Ashtanga Hridayam Chikitsa sthanam Chapter 12: Prameha Chikitsitam Adhyaya (Treatments of diabetes)    

The 12th chapter of Cikitsasthanam of Ashtanga Hridayam is named as Prameha cikitsitam Adhyayah. This chapter deals with the explanation of ‘treatment of diabetes’.

The topics covered in this chapter include –

– Sodhana – purificatory therapy
– Samana – palliative therapy
– Decoctions for Kaphaja Prameha
– Decoctions for Pittaja Prameha
– Pana anna – drinks and food processed with herbs
– Intake of Yava
– Remedies for Kapha-pittaja Prameha
– Trikantakadi taila and Ghrta
– Dhanvantara Ghrta
– Lodhrasava
– Ayaskrti
– Therapies and measures to mitigate kapha and medas
– Silajatu Rasayana
– Measures to be taken by poor patient of prameha
– Treatment for thin patients of prameha
– Prameha Pidaka Cikitsa
– Premonitory symptoms
– Medications for ulcer healing
– Medications for ulcer healing
– Appraisal of use of Shilajatu

Pledge by the author(s)

अथातो प्रमेहचिकित्सितं व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘treatment of diabetes’.  Thus say (pledge) Atreya and other sages.

Shodhana: Purifactory therapy

मेहिनो बलिनः कुर्यादादौ वमनरेचने ।
स्निग्धस्य सर्षपारिष्टनिकुम्भाक्षकरञ्जजैः ॥ १ ॥
तैलस्त्रिकण्टकाद्येन यथास्वं साधितेन वा ।
स्नेहेन मुस्तदेवाह्वनागरप्रतिवापवत् ॥ २ ॥
सुरसादिकषायेण दद्यादास्थापनं ततः ।
न्यग्रोधादेस्तु पित्तार्तं रसैः शुद्धं च तर्पयेत् ॥ ३ ॥
The patient of diabetes who is strong should be initially administered emesis purgation therapies after giving oleation therapy by drinking oil prepared with sarṣapa – Brassica nigra, ariṣṭa – Azadirachta indica, nikumbha – Baliospermum montanum, Terminalia bellerica, karañja – and Pongamia pinnata. Or oil processed with herbs commencing with trikantaka (enumerated in verse 17-18) or with other appropriate herbs (suitable to the doshas).

Afterwards asthapana basti (decoction enema) should be administered using the decoction of herbs of surasadigana (vide, chapter 15 of sutrasthana) added with the paste of musta – Cyperus rotundus, devāhva – Cedrus deodara, nāgara – and Zingiber officinale, with the decoction of herbs of nyagrodhadi gana. For pitta (decoction enema should be given) after these purifactory therapies. He should be nourished with meat soup.

Shamana: Palliative therapy

मूत्रग्रहरुजागुल्मक्षयाद्यास्त्वपतर्पणात् ।
ततोऽनुबन्धरक्षार्थं शमनानि प्रयोजयेत् ॥ ४ ॥
असंशोध्यस्य तान्येव सर्वमेहेषु पाययेत् ।
Mūtragraha – Retention of urine, rujā – pain, gulma – abdominal tumour, kṣaya – depletion of tissues etc. arise from apatarpana (under nourishment) as secondary diseases. Hence in order to protect the patient from these, he should be administered therapies to mitigate the doshas. The same should be administered to those who are unsuitable for purifactory therapy, in all types of diabetes.

Shamana: Palliative therapy

धात्रीरसप्लुतां प्राह्णे हरिद्रां माक्षिकान्विताम् ॥ ५ ॥
दार्वीसुराह्वत्रिफलामुस्ता वा क्वथिता जले ।
चित्रकत्रिफलादार्वीकलिङ्गान् वा समाक्षिकान् ॥ ६ ॥
मधुयुक्तं गुडूच्या वा रसमामलकस्य वा ॥ ७अब् ॥
In the forenoon, the patient should drink either (powder of) Curcuma longa put into the juice of Emblica officinalis and mixed with honey; dārvī – or Berberis aristata, surāhva – Cedrus deodara, triphalā – Terminalia chebula, Terminalia bellirica and Emblica officinalis, and mustā vā – Cyperus rotundus boiled in water; or decoction of citraka – Plumbago zeylanica, triphalā – Terminalia chebula, Terminalia bellirica and Emblica officinalis, dārvī – Berberis aristata, kaliṅga – and Holarrhena antidysenterica added with honey or fresh juice of Tinospora cordifolia or Emblica officinalis mixed with honey.

Decoctions for Kaphaja Prameha

लोध्राभयातोयदकट्फलानां पाठाविडङ्गार्जुनधन्वनानाम् |
गायत्रिदार्वीकृमिहृद्धवानां कफे त्रयः क्षौद्रयुताः कषायाः ॥ ७ ॥
The following three decoctions mixed with honey should be consumed in case of increase of kapha;

1.  lodhrā – either of Symplocos racemosa, abhayā – Terminalia chebula, toyada – Cyperus rotundus, kaṭphalānāṃ – and Myrica nagi;

2.   pāṭhā – Cissampelos pareira, viḍaṅga – Embelia ribes, arjuna – Terminalia chebula, dhanvanānām – and Grewia tiliaefolia; or of

3.  gāyatri – Acacia catechu, dārvī – Berberis aristata, kṛmihṛt – Embelia ribes, and dhava – Anogeissus latifolia.

Decoctions for Pittaja Prameha

उशीरलोध्रार्जुनचन्दनानां पटोलनिम्बामलकामृतानाम् ।
लोध्राम्बुकालीयकधातकीनां पित्ते त्रयः क्षौद्रयुताः कषायाः ॥ ८ ॥
The following three decoctions mixed with honey should be consumed when pitta is increased,

1. uśīra – either of Vetiveria zizanioides, lodhra – Symplocos racemosa, arjuna – Terminalia arjuna, candanānāṃ – and Santalum album;

2. paṭola – of Trichosanthes dioica, nimba – Azadirachta indica, āmalaka – Emblica officinalis, and amṛta – Tinospora cordifoli

3. lodhra – or of Symplocos racemosa, ambu – Cyperus rotundus, kālīyaka – Coscinium fenestratum and dhātakī – Woodfordia fruticosa.

Pana anna: Drinks and food processed with herbs

यथास्वमेभिः पानान्नं यवगोधूमभावनाः ॥ ९ ॥
वातोल्बणेषु स्नेहांश्च प्रमेहेषु प्रकल्पयेत् ।
Drinks and foods should be prepared from yava – Hordeum vulgare, godhūma – or Triticum aestivum which have been soaked in the decoction of the above herbs for eating.  In diabetes arising from increase of Vata, sneha (medicated fats-oil, ghee etc) should also be prepared with these herbs.

Pana anna: Drinks and food processed with herbs

अपूपसक्तुवाट्यादिर्यवानां विकृतिर्हिता ॥ १० ॥
गजाश्वगुदमुक्तानामथवा वेणुजन्मनाम् ।
तृणधान्यानि मुद्गाद्याः शालिर्जीर्णः सषष्टिकः ॥ ११ ॥
श्रीकुक्कुटोऽम्लः खलकस्तिलसर्षपकिट्टजः ।
कपित्थं तिन्दुकं जम्बूस्तत्कृता रागषाडवाः ॥ १२ ॥
तिक्तं शाकं मधु श्रेष्ठा भक्ष्याः शुष्काः ससक्तवः ।
धन्वमांसानि शूल्यानि परिशुष्काण्ययस्कृतिः ॥ १३ ॥
मध्वरिष्टासवा जीर्णाः सीधुः पक्वरसोद्भवः ।
तथाऽसनादिसाराम्बु दर्भाम्भो माक्षिकोदकम्॥१४॥
Cake of rice and black gram baked in steam, corn flour mixed with milk sugar and ghee, paste of pulses fried in oil prepared from Hordeum vulgare which has come out of rectum of an elephant or horse (which have been fed sumptuously with barley earlier) or seeds of bamboo tree are suitable. Similarly, the corns produced by grass like plants mudga – Vigna radiata etc. (pulses), old rice and sastika rice, beverage known as srikukkuta- the sour buttermilk processed with the residue of Sesamum indicum and Brassica nigra (after taking out the oil), kapitthaṃ – Feronia linonia, tindukaṃ – Diospyros malabarica, and jambū: – Syzygium cumini fruits and sweet drink powder of sour, sweets, spices, salts etc. prepared from them, bitter vegetables, honey, eatables (snacks) and paste of corn flour which are dry (non-fatty), meat of animals of desert-like regions inserted into a rod and roasted or which is well dried in sun, ayaskriti (described further on), madhvarista and madhvasava which are old, sidhu prepared from cooking sugarcane juice, drinking water prepared from herbs of asandi gana (vide chapter 15 of sutrasthana), or from – Desmostachya bipinnata or honey water, (all are suitable for patients of diabetes.)

Intake of Yava

वासितेषु वराक्वाथे शर्वरीं शोषितेष्वहः ।
यवेषु सुकृतान् सक्तून् सक्षौद्रान् सीधुना पिबेत् ॥ १५ ॥
yava – Hordeum vulgare is soaked in the decoction of Terminalia chebula, Terminalia bellirica and Emblica officinalis for the night and dried in the day. Paste of flour prepared from this yavasaktu should be consumed along with sidhu added with honey.

Remedies for Kapha: Pittaja Prameha

शालसप्ताह्वकम्पिल्लवृक्षकाक्षकपित्थजम् ।
रोहीतकं च कुसुमं मधुनाद्यात् सुचूर्णितम् ॥ १६ ॥
कफपित्तप्रमेहेषु पिबेद्धात्रीरसेन वा ।
Flowers of śāla – Shorea robusta, saptāhva – Alstonia scholaris, kampilla – Mallotus philippinensis, vṛkṣaka – Holarrhena antidysenterica, akṣa – Terminalia bellirica, kapitthajam – Limonia acidissima and rohītakaṃ – Tecomella undulata powdered nicely should be licked with honey. It can be consumed with the juice of dhātrī – Emblica officinalis in diabetes arising from kapha and Pitta.

Trikantakadi taila and ghrita

त्रिकण्टकनिशालोध्रसोमवल्कवचार्जुनैः ॥ १७ ॥
पद्मकाश्मन्तकारिष्टचन्दनागुरुदीप्यकैः ।
पटोलमुस्तमञ्जिष्ठामाद्रीभल्लातकैः पचेत् ॥ १८ ॥
तैलं वातकफे पित्ते घृतं मिश्रेषु मिश्रकम् ।
trikaṇṭaka – Tribulus terrestris, niśā – Curcuma longa, lodhra – Symplocos racemosa, somavalka – Acacia polycantha, vaca – Acorus calamus, arjuna – Terminalia arjuna, padmaka – Prunus cerasoides, aśmantaka – Bauhinia vahlii / Ficus rumphii, ariṣṭa – Azadirachta indica, candana – Santalum album, aguru – Aquilaria agallocha, dīpyaka – Trachyspermum ammi / Cuminum cyminum, paṭola – Trichosanthes dioica,musta – Cyperus rotundus, mañjiṣṭhā – Rubia cordifolia, mādrī – Gliricidia sepium (?), bhallātaka – Semecarpus anacardium should be made use of for preparing medicated oil for use in diabetes of vata-kapha origin, medicated ghee for that of pitta origin, mishraka (combination of two fats) for mixture of doshas.

Dhanvantara Ghrita

दशमूलशठीदन्तीसुराह्वं द्विपुनर्नवम् ॥ १९ ॥
मूलं स्नुगर्कयोः पथ्यां भूकदम्बमरुष्करम् ।
करञ्जौ वरुणान् मूलं पिप्पल्याः पौष्करं च यत्॥२०॥
पृथग्दशपलं प्रस्थान् यवकोलकुलत्थतः ।
त्रींश्चाष्टगुणिते तोये विपचेत् पादवर्तिना ॥ २१ ॥
तेन द्विपिप्पलीचव्यवचानिचुलरोहिषैः ।
त्रिवृद्विडङ्गकम्पिल्लभार्गीविश्वैश्च साधयेत् ॥ २२ ॥
प्रस्थं घृताज्जयेत्सर्वांस्तन्मेहान्पिटिका विषम् ।
पाण्डुविद्रधिगुल्मार्शःशोषशोफगरोदरम् ॥ २३ ॥
श्वासं कासं वमिं वृद्धिं प्लीहानं वातशोणितम् ।
कुष्ठोन्मादावपस्मारं धान्वन्तरमिदं घृतम् ॥ २४ ॥
Ten pala (480 grams) each of daśamūla – group of ten herbs, śaṭhī – Curcuma zedoaria, dantī – Baliospermum montanum, surāhvaṃ – Cedrus deodara, dvi punarnavam – the two punarnava (Boerhavia diffusa) roots of snuk – Euphorbia nerifolia, arka – Calotropis gigantean, pathyāṃ – Terminalia chebula, bhūkadambaṃ – Sphaeranthus senegalensis, aruṣkaram – Semecarpus anacardium, karañjau – the two Pongamia pinnata, varuṇān mūlaṃ – roots of Crataeva nurvala, pippalyāḥ – Piper longum, and pauṣkara – Inula racemosa, one prastha (768 grams) each of yava – Hordeum vulgare, kola – Ziziphus jujuba, kulattha – and Dolichos biflorus all three of them are boiled in eight times their quantity of water and decoction reduced to one quarter. To it are added the paste of dvi pippalī – the two pippali (Piper longum fruit and root), cavya – Piper retrofractum, vacā – Acorus calamus, nicula – Salix tetrasperma / Barringtonia acutangula, rohiṣaiḥ – Cymbopogon martini, trivṛt – Operculina turpethum, viḍaṅga – Embelia ribes, kampilla – Mallotus phillipensis, bhārgī – Clerodendrum serratum, viśvai: – and Zingiber officinale and one prastha (768 grams) of ghee and medicated ghee prepared. This formula known as dhanvantra ghrta cures all varieties of diabetes, diabetic ulcers, viṣam – poisons, pāṇḍu – anemia, vidradhi – abscess, gulma – abdominal tumour, arśaḥ – haemorrhoids, śoṣa – consumption, śopha – dropsy, gara – homicidal poison, udaram – enlargement of abdomen, śvāsaṃ – dyspnea, kāsaṃ – cough, vami – vomiting, vṛddhiṃ plīhānaṃ – disease of the spleen, vātaśoṇitam – gout, kuṣṭha – skin diseases, unmāda – insanity, and apasmāraṃ – epilepsy.

Lodhrasava

लोध्रमूर्वाशठीवेल्लभार्गीनतनखप्लवान् ।
कलिङ्गकुष्ठक्रमुकप्रियङ्ग्वतिविषाग्निकान् ॥ २५ ॥
द्वे विशाले चतुर्जातं भूनिम्बं कटुरोहिणीम् ।
यवानीं पौष्करं पाठां ग्रन्थिं चव्यं फलत्रयम् ॥ २६ ॥
कर्षांशमम्बुकलशे पादशेषे स्रुते हिमे ।
द्वौ प्रस्थौ माक्षिकात्क्षिप्त्वा रक्षेत्पक्षमुपेक्षया ॥ २७ ॥
लोध्रासवोऽयं मेहार्शःश्वित्रकुष्ठारुचिकृमीन् ।
पाण्डुत्वं ग्रहणीदोषं स्थूलतां च नियच्छति ॥२८॥
One karsha (12 grams) each of lodhra – Symplocos racemosa, mūrvā – Marsdenia tenacissima, śaṭhī – Curcuma zedoaria, vella – Embelia ribes, bhārṅgī – Clerodendum serratum, nata – Oroxylum indicum / Caesalpinia bonduc, nakha – Martynia annua, plava – Cyperus scariosus, kaliṅga – Hollarhena antidysenterica, kuṣṭha – Saussurea lappa, kramukha – Areca catechu, priyaṅgu – Callicarpa macrophylla, ativiṣā – Aconitum heterophyllum, agnika – Plumbago zeylanica, dve viśāle – the two visala (Citrullus colocynthis), caturjātaṃ – Cinnamomum zeylanica, Elettaria cardamomum, Cinnamomum tamala and Messua ferrea, bhūnimbaṃ – Andrographis paniculata, kaṭurohiṇī – Picrorrhiza kurroa, yavānī – Trachyspermum ammi, pauṣkara – Inula racemosa, pāṭhāṃ – Cissampelos pareira, granthi – Cynodon dactylon, cavyaṃ – Piper retrofractum, phalatrayam – triphala (Terminalia chebula, Terminalia bellirica and Emblica officinalis) are boiled in one kalasa (49 litres 152 ml) of waterand decoction reduced to a quarter, filtered and cooled. To this is added two prastha (1536 grams) of honey and kept undisturbed for a fortnight. This formula known as lodhrasava; cures meha – diabetes, arśa: – haemorrhoids, śvitra – leucoderma, kuṣṭha – skin diseases, aruci – anorexia, kṛmi – intestinal worms, pāṇḍutva – anaemia, grahaṇī doṣa – disorders of the duodenum, sthūlatāṃ – and obesity.

Ayaskriti

साधयेदसनादीनां पलानां विंशतिं पृथक् ।
द्विवहेऽपां क्षिपेत्तत्र पादस्थे द्वे शते गुडात् ॥ २९ ॥
क्षौद्राढकार्धं पलिकं वत्सकादिं च कल्कितम् ।
तत्क्षौद्रपिप्पलीचूर्णप्रदिग्धे घृतभाजने ॥ ३० ॥
स्थितं दृढे जतुसृते यवराशौ निधापयेत् ।
खदिराङ्गारतप्तानि बहुशोऽत्र निमज्जयेत् ॥ ३१ ॥
तनूनि तीक्ष्णलोहस्य पत्राण्यालोहसङ्क्षयात् ।
अयस्कृतिः स्थिता पीता पूर्वस्मादधिका गुणैः ॥ ३२ ॥
Twenty pala (960 grams) each of the herbs of asanadi gana (vide chapter 15 of sutrasthana) are boiled in two vaha (24 litres 456 ml) of water, and decoction reduced to its quarter. Two hundred pala (9.6 Kg) of molasses half adhaka (1536 grams) of honey and paste of the herbs of vatsakadigana (vide chapter 15 of sutrasthana), each one pala are added to itand poured into a pot smeared inside with ghee, honey and powder of Piper longum. The pot is then given a thick coating of jatu (lac) outside and placed inside a heap of yava – Hordeum vulgare. Thin sheets of magnetic iron are made red hot with the embers of khadira – Acacia catechu wood and immersed in the liquid several times till the iron gets depleted completely in the liquid. (then the mouth of the pot is sealed and kept undisturbed for a fortnight) This formulation known as Ayaskrti, consumed daily provides qualities (effects) greater than the previous one (Rodhrasava).

Therapies and measures to mitigate kapha and medas

रूक्षमुद्वर्तनं गाढं व्यायामो निशि जागरः ।
यच्चान्यच्छ्लेष्ममेदोघ्नं बहिरन्तश्च तद्धितम्॥३३॥
Deep, dry massage, physical exercise, keeping awake at nights and all such other activities both external and internal which mitigate slesman (kapha) and medas (fat) (to a patient of diabetes).

Shilajatu Rasayana

सुभावितां सारजलैस्तुलां पीत्वा शिलोद्भवात् ।
साराम्बुनैव भुञ्जानः शालीञ्जाङ्गलजै रसैः ॥ ३४ ॥
सर्वानभिभवेन्मेहान्सुबहूपद्रवानपि ।
गण्डमालार्बुदग्रन्थिस्थौल्यकुष्ठभगन्दरान् ॥ ३५ ॥
कृमिश्लीपदशोफांश्च परं चैतद्रसायनम् ।
One tula (4.8 Kg) of asphaltum is soaked and incarcerated well in the decoction of sara (herbs of asanadigana). He who consumes this (daily in appropriate dose) and eats boiled rice with the same decoction and soup of meat of animals of desert-like regions, gets cured of all the varieties of diabetes, though having many complications /secondary diseases gaṇḍamāla – and also scrofula, arbuda – malignant tumour, granthi – cysts, sthaulya – obesity, kuṣṭha – skin diseases, bhagandarān – rectal fistula, kṛmi – worms, ślīpada – filariasis, śophāṃśca – and swelling (dropsy). It is the best rejuvenator too.

Measures to be taken by poor patient of prameha

अधनश्छत्रपादत्ररहितो मुनिवर्तनः ॥ ३६ ॥
चन्दनमुत्पलं द्राक्षा उशीरं च पुनर्नवा ।
यष्टीमधुकश्रीखण्डं त्रिफलोत्पलशारिवा ॥ ३६१+१ ॥
The patient of diabetes who has no money (to provide for his treatment), should go on walk (by foot) for one hundred yojana (800-900 miles approx), without making use of an umbrella and without footwear adhering to the way of life of an ascetic (disciplined and hard life) or dig a reservoir of water by himself or wander along with a herd of cow exposed to the dung, urine etc. of the cows.

Treatment for thin patients of prameha

बृंहयेदौषधाहारैरमेदोमूत्रलैः कृशम् ।
The patient of diabetes who is emaciated should be stoutened / nourished well with herbs and foods which do not increase fat and urine.

Prameha Pidaka Chikitsa

शराविकाद्याः पिटिकाः शोफवत्समुपाचरेत् ॥ ३८ ॥
अपक्वा व्रणवत्पक्वास्तासां
Saravika and other pitaka (diabetic eruptions) which are unripe should be treated just as an inflammatory oedema. Those which are ripe; just as treating an ulcer.

Premonitory symptoms

प्राग्रूपमेवच।
क्षीरिवृक्षाम्बु पानाय बस्तमूत्रं च शस्यते ॥ ३९ ॥
तीक्ष्णं च शोधनं प्रायो दुर्विरेच्या हि मेहिनः ।
In their prodromal stage itself, it is beneficial to drink the decoction of bark of trees yielding milky sap and goats urine, resort to strong purifactory therapies, since generally patients of diabetes are hard in respect of purgation therapy.

Medications for ulcer healing

तैलमेलादिना कुर्याद्गणेन व्रणरोपणम् ॥ ४० ॥
उद्वर्तने कषायं तु वर्गेणारग्वधादिना ।
परिषेकोऽसनाद्येन पानान्ने वत्सकादिना ॥ ४१ ॥
Oil for healing the ulcers should be prepared from herbs of eladi gana (chapter 15 of sutrasthana) decoction for massaging prepared from herbs of aragvadhadi gana (chapter 15 of sutrasthana), water for pouring over the body from herbs of asanadi gana (chapter 15 of sutrasthana), drinking water and food proceeded with herbs of vatsakadi gana (chapter 15 of sutrasthana).

Medications for ulcer healing

पाठाचित्रकशार्ङ्गष्टाशारिवाकण्टकारिकाः ।
सप्ताह्वं कौटजं मूलं सोमवल्कं नृपद्रुमम् ॥ ४२ ॥
सञ्चूर्ण्य मधुना लिह्यात् तद्वच्चूर्णं नवायसम् ।
pāṭhā – Cissampelos pareira, citraka – Plumbago zeylanica, śārṅgaṣṭā – Clerodendrum serratum, śārivā – Hemidesmus indicus, kaṇṭakārikā – Solanum xanthocarpum, saptāhvaṃ – Alstonia scholaris, kauṭajaṃ mūlaṃ – root of Holarrhena antidysenterica, somavalkaṃ – Acacia catechu, nṛpadrumam – Cedrus deodara, should be powdered nicely and licked with honey (daily). Similarly, navayasa curna (chapter 16/14 of cikistsa sthana) may be licked.

Appraisal of use of Shilajatu

मधुमेहित्वमापन्नो भिषग्भिः परिवर्जितः ॥ ४३ ॥
शिलाजतुतुलामद्यात्प्रमेहार्तः पुनर्नवः ॥ ४३ऊअब् ॥
That patient of diabetes who has been rejected (refused treatment) by the physician, should consume one tula (4.8 Kg) of silajatu in suitable daily doses to become a new man again.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां चतुर्थे चिकित्सितस्थाने प्रमेहचिकित्सितं नाम द्वादशोऽध्याय: ॥ १२॥
Thus ends the chapter- prameha cikitsita- the twelvth in cikitsita sthana of Astanga hrdaya samhita composed by Srimadvagbhata, son of Sri Vaidyapati Simhagupta.