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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 4  |  Issue : 2  |  Page : 46-53

An overview on Siddha treatment guideline for diabetes mellitus: a non-communicable disease


Siddha Central Research Institute, Central Council for Research in Siddha, Arumbakkam, Chennai, Tamil Nadu, India

Date of Submission18-Apr-2022
Date of Acceptance06-Sep-2022
Date of Web Publication23-Jan-2023

Correspondence Address:
Dr. Panneerselvam Thenmozhi
Siddha Central Research Institute (Central Council for Research in Siddha, Ministry of AYUSH, Govt. of India), Anna Govt. Hospital Campus, Arumbakkam, Chennai - 600 106, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrsm.jrsm_13_22

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  Abstract 

Diabetes mellitus is a heterogeneous metabolic disorder characterized by altered carbohydrate, lipid, and protein metabolism which causes hyperglycemia resulting from insufficient insulin secretion, insulin action, or both. The WHO projects that diabetes will be the seventh leading cause of death in 2030. Diabetes can be treated, and its consequences avoided or delayed with diet, physical activity, medication, and regular screening and treatment for complications. It has various synonyms (Verupeyar) in Siddha system of medicine such as Miguneer, VeguMoothiram, InippuNeer, MeghaNeer, and Madhumegham. The Siddha treatment guideline for diabetes discusses the following headings: Definition (Noi iyalbu), Synonyms (Veru peyar), Etiology (NoiVarum vazhi), Clinical features (Noi Kurikunangal), Disease classification (Noi Enn), Investigations (Ennvagai Thervu), Differential diagnosis, Humoral changes (Thirithoda Marupadugal), Management and treatment plan (Maruthuva Vazhimurai), Pharmacological treatment regimen, Non-pharmacological treatment regimen, Dietary regimen, Karpam, Varmam, Yogic practices, Prevention, Post-clinical care, and the single herbs used in the Siddha system of medicine which has a potent anti-diabetic, hypoglycemic activity.

Keywords: Diabetes mellitus, Madhumegham, Neerizhivu, Siddha, Thirithodam, treatment guideline


How to cite this article:
Thenmozhi P, Lavanya A, Kannan M, Shyamala R, Sathiyarajeswaran P. An overview on Siddha treatment guideline for diabetes mellitus: a non-communicable disease. J Res Siddha Med 2021;4:46-53

How to cite this URL:
Thenmozhi P, Lavanya A, Kannan M, Shyamala R, Sathiyarajeswaran P. An overview on Siddha treatment guideline for diabetes mellitus: a non-communicable disease. J Res Siddha Med [serial online] 2021 [cited 2023 Feb 6];4:46-53. Available from: http://www.jrsm.in/text.asp?2021/4/2/46/368439


  Introduction Top


Diabetes is a heterogeneous metabolic disorder characterized by altered carbohydrate, lipid, and protein metabolism, which causes hyperglycemia resulting from insufficient insulin secretion, insulin action, or both.[1] It is one of the refractory diseases identified by the Indian Council of Medical Research for which an alternative medicine is a need for the treatment. Diabetes mellitus has become a growing problem in the contemporary world. India has today become the diabetic capital of the world with over 20 million with diabetes, and this number is likely to increase to 57 million by 2025.[2]

The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014.[3] The global prevalence of diabetes among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014.[3] Almost half of all deaths attributable to high blood glucose occur before the age of 70 years. The WHO projects that diabetes will be the seventh leading cause of death in 2030.[3] Healthy diet, regular physical activity, maintaining a normal body weight, and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes. Diabetes can be treated, and its consequences avoided or delayed with diet, physical activity, medication, and regular screening and treatment for complications.

The Siddha treatment guideline for diabetes signifies the following headings: Definition (Noi iyalbu), Synonyms (Veru peyar), Etiology (NoiVarumvazhi), Clinical features (Noi Kurikunangal), Disease classification (Noi Enn), Investigations (Ennvagai Thervu), Differential diagnosis, Humoral changes (Thirithoda Marupadugal), Management–Treatment plan (Maruthuval Vazimurai), Pharmacological treatment regimen, Non-pharmacological treatment regimen, Dietary regimen, and single herbs used for the disease.


  Siddha Treatment Guideline For Diabetes Mellitus Top


Definition (Noi iyalbu)

It is a clinical condition characterized by frequent urination resulting in deterioration and diminution of seven thathus (body constituents) and loss of weight.

Synonyms (Veru peyar)

It has various synonyms (Verupeyar) in the Siddha system of medicine like Miguneer, VeguMoothiram, InippuNeer, MeghaNeer, and Madhumegham. The disease is caused due to improper diet such as excessive intake of mucilaginous and sweet taste foods, excessive sexual activity, stress, decreased physical activity, hereditary, and stimulation of Moolatharam by the other excited Vayus (Keelnokkunkal, Melnokkunkal, Paravukal).

Clinical features (Noi Kurikunangal)

The clinical features (Noikurikunangal) can be explained as follows: early stage: polyuria, polyphagia, polydipsia, loss of weight, insomnia, fatigue, giddiness, dyspnea, perspiration, dryness of the skin, and dryness of tongue; later stage: body weight decreases day by day and it leads to further complications and other related diseases.[4],[5]


  Classification of Diabetes Mellitus: Noienn Top
[4],[5]

In the Siddha system of medicine, diabetes mellitus is classified into Vali, Azhal, and Aiyam.

Vali 4: 1. Neimananeer, 2. Pasumananeer, 3. Seezhmananeer, 4. Sadhaimananeer;

Azhal 6:1. YanaikozhupuMananeer, 2. KatrazhaiMananeer, 3. ChunnaMananeer, 4. InnipuMegam, 5. PalinguNeer, 6. MuyalKuruthiNeer;

Aiyam 10: 1. Iyaneer, 2. Thuimaineer, 3. Moolaineer, 4. Ilaneer, 5. Ulneer, 6. Thavalaneer, 7. Kazhuneer, 8. Thenneer, 9. Uppuneer, 10. Kavichuneer.


  Invesigations (Envagaithervu) Top
[6],[7]

It is the method of disease diagnosis in Siddha. This includes the eight methods of physical examination of a patient. It consists of eight types of physical examination and is called “Envagai thervu.” These include: i. tongue (Naa), ii. color (Niram), iii. speech (Mozhi), iv. eyes (Vizhi), v. stool (Malam), vi. urine (Moothiram), vii. touch (Sparisam), and viii. pulse (Naadi). The investigations (Envagai Thervu) are given in [Table 1].
Table 1: Invesigations (EnvagaiThervu)

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  Humoral Pathogenesis: Mukkutra Verupadu Top
[5],[6],[7]

The body is balanced by the three humors, namely, Vali, Azhal, and Iyam, which has a direct relation with the five primordial elements and six tastes. Any derangement in these three humors results in the formation of disease. Derangement of this is the humoral pathology.

Based on the derangement and their relationship with the taste and pancha bhootham, the choice of drug is determined. Due to inherent and acquired activities, there is an imbalance in Aiyam. It does imply an imbalance in other two humors (Vali and Azhal) and causes derangement of Dasavayu and deterioration of seven Udalthathukkal (Udalthathukkal are the physical constituents, or the seven tissues viz. Saaram, Senneer, Oon, Konzhuppu, Enbu, Moolai and Sukkilam), which causes the disease and other complications.


  Management Of Neerizhivu (Diabetes Mellitus) Top


The aim of the treatment focusses mainly to restore the principally transformed humor. In diabetes mellitus, Vali, Azhal, and Aiyam are affected. An acquired and inherent cause increases the Aiyam that affects the other thathu. Avalambagam and kilethagam (types of Aiyam) get affected. The drug that decreases the Aiyam and that has a bitter and astringent taste is chosen to treat diabetes mellitus. Azhal gets decreased. Bio-combustion is challenged. There is a decrease in digestive fire and thus the body does not receive the nourishment from the food that leads to deterioration. AnarPithamm, RanjakaPitham, SadhagaPitham (types of Azhal) get affected. Drug that increases the digestive fire and the drug that has a bitter and astringent property are given.

Vali is decreased. Dasavayukkal (types of Vali) gets affected. Increased Aiyam and decreased Azhal affect the Vali. It leads to the further complications of the disease. The drugs that nourish the body constituents and prevent from further deterioration are chosen.


  Treatment Plan (Maruthuval Vazimurai) Top


Neerizhivu

Due to Aiyam type of physical constitution, sedentary lifestyle, increased intake of mucilaginous and sweet taste food, Azhal decreased and Aiyam is increased. The treatment plan for diabetes melitus (Neerizhivu) is depicted in [Figure 1].
Figure 1: Treatment plan for diabetes mellitus (Neerizhivu)

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  Pharmacological treatment Top


The treatment primarily aims

❖ To restore the affected Thathu (Vali, Azhal, Aiyam) and Vayukkal;

❖ To enrich the deteriorated seven body constituents;

❖ To prevent from further complications.


  PROCEDURE 1 Top


Therapeutic purgation

To restore the affected thathu, therapeutic purgation is given. One among the following medicines can be chosen based on the kutram (Vali, Azhal, Aiyam) affected: Sanjeevi Maathirai (100 mg)—1–2 tab. at early morning with white goat’s milk,[1] Agathiyar Kuzhambu—130 mg with 5 g of chukku karkam at early morning,[1] Meghanatha Thailam—8–30 mL early morning in empty stomach,[1] Merugulli Thailam—10–20 mL at early morning in empty stomach.[1]


  PROCEDURE 2 Top


The following are the list of medicines given related to the signs and symptoms of the patient for the management of diabetes mellitus. The choice of drugs to be chosen related to the (Ezhuudarkattukal) 7 body constituents affected [Table 2].
Table 2: Choice of drugs to be chosen related to the (Ezhuudarkattukal) seven body constituents affected

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  Non-Pharmacological Treatment Top


Dietary regimen[16],[22],[24]

The diet that nourishes and improves the seven body constituents is given and the diet that controls the excess excretion of urine is advised. Taste that can be added are spicy, astringent, and bitter. The taste that should be avoided are sweet, sour, and salt. Food pattern such as hot, light, spicy, dry food can be added. Cool, heavy, sweetened, soft, unctuous, and viscous food can be avoided.


  Diet—to Add Top


Grain and pulses: Gothumai, Samba Gothumai, Kezhvaragu, Thinai, Saamai, Mungilarasi, Milagusamba Rice, Mani Samba Rice, Karunsamba Rice, Kaikuthal Rice, Barley (Hordeum vulgare), Thuvarai (Cajanus cajan), Sirupayaru (Vigna mungo), Karumpayaru, Kondaikadalai, Kollu (V. unguiculeta). Greens: Vendhaya Keerai (Trigonella foenum-graecum), Keeraithandu (Amaranthus tricolor), Karivepillai, Arakeerai, Sirukeerai (A. tricolor), Kothamalli (Coriandrum sativum), Pudhina (Mentha arvensis), Pirandai, Vasalai, Kodivasalai (Basella alba), Puliyarai (Oxalis corniculata), Thoothuvalai (Solanum trilobatum), Allipoo, Sevalli poo (Nymphaea nouchali). Vegetables: Midhipagal (Momordica muricata), Kovai (Coccinia grandis), Sundai, Manathakkali (S. americanum), Katharai (S. melongena), Murungai (Moringa oleifera), Surai, Pudalangai (Trichosanthes cucumerina), Vellari (Cucumis sativus), Mullangi (Raphanus raphanistrum), Vidhaimudhiraavarai (Lablab purpureus), Vendai (Abelmoschus esculentus), onion (Allium cepa), tomato (S. lycopersicum), Maapinju (Mangifera indica), Karunaikizhangu, Vazhaipinju (Musa × paradisiaca), Pala Pinju (Artocarpus heterophyllus). Fruits: Naval (Syzygium cumini), Nelli (Phyllanthus emblica), Elumichai (Citrus limon), Koyya (Psidium guajava), Kovai (C. grandis), Madhulai (Punica granatum), Athipazham (Ficus racemosa), Doothalampazham, Peareetchangai (Phoenix dactylifera). Animal products: Nattukozhi, Kaanaankozhi, Kaadai, Kavuthari, Pallaiyattuiraitchi, Naattukozhimuttai, Vayalnandu, NaatupasuNei, Viral Meen. Nuts and seeds: Verkadalai (Cicer arietinum), Aalividhai (Linum usitatissimum), Dharpoosanividhai (Citrullus lanatus), Thulasividhai (Ocimum tenuiflorum), Poosanividhai (Benincasa hispida), Ellu, Badam Paruppu. Spices, salts, and sweetness: Vendhayam (T. foenum-graecum), Manjal (Curcuma longa), Chukku (Zingiber officinale), Inji (Z. officinale), Elam (Elettaria cardamomum), KurosaniOmam (Hyoscyamus niger), Lavangapattai, Seeragam (Cuminum cyminum), Milagu (Piper nigrum), Venmilagu (Piper nigrum), Perungayam (Narthex asafoetida), Jathipathiri (Myristica fragrans), Jathikkai (M. fragrans), Poondu (A. sativum), Kothamalli (C. sativum), Thirikadugu, Indhuppu. Then, Kasakasa, Patchaikarpooram, Kumkumapoo. Oils: sesame oil, gingelly oil. Drinks: Ilaneer (Cocos nucifera), butter milk, Neeragaram, KainthuaariyaNeer, MukkarpangukaindhuaariyaNeer, hot water stored in Panjaloga vatu and vellipaathiram, NavalverNeer, KarunkaliverNeer, IlavuverNeer, NannariverNeer (Hemidesmus indicus). Food: Freshly prepared warm food, Koogaikizhangu, Maa (Mangifera indica), ParuppuSadham.

Diet restrictions

Grain and pulse: Savvarisi, Ulundhu (Vigna radiata). Vegetables: starchy vegetables such as beets, carrots (Daucus carota), green peas (Pisum sativum), plantain, sweet potatoes (Ipomoea batatas), potatoes (S. tuberosum), corn (Zea mays), sugar cane (Saccharum officinarum), PeruvalliKizhangu (Dioscorea bulbifera), SiruvalliKizhangu (Dioscorea alata), Kottaimudhirnthaavarai (L. purpureus), Pazhayapuli (Tamarindus indica). Fruits: grapes (Vitis vinifera), banana (Musa × paradisiaca), water melon (Citrullus lanatus), Paereetchu (P. dactylifera), Sitreechu (P. sylvestris), Palapazham (Artocarpus heterophyllus). Animal product: Vaankozhi Kari, KadalkellitruMeeen, KaruvavvalMeen, MattuIraitchi, SemmariyattuIraichi. Nuts and seeds: cashew nuts (Anacardium occidentale). Spices, salty, and sweetness: KarumbuVellam (Saccharum officinarum), UrundaiVellam. Oil: corn oil (Zea mays), soya bean oil (Glycine max). Food: over cooked rice, sweetened food, fried food, alcohol. Drinks: PazhayaIlaneer (Cocos nucifera).

Varmam:[18] BoomiKaalam, PidariVarmam, AamaiKaalam, Udhirakaalam, KozhunduVarmam, AlliVarmam, UllangalVellaiVarmam, VayuKaalam, NaaganapootuVarmam. If obesity present Rt. BoomiKaalam, ManjalVarmam, KaalkavuliVarmam, KaalkarandaikannuVarmam, UrumiKaalam.

Karpam[25]: VembuKarpam, VallaikodiKarpam, AyilpattaiKarpam, PoornaChandrodhayam, AyabringarajaKarpam, KarisalaiKarpam, AsogupattaiKarpam, ArugampulKarpam, InjiKarpam.

Yogam[25]: AttangaYogam: Aiyamam, Nyamam. Asanam: Surya Namaskar 10-step module 12 times twice a day. Standing asanas: Ardhakatisakrasanam, Trikonasanam, Parivritta Trikonasanam. Sitting asanas: Kukudasanam, Ustrasanam, Patchimotasanam, Vekrasanam, Ardhamatsyendrasanam, Seshangasana, Yoga mudra, Matchasanam, Suptavajrasanam. Supine position: Navasanam, Pavanamuktasanam, Halasanam, Sarvangasanam, Viparitakarni. Prone position: Bhujangasanam, Salabhasanam, Dhanurasanam. Relaxing position: Savasanam, Makarasanam, Balasanam. Pranaymam: Naadi Sudhdhi Pranayamam 9–27 rounds 2–4 times a day in empty stomach. Meditation: meditative postures: Padmasanam, Vajrasanam.

External therapies[26]: PodiThimirdhal: It must be done using herbal formulations. Vedhu (Kaal Sutigai) with herbs. Thokkanam and Thadaval Muraigal

[Table 3] represents the single herbs used in the Siddha system of medicine which has a potent anti-diabetic, hypoglycemic activity.
Table 3: Single herbs used for diabetes mellitus

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Financial support and sponsorship

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Conflicts of interest

There are no conflicts of interest.





 
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Abstract
Introduction
CLASSIFICATION O...
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Pharmacological ...
PROCEDURE 1
PROCEDURE 2
Siddha Treatment...
Classification o...
Invesigations (<...
Non-Pharmacologi...
Diet—to Add
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Management Of
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