TRADITIONAL AND AYURVEDA APPROACHES TO MANAGING DIABETES MELLITUS (MADHUMEHA) IN SRI LANKA: A SURVEY OF MEDICINAL PLANTS AND PRACTICES
DOI:
https://doi.org/10.5281/zenodo.21313240Keywords:
Madumeha, Diabetes Mellitus, Medicinal plants, Traditional medicineAbstract
Traditional medicine, folk or indigenous medicine, represents a cumulative body of knowledge developed over generations and predates modern medical systems. Ayurveda is an established medical system, provides detailed descriptions of Madhumeha, a condition closely resembling Diabetes mellitus (DM). This non-communicable diseases is a “silent killer,” and it impacts on human health. The prevalence of T2DM is driven by a complex interplay of genetic susceptibility, lifestyle behaviors, and environmental factors, placing with impaired glucose tolerance.
Traditional medicinal systems in Sri Lanka have diverse plant-based formulations to manage Madhumeha, with therapeutic efficacy. However, systematic documentation and scientific validation of these formulations remain limited. To address this gap, the present review compiles and analyses 79 unique medicinal recipes used to manage Madhumeha.
A comprehensive literature search was conducted using electronic databases, including Google Scholar, PubMed, Scopus, SpringerLink, and ScienceDirect, as well as academic books and Ola leaf manuscripts in Sri Lanka. Among electronically available reports, relevant studies were identified through structured keyword searches. In Ola leaf manuscripts, all relevant recipes were read, data were extracted and critically analysed.
Formulations of fifty one Kashaya (decoctions), eighteen Churna (powders), nine Kalka (paste), and one steam-based herbal preparation were systematically summarized. Additionally, bioactive phytochemical constituents of 10 frequently utilised medicinal plants were compiled and analysed.
This review highlights the therapeutic potential of traditionally used medicinal plants for managing Madhumeha and underscores their significance as promising sources of novel pharmaceutical agents. The findings emphasise the importance of preserving indigenous medical knowledge while bridging traditional practices with modern scientific research. The lack of standardisation and clinical validation of these formulations need pharmacological and clinical investigations to establish their safety, efficacy, and mechanisms of action. Such efforts may facilitate the integration of traditional medicine into evidence-based healthcare and contribute to the development of accessible and cost-effective strategies for Madhumeha management.
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References
Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al. IDF Diabetes Atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017;128:40–50.
Roglic G. WHO global report on diabetes: a summary. Int J Noncommun Dis. 2016;1(1):3.
Bandara S. Beat diabetes in Sri Lanka: too much sugar is not that sweet [Internet]. 2016. Available from: http://www.ft.lk/article/535309/Beat-diabetes-in-Sri-Lanka-Too-much-sugar-is-not-that-sweet
Rao MU, Sreenivasulu M, Chengaiah B, Reddy KJ, Chetty CM. Herbal medicines for diabetes mellitus: a review. Int J PharmTech Res. 2010;2(3):1883–92.
Gieroba B, Kryska A, Sroka-Bartnicka A. Type 2 diabetes mellitus: conventional therapies and future perspectives in innovative treatment. Biochem Biophys Rep. 2025;42:102037. doi:10.1016/j.bbrep.2025.102037.
Simon-Szabó L, Lizák B, Sturm G, Somogyi A, Takács I, Németh Z. Molecular aspects in the development of type 2 diabetes and possible preventive and complementary therapies. Int J Mol Sci. 2024;25(16):9113. doi:10.3390/ijms25169113.
Kumar B, Dhaka S, Kataria D, Chaudhary R, Raghav J, Kamboj S, et al. A review on herbs used in the treatment of diabetes mellitus.
Elkanawati RY, Sumiwi SA, Levita J. Impact of lipids on insulin resistance: insights from human and animal studies. Drug Des Devel Ther. 2024;18:3337.
Mizukami H, Kudoh K. Diversity of pathophysiology in type 2 diabetes shown by islet pathology. J Diabetes Investig. 2022;13:6–13.
Ramachandran A. Know the signs and symptoms of diabetes. Indian J Med Res. 2014;140(5):579–81.
Alam S, Hasan MK, Neaz S, Hussain N, Hossain MF, Rahman T. Diabetes mellitus: insights from epidemiology, biochemistry, risk factors, diagnosis, complications and comprehensive management. Diabetology. 2021;2(2):36–50. doi:10.3390/diabetology2020004.
Elkanawati RY, Sumiwi SA, Levita J. Impact of lipids on insulin resistance: insights from human and animal studies. Drug Des Devel Ther. 2024;18:3337.
Chimkode SM, Kumaran SD, Kanhere VV, Shivanna R. Effect of yoga on blood glucose levels in patients with type 2 diabetes mellitus. J Clin Diagn Res. 2015. doi:10.7860/JCDR/2015/5744.
Tran N, Pham B, Le L. Bioactive compounds in anti-diabetic plants: from herbal medicine to modern drug discovery. Biology (Basel). 2020;9(9):252.
Wang H, Zhu C, Ying Y, Luo L, Huang D, Luo Z. Metformin and berberine, two versatile drugs in treatment of common metabolic diseases. Oncotarget. 2017;9(11):10135.
Afzal S, Abdul Manap AS, Attiq A, Albokhadaim I, Kandeel M, Alhojaily SM. From imbalance to impairment: the central role of reactive oxygen species in oxidative stress-induced disorders and therapeutic exploration. Front Pharmacol. 2023;14:1269581.
Kashtoh H, Baek KH. Recent updates on phytoconstituent alpha-glucosidase inhibitors: an approach towards the treatment of type two diabetes. Plants (Basel). 2022;11(20):2722.
Lee BH, Eskandari R, Jones K, Reddy KR, Quezada-Calvillo R, Nichols BL, et al. Modulation of starch digestion for slow glucose release through "toggling" of activities of mucosal α-glucosidases. J Biol Chem. 2012;287(38):31929.
Lin AHM, Hamaker BR, Nichols BL. Direct starch digestion by sucrase-isomaltase and maltase-glucoamylase. J Pediatr Gastroenterol Nutr. 2012;55(Suppl 2).
Rakibul Hassan Bulbul M, Nizam Uddin Chowdhury M, Anjum Naima T, Ahmed Sami S, Shakil Imtiaj M, Huda N, et al. A comprehensive review on the diverse pharmacological perspectives of Terminalia chebula Retz. Heliyon. 2022;8:e10220. doi:10.1016/j.heliyon.2022.e10220.
Jia LR. A commentary on effect of chebulagic acid from the fruits of Terminalia chebula Retz. J Diabetes Med Care. 2022;5(3):56–57.
Jo SH, Cho CY, Lee JY, Ha KS, Kwon YI, Apostolidis E. In vitro and in vivo reduction of post-prandial blood glucose levels by ethyl alcohol and water Zingiber mioga extracts through inhibition of carbohydrate-hydrolyzing enzymes. BMC Complement Altern Med. 2016;16(1):111.
Huang YN, Zhao DD, Gao B, Zhong K, Zhu RX, Zhang Y, et al. Anti-hyperglycemic effect of chebulagic acid from the fruits of Terminalia chebula Retz. Int J Mol Sci. 2012;13(5):6320.
Eltimamy M, Elshamarka M, Aboelsaad M, Sayed M, Moawad H. Effects of alcoholic extract of Terminalia chebula dried fruit on blood biochemical profile in diabetic rats. J Diabetes Metab Disord. 2022;21(1):159–70.
Agrawal OD, Kulkarni YA. Treatment with Terminalia chebula extract reduces insulin resistance, hyperglycemia and improves SIRT1 expression in type 2 diabetic rats. Life (Basel). 2023;13(5):1168.
Alam S, Dhar A, Hasan M, Richi FT, Emon NU, Aziz MA, et al. Antidiabetic potential of commonly available fruit plants in Bangladesh: updates on prospective phytochemicals and their reported mechanisms of action. Molecules. 2022;27(24):8709.
Rutkowska M. Anti-diabetic potential of polyphenol-rich fruits from the Maleae tribe: a review of in vitro, in vivo animal and human trials. Nutrients. 2023;15(17):3756.
Huang SM, Lin CH, Chang WF, Shih CC. Antidiabetic and antihyperlipidemic activities of Phyllanthus emblica L. extract in vitro and regulation of Akt phosphorylation, gluconeogenesis and peroxisome proliferator-activated receptor α in streptozotocin-induced diabetic mice. Food Nutr Res. 2023;67.
Tirgar P, Shah KV, Patel VP, Desai TR. Investigation into mechanism of action of anti-diabetic activity of Emblica officinalis on streptozotocin-induced type I diabetic rats. Res J Pharm Biol Chem Sci. 2010;1(4):672–82.
Akhtar MS, Ramzan A, Ali A, Ahmad M. Effect of amla fruit (Emblica officinalis Gaertn.) on blood glucose and lipid profile of normal subjects and type 2 diabetic patients. Int J Food Sci Nutr. 2011;62(6):609–16.Salehi B, Machin L, Monzote L, Sharifi-Rad J, Ezzat SM, Salem MA, Merghany RM, El Mahdy NM, Klllç CS, Sytar O, Sharifi-Rad M, Sharopov F, Martins N, Martorell M, Cho WC. Therapeutic Potential of Quercetin: New Insights and Perspectives for Human Health. ACS Omega [Internet]. 2020 May 26 [cited 2025 Sep 14];5(20):11849–72. Available from:
https://pubs.acs.org/doi/full/10.1021/acsomega.0c01818
Srinivasan P, Vijayakumar S, Kothandaraman S, Palani M. Anti-diabetic activity of quercetin extracted from Phyllanthus emblica L. fruit: in silico and in vivo approaches. J Pharm Anal. 2018;8(2):109–18.
Abdel-Sattar EA, Elberry AA, Harraz FM, Ghareib SA, Nagy AA, Gabr SA. Antihyperglycemic and hypolipidaemic effects of the methanolic extract of Saudi mistletoe (Viscum schimperi Engl.). J Adv Res. 2011;2(2):171–7.
Raut NA, Gaikwad NJ. Antidiabetic activity of hydroethanolic extract of Cyperus rotundus in alloxan-induced diabetic rats. Fitoterapia. 2006;77(7–8):585–8.
Singh P, Khosa RL, Mishra G, Jha KK. Antidiabetic activity of ethanolic extract of Cyperus rotundus rhizomes in streptozotocin-induced diabetic mice. J Pharm Bioallied Sci. 2015;7(4):289.
Alshaer S, Al-Najjar MAA, El-Hajji FD, Abu-Tayeh R. Investigating the potential effects of olive leaves and ginger rhizome extracts on kidney and liver functions in alloxan-induced diabetic rats. Avicenna J Phytomed. 2025;15(3):1124.
Abouzid MR, Ali K, Elkhawas I, Elshafei SM. An overview of diabetes mellitus in Egypt and the significance of integrating preventive cardiology in diabetes management. Cureus. 2022;14.
Akash MSH, Afzaal A, Rehman K, Hussain A, Ibrahim M, Shoaib SM, et al. Identification of secondary metabolites of Cyperus rotundus L. and dose-dependent effects on antioxidant activity and carbohydrate digestion enzymes. Dose Response. 2024;22(4):15593258241308724.
Wei Q, Zhan Y, Chen B, Xie B, Fang T, Ravishankar S, et al. Assessment of antioxidant and antidiabetic properties of Agaricus blazei Murill extracts. Food Sci Nutr. 2020;8(1):332.
Patience OO, Estella UO, Philip FU. The search for new hypoglycemic agents from plants. Afr J Pharm Pharmacol. 2014;8(11):292–303.
Kooti W, Farokhipour M, Asadzadeh Z, Ashtary-Larky D, Asadi-Samani M. The role of medicinal plants in the treatment of diabetes: a systematic review. Electron Physician. 2016;8(1):1832.
Zhao P, Ming Q, Qiu J, Tian D, Liu J, Shen J, et al. Ethanolic extract of Folium Sennae mediates glucose uptake of L6 cells by GLUT4 and Ca2+. Molecules. 2018;23(11):2934.
Abid AI, Muzammel H, Javed M, Iqbal MM, Mahmood S, Zidan A, et al. Unveiling nature's antidiabetic potential in Berberis orthobotrys seeds for alloxan-induced diabetic rats. Sci Rep. 2025;15(1):746.
Ugwu MNNAEMEKA. Serum activity of alanine aminotransferase and aspartate aminotransferase in albino rats administered aqueous extract of fresh leaves Pterocarpus santalinoides. IDOSR J Sci Res. 2019.
Sanmugapriyaa E, Venkataraman S. Toxicological investigations on Strychnos potatorum Linn. seeds in experimental animal models. J Health Sci. 2006;52(4):339–43.
Shirwaikar A, Rajendran K, Punitha ISR. Antidiabetic activity of alcoholic stem extract of Coscinium fenestratum in streptozotocin-nicotinamide-induced type 2 diabetic rats. J Ethnopharmacol. 2005;97(2):369–74.
Adisakwattana S, Yibchok-Anun S, Jittaprasatsin W, Somtir D, Bunlunara W. Insulin-secreting and α-glucosidase inhibitory activities of Coscinium fenestratum and effects on postprandial hyperglycemia in normal and diabetic rats. J Med Plants Res. 2009;3(9):646–51.
Zhang X, Alshakhshir N, Zhao L. Glycolytic metabolism, brain resilience, and Alzheimer's disease. Front Neurosci. 2021;15:662242.
Uchio R, Okuda-Hanafusa C, Sakaguchi H, Saji R, Muroyama K, Murosaki S, et al. Curcuma longa extract reduces serum inflammatory markers and postprandial hyperglycemia in healthy but borderline participants with overweight and glycemia in the normal/prediabetes range: a randomized, double-blind, placebo-controlled trial. Front Nutr. 2024;11:1324196.
Mustafa SB, Akram M, Asif HM, Qayyum I, Hashmi AM, Munir N, et al. Antihyperglycemic activity of hydroalcoholic extracts of selected medicinal plants (Curcuma longa, Lavandula stoechas, Aegle marmelos, and Glycyrrhiza glabra) and their polyherbal preparation in alloxan-induced diabetic mice. Dose Response. 2019;17(2):1559325819852503.
Marton LT, Pescinini-e-Salzedas LM, Camargo MEC, Barbalho SM, Haber JFS, Sinatora RV, et al. The effects of curcumin on diabetes mellitus: a systematic review. Front Endocrinol (Lausanne). 2021;12:669448.
Jiménez-Osorio AS, García-Niño WR, González-Reyes S, Álvarez-Mejía AE, Guerra-León S, Salazar-Segovia J, et al. The effect of dietary supplementation with curcumin on redox status and Nrf2 activation in patients with nondiabetic or diabetic proteinuric chronic kidney disease: a pilot study. J Ren Nutr. 2016;26(4):237–44.
Mofidi Najjar F, Ghadari R, Yousefi R, Safari N, Sheikhhasani V, Sheibani N, et al. Studies to reveal the nature of interactions between catalase and curcumin using computational methods and optical techniques. Int J Biol Macromol. 2017;95:550–60.
Gupta A, Kumar R, Pandey AK. Antioxidant and antidiabetic activities of Terminalia bellirica fruit in alloxan-induced diabetic rats. S Afr J Bot. 2020;130:308–15.
Kumar V, Kumari P, Arora V, Dixit H, Singh R, Sharma N. Antimicrobial and antidiabetic activities of different parts of Terminalia bellirica fruits. Arab J Med Aromat Plants. 2022;8(3):115–30.
Latha RCR, Daisy P. Therapeutic potential of octyl gallate isolated from fruits of Terminalia bellirica in streptozotocin-induced diabetic rats. Pharm Biol. 2013;51(6):798–805.
Nampoothiri SV, Binil Raj SS, Prathapan A, Abhilash PA, Arumughan C, Sundaresan A. In vitro antioxidant activities of the methanol extract and solvent fractions obtained from the fruit pericarp of Terminalia bellirica. Nat Prod Res. 2011;25(3):277–87.
Fofie CK, Katekhaye S, Borse S, Sharma V, Nivsarkar M, Nguelefack-Mbuyo EP, et al. Antidiabetic properties of aqueous and methanol extracts from the trunk bark of Ceiba pentandra in type 2 diabetic rats. J Cell Biochem. 2019;120(7):11573–81.
Al-Ishaq RK, Abotaleb M, Kubatka P, Kajo K, Büsselberg D. Flavonoids and their antidiabetic effects: cellular mechanisms and effects on blood sugar levels. Biomolecules. 2019;9(9):430.
Zeleke YG, Atnafie SA, Aragaw TJ. Anti-diabetic activities of hydromethanolic crude extract and solvent fractions of Heteromorpha arborescens (Apiaceae) leaves in mice. J Exp Pharmacol. 2023;15:107–19.
Khaliq F, Parveen A, Singh S, Gondal R, Hussain ME, Fahim M. Improvement in myocardial function by Terminalia arjuna in streptozotocin-induced diabetic rats: possible mechanisms.
Ragavan B, Krishnakumari S. Antidiabetic effect of Terminalia arjuna bark extract in alloxan-induced diabetic rats. Indian J Clin Biochem. 2006;21(2):123–8.
Kumar C, Kumar R, Nehar S. Phytochemical properties and total antioxidant status of acetone and methanol extracts of Terminalia arjuna Roxb. bark and their hypoglycemic effect in type II diabetic albino rats. J Pharmacogn Phytochem. 2013;2(1):199–208.
Alam MMD, Haque A, Begum R. Anti-hyperglycemic and lipid-lowering effect of Terminalia arjuna bark extract on streptozotocin-induced type 2 diabetic model rats. Int J Pharm Pharm Sci. 2011;3(4):449–53.
Kumar A, Semwal R, Chauhan A, Semwal RB, Chandra S, Sircar D, et al. Evaluation of antidiabetic effect of Cissampelos pareira L. (Menispermaceae) root extract in streptozotocin-nicotinamide-induced diabetic rats via targeting SGLT2 inhibition. Phytomedicine Plus. 2022;2(4):100374.
Piero NM. In vivo antidiabetic activity and safety in rats of Cissampelos pareira traditionally used in the management of diabetes mellitus in Embu County, Kenya. J Drug Metab Toxicol. 2015;6(3).
Basumata C, Kalita JC, Mohan P, Baruah KK. Anti-diabetic effect of Cissampelos pareira Linn. (Menispermaceae) on fructose-alloxan diabetic rats. Int J Integr Sci Innov Technol. 2013;1(2):27–38.
Raghunath KR, Kulkarni DV. Experimental evaluation of anti-diabetic effects of Patha (Cissampelos pareira Linn.) and Gokshura (Tribulus terrestris Linn.) yoga in streptozotocin-induced diabetes in albino rats. World J Pharm Res. 2020;9.
KC, P R, SF J, S R, VP KM, BR S, et al. Molecular docking analysis of glycogen phosphorylase with inhibitors from Cissampelos pareira Linn. Bioinformation. 2021;17(10):866–9.
Bhatt ID, Rawat S, Badhani A, Rawal RS. Nutraceutical potential of selected wild edible fruits of the Indian Himalayan region. Food Chem. 2017;215:84–91.
Pokuri VK, Kumar CU, Pingali U. A randomized, double-blind, placebo-controlled, crossover study to evaluate analgesic activity of Terminalia chebula in healthy human volunteers using a mechanical pain model. J Anaesthesiol Clin Pharmacol. 2016;32(3):329.
Sheng Z, Zhao J, Muhammad I, Zhang Y. Optimization of total phenolic content from Terminalia chebula Retz. fruits using response surface methodology and evaluation of their antioxidant activities. PLoS One. 2018;13(8):e0202368.
Nisar MF, He J, Ahmed A, Yang Y, Li M, Wan C. Chemical components and biological activities of the genus Phyllanthus: a review of the recent literature. Molecules. 2018;23(10):2567.
Ju Y, Xiao B. Chemical constituents of Cyperus rotundus L. and their inhibitory effects on uterine fibroids. Afr Health Sci. 2016;16(4):1000–8.
Yadav K, Kadam P, Patel J, Patil M. Strychnos potatorum: phytochemical and pharmacological review. Pharmacogn Rev. 2014;8(15):61–6.
Siwon J, Verpoorte R, Van Essen GFA, Baerheim Svendsen A. Studies on Indonesian medicinal plants. III. The alkaloids of Coscinium fenestratum. Planta Med. 1980;38(1):24–32.
Rojsanga P, Gritsanapan W, Suntornsuk L. Determination of berberine content in the stem extracts of Coscinium fenestratum by TLC densitometry. Med Princ Pract. 2006;15(5):373–8.
Amalraj A, Pius A, Gopi S, Gopi S. Biological activities of curcuminoids, other biomolecules from turmeric and their derivatives: a review. J Tradit Complement Med. 2017;7(2):205–33.
Gupta A, Kumar R, Bhattacharyya P, Bishayee A, Pandey AK. Terminalia bellirica (Gaertn.) Roxb. (Bahera) in health and disease: a systematic and comprehensive review. Phytomedicine. 2020;77:153278.
Rashed K. Terminalia bellirica Roxb.: an important medicinal plant: a review. South Asian J Agric Sci. 2021;1(2):102–5.
Bhardwaj S, Chauhan V, Mishra D. A psychopharmacological research of Cassia auriculata.
Prateeksha, Yusuf MA, Singh BN, Sudheer S, Kharwar RN, Siddiqui S, et al. Chrysophanol: a natural anthraquinone with multifaceted biotherapeutic potential. Biomolecules. 2019;9(2):68.
Bhor AB, Gaikwad VJ, Bodake SN. A pharmacological review on Cassia auriculata. Int Res J Mod Eng Technol Sci. 2022.
Varghese A, Savai J, Pandita N, Gaud R. In vitro modulatory effects of Terminalia arjuna, arjunic acid, arjunetin and arjungenin on CYP3A4, CYP2D6 and CYP2C9 enzyme activity in human liver microsomes. Toxicol Rep. 2015;2:806–16.
Amalraj A, Gopi S. Medicinal properties of Terminalia arjuna (Roxb.) Wight & Arn.: a review. J Tradit Complement Med. 2017;7(1):65–78.
Gupta S, Bishnoi JP, Kumar N, Kumar H, Bishnoi CJ. Terminalia arjuna (Roxb.) Wight & Arn.: competent source of bioactive components in functional food and drugs. Pharma Innov J. 2018;7(3):223–31.
Gupta A, Shaikh AC, Chaphalkar SR. Exploration of active metabolites from Aegle marmelos and Emblica officinalis for determining their immunosuppressive properties. J Prog Res Biol. 2016;3(1):119–26.
Zhang R, Guo Q, Kennelly EJ, Long C, Chai X. Diverse alkaloids and biological activities of Fumaria (Papaveraceae): an ethnomedicinal group. Fitoterapia. 2020;146.
Kumari S, Anmol, Bhatt V, Suresh PS, Sharma U. Cissampelos pareira L.: a review of its traditional uses, phytochemistry, and pharmacology. J Ethnopharmacol. 2021;274
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