV. Indigenous sciences and technologies - the PPST endeavor. Congress on Traditional Sc and Technologies of India 28th Nov. - 3rd IIT, Mumbai. Dec. 1993.
5.Charak Samhita Nidan : 11 hindi commentary by Shashtri KM and Chaturvedi GN 5th Ed., Part I and II, Chaukhamba Sanskriti Sansthan, Varanasi. 1977.
6.Kohli, KR. Clinical evaluation of a few herbal extracts in prameha vis-a-vis diabetes mellitus, thesis submitted for doctor of philosophy in Ayurveda to the University of Mumbai. 1994.
7.Sushrut Samhita Nidan 6:6
8.Astanga Rhaday Nidan 10:7
9.Madhav Nidan - Madhukosh tika and saral hindi bhashantarsahit, Vyakhyakar Narendra Shashtri, 33/26.
10.Charak Samhita Su. 17 : 80 Hindi commentary by Shashtri KM and Chaturvedi GN 5th Ed., Part I and II, Chaukhamba Sanskriti Sansthan, Varanasi. 1977.
11.Sushrut Samhita Ci. 11 : 3.
12.Charak Samhita Ni. 4 : 4 Hindi commentary by Shashtri KM and Chaturvedi, GN 5th Ed., Part I and II, Chaukhamba Sanskriti Sansthan, Varanasi. 1977.
13.Charak Samhita Ci. 6 : 56 Hindi commentary by Shashtri KM and Chaturvedi GN 5th Ed., Part I and II, Chaukhamba Sanskriti Sansthan, Varanasi. 1977.
14.Charak Samhita Ci. 15 Hindi commentary by Shashtri KM and Chaturvedi GN, 5th Ed., Part I and II, Chaukhamba Sanskriti Sansthan, Varanasi. 1977.
15.Kar AC, Upadhyay BN, Ojha D. Prognosis of Prameha on the basis of insulin level. Ancient Sc Life 1997; 16 (4) : 277-83.
16.Rastogi R. Diabetes mellitus - problems and solutions. Sachitra Ayurveda 1994; 47 (6) : 405-6.
17.Jain SC, Uppal A, Bhatnagar SO, Talukdar B. A study of response pattern of NIDDM to yoga therapy. Diabetes Res Clin Pract 1993; 19 (1) : 69-74.
18.Sahay BK. Yoga and diabetes. J Ass Physicians Ind 1986; 34 : 645-8.
19.Sahay BK, Ramanand Y, Raju PS, Madhavi S. The effect of yoga in diabetes. In Bajaj JS (Ed.) Diabetes mellitus in developing countries. Interprint, New Delhi. 379-81.
20.Acharya RK, Upadhyay BN, Dwiwedi LD. Dietary management in Prameha. Ancient Sc Life 1996; 115 (3) : 176-89.
21.Kavikumar S, Ilango R, Gupta M, Majumdar UK. Hypoglycemic action of momordica charantia in normal and diabetic mice. Ancient Sc Life 1997; 17 (1) : 32-5.
22.Kamble SM, Jyotishi GS, Kamalakar PL, Vaidya SM. Efficacy of Coccinia Indica - W and A in diabetes mellitus. J Res Ayurv and Sidha 1996; 17 (1-2) : 77-84.
23.Monosereenusorn Y. Effect of capsicum annum on blood glucose level. QJ Crude Drug Res 1980; 18 (1) : 1-7.
24.Platel K, Shrinivasan K. Effect of dietary intake of freeze dried bittergourd (Momoradica charantia) in streptozotocininduced diabetic rats. Nahrung 1995; 39 (4) : 262-8.
25.Amalraj T, Ignacimuth S. Evaluation of the hypoglycemic effect of memecylon umbellatum in normal and alloxan diabetic mice. J Ethnopharmacol 1988; 62 (3) : 247-50.
26.Gray AM, Flatt PR. Antihyperglycemic actions of eucalptus globulus are associated pancreatic and extra-pancreatic effects in mice. J Nutr 1988; 128 (12) : 2319-23.
27.Gray AM, Flatt PR. Actions of the traditional anti-diabetic plant, Agrimony eupatoria : effects on hyperglycemia, cellular glucose metabolism and insulin secretion. Br J Nutr 1998; 80 (1) : 109-14.
28.Gray AM, Flatt PR. Insulin releasing and insulin like activity of agaricus campestris (mushroom). J Endocrinol 1998; 157 (2) : 207-13.
30.Sharma SR, Dwiwedi SK, Swarup D. Hypoglycemic, antihyperglycemic and hypolipidemic activities of caesalpinia bonducella seeds in rats. J Ethnopharmacol 1997; 58 (1) : 39-44.
31.Gray AM, Flatt PR. Pancreatic and extra-pancreatic effects of the traditional antidiabetic plant, Medicago Sativa (lucerne), Br J Nutr 1997; 78 (2) : 325-34.
32.Tinnart P. Effect of dietary fiber on blood glucose in diabetes. J Natl Res Coun Thailand 1983; 15 (2) : 67-89.
33.Lewis WH. Early uses of stevia rebaudiana (Asteraceae) leaves as a sweetener in paragyay. Economic Botany 1992; 46 (3) : 336-7.
34.Ivorra MD, Paya M, Villar A. Review of natural products and plants as potential antidiabetic drugs. J Ethnopharmacology 1989; 27 (3) : 243-75.
35.Januja KM. Role of minor minerals on human health diabetic control with chromium containing herbs - Part IV. Hamadard medicus, 1991; 34 (2) : 104-6.
36.Jenkins DJA, Leeds, Anthony R, Gassull, Miguel A, Cochet, Bernard, Albert, George K. Disease in post-prandial insulin and glucose concentration by guar gum and pectin. Ann Int Med 1977; 86 : 20-3.
37.Smith V, Holm G. Effect of guar gum preparation on glucose and lipid levels in diabetes and healthy volunteers. Atherosclerosis 1982; 45 (3) : 1-10.
38.Ammar N, Al-okbi S, Wassel G, Shabana M. Hypoglycemic activity of Xanthium pungens, compositae. J Res and Ed Ind Med 1992; 11 (2) : 19-23.
39.Jenkins DJA, Wolever TMS, Nineham R, Taylor R, Metz GL, Bacon S, Hockaday TDR. Guar crisp bread in the diabetic diet. British Med J 1978; 2 : 1744.
40.Jenkins DJA. Dietary fiber, diabetes and hyperlipidemia. Lancet 1979; 2 : 1287.
41.Jefferys DB. The effect of dietary fiber on the response to orally administered glucose. Proc Nutr Soc 1974; 33 : 11A.
42.Dryden PA, Jones GP, Durcher E, Pead RSD. Effect of chronic ingestion of dietary fiber on the rate of glucose absorption in rats. Nutr Rep Int 1985; 31 : 609.
43.Cherbut C, Mierien O, Ruckebush Y. Effect of diet on intestinal xylose absorption in dogs. Dig Dis Sci 1986; 31 : 385.
44.Suail PK, Schueehan BO. Pancreatic and intestinal response to dietary guar gum in rats. J Nutr 1983; 113 : 1544.
45.Kunihiro D, Masura M, Kawara A, Bada S, Nishikawa K. Treatment of diabetes with dietary fibers. The effect of high viscosity of fiber on the post-prandial blood glucose. J JPN Diabetic Soc 1982; 25 : 197.
46.Wahlquist MC. Dietary fiber and carbohydrate metabolism. Am J Clin Nutr 1987; 45 : 1232.
47.Haber GB, Heaton KW, Murphy D, Burroughs LF. Depletion and disruption of dietary fiboer : effects on satiety, plasma glucose and serum insulin. Lancet 1977; 2 : 679-82.
48.Geetha C, Easwaran PP. Hypoglycemic effect of millets incorporated breakfast items on selected NIDDM. Ind J Nutr and Diet 1990; 27 (11) : 316-20.
49.Krishnan SH. A preliminary communication of the action of Aegle marmelos (Bael) on heart. Ind J Med Res 1968; 56 : 327-331.
50.Santhoshumari KS, Devi KS. Hypoglycemic effect of a few medical plants. Ancient Sc of Lie 1990; 9 (4) : 221-3.
51.Shiva A. First aid remedies : Their sources and methods of uses. XVIth series (A1 Anaemia (B) Diabetes/Glycosuria) MFP News, 1998; 8 (1) : 8-9.
52.Swami Sadashiv. The ayurvedic encyclopedia, Sri Satguru Publication, a Div. Of Indian Book Centre, Delhi, India, Chapter 4 : 72-3.
53.Siddiqui S. A note on the isolation of three new bitter principles from the neem oil. Current Sc 1942 : 11 : 278.
54.Murty KR, Rao KN, Rao DK, Murthy LBG. A preliminary study on hypoglycemic and antihyperglycemic effects of azadirachta indica. Ind J Pharmacol 1978; 10 : 247.
55.Pillai NR, Santhakumari G. Hypoglycemic activity of melia azadirachta Linn. (neem). Ind J Med Res 1981; 74 : 931-3.
56.Kamble SM, Jyotishi GS, Kamalakar PL, Vaidya SM. Efficacy of Coccina indica W and A in diabetes mellitus. J Res Ayur Sidha 1996; 17 (1-2) : 77-84.
57.Mahapatra B. Hypoglycemic activity of coscinium fenestratus (gaertn) colber. J Res Ayurv and Sidha 1997; 18 (3-4) : 89-96.
58.Tank R. Indian Drugs 1990; 27 (11) : 587-9.
59.Upadhyay OP, Singh RH, Dutta SK. Studies on antidiabetic medicinal plants used in Indian folk-lore. Sachitra Ayurveda 1996; 48 (10 ) : 949-55.
60.Sepha GS, Bose SN. Clinical observations on the antidiabetic properties of eugenia jambolina and Pterocarpus marsupium. J Ind Med Assn 1956; 27 : 388.
61.Shrotri DS, Kelkar M, Deshmukh VK, Aiman R. Investigations of hypoglycemic properties of eugenia jambolana, vinca rosea and cassia auriculata. Ind J Med Res 1963; 51 : 464.
62.Lal BN, Chaudhary KD. Observation on Momordica charantia (Kavellaka) and Jamboo (eugenia jambolana) as antidiabetic remedies. J Res Ind Med 1968; 2 (2) : 161-4.
63.Antarkar DS, Vaidya AB, Joshi BS. Clinical screening for hypoglycemic action of 14 Ayurvedic plants-Third National Congress on Diabetes, Mumbai. 1975.
64.Kohli KR. A study of ‘kriyakala‘ of diabetes mellitus and its treatment with an indigenous drug - eugena jambolana, MD (Ay.) Thesis IMS, BHU, Varanasi. 1983.
65.Kohli KR, Singh RH. A clinical trial of in NIDDM. J Res Ayur Sidha 1993; 14 (3-4) : 89-97.
66.Chopra RN, Chopra IC. A review of work on Indian medical plants, ICMR, New Delhi. 1955.
67.Deshmukh VK. Isolation of a hypoglycemic principle from the bark of Ficus bengalensis. Ind J Physio and Pharmacol 1960; 4 : 182.
68.Shrotri DS, Aiman R. The relationship of the post absorptive state to the hypoglycemic action. Studies on ficus bengalensis and ficus glomerata. Ind J Med Res 1960; 48 : 162.
69.Joglekar GV. Further studies on ficus bengalensis Linn. I toxicity tests. Ind J Med Res 1962; 50 : 747.
70.Vohra SB, Parasar GC. Phytochemical and pharmacological studies on ficus bengalensis Linn. Ind J Physiol and Pharmacol 1969; 13 (3) : 143.
71.Vohra SB, Parasar GC. Antidiabetic studies on ficus bengalensis linn. Ind J Pharmacy 1970; 32 (3) : 68.
72.Singh N, Tyagi SD, Agarwal SC. Study of antidiabetic effects of alcoholic extract of ficus bengalensis (Linn) on diabetic albino rats. J Res Ayurv Sidha 1992; 13 (1-2) : 56-62.
73.Gupta SS, Variyar MC. Experimental studies on pituitary diabetes, Part IV, effect of Gymnena sylvestre and Coccinia indica W and A against hypoglycemic response of somatotropis and corticotrophin hormones. Ind J Med Res 1964; 52 : 200-4.
74.Chakravarti RN, Chakravarti DS, Itty MI. Crystalline saponin from gymnema sylvestre. Bulletin Calcutta Sch Trop Med 1996; 14 : 126.
75.Gupta SS. Effect of gymnema sylvestre and pterocarpus marsupium on glucose tolerance in albino rats. Ind J Med Res 1983; 7 : 501.
76.Khare AK, Tondon RN, Tewari JP. Hypoglycemic activity of an indigenous drug : gymnema sylvestre in normal and diabetic persons. Ind J Physiol Pharmacol ??; 27 (3) : 257-8.
77.Baskaran K, Kizar AB, Shanmugasundaram, Radha K, Shanmugsundaram ERB. Antidiabetic effect of a leaf extract from gymnema sylvestre in NIDDM patients. J Ethnopharmacol 1990; 30 : 296-305.
78.Murakami N, Murakami T, Kadoya M, Matsuda H, Yamahara J, Yoshikawa M. New hypoglycemic constituents in ‘gymnemic acid’ from Gymnema sylvestrae. Chem Pharma Bull Tokyo 1996; 44 (2) : 469-71.
79.Agrawal P, Rai V, Singh RB. Randomized placebo-controlled, single blind trial of holy basil leaves in patients with NIDDM. Int J Pharmacol Ther 1996; 34 (9) : 406-9.
80.Rai V, Iyer U, Mani UV. Effect of Tulsi (Ocimum santum) leaf powder supplementation on blood sugar levels, serum lipids and tissue lipids in diabetic rats. Plan Foods Hum Nutr 1997; 50 (1) : 9-16.
81.Shah DS. A preliminary study of hypoglycemic action of heartwood of Pterocarpus marsupium Roxb Ind J Med Res 1967; 55 (2) : 166-8.
82.Kohli KR. Clinical evaluation of a few herbal extracts in prameha vis-a-vis diabetes mellitus. Thesis submitted for Doctor of Philosophy in Ayurveda, to the University of Mumbai. 1994.
83.Raghuram TC, Pasricha S, Sharma RD. Diet and diabetes. National Institute of Nutrition, Hyderabad, India. 1993.
84.Noel PH, Pugh JA, Larne AC, Marsh G. The use of traditional plant medicines for NIDDM in South Texas. Phytotherapy Res 1997; 11 (7) : 512-7.
85.Akhtar MS, Shah MV. Elemental constituents of antidiabetic screening of a folklore medicinal plant prescription. Ind J Toxicology, Occupational and Envt Health 1993; 2 (1) : 46.
86.Rana TS, Singh KK, Rao RR. Some interesting reports on indigenous herbal remedies for diabetes mellitus from India. Fourth Int Cong Ethnobiol, NBRI, Lukhnow. Nov., 1994; 47 : 17-21.
87.Budhe PD, Sharma LK, Sharma BN, Pandey VK. Some significant medicinal uses of palash and lata palash. Bulletin of Medico-Ethno-Botanical Res 1996; 17 (3-4) : 107-13.
88.Deshmukh VK. Isolation of a hypoglycemic principle fro the bark of ficus bengalensis. Ind J Physio Pharmacol 1960; 4 : 182.
89.Chandola HM, Tripathi SN, Udupa KN. Hypoglycemic response of Cinnamonum tamala in patients of maturity onset (NIDDM) diabetes. J Res Ayurv Sidha 1980; 1 (2) : 275-90.
90.Sharma AK, Mujumdar M. Some observations on the effect of Clitoria ternata Linn. On changes in serum sugar level and small intestinal mucosal carbohydrate activities in alloxan diabetes. Calcutta Med J 1990; 87 (11-12) : 168-71.
91.Perez C, Dominique E, Ramiro JM, Romero A, Campillo JE, Torres MD. A study on the glycaemic balance in streptotocin-diabetic rats treated with an aqueous extract of ficus carica. (Fig. 3) leaves. Phytotherapy Res 1996; 10 (1) : 82-3.
92.Ragunathan V, Sulochana N. A new flavonol bioside from the flowers of hibiscus vitifolis Linn. And its hypoglycemic activity. J Ind Chem Society 1994; 71 (11) : 705-6.
93.Srivastav A, Joshi LD. Effect of feeding blackgram (Phaseolus mungo) on serum lipids of normal and diabetic guinea pigs. Ind J Med Res 1990; 92B (Oct) : 383-6.
94.Venkateshwarlu V, Kokate CK, Peddanna G, Veeresham C, Rambhau D. Pharmaceutical investigations on salacia macrosperma. Ancient Sc of Life 1990; 9 (4) : 215-9.
95.Nair RB, Bhat AV, Santhakumari G. Comparative study of the hypoglycaemic activity of the Salacia Spp J Res Ayurv and Sidha 1982; 3 (1-2) : 53-68.
96.Teixeira CC, Pinto LP, Kessler FH, Knijnik L, Pinto CP, Gastaldo FFD. The effect of syzygium cumini seeds on post-prandial blood glucose levels in non-diabetic rats and rats with streptozotocin induced diabetes mellitus. J Ethnopharmacol 1997; 56 (3) : 209-13.
97.Prince PS, Menon VP, Pari L. Hypoglycemicactivity of syzigium cumini seeds : effect on lipid peroxidation in alloxan diabetic rats. J Ethnopharmacol 1998; 61 (1) : 1-7.
98.Chandrashekhar B, Bajpai MB, Mukharjee SK. Hypoglycemic activity of Swertia chirayita karst. Ind J Expt Biol 1990; 28 (7) : 616-8.
99.Mukharjee SK. Scope and use of indigenous herbal drugs in ‘Madhumeha‘. An Indian scenario. International seminar on free radicals, mediated diseases and Ayurveda, faculty of Ayurveda, IMS, BHU, Varanasi, India. September. 1996; 2-4.
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