A case of diabetic male of 74 years, complaints as follows:

• Lack of Energy (Malaise)
• Loss of appetite (Anorexia)
• Loss of taste
• Foul smell and nausea associated
• Dryness and Itching of skin (from 2 months)
• Oedema on face
• Pitting oedema on lower limbs
• Pale skin
• Weight loss

History of Diabetes since 20 years.

Patient operated for coronary bypass, past 11 years.

Allopathic medications have been on going with intermittent changes by the Allopathy diabetologists on regular basis since diagnosis.

With the current presentation of patient it is advisable to start with a ‘low interventional and conservative’ approach. The patient needs to be given some essential symptomatic relief and stabilisation of bodily systems. This is done to achieve homeostasis. In the course of time, at the moment no allopathic drugs and medicines needs to stopped, as to avoid the sudden stoppage leading to immediate withdrawal complications. Rather a gradual tapering is expected along with strengthening of the body; so enough time is given for the Ayurvedic medicines to establish a strong platform for lowering and then withdrawal (if possible) of Allopathy.

Also the Panchkarma therapies must be started after providing the patient with enough symptomatic relief and physical strength (Rugna Bala). For the same purpose considering the case presented at the time of consultation, treatment according to the guidelines of Shootha with Rasa dhatu kshay avastha needs to be done while Bala Rakshan, Oja rakshan, Agni deepan must be done.

Here the patient is prescribed as follows

• Punarnavadi kasay
• Gokshuradi Guggul
• Rasayan Vati
• Shivakshar Pachan Choorna

The choices of medicines are based on the concept of line of treatment described. Also the patient is advised Basti karma after a month approximately, considering the changes in consecutive follow up.