The 13th chapter of Chikitsasthana of Sushruta Samhita is named as Madhumeha Cikitsitam Adhyaya. This chapter deals with Treatment of Diabetes Mellitus.

अथातोमधुमेहचिकित्सितंव्याख्यास्यामः।।१।।
यथोवाचभगवान्धन्वन्तरिः।।१२।।

We will now expound Madhumeha Chikitsa – treatment of diabetes mellitus; as revealed by the venerable Dhanvantari.

मधुमेहित्वमापन्नभिषग्भिःपरिवर्जितम्।।
योगेनानेनमतिमान्प्रमेहिणमुपाचरेत्।।३।।

The physician should reject (generally) the patient in whom Prameha has attained the stage of Madhumeha. A wise physician shall treat the patients of Prameha by the formulations which will be described henceforth.

Silājatu utpatti and guna – Origin and properties of bitumen

मासेशुक्रेशुचौचैवशैलाःसूर्यांशुतापिताः।।
जतुप्रकाशंस्वरसंशिलाभ्यःप्रस्रवन्तिहि।।४।।
शिलाजत्वितिविख्यातंसर्वव्याधिविनाशनम्।।

During the summer months of sukra (Jyestha) and suci (asadha), a lac like juice flows from the rocks of the mountains which are heated up by the strong rays of sum. These exudates are called Silajatu. It has a reputation of destroying all diseases.

न्नप्वादीनांतुलोहानांषण्णामन्यतमान्वयम्।।५।।
ज्ञेयंस्वगन्धतश्चापिषड्योनिप्रथितंक्षितौ।।
लोहाद्भवतितद्यस्माच्छिलाजतुजतुप्रभम्।।६।।
तस्यलोहस्यतद्वीर्यरसंचापिबिभर्तितत्।।
न्नपुसीसायसादीनिप्रधानान्युत्तरोत्तरम्।।७।।
यथातथाप्रयोगेऽपिश्रेष्ठेश्रेष्ठगुणाःस्मृताः।।
तत्सर्वतिक्तकदुकंकषायानुरसंसरम्।।८।।
कटुपाक्युष्णवीचशोषणंछेदनंतथा।।

Shilajatu consists of the essence of six metals like trapu i.e. tin and others, like lead, copper, silver, gold and iron. Therefore, it can be said that Shilajatu has six sources. Each kind of Shilajatu should be distinguished by its specific odour.

The Shilajatuobtained from iron containing rocks resembles shellac. It also possesses the potency and taste of iron.

Shilajatu obtained from the rocks containing the below mentioned metals are considered to be excellent in successive (given below) order and are also best in medicinal properties –

–        Tin

–        Lead

–        Iron

General properties of all varieties of Shilajatu –

–        Primary taste – Bitter and pungent

–        Secondary taste – Astringent

–        Virya – hot in potency

–        Vipaka – Katu, pungent taste after digestion,

–        Karma – actions – Sara – laxative, Sosana – causes dryness, Chedana – cutting or tearing of the tissues

तेषुयत्कृष्णमलघुस्निग्धंनिःशर्करंचयत्।।९।।
गोमूत्रगन्धियच्चापितत्प्रधानंप्रचक्षते।।

Below mentioned are the qualities of the best variety of Shilajatu –

–        Black in colour

–        Heavy

–        Unctuous

–        Devoid of sand

–        Emitting the smell of urine of cow

Śilājatu yoga – recipes of bitumen

तद्भावितंसारगणैर्हतदोषोदिनोदये।।१०।।
पिबेत्सारोदकेनैवश्लक्ष्णपिष्टंयथाबलम्।।
जाङ्गलेनरसेनान्नंतस्मिञ्जीर्णेतुभोजयेत्।।११।।
उपयुज्यतुलामेवंगिरिजादमृतोपमात्।।
वपुर्वर्णबलोपेतोमधुमेहविवर्जितः।।१२।।
जीवेद्वर्षशतंपूर्णमजरोऽमरसन्निमः।।
शतंशतंतुलायांतुसहस्रंदशतौलिके।।१३।।
भल्लातकविधानेनपरिहारविधिःस्मृतः।।
मेहंकुष्ठमपस्मारमुन्मादंश्लीपदंगरम्।।१४।।
शोषंशोफार्शसीगुल्मंपाण्डुतांविषमज्वरम्।।
अपोहत्यचिरात्कालाच्छिलाजतुनिषेवितम्।।१५।।
नसोऽस्तिरोगोयंचापिनिहन्यान्नशिलाजतु।।
शार्करांचिरसंभूतांभिनत्तिचतथाऽश्मरीम्।।१६।।
भावनालोडनेचास्यकर्तव्येभेषजैर्हितैः।।

Śilājatu should be kept soaked in the Salasaradi Gana Kashaya i.e. decoction prepared from the Salasaradi group of herbs.

Next morning, it should be made into a nice paste by grinding it with decoction of the same herbs. They shall be consumed in doses as suitable to one’s body strength.

One should wait till the shilajatu is digested. Once it is digested, boiled rice should be eaten along with soup of the meat of animals of arid lands.

Below mentioned benefits are bestowed on the person who consumes one tula i.e. 4 kg of shilajatu possessing nectar like qualities in this manner –

–        Freedom from diabetes

–        Good physical strength

–        Good complexion

–        Longevity of full one hundred years without senility, like Gods

Dose – Daily dose of Shilajatu can be increased by ten times i.e. ten pala or 400 grams dose. Similarly, the total quantity of Shilajatu can be increased to one hundred tula i.e. 400 kg.

The method of relief of untoward symptoms by use of Shilajatu should be considered as the same as prescribed for use in Bhallataka Yogas (as explained in Chapter 6, verse 17).

Benefits – Shilajatu consumed in the above-described ways cures the below mentioned diseases quickly –

–        Diabetes

–        Skin diseases / leprosy

–        Epilepsy,

–        Insanity,

–        Homicidal poisoning,

–        Consumption,

–        Swelling / dropsy,

–        Haemorrhoids,

–        Abdominal tumour,

–        Anaemia

–        Irregular fevers

All diseases are cured by Shilajatu and there is no such disease in the world which cannot be cured by Shilajatu. It breaks the urinary stone. It also removes the long standing and stubborn urinary gravel.

Shilajatu should be soaked in and consumed with decoction of appropriate herbs.

Māksikadhātu yoga – use of Iron pyrites

एवंचमाक्षिकंघातुंतापीजममृतोपमम्।।१७।।
मधुरंकाञ्चनाभासमम्लंवारजतप्रभम्।।
पिबन्हन्तिजराकुष्ठमेहपाण्ड्वामयक्षयान्।।१८।।
तद्भावितःकपोतांश्चकुलत्थांश्चविवर्जयेत्।।

Similarly,Maksika Dhatu should be used. It should be born in Tapi river which will have properties similar to nectar.

Maksika Dhatu which is shining like gold or silver and sour in taste is consumed, it cures the below mentioned conditions –

–        Leprosy

–        Diabetes

–        Anaemia

–        Consumption and also

–        Wards of old age (anti-ageing)

Meat of kapota i.e. dove and kulattha – horse gram should be avoided while using Maksika Dhatu.

Tuvarakataila yoga – recipe of Chalmogra oil / hydnocarpus oil

पञ्चकर्मगुणातीतंश्रद्धावन्तंजिजीविषुम्।।१९।।
योगेनानेनमतिमान्साधयेदपिकुष्ठिनम्।।

The patient suffering from kustha – skin diseases, leprosy – should be treated by the below mentioned recipe when –

–        The disease is beyond the reach of Panchakarma i.e. it cannot be cured in spite of administering PanchaKarma therapies – five purificatory therapies which are considered as best remedies for Kustha,

–        In patient who is faithful

–        In patient who desires to live long

वृक्षास्तुवरकायेस्युःपश्चिमार्णवभूमिषु।।२०।।
बीचीतरङ्गविक्षेपमारुतोद्भूतपल्लवाः।।
तेषांफलानिगृह्णीयात्सुपक्वान्यम्बुदागमे।।२१।।
मज्जंतेभ्योऽपिसंहृत्यशोषयित्वाविचूर्ण्यच।।
तिलवत्पीडयेद्बोण्यास्त्रावयद्वाकुसुम्भवत्।।२२।।
तत्तैलंसंहृतंभूयःपचेदातोयसंक्षयात्।।
अवतार्यकरीषेचपक्षमात्रंनिधापयेत्।।२३।।
स्निग्धःस्विन्नोहृतमल :पक्षादूर्ध्वप्रयत्नवान्।।
चतुर्थभक्तान्तरितःशुक्लादौदिवसेशुभे।।२४।।
मन्त्रपूतस्यतैलस्यपिबेन्मात्रांयथानम।।
तत्रमन्त्रंप्रवक्ष्यामियेनेदमभिमन्यते।।२५।। ‘
मज्जंसारमहावीर्यसर्वान्धातून्विशोधय।।
शङ्खचक्रगदापाणिस्त्वामाज्ञापयतेऽच्युतः ‘ ।।२६।।
तेनास्योर्ध्वमधश्चापिदोषायान्त्यसकृत्ततः।।
अस्नेहलवणांसायंयवागूशीतलांपिबेत्।।२७।।
पञ्चाहंप्रपिबेत्तैलमनेनविधिनानरः।।
पक्षंपरिहरेच्चापिमुद्गयूषौदनाशनः।।२८।।
पञ्चभिर्दिवसैरेवंसर्वकुष्ठर्विमुच्यते।।
तदेवखदिरक्वाथेत्रिगुणेसाधुसाधितम्।।२९।।
निहितंपूर्ववत्पक्षात्पिबेन्मासमतन्द्रितः।।
तेनाभ्यक्तशरीरश्चकुर्वीताहारमीरितम्।।३०।।
भिन्नस्वरंरक्तनेत्रंविशीर्णंकृमिभक्षितम्।।
अनेनाशुप्रयोगेणसाधयेत्कुष्ठिनंनरम्।।३१।।
सर्पिर्मधुयुतंपीतंतदेवखदिराम्बुना।।
पक्षिमांसरसाहारंकरोतिद्विशतायुषम्।।३२।।
तदेवनस्येपञ्चाशदिवसानुपयोजितम्।।
वपुष्मन्तंश्रुतिधरंकरोतित्रिशतायुषम्।।३३।।
शोधयन्तिनरंपीतामज्जानस्तस्यमात्रया।।
महावीर्यस्तुवरकःकुष्ठमेहापहःपरः।।३४।।

Fruits of Tuvaraka trees should be collected –

–        In cloudy season

–        From the trees that grow in the west ocean coast (Arabian sea)

–        Whose leaves are shaken by the wind coming from the ocean waves

–        Whose fruits are well ripened

After collecting the fruits, the marrow (pulp) inside them is taken out. It is dried in sunlight and later powdered.

Next, this powder of Tuvaraka fruits shall be pressed just like pressing the sesame seeds in an oil mill and its oil extracted. Alternatively, it can be boiled in a cauldron like Kusumbha – Carthamus seeds are done and its oil extracted.

In whatever method the oil is extracted, it shall be collected separately and boiled until all the water evaporates. The oil which is devoid of water molecules is now put into a pot. This pot is kept inside a heap of ash for fifteen days.

The patient should be administered with shodhana i.e. purificatory therapies after having administered snehana – oleation and swedana – sudation. With this, all the wastes are removed from the body of the patient.

Now the patient is made to drink Tuvaraka Taila on a pre-selected auspicious day, during bright fortnight, in between four meal times, in a dose which suits the strength of the body of the person.

Before administration, the oil shall be sanctified with the below mention hymn –

‘You, the essence of the marrow, who is very much powerful, please cleanse all the tissues. Lord Acyuta (Vishnu) who bears a conch, disc and mace in his hands, orders you to do so.’

The doshas are expelled from the body by consuming this recipe. The doshas completely come out through both, upward and downward routes i.e. through vomiting and purgation.

The patient should be given cooled Yavagu i.e. thick gruel in the evening. Fats and salt should not be added to the yavagu. In this manner, the oil shall be consumed for five days continuously. Later it should be discontinued and not consumed for the next fifteen days. He should eat only boiled rice along with green gram soup during this period. The patient would get cured of kustha – skin diseases including leprosy within five days itself, if he follows the above explained regimen.

Tuvaraka Taila should be boiled with decoction of Khadira, three times its quantity. The contents shall be kept concealed as explained before, for fifteen days. Later, it should be consumed for a period of one month, without laxity. After anointing the body of the patient with oil, he is given good food to eat. In this way, the patient of kustha should be treated, especially when he has developed a broken voice, red coloured eyes, and body parts which have been eaten by worms and have been mutilated.

The person lives for a span of two hundred years when he drinks Tuvaraka Taila mixed with ghee and honey followed by decoction prepared from Khadira and consuming soup prepared from meat of birds.

Below mentioned are the benefits of using the above said oil in the form of nasal drops for a period of fifty days –

–        Good and healthy body free from kustha

–        Good memory

–        Lifespan of three hundred years

The fruit marrow purifies the person when it is consumed in appropriate doses.

Thus Tuvarka,is the most powerful one and is considered to be the best to cure kustha and prameha.

सान्तधूमस्तस्यमज्जातुदग्धःक्षिप्तस्तैलेसैन्धवंचाञ्जनंच।।
पैल्ल्यंहन्यादर्मनक्तान्ध्यकाचान्नीलीरोगंतैमिरंचाञ्जनेन।।३५।।

The fruit marrow is burnt by the internal method. Herein, the marrow and burning coal, both are put in a pot and the mouth / opening of the pot is covered with a lid. After the marrow is thoroughly burnt, the pot is opened, and the oil of the marrow is taken out. The oil is then mixed with Saindhava and Anjana (Sroto Anjana). When this is applied as collyrium to the eyes, it cures the below mentioned conditions –

–        Pilla roga

–        Arma

–        Naktandhya

–        Kaca

–        Niliroga and

–        Timira

इतिश्रीसुश्रुतसंहितायांचिकित्सास्थानेमधुमेहचिकित्सितंनाम त्रयोदशोऽध्यायः।।१३।।

Thus ends the thirteenth chapter by name Madhumeha Cikitsita in Chikitsa Sthāna of Suśruta Samhita.