Madhumegam (Diabetes Mellitus) in Siddha system

  1. Introduction:

In Siddha system of medicine, diseases are classified into 4448 types. According to sage Yugi Vaithiya Chinthaamani, Meganoi is classified into 20 types. Madhumegam is one among them, which comes under Pitha type called Thithippu Neer and it could be correlated with Diabetes Mellitus in modern system.

1.1. Definition:

Mathumegam is a clinical condition characterized by frequent and excessive passage of urine with ‘sweetness’ eventually leading to deterioration of seven body constituents.

1.2. Epidemiology

As per the WHO estimate in 2014, the number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014. The global prevalence of diabetes among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014. Diabetes prevalence has been rising more rapidly in middle- and low-income countries. Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. In 2012, an estimated 1.5 million deaths were directly caused by diabetes and another 2.2 million deaths were attributable to high blood glucose. Almost half of all deaths attributable to high blood glucose occur before the age of 70 years. WHO projects that diabetes will be the 7th leading cause of death in 2030.

The incidence of diabetes is increasing rapidly among urban women in India, putting them at risk of various other diseases resulting in premature mortality. Prevalence of diabetes in 10.2%  and 9.2% among urban men and rural men respectively. Amongst women 8.0% and 6.3% in urban and rural respectively as per the National Family Health Survey 2015-16 in Tamil Nadu. The diabetes incidence is significantly associated with body mass index, waist circumference, waist-hip ratio, Blood pressure, fasting glucose and cholesterol.

1.3. ETIOLOGY :

  • Excessive indulgence in sex – depletion of total body strength
  • Increased body heat (pitham)
  • Excessive hunger
  • Excessive food intake like ghee, fish, milk, toddy etc,.
  • Physical inactivity
  • Psychosomatic stress
  • Genetic factors

1.4. PATHOGENESIS:

Due to intrinsic and extrinsic factors, the vitiation of Kabam and this is followed by the derangement of vaatham  espcially abanan which affects the body constituents (Udal Kattugal) Finally the function of vaatham, and pitham also altered resulting in derangement of normal structure and functions of the seven body constituents.

1.5. CLINICAL FEATURES     :

  • Excessive Urination
  • Excessive Thirst
  • Excessive Appetite
  • Dry mouth
  • Tiredness
  • Fatigue
  • Irritability
  • Fluctuation of weight
  • Blurring of vision, nausea, headache
  • Burning and spasmodic pain in urethra and dull ache in testis.
  • urine may be cold, slimy to touch, brownish yellow in colour and produces white sediments
  • Ants and flies are attracted to the site of voided urine.
  • When the urine is heated it gives honey odour.

1.6. DIAGNOSIS:

As per Siddha literature the eight types of examination (En vagai thervu) along with the symptoms mentioned above, Madhumegam (Diabetes Mellitus) is diagnosed and  the modern laboratory investigations are also carried out to confirm the diagnosis / prognosis.

1.7. AVATHAIGAL (COMPLICATIONS IN SIDDHA )

Yugimuni has described the complications of Madhumegam as “Avaithaigal”. There are ten avathaigal described one by one as follows:

  • Obesity and dilatation of urethral orifice.
  • Excessive urination, Defect in semen that leads to diminishment of brightness in the body.
  • Dryness of the tongue and distension of the abdomen due to formation and accumulation of excessive gas.
  • Delirium (Toxic condition) supervenes following dehydration due to excessive elimination of tissue fluid.
  • Polyuria, glycosuria and spermatorrhoea.
  • Breathlessness and restlessness.
  • Nausea, tastelessness, labored breathing, exhaustion.
  • Carbuncle and multiple abscess formation
  • Gastroenteritis with worm infestation.
  • Intractable troublesome, pulmonary infections leading to death.

1.8. COMPLICATIONS OF DIABETES MELLITUS

  1. Acute Complications
  • Diabetic ketoacidosis (DKA)
  1. Chronic Complications of Diabetes Mellitus
    1. Micro vascular
      • Retinopathy
      • Macular edema
      • Cataracts
      • Glaucoma
      • Neuropathy
      • Sensory and motor (mono- and polyneuropathy)
      • Autonomic
      • Ulceration of feet
      • Nephropathy
    2. Macro vascular:

      • Coronary artery disease
      • Peripheral vascular disease
      • Cerebrovascular disease
    3. Other:
      • Gastrointestinal (gastro paresis, diarrhea)
      • Genito urinary (uropathy/sexual dysfunction)
      • Dermatitis

1.9. LABORATORY INVESTIGATION:

           1.9.1.   Blood Sugar Levels

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If the patient is a known diabetic, the following tests are to be advised

  • Fasting blood sugar (FBS)
  • Postprandial blood sugar (PPBS)
  • Glycated hemoglobin (HbA1c)
  • Blood urea
  • Serum creatinine
  • Urine protein
  • Haemogram
  • Urine complete examination
  • Lipids (total cholesterol, triglycerides, HDL, LDL)
  • Liver function tests (LFT)

If the patient is not a known diabetic, the following tests can be advised

  • Glucose tolerance test (GTT)
  • Glycated hemoglobin (HbA1c)
  • Blood urea
  • Serum creatinine
  • Urine complete examination
  • Lipids (total cholesterol, triglycerides, HDL, LDL)
  • Liver function test(LFT)
  • ECG

2.0. LINE OF TREATMENT:

2.1. Prevention:

A) Diet :A balanced diet with veggies, fruits, whole grain, beans, fish, lean mean meat, non fat dairy, fiber rich food like salad is suggested. Frequent and portion meals is the best. Plan your plate. Divide the plate into two halves, fill one half with non starchy veggies like Spinach, broccolli. Divide the empty half into two halves again. Fill one half with carbohydrate rich veggies or whole grains and other half with proteins like lean meat or pulses or fish etc. It is myth that diabetics have to cut off sugar completely. One can take sugar and carbs in permissible limits.

B) Exercise : Exercise increases the blood senstivity to insulin stimulates muscle to use glucose. 15 minutes before exercise, diabetics should have some snacks or fruits else the sugar may dip making him/her hypoglycemic. Never exercise during fasting especially empty stomach. If low sugar happens to occur get 15-20 gms of sugar by having glucose tablets or fruits. Avoid foods like chocolates having both sugar and fats.

C) Yogam – Each Yogasanam is indicated for a definite effect in a particular region of the system by stimulating the internal organs to function in a normal way and to coordinate bodily functions. Villaasanam and Mayuraaasanam helps in the treatment of Mathumegam. In Mayuraasanam the presence of conjoined elbow against umbilicus region activates the pancreas to activate more. In Villaasanam the whole abdominal organs including the pancreas are properly tuned and stimulated well by the increase of intra abdominal pressure motivated towards pancreas.

  1. The following Aasanams are advised for controlling Madhumegam (Diabetes mellitus)
  1. Pranayaamam, Padmaasanam, Sugaasanam, Salabaasanam, Dhanuraasanam, Halasanam, Patchimothasanam, Sarvangasanam , Mayuraasanam, Artha machaendhrasanamcapture15
    Rejuvenation / regeneration of cells of pancreas due to abdominal stretching during yoga exercise, which may increase utilization and metabolism of glucose in peripheral tissues, liver, and adipose tissues through enzymatic process. More active practices followed by relaxing ones lead to deeper relaxation than relaxing practices alone, Muscular relaxation, development and improved blood supply to muscles might enhance insulin receptor expression on muscles causing increased glucose uptake by muscles and thus reducing blood sugar. Yoga postures can lead to improvement in the sensitivity of the beta Cells of the pancreas to the glucose signal and also the improvement in insulin sensitivity in turn can be due to the cumulative effect of performing the postures. yoga may also lower oxidative stress and blood pressure; enhance pulmonary and autonomic function, mood, sleep, and quality of life; and reduce medication use in adults with Diabetes Mellitus.2.2. Siddha Management in NIS:

    Restoration of deranged three vital humors by strengthening seven body constituents in diabetic management mentioned in literature.

    Purification and improvisation of blood quality

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    Strengthening muscles and reduction heat formed due to Madhumegam

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    To improve the quality of fat and strengthening bones

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    Symptomatic management for thirst, dryness of tongue, diahorrea, burning sensation and giddiness in diabetes mellitus.

     

    The medicines prescribed for the treatment of diabetes in NIS is a comprehensive therapy which would result in restoration of above conditions.

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    The medicine should be consumed as per the Siddha Physician advice.

    Most of the herbal compound drugs prescribed for diabetes in Siddha system is possessing  antioxidant and immune modulator activity and they plays vital role in the elimination of free radicals. This principle reduces the oxidative stress of cells that leads to physical wellbeing of diabetic individual.

    Certain  phyto chemicals like alkaloids, anthocynidins, curcuminoids, flavanoids, glycosides and organic phenols shows  potent anti diabetic activity in research  and they are integral part of the herbal compounds advised in diabetic management of siddha system

    3.0 Management of Diabetic Complications:

    3.1.) Management of diabetic foot ulcer (Madhumega viranam)

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    Madhumega viranam or diabetic foot ulcer is a significant complication of the Diabetic mellitus which leads to amputation, Septicemia, gangrene etc. Diabetic foot ulcer is the result of metabolic insult in diabetes to the micro and macro blood vessels. Siddha system of medicine has effective answers to the management of Diabetic foot ulcers. Manjitti Kudineer a recent find of the National Institute of Siddha, Chennai is a rediscovery of a potentially efficacious Siddha formulation in the form of decoction administered for the non healing of Diabetic wounds. It effects a remarkable closing and healing of the wounds whereby it reduces morbidity and septic complications including amputation.

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3.2. Diabetic Peripheral Neuropathy:

Diabetic neuropathies are a family of nerve disorders caused by diabetes. People with diabetes can, over time, develop nerve damage throughout the body.  Some people with nerve damage have no symptoms.  Others may have symptoms such as pain, tingling, or numbness, loss of feeling in the hands, arms, feet, and legs.  Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs.

3.2.1. CAUSES OF DIABETIC NEUROPATHY

The causes are probably different for different types of diabetic neuropathy.  Researchers are studying how prolonged exposure to high blood glucose causes nerve damage.

  • Nerve damage is likely due to a combination of factors:
  • Metabolic factors, such as high blood glucose, long duration of diabetes, abnormal blood fat levels, and possibly low levels of insulin
  • Neurovascular factors, leading to damage to the blood vessels that carry oxygen and nutrients to nerves
  • Autoimmune factors that cause inflammation in nerves
  • Mechanical injury to nerves, such as  carpal tunnel syndrome
  • Lifestyle factors, such as smoking or  alcohol use

3.2.2. Siddha Treatment for DPN

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Varmam treatment for DPN is a simple, low-cost and minimum time- consuming procedure. ( Vital points).

Leech Therapy

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Leech therapy is used for treating chronic ulcer like Diabetic ulcer, Vericose Ulcer to let out the impure blood around the wound region. There are 3-4 leeches applied in extensive wound region. Application should be for 20-30 mins. Before leech application the area should be cleaned with water. The leech mouth as a set of 3 jaws that bite into the host fleshes marking Y shaped incision. If leeches do not hold, a prick with sterile needle is made at the sight. A cold light gauze or cotton is kept over the leech when it sucks.  Please check (The leech could be made to roll over paddy husk and sesame powder). It will suck 15ml of blood and thereafter the leech could be used after 15 days.

 

CARBUNCLE:

A carbuncle is a red, swollen, and painful cluster of boils that are connected to each other under the skin. A boil (or furuncle) is an infection of a hair follicle that has a small collection of pus (called an abscess) under the skin. Usually single, a carbuncle is most likely to occur on a hairy area of the body such as the back or nape of the neck. But a carbuncle also can develop in other areas of the body such as the buttocks, thigh, groin, and armpits.

Application of vellai mezhugu over the carbuncles gives good results.

4.0 DIET  :

  • Rice or kanji: Clear Soup, Lemon juice without sugar, hand pounded boiled rice, Mani Samba rice
  • Unripped vegetables : Pahal (Momordica charantia), Atthi (Ficus racemose), Murungai(Moringa oleifera), Surai (Lagenaria sicerarie), Vendai (Hibiscus exculanta), Kathari (Solanum melangena), Chinna Vengayam (Allium cepa), Kovai (Coccinia grandis), Vellai Mullangi (Raphanus sativus).
  • Greens: Neeraarai keerai (Marsilea guadrifolia), Kothamalli (Coriandrum sativum), Puthina (Mentha arvensis), Karivepilai (Murraya koenigii), Kovaipoo (flower of Coccinia grandis), Puliyaarai (Oxalis corniculata), Murungai ( Moringa Oleifera), Vasalai (Portulaca quadrifida), Pon musutai (Rivea ornata), Vallarai (Centella asiatica), Manathakaali (Solanum nigrum), Surai (Lagenaria sicerarie), Kodivasalai (Basella alba), Keerai thandu (Amaranthus gangeticus).
  • Fruits – Koiya (Psidium guajava), Madhulai (Punica granatum), Pappali (Carica papaya), Naval (Zisigium cumini), Nelli (Phyllanthus emblica)
  • Pulses – Ulunthu (Vigna mungo), Paasipayaru (Vigna radiata).
  • Dairy products:  Cow’s butter milk
  • Non-vegetarian diet: Ayirai meen (Loach)

Millets

  1. Eleusine Coracana (Kelvaragu)
  2. Setaria Italica (Thinai)
  3. Panicom Sumatrense (Samai)
  4. Cuscuta reflexa (Kuthirai Vali)

The food made up of above ingredients which having low glycemic index and rich in protein is help in building the muscle. The functional components of this nutrients are mainly Anti-oxidents and Immuno-modulators properties. The millet diet is essential and integral part of diabetic food management.

5.0. DO’S and DONT’S   :

DO’S   :

  •       Sunbath and pranayamam must be practiced over day
  •       Diabetes patients should take adequate rest
  •       They should avoid mental tension
  •       During night it is better to have only half the quantity or food needed

DONT’S

Sweets, bakery products such as cream biscuits, cakes, pastries, concentrated milk    preparations such as beda and burfees etc.,

  • Ice-creams, soft drinks,fruit juices,
  • Tubers like potato, sweet potato,yam,carrot,beetroot and colachasia
  • Saturated fats like vanaspathi, dalda, ghee,and butter.
  • Nuts, dryfruits like pista, badham and mundhiri
  • Fatty meat cuts, organ meat such as heart, liver, kidney, brain, eggyolk.
  • Polished rice, tinned foods, starchy foods, sugar are should be avoided.
  • Fruits such as banana, mango fruits, sapotta, pineapple, jack fruits should be avoided

6.0. Research Publications:

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