DESCRIPCIÓN DEL INSTRUMENTO DE DIAGNÓSTICO

7. Water-wind associated diabetes which contains four types and the urine is characterised by:

• A strong odour and sour taste (Sithamparthanuppillai, 1982).

2.9.4. Complications of diabetes

Diabetes complications in SM incorporate lower abdominal pain, tiredness after urinating, flatulence, increased deficiency in sperm secretion, sperm in urine, general body weakness, loss of appetite, abscess formation, diarrhoea, unconsciousness, and death (Sithamparthanuppillai, 1982).

2.10. Level of scientific evidence available for plant species TM is to a great extent not accepted by biomedical practitioners because

traditional medicinal preparations have limited scientific evidence. For traditional medicinal preparations or medicinal plants to be accepted by biomedical

practitioners, scientific evidence such as the safety and efficacy of the

preparations are essential (Lemonnier et al., 2017; Wright et al., 2007). Equally, the existing data on preparation safety needs to be assessed. There are some benefits of grouping the levels of scientific evidence available for each plant species. Through this it will be possible to identify plant species that could be of interest for further study.

As in previous studies, the plants used in TM were categorised based on the traditional and scientific evidence available. For example, in a study conducted by de Montellano (1975), the plant species were classified based on information as plant species recognised botanically and the phytochemicals isolated. The findings of this study suggested to use both the traditional and modern

knowledge to assess the effectiveness of the plant species utilised in TM.

Another study, by Heinrich et al. (1992) determined that the majority of the plant species reported to treat gastrointestinal illnesses in an ethnobotanical survey already had scientific evidence. Furthermore, Edwards et al. (2015) also

classified common medicinal plants according to the maximum level of scientific evidence currently available in each.

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In order to accept TM preparations within the modern health care practice, an assessment of potential toxic effects is essential. Toxicity can be split into intrinsic and extrinsic. Intrinsic toxicity can occur at either a normal dose or in the event of an overdose. The extrinsic toxicity can occur due to the

contamination of preparations with microorganisms, heavy metals, pesticides, fertilizers, wrongly processed materials, and the addition of the wrong

ingredients (Zhang et al., 2012) or accidental or intentional adulterations.

An example of intrinsic toxicity is seen with the aristolochic acids (aristolochic acid I and II) the principle toxic phytochemicals identified in plant species from the Aristolochiaceae. Aristolochic acid I and II cause direct damage to human epithelial kidney cells (HEK293) (Bakhiya et al., 2009). In a more recent study, aristolochic acids containing herbal preparations consumed by patients in South Korea had Fanconi syndrome (a kidney tubule function disorder) and severe kidney injuries (Ban et al., 2018). They are similarly toxic to other parts of the body (stomach and glomerular) (Kumar V. et al., 2003). Moreover, chronic administration of high dose of these compounds can lead to tubular epithelial cell death, urothelial cancer, damage to DNA, tubulointerstitial fibrosis, and renal failure (Debelle et al., 2008; Li et al., 2010).

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Chapter 3

Materials and methods

3.1. Plants historically used to treat diabetes in Sri Lankan Siddha Medicine

3.1.1. Sri Lankan Siddha Medicine historical documents

There are several SM historical documents originally written and compiled in Tamil in SL. Still, they are all currently not accessible. On the other hand, some of the historical documents currently used as textbooks in Sri Lankan

universities in the Bachelor of SM and Surgery (BSMS) degree are widely available and easily accessible. These textbooks are considered to be standardised Siddha historical documents and they form the basis of SM knowledge for SM graduates. This study, because of that, utilised these textbooks to obtain the information about historical antidiabetic Sri Lankan Siddha preparations. The three SM historical documents used were:

1. Pararasaseharam (Fifth Part) ( ைைோசபசகைம் (ஐந்ேோம் ோகம்) -

Pararaasaseharam (Ainthaam Paaham)): This document was compiled under King Pararaasaseharan ( ைைோசபசகைன்) between 1478 and 1519. It was initially printed as a book in 1935 by Ponniapillai, I. in Mallaaham and reprinted in 2003 by Sripathy Sarma, P. and published by Niyanthree Publication in Nallur, Jaffna, SL. (Anonymous, 2003).

2. Seharaasasehara Treatment (கசகைோசபசகை ரவத்தியம் - Seharaasasehara Vaiththiyam): Contents of this document were compiled under King

Seharaasaseharan (கசகைோசபசகைன்) between 1380 and 1414. It was first printed in 1927 by Ponniapillai, I. and reprinted in 2000 by the Provincial Department of Indigenous Medicine, Ministry of Health Eastern and Northern Provinces.

(Anonymous, 2000).

3. Siddha Medicinal Procedure (சித்ே ஔைே கசய்முரை - Siththa Audatha Seimurai): This book was compiled by Ponniah, S.M. and Sabapathipillai, I. in 1980 and published by the Department of Ayurveda, Ministry of Health and Indigenous Medicine. (Ponniah and Sabapathipillai, 1980).

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Only Anonymous (2003) and Anonymous (2000) contain both information about the symptoms and causes of diabetes as well as information on the

preparations. On the other hand, Ponniah and Sabapathipillai (1980) only consists of information about the preparations. Only Sri Lankan origin

preparations were considered in this study, consequently, a few preparations mentioned in Ponniah and Sabapathipillai (1980) were excluded because they were stated as Indian origin.

3.1.2. Plant species stated in the Sri Lankan Siddha Medicine historical documents

Causes, signs and symptoms, and antidiabetic preparations were written in the form of verses in ancient Tamil in the historical documents Anonymous (2000;

2003). These verses were translated to modern Tamil and the names of the plant species were confirmed by Dr. Pholtan R Rajamanoharan (an SM graduate, community Siddha medical officer, planning officer at the Planning Unit, Provincial Department of Indigenous Medicine, and in charge of the Provincial Herbal Garden in Trincomalee). Ponniah and Sabapathipillai (1980) only comprises historical Sri Lankan and Indian SM antidiabetic preparations written in modern Tamil. It is important to note that there might be some inconsistencies in the plant species names mentioned in the historical

documents and current botanical identification. The exact botanical identification was based on the information available in the historical documents only. All the plant species stated in the historical documents are presented in Appendix A.

3.2. Plants contemporarily used to treat diabetes in Sri Lankan