Concept and description ofMadhumegam (Diabetes mellitus) in Siddha System of Medicine

Rapid socio-economic development and demographic changes, along with an increased susceptibility for Indian individuals, have led to the explosive increase in the prevalence of Diabetes Mellitus in India over the past four decades. Siddha System is one of the oldest Traditional Systems of Medicine in India and predominantly practiced in southern India especially in Tamil Nadu. The vital part of Siddha Medicine is to revitalize and rejuvenate dysfunctional organs that cause the disease and to maintain a healthy body and mind. According to Siddha, all objects and living bodies are composed of ive basic structural elements (Panchabhutams), namely earth, water, ire, air, and vacuum (ether). Siddha believes in the theory of Tridoshams, namely wind (Vaatham), bile (Piththam), and phlegm (Kabam). The Madhumegam has 20 typeswhich divided intoVaatham4, Piththam6 andKabam10 types. Madhumegam is a clinical condition characterized by the frequent passage of urinemore than the normal resulting in deterioration anddiminution of Seven Thathus. The diagnosis in the Siddha system is based on the Land (Nilam), Season (Kaalam), Pori alaridhal, Pulan alarithal, Threedosham status (Mukkutra Nilaigal), Udal Thathukal Nilai and Envagai Thervugal. As the researchers looking an alternative way for treating this high burden disease, it is the need of the hour to invests more on to create the evidence to prevent, control and treat this high burden disorder by synthesizing the evidence from the Siddha.


INTRODUCTION
Diabetes Mellitus (DM) is a chronic disorder, that occurs when the pancreas is no longer able to pro-duce insulin, or when the body is not able to use the produced insulin. (IDF, 2019) The DM is pandemic disease and India is considered as one of the epicenters of this global pandemic. In the last four decades, India has become the centre of Diabetes Mellitus, due to unplanned urbanization, rapid socio-economic changes and increased susceptibility for Indian individuals. (Unnikrishnan et al., 2016) There may be many factors that may cause a disease and allow them to prevail. The identi ication of those factors is necessary to facilitate effective changes in health care. According to the recent report, 425 million people globally or 8.8% of global adults are estimated to have Diabetes Mellitus. Globally, it is expected that people with Diabetes may have spent USD 727 billion per annum for Diabetes care and management. (IDF, 2017)

Siddha System of Medicine
Siddha System of Medicine, is one of the oldest Traditional Systems of Medicine in India, predominantly practiced in the southern part of India especially in Tamil Nadu. The eighteen Siddhars have contributed to the growth of this Traditional System of Medicine. The vital part of Siddha Medicine is to rejuvenate and revitalize the dysfunctional organs that cause the disease and to maintain a healthy body and mind. (Ayush, 2019;Ministry of Ayush , 2019) The Siddha System of Medicine describes the human as a microcosm and the universe as a macrocosm. (Siddha, 2019;Subbarayappa, 2001) According to Siddha, ive basic structural elements (Panchabhutams), namely water, air, ire, earth, and vacuum (ether) are combined to form the living organisms and other objects of the universe. Siddha believes in the theory of tridoshams, namely wind (vaatham), bile (piththam), and phlegm (kabam). These three doshams are physiological entities in living beings. Any imbalance of these tridoshams may cause disease in the body as it alters internal and external environment. (Subbarayappa, 1997) The Siddha System of Medicine has a unique way of diagnosing the disease. The diagnosis probes the causes for the sickness. The different ways of identifying the causative factors are through the examination of pulse, skin colour of body, tongue, study of voice or speech, urine, eyes and feces. (Medicine, 2019) The treatment in Siddha is based on the diagnosis of the above-mentioned parts and it consists of drugs, diet, and exercise. The system mainly depends on metals and minerals and animal products to prevent and treat the diseases. The marine products and animal products, metals and minerals are also being utilized widely as medicine for noncommunicable disease and non-curable diseases. Siddha system in course of time developed a Materia Medica which elaborates description of process methods of Mercury, Sulphur, Arsenic substances, Metals, and Minerals including gems to prepare as Medicine.

Diabetes Mellitus in Siddha System of Medicine
According to Yugi Vaithiya Chinthamani, "Megam" (body became emaciated due to excessive urine) is classi ied into 20 types. These 20 types divided into Vaatham-4, Piththam-6 and Kabam-10 types. "Madhumegam" , which is equivalent to Diabetes, is one among them under Piththam classi ication. While the classi ication of megam differs in description from author to author, describing the threedoshams in the Siddha system of medicine, especially the signs and symptoms are similar in all the classical texts. "Madhumegam" described by "Yugi Vaithiya chinthamani-800" inds a close similarity to the description of Diabetes mellitus. Madhumegam is also known as Neerizhivu, Inippu neer in the Siddha literature. (Munivar, 2005) "Madhumegam is a clinical condition characterized by the recurrent passage of urine above than the normal resulting in weakening and reduction of Seven Thathus which is called as building blocks of the body. In the term Madhumegam, 'madhu' is indicating the sweet substance similar to honey in taste, odor, and color but not in concentration. According to Siddha, there are many factors behind Madhumegam disease such as disproportionate intake of milk, ghee, toddy, ish and excessive indulgence of sex. It clearly indicates that the Siddha system of medicines consider that lifestyle factors are cause of this emerging non-communicable disease. The same is also discussed in other kinds of literature adding that increased body heat (Piththam) and excessive hunger also leads to Madhumegam. Yugimuni and other Siddhars also said that psychosomatic stress also causes Diabetes, Peptic ulcer, and Hypertension. (Muthaliar, 2012) The large quantity of urine at frequent intervals, experience burning, and pain in the urethra and dull pain in testis during urination are the major symptoms mentioned in the literature. The color of urine became yellow and produces light white sediments. The available literature also indicates that the patient's skin becomes pale and they experience body pain. If it is not treated in time properly the patient will die in death within ive years of the period.
The diagnosis in the Siddha System is based on the Land (Nilam), Season (Kaalam), Pori alarithal, Pulan alarithal, Three dosham status (Mukkutra Nilaigal)" Udal Thathukal Nilai and Envagai Thervugal. Fundamentally various herbals, herbo-minerals, and minerals are using in Siddha system to treat the Madhumegam. Various internal medicines such as Kudineer, Chooranam, Parpam, Chenduram and external medicines such as Pachai ennai are used in Siddha system to treat the Mathumegam and its complications. It aims at treating the causatives of the patient to eliminate the disorder while the other system aims at treating the disorder. Many studies in Ayurveda have concluded that medicines have a positive impact on Diabetes Mellitus. A systematic review shows that Ayurveda drugs have blood sugar-lowering effects. Another study result also indicates that the medicines signi icantly effective and clinically safe as no adverse events. It was concluded that ShodhanaKarma followed by Shamana along with Pathya Ahara and vihara was found as a suitable treatment plan to manage Diabetes. (Sharma et al., 2015;Sridharan et al., 2011) There are many herbs used in the Ayurveda System of Medicine to manage the Diabetes Mellitus such as Neem, Shilajit, Bitter gourd Turmeric, Rose apple, Amalaki, Coccineaindica, Fenugreek, Triphala, Bay leaf, Cinnamon, Gymnema, leaves of Bilva, and Aloe vera. (Zhao et al., 2006;Wang et al., 2013)We have searched PubMed central database to and identify the published evidence to support the Siddha System of Medicines to manage effectively Diabetes Mellitus. The Siddha System has very few papers published on Diabetes Mellitus. (Sathasivampillai et al., 2017;Kar et al., 1999;Shirwaikar et al., 2005)

CONCLUSION
There is a dearth of scienti ic evidence published even though the system has rich literature about the Madhumegam. As focus growing on traditional medicines, it is need of the hour that the traditional medicines researcher to focus on to create more scienti ic evidence to support the literature evidence.
As the global and Indian scientists are looking for an alternative way to treat this disorder, it is time to think and invest more on to create the evidence in the Siddha system to prevent, control and manage this highly threatening disorder.