Sushruta Samhita Chikitsasthana Chapter 11 Prameha Cikitsitam (Treatment of Diabetes)

The 11th chapter of Chikitsasthana of Sushruta Samhita is named as Prameha Cikitsitam Adhyaya. This chapter deals with Treatment of Diabetes.

अधाता: प्रमेहचिकित्सितव्याख्यास्यामः।।१।।
यद्योवाचभगवान्धन्वन्तरि।।२।।

We will now expound Pramcha chikitsa – treatment of diabetes; as revealed by the venerable Dhanvantari.

Prameha bheda – Kinds of diabetes

द्वौप्रमेहौभवता – सहजोऽपथ्यनिमित्ताश्च।तत्रसहजोमातृपितबीजदोषकतः,अहिताहारजोऽपध्यनिमित्तः।तयोःपूर्वेणोपद्भुतःकशोरूक्षोऽल्पाशीपिपासुभृशंपरिसरणशीलाभवति;उत्तरेणस्थूलोबह्वाशीस्निग्धःशय्यासनस्वपशीलःप्रायेणेति।।३।।

Prameha is of two types. They are –

1. Sahaja Prameha – caused due to hereditary / congenital causes and
2. Apathya Nimittaja Prameha – caused due to improper / unhealthy foods

Sahaja Prameha is caused due to Bija Dosha i.e. defects of the seeds – sperms and ovum of father and mother respectively.

Ahita Aharaja or Apathya Nimittaja Prameha is caused due to excessive consumption of unhealthy foods.

In Sahaja Prameha, below mentioned features are evident in the person who is having the disease earlier –

–        patient is lean,

–        he is emaciated and dry,

–        he eats very little food and

–        is thirsty and

–        always wanders around

In Apatya Aharaja Prameha, the below mentioned features are generally evident –

–        the patient is obese,

–        he eats more food,

–        is unctuous and

–        always desires to keep lying in the bed,

–        desires to sit and sleep for long periods of time

Cikitsa – Method of treatment

तत्रकशमनपानप्रतिसंस्कृताभिःक्रियाभिचिकित्सेत,स्थूलमपतर्पणयुक्ताभिः।।४।।

Treatment for lean Prameha patients – For lean patients, suitably processed foods and drinks, made nutritious in accordance to their liking should be administered.

Treatment for obese Prameha patients – For obese patients, fasting should be advised. Other suitable methods like dietetic control, purificatory therapies, indulgence in physical activities / exercises etc. should be administered. By administering all these, the obese persons should be made thin.

Apathya – Unsuitables

सर्वएवचपरिहरेयुःसौवीरकतुषोदकशुक्तमैरेयसुरासवतोयपयस्तैलपतेक्षुविकारदधिपिष्टानाम्लयवागूपानकानिग्राम्यानूपौदकमांसानिचेति।।५।।

All the patients of Prameha should avoid the below mentioned things –

–        use of fermented beverages like sauviraka, tusodaka, sukta, maireya, sura, asava etc.

–        use of water, milk, oil and ghee in excess,

–        use of products of sugarcane juice,

–        use of curds,

–        use of foods prepared from flour,

–        consumption of sour yavagu – thick gruel and

–        consumption of panaka – syrups and

–        consumption of meat of domestic and aquatic animals

Pathya – Suitables

ततःशालिषष्टिकयवगोधूमकोद्रवोद्दालकाननवान्भुञ्जीतचणकाढकीकुलत्थमुद्रविकल्पेन,तिक्तकषायाभ्यांचशाकगणाभ्यांनिकुम्भेदीसर्षपातसीतैलसिद्धाभ्यां,बद्धमूत्राजाङ्गलैमासैरपहृतमेदोभिरनम्लेरघृतैश्चेति।।६।।

Patients of Prameha should consume foods prepared from the below mentioned –

–        old sali,

–        swastika rice,

–        yava,

–        godhuma,

–        kodrava or

–        uddalaka

These foods should be taken along with any of the below mentioned –

–        soup etc. of canaka, adhaki, kulattha and mudga,

–        vegetables predominant in bitter and astringent tastes,

–        groups of vegetables and

–        oils of nikumbha, ingudi, sarsapa and atasi

Meat of animals living in desert-like regions from which fat has been removed should be consumed by the patients of prameha having obstruction to urination. It should be consumed without adding ghee and sours.

Cikitsa — Treatments

तत्रादितएवंप्रमेहिणंस्निग्धमन्यतमेनतैलेनप्रियङ्ग्वादिसिद्धेनवाघृतेनवामयेत्प्रगाढंविरेचयेच्चविरेचनादनन्तरंसुरसादिकषायेणास्थापयेन्महौषधभद्रदारुमुस्तावापेनमधुसैन्धवयुक्तेन,दह्यमानंचन्यग्रोधादिकषायेणनिस्तैलेन।।७।।

Oleation therapies should be given to the obese patient of prameha in the beginning itself. It should be done by administering with any medicated oil or medicated ghee prepared and processed using herbs belonging to  Priyañgvādi Gana.

Following this, he should be administered with those herbs which would cause more bouts of vomiting and purgation.

Asthapana Vasti i.e. decoction enema should be administered after purgation. It should be given using decoction of herbs belonging to Surasadi Gana added with paste of Mahaushadha, Bhadradaru and Musta, along with honey and rock salt.

Decoction prepared with herbs belonging to Nyagrodhadi Gana should be administered as enema without adding oil if the patient is having a burning sensation.

Mehahara yogas: Anti-diabetic recipes

ततःशुद्धदेहमामलकरसेनहरिद्रांमधुसंयुक्तांपाययेत्,त्रिफलाविशालादेवदारुमुस्तकषायंवा,शालकम्पिल्लकमुष्कककल्कमक्षमात्रंवामधुमधुरमामलकरसेनहरिद्रायुतं,कुटजकपित्थरोहीतकविभीतकसप्तपर्णपुष्पकल्कंवानिम्बारग्वधसप्तपर्णमूर्वाकुटजसोमवृक्षपलाशानांवात्वक्पत्रमूलफलपुष्पकषायाणि,एतेपञ्चयोगाःसर्वमेहानामपहन्तारोव्याख्याताः।।८।।

Any one of the below mentioned recipes should be administered to the patient whose body has been purified –

1. Amalaka – Emblica officinalis juice added with Haridra – turmeric powder and honey
2. Decoction prepared from the below mentioned herbs –

–        Triphala

–        Visala

–        Devadaru and

–        Musta

3. One Aksa (10 grams) each of Kala, Kanipillaka and Muskaka should be licked by adding the below mentioned to it –

–        honey,

–        sweet substances like sugar and jaggery,

–        juice of Amalaka and

–        powder of Haridra

4. Paste of flowers of the below mentioned herbs should be consumed –

–        kutaja,

–        kapittha,

–        rohitaka,

–        vibhitaka and

–        saptaparna,

5. Decoction prepared from the bark, leaves, roots, fruits or flowers of the below mentioned ingredients should be consumed adding honey to it –

–        nimba,

–        aragvadha,

–        saptaparna,

–        mürva,

–        kutaja and

–        somavrkşa

 The above mentioned five recipes are useful in curing all varieties of prameha.  

Viseşa yoga – Recipes special to each kind

विशेषश्चातऊध्य – तत्रोदकमेहिनपारिजातकषायंपाययेत्,इक्षुमेहिनवैजयन्तीकषाय,सुरामेहिनंनिम्बकवाय,सिकतामेहिनंचित्रककषार्य,शनैर्मेहिनंखदिरकषायं,लवणमेहिनंपाठाऽगुरुहरिद्राकषाय,पिष्टमेहिनंहरिद्रादारुहरिद्राकषार्य,सान्द्रमेहिनसप्तपर्णकषाय,शुक्रमेहिनंदूर्वाशवलपलबहठरनकसेरुककषायंककुभचन्दनकषायंवा,फेनमेहिनंत्रिफलारग्वधमृद्वीकाकषायंमधुमधुरमिति;पैत्तिकेषुनीलमेहिनंशालसारादिकषायमश्वत्थकषायंवापाययेत्,हरिद्रामेहिनराजवृक्षकषायं,अप्लमेहिनंन्यग्रोधादिकषाय,क्षारमेहिनमनिष्ठामेहिनमञ्जिष्ठाचन्दनकषायं,शोणितमेहिनगुडूचीतिन्दुकास्थिकाश्मर्यखजूरकषायंमधुमिश्रं;अतऊर्ध्वमसाध्येष्वपियोगान्यापनार्थवक्ष्यामः,तद्यथा सपिहिनंकुष्ठकुटजपाठाहिङ्गकटुरोहिणीकल्कंगुडूचीचित्रककषायेणपाययेत्,वसामेहिनमग्रिमन्थकषायंशिशपाकषायंवा,क्षौद्रमेहिनंकदरक्रमुककषाय,हस्तिमेहिनतिन्दुककपित्थशिरीषपलाशपाठापूर्वादुःस्पर्शाकषायंमधुमधुरंहस्त्यश्वशूकरखरोष्ट्रास्थिक्षारंचेति;त्रिफलाकषाय,दह्यमानमौदककन्दक्वाथसिद्धायवागूक्षीरेक्षुरसमधुरांपाययेत्।।९।।

The below mentioned recipes are specific for usage in particular types of prameha. Therefore, patients suffering from different kinds of prameha shall be administered the below mentioned specific kinds of recipes.

Kaphaja meha – For prameha predominantly caused by aggravated kapha

Pittaja meha – For prameha predominantly caused by aggravated pitta

Vataja meha – For prameha predominantly caused by aggravated vata

The pramehas caused by predominant aggravation of vata are said to be incurable. Further on, the recipes for use in these incurable pramehas will be described for controlling the disease.

In any variety of prameha, if there is associated burning sensation, yavagu i.e. thick gruel should be given to the patient. This yavagu should be prepared with decoction of tubers of plants growing in water. The gruel should be added with milk, sugarcane juice and sweets like sugar or jaggery.

Anya yoga – Other formulae

ततःप्रियडूग्वनन्तायूथिकापद्यात्रायन्तिकालोहितिकाम्बष्ठादाडिमत्वकूशालपणीपद्यतुङ्गकेशरधातकीवकुलशाल्मलीश्रीवेष्टकमोचरसेवरिटानयस्कतीर्लेहानासाकुति :ङ्गाटकगिलोड्यविसमृणालकाशकसेरुकमधुकामजप्वसनतिनिशककुभकट्वङ्गरोप्रगल्लातकपलाशचर्मवृक्षगिरिकर्णिकाशीतशिवनिधुलदाडिमाजकर्णहरिवनराजादनगोपधोण्टाविकङ्कतेषुवा;यवाअविकारांश्चसेवेत;यथोक्तकषायसिद्धांयवागूचास्मैप्रयतकषायाणिवापातुम्।।१०।।

Different formulations like asava (fermented infusions), arista (fermented decoction), ayaskriti and leha (confections) can be prepared from the below mentioned ingredients and consumed –

–        Priyangu,

–        Anañtä,

–        Yuthikä,

–        Padma,

–        Trayantika,

–        Lohitaka,

–        Manjistha,

–        Ambastha,

–        Dadima tvak,

–        Saliparni,

–        Padma,

–        Turnga (punnāga),

–        Kesara (nāgakesara),

–        Dhataki,

–        Bakula,

–        Salmali,

–        Srivestaka and

–        Mocarasa

The same recipes may also be prepared from the below mentioned ingredients and consumed –

–        Srngātaka,

–        Gilodya,

–        Bisa,

–        Mrīņāla,

–        Kaseruka,

–        Madhuka,

–        Amra,

–        Jambu,

–        Asana,

–        Tinisa,

–        Kakubha,

–        Katvanga,

–        Rodhra,

–        Bhallātaka,

–        Paläsa,

–        Carmavýkșa,

–        Girikaiņika

–        Sītasiva,

–        Nicula,

–        Dädima,

–        Ajakarna,

–        Harivěkșa (iñdravſkșa),

–        Rājādana,

–        Gopa,

–        Ghontā and

–        Vikankata.

Apart from this, foods prepared from yava – barley should be eaten. Yavagu or Kashaya prepared as described earlier should be given for drinking.

महाधनमहिताहारमौषधद्वेषिणमीश्वरंवापाठाभयाचित्रकप्रगाढमनल्पमाक्षिकमन्यतममासर्वपाययेत्,अङ्गारशूल्योपदंशवामाध्वीकमभीक्ष्णं,क्षौद्रकपित्थमरिचानुविद्धानिचास्मैपानभोजनान्युपहरेत्,उष्ट्राश्वतरखरपुरीषचूर्णानिचास्मैदद्यादशनेषु;हिङ्गसैन्धवयुक्तैषैःसार्षपैश्चरागैर्भोजयेत्;अविरुद्धानिचास्मैपानभोजनान्युपहरेद्रसगन्धवन्तिच;प्रवृद्धमेहास्तुव्यायामनियुद्धक्रीडागजतुरगरथपदातिचर्यापरिक्रमणान्यस्त्रोपास्त्रेवासेवेरन्।।११।।

The below mentioned recipes are administered to the Prameha patients who are very rich and who indulge in unsuitable and unhealthy foods, who also hate taking medicines or to those who are kings or nobles who lead comfortable and luxurious life –

–        asava (fermented infusion) prepared from more of patha, abhaya and citraka added with more quantity of honey for drinking,

–        sauces prepared from meat roasted in burning coal should be given or 

–        madhvika i.e. wine prepared from honey should be given in more quantities for drinking,

–        foods and drinks prepared and processed with honey, kapittha and marica should be given

–        powder of dry dung of camel, mule or ass should be consumed with yusa – soup after adding hingu – asafoetida, saindhava – rock salt and sarsapa – mustard to it,

–        foods which are suitable and having good taste and smell should be served for eating

The patient should indulge daily in the below mentioned, when the disease has greatly increased –

–        indulgence in physical activities,

–        wrestling,

–        sports,

–        riding elephants, horses and / or chariots,

–        indulgence in the work of foot soldiers,

–        brisk walking,

–        archery etc.

अधनस्त्वबान्धवोवापादत्राणातपत्रविरहितोभैक्ष्याशीग्रामैकरात्रवासीमुनिरिवसंघतात्मायोजनशतमधिकंवागच्छेत्,महाधनोवाश्यामाकनीवावृत्तिरामलककपित्थतिन्दुकाश्मन्तकफलाहारोमगैःसहवसेत्,तन्मूत्रशकद्धक्षःसततमनुव्रजेद्गाः,ब्राह्मणोवाशिलोवत्तिर्भूत्वाब्रह्मरथमुद्धरेत्,कृषेत्सततमितरःखनेद्वाकूपं,कशंतुसततंरक्षेत्।।१२।।

If the patient suffering from prameha does not have money, he should do the below mentioned things –

–        go on a journey on bare foot for a distance of one hundred yojana (1 yojana = 6 miles approximately), without taking money or any of his relatives with him,

–        without using footwear and umbrella while traveling,

–        lead a life only on foods (eating foods) obtained through begging,

–        stay at a village only for one day during the course of his journey, and

–        lead a life of an ascetic and

–        live with control over self

If the patient is rich, he should do the below mentioned things –

–        consume foods prepared from śyāmaka or nīvara, along with

–        fruits like āmalaka, kapittha, tiñduka and aśmañtaka and

–        stay in the company of animals in their pen or shed,

–        consume the urine and dung of these animals and also

–        move along with these animals always

The patients of Prameha who are Brahmanas should adopt the profession of sculptor. Owning that profession, he should carve a Brahmaratha – chariot of God.

The others should constantly get indulged in ploughing fields or digging wells.

Emaciated prameha patients should be constantly protected without allowing him to get indulged in any physical work.

भवतिचात्र —

One verse here

अधनोवैद्यसन्देशादेवंकुर्वन्नतन्द्रितः।।
संवत्सरादन्तराद्वाप्रमेहात्प्रतिमुच्यते।।१३।।

The patients of prameha who are not rich would get cured of the disease in one year or within one year if they adhere to these regimens including proper foods and activities, following the advice of the physician without any lassitude.

इतिसुश्रुतसंहितायांचिकित्सास्थानेप्रमेहचिकित्सितंनामैकादशोऽध्यायः।।११।।

Thus ends the eleventh chapter by name Prameha cikitsita in Chikitsa Sthāna of Suśruta Samhita.